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My point is not that I am advocating one or other as being the norm for the House of Commons; I am simply saying that there is a world of difference between the type of representation at the lower end of that scale and the type at the higher end. To pretend, therefore, that there will be no difference whether Members of the House of Commons represent 50,000, 60,000, 70,000 or 90,000 people is ludicrous. There has to be recognition of the nature of the relationship between constituents and their Member of Parliament, and that seems to be lacking in the Bill.

Lord Mawhinney: I have had the privilege of serving in the other place. I started immediately after a boundary redistribution with 60,000 to 65,000 constituents, and finished up with 95,000. I hope the noble Lord is not suggesting that in the latter years my constituents got a worse service.

Lord Harris of Haringey: No, my Lords, I am suggesting that the noble Lord no doubt had to work 50 per cent harder to deliver the service that he regarded was appropriate at the beginning of his time in the other place. That is fine, but we ought to-

Lord Tyler: I am grateful to the noble Lord for giving way. He is making a very powerful case for equalising the numerical strength of each constituency.

Lord Harris of Haringey: The case that I am making is that we have to define the appropriate numerical relationship between the electorate and the Member of Parliament. If you want to go down the route of

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equalisation, you should first define what the appropriate ratio is. If you do not know that, the argument is, frankly, pointless and otiose.

However, I do not necessarily believe that equalisation is the sole point that we should be looking at. One of the dogs that have not barked in this debate has been the question of what other factors are important, and the amendment provides the opportunity to consider the character of localities and their different natures. When I was the elected Member of the London Assembly for Brent and Harrow, I had the privilege of representing the most ethnically diverse local authority area in the country and, separately, the most religiously diverse. To suggest that the characters of those areas did not influence the nature of the work that I did as a public representative is, again, ludicrous. The characteristics of local constituencies matter. You will find that nearly every other jurisdiction recognises that as part of the factors that need to be taken into account when it comes to deciding where to draw boundaries.

The other dog that has not barked has been the size of the House of Commons. The issue has been brought up today but we have not had that debate. What will be the most effective size of the House of Commons to do the work that we believe it should carry out? What is the effective size for both representing constituents and scrutinising legislation? Where is that debate? We are sidestepping it because of the desire to push ahead without proper consideration of these issues.

My noble friend Lord Beecham talked earlier about the relationship with local authorities. My noble friend Lord Knight, who has just spoken, said that he was in favour of this. I have to say that I am against it. The Bill encourages, or at least would make it far easier for, constituency boundaries to cross local government boundaries. I do not believe that that is in the interests of good and effective representation. It will make it more difficult for MPs to cover the ground, and for them to have a relationship with local authorities so that in partnership they can achieve things for their constituents both at local government level and in working with central government in Parliament. Those are the issues that make talking about crossing local government boundaries in this way so inappropriate.

The final issue that I want to refer to, in terms of dogs that have not barked in this debate but that should have been allowed to be considered in detail, is the nature of the electoral data on which all this is based and the frequency with which they change. I have spent all my political life in London. London is an area in which, historically, there has often been underrepresentation because of the number of people who are registered to vote. That underrepresentation was at a particular peak when the community charge-the poll tax-was introduced, and all that went with that. A large number of residents in London chose to drop off the electoral register, as they did in many other urban areas and no doubt elsewhere. That legacy of underrepresentation remains.

We should also consider the turnover in big inner-city populations and the number who come in. At one point when I was leader of my local authority, the collection register for the community charge turned over by one-third each year, indicating a great flow of

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population dropping into and out of the area. That was partly a consequence of migration and partly because of the mobility of populations at that time, but it also involves the recognition of particular areas. Because the Bill is constructed around drawing up these boundaries and quotas on the basis of an already flawed electoral register, we are building into the system an inappropriate bias against areas with historic underregistration and areas with an historically very high turnover.

Lord Howarth of Newport: Does my noble friend agree that the factor he has just been speaking of will be exacerbated in consequence of the coalition Government's housing benefit changes?

Lord Harris of Haringey: My noble friend is absolutely right. The projections that people have talked about-of the flows of people having to move because they will be displaced by changes to housing benefit-necessarily means that he will be right. I also suspect that we will see more people dropping out of the system and being difficult to pick up. They will be trying to avoid various obligations as a consequence of that. I thought the noble Lord, Lord Rennard, was moved to intervene again but he has not done so, which is fine.

My point is that these are fundamental issues which should be considered before we make a final judgment as to the direction we are taking in this legislation. It may be that, after proper consideration, a simply numerical allocation would be the most appropriate way forward. It is not one that I would favour but I can see how we could get to that. First, let us debate these issues properly. This legislation is not giving us the opportunity, whereas my noble friend's amendment would enable that to take place, for the public to be engaged in it and for this to be as transparent a process as possible. If I remember correctly, transparency is one of the objectives of this Conservative-led coalition Government; they believe it is so important. Let us see that importance reflected in this legislation.

Lord Foulkes of Cumnock: My Lords, I make just two brief points, which arise from the debate so far. The first follows what my noble friend described as the dogs that did not bark. I ask Members of this House to imagine a Labour Government proposing an arbitrary number in the House of Commons, without any consultation or a Green Paper, and without any hearing arrangements whatever. What squeals we would hear from the Liberal Democrat Benches. We would have heard lectures from the noble Lord, Lord Lester of Herne Hill, about how it breached human rights. We would have heard squeals of high dudgeon and moral outrage from the noble Lords, Lord Tyler and Lord Rennard, about its being disgraceful and undemocratic. What have we heard in this debate of now two hours and 16 minutes? There have been three interventions from the opposite side, which is not prepared to engage in the argument.

I understood that the House of Lords gave us an opportunity to revise legislation-to debate it, which means to look at both sides of the argument. The situation now appears to be that the coalition is prepared just to sit there on its Benches, waiting for the debate

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to finish and prepared to use a built-in majority to push the Bill through without any debate. That is a negation of democracy. I do not understand how Liberal Democrats who sat through the Labour Government, attacking and criticising us for such things, can sit there and accept it. My noble friend Lord Grocott will recall that in the Labour Government there were certainly people on the Back Benches of the Labour Party arguing the case, questioning, challenging and making sure that the issues were properly discussed. It is quite astonishing that, apart from Labour Members and two distinguished, excellent contributions from the Cross Benches, no one has entered this debate.

My second and last point is for the noble and learned Lord, Lord Wallace of Tankerness, who will reply to this debate and who I know very well and have great respect for. I hope he will reply properly to the debate and deal with the issues that have been raised. I want him to deal specifically with this one. The Scottish Constitutional Convention preceded the setting up of the Scottish Parliament. It involved all the parties, civil society in Scotland, the universities, the trade unions and everyone in Scotland. It discussed what the powers of the Scottish Parliament should be, what should be devolved, how many Members there should be and what the electoral system should be. Before legislation was introduced, the Labour Government allowed that debate to take place. If the noble and learned Lord, Lord Wallace, will not agree to this for a major constitutional change to the House of Commons, he needs to search his conscience very strongly. Those are the only points that I want to make.

5.45 pm

Lord Boateng: My Lords, we are privileged in this House to serve in a Parliament that is widely perceived the world over as the mother of parliaments. That is a privilege we enjoy and one that several of us have now enjoyed in both Houses. I had a period of almost five years' absence from the Palace of Westminster, living and working in a country that was a new democracy. It valued its written constitution, which encapsulates some of the highest possible ideals of democratic participation and values. However, it was located in a continent-Africa-where, frankly, democracy has, over the years, been stretched and at times broken, albeit a continent that is now beginning to demonstrate a degree of movement towards a better and more truly representative democracy. Therefore, along with many other Members on all sides of this House and in another place, I have spent time-through the Commonwealth Parliamentary Association, the Westminster Foundation for Democracy and other institutions-working with parliamentarians and groups of citizens globally. They have seen in the Westminster system of democracy something that they seek to emulate and aspire to.

I have had an opportunity, over the past four years while I have been absent from this place, to see at first hand how parliamentarians and civic groups throughout Africa look to this place for examples of how they can better conduct themselves and how they should embark on constitutional reform. It is worth this House's while to reflect, just for a moment, on how this measure

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is perceived outside Westminster-not just in our own country but abroad and, in particular, in those places that have traditionally looked to Westminster as the best example of how to conduct constitutional reform and embed democracy in governance.

When we pause for a moment to think about how we are perceived externally, we might see something of value. I certainly see something of value in the amendment of the noble Lord, Lord Wills. It gives us time to pause and reflect; it seeks to proceed on a firm basis of evidence; it seeks to arrive at a consensus on the way forward in crucial matters, as many noble Members of this House have articulated in this afternoon's debate and earlier on Part 1; and it seeks for that to take place under the auspices of a High Court judge. That is important. Members from all sides of this House have been out and about globally, talking to and sharing with colleagues in other Parliaments on issues of governance, sometimes in very fraught situations. In the past we have always been able to reply in the affirmative to one of the questions that they have asked us: in the United Kingdom we proceed with constitutional reform on the basis of consensus. Speaker's Conferences and other devices have brought about a degree of consensus, and only when that consensus has been achieved are we prepared to go forward, even when it has meant delay or perhaps taking longer than many would have liked.

What I find so disturbing about Parts 1 and 2 of the Bill is that they are clearly being driven through without consensus; for us to pretend otherwise is just spurious. It will weaken our hand in the world as we argue for better governance globally, as we will no longer be able to say, "In our country we proceed by way of consensus". We will no longer be able to say that in our country-this applies particularly in relation to how constituency boundaries are drawn-we proceed only on the basis of an inquiry presided over by a legal figure in which people on all sides are able to give evidence and in which their views are heard.

Lord Soley: I am grateful to my noble friend for touching on an important issue that I want to raise when we discuss Amendment 59: namely, that when we act as international observers at elections overseas, most notably in some of the former Communist countries, one of the things we always look at is who decides the size and structure of a parliament in the context of whether that is done with all-party agreement or on an independent assessment. That is one of the ways in which we can flag up warning signs.

Lord Boateng: I am grateful to my noble friend for reflecting on that. Many Members on all sides of the Committee, some of whom are sadly silent this afternoon, know that what my noble friend says is true and that we will be weakened by the measures that we are debating and which some seek to push through the House. I ask us to pause and give serious consideration to the proposal in the amendment, as it would at least enable us to say that we have sought consensus and respected the role that the judiciary can, and ought to, play in this area of constitutional reform. A number of us have visited countries in the immediate aftermath

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of hotly contested and inconclusive elections, just as our election was hotly contested and inconclusive. We have said to them, "The last thing you as a Government should be doing now is pushing through a measure which could be perceived as enshrining your own power for longer than the electorate have given you a right to expect". Noble Lords on all sides of this House have given that message to others; it is a lesson that we ought to take on board ourselves.

Lord Maclennan of Rogart: My Lords, I have no mandate to speak on this matter for the coalition but I have listened to the debate for two and a half hours and I have heard assertions being made which certainly ought to be rebutted, not necessarily by the Minister but by those who have taken a strong interest in constitutional reform in this House and in another place. I have served in Westminster for 44 years and I am bound to say that the view that constitutional reform should be based on consensus is so unhistorical that I cannot recognise it as having even a scintilla of truth. The noble Lord, Lord Boateng, suggested that we should react to the recommendations of the Speaker's Conference. I served on the Speaker's Conference when it considered the voting age of members of the public. If that is not a fundamental question, I do not know what is. The Speaker's Conference recommended that people should have the vote at 20. The Labour Government of the time did not consider that that was right. The late Lord Gardiner, for whom I had the greatest respect, summoned me to his chambers to ask why the Labour Party's policy on having the vote at 18 had not been reflected in the Speaker's Conference recommendations. Did that Government respect the recommendation of the Speaker's Conference? No, they did not. They went ahead with the vote at 18.

Time and again we have had references to the 1832 Act. What sort of a royal commission was called before that 1832 Act was passed by Parliament? What kind of consensus was there in the country? There was nothing. There was political leadership from Earl Grey, who had strongly advocated these matters for some time.

Lord Wills: I have great respect for, and pay tribute to, the noble Lord's very distinguished history as a constitutional reformer and he was right to remind the Committee of that. I know that it was a long time ago and he may have forgotten exactly what I said in my opening remarks but I do not think that he was listening quite as carefully as he should to those remarks which informed the rest of this debate. I specifically mentioned practice over the past 100 years or so. I am not talking about the 19th century but of relatively modern times. I am not talking about the broad constitutional issues about which there will always be debate. My noble friends Lord Grocott and Lord Snape talked about the broad constitutional issues of the alternative vote system and I fundamentally disagree with them on that. I am talking about achieving consensus on a process that is, as far as is possible, independent and fair minded. Does the noble Lord not recognise that?

Lord Maclennan of Rogart: What I do recognise is that in my lifetime the entitlement to vote has changed considerably. There was, for example, a multiple vote.

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My father cast two votes for parliamentary elections in different constituencies and that was perfectly legal. I am conscious that that change in the law did not come about as a result of a high-powered discussion led by a judge. We know the opinion of judges. We have heard from former judges in this debate. The noble Lord, Lord Elystan-Morgan, gave us his view. What is there to suggest that a judge sitting on a committee comprising partisan people drawn from both Chambers will come up with any different view from that of the elected House of Commons, backed or not backed by this Chamber? It is a chimerical view that we could have a consensus on this set of propositions. It is a method of delaying decision, and constitutional reform requires decision.

Lord Foulkes of Cumnock: Does my noble friend-I still think of the noble Lord as my noble friend-not agree that the Scottish Constitutional Convention, of which he was part, provided us with an excellent model whereby we had a White Paper, then an all-party discussion and discussion with people from the community-indeed, I think there were some lawyers on it as well-and that that is exactly the right kind of model that we should be encouraging in this instance?

6 pm

Lord Maclennan of Rogart: I, alas, disagree with the noble Lord on that. As he said, I served on the Scottish Constitutional Convention but I am bound to say that it was a device to fill a gap in time when it was not possible to extract from Parliament the decisions that reformers such as the noble Lord were in favour of. It was a method of trying to cover up political delay. I am sorry but I do not think that it was ideal. I think it was he who suggested that all parties had participated. That is not the case. The Conservative Party did not participate.

I also sat on another convention which was attempting to draw up a constitution for Europe and, again, was filled with representatives of national Parliaments from all around Europe. I am bound to say that it came to nothing. What has come to something has been the treaty of Lisbon, which came about as a result of executive government in a number of different countries plucking from that convention the best that they could to give us a framework for our European constitution.

I am sorry, but I profoundly disagree with the thread of argument that has been built upon the amendment that we heard eloquently defended and advocated at the beginning of this debate. We have seen this process of setting up commissions. We had a commission-a royal commission-set up on the reform of this place, sitting under the noble Lord, Lord Wakeham. How many of its recommendations, consensual as they were, have been implemented here? Virtually nothing has happened.

The most notable reforms of the Government which preceded the present one did not all come about as a result of commissions of inquiry or looking for consensus. One of the most remarkable reforms was that which resulted in the appointment of the noble and learned Lord, Lord Falconer, to the Cabinet and concerned taking out of this Chamber active judges-active Members of the House of Lords, sitting in its judicial

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capacity-and the creation of a Supreme Court. That was done by the decision of the Prime Minister, backed by some influential members of his Cabinet. It was certainly not accepted generally or widely. There was no consensus about it. It was torn apart in this House and was considered for months in a committee of this House, but it was certainly not produced as a result of seeking consensus. After the event, it seems to have been a very wise move, which was backed by the then great Lord Bingham, who was the senior Law Lord.

Lord Sewel: I wonder whether the noble Lord will now try and square the argument he is putting forward with the argument for participatory democracy that his party advocates?

Lord Maclennan of Rogart: Yes, I will. We have a very imperfect system of participatory democracy, because we have a rotten electoral system. The first past the post system does not reflect in Parliament anything like the aspirational end of participatory democracy, and although I do not regard the alternative vote as the ideal system-again I speak for myself and not the coalition-it is none the less a step towards a better representation and a more participative end point in our constitution. It will, I believe, make people feel in their constituencies generally that their vote does count.

Lord Sewel: In that case, is the noble Lord saying that the individual citizen is limited to being just the individual elector and not an active citizen in the legislative process?

Lord Maclennan of Rogart: There are many ways in which one can be an active citizen, and I enumerated some of them when introducing a debate on that very subject in this House shortly before Christmas.

I do not wish to detain the House, and I am conscious that the hour is late and that many will wish to reach a decision on this. However, I want to say that I am distressed by the fact that so many noble Lords for whom I have a high regard should imply that this deliberative process would bring about a better end point than the deliberations of our Parliament, which the noble Lord, Lord Boateng, referred to as the mother of Parliaments. It is so highly regarded largely because it is thought to act, usually, in a deliberate and wise way. On this occasion, the silence on these Benches indicates consent to what the Bill is putting forward, and an awareness that those opposing it are seeking to stop it from making progress and to stymie the efforts to achieve the constitutional reform that is long overdue.

Lord Gilbert: My Lords, in the 27 years that I was in another place I represented all that time the good people of Dudley. The extraordinary thing is that I represented no fewer than three distinct and different constituencies, and was chosen to stand as a candidate for a fourth constituency, within the boundaries of Dudley. That was not so much an inconvenience to me, but an infuriating irritant to the good people of Dudley.



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I have also seen the consequences-as, no doubt, many other noble Lords have-of constituencies that cross local authority boundaries. That is not only an inconvenience to the Member of Parliament but an enormous inconvenience to elected councillors and paid officials of the different local authorities. It is beyond an irritant; it drives ordinary citizens berserk because they do not know who to go to. It is not a question of parliamentary convenience.

Long ago I came to the view that this manic idea that we have to have precise mathematical equivalence in constituency numbers is a hobgoblin of very small minds indeed. We should be big enough to accept certain anomalies in our constitutional system without recoiling with shrieks of "unfair, unfair". There is no such thing as a fair system, because what is unfair to the noble Lord, Lord Maclennan, whose speech I largely agreed with, is fair to me; and vice versa. There is no such thing as an ideal fair system which is just to be grasped and which ordinary reasonable people would sit down and agree with. Ça n'existe pas, it never will, and we should accept anomalies.

Earlier in this debate, one noble Lord talked about his difficulties in visiting a part of his constituency which was an island. When I first represented Dudley, it was an island.

Noble Lords: Oh!

Lord Gilbert: Oh yes it was. The centre of Dudley was a part of Worcestershire that was wholly surrounded by Staffordshire. I represented a constituency called Dudley, but which was actually and simultaneously Dudley and Stourbridge. The country got by quite well with that, except rather inconveniently at electioneering time when my wife and I swapped ends. In the mornings, I was in Dudley while she was in Stourbridge, and vice versa in the afternoons and evenings. However, the principle was exactly the same as that adumbrated by my noble friend. Surely to god this country is big enough to accept a few minor anomalies and have something like the Isle of Wight with a much bigger electorate, if it wants that. The idea that we should try to produce equivalence in numbers of constituents-with all the consequences that it produces-is quite absurd.

Lord Falconer of Thoroton: My Lords, this is a very important amendment and is the inevitable consequence of doing what the constitutional committees in both Houses of this Parliament have complained about.

The chairman of the Political and Constitutional Reform Select Committee in the Commons issued a report on 2 August which stated:

"Your legislative timetable has put me and my committee in an extremely difficult position. When the House agreed to establish the committee, it did so, in the words of the Deputy Leader of the House, 'to ensure that the House is able to scrutinise the work of the Deputy Prime Minister'. In the case of these two bills"-

one of them is this Bill-

scrutinise. Our own Constitution Committee said:

"In general we regard it as a matter of principle that proposals for major constitutional reform should be subject to prior public consultation and pre-legislative scrutiny. We recognise that there

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may exceptionally be good reasons for departing from this principle, but the perils of doing so are well illustrated in the present Bill. The case for proceeding rapidly with one Part of this Bill is far stronger than for the other".

It is possible that the effect of Part 1 of the Bill as drafted will have no effect on our constitution. There is no doubt that if Part 2 in its current form goes through, it will have a substantial effect on our constitution. I very strongly empathise with the very powerful speech by my noble friend Lord Boateng. What would we say to a country that said, "We are going to reduce the number of Members of Parliament in our country by 50 by using our majority to do so"? We would say, "It may well be sensible to reduce or increase the number of Members of Parliament in your country, but presumably there is some sort of independent process by which the number is to be assessed".

The number of Members of Parliament in this country has fluctuated over a period of 60 or 70 years. That fluctuation has always been as a result of recommendations of the Boundary Commission. It is a very dangerous precedent for a majority in the House of Commons, and then a practical political majority in this House, to push forward a change in the number of Members of the House of Commons.

Even if there was not some independent justification for the reduction from 650 to 600, is there some intellectual justification for the reduction from 650 to 600? How many of your Lordships were present when the Leader of this House, the noble Lord, Lord Strathclyde, gave as the justification that it was a nice, round number? There is no intellectual justification and no independent justification of any sort whatsoever. The noble Lord, Lord Maclennan, whom I respect for the work he did in pioneering the way for constitutional change, says sometimes you just have to bite the bullet and go for it; it is leadership that matters. We have never done that in this country since 1944 in relation to how our democracy is based.

In 1944 a Speaker's Conference set up the current method for determining constituencies and the number of Members of Parliament. That was given effect in an Act of 1949. There was a further Act in 1954 which gave effect to a consensus that there should not be too radical changes in the number of Members of Parliament. There were further changes in 1986 by a Government led by Mrs Thatcher-the noble Baroness, Lady Thatcher-which we, the Labour Party, broadly supported. Further changes were introduced in 1992 by a Government led by Mr John Major, which we broadly supported. There was one occasion in which jiggery-pokery was attempted by a Government and that was in 1969 by a Government led by Harold Wilson and the Labour Party. What happened was that this House rejected the Bill that sought to tamper with a boundary revision.

So do not tell us that Parliament has not proceeded by way of consensus; Parliament has behaved exceptionally well. I think that it is a disgrace that there is absolute silence from the other side, as without independent justification and without intellectual justification a Leader of this House treats this House and the parliamentary system with contempt by saying it is a

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nice, round number. I see Back-Benchers nodding that it is a perfectly respectable argument, but it is not; it is a disgraceful argument.

6.15 pm

There are two alternatives. The alternative that was forced upon me when I sought to reform the role of the Lord Chancellor was that this House spent 18 months looking at that Bill and a much better Bill came out at the end. A better alternative would be to do what the two cross-party committees say is the right thing to do, which is to have proper consideration of the Bill. Perhaps we could go through some of the issues which have not been considered at all. First, what is the right size of our Parliament? What has been said on this side of the Committee, as well as by a whole range of independent commentators, is that the way to determine the right size of the House of Commons is by identifying what you want your Members of Parliament to do. That has two aspects to it: first, what they do as constituency MPs and, secondly, what best makes the House of Commons function well. Some work should be done on that.

I ask the wholly admirable noble and learned Lord, Lord Wallace of Tankerness, what work has been done on that? What consideration have the Government given to that issue? What foreign examples, if any, have they sought to guide them in relation to that? What effect do they think that an increase by 25 per cent in the population over the last 25 years, when there has been only a 4 per cent increase in the number of Members of Parliament, has had on the work that they do? Do they agree with the implication of the noble Lord, Lord Mawhinney, that it has had absolutely no difference whatsoever on the workload of MPs?

As the former MP for Great Yarmouth, Tony Wright, said last year, today we need to ask the question as to what Members of Parliament are for, not least because they are asking it themselves and others are asking it of them. Peter Facey of Unlock Democracy told the Political and Constitutional Reform Committee of the other place:

"I would have preferred a debate about what the function of the House of Commons should be and what the appropriate number of MPs should be for that function and then having the debate about the number of constituencies".

Lord Mawhinney: Just for the record, I made no such implication as the noble and learned Lord has attributed to me. The point that I was seeking to make was that, whether the number of constituents is 65,000 or 90,000, it is perfectly possible for a Member of Parliament to handle that level of workload.

Lord Falconer of Thoroton: I apologise. I misunderstood what the noble Lord said. Obviously, further work would need to be done. I am happy to say that when I said further work was required, the noble Lord nodded-that is the point that I am making. First, what is the workload on a Member of Parliament and what is the right size for Parliament in relation to that consideration?

Secondly, what should be the basis of determining the constituencies? Of course, I think that it should be the electoral register, though there is an issue about population. There is a respectable view that says, where you have constituencies which have very significant

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populations which are much higher than the electoral register, those constituencies should, in some way, reflect that increase in the size of the population. For example, just as we have a geographical limit because we think it is too far for an MP to travel all around the constituency, is there a population limit above the electoral register which should have some effect on the size of constituencies?

Thirdly, the purpose of the deviation figure of 5 per cent from the electoral quota is to ensure that constituencies are broadly the same size. That would lead to a difference in the size of constituencies of about 7,000 if 76,000 is the average size of a constituency. The purpose is to get rid of what is described as the malproportion factor. Published work, in particular by Thrasher and Rallings, and by Lewis Baston, suggests that a deviation figure of 10 rather than 5 per cent would have the same effect in reducing the malproportion figure yet at the same time allow one, in determining constituencies, to keep communities together and not have the radical effect that the government proposals would have. What work have the Government done on whether 5 or 10 per cent would make a substantial difference to malproportion? Has any research been done on that? What effect on, for example, crossing county boundaries would a 10 per cent as opposed to a 5 per cent deviation have? The Government will not be able to answer all these questions; I am asking about the research that is being done on them.

Thirdly, what effect will this have on the Executive? Reducing the size of the House of Commons from 650 to 600 will increase the size of the Executive and reduce the number of Back-Benchers. Is it the intention of the Government to stick with that? If so, what effect will that have on Parliament as a place to hold the Executive to account?

Fourthly, what will be the effect of removing local boundary reviews that can be conducted in person? These reviews have had a 64 per cent effect on changing constituency boundaries. What work has been done to determine the effect on the reliability and acceptance of the boundaries that removal of the reviews will have?

If the Government will not answer those questions or have not done the work, the questions should be answered by somebody. This is not a great reform like the 1832 Act, as the Prime Minister said; it needs work doing on it. The effect of the amendment of my noble friend Lord Wills is that that work can be done. As my noble friend Lord Boateng said, our democracy is something that we rightly prize. The idea of rushing into this change, which has the support only of one side of the Houses of Parliament-let alone of either the country or the rest of the world-is wrong. It is not an acceptable justification to say that the Tory party agreed it with the Liberal Democrats between Friday and Tuesday after the latest general election. That looks like the worst sort of political gerrymandering. I ask the Government to reconsider and to give ground in relation to an independent look at the changes that they are making.

The Advocate-General for Scotland (Lord Wallace of Tankerness): My Lords, first I thank the noble Lord, Lord Wills, for introducing a debate that has

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given rise to a considerable number of important contributions. I am not sure that I can address all of them, but I will do my best to pick up most of the salient points. It is clear that the debate on this amendment has touched on many issues that will inevitably come up as we go through the Bill. Future amendments have already been tabled that deal with some of them. I hope to explain the principles that underlie the proposals that we will debate further. I hope also to explain why the proposals are reasonable and why a committee of inquiry is unnecessary.

It is clear that the amendment would slow down the proposed reform of our political process and system. It is highly unlikely that the proposals in this amendment would be in place in time for the next election. There would be a three-year deadline to report, six months to draft measures giving effect to the recommendations, and then time to legislate. That would be only for the legislation that set new rules for conducting boundary reviews. The reviews themselves would then need to be carried out. Therefore, even if the rules were in place before the next election, the new boundaries could come into effect only at the election after that.

I do not want to suggest that the political purpose of this has been to kick the Government's proposals into touch, although my noble friend Lord Tyler referred to previous committees of inquiry that delayed and postponed for many years what were seen by many as desirable reforms, and there was a general groundswell of support for his point on this side of the House. I also want to knock on the head the idea that I have accused noble Lords opposite of filibustering. The only complaint I would make is about the time taken up by them complaining that I might accuse them of filibustering. I also take great exception to the suggestion that the proposal is partisan. I do not believe that the opposition case stacks up. The noble Baroness, Lady McDonagh, pointed out that the issue of the size of constituencies applied as much to Conservative constituencies as to Labour ones. One cannot on the one hand say that reform will have the same impact on Labour and Conservative constituencies and on the other say that what we are trying to do is partisan.

I will pick up a point made by the noble Lord, Lord Wills, about his freedom of information application. I apologise that the noble Lord has not yet received a reply to his request. I will seek to ensure that he receives one as soon as possible. However, my noble friend Lord McNally, who is sitting with me, has indicated that as far as we are aware no work has been done on any kind of partisan measurement of what a new size of 600 for the House of Commons would bring about. No modelling has been done on that basis. I also say at the outset that amid all the outrage that we have heard from the other side, one would think that it was a constitutional outrage to support the principle of one vote, one value. That is what is enshrined in this part of the Bill; one vote should have one value in all parts of the United Kingdom. I do not believe that to be a constitutional outrage, except in Orkney and Shetland and the Western Isles. I am happy to argue that, as the noble Lord's party did in the Scotland Act in the case of Orkney and Shetland.



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My second point is that there would not only be a delay. If the 2015 election is to be fought in England on boundaries that took as their electoral registration base the year 2000-15 years previously-can anyone suggest that that is a constitutional principle that we should seek to uphold in this House? We wish to make progress with this so that we can have a boundary review that will deliver its report and be in effect by the 2015 election.

Lord Harris of Haringey: I am grateful to the noble and learned Lord for giving way, albeit slightly after the point that he was making. He said, on behalf of himself and the noble Lord, Lord McNally, that no political modelling had been done on the implications of this reform. I would have been very surprised had he told us that the Civil Service had done an exercise on behalf of Ministers that had demonstrated what the political consequences of these changes would be. However, is he also giving us an assurance that such an exercise was not prepared either by a special adviser-a political adviser in the relevant government department-or by the political parties concerned?

Lord Wallace of Tankerness: The noble Lord, Lord Harris, is absolutely right about the Civil Service. It would be improper for it to do this, and it has not done it. Nor are the noble Lord, Lord McNally, and I aware of any special adviser who has done it. I cannot speak for the Conservative Party, and while I may be able to speak for the Liberal Democrats, I honestly do not know what the answer is. I simply reaffirm the point that the principle here is one vote, one value. It would be a rash person who would predict the political fallout from this reform.

Lord Lipsey: How does the noble and learned Lord square what he is saying about this part of the Bill being about one vote with one value, with the argument that he and his Lib Dem colleagues have put forward for years that the only votes in our system that have value are those in marginal seats, because in all other seats the votes do not count at all because of the huge majorities?

Lord Wallace of Tankerness: We are debating the earlier part of the Bill and are not going to debate electoral systems. That would be beyond the scope of this amendment. What we have done in Part 1 of the Bill will lead to a better system. That is my personal view, and the view of my party. The Government as a whole will not take a view in the referendum. I have a number of important points to make and would like to do justice to them.

6.30 pm

Lord Soley: I understand the noble and learned Lord's problem in that he is a member of the Liberal Democrat party but is speaking for a coalition Government. The idea of reducing the size of the House of Commons to the suggested figure is not new. It was first put by the Conservative Party in 2004 and reiterated in 2009 and 2010. The two reasons given were, first, that the Tories did not get sufficient seats

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from the system with the current number, and, secondly, the cost. Those are the only two reasons that were given until the general election. They are in writing in a number of Conservative Party documents.

Lord Wallace of Tankerness: The noble Lord rightly reminds me that I am speaking on behalf of the coalition Government, and I reiterate that we have not done any political modelling on the possible political outcome of a House of Commons of 600.

Lord Howarth of Newport: My Lords-

Lord Wallace of Tankerness: I am not sure that I will ever be able to answer all the points.

Lord Howarth of Newport: The noble and learned Lord has dismissed suggestions as to why the Government might have alighted on the figure of 600 parliamentary constituencies. He has explained why they did not make that choice, but what is the rationale for that figure?

Lord Wallace of Tankerness: I thank the noble Lord for that question, because he has illustrated that if he had not intervened I might have reached that point by now. I hope noble Lords will allow me to answer that important point, which was made by a number of noble Lords, including the noble Lord, Lord Howarth. I hope to respond to these points as we proceed.

The noble Lord, Lord Wills, has made an ambitious attempt to balance the effect of almost every electoral procedure against every other one. His amendment asks us to wait longer to turn the Bill from a Bill that is workable and achievable into a deeply analysed but almost impossible one that would then have to be taken forward. As I have said, our objectives are clear and we believe that they are attainable. We want one elector to have one vote throughout the United Kingdom. By contrast, the amendment promises a comprehensive overhaul of the whole system that we are considering, including the maintenance of the union and the relationship between the two Houses of Parliament that might produce a magic number of electors and the optimum constituency size.

The current rules by which the Boundary Commission carries out its work have not been considered by a committee since the 1940s. They have been changed on a number of occasions since then by the decision of Parliament through legislation. There is a clear precedent for adjusting boundary rules in the light of experience. The changes have included important elements, such as a longer period of reviews of 10 to 15 years rather than three to seven years. It was right for a Speaker's Conference to determine the basis for boundary reviews when that happened for the first time back in the 1940s. When the Boundary Commission has asked in its reports for the rules to be made more coherent, Parliament has not asked a conference, a committee or an inquiry to consider what an independent-I stress independent-Boundary Commission has asked for. It is right for the debate to take place in Parliament. Even the 1944 Speaker's Conference recommended that electoral equality across the constituencies of the United Kingdom should be an overriding principle. We should allow the Boundary Commission to commence that work without delay.



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On Second Reading my noble friend noted the dangers of a perfectionist approach, which perhaps is the approach summed up in the amendment tabled by the noble Lord, Lord Wills, when he said:

"The Bill is not a panacea. It is not some holy grail in the scripture of political re-engagement, but it is a good start".-[Official Report, 15/11/10; col. 594.].

Again I say to noble Lords opposite that it is a great pity they did not start the process when they were given such a long opportunity to do so. The point was made by the noble Lord, Lord Gilbert, that there is no perfection of fairness; one person's fairness may be seen as another's unfairness. I believe that the Bill, by establishing one vote of equal value across the country, goes a long way to getting a better perception and reality of fairness. I would add that the British Academy report found that the new rules set out in the Bill,

and that,

A number of noble Lords, including the noble and learned Lord, Lord Falconer, and the noble Lord, Lord Howarth, asked how the figure of 600 was reached. We have never suggested that there was anything magical or ideal about a House of Commons of 600 any more than the current size of 650 is ideal. It is flawed legislation that has allowed the size of the House of Commons to creep up over time.

Lord Bach: The noble and learned Lord says that in the past Parliament has directed certain matters regarding the redistribution of boundaries, and he is right about that, but does he agree that no Parliament has ever set an exact number, such as the 600 in this Bill? No Government have ever done that. In the 1986 legislation and other previous legislation, Governments have left the Boundary Commission to set the exact number as a result of its inquiry. This Government in this Bill are trying to set a number of 600. That is unique, is it not?

Baroness McDonagh: May I add to that?

Noble Lords: Order.

Lord Wallace of Tankerness: I will give way to the noble Baroness in a moment. The noble Lord is factually correct but as I was about to say when he intervened, the legislation in place has allowed the number to creep up and up. The only occasion on which it has come down since 1945 has been post devolution to Scotland. The noble Lord, Lord Foulkes, indicated that the noble Baroness, Lady Liddell of Coatdyke, brought forward the order, quite properly, to reduce the number of Scottish constituencies from 72 to 59. Under this proposal, we are going even further. That is the only occasion when the number has come down. The fact that no number has been set has allowed the numbers to creep up and up over the years.

Baroness McDonagh: I want to add that not only has the number crept up but the electorate has increased from 33 million to 42 million in this period.

Lord Wallace of Tankerness: Indeed, but the point I was about to make about the present size of the House of Commons is that it is the largest directly elected national chamber in the European Union, and at

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600 it would still be relatively big. It would have fewer than the chambers of some comparable countries. The Bundestag, for example, has 622 members and the Italian Chamber of Deputies has a similar number. As indicated in an exchange between the noble Lords, Lord Foulkes and Lord Wills, each country has its own internal arrangements, be it some federal situation as in Germany or the United States, or devolution in our own country.

Lord Bach: The noble and learned Lord said that the numbers have gone up. I am sure that he knows that the number of Members of Parliament who were elected in 1945 was 640, with a population, as my noble friend just said, of 33 million. The number elected in 2010 was 650, with a population that is much higher than that. Will the noble and learned Lord admit that those figures are correct?

Lord Wallace of Tankerness: I have no reason to doubt the noble Lord, Lord Bach, but will he accept that, with the exception of the reduction of Scottish Members post the 1945 election, the numbers have gone up on every occasion?

Lord Wills: My Lords-

Lord Wallace of Tankerness: In fairness, it is the noble Lord's amendment, but I want to address the points that have been raised.

Lord Wills: I do not want to delay progress unduly, but the noble and learned Lord misrepresented, or misunderstood, the exchange between me and my noble friend Lord Foulkes. The point was not that one country has a better system than another. Those other countries-Germany and the United States-all had a profound, rigorous public debate on the right arrangements for their constitution. They have written constitutions. We are not having that debate now about this Bill, and we should. That was the point of the exchange and what we are asking the Minister to consider. We want a proper public debate on these crucial issues.

Lord Wallace of Tankerness: The point that I was making about the exchange between the noble Lords, Lord Wills and Lord Foulkes, was that a point was made about the Senate having 100 members and the US House of Representatives having approximately 434. The noble Lord, Lord Foulkes, pointed out that there are also state legislatures in 50 states. We are not comparing like with like. I took the point made by the noble Lord, Lord Wills, that international comparisons take you only so far. The noble Lord, Lord Snape, made the point about the word "gerrymandering" coming from the United States and seemed to suggest, although I am sure he did not mean to, that the Boundary Commission would somehow be heavied by the Government of the day. In the United States, as the commentaries following the elections in November made clear, the new boundaries will be set by the state legislatures, not by an independent boundary commission. That is the fundamental difference. I hope that noble Lords will accept that.



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To elaborate further, under our proposals, the 1 December 2009 register suggests that the electoral quota for the United Kingdom would be about 76,000. More than one-third of existing constituencies are already within 5 per cent either side of that illustrative quota, so the impact of our proposals will see constituencies of a size well within existing norms. However, if the House were to have, for example, 500 Members, that would push the size of the average UK seat above 90,000, and only three existing seats would be within 5 per cent of that quota. For that size to become commonplace would perhaps be too great a departure from what Members and the public are accustomed to. We therefore thought that 600 would seem to strike the right balance without reducing by too much and having regard to the fact that one-third of existing seats would be within 5 per cent either way of the existing norm. In addition, a slightly smaller House will mean that savings can be made without, in the Government's view, losing the capacity of individual Members or the Chamber as a whole to perform their functions.

Other points have been raised: for example, the fact that that should be linked to reform of your Lordships' House. I have no doubt that there will be ample opportunity to work out the implications for the reform of your Lordships' House when the draft Bill is brought forward. An important point was made first by the noble Lord, Lord Beecham, and picked up by several other noble Lords, including the noble and learned Lord, Lord Falconer of Thoroton. That is the relationship between the Executive and the elected House, the other place, if the number of MPs is reduced but not the number of Ministers.

The Government indicated in the other place that we agree that that is indeed an issue to be considered, but we do not believe that it is one that needs to be resolved in the context of the Bill. Reduction in the size of the House will not take effect until 2015, and we should therefore consider that issue in the light of decisions on, among other things, the size and composition of a reformed second Chamber. Historically, there has not been a consistent relationship between the size of the House and the number of Ministers within it. The number of Ministers in the Commons will be determined by what is needed to carry out the Government's parliamentary business, and will not be affected by the change in the size of the Chamber. It is not clear that legislation is the answer. If the issue is the size of the Government's payroll vote, there are ways to address that without legislation-for example, a reduction in the number of PPSs.

Lord Falconer of Thoroton: That was an absolutely riveting piece of information that the noble and learned Lord, Lord Wallace of Tankerness, dropped into the conversation-which is that, as I understand it, the size of this House will determine whether the Government are to reduce the number of Ministers. Have I misunderstood what the noble and learned Lord said? If I have, can he please explain it? Is it better if this House is bigger or smaller for the size of the Executive?

Lord Wallace of Tankerness: I indicated that an important factor would be the size of the reformed House, because if the overall number of Ministers is

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to be retained, it may be considered preferable to draw them from the elected House, with tested accountability mechanisms, rather than increasing the ministerial numbers elsewhere, including in this House.

The noble and learned Lord raised that issue, although the noble Lord, Lord Beecham, raised it first. It is an important issue. It is an issue which the Government have indicated needs to be addressed, but not in the Bill. There are other implications. For example, if Ministers were not to be in the other place, would they automatically be in this place? Would they have voting rights in this place? There are a whole host of issues which are perhaps more relevant to the debate about the constitution of the second Chamber in the context of a reduced House of Commons than to be dealt with in this debate.

6.45 pm

Another consideration which the amendment addresses is the time taken to complete the boundary reviews. As I said, the issue at hand here is simple. Reviews take too long, meaning that boundaries become out of date. The Government propose five-yearly reviews, with the first review to report in 2013. That leads on to another issue raised by noble Lords, such as the noble Lords, Lord Campbell-Savours, Lord Harris of Haringey, and Lord Wills, and the noble and learned Lord, Lord Falconer. That is whether we might use a population base rather than an electorate base to draw up constituencies. The electoral register has always been used for that task. I took the noble and learned Lord, Lord Falconer, to indicate that that is still his basic position. The 1986 Act, which contains the current rules, passed through Parliament without the intervention of a committee of inquiry. The secretary of the Boundary Commission for Scotland gave evidence to the Political and Constitutional Reform Committee where he discussed the practical problems with using population. I cannot see what an inquiry of potentially three years could resolve here that previous Acts of Parliament and the opinion of an independent Boundary Commission cannot.

Lord Wills: My Lords-

Lord Wallace of Tankerness: The noble Lord will get an opportunity to reply.

That does not mean to say that that is not an important issue. We have debated it in the context of Part 1. As the Committee will know, the Government are committed to taking forward the proposals already set in train-by the noble Lord, Lord Wills, himself-on individual registration. My right honourable friend the Deputy Prime Minister has also indicated that there will be a pilot scheme to allow local authorities to data match with other sets of data to try to get a better understanding and a better way to identify those who are not on the electoral roll.

To think that to fight an election in 2015 on an electoral roll that has as its basis the electorate in the year 2000 is in some way better defies rational consideration. What the Bill proposes-a rolling review every five years and efforts which we are making which, I think, will be widely supported across the Committee, to encourage individual registration and to identify where there are people who ought to be on

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the electoral roll but who are not-is far more likely to have an effect for the general election of 2020 than setting up a committee of inquiry that might take ages to report and then to have legislation following on the back of that. We are more likely to achieve what is a perfectly laudable and proper aim of ensuring that as many people who are entitled to vote as can be are on the electoral roll by the way that we are going about it. That is more likely to lead to success.

The noble Lord's amendment also questions whether equally weighted votes should be given priority over other factors. We are aware of and sensitive to other reasons-the noble Lord, Lord Howarth, and others mentioned the importance of local ties and communities-for proposing exceptions to the principle. An identity with or affiliation to certain areas of community is something that many people feel to be of considerable importance. Those of us in this House who have been Members of the other place feel that in particular. We acknowledge that there is a strength of feeling, and we would certainly want those with a local interest to make representations to the Boundary Commission in relation to local ties and for the Boundary Commission to be able to take them into consideration. The Bill will allow for constituencies to vary in the number of electors by as much as 10 per cent-that is, 5 per cent either way-of the UK electoral quota. That will allow the commission to take local factors into account. We will no doubt debate possible exceptions: I am sure that amendments have already been tabled to allow us that debate.

Another issue raised was workload. It is not the case that workload is a factor taken into account by the Boundary Commission at the moment. One speech suggested that somehow the Government excluding that was another manifestation of evil. It would be a judgment of Solomon for any independent inquiry to work out what is a relevant workload for a particular Member of Parliament. The noble Lord, Lord Martin of Springburn, mentioned the high asylum-seeker numbers in the constituency which he formerly represented with great distinction. I remember as a Scottish Minister once visiting his constituency on an asylum-seeker issue; I know precisely what he means. However, as a representative of a landlocked constituency, he never had to deal with an oil tanker carrying 84,000 tonnes of crude oil crashing and spilling its oil in the middle of his constituency. There are different things which different Members of Parliament have, by the very nature of their constituencies, to deal with. It would be more than a judgment of Solomon to try to weigh up what the different workload was for different Members of Parliament.

Lord Martin of Springburn: I did have the Forth and Clyde Canal to worry about.

Lord Wallace of Tankerness: And the mind boggles as to what kind of issues that may have given rise to. That probably just proves the point that every person who has been a Member of the other place can say why their constituency was that bit different.

I turn to the specific point raised by the noble Lords, Lord Touhig and Lord Elystan-Morgan, about their concern about the union. I am as passionately

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concerned about the union as they are. The important point to remember is that the reform means that a vote in Cardiff will have an equal value to a vote in Belfast, Glasgow, Edinburgh or London. To me, that does not undermine the union; giving an equal value to a vote in Cardiff, Edinburgh, Belfast and London will, we hope, bring the union closer together. The noble Baroness, Lady Liddell of Coatdyke, indicated that she brought forward an order that was of significant cost to the Labour Party in terms of the number of seats in Scotland following devolution. Indeed, if this Bill goes through, there will be a further decrease, but I have to be honest and say that I do not really remember the rafters falling in in Scotland. Indeed, people thought that it was important. My party argued within the Scottish Constitutional Convention that there ought to be a reduction in the number of Scottish MPs at Westminster if we got a Scottish Parliament dealing with a whole range of domestic issues. When it comes to workload, how are we going to evaluate the workload of an English MP vis-à-vis a Welsh MP or a Scottish MP? Is there going to be a differential? I do not think that anyone has suggested that we should have different MPs in terms of their quality.

The question of the Scottish Constitutional Convention which the noble Lord, Lord Foulkes, asked me to address was partly addressed by my noble friend Lord Maclennan of Rogart. The noble Lord's mind is perhaps playing tricks. It was not facilitated by a Labour Government prior to legislating for the Scottish Parliament. The Scottish Constitutional Convention was established under a Conservative Government. It not only did not include the Conservative Party; it did not include the Scottish National Party either. That was through no fault of the convention, I hasten to add, but because those parties chose not to join it.

There is no way in which I can say that the number of 129 seats in the Scottish Parliament was a consensus arrived at by all the parties. One day, I will perhaps tell the House how the noble Lord, Lord Robertson of Port Ellen, and I reached the number of 129 but if I do-"Not now" says the noble Lord, Lord Strathclyde-it probably means that the number of 600 will hit the heights of scientific measurement compared to how that was done.

Baroness Liddell of Coatdyke: One day, I will be very interested to know how the figure of 129 was arrived at. There are many different versions of the story. The point I would make to the noble and learned Lord is that when we came to the point of laying the order that reduced the number of MPs coming to Westminster, it was done with broad agreement across the House. This is the very point that I and others are trying to make to the coalition: if you proceed with consensus, or even seek to achieve consensus, you end up with a much more robust constitutional settlement at the end of the day.

Lord Wallace of Tankerness: I sincerely hope that when the Boundary Commission produces its review, if this Bill goes on to the statute book and the Boundary Commission review takes place, whoever is the Minister responsible for bringing forward the order will do so

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with the same determination and integrity as the noble Baroness. An acknowledgement that it had been done by an independent Boundary Commission would command support right across both Houses of Parliament.

A number of noble Lords made the point about how we bring this together. I conclude by indicating that the Government have an ambitious programme for political and constitutional reform. We are keen that Parliament has adequate time to debate all the proposals, and I have not complained that this debate has taken so long. Important issues have been aired. The committee is interested in how the Bill makes the political system more transparent and accountable, but our proposals will give the people a say in determining the method of electing Members of Parliament under Part 1, which they have never had the chance to express a view on before. It is with the people in mind that we want to equalise the size of constituencies to give their votes more equal weight. With these thoughts and reflections, I ask the noble Lord to withdraw his amendment.

Lord Wills: My Lords, this has been a significant debate. Everyone who has sat through the past three and a half hours would agree that everyone who has spoken has made an important contribution to public discourse on these important constitutional issues. However, in many ways the most significant speeches are those that were not made. As has already been pointed out, apart from a handful of brief interventions and one speech which seemed not to have been premeditated but to have been motivated by the rather noble intention to fill the great silence echoing across the Chamber from the other Benches, there was nothing from the Liberal Democrat or Conservative Back Benches. I wonder just how it is that all those distinguished Peers sitting on the government Benches have nothing to say about these crucial constitutional issues. As many noble friends have pointed out, that is revealing.

Then there was the speech that the Minister did not make. I would have hoped that he would have shown some recognition of the potential risks of rushing through this legislation in the way that the Government are doing. There are risks. These are very technical issues. They are complex and relate together, and the consequences are potentially profound. They have not been considered. Over and over again we have heard it admitted by Ministers. These issues have not been thoroughly considered. My noble and learned friend Lord Falconer asked for evidence of the deliberations and discussions. It could not have been deliberated upon or researched with any seriousness in the timescale available to the Government. That is what is needed. These signal a profound change in our constitutional arrangements, yet the Minister has avoided any recognition that there are risks involved in proceeding in the way that he has.

Nor did he produce any serious argument against this amendment. The only argument that he produced is that there is a need for speed, but what is this need for speed? This amendment does not kick it in to the long grass. I respectfully disagree with the noble Lord, Lord Maclennan. It is not inevitable that a commission of inquiry will mean that it is going to get bogged

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down and will never happen. It is simply a question of political will. If the Government have the political will to drive this forward now, surely in just three years, within the lifetime of this Parliament, they can muster the same political will again. It is entirely a matter for them. There is nothing inevitable or inexorable about this getting bogged down if this amendment were accepted. The Minister produced no good arguments.

I would have hoped that at the very least he might have done what my noble friend Lord Grocott urged him to do, which is what Ministers since time immemorial have done, which is to nod wisely and sagely and say that they will at least consider the issues raised by this amendment and perhaps return to it on Report. But he did not even do that, and I am surprised. I had not expected to push this to a vote because I had thought that I would have a more encouraging response from the Minister. But I did not get it, so I am now in two minds. On the one hand, I think that the frailty of the Government's position has been so exposed in this debate that it should perhaps be tested in the Lobby. But I am not without hope, so the other part of me still hopes that even now the Government may reconsider their position. I hope that they will recognise that their current position is so bereft of principle and so damaging to their credibility, not just in this Chamber or the other place, but among the people of this country who deserve and demand a say in the arrangements by which they will choose the people to represent them in Parliament. I hope that that will give them pause and that between now and Report they will reconsider and see whether there is a way that they can engage seriously with these issues.

Finally, I remind the Minister that I am not seeking to substitute my judgment for that of the Government on all these important issues. I am simply asking for an impartial, fair and independent process to resolve these issues within a timescale that most people would recognise as reasonable. In the end, I have decided that I will withdraw the amendment in the hope that the Government will reconsider. If they do not, I am afraid that we will have to return to all these issues on Report. In the mean time, I beg leave to withdraw the amendment.

Amendment 54ZA withdrawn.

House resumed.

Blood and Blood Products

Statement

6.59 pm

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, I should now like to repeat a Statement made earlier by my right honourable friend the Secretary of State for Health in another place. The Statement is as follows.

"With permission, I should like to make a Statement on hepatitis C and HIV infected blood.

Mr Speaker, what happened during the 1970s and 1980s when thousands of patients contracted hepatitis C and HIV from NHS blood and blood products is one of the great tragedies in modern healthcare. It is desperately sad to recall that during this period the

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best efforts of the NHS to restore people to health actually consigned so many to a life of illness and hardship. As the current Health Secretary, and on behalf of Governments extending back to the 1970s, I begin by saying how sorry I am that this happened and express my deep regret for the pain and misery that many have suffered as a result.

It is now almost two decades since the full extent of the infection was established and two years since the independent inquiry led by the noble and learned Lord, Lord Archer of Sandwell, reported. The majority of the noble and learned Lord's recommendations are in place, as are programmes of ex gratia payments, administered by the Macfarlane Trust and the Eileen Trust for the HIV infected and by the Skipton Fund for those with hepatitis C. But significant anomalies remain and I pay tribute to the noble and learned Lord, Lord Archer, to other noble Lords, and to honourable Members from all parties for highlighting them.

In October, my honourable friend the Member for Guildford announced a review into the current support arrangements to look at reducing the differences between the hepatitis C and HIV financial support schemes and to explore other issues raised by Members during the recent Back-Bench debate, including prescription charges and wider support for those affected. We also asked clinical experts to advise on the impact of hepatitis C infection on a person's health and quality of life and to consider whether an increase in financial support was needed.

My honourable friend the Member for Guildford met with representative groups to understand the impact that these infections were having on people's lives. She also met many right honourable and honourable Members and noble Lords who have been strong advocates on behalf of those affected.

We have now considered the findings of the clinical expert group and accept that the needs of those with advanced liver disease from hepatitis C merit higher levels of support. At present, the amount of money paid to this group depends on the seriousness of the infection.

There are two stages at which the Skipton Fund will make a payment. The first is when the person develops chronic hepatitis C infection. At this point, a person is eligible for a stage 1 relief payment-currently a lump sum payment of £20,000. Some may reach a second stage of developing advanced liver disease, such as cirrhosis or cancer, or require a liver transplant. They then become eligible for a stage 2 payment, which is currently another lump sum payment, of £25,000. Under the new arrangements that we will introduce, this second-stage payment will increase from £25,000 to £50,000. This will apply retrospectively. So if a person has already received an initial stage 2 payment of £25,000, they will now get another £25,000 lump sum, bringing the total to £50,000. In addition to this, we will also introduce a new, annual payment of £12,800 for those with hepatitis C reaching the second stage. This is the same amount that those who were infected with HIV receive.

Those infected with both HIV and hepatitis C from contaminated blood will now receive two annual payments of £12,800 if they meet the stage 2 criteria-one

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payment for each infection-along with the respective lump sums. All annual payments made to both those so infected with HIV and those with hepatitis C will now be uprated annually in line with the consumer prices index to keep pace with living costs.

We know that some of those infected with HIV or hepatitis C from NHS blood and blood products face particular hardship and poverty. Those infected with HIV can already apply for additional discretionary payments from the Eileen Trust and the Macfarlane Trust, but no equivalent arrangements are in place for those infected with hepatitis C. Therefore, we will now establish a new charitable trust to make similar payments to those with hepatitis C who are in serious financial need. These payments will be available for those at all stages of their illness, based on individual circumstances. Discretionary payments will also be available to support dependants of those infected with hepatitis C, including dependants of those who have since died. Again, this will echo the arrangements in place for those infected with HIV and enable us to give more to those in greatest need.

We must also ensure that those infected through NHS blood and blood products get the right medical and psychological support. I can therefore announce two further measures. First, those infected with hepatitis C or HIV will no longer pay for their prescriptions. They will now receive the cost of an annual prescription prepayment certificate if they are currently charged for prescriptions. Secondly, the representative groups raised the issue of counselling support for those infected through blood and blood products. We fully recognise the emotional distress that they experience. As a result, we will provide £300,000 over the next three years, allowing for around 6,000 hours of counselling to help these groups.

While we focus on those still living with infections, we must also recognise the bereaved families of those who have died. At present, no payment can be made to those infected with hepatitis C who passed away before the Skipton Fund was established. This is a source of understandable distress for those who survive them and it is something that we now want to put right. I can therefore announce that, until the end of March 2011, there will be a window of opportunity where a posthumous claim of up to £70,000 can be made on behalf of those infected with hepatitis C who died before 29 August 2003.

A single payment of £20,000 will be available if the individual had reached the first stage of chronic infection and another single payment of £50,000 will be made if their condition had deteriorated to the second stage where they suffered serious liver disease or required a liver transplant. We will work with the Skipton Fund and various patient groups to publicise this new payment to those who may benefit. These new payments, which will go to the individual's estate, should help more families to get the support that they deserve.

Taken together, these announcements represent a significant rise in the support available to those affected by this tragedy. Putting an exact figure on the package is difficult, as there is some uncertainty about how many will be eligible and how their illnesses may

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progress. However, we believe that these new arrangements could provide from £100 million to £130 million-worth of additional support over the course of this Parliament.

All payments will be disregarded for calculating income tax and eligibility for other state benefits, including social care, and while these changes apply only to those infected in England I will be speaking to the devolved Administrations to see if we can extend this across the UK.

Today's announcements cannot remove the pain and distress that these individuals and families have suffered over the years, but I hope that these measures can at least bring some comfort, some consolation and perhaps some closure for those affected. I commend this Statement to the House".

My Lords, that concludes the Statement.

7.08 pm

Baroness Thornton: My Lords, perhaps I may start by wishing the Minister and other noble Lords a very happy new year and by commending the Minister for his patience: he finally got to make the Statement. I welcome the Statement and congratulate the Minister and his colleagues on making progress in building on the work that the noble Lord knows we were trying to do on this important and tragic matter, to which I had a personal commitment. Of the haemophiliac community, almost 2,000 of the 5,000 infected people have died in the intervening period. For those with hepatitis C, it has become more urgent that the ex gratia payments should be reviewed.

This is a campaign about which we know people feel strongly. One of the saddest documents that I have read recently was a letter to the Prime Minister, written in October on behalf of the campaign for all those infected. It described how about 100 people travelled to London to listen to a debate and to lobby for the day. A number of them were very sick, including a double liver transplantee. There were widows, young people who had lost their fathers and another person whose son had died only weeks before. They felt very aggrieved by the business in the other place, which did not produce the results that they had expected. A shocked and saddened group of people struggled down the stairs from the Public Gallery to leave Parliament. The letter concluded by saying:

"It is not an Act of Parliament that is needed, but an act of political will".

To an extent, that is what has happened today. Indeed, their disappointment was added to before Christmas when they were expecting the announcement that we now have before us. I particularly welcome the extra amounts of money available and the fact that these will not be taken into account for the purposes of taxation and means-tested residential social care support, but I have some questions for clarification.

The first question concerns how the money will be distributed. The Statement says that a new trust is going to be established. Will the Minister expand on how the money is to be distributed through that trust? Will the trust be like the ones that exist at the moment or do the Government envisage something new and different? I should like some information about how the money will be made available and how it will be

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distributed. I would also like some clarification on prescription charges, because the Government's decision to abandon free prescription charges for people with long-term conditions has obviously impacted on the groups that we are referring to. I know that the Minister suggested that the prescription charges will be mitigated, but can he clarify whether that will cover, for example, those in the early stage of hepatitis C, not only stage 2? Will it cover everyone encompassed by the different stages of these conditions?

The areas that I feel are less welcoming concern the issues that have been discussed in this House on many occasions to do with considerations about mortgages, life insurance and travel insurance for people affected by these conditions. I cannot see anything in the review that suggests that consideration has been given to these matters. They form part of the completion and closure that is needed. I would also like an assurance from the Minister about support for the Haemophilia Society, particularly as I understand that the Government will be working with the society to help to deliver the information programme that is going to be necessary to ensure that people in this community take advantage of the benefit that the Government are offering.

My final questions concern where the money to fund this is coming from. If the Government are successful in persuading Scotland and Wales to expand this scheme, which I hope sincerely they will be, how is that to be funded? That is the question that those Administrations will be addressing. However, I very much welcome this Statement and I congratulate the Minister and his colleagues on the progress that they have made.

7.13 pm

Earl Howe: My Lords, I am heartened by and grateful for the welcome given by the noble Baroness to this Statement and the package of support that was announced in it. We think that it represents a fair and reasonable recognition of the suffering that many of these victims endure. We wanted to recognise that and I hope, as I said in the Statement, that it will be of some comfort to them and their families that they will receive better support.

The noble Baroness asked me some specific questions. She asked me first about the new trust and in what respects it will be different from the trusts that currently exist. I can say to her that we intend to set up the new charitable trust as quickly as possible. Its primary task will be to administer the discretionary elements of the payments that we have announced. In the mean time, the payments will begin immediately; in other words, there will be an in-year pro rata payment for the current financial year where people are due for an annual payment, and we can proceed with that speedily. As she will see in the paper that we have published, our advice is that those who feel that they have a claim should contact the Skipton Fund. There will also be a notice on the department's website to direct them appropriately. The new trust will be essentially a charitable trust with the kind of mandate that we have seen with the Macfarlane and Eileen trusts and the Skipton Fund, but for a different cohort of people.

The noble Baroness also asked me about prescription charges. What we concluded was that, while many of

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the victims of this tragedy are already in receipt of free prescriptions, there are some who are not. We have received vociferous representations from them and their representatives. Therefore, we will make arrangements through one of the charitable trusts, probably the new one, to pay those who are eligible a sum equivalent to the cost of an annual prepayment certificate, so that in practice all their prescriptions will be free of charge.

The noble Baroness asked about insurance and what consideration we had given to the requests made by campaigning groups on that score. The review highlighted to us that making provision for access to insurance was, first, unlikely to represent value for money because the administrative costs would be enormous in comparison with the benefits obtained. Also, and crucially, it would have been fraught with difficulty, including administrative complexity. There is no need to remind the noble Baroness that the current fiscal context makes it even more imperative that we achieve value for money in everything that we do. We judged that it was more important to set up a discretionary fund where, if necessary, people who were in particular hardship could look for additional support and perhaps fund insurance premiums from that support. However, an across-the-board arrangement for insurance premiums, as will be apparent from the report that we have published-I should also tell her that we took advice on this from the Association of British Insurers and various specialist insurers-ruled itself out for a number of reasons.

We intend support for the Haemophilia Society to continue. The noble Baroness also asked where the money is coming from. There will be a significant immediate cost to the departmental budget during this current year. I am pleased to say that we have found savings in our current expenditure for this year, which enables us to make room for these payments. We have had this in mind for some considerable time and I am pleased that it has come to fruition. In future years, we have found room in our central budgets for the ongoing annual payments.

As regards Scotland, Wales and Northern Ireland, obviously it would have been preferable if there could have been a UK-wide announcement, but clearly it is not for us to prescribe to the devolved Administrations what they should do. However, as I indicated, we are talking to them actively and it is up to them to consider whether this is something that they wish to do for those infected in hospitals in the various devolved regions.

7.20 pm

Lord Morris of Manchester: My Lords, I have two interests to declare, both non-pecuniary: as president of the Haemophilia Society, and as the architect of the independent public inquiry into the contaminated blood disaster headed by my noble and learned friend Lord Archer of Sandwell.

Is the Minister aware that, of the 1,241 haemophilia patients infected with HIV, only 361-29 per cent-are still alive, and that the number of deaths in the hepatitis C-infected community is much higher and continues to rise? Is he further aware that, as of now, an estimated 2,007 people have died from being treated with

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contaminated NHS blood and blood products? I congratulate the Minister on the progress that he has made, but will he now meet the haemophilia community and listen again to its plea for a response that is more in keeping with the scale of the disaster?

Earl Howe: My Lords, the noble Lord, Lord Morris of Manchester, to whose efforts I pay particular tribute in the context of this debate, as in many other contexts, has reminded us of the devastating effect of this tragedy on individuals and families. The previous Government recognised this and significantly improved the payments that were available to the victims of this disaster. We felt that there was still further to go, hence today's Statement. We have arrived at this point following a brief but nevertheless thorough review of the arrangements, informed by a scientific report which is also published today-noble Lords can read the advice that we received-to enable us to understand rather better the suffering that these victims endure in clinical terms as well as in human terms. On the basis of that, we have arrived at the arrangements whose details I have repeated.

We believe that this is a fair and reasonable package of support for these poor victims. We do not intend to revisit it in the future. I acknowledge that some people might have different views on the appropriate level of payments for this patient group, but the package needs to be considered in the context of the whole range of support that is available for the group, especially Department for Work and Pensions benefits, the care available under the NHS and the care available from social services. Having consulted widely, we consider that the sums announced in this package, taken in the round with the other support available to this patient group, are both appropriate and reasonable. So, while I understand the noble Lord's request, I am not in a position to accede to it at this point.

Baroness Hussein-Ece: My Lords, I congratulate my noble friend the Minister on the package announced in the Statement today. We very much welcome both it and, as the noble Baroness, Lady Thornton, said, the huge progress that has been made. Given that the commitment to review the current arrangements was made just last October, the Minister is to be congratulated on the swiftness with which this matter has been brought back to your Lordships' House. I hope that it serves to bring some comfort to those who have for so many years campaigned for justice, and particularly to the relatives of the deceased and the many other victims of this tragic episode.

The Minister announced that there would be a window for posthumous claims until the end of March 2011. There is concern that that is not a very big window and that it does not offer a lot of time to locate people and, for the many who may need assistance, to put a claim together. Perhaps the Minister can say why it is such a small window. Is he satisfied that it is sufficient time in which to track down as many people as possible who may have lost out?

It is not quite clear from the Statement who will receive posthumous payments. Will widows, partners and children be included in the arrangements? I would appreciate clarification on those points.



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Earl Howe: I am very grateful to my noble friend. The window of opportunity referred to in the Statement-until the end of March, which is the best part of three months-should be sufficient to enable those with a valid claim to come forward. On the whole, we believe that, in the haemophiliac community, the victims' families know who they are. I acknowledge that there is more difficulty with those who were in receipt of whole blood, but, again, we believe that the victims' families know who those individuals were as well. Our job now is to publicise these arrangements so that the families are aware of the support that is currently available to them. We think that the window is sufficient.

My noble friend asked who is to be included in posthumous claims. One claim per deceased estate will be considered. The deceased person may have left his or her estate to a spouse or, indeed, to charity, but whoever it is, the beneficiary of that estate is the person entitled to come forward to claim the money. We will deal with claims on the basis that the validity of the claim is proven in relation to the estate of the deceased person. That is a matter of public record.

Lord Archer of Sandwell: I thank the noble Earl for repeating the Statement and recognise his readiness to listen to and act on representations, but will he also recognise the efforts of a vast number of people of all political parties and none who have worked assiduously for a very long time to ensure that financial relief of a proper order is made available to those who have suffered from the tragedy and to their dependants? If it is in order, I would also like to pay tribute to the work of my noble friend Lady Thornton, who throughout this has shown a ready ear and sympathy for those who are affected. Of course I also pay tribute to my noble friend Lord Morris, who has worked tirelessly throughout so many years.

I congratulate the Government on addressing one very important anomaly that is suffered by the dependants of deceased recipients of the Skipton Fund. Do I take it that that is the only anomaly that the Government are proposing to address, or will their ears be open throughout the discussions to some of the other anomalies that have been uncovered? I am grateful for the increased benefits, but will the Minister explain why they are paid through charitable trusts and not directly from government offices as a direct entitlement of the beneficiary? There may be good reasons for that, but, so far as I am aware, they have never been given.

Finally, since this announcement was in the form of a Statement, does that foreclose further discussion on what is to be done, or will there continue to be discussions about the proposals during their progress through Parliament and into the future?

Earl Howe: My Lords, the noble and learned Lord, Lord Archer, is himself to be thanked and congratulated on the immense amount of work he did to inform the thinking of the previous Government and the current Government in these matters. I immediately echo his tribute to the work of so many people-people, as he said, of all political parties and none-who enabled us to gain a proper understanding of these issues. I am also well aware that the noble Baroness, Lady Thornton,

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was working very hard up to the time of the last general election to see whether a better package could be delivered. I was particularly pleased to hear her support for this series of announcements.

The noble and learned Lord asked me about the benefits for deceased victims and whether these were the only anomaly that we sought to correct. We identified two principal anomalies in the situation that has pertained hitherto: the first was the one to which he referred in relation to those who died prior to 29 August 2003, which was an arbitrary cut-off date; and the second was the clear imbalance of benefits for those who suffer hepatitis C as a result of receipt of contaminated blood. There was a gap to be filled there, and we were even clearer on that having read the scientific report that we received. We therefore sought to redress that particular imbalance. There are a number of other new elements in the package, but I have identified the two main ones that stood out to us.

The noble and learned Lord asked why we were choosing to use charitable trusts as the mechanism for payment. We feel that the arrangements have worked well so far through charitable trusts and we do not think it appropriate for these benefits to be paid through the Department for Work and Pensions. It is not really in the department's remit to do that; it is there to pay benefits and certainly not to decide on discretionary payments. We hope and believe that the victims who are currently in receipt of the benefits have good relationships with the trustees of all the funds.

As for the practical arrangements for paying these new sums, if there are queries we will endeavour to answer them. As I have indicated, we are directing people towards the Skipton Fund as the point of information on this, but the package that my right honourable friend announced today should be regarded as the final one because we believe that it settles the outstanding issues that we needed to address.

Lord Reid of Cardowan: My Lords, I thank the Minister and welcome the Statement today. As a former Health Secretary, I took some interest in this matter, but, like the Minister, I would like to congratulate my colleagues who have been involved in the issue in recent years. The one thing that I came to understand was that this was not only an intractable problem but an increasingly intractable problem. There are two reasons for that: first, as time passed, the human tragedy of the people afflicted became more and more obvious; and secondly, the scientific evidence became more and more complicated and difficult for the Government to avoid.

I have two quick questions. First, we have finally reached a stage which may not be completely the end and may not be completely satisfactory, but which is much fairer than the previous one. But does he accept that if there is a disparity between Scotland, England and Wales in terms of the treatment of victims and there is seen to be inequality and unfairness, it will detract greatly from any value that this has created? Secondly, as my noble friend and colleague Lord Morris said, although this goes a long way, there may still be outstanding issues. Will he not close the door completely to further discussions that could arise in the light of further scientific evidence?



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Earl Howe: My Lords, I am grateful to the noble Lord, who comes to this with considerable knowledge and experience as a former Secretary of State for Health. He is right: it has been a difficult if not an intractable problem for successive Secretaries of State. He is also right to say that the human tragedy has become more obvious as the years have passed. For one thing, it was not so obvious in the early days that there would be so many victims of hepatitis C, because that condition only tends to emerge after a considerable lapse of time. The HIV infection was more immediate and more obvious.

The noble Lord is right that in making this announcement for England, we are creating an immediate disparity with the devolved Administrations. As I indicated, I hope that in our discussions with the devolved Administrations-who are, after all, autonomous-we can arrive at a more equitable package for all victims across the United Kingdom. I am sure, without wishing to appear to interfere in the affairs of the devolved Administrations, that that is something that, as human beings, we would like to see. But I cannot pre-empt the decisions that will be taken in those Administrations.

Baroness Masham of Ilton: My Lords, I declare an interest as a vice-president of the Haemophilia Society. I am very pleased that the Government have recognised the plight of so many people and families who have suffered this disaster. But what safeguards are in place to prevent any infections from blood transfusions or blood products happening in the future? Prevention is so important and one never knows what is on the horizon.

Earl Howe: My Lords, the noble Baroness is, as always, absolutely on the mark. This has been an important issue not just for the current Government but for the previous one.

The measures in place to ensure the safety and quality of human blood, blood components and the blood products manufactured from them have developed significantly since the mid-1980s. We test for viral markers. Donations contribute to a plasma pool which is also tested for viral markers. In 1985, the introduction of heat treatment in the UK removed the risk of both HIV and hepatitis from blood products. Testing of all donations for HIV was also introduced in 1985. Testing for hepatitis C was introduced in 1991 when tests became available. The European directive is now in force. As of 2002, it sets standards of quality and safety for the collection, testing, processing and storage and distribution of human blood and blood components. We have a Community code for medicinal products which affects blood products such as clotting factors. On completion of manufacture, blood products are tested for compliance with specification by the manufacturer. All batches of blood products undergo independent testing by an EU official medicines control laboratory. We are in a different world entirely now from that of the 1970s and 80s.

Lord Corbett of Castle Vale: My Lords, can I ask-

Earl Attlee: My Lords, I am sorry but we are out of time.



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Health: Parkinson's Disease

Question for Short Debate

7.42 pm

Asked By Baroness Gale

Baroness Gale: My Lords, I declare an interest as chair of the All-Party Group for Parkinson's Disease and as a member of the charity, Parkinson's UK. Parkinson's is a long-term neurological condition and can be hugely debilitating. The fluctuating yet progressive nature of the condition means that symptoms can vary from day to day and even from hour to hour. Access to the right health and social care can make a huge difference to people with Parkinson's. It can enable them to live a more independent life for longer and preserve dignity and quality of life. With the right support, people can hold down a job and continue to lead a full life. When the necessary complicated medicines regime is carefully managed, symptoms can often be minimised.

In 2009, the All-Party Group for Parkinson's Disease conducted an inquiry into access to health and social care for people with Parkinson's, with the support of Parkinson's UK. I thank the noble Lord, Lord Walton, for his excellent contribution to the inquiry panel. It brought to light stark inequalities in Parkinson's services across the UK. We found that a postcode lottery dictated people's chances of receiving the support they need. This included seeing a specialist Parkinson's nurse, access to professionals such as physiotherapists and speech and language therapists, and ongoing review and rehabilitation. For instance, at that time more than one in four people with Parkinson's had never seen a Parkinson's specialist nurse, yet they can cut hospital admissions by 50 per cent. Although the number of nurses has substantially increased since then, mainly due to sustained investment by Parkinson's UK, it is vital that we do not see numbers fall back to the unacceptable low level. The inquiry found that half of people with Parkinson's had never seen a physiotherapist, whose treatment can avoid falls and injuries.

Worryingly, new threats to physiotherapy are emerging across the country. Some posts left vacant by retirement are not filled, leaving local people with Parkinson's without one of their most valued services. The previous Government put in place the national service framework for long-term neurological conditions, which set out key requirements for health and social care. The Department of Health is sending conflicting messages about the future of this framework. When will a decision be made? Can the Minister assure me that, if it goes, it will be replaced by something sufficiently robust?

This brings me to the likely impact of the Government's health White Paper. Some of the language used by the Government suggests that "localism", "choice" and

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"innovation" are more important than equal access to best treatment. Regional difference, we are told, is a good thing, driving up standards through competition. Consider that from the point of view of someone with Parkinson's, living in an area with no Parkinson's nurse, little access to a neurologist and no available physiotherapist or speech and language therapist, where people have to argue their case to receive NICE-approved treatments. Meanwhile, in the PCT next door, or perhaps a neighbouring GP consortium, services are much better. This approach simply seems unfair; will it drive up standards?

One area of concern is the decision to give GPs more power over commissioning. Most GPs have limited knowledge and experience of Parkinson's disease. They typically have just one or two patients with Parkinson's on their books. With a highly complex condition such as Parkinson's it is clearly necessary for decisions to be taken at a wider strategic level. Within the new structures outlined in the White Paper, the only way to ensure a comprehensive approach to commissioning high quality Parkinson's services is for the NHS commissioning board to have responsibility for this and to provide clear and specific commissioning guidance and outcomes for Parkinson's services. To ensure we have high quality Parkinson's services, we need specific, evidence-based quality guidelines and outcome measures. In other words, the Government must provide a standard against which patients can measure their service and, if services fall short, there should be robust mechanisms to hold providers and commissioners to account.

What assurances can the Minister offer that patients, including those with disabilities or conditions such as Parkinson's, will be supported to seek redress in a meaningful way? One idea is that people with long-term conditions should be represented on the proposed health and well-being boards. Can the Minister say something about that?

The provision of moneys for social care is another area of concern. Local authorities say that the £2 billion for social care will fail to plug the hole left by the 28 per cent cuts they are facing over four years, compounded by the pressures of an ageing population. Further, freed from ring-fencing and national audit, there is no guarantee that moneys will be spent as intended. Councils are already cutting back by changing eligibility criteria so that only those with the most critical needs receive support. Many people with Parkinson's and other conditions already find services inadequate. A resident of Cumbria told our inquiry:

"My only involvement with Social Services was [with] regards to a seat for the bath and I had to wait 16 weeks for this".

Another strong message from our inquiry was that more needs to be done to support carers. One carer told us:

"It is difficult to put into words the feeling of abandonment and loneliness I feel ... Carers have enough to cope with without the constant battle to get some attention for their loved ones".

I welcome the Government's refreshed set of priorities for carers. In particular, PCTs are being given £400 million for carers' breaks over the next four years, which I hope will benefit some of those who care for people with Parkinson's and other conditions, often with very little support or respite. Who will ensure that this

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money is spent as intended? Another concern is that the removal of ring-fencing will make the allocation of carers' funding to local authorities much more opaque. To ensure transparency, the Government should at least publish the nominal amount each council has received through the carers grants.

Given the current necessity to spend limited funds wisely, in the case of Parkinson's, quality care is proven to be cost effective. Will the coming changes mean that some areas will lose their Parkinson's nurses? Research has shown that such nurses can reduce hospital admissions by 66 per cent, which could be saving the NHS in England approximately £7.5 million.

If the Government are committed to reducing health inequalities, I urge the Minister to consider the report of the All-Party Parliamentary Group for Parkinson's Disease, whose findings are drawn from expert evidence from more than 360 people with Parkinson's as well as from their carers, health and social care professionals and key organisations. The report finds that huge inequalities exist in access to the care and support that are needed by people with Parkinson's and by their families and carers. I hope that the Minister will agree that access to the right services should not depend on where people live.

On behalf of everyone affected by the condition, I urge the Minister to do all that he can to ensure that there is a strategic, comprehensive approach to commissioning Parkinson's services that is underpinned by robust quality standards and by an effective, accessible system that will allow local people to hold services to account. I understand that the NHS commissioning board and GP consortia will have a statutory duty to reduce inequalities in healthcare provision.

My final question to the Minister is how he envisages reducing geographical inequalities in service provision, including for those with Parkinson's. I look forward to the Minister's response, and I thank all noble Lords who are taking part in this important debate tonight.

7.52 pm

Baroness Hussein-Ece: My Lords, I congratulate the noble Baroness, Lady Gale, on securing the debate. I also pay tribute to the tireless work that she has done in chairing the All-Party Parliamentary Group for Parkinson's Disease, which is a disease that, like other long-term conditions, can have a devastating impact on patients and their families. As we have heard, one person in every 500 has Parkinson's, which equates to about 120,000 people in the UK.

Like those who suffer from other progressive neurological conditions, Parkinson's sufferers and their families are entitled to a standard of care and treatment no matter where they live in the UK. When the national service framework for long-term neurological conditions was published in 2005 after considerable consultation with patients and groups, the framework was very much welcomed because it set out 11 quality standards with the aim of reducing differences in the treatment, care and support for people with long-term conditions-including Parkinson's disease-to ensure that their care is more accessible and better co-ordinated.

The national service framework applies to health and social care services that work with local agencies

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involved in supporting people to live independently. Such services include providers of transport, housing, employment, education, benefits and pensions. When the framework was first published, a main target was to reduce emergency bed days by 5 per cent by 2008 through improved care in primary and community settings for people with long-term conditions. As we have heard, there are places in the country where the target has been met successfully-for example, in north Devon, the provision of a Parkinson's nurse has helped to reduce emergency admissions by 66 per cent-but that has not happened in other places. Will the Minister perhaps comment on the accessibility of such specialist nurses around the country?

Patients with Parkinson's disease continue to suffer delays in diagnosis and in access to specialist treatment because of appalling gaps in NHS care, as the All-Party Parliamentary Group for Parkinson's Disease report mentions. The report also found severe inequalities in access to services across the country. At the time, there was a chronic shortage of specialist nurses. The report blames Ministers and health service managers for a lack of leadership on neurological services at national and local level.

Another concern is about access to appropriate services for people living in care homes and for black and minority ethnic groups. Does the Minister have any evidence to suggest that the situation for such people has improved?

In June 2006, the National Institute for Health and Clinical Excellence issued implementation advice to accompany clinical guidelines on diagnosis and management in primary and secondary care settings, in particular for primary care trusts and acute trusts. The advice also set out what support is available to help people with a condition to cope and how to plan for the future, with aims such as establishing individual care packages, establishing lines of communication, building support for the patients and looking out for any complications.

On care plans, which I think are very important, my previous experience from working in the NHS was that many patients were not really aware that the care plan belongs to them-they own it-and that they should have a copy of it. They should be able to take it home and share it with their families and relatives, but that is not always the case. Given that people are now living much longer with these long-term neurological conditions-indeed, people are living longer generally and are therefore more prone to developing such conditions-are care plans being reviewed to take that into account? Are care plans updated regularly? A patient's needs and conditions will change and vary quite radically over the years, but the care plan might not always be updated to reflect that. That is one of my concerns.

Other problems cited by the all-party group's report include poor access to therapy services, which has already been mentioned, and a lack of information for patients about what services are available. The limited provision of respite care is also an issue.

The NICE guidelines set out the importance of access to occupational health services and other allied health professionals. The key principle must be that it

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is important to treat the patient rather than just the condition because everyone is different and everyone has different circumstances. By doing that, we could prevent unnecessary deterioration and thereby reduce the burden on the health and social care system. Is the Minister satisfied that, in line with the NICE guidelines, patients have access to the full range of services, regardless of their postcode?

Finally, I pay tribute to Parkinson's UK, which has been at the forefront of campaigning for greater research and information on the disease and on treatment and therapies for patients living with Parkinson's disease.

People with Parkinson's disease deserve the right to access the essential services that they need, notwithstanding the inevitable budget cuts and other restraints on local authority budgets. There are concerns that the eligibility criteria will be tightened in some councils, as has already happened over the years, and that the criteria will differ from council to council. Does the Minister agree that standards should be set for such eligibility criteria, given that it does not seem fair that the criteria for people living in one borough might be tightened to a greater extent than in another borough next door with the result that people might not be entitled to the level of support in social care services on which they rely?

7.58 pm

Baroness Masham of Ilton: My Lords, I thank the noble Baroness, Lady Gale, for bringing this report on Parkinson's disease to the notice of your Lordships. The noble Baroness is a dedicated chairperson of the All-Party Group for Parkinson's Disease.

My late husband was diagnosed with Parkinson's, along with other complicated conditions. He was diagnosed in London but, as we live in North Yorkshire, I found there was a lack of interest in that specialty when I tried to find a consultant in the north. We found one consultant in Leeds, which was a long distance from home, and a very helpful Parkinson's specialist nurse. That perhaps illustrates from first-hand experience how the specialist care that is needed by people with Parkinson's is patchy throughout the country, as is stated in the report.

Two years ago, a friend living in the North Yorkshire dales needed the expertise of a consultant with a special interest in Parkinson's. I was pleased to find such a consultant in Leeds who visited a private hospital in Harrogate. I passed on this information and received a letter from the friend who said that he was very pleased with the consultant, whom he liked and found very helpful. When one has to have complex drugs, it is important that one can have trust and confidence in the consultant who is prescribing the drugs. When I read in the report that there are many people with Parkinson's who never see a consultant it causes concern, as having expert advice makes all the difference to the patients and their partners or carers.

As I read my Christmas cards this year, I had one which said: "Maureen cannot write this card as she has Parkinson's". People with Parkinson's need the help of expert doctors, nurses, physiotherapists, occupational therapists and speech and language therapists

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as well as social care. All have a part to play in the patient's journey while living with Parkinson's. There is concern among many people involved in patient care and groups of people living with long-term conditions that things may not get better when GP consortia are in charge. Can the Minister say what the terms and conditions of commissioning will be, and what will be the safeguards?

I congratulate Parkinson's UK on pump-priming nurses for the first two years. I wonder how many trusts take on the services of these specially trained nurses and how many, after two years, do not. The report states that the role played by Parkinson's disease special nurses in the care of people with Parkinson's disease was strongly endorsed by submissions from people living with the condition, from carers and from those medical specialists working alongside nurse specialists. Many people with Parkinson's disease and their carers outlined how Parkinson's disease nurse specialists provided them with a regular point of contact for advice on all aspects of the condition and for adjusting their complex medication regimes. This service was particularly valued by the group. When individuals did not have access to a nurse specialist, it tended to be identified as the most significant service inadequacy. I should be grateful for the Minister's views on nurse specialists.

A person with Parkinson's said in the report:

"The biggest help has been specialist Nurses, bit of a life saver really, could not imagine coping without them".

There is a great deal to do to make services better for all people living with Parkinson's disease: for those in care homes who are often neglected and for those who find help is not forthcoming or that there is a lack of joined-up working between health and social care. I hope this report will be read and used by many people. I have already sent it to someone in Yorkshire. I hope it will be used by health professionals, many of whom need educating about the needs of people with Parkinson's disease. I hope that the Minister will help to make services better for these people who really need them.

8.03 pm

Lord Harrison: My Lords, I, too, congratulate my noble friend Lady Gale and all her colleagues on Minding the Gap and on producing a groundbreaking contribution to the understanding of Parkinson's and its effects on people affected by it and on carers. I hope that the noble Earl will spare some of his time to talk about the carers, who have a particularly difficult time in caring for people with such a difficult disease as Parkinson's. I look forward to the Government's response and I hope that the fate that befell the multiple sclerosis review will not befall the NICE guidelines for Parkinson's this year, when the review is taking place. It would be very helpful to have an assurance that will not happen.

The 2011 review, indeed, offers a real opportunity not only to examine the recent evidence on the new drugs and treatments for managing symptoms but to scan the full multidisciplinary range of services provided to Parkinson's people for their present effectiveness. It would be helpful if NICE could include Parkinson's in the list of conditions for which it develops quality standards, because that will help avoid any postcode

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lottery approach to Parkinson's which undermines the proper national and comprehensive service which my noble friend Lady Gale has already mentioned. Again, I ask: is that possible?

Also, at a time of impending NHS reorganisation, it is imperative that GP consortia, which will be at the centre of change, should also commission services once they have sought expert advice and support from Parkinson's experts. Third sector organisations such as the Neurological Commissioning Support service, or NCS, should also be fully consulted, especially as they represent a joint initiative of the Mind, the MS Society and Parkinson's UK. The NCS is best placed to advise GP consortia about people with long-term neurological conditions. I wonder whether we can have an assurance there.

I should, perhaps, mention a local initiative in Chester and North Wales that may qualify as a contribution to the big society espoused by the Government. Last year, with the noble Lords, Lord Wade of Chorlton and Lord Jones, I was present at the launch of a co-operative arrangement between the local MS support centre and the local Parkinson's branch, of which I am very honoured to be the president. Indeed, we are having our Parkinson's branch AGM in the MS support centre later on in January. Such collaboration between natural allies should be encouraged as providing added value and not just as a cover for cost-cutting.

However, the more that I have come to understand Parkinson's, the more I have come to understand the central role of the Parkinson's specialist nurses, on which the two previous speakers commented. Those nurses stand as advisers, advocates and allies of Parkinson's people between the GP, who seldom has the detailed knowledge, and the consultant, who seldom has sufficient time within the very busy days that occupy them. The importance of the specialist nurse is that Parkinson's is a shape-shifter of a disease, which requires the prompt attention of expert nurses to match its every deleterious move. Some years ago in Chester our specialist nurse was axed by the local PCT, which was then experiencing financial difficulties. We fear that the new NHS commissioning changes will again imperil our specialist nurse post, which was re-established after the community worked long and hard to finance its future. Indeed, I fear for all 300 of the national team of specialist nurses for Parkinson's, who are in place and funded by local groups, Parkinson's UK and local PCTs. Can the noble Earl give us an assurance on maintaining the efficacy of that team?

For people with Parkinson's, maintaining personal mobility is key to leading a normal lifestyle. My local branch, for instance, has just supplied its specialist physiotherapy team with the latest laser-enhanced walking aids for their diagnostic programmes. They cost £150 but work wonders. Any move from specialist nursing to a more generalised provision of nursing will turn off the tap of such innovative approaches. Nurses are crucial advisers when it comes to mobility and passing on best practice. Indeed, one such best practice is the use of Nintendo Wii programmes that now help those who want to maintain their balance by, for instance, using a ski programme that allows you to go down ski slopes.

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That helps people with Parkinson's to maintain balance. We should be encouraging all these items.

I shall end on a more amusing note. It is good that Michael J Fox, who is himself a sufferer, continues to pour money into research into Parkinson's, but I was struck the other day that there is a new romantic comedy doing the rounds called "Love and Other Drugs". The feature of the film is that Anne Hathaway plays the part of an early Parkinson's sufferer. She tells us that she has enormous respect for Parkinson's, which she has learnt about as a result of doing this romantic comedy, and she says that in the throes of a passionate embrace on one occasion she had to simulate a Parkinson's tremor at the same time. It is interesting that something that is a reality for so many people outside is now beginning to filter in and be represented in films like this romantic comedy.

I commend again the work of the all-party group headed by my noble friend Lady Gale, and I hope that the Minister, who has always had a strong interest in all these issues, is able to give us some promising responses today.

8.11 pm

Lord Walton of Detchant: My Lords, in speaking in this important debate I must first declare an interest as a vice-president of Parkinson's UK, and as a neurologist who has looked after a great many people with Parkinson's disease in the course of my professional career.

It was in 1817 that James Parkinson, a general practitioner in Hoxton in London, published an essay on the shaking palsy, describing a disease that had previously been known as "paralysis agitans". As a result of that important essay, the disease eventually became known across the world as "Parkinson's disease". The pathology of the disease was well recognised many years ago, largely dependent upon the failure of nerve cells in a part of the brain stem called the substantia nigra. It was in the middle of the previous century that two Viennese pharmacologists discovered that the normal substantia nigra produced an important neurotransmitter called dopamine, and that when these cells degenerated, the dopamine declined. That ultimately resulted in the introduction of a drug, a precursor of dopamine called L-Dopa, or levodopa, which was of course a major development in the treatment of this condition. I had the privilege in the 1960s of conducting and supervising the first controlled trials of treatment in Parkinson's disease conducted by the Medical Research Council in the UK.

Many new drugs have been developed since that time. Some of them are new precursors; some of them are what are known as dopamine agonists, trying to persuade the cell to produce more endogenous dopamine; and there are many others. The treatment has improved immensely. The side effects of the treatment, however, are substantial. One of the lessons that everyone looking after patients with Parkinson's disease has learnt is that it is crucial to develop expertise in knowing how to handle that drug therapy-to adjust it according to the on-off periods that occur. This is a matter of great expertise, which is why Parkinson's patients require the expertise of a well trained neurologist or, at the very least, a well trained geriatrician with neurological training. That is crucial.



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There have been crucial developments in research. We now learn of the importance of the alpha-synuclein gene and we note that free radical scavengers play a part in the etiology of this disease. There has even been exciting work done in which foetal nigral neurones have been implanted into the brains of some patients, producing dopamine. The benefits have been substantial but the side effects are great, and more work will have to be done before these forms of treatment become a most effective part of the management of these patients.

I am grateful to the noble Baroness, Lady Gale, because it was a privilege to serve on this inquiry, which she expertly chaired, dealing with the management of patients with Parkinson's disease and the range of services available across the country. I repeat the first point: neurological assessment and the proper handling of treatment and drug therapy are crucial. However, so too are the services provided by carers, physiotherapists, speech and language therapists, occupational therapists and others. There is no doubt whatever that to have a team of people looking after those with Parkinson's disease, with a range of expertise, reduces the number of patients who are admitted to hospital for emergency care. That in turn is of great benefit to the National Health Service.

Sadly, though, as the report has demonstrated, the postcode lottery continues; it is alive and well. The range of services across the country is still desperately uneven. We have heard about the 2005 national service framework and the NICE guidelines that were published in 2006 to try to persuade health authorities across the country to provide a standardised range of services for people with Parkinson's disease, but they have not been universally adhered to.

I have serious concerns about the proposed GP commissioning consortia. I talked to the Secretary of State who said that the specialised commissioning services for this and other neurological problems will be handled by the specialised health commissioning board. I cannot see that a single national board is going to be capable of dealing with all the complexities of the specialised neurological services that Parkinson's and others require, and I do not see how it will work without some kind of continuing regional services for the commissioning of these services. Whatever the excellence of the general practitioners and the commissioning services of consortia that they produce, I do not believe that this will be adequate to meet the needs of patients with Parkinson's disease.

It is right that the Government must take action to do what they can to produce uniform national standards of care. Under the health Bill, have the individual care packages and accounts that were proposed by the previous Government made any contribution in the care of patients with Parkinson's disease? Are the Government taking account of the work of the neurological commissioning support service established by three major charities-the Motor Neurone Disease Association, Parkinson's UK and the Multiple Sclerosis Society? This body has made several important and far-seeing proposals. It is very important that the Government should take account of its views.



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These developments are things that people with Parkinson's disease and their families deserve. I hope the Government will take full note of what has been said today. I thank again the noble Baroness, Lady Gale, for so expertly chairing this inquiry.

8.18 pm

Baroness Thornton: My Lords, I congratulate my noble friend on initiating this debate, and thank her for her commitment to Parkinson's disease and for chairing the important all-party group's report. I doubt I shall address a question to the Minister that someone else has not already asked. None the less, as is traditional in your Lordships' House, I shall continue to speak.

As noble Lords will know, Parkinson's is a long-term degenerative neurological condition. Symptoms can include stiffness of movement, pain, incontinence and dementia, which fluctuate from day to day, as noble Lords have mentioned, and worsen over time. It has a profound impact on people who have it, their families and their carers. I might be the first person in this debate to mention that one of the key problems with Parkinson's disease is the stigma that goes with it. People may not recognise that people have Parkinson's. They might think that they are drunk or that there is something else wrong with them. That is an additional burden that people with Parkinson's disease have to carry with them.

The background to this debate is the brilliant report Please Mind the Gap, which took evidence from 360 people with Parkinson's, their carers, health and social care professionals and representatives of public bodies, royal colleges and the Government. It brought to light many of the geographical inequalities in availability of services across the UK.

We know that the timely intervention of a specialist nurse or a physiotherapist and proper access to services can reduce hospital admissions and greatly improve quality of life. We have discussed this. We could substitute many conditions for Parkinson's disease. We know that is the case. We know, therefore, that getting the provision of services for people with Parkinson's disease right is not only right but cost effective.

Take, for example, Parkinson's nurses. As a result of the investment from Parkinson's UK, which pump-primes nurses for two-year periods and to which I pay the highest tribute, there are more than 300 Parkinson's nurses. I have to say that I agree with other noble Lords: there must be a question mark over their future. I ask the Minister whether there can be some monitoring of what happens to these nurses. As pressures increase on primary care trusts and reform moves forward, what happens when you lose a Parkinson's nurse? How many more people are admitted to hospital? The Government need to look at what evidence there is.

The same applies to allied health professionals, such as physiotherapists, occupational therapists, speech and language therapists, psychologists and specialists in neurology. They are all vital in treating Parkinson's and other neurological conditions. The Minister will not be surprised to hear me ask how such coherent and co-ordinated provision will be made available under the proposed changes to the NHS commissioning structures. Parkinson's UK is extremely worried that it

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will mean a worsening of access to Parkinson's nurses, as well as all the other allied health professionals that are needed. Indeed, Parkinson's UK reports that it is hearing of posts remaining empty following retirement.

It is clear that proposals to transfer commissioning powers from PCTs to GPs are of great concern, not only to Parkinson's UK but to many organisations that deal with long-term and complex conditions. I agree with the noble Lord, Lord Walton of Detchant, that there must be a question mark over the ability of an NHS commissioning board to make sure that these services are delivered adequately by GP commissioning when we are not even sure how many GP commissioning boards there will be. One needs to ask: how will those consortia be able to commission the expertise to supply the support for this and the other neurological conditions mentioned by the noble Lord, Lord Walton of Detchant?

How will the Government ensure that the GP consortia involve the third sector in the delivery of these services? This question is being asked not just by Parkinson's UK. I happened to be at a meeting attended by the Multiple Sclerosis Society and the Motor Neurone Disease Association and they expressed the same concern about the ability of the consortia to commission the right services at the right level at the right time for patients when a doctor may only ever see two patients with Parkinson's disease as it is such an uncommon disease. We know that you effect change in the NHS through leadership. How can the Government ensure that the leadership for this condition will continue and develop? The NICE guidelines are to be reviewed this year. If the Government do not go ahead with that review and do not come forward with robust guidelines, how will they ensure that the leadership for this condition will be maintained?

The Minister cannot have failed to notice that the same questions have been asked with regard to stroke, diabetes, MS and epilepsy. With all those conditions the same level of anxiety is evident about what the future holds under the proposed changes to the NHS. I am merely amplifying what has already been said but we are getting to the point where we need answers about how these conditions will be managed.

8.25 pm

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, I begin by thanking the noble Baroness, Lady Gale, for tabling this Question for Short Debate. I very much recognise the considerable personal insight that she brings to this subject, not least as chair of the all-party parliamentary group.

Noble Lords have spoken eloquently this evening about Parkinson's and the devastating impact that it can have. The all-party group's report paints a compelling picture of the many failings of the health and social care system: limited information for patients and poor access to expert nursing and therapy services, underpinned by a failure to deliver joined-up services. The previous Government produced a number of policy documents designed to improve services and support people with Parkinson's disease. The National Service Framework for Long-Term Conditions, to which noble Lords have referred, and the NICE clinical guideline are both

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strong statements, which this Government support. The problem, made clear in this evening's debate, not least by the noble Lord, Lord Walton, is that all too often the vision of these documents is not put into practice and areas such as Parkinson's services find themselves at a disadvantage when competing for attention and resources. We want to put that right. Our reforms to the NHS will ensure that patients have far more information about services, more choice about their treatments and more influence over how healthcare is shaped in their community.

Local Health Watch organisations, building on local involvement networks, will ensure that the views and feedback of patients and carers feed into decisions about local health and social care services. Devolving responsibility for commissioning to GP consortia will mean that decision-making is closer to patients and more responsive to their individual needs. The noble Baroness, Lady Gale, is right: we will have to ensure that GP commissioners are ready and have the skills and awareness that they need to take these decisions. The noble Baroness, Lady Thornton, referred to that matter, as did the noble Baroness, Lady Masham.

As noble Lords are aware, poor commissioning is one of the main reasons for the low quality of some Parkinson's services and the patchwork quilt of standards about which we have heard. I know that some patient groups have expressed concerns about the skills and knowledge of GP commissioners. The key to this will be creating better care pathways. That is my main answer to the noble Lord, Lord Walton, who expressed his scepticism on this score. We will expect consortia to involve relevant health and social care professionals in helping to design care pathways or care packages for those with Parkinson's that achieve more integrated delivery of care, higher quality and more efficient use of resources. They should also talk with their local authorities, which will play an increasingly important role in co-ordinating care as we move toward joint commissioning and planning through health and well-being boards. There are certainly opportunities for patient groups to contribute to developing GPs' understanding of the condition and how to commission for it effectively. Regional neurological alliances, to which a number of noble Lords referred, have an important role to play, working with the NHS and councils, to make sure that patient needs are being met locally.

The noble Baroness, Lady Gale, referred to outcomes. The new NHS outcomes framework will help to deliver care that is safer and more effective and provides a better experience for patients. The outcomes and indicators in the NHS outcomes framework have been chosen specifically to capture the full range of NHS responsibilities. Where appropriate, they are not condition specific, but rather seek to capture those outcomes that an individual with any condition would consider important.

In these financially challenging times, it is important that we make the most of the resources available. Parkinson's services are a good example of where much more can be done and where inadequate services waste resources. With an ageing population, the number of people with Parkinson's is increasing and, as the

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Fair Care campaign highlights, the best way to save money is to deliver good-quality Parkinson's services when and where people need them.

Better, more effective care does not necessarily mean more resources. Doing things differently, good multidisciplinary teamwork, specialist support, early interventions and care planning can all make a significant difference. High-quality information, combined with the right support, is the key to achieving better care, better outcomes and reduced costs. We have been consulting on a new information strategy to improve the range and quality of information available to patients, professionals and the public, to increase transparency and strengthen accountability in the system.

Good social care is vital for people living with Parkinson's. It enables them and their carers to live the independent life that most of us take for granted. We want to build a social care system that is fair and sustainable-one that reflects individual autonomy and ensures that everybody is treated with dignity and respect. In November, we published our vision for social care, setting the future direction for adult social care in England. The vision looks at the role of social care in contributing to the development of the big society and includes a new leadership role for local councils to improve preventive services and develop community capacity, which is in part an answer to the question posed by the noble Baroness, Lady Thornton-in other words, inspiring and supporting communities to look after themselves. The vision encourages care and support to be delivered in a partnership between individuals, communities, the voluntary sector, the NHS and councils, including wider support services, such as housing.

Carers exemplify the big society. They provide care and support entirely from their own time and resources. In government, we need to reciprocate this commitment with measures that support carers. Last year, we published an update to the National Carers Strategy-Next Steps for the Carers Strategy. It provides a clear plan of action for the next four years, focusing on what will have the biggest impact on carers' lives.

A number of noble Lords, including the noble Baroness, Lady Gale, my noble friend Lady Hussein-Ece and the noble Baroness, Lady Masham, referred enthusiastically to the role of specialist Parkinson's nurses. Specialist nurses provide a very important source of support and advice to patients with Parkinson's disease and enable many patients to manage their condition effectively. It is of course the responsibility of local health bodies to make decisions on the funding of Parkinson's nursing posts. The Long-Term Conditions Delivery Support Team has, however, developed a guide to writing a business case for epilepsy specialist nurses for commissioners to use in making the case for improving those services. This guide could be adapted to make the case for specialist nurses for other long-term neurological conditions, including Parkinson's. The new commissioning arrangements will take all the evidence into account in deciding to what extent specialist nursing will be commissioned.

The noble Baroness, Lady Gale, asked whether all areas will retain their levels of Parkinson's nurses. We

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think that localism is the best way of holding local organisations to account. These decisions should in the end be made locally and will be influenced by the important inquiry that she has chaired.

The noble Baroness, Lady Gale, and others referred to the national service framework. While the vision of the NSF reflects that of the White Paper, the new NHS architecture, and particularly the arrangements for commissioning, will render somewhat outdated any lessons learnt from the review. Better outcomes for people with long-term neurological conditions will in future be achieved through the NHS outcomes framework. The framework will enable patients to judge the overall performance of the NHS and to hold the Government to account for progress. Through the Long-Term Neurological Conditions Research Initiative, the department has funded the development of Quality Neurology, a comprehensive audit tool for local health and social care economies to use in assessing their current status in meeting the quality requirements of the NSF for long-term conditions.

The noble Lords, Lord Harrison and Lord Walton of Detchant, referred to GP consortia needing to involve the third sector. I have already referred to this issue. The onus is on regional neurological alliances and patient groups to engage with GP consortia in the first instance. Through the then Section 64 scheme, the department funded the Neurological Alliance to establish a network of RNAs across England. The case for developing a quality standard for Parkinson's disease will be considered as part of the development of the comprehensive library of standards, in line with the plan set out in the White Paper. The longer-term aim is to develop a broad library of quality standards covering the majority of NHS activity.

The noble Baroness, Lady Gale, and my noble friend Lady Hussein-Ece asked about the status of the NSF for long-term conditions. The Government's health reforms place outcomes at its heart, as I mentioned. That fits very well with the aspirations of the NSF for long-term conditions. The issue is not the delivery mechanism-in other words, the NSF versus the Government's health reforms-but, rather, ensuring that services for people with a long-term neurological condition achieve the best possible outcomes.

The noble Baroness, Lady Gale, asked how we can ensure that money for carers would be spent as intended. It is for PCTs and, after them, GP consortia to manage their budgets and make decisions about how best to meet the health needs of their local populations, but we are looking at how we can make decision-making more transparent. That includes using the NHS operating framework, which sets out the priorities for the year ahead and makes it clear that breaks for carers are important. The NHS outcomes framework and the outcomes framework for adult social care will also push for clear and unambiguous accountability in this area.

As so often happens, the clock is moving against me. I have much material here to answer every question posed by noble Lords. I apologise that I will not have time to do that in my allocated slot and I will write to all noble Lords with answers. Suffice it to say that, while tonight's debate has highlighted variations in the

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quality of care, the fact is that there are some very good examples of Parkinson's services. In Barnsley, for example, there is an holistic, multidisciplinary service in a range of locations tailored to meet the needs of patients. We need to replicate such models, ensuring that everybody has access to comprehensive services and expert multidisciplinary care. Through our health reforms, we are determined to continue to transform standards and to achieve better outcomes for people with Parkinson's disease.

8.38 pm

Sitting Suspended.


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