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On the access of aid convoys by road and by sea, the two Foreign Secretaries insisted to the Government that there was now plenty of aid, both food and medical supplies, in the country and that the key issue is access—the ability to deliver the aid. Not nearly enough food, medical supplies or indeed aid workers have been able to enter the area.

I turn to whether British military assistance has been used in the conflict. As this conflict is not a new one, we have issued export licences for military equipment in a very limited and, I hope, judicious way. Although we have not investigated the matter, I very much hope that no such materiel has been used.

On the 13 UN workers, I believe that they still have not been released from the camps. I cannot tell the noble Baroness whether the Secretary of State and Foreign Secretary have yet spoken. As the Statement in the Commons was not that long ago, I am afraid the noble Baroness has caught me on that one.

On the Commonwealth discussions, I have been leading those and have been in regular touch with the Commonwealth secretary-general who, at this moment, is trying to organise the next CMAG. At the previous one, Sri Lanka was raised under other business. He is determined that it should be raised. Sri Lanka itself is currently a member of CMAG, which is about the breakdown of democracy in terms of the Harare principles that it seeks to enforce. The case needs to be made about the grounds and terms on which this discussion can take place, but the Commonwealth secretary-general has been clear in condemning the

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conflict, appealing for a ceasefire, and stating that this matter is the business and concern of the Commonwealth and that the Commonwealth has a role to play.

On the issue of there being no military solutions, we confirm that there needs to be a political process of reconciliation. We also need to be clear that this conflict has reached a point where one side has won in all but final name. Therefore, the conclusion of the fighting needs to be organised around that fact of life on the battlefield. We need to get an orderly end to the conflict followed by a process of political reconciliation and a meeting of the legitimate need for a say in their own government for the Tamil people. Otherwise, one can only fear that this conflict will resume in different, equally viral and pernicious forms in both Sri Lanka and abroad at a later date. We have been very clear that, while these two processes may be separate, there must be an end to the fighting and then a process of political reconciliation to address the roots of the conflict. The UK special envoy will be visiting next week as part of a parliamentary delegation. He has already been very active both internationally and with the Tamil community here in the UK, so we hope he is going to play an important part in the next steps of this process.

I agree with the noble Baroness that there is a clear UN duty to protect. It seems, in many ways, to meet the conditions of the responsibility to protect whereas the Government, because of the conflict, may not have properly met the need to protect their own civilian population. As always with a doctrine of international humanitarian law, the real issue is enforcement or implementation of that concept. The UN Secretary-General has been enormously active, as has his Under-Secretary-General for Humanitarian Affairs, in terms of seeking to secure entry to the conflict zones for a UN team to assess what is going on and, subsequently, to contribute to providing humanitarian assistance in that zone, arriving at a ceasefire, and improving the conditions and protection arrangements for civilians in the transit camps. The commitment that the UN Secretary-General thought he had for such a deployment has been challenged and delayed, so the UN is frustrated at not having more access at this time. It is seized with this and there have been urgent discussions in both New York and Colombo.

As to the role of the IMF loan, the preparations for that are continuing. It is due to be considered by the IMF board in the middle of the month and at that time it will be important to arrive at a view on it. Obviously, we have been trying to ensure that the IMF financing of countries caught up in the global economic crisis is done in as urgent and felicitous a way as possible, but we cannot look at this in isolation from the broader conflict currently under way in the country.

3.39 pm

Lord Naseby: My Lords, is the Minister aware that it is very welcome to see our Foreign Secretary go to Sri Lanka? If nothing else, it must have been a reality check for him. Does the Minister agree, however, that whatever way we look at it, the Tamil Tigers are a terrorist organisation? They do not represent the Tamil community. Is it not incredible that close to one quarter of a million people have been used as a human shield

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for the past four months, as they have been driven from the northern end of central Sri Lanka right to the far north-east of that country? Furthermore, the Tamil Tigers could have released all those people at any point but still today they refuse to let them go. Is it not a fact that the only people who have managed to escape have done so because the smashing of the bund by the government forces ensured that refugees could come through? It is a war, not a conflict. It is a war that has gone on for 25 years and must be brought to an end when the Tamil Tigers either surrender or are eliminated.

Turning to humanitarian matters, is it not time that the international community recognised that there are a quarter of a million refugees there in temporary camps who must be resettled? Should we in this country not now take a lead? Why could we not take a lead in restoring Kilinochchi, the provincial centre for Sri Lanka, and encourage others to join us so that we can resettle those poor people—not just Tamil, not just Sinhalese, not just Muslims? There are nearly 250,000 in the current camps and 100,000 left over from the earlier stages of the war. If this country believes in its special relationship with Sri Lanka, can we not give a real lead? Although the £2.5 million promised by the Prime Minister on Sunday is welcome, it is only a drop in the ocean. Should we not be talking about substantial sums to achieve the resettlement of those poor people?

Lord Malloch-Brown: My Lords, as the Foreign Secretary made clear in the Statement, the LTTE is a terrorist organisation that has held up to 200,000 civilians as human shields. He said that plenty of evidence was confirmed to him directly in his interviews in the transit camp that he visited that people who had tried to escape had been shot at and, in many cases, killed. There is no condoning, excusing, apologising for or defending the behaviour of the LTTE. Given that, fortunately and to the great relief of everyone, the democratic Government of Sri Lanka have the upper hand and are on the verge of finishing this conflict, it is perfectly proper for us as allies of that Government to expect from them the standards of a democratic Government: that they allow access and ensure that humanitarian assistance reaches the victims of the conflict; and that, in their military operations, they act prudently to protect civilians—on the simple principle, if no other, that two wrongs do not make a right.

On the noble Lord’s suggestion that we commit more resources for the resettlement of Tamils and others, I have no doubt that the time for that will come and that the UK will be a generous donor, but let me again say that at the moment the issue is not resources, which are available for this phase, but access for that humanitarian assistance which is in-country but cannot reach the victims. Most critical in future will be the willingness of the Government to live up to their pledge to resettle 80 per cent of those in camps by the end of this year. Then there will be something that we can support in long-term rehabilitation. At the moment, the people remain in camps.

Lord Sheikh: My Lords, there is a significant Tamil diaspora in this country. They are very concerned about what is happening to their friends and relatives,

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and we are very concerned about the humanitarian issue. As we all know, the Tamils are protesting outside in Parliament Square, and they have also been outside the Indian High Commission. Has the Minister met the Tamil leaders to assure them that have done everything possible to resolve the situation; and is there something special that they would like us to do? We learnt a lot by resolving the conflict in Northern Ireland, and I am sure that we would have something significant to offer to reach long-term peace.

Lord Malloch-Brown: My Lords, let me tell the noble Lord one very good piece of news. The last remaining young hunger striker today suspended his hunger strike and has been taken to hospital. More broadly, there has been a welcome by those outside to the visit of the Foreign Secretary and to the efforts of my right honourable friends the Prime Minister and the Foreign Secretary to address this issue and this crisis with the vigour that we have. We have sought to do what we think is proper in terms of the humanitarian case that we have made in Sri Lanka and what is proper in terms of British national interests. We have sought to communicate intensively with the British Tamils outside here in terms of those objectives. Equally, we have tried to take pains not to allow British policy to somehow be held hostage to these demonstrations. The critical thing has been to do what is right.

The Lord Bishop of Ripon and Leeds: My Lords, I am very grateful for the report and for the work that is being done in Sri Lanka. In the context of our particular link in Ripon with the churches in Sri Lanka and, particularly, with the Bishop Duleep de Chickera of Colombo, will the Government affirm, recognise and support the role of the churches as a tiny minority in Sri Lanka, working with international friends and allies in seeking to achieve peace, justice and humanitarian aid for all communities there? Will he comment on our view that the vast majority of Sinhalese, Tamils and Muslims in Sri Lanka want peace, work for it and that that is a source of substantial hope for the future?

Lord Malloch-Brown: My Lords, I had the privilege of meeting the Bishop of Colombo when he was here for the Lambeth Conference. I saw him as a remarkable spokesman, not just for the issues of the Tamils in this conflict, but for broader issues of freedom of speech, freedom of the media and freedom of religion in the country.

In a country that enjoys a democratically elected government, and a multi-ethnic society where strains have inevitably been introduced by such a violent and brutal 25-year civil war, he, and the churches more generally, have been important spokespeople for tolerance and mutual understanding and for the communities living in peace with each other. I affirm what the right reverend Prelate says; the great majority of Sri Lankans do live in peace with each other, are proud of the tolerance that they show towards each other and are as concerned as any outsider about the loss of tolerance that has resulted from a brutal civil war that has sharpened and hardened what has been a very compassionate, tolerant and inter-ethnic understanding.

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3.48 pm

Moved By Baroness Knight of Collingtree

Baroness Knight of Collingtree: My Lords, I would like to make it clear at the outset that those of us who criticise the NHS are not for one moment ignorant of, or unappreciative of, the great amount of good, even brilliant, treatment that so many patients receive. It must not be assumed that because we draw attention to the undeniable fact that some patients are very badly treated and beg for deficiencies to be remedied we are condemning the whole NHS. We certainly are not. But there are thousands of cases where clear proof of bad, even inhumane, treatment has resulted in suffering and death. We have a duty to bring those cases to public attention and to try to put things right, which is appallingly difficult.

Since 2002, I have been trying to ensure that hospital patients are routinely given food and water. In 2003, my Patients’ Protection Bill put forward some solutions; for instance, asking relatives and friends if they could come in and feed or give a drink to helpless patients, which is quite common practice in many European countries. That and other suggestions fell by the wayside. The Bill was allowed no further than Second Reading. Six long years later it is reported that patients in Stafford Hospital are so desperate to have a drink that they pull the flowers out of the vases and drink what is left. It is also reported that many have become severely dehydrated. I cannot bear to think of the suffering that they must have endured, nor that if warnings had been heeded and acted on, that suffering need never have happened.

The past six years have made no difference for the patients who do not get fed either. Only last month, figures came out showing that almost 30,000 hospital meals are thrown away uneaten and untouched every day. Is that because they are inedible or because some are not fed to patients? Or is it because the plate was put too far away for the patient to reach and whipped away with no help offered in either reaching or feeding, which is extremely common? Some hospitals throw away more than one-third of prepared meals. Some are even worse: the Middlesbrough primary care trust threw away 43 per cent of all prepared meals. What a wicked waste.

When asked about this, a health Minister in the other place blithely commented that no one should be concerned and that the situation merely reflects the need to give patients a choice. But I understand that those meals had already been ordered by the patients. They had made their choice. That excuse will not wash: figures released show that more than 8,000 people left hospital last year clinically malnourished. More than 240 people die in hospitals and care homes in England from malnutrition every year, which is truly shocking.

It is very wrong that there are still instances of MRSA, C. difficile andother killer bugs in our hospitals.

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Great efforts have been made to make the wards clean. Billions of extra pounds have been spent, but 24 trusts still fail basic hygiene tests. Wards are too crowded, with beds often packed tightly together. Nurses go out and about in the towns nearby, still wearing their uniforms. They pick up germs everywhere and go straight back to deal with patients in the same uniforms—which matron would never have allowed. Some hospitals allow too many visitors.

I am extremely concerned to have heard from several sources that the true numbers of deaths from these bugs are deliberately hidden and that death certificates often state the cause of death to be something other than MRSA et cetera. Trusts do not want the true cause known. No questions are asked if a person dies of pneumonia or a heart attack, but they do not want to let it get out that people are still dying of MRSA. Surely falsifying a death certificate is illegal.

Replacing matrons with managers was a mistake. I am sure that many hospital managers could run businesses brilliantly. But a hospital is not a business. One needs to have some medical knowledge in the task. Managers are not matrons. The former cannot be expected to run a hospital as efficiently as the latter.

I have raised other cases of bad treatment. For example, some patients are left in a cold ward with windows wide open and no warm coverings. Their deaf aids are taken or lost, which can make them seem confused and subnormal, and stricter discipline can be enforced. Ignoring repeated cries for help in getting to the bathroom is also common. A dossier of 25 cases, all of which I checked personally, was submitted to Ministers in this House. Those Ministers were helpful. They listened and the details were passed to the trusts concerned—where they met a blank wall.The allegations were either ignored or denied. Some of them were not investigated at all. The only thing that came out of the exercise was the introduction of a mysterious thing called a red tray. No one explained what it was, how it was proposed to use it, or what instructions to staff went with it. The noble Baroness, Lady Wall, kindly told me of her own personal experience, but none of the officials explained. So we never got far with the dossier.

The big question is whether this new body, the Care Quality Commission, will do better. Well, it is not exactly a new body, more a grouping together of three old bodies. The trouble is that, none of them, individually, has managed to right the wrongs that exist. In the introductory papers about the new body there is no admission whatever that there ever were any wrongs. The document says that the CQC will build on the good work of the existing commissions. That is the same old refusal to admit there is anything at all amiss—no hint of acceptance that improvements are needed. Sack the whistleblower: ignore the evidence.

Another quote from the document that the CQC put out says,

What does it mean “continue”? What quality are we talking about? It has not even started.

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The setting up of the CQC will hardly improve matters, since the lady named as chief executive is the very same person who was responsible for checking the standards of care at Stafford Hospital, to which I have already referred. That has a dreadful record. It is reported that hundreds died there needlessly because standards of healthcare were so bad. It is reported that the number was somewhere between 400 and 1,200. That does not sound as if her checking was up to much. Whatever excuses may be made, whatever denials or apologies, the Government cannot expect that this chief executive, with this record at Stafford Hospital, comes into her new job with any confident backing.

That excellent organisation, Help the Aged, is currently campaigning for sick and elderly people in hospitals to be treated with dignity. It has my strong support, especially its demand for an end to mixed wards. There is no dignity, and small protection, for those finding themselves in the next bed to a stranger of the opposite sex at night, when there are not many staff about, and the ward is dark and undersupervised. Ministers seem to have given up on the problem. They say the sexes cannot be separated. Why not? They always were. Unless we are talking about intensive care and patients who are unconscious, mixed wards are an abomination.

There is no dignity in being left to lie for hours in a soiled bed. On 31 March, the BBC reported the case of a pensioner who snatched her elderly husband from a Stevenage hospital. She was so upset at his bad treatment, including being left in a wet bed, that she resolved to take him away—and she did. There was a row with the staff, who threatened her with the police. That should never have happened, but it has happened since. The staff have no right to threaten such people with police action and give them a police record. That is appalling. Since then, that lady’s husband has been fine, much more comfortable and happy. I understand that following the programme, the BBC was deluged with listeners who knew from experience exactly why the wife was determined to take him. His was not an isolated case. I could mention other wrongs, but time is short and others wish to speak.

How sad that, while medicine and pharmacology have made such enormous strides, the standards of care and respect for patients as human beings has declined almost past belief. Our brilliant surgeons can do heart, liver and kidney transplants—soon they will be doing whole face transplants, apparently—and our marvellous scientists can produce drugs that can combat almost every known disease. We have thousands of excellent nurses, but we can no longer ensure that people who go into hospital will receive the most basic care or keep their dignity. Does the Government’s public health agenda include any resolve to tackle these problems?

4 pm

Lord Addington: My Lords, I congratulate the noble Baroness, Lady Knight, on her determination to follow through on a subject that she so clearly cares passionately about. I have chosen to concentrate on a different aspect of the public health agenda, which is that of

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trying to get people to help themselves through encouraging them to exercise. I often feel that I have to talk by myself on this subject and that people do not relate to me, but now I have the happy experience of being able to refer to an NHS document. I shall give the full title: A Systematic Review of the Evidence Base for Developing a Physical Activity and Health Legacy from the London 2012 Olympic and Paralympic Games. What the document shows as you go through it is that there is a huge public health benefit to be derived from getting people to take exercise. That is not a revelation, but the fact is that we should exercise because it is one of the most effective forms of, let us say, self-maintenance.

The problem is that the Olympic Games have gone from being a dream to a cure-all in many fields. The document goes into how things should be implemented and lists local authorities, primary care trusts, schools, colleges and stakeholders. Later it mentions local government, LOCOG, national stakeholders and so on. Noble Lords will get the idea. I have spoken about the benefits of exercise before, which has produced interesting exchanges. I have often asked the noble Lord, Lord Davies, which department is responsible for increasing the take-up of exercise. He has responded by saying that it is the NHS or the Treasury. When I ask who will do it, one or other of those two departments will be quoted, but how do they work together and where is the guidance?

I suggest that in encouraging people to take exercise and play more sport, we should note the difference between what is exercise and what is sport. It is rather odd. Sport is something that you decide is a sport. Going for a run can be thought of as a sport, but people may regard it as a way of trying to keep their waistline down because the doctor told them to or they want to fit into last year’s clothes. Is running a sport or is sport something that needs a different type of support structure?

Having indulged myself for a few minutes, I come to the essence of what I am trying to get at today. How are the Government going to support both the Olympic movement and other bodies that work with sports at the participation level, where we are not talking about elite athletes? How is the Department of Health encouraging people to get involved? For instance, is the department going to develop a policy of naming and shaming local authorities that do not provide sufficient parks in which to take a pleasant walk? That is basic exercise rather than playing a sport. A good walking strategy for each town centre should be provided because it certainly would cover an exercise agenda. Will we make sure that local authorities have to comply or, if they do not have to, will we shame them if they do not? Are we going to ensure that there is sufficient open space to walk dogs, for example? The great excuse for taking exercise in our society is walking dogs. In rural areas, will we ensure that all footpaths are open? Will this be monitored? Will this be driven forward? If the Department of Health is not doing it, who will do it? The big beasts of the departments are involved here. Sport lives in the Department for Culture, Media and Sport, but I would have it transferred to the Department of Health. There is disagreement in my party about this, but I like to nail my colours to the mast.

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