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There is anxiety, unease, uncertainty and fear out there overlying the situation of lack of trust. Democratic politics cannot be practised successfully unless we engage the people we seek to serve. The press are an important part of the problem. We live in an age of very unforgiving media, but we have to work around that. While I would like to put the editorial staff of the Daily Mail in jail, alas the legislation to achieve that might not pass muster with the Human Rights Act. We have to work as best we can to confront the arguments. The noble Lord, Lord Lucas, said that when these things happen you have to stand up and be counted. It is in all our interests to stand shoulder to shoulder when these issues arise and I hope that we will see more of that in the future.

I wish to make one final plea about something which is not mentioned in the Queen’s Speech but which suffuses everything—it is not one of the themes of the noble Lord, Lord Darzi, but maybe it should be—and that is the question of ageing. The issue of ageing arises in the areas of carers, health and so on; it affects the whole public agenda. When the noble Lord, Lord McKenzie of Luton, celebrates his 65th birthday in three years’ time it will be a red-letter day for a number of reasons. He will have reached a significant part of his life—I shall be a couple of weeks behind him—but in 2011-12, for the first time, the number of people joining the 65 year-old-and-over population will rocket; it will increase exponentially. These are the baby boomers; the bulge coming through. We will have had the benefit of being the earning generation and in 2011-12 we will be going into a significantly different phase of demographics.

This will affect the dependency ratio and will mean that fewer and fewer people will be carrying the load of wealth creation. That is why all the arguments and powerful speeches we have heard today about skills, universities, technical colleges and so on are so important. It is absolutely essential that we should establish these facilities right now because, if we do not, we will have to rely on people working to a much older age. Even with his Duracell capacity, we cannot expect the noble Lord, Lord McKenzie, to work indefatigably for ever. We have got to find ways of getting more people actively into the labour market—even if it is only part-time work—for the creation of good health, well-being and wealth at the end of their lives. If we do not address that agenda now—indeed, some would argue that it is already too late—we will put ourselves at risk. The wealth creation ability of the country will not be adequate to meet the needs of the pensions of the noble Lord, Lord McKenzie, and myself, and that would be a serious situation.

It is an important year for the House and the legislation is important. This legislative agenda can be improved and I hope it will be improved. Certainly those on the Liberal Democrat Benches will seek, as they always do, to do that. In the course of his speech, the noble Lord, Lord Baker of Dorking, said that he thinks we should take it more slowly and try to get it right. I think that that is about right as well.

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5.08 pm

Baroness Verma: My Lords, this has been a wide-ranging and most interesting debate. It has been well informed and has once again highlighted the real expertise of your Lordships’ House. It is a great privilege to be part of today’s debate.

Along with other noble Lords, I shall draw attention to the thin legislative programme that the Government have unveiled. The Bills announced suggest an Administration who have run out of new ideas. I have heard it suggested that the Government have such a thin legislative programme so that all business can be fitted into what will be a shorter than usual Session.

Today’s debate has been billed as covering health, social affairs, education and culture. The latter topic seems to have been hollowed out. I see that we are no longer getting the heritage Bill to which the Government referred earlier this year, so I am grateful to my noble friend Lord Brooke of Sutton Mandeville for his expertise and knowledge on the topic. I thank him for his thoughtful and well informed contribution. He has vast knowledge that will serve us well in the passage of that Bill.

My noble friend Lord Howe has covered health and the NHS in his usual trenchant manner and has given us all, not least the Government, plenty to think about. He has rather deftly shown how so much of the NHS reform Bill owes itself to opposition ideas set out in the Conservative draft NHS autonomy and accountability Bill, published more than a year ago. My noble friends Lady Cumberlege and Lord Colwyn spoke with remarkable and in-depth knowledge of the NHS and of the strengths and weaknesses of the Bill. I am sure that their contribution to the passage of the Bill will be invaluable in ensuring that it is a much strengthened piece of legislation as it passes through this House.

My noble friend Lord McColl moved the House with his most superb collection of tales of misery and desperation of the sex trade and child trafficking. My noble friend Lord Bridgeman, with his short but important contribution, raised an important issue and I hope the Minister will respond to it.

The proposals in the Bills set out by the Minister fall into two categories. The first category was not so much a new legislative programme but a weary collection of old government announcements raised again, while the second was a wholesale lifting of Conservative ideas. I am pleased that the Minister and the Government accept that the Conservative Party is driving the agenda.

Sadly, due to time constraints, I will speak only briefly on social affairs, a hugely important area that in recent days has attracted a great deal of the public’s attention. I declare an interest as a provider of social care for adults. We were all horrified at the terrible abuse reported in the Baby P case. It was right that we felt angry at the wholesale failings of all the departments and agencies involved with Baby P. Some 282 children died of neglect and abuse between April 2007 and August 2008. Violent, sexual and mental abuse remain a serious area of concern for many children, so plainly lessons must be learnt from this horrible tragedy. The large majority of social workers work incredibly hard,

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very often with poor and few support mechanisms and workloads that are quite unreal. There are clearly systems to be changed, challenged and better inspected, from local government all the way to the top. Will the Minister follow the call from my honourable friend Michael Gove for the serious case review of Baby P to be made public?

In its bid to tackle child poverty, Labour appears to be heading entirely in the wrong direction. The Conservatives of course support the aim of ending child poverty by 2020 and will support sensible legislation, but so far under this Government the number of children in poverty stands at 3.9 million after housing costs and is effectively unchanged in five years. The Institute for Fiscal Studies has predicted that on current policies the Government will miss their target to halve child poverty by 2010 by some 500,000.

To address poverty we must look at the root causes of poverty, not just the symptoms. The Government have unveiled, to a great fanfare and press leaks, the reform of the welfare system. I am once again pleased that the Government now agree with the Conservatives that the best route out of poverty is work. Along with that come the added benefits of better well-being, respect, aspiration and self-esteem. Perhaps the reason, once again, for the Government adopting Conservative policies that we announced in a Green Paper in January is that, despite having promised welfare reform since 1997 and despite having made over 30 announcements on the topic since Gordon Brown became Prime Minister, the reality is that he and the Government have done nothing of substance to address the increasing numbers of people falling dependent on the welfare state in the last 11 years or more. As always, even with yesterday’s announcement the devil will be in the detail, and we will look very closely at what the Government intend to do.

My noble friend Lord Baker of Dorking speaks with huge authority and expertise on education. He highlighted with passion the need for good quality delivery of vocational diplomas to meet the ever-changing demands of a competitive economy. I am sure we are all signed up to that. I also thank my noble friend Lord Lucas for his analytical contribution. He is well known for keeping his finger on the pulse in all matters that affect young people.

We believe that academies are making progress in raising educational standards, but much more needs to be done. Achievements are welcome and we applaud tangible improvement. However, the Government now seem to be adrift. The signals in favour of the academy programme seem to be lukewarm. Is that because of trouble at the top?

Will the Minister confirm unequivocally that his right honourable colleagues the Prime Minister and the education secretary, Mr Balls, completely support the academy programme? What are the Government’s plans to further roll out the scheme, to build on it and to improve it? Will the Minister tell your Lordships’ House what number of academies are to be built and in what time frame? Can the Minister also say what information the Government are collecting on individual academies’ policies so as to better understand what

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makes a particular academy more successful than others, and so that best practice may be incorporated into the way others are run?

In a world where we are constantly challenged to be more competitive, knowledge-based and responsive to global as well as domestic demands, what are the Government’s long-term proposals to drive up standards in schools outlined in the Bill? We on these Benches have argued consistently in your Lordships’ House and elsewhere that the key to helping young people get a positive start in life is to equip them for a career and for the job market. Therefore, we need to make sure that young people and children have a rigorous and thorough education and that they have these vital skills from an early age. Too many children and young people do not. Basic numeracy and literacy still remain a huge challenge.

The Government have had more than 11 years, and billions have been spent, but all the tinkering, the ever-changing targets and the continual interference have done nothing more than add frustrations among the teaching fraternity, with good teachers leaving and, ultimately, children losing out. It is too late to wait until young people reach the cusp of adulthood and then fret about what to do.

During the passage of the Education and Skills Bill—now an Act—in the last Session I, along with many noble Lords, argued that all children and young people should be provided with, at the very least, an adequate education but that our aspirations should be to nurture the great potential all young people bring and provide them with qualifications and skills that can stand the rigour of competition in a fast-changing, demanding world.

Are the Government committed to A-levels or not? It appears that the Prime Minister has pledged his support for A-levels only until 2013. Why not after? Will the Minister suggest what the Government might be supporting in 2014 if not A-levels? We on these Benches supported raising the participation age in education and training, although we differed over the methods; therefore, I can welcome the provisions in the forthcoming children, skills and learning Bill which are designed to supplement those measures. It is rather a muddled approach to introduce enabling powers to an Act which has already been passed, but better late than never.

The Minister has told us that this Bill will be introduced to raise school standards. He has told your Lordships’ House that it will strengthen confidence in qualifications by establishing an independent regulator of examinations and tests. We may assume from this that the Government agree with, and have now vindicated, my honourable friend in another place, Nick Gibb, who said last November:

“This underlines widespread concern about the failure of the Government to police exam standards. It reinforces the need for there to be greater rigour in the system ... The fact that half of school leavers are failing to achieve five good GCSEs including English and maths emphasises the need for urgent improvement”.

I am pleased that the Government have finally adopted Conservative policy in this area as their own. Imitation is, as they say, the sincerest form of flattery, but if they are going to make a proper job of it, they must stop the devaluation of exam standards.

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We have also been told by the Minister that the Bill will give schools more powers to tackle disruptive behaviour, including powers to search for alcohol, drugs and stolen items. That it is even considered necessary to spell out such powers is a horrific and damning insight into the extent to which poor discipline and outright threatening behaviour occur in some schools.

As I said previously, we on these Benches have long argued that a good education can be imparted only in a safe and respectful environment. That the Government recognise that there is a problem is welcome, but will not the Minister agree that head teachers should be allowed to conduct the business of educating their pupils in the best way that they, in their professional opinion, see fit? Head teachers must be able to exert discipline over their schools for the safety and well-being of staff and pupils alike, and ultimately be allowed to exclude disruptive and abusive pupils without fearing a weak appeal system that undermines their decisions.

Many noble Lords here today, my noble friends among them, have eloquently set out the shortcomings of current education practices and suggested imaginative and realistic ways to remedy them. The recently published Rose report was certainly imaginative, but I am afraid that I do not agree that it is in any way realistic. The way to drive up standards throughout the schooling system is not to sweep them away altogether for the very youngest. I do not agree that children will receive a better grounding in all the essential skills if subjects as we know them disappear. The report’s proposal to introduce themes through which children will gain knowledge of the world is wrong-headed. For example, to suggest that happiness lessons could be taught is to look at education in the wrong way. The happiness and well-being of the pupil are of course fundamental to their enthusiasm for learning, but that should be a description of the atmosphere of the classroom, not the subject which is being taught. My honourable friend in another place Michael Gove has said:

“The move away from traditional subject areas will lead to a further erosion of standards. This kind of ideology failed 40 years ago”.

I would welcome the Minister’s opinion of the report, because we do not have the time or the luxury to experiment with the education of our children.

The Bill is an implicit recognition by this Government of the mess that they have made of skills funding. They have restructured the system three times since 2001 and are now replacing one cumbersome bureaucracy with three. Without proper support mechanisms in place, the aspiration to offer an apprenticeship to anyone who wants one will remain that: an aspiration. The Government need to look carefully at their approach, which has created a bureaucratic mess and a shortage of quality apprenticeship places. What plans will be put in place to ensure that apprenticeships will be open also to disabled people, and what provisions will be made for them?

There has been no progress on university participation. Despite spending about £800 million on widening participation, it seems that the Government will miss their target of having half of young adults in university

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by 2010. At current rates, it may take a century to get to that level. Is this because the Government no longer believe that the policy is a good idea, or because they have run out of steam and fresh ideas are needed to see through their pledges?

How many students will lose out as a result of the recently announced cuts to student grants? How can Mr Denham in another place expect universities to spend money that is only temporarily available as a result of VAT reduction when they will face higher costs in NI contributions? Surely, the problem that most people will face in these turbulent times is reskilling, but the Government are insistent about cutting £100 million of ELQ funding. Will the Minister clarify the Government’s position?

I could go on, but I will conclude by drawing an end to this excellent debate and to a whole week of excellent debates. I would like to give the Minister plenty of time to address all the issues that your Lordships have raised.

5.25 pm

The Parliamentary Under-Secretary of State, Department for Work and Pensions (Lord McKenzie of Luton): My Lords, this has been a wide-ranging, knowledgeable and indeed compassionate debate and I would like to thank all noble Lords who have participated. We have covered the affairs of five government departments, including the DWP, my own, which between them account for more than half of all government expenditure each year and touch the lives and affect the life chances of every individual in our country—from the cradle to the grave, as it were. I am bound to say to the noble Baroness, Lady Verma, that it does not sound like a thin programme that we are dealing with here. I hope that noble Lords will forgive me if in the time available I do not respond to all the points raised, but I will cover as much as I can. I will start with issues around health.

My noble friend Lord Darzi explained that the Bill that we will debate will ensure the highest possible standards of care and give more power to individuals to shape the care that they receive. It is about driving up the quality of health services through a duty to produce new, quality accounts. I believe that the thrust of that was welcomed by the noble Earl, Lord Howe, and I thank him for his response. Incidentally, on the issue of recession and what that means for health, I understand that his colleague in the other place opined that recession was good for people's health. I am not sure that the noble Earl shares that view. However, I am delighted for his support on behalf of the Opposition and other noble Lords for the NHS constitution. I was interested to hear that the views of the noble Baroness, Lady Cumberlege, on the constitution were somewhat at odds with that and disappointing given that its development involved a thorough consultation with staff and patients, unlike the Patient’s Charter. I do not think that words such as “sad little document” are appropriate in this case.

The 60th anniversary of the NHS is an opportunity to put in place an enduring constitution that safeguards the future of the NHS. It reaffirms our right to NHS services free of charge and provides an opportunity to

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reaffirm the core values and refresh them for the 21st century so that they provide a basis for a modern, forward-looking NHS. A number of eminent people and organisations support the NHS constitution.

The noble Earl, Lord Howe, talked about tobacco. Contrary to what the noble Earl suggested, evidence from a number of countries shows that removing tobacco displays could reduce the likelihood of young people taking up smoking and support those people who want to quit.

The department is committed to reducing mixed-sex accommodation to an absolute minimum and single-sex accommodation should be the norm in elective care and remains the ideal for all admissions. It is not the case that local authorities are failing at LINks. Local authorities have been under a duty since 2008 to ensure that LINk activities can take place where it is taking longer than expected to establish the LINk itself. Strategic health authorities across the country will be working closely with their local NHS and local authority organisations, ensuring awareness of the new duty and supporting guidance.

I am grateful for the input of the noble Baroness, Lady Barker, into this debate and in particular for raising the important issues around the links between recession and health inequalities. Indeed, that feeds into the views of her colleague the noble Lord, Lord Kirkwood, about health and well-being and the causes of unemployment and how it all fits together. Narrowing health inequalities is a top priority of this Government. We have put in place the most comprehensive programme ever in this country to address them. For example, we are closing the absolute gap on cancer and cardiovascular diseases. Not only have mortality rates come down in our most disadvantaged areas, they have fallen faster than in the rest of England.

We are not cutting NHS resources. Despite concerns about the need to become more resourceful, the recent 2009-10 and 2010-11 revenue allocations represent a £164 billion investment in the NHS. PCTs will receive an average increase in funding of 5.5 per cent in 2009-10 and 2010-11, a total increase in funding of £8.6 billion.

The noble Earl, Lord Listowel, in a typically thoughtful speech, raised issues and concerns around the need to support staff, particularly those working in mental health with drug abusers and the young homeless, and the importance of carers and the role of health professionals. I shall write to him about the statutory issues he raised on health visitors.

My noble friend Lord Warner acknowledged the scale of investment in the NHS in the past decade, and our clear vision towards quality improvement, stating that we must focus on stroke services and end-of-life care. I thank him for his support for the NHS IT programme, and the major changes it is delivering in providing enhanced accuracy and speedier X-rays through the development of picture archiving and communications. I also thank him for his support of choose and book, which provides patients with a choice of healthcare providers. Patients and clinicians are now beginning to see the benefits that these systems bring to improving patient care.

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My noble friend Lord Brooke of Alverthorpe made an interesting contribution and displayed great knowledge about issues of drug and alcohol addiction. He raised a number of detailed points that I will pass on to my noble friend Lord Darzi. The new drugs strategy, covering 2008 to 2018, Drugs: protecting families and communities, builds on the success of its predecessor with a renewed emphasis on elective treatment, supporting drug users in fully reintegrating into their communities through access to housing, education, training and employment. We have invested over £50 million in new capital moneys to expand capacity and support better commissioning of the main abstinence-based activities: residential rehabilitation and in-patient detoxification.

The noble Lord, Lord Colwyn, raised issues within the dental profession. While we acknowledge that there are problems in NHS dentistry, it is in fact growing. The latest statistics show that there were 655 more dentists working in the NHS this year compared to last year. PCTs report no shortage of dentists coming forward when new contracts are offered, in contrast to the situation under the old contract. On the noble Lord’s point about whether the NHS Bill will impact on dentistry, the rights in the NHS constitution will apply for dentistry as for other services.

My noble friend Lord Harrison spoke about the negative public perception of the NHS compared to their personal experience, but it was necessary to concentrate, as we have, on greatly increasing investment and quickly tackling serious problems such as unacceptably long waiting times given the state of the NHS in 1997. These quantitative measures were often mistaken for ends in themselves. We are now free to concentrate on the things that we value most: quality, dignity, control and choice. We hope that perceptions will therefore change. My noble friend spoke also about services for, and care of, children with diabetes. We recognise that these services are variable, and are addressing the problems. The national clinical director at the Department of Health is leading a group taking forward the recommendations of the working group that looked at these issues.

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