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Baroness Masham of Ilton: My Lords, is the Minister aware that there is considerable concern throughout the country about the NHS Wheelchair Service? Is he aware of the case of a young woman with severe disability who is under 20 and has to stay in bed in Ripon because the local Wheelchair Service says there will not be a suitable wheelchair for her until Christmas? Is that not a disgrace? The case was highlighted two or three weeks ago in the local paper, the Ripon Gazette, and by Yorkshire Television. I can send the press cuttings to the noble Lord, if he is interested.
Lord Warner: My Lords, although I am unaware of the case that the noble Baroness raises—I can only sympathise with it—I will certainly look into it. I should be glad to receive anything that she can send me that would help with that inquiry.
Earl Ferrers: My Lords, I wonder whether the Minister would be kind enough to answer a question that I have always found puzzling. I am slightly apprehensive about asking it because I know how touchy he gets with anything remotely political—there is nothing at all political in this question. If the Government put in twice the amount of money that was put in in 1997—a tremendous amount of money—and if it were multiplied threefold, how is it in the end that NHS trusts make a loss? One could conclude that there was poor management somewhere. Is one wrong in that conclusion?
Lord Warner: My Lords, we have put more money in and we are getting more out. We do not have the kind of waiting lists that were around when we came to office. We do not have people on trolleys for 12 hours in accident and emergency departments. We do not have the death rates that there were or the waits for cancer treatment. That is where the money has gone, with the dedication of NHS staff, which all Members of this House have acknowledged. I would be glad to agree with the noble Earl that in some parts of the NHS—it is a minority of places that are in deficit—management could probably be improved.
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We know that there are variations across the NHS as there were when his party was in office. There are variations in length of stay, the extent to which people are discharged earlier and the use of agency staff. These are often matters of clinical and general management in particular places. We all need to strive to bring the performance of everybody up to the performance of the best.
Baroness Morgan of Drefelin: My Lords, I wonder whether my noble friend could help me on a couple of points. I have not seen the chief executive's report today but, like him, I am concerned that a number of NHS organisations are in deficit. I had been very pleased to hear that on a number of occasions Ministers have given undertakings that steps will be taken to ensure that patient care does not suffer as a result of these deficits. Will my noble friend explain what processes are in place to ensure that the current financial situation does not increase the disparity of care experienced in different parts of the country, which some people describe as the postcode lottery?
Also, what references has the NHS chief executive made to the national patient survey and patient satisfaction levels? In the long run, we need to understand the trends in patients' views and experiences as directly measured as much as possible. Does my noble friend agree with the description from, I think, the Picker Institute, which said that UK patients in comparison with those from other countries were less agitated or demanding? It would be good to try to change that. An analysis of patient satisfaction with clear trends and writ large in annual reports from the chief executive would be very helpful.
Lord Warner: My Lords, on that last point I direct my noble friend to the report published recently—I shall send her a copy of it—by the Independent Healthcare Commission, which contained a patient survey that showed that patient satisfaction was rising in the NHS. That source is independent from the Government. I shall make sure that there is also a copy in the Library.
My noble friend asked how we would ensure that patient care did not suffer. The independent Healthcare Commission will continue to produce its annual ratings of the performance across a number of domains of individual trusts. It continues to have a power, which it exercises, to put particular trusts on special measures if there are serious concerns about particular aspects of their clinical services. A strong SHA performance management system is in place, the national target requirements for waiting times and so on continue to be in place, and national clinical directors are in constant contact with the NHS, picking up any concerns about problems in particular areas.
Lord Colwyn: My Lords, I also thank the Minister for repeating the Statement and I pay tribute to all NHS staff, particularly those in the dental service, which, as usual, has no mention either in the Statement
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or in the chief executive's report. This report covers a period when we have seen the most far-reaching changes in the dental service. Of course, it is far too early to try to assess how the provision of NHS dentistry will be affected by this 2006 contract. Twelve per cent of dentists chose not to take the option of a contract, which reduces the availability of NHS dentistry by 4 per cent, but the movement of 2,500 dentists into the private workforce must mean that there will be a significant change in the dental market. It now seems that the new contract will be a temporary arrangement while PCTs design their local service and adjust to new financial arrangements.
The public reaction to the fee increases, which have been imposed on the majority of those who pay, has yet to be seen. The move to the private sector will inevitably move fee-paying patients away from the NHS. As PCTs evolve their controller practices, the work requirement relative to the UDA value will have to be attractive to the provider. Does the Minister still maintain that the changes that will take place will return and maintain the NHS dental service to financial balance and deliver the performance plan and that it will lead to open access to the millions of patients who were previously denied treatment?
Lord Warner: My Lords, as the noble Lord said, the people who declined to participate in the new contract arrangements represented a 4 per cent reduction in NHS capacity. Unlike in the past, the PCTs have the money to replace that dental capacity and, in fact, are doing so. As the noble Lord knows very well, this Government have brought in a large number of extra dentists, particularly from places such as Poland and Spain; we have expanded dental school capacity; and we are bringing back some dentists who were not practising in the profession. So we are increasing the capability.
The reason that dentistry does not feature in what is a six-monthly report is, on the noble Lord's own acknowledgement, that it is a bit too early to say what the full implications are of the contract changes that took place only in April.
Electoral Administration Bill
4.12 pm
Baroness Hanham moved Amendment No. 1:
"REGISTRATION OF SERVICE VOTERS: DUTY TO TAKE NECESSARY STEPS
In the 1983 Act omit subsections (3) and (4) of section 59 (supplemental provision as to members of forces and service voters) and insert after that section—
"59A REGISTRATION OF SERVICE VOTERS: DUTY TO TAKE NECESSARY STEPS
(1) Arrangements must be made by the appropriate government department for ensuring that every person having a service qualification by virtue of paragraph (a) or (b) of section 14(1) above—
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(a) is registered to vote unless they make a request under subsection (2), and
(b) has (so far as circumstances permit) an effective opportunity of exercising from time to time as occasion may require the rights conferred on him by this Act in relation to—
(i) the making and cancellation of appointments of a proxy;
(ii) voting in person, by post or by proxy.
(2) A person having a service qualification by virtue of paragraph (a) or (b) of section 14(1) above is entitled to decline to be registered by the appropriate government department if he has registered, or declined to be registered, with his local authority.
(3) Arrangements must be made by the appropriate government department for securing that such person receives such instructions as to the effect of this Act and any regulations made under it, and such other assistance, as may be reasonably sufficient in connection with the exercise by that person and any spouse or civil partner of that person of any rights conferred on them as mentioned in subsection (1)(b).
(4) In subsections (1) to (3) "the appropriate government department" means, in relation to members of the forces, the Ministry of Defence, and in relation to any other person means the government department under which he is employed in the employment giving the service qualification.
(5) The Ministry of Defence must maintain, in relation to each member of the forces who provides information relating to his registration as an elector, a record of such information.
(6) The Ministry of Defence must make arrangements to enable each member of the forces to update annually the information recorded under subsection (5).
(7) In relation to persons having a service qualification by virtue of paragraph (c) of section 14(1), the British Council shall be under a corresponding obligation to that imposed by subsections (1) to (3) on the appropriate government department.""
The noble Baroness said: My Lords, ever since the introduction of this Bill—I want to stress that at its introduction last year it contained no provisions at all on service voters—members of my party, in particular, have been pressing for improvements to the current system for service voting.
My honourable friend in the Commons, Andrew Tyrie, initially raised this matter in connection with his concerns about the registration of service voters and the difficulties that had resulted from changes to the Representation of the People Act 2000, which led to changes in service voter registration. I then took up the issue in this House, and the noble Lord, Lord Garden, from the Liberal Democrats has also been pushing at it with me since Committee.
It is interesting to note that under the current system of service voting, only 46 per cent of servicemen and women and just 28 per cent of those overseas actually voted in the last election. As I said, at previous stages of the Bill in this House, we have been supported by the noble Lord, Lord Garden, who is an Air Marshal. He and I tabled joint amendments on Report to press the Government to amend the Bill to deal with the difficulties being experienced by service personnel, which these figures demonstrate, and difficulties with registration.
In yesterday's Daily Telegraph, a report of a survey on service voting, conducted by the Defence Analytical Services Agency, showed that only 60 per
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cent of service personnel were registered to vote at the last election. Clearly, something is wrong. Out of those who responded to the survey, 61 per cent were unaware that they had to re-register every year to vote and that figure rose to 71 per cent among those posted overseas. So in total only 46 per cent of armed services voters voted in the last election. That quick summary of the profile of service voters shows that the major problem for them is registering to vote.
On Report, the Minister promised to come back with a solution that would re-enfranchise Armed Forces personnel. I know the efforts that she has made to ensure that her amendments are on the Marshalled List today. I believe she has been very brave in the way in which she has dealt with that. I wish I could say that they go far enough and that I accept them wholeheartedly, but the Minister knows that I shall not do that. In our view, one ingredient is still missing. The amendments do not go far enough. I shall explain.
While subsection (1) of the government amendment is welcome, as it will enable Armed Forces personnel to remain on the register for up to five years—relieving them of the task of re-registering every year, which could be logistically impossible for them—I am seriously disappointed with the Government's proposals as set out in subsection (2). Subsection (2) is a smokescreen which gives a false sense of security to those who are passionate about ensuring that servicemen and women are in the best possible position to vote, if they wish. The government amendment merely requires the Ministry of Defence to secure,
"(so far as circumstances permit) an effective opportunity of exercising from time to time as occasion may require the rights",
Not only does the amendment fail to put a duty on the Ministry of Defence to register armed services personnel to vote, but it also places a condition on fulfilling the provision of opportunity by stating that it must be done,
That is understandable when it relates to the casting of a vote which cannot be managed in the same way as registration. However, it is quite inadequate as regards the registering of personnel.
There is no reason why registration should not happen when people join the Army or while they are stationed in the United Kingdom. It is worth considering that the Army's conditions of employment divide into two distinct areas: entitlements and guidelines. I believe that the Minister's amendment would fall very firmly into the guidelines section. Perhaps I can quote from the Army's website. It describes the status of guidelines as,
"A Guideline represents something the Army will try to provide but may not always be able to guarantee".
Registration is at the heart of this issue. The survey tells us that 73 per cent of those who received an advisory booklet, Register to vote, did not get around to reading it. It is hardly surprising that registering oneself to vote is not at the top of the priority list when
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one is training to go to war or living in barracks in Basra. It is not unreasonable to expect that the Ministry of Defence should be required to ensure that the basic democratic right to vote is secured for all its personnel.
We have two amendments that go hand-in-hand to achieve registration among armed services personnel and to give them the most effective opportunity to vote. I must make it clear that Amendment No. 3 is a necessary consequential amendment to Amendment No. 1. Amendment No. 1 does exactly the same thing as subsection (2) of the government amendment, but it adds the duty on the Ministry of Defence to register servicemen and women and includes an opt-out should any individual wish to register either as a civilian or not at all. That is different from the current situation. Amendment No. 3 would leave out the unsatisfactory subsection (2) of the government amendment. Amendment No. 1 would effectively replace that subsection by inserting new Section 59A, "Registration of service voters: duty to take necessary steps", into the 1983 Act.
The Minister will be aware that, under current electoral law, householders have a duty to provide an electoral registration officer with information of all eligible voters in their household. I see no reason why that widely accepted principle should not apply to the Ministry of Defence. It is, after all, a most unusual employer. We want to ensure that, in the same way that all members of the armed services are entitled to accommodation, for example, they are also entitled to be registered to vote.
In a recent telephone call, the Electoral Commission expressed its support for our amendments, stating that they would achieve all its objectives as set out in its response to the Government. In its briefing, the Electoral Commission expressed the need for the government amendment to go further:
"We would strongly recommend that these provisions are introduced as part of a wider package of measures to ensure that members of the Armed Forces are registered to vote, and to avoid the risks of fraud associated with extending the service declaration period".
The government amendment fails to require the Ministry of Defence to take action. The proposed new subsection (3A) in government Amendment No. 2 seemed to offer a glimmer of hope:
"Arrangements must be made by the appropriate government department for securing that such person receives such instructions as to the effect of this Act and any regulations made under it".
While that is all right, and would be helpful, there is no room in that provision for giving the Ministry of Defence the responsibility to register its personnel. Rather, it puts the onus back onto the individuals in the forces, from where the current difficulties arose.
My amendment does not seek to force people to register or vote. It seeks to force the Ministry of Defence, which has a duty of care towards its very special employees, to ensure that the best opportunity is available to them to vote. The only way that they can guarantee that opportunity is by actively securing the
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registration of servicemen and women. It is clear that registration is a keystone of improving voting among the armed services. What is more, it has received support across the board from the beginning. The Minister in another place, Harriet Harman, stated that she was baffled that the Government had not been able to get the rocket science working to register Armed Forces personnel. In this House, the noble Lord, Lord Ramsbotham, who is not in his place today, spoke from great experience as former Adjutant-General when he told noble Lords that he had been concerned about the difficulties put in the way of service voters, and pleased about the progress made under the 1983 Act which gave the Ministry of Defence the duty to register servicemen and women.
The noble Lord, Lord Garden, repeatedly emphasised the importance of registration in his speeches in Committee and on Report. I absolutely agreed with him when he said that the problem is that the Ministry of Defence will not take responsibility for sorting it out, which, he said, goes back to the Ministry having abandoned the arrangements in place before 2001.
I understand that the Ministry of Defence is reluctant to take on responsibility for registering its members. I remind the House again, however, that it is not an ordinary employer. The military covenant, as described in the British Army pamphlet Basically Fair: Equality and Diversity in the British Army, states:
"As a soldier you are expected to put the needs of the Service first and to forgo some of the rights enjoyed in civilian life. In return you can at all times expect to be treated fairly, and to be valued and respected as an individual".
As I said at the beginning, the Government have moved a long way on this matter. But by not putting a duty on the Ministry of Defence to undertake the registration, they are not ensuring that registration will be total in as far as it can be. We are in terrible danger of missing a great opportunity in this Bill to make a radical improvement to this part of the lives of soldiers and other personnel. Perhaps today we can rise to the challenge of ensuring that while dedicated people train and fight in the interests of their country, their Government are doing everything they can to ensure their most basic of rights: the right to vote. I beg to move.
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