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The Bill will also reinforce the core purpose and values of the NHS by placing a duty on NHS bodies to take account of the new NHS constitution. The constitution will be published alongside the Bill, and will secure the enduring principles of the NHS and set out the rights and responsibilities of staff and patients. The Bill will commit the Government to renewing the constitution every 10 years, in consultation with patients who use the NHS, the public who fund it and the staff who work in it.

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The third commitment from High Quality Care for All, contained within the Bill, is the introduction of direct payments for health services in certain circumstances and with certain constraints. This is one of the ways in which we will explore the use of personal health budgets which have the potential to give people more control and influence over their healthcare. The experience of social care suggests that giving people greater scope to organise treatment and care around their own needs will increase both the quality of care people receive and their satisfaction with that care.

The Bill will also contain proposals not included within my review, but certainly consistent with its principles. Most notably, it will introduce measures to control the selling of tobacco, tackling the biggest single preventable cause of ill health and one which disproportionately affects the most disadvantaged in our society. On 9December, we announced in the other place the Government’s response to the consultation on the future of tobacco control. The vast majority of the 97,000 responses to that consultation were supportive. The Bill will therefore include provision to ban the display of tobacco by retailers and, via regulation, to prohibit the sale of tobacco from vending machines or to restrict access to those machines to people under 18. This will be a major step in preventing ill health, which, as your Lordships know, is always preferable to treating health problems that have developed.

Finally, the Bill will, as noble Lords asked and we agreed during the passage of the Health and Social Care Act in the summer, extend the remit of the Local Government Ombudsman to deal with the complaints of people who fund their own social care services. I am grateful to the House for championing the voice of this important group of service users.

As a humble surgeon, I am often enough told by other doctors, and to a lesser degree by nurses, that I cannot grasp the intricacy of their particular specialism. So I hesitate to risk the wrath of job centre employees and teachers by heading into their domains. However, as a non-expert, I ask your Lordships’ leave to outline our proposals on welfare reform and improving chances for children and young people.

We announced our intention in the Queen’s Speech to introduce a welfare reform Bill, a Bill that will help hundreds of thousands of people to find and keep work. It will turn lives around. We are offering a fair deal: more support in return for higher expectations. Put simply, the proposals outlined in that Bill will help us to achieve our ambition of ensuring that almost everyone claiming benefits should have the support and expectation to look for work. These measures are more relevant today, in these difficult economic times, than they could have been in the past. Most of all, we cannot afford to waste a single person’s talent.

The measures in the welfare reform Bill will bring about radical change. Our proposals are in stark contrast to the position, just over 10 years ago, when less than a third of claimants had to do anything substantial in return for their benefits. Even that third got only limited support to get back in to work. The rest got nothing. This Government set about putting that right. We created the New Deal. We merged the Benefits

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Agency and the Employment Service to create Jobcentre Plus. So everyone who signed on for jobless benefits was put on the path back to work.

That was the first phase of reform, deepening the obligation to work so that there is not an option to stay on benefits. As we saw those obligations cause youth and long-term unemployment to tumble, we set about the second phase of reform by widening their scope. We piloted helping those on incapacity benefits with the New Deal for Disabled People and then with the groundbreaking Pathways to Work programme, which increases the chances of someone being in work by about 25 per cent.

Since this April, we have required all new claimants to take part, except those with the most severe conditions. In October, we replaced the incapacity benefits with the employment and support allowance, which focuses on what people can do and not what they cannot. We improved help for lone parents. With the help of New Deal for Lone Parents, over 330,000 more of them are in sustained work. However, we wanted more people to benefit, so we are requiring lone parents of children between seven and 16 to look for work, which we expect to increase employment and lift 70,000 children out of poverty.

The Bill, combined with the measures outlined in the White Paper, Raising Expectations and Increasing Support: Reforming Welfare for the Future, published on 10 December, starts the third phase of the Government’s welfare reforms. Our proposals are based on a simple idea: that no one should be left behind, that virtually everyone should be required to take up the support that we know works.

The reforms will simplify the benefits system to ensure that it offers the right support; devolve power and responsibility to individuals, communities and suppliers to tailor services to local priorities and needs; increase the role of the private and voluntary sector, paying by results to help more people; develop a personalised programme of help for everyone on benefits who can work; increase targeted support and activity for groups most at risk from exclusion from the labour market; expect more of jobseekers and others in return for back-to-work support; enshrine in legislation our commitment to tackle child poverty, which is the biggest obstacle to individual achievement; ensure that housing benefit supports people moving off benefits; provide additional support for disadvantaged jobseekers; clarify rights and responsibilities; and facilitate choice and control. The themes of the health Bill can be seen in our approach to welfare reform. They extend also to the children, skills and learning Bill, which we will bring forward.

Last year, the Secretary of State for Children, Schools and Families published the Children’s Plan, which set out the Government’s vision for making this country the best place in the world to grow up, and making sure that every child, whatever their background and wherever they live, can have a safe, happy, fulfilling and healthy childhood. Today, the Secretary of State has issued a report setting out the progress that has been made over the past year and the challenges that remain in achieving this long-term vision.

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There has been some significant progress. We are implementing Dr Tanya Byron’s recommendations on addressing the potential risks from harmful and inappropriate content on the internet; a root-and-branch review of the primary curriculum, led by Sir Jim Rose, is under way; and the Youth Crime Action Plan has been developed, setting out a cross-government approach to reducing youth crime.

The Education and Skills Act, which received Royal Assent on 26 November, established an historic milestone by requiring that, from 2015, all young people stay in education until the age of 18. This has been welcomed by the education sector, business and trade unions alike. As David Frost, the Director General of the British Chambers of Commerce, put it,

“Raising the compulsory age of participation in the education system will help to ensure that Britain has a suitably well qualified workforce in the future”.

The children, skills and learning Bill will build on these achievements and the wider themes set out in the Children’s Plan. It will enhance our efforts to ensure that services to children and their families are locally owned, locally integrated and locally accountable. Children’s trust boards will be placed on a statutory footing, with new responsibilities to drive more effective local co-ordination.

Sure Start children’s centres will be given legal recognition that they are part of the local infrastructure of support available to all parents. Local authorities will become responsible for ensuring that 16 to 19 year-old learners are able to pursue the education, training and apprenticeships opportunities that best suit their needs and aspirations, and local authorities will also have new responsibilities for the education of young people in custody, to help ensure that our most vulnerable young people are given the best possible chance to get their lives back on track.

In education, as in health, more autonomy is being given to local services. Where national bodies exist, they do so to support local service delivery. That will be the case with the Young People’s Learning Agency, there to support local authorities in delivering on their new responsibilities to 16 to 19 year-old learners, and the Skills Funding Agency, responsible for adult skills, which has been designed to be flexible and highly responsive to employer needs and the changing economic demands facing this country. Further support will be available through the national apprenticeships vacancy matching service which we hope will lead to an increase of more than a third more people starting apprenticeships in England by 2020. We are bringing in a new right for those in employment to request time to train. This right will encourage individuals to refresh their skills and businesses to invest in training to boost their productivity.

Certain functions must be retained nationally to ensure consistency. To increase public confidence in the standards of qualifications and tests, the Bill will establish a new independent regulator for England—the Office of the Qualifications and Examinations Regulator, which will be accountable to Parliament rather than to Ministers.

The Bill will continue the drive to ensure that every school is a good school. For the best schools, this will mean a more flexible Ofsted inspection cycle. For

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those that are causing concern, there will be new powers to require local authorities to take earlier action. Where parents have concerns that cannot be resolved with the school, there will be a new way of handling such complaints. School support staff, including teaching assistants, caretakers and bursars will be recognised for their vital contribution to school life through the establishment of a new Schools Support Staff Negotiating Body, and the Bill will give local authorities and Ministers new powers to ensure that all schools take seriously their responsibilities to provide teachers with time for marking and lesson planning.

Finally, the Bill will support secondary schools in coming together to tackle poor behaviour and attendance more effectively by sharing expertise, resources and facilities. In response to Sir Alan Steer’s recommendations, schools and colleges will also be given extended powers to search pupils for alcohol, illegal drugs and stolen property.

This wide-ranging Bill will be supplemented by the final Bill I want to bring to noble Lords’ attention. This is a Bill aimed at tackling one specific problem—child poverty. In 1999, this Government pledged to eradicate child poverty by 2020. The child poverty Bill will enshrine that momentous commitment in legislation.

I hope that noble Lords can see the common threads running through these Bills. Let me summarise the parallels. I see quality being fundamental, whether it is in a hospital or in a school. I see help for the most deprived, to raise children out of poverty and to make it easier to quit smoking. I see clear rights and responsibilities, whether it is for the NHS worker or for the benefit claimant, and I see more personalised services, whether it is a tailored package of training for a teenager or a personal health budget for a patient. The Bills contained in the gracious Speech are nothing less than a coherent vision for public services for the 21st century and I commend them to the House.

12.04 pm

Earl Howe: My Lords, it is a pleasure to see the noble Lord, Lord Darzi, in his place on the Front Bench, which he has come to occupy with such distinction over the past 12 months. I know that the House will wish to thank him for his opening speech, which sets the scene for today’s debate helpfully. I shall not attempt to compete with him in ranging over departmental boundaries, but will instead confine my remarks mainly to health-related matters. My noble friend Lady Verma will concentrate on education when she comes to wind up.

Over the years of the current Government, this House has passed no fewer than 11 major Acts of Parliament originating from the Department of Health. The gracious Speech held out the prospect of another tempting morsel from that quarter. The NHS constitution has been in gestation for some time. I am not aware of any principled objection to it as a concept within the health service or within this House. In fact, my party has been quite enthusiastic about the idea of a constitution for some time, since long before the Government made their original announcement. In this respect, for us, the health Bill appears unlikely to turn into a major political battleground.

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However, there will probably be some aspects of the Government’s approach that we shall want to examine carefully. There does not seem to be much point in drawing up a set of regulations containing what everyone accepts are already the responsibilities and functions of the NHS and saying that the NHS must have regard to them, unless we see how this will add value to patient care. I need to understand rather better than I currently do what the practical implications of applying, or failing to comply with, the constitution will be for patients and staff and what “having regard to” will really mean.

It is certainly helpful to articulate and assert NHS values. There are those who are apprehensive that, with the private and voluntary sectors playing an increasing part in the provision of NHS care, those values may not always be to the fore and who believe that we need the constitution for that reason if for no other. The trouble is that NHS values, as such, are apparently not to be included in the constitution. Nor are there any proposals to enshrine the principle of independent regulation of healthcare, which is so important if we are to have a genuinely patient-centred service. Rather mysteriously, two of the principles set out in the NHS plan have gone missing, including the principle that the NHS will support and value its staff. I would be interested to hear the Minister’s comment on that.

We are told that one ingredient of the health Bill will be to strengthen public involvement in the commissioning arrangements of primary care trusts. It will be interesting to see what these provisions consist of. I say this with some degree of concern. Noble Lords will remember that, last year, we debated and passed the Local Government and Public Involvement in Health Act, which abolished patients’ forums and made provision for local involvement networks. LINks are meant to be in place and fully functioning across the country by the end of this month. Personally, I would be amazed if that happened. Everything that I and other noble Lords predicted during the passage of the Act has come to pass. There were meant to be transitional arrangements for patient and public involvement following the abolition of forums. Many local authorities have quite simply failed to understand the legislation properly and, in consequence, have failed to put in place those transitional arrangements. Information about the levels of service that host organisations have been contracted to deliver is being withheld, which makes it impossible to assess how well or badly they are doing. Many local authorities appear to believe that once a host is in place they have fulfilled their duties under the law—exactly the misconception that many of us fought so hard to avoid when we persuaded the Government to build transitional provisions into the Bill.

The Government have made public money available to fund such arrangements. Despite that, many local authorities have refused to reimburse volunteers their legitimate expenses. The net result of all this is that many committed and talented people have given up the struggle and are now lost to the system. It is the perception of those who represent LINk members that Ministers are in denial about how bad the situation

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is in many areas of the country. If the health Bill is to depend on LINks to deliver the promised strengthening of public involvement in commissioning, we really must have greater confidence than many of us do have that they will be up to the task.

I hope that the House will in broad terms welcome the idea of an NHS constitution, but at the same time we know that the main health agenda lies outside the strict confines of legislation. The noble Lord, Lord Darzi, is engaged in implementing his next-stage review. We should be in no doubt of the importance and magnitude of that task. One of the main challenges is to put in place mechanisms for drawing up so-called quality accounts. These in turn will depend on having appropriate quality indicators. I am right behind the noble Lord on this, but much will hinge on the ability of trusts to translate the data that they have into information that is useful and meaningful for patients. Trusts will also need to understand that collecting data and ticking boxes is not the end of the story. What will matter equally is whether they can take the relevant action if the quality of a service is found to be wanting.

Infection control is one area that springs to mind; many argue that without good hygiene and infection control the quality agenda is hamstrung. A recent survey by the Healthcare Commission found that a quarter of trusts are failing to meet at least one standard on hygiene—standards that relate to infection control, decontamination of equipment and the healthcare environment. This represents practically no progress from two years ago. The Government said in 2001 that all new hospitals would have 50 per cent single rooms, which is absolutely key to tackling infections. In fact, 82 per cent of hospitals opened since 2001 do not have 50 per cent single rooms. The Health Protection Agency has said that three-quarters of hospitals could not isolate patients with an infection because they did not have the facilities. Actually addressing shortcomings in quality will be very difficult for some trusts. The Healthcare Commission’s annual health check provides other quality indicators. The overall picture is, thankfully, improving, the notable exception being London, where quality scores are lagging a long way behind those in the rest of the country.

Quality accounts are not the whole story. A big part of what the noble Lord needs to create, as he well knows, is better standards of leadership. It was striking that, in the survey of NHS staff that the Healthcare Commission carried out last April, more than half those questioned did not think that the care of patients was their trust’s top priority. At one trust, only 3 per cent of staff thought that this was the case. How depressing. However, those findings illustrate, perhaps more than most others, what a job of work there is to do to make the values and principles of the NHS live in the minds of staff and how necessary it is for clinical leaders and NHS management to form more constructive working relationships.

We are promised measures in the health Bill to extend controls over the supply of tobacco products. If measures can be taken that will lead to a reduction in the number of young people taking up smoking, I do not believe that any of us could oppose them.

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However, we have to be satisfied that any measures that are taken are backed by rock-solid evidence that they are likely to achieve that objective. One has to question seriously whether a complete ban on point-of-sale displays of cigarettes will meet that criterion. Contrary to the impression given in the departmental press release this week, the evidence from Canada and Iceland is at best speculative. Evidence needs to be stronger than that if a ban on point-of-sale displays is to satisfy the test of proportionality. There is no evidence that displays of tobacco products have got bigger or more prominent in recent years. When tobacco advertising was banned, the Government made an explicit distinction between advertising and display, display being, in their words, “totally legitimate”.

We have only recently changed the law to make it illegal to sell cigarettes to persons under 18. I supported that change. However, against that background the department needs to explain why banning point-of-sale displays is going to get us any further in preventing sales to minors. Indeed, if you take away the ability of cigarette manufacturers to compete with one another through point-of-sale displays, they will be left with only one other way of competing, which is through price. If a cigarette price-cutting war were to take place, it would have the very opposite effect to that desired. I am open to persuasion on the issue, but as yet I remain a sceptic.

I am sure that I am not alone in looking forward to the coming Session, in which, as ever, we on these Benches will play our part in offering the Government our constructive comment and, where necessary, criticism. I have no doubt that today’s speakers will pave the way admirably across a wide range of issues for our debates in the coming weeks and months.

12.16 pm

Baroness Barker: My Lords, I thank the noble Lord, Lord Darzi, for his customary eloquent introduction to today’s debate. Like him, I see wisdom and valour in leaving DWP and education matters to my very able colleagues, my noble friends Lord Kirkwood and Lady Walmsley. I, too, will confine myself largely to talking about health and social care.

In his introduction, the Minister referred to the 60th anniversary of the NHS. We should remember that it was the work that went in beforehand on the creation of the NHS and the welfare state that was of importance. It was led in large part by William Beveridge, or as he is known on these Benches, “that great Liberal, William Beveridge”. It is my hope that, just as John Maynard Keynes is going through something of a renaissance at the moment, the rest of the world will come to understand what we on these Benches know: that it may take a lifetime for a Liberal to be recognised as being right, but we Liberals are, and we keep going on.

I am not being entirely facetious in those statements, because it is important to state that, although the measures in the gracious Speech are welcome, to discuss them in isolation from the current economic situation would be foolish. Therefore, we need to talk about the gracious Speech with reference to the economic climate, the Pre-Budget Report and the NHS operating framework

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for 2009-13. The NHS has been through a period of unprecedented funding, but it faces a period of unprecedented demand. The questions that politicians must focus on for the next two years are how in our public services, and health and social care in particular, we can achieve efficiency, we can avoid false economies, we can invest in preventive services that will increase well-being and how we can build a health service that has been designed to meet one set of challenges but which will operate over the next few years in a wholly different climate.

I disagree with some statements made by Conservative MPs over the past couple of months that the recession must run its course and that a recession might be good for the nation’s health. One only has to look at the lessons of history to see what happens to health during a recession. There is a wealth of evidence from factory closures that people who lose their jobs suffer increased illness—both physical and mental—no matter how healthy they were to start with, and that there is an increase in mortality and morbidity. Although some studies from around the world say that some conditions associated with affluence decrease, health inequalities increase in a recession because poorer people are more directly and immediately affected by lack of money. They also have an increased susceptibility to harmful behaviours. It will be different in this recession; we will not have the regional impact of recession that we had in times past, when manufacturing areas suffered disproportionately.

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