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The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, perhaps the noble Lord will allow me to intervene. I know that in the usual channels the Government have suggested ways of reforming the manner in which we undertake these debates. Sadly, agreement was not reached.
Lord Phillips of Sudbury: My Lords, I am grateful for the Minister's intervention.
I wish to say a few words, first, about the Football (Disorder) Act, and then, more importantly, about the prospective change in the court structure by the interposition of an intermediate tier of courts. I shall
say finally a word about the context within which criminal law reform takes place. I identify very closely with most, if not all, of what the noble Viscount, Lord Goschen, said on this point.The Football (Disorder) Act 2000 was heavily contested at the time and went through at the end of a parliamentary Session. I believe that anyone with an open mind would accept that it is a draconian piece of legislation in comparison with anything that we have ever put on the statute book before. There was a rare coalition of opposition to the Act. We on these Benches will be no more keen to see this Act renewed permanently than we were to see it introduced with its sunset clause.
The report on the workings of the Act--which is not a model of clarity--appears to indicate that in the year and a bit since the Act came into effect, only 44 orders have been issued under its provisions. I take issue with the noble Lord, Lord Rooker, when he justifies the existence of the legislation on the ground that,
- "it demonstrates that we take this issue seriously",
- "it demonstrates that we take this issue seriously",
As for it being "targeted", in my book that is another word for it being extraordinarily arbitrary in the way it is used. Given the extremely low hurdles that need to be leapt in order for magistrates to make a banning order, no one can tell me that the numbers to whom this Act could apply would not run into hundreds of thousands, if not millions, of citizens.
One does not need to prove a conviction for any offence of violence or disorder. Indeed, John Prescott may count himself lucky that he has not been a recipient of one of these orders. One needs to engage only in a gesture or a word which is considered to be insulting to trigger this measure--a word or gesture that is not unlawful, has never been unlawful and is never likely to be unlawful. In our view, this measure should be consigned to where it belongs.
I turn to the issue of a new tier of courts and, most importantly, the impact of such an introduction on the lay magistracy. The Queen's Speech and the new Home Secretary's remarks on this aspect of the forthcoming legislation were somewhat gnomic and sparse. One needs to read the Labour manifesto in order to understand what is at stake. The manifesto states:
- "The current system, split between Magistrates and Crown Courts, needs reform".
- "A unified system, including lower or intermediate tiers of court, offers simplicity and flexibility".
The manifesto and the Queen's Speech refer to the forthcoming report of Lord Justice Auld. Last October, Lord Justice Auld issued a progress report--which is the latest intelligence we have from him--in which he stated that there has been widespread support for the establishment of an intermediate tier of jurisdiction to deal with some of the less serious offences currently categorised as "either way" cases. As he put it,
- "It has been suggested that this might take the form of a District Judge"--
- "sitting with two lay Magistrates".
- "Whether or not Lord Justice Auld recommends such an intermediate tier, he is considering proposals",
It is common ground on these Benches that anything which reduces the power and authority of lay justices will be viewed with extreme scepticism. We believe that the introduction of this intermediate tier may have as one of its ulterior purposes an escape from the cul-de-sac into which the Government have driven themselves over the question of a reduction in the right to jury trial.
Secondly, it surely stands to reason that if there is to be an intermediate tier it will suck cases down from the Crown Court and it will suck more serious cases up from the magistrates' courts. The impact of that over time will, in our view, be seriously damaging to the prospects of survival of the magistrates' courts. Let there be no mistake, there is--how shall I put it--a kind of hidden hum which emanates, year on year, from the Home Office which is antipathetic to lay justices as such. Although the Lord Chancellor has made repeated unequivocal assertions as to his support for lay magistrates, a battle is going on behind closed doors. I repeat, we are absolutely committed to lay justices as the very foundation of justice in this country.
Perhaps I may briefly refer to the report of a senior lecturer at Sussex University, Richard Vogler, on the potential impact of the intermediate tier of a judge and two lay justices. He states:
- "Unfortunately, the evidence from other jurisdictions is that the functional role of the lay participants in a mixed bench is virtually nil...The professional judges naturally dominate the conduct of the trial and set the legal framework of decision-making...From Germany, for example, there is overwhelming empirical evidence"--
- "that their [the lay justices'] role is essentially passive and their influence negligible".
- "The mixed panel is popular with professional judiciaries precisely because it empowers them at the expense of genuine popular participation ...evidence from other jurisdictions suggests clearly that Lord Auld's interim proposals"--
- "are fraught with potential dangers and may represent a significant step away from democratic trial process".
I come back to the point that, together with juries, lay justices are the only part of our complex legal system that can reasonably be called justice of the people, by the people, for the people. We favour them precisely because they are deeply rooted in the public mind and in their communities. Lay justices and the magistrates' courts are among the few parts of the modern state that the so-called ordinary citizen understands. They have a high degree of public confidence. The number of complaints about them is astonishingly small in view of the fact that they deal with 95 or 96 per cent of all criminal cases.
They are ruggedly independent. We have a certain suspicion on these Benches that the endless desire of central government to have more and more control over the affairs of our society works against these individuals, who take no pay from the state, depend not on the state and are largely self-organising in their areas. In saying that, I make no disparagement of district judges.
Whatever comes out of the Government's consideration of the Auld report--and we hope that there will be an in-depth consultation with the public--we will be extraordinarily sceptical about any move to reduce the powers of lay justices, either directly or indirectly.
Finally, perhaps I may say a word about the context within which I believe criminal law reform should be undertaken at this time. We all, I have no doubt, consider that the turn-out at the general election earlier this month was truly disastrous. I do not think that any of us should try to "spin" it away. By some considerable degree, it was the worst ever turn-out since the introduction of universal franchise in this country. As the noble Lord, Lord Jenkins, made clear yesterday on the "Today" programme, comparisons with the 1918 election are false. However difficult it may be, we must attempt to understand why under six in 10 of our fellow citizens thought it worth while to cast that precious vote.
The underlying causes are elusive and contestable--and unprovable. But I am certain of one thing: in the oft-repeated refrain of this Government that they want to be "tough on crime and tough on the causes of crime", being tough on the causes of crime is a superficial exercise unless it reaches the underlying causes of public disaffection with the state and with most of its manifestations.
I should like to think that we in this House have a better opportunity than do our colleagues and superiors down the corridor to stand back and examine such issues as the rampant materialism of our society, which has as its counterpart the collapse of moral idealism; the rampant greed which I believe seriously disfigures our society, with its counterpart, the collapse of any idea of fairness of reward; the obsessive competitiveness of our society, which is not confined to the economy, and which has as its counterpart a collapse of the balance between public and private affairs and between personal and civic affairs. These and other issues undermine virtuous
values: they undermine co-operation and sharing, fairness and moderation, civic pride, public interest and altruism. Anyone who thinks that that has no impact on all the things that we "sweat over" in terms of the level and viciousness of criminality is simply not facing the truth about the society of which, in a way, we in this place are the head.I hope that, difficult though it may be, we shall try to get at these intractable facts and that we shall attempt to build them into the way in which we deal with legislation. I hope that we shall realise that legislation is often counter-productive of the very purposes for which it is enacted. I hope that we shall understand that the seedbed of our society is being soured and leeched of goodness. However good are the seeds of legislation that we plant in it, however copious are the fertilisers that we bring to it in the form of government grants, projects and initiatives, however much we spread insecticides to choke off criminality, all of that will be useless if the underlying seedbed is incapable of taking all that.
I wish the Government wisdom in the legislation that they bring forward. They can be sure that we shall treat it with rigorous but, I hope, public-spirited criticism.
7.44 p.m.
Lord Harrison: My Lords, I, too, welcome the noble Lord, Lord Rooker, to this House. He has proved himself no rookie in his first appearance here.
In the general election there were four categories of citizens who were deprived of the vote: those of us who were detained at Her Majesty's pleasure here in the House of Lords, those in prison, and those in Bedlam--sometimes all one and the same place; and, of course, children.
I do not advocate extending suffrage to children under 18. I am reminding your Lordships that in all senses of the phrase, "There are no votes in children". As a result, too few politicians speak up on their behalf. But children should not have to wait for their voices to break for their voices to be heard. In all deliberations, children should be seen and heard. So today, on my daughter Sara's 16th birthday, I shall concentrate my remarks on children, and on how their welfare may be affected by the content of the gracious Speech. What more appropriate venue is there in which to speak about children than in the House of Lords--for some, the home of our second childhood?
I warmly welcome the gracious Speech, which builds on the Government's substantial record of achievement in the past four years of strengthening the protection and welfare of children in the United Kingdom. The reintroduction of the adoption and children Bill will command widespread support. It has the personal imprimatur of the Prime Minister. However, I hope that the Government, in fleshing out the Bill, will be equally mindful of the advantages of long-term foster care, which can so often be more appropriate for older children. Greater use, too, of family group conferences can markedly increase the opportunities of successfully placing children within
the fold of their extended families. I speak feelingly on this matter, for I am eternally grateful to my brother-in-law's parents for informally fostering me some 40 years ago at a time when my immediate family suffered temporary setbacks. In supporting the adoption and children Bill, perhaps I may put in a special plea for continuing training for adoption staff, both on their social work courses and during their employment by local authorities.As a council member of the NSPCC, I welcome the Government's ambition to tackle the problem of highly dangerous sex offenders through the judicious use of indeterminate sentences for the guilty. Although it goes against the grain to detain our fellow citizens on such a basis, recognition that some seven in every 1,000 men have been convicted of at least one sexual offence against a child necessarily invokes the higher imperative of ensuring our children's protection against the gross invasion of the civil liberties of such offenders.
Apropos children's commissions, I am grateful for the written reply from my noble friend Lord Hunt on 27th February indicating that the Government are watching closely the inception of a Children's Commissioner in Wales to see whether such a departure would be feasible in England. I sincerely hope so.
Less encouraging is the omission from the gracious Speech of proposals to reform the law to give children the same legal right of protection from assault as that currently enjoyed by adults. For the past decade Britain has subscribed to the United Nations Convention on the Rights of the Child. It is time that we put our law where our mouths are and banned physical punishment, as set out in Article 19 of the convention. It is time to break the dispiriting cycle of violence begetting violence within the family.
The other day, I could barely restrain myself from intervening when I saw a clearly inadequate parent gratuitously, indeed metronomically, thrash her child in the street for seemingly the umpteenth time. That demonstration of the futility of the law of diminishing returns in family discipline was tragic fare for us as onlookers. There was nothing comical, however, about this bashed street kid, who in turn, a generation from now, will doubtless be found bashing her progeny in the street unless we act now. Sometimes, I think that there is a lot to be said for the nanny state.
Urgent, too, in the dawn of this new Government, is the need for a systematic review of all child deaths in the United Kingdom, particularly those attributable to abuse and neglect. We need to develop a better snapshot and definition of such child deaths. The reported rate of two fatalities a week may well be an underestimate, but we just do not know. We sorely need a national strategy for reducing such child deaths. Harmonising the collection of relevant data by local authorities would be a good first step. Can my noble friend the Minister indicate whether the Government would be sympathetic to the idea of consulting all interested parties in this matter through a Green Paper or a White Paper to help reduce the incidence of these needless deaths?
I hope, too, that the Government will not be too tardy in re-introducing the tobacco advertising Bill. This is a measure that will be proportionately more beneficial for children than for adults.
Perhaps I may now invade the territory of the Department for Education and Skills and make a plea for more and better school-based welfare services for children. As a former member of Cheshire County Council's education committee, I was made fully aware of the debilitating problem of bullying and intimidation which lies like a dead weight across the path of children seeking to pull themselves up by their bootstraps to gain freedom through education. I believe that there is a powerful case for boosting normal pastoral care by improved school-based welfare services. Do the Government agree?
All this may seem trivial when set against the staggering figure of 40 million infant deaths that are reported each year worldwide, as a result of war, famine, malnutrition, disease, natural disasters and drought. My former European Parliament colleague, Glenys Kinnock, rightly reminds us of that depressing statistic. But here, too, I commend the last Government's ambition to help eliminate child poverty in the world of the 21st century. The collaboration between Chancellor Brown and Clare Short of DfID was exemplary.
I should like to make a special plea for children in our own global backyard--Europe. I proudly sport today the tie of the British EU presidency of 1997, the design of which was specially commissioned by the British Government from children working together throughout the European Union. The tie illuminates the importance of children growing up in Europe, but the opportunities and dangers presented to our young people arising from the development of the single market, and from European Union enlargement, have been slenderly calibrated. On a future occasion I hope to enlarge upon this subject, especially about the four freedoms of the single European market--the free movement of goods, services, people and capital--each of which, individually, impacts unexpectedly on children and poses new challenges to the Government, who wish to ensure the protection of children in a deepening and widening Europe.
Yesterday's tragic news of a Portuguese mother, resident in Switzerland and arrested for a minor theft, whose 18 month-old child perished alone and abandoned in the parental flat following a breakdown of communication in social services, all too piteously illustrates the danger to children of a Europe on the move. All of us in Europe must redouble our efforts to ensure that, in opening up Europe, we do not leave children and their families exposed and vulnerable. In building a better Britain, as this Queen's Speech surely does, let us do so in partnership with our friends and families in Europe. For our children's sake, we fight a common cause.
7.54 p.m.
Lord Hylton: My Lords, I freely admit to being a grandfather, but I hope that I am not quite yet
beginning to enter my second childhood. More seriously, however, I regret that there is much that is wrong in British prisons. This has come out clearly from a number of earlier speeches. The problems have also been well described in the reports of the inspectors-general of prisons, both on individual prisons and in thematic studies covering, for example, women or young people, or suicides in prisons. Against that difficult background, requiring immediate and sustained government action, I should like to speak about two very positive initiatives. I hope that they will influence the whole prison system.The first is a voluntary and charitable initiative called "Fine Cell Work", which enables prisoners to do embroidery, needlework and quilting. Because these crafts can be done in individual cells and in the prisoner's own time, they do not depend on the nature of regimes or on the availability of workshops and supervisors. The work produced can be sold, with the proceeds saved for the prisoner on his release. The standard of work produced has been very high, so much so that some of it has been sold to leading interior designers. Prisoners can thus learn useful skills, and one man has been quoted as saying:
- "You feel you're supporting yourself. I feel proud I've been given something to achieve, to get pride and self-respect".
I notice that the patrons of "Fine Cell Work" include the noble and learned Lord, Lord Bingham of Cornhill, and Sir Stephen Tumim. Can the Minister say whether the Government are studying the ways in which this initiative works, and whether they will assist it to develop more widely? I believe that there could be many useful lessons to be learnt.
The second initiative is trying to apply some of the principles of restorative justice to sentenced prisoners in custody. It is well known that work has never been available to all prisoners. Quite often it is available for only a few hours per week. The nature of the work varies and does not always help prisoners to acquire skills that will be relevant and useful to them on release and re-entry into the community. Moreover, education is often available in a limited way for only a small percentage of all prisoners.
The restorative justice principles that are most relevant to a prison setting are those seeking to reduce re-offending by helping offenders to re-integrate into community life by taking responsibility for the harm or damage that they have caused and by doing something to benefit their victims, or the wider community. This makes sense when we know that Braille workshops and helping with riding for the disabled (in one prison at least, which is known to me) have always been popular activities with prisoners. They have enabled prisoners to feel useful by helping others, who are obviously disadvantaged.
From this level, it is clearly a huge step forward to bring prisoners into some form of contact with victims of offences, or their representatives. Well documented work of this kind has already been done in both Canada and in the United States of America. I am glad
to say that it is beginning in England. Prisons and young offender institutions at Stoke Heath, Huntercombe, Brinsford, Rochester, Springhill and the Mount have all made courageous starts.It is clearly good when a prisoner stops denying the impact of his offence. It is better still if he becomes willing to apologise or to make some kind of restitution. Such behaviour should be strongly encouraged and rewarded by privileges and remission. I therefore ask the Government to study carefully what has been done, both here and in other countries. I urge them to develop restorative regimes in as many prisons as possible. There is definite scope for involving many volunteers and voluntary organisations in such work. This must be positive, both for prisoners and for society generally.
7.59 p.m.
Viscount Bridgeman: My Lords, I trust that your Lordships will forgive me if I do not stay for the summing-up as I have a long-standing engagement. It is therefore with some diffidence that I ask the Minister if he will be good enough to write to me on any points I may raise. It is a pleasure to note that the Minister has retained the office he held before the election.
I wish to speak briefly about the partnership between the National Health Service and the independent sector. I must declare an interest as chairman of an independent charity hospital in central London. I hope that gone for ever is the doctrinal, almost theological, objection by the National Health Service to any private sector involvement which was the prevailing attitude up to comparatively recently. However, when I wrote this speech I was not aware that the Prime Minister would address that very point today. The culture went wider than that. Up to about 30 years ago there was a widespread attitude in the City of London that it was vaguely sinful to make money out of illness. However, happily now the mutual recognition of interdependence between the two sectors can only be to the benefit of the patient.
The independent sector's involvement is significant. The Mental Health Act Commission states that independent advisers deliver more than 55 per cent of the NHS's medium secure provision and 80 per cent of the country's brain damage rehabilitation. The Independent Healthcare Association is confident that over the life of this Parliament it will be able to offer 1 million treatments.
The independent sector trains many thousands of student nurses who spend several months at a time in independent hospitals and nursing homes where they learn about a wide range of specialties, particularly in the care of the elderly, where the independent sector plays a major role. It also provides postgraduate and management training for nurses. Similarly, for doctors there is a wide range of postgraduate accredited study courses.
In my own hospital we have for many years enjoyed a good and mutually fruitful working relationship with the National Health Service. Our hospice, which forms
part of the hospital, derives its income in three ways: from contracts from a number of health authorities; from fundraising and from any surpluses from the acute side of the hospital. That encapsulates the partnership about which we are talking. Therefore, we very much welcomed the concordat initiative. We are taking a number of surgical lists, initially with two teaching hospitals, but we are exploring possibilities of working together with several more.We have a rotating arrangement with a teaching hospital for the provision of resident medical officers who are studying for fellowship or membership of the royal colleges where they can work away from the stresses and strains of a large hospital. At the same time our patients get round the clock cover of high quality.
One of the great myths is that the independent sector somehow steals nurses away from the National Health Service. The fact is that over recent years less than 4 per cent of nurses who left the NHS moved to work in the independent sector. The remainder simply left nursing altogether, though hopefully for many of them not for ever. The contribution of the private sector is in such fields as human resource strategies as they apply to nurses, return to nursing courses and increased career and training opportunities. The independent sector can indeed regard itself as a partner of the National Health Service.
The independent sector stands committed to the success and constant improvement of the National Health Service. But let us be clear on one thing. The best people to run the National Health Service are National Health Service people. The relationship with the private sector is one of partnership, not wholesale privatisation. Speaking for myself, I have no problem with the recent remarks of the Secretary of State on that matter.
However, I fundamentally disagree with the trend of the service towards centralisation during the regime of the present Secretary of State. The reforms under the previous Conservative administration have been derided by the present Government. The much vaunted dismantling of the market in the provision of services is largely irrelevant. The central pillar--the creation of the purchaser/provider structure--remains intact. I hope that the Government will study carefully the speech of the noble Lord, Lord Harris of High Cross--who I am sorry to note is not present--on the perceptive article written as long ago as 1961 on just that point. However, the purchaser/provider structure is rendered to a large extent ineffective if with it comes the deplorable trend towards centralisation which I fear has been a feature of the past four years. The dead hand of bureaucracy was ruthlessly analysed in the Virgin report on the National Health Service in July 2000, which stated:
- "Within the Service there is the impression of 'management by cascading paper', of ideas and instructions being passed down from above. The dead hand of bureaucracy seems to stifle imagination and flair and obscure responsibility".
I refer to the contracts of service of newly qualified consultants who under the NHS Plan are contracted to work exclusively for the National Health Service for either the first five or first seven years of their contract and within that period are effectively required to work overtime within those contracts. I appreciate the arguments for that, some of which are more plausible than others. I agree that the National Health Service has invested large sums of money in the training of consultants, in return for which it feels entitled to the exclusive use of their services. A less tenable argument advanced by a highly respected friend of mine in a senior position in the National Health Service is that consultants can expect rich pickings later and a hair shirt at this stage does them no harm. In other words, are these highly qualified men serving a further apprenticeship?
The proposal has been heavily attacked by the BMA, which in my view correctly states that it goes against the spirit of the private and NHS sectors working in harness, quite apart from the clinical experience in a different dimension. Consultants at any age will almost certainly benefit from straddling the two. These proposals appear to run counter to remarks made by the Secretary of State on the "On the Record" programme of 11th June 2000 who said,
- "It would be a pretty odd state of affairs if we said to highly trained consultants, some of the most expert professionals we have in the Health Service, 'You are going to be denied a set of rights that everybody in the NHS has'".
This country has a tradition of excellence in the quality of nursing and clinical care which is without equal. In the quality of treatment now offered, on the other hand, we appear to lag behind many other countries. However, it is often overlooked when making these comparisons that in almost all of them there are charges, often hidden and indirect, to the patient from which in the NHS in this country we are mercifully free. Treatment in this country is indeed free at the point of delivery.
In the first 40 years or so of its existence the National Health Service was the envy of the world. It has, however, been encumbered by two factors not envisaged by its founders and for which no one is to blame. The first is the galloping cost of new technology and the second is the increased expectations on the part of patients which arise from the very success of the National Health Service. That point was most eloquently made by my noble friend Lord Dean.
I suppose that if we are to be honest we must say that all the problems of the NHS ultimately come back to funding. I do not propose to go into the many shortcomings which have been outlined tonight except to share with your Lordships the chilling experience of the case of the MRSA patient to which the noble
Baroness, Lady Masham, referred and whom I recognised as the son of great friends of my wife and myself.If there is one thing I ask the Government to achieve during the course of this Parliament it is the restoration of a climate where managements are trusted from above and their initiatives encouraged. In this they can rely on the independent sector to play an increasing role in a partnership, but never, I am sure, an intrusive or challenging one.
I echo the words of my noble friend Lord Forsyth. I am sorry that he is not in his place. This must not simply be an emergency run for cover to get waiting lists down during a hard winter. It must be a true partnership. There will be only one beneficiary of that partnership: the patient.
8.10 p.m.
Baroness Gale: My Lords, I, too, give my warmest congratulations to my noble friend Lord Rooker on his maiden speech and ministerial appointment. He will contribute greatly to your Lordships' House.
I was delighted to see in the gracious Speech a reference to women's representation. The measure is long overdue. Since 1918 women have been able to stand for election to the House of Commons; and since 1928 all women have had the right to vote. That right has in the main given women the right to vote for a male candidate and elect a male Member of Parliament. Is that what the suffragettes fought for?
Some people may wonder why, at the beginning of the 21st century, we should need to adopt such measures. They may even express the view that competent women will achieve and be selected if they are good enough. Others will argue that it is the democratic right of a constituency party to select the candidate who is the choice of its members. Who could argue with that? The surprising factor is that exercising that choice nearly always results in a man being selected. It is a strange form of democracy when the result is so skewed towards men. The law of averages should allow some woman to be selected but, generally speaking, that does not occur.
For many years I believed that women would eventually make the breakthrough: that the need was for the provision of training courses for women, the offer of confidence-building and public speaking courses and of ensuring that women were up-to-date with the policies of their parties. I am sure that many women of all parties will recognise this scenario. I went along with that idea for some time. Indeed, I organised such courses for women believing that this was the way forward. But even the best-trained women still could not get selected. As a Labour Party organiser, I was responsible for organising many selection meetings in constituencies. Time after time I saw men being selected rather than the very good, or in some cases excellent, women. Why would constituency parties not select those good women?
Eventually I began to question why women were not getting selected. I saw many women putting themselves forward. These were women who had achieved much in their chosen career. They were good speakers. They had confidence. They were bang up-to-date on policy matters and would have made excellent Members of Parliament. But no matter how good they were they could not get selected.
Perhaps one could argue that the male candidates were so exceptional that the women, however good they were, could not possibly match up to their excellence. But that was not the case. So what is the problem? Some political parties have recognised that there is a problem. They have made efforts to address it by bringing in rules which ensure that women get on to shortlists. Different parties adopted different measures. The Labour Party brought in rules which gave women equal opportunities with men; for example, allowing bodies to nominate two candidates, one woman and one man, with an equal number of men and women on the shortlist for final selection. Given this equal opportunity, one would have hoped that women candidates would come through, at least in some constituencies. However, the reality is that constituency members of all parties play lip service to women's representation.
What women want is not simply equality of opportunity but equality of outcome. Perhaps I may give the situation in Wales as an example. Before the last general election, 10 male Members of Parliament announced that they would be retiring. There were seven Labour, two Plaid Cymru and one Liberal Democrat. Male candidates replaced all 10. I am certain that all will make good Members of Parliament. But is it not odd that not one woman was selected in a seat that her party could win? I am pleased to note that in Ynys Mon where the sitting Plaid Cymru Member stood down Labour gained the seat. In the unlikely event of the selection of a woman she would have lost to the Labour man.
That example of men replacing men can be repeated in many constituencies throughout the land, although Wales seems a little more backward in these matters. People may ask, "What are you complaining about?" Wales has led the way. Let us consider the results at the Welsh Assembly elections in 1999. Of the 28 members of the Labour group, 16 are women. Plaid Cymru has six women out of a group of 17. The Liberal Democrats have three women out of a group of six. However, of the nine Conservatives elected, all are men. Nevertheless, women have a good representation in the Welsh Assembly.
How did that happen? In the debate last Thursday, the noble Lord, Lord Goodhart, suggested that the large number of women elected to the Welsh Assembly was the result of using the proportional system for the Assembly elections. However, most of the women were elected in the constituency seats on the first-past-the-post system. Fifteen Labour women, two Liberal Democrat women and two Plaid Cymru women were elected. Nineteen women out of 40 were elected on the first-past-the-post system. Only five women were elected out of 20 on the list system. Owing to the
resignation of my right honourable friend Alun Michael, Delyth Evans--she was number two on the Mid and West Wales list--took his seat, making the figure six.The same thing happened in Scotland. Out of 73 constituency seats, 26 Labour women were elected, two Scottish Nationalists, and two Liberal Democrat women. In total, 30 women were elected out of 73 seats.
Out of a total of 56 seats on the list system, 18 women were elected: two Labour, 13 Nationalists and three Conservative women. Again it demonstrates that more women were elected in the constituencies than on the list system. Therefore I argue that PR is not the solution in order to have more women elected in Wales or Scotland. I accept that the use of the zipping method, for example, in the European elections could help more women to be elected. But that system is dependent on the attitudes of the parties.
How were so many women elected to the Welsh Assembly when they cannot get elected to Parliament? The main reason is that the Labour Party had the courage to instigate a system of twinning. Paired constituencies selected one man and one woman. That ensured an equal number of female and male candidates. As Labour was likely to win the majority of constituency seats it was essential that it fielded a good number of female candidates for this brand new institution; otherwise it would be similar to Westminster where the majority of Members are male. Women are playing a leading role in the Assembly, especially at Cabinet level. They have proved that given the chance they will deliver.
The method of twinning was highly controversial. As the person who had to drive it through the party, I became aware of the prejudice and discrimination that exists toward women. I had, of course, been aware of the situation but it had not previously been so blatantly obvious. Now that women had the opportunity of taking winnable seats to which men had already put their names, the prejudice became more acute. That occurred in parties where attempts were made to redress the gender imbalance. It is certainly not unique to the Labour Party. Prior to the 1997 general election the Labour Party implemented a policy of women-only shortlists to ensure the selection and election of more women. The policy was successfully challenged at an industrial tribunal. Labour immediately stopped the procedure but many women had already been selected. It meant that a record number of women were elected in 1997. Some believed that with that success the mould had been broken. Unfortunately, that was not the case. Fewer women were elected at this year's general election than in 1997.
Without special measures in place, women will not get selected for seats that they can win. Members of all parties have shown a great reluctance to choose women as their candidates. The prejudice and discrimination against women in all parties is a disgrace. That, rather than the inability or weakness of
potential women candidates, is what prevents women becoming Members of Parliament or achieving other elected offices.There is only one answer to the problem, and that is legislation. The proposal in the gracious Speech to bring forward legislation to assist women in public life is most welcome. Although this is a great step forward, similar action has already taken place France. A new law, thought to be unique, was used for the first time at the local elections in May this year. As a result, approximately 48 per cent of councillors are women, as opposed to 22 per cent at the previous elections in 1995. Time does not allow me to elaborate on that law and what it means, but it shows that the French Government are prepared to bring in legislation to combat discrimination and prejudice against women. Where positive action is taken in favour of women, women prove that they are capable of doing the job, as has been shown in the Cabinet of the Welsh Assembly, where women are in the majority. People now say how good it is to have women in such high positions, rather than saying how terrible these women are for trying to get our seats. They are good role models for women in Wales, showing that they can hold tough portfolios and deliver for Wales.
It is essential that the proposed legislation be brought before Parliament at the earliest opportunity, in time for the selection of candidates for the Scottish Parliament and Welsh Assembly elections in 2003 and in plenty of time for the next general election. I am very pleased that Her Majesty's Government have recognised that this is the way forward. In future, political parties will be able to decide for themselves if they wish to have all-women shortlists without the worry or threat of legal action. Equally, there will be no compulsion on parties who do not wish to go down that road. Those who have tried for many years to assist and support women in their efforts to obtain elected office welcome the proposed legislation to get more women in Parliament. The campaign has gone on since women were first allowed to stand for Parliament.
I have nothing but praise for the Government on this issue. In the future, women will be given an equal chance with men at selection conferences and will have an equal chance of holding elected office. I hope that the Minister can give an assurance that this matter is regarded as urgent and that the legislation will be before Parliament at the earliest opportunity; otherwise there will be another generation of lost opportunities for women.
8.23 p.m.
Baroness Stern: My Lords, I shall say a few words about the commitment in the gracious Speech to modernise the criminal justice system and to reform sentencing. In that context, I very much welcome the excellent maiden speech of the noble Lord, Lord Rooker, and his commitment to thinking before legislating. I suggest that before they embark on a reform of sentencing, the Government might want to take a good hard look at what has happened to sentencing in England and Wales in the past 10 years.
They might want to reflect on the great changes that have taken place and to measure how far they have helped the Government to achieve their objectives of preventing crime, giving proper redress and satisfaction to victims, improving confidence in the criminal justice system, leading to a change for the better in the behaviour of criminals and, as the right reverend Prelate the Bishop of Durham said, restoring to their full humanity those who fail.As the noble Lord, Lord Williamson, pointed out earlier in the debate, there have been big changes in sentencing practice in England and Wales during the past 10 years. Our proportionate use of prison sentences has increased substantially. In 1990, out of every 100 men aged 21 or over sentenced for indictable offences, 17 received an immediate prison sentence. In 1999, the figure was 28--a 65 per cent increase. For women the increase has been even greater--a 166 per cent jump over 10 years. Of course the numbers in prison have gone up. On 15th June, we were locking up more than 66,000 people. On the last Friday in June in 1990, we were locking up 45,500.
Our treatment of children--defined by the UN Convention on the Rights of the Child as those under 18--has also changed markedly over the past 10 years. There are now more than twice as many children aged 15 to 17 sentenced and imprisoned as there were 10 years ago. Once again, seeming female wickedness has outpaced that of men. In 1988, 60 girls between 15 and 17 were sentenced to prison. In 1998, the figure was 302.
International comparisons are also interesting. We are moving further away from our European neighbours. Our imprisonment rate is the second highest in the European Union. It is now 64 per cent higher than in France and 21 per cent higher than in Germany. The European Union average for the proportion of the prison population aged 15 to 20 is 8 per cent. The England and Wales figure is 17 per cent.
As we heard in yesterday's debate on the gracious Speech, our spending on education is lower than that of our European neighbours. The same applies to health, as we heard today from the noble Lord, Lord Forsyth. However, our spending on imprisonment is higher than that of our European neighbours. What does that show about our priorities?
I apologise for subjecting the House to so many figures at this hour. I know that it can become very tedious, but I have quoted them to make the point that the changes that have taken place in sentencing in England and Wales in the past 10 years have not been slight or a minor shift in a different direction; they have been fundamental.
In recent years, the Home Office has been concerned that its work should be evidence-based. That description crops up in most Home Office documents about the criminal justice system. The paper Criminal Justice: The Way Forward produced in February this year tells us that,
- "the Government has embarked on a comprehensive evidence-based programme to reduce crime".
It is rational to look at the evidence. It would be interesting to know what evidence has driven the changes in sentencing over the past 10 years. Those changes have been steadily in the same direction, regardless of the change of administration in 1997. It would be useful to look at the evidence on the consequences of a policy that uses imprisonment not just for dangerous and violent offenders, but for many non-violent or petty repeat offenders.
In the United States, which has 2 million prisoners and the highest rate of imprisonment in the world--more than five times the rate in England and Wales--scholars are now working to measure what they call "collateral damage". What will be the long-term consequences, they are asking, of this high use of imprisonment over the past decade on families which are broken up by imprisonment and on the neighbourhoods from which most of the prisoners come--neighbourhoods where many young men grow up expecting not to go to university but to prison? What are the effects on the many millions of children whose parents are imprisoned?
It is often argued that the negative effects, whatever they are, have been worth it. To some, the matter seems very simple: lock up more people and crime goes down. Certainly the violent crime rate in the United States has decreased steadily. It is claimed that that is because so many people are in prison. The research, which is extensive, suggests that, perhaps at most, 15 per cent of that reduction can be attributed to the huge increase in the use of imprisonment. The research also suggests that if the money that has been spent on that huge increase had been spent on other measures, the crime drop would have been greater than 15 per cent.
The increase in the number of prisoners in England and Wales has also had consequences for the prison system. I hope that we shall discuss that in much more depth in the debate to be initiated by the noble Lord, Lord Hurd, next month.
The Government have high ambitions for the prison system. They want prisons to become places where rehabilitation is the norm, where education levels are improved, employability increased, and drug treatment successfully given. Those high ambitions are excellent, and there is no doubt that many staff in the prison service have the talent and commitment to fulfil them. But such efforts are continually defeated by the pressure of numbers. New prisons are always being built and still prisons are always overcrowded and battling with too many prisoners to do the job that the Government want them to do.
For the Government to fulfil their ambition to make prison a rehabilitative experience for each prisoner, considerable resources will be required. Prison staff will need much better training. They will need more time to give individual attention, time to make links with the community, and time to find employers who are prepared to give ex-prisoners a job. The cost of delivering such a prison system is very high, but it could be done if the number of prisoners were lower.
Resources could be used on those who need to be imprisoned for the protection of the public. Such resources could be concentrated on ways to help prisoners to deal with the problems in their lives that brought them there. Work could be undertaken to bring them to an understanding of the harm that they have done and the consequences of their actions on victims. As the noble Lord, Lord Hylton, pointed out, excellent work on those lines is already taking place in a number of prisons.
Published government plans talk of another 2,660 prison places to be built. Rumours circulating in criminal justice circles suggest that the Government are looking for quick ways to build another 10,000 prison places. I sincerely hope that that really is only a rumour. The Home Office's own projections for the future size of the prison population give three possible figures for the year 2008--the highest being 83,500.
Would it now be possible for the Government to look again at the theory that being tough on crime means locking up more people; that public confidence in the criminal justice system is built on a high use of prison; and that what victims mean by "getting justice" is heavy punishment? I wonder whether that is really the direction in which the Government want to go or whether, as the Chancellor said in the other place earlier this week,
- "the best ... anti-delinquency and anti-crime policy, is to take the next 1 million children out of poverty".--[Official Report, Commons, 25/6/01; col. 397.]
8.35 p.m.
Lord Mancroft: My Lords, I want to ask your Lordships to think for a moment longer about crime--about violent crime, acquisitive crime and drug-related crime, which so often are one and the same thing.
As we have been hearing, the Government have chosen to address the issue of crime in terms of the numbers of policemen on our streets. The assumption appears to be that an increase in police numbers, coupled with a reform of the process by which the criminal justice system operates, will restore confidence in the Government's ability to deliver law and order. Of course, maintaining law and order is one of the primary duties of government.
The single biggest identifiable cause of crime is drugs. The supplying and consumption of drugs, along with the acquisitive crimes needed to purchase drugs, have increased and continue to increase in exact parallel with the levels of relevant crime. Football disorder is clearly very serious, and the Government have addressed it through the gracious Speech. But the drug problem is now probably the biggest social problem facing our society today. However, the Government have not chosen to address it.
When it comes to children, it is amazing how parents from every walk of life, regardless of their colour, race, creed or whether they are rich or poor, share many of the same concerns. One of the greatest concerns that they all share is that of drugs. Because my interest in the subject is well known, parents often raise the subject with me.
What every parent to whom I have ever spoken has in common is a real fear of what might happen to their children and the fact that, even now, they have very little idea of what they can do. When they do obtain information from schools or social services, it is very little and often conflicting. They are right to be concerned. Over 400,000 children under the age of 16 now smoke cannabis. Drugs from cannabis to ecstasy to heroin to cocaine are routinely offered in pubs and clubs throughout Britain.
Yet the whole subject was ignored throughout the election campaign and, apart from the establishment of a criminal assets recovery agency, which the noble Lord, Lord Rooker, mentioned in his speech and which was in the gracious Speech and which may have a marginal effect at best, drugs got no mention at all in the gracious Speech.
The low turnout at the general election has worried many people. One reason why people feel detached from politics is, I believe, that they consider that politicians do not seem able to address the issues that people really care about. One of those issues is drugs. However, I believe that when the Prime Minister and Mr Straw appointed the drug czar after the 1997 election, they really did want to address this issue, in exactly the same way as Mr John Major and Mr Michael Howard really wanted to address it in 1992.
Indeed, the policy adopted by this Government is the continuation of the policy announced by Michael Howard in 1994. But that policy has failed and is continuing to fail for two reasons. First, it is based on impossible targets. The new Home Secretary has effectively sacked the czar, Mr Hellawell, because he has failed to reach his targets. But those targets were always unattainable, and to blame Mr Hellawell for failing to do the impossible does not fool anyone.
The targets to reduce drug use and the onset of drug use among young people by set amounts were never possible, particularly when the only real weapon available is the criminal law. They are impossible for a simple reason. Drug use becomes a serious problem only when users descend into addiction. Addiction is a health problem, and one cannot cure health problems using the criminal law. There may well be a role for the courts but not, I believe, the central role that they have now.
The second reason for that failure is that, although the policy of the previous Conservative government and of this Government seems to indicate a shift away from law enforcement towards treatment and prevention, the reality is that the move has been negligible.
The substantive point is this. Over the past decade, the quality of treatment for addicts here in the UK has improved enormously, predominantly in the private and voluntary sectors. We now have treatment of which we can be proud and, more importantly, which is economically viable and which produces demonstrable benefits. Extensive research conducted over the past few years, including the very good research carried out by the Department of Health, proves without a shadow of doubt that treatment works for the addict, for the family of the addict and for society as a whole. Twenty years ago there were no ex-addicts but today there are lots of them. I have been involved with treatment for more than 15 years. The Drug and Alcohol Foundation, which I chair, provides high-quality day care treatment here in central London. There is good news--thanks to the development of local authority funding, large numbers of our patients are referred by local authorities. The money really does follow the patient.
In the area of in-patient treatment there are other real problems. The lack of meaningful funding means that the number of drug treatment places has not increased in this country for more than a decade. If drugs is a "young people's problem", as politicians tell us, can someone explain to me why there is only one facility in the entire United Kingdom that specialises in the treatment of adolescent drug addicts? It is clear that that should be changed.
Drug treatment providers are currently waiting to see what the results of the new care standards that will be set by the Department of Health will be. If, as we have been led to believe over the past few months, those standards are to be based on the requirements of care for the elderly rather than for addicts, and that en suite bathrooms will become mandatory and that shared rooms will be banned, the number of places will fall by 20 per cent and I suspect that several facilities will close. I hope that the Minister will give me some comfort on that issue, although he may not do so today.
We know that treatment is only part of the answer. The long-term solution to the drugs problem lies in reducing the number of people who take drugs and, as a first step, in reducing the age at which people start to use drugs. The present Government accept that, as did the previous government.
Mentor UK, of which, for its sins, I am also chairman, is the UK branch of the largest non-governmental drug prevention organisation in the world. We work with many governments and are very happy to be working alongside the Home Office or the Cabinet Office. As my noble friend Lord Cope said, we assume that moving responsibility for drugs from the Cabinet Office to the Home Office involves a downgrade. But I really hope that it does not and that the Minister can give us reassurance on that point. I believe that drug prevention is one of the keys to this extremely complex problem. However, in order to achieve meaningful results the Government will have to start spending some real money and accept that it
may take a long time to get results. Advertising campaigns and reluctant schoolteachers are not the way forward. Michael Howard wrote in 1994 that,
- "teachers will discover that pupils know far more about drugs than they do".
Although the Government's reports, of which there are rather a lot, seem at first glance to be catalogues of success, it is worth noting that as yet not one prevention initiative has demonstrably led to a reduction in drug use within any defined social group.
At the same time that treatment and prevention programmes are starved of resources, we are pouring billions into the attempt to police drugs. The Printed Paper Office was kind enough to supply me with piles of expensive glossy brochures that were published by the Cabinet Office. They contain pages of tables showing the amount of seizures of drugs and the number of arrests and--this seems rather odd--three whole pages were about how to catch a drug smuggler.
I learnt that Customs and Excise exceeded its target of disrupting 5 per cent of class A drug traffickers in 1998. That was obviously felt to be very important because it appeared in bold black print. That really is not impressive. We do not want glossy brochures because we also know the other side of the coin. The illegal drugs industry is now the second largest industry in the world. Although Customs intercepted drugs worth £1.25 billion last year, one senior officer told me that he thinks that drugs worth well over £12 billion got through. When a large haul is intercepted nowadays the price of drugs on our streets remains unchanged and during the past 10 years prices have actually fallen while demand continues to rise. Noble Lords do not need to be professors of economics to understand what that means.
The noble Lord, Lord Rooker, said in his excellent maiden speech, on which we all congratulate him, that violent crime is down by 10 per cent. That is good. Moreover, it is very good that last week was the first week in more than a year in which someone has not been shot dead in central London in a drug-related crime involving illegal firearms. That good news is balanced by the fact that a new and particularly unattractive brand of machinegun was used to murder someone in a similar crime in Manchester. It is all swings and roundabouts.
We were told by the Government that when, following Dunblane, the legal ownership of handguns was banned, that would have a noticeable effect on the figures for the criminal use of handguns. When we voiced some doubts about that, they were brushed aside. However, we were right and the Government were completely wrong. A perfectly legitimate sport was destroyed, the taxpayer had to shell out £90 million in compensation and the provision has made no difference at all. Is it any wonder that politicians are held in such low esteem?
The reality is that the war on drugs is a hugely expensive failure and is now arguably causing more harm than good. I know it, noble Lords know it and most parents are beginning to realise it, too. Even the Right-wing media admits it; virtually every serious newspaper accepts the need to look again at the Misuse of Drugs Act. It is apparent that the only people who do not know that are our elected leaders.
Of course, this is an extremely complex and difficult subject. Anyone who tells us that they have all the answers is either very brave or very foolish. We shall have to look hard if we want to make progress and we must be willing to take political risks. In order to achieve any progress the Government will have to show a bit of humility, which they are not very good at.
Last year the Police Foundation produced an excellent report entitled Drugs and the Law. It was well received everywhere except at Queen Anne's Gate. Indeed, the Home Secretary rejected it out of hand within a matter of hours, which, if it showed nothing else, showed that he had not devoted much care or thought to it. It is difficult to have much faith in politicians when they do things like that. It merely serves to alienate people still further.
Perhaps the new Home Secretary knew what I was going to say tonight--he has just executed a policy U-turn by giving his cautious support to the police in Brixton, who announced that from now on they will only caution people who are caught in possession of cannabis so that they can concentrate on other drugs work.
Perhaps my right honourable friend Mr Portillo is canvassing my support--I cannot think why--by suggesting that my party should re-think its drug policy. He is quite right; we should. The Conservative Party and the Labour Party have had virtually identical drugs policies for more than 30 years, when they collaborated over the passage of the Misuse of Drugs Act 1971. That policy is now obsolete and destructive. When Mr Straw said that he would be tough on drugs, he did so in part, I suspect, because he thought that that is what people wanted to hear.
Public opinion is changing, and it is doing so quite quickly. People do not want tough policies or weak policies; they simply want effective policies, and they are not getting them at the moment. That means that change is needed; such change must be debated here in Parliament. I hope that the new Home Secretary will tell the other place what his view of the Brixton experiment is and I hope that noble Lords will also have an opportunity to debate it.
Today's debate, which focuses on health and crime issues, was an ideal opportunity to deal with a subject that straddles both the Home Office and the Department of Health. I presume that the lack of a policy commitment demonstrates a vacuum in the Government's thinking. I have always known that no government would focus on this issue until it rose up the political agenda. It has now started to do so and as Parliament proceeds we shall have to return to this subject in order to fill that vacuum.
The Government have a great deal on their plate if they are to deliver their election promises. They will certainly not be able to improve the levels of policing, improve the criminal courts, prevent the prison population from rising, reduce street crime, reverse the decline in A and E departments or deal with a whole host of other issues unless they address the drugs issue. Addressing the problems that are created by drugs use and drug-related crime has now ceased to be an issue that is on the political periphery. It has become a political imperative, and it will impact one way or another on the delivery of the reforms on which the Government will be judged at the next election.
8.49 p.m.
Baroness Howells of St Davids: My Lords, I welcome this opportunity to take part in the debate on the gracious Speech.
I express some sympathy with the Minister, who by now may feel that every issue of concern has already been raised. I am afraid that I am about to disabuse him of any such feeling by raising a specific issue that is of concern to the black British. I shall, however, be brief.
I begin with racism in the health service. I vividly recall the call that this nation issued after the last war to the colonies to come and assist Britain in rebuilding its public and private services by supplying the much needed manpower that had been lost to Britain in World War II. That call was responded to handsomely and, even though there were several hurdles to be overcome, that generation gave generously, especially to the health service. Britain can be very proud of the work that was done at that time because it certainly gained many plaudits for having such a wonderful service. Those people did that with fortitude and a willingness to serve the country that they regarded as the mother country. Their agenda was simply to ensure a better life for their children, better education and better standards of professional skills as a means of upward mobility.
I pause to read a quote from Desmond Tutu who said:
- "I am not interested in picking up crumbs from the table of those who consider themselves to be my master--I want a full menu of rights".
It is not bad health to which I want to direct my few minutes but rather the employment of the second and third-generation black Britons who suffer racism in the service. In the gracious Speech, it was said that the Government will introduce legislation to reform the health service and that they will bring forward a Bill
which will decentralise power and direct resources to the National Health Service. My plea to the Minister is that in so doing, I trust that part of the budget will be spent on the thorny issue of eradicating racism from within the service. Racism acts as a major hurdle to health and wealth. It puts a needless burden on the service that we provide by denying professionally qualified black staff equity and parity with the white staff of the service.A viable commitment must be put in place and monitored to address equal opportunities in employment. There must be a will to tackle harassment and to provide competent and consistent training in recognising the most subtle forms of racism. It does take an extremely subtle form in the field of employment. We must be aware of the time lost through cruel acts of racism within our society. The report to which I referred calls for a whole systems approach. I urge the Minister to ensure that that happens.
Diversity needs to be valued. Challenging racist and discriminatory practices must be part of the whole service. The previous government strengthened the Race Relations Act by the provisions of the Race Relations (Amendment) Act 2000. That placed a duty on institutions actively to promote racial equality. The report to which I referred, Racism in Medicine, gives a clear and direct account of some of the effects and consequences of institutional racism. It goes on to offer some very practical advice on how to deal with racism in institutions in order to deliver a fair and equitable service.
I invite the Minister to ensure that that report is read because the social exclusion of black British professionals could lead us down alleyways which we have not even begun to contemplate. That is not a threat; it is a fact. Our professionals are not happy with the treatment that they are receiving. I did not use the statistics in the report because I hope that every noble Lord will spend some time reading the facts as they are presented in that report by the professionals themselves.
I respect the number of years' service that the noble Lord, Lord Rooker, has given in the other place. I add my welcome and congratulate him on both the wit and seriousness which he brings to this House. I look forward to working with him as I have worked with the previous Home Secretary and the noble Lord, Lord Hunt.
8.55 p.m.
Lord Clement-Jones: My Lords, today we have had a very wide-ranging debate, as is customary, and we have had some memorable speeches. I do not plan to stray much beyond my usual remit on the health front but I want to mention in particular two speeches from other Benches which I found utterly lucid and compelling; notably, those from the noble Lord, Lord Mancroft, and the noble Baroness, Lady Kennedy. Both were superb speeches which informed this debate in an extremely helpful way.
I too want to add my congratulations to the noble Lord, Lord Rooker, on his maiden speech. I know that he will bring his well-known intellectual vigour and independence to the Home Office where many of us would think that it was sorely needed. I was particularly taken by his evidence-based approach because that is an approach needed in other government departments and I shall turn to that later.
Despite the great anticipation that we all had to hear the first Queen's Speech in this Government's second term, a highly significant event, I am afraid that on these Benches, many of our first and continuing reactions were of great disappointment. First, there is the failure to reintroduce the Tobacco Advertising and Promotion Bill. It is quite astonishing--that is not a word that is often used in this House--because it had already passed through the House of Commons in the previous Session and, indeed, had received a Second Reading in the Lords. Devastating critiques of the Government's decision not to bring forward that Bill were made by the noble Lord, Lord Rea, on the Government Benches and also by my noble friend Lady Northover. I entirely agree with them. Is that another demonstration of the power over this Government of the tobacco companies? It certainly seems to us to demonstrate the Government's lack of interest in preventative health measures since smoking has such a major effect on diseases which are meant to be important government priorities; for example, cancer, heart disease, lung disease and a variety of other respiratory diseases such as asthma.
The second disappointment is the failure to introduce new mental health legislation which is needed to update our very out-of-date mental health legislation going back to 1983. We have had a comprehensive review from Professor Richardson; we have had the Government response; we have had a consultation period. Surely we should now see the colour of the Government's proposals, at least in the form of a draft Bill. Is that simply the Government ducking another difficult issue?
Soon there will be more people in this country diagnosed as suffering from mental illnesses than from purely physical illnesses. That delay seems to demonstrate a complete lack of priority in this Parliament compared with the last when, as the noble Lord, Lord Williamson, made plain, some progress was made in the mental health services field.
Even more disappointing, perhaps, than those two failures is this Government's reaction to their failure to deliver on the health service in their first term of office. At times, the Government's message seems to be that the great salvation of the NHS will be the private sector. I was extremely interested to hear the contributions from other Benches with very similar themes--from the noble Lord, Lord Forsyth, to some extent from the noble Baroness, Lady Carnegy, and other noble Lords, in particular, the noble Lord, Lord Harris of High Cross. It seems a strange set of bedfellows for this Government and I wonder how comfortable they feel in that company. Indeed, the noble Lord, Lord Dean, gave the game away by saying
that he believed that the Government were following Tory policies on health and education. At that point I saw the Minister wriggle.As yet there is no evidence that the private sector has delivered, or that it has the capacity to make much difference to the NHS. In almost every case PFIs have delivered fewer beds than the hospitals that they replace and by closing and reducing services at small local hospitals, they reduce access to patients.
I shall not engage with the Minister in selective quotations from the recent IPPR report, Building Better Partnerships, which was published last Monday, but it is clear that the authors are highly sceptical that so far there have been any benefits in the NHS as regards PFI. The chairman of the commission that undertook the report is a former chief executive of Barclays Bank and the current chairman of W H Smith, so he can hardly be accused of being anti private sector involvement.
The authors say that a cautious approach to the use of PPPs in areas such a clinical services is needed with careful piloting and evaluation. They call for an evidence-based approach; they say that a wider range of procurement models than just PFI is needed. By that I mean procurement models in partnership with the private sector. They further say that accountability models are inadequate and that the public and the National Audit Office should be given greater access to information. The report further states that PPPs should be used to improve standards and not just lower costs at the expense of quality.
I welcome the Secretary of State's subsequent attempt this week to give more clarity to the role of the private sector, but in some ways he has strangely circumscribed the role of the private sector in what he has said. It was almost an over-reaction to the criticism that has been made. We need open information and open debate about the performance of the private sector in such partnerships, so that it can be evaluated properly. This is not a theoretical construct. In that respect I bow to the noble Lord, Lord Harris of High Cross. He is very able to build theoretical constructs; we are talking about practical application and whether benefits are brought about for the patients and the National Health Service.
Ministers extol the virtues of evidence-based medicine. We need hard evidence of the benefit of PFI and other partnership initiatives with the private sector. We are in a strange situation where the vice-chairman of investment at NM Rothschild urges the adoption of a wholly different PPP model, which provides better value and more flexibility for the taxpayer and the Government.
More generally, what kind of impact on morale does the Government believe that they have to extol the extension of delivery by the private sector as the way
to meet targets? It is clear that it is a serious deterrent to those contemplating a career in public service--dare I use that phrase--and in NHS healthcare.We do not have a great pool of untapped talent in the private sector, as the Secretary of State admitted at the weekend, so why are we demoralising those in the public sector where there is such a pool? As the King's Fund has said,
- "enterprise does not have to be the preserve of the private sector".
- "A more constructive way forward than chasing a myth would be to capitalise on the talents of public sector managers to improve standards across the service--not ordering in private sector teams to run red-light trusts, but harnessing the skills of the best NHS teams to help the not-so-good do better".
If, in the face of that, the Government have a privatisation agenda, let us hear about it in the open and not by stealth. A previous Secretary of State for Health, Mr Frank Dobson, certainly seems to disagree with the Government's current approach. He has stressed that taking on the health unions on the subject is not the right approach. No doubt today we shall hear the outcome of today's meeting at No. 10.
A second limb of the Government's response to their failure to deliver is their promised measures to decentralise. My noble friend Lady Northover was absolutely right to be sceptical about the Government's intentions. After all, that commitment comes after several years of relentless centralisation. How will merging the existing health authorities in England into 30 larger authorities constitute decentralisation? What discretion will they be allowed? What will be the acceptable level of variation? In what experimentation can they engage? What impact will all that have on a future English regional devolution programme?
Recently Professor Rudolph Klein summed it up well in the BMJ:
- "The first reaction to Mr Milburn's speech is, however, likely to be one of cynicism. At one time or other all Secretaries of State for Health--Conservative as well as Labour--have rhetorically embraced the notion of devolving power. But this has not stopped a seemingly unstoppable trend towards ever greater centralisation, culminating with the present government".
We on these Benches support genuine decentralisation and innovation--the public supports innovation--but it must be for patient benefit. As for improved patient representation--that rather interesting euphemism used in the Queen's Speech--I shall not anticipate the debates that we shall have on the Bill when it emerges, but we shall look at it with extreme scepticism if it bears any relationship to the scheme put forward in the last Health and Social Care Bill.
The Kidderminster Hospital drama is a lesson for the Government. A defeat of a government Minister
on a single issue campaign perhaps can be shrugged off when a government have a majority of 166, but this is a cloud that is no bigger than a man's hand that could blow up into a major storm if the Government continue down their current track. How this Government deliver will be just as important as what they deliver. Will they genuinely consult with staff and patients? Will they take their views into account? Will they be open and transparent about the performance of their initiative? Will they genuinely decentralise and empower those who run health services at local level?In the face of that, noble Lords may ask what our prescription is for the better health of the NHS and what are the priorities of these Benches. First, we believe that more resources are needed than are currently planned. In particular, an increase in staffing levels is needed beyond those planned. We desperately need to build capacity, as my noble friend made clear. No doubt Ministers have studied carefully the recent report that they themselves commissioned from the Policy Studies Institute which graphically describes the stress suffered by senior nurses in particular. Because of lack of staff, they fill the gaps themselves with extra shifts rather than taking on agency staff. Morale in the NHS is at an all-time low. Noble Lords will have heard a debate held before the election. All the evidence during the election supported what we said at that time. We knew then that four out of five doctors would leave the NHS if they could. Now we know that one out of three nurses is contemplating leaving the health service.
There is no substitute for more capacity and more health service staff. Last month the outgoing general secretary of the Royal College of Nursing, Christine Hancock, said,
- "Without enough nurses and other healthcare staff, make no mistake, NHS modernisation will fail".
All that means better recruitment and retention and we cannot achieve that without better pay and conditions. Furthermore, we cannot achieve it without being absolutely clear about the resources that are needed. Primary care, in which there is a gap of some 8,000 general practitioners between what the BMA says is necessary and what the Government are committed to providing, is a case in point. Problems over doctors' contracts arise to a high degree because of excessive workload, and reassurance about levels of recruitment are needed.
Secondly, we need to make better use of existing resources. We want to extend prescribing to nurses and professions allied to medicine and we share the Government's goals in that respect. We see a much greater role for community pharmacists. We see an opportunity for non-invasive surgical techniques and telemedicine to give a greater role to small hospitals.
We see the provision of intermediate beds at some of our small hospitals. Indeed, the Kidderminster case clearly demonstrates that we must find a role for these small local hospitals. Some of those proposals represent ways in which we can do that.Thirdly, we need a major change in management style. The Secretary of State is effectively the executive chairman of the NHS, which belies his decentralisation rhetoric. The purse strings are firmly kept at the centre with trusts in virtually every case having to bid for new money for initiatives. That is all very time-consuming and bureaucratic. Together with decentralisation measures, will the Government undertake to reduce such red tape and reduce the amount of micro-management that is taking place?
Fourthly, we need to define the benefits of public-private involvement. In particular, we need to evaluate the benefits of PFI. We need to use PFI and other forms of PPP where that is demonstrably superior to pure public investment. We need to improve the way in which we have public-sector comparators. We also need to remove the bias so that there is genuine choice for hospital trusts between the different ways of financing. We need to ensure that we introduce more flexible contracts. Above all, we need to define the risk being transferred into the private sector. At present, many contracts are pure fudge and we need to look at different models. We on these Benches are not against public/private partnership in principle, but we need transparency about whether or not they work.
Fifthly, we need to end bed-blocking. Unless we ensure that appropriate arrangements are in place either in the community, in intermediate care or in acute hospitals, we will continue to suffer bed crises, and not just in winter. We have disagreements with the Government on the funding of long-term care, which have been well rehearsed, But the Government now appear to be reconsidering their commitment to fund even the limited amount of free nursing care to which they committed themselves in the Health and Social Care Bill. Will there be a cap on the nursing care provided? We believe that there must be a response to the recommendations of the Future Imperfect report by the King's Fund on the state of support for older and disabled people. If there is no improvement, how will there be any incentive for older people to leave acute hospitals in order to free beds which are necessary for those requiring acute care?
There is a huge agenda ahead of the Government and the Minister is very active in responding to our criticisms and constructive suggestions. We will be constructive in our approach to legislation when it comes before the House. However, we expect evidence not assertion; we expect increases in capacity, not restriction; and we expect consultation, not diktat. On that basis, we shall certainly work with the Government.
9.12 p.m.
Earl Howe: My Lords, as we embark upon a new Parliament, it is perhaps appropriate that I should
begin my remarks today by congratulating the Government on their success in the general election. The majority which they have secured in another place is by any standards a remarkable achievement. The sense of disappointment shared by all of us on these Benches should not lead us to begrudge the Government their success. I am sure we are all delighted that the Prime Minister saw fit to reappoint the noble Lord, Lord Hunt, to his ministerial position at the Department of Health, a position which he has occupied so ably. I join other noble Lords in welcoming the noble Lord, Lord Rooker, to the Front Bench of your Lordships' House and in congratulating him on his excellent maiden speech.In remarking on the Government's majority in another place, it is worth saying that by virtue of that mandate the task which falls to us in this House of opposing the Government--by that, I chiefly mean probing them, testing them and calling them to account--is rendered all the more important. I have little doubt that that view is shared by noble Lords on the Liberal Democrat Benches but it is one which during the years ahead I believe we should all bear in mind, regardless of party. It is counter-productive and wrong for an opposition to oppose for the sake of opposing. The Minister knows that I for one will never do that.
Looking back over the previous Parliament, there were many areas in which the Minister and I were able to agree completely, but, as we consider the words of the noble and learned Lord, Lord Williams of Mostyn, last week, we must treat with great caution any proposal to reform our working arrangements if they risk hampering the ability of this House to discharge its duties effectively, particularly in the scrutiny of legislation. I am as passionate about that as I am open-minded about ideas for change.
If there has been one noticeable strand of thought permeating the contributions to today's debate, whether on home affairs or health issues, I suggest that it is humanitarianism. I have in mind in particular the thoughtful speeches of the noble Lord, Lord Fitt, both right reverend Prelates, my noble friends Lord Forsyth, Lord Mancroft and Lady Carnegy, and the noble Baronesses, Lady Masham and Lady Kennedy of The Shaws. I could mention several others. In that vein, it is a considerable pleasure to look forward with the noble Lord, Lord Harrison, to the arrival of an adoption and children Bill. If, as I hope, the Bill is modelled along similar lines to the measure which had to be withdrawn because of the general election, I can tell the Minister that we shall welcome it and give it our most constructive attention. I believe that the Government share our view that legislation on adoption should put the interests of the child at the centre of the adoption process. That was the general principle which underpinned the Children Act. It is terribly important that more parents should be able to
adopt children if they wish to do so, not as a means of gratifying their wishes--still less as a means of cutting bureaucracy, however much we may regard that aim as desirable--but rather as a means of giving more children the opportunity to have a loving and secure family environment in which to grow up.I was interested to read in The Times on Monday a letter from Liv O'Hanlon, head of the Adoption Forum, who has done so much to champion the cause of adopted children over the past few years. She particularly emphasised that any reforms will count for little unless they are backed by adequate funding. I suggest that we call that point to mind with some regularity during the passage of the legislation. I hope that the Minister will personally pursue it as he did the very similar issues which arose from the Children (Leaving Care) Act.
Like other noble Lords, I was surprised and bemused by some of the lacunae in the gracious Speech. As the noble Lord, Lord Rea, among others, pointed out, perhaps the most obvious lacuna is the proposed ban on tobacco advertising. Having been roundly told only a matter of weeks ago by the Secretary of State that the Government were determined to do something about tobacco advertising, and having heard the noble Lord, Lord Hunt, tell us that the Tobacco Advertising and Promotion Bill held out the prospect of saving 3,000 lives a year, it is odd that that measure is no longer the Government's priority that it once appeared to be.
Of equal concern, however, must be the absence of any announcement about a new mental health Bill. That lacuna was mentioned in particular by the noble Lords, Lord Williamson of Horton and Lord Clement-Jones. I hope that the Minister will take the opportunity to reassure us that there has been no weakening on the Government's part as regards their commitment to bring forward legislation to reform the current Mental Health Act. As all of us accept, that Act is out of date in the context of current practice and attitudes. I pay tribute to the Government for a good deal of useful work in preparation for such a Bill. I only hope that we shall see that work bear fruit before too long.
One measure to which we can look forward, no doubt with eager anticipation all round, is an NHS reform Bill. I hope that I do not sound too ungrateful, but it seems only the other day that we finished debating a very substantial NHS reform Bill. I am tempted to wonder how many more such Bills the Government have in store for us over the next five years. I understand the imperatives. From the point of view of the Government, there is a certain amount of unfinished business relating to patient representation. There are also a number of reforms to the GMC which I very much hope will prove to be uncontroversial. But the part the Bill which has received perhaps most coverage in the press and elsewhere is the proposal to devolve 75 per cent of NHS spending power directly to front-line staff. As the Minister knows only too well, I
am all for decentralisation. Giving front-line staff the responsibility for local spending decisions is definitely the way to motivate those staff better and to make the NHS more effective and efficient. That was the principle which lay behind GP fundholding, which, regrettably, the Government abolished.I hope that I may be forgiven for echoing my noble friends Lord Bridgeman and Lady Carnegy, among others, in sounding a slightly sceptical note as to how the much-heralded decentralisation will work in practice. If old attitudes in Whitehall persist and if what the Virgin Group in their review described as "management by cascading paper" remains ingrained in the culture of the NHS, then I am anxious. The Minister and I have been fond of teasing one another on the subject. But he will agree with me that at its heart this is a real and serious issue. Of course there have to be targets set from the centre. The question is what, and how numerous, those targets should be. The trend over the past four years has been to accentuate the role of the department in setting targets rather than the opposite. I believe it would be better for doctors, managers and patients if that trend were now reversed.
In that context, it was with considerable relief that I learned that the Government had abandoned their manifesto pledge from 1997 to bring down the numbers on the in-patient waiting list. If ever there was a recipe for the misallocation of resources and poor clinical prioritisation it was that policy. With the emphasis now on waiting times, I agree with my noble friend Lord Dean that we are certainly moving towards a better kind of regime. However, even here, I would respectfully counsel caution to the Minister. So long as such targets remain in blanket form, they are by their very nature indiscriminate and take no account of clinical need. They are useful as a general benchmark of performance but not, I suggest, as an absolute indicator of efficiency, still less of clinical effectiveness. I hope that Ministers will not try to have us believe otherwise.
The Government know that there is much that needs to be done to improve the delivery of healthcare in our country. We sometimes need to remind ourselves that in trying to improve the health service we are building on a strong base. I am talking now about the men and women who work for the health service and whose motivation in their professional lives lies in serving the public.
I was glad to read the letter in The Times last week from Mr Nigel Crisp, chief executive of the NHS, who reminded us that we need to take a balanced view of the NHS and its problems. But I would suggest to the Government that in reaching a balanced view we should look at some of the indicators that really matter.
It is a sad fact that clinical outcomes in England for many of the major cancers are below the European average, and often very considerably below the best in Europe. Many patients with heart disease are not receiving the best treatment in a timely fashion.
Disabled patients are subject to huge variations in service levels around the country. There is a shortage of dialysis facilities for renal patients. Standards of basic hygiene in hospitals have slipped. Trolley waits are too long and too many.Although I have just counselled caution over the interpretation of waiting times, there are signs that in certain fields there has been a regrettable deterioration in service standards since 1997. One example cited by the noble Baroness, Lady Masham, is audiology, which, despite the Government's welcome initiatives, is now badly under-resourced in terms of facilities and staff. I commend to the Minister, if the noble Lord has not already read it, the RNID's document called Audiology in Crisis--Still Waiting to Hear.
My noble friend Lord Forsyth, in his extremely wise and thoughtful speech, expressed the hope that the Government will not shrink from embracing a genuine partnership with the private sector for the delivery of healthcare. I share that hope. The Government's concordat with the private sector is not, of course, a panacea, but I believe that it opens the way to a real advance in the delivery of services to patients, provided always that Ministers make up their minds to follow it through. What counts for a patient is not where treatment is delivered but rather the quality of that treatment and its timeliness.
I have no doubt that in voting Labour at the general election, many people were implicitly putting their trust in the Government to deliver better services to the public, including healthcare. The next four or five years will be the test of that. It does not require any great insight on my part to point out that the key to success in healthcare will be to lift morale among staff, because on that morale depends the ability of the NHS to recruit and retain the GPs, the consultants, the nurses, the midwives and the other key professionals who deliver care to patients. Many staff are severely overburdened. There are serious shortages in nearly all the main disciplines. The challenges are therefore considerable. But much has been promised. From these Benches, in fulfilling our role as a critical Opposition, we shall nevertheless encourage the Government in their efforts to meet those challenges, and for the sake of us all as patients and as owners of the NHS, we wish them success.
9.25 p.m.
Lord Hunt of Kings Heath: My Lords, this has been a debate of very high quality, which we all agree was opened in splendid fashion by my noble friend Lord Rooker in his maiden speech. I am certainly delighted to welcome him to your Lordships' House, not least because he has increased the number of Birmingham Peers in the House by at least 25 per cent, although sadly not the even more limited number of Birmingham City Football Club supporters.
Responding to such a debate in the 20 or so minutes that are given to me is undoubtedly a challenge and I shall write to all noble Lords to whom I am not able to
respond during the course of my speech. But it is also a challenge because at first sight it might be thought, as the noble Lord, Lord Phillips, suggested, that health, social care and home affairs have little in common. Although I think that the noble Lord directed his dagger at the wrong source, I agree with him that there is a debate to be had about whether the way we debate the Queen's Speech at the moment is the most effective.When one looks closely at health, home affairs and social care, I would suggest that there are some strong interconnections between those areas in at least three respects. First, as the noble Earl, Lord Howe, identified, there was a humanitarian theme--a theme of civil liberties and individual rights--running through many of the contributions to the debate. The second is the impact on health and well-being in society of the devastating effects of crime and the fear of crime. The third is the management, direction and leadership of two great public services--the NHS and the police force. Noble Lords have today debated how those services might be improved and the role of government in that. I shall come back to that point in a moment.
The impact of crime on individuals is never less than serious. For some it can be devastating. As the noble Lord, Lord Dholakia, suggested, crime and the fear of crime often affect the most vulnerable in society. It is often the same group of people who also suffer from major inequalities in comparison with the overall health of people living in this country. Like other noble Lords, I listened to the remarks of the right reverend Prelate the Bishop of Durham, who spoke of some of the factors causing serious problems to the very fabric of our society and of the need to tackle the root causes of crime where legislation often has its limitations.
It is surely important to recognise that if we are to have a fair society where everyone in our communities, and not just some, get a fair chance to succeed, then strong public services, the fight against crime and the tackling of health inequalities must be a core part of our endeavours.
In his opening remarks, the noble Lord, Lord Cope, went through the list of responsibilities that have been taken away from the Home Office. I notice that none of them has been allocated to the Department of Health, which is probably just as well. However, I would say to him that the transfer of drugs responsibilities is by no means a downgrading of that matter within government as a whole. The Government will treat these responsibilities just as seriously as they take their responsibilities in tackling crime. As the noble Lord, Lord McNally, suggested, it allows the Home Office to focus on a number of important core activities and within the strategic framework suggested by the noble Viscount, Lord Goschen.
My noble friend's remarks concerning the need to look at previous Home Office legislation to see how
effective it has been and what lessons have been learnt certainly struck a chord with many noble Lords. I accept that that is a philosophy which we, too, in the Department of Health need to take to heart. If I have learnt anything during my years in the National Health Service, it is that it is a great challenge to move from policy agreement to actual implementation. I certainly agree that we need to focus our attention much more on how policy is implemented and on how to ensure that it is delivered consistently across the field. I noted the offer made by the noble Lord, Lord Harris of High Cross, to help the Home Office in its review. That will receive the attention that it undoubtedly warrants.That said, it is fair to point out that the Home Office Bills referred to in the Queen's Speech have generally received a welcome. The Government have set out a 10-year plan for reforming the criminal justice system as well as reforming the law to make it more effective in tackling crime. The criminal justice Bill will form the first stage of that programme and is designed to begin the process of reforming arrangements for sentencing. Several noble Lords have referred to the fact that, in the longer term, we shall have the report covering a major review of sentencing. I can assure the noble Lord, Lord Cope, and the noble Lord, Lord Williamson, that ample opportunity will be provided for consultation. We shall also be considering the proposals that will emerge from the review being conducted by Sir Robin Auld.
Like all noble Lords, I listened with great interest to the remarks made by my noble friend Lady Kennedy. She passionately raised the issue of civil liberties. Perhaps I may say that I agree with her comments that state powers have to be held in check. I agree that checks and balances must be put in place. However, as my noble friend Lord Mackenzie pointed out, we also have to consider the civil liberties of the victims of crime. A balance must be struck here and I believe that the Human Rights Act has enabled us to strike that balance.
As regards the issue of double jeopardy in the criminal justice Bill, I shall refer to the remarks made by the right reverend Prelate the Bishop of Durham and say that this was not a knee-jerk reaction. This followed on from the report on the Stephen Lawrence inquiry and was referred to the Law Commission, which reviewed this area of the law. The Home Secretary asked the commission to take into account our international obligations, including the European Convention on Human Rights. My noble friend Lord Rooker has stated that we wish to seek consensus in this area. We are keen to encourage the closest possible consultation with Members of your Lordships' House on these very important matters.
Likewise, I shall say in relation to the proceeds of crime Bill that it is surely right that we seek to take action against big-time criminals who for too long
have lived off the criminality of others and the misery of the law-abiding public. However, again we recognise that there are important issues which have to be considered. We shall welcome the consultation and full involvement of noble Lords in discussions on the Bill.The noble Lord, Lord Phillips, made some interesting remarks about reform of the criminal courts. He referred to the published interim report. I say to him that, in relation to the magistracy, the Government have said consistently that we see the lay magistracy as continuing to play a significant role in the criminal justice system. I certainly echo his remarks about the valuable role played by lay magistrates in our civic society. I would also say that, from the health service point of view, I regard their position as being similar to that of the non-executives in NHS organisations. They, too, play an enormously valuable role within the community. It is right to say that, although the noble Lord expressed doubts the failing civic responsibilities demonstrated by many people, the fact is that many thousands of citizens in our society make an enormous contribution to public life, and long may that continue.
I greatly appreciated the remarks made by the noble Baroness, Lady Stern, when she referred to a number of issues relating to prisons, the prison population and the rise in the number of prisoners. Let me make it clear that the Government believe that prison should be used to protect the public. Where the public are at risk from dangerous sex or violent offenders, or others who cause real harm to members of the public, it is right and proper that prison should be used. Where dangerousness is not an issue, there should be tough, demanding and focused community penalties which are designed to not only punish offenders but to guide them away from offending behaviour. The Criminal Justice and Court Services Act 2000 strengthened the use of community sentences by introducing a new focus on enforcement. It will be important to ensure that we monitor its appropriate implementation.
I echo the remarks of all noble Lords who have welcomed the future debate on prisons, which will be led by the noble Lord, Lord Hurd. The noble Lord, Lord Hylton, referred to two interesting initiatives in relation to prison. I shall be happy to take them back for the Home Office to consider and to respond to the points that he raised.
It is worth saying that we have invested money in a number of initiatives to improve the regime in prisons, including drug treatment programmes, offending behaviour programmes and injecting more resources into education. My own involvement from the Department of Health in working with the Home Office to improve the prison health service is beginning to pay dividends.
The noble Lord, Lord Dholakia, raised some important points about race relations in this country. I echo his remarks. He will know that the Race
Relations (Amendment) Act 2000 is the most radical piece of race relations legislation in 25 years. The remarks of my noble friend Lord Rooker in terms of a review of how we can make sure that such legislation is implemented effectively are important in relation to the questions that the noble Lord, Lord Dholakia, asked about the Government's determination to do all that we can to ensure that this country has excellent race relations. He will know that I very much share that view.My noble friend Lady Howells made some pertinent remarks about the problems and issues of racism in the NHS. I accept the challenge that she laid down to me in relation to equal opportunities in employment and the need to take a whole systems approach towards tackling racism and harassment in the National Health Service.
A number of comments were made in regard to asylum procedures. My noble friend Lord Rooker, who has responsibility for this issue, has listened carefully to the points that were made. I shall follow up a number of the specific issues that were raised.
A number of remarks were made about the management of both the police service and the NHS which I think it will be helpful to consider together. Although the structures and forms of accountability of the two organisations are very different, I believe that there are certain common themes. There is a need for accurate information by which to judge performance and to make that information readily accessible to the public; there is a need to ensure that value for money and efficiency are watchwords for both organisations; there is a need to encourage best practice and to iron out unacceptable variations in performance, and to intervene if such action is required. My noble friend Lord Mackenzie got it absolutely right when he referred to widespread differences and the need for robust leadership.
I heard what the noble Lord, Lord Dholakia, said about the Home Secretary's relationship with police forces, but I should say to him that our police Bill is designed to strengthen police forces, their efficiency and their ability to fight crime. The proposals for a new complaints system are the result of widespread consultation and have widespread support within the community.
The debates about the police service and its relationship to central government have the air of some of the debates that we have had in your Lordships' House about the relationship between government and the National Health Service. We have spent many happy hours discussing this. The noble Earl, Lord Howe, has returned, once again, to his charge of over-centralisation, which was echoed by the noble Viscount, Lord Bridgeman. I will not debate this issue for too long with the noble Earl. I suspect that when the NHS modernisation Bill comes to your Lordships' House we will have ample opportunity to revisit this question.
I believe that it is possible--and since I have been given responsibility for performance management in the NHS it is my job to make sure that we deliver this--to reach a sensible balance between the need for robust intervention where there is undoubted failure in delivery with ensuring that much greater autonomy is given to those who are succeeding, and to give people room to breathe, to innovate and to show the kind of leadership that is required. That is what "earned autonomy" is all about. I am determined to see that we put that into practice. The Bill allowing us to place 75 per cent of all NHS spending power directly to front-line staff will enhance that process.
I assure the noble Lord, Lord Williamson, that nothing will be done to undermine the commitment and the priority that is given to mental health. We certainly intend to legislate to reform the Mental Health Act. We are always subject to the strictures of the parliamentary timetable, but we are determined to make progress in that very important area.
The right reverend Prelate the Bishop of St Albans made some interesting points about partnership. I agree with him: it is an easy word to use. It is very hard to make real partnerships work for the benefit of patients and for the public. It takes time and determination. The good news is that, over the past two to three years, relationships between the NHS and local government, to take one partnership, have improved enormously. We want to build on that. The establishment of care trusts as a result of the Health and Social Care Act is one way in which that will be done.
I accept the right reverend Prelate's concern about the pressures on general practitioners. They are under great pressure. We owe them a great deal. We seek, of course, to employ more general practitioners. We have increased the number of medical education places. We also want to encourage more people to return to general practice where that is appropriate. But I also believe that some of the work that has been done in the primary care collaborative is available to show how GPs themselves can improve their working practices.
The right reverend Prelate raised the issue of overseas recruitment. Our aim is to recruit from those countries that have a surplus of medical or nursing staff and not to do anything to undermine the healthcare systems in those countries.
I listened with a great deal of interest to the noble Lord, Lord Forsyth--first, to his recantation in relation to some of the past structural changes to the NHS in which he was involved. I very much welcomed the noble Lord's intervention, although I do not accept his analysis of our stewardship of the National Health Service. I reject the noble Lord's assertion that a public NHS cannot provide a high quality service. I have always believed that if we get the funding right, with
the absolute dedication of the staff and the high quality teaching and research that we have in this country, we shall be able to produce the kind of high quality public health service that people in Britain wish to see delivered.Our approach has been to develop best practice. It has been to achieve greater consistency--that is why we have national service frameworks: the National Institute for Clinical Excellence, the Commission for Health Improvement. Alongside that, the approach is to increase our capacity, with more beds, more staff, renovated A&E services and new services such as NHS Direct.
The NHS is not perfect, but it is improving. I believe that it will go on to improve. I have great confidence that we shall be able to build the kind of NHS that was the express wish of the public in the general election.
A number of noble Lords referred to our intention in the forthcoming Bill to revisit the issue of patient and public participation in the NHS. There is nothing I should enjoy more than further debates in this area. I have said all along that there is only one test for our proposals; namely, that the public and patients will have a greater say, more influence and better representation in those arrangements than they do at present. I am very happy to be judged and tested on those proposals.
Several remarks were made about our relationship with the private sector. We believe that there is much to be gained from partnership. Unlike the noble Lord, Lord Clement-Jones, I believe that the private finance initiative can bring resources, investment and expertise to help us speed up, for example, our hospital building programme. In relation to beds, I also believe that the noble Lord is missing the point. If one looks at the trend of bed numbers going back over the years as regards publicly-financed hospitals, one will see a similar reduction. With the national beds inquiry that we have instituted and with our determination to increase capacity in the NHS, the equation will be changed both as far as concerns PFI schemes and publicly-funded schemes.
I should tell the noble Viscount, Lord Bridgeman, that we welcome the concordat with the independent sector. I believe that there is everything to be gained from a good understanding at national and local level. Over the past few months, I know that some very good contracts have been agreed between independent providers that have enabled the NHS to increase its capacity.
A number of comments were made during the debate about morale in the NHS. When I joined the NHS in 1972, I was told that morale had never been lower. I believe that it has always been a characteristic of staff to say that morale is low. None the less, we
must always take note of warning signs. It is most important that the staff in the NHS feel that they are part of the change and that they should feel ownership of the change. By increasing the number of staff, by trying to reduce some of the pressures on them and by improving working conditions and their access to training and development, I believe that we shall be able to improve morale. However, there is a tremendous leadership challenge at local level. One of the reasons that we established a leadership centre was to encourage and help leaders--managers and clinical directors--to develop and lead their staff. I am sure that that is one way in which we shall be able to tackle the issue of morale.My noble friend Lord Fitt mentioned the issue of juvenile arthritis. I certainly took note of what he had to say. In relation to NICE, I shall simply say that we established this organisation to combat postcode prescribing because the NHS had such a poor record in introducing new techniques, treatments and drugs when they had been proven to be highly effective. The point about NICE is that if it makes a judgment that such treatment is effective, we can then speed up its implementation in the NHS. I should point out to my noble friend that I believe the NICE process has been shown to speed up innovation.
I always take pleasure in debating dentistry issues with the noble Lord, Lord Colwyn. I confirm that we are committed to NHS dentistry. We want to work with the profession. We shall shortly be introducing a workforce review. I should tell the noble Lord that the strategy that I published a year ago is an essential foundation for a new working relationship with the dental profession.
The noble Lord, Lord Clement-Jones, the noble Baroness, Lady Northover, and my noble friend Lord Rea raised the issue of the tobacco Bill. I should like to reassure the House that we are committed to bringing back the Bill to ban tobacco advertising and promotion during the course of this Parliament. As noble Lords opposite well know, there will always be pressure and competition as regards places in the legislative programme. However, as my right honourable friend the Prime Minister said during a debate on this very matter in another place, this is a very high priority. If time permits, we shall try to accommodate it in this Session; otherwise, it will certainly be a high priority for a future Session of this Parliament. We shall, of course, take great note of the comments that have been made in your Lordships' House tonight.
I very much enjoyed and respected the speech made by the noble Lord, Lord Mancroft. I want to reassure the noble Lord that the lack of any legislation in the area of drugs and drugs misuse is
no indicator that that is not a priority for the Government. The noble Lord referred to the 10-year anti-drugs strategy launched in 1998. We are determined to press forward on all aspects of the strategy: young people, communities, treatment and availability. I agree with the noble Lord that research has clearly shown the links between drugs and crime and that getting drug misusers out of the criminal justice system and into treatment works.I listened with great interest to what he had to say about the potential impact of the National Care Standards Commission on drug treatment centres. I shall study those remarks to determine whether any problems will arise in that connection. As regards treatment, we have set up a national treatment agency. This is a cross-government initiative which brings together budgets from different parts of government. It will ensure that treatment is available and accessible and that there will be high quality services regardless of the route of referral.
I turn to the remarks of the noble Baroness, Lady Masham. I thank her and the noble Earl, Lord Howe, for their congratulations on my reappointment to the same post. The noble Baroness suggested that I be promoted. I cannot possibly comment on that. However, I agree with her that national specialties constitute a vitally important issue. In decentralising many decisions to the local level we also have to ensure that, particularly with regard to national specialties where there is only limited provision throughout the country, we make sure that there is provision and appropriate treatment and support. That is why we have a national specialties commissioning group. It is a matter to which I shall give full attention.
Last, but certainly not least, I return to the issue of children. Our debate has touched upon social disadvantage in a number of areas and none more important than among children. I very much agree with my noble friend Lord Harrison. He was right to mention welfare, long-term fostering and, of course, the impact of the adoption of children Bill. I agree with his remarks about the training of adoption staff. It is extremely important to ensure that when the Bill is enacted social services authorities will be able to implement it in as appropriate and efficient a way as possible.
My noble friend Lady Gale made some apposite remarks on the involvement of women in politics. As regards legislation being available in time for the Welsh Assembly and Scottish Parliament elections, I cannot give any commitment but I understand her desire for speed in that matter.
I have sought to draw some common threads through what I believe has been an excellent debate, although not, I hope, in any contrived or artificial
sense as noble Lords brought so many links to the discussion. The links between social exclusion, crime, fear of crime, health and well-being are so clearly apparent that a cross-cutting approach certainly in central government but crucially at the local level becomes ever more important. I believe that the legislation mentioned in the gracious Speech in relation to home affairs and the Department of Health will help us in that aim. I commend it to the House.
Lord Filkin: My Lords, I beg to move the debate be now adjourned until tomorrow.
Moved, That the debate be now adjourned until tomorrow.--(Lord Filkin)
On Question, Motion agreed to, and debate adjourned accordingly until tomorrow.
Barclays Group Reorganisation Bill [HL]
National Australia Group Europe Bill [HL]
The Chairman of Committees acquainted the House that pursuant to the resolution of 21st June the Bills had been deposited in the office of the Clerk of the Parliaments together with the declarations of the agents; the Bills were presented, read a first time, read a second time pro forma and committed to Unopposed Bill Committees.
- House adjourned at five minutes before ten o'clock.
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