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It has never been the case that the union should mean uniformity. It was born out of different interests. The English were concerned to secure the Protestant succession, and therefore to secure political stability and security. The Scots were anxious to gain access to the markets not only of England, but of England’s growing overseas possessions. The Scots were also concerned to preserve their Presbyterian system of church government from what they saw as the potential tyranny of the episcopate. I agree with the point of the noble Lord, Lord Patten, that discrimination against Roman Catholics is wrong. While I agree with his basic points, there are of course so many other things that would have to be changed in the treaty and Act of Union to correct that that it is an issue for another day.

The English wished to preserve their episcopal system of church government from what they saw as the potential anarchy of Presbyterianism. Each side equally wished to preserve its distinctive system of law. The commissioners for the union appointed by each Parliament took these differences of view and deeply felt concerns and—despite what the noble Lord, Lord Steel of Aikwood, said about historical research—wove them into a union which has lasted for 300 years. They took the approach that diversity should continue except in those areas where a common approach was required. This was a union of two Parliaments, two nations which had hitherto simply shared a sovereign, to create a new nation and a new Parliament.

Over the years, the union and the political stability it has brought have contributed to the greatness and the economic strength of the United Kingdom. A small, offshore country tucked away in the north-west of Europe at one time ruled half the world. Everyone is aware of the contribution that the Scots have made to that process, as engineers, explorers, soldiers—as referred to by the noble Viscount, Lord Trenchard—doctors and merchants. The larger English economic, political and military strength provided opportunities that the Scots could never have forged alone, but the contribution of the Scots significantly enhanced the nation’s ability to take advantage of them.

The new state fostered a new cohesion and a British national identity, ushering in a period of extraordinary national success. There can be no doubt that the creation of the United Kingdom Parliament was an essential precondition for Britain’s economic, social and democratic development, and for Britain’s rise as a world power. It was also one of the important factors in the growth of a British way of life based on active citizenship, a volunteering spirit and a strong civic society. The treaty created the largest free trade area in 18th-century Europe. It is no exaggeration to say that building on the back of that has made the United Kingdom the world’s fifth-largest economy. It is a significant market for Scottish goods and services. This, and our shared language, currency and geographical proximity are reflected in the fact that nearly two-thirds of exports from Scotland are to the rest of the UK. The Scottish economy is now a fundamental part of the wider UK economy.

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The Government entirely agree with those speakers who point to the continued importance of the union in sustaining our present position in the world. Yes, our particular concerns have changed. In England, we no longer fear the invasion of foreign powers through the back door of Scotland. The Scots no longer crave access to England’s colonial trading routes. In turn, as a result of 300 years of union, we share, as the debate has revealed, increasingly deep family and cultural ties. This interconnectedness is mirrored in every field of life: cultural activities of all kinds, a wealth of charitable activity and a host of personal and family connections. Many Scots make their homes and careers in England, as do many English people in Scotland. Many families have relatives in both nations, as we have heard today. Almost one in 10 of the people living in Scotland was born in England. The union represents our values and gives them expression to the world. Our constituent nations have retained their separate identity, but at the same time have drawn from each other. We have a fully integrated economy—not only between England and Scotland, but between all parts of the United Kingdom.

Divisions within the island of Great Britain—as everybody but the noble Earl, Lord Mar and Kellie, said—would be a significantly retrograde step. Even if all the parties remained within the EU, barriers and differences of economic policy would distort our markets. I saw a report last week that, in an independent Scotland, the Scottish National Party would seek to jettison the pound and introduce the euro, thus introducing an exchange rate question into trade between England and Scotland—not moving on into the future, but reversing 300 years of history.

Globalisation will pose increasing economic challenges. To improve our competitiveness in that increasingly challenging world, we must continue to enjoy economic stability which provides the framework and opportunity for people to create wealth. The union has played a huge part in providing economic stability. The union stood against Nazism in the Second World War, and created the National Health Service in the years that followed. It was, and is, a collective undertaking. It should not be put in jeopardy.

Unfortunately—and this is where there has been debate today—there have been disagreements about whether particular policies enhance or damage the union. It has been suggested that, in introducing devolution, or not changing it, the Government have put the union in jeopardy. We emphatically reject that allegation. Devolution, as I have said, was essential in securing and strengthening the union. It is unclear whether those questioning devolution today accept that proposition. Do they think devolution was necessary, post-1997? If they do not, what do they say should have happened?

Scotland, Wales and Northern Ireland all have legitimate concerns that the overwhelming number of Members of Parliament representing English constituencies means that specific Welsh, Scottish and Northern Irish concerns can get lost when legislated for by the Westminster Parliament. Devolution provides the right balance between local and national concerns. It frees the constituent parts of the United Kingdom

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to innovate local solutions for local problems. If there are different policies in different parts of the United Kingdom, that is one of the purposes of devolution. Yes, the arrangements are asymmetric, but if we were seeking symmetry or even logic in the UK constitution, we would have to tear up most of it. We are not about constitutional symmetry. We seek practical changes for practical goals. The great strength of our constitution is its effectiveness. It can accommodate difference and rough edges in support of wider goals of national unity, affiliation to the institutions of the state and the service of those institutions to the public.

But—and this is my second point of disagreement—I do not believe that it can accommodate an English Parliament or its proxy, the seductively entitled “English votes for English laws”. The noble Lord, Lord Shutt of Greetland, was right when he said that the critical point in this debate is not support for the union, which, with the one exception I referred to, all noble Lords are in favour of. Instead, the question is how best we achieve it. The big issue raised by this debate is whether English votes for English laws would promote the union or would, as I believe, be a significant step towards the break-up of the union.

Make no mistake: if we were to introduce English votes for English laws in the other place—and I note that there does not seem to be any suggestion that it should be introduced in this House—that would simply be the first step on the way to an English Parliament, and the break-up of the union would follow. I echo the words of my noble friend Lord Anderson who said, “Those who blow on the flames of English nationalism may find that those flames consume the union”. I agree that that is what proposals about English votes for English laws would do.

Why, it has been asked, should there not be English votes for English laws when the Scottish Parliament votes on Scottish issues? The reason there is a Scottish Parliament is because England is over 80 per cent of the United Kingdom. England has over 80 per cent of the population, over 80 per cent of Members of Parliament and over 80 per cent of the country’s GDP. If we had English votes for English laws, how would the system work? I cannot better the speech of the noble Lord, Lord Goodhart, who explained the absurdities and impracticalities that would arise. If we take what he said, and take it one stage further, all noble Lords would agree that the Government of the day must be formed by the party that commands a majority in the House of Commons. Is it seriously suggested that we could have a Government of the nation that could not pass legalisation in relation to England? That would be the effect of what is proposed. It is obvious that the moment that we do that, we end up in a situation where the United Kingdom Parliament gets completely dominated by English issues. The point of devolution is not a federation, because most constitutional experts who look at the concept of federation say that about 30 per cent is the largest that any one member of a federation can be without completely dominating it to the exclusion of its other parts. It is not a practical proposition, and it inevitably leads to an English Parliament.

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Lord Forsyth of Drumlean: My Lords, surely the situation the noble and learned Lord describes is what we have now. We have a Government who have been unable to get their education policies through without the support of Scottish Labour Members of Parliament or, in at least one case, without the support of Conservative Members of Parliament. Governments command a majority in the House of Commons; if not, they have to change their policies. What is wrong with that?

Lord Falconer of Thoroton: My Lords, the noble Lord misses the point: if we want a union, which most people do, there needs to be a Parliament that brings the union together. If we go down the route of English votes for English laws, we separate Parliament into two bits. As the noble Lord, Lord Goodhart, said, one bit would deal with issues to do with the DTI, defence, foreign policy and, perhaps, immigration and the other would deal with English domestic affairs. We would completely lose the institution and the constitutional arrangements that bind this country together. With respect, I say to the noble Lord, Lord Forsyth, that that is the argument he has to deal with. He must ask himself whether going down the route of English votes for English laws would promote the union. I have very little doubt that it would have precisely the opposite effect. Where would it stop? Should London MPs be the only MPs to vote on London? If we had English votes for English laws, a UK Government elected on a UK mandate might find themselves unable to deliver key policies on which they had been elected.

But if we put aside all that, we all understand that we as a nation, the whole nation of the United Kingdom, are inextricably linked. What we spend on education in England has a huge effect on what is available to spend in relation to education in the other parts of the country.

I note from what the noble Lord, Lord Strathclyde, said that English votes for English laws only is an issue which the constitutional convention or committee, or whatever it is Ken Clarke is sitting on, is considering. I very much agree with what the noble Lord, Lord McNally, said. One of the great and important aspects of this debate is to seek to discover the Conservative Party’s policies on the union and what steps it thinks will most promote the union.

I believe that everyone in this debate is sincere in wanting to promote the union. We should hear what is said in detail by the Conservatives about the steps that they want to take. The people can then judge whether they promote the union rather than, as I fear, drive it further apart.

I do not want to end this debate on a note of disagreement. The noble Lord’s Motion calls attention to the maintenance of the United Kingdom. I return to his opening words, in which he identified what the historic partnership has achieved. I entirely agree with him that the continuation of that partnership is essential to our continued success in facing the new global challenges which our country as a whole will have to face in the 21st century. The 300 years of our union have created a great nation. Long may it continue.

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3.25 pm

Lord Forsyth of Drumlean: My Lords, we have had a splendid debate. I thank everyone who participated in it. I thank also the Lord Chancellor for his reply. It is not a moment for further discord, as he indicated.

I started the debate by saying how proud I was to be British. I am proud also to be a Member of this House. The debate that we have had today is a classic example of the role that this House can play in teasing out the issues, which the Lord Chancellor will forgive me if say still remain to be resolved. I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.

Health and Care in the Community

3.26 pm

Baroness Gardner of Parkes rose to call attention to health and care in the community; and to move for Papers.

The noble Baroness said: My Lords, I am pleased to have the opportunity of opening this debate today. The wording of the subject is deliberately wide as “health and care” encompasses a vast part of all our lives. I thank those who are to speak in this debate and who have particular experience and expertise from which we can all benefit.

When I checked the dictionary for the definition of “health”, “care” and “community”, I decided that each of these means much more now than the definitions given, especially “health”. One cannot pick up any newspaper or magazine without finding some new angle on “health”. Fitness and health are often taken to be the same thing, but this is not so. A person can be healthy but unfit, or unhealthy but still fairly fit. Recently, a speaker at the Royal College of Physicians referred to “the ill and the worried well” and I thought that that accurately reflected part of society.

In spite of constant advice to modify our habits or diets, the majority of people think more about health when they suffer some setback. The young have always believed they are immortal. The old are only too aware of their mortality and the ageing process. There is constantly published conflicting advice about the food to eat, exercise to take and the lifestyle to follow. Even those who just take everything for granted and never give a thought to health expect immediate National Health Service care and attention to be available at the moment of crisis, and usually it is.

Chronic conditions are something that people have to live with, often over very long periods and at home rather than in any medical facility. This is where the major problem arises. Many face the living bereavement of loved ones suffering from Alzheimer’s disease or senile dementia. Others have children with special needs requiring a lifetime of care. There are so many different situations.

The dividing line between health and care is creating a huge gulf in services. Social care is provided by local authorities and can be simple or complex, depending on the needs of the individual. The noble

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Lord, Lord Bruce-Lockhart, introduced a very good debate in this Chamber on adult social care, particularly the local government aspect of it, on 7 December. I do not intend to use this short time to repeat that debate, but commend it to those who have not read it.

The Department of Health, too, covers social care. If the words “social care” were included in the title of that department, it might be recognition of the importance of the issue.

There is need for much closer liaison between the fully funded NHS care and the social care in the community that is often available only at a cost to the patient. Local authorities face a double budget difficulty with an increasing load being transferred to home care from the NHS and a restriction on increasing their council tax. Is it surprising that we constantly read reports and hear anecdotal evidence of social services being less available and more restrictive conditions being applied, so that only the most critical cases now meet the eligibility criteria for free personal care?

The differentiation of treatment between NHS and social services has always been controversial. It is a great pity that more was not done by the Government in recent years to bridge that divide. It would have been easier to make changes when the Government were pouring money into the NHS—sadly, without result. Until joint working of health and care is established, those problems will continue. The NHS is keen to send patients home at the earliest possible date, but someone has to deal with the continuing burden—and that area lacks clarity. If the patient requires continuing health treatment at home, that is funded by the state; if their rehabilitation is classified as social need, they are not covered in the same way.

At a senior management level, there are joint committees and there is some joint working and planning of NHS and social care; but there is need for partnerships to extend that down to the everyday working level. There should be joint NHS and personal care for people, whatever their needs. Where do you draw the line between health and care in the community? What exactly does “personal care” mean?

I look forward to hearing from other noble Lords who intend to speak about vital issues such as child services, respite care, terminal care and the hospice movement, and care at home to keep people out of hospitals. In addition to the many social workers employed by the councils, it is estimated that some 5 million people provide care informally. No matter how much care is provided officially, the greatest amount of caring is done by relatives and friends who give their time to that dedicated service. Often, those carers are themselves reduced to a state of ill health by their great efforts. The whole community owes them a debt of gratitude.

My noble friend and colleague in dentistry Lord Colwyn had hoped to be able to put the case for NHS dental services to be readily available to all. Unfortunately, he is operating today and cannot be here. It should be remembered that dentistry is not a free service for any

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but the priority classes, but it remains far from being available and accessible for all, in spite of the Prime Minister’s promise to the contrary.

When I was a local authority chairman of social services, long before Ken and his freedom pass, we introduced free travel passes for retired people. We realised that keeping our older residents active and mobile was one of the best forms of social care and meant that those people were very much part of the community—not isolated at home, perhaps seeing no one except the person delivering meals on wheels. Human contact is essential to keep people going and many voluntary organisations play an important part in that process.

For some years, I was on the advisory committee of RSVP, the retired senior volunteer programme—part of Community Service Volunteers. By involving the retired in helping others, volunteers not only provided much-needed assistance, but were given an important and demanding role from which they benefited themselves. I recall a retired bus driver who was helping a young person on a one-to-one basis; he was delighted to have achieved a result in a field outside his own qualifications and he went on to help others in the same way. Others shopped, read and provided company—the needs were almost unlimited. The work continues and many voluntary organisations do a great deal to help people.

In December, the joint report of the All-Party Group on Primary Care and Public Health and the All-Party Group on Social Care considered that there was a need to reconfigure existing provision and resources to achieve the increase in preventive health and social care envisaged in the Wanless report. As one of the signatories to that all-party group report, I took full part in the meetings and hearings of evidence on which it was based.

The report concluded that current funding was insufficient to meet present and predicted demographic pressures and that because the charge for domiciliary social care is—to put it mildly—unpopular with service users, it acts as a deterrent from using such services if the user has to pay. That often leads to earlier use of more expensive institutional care. In considering the best use of public money and the best way to provide services, it is important that the overall long-term costs and benefits are assessed.

We know that the Government plan to have more NHS treatment centres available in the community, which should be good—but only if those centres are up and running before the same services in the hospitals are closed. At the outset, that might be more costly as the services will need to be run in parallel during an overlap period, to establish the changeover. The savings would follow.

In London, many patients choose not to have a GP. They rely on going to the nearest A&E when they have a health problem, which clogs up those important emergency services. It would be better if those patients were able to go to a community treatment centre. It will, however, remain essential to have additional major trauma centres.

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