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Lord Hunt of King Heath: My Lords, we should be very cautious about accepting the figure of 80 at its face value. I can certainly assure the noble Baroness that the criteria being developed as a result of the work of the three Royal Colleges will be used by the NHS to help towards assessing the future provision of services. I can well understand the popularity of midwife-led units; indeed, as far as concerns low-risk births, there is no evidence to show that such units are unsafe.
Lord Clement-Jones: My Lords, it may be that as many as 80 smaller units are involved if press reports regarding the report of the Royal Colleges are to be believed. Is it not quite unacceptable that many of these units face closure due to lack of medical specialists when many young "obs" and "gynae" registrars in training cannot get consultant jobs because such posts have not been created? Is it not high time that the Department of Health got to grips with the problem?
Lord Hunt of Kings Heath: My Lords, as far as concerns obstetric and gynaecological consultants, I can tell the noble Lord that Ministers met with the president of the Royal College only last week. He put forward some very interesting suggestions as to how we should move forward in tackling the issue. We shall consider his suggestions most carefully in addition to the other matters that we have taken forward for consideration in relation to the problem of "obs" and "gynae" posts.
Again, I urge caution on the noble Lord as regards the figure of 80 units. The report that we received from the Royal Colleges does not make any recommendation in relation to the closure of units. However, the colleges have provided very helpful criteria under which the NHS can make proper decisions about the future configuration of maternity services.
Baroness Goudie: My Lords, today is the start of Breast-Feeding Awareness Week. Will the Minister confirm that the Government will ensure that all maternity units encourage the benefits of breast-feeding for the baby and the mother?
Lord Hunt of Kings Heath: My Lords, I would be happy to do so. Breast-Feeding Awareness Week has been run for a number of years. I believe that it has proved to be successful. We certainly continue our support for it. I believe that the campaign launched this week will be highly effective in encouraging those
Lord Hunt of Kings Heath: My Lords, as my wife gave birth to two children at home I very much agree with what the noble Baroness says. The latest figures I have show that throughout the 1980s home deliveries accounted for 1 per cent of the total number of births. That proportion has slowly risen. In 1994-95, 1.8 per cent of total births were home births. I very much accept that the NHS should do its best to meet the legitimate wishes of women who wish to have a home birth.
Lord Redesdale: My Lords, I must declare an interest as my wife expects to be using the maternity service in the next week and a half. Is the Minister aware that maternity services in London are under severe strain through lack of staff? This is apparent to those who are about to use the service.
Lord Hunt of Kings Heath: My Lords, the Government are committed to developing policies and practices to encourage more nurses and midwives to enter the NHS. The campaigns that we have run have been successful. We have attracted more nurses and more midwives. We have increased the number of training places available. I believe that those measures, along with the other work in developing maternity services, will ensure that the noble Lord and others receive the best possible service.
The Parliamentary Under-Secretary of State, Home Office (Lord Bassam of Brighton): My Lords, as I said to the noble Lord on 10th April we believe that prison can be a positive experience and our aim, and that of the Prison Service, is to make it work. Although Home Office Research Study No. 187 provides evidence that community-based programmes generally show better results in reducing offending, programmes which take account of "what works" principles can be successful in reducing offending in any treatment setting. There is considerable evidence that programmes in prison can be effective, as can the provision of constructive
Lord Bassam of Brighton: My Lords, I am sure that there are many reasons for increases in crime across the United Kingdom. However, this Government's commitment and determination to tackle all of those issues remain unaltered. We shall continue to press through and put in place effective crime reduction programmes. There is little doubt that crime reduction programmes will in the longer term have a most profound effect and impact on levels of crime.
Lord Ackner: My Lords, does the Minister agree with the oft repeated statement that prison is frequently an expensive means of making bad people worse? Does he accept that Parliament has accepted that proposition in legislation; namely, the Criminal Justice Act 1991, which makes prison the sentence of last resort?
Lord Bassam of Brighton: My Lords, prison may well be a sentence of last resort, but it is an effective and necessary sentence. I would like the noble and learned Lord and others to say what is the alternative for those who are convicted of offences, particularly serious offences. Prison constitutes an expensive provision, but it is necessary.
Lord Janner of Braunstone: My Lords, does my noble friend accept that, where possible, punishment in the community is preferable to punishment in prison for all kinds of reasons? Has he been able to assess, as yet, the effect of the probation programmes which are run according to the "what works" principles, and which he has said can be successful? But are they? What is the national programme to extend probation practice according to that principle?
Lord Bassam of Brighton: My Lords, we believe that "what works" is an effective programme. Research evidence shows that properly conducted offender treatment programmes can have a significant impact on reconviction rates, whether those programmes are conducted in prison or in the community. The research literature reveals a broad consensus of about a 10 per cent typical reduction in reconviction rates, compared with those offenders who do not attend the programmes. The "what works" initiative that we are introducing provides better planned, targeted and delivered programmes to bring down overall conviction rates. These programmes are based on methods known to stand the best chance of reducing reoffending. It is our intention to start introducing the first of these programmes later this month.
Lord Elton: My Lords, given that the average cost of a custodial sentence is £2,070 a month, according to government figures, will the Government spend a small percentage of the extra money that is necessary to ensure that the majority of prison sentences have the chance of proving to be the positive experience which the noble Lord tells us they are in terms of education, out of cell time and constructive work? Any money that is left over could be best spent in stopping people becoming criminals altogether.
Lord Bassam of Brighton: My Lords, I entirely agree with the final point that the noble Lord made. He speaks with great wisdom on the subject. This Government's programme is all about improving the purposive nature of people's time spent in custodial sentences. Between 1997 and 1999 we have managed to add an extra 20,000 teaching hours across the prison estate. That is part of our general programme. We must invest in education and training as we can demonstrate a clear and proven track record that that has the best effect in terms of what happens to prisoners when they leave prison and try to access the world of work. We must continue that work and put more money into crime reduction in the community. Those are the important points of our programme.
Lord Avebury: My Lords, does the Minister think that short custodial sentences are a positive experience for graffiti artists, or does he consider on the contrary that it would be better to give those people community service to enable them to remove the graffiti which has been daubed on walls by other people?
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