Lords Sitting of 1 April 1987

Preamble
The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.
Prayers—Read by the Lord Sandford.

Shipping Registry: Norwegian Proposal
Lord Campbell of Croy: My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they are arranging to discuss with the Norwegian Government the published proposal that an international registry for shipping be established in Oslo this summer.
The Parliamentary Under-Secretary of State, Department of Transport (Lord Brabazon of Tara): My Lords, we are not making any such arrangements. I did, however, informally discuss this proposal when I met the Norwegian Minister of Trade and Shipping in Oslo last November. The main purpose of the second Norwegian registry would be to stem the loss of ships from the Norwegian flag.
Lord Campbell of Croy: My Lords, I am grateful to my noble friend for that reply. Do the Government intend to inquire in friendly discussions into the effects of this project on the rules and standards at present required by Norway for shipping registered in Oslo considering that Norway has a problem of its ships leaving for flags of convenience?
Lord Brabazon of Tara: My Lords, it is essentially an internal Norwegian matter but our officials meet regularly in multilateral fora which discuss such matters. Certainly we shall be discussing that kind of matter with the Norwegians.
Lord Underhill: My Lords, does the Minister appreciate that his reply is extremely disconcerting? The reports that have been published indicate that it is not just a problem for Norwegian shipping; the proposal will attract shipping throughout the world. The hope is to attract associated shipping services away from London to Oslo. That could have a very severe effect upon our associated services. Surely this is a case not merely for discussion with the Norwegian Government but also with the Council of Transport Ministers all of whose countries will be affected. This is a further terrible advance for flags of convenience with lower costs and lower wages for crews.
Lord Brabazon of Tara: My Lords, the final proposals have not yet been published. We do not therefore know exactly what form they will take. As for the Council of Transport Ministers, I am sure that the proposal will be a matter of discussion. Norway, not being within the Common Market, is not a party to that. However, the Norwegians obviously feel that they have a reason to retain their shipping under their own flag, and these proposals are aimed at that.
Lord Mellish: My Lords, can we have an assurance that the Government are concerned that there will be an international register and that they will do all they can to ensure that nations are properly represented by their own flags and not by flags of convenience?
Lord Brabazon of Tara: My Lords, we already have a fairly similar kind of arrangement in the Isle of Man and dependent territories registers which keep ships under the British flag. However, as I say, this is a matter for the Norwegians. There is a limit to the amount that we can interfere with what they wish to do.
Lord Greenway: My Lords, bearing in mind what the noble Lord has just said, will he confirm that what the Norwegians are proposing is precisely what is available to British merchant fleets under the registers of the Isle of Man, Gibraltar and, I believe, the Cayman Islands?
Lord Brabazon of Tara: My Lords, I cannot confirm that it is precisely the same because we do not yet know the final details of what the Norwegians propose. However, I have said that it is very similar to the kind of arrangement we can offer.
Lord Geddes: My Lords, can my noble friend advise the House whether his officials are in communication with the General Council of British Shipping on this subject? If so, what is the reaction from that body?
Lord Brabazon of Tara: My Lords, I am sure that my officials are constantly in touch with the General Council of British Shipping. However, I have not heard its reaction to the proposal by the Norwegians.
Lord Underhill: My Lords, has the Minister seen the report in the Daily Telegraph of the 9th March this year which gives a far more disconcerting account of what the Norwegian Government are planning than the Minister has given? If he has not read the report, will he please do so and consult not only with the General Council of British Shipping but also with the International Maritime Organisation? The effect on British shipping is very severe. If action by the Norwegian Government to deal with their own problem led to the British Government taking the same course, it would, I am certain, be disastrous for the world.
Lord Brabazon of Tara: My Lords, I must admit that I have not seen the report of 9th March. I shall of course look at it now that the noble Lord has proposed it to me. I have said that we can offer a similar kind of arrangement through the Isle of Man and dependent territories registers.
Lord Harmar-Nicholls: My Lords, is it suggested that a report in a newspaper is more authoritative than a statement from the Dispatch Box in Parliament?
Lord Brabazon of Tara: My Lords, I do not know the answer until I have read the report in the newspapers. However, as I have said, we have still not seen the final proposals of the Norwegians. As I have also said, it is very much an internal matter for them. We cannot tell them that they cannot do this.
Lord Greenway: My Lords, is the noble Lord aware that the intention of the Norwegian register at present is to replace many of its experienced Norwegian crew with, I believe, Filippinos? Is there not a safety angle to be considered in this case?
Lord Brabazon of Tara: My Lords, the present requirement of Norway's register is that two-thirds of the crew should be Norwegian. One of the proposals is that the vessels could have all-foreign crews. It would of course be up to the shipping lines to satisfy themselves that they could still operate safely with that change. I do not think the proposal applies to the officers. I think that they will still remain Norwegian.
Lord Mackie of Benshie: My Lords, is the noble Lord aware that the British arrangements in the Isle of Man allow a relaxation of standards?
Lord Brabazon of Tara: My Lords, I do not think that impression could be taken from anything I said this afternoon. It certainly is not the case.

Spectacles: Supply Sources
2.44 p.m.
Lord Rugby: My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what alternative sources of supply of optical requirements are available to members of the public who for reasons of choice and cost do not wish to deal with suppliers operating under the opticians' "closed shop".
The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness 'Trumpington): My Lords, I do not accept there is an opticians' closed shop. Unregistered persons wishing to do so are permitted to supply spectacles to adults.
Lord Rugby: My Lords, are Her Majesty's Government aware that by insisting on its own highly restrictive and indeed inhumane interpretation of Section 21 of the Opticians Act, the General Optical Council has laid open Her Majesty's Government to direct proceedings which are now being brought forward under Article 169 of the Treaty of Rome for failure to fulfil its obligations?
Noble Lords: Reading!
Lord Rugby: My Lords, I have to cite the correct Act. When such restrictions have been removed in other member states, and also throughout the United States of America, why do Her Majesty's Government therefore continue to inflict this restriction upon the citizens of this country? Such a restriction fails to enable them to obtain their reading glasses by the best possible method; that is, by choice.
Baroness Trumpington: My Lords, perhaps the noble Lord needs new specs!
Lord Rugby: My Lords, I cannot hear the noble Baroness.
Baroness Trumpington: And a hearing aid! My Lords, conditions relating to the sale of spectacles vary from country to country. Some countries permit the sale of ready-made spectacles and others do not. The United Kingdom Government have struck what they consider to be the right balance in their regulatory arrangements. The link between the sale of spectacles and the sight test has been retained as a safeguard to the public. We have taken measures to increase competition in the sale of spectacles so that the public can also enjoy the benefit of low prices.
Lord Rugby: My Lords, does the Minister agree that the sight test is an inquisition which forces the customer to purchase an appliance which he would prefer to choose of this own volition, were such volition available?
Baroness Trumpington: No, my Lords.
Lord Monson: My Lords, can the noble Baroness confirm that there is no legal impediment to cross-channel ferries selling simple reading glasses without prescription outside British territorial waters? Can she also confirm that the same principle applies to airlines selling reading glasses outside British air space?
Baroness Trumpington: My Lords, I have to maintain that the Government considered there were good health reasons for retaining the link between sight testing and the sale of spectacles. Therefore there is the requirement for prescription.

Haringey Council: School Lessons
2.45 p.m.
Lord Ritchie of Dundee: My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they have now heard from Haringey Local Education Authority in reply to their inquiries last year and again in January this year as to the authority's plans to promote "positive images" of homosexuality, and if not, what action they propose to take.
Baroness Hooper: My Lords, Haringey Local Education Authority has now replied at some length to the further inquiries about its policies on the treatment of homosexuality in the school curriculum. My right honourable friend the Secretary of State for Education and Science is studying the reply and will respond shortly.
Lord Ritchie of Dundee: My Lords, I thank the Minister for her reply and I am most encouraged to hear that a reply has at last been received. I should like to ask the Minister whether or not Her Majesty's Government are fully aware of the extent of the disquiet and anxiety felt by many parents of the borough at the prospect of their children being exposed to they know not what in the way of unorthodox moral suggestions. In particular, may I ask whether the Government realises that a lot of the anxiety comes from ethnic communities; for example,

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the Moslem community in Haringey for whom a homosexual lifestyle is perhaps more taboo than it is in the Western world?
Baroness Hooper: My Lords, the Government are well aware of the situation as it has been reported by Haringey, and as I have said, as a result of the authority's lengthy reply they are aware of the case the authority itself makes. The situation arises in certain other authorities also. The Government are taking the situation very seriously and that is why in this first issue that has arisen a very careful analysis of the authority's policy statements and its plans for implementing them is being carried out.
Lord Campbell of Alloway: My Lords, is my noble friend aware that parent power under the Education Acts is bypassed on the pretence that promoting homosexuality is sanctioned by the equal opportunities legislation? Is she also aware that, odd as it sounds in your Lordships' House, that is what is happening in Haringey at this moment? Is she aware that the categoric prohibition in the Bill of the noble Earl, Lord Halsbury, with its direct enforcement procedures cannot be so evaded?
Baroness Hooper: My Lords, if not before, certainly now, I am aware of Haringey's attempt to side-step the provisions of the Education Act 1986. In fact, I understand that the Act applies to any sex education taught in schools, no matter when, where or how it is taught. So, changing the label does not alter that position. In fact, sex education is often not a separately timetabled subject but part of a broader programme of personal and social education or health education, and so the Education Act 1986 applies.
So far as concerns the reference to the Bill of the noble Earl, Lord Halsbury, my noble friend will know that it is scheduled for Second Reading in another place this coming Friday.
Lord Graham of Edmonton: My Lords, will the Minister confirm that the reason for the delay is that there have been lengthy and proper consultations by the authority with parents, teachers, pupils and governors? Can she also confirm that the positive images policy of Haringey has not been imposed on anyone? In fact, if it were to be considered and programmed it would be in conformity with Section 46 of the Education Act 1986.
Baroness Hooper: My Lords, we are indeed aware that Haringey argues that its policies are consistent with the law, that it is consulting locally on proposed steps to implement the law and that its previous actions have been misreported. These claims are being studied.
Lady Saltoun of Abernethy: My Lords, did the noble Baroness see the report in The Times of 17th March about the pregnant woman who went to a meeting of gays and lesbians in Haringey and was sworn at, punched in the stomach and thrown to the ground?
Baroness Hooper: My Lords, I am aware of the report. It is a most reprehensible situation, but it does not tie in exactly with the Question on the Order Paper.
Lord McIntosh of Haringey: My Lords, will the noble Baroness be good enough to answer the question of my noble friend Lord Graham and confirm that to the best of her knowledge no action has been taken in Haringey to promote positive images of gay and lesbian people and certainly not without the agreement of all concerned? Does she also agree that there is a very long path between election manifestos and implementation of those manifestos, whichever party they come from? Will she accept that the consultation, which has to take place in Haringey between the local education authority and the teachers and the governors, is likely to lead to very considerable further delays before any conclusion is reached?
Baroness Hooper: My Lords, I am sure that all your Lordships will welcome any delays in this matter. My understanding is that the local education authority adopted a general policy statement on equal opportunites in November 1985 and a more detailed report on this in relation to homosexuality last September. The primary purpose seems to be to discourage unfair discrimination against homosexuals and other minorities. It has currently set up a curriculum working party to develop guidelines for antiheterosexist approaches in schools and the local authority proposes to consult interested parties before adopting the guidelines. Clearly the subject will arise again when the local authority has come to a firmer decision.
Baroness Cox: My Lords, is my noble friend aware that if effective measures can be provided to prevent the promotion of homosexuality in schools, such as those provided for in the Bill of the noble Earl, Lord Halsbury, there will be widespread rejoicing not only among the parents in Haringey but also among parents in Ealing, Lambeth and throughout inner London, all of whose authorities are committed to precisely these policies?
Baroness Hooper: Yes, my Lords. We made our position very clear during the passage of the noble Earl's Bill through this House. We understand the reasons for its introduction and we entirely share the concerns which underlie its purpose.
Lord Beloff: My Lords, does my noble friend share my amazement that the Labour Party, which derives its inspiration from those two very active heterosexuals, Karl Marx and Friedrich Engels, now seems determined to confine its appeal to homosexuals?
Baroness Hooper: My Lords, I note my noble friend's remarks and would refer your Lordships to the date on the Order Paper.
Baroness Strange: My Lords, is my noble friend aware that the whole of civilisation as we know it, and most religions, are based on the foundation of a secure family unit consisting of father, mother, child and of course grannies and grandpas, uncles and aunties?
Baroness Hooper: Yes, my Lords. The Government believe that in this context schools should not avoid teaching about homosexuality but that it should be factual, balanced and sensitively handled. This is particularly important at this moment of time in view of the threat posed by AIDS. My right honourable friend will be addressing this in his forthcoming circular on sex education at school. There can be no justification for any teaching which advocates homosexual behaviour or encourages homosexual experimentation by pupils. However, the main thrust of the Government's policy has always been to set any such teaching in a family context.

Child Victims: Evidence in Court
2.55 p.m.
Baroness Faithfull: My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what action they are taking to relieve child victims of physical and sexual abuse from the trauma of giving evidence in court.
The Minister of State, Home Office (The Earl of Caithness): My Lords, the Criminal Justice Bill before another place would permit a child under 14 to give evidence at the Crown Court by live video link at the trial of an offence involving sex or violence.
Baroness Faithfull: My Lords, I thank my noble friend for that very encouraging reply. The National Children's Home, the All-Party Parliamentary Group for Children and the NSPCC pay tribute to the Government for supporting this part of the Criminal Justice Bill. Is there any possibility of the Government looking into the position of children giving evidence by video at the time or directly after the incident has happened and that video being used in court?
The Earl of Caithness: My Lords, I am grateful to my noble friend for her words of support. Indeed, yesterday in another place my honourable friend Mr. Mellor said that we are extremely well disposed to looking at such a proposal but we should of course want to consult all the interested groups first.
Lord Mishcon: My Lords, will the Minister take it for granted that the Government's view in regard to these dreadful cases is one that is shared in all parts of your Lordships' House? Will the noble Earl also consider whether there is a case for examining the possibility of corroborative evidence being available and in that event the prosecution being able to rely upon that corroborative evidence without subjecting a child to any cross-examination at all?
The Earl of Caithness: My Lords, I am grateful to the noble Lord for his support and I hope that it will apply to the rest of the Criminal Justice Bill when it reaches this House. With regard to his second point, as the noble Lord knows far better than I do, under our law there has always been a right of prosecution. I shall look very carefully at the point that lie has made and
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discuss it with my right honourable and honourable friends.
Lord Mellish: My Lords, will the Minister be kind enough to take the position that has been raised by the noble Lord, Lord Mishcon, very seriously indeed? I welcome the fact that a video from a child would be acceptable to a judge and jury but nevertheless the prosecution could demand that the child be brought into court in any case. That is what we dread about the whole issue.
The Earl of Caithness: My Lords, I assure the noble Lord that, along with all the other matters in the Criminal Justice Bill, we take this matter extremely seriously. As I said, I shall discuss it with my right honourable and honourable friends.
Baroness Faithfull: My Lords, can my noble friend say whether it is likely that the Government will have completed their investigative inquiry with regard to video-taped interviews before the Criminal Justice Bill comes to this House, or will it be after?
The Earl of Caithness: My Lords, it certainly will not be before, because, as I understand it, it is hoped that the Bill will arrive here fairly shortly. Whether our full consultations are achieved during the passage of the Bill before your Lordships' House is something that I do not know at the moment.

Business
Lord Denham: My Lords, at a convenient moment after 3.30 this afternoon my noble friend Lady Hooper will, with the leave of the House, repeat a Statement that is to be made in another place on higher education and research.
With the leave of the House, I shall arrange for a Statement to be made in another place this afternoon by my right honourable friend the Secretary of State for Scotland on higher education in Scotland to he printed in the Official Report.
With the leave of the House, I should also like to say a brief word about the length of speeches in this afternoon's debate standing in the name of the noble Lord, Lord Ennals, to which your Lordships have agreed to apply a five-hour time limit. On the principle that the mover is allowed approximately 20 minutes and that the Minister should rise to reply not less than 25 minutes before the scheduled end of the debate, all other speeches should be limited to a strict upper limit of 10 minutes. If any noble Lord should speak at greater length he will be doing so at the expense of other speakers in the debate.
Following is the Statement referred to:

Higher Education in Scotland
"With permission, Mr. Speaker, I wish to make a Statement on arrangements for planning and funding of higher education in Scotland announced in today's White Paper on higher education. This follows consultations on the recommendations in the report of the Scottish Tertiary Education Advisory Council on future strategy for Higher Education in Scotland and advice from the

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Advisory Board for the Research Councils and the Croham Committee on the UGC.
"In my Statement to the House on 17th July 1986, I said that the Government accepted STEAC's view that there is scope for improvement in the planning and co-ordination of provision in higher education by the universities and colleges in Scotland.
"In reaching decisions on the future, I have recognised that six out of eight Scottish universities opposed the central STEAC recommendation for a separate Scottish body with funding responsibilities for both the university and college sectors. I share the views of the universities that they should continue to be, and be seen to be, an integral part of the British university system and believe that that might be prejudiced by removing them from the British funding framework of the UGC and its successor.
"Irrespective of the source of funding, it is however highly desirable that both the university and college sectors can plan the development of their provision in the knowledge of what other institutions in Scotland are planning to do. But knowledge is not enough. We need arrangements to ensure that plans can be discussed, adapted and coordinated to take account of what other institutions intend to do and to ensure that overall provision in both sectors is in line with likely national and local needs.
"That is why we announce in the White Paper that we propose to accept and build on the recommendation of the Croham Committee that the proposed Universities Funding Council should have a Scottish Committee. The committee will play an important part in planning higher education in Scotland. It is important that the Universities Funding Council and its Scottish committee should take into account the needs of Scottish higher education as a whole. To this end in future the Secretary of State for Scotland shall give the Universities Funding Council guidance on plans for the other sectors of higher education in Scotland and will expect it to have regard to his views on the implication of Scottish needs for the university sector. These will, of course, be consistent with guidance given by my right honourable friend to the Universities Funding Council. The UFC and the Secretary of State for Scotland will then be able to plan provision, with the help of the Scottish committee, in the university and college sectors respectively with a clear knowledge of the implications of each other's plans.
"I expect the committee to advise the UFC on the implications of the Scottish education system for the needs of the Scottish universities. It will, in consultation with my department, consider the demand for higher education in Scotland and the balance of provision between its constituent parts.
"Appointments to the Scottish committee will be a matter for the Universities Funding Council in consultation with the Secretary of State for Scotland. I envisage that the committee will include members drawn from the non-university sector and employers, as well as from the UFC and the
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universities and that there will be representation from the Scottish Office.
"I believe that the establishment of a Scottish committee of the UFC on these lines will mark a very important development in the relationship of the Secretary of State for Scotland with the university sector, with far-reaching implications for the proper planning of higher education. For the first time he will have formal access to a group taking an overview of the needs of the Scottish university sector and will be able to discuss with them his views on the priorities for higher education in Scotland and the plans of the college sector.
"I am confident that the arrangements will be welcomed by the universities in Scotland. They will be able to maintain their role as part of the British system but will have a new focus for looking at Scottish needs. They will be better able to plan their provision in the light of knowledge of each other's plans and those of the central institutions. The CIs should welcome the more systematic opportunity afforded by the Scottish committee for joint planning between my department and the universities on how demands from students and employers should be met. Most importantly, Scotland at large should benefit from the improved arrangements for co-ordination and planning of higher education to meet the changes envisaged by the White Paper between now and the end of the century."

National Health Service
2.59 p.m.
Lord Ennals Lord Ennals rose to call attention to the state of the National Health Service, and to move for Papers.
The noble Lord said: My Lords, I am delighted that so many noble Lords have indicated their wish to speak in this debate and also that the noble Lord, Lord Peston, has decided to make his maiden speech today.
I shall start with what I call a short health of the nation statement. In spite of the National Health Service the United Kingdom has become one of the most unhealthy societies in the world. Is that sensational talk? No, it is not. First, the latest World Health Organisation figures show that Britain has the worst rates in the world for deaths from lung cancer, breast cancer and heart disease.
Secondly, the incidence of chronic illness in the United Kingdom is steadily rising. The latest available figures reveal that the percentages are 30 per cent. for males and 32 per cent. for females. That is a very substantial rise as compared with 10 years ago. Bluntly stated, it indicates that at any one time almost one-third of the adult population has a long-standing illness.
Thirdly, in Britain the expectation of further life at the age of 45 is among the worst in the developed world. Fourthly, cigarette smoking is still responsible for at least 100,000 deaths each year in the United Kingdom and for the additional burden to society from associated heart and lung diseases.
This debate on the National Health Service, and the essential services that go with it, comes at a time when

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the Prime Minister and other leading Ministers have been making what I believe to be exaggerated claims about the strength of our economy and while the Chancellor of the Exchequer has been distributing largesse in tax cuts largely benefiting those in the community who are fit and upwardly mobile. The health service received nothing from his Budget. The decision to give away £3 billion in tax cuts will, I believe, fuel the consumer boom and worsen the balance of payments. Prescription charges are increased while the real price of drink and cigarettes, left at the present level, is falling in relation to inflation. These are decisions taken in the run-up to an election when the Government will no doubt seek to defend the Prime Minister's statement that the National Health Service, which she and most other Ministers can afford, and prefer, not to use, is safe in Conservative hands. That tattered claim is not accepted by the public, who in every opinion poll about issues put the National Health Service very high on their list of concerns. The public say constantly that they would prefer more funding for the National Health Service and indicate their support for Labour policies as opposed to those of the Government.
As we are all aware, the National Health Service suffers from an acute lack of resources. I accept that this is not a new phenomenon; I accept that demands can never be totally met. However, as a result of the Budget, the Government can no longer defend themselves, as they have in the past, by the plea of shortage of resources. Their decision to deny the money needed by the National Health Service and to give it away to those in work who do not need it, was, in my view, deliberately anti-social and gravely damaging to the health service today and in years to come. It jeopardises the future of the National Health Service and the future health of our people.
In this respect, the Government's policies are cynical and uncaring, and I intend to spend most of my time seeking to prove it. I have sympathy for the Minister who has been put up to defend what I believe is the indefensible. I am very disappointed that the noble Baroness will not be replying the debate: she has an appointment overseas. I believe that her first responsibility is to your Lordships' House. I deeply regret that even though she knew about this debate three weeks ago, she did not feel it important enough to be present tonight to reply to the debate. I gave her warning that I would say this.
The Minister's brief will say that the Government are spending more on the National Health Service than ever before. That is quite true. Not once in 40 years has there actually been a cash cut. But it has been clearly proved by the House of Commons Select Committee on Social Services, based on figures given by the Government, and from a series of independent studies, that after taking account of the historic growth in the number of elderly people, with their increasingly heavy demands on the National Health Service, advances in medical technology, which we all welcome, the much higher inflation rate in the National Health Service and the Government's habit of paying for only part of staff salary increases, NHS spending in England has actually fallen by 5 per cent. over the past four years.
Examples are to be found on all sides and from all parts of the country. Rochdale has a £15 million overspend and has been warned that if it does not find ways of cutting that amount, commissioners will be sent in to run the health service for it. Salford has a £2 million overspend; Merton and Sutton a £1.25 million overspend; Mid-Glamorgan a £2.5 million overspend; and Shropshire a £2 million overspend. They are all technically bankrupt and are told to slash their already strained services or to go.
Bearing in mind that the position of Britain in the OECD league tables of percentage of national income is slipping year by year, it is quite clear that the National Health Service suffers from a grave shortage of funds. In the view of the Labour Party, the National Health Service in its current circumstances needs not less than a 3 per cent. real terms increase in order to fulfil our modest commmitment to improve standards of patient care, to step up the programme of health education, prevention and limitation of disease, and to raise the standard of living of health workers.
What is the situation today? Even with 3 per cent. annual real terms growth, we should still be almost bottom of the European league of percentages of GNP spent on health care. Ours is approximately half the figure for Germany and France. Let us look at some of the facts. Roughly 10,000 beds have been closed since 1979. That fact was given to me by the Minister herself. However, she says that more patients have been treated. Frankly, she does not know: her statistics only tell her how many patients are admitted and discharged. Let me tell the noble Baroness while she is present that, according to the most reliable evidence, the efficiency drive has too often led to patients being discharged too early and consequently often having to be re-admitted. On re-admission, the statistics record another new patient. My Lords, that is not efficiency. There are some cases of patients being discharged and re-admitted on the same day. But it helps the statistics.
Secondly, according to the British Medical Association, the cut in beds now means that 40 per cent. of acute beds are occupied by patients over the age of 65, thereby blocking beds for younger, acutely ill patients. Thirdly, in spite of all that has been said about waiting lists by the Secretary of State, and repeated by the noble Baroness, according to the latest figures, they are at an all-time high. Leaving aside the peaks during industrial action in the periods of both governments, the latest figure issued by the department shows that waiting lists stand at 673,000. That is 1.8 per cent. higher than six months previously and roughly 100,000 more than the average during the period of Labour Government. These are not just figures; they are men, women and children waiting in pain for hospital treatment, often in circumstances where their condition is getting worse and the chances of total recovery getting less.
Moreover, the waiting time for emergency cases—for emergency cases!—is also rising. The BMA reported 12 months ago that 63.5 per cent. of urgent cases had been on the list for more than a month and 25.8 per cent. of non-urgent cases had been waiting for more than a year. Quite frankly, this is appalling.
Health authorities are saving money by making hospital doctors work even longer hours. Up to 3,000

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hard-pressed junior doctors are working more than the stipulated maximum of 101 hours a week. In my view it is sheer exploitation of dedicated and skilled men and women which, at the same time, increases the risk that they may commit an error. It should be stopped.
There is a nursing crisis. Nursing really is in crisis. It is nothing to do with the dispute. It is a profession of 509,000—that is more than half the staff of the National Health Service—who have greatly earned the respect of the nation and of anyone who has ever been into hospital. Today there are grave shortages, with wards and theatres being closed for no reason other than the shortage of nurses. The NHS needs 30,000 additional nursing staff each year. On present estimates we face a shortfall of 10,000 qualified staff, and that may be as high as 16,000 by 1995.
It is not just the demographic factors. There are fewer young people reaching the age at which they would go into training for nursing, but it is not just that. It is pay and conditions. We need to keep those who have been trained and induce others to return. In 1981–82, 30,046 nurses entered training. By 1985–86 it was down to little more than 22,000. It is serious for the future.
In February 1987 the United Kingdom Central Council for Nursing, Midwifery and Health Visitors published Project 2000; crucially important proposals. I look forward to the Government's response to that document when the Minister replies. The document is called No Nurses, No Future. At the present time nurses are voting with their feet and have little confidence in the Government's commitment to them.
Hardly less important is the growing shortage of occupational therapists, and 19.2 per cent. of funded posts cannot be filled; of speech therapists; and of chiropodists, especially needed for our elderly folk. It is not just an immediate problem, although it is urgent, especially for the growing number of the elderly. But future prospects are horrific. Looking at the period up to 1994 the required growth rate is for chiropodists 30.6 per cent.; for dieticians, 25.8 per cent.; and for physiotherapists, 28.4 per cent. Occupational therapists, who mainly work with the elderly and the disabled—and I am interested because I am president of the College of Occupational Therapists—have a massive need for an increase of 73 per cent. What are the Government doing about it? That is the question that must be answered so far as these essential professions are concerned.
As president of the College of Occupational Therapists I have had countless meetings with Ministers in the DHSS and the Department of Education and Science. I hate to say it, but they do not seem to know, and nor do they seem to care, about the prospect that is facing us. As for speech therapists, it was only two weeks ago that it was revealed that only 25 per cent. of district health authorities had achieved the target of one speech therapist for every 5,000 children. Why is this? It is partly because they are paid less than a typist gets paid in London. You cannot expect people to go into significant and important professions which require great dedication,
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commitment and training and then pay them salaries that are simply not worth the challenge.
Let me continue with this sad saga. Prescription charges have risen twelvefold since 1979. I repeat that, twelvefold. Of course the Minister will say that 75 per cent. do not have to pay, so she can cross that out of her speech since her time is so short. But of the 80 million prescriptions that are paid for, about 32 per cent. are for items that cost less than £2.40, which is the prescription charge, according to the Prescriptions Research Centre, and it should know.
They are not allowed to pay less for prescriptions-only medicines, which means that the Government are making a profit out of any prescription which is less than £2.40. Talk about penalising the sick! It is an extraordinary situation that we face, and there is no point in the noble Baroness saying that I had to face it. In my day prescription charges were 20p and not £2.40.
There are two other consequences of the Government's money-making prescription charges. According to the Pharmaceutical Services Negotiating Committee there are about 100,000 patients a year who cannot afford to have all that is prescribed. That means they go without medicines that the doctors think necessary. Secondly, doctors are writing prescriptions for longer periods to save money for their poor patients. This leads to a great deal of waste with patients who for some reason or another do not use their medication.
Sharp increases in charges for dental treatment have had serious consequences. According to the Government's Dental Estimates Board the 25 per cent. increase in dental charges led to a 5 per cent. fall in treatment the following year. That is a substantial fall in root treatments; a 15 per cent. fall in extractions. Treatment of gum diseases which can save teeth in the long-term has fallen by 38 per cent. I had hoped that I would hear from the noble Lord, Lord Colwyn, and the noble Baroness, Lady Gardner, what they thought about this problem.
Only last week the Royal National Institute for the Blind expressed deep concern at the consequences of the Government's decision not to increase the value of spectacle vouchers for blind people on low incomes as from today, April Fools' Day. Honestly, how can they take such action when we know of the fantastic sums being earned by many in the City? It is a total discounting of priorities in our society. I find myself angered by such decisions. At a time when we are all supposed to be well off—except the National Health Service, which cannot afford to provide a decent service—health authorities in England have just written off £640,000 from bad debts by private patients.
I have time only for a brief conclusion. I am deeply worried about community care—the policy of the Government and their predecessor in respect of the mentally ill, the mentally handicapped and the disabled to close, so far as it is reasonable to do so, the big long-stay hospitals and to provide service in the community. Frankly it is not happening because the extra money is not there.
That is why the manifesto which has ben issued jointly by Dr. Barnardo's, Royal MenCap, MIND and

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the Spastics Society specifically calls for a central bridging fund to be established as a matter of priority to supplement joint finance in the transition from hospital to community care. I believe that it is absolutely vital that that should be done. I know that other noble friends will deal with some of the points which came up in the report from Sir Douglas Black. I shall not deal with those today.
My indictment of the Government's handling of the nation's health is fundamental. I believe it strikes at the root of the deep divide between the approach of our two parties in terms of health and social security. The time is past when the Government can meet the targets set out in our carefully documented programme. The people themselves must decide on the future of the National Health Service. I believe that they will do just that. I beg to move for Papers.
Lord Harmar-Nicholls: My Lords, before the noble Lord sits down—
Noble Lords: No. Order!
Lord Harmar-Nicholls: My Lords, before the noble Lord sits down, is he aware that in this Wednesday debate his speech had little to do with the National Health Service?
Noble Lords: Order! Sit down!
Lord Harmar-Nicholls: My Lords, it was nothing but a naked Labour Party propaganda attack.
Lord Hesketh: Order!
3.22 p.m.
Baroness Trumpington: My Lords, I must begin by offering your Lordships my most sincere apologies. Months before I knew of the existence of this debate I had accepted an invitation to visit West Germany on official business. I know that my noble friend Lord Hesketh will respond admirably to the points raised in the debate, but I deeply regret that I shall miss your Lordships' speeches,
The noble Lord, Lord Ennals, to my knowledge did not give me warning of his opening remarks. I am, however, grateful to the noble Lord, Lord Ennals, for giving us an opportunity to discuss the health service. It was not so long ago that he was the Secretary of State, so presumably a part of today's health picture follows his period in office.
When someone first comes into contact with the NHS, whatever the circumstances, they must above all feel they are being treated as an individual, not as a patient and certainly not as a statistic. As I have only 10 minutes, I should like to say a little about three major areas.
I begin with services for elderly people. In particular, I should like to remind your Lordships of the developments which have occurred in the health service's ability to treat older people. We all know people who have recently benefited from hip replacement operations at an age when even five or ten years ago they would have been considered too old to undergo surgery of any kind. We are focusing on hip
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replacements and on cataract operations and have set health authorities targets to be achieved by 1990 in both these fields. Such operations can restore mobility, independence, hope and dignity to elderly people.
The provision of community care services for elderly, and particularly very elderly, people is also vital to improving the quality of service which they receive. We aim to provide services that enable elderly people to live at home for as long as possible. There are many successes to report, such as an increase in the number of elderly people treated by district nurses. These successes must be sustained in the future.
Community care also has a vital role to play in the provision of better services for mentally ill people. This is a subject which I know is dear to the heart of the noble Lord, Lord Ennals, and it is certainly dear to mine. Though the newspapers mainly record bad news—and no doubt the same was true during the noble Lord's own time as Minister—progress in this area continues. There is a gradual shift of beds for elderly demented people from large district hospitals to pleasant local units. The work done by consultant psychiatrists at general practitioners' premises is increasing. And groups of well-trained social workers with a real involvement with mentally ill people are increasingly common.
Community care for mentally ill people is the preferred option in the majority of cases because it prevents the danger of institutionalisation. But this cannot happen without adequate professional support. This support is now being put in place. The number of community psychiatric nurses has far more than doubled. There are 480 day hospitals, well over two per district on average, and 155 district general hospitals. And by 1986 only seven health authorities had no psychiatric beds of their own.
I have talked so far about how the health service cares for those who already need help. But the health service is not just about treating disease; it is also about preventing disease and promoting good health. This will be a key theme in the future, and I believe that it is a theme whose time has come. It involves work on healthy eating and healthy lifestyle, and public education on how to avoid the greatest risks to health. All of these issues will be addressed by the new Health Education Authority which comes into being today and will be focusing particularly on coronary heart disease as its first major campaign and will of course be responsible for the AIDS public education programme.
Prevention is also linked to another theme which has assumed greater significance in recent years: it is that of women's health and how the service can meet the special needs of women. There are a whole range of issues here, but I will focus on the need to reduce the number of deaths from breast and cervical cancer. The Government are determined to reduce deaths from this type of cancer. On 25th February we announced our decision to implement a national breast cancer screening service. An extra £6 million will be provided in 1987–88 to set up a least one centre in each region. Four of these centres will be funded to provide a national training facility. The screening service will be extended over the next three years to cover all women in the age groups concerned.

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Because we are determined that the service will be introduced as efficiently and as quickly as possible, we are today announcing that Sir Roy Griffiths has been asked to lead a small team to oversee the implementation of the Government's policy on cervical and breast cancer screening. Sir Roy and his team will be working with health authorities and family practitioner committees to make sure that they have viable plans, not only for installing computerised call and recall systems but also to improve take-up of screening and to follow up when women do not respond after being called for screening. Sir Roy will be making regular reports, and I will keep your Lordships informed, particularly about progress towards the target date of 31st March 1988 for the cervical cancer screening service throughout England.
I have spent much of my valuable time this afternoon speaking about what our achievements in the health service will mean for patients, because I believe that that really is the bottom line. I should now like to take a few moments to say something about the role of nurses.
I know that the nursing profession is facing a period of change and development. There are major proposals for a new system of education and training and wide-ranging discussions, largely under the banner of the Project 2000 recommendations about the nursing role in the future. I cannot comment at the moment on the Project 2000 proposals themselves as they are still out for consultation, but I should like to record our appreciation of the work which has gone into their development. I should also like to restate the Government's real appreciation of the work done by nursing and midwifery staff, and of the dedication which they bring to that work. We have done our best to show our appreciation of that work. The nurses' working week has been reduced from 40 to 37½ hours.
We have established the Nurses and Midwives Review body. The review body is currently considering the evidence for 1987–88 and will report to the Prime Minister shortly. We remain committed to the review body system. In April last year we published the Cumberlege report on neighbourhood nursing. We encouraged wide public debate on the report and are now considering all the views expressed. We shall want to build on the areas of agreement that emerged during consultation.
Last week, my right honourable friend the Secretary of State announced that he was funding a fellowship in each of the 14 health regions for a nurse to study and formulate ideas for the nursing practice for those who are infected or who have AIDS but are not in hospital. They will be tenable for three months, awarded centrally and open to any nurse in England with an interest in a community approach to the care and treatment of AIDS patients. The reports of these studies will be published as a set of collected papers.
He has also doubled the allocation to the English National Board for nurse training on Aids in 1987–88. This will enable them to develop and expand their AIDS course. We will also, in consultation with the board, fund workshops in each of the health regions to offer training to community nurses on AIDS
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management. The chief nursing officer will shortly be writing to regional nursing advisers about this.
This subject is so wide and so much that has happened and is happening is so exciting that I feel terribly frustrated at having to merely skim the surface of just a few of the many innovations and improvements I could have talked about. I have not even mentioned the primary care review—the first of its kind for 40 years—and the steps we have taken to improve the position of disabled people, the waiting lists initiative or, of course, AIDS. During the past two years (to the day) since I have had the honour to hold my present job, I have had the chance to see something of the results of our policies. Let me give the noble Lord, Lord Ennals, some figures. There have been 1 million more in-patient cases treated; 3.5 million additional out-patient attendances; 400,000 additional day cases; double the number of kidney patients being treated and more than three times as many coronary artery bypass graft operations performed. These are just a few of the figures. And these are not just dry figures; they represent millions of people helped by the health service.
I have met some of the people whose stories are hidden under the statistics of extra patients treated, fewer babies dying, and so on. I have talked to them and I know how much they appreciate the National Health Service. Those people are loud in their praise of the care they have received. They represent lives saved, pain eased and hope restored. I contend that our record on the health service speaks for itself.
3.32 p.m.
Lord Winstanley: My Lords, may I say at once that I greatly enjoyed and indeed agreed with the speech of the noble Lord, Lord Ennals, every bit to the extent to which I have agreed with his speech on the previous three occasions on which he has made it. I do not for a moment say that in any sense of criticism. I say it merely in order to underline a point which is clearly apparent—that debates on the state of the National Health Service have now become frequent and regular events in your Lordships' House and they have done so for the very good reason that they are necessary. Indeed, it is necessary to say the things that the noble Lord, Lord Ennals, has said, and in fact it is necessary for them to be said over and over again. Perhaps I have reminded your Lordships before of the lines from Lewis Carroll in, I think, The Hunting of the Snark, where he said:
"What I say three times is true".
What the noble Lord, Lord Ennals, has said three times is true and what I shall now say for the fourth time is also true.
I accept the truth of everything the noble Baroness, Lady Trumpington, has said to us and I am absolutely sure that she herself is dedicated to the principle of an effective, efficient and humane National Health Service. I accept of course that the figures she has given us are true. We all know that the Government have put more money into the National Health Service; but we also know that this is a field in which we have to run extremely quickly if we are going to stay in the same place.

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Modern medicine is such that, were it allowed to do so, it could consume all the resources that there are. As we learn to keep people alive and continuing to require treatment—people who would formerly have died and been no expense to anybody—and as we learn to treat conditions for which formerly we could do nothing, as we learn new methods (highly expensive technological methods) of investigation, so we increase the burdens borne by the National Health Service and of course we have to increase the resources in order to meet those burdens.
The noble Baroness constantly comes to us with good news. Let me mention just one little piece. Not very long ago she gave us a Statement which reported that the Government had decided to put a lot more money into AIDS research. That is very necessary, and from these Benches I welcome that. The noble Baroness told us that every penny the Medical Research Council had asked for had been given. I welcome that; but of course what was not said was that most of the research being done into AIDS is being done by academic staff, the cost of which is borne by the University Grants Committee; and we heard nothing about extra funds for them. So sometimes the good news that we hear is not perhaps quite as good as it sounds.
The adequacy of the National Health Service depends on four factors. These are: the number and quality of the people who do the work (doctors, nurses, chiropodists and all the rest); the adequacy of the places in which they work (the hospitals, the surgeries, the clinics, and so on); the tools with which they work (the drugs, the instruments and the highly advanced technological equipment); and, finally, the administration whereby those other three are brought together and delivered to the patients. It is my belief that the National Health Service at present is deficient in all four respects. I will take them one by one and as briefly as I can.
First, as regards the people who do the work, I do not think we should say anything adverse about the quality of those people. We have doctors, nurses and other workers in different disciplines of medicine of the highest possible standard in Britain. I think there are certain anxieties about the training of them. Some of the training seems to me to be based on work in an institutional environment, whereas so many of them actually are now required—by government policy; and rightly so—to work in the community. That is rather different and perhaps that is a matter which could be dealt with at greater length in another debate.
There are shortages, which have been referred to by the noble Lord, Lord Ennals; and some shortages are acute. The noble Lord referred to nursing. I have seen nothing more illuminating and perhaps more worrying than the paper sent to all of us by the Royal College of Nursing. I think most noble Lords have seen that and I will not weary the House by going through it but I would ask your Lordships to consider one particular fact from the information sent to us which I think shows the predicament that we are in.
The Royal College of Nursing says that in 1982 there were 1 million 18 year-olds to recruit from and by 1992 that figure will have dropped to 600,000. More importantly, the Royal College says that the
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number within that figure who have between five 0-levels and two A-levels, from which the nursing services recruit at present, will also fall. Nursing takes 25 per cent. of all young women in that cohort at present. As the Royal College says, there is a demographic time-bomb under nurses which will cut off its supply of recruits unless the system is reformed. It is really a very worrying situation, and words which sooth us are not really helpful. We have to recognise that there is a real problem.
I have just mentioned that the community is the place where so many work. Talking of the people and the shortages, the noble Lord referred to Salford. It so happens that I have had a letter from the secretary of the Salford local medical committee, a copy of which has also been sent to Ministers. I do not have the letter with me but I have made some notes of what I recall having been said in it. The Salford local medical committee has written to Ministers to say that Salford people can no longer be considered as having a safe and efficient health service. The letter goes on to say that long waiting times for hospital services of various kinds have resulted in a situation which can no longer be regarded as safe. I am told by the Salford local medical committee that 80 acute hospital beds will have to close unless adequate staff are provided to man them.
The committee clearly maintains—and the family practitioner committee in Salford also maintains—that the resources, such as they are, have been efficiently managed locally. The problem has been resources coming from the centre. Members of the committee believe that they manage the local resources entirely satisfactorily. Having mentioned Salford, I think that underlines the North-South divide in terms of health. Noble Lords have heard much about Sir Douglas Black's report Inequalities in Health and we have had a further report recently which has underlined the fact that people living in poor housing and underprivileged circumstances are undoubtedly penalised and disadvantaged from the point of view of health. Those are the areas. The news which I have had from the doctors in Salford shows that there is insufficient recognition of the special needs of special areas if the health opportunities are to be equalised. That is the real problem there.
Having mentioned the North-South divide, let me touch on it once again in another connection. There is an extent to which the South-East and London in particular, which we blame as being privileged, suffer from the North-South divide, because the London teaching hospitals can no longer recruit nurses of adequate standard because those nurses, if recruited, cannot find anywhere in which they can afford to live. The question I should like to put to the noble Baroness or the Minister when answering is: what is left of the old nurses homes? It is my impression that most of the living accommodation for nurses in London has been sold off or has been diverted to other purposes so that it is no longer possible to recruit within the National Health Service in London staff of an adequate capacity because having recruited them there is nowhere for them to live.
Let me move on. We have a shortage of consultants in certain specialties, particularly those specialties

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which do not require English. An anaesthetist who does not have to talk to patients can disappear and get a job at a much higher salary in the EC. Many are doing so; many operating theatres are lying idle, not because of a shortage of nurses but perhaps because of a shortage of anaesthetists, sometimes of radiologists to do the X-rays in rheumatic conditions, and so on. That is a big problem. There is no doubt that GPs are often in the wrong places. As the noble Lord said, we have a shortage of chiropodists and speech therapists, and overall there is a big shortage of community workers.
I must conclude. I shall merely say how wise your Lordships' House was to remove crown immunity from National Health Service hospitals. We have recently seen a case of a London hospital where the wisdom of our decision has been underlined. However, the main place in which people now work is the community, not the hospitals. The Government are right in switching to an increased involvement in community health care, but you cannot have community health care unless you have the organisations within the communities to carry out the services. We do not have those.
Moving on quickly, it is difficult to have to dismiss the universe in a few easy phrases since it is an immense subject, but there are the tools with which people work. Drugs, of course, are the principal tool and I agree wholeheartedly with the noble Lord, Lord Ennals, that there are thousands of people every week going to the chemists and saying, "Which of these items must I have?" That is a deplorable situation. I have said before and will say again that if charges have to be made, the prescription charge is an unreasonable one. Why level a charge on the random need for a prescription and the random question of whether it contains several items rather than just one? If there must be a charge, it should be a charge for the use of the service, which would be more equitable. I should prefer no charge at all.
With regard to other tools, not a week passes when noble Lords do not get requests for funds, for donations for buying brain scanners and mammography X-ray machines or renal dialysis machines. There is a real shortage of technological equipment and that shortage must somehow be remedied.
Finally, as regards administration, we moved to a situation of management, and I thought that was good. With the Griffiths report we moved to a business system. We then found that the manager left because there was so much interference centrally and we now have the Minister for Health sitting as chairman of the National Health Service Management Board. At the moment we have the most centralising Government we have had in my lifetime; power in the National Health Service is being concentrated centrally instead of being diffused out to the regions.
To end, I merely repeat what I said at the beginning—that there is a gap to bridge. It must in part be bridged by health education. My noble friend Lady Seear will deal further with that. It must partly be bridged by better use of the resources we have. I hope we now begin to move back to the original concept of
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a comprehensive National Health Service, free at the time of use; not free, but free at the time of use to every man, woman and child in this country. It will not be easy, but I hope I live long enough to see it achieved.

Higher Education and Research
3.45 p.m.
Baroness Hooper: My Lords, with the leave of the House I shall now repeat a Statement on higher education and research which is being made in another place by my right honourable friend the Secretary of State for Education and Science. The Statement is as follows:
"With permission, Mr. Speaker, I wish to make a Statement about the Government's policies for higher education.
"Higher education is crucial to help our nation meet the economic, social and intellectual challenges of the final decade of this century. We must ensure that our universities, polytechnics and colleges respond to the country's requirements. Important reforms are already under way. I pay tribute to the efforts that are being made, especially in our universities, to adapt themselves more closely to the needs of the nation. The White Paper we publish today announces new policies in three key areas: wider access to higher education so that the United Kingdom gets the skilled people we need for economic success and to compete in international markets; secondly, the financing and management of polytechnics and colleges in England; and, thirdly, the thoroughgoing reform of the University Grants Committee, along the lines recommended in the Croham report.
"It is 21 years since the polytechnics were conceived. They have now come of age. They are successful mature institutions with a strong national role, complementary to our universities. But they are held back by current planning and funding arrangements. Control by individual local authorities inhibits their progress towards meeting the challenges of the 1990s and towards managing their resources to best effect.
"We therefore intend to legislate to convert the polytechnics and other mainly higher education colleges in England to free-standing corporate bodies under boards of governors. Local and regional industry and commerce will be strongly represented on these boards. We want industry and these colleges to work more closely together. Industry will find it more attractive to place contracts for consultancy and research. We will be setting up a new polytechnics and colleges funding council which will be independent of government, although subject to guidance from the holder of my office. This council will succeed the National Advisory Body and will contract with individual institutions for the provision of higher education.
"Local education authorities will retain control of those colleges which do not provide predominantly for higher education. The polytechnics and colleges funding council may contract for the provision of degree and full-time HND and equivalent courses at these colleges. Other courses, including all part-time

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sub-degrees, at colleges remaining under local authority control will be a local responsibility. The present expenditure pooling arrangements will end. Responsibility for the 530,000 students on non-advanced further education courses in some 360 colleges will continue to rest with local authorities.
"The voluntary and other colleges of higher education which are grant-aided by my department will be brought within the ambit of the new funding council. For the present, however, these arrangements will not be extended to cover the polytechnic and colleges of higher education in Wales.
"Secondly, we intend to introduce legislation to change the University Grants Committee to an independent statutory body on the lines recommended by the Croham Committee. We accept the Croham recommendations that this body should be smaller, with broadly equal numbers of academic and non-academic members, and a chairman with substantial experience outside the academic world. The new body will be called the universities funding council and its primary responsibility will be the allocation of funds to individual universities under new contractual arrangements.
"Thirdly, I want to encourage more people of all ages to go on to higher education. The Government already have an outstanding record on access to higher education. Student numbers have increased by almost 160,000 since we took office in 1979. After its fall in the 1970s the participation rate for young people has increased by 15 per cent., and the number of mature entrants has risen by about a quarter. We remain committed to providing places for all with the intellectual competence motivation and maturity to benefit from higher education.
"Over the next decade, however, the number of 18 year-olds will fall by one-third, and student demand will no longer be a sufficient basis for planning. A major determinant must also be the nation's demands for highly qualified manpower. The increase in graduate output already planned seems unlikely to do more than keep pace with the nation's requirements until 1990, and may be insufficient by the mid-1990s. This view is echoed in the excellent report published yesterday by the Council for Industry and Higher Education, which is chaired by my right honourable friend the Member for Waveney.
"For the present, the Government's best judgment is that they should plan for the student numbers envisaged in the higher of the two projections which I published last November. This projection involves an increase in full and part-time student numbers from 906,000 in 1985–86 to 957,000 in 1990; that is to say, an increase of 50,000. By the year 2000 almost one in five school-leavers would then be going on to higher education. The Government want to ensure that within the total numbers the shift towards scientific and other vocational courses should be carried through.
"Whether we reach these student numbers will depend crucially on this shift being achieved; on whether the schools and colleges succeed in raising the proportion of young people who qualify; and on whether the universities, polytechnics and colleges
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can admit more mature students and more young people with vocational qualifications. The Government believe that higher education will meet these challenges.
"Fourthly, the White Paper rightly acknowledges that the quality of our research is recognised worldwide. The Government are committed to maintaining and enhancing the strength and quality of the science base, of which our institutions of higher education are a major and essential part. We attach particular importance to sustaining the work of the most able scientists and their teams. The Government are accordingly making available an additional £15 million for 1987–88 through the Science Budget. This funding is in addition to the £39 million increase in that budget for 1987–88 which I announced on 6th November last year, and the extra £17.5 million over three years for AIDS research by the Medical Research Council announced since November.
"The consequences of the increase I am announcing today for later years will be taken into account when we consider the Science Budget in this year's Public Expenditure Survey. But I emphasise that we, and the scientific community, face difficult choices in the future. We must be more selective. We must concentrate resources. We must get even better value for money from better targeted research. We must exploit our science to the utmost—and that is a matter as much for industry as for government, the research councils and higher education.
"Mr. Speaker, our country's higher education is among the best in the world. Our policies will secure and develop its distinctive strengths. They will extend its benefits to a wider section of the population and will ensure that it serves the nation."
My Lords, that concludes my right honourable friend's Statement.
3.53 p.m.
Lord McIntosh of Haringey: My Lords, may I thank the noble Baroness for repeating the Statement made in another place? Will she accept at once from this Dispatch Box that that Statement is by no means as bad as it could have been? When I look back at the statements which have been made from these Benches, and by my honourable and right honourable friends in another place, I recognise many of the pleas that we have been making about the future of higher education, particularly in the light of the somewhat doomsday projections which were made in the Green Paper two years ago, as being reflected in the Statement made today. Will the noble Baroness accept that, in so far as that reflects a conversion, we welcome it?
But wider access to higher education is not just a matter of numbers, though indeed the numbers are more complex than she indicated in her Statement. Does she not agree that the bulge of 18 year-olds was actually reached in 1982 and that participation rates at that stage went down, although there has been some recovery since? Does she recognise in what the Statement says about access that it requires not only increased numbers in higher education but also increased resources for 16 to 19 year-olds?

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Will it not also require better provision for part-time students? This House has expressed its view quite recently about the provision for Birkbeck. Will it not be necessary to look again at mature student grants to assure access? Will it not be necesssary to look at the cost of access courses, to which some consideration is given in the White Paper?
Will it not also be necessary to look at the requirements by the higher education sector in terms of A-levels? The Council for Industry and Higher Education in its report yesterday called A-levels a ticket for limiting entry. Do the Government accept that there should be some relaxation or widening of the requirements for entry into higher education, and is that not the responsibility of our higher education sector as a whole?
I must also ask the noble Baroness about resources. She referred to the £15 million increase in the Science Budget for 1987–88, but will she not accept that that £15 million only provides for the salary increases which have been already agreed and will not provide for a single additional research project? When the Statement uses the words "more selective", does that not mean that more valuable research projects, more alpha research projects, will be turned down?
The Statement refers to the effect on public spending and says that the projections in the White Paper on expenditure plans are adequate for two years after 1987–88. Will she tell us more about what projections are likely to be necessary after that period and what provision is now being made for increased public expenditure on higher education? I hope the noble Baroness will accept that these are not intended entirely as antagonistic questions, but I think that they deserve to be spelled out before your Lordships' House.
Baroness Seear: My Lords, we on these Benches also wish to thank the noble Baroness for repeating the Statement which in general we welcome. But even now the scale of the changes proposed does not begin to meet the need. The type of universities at the present stage is such that only a quantum leap is adequate for making up the deficiencies. When the Statement says that we hope to get one in five of school-leavers into some form of higher education, we still shall not be up with the level which is adopted by our major competitors, and this is only a step in the right direction. It is not by any manner of means what we should like to see if we are to meet the needs of this country and to give the opportunities that we would wish to give to people seeking higher education.
Following the report yesterday from the Council for Industry and Higher Education, which I think the noble Baroness will agree was very encouraging, let me say that we need very much to look at the whole position for mature students and for people who can only work on a part-time basis. I should like to reinforce what the noble Lord, Lord McIntosh, said about entry requirements. If we are to draw into higher education a great many people who have the capacity to take it—and many of them may not be aware that they have—the traditional educational entry requirements which were appropriate for sixth form school-leavers are no longer appropriate for the sort of people
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that we have to draw into these institutions. That is a matter of the very greatest urgency.
I would also ask the noble Baroness to pay great attention to courses for part-time students. As we all know, there are a number of new types of teaching which help part-time students, but it seems odd that we have had these repeated appeals on behalf of Birkbeck College to be able to maintain its part-time student teaching, where it has been a pioneer in making part-time courses available for mature students. Surely part-time students, who are of the most serious kind or they would not be there and who are often studying at very great sacrifice, need major help and encouragement. There is a hint in this paper that that is so, but can it not be developed further?
The tone of this Statement is for greater encouragement for science and greater collaboration between industry and the universities. That is right. However, let us not forget that we cannot have good technical and applied science unless we have first class basic science. The maintenance of first-class research departments and research work going on in our universities in basic as well as in the applied fields is essential.
The main criticism that I make is that the emphasis in this Statement is too short term, too applied and fails to recognise that the basic work of universities must go on at the same time. Concentration is all right. However, we hope that it does not exclude the smaller institutions which may be enterprising in new fields of research and should not be discouraged in order to build up the larger departments.
This is a matter of such great importance that I should have thought it would be appropriate, through the usual channels, to see if we can have a debate.
4 p.m.
Baroness Hooper: My Lords, a number of issues have been raised. I am very happy that the noble Lord, Lord McIntosh, and the noble Baroness, Lady Seear, have felt able to welcome the Statement and the news which it contains. I thought that perhaps the noble Lord's "not as bad as it could have been" remark was a bit grudging. This is in fact very good news. And it should be welcome both to the institutions involved and to the public in general. It goes to prove that the Government do listen and do, when necessary, revise their policies. In this case, the Government have been reviewing their higher education policies for some time. Sir Keith Joseph published a Green Paper in May 1985, and it is in the light of responses to that, and of subsequent developments, that the Government have revised their policies, particularly on access and on planning and funding arrangements for polytechnics and colleges.
Both the noble Lord and the noble Baroness referred to access and to the increased resources that would be needed. As regards funding, we shall review our spending plans each year to take account of the numbers of students already in higher education and the numbers likely to be beginning courses in the future. We shall ensure that all students who are eligible to receive a mandatory student grant continue to do so. That is the position at present, and it will be the position in the future. My honourable friend the

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Parliamentary Under-Secretary of State is, as I have said on previous occasions in this respect, conducting a review which will be putting forward proposals for the future of the student support system in due course. I have no doubt that those proposals will be designed to encourage young people into higher education.
On resources for science funding, we have already announced that university funding in 1987–88 will be 10 per cent. higher than that in 1986–87, and that polytechnics and colleges will receive an 8 per cent. increase. Funding in later years will depend on the success of the institution in introducing necessary improvements. The published plans of the Government are that in 1988–89 and 1989–90, the funding will rise in line with inflation. Increases in student numbers have already been included in the planning targets adopted by the UGC and the National Advisory Body.
The noble Lord, Lord McIntosh, suggested that the additional £15 million to which I referred in the Statement was merely compensation for the recent pay settlements. I must emphasise that that is an addition; it is not compensation for pay settlements. It is designed to buy more first-class science highly selectively and it should go to sustain the work of our best scientists and their teams.
The Government have shown that they are continually responsive to the needs of science. As measured by the GDP deflator, the science budget has been increased in real terms by over 10 per cent. over the last seven years. This year, we have already made a special addition for AIDS research, which is the £17.5 million referred to in the Statement, for the next three years. We have now made this further exceptional addition of £15 million to secure outstanding science which would have otherwise been lost.
The question of access courses was referred to. Action on that subject mainly rests with the institutions and the validating bodies. The White Paper makes it clear that this is a perfectly respectable route into higher education. However, in the interests of the students who are directly concerned and to ensure the general acceptability of access qualifications, there is a need to give careful consideration to standards and, where possible, to avoid a sole link with a single higher education course.
Reference was made, particularly by the noble Baroness, to the question of part-time students. As I have said, this subject has been discussed previously in your Lordships' House and is being considered in the review which is being undertaken by my honourable friend. On the question of greater collaboration for science and technical subjects in schools, I should like to emphasise the opening remarks of the White Paper which point to the fact that the Government are proposing a package of solutions. In the arrangements announced in the Statement, the Government are building on improvements in schools and colleges and in admission arrangements for those with nontraditional qualifications.
As regards the question of holding a debate, mentioned by the noble Baroness, I shall refer to the usual channels. I believe that we have had some very useful debates, including that initiated by the noble
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Lord, Lord Chatfield, on scientific research and development and more recently on the Croham Report. Perhaps I may go so far as to say that the White Paper and the Statement made today go in part to meet some of the views expressed by your Lordships in the course of those and other debates.
I may not have covered all the questions raised by the noble Lord and the noble Baroness. If not, I shall try to rectify the position subsequently.
Lord Boyd-Carpenter: My Lords, may I support very strongly the request of the noble Baroness, Lady Seear, that we should have an early debate on this matter? Fortunately, the Leader of the House is present and has heard the comments. I hope that he will give serious consideration to that matter.
I am sure that my noble friend is aware that this is the most important Statement in respect of higher education since the Government of my noble friend Lord Home of the Hirsel adopted the Robbins Report some 23 years ago—a report which I had, under my noble friend's direction, a modest part in implementing. In view of the great importance of the subject, surely your Lordships' House could contribute a great deal.
There are two points which I particularly welcome and about which I hope my noble friend will add a word. The first is that I greatly welcome the decision to make a more workmanlike body of the University Grants Committee. That has been urged, I believe, from both sides of the House for some time. Although members of the University Grants Committee have worked extremely hard and devotedly—I cast no reflection on them—I have always thought that the structure was quite unbalanced. The second point which I greatly welcome is the transfer of polytechnics from local authorities. That should surely make the co-operation with industry which is so enormously important very much easier. It is well known to your Lordships that the relationship between industry and certain local authorities is not at all good. The relationship will be much easier if there is direct contact with the polytechnics.
Will my noble friend draw the attention of all concerned to what happens in that respect in the United States, where industry has the closest of links with higher education institutions and puts a great deal of money into them? Certain industries in this country are good in that way. Building and catering have a good record. Many other industries put little in. I ask my noble friend to give considerable emphasis to that point as part of the whole parcel of the polytechnics' new and improved status.
Baroness Hooper: My Lords, I am grateful to my noble friend for his comments. I need hardly say that I am grateful to my noble friend the Leader of the House for being present so that the wishes of the House in respect of a full debate on this topic will be clearly understood by him.
The restructuring of the UGC is an extremely important part of the proposals contained in the White Paper. While I recognise the valuable work that the existing UGC has done, it is hoped that the new body will be able to tackle the task with even more ease and

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efficiency. The link between polytechnics and local industry is an important plank of government policy. It is being introduced all the way through schools and other institutions. It is extremely important, as my noble friend said, that we look at the valuable example of such co-operation that exists in the United States. That co-operation was frequently referred to during the course of Industry Year last year. A number of initiatives which were taken then are proving valuable in the longer term. I shall certainly pass on my noble friend's remarks to the appropriate quarter.
Lord Taylor of Blackburn: My Lords, I, like the noble Lord, Lord Boyd-Carpenter, welcome the news of the UGC reorganisation. As the noble Baroness said, many of us have been advocating it. We welcome and recognise the work that the UGC has done over the years. One of the matters about which I am concerned, which I think was mentioned in the Statement, is the new independent body. I should like to ask the noble Baroness how independent is independent, because for years many of us have wondered about the independence of the UGC. I hope that this proposed new body will be independent and divorced from any government department.
Baroness Hooper: My Lords, I am grateful to the noble Lord for his welcome for the proposals and the proposed new funding council. After all, that is an acceptance of the recommendations and the broad thrust of the Croham Committee's report. Its general approach to the shape and functions of the UGC's successor has been taken on board. Further decisions on the detail will be taken in the light of continuing consultations on the report. The UGC's independence cannot be criticised in view of the number of measures upon which it has insisted. I believe that the UGC can be pointed to as a body which has proved how valuable independence from government can be.
Lord Beloff: My Lords, may I ask my noble friend two questions about the emancipation of the polytechnics, which I believe to be the most important part of the Statement? We are told that they are to have corporate status. Does that mean that they will have the power to award their own degrees; that is to say, will they be emancipated from the CNAA as well as from the local authorities, which I think would appeal at any rate to the larger and stronger among them?
Secondly, is my noble friend aware—I am sure that she is—that the new structure, which gives polytechnics a degree of financial autonomy in matters of expenditure within the grant that they receive, will demand considerable management qualities by polytechnic directors? In future, how are they to be appointed? Will that be one of the tasks of the boards of governors? I apologise if these questions are answered in the White Paper, but Back-Benchers do not have an opportunity to see those documents before Statements are made.
Baroness Hooper: My Lords, some of the queries raised by my noble friend are covered in the White Paper. In general, the effect of the new arrangements
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will be to create a kind of UGC relationship for the polytechnics so that they will, as mature institutions, be able to act responsibly and independently, making the necessary local contacts while being recognised as national institutions. I think that I can go no further than that. Some of the detail has yet to be worked out after further consultations.
4.15 p.m.
Lord Kilmarnock: My Lords, while I do not dissent from what the noble Lord, Lord Boyd-Carpenter, said about the importance of polytechnic-industry links, does the noble Baroness accept that it is important that some form of local authority link, and linkage with the local authority education system, should be preserved? In that connection, is she aware that the National Advisory Body is either on the point of publishing or possibly even has just published a report on the governance, management and status of polytechnics? Will that be taken into account before firm decisions are made on the matter? Is the noble Baroness also aware that an independent body under the chairmanship of Sir Alistair Pilkington is sitting to investigate polytechnic local links? Before firm decisions are taken in this matter, I ask that those contributions be taken into account.
Baroness Hooper: My Lords, the whole process of higher education and these arrangements for higher education are always subject to review, innovation and good ideas from any source. The form will not be fixed in concrete as a result of the present change. The work of Sir Alistair Pilkington's committee will be considered. It is important that polytechnics work out their own links with local industry, and to date many have. We have seen the benefit that can result from it. We are of course aware of the good management practice working group which has been studying the position. It includes a representative of the Department of Education and Science. The working group's brief does not go as far as the arrangements which are currently being made. Although I believe that the report is to be published shortly, it would not fully solve the problem that we feel we have tackled in the White Paper.
Lord Cledwyn of Penrhos: My Lords, is the noble Baroness aware that there will be considerable disquiet in Wales about the irresolute nature of the report as it affects the Principality? For example, the Statement refers to the arrangements not being extended to cover the polytechnics and colleges of higher education in Wales. How long will it take? Wales is smaller than England and even smaller than Scotland. Why should it take all this time? Why are we not being clearly told what will happen in Wales?
Secondly, I am second to none in my admiration for the work of the UGC and its chairman, but it is clear that the new UFC will have a Scottish committee with a direct relationship with the Secretary of State for Scotland. However, why is there no reference to Wales? Why did not Wales have a representative on the Croham Committee. Is the noble Baroness aware that in the Principality that is regarded as absolutely disgraceful. We shall come back to it again with more force on the next occasion.
Lord Ferrier: My Lords, may I ask my noble friend the Leader of the House—
Baroness Hooper: My Lords, if my noble friend will excuse me, I hope to hear his question in a moment. Turning to the important question of Wales, which I expected would be raised, the noble Lord, Lord Cledwyn, will be well aware that that is the responsibility of my right honourable friend the Secretary of State for Wales. My understanding of the differentiation is that the Welsh system is smaller and very few colleges concentrate on higher education so that the need for change is different. I believe that there is in fact only one polytechnic in Wales.
However, my right honourable friend the Secretary of State for Wales will consider making changes similar to those proposed for England if the Welsh Advisory Board does not demonstrate in its current review that it can offer advice based on national, not local, considerations. I can go no further on timing than that.
As regards Scotland, I am not sure of all the reasons but I understand that a separate Statement is being made in another place on Scotland which is not being taken in this House. However my understanding is that the proposals do not go so far as to suggest that there should be a separate arrangement on funding for Scotland.
The Earl of Selborne: My Lords, is my noble friend aware that the £15 million injection—
Lord Cledwyn of Penrhos: My Lords, can the noble Baroness explain what she meant in saying that this is decided on national, not local, considerations? I hope that she does not consider Wales as being a local consideration. I should be grateful if the noble Baroness would choose her words carefully. Further, her right honourable friend the Secretary of State for Wales signed the White Paper and, although he may be responsible for polytechnics in Wales, her right honourable friend the Secretary of State for Education and Science is responsible for further education in universities.
Baroness Hooper: My Lords, I understand that the words "national" and "local" are both to be taken within the context of the word "Wales". Does that help the noble Lord?
The Earl of Selborne: My Lords, is my noble friend aware that the £15 million injection of funds to the Science Vote will be of enormous relief and help to the research councils? They are in the great difficulty of having to turn down extremely well presented and important research projects. I am sure that the research councils will be greatly relieved that this injection of funds will give them the opportunity to award research funds to those projects which are so greatly needed.
Furthermore, will my noble friend now consider again whether the advice of the House of Lords Select
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Committee on Science and Technology on how industry might be persuaded to be more effective in taking up publicly funded research could be pursued? It will be recollected that in responding to the debate of the noble Lord, Lord Sherfield—when proposals were made, for example, that industry should be required to list in its accounts the amount funded on research or that there might be further tax advantages—these proposals did not receive as much warm support as he might have wished. Having said that, I am sure we are all grateful for the £15 million investment from public funds and we hope that industry can match it.
Baroness Hooper: My Lords, I am grateful to my noble friend for his comments and I shall draw them to the attention of my right honourable friend.
Baroness Lockwood: My Lords, is the Minister aware that between now and 1990 the majority of our unversities will be involved in the process of cutting back on their departments and on their staffs? Can the noble Baroness tell me how this can be reconciled with the policy for widening access contained in the White Paper when no additional funding is to be available? I ask that because widening access to differently qualified people means that more money will be required for in-service training and different facilities for teaching university students. Secondly—
The Lord President of the Council (Viscount Whitelaw): My Lords, order! Debate!
Baroness Lockwood: My Lords, I conclude with that one question.
Baroness Hooper: My Lords, the funding and other arrangements to be made by the universities are very much questions for the universities and the new funding council to work out. As was explained fully in the Statement, the Government's contribution does not represent a cut in funding in any way. Our aim is to urge the universities to co-operate with local industry, to encourage industry to have schemes which will help to provide funding from the private sector and also to make the best possible and most efficient use of the funds that are available.
Viscount Whitelaw: My Lords, I know that my noble friend Lord Ferrier wished to point out that the discussion on this Statement had gone on for too long. I appreciate fully that it is an important subject, but I must point out to your Lordships that it has taken 41 minutes and that is a great deal longer than we expect a Statement should take in the middle of an important debate. We must bear that in mind and perhaps we can now return to the debate.
The Earl of Dundee: My Lords, before we return to the debate I should inform your Lordships that because of the time taken for the Statement the conclusion of the debate has now been extended to 8.40 p.m.

National Health Service
4.27 p.m.
Debate resumed.
The Lord Bishop of Manchester: My Lords, I begin by apologising to the noble Lord, Lord Hesketh; owing to the length of the Statement I may not be in my place at the end of the evening.
I thank the noble Lord, Lord Ennals, for introducing this debate. Even if the subject has been discussed on many previous occasions, the National Health Service is of such great importance to the life of our country that it is right that it should be under review in your Lordships' House from time to time.
Some of your Lordships may have noticed in The Times a review of the new biography of Aneurin Bevan, who was one of the chief architects of the National Health Service, in which the writer, John Grigg, said:
"For all its faults it has remained so popular that even fanatical anti-collectivists have felt bound to proclaim themselves its champions".
I believe that to be true of its popularity, and many polls have shown this.
However, popularity is not enough. It is said that the price of liberty is eternal vigilance and so surely is the price of maintaining an adequate National Health Service, especially in view of the great pressures on it which have been outlined already this afternoon. There are the great problems of an ageing population and the development of costly hi-tech medicines, to which the noble Lord, Lord Winstanley, referred. It is vital that the National Health Service does not simply become a political football between the parties. The NHS is far too important to us all.
The main protection for the National Health Service must be a deep-seated conviction in this country that health care is vital and worth paying for by the nation; that such care should not be dependent on the ability of people to pay; that charges, if any, should be minimal; and that the principle of its being free at the point of use should be maintained. Therefore, the task facing us is to maintain the popularity of the NHS and the willingness of people to contribute to it a substantial proportion of our national income in face of the growing problems to which reference has been made.
The Churches, weaker though they are than in the past, perhaps still have some influence on the thinking of people about society. However, I believe that we have not done nearly enough over the years to give the backing to the health service that has been needed.
Yet there have been some efforts in this direction to encourage people to think about the philosophical and indeed the theological basis of the health service, and one such has come recently in the report from the Board for Social Responsibility of the Church of England entitled Not Just for the Poor—Christian Perspectives on the Welfare State. I should like to quote just one paragraph from that report because it gives a line on its approach:
"The social character of our human life and the responsibilities and duties which attach to it are consistently and persistently set out in biblical thought and in the development of Christian belief.
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Human beings are made for each other. We can find our vocation in relationships with others, in the service of others, and in community with others. The ordering of society should give expression to these basic truths about what it means to be human".
The report is emphatic in pointing to the dangers of having a divided society so far as concerns social benefits and indeed health care. It states:
"Our Christian understanding is that, not just within the Christian community but within society as a whole, 'we are members one of another'. In the light of this, welfare provision should not just be about directing benefits to the very poor. It should be concerned with justice for all citizens and any tendency to allow the development of a socially disenfranchised sub-class of those receiving benefit is unacceptable.".
I believe that the creation of the National Health Service owed not a little to the part played by those ideas in the life of our country in times past. It would be quite wrong to say that the inspiration came entirely from those who would confess that they were believing or practising Christians. That is quite untrue. Nor would it be true to say that it came from any one particular party, because its inception was widely supported by people from all parties. There was broad agreement on the ideas behind the National Health Service.
Today, while we welcome—and it is a welcome given by all parties—the National Health Service, we must ensure that this concept is not eroded in the years ahead. I believe that there is a grave danger that it is likely to be eroded unless action is speedily taken on certain fronts.
Reference has already been made to the important report some years ago about inequalities in health care—the Black Report: I think it is worth listening once again in your Lordships' House to what the Black Report said about inequalities:
"present social inequalities in health in a country with substantial resources like Britain are unacceptable and deserve to be so declared by every section of public opinion … we have no doubt that greater equality of health must remain one of our foremost national objectives".
That has been underlined by the row that has recently broken out over the report entitled The Health Divide. I could not help noticing the remarks of Dr. David Player, the Director General of the Health Education Council, which were headlined—again, I believe, in The Times—" I was signing my death warrant". Why, my Lords'? It was because he sent copies to 10 Downing Street. It would be very sad if a report that was underlining the serious situation that faces us over inequalities in health care was felt to be politically unacceptable in any one side of the political life of our country.
The noble Lord, Lord Winstanley, referred to Salford. As some of your Lordships know, I live in Salford, and I am often present in church congregations and other groups there. In the city of Salford the inequalities in health care hit me in the eye very hard indeed. I think that what must first be given attention in the years ahead is the very serious problem of basic inequalities in health care. I am not suggesting that nothing is being done. We have heard this afternoon from the noble Baroness about some of the things that are being done. However, it is not nearly enough to meet this major challenge in our national life at the present time.
There is also the question of the effect of private practice on the National Health Service. I do not want

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to say too much about that topic because your Lordships recently had a debate on this very matter; but I look back to the speech made by the Prime Minister in October 1982 when she said:
"Of course we welcome the growth of private health insurance. There is no contradiction between that and supporting the National Health Service. It brings in more money, helps to reduce waiting lists and stimulates new treatments and techniques.".
I do not believe that that observation is true. On the contrary I believe that the very rapid growth in private health care and insurance has diverted resources and increased disparities. Staff have been siphoned off; influential patients, who themselves would press for better provision and the ironing-out of inequalities, have been taken out of the National Health Service; and doctors and consultants have often been tempted away from what should be their proper duties. We should all appreciate the personal choice of those who opt for private health care for themselves and their families. I can readily appreciate that people have responsibilities; hut that is a different issue from public policy commitment. There should be no encouragement to the further growth of private health care. It damages the National Health Service and exacerbates some of the problems with which we are faced.
The other issue that I should like to raise concerns the question of how to achieve greater efficiency in the National Health Service. Surely that is something with which we are all concerned in such a vast organisation, and it is a problem that always faces us. We all ought to be agreed on the need to promote more efficiency. Yet there is the other side of that question, which is the care of those who work for the National Health Service—not only nurses (to whom reference has rightly and properly already been made this afternoon), doctors and medical staff, but also those who maintain its basic services. I believe that to go down the road of privatisation is not necessarily to take the right road at all so far as concerns basic services such as cleaning, laundering and catering. Those tasks represent work of constant volume in hospitals. The morale and pay of those who work in those services are a very important part of our National Health Service these days. The last thing we should be doing is exploiting the very low paid in a service that is meant to maintain basic health in the life of our country.
Of course the National Health Service cannot bear the whole burden of trying to achieve greater equality in health care. As we all know, it covers many different areas such as housing, unemployment and so on. Yet the conduct of the National Health Service, the way it is organised and the way in which its resources are distributed, are vital to the health care of many people in our country. Our people are our wealth. This is very closely related to productivity and concerns our ability as a nation to earn a high standard of living. I believe that in the years ahead the National Health Service, far from being a political football between the parties, ought to be something for which we all care and whose improvement we wish to see.
4.37 p.m.
Lord Peston: My Lords, I have just been experiencing the acute tension of waiting to make my maiden speech coupled with the extreme frustration of
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not being able to join in the previous item of discussion on higher education. The result is that I may become a burden on the National Health Service sooner than I had anticipated.
In speaking to your Lordships on the subject of the National Health Service, as a matter of courtesy I ought to declare an interest—indeed, a multiplicity of interests. My wife's career has largely been in the National Health Service: as a speech therapist, as the secretary of one of the first community health councils, and now as a part of the administration of one of London's major teaching hospitals. Like many other academics, I have sat on research committees of the MRC and the DHSS. I was also a member of the Nuffield Foundation inquiry into pharmacy and am now a lay member of the Council of the Pharmacy Society of Great Britain. I am proud to say that I was a founder member of ASH (Action on Smoking and Health) and I continue to support that body.
I am not here to boast of my credentials however. In my maiden speech I want to emphasise a commitment to the National Health Service as such, the principles and values of care and concern with fellow human beings and the devotion to duty that lay behind the setting up of the service. Those are values which I believe continue to permeate the health care profession despite the occasional cynical dissenting voice to the contrary.
Let me mention what seem to me to be the key principles, the first of which is universality. The NHS is available to all citizens; it is not limited to those with the ability to pay. Therefore, ipso facto, it is redistributive. On this occasion again I must refrain from entering the debate on inequality and health, fascinating though it is.
The second principle is that the health care offered should be that which is most appropriate to the patient; if you like, the best. Even though in this case a private alternative is available, in fact in health care one cannot buy a better treatment than is offered by the National Health Service. Of course, one can purchase more privacy, luxury or immediacy, but that is another matter.
On waiting lists, the present position is not good. One can even say that it is intolerable, especially for what one might call straightforward or bread-and-butter surgery which can so enhance the quality of life. I for one, would give the highest priority to the use of additional resources for that purpose. Unless I misunderstood the Minister, she was taking the same view in her contribution to this debate.
To me, most importantly, the health service offers to the patient and to his or her family a kind of certainty—given the anxiety that illness causes, together with economic worries arising from loss of time at work—that doctors, nurses and most other health care professionals are accessible without direct charge. All this involves vast resources. No one is or ever has been ignorant of that. Indeed, the whole purpose of having a system of taxation is to finance activities for which charging at the point of service is inappropriate. It is economic nonsense to suggest otherwise. Moreover, since we all require health care at some time in our lives, and benefit from the treatment which others receive as well, public

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finance—which one can interpret as a form of insurance system—is the best way of paying for it all.
Nonetheless, resources are not unlimited. The economist must emphasise his dismal science and say that he is aware, as I am aware, that no matter how rich we become, there is no limit to our demand. In the case of the NHS I would go further. I would expect the demand for health care to rise more rapidly than income. I would also expect technical advance to be more rapid. In addition, the expectation of life has risen, and I would hope to see it continuing to rise.
Putting all these factors together, there can be little doubt that there must be some tendency for health's share of public expenditure to rise, and indeed for the share of health expenditure in gross domestic product to rise. I agree with the right reverend Prelate the Bishop of Manchester that it is undesirable for those who work in the NHS to go on subsidising the rest of us. It is surely reasonable for them to wish to participate in whatever national prosperity there is available.
On resources, there are no easy ways out. Those who place their faith in new forms of finance are chasing a chimera. Paying for things is always difficult. The pursuit of efficiency is highly important. Some of us have been pressing this for years. But while it is a duty to use available resources as effectively as possible in the interests of a patient, it is impossible to ignore the fact that in too many areas there are simply not enough resources in the first place.
I am aware that I have been moving too close to controversy and must start to draw back. However, I must raise the topic of prescription charges which others have mentioned. I give my support to what my noble friend Lord Ennals has said. As an economist I am never doctrinaire on sources of funds. If prescription charges are a source of finance without adverse side-effects, why not use them? The problem today is that they have risen so much in real terms that they may, and indeed in my view must, be harmful. It is entirely right that the medical profession should be aware of the expense of items and should not prescribe what is dearer when what is cheaper is just as good.
I supported the introduction of the limited list and will continue to support greater rationality in prescribing. But high prescription charges—and there is some argument about the exact figures—even though they fall on only half of all patients, go further than that. They may cause the doctor to prescribe too much at a time and the patient not to purchase what the doctor regards as necessary, therefore adding to the so-called problem of non-compliance.
The Nuffield Foundation report was surely right to recommend an enhanced advisory and counselling role for the pharmacist. But that was to help and not to get in the way of the general practitioner. There is now a growing tendency for patients to ask the pharmacist for advice because the total cost of all the items on the prescription form is more than can be afforded. This places the pharmacist in the impossible position of having to respond to the question, "What does the doctor want me to have?" Following on from that, in some cases prescription charges may cost the service more than it says. It seems to me therefore that
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the time has come to look at them again in a dispassionate and open-minded way.
If Ministers ask the usual question, "Where will the money come from?", for once there is an easy answer. Let me suggest that they raise—or advise their right honourable and honourable friends to raise—the excise duty. That is a financial policy which has clear health benefits.
Those of us who were brought up in the liberal —with a small "I"—tradition of western civilisation believe most strongly in the value of debate and criticism. But we sometimes forget that we need on occasions to support and praise our institutions. My purpose in intervening today has been to do precisely that. Those who claim that nothing radical or progressive can be achieved by parliamentary democracy can be rebutted in many ways, not least by the foundation of the National Health Service.
In conclusion, I offer my support and thanks to all those in the health service—the doctors, nurses, ambulance drivers, speech therapists, pharmacists, auxiliaries of all kinds, porters, clerks and, not least, the administrators. Together, they comprise a health care team of which we can be proud.
4.47 p.m.
Lord Nugent of Guildford: My Lords, perhaps I may begin by thanking the noble Lord, Lord Ennals, for raising this debate this afternoon and for limiting it in time. I am afraid that I have to make an apology; I also have to leave before the debate concludes. I hope that I may be excused.
My first pleasure is to congratulate the noble Lord, Lord Peston, on his maiden speech which, he will have observed, was much enjoyed by all sides of the House. He contrived the right balance between expressing some of his views—which are obviousy strongly held—without being controversial. If I may say so, we all felt that he made a most valuable contribution to the debate. We look forward to hearing him on many occasions in the future.
The noble Lord, Lord Ennals, made a wholesale condemnation of the Government's record in the health service in every aspect of its work, referring to shortfalls of all kinds. My reply to that is yes, of course, it is not perfect; and, yes, of course, much remains to be done. However, I would say—and with his ministerial experience the noble Lord well knows this—that in judging this Government's record on the health service we must have regard to the reality of the position from which the Government started.
Over the past eight years the achievements are impressive. If we look at the record since 1978, the last full year of the Labour Government, there are 4 million more patients being treated every year. They comprise in-patients, day patients and out-patients in hospitals. It is a very substantial number. But that is what the health service is all about. There are 12,000 more doctors and dentists—a quite substantial figure. There are 63,000 more nurses and midwives. There is more cash to the tune of 26 per cent. plus in real terms. I ask the noble Lord, Lord Ennals, to take note because he rubbed our noses in the fact that the EC had observed that we needed an extra 3 per cent. per annum in real terms in order to achieve the health

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service that we should like. This 26 per cent. in eight years, unless my arithmetic is wrong, is more than that figure; so we are doing something. I agree that there is much more to be done. This is as good a record as any government have achieved.
I should like to congratulate my noble friends Lady Trumpington and Lord Hesketh, and in particular my right honourable friend Mr. Norman Fowler, on what they have done. In particular I join with the noble Lord, Lord Peston, in thanking and congratulating the 800,000 dedicated health service workers who make this tremendous service possible. Of course, there are still complaints and delays.
It is interesting to look at the whole picture. I should like to pick up two points made by the noble Lord, Lord Peston. I was going to make precisely the same points. There are two major factors which will always ensure that demand exceeds supply. We are a longer-lived population; our expectation of longevity grows and grows. I become 80 this year and I confidently expect, the Lord willing, I might even get to 90. Who would have expected this 50 years ago? This is the same for everyone.
As the noble Lord quite rightly said, the older we get the more support services we need, which makes greater and greater demands. Alongside that there is the continuous stream of improvements in surgical and medical skill, not to mention anaesthetics, radiology and ever more ingenious drugs. Yesterday's incurable is today's curable. What wonderful news that is for everybody, and it is a great credit to the National Health Service.
I have had the interest in Guildford of seeing on my doorstep the development of one such scheme. Guildford and Edinburgh were chosen as the two pilot scheme sites for mammography screening following the success of the scheme in Sweden. The team in Guildford consisted of a surgeon with an international reputation, Mr. Boulter, who is an old friend of mine, a similar star radiologist, Professor John Price, a pathologist and an administrator.
The team spent two years making its plans on paper and it went into action about eight years ago to call up all women in its area between the ages of 45 and 55. It won an excellent response. The administrative work of call and recall is formidable, but it was successfully coped with. Patients with incipient lesions were treated with radiotherapy and success achieved with—what is even better news—ever-decreasing doses of treatment. As the noble Lord, Lord Ennals, will know, often in the past radiotherapy did more damage than benefit. But the team had the most valuable experience in that respect.
The experiment was completed, and it was critically structured with some areas where there was no such treatment to see what mortality was in those areas. The experiment proved that early diagnosis and treatment save much mortality and very much suffering. Hence the report of Sir Patrick Forrest and the health service adoption of the policy for the national scheme for the whole country as rapidly as possible. I should like to make the point to my noble friend Lord Hesketh (I am sure he will take it away) that the training of the teams for the 100 centres to he set up will be formidable. It will be a major
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undertaking which will need the greatest possible attention.
This is a wonderful story. Many such things are happening today. Each one makes greater demands on the health service and gives rise to greater cost. I have mentioned the scheme in Guildford because I was lucky enough to see it. However, when we think of the cost and the burden of the research work and the treatment for AIDS, which are bound to grow and grow, we must make the point that this demand will continue and continue. There will always be some delays and shortages. Even with the present Government, who have a very good economic record whatever noble Lords opposite may say, it is possible only to increase the funding of the health service by a certain amount year by year. Therefore, there will always be shortages somewhere. To go at a faster rate is to court disaster and leads to overspending; you end up not only without an increased health service but a sharply reduced one.
The experience of 10 years ago, which the noble Lord, Lord Ennals, so painfully had himself as the Secretary of State, confirms that this is what happens. He actually had to cut the health service in order to bring it within the economic requirements of the day. These are the harsh realities of life and good intentions do not alone provide the health service of our dreams. We have to watch all the time how we manage to provide the money for such a service.
In my contribution to this debate I should like to say that by comparison with the record of any government of the past, and especially the government of noble Lords opposite, the record of this Goveernment in relation to the health service has been a good one. Not everything has been done; masses more remains to be done. However, I believe that this Government deserve a major measure of congratulation on what they have achieved.
4.55 p.m.
Baroness Seear: My Lords, I should like first to apologise to your Lordships' House for the fact that, owing to an engagement which I had accepted long before I knew that this debate was to be held, I shall not be able to be here for the reply from the Government Benches later this evening.
It gives me more than usual pleasure to congratulate the noble Lord, Lord Peston, on a well-informed and balanced maiden speech. We look forward to hearing from him on very many occasions. He is a necessary addition to his party's strength in this House. It gives me special pleasure because he was a colleague of mine from the London School of Economics before he left us to go to other places. Indeed, we are almost reaching the point when we need, or can justify an ex-LSE House of Lords society—something which once upon a time would have been considered a contradiction in terms.
In the brief time allowed to me I should like to say something about the paper, The Health Divide, referred to earlier this week and to which passing references have already been made. We cannot pass a debate of this kind without making further comment on this very important paper. It shows beyond a doubt the growing social inequalities in health and the extent

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to which these inequalities are due to not only failures in the health service (perhaps inevitable failures in the health service) but also to a whole range of social issues which require attention on the preventive side.
We have to remember that although the National Health Service spends most of its time curing people, it is far better to prevent than to cure. If some of the advice given in this report was followed up, prevention would be a great deal more effective and would in turn save resources. It is highly important that this report should be properly followed up. It is well-documented; the evidence is beyond question, and the picture that it shows is of quite unnecessary ill-health and early death arising from a whole variety of causes, some of them preventable. In a debate of this kind this is a matter which we cannot possibly ignore.
Having said that I must also say that we on these Benches deeply regret the fact that the Government have seen fit to change from the Health Education Council to the newly appointed Health Education Authority. We ask them to give the true reasons why they have seen fit to make this change. We are also much concerned about the change in the nature of the work to be done by the new authority. The Health Education Council had the duty not only to educate but also to promote good health. In the light of the information contained in the report, there can be no shadow of doubt that health promotion, as well as health education, is urgently needed.
Health promotion is part and parcel of the preventive work which I am sure all noble Lords agree needs to be done. Why then have the Government said that the new health authority will not have a promotional function but only a much more limited educational function? This would appear to be a step backwards and a step which we greatly deplore. We also deplore the fact that the new authority is to be a limb of the DHSS and is not to be an independent body. Surely in a matter with the ramifications for health that the National Health Service has, serving so many people across the country, it is extremely important that there should be an independent body able to speak its mind based on the information that it collects—a body which is seen to be separate from the DHSS. To have moved this body into the DHSS, or rather to have moved it directly under the DHSS, is surely a retrogressive step. We should very much like the Minister to explain why the Government thought that it was necessary to take this step.
It seems to me that this is yet another example of this Government's extraordinary determination to centralise wherever possible. That is a most extraordinary development for a Conservative government. Whatever the demerits of previous Conservative governments, nobody could have said that they were centralisers, but this Government seem to wish to centralise everything they can lay their hands on. They have now centralised this council. We deeply regret that and we should like to know what the justification for that was and to say that we believe that a powerful independent body which could voice its findings about the state of health in this country is a very necessary part of the whole machinery for making the National Health Service and society as a whole work properly.
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The question of machinery is a big question which in the tail-end of a Parliament, as this can now presumably be described, probably must be a matter to be discussed in the future. However, looking at the problems of the NHS, is it really sensible to have the great variety of things which are covered by it at the present time in one department, one huge DHSS? Surely there should be a Minister for the National Health Service who could concentrate on the problems of prevention, cure and health. Surely that is job enough for one man. Why cannot it be under one person? Why does it have to be dealt with by a department which handles such complex matters as pensions and the payment of benefits and general social services? Surely the NHS is a job in itself which a Minister should do? Those of us who try to deal with government departments know what a very great advantage it is if one can deal with a Minister whose attention is entirely focused on one particular field of work.
In the two or three minutes left to me I wish to pick up some things which have already been said about community care. Moving people from institutions to community care is generally approved of. I urge the Government to look at this very carefully indeed. I suspect—and I am not qualified to say this with any authority—that there are some people, especially the mentally handicapped, for whom moving out of an institution may be very difficult indeed. They may have been there for a very long time and have come to terms with the institution and have made a world for themselves inside that institution which they can understand.
While I and my noble friends on these Benches are entirely in favour of the general thrust towards community care, we should like to state a reservation that there should be careful examination of that residue of people for whom it surely will not be suitable. Consideration should be given to how their needs will be met.
For those who come under community care there must be community care, not just a pushing of people out of institutions back into society, into bed and breakfast accommodation from where they wander around during the day trying to find somewhere to go and something to do. That is not community care. Nor is it community care to expect families, however devoted, to take on the total caring of people who come out of institutions.
For 20 years I have been chairman of the National Council for Carers and the Elderly Dependants and I know that the problems of the carers are acute, unless they are very well supported. It is hypocrisy to talk about community care unless the Government are prepared to provide a far larger home-help service, a far better local nursing service, day centres, respite centres and respite opportunities so that people can put those for whom they are caring into some kind of home for two or three weeks in order that they can get away. Help should be available with sitting-in. Indeed, a whole range of things are necessary. We need a charter for carers if community care is not to create almost more problems than it solves.
5.5 p.m.
Lord Hunter of Newington: My Lords, may I first add my congratulations to the noble Lord, Lord Peston, on his maiden speech. Preventive medicine, which has been coming to the fore in this debate, if successful saves lives and prevents ill-health. It also saves resources, but what is distinctive about it is that in order to be successful it requires the co-operation of individuals and often requires the support of the community.
Sometimes success depends on one thing; for example, inoculation. Sometimes it depends on a combination of inoculation, public health measures and thereapy. I shall give a number of examples. Fluoride prevents dental caries. A poll conducted in February this year by the National Association of Health Authorities found that 76 per cent. of people thought that fluoride should be added to the water supply and 15 per cent. were against it. What do we do? If there is a decrease in dental caries in the young, there will be more dental capacity to look after the increasing number of old people, perhaps at no additional cost. Will the Minister please tell us how many local authorities at the present time add fluoride to the water supply?
The virtual elimination of tuberculosis required the combination of preventive inoculation, public health measures and drug treatment. The result is that there has been a massive redeployment of staff and hospital resources which were previously committed to the treatment of tuberculosis. This made more room for the long-term sick and many others. However, in order to maintain this situation there must be constant vigilance and preventive measures, urgently applied if necessary; and this means public co-operation.
Inoculation is very effective in preventing whooping cough and measles. With whooping cough there has been some damage in the past. As your Lordships know, the resultant campaign, conducted because of sympathy for the sufferers, has had a devastating effect, lowering the whooping cough inoculation rate and influencing the measles inoculation rate which at the moment is perhaps about 40 per cent. The children who are not inoculated are exposed to risk, particularly when they go to school. The risk is serious, the worst complication being meningitis. Should we require inoculation against measles of all children before they go to school? In the United States this has virtually controlled the disease. However, this is a matter for the expression of public opinion. The means to do it are available and can be provided by the National Health Service. Perhaps I may ask the Minister for the present inoculation rate for measles.
In recent weeks the noble Baroness, Lady Trumpington, has made a number of announcements about funding. These have been referred to. The most recent were announcements about research into AIDS and screening for breast cancer. Additional sums have been made available for cardiac surgery and screening for cancer of the cervix. In these days of patient awareness, the demand to see patient records and the desire of any patients to make their own decisions about treatment, and also the increasing threat of litigation, I thought it might be helpful to analyse these situations just a little further, remembering perhaps
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that one is talking about guidelines and evidence and that the diagnosis and treatment of individual patients requires very specialised skills. This is the kind of evidence that is taken into account by courts of law concerned with claims for negligence.
Regarding AIDS, the substantial sums mentioned by the noble Baroness, Lady Trumpington, were for research to try to find a vaccine. Additional sums were also provided for the care of sufferers. There is no treatment—only prevention by individual decision.
With regard to carcinoma of the cervix, it took 50 years from the time that Marie Curie discovered radium until an effective safe treatment was developed which did not cause damage to patients or doctors. Here the emphasis is on early diagnosis because an effective safe treatment is available. The substantial sums mentioned by the noble Baroness and the noble Lord, Lord Nugent of Guildford, for screening for carcinoma of the breast are again given for different reasons.
In 1971 the first results were published in the United States showing that the early detection of breast cancer had a mortality one-third lower than undetected cases. These results have now been confirmed in Sweden, the United Kingdom and Canada; but the importance of this finding and why it is being strongly supported is because radical excision has not been shown to be of greater benefit than simple excision, and radiotherapy in some cases is disappointing. Expert advice is required in individual cases; but this investment in screening by mamography is of great importance. Again, it requires co-operation. As we recognised, the sums voted so far are modest—one centre for each region. What of the future? How rapidly can this be spread? They are matters of public concern and public opinion.
Hepatitis B presents a different problem again, and I suspect that it would have been very much in the public concern if AIDS had not happened when it did. The virus is known, the diagnostic tests are available and vaccines prepared from antigens in the blood are already on the market. The antigen which is now licensed in Britain is perfectly safe for infants. If we could immunise the entire world population, and immunise babies born to carrier mothers at birth, all cases would disappear in two generations.
In practice, what can be done? Ideally in Britain we should screen all mothers and immunise the babies of carriers at birth. That would be ideal, but it seems absolutely essential that all mothers of Chinese, African, Indian and Asian origin should be tested. What responsibilities do we have? Is this a health-promoting exercise which should have a high priority? Will the Minister say what is the Government's policy as regards this serious matter?
Additional sums have been set aside for coronary by-pass operations. But the sums became available for a different reason again. Controlled clinical trials were started and then abandoned, such was the immediate success of the operation.
Thinking of these matters which are examples of health measures, where informed public opinion is necessary to influence the Government on the expenditure of limited resources, one is considerably

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distressed by the changes that are taking place in public opinion in relation to medicine.
As the noble Lord, Lord Pitt, said in the debate of the noble Lord, Lord Hacking, on civil liability, the United Kingdom is following the American pattern in many fields and solicitors are advertising for dissatisfied patients to consult them on a non-fee basis. I agree with his view and those of the British Medical Association on the need for no-fault compensation.
We in Britain are fortunate in having general practitioners available as a gateway to the health service, and it is hoped as a guide, counsellor and friend to the patients. The importance of this cannot be exaggerated. When this is absent, patients may choose their own doctors perhaps for the wrong reasons, and they are often actually aware that the meeting has a financial basis. As a result of this, relationships can be clouded and doctors tend to do many tests to cover themselves because of the possibility of litigation, perhaps when such tests are not strictly necessary. The results are further increases of costs. I sincerely hope that that spiral does not happen here.
There are two vitally important areas for all members of the public to have an active interest. First the positive approach to their own health and measures about their lifestyle; and secondly, an opinion about matters of the kind that I have referred to earlier in my speech where public opinion can make the difference between success or failure.
5.14 p.m.
Lord Soper: My Lords, I begin with congratulations on my own part on the maiden speech of the noble Lord, Lord Peston. It was admirable and, if I may say so, one of erudition and warmth, and I am sure that the House will be in his debt on many occasions in the future.
I have said often and say again that in my experience the welfare state is the most Christian thing that has happened in my lifetime. The older I become the more convinced I am that that is not untrue. It is for that reason that I am more concerned by the kind of erosion of its principles and the occasions of default in its practice which were enumerated in a bristling catalogue of information about the welfare state and the National Health Service in the opening speech of the noble Lord, Lord Ennals, and for which I was extremely grateful. The accusations have not been met.
I presume to take what I have to say from an experience which is mine. I was instrumental in founding the West London Day Centre some 15 years ago. I have looked into the experiences of that day centre for the kind of evidence which I presume to present before your Lordships in the realm of the National Health Service, and in particular in the difficulties which it faces and the omissions for which I believe there must be a speedy remedy.
The first is the question of prescription charges. Your Lordships have been told this afternoon that since the last Labour Government the charges have risen from 20 pence to £2.40. The British Medical Association and British Dental Association have
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passed comment which I think is worth repeating. The British Medical Association states that there is a large measure of deterrence as prescription charges increase, and that more and more people who ought to be treated are making the choice—however silly and economic it may be—to refuse or not to accept the responsibility of doing what the doctor says when it will cost them something to do it.
The British Dental Association has been more specific. Only the other day it said that the prescription charges are excessive and socially divisive. I found that to be the experience of many people in the day centre. I believe that that fact has been enlarged and established in speeches which have been made in your Lordships' House this afternoon. I believe that the whole concept of the welfare state is imperilled by the prescription charges.
Secondly, as I looked into the experiences of those who come into the welfare centre, I was impressed by the long delay, accompanied by much suffering and pain, which is the accompaniment to the kind of problem about which your Lordships have heard a great deal today. There are 600,000 or more people who need relief from pain and who are denied access to the opportunities of that relief.
Representation of fact by the St. Thomas's Hospital implies that of the 10 health authorities in London and the South-West the cut in beds will be by 15 per cent. to 36 per cent. before 1993. I am a little allergic to statistics; one can prove almost anything by them. However, I suggest that the evidence is incontrovertible: that the absence of opportunities at the emergency state has been increased and is constantly being increased.
I have a simple comment to make about that. Pain is a sufferable but sometimes an almost insufferable condition. Noble Lords will not think that I am sentimental if I remind myself that there are a great many people who are in considerable pain every day of their lives and in a society which could afford, if it was only conscious enough of its moral responsibility, to do more for them than to say, "You will be postponed in your treatment for so long". That time seems to become longer as their pain increases. This is, I believe, an experience in that the microcosm of the West London Day Centre is represented in the macrocosm of society as a whole.
There is an even more serious element. It will not surprise your Lordships that quite a number of people, when you mention in this day centre the welfare state or the national health condition, regard it as a rather sick joke. They feel that they have no part in it, that they have no access to it; and in particular this is true of the homeless. I shall read to your Lordships, if I may, a short excerpt from a publication by UNLEASH, which is the United London Ecumenical Action on Single Homelessness, an imposing statement of participation. There is an even more significant statement in the publication itself:
"To be single and homeless for any period of time is to endanger one's own health to a far greater degree than normal; yet normal health care is precisely what is commonly denied to single homeless people. Numerous studies have shown that homeless people not only suffer from higher levels of illness and handicap, but also are likely to have much greater difficulty in gaining access to health services.".

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That is the experience that we have undergone in the centre to which I refer.
One of John Wesley's injunctions to his followers was in a document called Twelve Rules for a Helper. One of those rules which was impressed on me when I was a student was:
"Go to those who need you, and specially to those who need you most".
I believe the homeless are those who are in the greatest need. Remember, if you will, that a great many of these homeless are not destitute in the old-fashioned Dickensian sense. They are without a house to live in or an accommodation in which they can lay their heads, and they find it increasingly difficult to believe that the National Health Service really is concerned with the overall well-being of the community as a whole.
I do not say that with any rancour. I say it because it is an increasing experience of those who are not particularly susceptible to all the statistics of the increasing amount of money that is given to the health service; whereas there seems to be an ever-increasing divide between those who have, and have the opportunity of having more, and those who are impoverished and find very little access to those means of the welfare state which are often trumpeted as their opportunity.
I believe in the welfare state because I believe that it is substantially the only way in which you can create and maintain community. I deplore the invasion of privatisation which is a thoroughly un-Christian word, and the invasion of what is called caring capitalism, which in my judgment is a contradiction in terms.
I therefore press the House, if I may, that we take much more seriously our opportunity of doing two things: of spending more money in ways which have been academically set forth in your Lordships' House this afternoon by which we could immensely improve the whole working of the health system if more money were centrally offered to those projects which are now in decay; secondly, to rededicate ourselves to the concept of the welfare state, which is the only way to rescue the health service as it is now from an increasing polarisation and the decreasing sense of its commitment to one of the prime requirements of a civilised society—to care for all, and to expect from all that which they can contribute to that care.
It is in that respect that I offer these comments. I hope that out of the conversation this afternoon there may be more caring, and in that caring a new dispensation for the welfare of those who are our brothers and sisters and to whom we owe, and should continue to owe, the duty of comradeship.
5.25 p.m.
Baroness Cox: My Lords, I too congratulate the noble Lord, Lord Ennals, for initiating a debate which covers so many matters of great and urgent concern. I also congratulate the noble Lord, Lord Peston, on his excellent maiden speech. I must apologise if I have to leave just before the end of the debate due to a longstanding commitment to chair a meeting which cannot take place in my absence. I apologise.
While this debate gives my noble friend the Minister a most welcome opportunity to emphasise the very
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real achievements of the Government, it also provides an opportunity for other issues to be raised for consideration and, hopefully, for reassurance by my noble friend. I shall confine my contribution to just two issues: community care, and my own profession of nursing.
The principles behind the policy of community care are commendable. Of course in appropriate circumstances it is preferable for people to enjoy the greater freedom and independence of life in the community rather than to become dependent and institutionalised in long-stay residential care. In many places arrangements for transition from residential institutions to life in the community are imaginative, sensitive and finely tuned to the needs of each person. Where this is happening, this is good news.
However, sadly there are also many reports of real suffering due to unsatisfactory transfer to community care. The people involved are very vulnerable: they include the mentally ill, the mentally handicapped, and the elderly. Many have been residents for years, even for decades, in places which often had the good characteristics of the term "asylum"—institutions offering refuge, security and care in a protected environment. For thousands of residents their residential institution has been home; it has been their world. For them, to be moved out into the community can be a dislocation of their entire way of life and of all the human relationships which make life meaningful.
There is no shortage of evidence of concern for real suffering. Organisations such as RESCARE, the National Society of Mentally Handicapped People in Residential Care, and the National Schizophrenia Fellowship have been urgent in their pleas to rethink the massive shift to the community, or at least to slow it down until really adequate alternatives are available. Also, the Audit Commission report Making a Reality of Community Care, and the report published by MIND, When the Talking has to Stop: Community Care in Crisis, both discuss problems for those who have already been discharged into the community—problems caused by indadequate funding and staffing, fragmentation of responsibility and poor communication.
In the temperate words of the Audit Commission report:
"It is not surprising that joint planning and community care policies are in some dissaray.".
The MIND report claims rather more graphically:
"Community care is not dumping all responsibility onto informal carers, in the vast majority of cases women; it is not pushing people into bedsit poverty and isolation; it is not hostels which, rain or shine, turf people out at eight in the morning until five at night; it is not homelessness and destitution … scandalously, this is what it means to so many people at present.".
I am aware that the Government have set up an inquiry into community care to be chaired by Sir Roy Griffiths, but can my noble friend the Minister indicate what steps are being taken now to alleviate the anxieties and sufferings of people such as these?
This leads into my second topic, nursing. A part of the solution to some of those problems could lie in the development of neighbourhood nursing services as proposed by the Cumberlege report, and endorsed by the report of the Social Services Select Committee on Primary Health Care. Perhaps 1 may ask my noble

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friend the Minister whether the Government will at least consider setting up some pilot or experimental schemes embodying some of their recommendations, such as the establishment of community nursing services in smaller units; or the establishment of some nurse practitioner posts with specified powers of prescription; or the development of some schemes with appropriately trained nurse practitioners working with GPs to provide a complementary service for elderly people; or, finally, a manpower planning exercise on the training and supply of community nurses. Such measures could not only involve improvement in community care but could also lead to more effective nursing, which would enhance professional job satisfaction. I think some reassurance from the Government on those lines would mean a great deal to the morale of the nursing profession.
It is urgent, because nursing in general is in a state of crisis, as the noble Lord, Lord Ennals, emphasised. It is in a crisis of recruitment and a crisis of training. One-third of students fail to complete their training. There is a crisis of retention of trained staff and a crisis of shortages of staff in many parts of the country, shortages so extreme that wards have had to be closed. Morale is at an all-time low in many places. That is not surprising, especially given the pay and conditions of service. A qualified staff nurse, after over three years of training, earns a mere £6,475 a year—now much less than the new scales for non-graduate teachers.
Conditions of service involve work which is inherently stressful. For example, research has shown that student nurses, caring for patients who are in severe pain or who are dying, experience stress levels comparable to those occurring during major personal tragedies, such as bereavement. There is the unremitting responsibility of being in the front line of patient contact, where errors may mean serious physical harm and even death.
I ask my noble friend what reassurances the Government can give to the nursing profession. Recent pay awards recommended by the pay review body were not given immediately in full. They were staged in a way which appeared churlish and resulted in a real loss of salary of several hundred pounds for each nurse.
My noble friend may respond by pointing to an increase of over 50,000 in the numbers of nurses and midwives. But those figures cannot be taken at face value. Nearly half of that increase was needed to compensate for the reduction in the working week, and the remaining real increase of about 27,000 also needs to be put into context. For example, those figures include untrained staff, and also much of that increase had already taken place by 1983, since when there has not been much growth.
However, as we have heard, there is great and justifiable pride in the increase in the number of patients treated. For example, in-patients have increased by 18 per cent. and day patients by a staggering 71 per cent. But that quicker and more cost-effective throughput means that patients are in hospital for a much shorter time, during which they are much more dependent and require much more intensive nursing care. The increase of around 7 per
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cent. of qualified nursing staff between 1978 and the present has to care for far greater increases in patient numbers and needs. This is often associated with great stress for the nurses and what is in technical jargon often called "burn-out".
It is not surprising that nurses are leaving in droves. Even more worrying perhaps is the decline in new entrants, with a drop in the number of school-leavers, but also, sadly and significantly, fewer of those choose to go into nursing. There is a real danger that if the Government do not respond appropriately to these crises in the nursing profession there just will not be enough nurses left to staff the NHS. The National Health Service itself could then face a crisis of unprecedented proportions.
I appreciate the reassurances given earlier this afternoon by my noble friend, but I also urge him to consider very carefully the questions which I have raised, so that not only can nurses be encouraged but also those for whom they are responsible can benefit from the highest possible standards of health care which we as a nation would wish them to receive and which the National Health Service was established to provide.
5.34 p.m.
Lord Porritt: My Lords, thanks to the initiative of the noble, and perhaps this afternoon slightly bellicose, Lord, Lord Ennals, we are again discussing the state of the National Health Service. Medically speaking I feel that that state is such as to give rise to acute anxiety. The NHS seems to be suffering from an extensive number of serious diseases.
There comes immediately to mind a severe lack of financial sustenance; repeated and continuing attacks of acute wasting disease; painful disability from increasing rigidity; an apparently unlimited degree of giantism as evidenced by overmanning in excelsis and overbuilding in extenso—big is not always beautiful—plus excessive doses of misplaced and blinkered enthusiasm derived from short-sighted estimates and contorted values. Add to this psychologically an insidious growth of material and monetary motivation which has been steadily eroding those idealistic and humane characteristics with which the service was endowed when it was born. All this being so, I cannot help feeling that there is an urgent case for emergency surgery, followed by prolonged intensive care and after that a long rehabilitation.
I trust that your Lordships will not feel that it is in any way a frivolous contribution with which I have started my words in a serious debate. I can assure the House that the words I have used are not lighthearted. In fact it was with rather a heavy heart that I finally decided to take part in today's proceedings and risk once again skillful brickwall treatment in an attempt to get beyond the hotchpotch of piecemeal and hand-to-mouth methods by which the affairs of this colossal organisation that we call the NHS is managed today. We should get back to and get down to an unbiased, wide-ranging, long-term strategy for the future. Only by such a non-partisan, non-party and, I humbly suggest, non-political approach can we hope to save the best of this fine idealistic concept which is both financially and administratively slowly strangling itself in front of our very eyes.

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One of the advantages of growing older—I am pretty well ahead of the noble Lord, Lord Nugent—is that to some degree one can see things more clearly in perspective. Some 40 years ago, admittedly on the outskirts, I was involved indirectly and to a very minor degree in the early days of the NHS. I met socially, got to know, admired and liked Aneurin Bevan. His Welsh oratory, his shrewd political sense, his opportunism and almost evangelistic enthusiasm, singled him out as a very special individual. His Achilles' heel was his quite rigid socialist idealism. His health for all given free (so-called) at the point of delivery was simply against human nature. Financial stringency did not take long to make its unwelcome appearance and early charges for spectacles and dentures led to Bevan's resignation—a loss that must always leave, to my mind anyway, an historical query.
Ten years passed. The National Health Service seemed to prosper, largely owing to the loyalty of a not originally very approving army of general practitioners. The profession decided to see how it could improve the service after this initial experimental period and so the Medical Services Review Committee was set up. I was now very directly concerned as its chairman. That report, representing the views of the totality of the medical profession at the time, was constructive, comprehensive and practical. It was shelved by the Government.
The committee made three major proposals, among some 50 altogether. The first was agreed to soon after the publication of the report: namely, that the original three parts of the NHS—general practice, hospital practice and public health (what we now call community medicine and community care)—should be united to effect economies in administration and personnel. The remaining two, another 30 years on, still remain unsolved or unconsidered; namely, that the capitation system of remuneration of doctors is inferior to other methods. No other country in the world has followed our lead in this respect.
Secondly, the detailed administration of the service must be at the periphery, where doctor and patient, supplier and consumer meet. This is where detailed methodology should be dealt with: not at the one colossal monolithic centrepiece of the NHS as it stands at the moment.
So here we are now, with vastly increased commitments in responsibilities, buildings, equipment and staff of all sorts, struggling on with roughly the same old organisation, concerned chiefly with financing a system that has grown out of all recognition and improved to an almost magical degree over the intervening years. Why must the health service be a party concern? No party owns the national health. I must admit to being embarrassed and often disappointed when I hear able Ministers beating a party drum, metaphorically, to drown out the querulous and petty criticisms of an equally able opposition, as if the only solution to all the ills that beset the National Health Service is more, more and more taxpayers' money.
As I have pointed out on previous occasions, there are many other ways of raising money for such a vital matter as the National Health Service if only these could be considered in an open-minded, unbiased and
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long-term manner. Money, essential as it is, is far from being the only problem to be faced in dealing with a human clientele and a humane profession. The problems are important enough to require—even, I would say, to demand—wholehearted co-operation on the part of all concerned.
Why is it beyond the power of government—any government—to set up an independent group, preferably of people with a philosophical outlook, to advise medically and economically, to investigate the whole infinitely complex scenario, to be courageous enough to dismantle machinery where necessary and to plan a fresh start from basic principles?
Purely as tentative suggestions, I would envisage, as mentioned by the noble Baroness, Lady Seear, the study in depth of certain simple and fundamental questions. For instance, why must pensions be linked with health? There should be a more precise definition of health and illness: that is to say, preventive measures and therapeutic methods. Is the capitation system the best means of remunerating doctors? Is the technologically and scientifically trained doctor of today best suited to serve the better informed and more demanding patient of today? Why, in hospital management, administration and so on are 10 people required today to do the work of one 30 or 40 years ago?
Why do highly trained nurses have to become business managers in an office in order to gain promotion? Should the large modern hospital entirely take the place of the hostel-type of hospital, which deals so well with the geriatric and the mentally handicapped, and of the small urban and suburban hospital? As selective medicines become necessary, thanks to the amazing developments of modern therapy, how and by whom is the selection process to be managed? Also, is today's patient happier, either in the hospital or in the doctor's surgery, than his counterpart of 30 or 40 years ago?
These are simple questions. These simple questions and a hundred more that are pertinent beg for answers. Perhaps it is already too late. Ingrained habit is notoriously difficult to eradicate; but I would suggest that these sorts of questions fairly represent the state of the NHS today. I would not want to appear to be a prophet of doom—perhaps just a prophet in his own country—and I assure your Lordships that I maintain an unquenchable optimism that ultimately a great and historical profession will win its way through all its present difficulties and dilemmas.
5.44 p.m.
Lord Bottomley: My Lords, I should like to join with others in thanking my noble friend Lord Ennals for raising this subject for debate today. He spoke with his usual skill and knowledge. I should like also to congratulate my noble friend Lord Peston on a model maiden speech. He will be a very worthy addition to Her Majesty's loyal Opposition and we look forward to hearing from him often in the future. It is a pleasure to follow the noble Lord, Lord Porritt. When I was Secretary of State for Commonwealth Relations, he was the distinguished Governor-General of New Zealand.

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As Commonwealth Secretary of State and earlier as Secretary for Overseas Trade in the Attlee Administration, I had an opportunity for considerable travel overseas. It was with pride and pleasure that I learned how highly regarded was our National Health Service. The service was also admired and respected by the British public. I regret to say that this is not so today, as the standards of the service have fallen. In many other countries the provision of health services is superior to our own.
The creation of the National Health Service in 1948 was probably the greatest social advance of this century. During the post-war years it encouraged values of equity, social duty and solidarity. That the service was available to all through financing by the national exchequer brought security to millions who in earlier years had feared the cost of ill-health. It is the duty of the Secretary of State for Social Services, as laid down by the National Health Service Act 1977, to continue the promotion of a comprehensive health service, designed to secure improvements in the physical and mental health of the community and the prevention, diagnosis and treatment of disease.
Standards fall far short of these requirements today. Less is being spent as a proportion of the gross domestic product, and per head of the population, than in other comparable developed countries. The lack of public resources available to the National Health Service will mean a recurrent problem in providing the necessary health care for our people.
Since the early 1960s the proportion of the nation's wealth spent on public health programmes has fallen. Spending on the National Health Service has failed to match the rapid increase in the numbers of very old people in the population and the extra inflationary costs of medical technology. The National Health Service has been damaged by the growth of powerful commercial interests such as the new contract-cleaning companies, the private clinics, health maintenance organisations and private hospitals.
A Consumers' Association report has said that private hospitals will not necessarily give access to the best facilities. Private hospitals could be less able to cope if unexpected complications arise. National Health Service hospitals are much better equipped to deal with emergencies and complex operations than most private hospitals.
The private hospitals cream off the lucrative surgical work, leaving the care of the old, the chronically ill, the mentally sick and the handicapped to the state. They poach the nurses trained by the National Health Service. The role of health service consultants with part-time private practices is questionable, particularly with their use of NHS facilities. The government auditors' reports show that there have been substantial losses of revenue through non-payment for national health services.
Priority is given to private patients causing NHS waiting lists to be kept long, while instant treatment is available privately from the same consultant. The situation is aggravated by the government policy of cutting social expenditure and shifting the balance between public and private sectors and constructing a permanent unemployment economy. We now need to
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restate that the resources of medical skill and healing should be placed at the disposal of the individual when he or she needs them, that medical care should be a community responsibility, available to rich and poor alike in accordance with medical need.
The financial restraints placed upon the National Health Service have meant the postponing of essential services, cutbacks in research and the placing of obstacles in the way of improving training for nurses and professions supplementary to medicine. The NHS is still relatively efficient, in spite of the old, badly equipped hospitals. Hospital staffs are stretched to the limit and are among the poorest-paid workers in the country. The Government have neglected the NHS by their encouragement of the commercial sector. By their enforced privatisation programme and their inappropriate application of business principles to the managment of illness, distress and death they emphasise the need for a public service, free and available at the time of need.
The report Inequalities in Health is the most important document on health since the Beveridge report in 1942. It sets out an analysis of ill-health in contemporary Britain and strategies for the prevention of disease, and the encouragement of health. Its principal finding was that ill-health was strongly class-related and that the causes were to be found in the economic and social structure. Key factors such as accidents at work, overcrowding, a dangerous environment and poor nutrition have to be tackled. The National Health Service has to operate within a society dominated by powerful commercial interests. Its success in meeting the health needs of the population has been restricted by the conflicting demands of the market. The result has been an erosion of the National Health Service by government cuts in services and jobs, low wages, privatisation and charges for national health services.
There is an increasing neglect and despair of the very old and the mentally ill. For all the major advances in eliminating the old killer diseases and development of powerful therapies, the general health of the population is improving less rapidly than in other European countries.
The regional and district health authorities are undemocratic; they are not elected; many of those who serve on the committees are appointed and they do not live or work in the area for which they are responsible. Among the community there is a strong sense of an imposed and alien authority. As an illustration, an admiral who was partly responsible for the privatisation of the Royal Naval dockyards is now the chairman of the regional health authority. There must be more political awareness of the need for the resources of the community to be used in the service of the people and not for managerial staff to control and operate.
5.55 p.m.
Lord Hastings: My Lords, I shall not enter into the political debate going to and fro across the House. I rather agree with the view which has been expressed that if we can keep politics out of health, so much the better.

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I happen to know two groups of disabled and handicapped people which I want to talk about because I am sure the House will agree that that at least is a non-political issue. One of them has been mentioned: that is, the mentally handicapped. I see a lot of mentally handicapped children much of the time and many young mentally handicapped adults in the working villages of the CARE organisation, in the Camphil organisation, and in the Gateway clubs for young adults run by MENCAP. These are nice people, fully capable and fully deserving of a good life, enjoying and appreciating it.
When we talk about care in the community, I think the noble Baroness, Lady Seear, gave a warning note with which I entirely agree. The noble Baroness, Lady Cox, very effectively enlarged upon this issue and I agree with every single word said by both noble Baronesses. Having listened to the noble Baroness, Lady Trumpington, making this one of the main issues of her speech and stating that a lot of money is being spent on providing extra social psychiatric workers as well as extra day centres, I find that this is good news, but she failed to mention accommodation.
I should like to know where these people are living. Arc they in council houses? Are they in rented flats? Are they in hostels? Where are they and what are they doing during the daytime? What sort of supervision is being given to them? They cannot just be left to get on with things by themselves. The accommodation issue is one which I would ask the Government most sincerely to investigate thoroughly. I should like to be told whether they even know—we should all like to know whether they know—the answers to those questions, because it is a very serious matter indeed.
I have heard of schemes where instead of selling off hospitals, or at least not selling off all their grounds, the outbuildings can be adapted, new ones can be built and a little village can be created within the grounds which is not far removed from the general community, because many of these hospitals are right in the middle of it. Yet they would still have a small clinic for their daily care which they will need. Have the Government heard of such a scheme? Have they examined such a possibility? Are the Government selling all the hospitals, and if so, where is the money going? I think we should like to know.
I am afraid that some of these mentally handicapped people—I am not talking about the mentally ill but the mentally handicapped—will end up in trouble if we are not careful, because they are innocents abroad. Instead of ending up back in hospital where they came from, some of them may unfortunately end up in prison, a place where they should never—I repeat "never"—in any circumstances be sent. This is the danger.
Now I should like to turn to an even smaller minority group, the mass of the people who suffer from epilepsy. Some of your Lordships may remember that I said on another occasion that I had been the president of the British Epilepsy Association for well over 20 years; and I declare my interest again. Over the last 30 years, there have been several reports on this subject. There was the Cohen Committee in the late 'fifties, then the Reid Committee which reported in 1969—when something actually was done—and
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then the Bennett investigation into the results of the Reid report. Finally, there was this document, the report of the Working Group on Services for People with Epilepsy, which was asked for by the DHSS itself and produced in 1984, but not, strangely enough, sent out and made available to those interested until July, 1986.
Then a circular was sent out by the DHSS saying:
"It is not however the DHSS's intention that the report should be treated as a 'blueprint' for the provision of services by all authorities. It is hoped that the report will stimulate discussion on the scope for improvement.".
Then later, on the question of funding—and I have had correspondence with the department on this matter—I was told that the responsibility for funding lands firmly upon health authorities and depends entirely on the extra funds made available to them by the Government. But the decisions are the health authorities' own according to their priorities and the resources available. That is a classic formula for doing absolutely nothing. I know it, everybody else knows it, and I am quite sure that the Government know it. I think that this is not quite fair and not quite good enough.
The main recommendations are simply that, in addition to the three special assessment centres—one at Oxford, one at Chalfont and one in York set up after the Reid Committee—there should be two more, one in the Midlands and one in the South-West. They should have supra-regional funding, which means that the Government have to pay, and that, I am afraid, is what the DHSS does not like about it.
The other important recommendation is that there should be special epilepsy centres attached to neurological units in as many general hospitals as possible. There are diabetic centres and it is not very difficult to have epilepsy centres, yet this has not been pushed at all. I ask the Government simply whether they have followed up that circular. It went to health authorities, social workers, local authorities, district councils, county councils and a whole lot of people who ought to be able to get together and do something.
This is a small but important group. These people suffer and there is no reason why they should. They are perfectly capable of having a very good life. Lots of other people do not even know that they have epilepsy, but if it is known it is still a local stigma and the Government, with very little money, could do an awful lot. I simply ask them, please, to follow up this report, not let it gather dust, ask all these authorities what they are doing and say, "Please, even if we, the Government, do not have to pay, find the money for it".
6.3 p.m.
Baroness Robson of Kiddington: My Lords, I should like to join other noble Lords in thanking the noble Lord, Lord Ennals, for raising this issue yet again. I should also like to join in the congratulations to the noble Lord, Lord Peston. My noble friend Lord Winstanley referred to the fact that this is the third time that he has had to listen to the noble Lord, Lord Ennals, making more or less the same speech—
Lord Ennals: No.
Baroness Robson of Kiddington: He did.
Lord Ennals: He did, but he was wrong.
Baroness Robson of Kiddington: But, my Lords, I have been present on at least two of those occasions and I have been staggered by the similarity of what has been said. On every occasion we have heard from the Government that they have put a lot more money into the health service. From this side of the House we refute that argument, or try to.
As a former regional chairman, I thought that I would look at the regional cash allocation for the year 1987–88 and what it means for the regions to try to solve this problem. Is the extra money really extra money? There is built into the 1987–88 allocation 3.75 per cent. for increases in pay and prices. All inflation above that figure will have to be met by the health authorities out of the total budget.
Much has been said in this debate already—and there has been no disagreement on nurses' pay—about the loss of nurses to the health service. I wonder whether anybody in this House believes that the review bodies for both doctors and nurses are likely to recommend pay rises within that limit if they want to stop the drift of nurses out of the service. I do not believe that they can. The inflation of prices is immaterial compared with what we ought to pay the people who serve us in the National Health Service for lost ground within recent years. I should be very surprised if the Government, in an election year, even attempted to keep the pay increase to below 3.75 per cent. On the basis of the inflation allowance to the regional health authorities there is a very bleak outlook.
Additionally, over quite a number of years the NHS has been under pressure to produce extra cash through compulsory efficiency programmes. I am not against saving money through efficiency programmes. It started even before I left the health service, but it was always understood that that saving should be for developing the service. It should not be for topping up the inflation charge that the Government are not allowing to the health service, and, in practice, almost all of the savings have gone towards meeting the costs of pay awards.
In addition, I must grant the Government, in this year's allocation the NHS is receiving a 1 per cent. growth in real terms, presumably for development. This 1 per cent. has to cover all extra costs associated with the increase in the elderly population and technological advances based on extremely expensive equipment. As well as that, the Secretary of State is now setting targets for various types of care which he wants to see improved, such as renal services, cardiothoracic services and hip replacements. We all want to see those services improved, but they have to be paid for out of the 1 per cent. growth money, plus the savings achieved through efficiency programmes.
Thus we are asked in the NHS to use all our savings twice over. We are asked to use them to top up the pay awards over 3.75 per cent. and we are asked to cover increased charges, because the population pattern has changed and technological advance asks us to invest more money. I have never heard anyone adequately
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dispute that the figure necessary to cover both demographic change and technological change is at least 2½ per cent. per annum. It follows that the future is grim so far as any improvement in the service is concerned, and we may be approaching a time when rationing will be the order of the day.
If we add to that in certain regions, such as metropolitan regions, the additional problems of RAWP, then the picture becomes even bleaker. The four inner London regions were asked to cut £109 million in acute service spending between 1983–84 and 1993–94. In the years 1983 to 1985, they have achieved 74 per cent. of the planned 10-year bed reductions. However, they saved only £30.9 million or 34.5 per cent. of the projected revenue reductions. One does not need much imagination to visualise the deterioration in services which will result from a further compulsory saving of £78 million.
I should therefore say that the picture is in line with that painted on this side of the House. The increased moneys which, according to the Government, have been given to the health service have been more than spent by the changes that are necessary. Improvement is therefore minimal.
I was also in agreement with the noble Lord, Lord Ennals, and was very concerned when he referred to the excessive hours worked by junior doctors. It is a frightening thought that a junior doctor who has been on duty over a weekend should not be allowed off duty until the end of Monday. I do not believe that one can ask people to make reasonable judgments after working such excessively long hours. Long before I retired as a regional chairman, and as long ago as 1980, there was a plan to increase consultant cover in order to deal with this problem. I should like to ask the Government how many new consultant posts have been created and how many regions have been able to afford to take up the possibility of appointing new consultants. I can remember in my day that two consultant posts were granted and the districts in my region could not afford to take them up. I should therefore like to know how many consultants have been appointed.
I was going to speak for some time about the Health Service Commissioner, which was what I really wanted to speak about. However, I see that my time has run out and I therefore hope that on the next occasion when the National Health Service is discussed I shall be able to make my point.
6.15 p.m.
Lord Dean of Beswick: My Lords, along with previous speakers in your Lordships' House I wish to express my appreciation to my noble friend Lord Ennals for giving us the opportunity to debate what is probably the most important personal service that we as a nation provide. I also congratulate my new colleague, my noble friend Lord Peston, on his maiden speech. Knowing his reputation, we expected a high standard and I think that that was achieved. I have no doubt that we shall hear from him on numerous occasions in the future.
For part of my contribution, I wish to deal with a specific problem in an area of Manchester. Much has already been said about the National Health Service in

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a national context. We are sometimes a bit repetitive in highlighting the same problems. However, I was interested to hear the contribution of the right reverend Prelate the Bishop of Manchester with his knowledge of Manchester and Salford. Those who do not know the geography of that particular area may not realise that Manchester city centre and Salford actually meet. They are separated by the River Irwell.
Manchester and Salford are very much interlinked in terms of needs and wants. In speaking of that particular area, we are referring to one of the most deprived areas in the United Kingdom. Previous speakers have mentioned London and what I shall say could be applied to many of the major conurbations. A short time ago we discussed these matters in a debate concerning inner cities. Those areas need—I do not say demand—a higher proportion of care in dealing with their problems than the more affluent areas. I shall not go into many statistics. However, it is a fact that in the major city areas and certainly in the Manchester area there is a far higher incidence of death through heart failure. People die much younger on average, a high proportion of people die due to various forms of carcinoma and a child born in the centre of such cities has, as I understand it, four times more chance of dying before it is 12 months' old than a child born in one of the better areas.
Manchester has three area health authorities: the Central Health Authority, the South Health Authority and the North Health Authority. Most of my remarks will concern Central Manchester Health Authority. However, they are indicative of what is taking place in most areas. There is an increasing workload and a diminution of resources to deal with the situation. Like the noble Baroness, Lady Robson, I intended to make one speech and I find that I must make another in order to get my points over. However, the fact is that between 1982 and 1986 Central Manchester Health Authority lost, in terms of financial support, nearly £3 million. That is a lot of money. At the same time, between 1st April 1982 and 31st March 1985, there was an increase in workload. In-patient workload increased by nearly 9 per cent., district specialties increased by 22 per cent. and day cases increased by 29 per cent.
The more mundane part of what I wish to say concerns the fact that there has been a further load increase placed on Central Manchester Health Authority, whose main hospital is Manchester Royal Infirmary, by the closure of the emergency and casualty department of Ancoats Hospital. Anyone who comes from that side of Manchester, as I do, will know that Ancoats Hospital was a small hospital which dealt with many local cases. It had mystique and many people in that area literally did not know of any other hospital. That was their hospital and it flourished in the past, very often because the local people donated generously in a charitable way to keep the hospital going. What has happened is that the accident and emergency services have had to close.
A few weeks ago there was a debate in another place in which the Member for central Manchester and the Member for north Manchester highlighted the difficulties raised by the closing of these accident and emergency services in that hospital and what was happening. I should like to give briefly some of the
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statistics which have been quoted concerning the burdens which will fall on the Manchester Royal Infirmary, without, as I understand it, additional funding. A document I have states:
"In 1986, the MRI Accident and Emergency Department treated 43,286 new patients and 7,071 follow up patients. Total: 50,357".
The document continues:
"It is impossible to quantify the effect the daily short closures of Withington Hospital Accident and Emergency Department will have on the MRI".
That is a hospital in south Manchester where facilities have also been withdrawn. It places an additional workload on Manchester Royal Infirmary. The document then states:
"In 1986, Ancoats Accident and Emergency Department treated 25,656 new patients and 11,611 follow up patients. Total: 37.267".
If the situation continues, those patients will have to be dealt with by Manchester Royal Infirmary which is already dealing with an increased load on a diminishing supply of money. The hospital is almost at breaking point. I think it has had to use capital resources, as have other hospitals, which should have been used on the hospital's fabric and maintenance, in order to keep those services ticking over. That type of thing was featured last year in reports on the nation's housing, education and health service establishments. They are seriously deteriorating and in some cases they are in a dangerous condition. That cannot be allowed to go on.
Manchester Royal Infirmary says that it will require an extra £189,000 to deal with the additional load which has been placed upon it. No one can deny that it makes out a genuine case for that additional funding.
I wish to return to the subject of Ancoats Hospital. As I said, the subject was raised in another place. I make no criticism, but the Minister was unaware of the hospital and what it meant to the area. I know that it will be difficult to reply to a small point like this in a major debate, but will the Minister ask his right honourable friend in another place whether he will consider the future of Ancoats Hospital as a matter of urgency? I am not trying to simplify the matter and say that it is easy to make a decision to restore the emergency and accident services. It is not a simple matter, but I do not have time to go into the details. All I ask is that the Minister give an undertaking to look at the matter to see whether it is possible to comply with the requests of the local people, and the staff of that hospital who throughout its history have performed a marvellous service.
In 1940, when we were waiting for the blitz in Manchester, I was (I will not say that it was a privilege) one of only two patients in a ward in that hospital. I had been knocked down by a hit-and-run car during the blackout. I do not know whether it was lucky or unlucky that I survived, but that hospital has been like a beacon in the area. Will the Minister please look at the situation to see whether something can be done about the cuts and whether services can be restored in that densely populated and underprivileged area?
6.23 p.m.
Lord Ferrier: My Lords, in his programme "The Week in the Lords" on Saturday, Christopher Jones said that this debate was a forerunner to the election.

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I think it is safe to say that there has been a minimum of political give and take across the Chamber. We have had a remarkably informed debate despite the fact that over 40 minutes have been cut from it by a mini-debate on higher education.
To my mind, the outstanding speech was that of the noble Lord, Lord Porritt, who could remember the early days of the National Health Service. I remember that in my maiden speech I made a remark which led to the substitution of the words "supplementary benefit" for "national assistance". That was greatly to advantage in the distribution of assistance.
The noble Baroness, Lady Cox, made a well-informed speech which contained an up-to-the-minute approach to the problems which face the DHSS. A debate which has 28 speakers and lasts five hours epitomises the position referred to by the noble Baroness, Lady Seear, and to some extent by the noble Lord, Lord Porritt. Mixing health problems and social security leads to a great deal of overlapping everywhere. If it is correct to say that old men dream dreams, one of my dreams is that the time will come when the two departments will be separated.
I do not know whether it is correct, but someone has said that National Health Service morale is going down. The lack of a Minister responsible for health contributes to any weakness of morale in this wonderful service and the thousands of people who make their careers in it. I find it to be a marvellous success story (I think we all should) despite the difficulties which have arisen and which were mentioned by my noble friend Lord Nugent.
The large number of speakers taking part in this short debate shows how important the service is felt to be. We have talked about this matter before. It was talked about years ago, but the longer we put off separating the two departments and having two Ministers, one responsible for health and one for social services, the more difficult the division will be. That is the first of my dreams that I wish to put to your Lordships.
My next point is a simple one, which I have mentioned in the House before. The time has come for manipulative therapy to be accepted by the National Health Service as part of the services it makes available. It is all very well having views about whether or not it is good, but we know that there could be an enormous financial saving if surgery, drugs and beds were replaced by the modern practices of osteopathy and chiropractic. I hope that that will come our way. It is a task which can be faced by the next government, whoever they are.
I come next to the subject of social security. The most important social security problem which has been considered in your Lordships' House in the past year or so has been that of aged and handicapped people in cold weather, and insulation, draught exclusion and other ways of ensuring that next winter old folk and handicapped people will be better treated and given more assistance.
I say that because, years ago, I was promoting the use of night stored electricity—off-peak electricity. I believe that in the years that have gone by we have reached a stage where there have been enormous
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advantages in the actual materials used for the storage of heat. One of the tasks that I have set myself, and one of the dreams that I dream, is that by next winter it will be possible to have small night storage heaters available for off-peak electricity.
In the debate on heaters in this House some months ago it was said that the night storage heater is a failure. It is not the heater which is a failure; it is the switchgear. What goes wrong with them today is that if there is a power failure the switchgear stops and the heater goes on at the wrong time of the day. I urge the Department of Health and Social Security to help me in tackling the whole question of off-peak tariffs.
I believe that our electricity is far too expensive. When I first came home from India and set up house in Scotland in 1952, the off-peak tariff was one halfpenny (in old money) per unit. Today it is 2.3 new pence; in other words, it is seven times more expensive than in 1952. One reason for that was because we had a hydro-electric base in the Clyde Valley. However, I believe we should have a real attempt to do something and I am going to see Sir Philip Jones of the Electricity Council in the next week or so to press for a revision of the approach to off-peak tariffs and the use of night storage heaters for relieving the difficulties of heating for old and infirm people during the winter.
I could go on and on, but I shall not do so—which will be a relief to your Lordships. However, I feel that we should be pleased that this House has given this subject some attention. We have had most informative speeches by senior medical people such as the noble Baroness, Lady Cox, and so on. I hope that the Government will take note of one or two of the points that have been raised.
6.33 p.m.
Lord Dunleath: My Lords, I hope that the noble Lord, Lord Ennals, to whom we are grateful for having initiated this debate, will not consider me unduly opportunist in making use of the occasion to draw to the attention of Her Majesty's Government what is an apparent and notable gap in the coverage of the National Health Service and one that is peculiar to Northern Ireland.
I should like to refer to homeopathy, which is a subject on which I have no special knowledge and in which I have no personal interest: Indeed, I had hardly heard of it until the subject was debated in the Northern Ireland Assembly on 14th March 1964. I remember the occasion clearly, because I was unable to participate in the debate due to the fact that Mr. Speaker was otherwise engaged and I was stuck in the Chair for most of the afternoon.
However, I recall that we were told that there was a distinct difference in the coverage of homeopathy in the National Health Service in Northern Ireland as opposed to the rest of the United Kingdom. In Great Britain there are five hospitals which specialise in homeopathy and which give National Health Service treatment to patients. However, that is not the case in Northern Ireland where there are just eight doctors who specialise in the discipline and anyone who requires treatment has to go to them as a private patient.

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I was not alone in being surprised and concerned at that information given to the Assembly on that occasion. Such was the concern that the Health and Social Services Committee of the Assembly took evidence on the subject and produced a report to the Assembly on 4th March 1985. It was most comprehensive and was widely acclaimed. It was approved by the Assembly and sent to the Secretary of State on 20th March 1985.
The main recommendations of the report were, first, that a referral clinic should be established and that patients should be allowed to be referred to such a clinic by their doctors, where they would receive homeopathic treatment on the National Health Service rather than having to pay for treatment as private patients. The second recommendation was that a clinical research facility should be established to ascertain precisely the efficacy of homeopathic treatment. The implications of that are that for the research facility an estimated £25,000 a year for two years would be required. Thereafter it would have to be reviewed. In the case of the clinic the cost would be that of the National Health Service personnel providing the services.
Some 10 months later, on 16th January 1986, the Secretary of State replied, conveying the Government's response, to the effect that further research would be inappropriate until the research presently taking place in Great Britain had been completed. The second response in respect of the clinic was that there would be no justification in establishing such a referral clinic until the demand for homeopathic treatment was known and proven.
Since then two developments have occurred. First, the fairly limited research which took place in Great Britain—I understand in Glasgow—revealed that homeopathy is not a matter of giving placebos. Homeopathy must be taken seriously. It was also revealed that further and much more scientific study is required; and that is what the Northern Ireland report advocated. Indeed, one of the witnesses who gave evidence was Professor P. F. D'Arcy, the Dean of the Faculty of Science at Queen's University, Belfast, and Professor of Pharmacy. Professor D'Arcy said that he would be prepared to carry out such a research programme and confirmed that he had the expertise among his staff and the equipment with which to do it if he was given the funds. I should add, with respect, that Professor D'Arcy is a self-confessed agnostic as regards homeopathy. He does not know, but he would like to know. I am in the same position and so are a great many people; but the difference is that Professor D'Arcy is in a position to find out because he is a scientist. He is not the sort of man to listen to hearsay or anecdotes. As a scientist he wants facts and it is only facts that will convince the rest of us.
In answer to the second response, the Northern Ireland Homeopathic Society surveyed province-wide all the general practitioners in Northern Ireland to inquire whether, if a referral clinic were to be made available, they would actually make use of it and refer their patients to it. Just over 20 per cent. said that they would. That does not mean that 80 per cent. said that they would not. Some practitioners did not reply and
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some were equivocal, but over 20 per cent. said that they definitely would use it.
The Northern Ireland Homeopathic Society also consulted Price Waterhouse about the possibility of doing a feasibility study on setting up a clinic, and it found that it would cost £11,000. In September last a delegation was sent to the DHSS Department of Community Health to see whether grant aid could be obtained towards the cost of the feasibility study, but it was refused. However, the Department of Community Health suggested that the society make application under the clinical research grants scheme, and it duly did so, requesting £10,000 per annum for three years to research the subject of "Homeopathy, the Answer to Childhood Respiratory Disorders", which it felt would be a particularly appropriate and relevant topic to test the efficacy of homeopathy. Again it was turned down.
Meanwhile the same society raised £3,000 by voluntary effort to provide funds for patients who wanted such treatment but who could not afford it as private patients, and so assisted them in that way. In the absence of public funds, self-help has been tried as an interim measure. Having said that, I emphasise that I myself am not a member of the Northern Ireland Homeopathic Society.
In the light of that situation and in view of what has happened since the Assembly report was delivered, I respectfully ask Her Majesty's Government, first, whether they will now provide £25,000 for two years to undertake a preliminary study on the efficacy and scientific basis of homeopathy; secondly, whether they will be prepared to set up a referral clinic linked with that research unit whereby National Health treatment can be provided for patients. In advocating that Her Majesty's Government should follow that course, perhaps I may conclude by summarising three points.
First, the research that has already been carried out reveals that homeopathy is not to be dismissed. It works—we know that—but we do not know how it works. That is why more research is needed. Indeed, the London faculty of homeopathy has recommended Northern Ireland with its compact community as being an ideal situation in which to carry out such an exercise. Secondly, a referral clinic would not just bring parity with Great Britain, which is only fair: it would also meet an increasing demand that has now been quantified. That is unlike the previous position. Thirdly and finally, in the context of the National Health Service budget, the outlay would be insignificant, particularly in the context of the bill for drugs and prescriptions. In Northern Ireland alone in 1970 the cost was £8.1 million and in 1983 it was £56.9 million. In that context the outlay would be insignificant. It would not be money well spent; it would be money well invested and I believe that it would be one of the best investments that the National Health Service could make.
I commend this proposal to Her Majesty's Government. I do not expect an answer immediately from the noble Lord since he has not had notice of this point but I should he grateful for a reply as soon as he has had an opportunity to ask his staff to look into the matter.
6.45 p.m.
Lord Taylor of Blackburn: My Lords, I too should like to thank my noble friend Lord Ennals for initiating the debate and for drawing attention to this matter. I should also like to congratulate my noble friend Lord Peston on his excellent, non-partisan speech. My noble friend will not, I believe, take that line again in the House. I expect that he will be more partisan in future and I look forward to listening to him when he is perhaps in better form in that respect.
At Question Time one hears many requests to Ministers concerning various aspects of the National Health Service, and one notes the replies of Ministers concerning the amounts of money that are spent and the quality of the service. However, I am in the position of a Back-Bencher. And from the Back-Benches, I often think of what my next door neighbour might say if he heard the answers that are given. I recall that when I was a child, the boy next door suffered from tonsilitis and had trouble with adenoids. He had to wait for 15 months—perhaps it was much longer—to go into hospital for treatment, and during that time he was constantly off school.
One wonders not only what my neighbour would say but also what a woman who has already been waiting two years for a gynaecological operation and who has been constantly in pain would say. Or what about a man who is waiting for a hernia operation and frequently has to take time off work? So it goes on.
I think about such things when I sit on these Benches and hear statistics bandied about in the way that they are. What does the man in the street think? He or she is not interested in the amount of additional money provided; he and she are more concerned about the time they have waited to go into hospital. They cannot see any improvement as a result of the additional moneys. They find the waiting lists just as long as they were years ago. We must get over the message that the waiting lists have to be reduced. This must be brought again and again to the attention of hospital authorities. The first priority is to treat people who are waiting for treatment.
My second point is that I want the Government to realise the amount of voluntary contribution that is made towards the health service. I do not think that this aspect has been followed up today, although it has been casually mentioned by one or two noble Lords. I want to say thank you to those people who give their time most generously working in hospital wards, not performing professional tasks but relieving nurses in ways such as arranging flowers and writing letters for, or comforting, patients and running errands for them. We should remember those people who are working hard and keeping the National Health Service going.
Another group of people contribute by paying heavy taxes through their weekly stamps and so on. Some are going deeper into their pockets to provide for hospices, scanners and so on. In my particular area of East Lancashire—in Blackburn and the Ribble Valley—we have a very proud record of that sort of service. We do not rely on the state to provide everything for us. We are prepared to help. Those efforts are co-ordinated by the local newspaper which is doing a tremendous job in encouraging the community to dip into its pocket.
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There is a scheme at the moment for a scanner which requires a tremendous amount of money. I am sure however that in the next 12 months we shall provide that scanner for one of our hospitals. If the community is prepared to dip into its pocket in that way, surely the Government can encourage such people, not by putting the money into ordinary allowances for the DHSS but by giving something extra where they find a community that is prepared to provide certain amenities out of its own resources.
Perhaps the Government will consider this position. If the community can make this effort, then the Government can match it pound for pound, or by some other means. I am sure that this would encourage a great response throughout the country from the man in the street. We know that we are a very generous nation when there is a call for contributions to be made. We should therefore use the facilities and resources which exist to be tapped by the state.
6.50 p.m.
Lord Auckland: My Lords, the noble Lord, Lord Ennals, must be very gratified that this debate has inspired nearly 30 speakers to take part. It has given us an opportunity to hear the inspiring maiden speech of the noble Lord, Lord Peston. I am particularly interested, although not financially or professionally, in the pharmaceutical industry, and his speech was of much interest on that aspect. If we debate that aspect of our lives I hope that we shall hear from him again, and on other subjects.
There are two areas where expenditure is essential. I believe that one is defence and the other is health. To be a strong country we must be defended. To be a strong country we must also be healthy. It is a matter for great regret, and this has been mentioned by a number of Members in your Lordships' House this afternoon, that party politics seem to be seeping more and more deeply into the National Health Service. To some extent this may be unavoidable.
I have taken part in a few election campaigns for colleagues in another place. Come the election, Party X says, "I am spending Y amount of money on the health service". The other party says, "I am spending Z amount". For those who are on waiting lists and for those who are working in the health service, very often on inadequate pay, it is little consolation to hear politicians trying to score points off one another. I believe that this is one of the most important aspects of the debate.
I have served for some 30 years on hospital committees, both mental and long-stay hospitals. Currently I am president of the friends of our local district hospital in Surrey. I was a patient there 18 months ago having a gall bladder operation. I was in hospital for only nine days. Ten years ago for an operation like that one was in hospital a good deal longer. Recently my wife was in the same hospital having an operation on the veins in her leg, a frequently performed operation. She was in for three days. We were both extremely well treated.
In this connection I should like to pay tribute to the Leagues of Friends of various hospitals. I declare a non-financial interest as president of the friends of our local district hospital. I know something of what goes

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on there. It is not a party matter, but under all governments, if it were not for the friends facilities for some of our hospitals would be very much less adequate than they now are. At our local hospital the friends raised about £6,000 towards equipment for the intensive care unit. That is not a lot of money for the equipment which may be needed but it is a very fine contribution.
I should like to say a word about the pay and conditions of nurses. My noble friend Lady Cox, who has much experience in this field, made a speech which was acclaimed on all sides of your Lordships' House. Special pleading must play some part here. We have a younger daughter with a young family who, if she were to return to nursing—which she wished to do—would be earning about £6,400 a year gross, plus about £900 a year in London weighting. Having small children she needs a creche. She told me the other day—I have checked these facts—that she has to pay about £30 a week for a crèche, or £3.50 per session. On a salary like that how can any government expect experienced nurses—she has her SRN—to return to nursing? I hope that the Minister will bear this point in mind. The situation has probably existed under all governments.
We pay a great deal of money for various people to stay in bed-and-breakfast hotels on social security. I do not wish to comment on the rights or wrongs of that. But is it rational or logical that £30 a week should have to come out of the earnings of experienced nurses who have been through their training, who have a young family and therefore need a crêche? I believe that this is a fair point.
Another matter that has not yet been raised is our service hospitals. The report by the Comptroller and Auditor-General on the Ministry of Defence hospitals mentions, for example, Aldershot. The military hospital there had a surplus of 91 nurses over a complement of 236 in 1986. The Royal Air Force hospital at Ealing had a surplus of 48 nurses over a complement of 148. Are facilities at these hospitals available for national health patients? If our service hospitals are not full, if the beds are not being used, here is a way in which waiting lists could be cut. All governments want to cut waiting lists in hospitals. It is not a monopoly of any political party. How it is accomplished is a much more difficult matter.
I should like to say one word about private hospitals, which have been touched upon. It is fair to say that St. Thomas's Hospital in 1985 was provided by private hospital funds with a lithiotripter for crushing kidney stones. Two thousand patients have used it, many of them from the National Health Service. I mention that point not to cast favour or otherwise on private medicine. I believe in an ideal society. Having recently read Mr. Bevan's speech on the Second Reading of the National Health Service Bill it is my interpretation that he did not wish completely to abolish private medicine. I believe that there is a place for private medicine and the National Health Service to work side by side. Every country has a certain amount of private medicine—even in Eastern Europe. I go around a number of countries and I see this working.
To conclude the plea, we have a National Health Service which is composed of thousands and thousands of dedicated workers. Let politicians remember that.
7 p.m.
Baroness Turner of Camden: My Lords, I too should like to commence by thanking my noble friend Lord Ennals for the opportunity afforded by this debate. I should also like to congratulate my noble friend Lord Peston on an admirable maiden speech. I am sure we all look forward to hearing a great deal more from him.
Like the noble Lord, I wish to commence by declaring an interest. I am a union official. My union, ASTMS, organises extensively in the National Health Service. In the public mind, although not, I am sure, in your Lordships' House, the National Health Service consists mainly of doctors and nurses. However, it has to be appreciated that it employs many thousands of highly skilled people in other professions.
There are about 26 professions in the National Health Service where the people concerned are members of my union. There are scientific officers, medical laboratory technicians, radiographers, clinical psychologists, pharmacists, therapists of various kinds, and so on, and fairly recently your Lordships' House has debated the problems that face speech therapists. These are not professions which people join if they are out to become rich or even moderately well off. Although the work is often highly skilled and requires a great deal of training, as has already been indicated in the debate, the pay is pretty low. You have to be dedicated to do this work and most of the people who do it are dedicated.
A medical laboratory technician, for example, working on cancer screening or on AIDS would have a commencing salary of £6,000 a year, rising in a number of stages to the princely level of £8,000. A principal medical laboratory scientific officer, with many years of experience and a staff of around 60 working under him, can expect to get about £16,000 per annum. This is hardly a fortune for the type of work and responsibilities undertaken.
Since 1979 the real disposable income of these people has gone down by about 16 per cent., yet arguably the work has become more skilled and more demanding. We have heard on several occasions during the debate that there is a shortage of nursing staff. This point has been dealt with in some detail by the noble Baroness, Lady Cox, and by the noble Lord, Lord Auckland, and I do not wish to add to what has been said. Poor pay and working conditions have combined to produce a shortage of highly trained people. The gap between National Health Service pay and the rest of the workforce is exacerbating the difficulties and quite clearly is creating problems that have to be overcome.
However, I do not intend to use the opportunity afforded by this debate simply to air the problems of poor pay, except to say that these are a symptom of general underfunding and inadequacy of resources. We are—and I believe that this is true of most of us in your Lordships' House—very proud of our National Health Service. It was founded in 1948 to provide, as other noble Lords have said, a comprehensive service available to all on the basis of medical need and free at the point of use. That was a very high ideal. These principles have been the guiding light of the service since the beginning. However, the continued

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effectiveness of the service depends on matching needs with resources.
There is a growing gap between needs and resources. This continues to widen, despite an increase in total care expenditure. The Government have repeatedly said that they are spending more than ever on the National Health Service—and they are. However, as other speakers in this debate have said, we are having to meet the pressures of an ageing population, the advance of medical technology which leads to greater expectations on the part of people generally and added issues such as drug abuse and AIDS.
Compared with our competitors in the industrialised West, the UK fares badly in terms of expenditure on health care. The United States spent 10.8 per cent. of national income on health care in 1983, France spent 9.3 per cent. and Italy 7.4 per cent., compared with our expenditure of 6.2 per cent.
I know that it is claimed that spending on the National Health Service has risen by over 20 per cent. in real terms between 1978 and 1985–86. However, a large part of this increase was absorbed by the pay settlement for medical and nursing staff. Clearly this was absolutely necessary because there had been years when salaries had fallen behind. Nevertheless, despite the fact that it is proposed, I believe, to spend more for the next three years, it is questionable whether this will be enough to meet the needs.
A major problem is that real growth in spending is absorbed by increasing demands made upon the National Health Service by the changing demography in the United Kingdom. As has been mentioned a number of times in the debate, and I think it is a highly important point, this is instanced by the rising number of people over the age of 75 who use the hospital service. Over half the average daily hospital in-patient population is concentrated in the demanding areas of geriatrics and psychiatric medicine.
As has been referred to previously, there has been a policy of developing community care for certain patient groups since 1976. The aim of the policy, as we know, is to transfer appropriate elderly, mentally ill or mentally handicapped patients from hospital into the community, often in their own homes. The principle of care in the community is a good one, but comprehensive community support must be developed if these very vulnerable groups are not to suffer. At present there is an insistence that funding for these developments must come from existing resources. We have an obligation to see that these vulnerable groups are not forced into an unprepared community because in-patient facilities are closed before alternative facilities have been developed. Indeed, a worrying feature of inadequate hospital funding is the growing list of hospital closures.
Between 1979 and August 1986 a total of 205 hospitals were approved for complete closure. There may have been good reasons in some cases but, as has been mentioned, waiting lists have been growing. Between 1981 and 1985 waiting lists rose by 66,000 to 802,000, with nearly 20 per cent. of the patients queueing for orthopaedic surgery. Wards have been closed and, as already indicated, there are staff shortages. We have reports reaching us at the union
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office of concern expressed by staff about the decline in standards of the fabric of the hospitals in which they are working and the need for money to be spent on supporting those structures and improving the environment generally.
New developments in medical care and technology also need increased spending. In 1985 a third heart transplant programme was established at the Freeman hospital in Newcastle to supplement the work of Papworth and Harefield. Up to 1986 a total of 348 heart transplant operations have been performed, including 57 heart/lung transplants. Operations such as coronary artery by-passes help prolong the life of people with heart disease, and these operations are increasing. The number of liver and kidney transplants is increasing but such operations are extremely expensive. A liver transplant costs about £19,000 for an adult and about £75,000 for a child, with £5,000 per patient per year in subsequent costs. Kidney transplants cost around £8,000, with £2,700 in subsequent therapy.
The publicity that such achievements receive has led to advances in public expectation, but there is a shortfall in the number of such operations that can be undertaken. Therefore, any real spending increase has to cope with growing and, for example, in the case of AIDS, with entirely new demands. AIDS is being tackled as a central initiative. But it also has considerable implications for the regional health authorities. As the incidence of AIDS increases and the disease spreads—although one hopes that it will not, the indications are that it could—a significant increase in resources will be called for. Drug abuse is a further area that calls for centralised help and this should essentially be long term.
There has been a decline in deaths from certain diseases. On the other hand, as with AIDS, there are less encouraging signs. Deaths from heart disease among women fell by only 1 per cent. in the years 1979 to 1984, while deaths from lung cancer among women rose by 20 per cent. That is an indication perhaps that far more women are smoking and are not being prevailed upon to give it up.
Despite the publicity accorded to the campaign for screening to identify cervical and breast cancer at an early enough stage and thus take steps to deal with it, there is still not enough being done to monitor and to check on the women at risk. A disturbing development has been the introduction of a commercial service in the screening area. We have information which would seem to indicate that National Health Service staff are working on commercial projects concerned with screening and testing smears, and so on. We think that that development should be watched. In any event in this area we still believe that there are too many preventable deaths.
Nevertheless, improvements in the quality and length of life since the Second World War owe much to the existence of the National Health Service. It promised security to millions who in earlier years feared the costs and consequences of illness. Peri-natal mortality has been falling for years. Life expectancy across all classes has been improved. Children born in the years 1982 to 1984 can expect a life span two years longer than those born 10 years before.

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The NHS was designed to meet the health needs of all citizens without regard to income. It has been able to respond to an ever-widening range of health care needs thanks to the developments in care and the treatment, devotion and dedication of its staff. But, as has been said during the course of this debate, there are problems because the resources are simply not keeping pace with demand. The suggestion has been made that my noble friend Lord Ennals was bellicose in his attack upon these issues. I fully support his comments and I prefer to say that he made a passionate demand for further resources, and that that is a demand which we all should support.
7.12 p.m.
Baroness Lane-Fox: My Lords, I should like first to thank the noble Lord, Lord Ennals, for initiating this debate and to congratulate the maiden speaker the noble Lord, Lord Peston. Many who, like me, have been the recipients of clever and good treatment under the NHS consider it deserves all the help it can get. Equally, there are employees of the NHS who, after giving so much effort and expertise, sometimes think that their services are not fully appreciated.
In 1987–88 no less a sum than nearly £20 billion is to be spent on the NHS. That must go part way to meet both the views that I have given. As my noble friend Lord Auckland said, considerable individual sums are raised voluntarily all over the country for separate parts of the service. For instance, last week I addressed the AGM of St. Stephen's Hospital League of Friends. In just one year it had contributed £30,000 for vital hospital equipment and other invaluable service in their hospital. With effort like that, who could deny the strong pulses beating throughout the service?
The Phipps Respiratory Unit Patients' Association, to which I am attached, so far has raised £650,000 of the £1 million it needs to equip the unit's future in new purpose-built surroundings. This has been achieved through the work and devotion of ex-patients. Some, like me, are timid about raising funds and tend to be lured by voices saying, "Why is this not done by the NHS?" But most of us appreciate the crying other needs to rebuild so many out-dated hospitals, the ones whose crumbling conditions were overlooked in the past. Now, the biggest hospital building programme in NHS history has been embarked on by the Government. This includes over 170 schemes, each worth more than £1 million, which have been started and completed since 1979, with 400 schemes in the pipeline, 100 to be completed in the next three years. Wonderful doctors and nurses deserve to work in the best hospital surroundings. It is incredible that this unwritten rule was abandoned by the previous government.
The large increase in patient treatment and the success of new sophisticated methods employed is a tribute to all concerned. It would not be possible without an overall increase in provision and of course without the skill and proficiency of hospital staffs. Medical science is so diverse and progressive that it can take on and defeat so many illnesses and conditions that would be fatal or crippling if left alone. Although there are economies to be made to public expenditure when people are restored to look after
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themselves, medicine overall essentially is an extremely costly programme.
It appears to me that the only way to keep the cost ceiling in place is to encourage everyone to understand good health education. Towards this end we have the new Health Education Authority. I am hoping that this will see the message of good health instilled into everyone and especially into the student teachers for they can have a great influence on the common sense of their pupils in this. Many teachers could be amazed to find just how much good posture and good example affects the future health of children, as of adults.
I am told by a very knowing Scandinavian physiotherapist that the teaching of physical education needs to include a degree of anatomy, physiology and psychology just to show the reasons for care and a smattering of kinetics to show the relation between movements and the forces acting against them. This is needed particularly to help in lifting methods.
If the message of health discipline gets across it can I believe cut the numbers of slipped discs and hernias for a start, let alone coronaries, arthritis and the rest. While on this subject, I implore every hospital ward to have not only an efficient hoist for lifting patients but also nurses who know how it works. I do not say this only for the increased comfort of patients but also in order to protect nurses' backs. If, like me, you happen to measure nearly six feet and to be of ample proportions to match, it is rotten luck for patient and nurse if for six days you have to be manually lifted up the bed several times a day on a hospital ward. When you are discharged your conscience very rightly worries you about all the damage that you have left behind.
Other countries admire the Government's campaign about the scourge of the 1980s—AIDS. Of course there were some who sought to deride the campaign, yet who could possibly deny that it has made known the grim facts more widely than could ever have been hoped? Government funds have encouraged charities to prepare to take part of the strain and to raise necessary funds to help with care for cases in the community. I am attached to one such organisation and I am aware of the heavy programme and workload that is expected. Joint finance and other flexible plans are welcome in community care, but I, like several other speakers, should like that to be expanded. There are patchy conditions of care in the community, even in London. The back-up support of charities such as Crossroads Care Schemes and CSV deserve funding even more than they are at present.
District nurses do such wonderful work, yet I am amazed to find that, unless they own a car or a bike, in some districts they have to walk. In my area their patients can be as far apart as Knightsbridge and Earl's Court. With the new potential load I ask my noble friend to agree that every area should have its own car.
I particularly want to refer to RAWP because to my mind it is a ghastly trouble to London hospitals. It is particularly bad in that there are RAWP losers and RAWP gainers. However, what I believe to be wonderful, and a real step in the right direction is the fact that there has lately been a recognition of that. There has been a total grant of £30 million towards the hospitals which were in real trouble, with £10.6

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million allocated to the Thames regions. Many of us see this as a small amount, but the hope is that it is a first step and that it will lead to more recognition that our heritage of hospital centres of excellence does not fall back and fall hostage to the RAWP theory.
It should be remembered that it was not this Government that initiated this uncomfortable scheme: it was thought out before, and particularly when noble Lords opposite were in government. I think that RAWP is particularly difficult for London because it ties the money to the people. It means that when somebody moves to live in the country then decides to commute back to London and use London hospitals, the money is not there to pay for them.
I cannot end my speech without reference to the most welcome establishment from July of a special health authority for the artificial limb and appliance services. Being an old client of the appliance centres, I applaud this and especially the selection of the noble Lord, Lord Holderness, as chairman, and Professor McColl as vice-chairman. I should humbly like to thank the Secretary of State on those appointments and for the attention paid to the McColl Report.
7.22 p.m.
Lord Rea: My Lords, I should like to spend about five minutes talking about the state of the nation's health, and about five minutes on the direction in which I feel that the National Health Service should be moving in order to cope with our major problems.
Just over four years ago I was in the same position as the noble Lord, Lord Peston, when I made a maiden speech, though not such a good speech. It was directed to what is again a topical issue: inequalities in health. My text was the Black report, which, incidentally, has never been fully debated in your Lordships' House. For me the most significant implication of that excellent report was that our health record could be equal to the best in the world—for example, that of Scandinavia, Holland or Japan—if the health of our least well off people could be improved to match that of the best off. The good state of health of the professional classes in the United Kingdom has been achieved by some whole nations. The higher mortality rates in this country of manual workers and their wives and children are more characteristic of less well developed nations, despite the fact that we are still a comparatively rich country with a long tradition of public health.
The report re-emphasised that the differences in health between the social classes were only partly dependent on health services as such, and were more related to long-term environmental influences such as housing, nutrition, education, smoking habits and conditions at work. It made 37 recommendations, 20 of which would have cost little or nothing to implement. Others, particularly those relating to child health and nutrition, had cost implications—£2 billion was one estimate. The suggestions of the report were therefore dismissed as being far too expensive and out of the question.
That now seems to be rather ironic considering the fact that £2 billion is the sum which has just been handed back to income tax payers at the better end of
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the pay scale, let alone all the money that has been received by the Government from the family silver auctions over the last five years. I believe that there is more to come from the nice furniture in the sitting-room, if I remember the words of the late Lord Stockton. In fact, only a few even of the cost-free recommendations of the Black report were carried out. Those were usually done by the district health authorities or the local health authorities rather than from central government initiative. As regards school meals, an exactly converse policy to the report's recommendations has been carried out.
We now have an update of that report called The Health Divide, compiled by Margaret Whitehead and published by the Health Education Council. Unlike some noble Lords, I have had a chance to read this fascinating and well-written document. It is a worthy successor to the Black report, with some 300 references to work done in the intervening seven years. It is an objective account. It does not question, for instance, the fact that overall our statistics have improved. It points out one example where social class differences have actually narrowed—in post neonatal deaths—illustrating that the class differential is not inevitable and can be reduced provided that resources are properly mobilised.
However, many more examples are given of the converse where the gap between the social classes has actually widened. In the case of coronary heart disease, not only has the gap widened but the actual rate of mortality has increased in manual workers and their wives, and deaths from carcinoma of the lung have also increased in the wives of manual workers. As has been pointed out, these differences can be largely attributed to the fact that smoking is more widely prevalent at the lower end of the social scale. The Government's decision not to increase the excise taxes on cigarettes and alcohol in the last Budget should be condemned.
However, recent research has shown that coronary heart disease in adult men is not only related to smoking but is also associated with a deprived childhood. Almost certainly a nutritional factor was involved in the childhood of those men, backing up the Black report's emphasis on the importance of child nutrition in improving the nation's health. One social class, if one can call it that—the unemployed—has become much more numerous since the Black report. Clear evidence is presented to show that their health experience, for both physical and mental illness, is much worse even than that of unskilled labourers in work.
A section of the report which looks at international comparisons describes the reduction of health differentials in Finland as a result of government policy. An important part of that was a concentration on primary care in the areas with the highest mortality. I quote:
"Building costs were switched from hospital to health centre buildings. By 1981 the community and hospitals sector were taking equal shares of the building budget (formerly the hospital sector took the major share)".
At the same time:
"Differences between cities and rural areas in mortality rates of men aged 35–75 are said to have disappeared".

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That leads me on to a brief look at primary care services in the United Kingdom and last year's Green Paper. Now that the consultation period is over, we should be interested to know whether the Government's plans for primary care will be announced soon; or must we wait until after the election? If we do, we may be in a position to make proposals from this side of the House, though we shall be on the other side of the House by then.
One of the most important commentaries on the Green Paper is that of the Social Services Committee of another place, which has been mentioned by the noble Baroness, Lady Cox. I entirely agree with her speech and the points that she made: exactly the converse of her speeches when she is talking about education.
The Select Committee report is a distillation of much evidence both from the concerned professions and from the consumers. I find myself in agreement with most of their 55 recommendations. In fact, I should be pleased if the Government took them over lock, stock and barrel and incorporated them.
There is little doubt that good primary care is the key to an efficient health service, particularly with regard to reducing health inequalities. To increase hospital spending in deprived areas may be fair if it reflects the increased demand for acute care made by a less healthy population, but by itself it will do little to improve the poor health of the population. It may even deflect scarce resources away from the preventive and promotive activities which are an integral part of good primary care.
I would suggest that the Government take seriously the suggestions of the BMA and the Royal College of General Practitioners (my own college; and here I declare an interest) that the good practice allowance suggested in the Green Paper be dropped as such and replaced by performance linked contracts which could be entered into voluntarily by GPs prepared to provide an improved range of services. They could contract to provide these services to an agreed standard, taking appropriate training if need be. Such services include, for instance, computerised call and recall services for cervical screening or high blood pressure screening, child health surveillance, minor surgery, and special clinics for the surveillance of chronic diseases. There are other needs, and new priorities may well arise.
Additional costs for providing these services would need to be recognised. Recommendation 5 states:
"we recommend that the Government enter into negotiations with the medical profession about alternative ways of remunerating GPs to include a range of separate allowances related to the type of service offered".
In this way GPs will be encouraged to provide help to those who need it most but who do not come forward until too late as things are.
As there is still a little time to run, I should like to add a further recommendation to those in the Green Paper. It is one which seems to have been omitted. Individual GPs vary enormously in the frequency with which they refer patients to hospital. One study has shown that the costs of the hospital care of their patients per doctor ranges from £100,000 to £500,000 per annum.
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A recent study in Manchester was unable to determine whether high or low users were practising the best medicine. I suggest that GPs may make more rational use of expensive National Health Service facilities if they are each sent confidential statistics of their referral patterns compared with national and local averages. This was an important point made by the Green Paper which seems to have been omitted by the Select Committee report. There are many other recommendations in the report that I should like to describe to your Lordships, but time is short. I commend the report to the Government, and I hope they will be guided by its very wise suggestions.
7.35 p.m.
Baroness Masham of Ilton: My Lords, my life was thrown into confusion this week. The BA aircraft on which I was due to return from holiday broke down. There was a delay of 17 hours. This meant I was unable to ask a supplementary question on Monday about the future funding and management of the Portman and Tavistock clinics. The answer given by the Government makes clear that they are still deferring a decision. The insecurity and lack of decision is not good for staff morale.
These clinics try to help some of the most complicated and difficult cases in society. They deal with the sexually abused and those who do the abusing. They train social workers and other staff throughout the country. Recently they have had an application from the health district of Hull to train 400 staff. This illustrates how wide is the need. It seems sensible to create a special health authority to deal with the growing problems of sexual abuse and the horrendous outcome.
Many noble Lords have mentioned the crucial problem of nurse recruitment. A sister at the Westminster Hospital told me only yesterday that recruitment was at rock bottom. I was recently a patient at Stoke Mandeville Hospital which has recruited nurses and auxiliaries from the north of England, many of them splendid people ready to learn. But the accommodation offered them within the hospital was very poor and they could not afford to live out.
Several staff left because the pay was so bad. An auxiliary receives between £3,000 and £4,000 a year. One day a doctor stormed into my room, his face white with fury. A government Minister had made a statement that 90 per cent. of nurses had their own accommodation. The doctor said, "It is not true. In Oxford, if they can get accommodation, they cannot pay for it. In Aylesbury, it is the same".
Today, one of your Lordships' staff told me that his local hospital has had to close wards and the casualty department because of lack of staff. This is the West Middlesex Hospital. I hasten to add that among nurses there are some glowing stars of first-class efficiency and dedication. Many of them come from southern Ireland.
Last night, I went through 122 job applications for a director of our North Yorkshire Red Cross. Several were senior nurses in post in the National Health Service. While pleased that they are applying to the Red Cross, I am worried that they are not content to

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stay within the health service. What has gone wrong? Is it job satisfaction or frustration within the administration? In this case, it is not money, as the Red Cross cannot afford high wages.
The regional health authority of Yorkshire is losing its general manager, an excellent person with a good wage, but the appointment is only for three years. Do not even general managers need security? Even someone of that calibre who comes into the National Health Service from outside takes time to learn about the vastness of, and the complexities within, the service. It is sad when they leave after two years.
A few weeks ago I attended an interesting conference organised by the DHSS on incontinence. The message from the conference, attended by health managers from throughout the country, was that incontinence is a matter which needs specialised treatment and support, especially in the community nursing service. Many of the specialists working in the community were overwhelmed by the amount of work. They felt isolated and in need of support. Many National Health Service staff working with emotional and difficult health problems need support and a good supply of equipment to deal with those problems. It would be serious if incontinence aids were not readily available because of cost.
One of the frustrations for some staff working within the hospital service is outdated and inadequate equipment. I have had letters about a three-year-old child who is on a ventilator. The correct ventilator was not available. Her parents were devastated with worry. Voluntary contributions to hospitals are most important, but it seems that every health district needs a Jimmy Savile, who has a gift for fund raising.
Having recently been a patient in a National Health Service hospital, I found the food in the spinal unit of Stoke Mandeville Hospital monotonous, with hardly any fresh vegetables, and badly presented. For patient morale and wellbeing, this is serious. One pound and eight pence is allocated per day per patient for food, and this includes drinks. Many patients send out for take-away food, which is delivered by taxi. Patients who cannot afford this borrow money from other patients, and I wonder whether they ever pay it back. I feel that if food was better and more imaginative, patients might get out of hospital quicker.
With the increase in alcohol abuse and illegal drug taking, violence in casualty departments is increasing. We must find ways of protecting our hardworking hospital staff. Not only are they at risk from infection; they are at risk from violent assaults.
I have a few minutes in which to thank the noble Lord, Lord Ennals, for instigating this debate. I hope that he will do so on many more occasions. I also congratulate the maiden speaker, who is not in his place, and say that I hope we shall often hear from him. It is always good in your Lordships' House to have new supporters for the National Health Service. They are greatly needed. I was hidden behind Bar but I listened to every word said. By concluding my remarks now, I am able to provide a few extra minutes to other speakers.
7.41 p.m.
Lord Cullen of Ashbourne: My Lords, I shall be very brief. It had been my intention to make two points only. Fortunately one of these has become unnecessary owing to the speeches of the noble Lords, Lord Ennals and Lord Winstanley. I had intended to endeavour to bring to an end the endless accusations of Opposition speakers and the media about cuts in the National Health Service, but both noble Lords were refreshingly realistic on this score. They appreciate that National Health Service spending rises annually in real terms. In fact, I understand that since 1978–79 it has risen by 26 per cent. in real terms, which is a very large increase.
Now that the two noble Lords have acknowledged that former accusations of tax cuts are completely wide of the mark, I trust and hope that the media will follow suit. It has been tedious and highly misleading to the public to continue year after year and month after month with these false accusations. Now at last the criticism that the Government are not spending enough on the NHS is quite fair. It may even be right, though I feel sure that my noble friend Lord Hesketh will come forward with a robust argument to refute it.
Secondly, I should like to draw to the attention of any noble Lords who have not seen it a very interesting document issued by the Institute of Directors entitled The Business Leaders' Manifesto. This is its manifesto for the incoming government, whoever and whenever it will be. It is easy to read. It explains the poor performance of this country since 1945 against that of our competitors and makes radical recommendations over a wide front and over a long timescale.
The noble Lord, Lord Porritt, in an extremely interesting speech pleaded that the whole structure of the NHS should be re-examined. That is what the Institute of Directors has done. Many noble Lords have observed that whatever government are in power the National Health Service never has sufficient resources to cope with demand. The institute is well aware of this; hence its wish radically to change the structure that exists today and to reconstruct it on the lines originally envisaged. It is probable that unless we do this we shall never overcome the difficulty.
Among other things, the institute proposes, first:
"a return to the principle of Beveridge in the financial structures of health and social security spending, making them honest, open and transparent to the individuals who pay for them".
Secondly:
"introducing tax reliefs for private health and welfare insurance and eventually introducing financing based on compulsory insurance provision with the State paying the premiums for the small group unable to meet them".
It is not possible for me to do other than point your Lordships in the direction of this manifesto. It covers a whole range of other issues: social security, taxation, local government, employment, and so on. It all hangs together.
I believe that all of us must be equally concerned over the huge and mounting costs of our welfare state. I for one am grateful to the institute for putting forward solutions to that pressing and escalating problem, among others. I commend them to your Lordships.
7.45 p.m.
Lord Kilmarnock: My Lords, a commentator suggested recently that after the Royal Family the National Health Service was our most popular national institution. The number of speakers this afternoon has given some credence to that point of view. The right reverend Prelate the Bishop of Manchester said that it was popular even with fanatical anti-collectivists.
I shall not go into all the statistical wrangles, claims and counterclaims on expenditure. The noble Lord, Lord Ennals, said that the service needs a 3 per cent. increase in real terms per annum and the Labour Party is pledged to that. The Government claim 26 per cent. since they came to power, though my noble friend Lady Robson has given indications as to why that does not quite work out in practice and the Alliance is pledged to 2 per cent., with a substantial development fund. I want rather to spend my few minutes dealing with the receiving end of the service where the claims of politicians meet their real test.
The Health Education Council's swansong, The health Divide, which one might call a successor to the Black Report, has been mentioned this evening particularly by my noble friend Lady Seear. It is indeed a remarkable document, not least because it is scrupulously fair about the difficulties of evaluating some research data. But its central message is not open to challenge; namely,
"the results of these studies taken together, give convincing evidence of widening health inequalities between social groups in recent decades especially in adults".
I was surprised to hear the noble Baroness, Lady Trumpington, counter this on Monday by repeating that, overall, health in the United Kingdom is improving steadily, with rising life expectancy and reduced infant mortality. Of course it is: the report recognises that. The noble Baroness, Lady Turner, recognised that in her speech, but it is not the point. The point is that:
"In general, death rates have declined more rapidly in the higher than in the lower occupational classes, contributing to the widening gap. Indeed, in some respects, the health of the lower occupational classes has actually deteriorated against a background of general improvement in the population.".
Frankly I do not find that surprising. Inequalities are seldom isolated phenomena.
Just as the gap between the richest and the poorest has increased within an overall increased national income—and the plight of the homeless has become worse within an overall pattern of increased home ownership—so health inequalities have increased. It is all part of the same pattern. Indeed shortcomings in other spheres of policy such as housing and employment feed through into health, just as one would have expected and as my noble friend Lady Seear said in her speech.
This being so I want to ask the noble Lord my first question. How does this trend accord with the Goverment's commitment in 1980, renewed, I believe, in 1984 together with the 33 other members of the European Region of the World Health Organisation to ensure that:
"By the year 2000, the actual difference in health status between the countries and between groups within countries should be reduced by at least 25% by improving the health of the disadvantaged nations and groups."?
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Can the Government say in the light of this report how these aims are to be advanced, because all the evidence is that the trend is moving in the opposite direction at an accelerated rate? That is my first question.
I turn to the subject of waiting lists. They have already been discussed but they constitute one of the major flaws in the whole system. The last figures available, which are the Government's figures, show a total of 717,761. The noble Lord, Lord Ennals, gave a smaller figure but I believe that that referred only to England while this is the most recent figure available for England and Wales. It represents a 3 per cent. increase over the year ended September 1985. It is particularly disappointing when all health authorities have been asked to prune the lists of those no longer requiring an operation or of those who have moved away from the district.
We are going to have a debate on the crisis in nursing and there will be other occasions to go into this in more detail. But it is interesting to note that the situation is so bad that the College of Health now publishes a guide to hospital waiting lists, an advance copy of which I hold in my hand. It analyses the background to the waiting lists and gives valuable advice to those who are able and willing to shop around and seek treatment in another district.
As your Lordships will know, there is already a system of cross-boundary flow payments, and the patient's general practitioner may be prepared to co-operate. But it all requires a lot of homework in ringing around and consulting one's community health council, etc. Even if you have the time and the initiative, there are problems with this DIY approach, such as the cost of travel to another district and difficulties for your relatives in visiting you, and so on. Basically you are trying to beat a system which is no longer user-friendly.
Why should the system not be user-friendly? As I said, cross-boundary flows are already rather reluctantly recognised. We on these Benches would go further and suggest that DHAs should adopt a deliberate policy of buying in some services from other districts and selling their own specialties on a much wider scale than at present. This could benefit authorities with strong specialties which lose money under RAWP, as was mentioned by the noble Baroness, Lady Lane-Fox, and allow them to use to the full their manpower and facilities. That is far better than sacking staff, closing wings and maintaining empty beds. I gather that Guy's and St. Thomas's have been trading in this way for some time, and the system could be extended much more widely. If accompanied by a right for the patient to be treated within a certain time, it would give a tremendous boost to the reduction of waiting lists.
What have the Government proposed? Last July the Secretary of State announced a new drive to reduce waiting lists. It was to continue over three years and the intention was to treat an additional 100,000 patients a year. He allocated £50 million for two years. On 17th February last it was confirmed that £25 million would be available for the present year and that the extra funding would allow for at least 5,000 extra hip replacements. But at £2,500 a time, these will cost £12.5 million, leaving only an equivalent

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amount of £12.5 million for the remaining 95,000 operations.
In a press release on the same day, 17th February, the DHSS said that these operations would include 22,000 general surgery operations, 20,000 orthopaedic, 14,000 ophthalmic, 14,000 gynaecological, 8,000 ear, nose and throat and 6,000 concerned with plastic surgery. That is marvellous news if it can happen, but can the noble Lord tell me how on earth all those operations are going to come out of the remaining £12.5 million in this year's allocation? To put it the other way round, will the Government pledge themselves to those 100,000 additional operations and pay whatever is necessary to deliver them—or are we to be sceptical in the future of the department's press releases? I very much hope that the noble Lord will assure me that that is not the case.
Finally—and I do not want to trespass on the generosity of the noble Baroness in having given us a minute or two more, as other speakers are to follow—I turn to an area in which the Government have a relatively good record; namely, the treatment of AIDS. I want to ask the noble Lord two questions, of which I have given him notice. I hope that he received my note. A community care conference was held on Wednesday, 25th March, chaired by the Secretary of State, which considered among other things care in the community for AIDs victims. I believe that the Secretary of State was much impressed by what he saw in San Francisco. Can the noble Lord say what money the Government will put into a similar system of hospices in this country? Is he aware that the London Lighthouse Project has enough money for only another three months of its building programme? Is any help at hand?
I am still not clear—indeed I think none of us is entirely clear on this matter—how every district health authority in the country is to comply with the Secretary of State's direction to draw up an AIDS plan, to appoint an AIDS prevention officer, to instruct its own professionals in AIDS detection and so on within its normal budget. I am aware that it is the Government's intention to finance AIDS expenditure through the usual channels. There is something to be said for not having a whole separate system which might seem to relegate the disease to the category of a plague or to give it some kind of ghetto status.
Even so, additional sums have been made available to some regions and they will become increasingly necessary. AIDS care is labour-intensive. Existing teams are in danger of burning out. There is a lack of junior doctors because training posts are not available and they cannot count work in this field as a career credit. In short, there is a host of problems which cannot be solved by inadequate central subsidies plucked out of the sky in an emergency. Would it not make more sense to set up a central AIDS fund to which districts could make bids for sums specifically related to their own plans and requirements, and indeed to the incidence of the disease in their own areas? All these vary very much up and down the country. Would the noble Lord discuss this suggestion with his honourable friend the Minister for Health? He cannot give me an answer now but I throw this into the
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pool for discussion and I very much hope that it will receive serious consideration. Otherwise I think we shall run into trouble in that area, despite the Government's excellent efforts to date.
In contradistinction to some of the other areas we have discussed this evening, I think the Government's approach to AIDS has obtained widespread general support. It would be a pity if this essential element of public confidence was to be eroded by an inadequate funding mechanism. I hope very much that the noble Lord will be able to reassure me on these points.
7.57 p.m.
Lord Prys-Davies: My Lords, for over four hours we have been debating a subject of vital interest to the people of the four countries of the United Kingdom, because we are all patients or potential patients. We are grateful to my noble friend Lord Ennals for the opportunity to focus attention on the National Health Service.
We have listened to a series of important speeches, often based on considerable experience of the NHS. According to my account, the issues which have dominated the debate are the inequalities in health which have been referred to by some eight or nine speakers, the underfunding of the NHS, the inadequacy of the community care facilities, the crisis in the nursing profession and the growing waiting lists. Those are the issues which have dominated the debate, and many searching questions have been asked. They are begging for an answer, and we await with interest the Minister's replies. Of course I join with other speakers in thanking my noble friend Lord Peston for his well-informed and reflective speech.
The subject is wide, but I propose to exercise a little discipline and go straight away to the Government's central theme in relation to the NHS. It has been the Government's case for some time that the NHS has been prospering since 1979. This case rests on four assertions, and they were advanced last Monday during Question Time by the noble Baroness, Lady Trumpington. They are recorded in col. 360 of Hansard for 30th March. The four main assertions are these: the increased resources which the Government have put into the health service since 1979; the increasing number of patients who are being cared for; the improved treatment which is being offered; and, finally, the assertion that the overall health in the United Kingdom has improved steadily. That is the Government's case.
It is our case that these assertions or arguments are sometimes misleading because they are not based on the whole truth or because they are taken out of their true perspective. I shall analyse them very quickly. My noble friend Lord Ennals, the noble Baroness, Lady Robson of Kiddington, as well as several other noble Lords have brought the increased budget into its true perspective by reminding the House that the increased funding—and certainly we do not deny that there has been increased funding—has failed at least since 1982–83 to keep pace with additional demands being made by the growing number of elderly, the increase in costs of medical technology and the increase in NHS pay and prices.

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That is the main reason, though not the only reason, why we read all too frequently about wards and operating theatres being closed permanently or temporarily because of shortage of funds for that particular service or shortage of nurses in key specialties such as intensive care units and theatres.
Then the Government go on to call in aid the increased number of in-patients who have been cared for in our hospitals since 1979. But increased productivity is not new; it has been improving ever since the first day of the NHS. Of course we are immensely grateful for that, and this gives me the opportunity to express our appreciation of the skills and care of all the members of the health team who work in hospitals and in the community.
It must be noted that the improved productivity since 1979 has been achieved notwithstanding a reduction of about 36,000 or 37,000 hospital beds. It will be our case that further improved productivity is no longer a risk-free policy because it inevitably reduces sharply the period of convalescence in hospital, and if reduced too far this could lead to premature discharge. Is this already happening? Will the Minister, when he comes to reply, enlighten the House as to how many patients were re-admitted to hospital once or twice within 12 months of their discharge in 1986?
We cannot leave the question of productivity without drawing attention to the very long waiting lists. This has dominated the debate. They have grown, according to my account, by about 2 per cent. to 673,000 in the last six months. This would have been the highest ever recorded if the lists were currently being calculated on the same basis as before 1979. In the 1983 debate in your Lordships' House on the state of the NHS, the Minister could bracket the figures of improved productivity with the steady progress in reducing the waiting lists. But this is something which the Minister can no longer do. I noticed that when opening the debate the Minister was silent on the question of the waiting lists. I submit again that this is the price we pay for closed wards and the shortage of nurses in the key specialties.
One could demonstrate how the long waiting lists can lead to unfairness. For example, three weeks ago I heard of a woman patient in my parish who had a lump in her breast but could not obtain an NHS consultant appointment in under six months. Worried, she agreed to pay the fee for private consultation and was seen within five days. But this option is not available to all patients. We say that it is unfair and unjust that patients in a priority category such as this should have to wait six months or more for an urgent consultation. I am sure that this lady in my parish is not an isolated figure.
I move onto the third assertion; namely, the improved treatment which is being given. Of course we are immensely grateful for improved treatment, wherever it is on offer; and it has been on offer since 1948. But let it be remembered that the improved treatment of today often rests on a long line of research and also on the level of excellence in our teaching hospitals. I think this point was touched upon by my noble friend Lord Bottomley and it may have been elaborated on by the noble Lord, Lord Nugent. This is a subject which your Lordships' House discussed on
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26th November 1986 when we drew attention to the fact that medical research is now in jeopardy and that the country has lost, since 1979, the equivalent of one medical school. If we are today denying the Medical Research Council and the medical schools adequate funds, where will the medical miracles of tomorrow come from? I should therefore be grateful if the Minister would tell the House what level of support the MRC and the medical schools and teaching hospitals can expect to receive from this Government.
To return to the question of improved treatment. perhaps I may say that it is patchy. For example, has the treatment improved for those suffering from chronic bronchitis? We have heard that the Government are setting targets for so many extra hip replacements, so many extra coronary bypass operations, so many bone marrow operations, so many extra cataract operations, as well as the list to which the noble Lord, Lord Kilmarnock, referred. We gather that the Government are setting targets for additional operations, but this is some acknowledgement, nevertheless, of an unmet demand.
What about the care received by the mentally handicapped, the mentally ill and the elderly in the community? Has their treatment improved? Organisations such as the National Schizophrenia Fellowship and the newly-founded RESCARE are by now actively campaigning for the retention of many of the hospitals scheduled for closure until such time as improved facilities are available outside the hospital. Indeed, they are holding a meeting here in Westminster in a few weeks' time, because experience tells them—and I think this is the point that has been made already this evening—that in general, life in the warmth and within the community of the hospital is far better than existence in many bed and breakfast lodgings which have mushroomed since 1982 and which are financed by the DHSS.
The testimony of these two voluntary organisations can be coupled with the illuminating evidence of the Audit Commission published last December which has been referred to. The commission found that there are today at least 25,000 fewer long-stay hospital beds than there were 10 years ago, but there are only an additional 9,000 day-care places. As has been said, very little is known of the whereabouts of the 17,000 or 20,000—it could be even more—who would have been in hospital 10 years ago. The noble Lord, Lord Hastings, asked a number of searching questions: where are the missing 17,000 or 20,000! What care are they receiving or not receiving? Is it true, as has been reported to RESCARE and has been suggested by the noble Lord, Lord Hastings, that a small number of mentally handicapped persons may even be in prison? If that is true, what on earth is being achieved by sending these unfortunate people to prison?
Forty-eight long-stay hospitals are due to close in the next eight years with the loss of 10,000 more places. Yet I have been told that the DHSS or the regional boards or both are pressing the district authorities to accelerate this planned rundown. Will the Minister take heed of the warnings of the voluntary organisations and the warnings that have been issued in the Chamber this afternoon? Can he therefore confirm whether or not the regional boards are pressing the district authorities to accelerate the

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planned rundown? Indeed, will the Minister tell the House which of the Audit Commission's recommendations have been accepted by the Government?
Finally, I come to the Government's fourth assertion—that overall health in the United Kingdom has improved steadily. Of course TB is not the plague that it was and people are not dying from diphtheria, but then we have the evidence of The Health Divide which has dominated the debate today. This document published last week shows that all the major killer diseases now affect the poor more than the rich, and confirms that the inequalities in health between the social groups are widening.
I can only ask the Minister whether this report, like its predecessor the Black report, is to be shelved or ignored. Unless the Government can demolish the Black report and The Health Divide report—and we on this side of the House do not believe that they can be demolished—the noble Baroness and the Minister cannot assert that overall health in the United Kingdom has improved steadily since 1979.
I must now conclude. The Government's case that the NHS is flourishing rests on the four assertions which we have examined, and it is our submission that those assertions are misleading. But it is rather interesting that no one has attacked the concept of the NHS, the principles of the NHS, which is after all one of the outstanding creations of the post-war Labour Government; and its principles are for the vast majority of people every bit as relevant as they were in 1948. That has been suggested by the noble Lord, Lord Soper, and by the right reverend Prelate the Bishop of Manchester. So when we talk of the failure of the hospitals to tackle the waiting lists, or the failure to provide adequate community care facilities, we are talking in the main but not exclusively about the shortcomings of a government who seek to run the NHS on the cheap.
8.12 p.m.
Lord Hesketh: My Lords, I have a very heavy right arm with the many questions raised in this afternoon's debate, and a great debate it has been. But before I say anything I should like to congratulate the noble Lord, Lord Peston, on a remarkably good maiden speech. I thought he summed up extremely well part of the whole problem that lies before us today. I hope he will forgive me if I slightly paraphrase him. He said that no matter how rich we become, we shall never be able to exceed demand. That is true.
I would also, before answering as many of the questions as I can, like to reply to the noble Lord, Lord Ennals. He suggested that Ministers do not use the National Health Service. This Minister, be he very junior, was for four days an in-patient of the National Health Service quite recently and is very grateful for the fine service which he received.
I think we all agree on both sides of the House about our wholehearted support for the very fine work that everyone in the health service has done for the service. The noble Lord, Lord Taylor of Blackburn, the noble Lord, Lord Auckland, the noble Baroness, Lady Lane-Fox, and many others paid great tribute to the voluntary sector and I wholeheartedly support the
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tribute paid to those who undertake voluntary work in the health field. It is hard to overstate the value which we place on this and I shall take the suggestions on board, particularly those of the noble Lord, Lord Taylor of Blackburn, and draw them to the attention of my noble friend the Minister. I believe that the noble Lord, Lord Porritt, spoke for all of us in this debate, as did the noble Lord, Lord Prys-Davies, at the end, in saying that no one questioned the National Health Service and he hoped very much that its future could be discussed without politics. I for one wholeheartedly agree with that.
The noble Lord, Lord Ennals, felt that the Government claimed that we were spending more money on fewer hospital beds. It is true that there are fewer hospital beds, but those which we have are being used more intensively and effectively than ever before. Sometimes the increased levels of activity run ahead of the resources available, and temporary reductions in services have to be made if authorities are to remain within their cash limits.
It will always be difficult, if not impossible, to explain the rationale behind such decisions to those who are still waiting their turn. But I know that your Lordships will recognise the underlying significance and the advantages to the National Health Service and its patients of higher productivity and lower unit costs, which the noble Lord, Lord Prys-Davies, also mentioned.
The noble Lord, Lord Ennals, and the noble Baroness, Lady Turner of Camden, referred to spending on health in this country compared with overseas. International comparisons of this kind are notoriously unreliable because of differences in the definition and range of services provided. For example, what we classify as personal social services others may include in health service provision. Nevertheless. I hope your Lordships will recognise as significant the fact that health spending per head of population grew in real terms in the United Kingdom by 21 per cent. between 1978 and 1983—well above the average for Western countries.
The noble Baroness, Lady Robson of Kiddington, felt that the cash allocations to regional health authorities would not enable nurses to be awarded the pay rise that they deserve. She will surely recognise that planned cost improvements, amounting to savings of as much as £150 million, will be retained by health authorities to the benefit of their local services.
The noble Lord, Lord Ennals, and the noble Baroness, Lady Lane-Fox, drew our attention to the need for more money for community care. The latest estimates we have of expenditure by local authorities on personal social services indicate an increase of almost 30 per cent. in real terms nationally between 1978–79 and 1986–87—substantially more than is required to keep pace with demographic pressures. For 1987–88, the rate support grant settlement allows for a 3½ per cent. increase.
The noble Baroness, Lady Seear, the noble Baroness, Lady Cox, and the noble Lord, Lord Hastings, drew our attention to the importance of real care for those who need community care. I refer them to my noble friend's speech with regard to the position of those discharged from long-stay care. We have

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consistently said that no long-stay patient should be discharged until appropriate care is available to support him or her outside the hospital.
The noble Lords, Lord Ennals, Lord Winstanley and Lord Soper, drew our attention to prescription charge increases. The recent increase in prescription charges of around 9 per cent. is broadly in line with rising costs of medicines. We believe that people who can afford to do so should contribute. I remind your Lordships that 75 per cent. of all prescriptions are dispensed free. There was a further point raised by certain noble Lords that the cost of 30 per cent. of prescriptions was beneath the charge for the prescriptions themselves. But the remaining 70 per cent. cost rather more than the prescription charge.
The noble Baronesses, Lady Cox and Lady Robson, spoke about the low morale and low pay of nurses. Pay is a matter for the independent Pay Review Body, which is expected to report to the Prime Minister shortly. Members will not expect me to anticipate the review body's recommendations, other than to say that it will be carefully considered by the Government when it reports. I take this opportunity to remind your Lordships that the basic pay rates for nurses have risen by 10 per cent. in real terms since 1983 and 23 per cent. since 1979.
The noble Lord, Lord Ennals, referred to the shortage of nurses. In the country as a whole the picture is less gloomy than some anecdotes might suggest, but there is evidence of shortage in key specialities in London and the South-East, particularly in the inner-city areas. Basic pay, which is a matter for the independent Pay Review Body, does not appear to be a major factor affecting recruitment, though the high cost of housing in the South-East is a major source of difficulty. The National Health Service Management Board is now discussing with the regional health authority chairmen what action might be taken in conjunction with local management to overcome problems.
The noble Lord, Lord Winstanley, drew our attention to the shortage of nurses' accommodation. I am aware of a shortage of reasonably priced housing in some parts of the country, particularly London and the Home Counties, which affects the ability of some health authorities to fill key nursing posts. Consideration is being given to what measures can be taken. In so far as certain accommodation has been sold, often it has been inappropriate and unsuitable for young professional people to use. Therefore, it is not entirely a case of property being sold which is suitable for nurses, because it was deemed to be unsuitable for them.
Lord Ennals: Slum property.
Lord Hesketh: The noble Baroness, Lady Seear, referred to the new Health Education Authority. I should like to speak at some length on that matter. The new Health Education Authority will be directly involved in planning disease prevention and health promotion within the National Health Service. It will do that in a way in which the old Health Education Council never could. The Health Education Council stood outside the National Health Service and had only limited involvement with district and family
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practitioner committee planning and service provision.
The chairman of the new Health Education Authority has been given a seat at the table of the Secretary of State's health cabinet where regional health authority chairmen meet regularly with Ministers. He will thus be directly involved in the process of developing policy and service provision within the National Health Service. Not only will health education be directly represented for the first time at these meetings. The development of health education itself will also be greatly assisted by being kept firmly in touch with service needs.
The right of the new authority to take an independent stance on matters within its remit is not at issue, given that it will work, just as the HEC did, within the framework of ministerial accountability to Parliament. The policy to increase the vigour and effectiveness of action throughout the National Health Service to prevent illness and promote good health as part of the National Health Service with access to Ministers means that there will be no need for confrontation or pressure group tactics.
Lord Dean of Beswick: My Lords, will the Minister give way for a moment? As regards the chairman of the new authority being allowed a place at the table with the chairmen of the regional health authorities, the Minister must be aware that the overwhelming number of members of regional health authorities are now either members of the government party or active supporters. Therefore, where will this independence come from?
Lord Hesketh: My Lords, that is a point on which we must agree to differ. The right reverend Prelate the Bishop of Manchester referred to the suppression of The Health Divide. The Government have not been involved at all in the commissioning or publication of that document. The Government did not attempt in any way to prevent publication, and the document has been distributed and is freely available. I understand that the chairman of the Health Education Council has emphasised that at no time did Ministers intervene.
The noble Lord, Lord Hunter, brought up the important matter of measles inoculation. I am glad to say that the uptake rate in England and Wales of vaccination against measles has improved from 63 per cent. in 1984 to 68 per cent. in 1985. Further improvement is essential if children are to be spared the avoidable distress of disability arising from the disease.
The noble Lords, Lord Bottomley and Lord Soper, together with the right reverend Prelate the Bishop of Manchester, felt rather opposed to the private sector in health care. However, patients have had the right to private care since the beginning of the National Health Service, as have doctors. That follows the fundamental principle that people in this country have a right to spend their money on anything they wish including their health care. Private medicine is no threat to the National Health Service. On the contrary, the existence of a thriving private sector usually strengthens the health service by relieving it of some work and enabling it better to meet its obligations.

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The noble Lord, Lord Ennals, raised the matter of occupational therapists. The department accepts that the supply of occupational therapists is insufficient to meet continually rising demand, although recent surveys show that the number of funded posts in the National Health Service unfilled for three months or more has fallen significantly.
The noble Baroness, Lady Cox, who is not present, raised the matter of pilot projects with regard to the Cumberlege Report. The points made in the report which attracted particular comment include the concept of a neighbourhood nursing service, which in some areas is already being provided although perhaps under another name. The report also recommended a manpower planning exercise on community nursing numbers. We have already amended the National Health Service planning system to ensure that we receive information on future plans for seconding nurses to district nurse and health visitor training. Unsatisfactory responses will be taken up within individual regions throughout the accountability review process.
The noble Baroness, Lady Seear, and the noble Lords, Lord Porritt and Lord Ferrier, together with many other noble Lords, suggested that the department be split up. In my humble position, I suggest that this is a subject of which I should steer very clear. The noble Lord, Lord Hastings, drew our attention to two services for epileptic people and suggested that they should be designated as supranational. An application to recognise certain special services for people with epilepsy as supra-national has been put to the Advisory Committee on Supranational Regional services. My right honourable friend the Secretary of State is awaiting the advice of the committee.
The noble Lord, Lord Dean of Beswick, referred to the possible closure of the accident and emergency departments at Ancoats Hospital. I understand that the North Manchester Health Authority will shortly be consulting the community health council and the public generally on the future of the accident and emergency departments. The Secretary of State will take into account the views expressed, and particularly those expressed this evening by the noble Lord.
The noble Lord, Lord Dunleath, drew attention to homeopathy in Northern Ireland. He kindly offered to allow me to answer his question after this debate. I am extremely grateful. Time is beginning to run out but I shall try to deal with a few more questions. The noble Baroness, Lady Turner of Camden, pointed out that 205 hospitals had been approved for closure since 1979. I agree with that. However, I remind her that that is fewer than the number of hospitals closed in the five years from 1974 to 1979
The noble Lord, Lord Rea, drew our attention to the situation in primary health care. In the consultation period the Minister chaired 12 public consultation meetings. Over 2,000 written comments were received, some of them after the 31st December deadline. The Government are now studying the large body of evidence submitted, including a report by the Social Services Committee of the House of Commons. They will decide in the light of those consultations
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what changes to pursue. I am sure that noble Lords would not thank the Government for reaching hasty judgments on these matters.
The noble Lord, Lord Kilmarnock, asked about AIDS and hospices. The local health authorities must make local decisons about the level of spending on hospices. The provision of hospices may be the right approach in some districts. My right honourable friend the Secretary of State recently announced a central allocation of £7 million in 1987–88 to meet extra costs generated by AIDS.
The noble Lord, Lord Prys-Davies, asked me a question concerning the number of extra cases in the health service which were readmissions. Studies suggest that while some of the increase in cases treated is due to readmission, the greater proportion is for new patients. Furthermore, many readmissions are in any case a planned part of the patient's treatment.
The Government have shown how they care for patients by putting patients first. We have done this by ensuring that the health service is more efficient, more flexible, better managed, better financed and better housed. Efficiency is about putting patients first, because it is about delivering more care for every pound spent. My noble friend Lady Trumpington has already quoted some exciting and impressive examples of the improvements in efficiency in recent years.
The health service is also using resources more wisely. We are making better use of facilities. Over 38 cases were treated per bed in 1985 compared with 28 in 1978. We are also making better use of financial resources. For example, rationalisation of NHS land usage will produce £200 million from the sale of surplus land and property in 1987–88.
The health service is now more flexible, and is more responsive to patients' needs and wishes. Waiting lists for NHS hospital treatment are now over 70,000 less than when we came to power. We recognise that in some areas and for some specialties patients have to wait too long. This is a major cause of frustration, inconvenience and distress. That is why we have launched a major three-year initiative to improve waiting times and waiting lists. To help health authorities to make a more rapid progress in tackling this problem we have established a special waiting-list fund of £50 million over two years. My right honourable friend the Secretary of State recently announced the allocation of the first £25 million for 1987–88. This will support over 350 projects throughout the country and enable an additional 100,000 cases from the waiting lists to be treated. These will include at least 5,000 hip operations and 8,000 extra cataract operations. I am sure noble Lords will understand exactly what that means in human terms.
Good management is essential to the efficient and effective running of any organisation, and the health service is no exception. This is why we have taken steps to ensure that the service is better managed. The introduction of general management, as my noble friend Lady Trumpington has said, has been a big step in securing a well-run service.
Not only are we making more efficient use of resources; there has been real growth in the resources the Government have devoted to the service. That

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commitment to growth in the health service is a continuing one. The figures on health service finance are large. In 1987–88 we shall be spending nearly £17 billion in England alone—£1 billion more than in the last financial year, and almost three times the amount spent in 1978–79. In other words, we shall be spending about £47 million per day. This means that spending will have risen about 28 per cent, ahead of inflation since we came to power.
Finally, the service is better housed. It always irritates me that the opening of a new, modern hospital is news for only a day, whereas the closure of a hospital can be bad news for years. Our health service building programme is of a massive order. We have started and completed more than 170 health service building schemes, each worth over £1 million. In the coming financial year alone we shall be spending more than £1 billion on capital schemes, and looking to the future, over 100 such schemes costing a total of about £700 million should be completed over the next three years. This is the biggest health service building programme by any government. Look back into what happened during the previous Labour Government. It is a dismal picture of cuts and cancellations.
I fear, listening to some of the contributions made by noble Lords this afternoon and this evening, that one could end with a distorted picture of the health service today. It is a caring service. Its job is caring for individual people. It is now providing more care more efficiently than ever before. In the future we are committed to improving and expanding the service still more. That is why I am proud to stand here today and talk about the health service which we all cherish. The Government's commitment is to the people of this country in sickness and in health, today and into the future.
Lord Kilmarnock: My Lords, before the noble Lord sits down, he answered my first question on AIDS but not the second. Will he write to me?
Lord Hesketh: I will.
Lord Ennals: My Lords, let me say how grateful I am to noble Lords in all parts of the House for taking part in what has been an excellent debate. I should like to thank the Minister for the replies he gave. Fortunately my task is not to reply to the debate or we would have another debate.
Although we have discussed various aspects of the health service on a number of occasions, this is the first time in four years that we have had a debate on the National Health Service as a whole. I want especially to congratulate my noble friend, who has been congratulated by everyone. He must be feeling great.
I have three quick points. First, at the time of the Budget the Government had to decide whether to make tax cuts or to put more money into the NHS. They decided on tax cuts rather than more money. I repeat that because it is a fact.
The Minister of State, Ministry of Agriculture, Fisheries and Food (Lord Belstead): No.
Lord Ennals: Yes, yes, yes.
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Secondly, I want to emphasise what was said by a number of noble Lords about community care. Voluntary organisations and local authorities must provide services before people are moved from long-stay hospitals. As I said, is not bridging funding essential? I was disappointed not to have had a reply on that.
No one has said anything about my third point, but I believe that too many people are chock-full of pills. They are given a pill, or six of them, for every ill. I am increasingly aware of the importance of a healthier lifestyle and the value of natural medicines.
I warmly welcome the debate that we have had and feel privileged to have had the opportunity of opening it. I beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.

Cardiff Bay Development Corporation (Area and Constitution) Order 1987
8.35 p.m.
The Minister of State for Defence Procurement (Lord Trefgarne): My Lords, I beg to move, That the order laid before the House on 12th January be approved.
This order is made under provisions in the Local Government Planning and Land Act 1980. Under Section 134 of that Act the Secretary of State for Wales is empowered to designate an urban development area. Section 135 empowers him to establish a corporation for the purpose of regenerating the area. The order before your Lordships designates an area of 1,089 hectares in the City of Cardiff and the Borough of the Vale of Glamorgan in the County of South Glamorgan and will establish the Cardiff Bay Development Corporation to bring forward the redevelopment of the area. Incidentally, I am told that 1,089 hectares is 2,700 acres.
The order has been judged to be hybrid and a petition was made against it. A Select Committee of your Lordships examined the case put forward by the petitioners for the exclusion of an area of land from the urban development area. The Select Committee concluded that the order should proceed unamended. I am pleased to say that there were no petitions against the establishment of the corporation as such.
The Cardiff Bay area was once the hub of commercial activity in Cardiff, reflecting in particular the growth in coal production at the end of the last century and the early part of this. At one time, the port of Cardiff had a greater throughput of traffic than any other port in the world. The decline in coal exports from the time of the Great War however saw a decline in port-related activity and this decline has continued to the present day.
Some of your Lordships know the area a good deal better than I and will know that the two main communities in the area epitomise many of the problems associated with our inner cities. It is right that these communities should look to government both central and local to help bring about change. This is the objective, and we are confident that the future

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holds out every prospect of new life being breathed into the area to make it once again a vibrant and important centre for the economy of Wales.
I am pleased that the proposal before your Lordships has met with widespead support in the area. All the local authorities in the area have pledged their full backing for the proposed corporation, including the South Glamorgan County Council under the leadership of the noble Lord, Lord Brooks of Tremorfa. It is, I believe, highly relevant that this support spreads right across the political spectrum.
It is for this reason that my right honourable friend the Secretary of State has decided that the corporation, by working closely with the local authorities and other public bodies in the area, can be small but will have to provide the drive and motivation to bring this massive redevelopment forward. My right honourable friend has decided not to give the corporation all the development control functions given to the UDCs in England at the outset as he believes that the cooperative approach with the local authorities can provide the necessary stability in policy terms and produce the quick decision-making necessary if the private sector is to have the confidence to invest. The corporation will have all the powers necessary to see its task through, including the powers for land acquisition, land reclamation and servicing, the provision of infrastructure and will be able to work with the private sector to bring forward development.
The chairman-designate of the corporation has already been announced. Mr. Geoffrey Inkin knows the area well and has the enthusiasm and drive to make a success of this project. Other appointments to the board will be announced very soon and will include a number of local people who have close ties with the area as well as others who have the particular skills and experience necessary to ensure that the corporation is successful.
The studies that we have commissioned suggest that,
"this is a rare opportunity to develop a superb environment setting which will have few, if any, competitors in Great Britain".
The corporation is needed to ensure that this opportunity is grasped. The local authorities and others in the local community agree with the Government that this is the way forward. I commend the order to the House. I beg to move.
Moved, That the order laid before the House on 12th January be approved. [15th Report from the Joint Committee].—(Lord Trefgarne.)
8.45 p.m.
Lord Cledwyn of Penrhos: My Lords, we are grateful to the noble Lord, Lord Trefgarne, for his explanatory opening speech. We are also glad that he has found the time to sail from the unpredictable seas of the Ministry of Defence into the peaceful haven of Cardiff Harbour. We are also grateful to the noble Lord, Lord Elton, the Chairman of the Select Committee, and his noble colleagues for their work in the Select Committee.
Cardiff is a capital city of which we have every right to be proud. Its civic centre with its fine, well laid out buildings would grace any capital city. I remember the late Clement Attlee saying that it was one of the finest
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in the world. Its people, moreover, are industrious and forward-looking. Wales, historically, had no fixed capital city although there were attempts to establish one over many years. It is the kind of subject upon which it is not easy to find a solution in Wales. Sir Owen Edwards, who was a Member of the other place for a time, begins his history of Wales with this sentence:
"The history of Wales is a history of tribal warfare.".
When I was Chairman of the Welsh Parliamentary Party many years ago I had the privilege of leading a deputation of my colleagues to the then Home Secretary to recommend that Cardiff should be designated as the capital city of Wales. It was a bold, some say a rash, step to take because Swansea, Aberystwyth and Caernarfon also laid claim to the distinction. I confess that as a native of Gwynedd and then the Member for Anglesey I felt in my heart that Aberffraw, the capital of the great Llywelyns, had some claim to consideration. However, our task was made easy because at that time the Home Secretary was a Welshman—the late Gwilym Lloyd George. We overcame our tribal loyalties and decided that Cardiff was a worthy choice. We have not been disappointed; and all parts of Wales look to Cardiff as its capital city—even those from the far North.
The House will be aware of some of our problems in Wales at the present time. We suffer from unacceptably high levels of unemployment, especially in some areas, and there is a need for urban renewal on a substantial scale. The chief cause of our difficulty has been the decline of our basic extractive industries on which we had become over-reliant and upon which the great ports of South Wales, notably Cardiff, depended for their prosperity. The tragic disaster of Aberfan, which shocked the world, was a poignant reminder that major changes and new developments are urgently required.
As Secretary of State at the time—Aberfan was the worst moment in my career in politics; and I know I have the sympathy and understanding of my noble and learned friend who was Attorney-General at the time—I recall in a discussion of the implications with Sir Goronwy Daniel, the Permanent Secretary, asking if there was anything we could extract from so awful a catastrophe. Out of that we created the derelict land unit which has during the intervening years carried out one of the most extensive programmes of land reclamation in the whole of Europe.
Cardiff inevitably suffered from the decline to which I referred, but it has also developed into a great administrative, commercial and cultural centre and many interesting projects are now under way there. But the greatest project and the most exciting enterprise is the one we are discussing this evening. If it is fully realised it will bring a new impetus and a new opportunity to Cardiff and also to the adjoining areas. I sense an atmosphere of hope and of excitement in Cardiff which does not exist in many places today. I remember sensing the same spirit when I visited Aberdeen a few years ago.
This proposal to develop the Cardiff waterfront is partly responsible for this expectant atmosphere. It is comparable with the London dockland development and a few other similar projects. A study by the well-

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known firm of Messrs. Jones Lang Wootton found that there is an area in South Cardiff of about 3,000 acres which is immediately available for development; of which 600 acres are immediately available for development close to the water's edge. I note that the right honourable gentleman the Secretary of State for Wales, who has played a major role, compares it with the waterside development of the Baltimore inner harbour in the United States which is now world famous and which attracts over a million visitors each year.
The commercial, cultural and entertainment possibilities are endless and there are ample attractive sites for imaginative housing development. I understand that it comprises 65 per cent. of the land immediately available for industrial development in the whole of the City of Cardiff. What is proposed is that this huge derelict area can be transformed to the immense advantage not only of Cardiff but of the economy of South Wales, and especially the valleys of South Wales which have suffered so much in terms of employment and industrial dereliction over many years.
The support for the scheme in the Cardiff area is widespread and enthusiastic and my friends from the local authorities are anxious to get it under way. This can be summarised in the words of Mr. Eurfyl Davies, the Cardiff City Planning and Development Officer, who said:
"Cardiff City Council has long been concerned about its docklands area with its serious problems of declining economic activity, social deprivation and physical decay and is highly committed to its regeneration".
Mr. Davies was one of the witnesses who appeared before the Select Committee of this House but he was reflecting a general view when he uttered those words. He also emphasised the importance of the inclusion of the whole Roath Basin area within the early development.
As the noble Lord said, this is a project supported by all local authorities including the South Glamorgan County Council, the Vale of Glamorgan Council and, of course, Cardiff City Council. It also embraces all political parties and all public bodies. It is right that I should also mention that my right honourable friend Mr. James Callaghan has taken a great interest in this venture and is in full support of it. The city council has underlined its commitment in several ways and I should like to pay tribute to it for the enterprise and the work it has done.
This is a substantial commitment, as the House must agree. One obvious and essential point is that this great scheme must be adequately planned and administered. There must be effective central control. We note with great interest the composition of the corporation; with five directors from the local authorities together with eight others and a chairman who has already been appointed by the Secretary of State, as the noble Lord mentioned. We wish the new chairman every success in his important task. We hope that the other members will be able, experienced and with a commitment to Cardiff and to Wales.
This scheme will be in our capital city and it must have a Welsh flavour and be identifiably Welsh. We give this enterprise our warm support. We shall watch
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its progress with great interest and we wish all those who devote their energies to it every success.
Lord Trefgarne: My Lords, I am most grateful to the noble Lord for the warm welcome he has given the proposal that I have ventured to bring before your Lordships this evening. Perhaps I may finish on a personal note. My right honourable friend the Secretary of State has been very much the architect and supporter of this project from the start; indeed he has given it his close and continuing personal attention during the preparation of the various orders and their passage through the other place. He was, in fact, good enough to assist me in preparing my remarks to address to your Lordships this evening. My right honourable friend has made it clear that he does not intend to stand at the next general election. I venture to suggest that this project will remain as a memorial to his time in the Welsh Office; and a very splendid memorial it will be.
On Question, Motion agreed to.

Social Security (Class 1 Contributions— Contracted-out Percentages) Order 1987 State Scheme Premiums (Actuarial Tables) Regulations 1987 State Scheme Premiums (Actuarial Tables—Transitional Provisions) Regulations 1987
8.50 p.m.
Lord Hesketh: My Lords, I have to apologise to the House that there are errors in the Motions standing in my name on the Order Paper. Reference is made to an order and regulations laid on 16th March and regulations laid on 18th March. The order and regulations were withdrawn by the Government on 30th March and replaced by a fresh order and regulations which I am now asking the House to approve.
With your Lordships' agreement, for the convenience of the House, I propose to deal in my opening remarks with the draft order to which I have just referred together with the two sets of draft regulations which appear next on the Order Paper.
The reports by my right honourable friend the Secretary of State for Social Services and the Government Actuary show the technical complexity behind the three statutory instruments to be debated. I propose, as did my predecessor when these matters last came before the House five years ago, to do my best to avoid burdening your Lordships with too many technicalities, but rather to concentrate as far as possible on the social and policy issues involved.
The terms for contracting-out of the earnings-related additional pension part of the state retirement pension scheme were contained in the Social Security Pensions Act 1975, which came into operation in April 1978. My right honourable friend the Secretary

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of State has a statutory duty to review these terms at least every five years. The revised terms will take effect from April 1988.
In 1986 widespread consultation took place on the terms of contracting-out on the basis of memoranda prepared by the Government Actuary. The comments received were taken into account by him in the preparation of his formal report.
The basis on which schemes have been contracting-out since 1978 has been that schemes guarantee to provide a pension that is broadly equivalent to the state additional pension. In return, national insurance contributions for contracted-out employments are reduced. This reduction is commonly called "the rebate". It was thought right in 1978, and again when the terms were first reviewed in 1982, that the rebate should contain a contingency margin. The margin was to allay anxieties that schemes would have an open-ended commitment, because accrued rights would be related to future earning trends and future returns from investments were uncertain. Other safeguards were provided when schemes had to buy back into the state scheme. The success of these arrangements is shown by the fact that of the 11 million members of occupational pension schemes, nearly 90 per cent. are contracted-out.
It is disappointing, however, that the number of people in occupational pension schemes has remained virtually static for two decades. The Government's wish to provide new opportunities for the expansion of occupational pension and personal pension coverage resulted in the provisions of the Social Security Act 1986. The provisions of that Act were widely debated here and in the other place during 1986. I do not, therefore, propose to refer to the detail contained in the Act. I will just say this. Our aim has always been to give everyone the chance of having their own pension and more choice of how to save for it. In future it is expected that it will be the exception for people to reach retirement without a pension of their own.
The 1986 Act introduced a new money purchase test for contracting-out and also contracted-out personal pensions. The minimum amount that is to be paid to money purchase and personal pension schemes is equal to the amount of the rebate that will apply to salary related schemes.
That is the background to the current review. The cost to salary related schemes of providing guaranteed minimum pensions was calculated as being 7 per cent. of reckonable earnings from 1978 to 1983, and currently it is 6.25 per cent. The cost for the five years from 1988 to 1993 is calculated to be 5.4 per cent. Your Lordships will see that the cost is decreasing as the average rate of accrual of guaranteed minimum pension declines. This is because those who were in the scheme from 1978 enjoyed a faster rate of accrual than those joining later. The figure of 5.4 per cent. includes, as do the figures for previous periods, a contingency margin of 7½ per cent.
My right honourable friend has decided that from 1988 to 1993 the rebate should be 5.8 per cent. This will include an additional margin of 0.4 per cent. over the average cost of providing a guaranteed minimum
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pension. The additional margin provides a further safeguard against any additional costs arising from the implementation of the 1986 Act. The amount of the rebate will give increased confidence to existing contracted-out schemes and encourage the setting up of new money purchase and personal pension schemes. The additional margin will apply for the period 1988–93 only. The 5.8 per cent. rebate will be shared so that employers receive 3.8 per cent. and employees 2 per cent. This reflects very closely the apportionment of the present rebate.
Contracted-out schemes may in certain circumstances transfer their liabilities for guaranteed minimum pensions to the state scheme by paying premiums. This is commonly referred to as "buying-back". It is necessary to provide different actuarial tables in respect of guaranteed minimum pensions that accrue up to April 1988 to those that accrue from April 1988. This is because guaranteed minimum pensions paid on account of accruals from April 1988 will include revaluation of up to 3 per cent. per annum. The tables represent the average cost of providing guaranteed minimum pensions. This cost is adjusted by a device called the market level indicator which allows for investment yields at the time of the buy-back. Without this protection a scheme could find itself in difficulty in meeting the cost of premiums if there were a fall in the market value of its investments. In current investment conditions the premiums are roughly equivalent to the amount of the rebate and the scheme is able to retain the profit from the investment appreciation. The new market level indicators will ensure that schemes are fully protected against sudden falls in the market value of their investments whilst reducing the scope for profits to be made from ceasing to contract-out.
The Government announced on 18th March that new personal pensions will be introduced in January 1988. Not only is this three months earlier than originally planned but those without a pension will be able to backdate contracting-out to April of this year. This is a considerable achievement. Premiums may be payable by schemes that have ceased to be approved as "appropriate" by the Occupational Pensions Board. Although it is extremely unlikely that a scheme would cease to be appropriate before April 1988 it is still necessary to provide legislative cover against that contingency. The transitional regulations provide that cover.
I opened by referring to the technical complexity of this subject; but I believe I have been able to indicate to your Lordships the importance of these statutory instruments and how they fit in to the Government's overall pension strategy. I beg to move.
Moved, That the Social Security (Class 1 Contributions—Contracted-out Percentages) Order 1987 laid before the House [16th Report from the Joint Committee]; the State Scheme Premiums (Actuarial Tables) Regulations 1987 laid before the House [16th Report from the Joint Committee]; and the State Scheme Premi urns (Actuarial Tables—Transitional Provisions) Regulations 1987 [16th Report from the Joint Committee] be approved.—(Lord Hesketh.)
Baroness Jeger: My Lords, I must begin by protesting at the inconvenience that has been caused to

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the House by the fact that these measures were due to be put before your Lordships on Monday and that they were then taken off. I am told, and I have a letter from the Printed Paper Office in front of me which says:
"The reason for re-laying these instruments was indeed a drafting error".
I think it is quite fair for me to ask who made the drafting error and why that error was not put right. It has been a great inconvenience to many noble Lords that the timing was altered from Monday to Wednesday.
I understand also that these provisions have not been laid in the other House. Although I realise that it is not absolutely essential for the other place to take them first, there is some anxiety about when they are to go to the other place in order that they can be legalised. Of course, the provisions arise out of the Social Security Act and therefore there is no reason why we should take a great deal of time dealing with the details.
However, I must put on record that for many of us it has been of great inconvenience that there has been this muddle; that someone who is unidentified has put the papers in the wrong position and has not corrected the matter. This is not the first time that this has happened with the DHSS. The department seems to be in total confusion. There have been more mistakes—and I say this as a former civil servant—from that department than from any other with which I have had contact.
I shall not propose that we have any unkind discussion tonight. I shall say only that it is an absolute disgrace that my noble friends and I are pushed around from Monday to Wednesday and that nothing seems to be correct that comes from that department. I have every sympathy with the noble Lord who has to deal with these matters. In that spirit, I hope that he will appreciate that we give a grudging consent tonight.
9 p.m.
Lord Kilmarnock: My Lords, I thank the Minister for having explained these orders and regulations, complicated though they are. I speak on behalf of my noble friend Lord Banks, who was prepared to deal with them when they were originally due to have been introduced. He has asked me to express his great regret that he is unable to be here tonight. He is disappointed to be unable to intervene on a matter on which he is perhaps the greatest acknowledged expert in the House.
The measure that excites the most interest is the Social Security (Class 1 Contributions—Contracted out Percentages) Order 1987. This interest arises because all employers with contracted-out schemes need to know the amount of the contracted-out rebate from April 1988 in order to reassess their positions. Most particularly, all employers contemplating a new contracted-out occupational scheme—whether final salary or money purchased—under the new arrangements also need to know the position. Likewise, individuals contemplating contracting out by means of a personal pension plan need to know what rebate will be paid by the DHSS into their policy.
There has been considerable speculation as to what the new level of rebate might be. The figure of 5.75 was
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widely canvassed. It has turned out to be 5.8—not a great difference. It has always been understood that the rebate would reduce as those with higher accrual rates were gradually replaced by new people coming in with lower accrual rates, to which the noble Lord referred. Thus we have had the reduction in 1983 from 7 per cent. to 6.25 per cent. We now have a further reduction to 5.8 per cent. As the noble Lord, Lord Hesketh, told us, the Government Actuary thought that 5.4 per cent. would be sufficient, including the 7.5 per cent. contingency reserve. To be on the safe side the Secretary of State has gone to 5.8 per cent., for which contracted-out contributors will be grateful.
To this extent the order is welcome. The difficulty is that the new provision for personal pensions takes effect from 1st January. The new rebate does not become effective until 6th April 1988. This means that for this period—approximately three months—the old rebate will apply to personal pensions. Will it not therefore be a little confusing for those effecting personal pension plans in the first three months of 1988 to be faced so soon with a reduction in the DHSS contribution that they can expect? Is there not a danger that people may jump in on one basis only to find that their long-term commitment is on another?
Turning to the actuarial tables, these indicate the cost of buying back into SERPS on ceasing to be contracted out. These tables have to be revised periodically to reflect market conditions and any consequent change in the cost of providing each £.1 worth of pension.
The second measure sets out the table required to replace the 1978 tables and the 1982 amendments. The first measure, which is a transitional one, is necessary to provide the appropriate tables for personal pensions in the period of this hiatus between 1st January and 6th April. This is a further complication resulting from the decision to start personal pensions from 1st January.
Two questions arise from that. Would it not have been better to have held back the personal pensions until April, especially as most potential providers are complaining that they do not yet have sufficient information about the general regulations—not these regulations—governing personal pensions, the terms of the policy, and so on? They do not have sufficient information to design and prepare their schemes in time. That is a complaint in the industry. Also, does not the initiation of the new personal pension on 1st January and the new money purchase employers' scheme in April favour the former against the latter, particularly as those who take out a personal pension plan between 1st January and 6th April can claim an extra year's contracted-out rebate in addition to the 2 per cent. incentive?
If this situation seems surprising I am assured that this is the pension industry's interpretation. If it is not true the noble Lord will tell me. If it is true, does it not provide the personal pension with an additional attraction for the new entrant at the expense of any money purchase scheme an employer may introduce from April? Would it not have been better to introduce the two types of schemes on all fours and on a level

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platform? I shall be most grateful if the noble Lord can comment on those remarks.
Baroness Turner of Camden: My Lords, I had not intended to intervene in the debate until I heard what the Minister said. In addition to the points raised by the noble Lord, Lord Kilmarnock, I am concerned by the additional incentive that the Government appear to be giving to personal private pensions. Noble Lords will know what we on this side felt at the time of the Social Security Bill about private personal pensions. Indeed, we hold that the Government by their attitude are assisting to some degree to undermine very good collective occupational pensions provision by their apparent support for PPPs.
I should like to put on record—although it is over and done with now—my objection to bringing the date forward to January 1988. I speak as a member of the Occupational Pensions Board and I think it is going to be very difficult to get everything in place in time to be ready for January 1988. This is a further complication.
I draw the attention of the Minister to the fifth report of the Social Security Advisory Committee where it deals with personal pensions. It expresses grave doubts about the degree of security that an individual will have if he switches to a money purchase-type arrangement with personal private pensions. That is made very clear in the final paragraph:
"We are concerned about the risk inherent in money purchase schemes since investment in a pension constitutes a major element of personal finance for most people".
It is talking in that connection about private personal pensions. I put those points to the Minister because I think they are relevant in the context of these regulations.
Lord Hesketh: My Lords, first I take this opportunity of apologising to the noble Baroness, Lady Jeger, for the unfortunate situation. I am not entirely sure who is responsible, and I fear that that will come as no surprise to the noble Baroness.
The noble Lord. Lord Kilmarnock, questioned me with regard to the rebate for personal pensions taken out in 1987–88 which will be backdated to 1st April 1987. They will be the present rate of 6.25 per cent. Those involved in selling personal pensions will no doubt make it clear that the rebate from April 1988 will be 7.8 per cent.—that is, a rebate of 5.8 per cent. together with a 2 per cent. incentive rebate. The 2 per cent. additional rebate will also be available to contracted out group money purchase schemes.
The noble Lord, Lord Kilmarnock, also said that personal pensions providers will not have sufficient time. The regulations will be out towards the end of May this year, but personal pensions will be backdated only for those who are not contracted out between April 1987 and January 1988. In so far as concerns the other point raised by the noble Lord, Lord Kilmarnock, I will write to him.
The noble Baroness, Lady Turner of Camden, expressed her feelings concerning PPPs, and I fully understand her position. However, I am sure that she
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is well aware that the Government are very keen on promoting the concept of individuals being able to have individual pensions. But I fully understand the points that the noble Baroness makes and take them aboard.
I shall write to noble Lords concerning any further points which I have not covered. I hope that the regulations will prove to be a success. I am confident that the statutory instruments before us today form an integral part in the Government's strategy for the provisions of pensions for all. I commend them to your Lordships.
On Question, Motions agreed to.

Channel Tunnel Link with East Sussex
9.11 p.m.
Lord Hardinge of Penshurst Lord Hardinge of Penshurst rose to ask Her Majesty's Government whether they accept the necessity for major road works between Hastings and Hythe in view of the fact that the A.259 has been preferred as the main trunk route between the Channel Tunnel and the towns of East Sussex, and in particular of the need to by-pass Dymchurch and St. Mary's Bay as well as New Romney.
The noble Lord said: My Lords, it is with some humility and after much thought that I have decided to press this question. To some extent this is a specialist field and some of the greatest experts in the land are at work on it. I refer in particular to the passage of the Chunnel Bill itself and also the awesome task undertaken by the group of experts who form the Select Committee of your Lordships' House. But I believe it is justified to draw attention to the needs of a particular large area involving a substantial population. The timing of the question may not be perfect, but it is difficult to see what would have been better. I first heard of this issue in June last year. It is now April 1987—nine months later. I am told that it is possible that the Select Committee may still be hearing evidence for a long time. So, perhaps it is as good a time as any.
I must express my particular gratitude to noble Lords who have put their names down to speak this evening. All their contributions will be important and at least two noble Lords are rather expert on transport, which I am not. There is a lot of interest in, and support for, my Question in East Sussex apart from noble Lords who will speak tonight. My noble friend Lord De La Warr is concerned and although he is not here to speak tonight I think your Lordships may hear from him at some time during the passage of the Bill. My noble friend Lord Chelwood has taken the greatest interest and trouble and, despite illness, has been in touch direct with the Minster about the matter. He would certainly have spoken had it not been doctor's orders that to do so would delay his convalescence. I am quite sure all noble Lords wish most warmly that his convalescence will soon end and he will be back to full health.
My concern in this Question comes from the fact that I have lived in East Sussex almost all my life and never very far from the town of Hastings. Apart from this I have no personal or financial interest of any kind

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to declare. Before coming to the background of the Question itself, I should like to say a few words about the town of Hastings, which is at the very centre of this particular matter. I am really repeating what my noble friend Lord Teviot said on the Second Reading of the Chunnel Bill. These points will bear repetition.
First, Hastings is not part of the so-called pampered South-East. It has never been a wealthy town and has recently had unemployment figures as high as 20 per cent. As my noble friend said, it has somehow always been a bit rundown. One reason that it has been in part isolated from the south-eastern boom has undoubtedly been the lack of good access roads, but I shall come to that in a minute. My noble friend also made the point that Hastings is one of the most famous towns in the world. It is impossible for anyone anywhere in the world who knows anything at all about European history not to have heard of Hastings. This of course is due to the battle, and the fact that the battle took place somewhere else is neither here nor there. It is called the Battle of Hastings.
I hope that I am not being slow in coming to my Question but these points are all relevant, as is the situation on the A.21. In general we should congratulate the Government on what they have done and what they are doing about roads. It is true that progress is being made, and further progress is planned on the A.21 between Pembury and Hastings. It is clear that progress will be made. I am not offering any criticism of this Government or departments or councils when I say that previous development of the A.21, which is the natural link between Hastings and the M.25, has been snail-like, to put it politely. Indeed, a vigorous snail might take exception to the comparison.
I am much older than the Minister and I have seen all this going on—if those are the right words—since before the war. In the late 1950s I used to ask Neill Cooper-Key, who was then the MP for Hastings, what he was going to do about the A.21. So I have been concerned with this problem for a rather long time.
Therefore Hastings, Bexhill, Eastbourne, Battle, etc. must look for their opportunity in road developments that are consequential on the building of the Chunnel. That is why I have chosen to ask the Government this Question in this particular form rather than try to intervene at one of the stages of the Chunnel Bill, though again I congratulate my noble friend Lord Teviot on his efforts at Second Reading.
That is the preamble and the general situation. I shall now try to set out the relevant details. ESFLAG is the acronym of the East Sussex Fixed Link Action Group. The members of it are East Sussex County Council, Eastbourne Borough Council, Hastings Borough Council, Rother District Council and Wealden District Council. Observers are Lewes District Council and Ashford Council. Their concern is that there should be sufficient access to these places, to the 1066 country, the South Downs, etc. in the event of the Chunnel being built. They have been very modest in what they ask for. They are not shouting for great dual carriageway roads. They just say that they want one good road, or preferably two good roads, linking them to the Chunnel terminals.
Thanks to the efforts of East Sussex County Council and also Hastings Council, I was able to place in the
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Library a week ago a map that makes this whole Question easier to understand. It is a simple black and white line map. There are in existence some magnificent road planning and projection maps but they are hard to copy in many numbers.
The original thrust of ESFLAG's argument was to stress the need for the Hastings eastern bypass, etc., for major comprehensive improvements on the A.259 east of Hastings to Rye and Brenzett, which is in Kent, and to urge that the A.2070 from Brenzett to Ashford should be trunked and become the main access route between the M.20, which in this context effectively means the Chunnel and the South-East. This is a logical route on the map despite the fact that private cars will load and unload at Cheriton. A powerful consideration was that, while there was a decent road as far as Brenzett, it would be comparatively short and simple to trunk the A.2070 to provide a good road to Ashford and the M.20. It was influenced by the obvious major problems in converting the A.259 east of Brenzett into any form of major road conduit. This road is at present very inadequate.
The Department of Transport press notice No. 562 of 23rd October 1986 makes no mention at all of the A.2070. It is headed "Further Trunk Road Proposals for A.259 corridor in Kent and East Sussex", though in fact—and properly I dare say—it concerns itself more with Kent. Among other things, this notice promises a bypass for New Romney while apologising for the disappointment that may be caused by the absence of plans to bypass St. Mary's Bay and Dymchurch. If I may quote from the words here attributed to Mr. Peter Bottomley:
"We remain unconvinced that traffic growth estimated for the A.259 justifies reinstatement of these suspended schemes at present".
I shall come back to that later.
On 17th December 1986 I wrote to my noble friend the Minister and received a most courteous reply dated 20th January this year. Obviously his letter is important, and I am particularly grateful for the reassurances that it gives about some of these problems and the promise of future government activity. With the leave of the House I shall quote one sentence from his letter:
"We have explained to ESFLAG in recent correspondence that we do not see any compelling strategic reasons for making the A.2070 the trunk road in place of the eastern section of the A.259 from Brenzett to Hythe and we would only be prepared to pursue this if Kent County Council were of the same view as ESFLAG".
But in this particular matter Kent County Council apparently is not of the same view as ESFLAG. If I may again have leave to quote, Mr. John Fassenfelt, on behalf of the Kent county surveyor, wrote to Mr. Roger Carrier, the Hastings chief executive, on 4th February and said (among other things):
"You mention in your letter the question of trunking the A.2070. This is not something that the county council is pressing for at present".
I am not criticising anyone at all about this matter. There is no criticism implied in the Question. It is a question of seeking enlightenment, not of criticising the Government; certainly not Kent County Council or anyone else.
In view of what I have said, it seems that ESFLAG and everyone else must accept the trunking of the

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A.250 east of Brenzett in preference to the A.2070. The purpose of my Question is to draw attention to the obvious inadequacies of this road at present. In particular—and perhaps I am just being stupid here—I cannot follow the logic of bypassing New Romney but not Dymchurch or St. Mary's Bay. The map illustrates this point and of course I have been to look more than once.
I am not alone in seeking enlightenment on this point. I have read the relevant minutes of evidence heard so far by the Select Committee, which show that Kent County Council also endorses the need to bypass these two towns. This very important information has been confirmed by the Hastings chief executive, as has another important fact: that Shepway District Council is also concerned by the absence of proposals to bypass Dymchurch and St. Mary's Bay. I am aware that in the past the Government have given some answers to this question, but there is still widespread concern.
I have almost finished, but there is just one thing that I should like to say about forecasting in general. There is a bit of chicken and egg about it. If you say there will be no traffic so we need no road, well of course there will not be any traffic. It is self-fulfilling. That is enough of snails, chickens and eggs. We all recognise that this is a serious debate on a serious matter. I again thank noble Lords who will speak. I shall listen with great interest to what is said, and of course to the Minister's reply.
9.25 p.m.
Lord Teviot: My Lords, my noble friend has taken a great deal of trouble and has followed every road to do with this important subject. I shall hardly mention roads at all because he has covered the whole road aspect. The noble Earl who is going to follow me also, I gather, knows quite a lot about roads.
This Question goes a little beyond roads, as my noble friend equally mentioned. The Channel Tunnel is going to make a great difference to a great many people's lives, not only in the county of Kent and East Sussex but in the rest of the country. I shall go on to speak about East Sussex in a moment. It is going to be a trauma for all of us. Some people have supported the tunnel, and some have not. However, it is something that is going to come into being, though others may think otherwise. Let us take it that the tunnel will come here very soon.
Quite properly the Government have had a Kent consultative committee. I do not suppose that they could have afforded a Sussex consultative committee, but East Sussex is in close proximity. I am not speaking as my noble friend did, as a transport expert. He has covered transport so far as concerns roads and there is little for me to say except that I think I can say here that British Rail has been rather outstanding on this matter. It has promised to improve its line between Hastings and Ashford. I shall refer to British Rail later in my short speech. One follows the excellent advice that one has received from East Sussex County Council and the district councils of the organisation my noble friend mentioned.
Apart from roads, my noble friend mentioned that I spoke on the Second Reading of the tunnel Bill, and
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perhaps made a "funny", or an amusing remark, or whatever, and referred to the town of Hastings. But, as my noble friend mentioned, Hastings is a serious subject. It is a place that has been forgotten for a long time. I do not see why the Channel Tunnel should make any difference to Hastings, but here is an opportunity for an area to have a bit of consideration.
Although there are industries there, if there could be something more (though not too much) to employ in proportion some of the 20 per cent. unemployed, that would be a great thing—not just industry, but even tourism. I think I can speak a little about tourism not only for Hastings itself, which is an ancient town, but for that delightful part of the countryside.
When we speak about tourism and the Channel Tunnel, we speak about tourism from abroad. We are good ourselves at going to the Continent to have short breaks. One would like a little reciprocity from the Continent to here for short breaks in Kent and East Sussex. One hopes that with the Channel Tunnel tourism will increase. If visitors come for a week, 10 days, a fortnight or even longer they can see further sights in Great Britain and enjoy them.
I am sure there will be a time when people will make trips through that tunnel with their motor cars and will want just short holidays and will go to see East Sussex, which has a great deal to offer—not only the town of Hastings, but Rye, and wherever. The noble Earl lives at Hurst Green. I do not know whether he lives in the part of Hurst Green in the parish of Salehurst or in the parish of Etchingham, but there are two typical English villages. There is the small town of Robertsbridge and the church at Salehurst. There is also the magnificent church of Etchingham with its misericords. There is a great deal for people to see. Very soon I shall stop talking. My noble friend spoke largely about roads. I hope I have opened the subject enough to prove that there is a great deal to see in East Sussex.
My last comment to your Lordships is that the Channel Tunnel may give encouragement to other noble Lords to promote similar Unstarred Questions on other subjects. My noble friend has made it worth while for all of us to consider that.
9.30 p.m.
The Earl of Longford: My Lords, I rise to offer warm support from the Opposition for the proposition advanced by the noble Lord, Lord Hardinge, in such an effective fashion. He indicated that out of the five speakers to follow him, two might be regarded as experts on transport. The noble Lord who has just spoken is clearly one of those, but that leaves four others. I do not know who the other one was he had in mind; it was certainly not me.
In many years in the House I have only once spoken on road transport. Then I was on the winning side, ultimately; I joined in the mass protest against the desecration of Christ Church Meadows, Oxford, and that road has never been driven through. I hope that I shall be on the winning side again here. As the noble Lord who has just spoken said, I have a house in Hurst Green, which is perhaps seven or eight miles from Battle. It seems a long way to walk, which I still do just occasionally—more and more occasionally—but I

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know that walk and it is about twice as far to Hastings. However, I live in that part of the world.
My only credential, which my colleagues here will appreciate, even if no one else does, is that I am president, no less, of the Battle and Bexhill Labour Party. That is an important office. It is a fine body of men and women. They have not yet threatened the occupying power, but we hope to put that right very shortly otherwise I may be evicted from the presidency after so many years of relative failure.
As the noble Lord indicated, I have come into this more out of my respect for him than for any other reason that occurs to me. I have this high regard for him, and as I live there I should have seemed to be rather a backslider if I had not spoken for a few minutes. The noble Lord drove me round the district on Sunday. We spent about two and a half hours on the job so I am much better qualified to speak. I might speak indefinitely after all that; but as he has said it all so well I do not need to say much more.
I realise it is difficult to discuss these things however clearly they are put except against the background of the various excellent maps; but those who are present at the moment and those interested who read Hansard will be able to understand the argument clearly from the maps. I side entirely with those who say that the crucial communications between Hastings and Hythe—to take those two places only as part of the whole issue—should be vastly improved. That is obvious to any simpleton or anyone who is as ignorant of road transport as I am even after a drive round the district with the noble Lord, Lord Hardinge. As I said, the details of this have been clearly explained by Lord Hardinge and I shall not repeat them. I echo every word he said; for the most part with full comprehension. for the rest in blind faith.
Many years ago the great Edmund Burke spoke with so much eloquence that the next speaker, so we read in our history books, a certain Mr. Cruger—not spelt the same way as the president of the Transvaal, Mr. Kruger—could think of nothing better to say when it came to his turn except:
"1 say 'ditto' to Mr. Burke."
In fact he was so keen on saying that, that he ended by saying:
"I say 'ditto' to Mr. Burke."
All I can do now is to end by saying:
"I say 'ditto' to Lord Hardinge."
9.35 p.m.
Lord Monk Bretton: My Lords, I also would like to thank my noble friend Lord Hardinge of Penshurst for putting down this Unstarred Question. It gives me the opportunity to say a few words. I think also I ought to congratulate my noble friend upon what I gather was an enjoyable all-party car trip that he organised last week-end. I really want just to dot a few i's and cross a few t's following what has been said.
I wish to emphasise the situation of Hastings, where unemployment is very much the highest in the county of Sussex. I believe the figure last December was 13.6 per cent. I should also like to mention that in the hinterland there is a rural development area. About two-thirds is in Kent and one-third in East Sussex. It
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was promoted by the Sussex Rural Community Council and the Sussex committee of CoSIRA, to both of which committees I belong, with the backing of the Kent CoSIRA and of the two county councils. So there is no doubt that this is an area where there is a severe problem.
As regards the impact of the tunnel, I believe the informed wisdom in East Sussex is that it is likely to close the Newhaven-Dieppe ferry route. That means the loss of 900 jobs in Newhaven and probably also a loss of tourism owing to the inaccessibility of the area from anywhere else, and the lack of road communications along the coast.
There is no doubt that going eastwards along the coast and arriving at Brighton, one is confronted with a rather interesting choice if one wants to go on to Dover. Undoubtedly it is quickest to go straight up the Brighton-London road on to the M.25, down the M.20 and across perhaps to the M.2. It is a great long trek but probably saves half an hour over any other route.
There are about four other choices that one can make—combinations of bucolic charm and frustration by traffic. Probably the worst choice of route at the moment, until something is done, is to continue along the A.259, the coast road. It is absolutely no good as regards communications with Hastings. One must stress the importance of doing something for the Hastings area in order to prevent further deterioration taking place, as it could so easily do. One has also to consider the support for the tourist industry in East Sussex. I would imagine that the transport authorities have also to consider what needs to be done ultimately about relieving the southern sections of the M.25. I would strongly suggest that there is a good deal to be said for not continuing to deal in a piecemeal fashion with the A.259. Much needs to be done. It is highly desirable that something pretty effective should be in place by 1993 when the tunnel opens.
To return to the Hastings problem for a moment, the destinations for tunnel traffic would, to my mind, be both Folkestone and Ashford. I remain concerned that there is to be no trunking of the A.2070 from Brenzett to Ashford. I am very hopeful that we may hear more about that tonight because I believe, in the end, it will be most necessary.
I realise that there will be residents of Kent with susceptibilities, and I am sorry that there are no noble Lords from Kent speaking tonight. I can only hope that they are not too discomfited by what we are saying. I am afraid there is no doubt that my noble friend the Minister will have to keep a balance if we transgress a little too far. Here we are all from East Sussex, having our say. I hope very much that the Minister might be able to relieve our minds somewhat tonight about the problems in East Sussex.
9.42 p.m.
Lord Carmichael of Kelvingrove: My Lords, I think we should first of all congratulate the noble Lord, Lord Hardinge of Penshurst, on raising the question of roads in East Sussex. I should also like to thank the Minister for sending me a map showing the existing and proposed road system in the area. I must pay tribute,

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as always in matters of roads and traffic, to the Royal Automobile Club and the Automobile Association who have both been most helpful in informing me about an area of the country which could not exactly be considered my own backyard. It is an interesting reflection that when I looked up the map I realised that where I live in Central Scotland is almost half-way between the extremities of the British Isles from Shetland to Hastings. That gives one some idea of just how far it may be from me and also people tend to forget that the country goes a long way further north than we sometimes imagine.
I have been most interested in the comments which have been made. I am absolutely sure that the noble Lord, Lord Hardinge of Penshurst, and my noble friend Lord Longford, who are knowledgeable about the area and also Lord Monk Bretton are familiar with the roads and realise the great problems arising from the shortage of roads in the area. However, I also appreciate the Government's problem of priorities which is always very great. It is interesting that every speaker as well as the wording of the Unstarred Question by the noble Lord, Lord Hardinge of Penshurst, has mentioned the Channel Tunnel and the infrastructure. The point came out during various debates which we had on the Channel Tunnel, and it was made by the noble Lord, Lord Teviot, both on the Second Reading and again this evening that the whole country is concerned about the Channel Tunnel and its infrastructure. Certainly any extra money put into that infrastructure will be looked at very closely by other regions and it will also be closely watched, as I am sure the Minister will be aware, by the ferry operators who feel they are not being very fairly treated.
I think the noble Lord, Lord Monk Bretton, spoke about the difficulties of Newhaven and the possibility of it being almost by-passed or even closing down once the tunnel comes into operation. Although I have been marginally keen on and in fact was at one time very enthusiastic about the tunnel, all these problems are beginning to arise which might make us think twice about the project. The ferry people are really quite concerned. I am sure many noble Lords received the letter from Sealink Ferries. We all know that they have an axe to grind, but they say this:
"We all know that the planning process for road improvements is tortuous and that governments might say they will make improvements in access to ferry ports, then just hide behind planning difficulties and do nothing.".
That is as against the ones to which the Government give a high priority. The Channel Tunnel will go ahead much more quickly and many of the processes will be by-passed.
I am sorry to appear less than totally enthusiastic about the urgency which noble Lords have expressed over these roads. I think that the noble Lord, Lord Hardinge of Penshurst, who probably knows the problem better than us, may be a little disappointed. I am interested in what the Minister's reply will be. It is not that I do not sympathise with the strong feelings about the amenities of the area, but I know that fighting for roads is something with which the Minister will be all too familiar. Every group of people in this House and in another House have their own priorities
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and it is up to the department to make balanced judgments.
I do not have a great deal of faith in the belief that there is some mystical way, some fundamental scientific way, in which the department makes its assessments of traffic, accident losses and all the other paraphernalia. I have seen too many roads brought on by political expediency or some other reason in both parties to believe that there is any scientific way of making an assessment. The department produces figures—
Lord Teviot: My Lords, the roads in East Sussex and South-West Kent are rather similar to Highland roads. I do not know whether the noble Lord has visited these roads but they are not dissimilar.
Lord Carmichael of Kelvingrove: My Lords, I agree that they have something in common. We were a little lucky in that off the North-East coast of Scotland oil was discovered and there was a sudden readjustment of priorities to accommodate it. In East Kent there is a great readjustment to accommodate the Channel Tunnel which will possibly burn itself out. I wish the noble Lord well in his campaign for road improvements in the area. As I said, I do not want to be too dampening. But I have a little experience of fighting for roads in different parts of the country and in listening to people who are fighting for roads.
I am probably doing the department a great disservice here, but at the end of the day it is like a whole lot of other things. To use the Scottish expression,
"The greetin' wean gets fed first",
and that is what happens, unless there is something overriding, like oil or the Channel Tunnel. But other roads tend to be built according to the political and other pressures which are put on the Government or the department. Therefore, I wish the noble Lord well in his efforts.
9.49 p.m.
Lord Brabazon of Tara: My Lords, let me first say how grateful I am to my noble friend Lord Hardinge of Penshurst for the Question he has asked about the A.259. I also take the opportunity of thanking other noble Lords for their contributions. The noble Lord, Lord Carmichael, and I have something in common in that I do not think that either of us has any local interest in the area though I must admit that I once had a great uncle and aunt living in Dymchurch.
This part of the A.259 forms the most easterly section of the south coast trunk route between Honiton in Devon and Folkestone in Kent. From Southampton eastwards, the south coast trunk route consists of the M.27 to Cosham, near Portsmouth, then the A.27 to Pevensey near Eastbourne, and then the A.259 to Folkestone. The A.27 serves a number of important towns such as Havant, Chichester, Arundel, Worthing, Brighton and Lewes, before terminating at Pevensey. From Pevensey eastwards the A.259 passes through Bexhill, Hastings, Winchelsea and Rye and across the Romney Marshes by New Romney, St. Mary's Bay and Dymchurch to Hythe and Folkestone. Some of those towns already have bypasses. Several

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further bypasses are proposed as part of the Department of Transport's extensive plans for substantially improving the route. The improvements planned are a measure of the importance which we place on this essential part of the national trunk road network.
The standard of trunk routes is determined by the traffic expected to use them. An important feature of the A.27/A.259 route, which has to some extent determined priorities, is that traffic reduces, except around Brighton, the further east one travels. For example, traffic flows in 1985 on the M.27 near Portsmouth were 52,700 vehicles per day; on the A.27 east of Chichester the flow was 24,000; east of Arundel it was 19,000 and east of Brighton it was 25,700. However, west of Eastbourne it was 12,000 and on the A.259 east of Hastings it was about 7,000 vehicles a day.
Until recently, resources in the South-East have been concentrated on major routes of national importance, such as the M.3, M.4, M.20, M.23, M.25 and M.27, although some of these routes have of course helped Sussex by improving access to and from the area. Following the excellent progress that has been made on the major strategic routes, we are now giving high priority to the improvement of the A.27 and the A.259. Prior to the renewed interest in a Channel fixed link in April 1985, to which I shall return, there were seven major schemes on the A.27 and two on the A.259 in the national trunk road programme. The June 1985 review added three further schemes, two on the A.27 and one on the A.259.
I shall not on this occasion detail the progress that has been made on the A.27 schemes. But when completed the nine major A.27 schemes in the current programme will provide some 32 miles of improved trunk road at a total cost of about £125 million at November 1983 prices.
I shall deal with the A.259 section of the trunk route shortly. I turn first to the implications of the proposed Channel Tunnel. The Government are committed to ensuring the adequacy of the trunk road network, particularly in Kent, for traffic to and from the Continent following the proposed opening of the tunnel in 1993. It should not be overlooked that the road infrastructure needs to take account of traffic using both the tunnel and the Channel ports, and that most of the proposed motorway and trunk road improvements are required to cope with the projected increases in traffic with or without a tunnel.
Since the Channel Tunnel came once again under active consideration, a number of reviews of the specific road infrastructure requirements have taken place. It has for many years been the Government's policy that the M.20 should be the principal corridor from London and the M.25 to the Channel ports of Dover and Folkestone, whether or not the Channel Tunnel was built. The Channel fixed link White Paper of February 1986 explaining the choice of the Eurotunnel proposals confirmed the decision that the M.20 should be the principal corridor and the department's intention to complete the M.20 Maidstone-Ashford section, the widening of the Maidstone bypass section of the M.20 from two lanes to three and the improvement of the A.20 between Folkestone and Dover.
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In the late summer of 1986, the Department of Transport carried out an assessment of possible improvements along the A.259/A.261 corridor. My honourable friend the Minister for Roads and Traffic subsequently announced in October 1986 that a New Romney bypass (suspended since 1980 along with bypasses of St. Mary's Bay and Dymchurch) would be restored to the active programme and that consideration would be given to a possible A.259 eastern bypass of Hastings. My honourable friend also announced that we planned to detrunk the A.259 between Hythe and Folkestone and to trunk instead the A.261/A.20 route from Hythe to the M.20 at Stanford. In this connection he said that he would consider whether a scheme to improve the A.261/A.20 should be included in the review of the trunk road programme which is currently being undertaken.
My honourable friend also said, with regret, that the bypasses of St. Mary's Bay and Dymchurch would remain suspended at that time, though they would be kept under review.
There has been concern about the suitability of the A.261/A.20 route between Hythe and the M.20 as a trunk road, which my honourable friend Mr. Howard, the Member for Folkestone and Hythe, has drawn to the Government's attention. My honourable friend the Minister with responsibility for roads and traffic has considered whether a scheme to improve this route should be added to the programme in the current review. I am pleased to announce his decision to include it. We shall appoint design agents to investigate and prepare detailed proposals for the improvement. This will include examination of all options, both along the line of the existing road and along new routes.
We need, however, to trunk the route in order to be able to exercise our powers to improve it. The next step will be to publish draft orders for both the trunking of the A.261/A.20 route and the associated detrunking of the A.259 east of Hythe, probably in the summer. These orders would be formally open to objection which would give people an opportunity to express their conerns. Depending on the objections, a public inquiry may be held.
I turn to the A.259/A.261. Our current predictions of traffic on the A.259 indicate that the Channel Tunnel may generate about an extra 1,000 vehicles per day in the year 2008, split between the A.259 and the A.2070 from Brenzett to Ashford. This would not be likely to add more than 10 per cent. to the A.259 traffic there.
We also recognise that there is an alternative route from Hastings which follows the A.259 to Brenzett and then heads northwards on the A.2070 to Ashford, thence via the M.20 to Folkestone. Provision for the proposed Ashford south orbital road is included in the Channel Tunnel Bill. And the Government have offered transport supplementary grant to Kent County Council for this scheme and improvements to the A.2070 at Ham Street and at Ashford.
I note the views of my noble friends Lord Hardinge and Lord Monk Bretton that the A.2070 should become a trunk road. My right honourable friend does not accept that there is any compelling strategic reason

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for making that road a trunk road either in addition to the existing A.259 trunk road between Brenzett and Folkestone or in place of our strategy of making the existing A.259, between Brenzett and Hythe, and the A.261, following trunking, the preferred route for traffic wanting access to the tunnel terminal at Folkestone. The A.2070 is the responsibility of Kent County Council, which has made no proposal to trunk the road and supports our strategy to trunk the A.261/A.20 route.
I turn again to the A.259 between Brenzett and Hythe and my noble friend's concern that the communities of St. Mary's Bay and Dymchurch be bypassed. Since the conclusions of the A.259/A.261 review were announced in October 1986. Kent County Council and Shepway District Council and others have expressed their concern that the department's proposals for the A.259 do not go far enough. They have made petitions to and appearances before the Select Committee on the Channel Tunnel Bill. In particular, Kent County Council has called for reinstatement in the programme of the bypass schemes to St. Mary's Bay and Dymchurch, and Shepway District Council has asked for further consideration to be given to the possibility of a new trunk road to replace the A.259 which would pass to the north of Rye and link to the M.20 at Stanford. Taking Shepway's point first, my right honourable friend could not, in view of the modest traffic flows, justify providing a completely new route between Rye and the M.20 at Stanford, nor indeed between Brenzett and Stanford.
What my right honourable friend has done, however, is to look again at the possibility of including a bypass of St. Mary's Bay and Dymchurch in the current review of the trunk road programme. He has had to weigh a number of factors. We do not have unlimited resources for road improvements and there are many schemes nationally competing for a place in the programme, as the noble Lord, Lord Carmichael, pointed out. We have also had to consider the local aspects of a scheme for St. Mary's Bay and Dymchurch, including the visual impact of a new road 4.2 miles long with a bridge over the railway line, encroaching into Romney Marsh. The marsh itself is designated as an area of special significance to agriculture and contains valuable areas of unimproved pasture. I am pleased to announce that my right honourable friend has decided to add this scheme to the programme and the design agents will take these environmental considerations into account. I hope the exceptional reasons for announcing today these additions to the national programme will be understood.
If I may summarise in conclusion, Her Majesty's Government accept the need to improve the A.259 between Hastings and Hythe and from there via the A.261/A.20 to the M.20 at Stanford. We already have four major schemes in preparation—bypasses of Bexhill and Western Hastings, Winchelsea, Rye and New Romney—to which we can now add St Mary's Bay and Dymchurch and the A.261 scheme. When completed, these schemes will provide some 22 miles of improved trunk road at a cost of about £40 million at November 1983 prices. In addition, the regional
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programme of smaller schemes includes improvements at Guestling Thorn, Icklesham, Brookland and Brenzett.
Our aim is that these schemes should be completed or under construction by the time the Channel Tunnel opens; but my right honourable friend cannot guarantee that timing given the need for detailed preparation and design and the uncertainties of the highway inquiry procedures. This represents a substantial investment in the A.259, which, even with traffic generated by the tunnel and its associated developments at Folkestone and Ashford, will remain lightly trafficked compared with most trunk roads. Implementation of the present proposals for the A.259/A.261 and for the A.2070 by Kent County Council will mean that East Sussex will be connected to the M.20 by two improved routes east of Brenzett, the choice of route depending on the final destination—by A.2070 to Ashford and the proposed inland clearance depot or the more direct A.259 route to Folkestone and the tunnel. I can confirm that my right honourable friend the Secretary of State for Transport will consider very carefully in the current review of the trunk road programme whether a place can also be found for an eastern bypass of Hastings.
Once again I should like to thank my noble friend for raising this matter and I hope that both he and those concerned in Kent and East Sussex will be pleased with the announcements I have been able to make tonight.

Housing (Scotland) Bill [H.L.]
Reported from the Joint Committee with amendments, and recommitted to a Committee of the Whole House.
House adjourned at two minutes past ten o'clock.