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Lord Foster of Bishop Auckland: My Lords, I am delighted to be able to make my maiden speech in a debate that goes to the heart of the health of local democracy and to the heart of the debate about trust and politicians.

At the outset, I have a confession to make. In 1975, together with everyone else who attended the Labour Party conference of that year, I voted to abolish your Lordships' House. On that occasion, we were all gently chided by one of my mentors, Lord Shinwell, who reminded us that he had voted to abolish your Lordships' House in 1929. After a very long and very distinguished career in another place, he said, "I had nowhere else to go". I leave it to your Lordships to judge whether I have nowhere else to go, but if that is the case I can think of no better place to go.

I used to chide my younger colleagues in the other place that they were not proper politicians if they could not speak for 10 minutes without engaging the brain. Again, I leave your Lordships to judge whether on this occasion I have taken my own advice.

I came into politics 33 years ago, the son of a shipyard worker in Sunderland, who had been unemployed for seven years during the 1930s. It is not surprising that I had one or two small matters on my agenda when I entered politics, such as abolishing poverty, abolishing unemployment and abolishing educational inequality. My commitment to those objectives has remained firm over all those years and my noble friends on the Front Bench espouse those objectives too. Over the years some progress has been made.

I had another objective, which was to prevent too much power ending up in too few hands. Perhaps it was the nonconformity that I learnt at my mother's knee. I leave your Lordships to speculate how someone who was a nonconformist to his finger tips ended up as the agent of conformity for 10 years in the other place. How that happened I cannot tell. Because of that nonconformity or for some other reason, I have always been a decentraliser and a devolver, both by instinct and by experience.

Perhaps I may be allowed to refer to my former constituency, the town of Bishop Auckland, by way of example. Perhaps the only thing for which Bishop Auckland is known throughout the world is its superb amateur football club. In the 1950s and 1960s the team regularly ended up in the final at Wembley playing in front of 100,000 people. The people of Bishop Auckland are rightly proud of that great football heritage. They are also proud of the fact that the town has been the home of the bishops of Durham for 800 years.
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A few miles down the road is Shildon. In 1825, slightly before my time, Timothy Hackworth began to build rail rolling stock in the town of Shildon. The building of that rolling stock went on until 1983, sometimes employing 2,600 people. The people of Shildon tend to celebrate their railway heritage now because of the efforts of Shildon Borough Council and the National Rail Museum at York where they have Locomotion, a rail museum with 60 rolling stock, which has attracted approaching 150,000 visitors in the short nine months since it opened.

A few miles in another direction, in Spennymoor, people are immensely proud of their mining heritage. I will be marching behind the Spennymoor town band at the miners' gala as I have done every year for the past 15 or 20 years. The gala is a great celebration of mining. It is such a moving occasion, when you watch 30 bands coming over Elvet Bridge with banners flying and stopping in front of the hotel in the centre of Durham.

All of those are sources of immense pride in my communities but I am even more proud of the miners' settlements in Spennymoor because they have nurtured many painters among former miners who are of regional significance—and two who are of national significance; Tom McGuinness, who worked for 50 years in the mines in Bishop Auckland, and Norman Cornish, who was also a miner in Spennymoor.

I have only Teesdale left to mention out of my former constituency—almost 600 square miles of the most glorious countryside in the whole of the north of England. Barnard Castle boasts the national gem of the Bowes Museum under its very able young director, Adrian Jenkins, which is chaired most ably by the noble Viscount, Lord Eccles, who I am glad to see is in his place.

If we are to regenerate further these communities we can only do so by building on their already established sense of civic pride in their history. That cannot be done by central government from the top. Of course, there has to be a strong strategic centre. If we had nothing but centralisation, I fear that we would end up with chaos. We need a strong strategic centre voting on policies and allocating the money to allow interesting things to happen at local level. However, we can regenerate communities only by releasing the skill, commitment and creativity of local people.

Local government, as well as national government, can be centralising. Our message ought to be directed at both central and local government. No regeneration of communities can take place without engaging the skill and creativity of local people.

We are not only talking about the health of local democracy this morning; the matter goes to the reform of the public service. We have tested to destruction the view that you can micromanage the health service from the centre. We have learnt that you have to release the skill and creativity of people at the sharp end. We have all learnt that, but I am not certain that we have learnt the mechanisms by which it can happen. Perhaps that is because there are echelons of managers
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who have been brought up in the command-and-control culture and find it difficult to learn that managing these days, both in business and in public service, is a matter of releasing the skill and creativity of the workforce. I look forward to the Government pursuing that agenda with even greater vigour.

I am very pleased to have been allowed to make a small contribution to this debate, and I hope that other opportunities occur.

12.15 pm

Lord Chan: My Lords, I warmly congratulate the noble Lord, Lord Foster of Bishop Auckland, on his eloquent and thoughtful maiden speech. I first met him when he was a Member of Parliament, and I visited Bishop Auckland as part of a small group representing the Commission on the Future of Multi-ethnic Britain, in 1999. It was a most revealing and helpful visit, to see the disparity of those who were very poor living side by side with those who were very affluent—and the lovely countryside of north-east England.

After a long and illustrious career in local councils in the north-east of England, and 26 years in the other place, I have no doubt that the noble Lord will make very important contributions in future debates, particularly in the fields of economic development, employment and the environment. He also has very interesting and broad-reaching contacts; for example, he is a member of the Salvation Army and has a tremendous interest in youth affairs. I am delighted that he is here and look forward to his valuable contributions in future debates.

I also congratulate the noble Lord, Lord Phillips of Sudbury, on securing this debate on a topic that particularly affects service delivery and the well-being of all citizens and communities. I shall focus on health and social care-related issues, drawing on my experience in Merseyside, which is an area where significant pockets of socio-economic deprivation are located close to affluent communities.

To provide services for the needs of those two distinct population groups with very different needs would require careful local planning. However, quality of services is best regulated through standards set at the centre. That arrangement is to be found in healthcare: standards are set by the centre through National Health Service frameworks, treatment guidelines provided by the National Institute for Clinical Excellence—NICE—and supported by agencies such as the National Patient Safety Agency and the National Clinical Assessment Authority.

The performance of local primary care trusts and hospital trusts is self-assessed by the local trust's audit committee, corporate and clinical governance groups and the finance committee, all led by non-executive directors. Here I declare that I am a non-executive director of Birkenhead and Wallasey PCT; I also serve on a steering group of the National Clinical Assessment Authority.

Good policies do not guarantee improved service delivery, because delivery depends on effective implementation of policies locally. In the past four
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years, the Government have directed healthcare services from the centre by setting numerous targets for primary care trusts to achieve annually in order to be awarded star status, ranging from zero to three stars. Rewards worth £1 million each have been given to three-star primary care trusts every year—and I am pleased to report that mine is one of them.

This system of centrally led healthcare delivery has produced limited improvements in patient satisfaction and in the health of communities. It has also caused staff to become frustrated with having to work to targets that do not necessarily improve the health of patients. Not surprisingly, the second phase of the NHS Plan announced six months ago emphasised a moving away from national to local initiatives. This new phase has been labelled the patient-led NHS. It is based on patients' choice through information and involvement with greater influence of primary care and GPs through local staff leadership and motivation.

Before we become excited by the prospect of local autonomy I inform your Lordships' House that more changes are envisaged in the work of PCTs and hospital trusts. A system of listening to patients and local residents is still rudimentary. One excellent example of this is the National Patients Survey (NPS) programme introduced in 2001 by the Department of Health. Listening to Patients is the collaborative annual survey of PCT patients first surveyed in 2003. Every PCT pays its share towards the commissioning of that survey.

A significant finding was that in 2004 some 70 per cent of those surveyed were content with the information they received about side-effects of medication prescribed for them, which means that 30 per cent of them were not. As a result PCTs on Merseyside are changing their contracts with community pharmacists to ensure that pharmacists will speak with every patient collecting their medication to discuss any medication issues. The report states that when patients were asked whether they had asked a pharmacist for any advice on medicines in the past 12 months, 26 per cent said that they had. Of this group 82 per cent said that the pharmacist's advice was definitely helpful and 4 per cent said that it was not helpful.

Clearly, eight out of 10 of patients on Merseyside do not speak with pharmacists. Therefore, it is important for the community pharmacist to initiate conversation with patients and ask them if they have any concerns regarding their medication, how they are to take their medicines and how to reduce side effects. If that were to take place, it would reverse the high proportion—about 70 per cent—of patients on Merseyside who do not complete the course of medicines prescribed by their GP or hospital doctor.

Computerisation of GP clinics is being developed so that primary care doctors may send information on their patients to hospital specialists through secure systems. If I may be provocative, an alternative system of sharing patient information would be for all users of
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the NHS to carry identity cards holding personal information about their health to share with GPs and hospital doctors.

Another example of local autonomy that will rapidly improve public health is that of having smoke-free workplaces. On Merseyside local authorities and NHS trusts have been more focused on achieving smoke-free workplaces that include shopping malls than the Government have been on their proposal to allow smoking in public houses where no food is served.

Public consultation on Merseyside has demonstrated that the majority of smokers also support smoke-free workplaces, public houses and shopping malls. The importance of this finding is particularly significant when we realise that Merseyside has the highest rate of lung cancer in England. Local autonomy on Merseyside has led to very sensible decisions on improving public health. Therefore, I hope and trust that central government will support local authorities and local groups on this most worthy decision to promote smoke-free workplaces, public houses and shopping malls especially the Bills for a smoke-free Liverpool and London.

The Government have made health and the NHS a priority. Spending on the NHS by 2008 is set to double that which was given in 2000. To achieve the maximum benefits the Government must trust local people who care and who are dedicated to improving the health and well-being of local communities. Appropriate services, whether provided by public or private sectors, should seek to meet the needs of people where they live. To be relevant and effective, service provision and delivery must be locally determined. I look forward to hearing the Minister's views.

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