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Lord Ackner: My Lords, I wonder whether the Minister can assist with the answer to one question. Frequently, she used the word "victim". Is that synonymous with "alleged victim" or "complainant"? If it is, would it not be wiser to use either of those two words in order to avoid the risk that it sounds as if the
onus of proof is on a defendant and not that a defendant is presumed to be innocent until the contrary is proved beyond all reasonable doubt?
Baroness Scotland of Asthal: My Lords, I understand the import of what the noble and learned Lord said in relation to the distinction that should properly be drawn between "victim" and "alleged victim". However, noble Lords will know that I have made a generic speech in which I was hoping to seek to draw the attention of the House to the reality that there are very real victims of crime. We seek to address their needs in our legislation better to support them so that they are able to obtain justice. Of course, the noble and learned Lord is right to say that that does not, in any way, prejudge whether a defendant has committed an act for which he or she should properly be dealt with. However, it is right for us to recognise the victims. They suffer, and we must address their needs.
3.30 p.m.
Baroness Anelay of St Johns: My Lords, I thank the Minister for introducing this part of the debate on the Address in the manner in which she has done so. All governments have a duty to protect their citizens, when they are unable to protect themselves. Any measures that the Government introduce this year that seek to achieve that without any improper or undue assault on civil liberties will attract our strong support.
I shall address my remarks to Home Office issues only. I appreciate that the noble Baroness may address health matters; my noble friend Lord Howe will speak on those later. The noble Baroness rightly put her remarks in the context of matters of justice. I know that, on other days, my noble friends will address issues relating to civil partnerships, so I shall not encroach on those matters today.
As the noble Baroness said, we have two draft Home Office Bills to consider this year. I was, as I am sure she expected, tantalised by the prospect of a third Bill, one on corporate manslaughter. That will be a serious matter and will attract much comment not only from the legal fraternity but from many interest groups.
The Bills that we will soon have in front of us are those on identity cards and charities. I have no doubt that my noble friends on the Back Benches will give detailed and robust consideration to those Bills, when the committees are formed. The Home Secretary has claimed, as the noble Baroness did today, that identity cards are needed, so that the Government can tackle crime, fraud, illegal immigration and terrorism. The problem is that, so far, the Home Secretary has failed to demonstrate the benefits that identity cards would bring. He is yet to provide clear safeguards for our civil liberties, and some of his Cabinet colleagues have, over the past few weeks, made it clear to the press that the Home Secretary has failed even to persuade them that the scheme should go ahead. It is right that the Government should confine the matter to a draft Bill at the moment, so that we can give it rigorous scrutiny.
The Minister referred to the charities Bill. We look forward to making good progress on it. The Minister is right to say that charities have long sought legislation.
Whether or not the Bill reflects the detail of what they want, they support the principle that the Minister outlined today. Charities play a valuable role in all areas of public life, but they are often held back by unwieldy bureaucracy. I hope that the Bill will not be heavily bureaucratic. We will want to examine closely the Government's new legal definition of "charity", which must not be used to undermine the valuable work of existing charities, particularly those in, for example, the education sector.I turn to the two important Home Office Bills that lie ahead in this Session. As always, we wait to hear how many extra government Bills are waiting in the wings for our enjoyment. One of the Bills has, in its Short Title—it seems like a long one—the word "crime". The Government could, I suppose, treat it as a Christmas tree Bill. It might be that what is sauce for the goose is sauce for the gander. We shall see what happens.
There is to be a Domestic Violence, Crime and Victims Bill. I recognise, as the Minister rightly did, the concern raised by the noble and learned Lord, Lord Ackner, about the way in which we use the word "victim" in a context in which it could mean an alleged victim or somebody who had, in fact, suffered some injury. I hope that the noble and learned Lord will forgive me for using the abbreviated form "victim". Like the Minister, I recognise that, although, in every case, somebody alleges that they have suffered damage, they cannot be called a "victim" until that damage has been proved in a legal context. I know that organisations that put together statistics include all those who have claimed damage, as well as those who have been proved to have suffered damage. I suspect that one of the Government's driving motives is a concern that people who are, indeed, victims have, because of problems in the system, been unable to prove that they are. Such victims will always feel aggrieved. We share the Government's concern about that.
We have always made it clear that we would welcome new legislation on domestic violence. Part of the Bill relates to domestic violence. It is an appalling crime that, by its very nature, often remains hidden behind closed doors. We have said and will continue to say that we will work constructively with the Government to introduce effective legislation to protect the victims. The noble Lord, Lord Warner, will respond this evening. Does he agree that tackling domestic violence is not necessarily a matter primarily of legislation? We already have legislation that could be used more effectively. What we must do is tackle the culture that regards domestic violence as somehow acceptable.
I am disappointed by one measure. The Government have not yet set a date for the start of their telephone helpline for victims of domestic violence. I would be grateful if the Minister could say why it has not been possible to set that date. The House will know that there is huge demand from the victims of violence that the current helplines, run by national charities, can barely meet. The Government's delay is
especially disappointing, given that two women die every week as a result of violence by a current or former partner. A quarter of violent crime occurs in the home.The noble Baroness rightly said that, every day, thousands of children witness cruelty and violence at home. In considering the Bill, we should not confine our attention to violence against women. We must recognise that domestic violence can also affect wider family relationships.
I read with interest the Victim Support publication, Criminal Neglect: No justice beyond criminal justice. As it points out, being a victim of crime may, for some people, be a minor inconvenience, but, for many others, it can be a devastating experience, and it can take weeks, months or even years for people to begin to pick up the pieces. For a large proportion of victims, being a victim of crime is not an isolated event but an ongoing experience. Some surveys have shown that 4 per cent of victims suffer 41 per cent of crimes.
Experience shows that a person's ability to recover from an offence can be considerably improved when others recognise the significance of the event. Sadly, that is not the experience of most victims, so we welcome the Government's commitment to raising the standards of service that victims of crime receive from the criminal justice agencies. However, the blame lies not just with the agencies; the system does not fail entirely, and there are those in the criminal justice agencies who work valiantly to assist victims and alleged victims.
I hope that the Bill will not foist more bureaucracy upon us, as a means of trying to achieve a better service. We should not go down that route. A commissioner for victims or witnesses will, I hope, achieve much, but he or she will achieve little, if tied up in targets and made remote from the people who need help. In passing legislation to help victims, we must not let them down by drowning them in the toxic waste of bureaucracy. The truth is that, if victims are asked what they really want, they do not clamour for a commissioner or for counselling; they want the offender to be caught, so that he cannot commit the offence again. If they could wave a magic wand, they would wish that the offence had not happened in the first place. Overall, that is what the Government need to address.
I turn now to the Asylum and Immigration (Treatment of Claimants, etc) Bill. If anyone could persuade us to still our beating hearts on this matter, it would be the Minister. She made an extremely valiant attempt; she will return when the Bill comes before this House. But I must tell her that my heart is still beating far too fast for my own health on this matter.
This is the Government's third Bill on the issue as they try to patch up the failures of their policy so far. Last week, the Government said that the Bill is the final stage in their reforms. I hope so: I remember all too well that they said exactly the same about the last Bill last year. Perhaps we may hear the same again next year. For everyone's sake, I hope not; particularly for the sake of those who come to these shores with justice behind them and who should be welcomed here.
Last week, the Government invited us to celebrate a reduction in the number of people making asylum applications. On 27th November, my right honourable friend David Davis said:
- "We welcome the fact that the number of asylum seekers has apparently come down, but these figures should be treated with a large amount of scepticism. How much of the fall can be explained by the vast increase in the number of work permits? How much of the fall can be explained by the Government turning a blind eye to illegal immigrants?".
Even the Home Secretary admitted that he does not have a clue about the number of illegal immigrants who are in the United Kingdom now.
Some parts of the Bill, which are new or seem to be new, will be welcome. We shall look forward to investigating them thoroughly and to giving them a fair wind. Perhaps I may take an example; namely, the proposal to introduce a new offence of human trafficking for non-sexual exploitation, with a maximum penalty of 14 years' imprisonment. That is new to this Bill, but it is not a new matter altogether. With some pleasure, I recall the valiant efforts made by the noble Earl, Lord Sandwich, last year when he introduced similar amendments to the previous Bill. I hope that he will achieve his objectives this time.
Much of the rest of the Bill appears to be a story of building on failure and not building on success. A Home Office press release dated 27th November stated that key measures in the Bill would,
- "introduce a new speed and finality to the appeals and removals process".
The UNHCR has made a valuable offer to the Government in its comments on the Bill, published last Wednesday. It is prepared to lend its good offices to the UK Government with the aim of achieving an improvement in the overall quality of decision making. I should be grateful if the Minister would tell us the Government's reply to that offer. Can the Minister give an assurance that the new restrictions on legal aid for asylum applications will not prevent those with a rightful claim for asylum from taking their case to successful appeal?
Another major problem for the Government is also of their own making; namely, their failure to remove those people who have no right to remain here. Recently, they have come up with two solutions, neither of which covers the Government in glory. The first solution, unveiled on 24th October, was simple; that is, not to remove people at all. The Government announced an amnesty for up to 15,000 families in this country, awaiting determinations, who claimed asylum before 2nd October 2000. Those families will now be eligible for leave to remain. The problem is that
that solution must have sent out the wrong signal—I hope that it is the wrong signal—suggesting that the Government are not serious about getting the system right, but just want to get the figures right, whatever it takes.The Government's second approach to the removal of people is in the new Bill. Last week, an official Home Office spokesman told the press that it is backed by the Government's intention to take the children of asylum seekers into care to force asylum seekers to return home, which many people consider to be deeply distasteful. The Minister put that issue in a slightly different context today. I was interested in her explanation. I shall read carefully what she said. But what she said was not borne out by the Home Office spokesman last week. If her explanation reflects further consideration by the Government, I am grateful.
When my right honourable friend Michael Howard raised the issue in another place last week, the Prime Minister had the opportunity to deny reports of the proposal. He did not do so. As a result, to give the Government a further opportunity to respond, my right honourable friend wrote an open letter to the Prime Minister asking him to put on the record whether he still intends to implement that particular proposal. If so, how does the Prime Minister intend to do that? Are the Government relying on this Bill or on some other legislation?
I am the first to recognise that when benefit is withdrawn from asylum seekers who have no genuine claim, local authorities sometimes might need to take action to protect children. I do that because when the section to withdraw benefits from families was introduced in the Government's Bill last year, I was aware that it was a policy that we first introduced and that was being reintroduced by the Government. But there is a great difference between us.
When we introduced our measure, we did not make any claim about taking children into care as being a background to persuading people to leave this country, nor was there ever any intention that that should occur. Asylum and immigration policy needs to be firm, efficient and fair, but we have concerns about the Bill. Our concern is that, above all, policy needs to be humane. We shall work constructively to achieve that.
3.46 p.m.
Lord Dholakia: My Lords, perhaps I may thank the Minister for opening the debate despite the discomfort of her croaky voice. I hope that she will recover soon because it is always a delight to listen to her.
The Government's legislative programme for this Session of Parliament is suitably summed up in the editorial in the Evening Standard of 27th November—the day of Her Majesty's gracious Speech. It stated:
- "The Prime Minister's insistence that 'fairness' and 'the future' are the themes uniting his programme do not do away with the overriding impression that this is a ragbag of legislation which makes up in business what it lacks in coherence".
There is substance in that statement, but there are many good things in the Government's programme.
The Home Secretary has been very busy: there have been 43 Home Office Bills since 1997. Fortunately, the major matters relating to crime this year do not seek to make changes to the criminal justice process of the order of recent criminal justice Bills. For that we are grateful.
I do not wish to argue for more criminal justice legislation. The previous Bill demonstrates that, apart from the perpetual burden on Parliament created by the Home Office, it is evident that those on whom we depend to implement the laws simply find it difficult to cope with constant change. It may sound simplistic, but evidence demonstrated by the prison population makes it clear that the more criminal justice legislation there is, the greater the use of prison to cure society's ills. If the Government want sustained improvements, they should resist the temptation to flex their legislative muscles at every opportunity. Occasionally, there should be less haste when promoting such legislation.
The Home Office note published at the time of the Queen's Speech about the implementation of the criminal justice and anti-social behaviour Acts makes it clear that "custody plus" remains a distant dream. We are told that implementation will be as soon as possible after next year. What is the point of passing legislation that is not used? Obviously, we shall talk about the Government's legislative programme. First, we should look at what is missing from the programme.
I have expressed serious concern about the rising prison population. We shall continue to hammer the Home Office about the unacceptably high number of people incarcerated in our prisons. I am a member of the Commission on Women and the Criminal Justice System. Two weeks ago, it produced a damning report about women offenders. Its major conclusion is that an urgent Government rethink is needed to tackle women's offending. The female prison population is soaring. Between 2001 and 2002, the number of women in prison increased by 15 per cent, compared with a 6 per cent increase for men. Ten years ago, there were 1,560 women in prison, and today there are 4,461. Nearly six out of 10 females leaving prison are reconvicted within two years, the same as adult males.
The numbers are a serious matter, but I am even more concerned about where in the criminal justice system we have produced a discrepancy that channels more women into custodial sentences. The Home Office ought to tell us how it intends to develop adequate community sentences for women that will tackle the offending by addressing abuse, mental health problems, and drug and alcohol problems. When does the Home Office expect to amend the Sex Discrimination Act to ensure that all public bodies in the criminal justice sector, from the police through to prisons, have a positive duty to promote sex equality? I hope that the Minister will give that serious consideration, because many of the report's recommendations can be implemented without recourse to a legislative framework.
The establishment of a children's commissioner for England is an important step forward in promoting children's rights. Will the Minister clarify whether the commissioner's remit will extend to children detained in custody? This country now locks up around 3,000 children at any time, approximately double the number 10 years ago. Those children are a particularly vulnerable group, and typically have backgrounds involving abuse, neglect, family conflict and breakdown, local authority care and mental health problems. Their detention can increase their vulnerability by putting them at increased risk of bullying, intimidation, self-harm and suicide attempts. It is important that the children's commissioner should have jurisdiction to promote and represent their interests, as well as those of other children.
Overall sentencing must examine better opportunities for payback to communities, including opportunities for local people to choose what community work needs to be done by offenders. Is the probation service adequately resourced? We need imaginative use of the latest technology to get prison numbers down. We need better mediators to avoid neighbourhood disputes and thus arrest anti-social behaviour escalating. We need to accept that the record level of our prison population does not facilitate a rehabilitative strategy. The latest research shows that offending behaviour programmes in our prisons are not working.
We wish to offer our support to a number of Bills proposed by the Government. We accept that the criminal justice measures announced in the Queen's Speech are, for the most part, more positive and constructive than those relating to asylum and immigration. We welcome the Government's intention to introduce more effective laws to tackle domestic violence, which currently accounts for more than a quarter of all violent crime. At some point in their lives, 30 per cent of women experience an act of violence by a male partner. The Government's proposals for better links between civil and criminal proceedings and the easier availability and better enforcement of non-molestation and restraining orders will help to combat domestic violence more effectively.
We welcome the fact that the Government have dropped the idea of removing benefits from anti-social tenants. That is a vindication of the opposition to those proposals. The text of the Queen's Speech suggests that the Bill may not be as wide as first anticipated, as only domestic violence and a commission for victims and witnesses are mentioned. We shall await the publication of the Bill with interest.
If we are to tackle domestic violence effectively, we need not only an effective legislative framework, but a long-term sustainable funding strategy. The £14 million announced by the Government in February this year for crime and disorder reduction partnerships to tackle that problem over a three-year period seems significant at first sight, yet it amounts to only £12,000 per crime and disorder reduction partnership per year. Some excellent work is being carried out to prevent domestic violence and to support those who suffer
from it, including the provision of refuges, outreach work and helpline support. Many of those services are provided by the voluntary sector, including my own organisation, NACRO, of which I am now president. However, the development of that work is often significantly undermined by short-term and insecure funding. That means that projects are set up and work effectively, but then fold when their funding ends.We welcome the proposed establishment of a commissioner for victims and witnesses, who can represent the interests of victims and witnesses across government in the development of policy and the delivery of services. We will support that measure. However, at the same time as the Government propose to introduce that welcome legislation, they have brought forward proposals to devolve the funding which they currently give to Victim Support for local victim and witness services to criminal justice boards, so that they can make separate contracts for the work.
That is a recipe for the fragmentation of services. It will jeopardise the effective work which Victim Support has carried out to ensure that local services sign up to and operate a high-quality standard. We hope that the Government will reconsider that misguided proposal. The Bill is a good opportunity to put Victim Support services on a statutory footing, thus enhancing much of the good work Helen Reeves and her staff are doing at Victim Support.
We would also like to see an expectation of prosecution in domestic violence cases. However, we are concerned that, while the Government talk about helping victims, they look set to cut the money going to victims through the criminal defence service.
The Bill dealing with the Supreme Court, judicial appointments and the abolition of the Lord Chancellor is a matter for the new Department for Constitutional Affairs, and my noble friend Lord Goodhart will deal with it at the appropriate time, but it has relevance to home affairs. In principle, there are strong arguments for the establishment of a Supreme Court and the clearer separation of powers that it would involve. However, it is crucial that adequate safeguards are built into the new arrangements to ensure the independence of the judiciary from government pressure and to avoid potential political bias in the appointment of judges to the Supreme Court. It will also be vital to ensure that the judiciary is fully and effectively consulted about proposed legislation and policy developments relating to criminal justice. We will scrutinise the legislation carefully to see whether it meets those requirements.
We particularly welcome reform of the system of judicial appointments. The previous system has reinforced the profile of a judiciary which, despite the very high quality of so many of its individual members, has far too few members who are women or are drawn from minority ethnic groups. We therefore welcome the establishment of a new judicial appointments commission and a more open process of judicial appointment.
Let me now come to those aspects of the Government's proposals with which we disagree. We have real concern about the proposed immigration
and asylum Bill. This weekend, we were told that the Government had embarked on a big conversation, but that Bill looks to me like a big con. On 27th October, the Home Office and the DCA sent a joint letter to stakeholders setting out joint proposals for the new legislation in the vaguest of terms. The deadline for responses to the letter was 17th November, which allowed a mere 15 working days for replies. There is no indication that a White Paper is planned or that there will be further consultation. That is a breach of the Cabinet guidelines.Why such haste? The Government have been bounced again by the right-wing press into legislating in order to be seen to be in control, and doing so in a way which removes important safeguards from a system which has saved countless thousands of individuals from persecution. Proposals in relation to undocumented asylum seekers; removal of benefits from the families of failed asylum seekers and the placement of their children into care; cutting back on the vital appeals system—all those are measures designed to deal with the symptoms, not the causes, of a very inefficient asylum system. All are extremely illiberal ideas which used to have no place in the Labour Party.
The Government's strategy of feeding the wolves on the far Right in the hope that they themselves will not be savaged is dangerous and foolish. On the rare occasion when we see the Home Secretary stand up and argue for the rights of asylum seekers, as he appeared to do when an amnesty of 15,000 families was announced last month, he produces a barrage of right-wing policies as a means of covering his back from the critics. He should have the courage of his convictions and stand up to his critics. We have said again and again that the Government have got it wrong. This is the fifth Bill since 1993 and, again, I believe that it will not be the last. Although we do not have a fundamental objection to streamlining the appeals process, we could support such a move only if the quality of initial decisions were dramatically improved.
We are against the removal of the right to appeal. At present, 22 per cent of asylum appeals are successful, suggesting that Home Office officials are making serious and frequent errors in their assessment of asylum claims. Under those circumstances, the current two-stage appeal process is an essential guarantee of fairness. It should be noted that many such cases involve victims of torture and persecution and that, for them, the asylum decision can be a matter of life or death.
Although the organised gangs which smuggle people into this country often advise prospective asylum seekers that they will maximise their chances of success by destroying their documents, many asylum seekers will lack identity papers in the first place. They may have lost their papers en route, or had them confiscated by the authorities in their country of origin or by the people smugglers. We should not penalise, and potentially imprison, genuine asylum seekers who have no papers through no fault of their own.
A fair and efficient asylum system is one that can distinguish accurately between applicants who have legitimate reasons for seeking protection in the UK and those who have no such protection needs. A credible determination process also makes it easier to tackle misuse of the system because the appellate authority is not clogged up with genuine refugees who have received poor-quality initial decisions.
- "I did not come into politics to be the King Herod of the Labour Party".
In conclusion, we give notice thus: we shall always err on the side of civil liberties. That is a value which we shall not sacrifice.
4.2 p.m.
Lord Clinton-Davis: My Lords, there was a time when, as a solicitor, I dealt with a substantial number of immigration cases. For a time, I was also the chairman of the Refugee Council. It gives me no pleasure to be critical of a Government whom, by and large, I support. My hope—it may be a hope against hope; I do not know—is that the Government will change their mind about asylum seekers in substantial measure.
I come from grandparents who sought refuge in this country. They, and others like them, had to bear contumely, even hostility. The Aliens Act 1905, as well as the speeches in support of that invidious measure, demonstrate clearly what I am talking about.
The racial appetite of the British National Party, like that of all fascists, can never be satisfied. It gives me no satisfaction to know that, in my view, the Tories would have been even more draconian so far as concerns asylum seekers, despite the honeyed words of the noble Baroness, Lady Anelay, whom I greatly respect. The suggestion, for example, that asylum seekers should be sent to some unidentified island is as abhorrent as it is implausible.
One of the worst aspects of the proposals that the Government have outlined is the treatment of some of the children whom it is proposed should be taken into care. I believe that that is inhumane and cruel, and it should have no place in our agenda for change; nor do I consider that children should become the playthings of politics. I am not saying that all asylum seekers have no underlying motives or that all are free from crime, fraud or bogus claims. But even that should not provide a reason for treating them, or some of them, with disrespect.
The new approach is said to be balanced concerning immigration and asylum. But is there true balance? It is one thing to tackle abuse of the asylum system and
illegal immigration but it is quite another to deny basic rights to asylum seekers and immigrants. There is a great deal of suspicion about the Government's intentions among immigration groups and also solicitors who, day in and day out, deal with asylum seekers and immigrants and who, contrary to the apparent beliefs of the Prime Minister and the Home Secretary, do not make a fortune out of the system. They are not treating it as a milch cow. In my view, such people are entitled to be consulted, but that does not happen at present.I want to see helped rather than hindered all those who ultimately, perhaps on their second appeal, win their cases. Are they, or any of them, less equipped to claim that they have genuinely fled persecution? Is there any real evidence that such people, albeit a minority, have exploited the system? What will happen so far as points of law are concerned? Are they to be consigned to the dustbin? I hope not.
I gather that the Home Office believes that the destruction or other deliberate loss of travel documents will probably amount to an avoidance of immigration laws. However, frankly, that is not always the case, as was pointed out by the noble Lord, Lord Dholakia. Rightly or wrongly, there may be, for example, a belief that, for one reason or another, it is imperative that such documents will incriminate their holders. That issue must be dealt with.
I applaud the idea of helping genuine refugees and of absorbing them into the community. On the other hand, I contend that a genuine system of legal aid is vital to those who seek justice. I do not believe that seeing someone for a maximum of five hours is a sufficient guarantee that that person's case will be dealt with properly. After all, currently the average is about 10 hours, and I simply cannot accept that the overwhelming number of solicitors abuse the system. The simple fact is that such firms are hard put to make such representation pay, and yet most of them still do it.
We need to liaise closely with the immigration organisations and with the Law Society and the Bar Council about these, and doubtless other, problems. Not only do we need to speak; we are obliged to listen. We need to recognise that some asylum seekers are fleeing tyrannical regimes and are in fear of their lives. We cannot, and must not, take a chance with their future.
I want to make another plea—one borne out of my personal involvement in this matter—that the majority point of view is not always the most reliable. Where would it have got us in relation to capital or corporal punishment if we had listened to the majority point of view? Sometimes the minority also has to be considered. This needs courage, but that is what democracy is all about.
We should also be convinced that the Government conform to the law but, regrettably, that has not always been the case. For example, the High Court quashed the provision in the 2002 Act that deprived asylum seekers of shelter, food and clothing unless their claim had been made on arrival. That provision
ranks as odious as the concept that those asylum seekers who refuse to accept a voluntary flight to their native country will be faced with not only the loss of benefits, but their children will be taken into care. How does that conform with our international obligations?Article 31 of the 1951 refugee convention, repeated in the Immigration and Asylum Act 1999, states that:
- "The contracting states shall not impose penalties, on account of their illegal entry or presence, on refugees who come directly from a territory where their life or freedom was threatened in the sense of Article 1, enter or are present in their territory without authorisation, provided they present themselves without delay to the authorities and show good cause for their illegal entry and presence".
I conclude by saying that the Government—my Government—should think again about these issues because while they touch what is albeit a minority, they also touch whatever we stand for. I beg of my noble friends to listen to this plea.
4.12 p.m.
Lord Fowler: My Lords, I wish to make one point in introduction. During the progress of this debate, a number of tributes have been paid to Lord Williams of Mostyn. Perhaps I may add one or two words to those tributes. Gareth Williams and I were at Cambridge together. I have a photograph of the Cambridge Union Committee in which we are standing almost side by side, although not everyone in the House today would recognise Gareth's 1960s haircut at that stage. As it happened, in later life our two daughters, Kate and Imogen, became very close friends and, as Gareth remarked after my maiden speech, illuminated both our lives. I should like to say that I very much miss his contribution to politics and to remark that, thank goodness the House of Lords enables personal friendships to flourish across the political divide.
No one can complain that, in this Queen's Speech, we lack choice in the areas of home, social affairs and health. We have, for example, new measures on political asylum on which the noble Lord, Lord Clinton-Davis, spoke so movingly and strongly a few moments ago. I cannot help but recall that, when I was shadow Home Secretary in the other place, I was lectured by the then Home Secretary, Jack Straw, on the total inadequacy of the measures introduced by the Conservative Government and how he would now transform the position with a series of new measures under the title, "fairer, faster and firmer". We now have a new Home Secretary with a new series of measures following, to be frank, the failure of the measures introduced by his predecessor. As the noble Lord, Lord Clinton-Davis, so rightly pointed out, the House will want to scrutinise very carefully indeed what is being proposed.
I shall concentrate, first, on a Bill which dared not speak its name in the Queen's Speech, but which has already had its First Reading. I refer to the Health Protection Agency Bill. The Explanatory Notes say that the purpose of the measure is to set up the agency as a UK-wide non-departmental body with the one
intention of improving the ability of the UK to tackle the problems posed by infectious disease. That is an aim that I entirely endorse for what the agency—previously known as the Public Health Laboratory Service—does with superb professionalism is objectively to measure public health trends.Last week, the agency—it already operates under that name—presented a report on HIV and other sexually transmitted infections. In my view, that report presents a profound challenge to this Government. It showed that, last year, the prevalence of HIV increased by no less than 20 per cent in this country; that 50,000 people now live with HIV and that during 2002 some 5,500 new diagnoses were made, double the rate in 1998. Just as alarming in the report was the finding that sexual disease generally has also increased dramatically. I might say in parenthesis here that this is not something that can be blamed on new immigrants or asylum seekers. No doubt they are included in the figures, but there is also a very British problem here and we ignore it very much at our peril.
One result of those figures is very clear: the pressure on sexual disease clinics is now extremely intense, in particular in London. We should remember that these clinics were set up in the aftermath of the First World War to provide not only an anonymous service, but a free one, long before the National Health Service was created. Those clinics also provided a walk-in service with immediate consultations. They were immediate because we wanted to prevent the spread of disease. It was in the public interest that consultation should be so immediate, but that is no longer the case. Waiting is now the order of the day, with all that that involves in spreading infection. You only have to visit one of the clinics to appreciate the pressure under which the staff work in what are, to be frank, utterly inadequate premises. So improvement here is a matter of urgency.
In addition, there is one other crucial action which the Government need to take. We were told at Question Time that the Department for International Development has today published a paper entitled the United Kingdom's Call for Action, but some of that call for action needs to go to the Department of Health. We need to mount a far more effective public education campaign in this country. There is enormous pressure for better treatment and for wider access to drugs. Obviously much of that pressure comes from those who are infected with and suffer from HIV—and they are 100 per cent right to press. But we also need to campaign for measures of prevention, for telling the public of the dangers. Here I have to say that, in this respect, I think that the Department of Health has been off the air for far too long. We have done too little to educate and to inform. The figures reveal a rising trend of HIV infection dating from the mid-1990s.
I am sure that the Minister will be able to mention a number of what are now termed "targeted campaigns", but common sense and the figures produced at the weekend by the Terrence Higgins Trust tell us that those campaigns have not made the impact or had the effect that we want on the young people who are most vulnerable. For example, one in
three young people think that there is a cure for HIV; there is not. When I was the health Secretary, I ran a campaign entitled, "AIDS—Don't Die of Ignorance". Medical advances have reduced the death rate, but they have not produced a cure. Further, I am absolutely certain that there is still a vast amount of ignorance out there.But, quite rightly of course, the Queen's Speech also mentioned the challenge of HIV/AIDS world-wide. I am conscious that I am moving from one government department to another in my remarks, although as Question Time today demonstrated to an extent, I am not sure that it is right for HIV/AIDS to be divided in this way. I recall that when I was the Secretary of State for Transport, I was responsible for all transport unless it took off and flew, in which case it became a matter for the Department of Trade. Indeed, at one of our meetings in Brussels, an interpreter was put between myself and the trade Minister, the noble Lord, Lord Tebbit, to help us to communicate on this issue. That position was reformed. HIV/AIDS is a global issue and we need to consider how liaison between the two departments can be improved.
I do not believe that the response from the developed countries of the West has remotely matched up to the crisis of the pandemic which has devastated so many African countries and now threatens India, China, Russia and some of the countries of eastern Europe. It has so far claimed more than 20 million lives—four times the toll of the Holocaust. The lack of public anger in the West at what has taken place and what is happening now has been extraordinary. A recent poll in Britain showed that HIV/AIDS came last out of 26 charitable causes for which the public would volunteer money or time.
Perhaps we are unable to comprehend the scale of the scourge which has created millions of orphans in Africa. Perhaps the centres of death are too far away. Perhaps there is still a reluctance by governments all over the world to get drawn into inevitable debates on sexual habits and risk offending domestic voters. For whatever reason, no one can seriously claim that, either in terms of prevention or treatment, we have done enough.
I have always been in favour of the European ideal of being a force for good in the world, but I cannot help wondering what later generations will say when they realise that we spent £30 billion a year on the common agricultural policy and so comparatively little on preventing death and suffering in countries that so urgently needed our help.
The worst part of the story is that the pandemic is not remotely at an end. There are some who believe that the epicentre is now moving to Asia. India is particularly under threat. Estimates are difficult to make but the semi-official figure of 4.5 million is quite likely to be 7 million or 8 million. In China there is an estimate of 1.5 million but the real figure could be much more, while Russia has a probable figure of more than 1 million.
The depressing feature is that, in spite of the evidence of what works in fighting AIDS, countries are still debating the measures needed. In India there is an official reluctance to promote the use of condoms in spite of the obvious effect they can have. In Russia, which is having to cope with the impact of shared needles used by intravenous drug users, there is official reluctance to promote free needle exchanges. We introduced such a programme in the United Kingdom in 1987, in spite of some very vocal opposition at the time, and the one part of our figures which has remained consistently low has been HIV spread by shared needles.
There is little here for your Lordships' comfort. The hope comes from the dedicated people who are actively combating the pandemic—the doctors, the nurses and the volunteers—and from voluntary organisations and bodies such as the World Health Organisation and the organisations of the United Nations.
I should mention also the impact that the media can have in arousing public concern and getting over messages. It is wonderful that the Sun, with its massive circulation, has today devoted so much space to the issue. I pay particular tribute to the BBC World Service and the World Service Trust for the heroic efforts they have made and are making to spread knowledge, to inform and to educate.
Finally, I should like to concentrate on an organisation which is capable of making a real contribution—that is, the Global Fund, which has been set up to fight the spread of AIDS, tuberculosis and malaria. The fund effectively started at the beginning of 2002. It entered the field not only with money but with a fresh approach. It does not deliver services itself, nor does it impose its view on what nations should do. Instead it finances the worked-up plans of organisations, public and private, the proposals of which have to pass a stringent checking test. To date, the fund is supporting 224 programmes in 121 different countries at a cost of 2.1 billion US dollars.
The predicted outcome of these initial programmes— which provide training for doctors and midwives, care for thousands upon thousands of orphans and major education and treatment programmes—is that more than 700,000 people will be receiving anti-retroviral treatment, tripling coverage in developing countries by 2005; and 35 million people will be reached through HIV voluntary counselling and treatment.
As always, however, the problem will be to keep the resources flowing in. Britain, like the United States, claims that the priority is established bilateral programmes. The Global Fund in no way challenges that. Rather more softly comes the additional argument that the Global Fund has still to prove itself. "Let us see what happens", tends to be the official response. "We should move cautiously". Frankly, we are way beyond the "Let's see" stage of policy development. The crisis is now. The forecast is that unless action is taken the next 10 years could well see
the number of people infected with HIV doubling throughout the world to more than 80 million. The extra resources needed fully to resource the Global Fund are well within the ability of the developed world to provide.Some say that the forecasts of the global spread of AIDS are alarmist. But I remember that the same was said in the late 1980s. Tragically, the predictions then proved to be not an over-estimate but an under-estimate of what would happen around the world. The lesson is that we should attempt to redeem our past failure. We should back the Global Fund to its full potential; back our own programmes to their full potential; and try and try again to reduce the impact of this terrible disease.
4.27 p.m.
Baroness Walmsley: My Lords, I shall address a few brief comments to a number of different Bills—some of them Home Office Bills and some of them not—and to two or three matters that I should have liked to see in the Queen's Speech but which were not. The common thread holding my remarks together is that they all refer to the way in which the proposed legislation will impact on children and young people.
I turn first to the funding of higher education, which has at its heart the amazing disappearing policy on top-up fees. It is the Cheshire Cat of policies. It appears leering at us in the trees in one place; people say "boo" to it and it disappears. It then appears again somewhere else and leers at us again. It is criticised once again and then it reappears in a slightly different form. That is what is happening to the policy on top-up fees at the moment.
We need a system of funding for higher education which is fair to all the universities and which provides them with the resources they need to be a cutting-edge higher education system to lead the world. It must also be fair to all students who have the talent and ability to benefit from higher education. Top-up fees, whether they are imposed before or after a student goes to university and graduates, fulfil neither of those criteria.
The majority of the general public agree with us. Few policies have been greeted with such universal condemnation. The Government know this. They feel that they have found a get-out-of-gaol-free card in relation to top-up fees through the PR stunt known as the "Big Conversation". If the Government feel that they need to hold these conversations with the general public to find out what really concerns people, they are not fit to govern. They should turn to their MPs who, if they are doing their job properly and holding their surgeries, should know exactly what concerns the general public. I believe that the Government are likely to use these big conversations as an excuse to be seen to listen to the general public and to do a big U-turn on top-up fees. We should watch this space.
I turn now to the Bill on domestic violence. I went to the meeting in one of the large Committee Rooms in the House of Commons when the White Paper, Safety and Justice, was launched by the Home
Secretary. I was horrified to note that children were not mentioned at all in his introductory presentation. In 90 per cent of cases of domestic violence, children either witness directly the violence visited upon their mother or are in the next room. It has the most enormous effect on those children—it affects their mental health, their ability to benefit from their education and their ability to socialise normally with other people, both of their own age and adults.We need to put the safety and protection of children right at the heart of this legislation on domestic violence. It must, of course, be an overriding factor in the contact arrangements. I hope that the legislation will ensure that there is a very robust and continuous assessment of offenders in relation to the contact arrangements with the children for whom they have some responsibility. Where bail conditions are imposed, I hope that there will be a statutory requirement for the criminal court to inquire about the children's circumstances.
There is also a great deal to be said for a domestic violence register. Like the sex offenders' register, it could very well assist the police to protect children. One way or another, it is most important that the domestic violence Bill should contain a broad and inclusive definition of domestic violence. It should acknowledge all potential manifestations of domestic violence in familial or other interpersonal relationships—including that of female genital mutilation, which is usually visited upon small children.
I now turn to the asylum Bill and the way in which it will affect children. I noted the comments of the noble Baroness, Lady Scotland, in her introduction, about the idea that families should be denied support if it has been decided that their asylum application is without foundation and that if the children were likely to be in need, they would be taken into care. I do not believe that it is ever in the best interests of children to be taken into care when they have caring parents and where the only reason why those parents may not be able to look after them is that the Government are not humane enough to ensure that they have the means. Children should not be used as tools to coerce parents, and I hope that, in reverse, asylum-seeking families would not use their children as tools to coerce the Government.
There are some measures relating to children that I would like to see in the asylum Bill. I hope that separated children will always have the right of appeal in-country. Children are different from adults and it would be dreadful if that right were taken away from them. I would like to see the abolition of the detention of children from asylum-seeking families. Such children should have mainstream education and should not have to stay in a detention centre.
The needs of children must be assessed while they are in the induction centres. They are often very needy and those needs should be assessed and arrangements made for providing the needs right at the beginning when they arrive in this country and apply for asylum.
On the children's trust fund Bill, I would just say this: I appreciate that the Government's intention in providing a small trust fund for children which can be drawn on when they are 18 is an attempt to reduce the discrepancy between the haves and the have-nots. It is part of the Government's policy to address child poverty. The problem is that by the time they are 18, that money will not be an enormous contribution to the costs of their higher education or to getting launched on their path in life in adulthood.
I think that we are all familiar with the research that shows that if you invest £1 or one dollar when children are young, they reap the benefits sevenfold when they are older. It can ensure that they have a good education, skills that can contribute to the economy and that they do not need to draw on mental health services, for example, or get involved with the criminal justice system, both of which have a cost attached to them. I would prefer to see that money put into high quality, early-years education and care for all children whose parents want it, right down to the very youngest, obviously concentrating first and foremost—but not exclusively—on children from very disadvantaged families.
Those of us who have been campaigning for a child protection Bill are delighted that it will contain measures for a children's commissioner. Clearly, it is important that that person should be independent and work within a rights-based framework. Those rights should come from the United Nations Convention on the Rights of the Child. I hope that the measure will mean that the commissioner has the ability to influence law and policy and, where necessary, to enter institutions where he or she feels things are going wrong and to take legal action.
We also very much welcome the proposals to extend the duties to safeguard children to professional agencies other than those that already have them, such as social services and education. They should, of course, extend to, for example, the housing services, the police and the prison services.
I also welcome the post of director of children's services in local authorities. However, the critical issue there is the accountability of that person for services other than education and social services where he or she will not have day-to-day management responsibility.
The matter of information-sharing, to ensure that children moving around the country do not fall between two stools, as it were, is very important and could have advantages for child protection. It is important that there are very clear guidelines on what can be input, when it will be input and who can access it and ensure that the changes genuinely provide real benefits for children.
I shall say a few words about the things I was disappointed not to hear in the gracious Speech. Those of your Lordships who have heard me speak before on child protection will not be surprised to hear me say that I was very sorry that there was nothing about the removal of the archaic defence of "reasonable
chastisement". To remove that particular defence, which people have been using to justify, within the courts, very unreasonable chastisement of children, would help improve child protection. It would help children, and others, to identify where real abuse is taking place—by which we do not mean a gentle smack from a caring parent. It would also make it easier for the professionals to act where there is genuine child abuse.Secondly, there is no mention of any legislation to address the problem of prosecution in cases of the death or serious injury of a child when it is unclear which of two defendants actually did it. That problem has come up in some recent cases, and I am so sorry that the Government have made no attempt to address it.
Finally, I am sorry that there was no mention of a major review of the youth justice system. There is a great deal that is right with the youth justice system. The youth offending teams do a lot of very good work, as the Minister, who is nodding his head, knows from personal experience. Multi-agency work, when agencies work closely together, is producing some very good results in reducing reoffending. However, some things still need addressing. First, we should address the age of criminal responsibility, which is the lowest in Europe. The Criminal Justice Bill that has just passed through your Lordships' House imposes appalling sanctions on young people who, in other civilised countries, would be regarded as being below the age of criminal responsibility. The average age in Europe is something like 14, while ours is 10. We need to consider that question again.
The main objective of the youth justice system is to reduce reoffending. However, alongside that as a prime objective should be the welfare of the child. If we can address that issue, we will immediately address the issue of reoffending, because many of the children involved are very damaged. We have failed them, and we have a duty to promote their welfare, which in itself will deliver the Government's objective of reducing reoffending.
We should also consider the transition of the justice system into the adult world. The services available for 17 year-olds and under all disappear when the young person reaches 18. They fall off a cliff. That transition stage is often bridged by the youth offending teams, which start dealing with young people when they are 17; the programme does not finish until they are over 18, but they do not get funding for that. That is crazy. We should not simply leave it to the sense of duty of youth offending teams to carry on and complete programmes that deliver such benefits to the individual and to the crime figures.
I do not believe that the Prison Service is the right agency to have responsibility for caring for children. Therefore, we need to consider how we look after children in custody, and where we look after them. Of course, there are too many children in that situation. Finally, there is not nearly enough meaningful education in prisons, for those under or over 18. I very much regret that nothing in the gracious Speech addresses that state of affairs.
After that sweeping survey of the way in which the legislation will affect young people, I hope that the Minister will be able to set my mind at rest about some of the issues that I have raised.
4.42 p.m.
Baroness Dean of Thornton-le-Fylde: My Lords, I, too, welcome the gracious Speech. The noble Baroness, Lady Walmsley, should not feel too embarrassed, because I am going to do something similar. I have taken the word "home" from the title of the debate, and I shall use it in its broadest context.
I was particularly grateful for the way in which my noble friend the Minister introduced the debate, and the manner in which he spent considerable time on the Bill to be introduced on domestic violence. That is a watershed, as the issue has been discussed for many years and is at the core of our society. As we have heard, a quarter of all violent crime comes under that category. Domestic violence does not only harm the perpetrators or the direct victim, who is usually the woman in the home, but affects the children. Children who observe their mothers being battered quite often turn into adults who batter their own wives—and so the treadmill goes on. I was extremely pleased when the noble Lord, Lord Strathclyde, made a particular point of welcoming that aspect of the gracious Speech. We shall have cross-party support for the measure, which will result in a positive piece of legislation.
Another part of the Queen's Speech with which the Minister dealt today was the introduction of legislation on disabilities. That really is unfinished business, as the Government set up a task force to consider the matter, which reported in 1999. From my own experience of chairing a group that has considered the question of people with disabilities in relation to housing, I know that those people want to be independent. They do not want simply to be categorised as a group in our community who are disabled. They need to have their disabilities recognised, and to be assisted to deal with areas of discrimination in employment or allocation of housing. We need to address the insufficient resources going into housing for people with disabilities, so I very much welcome the Bill. My noble friend Lord Ashley, when moving the Address, dealt fully, fairly and adequately with the matter. We are all waiting for the Bill to be introduced, as it deals with unfinished business, although the Government have made terrific steps and taken measures to support current legislation.
Taking the word "home" in its widest sense, I take the opportunity to welcome the indication in the gracious Speech that a housing Bill will be introduced. We have seen a draft housing Bill and a consultation, and now we need to see some changes. That part of the gracious Speech referred to improving the quality of people's day-to-day lives. The whole area of welfare support is crucial, including education and health, but if one does not have a decent home to live in, one is really losing out as a member of our community.
There are some key issues in the draft Bill. The debate on right to buy has moved on; the policy has been very successful across a range of areas, but it has also been abused, as surveys have shown. It has also meant that, in a community that is changing so fast, with the fragmentation of families and people living longer, the demands for housing are greater and there is a need to increase the supply. Giving the people the right to buy is inhibiting that in some areas.
Some 40 years ago, about 45 per cent of the population bought their own homes; today that has risen to about 70 per cent. Most people want to buy their own homes, but many realise that, with the price of property today, that is an aspiration that they may never be able to achieve. Therefore, we need to consider different ways of enabling people to get a stake in their own homes. I hope that the housing Bill will provide for that.
Licensing of rented property is another contentious issue, but the Government should be congratulated on grasping the nettle. It is all about communities. I must congratulate the Government, too, on taking forward the community interest companies. There has been a lot of support for them, especially in communities, but they will not get off the ground if they do not have tax incentives, as charities do. We need to ensure that the outcome of the Bill will be a real change in tax incentives.
As with housing, there has been a draft Bill and consultation on planning. Here I must declare an interest, as I am non-executive director of Wimpey, the builders. Planning is an area of tremendous interest in increasing the supply of housing. Everyone agrees that it needs reviewing, revamping, modernising and speeding up. The proposals are progressive, but they are littered with potential unintended consequences. If we want to speed up planning, we must ensure that they do not have exactly the opposite effect. If we do not discuss the Bill properly and the Government do not consider amendments—although I am sure that they will—we could end up with that result. We do not consider planning often but, when we do, we must ensure that we put in place a system that will stand us in good stead over the coming years.
There are two other areas that are not under consideration today but are in the gracious Speech. I listened to the debate last Thursday, when several noble Lords raised the issue of pensions. The pension protection fund is very welcome. Part of the intention is to bring back trust in pension funds—which has almost been the unsung hero. As a trade union official, I know that my members used to believe that pension fund membership conferred safety and security and would provide them with a decent retirement. That trust has been severely damaged, for a number of reasons, and we need to rebuild it. However, so many people have lost trust that it is difficult to know how it can be restored. How do we convince the younger generation that it is right to save for retirement through a pension fund? Many of them are aware that they would have been better off by investing in a different type of provision for old age. It is going to be a real challenge.
The pension protection fund will do nothing at all to help the thousands of workers who have lost their funds—I could cite a whole stream of names of those affected. Those workers were expecting to retire on a decent pension, but now they will simply not receive it.
That brings me to an issue where I believe the Government's approach is badly mistaken—annuities. Last week, I heard my noble friend the Minister's reply on annuities. I very politely say to him that the agenda has moved on: in the future we will see workers in money purchase schemes, not final salary schemes. People should not be told that they have to invest everything in an annuity or they can have nothing, or that no changes can be made because income tax rebates have been paid into an annuity. The annuity age limit of 75 was introduced years ago when life expectancy was less than 75. I believe that we can much more pragmatically apply the ceiling to prevent people withdrawing money from their tax-free pension savings and the state becoming responsible for them. At the same time, we could ensure that people are not lumbered when they reach 75 with the absolutely awful returns available from annuities. I am sure that there is a halfway house in addressing the issue.
I say with the greatest respect to my noble friends on the Front Bench that if the Government maintain their current position they will realise how big an issue this is. Pensions will undoubtedly be an issue at the next general election.
Finally, as a member of the non-statutory Appointments Commission, I very much welcome the fact that I will be made redundant in that role. I welcome the legislation to introduce a statutory appointments commission and tomorrow's debate on the issue. It is the right way to go. The Wakeham commission, of which I was privileged to be a member, suggested that the change be made. It cannot happen fast enough for some of us.
4.52 p.m.
Lord Colwyn: My Lords, the Queen's Speech contained an announcement of continued reform of the NHS by giving more choice to patients, more freedom to NHS staff and more control over hospitals to local communities. This time last year, progress with the devolution and modernising of the dental services was slow and enabled me to ask the Minister some difficult questions. This year, however, I am able to congratulate the Government on their genuine interest in improving the way in which dentistry is funded and administered and on their legislative initiative which makes the biggest improvements to dental commissioning in the past 50 years.
There is clear interest among the profession who have sought a way forward from the treadmill effect of fee per item of service, but there is still concern among dentists—particularly, but not exclusively, among those in general practice—about how long it is taking for much of the fine detail to be publicised and explained.
The proposed changes in April 2005 are now only 16 months away, and my dental colleagues need sufficient lead time to make decisions about the future of their practices, or their employment in a practice. April 2005 is critical. Once the Dental Practice Board is abolished, there will be no going back and no transitional period. NHS dentists will move from the present system to a cash-limited system—a salary. Although many would be happy with a salary, we must not forget that there are practice owners who have borrowed money, mortgaged their houses and invested capital to provide the premises from which this service is to be provided, and they are now going to be subjected to a limited income. It will be obvious to the Minister that no one who has invested in their own business in this way will be happy with this restriction. So there is still a real risk that many dentists will either leave the NHS or increase their private work in the face of this uncertainty.
The implementation of this new system from the end of March 2005 to a population with decidedly uneven levels of dental health will reveal further pockets of dental inequality as PCTs seek to provide a uniform level of service across the country. Adequate funding must be available. The chronic underfunding, where dentistry's share of the total has fallen from 5 per cent to 3 per cent, must be reversed. One of the major attractions of private work for dentists is that it tends to generate sufficient income to provide the ability to invest in and improve practice facilities.
While the profession is grateful for the new money promised this year for capital funding and IT infrastructure, the new system must remedy the shortfall. The Government must provide assurances that further funds will not be provided by stripping some areas to provide for others.
In 2001, the Government announced a workforce review which has yet to be published despite its being a key step for a strategy to address specific local and national issues. Positive action must be taken to ensure that sufficient numbers of dentists, dental nurses, dental hygienists and dental therapists are trained and in post to cater for the increasing levels of patient demand. Insufficient workforce planning has been partly responsible for the problematical access to NHS dentistry in some parts of the country.
The important work of salaried staff should not be ignored. The transfer of responsibility for dental commissioning in PCTs offers some exciting opportunities for co-ordinated and consistent delivery of dental services and opportunities for integration of community and general dental services. Dentists working in the community service have considerable experience in this area and need assurance that such care will be a priority for PCTs under the new arrangements.
I have further congratulations for the Government. The British Dental Association and many other dental and medical organisations and associations were delighted by the decision of Parliament to give communities the right to choose fluoridated water. This simple process could make a real difference to the
levels of tooth decay and disease and there is now the opportunity of making it a reality. Dentists up and down the country will be delighted to see that on the statute book.Some important work has been done this year by the BDA in co-operation with the deputy chief dental officer, academics, Community Dental Service representatives, the Office of the Deputy Prime Minister and the Big Issue on dentistry and the homeless. The report, Dental Care for Homeless People, examines the extreme exclusion experienced by the most vulnerable, powerless and disadvantaged members of society. I urge the Government to continue to show an interest in the dental healthcare needs of this very important group and hope that the report will play its part in raising the issue of dental care for the homeless. I hope that the Government will work with organisations such as the BDA in seeking help for the specific and complex dental issues faced by this very vulnerable group.
We have not discussed complementary medicine in this House for some while. I should like very briefly to remind the Minister of the importance of day-to-day medicine working together with complementary therapies. Perhaps this message is best delivered by reminding your Lordships of the key principles of the Prince of Wales's Foundation for Integrated Health. I declare an interest as co-president of the All-Party Complementary Medicine and Integrated Healthcare Group—I think that that is how it is described now; we have just changed our name and it may be slightly different—and also a member of the Select Committee on Complementary and Alternative Medicine chaired by the noble Lord, Lord Walton.
Healthcare should be promoted by an holistic and integrated approach that considers all aspects of a patient's being. Individuals should take more responsibility for their own healthcare and acknowledge the in-built intrinsic healing capacity of each person. Different approaches and interventions may be needed to work together to restore health and well being. The Government should facilitate the establishment of an evidence base for integrated healthcare, using a range of research and evaluation methods. Every person should have the ability freely to access the treatment approach of their choice, safe in the knowledge that it is effective and well regulated, and provided by appropriately educated, safe, competent and regulated practitioners. This is important. I should be grateful if the Minister could confirm the Government's continued support for complementary therapies and their integration into primary healthcare wherever possible.
Many dental practices work with and support complementary therapists and provide complementary therapies. The dentist is in an ideal position to monitor dental and general health—to practise preventive medicine. It has been an uncertain year for dentists. The loyalty and dedication of NHS dentists is a great asset to this country and the Government need to maintain and increase their trust
through the transition of the next 18 months with a well managed implementation, adequate funding and proper attention to workforce issues.5.1 p.m.
Baroness Thomas of Walliswood: My Lords, I intend to speak mainly on the subject of domestic violence. But before doing so I should like to refer briefly to two other subjects: to one because it is in the Queen's Speech; and to the other because it is not.
First, I want to welcome enthusiastically the inclusion of a Bill to provide for the civil registration of gay partnerships. The Government's support for a Bill of this kind was indicated in the debates on the measure introduced by my noble friend Lord Lester of Herne Hill in the previous Session. I am sure that it will receive wide support in Parliament.
The Government will perhaps think me ungrateful if I immediately point out that there are many people who live together and suffer some of the same disadvantages as gay couples on the death of their cohabitee. There are, for example, heterosexual unmarried partners or those who have cared for a friend or relative over many years and who may nevertheless have to pay estate duty on the share of the jointly owned home left to them by a partner, dependent friend or relative. A need to sell the home to pay the duty could well have a devastating effect on the well being of the person left behind and their dependants. My first question, therefore, is: have the Government considered whether there is a need to deal with those and other serious disadvantages which are suffered by others living together in unmarried partnerships—especially now that nearly 40 per cent of children are born out of wedlock?
Secondly, I want to draw attention to the absence of any reference in the Queen's Speech to the new single equality body or commission. Of course I welcome the disabilities Bill, which is part of this year's programme. However, in the context of a new equality commission to administer equality legislation, which we know the Government intend to have up and running by the end of 2006, the absence simply highlights the differences between the law as it applies to different groups, all of which will have to be administered by the new single equality commission. Personally, I share the view of those who believe that we first need to unify the law and secondly deal with its administration. Unfortunately, that is not the view the Government have taken.
In particular, I believe that at the very least a positive duty should be placed on employers to promote equal treatment of women, as now exists in regard to the treatment of ethnic minority employees. So my second question to the Minister is: will the Government at least carry out this minor reform of equality law prior to introducing legislation to promote a single equality commission?
I want to give a very warm welcome to the Government's proposed action in respect of domestic violence. Now is not the time for detailed analyses of these proposals, which are as yet only in the form of a
consultation document. Nor am I saying that we shall necessarily always agree with the Government on the details of whatever proposals are forthcoming. That is not the way of this House, after all. However, like other speakers, I believe that we shall come to the legislation with a willingness to reach agreement with the Minister.Every year, 120 women and 30 men are killed by a current or former partner and domestic violence accounts for nearly a quarter of recorded violent crime. Domestic violence occurs in all economic, social, geographic and ethnic groups. Partners in homosexual couples can also be victims and perpetrators. It has the highest rate of repeat victimisation of any crime. The victim can suffer lasting physical and psychological effects, affecting her capacity to work, her mental health and her capacity to cope with normal life. I say "her" because so often the victim is a woman.
Domestic violence is also a major cause of homelessness. Until recently it has been a semi-secret crime, committed in the sacrosanct privacy of the home and even today one in 10 young women and one in five young men believe that violence towards a partner is acceptable; for example, if the woman has slept with another man. While the principal victims are women, children also suffer immediate and long-term damage, as my noble friend Lady Walmsley told us in her excellent speech. In particular, the single greatest predictor of offending behaviour by young people is the breakdown of family life to which domestic violence bears such strong witness. All credit, then, to the Government as they try to tackle this challenging problem.
Interestingly, much of the Government's action in this field does not require legislation and is already under way. Indeed, a huge number of ongoing as well as proposed administrative initiatives are described in the consultation document. These range from requiring schools to tackle the subject of domestic violence in the context of personal, social and health education; through assisting health professionals to recognise the effects of domestic violence when it presents in the outpatients' department or the GP's surgery and dealing with it effectively; improving the multi-agency approach to the prevention of repeat offending; and on to better training of magistrates and improved support services for victims after the legal process has come to an end. I especially welcome the Government's decision to amend the contact and residency forms in the context of the Adoption and Children Act 2002 so as to allow details of domestic violence to be raised early in the process by which children's contacts and residency details are determined by judges.
I have no doubt that some of these initiatives may be controversial in themselves; for example, the eminently sensible idea that there should be greater sharing of information between the civil and criminal courts and the police in order to speed up the process. However, I have a somewhat different problem to raise today. Many of the ongoing and proposed initiatives
require a high degree of collaboration between various agencies from local government, the NHS and the criminal justice system. My question to the Minister is: what funding are the Government proposing to make available for this multi-agency working?Multi-agency working can be very effective, but it is not cost-free. To put it at its baldest, whether one is sitting in a meeting creating a strategy, monitoring the roll-out of that strategy or reviewing it, one cannot be meeting clients to explain what services are available to victims or attempting to help them tackle their own offending behaviour. Millions of pounds will be put into housing for victims of violence and I greatly welcome that, but will there be funding for a slight easing in the numbers employed in social services and probation services in particular? Without that, I fear that multi-agency working will not be as effective as it should be. Probation services in particular are short of senior members with the time to spare to sit in endless meetings. That can be a real deterrent to smaller organisations.
Of course, it is too early to ask the Government what the content of the Bill will be when it finally reaches Parliament. I believe I am correct in saying that the consultation ended only on 13th September. Therefore, we must expect a little pause before we deal with the Bill which may well have its controversial areas. For example, it is clear from certain responses to the consultation that a major plank in the Government's proposed action for criminalisation of breaches of civil orders is not universally supported.
Finally, I should be very interested to know when the Bill will be brought before us and whether it will be subjected to pre-legislative scrutiny.
5.10 p.m.
Baroness Finlay of Llandaff: My Lords, I apologise to the noble Baroness, Lady Thomas of Walliswood, as I was so riveted watching the debate on the monitor that I forgot to check the order of speakers. In running to the Chamber I believe that I missed a few sentences of the noble Baroness's speech.
Many noble Lords who have spoken so far have addressed the very important issues in the gracious Speech. I wish to address an area that I do not believe has been touched on so far tonight. In the gracious Speech a Bill was announced to regulate the retention of human tissues after death. After the deep distress of Alder Hey and Bristol, there has been a cry for regulation. The requirement is clear. Such regulation will need to balance issues of consent with those of a duty to ensure that the cause of death has been accurately ascertained and that in the future additional important information remains available from tissue blocks and slides.
There is no doubt that after a death the relatives want to be certain that organs have been returned to the body, but what of the parts of organs taken to prepare blocks and, from these, finely sliced sections for slides? The preparation of the block might in some cases require about 15 per cent of an organ, or even the whole organ in the case of something such as the
pituitary gland or the adrenal gland. However, often only a very small part of an organ is removed and retained.Tissue blocks and slides taken at post-mortem have traditionally been retained in pathology departments. They are used to provide more information on the cause of death and the effect of treatment. Archived tissue samples can also aid public health surveillance, for example, to monitor national levels of variant CJD or to develop programmes that prevent the spread of infectious diseases. The ability to go back, sometimes many years later, to archived material can be very important. For example, when a new gene locus is identified it becomes possible then to investigate genetic disorders and possibly to aid diagnosis of other family members who may be affected. This could include helping to prevent similar disorders in children who have not yet been born. For education and training purposes, including quality control, slides are an essential part of the process.
There are some very real difficulties in trying to write protocols for the conduct of post-mortems. Histology cannot be protocol-driven as the pathologist does not know what will be found prior to the autopsy and so cannot predict which areas and how many specimens will be important. Less proper histology will lead to less accurate information. The number of post-mortems being conducted has dropped dramatically since the introduction of longer consent forms, but interestingly this is not because the number of refusals has risen significantly. The resource issue in obtaining consent for post-mortem is having an impact.
If explicit consent has to be obtained for post-diagnosis block and slide retention and subsequent use, the specimens will not be there for audit, education or quality control of histology. For a staining technique, a normal control and a disease specimen are needed for comparison. When the diagnosis is of a rare condition, the archived material comes into its own. Attempts to contact the relatives of the deceased will cause diagnostic delays for patients and distress to the bereaved. The current shortage of pathologists is set to continue and one could question whether it is a good use of their time trying to contact those who may have moved away and for whom the specimen no longer has relevance.
Since the judgment in the Touche case, it should be apparent that focusing only on the anatomical cause of death is too narrow. Questions relating to human culpability in the circumstances around a death, rather than the natural cause alone, may be raised at a future date. If material is no longer available, an opportunity to address those questions is lost. That may be detrimental to the interested parties in the specific case and to general public health and safety. So there is another area of great concern—without the capacity to revisit blocks and slides, revision to allow appeals in the light of new knowledge will not occur. It must be possible to review a case beyond the time of apparent completion of the process in law. The risk of miscarriage of justice—both wrongful and failed conviction and the impact on wider public safety—cannot be ignored.
The proposed legislation will need to look very carefully at the balance of information given, the distress that such information can cause, and the responsibility to further knowledge for the wider good. Without practical education the quality of histology services will inevitably suffer, and that is extremely worrying. It is welcome that the proposed legislation seeks only to regulate retention of human tissues after death; that is, the taking of specimens at post-mortem examination. Any attempt simultaneously to regulate for explicit consent for the use in audit, quality control and education of all tissue blocks and slides from surgical material from the living would consume huge resources and might inadvertently destroy the high quality pathology services on which accurate diagnosis depends. Blanket consent must remain the norm with patients able to opt out of allowing their specimen to be archived. I suggest that it is wrong to use human tissue against the wishes or best interests of the owner, but that it is just as wrong to prevent the use of human tissue for the good of all if the owner does not object to that use.
I turn briefly to the importance of maintaining an environment that promotes research and active inquiry. Specimens taken during surgery are essential for all aspects of a histopathology service, not just the diagnosis of an individual patient. That is illustrated by the history of the discovery of helicobacter as a cause of peptic ulcer. There was no formal protocol or even line of inquiry, just a hunch that the strange wiggly shapes on the slide were a bit odd. Review of archive slides allowed pathologists to see that shapes previously discounted as artefact were identifiable in specimens of inflamed tissue. Another example was the review of resected rectal tumours which showed the importance of tumour-free margins to avoid local recurrence, and has completely changed surgical practice for the better. If the pathologist had to apply for a grant to finance the contacting of every relevant person, or the relatives of the deceased person from whom the slides had been taken to ask whether the specimen could be reviewed, that discovery would not have been made. Current evidence shows that about 25 per cent of even highly motivated patients do not respond to requests whether their specimens can be used, although when asked face-to-face in outpatients' departments, they do not object. The changing environment is having a serious impact on our ability to carry out important research.
I turn briefly to a disappointment. In the gracious Speech no reference is made to smoking in public places. Since the Welsh Assembly has already voted to prohibit smoking in public places but lacks the necessary empowering legislation, I have tabled a Bill to allow the Assembly to determine how smoking in public places is to be prohibited within Wales. I hope that the Government will support empowering the Welsh Assembly to do whatever it wishes, however it wishes.
5.19 p.m.
Lord Thomas of Gresford: My Lords, perhaps I may take up the theme of the noble Baroness, Lady Finlay of Llandaff, of the powers of the Welsh Assembly.
Outlined in the gracious Speech is the prospect of the Public Audit (Wales) Bill which will begin its progress in this House next Tuesday. That Bill will affect Wales only, allowing for the establishment of a single public audit body for Wales across the public sector in order to keep an eye on the way in which taxpayers' money is spent.That proposal, put forward by the partnership government of the Welsh Assembly in 2002, has now found its way into the list. In March of this year the Cabinet of the Welsh Assembly put forward four proposals for primary legislation: one dealing with education in Wales, designed to carry out its published policy, called The Learning Country; one dealing with the public services ombudsman in Wales, one improving accommodation for tourism and finally a Transport (Wales) Bill, which would give the same sort of powers to the Assembly in Wales that the Mayor of London exercises in London. We hope that that will be a good thing but we would have thought that it is for the Assembly to decide what is the appropriate policy.
None of those four Bills has found its way into this year's legislative programme. That illustrates—as the noble Baroness, Lady Finlay, illustrated—the fact that there is no primary legislation in the Welsh Assembly and, accordingly, its policies cannot be fully expressed and fully carried out. I leave your Lordships with this thought on Wales. We shall return again and again to this matter until the people of Wales enjoy the same powers over their future as the Scottish people have in the Scottish Parliament.
I turn to one aspect of the home affairs part of the speech; that is, victims and victim support. It is the sign of a tired government to announce as radical new initiatives matters which have been in place for years. The Victims Charter 1996 was passed by the Conservative Government. It was reviewed and re-assessed. I recall debating the matter with the noble Lord, Lord Bassam, who is in his place, in 2000. At that time the Government set aside £4.6 million for victims' personal statements, £4.2 million for witness support schemes, and £3 million to enable the Crown Prosecution Service to explain to victims and their families the reasons for judgments and sentences that had been passed in court, and so forth.
The Domestic Violence, Crimes and Victims Bill has had its First Reading today and we shall not know the detail until tomorrow. However, we look at the proposals to see what we can glean that is new. The only new point that seems to emerge is the setting up of a victims' commissioner. We have had czars and commissioners in all sorts of fields as an excuse for doing something that is not too expensive. What will a commissioner do for victims? What rights of victims will a commissioner support? The Government have not attempted to tell us what victims' rights are or the kind of issues that a victims' commissioner can take up and argue with the authorities, so we have nothing to support what a victims' commissioner is about. If it is about anything, one would have thought it would be about proper compensation, a matter to which I have referred many times.
Your Lordships will remember that the Criminal Injuries Compensation Authority—I declare an interest as a former member—was set up on a non-statutory basis and provided compensation for victims which was equivalent to damages in a civil action. It was a well-funded scheme which did much to help victims with the injuries they had incurred as a result of crime.
The noble Baroness, Lady Scotland, today said that victims and witnesses will be placed at the centre of criminal justice. She stated that the Government promise to provide better services, setting out in statute the support and advice they should receive. That is the tired rhetoric of Mr Jack Straw in 1995, who tabled an amendment to the Criminal Injuries Compensation Bill 1995 in which he said that the Bill—obviously a Conservative Bill—had proposals which failed adequately to reflect society's obligations to assist victims to recover from their experience of crime and failed to place victims at the centre of the criminal justice system. So, eight years on, six of which have been occupied by the Government opposite, they are still talking of placing victims at the centre of the criminal justice system.
The Explanatory Notes to the Criminal Injuries Compensation Act 1995, which was opposed by the Labour Party in opposition, stated that the scheme then in existence would cost £460 million by 2000. However, the proposals which were implemented by that Bill resulted in a much-reduced cost of compensation. The money actually paid in 1996–97 dropped to £220 million. On 25th November, last week, we read in the newspapers a statement from the Home Office that:
- "No amount of money can make up for the injuries and trauma of being a victim of crime",
- "but our CIC Scheme is the most generous in the world, receiving nearly £200 million in government funding each year".
I said that the Labour Party in opposition objected violently to the 1995 Bill. One of the points made by the then shadow Home Secretary, a Mr Tony Blair, was that nothing so exposed the Government's claims about law and order as the scrapping of the current system of compensation. He said that thousands of people would be worse off under the new arrangements and many would be substantially worse off. Mr Tony Blair was absolutely right in 1995, but his Government have had since 1997, ample time, to do something about it. What do we get in the Queen's Speech? We have the appointment of a victims' commissioner, full stop. There are no new initiatives and no additional money, which is perhaps the best way of giving rights to victims of crime. In 1994 the noble and learned Lord, Lord Irvine of Lairg, who is no longer in his place, quoted Article 4 of the
European Convention on Compensation for Victims of Violent Crimes, ratified by the United Kingdom in 1990. The noble and learned Lord told this House:
- "Compensation [according to Article 4] shall cover, according to the case under consideration, at least the following items: loss of earnings, medical and hospitalisation expenses and funeral expenses, and, as regards dependants, loss of maintenance".
- "The current compensatory scheme treats every case as an individual case. It has regard to particular circumstances of each individual victim of violent crime and the loss that he or she has suffered and will suffer".—[Official Report, 2/3/94; cols. 1077-1078.]
Until recently, the noble and learned Lord, Lord Irvine of Lairg, was very much a leading member of the Government. His departure is to some degree regretted on these Benches. So, two of the most senior members of the Government were in 1995 stating that the victims of crime should have proper compensation. Yet they have been party to a reduction in the amount of money paid out to the victims of crime. Again, what do they offer today? The new initiative: a victims' commissioner, to look after rights which the Government do not even begin to define.
So, we are talking about a gap perhaps now of £300 million that does not go to the victims of crime; we are talking about the setting up of an office which if it costs £10 million is probably an over-exaggeration; and we are talking about victim support schemes and helping witnesses and so on, which were costed only two or three years ago at about £10 million. This Government are getting away with murder. They talk about victims, how they must be at the centre of justice and so on. They have been talking about that since 1995, but they do nothing. It is a disgrace that that should be so.
5.32 p.m.
Lord Sheppard of Liverpool: My Lords, the gracious Speech contained the statement that the Government would continue to reform the NHS by giving more choice to patients, more freedom to NHS staff and more control over hospitals to local communities.
I want to pick up the point about increasing freedom for staff. I believe that is producing very positive results. I speak from the experience of wrestling with cancer for the past two and a half years. For the past six months I have been a patient at Clatterbridge Centre for Oncology, near us on the Wirral, receiving chemotherapy, which is why I have been absent from your Lordships' House. I am thankful to say that I feel really well; my recent CT scan showed that the cancer had been held back; and the oncologist does not want to see me for three months. I hope that I am not out of order in making a personal remark. I should like to say how much the support expressed in cards and letters from many Members of your Lordships' House has meant to me.
My own experience makes me praise the quality of nurses. Morale is high. I felt that I was in the hands of very professional staff. One feature to which I want to draw attention is offering accessible information both to patients and carers, marking the role of carer as an important part of the healing process. Another feature
is contact with the patient, or carer, when the patient or carer needs to be in touch. I was given telephone numbers at each stage of two operations and during chemotherapy for two periods of six months that would put me or my wife in touch with a specialist nurse to ring whenever we needed or a hospital ward over weekends. That contact bred confidence and a sense of support during anxious times.I recognise that specialist units like Clatterbridge or, for example, the Broad Green Cardiothoracic Centre in Liverpool can and do offer magnificent services that general hospitals probably cannot match. We should not expect them to. General hospitals serve patients in numbers and with conditions that stretch them beyond calculated limits. For example, they are not the most appropriate places to care for infirm elderly people. General hospitals cannot discharge them often because of the lack of facilities in the community for elderly people. The closure of nursing homes for the elderly when there is an urgent need for more beds for them is a very serious issue.
None of that detracts from the radical and creative changes to the role of nurses such as I have been meeting. NHS Direct and walk-in centres are giving nurses increasing responsibility, including prescribing for patients. Nurses are being treated more and more as equally professional partners; and rightly so. So the first thing I want to say is, "Hooray for nurses".
As the Minister set out, a massive amount of money is being put into the NHS. Often it has to be said that the lion's share has gone into hospitals. The public debate often focuses on their performance—and very important it is. But in my years in Liverpool I came to believe that the key to reducing inequalities in health—so blatant in cities such as Liverpool and Manchester—lies most of all in primary healthcare. That is the second point I want to make. That sets GPs at the heart of the provision that needs to be strengthened; and there is a shortage of GPs. Their new contract is an important milestone. We need to recruit more people for general practice. That calls for a higher regard for their role and an understanding of the pressures they face.
For a long time the gap in health between better off and poor people was getting wider. In poorer areas people were coming to the doctor too late. The primary provision was often less than desirable. I recall—and I am sure other noble Lords do—queues of patients standing in the street on wintry days because there was no proper waiting room; and I recall one vicar's wife in an outer estate telling me of the GPs centre, "The vet's is cleaner". In recent years GP centres have vastly improved in Liverpool. Some of that improvement is the result of actions taken 20 years ago—a reminder not to demand improvements at the drop of a hat. But we need to continue to treat primary care as crucial.
The third point I want to make is that many people do not need to be in hospital. The advice I receive is that much chronic disease should be managed in primary care. For example, chronic respiratory disease
shows itself in episodes for which patients are often taken into hospital. But frequently GPs could manage these by putting in place services for care in the home.Primary healthcare can often mean prevention of disease. It has been said that there is no evidence of "out-of-hospital" services achieving prevention. That is questioned. The right kind of advice can, for example, prevent falls by old people. Even a 10 per cent reduction in falls would mean a considerable decrease in hip operations. Improving figures, for example, for heart disease in Knowsley are likely to be attributed to education and going to the doctor earlier. Education also means equipping lay health workers who have learned how to manage their illness for themselves and in their family. I was told this weekend that encouraging figures in Liverpool show increased numbers of vaccinations and the numbers of teenage pregnancies coming down.
I understand that Derek Wanless has been asked by the Treasury to carry out a second review of NHS funding, to report in February. At the top of the terms of reference for this second Wanless inquiry is the need to make recommendations to the Government on improving population health, prevention and reducing health inequalities. It will be very interesting to see what he believes might be the financial value of programmes of prevention. My hope is that he, and indeed my noble friend in replying to the debate, will underline the role of primary healthcare and strengthen its case for good resources.
As we welcome the increased expenditure on the NHS, I hope we may indeed give higher priority to primary care and to prevention.
5.38 p.m.
Lord Addington: My Lords, when I put down my name to speak in the debate on the gracious Speech, I wondered for which day I should try to do so. I wanted to speak primarily about the forthcoming draft disability Bill and I initially felt that technically it fell under the responsibility of the Department for Work and Pensions. But a little reflection showed that if ever there was a subject that is badly covered by its ministerial grouping, it is disability, because the department really does not have very much to do with the lives of disabled people outside actually dealing with benefits.
Most of what will be addressed in the Bill, and with which we shall be concerned, is reflected in what we are talking about today; that is, health and social inclusion. We have been waiting for the Bill for a very long time to try and effectively get the disabled into society on even terms. It is against a background where, increasingly, the Government seem finally to be honouring the commitment that they made in the 1997 and 2001 manifestos to introduce the Bill. We can all applaud the idea of working towards a single equality commission.
The draft Bill is essential, as the 1995 Act is as comprehensive as a colander and excludes whole areas of activity—eventually, education was exempt. The
incredibly long lead-in time of over nine years before small businesses had to be made accessible was absurd. Now people are panicking about implementing the legislation; they did nothing about it previously, as it had been a long-term or intermediate-term problem.Your Lordships' House has been the major player in dealing with the problem. We have dotted the i's and crossed the t's in this area. I hope that we will get a full opportunity for involvement in the discussions. We should not allow a draft disability Bill that does not have the noble Lord, Lord Ashley, tearing away at its sides to see what it is made of.
If we are to address the problem properly, we must bear in mind that the legislation must be brought into line with that on racial discrimination and sex discrimination. My noble friend Lady Thomas, who warned me that her hunger pangs could not be abated for much longer and had to depart, raised the issues of sex equality and racial equality. The Bill must contain a duty positively to campaign for equality. The legislation must not, as before, take a piecemeal approach by trying to prevent problems that have arisen previously, as everything that I have referred to stems from that. Asking "What can we do now?" or "What should we do and what is the priority?" has led to the lawyer's delight that is current disability legislation—every single section. Education, health and employment provisions have been introduced at different levels and at different rates. Unless we take a uniform approach, there will always be hundreds of gaps.
Will the Minister assure us that the Government will seek to create—in the DRC or its successor body, the combined commission—a campaigning body that can avoid the reactive approach of going to law when a complaint is made? If the noble Lord can say that such a body will have a campaigning role and that it will not rely upon case law and reactive solutions, we will be able to progress with confidence. If we cannot, my short speech will grow much longer in the days to come. If the Government do not wish to include such a commitment in yet another manifesto, not only should we get through a draft Bill in this Session, we should have a real Bill within the year, at least.
5.44 p.m.
Lord Turnberg: My Lords, I, too, very much welcome the gracious Speech and the Government's commitment to more choice for patients and greater freedom for NHS staff. It is a pleasure to hear and see the noble and right reverend Lord, Lord Sheppard, in such fine voice and great shape. I wish to comment on a matter of concern to the NHS in general that will have an impact on how those laudable aims can be met—the important role that the NHS could, and should, play in research and development, to which it is ideally and uniquely suited. Some would say that my return to the subject was inevitable.
First, however, I cannot resist the temptation briefly to mention a particularly irritating and counterproductive feature of the NHS: the heavy burden that the many regulatory bodies place on those
trying to provide healthcare. I shall give noble Lords a short selection: the Commission for Healthcare Audit and Inspection (CHAI), NICE, the Audit Commission, the National Clinical Assessment Authority, the National Patient Safety Agency and the Medicines and Healthcare Products Regulatory Agency, to say nothing of the professional regulatory bodies, the GMC, the GDC and the medical and nursing Royal Colleges, which also inspect and audit for training purposes.Many of the government bodies were set up, at least in part, in response to public outcries following such scandals as the Shipman affair or the Alder Hey and Bristol inquiries. The stimulus to do something, therefore, is strong, especially when the press fan the flames. But we have accumulated so many different bodies that their combined impact on those at the front line of clinical care, the vast majority of whom work their socks off in a perfectly reasonable and acceptable way, is to cause not simply irritation but a damaging distraction in time and effort from their primary role of caring for patients. My plea is that the Minister instigate a close examination of the myriad bodies to see whether they are all essential, and whether it might be possible to rationalise them, or, in NHS-speak, modernise them. He would earn enormous gratitude from great swathes of NHS staff if he did just that.
On research, two important reports have been published recently. The first is the Academy of Medical Sciences report Strengthening Clinical Research. I express an interest as a member of the group that produced the report, as vice-president of the academy and scientific adviser of the Association of Medical Research Charities. The other report is the Bioscience Innovation and Growth Team report Bioscience 2015: Improving National Health, Increasing National Wealth—the Cooksey report, for short. The importance of both reports is that they point to a need to invest in the infrastructure for clinical research, including mental health research, by Government and others in partnerships.
On the one hand, the UK does pretty well in basic biomedical research; but we lack the facilities and personnel to undertake the vital research required to translate basic research into clinical practice. The ability to do research with patients and to carry out clinical trials of new treatments is essential. There is only one place where we can do that research—the NHS, which is ideally suited to the purpose. The Cooksey report reaches a similar conclusion regarding the biotechnology industry. Ultimately, all investment in new drug development must be followed by trials with patients, so a well founded clinical research base is essential to industry, too.
Such investment would be a win-win situation—everyone would gain. Patients win because they stand to gain most from the prospect of new cures and better treatments. I know from my experience in the Association of Medical Research Charities, which covers the full spectrum of diseases, that patients are desperately keen for, and very supportive of, clinical research. They know, too, that if they are involved in clinical trials, they tend to do better than if they are
not, even on a placebo in a control trial. When asked, patients are almost always keen to volunteer to be involved in research. Patients win and they know it.UK plc gains because a country where good clinical research is going on is one in which the biotech and pharmaceutical industries—major players in the UK economy—wish to invest. That is well described in the Cooksey report.
Thirdly, medical and nursing staff engaged in research gain because they are stimulated by constantly striving after new and better ways to treat their patients. For many, simply being engaged in research is tremendously motivating. Of course, the NHS is highly dependent on a motivated workforce. The NHS also gains by having a more immediate access to the best treatments for the patients it serves, so everyone gains.
We must, however, put the infrastructure in place in the NHS if we are to reach this nirvana. By infrastructure, I mean the facilities to support clinical research, especially dedicated space and personnel. A good example of the type of research space that I mean is the CRFs—the clinical research facilities—set up by the Wellcome Trust a few years ago in five major teaching hospitals around the country, although none is in London. We need many more of those dedicated resources, preferably one in each of our university teaching hospitals, and we need the time for staff to do the research. I hope that the human tissues Bill is so drafted that the research is not inhibited, as the noble Baroness, Lady Finlay of Llandaff, so eloquently described.
Most of the funds for research come from grant-giving bodies such as the MRC, research charities or industry, but it is only right that the NHS should also contribute. A few years ago, the government of the day made a commitment to invest 1.5 per cent of their budget in research and development. Unfortunately, we never reached that figure. We still only put in less than 1 per cent, and much of that is diverted to non-research related activities. We should aim for 1.5 per cent. That is not too much to ask, as I am sure my noble friend the Minister agrees.
I have not mentioned funding for universities and medical schools because, although it contributes to clinical research, it comes through the Department for Education and Skills and the OST. If I could have spoken on education day, I would have said that no fewer than three discussion documents about research funding in universities are in circulation. If they were all put into action, their combined effect on clinical research would be disastrous and would act against any proposals that might emanate from the Department of Health. Clearly, that is one case in which joined-up government is desperately needed. If my noble friend pays heed to only one plea, it is that we must bring together plans in these two great government departments so that clinical research will not be frustrated.
Finally, I would like to be as helpful as I can to my noble friend by suggesting where he might find at least some of the £100 million per annum or so that the
Academy of Medical Sciences suggest is needed to get the programme for clinical research moving. If he were able to remove just a few of the regulatory bodies about which I spoke earlier, it would give him a head start in funding something that, by anyone's standards, must be more cost-effective and worthwhile. I do hope that he finds that helpful.5.52 p.m.
Lord Chan: My Lords, I welcome the gracious Speech. I will focus on health issues, especially in the context of primary care trusts, as I am a non-executive director of the Birkenhead and Wallasey Primary Care Trust.
The Government have indicated their intention to continue to reform the National Health Service by giving, as other noble Lords have said, more choice to patients, more freedom to NHS staff and more control over hospitals to local communities. All those three proposals are to be welcomed, but only if the disruption to existing primary care services is kept to the minimum. After many years of continuous reforms, staff working in primary care are understandably easily alarmed by proposals likely to involve upheaval of services through reorganisation, reconfiguration and target achievement.
Key reforms took place in April 2002 when primary care trusts came into being to replace district health authorities. That substantial change, particularly in the relationship between hospitals and primary care trusts, has not quite settled. The last thing that NHS staff need now is further reorganisation while they are trying to get used to changes introduced in the past 18 months. Current issues between hospitals and primary care trusts include the high rates of emergency admission to hospital that began during the summer. Hospitals are asking for more funds to cover the extra work, but primary care trusts are examining the method used for counting emergency admissions.
Good progress has been made to reform health services to put the choice of patients as first priority. For example, most patients in England can now obtain an appointment to see a doctor in primary care within 48 hours of their request. That success has been achieved through help given to GP practices by advanced access support personnel trained by the National Primary Care Development Team. As a result, patients can now expect to be seen within 48 hours by doctors at their GP surgery as well as make appointments for several weeks in advance to attend for chronic conditions such as diabetes and cardiovascular disease. However, the onus is on the patient to remember to make the appointments and to turn up.
Similar success has been achieved by the national scheme for heart surgery for patients who have waited more than six months for surgical treatment. I declare my interest as a national trustee of that project. Within 12 months of the scheme being launched in July 2002, of the number of patients considered to be eligible on waiting times alone, 6,658 patients—more than one in
three or 37 per cent—had their operation at an alternative provider. A cash injection of about £100,000 made this goal possible by providing choice of treatment at other NHS centres, private hospitals and centres in continental Europe. Not surprisingly, most patients opted to wait for treatment at their local centre because they wanted to be near home. For patients who chose another centre, travelling home from a distance was the most unsatisfactory part of their experience.That scheme of heart surgery for patients with coronary heart disease has now become a mainstream responsibility of primary care trusts. Despite improved funding of PCTs, financial pressures will continue and it is unlikely that the programme will expand. A further area of potential concern is that only 5 per cent of the patients included in the patient choice initiative came from minority ethnic groups, even though the frequency of coronary heart disease is higher in patients from south Asia than in the general population.
The prospect of extending patients' choice to other forms of treatment is worrying staff working in GP practices because of the likelihood of increased paperwork when offering a number of treatment options for every disorder. It is estimated that for any chronic disease, a patient would have to be offered four or five places where they can receive treatment. Wider choice could also increase the cost of treatment if patients opt for alternative providers.
Foundation hospital trusts are expected to provide opportunity for control by local communities. But efficiency and quality of hospital care has to be measured by indicators such as improved access, shortened hospital stay and reduced readmission rates. Therefore, the monitoring of foundation trusts by a variety of measures is crucial when the first wave of hospital trusts is reviewed by the Commission for Healthcare Audit and Inspection—CHAI. I look forward to the publication of those reviews before the next wave of foundation hospitals is selected. In that connection, I have a concern about CHAI. Currently, the Commission for Health Improvement includes a diversity audit about the care of ethnic minority patients for 20 per cent of their reviews, especially in areas where a significant proportion of the local population comes from this background. I would be grateful if the Minister could reassure me that that practice will continue when CHAI takes over reviews.
Public health concerns in primary care in the north-west of England revolve around childhood obesity and cigarette smoking. Childhood obesity affects 15 per cent of 15 year-olds and 8.5 per cent of six year-olds according to government statistics. The Food Standards Agency estimates that treating obesity in Britain will cost £3.6 billion a year by 2010. Obesity in children from socially and economically deprived areas in the north-west, such as in Birkenhead and Wallasey, is a high priority for the PCT. Although the need to eat five portions of fruit daily is promoted and implemented through neighbourhood renewal programmes, more could be done to support children and their families in cooking healthy meals, rather
than relying on the easy but costly and unhealthy option of fast foods with a high content of fats, sugar and salt.Smoking-free public places are considered to be important by public health directors in PCTs in the north-west of England to encourage people to give up smoking cigarettes. The proportion of smokers in Britain has changed little in the past five years. Children living with adults who smoke are prone to asthma and frequent respiratory infections, according to research in Merseyside. The Government should support and commend plans such as that of Liverpool City Council to make Liverpool a smoke-free city by 2008, when the city becomes the European city of culture. Such bold projects should receive incentives and nationwide publicity. The scheme to make the Cherry Tree shopping centre in Leasowe in the Wirral a smoke-free zone is another bold local project. The Cherry Tree centre today is filled with a haze of cigarette smoke during trading hours. The determination by the management and staff of that shopping centre to ban smoking should receive the strongest support from government and all statutory services, including the NHS. In primary healthcare, more funds are needed to provide more smokers who wish to give up—especially young ones—with nicotine patches.
I hope that the Minister has taken note of the recommendation made by the noble and right reverend Lord, Lord Sheppard of Liverpool, that primary healthcare should be the priority for resources, particularly in tackling health inequalities and preventing ill health. I strongly support that and hope to hear more from the Minister.
6.2 p.m.
Baroness Wilkins: My Lords, I greatly welcome the announcement in the gracious Speech that a housing Bill that aims to "protect the most vulnerable" will be introduced in the coming year. I particularly welcome the opportunity that it gives us to encourage housing provision that builds communities, reducing the demand on other services and enabling individuals to retain their dignity and respect. The Bill could have a great effect on our health and social care.
For the vast majority of us, our home is the basis of our security and our mental health. Like all of us, I worry about the future and how I might manage. As we approach old age, we have to plan for the time when today's arrangements are not enough or are not appropriate. Yet, the options available to old people do not fill one with enthusiasm.
Today, I shall concentrate on a way of living that is struggling for recognition in this country but could do much to expand the choices available in old age. I refer to sustainable communities of older people, where they can help and support each other. I am talking about the creation of co-housing communities, which, I hope, will be supported by the forthcoming housing Bill.
In our society, a third of men and two thirds of women over 75 years old live alone, the vast majority in mainstream housing. They may have family,
neighbours or friends close by to offer support, but, if they have not, they are very much on their own. The state will step in when someone has grown so old and frail that they can no longer manage independently, but, meanwhile, they cope. Old age should not be about just coping, and it does not have to be, if people address the needs of old age well in advance of being needy.Co-housing is one possibility, but what is it? It is a way of keeping all the benefits of living alone, while enjoying the advantages of a group set up to sustain people in that endeavour. A co-housing community is a neighbourly peer support system that is particularly appropriate for older people. It has the advantage of being entirely under their control. How many of us have, at some point in our life, sat with a group of friends and said, "Wouldn't it be good if we could live close together in our old age, so that we could support each other?". That is the essence of a co-housing community. People have their own home and their own front door, but they live alongside a group of people of their choosing in a community that they run jointly. That is very different from the choices currently on offer to older people.
Co-housing involves and invigorates people, and it is in demand among growing numbers of older people who want to stay in charge of their life. It is an investment in prevention, and it offers a real sense of security to those who know that, otherwise, they will end up alone. The Dutch and Danish Governments have done much to encourage the development of that form of living. They recognise that such self-governing communities represent a valuable investment in the health and well-being of older people and a housing solution that will reduce pressure on health and social care services. A co-housing community on the Dutch model offers older people an active mini-neighbourhood, where they will know their neighbours, share activities and events and make all the decisions about how they want to live. It is a setting in which someone is bound to notice if someone else does not get up one morning, and it provides a lifetime home where people can grow old easily.
About 200 co-housing communities have been developed in the Netherlands. For instance, in Amersfoort, around 40 people got together 20 years ago because they shared an interest in gardening. Now, a group of people aged from 50 to 90 still lives together around the beautiful garden that they created and continue to maintain. In Rotterdam, there is a community of Chinese elders living around a communal kitchen, comfortable in their own language and culture. In the Netherlands, it has been made easy for people to come together because they want to share certain activities or because they just want a sense of belonging.
The essence of co-housing is that it is self-initiated. It is also self-managed. The group allocates the tenancies and shares resources, and members offer each other neighbourly support. In the process, they build and sustain a sense of community. Newcomers join on the basis that they are responsible for a shared endeavour. Each member has his or her own home, but there is
considerable sharing of common space and facilities. The age range—from 50 to 90 or older—ensures liveliness of a kind missing from most institutional care.What are the options for us in Britain? Our society is ageing rapidly. Soon, over 40 per cent of the population will be aged over 50, and more and more people are living alone. In Britain, despite social policy emphasis on choice, independence and self-determination, all we have to offer are the traditional supported-living models. Retirement homes and villages, sheltered and extra care housing and schemes such as Abbeyfield houses are all run for older people by others. Where is the scope for self-determination, independence, and choice, the watchwords of the Government's social policy? The concept of co-housing is in tune with those goals, and it reflects the aspirations of the rising number of people from the post-war baby boom generation.
In the past decade or so, groups of like-minded individuals have struggled to create self-determined communities for older people on this model in Britain. Despite heroic efforts, none has yet succeeded because, by definition, an element of public support or, at least, encouragement is needed. In the Netherlands, local authorities employ community development workers to assist such groups, and housing associations actively seek them out. In Britain, groups must confront the rigidities of a traditional, top-down, unimaginative, bricks-and-mortar approach to housing and planning that—in the Deputy Prime Minister's words—forgets about people.
Two such groups of older people in this country are the Older Women's Co-Housing Project and the Full Circle group. The Full Circle is a group of disabled and able-bodied men and women aged 50 and over in the west country. Their dream is a community where they call the shots and where they share resources and help each other.
Currently, the more established group is the Older Women's CoHousing (OWCH) project, which is a low-income group of women aged between 50 and 80, all of whom live alone in London. With the help of consultant Maria Brenton, and financed by the Joseph Rowntree Foundation, for the past five years the women have met regularly to build a sense of group cohesion and to plan the community they wish to create. They intend not only to support each other but also to become a resource for the wider neighbourhood. I declare an interest in that I share a house with the consultant. Perhaps that is the start of my own co-housing community!
OWCH has attracted the support of a small housing association—Housing for Women—which is looking for a site. It has also been adopted as a pilot by the Housing Corporation, which has sponsored research into the project's legal and financial feasibility. However, the Housing Corporation cannot dream up a site in London. It does not have the means to persuade local authorities and housing associations to
see the wisdom of joined-up thinking and to welcome the efforts of a group of older homeowners and renters determined to stay independent for as long as possible.The example set by the old women's group was acknowledged in the London Plan where boroughs are exhorted to,
- "promote new concepts in urban living such as CoHousing communities, which are resident developed projects where mixed tenure homes are clustered around a common space, with a range of shared facilities".
In this, it was recognised that the co-housing model would be helpful for other groups besides older people; namely, younger single workers, key workers and so forth. Throughout the United Kingdom, there is a growing network of co-housing groups struggling to shape their own communities within local housing policy, which is far from favourable to their efforts.
The co-housing model enshrines all the concepts which the government espouse; that is, choice, self-determination, independence, keeping older people active, providing for old age, sustainable communities and joined-up thinking between housing, health and social services. Why should it be so hard to establish that in Britain?
Our present system lacks the flexibility for new forms of living based on choice and it is poor at shaping communities. One formidable hurdle is finding land or buildings. Many Dutch older-people communities are housed in converted redundant schools and hospitals. In Britain, those buildings tend to be sold to the highest bidder and end up as expensive loft apartments. If groups in Britain want to remain inclusive and have a mixed tenure, they need an element of public subsidy, but that is extremely difficult to obtain. Local authority nominations for tenancies in social housing are based on local residency and definitions of need that do not include the wish to live as a group. That is a barrier to crossing local authority boundaries, which blocks any possibility of choosing the people among whom one might want to live.
It is understandable that local authorities focus on pressures to house homeless families and to provide for key workers, but it is short-sighted to neglect the self-help efforts of older people who, otherwise, may later become a charge on local services. By keeping older people happier, healthier and more active, co-housing communities are likely to reduce demands on health and social services' expenditure, which is why the Dutch government have supported such development throughout the past two decades.
I gave the Minister notice of a number of questions. Do the Government have plans to encourage the development of new forms of living, such as co-housing communities, particularly for older people? Will they encourage local authorities to give their support? Will they give support to follow up the Housing Corporation's pilot project? Will the new regional approach to affordable housing result in greater flexibility in allocations that reflect the need for community and support as well as for housing? Will self-help and choice among older people be reflected in government policies, which not only promote it but
also make it easier? Does co-housing form any part of interdepartmental discussions on housing for older people? The time for co-housing has come. To succeed it needs the Government's encouragement, which I hope that the housing Bill will give.6.14 p.m.
Lord Clement-Jones: My Lords, we have had an excellent and wide-ranging debate, touching on a huge variety of topics. In particular, I was pleased to see the noble and right reverend Lord, Lord Sheppard, in his place; I think that we are all agreed he is in good form. In her customary style, the noble Baroness, Lady Scotland, made what I thought was the very best of a rather weak hand. I am sorry that she is not in her place for the conclusion of the debate. There was even some enthusiasm on these Benches for certain Government measures, including the new Bills on disability discrimination, domestic violence and child protection.
However, the Government have executed a neat diversionary tactic with their big conversation exercise. The problem is that this has been initiated by a Prime Minister in his sixth year of office who states that he has no reverse gear. It is no wonder that public and press reaction has been somewhat cynical.
Inevitably, the Queen's Speech and the big conversation both give rise to the question: what has the Government's second term really achieved? Looking back to the debate on the Queen's Speech last November, I concentrated on the issues of the new system of specialised commissioning by PCTs, patient and public involvement in the abolition of CHCs, foundation hospitals and delayed discharge. It would be easy to think that for some time we still will be bogged down on the same issues. However, I am sure that the noble Lord, Lord Warner—especially in his new calm incarnation, identified by the Health Service Journal—will be a worthy respondent to what, if it has not been a big conversation today, certainly has been a significant conversation.
In the Queen's Speech, the Government announced a health-related Bill, which will come before us shortly; that is, the human tissue Bill. It will regulate the retention of human tissues after death. The noble Baroness, Lady Finlay, forensically took us through some of the pitfalls involved. In principle, these Benches welcome that legislation. As past events have shown, patients and their families need to know that tissues will be retained and used only with consent. The Alder Hey and Bristol inquiries proved that unnecessary distress was caused to the relatives of many due to a failure to obtain consent.
The original Human Tissue Act 1961 consisted of just four sections, two of which concerned the removal and use of organs and tissue. It did not provide legal penalties if organs are removed or retained without proper consent. Therefore, the new Bill, which requires researchers to obtain "explicit consent" before organs and tissues can be used for research, must be welcomed. As the noble Baroness, Lady Finlay,
pointed out, consideration must be given to the importance of future medical research, which means that record-keeping systems must be exemplary.There must be mechanisms in place to record and retrieve the wishes of patients. According to one senior pathologist, that is a massive exercise, which does not seem to have been considered by the Department of Health, let alone to have been costed. We need reminding that 3 million tissue samples are taken in NHS operations every year. Since the Alder Hey and Bristol inquiries, it is extremely important that the Government address the recruitment crisis in pathology services more vigorously to ensure that patients receive the services they need and to ensure that medical research is not damaged in the process.
Although it was not contained in the Queen's Speech, a Bill has been announced to establish the new health protection agency as a UK-wide non-department body. It will act in succession to the Public Health Laboratory Service—I am pleased to see the noble Lord, Lord Turnberg, the former chair of the PHLS, in his place—to implement some of the proposals in Getting Ahead of the Curve.
Although the Minister was not in his present position when we debated the proposals in this House, he may be aware that on these Benches we have largely supported this move. In particular, we support the proposal that the new body will take in the Communicable Disease Surveillance Centre at Colindale, the Centre for Applied Microbiology and Research at Porton Down and the National Radiological Protection Board. But we have long had strong doubts about dispersing the 31 microbiological laboratories previously managed by the PHLS. The jury is still out on whether this will be a plus for the public health service, but it is doubtful. We look forward to the draft Bill.
We have now heard that the Government plan to introduce a draft mental health Bill. An update of current legislation—the Mental Health Act 1983—is long overdue. It is in desperate need of reform to improve patient care, to reflect modern treatment patterns and to ensure that the rights of patients are protected under a new system.
We welcome the noble Baroness's statement that it is vital to get the legislation right. However, we have long made it clear that many provisions of the previous draft Bill are wrong in principle. We are thinking of the definition of mental illness, the lack of right to an assessment, and the issue of a compulsory treatment order. As a consequence of some of those issues, the Royal College of Psychiatrists has said that that draft Bill could,
- "inflict damage on patient care".
If the Bill remains in its existing form, it could also have a major impact on the resources needed for the mental healthcare system as it currently exists. According to an assessment of the Bill's implications by the NHS Confederation released in November, the Bill could increase the workload of mental health
service staff severely, requiring an estimated 1,000 extra staff simply to handle existing cases. The report estimates a 50 per cent increase in work associated with the legislation for psychiatrists, social workers and administrative staff. The number of tribunal hearings would likely double.Already, significant staff shortages exist in several essential mental health areas, as evidenced by vacancy data from the Royal College of Psychiatrists. Putting more pressure on a system already suffering from unmet demand could bring about a human resources crisis for the mental health services.
The Government's much-vaunted additional resources are simply not getting to the front line in mental health services. The recent survey by the Sainsbury Centre for Mental Health showed that, far from the 11.5 per cent increase that the Government claimed was going into mental health services, the increase for new developments in mental health is actually 1.6 per cent. It is vital that the new mental health Bill does not make the situation worse, and that the Government commit to greater resources at the same time.
We on these Benches very much welcome the intention to introduce child protection measures following the Climbie case, heralded in Every Child Matters, as my noble friend Lady Walmsley stated earlier. However, I share her view about the lack of any provision for the abolition of reasonable chastisement in the Queen's Speech.
In the gracious Speech, there was also mention of further reforms to the NHS being continued, including giving more choice to patients, more freedom to NHS staff, and more control over hospitals to local communities. That opens up a very wide range of speculation. Those are all laudable ambitions, and many of them may not need legislation. However, as we saw with foundation hospitals, the issues are fraught with difficulties for a Government who simply do not listen.
Let us take patient choice first. That should include not only a choice of treatment centre and appointment time, but access to information, so that patients can have more choice and flexibility in treatment options and ability to make decisions. Those who have little access or ability should be assisted to make well informed health choices, and should not be marginalised. It is also important that we examine the effects that choice will have for other policy initiatives, such as commissioning, so that high standards of patient care can be maintained. What will be the effect on waiting lists? Are we in fact shifting the problem rather than solving it?
Then we have Agenda for Change, which I assume is caught within the phrase, "freedom to NHS staff". We are told that it is an important step towards increasing staff numbers in the NHS, ensuring flexibility and refocusing services around patient needs. Yet huge differences remain among NHS staff about the desirability of Agenda for Change, particularly among professions allied to medicine. That is not surprising
when newly trained radiographers, who are in very short supply, will receive less than they did before in the face of massive shortages in clinical oncology services. As a result, agency staff are being employed at double the cost to the NHS of a staff radiographer.Payment by results, another initiative, will force hospitals labelled as "inefficient" to cope with budget cuts of millions of pounds—losses that can hardly be recouped through savings. That could translate into staff cuts and reduced patient services. At worst, it will continue a two-tier hospital system started with foundation hospitals, and will regularly penalise the worst-off hospitals while rewarding the better funded. All those are areas where I very much hope that the Government will indeed have big conversations.
There are also major structural reforms in the pipeline. The Health Secretary, Mr Reid, recently announced cuts that would shrink the Department of Health's staff numbers by more than a third by October 2004. In our view, that is a positive move, but we need to be wary. It is clear that, as the Department of Health has itself admitted, the NHS has spent more than £70 million on redundancy and restructuring in the past two years. That sum is equivalent to the cost of refurbishing a large hospital, or two-thirds of what the National Institute for Clinical Excellence added to NHS spending in a full year by recommending the use of more effective drugs. Was that really necessary? What will the costs of reorganising the Department of Health be? Perhaps the Minister will begin to answer that question.
The noble Lord, Lord Turnberg, referred to regulation. In the report by the Better Regulation Task Force, the NHS was said to be the,
- "greatest victim of regulatory excess".
Needless to say, we welcome the move. Regulation in the four key areas—national standards, performance management, safeguarding of patients, and education, training and clinical governance—must be rigorously examined. We on these Benches look forward to seeing the Government's proposals for rationalising the number of regulators, so that NHS staff can more easily get on with their jobs.
I shall move swiftly on to other areas. I could deal with long-term care or specialised commissioning, but I shall turn to public health. That area was raised in an interesting way by the noble and right reverend Lord, Lord Sheppard, and the noble Lord, Lord Fowler, in one respect. The Liberal Democrats believe that primary care—preventive care—is extremely important. There are three key areas in which we believe that the Government are dragging their heels.
The first was dealt with quite adequately in the Starred Question today. It is clearly inadequate for the Government to be dragging their heels on the banning of smoking in public places. A powerful alliance of leaders of all 13 royal colleges of medicine made the demand, and we believe that the Government's actions are inadequate.
Obesity is the second of the three major issues in the public area that we believe need addressing. It was described as a "time bomb" by the Chief Medical Officer recently. It perhaps poses the most serious threat to the health of a huge number of young people in this country. If current trends continue, by 2020 one in three adults is expected to be obese. We look forward to the report of the Food Standards Agency and to what it recommends on advertising to young people. We support what Tessa Jowell is trying to do—asking that the Ofcom code be beefed up—but there must be coherent making of public policy in this respect. Who is actually making policy in the area? Is it Tessa Jowell? Is it the FSA? It is only right that we should have that debate, but it is important that we wait and see what the FSA has to say before Ofcom goes for a new code.
The noble Lord, Lord Fowler, raised in a very impressive way the issue of sexual health, particularly given his track record. One could cite any number of figures. I choose the figure for chlamydia, which has gone up by 139 per cent in the past six years. The figures may be more alarming in other areas, but the whole issue of chlamydia screening has been dealt with completely inadequately. In European countries such as Sweden there is widespread availability of tests, and there is no reason for us to be dragging our heels on the matter. The release of £15 million by the Department of Health for STI clinics in England is merely a drop in the ocean in those circumstances. It is interesting that there is no reference to sexual health in the big conversation consultation document. As it is an issue of such major importance, the Government should be ashamed of themselves in that respect.
Many other areas of the Government's policy give cause for concern. We can only take a snapshot and assume that, at some stage later in the year, we shall be able to debate them at greater length. In the mean time, I shall be very interested to hear what the Government have to say. The Minister has a most unenviable task.
6.30 p.m.
Earl Howe: My Lords, any Minister who is called upon to reply to a debate on the gracious Speech never knows quite what will hit him from what direction. However, I believe that the noble Lord, Lord Warner, will agree that today we have had some excellent and thoughtful contributions from all sides of the House. It is also something of a relief to note that, with perhaps one signal exception, the areas of policy covered by this section of the debate are not of a kind to excite fundamental party-political controversy. We have had quite enough of that in health and home affairs during the past nine months or so to last us for a considerable time.
I suggest that the one exception is asylum and immigration policy, where the failures of the Government and the illiberal character of their proposals were so clearly exposed by my noble friend Lady Anelay, the noble Lords, Lord Dholakia and Lord Clinton-Davis, and the noble Baroness, Lady Walmsley.
We heard a most powerful and authoritative speech from my noble friend Lord Fowler on HIV/AIDS, every word of which I agreed with. We listened to some extremely wise words on domestic violence from the noble Baroness, Lady Thomas, and on victim support from her namesake and noble colleague, the noble Lord, Lord Thomas of Gresford. We were given some well founded warnings by the noble Baroness, Lady Dean, about pensions, and a truly magisterial tour d'horizon on dentistry from my noble friend Lord Colwyn.
The noble and right reverend Lord, Lord Sheppard, whom we warmly welcome back to our debates, shared with us a characteristically perceptive set of observations on the NHS and on primary care, as did the noble Lord, Lord Chan. The noble Lord, Lord Addington, spoke with great sense and wisdom about disability. I listened, as I always do, with great respect to the noble Lord, Lord Turnberg, in all that he had to say about clinical research in the NHS. Finally, the noble Baroness, Lady Wilkins, treated us to a seminal and most illuminating speech on co-housing. I have not forgotten the noble Baroness, Lady Finlay, to whom I shall come in a moment. But that, by any measure, is a mixed bag of delights for the Minister to take away with him.
I want to follow the noble Lord, Lord Clement-Jones, in welcoming the forthcoming arrival of the human tissue Bill. It is a measure which, subject to the detail within it, we shall support. However, it is also a measure for which we have waited a disappointingly long time. There is a certain irony in the fact that today, 1st December, sees the final disappearance of community health councils, to whose work on behalf of patients and the public during the past quarter of a century I pay tribute once again. It is now four years since the Association of Community Health Councils for England & Wales first raised concerns about organ retention; nearly three years since the Alder Hey report; and two years since the Chief Medical Officer said that the Human Tissue Act needed to be amended "as an immediate measure".
We thought that we would have a draft Bill on that subject before the summer Recess. That was the clear indication given by Hazel Blears in April. We have not yet had it and, given that the draft version will require adequate time for consultation beforehand, I wonder how this further slippage in the timetable will affect the passage of the eventual Bill during this Session.
I feel that consultation on such sensitive matters will be very important. I think here not only of families and individuals who have been closely affected by organ retentions in the past but also of the medical community, for whom human tissues and organs are essential for the continuation of medical research and
public health surveillance. The truth is that, in the time-honoured phrase so beloved of Ministers, this Bill will require a balance to be struck if it is to achieve the best possible results for patients.We need, above all, to restore public confidence in the system and in the professions that run it. What we saw in the Alder Hey report, and in last year's consultation document entitled Human Bodies, Human Choices, was a frank admission that the practice of retaining organs after death without consent was one which, unlike every other area of medicine, had remained rooted in old-fashioned paternalistic attitudes about what was best for doctors and about what patients did or did not need to know. The emotional trauma suffered by so many people on discovering, belatedly, what had been done to the vital organs of their children or husbands or wives was a sufficient indication, if any were needed, that the balance had been very wrong for a very long time.
Scientific rationality—the view that human organs, once a person is dead, are of no benefit to that person and might as well be put to a relevant use—is not enough when we are dealing with human emotions and deep-seated personal beliefs. My own opinion is that the whole issue turns on a very simple proposition: if you tell people the truth at the very beginning, they will usually be content. Obtaining the consent of a patient's relatives to the removal of tissue or organs depends on explaining exactly what tissues are being asked for, why they are being asked for, the strict nature of the guidelines governing their use, and the reasons that medical research and education depend so heavily on donations of that kind.
We understand that activities which involve what is termed "the everyday life" taking of tissue such as hair or nail clippings will be outside the scope of the legislation. I simply say to the Minister that I believe we need to be very careful here. I considered the speech of the noble Baroness, Lady Finlay, to be a landmark of its kind and I congratulate her on it.
Most people would regard blood samples, swabs and microscopic quantities of tissue as being different in degree and kind from whole human organs. But it is dangerous to take that assumption for granted in the climate of mistrust which currently surrounds us. It would be helpful if the Minister could say a little on that aspect of the matter when he comes to speak. Like the noble Lord, Lord Clement-Jones, I should also be glad if he could share with us what plans the Government have to ensure that systems are in place to register and retrieve the wishes of patients—a requirement which potentially poses considerable logistical challenges.
We shall want to examine a range of core issues once the Bill is before us—not least the definition of fully informed consent; who exactly should count as the next of kin; the structure of regulation governing tissue donation; and the support to be given to family networks. The considerations are different according to whether the human tissues emanate from a child or from an adult and according to whether the post
mortem is conducted in a hospital or by a coroner. But the problem in each case is identical—that is, building public confidence.Pathology, and especially paediatric pathology, has been badly affected by Alder Hey and by similar instances of unauthorised organ retention around the country. I know that the Government have been trying to boost the numbers in the pathology profession in a variety of ways, although the success of those efforts is not yet apparent.
One could say something similar about the Government's efforts to bring forward new mental health legislation. I have lost count of the number of Queen's Speech debates which have deplored the absence of a mental health Bill, but this time we really do have to wonder whether we shall see legislation in place this side of a general election. After all that has been said and done on this vital subject, that is a deeply disappointing state of affairs. While the Secretary of State's recent announcement that there would be pre-legislative scrutiny of a new draft Bill was welcome, we do not have any clear idea of the timing.
Perhaps I may make one or two observations. The first relates to the Mental Incapacity Bill, about which—once again—no mention was made in the gracious Speech. I hope very much that progress has not stalled on that Bill, which has already undergone extensive pre-legislative scrutiny. By no means am I the only person to believe that the provisions of the Mental Incapacity Bill need to be absolutely consistent with those contained in the mental health Bill. The Law Society has had some cogent things to say about that.
The basic premise of the Mental Incapacity Bill is the empowerment of individuals. That is the theme of much of the Government's policy work on healthcare, and I welcome it. However, it is a theme that does not sit at all well with the emphasis of the draft mental health Bill published last year; it was one of compulsion and coercion. To enable vulnerable people to pluck up the courage to seek help, we must have in place a system which does not deter them and professionals in whom patients can place their full trust. The emphasis on dangerousness in a Bill of this kind is, in my opinion, quite wrong. It adds to stigma and detracts from the proper care of the mentally ill, and distorts the extent and nature of the risk posed by a very few individuals.
We badly need to update the 1959 and 1983 mental health legislation. I hope that the Minister can give us some reassurance that a new draft Bill will be published soon, a Bill that is shorn of earlier, unacceptable features and guided by principles that are genuinely patient-centred.
If respect for the individual was one of the themes of the gracious Speech, another was enhanced lifetime opportunities—not least, if I may so refer to them, enhanced lifetime opportunities for hereditary Peers. As this may be the last debate on the gracious Speech in which I may have the privilege of participating, it is a particular pleasure for me to look forward to the coming Session against the backdrop of the very
stimulating contributions made by noble Lords today. I have every confidence that the Minister, in his first foray in winding up for the Government at the start of a parliamentary Session, will do justice to those contributions in his reply.6.43 p.m.
Lord Warner: My Lords, I am grateful to the noble Earl for the confidence expressed in his final remarks. I join with him and other noble Lords in paying tribute to the many thoughtful contributions that have been made to this debate. In her opening remarks, my noble friend Lady Scotland sought to demonstrate how both her department and my own are working together in areas covered in the Queen's Speech such as drug use, the victims of domestic violence and mental health. I shall not repeat the arguments she made earlier. However, in my response to noble Lords I shall try to pick up on as many as possible of the points that have been made. Let me reassure the noble Lord, Lord Clement-Jones, that I shall do so in my normal calm and—if I may draw his attention to the article he referred to—responsible manner. I shall be calm and responsible in my response to the debate.
I think that I may interpret the noble Baroness, Lady Anelay, as being supportive of the Government's approach to domestic violence. She raised certain questions about our position in some of the current policy areas. We are certainly pressing on with seeking to raise public awareness of domestic violence and before the end of the year we shall be launching the 24-hour free-phone helpline. That will be backed by an online database giving information about refuge accommodation and support services. I think that we can be confident that that will be in place by the end of the year.
The noble Baroness took issue with the Government on some of the points related to asylum matters. I noted in passing—I had certain responsibilities in this area during the early days of this Government—that she expressed a slight dissatisfaction with the statistics she cited. However, as I recall, members of the party opposite were quite happy to accept some of those statistics when they pointed in the direction that they wanted. The noble Baroness asked for assurances on legal aid for asylum cases, in particular that reductions in legal aid would not prevent legitimate applicants taking forward an appeal. I can assure the noble Baroness that legal aid will still be available to take forward appeals. In extreme and/or complex cases, appellants may be able to receive more than the normal five hours of legal aid. I hope that that goes some way towards reassuring her.
The noble Baroness and a number of other noble Lords raised issues regarding the media coverage of the treatment of children under the proposed asylum legislation. Anyone who has read Clause 7 of the Bill published last Thursday will see that it does not include any provision for taking children into care. The position is that local authorities in the United Kingdom have duties towards all children in need living in their areas, including the children of failed asylum seekers. A local authority may accommodate
or otherwise look after a child who is in need in their area. Children are taken into care only when they are suffering or are likely to suffer harm.Failed asylum seekers are not legally in the UK and therefore cannot expect to make unconditional and unlimited claims on public funds. We will continue to provide support while they prepare themselves for voluntary departure. However, we will withdraw that support if we believe that those people are able but unwilling to leave the UK, if we believe that they are refusing to co-operate with the redocumentation process or otherwise fail to place themselves in a position whereby they may leave the country. At that point, local authorities must consider whether they need to help to support the children by providing them with accommodation or otherwise looking after them. Children who are suffering or are likely to suffer harm may be taken into care, but that may happen in any event and is not in any way affected by these proposals. I hope that that clarifies the position under this legislation and responds to points raised both by the noble Baroness, Lady Anelay, and other noble Lords.
The noble Lord, Lord Dholakia, welcomed many of the new measures in a characteristically generous speech. He asked whether the children's commissioner could consider young people being held in detention. The consultation period on the DfES consultation paper, Every Child Matters, ends today and we shall be further developing our proposals in the light of that consultation. However, the Government have said that the commissioner will act as a children's champion, independent of government, and will speak for all children, in particular for the disadvantaged, whose voices are too often drowned out. I hope that that offers a little reassurance.
The noble Lord also asked about asylum appeals, as did my noble friend Lord Clinton-Davis, and other noble Lords. The new single-tier system would continue to provide a right of appeal and a fair hearing, but applicants should not be able to appeal endlessly at taxpayers' expense. That is the Government's policy. It is worth bearing in mind that only 3 per cent of onward appeals to the tribunal—the current second tier—result in a decision being overturned. The outcome at appeal reflects many factors, including delays, which can encourage new issues to be raised late in the process. The procedure is now much faster. I shall come back to that in later comments.
My noble friend Lord Clinton-Davis raised a number of points in a particularly trenchant speech. I shall deal first with the issue of the compatibility of proposals to penalise undocumented applicants and whether that is within Article 31 of the refugee convention. We have taken account of Article 31 of the refugee convention, which is reflected in UK law by Section 31 of the Immigration and Asylum Act 1999. We do not intend to amend Section 31 as a result of any measures in the Bill. I have dealt already with some of the points my noble friend raised in regard to a single tier of appeal.
My noble friend Lord Clinton-Davis drew attention to the Government not trying to ape or position themselves differently from the party opposite. I gently remind him of the remarks made by Oliver Letwin in early October when he was talking about what one can only describe as a fantasy island.
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