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Lord Brett: My Lords, as I said in my initial response to the noble Baroness, the situation is daunting, but we should not be deterred by that. We need to work with our allies-all 43 ISAF countries or the 60 countries that are seeking to assist in the area. I do not think that it was ill-conceived. We have to take on the situation with the Afghan Government and in terms of the five commitments that President Karzai's new Government's have adopted-on security, governance, reintegration, economic development and regional relationships. I am not sure that discussing whether things are ill-conceived is the best way forward. In my view, the best approach is to look at the problems we have and then at how to solve them.
Lord Sewel: My Lords, the Minister rightly quotes President Karzai as wishing 50 per cent of development aid to be routed through the Afghan Government. Has the Minister any figures on the percentage of development aid allocated to the Afghan Government that is actually applied to development?
Lord Brett: My Lords, I shall answer my noble friend by talking in terms of amounts of money and where it is spent. Some £60 million this year goes to the Afghanistan Reconstruction Trust Fund-the ARTF-which finances the salaries of over 320,000 public servants of whom over half are teachers. Some £32 million over an eight-year period from 2003 is being spent to elect almost 22,000 community development councils and initiate 50,000 locally generated projects to improve water, roads, health and education. More than £40 million over 2002-09 has gone to the microfinance investment and support facility, which is benefiting 1.5 million entrepreneurs with women being 60 per cent of the total.
Lord Alton of Liverpool: My Lords, will the Minister accept that one reason for the haemorrhaging of public support for military engagement in Afghanistan has been the perception of widespread corruption in the Karzai regime? What protocols are being put in place to ensure that public money is used in an honest way for the reconstruction of the country, and is not used for corrupt purposes?
Lord Brett: The noble Lord makes a good and important point, which is recognised by many people in Afghanistan as well as many outside it. President Karzai made a renewed commitment to the Afghan people that he would tackle corruption in his second term. We have heard the words in his inaugural address; we now seek the action, which I think will come when we see the formation of the new Government supporting him, and the appointments to governorships and other positions. At the moment, funding to Afghanistan through the Government is very much based on seeing the results; in other words, for teachers, we repay the Government of Afghanistan when those teachers have been paid their salaries. That is the best way forward. Also, we called for a new anti-corruption commission and look forward to the appointment of the new body for that task, which the President has announced.
Lord Brett: I do not have an absolute figure for that. That amount-40 per cent-sounds tremendously high. We need civilian specialist staff in Afghanistan to assist in the DfID programme and others, but if I may I will get back to the noble Baroness with detail.
Lord Elton: My Lords, I shall put the question of the noble Lord, Lord Alton, in another and perhaps a more focused way. Is an audit trail being constructed on President Karzai's performance that can be examined to see whether he honours his commitments? Can we see those answers?
Lord Brett: We share the noble Lord's anxiety to ensure that we convince our people in the United Kingdom who are financing the humanitarian development costs, convince the international community and convince-not least-the people of Afghanistan. We believe that we will see new Ministers with a clean track record presenting policies that will be put through without the corruption that people suspect has taken place in the past. There have been arrests of senior police officers and investigations of Ministers. Afghanistan is moving. We want it to move much more quickly and resolutely.
Baroness Thornton: My Lords, we all agree that hospital stays should be for as short a time as possible, but that must be balanced against the complex health needs of a patient with dementia. The National Dementia Strategy addresses the issue, including the appointment of a senior member of staff to improve the quality of care for people with dementia, proper training for all staff and specialist older people's mental health teams working in hospitals.
Baroness Greengross: I thank the Minister for that Answer. At present, up to a quarter of hospital beds are currently used by older people suffering from dementia, with unacceptable variations-as I am sure she will accept-in the quality of care they receive. Recently, both the National Audit Office and the Alzheimer's Society highlighted opportunities for significant NHS cost savings in hospital care which could be more effectively reinvested in workforce development and community services if care for dementia
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Baroness Thornton: The noble Baroness points to an important problem. As I said in my Answer, the problem here is the complexity of dealing with someone with dementia in hospital. For example, if someone is admitted with a broken leg and then diagnosed with dementia, a whole new health team and social care kick in. It is not straightforward. However, that is not an excuse for adding to the length of the stay in hospital or for there not to be adequate care. We are committed to the National Dementia Strategy, which has been the focus of debate in your Lordships' House on more than one occasion, and we are working closely with the Alzheimer's Society on its implementation. An important part of that implementation is dealing with people who have dementia and who are in hospital. No doubt money could be saved. However, this is not an appropriate target to set because, ultimately, clinical decisions will have to be taken by the doctors concerned.
Baroness Tonge: My Lords, the Minister will be aware that it is estimated that over the next 15 years there will be more than 1 million people with dementia in this country, which will cost the nation as a whole £25 billion. What planning is taking place in the Department of Health to account for these numbers and to ensure that our hospital services and our already overstretched and under-funded mental health services are not swamped by these patients?
Baroness Thornton: We are two years into the 10-year National Dementia Strategy, which has had widespread support and has been backed by funding of £150 million in its first two years. Its major strands include early diagnosis, support for those who care for people with dementia, training, increasing the science base and research; it is a very comprehensive strategy. A 10-year strategy is the way to deal with this issue.
Lord Ashley of Stoke: Does my noble friend agree that, because dementia affects different people in different ways, they should all be treated individually regardless of whether or not they are in hospital?
Baroness Thornton: We need to make sure that we prevent people with dementia from going into hospital in the first place-my noble friend is right about that. The way to do that is to make sure that doctors can diagnose dementia early and that people receive the right level of treatment and support in their homes to enable them to stay there and avoid hospital admittance.
Lord Skelmersdale: My Lords, under the Government's current plans for healthcare in the community, many more nurses will have to be peripatetic. How many does the Minister expect to move out of the hospitals and into the communities?
Baroness Thornton: I do not have a precise answer in front of me but the noble Lord is right that nurses will have to work in the community, as many of them already do. It is not a question of taking nurses out of hospitals but of increasing the number of people who
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Baroness Pitkeathley: My Lords, while undoubtedly excellent work is going on under the National Dementia Strategy, does my noble friend agree that the pockets of good practice are at best patchy? What is the Department of Health doing to ensure shared learning about co-operation between health, social care and third sector organisations, which provide so much care?
Baroness Thornton: There is a ministerial group, led by my honourable friend Phil Hope, whose membership covers all the different groups that my noble friend mentioned. It meets regularly to make sure that the strategy is both carried forward and implemented.
Baroness Murphy: Does the Minister agree that, since one-third of older people admitted to hospital in an emergency are suffering from either a confusional state or dementia, the assessment and diagnosis of dementia in hospital and the solving of the problem which the noble Baroness, Lady Greengross, raised, must start at a very early point of diagnosis? At the moment, there is no such assessment in diagnosis in 50 to 60 per cent of hospitals. How can this be addressed?
Baroness Thornton: One way in which it is being addressed is by every hospital having a senior member of staff charged with providing leadership for improving the quality of care for people with dementia, for hospital staff having the proper training and for the development of the kind of pathway for people with dementia to which the noble Baroness referred. That cannot be delivered in a year; it is why we have a 10-year strategy.
Lord Bassam of Brighton: My Lords, as there is no speakers list for today's debate, it might be helpful if I say a few words about the expected running order. The debate will be opened by the Chairman of Committees, the noble Lord, Lord Brabazon of Tara, who will be followed by my noble friend the Leader of the House, Lady Royall, the noble Lord, Lord Strathclyde, the noble Lord, Lord McNally, and the noble Baroness, Lady D'Souza. At that point, the House may wish to hear from the right reverend Prelate the Bishop of Chester, before other noble Lords rise to speak. With the leave of the House, my noble friend the Leader of the House will reply to the debate.
Lord Peston: My Lords, I am extremely puzzled by this method of doing business today. If the Chairman of Committees is introducing the debate, which is about a proposal from the House Committee, why is he not replying to it?
Lord Bassam of Brighton: My Lords, my noble friend the Leader of the House feels that it is right, and I believe that the House will agree that it is right, that the Government should conclude the debate since they are ultimately the paymaster.
The Chairman of Committees (Lord Brabazon of Tara): My Lords, in opening today's debate, I should perhaps take a moment to explain the procedure that we will follow. The Motion before the House asks it to agree to the four recommendations contained in the House Committee's report on the Review of Financial Support for Members of the House of Lords by the Senior Salaries Review Body. As I shall explain, agreement to this Motion today will not be the end of the process; ultimately, detailed resolutions to adopt the new scheme will be put to your Lordships by the Leader of the House in the spring.
At the outset, it may be for the convenience of the House for me to make a general declaration of interests on behalf of all noble Lords taking part today. I claim travel expenses under the scheme and am a paid officeholder. I am sure that most, if not all, noble Lords taking part in today's debate will have similar interests as claimants under the Members' reimbursement scheme. Therefore, it is not necessary for noble Lords to begin their speeches with a declaration of interests.
I turn to the short House Committee report before the House. The report, which was agreed unanimously, recommends that the House accepts the "architecture and principles" of the system contained in the SSRB report, with a view to the new system being in place for the start of the new Parliament next year.
If the House agrees to the Motion today, I would hope that the House Committee would be in a position to appoint the group at its meeting tomorrow, so that it can begin work immediately. In that event, I would propose to inform the House of the appointment by way of a Written Statement.
Many of the SSRB recommendations, which I will briefly outline, require careful and detailed thought about how best to implement them. For that reason, the ad hoc group of Members proposed by the House Committee will take the recommendations away and look at them in detail. The group will report back to the House Committee, which will then feed its recommendations in to the Government. As I have said, the end of the process will be in the spring, when, in the normal way, the Leader of the House will bring resolutions to the Floor of the House for agreement.
Significantly, the House Committee report also proposes that the committee should be tasked with monitoring and reporting on the impacts of the new system after a year of operation. This is an important part of the implementation process. The changes recommended by the SSRB are fundamental and very wide-ranging. As thorough as the SSRB's work has been, the impact of the new system is to a degree unknown and it will be important for us to be alive to any unintended consequences.
Before I turn to the detail of the recommendations contained in the SSRB report, it may be helpful for me to remind noble Lords of the context to the recent review. In June of this year, as noble Lords will recall, the House Committee asked the SSRB, via the Prime Minister, to conduct a review of the system of financial support for Members of the House. On the advice of our Audit Committee, we took the view that the arrangements for financial support required greater clarity to reduce any risk of abuse, which might expose both individual Members and the reputation of the House as a whole. While the system had some pragmatic benefits-it was good value to the taxpayer and easy to administer-there was a need to ask an independent body to conduct a comprehensive review of our system. We decided that the best body to conduct this review was the SSRB, which had historically made recommendations on our system and has the specific remit to review parliamentary pay and allowances.
"To review options for the system of financial support for Members of the House of Lords, given its current role and composition; and to make recommendations. In conducting the review, SSRB will have regard to clarity and transparency; accountability and public acceptability; value for money; differing attendance patterns of Members; the geographical spread of the membership of the House; the financial consequences for Members in participating in the work of the House; schemes operated in comparable circumstances by other institutions".
The SSRB conducted extensive consultation in the short time available. Three open meetings were held with Members before the Summer Recess, which around 150 noble Lords attended. The SSRB held a series of additional meetings with smaller groups and individual Members, including the Lord Speaker, the leaders of the three main parties and the Convenor of the Cross-Bench Peers. In addition, noble Lords submitted a total of 121 written responses to the consultation document issued in July.
The SSRB reported on 26 November. What one might call the headline conclusion of the report was a validation of the House Committee's decision to seek a comprehensive review by an independent body. The report says:
"Having now examined the House's arrangements for financial support as they have evolved over the years, we can only conclude that they do not meet the standards of governance, precision and transparency now demanded for the use of public funds".
The SSRB has made recommendations for an entirely new scheme. In some areas, if its recommendations are accepted, Members will no longer be able to claim allowances to the levels that they can under the current arrangements. It is important to put on record that this does not constitute any criticism whatever, implied or explicit, of those Members who have legitimately claimed allowances under the current scheme. Such Members have followed the rules as they stand and have acted entirely properly.
The report makes 26 specific recommendations for a new system, which the SSRB believes would meet the necessarily high standards. I will briefly take the House through some of these recommendations. In doing so, I do not propose to address the two recommendations in Chapter 6 on ministerial allowances, or recommendation 26 on a future role for the Independent Parliamentary Standards Authority, where the recommendations of the report are addressed primarily to the Government rather than to the House.
The SSRB recommends a new daily fee for attendance of £200. This fee would replace the current day subsistence allowance of £86.50 and the office or secretarial costs allowance. The new fee would be higher than the combination of those two allowances, but the current reimbursement of expenses for the "additional 40 days" office costs would be discontinued. The report recommends that the fee should be paid on the basis of attendance. The House is invited to consider and define which activities, in addition to attendance at sittings of the House or its committees, should qualify Members to claim the daily fee.
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