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The Minister of State, Home Office (Lord Williams of Mostyn): My Lords, before the noble Lord, Lord Clement-Jones, addresses the House, your Lordships may have noticed that my noble friend Lady Hayman is not at all well. She means no discourtesy. I am sure that we wish her a speedy return to reasonable health as well as to your Lordships' House.
3.40 p.m.
Lord Clement-Jones: My Lords, I join the noble Earl, Lord Howe, in expressing our appreciation for this opportunity to debate health and home affairs issues today. My noble friend Lord Dholakia and I will be dividing our responsibilities in similar fashion. I am sorry that the noble Baroness is not present. I was going to suggest a controlled experiment because I noticed that she was battling with a heavy cold. Professor Warburton of the University of Reading has carried out some experiments and has found that enjoyment even in small doses boosts the effective of the immune system. We do not yet have any evidence of what effect speeches in this House have on the immune system but I was going to suggest that if the noble Baroness sat through the debate she might feel better at the end of it. It would depend on the quality of course.
It is significant that in the 50th anniversary year of the NHS we should be facing a major Bill to reform it. My own celebrations of the golden anniversary of the health service took place slightly early, in March this year, when at St. Thomas' Hospital across the river my wife Jean gave birth to our first child, Harry. As noble Lords will imagine, I felt very much at home at the National Childbirth Trust lobby across the way in Westminster Central Hall only today. I very much hope that Ministers will listen with some interest to what it has to say.
Especially in this anniversary year we need to be clear about what kind of health service we want to see for the next 50 years. This Government use the word "modernisation" at every opportunity. My noble friend Lord Rodgers pointed out earlier that the word of itself is entirely value free. We must be clear, therefore, about the underpinning values that will inform the NHS for the next 50 years. We can say "yes" to modernisation, but only if it leads to better patient care and a diminution of health inequalities. There needs to be greater public accountability over the commissioning of services, improvement of standards and greater consistency, but throughout, I believe, retention of the human side of medicine. Those will be the tests for my party of any proposals that come before the House.
We welcome many of the Government's intentions, particularly in the face of some of the disastrous 1991 reforms introduced by the previous government. In particular, we support the drive for quality with improved clinical governance and a new clinical emphasis on evidence-based medicine. We welcome the recognition that health inequalities must be tackled, leading to a focus on public health and preventive as well as hospital medicine.
We also welcome further resources being made available for the NHS, but we do not fool ourselves that Christmas for the NHS has arrived in quite the same way as the Secretary of State would have us believe. He is keeping extremely tight control over the purse strings, not least with the so-called modernisation fund. The Government's obsession with waiting lists has meant that more than £1 billion--10 times more that originally anticipated--is being spent on relatively minor operations. In addition, what the Government are failing to do is to look at the whole picture. There are still huge delays in people waiting for a consultant's appointment. Only after they have been seen, and it has been confirmed that they need an operation, do they actually appear on those waiting lists.
We welcome change in commissioning away from competition and towards co-operation, although in our view this does not go far enough. We will want to look carefully at the legislation. We believe that primary care groups and primary care trusts should be part of an integrated social services and health authority commissioning structure going beyond the partnership proposals produced by the Government. We are concerned about the cost of PCGs and PCTs and how they will operate. Management costs have been cut in health authorities at the same time as they are supposed to give support to setting them up. Will the PCGs and PCTs become too GP dominated? How will new patterns of care involving nurses and pharmacists evolve with this level of control? As it is, we are concerned about the timetabling for setting them up. In addition, much more clarity is needed over commissioning of tertiary care in areas such as mental health and oncology.
The new Bill will also deal with several aspects of clinical governance in the NHS. This is clearly a vital area if we are to avoid further Bristol cases. The Secretary of State has talked about,
- "an integrated approach to the raising of standards".
The medical profession is beginning to take the question of clinical governance extremely seriously. I welcome the profession's acceptance of the concept of revalidation for specialist hospital doctors. However, the GMC as a body needs to ensure that appropriate
mechanisms are implemented as soon as possible. What of NICE itself, too, in terms of determining best clinical practice? I wish Professor Rawlins well, but so many hopes and expectations have been piled on NICE that it is difficult to see quite how he will do his job. How will he operate with a budget of only £9 million, the figure which has been widely quoted? I note Professor Rawlins' distinguished background but I hope that NICE will have a wide remit well beyond drugs and technologies and that it will also include other aspects of health, including the whole area of equity of access.One of the great disappointments of this Government is their failure to grasp the rationing nettle and admit that rationing takes place in the NHS. As a result, there is a large hole in the middle of the NHS reforms. Viagra and Zenical are but recent examples which have made it quite obvious that the NHS cannot fund every form of treatment. But any clinician or health manager will tell you that rationing exists in all kinds of ways in the NHS. I am personally acutely aware of what difficult choices have sometimes to be made, but these should not simply be laid at the doors of doctors or local managers. We need to install a transparent system, such as a standing conference, which can openly debate priorities on a national basis.
We know of the huge problems involved with nurse recruitment. I welcome the assurance given on training places by the Secretary of State in his speech in the other place. He highlighted that new nurses are not necessarily as well equipped with the practical skills as they would like to be and he has asked the UK Central Council for Nursing, Midwifery and Health Visiting to look at this. The technical quality of our nurses, as a result of Project 2000, is, I am sure, excellent, but it is in the area of practical management and caring skills where I agree that the Secretary of States's initiative is needed. However, I feel that a highly skilled cadre of people who were persuaded that nursing was to have a more academic and technical content and an improved status have in many ways been sold a false prospectus. Any hospital doctor will tell you that nurses' pay is a disgrace. One said to me only last week that if pay was not raised substantially he doubted the future of the health service. I urge the Government to recognise in all their actions in the NHS the reality of that fact.
On the medical side, I can see a different set of problems. There is a massive shortage of doctors. The combination of the Calman training reforms and the new deal restricting junior doctors' hours to 56 means that continuity of care is provided only by consultants. The problem will be exacerbated by a reduction to 48 hours under the working time directive. Yet there is a bow wave of trained hospital doctors coming through the service for whom there are no consultants' jobs. The NHS urgently needs to increase the numbers of consultants but at the same time to re-define their role. This needs to be done ahead of the absurdly slow evaluation being conducted over three years. We may well need different categories of consultants to reflect the training that has been received as many of the new consultants may not be qualified to "stand alone" after full training.
On the public health side, we welcome the Government's acceptance of the link between income, family, social environment and health, and their commitment to health improvement plans and a partnership between local authorities and health authorities. The excellent Acheson Report has also tackled the priorities to be pursued. However, there are questions surrounding health improvement programmes and involvement of the voluntary sector and how primary care groups will relate to them. As Sir Donald Acheson pointed out, health improvement programmes will be the key way in which priorities and objectives for reducing inequities will be agreed. It is vital that the way in which these are drawn up includes input from the widest possible range of sources at local level.
In public health generally we need to recognise the realities of devolution to Wales, Scotland and Northern Ireland. If we have a mechanism through health improvement programmes, and perhaps, as Sir Donald has suggested, a new duty on public health directors to produce "equity profiles" for combating health inequalities, we also need to have new methods for co-ordinating information on best practice and standards across the whole of the UK, for example through a public health commission.
As regards the pharmaceutical price regulation scheme, this is an area where we shall look closely at the detailed proposals of the legislation. Is what is being proposed simply a stick to beat any recalcitrant pharmaceutical company in negotiations, or will a detailed scheme be proposed? We back the creation of a fourth hurdle in the existing scheme so that clinical effectiveness must be demonstrated; but there may well be a case for going further--while still recognising the contribution that UK pharmaceutical companies make to employment and the economy--and moving towards a price per product formula.
There will be debated on Second Reading in the Commons next week, and thereafter in the Lords, the NHS charges Bill referred to by the Minister. We are not yet convinced of the validity of this proposal. We believe that it is important at least to establish that those charges levied on behalf of the NHS by the CRU will not simply be clawed back by the Treasury. We need to establish how the bureaucracy of collection will operate. We believe that the estimate of costs for collection may well be optimistic. But if the new mechanism is being set up by the CRU, why not follow the logic of the Law Commission's consultation paper issued in 1996 in full? Why should not the Bill include reference to occupiers' liability insurance, employers' liability or product liability? Why simply stick to road traffic? Is not this a lost opportunity?
What of some of the non-events of the Government's legislative programme? Let us take the food standards agency. It is no secret that the Government's failure to include legislation in the Queen's Speech is a massive disappointment to many of us. My party fully supported the White Paper, its aim to provide proper protection for the public and its recommendations for proper enforcement powers for the new agency, which would be independent but subject to overview by the
Department of Health. My party awaits a full statement from the Government on their intentions now that there is no prospect of a Bill in this Session.A further blow for those of us who are passionate about food safety is the delay in bringing forward freedom of information legislation. Your Lordships may recall Sir Donald Acheson--the former Chief Medical Officer I have mentioned already--telling the BSE inquiry that information about possible BSE contamination of medical products such as vaccines had been withheld from him while he was Chief Medical Officer because of secrecy imposed by the present medicines legislation. It is clear that delay in bringing forward a freedom of information Bill will allow this dangerous kind of secrecy to continue. In the midst of a number of positive proposals for reform by the Government in the area of health, that is a serious blot on the Government's record.
3.54 p.m.
Lord Warner: My Lords, in rising to make my maiden speech, I am only too aware of Shakespeare's rather gloomy remark that,
- "crabbed age and youth cannot live together".
I should at the outset declare an interest. Recently I became Chairman of the Youth Justice Board for England and Wales, established under the Crime and Disorder Act 1998. It will come as no surprise if I say that I support strongly the measures in that legislation for reforming the youth justice system. The board has begun the task of focusing hard on the new statutory aim of preventing offending by young people. Our emphasis will be on earlier intervention with youngsters who offend and trying to change their behaviour for the future. But the 1998 Act left some unfinished business. At present the youth courts do not do enough to help change offending behaviour by young people. In my view, the Government are right to want them to do more. I welcome the decision to bring forward legislation in this Session which will create a new sentence for youngsters convicted for the first time in a youth court; namely, a referral to a youth offender panel. These new panels will work with young offenders by drawing up a contract to include programmes and activities that will address the causes of offending behaviour.
This change is completely consistent with the new approach the Youth Justice Board is encouraging and that will be a feature of the local youth offending teams now being established across the country. I am confident that by the time these youth court changes are enacted, the local structures and programmes will be well advanced through youth offending teams to make these changes work well on the ground.
But these further legislative changes are only part of the wider reforms needed to tackle the problem of social exclusion presented by many of the troubled and troublesome youngsters who are the concern of the Youth Justice Board and youth courts. Social exclusion,
of course, is not a topic that one immediately associates with this House, although perhaps familiarity with the concept will increase as this Session progresses. Indeed there has been a recent example in this year's State Opening of Parliament, when people turned their backs on Silver Stick in Waiting and the Gentleman Usher to the Sword of State and told them they were no longer wanted. That is the problem for many of the youngsters I am talking about. The world has turned its back on them. Typically they have been excluded from school, placed in public care or are homeless. Nearly 40 per cent. of young prisoners have been in public care. About two-thirds of young prisoners were unemployed and most of them have no educational qualifications. Your Lordships may occasionally trip over some of these youngsters as they sleep in shop doorways. Many have been victims of abuse and crime themselves. Many will form a large part of tomorrow's resident population of our prisons and our psychiatric hospitals.It is to the enormous credit of this Government that they are trying to tackle the problems that many of these disadvantaged young people face. Initiatives such as the New Deal, behaviour support plans in schools, the anti-drugs strategy, the work of the Social Exclusion Unit and a more coherent family policy that supports parents and tackles children living in poverty do much to help. So, too, will the improvements, backed by extra resources, that are to be made for children in public care and the improved support they will get when they leave public care.
A former Member of this House, the late Lady Faithfull, was a formidable champion of the interests of children and young people. Today I would like to acknowledge her contribution. If she had been with us today, I am sure that she would have said that many of the disadvantaged young people I have been talking about need help and support as well as having their offending behaviour checked. This help and support has never been more necessary than when children are themselves the victims of crimes, sometimes within their own families.
That is why I welcome the Goverment's intention to legislate in this Session to provide more support and protection for children who are witnesses. As a former director of social services I have seen what some children involved in sexual abuse trials have had to endure in the courts. Too often, our pre-occupation with protecting the rights of defendants has caused the courts to treat children as witnesses very insensitively and to repeat through the judicial process the very abuse that they have already suffered. The result has often been that too many offenders go scot-free because prosecutions fail when children cannot face the ordeal of being a witness.
In conclusion, I hope that when this House comes to consider the youth justice and witnesses Bill in more detail, noble and learned Lords will give full weight to the needs of children as witnesses and the importance of reforming youth courts so that offending behaviour by young people can be tackled more effectively.
4 p.m.
Lord Ashbourne: My Lords, it gives me great pleasure to congratulate the noble Lord, Lord Warner, on his admirable maiden speech. He has wide experience, having worked in the Home Office and in social services departments. In the past he worked in the office of the noble Baroness, Lady Castle, who is in her place to welcome her protege, if I may, with no disrespect, put it that way. I believe that when he worked in her office he was known as one of "The Three Musketeers"; the other two being the Home Secretary and Janet Anderson, MP. The noble Lord has a wide background of experience and I have no doubt that he will make some signal contributions to your Lordships' deliberations in the future. We offer him a very warm welcome to the House.
I must now apologise most profoundly. I regret that I shall not be able to stay until the end of the debate. I have a long-standing engagement with some people from abroad, and I shall have to leave before the end. However, I shall read Hansard most carefully to see what has been said.
I was disappointed that the gracious Speech contained nothing about the role and importance of the traditional family. The Government's recent consultation document entitled Supporting Families starts with these words:
- "Families are at the heart of our society. Most of us live in families and we value them because they provide love, support and care. They educate us, and they teach right from wrong. Our future depends on their success in bringing up children. That is why we are committed to strengthening family life".
I must declare an interest. I am chairman of the Lords and Commons Family and Child Protection Group, a Back-Bench group of parliamentarians from both Houses, formed some years ago because MPs and Peers were worried by attacks on the traditional family and the erosion of family values.
We strongly support the initiative of Her Majesty's Government in stating their support for marriage. Indeed, paragraph 8 of the introduction to Supporting Families states:
- "But marriage is still the surest foundation for raising children and remains the choice of the majority in Britain. We want to strengthen the institution of marriage to help more marriages to succeed".
It is in the family that we learn the virtues of self-discipline, selflessness, loyalty, moral discrimination, hard work, planning for the future, integration and socialisation. So the traditional family is not a lifestyle option but the fundamental building block of society. A stable society needs strong families centred around the marital bond. Even more importantly, the family is a vital line of resistance against totalitarianism. So I am disappointed that Her Majesty's Government are reluctant to defend the traditional family unit more robustly.
The gracious Speech ends with a prayer that the blessing of Almighty God might rest upon our counsels. I hope, trust and pray that Almighty God will answer that prayer. I pray that He will continue to give this House the courage to stand up to the Government when they are wrong. That is our constitutional duty before God, the monarch and the people of this land. It is a duty from which we must not shrink.
4.4 p.m.
The Lord Bishop of Winchester: My Lords, I too congratulate the noble Lord, Lord Warner, on his maiden speech and on his important observations, made from his considerable experience. I had hoped to be able to invite your Lordships to join me in welcoming the right reverend Moderator of the General Assembly of the Church of Scotland and his party, but he has just left the seats below the Bar.
I want to refer to two paragraphs in the gracious Speech, both the remit of the Secretary of State for Home Affairs. First, there is mention of a Bill to modernise the law on immigration and asylum, following the White Paper, Fairer, Faster and Firmer. Like the Church of England Board for Social Responsibility, and following a debate in the General Synod last November--the results of which were notified to the Secretary of State--I welcome many of the Government's principles and intentions. I welcomed also many of the proposals set out in the White Paper, including the points clearly made at the beginning and throughout concerning the strengths and benefits that this country has received from immigrants and those who have been granted asylum over the years, especially in recent years. I welcome the recognition of the injustice and cruelty of many aspects of the present system which is admitted to be chaotic and to compromise a network of unsatisfactorily linked arrangements. I welcome the sense of the need to take steps to make the arrangements less open to abuse, some of which undoubtedly is professional and systematic. I welcome the commitment to make the whole range of procedures fairer and faster. That is urgent. Although it would destroy the alliteration, I would prefer to use a phrase like "more just". The word "firmer" smacks uncomfortably of populism.
However, there remain deep concerns about the White Paper among many organisations active in this area, including the Church of England Board for Social Responsibility and the Churches Commission for Racial Justice. I want to highlight a few of those.
A crucial point is that clearly all the processes should be undertaken faster. The enormous backlog has to be dealt with--and dealt with as quickly as possible on every possible ground. However, will sufficient staff be provided, especially in the next few years, to enable that backlog to be dealt with properly, on which so much else in the White Paper hangs? Will the staff be trained sufficiently in many respects, including the recognition of trauma, and even torture, and in racism awareness? Will the staff be of the appropriate gender? When "faster" is the watchword--and justifiably so--are there points at which the procedures may have to take place so fast that it may be difficult for those concerned responsibly to gather the material that will be needed, especially when those at the heart of the matter may be traumatised?
We need to look hard at the conduct and process of the first interview on arrival, about which many of those working in that area have the greatest anxieties
at present. We need not only accuracy and efficiency, but also compassion and justice in what, understandably and yet often destructively, remains a culture more of disbelief than of open-mindedness.What happens if those most in need of asylum, as well as those most abusing the system, have been turned back by more and more efficient airline liaison officers at points of departure? It matters not only where the airline liaison officers are located, but also where they are not. There are some countries where it would be regrettable if such people were located and worked too efficiently.
I appreciate the reasons for proposing in the White Paper a largely cashless system, one that runs on benefits in kind. I appreciate, too, the wish to spread those awaiting consideration under these processes around the country, out of London. However, I wonder whether the White Paper has taken sufficient heed of the administrative costs of the new procedures and, still more, their possible effects on the welfare, self-respect and just treatment (and the speed and accuracy of that treatment) of those who will be the subject of asylum and immigration procedures. There are potential difficulties in regard to access to lawyers who are unreasonably congregated in London. There are difficulties in the locating of vulnerable people in out-of-the-way localities, in estates and areas already under pressure for other reasons, where there is not adequate support and from which people may easily drift back to London and become vulnerable through exploitation, or worse.
Lastly, in relation to this section, there is a range of questions surrounding detention. The White Paper speaks admirably of a presumption in favour of temporary admission or release. But there remains, especially in Chapter 12, a strong emphasis on detention. More than a whiff of that emphasis is caused by a continuing sense that detention has to be there as a deterrent and for a wide range of categories of asylum seekers. There are founded, documented anxieties about how deeply unsatisfactory are the present regimes in detention centres, firmly fixed as they are within the prison system, even if some are not strictly speaking prisons. I shall not go into detail, but those who know most about this aspect are very discouraged, particularly by Chapter 12.
There is a great deal to be supported in regard to the Government's will, intention and principle in this matter and many of their proposals. However, there are serious questions to be raised, especially in regard to the resources to be made available for the education and training that will be offered to the human elements in those resources. It is important to state that if those resources are not made available, the cost, which will be considerable, will continue to be suffered by those who are caught up in the system, many of whom are profoundly and multiply vulnerable.
I note the paragraph in the gracious Speech:
- "Parliament will be given an opportunity to vote on the age of consent. The Bill will strengthen the protection of young people from abuse of trust".
The Church of England, along with the other Churches and major workers with children and young people, recognises the deep seriousness of this range of questions. It has done a great deal of work on its own processes in recent years, and continues to do so. I regret, although I was expecting, the former leg of that paragraph relating to the reintroduction of the Bill to lower the age of consent. I anticipate that I am by no means the only Member of this House who is no more convinced now than I was in July that this is a wise or caring proposal. I do, however, appreciate the Government's difficulties following the ruling of the European Court of Human Rights in the Sutherland case. Nevertheless, I ask that when this part of the Bill comes before both Houses, those who bring it forward and support it take the trouble to argue their case and respond to the arguments and concerns that I and many others have raised.
When the matter came before the other place and this House in June and July, there was much use of admirable and important words and concepts such as "justice", "discrimination", "anti-discrimination", and "modernisation". All are critically important concepts and activities. However, it is extremely important that we do not allow our minds and critical faculties to be numbed when certain words which have become slogans on many sides of our society are used. I hope that we and those bringing forward the legislation will not allow our senses to be relieved of the need to weigh and respect evidence in these matters, to respond to argued cases and to recognise and evaluate social trends and influences upon our society, particularly in relation to those growing up within it.
Finally, notwithstanding the criticism of the Bishop of Edinburgh in the November edition of the Parliamentary Monitor, I do not believe that either your Lordships or the public would want those who are called to sit on these Benches to retreat from our responsibility, in this or any other matter, to seek to offer advice, whether on the side of change or on the side of the status quo, on what we discern to be, as the Prayer Book puts it, godly government.
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