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The DWP is also developing a range of tools to provide practical support for GPs and other healthcare professionals. For example, it has produced an online learning module for GPs about handling difficult consultations with patients on the subject of a return to work. This programme of work builds on ground-breaking independent research, commissioned by the DWP and published in September 2006, showing for the first time that work truly is generally good for health and well-being. In some areas, GPs and Jobcentre Plus are working together closely on the ground, and Jobcentre Plus representatives are working in health centres, which is excellent.
The noble Baroness, Lady Finlay, spoke about the management of chronic pain. I have visited her excellent clinic in Wales; it is not just a small clinic but
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The noble Lord, Lord McColl, mentioned the QOF. GPs are, of course, at the forefront of managing musculoskeletal conditions. Work in other clinical areas, such as coronary heart disease, asthma and diabetes, has shown that both the level and quality of care for these conditions in primary care can be greatly improved by inclusion in the quality and outcomes framework. I know that many noble Lords see the inclusion of musculoskeletal conditions, such as osteoporosis, within the QOF as key to improving services.
The Department of Health is committed to developing new clinical areas within the quality and outcomes framework. Indeed, we have found it frustrating that the negotiating process has not succeeded in delivering the continuous quality improvements that we see as a fundamental feature of the QOF. That is one reason why my noble friend Lord Darzi signalled in his interim report that we intended to take a more wide-ranging look at how to reshape incentives for quality and outcomes in primary medical care.
The activity that I have mentioned is now starting to bear fruit and we are seeing a real and positive shift in the way that healthcare professionals consider employment. Perhaps I may give one example. Dame Carol Black has met more than 30 of the main medical colleges and health professional bodies to agree a ground-breaking consensus statement on health and work. However, it is clear that we need a real change in attitude if we are to help more people of working age to find and stay in work, regardless of health conditions. As is said in the report, Fit for Work? Musculoskeletal Disorders and Labour Market Participation, we need to be more positive, focusing on what people can do and not on what they cannot do.
To support this change in culture, the DWP is also currently revising the format and content of the statutory medical certificate, moving towards more of a fit note system than a sick note one. The department is working with employers, employees, healthcare professionals and their representative bodies to produce a certificate that will assist and encourage doctors to provide clearer and more helpful fitness-for-work advice for their patients. The revised certificate will also provide employers with the information needed to help to facilitate an employees earlier return to work wherever possible.
Alongside that, the DWP has been working to ensure that the welfare system supports people with health conditions to move back to work, rather than condemning them to a lifetime on benefits. Incapacity benefits are being replaced from October this year with a new employment and support allowance. The new allowance will have a revised medical assessmentthe work capability assessmentwhich will be much more positive than its predecessor. It will consider what customers can do, as well as what they cannot. It will also consider the customers perceptions of their illnesses and the barriers that
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All that demonstrates just how much progress we have made, but of course there is more to do. That is why my right honourable friends Alan Johnson and Peter Hain asked Dame Carol Black to carry out a review of the health of working-aged people. The review, which is due to report shortly, will contain recommendations for government and should help to shape the agenda over the coming years. In particular, Dame Carol is likely to focus on ways to expand access to occupational health and early interventions, provide more support for employers, move to a more positive fit note not sick note culture, and improve links between GPs and employersall the things that noble Lords have today rightly asked for.
In conclusion, we welcome this debate and firmly support my noble friend and others in their efforts to raise awareness of this critical issue. From my experience of working in the south Wales valleys with an MP and his constituents, I am well aware of the impact of musculoskeletal diseases on the lives of individuals, their families and communities. But that was 20 years ago, and there was not such great understanding then of the link between work and well-being. Work was seen as being for the fit and healthythe wholly well. I am glad that attitudes have changed and continue to change and that work these days is much more flexible. The Government have recognised the importance of the issues raised and are taking steps to address them. Debates such as this will, I trust, not only act as a catalyst for further action by all partners involved, but in some way contribute to a much needed change in the culture.
Lord Harris of Haringey: My Lords, I am obviously enormously grateful to all noble Lords who have contributed to the debate. I should like to think that the importance attached to the issue is reflected by the substantial number of Members of your Lordships House who are present at 4.15 on a Thursday, but I fear that it may be rather more to do with the noble Lord, Lord Steel, than anything that was said during the past hour and a half or so. Nevertheless, many noble Lords who may have caught the last few minutes of this discussion will understand the salience of these issues, because of the prevalence of back pain and the importance of trying to bring together the work of different government departments. As the noble Lord, Lord Rea, said to me as he moved from one part of the Chamber to another earlier, this is all about joint working.
I was especially grateful to hear the vivid examples given to us by the noble Baroness, Lady Masham of Ilton, and about the importance of pain management,
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I am obviously grateful to my noble friend Lady Royall for her response. Earlier, the noble Lord, Lord Addington, talked about the difficulty of punching holes in Chinese walls within government. The noble Lord, Lord McColl of Dulwich, apart from his chilling example of Mrs Thatchernow the noble Baroness, Lady Thatcherstraightening out a senior civil servant, about which we might all have liked to have heard more detail, stressed the importance of having senior ministerial championing of the issue. It is very nice to see my noble friend Lord Hunt of Kings Heath in his placeI know that that is for another purposebecause in his previous roles in both the Department of Health and the Department for Work and Pensions, he was very keen to pursue this agenda.
I hope that my noble friend Lady Royall will take away from thisand will discuss with the senior colleagues she mentionedthat, in responding to the Carol Black review, this is not a zero-sum game. Resources can be moved. This is not just looking at the amount that the health service spends on drug and other treatment. This is about looking at the best way of using government resources to improve the health and well-being of this country. I hope that there will be a senior ministerial champion for following this agenda.
The noble Earl said: In moving Amendment No. 1, I shall speak also to Amendments Nos. 2, 13, 38, 69, 72, 73, 75, 81, 91, 96, 98, 104, 106, 114, 119, 134, 154, 156, 159, 160, 164, 166, 170, 172, 177, 179, 180 and 193.
First, I must apologise to the noble Lord, Lord Steel of Aikwood, for not being in my place to speak at Second Reading. Like him, I live in Scotland, but a little bit further north than he does. I was not able to be in the Chamber that afternoon. Secondly, I want to pose a question to the Government. Given that this has been a much-discussed subjectthere are government proposals; a cross-party group meeting; the Public Administration Committees report; and a huge amount of other business that we always say we do not have time forwill the Minister confirm that this Bill is being treated in accordance with the principles and usual procedures of this House and that there is not a special government procedure for this Bill? Will he also confirm, as he did at Second Reading, that there is a binding commitment to the retention of hereditary Peers, as far as the Government are concerned? Will he further confirm that the Government will not be giving time to this Bill, should we not get to the end of the Committee stage today?
Lord Denham: If my noble friend Lord Caithness will forgive me, I wonder if he has considered whether his amendment is wise and in the interests of the House, because one of its consequences might be to inhibit debate on Clause 10 of the Bill, which is a most significant clause, and one which I would wish to oppose. I would like to give notice now that I reserve the right to speak on Clause 10 at the time when that Question is put.
The Earl of Caithness: I, too, was concerned that I might be preventing a debate on parts of the Bill, but I was assured that I was not, and that this was the normal practice in your Lordships House when one wanted to put down an amendment. It happened to be put here, but as my name is also attached to the Motion that my noble friend Lord Denham has just mentioned, I, too, do not want to restrict discussion on any part of the Bill.
There are two main parts to my proposal. Amendment No. 1 would change the name of this Chamber from House of Lords to Senate. We did discuss this both before and subsequent to 1999. I am delighted that the noble Baroness, Lady Whitaker, has tabled Amendment No. 3 on somewhat similar lines. The reason it is time to change the name of this second Chamber is due to consequential Amendment No. 72. Amendment No.72 gives power to the commission to separate peerages from people sitting in Parliament. That is important. After putting down this amendment, I read the recent report of the Public Administration Select Committee, Propriety and Peeragesits second report of the 2007-08 session. What it says is interesting, because it coincides with my thinking. Paragraph 138 of the report states that,
That paragraph supports my argument that we ought to split the occupants of the second Chamber from the peerage. If that is going to be the case, we need a new name for the second Chamber. Reading on, paragraph 140 of the report says:
The Government has indicated in its last White Paper not only that it agrees that the link between the honour and the seat in the legislature should be broken, but that this idea had support from the cross-party group convened by Mr Straw before that White Paper was published.
Could I ask the Minister, rather than the noble Lord, Lord Steel, what the Government thinking is on this? Those two paragraphs clearly recommend a split between a peerage and the right to sit in the second Chamber, and the consequential effect of that is a requirement to change the name. I declare that I am not hooked on the word senate. It was the word I chose, but I would not mind something elseI am concerned with the principle. For clarificationnot related to the amendmentI will make my position clear on reform of this House. It has not changed at all, and is that the second Chamber should be wholly electedand if we cannot get to that stage, it should be wholly appointed. I am not convinced that there should be any mix between the two. I beg to move.
The noble Lord said:This amendment would amend the new clause proposed by the noble Earl, Lord Caithness. I say at the outset that there is a terrible sense of having been here, not once before, but perhaps 17 times.
Lord Richard: Nineteen, is it? My noble friend may well be right. Most of the arguments have been heard. But, as has often been said, all the arguments have been heard, but not yet has everybody put them. I suspect that a certain amount of the debates in Committee will be repetitious. I say at the outset that I propose to be repetitious, for one good reasonbecause it is important, now that the Bill has been introduced, that the arguments for and against the Bill and its principles are expressed clearly and unmistakeably, so that those who are not in this House may have a clear opportunity to see what these views are.
However one looks at it, the idea of calling this Chamber a senate and us all becoming senators is a pretty major step. When I was a boy I had four ambitions. First, I wanted to be a senator; secondly, a cardinalwhich one could not be; thirdly, a tenor; and fourthly, a jockey. Alas it is the tragedy of my life that I ended up as a double bass and weighing 17 stone. Nevertheless, the noble Earl, Lord Caithness, is giving me the opportunity at some point to become a senator.
I cannot help but observe in passing on this issue that senators were usually elected; certainly they were in Rome. They were not appointed, but gained their position as the result of an election. If I were elected as a senator, I would be more pleased than if I were to become an appointed one.
More seriously, the principal argument against the amendment is that the new clause pre-empts the forthcoming White Paper. We all know that the Government have been in intense discussions and that an all-party group has been meeting. We have been assured that the result of those discussions will emerge in the not too distant future, so to pre-empt the result of the talks and the forthcoming White Paper by taking a decision now on whether we should be called senators, is going too far. As I have said, I do not necessarily oppose the principle of calling the second Chamber a senate, but I do object to pre-empting the White Paper. For those reasons, we should not pass this new clause until it has emerged. I beg to move.
Lord Campbell of Alloway: I rise to oppose Amendment No. 1 and to speak in opposition to other amendments in the grouping, not as to the merits of any single amendment but to the common factor which relates to changing the composition of your Lordships House. That, under the Cranborne deal which was accepted by the Government and thus is to be honoured, is not possible until stage 2 of the reforms. That is because it is a part, but not the whole, of the essence of the deal that your Lordships House as constituted shall remain until stage 2. So your Lordships will be relieved to hear that this will not be a long speech on the tangled vineyard in which the grapes cannot even ripen until stage 2. We are not concerned either with the merits of the Cranborne deal.
Amendment No. 1 destroys affinity with the monarch as to the creation of a life peerage under the royal prerogative, which is also slighted by other provisions in the Bill, but I shall not take your Lordships time to go through those at this point; there are quite a few of them. The Oath of Allegiance, taken on grant of a written summons of attendance, will presumably go, thus making another change to the composition of the House. It would change it from a wholly appointed Chamber into a wholly elected Chamber, which cannot be achieved under the Cranborne deal.
We enter very choppy seas in this debate in Committee. Is Clause 10, which reneges on the deal, to stand part of the Bill? This was discussed at Second Reading and need not be discussed at this point in the Committee stage. Are Clauses 14 to 17, which foreclose on the peerage for life granted under the Royal Prerogative to stand part of the Bill, albeit, as recognised by Section 2 of the House of Lords Act, no enabling provision as to implementation under standing orders is given to this Actprime legislation which operates direct? It is contrary to convention as recognised by the House of Lords.
How can we know whether the ship of state will weather these seas today? The Bill has been drafted and brought forward by a series of well-meaning volunteers who really represent no one. One has to take that into account in a venture which is, in essence, not particularly constructive. The Government have affirmed for the fifth time, from 1999 until the Second Reading of this Bill, that they propose to honour the Cranborne deal. Is not the reality of the situation that whatever amendments are made to the Bill, should it reach the other place there will be an objection and the Bill will failthe fate of any Private Members Bill which is not taken up by the Government? I oppose Clause 1 and I shall oppose in due course, for these reasons, many other amendments.
Lord Steel of Aikwood: I hope noble Lords will forgive me if I intervene early in the debate to indicate the views of the promoters of the Bill, not only on this amendment but on a whole raft of the amendments which are before us. The point that I want to dwell on very heavily is that there have been two significant events since Second Reading which I believe the House should take into account.
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