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When a new Government come in, they choose the levers that they will depend on to lead their reform over the following years-the flag-bearers of what they want to do. I am disappointed that this Government have chosen structural change and illusory freedom. They should have chosen to say, "The quality of teaching is what will make the difference and our policies will serve that end". The quality of teaching makes the most difference to the children from poor backgrounds and disadvantaged areas. I look forward, over the coming months, to hearing more about government policies that will help with that. So far, I am afraid that I am a little sad that this Government

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have almost reinvented the wheel, by seeking one more change in governance and in school status, with some more academies in the hope that that will bring about the reform that we all need. We should learn from research and from the evidence of what works. That does not lead us to more academies, with local authorities being squeezed out of the provision of education.

1.58 pm

Lord Kakkar: My Lords, it is with great humility that I beg your indulgence on this, the first occasion on which I address your Lordships' House. In the few weeks since my introduction, interrupted by the general election, I have enjoyed the warmest of welcomes from so many noble Lords and Baronesses, for which I am most grateful-as I am for the courteous, kind and thoughtful help that I have received from numerous members of staff, including the Clerks and the dedicated Doorkeepers. My happiness in making this speech is tempered by thoughts for Black Rod, who was particularly kind to my family at my introduction and whom I have had the chance of seeing, most recently yesterday evening, in hospital. I know that all our thoughts are with him and his family.

I also express my particular thanks to my supporters: the noble Lords, Lord Higgins and Lord Patel, and the Convenor of the Cross Benches, the noble Baroness, Lady D'Souza.

I could not let this occasion pass without recognising the role of the House of Lords Appointments Commission in my being here. Its thorough interrogation to which I was subjected was without doubt the most demanding and insightful of my professional career to date.

My emotions always run high as I enter the House. I never cease to be amazed by the history that attends our deliberations and the vital role that your Lordships play in ensuring that potential legislation enjoys rigorous scrutiny, so that the best possible laws may join the statute book for the benefit of all our people. That this important work is conducted in such a decent, thoughtful and selfless fashion, calling upon a wide range of scholarship, expertise and, above all, experience, makes this House truly unique.

Nor do I cease to be amazed that I find myself among your Lordships, something I could never have imagined on 7 December 1977 when, as a schoolboy, I made my first visit to this House, on which occasion I was filled with awe, excitement and a passion for our nation's democracy, debate and political discussion. The educational outreach programmes conducted by your Lordships are invaluable, and I hope to be able to contribute to these to help enthuse future generations of schoolchildren about the important work of your Lordships and about what is done in this House and how it forms a cornerstone of our much cherished democracy.

My professional life outside your Lordships' House is as professor of surgical sciences at Barts and The London School of Medicine and Dentistry, part of Queen Mary College in the University of London, and consultant surgeon to University College Hospital. I also have the privilege to be director of the Thrombosis Research Institute in London, a world-leading centre dedicated to better understanding the problem of blood clots and how best they can be prevented and treated.

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In the practice of medicine and my interest in thrombosis, I follow my father, a professor of surgery, and my mother, an anaesthetist, who came to our country in 1961 to complete their medical training. They were part of a substantial wave of immigration from India made possible because of a national consensus, long held, that has ensured opportunities and advancement for immigrant communities willing to integrate and contribute broadly to British society. What excitement there must now be among all British citizens of Indian origin on learning in the gracious Speech about the Government's desire for enhanced partnership with India, a wonderful opportunity for this vibrant community to contribute to securing broader opportunities for the entire nation.

In many ways, consensus and institutions define our national character. It is about one of our great national institutions, the one in which I continue to have the privilege to practise as a surgeon and about which I must therefore declare my interest-the National Health Service-that I would like to speak to your Lordships today. Like any great institution, the NHS cannot and must not be taken for granted. It needs to be nurtured, nourished and pruned thoughtfully and sensitively where necessary but, above all, respected.

The gracious Speech indicates the Government's desire to enhance the voice of patients and strengthen the role of doctors in the National Health Service. These are indeed important ambitions, and are made recognising the nation's serious fiscal challenge, a situation that will dominate the way that all public services can be delivered for years to come.

Time and again, Governments have felt an obligation to turn to the question of NHS reform. Why is this necessary despite substantial investment, a dedicated and talented workforce and its unique place in the nation's affections? Why is it that the care received by patients, and their experience of it, varies so considerably; that patient safety and dignity can still regularly be jeopardised; that we have not been able to define models and pathways of care that successfully cross the barriers of the hospital and general practice environment; that we are still witness to some shocking inequalities in health, none more so than those experienced by the homeless; that we have failed to develop a sustainable public health strategy; and that we are often unable to successfully disseminate and rapidly adopt innovation and the findings of medical research for the benefit of our patients? So much has been achieved, yet there is so much more that we need to do if we are to retain a sustainable National Health Service for the benefit of all. The nation's continuing commitment to the NHS offers both opportunities and important challenges to the medical profession.

All life is a journey, and in my own as a clinical practitioner and academic I have learnt so much about the dignity and resilience of human beings, but also about their frailty and insecurity. It is with this in mind that individual practitioners must deliver healthcare, at a time when both patients and relatives are at their most vulnerable. Beyond the delivery of care to our patients, however, clinicians will have to direct their current skills, and develop new ones, to help ensure that the very best possible gains in public health can be

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achieved, and that we facilitate the most effective use of the public funds available for healthcare to deliver maximum societal gain.

This is an impressive challenge, but one with which my own profession must fully engage, and I am sure it will, through providing clinical leadership. Indeed, in its report, Future Physician: Changing Doctors in Changing Times, the Royal College of Physicians of London recognises this to be a critical issue and an obligation for the medical profession. However, there is an important distinction between leadership and management in the NHS, a distinction that needs to be clearly understood so that the development of true leaders across both primary and secondary care can become enshrined in the way that we nurture the careers of our most able clinicians.

Leadership is never easy, and clinical leadership will require healthcare professionals to engage with difficult decisions. How can resources be most efficiently utilised? How can the delivery of care be safe and effective while always ensuring that patients are treated with dignity and humanity? How do we ensure that advances in medical research and innovation, once proven, are rapidly adopted for the benefit of our patients, communities and society more broadly?

To effect change, partnership will be essential-partnership between patient and doctor, academic and clinician, hospital doctor and general practitioner, and of course Government and healthcare professional-always focused on the best that we can achieve for our patients while working to ensure that the precious and generous funding available for healthcare provides maximum benefit.

Despite being one of our country's most cherished and important institutions, the NHS, like all healthcare providers around the world, faces immense challenges. With ever increasing costs on the one hand, and both the delivery of care and the nation's health failing to meet expectations on the other, courage will be required to secure a sustainable NHS for the benefit of our people. The forthcoming health Bill offers the opportunity to ensure clinical leadership and partnership within the NHS. The expertise of your Lordships' House will play an important role in achieving that. I thank noble Lords for having given me the opportunity to speak.

2.08 pm

Baroness Andrews: My Lords, it is my great pleasure to congratulate the noble Lord, Lord Kakkar, on an excellent maiden speech and in particular on his passionate advocacy of the NHS and patients; that is most welcome in this House. He knows that he joins a galaxy of talent among our noble medics, but we have never before had a specialist on thrombosis. He spoke about leadership, and I understand that he leads the only multidisciplinary programme in the area of cancer-oriented thrombosis.

I made the mistake of printing out the noble Lord's list of publications. Several hours and reams of paper later, I can vouch for his industry as well as his expertise. In addition, thrombosis affects us all, and he will be listened to most attentively in this House-particularly, I suspect, from the Front Bench, which spends hours sitting still. We look forward to his expertise.

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The noble Lord is also clearly a man of action as well as a tremendous, internationally renowned expert, a deadly combination that puts fear into Ministers. I am sure that we will welcome whatever contribution he has to make in the future.

I also welcome the Minister for Education to the Dispatch Box, and all the maiden speakers who have spoken so eloquently today. Not wishing to be left out, I will claim that I, too, am a maiden speaker. I am speaking from the Back Benches after a long period of exile to the Front Benches; I am speaking in opposition, which is an interesting angle; and I am speaking on a topic on which I have never spoken before but shall return to. It is a sort of cygnet song. I refer to the historic environment and the buildings and places which frame our lives, experiences and memories.

As one of the quartet of policies that we are discussing today, it is a useful and beautiful link between them all. It makes us feel better; it creates jobs and skills, and nurtures experience; and it opens doors to our history. Both the right reverend Prelate the Bishop of Guildford in his terrific speech and the noble Lord, Lord Baker, spoke about the importance of history-of knowing ourselves and knowing our country. I think here also of how we frame so much of our cultural activity in our great buildings. For example, in Belsay Hall at the moment there is a magnificent exhibition of contemporary art. This is one of English Heritage's properties. I must declare an interest as chair of English Heritage.

I want to focus on this area of policy for serious reasons. At a time when we face one of the greatest tests as a country-to rebuild our economy and protect our communities-we must realise, simply, that we must exploit all our resources: our knowledge, our skills and our wealth. In adversity nothing could serve us better than to make more of our historic assets. Sadly, those assets now face significant and new risks. If we are to maximise the possibilities of our historic environment, we need to understand the scope, source and scale of this wealth. Heritage is the main stream of our tourism industry. Four out of 10 people who come here say that they do so because of our heritage. Accounting for £2.6 billion from international tourism and a further £5 billion from domestic tourism, as an economic asset it is just below agriculture and well above motor manufacture. It creates jobs. Between them, the private and public sectors of heritage provide 270,000 jobs and they are not just in the south-east. They are also in those remote and rural areas of the country where options are so few. It has the capacity to grow and become an even greater source of national reputation and wealth.

In short, we are looking at what could become part of the national recovery programme. That is why I am delighted that we now have a dedicated Minister who will combine his responsibilities for heritage with those for tourism. Improving our world heritage site at Stonehenge, which is of global significance and requires a setting which is worthy of that, will form part of the Olympic celebration. We also welcome the Secretary of State's assurances that the National Lottery will be reformed and funds returned to the four original good causes, including the Heritage Lottery Fund. That means more strategic support for heritage, which is very welcome.

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The Government have also made it clear that they want local communities and local authorities to take more control of future services and assets. In some ways they are building on what the previous Government did by putting local assets into the hands of local people to use for community benefit. There is nothing more potent, more local and more important to people than the place where they live. It does not matter whether it is the Sussex Weald or Victorian terraces. This is a Government who want us all to get involved and this is how people do so. Nothing is more evident than this in the big society. Organisations such as the Heritage Alliance and the new Civic Voice will give every encouragement to that.

I hope that, in the decentralisation and localism Bill, a presumption for sustainable development will not turn into a short cut to development at all costs. That would be simply a recipe for disaster. A third asset is the fact that our historic places are, by definition, sustainable resources-far better to invest in them than to let them decay. It is far better that the parish church of which the right reverend Prelate the Bishop of Guildford spoke so eloquently becomes a post office or shop than for it to be redundant and unused. I firmly support his appeal for the Government to maintain the VAT exemption on church buildings, which is incredibly important.

The Government need to be alert to this and to the cost benefit. Some of the best and most sustainable examples of social and economic regeneration and success in recent years-places such as Weymouth and Blackpool-have been successful because they are built around their heritage. That must continue. I would suggest that it is a good argument for why a regional funding capacity should continue, so that it can step in where national and local authorities can fail.

The case that I am making must be made now in the context where the risks to this extraordinary heritage have been increasing in recent years. The recession has had a major impact on our ability to protect historic places. Investors are more risk-averse, and owners and developers find it difficult to borrow money. Decay leads to dereliction and disaster. Once you have lost a building-think of the Euston Arch-you cannot recover it. It is not like shutting the door on a room in an art gallery. That risk is accelerating, particularly in relation to our industrial and cultural heritage. Local authorities are losing skilled staff, including conservation officers and planners-the people who guarantee that the places where we live are the best they can possibly be. That context-the financially challenging times that we live in and the accelerating risks-reinforces the case for greater heritage protection and the need for the Government now to provide time for a heritage Bill which will reduce red tape, simplify the system and increase our ability to protect buildings and places at risk. The cost of not doing that will be the huge bills of dereliction and social diminution in the next few years.

I end with this thought: this country leads the world in the care and protection we give the historic environment. People from Moscow, Naples and all over the world come to see how we have done it and to learn from us. Other countries are waking up to what they have already lost. If we do not send the signal

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that this matters to us, we will lose not only culturally but economically. We will also lose our leadership, which is so important to the rest of the world. Nothing could be further from the truth than that this does not matter. Failure will carry an extremely high price.

2.17 pm

Lord Rix: My Lords, it was just over 18 years ago that, during the debate on the gracious Speech, I made my maiden speech from this side of your Lordships' House, from this very Bench, flanked by Lord Allen of Abbeydale and the noble Earl, Lord Snowdon. I must say that the House was somewhat better then than it is today.

I made reference then to the labels-often unacceptable and hurtful-which apply or have applied to people with a learning disability. I was then the chairman of Mencap, but for the past 12 years I have had the honour to be that society's president. I am delighted to report that, during this time, opportunities and quality of life for many people with a learning disability have improved considerably. As an example, the closure of overcrowded, austere and remote institutions-comparable to prisons rather than hospitals-has been particularly welcome, and ensures that more people with a learning disability are no longer hidden away, out of sight and out of mind, but are able to enjoy the benefits of living in their own local communities, making friendships and forming relationships. This is a thoroughly good thing and we must build on this progress.

It would be remiss of me if I did not place on record my personal appreciation of the work of successive Governments and pay tribute to all those who have helped to make this happen. The extent of this progress is reflected in the different tone of language and terminology used with respect to people with a learning disability over this time. At the time of my maiden speech the term "mentally handicapped" was used, but the term "learning disability" is more suitable for the modern day. However, since it can be confused with "learning difficulty", no doubt the label will change yet again. But in many respects the use of language is the easy part. There is still a great deal more progress to be achieved if the 1.5 million people in our country with a learning disability, and their families and carers, are to be fully empowered and enjoy the opportunities of living independently, along with dignity and respect, and if the scourge of bullying is to be totally eliminated.

I take this opportunity to congratulate all noble Lords who have been appointed to the coalition Government and wish them every success in their new roles. The single biggest challenge facing the coalition Government-reducing the public deficit by reducing public expenditure-also poses a considerable threat to the quality of life experienced by people with a learning disability, their families and carers. I strongly urge the coalition Government to recognise this threat and ensure that people with a learning disability do not become the unintended victims of centrally driven, yet locally delivered, "efficiency" savings. Those who can afford it the least must not be expected to pay the most.

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Twenty-two separate Bills were set out in the Queen's Speech, but I shall refer only to those which have the greatest interest from my point of view. The welfare reform Bill aims to simplify the benefits system while increasing incentives to find work. Many people with a learning disability want to enjoy the benefits of going to work and living more independently but, due to ever-present prejudice and discrimination, are unable to do so. Latest government statistics reveal that while 48 per cent of all disabled people are engaged in some form of paid employment, for people with a learning disability this figure is just 10 per cent. Regrettably, this figure has remained at this level for the past 10 years. I seek assurances from the coalition Government that the welfare reform Bill will be used as an opportunity to abolish much of the bureaucracy that prevents people with a learning disability from getting a job and that it will instead provide the support and assistance that will help empower them so that they can have an even greater control over their own lives.

In the area of education, the gracious Speech referred to a couple of Bills: one, the Academies Bill, will introduce legislation to enable more schools to achieve academy status; and the other, the education and children's Bill, will act as a companion piece to the Academies Bill. I recognise the coalition Government's aim of driving up standards and increasing choice in education and the opportunities provided by greater freedom to be more innovative and creative in delivering education on the ground. However, I seek assurances that, as a consequence of these greater freedoms, children with a disability and their parents will also have the opportunity to enjoy the promised benefits and advantages of receiving their education within an academy or a so-called free school. Due to the seven-minute time limit, I have had to cut many of the things that I wished to say about education. However, I am glad to say that the Academies Bill, which is due to have its Second Reading on Monday, has been able to house all the notes that I wished to speak on now.

The final piece of legislation referred to in the gracious Speech on which I wish to comment is the health Bill. The coalition Government's aim is for the voice of patients and the role of doctors to be strengthened in the National Health Service. I welcome the Government's intentions to devolve greater power to patients and hope that this will lead to a reduction in the health inequalities often faced by people with a learning disability when they attempt to access healthcare in the NHS. Mencap's widely regarded Death By Indifference report and the subsequent inquiries highlighted the tragic experiences faced by six people with profound and multiple learning disabilities and the reasonable adjustments that healthcare professionals must make in order to listen to a patient's family and not make assumptions about a person's quality of life and health just because they have a disability.

In conclusion, I hope that the new coalition Government are successful in delivering their stated aim of promoting freedom, fairness and responsibility. With those guiding principles at its core-most notably fairness-I very much hope that people with a learning disability can feel that they too have a stake in this Administration and that it will help them to live more

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independent, free and prosperous lives. Whether that be in the fields of welfare reform, education, health or even culture, I look forward to working with the new coalition Government to improve the lives of people with a learning disability and their families and carers. For the past 18 years, successive Governments have done their best in this regard. I cannot believe that a coalition Government cannot do even better.

2.24 pm

The Lord Bishop of Lincoln: My Lords, I welcome this opportunity to join others in paying tribute to the new Minister. I also pay tribute to the noble Baroness, Lady Morgan, with whom I have locked horns once or twice in the past. I was very grateful for her speech and for the maiden speeches of the noble Lords, Lord Hill, Lord Hall and Lord Kakkar, and of my noble friend the right reverend Prelate the Bishop of Guildford.

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