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This year’s Queen’s Speech is interesting, as is its political context. I have never known the situation where the Prime Minister launches a great parliamentary programme for the year, safe in the knowledge that he will never see it through. It is a bit rich for the noble Lord, Lord Warner, to talk about this being a vibrant programme; the only vibrancy we will see in the next year is Gordon Brown’s pager going off when he is summoned to No. 10. That will be a seminal moment, when the political terms of trade will substantially change. We are all, in considering the Speech today, in a bit of a hiatus. We do not know who will step up to the plate and when, and what difference that will make. Government is about more than a programme of legislation and a list of Bills; it is about personalities and delivery, and we heard some strong speeches earlier in the debate. I look forward to seeing how the programme pans out.
This institution, important as it is—and the House of Lords is an important part of Parliament—now has to share power much more with the devolved legislatures in Scotland and Wales, and with Brussels. The encroachment of some of the international dimensions of policy-making is new. It is all very thrilling to watch, as I did, the ceremonial pageantry of the Queen’s Speech and the Blues and Royals riding on 17-hand war horses. Actually, however, we do not run the world as much as we used to. We have to share power. The legislative power that we are bringing forward this year cannot be entirely controlled by us. We have to bear that in mind in future as well.
A number of themes came through powerfully in the debate. Many speeches concentrated on front-line delivery—not policy programmes or legislation but how the legislation is delivered at the front line,
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On delivery, I was reminded by the noble Lord, Lord Fowler, that, as a spokesman in the other place, I was a beneficiary of his excellent approach to AIDS. I am by academic training a pharmacist, and I was baffled by the disease when it first appeared in Edinburgh through a drug route. The noble Lord stimulated a Friday debate that I remember well. The difference about that debate was that he invited all the spokesmen, and anyone else who was passing and interested at the time, to come and talk to the Chief Medical Officer of Health. That completely changed the tone of the debate. It became less confrontational and less about people scoring points off one another. Everyone realised what was going on—or perhaps they did not understand in the early stages.
I pay tribute to the work that the noble Lord did then and absolutely agree with him that the public advertising programme which he put in place was unique in western Europe. It was a model that has been used since. It perhaps demonstrates not only that there is a need for a fresh AIDS programme in order to protect our children—another powerful theme of the debate—but that there is a role for sensible, sensitive public advertising policy. This is an age of the image. If we can get cleverly done programmes on television it will attract young people's attention, which is a hard thing for politicians to do. I pay tribute to the noble Lord’s work and entirely support what he was saying earlier.
The importance of children came through very strongly, not only from my two distinguished colleagues behind me, who have a daunting record on the subject. As I think the noble Earl, Lord Listowel, said, children are an investment for the future. The demography is changing. If we are to have a workforce that can generate wealth to pay my pension and the noble Earl’s pension, we have a self-interest in that. But so does the nation. It is wrong to consider children as capital assets—I am not suggesting that for a moment—but if we cannot make the best use of everyone we have, we will be doing ourselves no favours and cutting off our political noses to spite our faces. That serious message in the debate came through strongly to me. I hope it came through equally strongly to the Minister.
The issue of children in care, which came through strongly from three or four colleagues, is immediate and must be attended to right now. I have in my library all the law reports of the noble Baroness, Lady Butler-Sloss, who highlighted the importance of social workers. I also have the pamphlets of the noble Baroness, Lady Meacher. I would not be without them because I read them late at night when trying to get to sleep. There is a difference between meeting the needs of children right now, whether in care or with
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I am, if anything, a social security person—interested in social security. I think that the Government can meet the 2010 child poverty targets, if that is what they are trying to do, only by making immediate short-term increases and changes to the benefits system. However, I am absolutely convinced that, by 2020, dealing with child poverty will be not a social security problem but an education and training problem. The only way in which we will get anywhere near abolishing child poverty by 2020 is if we seize the initiative and deal with the generation that is five years old right now, get them educated and give them life chances that will enable them to support themselves and to trade their own families out of poverty. Otherwise this cycle of intergenerational inequality will continue and worsen every time that it comes around. I absolutely agree with all the important points on early years provision and about part-time education being the poor relation. Further education and skills are part and parcel of that.
Another important theme of the debate was mental health. Mental health comprises two parts; it is not just mental illness. People often think that people who are mentally ill are not really compos mentis. People who are mentally ill are perfectly capable human beings, but their illness has to be treated and there is a clinical dimension to that. An intermittent pattern of some mental illnesses prevents people working, because of how the illnesses rub up against the personal capability assessments. The noble Baroness, Lady Meacher, referred to that very powerfully. She is absolutely right that the benefit-linking rules are completely out of kilter with anything that can begin to assist those suffering from intermittent mental illnesses which prevent them going into work. She is also absolutely right that the benefit rules are substantially deficient in other ways as they affect mental health.
The noble Lord, Lord Low, in a powerful speech, made the point much more eloquently than I could. It defies belief that people who have challenged sight cannot get extra transport assistance. He referred to a slightly different problem of which I am personally aware—that only the lower rate of mobility allowance is available to people with challenged sight. That is a scandal and runs completely counter to the grain of the Government’s active labour market policy of trying to get the one million people who are on the incapacity benefit lists at the moment—“the stock”, as it is rather inelegantly called—into the labour market. Many of them could be traded off.
I have some hopes and I think that the Government have made some changes. Lisa Harker’s work on child poverty looks at more flexible use of pathways to work and condition management programmes. It looks at families as a whole and at giving them more flexible support and sticking with the support. Part of that has to be providing transport and increased mobility allowance. Why people who are partially sighted do not receive the higher rate of disability living allowance completely
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I come from south-east Scotland, a very rural and slightly provincial—in the best sense of the word—part of the world, but I visit some of our biggest cities in pursuing social security interests. I am struck by the diversity in places such as Birmingham and Manchester and by how we need to respond better to that diversity. I think it was the noble Baroness, Lady Verma, who made the point that we need to embrace that properly and to provide better role models for young people. In my work in the Social Security and DWP Select Committee in the other place, I was struck by the spatial concentration of poverty in some of our ethnic communities, particularly in London. There is a lot of poverty—real, abject poverty—in London right now. A lot of it is in minority-ethnic groups. I think that that needs to be attended to. That theme certainly came through to me in the debate. A lot of the speeches will repay careful study, and I propose to do that myself. I hope that the Front Bench ministerial team will do the same.
If there is one overarching difference between what the Government are proposing and what has been said this afternoon, it is that the Government are much more interested in and focused on national security, and we seem to be talking about social or personal security. They are not mutually exclusive but, for my money, if there is a limited public purse and if you are trying to enhance people’s lives in the United Kingdom in the upcoming 12 to 18 months and beyond, I would deal with some of the important social gaps mentioned this evening on both sides of the House just as urgently as I would deal with terrorism.
My noble friend Lady Walmsley said it for me: if you do not get into this subject at a social level at an early stage with the citizens of this country you will never win the argument, because it is a hearts-and-minds argument as much as it is a cops and robbers, MI6 and people-in-tanks argument. That came across very strongly to me. You do not need to be interested in social security to know that. I am particularly worried about the increasing conditionality of benefits. There will be a time and place for this during the Welfare Reform Bill, which is subject to a carry-over Motion. It will give us a chance to look at some of the ways in which conditionality is creeping into benefit entitlement all over the place, which creates uncertainty. It certainly does so for people with a mental illness claiming incapacity benefit. That is increasing uncertainty. Pension uncertainty is not helping people to sleep more easily at night. Under the Stern report proposals, the poorest will get hit first and hardest when the additional 2 per cent Stern-assessed contribution to deal with climate change comes in. They will be on the front line facing the consequences. That creates uncertainty.
We have not spent a lot of time on immigration this evening, but it affects people’s judgment of their employment prospects in a way that the Government
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Government is hard. None of this is easy. The Government have done a lot; they have been running very hard to try to make progress on child poverty, and a lot of progress has been made. There are some problems in the list of Bills. Regarding the Child Support Agency, if they really are going to write off the debt of £3 million or so, that would cause me to quail, as it would a lot of other people who anticipate getting hold of some of that money eventually. For a Labour Government to be in power for so long and do absolutely nothing except top up slightly the Social Fund is puzzling. I do not understand why more use is not made of loans to keep people out of the indebtedness levels that we see and to protect them from loan sharks. It has long been necessary to address that. Rehabilitation has not been mentioned, but some interesting work has been done at Cardiff University by Mansel Aylward on getting a biopsychosocial model of some of the personal capability assessments. That is much more focused on the Welfare Reform Bill that we will talk about later, which is important to me and, I hope, to the Government.
It has been a very good debate. I hope that the Government will listen carefully to what has been said about the delivery mechanisms and the need for targeted investment. More than anything else, my message to the government Front Bench this afternoon is that if they are really looking to tackle the underlying causes of insecurity, they cannot ignore investment in social policy. Plenty of ideas have been put forward in this excellent debate. It would be a shame if the Government did not go away and think carefully about some of them and implement them as soon as they can.
8.15 pm
Earl Howe: My Lords, the noble Lord, Lord Hunt of Kings Heath, has the unenviable task of summing up this extraordinarily rich and wide-ranging debate and, although I have no doubt whatever that he is up to it, this is one occasion when I am rather glad that each of us is located where we currently are. Indeed, I am quite sure that the noble Lord would not have things any other way.
I cannot remember when the House has had the privilege of listening to as many as six maiden speeches in an afternoon, but it can certainly never have heard so many of such a high order of excellence. In every one of them, we found ample evidence of the way in which this House is enriched by its new Members. I recall to your Lordships’ minds the noble Baroness, Lady Meacher, who made important observations on the benefits system in the context of those with mental health problems. The noble Baroness, Lady Butler-Sloss, commented on children in care and social work, born
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The debate as a whole has taken us into all sorts of policy areas, from pensions to the HFEA, and from dentistry to rural health services, but there have been some distinct and recurrent themes: the disabled and care of the elderly; vulnerable and looked-after children; education and skills in their various dimensions; and sexual health. I hope that the Minister will be able to give time to all those themes when he winds up the debate.
Perhaps the oddest thing about the gracious Speech is what it did not contain. Earlier this year, the Government published a landmark White Paper, Our Health, Our Care, Our Say. It was not unreasonable for some of us to expect that a number of key measures might emerge from that—widening the scope of direct payments, creating individual budgets and unifying the complaints system across health and social care. In July, the Department of Health published A Stronger Local Voice, which outlined the latest proposals to remodel patient and public involvement in health—a much talked-about and much heralded set of changes that we expected to be set out in a Bill. On the same day, it published another document setting out a commissioning framework, from which we believed we would see all sorts of new legislative proposals designed to carry through the Government’s reform agenda on commissioning, patient choice, provider regulation and the extension of foundation trusts.
As long ago as November 2004, Ministers announced that they wished to merge the Healthcare Commission with the Commission for Social Care Inspection and the Mental Health Act Commission. We expected to see those changes set out in a Bill. In July, the Audit Commission made a number of recommendations relating to the governance and accounting systems in the NHS, not the least of which was the need to develop a clear failure regime to deal with situations in which NHS trusts found themselves in financial distress. We could perhaps have been forgiven for thinking that the gracious Speech might have made some mention of those matters as well.
But on all those issues, disparate as they may be, there has been a strange and unaccountable silence. No Bill has been announced. What can we read into that? Are we really to suppose that the Department of Health was unsuccessful in bidding for parliamentary time to legislate on so many key planks of its health agenda? Have the Government had second thoughts about any of them? If they have not and if the proposals are still on the table, can the Minister enlighten us on when we might expect to see a Bill? I ask that question in a sprit of genuine inquiry. If the best answer he can give is, “When parliamentary time
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It seems a long time since the gracious Speech of 2005. Numerous Bills have passed through your Lordships’ House; indeed, the wide and flowing river of government legislation is still in spate and has in no degree abated. But one Bill announced successively by Her Majesty and by the noble Lord, Lord Adonis, in May last year that never reached us in the last Session was the Mental Health Bill. First, there was a resounding silence and then a full year later, in May 2006, the Minister of State, Rosie Winterton, announced that the Government, after all that had gone before, had abandoned their plans to replace the 1983 Act and would instead seek to introduce a much shorter Bill designed only to amend the existing legislation. Another six months down the track and that amending Bill has been published.
It may just be me, but it hardly seems credible that, having begun as long ago as 1998 the task of constructing a new and updated legislative framework for mental health, having promised that that framework would replace altogether the Act of 1983, which itself is based on legislation passed in the 1950s, and having set themselves that worthy objective, the Government could reach the point of saying, eight years later, that a brand-new Bill was all too difficult and complex and that they were going to settle on a repair to the old jalopy instead of a bright new model from the showroom. There were, as we all know, extensive criticisms of the two draft Bills of 2002 and 2004, but we hoped that whatever finally came forward would represent a clean start for this area of legislation.
The Second Reading of the Mental Health Bill takes place next week and I do not want to pre-empt that debate today. However, I would like to make a couple of broader points about this area of policy-making. The first is that changing the law relating to mental health inevitably takes us into very sensitive territory. There are proposals in the Bill to change the definition of mental disorder, to change the criteria for detention and to legalise compulsory treatment in the community. I am not going to comment this evening one way or the other on the merits of those proposals; I simply observe that they are potentially very far-reaching. They profoundly affect service users, health professionals, voluntary organisations, carers and many others. Unless those groups are signed up to them, the proposals will simply not be workable. Parliament has to listen with more than its usual care to the concerns and views of interested parties, because to fail to do so will let down the single most important interested party—the patients. For that reason, I believe very strongly that the Bill should be the subject of at least some form of pre-legislative scrutiny. Even at thislate stage, I appeal to the Government to give pre-legislative scrutiny serious thought.
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My second point is that, before considering any legislation that would allow certain groups of adults to receive medical treatment against their will, we have to be clear why we think that it is right to make an exception to the rule that in all other circumstances is regarded as sacrosanct; namely, that medical treatment may be administered only with the active consent of the patient. We need to be clear what it is about people with a mental illness that makes them different from people with a physical illness. In my view, the Government have not adequately explained that, and they will certainly need to do so by Second Reading. The rationale cannot be that mentally ill people lack the capacity to take decisions. The vast majority of mentally ill people have perfectly good decision-making capacity—a point made very well by the noble Lord, Lord Kirkwood. The difficulty arises with certain individuals whose decision-making capacity is in some way impaired. However, if that is so, we need to define whom exactly we mean and why compulsion is the best and only way of addressing the difficulty that they present. I sometimes think that, in their general pronouncements on the Bill, Ministers are too inclined to take as read a proposition that in any other area of medicine would meet with the most vigorous challenge.
It is time to bring the noble Lord, Lord Hunt, to his feet. This has been a varied and fascinating debate, and I await with more than my normal degree of fascination the response that the Minister is to give us.
8.26 pm
The Parliamentary Under-Secretary of State, Department for Work and Pensions (Lord Hunt of Kings Heath): My Lords, we have certainly had a very wide-ranging and first-class debate covering six Bills and three government departments. It will be difficult for me to do justice to every contributor but I want to congratulate our six maiden speakers on their excellent contributions.
The noble Baroness, Lady Butler-Sloss, commented on the inconsistency of the colour of our carpets. I do not know whether she has yet encountered the Pugin Room, which will confuse her as it is red. It belongs to the House of Lords, yet we cannot use it. If she can find a way through that, we shall all be very grateful.
The noble Baroness, Lady Meacher, comes very well qualified to talk to us on mental health issues. She has a long record in this area and is also the current chair of a mental health trust.
My noble friend Lord Bradley, who has perhaps returned to Manchester, promoted the city with great skill. As a Birmingham resident, I was rather squalling when he seemed to try to track yet more government money towards Manchester, but certainly all of us who went to that city in the autumn acknowledge the tremendous developments that have taken place there.
The noble Lord, Lord Low of Dalston, brings considerable experience and expertise to your Lordships’ House. He made the point very strongly that it is wonderful to see the achievements of many
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