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House of Lords

Wednesday, 25 November 2009.

3 pm

Prayers-read by the Lord Bishop of Manchester.

Defence Medical Services


3.06 pm

Asked By Lord Lee of Trafford

The Minister for International Defence and Security (Baroness Taylor of Bolton): My Lords, I am sure that the whole House would wish to join me in offering sincere condolences to the family and friends of Sergeant Robert Loughran-Dickson of the 4th Regiment Royal Military Police, who was killed on operations in Afghanistan this past week.

The Ministry of Defence announced to Parliament on 27 March 2007 its Defence Medical Services uniformed regular manpower requirement. The requirement to support and sustain operations, provide peacetime healthcare and allow for continued training and the provision of headquarters staff during deployment is 8,251, including a manning and training margin of 676. As of 1 April 2009, the total DMS personnel was 7,468, which can be broken down into 6,525 trained personnel and 943 personnel in training.

Lord Lee of Trafford: We on these Benches join the tribute to Sergeant Loughran-Dickson. Is the Minister aware that the BMA is reporting that an increasing number of health trusts are making life very difficult for their reserve doctors in fulfilling their training obligations and, indeed, are increasingly reluctant to recruit them in the first instance? Will she liaise with her opposite numbers in the Department of Health and make it clear to those health trusts that they have a national obligation at a time of war to release their reserve doctors for their appropriate military service? Those that refuse to do so should be named and shamed.

Baroness Taylor of Bolton: My Lords, I know that the National Health Service is committed to allowing doctors to serve in the Reserve Forces and that it recognises the skills that staff develop through training and through deployment, which can bring significant benefits to the trust. I am aware of the recent letter from the BMA Armed Forces Committee about time off for training. Ministers and officials liaise on these issues and I assure the noble Lord that we are very hopeful that there will be no undue difficulties. We accept that there are pressures in certain areas, but we hope that everyone can work towards ensuring that our medical services, especially on deployment, are as strong as possible. Thankfully, they are.

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Lord Astor of Hever: My Lords, we on these Benches join the noble Lord, Lord Lee, in sending our condolences to the family and friends of Sergeant Robert Loughran-Dickson of the Royal Military Police. Last year, the BMA survey was very critical. Does the Minister think that the situation has greatly improved since then?

Baroness Taylor of Bolton: My Lords, we have certain pinch points and we have to use reservists when necessary. Indeed, we also use secondees and contractors. I think that everyone recognises that a great deal of effort has to go into making sure that the Defence Medical Services on operations work as smoothly as possible. The Defence Medical Services have responded fantastically to the pressures on them. The services that we provide, especially in the field hospital in Camp Bastion, are second to none.

Lord Bramall: My Lords, does the Minister accept that the Defence Medical Services are still grossly understrength in surgeons, anaesthetists and other specialists, have been suffering actual cuts in vital clinical training and professional development and are excessively reliant on the National Health Service and the Reserve Forces for the comprehensive handling of battle casualties? All this is happening at a time when any surge in the numbers in Afghanistan is likely to make even greater demands on them.

Baroness Taylor of Bolton: My Lords, I do not accept that there is an excessive reliance on the National Health Service; rather, there is a complementary relationship, which is the whole idea behind having reserves. It is true that there are pinch points in terms of some of the skills that are needed. For example, we have had to enter into a contract in order to provide a neurosurgeon. Perhaps that should not be surprising, because it would be difficult to provide every level of expertise in a field hospital without some additional help. No cuts have been made in the Defence Medical Services. The pressures have arisen out of the difficulties of recruiting and retaining the skills that are necessary. Significant steps have been taken to improve remuneration and pensions. Retention rates are improving. We are seeing some benefits and improvements, which should be reassuring, although it is not the end of the problem.

Lord Walton of Detchant: My Lords, I declare an interest as a former commanding officer many years ago of the 1 Northern General Hospital (TA) and its successor unit, the 201. The unit is celebrating its centenary this year. Does the noble Baroness accept that large detachments from that unit have served with great distinction in the Gulf, Iraq and, more recently, Afghanistan, but the problem is a difficult one because in many instances they face repeated deployments overseas to the detriment of some of them in relation to their careers in the National Health Service? What efforts are the Government making to increase the recruitment of regular RAMC officers in the Regular Army, perhaps helped by the recruitment of cadets?

Baroness Taylor of Bolton: My Lords, I am happy to join in the congratulations offered to those who have served in the distinguished way outlined by the noble Lord. As I said earlier, it is true that there are significant pressure points. We are trying to avoid

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repeated deployments and the Defence Medical Services have been somewhat imaginative in how they have gone about this. They look to regular members for the first contribution, but if that does not make up the numbers they look to the reserves. If there are still problems, they look for secondees from the National Health Service and, in exceptional circumstances, they have to look at using a contractor under a special contract. This has eased some of the pressure and it is hoped that it will be of long-term benefit. However, I remind the House that the services that we provide are there for our allies, with whom we work. Recently the Danes have been providing a great deal of medical assistance in Camp Bastion as part of an agreement that we have had with our allies.

Lord Addington: Virtually all of us have received briefing that states that many members of the Defence Medical Services are thinking of leaving, often because they do not believe that they are being well enough paid. What is being done in practical terms to encourage those who are in the services to stay?

Baroness Taylor of Bolton: My Lords, as I have said, significant retention items have come up for discussion in quite an imaginative way and I think that the situation is improving. What the House needs to remember is that those who serve on operations often gain significant experience, especially in field trauma, which would not be available elsewhere. That is valuable to them in their work and, indeed, valuable to their trusts when they return. The pinch points that we have had have been addressed. The pay review body tries to ensure that there is comparability with the National Health Service.

Independent Safeguarding Authority


3.15 pm

Asked By Lord Northbourne

The Parliamentary Under-Secretary of State, Home Office (Lord West of Spithead): My Lords, no.

Lord Northbourne: My Lords, I am most grateful to the noble Lord for that helpful Answer. Is he aware that in the year ending March of this year, the main complaint and problem of the 17,406 children who telephoned ChildLine was physical abuse in the home and that a significant part of this was by people who were not their parents? Is he further aware that it is extremely likely that a child living with the natural mother but with a stepfather-especially if the stepfather is not married to the mother-is liable to be exposed to sexual and physical abuse? Do we not owe these children a duty of protection when their parents are unable or unwilling to protect them?

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Lord West of Spithead: My Lords, the noble Lord raises a very important issue. When I asked whether we have clear statistics which show whether abuse is by a stepparent or by a natural parent, I discovered that we do not have a breakdown of those figures; perhaps we should start collecting them. He is right about the large numbers, some of which are real, some of which are not. However, the Independent Safeguarding Authority, which the Question is about, is looking specifically at those seeking to work with, or volunteering to work with, at-risk adults and children. A child sexual offender review disclosure pilot is looking into the areas raised by the noble Lord.

Earl Ferrers: My Lords, does the Minister realise what pleasure it gives to hear an Answer of such brevity as his original Answer? Will he encourage his noble friends on the Front Bench to give equally short Answers instead of waffling on?

Lord West of Spithead: My Lords, yes.

Baroness Falkner of Margravine: My Lords, given that the Keeping Children Safe pilots, to which the Minister referred, are to be decided on fairly shortly, can he say whether the disclosure requirements will be sensible and measured and not encourage vigilantism?

Lord West of Spithead: My Lords, the scheme was carried out in Hampshire, Cambridgeshire, Cleveland and the whole of Warwickshire. It lasted for 12 months, finished in September and is being independently evaluated at the moment. The final evaluation report is due in January 2010. This will be looked at in a cold, sensible way because we absolutely must not go for vigilantism. There is an awful lot of passion in this area because it is such a horrible business. One needs to look at it in a cold, calm way; otherwise one could go to extremes which cause a lot of trouble.

Lord Astor of Hever: What training is given to the ISA employees who have to decide who should be placed on the barred list?

Lord West of Spithead: My Lords, I know I have this information somewhere at my fingertips but I cannot find it at the moment. By narrowing this function down to the ISA, compared with the old system we will have fewer people, it will be easier to do the training and the costs will be slightly less. However, there will be one focus and it will pull in evidence from all the various departments. Perhaps I may get back in writing on the specifics of the specialist training.

Baroness Butler-Sloss: My Lords, are the Minister and his department sufficiently aware that the majority of children who suffer physical, sexual or emotional abuse or neglect do so within the family home? Therefore, a substantial minority of abusers will be not the actual father. As the Minister suggested, it is extremely important that this should be looked at with some care so that one can tell the proportion of natural fathers and of stepparents. I understand that the Independent Safeguarding Authority should not be doing this, but someone should be looking at the issue of stepparents going into homes. I have not time to tell your Lordships' House how many examples I have of that situation.

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Lord West of Spithead: My Lords, as I have said, it is important that we get a breakdown of some of these statistics, because a lot of folklore has grown up around them. We are aware of how much violence of this kind goes on in the home. It is difficult, because women as well as men are committing it, as we know from some awful cases recently. We need the statistics; we need to look at them carefully; but I believe that this pilot scheme will enable things to be done.

Baroness Hollis of Heigham: My Lords, will my noble friend confirm that stepfathers are six times more likely to abuse children than natural fathers? There is adequate research to show that the Question asked by the noble Lord, Lord Northbourne, is well founded in research evidence.

Lord West of Spithead: My Lords, I thank my noble friend for that. I was not aware of those figures. When I asked yesterday whether we had a breakdown of them, I was told no. I shall go and thrash whoever was responsible and find out why this happened, but I thank my noble friend very much.

Lord Geddes: It is with pride and pleasure that I take my eight year-old stepgrand-daughter to and from the carol service practice in our local church. Do I need to have clearance from the Independent Safeguarding Authority?

Lord West of Spithead: My Lords, the answer is no, but the noble Lord raises an issue. I spoke about there being too much paranoia about this. We have to remember that while there have been horrible cases-indeed, the reason for the ISA is the Bichard report on the Soham murders-the vast majority of people in this country are decent people who have children and look after children and take them around. We must not let these safeguards drive us down the route of doing ludicrous things. However, we have a statutory duty to try to look after people and there has to be a balance. In general, we have got that balance right. The briefing that I read in preparation for this Question-it is why Questions are useful-suggests that we have gone slightly too far in one area, which I shall raise. However, generally, the balance is right, but we must not overreact to these things.



3.22 pm

Asked By Lord Wallace of Saltaire

Lord Brett: NATO Secretary-General Rasmussen has appointed an independent group of experts to advise him on the content for a new strategic concept. They will report next spring and Rasmussen will then produce a draft concept for consultation with Governments. We believe it appropriate that Parliament discuss that draft should time allow. My honourable friend the Minister of State responsible for NATO would be ready to host a meeting with interested Members of both Houses before then.

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Lord Wallace of Saltaire: I thank the Minister for that reply. I am sure that there are many of us who would like to take up the offer to meet the Minister of State concerned at an early stage. How do Her Majesty's Government respond to the Obama Administration's views on the future of NATO-that it should be more a regional alliance than a global alliance, and that it should move from being a collection of bilateral relations with the United States towards having a much stronger European grouping within it?

Lord Brett: My Lords, it is clear that Article 5 of the treaty, as affirmed by the Declaration on Alliance Security at the Strasbourg summit, will remain the core purpose of NATO, binding us to defend any nation within NATO which is under attack. That does not gainsay the fact that new forms of terrorism mean not only that we can have a defensive role but that we should be able to go on deployable operations. It is not a choice of one or the other. Threats to our security are continually evolving and are likely to become increasingly complex. NATO must be willing and able to to respond to these threats whenever possible.

On the second part of the noble Lord's question, NATO-EU co-operation is of particular importance given that the security objectives of the two organisations are so closely intertwined. The concept should give a strong commitment to maintaining and strengthening the alliance's partnership with the EU and developing mutual reinforcing structures and capabilities without duplication. This will enhance both organisations' ability to address the hard and soft security challenges of the 21st century.

Lord Judd: Will my noble friend assure the House that, in this work that is being done, full consideration will be given to the traditional role of the UN Security Council in global security and peace-making?

Lord Brett: My noble friend makes an important point. NATO does not exist in isolation. While we must collaborate with the EU, we must have collaboration also with the United Nations and regional collaboration with other forces in this world, whether it is the African Union or others. My noble friend's point is well taken.

Lord Hannay of Chiswick: My Lords, will the Minister confirm that this review of the strategic concept will include NATO's nuclear posture? What input will the British Government make on that aspect? Will they ensure that any revision of NATO's nuclear posture is firmly in line with the unanimous decision of the UN Security Council under President Obama's chairmanship to work towards a world free of nuclear weapons?

Lord Brett: My Lords, yes.

Lord Howell of Guildford: Will the Minister assure us that, in moving towards a new strategy for Afghanistan, and with the American President's announcements just coming up, all our NATO allies, including this country, have been properly and adequately consulted about the strategic implications and the lessons that we need to learn from Afghanistan?

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Lord Brett: The noble Lord makes an important point, and one that I believe the Government have clearly on board. A letter was recently sent by the Prime Minister to the Secretary-General, pointing out the need for a greater communal effort from within, from our partners. Indeed, we have been in discussions as a Government with our strategic partners in NATO and there is to be a conference in January to consider the outcome of that. We are looking to fellow NATO member states to increase their commitment in line with ours and with what we expect to be an increased commitment from the United States. I have given the long answer-the short answer is yes.

Baroness Falkner of Margravine: Does the Minister agree that the transformation of NATO's military capabilities so that it can conduct more out-of-area operations is extremely relevant to this? Will the Government's position be to argue for that transformation?

Lord Brett: Again, I can please the noble Baroness-and the noble Lord-by saying yes.

Lord Ashdown of Norton-sub-Hamdon: Can I bring the Minister's attention back to the central Question asked by my noble friend? The Obama Administration have now proposed, as Kennedy and Kissinger did before, a twin-pillar NATO, with Europe co-ordinated so that it becomes a dialogue of equals rather than one between a giant and a collection of pygmies. Are the Government in favour of that?

Lord Brett: I shall resist the temptation to give a short answer and say yes, although that is the essence of my answer to that question. As I said, we need greater collaboration within NATO and a leaner and more efficient NATO defending the collective body that is NATO-but also one that is ready to intervene in other areas where failed states are a threat to NATO's security. That is the long answer; the short answer is still yes.

Lord Teverson: Will the outcome of the Georgia war last year mean that who joins NATO in the future is determined by the Russian Federation and the Kremlin, rather than the members of NATO?

Lord Brett: I would hope that the noble Lord never believed that for a second. It is not the case, and I can give the very simple answer-no.

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