Lord Bach: My Lords, there have been a variety of proposals from think tanks and others for a league or other grouping of democracies. In assessing any such proposal, we would consider its aims and how it might complement existing multilateral organisations and democracy-based groupings, such as the Community of Democracies.
Lord Hannay of Chiswick: My Lords, I thank the noble Lord for that Answer, which would undoubtedly have done credit to the oracle at Delphi. Will he comment on the undesirability, rather soon after the ending of the Cold War, of systematising the divide in the world between democratic sheep and undemocratic goats, and on whether any of the large democracies of the developing world, such as India, Brazil, Indonesia and South Africa, are joining up for this journey? Does he agree that it would be better for this subject to be given a full airing this year rather than to find ourselves next year facing an American president who thought that it was a good idea?
Lord Bach: My Lords, I thank the noble Lord for the compliment that he paid me; I am grateful. As he is aware, the proposals are currently informal, but they are an interesting concept. Our Prime Minister believes that we need to look again at the range of international institutions and how they can be improved to meet the global challenges that we all face. The Government very much welcome the Question from the noble Lord, Lord Hannay, and the questions that will follow, as this is an important matter for debate and one that should be open to new suggestions and ideas; let a thousand flowers bloom.
Lord Howell of Guildford: My Lords, it will probably surprise the noble Lord, Lord Hannay, to hear that I strongly agree with him on this occasion. It is possibly worth pointing out to the think tanks and the creators of this idea that a perfectly good, transcontinental and multifaith network of either democracies or aspiring democracies exists throughout the world already; it is the Commonwealth. It contains more than six of the worlds leading and most dynamic countries, and it is ready, provided we give it a bit more support than we
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Lord Bach: My Lords, I agree and disagree with the noble Lord. I agree that the Commonwealth is an excellent organisation; I remember reading his letter to that effect when this debate ran in the Financial Times about a month ago. I do not agree with him when he says that we do not treat the Commonwealth with sufficient seriousness.
Lord Wallace of Saltaire: My Lords, in this post-Blair Government, will the Government not admit that the idea of a league of democracies is very much a neo-conservative idea that is floating around Washington, with a number of undesirable undertones? It is the fag end of the regime change and forced democratisation ideas that led to the invasion of Iraq. Do the Government at least agree, and will they say in public, that our approach to multilateral international institutions should be inclusive rather than exclusive, and that attempting to build an exclusive group of countries to do some of what the United Nations has done before would be highly undesirable?
Lord Bach: My Lords, I cannot agree entirely with the noble Lord. These recent ideas have not been formally proposed by the United Statesthey are part of a broader policy debate taking place there as well as here. It is something that we should be pleased about. We would not want any multilateral organisations to undermine the United Nations because it clearly remains the most important international organisation. It is at the heart of the multilateral architecture. Its universal membership gives it an unparalleled political legitimacy.
Lord Anderson of Swansea: My Lords, is not part of the problem of a proposed league that there would almost certainly be a premier division, a first division and a second division; promotion and relegation; and perhaps even yellow and red cards? Who will decide on all those important matters? Surely it is a recipe for discord.
Lord Bach: My Lords, indeed, a lot of questions would need to be answered before it became policy, which can perhaps be summed up as: what are the aims, activities and criteria? My noble friend makes a good point.
Lord Howe of Aberavon: My Lords, does the Minister agree that there are several organisationsnot just onefounded on democracy and that both the Commonwealth and the European Union have that same objective? The world already has sufficient organisations to shrink back from the idea that the Minister advanced that we want to see a thousand flowers grow. Would it not be better to continue nurturing and strengthening the flowers that already exist?
Lord Bach: My Lords, by flowers I meant ideasideas on foreign policy and how to get a better world. We have organisations that play a very important part
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Lord Hylton: My Lords, does the noble Lord agree that the Alliance of Civilisations, pioneered by Spain and Turkey, is a very good example in this field? Does this country belong to itI hope it doesand will it recommend the practical projects of the alliance to other Commonwealth states?
Lord Pearson of Rannoch: My Lords, is the noble Lord aware of a joke going round in Eurosceptic circles to the effect that the beloved European Union of the noble Lord, Lord Hannay, would fail to join itself because of its democratic deficit, which excludes its people from its law-making process?
Baroness Thornton: My Lords, using projections by the Institute of Psychiatry and the London School of Economics presented in the Alzheimer Societys Dementia UK report, our estimate is that there are currently 700,000 people with dementia in the UK and that that figure will rise to 940,000 by 2021. We have identified dementia as a national health and social care priority, and we are developing a national dementia strategy. The detailed consultation document was published last week.
Lord Ashley of Stoke: My Lords, I thank my noble friend for that reply. I am delighted with the Governments decision to establish a national dementia strategy. Can my noble friend confirm to the House that the proportion of her department's research and development budget allocated to dementia has been less than 3 per cent? If that is so, it is disgraceful. The Government are leaving these lost souls in limbo because without proper provision by her department, they have no voice. In view of the remarkable increase in the number of people affected, can we have a remarkable increase in the funds provided for this?
Baroness Thornton: My Lords, my noble friend is correct that there is a huge challenge surrounding the funding of care for dementia. The condition is devastating, which is why we are determined to address those challenges. The department is investing £20 million over five years in the national research network on dementia and neurodegenerative disease, which was launched in 2006. There is already significant government funding in this areait was close to £25 million in 2005-06. The national dementia strategy, which was launched last Thursday, looks at the priorities with organisations and people who are directly involved in dealing with this condition. Once the strategy is finalised, we will ensure that there are sufficient resources available in overall PCT allocations to deliver on the national and local priorities set out in that strategy.
Lord Hodgson of Astley Abbotts:My Lords, are the Government making any study of the link between dementia and the use of thimerosal in the flu vaccine? Thimerosal contains ethylmercury, and there is growing concern in the United States that its use may be leading to the dramatic increase in dementia to which the Minister referred. Is part of the strategy to consider that; and where are we on that study, if there is one?
Baroness Thornton: My Lords, I am afraid that I do not know the details, although I am confident that it will be included in the research being carried out. I will find out about the detailed issue raised by the noble Lord. I will write to him and make the information available to the House.
Baroness Murphy: My Lords, as dementia is now the main cause for people going into residential and nursing care, and the main economic burden of a single illness in this country, what progress is being made to improve the training of staff in community and in residential and nursing care to deal with this issue?
Baroness Thornton: My Lords, the noble Baroness makes a good point. Training has emerged as a major theme in the development of the national strategy. We need to ensure that basic vocational and professional training provides sufficient expertise in dementia and that continuing professional and vocational training keeps those skills up to date. That is as true for medicine as it is for nurses and social care workers. The strategys external reference group, which is chaired by the chief executive of the Alzheimers Society, is involved with a range of care people on dementia, including GPs and nurses. We regard this as a priority.
Baroness Pitkeathley: My Lords, would my noble friend agree that as well as what she rightly calls the devastating effect of this condition on its sufferers, this condition can have a pretty devastating effect on the families who look after them? How will the national strategy for carers, which was recently launched by the Government, impact on these families?
Baroness Thornton: My Lords, my noble friend is absolutely right that many families struggle to keep parents and relatives at home and do not always receive the support that they need. With early diagnosis and interventionI have to say that only one-third of people with dementia are diagnosedit is possible to live a good life with dementia, given appropriate and timely care and support. The new deal for carers, which was launched by the Prime Minister on 10 June, is investing a total of £255 million on short-term commitments. The strategy has an ambitious 10-year vision. There is also an increase in the carers grant, and we are establishing a carers information and service helpline. This link to the Green Paper on the longer-term strategy and the end-of-life care programme will, I hope, show my noble friend that the Government are taking this very seriously indeed.
Lord Walton of Detchant: My Lords, the new dementia strategy is most welcome in that it includes three main strands: one is the crucial importance of improved care; the second is improved methods of management and treatment with drugs and other techniques; and the third is research. Does the noble Baroness accept, however, that there is no current evidence to indicate that heavy metals play any significant part in the causation of Alzheimers disease? Many years ago it was thought that aluminium might play such a part. That has now been disproved. The current evidence is against any involvement of other heavy metals in the disease.
Baroness Thornton: My Lords, the noble Lord has very helpfully outlined the national strategy and its main strands. Indeed, he also underlines the need for further and continuing research in this area.
Baroness Barker: My Lords, given that two-thirds of people who live in residential homes have dementia, does the noble Baroness agree that it is now time to close the loophole through which residential homes can refuse to take people who have dementia, claiming that they cannot deal with their needs?
Baroness Thornton: My Lords, the noble Baroness outlines a very serious problem. Many care homes provide an excellent standard of care, but approximately 80 per cent of people in care homes are now reckoned to suffer from some form of dementia, and the overall numbers will increase with the ageing population. Our strategy is therefore, first, to prevent admissions to care homes through early identification and effective intervention in the community; and, secondly, to ensure that proper standards are met, that staff are properly trained and that the best care is provided for the years ahead.
The Parliamentary Under-Secretary of State, Home Office (Lord West of Spithead): My Lords, the Government recognise the concerns and the need for a current and appropriate response. Our 2008 drugs strategy action plan commits us across relevant government departments to consider further the individual and social harms created by khat use. If there is a material adverse change in our understanding, we will ask the Advisory Council on the Misuse of Drugs for further advice on the case for control.
Baroness Warsi: My Lords, I thank the Minister for his response, but I am somewhat surprised that this matter is still being consulted on in 2008. I am sure that he is aware that his Government consulted on the matter in 2005. Indeed, they received a report from the Advisory Council on the Misuse of Drugs and set up a khat working group. My noble friend Lady Anelay asked this Question in Parliament in 1998. This drug is destroying the Somali, the Yemeni and the Ethiopian communities. Families and young childrens education are being destroyed. If the achievements and aspirations of communities are being denied by not being protected from this drug, the equality of opportunity agenda in this country is not being met for certain communities. This is essential for community cohesion. Will the Minister deal with the matter by classifying this drug?
Lord West of Spithead: My Lords, I know that the noble Baroness feels great passion about this subject. Indeed, I read an article by her in one of the broadsheets which my wife takes and which we have family disputes about at times. The noble Baroness is absolutely correct that this was looked at in detail in 2005 by the advisory council, Nacro and Turning Point. It was decided at that stage that this would be treated as a public health issue rather than with a criminal justice response. That is the basis on which we have gone ahead. It in no way underestimates the harm that the drug can cause. We believe that the right way to tackle this is prevention, harm reduction and education. We have made great strides, but I do not underestimate what a real risk this drug is.
Baroness Finlay of Llandaff: My Lords, does the Minister agree that one of the main harms from khat is liver disease in the person who takes it chronically, rather than harm to others? One difficulty for regulatory authorities is recognising khat. It is imported as a vegetable and is difficult to recognise at points of entry. I must declare an interest as a member of ACMD. On the balance of harms, given that it is difficult to police and does not seem to be related to mainstream criminal activity, there would be more disturbance within the Somali and Yemeni communities by criminalising it than by trying to educate people to avoid the devastating liver disease that ensues.
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