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House of Lords

Wednesday, 20th October 1999.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Lichfield.

Baroness Ashton of Upholland

Catherine Margaret Ashton, having been created Baroness Aston of Upholland, of St. Albans in the County of Hertfordshire, for life--Was, in her robes, introduced between the Lord Levy and the Baroness Thornton.

Baroness McIntosh of Hudnall

Genista Mary McIntosh, having been created Baroness McIntosh of Hudnall, of Hampstead in the London Borough of Camden, for life--Was, in her robes, introduced between the Baroness Blackstone and the Lord Puttnam.

The Earl of Guilford --Sat first in Parliament after the death of his father.

Viscount Kemsley --Sat first in Parliament after the death of his kinsman.

Lord Ebury --Took the Oath.

NATO and the UN

2.50 p.m.

Lord Jenkins of Putney asked Her Majesty's Government:

    In the event of a difference of view between NATO, the Security Council and the General Assembly of the United Nations, which body is the supreme authority, and on what basis Her Majesty's Government would make a decision as to military action.

The Parliamentary Under-Secretary of State, Foreign and Commonwealth Office (Baroness Scotland of Asthal): My Lords, NATO and the United Nations are not competing organisations; nor are they part of an international hierarchy. Within the United Nations, the Security Council has primary responsibility for the maintenance of international peace and security, and resolutions of the council, taken under Chapter 7 of the United Nations Charter, can have legally binding effect. Any decision to take military action will be based on an objective assessment of the factual circumstances at the time.

Lord Jenkins of Putney: My Lords, I thank my noble friend for that Answer. Does she agree that in recent experience there has been some confusion on that

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point? One wonders whether the question of where the particular responsibilities lie should not be more closely defined. Does my noble friend agree that a result of that confusion was that NATO took a leading role in the recent intervention in Yugoslavia, which will increasingly be perceived as mistaken, and ultimately shameful?

Baroness Scotland of Asthal: My Lords, I cannot agree with my noble friend. It has been said in this House on a number of occasions that all it takes for evil to prevail is for good men and women to remain silent. Her Majesty's Government were not silent; neither were the 18 democratic countries which joined with us to address the tragedy happening in Kosovo.

Lord Moynihan: My Lords, I appreciate that this is not an easy question to answer, so I have given the Minister notice of it. During our debate on Friday, the Minister told the House that,

    “The old ways of settling conflicts without resolving the underlying causes are no longer tenable".--[Official Report, 15/10/99; col. 731.]

She also spoke of the need for a new model to settle conflicts in our increasingly interdependent world. Will she take the opportunity today to define the Government's vision for that new model in the specific context of the authority of NATO, the UN Security Council and the UN General Assembly?

Baroness Scotland of Asthal: My Lords, as I said on Friday, the world is faced with a new challenge: with intra-state conflict more than inter-state conflict. To that end, there is now a vigorous debate at the UN to try to decide how best to address that issue in terms of humanitarian intervention. I can give the noble Lord only a very general answer, but I shall be happy to write to him more specifically if and when there are greater details than I am able to reveal now.

Lord Bruce of Donington: My Lords, with all those considerations in mind, can the Government give the House an assurance that the position of the United Kingdom in the Security Council will remain undisturbed?

Baroness Scotland of Asthal: My Lords, I can.

Mental Health Care: GP Training

2.53 p.m.

Lord Laming asked Her Majesty's Government:

    Whether they have any plans to improve the training of general practitioners in response to the growing number of patients with mental health problems who consult them.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, appropriate training is currently available for all general practitioners to help them meet the mental health needs of their patients. In addition, we are

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introducing a modernised system of GP training early next year which will ensure that all trainee general practitioners receive an educational needs assessment at the beginning of their general practice training. That will ensure that a range of appropriate experiences will be on offer.

Lord Laming: My Lords, I am grateful to the Minister for that helpful reply. Perhaps I may take this opportunity to congratulate my noble friend most warmly on his appointment as Minister. I feel sure that all Members of your Lordships' House will feel that this promotion is well-deserved, and we wish him well.

Does the Minister agree that the vast majority of people who experience mental health problems are now cared for by the primary care teams? Is he aware of the recently published survey initiated by the Mental After Care Association which indicates that GPs spend as much as 30 per cent of their time on mental health problems, and yet many of them feel ill-equipped to deal with that work, especially when it is complicated by a greater misuse of drugs?

Lord Hunt of Kings Heath: My Lords, I thank the noble Lord for his warm welcome. Of course, he is right. Most mental health problems are dealt with by primary care: by GPs, by other support staff and by community psychiatric nurses. I believe that the survey which he mentioned is important and it is one that we are considering very carefully. However, I am satisfied that the appropriate arrangements are in place to ensure the training of GPs to undertake this role, both at undergraduate level in training to be a GP and in the crucially important area of continuing professional development once they have become GPs.

Lord Clement-Jones: My Lords, I join the noble Lord, Lord Laming, in congratulating the Minister on his appointment. The noble Lord, Lord Laming, mentioned the survey of the Mental After Care Association which did, indeed, raise some worrying issues about the training of GPs. In the light of that survey, have the Minister and his department made an assessment of the implications of Professor Graham Thorneycroft's national service framework proposal? In particular, have they considered what further resources in terms of training and recruitment will be required? Will the £700 million over three years promised by the Government be adequate? In addition, will sufficient community psychiatric nurses be available in the light of the current major shortages? Do the Government have accurate figures in that respect?

Lord Hunt of Kings Heath: My Lords, again I thank the noble Lord. We are not aware of any particular problems in relation to community psychiatric nurses. However, a survey is being undertaken at the moment and we hope to have the interim results by March 2000. I believe that it is worth making the point that community psychiatric nurses play a very important leadership role. It is an attractive role which is very

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helpful in relation to future recruitment. I am glad that the noble Lord mentioned the £700 million extra resources which we are putting into the health service over the next three years for mental health services. That will undoubtedly help to underpin the development of a national service framework, which in itself will underpin the integration of both primary and specialist services.

Lord Rea: My Lords, as a former general practitioner, I congratulate the noble Lord, Lord Laming, on the relevance of his Question. It is not only a question of knowledge per se but of attitude. Like many of us, some doctors find emotional problems difficult to handle as well as extremely time-consuming. Therefore, is not a team approach, as was mentioned earlier, the most suitable way to handle such problems? A general practitioner should be able accurately to spot a problem and then refer the patient to another member of the team, such as might be done, for example, in a primary care group. Is my noble friend aware of the very good work that is being done by the Royal College of General Practitioners' primary care mental health education unit and also in conjunction with the Royal College of Psychiatrists?

Lord Hunt of Kings Heath: My Lords, first, I agree with my noble friend that the Royal College of General Practitioners has done sterling work over 40 years in helping to drive up the quality of primary care services and particularly the work of general practitioners. Of course, some people who have mental health problems present major challenges to GPs. It is important that we have the right structure to enable the service to deal with those effectively. That is what the national service framework is about. It recognises the pivotal role of primary care and that GPs and support workers, whom my noble friend mentioned, have a major role to play. But it also develops protocols for the effective referral of people with severe mental health problems to specialist services, and it enables specialist services to provide support and advice to general practitioners in their general work.

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