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Lord Adonis: My Lords, the better the support that is available to children in care, both to prevent them going into care in the first place and to tackle issues such as the poor standard of education which children in care experience at present, the more likely we are to keep them out of the custody system—a measure which I am sure the right reverend Prelate supports. A whole section of the Green Paper, which
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Baroness Walmsley: My Lords, the Green Paper published last week contained the very welcome measure that young people can choose to remain in foster care until the age of 21, or even later if they are in further or higher education. Has the Minister any idea of the number of young people choosing to do that? Will he assure the House that, when the relevant figures are collected in future, the figure relating to those children will be recorded separately so that we can genuinely see any increase or decrease in the number of children in the lower age groups taken into care?
Lord Adonis: My Lords, as the noble Baroness will be aware, for two years now children coming up to16 have had the option to remain in care. Better support arrangements are in place to enable them to do so. A substantial and rising proportion have chosen to do so. I believe that we will monitor the number in the older age ranges who choose to stay in care. I shall let the noble Baroness know how we propose to do that.
Baroness Morris of Bolton: My Lords, the most alarming fact about children in care is that they are 66 times more likely to have their own children taken into care, creating a generational vicious circle. There are massive variations in the number of children taken into care across the country. What action has been taken, other than publishing the Green Paper, to address that?
Lord Adonis: My Lords, when we discussed the Green Paper last week, the noble Baroness pointed out, for example, the work that Kent County Council has done to better support children in care. We are doing a great deal to promote best practice between local authorities in this area, which is a prime local authority responsibility. I accept that there is more that we need to do in future, and we will seek to do it.
Alzheimer's Disease
3 pm
Baroness Greengross asked Her Majesty’s Government:
Whether, in accepting the decision of the National Institute for Health and Clinical Excellence to deny Aricept to people with early stage Alzheimer’s disease, they have taken into account the full cost of the decision.
The Minister of State, Department of Health (Lord Warner): My Lords, the National Institute for Health and Clinical Excellence has done a very thorough
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Baroness Greengross: My Lords, I thank the Minister for that helpful reply. I agree that NICE plays a very important role in assessing the benefits of particular drugs and the direct costs of providing them through the NHS. But does he not agree that it is the Government’s job to set those costs against their own priorities, for example prevention of disease and early intervention, and to take into account the costs of alternative medications that are often needed and the huge cost to families, whose lives are turned upside down when Alzheimer’s strikes? Above all, there are the costs to the national economy of carers being forced out of the labour market, often on to state benefits for the rest of their life. Will the Minister agree to take all those costs into account and tell your Lordships’ House whether these drugs, at £2.50 a day, are really not cost-effective?
Lord Warner: My Lords, we set up NICE with cross-party support, and it has achieved a huge international reputation. It needs to be able to carry out its difficult work free from political interference. If Ministers were to overrule NICE, it would set a dangerous and undesirable precedent.
The findings of the appraisal do not in any way suggest that the drugs concerned should not be used for moderate to severe Alzheimer’s disease, except Ebixa, a new drug that was not recommended for the treatment of moderate to severe stages. The three existing drugs continue to be recommended for moderate to severe Alzheimer’s, and the patients currently receiving all four drugs, whether routinely or as part of a clinical trial, may continue to do so until it is considered appropriate to stop. This is not a wholesale removal of those drugs from the treatment of Alzheimer’s disease.
Lord Forsyth of Drumlean: My Lords, does the Minister not accept that the health service once had a principle that people should be able to get the care they need regardless of ability to pay? No one is disputing that Aricept is not effective in the early stages of treatment of Alzheimer’s. What is happening is that only those who can afford to buy the drugs will get the treatment. That cannot be right, and the Minister cannot hide behind his responsibilities as a Minister to ensure that the health service does what it is supposed to do and remains true to its central principles.
Lord Warner: My Lords, it is this Government who have adhered firmly to the principle that the NHS provides free care at the point of clinical need. If I may say so to the noble Lord, it is his Governments who from time to time have wavered on that principle, so I do not feel inclined to accept lectures on this issue
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Lord Walton of Detchant: My Lords, does the Minister accept that many neurologists and psychiatrists have been disappointed, as he is aware, at NICE’s recent guidance, not least because it is a matter of extremely difficult clinical judgment to tell when early Alzheimer’s disease becomes moderately severe, when the drugs may be prescribed under the NICE guidelines, and when it is advanced, when according to the guidance the drugs may not be prescribed? It is crucial that the guidance to be produced next month should be carefully examined, because the medical profession is concerned about its effects in this situation.
Lord Warner: My Lords, the noble Lord is right that this is a complex issue. That is why NICE will produce the clinical guideline next month, following consultation with a wide range of clinicians of different opinions.
Baroness Pitkeathley: My Lords, does my noble friend appreciate that the families of people with Alzheimer’s disease are hungry for any kind of support? That is why there is so much emphasis on these drugs, although everyone accepts they are not effective in every case. Can the Minister give us more details about the kind of support that he mentioned in his Answer, which is to be offered to patients and families?
Lord Warner: My Lords, my noble friend is right. I do not deny that we appreciate that the NICE guidance for people with Alzheimer’s disease is terribly important to their carers and clinicians. I cannot anticipate the precise terms of NICE’s clinical guideline, but it is intended to help clinicians, the public and carers to understand the best ways to meet the need for care and support, alongside drug regimes, for people who unfortunately suffer from Alzheimer’s disease.
Lord Addington: My Lords, does the Minister not agree that we have this familiar debate every time a new type of drug or service comes up? Do the Government agree that, whatever NICE is doing, its way of explaining it to the public and politicians is failing? Can the Government give a guarantee that everyone will be brought on board in producing the new regulations, including the Plain English Campaign?
Lord Warner: My Lords, I do not accept that NICE has failed to communicate its ideas properly and appropriately. It has been extremely transparent at all stages of its process in putting information on its website and into the public arena. It sends regular briefing on its work to all Members of both Houses.
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Education and Inspections Bill
3.08 pm
Clause 1 [Duties in relation to high standards and the fulfilment of potential]:
Lord Judd moved Amendment No. 1:
The noble Lord said: My Lords, I shall speak also to Amendment No. 2 and strongly support Amendment No. 7, standing in the name of the noble Baroness, Lady Walmsley.
In one sense, the purpose of the amendment is to emulate the example of legislators north of the Border in Scotland. They have seen fit to put on the face of their legislation, as the cornerstone of everything they want to achieve, the principle of the right of every child to education. I should declare an interest at this point, because I am a half-Scot and sometimes my English half wishes that we had the courage of Scots conviction. With the greatest possible respect to the Minister, I believe that he should again look at this point before he finally makes up his mind.
The Minister listens very carefully to arguments—he is almost exemplary in how this should be done—and he is extremely courteous and thorough in following up points. We approached and discussed this issue in Committee, and I deeply appreciate the full letter that he has sent to me about the concerns behind my amendment. I am sure that it was no fault of the department, but I am afraid that the Minister’s letter did not reach me in time to have meetings with his officials before this discussion. However, because I take his letter seriously, I should like to examine some of the points that he makes in it.
The Minister emphasises that the right to education is guaranteed by Article 2 of the first protocol to the European Convention on Human Rights and, for children, by Article 28 of the European Convention on the Rights of the Child. The right to education, he argues, is provided by the European convention and is already part of national law by virtue of the Human Rights Act 1998. We recognised that when we argued our case in Committee.
I do not believe that anyone could be a more committed internationalist than I am. I am glad that the conventions say what they do and I am proud of the part that Britain played in leading the cause in making those conventions. However, internationalist though I am and seriously though I take the conventions,
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The Minister argued that, because the objective is spelt out in the Human Rights Act 1998, the amendment would confuse the issue as it would not be clear whether the Human Rights Act or this Bill prevailed. I do not think that there is any problem in that respect. As I understand it, it is absolutely clear that ultimately the European Convention on Human Rights prevails in all aspects of legislation and activity in this country.
My noble friend also goes on to emphasise the importance of the judgment by the noble and learned Lord, Lord Bingham, in the Ali case, when he upheld what has been described as the fourfold foundation for this right. The Minister very kindly spells out again in his letter to me what the fourfold commitment amounts to. The first element is the duty of parents under Section 7 of the Education Act 1996 to cause their children to receive efficient and suitable full-time education, either by regular attendance at school or otherwise. That is a great objective and a great principle. But what happens if the parents do not share that commitment or do not fulfil it?
The second element is the Secretary of State's duty under Section 10 of the Education Act 1996 to promote the education of the people of England and Wales. Again, that is absolutely salutary. That is great, but that is not an objective that automatically becomes fulfilled. To promote the importance of it is not actually ensuring that it happens.
The third element is that local education authorities are required by Section 13 of that Act to secure that efficient education is available to meet the needs of the population of their areas. Such education being available is not ensuring that every child enjoys it. The fourth element is that maintained schools themselves have a responsibility to ensure that their governing bodies conduct the schools with a view to promoting high standards of educational achievement at the schools. Again, that is excellent but it does not ensure that every child is able to enjoy that provision.
On Report, we are proposing, in a slightly different form, that, because of the residual overall responsibility of local education authorities, it should be made quite clear that those authorities have a responsibility to secure the right to education for every child. We then go on to demonstrate how that should be done. Part 1 of the Bill talks about the responsibilities of local education authorities. For local education authorities in England it is about promoting high standards,
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I know that the noble Baroness, Lady Walmsley, with all her experience and all her usual commitment and analytical power, will put forward a powerful argument to this set of amendments. A mistake that all of us in Parliament sometimes make is to think that the battle has been won when we have introduced legislation. We have seldom won the battle; at best, we have usually created opportunities. What wins the battle is winning the hearts, minds, commitment and understanding of the widest possible cross-section of people to the principles that we are trying to achieve by education and by enthusing the population as a whole with an objective that is worth while achieving.
I ask my noble friend to say that a responsibility and a right are spelt out in international conventions, but we, for a host of convoluted reasons, do not think it is appropriate to spell out that right in the Bill as the cornerstone and presentation of all else we are doing. I think that is sad. With the greatest possible respect to all concerned, I think it is institutional Whitehall getting caught up in the niceties and missing an opportunity to take the nation forward.
In his letter to me, the Minister emphasised—and he was generous to do it so strongly—that if there are doubts about legal problems that might be opened up by such a declaration, one can look at Scotland where no single parent has tried to introduce any complaint or criticism on the grounds of that declaratory principle in the Bill. That is very significant. He says:
which he has gone into in some detail in his letter—
- “the Scottish Executive took the view that the declaratory benefits were worth the risk of legal challenge. This is not a view that, on serious reflection, we share”.
I beg the Minister to indicate in his reply that he and his officials will go away and think about this. I am a very open-minded sort of chap, and if he can come back to the House—or indicate that he is prepared to do so—with some wording that gets this principle flying as a standard at the head of all we are trying to do on education and, with the legal advice that has so far been holding him back from endorsing our amendment, expresses in a watertight way what we enthusiastically propose, I shall be greatly encouraged. I beg to move.
Baroness Walmsley: My Lords, I support the noble Lord, Lord Judd, on Amendments Nos. 1 and 2, to which I have put my name, and I shall speak also to Amendment No. 7, which is tabled in my name and that of my noble friend Lady Sharp. The Bill gives a clear duty to the LEA to identify those children who
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I am a great believer in clarity in the law and in making it easily understandable and, in particular, accessible to the citizens of this country, not just to clever lawyers. In Committee, and in his letter to the noble Lord, Lord Judd, the Minister made clear that several bits of law added together do what the noble Lord and I seek to do today. He referred to several pieces of statute in different Acts of Parliament and a case-law judgment by the noble and learned Lord, Lord Bingham, in which those are all listed. Other clauses lay out the sanctions that the LEA and the courts can use against parents who do not send their child to school or provide a suitable education at home. I do not think that is good enough. In the Bill, we have an ideal vehicle of statute to make the law clear, as was done in Scotland.
We would not need to rely on case law. People would not need to go into a lawyer's office and have him take down several Acts of Parliament in order to explain what the child’s rights were. We would not be just talking about sanctions against the parents, but making it clear that it is the duty of the legal authority either to ensure that the child has a place in a suitable school—that can be very problematic these days where children cannot even get a place in their first six choices of school—and actually attends the school, or to satisfy itself that the alternatives are in place for a home education.
Frankly, I do not mind if this involves a certain amount of repetition. British law is no stranger to repetition. That is why some people call for a total review of our laws, a codification and clarification. I understand that this may take a very long time and result in a vast reduction in the size of legal libraries, let alone legal bank balances. However, it is not a bad idea. I do not seek to do anything so ambitious today, but I am loath to let pass an opportunity to make the rights of children to receive an education absolutely clear, and to make clear on whom the duty lies to fulfil that right.
The noble Lord, Lord Judd, mentioned the rights of children enshrined in a number of international human rights conventions, but it is UK law that gives effect to the rights of children enshrined in those conventions. Let us not lose an opportunity to emphasise our commitment to children's rights as enshrined in those conventions by not clarifying the law in this way today.
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