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When debating the Address last year, I reminded the Minister of the general concern about dental corporate bodies, which some dentists saw as a threat to their practices. It may well be that they just provide another way for patients to access services. But I feel that the restrictive practice which prevents other practitioners working together to set up similar environments is probably contrary to European restrictive practice law. In his letter to me, which was much appreciated, following the debate the Minister agreed with my views on corporate bodies and said that the necessary order would be laid once it was possible to amend the Dentists Act following the regulatory reform Bill. Can he confirm that this change is still on track?
I should like to take this opportunity to ask the Minister, or perhaps the Chief Dental Officer, why dental practitioners are prevented by law from prescribing medicines for patients by telephone. During my practising life, I have regularly prescribed simple analgesics or antibiotics direct to pharmacists so that the patients could avoid a journey to the surgery. Unlike the service provided for medical practitioners, I am aware that pharmacists are not obliged to accept telephoned or faxed prescriptions from dental practitioners. In the past most pharmacists have turned a blind eye and helped, but recently dentists have had many more problems prescribing in that way. I had to waste time recently speaking to five pharmacists in Sunbury before I could find one who would provide a simple antibiotic for a patient and save him the journey into central London. It is time that dentists were allowed to prescribe in a similar manner to their medical colleagues and I should be grateful if this simple measure could be incorporated into some appropriate legislation in the near future.
Any speech of mine on health would not be complete without a reference to funding. I stress yet again that the assumption that greater availability of medical services, more hospitals and clinics, doctors, nurses and health-related personnel and the development of a wider range of drugs and surgical techniques will lead to an improvement in health, increased longevity or an eradication of disease is ill founded. A better health service is not all about money. Health promotion is about the maintenance of good physical and mental health. It has very little to do with medicine and disease management and everything to do with how people live and their social and psychological environments.
In our debate at the end of March on the Select Committee report on complementary and alternative medicine, we thanked the Government for their acceptance of virtually all the recommendations. The Minister announced that he would be asking the National Health Service Research and Development Workforce Capacity Implementation Group to consider research capacity for development needs in complementary and alternative medicine and how they might be met. He also said that the exact amount of funding that may become available depended on the outcome of discussions with those who can take forward such matters. It would be helpful to have some indication of whether those discussions have taken place and whether any decision has been taken on the written strategies from the organisations that suggested ways forward for research.
The concept of integrated medicine, with complementary therapies working hand in hand with routine medicine, is the way forward. I hope that the Government will remain committed to their response. They said:
Baroness Masham of Ilton: My Lords, I add my congratulations to the Minister on his maiden speech. I also congratulate the noble Lord, Lord Hunt of Kings Heath, on retaining his ministerial position. Those in another place do not always realise how hard some Ministers in your Lordships' House work. I thought that the noble Lord might have moved up the health ladder after his hard work.
I welcome the Government's commitment in the gracious Speech to making health one of their main priorities in this Session. Some form of health crisis can affect many people in many different ways, often when they least expect it. I am told that one of the Prime Minister's favourite sayings is, "What counts is what works". The gracious Speech states:
Surely there must be a balance. If the Government decentralise too much, there will be cover-ups and national standards will fall. The biggest waste of National Health Service money, which is taxpayers' money, is on large compensation payments in negligence claims. The human heartbreak in many such cases is even more important. Recently we heard of a man who died in agony with a tumour on his tonsil. The last doctor who saw him told him that he had flu. The country has lost a lot of confidence in a profession that was trusted and is vital for the wellbeing of the UK and beyond. Correct diagnosis is all-important. We must have protection for patients over cases such as Shipman. No doubt many shortcomings will emerge from that case.
We need well trained, dedicated doctors. Why is there a blockage in the training and registration of some doctors who come from abroad and want to train to be surgeons? We need up and coming, first-class surgeons with the right skills to tackle the ever-growing needs of the health service. I know personally of two such young doctors who come from South Africa. They have perfect English. How many more must there be? I shall not let the matter rest. The Government say that we need more doctors, yet there is a blockage. Surely the situation should be unblocked. I can send the Minister the names of those two doctors and the hospitals where they are working.
I am also told that nurses coming from such countries as New Zealand and Australia face long waits for their UK registration. Our hospitals and home care situations are crying out for them, but they have to wait. The Prime Minister wants to know what works; speeding up the process of registration will work. Perhaps the Minister can do something to oil the wheels of progress.
I am the founder and president of the Spinal Injuries Association. The association is most concerned when its members who have sustained injury to the spinal cord resulting in paralysis through trauma or illness, with loss of feeling and movement, do not get treatment in a spinal unit. I shall give an example of how important that is. A young man in his 20s broke his neck in a diving accident in Venezuela last year. Because there was no bed at the national spinal unit at Stoke Mandeville hospital for various reasons, he had to be admitted to Charing Cross general hospital, where he had a disastrous time and developed a serious pressure sore. Nobody evacuated his bowels, which is the procedure for paralysed patients. He caught MRSA from having a tracheostomy and was nearly injected in his neck rather than in his leg due to a language difficulty with a member of staff. He eventually went to the spinal unit at Stoke Mandeville, but, due to the pressure sore and MRSA, his rehabilitation has been held up and he has had to spend months in isolation.
That is why we need national standards. The Government should not shelve their responsibilities. They must ensure that patients who need it get the correct treatment whatever the conditions and wherever they live.
The gracious Speech says that there will be more patient participation in the National Health Service. That is welcome, but it will not work unless there is a clear, friendly, efficient point of contact. There must not be fragmentation. People who need help and others who are able to give advice need an efficient means of contact and a forum to be heard. CHCs have been good in some districts and ineffectual in others. Whatever we have in the future must be better. I hope that the Government will realise that voluntary organisations collect a great deal of information and represent many different groups that need to be taken into consideration. They need help and support.
The Royal National Institute for Deaf People says that there is a pressing need for an early, unequivocal commitment to and timetable for the national roll-out of the first wave of the modernising NHS hearing aid services project. Audiology services in the UK are facing a cash crisis that threatens to undermine recent embryonic improvements before they bear fruit. NHS audiology services are facing increasing demand from an ageing population, yet they are chronically under-resourced. Audiology services are being pushed to crisis point. Current funding is inadequate to keep up with basic demand. Many vital services for disabled people have been fragmented by contracting out. The wheelchair service is an example of that. Users of the health service need and appreciate a good, efficient service.
I hope that the Government will act on the recent damning report of the Audit Commission. With our excellent British engineering, we should be able to do much better so far as concerns disability. Perhaps the noble Lord, Lord Rooker, will agree on that point. This matter is important for the quality of life of individual people with disabilities and their helpers.
The health of the people is vital. With outbreaks of TB and food poisoning and dangerous hospital infections, I hope that the Government will keep infection control high on the agenda. With more power being given to local health staff, there is a danger that it may become fragmented. Can the Minister give an assurance that infection control will not be submerged at local competition level? It is far too important an issue to be neglected. There need to be adequate infection control personnel in hospitals and in the community. There should be a clear code of practice; the matter should not simply be left to individual trusts.
This debate embraces health and home affairs. It gives me the opportunity to bring to your Lordships some of the devastating problems facing many rural communities. Foot and mouth disease has caused many problems which will have far-reaching effects on the health of individuals and communities. There is isolation, heartbreak, anger, sadness,
Ill and disabled people, for fear of spreading the virus, have done without district nurses visiting them. Children and families have been traumatised by losing their animals. The endless worry continues as the virus still keeps appearing. The way in which some animals have been killed has appalled many people--both farmers and the public. There is a feeling of helplessness, and many people in badly hit areas or nearby feel that they are living in limbo. There is concern about toxic results from the disposal of millions of animals. I hope that the Department of Health will realise that there are health matters which need to be understood.
Sheep were being rounded up to be killed on the moor next to where I live. The son-in-law, aged 40, was helping the owner. He suddenly dropped down dead. That is just one of the many tragedies connected with this scourge. Foot and mouth brings a terrible added pressure on the countryside. Many people in tourism and farming are stretched to breaking point. The lack of knowledge about how the virus is spread is also an on-going worry. Can the virus live in a person's nose, as does MRSA? Perhaps the Minister will write to me about that. Is it not time that vaccination was tried out on controlled groups instead of relying on the horrific killing of valuable breeding stock?
As did the noble Lord, Lord Rea, this week I attended a conference hosted by the Foreign and Commonwealth Office on the global problem of drug abuse. The world-wide problem of illegal drugs increases crime and the human suffering of families. Alcohol also continues to disrupt many people's lives, including those of young children. We heard of the huge problem of the smuggling of alcohol by boot-legging and of children as young as seven and eight drinking alcohol. On Monday, I heard of a new swizzle-stick which detects drinks which have been spiked with drugs. That could be a useful piece of detection equipment for clubs and bars.
There are so many young people in our young offender institutions. I hope that those young people will not be locked up for hours but will be given education and work to help them to get back into a useful routine for life outside.
It is frightening when society gets out of control. When one considers the recent disorder that took place at international cricket matches, is it not time that clear guidelines were given to the police? People who attended those recent matches said that the police did not seem to act when fire crackers were used and flying objects were let off and thrown on to the pitches. It appears wrong that families cannot feel safe and enjoy a day out together.
My husband attended the match at Headingley, Leeds. When I heard on the radio of the uncontrolled rushing on to the pitch, I was concerned. I would support making matches safe by controlling the people and by cutting alcohol consumption and the use of
Baroness Carnegy of Lour: My Lords, the noble Baroness has ranged far and wide over the subject matter of this debate. When I first noticed the twinning of the two subjects of home affairs and the health service in one debate, I considered it to be a very bad idea. That was until I heard the deeply thoughtful speeches of my noble friend Lord Forsyth and the noble Baroness, Lady Kennedy of The Shaws. Then I realised that the whole debate concerns human rights. I am sorry that the noble Baroness, Lady Kennedy, is no longer in her place because I wanted to pay tribute to her.
We are talking about human rights in relation to a better health service and justice. Both issues could not be more important. During the election campaign and since, discussion on the future of the National Health Service has centred, albeit somewhat vaguely, on the advantages that private sector ways and private sector money may or may not have for the NHS. Doubtless, once we study the Government's precise proposals on this matter, our thinking will focus more sharply. Indeed, we may move on to thinking in the direction indicated by my noble friend Lord Forsyth.
In the meantime, I want to suggest one thing to the Government. I believe that one single, simple lesson must now be learned from the private sector. If the National Health Service is ever to recover from its increasingly parlous state--a state which, as the noble Baroness, Lady Masham, illustrated, is causing a great deal of suffering, often to the weakest people--a sea change must come about so that the NHS can move, as the Government rightly wish, to providing the best healthcare in Europe.
Sometimes the blindingly obvious has to be restated, and I hope that I shall not be accused of being over-simplistic. But I believe that a sizeable number of your Lordships who have had responsibility for attempting to improve the effectiveness of public services--whether as central government Ministers or as local government councillors, as I myself was when I was in charge of a local education service, or, indeed, as civil servants or local government officers--know the type of special problems that arise in running a public service effectively and cost-effectively. Noble Lords who have also been involved in the private sector or in running a private sector business, large or small--my own was simply a farm--will know all too well the principal difference between the two experiences.
Clearly in both the public and private sectors a business has the same five requirements. It has to have agreed objectives that are known to everyone concerned, the right staff, a suitable management structure, and financial and material resources.
In the private sector, such matters are settled within the business. Shareholder interests are a consideration for some. Workforce and trade union negotiation is needed, and internal management opinions need to be
In the public sector--the National Health Service is an outstanding example--however much is theoretically devolved downwards and however much the customer is supposed to be taken into account and protected, it is in effect an elected politician who takes such decisions. Through legislation, funding deals or so-called "guidelines" politicians set the objectives, decide which staff can be afforded and how training establishments will be funded. Politicians decide on the structures and allocate resources according to their perception of needs. Of course, we all know how politicians behave--for one thing, they keep changing their minds. As someone wrote the other day,
It may be obvious but we should remind ourselves of the important fact that even when the public sector sincerely tries to devolve downwards, as the Government did in previous legislation when the so-called system of "earned autonomy" was invented under which NHS bodies that do well will be allowed to take more of their own decisions, it is still the Secretary of State who decides the criteria for doing well. His or her ambivalence about where the customer comes in and when public relations must take precedence are important in that regard. For the Secretary of State it is not only patients who form public opinion, but the unions, the Royal Colleges and the BMA, and it is sometimes puzzling for a Secretary of State to know which matters most.
There is an important difference between the private and public sectors--the public sector of necessity has a politician in charge, who has his own priorities. The private sector can make its own decisions and its priority has to be the customer. That almost always works better. The Government have to learn that lesson and explain it clearly to the public. I do not believe that most members of the public see the difference as clearly as noble Lords do.
It is important to remove the local units--I suppose that they are the trusts--within which we manage healthcare. We should so far as possible isolate them from politics and leave them to take their own decisions; that is what is done in the private sector. My noble friend Lord Forsyth discussed that in a
The system will have to ensure in some way that the money that is available follows the patient and that the patient has an element of choice. Unless that is done the value of treating patients will not be apparent to those providing that treatment and the right motivation will not be there. An appropriate element is present in the private sector but not in the public sector. I do not know how that should be done, but it is not my job to tell the Government how to do so. It will not be easy and it will take much courage, but the Government have the strength of their enormous parliamentary majority. They believe that the private sector has lessons to teach. Unless that fundamental sea change is brought about soon, no amount of extra money or ingenious mechanisms for funding or management will work.
Baroness Northover: My Lords, the gracious Speech is short and perhaps to the point on health. The Government would, it seems, decentralise power and direct resources to NHS staff, give patients a greater influence in the running of the NHS and strengthen regulation of the health professions. But what does that actually mean? I am afraid that the phrase that immediately leapt to mind when I heard that commitment was "double-speak". Could it be that George Orwell's dictums, "War is peace" and "Freedom is slavery" might apply in this context?
The Government wish to decentralise power. Or do they? Have they suddenly had a change of heart? They want to put more power in the hands of NHS staff. Well, that makes a change. They have not done so up to now.
They wish to put more power in the hands of the patient. Or do they? Do they now regret trying to abolish community health councils and replacing them with some odd mishmash? I take it that we will now have the one-stop shops that are best suited to patients. Or will we? We await the legislation with interest.
What of the third provision, which was about increased regulation of the health professions? We certainly support measures that would ensure that health professionals are trained and work to the highest standards. There have indeed been cases in which that was clearly not so, and it has been exceedingly difficult to ensure that those closest in are dealing appropriately with lapses. The attitude of "There but for the grace of God go I" too often paralyses those who should be taking action. However, more regulation simply does not go to the heart of the problem. The NHS is too often at breaking point because it has too few staff and morale plummets under too much pressure.
We know from the largest ever survey of NHS staff--it was of 80,000 people--that the state of mind of those in the NHS is best summed up by the phrase, "Stressed out and over-worked". My colleague in another place, Paul Burstow, analysed the figures. Perhaps the Department of Health could not bring itself to do so. I have previously quoted the figures but they merit repetition in this context because of their importance. They are that 52 per cent of staff in the eastern region said there were insufficient resources to do the job properly, that 60 per cent of staff in the northern and Yorkshire region said that morale was not good and that 77 per cent of staff in the north-west region said that they were not coping with their workload. Why is that? Constant reorganisations--I see that more are coming down the track--long hours, low pay, long waiting lists and the number of dissatisfied patients are contributory factors. But the key factor, time and again, is simply lack of staff. If, as the Conservatives did, you cut training places for doctors and nurses, how can you be surprised at that outcome? The number of nurses recruited fell from 37,000 in 1983 to only 6,000 in 1995. We are paying the price for that now. So where does the gracious Speech address staff shortages and morale? I cannot see.
What else does it omit? There is no reference to mental health reform, even though that was apparently regarded by the Government as badly needed. Wide consultation has already taken place on that issue.
What of PFI? What an indictment of planning within the NHS that that is the only way in which large projects seem to be able to be taken forward, with future generations picking up the tab. What is intended in that regard?
I turn now to what, for me, is the most astonishing omission from the gracious Speech; that is, that there is no Bill to ban tobacco advertising and promotion. Why not? I agree wholeheartedly with what the noble Lord, Lord Rea, said on that matter. If you cast your eye over history, it is public health measures which have made the real difference in lengthening lives and improving the quality of life. In 19th century Britain, it was sanitary reform that made the difference.
Professor Sir Richard Peto, of the Imperial Cancer Research Fund, speaking to the third global conference for cancer organisations yesterday stated that 1 billion people world-wide are likely to die this
So what on earth did the Government's cancer czar, Professor Mike Richards, and his group of expert advisers have to say when that Bill, delayed in the last Parliament, was omitted from the gracious Speech? I hope that they made their feelings extremely plain.
We hear rumours that the Department of Health is not happy that that Bill is not before us today. Indeed, I trust that it is very unhappy and that what it has heard in this debate will strengthen in arm in whatever negotiations it is carrying on with whoever is resisting it, and that that Bill will be brought back to us without delay.
So what do we make of this gracious Speech? What is most notable in relation to health is what is missing or what is expressed in a somewhat surprising fashion. We expect swift action in those areas so far omitted, particularly as regards tobacco advertising. Meanwhile, we are surprised and delighted that the Government are committed to a devolved, decentralised health service in which patients have more power. We look forward with the keenest of interest to see in reality the rapid about-turn that the Government must perform in order to achieve that.
Lord Mackenzie of Framwellgate: My Lords, I start by joining in the congratulations to the noble Lord, Lord Rooker, on his appointment to the Front Bench speaking on Home Office matters. I read a survey recently which stated that people's biggest fear was the fear of speaking in public. People's second biggest fear is the fear of dying. I am told that there is a third fear; that is, the fear of dying while speaking in public! I know that your Lordships will not allow that to happen to me this evening.
I am delighted to welcome the provisions of the gracious Speech. We hear a great deal in this place about the welfare of prisoners and prison reform. I respect those noble Lords who represent that particular lobby. It is a fine position from which to be coming from a humanitarian point of view,
I start with the proposal to abolish the double jeopardy rule. In 1997, as president of the Superintendents' Association of England and Wales, I addressed the national conference which was to welcome for the first time the new Home Secretary, the right honourable Jack Straw. In my speech in 1997, I called for the abolition of the archaic double jeopardy rule. We had been through a period in which a number of wrongful convictions had been identified for various reasons. Those miscarriages, quite rightly, had been corrected.
I recalled many years previously, long before I was a police officer, the case of a man called Stanley Setty who had been murdered. His dismembered body parts had been thrown from an aircraft into the North Sea. I recall graphically the trial of one Donald Hume for that grotesque murder. He was eventually acquitted.
As a young student of the criminal law at that time, I remember my horror at reading for the first time the gruesome details of the murder by none other than the self- confessed murderer himself, Donald Hume. He wrote his story in a Sunday tabloid--I think it was the Sunday Pictorial, and that shows how long ago it was--detailing the murder, how he chopped up the body and distributed the body parts from a light aircraft. I have little doubt that he earned quite a fat fee for his memoirs.
I was even more disturbed when I realised that for all his admissions, he could not be prosecuted because of that ancient common-law doctrine of autrefois acquit which, in essence, meant that an accused could not be put in jeopardy twice for the same offence. It was a rule which was created in ancient times when the odds were stacked against the criminal. For example, in those days, the accused could not even give evidence in his own defence. It seemed to my simple mind at that time that the interests of justice would be served by accepting the principle that a wrongful acquittal was just as much a miscarriage of justice as a wrongful conviction. Times change, and it seemed to me that with modern forensic evidence and other legal safeguards, the time had come for a change. Justice should reflect the public interest.
There have been more recent cases. In the North East, for example, a man was charged with the murder of his girlfriend, whose body was subsequently found by her mother hidden behind the bath. The man was acquitted and following an indiscreet admission of guilt when in prison, he was subsequently charged with giving false evidence at his own trial. He was sentenced
We have to look no further than at the case of Stephen Lawrence to see that, as the law stands at present, an unwise private prosecution, followed by an acquittal, completely prevents a retrial of those against whom there may be a prima facie case of murder.
In 1997 my plea fell on deaf ears at the Home Office, but I am delighted that those at the Home Office have now seen the light. I hope that the provisions are retrospective so that past miscarriages of justice can be corrected. Justice demands nothing less.
Reform of the police is equally important. In the press there has been much discussion about the police service. Having been in it for 35 years I have some little knowledge of its culture and the way in which things are done. In 1997, for example, medical retirements in the Merseyside Constabulary were running at about 77 per cent, whereas in Kent the figure was 16 per cent. That cannot be right and must have something to do with the way in which sickness is managed in police forces. If some medical retirements are bogus, as is suggested, what about the doctors who are signing the medical certificates? However, do not throw out the baby with the bath water; let us not condemn the many for the actions of the few. Policing is a demanding and dangerous job and we must be sympathetic to those officers who are invalided out of the service in the line of duty.
Exemplary leadership in the police service is extremely important. Those at the top of the profession must practise what they preach. Often we do not require improved management, but improved leadership.
The police force also has people like Detective Superintendent Ray Mallon of Cleveland who has been suspended for three and a half years, originally on serious allegations, resulting in operation Lancet being set up. He has since been cleared of all criminal allegations, but he remains suspended pending disciplinary matters. It would have been the easiest thing in the world for Mr Mallon to walk away from the accusations, suffering perhaps from stress, and taking an enhanced medical pension, rather than face his accusers. He chose not to do that, which shows the difficulty of the situation. Ray Mallon is a prisoner of the police complaints system. In my view, he is a credit to the police service.
Such a case emphasises the need to reform and improve the police complaints system. It is a scandal that a senior officer, of high integrity, is suspended for four years on what now amounts to internal disciplinary matters. It follows that I am delighted that the complaints system will be made more accessible, more open and will not, I hope, allow the disgrace of innocent officers remaining suspended for such a long period. The police too are entitled to justice.
The public are entitled to a reasonable quality of life. Only today in an Underground station at Hyde Park Corner I had difficulty walking past two settees which were clearly the beds of two poor individuals who presumably slept there at night. In 2001 that is simply unacceptable. That is a social problem that needs dealing with. I despair. In this new century I believe that the police and social services should take action to deal with such difficulties. There must be better ways of dealing with people than allowing them to sleep in such places. Tourists were falling over them. It was quite disgraceful.
The Lord Bishop of St Albans: My Lords, I thank the noble Lord, Lord Mackenzie, for his speech. It may be of comfort to him to know that the terrors of speech-making are shared by us all, but medically speaking the time of greatest risk is when a speaker sits down as that is when the blood pressure really rises.
I hope that all that I have said will not be construed as an attack on GPs. My point is the exact opposite. If "partnership", as a concept in medicine, is to have any validity at all it needs time and yet in my experience GPs do not have time. They are now pushed to their absolute limits. Partnership can work as a concept only if there are more GPs--and, yes, I know that more are promised--together with more nurses. But there is a moral question hidden away about whether or not it is right for a relatively wealthy nation to take medical staff from countries which are themselves frequently in desperate need.
Now let me gear the picture up a level. I have spoken so far about GP-patient relationships; they are, essentially, one-to-one. What will happen to the management of medical time if, as I believe is right, power is shifted from Whitehall to the NHS front-line and if that is combined with a political and social emphasis on patient power and on partnership? I venture to suggest that the stress load on management and on medical staff at a local level will be unendurable. We are asking NHS staff to offer more and more time to their patients and we are also asking them to offer more and more time to the efficient running of local services when time is already the factor in desperately short supply.
That kind of impossible demand could lead to serious breakdown in the service because two contradictory messages are being given. The first is, "Give your patients"--and for "patients" read "partners"--more time. The second is, "Give local management of healthcare more time". Meanwhile into the general stream of public discourse slide phrases such as "patient-centred partnership" and when that happens public expectations are raised to extraordinary heights.
Therefore, I suggest that we have some very powerful forces at work in our society. There is peer pressure within medicine to move to a partnership model of patient care; there is raised public expectation of partnership models; and there is a further demand that at a political level partnership must involve the devotion of more time to local management of healthcare delivery.
At the very centre of all these immense pressures are the clinical staff upon whose personal well being the entire system depends. It is a recipe for human and systemic breakdown. I do not need to add to the statistics about staff, so eloquently and forcefully outlined by the noble Baroness, Lady Northover. Those points were well made.
Can Her Majesty's Government assure us that the impossible demands will be carefully monitored? Can they also assure us that the care and well being of NHS staff are genuinely central to the Government's NHS policy? Without that, the anger, scepticism, sadness and despair, which currently exist among NHS staff, will continue to grow and the concept of partnership will be regarded as an idea which is entirely empty of meaning.
Lord Dean of Harptree: My Lords, it is customary for a maiden speaker to be congratulated only by the noble Lord who follows. However, I believe that on this occasion an exception should be made. The noble Lord, Lord Rooker, made a highly effective contribution. He and I served together in another place for many years. We were on opposite sides of the fence of course, but I remember how highly effective he was both in Government and in Opposition. Therefore, I believe that I can make an exception to the normal rule and congratulate him on his appointment and on coming to this House.
I intend to refer to health, and I am pleased that the noble Lord, Lord Hunt of Kings Heath, is one of the few Ministers still in the same post. We all respect his deep knowledge of the health service and we look forward to his reply at the end of the debate. It is also nice to see my noble friend Lord Howe on the Opposition Front Bench because his knowledge and experience of the health service are equally great.
I want to spend most of my time talking about the public-private partnership which is developing, particularly in relation to the health services. I decided to speak on the subject some weeks ago and had not then realised how topical and controversial it would be. Nor had I realised that on this very day the Prime Minister would be meeting trade union leaders to try to calm their fears about the way in which government policy is moving. I realise that it may be too early for the noble Lord, Lord Hunt, to comment on the Prime Minister's meeting, but I am sure that the House would be interested to hear any comments he can make.
During the years we have seen a steady development of partnerships. It has usually meant that the private sector has increased and the public sector has decreased. However, in some cases finance has remained with the public sector and delivery has passed to the private sector. An early example of the decrease in the public sector was the sale of council houses to sitting tenants at favourable terms. That was introduced many years ago by a Conservative government. It was at that time opposed by the Labour Party and by Labour councils but it proved to be an instant success. One saw the appearance of new front doors on council houses and other improvements being made. Many people who would otherwise be council tenants were able to have a pride in ownership.
We then saw the return of the nationalised industries to the private sector. That began in a modest way with the Conservative government in 1979 and soon became a flood. We found that many of the industries became profitable and began paying taxes rather than being a big drain on taxpayers. Of course there are problems in some areas, the railways being an obvious example, but they might have been in a worse mess had they still been nationalised.
I am delighted that the principle of public-private partnership is being extended to education and health. Those developments are most important and welcome. The principle is right but the details need a great deal
As regards education, it is now recognised that the comprehensive system does not provide the variety and diversity which is required to meet the needs of all children. We welcome the new ways which are being developed in which the private sector and Church bodies can support schools and take over the running of bad schools. We also hear that there will be advanced specialist schools and that firms will be encouraged to sponsor new city academies. That diversity and choice are most welcome and should certainly raise the quality of our education service.
I turn to health services, where I believe the new initiative is most needed, although it is controversial. This matter was referred to by my noble friends Lord Forsyth and Lady Carnegy. When the health service started in the late 1940s it was thought that the cost would become static as soon as the backlog of ill health was dealt with. How wrong those forecasts proved to be. We now know that the demand for resources is insatiable, for which there are two or three obvious reasons. The first is the enormous advances in medical treatment and equipment and, therefore, the requirement for new hospitals and health centres to accommodate them. The second reason is that there are more elderly people in our population. It is a great blessing that people live longer, but inevitably it means more pressure on health and social services. Thirdly, people's demands for higher standards rise all the time.
Inevitably, those three features mean enormously increased pressures on the National Health Service and its staff. Some years ago when I was a governor of BUPA it was always said that the NHS and the private sector should be complementary, not competitive. That was anathema to the Labour government at the time, but the present Government take a different view. I warmly welcome the concordat which has been negotiated between the National Health Service and the private sector which allows the NHS, in appropriate circumstances, to use private hospitals where beds are available. I understand that in various parts of the country there are already good results as a result of this initiative. Waiting times for treatment, which are far more important than waiting lists, are coming down. That still preserves the cardinal principle of the National Health Service that treatment at the point of delivery is free. When someone goes into a private hospital it is the NHS, not the patient, which pays.
We also welcome the private finance initiative whereby private money goes into the building of hospitals. It must be clear by now that we need all health resources, both public and private, working together to improve the quality of services to patients. Of course there will be problems and controversies, but the principle is right and I hope that the Government will pursue it.
Lord Fitt: My Lords, first, I sincerely thank the noble Baroness, Lady Gale, for permitting me to speak at this time, particularly having listened to my noble friend sitting beside me. I have an appointment for a heart scan tomorrow morning. Having listened to my noble friend, I am slightly apprehensive about it. The reason that I take part in the debate is that in London at the beginning of the week of the general election I received a letter from a parent in Belfast who explained that her small daughter was suffering from juvenile arthritis. What she said in the letter really affected me. I jumped on a plane next morning and met the parent. Having spoken to her, I became personally and passionately involved in an issue that had never affected me throughout the whole of my political life.
I found out that there was such a thing as juvenile arthritis which can affect anyone from the age of three right throughout his or her lifetime. The pain and distress that those affected must endure are unbelievable. Since speaking to the mother I have become involved. I rushed out to phone the Minister of Health in the Northern Ireland Parliament who is a member of Sinn Fein. It is well known from the years that I have been in your Lordships' House that politically I do not have anything to do with Sinn Fein. However, I let my misgivings go because I wanted to speak to the Minister about the terrible case about which I had just heard. She was on and off the phone or somewhere else. Perhaps she did not want to speak to me as I am an opponent of her political party. My attitude in this case was determined by humanity, not politics.
I then became more involved and rang a colleague of the Minister to see whether I could arrange a meeting to discuss the particular case. Again, the individual was not available. I returned to Stormont. The Minister was again very busy but I met her private secretary. I explained the case in which I had become so involved.
I contacted the hospital treating the patient. What I found out, and now illustrate, is in total contradiction to every idea of the National Health Service as we know it. It states--I believe that it has been said here as well--that it awaits a report from the National Institute for Clinical Excellence to see the effects of the new drug. There are now two new drugs available in England and the Republic of Ireland: one is Etanercept and the other is Infliximab. These drugs, which produce absolutely no side-effects, have been available in the United States for the past five years. Consultants who are closely involved in the treatment of this terrible condition have confirmed to me that those drugs have absolutely no side-effects. They are quite confident that some time in October or November of this year NICE will conclude that this drug has no serious side-effects.
The reason this drug has not been used in Northern Ireland as in other parts of the United Kingdom is that it is expensive: the cost per year is between £6,000 and £7,000. If one sees as I have the terrible consequences of this disease, that would be a very small price to pay to alleviate the suffering. There are now 75 cases in Musgrave Park. Every day, every hour and every minute they wait for the consultant to say that the drug can be made available to ease pain, but they have been told that nothing can be done until NICE makes its report some time later this year.
Today I received a telephone call from a hospital in Belfast about a female patient whose hands are twisted very badly and who is suffering immense, unbearable pain. She told her doctor that she could bear it no longer and her family would get together to see if they could raise the finance to enable her to have the new drug. The consultant to whom I have spoken says that undoubtedly if this patient is given the drug it will help deal with the complaint.
I heard of another young man aged 21 or 22 who worked with computers. He developed arthritis. He was put on a waiting list and was told that it would be a year before he could receive any treatment. His family went around and collected £6,000 among themselves. The drug was given to the young boy. There was a great improvement. I shall not try to say that it was a miraculous cure, but he is back working now because he received that drug.
The position in Northern Ireland is that there are 75 cases of people suffering cruelly because the Government will not prescribe this drug. The reason the Government will not prescribe the drug is because of its cost. I know that in England its prescription depends on where one lives--postcode medicine. If one lives in a certain place one is permitted to have the drug; if one lives in another postcode one is not.
I understand that in the Republic of Ireland this drug is readily available. Indeed, I have heard that it is written into the Irish constitution that if one is in need of it, one cannot be prevented from having it.
The cost of £7,000 or £8,000 may sound very high, but the drug has dramatic effects. One noble Lord said that the National Health Service in this country was one of the great beacon lights of our democracy. The clinical experts, the local authorities and the health service boards will determine whether the requisite finance will be given in order to give a certain drug to any given patient. The people who know more than the local authorities are the consultants, the doctors and the nurses who tend to these people in hospital: some as in-patients and others as out-patients. I have spoken to them. They have issued documentation which states that they are quite certain that if there is adequate finance they will do everything possible to eradicate this terrible disease.
I am here today to try to alert the Government, and in particular to speak of those 75 people who are lying in hospital beds in Northern Ireland, waiting desperately for the consultant to come and say, "The funding has now been agreed to permit you to have this drug".
I thought that this was a disease that came with age. I did not realise that there was such a thing as juvenile rheumatoid arthritis. I now know. The reason I know is because of devolution. The Minister of Health in Northern Ireland may be working to a budget. She may say that there are other authorities, that the state of Northern Ireland under devolution does not have the wherewithal and the finance to pay for the acquisition of this drug. There is nothing more important in Northern Ireland. There is nothing that should be given more priority than the health of the people who are suffering so dreadfully there.
I hope the Minister will make inquiries as to what is happening in Northern Ireland and whether it needs more funding. This is a British Exchequer grant which is given to Northern Ireland under whatever existing financial formula. It is in effect the British Government, the British Exchequer, which will pay for the implementation of this drug to be given in Northern Ireland. I urge the Minister to impress upon the Northern Ireland executive the necessity of granting financial aid to try and cope with this terrible disease.
The Sinn Fein Minister in Northern Ireland now has the reins of power in her hands. I can imagine that the Sinn Fein party before it was in government would have spoken with the same passion with which I am speaking. But now that it is in government it must see the reality and the extent of the cost. I repeat, something should be done immediately about the 75 people who are in this particular hospital in Belfast.
Lord Harris of High Cross: My Lords, I was very much cheered up at the outset of this afternoon's debate to hear from the engaging maiden speech of the noble Lord, Lord Rooker, that the Government occasionally check out whether earlier Acts of Parliament have had the desired effects. I thought that comparing the unchecked flood of legislation year in year out with the, should I say, "patchy performance" must be a rather disillusioning task, although I would very much like to offer my services in the assessment of some parts of legislation.
I shall take up where my former student at St Andrew's, the noble Lord, Lord Forsyth, left off. His clarity, candour and courage were all that I might have anticipated. I shall try to do justice to the theme, although perhaps at somewhat shorter length.
I personally was very disappointed with the grand debate on the NHS during the election campaign. For me, as I watched the television story unfold, it seemed like a twist on the old story of the emperor who had no clothes with a difference. While the three party leaders invited us constantly to admire the fine raiment of this institution, the nurses, the GPs, the consultants and many patients simultaneously blurted out that in practice much of it is in tatters.
I gave up collecting cuttings, but one single month's supply on the health service included the following headlines: "NHS catastrophe in Kent hospitals", "Ministers try to head off NHS mutiny", "Hospital waiting lists rise", "Hospitals move waiting list goalposts", "Milburn abandons waiting list targets", "Labour at war with BBC over NHS expose", "GPs threaten to quit over workload", "Consultants may split with NHS", and "Nurse's leader condemns third world health service". That is not Tory Party propaganda.
It is not easy, even from the Cross Benches, to launch into a full-hearted denunciation of the concept of the National Health Service. I have long thought that the whole of the argument about it being the envy of the world, although nowhere in the world endeavours to copy it, was a spoof, if not a fraud. Of course, many families and individuals pay heartfelt tribute to the personal debt they owe to the National Health Service. But what has mostly saved lives, cured ills and eased pains is the miracle advances in drug therapy by profit-making multi-national companies, about which we heard from the noble Lord, Lord Fitt, and the developments in diagnostic and surgical practices through competitive innovation by dedicated professionals. The unique contribution of politicians of all parties over the past half century has been to hold back progress by confining investment in the health service to finance that could be raised through taxation, thereby suppressing choice, prolonging illness and even allowing premature deaths.
This harsh verdict is not based on hindsight. As the founding General Director at the Institute of Economic Affairs, I am proud to quote from one of our very earliest Hobart Papers, published in 1961. It was written by a young, physically handicapped,
Instead of arguing their case, the defenders of the NHS have gone on claiming the moral superiority of a system that attaches more importance to services being described as "free" than to the fact that the services are not actually available. That moral smokescreen has for too long paralysed fruitful debate on alternatives to the elephantine, politically mismanaged and manipulated monopoly of the NHS. The growth in the private health sector is itself a measure of the failure of the NHS, since millions elect to pay twice over--once in taxes for the service they do not use and again for insurance out of their taxed income.
The easiest way to dispose of this kind of criticism is to dismiss it as the ravings of a right-wing lackey of capitalism in its advanced stages. That strikes the right intellectual note for some of the participants. But that will no longer do. All of those unpriced expectations are now coming home to roost and for reasons quietly anticipated by some socialists of unquestioned credentials.
I have long treasured a second IEA paper entitled Paying for the Social Services. It was written in 1968 by Douglas Houghton, who became a Labour Peer and will be remembered in this House as a wise old bird with the courage of his convictions. In that paper, written more than 30 years ago, there appears the following luminous passage:
Lest those be thought the musings of a maverick, I shall now quote one of the great intellectual pillars of Harold Wilson's Labour Party, Mr Richard Crossman. In the introduction to his now long-forgotten panacea of National Superannuation in 1969, he wrote:
It was political monopoly that abolished matrons, introduced mixed-sex wards, manipulated waiting lists and surgical priorities and issued orders to clean up hospitals in areas to which the public had access. A monolithic state monopoly can never cater sensitively for differing and developing personal preferences. I describe it as essentially a Napoleonic, even totalitarian concept best confined to the Armed Forces, the police, the fire service and street lighting, where choice between competing suppliers is less feasible.
Dare I add, after the outbursts which have come from the Liberal Democrat Back Benches, that state dictation is especially inappropriate from a party that now attracts fewer supporters than there are adult smokers?
Viscount Goschen: My Lords, like many other noble Lords who have already spoken in the debate, I was particularly impressed by the maiden speech of the noble Lord, Lord Rooker, not only for the fluidity, clarity and brevity with which he addressed such a substantial subject, but also because he had the courage to address what is becoming an ever more important issue; that is, the sheer volume of legislation which is emerging from his department.
The noble Lord, Lord Rooker, drew attention to the efforts being made within his department to examine the efficacy of previous measures that have been brought forward. I am sure that in due course the House will be interested to hear much more about this, because there is certainly a fear that, as the statute book becomes ever more complex with each Queen's Speech, the question remains unanswered as to whether the system has become any more effective at controlling crime--its primary purpose.
In the last Parliament, some 30 Bills out of a total of 154 government Bills were associated with the Home Office. The Crime and Disorder Act formed an important part of the Government's programme over the last Parliament. It contained a range of provisions which were intended to tackle youth crime and anti-social behaviour. But how effective have those measures been? I understand that, according to figures published last September, by that stage no child curfew orders had ever been applied for and that only just over 100 anti-social behaviour orders had been successfully applied for. Since that time the figures may well have changed, but surely there is a relevant and valid contrast to be made between the enormous resources--parliamentary, official, agency, police and others--which have been poured into those measures with the meagre results which they have brought thus far.
The 1998 Act also established crime and disorder reduction partnerships. Again, the objectives of those schemes were admirable, but where are the results and what efforts have been made to attempt to quantify them?
The Criminal Justice and Police Act 2001 has only recently been introduced, but again a huge variety of measures were introduced relating to police powers and the ability to deal with offences, such as issuing on-the-spot fines for disorderly behaviour and the extension of the curfew scheme to which I have already referred--despite the lack of evidence on the results of the original scheme.
Of course reference has also been made to the Football (Disorder) Act. The Act could be considered as one of those referred to by the noble Lord, Lord Rooker, as having popped up "out of the blue". Indeed, at Question Time only yesterday or the day before, calls were made for additional legislation and measures to be introduced to cope with disorder at cricket matches. If we continue on this path, we shall reach an absurd point. I hope that we shall not see a rugby union disorder Bill, a rugby league disorder Bill
Beyond pure criminal justice, we also passed the Private Security Industry Act which, while although a great deal of support was expressed for its original aims, was extremely cumbersome and will bring literally hundreds of thousands of people under a brand new regulatory regime. We hope that it will improve standards in that industry and that, as a consequence, there will be a reduction in crime. However, it will need to be closely monitored.
The noble Lord, Lord Rooker, produced some statistics on the fall in the level of crime. However, statistics can tell different stories. Certainly I have some statistics available which tell a rather different story as regards the overall level of crime. Notwithstanding that, it is difficult to draw specific conclusions from the crime statistics which we have at our disposal: have the measures which we have discussed been efficient at addressing their principal purpose?
There is a very real sense that an attitude has been adopted that one can legislate against crime. But surely the legislative framework is only one part of the matrix of maintaining law and order. Are we not in danger of overloading the police and the courts with an ever-thicker statute book, which I believe has now moved well to the wrong side of the diminishing returns curve?
Under this and under previous administrations we have seen scores of special initiatives, many of which have been developed in great haste as a response to certain current events, but very few of which have been demonstrated to work well over a period of time. I should be interested to know how many additional criminal offences were created over the course of the last Parliament. I do not expect the Minister who is to respond to our debate to have those figures tucked in his inside pocket, but it would be interesting to know in due course not only the exact figure, but also whether that figure easily can be found. Is anyone keeping a tally of what I think is an important issue?
Tough but impractical legislation should not be used as a smokescreen to divert attention away from poor execution and resourcing, although there is a temptation to do just that. All of the legislation which has been dreamt up will not make up for the fact that, for example, there has been a decline in the number of policemen. Surely it is a priority to concentrate on improving delivery and performance.
Having said that, clearly there are areas where the Government can and should make a strong case for introducing fresh legislation to enhance that delivery. An example of that might well be the police reform Bill. It is clear that the organisation of our police forces in this country is something of an archaic legacy from ancient times. A great deal could be done to remove the structural obstacles and thus to enhance efficiency.
While on the subject of the police, I feel strongly that it is up to the Government to demonstrate their overt support for the police and to draw attention to their extraordinary work. Only then will public confidence in our police forces be enhanced. All too often we see a tendency for Ministers to associate themselves with the police when things are going well, but under difficult circumstances and in troubled times there has also been a tendency for the police to be allowed to hang out to dry without receiving necessary government support.
The credibility of the Home Office measures which have been brought forward is diminished by the lack of a strategic framework into which they could fit, as well as by the sheer volume of the legislation. A great deal of time in the last Session was taken up by redrafting measures such as the ill thought-out Regulation of Investigatory Powers Act. The reintroduction of the hunting Bill merely reinforces my view that the Government do themselves no favours by diverting attention from the important issues, which undoubtedly they are trying to address, given the programme of Home Office legislation brought forward in the gracious Speech.
Lord Phillips of Sudbury: My Lords, I, too, should like to welcome the noble Lord, Lord Rooker, to his hot seat, even if at present he is not occupying it. At the same time I should like to express my--I am not sure what is the most apt sentiment--gratitude, in a sense, to the noble Lord, Lord Bassam. Noble Lords on these Benches did doughty battle with him night after night. It is odd how, as a result, one then develops symbiotic relationships with those with whom one locks horns in that way. I like to think that we always conducted a sensible and respectful engagement. I am sure that it will be the same with the noble Lord, Lord Rooker.
Perhaps I may repeat briefly a comment I made about the last Queen's Speech. I must express a certain frustration that the debates on health and home affairs are hitched together, even though they have nothing whatever to do with one another. It seems to be an unnecessary problem for all concerned and detracts from focus in debate. I am afraid that I do not buy the Government's explanation that it would increase government time on the Front Benches and leave less time for those on the Back Benches.
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