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House of Lords

Monday, 9 February 2009.

2.30 pm

Prayers—read by the Lord Bishop of Manchester.

Railways: East Coast Main Line


2.36 pm

Asked By Lord Bradshaw

The Minister of State, Department for Transport (Lord Adonis): My Lords, National Express East Coast is meeting the terms of its franchise agreement, with the exception of responding to all written customer correspondence within 10 weekdays. Currently, National Express East Coast is responding to approximately 94 per cent of correspondence within agreed timescales and is putting measures in place to remedy this situation.

Lord Bradshaw: My Lords, I thank the Minister for that reply, but are the facts that fares are rising very sharply, on-train service is declining and staff morale is shattered the result of a thoroughly flawed franchising process that is in desperate need of overhaul?

Lord Adonis: My Lord, those were some good sound bites, but they do not bear much relation to the real situation on the ground. In terms of the statistics on punctuality on National Express East Coast, the proportion of trains arriving within 10 minutes of their scheduled time has increased from 81.2 per cent to 85.7 per cent in the past 12 months and the independent national passenger survey of customers’ overall satisfaction with the franchise for the autumn stood at 88 per cent, up from 84 per cent in the spring of 2008. The more one looks at the facts, the less the noble Lord’s picture stands up to scrutiny.

Lord Berkeley: My Lords, can my noble friend assure the House that if National Express or anyone else comes to him and says, “I can’t carry on with my franchise any more. Here are the keys back”, he will not bail them out but will go out to tender again and in the mean time operate the franchise from the Department for Transport?

Lord Adonis: My Lords, I am glad to say that National Express East Coast is fulfilling the terms of its franchise agreement and it, and we expect that to continue.

Lord Hanningfield: My Lords, I will follow the noble Lord, Lord Bradshaw, in his line of questioning. Has the Minister been meeting any of the franchisees to discuss the effects of the recession and the possible drop in passenger numbers?

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Lord Adonis: My Lords, the train operating companies met my right honourable friend the Secretary of State a short while ago. They made no request for government assistance, nor did they indicate any intention of cutting train services.

Baroness Harris of Richmond: My Lords, I declare an interest as a weekly commuter on the east coast main line. I heard what the Minister said about the speed of the trains. Indeed, it is very good. However, the quality of service is also important. If the Minister did not specify in the contract that the quality of the service, on first class, certainly, was part of the franchise, that is a real defect. The service has been deeply degraded and does not now give value for money. It was an outstanding service when GNER had it, but is now third rate.

Lord Adonis: My Lords, there were a number of assertions in the noble Baroness’s question. If she wishes to make particular points to me about service quality, I will, of course, look at them. In terms of service punctuality, which is a key issue for passengers, punctuality on the east coast main line has improved and independent surveys of passenger satisfaction show that it is rising, not falling, on the east coast main line.

Viscount Tenby:My Lords, what are the Government’s views on the wholesale closure of many stations halfway through the day and on the many redundancies, some compulsory, in front-line staff, such as ticket clerks, porters and the like? Does he agree that actions of that sort bear most heavily on the infirm, the handicapped and the elderly? Is it not the case that it drives a coach and horses through the Government’s avowed intention of getting people out of their cars and making a carbon-friendly gesture? I declare an interest as someone who commutes on South West Trains three or four times a week.

Lord Adonis: My Lords, I am glad to say that there have not been wholesale closures. The noble Viscount rightly refers to the position in respect of South West Trains. As he may be aware, my right honourable friend the Secretary of State and I had to make a decision recently on a request by South West Trains for a significant cut-back in the staffing of ticket offices and their opening hours. We rejected a substantial proportion of the request for reduced opening hours in ticket offices in the South West Trains franchise area for the reasons that the noble Lord gave in terms of the duty that we have to see that there is widespread, easy access to tickets and that passengers are not unduly inconvenienced.

Lord Walton of Detchant: My Lords, I came down this morning from Berwick-upon-Tweed, where there was several inches of snow, on National Express. The train left on time, it arrived in London on time, and I had a very comfortable journey. But does the Minister accept that we are very concerned about the reduction in the catering facilities on National Express? It has closed the dining car, except on very limited occasions, and even the snacks are not up to standard. I am no longer able to get my usual: a tomato juice and a tuna sandwich.

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Lord Adonis: My Lords, my powers may not extend to tomato and tuna sandwiches. Until the last part of the noble Lord’s question, I thought that he would be fronting our next advertising campaign for the railways. On the catering on the east coast main line, the noble Lord is correct to say that there has been a reduction in the number of restaurant cars. They have been replaced by an at-seat dining service, which makes the dining facilities more readily available to passengers than was the case when they were available only in the restaurant car.

I have perused the menu of the at-seat dining service, so solicitous am I for the noble Lord’s welfare. He can choose between crayfish and chorizo risotto, Italian brunch, and steak sandwich served with Italian mixed leaves, not to mention the east coast fish pie. The wine list is not bad either. There is a 2006 Merlot, a Shiraz 2005, a Cabernet Sauvignon 2006 and, if the noble Lord really wants to treat himself, there is also a Laurent-Perrier, although I have to say that that comes at £45. I do not think that that is too bad.

Lord Brookman: My Lords, my noble friend has given us a lot of statistics. If a Premier League-style table were drawn up, who would be top, who would be bottom and who would be somewhere in the middle?

Lord Adonis: My Lords, I think that they would all be somewhere in the middle.

Lord Faulkner of Worcester: My Lords, can my noble friend confirm that not all passengers on National Express are first-class ticket holders who are Members of your Lordships' House and that the figures that he revealed from the national passenger survey, which show an increase in satisfaction among ordinary people paying for standard class tickets, indicate that we are not actually doing that badly?

Lord Adonis: My Lords, I entirely agree with my noble friend.

Health: GP Surgeries


2.44 pm

Asked By Baroness Jones of Whitchurch

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, thanks to the efforts of general practitioners, their staff and primary care trusts, the NHS exceeded our objective of at least half of all GP practices providing extended opening hours by December 2008. Seven out of every 10 practices currently offer extra appointments outside normal working hours. That proportion continues to increase.

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Baroness Jones of Whitchurch: My Lords, I thank my noble friend the Minister for that reply. I endorse the fact that GP services are improving—my own service in Brighton is exemplary. However, does he acknowledge that there are some worrying regional variations in the extension of opening hours? Is he concerned that this might lead to greater inequalities in healthcare provision than already exist between deprived and affluent areas?

Lord Darzi of Denham: My Lords, I said that 50 per cent of GP practices are open for longer but in fact 70 per cent across the country are opening longer, and we anticipate that that figure will have improved by March. As for inequalities, the extra £100 million that the Government have invested includes provision for setting up 112 traditional primary care practices to tackle inequalities. That is in addition to our attempts to develop the quality of care provided in deprived areas through improvements in the QOF scores.

Baroness Tonge: My Lords, does the Minister agree that whatever the opening hours for GPs, GP practices should be allowed to be more flexible in the appointments they give, thus allowing patients not to have to make numerous phone calls in order to fit in with the 48-hour target?

Lord Darzi of Denham: My Lords, the recent survey we carried out showed that 87 per cent of the population are happy with their ability to obtain appointments within 48 hours. I could not agree more with the noble Baroness that flexibility is an important part of that. I am delighted to report that nearly 70 per cent of patients can also book the specific general practitioner whom they wish to visit.

Lord Naseby: My Lords, how are the Government monitoring the incidence of patients who book an appointment but fail to turn up, and fail to ring the practice to inform it that they are not going to turn up? Will the new constitution help in resolving this clear waste of resources?

Lord Darzi of Denham: My Lords, I have no doubt that that information is recorded and measured at a practice level and that many general practitioner colleagues and staff, such as practice managers, are actively recording that information and feeding it back to patients who may, as the noble Lord points out, be abusing the system.

Baroness Billingham: My Lords, are not Saturdays one of the prime times when working families would like to see their doctor? If so, what progress has been made in that direction?

Lord Darzi of Denham: My Lords, that is part of our policy: “extended opening hours” refers not only to evenings but also to Saturday mornings. As I said, a large number of practices—50 per cent to date—are opening on Saturday mornings to meet the needs of the local population.

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Lord Colwyn: My Lords, does a doctor have to be present during opening hours, or can a practice nurse supervise the routine running of a practice?

Lord Darzi of Denham: My Lords, all of these health centres will have a general practitioner available from eight in the morning to eight in the evening, seven days a week. As the noble Lord will be fully aware, in addition to a general practitioner, other team members, including nurses, practice managers and others, will be available.

Baroness Gardner of Parkes: My Lords, what is the current situation regarding visits by general practitioners? When I was involved in running the health service in London there was a major problem in that certain areas were not safe for general practitioners to go to after certain hours. This applied particularly to women practitioners, who often had to take a large dog or a bodyguard with them. In view of all the knife crime in London, is this a continuing problem, or is there now no difficulty?

Lord Darzi of Denham: My Lords, I think that the noble Baroness is referring to out-of-hours home visits by general practitioners. I agree that it was an issue, and it is why 10 regions around the country have considered the acute pathway in designing services around the needs of patients out of hours, possibly including a dedicated telephone number by which a patient can be evaluated and the appropriate expertise sent in an out-of-hours visit to meet the needs of the patient.

Lord McColl of Dulwich: My Lords, does the Minister accept that there are general practices where there is no demand by the patients for these extra hours—some country districts, for instance? Will the Government allow them to carry on as they are, or will they all be forced to open?

Lord Darzi of Denham: My Lords, as a medical practitioner like the noble Lord, this is the first time I have heard that patients may not wish to see doctors being available out of hours. The answer is that we have negotiated contractually with the BMA to ensure that within each area there are certainly a number of practices that might offer extended opening hours. I have no doubt that collaboration at local level will allow a degree of flexibility.

Lord Grocott: My Lords, has my noble friend noticed that there have been very few supplementary questions on this Question? That is one the reasons why I am standing up now. Does that not reflect the fact that in this area of operation of the health service there is actually widespread approval of what the Government have been doing? People will quickly raise queries and complaints when they are there. It is not just in this area of the health service; as a general proposition, it holds true that while people may make generalised complaints, their own experience of the health service is one of overwhelming support for the doctors and nurses and for what the Government have been doing.

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Lord Darzi of Denham: My Lords, I am grateful to my noble friend. To reaffirm the points he made, I understand that we currently have the highest satisfaction levels with the NHS since patient satisfaction surveys began.



2.51 pm

Asked By Lord Dykes

Lord Davies of Oldham: My Lords, we are gravely concerned at the allegations made by such credible organisations as the International Committee of the Red Cross and the United Nations. The UN Human Rights Council, in its resolution of 12 January, has decided to send an international fact-finding mission to investigate violations of human rights law and international humanitarian law by Israel in Gaza. We will consider the results of the fact-finding mission once they are available; and at that stage the parties and the international community will need to decide on any further action.

Lord Dykes: My Lords, I thank the Minister for that very positive Answer. In view of the Foreign Secretary’s unequivocal assertion in the other place on 12 January that all ICRC-routed complaints of possible war crimes should be investigated, will the Government therefore now work energetically and unceasingly with our EU partners to secure comprehensive and objective investigative machinery under universal international auspices as quickly as possible, while the evidence remains fresh?

Lord Davies of Oldham: My Lords, it is expected that we and the international community will co-operate with the investigation that is being carried out under the UN Human Rights Council. We will need to evaluate those results when we have the evidence but contributions will be made from a number of sources, and the British Government will play their part in any way that they can.

Lord Clinton-Davis: My Lords, is not the top priority now to examine the possibility of working out a permanent peace settlement, in view of the tremendously fragile character of the situation at present?

Lord Davies of Oldham: My Lords, I agree with my noble friend. The priority is certainly to look towards establishing a permanent ceasefire and the basis for a stable peace. That is the area in which the British Government can play a constructive role together with our partners in the EU.

Baroness Northover: My Lords, what will the Government do to ensure that this is indeed an independent and full investigation? To pick up my noble friend’s question, could this be referred to the EU sub-committee on human rights for it to investigate whether the trade agreement with Israel should now be suspended?

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Lord Davies of Oldham: My Lords, on the independence of the investigation, as I have indicated, it will be conducted under the international auspices of the United Nations Human Rights Council, which will investigate the facts as fully as it is able to do. Additional action with regard to Israel and any action by the European Union are matters for the European Union to consider, but the main issue on human rights is properly located with the international body responsible for the investigation.

Lord Howell of Guildford: My Lords, following observations in this House last Friday and the assessment of the overall situation, would it be understood that, if any investigations were to be carried further, they would involve actions by both parties to this horror because direct attacks on civilians appear to have taken place on both sides? Is it accepted that the investigation would have to be even-handed and fair?

Lord Davies of Oldham: My Lords, I am at one with the noble Lord in recognising the value of Friday’s debate which covered these issues very intensively. It is quite clear that rockets from Gaza have killed and injured civilians in Israel. The United Nations Human Rights Council is to investigate violations of human rights law and the international humanitarian law by Israel as a state operating in relation to Gaza. That is the proper role of the United Nations body.

Lord Elystan-Morgan: My Lords, does the noble Lord accept the wise precept of the noble and learned Lord, Lord Woolf, tendered to this House a fortnight ago, that we should not rush to judgment in this matter until and unless the facts are fully and accurately established? Does he further agree that no nation should condemn out of hand the state of Israel, unless that nation too has walked through the valley of the shadow of death and lives within range of the malice of enemies who are determined to bring about its annihilation?

Lord Davies of Oldham: My Lords, I am grateful to the noble Lord for establishing the context in which these issues are to be resolved. As an earlier question reflected, we shall need good will on all sides to promote a long-term solution to the positions of Israel and Palestine. He will appreciate that the United Nations Human Rights Council has been charged with the task of this investigation. Of course, it is working on the premise that he is working on: namely, that no one has the right to lay any charges until the facts have been investigated.

Lord Anderson of Swansea: My Lords, clearly there were an appalling number of innocent civilian casualties, but will the inquiry also be empowered to look at the scale of those casualties because the memory of the exaggeration of Jenin is very fresh in the minds of many?

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