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I do not claim for a moment that all the issues can be solved by government. The churches, particularly the Roman Catholic Church, can do more. It is a tragic irony that the Catholic Church, with all its influence and power to do so much through its aid societies—it does a vast amount through them—to care for the victims of HIV/AIDS, does so little to prevent it. Its attitude to condoms as a disease prevention measure is a case in point. So much suffering and death could have been prevented by taking a more sensible attitude in that area.

Government cannot do everything but they can do much more to tackle the crisis—and it is a crisis—that we face today. There are three central failures of policy. The first failure is in public education. The efforts to get over general messages of information and advice in this area have been woefully inadequate. The public will listen to authoritative advice given by professionals such as the Chief Medical Officer in the Department of Health, but that advice has not been given on a national scale in a convincing and persuasive way. It never occurred to me when I ran my campaign in 1986 that the Government would, in a truly national sense, go off the air for the next 20 years.

The second failure is in education. Young people are often still not receiving good-quality sex and relationship education. We raised that point with the Minister in a debate some months ago. Properly

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taught, it can lead to young people starting sexual activity later, having fewer partners and being much more likely to take precautions against sexually transmitted infection.

The third and crucial failure is funding, to which my noble friend on the Front Bench referred. Not only is the area generally underfunded, but even when an effort is made to provide resources they all too often do not reach the service providers. The Government made a much publicised announcement about how they were providing £300 million to be targeted on sexual health. Press releases were written and ministerial Statements were made, but the only trouble was that a large proportion of that £300 million did not reach the sexual health services or result in major public education campaigns. The decision was left to the primary care trusts, many of which used the money to pay off budget deficits or for other purposes. Many trusts do not have HIV or sexual disease as a priority. It is not a cause that has loud public support and the trusts reflect that. I am in favour of devolution, but in public health, particularly sexual health, the case for ring-fencing budgets seems to me to be overwhelming. Public health is a national responsibility; there are no boundaries in infection and it should be dealt with in that way.

This is not a popular area of policy-making; we all know and recognise that. Those who enter it are liable to be attacked from the right and ridiculed from the left. Nevertheless, it is a vital area. Disease is disease and in a truly national health service it should be tackled with commitment and energy. Most of all, this area needs political leadership. Frankly, that leadership has been lacking for a number of years.

12.42 pm

Lord Low of Dalston: My Lords, in government it must often seem that you cannot win: if you give advance notice of your legislative programme in the interests of greater transparency, when it comes to the Queen’s Speech you are told that it contains nothing new. The gracious Speech is said to be long on aspiration but short on vision. It is our job to hold the Government to account, but in an age when the business of politics is increasingly debased by partisan agendas, the 24/7 news culture and the corrosive canker of cynicism, it seems to me that we ought to be prepared to give credit where credit is due.

A programme designed to meet people’s aspirations—for better education, housing, healthcare and children’s services, with a commitment to raising educational standards along with the school leaving age and addressing the important skills agenda of the Leitch report; which envisages the building of 3 million new homes in the next 10 years, the largest housebuilding programme since the 1950s, which is long overdue; a healthcare system organised around the needs of the patient; all children having the best possible start in life and improved services for vulnerable children and young people, including those in care; a better balance between work and family life; which is committed to tackling climate change in a manner which suggests that it means business, and to tackling congestion and improving

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public transport, not to mention the even larger agenda of reducing global poverty with renewed efforts to achieve the millennium development goals—such a programme hardly fails on the score of vision.

It is on the score of delivery that it seems to me that Governments—all Governments—are vulnerable, and increasingly vulnerable, in a society beset by a crisis of authority, where the imperative of consultation means that all decisions are contested and where the traditional levers of influence flop limp in Ministers’ hands.

I was intrigued by the noble Lord, Lord Anderson, saying in yesterday’s debate that the problem lay mainly in the external arena and that domestically delivery could normally be guaranteed—would that it were so! Nowhere is the gap between rhetoric—no, let us be fair—intention and performance more stark than in the arena of social care, which is truly the Cinderella among the subjects we are debating today. Expenditure on personal social services has increased substantially in recent years, by 10 per cent in real terms between 2003-04 and 2005-06. That is something for which the Government deserve real credit, but it is still not enough, and growth in spending on social care is being dwarfed by the growing needs of our ageing population.

Despite the Government’s best efforts, provision is falling further and further behind need, and the system is slipping deeper and deeper into crisis. In March 2006, the Local Government Association reported that seven out of 10 people receive social care only if their needs are substantial or critical, and 80 per cent of councils plan to tighten their criteria still further. That has forced many disabled and elderly people back on to their own resources, leaving some to rely on family or friends for essentials and others simply to go without. The Government’s answer in the Health and Social Care Bill is stronger regulation. That may help to drive up standards, but it is also a question of resources. The above-inflation increase for the Department of Health in the recent Comprehensive Spending Review should not be allowed to conceal the fact that, with growth in the funding for local authorities standing at just 1 per cent above inflation over the next three years, much of which is already accounted for, social care services are promised relatively little. If the Government can be asked to reconsider the adequacy of their spending on defence, should they not also reconsider whether their spending on the needs of the most vulnerable in our society is adequate and whether fair access to care services can continue to be sustainable at this level of funding?

We must never lose sight of the basic purpose of social care: to enable people to live independently. That is why I have been so dismayed by the bureaucracy of the ordinary residence rules, which stop people moving around the country to new jobs, educational and other life opportunities. I hope that some progress can be made on these issues during this Session. I hope, too, that the Government will be prepared to give a fair wind to the Bill introduced yesterday by the noble Lord, Lord Ashley, to develop a range of services that would enable disabled people

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to have true independence; either that or bring forward some proposals of their own, perhaps based on the report of the noble Baroness, Lady Campbell, which is currently being considered. That was the object of the Cabinet Office’s Improving the Life Chances of Disabled People report, though I would urge the Government not to be beguiled by prescriptions which are too monolithic. There are those who feel, for example, that individualised budgets do not suit everyone, and that the report takes insufficient account of the needs of elderly people—the majority of disabled people—and those with severe, multiple, complex and learning difficulties.

The purpose of the employment simplification Bill is to,

One aspect that I am particularly interested in clarifying and strengthening relates to retaining newly disabled people in work. I believe that as part of the Government’s welfare to work reforms, much greater priority must be given to supporting disabled people in work who are at risk of leaving their employment for a reason related to their disability. Catching those people who are likely to leave work for disability-related reasons will, without doubt, bring greater savings for the Government than engaging with the same people once they have left work and claimed incapacity benefit.

The Government gave a specific commitment in the Warwick agreement to introduce in this Parliament greater support for people who become disabled while in work. As set out in the National Policy Forum report Britain is Working of September 2004, the commitment is to,

This policy has gained considerable support in another place as rehabilitation leave. It has been promoted for more than a decade by my organisation, RNIB, but it should now be seen as an idea whose time has come. People who become disabled while in work, or who experience a change in an existing impairment or health condition, would be able to have some time away from work to undertake rehabilitation and retraining to return to their previous role, or if that is not possible, an alternative appropriate position, and so avoid going on to incapacity-for-work benefits.

I cannot conclude without commenting on the omission from the gracious Speech of a single equality Bill. The Government published a Green Paper in the summer that was intended to prefigure a single equality Bill, but it was the subject of considerable criticism, particularly for the impact the proposals would have had on the disability equality duty. Many felt that the Green Paper lacked, among many other things, vision and failed adequately to address the role of the private sector in promoting equality. It is therefore gratifying to learn that the proposals are being reconsidered.



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However, the Secretary of State’s announcement that there will be a Bill in next year’s Queen's Speech, but with very limited further consultation or scrutiny, has caused widespread concern. On 25 October she said in another place that,

This is not really good enough. On a matter as complex and technical as this, there needs to be further consultation and there is a strong case for a draft Bill to be published in order that pre-legislative scrutiny may take place. Your Lordships will remember that such an approach was adopted for the draft Disability Discrimination Bill, which led to the 2005 Act, and that this was widely welcomed and generally considered to have had a beneficial effect in helping to build consensus.

12.52 pm

Baroness Pitkeathley: My Lords, I have worked in the fields of health and social care all my professional life and to declare all my interests would take more time than could reasonably be permitted. I will declare just two. I am chair of CAFCASS—the Children and Family Court Advisory and Support Service—which deals with children and families when they are at their most vulnerable, and I am vice-president of Carers UK, which supports and campaigns for that other most vulnerable group, the 6 million people who provide the majority of health and social care to their families and friends.

The first thing I want to do, as well as congratulating my noble friend on his opening speech, is to celebrate the title of this debate—that the words “social affairs” are included in it at all. It is perhaps a sign that social care, for so long the poor relation in care matters and always swamped and often overlooked by what are often seen as more glamorous or dramatic issues about saving life or life crises, is recognised at last—or at least becoming more recognised. Social care is much more often about things that are singularly undramatic and most certainly not glamorous.

I am delighted with the progress that we have made towards more recognition of social care, social work and, indeed, social workers under this Government. We have a Minister for Social Care for the first time and we have a General Social Care Council, of which I had the honour to be the first chair, and which has done so much to raise the status and quality of the dedicated professionals who work in this field. It is a field, let us never forget, which has great difficulty in recruiting staff, not only because of inadequate levels of reward, but because of the extraordinarily stressful nature of working with clients, families and individuals who are most needy and often most hard to help. It is remarkable how easy it is, even for those of us who have spent our lives on the front line, to forget how difficult social work is.

In this regard, the Commission for Social Care Inspection has been of the utmost importance in championing social care, highlighting successes and

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failings and providing a strategic lead for the whole sector. The Health and Social Care Bill announced in the gracious Speech will contain provisions to create what I understand will be called the Care Quality Commission—to replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. It will require all providers of health and social care to be registered and a consistent approach to regulation and inspection will no doubt bring benefits to patients and to service users. But we must ensure that the expertise built up by CSCI and shown to such advantage in reports such as The State of Social Care in England, published in January this year, is not lost.

In addition, CSCI has a fine record in making the views of users and carers not just known but central to its functioning. We must ensure that this continues with the new body. It will have a smaller budget, but this is one area where we must not cut corners. We must remain concerned that the institutional attention of the new body does not become entirely focused on healthcare at the expense of social care and that resources are balanced accordingly. For example, there are concerns regarding the fresh duties for the Care Quality Commission, such as the current focus on the cleanliness of hospitals—as a survivor of a severe case of MRSA, I am all in favour of cleanliness in hospitals. But we must ensure that that does not cause already tight resources to move from social care to health. I hope that the Minister can provide some assurance on that in his reply.

One of CSCI’s key functions is that of providing impartial and objective information to potential users of social care services and their families, not least because one third of such people already fund their own care. This role must be continued and, ideally, expanded. It must link effectively with the national helpline for carers that the Government are setting up to provide consistent information to families in need of care services.

The CQC must support social care services in focusing more on supporting carers in employment. Currently, the 4 million working-age carers are being failed by the system. Evidence from Carers UK’s recent employment carers and services research carried out by the University of Leeds shows that more than 40 per cent of those caring full time and not in work say they cannot return to employment because of the lack of services available to support them. Current systems do not support carers at key stages of their lives. They must have reasonable expectations to a life beyond their caring role, as enshrined in the very welcome Carers (Equal Opportunities) Act 2004, but we must help them to fulfil those expectations.

I wish to mention another Bill; it is not strictly the subject of this debate, but carers will very much welcome in the Pensions Bill the creation of a new scheme of low-cost personal accounts that will give them some advantage. We need to make sure that personal accounts are sufficiently flexible for those moving in and out of work, as carers often do.

There is also a continued need for a stronger focus on carers within the NHS. The NHS will benefit from

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a 4 per cent increase in its funding, as announced in the CSR. A great many of the reforms are predicated on the basis of people caring for people at home. Yet carers are often ignored and invisible to the NHS. It is vital that we ensure that carers are a priority for spending from the NHS budget, as well as local authority budgets, and that they are treated as partners in care.

In this context, I want to mention the National Voices initiative—a new collaboration of which I am chair, succeeding the noble Baroness, Lady Morgan of Drefelin—which aims to bring the views of patients, carers and service users directly into the heart of health and social services, attempting to bridge the gap between the rhetoric and reality of user-led policy making. We have been delighted with the support given for this initiative by Department of Health Ministers and have every confidence that National Voices will soon be established as a true partner in the development of policy.

Other key issues are to be welcomed in the Government’s plans—in particular the Green Paper that we are promised on the future of social care funding, which signals a major reform of the current system. The CSR statement made it clear that the Government believe that there are real opportunities for reform within a system that shares the cost between the individual and the state and that provides both universal and progressive elements. A sustainable funding settlement is essential because, while the announced increase in social care spending will help carers and the people for whom they care, it will not, as we have already heard, meet the level of unmet need that currently exists, leaving many families to struggle on as before.

I understand that my honourable friend in another place is beginning the consultation on the Green Paper immediately. When it is published we hope that at its heart there is a recognition that most care is provided by families and that the formal care system needs to fit around that, rather than the other way around. Of course, the review of the National Carers Strategy is also very welcome. I sincerely welcome the Prime Minister's interest in carers and greater awareness that carers are providing care at a cost to their own health, wealth and employment prospects. We need better recognition of the crucial role that carers play in society, reflecting that the care provided by families massively—I emphasise “massively”—outstrips that provided by formal services. We must also welcome the Standing Commission on Carers, which has been established. It is important that it is given suitable resources and a strong remit to advise across government.

The New Deal for Carers, as the revised National Carers Strategy will be known, will be a 10 to 15-year vision. In order to implement and monitor the strategy effectively, it is essential that we have the required statistics. In that regard it is absolutely essential that the carers’ questions are retained in the 2011 census. That is an issue on which the All-Party Group on Carers has been active and we must continue to pursue it with the Department of Health, the Treasury and the Office for National Statistics. In

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fact, all government departments should have an interest in retaining this question if they are to deal accurately with the impact of demographic change. I very much hope that the Minister will be able to give some reassurance on that.

I said at the beginning that I was glad to see health and social affairs included in the title of our debate today, but I want to conclude by saying how glad I am that education is also included and that the noble Lord, Lord Adonis, is to reply to the debate. CAFCASS is sponsored by the Department for Children, Schools and Families, although it works in close co-operation with the Ministry of Justice because of its work in the court system. However, the fact that our sponsoring department is the DCSF is recognition that the work of CAFCASS is essentially part of the Every Child Matters agenda, and that safeguarding and caring for children at whatever stage of their lives encompasses public and private law issues, education and the provision of social care.

We should never forget that, for the client, the user and the carer, which agency provides that care is of little interest and almost of no consequence. What is important is the quality of care and the quality of the intervention. To that end statutory agencies, voluntary sector providers and private sector providers must be prepared to work in the closest possible co-operation and partnership, keeping the focus always on the most vulnerable members of society who use the services. Government departments must similarly work in partnership and listen always to the voice of their users. Any legislation and especially some of the legislation we shall be considering in the next few months must keep that at its forefront. Safety and quality are everyone’s business and that includes the users and carers.

1.03 pm

Lord McColl of Dulwich: My Lords, I, too, congratulate the noble Lord, Lord Darzi of Denham, on his opening speech. We were surgical colleagues together for many years and I enjoyed working with him very much. I think we both find surgery a good deal easier than politics.

I wish to deal with a practice that leads to a vast amount of ill health. I refer to human trafficking, which is the debasement and violation of one human’s rights by another. In March 2007, we remembered and celebrated the great work of William Wilberforce and it is now our duty to eradicate slavery in our society. The facts and figures surrounding trafficking are truly appalling. Save the Children estimates that there are 5,000 child prostitutes in the UK, nearly all of whom have been trafficked. The Home Office recently estimated, in a Written Answer, that as many as 4,000 women victims of trafficking for prostitution are in this country. The International Labour Organisation says that there are approximately 12.3 million people in forced labour, bonded labour, forced child labour, and sexual servitude at any given time. UNICEF believes that two children a minute are being trafficked domestically and internationally. Of course, the nature of this abhorrent crime prevents accurate figures, but when one considers that the generally held estimates in this area could themselves

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be multiplied by as much as 10, it seems vital that the Government take further action to stop this traffic.


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