I am afraid that Oregon’s figures do not confirm safety but show an almost fivefold increase in the incidence of reported physician-assisted suicide. That would translate, as has been said, to about 1,200 assisted suicides each year in England and Wales. That means that in Oregon since 2008 there has been a 21%

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increase in physician-assisted suicide, from 19 to 24 cases per 10,000 deaths. Compare that with the UK, where currently fewer than 20 cases cross the DPP’s desk. Oregon has no audit system to shed light on what is happening there. The dynamic seems to have changed. The Bill of the noble and learned Lord, Lord Falconer, gives eligibility criteria, not safeguards. It seems to be looser than the Bill proposed by the noble Lord, Lord Joffe. The current proposal has no reporting and audit system to detect abuse. Indeed, in Oregon, it was only research that showed that one in six patients who ended their life by physician-assisted suicide had clinical depression that was undiagnosed and untreated. There are also reports of patients being offered not oncology treatment but physician-assisted suicide.

The inquiry by the noble Baroness, Lady Neuberger, into the Liverpool care pathway called for research to improve prognostic tools for the last weeks and days of life. We are very bad at prognosis. The Royal College of General Practitioners has said that we can,

“make reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months, then the scope for error can extend into years”.

People are particularly vulnerable when very ill. On call last weekend, I was acutely aware how each patient hung on my every word and gesture, reading into it how I thought things were going. Behind each question was another. The GMC guidelines are absolutely clear—they enable in-depth discussions with patients about their dying or their fluctuating wish for death, and doctors are not frightened today of talking about death and dying. People fear being a burden on family, society or state, or being disempowered by the scandalous care that hits the headlines. The message that proponents portray is that for some the only way in which you have dignity when dying is by assisted suicide, that suffering is inevitable and pain often uncontrollable. That is deeply misleading and creates a great deal of anxiety.

Futile treatment is stopped because it is a burden not a benefit, not to bring about death. However, when a patient asks for help to end it all, the doctor can respond by processing the request at face value, which risks sending a subliminal message that the person would be better off dead; but when I ask, “What is making today so difficult?”, and, “What can I do, however small, to improve today?”, I give the message that, “You are worth me working hard for”. I have to redouble efforts, and rethink and reharness resources to meet the patient’s need to give true choice in care to the person.

A clinician cannot go in two directions at once by striving to improve quality of life and revise and review, while simultaneously booking an appointment for death. Physician-assisted suicide is being placed in the comfort zone of medicine, suggesting to society that it is some kind of therapy. We have heard euphemisms—assisted dying is not really assisted suicide or will not be extended to euthanasia, we have heard. Let us be clear: what is proposed is that Parliament should license an act that is otherwise regarded as criminal. As the Royal College of Physicians has said, a doctor’s duty of care to a patient,

“does not include being in any way part of their suicide”.

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2.05 pm

Lord Beecham (Lab): My Lords, as the noble Baroness has just reminded us, this debate encompasses two issues. The first is one that has clearly attracted unanimous approval throughout the House: the need to provide care and support for the dying at the end of life and to honour their choice, particularly in relation, for example, to whether they die at home, in hospital or in hospice—matters referred to by the noble Baroness, Lady Murphy. There is clearly agreement that this objective should be fulfilled, and there are ways in which matters can be taken forward from the current position. Compassion in Dying, for example, has recommended that progress be made in dealing with advance decisions, and simplifying the procedure for living wills and lasting powers of attorney. The noble Baroness, Lady Meacher, referred to establishing a register that, again, Compassion in Dying has referred to. There is the issue of training for professionals and much else. I hope that the Government will look at these matters.

One matter came to my attention yesterday by virtue of an article by Jackie Ashley in the Guardian pointing out that whereas people can get leave from work for various reasons, there is no provision in law for leave for carers of those who are terminally ill. Perhaps the Government could look at that. I am of course not asking the Minister for a response today but it is something that I invite her and colleagues in other relevant departments—BIS and so on—to look at. It could well make a significant contribution.

The second area with which we are concerned is assisted dying. On this we have had a very balanced debate. I have been keeping a scorecard of those who have spoken in favour and against, and it roughly balances out across your Lordships’ House. I must also say that the debate has been in the highest traditions of this House in terms of thoughtfulness and sensitivity. There are clear issues here—ethical, moral, religious and practical—that need to be addressed. It is not a party issue. There is no official opposition line, and I suspect that there is no official government line. I speak from a personal standpoint.

However, it is perhaps necessary briefly to rebut three points that have been made by some speakers. The noble Baroness, Lady Morris, said that under the proposals of my noble and learned friend’s Bill doctors would be required to take the life of patients. That is not the case. The Bill specifically deals with self-administered drugs that could end life. The noble Lord, Lord Alton, spoke of the “emasculation” of the hospice system. I see no evidence of that at all. As I shall say later, I have knowledge of the working of the hospice system and I do not think that anyone who might support my noble and learned friend Lord Falconer’s Bill or some version of it would for a moment wish to diminish the effective role of an important part of our health provision. There was a suggestion by the noble Lord, Lord Hylton, that among the major religions Buddhism was clear in its maxim that one should do no harm. That, of course, is also the substance of the Hippocratic oath. However, the question is: what constitutes harm? Is it confined only to causing death? Can it not also be allowing or facilitating the prolongation of suffering? Therefore, the situation is perhaps more nuanced.

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My own position is informed by my personal experience. My wife died five weeks after I was introduced into your Lordships’ House, having suffered from bowel cancer for two years, with secondaries in the liver and lung. It was always a treatable but not curable condition. She was the daughter and sister of doctors. She nursed her mother, who died of cancer, in our home. She was a health visitor, a nurse and a Relate counsellor. From the outset of her illness, she was very clear that, should she suffer considerable pain, she would wish to be helped to end her life. She received wonderful treatment from the National Health Service in Newcastle and from the hospice in which she spent her last few days. Fortunately, she never experienced quite the degree of pain that would have led her to invoke the remedy, which in any event would not have been available to her.

She lived very fully in those two years. She made a television programme about bowel cancer; she made a DVD about stoma, having undergone a cystostomy; and, with friends, she produced a book about living with cancer. Therefore, she was very conscious of the condition and anxious that people should learn from her experience. However, I know that she would have wished me to express support for the choice that in the end she did not have to make. I suppose that I had the dubious privilege—nevertheless, I felt it to be a privilege—of being with her when she died in the hospice. She had been sedated and was out of pain for those last few days. Of course, not everybody has that opportunity, and there are those who would clearly wish to have the chance to end what can be a very painful experience.

I have friends who are undergoing precisely these difficulties now. I have a particular friend who has also suffered from cancer, and it is a recurrent condition. Having, again, been treated very well in hospital and in a hospice, she is now having home care and there is great gratitude for that but, frankly, it is a very painful condition—more painful than my wife endured. It is one which my friend wishes could end swiftly, rather than see her pain prolonged, even though she is having wonderful care, with full medical back-up, at home with her family. I have other friends who have undergone very difficult experiences, and there will be many in your Lordships’ House who can testify to that.

So we have some difficult choices to make. We are not asked to make choices today; we are debating and discussing how policy might evolve in both the areas that have been the subject of this debate. I take the point made earlier that, if you have the means, it is possible to avoid that debate. You can go to Switzerland, as some people have done, and leave the stage, as it were, there under the system that currently prevails. However, a minority of people can take that course and there will not be many, although there will be some, who would prefer the alternative, which my noble and learned friend’s Bill would secure. Of course there are issues of safeguarding and of avoiding people being persuaded to take that course of action, and it would be essential to embody that in any legislation, should we reach that position.

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There are clearly many who would adopt the approach that Dylan Thomas advised in a memorable poem:

“Do not go gentle into that good night …

Rage, rage against the dying of the light”.

For those who do not want to go gentle, whether they want to rage or not, of course we must offer every conceivable support to allow them to do that. However, others would take a different line of poetry. They might take the line from Keats and wish:

“To cease upon the midnight with no pain”.

In my view and the view of some of your Lordships, that is a decision which should also be respected, supported and facilitated, but with the very clear proviso that there must be proper safeguards and that nobody should be required to go against their conscience—for example, as a medical practitioner—to administer what would be required to produce that ceasing upon the midnight with no pain.

2.15 pm

Baroness Jolly (LD): My Lords, I thank the noble Lord, Lord Dubs, for securing this debate. I fully appreciate his position on this issue, which is clearly personally heart and head-felt. I know that, as a member of the All Party Parliamentary Group on Choice at the End of Life, this is a subject in which he takes a great deal of interest.

I echo the words of the noble Lord, Lord Beecham. This is a well informed debate, and at times it has been very moving to hear personal stories from Members of your Lordships’ House. With a four-minute time constraint on speeches, noble Lords have focused their thoughts, and that has led to many powerful points being well made. Here, I should like to make special mention of the maiden speech of the right reverend Prelate the Bishop of Sheffield, which was sensitive, thoughtful and thought-provoking. I am sure that he will make a huge contribution to the work of your Lordships’ House.

This is an important debate on a highly emotive and complex issue. Death affects us all. First, I assure noble Lords that, as a Government, we are committed to improving quality and choice in end-of-life care. Today, many noble Lords have focused on assisted dying. As was highlighted by the noble Lord, Lord Dubs, and others, the Government believe that any change to the law in this emotive and contentious area is an issue of individual conscience and a matter for Parliament to decide rather than one for government policy.

The Assisted Dying Bill, introduced by the noble and learned Lord, Lord Falconer of Thoroton, seeks to legalise, in England and Wales, assisted suicide for terminally ill, mentally competent adults who are reasonably expected to die within six months and who have been ordinarily resident in England and Wales for at least 12 months. The Government will take a collective view on the noble and learned Lord’s Bill in order to respond to the debate on its specific provisions at, but not before, Second Reading. As things stand, however, no date has been set for the Second Reading of his Bill and today’s debate does not address it.

My noble friend Lord Taverne raised the question of the DPP’s role in prosecuting offences. Prosecutors must apply the two-stage test set out in the Code for

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Crown Prosecutors in cases of encouraging or assisting suicide and all other offences. The full code test has two stages: the evidential stage and the public interest stage. A case which does not pass the evidential stage must not proceed, no matter how serious or sensitive. Where there is sufficient evidence, prosecutors must then consider whether a prosecution is in the public interest.

The noble Lord, Lord Davies of Stamford, stated that the DPP has said that he will not prosecute those who encourage or assist suicide. The DPP’s policy is clear that it,

“does not in any way ‘decriminalise’ the offence of encouraging or assisting suicide”.

Indeed, it specifically says:

“Nothing in this policy can be taken to amount to an assurance that a person will be immune from prosecution if he or she does an act that encourages or assists the suicide or the attempted suicide of another person”.

Lord Davies of Stamford: I am grateful to the noble Baroness for giving way. Of course, in a four-minute speech I had to use some shorthand, but my essential point was that it was extremely undesirable in the interests of both the clarity of the law and in how our democracy works to have the law on such an important subject made by the back door—by DPP decisions or even by jurisprudence. Would the Minister like to comment on that remark?

Baroness Jolly: I take the noble Lord’s point. I am not a lawyer but I will certainly write to him to ensure that his point is answered. In a letter to all Members of this House I will make sure that they, too, hear the same response.

Noble Lords may be aware of the different ways in which to document decisions on end-of-life care. Many of the general public are not. One option is a health and welfare lasting power of attorney. It allows someone to give authorisation to the attorney to make decisions about health and care, including decisions on life-sustaining treatments. Another option is making an advance decision. This enables anyone aged 18 or older who has capacity to make a decision about their future care. They may wish to refuse a particular treatment or intervention in the future when they no longer have the capacity to make their wishes known. It is a way of making plans for the future. It is a legally binding way of being able to refuse a treatment or intervention. An advance decision can be made not to be resuscitated under certain conditions. An advance decision can be made to refuse all life-sustaining care, provided that certain conditions are met. The decision must be witnessed and made in writing. These advance decisions are legal mechanisms to help a person plan their care. Both advance decisions and lasting power of attorney exist in addition to the systems that clinicians use to record patients’ wishes for end-of-life care.

The noble Lord, Lord Dubs, said that there should be a positive duty to inform a patient of their rights. Healthcare professionals should proactively seek to communicate with their patients and where appropriate, the patients’ families to find out their needs and preferences, and to capture these in an advance care

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plan if the patient so wishes. Healthcare professionals should understand the Mental Capacity Act so that they can inform patients about these rights if the patient is willing. It would be inappropriate to compel healthcare professionals to force such information on people who do not want it.

The noble Baroness, Lady Meacher, suggested that it would make a lot of sense to ensure that advance decisions are stored so that they could be accessed at the right time. It is important that those making an advance decision should decide how best to record their decision to suit their individual circumstances. There are also practical issues in trying to rely on a central register to record wishes, such as ensuring that it is up to date and accurately reflects current issues and wishes. Even if a register was established and showed that an advance decision was in place, healthcare professionals would still be required to satisfy themselves that it was valid and applicable, and would have to seek information from other healthcare staff and close family to ensure wishes, so a register would not be solely relied on. The noble Baroness, Lady Meacher, also raised the point of whether NICE should issue guidance on the use of advance decisions. NICE is an independent body and anyone can suggest a topic to it through the topic selection procedure. These are then evaluated to decide the topics on which guidance will be developed.

The noble Baroness, Lady Hollins, asked what is being done about ensuring that we have the right palliative care services. She raised various points, and when I get to the body of my text I will address that subject. All patients should receive high quality and compassionate care in the last days and hours of their lives, and we know that choice is at the heart of this. The noble Baroness, Lady Murphy, highlighted two issues: legislative decisions and policy decisions. I will direct the rest of this speech to policy-related actions and decisions.

The mandate to the NHS was refreshed in November this year. We highlighted the importance of improving standards of care at the end of people’s lives as a priority for the NHS and an area in which we expect particular progress to be made. In response to a recommendation made by the NHS Future Forum, the Government updated the NHS constitution in March 2013 to make it clear that patients should be fully involved in all discussions and decisions about their health and healthcare, including end-of-life care.

I now want to set out further details on the work that we have planned for extending choice in end-of-life care. We recognise that dying well means people being able to exercise more choice in where they receive their care, and to have quality services delivered where and when they need them. We know that most people would prefer to be cared for and to die at home, in familiar surroundings, surrounded by friends and family. We know that currently more than 50% of people die in hospital, the place where they would least prefer to be. We want to make sure that services are set up to help people to die at home, with high quality end-of-life care for all those who need it. However, increasing choice is not an easy task that can be done overnight.

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In Liberating the NHS: Greater Choice and Control, we set out our commitment to move towards offering more choice nationally to support preferences on how to have a good death. In light of this, we have been working with the National Council for Palliative Care to undertake a review, of when and how choice could be offered in end-of-life care. Noble Lords will be interested to know that a workshop involving all the key individuals and organisations in end-of-life care will take place early in the new year. It will discuss the key issues and barriers that the review will need to consider. In particular, a review will consider when such choices could feasibly be introduced, with the right services and support in place to deliver this. Our intention is that the review should be as comprehensive as possible, looking at all the issues in depth and involving all key stakeholders. We would therefore encourage and greatly appreciate your Lordships’ input. Any changes requiring legislation would be introduced using existing legislative powers. The outcome of the review will inform NHS England’s future approach to choice in end-of-life care.

The noble Lord, Lord Dubs, asked when we could expect proposals to replace the Liverpool care pathway. The work on a response to the independent review of the Liverpool care pathway is being led by the Leadership Alliance for the Care of Dying People. The alliance is currently engaging on draft outcomes and guiding principles that would underlie the care of people at the end of life in all settings. The system-wide responses will be published in the first part of 2014 after the engagement concludes. The right reverend Prelate the Bishop of Sheffield asked about the role of chaplaincy services. The College of Health Care Chaplains is represented on the alliance and will be part of the process of developing the final version of the outcomes and guiding principles. I endorse the comments made by the right reverend Prelate on the key role that chaplaincy services can play in end-of-life care.

Recent survey findings indicate that there is an increasing trend that people wish to die at home, and we cannot ignore that. The End of Life Care Strategy, published by the Department of Health in 2008, set out the ongoing ambition to support more people to die in their preferred location. Work is ongoing from NHS England—the leadership alliance—to refresh the strategy. This refresh will look at the strategy’s recommendations, including on patient choice, and build on them for the future direction of end-of-life care. NHS England is looking to complete this work early in 2014, which will inform its future approach. Following on from this, we know that one of the main barriers to people receiving the care they deserve is a lack of open discussion between health and social care staff. The noble Lord, Lord Dubs, spoke of the death taboo slowly receding, but in some cultures death is still considered part of life itself.

We know that after speaking to their loved ones about plans for end-of-life care, GPs are next on the list of people that patients most want to talk to. We also know that where GPs initiate conversation, nine out of 10 people are happy to continue with it. However, we recognise that some people would not wish to enter into conversations, either with their family or with

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health and social care staff. If this is their choice, we would expect healthcare staff to respect that.

All this is the background to the Find Your One Percent campaign. One per cent of people on a GP list will die each year. The purpose of the Find Your One Percent campaign is to help GPs make sure that people who may be approaching the end of their life have the chance to discuss and plan for their end-of-life care. The campaign is hosted by the Dying Matters coalition, working with Macmillan Cancer Support, the Royal College of General Practitioners and others to ensure that clinicians are provided with the information and, more importantly, the resources they need to support a good death.

The focus is on helping. We believe that GPs play an important role in helping patients to make choices that are right for them and to make sure that this happens. Guidance has been produced for GPs to help patients make informed choices. It is not compulsory for them to follow, nor is it about hitting government targets: it is about improving the quality of people’s experience at the end of life and ensuring that they receive the care they need, when they need it. GPs can help make sure that that happens by offering people the opportunity to prepare an end-of-life care plan. Care planning of this type is not a single event. Plans evolve as people’s conditions change or their preferences alter. This mechanism allows GPs to ensure that people get the treatment they want at the end of their lives, and have a chance to discuss this difficult topic and express their preferences.

Further, the quality and outcomes framework, a voluntary reward and incentive scheme for GP practices in England, currently has two dedicated indicators for palliative care. The framework encourages GPs to establish and maintain a register of all patients in need of palliative care and to have regular, multi-disciplinary case review meetings where all patients on the palliative care register are discussed. These indicators are being retained in the quality and outcomes framework for 2014-15.

In October 2013, NICE, the National Institute for Health and Care Excellence, announced that it is shortly to review its quality standard for end-of-life care for adults and the support guide for commissioners. This will provide further help to develop end-of-life care services and provide incentives for better conditions.

Many noble Lords have recognised the valuable role that hospices play in delivering end-of-life care services. The noble Lord, Lord Judd, spoke powerfully about a community’s sense of identity and ownership in their local hospice. Building on the success of the £40 million capital budget for hospices in 2010-11, which funded 123 projects in 116 hospices, the Government have provided a further capital budget for hospices of up to £60 million.

The independent Palliative Care Funding Review panel, set up by the Secretary of State for Health, was asked to recommend how a new per-patient funding system for adults and children should be developed. It reported in July 2011 and was recommended by the Government. As noble Lords will know, pilots were set up as a result of this and are currently gathering

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evidence. This evidence gathering will finish in March 2014. We have already stated our position: we see merit in removing the means test at the end of life, and this is being considered as part of the review. Noble Lords will be pleased to note that we have committed to introducing the new funding system by 2015-16, which is a year earlier than recommended by the review.

Before concluding, I thank those charities and hospices that do such wonderful work with patients at the end of their life, and with their friends and families after death to come to terms with their bereavement. In particular, Marie Curie, Sue Ryder and Macmillan Cancer Support have all been mentioned in today’s debate, but there are other smaller organisations.

I hope that I have been able to offer some reassurance that the Government are making progress on these complex and sensitive issues. If there are any questions that remain unanswered, I will write to all noble Lords who have taken part in this debate.

2.35 pm

Lord Dubs: My Lords, it was a privilege for me to secure this debate, in which there were some outstanding contributions. It was also very humbling to hear matters of conscience discussed so openly and with such obvious honesty and sincerity. I pay tribute to the right reverend Prelate the Bishop of Sheffield. I hope we will hear from him many times in the future, but perhaps on issues where he and I are in agreement. I am grateful to the Minister for the way she has dealt with this and to my noble friend on the Front Bench. All I can say is that we are going to debate these issues again and again.

Motion agreed.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Question for Short Debate

2.36 pm

Asked by Lord Chidgey

To ask Her Majesty’s Government what assessment they have made of the impact of the replenishment pledges for the Global Fund to Fight AIDS, Tuberculosis and Malaria, made by world leaders in Washington in early December.

Lord Chidgey (LD): My Lords, at their meeting in Washington at the beginning of this month, world leaders confirmed their pledges on the fourth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund congratulated the UK on demonstrating strong leadership in global health, with a major contribution pledged to the Global Fund for the next three years. The United Kingdom will contribute £1 billion to the Global Fund for the 2014-16 period, the second largest pledge by any Government so far after the United States of America. Dr Nafsiah Mboi, the Global Fund chair, cited the extraordinary generosity and leadership of the United

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Kingdom since the fund was founded in 2002. She said that this new commitment would underline a transformative step forward for the Global Fund partners in their fight to defeat HIV/AIDS, TB and Malaria, and gave an inspiring model of responsible global partnership.

Perhaps I may say at this stage how pleased I am that my noble friend Lord Fowler is in his place and will be contributing the benefit of his wealth of knowledge on these issues to the debate. I also welcome my noble friend Lord Verjee, who I am delighted to say has chosen to make his maiden speech in this debate. I know that my noble friend is able to speak from his personal experience in these matters and I look forward to his contribution today and to many more in the future.

The United Kingdom commitment to the Global Fund is geared towards encouraging other donors to maximise their own pledges and thus unlock additional funds with each new pledge. Can my noble friend the Minister say in her response what has been the impact so far of the Washington pledges on securing new pledges, or even indications of new pledges, at this time?

In its contribution towards ending world poverty, the United Kingdom is helping to halve malaria deaths in 10 of the worst affected countries by 2015. The United Kingdom has targeted saving the lives of 50,000 women in pregnancy and child birth, and 250,000 new-born babies, as well as helping to immunise more than 55 million children against preventable disease. The Global Fund pledging conference has set a target of $15 billion for the fourth replenishment. So far it has received $5 billion from the USA, the equivalent of $1.6 billion from the United Kingdom, and $612 million from Canada. A number of other pledges, notably from northern Europe, bring the total pledged to date to more than $12 billion.

The Global Fund was created in 2002 as a public-private partnership to raise funds to change the course of HIV/AIDS, TB and malaria. The United Kingdom has now become the second largest donor after the USA, pushing France into third place. Since 2002, the fund has approved more than $23 billion for grants spread over more than 150 countries. The fund accounts for 21% of all international funding for HIV/AIDS, 82% of international funding for TB and 50% of global malaria funding. It is the biggest funder of programmes to prevent, treat and care for people with these diseases. Big strides have been made, with 9.7 million people receiving antiretroviral therapy for HIV/AIDS and a further 30 million mosquito insecticide-treated nets being distributed in the first six months of 2013, making a total of 340 million nets. My noble friend may be aware, however, of disturbing reports that in some areas these bed nets are being used as fishing nets, which is clearly totally inappropriate. Does her department have any details of this departure and the effect it may have on the impact of the fourth replenishment?

The Global Fund’s TB programmes are continuing to expand, with the number of cases being supported now exceeding 11 million. However, the UK could be doing more, to which I shall return later. The UK’s

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latest £1 billion pledge to the Global Fund will maintain the record of “a life saved every three minutes”. Taking a lead in the worldwide fight against HIV/AIDS, TB and malaria, United Kingdom support over the next three years will deliver antiretroviral therapy to 750,000 people, 32 million more insecticide-treated mosquito nets to protect against malaria, and TB treatment for over 1 million more people. The UK’s allocation to the Global Fund will save a life every three minutes over the next three years and it will dramatically improve the lives of millions of people across the globe. Your Lordships will be aware that there are those who question the efficacy of organisations such as the Global Fund and its ability to channel the generosity of the United Kingdom into effectively combating diseases such as AIDS, TB and malaria. However, serious analysis confirms that the statistics demonstrate incontrovertibly that we can win this global battle on behalf of the poor.

On a human scale, I am sure that noble Lords can recall, like me, witnessing the suffering of those afflicted by these diseases and their like. I think of my visit to a hospice in Soweto in 2004, where volunteers were comforting and caring for patients dying from AIDS. Many were too weak to speak and unable to understand what was happening to them, having been abandoned by their families. Left to die on the streets, they were brought into the hospice by volunteer community workers who had been trained in basic healthcare by a handful of dedicated nurses. Almost 10 years on, thanks to organisations such as the Global Fund, the ravages of AIDS are gradually diminishing, with the hope that they will become something of the past in due course.

More recently, indeed just this summer, under the sponsorship of the charity RESULTS, I visited a district hospital outside Lilongwe in Malawi where small children were being comforted by their mothers as they struggled for breath and literally for life against the advances of pneumonia and TB. Further afield, at village health posts, I watched children being vaccinated by health workers, who were hampered by the fact that the transport of the cold boxes essential for the storage of vaccine was at the mercy of the poorly maintained and therefore unreliable fleet of motorbikes. Just to add to the difficulties, it was a 14-kilometre walk to the health posts for families living in the most remote communities.

Considering the Global Fund’s present challenges and the UK’s responses, it is the case that the poor relation in the three worldwide health campaigns seems to be tackling tuberculosis. TB is contagious and airborne. It is the second most deadly infectious disease in the world, and last year it was responsible for 1.3 million deaths and 8.6 million new cases. TB is the leading cause of death for HIV/AIDS-positive people and is responsible for one in five HIV deaths—that was 320,000 deaths last year alone. TB is estimated to have killed more people than any other pandemic in history, and is developing a drug resistance which makes it more expensive and more difficult to treat, with many more adverse implications and side-effects for patients. An estimated 3 million people a year who develop TB are not officially diagnosed or treated, with no guarantee of treatment outcomes.

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The Global Fund has demonstrated that, with investment and leadership, significant gains can be made, but it needs to work with agencies such as DfID to be fully successful. It cannot operate in isolation. DfID can and should invest in issues such as TB which have an impact on health outcomes in the UK. DfID can and should prioritise issues that are important to the UK taxpayer. DfID can and should invest in new and innovative projects that could represent significant steps forward.

TB is a largely neglected disease. Only one new drug has received regulatory approval in 42 years and the old-fashioned BCG procedure offers no protection to adults and cannot be used on people with HIV. Moreover, it does not protect against the most common type of the disease. It is estimated to cost the EU region alone almost €6 billion a year, yet the region accounts for only 4.7% of global cases. Leadership from DfID in a country like the UK could be transformative. It could lift the profile of the disease and show that it is still a major issue, which could lead to additional investment. DfID has provided a model response to malaria, putting it at the forefront of the global aid agenda. The 1.3 million people dying every year from TB and the 8.6 million who suffer from the disease need the level of support and commitment that only an aid agency like DfID can provide.

I should be very grateful if, in her response, my noble friend could address this and the other issues that I have raised.

2.46 pm

Lord Fowler (Con): My Lords, I congratulate my noble friend Lord Chidgey on his speech and I look forward to the maiden speech which is to follow in a few minutes. I should perhaps declare a new interest. Last week I joined the board of the International AIDS Vaccine Initiative in New York. I agree entirely with what my noble friend has said in introducing this short debate, in particular about the value for money that the Global Fund represents and, of course, the contribution that it is making to the fight against TB. I will not repeat his arguments because I want to come to this issue from a slightly different position.

Over the past 18 months, I have been looking at HIV and AIDS in different cities around the world. What has struck me is that when I explain this in this country, I am met with the response, “You mean, it is still a problem?”. It depends on what you mean by a problem. Last year some 1,600,000 people worldwide died from AIDS, while 2.3 million were newly infected, and for every person who was put on to antiretroviral treatment, two were infected. Some 36 million people around the world live with HIV, including 100,000 in this country, accounting for a drugs budget in the region of £800 million.

It may be true that Africa has the biggest problem, but more than 2 million people live with HIV in India, while in Russia and Ukraine there are major problems of injecting drug users, home-made drugs and shared needles. Of those with HIV, up to a quarter are undiagnosed and, all other things being equal, continue to spread the virus. Even when people are on antiretroviral

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drugs, many do not adhere to the treatment, storing up all kinds of problems for the future. So, yes, not only is there a problem, but there is an acute and urgent challenge to every Government in the world. Thanks to the Global Fund and to the President’s fund in the United States, enormous progress has been made. The United States Government in particular should be given credit for what they have done—of course, I agree with my noble friend—as should the Government here, who have redeemed the pledge of my right honourable friend Andrew Mitchell to increase their Global Fund contribution. We should also recognise, however, that over the past few years the overall global contribution has remained stable in real terms; it has not increased.

In no way do I deny the progress that has been made because it has been formidable and dramatic in terms of the number of lives saved, but I would suggest that the lesson is that we must not give up now. We should recognise what that means: we are talking about a lifetime commitment to people living with HIV. It is not a condition where, after treating a patient for six months, you can move on to the next one. That is one reason why the world needs to put far more emphasis than it has on preventing new cases of HIV. As I mentioned, I have joined the board of IAVI and did it for this reason. A vaccine gives the best hope for the future: you cut through some of the prejudice that surrounds testing and, from the financial point of view, it opens up the hope of reducing an otherwise constantly increasing bill. That was why—if I may say so to my noble friend—I was surprised and dismayed a month or two ago, before I joined the board, that the Government slashed the help from a hardly princely £9 million or £10 million down to £1 million.

I accept that there is, at present, no cure and no vaccine—which is exactly what I said back in 1986. That means we have to do two things. First, we need to keep up our contributions to the Global Fund. It needs to be underlined that, in the vast majority of cases, that has been money well invested, resulting in tremendous advances and the saving of lives. Secondly, we need Governments globally to engage with the key minority populations where the risk of HIV is highest. It is absurd, unjust and counterproductive that homosexuality is criminalised in so many countries in the world. We also need to treat drug dependence as a medical issue, not just as part of a so-called and unsuccessful war on drugs, and to introduce more clean needle schemes, which we did in this country in 1987. We need to engage with people such as sex workers, where the rate of HIV remains very high, and not simply pursue a policy of looking the other way. We also need to fight discrimination against transsexuals, which often forces them into sex work.

We have made massive progress, much of which is down to the success of the Global Fund, to which I pay tribute. However, we should also recognise that there is still a hell of a long way to go.

2.52 pm

Lord Verjee (LD): My Lords, it is with a very full set of emotions that I stand before noble Lords this afternoon to make my maiden speech in the House.

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These emotions are hard to describe but they include great trepidation, great gratitude and great humility. I will deal with the easy one first: great trepidation as I stand before this august House, full of its long history, tradition and the wisdom of all the noble Lords gathered here today. This would indeed be humbling for any new Member of this House and I will have a great sense of relief when I complete this maiden speech and sit down.

I stand here in gratitude for so many reasons, including gratitude to my noble friend Lord Chidgey for introducing this debate. I am very fortunate to speak in this debate for many reasons. We are debating here a Global Fund not just for HIV but for tuberculosis and malaria, and in the country where I was born, Uganda, malaria is still the biggest killer. It accounts for nearly half of all the deaths of children in any one year.

Ten years ago, I myself contracted malaria in the jungles of India. There are two types of malaria. There is the less lethal type that none the less revisits you and debilitates you year after year, and then there is what is called “cerebral” malaria, which goes straight to your brain and kills you. I had the second kind. That day, I could have easily joined the ranks of the well over 500,000 people who die of malaria every year. I was told I had only a day or more to live. It is only because I had access to the best medical treatment that I survived. Today, thanks to the deal that was recently made in Washington DC, far more people will survive and become malaria-free, as I did. I am proud to say that the British Government’s contribution to the fund has trebled, and we continue to be the second largest contributor in the world—for this, I am here to say thank you.

I am also full of gratitude to all the staff, team, police and security personnel, and to Black Rod’s department, for all the most courteous, patient and kind help over the past few weeks as I so obviously wandered around very lost but trying hard not to appear so. I am full of gratitude, too, to my supporters: my noble friends Lord Dholakia and Lady Brinton. To follow in the immense footsteps of my noble friend Lord Dholakia is both a privilege and a challenge for a new Member of the House, and for me in particular, as we both hail from east Africa. I am full of gratitude to my noble friend Lady Brinton for all her help, support and confidence as we launched a leadership programme for my party that is designed to mentor and develop people from underrepresented groups so they can become MPs and participate in the governance of this country.

I am full of gratitude most of all to the country and people of Great Britain. My family were dispossessed by Idi Amin of Uganda in 1972 because we were Asians, yet I was able to come here and prosper in this country and become an entrepreneur, and my family and I were able to live in freedom and dignity. This country gave me the opportunity to thrive and I truly hope I can help many more people to have that very same opportunity.

The Global Fund and similar institutions provide these very same opportunities to people all over the world. I recently had the honour to travel with former

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President Clinton, who works with the Global Fund, to five countries in Africa. We visited Zambia, Malawi, Rwanda, Tanzania and South Africa, to see the projects supported by the Clinton Foundation. In Zanzibar, we visited a project called ZAPHA+, established some 20 years ago for Muslim women in a tiny community who had been stigmatised and shunned for being HIV positive. This project took them in, provided support groups and business skills for them and helped them to turn their lives around. When we visited, the women were happy, healthy and confident, and introduced us and President Clinton to their HIV negative children. It showed me what aid money can achieve when it is well spent. I assure noble Lords that the money committed by our Government will transform lives.

Finally, I speak with a great sense of humility. The late President Nelson Mandela once said that,

“after climbing a great hill, one only finds that there are many more hills to climb”.

It has indeed been a great hill for me to climb from my birth in Uganda to my ascent into the House of Lords. I see now that there are many more hills to climb—hills on which there are people who need our help. I can rest at the end of this, my maiden speech, knowing that I will be climbing those hills together with other noble Lords. Thank you.

2.58 pm

Baroness Hayman (CB): My Lords, it is a real pleasure for me to be able to congratulate the noble Lord, Lord Verjee, on what I think all noble Lords would agree was an outstanding maiden speech. It was passionate, very personal and very modest. The noble Lord’s story is an extraordinary one of academic, entrepreneurial and philanthropic success. His business achievements are manifold, but anyone who has ever fought an election campaign will always owe him a particular debt of gratitude as the founder of Domino’s Pizza in the UK.

In his speech, the noble Lord referred to what aid money can achieve when well spent. The noble Lord, Lord Verjee, is not only a generous but an intelligent philanthropist. He works, through the Rumi Foundation, in a variety of fields, but I pay particular tribute to the work that he has described today in encouraging, through the leadership programme, people from underrepresented groups to participate in political life. We hear and see a great deal about the perpetuation of privilege in public life in this country and it is enormously important that stories about those who overcome obstacles and the triumph of talent are also told as examples to others. I first heard about the noble Lord, Lord Verjee, from my son, who works in the philanthropic field. He said, “You should meet Rumi, Mum, he’s one of the really good guys”. I think that the House will share that opinion as time goes by.

Noble Lords: Hear, hear.

Baroness Hayman: When speaking about the Global Fund, I must declare my non-financial interests. I am a trustee of the Sabin Vaccine Institute, a vice-chair of the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases and a trustee of the Malaria

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Consortium. I pay tribute to what the fund has achieved in the battle against malaria, to which the noble Lord, Lord Verjee, referred. Hearing the statistic that since 2001 the number of child deaths from malaria has been halved reminds you what aid money well spent can achieve. The Global Fund has been enormously important in that. The Malaria Consortium is the leading UK implementer of Global Fund money. In Uganda, with the fund’s support, we are working with the Ministry of Health to distribute more than 20 million long-lasting insecticidal nets to achieve universal net coverage in that country.

As many have said in debates about the Global Fund, it is essential that we replenish the fund if we are successfully to continue and build on what has already been done. The fund is hugely important, not only in its own work but—as was made clear to me at a meeting of the all-party group last night—in the effect it has on the upstream work to face the new challenges and create the new vaccines, medicines, insecticides and diagnostics. While those are being developed, there must be the encouragement of knowing that there will be an implementation machine to take them to the patients. It is tremendously important that the fund is replenished.

Replenishment will also allow the Global Fund to build and extend its work. I very much welcome the new funding model, which seeks to align investments in combating HIV, TB and malaria with national health strategies, while strengthening health systems and serving as a platform promoting the health of a person rather than combating only specific diseases. I feel this particularly strongly when I look at the issues of maternal and child health and of neglected tropical diseases.

For the world’s poorest people, these things do not fit into nicely delineated silos and different funding streams; these are the health issues of the poor. To be effective, we need to combine the programmes to ensure that the synergies are achieved and the best value for money is obtained. I think of it most particularly with regard to schistosomiasis. Schistosomiasis increases by twofold or threefold the likelihood that an adolescent girl exposed to HIV will contract HIV. The treatment for schistosomiasis is very cheap but, as a neglected tropical disease, it does not fall within the bounds of the Global Fund. My question to the Minister is: what are the Government willing to do to encourage the Global Fund to take a broader approach to health in the future?

3.04 pm

Baroness Nye (Lab): My Lords, I join the noble Baroness in congratulating the noble Lord, Lord Verjee, on his most eloquent maiden speech. I look forward to his future contributions. I, too, am grateful to the noble Lord, Lord Chidgey, for securing this important debate and for his efforts to keep the fund at the forefront of the development agenda.

As the noble Lord said, the fund’s achievements have been remarkable: 6 million treated for HIV; 11 million diagnosed and treated for TB; and 360 million bed nets. I thank the Government for maintaining the

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support shown to the Global Fund by the previous Labour Government by making such a generous pledge. Although the replenishment campaign is over, the work of replenishing the fund must continue in order to ensure that it reaches its target.

I, too, look forward to the Minister giving us an update on what the Government are doing to galvanise support from other donors to ensure that UK and US money is not left on the table and on what part they are playing to ensure the long-term stability of the funding stream. Only with sustained, long-term funding can you achieve the scale of the interventions needed.

For all these efforts, gaps remain in our responses to these diseases. For 10 years, the UK charity Target Tuberculosis has been working in the field through local partner organisations, focusing on the needs of the poorest communities, who often live in remote locations far from government-led national TB programmes, which receive the bulk of the Global Fund allocations.

Currently the British Government do not engage in any bilateral funding of programmes related to TB, despite the Prime Minister co-chairing a high-level panel report on the post-2015 framework that identified treating TB as the most cost-effective health intervention measured. It returns £30 for every £1 spent. Perhaps the Minister will explain why the British Government do not fund TB-specific projects through bilateral funding.

In October the WHO launched its annual Global Tuberculosis Report in London with RESULTS UK, to which I am grateful for the work that it does and the briefing that it has provided for this debate. The report named five key priorities for beating the TB epidemic. I am going to concentrate on the need to:

“Accelerate the response to TB/HIV”.

Last year 1.3 million people lost their lives to TB. As the noble Lord said, 320,000 of those people were HIV positive. TB is the leading cause of death for people with HIV, yet only just over half of all those who are HIV positive and have TB can access anti-retrovirals. TB preys on a weakened immune system and, without access to anti-retrovirals, TB will progress faster in an HIV-positive patient. Co-infected patients without anti-retrovirals are more likely to die. A priority for reducing the number of deaths from TB and HIV is to scale up the response to co-infection and ensure that everyone with TB is tested for HIV, and vice versa, and given the proper medication.

The Stop TB Partnership, the WHO and UNAIDS stated that 1 million deaths could be prevented among people living with HIV by 2015 if the world implemented simple strategies; that is, everyone with TB gets an HIV test and access to treatment. Worryingly, there remains a huge gap between where we are today and complete coverage of anti-retrovirals for TB/HIV patients, as the noble Lord, Lord Fowler, said. The recent DfID position paper reaffirming its commitment to TB/HIV is to be welcomed.

The fund’s strategy committee has decided that it should do more on TB/HIV. It has mandated that any country with high rates of TB/HIV co-infection that applies for funding for treatment programmes will have to design its programmes in a single unified

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application. Every country will have to have joint, integrated, co-ordinated programmes for TB/HIV. This could be a huge step forward, as the fund provides 80% of international financing for TB and more than 20% for HIV. I urge the Government to take the lead and to support the Global Fund, not with money this time but by supporting and adopting similar policies and by urging other partners to do the same.

Finally, in a week when the eyes of the world have been on South Africa, there is one other area where we could make a difference. South Africa’s gold mines contribute 9% of the global total of TB cases, which in turn fuel the HIV epidemic in the region. The British Government could show real global leadership and I hope that the Minister will update your Lordships’ House on the Government’s recent meetings with mining companies. The South African Health Minister and chair of the Stop TB Partnership board has called a regional gathering of Health Ministers and mining companies for early next year. The meeting will seek to drive a regional response to the disease. It would show real commitment if the British Government sent a high-level representative to that meeting. This is the kind of leadership that the British Government could and should provide. They have stated that TB/HIV is a priority; now I urge them to prove it.

3.10 pm

Baroness Tonge (Ind LD): My Lords, I thank the noble Lord, Lord Chidgey, for securing this debate and congratulate the noble Lord, Lord Verjee, on a brilliant maiden speech—I congratulate him even more on surviving cerebral malaria.

I have not exactly heaped praise on the coalition Government in the past three years, but I praise them for having the vision and good sense to see that overseas aid, prudently spent, not only benefits people in developing countries but will eventually benefit us all by reducing poverty and migration and increasing our markets abroad.

Not being a great fan of “vertical lines of expenditure” on specific issues, I was sceptical when the Global Fund was set up, but I accepted that the three diseases that we are discussing were causing such devastation that a new approach was clearly needed—and the Global Fund was that new approach. It has been successful, as we have heard from the fund itself in the excellent briefing that we have received from it and from other noble Lords. I shall therefore congratulate the fund but not repeat what has already been said by other speakers.

Replenishment of the fund is now needed, and we have heard of the plans for it. We must keep up support for the fund and nag other countries to keep pledges. Drug resistance is growing and we must stay vigilant.

This applies also to my main interest, which is population and development, and expenditure on sexual and reproductive health, particularly family planning. According to the ODA, funding for population assistance is still increasing, but at a much slower rate than prior to the financial crisis. This is despite the tremendous boost given to accessible family planning by our coalition

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Government at the summit in London last year and carried forward by the Gates Foundation, to which we owe a huge debt of gratitude.

Allowing women in the least developed countries to have access to family planning to limit the number of children they have is still crucial to the achievement of the millennium development goals. If the world’s population continues to increase, the MDGs become harder to achieve. We may feel that we are making progress, but more and more people coming into the world will need more help and more treatment. It is crucial therefore to keep up the pressure on family planning provision, always ensuring of course that there is no coercion. If you consult the statistics, you will see that economic growth always follows reduction in family size; it is not the other way round, as used to be believed. And that, reduction in family size, is the way out of poverty for most developing countries.

One of the factors which led to my lack of enthusiasm for “vertical” programmes such as the Global Fund—this has been alluded to by the noble Baroness, Lady Hayman—is that while a patient may get his or her treatment for HIV/AIDS or TB, the provision of reproductive healthcare and contraception may be in another clinic or another place, necessitating another long journey to a health centre—and sometimes the provision does not exist at all. I am delighted, therefore, that the Global Fund is now trying to ensure that more comprehensive health systems will be set up alongside the treatments for AIDS, TB and malaria. I would love to hear the Minister’s assurance on that. There is a direct link, too: contraception in the form of condoms is after all the first defence against AIDS while we are waiting for a vaccine. Every health facility dealing with AIDS should remember this fact and have those available.

Once again, I congratulate the Global Fund and the current and previous Governments on having achieved so much in international development during the past two decades, and I look forward to the next decade with some confidence.

3.14 pm

Lord Shipley (LD): My Lords, I, too, am grateful to my noble friend, Lord Chidgey, for securing this debate, just 10 days after the Global Fund’s replenishment conference. I join others in congratulating my noble friend Lord Verjee on an excellent maiden speech. I want, too, to congratulate the Government on their commitment to the fund, which has raised a remarkable $12 billion for the next three years and made unprecedented strides against HIV, TB and malaria.

When the Economic Affairs Committee took evidence a couple of years ago on the economic impact and effectiveness of development aid, I noted in particular the evidence of Professor Jeffrey Sachs of Columbia University, who said he was,

“a big fan of well targeted, well defined programmes that can accomplish well designed and specified purposes”,

such as delivery of bed nets or vaccines. This is what the Global Fund helps to achieve: as we have heard, 11 million cases of TB have been diagnosed and treated, 360 million bed nets have been distributed to protect against malaria, and 6 million people have received life-saving antiretrovirals.

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However, huge gaps remain. Every year, there are 3 million people around the world who develop TB and are not officially diagnosed or treated and remain infectious. That number has not changed for six consecutive years.

There is one initiative which would help: a Stop TB Partnership project called TB REACH, created with a grant from the Canadian Government amounting to $120 million. It is important because, while the Global Fund provides more than 80% of international financing of TB treatment, it is unable to fund projects that do not have a track record of proven success, which inhibits innovation.

TB REACH undertakes feasibility studies for donors such as the Global Fund. It incubates innovations in TB care delivery; for example, using mobile phone technology, developing public/private partnerships and rolling out new, rapid diagnostic tests. That is exactly what it did in Ethiopia, where it supported a project that saw 1,200 community health workers team up with motorbike riders to get TB samples from remote villages.

The project put a comprehensive package of measures in place to improve access to TB care. Health workers identified people who had been coughing for two or more weeks and collected sputum samples, prepared smears and supervised treatment, leading to a doubling of case detection and a 93% treatment success rate. That scheme has since been supported and scaled up by the Global Fund and the Ethiopian Government. It now has a sustainable future.

However, I understand that there may have been concerns about the number of small projects that TB REACH funds, and about their sustainability and their scalability. Inevitably, with any initiative that funds innovation, not all projects will be a success and not all can be scaled up, and that is the price of innovation. But TB REACH is broadly successful, providing fast-track funding so that projects can deliver results within six months of a proposal being received. Its outputs seem impressive. In the past three years, TB REACH has contributed to the detection and treatment of more than half a million people with TB, through more than 100 grants in 44 countries targeting key groups including TB in mining communities and childhood TB. In addition, TB REACH projects have prevented 750,000 people becoming infected.

I am aware of two reports that have the Government’s seal of approval. The first is the high-level panel report on the post-2015 framework, co-chaired by the Prime Minister. The report found that TB interventions offered the best return on investment of any health intervention. The other report is the recent DfID Health Position Paper, which identified the critical importance of innovation in solving the world’s most intractable health problems. I think that the Government are right to identify the importance of TB interventions, and the importance of innovation. I therefore hope that they will look very carefully at the strong case for extra funding for TB REACH.

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3.18 pm

Lord Collins of Highbury (Lab): My Lords, I, too, thank the noble Lord, Lord Chidgey, for initiating this very timely debate. I also congratulate the noble Lord, Lord Verjee, on his excellent and moving maiden speech, making a very powerful, personal case for the fund.

As my noble friend Lady Nye said, the Global Fund to Fight AIDS, Tuberculosis and Malaria has since its inception provided 6.1 million people with life-saving access to HIV treatment, 11 million people with tuberculosis treatment, 360 million households with insecticide-treated nets to prevent malaria, and treated 260 million cases of malaria.

As we have heard from noble Lords in the debate, it was rated as “very good” value for money in DFID’s 2011 Multilateral Aid Review, and continued to make progress according to the 2013 follow-up.

As we have heard in the speeches this afternoon, the donors’ decision earlier this month to pledge $12 billion over the next three years is extremely welcome but still $3 billion short of the $15 billion needed. If that goal was achieved it would mean that: 17 million patients with TB and multidrug-resistant TB could be treated, saving more than 6 million lives over the three-year period; 1.3 million new HIV infections could be averted each year; and 196,000 additional lives could be saved from malaria, helping to avert a resurgence of the disease that could see the world return to levels of mortality not seen since the year 2000.

Like the noble Lord, Lord Fowler, I pay tribute to the US Government for their action here. The US has committed itself to a one-third match of all funds raised up to the full $15 billion, so a further $1 billion is now on the table if other donors can step up to raise the remaining $2 billion needed. Like the noble Baroness, Lady Tonge, I am very proud of this Government for maintaining my Government’s commitment to the £1 billion funding. That places us in a strong position to exert influence over others for this round of replenishment. What steps will the Government and department take to help the fund realise the full $15 billion replenishment and thereby maximise the support from both us and the USA?

Key to this will be more effective engagement with emerging economies that have the capability to support the fund. As we have heard in previous debates, India and China between them donated less than Ireland did on its own. For malaria, the Global Fund represents half of all international financing and will go a long way towards helping meet some of the urgent needs for prevention, diagnosis and treatment. Current prevention measures have dramatically reduced malaria cases and deaths, particularly in young children. The WHO World Malaria Report published yesterday shows impressive progress in the global malaria campaign. However, as quoted in today’s Guardian, Margaret Chan—director-general of the WHO—warned:

“This progress is no cause for complacency. The absolute numbers of malaria cases and deaths are not going down as fast as they could”.

The Global Fund also makes up more than 80% of all international financing for TB, making it the single most important funding mechanism in the fight against

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TB. If global funding for HIV, TB and malaria were to flat-line, we could see 2.6 million new HIV infections every year, some 3 million fewer people treated for TB, and 430 million malaria cases that could have been prevented. As Mark Dybul, executive director of the fund said:

“We have a choice: we can invest now or pay forever”.

3.24 pm

Baroness Northover (LD): My Lords, I thank my noble friend Lord Chidgey for securing this important debate at a very important time. I also pay tribute to my noble friend Lord Verjee for his moving maiden speech. I am absolutely delighted that, with all his wide experience—as the noble Baroness, Lady Hayman, outlined—he chose to make his first speech in this debate, which I am answering. It is also excellent that so many noble Lords who have such an outstanding track record in this area, especially my noble friend Lord Fowler, have contributed. I thank noble Lords who paid tribute to what we are doing, especially my noble friend Lady Tonge, as I know how very hard won is her praise.

As noble Lords made clear, AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2012 alone, AIDS killed 1.6 million people, malaria 627,000 and TB 1.3 million. However, great progress has been made: new HIV infections are declining in many of the worst-affected countries; there has been a significant reduction in malaria incidence and deaths; and the world is on course to halve TB deaths by 2015, compared to 1990 levels. Just 10 years ago, the world struggled to respond to HIV, TB and malaria, and access to key prevention and treatment interventions was very limited—as noble Lords will remember. This picture has now been transformed and the Global Fund to Fight AIDS, Tuberculosis and Malaria has played a major part in this. Since 2002, Global Fund-supported programmes have detected and treated 11.2 million TB cases and distributed 360 million treated nets. Some 6.1 million people living with HIV are now receiving antiretroviral therapy thanks to the Global Fund. That is truly a remarkable achievement.

However, as my noble friend Lord Fowler and the noble Lord, Lord Collins, pointed out, we must not give up now and cannot be complacent. Improvements are not uniform in all countries. As my noble friend Lady Tonge said, resistance to effective medicines is a growing threat. Devastating rebounds can occur quickly. That is why we must redouble our efforts and increase our commitment. As my noble friend Lord Fowler made clear, we now have a historic opportunity to make a decisive impact on these diseases. We have effective tools to prevent and treat them and an unprecedented global commitment to transform the three diseases into manageable health problems rather than national and global emergencies.

Last week at the Global Fund’s replenishment conference in Washington, donors pledged $12 billion. That is the largest amount ever pledged—a 30% increase on the amount pledged at the 2010 replenishment conference. But $12 billion is only the start: the fund aims to raise a further $3 billion over the next three

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years to bring this to $15 billion and make the most of this historic opportunity. The UK is playing a groundbreaking part in that, as noble Lords noted. We are committing £1 billion—provided that that is not more than 10% of the total replenishment value—to encourage other donors to come forward and meet the target. Developing countries, civil society and the private sector also have crucial roles to play. Last week the Gates Foundation announced that it would provide up to $200 million to match other donor commitments. We hope that that will encourage new partners, including private contributors, to join the global effort.

I assure my noble friend Lord Chidgey and the noble Baroness, Lady Nye, that we are working very hard to ensure that others follow suit. That is why the UK, the US and the Gates Foundation have made our contributions conditional. The most important role, of course, will be played by the countries themselves: designing effective national strategies; using funds transparently and well; and providing the bulk of financing from their own domestic resources. It was notable and historic that Nigeria participated in Washington as an equal partner, committing $1 billion for investments in treatment, care and prevention for Nigerian people affected by the diseases.

The noble Baroness, Lady Hayman, asked about the broader health sector support for the Global Fund. Clearly, the focus of the Global Fund is on the three diseases, but there has been a widespread understanding of the effect that it has on other diseases and the importance of ensuring that action in one area is supported by action in another, and that it is important to look across the sector. Whether it is neglected tropical diseases or family planning, to which the noble Baroness, Lady Tonge, referred, it is recognised that these areas interplay.

The noble Lord, Lord Fowler, asked about key populations. We strongly support a public health approach to key populations affected by HIV, including men who have sex with men, sex workers and injecting drug-users, that respects human rights and addresses the stigma and discrimination that they face. It is very important that that is recognised.

Of course, we wish to see the money spent effectively. On the misuse of bed nets, I can assure my noble friend Lord Chidgey that the World Health Organisation’s World Malaria Report 2013, which was launched yesterday, estimates that 86% of people who had access to a bed net used it to protect themselves from getting malaria. We are supporting efforts to maintain and increase that.

On TB, we are committed to the global goal of halving deaths from it by 2015. Various noble Lords mentioned this. The noble Baroness, Lady Nye, suggested that there were no TB-specific bilateral programmes. The majority of UK funding for TB treatment is through the Global Fund, but we are providing bilateral funding to TB-specific programmes in a number of countries, including South Africa, Burma, Nigeria and India. In August, we announced support for nine public-private partnerships, including FIND, the TB alliance and Aeras. These partnerships will help fund crucial work on developing new and more effective

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tools to prevent, diagnose and treat TB, in addition to our spend through the Global Fund.

In addressing my noble friend Lord Shipley on TB REACH, I will say that we have reviewed its external mid-term evaluation and agreed that it has successfully funded innovative approaches leading to additional TB cases being detected among high-risk populations and in high-burden countries. Besides supporting it through the Global Fund, DfID also supports TB REACH through our £53 million annual core support to UNITAID.

The noble Baroness, Lady Nye, spoke of integrated approaches to tackling TB and HIV, which is something that her noble friend Lord Collins put to me the other day. DfID has been leading in this area, and we have been strongly involved in the recent Global Fund requirement for countries burdened by the two diseases to put forward a unified and integrated application for joint TB/HIV programmes. This is a strong signal that disease-specific initiatives will not address TB/HIV co-infection alone. That is also highlighted in DfID’s HIV position paper review, which has just been published, because we recognise the importance of co-infection.

In terms of working in the extractives industry, which the noble Baroness, Lady Nye, also brought up, we are working with the Government of South Africa, the Chamber of Mines and the World Bank to expand the quality and access of TB-related services, including TB control and treatment referral across borders. There are some other details, which I can provide to her.

We now have to ensure that we use the funds pledged at the recent conference, and those that will follow, as we seek to meet the $15 billion requirement for the Global Fund. We have to make sure that these funds are used in the most effective way possible, so that we achieve the greatest impact from the money contributed. The UK will continue to work closely with the Global Fund to ensure: that we are financing the highest-impact interventions; that we are increasing funds to the lowest-income or most fragile countries with the greatest disease burdens; that we are focusing interventions on the most at-risk populations, using the latest epidemiological evidence to target disease hotspots in country; and that we are using funds to support implementation of robust national disease strategies with full country ownership.

We will ensure that the Global Fund implements and builds on its new systems of governance and risk management, so that no one is denied access to life-saving treatment due to a loss of funds through fraud and corruption. We must not forget the importance of shaping markets and reducing costs, and have made huge strides already in this area, which I think that noble Lords are familiar with. But with continued work, we believe that further sustainable price reductions are possible, so that more lives can be saved for every £1 raised.

The $12 billion pledged in Washington is the start of a process towards full replenishment and achieving the maximum impact from $15 billion. This in turn is part of something bigger, with vital contributions from other donor sources, the private sector, civil society, and, most importantly, from the countries

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themselves. Working together in a true global partnership with clear goals and targets and unwavering national and global commitment is the only way to end the death and suffering caused by HIV/AIDS, malaria and TB.

House of Lords: Size

Motion to Take Note

3.36 pm

Moved by Lord Norton of Louth

To move that this House takes note of the case for reducing the size of the House of Lords.

Lord Norton of Louth (Con): My Lords, the proposition I wish to put to the House is straightforward. In terms of membership, the House of Lords has grown, is growing and ought to be reduced. There is an immediate problem; there is an even greater prospective problem.

My starting point is that this House does a good job in fulfilling functions that add value to the political process. It complements the elected Chamber, not least in carrying out tasks that the other House may not have the time, resources or political will to fulfil. However, the fact that we do a good job does not mean that we could not be even more effective than we are. Enhancing our effectiveness has two elements. One is making changes to how we operate and the other is bolstering public confidence in what we do. Unlike the other place, we cannot take our legitimacy for granted. We have to earn it. The changes that would enable us to fulfil our functions more effectively and enhance public support go well beyond limiting how many Members we have. However, addressing the size of the House is critical because of its relevance to fulfilling the functions of the House and our public standing.

There are two aspects to the size of the House. One is the total membership and the other is the active membership. The total membership is especially relevant to how the House is seen by the public, and the active membership is relevant to the capacity of the House to do its job. In terms of total membership, the House has grown markedly since the passage of the House of Lords Act 1999. At the start of the new Session of 1999-2000, we had 666 Members—in other words, a membership slightly larger than that of the House of Commons. Today, we have a total of 835 Members, making the House more than a quarter larger than the House of Commons. We are the largest second Chamber in the world. That remains the case even if we exclude those who have taken leave of absence or are ineligible. Excluding those who are ineligible or have taken leave of absence, we have 781 Members. However, we have to take into account the fact that ineligible Members, such as those holding judicial posts, will in due course be able to resume their seats. Some of those on leave of absence because of the positions they hold, such as the noble Baroness, Lady Ashton of Upholland, may well resume their seats upon completion of their current posts.

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However, even working with the figure of 781, imagine what will happen if a new list of Peers is announced. Then think ahead to the next Parliament and the likely creation of another list. There may be ebbs and flows—we lose some Members each year and there is a lull between lists—but the underlying trend is clear. That is demonstrated graphically in Figure 2 of Meg Russell’s pamphlet, House Full, published in 2011. As she points out, the largest single number of Peers to be created in any one year since 1999 was the 117 who were created in 2010-11.

The number, be it of all Peers or just of eligible ones, is rising and has risen most markedly in the past three years. It is not beyond reason to envisage a House at some point in the next Parliament with a total membership close to, or even in excess of, 900 Members. A House of that size, whether active or inactive, does nothing for the reputation of the House; it is difficult to defend in the public arena.

One can certainly justify a House similar in size to that of the other House, given that we need a large membership to sustain an active House of part-time Members. We benefit fundamentally from Peers having outside links and maintaining current expertise. This House forms an invaluable arena for discourse by civil society. However, the more that we grow in number beyond the size of the other place and, like Topsy, just grow and grow, it is difficult to defend against the criticism of being primarily an expanding repository of political patronage.

There is no obvious justification for the expansion in terms of fulfilling the tasks that are core to our activity. The more that we grow in size, the more that the position becomes indefensible. It would not be bad if there were a rational argument for the growth in numbers, but there is no clear intellectual basis for it. The composition of the new membership in this Parliament bears little relationship to the stated aim of the coalition agreement in terms of membership proportional to votes in the general election. To achieve proportionality now would require a further, substantial injection of new Peers.

There is a more tangible problem in terms of the resources of the House. The growth in membership in recent years has brought in Members who contribute regularly to the work of the House. This is reflected in the daily attendance: the average daily attendance in the Session 2009-10 was 388, while in the most recent session, 2012-13, it was 484. As Meg Russell records, this substantial recent growth in the active membership generates three problems. First, it puts pressure on the limited resources of the House. Secondly, it puts pressure on the work of the House, not least in terms of demands to contribute to Question Time and debates. Thirdly, it has a negative impact on the culture of the House. The more that Members are brought in quickly and in large numbers, the more that this makes it difficult to socialise Members in the accepted norms of the House, and the danger is that the House may become more fractious and partisan.

The pressure on resources is fairly obvious, not least in terms of space. Members have always been underresourced relative to Members of the other place. This is shown in the extent to which Peers are allocated

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not offices of their own but rather desk space. The pressure is also obvious in the Chamber, in that at various times it is not able to accommodate all the Members who wish to attend. We have a smaller Chamber than that of the other place but a larger membership. The Commons has seating for more than 60% of its Members; we cannot match that, even based on the average daily attendance, and the situation is clearly growing worse.

The increase creates particular problems in a House that works on a fairly lean support base. The cost of this House is notably less than that of the House of Commons. In the previous Session, the cost to the public purse of the House of Commons was £392 million while the cost of the House of Lords was £87 million. We may take some pride in delivering value for money, but making a case for more public money at the present time is difficult. We are expected to make efficiency savings. That will be difficult with an influx of new and active members, each eligible for an attendance allowance and transport costs and adding to the demands on the resources of the House. There is clearly a problem in how this will be seen by the public. There is also the problem of how we can cope within our existing physical capacity and administrative support. The demand is in danger of outstripping the ability of the House to meet it.

So the situation that we are in is clearly problematic, and if there are many more creations then it will likely become unsustainable. What, then, is the answer? There are various steps that can be taken, although in taking them it is important to have regard to certain principles. One is that no party or coalition of parties forming a Government should have an absolute majority. Another is that there should be a protocol, a formula, on the balance between the parties in order to prevent another escalation in membership. Any reduction needs to have regard to the balance between political groupings in the House. A third is that we should work towards a membership that is smaller than that of the House of Commons. That may take time but it is a useful aspiration; it provides a framework for managing the reduction in numbers.

One immediate and rather modest step would be to put a limit on the size of the House. One proposal is to have a moratorium on the creation of new Members. I would propose a cap on membership. That way, one could create new Members but only when existing ones had demised. One could develop a formula of creating, say, only one new Peer for every three who left the House. That would gradually reduce the size of the House; it would be a slow process, but over the course of the Parliament it would reduce the size of the House by at least 50.

Other steps include those embodied in the Bill introduced in this House by the noble Baroness, Lady Hayman, and that in the other place by Dan Byles, such as removing Peers who hardly ever attend. That would not affect the active membership but would have a beneficial effect in terms of public perception. Another provision of the Bill would create a form of retirement provision, which would have the effect of the Members ceasing to be Members of the House, with no provision for retirement to be rescinded.

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More radical proposals have been canvassed. These include proposing a mandatory retirement age or imposing a set period for which a new Peer may serve, such as 10 or 15 years. The problem with each of these is that it has the potential to rid the House of Members who are making a substantial contribution to it. There is another proposal that would not have such an arbitrary effect and could be geared to the need to maintain a balance between the parties in the House and allow for some recalibration in each Parliament: to determine the number that each political grouping should have in a Parliament and to allow each to elect from within its own ranks those who should remain within the House—in other words, a scheme not dissimilar from that employed in 1999 to determine which hereditary Peers should remain in the House.

My purpose this afternoon is not to put forward a particular proposal, but rather to emphasise the necessity to address the problem. The more we can get on record the need to act, the sooner we may be able to achieve some steps by government to address the compelling need for some corrective action. Accepting the need for a cap on membership would be a starting point.

Given that, may I invite my noble friend the Leader of the House to focus not simply on where we are now, but on where we are likely to be in two, five and 10 years’ time? In terms of creations already announced, could he give us some indication of the additional costs estimated to be incurred in a full financial year once the introduction of the current tranche of new creations has been completed? Does he accept that a further list of Peers in the current Parliament will create not just additional but significant difficulties in terms of the finite resources of the House? Projecting ahead, would my noble friend accept that the problem will be exacerbated in the next Parliament, especially in the event of the return of a new Government? That will be the case if the new Government is a majority Conservative Government. Would not the new Government expect to create more Peers? If my noble friend accepts that there is a problem, either now or prospectively, what steps does he anticipate the Government taking to address it?

The problem has been touched upon by various bodies in recent years, including the Leader’s Group chaired by my noble friend Lord Hunt of Wirral, who I am delighted to see in his place, as well as more recently by the Political and Constitutional Reform Committee in the other place. My noble friend told the committee that he found that there was a broad consensus among Members that the current House is too big and the overall size should be reduced. Given that there is such a consensus on the problem and what should be done about it, I look forward to hearing from my noble friend, speaking as the Leader of the House, what he plans to do to give effect to the will of the House. I beg to move.

Earl Attlee (Con): My Lords, may I point out to the House that the timings are very tight indeed for this debate? I can help.

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3.48 pm

Lord Tyler (LD): My Lords, I congratulate my noble friend Lord Norton of Louth on this very timely debate. He and I gave evidence to the Select Committee of the other place that looked at this issue, and I shall briefly refer to its report because it was rather useful for people outwith this House to look in, although it has to be said that very many distinguished Members of this House gave evidence to that committee. My noble friend referred to some of the issues looked at—for example, the proposal that there should be legislation to expel Peers who have been convicted of a serious offence. I do not think that reform would produce a serious decrease in the size of the House; I would hope not.

The committee recorded strong agreement that action should not be taken in two areas: first, in relation to the introduction of a long-term moratorium on new Peers, and secondly, in relation to the introduction of a compulsory retirement age. It specifically said that it did not think either of those things were appropriate or would receive proper support in either House. The committee went on to say that there seemed to be some widespread support for no longer replacing hereditary Peers in the House of Lords when they died. That has proved very contentious in this House, so maybe there was a certain naivety at the other end of the building on that issue. On the other hand, the committee quite sensibly pointed out that tackling the issue of persistent non-attendance is by definition not particularly useful in dealing with problems of overpopulation in this House. It is a classic non-solution. Finally, it said that it thought that the evidence about introducing fixed-terms appointment for Peers suggested that it would prove to be just as controversial as some of the more major reforms that both Houses have been looking at in recent years.

The chairman of that Committee, Mr Graham Allen MP, said in introducing the report:

“Establishing a consensus about the principles that should determine the relative numerical strengths of the different party groups in the House of Lords, and for codifying such principles, is probably the most contentious of all the issues we considered in this inquiry, but it is also the most crucial to any further progress. We call upon the Government and political parties in the Lords to set out their positions on this matter and to engage in dialogue that will establish a consensus before the next General Election, so that both Houses can act upon an agreed reform”.

My noble friend the Leader of the House may be able to respond to that challenge. I was disappointed that the committee did not see fit to take evidence from my noble friend because on a number of occasions in this House he has given a very effective, robust and rigorous analysis of the issue of active membership of this House, which is not fully explored in the Library note, which is otherwise excellent.

The search for consensus is fascinating in politics, not least in this building. My very good friend Dr Chris Ballinger of Exeter College, who has given evidence to a number of committees, said recently that,

“seeking a perfect reform through consensus is a fast track to inertia”.

I suspect that is where we are again today. Already we can see that Dan Byles’s Private Member’s Bill, which

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has now come to our House and is based on the previous Bills introduced in this House by my noble friend Lord Steel of Aikwood, whose Bill was passed by this House, and the noble Baroness, Lady Hayman, is likely to be squeezed out in the current Session by the Conservative high command’s insistence on giving precedence to the European Union (Referendum) Bill. Is there really a chance of making progress in this Session—I doubt it—or the next Session, a few months before a general election? Presumably we can now confidently assume that all three major parties will reiterate their previous and repeated manifesto commitments to full reform of this House. It would presumably be perverse if Labour failed to commit itself to legislation which incorporated all the main features of Jack Straw’s White Paper of July 2008, including specific recommendations on the transitional, steady reduction in the size of the House. I am delighted to see the noble Lord, Lord Hunt of Kings Heath, in his place this afternoon. He was not only a crucial author of those proposals; I think that he was really the godfather—I mean that in the nicest sense, not the Italian sense.

Lord Hunt of Kings Heath (Lab): I just say to the noble Lord that I continue, with him, to seek consensus in this matter.

Lord Tyler: We may both of us lose more hair before that happens; even so, I welcome his support.

There was in both Jack Straw’s White Paper and the Bill a specific, careful, planned reduction in the size of the House. Can we expect those proposals in the Government’s 2012 Bill to see the light of day again? There is a mystery here. I heard just recently in your Lordships’ House a distinguished Member—indeed, a distinguished former Member of the other place—say that the Government’s Bill had been defeated. Not so: that is a myth. It was not defeated. On 10 July 2012, the House of Commons gave the coalition government Bill a record majority at Second Reading of 338 votes. Even more significantly, there was a substantial majority of supporting MPs in all three major parties: 193 to 89 Conservatives; 202 to 26 Labour; and 53 to zero Liberal Democrats.

As we all know, the Labour leadership, understandably perhaps, refused to support a programme Motion—any programme Motion—so the Leader of the House had to announce that no progress could be made. The Prime Minister sought agreement to press on but failed to achieve it. The Bill was pulled, not defeated. Indeed, had Labour not sacrificed its principles and manifesto promises on the altar of temporary expediency, there would now be a reform Act, or one on its way, as a result of the Parliament Act. The problem of the long-term size of the House would have been solved, but by the votes of our fellow citizens rather than by the contrived patronage or blackballing of party bosses.

We can all speculate about the outcome of the next general election in May 2015. Maybe there will be a dramatic swing to the right. Maybe it will end up with a coalition between UKIP and the Conservatives, but I think that that is unlikely. It therefore seems to me that in May 2015, which is not that far ahead, the

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noble Lord, Lord Hunt and I may well see a consensus in the other place that we should make progress on a Bill with that considerable support. This problem, so well identified by my noble friend Lord Norton of Louth, may therefore be on its way to a solution, not because of what the parties say but because of what the people say.

Winston Churchill was once a great Liberal—some people think that he lost his way later on in life—and at one point he said, “Let’s trust the people”. I think that that would be my position.

3.56 pm

Lord Kakkar (CB): My Lords, I, too, congratulate the noble Lord, Lord Norton of Louth, on having secured this important debate. In so doing, I declare my own interest as chair of the House of Lords Appointments Commission. The noble Lord, Lord Norton, raises an important issue which has implications for the practical discharge of the work of your Lordships’ House, as he rightly pointed out in his excellent introduction to the debate. It also has an important impact on the external perception of your Lordships’ House and therefore more broadly on the regard and standing of Parliament.

It is therefore vital that we look at the size of your Lordships’ House in the context of what the ongoing role of a second Chamber might be in the 21st century, in a bicameral Parliament where the primary Chamber enjoys the democratic mandate and has reserved for itself specific powers with regard to supply and confidence; and where there is a convention that your Lordships’ House does not frustrate the will of the primary Chamber but, rather, plays an important and active role, respecting the democratic mandate of the primary Chamber; in scrutinising and revising legislation, ensuring that our fellow citizens can live under the best possible laws that have been informed by active consideration in your Lordships’ House; by holding the Government to account, applying itself in a rigorous and fastidious fashion, questioning what the Government are doing and how the Executive are discharging themselves; and, of course, stimulating and initiating debates and inquiries which address concerns of national importance.

To discharge those functions, your Lordships’ House has concentrated on work in the Chamber, but also in Grand Committee and a number of Select and ad hoc Committees, currently over 30, populated by noble Lords who bring unique insights and expertise to their work. It is in that context that we need to consider how your Lordships’ House should be populated in the future. A driving principle of membership of this House has been that it brings experience, insight and expertise to much of the work that it does.

That has been an important and distinguishing characteristic of the composition of your Lordships’ House and it helps us to distinguish it from the other place. Therefore, in considering questions of the future size of your Lordships’ House it is important to understand whether at the heart of that particular question your Lordships and those who are in a position to make appointments to the House are fully cognisant of the current composition of the House and, in particular, what expertise exists within it.

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For instance, do we have any clear understanding of the range of expertise that is required in a Chamber of this nature to be able to address issues of complexity in terms of modern legislation? How frequently is the declared expertise brought to bear in addressing in detail—in Committee and in work in the Chamber—the kinds of issues of legislation that your Lordships’ House is faced with, to ensure that the citizens of our country can be certain that they live under the very best laws, which have been thoughtfully considered? How often are we able to refresh that expertise to ensure that we are able to discharge our constitutional responsibilities? How can the House go about identifying the kinds of issues—and therefore the kinds of expertise—that might be required on the horizon to ensure that we can continue to discharge our responsibilities to scrutinise and revise legislation appropriately?

An important example of one of the areas where your Lordships’ House has taken a particular leading role in this Parliament is on the question of the scrutiny of legislation from Europe. I declare a further interest as a member of Sub-Committee B of your Lordships’ European Union Committee. The work of that network of European Union committees is highly regarded. It informs debate in the other place, and of course it informs further consideration among the European institutions and among other member states. How are we to ensure, when considering the size of a future House, that we retain that type of expertise?

Your Lordships’ House has another very important function in this bicameral Parliament. That is to ensure that Parliament, in the broadest sense, is able to reflect the diversity—in age, gender, ethnicity and in geography—that reflects our country as a whole, and which may not always be achieved through the ballot box and our particular electoral system in terms of membership of the other place. It would be a great pity, when considering questions about the size of your Lordships’ House, if those important defining characteristics were lost through the application of arbitrary solutions. That is not to say that the question of size is not an important one, but in addressing that question, your Lordships and others must be sensitive to the fact that your Lordships’ House, as the noble Lord, Lord Norton of Louth, said in his introduction, works well, discharges those important responsibilities, and must be able to do so in the future.

4.03 pm

Lord True (Con): My Lords, it is always a great pleasure to follow the noble Lord, and I agree wholeheartedly with what he said about arbitrary solutions. I thank, as have other noble Lords, my noble friend Lord Norton of Louth for initiating this important debate. However, sometimes, and increasingly, it seems that debates about our own future are becoming like the story of Penelope’s tapestry in Homer’s Odyssey: great labour, ingenious designs, but of it there never comes an end.

That this House should be comfortable with itself is important. But if the belt fits a little tightly at some times and in some places, is that the end of the world? We did not need too many sharp elbows to get to our

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places this afternoon; some looking on will be bemused at the idea that a House so allegedly overcrowded looks so empty. What is so urgent or damaging about this alleged problem that it claims our monthly attention? Surely it cannot be that some, as well as not wanting hereditary peers any more, do not want too many more like ourselves. I express my unqualified welcome to new Members of the House on all sides—I am sure they will enrich our work.

Most of your Lordships have recently rejected a reduction in the size of the other place. The House also set its teeth, as my noble friend Lord Tyler said, against the solution of election of a set number of Peers to stock the political Benches of this House. That would be the easiest way to set a cap on the political sides of the House, while preserving through appointment the independent expertise of the Cross-Benchers.

This House is still one of the cheapest in the world. Why are we agonising so much about cost? It continues to be a House of expertise, unpaid and part-time. Few here want to change that. Such a House inevitably needs a larger pool of Members from which to draw to do its work. There are high hopes of proposals for permanent retirement, and I welcome them, although I could not support a payment to leave. Voluntary retirement would be preferable to compulsory ejection of Members who reach a certain age—and I agree fully with the comments of my noble friend in the report of the Commons Select Committee on this issue.

In a country where policy-making and comment on it is ever more dominated by people under 45, while the growing majority of the electorate is—and will continue to be for the foreseeable future—over 45, it seems highly eccentric to seek out one of the few parts of our constitution where the voices of older, more experienced people are regularly heard and to force them out. It is often a little more experience and a much longer view we need in the counsels of the state, not less. So I am against age limits.

The arguments for a formal cap on the size of an appointed House raged three centuries ago over the Peerage Bill in 1719, and were skewered very effectively by Robert Walpole in debates on that legislation, not only by frightening his fellow MPs that, if they voted to limit the size of the House of Lords, a pleasant retirement home would be denied them, but on the more serious basis that a firmly capped unelected House could not be overborne by new creations if it brought a government to deadlock. Creation to secure the Crown’s business was needed or threatened in 1711, 1832 and 1911, and some of us are old enough to remember hearing Tony Benn call for 1,000 Peers to carry Labour’s programme of 1976. Even with the cumbersome blunderbuss of the Parliament Act, an unelected House can still disrupt business, as we all recently experienced. There needs to be an ability to break a cap, and defining that would be difficult.

Nor is a moratorium reasonable for obvious reasons of renewal and political balance. Roughly half the existing life peerages were recommended under the Blair Governments of 1997 to 2007. It is a little chary, in this light, to chunter that my right honourable

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friend the Prime Minister is overegging it. Mr Blair allowed only 49 Conservative Peers in his first two Governments; my right honourable friend has allowed 44 additions to a Labour Party that was already the largest in the House in one as yet uncompleted term. In his first three years, Mr Blair appointed Labour Peers at a rate 50% faster than that allowed himself by Mr Cameron in appointing Conservative Peers. Mr Cameron has, by contrast, been actually restrained.

We have been through a stage of exceptional creation—a missile-building period—and the House will take time to get over the hump of those massive creations. But I think that it can return progressively, as I hope that it will, to the lower rates of creation that were standard in the past. There may well need to be a steady decommissioning of the stacks of Back-Bench ICBMs, waiting in the Bishops’ Bar to come into Divisions—but with patience and a will, it can be done. Even in the quarter century from 1905 to 1929, which included the Lloyd George era, the average was 11 creations a year. In 1929 to 1955, with many changes of Government, it was 12. Those figures are less than the number of those leaving the House in every year so far this century—and, with an average age of 70, sadly, the number of leavers is likely to be steady in the years ahead.

We should be far more relaxed on this score, stop constantly fussing about the matter and turn our attention to other affairs of state, although I think that ingenious heads might come together in the usual channels to consider the active House and the escalating size of Divisions, the main reason why many are called to the House day by day. Pairing would be extremely difficult in this House, partly because of the coalition but also because of the existence of Cross-Benchers. However, a search for a START treaty in the usual channels might bear fruit, if searched for. If some of the Peers who do not intend to take part in proceedings could be slipped from the duty to vote, the House could keep, and draw on, the pool of their wisdom while not flooding the byways of the House for the more humdrum Divisions that punctuate our lives. That task would be difficult but I hope that the Front Benches might rise to that challenge and prefer it to mechanistic and legislative solutions.

4.10 pm

The Lord Bishop of Leicester: My Lords, this House owes a debt to the noble Lord, Lord Norton, for his assiduous work towards creating a more effective second Chamber. As usual, he has today rehearsed very clearly and effectively the case for reducing its size.

It seems to me that the challenge is clear. In spite of the speech of the noble Lord, Lord True, there is surely overwhelming agreement with the fundamental proposition that this House is too large. The question, therefore, is to find ways not just of agreeing with the principle of creating a smaller House, but to give effect to it. In that sense, this debate is part of a wider discussion upon which hangs the reputation and credibility of the political class.

A noble and right reverend former Bishop of Durham said about Lords reform a few years ago:

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“I would rather be a Member of an upper House which works effectively as a revising and scrutinising Chamber than retain membership of one which is not fit for purpose”.

For the avoidance of doubt, I do not quote this in order to offer up this Bench for abolition but rather to make a different point about what will bring about change; namely, that the overriding issue for examination needs to be what makes for the good governance of our country. On that point hang successive submissions from the Church of England in the past 10 years, and I believe it is on this basis that the debate should proceed.

This Bench supports the thrust of the proposals of the noble Lord, Lord Norton. We passionately believe that the function and, therefore, the character and composition of this House need to be different from that of the other place. To achieve that, any reduction in size needs to maintain true and impartial accountability and to represent the breadth and diversity of civil society and intellectual life. Therefore, any reduction in numbers will need to have regard to the proportion of independent Members as the pressure for political appointees continues to mount.

We will see nothing but serious dysfunction if these principles are not given effect soon. The coalition agreement appears to enshrine the doctrine that membership of your Lordships’ House should reflect the proportions of votes cast at the 2010 election. Unless there is change, and if this doctrine continues to obtain, we all know that the consequence will rapidly become unmanageable. If the suspicion is to be allayed that the necessary limited reforms of this House are being frustrated in order to create the conditions for more radical reform, surely we need to proceed to action soon. This House is not, and never has been, a Chamber embodying the doctrine of proportional representation—our character, purpose and raison d’être lie elsewhere.

I speak from a Bench whose Members are required to accept the disciplines of a cap on numbers and a final retirement age. Certainly, those limitations have not prevented this Bench playing a full part in the range of policies and laws which come under scrutiny in this House. Indeed, a process of appointment which is time-limited and number-limited enables Members of this Bench to reflect our regional involvement and speak not out of self or party interest but rather reflect the truth that profound moral and ethical questions surround a great deal of the work of your Lordships’ House. From this experience we have consistently argued in favour of measures to allow for the expulsion, retirement and suspension of Members of a reformed House of Lords, believing those measures to be the interests of this House and of Parliament more widely.

However, we need to be open also to reform on this Bench. We have indicated in evidence to the Select Committee on the Clegg Bill that we would be willing to work with government to find ways in which a small Bench of Lords spiritual in a proportionally reduced House could continue to play its full part in its proceedings and offer rather more than is presently possible. More immediately, we have begun to explore the possibility of modification to the Bishoprics Act, which governs the succession of Lords spiritual after a vacancy, in order to make it possible for women who may be ordained as bishops in the next few years to be fast-tracked

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to this Bench. I am glad to say that the Prime Minister was able to give an encouraging response to the Second Church Estates Commissioner when asked about this recently at Prime Minister’s Questions.

Many of the issues raised by this debate were extensively explored by the Select Committee of both Houses, of which I was a member and which gave pre-legislative scrutiny to the Deputy Prime Minister’s reform Bill two years ago. I cannot remember a single witness to that committee, or a single member of it, arguing that the present size of this House is optimal. What we do here is of vital importance to the nation. We surely cannot tolerate increasing and inevitable dysfunctionality. My hope is that this debate will help us to define some practical proposals around which it will become possible for all of us to gather, and soon.

4.16 pm

Lord Maclennan of Rogart (LD): My Lords, I express my appreciation to the noble Lord, Lord Norton, for introducing this debate—and for doing so in a thoughtful way, as is his wont.

I must say, however, that the real question that has to be asked about this House is: does it do its job properly and with effectiveness? The answer has to be that it does. That is increasingly clear. Meg Russell, probably the greatest scholar on this House, has indicated the impact that we have on the legislative process. That impact has grown since the reform of 1999, when there was a self-denying ordinance to some extent. The Select Committees of this House also give great scope, perception and insight to others who are contemplating legislation in these fields. As a member of the Select Committee on the European Union and its sub-committee on external affairs, I am conscious of how well regarded the work of the committee is, not just in this country but in the other member countries of the European Union.

The main problem that we face, which has been raised by the noble Lord, Lord Norton, comes from the lack of understanding of the role played by this House, which is largely due to the press and media—particularly the press, which used to quote in columns what was said in the debates in the House. In the broadsheets, that gave some weight to our deliberations. I regret that we now suffer mostly from comment that is to some extent derisory and does not convey the practical reformative work that is being done here.

There are modest changes that could be made and they have been largely encapsulated in the Bill produced by the noble Baroness, Lady Hayman: the changes providing for permanent retiral, ending by-elections of hereditary Peers’ successors, enabling those who do not attend a full Session of Parliament to come back, and excluding serious criminal offenders. Those all seem commonsensical. The probability is that they would not have a massive effect on the Members of this House but they would meet the observations of those who want to see some change. I hope that they might be considered in legislation before the end of this Parliament.

However, I think it would be wise if we looked at the wider functions of this House and its representative nature in a much broader context. We are, after all,

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facing the possibility of a restructuring of the governance of the United Kingdom. We face the possibility of Scotland becoming independent, and it seems to me that we are tinkering at the margins if we become obsessed about this House before we have understood how the nations of the United Kingdom are to be governed. If there are changes, they might have to be reflected in the structure of the second Chamber.

Consequently, I repeat what I indicated not very long ago in a debate in this House: I think that it would be wise to establish a convention on the future governance of the United Kingdom. That should not be done in a hurry; it should be deliberated upon and attract input from the citizenry of this country so that they can sense that what is being done is based on a consensual decision with the backing of the majority. I do not believe that including reform of the House of Lords in a manifesto will necessarily give that kind of legitimacy. Manifestos list dozens of policies, and what moves people’s minds in elections is not necessarily the small print of manifestos. The structure of our governance is so important that it needs to be considered not in an election period of three, four or five weeks but in a wider context involving expertise and the general will of the British people.

I hope that before the Scottish independence referendum an announcement might be made that such a convention will be established; otherwise, as I have said before, the Scots might think that there are only two choices—independence or the status quo. However, it would also have a much wider impact on the thinking about the effectiveness of our governance.

4.25 pm

Baroness Hayman (CB): My Lords, I join in congratulating the noble Lord, Lord Norton of Louth, on introducing this debate with his usual clarity and intellectual analysis, and on his passionate commitment to this House and the way in which it does its job. It is a commitment shared by all those who have spoken, most notably the noble Lord, Lord Maclennan, who enjoined us to look at the quality of the work that we do rather than having an obsession with size.

Size does matter, actually. Political balance matters, and the balance between the political appointees and the independent appointees matters. It matters because the function of a second Chamber, particularly one like ours that is not elected directly, is to ask the directly elected Chamber where power resides to think again. That is a very important responsibility of this House, and it is important that the House can discharge that responsibility, not least when, as we know because of timetabling in another place, much legislation comes to this House without having been scrutinised.

The role of this House is not to overturn or to have the final say, but it is very important that it should be possible for a Government to be defeated in this House so that the other place can have second thoughts—or sometimes first thoughts, because it has not looked at the legislation at all. It is imperative to safeguard that. The quality of the work that we do is not essentially posited on the size of the House. We all agree that we probably need a larger House than we might think at first glance, because of the part-time

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nature and the quality that is added to our work by the fact that people have interaction with the outside world.

When I joined the House in the Session 1996-97, the absolute membership was 1,204 and the daily average attendance was 381. In the previous Session, 2012-13, the absolute membership of the House was 810 and the average daily attendance was 484. Where was the decision taken that we needed a 25% increase in average attendance to improve the quality of the work that we were doing? This has happened. It has happened because of some of the political dimensions that the noble Lord, Lord True, spoke of, and without an analysis of the need for it to happen.

It is really important to stop, take a breath and think about that. I have a question for the Leader of the House. I asked it twice in Written Questions of his predecessor, and never got what I would call a satisfactory Answer. I asked to which of the political parties that fought the previous general election the pledge that the House of Lords should reflect the votes cast in that election applied. It is quite an important question.

What has been done is that the membership of the House has been changed in line with the two major parties that form the coalition, not by taking a totally proportional view and bringing in minor parties. I do not particularly mind not having the votes cast for the BNP or indeed UKIP at the previous general election represented in membership and appointments to this House, but it is very important that we understand the terms of engagement going forward into the next general election. We need consensus and convention on this. The famous definition of consensus—that it is what the House of Commons votes for—does not do it in this respect. We will not get unanimity on many of these issues, but it is important that they are addressed.

I welcome the Bill that Dan Byles introduced into another place. It is true that not many criminals will be barred, but it brings disrepute to this House if any people who have committed serious criminal offences can return as Members. It would not make a huge difference to numbers if non-attenders were not allowed to attend. However, some of us with long political histories know that there is danger in having a group of people who may not participate all the time but who have the right and the power to participate in moments of great political crisis. If I have not been clear enough in my message about that, I will say only three words—the poll tax. So it is important that the membership of this House reflects those who are active and participatory.

I have no desire to introduce mechanistic or arbitrary solutions to this issue. I do not believe in a moratorium on new Members because I also welcome what the new Members have brought to this House and continue to bring. However, we cannot just continue to expand. I sometimes said when I had the honour of representing the House and acting as its ambassador that I sometimes thought the Government believed that the Chamber of the House of Lords was the TARDIS—it got bigger and bigger inside so that it could accommodate whoever came in. It is not quite like that. This is not

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only about having enough seats but about having time to speak in debates—a one-minute limit on speeches—and a whole range of issues.

I hope that the Leader of the House, with support from the Government—I am not as pessimistic as the noble Lord, Lord Tyler, on this—when Dan Byles’s Bill becomes law, will undertake to have discussions with leaders of the other parties about retirement provisions and how we could make progress on reducing the size of the House in a sensible, constructive way that will not damage our performance. However much we know that 800 is not a bad thing at the moment, the outside world finds it difficult to understand those kinds of numbers and we should do something to reduce them.

4.33 pm

The Earl of Caithness (Con): My Lords, a Session of Parliament without a regular debate about ourselves would not be the same. We have become so used to having such debates over the past 15 years, or even longer, and our regular navel gazing has become part of each Session. I therefore thank my noble friend Lord Norton of Louth for introducing the debate.

The noble Lord, Lord Kakkar, hit the nail on the head when he said, “What is the purpose of a second Chamber?”. Once you have the role of second Chamber, you can then decide how that is best fulfilled, and on its numbers. However, deciding on a role for the second Chamber depends on the role of the first Chamber—in our case, the House of Commons. Despite joining Europe and many powers going to Europe, both Houses have evolved to the state they are now in, and perhaps we ought to stand back and say what we really want from them.

It was interesting and a matter of concern to read that, despite the low level of scrutiny of legislation in another place, the number of amendments tabled in your Lordships’ House, and the number agreed, have gone down. The statistics on this from the Library are interesting. In the period 2005-06 to 2010, the number of amendments tabled in this House dropped from around 10,000 to about 2,000. We pat ourselves on the back and say that we are doing a good job, but I do not know whether we are. When I cast my mind back 44 years to when I first came here to the job the House was doing then, and a Conservative or whatever Government of the day were defeated, just as today’s Government are defeated, I wonder whether we are doing a better job than our predecessors. There are more people and we are doing more work, but is it better? I am not in a position to answer.

My noble friend Lord Maclennan made a good point when he mentioned the work of the European Union Committee sub-committees. When he said that, I immediately thought of two reports, one of which was on the common fisheries policy. That report had a marked effect on the thinking of the Commission in Brussels, because most of the ideas set out in it were taken up and brought forward as proposals in EC legislation. The other report is one that I have been involved with: the report of Sub-Committee A on the financial transaction tax. It made our Government think again and led to them submitting a legal objection

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to the Commission. Those are two instances where our reports have had a marked effect, but I wonder whether in the generality, despite some extremely good work, our reports are getting the attention they deserve.

On the question of our work, another statistic that has both surprised and alarmed me is the number of Written Questions that we are putting down. The rate is on an almost perpendicular upward trend at the moment. Each Written Question costs a lot of money to answer and takes up a lot of civil servants’ time. Why has there been this sudden trend? The population of the House has not grown markedly over the past couple of years, and yet the number of Written Questions has, and that is a potential cause for concern.

My noble friend Lord True mentioned the age profile, and of course he is absolutely right. I agree entirely that it is very good that an older House up here complements the young enthusiasm of the Commons, but a closer look at the statistics shows that we now have only 31 Members under the age of 50. I think that some of us regret the passing of the hereditary Peers in 1999, because at least a lot of young people were brought in, which added to the balance of the House. At the same time, 24 Members of the House are over the age of 90, and 13 of them are active. The great majority of the House, something like 66%, is aged between 60 and 80, and the average age is around 70. I cannot think of any job or organisation in the world that I could have been a member of for 44 years and still be under the average age, and I am extremely grateful that I am still here and able to participate. But perhaps it is something that we ought to contemplate.

As long as we have the Prime Minister’s prerogative to create peerages, we are never going to solve the problem of numbers. I do not think that past Prime Ministers, such as Prime Minister Blair and Prime Minister Brown, did this House any good, and in fact I am not certain that my Prime Minister and the Leader of the Liberal Democrat party and Deputy Prime Minister, Mr Clegg, have done us any good with the number of people they have appointed. That has changed the House quite markedly. The noble Baroness, Lady Hayman, said that the House ought to be politically balanced. To an extent that may be so, but if every five years there is a marked swing in another place, a whole lot of new Peers will have to be created here—

Baroness Hayman: I apologise for taking up time in a timed debate, but I did not intend to say that I thought that the House should be politically balanced. I said that I thought there should be some agreement on the parameters of political balance, and on the balance between political appointees and non-political appointees.

The Earl of Caithness: My Lords, I am grateful to the noble Baroness for that clarification. However, if one follows the argument that one needs political balance, if there is a dramatic swing in 2015, more Peers will have to be created to reflect that balance. If there is a sudden drop in support for the Labour Party—which I fully anticipate—I am sure that some Labour Peers would want to resign from here in order to get that balance, rather than see the creation of new Conservative Peers.

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The suspension of the succession of hereditary Peers has been raised, but that would not be effective. Any Government—particularly a Conservative Government, because our party has the most hereditary Peers—would just appoint life Peers, most of whom would be older than the current possible successors to those hereditaries, so that would not be very good.

I have a couple of suggestions for my noble friend on the Front Bench. Why not create the equivalent of the Irish peerage? We could offer people a peerage, but no right to sit in this House. That would be a good thing. Then there are the ex-MPs, who make up 22.7% of this House. I welcome them. Most are Labour, and have kept this House even though they were all part of a party that wanted to abolish it. However, perhaps there ought to be a five-year moratorium after someone has been an MP before they are offered an active peerage in this House.

4.41 pm

Lord Dykes (LD): My Lords, I am sure noble Lords are all grateful for the explanation of the age paradox from the noble Earl, Lord Caithness. I hope I am correct in saying that the main speaker in the debate so far who has not been worried about size in the future was the noble Lord, Lord True, whose points I can understand. The general sense of the debate so far, as far as I can tell, is that size is a problem and that something needs to be done.

The Bill from Dan Byles MP in another place has 11 very able and senior members of all the parties acting as sponsors, including some of course who are also in favour of an elected House of Lords. When it comes to this House, it will have a very tight timetable for us as well, as it will follow the European Union (Referendum) Bill, with its equally stringent timetable. I hope that there will be ample time for discussion. The Dan Byles Bill is really the intellectual and psychological follower of the four earlier Steel Bills—which were, incidentally, ignored by two Governments, not just by one. If we add Peers who do not attend during a Session and do not apply for a leave of absence under the Standing Orders, ceasing membership would be an important part of any future elements.

All the way through the efforts that I have detected to make rational progress on the successive Steel Bills, as I will call them, the hope was entertained that the Government of the day would pick up the Bill and make it central government business. There is still an opportunity for that and I think more and more Peers would support that aspiration. Although the three or four measures for reducing individual membership seem to be very modest and at the margin, the practical effect would be quite rapid over time. It is crazy that we contemplate the fact that this Chamber is literally too large with some calmness at the moment—although I hope not too much. It is around the size of the entire European Parliament, which represents 28 member states. The latest text of the Bill, which began its Second Reading before June 2010, in February 2009, added the helpful provision of non-attendance producing disqualification.

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Whatever the fate of the fundamentalist parts of these ideas—mostly having elected Members in the future—in the Joint Committee’s plans published at the end of April 2012, the stage has now been decisively and helpfully set to bring about a reduction in numbers if this legislation becomes government business. To my mind, the Commons would never have accepted the election plan. Although there was a huge majority on Second Reading of the fundamental reform Bill, ironically it began to unravel almost immediately after that. Many members of the leading coalition party refused to ordain new laws which they feared would inevitably lead to the upper House challenging their unique powers and legislative primacy. Eventually, beyond the inaugural Session of a new elected House of Lords, they would presumably want to turn themselves into an ambitious senate in no time at all. There were articles about this saying that there would eventually be senators in the House of Lords demanding office facilities and staff expenses of £1 million per office to deal with all the correspondence and work that would now arise as a result of being elected. The House will indeed be large and expensive if attendance claims rise, even if, as we hope, they rise because of expanding membership rather than individual claims as the number of days goes down.

This has been a long, drawn-out, painful episode of various bits and pieces. The provisions of the Constitutional Reform and Governance Bill of July 2009 that covered the suspension, resignation and expulsion of Members were taken out of the text in the final version; hence the reintroduction pledge by my noble friend Lord Steel. He repeated his view then that the Bill did not deal with future composition. The Bill also provided for the end of the hereditary Peers’ by-elections, which were described as farcical by some, but that section was later taken out.

All these matters lead to the fact that a good number of non-Tory Peers have always agreed with Tory traditionalists in both Houses that an elected senatorial peerage would be bound to challenge the superior powers of the other place. In the mean time, the size problem has acquired the ominous characteristic of an almost grotesque situation, with Parliament being unable to make rational progress on these matters, in a perverse and ridiculous setting, which gives rise to very great public dismay. The most recent intake of nominated Peers, we remember, had to be announced deliberately after the House rose for the summer holidays. There was an outcry in the press and it is very difficult for the public to accept the seeming illogicality and absurdity of yet another large increase.

It gives me no pleasure to say these things about the financial side of it but the reality that we now face is that the incidence and weight of the Tory party’s very large tribe of donor Peers gives much offence to the public—I am sorry to say that but I have to—especially among those who happen to believe that the House of Lords does a pretty good job as a revising and improving Chamber, which I feel is definitely the case. Of course, all parties have donors so I will avoid smugness. I will only mention in passing that we Liberal Democrats have donors only from time to time; they do not come along in serried ranks. Labour, too, has a good crop nowadays, which only underlines one of the great

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weaknesses in British politics, which is the failure in recent times, mainly in the Commons, to reach consensus on vital factors affecting Parliament as a whole.

We should think of the damage that has been done by the terrible imbroglio over the MPs’ expenses saga and our own expenses saga, when the Times took the lead because it was annoyed that the Telegraph had the priority with the previous articles, and the fact that there was not any consensus between the party leaders. I understand the pressures but the competition between political parties is now so excessive that no party can admit that it believes in anything that the other parties are suggesting—apart from the coalition parties, of course. The pressure is very strong.

We should work to persuade people in the Commons to listen to this and to revive the suggestion of £5,000 maximum personal donations with, if necessary, further restrained sums of public money for essential party infrastructure spending. The opposition leader’s offer to break the trade union membership nexus is a concrete, positive step, which might help to get the parties around the table soon, but this has been going on for an awfully long time and it is about time they reached agreement on this matter.

The only time when an independent recommendation for a salary increase for MPs was accepted was when Edward Heath was Prime Minister in 1972. All the others were blocked, once again because of the lack of consensus. This is doing damage because these are parliamentary matters rather than matters of different policies and competition between parties on policy. If we can separate those two things out and see how the Dan Byles text makes progress in our House and goes back to the Commons in unamended or amended form, we can begin to see the beginnings of common sense in size reduction. I hope that the Leader of the House will be able to give us some guidance today.

4.49 pm

Lord Cormack (Con): My Lords, it is about 12 years since my noble friend Lord Norton and I formed a group to which many of your Lordships come quite often: the Campaign for an Effective Second Chamber. Over the years, my noble friend has with assiduity acted as our convenor, and I have chaired the sessions, and we have had some fascinating discussions. We are all grateful to my noble friend for the clear, forensic way in which he introduced the debate today.

Our group was formed because we believed in a second Chamber that was appointed and not elected and therefore did not challenge the unambiguous democratic mandate of another place. I still strongly believe that there is a real place for such a second Chamber and I believe that we have demonstrated that in recent years. We all know those wonderful lines from “Iolanthe”, looking back to previous eras:

“The House of Peers, throughout the war

Did nothing in particular And did it very well”.

Well, we have over the past 12 years and more done quite a lot of particular things and done them very well. We live in a time, as has already been referred to, where much legislation comes to us not having been discussed at all in another place. The skill with which

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the experts in this place analyse and scrutinise is of incalculable importance to the people of this country.

That is why it is important that the reputation of this House should stand high. I believe that it does. The right reverend Prelate the Bishop of Leicester made an interesting speech, but he referred to our being dysfunctional in some respects. I do not think that we are. There are of course dangers, and my noble friend Lord Norton of Louth and the noble Baroness, Lady Hayman, and others have been right to refer to them, but my noble friend Lord True was also right to refer us to an era when only 12 or 15 Peers were appointed each year. The answer to the problem of size—and it is a problem—lies in three things. The first is an abandonment of any idea of a ratio to the last general election; the second is a degree of self-restraint; and the third is underlining in the appointments that are made the fact that this is indeed a House of expertise.

I welcome as others have done those who have recently joined our ranks. It would be invidious for me to pick out a whole list of names, but I give just four to your Lordships to illustrate the importance of bringing in fresh blood: on these Benches, the noble Baroness, Lady Neville-Rolfe, who has remarkable experience in commerce; my noble friend Lord Bamford, who has achieved so much in industry; and from the Cross Benches, the noble Baroness, Lady Lane-Fox, who is already making a real mark in this House and who knows more about the technological revolution than most of the rest of us put together. And then one thinks of the former Governor of the Bank of England, the noble Lord, Lord King, to whom I was speaking yesterday. The appointment of people such as this enriches this Chamber and therefore enriches the counsels of the nation. It is very important that we should continue to do that.

But there must be an abandonment of the ratio idea and there must be a paring-down of the number of Peers who are appointed each year. As someone earlier pointed out, sadly, we lose 12 or 15 Members each year on average. If the number of annual appointments was of that order, we would certainly not be inflating the size of the House. My noble friend Lord Norton in his very admirable speech referred, as did the noble Baroness, Lady Hayman, to the average attendance now being 484 per day, but we must bear in mind that they are not the same 484 people day after day. If we are to draw upon a wide range of experience and deep reservoir of talent, we must not be over-worried about numbers, although we are right to be concerned. Concern is something we all share. We are concerned about the reputation of this House.

I very much hope that Mr Dan Byles’s Bill will complete its passage through another place, come to this House and be given an expeditious passage. In effect, it was passed here last year. It can then get on to the statute book with the Government’s support and it is right that it should. But I will just make one specific request and one suggestion to my noble friend the Leader of the House, fully appreciating that he cannot comment in detail on the first point that I will put to him. When people are being appointed to this House, let us bear in mind the need for expertise. Let us ask

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ourselves the question “Do they also serve who only come to vote?”. To appoint people to this House who play really no part in our proceedings and merely vote in the Lobbies is not serving the nation or Parliament as it should.

Apart from that comment, I put two suggestions to my noble friend the Leader of the House. The noble Baroness, Lady Hayman, was an admirable Lord Speaker of this House. In her just as admirable speech, she suggested that party leaders should try to get together. I agree with that but something else should be done. I say this with a degree of hesitation and reservation because I do not want to see a proliferation of committees, but in the last year of this Parliament there is a real case for establishing a Select Committee of this House to consider the sort of suggestions and comments that have been made this afternoon and to try to draw up what might be a blueprint for the House of Lords as we move through the 21st century.

There will always be a need for a place like this. There will always be a need for men and women of expertise and experience to debate the laws of the land. There will always be a need for those set-piece debates—we do not have enough of them—such as we had on Syria where the enormous and varied experience can bring to the counsels of the nation a true balance and some real worth.

4.57 pm

Lord Hunt of Kings Heath: My Lords, I, too, welcome the debate and particularly thank the noble Lord, Lord Norton. We are indeed fortunate in having such a constitutional expert as a Member of your Lordships’ House. As the noble Lord, Lord Cormack, said, while I do not always agree with all the emanations from the group that the noble Lord, Lord Cormack, chairs, there is no doubt that it has added very much to our knowledge and enabled us to debate some of the very important issues that we must when it comes to reform of your Lordships’ House.

I tend to agree with the key point made at the beginning by the noble Lord, Lord Norton, that your Lordships’ House has grown, is growing and ought to be reduced. I think I share the following point with a number of noble Lords: while the size of the House is important, much more crucial is the question as to whether it is effective in acting as a check on the Executive and as a revising Chamber, and in adding to the effectiveness more generally of parliamentary scrutiny.

As ever in your Lordships’ debates, most noble Lords who asked that question have tended to come to a view in the affirmative. Of course, we all understand the strengths of your Lordships’ House but we ought to examine its effectiveness in the context of the impact of coalition government. We have a situation where the coalition parties in your Lordships’ House have a political majority over the opposition. I would argue that that threatens the effectiveness of the House. I know that the noble Lord, Lord Hill, when he comes to wind up will refer to the defeats that his Government have suffered here but the rate of defeat is much less compared to the period of 1997 to 2010. I know that it is a little early to draw conclusions from the impact of the latest appointments to your Lordships’ House but,

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certainly from this side of the House, it would appear that the Government are able to win votes which in normal terms they would not have done. The problem with that is that if a Government are no longer able to be defeated in your Lordships’ House on a regular basis, this can no longer call itself a revising Chamber. We need to consider that very carefully.

I also agree with the noble Lord, Lord Maclennan, on substantive reform in the sense that we surely need to see the outcome of the referendum in Scotland and any constitutional fallout from it. Substantive reform of your Lordships’ House cannot be considered in isolation from either wider constitutional issues or the impact on the primacy of the Commons. At the risk of tempting the noble Lord, Lord Tyler, to get up and remind me of my past sins, in the joint working group chaired by my right honourable friend Jack Straw—the noble Lord is right that I served on that, with its cross-party talks—there was a failure, which the Deputy Prime Minister repeated, even to contemplate how an elected second Chamber fits with a House of Commons when there is a pretty consensual view that we wish to retain its primacy. That failure, in my view, led to the failure of Mr Clegg’s Bill. In the end, that was a failure; it was quite clear from what was happening in the other place that it did not stand an earthly chance of getting through.

The question of size was discussed by the committee of the noble Lord, Lord Hunt, on which I had the honour to sit. It came up with a proposal to allow Members of your Lordships’ House to retire and it has been enormously successful, as noble Lords will know. I think we have not quite yet reached double figures but one is ever hopeful. The Hunt committee said that the problem with an ever increasing size is that it risks the reputation of the House, that it probably makes conducting business more difficult and that the effect of the additional Members on the resources of the House and its ability to do its job would also be adversely affected.

We are right to ask the noble Lord, Lord Hill, the Leader of the House, what the Government’s intention is with regard to any further appointments between now and the general election. Are the Government intent on implementing what was in the coalition agreement or have they stood back from that commitment? Does the Leader of the House accept that the general view of Members of your Lordships’ House is that there should be very few appointments between now and the general election? Does he agree with the noble Lord, Lord Norton, that there ought to be a cap on membership, and will he institute cross-party discussions as suggested by the noble Lord, Lord Tyler? The noble Lord, Lord Cormack, suggested that there might be a Select Committee of your Lordships’ House and there is an argument in favour of the political parties and the Cross-Benchers discussing these matters in a small group or in a more formal Select Committee. It would surely be useful, in the run-up to the election, for there to be some discussions across the House.

Does the noble Lord, Lord Hill, agree that if the size of the House is limited, in the end there have to be questions as to how to achieve a party balance? It is

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not possible to have a cap without some general agreement on how the parties should be balanced in your Lordships’ House. That would also need to reflect on Cross-Bencher representation and on the number of Bishops who should remain in your Lordships’ House in the event of such agreement.

Does the noble Lord, Lord Hill, take the point raised by the right reverend Prelate the Bishop of Leicester that if we see women bishops, as many of us devoutly hope, will there be a way of accelerating them to membership of your Lordships’ House? I am not sure whether this is a question of law or of practice, but no doubt the noble Lord will be able to inform us of that.

My next point is one that was raised by the noble Lord, Lord Norton: what advice would the noble Lord, Lord Hill, give to an incoming Government in 2015 faced with a political majority against it? How many noble Lords does he think an incoming Government ought to appoint if we are to keep to the mantra that he has stuck to over the past three and a half years? I must say that I rather warmed to the reference by the noble Lord, Lord True, to Tony Benn’s 1,000 Labour Peers; that has a certain ring to it.

I want to ask the noble Lord, Lord Hill, about time and the question of whether a fair wind will be given to the noble Baroness, Lady Hayman, on the assumption that she takes through Mr Dan Byles’s Bill. I was rather shocked by the suggestion from the noble Lord, Lord Tyler, that the time taken for the European Union (Referendum) Bill might crowd out Mr Byles’s Bill. I do not think that that would be the will of the House; I think that the will of the House would be that the noble Baroness should be given a fair wind.

Lastly, I want to ask the noble Lord, Lord Hill, about finance. I have been riveted by the debate on the recommendations of IPSA regarding MPs’ pay, but I noted the Prime Minister’s comment that he wished to see the cost of politics reduced. Although I accept that the costs of your Lordships’ House are rather modest compared with the other place, I wondered whether the noble Lord thinks that the Prime Minister making all these appointments is consistent with wishing to reduce the actual amount that our politics cost us.

5.07 pm

The Chancellor of the Duchy of Lancaster (Lord Hill of Oareford) (Con): My Lords, earlier today this House was debating death, and I know that the noble Baroness, Lady Hayman, has spoken in both debates. In his choice of debate, my noble friend Lord Norton of Louth has brought us forward a few years chronologically, perhaps to the transit lounge from the departure lounge.

This has been a good debate and I know that we are grateful to my noble friend for giving us the opportunity to raise some extremely important issues. As always, I am reminded of how much noble Lords know, and how well they appear to know every twist and turn of the history of the composition of this House.

I start with a point that I do not believe is contentious—one that my noble friend Lord Maclennan and others made—which is that we perform a vital role and that we do so very well. I start with that point

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because sometimes, when we discuss our internal matters, we can be in danger of losing that bigger picture. I believe that our scrutiny of primary legislation is as thorough and as expert as ever; I agree very much with my noble friend Lord Cormack on that. Having had the dubious pleasure of taking legislation through your Lordships’ House, I can speak from experience about the rigour of that scrutiny. We may be polite but we are relentless.

The contrast between scrutiny in this House and scrutiny down the other end is remarkable, as a number of noble Lords have said, and I see no sign of any diminution in our performance of that most fundamental role. I agree with the noble Baroness, Lady Hayman, on the importance of being able to defeat the Government—a point made also by the noble Lord, Lord Hunt of Kings Heath. That is what we have in this House. However, we need the addition of new expertise and new vigour from time to time to help us to carry out that role of scrutiny.

Unlike in the other place, all Members in this House can take part in all stages of legislation. All noble Lords can table amendments and, because there is no process of selection, they are guaranteed a debate on each of those amendments, should they wish to have one. Less visible, but, I think, of great importance is the work that we undertake on secondary legislation. Our House gives more time than the other place to scrutinising these rather unglamorous yet often highly significant pieces of legislation—and, again, in this House, all Members can participate fully in all stages of that scrutiny.

Through Oral and Written Questions, Questions for Short Debate and longer debates such as this, the House holds the Government to account, as it does through the work of our Select Committees, involving large numbers of your Lordships in detailed investigations of different areas of government policy. In this context, I thought that the important points made by the noble Lord, Lord Kakkar, were very pertinent. I know how much we all welcome his appointment as chairman of the House of Lords Appointment Commission.

I am reminding us of the work that we do not to give us a self-congratulatory pat on the back, although sometimes that is not unknown in your Lordships’ House, but to make the important point that not only has the work of the House not been damaged by increased attendance, it has in many respects continued to improve year on year—and long may that continue.

We have talked about numbers this afternoon, and there has been talk, including by the right reverend Prelate the Bishop of Leicester and my noble friend Lord Dykes, about packing the House and overcrowding. I listened to the figures adduced very carefully, but there are other figures. It is the case that the list of new Peers announced in August was the first political list for three years. I am afraid that I have to disagree strongly with the comments made in that context by my noble friend Lord Dykes. There are only 24 more eligible Members in the four main groups than there were in 2007, and I am not aware that in 2007 people were making the point that there were too many Peers in the House. There have certainly been new Peers

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created since 2010, but around 100 Members have sadly died or taken leave of absence over the same period. I argue that the figures also show that my right honourable friend the Prime Minister has been even-handed in his appointments. For example, 39 Labour Peers were appointed in his first year compared with 47 Conservatives, as my noble friend Lord True reminded us.

I think there has been general acceptance this afternoon that we need to refresh our ranks from time to time, rather than freezing the membership at a particular point in time, so that the expertise and experience on which the House relies for its good name can be kept up to date. In fact, I think the real issue is not so much the absolute number of those entitled to vote—a point that has already been made—which has been more constant over the past five years than many people recognise, but the higher level of attendance.

I accept that average attendance has been increasing—it was about 480 in the previous Session—but that is the figure we should concentrate on, not the figures we sometimes read about which do not relate to our day-to-day experience. I recognise that higher attendance means that the House will sometimes be crowded on popular occasions, but it is important to remember that we should not overstate the problem. There is plenty of space in the Chamber and in Grand Committee during the great majority of our business, particularly legislation, and the same is true of debate—there are some empty spaces here this afternoon.

Members generally have time to speak. There has been some reference today to Members having only one minute to speak. They had an average of nearly six minutes in time-limited QSDs in the previous Session, and more than nine minutes in balloted debates. Even during Oral Questions, which I know, probably more than anyone, is a particularly busy time, we have a wide range of participants. Work done by the Clerk of the Parliaments earlier this year showed that in the first quarter, 288 noble Lords asked one or more supplementary questions during Oral Questions. Because more Members are attending, one of my priorities has been to increase the scope for Back-Bench Members to take part in the work of the House. Perhaps most noticeably, we have almost doubled the amount of time we make available for Back-Bench QSDs, and the results have been dramatic. The only noble Lords yet to be offered time for their QSDs are those who have already had a QSD this Session.

Indeed, the supply of time is sometimes exceeding demand. For example, this Tuesday evening, the House rose at 6.20 pm because the Whips’ Office was unable to find anyone to ask a QSD or put forward a Select Committee report for debate after the Second Reading. We have also introduced a new slot in prime time for a weekly topical QSD, which Back-Benchers had said that they wanted. We supported the creation of additional Select Committees, especially ad hoc committees and post-legislative scrutiny committees, so that more noble Lords would have the opportunity to participate in that important aspect of our work.