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House of Lords

Wednesday, 10 March 2010.

3 pm

Prayers-read by the Lord Bishop of Bradford.

NHS: Out-of-hours Cover


3.07 pm

Asked By Lord Naseby

The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): My Lords, we are of course committed to improving the quality of GP out-of-hours services. Dr David Colin-Thomé, national clinical director of primary care, and Professor Steve Field, chairman of the council of the Royal College of General Practitioners, were asked to report on how best to strengthen this service. Their report was published on 4 February and the Government have accepted their recommendations in full.

Lord Naseby: Is the noble Baroness aware that that reply is not totally adequate? Why has it taken five critical reports-one from the Public Accounts Committee, two from the Health Select Committee, one from the two gentlemen to whom she referred and, above all, one from the coroner from Cambridgeshire-for this Government to take at least some action in this important area? Will she give a specific commitment on the three areas highlighted by the coroner? They are, first, to tighten up the clinical training of the out-of-hours doctors; secondly, to double-check that every doctor who does out-of-hours work speaks and understands English; and, finally, to instruct every primary care trust that they must work together to improve out-of-hours services for NHS patients.

Baroness Thornton: We are very aware that improvement was needed and we are very sorry that there has been a death. We have instigated a top-level investigation to deal with that. We are carefully considering the coroner's recommendations. It seems clear that all the recommendations, including those mentioned by the noble Lord, have already been taken into account and are part of the recommendations brought forward in the report by Dr Colin-Thomé and Professor Field. While the current system has safeguards, we recognise that these are not always carried out to the same high standard across the country. That is our priority and the challenge that we have.

Lord Forsyth of Drumlean: My Lords, will the Minister explain why the Government increased the remuneration of general practitioners enormously and at the same time agreed that they should be less available in the evenings and at weekends?

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Baroness Thornton: Neither the general practitioners nor the noble Lord's party want to return to the old system of doctors being responsible 24 hours a day for their patients. It was recognised that that was not sustainable or in the best interests of the patients. As for the system that we have now, the National Audit Office has said that we are in "the forefront of thinking" about out-of-hours care and that we compare well in terms of cost and quality with the rest of Europe.

Lord Eden of Winton: Will the noble Baroness bear in mind the urgent need to consider adequate communications, particularly in relation to out-of-hours work? I am aware of a very serious case where, because it was the weekend, there was no communication from one hospital to another about a particular patient. That is not acceptable.

Baroness Thornton: The noble Lord is right: that is clearly not acceptable. One of the recommendations that the coroner made in the recent case was about having a national system for communications that would operate out of hours. We are working with the medical organisations to develop that national database and to consider what data should be placed on it.

Lord Tomlinson: Does my noble friend accept that, notwithstanding the National Health Service's occasional lapses from its normal high standards, the vast majority of people in this country, like me, who depend on the NHS are satisfied with the quality of treatment that they receive and would want to congratulate the Government on substantial improvements in the vast majority of NHS provision?

Baroness Thornton: My noble friend is correct. Indeed, our out-of-hours GP services are meeting the needs of patients, by and large, extremely well. We know that there are some problems around the country, as my noble friend has mentioned, but they will be tackled. This is an improved and improving service.

Baroness Barker: Does the noble Baroness agree with the statement made in the Health Select Committee report that the change to the GPs' out-of-hours contract suited no one but doctors? In her first reply, she said that the Government had accepted Professor Field's report in its entirety. What is the deadline for the implementation of the report's findings?

Baroness Thornton: We are working to do it as quickly as we possibly can.

Lord Patel: One of the problems about the quality and safety of out-of-hours cover provided by doctors coming from certain countries, particularly those within the EU-it happened in this case to be a German doctor-is that, once they are on the register of one country, they do not have to be registered here. That issue can be tackled by subjecting to assessment all doctors coming for their first employment in the NHS, even though they may have been British trained.

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Baroness Thornton: The noble Lord raises an important point because, at the moment, as he will know, the medical qualifications of such doctors are assessed by the GMC but not necessarily their language qualifications, particularly if they come from within the European Union; those language tests depend on the PCT and the employers of the doctors getting it right. That is one of the main recommendations in the Thomé report. The noble Lord will also be aware that we are addressing the issue of how we can guarantee language testing as soon as possible, including raising this with European partners when the time comes to review the arrangements.

Lord Carlile of Berriew: Does the noble Baroness agree that one of the greatest models for out-of-hours services were the GP co-operatives pioneered in Bolton and elsewhere? Will she try to ensure that GP co-operatives are given every encouragement to re-establish themselves around the country? They are, after all, accountable to the people whom they serve.

Baroness Thornton: The noble Lord will know that, with my Co-operative background, I completely agree with him. Indeed, in a former life, I have been a great supporter of the GP out-of-hours services operating from south London. They continue to operate and have our full support.

Baroness Masham of Ilton: My Lords, does the Minister agree that, if out-of-hours doctors had lists of severely ill patients, that would lead to much greater confidence?

Baroness Thornton: Out-of-hours doctors are dependent on the information that they receive through the GP practices for which they do their work. However, I shall take back the noble Baroness's point and let her know the answer.

EU: International Development


3.14 pm

Asked By Lord Judd

Lord Brett: My Lords, Her Majesty's Government's four main priorities for working with the EU on development are: greater EU leadership on the international stage, particularly on the millennium development goals; ensuring greater coherence between EU policies in support of development; to improve the quality of European Commission development and humanitarian assistance; and to work through the EU-Africa Infrastructure Trust Fund to accelerate integrated regional development in Africa.

Lord Judd: I thank my noble friend for that very encouraging reply. Does he agree that the issues of world poverty, together with those of climate change, trade and international security, are so complex that they simply cannot be solved on a basis of national programmes, and that international co-ordination is absolutely indispensible? Does he therefore accept that

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the EU has a key role to play in this, and that our commitment to its institutions is essential in ensuring that it happens properly?

Lord Brett: My Lords, my noble friend makes an important point. Indeed, 2010 is five years before the deadline for meeting the millennium development goals. The global development plan which we are seeking in partnership-starting with the DfID conference tomorrow which will move on from the European Union position towards an international view-is an attempt to identify where we are deficient. The EU is off track in meeting its interim ODA target of 0.56 per cent of gross national income by 2010 although the United Kingdom is on track. There is failure to meet a number of the millennium development goals and 1 billion people in the world are still hungry. There is a lot of work to do. However, I agree entirely with my noble friend that it can only be done in collaboration with our European partners and our international partners as well.

Baroness Rawlings: Given that in 2008-09 DfID contributed £1.15 billion to the European Commission's aid programme-about a fifth of DfID's total programme that year-what discussions have DfID Ministers had with the new Development Commissioner to make certain that British aid spent through the European Commission is spent effectively, swiftly disbursed and properly focused?

Lord Brett: My Lords, the Department for International Development and the Foreign Office have ongoing discussions almost daily with the relevant parts of the European Commission in Brussels, particularly in the light of the Lisbon treaty and the new arrangements that are in place. We certainly regard the Development Commissioner as extremely important. Of course we ensure that our money is spent on issues and in areas where we believe it will do the most to eradicate poverty. We have a strong record in this area. We have been at the forefront in seeking efficiency reforms within the European Union to aid that task, and we will continue to do so.

Lord Steel of Aikwood: My Lords, having returned just yesterday from Gaza, perhaps I may press the Government to be more robust on the continuing blockade of the Gaza Strip. Is the Minister aware that European aid funding has already been earmarked for more than 2,000 badly needed new houses, for which plans are agreed, but that the Netanyahu Government refuse to allow in the necessary construction materials? Will he follow the example of Vice-President Biden and make it clear, on behalf of our taxpayers, that their continuing behaviour is intolerable?

Lord Brett: I recognise the noble Lord's question if only because I think that, only a couple of weeks ago, I featured in giving an answer which was in almost the same terms. Yesterday's speech by Vice-President Biden was a very clear signal to the Government of Israel of not only the United States' concern but the concern of Europe and Britain, which we continue to press at every turn. The sooner that message gets home, the

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sooner we will see the reconstruction that will remove the misery that people in Gaza are living in, and the sooner we will be able to take that step towards meaningful talks on peace in the region.

Lord Pearson of Rannoch: My Lords, further to the question of the noble Baroness, Lady Rawlings, what proportion of our foreign aid is filtered through the European Union and how much of it goes astray? Would it not better to cut such aid and replace it with investment in agriculture and with free trade, which is often denied to the countries in question?

Lord Brett: My Lords, we spend money both bilaterally and multilaterally through the EU because the European Union makes policy on climate change, trade, agriculture and fisheries and is therefore in a unique position in terms of aid, trade and foreign policy. I can give a breakdown on the proportions of the money spent. I know that the noble Lord's enthusiasm for Europe is less than total, but international development is one area in which even he could not find much to criticise Europe. He makes the point about fraud, but the truth is that the amount of fraud is very small. The auditors have made a point about inadequate reporting by member states, and in 2009 they named Spain, Italy and Portugal as responsible for 80 per cent of the financial errors. However, actual fraud was found in only two cases among all the irregularities considered in 2008. Methinks that the noble Lord doth protest too much.

The Lord Bishop of Bath and Wells: My Lords, meeting the development goals is very important in respect of the young people of this country. What steps are the Government taking with the European partners to ensure that there is an appropriate education policy to enable our young people to be fully participant in the process of helping to achieve these goals?

Lord Brett: The right reverend Prelate makes an important point. Personally, I am quite encouraged. We, as people involved in politics, may sometimes despair at the willingness of young people to take a more serious attitude to the domestic political agenda, but I have found that when you talk to them about the international agenda, issues of climate change and poverty in Africa, there is a very ready understanding. The right reverend Prelate is absolutely right: we must continue and extend our efforts to ensure that all our young people are aware of the world in which they live, and the important part that they play not just in the United Kingdom and in Europe but in developing a better world for all of us.

Lord Lea of Crondall: My Lords, when it comes to the efficiency of expenditure, is it not the other way round from what the noble Lord, Lord Pearson, has said? If you go round different countries in Africa-as I do quite a lot as vice-president of the All-Party Group on Africa-you will find that the recipient countries have very limited resources. They do not want Britain, France, Germany, the Netherlands, Sweden and half a dozen other countries coming in, one after the other, with different priorities. Over the past few years it has been very noticeable, from Senegal to Madagascar, that the efficiency of the European channel

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lies in bringing things together and helping with technical assistance at the same time. It is a great step forward in most cases for the effectiveness of our expenditure.

Lord Brett: I agree entirely with my noble friend. Previously, when the European Union had delegations in member countries, those delegations were often regarded by various political actors and civil society in those countries as key, crucial and, in some ways, impartial in terms of the advice and guidance given. They were not the former colonial power and they were not people who came in with a particular nationality; they were seen as a European responsibility and as a European response to world problems. I think that we are enhanced by such arrangements. We will be even more enhanced when we develop properly the new system that Cathy Ashton will be responsible for.



3.23 pm

Asked By The Earl of Sandwich

The Minister of State, Foreign and Commonwealth Office (Baroness Kinnock of Holyhead): My Lords, we are committed to supporting the south Sudan referendum in January 2011. We will continue to support institution building and development work in south Sudan, both before and after the referendum irrespective of its outcome. We will work with our international partners to press both parties to reach an agreement on critical issues including oil sharing, debt and border demarcation. We will also work with others to tackle corruption and encourage international business investment in south Sudan.

The Earl of Sandwich: My Lords, I thank the Minister for her reply and for her commitment over many years to Sudan. Would she agree that it is essential, immediately after the April elections, that leaders from north and south sit down to work out arrangements after the referendum, whatever the outcome, whether the people vote for unity or for secession? Are they not expecting all of us in the international community to take part in these arrangements? If they are not able to look forward, many of them will turn back to violence.

Baroness Kinnock of Holyhead: I thank the noble Earl and pay tribute to his work and commitment to Sudan. He is absolutely right to say that this is a critical year for Sudan. It is vital that the gains from the past five years of peace are not lost and can be built upon. The south must decide its own future in a referendum and, whatever the results of that referendum, it must be respected by all the parties and also by the international community. There will continue to be risks and uncertainties, and undoubtedly there will be delays, too. I reassure the noble Lord that, in recent days, we have seen a deal being made on the census and an agreement to provide extra seats in the national

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assembly, a code of conduct and so on. The international community has to play a serious and committed supporting role in all those processes. For that reason, we are upgrading our role in the south.

Lord Avebury: Will there be a more proactive role for UNMIS in south Sudan, particularly in the conflict zones of Jonglei and the Lake state? That would seem to be within the mandate of UNSCR 1590. Is the Minister doing anything to promote enhanced assistance to the Government of south Sudan for security sector reform, particularly for the enhancement of the capacity of the south Sudan police service?

Baroness Kinnock of Holyhead: I can reassure the noble Lord on UNMIS; we continue to support peacekeeping in Sudan and work very closely with UNMIS, which has a key role to play around the elections, as well as up to the referendum in January 2011. There will be that hiatus between the election and the referendum, when it will be very important for UNMIS to be very active.

In the UN Security Council consultations and in meeting the new Special Representative of the Secretary-General, Haile Menkerios, the UK has emphasised and will continue to emphasise the importance of UNMIS in protecting civilians during this crucial time. Of course, the noble Lord is correct in drawing attention to the need for security at this time, as people need to feel confident that they can go about their business and that peace can be protected, as well as being able to be sure that their right to vote will take place in a peaceful way, without the beginning of any more conflict or tension in the south, where it is always possible that that may occur.

Baroness Cox: When I was in southern Sudan two weeks' ago, the Government of southern Sudan expressed great appreciation of the Minister's recent visit and of all the aid that Britain is giving in humanitarian assistance and capacity building. Is the Minister aware that southern Sudan suffers from a humanitarian crisis, with one in seven children dying before the age of five and one in seven mothers dying in childbirth and with only 20 per cent immunisation? Could DfID take an overview of the distribution of aid to ensure that it reaches all those in need, both to save lives and promote stability before the elections and referendum in the south?

Baroness Kinnock of Holyhead: I thank the noble Baroness. She makes the very important point that support for south Sudan and its Government is very important. We will provide approximately half of our £140 million development assistance for 2010-11 to south Sudan. UK funding will cover basic services, primary education, support for health infrastructure, along with efforts that will be made with water and sanitation. When I was in south Sudan recently, I was able to see the enormous needs that people have there. After the conflict, with the suffering that they have experienced in that country, they will expect to see a peace dividend. We all have to work together to ensure that we increase our staff in Juba and increase our support for the Government of south Sudan.

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