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House of Lords

Thursday, 18 December 2008.

11 am

Prayers—read by the Lord Bishop of Norwich.

Children: UNICEF report


Asked By Baroness Walmsley

11.06 am

Baroness Walmsley: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a trustee of UNICEF UK.

The Parliamentary Under-Secretary of State, Department for Children, Schools and Families (Baroness Morgan of Drefelin): My Lords, the Government are passionate about helping children to reach their full potential and about eradicating child poverty. We are proud of the progress we have made through our childcare strategy. We recognise that we have more to do. Our relationship with UNICEF is important to us but we are concerned that the report does not reflect our major achievements and falls short of the high standards of accuracy that we expect from the organisation.

Baroness Walmsley: My Lords, I thank the Minister for her reply. I hope she will accept that organisations sometimes have to take OECD data that are not as up to date for every country as they are for some, and I hope she will recognise that UNICEF has recognised the Government’s commitment to young children. However, what about parental leave? Does she accept that remuneration, as well as duration, is crucial regarding whether parents can afford to take the full amount of leave to which they are entitled and that this is important for the cognitive, social and emotional development of their babies? Do the Government have any plans to increase the level of remuneration for both parents so that they can spend that important time with their babies?

Baroness Morgan of Drefelin: My Lords, the Government made their plans clear in the recent pre-Budget announcement. We intend to continue making significant investment in childcare and support for parents. I accept the noble Baroness’s assertion that the financial position of parents is extremely important in allowing them to support their children. That is why we have worked so hard to promote child tax credits to 450,000 lower and middle income families. I will look carefully at what plans we have on parental leave, but she must accept that we have made real progress in

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supporting parents to take the time off that they need to look after their children when they are young.

Baroness Verma: My Lords, given the Government’s commitment to childcare provision, why has the United Kingdom fallen behind countries such as Slovenia and Hungary in achieving the benchmarks laid out in UNICEF’s report, managing only five out of the 10 benchmarks?

Baroness Morgan of Drefelin: My Lords, I would not say that we have fallen behind. If we were to look carefully at how the benchmarks are defined we might find that this country deserves a further three benchmarks, which would put us on a par with France and Denmark. I do not really wish to be lectured by the party opposite on the question of childcare because I can remember a time when it felt that childcare was very much a private matter and not something that the Government should invest in.

Baroness Howe of Idlicote: My Lords, given the point made by the noble Baroness, Lady Walmsley, about the need for both parents to be supported in their role and in view of the fact that very little flexitime is given by employers to male parents, what do the Government intend to do to encourage a better response from employers in this direction?

Baroness Morgan of Drefelin: My Lords, it was in the Times that the role of fathers in childcare was picked up. The UNICEF report does not look very carefully at the role of fathers as parents. The noble Baroness is right because it is not until both parents have the opportunity to fulfil their potential as parents that we will see children benefit from the maximum potential of quality childcare. There is therefore a great deal more that we can do as government. We do a lot of work to promote positive parenting through more than 2,900 children’s centres around the country. We are committed to make sure that we have a children’s centre in every community.

Baroness Sharp of Guildford: My Lords, given the importance attached by the report to high quality care in those early childhood settings, how far is the Minister encouraging graduates to go into childcare in order to improve professional development in those settings?

Baroness Morgan of Drefelin: My Lords, it is our ambition that a graduate should be taking a leadership role in every early-years setting. It will take us some time to get there, but we are investing significantly in developing the children’s workforce, including early-years staff. The noble Baroness is right to draw out that question. It is very important that we have high quality people working in these settings.

Lord Skelmersdale: My Lords, if the Government’s ambition is to have childcare all around the country and they have not yet achieved it, why are they encouraging single parents with children between one and five to get into work?

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Baroness Morgan of Drefelin: My Lords, we need to make it clear that it is this Government’s expectation that lone parents should work where they have the opportunity to do so and quality childcare is available. It is in the interests of their children because of its impact on child poverty. As we know, the intergenerational effect of child poverty is marked. Ninety-five per cent of three year-olds and four year-olds in this country now take up free early learning and childcare, which was never available in the past. We are also piloting an entitlement for two year-olds to have access to the new early-years foundation stage. These are transformational changes in the availability of childcare places, which has doubled in recent years. We are not expecting anyone to go out into the workforce where we are not doing our best to provide adequate and appropriate childcare.

Lord Pearson of Rannoch: My Lords, are the Government satisfied that the training of social workers and other professionals involved in childcare is adequate to their task, or does that training remain bedevilled by the gender, race and class agenda?

Baroness Morgan of Drefelin: My Lords, the Government feel strongly that we need to do an enormous amount of work to embed the improvements that we have made across the board in the children’s workforce. The noble Lord referred to social work. Last week, we established a joint task force with the Department of Health to take an end-to-end look at the profession, from recruitment and retention to training, and higher education, too. How we can improve and develop further the training of workforces such as those in social work and early years is an important question for us.

Health: Physicians


11.14 am

Asked By Lord Roberts of Llandudno

Baroness Thornton: My Lords, I think that the noble Lord will not be surprised to learn that data from different countries on the number of physicians per capita cannot be easily compared, due to definitional issues and whether we are dealing with just NHS doctors or with private doctors, too. However, there has been unprecedented growth in the medical workforce since 1997, including a 40 per cent increase in the number of doctors employed and a 53 per cent increase in the number of doctors in training.

Lord Roberts of Llandudno: My Lords, I thank the Minister for that Answer. She will be aware that out of 27 countries in the European league table, we are in the bottom four or five, as far as the ratio of doctors

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per patient goes. We have fewer than everybody else except, I think, Romania and Poland on the last count. Is the Minister aware of the difficulties these inequalities cause to the most vulnerable parts of our communities, such as parts of Wales and the north-east of England? If she is, what is she doing to remedy that?

Baroness Thornton: My Lords, health inequalities exist for a number of reasons, and access to high-quality primary healthcare, and therefore the availability of doctors, is certainly one factor. However, it also includes other issues such as diet and lifestyle. International research by the academic Barbara Starfield has demonstrated that increasing the number of primary care clinicians in areas with the greatest health needs is one of the most effective ways of improving the population’s health—the noble Lord is indeed correct—so we are investing an additional £250 million annually in new primary healthcare services. We have asked every PCT to develop a new GP-led care plan, and are establishing 112 new GP practices in those areas of the country with the fewest GPs and the greatest health needs. I cannot comment on south Wales, because that is a devolved matter.

Baroness Gardner of Parkes: My Lords, it is clear from the supplementary question that the questioner used the word “physicians” to mean doctors in general, because that is the table he cited. I would like to turn to the specific point about physicians, and, in particular, consultant physicians. Is the Minister aware that, as a country, we are unfortunately reaching the point that when you go to see a consultant, you are looked at as a kidney, a toe or some individual organ? There is a great need for more general consultant physicians in the UK. Will she do whatever she can to encourage the training and education of more consultant physicians?

Baroness Thornton: My Lords, the noble Baroness describes being a toe or a part of a body very well indeed. We are obviously very concerned to increase the number of doctors. At the moment we have 46,783 doctors in training, including doctors who will go on to become consultants. That is an increase from 30,313 in 1997. The noble Baroness is completely right: improved patient outcomes depend on having the right staff in the right place at the right time with the right skills.

Lord Walton of Detchant: My Lords, when I was appointed a consultant neurologist in 1958, there were 134 consultant neurologists in the UK, compared with 400 in Finland, with a population of 5 million. As the Minister has said—it is welcome—there has been in the last 10 years a major increase in all specialties of the consultant establishment. But, as reports from the royal colleges have demonstrated, would she accept that we are still far short of the ideal establishment of consultants in all medical specialties which would be required to give a full and satisfactory service to the UK community as a whole?

Baroness Thornton: My Lords, the noble Lord has raised a very interesting point, because, as far as we

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can see, there is nowhere in the world where anybody says that there is an ideal number of doctors per head of the population. I specifically asked my officials to find that out for me. But we hope that, with the restructuring and decentralisation of NHS services, there will be an increased recruitment of professionally qualified staff, including GPs and consultants. We hope that the new system of recruitment and training will produce the outcomes we want.

Viscount Simon: My Lords, on the basis that one size does not fit all, how will the Government cope with different needs in different areas?

Baroness Thornton: My Lords, my noble friend is absolutely right. As proposed by my noble friend Lord Darzi in his report, we anticipate that successfully shifting services closer to home will result in services being more convenient for patients and service users. For example, with conditions like diabetes, which is increasing in the population, we anticipate that community-based services will play a more prominent role. Providing care closer to home can improve patient recovery, which ends repeated trips to hospital and gives more personalised service.

Lord Rea: My Lords, will my noble friend agree that not only does increasing the number of general practitioners in primary care improve the health of the population, but increasing the support of other health professions in relation to medicine, such as nurses, health visitors and counsellors, does? In my professional life, I have found that it is enormously more satisfactory to work in a team that includes such people.

Baroness Thornton: My Lords, my noble friend is correct. The OECD report referred to by the noble Lord recognises that in the UK we have a higher than average number of nurses, and that we have very good team working with good health outcomes.

Earl Howe: My Lords, will the Minister concede that the problem over the past few years has been that workforce planning has been something of a mess? As my noble friend said, there is a shortage of consultants in key specialties, yet there is an oversupply of doctors who have competed their basic training but who cannot find a consultant’s job. What specific measures are the Government taking to address that?

Baroness Thornton: My Lords, the workforce planning cycle coming into force begins with primary care trusts and local councils commissioning services to meet the healthcare needs of their local populations. In other words, we are no longer setting national targets. We did that some time ago to boost the number of doctors, clinicians and professionals that we needed in the healthcare service. The restructuring and decentralisation should mean that increased recruitment of professionally qualified staff, including GPs, will have an impact on the training and the number of hospital doctors who will have a sufficient case-load volume to achieve the best outcomes.

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Government Borrowing


11.22 am

Tabled By Baroness O’Cathain

Lord James of Blackheath: My Lords, at the particular request of my noble friend Lady O’Cathain, I beg leave to ask the Question set against her name on the Order Paper.

Lord Davies of Oldham: My Lords, figures from the November 2008 public sector finance release, issued this morning, show that public sector net borrowing was £56 billion in the first eight months of 2008-09. The latest population estimates from the Office for National Statistics indicate that the UK population reached 61.4 million by the end of 2007-08.

Lord James of Blackheath: My Lords, I thank the Minister for that Answer, but perhaps we could turn the Question slightly for his benefit. The total number of taxpayers in the country—a more relevant assessment—is 31 million, each paying an average tax of £4,830 per year. The 60 million alone represents a burden on each taxpayer of £3,722. By how much has borrowing gone up in the past year as a future burden to be repaid from revenue? How do the Government intend that to be carried as a burden on taxpayers into future years?

Lord Davies of Oldham: My Lords, the House will recognise that the burden increased significantly as the Government set about introducing the fiscal stimulus to the economy. The noble Lord, having slightly changed the basis of the Question, still shifts from the basis on which this debate normally occurs among economists and in politics, which is as a percentage of GDP. In those terms, we approached the recession with the second lowest debt in the Group of Eight countries. It is clear that our debt is about to increase significantly. That is also the case for other countries.

Lord Forsyth of Drumlean: My Lords, if government borrowing is to rise to these very high levels, can the Minister help me by explaining how that will not result in the crowding out of the private sector? The high levels of public borrowing will make it harder for businesses to get the funds that they need, which is what the Government say they want to achieve.

Lord Davies of Oldham: My Lords, that question is more relevant to the past decade than to the situation in which we find ourselves. As I am sure the noble Lord will readily appreciate, small and medium-sized businesses, and business as a whole, cannot get investment funds at present because of the credit crunch and the position that our banks are in. That is why the Government have set about the recapitalisation of the banks in order to guarantee that the very problem that the noble Lord has identified is tackled.

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Lord Barnett: My Lords, does my noble friend accept that the borrowing will, indeed, be very high—it would very likely be even higher without a fiscal stimulus, as the recession would probably last longer—and that it will have to be repaid once the recession is over? Has he read the article in the Times this week by Anatole Kaletsky, the only decent writer on that paper, particularly on economics, who agrees with the fiscal stimulus but suggests that one method of repaying it in due course might be through the fuel escalator, which we have suspended for the moment, set at 5 per cent above inflation every year? That would, indeed, be a reasonably sensible thing to do given that oil prices are now coming down substantially.

Lord Davies of Oldham: My Lords, oil prices are, of course, an important determinant. However, my noble friend will recognise that oil producers are addressing themselves to oil production, so the drop in price may not continue. On the more general point that he makes, of course the Treasury will examine every proposition with regard to the most effective way of repaying the very significant debt that will accrue so that we keep the depth of the recession as shallow as we possibly can.

Baroness Noakes: My Lords, the amount of debt is quite extraordinary; it will exceed £1 trillion, the highest level for 40 years, and borrowing will be at the highest level for more than 60 years. Does the Minister think that the Government have made any mistakes at all over the past 10 years?

Lord Davies of Oldham: My Lords, if the noble Baroness were in any other Parliament, she could say exactly the same of any other Government. Of course mistakes have been made but I think that, given the international nature of this crisis, it scarcely behoves us to point the finger of criticism at any one Government and certainly not at our own. We are faced with a global collapse of the financial system on an unprecedented scale. That is why, as she rightly says, we have introduced a fiscal stimulus, which produces debt way above the levels that we have had since the Second World War. Of course, that has to be repaid. The alternative, however—and this is what we largely hear from the party opposite—appears to be to follow the strategy adopted in the 1930s and we all know what that led to.

Lord Newby: My Lords, we on these Benches accept the need for a fiscal stimulus but are rather bemused about why the VAT route has been chosen, given that, by the Government’s own estimate, half of that will go into savings rather than into boosting expenditure. Will the Minister explain why VAT was chosen as a way of introducing a fiscal stimulus rather than a more effective way of increasing spending on the high street?

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