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House of Lords

Thursday, 8 November 2007.

The House met at eleven o'clock: the LORD SPEAKER on the Woolsack.

Prayers—Read by the Lord Bishop of London.

Introduction: The Lord Bishop of Carlisle

The Lord Bishop of Carlisle—Geoffrey Graham, Lord Bishop of Carlisle, was introduced between the Lord Bishop of London and the Lord Bishop of Winchester.

Human Fertilisation and Embryology Bill [HL]

11.10 am

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, I beg leave to introduce a Bill to amend the Human Fertilisation and Embryology Act 1990 and the Surrogacy Arrangements Act 1985; to make provision about the persons who in certain circumstances are to be treated in law as the parents of a child; and for connected purposes. I beg to move that this Bill be now read a first time.

Moved accordingly, and, on Question, Bill read a first time, and ordered to be printed.

Regulatory Enforcement and Sanctions Bill [HL]

Lord Bach: My Lords, on behalf of my noble friend Lord Jones of Birmingham, I beg leave to introduce a Bill to make provision for the establishment of the local better regulation office; for the co-ordination of regulatory enforcement by local authorities; for the creation of civil sanctions in relation to regulatory offences; for the reduction and removal of regulatory burdens; and for connected purposes. I beg to move that this Bill be now read a first time.

Moved accordingly, and, on Question, Bill read a first time, and ordered to be printed.


Lord Grocott: My Lords, as regards an advisory time limit for speeches, the situation is a bit easier than yesterday. We have a target rising time of seven o’clock and more than 30 speakers, but we shall easily accommodate them if the Back-Bench speeches are no longer than 12 minutes. That is not a bad length of time.

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Debate on the Address

11.12 am

Debate resumed on the Motion moved on Tuesday last by the Baroness Corston—namely, That an humble Address be presented to Her Majesty as follows:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, this Government have a proud record of improving health and education services. We have increased resources, from £35 billion in 1997 to more than £90 billion in 2007, rising to £110 billion by 2010-11. We have improved services. Extra staff and investment have led to improved patient outcomes, as Derek Wanless recognised in his recent report. Mortality rates from cancer are down by 17 per cent and from cardio vascular diseases by 35 per cent. More than 1 million extra operations take place every year. Waiting lists are down while satisfaction levels are up. One hundred new hospitals are benefiting from state of the art equipment.

It is a similar story in education: 1,558 Sure Start children's centres have been established so far, offering services to well over 1 million young children and their families. More than 60 per cent of our 15 year-olds are now achieving five good GCSEs and the number of schools where more than 70 per cent of pupils gain at least five good GCSEs has gone up tenfold from just 83 in 1997 to 857 in 2007. The number of young people participating in apprenticeships is at a record level with more than a quarter of a million now in learning—up from 75,000 in 1997.

In my recent interim report of the NHS Next Stage Review, I set out a vision for a world class NHS that focuses relentlessly on improving the quality of care. One of the key components of quality is that the system is safe. It should be as safe as it possibly can be, giving patients and the public the confidence they need in the care they receive.

The Health and Social Care Bill will be introduced into Parliament shortly. It will do much to ensure the safety and quality of services. I must declare an interest here as a practising clinician. The Bill will create a new integrated regulator of health and adult social care, which will focus on providing assurance of the safety and quality of care for patients and service users. The creation of a new regulator—the Care Quality Commission—will bring together the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. The regulator will have tougher powers to inspect, investigate and intervene where hospitals and care providers are failing to meet hygiene and other safety and quality requirements. The commission will also have new powers to apply a consistent approach

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to regulation, by requiring providers of health services and adult social care, both public and private, to register with it.

As well as improving the regulation of the NHS and the adult social care system, the Bill will enhance professional and public confidence in the regulation of healthcare professionals and social care workers. Following the publication of the White Paper on professional regulation and the government response to the Shipman inquiry, the Bill introduces a number of measures to improve professional regulation. The Bill introduces a new set of public health measures to help to prevent or control the spread of infection or contamination. The measures in the Bill willbalance the need to restrain activities where they could present a threat to public health with the need to respect individuals’ rights. The Bill will also create the health in pregnancy grant, which will be a one-off payment to all expectant mothers ordinarily resident in the UK.

I spoke earlier of new services and new challenges. Nowhere is the pace of change greater than embryology. The Human Fertilisation and Embryology Bill will help to maintain the UK’s position as a world leader in groundbreaking research for the treatment of serious diseases, including through embryonic stem cell research. The Bill’s provisions represent an overhaul of the existing law, the Human Fertilisation and Embryology Act 1990, taking account of developments both in technology and in attitudes, and will promote public confidence together with best regulatory practice.

That is not to say that the existing system has broken down or that it has not been successful. On the contrary, the regulatory framework put in place in 1990 has proven to be robust in the face of challenges. It is a tribute to Parliament, and to several Members of your Lordships’ House in particular, that this is the case. The regulator—the Human Fertilisation and Embryology Authority—has also performed well.

We have therefore kept to the fundamental underpinnings of the regulatory scheme based on the report of the Committee of Inquiry chaired by the noble Baroness, Lady Warnock, on which the 1990 Act was based. Nevertheless, technology has moved on, and so have attitudes. There are, for example, novel ways of creating embryos for research, a much-increased capacity to screen embryos for serious genetic diseases and, at the same time, a legal recognition for different family forms. Those developments demand an examination of the legal and regulatory framework through parliamentary debate, and a resetting of the relevant parameters for the future. The Government published their proposals for updating the law in their December 2006 White Paper. That was followed by publication of the Bill in draft form, which was then titled the Human Tissue and Embryos Bill. The change in the title of the Bill reflects the Government’s decision not to proceed with a proposal to merge the HFEA with the Human Tissue Authority.

The key aims of the Bill are to ensure that all human embryos outside the body—whatever the process used in their creation—are subject to regulation; to clarify the regulation of “inter-species”

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embryos for research; to impose a statutory ban on the sex selection of offspring for non-medical reasons; to recognise same-sex couples as legal parents of children conceived through the use of donated sperm, eggs or embryos and to increase the scope of legitimate embryo research activities, subject to controls. These are issues on which a range of views are sincerely held.

The Children and Young Persons Bill and the Education and Skills Bill provide a framework for young people. We want to increase participation in learning and improve life chances for all children. This Children and Young Persons Bill is designed to make those ambitions a reality for some of the most vulnerable children in our society—children in care. As achievement figures soar to record levels, children in care, by contrast, are five times less likely to achieve five good GCSEs and nine times more likely to be excluded from school. More than 30 per cent of former care leavers are not in education, employment or training at age 19, compared with 13 per cent of all young people. They are less likely to progress into higher education and more likely to end up in prison.

It is our responsibility to improve the educational and care experience of young people looked after by the state. We all share this responsibility—to look out for these young people, to support them, as we would our own children. Following a Green Paper and extensive consultation over 18 months, the Government’s Care Matters White Paper set out the reforms needed to transform the life chances of children and young people in care.

It is built on four central principles: high ambitions for children in care—we want those who enter the care system to achieve the aspirations we have for our own children and we need to reduce the achievement gap between children in care and their peers; addressing the challenges of parenting within a complex system of different services and, in doing so, addressing the educational, social and health problems which children in care experience; greater placement stability and more consistency for children in care, so they are not uprooted and moved around before they have had the chance to settle in a school or make friends—currently children can go through as many as nine or 10 placements within two years and see as many as 30 social workers; and making sure children in care can have their say in important decisions that affect their life.

These four principles have guided the Government in deciding to legislate to: enable local authorities to test a different model of social care by delegating social care functions to social care practices; increase the focus on the transparency and quality of care planning—in particular, by strengthening the role of the independent reviewing officer; increase schools’ capacity to help children in care by placing the role of the designated teacher on a statutory footing and ensuring that children in care do not move schools, particularly in GCSE years, except in exceptional circumstances; ensure that young people up to 18 are not forced out of care before they are ready, by giving them a greater say over moves to independent living and ensuring they retain support and guidance as

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long as they need it; and limiting “out of authority” placements, securing higher placement standards and ensuring children in care in custody are visited regularly. I am pleased that there has been considerable consensus around many of the proposals in the Bill and about how we achieve that aim.

The second Bill to be introduced jointly by DCSF and DIUS is the Education and Skills Bill. It will increase participation in learning for young people and adults, driving towards the Government’s aim of a country with world-class skills by 2020. The legislation will ensure that more young people participate in education and training, post 16. We will go beyond our current aspiration of 90 per cent participation among 17 year-olds by 2015 to reach the 10 per cent of young people—often the most vulnerable—who would still not be reaping the benefits of formal accredited learning.

This is not about requiring young people to stay in school. Our wider 14 to 19 reform programme is putting in place an attractive package of post-16 learning routes including the new diplomas, which will bridge the historical divide between vocational and academic qualifications. In future, our 16 year-olds will be able to choose a number of ways to participate: through full-time education in school, at college or at home; on a work-based learning programme, such as an apprenticeship; or part-time alongside employment or volunteering that takes more than 20 hours a week. We believe that this will provide all young people with the opportunity to participate, whatever their background, whatever their goals in life.

However, an element of compulsion is important if we are to reach those young people who, whatever options the Government put in place, will not participate voluntarily because they do not recognise the longer-term benefits of improving their skills. It will galvanise the education system to prepare every young person to participate. The new duty to participate will be backed up by a comprehensive system of information, advice and guidance, not just for young people, but for parents and carers so that they are in a better position to encourage the most appropriate form of learning.

As a step towards ensuring that the organisations closest to local provision and individuals’ needs are in a position to advise, this Bill will transfer to local authorities responsibility for the careers advice and guidance services currently delivered by Connexions. To back this up, the Bill will introduce national standards for information, advice and guidance provided by local authorities. More than 70 per cent of the UK’s working-age population in 2020 will already be over the age of 16. That makes enabling low-skilled adults to re-engage with and access learning a crucial task in ensuring the UK’s economic and social health.

Responding to the recommendations in the Leitch review of the UK’s skill needs, the Bill promotes increased participation and achievement among people over 18 years of age. It will put in place a statutory framework to enable all adults with low skills access to the basic platform for employability,

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basic literacy and numeracy skills, leading to a first full level 2 qualification. For those between 19 and 25 years old, it will provide free training towards a first full level 3 qualification.

The Bill is a landmark in education, comparable with the Butler Act of 1944. It is now more important than ever before that we improve the skills base in this country and tackle the tail of underachievement among young people and adults alike. The Government’s legislative proposals are aimed not just at economic productivity. Increasing skill levels is crucial to improving an individual’s life chances and to the Government’s wider goal of social justice for all. The Bill is about changing the expectations in a system where it is still acceptable for young people to leave education and training at 16, never to return.

I turn, finally, to the Sale of Student Loans Bill which is being introduced by the Department for Innovation, Universities and Skills. It is an enabling Bill, which gives the powers needed to embark on a programme of sales from the income-contingent student loan book. The student loan book is a considerable asset, currently around £18 billion. It is set to grow very significantly over the next decade, so it is right that the Government think carefully about how that asset fits within the overall policy on public finances. Making sales from the student loan book fits with our established policy of not retaining assets in the public sector unless to do so fulfils a public policy purpose. Retaining the loans in the public accounts exposes the Government to the risks associated with the uncertainties surrounding the repayment of very large amounts of money. It is not usual government business to remain exposed to large amounts of debt-related risk and we believe that the private sector is well placed to take on and to manage those risks.

Lord Higgins: My Lords, it is not apparent that there are lessons to be learnt from the present situation in financial markets? Is the Minister proposing that the Government securitise student loans that may well turn out not to perform?

Lord Darzi of Denham: My Lords, the noble Lord raises the issue of security, and I am sure it will be debated during the passage of the Bill, which is an enabling Bill as I said earlier. I shall make that point as I go through the remainder of my speech.

It is not usual government business to remain exposed to large amounts of debt-related risk, and we believe that the private sector is well placed to take on and manage those risks. The Bill will enable us to put in place that programme of sales, making transactions that are judged to deliver good value for money for the taxpayer. It is, however, an enabling Bill. It does not require us to make sales, let alone constrain us as to when or how much to sell. The Government will ensure that they benefit from the highest quality commercial and legal expertise in designing the sales programme and in preparing each individual transaction. I hope that reassures the noble Lord. For each transaction, we will need to be satisfied that market conditions enable us to secure good value for money for the taxpayer.

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The ownership of the rights to the loan repayments that graduates make does not affect how we design and deliver policy on student support. It is central to the Government’s policy that borrowers with student loans should experience no difference whether their loans are sold or retained in the public sector. Purchasers of loans will not be able to alter the terms and conditions. They will not be able to change interest rates, repayment thresholds or rates of repayment. The Bill enables us to ensure that if the Secretary of State changes the terms and conditions of existing loans, that will affect sold loans in just the same way as those still in the public sector. The administration of the income-contingent repayment system, with collection by Her Majesty’s Revenue and Customs through the tax system and the maintenance of borrower accounts by the Student Loans Company, will remain as now for all loans. Borrowers’ data will be fully protected and their experience of the system will be the same whether their loan is sold or not.

The Sale of Student Loans Bill is not about altering policy on student support. It is not about converting student loans into commercial loans. The Bill is rather about enabling the transfer of ownership and risk of the underlying financial asset, while expressly leaving individual borrowers and the system of student support in the same position as before.

The Government are passionate about quality, be it in the NHS, social care, embryology, children’s welfare, developing skills or student loans. Improving quality in these areas is challenging, and these Bills are crucial in rising to that challenge. I commend this legislation to the House and look forward to the important and, no doubt, vigorous debates ahead.

11.33 am

Earl Howe: My Lords, it is a pleasure to follow the excellent and very stimulating opening speech by noble Lord, Lord Darzi. I know that the House will be grateful to him for preparing the ground so ably for a debate that is inevitably going to prove fairly wide-ranging. The subject matters of today’s debate are health, social affairs and education. I am not even going to attempt to cover the full extent of those policy areas. My noble friend Lady Morris will concentrate at the end on issues relating to education and children and I shall focus, in my brief set of remarks, on health and social care.

We live in strange times. Whenever I think of the noble Lord, Lord Darzi, I heave a sigh of relief that somebody sensible is looking at health policy across the piece and is doing so from the point of view of the patient to see what is best to meet patient needs. We have high hopes of what he will tell us when he reports next year, although nobody underestimates the scale of his task.

In the mean time, the Minister has inherited an NHS that is far from being the happy and cheerful scene that some of his colleagues like to present to us. First, there are the NHS finances. The year before last, 2005-06, the NHS ran up a net deficit of over £0.5 billion, so enormous efforts were devoted to reining in the finances in the year that followed. The

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outturn in 2006-07 was a net surplus of £0.5 billion, although within that figure almost a quarter of NHS organisations finished the year in deficit.

My noble friend Lord James will enlighten us further on this whole subject, as he is so ably equipped to do. I hope that he will agree with me on a key point, which is that the surplus recorded last year was largely illusory. It was achieved only by dint of savage cuts to training and education budgets by strategic health authorities and by raiding public health budgets. Budgets for buildings maintenance were also heavily raided. When the outturn for the year was announced, Ministers patted themselves on the back for having saved a lot of money. However, if we look at how they achieved it, not many of us think that it is a cause for congratulations.

A similar point could be made about waiting time targets. Reducing waiting times is important and needs to be measured, but we need to remember that the target relates only to a fraction of NHS activity. The mammoth effort being devoted to bringing down waiting times distorts clinical priorities, not least because it tends to suck money in from other areas of healthcare which are not subject to targets, such as chronic long-term conditions and follow-up, emergency and maternity care.

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