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Demographic change is, of course, one of the biggest challenges that this country faces, as was pointed out by the noble Baroness, Lady Fookes, and others. We
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I thank the noble Lord, Lord Kirkwood, for branding me as something like the Mary Poppins of the Government, but I take issue with him on one point. We are very much aware that these are enormous challenges which have to be resolved over a period of time. There is no silver bullet here. However, I think it is fair to say that the current health and social care system has changed substantially from the one that the Government inherited in 1997. I hope that we now have a system that is more responsive, more flexible, more expansive and more empathetic.
Concerns about the care of older people are not new. This Government introduced the first National Service Framework for Older People, the first ever strategy aimed at ensuring high-quality, integrated health and social care services. Since the national service framework was published, there has been steady progress in eliminating age discrimination and improving community health. We have also taken action to extend, for example, access to preventive services, such as flu vaccinations, blood pressure control and breast cancer screening. Older people, in particular, are reaping the rewards of this extra investment.
The next-stage review of the NHS by my noble friend Lord Darzi, published in June 2008, presents a vision of the NHS that consistently delivers the highest quality of care to patients and empowers staff to offer care that is personal, effective and safe. High Quality Care for All, the final report of the next-stage review, sets out the national framework that will enable and support the delivery of the ambitious visions for health and social care published by strategic health authorities last year.
We are also facing unprecedented challenges within social care. An ageing population, higher expectations about what services should be delivered and technological changes mean that a radical rethink is required of the care and support system to meet long-term pressures. That is why, later in the spring, the Government will publish a Green Paper, referred to by many noble Lords, on the reform of the care and support system. This will look at options for developing a sustainable care and support system and at whether it will be possible to develop a new system for all adults and not only for people over 65. The noble Earl correctly outlined the challenges with his usual eloquence. I take on board his reading recommendations, together with those of other noble Lords.
Noble Lords should be, and I believe are, aware that a great deal of work has gone into developing the Green Paper. The public engagement process that ran
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Although the Green Paper will be a major step forward, it is only part of the journey that we are undertaking in transforming care and support. My noble friend Lord Lipsey, with his long-standing expertise, outlined many of the challenges in, as he put it, the landscape of reality that we all face. I also agree with my noble friend and the noble Baroness, Lady Thomas, about the importance of good-quality, accurate and independent advice and information for those facing the challenges of old age.
Noble Lords will be aware that the Government launched the national dementia strategy last month, as was mentioned by the noble Baronesses, Lady Greengross and Lady Gardner. We hope that this landmark document will set out initiatives to increase awareness of dementia, ensure early diagnosis and treatment, and radically improve the quality of care that people with the condition receive. We are also investing in research into dementia and related neurological conditions.
I hope that, as a Government, we are taking steps to deliver better services for older people. In May 2008, my colleague in another place announced that a prevention package for older people would be developed to address the challenge of providing more and better preventive care. Therefore, we are taking forward core prevention services, such as sight tests, and making the case for commissioners to improve services for foot care, falls and fractures, together with all the important preventive measures that can make such a difference to the lives of the elderly.
Through the carers strategy, we have put a deserved spotlight on the unsung heroes in our society, movingly explained to us by the noble Baronesses, Lady Gardner and Lady Fookes, and others. I refer to the 6 million carers who make an enormous contribution to their local communities and who should get all the support they need to continue this important work. We launched the carers strategy in June 2008. The aim of its key components is to ensure that carers have increased choice and control, and we are investing £255 million to ensure that the new strategy is implemented. That includes £150 million over two years for people to take breaks from caring—a point rightly highlighted by the noble Baroness, Lady Fookes.
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Before moving on, I shall refer quickly to a few other points that were raised concerning older people. The noble Baroness, Lady Thomas, made a very interesting contribution about the Hampshire commission’s report, which I should like to read. It seems to take a very practical look at the challenges that people face, and it sounds like a document that deserves wider appreciation.
The noble Baronesses, Lady Fookes and Lady Thomas, and the noble Earl, Lord Howe, raised the issue of people selling their homes. In 2001, we ended the unfair system whereby people in care homes paid for their nursing costs by selling their home, and introduced deferred payments to help people to avoid having to sell against their wishes. However, charging for care is not new; people have always had to pay for their social care, but there is obviously a continuing debate about that.
The noble Baroness, Lady Fookes, raised the issue of personalisation and giving people choice and control over their social care needs. Putting People First, when it was launched over a year ago, earmarked £520 million in total to develop personalised social care, £85 million of which has already gone into the system and £195 million is coming on stream in the next year. It is central to the transformation of giving individuals a personal budget and understanding how it should be met, but I agree that it has to be a supported choice.
So far I have focused on the needs of older people but we should not forget the challenges we face concerning all adults and disabled people who have the right to expect quality of citizenship, independence and a full life, as mentioned by the noble Lord, Lord Rix, the noble Baroness, Lady Emerton and the noble Earl, Lord Howe. Last year the Government launched the independent living strategy which aims to give disabled people greater choice and control over the support that they need to go about their daily lives and how it is provided. We are making progress in delivering this strategy and we are committed to measuring it and reporting on it annually. The principles of control, choice and, particularly, empowerment are fundamental to Putting People First. This concordat sets out a cross-sector commitment to personalising public services and the need for the state to empower citizens to shape their own lives and the services they receive. It supports the commitment to independent living for all adults and is unique in establishing a collaborative approach between central and local government, the sector’s professional leadership, providers and the regulator.
User-led organisations which are controlled by disabled people have a key role to play in delivering personalisation and independent living. Indeed, following this debate I am going to a workshop about exactly that. We are investing more than £1.6 million over the next two years to support the development of up to 25 learning sites around the country to develop best practice and share experience. We will announce very shortly the sites that will receive the funding.
The new equality Bill will also benefit the most vulnerable among us and create a more equal society. The Bill will streamline the law, distilling nine pieces of legislation into a single Act. I am not aware of any delay on its production at the moment. I was at an
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The noble Baroness, Lady Greengross, spoke movingly about the importance of tailored care packages and the need for humanity and kindness to be at the heart of all our work. She is absolutely correct about that.
I shall now respond to some of the comments made on the issues. I promised the noble Lord, Lord Rix, that I would try to answer his points about the campus and care for learning-disabled people. The responses to the Valuing People consultation published in December 2007 showed a common theme from respondents across the stakeholder groups that what was needed was choice in housing options. For some people that meant choice over where a person lived and for others it meant retaining the kind of residential service options alongside tenancies and home ownerships. Experience shows that a number of plans might indicate a preference for congregate living and we need to recognise that. I believe that it is a transitional problem. To support the programme to close NHS campus-style services, a £96 million revenue grant has been made available over the next three years, increasing to £175 million in the coming period.
I am afraid that I cannot address all the questions that were raised, but I want to end on an optimistic note. The noble Baroness, Lady Gardner, reminded us that we should be optimistic, especially when she talked about the research and the hope for medical advances in these areas. She was absolutely right. The noble Baroness, Lady Emerton, reminded us of the importance of leadership and nursing practice in the care of elderly and disabled people. My noble friend Lady Morris reminded us through her explanation about First Taste that this is not just about caring for bodies but also about caring for people’s souls. The noble Viscount, Lord Tenby, also reminded us that we need to move forward optimistically.
We might anticipate that a debate led by the noble Baroness, Lady Fookes, and with the participation of distinguished colleagues from around the House, would be of the highest quality, and indeed it was. I thank noble Lords once again for their excellent contributions today.
1.36 pm
Baroness Fookes: My Lords, from the bottom of my heart I thank all those who have contributed to this fascinating debate today. Each one has brought a degree of expertise and personal experience that has been truly illuminating in this very important subject. While all those who spoke seemed to suggest that we needed a radical look at the whole policy for the
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Charles Darwin
Debate
1.37 pm
Baroness Hooper: My Lords, it is a great delight and honour for me to open today’s debate about a great man who represented a great era in our history, when scientific and technological developments moved us into a new world. This very building is a product of that age and I have been wondering whether the great man spent any time here in your Lordships’ House. I feel sure, however, that had the Life Peerages Act been around then, he would have been a most distinguished Member of this House.
Charles Darwin was a man who asked questions and found many of the answers. He was a diligent collector and a meticulous observer who had the patience to spend 20 years evaluating his evidence and developing his theories. He has been called one of the most influential Britons of all time and the most important natural historian ever. There can be no doubt that his theory of evolution by natural selection shaped scientific thinking and dramatically influenced the society in which we live today.
His achievements are rightly being celebrated in this bicentenary year and this, in turn, has drawn our attention and recognition to the work of his contemporaries, such as Sir Richard Owen, the founder of the Natural History Museum, Wallace and Lyell—with whom he corresponded extensively—and William Paley, the Archdeacon of Carlisle, to name but a few. That also cross-references to the work of Mendel and other scientists, leading us on to the double helix of Francis Crick and James Watson in the 1950s. It is a compelling fact that 150 years after the publication of The Origin of Species modern genetics has proved that all life is related.
Today is also a family occasion. Direct descendants of the Darwin family are present in your Lordships’ House and some of the descendants of friends and colleagues of Darwin will be speaking in this debate. Another remarkable coincidence is that this is the 150th anniversary of the first publication of The Origin of Species and the direct descendant of John Murray the publisher, which is still a family business, will re-enact the publication of the original book on 24 November this year. These links provide a wonderful sense of continuity of history and enjoyment of our heritage.
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When I tabled this Motion for debate towards the end of last year, I was concerned that the bicentenary of this great man might not be duly recognised. In the event, I was proved very wrong. There has been almost overwhelming coverage: the splendid exhibition at the Natural History Museum; the Radio 4 series, preceded by one of the special programmes made by the noble Lord, Lord Bragg; the television series—need I mention Sir David Attenborough and Andrew Marr in this context?—innumerable books devoted to Darwin’s life and times; and exhibitions and conferences up and down the country. The exhibition at Down House, Darwin’s home, is particularly significant. In the words of Sir Barry Cunliffe, the chairman of English Heritage, that exhibition,
- “places Down House firmly on the international map as one of the world’s most important scientific heritage sites and brings to life the man and his family, his painstaking research and his groundbreaking theories”.
There is even the launch of the Beagle project, about which we shall hear more from the noble Lord, Lord Livsey, in due course.
Perhaps I should explain my interest and involvement in the work of Charles Darwin. It stems from my love of Latin America, in particular, of Ecuador, where I was fortunate enough to spend a postgraduate year—now many years ago—and although my thesis focused on international law and economics, I became intrigued by the tales I heard of the Galapagos Islands and was infected by the enthusiasm of the then British ambassador to Ecuador, Gerard Corley Smith, who eventually become one of the first chairmen of the Charles Darwin Foundation, which is celebrating its 50th anniversary this year. The fact that Charles Darwin was so stimulated as a young man by what he found in Brazil and other parts of South America as well as in the Galapagos Islands warmed me to him. The amazing fact about the Galapagos Islands is that all the birds that Darwin saw are still there. However, the mocking birds—the main basis for his research, not the finches as is popularly thought—although still there, are critically endangered. There is an urgent need to preserve all the things that mocking birds depend on. There is a project led by Felipe Cruz of the Charles Darwin Foundation on the island of Floreana, so action is being taken. I know that the noble Viscount, Lord Montgomery, intends to elaborate on it and on the invaluable work of the Galapagos Conservation Trust, which is trying to preserve the environment of the islands.
However, the fact remains that modern communications and, unfortunately, tourism have deprived the Galapagos Islands of the isolation that they had enjoyed for so many thousands of years. What Darwin saw there—cormorants that had lost the power of flight, lizards that swam out to sea, the mocking birds and the giant tortoises—may still be there, but they are threatened on a scale never before seen. It is important that there should be awareness of this and that appropriate action should be taken.
Lord Lea of Crondall: My Lords, this is meant to be a helpful interjection. The noble Baroness makes a fascinating point, but I shall pose one of the central questions. Some people think that the whole point of
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Baroness Hooper: My Lords, that was a helpful interjection, and some of my distinguished colleagues will be able to tackle that question much better than I can.
I was on the point of moving from that aspect of Darwin’s life to explore a little the controversy over his theory of evolution and the concept of intelligent design. In other words, the arguments of the Bible literalists and those who say that Darwin’s theory reduces humanity to a by-product of blind forces against those who say that God cannot exist because there is no evidence to prove it. I realise that the noble and right reverend Lord, Lord Harries of Pentregarth, and doubtless other noble Lords will be exploring this further before there is another helpful interjection.
My view is that between the extremes of the argument lies a middle path. I agree with the view that faith and science are not fundamentally opposed to one another, and I also believe that faith is a gift. I somehow feel that Darwin was not an extremist. He saw what he saw, his observations were scientific and his methodology was rigorous. As he says in his autobiography, at one stage in his life, he was convinced that,
I think that is a wonderful way of describing what many of us feel. Yet we are told that he died an agnostic, so not only did he not know, but he did not know whether it was possible to know, which I understand is the definition of an agnostic. The reasons for Darwin’s loss of faith are of interest and relevance to believers and non-believers today. Questions about what constitutes legitimate and sufficient evidence for religious beliefs or how we understand or accommodate suffering within a religious context continue, and doubtless will continue, to be asked. However, it is important to remember and be guided by the fact that in spite of everything we are told, Charles Darwin remained as courteous and respectful to those who retained religious beliefs as he was to fellow agnostics. That is an example to be followed.
Finally, in considering the celebrations of this bicentenary year, we should also consider the legacy and look to the future. Much is known about 5 per cent of the universe, which leaves the challenge of the remaining 95 per cent. The Large Hadron Collider project in Geneva may give us some of the information and some of the answers on this. It may even give us more information on the Higgs particle, the so-called God particle. The important thing is that there should be people who question and people who are prepared to do the necessary research. Who will be the next genius to follow in Darwin’s footsteps? Are we doing enough to encourage young people to take an interest? I believe that this debate and the many celebrations of the Charles Darwin’s great achievements help us to move things forward.
This has been an absorbing subject on which to prepare for a debate. I have learnt a huge amount in doing so, and I look forward to learning more from the many distinguished participants in today’s debate.
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1.48 pm
Lord Haskel: My Lords, I congratulate the noble Baroness on introducing this extraordinarily interesting debate. It is topical not only because it celebrates Darwin’s bicentenary but in other ways to which I shall draw your Lordships’ attention. As the noble Baroness explained, Darwin made a wonderful discovery and his scientific principle is full of depth and subtlety—other noble Lords will be able to explain the science far better than I can—but it is also a powerful idea that when removed from the subtlety of science to the bluntness of politics becomes a pretty blunt political instrument.
There are no special ethics for science. As the noble and right reverend Lord, Lord Harries, said, science deals with the “how”, so it does not need its own ethical system. It is when you move on to the “therefore” and what follows the science that ethics and morality enter the equation. Because there is no special morality attached to how nature works, unscrupulous people extend the absence of the need for special ethics to the “therefore” and to what follows.
That was used to justify slavery and colonialism by Europeans. If only the fittest survive, there is no point in helping the less fit or the feeble-minded to survive, argued Malthus. If Darwin is right, why not use eugenics to breed better humans and to help natural selection along? It is to the great credit of this Parliament that a Bill to that end was talked out in 1912. Not so in the United States. There, the Supreme Court agreed that it was legal to use sterilisation by force to strengthen the US breeding stock. As we know, those ideas reached a climax in Germany with the ideas of the master race and the elimination of the Untermenschen. All that was justified by Darwin’s theory of natural selection and the survival of the fittest and the use of Darwin’s theory as a means to view other people as fundamentally inferior and not like us.
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