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In his opening statement, the Minister spoke about his passion for quality. That message is well known to this House and the NHS. The noble Baroness, Lady Jay of Paddington, who was the Minister of State for Health in September 1997, put out a press release with the headline:

She went on to say:

The noble Lord, Lord Darzi, stated in his report 10 years later:

and later,

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Although I have to say full marks for honesty, this Government are extremely slow learners. Having negotiated a fairytale contract for GPs, the Government are now having to entice them back to the awful grind. This acknowledges that illness does not strike in the 40 or 50 hours the practice may be open on five days a week but can occur in any one of the 1,268 hours in the week when the GP should be there as the lead health professional.

The Minister endorses the idea of super-clinics—certainly an idea for fierce political debate if only because it is highly contentious and, according to the BMA, probably flawed. Why not build on the network of existing community hospitals rather than close them? Why close so many maternity units when even Ministers are marching in the streets to save them? Saving them, from themselves. I do not want to discuss these issues now but I remind the Minister that these are highly charged political questions that must be answered, in almost all cases, by him. Why? Because he is party, with his fellow Ministers in the department, to making these policy decisions.

In the forthcoming parliamentary year we look forward to two major health Bills. The first, likely to start in this House, is the human fertilisation and embryos Bill which was published in draft form earlier this year. I agree with the noble Lord, Lord Harries of Pentregarth, that that is a very good process to follow. However, among other things, the Bill will contentiously remove references to the need for a father, as the noble Baroness, Lady Deech, said, and also recognise same-sex couples as the legal parents of children conceived through the use of donated sperm, eggs or embryos. I can see many hours of debate with contributions from those with great expertise, including the noble Baroness, Lady Deech. I am delighted that the Minister will be taking this Bill through your Lordships’ House with, I am sure, huge clarity and skill.

What concerns me is the second Bill, the Health and Social Care Bill, which has been dubbed the “medical professions shake-up”. This could be equally contentious, with the big health battalions scrutinising every word. Apart from amalgamating two major commissions and part of a third, the new Care Quality Commission will have tougher powers and will allow a civil rather than a criminal standard of proof. There will be a new independent adjudicator to review decisions taken by the regulators. All healthcare organisations will have to appoint a responsible officer who will work with the General Medical Council to,

Having spent a year leading a working party on medical professionalism for the Royal College of Physicians and a second year selling it through road shows to the profession, I know how fragile professionalism can be. The Bill must do nothing to jeopardise, but rather to strengthen, the trust that the public have in doctors. As I understand it, this challenging Bill will not be taken through by your Lordships’ accountable Minister, as he is perceived to

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have a conflict of interest; and here is the rub. It would be a terrible loss to surgery if the Minister gave up his practice, but if he is to be effective as a Minister—a top-flight politician effectively answering to the people through Parliament—surely he must agree that he has accepted a post as a politician under our constitution. He is a Minister of the Crown in a Labour Government, a Government who have more than doubled the NHS budget, reduced output per employee, introduced real fear in patients going into hospital when hospital-acquired infections kill thousands, and made an incredible mess of junior doctors’ employment. There is much political work on his plate.

In conclusion, I am sure that the whole House wishes the noble Lord, Lord Darzi, every success, as do I. But it is fair to say that we in your Lordships’ House have every right under the constitution to expect the Minister to take major Bills through this House and to attend when required. It is the duty of the Minister—crudely, it is part of the job—to be available, so that he can be called to account for his Government’s policy. I appreciate and have great sympathy that the Minister has a serious dilemma, and a choice that he alone can make.

4.03 pm

Baroness Warnock: My Lords, I return to the subject of education and confine myself to a few points on that aspect of the gracious Speech. I congratulate the Government on undertaking to provide new rights for adults to acquire skills and training, a subject on which many of your Lordships feel strongly. However, the proposal on keeping young people in education or training until they are 18—the only other specific undertaking in the gracious Speech—seems more dubious. I share the anxieties that were powerfully expressed earlier by the noble Lord, Lord Pilkington. It seems to me that the Government are starting at the wrong end.

In his opening speech the Minister said that there would be no compulsion except in the case of young people who did not recognise the benefits of participation in the scheme. I am certain that there will be many such young people, for the good reason that they have come through their entire time in the school system unable to read or spell or perhaps to perform the simplest calculation. After all, even for vocational education you need to be able to read. Some of the non-participants may already be in prison, where their chances of education are pitiably low in any case.

Many of these young people have the disability, of varying severity, broadly known as dyslexia. Here I must declare an interest as president of the British Dyslexia Association. The truth about dyslexia is that it is a specific learning difficulty that can be identified in the first year at primary school, and the probability of dyslexia can be identified even before then, in the reception class. It is also known that early intervention is both possible and essential if the child suffering from it is to acquire the strategies needed to overcome his disability. But it is also known that teaching these strategies is a job for teachers with

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specific training in teaching dyslexic children—and, with much more difficulty, teaching dyslexic adults.

Severely dyslexic children are often very bright and competent. If properly taught, they can excel academically. They can be taught how to read music and may do very well at it; the same goes for mathematics. But left without specialist teaching, they will never fulfil their potential, an aspiration unsurprisingly mentioned in the gracious Speech. As well as, or indeed perhaps instead of, concentrating on young people who have already failed, the Government ought to give an undertaking that, by 2012, every child should have access from the very beginning of their education to a specialist teacher if that is needed. This is a matter of the greatest importance and urgency.

This means that every teacher should be trained in the course of their initial teacher training to identify the signs of dyslexia. However, many of us have experience of how difficult it is to persuade those responsible for initial teacher training to add new components to the curriculum. However, that is vital. If a child has been identified as at risk of developing dyslexia, or as already dyslexic, he can be handed over to a specialist to be taught for at least one hour a week, and a specialist is what is needed. It is literally worse than useless for an untrained classroom assistant to try to help a dyslexic child who is in difficulties. It may do more harm than good. Many schools now claim that they are “supporting” a child who has difficulties simply on the grounds that he has access to a classroom assistant. That is not enough and may make things worse as the years go by. The question of so-called support in schools, not in amount but in quality, must be addressed by the Government as part of their policy of inclusive education. If a child is given inadequate support, inappropriate support or ignorant support, his confidence, already low, will gradually fall even further.

The tragedy in all this, and it is a tragedy, is that we know that early diagnosis and proper teaching can work. There are numbers of anecdotes of severely dyslexic people who succeed academically and otherwise as the result of proper teaching. The proof of this knowledge, sadly, is in independent schools. Nowhere is there such a huge gap between independent and maintained schools as in their provision to allow pupils access to specialist teachers. Attitudes have changed enormously over the past 20 years or so, and now the well known public schools—including the 25 schools comprising the Girls’ Day School Trust—and nearly every private preparatory school, all of which are independent and very expensive, have at least one specialist teacher on staff either full time or for a few days a week.

At the beginning of the debate the Minister indicated that the gap between academic and vocational education was to be narrowed, but surely we should be aiming to narrow the gap between independent and state education as well. That must be an aspiration of this or any other Government.

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4.10 pm

Baroness McIntosh of Hudnall: My Lords, the gracious Speech offers a rich mix of opportunities for comment and it was quite hard to decide where to jump in, an experience which a number of noble Lords have had. I might have chosen the Climate Change Bill, which, like the noble Baroness, Lady Barker, I welcome. However, it still fails, in my view, to take a sufficiently urgent view of the threats we face, particularly from the growth of the aviation industry. But it is the wrong day to talk about that or about the challenges in balancing national security against the preservation of civil liberties, although I hope that at least some of your Lordships saw the admirable drama “Britz”, broadcast by Channel 4 last week, which gave considerable food for thought on this subject. Although I must not mention the proposed changes in the planning system, I am assuming that at the appropriate time other noble Lords will encourage the Government not to allow local opinion to be overridden in the drive for infrastructure growth.

Today, however, is a good day to talk about young people. That has been shown by the many wonderful speeches we have heard, particularly by the moving contributions of several noble Lords about the needs of looked-after children. I want to talk about how we can help them to make the most of education and training and how they can link their skills and enthusiasm to the world of work. In this connection, I want to make particular reference to the Make Your Mark campaign and to its annual enterprise week, and to mention the role that the arts can play in education, as the noble Lord, Lord Ramsbotham, did earlier.

Quoting from its own publicity, Make Your Mark is,

It was founded by the British Chambers of Commerce, the CBI, the Federation of Small Businesses and the Institute of Directors and is principally funded by the department we must now call BERR. It is supported by a wide range of organisations from the business community, education and the voluntary sector and has attracted significant corporate and media support for specific elements of its campaign such as “Make Your Mark in Fashion”, which has just launched with a nationwide competition for young people to create a new range for an established sustainable fashion label. Nine leading sustainable fashion businesses are partnering Make Your Mark in this competition. I should at this point own up to a special interest because my son is part of the team running the campaign. I wonder whether the “Pink and Powerful” day in Liverpool, which was mentioned by my noble friend Lady Morgan, will be joining in. I hope so.

Make Your Mark’s best known activity is enterprise week, which this year is taking place next week from 12 to 18 November. It aims to be a national celebration of enterprise, inspiring young people to turn their ideas into reality. Last year there were 3,184 events organised by 1,410 organisations and this year looks set to be just as successful. All this energy is directed

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towards enthusing young people about the possibilities of developing their own business ideas because, as Make Your Mark says,

The Government’s Household Survey of Entrepreneurship published by the DTI, when it still existed, in 2006 reported a growth of 22 per cent between 2003-06 in the numbers of 16-24 year-olds thinking of starting a business compared with a growth of only 3 per cent for all ages combined. We need to make sure that we are providing the right educational environment for all this potential enterprise to flourish.

The new Education and Skills Bill will raise the age for compulsory participation in education first to 17 and then to 18. I support this intention. The Bill will provide for young people to continue their education post-16 in a number of different ways, including full-time school or college, work-based learning and part-time education or training if they are employed, self-employed or volunteering. This range of options recognises the many different ways in which people learn. An even higher degree of co-operation between education and training providers, local authorities, parents and students will be required than we are able to achieve at the moment, but flexibility and diversity in provision are vital to give everyone a better toolkit for dealing with the increasingly unpredictable world into which they will be moving as adults. More people will have to be enterprising and ambitious on their own behalf rather than relying on old models of employment.

The critical thing, however, must be the quality of education and training on offer. What work is being done, and what resources are being made available, to ensure that we can consistently deliver the highest standards in what is offered to young people in future? I noted the remarks of my noble friend Lord Soley on, among other things, personalising the provision of education services. That is so we can minimise the risk of developing a new cohort of educational refuseniks needing to be managed by coercion and sanction. I draw attention to the remarks of the noble Lord, Lord Ramsbotham, on the assessment of people at different stages in education and how important it is that we know what people can do rather than asserting what they should do.

I suspect that success will depend upon the contribution of a wide variety of organisations, of which Make Your Mark is obviously one, but I remind my noble friend the Minister of the importance of the arts in developing the capacity of children and young people to learn effectively. I hope he will ensure that the valuable support of his former department, the DfES, for the excellent work being done by, for instance, the Roundhouse in north London, of which I am a trustee, does not diminish under the new departmental arrangements. Its programmes are designed to engage young people for whom conventional educational models do not work so well—and there are many of those, as the noble

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Baroness, Lady Warnock, pointed out—and have already attracted approximately 8,000 participants from the 16-plus age group since the Roundhouse reopened just over a year ago.

I hope the Government will continue to invest in creativity and imagination throughout the educational system because children who are encouraged from the start to think for themselves, to express themselves through music, sport or drama and thus to learn to communicate—again I refer to the remarks of the noble Lord, Lord Ramsbotham, on the subject—and discover in these ways where their aptitudes and enthusiasms lie will have a better chance of taking advantage of the opportunities envisaged by the Bill. Enterprise, ambition and a willingness to learn are hard to insist upon between 16 and 19 if they have not been instilled much earlier.

4.17 pm

Lord Dearing: My Lords, I thank the noble Lord, Lord Darzi, for his lucid exposition of the parts of the gracious Speech referring to health, social matters and education. We have a great task facing us, as has been mentioned. I recall that when I was chairman of the Post Office there were two jobs I felt were well beyond me. One was trying to run British Rail and the other was running the health service. Thank God no one asked me. The Minister has the great advantage of knowing what he is doing.

I shall move on. On Tuesday, the noble Lord, Lord Strathclyde, referring to the challenging problem facing the ninth husband of Zsa Zsa Gabor, said that he knew what to do but his problem was how to make it interesting. I reflected on the education Bill facing us, and thought that there is many a teacher who may be wondering how to make continuation of education interesting for some likely lads and lasses until they are 18.

For 140 years, we have been searching for a solution to the problem of the serious skills deficit of this country. Like that ninth husband, we have not found a way—and I must choose my words carefully—of matching the challenge, which was first addressed by a parliamentary Select Committee as long ago as 1868. In the century that followed, no fewer than 20 other committees addressed the problem of our shortage of skills. In the 40 years that have followed that century we have still been searching. During my tenure at the School Curriculum and Assessment Authority, I was invited to make a contribution. I was lucky to be able to introduce the GNVQ into key stage 4, which increased the number of children engaging effectively in education. However, it was a very modest contribution, and I recognise the progress that the Government have made in this during their years in office, but we have been playing a game of “catch up and keep up” rather than leading the race.

I welcome the four measures taken by the Government that come to mind. One is the introduction of the new specialist diplomas. The second is their unambiguous “yes” in their response, signed by no fewer than six Ministers, to the Leitch report, which said that by 2020 more than 40 per cent of the population between the age of 19 and retirement age will need to be up to

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level 4 and beyond. Thirdly, we have the proposals on the extension of the leaving learning age—we must not call it the leaving school age—and, fourthly, we have the new Children and Young Persons Bill. All those measures are a coherent response to the need to lift our effective investment in young and older people—as has been said, we must not forget that 70 per cent of those at level 4 are already at work.

I welcome all that, subject to two comments—although, having heard the noble Lord speak about prisons, I shall raise that to three. My first point is that 40 per cent of people reaching level 4 and beyond is not enough. As leaders in the world economy, Japan and the United States have already achieved that. We are talking about where we will be in 2020 and, unambiguously, we must have reached a figure of 45 per cent. Secondly, as much of the lift from the present 29 per cent to 40 per cent—or, as I said it should be, 45 per cent—has to be achieved by people who are already at work, we must be concerned about our capability to engage with those people.

I have one question on which I should like to ask the Government to reflect again: will their support for these people be adequate? Of course, we do not want the Government to substitute Exchequer money for the billions of pounds that employers rightly put into training. They cannot afford to do that, but plenty of others—for example, in many small and medium-sized enterprises—are not looking into the long term and are not investing in their people. Obviously, quite a few employers worry about making such investment because, if they uplift their skills, they are in danger of losing some of their best people. There are also people who are just trying to get on to the housing ladder and are skint, and then there are carers and women returning to work who are not in comfortable circumstances. If we want to lift investment in these people, we have to help them more.

My third point, raised by my noble friend Lord Ramsbotham, is concern about young people in prison, although I would extend that to all people in prison. What an awful waste it is to pay £40,000 a year to keep a person there with the high risk that he or she will return. It would make good personal and national economic sense to enable these people, on a scale that we have not attempted in the past, to engage successfully in training. I do not know whether there have been any studies into this but perhaps we should also think about the special problems facing the children of long-term prisoners.

I want to make two points this afternoon. First, to address the skills agenda and to make more young people want to continue in learning—which I believe is an essential element in a successful policy to extend the learning age to 18, for coercion on any scale simply will not work—we have to rethink the comprehensive model of education for 14 to 18 year-olds. It is not the best model for delivering the Government’s agenda for world-class skills on the scale required. We need to be able to offer young people the opportunity at age 14 to go to a college of technology in our cities and big towns specifically to develop skills preparatory to an apprenticeship or to pursue specialised diplomas that require specialist

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equipment. The noble Lord, Lord Darzi, referred to a record number of 250,000 people being in apprenticeships; the Leitch report refers to our needing 500,000. The task is therefore huge.

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