Previous Section Back to Table of Contents Lords Hansard Home Page

Any Government will have to face the problem of how to help parents address their anxieties and concerns during their children’s teenage years. Almost any parent will tell you that it helps in difficult situations to talk to other parents. Often that shared experience will enable you to think of other ways to handle a problem presented to you by a young person. I am not sure how we could do that; I simply say to the education Minister, who has been very thoughtful on areas like this, that we need somehow to make it easier within schools and other educational establishments for parents to meet and discuss these issues. We also need to use the internet more imaginatively. There are websites where you can share your experiences of parenting, but they are limited and often hard to find. Finding ways to enable people to talk about this is more helpful than we might think.

Quite a few years back—in 1994, if I remember rightly—it was the United Nations Year of the Family. I was an MP at the time and held some useful committee hearings in the House of Commons, which some noble Lords who were not Members of this House at that time had a hand in, as did the noble Lord, Lord Northbourne, who was a member of that committee, although he is not with us today. Many of the lessons that came out of those hearings have been picked up on, although not all of them by any means. What we need to do about parenting is not so much legislate for it—Governments cannot lay down ways of parenting—but rather enable a discussion to take place on the issue rather more effectively than has been the case.

One of the problems Britain has as a society is that we are far less likely to intervene when we see young people behaving badly in public. Although I am quite happy to sit down and look at all the bad and embarrassing things I did as a youngster—and therefore I hope I am a bit better at understanding such behaviour—that does not mean I think we should not intervene when we see it happening in the street. We should, and at the end of the day most young people will welcome that. It is not easy, though; anyone who has tried to intervene, as I myself have on a number of occasions, will have noticed that everyone else on the bus buries their head in their newspaper, or finds they are looking on the floor for a coin they might have dropped, or something of that nature.

We are quite curious in Britain in that we do not wish to get involved, and yet at the same time we often lay down conditions on risk-taking for young people. We go to the other end of the scale when children are taken out on expeditions and there is an accident, perhaps even a tragic death, and the next thing you know there are headlines asking who is to blame. The blame culture stops kids taking risks—but we have to take risks, even if tragedies happen from

8 Nov 2007 : Column 192

time to time. We also have to encourage involvement by adults. We have a strange balance. We are less good at this, unlike quite a few other cultures, particularly in the Mediterranean. This situation is not unique to Britain—it is more a problem of northern Europe—but it is quite pronounced here.

We have specific problem areas such as alcohol and drugs, where there is much more work to be done. Black-on-black gun crime has caused a lot of problems in the area I used to represent, Shepherd’s Bush. All these problems have a parenting aspect. It does not follow, incidentally, that the parent is to blame; sometimes they will be caught up in a situation and a series of events they feel they have lost control of. Alternatively, they might just have opted out and not be pursuing their role any longer. That is why we need to have a wider debate on parenting, although not in terms of what is “good” or “bad”. I have yet to find, as has anyone who knows anything about this, an acceptable definition of “good parenting”. The old phrase, quite rightly, used to be “good enough parenting”. Ultimately any parent will have periods of good parenting and bad and it can be very hard, particularly at the time, to judge which is which.

Then there is the broader question of how we deliver our public services. I wrote a paper a couple of years back and had discussions with people who were not then Ministers but are now—James Purnell was one of them—on shifting, not away from the idea of choice, because that is still important, but towards the idea of personalising and customising public services. That applies particularly to areas such as education, health, housing and so on, where the approach needs to be “How do we help you solve your problem?” and “How do we help you deliver the service?”. A number of people already support this idea. I notice the words “personalising” and “customising” in the Government’s lexicon now, and I welcome that. It is not easy, though, and the devil is in the detail. Indeed, it was mentioned earlier today that we ought to give people who are spending money on social care their own financial package to spend as they wish. That is a good idea and I support it, but we should bear in mind that the difficulty lies in the detail: in the first instance where such money is used inappropriately, whether for good reasons or bad, and the state then has to step in and provide it again or else leave the person by the wayside, you can imagine the headlines.

Personalising goes on much more in education. If a child at a school—it may not be a child who is failing or of great intellectual ability but one who comes somewhere in between—has particular educational needs, he should be brought forward in certain studies that he could be good at but does not do well in at the moment. There needs to be a way of identifying that and personalising an additional educational package to help that child through. We should not think of this applying just to gifted children or to those with problems; rather, we should think of a range of things that would work well for the child and ask how we could put together a package of educational provision outside as well as inside the school. Such a package should be put together in consultation with the parents and the school so that the child’s life chances

8 Nov 2007 : Column 193

are improved; in other words, we need to identify the problems and work on them with the parents and the family.

I think that we are going down that route and I very much welcome it. However, it is a lot more challenging than people think. We should not think that it is common sense and that we can all do it. All sorts of problems are attached to delivering the detail but I am sure that it is the right road to go down. The idea of customising and personalising public services has to come high up in our thinking on public services in the future, because it is what people now expect. That expectation is not simply of a broad general right to a public service that will remain but of a right to a service that will in some way be better at delivering in relation to specific needs.

I hope that we ensure that those thoughts run through our legislation but, above all, perhaps we can start the debate on parenting when we discuss some of the Bills that come out of the Queen’s Speech. We need to share this very complex problem with which all people struggle in one way or another. We do not have any answers to it and government certainly cannot solve it but this discussion is important.

2.42 pm

Lord Colwyn: My Lords, the gracious Speech refers to a commitment to providing a healthcare system organised around the needs of the patient and thus it enables me once again to draw noble Lords’ attention to the current situation affecting the provision of NHS dental services.

The Minister will know, as did his predecessors—I see that the noble Lord, Lord Warner, has just left the Chamber because he has heard all this before—that I support the concept of change in NHS dentistry and have commended the Government for their courage in tackling a dental service that has long needed revision, an end to the fee-per-item-of-service treadmill and help for the less well-off. But the dental profession, which is providing the service, does not believe that the new contract is working. The Government need more courage to consider changes; they need to undertake urgent discussions with the profession and all providers of NHS dental services so as to put the contract back on course.

In 1999, the Prime Minister pledged that by September 2001 everyone would have access to an NHS dentist, no matter where they lived. In March 2006, on the eve of the new contract, 46.2 per cent of patients were registered with an NHS dentist. There are no figures for registration since the new contract, so it is difficult to assess the number of patients who now have regular dental care.

The new contract was introduced to improve access, but recent surveys have shown that only one in five NHS dentists is taking new NHS patients and that four out of five restrict access in some way. Most dentists believe that the new dental contract has failed to make it easier for patients to get an NHS appointment and that the quality of care that patients receive has got worse. According to the recent Dentistry Watch survey, commissioned by the

8 Nov 2007 : Column 194

Commission for Patient and Public Involvement in Health and published on 15 October 2007, about 20 per cent of all patients are declining treatment because of the cost and about half of all patients simply do not understand the charges system.

The new contract in 2006 gave primary care trusts responsibility for commissioning NHS dental services using a fixed budget set by central government. The National Audit Office has cast doubt on the ability of the PCTs to commission dental services. It found that the PCTs had little experience of high street dentistry and would need to ensure priority for the delivery of appropriate contracting arrangements, expertise and resources. The contract was not fully negotiated with the profession, to the extent that 1,649 dentists withdrew from the NHS between March and June 2006, just as the new contract was implemented. According to figures published by the Department of Health on 23 August this year, patient charge revenue generated only £475 million instead of the expected £634 million, resulting in a £159 million shortfall in the dental budget.

It may be helpful to noble Lords if I explain that, under the system of dental charges introduced on 1 April 2006, the previous list of 400 individual charges was reduced to three price bands: band 1 at a cost of £15.90 for a basic examination, radiographs and cleaning; band 2 at £43.60 for single or multiple fillings, extractions or root canal work; and band 3 at a cost of £194.00 if construction work such as crowns is included. The new system means that the minimum charge for a treatment, which was previously £6, has risen more than two and a half times. The money paid to dentists, which is dependent on the number of units of dental activity accumulated, does not reflect the amount of work carried out. For example, dentists receive the same amount of UDAs from the primary care trust for treating a patient regardless of whether they do two fillings or 10. The number of UDAs awarded is not necessarily related to the time taken to complete the treatments. I understand that this can create a swings-and-roundabouts situation but it is not conducive to carrying out the best possible treatment for each patient.

At a meeting of the Westminster Diet & Health Forum on Tuesday this week, I mentioned that 1.4 million fewer people receive NHS dentistry than did at the start of the new contract. I was corrected by Dr Barry Cockcroft, the Chief Dental Officer, who told me that access over the two-year period has remained broadly stable, with a 0.1 per cent fall of 47,000 according to the latest Department of Health statistics. I have the highest regard for the Chief Dental Officer, who is a brilliant champion and defender of the changes made by the Government. He has worked for 27 years in NHS general practice and has been closely involved with local dental committees and the task groups that formed the basis of the Options for Change report. His skills in the negotiation, explanation and implementation of the new contract are commendable, but sadly the views of the Government, the Department of Health and Dr Cockcroft are at variance with those of most of the dental profession.



8 Nov 2007 : Column 195

Most dentists want to work for the NHS to provide a quality, preventive dental service, but the contract is seen as being flawed and this opportunity is being denied. The Government have created a system based not on prevention but on a new treadmill, creating the unnecessarily prescriptive system of monitoring output via units of dental activity. Specific oral health advice, spending time with patients and advising on diet, smoking, drinking and good personal oral health regimes, does not attract any units, although I am aware that next week all practices will be sent information on evidence-based prevention and primary care and how this should be provided under the dental contract.

I think that when the Minister, the noble Lord, Lord Darzi, made his recent statement on obesity, he agreed with me that the dental profession should be in the front line in providing advice to patients on nutrition and diet. Good oral health is vital for good general health. Promoting the potential of fluoride either in toothpaste or by targeted water fluoridation will reduce tooth decay significantly. I should be grateful if the Minister could confirm the Government’s continued support and funding for the British Fluoridation Society.

The British Dental Association is suggesting that a range of performance indicators should monitor dentists’ activity, rather than reliance on the UDA as a predominant indicator. These should be agreed locally between the PCT and dentist contractor, based on the practice profile and the needs of local patients. Indicators may include numbers of patients seen and time and provision of additional services in conjunction with UDA monitoring.

Rather than relying on 25 per cent of the dental commissioning budget coming from an unpredictable amount of patient charge revenue, PCTs should receive their dental commissioning budget in full. This would provide PCTs with financial certainty and allow them to commission the maximum amount of NHS dental services. I welcome the announcement that the Health Select Committee in another place will undertake an inquiry into dental contracts, including the general dental contract and the NHS personal dental services agreement.

I welcome also the publication on 1 November of the London Assembly report on NHS dental care in London. It highlights concerns over the way in which NHS dentistry is delivered and calls for the department to revise the contract to encourage preventive care. Oral health across England varies widely and London is at the bottom of the list. In his Statement on obesity on 17 October, the noble Lord, Lord Darzi, said that he might look at the allocation of UDAs in respect of prevention. The report calls for revision of the dental contract to see how it might be possible to build preventive care into the equation. If the noble Lord, Lord Darzi, is responsible for that, I congratulate him.

The Government need to trust the profession and to make the profession feel part of the NHS family. The Minister will be aware of the number of times that I have drawn attention to the absence of any reference to the dental service in government NHS

8 Nov 2007 : Column 196

policy. About 120,000 people work in NHS dentistry, including dentists, nurses, receptionists, practice managers, technicians and members of the community and hospital service. They should be consulted and represented and their contribution should be recognised. I shall look forward to hearing the Government’s plan for the future.

2.51 pm

Lord Harries of Pentregarth: My Lords, from the gracious Speech, I intend to focus only on the Bill to regulate human embryology and fertilisation. I must declare an interest as a member of the Human Fertilisation and Embryology Authority. The 1990 Act, which accepted the main recommendations of the committee chaired by the noble Baroness, Lady Warnock, has been a remarkably robust piece of legislation, as the Minister rightly pointed out. It provided a legal framework for the regulation of both treatment and research involving the use of embryos outside the body that has stood the test of time and has been deeply respected in other parts of the world. It has meant that public confidence, so vital in the area of evolving research, has been retained and that top-class researchers, who need a stable research environment, have been drawn to this country.

It is only 17 years since that Act, but, since then, things have moved on most remarkably. Scientific advances, not envisaged by the framers of the 1990 Act, need to be regulated. In addition, social changes, already embedded in law, have taken place that Parliament will need to consider and evaluate in relation to this regulation. I therefore welcome the fact that we have a new Bill before us.

The process whereby this Bill has come before Parliament has been a model of good practice. Consultation has been going on for at least two years, if not longer. First of all, the HFEA and stakeholders in the field were allowed significant input at the drawing-up of a consultation paper. The consultation paper was then widely discussed and input received by the Department of Health, before a draft Bill was brought before Parliament for pre-legislative scrutiny, the importance of which was rightly emphasised by the noble Baroness, Lady Barker. The Joint Committee set up for the purpose received evidence from a wide range of opinion and made a report to which the Government responded, before drawing up the revised Bill that we will consider. It has been a long and thorough consultative process, which is the very epitome of good parliamentary legislation.

Like other noble Lords, I acknowledge the willingness of the Government to change their mind over one crucial feature of the legislation. It was originally proposed that the Human Fertilisation and Embryology Authority and the Human Tissue Authority should merge to form one new body, RATE, which would be responsible for regulating both fields. It has long seemed to the professional bodies that are most involved that the two areas were so different that a single body could not regulate both of them without losing a great deal of expertise. That view was strongly endorsed by the Joint Committee, whose recommendation the Government accepted,

8 Nov 2007 : Column 197

even though the path to a merger had already been travelled for some time. When a Government change their mind in that way, in response to the best informed opinion, that should be commended as a sign of strength, rather than derided as an expression of weakness.

Another aspect of the Bill illuminates the wider question of the relationship between Parliament, regulatory bodies and those who work in the field: the possibility of cytoplasmic hybrids. It is right that major issues of principle, about which the public are hesitant if not hostile, should be decided by Parliament. A regulatory body regulates only on the basis of what Parliament has decided, making general decisions about good practice, while properly leaving other decisions to professional bodies and clinicians. The legal advice to the HFEA was that cytoplasmic hybrids were embryos within the meaning of the 1990 Act and were in principle within our remit to regulate. However, it seemed to me—this is a personal view—that this is a development of such significance that it is absolutely right that it should be considered by Parliament. The HFEA initiated a major consultation. Scientific researchers, initially frustrated about delays to their research applications, were later understanding of the need for a major development such as this to be considered by Parliament. I am sure that the noble Earl, Lord Howe, was absolutely right to raise the important question of the right balance between the respective responsibilities of Parliament and a regulatory body such as the HFEA. On this issue, the balance is right, and it is right that Parliament should consider it. A good number of highly significant decisions have to be made by regulatory bodies—they cannot look to Parliament all the time—but fundamental issues arise which should be so referred. Although I support work on cytoplasmic hybrids, I welcomed the wide public consultation and the prospect of a debate on them in this Parliament.

The strength or weakness of a Bill such as that coming before us will be in the detail. A great deal of consultation, thought and care has already gone into that detail. Nevertheless, the Committee stage, when we look at the Bill clause by clause, will be crucial.

As well as allowing for new scientific developments, the Bill takes into account changing social attitudes. There was a time, as the old song put it, when love and marriage went together like a horse and carriage. They went also with sex, pregnancy, birth and children being brought up by that couple. In the 1960s, with the advent of reliable contraception in the form of the pill, the link between sex and pregnancy was decisively broken. Since then, advances in medical techniques and changing social mores have combined to break the nexus of marriage, sex, pregnancy, birth and upbringing at every point. I take just one example: it was reported not long ago that a single Japanese woman in her 60s, who had gone to America to have a donated embryo implanted in her womb, had given birth to a child.

The one moral principle to emerge with increased force from this great social change is that of informed consent. This is a key principle in both treatment and

8 Nov 2007 : Column 198

research, and the HFEA takes it very seriously—a good number of clauses in the Bill deal with it. However, if that informed consent is in place, what grounds do others have to refuse what a woman says she most wants? The noble Lord, Lord Winston, states in his book, A Child Against the Odds, that his overriding concern as a clinician is the health of the mother and any baby who might be born; otherwise, he states, he respects,

As parliamentarians, we have to ask also whether there are wider, social reasons for particular requests not being granted. If such requests are to be refused, there must be good, convincing, grave reasons; otherwise, the principle of informed consent will remain the only and the overriding consideration.

We have all heard that amendments might be made to the Bill, either to make abortion easier in the early stages of pregnancy or to make it more difficult for someone to obtain. If so, there will be a great deal of strong debate around these propositions. We must not forget that this Bill is primarily about legislating for treatment and research. It is an important Bill in itself, and the good legislation of the 1990 Act, the extensive consultation that has gone into this Bill and the willingness of the Government to listen and change their mind over one crucial proposal have set a good precedent for us doing as well for people who wish to have children, and the whole sector, in the future as our predecessors did 17 years ago.

3 pm

Baroness Warwick of Undercliffe: My Lords, it is a pleasure to speak on this Queen’s Speech debate on education, health and social affairs and to congratulate my noble friend Lord Darzi on an authoritative and convincing opening speech.


Next Section Back to Table of Contents Lords Hansard Home Page