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Lord Hunt of Kings Heath: My Lords, the current policy is to delegate that decision down to individual trusts. In the past few years we have seen trusts employ many more interpreters and link workers. That has proved to be very successful. However, we are looking at a recent report published by the King's Fund on link workers in primary care. We will be exploring with the King's Fund and others ways in which to take forward this issue. We will look at the national system as regards criminal justice to see whether any lessons can be learnt.
Lord Hunt of Kings Heath: My Lords, there is an issue concerning the varying inequalities in health among all groups. I agree with my noble friend that inequalities in health among ethnic minority groups is a particularly serious problem. It is one of the reasons we invited Sir Donald Acheson to produce a report on tackling health inequalities. In his conclusion he recommended that the needs of minority ethnic groups should be specifically considered in terms of the allocation of resources to the NHS and specific programmes. We are considering our response to that report at the moment.
Baroness Gardner of Parkes: My Lords, is the Minister aware that there is a very great volunteer element in interpreting? Is he further aware that, as a dentist, I regularly had people come to my surgery with a friend or relative? Would it not be better to encourage that volunteer element rather than to involve ourselves in the vast expense arising from the court system, which I recall as a magistrate?
Lord Hunt of Kings Heath: My Lords, I am glad to pay tribute to the work of volunteers in helping the NHS in this area. We rely on volunteers and members of families to help people who use the NHS by interpreting for them. However, there are circumstances where it is not appropriate--perhaps in the case of a child or someone who does not speak English as a first language--for a volunteer to be present at a consultation. It is essential that we have the back-up of a professional service as well.
Baroness Ludford: My Lords, given the Minister's earlier reply, with which I agree, will he confirm that extra funding will be made available for those health authorities that need to employ professional translators; for instance in inner London, where patients may speak any of some 60 languages? Given that the funding of services for ethnic minorities is under pressure in the education sector through local government grants, will the Minister assure the House that that element of health funding will not be under pressure?
Baroness David: My Lords, I appreciate what the Minister said about national health trusts, but will he tell the House what information is now available to them as regards the needs of language and the cultural backgrounds of the people in their area so that the trusts can provide a baseline from which to plan appropriate services?
Lord Hunt of Kings Heath: My Lords, the most comprehensive set of data on local areas is provided by the 1991 National Census. However, that records only ethnic group and country of birth, not language or religion. Therefore, information at local level is more likely to be the product of local initiatives on the part of health authorities or local authorities in commissioning surveys.
The development of the new NHS proposals, particularly given the intention to develop health improvement programmes in consultation with local authorities and taking in primary care groups and NHS trusts, will provide the motivation to ensure that the information we have is as accurate as possible. That will then help us to plan the kind of services that we require.
Lord Astor of Hever: My Lords, is the Minister aware that there is no legal requirement for GPs to be able to speak English, and that that can in certain circumstances be dangerous for the care of patients? Will the Minister undertake to look into the matter?
Lord Hunt of Kings Heath: My Lords, I shall respond to the noble Lord on that issue. In relation to the training of doctors in this country, we have made it clear to the medical schools that we wish them to ensure that all medical students well understand the needs of a multi-cultural society.
Lord Merrivale: My Lords, I thank the Minister for that reply. Will he confirm that the directly employed labour force of 68, previously employed by Balfour Beatty, will be retained as a unit for the duration of the contract, as mentioned to me last Monday by the managing director of Hyder, Mr. Frederick Psyk? Will he also give an assurance that there is no question of employing casual temporary labour from across the border, to the detriment of local sub-contractors and workers, again as was said to me by the managing director of Hyder?
Lord Gilbert: My Lords, my figures are slightly different from the noble Lord's. I understood that 87 employees were involved, not 68. However, maybe the figure is 68. Yes, the noble Lord is right. The company is taking the entire number, and I can assure the noble Lord that they will be there for the full term of the contract. As regards bringing in workers from across the border, given what the Spanish authorities have done at the border, I should have thought that it would be rather difficult for them to get through at present.
Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply. However, it seems to be in conflict with reports that I have read in the press. Is he aware of the degree of anxiety that is being caused to parents who are able to continue in employment only because of the present au pair system? If there is to be a change from the "reasonable allowance" provided for under Part 4, Section 88 of the Home Office Immigration Rules to the Department of Trade and Industry's national minimum wage, the cost of an au pair will almost double. It will be from £70 to £95 per
Lord Williams of Mostyn: My Lords, I do not think that there is a fundamental change. For well over 20 years now, by virtue of the Employment Agencies Act 1973, employment is explicitly defined to include situations involving the engagement of au pairs by families. So the concept of employment is not new. An au pair should not work for more than five hours a day, with two days off. The national minimum wage proposals provide for a payment of £3 for the younger segment of au pairs and £3.60 for those aged over 22. As regards taxable benefits, I shall certainly transmit the noble Baroness's suggestion to my right honourable friend the Chancellor of the Exchequer--with what hope of success I cannot guess.
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