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Baroness Amos: My Lords, I thank my noble friend Lord Hunt of Kings Heath for initiating today's important debate. I need to declare a number of interests. I am chair of the Afiya Trust which works to promote equity in health and social care. I am chair of the board of governors of the Royal College of Nursing Institute. I am a senior associate of the King's Fund and a member of its general council. I am also a non-executive director at University College London Hospitals Trust. I was pleased that in his announcement yesterday on the future of health services in London the Secretary of State supported the development of a new university college hospital which would involve the centralisation of services on one site to enable the provision of quality local and specialist services.

I must also declare an interest as a user because I continue to be impressed by the quality, competence and commitment of NHS staff. I focus my remarks today on the contribution of ethnic minority workers to the NHS because they have been an important part of NHS history. I hope that they will be a core part of its future. For me 1998 is a significant year not only because it is the 50th anniversary of the NHS but also because it is 50 years since the arrival of the "Empire Windrush", heralding a period of post-war migration from the Caribbean to Britain. Members of Britain's ethnic minority communities have made a significant contribution to the NHS over the years. There were strenuous efforts to recruit workers from overseas in the 1960s and 1970s.

Studies have shown an over-representation of African Caribbean, Chinese and African women in nursing compared with the distribution of other ethnic groups in the nursing workforce. But their experiences have not always been positive. Some of your Lordships may recall the PSI survey on nursing in a multi-ethnic NHS which was published in 1996 and which considered the experiences of ethnic minority nurses in the NHS. Its findings made bleak reading. They pointed to an over-representation of ethnic minority nurses in specialties such as geriatric care and mental illness. The survey referred to a lack of access to training, development and promotion and the under-representation of ethnic minorities at senior levels and the prevalence of racial abuse and harassment at work. That experience is not limited to ethnic minority nurses; it applies to other ethnic minority workers who have commented on areas of discrimination and

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disadvantage. That is why the commitment of the Government to deal with racism in the NHS is so important.

The Secretary of State for Health has on many occasions restated his determination that there should be no discrimination in the NHS for patients or for staff and his commitment to a service where employment opportunities are based on the ability to do the job, and staff feel they are valued and respected and to the delivery of fairness and equality at work. Action has already been taken in some areas. The NHS Executive is working with the Commission for Racial Equality to develop a set of racial equality standards in the NHS. An equality award scheme is being developed to promote and reward best practice. Initiatives are being put in place to tackle harassment and abuse. There is a commitment to the extension of ethnic monitoring so that data are available to enable targeting as appropriate. I hope that sustained action in these and other areas will ensure that the NHS will continue to attract staff from ethnic minority communities, many of whom are ambivalent about the commitment and ability of the NHS to meet its equality and diversity objectives.

The objectives in the White Paper on the new NHS should go some way to dealing with the concerns of those in Britain's ethnic minority communities, given the focus on primary care and on collaboration and partnership. Research published last year shows that health inequalities vary between ethnic minority groups and are directly related to socio-economic status, with those in poorer socio-economic groups having poorer health. As primary care is the first point of contact for users of the NHS, improving primary care for black and ethnic minority groups is essential to eliminate inequalities in health. We need to raise public awareness, tackle language and cultural barriers and focus on prevention. The need for more effective health promotion within primary care and community services must be met.

We also need a multi-disciplinary, multi-agency approach. The health action zones which will provide a framework for the NHS, local authorities and other partners to work together to improve services and to provide more integrated care for patients will have a key role to play in ensuring that issues of discrimination and disadvantage are tackled as a central part of their strategy. I welcome the renewed commitment in the White Paper to a National Health Service based on need and the recognition that continuing to improve the National Health Service will depend on maintaining the confidence of staff and patients; the efficient and effective management of resources; and a focus on excellence and quality. It is a challenge that I have every confidence the NHS is equipped to meet.

6.7 p.m.

Lord Davies of Coity: My Lords, after 50 years of the National Health Service we celebrate and acknowledge its contribution to the health of the nation. That is the topic of our debate. First, I thank my noble friend Lady Jeger for reminding us how the National Health Service was born and the opposition there was

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to it. Secondly, I thank my noble friend Lord Prys-Davies for reminding us what happened in the 1980s, to which I shall refer later.

Most of us--but not all, I hasten to add--will have recollections of 50 years ago and of the year 1948. However, those recollections will all be different. At 12 years of age I could not claim to understand the deep and profound significance of the creation of the National Health Service. But what I do recall is the direct effect it had on our family because my father had worked in a hospital since 1929. My father was a male nurse in a mental hospital, or at least that was how he was described after the National Health Service was formed. Before that he was known as an asylum attendant. His job was certainly secure but it was not well paid before the National Health Service was formed. I know that because my mother went out to work and we took in what the "posh" call paid guests but we called lodgers to enable my parents to pay the mortgage and to make ends meet.

When the National Health Service was formed, I recall my father having a pay rise and back pay. That was the first time I saw a £5 note which looked like a large sheet of white paper. On the strength of that back pay, we had our first family holiday and came to London.

Those are my recollections of 50 years ago. It was later that I came to appreciate what the National Health Service stood for. The National Health Service was the dream of Aneurin Bevan to ensure that the healthcare and medical treatment of all the people of this nation would be administered and provided on the basis of need and not on ability to pay. It was that dream that Aneurin Bevan put into reality 50 years ago--a reality, I suggest, that must continue to be the undying obligation of all of us if we want to claim to be a civilised society.

I am not saying that everything has been perfect at any time in the National Health Service throughout the past 50 years. I am not saying that everything will be perfect in the next 50 years. But what I claim is that throughout the whole of the past 50 years we should have been aiming for perfection; and at this anniversary, we should certainly be dedicating ourselves to that objective for the next 50 years.

Of course, the National Health Service has produced great achievements for the health of the British people to which we can all testify. But that, as we also know, is not the whole story. Until the 1980s there was a broad consensus on the one nation state, and across party divides there was, perhaps with differing degrees of emphasis, a general acknowledgement of the need to preserve and protect the one-time envy of the world--our National Health Service.

But then came the 1980s, the Thatcher years; and despite the clarion call, "The National Health Service is safe in our hands", we witnessed massive increases in prescription charges, longer waiting lists for treatment and operations, greater encouragement of private medicine, hospital closures, ward closures, shortage of nurses and shortages of doctors. We witnessed patients lying on trolleys in hospital corridors for hours, some

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dying. We witnessed patients being rushed across the country to find hospitals and surgeons to perform emergency operations, many not arriving in time. That is the evidence of the neglect and indifference displayed by the government in the 1980s to the deterioration of our National Health Service--all, I suggest, because of a head-led obsession with economics and a gross lack of heartfelt compassion. It was price tag medicine instead of medical treatment directly related to need. It was the complete opposite of what Aneurin Bevan set out to achieve.

How well I remember the statement, "If people wish to spend their money on medical care and treatment"--I suggest that that probably applied also to education--"instead of holidays and other luxuries, why shouldn't they?" But the problem was that the people expressing that view came from backgrounds where those who could afford private medicine could also afford holidays, luxuries and often second homes, whereas far too many people who came from my background could not afford the holidays let alone private medicine.

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