Lords Sitting of 28 February 1996

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

Lord Kilpatrick of Kincraig
Sir Robert Kilpatrick, Knight, CBE, having been created Baron Kilpatrick of Kincraig, of Dysart in the District of Kirkcaldy, for life—Was, in his robes, introduced between the Lord Richardson and the Lord Walton of Detchant.
Lord Gillmore of Thamesfield
Sir David Howe Gillmore, GCMG, having been created Baron Gillmore of Thamesfield, of Putney in the London Borough of Wandsworth, for life—Was, in his robes, introduced between the Lord Wilson of Tillyorn and the Lord Wright of Richmond.

Bus Drivers: Recruitment
2.58 p.m.
Baroness Gardner of Parkes Baroness Gardner of Parkes asked Her Majesty's Government:
Whether they are aware of the current practice of recruiting in Australia bus drivers to drive buses in the United Kingdom.
The Parliamentary Under-Secretary of State, Department of Transport (Viscount Goschen): My Lords, we are aware that one company has been recruiting drivers in Australia to meet the needs of its business. Provided that the immigration and driver licensing requirements are fulfilled, this is a matter for the company.
Baroness Gardner of Parkes: My Lords, I thank my noble friend for that Answer. In view of the fact that it costs £2,500 to train a lorry driver, is he able to tell me how much it costs to keep one of our own unemployed people on benefit for the year?
Viscount Goschen: My Lords, I am sure that it costs more than training a driver. The issue at stake is that the company must remain free to recruit people where it wishes provided that it complies with the immigration rules and provided that those people are properly licensed. My information is that the drivers who have been brought over are British born and hold British passports.
Lord Campbell of Croy: My Lords, if those drivers have to hold work permits, will my noble friend say how long they will be allowed to stay in this country? After how long would they become eligible to play
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cricket for England? That might be very helpful, but it might involve driving of another kind—on the on and the off.
Viscount Goschen: My Lords, I think it highly unlikely that work permits would be issued to bus drivers. These people are coming over on the basis that they are British born, British passport holders, or one of their parents or grandparents was British born.
Lord Clinton-Davis: My Lords, is it possible that the company involved confused the abilities of our own home-trained bus drivers who are unemployed with the abilities of the English cricket team?
However, is it not a serious matter that that bus company has been a major contributor to the congestion and dangerous driving that occurs in Oxford where, in particular, it operates, and that it has a particularly bad record? Can it really be the case that there is an insufficiency of unemployed, well-trained bus drivers in this country?
Viscount Goschen: My Lords, the bus industry has been extremely successful after bus deregulation. There is a thriving industry. There are now more operators on routes driving more miles at lower cost.
The party opposite continually champions public transport. The fact is that the bus industry is thriving; unemployment is coming down in the region; and there is a skills shortage. That company has decided to address that issue in an innovative way.
Lord Beloff: My Lords, is my noble friend aware that, as a frequent visitor to Oxford, I have noticed the enormous improvement in bus services in that city since I was a resident there? It is largely due to the efforts of that company. To suggest that it voluntarily takes less efficient drivers than are available in this country seems to me to be quite absurd. This is again a matter of the strong prejudice against the improvement in bus services which competition in Oxford and on the Oxford-London route has brought about.
Viscount Goschen: My Lords, of course I welcome my noble friend's first-hand experience of the bus market in Oxford. Clearly there is now competition which has led to more services being put on, and there are more operators of bus services. Like any other company, this company must be free to make its own employment decisions, provided they coincide with the licensing and immigration rules.
Baroness Faithfull: My Lords, what are the employment laws? In Oxford, as of yesterday, there were 9,345 unemployed people in the city and villages around. Surely, among that number there must be people who can drive or be helped to drive well. Therefore, should not they apply and be given jobs rather than companies having to bring people over from Australia?
Viscount Goschen: Yes, my Lords, I quite agree that such people should be applying. However, the company has advertised extensively in the UK, working closely with the local jobcentres. I understand that at the moment positions are advertised both for qualified

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drivers and for trainee drivers. In the growing market, there is a shortage of drivers and the company is having real difficulty in filling places. That is why it looked overseas.
Baroness Gardner of Parkes: My Lords, some weeks ago the Minister told us that a number of heavy goods vehicle drivers might no longer be able to drive if they wore glasses. Under a new European directive they would lose their jobs. Could he tell me whether it would be possible to make some fast-track training available for those people who are already experienced drivers and who drive heavy goods vehicles? They would have to convert to a public vehicle licence. Would it be possible to consider that, even if the Minister cannot give an answer on it immediately? It seems, according to the answer we were given, that there might be 3,000 drivers of heavy goods vehicles out of work.
Viscount Goschen: My Lords, my noble friend is not entirely accurate as regards what I said about the new driver licence directive. Bus drivers will be caught by the directive, as will heavy goods vehicle drivers. However, it is not the case that all those with glasses will not be able to continue to drive; it will be those who have very bad sight indeed in one eye, without the use of glasses, and who cannot see even the biggest letter on the optician's chart. Therefore, there is no difference between those who drive passenger carrying vehicles and those who drive heavy goods vehicles in that regard.
Lord Clinton-Davis: My Lords, if the Minister seeks to dismiss what I say—as he is entitled to—will be take more notice of an article that appeared in the Sunday Telegraph? It usually subscribes to his party's forlorn case. I quote in regard to Oxford:
"The city centre is clogged and polluted, passengers are confused and irate. But such is life in Oxford, where two companies have been battling for supremacy since bus deregulation was introduced 10 years ago".
That is a far cry from the Minister's representation of the facts.
Viscount Goschen: No, my Lords, that equals competition, which equals benefits for passengers, which equals more service. It is exactly what people have been calling for for a long time.
Lord Gisborough: My Lords, after the comments of the Opposition on the congestion caused by buses, are we to assume that they are not in favour of public transport? Alternatively, can we assume that they have no more idea of what they want than yesterday when they did not know what their policy was on the subject under discussion?
Viscount Goschen: My Lords, I thank my noble friend for that clear question. It appears that the Opposition refuse to recognise the benefits that come from companies operating public transport services.
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Over and over again we see those benefits in the bus industry, and we will see the same benefits with railway privatisation.
Lord Cledwyn of Penrhos: My Lords, on the threshold of St. David's Day, will the Minister give an assurance the drivers will not be allowed into Wales unless they speak Welsh?
Viscount Goschen: My Lords, much of the concern is that the drivers should speak English in the first place. According to the programme "Neighbours", Australians speak a version of English.
Lord Brougham and Vaux: My Lords, is my noble friend aware that the subject was covered on the programme "Today" a few days ago? It is not a matter of bringing bus drivers over from Australia but of getting them trained fast enough in England.
Viscount Goschen: My Lords, it is extremely important that people should be trained properly, but it takes time and there is a cost involved. A balance must be made. It is important that the bus industry here should be served by people who are properly trained and who have the right qualifications. However, there is a time lag involved.

Drugs and Driving
3.7 p.m.
Lord Campbell of Croy Lord Campbell of Croy asked Her Majesty's Government:
Whether they are considering the introduction of tests for drugs for drivers of motor vehicles on similar lines to those now applying for alcohol.
The Earl of Courtown: My Lords, there are already powers to test drivers for drugs but we have no current plans to introduce roadside testing. Research is being commissioned to help to assess the level of drug use among road accident fatalities in Great Britain. That will assist us in determining whether action may be necessary.
Lord Campbell of Croy: My Lords, I am grateful for that reply from my noble friend. Can he confirm that police and doctors consider that certain drugs do dangerously affect driving? When particular drugs are prescribed medically, doctors normally tell the patients not to drive. But in any future scheme, in cases of harmless drug medication, should doctors supply certificates which would explain traces found upon roadside testing? Is my noble friend aware that the RAC has today launched a nationwide campaign on the scale and dangers of drugs and driving?
The Earl of Courtown: My Lords, since 1977 the legislation has ensured that medicines which can affect drivers adversely carry warnings. It is also best practice on the part of the medical profession to warn patients of the effects of prescribed medicines. However, prescribed drugs can be misused or patients fail to exercise sufficient care. It is every individual's

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responsibility to ensure that they are fit to drive. If they then drive while unfit through drugs, they have committed an offence. It is for the courts to consider whether there are other factors which should be taken into account in each individual case.
Lord Monkswell: My Lords, are the Government aware that tiredness is also a cause of problems with drivers? Will they take steps to prevent motorway service areas levying parking charges on those who might feel drowsy and stop to have a little kip before proceeding on their journey?
The Earl of Courtown: My Lords, I am not aware of service stations levying charges. The noble Lord nods. I learn something new every day. I have travelled up and down the country on many occasions. When I am tired, I pull into a service station and have something to drink—soft, of course—and something to eat.
Baroness Masham of Ilton: My Lords, is any research being done in relation to roadside kits so that people on illegal drugs can receive blood and urine tests without having to go to a station?
The Earl of Courtown: My Lords, no equipment is presently available that can test for drugs in the same way as roadside breathalysers. Some kits exist to detect the presence of certain illicit drugs on a person; for example, if someone has handled an illicit drug. However, I understand that at present there is no equipment that can be used to test whether someone is under the influence of a drug.
Lord Clinton-Davis: My Lords, is the Minister aware that in 1994 678,500 breath tests were carried out, of which 14 per cent. were found to be positive? Is he further aware that, in the same period, 1,000 drugs tests were carried out following negative breath tests and Department of Transport figures indicate that 90 per cent. proved positive? Having regard to the fact that there can be no doubt as to the lethal quality of some of those drugs, is there not a case for an urgent and rapid inquiry to be undertaken by either the Department of Transport or the Home Office in order to ensure that proper cognisance is taken of the advice given by the police and many others?
The Earl of Courtown: My Lords, I was not aware of all the statistics that the noble Lord gave. Research is being instigated between the Department of Transport, the Home Office, the Coroners' Society and the Association of Chief Police Officers. That is to establish systematically the instance of drug use among fatal road casualties in Great Britain. It relates not just to illicit drugs, but also takes into account those that are prescribed and those available over the counter which may affect the ability of a driver to drive safely. It is a three-year research programme. It will report on a regular basis, and if research brought to our attention implies the need for some legislation, we will take action.
Lord Avebury: My Lords, while at the present stage of knowledge it may not be possible to conduct roadside tests for the presence of illicit drugs in the body of a driver, do the police have the power to subject blood
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samples taken in the course of testing for alcohol to laboratory tests, off-line, so that the presence of illicit drugs could later be established and presented as evidence in court when the question of a person's impairment through the use of drugs may arise?
The Earl of Courtown: My Lords, Section 4 of the Road Traffic Act 1988 empowers a constable to arrest a person if he has reasonable cause to suspect that that person has been driving or has been in charge of a mechanically propelled vehicle when unfit through drugs. Section 7 of that Act empowers a constable to require the suspect to provide a specimen for laboratory analysis.
Baroness Rawlings: My Lords, does the Minister agree that it is not just illicit drugs that cause such problems; ordinary drugs can cause drowsiness? The police say that that is very difficult to check. Will the Minister refer this very serious matter to the Secretary of State for consideration?
The Earl of Courtown: My Lords, my noble friend makes a very good point. This area is also being examined in relation to the research that will be carried out, starting on 1st July. That will look into various types of drug: alcohol; amphetamines; and methyl-amphetamines, which I am told include ecstasy, cannabis, cocaine, opiates, methadone, LSD, benzodiazepines and tricyclic anti-depressants.
Baroness Thomas of Walliswood: My Lords, might one of the problems in roadside testing be that it is not necessarily so easy to detect the difference between various sorts of drugs in chemical residues in the body as it is with alcohol? If so, are the Government conducting or funding any research into that approach; in other words, developing better equipment to enable roadside testing to take place?
The Earl of Courtown: My Lords, the noble Baroness is quite correct. There is a great problem with this subject because of the wide range of drugs that can affect drivers and the matter of degree of substance in the bloodstream or urine. I believe that investigation into this area is currently being carried out.

Detention of Juveniles
3.15 p.m.
The Earl of Longford The Earl of Longford asked Her Majesty's Government:
What is their response to the decision of the European Court of Human Rights of 21st February on the detention of juveniles.
The Lord Advocate (Lord Mackay of Drumadoon): My Lords, the Government are disappointed that the court has found against the current procedure for deciding on release for those detained during Her Majesty's pleasure. We are considering the

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implications of the judgment and will announce what changes will be made to take account of it as soon as possible.
The Earl of Longford: My Lords, am I to gather that in the absence of the noble Baroness, Lady Blatch, the Minister is saying that the Government do not accept the finding—which, as most of us are aware, they are bound to accept—but are still equivocating? Are the Government now prepared to bear in mind that there are some 100 young offenders whose tariff has expired and who have been told that they must be detained during Her Majesty's pleasure? Does the Minister agree that, under the court ruling, those 100 cases should therefore go to the Parole Board? Are those young people being allowed access to the Parole Board; and are the Government ready to accept the finding of the Parole Board, or are they still equivocating?
Lord Mackay of Drumadoon: My Lords, as I indicated, the position is quite clear. The Government will announce what changes will be made to take account of these judgments. The Government accept the judgments, which were pronounced on the 21st of this month. I venture to suggest that to have to come to any decision within the period of time from that day to today's date on precisely what the new procedures will be would have led to an accusation of rushing the matter and not thinking it through clearly. I have given an undertaking that, when the changes are decided upon, they will be announced to the House as soon as possible.
The noble Earl raises the question of how many people may be affected. My information is that in England and Wales some 235 cases are potentially affected by the judgment. While each and every one of those cases is being looked at urgently, it is likely that primary legislation will be required to set up the new procedure. In the interim, before primary legislation is passed, cases where the tariff has expired will be dealt with on an administrative basis.
Lord Boyd-Carpenter: My Lords, can my noble friend say whether, despite the fact that Parliament was not consulted about this matter, the Government regard the decision of this particular body as binding?
Lord Mackay of Drumadoon: My Lords, the Government regard the judgments in these two cases as ones that will require a change in the procedure. As I have indicated, that change will require to be done by way of primary legislation, which will be brought before Parliament as soon as practicable. It affects only those detained during Her Majesty's pleasure. As the House will know, those are people whose offences were committed while they were under the age of 18. It has no effect on people convicted of murder when they were 18 years or more on the day that they committed the offence.
Lord Renton: My Lords, during the hearing of this case, was the attention of the Court of Human Rights drawn to the law in this country and the sentencing
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practices that have arisen under it? And was the court told of the likely effect in this country of the decision that it reached?
Lord Mackay of Drumadoon: My Lords, my understanding is that the court was fully informed as to the law in this country and the procedure that has been followed in such cases for many years. I am sure that the noble Lord is aware that detention during Her Majesty's pleasure was introduced as long ago as 1908. The procedure followed since then has been to sentence young offenders to be detained without any limit being specified to the time of the detention. Subsequently, at an appropriate juncture, the issue of when they fall to be released is considered by the Parole Board.
The Government were represented before the court by David Pannick, QC. I have copies of both judgments before me this afternoon. Having read them, and from the advice I have received, I am quite satisfied that the court had placed before it not only the law but the implication that a change to the law would be required were the decision to go against the Government, as in each case it did.
Lord McIntosh of Haringey: My Lords, the Minister has given answers that are both factual and helpful, but has be not considered the possibility that the judgment may apply not only to those who are detained at Her Majesty's pleasure but also to those whose tariffs may be affected by the Home Secretary? In other words, the issue may be wider than previously supposed, and the involvement of the Home Secretary—a politician—in sentencing may not be at risk. Have the Government considered that possibility?
Lord Mackay of Drumadoon: My Lords, the Government have given consideration to that possibility. The advice that the Government have is that the decision does not affect the power of the Home Secretary to impose a tariff in cases of this nature in England and Wales.
Lord Harmar-Nicholls: My Lords, the Minister did not appear to answer the question put by my noble friend Lord Boyd-Carpenter. My noble friend asked whether we had to change the law to fit in with this ruling or could refuse to do it. Are we, under treaty, obligated to alter our law to fit in with the court, or can we leave it as it is if we wish?
Lord Mackay of Drumadoon: My Lords, I believe that the attitude of the Government to the decisions of the European Court of Human Rights is well known. On occasions its judgments are not welcomed or agreed with, but because the Government believe in the rule of law those judgments are respected. That is what is to happen in this case. The effect of the judgment will be respected, and as soon as practicable my right honourable friend the Home Secretary will bring forward proposals to amend the law in England and Wales.
Lord Callaghan of Cardiff: My Lords, is the Minister aware that to those of us who remember the hard work put in by the noble Viscount, Lord Eccles,

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and Sir David Maxwell Fyfe (as he then was) towards bringing in the Convention on Human Rights in Strasbourg and securing its adoption by other European countries, this decision sounds a very sensible one?
Lord Mackay of Drumadoon: My Lords, I am fully aware that the British Government and senior Government Ministers at that time did a great deal of work in setting up the convention. As is well known to noble Lords, the Government have no quarrel with the terms of the European convention itself.
The problems that have arisen over the years, and particular recent ones, have related to the decisions of the court. Because of that, my right honourable friend the Prime Minister announced in another place early in December that steps were being taken to discuss with members of the Council of Europe, and members and officials of the court, whether or not anything could be done to improve the court's procedures so that its decisions commanded greater and wider public respect than unfortunately has been the case in recent months. While the convention is clearly important and falls to he respected, and some noble Lords may welcome the decisions in these two cases, the issue whether or not the Government welcome it is neither here nor there. The Government respect the judgments and will act accordingly.
Lord Mackie of Benshie: My Lords, is the Minister able to tell us what the position is in Scotland?
Lord Mackay of Drumadoon: My Lords, not surprisingly the position in Scotland has been considered by the Lord Advocate since it was suggested that he might answer this Question! Having given the matter the briefest of consideration, although not having had the opportunity to discuss it with my right honourable friend the Secretary of State for Scotland, I have little doubt that consideration will have to be given to amending the law of Scotland as well. In Scotland, no tariffs are set for young people who are detained at Her Majesty's pleasure. Therefore, two issues will have to be looked at in Scotland: the setting of a tariff and a procedure to deal with the release of such prisoners once the tariff has expired.
Lord Stoddart of Swindon: My Lords, is one to understand from the answers given by the noble Lord this afternoon that the Government now believe that the public interest is best decided by the European Court of Human Rights rather than by the elected government of this country?
Lord Mackay of Drumadoon: My Lords, the noble Lord is wrong to jump to that conclusion, as I suspect many Members of the House will readily appreciate. The issue comes down to the basic question of whether or not we respect the judgments of the court and act in accordance with them. Those who are bound by the rule of law occasionally have to follow decisions of courts with which they do not agree. That is what the rule of law is all about. Procedures are set up to adjudicate on cases. When the court rules accordingly, those bound by the decision have to take it into account. That applies
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to individual members of society as well as to this Government, of which I am a Member. The Government do not suggest for one moment that the European Court is the place to decide these issues in preference to Parliament, but when an issue arises they have to consider it. It is then for Parliament to decide what new procedures are put in place.
Lord Brabazon of Tara: My Lords, my noble and learned friend said that legislation would have to be introduced to change the law of this country to bring the judgment into effect. What happens if both Houses of Parliament unceremoniously throw out such legislation?
Lord Mackay of Drumadoon: My Lords, as a new Member of your Lordships' House I find it difficult to answer any question. I find it impossible to answer hypothetical questions, and I decline to do so.

Business
3.24 p.m.
Lord Strathclyde: My Lords, at a convenient moment after 4.15 p.m., my noble friend the Leader of the House will, with the leave of the House, repeat a Statement that is to be made in another place on Northern Ireland.
I should also like to say a word about today's debate standing in the name of the noble Lord, Lord Winston. Other than the mover, Front Bench spokesmen and the Minister replying, speakers will be limited to 10 minutes. I should remind your Lordships that if any noble Lord speaks at greater length he will do so at the expense of subsequent speakers in the debate. I also remind your Lordships that when the digital clock shows 10 minutes the full 10 minutes have elapsed and the speaker will already be trespassing on the time of others.

Business of the House: Debates, Friday, 8th March
The Lord Privy Seal (Viscount Cranborne): My Lords, I beg to move the first Motion standing in my name on the Order Paper.
Moved, That Standing Order 38 (Arrangement of the Order Paper) be dispensed with on Friday, 8th March to enable the Motion standing in the name of the Earl Howe to be taken before the Second Reading of the Defamation Bill [H.L.].—(Viscount Cranborne.)
On Question, Motion agreed to.

Business of the House: Debate this Day
Viscount Cranborne: My Lords, I beg to move the second Motion standing in my name on the Order Paper.
Moved, That the debate on the Motion in the name of the Lord Winston set down for today shall be limited to four hours.—(Viscount Cranborne.)
On Question, Motion agreed to.

Housing Grants, Construction and Regeneration Bill [H.L.]
The Minister of State, Department of the Environment (Earl Ferrers): My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That it be an instruction to the Committee of the Whole House to whom the Housing Grants, Construction and Regeneration Bill [H.L.] has been committed that they consider the Bill in the following order:

Clauses 1 to 100,

Schedule 1,

Clauses 101 to 121,

Schedule 2,

Clauses 122 to 145,

Schedule 3.—(Earl Ferrers.)

On Question, Motion agreed to.

National Health Service
3.27 p.m.
Lord Winston Lord Winston rose to call attention to the level of concern among health service staff about current developments in the National Health Service, and the potential effects upon patients; and to move for Papers.
The noble Lord said: My Lords, first I do not intend to indulge in political invective. In particular, no disrespect is intended to the noble Baroness, Lady Cumberlege. This is not personal. She is honourable and her reputation is high because she appears to listen and clearly cares about the health service. She is highly respected by many of my colleagues throughout the country, but sadly her attitude does not entirely reflect the damage that I feel has been done to the National Health Service over 16 years of this Government. I do not blame her.
Secondly, I do not want to indulge in the politics of invective or hysteria. That is something which occurs in another place. I speak simply from the coal face. I do not come here with a political motive. I do not believe that the National Health Service should be a political football. This House is respected for its reasoned argument and consideration of the facts. I have no desire to be vexatious. However, it is difficult for me not to use strong language for what many of us feel is the disgraceful mismanagement of the National Health Service, for which this Government have been largely responsible. I ask the House to forgive me if I speak with some emotion. These are very emotional matters.
I shall not introduce all the things that are wrong in the National Health Service. Other speakers will deal later with, for example, nursing staff, who, quite rightly, are regarded as the backbone of the health service; general practitioners; primary care and care in the community. I intend to deal mainly with the latest, most important and significant reform; namely, the National Health Service internal market.
The principle is simple enough. Noble Lords will forgive me if I explain what may be well known to some of your Lordships. I do so because many members of
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the public do not understand the internal market. Indeed, one might add that because the far-reaching changes were thrust without proper consultation upon the National Health Service itself, many people working in the National Health Service, including doctors, do not fully understand them either. I do so because this issue will undoubtedly become one of the most important electoral issues in any forthcoming General Election. Inevitably, too, I have to say, the press will be listening and it is important that what is happening in our health service should be explained to them. In my clinic, I find that very few patients indeed, even those with high qualifications and university degrees, understand the implications to them of the reforms of the health service. This is not a political point. Any hospital consultant can confirm it, unless he is extremely partisan.
Among other things, the reform means that purchasing health authorities, responsible for providing care to their local populations, are given a sum of money to buy medical treatment to meet their catchment area's needs. Providers, which in my case means most hospital based medicine, are the NHS Trust Hospitals. They compete with each other to tender the best contracts for medical services to the purchasing authorities, who then decide on the basis of various criteria whether they will agree to contract for those services.
It would be entirely foolish to say that there are not signal advantages to that system. Indeed, the Government repeatedly take credit for the improvements. The internal market has resulted in many hospitals improving outpatient facilities, improving comfort for patients, improving waiting times in clinics and in some cases improving waiting lists. There is no doubt that that has happened. It has resulted because hospitals are more assiduous and give better information to patients, and because any hospital not making those simple improvements would be likely to lose its contracts and hence its essential funding.
However, I and many of my colleagues feel that the internal market was largely an attempt to mask underfunding and to ration healthcare locally. It has so many adverse facets, as it was envisaged, that it now stands as a monument to government deafness, bureaucratic inefficiency and incompetence. What are its effects? Let me examine some of them.
First, this is the Government of choice. Yet we see a loss of patient choice. It was no idle boast in the old health service that any patient could be referred to the most expert person involved in managing his or her condition. That was one of the star qualities of the National Health Service. It was much envied all over the world, including in the United States of America. For example, in the 1970s and 1980s in my unit at Hammersmith I saw patients for complex surgery from Truro, Inverness, Belfast and all over the United Kingdom. What did that mean? It meant that we grew in expertise and were able to give an unparalleled service. We could provide medical improvements in that particular condition which were copied all over the world. Indeed, post-graduate students came from over 80 countries to study there during that period of time.
What has happened since then? No longer do we get those patients. Now they go for that treatment to their local health authorities. Nobody wants to purchase that treatment because of the competing demands made locally and the need for contracts. It now means that instead of doing 12 or 18 of those operations a week, sometimes in a good week—when beds are available of course—we might do only three to six such operations.
Let me give another example about freedom of choice. Perhaps noble Lords will excuse me if I mention my mother. Her problem took much of my time this week on the telephone. She is a brittle diabetic, very sensitive to insulin. She responds very rapidly to overdoses and underdoses of that drug. She has been cared for at Hammersmith Hospital for 15 years. During that time, she has attended in acute diabetic coma many other hospitals: University College Hospital, the Middlesex Hospital, the Royal Free Hospital and other hospitals in London; and, when she did community work outside this country, hospitals in The Hague, South Africa and so on. She has been to more hospitals than I certainly have. Invariably, after those comas, she came back to Hammersmith because she needed stabilisation. Like many older people with diabetes, bits stop working. Consequently, from time to time she has been to see the urologist at Hammersmith Hospital, the gynaecologist at Hammersmith Hospital, the chest physician at Hammersmith Hospital, renal people at Hammersmith Hospital, the vascular people at Hammersmith Hospital and the orthopaedic people at Hammersmith Hospital.
What happened last week? Despite a bad cold she went to Buckingham Palace to receive an honour for her longstanding public service. It was a cold day and she developed a worsening chest infection. My sister tried to arrange an urgent chest appointment for her to be seen by the Hammersmith Hospital chest physician, whom she knows very well and who knows her. However, because she had not attended that particular part of Hammersmith Hospital for the past two years, where, of course, her notes were, she was refused an appointment; they needed a referral letter from her general practitioner. That was not done on clinical grounds but simply because it was the required form. On the other hand, a general practitioner refused to give her that referral because he was contracting with another providing authority.
That bureaucratic muddle resulted in delay in her being seen in the proper chest clinic. The matter has been resolved because nature intervened and her chest got better despite treatment, as so often happens in medical practice. But many hundreds of thousands of older people in this country do not have somebody who can clout for them and go in there and bat for them.
Secondly, the internal market has meant competition, not co-operation, between doctors. It has meant that many hospitals now compete to try to give the same medical services. I give noble Lords one trivial example from my own area, but it is one that shows very clearly the potential wastage of National Health Service resources. Chelsea & Westminster Hospital has recently set up an IVF clinic. Indeed, it was in the news recently. It was prepared, it said, to try to undercut any of the other National Health Service hospitals in its area
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and would try to provide a cut-price service on St. Valentine's day and indeed advertised that. Just down the road is Hammersmith Hospital, which has the most expert NHS IVF service in the country, probably in Europe, and is offering that treatment at some 15 per cent. to 20 per cent. less than the cost in the Chelsea & Westminster Hospital. Moreover, Hammersmith Hospital has a huge number of patients, so it is extremely efficient, with a very short waiting list of less than three months, thanks in part, admittedly, to the Government's waiting list initiative.
These are not bad doctors but they have been corrupted by the system in which they work. This week, a patient who had been referred to me by her general practitioner, in error telephoned the Chelsea & Westminster Hospital. Over the telephone, without investigation and without assessment it said that it would offer her treatment which would undercut the Hammersmith Hospital's IVF unit. That would have been in a unit which cannot offer the specialised service and the degree of skill that we can offer because of our huge expertise and large scientific background. What will happen if that practice continues? It will mean that Hammersmith will inevitably lose patients and will have to put up its prices, again increasing the costs to the health service. It means loss of research to an alpha-rated department and probably lowered IVF success rates. Also, because it has not costed its operation properly, it will probably mean that after two years' wastage of money the Chelsea & Westminster Hospital will have to close that unit.
We have a burgeoning administration in the health service. Other noble Lords will speak of that. But one of the things the Government did was introduce a massive administration without the proper information technology. The Secretary of State now wants to decrease the managers by 8 per cent. and to do so, of course, would bring further chaos. In the absence of information technology, they cannot know what the cost of the market is. In fact this is not a market; it is a lottery. There is no serious audit; there is no professional basis for making judgments about buying on behalf of purchasers.
Let me draw your Lordships' attention to a letter I recently received from Professor Jacobs, who is a particularly distinguished professor of endocrinology and Britain's leading reproductive endocrinologist. He says,
"At present, patients see me either because they are part of a block contract, because they're referred by GP fundholders or because they are extracontractual referrals. The cost of these referrals varies according to type. The number of GPs becoming fundholders is steadily increasing and there is expected to be a new tranche of fundholders on 1st April. Of course, as new contracts are forged, so the number of people who come to us as ECRs varies. It turns out that if a patient is being seen as part of an overperforming block contract and that patient comes from a practice that has become a GP fundholder, by definition the swap from the overperforming block contract to GP fundholding increases the income to the institution. If, on the other hand, the patient was an ECR but now the patient's doctor becomes a fundholder, the institution will almost certainly lose. If the ECR patient does not have many re-attendances, there is no gain to the institution by the patient becoming that of a fundholder, but if the patient has a high

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rate of re-attendance (clearly a chronic and severe disease) then the institution gains because fundholders are requested, at least by this institution, to pay per attendance".
Lord Callaghan of Cardiff: My Lords, will my noble friend allow me to intervene? I find it a little difficult to follow what he is saying. Can be translate it into a simple proposition so that I can see what he is really saying?
Lord Winston: My Lords, in summarising, Professor Jacobs says,
"If a patient changes from a 'correctly performing' block contract"—
one where they do not see too many patients, even though it would be cheaper for the health service—
"to a GP fundholding contract then the institution neither benefits nor gains".
He summarises by saying,
"This Alice in Wonderland version of economics is called the contracting system in the National Health Service".
That muddle is totally unintelligible. It means that it is unfair because, if a patient is not from a fundholding practice and if he is referred to an over-performing hospital, he may not get his operation this year but have to wait until next year because of the needs of the health service. How many administrators does it take to work that nonsense out?
There are bed shortages due, partly, to the burgeoning administration and the money spent on it. It is interesting to note that nurses have had a small pay rise; chief executives have had pay rises of up to 7.6 per cent. When I asked the noble Baroness, Lady Cumberlege, on 21st February, how the extra money for the nurses' miserable pay rise will be funded or whether it will simply come from trusts' hard-pressed budgets, she mentioned that some would come through, to use her words, improved "efficiencies and other economies". What does that mean? It means improved efficiency and economies in those hospitals. That adds to the increased cost of the administration and, among other things, leads to fewer beds.
The chairman of the Health Services Research recently stated that the pressure on emergency beds is up by 15 per cent. The Middlesex Hospital this week had nine patients waiting for cancer treatment, which was cancelled because it had no beds available for them. One can imagine the problem for those patients who had to wait until the following week to receive their oncological care. That can be cancelled again and only then are they placed on a priority list when they might receive their treatment. I understand that that is the situation in that excellent hospital.
This week I was delayed in coming to this House because there was a young woman in her thirties who was bleeding and for whom I could not find a hospital bed. Three of us had to phone round to try to find her a bed and all the time we were giving instructions over the phone to explain to the people who were with her how to staunch the bleeding by internal pressure. That procedure was carried out in the 17th century but, because there was no other alternative for that patient,
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we were forced to give that advice. God intervened, otherwise the patient would have died, and the bleeding stopped. But we could not find her a bed in a National Health Service hospital or in Queen Charlotte's Hospital.
In the last few minutes available to me I want to touch on medical education. It is worth bearing in mind that we used to have probably the best medical education in the world. Students came from all over to study in the United Kingdom. It is worth looking at the problems that the universities are now facing. The cut in capital budget, which involves equipment as well as building, is 30 per cent. this year. The PFI, in spite of the Government's claims, cannot possibly replace that funding. It is doubly serious for the NHS because many projects are jointly funded by the National Health Service and health authorities in collaboration with universities.
What do the Government do? They promote the Dearing Report. They kick it into touch at a time when universities are in crisis and so we are delayed for at least another year and it is probable that any implementation of that review cannot take place until 1999. This week we sat through a committee at the Royal Postgraduate Medical School to work out what we could do about the 3 per cent. cut with which we were immediately faced. Because we are particularly well managed, it will not actually prevent our continuing to build the library. But there is no doubt that this is the last cut that we can possibly sustain, and certainly our building scheme constitutes a serious problem.
Another matter which I should like briefly to draw to your Lordships' attention is the Calman reorganisation of junior staff training. The idea of a unified training system is not bad. It is due to start in April. But even my own highly intelligent medical staff who are entering that training system do not understand it. It shortens the training programme for staff in specialist training, but limits the choice of hospital department; it limits their freedom of movement and thence experience; above all, it will inhibit their ability to do clinical and basic research in hospitals—in fact, there will be no advantage in doing clinical research because they are in a set programme. Who will look after the patients? The consultants will not only have to continue their clinical work, but will also have to give lectures to students and demonstrate operations to them. That is a real crisis which worries medical people in the health service.
It is not surprising that we have serious concerns in the National Health Service. In answer to a question I asked on 17th January in relation to the acute bed problem in West London, the noble Baroness, Lady Cumberlege, replied with pride,
"I believe that we have a remarkable National Health Service; it is a near miracle".—[Official Report, 17/1/96; col. 591.]
I weep at that reply. I believe that they do not understand what is happening. We face a serious situation. Of course this Government have spent on the health service. Of course they have spent in real terms—no doubt we shall hear more about that from the Government Benches. We are familiar with their story of spending on the National Health Service. The truth is that this is a spent government. Having spent unwisely

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on the National Health Service, they may have to pay the cost at the next general election. Sadly, another government will have to pick up the bill.
My Lords, I beg to move for Papers.
Lord McColl of Dulwich: My Lords, before the noble Lord sits down, in view of the fact that he said extensive cuts had been made in the NHS funding, can be say by how much be would like that funding to be increased? Will be also declare an interest?
Baroness Gardner of Parkes: My Lords, this is a time-limited debate and we do not normally have interventions because that takes from other people's time.
3.49 p.m.
Lord Clark of Kempston: My Lords, I am sure that the whole House is indebted to the noble Lord, Lord Winston, for drawing the National Health Service to the attention of your Lordships. I believe that the general public are getting a bit sick of the denigration of what this Government have done in the past 15 or 16 years. Whether it relates to the economy or the National Health Service—perhaps the noble Lord would be kind enough to listen for a few moments—welfare, education or whatever, it is always a question of underfunding.
The noble Lord spoke about cuts in the National Health Service. What he did not say is that those cuts were projected expenditure which the Treasury then reduced. That is not a cut. There were increases, but not as much as asked for by the departments. I remind your Lordships that when one considers the situation between 1979 and today, some £41 billion has been put into the National Health Service. In simple terms, that means that for every man, woman and child in the country in 1979, £433 was spent on the National Health Service. Today the figure is £697. In real terms the increase in the National Health Service budget is 66 per cent.
Noble Lords will probably ask how that has been done. In my view, it has been achieved because of good national housekeeping. Perhaps I may return to that in a few moments. The noble Lord agreed that more patients are being treated. The figure is now 3 million. Waiting time has been reduced; and the noble Lord paid tribute to that. Those are the kinds of things that we need to talk about regarding the National Health Service. Fund-holding for GPs has been a great success. God forbid that the noble Lord's party should ever get into power!—they would abolish that.
What we must remember about the National Health Service is the fact that the advances in medicine are beyond our comprehension when one considers what patient treatment was some 20 or 30 years ago. There is no comparison with today. There are so many new cures and we are living longer. Quite obviously these factors produce extra drain and strain on the National Health Service.
As regards the nurses, as your Lordships know, the Government have accepted the independent review body's offer of 2 per cent. In addition to that, there is whatever the nurses can negotiate locally. I believe that
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even the noble Lord will pay tribute to the fact that the National Health Service is generally very healthy. It employs more nursing staff, care staff and so on.
Perhaps I may return to the question of nurses' pay, and something which the noble Lord did not mention. In real terms, over the period of this Government since 1979, nurses' pay has increased by about 79 per cent. Perhaps I may remind the noble Lord that under the last Labour Government in real terms nurses' pay was reduced by 3 per cent. How does that square with what the Labour Party are saying today? It is hypocrisy for it to criticise the National Health Service. I remind the noble Lord of the time when the Labour Government had to go cap in hand to the IMF. That meant a cut-back not only in nurses' pay, but also a tremendous reduction in capital expenditure within the National Health Service and other departments.
Perhaps I may now turn to hospital trusts, to which the noble Lord paid some tribute. As regards hospital services, 98 per cent. of them are hospital trusts. Consequently, that means that there is more power held locally in running the local health service. The Government are shortly to abolish the regional health authorities. That again will create more efficiency and more local power as regards the National Health Service.
I referred earlier to how this was being done. The Government have increased taxpayers' expenditure on the National Health Service and also on other departments such as education. That has been achieved because of the Government's economic policy. Whatever one likes to say about this Government, their economic policy has reduced inflation from 26 per cent. to under 3 per cent. That helps everybody: it helps the National Health Service and the nurses. Bank interest rates are down from 15 per cent. to something like 6.25 per cent. and they are falling. I have no doubt that they will fall further. Unemployment is also down. The unemployment figures have come down for 29 successive months. It is due to good national housekeeping.
When one considers inward investment, that is proof positive that the foreign investor looks on this country as a good bet and a good place in which to put his goods. Exports have increased and also the number of small businesses. This is good national housekeeping. The standard of living has improved for everybody in this country by about 40 per cent.
These are the factors which determine whether any government can spend money on, for example, education, the National Health Service or whatever. Government are only the trustees of the taxpayers' money and unless the economy is buoyant then this money will not be available for the National Health Service. That is how this Government have increased expenditure on the National Health Service.
When one hears from Labour Members of Parliament and noble Lords in opposition, one never gets a figure or an explanation in relation to their grandiose schemes. Whether that is the frivolity of opposition, I do not know. They announce grandiose schemes but they never price them. That is what the general public want to

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know. If expenditure on the National Health Service is to be increased, the public want to know where the money is coming from. Will it come from the taxpayer; will it be borrowed, or what? Will it lead to an inflationary spiral as we had under the last Labour Government?
If the Labour Party want to show any credibility, it really is high time that the leaders of the Labour Party came out fair and square and said, "All this is going to cost more. More teachers will cost the taxpayers more. More money spent on the National Health Service is going to cost so much more". At the end of the day the Opposition should say where the money is coming from. That is something they shy away from. It is becoming so serious that I believe the Opposition are losing credibility. Anyone in opposition can promise, but it is only if one is in government that one has to deliver and that can only be done if there are the resources available.
The future danger for this country is that if there were a change in government, that would mean a minimum wage. I believe that all economists and many Members of the Opposition agree that that would increase unemployment. If we accepted the social chapter that would increase the unit costs of production, which even the Germans and the French now realise. They realise that the social chapter is not really working. If there were a change of government and we ended competitive tendering, that would be disastrous so far as the economy is concerned. Any diminution of our economy must mean that there will be fewer services for the National Health Service. Therefore, I trust that my noble friend will resist the criticism.
3.59 p.m.
Lord Walton of Detchant: My Lords, I am grateful to the noble Lord, Lord Winston, for introducing this debate and for the opportunity of contributing to it. At the outset I must express my sincere apologies to him and to the noble Baroness who will reply for the fact that I only learnt last week that this debate was to be held. I had already accepted a pressing engagement for later this afternoon which may prevent me from listening to the entire debate. I shall read all the closing speeches.
I have been a fervent supporter of the National Health Service since it began in 1948. That resulted from the fact that my salary as a medical registrar at the very beginning of the NHS was immediately increased from £400 to £775 per annum. In 1958 I became a consultant. I later held an honorary Chair and later still had six university sessions as a professor while retaining five NHS sessions. Even when I was translated to the dreaming spires of Oxford in 1983, I continued to hold two honorary sessions as a consultant until some four years ago when, on reaching a certain age, I was told by the health service that my honorary clinical contract had expired and that I could visit the hospital for social reasons, but without any clinical facilities.
That introduction may be irrelevant, but the point I want to make at the outset is that I lived through the halcyon days of expansion in the NHS when my
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department and the facilities and staffing available continued to expand. We saw almost incredible advances in medicine with imaging, transplants, spare parts surgery, immunology, rehabilitation, cardiac surgery and many more developments. I eventually headed an academic and research unit which received referrals from all over the country and, indeed, from many parts of the world. Those were wonderful days—they were days when I was very proud to work in the NHS. Indeed, we can still take a justifiable pride in our National Health Service, upon which we still spend less than 6 per cent. of our gross domestic product, one of the lowest proportions spent by any developed country.
However, we have an ageing population and we have a population with greater expectations than ever before about what the NHS can provide. Why should they not have hip replacements? Why should not everyone who can benefit from it have cardiac surgery? The introduction of new expensive drugs such as Beta Interferon for multiple sclerosis and of new procedures has imposed immense demands on our NHS.
I still believe that the NHS provides the best emergency care in the world, but even in the early 1980s we began to see the gathering clouds on the horizon and to recognise that no developed country can ever produce a health service which provides every conceivable medical treatment irrespective of cost. At that time I suggested, rather interestingly, the possibility of predicated taxation and the introduction, which I believe that the country would welcome, of an index-linked income-related health tax, but I was told that the Treasury would never stand for it. I often wonder whether we will ever be able to relax the iron hand of the Treasury in promoting desirable developments. However, that is water under the bridge.
The Government's response to the problems that we saw at that time was to introduce a review of the National Health Service. I believe that what has followed has in many respects been very beneficial: better management and better cost control, with doctors for the first time fully understanding the costs of the procedures and forms of treatment that they offer. I think that GP fundholding has many great benefits to offer, although there is clearly a risk of a two-tier service. Nevertheless, with the academic and vocational training of general practitioners we have seen an enormous improvement in community care and in the quality of British general practice which I now believe to be the best in the world.
The contractor-customer principle carries certain benefits hut, as the noble Lord, Lord Winston, said, it has also brought problems, some of which were highlighted in a report on medical research in the NHS in the light of the reforms which was based on a Select Committee inquiry which I chaired and which was debated in your Lordships' House last year. There is no doubt that tertiary referrals for patients with difficult clinical problems requiring specialised treatment in centres of excellence have fallen sharply, if only because local managers have taken the view that the treatment can be equally well offered in a local hospital instead of sending the patient to, say, Hammersmith or

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to the Newcastle General Hospital, where I once worked, or to other centres where highly specialised care can be provided.
I know full well that the Minister will give us much information about the increasing resources that are being devoted to the National Health Service, about the reduction in waiting lists and the increased standard of care. I accept all the points that she will make: more money is being spent on the NHS. Indeed, I congratulate the noble Baroness on her spirited and dedicated advocacy of the National Health Service, which has invariably won the respect of the entire House.
However, without doubt the storm clouds are gathering again—and they are deepening. Morale in many of the professions in the National Health Service in many of the professions is at its lowest for a decade. Many hospitals have improved their standards of care through day surgery and short stays, but I believe that the closure of acute beds has happened too fast. That can be seen from isolated examples, such as the Sidcup patient who had to be flown to Leeds, the Stepping Hill case where a scanner was not available in the evening, and the recent story of the cancer care unit in Bristol which has had to turn away patients. Those are isolated examples occurring against a background of increasingly high standards of general medical care, but they are happening far too often. The National Association of Health Authorities and Trusts has produced figures to show that over the past three years there has been a 14 per cent. increase in emergency admissions. One of the inevitable reasons for that is our ageing population.
But why in certain areas has there been a veritable stampede of consultants seeking early retirement at the age of 60 rather than wanting to continue to serve the NHS to the age of 65? Why are we unable in many areas of the country to recruit consultants in psychiatry, anaesthetics, paediatrics, accident and emergency, and orthopaedics? Why in the region in which I used to work has the Shotley Bridge Hospital had to close its accident and emergency department because it is unable to recruit doctors to staff it? When I was the Warden of Green College and when I was Dean at Newcastle many of the brightest medical students wanted to enter the new, developing and exciting branch of general practice with vocational training, but there has been a 14 per cent. reduction in the number of young doctors entering general practice training as registrars. I shall not comment on the nursing shortages as I am sure that other noble Lords will mention them, but I do believe that the recent pay award was unfortunate, to say the least.
I turn now to academic medicine. Professors, senior lecturers and lecturers have a clinical contract and do a great deal of clinical work, but the evidence from our Select Committee inquiry showed that at present 24 clinical Chairs in the United Kingdom are vacant for lack of suitable applicants, 10 of them having been vacant for more than 12 months. Fortunately, the Committee of Vice-Chancellors and Principals has established an inquiry under Sir Rex Richards of Oxford to look at the future of clinical academic medicine which, without any question at all, is in crisis.
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Yesterday we considered the Reserve Forces Bill on Report. That presents us with another little problem. I served for 16 years in the Territorial Army and was happy eventually to command a Territorial Army general hospital. I understand that there is now pressure from managers not to allow doctors to enrol in the reserve forces in case they are called out in an emergency. There was a problem during the Gulf War when the NHS suffered through the call up of many doctors in the Territorial Army.
Those are just a few of the problems which the NHS is facing. I believe fervently in its future. I believe that the NHS is one of the things of which this country may be justly proud. However, I urge the noble Baroness, her colleagues and her right honourable friends to undertake discussions with the medical royal colleges, the nursing profession and many others, and to look at some of the emerging problems to which I have drawn her attention because they present a considerable threat to the future of our beloved NHS.
4.8 p.m.
Baroness Hayman: My Lords, it is a pleasure to follow the noble Lord, Lord Walton of Detchant, and to express my gratitude and, I am sure, that of the House to my noble friend Lord Winston for initiating this debate. We are grateful to him—the NHS is grateful to him—for his professional contribution over many years. I know that that gratitude is shared by many patients.
My only quarrel with my noble friend lies in his framing of the Motion. Inevitably he started with the word "staff". When I talk about the NHS I think that it is a good principle to start with "patients", but that word does not appear until the very end of the Motion.
The noble Lord, Lord Clark of Kempston, said that we should declare our interests. I declare an interest as the Chair of an NHS trust hospital. But there is an interest that we all share as patients or potential patients of the National Health Service. It is a very real interest, even for those who are covered by private insurance and who normally take their healthcare elsewhere. I refer to the fact that there is no alternative in terms of emergency provision to the National Health Service. We all may have cause to be grateful for and be dependent on the qualities of care within that service.
There is a justification for focusing on the concerns of staff in our deliberations today because it is proper that we should be aware—and that anyone involved in the political process should be aware—that it is not within the purview or power of a Secretary of State to deliver the quality of care and the kind of health service to which we aspire. That can only be delivered by the staff who work within that service. It is only because of the commitment of the staff who have worked within that service over generations that we have the National Health Service of which we are all, I think, rightly proud.
We have therefore to take very seriously the concerns of people who work within the service. I hesitate to make wild assertions about morale. It is very dangerous to talk about morale because it is a difficult and notoriously dangerous area to try to quantify. In my

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experience of the public services it is unusual for members of staff to come up to you and tell you how high morale is. That having been said, it would be wrong not to acknowledge the wide-ranging and deep-rooted concerns that exist among various groups of staff within the National Health Service. The noble Lord, Lord Walton, alluded to some of them.
When the explicit commitment of the National Health Service is to a primary care led service, we must all be concerned about the extremely worrying difficulties of recruitment into general practice. General practice in this country has been the jewel in the crown of the National Health Service. It has been of tremendous importance to the quality of care for individual patients and to the continuity of that care. It has also been of crucial importance in keeping down the costs of the NHS because of the gate-keeping role of the general practitioner. We sacrifice that role and demoralise those people at our peril. The difficulties of recruitment into general practice are something that should cause very great concern.
Looking at morale, the nursing profession is also faced with enormous changes. Its members are being asked to take on—and want to take on—developing roles in response to our commitment, as a service, to reducing junior hospital doctors' hours, by expanding their practitioner roles. That is foolish in the extreme when recruitment is getting more and more difficult. There was a time during the recession when recruitment was not as difficult, when there was a great stability in the nursing workforce, but that is gradually changing and recruitment is becoming more and more difficult. It was foolish as well as insulting to treat the nurses' pay round as we have done this year.
As to the state of morale among managers, it is very easy to attack managers. It is very easy to call them bureaucrats, to talk about grey suits and to assume that if we only got rid of them and saved the money we spent on them it would solve all the problems within the NHS. The NHS is an enormous, expensive, labour-intensive and extremely complex organisation, and it deserves the highest quality of management.
It is hypocritical to say that we have to cut the costs of management without taking away any of the tasks of management. My quarrel—one of my many quarrels—with the reforms is that the tasks that have been put on the NHS have not been of management but of bureaucracy; of dealing with the nightmare of year-on-year contracting which takes up huge amounts of time and energy to very little avail, and which turns it into an organisation more interested in patients' postcodes than their prognosis, and into a paperchase of trying to build different parts of the service for different bits of care that is given. That has been a terrible distraction, among the reforms, from the very real problems that affect the service.
I was surprised at the speech of the noble Lord, Lord Clark. It seemed to me that he was harking back to a vision of a Labour Government that I did not very much recognise, and to a vision of a future Labour Government—which I certainly did not recognise—with a little synopsis in the middle of an NHS under the
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Conservative Government that no one that I know who works in the NHS would recognise. Certainly everything in the garden is not as rosy as he suggested.
I am not suggesting that there are simple answers or that these are black and white questions. There are, internationally, huge and recurring problems that have been alluded to: the problems about rising expectations, about changes in demography and about what we can do by the extension of technology, which has both pluses and minuses on the treatment and the costs side. They are dilemmas for every country and every health service in the world, whether you are in Bangladesh and paying $10 per head per year on health care or in the United States where the government is looking at $2,500 per head on health care. We are still talking about affordability, about the best structures for delivering high-quality, cost-effective care. They are real and difficult issues that we must tackle.
There are real and difficult issues in this country that we have to tackle. We must look at the Calman changes for doctors in training and the changed role that we are asking consultants to take on. The correspondence in the BMJ illustrates the real concerns about who will deliver the care to patients when consultants are doing more teaching, junior doctors are doing more learning, and there are more and more demands from patients. So there are real issues there.
There are real issues raised by the Culyer Report and how we will finance research within the NHS. There are real issues about what a primary care led NHS means, what the public think it means and how much they want to support it. There are real issues, which were discussed in the House recently, concerning community care, the spectrum of community care and whether, when we closed the long-stay institutions, for very good reasons, we perhaps looked after patients who were already in them but did not anticipate well enough what would be needed for patients who would have gone into those institutions in the future. That was a real problem.
There are enormous, real difficulties. No one within the health service thinks that we can spin gold out of straw. We know that there are resource constraints and we know that there are real dilemmas about priorities that all governments have to face. What distresses me is that we have spent the past few years pretending that the market had a solution to those problems and that we could deal with structures and not deal with the real problems, and that we have been diverted from facing them.
4.19 p.m.
Baroness Gardner of Parkes: My Lords, it is good to have this opportunity to debate the NHS, and I thank the noble Lord, Lord Winston, for his choice of subject. To listen to him, is to hear one side only of the health service story. Let us not be too depressed. There is a great deal of good news to tell. Indeed, one concern that the noble Lord did not mention is that many staff working in the NHS feel that they tend to be taken for granted by the public who do not appreciate their great contribution. Instead of flagging up the marvellous results they have achieved, and valuing the efforts that

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have gone into that, they hear only moans about what more the health service should do. An example of that is that 17 per cent. of patients failed to keep their NHS appointments in hospitals.
My interest as chairman of the Royal Free NHS Trust is one that I have declared often, and I do so again. In many ways, the introduction of the Government reform of the health service has been highly successful. At the Royal Free we have treated more in-patients each year. This year we have treated 25,000 more than in 1990. We have now more beds, many new facilities, a newly built renal unit, many state of the art pieces of new technology, a gamma camera, CT scanners and MRI scanners. We are currently developing an expanded A&E department. Next year we shall have increased out-patient facilities.
Recently a world famous actor came to the hospital to unveil our replacement and updated CT scanner—a great improvement in technology and patient comfort. He asked me who had donated it, and expressed great surprise when I was able to tell him that it came out of the national health budget. He had been led to believe that the health service was so strapped for cash that only generous donors or public appeals could supply any equipment even if it were considered to be essential. The patients and staff need to know that the health service is still making a huge investment in patient care.
It is true that the staff are working harder than ever. That is true also of jobs in industry. Those who are in employment find that the demands made on them are increasing. New computer technology which is planned to assist can often involve considerable extra effort, especially during a learning phase. Hospital patients dislike the fact that the nurse or receptionist can see the screen while they cannot. That causes friction and adds to the staff burden.
The reduction in junior hospital doctors' hours has been good for them, and we hope for the patients, but it means that nurses are taking on duties which were previously done by the junior doctors. Someone else will need to take on the duties that were done by the nurses. NHS work is never ending.
In any health system there are always concerns about growing demands and the availability of resources to meet those inevitable demands. The demographic changes of an ageing population and the constant advance of technology are familiar to us all. I know from my own experience that the staff express anxiety about that dilemma.
Local pay is an issue. Trusts have supported the introduction of local pay, and it is right that successful trusts should have the opportunity to reward staff fairly; but there is anxiety that with the additional 3 per cent. central funding for pay in the NHS, it will be difficult to meet reasonable expectations above that level, especially when central decisions on those staff with national arrangements—for example, the Doctors and Dentists Review Body groups—have given rises in excess of 3 per cent., and for senior registrars and registrars at a nett cost of 4.63 per cent. in 1996–97.
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Some issues are creating staff concern in the Royal Free Trust. There has been a national reduction in the funding of HIV/AIDS services in the light of the anticipated flattening out and potential reduction in new AIDS cases in the future. However, there is concern that those national reductions take little account of local variation in the delivery of service at designated treatment centres. Our trust has seen a continuous growth in the numbers of HIV/AIDS cases under treatment—20 per cent. more last year. As those patients can go to any treatment centre, and often choose to be away from their own areas, predictions cannot be made accurately. The actual trend needs to be recognised in funding terms. The Minister has agreed to look retrospectively at where those patients receive their treatment.
The Royal Free is one of the largest providers of specialist services to haemophiliacs in the country. Great strides have been made in the treatment and care of those patients, but the costs are rising inexorably. New methods of purifying the products necessary for blood clotting are being developed. They will increasingly ensure safe transfusion, but they cost more. Those services are not supported by any national funding arrangements and must be met from local resources. The rising costs cause huge pressure on existing budgets and have a knock-on effect on other hospital services in-year.
I quote those two points as they are examples staff have taken up with me of highly specialised treatments where the financial pressures are concentrated on only a few treatment centres in the whole country.
New management procedures have been successful, and there is a greatly improved standard of managers. Our trust does not have all the excess management staff of which I hear talk. Our managers work hard with all the other staff, and a genuine effort is put in by all in the trust to provide the best possible patient care. Better use is made of beds. Complaints, no matter how few in number, are taken seriously, as we aim to learn valuable lessons and to ensure that mistakes are not repeated.
It is time to reassess the Patient's Charter standards, to see whether they have proved to be the most relevant or whether they require amendment. There is a case for a degree of variation to cover chief teaching hospitals where the aim is to combine education and treatment.
Health of the Nation priorities should be reviewed regularly. The health needs of our population are changing constantly. We have good NHS staff and a good NHS. We must be sure that that continues in the future and that the efforts of those working in the NHS are valued. A number of conflicting statements have been made in the debate. For example, the noble Baroness, Lady Hayman, spoke of when GPs were better, but I think they are better now. Many GP practices now offer amazingly good services. They run minor accident centres.
Baroness Hayman: My Lords—
Baroness Gardner of Parkes: My Lords, I am sorry but I cannot give way as my time has almost run out. What we have found is that the better the GP the greater

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the hospital referrals. I may have misunderstood what the noble Baroness said. The discussion was about a primary-care led health service. If there are better informed GPs who look after their patients better there is more work in the hospitals and not less.
The noble Lord, Lord Winston, referred to Caiman. We are concerned about the costs and the structures of Calman. We estimated that in the past doctors had 46,000 hours of experience before they became consultants. Although opinions seem to vary on this, they will now have between 13,000 and 18,000 hours of experience. There will be dramatic changes. As regards the funding, I understand that the department is aware of the pressure that that will put on hospitals and that that will be taken into account in the planning of the health service.
The noble Lord looked two ways. He wanted all these major services in big centres, and yet he complained that they had them in too many; for example, the Westminster and Chelsea, and the Hammersmith. We cannot have it both ways. I am proud of our health service. I wish to see it continue.

Northern Ireland
4.29 p.m.
Viscount Cranborne: My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Prime Minister on the Anglo-Irish Summit earlier today and its implications for the peace process in Northern Ireland.
"The Taoiseach and I met in Downing Street this afternoon and agreed a way forward, set out in our communique, copies of which have been placed in the Library of the House. Let me summarise the main points of the approach.
"First, both Governments condemn unreservedly the IRA abandonment of the ceasefire and subsequent acts of terrorism and call for the immediate and unequivocal restoration of the ceasefire.
"Secondly, we have confirmed that the two Governments will have no ministerial dialogue with Sinn Fein until the ceasefire is restored. Thirdly, I am glad to say that the Irish Government have now made clear their support for an elective process that is broadly acceptable to the parties in Northern Ireland. We and the Irish Government will conduct further intensive consultations with the parties between now and mid-March. After that, this Government will bring forward for consideration by this House appropriate legislation for the elective process, and we will take other decisions necessary for the peace process to take place.
"Fourthly, both Governments reaffirm their commitment to all-party negotiations with a comprehensive agenda. These will be convened on 10th June, following a broadly acceptable elective process. Whether those negotiations will include Sinn Fein will depend on whether the ceasefire has been restored.
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"Fifthly, we have agreed that at the beginning of the negotiations, in order to build confidence, all participants, including Sinn Fein if the ceasefire has been restored, will need to make clear their total and absolute commitment to the principles of democracy and non-violence set out in the Mitchell report and to address, also at the beginning of the negotiations, Senator Mitchell's proposals on decommissioning.
"Madam Speaker, I believe these agreements and commitments represent a balanced approach to which I hope all the parties in Northern Ireland will be able to subscribe. No-one will find in there all they might have asked for. Equally, no-one need fear that their basic interests and requirements are being overlooked.
"The approach the Taoiseach and I agreed marks out a clear route to all-party negotiations. We believe that this route is viable and direct. That is why we have set a firm date by which the negotiations will be launched. There is still detail to be filled in, and some important issues to be settled. That is the purpose of the intensive consultations due to start next week and last until mid-March. But we now have a framework and a timescale to address and decide these matters. We are ready to meet all the parties in whatever format best suits them, but I repeat that there can be no dialogue between Ministers and Sinn Fein until the ceasefire is unequivocally restored. That is the Irish Government's position as well.
"The issues still to be settled include: first, the nature of the electoral system to be used in the elective process. There are strong views for and against different systems. While the decision is for us, we intend first to explore and test all the options in discussions with the parties before coming to our decision on what seems most broadly acceptable; secondly, the nature and role of an elected body that will come out of the elections. Again there are strongly held views, although many believe such a body has a role to play as a forum for peace; and, thirdly, format, structure and agenda of the negotiations themselves.
"Madam Speaker, we have been discussing these issues intensively with the Northern Ireland parties and the Irish Government for some time now. I would have liked to have been in a position to announce agreement on these issues and to have been able to publish detailed proposals today. There are, however, still gaps to he filled in. That is why we have called for fresh but time-limited consultations to make a last effort to reach agreement on these issues. If I judge it would be helpful I may put forward to the parties, and perhaps publish, specific written proposals during the consultations. At the end of that period, the two Governments will review the outcome.
"Whether or not final agreement on all issues can be reached during this period, let me make clear that at the end of it, the Government will put forward to this House legislative proposals for elections in Northern Ireland. Decisions on the other outstanding arrangements will also be announced. These decisions will be taken on the basis of a judgment of what is most likely to be broadly acceptable to the parties,

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and to the people of Northern Ireland. We have decided to act in this way to make clear that the process cannot be held up further if in the end there is still lack of agreement.
"Madam Speaker, we are taking these decisions upon ourselves together with the Irish Government where appropriate, because we do not believe that the overwhelming desire of the people of Northern Ireland for lasting peace will brook further delay. We are ready to fulfil our responsibilities.
"There is one other aspect of the communiqué I should bring to the attention of the House—the suggestion that there could be referendums in Northern Ireland and the Irish Republic. These could be held on the same day as the proposed election in Northern Ireland. The aim would be to give the people of Northern Ireland the opportunity to speak clearly about their own commitment to peaceful, democratic methods and rejection of violence.
"The Government will consider with the parties whether such a referendum would be valuable or not. There is clearly room for debate about what the question or questions should be in such a referendum. But we will listen to the views of the parties and make our own views clear at the end of the consultation period.
"Meanwhile, let there be no doubt about three points: first, that there is no place whatsoever for violence or the threat of violence in the peace process or in the negotiations. Those who advocate violence or do not dissociate themselves clearly from its use or threat by others cannot expect others to go on sitting at the negotiating table with them. Senator Mitchell's report sets out clear principles on democracy and non-violence, makes clear the priority to be attached to the decommissioning of illegal weapons and makes proposals on how this can be tackled. These issues, however difficult, cannot be dodged. They will be on the table at the beginning of negotiations. If it becomes clear that any party is not committed to these principles and this approach, either at the beginning of negotiations or subsequently, there will in our view be no place for them at the table.
"The second point is that there has never been any justification for terrorism and violence in Northern Ireland. These proposals and the firm commitment to all-party negotiations by a fixed date will remove any lingering shred of obfuscation and pretence about this. Thirdly, the battle against terrorism is being intensified. Co-operation between us and the Irish Government has never been better. We will hunt down those responsible for bombings and killings and maintain security at whatever level it needs to be to protect the citizens of this country as they go about their daily business.
"Madam Speaker, the people of this country and the Irish Republic have made clearer than ever before their demand for an end to violence. That demand must now be met and the people have the right to expect the violence to stop for good.
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"The search for peace has been much complicated by the resumption of terrorism on 9th February. But the Government said they would not be deflected from their efforts and we have not been. I am grateful for the support we have received in our efforts from this House, across all the parties. We and the Irish Government are united in our determination to stamp out terrorism and bring lasting peace. With the support of this House I believe we will succeed. But I warn the House that the road ahead may yet be long and stony. The men of violence will not give up lightly. Among them are people who do not truly want peace as we understand it.
"As we go though the process leading to the negotiations and take the difficult decisions, concerns will be raised from this or that side, this or that interest. We will, of course, take account of all views, but we will not be deflected from our central objective. Because the men, women and children of Great Britain and Northern Ireland demand no less of us. It is their lives and their futures that must be our first concern.
"Madam Speaker, I commend to the House this approach to negotiations and ultimately to a lasting and comprehensive peace."
My Lords, that concludes the Statement.
4.40 p.m.
Lord Richard: My Lords, on behalf of the Opposition, perhaps I may thank the noble Viscount the Leader of the House for repeating the Statement that his right honourable friend has just made in another place. I should like to say at the outset that we welcome the Statement. We believe that the Government are right to pursue that potential road to peace and we therefore support it.
For the sake of clarification, as I understand it there are basically three elements in the route that is now proposed. First, June 10th is now a firm date for the commencement of all-party talks, negotiations, or whatever word one likes to use. Secondly, there is to be some form of electoral process in the period between now and 10th June. Given the pressure of time that that imposes, I imagine that that process will be sooner rather than later. However, I am not clear from the Statement—and I shall be most grateful if the noble Viscount could help us in this respect—of precisely what it is that the electoral process is designed to produce.
I believe that the right honourable gentleman the Prime Minister says in the Statement that perhaps it could provide a forum for peace. Can the noble Viscount say whether it is intended that the elections are to be held in order to produce negotiating teams with a negotiating mandate to go into the negotiations on June 10th, or whether there is some other reason for them which is not set out in the Statement?
Thirdly, as I understand it, preliminary talks over the details are to start very early; indeed, I believe that someone has said as early as the beginning of next week. A possible fourth element is the idea of having a referendum. I assume that that would be a referendum

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both in Northern Ireland and in the Republic, although, again, that is not clear from the Statement. Of course, that may be because the right honourable gentleman is speaking for this country and not for the Irish Republic. If the noble Viscount can tell us that that is how it is envisaged, we would be grateful.
One's immediate comment is that clearly it is most important now to ascertain what the attitude of Sinn Fein will be to this route towards all-party talks. Sinn Fein has urged all-party talks for a very long time. It seems to me that Sinn Fein now has a very clear and obvious route whereby those concerned can get the all-party talks for which they have been pressing. We would obviously prefer—indeed, everyone would—that Sinn Fein were part of the whole process and taking part in the talks. However, I very much agree with what the noble Viscount said: Sinn Fein cannot run them and it cannot be in charge of the process. It is right that Sinn Fein should have to accept the Mitchell principles, if I may call them that, before its members fully participate in the all-party talks. On one point of detail in that respect, is it envisaged that Sinn Fein should accept those principles before the talks start, or will they be on the table when they all sit down in order to try to negotiate?
Those are not minor points but they are, perhaps, peripheral ones for today. I believe that the best we can do today is to welcome the progress that has been made and emphasise yet again how important it is that the two Governments march in step on the whole issue. We wish the process well, and hope that it will succeed.
Lord Holme of Cheltenham: My Lords, from these Benches perhaps I may, equally, welcome the Statement just repeated by the noble Viscount the Leader of the House. I believe that the process was always going to be bumpy. Just as it is incumbent upon us not to be over-depressed or cast down by the had times, the terrible things that happen and the had moments in the whole process—and let us remember, for example, that the process of peace in the Middle East has been marked by periodic and terrible explosions—so I believe that we should not overreact or become over-euphoric at happier moments like this.
I believe that this is a happier moment, not so much because the package in the Statement represents some sort of magic solution to the multifarious problems of the advancing peace in Northern Ireland, but because it demonstrates that the two Governments are together again. After the very dangerous period of the past few months when the two Governments diverged, they have now made it their highest priority to find agreement.
I suspect that the noble Viscount will agree, but it seems to us on these Benches that, whenever the two Governments are together as they were so conspicuously at the time of the framework document and the joint declaration, the terrorists do not thrive and when the two Governments open up a space between them in that atmosphere, the terrorists come out again from under their stones. The fact that the two Governments are together is the indispensable rock upon which any sort of progress has to be built. Through the noble Viscount,
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I should like to extend our congratulations to the Prime Minister and to the Taoiseach on the imagination and energy that they have undoubtedly put into the package that we are looking at today.
Perhaps I may make one or two observations. There are all the characteristics in the package of a trade-off—that is, a trade-off between the Irish Government's emphasis on fixed dates for all-party talks and the British Government's emphasis on the helpfulness of the elective process. When he replies, can the noble Viscount say whether he is now convinced that the commitment of both Governments to both elements of the package is complete? It will be tested severely in the weeks ahead.
I turn now to the second observation that I should like to make. What a conspicuously impressive phenomenon it was last weekend to see those demonstrations in Belfast and Dublin of tens of thousands of people saying that they wanted their ceasefire back! The demonstrators were turning their backs on the terrorists in a way that we have very rarely seen so publicly. In that context, I should like to emphasise particularly the brave and outspoken words of the Taoiseach, John Bruton, on the subject of the IRA.
I have one or two further questions for the noble Viscount. First, can be clarify the conditions for Sinn Fein participation in the talks? I am sure that it is right to put the onus on Sinn Fein to say whether it wants to be part of the process. There have already been three scares today in central London. It is an ever-present question in all our minds. The Government said quite clearly that the first condition is that there should be a ceasefire again. I am sure that that is right. Beyond that, I am afraid that the Statement leaves me slightly confused. In order to take part in the elections and the talks that follow, does Sinn Fein have to commit itself to the Mitchell principles? At one point in the Statement it appears that during the talks Sinn Fein will have to be consistent in its approach to those principles rather than that being a precondition. I should be most grateful for some guidance on that question.
Secondly, among the issues to be settled—they are very large issues and I fear that, as so often, the devil will be in the details of the package—there is the question not so much of electoral systems (where I gather the intention is to have preferential voting) but of the basis of the constituency. As the Statement does not refer to that matter, perhaps the noble Viscount will be able to clarify that aspect.
Thirdly, there is the important question of what the nature and the role of this elected body is to be. If we cannot be clear as to what it is—and, indeed, the Statement is not clear on that—we should be clear as to what it is not. Are we clear that it is not a reversion to Stormont? In other words, that it is not to be a talking shop, but simply a transitional gearing towards a negotiating body. I must say that I am most unclear from the Statement as to the answer to that question.
I turn next to the point made by the noble Lord, Lord Richard, regarding the linkage of the election to the 10th June negotiating date; in other words, the

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gearing between those two. That may not yet be agreed, but I believe that it would be better for us to know whether that is the case.
Finally, I should like to say a few words about a referendum. If we are to have a referendum, please let us have a meaningful question. It would be totally meaningless to have the sort of question that has so far been discussed, for example, "Are you against violence?", or, "Are you in favour of motherhood and apple pie?" If we had such a referendum, it might be sensible to ask: "Should only parties committed to a peaceful future take part in talks?" That would be a meaningful referendum question. Let us only have a referendum if it asks a question which has some meaning in it and which will advance the process.
Viscount Cranborne: My Lords, I am extremely grateful to both noble Lords for the measured, restrained and extremely constructive welcome they have given to my right honourable friend's Statement. One of the most comforting elements during these distressing past few weeks has been the statesmanlike support both parties opposite have given to the Government in what has been a difficult process.
I can confirm the analysis of the noble Lord, Lord Richard, of the three elements. I shall not bother to repeat them here, except to say that he is right about that. As regards the referendum, which is the fourth element that the noble Lord mentioned, that is a kite which has so far been flown and we do not yet know whether it will be brought successfully to earth. However, it is clear that it could be helpful in the prosecution of the process to hold a referendum both in the north and the south. I certainly note what the noble Lord, Lord Holme of Cheltenham, said about the nature of the question. I shall make sure that that is brought to the attention of my right honourable friends in the consideration of what the question ought to be. It is a matter which will have to be discussed between the parties in the course of the intensive talks, which it is hoped will begin on 4th March next. It is hoped that they can be brought to an end by 13th March. That is another question that the noble Lord, Lord Richard, asked.
I was also delighted to hear the noble Lord, Lord Richard, say that Sinn Fein cannot run the talks. It is absolutely right that they should renounce violence, particularly in view of the undertakings that they gave at the beginning of the 17-month ceasefire. It is important that they should be able to convince us this time, if and when they declare another ceasefire, in the most believable manner.
In that context I should make it plain to the noble Lord, Lord Holme, that the condition for Sinn Fein, and any other party which has been associated with violence (and we should remember that Sinn Fein is not the only party that has been associated with violence), is that there should be a ceasefire. In answer to the two understandable questions which the noble Lord asked arising out of his observations I can do no better than quote the words at paragraph 12 of the agreed communiqué which was issued at the end of the talks which my right honourable friend held this afternoon
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with the Taoiseach. In relation to the discussions which will take place after the elections among the negotiating teams, both Prime Ministers agreed that:
"all participants would need to make clear at the beginning of the discussions their total and absolute commitment to the principles of democracy and non-violence set out in the report of the International Body. They would also need to address. at that stage, its proposals on decommissioning".
Therefore, I hope that it is clear that at the beginning of that process both those matters would be addressed.
Both noble Lords asked what was the purpose of the elected body. The electoral process is designed to choose the negotiating teams. As my right honourable friend's Statement indicated, there could also be a role for a forum consisting of all those elected, which, as my right honourable friend also said, many believe has a role to play as a forum for peace. Precisely what that role will be will have to be nailed down between 4th and 13th March. Clearly, before we can proceed it is important that all the parties we need to persuade to participate in the process should agree what that role should be. I should be grateful if noble Lords will allow me to rest my comments at that point.
I wholly sympathise with the warning of the noble Lord, Lord Holme, that we should not be over-optimistic, just as we had no need to be over-pessimistic during the past two or three weeks. Nevertheless, as my right honourable friend has emphasised, we should be aware that the road ahead will be difficult and stony. As both noble Lords said, the only way we can hope to make progress is by trying to ensure as best we can that both Governments move as one.
Finally, I shall of course pass on to my right honourable friend, and via him to the Taoiseach, the congratulations of the noble Lord, Lord Holme. The best reward that any of us can have is that this process should lead to a successful conclusion.
4.56 p.m.
Lord Mason of Barnsley: My Lords, I agree with what my noble friend said. I agree with the Statement, and I believe that all parties in this House will be prepared to back the course that has been outlined by the noble Viscount the Leader of the House, and especially the election proposals for the Province. I believe that eventually that will reveal the democratic strengths of all the parties concerned, but particularly the strength of the Provisional Sinn Fein.
I agree in particular with what the noble Lord, Lord Holme, said. The vast majority of the peoples of the island of Ireland are yearning again for a ceasefire. They have had 18 months of peace and are yearning for a return; witness the thousands of people who marched in north and south last weekend. If there was a referendum in both north and south—without worrying at this stage about the words, which would be centred upon peace—there would be a vast majority in support. What is more, it would be a clear declaration that the Provisional IRA would be isolated.
Has not the Provisional IRA army council taken the view that holding the republican movement together is more important than the continuation of talks? The

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extremists, the marxist ideologues, the bombers, will not change. The hasty activity of Ministers to meet and prepare further plans, with which I agree, may have given the Provisional IRA the impression that bombing pays. They must be absolutely denied any satisfaction on that point.
Did the Government ascertain whether Gerry Adams knew that war was to be declared, for that is what it really is? If so, why did he not warn Her Majesty's Government? If he did know, he should have warned them; if he did not know, what credibility has he left to negotiate a ceasefire? Are Her Majesty's Government still dependent on Adams to assist in effecting a ceasefire, or have they determined—as was indicated in the Statement—to go ahead with all-party talks to the exclusion of Adams?
Of course we are trying to be optimistic, but there are many irreconcilables to be considered during the course of the next few months. I notice that the Provisional Sinn Fein say that there should be no elections before talks; Her Majesty's Government say that elections must precede talks. We cannot iron out those differences at the moment, but they will be some of the imponderables.
In my opinion it is essential that the Government have a referendum as quickly as possible, in both north and south. The result is already clear to us, but it will be a clear indication to the Provos that they are isolated and the vast majority want peace.
Viscount Cranborne: My Lords, I hope that the words of the noble Lord will reverberate far outside this Chamber. I am sure that when they do, his remarks about the desirability of a referendum will reverberate with them and we will be able to take note of his strong recommendation.
I agree with what he implied about the electoral process revealing the true strength of Sinn Fein. I also would like to associate myself with his remarks about the extraordinary demonstrations that were seen in recent days in both parts of the island of Ireland; and, if I may say so, the touching and extraordinary courage of the parents of the young bomber in their declaration about the nature of their son's funeral.
The noble Lord rightly asked me whether it could be said that this latest development proves to the IRA that bombing pays. I think it is fair to say that we would have had a much better chance to have been where we are today a week or two ago if the bomb had not gone off. I would suggest to the noble Lord that far from hurrying the process of agreement between my right honourable friend and the Taoiseach, the explosions that we have seen in London over the past few days have delayed the process. If noble Lords take that same view with me, it is all the more important that we should proceed and realise that it is up to Sinn Fein whether it participates in a process that will take place anyway among parties who have renounced violence and who can agree on the way forward. Those parties are committed to the parliamentary traditions with which we conduct our politics in the United Kingdom and in the Republic of Ireland. I do not know whether Mr. Adams knew or did
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not know of the resumption of violence. I am not privy to the internal counsels of Sinn Fein IRA. However, if he did know, I can do no more than say that I am driven to the same conclusions as the noble Lord.
Lord McConnell: My Lords, as an Ulster Unionist, perhaps I may join in the welcome that has been given to the Statement this afternoon. I was particularly glad to hear the noble Viscount condemn violence and assert that the Government would not give way to it. To give any concessions as a result of bombs would be shortsighted and irresponsible in the extreme because it would merely invite more bombs to produce more concessions.
I was, indeed, glad to hear the noble Viscount say that he would not deal with Sinn Fein until it renounced violence; and, I hope, until the weapons are handed over. You cannot have democratic discussions or negotiations if one of the parties has armaments and bombs readily available if that party happens to feel dissatisfied with the progress of those negotiations.
I note that the noble Viscount said there would be no ministerial dialogue with Sinn Fein. I understand from a press report that a few days ago there was a meeting at Stormont between members of Sinn Fein and civil servants. As we all know, civil servants must report to their Ministers. Is this just a device for achieving communication, while at the same time saying that there is no ministerial contact? I should like to hear an assurance from the noble Viscount the Leader of the House that negotiations, or even discussions, should not be held with Sinn Fein in any roundabout method or with any subterfuge.
I join with what the noble Lord, Lord Mason, said about the demonstrations that we saw recently in Northern Ireland. I think that they are a clear indication of the feelings of people of all political persuasions who are completely disgusted with the bombing which has gone on over so many years.
When it comes to the election, it is said that various methods will be discussed. However, I believe that the good old British system is by far the best and that we should not start playing with systems such as lists, and so on, which are quite alien to British democracy.
As regards a referendum, certainly in Northern Ireland—what they do in the Irish Republic is their own affair—I agree that the question to be asked is important. We have all seen opinion polls where a loaded question produces the answer that the person running the poll wishes to obtain. Therefore it is important that any question should be fair. Subject to those reservations, I join with other noble Lords in welcoming the Statement.
Viscount Cranborne: My Lords, the noble Lord speaks with great authority on these matters. I agree wholly with what he says about the shortsightedness of appearing to prove to terrorists that terrorism works. They are all too convinced of that delusion already.
On decommissioning, I can do no more than refer the noble Lord once again to the two sentences that I quoted a little earlier from paragraph 12 of the communiqué which seemed to me to be about as clear as we can be on the subject.

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I am pleased that the noble Lord referred to the contact between officials and Sinn Fein. It was broadcast on Sunday evening last by some news channels, I think, as being talks. It is well worth making it clear that the contact which occurred was at the request of Sinn Fein and that officials merely listened to what was characterised as an urgent message. I understand that their response was no more than a restatement of present government policy.
I believe your Lordships would feel that it would be sensible at least to have a listening post so that if a communication has to be delivered there is a mechanism for doing so. But I believe that my right honourable friend has been perfectly clear that negotiations are matters for Ministers and that until Sinn Fein renounces violence in the terms that I have described to your Lordships this afternoon negotiations will not be open to Sinn Fein if it wishes to deal with Her Majesty's Government. I am delighted to be able to say that the Republic of Ireland Government maintains precisely the same position.
Lord Elton: My Lords, in adding my name to those who welcome the Statement, it would be proper to add a note of admiration for the way in which we have been brought to the situation. It will not have escaped your Lordships' notice that the return of terrorist activity, the pressure of important international events, and quite serious political difficulties have not for a moment detracted the attention of the Prime Minister and his Secretary of State from this issue as a first item of importance on the national agenda. In those circumstances, to deny any of the participants in the negotiations preceding the Statement any advantage whatever from the local domestic political difficulties is a mark of great political statesmanship and integrity which should not pass unremarked.
Viscount Cranborne: My Lords, I am most grateful to my noble friend. I know the pressures there have been on my right honourable friend the Prime Minister from a number of quarters in the past few days. I can testify to your Lordships' House that never for a second has he thought of trying to obtain party advantage out of the talks. I only hope that in his position I should have had the same courage.
Lord Merlyn-Rees: My Lords, I welcome the talks and the fact that the two elected governments are working together. It has not always been thus, and that is the main reason that after the events of last week there has been the announcement today.
With regard to the IRA, in my view, we should not underestimate the possibility that throughout Belfast anyway the story will be that the bombs in London have brought about the Statement today. It is easy to do that. I refer to the electoral system and testing. One test has already taken place under the chairmanship of the noble and learned Lord, Lord Lowry. As Lord Chief Justice of Northern Ireland, and after permission from the noble and learned Lord the Lord Chancellor, he chaired the convention of 1975 when there was an election and a forum. Noble Lords should look at copies of Hansard and read the debates. If anyone expects a negotiating
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position to come out of this, it will not happen. Negotiating is a difficult job. As regards the forum, I believe we should not forget that there are elected representatives in the north and south who were elected to Parliament or the Doyle. They must not be forgotten in the story.
I wish to raise one point on the electoral system that may or may not emerge. We must have wide representation on the negotiating body; noble Lords should not forget the Protestant paramilitaries who have political parties. Under most systems they would not be elected because they are powerful in only one or two parts of Belfast. However, if they are not at the negotiating table it will lead to problems. I know that they meet with government representatives. It ought to be made clear to one of the groups that if they go down to the south and bomb Dublin, the same position will apply to them as applies to Sinn Fein: they will not be at the negotiating table. I wish the Government well; they have a difficult task ahead.
Viscount Cranborne: My Lords, I am extremely grateful to the noble Lord for what he said. As regards the so-called Loyalist paramilitary parties, I should emphasise that so far they have played what anyone would call an important and constructive role. We sincerely hope that it will continue. What is sauce for the goose is sauce for the gander. It is not just Sinn Fein who have to denounce violence in the terms that I have attempted to describe to your Lordships this afternoon; it is all parties. Some parties will find that more difficult than others. We shall see. Nevertheless, the noble Lord's point is well made and taken.
We will want to put forward proposals in intensive multilateral discussions about how to deal with parties who do not achieve an adequate electoral mandate. I am sorry that at this stage I cannot be more specific to the noble Lord, but I am sure that he will understand.
I wholly agree about the story which is no doubt already running in certain parts of Northern Ireland and the Republic, as well as perhaps certain parts of Great Britain, about whether "It was the bombing wot did it". I have attempted to give my answer to that canard. We have clear internal evidence, when the story of the negotiations comes to be written, of what I regard as being the incontrovertible truth of what I have told your Lordships this afternoon. Whether we can be clever enough, direct enough and forthright enough to "unconvince" people who are inclined to believe that canard will be up to the people of Northern Ireland and the south. However, like everyone else in your Lordships' House, I am encouraged by the size of the demonstrations which may enable us to ensure that the truth is given a proper hearing.
As regards the electoral system, in the main two systems have been proposed so far. In fact, there have been many more, but two seem to be the front runners. Our mind is not closed and it is important that between 4th March and 13th March we ascertain whether we can reach an agreement which is acceptable to the parties. My right honourable friend has made it clear that in the absence of that agreement, Her Majesty's Government

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will put forward proposals which they will deem to be the best and most acceptable under the circumstances. That should not lead to holding up the process.
Lord Boyd-Carpenter: My Lords, I wish to express the view that the Prime Minister's handling of the matter greatly increases the admiration which many of us feel for him. We would like respectfully to send our congratulations to him that, despite many other manifold problems, he has handled the matter in a courageous and masterly way. I am sure that all elements in this country are profoundly grateful to him for it.
Viscount Cranborne: My Lords, I am grateful to my noble friend and, with his permission, will, with the greatest pleasure, pass his sentiments on. I also associate myself with them.
5.15 p.m.
Lord Marlesford: My Lords, does my noble friend agree that: given the fact that Sinn Fein and the IRA are one and the same organisation, that membership of that organisation is both tiny and wholly unrepresentative of the people of either Ireland or Ulster, that it has four components: first, a few genuine Irish Republican Nationalists; secondly, a few committed Marxists whose long time desire has been for a united Ireland (Gerry Adams having been a long-term member of that persuasion); thirdly, a small number of dangerous psychopaths who enjoy the process of killing and maiming; and, fourthly and overwhelmingly, a group of criminal extortionists who for years have been making a very satisfactory living out of this form of crime, there is a certain conceptual contradiction in trying to arrive at a political agreement with Sinn Fein/IRA? Indeed, is it not rather like trying to arrive at a political settlement with the Mafia in the United States?
Does my noble friend agree that for the vast majority of the active members of the Sinn Fein/IRA a political settlement in Northern Ireland would represent a terminal threat to their chosen way of life, and that is precisely why the Governments of the United Kingdom, Ireland and the United States must continue to strive for such a settlement?
Viscount Cranborne: My Lords, I am grateful to my noble friend. As negotiations begin, we shall see whether Sinn Fein is able to change its spots.

National Health Service
5.17 p.m.
Debate resumed.
Baroness Masham of Ilion: My Lords, we now go back to the National Health Service. I thank the noble Lord, Lord Winston, for initiating the debate. Having been a member of a health authority for many years I have seen numerous changes. One is how the current competition among hospital trusts has not always been as happy as it might be. I have heard the saying: "Trusts no longer trust each other".
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I have nothing against competition which will raise standards for everyone, most of all the patients. But now trust hospitals are pinching each other's staff and working under the stress of always having to save money. So the pressure throughout a hospital penetrates down to patients. Efficiency is not always about direct money. It should also be about the standard of care at patient level where time can be wasted with inefficiency.
A friend of mine with whom I had lunch last week told me that he had just been to a London teaching hospital for a stomach investigation under anaesthetic. Just before he was given the injection the doctor checked his notes and asked whether he had stopped taking the tablets which he had been on so that the investigation was viable. He had not; no one had told the patient. The doctor used two words which I could certainly not repeat in your Lordships' House and the operation had to he postponed for a month, wasting everyone's time.
So often, the staff making the arrangements with the patients are very junior or, as happens nowadays, are agency staff brought in to fill the gaps. They may not know the procedure for different investigations. Surely there should be a checking system so that the patient knows exactly what to do.
Living as I do in the rural part of north Yorkshire, I know how important it is for everyone to have a first-class GP service. Hospitals can be a long distance away. We are lucky to have many good GPs in north Yorkshire.
My GP and his wife trained at St. Bartholomew's Hospital and have been greatly affected by the saga of Bart's. His loyalty to his teaching hospital has been steadfast, but his commitment to being a GP in England is wavering. After a visit to Australia, he keeps talking about it. Speaking as an FHSA member, we in north Yorkshire are concerned about the lack of general practitioners coming forward for selection when a practice vacancy occurs. A few years ago there might have been as many as 200 applicants. Now we are lucky to have five—and most of those will not have reached the standard required.
There needs to be careful consideration as to why there is a shortage of general practitioners. There are many reasons: too much paperwork; drugs and alcohol violence; demanding patients; out-of-hours working; isolation; too many sick patients in the community who a few years ago would have been treated in hospital; a feel for working in developing countries on the part of many young doctors, and many other reasons. But perhaps also it has something to do with our restless society, which brings with it a lack of long-term commitment. That is reflected not only in the medical profession but in many other professions.
I am president of the Spinal Injuries Association. Since our formation 22 years ago we have always pressed for all patients with damage to their spinal cord resulting in paraplegia or tetraplegia (paralysis from the lesion down) to he treated, whenever possible, in a specialised spinal unit. If you do not feel your paralysed

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parts there is a serious possibility of developing pressure sores, especially while a patient is in spinal shock during the first 24 hours after injury.
I raise this matter today as it is of great concern to the medical staff of spinal units, and of even greater concern to the patient and his family, if a patient develops a pressure sore before he comes to a spinal unit. It is one of the biggest problems, holding up rehabilitation and unnecessarily costing the NHS an immense amount of money. In spinal units there are procedures for turning patients regularly to relieve pressure, with special equipment and nursing expertise.
Patients who are treated in general trust hospitals are still developing pressure sores. In the south of England there are some excellent, up-to-date spinal units; and the one in Scotland which I visited recently must be one of the best in the world. I ask the Minister: what is happening in the north of England? There is concern about the Hexham and Wakefield units.
It is so important for spinal patients to have the correct treatment. Would it not be of great benefit to everyone if there were a central reference point in finding beds? Is there not also a request for this from neurosurgical departments? It seems that the Department of Health could do much more to help these critically ill patients and the doctors who need to find specialised beds for them. Surely it is possible to have a national database linked with A&E departments. If department stores can do that when one goes to buy a dress, surely the National Health Service must be able to do it too?
In recent weeks throughout the country there has been great concern over the lack of intensive care beds both for adults and for children who need critical care. These patients do not come in regimented order. Serious illness and traumatic injury is spasmodic. Would it not be possible to have multi-disciplinary training in critical care for all ages, and nurses who could be used more flexibly and moved to other departments should the critical care beds not be occupied? These beds are very expensive to fund, but they are an insurance policy for everyone who may need them. It is frustrating and tragic for everyone when lives are lost that could have been saved had such a bed been available.
I have heard that social workers have been withdrawn from hospitals in Buckinghamshire by social services, so that links between hospital and the community have been cut. That has caused great concern to hospital trusts such as Stoke Mandeville, which now has to fund its own discharge co-ordinators. Making community care work, especially with elderly patients, is very important. It is a difficult problem. It will mean that hospital beds will be blocked if patients cannot be got back to the community. There seems to be a problem, and I hope the Minister will look into the matter.
There are many needs in this vast health service. Many people work hard to raise money to help provide equipment and keep it up to date. When a scanner to diagnose a critical patient does not have a 24-hour on-call person to work it, there is dismay and disbelief. I hope there will be ways to provide what is needed to
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save as many lives as possible and to rehabilitate those who need it, so that they can have the quality of life that they are able to attain.
If you ask doctors and dentists in the health service these days how they feel, many will say that bureaucracy is swamping them. They have so much pressure on them to use cheap products that at the end of the day job satisfaction is not as good as it should be.
5.27 p.m.
Lord Desai: My Lords, I rise to speak not as anyone who has managed a trust, has been a doctor, or is active in the National Health Service. I take the opportunity to ask this question. If so many extra resources have gone into the health service—as the noble Lord, Lord Clark of Kempston, emphasised and as we all acknowledge—why is there such a high degree of dissatisfaction with the service?
The noble Lord, Lord Clark, said that we were denigrating the National Health Service. I do not think that is the case. Every morning I buy six newspapers: the Sun, the Daily Mail, The Times, the Independent, the Guardian and the Financial Times. I read the Sun first, and then the Daily Mail. I tell the noble Lord: read the tabloids every day. There is always a national health story in which people are complaining. This is not made up. As the noble Lord, Lord Walton, said, perhaps these are events on the margin, whereas the broad flow of service is satisfactory. However, I do not think it can be said that the Motion tabled by my noble friend was somehow concocted from his imagination, or that it merely represents Labour Party denigration of the Government.
The National Health Service is in trust to all the parties. We agree with that. All the parties have helped to make it what it is. It is a valuable asset to us. We are discussing this matter now because in our various ways we care about it. It is in that spirit that I wish to address the subject today.
I believe that there is a problem with the internal market. In my view, the problem is that the internal market does not work like any other market. In the recent past I have had occasion to speak on the Broadcasting Bill, the issue of student loans and several other issues. I have pointed out again and again that this Government say they believe in a free market but do not understand how a free market works. Unfortunately, what turns up is a series of bureaucratic pricing rules and contractual arrangements which make work rather than reduce it.
My noble friend Baroness Hayman was entirely correct. Managers should be there to manage. Of course they have very important things to do. However, they cannot manage but have become bureaucrats. They have become bureaucrats, for the very simple reason that since the introduction of internal market reforms we do not have a market which prices services or commodities, but a series of centrally set prices and contractual arrangements.
What is the temptation of central government? Ultimately, in their search to emulate the market they make more and more pigeonholes, as my noble friend

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has described: fund-holding GPs, non fund-holding GPs, what the patient's history is, which hospital he or she has been to, the length of stay, and so on. Each carries a different price. Those prices are bureaucratic and do not allow for any adjustment.
The welfare state is run in the same way. We create lots and lots of categories just to make a difference of 50 pence to how much we pay somebody each week. If one has so many categories and prices to worry about they are not prices at all. They are what may be called "soviet" prices. Such prices lead to bureaucratic work. A hamburger will cost a different price in a town versus a city, in different parts of a city and in different kinds of hotels and restaurants. Why is that? It happens because the market offers a variety of different prices and lets matters adjust. What we are doing is setting the same price across the country for each separate category rather than allowing local managers to manage. I am not saying that it is easy, because health is not a simple commodity. Health is a bundle of commodities. One does not have to take my word for it. Professor Alan Maynard, who is a more fervent believer in the free market than I shall ever be, is critical of the internal market precisely because it is not a free market.
I was briefly responsible for the health portfolio and spoke from the Front Bench. During my brief tenure the Tomlinson Report came out. That report identified a very simple problem. If you impose on inner city hospitals the same costing rules that you impose on other hospitals, especially if you include the price of land as one of the costs to be met, they will end up as high cost hospitals. If one has the same price across the country for a hip operation they will price themselves out of the market. One does not require a sophisticated diagram to show it. Therefore, one has a single price and bureaucratic rules which say that costs have to be met, with the result that inner city hospitals are shut down. With the finest of intentions, it was said that there were too many inner city hospitals, that technology was changing, that people liked treatment at home and that there should be more primary health care in London. That is fine. But if one does not put primary health care in place long before one shuts down hospitals, if one does not educate people who are used to going to hospital for their problems that alternatives are available, and the transition will be as costly as I have said that it will be—to shut down hospitals does not save money but costs money—one will have a little bit of pinching here and there.
We have not properly thought through the internal market. How to price differentially a hip operation, or anything else, across regions, hospitals and age and gender is not an easy thing to do, but I believe that a lot more flexibility can be allowed. What we have is a system of soviet pricing and decentralisation and, even at a time of a growing budget, budget restrictions. Therefore, a lot of time has to be spent filling out forms.
My experience as an inner city academic is that as money gets tighter there are more forms to fill out. As money gets tighter we have not learned any way of allocating money except bureaucratically by filling out forms. The Government will not allow us to charge any
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particular student fee that we want to charge because that will be too much of a free market. They cannot stand it. It may also antagonise the middle classes. Therefore, we have no free market in student fees and restrictions on the number of students we can take, but we are supposed to behave like an internal market. It does not make any sense. All it does is to make us do things that we are no good at: filling out forms.
I have nothing against managers, but a tremendous amount is spent on them. If they have not been able to solve this problem it is because they have not been given the freedom to do so. They operate under constraints which are unreasonable. Until those reforms are properly implemented we will go on having problems, regardless of which party is in power.
5.36 p.m.
Viscount Bridgeman: My Lords, I should like to thank the noble Lord, Lord Winston, for initiating this debate. I must declare an interest. First, I had the privilege of playing a small part as a special trustee in the noble Lord, Lord Winston's hospital, the Hammersmith. Secondly, until the end of 1994 I was director of a PLC medical services group which included the provision of agency nurses.
Of one thing we ought to be clear. Some of the more uncritical supporters of the purchaser/provider regime may give the impression that we moved straight from stagnation in health care management to the broad sunlit uplands of the Griffiths reforms. It was not like that. Many of the developments that we now see were already under way. It was just that the new climate enabled them to happen more quickly. That having been said, on the whole we have an exciting and motivated National Health Service which is not without its attendant problems, several of which have been articulated by noble Lords this afternoon. At the root of it all, the health service is becoming more patient-responsive. Waiting lists are down and the Patient's Charter has some meaning to it. I suggest that that derives from better management and use of resources; in particular better management in the difficult areas of cross-discipline problems such as mental health and chronic diseases. Lest it should be thought that I am seeing all of this through rose-coloured spectacles, I should add that there is a danger of over-efficiency. A drastic cutdown of beds probably results in a lack of surgical beds when there is a crisis in acute wards, but they are developments that are capable of adjustment in the light of experience.
The success of the new service owes a great deal to that much maligned body of men and women, hospital administrators, for whom, contrary to much that appears in the media, I have found widespread appreciation on the part of the medical profession. I take issue with the noble Lord, Lord Desai, and the noble Baroness, Lady Hayman. There may be bureaucracy in the health service, but in the vast majority of cases managements across the country are very effective. There is also a perception that there is better local planning and welcome delegation of responsibility from central government to the health service and, within the health service, to a level close to local communities. At this

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stage there is perhaps more promise than delivery, but the groundwork is in place. Per capita funding is to be welcomed where the resources follow the population, though I know some inner-city trusts feel disadvantaged under the department's current formula vis-à-vis those in suburban and rural areas. Should not weighting for deprivation be applied to all health authority funding without exclusion of some elements as at present? I hope that my noble friend the Minister will look at that afresh.
One hears of a release of enthusiasm for innovations. GP funding is a high profile and successful example. But initiatives can be found in many areas of the hospital and community services and indeed in collaboration with the voluntary sector. But let us not be blind to problems which radical developments of this nature bring in their train. The trusts and authorities must be sensitive to a fault that extra responsibility is not forced on those who do not want it, whether for reasons of age or innate conservatism, or quite simply because they just want to get on with the job of treating and caring for the sick for which they joined the service. Those people must be left to get on with their chosen line. But at the same time, it is good to know that in the current climate it is the young Turks, too, who are being given their head.
Lastly, let me say a word about nurses. Mistakes have been made in the past. Nursing training schools were closed down to a far greater extent than they should have been. It can never be said that nurses are adequately paid, despite the very telling statistics produced by my noble friend Lord Clark. The nurses' case always seems to me to be less well articulated than—dare I say?—that of the junior doctors. But nursing directors speak of the motivation that nurses now have. They arrive with, if not a degree, at least a university standard of qualification. They are ambitious to get on. Trusts now provide a wide range of in-house training and there are management opportunities for those so inclined. A good example is the present chief executive of one of the three largest Manchester trusts, who is herself a qualified nurse. The significance will not be lost on the profession.
At a lower level, nurses are increasingly involved in consultations affecting every aspect of their work. The development of the role of nurse-practitioners, to do work previously done by doctors only, is an enormous step forward, not—one nursing director pointed out to me forcefully—because it enables junior doctors' hours to be reduced, desirable though that is, but quite simply because the patient gets better service, often by the elimination of lengthy delays. The increased practice of named nurses to accompany patients through different departments of the hospital is another small example of improving care for the patient.
The reforms of the National Health Service are far from complete and inevitably there will be frustrations and mistakes. But I suggest that the omens are good
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for the twin goals of better care for patients and occupational fulfilment for all those committed to their well-being.
5.43 p.m.
Lord Dubs: My Lords, I welcome the opportunity for debate given by my noble friend Lord Winston and also his very interesting and purposeful comments when introducing it. I should declare an interest. I am a non-executive director of an NHS trust in south London which deals with mental illness. Some years ago I was on the Kensington, Chelsea and Westminster Area Health Authority.
I note from the debate that there seem to be two health services in this country. There is the one described by some Conservative Members opposite as a system which is working perfectly, with which nothing can go wrong and in which all is ideal. Then there is the National Health Service which we on this side of the House describe. That is based, I suggest, on fairly broad experience and it tells us that there is quite a lot amiss with the National Health Service. We have to note that over the years since the Conservative Government were elected there have been repeated statements made by Ministers about their wish to have an increasingly large private sector of healthcare in this country. There have also been other comments which may have made some of us wonder whether there is a total commitment to the National Health Service. I totally exempt from those remarks the noble Baroness, Lady Cumberlege. I know her very strong commitment to the health service. But over the years, there have occasionally been other signals.
I believe that in this country we are getting our health service on the cheap. As a country, we spend far too little of our gross domestic product on healthcare. Compared with every other advanced industrial country, the percentage of our GDP spent on the health service is less. The latest figures that I have are for 1994. In the UK we spend 7.1 per cent.—that is for all healthcare, private and public; in France the figure is 9.8 per cent.; in Germany it is 8.6 per cent.; in Canada it is over 10 per cent. and the United States spends over 14 per cent.
I believe that part of the reason is that over the years the National Health Service has been extremely cost-effective in delivering healthcare. All the evidence suggests that a state-financed health service, financed from the centre, is a better and more effective way of providing healthcare than the whole range of private and insurance-based schemes that we see in other countries. But there is a price to be paid for that. Because it means that the Government have to make one decision every year about how much money goes into the National Health Service, it is all too easy for a government to provide less than they should. Therefore we spend the low percentage of GDP to which I referred.
I turn to the subject of managers. I believe that one of the regrettable consequences of the purchaser/provider split and moving on to a market-based system has been a proliferation of managers of various levels in the health service. On the

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other hand—I speak from my experience of the health service to which I referred—there is a need for good and effective management in the health service. I should be very disappointed if the arguments about the first point—namely, the need for additional management simply to have an internal market—were to distract attention from the need to have good, effective and adequate management, so that in turn we can provide better and more efficient healthcare for patients. My fear is that in these arguments the second point will not come out so clearly.
The Pathfinder Trust, of which I am a non-executive director, in my experience has an extremely dedicated staff who often are working against difficult odds. There are some excellent non-executive directors and indeed executive directors to manage the trust. It is a pleasure to be there with them. The trust also provides a number of national or wider-than-regional services, such as a specialised service for the deaf mentally ill. That is all very positive. But I believe that the context in which we and other bodies in the health service are working is often a difficult context, which is made more difficult by some of the activities of the Government.
I turn briefly to care in the community, to which we paid some attention in this House only a few days ago. Traditionally, the expression "care in the community" seems to have been applied to resettling long-term hospital residents into supported places in the community. But the definition has now become wider. We are speaking about an approach to mental healthcare which has as its aim the avoidance of care in institutions whenever possible. That is not an easy or inexpensive option. In fact, it might be a more expensive option because providing intensive support in the community may indeed cost the provider of the service rather more than long-term stays in hospital. So it seems to me that we must not regard community care as an inexpensive option but as one which is right and proper when handled well and in the interests of patients.
There is one other aspect of our mental illness services to which I shall refer. I have noticed at Pathfinder that there is a disturbingly large proportion of black people in Springfield Hospital. It is even more disturbing that, when one asks how they have been referred to the hospital, they seem to be referred by different means from those for other patients in the hospital. In other words, fewer of the black people in the hospital are referred by GPs and therefore picked up early in the process when they become ill; but, alarmingly, a larger proportion of black people are referred by the police when their illness has become very severe. There must be something wrong in that regard. I do not know what the answer is, but it is right to draw attention to the problem. It is widely understood by those who have studied it; nevertheless, it is a matter of some importance and concern.
We recently had to move to determining pay at a local level. I am bound to say that I find that process difficult. One trust alone negotiating pay—we have not yet started this year's negotiations; we are about to—is in a difficult position. We have to look to see what others are doing and wait. That is not a sensible way of moving
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forward but the resources and options are limited. I question the idea of local pay rather than utilising the old system, which seemed to me to work well.
Perhaps I can refer to one aspect of preventive health care, or the lack of adequate preventive health care related to teenagers who smoke. It is disturbing that smoking by 11 to 15 year-olds increased by 12 per cent. in the last year for which we have figures. That means that 280,000 regular smokers are aged between 11 and 15 years. If one adds the occasional smokers, it means that over 20 per cent. of that age group, none of whom should be allowed to buy cigarettes and tobacco, are smokers. It is also disturbing that girls feature more prominently in those figures than boys. The consequences to the National Health Service will be that at some future time it will have to deal with the increased severe illness that arises from people who begin smoking at an early age.
The Health Education Authority has had less money available to deal with the problem of teenage smoking. In 1991–92 it had a budget for that purpose of £1.7 million and in 1995–96 it was reduced to just £850,000. It is an extremely serious problem with long-term implications for the health service. It is being made worse by the fact that, though television advertising of cigarettes is not permitted, there is so much sport sponsorship, all of which feature the tobacco companies, that many teenagers in surveys still think that cigarettes can be advertised on television. That is undesirable and I urge that more effort is made in promoting health education for young people in order to reduce the number of teenagers who smoke.
5.53 p.m.
Baroness Cox: My Lords, like other noble Lords, I am grateful to the noble Lord, Lord Winston, for initiating a debate which allows so many important issues to he addressed. I declare an interest as a vice-president of the Royal College of Nursing. In that capacity I shall address some of the problems facing the nursing profession in Britain today.
I appreciate that the Government have introduced many reforms which have offered nurses many new opportunities and some of those were identified by my noble friend Lord Bridgeman. However, this afternoon I speak with a heavy heart. I fear that my contribution will sound negative, but that is because it is born in the concern experienced by so many members of a profession which is staffed by dedicated people who now feel undervalued by the Government and by a review body which recommended so much less remuneration for them than for other professions, including junior doctors.
I shall address four interrelated problems: shortages of nurses; morale; recruitment and pay. In each of those areas I shall refer back to answers given by my noble friend Lady Cumberlege in response to questions asked in your Lordships' House on 21st February. I hope that she will be able to give rather more reassuring responses today to a profession on which the National Health Service depends for 80 per cent. of the care it gives to patients.

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I turn first to nursing shortages. My noble friend referred to an excerpt from the review body's report, asserting that there is no general shortage of nurses, though the report admits that there are difficulties in some areas. It also points out that there are signs of more shortages to come. My noble friend also claimed that local pay negotiations are the best way of meeting such shortages. Can my noble friend say whether that principle is being applied to other professions such as doctors, teachers and social workers? If not, why are nurses singled out for that treatment?
Is my noble friend aware also that the principle of local pay negotiation is quite invidious? Trust executives are making the point that salary increases for nurses can only be made at the expense of resources available for patient care, and that has an inhibiting effect on a profession manifestly dedicated to promoting the highest possible standards of care. It therefore feels uncomfortable in competing for resources which would otherwise go to patients.
I also fear that my noble friend's confidence in local pay negotiations for reducing nurse shortages may prove unfounded. For example, there is only a small pool of nurses available for recruitment to the NHS. The unemployment rate for nurses is now only 2.5 per cent. compared with a figure of 8.6 per cent. unemployment rate for the general population. That small pool of available nurses also needs to he seen in the context of expanding demands for nurses. According to Department of Health statistics, the demands for nurses in the NHS, in the independent sector and in GP practices expanded by over 20,000 whole-time equivalents in the five years between 1989 and 1995. Since one-third of nurses work part-time, that probably means a net expansion of at least 27,000 nurses in the past five years.
That expansion occurred at the same time as a sharp cut-back in the number of students in training. In 1983, 37,000 nurses qualified. In 1986, the figure dropped to a mere 14,000. Though the Government announced recently a proposed increase to 17,000, that is still a far cry from earlier years. Taking retirements into account, the prospects are that the pool of nurses available to meet the expanding demands of the NHS will shrink; that shortages will increase, and that patient care will suffer.
Perhaps I may give a few examples of current shortages from the many which I could have chosen. Glasgow Royal Infirmary delayed opening its winter medical ward by two months because of problems in recruiting nurses. Leighton Park Hospital in Crewe, where there were 76 unfilled vacancies, issued a public appeal for nurses. I have just heard that the Maudsley Hospital, a Mecca for psychiatric care, has around 100 unfilled places for nurses. In November 1995 Whipps Cross Hospital had to close to emergencies for 15 hours because of a shortage of qualified staff. In January this year Great Ormond Street could use only 11 out of 19 paediatric IT units because of staff shortages. A survey by the Royal College of Nursing's journal, Nursing Standard, found that two-thirds of trusts are finding difficulty in recruiting qualified nurses; one in five nurses believes that staff levels are
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"dangerously" low and 70 per cent. said that they thought staffing levels were too low to provide adequate care to patients.
From my experience of nursing I know that one of the most potent sources of low morale is the inability to provide the quality of care for patients and their families which professional standards require. If one spends a shift run off one's feet without a proper meal break, it is not the hard work, the long hours, the physical exhaustion or the lack of a meal which gets one down; it is the care one could not give because the ward was too short-staffed; the patient one did not have time to talk to when he was lonely or depressed; the relatives one could not spend time with when they needed reassurance; the students whom one could not supervise and teach, or the personal care of a patient which had to be rushed, for example, because so many patients were coming and going to theatres and life-threatening responsibilities had to take priority over other kinds of care.
One shift like that is not only physically and mentally exhausting; more seriously, it creates frustration and a lack of job satisfaction over the shortcomings of the quality of care you could not give to your patients. But shifts like this, day after day, week after week, create demoralisation and may well lead to resignation from nursing.
It is perhaps not surprising that the Royal College of Nursing has analysed new evidence from the Department of Health, which confirms a worsening picture of rising demand and falling recruitment. Turnover and wastage in nursing have been increasing steadily over the past three years, with turnover rising from 11.1 per cent. in 1992 to 14.7 per cent. in 1995; and wastage rising from 7.5 per cent. to 9.3 per cent. over the same time. I believe that this evidence was excluded from the Government's own evidence to the review body. These are the hidden costs of shortages behind statistics and are closely related to morale.
As part of its evidence to the Nurses' Pay Review Body, the RCN commissioned the largest ever survey of UK nurses. It found dissatisfaction with pay, career prospects and job security had reached record levels. Among reasons given by nurses for leaving the NHS, almost one-third cited low job satisfaction or concerns about career prospects or pay; nearly 40 per cent. said that they would leave nursing if they could.
Another aspect of my noble friend the Minister's reply last week indicated satisfaction with the number of applicants wanting to come into nursing. But these figures must be seen in context. I am happy to say that there has always been a pool of idealistic, young and not so young, people prepared to enter nursing despite the relatively low pay, anti-social hours and life and death responsibilities, making personal demands which add incalculably to the stress of professional responsibilities. But these figures must be seen in the context of reductions in the number of student places and in newly qualified nurses to the extent to which I have already referred. Moreover, the fact that nearly 40 per cent. of qualified nurses are considering leaving the profession can hardly be encouraging for new recruits.

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Probably the most discouraging development of all is the last point I want to address—the level of pay relative to other professions and the derisory 2 per cent. recommendation by the review body. I ask my noble friend what encouragement she can give to nurses concerning this recommendation of a 2 per cent. pay increase, when a qualified nurse already earns 23.6 per cent. less than a police constable; 21.4 per cent. less than a teacher and 31.2 less than a social worker? And what explanation can my noble friend give for the disparities in recommendations for the 2 per cent. for nurses compared with between 4.3 per cent. and 5.8 per cent. initial increase for junior doctors, with a further 1 per cent. from December?
Will my noble friend understand that these discrepancies are extremely demoralising for a very hard-pressed profession? Does she appreciate that a relatively low salary structure already exists? A newly qualified staff nurse with major clinical responsibilities earns a mere £11,895. A small percentage on a small salary is a very small increase indeed and cannot be seen as fair or encouraging.
Finally, my noble friend Lord Clark claimed that the Government had treated nurses very generously. NHS nurses' pay has increased by 6.2 per cent. less than average earnings since 1989. In relation to other professions, nurses would need an 8 per cent. increase to achieve the same level of pay as a teacher. Can my noble friend explain how these developments can be interpreted as encouraging to a profession on whom the National Health Service depends for quality of patient care?
6.3 p.m.
Baroness Nicol: My Lords, I am very grateful to my noble friend for giving me the opportunity to air one of my own particular worries, but also for allowing us to hear the very expert speeches from so many Members of this House, not least that of the noble Baroness, Lady Cox, who has just spoken. I found her speech extremely inspiring in its way because one begins to feel that there is little understanding of the whole problem of nursing. She encapsulated it for us.
My approach to health provision is that, within the National Health Service, there should be no discrimination between patients on the grounds of money, background or influence. That probably now sounds old-fashioned. There should be just one criterion governing the provision of treatment and that is medical need.
For many years it was a matter for national pride that our approach to the provision of medical care was that it should be free at the point of need and available to all without discrimination, within the hounds, of course, of available resources. The introduction of market ethics has changed all that and I wish to devote my few words to the effects of some of those changes rather than reciting the details of the changes with which we are all familiar.
I find that Government Ministers are cynical about cases quoted by Opposition speakers so I propose to quote at some length from a speech made last November
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by the BMA Chairman of Council, Dr. Sandy Macara. This is what he had to say about the internal market in the National Health Service:
"It was assumed that competition, with the philosophy of 'winners' and 'losers' replacing that of co-operation, would deliver the goods … It is little surprise that a majority of senior doctors now crave early retirement, and an unprecedented proportion of young doctors are abandoning medicine after many years of gruelling and expensive education. Where, they ask, stands equity, when the cash lottery dictates priority to patients with lesser need? Where stands integrity, when doctors are instructed, as in Deal earlier this year, to conceal from the town's fund-holding general practitioners' patients the reason why their treatment had to be deferred—because their doctors' money had run out? Where stands the theory of money following patients, when patients have no choice but to follow the money or to await the next contract? Where stands patient choice, when bulk contracts unrelated to relative need dictate place, time and person providing care? Where stands management, whose proper function is to care for those who do the caring, when the government's policy forces them to take the blame for inability to meet heightened demands incited by successive patients' charters?".
Surely the Government will not claim that Dr. Macara does not know his facts or that he has a party political viewpoint.
During a recent debate in another place on the subject of GP fundholding, my honourable friends and others, reported evidence of the inequalities of availability of hospital treatment between patients of GP fundholders and non-fundholders. In the long and sometimes rambling answers from the Secretary of State, I could not discover any concern for the patients of the 50 per cent. or so of doctors who are not fundholders. The concern was all for the success of this particular scheme; the patients obviously taking second or even third place.
I agree that all sections of the National Health Service should be expected to take account of the costs of running the service. But I strongly oppose the idea that medical practitioners should be expected to put financial efficiency ahead of the needs of their patients. So does the chairman of the BMA Council and I quote once more from his November speech. In relation to the use of resources, he said,
"Of course, everyone—manager, professionals and those whom they serve—has an absolute duty to make the best possible use of the available resources, which will always be finite".
He then went on to say,
"More adequate resources would, naturally, make decisions less painful but, as Kierkegaard observed 'in every choice there is a sacrifice'. But any sacrifice should be minimal and bearable, such as having to wait a little longer for treatment which is neither life-threatening or disabling. The blanket refusal to provide whole categories of treatment with total disregard for the claims of individual patients, as the Berkshire Health Authority sought to do, is not only illegal but totally irresponsible".
Those are strong words from someone in a very senior position. I hope that the Government will take them on board.
For me there is something deeply offensive about any system which discriminates against someone in medical need, in favour of someone in less medical need, but for whom money is forthcoming, whether that money is from the GP fundholder or any other source. Where medical services are rationed for whatever reason, there should be only one criterion for priority in treatment—medical need. That used to be the ethic by which the

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health service was run and the sooner we can return to it in the health service, the better it will be not only for the health of the nation, but for the confidence of people in the service and for the morale of both patients and health service workers.
6.10 p.m.
Baroness Brigstocke: My Lords, like the noble Baroness, Lady Nicol, I feel privileged to be taking part in this debate in which there have been so many informed and fascinating speeches. I speak as a non-executive director of the Health Education Authority but, more importantly, as a mother of someone who has been a nurse and, for many years, a sister in a busy accident and emergency department in a well-known inner-city hospital.
I turn first to the Health Education Authority, which is a key player in implementing the Government's health of the nation strategy. Its health promotion work is recognised nationally and internationally. I should like to make it clear that the HEA is not part of the Department of Health. It works not only for the department but for other agencies and organisations on a contract basis. To respond to a remark of the noble Lord, Lord Dubs, I should like to say that the HEA is happy to work with the present funding arrangements.
By helping to educate the public, the potential patients, not only during their school days (regrettably, there has been an increase in the number of teenage girl smokers) but also later in life by encouraging a healthier lifestyle, such as encouraging the elderly to take more exercise, to get more fresh air and to have a better diet, the HEA plays some part in making us all fitter and thus less likely to overload our GPs, hospitals and health professionals with trivial complaints. How we get the middle-aged to be more thoughtful and less self-centred is, I fear, beyond the powers of the Health Education Authority.
My two points relate to abuse of the National Health Service and to its management style. There are difficulties in the NHS—no huge organisation is without them—but they do not arise only from, to quote from the Motion,
"current developments in the National Health Service".
Many are the result of gross abuse by the public, as voiced this very day by many strained and overworked GPs. The notion of care as expressed in the Health of the Nation should apply not only to patients, but to doctors and nurses also. The public—the potential patients—have a duty to behave responsibly. How can we prevent patients from abusing the service?
I speak now entirely on my own account and from a personal point of view. I respect and admire the high quality of so much in the National Health Service, but I do have some concerns. What I say is based on what I have learned from my daughter who, as I have already mentioned, has over 10 years' experience in an accident and emergency department. She has seen many examples of abuse of the National Health Service, especially on Thursday nights when the dole has been handed out and abuse comes from drunken louts using unimaginably disgusting language. Last
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week, for instance, two men came in, escorted by the police, having attacked each other in a pub with an axe.
I was delighted to hear my noble friend the Minister refer in answer to a Question earlier this week to the accident and emergency department at the Royal London Hospital, which could deal with three times the number of emergencies that it sees. Unhappily, that is not the position in my daughter's hospital. I shall not enumerate the problems for nursing staff and patients which she has encountered when there are simply not enough beds or nurses available. Both she and I realise the financial constraints, but it is demoralising to a responsible professional when nurses in the department are not asked for their advice or to give an answer to even the simplest of problems, such as what colour to paint the accident and emergency department. In come the engineers and they decide the colour. It will certainly be the cheapest paint. They do not ask the staff who have to work in the painted area, yet colour can have an enormous effect on patients and staff, their well-being and behaviour. Soothing colour is very important in casualty.
Now that the overall necessary restructuring of the National Health Service has taken place, could the management style be looked at again? I know that there are many good examples, but I want all hospitals to reach the same high standards. It seems to me that the overall management style is still inappropriate. A command-and-control management style is more suited to the running of an old-fashioned car factory. It is the managers and the senior consultants who could improve that and thereby improve the morale not only of the nurses, but also of the junior doctors. They are all skilled professionals and should be consulted and have the opportunity to contribute to decisions on all matters relating to their work. One cannot blame the Government or a shortage of money for everything. Let the managers and the senior medical staff sort this out. They are the ones who can improve the morale of the nurses.
Managers and senior medical staff are responsible for considering major incident procedures. That has been particularly important in the past few days in the light of the recent bombings with the threats of even more. Here is a perfect opportunity for managers and senior and junior medical staff to work together. It is always easier to talk about the problems than the solutions.
I urge my noble friend the Minister, for whom I too have the highest regard and admiration—I cannot express it as fluently as the noble Lord, Lord Walton—to continue supporting all the education programmes which seek to make people fitter, as outlined originally in the Health of the Nation report. Will she also look at ways to help all managers and senior staff to consult and to use the superb professional expertise of all their staff, especially the nurses who are so often those who really know what is needed on the wards to give even better care to their patients?
6.19 p.m.
Lord Ashley of Stoke: My Lords, I should like to congratulate my noble friend Lord Winston on initiating

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this valuable and important debate, and on the way in which he spoke. He got the debate off to a fine start with a first-class speech, and we are all grateful to him.
As to his reference to the market, I wish to comment on its effect on profoundly deaf people. Their story is a staggering one, and I use that word advisedly. I am concerned about profoundly deaf people—adults and children—who are being deprived of something which can magically transform their lives. I refer to a cochlear implant; an electrical stimulation of the ear which introduces or restores the perception of sound. It is totally unacceptable that any adult or child should be deprived of this wonderful device.
On a personal note, after 25 years of total silence, when I could not even hear my own voice, I have benefited from a cochlear implant, and it has transformed my life. I can now participate in conversations whereas I could not do that before; I can hear all kinds of ordinary sounds. It has transformed the lives of some 15,000 people throughout the world, and will transform the lives of many more millions in future.
Let me remind the House of the words of the Minister, whom we all respect and expect to give a positive answer to the many speeches we have heard tonight. On 9th December 1993 she said,
"I would be very surprised if there are people being denied this treatment".
The Minister also said,
"Health authorities are required to meet the costs of cochlear implants in all cases where that is the appropriate treatment".— [Official Report, 9/12/93; col. 1015.]
I greatly appreciated what she said, but there is abundant evidence that many district health authorities have been evading their responsibilities. At first their very limp excuse was that the cochlear implant was unsafe and unproven. That was said after it had been in use for years and years and before the official report of the Medical Research Council's Institute of Hearing Research which said that cochlear implants were "safe and effective". Some district health authorities then changed their tune and their excuses. They then said, "Well, these are too expensive." Either way, whatever the excuse, the patient suffered.
How has it come about that profoundly deaf people are deprived of cochlear implants? It is because of the market system. Some health authorities are instructing the local ENT surgeon, or even the local medical officer of health—neither of whom are specialists in cochlear implants—to decide whether or not a deaf person should be considered for a cochlear implant. That is ridiculous, is it not? Health authorities acting in this way are doing so because of limited budgets and a need to have priorities. I recognise that, hut some DHAs fail to appreciate the profound significance of total deafness.
One of the most staggering examples of this ignorance was shown by the Dudley Health Authority and its director of public health. She questioned whether a woman who was totally deafened by meningitis should have a cochlear implant operation. She wrote in one letter to a surgeon,
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"this lady's GP tells me that she leads an active and virtually normal life with no detrimental effects from her deafness".
"No detrimental effects" from total deafness—how irresponsible can you get? How can deaf people hope to have the medical treatment promised by the Minister if that kind of attitude is shown by district health authorities? We need a much greater appreciation of the problems of total deafness and a greater willingness to make treating it a priority.
A disturbing aspect of the behaviour of some but not all district health authorities—there are some great district health authorities—is that they react in different ways to total deafness. They are not really making available their criteria for funding or not funding cochlear implants. As a result, it is a lottery for deaf people. That cannot be right given the ethics and the basis on which we believe the National Health Service is run.
I shall quote the case of the Lincoln Health Authority. In a letter dated 26th October 1995, that health authority told a deaf woman's Member of Parliament that it had not funded any cochlear implants at all that year. It was oblivious to the fact that cochlear implants had been available on the National Health Service since 1990. Instead the health authority had commissioned an internal report into the costs and benefits of cochlear implants. There was no need to do that because of the official report of the Medical Research Council which was already in hand and which was published a month or two after the local authority report.
When the notable surgeon, Mr. John Graham, asked the district health authority for that report, it refused to disclose it. He was entitled to know the criteria for allowing or not allowing cochlear implants, but the health authority simply refused to disclose the report. That, too, I find unacceptable.
Will the Minister appeal to that district health authority to state its criteria for agreeing or refusing cochlear implants, and place its response in the Library? I also urge that all district health authorities should report annually on the number of cochlear implants that they have authorised.
Some district health authorities are saying that they will only do one or two operations per year, and those will be for children. Of course I strongly support implants for children—they are the most important of all—but it would be unfortunate if ageism began to creep into the cochlear implant programme; adults are as entitled to them as anybody else.
The real problem is that there is a backlog from before this operation was invented and perfected, and that backlog will be neglected if the district health authorities insist on a children only policy. More funds must be found by the Government—they are the only source of funds—for operations for adults. The backlog must be tackled otherwise some deaf people will be left in limbo for ever.
We are discussing an operation which costs £39,000. That is what the operation costs with the concomitant rehabilitation. If it were a case of an operation costing £39,000 which could restore the sight of blind people, and they were denied that operation, there would be a

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great outcry and people would march on Whitehall—and rightly so—because that would not be considered acceptable. But the same thing does not happen when deaf people are deprived of an operation which can restore their hearing, or give hearing to people born congenitally deaf. This is a situation which cannot be tolerated in a civilised society, and I hope the Minister will do her best to resolve it by appealing to and pressing the district health authorities on this matter.
6.29 p.m.
Baroness Flather: My Lords, first, perhaps I, too, may thank the noble Lord, Lord Winston, for initiating the debate; and, secondly, take issue with one statement that he made when he said that his speech was going to be non-political. All I can say is that I am greatly looking forward to hearing a political speech from him so that I may have a chance to compare the two.
My first question is: could the health service have continued in the same shape and form in which it existed before the reforms? I am sure that different people answer that question differently. I do not believe that it was possible for the health service to continue as it was. There have been such advances in medicine, about which we all know. They are not new. We have also to remember that we are giving more and more people more and more expectations. I do not believe that any amount of money will, in the end, meet all expectations. There will never be a government who will not be accused of underfunding the health service. It is true of every country. It is happening all over the world.
This country still has one of the best, if not the best, health services. I know that it has been said that we spend less money on it than other countries. All I can say is that we must be receiving better value than other countries. I saw a programme on Monday about Wheeler's "America", which I am sure many other noble Lords saw. What we saw in that programme about the richest and most powerful country in the world should make us realise that we are not as badly off as we think we are. We have got into the habit of continually running down this country. I do not understand that. It is my adopted country, so perhaps I do not have the British psyche after all. On this occasion, I am pleased that I do not have it.
Whenever I go to the countries of our European partners or to the USA all I hear is, "What a great place this is. Look at what we are doing and what we are achieving. Look at the structures we have put into place. Look at what we have done". As soon as one comes here all one hears is that everything is dismal, everything is negative and everything is doom and gloom. That applies also to the health service.
We heard from the noble Baroness, Lady Hayman, that staff morale is low. If one awoke every morning to read in the press that one's morale is extremely low, and everyone spent their entire time saying that one's morale is low, I doubt very much that one could raise one's morale. One would be completely confused about what is going on within one's area of work and about what one is being told is going on. Everyone has heard of the self-fulfilling prophecy. I believe that in this case it is a question of a self-fulfilling prophecy.
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I am a non-executive director of Hillingdon Hospital Trust. It became a trust in the first wave of trusts. It was one of those general hospitals which was grossly neglected and badly run. It was dirty and uninviting. When one went into the hospital one could find no one to give directions. As a non-executive director, I experienced that. I am pleased to say that I was never a patient in that hospital at that stage. I should not have liked to go there. The place was confused. One could not find one's way around and there was no structure to the place.
It has been transformed in the years since it has been a trust. The waiting list has decreased by almost 1,000. The workload has increased by about 20 per cent. Hillingdon is situated in an area with a high ethnic minority population. There was a beautiful policy document, but no one had ever bothered to open it. We now have a substantial action plan in place to meet the needs of ethnic minority patients and ethnic minority staff. That in itself is extremely important.
There are new developments in areas of sensitive service such as a women's unit for surgery and consultant clinics which have moved to become community clinics. They are not just for fundholders. They are specifically for non-fundholding GPs.
A great deal has been said about there being too many managers. I do not believe that we have too many managers. I do not believe that we have enough. The hospital's turnover amounts to £53 million a year. We have five managers. One of them is at the lowest grade. That is not too many managers for that size of turnover. Their salaries would not be acceptable anywhere except in the NHS. It has become a habit to knock managers. I am sad about that, because many of the managers work extremely well and hard.
I should mention also the continual harping about there being no beds. We have never for any reason shut our A&E department. We have always found a bed for every patient. There is a detailed protocol in place at the hospital, agreed by the RHA, as to what steps should be taken. I urge my noble friend the Minister to ensure that all hospitals plan carefully what to do in case they are under pressure, so that it is not said that they are being lazy, but are trying to find a suitable bed for everyone who needs one.
One swallow may not make a summer, but we have heard that there are many trust hospitals which have improved beyond all recognition as a result of the reforms. Let us at least be optimistic about the chink of light and not dwell constantly on doom and gloom.
6.37 p.m.
Lord Haskel: My Lords, perhaps I may start by saying that I have no interests to declare. I have never served on a health authority, on a hospital board, or, indeed, on any quango. I would describe myself as a user of the health service. As such, I should like to record my debt of gratitude to all the people who work in the health service—the staff, the doctors, the nurses, and, yes, the administrators. I too should like to thank my noble friend Lord Winston for giving me the opportunity to express my gratitude.

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My experience is in industry. From what I read and observe, I must agree with my noble friends Lord Winston and Lady Hayman that the health service seems to be suffering from low morale. All the signs are there. We have heard about high staff turnover, unfilled vacancies, dissatisfaction over pay, excessive paperwork, early retirement, and all kinds of grumbles. Other noble Lords have suggested that the cause of the low morale is not just underfunding but too much management. Even the Government have become alarmed at that. I understand that Mr. Stephen Dorrell has said that he hopes to cut management costs by some 7 per cent. during the current financial year.
However, a 7 per cent. cut in management costs is only a small part of the solution. It seems obvious to me that the solution is not just less management; it is more leadership. The difference between management and leadership is a matter in which I have taken an interest for a number of years. But the Minister does not have to take my word for it. She can get it from her own colleagues. Just down the road, at No. 1 Victoria Street, at the Department of Trade and Industry, one will find one of the Government's more imaginative schemes. It is called "The World Class Companies Scheme". This scheme is designed to assist our better companies to become world class.
My proposal is simply that the National Health Service takes their advice: the Labour Party has. The party is busily introducing facets of the scheme into its headquarters at John Smith House. What is more, the Labour Party has appointed a person to introduce this and other schemes into the local authorities controlled by Labour.
As other noble Lords have said, it is of course management's role to manage, but it is also management's role to lead. What is the difference? Management deals with important practical matters, such as organisation, budgeting, finance, technology and marketing. It also spends time at the centre monitoring activities at what my noble friend Lord Winston called the coalface. Incidentally, as it is made easier by centralised decision-making, perhaps this is the real reason why the regional health authorities are to be abolished in April and not, as the noble Lord, Lord Clark, suggested, for financial reasons.
Leadership is less practical. It deals with vision, progress, ethos, cohesion and, yes, morale—and despite the warning of my noble friend Lady Hayman, I would like to speak about morale. I would like to start with trust. I have had occasion to quote in your Lordships' House on earlier occasions from Professor Fukayama's recent book. His point is simple: that trust is an important element of leadership: trust that contracts will be honoured, trust that the truth will be told, trust that institutions are responsive and accountable and trust that people's words are their bonds. From what I have heard today, a little less management and a bit more trust could work wonders for morale in the NHS.
Down in Victoria Street they will tell you that leadership matters a lot in "people businesses". If ever there was a people business, it must be the National
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Health Service, which employs 1 million people. Other people businesses, such as advertising or research organisations, flourish under a light management touch and react to leadership because most people prefer to work that way. Directors know that low morale means low profits. This is the direction in which business in general is moving, encouraged by the DTI, I might add.
It seems to me that the NHS is moving in the opposite direction, having recruited 20,000 managers since 1981; and they are now trying to reduce that number. Mr. Marco Creste, chairman of the National Health Service Trust Federation, agrees.
"What needs to be done first is to reduce the administrative burdens put on trusts",
he says. Neither he nor I are suggesting that financial controls should be reduced, and of course trust executives must be accountable to their boards. What I am suggesting is that world-class companies have learnt that staff perform better if they are managed less and trusted more.
We have been told by noble Lords that the health service keeps down costs by being market driven. What do the Minister's colleagues down in Victoria Street say that world-class companies should do about this? They acknowledge that cost cutting and tight budgeting are necessary, but that it is not enough. If your Lordships will excuse the jargon, you also have to create value in the marketplace. To create this value in a people business you need your employees to become better trained, better skilled, more conscientious and better informed, and to be willing to educate and improve themselves. Nowadays people understand that to achieve this it is sometimes necessary to work longer hours and under more pressure. In an organisation such as the National Health Service, where people see their work less as a job and more as a vocation, I am sure it is easy to achieve this result.
The reward for all this effort should be more meaningful employment and a greater value put on employees. The noble Baroness, Lady Cox, described this for nurses, and in this way people perceive fairness in the organisation and have an incentive to co-operate. This is what keeps morale high. Sadly, in the National Health Service the reward seems to be insecurity, with short-term contracts, frustration from unfilled vacancies and divisiveness from competition for resources. With this low morale, no army of managers will get employees to lift their performance. Money incentives alone will not do it.
Another lesson the Minister could learn from businesses striving to become world class is that management development is the key, not imposing management. By adding management to the skills of engineers, salesmen and accountants industry has made them more accountable. I think the noble Baroness, Lady Brigstocke, was trying to suggest this. If you do not involve medical staff in management how do you fully measure the success or failure of their work? Without this measurement management becomes administration; and this is why I think my noble friend Lord Winston told us that there is no serious audit.

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One final point: to a businessman it has always seemed to me rather naïve to think that money will follow the patient. Experience tells us that the patient will follow the money. The management philosophy in the NHS to me still seems to be stuck in the 1980s, when the market was considered to be little more than the law of the jungle. Better companies in the 1990s have found that they can become world class by taking wider considerations into account.
At the same time it will not have escaped people's attention that generally better companies pay better wages. This is the way they share out success. My noble friend Lord Winston spoke of unnecessary competition. World-class companies now co-operate with their suppliers and get better results than they did with the old adversarial relationships. Surely it is time for the National Health Service to learn this lesson instead of opposing it on the grounds of "collusion". The price of failing to deal with these issues is a low-grade NHS, which in my view is too high a price to contemplate.
6.46 p.m.
Baroness O'Cathain: My Lords, the wording of the Motion is very specific and I will keep my remarks specific to that wording; namely, dealing with the level of the concern among Health Service staff. Before I do so, perhaps I should declare an interest. My interest is that the National Health Service impinges upon my life through the wonderful, unstinting and efficient service given to my husband by our local general practise which, despite many and deep-seated concerns about fund holding, now finds that it is workable and much more efficient in dealing with patients.
I would add another interest. I am a taxpayer and a contributor to national insurance. Both of these are probably not specifically the types of interest that one would expect to be declared, but actually unless a business—and the National Health Service is a huge business: a £41 billion per year business—takes the needs of its customers, like my husband, and shareholders, as I feel I am, into account that business will not thrive.
The National Health Service is an internationally respected and admired business. What we must do is to make that business even more efficient and more effective. I know from personal conversations with employees of the National Health Service that one level of concern among them is the rapid development of what are called business management approaches to the service. Those who work in the National Health Service have as their main objective the provision of the best possible health service to the population as a whole. But probably because of less-than-perfect communication processes they have not been convinced that some of the proposals currently being put forward are in the best interests of the patients and of those who work in the service.
My specific point relates to the non-espousal of the concept of local bargaining of pay and conditions of employment for nursing staff, midwives, health visitors and professions allied to medicine. The National Pay Review Body in 1995 recommended that an element of
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local pay negotiation should be contained in the annual settlement of pay and conditions. That was recommended for several reasons, not least because local pay determination is an inherent part of the Government's National Health Service reforms. That might be greeted with scepticism or even derision, but before it evokes that response, perhaps I may, as someone who has had a long career in business, put forward some facts—and I mean facts—about local pay determination.
Those of us in business know that local pay determination provides for flexibility in both organising the provision of labour to meet the needs of the local conditions and flexibility in employing staff to meet the staff's own needs. It is a partnership between serving the customer and serving the special circumstances of those who wish to be employed in the serving of that customer.
I give your Lordships an example. In the retail business some staff want the flexibility to be at home when the children arrive from school; and some staff who have retired early from their full-time career want to continue some sort of economic activity and feel that they wish to get out of the house on a regular basis and get involved once more in paid work—not necessarily on a 35-hour per week basis, but perhaps on a 20-hour per week basis. Neither of those groups of people is being exploited; those people are getting annual salaries with adjustments made for the work patterns that they have requested and that they have seen as best suiting their own specific needs and wants.
From the employer's point of view, the flexibility offered by that type of arrangement permits greater flexibility in scheduling staff cover for peaks and troughs of activity; flexibility to cover what many would think of as being "unsocial hours" but which the staff in question welcome because it has been their choice.
They are but two of the advantages. Logistics must also be considered. Is it realistic that pay and conditions for 430,000 nurses can be dealt with centrally? How can that be efficient? How can the differing needs and wants of both patients and nurses be assessed at long distance? I suggest that both groups would be much better served by local bargaining on pay and conditions if it were espoused because it would, in effect, result in what is currently known in management terms as empowerment. Empowerment implies trust and that really goes along the lines supported by the noble Lord, Lord Haskel.
We keep on talking about educating our workforce to take its place in the constant struggle to improve competitiveness. All young people must be aware of this now—there are so many statements made to that effect. In the course of such education we emphasise the need for decision making. We raise expectations that when young people enter paid work they will be able to contribute to the decision-making process. Greater autonomy is seen as the method by which a business can and will flourish. Smaller units which can make decisions on the spot to deal with particular local needs and wants of the customer are at the root of the most successful businesses in this country. Greater autonomy demands greater control over resources, and one of the most important of those resources is staff.

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The latest report of the National Pay Review Body makes somewhat sad reading on the issue. In effect, it describes how, despite signalling the change in 1994, little progress has been made. The Royal College of Nursing did little to counter the impression that the basic rate of the national agreement was all that the staff would get. Even my noble friend Lady Cox stated that nurses were offered only 2 per cent. That is the national salary scale. On top of that, it is expected that local pay increases will be granted. Sadly the whole concept of the two-part approach—a basic national rate plus an element of local pay—has been interpreted as a one-part approach; namely, the basic national rate.
Last year, a big communication exercise was not effective in countering the widespread belief that only a minimal pay rise was offered. As an outsider I have to say that it appeared that there was a deliberate campaign to obfuscate the issue; in other words, as I have already said, there existed a "less-than-perfect communication process".
There was actually a campaign by the Royal College of Nursing to seek offers from the trusts of a certain universal rate—the same rate whether one lives in Aberdare, Brighton or Cirencester—without any conditions as a requirement for accepting any local offer. The trusts' freedom for action was limited by the refusal of the staff side to sanction any local pay negotiation. However, some seven months after negotiations commenced, the Department of Health and the Royal College of Nursing reached an agreement on a national framework within which local pay arrangements could be implemented. Some progress has been made and I hope that more progress will follow.
The whole new system proposed contains strong safeguards for equitable treatment and for the appointment of local representatives of staff to carry out negotiations. It is not a recipe for bulldozing the staff to accept pay cuts or any such devious plan: it is the devolution of power to local level; it is at the local level that patients are treated; it is at the local level that staff are employed; and it is at the local level that intelligent, hard-working and committed staff should be empowered to have a much greater say in the application of the great strengths of the National Health Service to the improved level of local service—and, indeed, even empowered to choose the colour of the paint in the working environment, as required by my noble friend Lady Brigstocke. That is what local bargaining on pay and conditions achieves. That is what business has discovered.
The NHS business is one of the biggest businesses in the country. I suggest that the time has come for it also to discover the benefits. Like the noble Lord, Lord Haskel, my experience is in industry and business. I am sure that he would agree with me that, in the case of efficiency and effectiveness, the central bargaining on behalf of over 400,000 staff cannot he efficient..
I return now to the word "concern", in respect of which morale has been quoted. We have heard of the shortage of nurses. However, in the report of the National Pay Review Body, I was interested to see that,
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on 31st March 1995, total vacancies for nurses which had lasted for over three months as a proportion of total establishment was 1.4 per cent. In business, that would actually be welcomed as a very low figure.
Concerns are often fuelled and the flames fanned by the supporters of the status quo. Nothing stands still; nothing is unchanged in our ever-changing world, particularly in the health sector where I have been reliably told that some 90 per cent. of extant medical knowledge is 10 years old or less. Indeed, a graphic account of the scale of recent developments has already been given by the noble Lord, Lord Walton of Detchant. We cannot have a lopsided National Health Service where the technology has surged ahead, yet there are attempts to fix the issue of pay and conditions in some "time warp" which has long been deemed to be past its sell-by date by the rest of the business and commercial world.
6.59 p.m.
Lord Rea: My Lords, as someone who has spent most of his professional life in general practice, I shall concentrate on the current situation as it affects GPs. For a number of years, until about 1990, general practice was a popular choice for medical graduates. With vocational training, as other noble Lords have pointed out, standards have risen and the importance of primary care has been recognised by the Government to the extent of coining the phrase, "a primary care-led National Health Service". That concept has been cautiously welcomed by the General Medical Services Council of the BMA which represents the interests of GPs and the Royal College of GPs which is the academic arm of general practice, provided that the necessary resources are made available.
The Royal College spelt out what is required in a recent statement. On resources, it said that,
"shifting resources from secondary to primary care at least equivalent to the shift in the balance of work,"
is necessary, as are "adequate funds" for,
"the training and continuing education of general practitioners to ensure they have the skills necessary to undertake an extended role".
The college also asks for the development of:
"structural and financial mechanisms to support the delivery of high quality patient care".
To run down or trim hospital services and to discharge patients early before the necessary community and primary care services are up and running will lead, as my noble friend Lord Dubs said, to overstretching of health workers in the community, a fall in standards and a fall in morale. That is already happening to some extent, and is one reason for the rise in emergency admissions. Some patients have to be readmitted because they have been discharged too early, in too unstable a condition for community health resources to handle them. That is especially although not entirely true with regard to mental health problems.
While I recognise the increased and even pivotal role of primary care, we must not allow developments there to follow the pattern of community care for the mentally ill in the mistaken belief that it will save money. As

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noble Lords are only too well aware, and as has been mentioned, community care for the mentally ill, however laudable the objective, is not adequate at present to cope with the caseload of mentally ill patients needing care. That will be the case even after Mr. Stephen Dorrell's recent emergency injection of some £90 million.
Just as the idea of a primary care led NHS has been taking shape, the GMSC of the BMA has come up with a rather disturbing report. Under the heading:
"Where have all the doctors gone",
it states that
"general practice faces a deepening workforce crisis"
and
"there are insufficient doctors to meet the increasing demand and the changes in the roles and responsibilities of GPs working in the NHS".
That report is a warning of trouble ahead.
Until 1994 the total number of GPs was rising. However, since 1989, as the noble Lord, Lord Walton, pointed out, the number of newly qualified doctors entering training schemes for general practice has fallen by 18 per cent. That is my calculation; the noble Lord, Lord Walton, said that it was 14 per cent., but I have checked and I believe that 18 per cent. is the correct figure. That is an early warning sign that doctors are turning away from general practice.
More GPs are retiring early before the age of 65. The total number of male GPs has already started to fall. Luckily, the number of new women GPs has been increasing sufficiently to keep the total rising. Many of us would say that is a very good thing. I certainly agree. However, it is well known that the majority of younger women doctors will need to take time off to produce and care for children. Therefore, more are needed to provide the equivalent number of full-time doctors. Already the proportion of doctors working part-time has increased from 5 per cent. to 11 per cent. of the total in the past five years.
One reason for the decline in the number of male entrants to general practice is that more consultant posts have been created-18 per cent. more since 1988. That is another welcome development, which no one would want to see reversed. However, the hospital service also suffers from the fall in recruitment to general practice training schemes, because two out of the three years in those schemes are spent in hospital SHO posts. Already, because of manpower needs, some of the training programmes are having to recruit from overseas. Those doctors—from Spain, Holland or wherever it might be—will return home after they have received their training at our expense. Of course they will have worked here during their training period and nearly always given very good service, but we lose them in the end.
As the noble Baroness, Lady Masham, said, there are often very few applicants for some practice vacancies. To cope with the problem, the GMSC recommends that at present no more healthcare activities are transferred from hospitals to primary care. I am very sad about that, but it may be necessary. It also recommends that medical school intakes be reviewed urgently, both because of the falling number of GPs and the increasing
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number of consultants. The GMSC says, logically enough, that a primary care led NHS cannot exist without an adequate supply of properly rewarded GPs. It also states, among other suggestions, that
"support must be provided in the form of additional resources to provide staff, premises and technical assistance",
and that
"additional incentives will be required in those areas where there are particularly acute recruitment problems".
Those are usually deprived, inner city areas.
Deprivation payments to GPs have been made since 1990. The scheme has been of help in keeping some GPs in inner city areas and raising the income of some of them to an average level. It used to be lower. However, it is an inadequate system, both in terms of the extra workload which deprived patients cause and their additional health burdens, and also because of the high level of deprivation which a community has to reach before the doctors there qualify for extra payments. I believe that the system should be reviewed urgently and more appropriately targeted. Discussions should reopen with the profession on the best methods of achieving that.
General practitioners feel that the additional tasks required of them through the 1990 contract, which include much preventive medicine and health promotional activities such as reaching immunisation and cervical cytology targets, and so on—which are aspects which are not fully covered in their training—have diverted them from their highly valued task of providing high standards of continuing personal clinical care. Many of those tasks can be delegated to nurses and other workers, who do them better and more methodically. However, for that to be achieved proper premises and facilities must be available. The procedure by which the contract was virtually imposed on the profession has left a lasting distrust of the Government among general practitioners.
Several noble Lords opposite have praised the GP fundholding scheme. It is now fairly clear that, despite enthusiasm by some fundholding GPs, the scheme has caused more problems than it has solved, quite apart from its divisive effects. Recent research based reports have shown little long-term change in referral patterns or prescribing by fund holding GPs.
Other noble Lords have mentioned increasing expectations of patients, such as the increased number of calls for night visits. That is a manifestation of a socially fragmented society—which has been getting worse during the lifetime of this Government.
Those are just some of the reasons doctors have been turning away from general practice. To make a primary healthcare led NHS a reality a real injection of resources into undergraduate and postgraduate training and increased support of GPs in their work is needed. The details should be the subject of immediate negotiations between the profession and the Department of Health.
7.8 p.m.
The Earl of Clanwilliam: My Lords, if there were not concern in the NHS about developments it would be remarkable in such a large organisation. Noble Lords

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have spoken both in the general and in the particular. I shall speak in the particular, as no doubt the noble Lord, Lord Winston, would expect. I take this opportunity to congratulate him not only on his maiden speech but on his opening speech today.
One fact that I find compelling, and which is a development which should be of great concern to the NHS, is that conventional medicine uses modern drugs which are becoming less and less reliable as the viruses they are designed to treat become resistant and the bacteria learn to mutate. Logically, we could eventually reach the point where the pharmacist has been defeated.
Before I am accused of scaremongering, perhaps I may quote from the report of the Parliamentary Office of Science Technology entitled Diseases Fighting Back, published less than 18 months ago. The noble Lords, Lord Flowers and Lord Dainton, and the noble Baroness, Lady Platt of Writtle—whose permission I have to mention her name—were members of the panel. Noble Lords will appreciate that I am encouraged to quote from a report which speaks with such authority. Paragraph 2.2 on page 4 states,
"As antibiotics became widely used, it soon became apparent that bacteria which were previously susceptible to a particular drug could acquire resistance to it. This 'acquired resistance' stems from the natural ability of bacteria to adapt genetically to a new threat".
As noble Lords know, the body has its own powers of resistance to and recovery from disease. Sometimes that is included, quite wrongly I believe, in the placebo effect. The report continues at page 5:
"A proportion of the natural bacteria population in the body are capable of defending against an antibiotic … treatment subjects the bacteria to a 'selection pressure' which will soon lead to the resistant strain becoming a dominant one".
We have recently had a Starred Question on the subject of MRSA; a subject relevant to this point. The report continues at paragraph 4.1 that 9 per cent. of the 5.7 million NHS patients—over 500,000 citizens—acquire infections while in hospital and some 60 per cent. of MRSA infection involves multi-resistant strains. If we solve that problem, the nine cancer patients referred to by the noble Lord, Lord Winston, would soon find beds. Why does the medical profession not do something about this extraordinary scandal, where patients are being poisoned in hospital by medicine presented to them? It is not the fault of the National Health Service, but of the medical profession. This surely must be a development that causes concern to the health service.
But history shows, on the contrary, that herbal preparations are not subject to these self-defeating effects. It is not only our own UK brand of herbalism which makes the point, but Chinese herbalism and its thousands of years of proven benefit with traditional remedies continuing to bring relief to patients in a wide field of therapy. In particular, there is the example of the severe atopic eczema to which I referred in a previous debate.
On the subject of male infertility—currently a subject of great national concern according to the press—traditional Chinese medicine has developed techniques which have relieved that problem over centuries. Studies
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in China cover 13 associated problems ranging from azoospermia to varicocele spermophlebectasia, with 11 other activities which are either unpronounceable or too indelicate to repeat.
Eight different studies involve over 1,500 patients with success rates varying between 71 per cent. and 94 per cent. Indeed, a small number of patients have been treated at the Chiswick Clinic over periods of 50 to 90 days with results of considerable importance. Is all this to be discarded as anecdotal, as all herbal treatment is considered? Even if it is anecdotal, it should be followed up and funds provided for further clinical trials. That would relieve pressure on the NHS.
As regards the concerns of NHS employees and practitioners, a revolution is being brought about by the department to keep up with modern technology of the IT variety and the ever-increasing flood of new technology from medical research. The noble Lord, Lord Walton, and the noble Baroness, Lady Flather, explained that point. It is a revolution which provides more care to more people every day in an atmosphere where there is an insatiable demand for eternal health.
Where is it all to end? Is it not enough that 1 million more patients are being treated this year than in 1991? That is 3,500 new patients every day. Is that not a remarkable achievement? How can anyone carp at the National Health Service when it provides a service like that? Waiting lists are dropping and, yes, I know that there are always some statistics which will indicate problem areas somewhere, especially at a time of such expansion in this huge organisation which is the largest employer in Europe.
Let us imagine the NHS still juddering along in the old way before the Conservative Party started to put it to rights. The miracle is that those waiting lists and problems are dwindling despite what anyone can say, and under extraordinarily difficult circumstances. This is all being achieved at a time when the bacteria are busy with genetic mutation to counter the wonders of modem science-based medicine. There will obviously never be enough money to fund the health service. There never can be. It can only be more efficiently organised.
I hope noble Lords will accept that applying some of the non-conventional systems might relieve pressure on the health service. That is not a total panacea but a help. The noble Lord, Lord Desai—unfortunately he is not in his place—said that not a day went by without some tabloid horror story coming forward. The truth is that hardly a day goes by without complementary medicine being mentioned in the press. In The Times today Donald Lane, vice-chairman of the National Asthma Campaign and consultant chest physician at the Churchill Hospital, Oxford, states that there was little doubt that some complementary therapies helped but they had to be used in addition to, not instead of, standard treatments. Chinese medicine combines them all. That is how treatments should go forward. It is not a question of one or other, but of using all opportunities together.
I congratulate my noble friend on the success of the department in running the NHS in the face of such adversity and carping, and the remorseless advances in

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science, costs, and the demographic effect. Perhaps I may draw the attention of the House to the fact that the NHS will never be in trouble because in this debate 11 noble Baronesses have spoken and only 11 Peers.
7.18 p.m.
Baroness Robson of Kiddington: My Lords, I, too, thank the noble Lord, Lord Winston, for introducing the debate. It is particularly significant that the debate has been introduced by a member of the medical profession actively involved not only in the service but also in the education and training of doctors, and in research. He is someone who really knows what he is talking about. The noble Lord introduced the debate by giving his impression of the impact of the reforms and the problems that have been created through the creation of the internal market. That set the pattern for our debate.
The large number of speakers taking part in the debate and the frequency with which health service Questions appear on the Order Paper is a sign of the deep concern felt on all sides of the House as well as all over the country about what is happening to our National Health Service.
I should like to begin, first, as have many speakers, by thanking all the people, in whatever capacity they work in the health service, for all the work they do and for their dedication, often under very difficult conditions. Secondly, I wish to emphasise how lucky we are in this country to have a system based on the general practitioner service which ensures that everyone in this country has his or her family doctor to turn to in times of need. That is probably the greatest strength of the NHS.
I was born in another country, Sweden, which has often been held up as the shining example of a perfect health service. But for years it had no general practitioners. As a result, the hospital clinics became overcrowded. Sweden has now finally had to start creating a general practitioner service. I believe that that is one of the most important things in our health service. However, we have reached a point where all the dedication of nurses and doctors is not enough. As a nation, we cannot go on expecting people to perform well beyond the call of duty.
I wish to return to the problem of the fall in the number of doctors who enter general practice. Between 1988 and 1994 the number of GP registrars fell from 2,165 to 1,840. At the same time, there was an increase in the number of women GP registrars, which adds to the problem of the lower numbers as women GPs are likely to work part-time during at least some period in their lives and careers because of family commitments. For every 100 GPs retiring, today we need 110 new recruits, not fewer than we had before. So we must ask: What is the reason for the fall in the intake of general practitioners? Many noble Lords have said that it is largely to do with the increased workload because of the increasing shift in the health service towards primary care and also the unsocial hours. Both contribut to low morale in the service. In addition to low recruitment figures, an increasing number of GPs are also considering early retirement. In some parts of the country, I am told, it may be as many as 50 per cent. In
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my family I have a consultant at a hospital and a GP, both fairly young people. They are already seriously considering taking early retirement because of the pressure of work.
In addition, the Government's decision to phase the recommendations of the pay review body has only exacerbated the problem. We need urgent action now to safeguard our GP services. As a first step, there should be a complete halt or moratorium on any further work being loaded onto general practice until the problem of recruitment has been dealt with. I ask the Minister to consider that.
There is also a shortage of doctors in the hospital sector. This was clearly set out in the report of the Department of Health's own medical workforce Standing Advisory Committee last June. Furthermore, we have been told that emergency admissions increased by about 13 per cent., 14 per cent. or 18 per cent.— I am not sure which is the correct figure—between the years 1990 and 1993. According to NAHAT, the most likely reasons for the increase are: patients are older, there are more cases of some illnesses, patients have higher expectations and GPs feel less able or willing to cope with seriously ill patients. Early discharge has been mentioned, in other words the revolving door of going back into the accident and emergency department. Also, family life is quite different and families are less able to look after their own members. So there is an inter relationship which is clearly visible between the hospital service and the GP service.
We know that the greatest shortage exists in the A&E departments where, because of the closure of a number of departments, bed closures and ward closures, the workload is now almost impossible. That results in long waits on trolleys, departments running out of trolleys and having to borrow them from the x-ray and theatre departments, with treatment having to he carried out in the accident and emergency department which should be carried out in wards. Too often, the standards of the Patient's Charter—of which the Government are proud—for accident and emergencies of a bed within two hours of admission cannot be fulfilled.
The above concerns are echoed by the Royal College of Nursing. The noble Baroness, Lady Cox, told us about her concerns. For two years the RCN has been warning the Government of a growing nurse shortage problem. It is now acknowledged that there is an acute shortage in certain areas: intensive care, theatre nursing and paediatric intensive care. Faced with those admitted shortages, it seems incomprehensible that a number of senior nurses across the country are being made redundant as a result. In the Trent region 32 senior nursing posts are threatened as part of the Government's proposed management cuts. We are all aware that the quality of care in clinical areas depends on the skill and experience of the ward sister. We cannot afford to get rid of our senior nursing staff.
In the present climate, we need a national workforce planning system, not a local one, to identify the need for nurses all round the country. Nurses feel unable to fulfil their tasks in the face of those shortages and, as the noble Baroness, Lady Cox, told us, as many as

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40 per cent. of them are considering leaving the profession. The recent national pay award of 2 per cent. has added to the problem, making morale among nurses at an all-time low. Any extra will have to be negotiated locally. NAHAT itself admits that each trust will need to make its own judgment in the light of its financial position which is bound to vary from trust to trust.
The noble Baroness, Lady O'Cathain, said that the right to remunerate at different levels is not necessarily wrong. I agree with that, but it should be for good performance over and above the basic rate. It should not be dependent on an award of a 2 per cent. increase, which is below inflation. It should not be phased, as it is for doctors. The nurses who, a few years ago, were delighted when they achieved their own pay review body must wonder whether they have achieved all they thought they were going to.
I believe that the recommendations of the pay review body should be altered or varied only with the assent of Parliament. If the Government decide not to follow the recommendations, as they did this year, by delaying implementation, it should require parliamentary approval. That will give parliamentary protection against the actions of any government who want to change what the independent body recommended. After all, both the Government and the staff had agreed to accept the pay review body decision.
I also believe that there should be national criteria for local flexibility. There is need for that flexibility, but there should be national criteria to govern how it is supplied. For example, there should be flexibility to reorganise the staff structure in a trust, to deal with a local recruitment problem or to reward exemplary performances. That flexibility should be used within a pattern established for the country as a whole. After all, we pride ourselves on a national health service, not a local health service.
Baroness Jay of Paddington: My Lords, we have had an extremely informative and rather disturbing debate—about probably the most important factor in any successful healthcare system; namely, the well-being of the people who themselves look after patients. In the NHS, the quality and dedication of the staff is, rightly, universally recognised. It is because of their work that the health service has always been so widely admired and held in such esteem and affection by us all. I emphasise "by us all" because any attempts by noble Lords to pretend that the estimation of the health service is a partisan issue is completely incorrect.
That is why I echo the noble Baroness, Lady Robson, in saying that it was particularly disturbing to hear a distinguished senior member of the medical profession give the kind of description of his and his colleagues' concerns that my noble friend Lord Winston gave in his opening speech. I am very grateful indeed to my noble friend for tabling this Motion and making such an authoritative contribution. Almost all who took 'part in the debate spoke from personal experience and knowledge. I hope that, in replying, the Minister will not suggest that those who are critical speak from ignorance. Too often we are told by the Government
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that it is only the ill motivated or ill informed who are alarmed by current developments in the NHS. Indeed, in previous debates the noble Baroness herself has said that there seem to be two health services—the one she knows and sees, and the one about which she reads and hears. I hope that today she has been convinced by the evidence of grave concern that was demonstrated. And I hope that her reply will contain positive proposals for addressing those concerns.
I speak from some personal experience, and must declare three relevant interests. First, I am married to a senior consultant physician. His immediate concern is that his department in a London teaching hospital faces an 8 per cent. cut in its budget this year. He and his colleagues have spent a very great deal of time since the cuts were announced, just before Christmas, trying to juggle with figures and adjust plans—time that they might better have spent in clinical work or teaching. They have come, unhappily, to the conclusion that, with rising patient numbers, they cannot possibly absorb an 8 per cent. cut in funding. They will have to close wards and clinics this spring. When the Government speak of ever—increasing funds for the health services, it pays to look at the fine print. Too often extra money does not go to patient services. As the Labour Party discovered this month in parliamentary Questions in another place, an extra £1.5 billion has been spent in the past five years on bureaucracy.
In another part of London I serve on a commissioning health authority. That is my second declared interest. That agency is very well managed. Nevertheless, problems of staff morale, from the most senior to the most junior levels, are a constant concern. Staff there have particular anxieties about the inadequate services they are providing for the mentally ill living in the community—an issue discussed in this House last week and referred to again this afternoon by my noble friends Lord Dubs and Lady Hayman. They also have anxieties about how they can cope with continuing care for the elderly, and anxieties about proper primary care. They are still uncertain that hospital bed closures will be effectively replaced by the much advertised hut not very visible improvements in community services that we have all been promised. These are all legitimate anxieties about the quality of care that they can offer and which affect both staff and patients.
My third declared interest is as national chairman of the League of Hospital Friends—a role that takes me into many health service organisations all over the country. My visits are often to celebrate achievements or to mark the opening of new facilities. But I cannot count the number of times that my hosts, who may be local medical staff, nurses, or indeed managers, have taken me aside at a reception or followed me across a car park to start conversations which always begin: "Of course, we are very happy with what has happened today, but extremely worried about what is going on in general". Many of the issues they want to raise are those referred to in the debate this afternoon: the complications of contracting; professional training; local pay bargaining; ITU beds; and above all, staff shortages at every level and in every part of the service.

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Two other general worries are also often presented to me. One is the frustration that many professionals in the health service feel about being asked to compete with other health service trusts. These are often neighbouring hospitals which, in the past, were regarded as colleagues and collaborators in patient care and which must now be treated with suspicion as market competitors. On the ground, it is that spurious and artificial boundary that is fuelling fears that the National Health Service is fragmented. As my noble friend Lord Winston demonstrated very clearly, it can give rise to very serious clinical anxieties.
General concern about fragmentation also goes with the feelings of isolation that many staff have as regional health authorities disappear and the Government abrogate more and more responsibility to a very local level. In the past, many enjoyed and took pride in the sense of belonging to the nationwide family of the NHS, which provided networks of professional support and patient referral, as the noble Lord, Lord Walton, explained in his contribution. As well, they maintained universal standards of care. Today, there is very little of that. Horizons are limited to the small business interests of individual trusts. One medical director commented rather sardonically to me recently that the esprit de corps in his particular trust was now expressed through the local marketing brochure and improved hospital signposting, rather than through national recognition as a centre of excellence. I have to say, without any discourtesy, that something of that was conveyed in the contribution of the noble Baroness, Lady Flather.
All of this can be dismissed either as shroud-waving or as anecdotal. But many speakers this afternoon rightly quoted from the growing amount of objective, independent evidence from surveys and reports about the attitudes and concerns of health service workers. I make no apology now for again highlighting some of those findings.
First, in relation to nurses, as the noble Baroness, Lady Cox, said in a very powerful speech, they are the largest single group of staff working in healthcare. The noble Baroness quoted the RCN survey which showed that two-thirds of trusts are having difficulty recruiting qualified nurses. Both the noble Baroness, Lady Cox, and the noble Baroness, Lady Robson, referred to the tragically high figure of 40 per cent.—I repeat, 40 per cent., my Lords—of nurses who are considering leaving the profession. Nurses rightly feel that that leaves them in a situation that can often be described as dangerous, and is certainly inadequate for them to feel that they are providing proper patient care. The recent miserly national pay award of 2 per cent. is, as my noble friend Lady Hayman said, bound to undermine morale still further, particularly when it is compared with last year's pay award to chief executives in the health service of 7.6 per cent. UNISON has already polled its nursing and midwife membership about morale. More than three in four—78 per cent.—feel that the morale on their ward or in their unit has worsened in the past year.
My noble friend Lord Rea, with his long experience as a family doctor, focused the attention of the House on the anxieties and concerns of general practice. My
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noble friend quoted from the GMSE report published last week, on 21st February. To me, perhaps the most disturbing finding was the recruitment crisis that it showed of a 15 per cent. fall in the number of trainee GPs in the past six years. And at the other end of their professional lives, the report noted that six out of 10 wanted to take early retirement.
The Government constantly tell us that family doctors are completely happy with the changes in the health service; that GP fundholders are the enthusiastic standard—hearers of the reforms. This latest report paints a totally different and very gloomy picture—one that the noble Baroness, Lady Robson, painted in some detail. The only encouraging fact is perhaps the accompanying NOP poll of the voting intentions of GPs, which shows a dramatic swing to Labour. Apparently, the Labour Party now enjoys more GP support than all the other parties combined.
My noble friend Lord Winston, the noble Lord, Lord Walton, and other noble Lords, gave us a vivid idea of the situation in our hospitals. Their experiences of pressures and shortages are reinforced by this month's Health Director Magazine which publishes a survey by the National Association of Health Authorities and Trusts called "Is there a Doctor in the House?" With very dramatic graphics of "wanted" doctors, it shows that most NHS trusts cannot recruit doctors in a whole range of specialties. Seventy per cent. do not have enough psychiatrists; 64 per cent. have shortages of anaesthetists; over a quarter are unable to recruit enough paediatricians; and the same number have shortfalls in accident and emergency specialties. In all of these areas there is real anxiety about the need to rely upon locums or other non-specialist staff, the impact upon waiting times and, above all, the quality and standards of patient care. No wonder that hospital consultants mirror GPs in seeking early retirement! Another survey showed that 70 per cent. would take it if they could.
All of this points to an NHS staff situation which is one of growing shortages and falling morale. That is a very unhealthy combination. We began this debate with an important contribution from a very distinguished physician. I should like to conclude by quoting the president of the Royal College of Physicians who recently sent a letter to fellows of that royal college, all of whom are very senior doctors. In that letter, Professor Sir Leslie Turnberg succinctly summarised the case that we have argued today. He wrote:
"There is widespread concern amongst physicians that increasing pressure to take on ever more work is impeding their ability to practise the high standards of medicine to which they aspire. Uncertainty, frustration and even despondency are beginning to threaten the sense of commitment to the NHS of many physicians … I constantly bring to the attention of the Department of Health and the NHS Executive the damage that this is causing to the quality and standard of care we provide. … Threats to increase this burden still further have become unconscionable for many. This, coupled with a sense that some employing authorities do not appreciate the work and dedication of physicians, combines to form a depressing picture".
This depressing picture must be changed. One million people work in the health service. Without their motivated commitment the NHS will begin to disintegrate. It is the Government's responsibility to act now to prevent that happening.
7.43 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I am most grateful to the noble Lord, Lord Winston, for initiating this debate and for his generous opening remarks to me personally. As a pioneer in the rarefied field of fertility, he is not only the "father" of thousands, a highly respected academic, and a clinician with a formidable reputation, but also, I understand, a former Thespian. One may think that that combination is perfect preparation for your Lordships' House. However, in the course of the debate I wondered whether the noble Lord was attempting to construct an alternative reality, or a make-believe land, because I did not quite recognise the picture that he painted.
The noble Lord referred, quite rightly, to the Government as the Government of choice. He went on to suggest that we had restricted patient choice. But for the first time ever choice is enshrined in the Patient's Charter. The charter gives patients the right, with the agreement of their GP, to a second opinion. While in no way decrying the international recognition and reputation of the noble Lord's department at Hammersmith Hospital, which I know to be extremely well led and a first-class unit, if health authorities feel that with the agreement of patients they can get better value locally, or wish to break traditional patterns of referral, we do not wish to deny them that right. If I may be a little cheeky, we all know that referral patterns in the past may have had more to do with medical networks than patient choice.
The noble Lord, Lord Dubs, implied that noble Lords on these Benches thought that the NHS was perfect in every way. That is not so. Your Lordships have heard many of my noble friends say this evening that we are never complacent or satisfied with the NHS. I believe that some noble Lords on the opposite Benches under-estimate recent achievements, which have been Herculean. Great credit for that goes not only to the Government but, more importantly, to the commitment of NHS staff.
There are three very powerful forces that influence the service. These were referred to by my noble friend Lord Clanwilliam and went unchallenged by any of the speakers on the opposite Benches this evening. They are the increasing number of elderly people, mounting consumer pressure, and technical change. The noble Lord, Lord Winston, is at the leading edge of developments in medical science and must also be well aware of consumer pressure. He will know that these forces are hard to influence. Indeed, some argue that they are unstoppable. He will also know that not only is change a challenge to manage but that the provision of buildings, technology, staff training and the redevelopment of a service take time.
The noble Lord, Lord Winston, mentioned another factor: politics. In commercial firms which, like the NHS, also have to change, restructuring can be done without the glare of publicity. In the NHS, which we all recognise as one of the great institutions of this country, policy and management are always topics for debate, including debate in the political arena. The noble Lord,
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Lord Desai, was right when he said that there was a lot of coverage in the media. But the media searches for stories among those things that go wrong. The Opposition parties seek to make political capital by exposing errors. It is the role of Opposition parties to oppose, and errors need to be exposed. We believe in open government. However, my noble friend Baroness Flather put her finger on it so rightly when she said that constant knocking demoralised staff and did not help recruitment.
The Government are engaged UK-wide in spending over £41 billion of taxpayers' money. We are accountable for doing that prudently and for the benefit of the whole population. It is a responsibility that any government accepts. However, there is a fundamental dilemma. The media and well-organised opposition can together make people believe that the NHS is not doing a marvellous job. They neglect the fact that 83 per cent. of people who have used NHS services say that their treatment has been average, satisfactory or very satisfactory. That is a higher satisfaction rate than almost any service industry can show.
The Government have privatised many industries, such as British Steel, British Airways and Britoil. In so doing, they have removed their management from the political arena and so concentrated the areas of opposition on fewer services. But the NHS is still a mutual society and is there solely for the benefit of taxpayers and users. One may say that it is "nationwide". Sadly, the NHS has become, not a treasure to be guarded, but a quarry to be thrown to the pack. That is not a good principle of management. Everybody wants to work for a winner. The NHS is a winner, not only among most staff but among most patients, but some parliamentarians egg on the media and are motivated to portray the NHS as a loser. I accept it but resent it, because it is not like that. The NHS combines two great principles: "love thy neighbour" and "each according to his needs". When one has great principles they are an inspiration but are incredibly difficult to fulfil. Doom and gloom can trickle down from Parliament into the NHS and on to patients.
As the noble Baroness said, the NHS has a staff of nearly 1 million, but its great ethos draws millions more actively to support it. Hundreds of thousands are volunteers, and millions give money. They manifest the great achievement that the NHS belongs to the people. Few organisations have so many and so sure defenders.
I agree with the noble Baroness, Lady Hayman, that it is extremely difficult to define and gauge morale. I spend much time visiting throughout the service and find both high and low morale. Recently, I went into a ward in a hospital and was met with a barrage of complaints from the ward sister. She complained of under-resourcing, under-staffing, absenteeism, the junior staff wanted to leave—nothing was right. A few minutes later on another ward in the same specialty, and in the same hospital with the same catchment area, it was all smiles and only a slight embarrassment at the size of the waiting list. I refer to the waiting list of staff who wanted to join the team.

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Now, of course, there are jobs that are hard to fill in some of the best hospitals and GP practices, but behind many local disasters lies indifferent leadership. Rather unexpectedly, and delightedly, I agree with the noble Lord, Lord Haskel. The importance of leadership is crucial. I am sure he will agree that managers must also lead and that we have a huge workforce that needs to be led, the vast majority of whom are excellent. But, as my noble friend Lady Brigstocke implied, it would be beyond belief if we did not have a few bad doctors, a few bad nurses, a few bad managers and a few bad technicians among a million people. But they are remarkably few because, on the whole, the NHS is full of committed staff and it is very well run.
I am pleased that the noble Lord, Lord Rea, welcomed the move to a primary care led NHS. I share the admiration of the noble Baroness, Lady Robson for GPs. Perhaps this is the time for me to declare an interest. I am the daughter of one and I grew up in such a family household. We all agree that family doctors are central to the NHS. Together with community nurses they are nearest to patients. They understand the family dynamics, the nature of an individual's employment and the community in which they live. A primary care led NHS puts the GP at the heart of healthcare—no longer a doctor, as the noble Lord, Lord Moran, declared, who had "fallen off the ladder". I strongly agree with my noble friend Lady Gardner that GPs have never been better. Today, the vast majority are highly trained and supported by a skilled primary healthcare team with better premises and increased staff. They are pivotal to the future development of the NHS, a recognition warmly welcomed by the Royal College of General Practitioners in its statement on A Primary Care Led NHS, published earlier this month. GP fundholding is an extension of that. But, as my noble friend Lord Clark of Kempston said, in a very powerful speech, the party opposite wish to abolish GP fundholding; unlike Brian Abel-Smith, the former chief adviser on health to the Labour Party and presently vice-chairman of the Fabian Society, who recently said that all GPs should be fundholders.
Who would have imagined five years ago, when GPs and the BMA were implacably opposed to it, that today we should witness over half of all GPs having chosen to become fundholders. As the noble Lord, Lord Walton, said, pioneering fundholders have shown what can be achieved. They have negotiated same day test results, arranged consultant clinics at their surgeries and provided extra physiotherapy, chiropody and complementary therapies on site. The benefits are many and other GPs wanting to do the best for their patients have followed the lead. Fundholding gives them opportunities which they never dreamt were possible only five years ago.
The noble Baronesses, Lady Masham of Ilton and Lady Hayman, suggested that GP morale was in crisis. But that is scarcely borne out by their recruitment, which is an issue that concerned the noble Lord, Lord Rea, and the noble Baroness, Lady Robson. Despite recent pessimistic reports, I am pleased to be able to tell your Lordships that the number of GPs increased by more than 11 per cent. between 1984 and 1994. It
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continues to increase every year by about 1 per cent. At the same time, the lists of GPs have become shorter and the average size is now under 2,000 patients. According to the Medical Practices Committee, 80 per cent. of GP practices recruited successfully, with each post attracting an average of 10 applicants.
That is not a picture of a service in decline; but the Government are anxious to ensure that the pivotal role of general practitioners remains attractive to doctors in training. To help understand where government action might be able to enhance further the delivery of primary care, my right honourable friend the Minister for Health recently embarked on a listening tour to hear at first hand the aspirations and concerns of family doctors. I am sure that he will pick up many of the points mentioned by the noble Lord, Lord Rea.
Like my noble friends Lady Gardner and Lady Flather, the Government have been resolute in their appreciation of good management. It is quite bizarre to think that highly complex hospitals or GP practices can be run without the highest quality management. I am sure that the noble Baroness, Lady Hayman, will agree, as no doubt will the noble Lord, Lord Haskel, that getting the numbers right is a process of adjustment. We share the noble Lord's view that training doctors, nurses and technical staff to manage is an imperative. Personally, I am very encouraged that over 30 nurses are now chief executives of trusts.
We agree with the noble Lord, Lord Desai, that bureaucracy must not take over and gobble up resources that could be better used. By abolishing regional health authorities—a move opposed by the noble Lord's party—and also by merging FHSAs and DHAs, and streamlining the department, we have cut bureaucracy and saved £300 million a year for reinvestment in patient care.
The noble Lord, Lord Winston, was critical of the internal market, which he described as a mask for under-funding. The separation of responsibilities between hospitals and health authorities has, as the noble Lord acknowledged at one point, brought immense benefits to patients. He is right that health authorities, through their pressure on quality standards and trusts, have ensured that hospitals have delivered shorter out-patient waits, shorter waiting times for operations and shorter waiting times in A&E departments. They have also put appropriate pressures on community services. That is not a mask for underfunding. Under this Government, funding for the NHS has increased every year and now, as I said, stands at £41.2 billion in the UK.
The noble Lord, Lord Desai, was critical of the way in which the internal market is working. But one has to bear in mind that this is still very new and very young. It needs time to mature. I can assure the noble Lord, Lord Haskel, that co-operation is breaking out. I could give a list of examples, but time is running on.
When the internal market was introduced, the Labour Party predicted total collapse. That did not happen. It was a relatively smooth transition and we are beginning to see the benefits coming through in a very

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tangible way. I agree with my noble friend Lord Bridgeman that the management is better and resources are more appropriately used.
My noble friend Lord Bridgeman also referred to nurses training. He is right. We have invested hugely in the Project 2000 courses. From April they will be countrywide. The benefits are visible. One has only to walk the wards or go into the community and one finds confident, competent, thinking nurses doing a very good job indeed.
The noble Lord, Lord Dubs, mentioned the percentage of GDP spent on healthcare. But he acknowledged that the percentage of GDP is no measure of the healthcare that is provided. My noble friend Lady Flather was right when she pointed out that the real measure is what that money can buy. We believe that £41.2 billion in the NHS represents outstanding value for money.
I am very grateful to the noble Lord, Lord Walton, who described accident and emergency care in this country as the best in the world. But I understand the concerns of the noble Baronesses, Lady Masham and Lady Robson. A&E services are demand-led and it is not easy to find the right balance, so that peaks can be accommodated while avoiding the inefficiency of empty beds and wasted resources. But in the majority of cases, that balance has been found. However, this winter we have seen undue pressure on accident and emergency services in many parts of the country. There are many reasons for that. The 'flu epidemic early in the year both increased the demand for beds and reduced the number of fit staff; more people are coming forward as emergency admissions; discharge procedures in some areas are preventing beds becoming available. I also have to say that not all social services departments have got their act together in regard to discharge procedures.
The NHS has tackled peak demand in its customary professional way. The Government have also responded flexibly. Earlier this year my right honourable friend the Minister for Health announced that trusts can appoint extra staff-grade doctors to ensure full cover for A&E departments. In addition to the 39 extra consultant posts funded through the new deal, we have also approved a further 38 specialist registrar posts. Consultant expansion in A&E is the fastest within the medical specialties.
The noble Baroness, Lady Masham, raised the issue of intensive care beds. Those have increased by nearly 90 in the past four years and now stand at 2,600. The number of qualified intensive care nurses has also increased by over 1,000 to 7,650. However, there will be times when intensive care units, despite having a full complement of staffed beds, will be full. In those circumstances, suitable specialist beds will be found in an alternative hospital as close as possible. Perhaps I can reassure the noble Baroness that to ensure that transfers can be arranged where necessary the are reviewing the options for a central intensive care bed bureau to build on the pioneering work which has been so successful in London and which we believe could be used in other areas.
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My noble friend Lady Gardner asked about junior doctors. I thank her and other noble Lords who are actively involved in the NHS. My noble friend spelt out clearly the achievements of the Royal Free Hospital. She also made clear that running a trust to deliver a high quality, modern healthcare service is a demanding task. She referred to the new deal, which we put in place to improve the living and working conditions of junior doctors. It has meant that they are better able to deliver care to the benefit of patients and to benefit from their own training.
The noble Baroness, Lady Hayman, expressed concern about the future of research. This country used to have a brain drain; today we have a brain gain. Scientists beat a path to our door to visit the Cochrane Centre—a world beater—to talk to our director of research and development; an appointment due purely to your Lordships who moved for that when a Bill passed through this House. They come to see how we guarantee central funding for research and development and they come to work here. My noble friend Lord Bridgeman also asked about the investment in nurses and the services that they carry out today. That is an issue close to my heart and I concur with all that he said concerning the increasing role of nurses and the pivotal role that they play.
Many noble Lords raised the question of nurses' pay. It was an issue clearly addressed by my noble friends Lord Clark and Lady O'Cathain. My noble friend Lord Clark, as a master of finance, put the case clearly in terms of figures and I do not want to go over that ground. But he is right to contrast this Government's good record on nurses' pay with that of the Labour Government, whose record I have to say was miserable. In their time in office nurses' pay did not even keep pace with inflation year on year.
The noble Baroness, Lady Hayman, and my noble friend Lady Cox referred to impending shortages in nurse recruitment. But the review body was in no doubt that the Government's move towards local pay is right. It is right that the solutions will increasingly be in the hands of trusts, the local employers. No organisation can afford not to have control over 70 per cent. of its costs. My noble friend Lady Cox asked why only nurses are subject to local pay negotiations. But every group in the NHS is subject to local pay, except the doctors; they are the one exception. But even this year the doctors and dentists' review body will start to introduce local pay by abolishing C awards and introducing a local points system. My noble friend Lady O'Cathain put the case on local pay so well, and I want to endorse all that she said. It makes a nonsense today to have centralised pay countrywide; no other organisation does it.
My noble friend Lady Cox was right to draw our attention to staffing issues. I hope that she will take comfort from the fact that next year the commissions for training will be increased by 14 per cent. That has already been debated this week in your Lordships' House and I am sure that my noble friend knows the issues as well as I do. But I just want to say on shortages that it was only three or four years ago that the RCN's concern was that nurses were without jobs; that we were training nurses for the dole.

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The noble Baroness, Lady Nicol, was worried about two-tierism. The Government stand by the 1991 guidance agreed with the medical profession which states that common waiting lists should apply for all urgent cases and no hospital should offer contracts to one purchaser which would disadvantage the patients of another. That refers particularly to GP fundholding. We are determined that there should not be two-tierism, but we want to ensure that we bring the rest up to the level of the best.
Issues were raised on medical teaching and training but time is moving on and perhaps I could write to those noble Lords who raised that point.
I thank my noble friend Lady Brigstock. She is absolutely right that we have to ensure that staff are consulted and have an influence on the nature of the work that they are doing, their organisations and their trusts. Indeed, we believe that with our new arrangements that is easier.
The noble Lord, Lord Ashley, mentioned cochlear implants. I am grateful to the noble Lord for his courageous advocacy on this issue. I can assure him that all health authorities have been sent copies of the famous report to which he referred and it is something that we are watching closely. If there are individual cases, I shall be grateful if he will bring them to my attention. I thank my noble friend Lord Clanwilliam for his contribution and we will study it carefully.
In summing up, I believe that the NHS is a pioneering organisation. Every year we see an increase in new developments. Ten years ago we carried out three lung transplants; last year 115. Cataract removals are now carried out on a day-case basis; where they were once considered leading edge, they are now the norm.
The NHS is full of innovation, full of change. I do not believe that we would see nurses raring to prescribe—which is one of the projects in which I have been interested—nor that we would be seeing GPs more than meeting their targets if this was a service on its knees. It is not a service in decline; rather, it is an NHS that strives year after year to do better and better. It is part of our heritage, a force for unity and inspiration; but it is inextricably dependent upon the fortunes of this country. A thriving economy cherishes a thriving NHS. A thriving NHS requires acceptance of change by staff, resolution by government and understanding from the people. The lesson we are all learning is that only the best will survive. In global terms, I believe that the NHS is the very best; it deserves to survive and we should rejoice in its supremacy.
8.8 p.m.
Lord Winston: My Lords, I thank all those who spoke this afternoon and also the Minister for replying to our anxieties. However, I feel that we are faced with a serious problem. The problem lies in being courageous enough to stand up and talk about what is happening in one's own area of practice. That is not easy for a medical practitioner to do; it is not easy for ,a trust manager and it is not easy for a nurse.
It would be invidious of me to single out specific speakers in this debate. However, I draw your Lordships' attention to the remarkable and eloquent
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comments made by the noble Baroness, Lady Cox, which seemed to me to be extremely courageous. I fear the trouble is that when Ministers visit the trusts and the practices they see basically what we want to show them, which generally is an attempt to try to impress them. Not to impress them is to assassinate oneself. It is a serious problem. I invite the noble Baroness, Lady Cumberlege, to visit us and I will show her the wards.
I do not want to denigrate managers; I never said that. I am concerned about the bureaucracy, which is quite different. I would just say to the noble Lord, Lord Clark, that it seems to me he is perhaps just a touch complacent, if not a touch out of touch.
The health service is a major constituency. It has a million employees. A manager said to me about two weeks ago, when I was trying to negotiate treatment for a leukaemic patient, "I have had to make eight telephone calls on my inflated salary to different managers". The manager said to me, "Don't blame me, I did not start this ridiculous system". Many eminent consultants and friends of mine who are certainly Conservatives, say that they will not vote for this Government again. I fear that as regards the National Health Service the moving finger has come out; the writing may be on the wall. I fear that the Government have been weighed in the balance and found wanting. I beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.

Treaties (Parliamentary Approval) Bill [H.L.]
8.11 p.m.
Lord Lester of Herne Hill: My Lords, I beg to move that this Bill be now read a second time.
The Bill's purpose is to provide for parliamentary approval of treaties before they are ratified. It responds to the democratic deficit; the want of parliamentary control over the Executive—a deficit widened by the Maastricht Treaty, which introduced two major areas of inter-governmental co-operation with very little parliamentary accountability.
The Bill is short, simple and modest. It seeks to involve Parliament in approving, mainly by negative procedure, the dozen or so treaties a year which require ratification before they come into force for the United Kingdom. It also provides for Parliament to be given basic but essential information about the practical consequences of ratification. Exceptionally, the Secretary of State may circumvent the procedures in the Bill altogether provided that an explanation is given to Parliament.
Treaties no longer deal solely with military alliances and other matters remote from our daily lives. Commercial and financial transactions, transport and communications, internationally-protected human rights, cross-border police powers, labour, social security, environmental protection, and many other aspects of modern society are governed by treaty law, reaching into the nooks and crannies of our daily lives.

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There are very few treaties whose effects are entirely confined to the level of inter-state relations of concern only to governments. Yet as Professor Francis Jacobs QC, now British Advocate-General in the European Court of Justice, has noted,
"by a strange legal anachronism, some States, notably the United Kingdom, still seem to consider that treaties are matters for governments alone".
It is of course the prerogative power of the Crown—that is of the Foreign and Commonwealth Office, appropriately located on King Charles Street—which gives the government exclusive power to negotiate and enter into a treaty and to decide what international obligations the United Kingdom shall undertake. This is a monopolistic power, medieval in origin. It is arbitrary in the sense that it is not governed by binding principles or rules, but is exercised entirely as a matter of executive discretion on behalf of the state. Except in the very rare case where a statute so provides, the government do not have to obtain Parliament's approval before they enter into a treaty that binds this country.
Treaties of far-reaching importance for the people of this country and its system of government, such as the European Convention on Human Rights, have been entered into by the government of the day without any parliamentary scrutiny, debate or approval, even though the effect of such conventions is to transfer important legal powers from Westminster and Whitehall to international institutions, such as the European Court of Human Rights.
When the second Wilson administration ratified the UN International Covenants on Human Rights in 1976, there was a vigorous Cabinet debate because ratification meant that a future government and Parliament would no longer be able to abolish independent schools without breaching international law. Yet Parliament was kept completely in the dark.
A year ago the Government ratified Protocol No. 11 to the European Convention, guaranteeing a permanent right of access by alleged victims of breaches, to a new, streamlined European Court of Human Rights. It was a major step forward in relation to a very important treaty; but the protocol was ratified without the Government having initiated any parliamentary debate, still less having sought parliamentary approval, for undertaking new international obligations directly affecting the rights of the governed against the state.
Even though the practical reach of treaties has so greatly increased, the use of prerogative power has scarcely changed since the heyday of the British Empire when Palmerston was Foreign Secretary and the parliamentary franchise was being gradually extended.
We are out of line with the other member states of the European Union, the majority of which involve Parliament in the treaty-making process. The European Parliament now has the right to be consulted on, and to assent in certain cases, to agreements concluded' by the European Union with third countries and international organisations, unlike the British Parliament, which is sorely neglected in the conduct of domestic foreign policy.
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The dead hand of British practice has been rejected in some former British colonies, including the United States and South Africa. It is the established practice in Canada for the government to seek parliamentary approval of important treaties by way of a resolution of both Houses. Traditional British practice may well soon be rejected by Australia as well. A cogent and comprehensive report published in November 1995 by the Senate Legal and Constitutional References Committee has criticised the traditional imperial approach which leaves treaty-making entirely to the government. I have arranged for a copy of the report to be placed in the Library.
Having outlined the general mischief which the Bill is designed to tackle, I must now enter into just a little more explanation. There are various ways in which states can signify their formal assent to be bound by a treaty. Some, including most bilateral treaties, become formally binding by mere signature or by exchange of letters. However, if the bilateral treaty is an important one, or if what is involved is a multilateral treaty, it is more common to require not just signature, but a second step known as ratification. It is this latter step, the communication of a formal instrument, that constitutes the consent of the state to become bound by the treaty. In this country that is done by affixing the Great Seal. If a state which was not present at the negotiation of the treaty, or for any other reason has not signed it, subsequently wishes to become a party, the formal process by which it does so is commonly called accession or adhesion. The legal effect is the same as that of ratification.
In many countries the Executive is not free to bind the state to a treaty without the approval of the legislature, or some part of it. In the United Kingdom, however, Parliament generally has no such role. If a treaty entails a change in the internal law of the land before it can be implemented, then legislation is needed; and in such cases the normal (but not invariable) practice of the FCO, is to delay acceptance until the necessary domestic legislation has been passed.
But in such cases the substance of the legislation required to implement the treaty obligations is determined by the substance of those obligations over which Parliament has had no say at all. There may also be other important parts of that treaty which do not entail a change in domestic law, and in respect of which the approval of Parliament is consequently not sought.
Only a minority of treaties are incorporated directly into English law. There is incorporating legislation only if, in the Government's view, the treaty demands a change in domestic law involving a cessation of territory, or requires the raising of revenue or the alteration of taxation. The mere fact that adherence to a treaty will give rise to recurring expenditure—for example, to meet the costs of or to satisfy awards of damages by the European Court of Human Rights—is not regarded by the Government as requiring incorporating legislation, but is routinely dealt with under the annual Appropriation Act. For the very many treaties which do not involve any change at all in the law of the land, Parliament has no formal role to play

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even if important international obligations and substantial limitations on the sovereignty of this country and of its legislature are involved.
It has been the practice of successive Governments to lay before Parliament as Command Papers all treaties signed by the United Kingdom, but only after their entry into force. It has also been the practice, known as the "Ponsonby Rule", to lay before Parliament, before its entry into force, any treaty which has been signed subject to ratification. Such a treaty lies on the Table in the normal case for a period of 21 sitting days, after which it is ratified.
When a treaty is laid before Parliament, only the text itself is laid. There is no accompanying White Paper or explanatory memorandum informing Parliament of the object and purpose of the treaty, the reasons for its ratification, and the likely costs and benefits for the United Kingdom and its inhabitants of the treaty entering into force. The process of laying treaties before Parliament is opaque. One has to be an expert insider to understand what is really happening.
In theory it is open to the Opposition, or to any Member, to table a resolution deploring the terms of a treaty duly laid and condemning the Government's intention to ratify. Even if the impact of the treaty were readily understood without government explanation, and even if parliamentary time were found for such a Motion, and even in the unlikely event of the Government being defeated on the Motion, the Government would not be legally obliged to heed the will of Parliament. In reality, in the well-chosen words of Professor Rosalyn Higgins QC (now the distinguished British judge at the International Court of Justice) Parliament's role on ratification is "both formal and passive".
Indeed, as the noble Baroness, Lady Chalker of Wallasey, made clear in a Written Answer on 1st November 1995, the Government do not regard themselves as precluded in what were laconically described as "appropriate cases" from proceeding to ratification (or its equivalent) without laying for 21 days in accordance with the Ponsonby Rule. When that happens, there is no obligation on the Foreign and Commonwealth Office even to inform Parliament of the reasons for dispensing with the laying of the treaty.
Arthur Ponsonby was a diplomat, a Member of both Houses and of the Liberal and Labour Parties. His experience as a diplomat at the Foreign Office made him a staunch advocate of democratic control of foreign policy in place of secret, elitist diplomacy. When he became Parliamentary Under-Secretary of State for Foreign Affairs in Ramsay MacDonald's frail, brief, minority Government in 1924, Mr. Ponsonby used a debate on the new peace treaty with the Turks as an opportunity to introduce a modicum of parliamentary control. He read out his famous memorandum during a debate in another place on 1st April 1924.
According to his biographer, Raymond Jones, Ponsonby made the statement knowing that it was out of order and raced through it to get it down in print. That was all that he could do given the difficult circumstances of the parliamentary timetable. A Bill
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was out of the question, and even a resolution of both Houses would have required two days of parliamentary time which were simply not available in the difficult, straitened circumstances of Ramsay MacDonald's minority Administration. Understandably, Ponsonby failed to achieve what he had intended as a proper partnership between government and Parliament in the making of treaties. His hastily uttered statement did not lead to the change for which he—and, I think, Ramsay MacDonald—had hoped.
Ponsonby's statement expressly envisaged that, in the case of important treaties, the Government would submit them to each House during the 21 sitting days not just as a formality, but for parliamentary discussion. The Government, he said,
"desire that Parliament should … exercise supervision over agreements … by which the nation may be bound in certain circumstances".
He also said that,
"if there is a formal demand for discussion forwarded through the usual channels from the Opposition or any other party, time will be found for the discussion of the Treaty in question".—[Official Report, Commons, 1/4/24; col. 2003–2004.]
Yet again and again important treaties have been ratified without being submitted to Parliament for discussion or supervision. The noble Lord, Lord Chesham, kindly made clear in a Written Answer on 20th December 1995 that there is no question of Ponsonby's statement being a binding convention or rule. In his words, the present Government
"do not consider themselves bound by a statement made over 70 years ago by a member of an Administration of a different political persuasion".—[Official Report, 20/12/95; col. WA152.]
In a Written Answer on 1st November 1995 the Minister admitted that there had been departures from the Ponsonby Rule during the past 15 years, but stated that such departures had been rare. The noble Baroness also stated that there would be disproportionate cost in listing the departures and the reasons for them. In another Written Answer on 19th December 1995, the noble Lord, Lord Chesham, explained that there are no fixed criteria for determining which treaties are debated in Parliament for discussion. The Government decide the matter case by case.
I asked the Government which of the other member states of the Council of Europe require parliamentary approval to be given for the ratification of treaties. In another Written Answer on 19th December 1995— apologise for cluttering Hansard with so many Questions—the noble Lord, Lord Chesham, stated that this information is not readily available and could only be obtained at disproportionate cost.
So I have done some research of my own. Naturally there are variations from country to country. But all of them (other than former British colonies)—whether the countries are monarchical or republican, whether "dualist" (like the Nordic countries) or "monist" (like most European states)—are legally bound to obtain parliamentary approval for entering into important treaties.
I have not discovered any European country which excludes Parliament from the treaty-making process. Ireland comes closest to the British position, for

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historical reasons, but even Ireland has a constitutional guarantee of parliamentary consultation—of a rather rudimentary kind. Most OECD countries also require parliamentary approval of at least some categories of treaty. Their position contrasts starkly with our own Parliament which, as I have explained, has no function in treaty-making properly speaking. It may occasionally, and entirely on the Government's initiative, be consulted beforehand, but there is no requirement for approval by Parliament of treaties before they are ratified. Unless the treaty has to be woven directly into the fabric of our law, the treaty is treated as government property.
The Australian Senate Committee, whose inquiry took extensive evidence, found that in countries which require some form of parliamentary approval for entering into treaties, the pursuit of foreign policy objectives is not necessarily restricted or delayed. It recommended that Parliament should be involved before ratification, so that it can make a free choice without the possibility of a potential breach of treaty obligations. The Australian Senate Committee proposed legislation requiring that all treaties be tabled before ratification together with a treaty impact statement, with special exceptions for urgent treaties and sensitive treaties (such as those whose early publication would threaten the safety of people or the effectiveness of law enforcement operations). The committee also proposed the creation of a joint parliamentary treaties committee to keep Parliament informed about the implications of treaties and to consult the public and interested groups about them; and a government duty to report annually to Parliament on actions taken during the previous year to implement treaties to which Australia is a party. I would hope that both those proposals might commend themselves to our Government and our Parliament.
The present Bill is deliberately modest and, I hope, easy to operate. It applies only to treaties as defined in Clause 6, that is to those, mainly multilateral treaties which are subject to ratification or to equivalent acts of consent such as accession or approval. The Bill does not apply at all to the very many bilateral treaties which require only the signature of contracting states or an exchange of notes for them to become binding in international law upon the states parties. This deliberately leaves a wide latitude to the FCO and line departments concerned with the particular subject matter of such treaties. In practical terms, only some 14 treaties a year out of about 70 treaties would become subject to parliamentary scrutiny under the provisions of the Bill.
By virtue of Clauses 1 and 2, the Government are obliged to lay before each House every treaty to which the Bill applies, before ratification, together with an explanatory memorandum informing Parliament of the treaty's object and purpose, the reasons for the proposed ratification, and the likely benefits and costs for the UK and its inhabitants.
Clause 3 prescribes two familiar methods of approval; by affirmative or negative procedure. Where the treaty would affect existing laws or private rights, or lay a pecuniary burden upon the people, or cede any part of the territory of this country, ratification would be by affirmative procedure. In most of these cases, some form
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of domestic implementing legislation will, in any event, be required. The order authorising ratification will, however, enable the general impact of the treaty to be debated and not merely those parts, which may not be the most important parts, requiring legislative implementation. In other cases, approval would be by negative procedure, within a period of 21 sitting days, as under the present Ponsonby arrangements.
Clause 4 empowers the Secretary of State, in exceptional circumstances, to circumvent the procedure for parliamentary approval altogether. If the Secretary of State decided to use this special, fast-track procedure, he would be obliged by Clause 4(2) to notify Parliament of his decision and of the reasons for it, so as to ensure transparency and accountability.
Some may think that the Bill is timorous in narrowly limiting the categories of treaty whose ratification requires the positive approval of both Houses. But Clause 3(3) empowers the Secretary of State to add to those categories by statutory instrument. The existence of such a power would be useful in concentrating minds, both in the FCO and in Parliament, on whether the limited degree of scrutiny provided for in the Bill is sufficient, reconciling the need of the Government to act speedily and efficiently in concluding treaties with the need for Parliament to exercise real oversight and control over the Executive in an area of ever greater importance to us and our fellow citizens.
Your Lordships' House has been in the vanguard of promoting more effective scrutiny of European Community legislation and British delegated legislation. This Bill provides a further opportunity for the Upper House to secure more effective parliamentary accountability by enabling Parliament to approve treaties before they are ratified. I very much hope—and I am an optimist by nature-that the Government will not strive officiously to preserve intact their ancient but outmoded citadel of unlimited prerogative power on grounds of administrative convenience. The whole House will surely wish to endorse the modern democratic principles of transparency, consultation and parliamentary accountability upon which the Bill is based. It would be excellent too if we eventually had the benefit of a Select Committee to facilitate the Bill's procedures, along the lines of that proposed by the Australian Senate Committee. I respectfully commend the Bill to your Lordships. I beg to move.
Moved, That the Bill be now read a second time.— (Lord Lester of Herne Hill.)
8.35 p.m.
Lord Beloff: My Lords, the noble Lord, Lord Lester of Herne Hill, is not only a natural optimist, as he has told us, but also a man of great kindness. He has perceived that I am afflicted by an increasing nostalgia for the academic world that I have left, and therefore has given a very good academic lecture of the kind I used to hear.
I say "academic" because, whatever the merits of the Bill might have been in Ponsonby's time—and I remember that event—it is wholly out of touch with the present situation. It refers to a Britain which had

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national sovereignty, the authority of whose Parliament was unchallenged, and it is peculiar that Parliament at the time of its greatest influence did not go into the field to which the noble Lord refers.
The situation is very different today. At Question Time we were assured by the representative of Her Majesty's Government that we had no option but to accept decisions of the European Court of Human Rights and to alter our legislation accordingly, despite the fact that that court must naturally have a large majority of members who are trained in a wholly different legal tradition to our own.
But much more important, of course, to those who have not got the misfortune of running into a human rights problem, is the fact that through the Treaties of Rome and Maastricht the legislative functions of this Parliament have been reduced to a very considerable extent. Only the other day I heard the right honourable gentleman, the Minister for Agriculture, Fisheries and Food say that only 30 per cent. of the decisions that he had to make emanated from British policy; 70 per cent. had to do with the implementation of policy formed in Brussels. One could take other areas of national life where the same is true. As the noble Lord, Lord Lester of Herne Hill, reminded us, the Maastricht Treaty itself brings further possibilities of encroachment.
So what is left? After all, the noble Lord, Lord Lester, belongs to a political party—he sits on its Front Bench at the moment—which is dedicated to continuing that process of sacrificing British sovereignty by making Britain part of a European federation. That is how I interpret the speeches of his political leader, Mr. Paddy Ashdown, and others of the party. If Britain became, as they wish, a member of a European federal system, it would not have any treaties to make at all. South Dakota has no treaty-making power. So we must regard this as an exercise in the might have been, rather as though one could say what would have happened in the Battle of Hastings if King Harold had had a Kalashnikov.
However, as it would be unfair to the noble Lord not to consider his Bill as it stands, I propose that we overlook the fact that it is no longer relevant and go into some imaginary situation. Let us suppose that Europe tires of the Franco-German domination enshrined in the 13russels' institutions; let us suppose that the European Union in its present form explodes, as a result of the attempt to introduce a single currency or other scenarios. Let us suppose then that we would clearly have to make, as other countries would have to make, a new series of treaties to regulate relations between European countries. Would we, if we had to embark upon that process, want Parliament to he involved?
There the noble Lord has a good case, because one of the lessons, perhaps, of what has happened in the diminution of this country's democracy, has been a lack of attention, except intermittently, to the positions being created by the exercise of a treaty power.
Even supposing that the Government on that future date were a government of extraordinary competence, intelligence, and far—sightedness, so that all the treaties they proposed were admirably suited to the problem,
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there is still the argument that the public discussion and debate in a legislature of a treaty has an important educative function.
The country which seems to me to he much more interesting in that respect than the countries of the European continent, where parliaments, though they may be formally associated with the treaty-making power, have in many instances a rather restricted command of the political scene, is the USA.
The record of the role of the American Senate in the treaty-making power of the USA is, perhaps, from our point of view a mixed one. It was, after all, the need to obtain legislative consent which prevented the USA from joining the League of Nations. Many people would think that that was perhaps one of the root causes of the subsequent instability of Europe and the world. On the other hand, it was the debates in the American Senate about the North Atlantic Treaty that helped to bring America into the position of the guardian of Western interests in which it remained for the duration of the Cold War.
Whether it means that one cannot do something which perhaps in retrospect one should have done, or whether one takes the advantage of public discussion, one would have to look in depth at America's experience rather than the experience of other countries on the Continent. Although in some cases, of which perhaps the German Federal Republic is at the moment the most obvious, there is clearly an inherent power in their legislature, perhaps partly because it is a federal one.
When we look at the Bill in that respect it seems, on the whole, to classify correctly the kind of treaties where it would be especially desirable for the approval of ratification to rest with Parliament. I am slightly surprised that in Clause 3, which sets out the treaties where it is thought that positive approval should be sought, the noble Lord refers to the secession of UK territory among those examples. It is of course true that there is a foreign country with which we are endeavouring to act which in its constitution lays claim to an important part of the UK. That is an exception which we may hope will vanish in due course.
I am surprised though that the noble Lord did not include possessions of the British Crown overseas. It is much more likely that some government might be pressured to have a treaty ceding the Falkland Islands to Argentina or Gibraltar to Spain. I should have thought that in those cases the need to secure the assent of Parliament would be essential.
The noble Lord referred, in relation to the Australian proposals, to the need for a select committee of some kind. Clearly Parliament, as at present organised and constructed, especially the other place, is not particularly well suited to the kind of detailed work which the scrutiny of an important multilateral treaty would demand. Therefore there would clearly have to he a procedure which would involve a committee, with perhaps committee hearings on the American model. It may be desirable, given the distribution of experience as between the two Houses, that it should be a joint committee of both Houses of our Parliament.

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There are many interesting hares which the noble Lord has raised which one could pursue. I rather like being propelled into this kind of imaginary world. Together with other noble Lords, we owe some thanks to the noble Lord, Lord Lester, for having put us on that road.
8.47 p.m.
Lord Kennet: My Lords, the noble Lord, Lord Beloff, had many wise things to say in the second half of his speech, and I agree with them. But in the first part of his speech, he contended that this is all pure theory and not practical politics. He had the argument upside down. Let us suppose that at the time of the signature of the Treaties of Rome and Maastricht this Bill had been law, would he not have welcomed the opportunity to state his views, (had he been in the British Parliament at the time of the first treaty) as fully as he has done now, and also the opportunity of putting them to the vote to see which way this country would have gone?
If that had been possible, we should have been spared, I believe, 25 years of destructive and exhausting political strife within both the major parties, which became necessary just because Parliament had not had the opportunity to sort out its views when it would still have had an effect.
Lord Beloff: My Lords, perhaps it was my fault, but I fear that the noble Lord did not appreciate my central point: if the legislation had already been in operation, it would have been of great benefit to us when questions of uniting with Europe came along. What I argued in the first part of my speech was that in fact they have now become part of the scene, and that we cannot go back beyond that: we cannot retrospectively put ourselves in a better position than we were.
Lord Kennet: My Lords, of course, no legislation—unless it deliberately does so—can do anything retrospectively, but I would not go as far as the noble Lord in accepting that we are, in effect, already a South Dakota. I do not believe we are that. There are still many international issues which can well affect the destiny of our people in major ways, which have nothing to do with the European Union.
Clearly the House must thank the noble Lord for bringing forward the Bill. If it gets through—I hope that it will—it will provide a clear advance in the ability of the elected legislature to obtain control over the totality of British government policy. In some respects the part which the legislature does not now control—namely, the introduction of treaty law—is the most important of all. Its importance is not readily visible to the whole people simply because they know so little about what is going on in international affairs. The passage of this Bill would sharply increase what the public knows. As the noble Lord, Lord Lester, pointed out, very few states do not have parliamentary ratification in one form or another. We are an anachronism in being without it and I endorse his phrase that the British Parliament is sadly neglected in the conduct of foreign affairs.
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Let us consider for a moment what would happen if this Bill were passed and how it would affect the fabric of British foreign policy and the role of Parliament towards the totality of the destiny of its people. If a proposed treaty which was under negotiation began to look a bit "dicey" for the government—began to look as though it would be unpopular with the people when it came into effect—then the Secretary of State for Foreign Affairs would have every inducement to keep Parliament in the picture throughout. Before the signature he would come back from Strasbourg, Brussels, Washington or wherever, and he would keep Parliament up to date in a narrative manner—"we have gone this far and we have gone that far"—and he would listen to what advice he could get from both Houses. This would enable him to feed British opinion—the British national will, if you like—correctly into the negotiations instead of getting it wrong, as I think everybody knows does fairly often happen.
What I have been saying is true of all treaties that this country will negotiate from now on if this Bill becomes law, but it is of course especially true of the developments from Rome and Maastricht as they come along, as they will. These are and will be the vital treaties which—here I share the view of the noble Lord, Lord Beloff—most directly impinge on British sovereignty. To put it at its lowest, I believe the passage of this Bill would allow all Foreign Secretaries from now on a much smoother ride than they have had. If it goes through, it will at last complete the control of Parliament over all those things which it began to control with increasing effect—the noble Lord will correct me if I am wrong—shall we say from the late 16th century onwards.
It would be an immense accretion—and if it had been introduced 20 years ago it would have been even more immense—but it will still be an immense accretion to the validity of parliamentary government. It will strengthen our democracy from top to bottom and will put it on a par with that of other countries. It will also lead to a great deal of public enlightenment and help us to rise out of what I myself perceive as a fairly severe degree of insularity and ignorance of world affairs which at present afflicts the British people. It is a fact that the more time you spend abroad the more you are amazed at the ignorance of foreign affairs displayed by our people, as compared with the better knowledge of British affairs that you find abroad.
I think we should go through the Bill in some detail, with a lot of probing amendments in Committee. I am not at all sure that the Bill goes far enough, particularly in Clause 4, which allows the Secretary of State to decide what he may ratify without parliamentary approval and then later face the music, or not, as the case may be. That is unjustifiable, I think. It does not take a great deal of effort to get an hour or two in both Houses of Parliament if there is a real crisis over a treaty; nor can I readily imagine a situation in which it would be so urgent to ratify a treaty. So let us try removing that one later on and try putting the entire conduct of substantial treaty-making under parliamentary control.
8.55 p.m.
Lord Bridges: My Lords, I too would like to thank the noble Lord, Lord Lester, for introducing his Bill. The subject is not one which normally attracts much attention and I rather agree when he says it is worth looking at our current practice regarding the ratification of treaties and considering the possibility of putting it on some more formal basis. I begin by examining the origins of our present procedures, which are not without interest.
The treaty-making power was originally a compact between monarchs. An emissary sent by a sovereign to negotiate abroad carried with him a letter in Latin giving him authority to act. This letter was produced and shown to the other party. It was called a "Full Power" and generally contained a promise to confirm, approve and ratify the result of the negotiations.
This practice developed rather considerably in the 17th century, particularly with the beginning of what we would now call multilateral diplomacy which preceded the signature of the Treaty of Westphalia in 1648 and which ended the Thirty Years War, and the Treaty of Nijmegen in 1697. On the latter occasion much time was spent examining the powers of the delegates, which were different. It was eventually agreed that a common form of words should be adopted, stating that the person concerned had the power to conclude the negotiation. Thereafter the Full Power given to a diplomatic representative contained words amounting to a promise to ratify the results of the negotiation.
This practice changed after the French Revolution and after American Independence. Treaties were no longer compacts between sovereign princes but became agreements between states. Thus Article 4 of the French Constitution of 1794 contained an express reservation that treaties were invalid unless they were examined, ratified and confirmed by the National Committee and the Committee of Public Safety. Just three years later, in 1797, President Adams drew up Full Powers for the American representatives in Paris and requested them to convey the agreements they reached with France, in his words,
"to the President of the United States for his final ratification, with the advice and consent of the Senate of the United States".
This was a form of words to which much thought had evidently been given.
Thus the customary promise to ratify contained in the earlier Full Powers had given way to this formal and specific reservation. We in Britain followed suit a few years later. When a Full Power was drawn up in 1824 for the signature of a treaty in Latin America, the Foreign Secretary, Canning, himself deleted from the draft the customary promise to ratify, and minuted this in the margin:
"It is necessary, or may it not be expedient, in so singular a business as this, to omit this strong promise and rather to say that when ratified by us we will never suffer it to be infringed, or something of that kind."
I wonder what Sir Richard Scott would make of that!
So in broad terms the current practice of regarding ratification as an act quite separate from negotiation developed with the growth of parliamentary
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democracies in the 19th century. At the same time it was generally agreed in Europe, but not in the United States, that the only substantial grounds on which a sovereign or president could refuse ratification was when a diplomatic agent exceeded his instructions; and that when this happened a clear statement of the reasons should be given. Palmerston said that in Parliament in 1864. But that, too, gradually gave way to a different concept, closer to the American practice where the absolute right of the Senate to make its own decisions on ratification was insisted upon. Thus we arrived at the current situation, where ratification is often perceived as part of the process of democratic control by national parliaments which the noble Lord, Lord Lester, wishes us to adopt in a more specific form in his Bill.
My impression is—and I am sure that the noble Lord, Lord Beloff, will correct me if I am wrong—that the origin of the movement in this country for more democratic control was the cession of Heligoland to Germany in 1890. That was done in recognition of the growing power of the German Reich, the desire to avoid unnecessary friction with Germany and the realisation that it would be difficult to defend that particular piece of real estate so close to the German coast.
The treaty was drawn up and ratified by the Sovereign but Parliament was not consulted. Some Members of another place did not like that use of the Crown prerogative. I understand that Mr. Gladstone himself raised an eyebrow. Those anxieties were, with good reason, greatly magnified when it was discovered at the outbreak of the war in 1914 that secret negotiations had taken place with France about the military help that we could provide in the event of German attack upon her. There was also widespread dismay and resentment at the extent of the secret undertakings made by all the great powers which had created the fatal network of obligation, misunderstanding and miscalculation which led to the outbreak of war.
That feeling was very strongly held in the centre and Left of British politics. It led to the resignation of Lord Morley in August 1914. The apostle of democratic control was E.D. Morel, and Arthur Ponsonby was one who thought likewise. He took the opportunity of the ratification of the Treaty of Lausanne, negotiated by a different government, to expound what we know as the Ponsonby rule.
The latter is not really a rule at all; rather it is a unilateral statement of intention by a junior Minister which has come to be our accepted practice, although not binding in any formal sense. It has worked rather well, I believe. Important treaties are brought before Parliament for discussion and, where necessary, to make changes to our own law. Also, if desired, specific reservations can he made on the text.
I heard the complaint made by the noble Lord, Lord Lester, that we adopted the European human rights convention without debate, but I suggest that that occurred because the convention was not perceived, at the time, to present any difficulties: its principles were widely accepted in this country, and much of the language had been drafted by our own lawyers. It could have been debated if there had been public interest in

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doing so. It is, however, news to me that we have adopted Protocol 11 on the permanent right of individual petition to the court. Perhaps the Minister would be able to tell us about that.
There are a number of specific matters raised by the text of the Bill upon which I should like to comment. First, if I read Clause 2 correctly, every treaty must be submitted to the House with an Explanatory Memorandum. I suspect that that would mean a lot of paper. It would help to know the volume of the treaties which would be involved. I heard the noble Lord, Lord Lester, say that he thought that the procedure would only cover a dozen treaties, but perhaps I misunderstood what he said. Indeed, I would expect the number to be rather more.
I turn next to the definition in Clause 3(1)(a) which is very widely drawn. I would suppose that that would cover the majority of international agreements. If I am right, that would mean the passage of a considerable number of resolutions by Parliament. That being the case, as has been correctly pointed out by the noble Lord, Lord Beloff, it would probably he necessary to set up a Select Committee, either in both Houses or, indeed, a joint committee.
Then there is the question of the class of treaties about which we are talking. I do not believe that the Bill defines in any exact way the treaties to he covered. I have heard that there is a Vienna Convention which contains such a definition. If it is satisfactory, that might he included in the text. But I suspect that this is not a straightforward matter. Agreements take different forms in various countries and so do their procedures for ratification. As the noble Lord, Lord Lester, reminded us, the United States has a category of Executive Agreements which do not require ratification by the Senate, and thus do not have any binding status in American law.
An example of that which I happen to know about is the bilateral agreement on civil aviation between the United Kingdom and the United States, called Bermuda 2, which I helped to negotiate some 20 years ago. Although that is important for many commercial airlines in both countries (thus falling within Clause 3(1)(a) as proposed by the noble Lord, Lord Lester), it has not been ratified by the United States because it is an executive agreement. Thus, if we are not careful, we might, as in this case, give the American airlines rights here which our own companies might not enjoy in the United States. I think that we may need some further thought and clarification about the classes of treaty which require ratification and how that might best he expressed in a Bill.
One other potential problem exists; namely, the practice of requiring what amounts to a second round of negotiation in order to secure the ratification of a treaty by a particular foreign legislature. There have been many examples of this over the years and it may, perhaps, be unavoidable if democratic control is to be fully exercised. But I do recall difficult times in Washington in the 1970s when it was necessary to persuade Congress to ratify commercial agreements on trade issues, after those agreements had been painfully
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negotiated with the Administration. Further concessions often had to be made in order to secure the approval of Congress. In effect, the foreigner had to pay twice. I hope that we do not fall into that practice if we do formalise our procedure for ratification.
Something rather similar happened in Germany recently when the Bundestag ratified the Maastricht Treaty. The Bundestag passed a resolution requiring further debate before part of the treaty could enter into force. One might say that the Bundestag unilaterally inserted an opt-out clause of its own. I have long believed in that excellent German concept, Vorsprung durch Technik, but here they seem to have found a method of how to half ratify a treaty. That is also an example which I believe we should seek to avoid.
I do not wish to suggest that any of those matters cannot he dealt with in one way or another. However, if we are to proceed, I think that we need some more thought and clarification of them. As I said at the beginning, I have some sympathy with what the noble Lord, Lord Lester, proposes, but we should remember that we have at present the benefit of a system which I believe works rather well. In particular, we do not suffer from the immensely long and convoluted procedures over ratification that I have seen in other legislatures. This can take years, and I do not exaggerate. Nor do I agree with the rather disgraceful article which appeared in the Financial Times last Saturday, which comes close to accusing the Foreign Office of old style, secret diplomacy, a charge which I think is wholly unjustified. That is a rare and regrettable lapse by that newspaper. Perhaps the noble Baroness will have something to say about that.
The best advice on this subject was given to us by none other than Mr. Arthur Ponsonby in his celebrated speech on 1st April 1924. He said:
"I would however remind the House of the paradox that, under the British Constitution, it is rules that depend solely on practice and usage which are the most immutable. A change effected by Acts of Parliament is not likely to last so long as one effected by Ministers as a change of practice, and dependent only on the will of the Members of the Legislature for the time being".
As his procedure has now lasted for 70 years, that was a prophetic remark. As the French proverb has it, rien ne dare contrite le provisoire.
9.8 p.m.
Lord Wallace of Saltaire: My Lords, I am very grateful to my noble friend Lord Lester for raising this debate. As the noble Lord, Lord Bridges, made clear, we are talking about a remnant of the medieval or at least very early modern, British monarchical constitution. It makes nonsense of the principle of the doctrine of parliamentary sovereignty that the Crown retains the right to sign and ratify treaties without submitting them to Parliament.
A number of very good points have been made about the difficulties now of defining treaties. As a former student, I hesitate to disagree with the professor who first taught me about the Ponsonby rules, but I must point out to the noble Lord, Lord Beloff, that some states within federal systems do indeed sign at least international agreements. The state of California has

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caused much difficulty to the British Government over a number of its international agreements in the past few years, and some of the provinces of Canada operate relatively autonomously for all kinds of purposes in international activities.
The noble Lord, Lord Bridges, is quite right to say that there are many agreements which are not quite treaties which have effects that go deep into domestic politics.
I am struck by how much more, day by day and week by week, the operations of the British Government are bound by such multilateral negotiations, not only involving the Foreign and Commonwealth Office but also many other departments of state. Indeed, increasingly they involve other agencies of the British Government. Some years ago I spoke to a conference of military officers and others and had touched on some aspects of this subject. I was told quietly over coffee by the chief constable of a provincial force that his force had just signed an agreement with its French opposite number on the conditions under which they might carry arms on each other's territory. I asked him how that had been reported to Parliament. He said, "We asked the Home Office about that, and they said they would prefer not to know officially".
There is a whole range of agreements which bind us. The problem is that if governments—not only our Government but many other governments—agree matters which are not explained to their parliaments particular suspicions grow up that bureaucrats are imposing roles which we do not ourselves understand. Usually it is assumed that they are foreign bureaucrats, although often it is British bureaucrats responsible to British Ministers who are actively engaged in negotiations.
I recall many years ago when I acted as adviser to the Treasury Committee of the other place having to explain to Members of the other House that we had signed a number of treaties of which they appeared to be unaware and which had certain consequences of limiting our freedom of action. Much of the discussion of the European Convention on Human Rights takes place in the same context—the sense that somehow or other the British Government ought not to have accepted this vast incursion into our natural sovereignty.
Perhaps I may again disagree politely with the noble Lord, Lord Beloff. He suggested that the majority of judges in the European Court of Human Rights follow a code of law which is wholly foreign to this country. I believe that I remember correctly. I suspect that the noble and learned Lord the Lord Chancellor and other Scottish lawyers might disagree with such an English statement.
The extent to which we have a widening gap between the unavoidably multilateral processes of Government and the continuing national discussions of Parliaments raises a real problem. From time to time it leads to an outburst of parliamentary or press anger or of popular frustration at things which are said to have been agreed in our name and about which
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we have not been informed. Now that we have within the European Union not only the first pillar of the European Community, but the second pillar of common, foreign and security policy, and the third pillar of justice and home affairs, the number of agreements and semi-treaties into which our Government and others are entering which are not reported back to national parliaments concerns me very much.
As regards the third pillar, the extent to which the British Government and their colleagues have gone deeply into co-operation among intelligence services and police forces, and other agencies of Government such as Customs and Immigration, ought to be more fully reported to this House and another place.
Academics of my profession now write of governments playing two-level games—of negotiating with each other, and then having to negotiate with their domestic audience. The noble Lord, Lord Bridges, pointed out that in the United States that is an explicit two level game as it is for some purposes in Germany. In this country it is only an implicit two level game because it does not evolve through a regular constitutional process. The Bill proposes that there should he a more regularised constitutional process. It is not a radical reform; it is rather a prudential measure to make the British Parliament more self conscious of the limits to sovereignty, of the advantages to Britain of operating through multilateral rules, and of the obligation which Ministers are accepting in our name. It imposes on Ministers of whatever government the obligation of explaining to Parliament what they have signed and why they have signed it.
Several noble Lords have remarked on the sheer weight of paper and the sheer number of agreements in which that might involve us. There seems considerable merit in the idea of a committee of both Houses monitoring those agreements. We all understand that in the next few years the weight of multilateral agreements encompassing this country is likely to increase as issues of international environmental law, climate change, and so on, add to all the other areas on which governments now have to accept further limitations on what was formerly their sovereignty.
This proposal suggests one step in that direction. It is a step that will help government, not hinder them. It will work to limit popular and parliamentary suspicion and, one would hope, therefore to carry greater public support. Not only in Britain, but in other countries across the world—from the United States across western Europe—we find increasingly the problem of a populist backlash against the growth of international co-operation—politicians who set themselves out to be outsiders and argue, "Your government have betrayed you. Your government should not have accepted the latest World Trade Organisation agreement, the latest European agreement", or whatever it might be. There is a real danger of a populist backlash, a nationalist backlash, against which prudential Government should guard.

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Greater openness in governments explaining to their parliaments what they have agreed in their name would help to limit that backlash.
9.23 p.m.
Lord Bruce of Donington: My Lords, I support the Motion for a Second Reading of the Bill which has been so ably presented by the noble Lord, Lord Lester of Herne Hill. As he indicated, this is a modest Bill and may not affect more than 10 or 12 treaties per annum. Nonetheless, it is very important.
I am most encouraged. I regard the Bill as one small effort to claw back from the Executive the powers of Parliament which have been taken away from it either by the existing domestic establishment, which regards the people as an occasionally convenient instrument of popular support, or by those in Brussels who seem to regard themselves as rather beyond the normal hoi polloi of human life and existence.
I welcome this first step. Unlike the noble Lord, Lord Beloff, I am more of an optimist because I recall—I have it on the authority of one of the most learned Lord Chancellors that we have had for a long time, the noble and learned Lord, Lord Hailsham of Saint Marylebone—that no government can bind its successors. Succeeding governments can overturn anything that a previous government has done. Ultimately, Parliament remains supreme because all members of the Government are taken from it.
I do not know that there will be any resistance because I have not had the advantage of seeing the notes of the noble Baroness, Lady Chalker. However, for the life of me I cannot understand why there should be any resistance, particularly after the observations that fell from the lips of her colleague dealing with the Scott Report. He promised in specific terms that Parliament, including its Select Committees and the public, would receive as full information as possible about the policies, decisions and actions of the Government. We were going to have far more open government. Perhaps the noble Baroness will agree with the Bill, in which case she has my felicitations in advance.
We all know that most Ministers—let alone Members of Parliament—do not even know what is in the treaties that their Government sign. We had the immortal example of the Chancellor of the Exchequer who admitted that he had not read the treaty, even though it was passed by the Cabinet. On the basis of personal experience I am bound to say that the number of Ministers who have detailed, comprehensive knowledge of the Treaty of Maastricht, for example, could almost he numbered on the fingers of one hand.
I am not so much concerned with ourselves. We are a breed that is presumably about to go into extinction, but we can at least utter a few dying words before we depart. It is in the interests of the people of the United Kingdom and the Government that as much information as possible is made available initially to Members of Parliament and, after them, the public. I see the requirements set out by the noble Lord, Lord Lester, as being a modest step in that direction. I hope to revive
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the enthusiasm of the noble Lord, Lord Beloff, in due course, but with him we may well take advantage of the Committee stage of the Bill to make some surprising suggestions, particularly as they affect the multilateral treaties to which one of the parties may be the European Union. That opens possibilities for discussion of some of the issues that are important to our country today.
It has been complained—though not overmuch or tendentiously—that we should have regard to the volume of paper likely to be involved if the seven or eight treaties complied with the procedures set forth in Clauses 2, 3 and 4 of the Bill. If it takes that many quires of paper to explain the treaties, it is clear that the interests of people in the country will be affected in one way or another, otherwise they would not need such detailed explanation.
When it comes to bulk of legislation, let us be adult. Week by week by week, I examine tons of paper that come from the European Commission, including its proposals, including the explanatory memoranda added by the Government—explanatory memoranda which I am quite confident in some cases, because I have a great affection for individual Members of the Government, they cannot possibly have agreed with or, if they did agree, they certainly did not understand. The explanatory memoranda issued with some of the draft legislation and proposals that cascade into the British Parliament week after week is something that has to be seen to be believed.
That suits the Establishment, although I do not mean all members of it. I do not include the noble Lord, Lord Bridges, in that category; he has the advantage of a long history. The fact is, it suits the Establishment and it suits the Civil Service for there to be such a cascade of material that people cannot even find time to read it. Over the past 20 years, in particular, the powers of the British Parliament have been progressively taken away, either by delegated legislation or by legislation from continental institutions. That has to be reversed.
I can remember a time during the war when Parliament was held in very high regard. It was at one with the people, regardless of what political party was represented there. Parliament was held in very great respect indeed. Some of our statesmen in those days held it in very high regard. Not any longer.
Our task here—and my task for the remaining years during which I may be privileged to address this House—is progressively to increase the power of Parliament; to claw back some of the powers that we have lost in order that we can really represent the people whose interests we are supposed to safeguard, however small and insignificant they may be, however literate or otherwise they may be, however poor or wealthy they may be. That is our trust. And trust is based upon truth. It does not speak with a forked tongue. The quicker we get some facts from the Government about the legislation they propose to pass or the treaties they propose to enter into, the better it will be for the country as a whole and its future.
9.28 p.m.
Lord Howe of Aberavon: My Lords, attractive though the prospect might be of following the noble Lord, Lord Bruce of Donington, and indeed my noble friend Lord Beloff, on the powers that they have explored, from Scott to South Dakota, I shall refrain from that pursuit. Indeed, I hesitate to join this debate at all because of my own past record. As I told the noble Lord, Lord Lester, when first he discussed this Bill with me, I must be on record myself with enough words in another place commending the existing system to make it embarrassing for me now to enlist under the noble Lord's banner. So I speak with some hesitation.
I remember, at the Second Reading of the European Communities Bill, when we made the very first move down that road, spending almost a complete 24 hours under the never-exhausted chairmanship of Sir Robert Grant-Ferris, as he then was, before we even completed the points of order on that ratification process. My noble friend Lady Chalker will no doubt recollect sharing with me the burden of securing the enactment of the Single European Act in a more beneficent era, when our noble friend Lady Thatcher was happy to impose a guillotine in support of the swift enactment of those pan-European measures. Therefore I approach this modest measure pretty warily. However, there are some arguments in favour of giving it serious scrutiny. First, it is introduced by the noble Lord, Lord Lester, for whose perception and dedication to justice in this field I have high regard. Secondly, the Bill has the merit of being compact and clear. I also have enthusiasm for simplicity in legislative draftmanship. Thirdly, it appears to have limited objectives, essentially the provision of an explanatory memorandum, which is not unimportant, to back up the parliamentary approval procedure, with a sensible provision for exceptions in exceptional cases.
Parliaments elsewhere in the world have been increasingly involved in the approval of treaties in this way, notably even the European Parliament, although to some extent that may have been conceded to it as a relatively harmless addition to its diet. But there are arguments against the Bill which deserve scrutiny. First, it can be said that the Ponsonby Rules, if not more flexible, are certainly flexible enough to provide for effective parliamentary review of any significant new treaty obligation. The noble Lord, Lord Bruce of Donington, with his clamour for the clawing back by Parliament of powers long since departed, has an exaggerated view of the diminution of parliamentary authority. Anyone who has been concerned with any major measures enacting European legislation can hardly feel that he is sailing along smooth parliamentary seas. Both Houses of Parliament have a notable power for getting their teeth into significant changes which inflict treaties upon this country. One should not be too concerned about it.
The other argument that deserves some scrutiny—and worries me—is that there is a risk that the procedure proposed by the noble Lord, Lord Lester, may extend the amount of parliamentary time that perforce has to be added to the process of approving treaties. It appears to introduce a necessary separate stage. That is not decisive, although as a former Leader of the House of
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Commons I am always anxious not to have inescapable burdens of parliamentary procedure imposed upon our procedures. I would be content for this Bill to be examined with sympathy if it was necessary to ensure the filling of any realistic gaps in the opportunity for parliamentary scrutiny. I am not satisfied that for practical purposes there are such realistic gaps, but if there are I hope that the Government will look at the Bill with sympathetic attention.
On the other hand, I hope that the noble Lord, Lord Lester, will consider how far the range of Bills to be covered by Clause 3(1)(a) may impose a double jeopardy upon the legislative process. The noble Lord, Lord Kennet, rather blithely said that the whole process would ensure a much smoother parliamentary ride for treaties and Ministers alike. I am not sure about that. My anxiety is that it will place the passage of parliamentary approval of new treaties at risk of double jeopardy. If that were the case, I would be tempted to conclude with the simple proposition: Ponsonby Rules okay. I believe that the noble Lord, Lord Lester, has presented to the House with characteristic clarity a prima facie case. I am not sure that it deserves to go forward to the next stage of its procedure, but we ought at least to consider the possibility with sympathetic care.
9.34 p.m.
Baroness Williams of Crosby: My Lords, this has been a remarkable debate and one in which we have had some knowledgeable and wise contributions. This House has reached a level of consensus which is somewhat surprising, not only across the Floor of the House. I am delighted that it includes the support of the noble Lord, Lord Bruce of Donington. I was extremely pleased to hear his support for the Bill.
In presenting the case for this Bill, my noble friend Lord Lester outlined the very strange situation in which the United Kingdom finds itself in comparison with not only most other European countries but most other Commonwealth countries as well. He commended to the House the report of the Australian Senate. The report of that senate, which went in great detail into the whole issue of the ratification of treaties and the approval of that ratification by parliament, dealt with some of the issues raised in this debate, in particular, by commending very strongly the idea of a joint select committee of parliament. It dealt with some of the issues which concern the noble and learned Lord, Lord Howe of Aberavon, in reminding us that there could be heavy demands on parliamentary time.
The establishment of a joint committee of the two Houses of Parliament would itself go a very long way towards ensuring that there is proper scrutiny of treaties and that the Houses themselves have commended to them those treaties which deserve further observation and further debate. Many of us in this House and the other place would feel much more content if we knew that treaties were being carefully investigated in that way. It is already the case that the Select Committee on the European Communities deals with many of the directives which come forward from that quarter and

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which, as the noble Lord, Lord Bruce of Donington, pointed out, already involve a very considerable burden of scrutiny on that particular committee.
The burden of the treaties, to which my noble friend Lord Lester referred, is considerably less. According to a Written Answer the number of treaties needed to be ratified subject to the Ponsonby Rules—in other words, laid before Parliament—is only 72 since 1st January 1991; an average of just over 14 treaties a year. If my noble friend's example of an explanatory memorandum holds good, that would involve only a minute proportion of the kind of weight of paper that arrives in this House every week of the year as a result of secondary legislation in the form of regulations.
I should like to refer to a matter put to the House by the noble Lord, Lord Kennet, and my noble friend Lord Wallace of Saltaire; namely, the growing significance of treaties as a proportion of the legislation passed by Parliament. There are not only the treaties that we have referred to in respect of global dealing with environmental problems, and with other problems increasingly, that require an intergovernmental response to the problems established. There is also such new legislation as flows, for example, from the Anglo-Irish Treaty—an area of intense interest to this House and another place—which is nevertheless in the form of a treaty rather than domestic legislation; involving, as it does, more than one government. There are many other illustrations that I might bring forward of the way in which treaties between governments are becoming more and more crucial to the exposition and discovery of the objectives of domestic policy in all the countries of the European Union and, indeed, beyond.
If I may say so, this is intended to he a modest Bill. The noble Lord, Lord Kennet, asked whether Clause 4 allowed too great a degree of discretion to Ministers in enabling them to go ahead with urgent treaties, with an explanation to the House of why they felt obliged to ratify without going through its procedure. But that was deliberate on the part of my noble friend. He wants to ensure that there can be no reasonable objections to the modest Bill that he proposes to the House this evening.
The noble Lord, Lord Beloff, brought forward a rather strange argument—the argument that because, in his view, democracy had been limited by our membership of the European Union, it was appropriate to limit it still further by not taking the powers proposed in this Bill. I found that a strange argument. I found it even stranger that he was not willing to consider the position put forward by my noble friend Lord Wallace of Saltaire that in many ways today the German federal constitutional structure—the German Federal Government—has considerably greater influence over the pattern of the treaties of the European Union precisely because the national parliament has insisted upon debating the treaties and in some cases even attaching conditions to the passage of those treaties. The example that springs to mind is the requirement by the German Bundestag that there can be no ratification of a new treaty involving the setting up of the European Monetary Union without the full approval of the German Bundestag—incidentally, something that did
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not apply in the same way to most of the other countries of the European Union. It is an example which shows that both national parliaments and the European Parliament can be given greater responsibility and accountability by working together rather than fighting one another over the shrinking area for which they are found to be responsible.
The noble Lord, Lord Bridges, gave us a fascinating history of earlier treaties and raised some specific problems with which my noble friend Lord Lester will deal, but perhaps I can again mention, first, that the burden of treaties is a relatively limited one, at least up to now; secondly, that an explanatory memorandum can be brief and clear; and, thirdly, that the proposal for a Select Committee of both Houses on the lines of that proposed for the Australian Senate would go a long way indeed to give the House the assurance it needs without involving a heavy demand on parliamentary time of the kind about which the noble and learned Lord, Lord Howe, expressed concern.
Perhaps I may make one or two brief references to the suggestions made by my noble friend Lord Wallace of Saltaire and the noble Lord, Lord Kennet, regarding the extent to which we might widen the educational understanding of this country in international affairs if treaties were required to be ratified by Parliament. That seems to me to be an extremely important point; that is, that Parliament might create its own backlash against treaties signed in its name.
Perhaps I can give a precise example of what we have in mind. The danger of backlash can be met to a great extent by what the architect of the German constitution, the famous Karl Joachin Friedrick, referred to as the "law of anticipated reactions". He said that in drawing up treaties governments would be constrained by the very fact that those treaties had to be approved by the legislature and would therefore bear in mind the interests of the people in the very ways in which they negotiated treaties. That seems to me to be a serious and important point.
The noble Lord, Lord Bruce of Donington, referred to the accountability of the Executive to Parliament and in particular to the dangers of Executive prerogative, widening in such a way that Parliament became increasingly ineffective. I am bound to say that I have some sympathy with his point. Parliament has allowed itself to be sidelined, though it must be said that perhaps earlier this week and last week were good examples of the way in which Parliament is once again beginning to reassert its independence and its conscience.
I conclude by referring to the speech of the noble and learned Lord, Lord Howe of Aberavon, and perhaps I can again draw attention to the point made by the noble Lord, Lord Beloff, and my noble friend Lord Wallace of Saltaire. I refer to the extension of the European Treaty into what were called the second and third pillars; the common, foreign and security policy being the second pillar and the third pillar with its concern and interest in matters of internal security.
Accountability, particularly in the case of the third pillar, falls between the two stools of national parliaments and the European Parliament. There is no

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adequate accountability, as my noble friend Lord 'Wallace pointed out, for matters concerned with the issues under the third pillar. Yet it is the treaties under that pillar that most demand to be carefully scrutinised, for in many cases they directly affect the liberties of individual citizens of the European Union.
I therefore believe that my noble friend's Bill will bring those matters to the attention of the House; will hopefully bring them to the attention of a Joint Select Committee of this Parliament and in so doing will go a considerable way to try to provide democratic accountability and scrutiny over an area of policy that is important, that is widening, and that is insignificantly scrutinised by a democratic institution. I am proud to support it.
9.45 p.m.
Baroness Blackstone: My Lords, like other speakers, I should like to begin by thanking the noble Lord, Lord Lester, for introducing this Bill. I admire his initiative not just in identifying a gap in our procedures, but also in undertaking the historical research on the Ponsonby Rule and how it is operated, and other matters, and in investigating what happens in other countries as well.
I have to admit that, unlike other speakers, I am no expert on either parliamentary procedure or international law. I am not sure whether that is an adequate excuse for my failure to have noticed that there is in fact a democratic deficit with respect to consideration of treaties by Parliament. I am very grateful therefore to the noble Lord, Lord Lester, for drawing it to my attention and for drafting this Bill which, if enacted, will help to rectify it.
There may be details in this Bill on which further work is needed. I believe the noble Lord, Lord Beloff, drew our attention to one or two omissions and, with the noble Lord, Lord Bridges, to some problems of definition. However, the arguments of the noble Lord, Lord Lester, are in my view persuasive on the need for changes to our procedures in order to deal with this democratic deficit.
We have had an extremely interesting debate on this Bill this evening; in fact, it had some of the qualities of an academic seminar, but perhaps I may say to the noble Lord, Lord Beloff" that I do not believe that it has been impractically academic in any way.
We are debating this Bill in the same week as a major debate in this House and in another place on the Scott Report. As my noble friend Lord Bruce of Donington has already indicated, in that debate the Government accepted the need for a number of changes in both Whitehall and Westminster governing the export of arms. Some of these changes concern greater openness and transparency, including the consideration of policy guidelines and how they are arrived at in Parliament and reporting to Parliament on their implementation.
In acknowledging the importance of ministerial accountability to Parliament in this area, like my noble friend and the noble Baroness, Lady Williams, I hope that the Government might also be willing to accept that there needs as well to he an improved system in place for the Executive to obtain parliamentary approval in
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this rather different area of multilateral treaties which is before us today. I very much look forward to the Minister's reply and in particular ask whether she can throw some light on the number of treaties likely to come before Parliament each year, if this Bill were enacted, and on which there appears to be some dispute this evening.
Quite rightly, the noble Lord, Lord Lester, drew our attention to the fact that most treaties today have considerable ramifications for domestic policy. They are rarely about alliances which commit us to send gunboats or their modern equivalent. They are instead about a very wide range of matters which he mentioned at the beginning of his speech. In the past treaties largely about military alliances and diplomatic relations had relatively little direct impact on people's lives because for the most part they never had to be activated. By contrast, many of today's treaties reach deeply into our daily lives and do so on a continuing basis—in other words, treaties which cover such subjects as environmental protection, have an ongoing effect from the very day on which they are ratified. Because of that they are obviously not a matter for governments alone and should be approved by Parliament even if it means that there is a bit more paper—to use my noble friend's term—cascading" into both our Houses.
Moreover, as the noble Lord, Lord Lester, has pointed out, our membership of the European Union means that there will be an increase in the number of treaties likely to require ratification. In that context, it is interesting, (is it not?) that there appears, as the noble Lord, Lord Lester, has already said, to be no other European country which excludes Parliament from the treaty-making process in the way that Britain does.
I was a little surprised that the Foreign and Commonwealth Office was unable to answer the noble Lord's Written Question on the practice of other countries. Perhaps the Minister could confirm tonight that we are out of line with the rest of Europe in that respect. If we are out of line and the Government are prepared either to accept the Bill or to introduce their own legislation to rectify the situation, we may be faced with one of those rare occurrences where Euro-philes and Euro-sceptics can agree. Those in favour of greater integration will presumably welcome the UK coming into line with other European countries on this matter and, despite the argument of noble Lord, Lord Beloff, which I too found a little perlexing, those who are against it may favour more opportunity for Parliament to consider European Union treaties and, indeed, treaties that may be made with other parts of the world. Incidentally, I was delighted to find myself in agreement with my noble friend Lord Bruce of Donington. On many such matters he is usually on the side of the noble Lord, Lord Beloff, rather than on mine.
When my attention was first drawn to the need for this Bill, I was concerned about potential delays in getting agreement to important treaties. However, my anxieties have been allayed by subsections (1) and (2) of Clause 4, where the Secretary of State is able to cite exceptional circumstances requiring rapid ratification of a treaty, and therefore the bypassing of the Act. It is right that, as the Bill proposes, reasons for urgency

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should be given to Parliament. Therefore, I am afraid that I am not in agreement with what my noble friend Lord Kennet said on that.
The Minister may say that all treaties which require domestic legislation are considered by Parliament anyway. She may also, following the noble Lord, Lord Bridges, say that the Ponsonby Rule (under which, as we have already heard, treaties subject to ratification are left on the Table for 21 sitting days after which they are ratified) provides for satisfactory parliamentary scrutiny. However, I think that the noble Lord, Lord Lester, has made the case for rejecting the view that those provisions are entirely adequate. I do not need to repeat all his arguments.
I have looked at the Report of the Senate Legal and Constitutional References Committee of the Australian Parliament, to which the noble Lord, Lord Lester, and the noble Baroness, Lady Williams, have already referred. It is an interesting report, and I commend it to the Minister if she has not already seen it. However, I am not entirely clear about what the position of the Australian Government now is. Have they indicated that they will accept the recommendations? I assume that they have not yet decided. If, however, Australia goes ahead, the UK will become even more unusual in its failure to provide for proper parliamentary scrutiny and approval of treaties in law.
The noble Lord introducing the Bill has made a very persuasive case for it. Perhaps the Minister will make an equally persuasive case for rejecting it. On the face of it, I believe that she will find that difficult, but I greatly look forward to hearing the Government's position after a debate in which, apart from the noble Lord, Lord Beloff, who opposed the Bill, there has been considerable support for it—in fact, from noble Lords on all sides of the House, including interestingly from the noble and learned Lord, Lord Howe, who, as a distinguished former Foreign Secretary, has more experience of these matters than most of us speaking tonight. Like the noble and learned Lord, I hope that the Government will look sympathetically at the Bill.
9.59 p.m.
The Minister of State, Foreign and Commonwealth Office (Baroness Chalker of Wallasey): My Lords, the noble Lord, Lord Lester of Herne Hill, has brought an interesting Bill to Parliament tonight. It has been a fascinating debate for those of us concerned with procedure and concerned to see greater openness, as are those of us on the Government Front Bench.
It was interesting to see the new alliances that have been formed tonight between the noble Lord, Lord Bruce of Donington, and the noble Lord, Lord Lester of Herne Hill. I felt sorry for the noble Lord, Lord Kennet, who was rather out on his own in the debate tonight. He may he a supporter of the Bill but he was not arguing from quite the same basis.
Lord Kennet: My Lords, may I ask the Minister to specify the respect in which I was out on my own?
Baroness Chalker of Wallasey: My Lords, I will not be drawn down that path. I will read tomorrow what the noble Lord said but, as I understood him, he was not quite on the same wavelength, as his noble friend Baroness Blackstone has just said.
It was amazing to see that the noble Lord, Lord Bruce of Donington—who is a great friend of my noble friend Lord Beloff—found himself, for totally different reasons, in a similar position to the noble Baroness, Lady Williams of Crosby.
Then came my old boss, if I may affectionately call him that, the noble and learned Lord, Lord Howe of Aberavon. As always when listening to him—and when we read his remarks in Hansard—we understand that while he too is very much in favour of openness, he can see some downside risks in the Bill. That does not mean to say that its intent is not perfectly worthy, but he can see some downside risks and I believe that he gave us some valuable advice tonight.
The Bill provides that no treaty shall be ratified by Her Majesty's Government without its first having been approved by Parliament. The Government share the noble Lord, Lord Lester's concern that the international obligations of the United Kingdom should be the subject of a proper scrutiny by Parliament. The real question—which I am not sure that we have yet answered in the drafting of the Bill—is what is the best way for this to be carried out. We may need more thought and clarification on that.
The present arrangement for parliamentary consideration of treaties is flexible. It provides for proper opportunity for debate and, as the noble Lord, Lord Bridges, said, the system works rather well. It has worked remarkably well considering its age—but then, in this House, I am a great respecter that good things last a long while.
The Bill worries me because it would introduce fixed procedures which could impinge upon Parliament's timetable and yet do little to further the democratic scrutiny of international agreements concluded by the Government. Successive British Governments have long recognised the importance of ensuring that their international obligations and responsibilities are well understood, publicised, and that Parliament is kept fully informed. That is why this Government, like all governments before them since 1924, comply with the Ponsonby rule, as we have discussed tonight. Under that rule it is settled practice that treaties requiring ratification, acceptance, approval or accession are laid before Parliament for 21 sitting days before the Government deposit their instrument of ratification, acceptance or approval. It provides opportunities for comment and debate if Parliament so desires.
In addition, to the extent that any treaty would alter the law or require legislation for its implementation, it is settled practice to ensure that the necessary legislation has been passed before the treaty is entered into. This is exactly what my noble and learned friend Lord Howe meant when he spoke of the flexibility of the Ponsonby rule.

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There are special cases in which, by convention, treaties are not entered into without parliamentary sanction. Noble Lords will remember that Parliament expressly provided in the European Assembly Elections Act 1978 that no treaty which provides for an increase In the powers of the European Parliament may be ratified by the United Kingdom unless it has been approved by an Act of Parliament. That is certainly something of which the noble Lord, Lord Bruce of Donington, definitely approves.
In addition to that special case, there are five situations where treaties are not concluded without parliamentary approval, usually in the form of statute. Those are where they require an amendment to UK law; where they affect private rights; where they create a charge on public funds; where they attribute new powers to the Crown; or where they cede British territory.
There are then other cases where Parliament sanctions in advance, by general legislation, the conclusion of bilateral treaties in particular fields within the minutes laid down. Examples here are extradition treaties, double taxation treaties, and reciprocal social security benefit treaties. Here it is often provided that the terms of the treaty take immediate effect on being scheduled to an Order in Council.
I shall turn now to some of the points raised in the debate. The noble Lord, Lord Wallace of Saltaire, was worried that parliamentary sovereignty is infringed by the Crown's prerogative to ratify treaties. I do not believe that is so, because parliamentary sovereignty requires that while the Government may make treaties without parliamentary approval, it must seek approval by means of prior legislation where existing law is affected. That is why the European Communities Act was required to give effect to the Treaty of Rome. That is why on other occasions in recent years we have had some long and interesting debates in the House which I well remember.
Whenever we are talking about bringing more information to Parliament, the reason given for it, as given by the noble Lord, Lord Lester of Herne Hill, and by others today, is that there is a democratic deficit. I am not sure whether there is a democratic deficit here, because the power to make treaties is not vested in the Crown only, it is exercised by the Secretary of State for Foreign and Commonwealth affairs. He must consult those of his colleagues whose departments are responsible for implementing the provisions of a particular treaty. The authority of the Government rests upon a democratic mandate, and effective government requires the support of the majority of the Members of the other place.
While Parliament may not invariably have a formal role in the ratification of the treaties, unless it decides to debate them, it has every opportunity to scrutinise their provisions. Through Parliament, governments will always be democratically accountable for their actions. They include the making of international treaties.
I have been involved in a number of signings over the past 10 years. I cannot remember a case where, when (here was something to he questioned, it has not been questioned. Others may differ in their view on that
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matter. Others may say that the Bill is a safeguard. But I believe that this is something about which the Foreign and Commonwealth Office is a good deal more diligent, as the noble Lord, Lord Bridges, intimated, than the House may have assumed from having listened to the debate.
Baroness Williams of Crosby: My Lords, I thank the Minister for giving way, but before she leaves the section of her speech which she is now devoting to the issue of parliamentary scrutiny, will she consider the issues raised about an explanatory memorandum, given that some treaties are complex, and that that would enable the two Houses to understand much more clearly what is at stake in some of the treaties?
Baroness Chalker of Wallasey: My Lords, I shall be coming to that matter a little later, because I see the possibility of some good practice being developed along those lines. If I may, I shall leave the point until a little later.
I remember well the concern about the European Convention on Human Rights, because the noble Lord, Lord Lester, has queried matters of that nature with me previously. It is important to note that when the European Convention on Human Rights was to be ratified, long before I came into Parliament, the convention was laid under the Ponsonby rule on 23rd January 1951. Members' attention was drawn to it on 5th February 1951 in a Written Answer from the then Minister of State for Foreign Affairs, Mr. Kenneth Younger. There were no objections raised, despite the fact that that Written Answer actually invited them, and therefore the convention was duly ratified. That seems to me a very sensible way under the existing system to proceed, to notify by Written Answer that if objections are not made within the 21 days after the convention has been laid, then it will be duly ratified. That obviously does not answer the noble Lord, Lord Lester, or the noble Lord, Lord Wallace of Saltaire.
One of the things I believe we can do is to look at these cases in a positive light: that is to say, to look at these cases and see on each occasion how it has been dealt with. The noble Lords, Lord Bridges and Lord Lester, both asked me about Protocol 11 of the European Convention on Human Rights. Once again, the protocol was laid before Parliament in the normal way. The Ponsonby rule was completely complied with and an opportunity was given for debate, though none was in fact held on that occasion.
When we come to the inevitably interesting question of the ratification of European Community treaties, which was raised by the noble Lord, Lord Lester of Herne Hill—my noble friend Lord Beloff said that his most interesting speech would be a "very academic" speech—one has to realise that all treaties amending the European Community's treaties require the government to introduce legislation. I have already given the example of the European Communities Act 1972. Any proposal for one of the communities themselves to enter into a treaty is already submitted under cover of an explanatory memorandum to the Scrutiny Committees

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of both Houses, so in a sense part of what the noble Lord, Lord Lester, is asking for is actually carried out in that case.
The noble Lord, Lord Wallace, asked me about third pillar agreements, as did a number of other noble Lords. The Government have already undertaken to provide Parliament with texts of draft third pillar conventions while they are still under negotiation. I think this is very important. Normal ratifications as at present would proceed after signature, but the very fact that there is to be prior notice while negotiation is going on is certainly a step forward. I noted what the noble Lord, Lord Wallace of Saltaire, said about the liberties of citizens. May I just say to him that common positions, joint actions or joint positions adopted under the second and third pillars, while they may impose legally binding obligations, are not normally subject to ratification. That is why they do not occur under the Ponsonby rule. Also I must point out that under this Bill they would not be subject to that process either.
The noble Baroness, Lady Blackstone, asked how many treaties might come before us if this Bill were to he given Royal Assent. That is a matter which as we as answered in a Parliamentary Question, varies from year to year, some 72 treaties having been ratified between 1st January 1991 and 31st December 1995: in other words, the number is running at between 10 and 15 a session. I should also like to point out that 280 treaties have entered into force for the United Kingdom in the same period, either on signature or by a notification contained in an exchange of diplomatic notes. Of course, neither of these two circumstances would be covered by this Bill.
I believe, too, that although there may be only 10 or 15 treaties a Session requiring resolutions from both Houses, there would be a significant additional amount of parliamentary time required under the noble Lord's Bill without necessarily demonstrably contributing to the better scrutiny of the treaty-making process. It seems to me that that scrutiny should come rather earlier in the process than when one is at the final treaty stage. Undoubtedly there are problems with a number of the elements of the Bill which, if it is given a Second Reading, I am sure your Lordships will want to go into at a later stage.
I turn now to the comments made by the noble Lord, Lord Bridges, about the article in the Financial Times of last Saturday by Mr. A Hermann, and especially the comment made by the noble Lord about secrecy. After my 10 years in the Foreign Office, I am absolutely convinced that the ratification process is not secret. A distinguished noble Lord who is a former member of the Diplomatic Service will know full well the amount of quizzing about treaties which takes place.
One of the difficulties involved is the point raised by the noble Baroness, Lady Williams of Crosby; namely, that there are complex treaties. Indeed, there are treaties which, except to experienced lawyers such as the noble Lord, Lord Lester of Herne Hill, and my noble and learned friend Lord Howe of Aberavon, are not clear. But there is no question, as the writer of the article in the Financial Times said, that it is a secret matter. The
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Foreign Office has no interest in keeping secret things which can be shared. I believe that that is the right way to proceed.
A number of questions were asked about practice in other countries. Certainly the essentials of our practice on treaty making and the balance of responsibilities between the Executive and the legislature is actually common to most countries. In the majority of OECD countries, parliamentary approval is required for certain types of treaty. But in most other countries, unlike the UK, the treaties take effect directly in national law upon ratification.
In the United States, treaties are subject to presidential ratification and require approval by two-thirds of the Senate. But the American constitution also provides that all treaties made under the authority of the United States shall be the supreme law of the land and that the judges in every state shall be bound by them, notwithstanding anything to the contrary in the constitution or laws of any state. That is obviously not the case in the United Kingdom; treaties cannot and do not take effect in our law without implementing legislation.
There are countries, such as Denmark, where treaties are not self executing. Prior parliamentary approval is required for the ratification of treaties requiring implementation in national law in that country. The purpose of that is to prevent its government from undertaking international obligations which its parliament might refuse to implement.
However, it is the consistent practice of HMG not to ratify any treaty requiring implementation in UK law until such legislation has actually been passed. As regards the question put to me by the noble Baroness, Lady Blackstone, of how it affects other European countries, perhaps I may write to her on the matter because I do not have details of the situation in each country to hand at present. Those situations vary and it would take me a considerable amount of time to explain them.
We have heard a good deal tonight about the Australian constitution. Although there is much talk in Australia at present about a change in the matter, I am sure that neither there nor, indeed, in New Zealand or Canada are the treaties subject to parliamentary approval. We answered the noble Lord, Lord Lester, on that point in a Written Answer a short while ago.
I am happy to put in writing the detail about the Australian Federal Parliament, but it is a situation which has been very much akin to our own. The difficulty is that the Australian Parliament did not actually use the practice which it was afforded by its written constitution. The Parliament had 12 sitting days prior to ratification, but those concerned allowed their system to fall into disuse. They then overtook the practice that they had previously kept to by tabling treaties in bulk every six months, with the result that many treaties were tabled after ratification. That is why there has been a great debate in Australia. Your Lordships would be right and, indeed, would have every reason to complain had we followed such a practice of tabling treaties in bulk. We have not done that. If our Australian friends had

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used something like the Ponsonby rule on treaties effectively one by one they would not be in the situation in which they now find themselves.
We are very different from the Australian Government in this. We are committed to a policy of open government. The full texts of all treaties are published. We give guidance on the treaty practice and procedures. That has been laid in both Houses, and it is available to the public on request from the Foreign and Commonwealth Office.
There has been some comment tonight about lack of infon-nation to answer the questions of the noble Lord, Lord Lester. This is a recent matter in terms of the great interest that the noble Lord, Lord Lester, has brought to the subject. We have been computerising treaty records. Some 12,000 items, dating back to 1835, are now being entered on to computer. No doubt, hit by hit, we shall be able to do an analysis of them which might answer the questions that the noble Lord, Lord Lester of Herne Hill, keeps asking me. I do not know whether I can do that quickly, but it may come.
Several times I have spoken about openness and have mentioned the explanatory memorandum. It is the practice of the Foreign Office to be as open as possible to the public and, of course, Parliament. There has been a massive increase in openness in the last 10 years since I first went to the Foreign Office. I hasten to add that that has nothing to do with me, although I am very much in favour of it. Ministerial speeches and correspondence are a growing feature of government business. In 1994 the Foreign Office exchanged 11,000 letters with Members of Parliament. That is a much higher figure than ever before. We make available verbatim copies of all ministerial speeches. I have already mentioned the treaty series, which is published by the Foreign Office.
However, that may not he enough. That was the point that the noble Baroness, Lady Williams of Crosby, made. The suggestion concerning explanatory memoranda is one that is worthy of further consideration whether or not this Bill becomes law. We should try to see that suggestion in the positive light in which I know it has been proposed. I shall want to examine it further with my colleagues before giving a definitive answer, but it seems a sensible way to proceed.
Certainly, I can assure your Lordships that if an MP or one of the Select Committees ever writes asking for an explanation, not only of a treaty but of anything else, they receive one. Frequently it is in memorandum form. I can assure the noble Lord, Lord Bruce of Donington, that I will not sign any explanatory memorandum without having not only read it but also learnt to understand it. Sometimes that takes a little more work than may at first sight be apparent.
As the noble Lord, Lord Bridges, says, it is more than 70 years since Arthur Ponsonby put the case forcefully against a measure such as that which the noble Lord, Lord Lester of Herne Hill, wishes to introduce. I believe that the noble Lord, Lord Bridges, used the same quotation that I had picked out from that speech. Arthur Ponsonby said:
"Resolutions expressing Parliamentary approval of every Treaty before ratification would be a very cumbersome form of procedure and would burden the House with a lot of unnecessary business".
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Today, I would not use the word "unnecessary". It is probably quite time consuming, but your Lordships might deem it necessary.
It is clear that the Ponsonby rule, as it has been applied consistently over many years, has the great merit of allowing flexibility. My noble and learned friend Lord Howe said that the Bill of the noble Lord, Lord Lester, might impose inescapable burdens. That is a matter that your Lordships need to examine very carefully at a later stage in the Bill. We want not only the flexibility but the efficiency of the Ponsonby rule, while preserving the sovereignty and prerogatives of Parliament. Parliament has ample opportunity, whenever necessary, to examine and discuss new international responsibilities. But administrative and procedural costs must be minimised as well as making sure that the information is always available. We want parliamentary control which is effective. We want scrutiny maintained. It is not, as many noble Lords seemed to imply tonight, that the Foreign and Commonwealth Office or any other government department would feel greatly hampered by the Bill. What we must not do is to burden Parliament in such a way that Parliament cannot cope with the Bill. That is why I do not have an open-handed welcome for the Bill but a little scepticism (if I may so put it) about whether this is the best way for Parliament to go.
The Government will not seek to impede the progress of the Bill of the noble Lord, Lord Lester of Herne Hill, in this House. What we shall ask your Lordships to do is to give it strict scrutiny. It is in those terms that I welcome the debate that we have had tonight. However, as my noble and learned friend Lord Howe of Aberavon said, we should investigate the realistic gaps which may exist and see what can best be done about them.
10.21 p.m.
Lord Lester of Herne Hill: My Lords, I am extremely grateful to all noble Lords who have taken part in what for me has been a remarkably interesting debate. I am particularly grateful to the noble and learned Lord, Lord Howe of Aberavon, for his over-generous personal remarks about me and for his participation as the most experienced former Minister in this area in the House.
The debate has already been summed up by the preceding three speakers. At this late hour your Lordships will not wish me to do so again. If I do not deal with all the points raised, I hope that your Lordships will not think that it is out of lack of courtesy to anyone.
I am extremely encouraged by several aspects of the debate. First, the noble Lord, Lord Beloff, paid me, I think, the doubtful compliment of describing me as though I were a professor. I would reply that to my mother I might he a professor, but to a professor I certainly would not be. Apart from the remark of the noble Lord, Lord Beloff, at the outset of his speech, every noble Lord has spoken with the same objective. Indeed, I believe the noble Lord, Lord Beloff, has the same objective. It is that there should be effective parliamentary scrutiny combined with flexibility and

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efficiency with no unnecessary overloading of Parliament. I believe that that is the common view on all sides of the House.
Secondly, it is generally recognised that this country lags behind in practice compared with other Parliaments—that there is a democratic deficit. That deficit was brought home to me as a member of the IGC Sub-committee of the Select Committee of this House in the evidence given by such experienced people as the noble and learned Lord, Lord Howe of Aberavon, and Sir Leon Brittan who emphasised the need to enhance the role of national parliaments especially in the context of the European Union.
Thirdly, I share the distaste expressed by the noble Lord, Lord Beloff (I think that it was distaste) of the excessive scrutiny given by the American Senate in this area. The last thing that I should like to sec are telephone directory-sized explanatory memoranda, coupled with Senator Bricker style amendments, and all the other gadgets built into the American process. However, we are far from that in the Bill.
Fourthly, even though we appreciate the explanatory documents that we receive from the Foreign and Commonwealth Office and other departments, one should not overestimate the problems of parliamentarians in understanding what is going on. Perhaps I may give one brief example. We considered the Europol Convention in Sub-committee E. It was impossible to obtain an authoritative text of the treaty. It was a had English translation of a German text. The result was that we were never able properly to understand what the treaty was about. There were endless arguments about what the German text meant, and so on.
A group of extremely able experts was on the committee dealing with the treaty. I believe that lack of information provided at the right time is at the heart of the problem. Therefore, I have sought to balance the need of Parliament to he properly informed with the need of the Executive to get on with the necessary business of government and move speedily.
I take full personal responsibility for the policy of the Bill but I have been greatly assisted by advice from much greater experts than myself: Professor Maurice Mendelson, Professor James Crawford and Mrs. Eileen Denza, who is well known to this House. They all scrutinised my Bill. The definition of "treaties" comes from the Vienna Convention and I believe is correct.
The reason for including Clause 3(1)(c), dealing with the cession of any part of the territory of the United Kingdom, in that form is that the definition of the United Kingdom includes overseas dependent territories of the United Kingdom. It is not necessary to say so on the face of the Bill, it is in the Interpretation Act.
The noble and learned Lord, Lord Howe of Aberavon, raised the point on double jeopardy. It will need to be carefully examined because one does not wish to clog the business of the House or both Houses with unnecessary procedures. On the other hand, not many treaties cede parts of a territory of the UK or "lay a pecuniary burden" on the inhabitants of the UK, in the
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words of subsections 3(1)(b) or (c). As the Minister confirmed, one is talking about 15 treaties a year at most.
As a practical person who has to read too many pieces of paper in my professional life, I am convinced that it is not beyond the wit of civil servants to produce explanatory memoranda of the kind that they produce for their own Ministers. They would explain to Ministers the object, purpose and likely impact of the treaty, to brief Ministers when they come to both Houses of Parliament to explain. It seems to me that just as Notes on Clauses for Bills are widely provided to Parliament so that we can understand what is in the Bills, so it should he possible to find a practical way of supplying timely and concise explanatory memoranda. They should not be enormous documents, but well-focused and practical, provided at the time when the treaty is being laid, during the 21 days.
Your Lordships should be well aware that the negative procedure which would be the main procedure under the Bill is used by both Houses for all British delegated legislation, but using 40 sitting days instead of the 21 under the Ponsonby rule. To use the same period of 21 days with negative procedure for almost all treaties would not in any way burden the House, any more than the thousands of subordinate instruments which we already have.
As regards the late Arthur Ponsonby, several noble Lords suggested that he was against legislation. That is what he said during the debate, but if noble Lords borrow from the Library Arthur Ponsonby: The Politics of Life by Raymond Jones, they will find that on the day of the debate he wrote to his wife Dolly. In that letter he said that he really would have liked to have legislation but it was not possible. He knew his friend E. D. Morell was very disappointed about that, but it was the most that he could do. He probably put a brave face on it in the course of the debate.
I am in no way wedded to the precise form of the Bill and I would welcome strict scrutiny in Committee. If the Government came up with a practical administrative scheme that did not require legislation at all, I should be delighted to take the consequences into account in looking at the future progress of the Bill.
It is ironic that the position with regard to treaty-making remains undemocratic, to some extent, in this country. Her Majesty the Queen graciously consented to my humble request that her Prerogative might not stand in the way of the Bill being considered. I am a firm supporter of the ancient monarchical system of government that we have in this country because it has a unique capacity to evolve in response to changing needs and contemporary values. I am not a republican. I respect our constitutional heritage. But that does not mean— and I know that the noble Baroness the Minister agrees with this— that Ministers should cling to Royal Prerogative powers without effective accountability.
I am, as I say, very encouraged. I am very grateful to all noble Lords. I commend the Bill to the House and respectfully ask that it be given a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.

Leicestershire (City of Leicester and District of Rutland) (Structural Change) Order 1996
10.30 p.m.
Earl Ferrers Earl Ferrers rose to move, That the draft order laid before the House on 18th January be approved [6th Report from the Joint Committee].
The noble Earl said: My Lords, this order implements changes from 1st April next year in the structure of local government in Leicestershire. These changes were recommended by the Local Government Commission.
The order creates two unitary authorities— one for Leicester and one for Rutland— with the remainder of Leicestershire remaining as a two-tier authority.
Leicester City has a long history of unitary government. It was a county borough from the late 19th century until 1974, when it became part of Leicestershire County Council. It is therefore returning, as it were, to its previous incarnation. It is the second largest of the non-metropolitan districts. Opinion polls, both in the city and in the county, suggested that there was a majority in favour of a unitary Leicester. Within the city there was support for one or other of the options which involved a unitary city; 41 per cent. were in favour of a unitary authority and 17 per cent. preferred no change. We think that the city will be able to fulfil the functions of a unitary authority perfectly well.
In the case of Rutland the question of local identity was particularly significant. Surveys found what is called a very high "community identity". Eighty per cent. of people who replied had a very, or fairly strong feeling of "belonging" to Rutland. That strength of feeling is unmatched anywhere else in the country. It undoubtedly reflects the feeling of people who live in Rutland that they do not like the idea— and they never have— of Rutland being swallowed up by Leicestershire, which happened some 20 years ago. That very strong feeling was the reason why the Local Government Commission recommended that the county of Rutland should be re-created for ceremonial and related purposes.
But community identity is not enough on its own. That is why, if Rutland is to become a unitary authority, we wanted to be sure that the costs could be met within the same financial systems and constraints as apply to other reorganised authorities. We also sought assurances that good practical arrangements would be made for providing the local services economically.
Although Rutland is a small authority it has convinced us that it is capable of providing cost-effective services. As an enabling authority— one which looks to others to provide services while it concentrates on the necessary level of services and how they should be developed— Rutland already has a good history of reducing overheads and of improving services. Nevertheless, we accept that special arrangements will be needed in order to ensure the services will be provided properly, and we have made it clear that there should be joint arrangements wherever necessary. That is particularly so for social services. The
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Social Services Inspectorate of the Department of Health has considered the arrangements for social services which Rutland District Council intends to put in place, and the inspectorate is content that it will be a viable social services authority.
As a consequence of this order Rutland will have its own separate Lieutenancy and its own Shrievalty. Rutland is different from almost all other new unitary authorities because of its previous history as a county.
It has been suggested that Rutland should remain within Leicestershire County Council as at present, but that it should be given "historic county" status. In fact, that is not possible. The status does not exist. Rutland can have a separate ceremonial identity only if it has a structure change. In other words, it can become a county again only if it becomes a unitary authority. That is what is proposed.
Leicester City will be deemed to be part of Leicestershire for ceremonial purposes. We shall bring forward a provision after April which will deal with the ceremonial arrangements in all the 1997 reorganisations.
We believe that authorities which are to assume unitary status should have a fresh democratic mandate. The order, therefore, provides for elections to the whole of both Leicester and Rutland councils this May. The councillors, who are then elected, will plan for the change and take over responsibility for running all local authority services in their areas from 1st April 1997. The order also includes arrangements for the authorities to return their normal electoral cycles.
Under regulations which were made last year, the county council and district councils will have additional powers and duties to prepare for the transfer of functions. The councils will be able to begin preparations from the time when this order is made. However, certain decisions can only be made once the new councillors have been elected in May, such as the appointment of chief officers. The councillors who are elected in May 1996 must consider whether particular functions can best be carried out through voluntary joint arrangements with other authorities. These provisions, taken together, should ensure that there is a smooth transition to the new structures with proper safeguards for essential services.
The order allows for a combined fire authority for Leicestershire, which will include Leicester City and Rutland. This will be created by my right honourable friend the Home Secretary by a separate order under the Fire Services Act 1947. The order also provides for the county council and the two new unitary authorities to be represented on the joint committee which makes appointments to Leicestershire police authority. This also follows the commission's recommendation.
The unitary authorities will be responsible for strategic planning, which will he new, as well as for local land-use planning, which they have at present. The order transfers Leicestershire County Council's strategic planning responsibilities for the areas of Leicester and Rutland to the Leicester and Rutland councils respectively. This will enable all three authorities to make voluntary arrangements for joint working on the

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structure plan covering their combined areas so that strategic planning can be retained across the area of the county as it exists at present.
I see that my noble friend Lord Kimball has put down an amendment to this order, as has the noble Baroness, Lady Hamwee. To have an amendment to an order which one is taking through the House is pretty alarming stuff; to have two is positively unnerving. I will restrain myself from what is sometimes rather indecorously called a knee-jerk reaction— on this occasion with both knees— until I have heard my noble friend's views and those of the noble Baroness, Lady Hamwee. As the views will he coming from such magnanimous Members of the House, I have no doubt that they will be of a non-contentious and wholly agreeable nature. I will give a considered reply to the amendments when I answer the debate.
The Government are of the view that the changes which this order will make will enable local councillors to provide better and more effective local government, and one which will be more directly accountable to the local people. But the authorities will have to set aside any differences which they may have and work together to make a success of the reorganisation. I am sure that they will do so. I commend the order to your Lordships. I beg to move.
Moved, That the draft order laid before the House on 18th January be approved [6th Report from the Joint Committee].— (Earl Ferrers.)
10.40 p.m.
Lord Kimball Lord Kimball rose to move, as an amendment to the above Motion, to leave out ("approved") and insert ("withdrawn and be replaced by an order that directs the Rutland and Leicestershire County Councils and the City of Leicester unitary authority to maintain the current unique museums, arts and records services for all three authorities").
The noble Lord said: In moving the amendment, I must declare an interest in that I am chairman of the management committee and trustee of Leicestershire's 15th fledgling museum in Melton Mowbray. I start by thanking the usual channels for the fact that, even at this late hour, we are having a proper debate on the Floor of the House. There was serious concern that in another place the order was taken upstairs in a committee, at which the Leicestershire County Members of Parliament who wished to vote against it were unable to do so. It is only right that those doubts should he aired here tonight.
I was brought up in Rutland. I served on the original Rutland County Council. I have always supported the restoration of historic county status to Rutland. It is unfortunate that the English Act does not allow the Scottish solution. After all, Sutherland, Caithness and Ross-shire are historic counties within the area administered by the Highland Regional Council. I think we made a mistake, when the English Bill was passing through this House, in that we did not spot the need to insert the necessary provision to allow such a status for the county of Rutland, which in my opinion would be the right solution.
The House must not underestimate the problems of running a unitary authority, carrying, as a result of popular demand and granted by the Government, full county status with 33,000 people. It would depend on joint arrangements for many services: museums, police, fire and specialist services. My noble friend mentioned the police force. Perhaps I may just say that there is serious concern that Rutland's representatives, coming from an independent authority with no political status, will have difficulty in obtaining the correct number of places where representatives on a joint authority such as the police are chosen by reference to the aggregate number of councillors elected by party. It is rather a unique problem which is particular to Rutland. My noble friend has assured the new county of Rutland that it will have its lieutenancy and its High Sheriff.
But all those matters, and even the reservations, are minor points compared with the great achievement of the Government, which at last listened to the wishes of the local inhabitants and appreciated the fact that the voluntary services in Rutland are committed to making the county work. We must wish them well in their bold venture.
I now turn to the worries of this order in relation to Leicestershire and Leicester City. The geographical position of Leicester City reinforces the interdependence between the city and the rest of the county. No other proposed unitary authority is as central to, and interdependent within its county, as Leicester is within Leicestershire. In Lincolnshire there is Scunthorpe and Grimsby, right at the extremity of the county, splitting off as unitary authorities. But Leicester City is right in the centre of the county.
The major problem is how to achieve the economic revitalisation of Leicester City within the countrywide framework. Land is needed for homes and jobs. There is no potentially derelict land within the city of Leicester for recycling. Leicester City will be looking for substantial boundary extensions. The commission made the mistake of assuming that Leicester's central role in the county is now less important than its greater role as a freestanding settlement operating on the national stage. In fact, Leicester is the heart and focal point of the county.
I am concerned about the strategic planning, in particular for land use. The Government have assumed that this will work with the proposed two unitaries and the county council assuming joint responsibility for structure planning. Experience elsewhere has shown that it is difficult to achieve consensus on planning and transportation matters across areas which are geographically cohesive without the presence of a single authority. It is naive to believe that that can be done just by voluntary participation.
Because of my great concern about those joint arrangements, I tabled the amendment to the Motion. I hope that it will fall on fertile ground. My noble friend is familiar with the Leicestershire museums, arts and records service. He was kind enough to interrupt his Christmas Recess to come to the county, open the Bakewell Exhibition and renew his family's historic connections with the county of Leicestershire. In

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coming to Leicestershire he passed through Rutland and he very nobly agreed to make the traditional payment by a Peer of the realm entering that county. Noble Lords should beware. It costs noble Lords a golden horseshoe to the Lord of the Manor of Oakham, to be added to the collection in Oakham's Castle Museum— a contribution to be held by the joint forces of all three authorities. Rutland is well aware of the guidance produced for the management of museums, and has undertaken to consider this when deciding how the service will be administered.
My amendment uses the word "unique". I had slight trouble in persuading the Clerk of the Parliaments to accept that word. The point is that the museums service in Leicestershire is in fact unique. It is recognised as the finest provincial museums service in the country. It has been singled out as an example of excellence by the Museums and Galleries Commission. The local government review in Leicestershire highlighted the overwhelming desire of service users, interest groups and the general public, as well as regional and national professional opinion, to maintain the service as an integrated, countrywide service. Specific provision should have been made in the order if the danger to that flagship service from the combustible combination of party politics is to be avoided. The 190 staff, its 14 museums, its five historic sites and its collection of 3 million objects should not be divided up.
Finally, we must consider public opinion in relation to Leicestershire. The proposals for structural change are not popular. After all, the commission itself said:
"Unlike some of the other areas the Commission has so far reviewed, there was no groundswell of opinion that local government in Leicestershire needed drastic reform. There was strong support for the present structure, reflected in the fact that for the past the two-tier system has worked well".
The tragedy is that the Local Government Commission failed to offer the choice of "no change". And the Secretary of State failed to take into account the strength of public opinion in Leicestershire. I beg to move.
Moved, as an amendment to the Motion, to leave out ("approved") and insert ("withdrawn and be replaced by an order that directs the Rutland and Leicestershire County Councils and the City of Leicester unitary authority to maintain the current unique museums, arts and records services for all three authorities— (Lord Kimball.)
10.45 p.m.
Baroness Hamwee: My Lords, in speaking to the amendment of the noble Lord, Lord Kimball, and to the main Motion, I shall speak also to my amendment, though I am not at this point moving it. For the convenience of the House, perhaps I may read it. It seeks to insert, at the end of the main Motion, the words,
"('but that this House regrets that the draft order is made under primary legislation which contains no statutory safeguard for effective strategic planning across the area of the county council of Leicestershire in the event of any failure of voluntary joint working to that end between the new authorities')."
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To pick up the Minister's adjectives, my amendment is perhaps considered contentious, but if both his knees jerk at the same time he is liable to fall over. I hope that I do not provoke such an extreme reaction.
I confess to little connection with either the City or the county, save for occasional trips to the Haymarket Theatre where I have seen some exceptionally good productions. My remarks on the main Motion, therefore, are largely based on what I understand to be public opinion as it has been assessed.
The statutory objectives of the legislation were to reflect the interests and identities of local communities and to secure effective and convenient local government. In a Question requiring a Written Answer, I asked the Minister about local opinion; after all, that reflects local communities. I referred him to comments made by the Secretary of State in a news release of September 1993 that the views of local people are of paramount importance. A more recent remark was made by the noble Earl, Lord Lindsay, in April 1995, when he said,
"the opinion of local people who live and work in these areas will be important— [Official Report, 25/4/95; col. 783.]
On 21st February, 1996, the Minister replied to me by way of Written Answer:
"We are currently considering the … Commission's recommendations on the … reviews along with the representations which we receive. The June 1995 Policy and Procedure Guidance to the Commission makes it clear that the views of local people are important as an element of community identity, and we shall give proper attention to that factor. However, our decisions must be taken as a result of attention to all the issues, not just one element".— [Official Report, col. WA80.]
One would not argue that there are not other issues to be considered. I was depressed by that answer, which, frankly, did not seem to me to give proper weight to local opinion that local people must have hoped that it would receive.
At best the support for a new unitary City and County of Leicester can he said to be inconclusive. Indeed, points raised against a unitary Leicester seem to me to be very similar to those raised by the Commission when it rejected unitary authorities for Norwich on the question of boundaries, and for Northampton on the question of public opinion and the importance of having a county town.
The Minister has referred to the opinion polls and surveys. The NOP poll, taking together either one or two unitary authorities and two-tier elsewhere, showed in favour 47 per cent. for a unitary authority and 39 per cent. for change. Over the county as a whole the figures were 49 per cent. to 34 per cent. for no change. That is very high support for no change since that option has to be written in by the respondents. The MORI survey, using different methodology— it was a survey and I am someone who is more inclined to trust them if they are well done rather than polls— showed in Leicester 27 per cent. in favour of unitary arrangements and 17 per cent. in favour of no change. Across the county the figures were 29 per cent. for unitary arrangements and 21 per cent. for no change. Those are really quite close figures. One must remember that the

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county figures are swayed by particularly strong feelings about Rutland, which to me suggests that these figures are even less conclusive in arguing for change.
Major changes in government need very solid support. It is accepted and admitted that there are differences of views within all the political parties over the exercise, but I have rarely seen them so strongly expressed as in the comments made by the chairman of the county, a member of the Conservative Party, when he resigned from the party. There are also the comments made by a Conservative county councillor in Rutland to the vice-chairman of the Conservative Party. I dare say that other noble Lords have seen copies of the correspondence which uses extremely strong language, such as,
"The proceedings typify this Government's cavalier approach"
and referring to,
"a flawed and tainted scheme".
In the heat of emotion over important local matters I know that feelings run high. It is unusual to see them expressed quite so forcefully and in print.
That councillor is from Rutland where there is a lot of opinion which differs from hers. I recollect the murmur which ran round this House in March last year when the announcement was made about Rutland. I got something of a "boo" from the Bench behind me when I said then that Rutland's county status might he a matter of considerable nostalgia, and nostalgia was all right in its place, but some say nostalgia is not what it used to be. I make that remark again because I believe that the Government have to he particularly sure that so small a unitary authority can operate effectively.
The Minister has mentioned the question of social services, and I am sure that other noble Lords will refer to them. The House should he able to understand on what basis he has satisfied himself - and the Secretary of State has satisfied himself - about the viability of a unitary Rutland and in particular that discussions between the district and the social services inspectorate should be a matter of public record or, at any rate, that the basis for the views should he a matter of public record.
I understand that the MORI survey was the first— perhaps the only survey— which asked whether people would be willing to pay more. Close to 90 per cent. of people said no. That highlights the importance of every survey putting a question in context.
The changes proposed will have on-going costs of some £6 million. That is according to the commission's estimates. Others estimate that it will cost more in indirect costs. Although it will cost £6 million, as the Minister said, Rutland will not get an all-purpose authority such as we might expect to see, but one which is greatly dependent on arrangements with other service-providers. The Minister used the word "enabling". I think that every authority is an enabling authority these days, but Rutland will be an extreme example. I repeat that that £6 million could be spent on direct services.
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I have considerable sympathy with the points made about services by the noble Lord, Lord Kimball. Without repeating the detail of his argument, I should like to express the support of these Benches for his Motion. As well as museums, many other services cover a wide area. I should like to add libraries to that list, noting that the Library Association says that Rutland will be totally dependent on the goodwill of neighbouring authorities to provide an adequate service. In noting the level of support for a unitary Rutland, I think that it might have been better if such provisions had been brought forward in a separate order.
The noble Lord, Lord Bancroft, is unable to be present tonight but I noted that in speaking on the order on Cleveland on 23rd January 1995, he mentioned what he called the,
"whimsically outspoken chairman of the commission— "
the then chairman, who confessed at a recent ACC conference that he knew,
"of no evidence that smaller unitary authorities will be better placed to deliver effective and convenient local services … Surely we are entitled to expect more than assertion before gambling literally millions of pounds of public money on a costly and risky reorganisation".-[Official Report, 23/1/95; col. 929.]
My particular concern, to which I have referred in previous debates in this House, is the matter of strategic planning, hence my amendment. The Minister said that the strategic planning arrangements would enable the three authorities— I think that I noted his words correctly— to continue voluntary joint working "as before". I differ from him - they may not continue "as before".
In July 1995, in response to a question from the noble Lord, Lord Bancroft, the then Minister replied to a question about in what circumstances the power to establish a statutory joint arrangement under Section 21 of the Local Government Act 1992 will be available to the Secretary of State for the Environment.
The reply was that the Government's policy was that local authorities which were granted unitary powers should be capable of undertaking the full range of functions entrusted to them. The Minister went on to say that Section 21 contained back-up powers for the Secretary of State to establish a statutory joint authority where voluntary arrangements had not been made or had broken down. He then added that he was advised that that power would he available only in those cases where joint working was to take place between authorities, all of which had acquired the relevant function as a result of a structural or boundary change. That would not be available where, for example, a new unitary authority had been asked to work with an existing county council. In other words, that statutory provision does not apply in the case of a "hybrid" council (as they have come to be called) such as Leicestershire will become, with its two unitaries. I do not understand why the Government have apparently set their face against the very minor necessary legislative amendment to fill that gap.
The point is important in a large number of areas given the general pattern of the outcome of the review which has— if it can be characterised as a whole— unitary cities, in a two-tier county context, in many parts of the country. In those places, as in Leicestershire, the

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Government will rely entirely on voluntary arrangements. I support voluntary arrangements; the most important thing is that political representatives, like everybody else in society, should be able to work together. But not all marriages are made in heaven; some might have to be made in Marsham Street— which is not everyone's idea of heaven, I concede.
The Government have accepted the point that joint working might have to be imposed by including it in legislation in the first place. If the omission is simply an error— and I think it must be— then should not the Government admit that they have made an error? There is no crime in making a mistake; what is more serious is refusing to rectify that mistake once it has become apparent.
Strategic planning, as the noble Lord, Lord Kimball said, is inseparable from matters such as transport and economic development. In Leicester there is little brown field land for development. The city is in the middle of the county— the county around it like a doughnut— and, as the core city, it is economically, demographically and geographically linked with its surrounding areas. It may well want to consider development— expansion might be too emotive a term— and if it is constrained by green wedges and flood plains, what then if it and the county fail to make voluntary arrangements?
While I recognise that this is the last place in which to discuss direct representation, I should add from these Benches a word about the cherry picking which appears now to extend to the handling of the order in another place. It is arguable that the Committee in another place should have included no local members, but what cannot have been right is that if it were to include local members, they would he representative of one view only. We cannot tell another place how to conduct itself, but we can comment on the Government's apparent inability to do things properly when they fear the outcome will not be their preferred result. I accept that the Minister may differ from me on that.
If the order is agreed, I join with the noble Lord, Lord Kimball in wishing the new councils well, and in thanking the members and staff of the existing authorities. Perhaps they should all have golden horseshoes.
11.3 p.m.
Lord Dormand of Easington: My Lords, as to the proposal concerning Rutland, I see in it some difficulties which I hope might be resolved in this debate.
There is little doubt that many people in Rutland take great pride in living there, not least because of its history. We were all told at school that Rutland was the smallest county in England. That status was lost in 1974, and now that it is proposed to return it that has been welcomed by many people. It is necessary to examine how that welcome was arrived at. The commission sought the views of residents by
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means of a leaflet with a detachable questionnaire, which was delivered principally by the Royal Mail to households throughout the county. That was supplemented by newspaper advertisements and additional deliveries.
There was, in addition, a MORI poll conducted on behalf of the commission. Only 2 per cent. of the questionnaires were returned, and 770 letters were sent. I am bound to say that it seemed to be a comprehensive attempt at determining public opinion, although a 2 per cent. return and a number of letters are not convincing. In letters and questionnaires there was a 60 per cent. preference for Rutland to have unitary status. The MORI poll showed that 34 per cent. of the people of Rutland preferred Rutland to have unitary status. The rest preferred other options, or no change, or did not know what they preferred.
The commission says that it placed greater weight on the findings of the MORI survey because of its representative nature. Your Lordships may agree that that is of some significance bearing in mind MORI's reputation. One of the key factors which emerged from the MORI survey was that in Rutland 48 per cent. of those questioned preferred unitary status for Rutland. In such polls, 48 per cent. might be considered to he a high figure, but it is not a majority.
One of the difficulties to which I referred earlier is considering the popularity of the proposal against the view that an area with a population as low as 34,000 cannot sustain the wide range of services which a unitary authority is expected to carry out. That is the difference I have discovered since the report has been published.
There is an additional difficulty. Are those who express support for the change prepared to sustain it if the proposal means paying more in council tax in order to have it? In its draft recommendations, the commission saw that as a potential problem, because it said that it would be prepared to recommend unitary status,
"as long as the people of Rutland understood the cost implications".
When the commission sought the views of Rutland residents, it indicated to the public that there would be an additional cost of between £83 and £125 per household should unitary status be granted. It made a final recommendation which increased the cost to £170.
From the documents I have, I cannot ascertain whether that increase was made clear to the people of Rutland. In my political experience I have found that the electorate may be enthusiastic about proposals, whatever they may be, but not so enthusiastic when the bigger bills drop through the letter box. Rutland District Council commissioned an exercise carried out by independent consultants. The outcome was that the overall impact upon a Rutland council taxpayer would be a saving of between £15 and £45 per annum on a Band D property. I ask the Minister whether the Government have been able to look at that, and, if so, do they agree with the findings?

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What is an amateur like myself to make of such a discrepancy between the two sets of figures that I have mentioned? I assume that the Minister has some figures on what is, after all, a crucial factor in determining whether an area should have unitary status. I hope that when the Minister replies he will be able to help me on that aspect of the matter.
I return to the problem I posed in my earlier remarks about whether a population of 34,000 can deal with the necessary services to be carried out by a unitary authority. It appears that many people doubt it. I have had letters from head teachers, former social workers, councillors and the Labour Party. Perhaps that is of some significance, because your Lordships may know that the Labour Party in general supports unitary authorities. All these and others are deeply concerned about what they believe will be a rapid deterioration in service, particularly in education and social services.
In two respects the commission is quite clear. It says,
"in our judgment no additional recommendations are required to ensure the effective and convenient delivery of an education service in Rutland."
The commission's other major concern— that of effective provision of services— is met in that Rutland has accepted the need to enter into formal joint arrangements with other authorities, especially to provide continuity in the recently established community care planning framework. Of course there was initial doubt by the commission about social services and so that was referred to the social services inspectorate. The reply from the inspectorate, as the Minister mentioned, is that it is satisfied with the proposals, which include the joint arrangements to which I have just referred. Perhaps I should say, too, that I share the concern of the noble Baroness, Lady Hamwee, in saying that none of that has been made public and it is just possible that there might be a difference of opinion on the conclusion which the inspectorate reached.
The education service needs to be mentioned. A director of education will have to he appointed. I have to say that I see two disadvantages here. First, I suspect that very few people will be attracted by such a small population. Secondly— and related to it— the area has no secondary schools and so there would he a director of education for primary education. It would be the only LEA that I know of in the country where the director of education would have no secondary schools to administer. It is doubtful whether a council would receive highly qualified applicants in such circumstances. If it did they would be from brighter younger people eager to enter educational administration for the first time. But I fear they would leave after gaining two or three years' experience, or perhaps a little more, in that field. I must say that that would not be good for Rutland's education service.
There are some services which by their very nature could not be conducted by an area as small as Rutland. It was to be expected that police, fire,
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probation and magistrates' courts would be administered over the whole of the existing Leicestershire County Council area, and the Minister spelt that out in his opening remarks.
This brings me to the amendment of the noble Lord, Lord Kimball. It appears to me that there is a strong case for the proposal and, as I understand it, the same arrangements exist in many other parts of the country. The noble Lord expanded on the word "unique" and I was pleased to hear that. Any measure using that word ought to receive careful attention and I hope that the Government will accept the suggestion. I read, too, that the view expressed in the amendment is supported by the Museums and Galleries Commission and by the Museums Association. I suspect that the people of Rutland believe that the Leicestershire Museums, Arts and Records Service is one of the best in the country and they would not wish to see it changed in any way.
Most people in the area do not feel that they have been consulted. There have been two opinion polls and a virtual 190 per cent. leaflet distribution, but they do not appear to have made any impact on the population of Rutland. I believe that a referendum ought to have been held. In normal circumstances that might have been a difficult and costly project, but, as we are always saying how small Rutland is, in my view it would not have been so difficult or, indeed, so expensive to carry out.
In a referendum— which is a very different matter from the leaflets and newspaper advertisements that I mentioned earlier— the possible additional cost could have been made abundantly clear. I feel that that is probably the most important aspect of the reorganisation. Presumably the commission would have had to say that the new structure would result in up to an extra £6 million each year being spent on administrative costs, together with the one-off cost of £4 million to £6 million in changing to the new structure. Those figures come from the commission. Again, I ask the Minister to say in his reply who will pay those sums. The financial implications of the proposals are important and could well decide the attitudes of the people of Rutland. I hope that we can hear the Minister mention those implications tonight.
It seems certain from the evidence that there is no overwhelming desire by the inhabitants of Rutland to have unitary status. From my own personal experience, I believe that there is a strong community feeling in the area; a feeling— as I said earlier— which is attached to the pride of having been the smallest county in England. But, for the sake of emphasis, I repeat that that feeling cannot be detached from the concern about the cost involved and whether the present high standards of service can be maintained with such a small population. In those circumstances, I look forward with very great interest to the Minister's reply.
11.16 p.m.
The Earl of Gainsborough: My Lords, the Minister explained the purpose of the order and therefore I shall not spend any time discussing it. I mention only that, in a way, it is a status quo in that the city of Leicester will become again as it was before— an all-purpose authority, a county borough— and Rutland will again be a county, though now a unitary authority and not as it was when I was chairman of the county council with, at one time, no less than four district councils. It has always been small; its motto is multum in parvo.
We are very pleased in Rutland that the noble Lord, Lord Dormand of Easington, has come to live with us in his retirement. I believe that the noble Lord already more than accepts the area and has been made very welcome. The noble Lord mentioned a number of matters of great importance about costs and other considerations. I can assure him, and your Lordships generally, that the councillors on the Rutland District Council— and I was, until recently, one of them— took great care to ascertain from their constituents whether they wished Rutland to he restored to an independent county. I believe that there is a strong feeling within the area for Rutland to be independent as it was before. However, there is the question of costs and it will remain to be seen how that will work out eventually. I served as a councillor in Rutland from 1948 to 1992, so I know a little about how local government works in the area.
There are three comprehensive schools in Rutland and a sixth-form college; but I understand that two of the schools have opted to be grant-maintained and that the third one will probably do so. There is something in the point made by the noble Lord, Lord Dormand of Easington, about schools. The shadow education committee of the district council has dealt with all these matters and is fully satisfied that it will be able to deliver good education in Rutland, as was the case in the past. Our schools produced some excellent results. I still keep in touch with some people I knew when they were pupils in those schools. They have all done very well. Most of them have left Rutland, and they work all over the country and the world.
The noble Lord, Lord Kimball— outside this House I would refer to him as my noble friend, but I am not supposed to do that here because I sit on one side of the House and he sits on the other— is a close friend of mine and has been for many years. He and I served together on the county council. He mentioned, rightly, the excellent county museum service. It has been a great benefit to the Leicestershire county area, of which Rutland has been a part. Even before 1974 the city of Leicester provided a very good museum service. I had many dealings with it, as some of the artefacts belonging to my family were handed over to the museum service for safekeeping and so that the public could see them. I understand from my former colleagues on the Rutland District Council that they are in conversation with the other authorities with a view to setting up a joint operation so that the museum service can be maintained as a single Entity
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with its excellent professional staff, some of whom have been present this evening although because of the late hour most of them have had to go home.
There may he difficulties with some of the specialist services due to the size of Rutland. I am afraid that it is inevitable that some of those services will have to be obtained from outside the county, from the best available sources, and be paid for by Rutland. Some services can be provided internally but, because of the size of the county, not all.
The social services are extremely important. I remember that when I was quite a junior member of the county council, almost 40 years ago, the time came to appoint a children's officer. In those days the children's officer was responsible to the council for looking after children who needed care and attention. We appointed a very capable lady, who dealt virtually single-handed with all the matters relating to children and young people in the county. It is very encouraging to see the noble Baroness, Lady Faithfull, in the Chamber. She knows more about the subject than any of us, and certainly more than I do. She knows very well how those services started, having once herself held the post of children's officer in Oxfordshire.
Social services involve a great deal more today than they did 40 years ago. It will be important to see that social services are delivered in Rutland in a satisfactory manner. Again, there will have to be some help from outside. It may be more expensive than my former colleagues believe to deliver a good service in Rutland.
I admit to being one of those who are worried by the cost. The scale of operation of the new authority will mean that if the government grants and SSA levels are unfavourable towards Rutland the council tax will undoubtedly rise to a considerable extent. The Secretary of State has confirmed that resources will follow services, and it remains to be seen exactly how that will work out in practice. The noble Lord, Lord Dormand, spoke about the Local Government Commission's estimate of the additional costs. I shall not refer to that.
I believe that my former colleagues on the district council are confident that the figure of £125 per Band D household is higher than is likely to be the case. What will happen remains to be seen. I feel that Rutland people will probably have to pay quite a lot for their newly-acquired independence. However, I believe that they are willing to do so. There is a great community spirit in Rutland. I am sure that, even if costs are higher than before, provided that the services are delivered satisfactorily people will not mind paying for good services, delivered locally by councillors whom they know.
All councillors have to be elected. When I first went on the council we were never opposed. I had nearly 40 years of service. No one ever opposed me, except on one occasion, when I was defeated; but that served me right. Three years later I stood again. I knocked on everyone's door and was re-elected. The other poor chap was hardly seen again.

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I shall conclude because the hour is late. I still live in Rutland and do some work there. If Rutland succeeds in its new role it will be a formidable achievement. Many pundits say it will be impossible to achieve. I do not believe that it will be impossible, although it may be difficult. The Rutland motto is multum in parvo. I am sure that in its new incarnation it will live up to that motto very well.
11.27 p.m.
Lord Rees: My Lords, I support the amendment moved so eloquently by my noble friend Lord Kimball. I intervene in the debate with some diffidence because I have never lived in either of the old counties of Leicestershire or Rutland; nor— since my noble friend mentioned the new museum at Melton which is involved— have I ever kept horses in either of those two counties.
However, I speak as a member of the Museums and Galleries Commission. I am delighted to see that my colleague from the commission, my noble friend Lady Brigstocke, is present. The commission and I are very concerned about the future of the museums, arts and records service. It has existed for over 20 years. I do not wish to paint any of my noble friend's lilies in this regard, or to try to tap off what the noble Earl said about the service. I understand that over the past 20 years it has assembled a very capable and devoted staff. It has brought together many cultural functions. It has had many achievements, culminating— if that is the appropriate word— in the formation of the Snibston Discovery Park at Coalville, which has won a notable and satisfactory award.
I believe that all three parties during the review of the local government structure were in favour of some form of combined perpetuation of the service. Certainly the Museum and Galleries Commission is concerned about this. I believe that they have the support of the East Midlands Museum Service and the East Midlands Arts Board. Perhaps I may say this to my noble friend who moved the order. His department has been a little vague, or not precise in the direction it has given, about the division of assets and staff, which is of critical importance when one is talking about a museum service. On that basis I support the amendment of my noble friend.
If the order were to become law, I hope that my noble friend Lord Ferrers will give encouragement to the view that there should be some combination of the three authorities to provide those services. There is a good precedent in Norwich, although I shall leave it to the noble Baroness who will speak later in the debate to tell us more about that precedent. I noticed that when the noble Earl moved the order, he mentioned that there would he a combination for the purpose of appointments to the police authority. So there is plenty of precedent for something along those lines, if the division of the three authorities goes ahead.
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Finally, I make a plea to the noble Earl that in the broad sweep of local government reform, the role of museums and of the local authorities in their provision for museums should not be overlooked.
11.30 p.m.
Baroness Farrington of Ribbleton: My Lords, I speak tonight as someone who was born and grew up in Leicestershire, who returned to Leicestershire as an adult at a time when my involvement through my husband's job was in education, prior to reorganisation. In those days people who lived in what they viewed as Leicester, particularly people who moved to the locality, could not understand the boundaries. I am not certain that that problem is resolved by the order before us tonight. I speak also as someone who spent most of their adult life away from Leicestershire, living in Lancashire. I know that the sense of place can encompass both county and locality. Those who fiercely support their right to be Prestonians and proud of it will also sing that they are lassies from Lancashire.
I question whether the order started from a process with the wrong questions put in the wrong way. The sense of place that people possess and the strength of community feeling are important. I find it difficult to accept from a Government who have, over a considerable time, managed to produce legislation which has been decidedly unpopular, that it appears to be beyond them to bring forward fairly minor legislation to allow the people of Rutland to have a ceremonial county, without having to have a unitary local authority. From these Benches, were we minded to support that solution, I am sure we could come up with a consensus as to which legislation at present could be put on one side to allow such a piece of legislation to pass.
At this hour I would not dream of repeating them but among the many points raised to do with strategic planning, the library and museums service and other services, my noble friend Lord Dormand referred to the most important issue. The people of Rutland, when questioned, appeared to make it clear that, if additional cost were to result, they did not want to see a change in the structure of local government.
I refer to that because the whole review of local government has started badly. Functions and finance are obviously integral to good, effective, enduring local government structures and a realistic assessment of the costs of change is necessary. We can already see people in Scotland, Wales and parts of England objecting to the fact that, far from providing money for reorganisation, the Government have allowed too little to be borrowed by local communities to pay for the cost of change. I am not clear that, on the Government's own admission, given that most of the important services will have to be purchased from elsewhere rather than be provided by a democratically elected authority whose members the people of Rutland are entitled to elect directly, the people of Rutland have been given a fair opportunity to answer the real questions.

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I repeat my question, to which I am sure we shall receive a reply; namely, why have the detailed views of the inspectorate on the issue of social services, and other matters raised, not been made public?
It is now becoming quite clear that the Government are beginning to recognise the cost implications of local government reorganisation. The Secretary of State, Mr. Gummer, said in answer to a Question from Sir Colin Shepherd that the implementation of reorganisation in England must proceed at a pace that would take account of the resources available.
What is the position with regard to those resources? It is that the authorities that face reorganisation on 1st April this year bid for a total of £113 million under the 1995–96 scheme, but were allocated approval to borrow a mere £50 million. In 1996–97 the sum of £100 million in borrowing approvals for all reorganisations has been set aside and taken out of the local authority finance settlement. That is inadequate. The local authorities that are already subject to reorganisation orders have assessed the costs and the total bids for reorganisation to be £220 million. The figures do not include orders such as the one before us tonight. I cannot believe that the allocation of £55 million will be adequate for the orders that the Government intend to bring before Parliament to implement reorganisation.
At a time when local government services are not adequately funded, when services are suffering as a result of government constraints on expenditure, when the people of Scotland are marching in large numbers to object to education cuts and referring to the imposition of a reorganisation tax, it is very difficult to accept that the answer that people from a new county of Rutland will give to the Government in 12 months' time will be the one that the Government want to hear or appear to anticipate.
Speakers referred to many concerns about this reorganisation proposal. It is critically important that services are protected. The functions of local government have changed in emphasis since the old pattern prior to the last major reorganisation. It is critically important that authorities have the resources and the capacity to protect the vulnerable who need care in the community and services to meet special educational needs. There is one assurance that the Minister ought at the very least to give the House tonight. If the Government are determined to press ahead with changes such as those in the order, they owe it to people in the areas to fund the costs of their policy and to allow those in the locality to protect and strengthen services following a government-imposed reorganisation.
11.34 p.m.
Lord Boardman: My Lords, some years ago I was Member of Parliament for one of the constituencies in the City of Leicester. I also live on the borders of Leicestershire. So I have some knowledge of the area and the problems that arise from these orders. I shall say little about Rutland because I know less about it,
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and a number of expert views upon it have already been given. I simply say that for a county of some 34,000 it seems to be stretching it quite a lot. I am a great admirer of their spirit in going for this target, but am less enthusiastic about their economics. I say nothing about the museums. Experts have commented on them, and I entirely endorse what they have said.
I confine my remarks to the City of Leicester becoming a unitary authority.As my noble friend on the Front Bench said, I recall that before 1974 it was a county borough. To some extent, it is reverting to that state. I recall, too, the regret at the change which was brought about in 1974. That took place over 20 years ago. The initial cost and disruption to which it gave rise have been absorbed. It is now working reasonably well, if not very effectively. As my noble friend Lord Kimball has described it, the City of Leicester is central to and interdependent with the county. It is an ideal example of a county town. It shares most services with the county. Most of the services will be fragmented as a resulted of these proposals. It is, as the commission described, almost a perfect example of a town which should not be a unitary authority, Had the city boundaries been wider than they are, I might have shared the commission's views on this order. Regretfully, I do not.
The very narrow boundaries which surround Leicester cause considerable problems. I shall not bore your Lordships with references to the Redcliffe-Maud Report, which I am sure my noble friend knows well, or The Crossnian Diaries that came out shortly afterwards. They gave reasons why the boundaries were kept so tight for political reasons, which I am sure no one would wish to copy today. But those boundaries are tight. There is no room for expansion. The county boundary cuts across pretty well every road in the city. One can cross the county boundary without touching a patch of grass or anything other than urban streets. There is no room for expansion or growth, or for the provision of services of various kinds, such as waste disposal and those kinds of things. They have to be begged somehow from the county. Despite the goodwill which I am sure we all help to create between county and city, there is an underlying dislike for handing over land from the county to the city and, with it, the people living on it.
The noble Baroness, Lady Hamwee, and other noble Lords have referred to the structure plan. Three authorities— city, county and Rutland— are being encouraged to work together on a voluntary basis. There is no suggestion of a boss who will knock their heads together if they do not agree. Goodness only knows what will happen if they do not agree. I ask my noble friend to persuade them to take a more realistic view of this. It is impossible to imagine that the city will be able to demand an expansion beyond its boundary to Wigston, or somewhere like that, to the offence of occupants there, without causing major problems in the county.
Services which have bedded down and have been working satisfactorily for the past 20-odd years are to be torn up by their roots and divided. The services cover such matters as education, social services,

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museums and libraries, and so on. Under those, there are 63 separate operations that have to be split. Each of those will no doubt want a new head of department and will probably want new offices and buildings. Goodness knows what will happen to the standards! I feel that it is very regrettable.
My noble friend referred to the police. The police have to come under a new joint committee which has to be formed. As my noble friend Lord Kimball said, it has to reflect the party political balance of the constituent components of the county, the city and Rutland. It will present a massive problem because, as I understand from the noble Earl, Rutland does not have a party political attitude to these matters. Apart from that difficulty— it is not a difficulty but rather a pleasant state of affairs, is it not?— the numbers will presumably be related to the number of councillors. Rutland will have one councillor for every 1,685 people; the city of Leicester will have one councillor for 5,160 members of the population; and the county will have one councillor for every 10,640 people. Those are the ratios. Each of them will presumably have the same pull and authority in that key joint committee for the police.
That illustrates one of the kinds of problem that will arise. I am sure that they will manage to tackle it and overcome it, but it will be very difficult and one of quite a number of problems.
Perhaps I may refer to a problem which is perhaps quite unique to the city of Leicester compared with other counties and county towns of the same kind. Leicester has a very large ethnic community. Much of that community has dispersed into the county around it. Leicester and the county have behaved with great responsibility over the past 25 years in dealing with that problem. They have a very proud record. It is most important that nothing should arise which could cause any disturbance to that. But fears have been expressed to me that to isolate Leicester in the way that this order may tend to do, may, with a further ethnic community coming into it, produce a very large element in a city, which would run the danger of creating problems. It is a very delicate area and I do not want to say anything to suggest that there are likely to be any difficulties. I am sure that there will not be. On the other hand, I should have felt happier if the commission had looked at this very particular problem before making its judgment. It is of very great importance that nothing must be done to disturb or disrupt the community that has existed so well, considering the difficulties, over such a long period.
The noble Baroness, Lady Hamwee, referred to the cost, which is an extra £6 million per annum. That is very little compared with the total budget. But it will not produce an additional teacher, or any extra person. It is £6 million per annum paid in order to achieve this result, with an initial sum of between £4 million and £6 million. I ask, why? So far as I can see, no one has asked for the change to be made, and no one seems to want it particularly. My noble friend referred to a public opinion poll and said That there were some
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41 per cent. in favour of the change. If I understood rightly, that figure was arrived at by taking all the three options put together which proposed unitary status and adding together. the replies that came. One can make anything one likes of the various statistics. One could quote them all evening and still not get agreement.
There is, however, one statistic which I find impressive; namely, the response from the opinion poll. Something like 2 per cent. responded. The highest proportion of those consulted wanted the change that is now suggested. Almost the same number wanted no change. I am not quite sure why two amounts of 1.5 per cent. add up to 2 per cent. but apparently it is so— 1.5 per cent. of those consulted wanted the change and a similar 1.5 per cent. wanted no change. Incidentally, that was not one of the options on the survey paper; but it indicates that there was hardly an overwhelming thrust of people wanting to spend that extra money and to sacrifice those services to make the change.
Others who are opposed to the change include the majority of parish councils, the majority of voluntary organisations and the majority of those with educational interests. I find that worrying. Reference was made to the fact that this issue was not discussed in the other place, except in committee. There is considerable resentment in Leicester and Leicestershire that their Members of Parliament did not have a part in the committee considering the order when it was a matter which meant so much to their constituents. Those of us who know a little about the area have been given the chance today to discuss the matter, and I am grateful for that. I should have liked to urge the Government not to fix it, as it is not bust. However, if we have gone beyond the point when I can do that, all I can do is wish the councils well in their new role, and only wish that it were not so.
11.50 p.m.
Lord Dixon-Smith: My Lords, at this hour of the night it is not my intention to go over ground already covered so ably by other noble Lords. I shall therefore throw away much of what I prepared, but perhaps I can make just one or two points.
I have always found the process of structural change in local government a fascinating one. It has changed in detail and method over the years, but the essential principles, rather like shuffling a pack of cards and dealing them out, have remained the same. That similarity is all the more pertinent given that we live in a time when resources are restricted. I cannot help feeling that the people of Leicestershire at large will finish up holding a pretty poor hand. And the people of Rutland in particular are being dealt a yarborough, for which they will pay dearly when the bills are finally presented.
Even if the overall effects of those changes were cost neutral from a national point of view— we know that they are not— experience suggests that a shift of

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financial resource in the form of standard spending assessment to the urban areas is the result of change. In any event, the loss of the ability to spread costs over both urban and rural communities tends to leave rural areas with higher costs than is the case where both work together in a unified way.
Can my noble friend the Minister give me any assurance that the people of Rutland, for instance, will be in any way protected from such effects? We have the commission's estimate that after the changes a Band D council tax payer in Rutland will have to pay over £170 more in the first year than would have been the case under present arrangements. We heard tonight that the district council has made other estimates, and indeed expects to achieve a saving. I should like very much to hope that that might be so, but in my experience— and I spent a very long time in local government— one usually found that district councils, in looking at these situations, were preparing their estimates on an unrealistic basis.
Local government is not just about money; it is also about the provision of essential services to the community. The new Rutland, which in my own county of Essex would be joined with an adjacent area to form even a district council, is likely to have particular problems in this respect. While it may manage well enough in respect of the generality of services, it will be likely to have particular problems with specialist services where its small scale will make adequate levels of investment difficult.
I mention two areas. I understand that there are 156 children in the Rutland area who are statemented as having special educational needs. While such cases are increasingly dealt with through the ordinary schools system, many of the cases will require additional, specialist facilities. Again, can my noble friend the Minister assure me that adequate co-operative arrangements with neighbouring authorities will be in place at the changeover to ensure that no child has to suffer more difficult conditions than those that exist before the change?
Similarly, we see increasing numbers of elderly people in the community. Indeed, we should rejoice in the rising standard of living generally that makes this possible. However, as the elderly increase in number and as people tend to live longer, so does the number of the elderly mentally infirm increase. That puts a particular burden on the local authority to provide the specialist facilities that such cases require. Again, I ask my noble friend the Minister whether he is satisfied that adequate arrangements, sufficiently resourced, will be in place in the new Rutland so that no one is less well served than they have been in the past.
I admire the sheer bravado of the Rutland case, although I fear that it is a bravado which will cost its people dearly. I hope that I am wrong; indeed, I would like to be proved to be wrong, but in the meantime I shall await the response of my noble friend the Minister with interest.
11.57 p.m.
Baroness Brigstocke: My Lords, like my fellow commissioner and noble friend Lord Rees, I rise to support the amendment of my noble friend Lord Kimball. I shall be brief. I have just chaired a committee of experienced and knowledgeable museum education experts who produced the guidelines on museum education for the Museums and Galleries Commission. They all share the concern that small museums on their own do not have the resources or the expertise to provide the educational support for the National Curriculum, or indeed the public at large, which can come from a larger, co-ordinated museum authority with a wide range of specialists. I only hope, as the noble Earl, Lord Gainsborough, indicated, that, as in the case of the Norfolk museum service, Leicestershire will be able to run a joint museum board and thus preserve its specialist expertise, collections care and local services.
This debate, whatever its outcome, provides an opportunity to stress the importance of museums in their local community. It is evident that in the broad sweep of local authority re-organisation there is real danger that, despite the best efforts of the Museums and Galleries Commission, museums may be overlooked because they appear a relatively small component in the bigger pattern of local authority services. They are not; they are a vital element in the overall education provision of this country.
Midnight
Lord Crawshaw: My Lords, I feel that I ought to declare more than a passing interest in the county of Leicestershire. I was born there and I still live there. Although I am not a councillor, I am a subscriber to and consumer of the services provided. I have had a certain amount of involvement with public life in the county and my only concern is to try to get the best for the maximum number of people in Leicester and Leicestershire. My main experience of public life in the county and the city has come through the Scout movement in which I served as a county commissioner for 20 years, and in that role I went to all parts of Leicestershire and Rutland.
Leicester is, of course, the county town. It is centrally placed and was, and is, the focal point. However, I perceived something of a fortress mentality within Leicester, emanating from local government, and from which people in other spheres always took their cue. It is a mental rather than a physical wall because at least 40 per cent. of the people working in Leicester live outside in the county.
As we have heard, Leicestershire and Leicester are very much interdependent. I am not sure of the origin of that introspective attitude. After all, the city of Leicester has performed on a national plane since the Romans made it an important centre with a fosse way through it, connecting Watling Street to Ermine Street; Simon de Montfort called the first Parliament there; the city witnessed the last journey of Richard III; Cardinal Wolsey lies in the remains of the abbey,

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which was demolished, to his great shame, by Henry VIII— and so it goes on, through the Civil War, and the Chartist movement to the present time.
Pride in the city is understandable and admirable, but that should extend beyond the mental wall into the surrounding county. So now, when at last we have all our councillors under one roof, it seems a great pity to dismantle that at great expense. I believe that the extra expense is in the order of £6 million per annum.
My noble friend Lord Kimball mentioned museums, arts and records— and I support him. I too have a list. My noble friend Lord Boardman counted 63 specialist services; I make it 66, but whatever it is, it is a great number, and they would be fragmented or duplicated under the proposed order. Your Lordships will be glad to hear that I do not intend to go through them all. I was going to say something about strategic land use and planning, but that subject has been fairly well aired. The proposal for three new authorities assuming joint responsibility for planning instead of a single authority must be doubtful, to say the least. That is what the noble Baroness, Lady Hamwee, was concerned about in her amendment.
In one way the fortress mentality is justified because Leicester's boundaries, drawn up in 1935, are very tight and in many ways artificial. There is not enough room to meet all the needs, so many joint arrangements would be required, thus completely undermining the principle of a unitary authority.
There are no tracts of derelict land to be recycled. I remember years ago driving along the Belgrave Road area and seeing rows and rows of depressing back-to-back houses and wondering when they would he knocked down and replaced. Then along came the mass immigration of Asians from Uganda et cetera who have renovated and relit the area, as well as set up scores of prosperous businesses. That is a very good thing in many ways, but excludes thoughts of new houses for the home population.
So, as the Local Government Commission has to admit,
"There remains little scope for further development within the present boundaries, so inevitably the future planning and economic development of the area will need to involve parts of Blaby, Oadby, Wigston, Charnwood and possibly Harborough".
A unitary Leicester on present boundaries would also have a detrimental effect on surrounding suburban and rural areas which rely heavily on services, such as special schools, based in Leicester.
As to Rutland, although it is not really within my sphere I confess I was pleased when I heard that Rutland was going to stage some sort of revival. I have always been fascinated by England's smallest county and enchanted by the county town of Oakham. Indeed, I am physically incapable of using any other address than "Oakham, Rutland" on an envelope.
I have no wish to snuff out or take over some 34,000 people and this land. For example, the
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Leicestershire and Rutland police have always got on well together and should remain like that, but a rigid unitary authority again gives me visions of a fortress mentality. Rather surprisingly, I thought at the time, I have been written to by various householders, councillors, schoolteachers, etc., in Rutland asking me to try to ensure the continued alliance with Leicestershire. Householders are not anxious to pay between £125 and £170 per annum minimum as their share of the increased total of £2 million per annum. In education, for example, Mr. Hitchcox of the Ketton Church of England primary school in Rutland, is only one schoolmaster who asks your Lordships to prevent, using his words, "the proposed insanity".
Your Lordships may by now have the impression that I am not exactly impressed with this order and could not vote to approve it. After what has been said, I hope my noble friend Lord Ferrers will recognise our feelings and suggest how we might proceed. After all, the noble Earl has more Leicestershire blood in his veins than anyone else here.
As I understand it, until today this order has had only one hour and 30 minutes scrutiny by the Standing Committee in the other place. The composition of that committee was strange, to say the least. I fear I have only recently become directly involved in these proposals, having been laid up for most of last year, but there is a great deal of experience in this House which cannot be expressed in one evening and at this hour. I would happily vote for some motion or amendment that would have the effect of allowing more time to scrutinise the order. Perhaps my noble friend Lord Ferrers will suggest that we refer the matter to a Select Committee.
There is a great deal at stake and everybody in the area is bound to he affected in some way. At the moment many of us feel that change is being proposed for change's sake and not because the present set-up is unsatisfactory. No other proposed unitary authority is as essential to and independent with its county as Leicester is with Leicestershire. I am sorry to have to say that I fear this order will be expensive and a retrograde step.
12.9 a.m.
Baroness Faithfull: My Lords, I must apologise that my name is not on the list of speakers. I was at a meeting in the City this morning; I found myself in a traffic jam outside St. Paul's and did not arrive before 12 o'clock in time to put my name down.
I speak, as the noble Earl, Lord Gainsborough, knows, as a children's officer and a director of social services. I spent three-and-a-half very happy years working in Leicester, Leicestershire and Rutland, and therefore I have a little knowledge of that delightful area of England.

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Oxford has a great historic background, as has Rutland. We have a Lord Mayor and ceremony. I should have thought that Rutland would be able to have the ceremonial procedures that it wants. I cannot think that Rutland will ever lose its wonderful historic identity.
I shall talk about the social services. The noble Earl, Lord Gainsborough, spoke about the wonderful woman Rutland had as a children's officer. Since then social services have changed completely. They have now to deal with the Children Act 1989, which produces an enormous amount of work; the community care legislation; and, as has been said, Part III of the Education Act.
A director of social services in Rutland will now have a solely bureaucratic job. It will not involve social work, because Rutland will be unable to provide the facilities that it will need to deal with all the social work cases. It will find itself buying in services through the purchaser/provider system. So the director of social services will not be doing social work but merely obtaining services by buying them in. Under those circumstances, a true social worker would not find the job satisfying, although he or she would be satisfied at living in a lovely place like Rutland.
Several noble Lords have talked about the social services report. I can tell your Lordships why it has not been seen: it has not been published. I have made inquiries about it. The social services inspectorate of the Department of Health has visited Rutland. It has talked to Rutland, but it has not said whether it agrees or disagrees with any recommended change. It has asked Rutland to produce a plan, and that plan has not yet been produced. I hope I have not misunderstood that, because I have made careful inquiries. We do not yet know what the social services inspectorate will recommend.
Coterminosity will cause a great deal of extra work. Rutland will find it difficult to work with the police, the Probation Service, the courts, and the child protection teams. It will find it far more difficult than it envisaged because when it was its own authority it did not have that range of work to do.
Other noble Lords have talked about costs. Do the people of Rutland really know what this will cost them? I acknowledge that some of them are so anxious to have independence that they believe the price is worth paying, but it will come hard to a number of people in Rutland.
When I worked in the area, Leicester City and the County of Leicester worked harmoniously with the county and City of Rutland. I cannot believe that it will add to the efficiency of education, the social services, and other services for them not to be as one. Oxford is an old historic city which goes back to the 12th century. We have the county, and we have the status quo. It is working out extremely well. Leicester is in the centre of the area, as is Oxford. I would say that the system of one central department, with branch offices all with the same policy and operating in the
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same way throughout the county, gives both flexibility and a cohesive service. Therefore I support the amendment of my noble friend Lord Kimball.
12.15 a.m.
Baroness Hollis of Heigham: My Lords, let me first of all declare an interest as a vice-president of the Association of District Councils. This has been a full and interesting debate, especially on issues of cost, boundaries and democratic representation. These are issues which, if I may say so, have been more thoroughly explored and at greater length in this House tonight than they have been in the other place.
As it is late, I will not say much of what I was going to say. The 1974 reorganisation, as is widely agreed, was especially unfortunate for those former county boroughs, like Leicester, which for centuries, as proud and independent cities, had run their own affairs— and that at a time when in county councils the administration was by justices in quarter session.
With a population of 285,000 and a strong tradition of self-government, I think it could be argued that Leicester should never have lost so many vital functions in 1974. Reorganisation, we are now told, has strong local support. I think there can be no doubt about the competence and viability of Leicester City, nor of the remaining county council, to provide the full range of services; and in so far as it would allow the county council to focus on more rural matters undistracted by the urban focus of the city of Leicester and its strong ethnic mix, referred to by the noble Lord, Lord Boardman, then we very much hope that reorganisation will, for the people of Leicestershire and of Leicester City, be a win-win proposal.
These orders are consistent with those so far proposed for Bristol, York and Hull, and for others like Nottingham, Derby, Plymouth, Portsmouth, and so on, which are in the pipeline. I have to say that the situation is rather different when one looks at Rutland. As many speakers tonight have said, Rutland clearly has a strong sense of community and historic identity. Very real worries have been expressed about cost, to which my noble friend Lord Dormand referred. Rutland is extremely small: smaller in population, as the noble Lord, Lord Dixon-Smith, said, than many urban parishes and many town councils, although it is of course larger than the Scilly Isles and some Scottish island councils. The jury, I have to say, may he out in some eyes on Rutland's competence to ensure the delivery of all services to an acceptable level. I think one does accept many of the worries mentioned by the noble Baroness, Lady Faithfull, tonight.
However, if the Department of Health is satisfied in terms of its social services provision, and given the move to local self-management of education— which means, of course, that schools are no longer dependent on having a large number-based local authority to run them-I join with other noble Lords tonight in hoping and trusting that Rutland Council will be an effective and efficient local authority. We wish it well, whatever question marks we may have about the

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viability of its services. What it does, of course, is to once and for all destroy any of the arguments that only local authorities of at least 100,000 or 150,000 can be viable. In so far as Rutland is evidence of the plurality of English local government, that too performs a useful service.
What I want to do in the remaining time is to focus rather more explicitly on the issue of museums, raised by the amendment of the noble Lord, Lord Kimball. At the 1974 re-organisation the museums service was, unusually, made a concurrent function; that is, both district council and county council could take responsibility for it. Virtually all former county boroughs of which I am aware— for example, Hull, Derby, Nottingham, Plymouth and Portsmouth— chose to continue to run their own museums authority. That means that, as they become unitary authorities, there is no question involved of splintering, dividing or trying to take apart what has been knitted together. They have run side by side and county councils have done likewise. Therefore, no historic properties, no collections and no professional staff need to be untangled.
Two counties, both of which have been mentioned tonight— Norfolk and Leicester— followed a different route in 1974. In that year, Leicester City was running a museum service in which 70 percent. of its collection referred not to the city but to the county; in other words, the city was running a truncated, county museum service on a county-borough base. While that was just possible financially on such a base, it clearly became impossible on the much smaller budget of a district council. Therefore, by agreement in 1974, and uniquely, which I believe is the right word to use tonight, the entire city museums service was transferred to the county: its historic buildings and its collections and records, lock, stock and barrel. So far as I am aware, it was the only former county borough so to do.
However, Norwich and Norfolk (the other aberrant county) did it differently, as one might expect. We set up— and I speak as one of the negotiators for the arrangement in 1972— a joint museums authority. The city council retained ownership of its historic properties, including the castle and its pre-1974 collection; but the county ran and managed the entire collection and owns the post-1974 additions. The museums authority is steered by a joint committee of city and county councillors, the more easily, I believe, because museums are not normally politically contentious and all members are guided by their professional officers. They are very dependent on that advice. Were Norwich to become a unitary authority I am confident that the same joint— authority arrangements would rightly and properly continue. I would certainly argue vigorously for that.
Therefore, in most of England, former county boroughs, which are now becoming unitary authorities again, kept a separate, independent and free-standing museum service. Norfolk went for a joint museum service. Leicestershire, uniquely, went for an exclusively county service. That is why the noble
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Lord, Lord Kimball, is absolutely right tonight to focus on the particular problems that that presents at re-organisation.
Since 1974, Leicester .county has built up that service to what I believe is possibly one of the finest in the country. It has 200 staff, a strong archaeological unit which, inevitably, has to be county-wide, a strong county ecology service, a strong county records service (though one, I have to say, that is so strong that it tried to charge me twice for using the service once; no doubt that will show its financial viability in the future, and I am sure that it was not personal) and pioneering community and disability access. It is clearly a service which is hugely popular.
It is clearly difficult and certainly unwise to splinter an integrated service. How does one break up the collections? Does one do so by way of where the material came from, from where it refers to or even by ascertaining whether it was acquired before or after 1974? If I may suggest it, the answer is that the city and the county together should consider, as the noble Baroness, Lady Brigstocke, said, a joint solution along the Norfolk lines which will protect and strengthen an integrated service.
The very "interconnectedness" that so many speakers have mentioned tonight of city and county makes that a sensible solution in my view. Such a service does work. I know. I can personally recommend it. To my pleasure, I believe that the city of Leicester, as well as the county of Leicestershire, also recognise that fact. In a letter to the Minister of 27th February of which I have a copy— and I know that the noble Earl will forgive me for mentioning it— the leader of the city council said:
"I am writing to confirm that Leicester City Council is fully committed to establishing robust joint arrangements for the Museums. Arts and Records Services".
This could be a joint board or a joint committee. Either way, I was assured this evening on the telephone by the leader of Leicester City Council, Peter Soulsby, that there will be an integrated service, run by a joint authority, with councillors drawn from both authorities and with shared financial responsibility. The leader of Leicester City Council told me tonight that he expects that those joint arrangements will be in place by the end of June at the latest and probably well before then.
Therefore, as a result of the amendment proposed by the noble Lord, Lord Kimball, with the support of other noble Lords led by the noble Lord, Lord Boardman, the city and county councils have been brought together to a sensible view that there should be an integrated museum service. A joint museums authority will follow. I am sure that that will benefit the people of both Leicester and Leicestershire. With those assurances on an important service, we are happy to support the recommendations.
12.25 a.m.
Earl Ferrers: My Lords, we have had an interesting debate. I find myself in some slight

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difficulty because, owing to the lateness of the hour, one might wish for a short reply, but it would he a discourtesy if I did not reply to noble Lords who, correctly, have aired their anxieties.
I know that this is a matter of considerable concern to many people who live in Leicestershire and Rutland. It is notable that tonight we have heard from my noble friend Lord Kimball, who has lived in Rutland and is well connected with Leicestershire; the noble Earl, Lord Gainsborough, who lives in Rutland; the noble Baroness, Lady Farrington, who lives in Leicestershire; my noble friend Lord Boardman, who was Member of Parliament for Leicester; and my noble friend Lord Crawshaw, who is also a great Leicestershire man. Therefore, a great deal of interest has been shown in Leicestershire this evening.
My noble friend Lord Kimball said that there was no groundswell for change, as did my noble friend Lord Boardman. That is perfectly true. One of the difficulties about any local government changes is that nobody actually likes change but everyone wants to hang on to what they have. However, it was necessary for the Government to set up the Local Government Commission to suggest what changes ought to be made where it considered that necessary. That is why we have taken the advice of the Local Government Commission.
My noble friends Lord Kimball and Lord Boardman and the noble Baroness, Lady Hamwee, criticised the way the order was dealt with in another place. I shall not follow that track because that is a matter for another place.
I was glad that the noble Lord, Lord Dormand of Easington, welcomed the return of Rutland. I gather that that is very popular in the area of Rutland. Indeed, I am told that one brewery there— none other than Ruddles brewery in Oakham in Rutland— is producing a special beer called Independence, so the order may please some people, and it will please a great many more who have had a swig of the beer.
It has been questioned whether Rutland, with a population of 34,000, can provide the necessary services. I believe that it can. It is not the smallest county. There are other authorities which are smaller. For instance, Orkney, Shetland and the Western Isles are three Scottish councils which have been unitary authorities since 1975. They are all smaller than Rutland. Orkney has a population of only 20,000, which makes Rutland look quite big in comparison. Therefore it is possible for the change to be carried out properly. It will be an enabling authority. That means that it can buy in services as necessary. The job of that unitary authority will he to ensure that services are available to the people of Rutland, whether those services are provided by the authority itself or are purchased from another.
The noble Baroness, Lady Farrington, was concerned that this should be a ceremonial authority without being a unitary authority. I am hound to tell her that Rutland can only have a ceremonial identity if there is a structural change. There is no such thing
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as an historic county status. Therefore it can only become a county again if Rutland becomes a unitary authority.
That puzzled my noble.friend Lady Faithfull. She asked, "What about Oxford?" Oxford has a Lord Mayor because it is a city. Oxfordshire has a Lord Lieutenant because it is a county. At present, Rutland cannot have a Lord Lieutenant because it is not a county for the purposes of the Local Government Act 1972. It can only become a county and have a Lord Lieutenant if it becomes a unitary authority.
I thought my noble friend Lord Kimball made a convincing speech in support of his amendment. My noble friend Lady Brigstocke, my noble friend Lord Rees, and the noble Baroness, Lady Hollis, also agreed with what he said about the museum, arts and records service. The noble Earl, Lord Gainsborough, said that it was a good museum service as— this was not the reason he gave to justify that— it had the records of his own family. I, too, believe that it is a good service; it also has the records of my family.
I know that there has been considerable concern in the locality about what will happen to the museums, arts and records' service. Having been brought up in Leicestershire, and having gone in the New Year to open a Robert Bakewell exhibition, put on by the museum service— my noble friend Lord Kimball referred to it— I know only too well what an excellent service the people in "old" Leicestershire have.
My noble friend was quite right, because I had been to Rutland I was asked to give a golden horseshoe at the Castle Museum, Oakham. I was told that one of the requirements is that a Peer who visits Oakham should give a horseshoe. I was asked to do so, and I said in a conciliatory way that of course I would give a horseshoe. I was not aware until this evening that it was supposed to be a golden horseshoe. However that may be, a horseshoe of some description will appear in due course. I think it is a very good thing to have such practices.
When I went to Leicestershire, none of those whom I met could resist the opportunity of giving me the full flood of their views; and I do not take any exception to that. They were quite right to do so and they did it with great courtesy. I have also had the pleasure of receiving various letters about the matter— all virtually saying the same thing, "We have an excellent service and we don't want it bust up".
After all, the service has received support from local, regional and national organisations; and the creation of this service some 20 years ago brought together a whole range of "heritage" activities where the whole becomes much more than the sum of its parts.
I hope that I can allay some of the fears which some noble Lords have understandably expressed this evening, and which to an extent I share. In the end it must be for the authorities concerned to decide how best to provide the full range of local government services in their areas. It would not be right for the Government to try to force them to adopt joint arrangements. In fact it is not possible for us to do so.

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The fact is that the Government have no powers to force them to adopt joint arrangements. First, the provision of a museums service is discretionary on the part of local authorities. They are not obliged to provide the service. Secondly, if we were to force them to join together we would be changing a discretionary function into a compulsory one. We cannot do that.
It was because we understood the concerns which people had locally that my honourable friend the Parliamentary Secretary took the unusual step of writing to the authorities concerned. He told them that we expect them all to co-operate in setting up good arrangements to safeguard the county's museums. Those arrangements should be to the satisfaction of the Museums and Galleries Commission which has issued guidelines to local authorities on the provision of the service. He also asked the local authorities to keep the Department of National Heritage informed of their arrangements.
Both Rutland and Leicester City Council have confirmed that they are sensitive to the need for an integrated service and they have undertaken to follow the guidance on the provision of museum services provided by the Museums and Galleries Commission and the Department of National Heritage.
As the noble Baroness, Lady Hollis, said, I received a letter today from the leader of Leicester City Council. I confirm that he said that they were:
"committed to establishing robust joint arrangements for the Museums, Arts and Records Services",
and that they were "anxious" to reach a sensible conclusion with the county council which:
"preserved the integrity of the collections".
He also said that it had been decided to hold a special meeting of the members and officers of the two authorities within, they hoped, the next two weeks. That is a pretty convincing undertaking. The letter also said that the council was working with the Museums and Galleries Commission to find a suitable solution.
My noble friend Lord Rees said that we, the Government, had been slow about saying how the assets would be divided up. I hope that the assets will not be divided up. The whole purpose of what we have been trying to do is to ensure that the assets will not be divided up. I do not see that there should be any difficulty in keeping the same excellent standard of service as has been achieved to date; but it will be organised by a joint committee of the three authorities, if that is what they want.
After all, there is nothing new in that. As the noble Baroness, Lady Hollis, said, it has been done in the county in which I now live. I am not a peripatetic person, but it just happens that I live in Norfolk, whereas I used to live in Leicestershire. Therefore, I happen to have experience, in a modest way, of both. That has happened in Norfolk and has worked well for the past 20 years.
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In my personal modest judgment, it would be a disaster if the Leicestershire Museums, Arts and Records Service were to be split up. It would be quite unnecessary. I simply cannot believe that it would be in anyone's interest to use up valuable staff resources in busting up a service which is doing good work. I am sure that there are enough people of stature and goodwill in Leicestershire to ensure that that does not happen. If the three local authorities work together— and there is no reason why they should not and I understand that they intend to— I see no reason to think that the services will not continue.
I turn to the amendment of the noble Baroness, Lady Hamwee, in which she says that there is no statutory safeguard for effective strategic planning. I mentioned earlier the joint arrangements which we seek for structure planning in Leicestershire. Our policy is that where there needs to be joint working, it should be done on a voluntary basis. We think that this is more accountable. For all services there should be statutory joint arrangements only where it is absolutely necessary. Authorities locally are in the best position to know what arrangements are most suitable in their own circumstances.
As the noble Baroness said, Section 21 of the 1992 Act contains a power for the Secretary of State to set up a statutory joint authority in cases where voluntary arrangements do not work. I am advised though— and the noble Baroness confirmed this— that the power is not available in hybrid situations like Leicestershire. My right honourable friend has made it clear that he is looking to the authorities concerned to produce a structure plan for their combined areas. He has asked them to set up joint working arrangements to maintain the Leicestershire structure plan.
The department has recently consulted on a draft circular about that. The circular contains advice on development planning after reorganisation. We expect to publish the final circular within the next month or so. The local authority associations and planning officer societies are working together to provide practical guidance to their members nationally. It will cover the different approaches to joint working which are possible under Section 101 of the Local Government Act 1972. They expect to publish a guidance note shortly. I find that encouraging.
My noble friend Lord Kimball and the noble Lord, Lord Dormand, were concerned about the size of Rutland, saying it was too small. I have explained that there are other unitary authorities smaller than it. The noble Baroness, Lady Hamwee, was concerned about the social services findings. The Department of Health found that Rutland understood the scale of the role which it will assume. Rutland is aware of the need to adopt an enabling role rather than to provide services directly itself, and that it must co-operate with other authorities in the provision of those services. Considerable progress has already been made in identifying the issues and in finding the solutions.
The social services inspector was in regular contact with the district council. This included meetings with the authority and consultants advising the district on

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its unitary preparations. The inspector concentrated on assisting Rutland to identify and to explore the more critical issues in order to find a tailor-made solution.
The noble Lord, Lord Dormand, was concerned about the cost implications. The commission made it perfectly clear that there were cost implications. The response from the people of Rutland was, nevertheless, still to support the unitary status. Given the anxieties expressed, we undertook a further analysis of the financial implications. Independent advice from the Institute of Public Finance estimates the increased council tax to be somewhere between £6 and £15, which is much less than the estimates of the commission.
The noble Baroness, Lady Hamwee, and the noble Lord, Lord Dormand, were concerned, again, about the costs of transition. The authorities can apply for supplementary credit approvals for transitional costs. That allows them to spread the costs over many years and in some cases to defer all repayments for a while. That is in order to enable reorganisation to be implemented smoothly and effectively.
The noble Baroness, Lady Farrington, was concerned about Rutland being an enabling authority. I do not think it is true to say that enabling authorities are less democratic than those that offer the direct provision of services. It is still the councillors who decide what the level of service should be and how those services should be provided. It may be that they decide to provide the service themselves, or it may be that they decide to buy it in. But either way it is a democratically provided service.
The noble Baronesses, Lady Farrington and Lady Hamwee, and my noble friend Lady Faithfull were concerned about the publication of the report by the Social Services Inspectorate. I shall look into the matter, if I may. My noble friend Lady Faithfull said that the Social Services Inspectorate has not made a recommendation. However, the report says in terms that, given its work with Rutland, it has no reason to object to the decision to award Rutland unitary status.
My noble friend Lord Boardman, with all his experience as a former Member of Parliament for Leicester, was concerned about the expansion of Leicester's boundaries. The commission looked at this issue pretty carefully before producing its draft report. It found that the city council is not pressing for an increase in its boundaries. There is evidence that people outside the city would strongly oppose being included in Leicester. It therefore concluded that there would not be an extension.
My noble friend Lord Dixon-Smith was concerned about special educational needs. The authorities are determined that there should be no deterioration in the service. Various options are being explored to ensure that that does not happen. No local authority is totally independent in the provision of special education, and it is normal for those kinds of schools to take children from other areas. That is already the case in Leicestershire now.
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My noble friends Lord Dixon-Smith and Lady Faithfull, and the noble Lord, Lord Dormand of Easington, were concerned about future costs in Rutland. The council tax must be the result of the authority's decision on its level of spending and organisation. Rutland has made a commitment to residents that it will organise itself so that there will be no heavy tax burdens resulting from reorganisation. In the end, it must be the councils which are accountable to the electors.
My noble friend Lord Boardman and others referred to the representations on the police authorities. I accept that the present system may throw up difficulties. The local authority associations have suggested, and we have agreed, that the effects of the present rules in those areas where local government is being restructured should be looked at after October, when the police authorities start to reconstitute themselves for the changes on 1st April 1997, when we shall have a better idea as to what the effects across the country are.
A number of noble Lords referred to structure planning. That depends on a voluntary approach. The Secretary of State for the Environment will continue to scrutinise the structure plan proposals in the normal way. His powers of intervention in the plan maturing process under the Town and Country Planning Act 1990 remain unchanged. He will consider using them as necessary to ensure that plans remain up to date and consistent with the relevant regional planning guidance. I know that whenever reorganisations of local government take place they throw up a tremendous number of anxieties and concerns. The most prevalent anxiety is that people do not like moving from positions that they know, accept and understand. On the other hand, as time goes on one has to have a relook and consider whether local government services are provided in the best possible way in view of what is likely to happen in future. It was for that reason that we set up the Local Government Commission which produced a report. I hope that, despite the anxieties expressed by noble Lords, they will feel that this is worth a good shot and that I have been able to reassure them on those matters about which they have been particularly anxious. I hope that my noble friend Lord Kimball and the noble Baroness, Lady Hamwee, may feel it prudent not to press their amendments. If so, I will later move that my Motion be agreed to.
Lord Kimball: My Lords, despite the late hour, we have had a very good debate. I am most grateful to all noble Lords and Baronesses who have supported me in my amendment. We keep using the term "unique". I do not know whether it is unique in your Lordships' House that almost 50 per cent. of the contributions to the debate have been made by noble Baronesses on all sides of the House. There is only one extra male speaker.
I should like to say how grateful everybody in Leicestershire and the museum service will be for what the noble Baroness, Lady Hollis, has said,

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making it perfectly clear that some form of joint board or committee to maintain an integrated museum service is in everybody's mind.
After the forthright and positive way in which my noble friend has wound up the debate, I hope that the whole House will agree that the proper thing for me to do is to thank him for the guidance in his wind-up speech and to seek your Lordships' permission to withdraw my amendment.
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Amendment, by leave, withdrawn.
Baroness Hamwee: My Lords, with considerable reluctance I do not move my amendment.
[Amendment not moved.]
On Question, Motion agreed to.
House adjourned at thirteen minutes before one o'clock.