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Wearing both those hats, I welcome the move to develop an NHS constitution. It is an important step forward for patients and public, and I look forward to working on the legislation as it proceeds to ensure that

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it is clear and non-confusing for patients, and as accurate as it can be legally. It is clear that simplifying and codifying the many interlocking rights, responsibilities, duties and pledges which relate to healthcare is a difficult task. For example, as other noble Lords have asked, how will the constitution be used in relation to services which are not provided by the NHS at all but by another agency or third party? The commitment to publish a separate statement of accountability is welcome, but patients must be clear about where accountability lies.

The focus on quality of care, and reflecting the needs and preferences of patients, their families and their carers, is welcome and continues the excellent progress made in the carers strategy. The strategy set out that carers will be treated as expert partners in care. As vice-president of Carers UK, your Lordships would expect me to acknowledge how important that is, but it is important, too, to put in place support mechanisms to help carers develop their skills and confidence.

Informed choice is important to all patients and has become a major determinant of treatment options, but choice is real only where alternatives are available. The formal recognition of patient choice in the NHS constitution and the placement of patient choice as a major determinant of treatment options are very welcome, but to realise this so far as, for example, specialised treatment is concerned, PCTs will have to provide information on the quality of clinical services. There is still a long way to go before accurate, reliable and meaningful data become available that enable patients, working with their doctors, to make fully informed choices about what is available to them. The new legal right to choice is therefore welcome, but we must remember that real choice includes services and treatments as well as providers, and is dependent on the provision of accurate information.

It is also important to ensure that the constitution makes it clear that the Human Rights Act, which confers the right to dignity and privacy, underpins it. This would enable members of the public better to appreciate those rights and to know what to expect in practice when receiving services provided by professionals for or on behalf of—I emphasise “on behalf of”—the NHS. This will empower patients to demand their rights and to seek redress when those rights are not upheld.

I turn finally to the position of carers and I am grateful to other noble Lords for mentioning this. Many of their concerns fit more adequately into yesterday's equality debate, but their needs cannot, of course, be divorced from health and social care issues. Alarming new statistics recently published by Carers UK reveal that the nation's carers are under even more pressure as living costs rise and the economic crisis affects even more families. Nine in 10 of the carers recently surveyed say that their financial position is worse than 12 months ago yet they provide vital support, unpaid, to their elderly, sick or disabled relatives, making a contribution worth £87 billion a year to the UK economy.

Half of all carers are cutting back on food just to make ends meet—more than double the rate of only a year ago—and 32 per cent of those paying rent or a

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mortgage say that they cannot afford to pay it. The draft NHS constitution mentions carers and states:

“NHS services must reflect the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment”.

That recognition of the importance of carers is extremely welcome. The NHS must, however, start to view carers as partners in care and welcome their knowledge and opinions.

As well as this legislative change, we need a cultural change at local level so that the training for professionals to recognise carers, for example, must proceed much more quickly than it has done hitherto. Improving complaints procedures for people who have arranged their own social care is welcome, as the impact of poor service has a significant impact on carers and their health, income and ability to work. It would give families greater power to demand a good service for the person they care for.

I look forward to taking part in the debates as the legislation proceeds, particularly those around direct payments and personalisation, which will have tremendous significance for those caring families. They are very welcome developments, but it is important that we continue to take account of the 6 million people who provide by far the majority of health and social care provision in our country.

4.07 pm

Lord Jones of Cheltenham: My Lords, it is a great pleasure to follow the noble Baroness and to take part in this well informed debate. I wish to concentrate on two issues: first; how education needs to be much more rounded in order to produce not just academically qualified young people but healthy bodies and healthy minds too; and, secondly, I want to say a few words in support of the state of the good old British pub.

In the gracious Speech, there was mention of the children, schools and learning Bill. When I served in another place, I often visited local schools, colleges and businesses in my constituency. In schools, I was able to see the excellent job that many teachers do in helping young people get to grips with the basic skills that they will need in later life and we should congratulate our education professionals on the work that they do. They are dedicated, tolerant and long-suffering, sometimes in the face of unacceptable behaviour from a minority of pupils and all too often their unreasonable parents.

One issue that concerns me is the reduction in physical activity in schools. The selling-off of school playing fields is a terrible thing and the failing to make maximum use of existing playing fields also adds to problems such as disorder and obesity. I remember meeting some young people one summer who were hanging around on the street corner complaining that they had nothing to do. Less than 50 metres away was a school with a playing field that was unused, crying out for activities to be organised to use up the energies of these young people. I often wonder what happens to sportsmen and women after they finish their sporting careers. Surely, we should make use of those people who have been used to maintaining a fitness regime to teach our young people what they need to do to

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become fit, stay fit and develop skills that would enable them to take an active part in ball games, athletics, swimming and other activities—activities that would not only keep them healthy, but through which they would also meet people they would otherwise not meet and form friendships which may last a lifetime.

It would be much cheaper for the new Bill to contain provisions for a small budget for each school to enlist the help of sports professionals after they have retired to keep playing fields in use during school holidays and at weekends—far cheaper than the clean-up costs of dealing with bored young people becoming unfit and obese, taking up bad habits such as smoking, drinking to excess, taking illegal drugs and falling into crime. It might also increase the pool of sporting talent from which our national teams can be selected.

At a meeting of the Central Council for Physical Recreation a few years ago, the guest speaker was the great Welsh rugby maestro Cliff Morgan. He told us that a quarter of 16 year-olds show early signs of heart disease. I know a thing or two about heart disease. It costs the nation an absolute fortune. We must help to prevent young people leading a lifestyle which will lead to development of problems of this kind early in their lives.

Thankfully, many organisations outside our formal education establishments invest in our young people. I give my own local football club, Cheltenham Town, as an example, and declare an interest as a vice president. Cheltenham Town is using the power of sport to inspire, motivate and educate thousands of individuals within the local community. Only last weekend, more than 200 youngsters from Leckhampton Rovers, supported by their parents and friends, took over the Whaddon Road ground for a football bonanza. The purpose behind Cheltenham Town's programme is to build a better community. Nelson Mandela once said:

“Sport has the ability to inspire. It has the power to unite people in a way that little else does. It speaks to youth in a language they understand. It is more powerful than Governments. Sport has the power to change the world”.

Let us not forget those who are disabled. We all marvelled at the success of our Paralympians in Beijing. Those who help disabled young people do a wonderful job. The National Star College, located just outside Cheltenham, provides profoundly disabled young people with the technical equipment to develop their skills, including sporting skills. The private sector has a responsibility too, not just in sport, to ensure that it concentrates on our young people during this downturn. I was delighted to read comments by Richard Steer of Gleeds, the construction industry project managers, urging the construction industry not to give up on the graduate. He argues that industry needs to develop local talent in areas such as quantity surveying and project management now, otherwise, when the upturn comes, we will need to import those skills in the future, probably at higher cost, on short-term contracts from abroad. I hope that the Government will bear these factors in mind during the passage of the new Bill.

On the plight of the community pub, I declare an interest as a former chairman of the All-Party Parliamentary Beer Group. Two years ago, the group was concerned to learn that five pubs a week were closing across the United Kingdom. Many of these

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were in small communities, where the local shop and post office had closed and, apart from the church, the pub was the last social facility in the village.

The group decided to conduct an inquiry to gain a full picture of what was happening. Research took two years and produced some alarming figures. Today, instead of losing five pubs a week, the nation is losing about five pubs a day—it is losing 36 a week. This is a net figure. Beer sales are down 16 million pints a day since the peak of 1979, reaching the lowest level since the Great Depression of the 1930s. More than 40,000 jobs have been lost in the sector in the past five years. A further 43,000 job losses are projected over the next five years.

The pressures escalated further following the Pre-Budget Report. Pubs were denied any potential benefit from the VAT cut because of another hike in excise duties. Beer taxes have increased by 17 per cent this year alone. Not only that, the cost of implementing the VAT change is estimated to be around £30 million, a price which will have to be paid again when VAT is restored to its previous level in a year or so. Further pressure has been put on pubs through the impact of irresponsible high street trading from supermarkets and high volume on-trade outlets with offers of “two for the price of one”, “drink as much as you like for £10” and happy hours. I am pleased that the Government seem to be addressing some of these practices but more needs to be done to prevent the practice of “pre-fuelling”.

A pub does not just sell beer. It is a social centre providing meals and snacks, raising money for local charities and diversifying offerings all the time. Pubs provide a place where the consumption of alcohol is regulated. They use local produce to provide nourishing meals and are a source of great comfort to many pensioners and families. When a pub closes, all that goes, jobs are destroyed and the Treasury is out of pocket.

Prompted by His Royal Highness the Prince of Wales, an organisation, Pub is the Hub, was formed. It has had a number of successes in turning non-viable shops, pubs and post offices into single viable businesses. In places where this has happened, instead of losing all three services, the local community now keeps all these services, and others. Some of the “Pub is the Hub” successes now provide libraries, school meals and centres where pensioners can go and read the papers and get coffee at half price before 11 o’clock.

Yesterday, Michael Turner, chairman of the British Beer and Pub Association, made a speech at the Parliamentary Beer Group and BBPA reception in the House of Commons. He said:

“The British pub is the heart of the local community, the envy of the world, and the home of responsible drinks retailing, where not only the sale, but also the consumption of alcohol is supervised. It is a national treasure, and is a key part of our tourism industry.

British beer consists of a wonderful array of traditional and handcrafted ales, together with world famous lager brands. There is a tremendous diversity of colours, flavours, styles, and textures, and there is something for everyone. It is an industry to be ... proud of.

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Together these two industries employ 600,000 people; ... are responsible for duty and VAT of £6 billion; and are part of an industry that makes total tax contributions of £25 billion”.

It would be a tragedy if, when the Olympic Games come to Britain in 2012, our friends from America, Europe, Japan and elsewhere cannot find a decent pub where they can enjoy traditional British hospitality. I hope that the Government will look very closely at the report produced by the Parliamentary Beer Group and act on the recommendations.

4.17 pm

Lord Griffiths of Burry Port: My Lords, I guess that it is an unintended irony that that wonderful eulogy in favour of the British pub should precede an intervention by a Methodist minister. I say amen to the sentiments just expressed.

It is no intended discourtesy to the House that I was absent for much of the middle part of the day. The various strands in my life are demanding a lot of me at the moment. I crave the indulgence of the noble Earl and the noble Baroness on the opposition Front Benches for not having heard all that they said. I trust that the fact that I heard 10 consecutive subsequent speeches will be counted to me for righteousness.

I am delighted to play my part at the fag end of these discussions on the Queen’s gracious Speech. A debate it certainly is not; it seems rather a series of reflections on the speech occasioned by various hanging points on which we can put our thoughts. Certainly, it gives us an opportunity to relate fields that we would normally discuss separately. I wanted to consider health and education, but time will not allow me to do that. However, I shall refer to a health issue, largely because it is so topical this week.

I am in my fifth year of membership of your Lordships’ House. During that time we have considered three Bills on assisted dying. A detailed Select Committee report has been produced and other debates have taken place in which I have taken part. The mind of this House has been made clear on each of the occasions that that mind has been tested. If there is to be any further debate, it should happen in the other place, which needs its mind tested, too. I congratulate the Government on specifically stating that this issue has no place in the end-of-life care strategy. We happen to be world leaders in palliative care and there are constantly developments in that area that will redefine the parameters within which we discuss the whole question of care for the dying. I wanted to interject that remark from what would have been a string of remarks about health, had I felt that there was time to pursue both lines of investigation.

Education is where I want to dwell. I say in passing that I do not envy those who are to sum up the debate. I look forward with some eagerness to assessing their skills in commanding the heights of the summits from which people have spoken. We are heading towards the end of this Parliament and health and education will be battlegrounds as people try to get votes from the electorate. A Bill was promised in the Queen’s Speech—it is not a bad thing to remind ourselves of what was said in the pellucid prose—

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All of this is subsumed under the words,

Who can be against that? Although I must remark that the phrase that purports to address our needs to improve education includes a split infinitive.

I say hooray for what I heard in the Queen’s Speech, but I listened to what I heard and to the interventions that have been made on education in today’s debate with some dismay. I want to share my feelings about that. I am wholeheartedly in favour of much of what I have heard. I have heard in earlier interventions that the Bill that will come before us will make good omissions from the plethora of Bills that have previously preoccupied us. So why am I a little dismayed? I have heard the proposals, and I have taken part in and listened to previous debates, as a school governor and now as the vice-chairman of a foundation trust that administers quite a significant piece of education in two inner London boroughs, Tower Hamlets and Islington. Hearing these things as a school governor, and being aware of the workloads and of the taxed minds of the teachers who have to deliver what we are so wise about, I register a cautionary note.

It is said that the Government need to seek for themselves powers to ensure the delivery of what we decide. That is fair enough. We do not think that anyone else should have powers to enforce pay agreements. We have heard the noble Lord, Lord Dearing, talk about regulatory bodies accountable either to Parliament or to the Minister of State, and the setting up of an independent regulator of examiners called Ofqual—there is a whole pile of those now. There will be the QCDA, a set of initials that you cannot make a suitable memorable acronym out of, which will be a development agency for the curriculum, assessment and qualifications. We have had a summer of misfortunes in the area of examination results, so it is a good thing to tighten that up, and I am sure that the Government must do it. However, on the remark that the Government will seek to ensure that teachers have enough time to prepare for lessons, I wonder whether we have not transgressed into ground that does not really belong to government at all. Indeed, if the Government were not so active in the field of legislation, there would be plenty of time to prepare for lessons.

In the area of local authorities—the noble Lord, Lord Dearing, and the noble Baroness, Lady Howe, said this—holes are going to be filled that were left dug after previous legislation. Good. These are the holes. I understand that the Sure Start children’s centres will become statutory bodies. Let us rejoice about that. There will be an attempt to reform pupil referral units. If they fail or are seen to be failing, local authorities will have powers to intervene in order to achieve those reforms. There will be a strengthening of children’s trusts and an attempt to join up local services, required by law, while children’s trusts boards will be set up on a statutory basis. Once again, with recent events in mind, joining up services in local authority areas is very necessary. Local authorities will also establish young people’s learning agencies, to support

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them when it becomes time to implement the provisions for 16 to 19 year-olds in 2010 and 2011. All those things will happen and local authorities will have to carry them through.

As a school governor, I dread the thought of yet more sets of guidelines and regulations. To fulfil one’s duties in the voluntary sector we will have to learn them, go on courses about them, give up another evening for them and miss your Lordships’ wise debates in order to be there and not here. I wish that the noble Baroness, Lady Neuberger, were in her place, as she has some understanding of the demands for the delivery of services that, more and more, are placed on volunteers—people who give their time and skills for the administration of various aspects of public policy. I know how hard it is to get a set of governors together for a tough, inner-city school and to feel confident that, around our table, we can give the attention that we ought to the detailed outworking of the plans and policies before us. When faced with something like 30 or 40 pages of closely typed accounts, I feel totally deskilled. I wish that the Minister, who has skills in that area, were doing it in my place and that I were summing up the debate in his.

At local authority level, we will also be bringing young offenders into mainstream education. Again, I can only rejoice about that, but when I think of the demands that have been placed on schools as they have sought to accommodate disabled children and people with mental and learning disabilities, all of which is necessary—I approve of it 100 per cent—it isn’t half demanding. Bringing in young offenders now will create a heterogeneous classroom situation, which will demand such a range of skills and levels of patience, tolerance, imagination—all those things—that I wish more thought were going into what happens to empower teachers and governors who have to take what we lob to them and make something of it.

I could go on, and your Lordships may think that I have. Schools are to be given powers to tackle disruptive behaviour. They are to be given powers to search pupils. Parents are to be given a more streamlined complaints procedure. I look forward to seeing the legislation before us and hearing the debates about it. I am glad that holes will be filled; I hope that that will bring to a complete circle our consideration of education for a while, to let things settle a bit and take the thinking through and to give some attention to the needs of those volunteers who give their time to school governance and those teachers who cope, year after year, with the latest raft of guidelines and outworkings from our deliberations.

4.29 pm

Lord McColl of Dulwich: My Lords, I will speak on the subject of human trafficking, which causes a great deal of ill health. Those who are trafficked are deprived of their freedom and, often, of the medical attention that they desperately need for the diseases that they inevitably have forced on them. It was therefore reassuring to see reference in the Queen’s Speech to a Bill that will be brought forward,

and to include measures to reduce human trafficking.

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Human trafficking is a scourge that affects every country worldwide and may produce revenues of as much as $42 billion, which is equal to those of Microsoft and twice those of Coca-Cola. Human trafficking involves the dislocation of men, women and children by deception or coercion for the purpose of exploitation. The International Labour Organisation says that worldwide more than 12 million men, women and children are in forced labour at any given time and, of those, 2.4 million have been trafficked. UNICEF believes that throughout the world a child is being trafficked every 30 seconds. Approximately 80 per cent of those trafficked are women and girls and the majority come from the poorest countries.

The British parliamentary Joint Committee on Human Rights considers human trafficking to be,

It outlines varying forms of enslavement, including children being drugged and forced to fight as soldiers, men bonded or chained in labour on mines and farms, women enslaved in quarries and households, women and girls trapped in the sex trade and boys forced to fish in dangerous waters. Save the Children estimates that there are 5,000 children in prostitution in the UK, nearly all of whom have been trafficked.

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