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6.24 p.m.

Baroness Robson of Kiddington: My Lords, the noble Lord, Lord Houghton of Sowerby, paid a great compliment to those who spoke before him. But I am sure that all noble Lords will agree that no one comes up to the standard of the noble Lord himself, who speaks without a note. I notice that he is the only one this afternoon who has spoken without a note, but I am afraid that I cannot rise to that challenge.

The noble Baroness the Minister began her introduction to the debate by stating that there were 10 different aspects of social policy that fell within this afternoon's discussion. She then said that she was very pleased to announce that there was no legislation on education because it had had a surfeit of legislation over the past years. I would have been very pleased if she had said that there was no legislation on the NHS either because in my view we have also had a surfeit of legislation on the NHS.

I became a regional chairman in 1974 during the first reorganisation of the NHS. The NHS managed to survive--I think fairly well--from 1948 to 1974, and I do not believe that a mass of legislation necessarily improves the service that we are all looking for. However, the gracious Speech states that legislation to make further improvements to the management of the National Health Service will be included in this Session. It talks about "further improvements"--once again "further improvements". But when one analyses what I presume will be in this legislation, I doubt whether most of what is proposed will be "improvements".

To start with, the abolition of the regional health authorities and their replacement by eight regional offices under the NHS management executive is claimed to improve the gap between policy and implementation and to offer better knowledge of what is happening on the ground. I am fully aware that we have lost an enormous amount of the local input in all our health

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authorities, both in districts and in RHAs. But surely local input is more likely to be aware of what is happening on the ground than a group of civil servants from the Department of Health. I am also worried that it is a contradiction of the Government's own policy of decentralisation and their desire for greater devolution. In my view, eight outposts under the NHS management executive is not devolution; it is bringing back more power centrally.

The Minister also stated in her opening remarks when talking about the health service that economically the abolition of the regional health authorities would mean a reduction in the staff employed from 3,900 to 1,100. I understand that the 3,900 staff employed by regional health authorities relates to two years ago. Since then there has been the start of amalgamations with the regional health authorities. Their duties have changed. With only eight instead of 14--and with a different set of duties under the new system of management in the NHS--it would be perfectly easy to reduce the staff of the regional health authorities to 1,100, but we would retain the interest of the local people.

I am also concerned about what will happen to the medical input at the regional office level. I sincerely hope that a medical advisory committee will be retained to advise the regional office on such specific matters as regional specialty strategy and capital improvements.

But, above all, I am nervous about the impact on research and medical education. If the regional health authorities are removed, you also remove the statutory position which universities with medical schools have under the 1990 National Health Service and Community Care Act which enables them to participate in planning and decision-making at that level. I hope that somehow that will be preserved under the new system of regional offices. That is one part of the change to the NHS which is taking place and which will be legislated for in the coming Session.

Secondly, and perhaps even more worrying, are some aspects of the proposed legislation for the treatment of the mentally ill in society. All Members of this House will remember that in 1990 we had a tremendously long debate on the National Health Service and Community Care Bill. There was great dissension on the reorganisation of the governance of the NHS, but there was 100 per cent. backing for the propositions put forward in the community care Bill. They were accepted by the whole House. But they were accepted on the basis that the community care Bill should be in position and implemented before proceeding to close the psychiatric beds in the hospitals. That warning was not heeded. In fact, the NHS part of the Bill was implemented a whole year before the community care part was implemented.

So far as I remember, the community care Bill also provided that every psychiatric patient released into the community should be the responsibility of one person in the community care team. That is especially important when dealing with people who are suffering from psychiatric problems such as schizophrenia. But that has not taken place. In my view the Government's main

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concern has been to speed up the closure of psychiatric beds, without adequate provision being made in the community.

The Government's own task force set up in 1992 to find out why progress on bed closures had been so slow--although none of us would have said that that was the case--reported in 1994 that in places hospital beds had been replaced too fast. The Audit Commission found that no district survey had an adequate range of community services. The Royal College of Psychiatrists has said that advice is urgently needed as to what psychiatric teams are supposed to do when all the beds are occupied. They are now blamed for the discharge of patients too early without adequate community care being available. It is not their fault. There is a revolving door. The patients go out into the community and come back again into hospital because there is no other place for them to go. That is not the care in the community that they should expect to receive.

We have put the cart before the horse and have almost endangered the human rights of psychiatric patients by the proposal to introduce the power to convey without being able to claim the support of a court. Because of the overhanging danger for a psychiatric patient, it will be almost impossible to devise treatment plans to which the patient is supposed to give informed consent. How will the patient give that freely if the alternative is compulsory detention?

I believe that the Government should concentrate on having greater resources placed in the hands of the community services. Until such time as they are in place, no more hospital psychiatric beds should close; we should even open more in some cases. But this particular piece of legislation in itself will not solve anything. In some cases it will be detrimental to the psychiatric patient. Nothing will solve the problem except an increase in community care funding.

6.36 p.m.

Lord Simon of Glaisdale: My Lords, this debate covers an enormous area: the whole of home affairs and the whole of social affairs. The noble Baroness spoke mainly on the social aspects, of which she has great experience and knowledge. I hope that she will excuse me if I do not follow her on that path but deal rather with the constitutional matters that were raised by the noble Lord, Lord Lester of Herne Hill, the noble Baroness, Lady Carnegy of Lour, and my noble and learned friend Lord Wilberforce.

Before I do so, perhaps I may take up the subject of the enormous area that has to be covered today. At the end of the last Session there was a debate on the sittings of the House and vague noises were made from the Treasury Bench, holding out hopes that the sittings would end at a more reasonable hour. It was pointed out from all parts of the House that, your Lordships being an elderly and unsalaried Chamber, it is impossible to expect a reasonable House after 8 p.m. and certainly any reasonable hope of a majority vote after that hour.

How have we started this Session, in view of those hopes? On Thursday we had a debate on the foreign and defence aspects of the gracious Speech. There were 39 speakers. The debate ended just after a quarter to eleven

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at night. Repeatedly during the debate the plea was made--reasonably and cogently made--that foreign affairs could conveniently be debated separately from defence matters. That was not done. Again, today, there are 38 speakers. It is true that it is one fewer, but in view of the complexity of the debate and the number of matters with which the noble Lord, Lord Mackay, will have to deal in his reply, I reckon that we shall be very lucky to get away before 11 o'clock tonight. Again, there is no reason why we should not have a whole day for home affairs and a whole day for social affairs. There is more than enough to discuss and ample knowledge and experience in your Lordships' House, as the noble Lord, Lord Houghton of Sowerby, pointed out, to justify such a course and for the debates to be rewarding.

Having said that, I venture to return to the constitutional issues raised by those to whom I referred earlier. I agree entirely with the identification of the issues that need to be addressed. I hesitate only because my own feeling is that we dare not enter into these inter-related matters without the most careful investigation; indeed, by a Royal Commission on the constitution. I rather think that when the noble Lord, Lord Lester of Herne Hill, replied to the noble Baroness, Lady Carnegy, he was almost prepared to accept that view.

The matters that fall for discussion are devolution, reform of the House of Lords, proportional representation, and several others. I deal with only two in order to emphasise their complexity and the danger of an over-simplistic approach. I turn first to devolution. If one may render a judgment from the Cross-Benches south of the Border, I thought that the noble Baroness was correct to say that the question of the Union was clearly before the electorate and specifically before the electorate of Scotland at the last general election. But, as I understand it, that is not what is now proposed.

The Labour Party seem to be proposing that certain domestic matters of purely Scottish concern should be considered by a Scottish assembly. That comes very close to what was advocated by my noble friend Lord Perth and to which we on the Cross-Benches naturally paid great attention. But even at that stage an enormous number of matters need to be considered. The noble Baroness, Lady Carnegy, mentioned one of the most important; namely, finance. How is finance to be distributed between the devolved functions and the remaining functions? Then there is what the noble Baroness referred to as the "West Lothian factor"; namely, whether it is right that if there is devolution on the lines that I mentioned--that is, to a Scottish assembly--why should Scottish MPs have any concern with English matters of a similar nature? I refer to health, education and so forth. It is difficult to see any answer to that and I do not believe for a moment that the answer lies in saying, "We will have English regional authorities". I see absolutely no call for regional authorities in this country.

The West Lothian factor is therefore the second big question which must be considered. Together with that is the whole question of representation at Westminster. What functions remain at Westminster and who is to

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represent the various parts of the United Kingdom for their consideration? Even stopping there, there is an urgent call for a Royal Commission on the constitution.

I mention only one other point, and that is the House of Lords reform. As I understand it, the Labour Party will now seek simply to abolish the right of hereditary Peers to vote in your Lordships' Chamber. The noble Lord, Lord McIntosh, will correct me if I have that wrong; I see him looking at me and I do not know whether or not it is quizzically. That leaves out entirely the question of who appoints the remaining Life Peers in your Lordships' House. If, as at present, they are to be appointed by the Prime Minister, that gives the potentiality of single-chamber government.

If the Prime Minister, despotising as the Government now do over the other place, appoints the Members of your Lordships' House, we are a big step towards the great constitutional insight of my noble and learned friend Lord Hailsham; namely, an elected dictatorship. We should not forget that Hitler governed throughout by parliamentary sanction. It was an elected dictatorship. Because we have not got one and seem not to be in sight of one at the moment, we should not lightly disregard the powerful argument of my noble and learned friend.

Each of the points I raised--I noted also the referendum --are immensely complicated and call for investigation by a Royal Commission on the constitution. I gave the noble Lord notice that I intended to raise these points and begged him not to tell your Lordships that everything in the constitutional garden is lovely--it is not; we have heard sufficient today to know that--and not to tell your Lordships that two decades or more ago we had the Crowther-Hunt/Kilbrandon Commission. The terms of reference were very different from what is now required and, in any event, situations have greatly changed since that day.

I want to mention two further points, quite summarily, in view of two matters raised at the end of the last Session. The first is the relationship between the two Houses, mentioned by the noble Lords, Lord Rodgers of Quarry Bank and Lord Lester. I refer to the Home Secretary brushing aside amendments passed by your Lordships' House. The most important amendment was proposed by a former Home Secretary and supported by a Conservative Home Secretary, by other former Home Secretaries, by my noble friend Lord Allen of Abbeydale, a former Permanent Secretary of the department, and by a great many junior Ministers from the Home Office who are now in your Lordships' House. Not only was the amendment brushed aside, but it had enormous merit to commend it.

The amendment would have ensured that the security scheme could be brought into force at once instead of having to wait until the first of the specialised prisons in the Bill. It was said that it was essential to get the young tearaways out of circulation, but they have been left in circulation for three unnecessary years because the Home Secretary insisted on having his way. One is bound to ask: is he an oracle that "when he opes his lips let no dog bark", least of all the watchdogs in your Lordships' House?

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The other point is an argument which was advanced on the same occasion from the Conservative Benches although, I am glad to say, it was not by the Minister. It was to the effect that when your Lordships passed an amendment, if it were rejected by the other place then that was the end of the matter. If that were so it would mean that the Labour Party would not need any scheme such as it proposes. Just for the fun of it, it might well proceed to eliminate the hereditary Members of your Lordships' House, but it would be utterly unnecessary if the noble Lords who propounded that strange constitutional doctrine had their way. I hope that the Minister himself will repudiate such a doctrine and say that it is no part of government policy.

In that connection he might glance at an article written by the political correspondent of the Evening Standard which appeared on 6th July last. He said that senior Conservatives in the other place were urging the Prime Minister to get rid of the leadership in your Lordships' House because of the humiliating and embarrassing defeats that your Lordships had inflicted in the course of the passage of the Criminal Justice and Public Order Bill. Does the noble Lord, Lord Mackay, say that when your Lordships pass an amendment, particularly with the weight of authority which was behind the amendment on that occasion, that that really is an embarrassment to the Government? Is it really a humiliation, or do the Government recognise, as I believed was Conservative doctrine, that we are a two-chamber Parliament and that your Lordships have much to offer in that connection?

My final constitutional point is a very narrow one arising from the deregulation Bill and out of an amendment which was moved by the noble Lord, Lord Vinson, supported by my noble friend Lord Northbourne. It was to the effect that even the most beneficent law or regulation which does justice generally may, in some particular case, do an injustice. Added to that, even the most beneficent general rule may be harshly, even maliciously, or spitefully applied. It was suggested that we need something equivalent to courts of equity in this country and in Scotland not to invalidate regulations generally, but to relieve against the hardship or the spite.

The Minister who was in charge of that aspect of the deregulation Bill has lately resigned. I hope that the noble Lord, Lord Mackay, will assure your Lordships that that matter is still under consideration and being given weight. As I see it, the main difficulty is that many of the regulations are binding on us because they ultimately come from Brussels. I do not believe that that is an objection which cannot be overcome. What I have suggested should certainly be considered in the light of the run-up to 1996.

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