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We need a new system of organ donation, one which will allow for supply to meet the need or the demand. I urge the Government to look carefully at an “opt-out”, or presumed consent, system for renal donation after death. Kidney donation has dramatic results; it can transform the recipient’s life. Seventy

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per cent of the public say that they would be willing to donate, but only 20 per cent have registered on the NHS organ donation register to donate their organs after death. But despite 14.1 million people being registered, 459 patients died last year while awaiting their transplant. That is more than one a day, waiting on the list and dying before they get there.

Organ shortages lead to poor tissue matches and greater risk of transplant failure, and so it gets worse and worse. Those who are desperate will sometimes turn to the terrible trade of organ trafficking. This trades on poverty and despair, often in the poorest parts of the world. It is tragic, but it will continue if the Government do not grasp the nettle of deceased donors.

Finally, I turn to a different type of trafficking referred to in the gracious Speech—that of drugs. Have the Government heeded the debate that we had recently in this House? I simply reiterate the call for an agricultural policy that works with Afghan poppy farmers so that we buy up the raw opium and encourage other crops. Surely we must have a policy that allows us to grow poppies, not terrorists.

12.09 pm

The Lord Bishop of Leicester: My Lords, many of us on this Bench add our congratulations to the Government on their plans for legislation as outlined in the gracious Speech. There is much we welcome here, and we look forward to making our contribution to the debates on the many Bills that will come before your Lordships’ House. However, there is no greater duty placed on a Government than that of their care for their most vulnerable in society. It is on that issue that I shall focus today, particularly in relation to children and young people, speaking as the chair of the Children’s Society.

I welcome the Government’s proposal to radically improve childhood outcomes and life chances for all children, especially for looked-after children. I welcome the implementation of the Government’s White Paper, Care Matters, as the reform of the care system proposed in the Children and Young Persons Bill is, as we know, long overdue. The Government’s aspiration to reduce the outcome gap between children in care and their peers and to improve the experience of education for children in care is clearly right but, as always, this particular legislation will require close examination and monitoring. That is because, as I am sure this House is aware, for successive generations we have not satisfactorily looked after our children and young people in care. We need to ensure that the many suggestions arising from the debate on the White Paper do indeed find their way into the proposed Bill and that we are able to build a consensus around the reforms needed.

Policies without people and resources, however, are empty shells and doomed to failure. The new legislation reflects high ideals about what children need, but local authorities, as we have already heard today, are overstretched. We know that council taxes are not going to cover the extra resources required. Professionals involved in making crucial decisions about the welfare of children are boxed in by

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diminishing budgets and increasing demands on their resources. I wonder how the local authorities are going to find the money to make these proposals work, when the Pre-Budget Report failed to show how we are going to make the painful decisions needed about the redistribution of wealth.

In that connection, I want to draw attention to the one in three children who are living in poverty or with serious inequalities today. Many of these children are suffering family breakdown and rely on child maintenance. The Child Maintenance Bill is the focus of enormous concern about the crucial role maintenance plays in relieving child poverty but also anger about the inability of the Child Support Agency to create a straightforward and effective way of collecting the maintenance. To many commentators the Bill seems to be just a repackaging of old models, rather than containing any radical rethinking of how best to spend government money in this area and encouraging parents to be generous towards their children according to their own means.

There are two specific aspects in this area where I encourage the Government to be bolder. I hope the new legislation will include a right to advocacy for children with disabilities. As the Children’s Commissioner for England stated in his response to the Care Matters Green Paper consultation,

There are some 13,300 children and young people with disabilities placed away from home in England and they need a statutory right to independent advocacy, which is about helping them get their views heard and helping them take their proper part in the decisions that affect their lives. This is what gives them dignity, respect and independence, which they are so often unintentionally denied, and it can provide a source of protection by ensuring that their voices are heard within what is otherwise experienced by them as a closed system.

Yet, despite government guidance which says that advocacy providers should ensure that their services are accessible to disabled children, new research has shown that that is not the case. For example, over two-fifths of those surveyed said that they could not provide advocacy for children who did not communicate verbally and over one-third of the services could not provide advocacy for autistic children. Of course, parents can be the children’s first and best advocates, but children need formally appointed advocates when the problem is about the child’s parent or primary carer or when the child does not want to share their concerns with their parent or simply chooses the independence of having their own advocate.

Another vulnerable group is children and young people who enter this country unaccompanied as asylum seekers. We need the Government to move towards a guardianship scheme for children such as these. Each year, some 3,000 children come to the United Kingdom to seek asylum and they can become virtually invisible when they enter the highly complex asylum process, putting them at risk of

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exploitation and many other forms of harm. Many have experienced abuse, loss or trauma and need support to help them to talk about what has happened to them before they can make an asylum claim. Local authorities work hard to offer support to these children but their work needs strengthening, supporting and resourcing. The proposed legislation focusing on the care of children and young people provides us with an opportunity to ensure that unaccompanied children seeking asylum are provided with the guardianship that they need to navigate the care, support and asylum processes, as might a parent for a child within a family. Such schemes operate successfully in other countries, where they ensure that the child’s best interests are safeguarded in all legal and other proceedings affecting them. Surely this is the least that we should be doing for this most vulnerable section of our children.

I turn briefly to comment on one other area of the gracious Speech under debate today. I very much regret that the right reverend Prelate the Bishop of St Albans is unable to be in the House today to speak on the Human Fertilisation and Embryology Bill, as he made a significant contribution to the work of the Joint Committee which scrutinised the draft Bill. I know that he would have welcomed the Government’s decision not to create a new regulatory body combining the functions of the Human Fertilisation and Embryology Authority with those of the Human Tissue Authority. No single body could give adequate scrutiny to such a wide range of important questions, but, as the Church of England’s response to the Joint Committee outlined, we remain deeply cautious about the creation of cell nuclear replacement embryos—that is, cloned embryos—and especially about the creation of human/animal hybrids. We will continue to press for very tight controls on embryo experiments and for constant review of the licensing of research into hybrids to ensure that the claimed therapeutic benefits are the only rationale for continuing research programmes.

The start of any new Session of Parliament brings a sense of hope and expectation—perhaps especially one with a new Prime Minister at the helm. I am conscious of the demands that such hope and expectation will place on your Lordships’ House and the desire of the Government to deliver on their commitments, but the care of the vulnerable and those without a voice is the standard by which any civilised and just society must be judged. I hope that in this Session we will have the resolve to defend those most in need and place the vulnerable, and especially the needs of children and young people, at the heart of our concerns.

12.20 pm

Lord Warner: My Lords, I apologise to my noble friend Lord Darzi for missing the first part of his speech, for transport reasons that were totally beyond my control. It is a pleasure to participate in the debate secure in the knowledge that I will not have to wind it up and think of something sensible to say in response to the diverse contributions that your Lordships will no doubt make. I readily sympathise with the position

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of my noble friend the Minister, so I shall try not to add to his burdens in that respect.

As someone who has a long-standing interest in social policy and a commitment to the interests of children and young people, I thought that the gracious Speech and its legislative programme were a good blend of the visionary and the practical. It is an ambitious programme, which extends education and training to 18 year-olds, provides mechanisms for increasing social and affordable housing, improves services for vulnerable children, especially those in care—I shall speak about them in a moment—strengthens workplace pensions, uses unclaimed money in bank accounts to improve youth facilities and helps to improve the balance between work and family life. Those on the opposition Benches in another place who suggested that the programme lacked vision were really saying that they do not like the vision of a Government who are concerned with social justice, fairness and opportunity.

I welcome particularly the measures to improve services and, I hope, outcomes for children in and leaving care. For far too long, and under successive Governments, their life chances have been poor when compared with those of their contemporaries outside care—I know that from my six years as a director of social services. I hope that the Government will commit the resources necessary to ensure much more stability in the placements of young people and the stability of the key workers and mentors who support them during their time in care. Those young people, who never chose to be in care, hunger for greater stability and continuity in the significant adults who work with them.

We know from the expansion of youth facilities how much those services and activities can contribute to reducing crime and anti-social behaviour among young people. I saw that during my time as chair of the Youth Justice Board, when we used the money provided by this Government to expand preventive programmes. I hope that measures in this area will enable us to take those preventive programmes much further.

There is one area of the legislative programme, affecting another group of children, where I hope—although I have fairly low expectations—that it is not too late for the Government to think again. This group consists of the as yet unborn children who will be affected by a proposed change in the Human Fertilisation and Embryology Bill. That the Bill retains the duty in the 1990 Act to take account of the welfare of children in providing fertility treatment is welcome. Less welcome is that the Government are, it is believed, proposing to remove the words,

from the concept of children’s welfare in the 1990 Act. I understand the pressure that the Government have been under on this issue; I know the power of some of the lobbies that have argued on it. However, children are not accessories to adults’ preferences. I hope that we in this House will think again about retaining the words of the 1990 Act on a child’s need for a father.

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On a happier note, I turn to the Health and Social Care Bill. I should acknowledge that I was heavily involved in the Bill as a Minister, so it will come as no surprise that I fully support the Government’s approach in it. On the changes to the healthcare professional regulatory bodies, there are already rumblings from BMA House. When the Bill is in this House, I have no doubt that your Lordships will be briefed to the effect that civilisation as we know it will end if there is a change to the civil standard of proof in professional disciplinary cases. I urge noble Lords to use their well honed powers of scepticism and capacity for detecting the whiff of self-interest in considering these aspects of the Bill. The Government deserve our support on this issue in the interests of patients, as the General Medical Council well recognises.

On the other main measure, a new integrated system of health and adult social care regulation, we shall no doubt have many discussions in this House. A lot of the devil will be in the detail. The noble Earl, Lord Howe, and I are veterans of earlier discussions on some of these issues in the 2003 Act, and I am sure that we shall dust off our campaign medals and volumes of Hansard to return to some of those issues during debates on this legislation.

All that I should like to do today is to offer two pieces of advice to my noble friend the Minister to pass on to his colleagues in Richmond House. First, a new regulatory system in this area must be totally even-handed and operate on a level playing field between service providers, whether from the public, private or third sectors or from social enterprises. I include in that the important point made by the noble Baroness, Lady Barker, about the application of the Human Rights Act to all providers of public services, including health services. That approach is critical to the promotion of choice and competition, as the Government recognised in their original consultation document and recently published response to that consultation. If we are to have the personalised healthcare system that the Prime Minister rightly wants, choice and competition with a mixed economy of providers, in an open and fairly regulated market, are critical to success. I believed that as a Minister and shall continue to do so as we take the Bill through this House. We need to make market entry and exit as equivalent as possible for all providers of NHS services.

The second key issue is the coverage of the registration of care providers, to be included in the new regulatory system. The Government are rightly consulting further on the issue. I remind them, as they consider this further consultation, to remember the January 2006 White Paper, Our Health, Our Care, Our Say: A New Direction for Community Services. This demonstrated that the traditional boundaries between primary care, community services and secondary care were being blurred rapidly with advances in medical technology and changes in patients’ preferences. That point is well understood and has been well argued by my noble friend Lord Darzi in the work that he has done in reviewing the NHS in London and elsewhere. Any registration system that excludes significant elements of primary care and community services will

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not produce a fair regulatory system and will ossify the development of more patient-responsive services. Whatever the pressures from vested interests to be excluded from the regulatory system in this area, I hope that the Government will see them for what they are and ignore them.

I have resisted the temptation in this speech to respond to the criticisms that the noble Earl, Lord Howe, made of the Government’s stewardship of the NHS, including no doubt my part in that stewardship as a Minister. He will be surprised to hear me say that I believe that over the 10 years of this Government we have made some mistakes, but we have also tried to correct them. However, those mistakes pale into insignificance compared with the failures by the party on the Benches opposite to invest in the NHS in the two decades before we took over responsibility; that party left the NHS on its knees and with a deficit that in percentage terms was higher than has ever occurred under this Government.

In conclusion, I congratulate the Government on a visionary and practical gracious Speech and legislative programme, which continues public service reform in the interests of fairness, opportunity and service-user responsiveness, and on their continuing good stewardship of the NHS.

12.29 pm

Lord Fowler: My Lords, I was going to congratulate the noble Lord, Lord Warner, on a speech free from the shackles of government, but as, judging from his last remarks, he seems a bit reluctant to leave those shackles, I shall modify my congratulations. The noble Lord was a senior civil servant in the DHSS when I became Secretary of State. I do not take it personally but I note that he left immediately I arrived.

I congratulate my noble friend Lord Howe on his speech. I was concerned only by his reference to the Maastricht experiment. I do not know what the Maastricht experiment is, but my experience as Conservative Party chairman leads me to the conclusion that we should strongly avoid anything to do with Maastricht.

It sometimes needs an outside intervention to clear the mind on the National Health Service. Over the last weeks, two prominent American politicians—both, as it happens, fighting for the Republican nomination for president—have gone out of their way to criticise the National Health Service as well as many other things European. At the end of October, Mitt Romney singled out the British National Health Service for criticism and warned America of the danger of becoming a second-tier nation like Britain and other European countries. Then Rudy Giuliani attacked the National Health Service even more specifically and claimed—as it happens, quite wrongly—that the survival rate from prostate cancer in the United Kingdom is only 44 per cent under what he termed “socialised medicine”. In actual fact, the figure is 75 per cent, but that has not prevented him from launching a radio advertising campaign complaining of European-style socialism.

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For six years I was Health Secretary in Margaret Thatcher’s Cabinet. As we developed the National Health Service—I hope that the noble Lord takes note of that phrase—it had not occurred to me that we were involved in some vast left-wing project. It was not a criticism normally made of Margaret Thatcher, any more than it was of Churchill or Harold Macmillan, who also followed the same policy. The sensible attitude to take, and the point to remember, is that the National Health Service has been developed by Governments of both parties and will continue to be so. Frankly, I do not entirely comprehend the language of the two contenders campaigning against the nations of Europe when we assume that their aim—if ever they were to be elected president—is to have good relations with those European nations. I should not have thought that the United States is so rich in overseas friends that it needs to kick those who are already friends, but I leave that to one side.

The principle of the National Health Service and its whole basis is that no one should be prevented by a lack of income from accessing good healthcare. That is an important principle and one worth fighting for. I am delighted that the leader of my party, David Cameron, has emphasised his commitment to it. Does that mean that the National Health Service is perfect? Of course it does not. Too often extra resources have not resulted in improved services. Back in the 1980s, I introduced not administrators but general managers. That has led to much improvement. If I was to go one step further, I would separate the management of the health service from the health department. The latter contains much professional expertise but not necessarily vast management experience.

There are undoubtedly areas where the health service can be improved. Examples were given by the noble Baroness, Lady Finlay, who leaves the Chamber immediately that I mention her name. That practice seems to be catching, but the noble Baroness may go; I shall not mention her again. The National Health Service is failing in the area of public health, particularly HIV/AIDS and sexual health generally. I doubt whether that would come high on the list of Messrs Giuliani and Romney. Almost exactly five years ago in a debate in this House, I warned that,

Today that position has deteriorated further. New diagnoses are now 7,500 a year—a figure that has trebled in the last 10 years. The number living with HIV is now between 70,000 and 75,000, not 30,000 and 35,000, and there is unmistakeable evidence that young people in particular are ignoring safe sex messages.

The Royal College of Nursing rightly points out that HIV is not just a sexual health issue but a chronic condition, as people with HIV now live into their 50s and 60s, producing a need for specialist nurses working in HIV care, while all the time many of those with HIV suffer prejudice. Recently I was looking at HIV in India, where there were certainly examples of prejudice. I regret to say that there are examples of it

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in this country, too. I am a trustee of the Terrence Higgins Trust and only this week a very reputable charity wanted to know what it should say in warning its clients that the furniture donated to it had belonged to someone with HIV. This is 25 years into the epidemic in a highly educated society. The prejudice is born of ignorance, which in turn comes back to a lack of public information and discussion.

Of course, HIV/AIDS is not the only problem. The figures for sexual health generally provide no greater comfort. The latest figures show that new instances of chlamydia have doubled over the last decade. In 1998 the figure was 48,000; today it is something like 110,000. If you take another sexually transmitted disease, syphilis, you find that whereas in 1998 it had almost disappeared, today there are almost 3,000 cases a year. This is a great challenge to this country. Why do we not take the issue more seriously? Perhaps we take the view that, as the issue is more serious in some overseas countries, such as those in Africa, we can be relaxed about it. I do not think that that is right. If we have pretensions to give aid and help in those areas, we should set an example.

The great irony is that we took more urgent action back at the time of the First World War when confronted with the scourge of venereal disease. We set up a royal commission, opened clinics around the country and promised immediate walk-in and anonymous treatment. Today, the clinics are overcrowded and too often run-down, and delays in treatment are all too common because appointments have to be booked. It is not a good story. Almost 100 years ago our predecessors showed more determination to tackle the issues effectively.

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