Lords Sitting of 13 January 1999

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

CAP Reforms: ECA Opinion
Lord Thomson of Monifieth Lord Thomson of Monifieth asked Her Majesty's Government:
What response they are making to the report of the Court of Auditors of the European Union that the reforms of the common agricultural policy "are not sufficiently wide-ranging".
The Parliamentary Secretary, Ministry of Agriculture, Fisheries and Food (Lord Donoughue): My Lords, the Government generally welcome the ECA Opinion on the Agenda 2000 proposals which lends support to the United Kingdom view that the Commission's reform proposals, although representing a move in the right direction, do not go far enough in reducing support prices. The Government are continuing to press for comprehensive CAP reform.
Lord Thomson of Monifieth: My Lords, I warmly welcome the first part of the Answer given by the Minister. However, is it not a stark fact that unless there are more radical reforms to the common agricultural policy, including a more effective tackling of the problem of agricultural fraud within member states, it will be simply impossible to carry forward the policies of enlargement and that that would have serious political consequences?
Lord Donoughue: My Lords, I and the Government agree absolutely with every word said by the noble Lord. Wider-ranging reforms than have been proposed are desirable in their own right because the present system has many faults. They are particularly necessary as we embark upon enlargement. Were the European Union to enlarge without reform, especially reform of the CAP, we believe that the costs would be intolerable to the European taxpayers and especially to the British taxpayers and the British Government.
The question of fraud is quite complex. Two quite different kinds of fraud are currently under discussion; first, the humanitarian aid central fraud and, secondly, CAP and other frauds which were reported on by the European Court of Auditors. On that point the Government totally support the noble Lord. We are totally in favour of stricter measures to control fraud. However, I should point out that the CAP fraud comprises a relatively small percentage, around 0.4 per cent. of expenditure, compared to the overall alleged 5 per cent. fraud of the budget as a whole.
Lord Bruce of Donington: My Lords, can the Minister make clear to the House that the Government will at all
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levels and in all circumstances, whether at meetings of heads of state, the European Council, the Council of Ministers or at any unofficial conference that from time to time takes place, support the complete independence of the Court of Auditors? In the light of the other observations made by the noble Lord relating to fraud, can the Minister assure the House that the Government, once again at all levels, will protect the Court of Auditors from the rule established by the Commission for its own purposes; namely, that when it wants the Court of Auditors' report altered, all it needs to do is to make representations to it? In that connection I draw your Lordships' attention to the observation I made on that point five years ago.
Noble Lords: Hear, hear!
Lord Donoughue: Yes, my Lords; I am sympathetic to what my noble friend said. I should point out to him that on the question of the monitoring and control of fraud, proposals have been made by the Commission and Parliament for greater independence. Those proposals were the subject of discussion at the Vienna Council. It was decided then that they should be pursued urgently and we are expecting a decision at the Cologne Council. The Government are certainly sympathetic—they are not always so—towards the remarks of my noble friend.
Lord Marsh: My Lords—
Lord Clark of Kempston: My Lords—
Lord Mackie of Benshie: My Lords,
The Lord Privy Seal (Baroness Jay of Paddington): My Lords, as always, I shall abide by the decision of the House on who should speak next. However, as there is plenty of time, and I believe that the feeling of the House is that the Cross-Benchers should ask a question, I ask the noble Lord, Lord Marsh, to speak.
Lord Marsh: My Lords, given the length of time that we have been discussing the problems of enlargement, with the need to discuss the various factors, can the Government give some indication as to when they first became aware of the scale of fraud in that area?
Lord Donoughue: My Lords, I believe that the Government have always been aware of the fact that there is a problem with fraud. As regards the scale of the problem, particularly in other countries, we are dependent on official reports on the matter. In relation to the common agricultural policy, which is the only area for which we are responsible, we believe that the monitoring of fraud in some cases reveals genuine errors. Noble Lords opposite who are farmers will know that the system is immensely complex and bureaucratic. The number of errors or frauds discovered has risen but the value of them has declined. As I have said, for the CAP the figure was 0.4 per cent., about £122 million

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for the whole community. Though we believe that is not acceptable and is possibly not the whole story, we feel that sometimes it is represented out of perspective.
Lord Mackie of Benshie: My Lords, can the Minister tell the House how he proposes to solve the problem of applicant countries coming into the European Union? For example, do Her Majesty's Government propose to drop the price level in this country to world level and ensure that the applicant countries are at that level, which would save a lot of money? Alternatively, do the Government propose to keep the assistance at a level which will raise the level in applicant countries?
Lord Donoughue: My Lords, the proposals for scrutiny of applicant countries are set out by the European Union and by the Commission in this area and are to be found within the structure of Agenda 2000. The British Government's hope is to move towards world prices to diminish and ultimately—it would be nice—eliminate price support, to eliminate control of supply and to increase environmental support. However, within Agenda 2000 is a more modest proposal and the applications are being conducted within that framework.
Lord Clinton-Davis: My Lords, is my noble friend the Minister aware that, in the Commission on which the noble Lord, Lord Cockfield, and I had the privilege to serve, the noble Lord introduced proposals, with the agreement of the whole Commission, to deal much more effectively with questions of fraud which were then opposed by at least some of the member states? Will my noble friend also comment on whether or not the southern European member states are becoming more sensitive to the arguments that he has adduced before the House this afternoon regarding the need for much more radical reform of the CAP?
Lord Donoughue: My Lords, as regards my noble friend's first question, I can confirm that I was aware of that fact. However, I believe that the climate in Europe has changed. The activities in the European Parliament of late regarding all member states, which will conclude with a vote on this issue tomorrow morning, reflect the fact that there is now a much tougher attitude to, and a greater awareness of, the problem.
On the attitudes of the Mediterranean states, I believe that a little more education may need to be provided in that respect. However, we must always appreciate that they are recipients of a positive balance in all of these areas. Member states are often reluctant to give up the financial subsidies that they receive, but that will be a matter for the whole debate which lies ahead. Britain, Germany and others are very determined to try to achieve a reform in the interests of the British taxpayer, the British consumer and, indeed, the British farmer.

Soldiers Executed in the First World War
2.47 p.m.
The Earl of Carlisle The Earl of Carlisle asked Her Majesty's Government:
Whether they will arrange for a pardon to be granted to the 343 officers, non-commissioned officers and soldiers from the United Kingdom and the British Empire who, during the First World War, were "shot at dawn".
The Minister of State, Ministry of Defence (Lord Gilbert): My Lords, the House will be aware that, as the then Minister of State for the Armed Forces, Dr. John Reid undertook a very careful and thorough review of the cases of servicemen executed during the First World War. He concluded that, regrettably, 80 years after the events, the little evidence that survives did not provide a sufficient basis for the Secretary of State to be able to recommend a pardon for all these men. However, they have now been publicly recognised and remembered as victims of the war. A copy of the summary of the review is available in the Library of the House.
The Earl of Carlisle: My Lords, I thank the Minister for his Answer, which I find disappointing and a little dispiriting. Although I welcome the expression of regret and the resolve of Her Majesty's Government to remove the death penalty from the Army Act, is not the time now long overdue—bearing in mind that these events took place eight decades ago and many were miscarriages of justice, as has now been recognised—that these men should be granted a free pardon either by invoking the Royal Prerogative or by introducing legislation? Does not the Minister wish to remove the stigma which the families feel, the slur on the names of the regiments in which they served with great gallantry and the long shadow cast over the War Office, now the Ministry of Defence, which the Minister represents with great distinction and humanity?
Lord Gilbert: My Lords, I am grateful to the noble Earl for his remarks. I quite understand why he feels a sense of disappointment. However, perhaps I may correct him on one minor point. I am sure that he will welcome, as I do, the fact that the death penalty ceased to be available for any military offence in the Armed Forces from November of last year. That is already in place.
With respect to granting pardons, these are extremely difficult and complex matters. They involve inviting the Queen to intervene and overturn a decision of a properly constituted judicial tribunal. That is a difficult thing to do. As I said in reply to the noble Earl, the evidence is scanty and concerns events that took place 80 years ago. I agree with him that even one execution is one too many, but unfortunately these matters occurred in the past and I am afraid we must leave matters as they are.
Lord Renton: My Lords, as one who lived throughout the First World War and well remembers its

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agonies, will the noble Lord bear in mind that we have to judge people by the standards of the time in which they lived and not by the more enlightened standards of our own days, as we believe them to be? Will he therefore ensure that in considering this matter those who did their duty, which resulted in these men having to be shot at dawn, will not be condemned for doing that duty?
Lord Gilbert: My Lords, I take seriously the points that the noble Lord makes and of course I bow to his experience. I think it is worth recalling to your Lordships that nearly all these courts martial were conducted by junior officers with immediate and relevant experience in the field of battle with regard to the people on whom they sat in judgment. Some 20,000 servicemen were charged with offences during the First World War to which the capital penalty then attached. Of those 20,000 some 3,000 were convicted and of those 3,000 only about 10 per cent. were executed. I do not think that makes the matter any better but I thought that your Lordships might like to know those facts.
Earl Russell: My Lords, does the Minister agree that his argument that the evidence is scanty in a matter involving reasonable doubt is capable of cutting both ways? Does he agree that the medical effects of trauma were much less well understood 80 years ago than they are now, and that that fact alone might well give rise to a reasonable doubt?
Lord Gilbert: My Lords, I am quite sure that the main point on which the noble Earl rests with respect to recognition of the medical effects of trauma is absolutely correct. However, one has to recognise that there was a whole range of offences for which these men were convicted. I am afraid to say that in some of those cases there was little doubt that the tribunal came to an appropriate verdict. We must accept that. As regards the fact that matters have changed with respect to medical assessments, I am sure the noble Earl is right about that. However, not only did my honourable friend undertake this review, but a review was also undertaken by the previous government which came to exactly the same conclusions.
Lord Monson: My Lords, does the Minister agree that no more than 25 German servicemen were executed for similar offences during the whole of World War I? Given that British and Empire servicemen were no less brave and steadfast than their German counterparts, does this not indicate that if the less draconian standards prevailing in other combatant armies at that time had been applied by the British Army, probably no more than 30 British and Empire servicemen would have been executed? If the Minister agrees with that analysis, will the Ministry of Defence issue a public statement to that effect so that the descendants of those who were executed can console themselves with the thought that their forebears were statistically probably among those who were unjustly executed, even by the standards of 80 years ago?
Lord Gilbert: My Lords, I did not come armed with the number of German soldiers who were executed
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although I have the figures relating to various Commonwealth countries. I agree with the noble Lord that standards were different and discipline was much harsher in those days. I shall certainly pass his suggestion to my honourable friend the Minister for the Armed Forces. However, I can see no way in which I can encourage the House to believe that the Government will move towards granting a pardon for all those concerned.

Steel Imports: Unfair Pricing
2.54 p.m.
Lord Hardy of Wath Lord Hardy of Wath asked Her Majesty's Government:
How many allegations of unfairly priced imports of steel they have received, how many of these have been found to be justified and what action they have taken in response.
The Minister of State, Department of Trade and Industry (Lord Simon of Highbury): My Lords, it is the responsibility of the European Commission to investigate allegations of unfairly priced imports if it believes there is sufficient prima facie evidence to warrant doing so. The Commission consulted member states about a number of investigations concerning steel imports in 1998. As a result anti-dumping measures were imposed on stainless steel fasteners from China, India, Malaysia, Korea, Taiwan and Thailand. Anti-subsidy duties were also imposed on stainless steel bright bars from India. However, anti-dumping duties on the same product were found to be unjustified and the investigation was closed. Additionally, the Commission is currently investigating six complaints of allegedly dumped steel imports and three complaints of allegedly subsidised steel imports.
Lord Hardy of Wath: My Lords, while I am most grateful to my noble friend for the information he has just given the House, I point out that in the previous critical period it was quite obvious that there was extremely serious and unfair competition within the EU. Is it not now clear that at present the situation is far-reaching and serious? May we be assured that the department will maintain the keenest monitoring of the situation because the achievements of the British steel industry in recent years ought not to be impaired by dumping on the part of some from overseas?
Lord Simon of Highbury: My Lords, I assure my noble friend that the department will certainly keep a close watch on the way the world marketplace is developing and the way that competition is intensifying. I agree with him that the performance of British Steel in the world marketplace is outstanding. Despite the difficulties of competition I note that it is exporting more both to the European Union and elsewhere than any of its competitors from inside the Union. We shall seek to maintain that position and defend strenuously the interests of a good British company.
Lord Clark of Kempston: My Lords, does the Minister agree that any subsidy impairs the competitive

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position of this country? Would it not be better for the Commission to pay attention to the unfair competition that would result from the harmonisation of income tax and corporation tax?
Lord Simon of Highbury: My Lords, we have discussed subsidies as a principle within the European Union at great length within the Council. It has been one of our objectives to ensure that the level of state subsidies across the board is reduced. That is happening. As part of the single market action plan there is a comprehensive analysis of state subsidies, league tables and a targeting process to reduce these elements which falsify competition. As regards tax harmonisation, the noble Lord makes a hypothetical assumption that this will be a subsidy to competition. Where subsidy exists, we shall try to reduce it. Where it is hypothetical, we should wait to see whether it becomes reality.
Lord Brookman: My Lords, does the Minister agree that this is a matter of great urgency and it is therefore essential that the Government, working in harmony with employers in the United Kingdom, ensure that these illegal subsidies in Europe are investigated speedily as imports are increasing at a tremendous rate? It is vitally important that there is speedy action on this point.
Lord Simon of Highbury: My Lords, my noble friend is absolutely right. We shall certainly do our best to ensure that that is done. The marketplace is dynamic and many of the issues to do with subsidy and dumping comprise allegations which have to be carefully investigated. This is a detailed area. As I have already said, those investigations which took place in 1998 have already been resolved. Those which are being investigated currently through EUROFER—which is the group which looks after the interests of the steel industry in conjunction with the Commission—will not be left on the back burner.
Baroness Denton of Wakefield: My Lords, I am delighted to hear that the department is monitoring the situation. However, we are concerned about the speed with which anti-dumping legislation is put in place. That is a matter not for us, but for Europe. Of late, the problem has worsened because the Americans can move through anti-dumping procedures quickly. How many meetings has the department held with the Commission to ensure speed once the case is proven?
Lord Simon of Highbury: My Lords, I assure the noble Baroness that there are continuous meetings on the state of the development of the marketplace. I have no detail as to how many have taken place. There are continuous discussions between the department and the industry, the industry and EUROFER, and between EUROFER and the Commission. If the noble Baroness wishes to raise any detailed points with me outside any of those meetings, I shall be happy to comply.
Lord Ezra: My Lords, it is indeed satisfactory to note that a real and continuous effort is being made to
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remove the subsidies. They have been in place for many years, particularly in certain countries such as Italy and Spain. Will the noble Lord indicate when effectively the subsidies could be removed? Secondly, a problem that arose in the removal of subsidies related to the social consequences that their removal would have in those countries where alternative possibilities for employment were practically negligible. Has that problem been tackled?
Lord Simon of Highbury: My Lords, it would be wrong to say that there is a target date for the removal of all the subsidies within the system. They are coming down very quickly. Those countries which have the highest levels are under the greatest pressure at Council meetings to remove the subsidies. In Spain in particular there have been successful developments within the industry in that direction.
As to the balance between reduction of subsidy and the social impact within various countries, those are matters for national governments. They are discussed at Council level but form part of the national plan for labour market flexibility and development that has been devolved to each country to solve. That is the right approach. I do not believe it is right for the Commission to try to handle labour market flexibilities and compensations between industrial sectors in the economy as a whole. As most of us would agree, the matter can be handled more effectively at a national level with an overall target to reduce across Europe the level of subsidy.

Audiology Services
3.2 p.m.
Lord Clement-Jones Lord Clement-Jones asked Her Majesty's Government:
What steps they are taking to ensure that there is an increase in hearing tests and a reduction in undiagnosed hearing loss.
The Parliamentary Under-Secretary of State, Department for Health (Baroness Hayman): My Lords, the Government are committed to the provision of high-quality audiology services that minimise the risk of undiagnosed hearing problems, and in June 1997 my right honourable friend the Secretary of State for Health helped to launch the Royal National Institute for Deaf People's information campaign for general practitioners.
In addition, the Department of Health has recently commissioned a review to look at the acceptability, benefit and costs of early screening for hearing disability.
Lord Clement-Jones: My Lords, I thank the Minister for that helpful reply. What steps are being taken by the department to iron out local variations in the waiting times for both hearing tests and the fitting of hearing

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aids, which are currently considerable? Will the primary care groups that are now being set up have a role to play?
Baroness Hayman: Yes, my Lords, the noble Lord rightly points to the fact that there are variations in the service throughout the country. In 1997 the National Health Service Executive set up a working group to examine hearing aid services. That has since been broadened to include audiology services, as the two services need to be looked at together, and to see what can be done in line with the new NHS programme for equity of access and high-quality services to improve and iron out unwarranted variation in service.
Lord Ashley of Stoke: My Lords, my noble friend's response to the Question was very helpful. Many people suffer deafness unnecessarily if it is not diagnosed or treated. Recognising, as she does, that something has to be done, does she agree that we need to improve the staffing levels in audiological services and the range of hearing aids? Does she further agree that we should also try to improve, as far as we can, all the arrangements relating to audiological services? In Britain today those services are inadequate and inconsistent. As the Minister said, they are variable—thanks to the Tory government. What do the present Government intend to do about that?
Baroness Hayman: My Lords, the noble Lord is right to recognise the problems in audiology services which he and many others have taken a great deal of effort to draw to the attention of government. I hope that when we see the results of both the hearing aid review and audiology services we can take action to implement higher quality services across the board. There are ways in which that could be done: for example, by using outreach sites and providing more access, and in promoting awareness among general practitioners. The primary care groups will be an important mechanism for ensuring that general practitioners provide a high quality of care in their localities for those people with hearing loss, who are the second largest group of people with disabilities in the country.
My noble friend referred to a range of hearing aids. As he is aware, a range of potential appliances is supplied by the NHS. More than half a million hearing aids per annum are used within the NHS at a cost of £16 million pounds. We must also examine continuing advances in technology.
Earl Howe: My Lords, to take up the point made by the noble Lord, Lord Clement-Jones, is the Minister aware that waiting times for hearing tests vary around the country from a matter of days to up to 18 months, and that having a hearing aid fitted can sometimes take several months longer? Is that not a good illustration of how bare numbers on a waiting list are a poor indicator on their own of patient need? Does she agree that a much better indicator is the length of time patients have been waiting for a consultation or treatment?
Baroness Hayman: My Lords, these are not "either/or" issues. We have to examine the whole
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provision of services. The noble Earl is right to point out that we must examine everything that is offered to a patient who requires care, not simply one small part of the process.
Referring to what I suspect underlies the noble Earl's question, as well having great success in reducing numbers on the waiting list, we are also, as he will be pleased to hear, having enormous success in reducing waiting times.

Access to Justice Bill [H.L.]
The Lord Chancellor (Lord Irvine of Lairg): 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 Access to Justice Bill [H.L.] has been committed that they consider the Bill in the following order:
Clause 1,
Schedule 1,
Clauses 2 to 7,
Schedule 2,
Clauses 8 to 14,
Schedule 3,
Clauses 15 to 22,
Schedule 4,
Clauses 23 to 35,
Schedule 5,
Clauses 36 and 37,
Schedule 6,
Clauses 38 to 51,
Schedule 7,
Clause 52,
Schedule 8,
Clauses 53 to 61,
Schedule 9,
Clauses 62 to 75,
Schedule 10,
Clause 76,
Schedule 11,
Clauses 77 to 80.—(The Lord Chancellor.)
On Question, Motion agreed to.

HIV/AIDS in sub-Saharan Africa
3.7 p.m.
The Earl of Sandwich The Earl of Sandwich rose to call attention to the case for an adequate contribution to the control and prevention of HIV/AIDS in sub-Saharan Africa; and to move for Papers.
The noble Earl said: My Lords, it is a considerable honour to lead this debate today. I am grateful to everyone who is taking part, especially since over Christmas I had a terrible feeling that I might be a solitary speaker. I am relieved to see so many noble Lords present. We are discussing an issue of great importance to all of us; namely, an epidemic of the human immuno-deficiency

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virus in sub-Saharan Africa which claims thousands of lives every day, affecting 21 million, or two-thirds, of the 33 million who are infected with HIV worldwide.
If this were a war in Africa with the same death toll as AIDS, we should be discussing it every day. Someone dies of AIDS in Africa every time I finish a sentence. Nearly 2 million have died in Uganda alone. It is a topic as serious as war in terms of the loss of human life, its drain on resources and health services and its catastrophic effect on Africa's economy. In some countries in Africa this sense of urgency exists; in others, especially in rural areas, where there is less awareness, the victims are getting younger and there is a crisis still to unfold.
I intend to speak from recent experience in East Africa, mainly a rural AIDS programme supported by Christian Aid and Youth With a Mission. I shall also refer to other regions.
I salute the work of UNAIDS which, through its website, has helped to promote the cause of AIDS sufferers the world over. In Uganda, an estimated 870,000 adults and 67,000 children under 15 were infected by HIV/AIDS at the last count, roughly one in 10 Ugandan adults. One million more are orphans. Half the hospital beds in Kampala today are occupied by HIV patients.
Other parts of Africa are even more seriously affected. In South Africa, one in eight adults live with HIV infection. In Zimbabwe, one survey shows that between 20 per cent. and 50 per cent. of pregnant mothers are infected, with at least one third of them likely to pass HIV on to their babies. Botswana, Namibia and Swaziland are hard-hit, with one in five people aged between 15 and 49 living with HIV. Zaïre, where HIV was first reported, continues to suffer, while many areas are afflicted by civil war. West Africa, on the other hand, seems comparatively stable, with Senegal a recognised example of successful prevention.
AIDS poses a particular threat to young people, with most new infections concentrated in younger age groups. Adolescent girls under 18 may be five times more likely to die of AIDS than women of 20 to 25, according to WHO. Save the Children is one agency that I know is especially concerned about abused and vulnerable children. Children as young as seven, it says, should be receiving education about AIDS in primary schools. Its staff are successfully using peer counselling to spread the message in countries like Mozambique.
Another sad consequence of AIDS is the number of orphans: over 7 million in Africa. In Uganda alone, the number of children who have lost their mother or both their parents was 1.1 million at the end of 1997, a larger number than the orphans from the civil war. AIDS is responsible for about 40 per cent. of all Uganda's orphans and this figure is bound to increase as an average of two-thirds of babies born to infected mothers escape infection themselves.
As a patron of the UK UWESO Trust (that is Ugandan Women's Efforts to Save Orphans), I am concerned that these children should be as high a priority for aid donors as I know they are for Uganda
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itself. Almost every family there has suffered losses, some multiple, as I soon discovered when meeting people during my visit last September. I will only mention a few personally known to me. Sam, the able young director of the Kangulumira AIDS project has lost two sisters to AIDS. Rebecca, a staff member, had lost her father, stepmother and uncle before she was 20. Fatuma, like so many other widows, was chased out of her husband's family house soon after he died of AIDS, then lost four children to the disease and related causes, besides contracting it herself. Finally, Eva, who trained as an AIDS counsellor and health worker told me:
"Every day we heard of someone dying in my village. One night I dreamed I was helping HIV patients. So I began visiting their homes, cleaning, washing for them and listening to their problems".
In the last three years, 81 local volunteers like Eva have received basic training in community healthcare, to serve 35 villages in the area. They are primary school teachers, farmers, members of women's groups, friends of AIDS patients, ordinary people who care what happens in their community and who now complement the 45 full-time health workers.
As a result of all this, Uganda, like Thailand, is one country on the emergency list where there has been measurable success in the past few years. A progressive decline in HIV prevalence rates has been recorded in ante-natal clinics in Uganda since 1992. The number of infected pregnant women has halved. UNAIDS reported a decline from 13 per cent. in 1994 to 9 per cent. in 1997, especially among urban Ugandans in their early 20s. The Medical Research Council confirms this trend.
Elsewhere in East Africa there is some preliminary evidence of decline. For example, in urban areas of Kenya there was a reported decline between 1995 and 1996 and later figures are expected to confirm that. Tanzania is also showing positive signs.
Why has this happened? Uganda's success follows from the commitment of health workers and community leaders, and the vigorous campaign by the government, media, schools and religious bodies to bring awareness of AIDS into every family. The Churches regularly mention AIDS and safer sex, there are posters and news-sheets advertising condoms everywhere and a remarkable honesty and openness exist which would adorn a health education campaign in any society.
A network of Ugandan NGOs and others from abroad, working alongside the health services, are active in care, self-help and training. Mildmay International, which has a good reputation in AIDS palliative care, has opened a new centre outside Kampala which hopes to train health workers over a wide area. Other NGOs have deliberately chosen to work in more deprived rural areas.
Yet the conditions which help AIDS still thrive. The MRC Uganda study shows that the presence of sexually transmitted diseases greatly increases the risk of HIV infection. Genital herpes, for example, infects nearly three in every four young women under 21, yet only 5 per cent. of women and 10 per cent. of men complain of symptoms, indicating that only a small minority are aware of or admit to its presence.
The necessity, therefore, for prompt treatment of both STDs and AIDS implies that in Uganda there is still a huge potential for containing the epidemic altogether, provided that resources can be well targeted. The training of health workers in particular is a priority in all areas where there has been a high HIV incidence.
Beyond patterns of behaviour loom larger issues of endemic poverty and the shortage of skills and resources. The AIDS epidemic has again revealed the appalling inequality in resources between our own society and the developing world. There is a scientific imbalance which has allowed patients in industrialised countries to benefit from the anti-retroviral vaccine. But more critically, in my view, there is a developmental fault line which allows us the luxury of an almost comprehensive health service and leaves national health and education budgets in Africa with only a few dollars per head. I need only quote the chairman of the local council in Kangulumira:
"Our problem here is poverty. Good as the training is, if the people have no sanitation and clean water, and if illiteracy is as high as 60 per cent., unless we improve these services, how can we improve the people's health?"
Some will still counter this with the old chorus of corruption, political influence and inefficiency. But if we had been put off by that, we would never have conquered ill health in the 19th century. Like our Victorian forebears, we have to make a much greater world commitment to sanitation and clean water supply if we can ever hope to defeat epidemics like AIDS and cholera. As the Secretary of State said on World AIDS Day:
"AIDS is more than a health issue, it is an issue of deepening poverty".
We have evidence from one study in Tanzania that 42 per cent. of AIDS incidence was reduced by the provision of a clean water supply. The aid agencies have other examples. Yet will our OECD leaders ever open their eyes wide enough to see poverty and not Saddam Hussein as the biggest threat to the world today?
One way for our Government is to work through trusted local community organisations and NGOs, wherever possible. Aid should be highly targeted and carefully monitored. It is often not money which is lacking but a well-designed project which truly involves and specifically reflects the local need.
Even if we do not find an affordable vaccine for AIDS in Africa, we could alter the conditions which allow it to flourish. The question is whether the risks of the epidemic will so alarm the industrialised world that it will be forced to take more action through the World Bank and the IMF.
One possible motive may be economic. The world cannot afford to allow an economy like that of South Africa to fail because of its inability to tackle the acute problems of education and health left behind by apartheid. Increased economic activity, migration and the ability of countries to trade have been a strong force behind the greater movement of labour. The habits of long-distance drivers and traders have encouraged
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prostitution and the spread of infection. This is another reason for the business community to step up its support for AIDS campaigns.
AIDS is taking a heavy toll among skilled people, and businesses are already counting the cost. One company in Zambia reported that losses through illness and death from AIDS cancelled out its entire annual profits. In Zimbabwe, insurance premiums have quadrupled. On the other hand, investment by companies in AIDS and STD prevention has been shown to save a high proportion of those losses.
I have the following question for the Minister: are the Government taking enough of a lead in the OECD to back vaccine research and attract funding which will lead most quickly to the development of vaccines?
Political endorsement for national AIDS campaigns by leaders such as Mandela and Museveni is essential. I met President Museveni just before the address to the seminar on AIDS and I was impressed by his words and his famous determination and commitment which has got Uganda where it is today. He said that Uganda needed to use activist methods to reach the widest cross-section of people and to involve the consumers of health in their own health care. President Mandela's New Year message reaffirms the ANC's pledge to end poverty and inequality. He said that every sector of civil society declared its commitment to help turn the tide against this epidemic.
Unfortunately, this tide has not yet turned in South Africa or elsewhere in the region. The Health Minister there has been criticised for preferring prevention to treatment, but at least she has helped to raise the profile of AIDS. This year's World AIDS Conference in Durban should help, but it will require more political will there, and elsewhere in Southern Africa where firm leadership is less obvious.
Governments are trying to find an effective and affordable AIDS vaccine for Africa, but the £10,000 or so a year needed for every patient to have triple anti-retroviral therapy is far beyond most families' means, and scientists have yet to agree on the best way forward. The World Bank and UNAIDS are financing an interesting scheme in Cote d'Ivoire. Expectations are being raised but it seems that disappointments are inevitable. The International AIDS Vaccine Initiative has made a start. For example, it supports Professor McMichael's research in Oxford, involving an East German company, which will be tested later this year. IAVI has another project to develop a new vaccine for South Africa.
The problems are the urgency and scale of the need, the high cost, and inadequate backing from pharmaceutical companies. I ask the Minister: is the UK response to the epidemic adequate? Is it concentrated enough on rural development—for example, primary health care, prevention and education—which will ensure that more can be helped at home in rural areas? Are resources too highly concentrated in certain countries? What co-ordination exists among the donors, especially the European Union? Are the Government satisfied with the present level of funding of £2.7 million from the Uganda budget, or are they waiting to see what needs arise

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elsewhere in Africa? Specifically, are the Government taking more action to educate younger, primary-age children about the risks of unprotected sex and HIV?
In conclusion, as deaths from AIDS in the UK fall and more and more of our patients benefit from vaccines, I am sure that we would all like a reassurance that we are doing our utmost to turn the spotlight of funding and research towards Africa and parts of Asia where the need is more acute. Surely more could be done to identify isolated communities, where a higher investment in health and education would prevent the epidemic occurring in the first place. My Lords, I beg to move for Papers.
3.23 p.m.
Lord Judd: My Lords, I am sure that the whole House will want to congratulate the noble Earl, Lord Sandwich, for introducing this important subject today. It is characteristic of his very practical and deep commitment to humanitarian issues across the world. I am sure that the Government will take very seriously everything that is said in the debate.
I hope that the noble Earl will agree with me that if we are to look at the issue of sub-Saharan Africa, it is very important that we look at that in the context of the global situation and the global challenge to governments who are trying to meet this terrible crisis.
Worldwide, more than 30 million children and adults are estimated to be living with the virus. This could be 40 million by the turn of the century if current trends continue. The principal UN agencies concerned estimate that 5.8 million people became infected in 1997 at a rate of 16,000 new infections per day. Sixty per cent. of new HIV infection is in the 15 to 24 year-old age group, underlining the vulnerability of young people. More than half of the world's population is under 25, and more than half will have had unprotected sex before the age of 16. Increasing drug abuse exacerbates the problem. Ninety per cent. of infants living with HIV contracted the virus from their mothers. More than 8 million children have lost mothers to HIV/AIDS.
In an excellent policy paper, the Save the Children Fund has summed up the situation in these words:
"Many factors contribute to the spread of the virus. These are firmly rooted in poverty, both micro and macro economic, social deprivation, gender inequity, cultural attitudes and behaviour, under-resourced health, education and welfare services, conflict and war, the movement of people and growing urbanisation, a lack of preventative education and services to the 10–19 year old age group, discrimination and a lack of political and legal commitment".
The paper continues:
"There is no cure for AIDS…It is anticipated that it could take another 10 to 15 years to develop a preventive vaccine. Meanwhile HIV continues to spread virtually unchecked, particularly in the poorer nations of the world where 90 per cent. of current HIV infection is located".
That, of course, is very much sub-Saharan Africa.
The noble Earl referred to the position of SCF. The SCF paper stresses that children are seldom seen as a priority for HIV preventive work, and that usually children are targeted too late. As the noble Earl has said,
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sexual experience—usually unprotected—first occurs between the ages of seven and 15. But the majority of children are denied access to the services, education and information which could help them to protect themselves from the disease.
Globally, epidemiological data are not available on HIV/AIDS for children between the ages of five and 19. Consequently, children are not prioritised for prevention. It is essential to highlight data on age of first sex, teenage pregnancy, incidence of sexual abuse and exploitation, non-consensual sex and child prostitution. It is also vital to emphasise that, although women and girls are biologically and socially more vulnerable to HIV/AIDS, preventive work nevertheless too often lacks a gender-sensitive approach. For every four men living with HIV, there are six women living with it. Obviously, the protection of women and girls from HIV is the key to the prevention of mother-to-child transmission.
The Save the Children Fund spells out three social consequences. In most societies, women and children are most vulnerable to HIV infection, yet often it is they who carry the major burden of care and support. The number of children orphaned by HIV/AIDS challenges the abilities of communities to cope. The capacity of welfare and health systems can also be challenged when children are needlessly institutionalised as a result of HIV/AIDS. SCF argues that, whenever possible, children living with the virus, or orphaned as a result of it, need to remain with family and community. That makes humanitarian, social and economic sense.
The recognition of the wider social and economic impact of the HIV/AIDS pandemic is shared by us all. The United Nations system is doing heroic work—with, as usual, far too few resources—and the Save the Children Fund is not alone as a non-governmental organisation in its courageous endeavours to grapple with the crisis. Among numerous other NGOs, Oxfam—here I should declare an interest as a former director and currently an Oxfam Association member—has repeatedly made the point that, even with the eventual development of a preventive vaccine, there will be no quick fixes. Simplistic interventions which address HIV/AIDS prevention in isolation from political, economic and social realities are doomed to prove ineffective. Like SCF, Oxfam argues that it is imperative to integrate HIV/AIDS work into national poverty reduction plans. That means that HIV/AIDS ought always to be part of policy and programme assessment, of monitoring and of evaluation. When my noble friend comes to reply, it would be good if she could reassure us that, in fact, it is.
Of course, HIV/AIDS programmes should always be part of strengthening overall health systems, social development and education programmes. The relevance of the functional approach to literacy, dealing with the responsibility of men as well as of women, with gender awareness, with health and with social hygiene, cannot be over-emphasised.
I am sure that my noble friend agrees that macro-economic policies are criminal in effect when they undermine the ability of society to cope. They are also stupid by making long-term social and economic

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viability even more difficult to achieve. Instead, macro-economic policies should invariably seek to strengthen coping capability. I would be grateful if my noble friend could reassure us on how this is being ensured.
There are four priorities to which many of us in the front line of the battle against HIV/AIDS are deeply committed. I hope that my noble friend can deal with them when she comes to reply. First, access to basic healthcare is crucial to the prevention and management of HIV/AIDS. This requires primary healthcare systems that work, with access to essential drugs, referral systems and, above all, to information and to the treatment of sexually transmitted diseases.
Secondly, policies that deal with gender inequality and the empowerment of women are indispensable if women's vulnerability to HIV/AIDS is to be decreased. That demands legislation designed to improve the status of women, including their access to education, employment and decision-making at all levels of social organisation ranging from the household to the political arena.
Thirdly, there needs to be emphasis on community participation in programme design, monitoring and evaluation which is meaningful and goes beyond simply sharing the costs of the programmes.
Fourthly, on the global stage, new trade agreements and intellectual property agreements should take fully into account the implications of patent laws on current and future access to the drugs that are needed to fight HIV/AIDS.
There must be collaboration between donors, UN agencies and national governments to promote sustainability and cost-effectiveness. Civil society, including a wide range of non-governmental organisations, has a major part to play in raising awareness and ensuring human rights in relation to HIV/AIDS. Whatever the Government can do to facilitate this deserves all possible support.
3.32 p.m.
Viscount Brentford: My Lords, I too thank the noble Earl for introducing this subject. The figures are horrendous. As he rightly said, this problem affects more people than most wars that come to mind. Two-thirds of the world's population with HIV and AIDS live in sub-Saharan Africa. Eighty per cent. of women with HIV throughout the world (8 million), 90 per cent. of children born with HIV infection, and 95 per cent. of all children who have lost their mothers through AIDS live in sub-Saharan Africa. This is an horrendous problem and that particular area suffers the most.
When my son worked in Kampala he set up a scheme to work with street children, to help them and to rescue them. He confirmed to me that quite a number of boys living on the streets (albeit only a minority) had been orphaned because both parents had died of AIDS. The extent of this problem hits one when one visits those countries. Already 11.5 million have died of AIDS-related illnesses in sub-Saharan Africa. That is an horrendous figure.
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It is important to note that not only do many people suffer because of HIV/AIDS, but economies and businesses are also hit—and that will therefore have an effect on the UK economically. Aidscap calculates that by 2005 Kenya will have lost 14 per cent. of its GDP because of AIDS. Other countries will be in a worse state. That will affect UK trade, as well as Kenya's trade. The costs to businesses in those countries (of lost productivity and of replacement training) are very high—let alone all the costs of looking after suffering people.
In that part of the world, HIV transmission arises primarily from two sources, neither of which is related to homosexual contact. The first is generally through heterosexual contact. In some countries, over 40 per cent. of women who attend antenatal clinics are HIV positive. This is true more in southern Africa rather than further north in sub-Saharan Africa. Where there is appropriate access to information and services, it appears that the age of first sexual intercourse rises, which is good news. In addition, the use of condoms, including female condoms is spreading. That helps to slow the spread of HIV. A recent survey in Kenya revealed that on average girls lost their virginity between the ages of 14 and 15 because there was no reproductive health education in schools to educate girls to avoid early sex. That is very damaging in terms of the increase in HIV.
The second means of HIV transmission is from mother to infant at birth. Preventive approaches prove to be highly cost-effective, because obviously a great deal of money is saved if babies do not suffer from HIV. I understand that Glaxo-Wellcome has produced the drug AZT which appears to reduce the spread of HIV from mother to infant. Perhaps the noble Baroness is able to confirm that that drug is proving to be effective in sub-Saharan Africa.
In conclusion, I make three points. First, I return to the problem of motherless children. Community visiting, involvement and responsibility seem to work well when in place. In Zimbabwe, for example, there are schemes under which village heads take the initiative and villages make provision for AIDS orphans. They give practical support, such as the setting aside of village land to be cultivated to provide money and practical help for those orphans, and emotional support and guidance. It is good that the local community should take that initiative, but with the possibility of the disease spreading throughout the area, will communities be able to cope? Have the Government discussed this matter with the national governments of sub-Saharan Africa? Can more help, both practical and financial, be given to them?
Secondly, I refer to education, information and training, particularly for the young. What are the Government's present plans to encourage training so that young people in particular can take control of their own sexual and reproductive health? We are very grateful to the Government for having provided £2 million for the Mildmay Centre in Uganda. What are the future plans of the Government in that respect?
Thirdly, I understand that use is being made of charities and NGOs, some of which have already been mentioned. I refer to the Mildmay Centre and to Aids

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Care Education and Training (ACET), to both of which I am indebted for up-to-date information and with which my wife and I have worked for many years. I look forward to an encouraging response from the noble Baroness.
3.39 p.m.
Baroness Miller of Chilthorne Domer: My Lords, all noble Lords are inclined to begin their speeches with statistics. I shall refrain from doing so because the statistics that have been quoted are shocking. I share the frustration of the noble Earl, Lord Sandwich, that despite the statistics we appear to have such a quiet world disaster on our hands. All of us who have worked in that part of the world for any length of time are outraged by it. Even when the UN report came out in the autumn of last year highlighting these astoundingly dreadful statistics, it was barely reported here. If this scale of death were occurring through famine or war, especially if it were occurring nearer home in Europe, we should consider it a world emergency and it would be headline news every day. Is it because the disaster is further away or is it because public response is still tinged with, "AIDS is a result of casual sex so people get what they deserve"? I certainly hope that is not the case, but let us not forget that it is not so long ago that it was highly newsworthy in Britain when the late Princess Diana shook hands with an AIDS victim to show that AIDS was not abhorrent or something to fear.
In addressing this problem, enormous efforts need to be made to keep the still healthy population healthy. In the country of which I have experience, Botswana, it is estimated that one in four adults is HIV positive. That means that three adults in four are still healthy. References have been made to the production of effective vaccines, and that is a priority, but in the short term we must concentrate hard on what should happen between now and the production of that vaccine.
The widespread provision and use of reliable condoms is vital, but the problems concealed in those few words are tremendous. Who in political circles, especially at the more local level, will raise the real problems involved in achieving widespread use? The noble Earl referred to the fact that openness is the key to this. There are very few women in decision-making political arenas, especially local ones, in sub-Saharan Africa. My own area of work in Botswana was with women at local council level. The British Council played a great role in terms of enabling that programme of empowering and trying to raise the confidence and awareness of women at a local political level. Women there have a battle to make their voices heard. They are substantially in the minority and are usually kept on the back benches. When it comes to the men, a lot of what has to be said about condom use is difficult and embarrassing. Which male politician, especially in his own local community, not in the safety of his national parliament, wants to address the real reasons why his colleagues, friends and voters will not use condoms? The fact is that men do not like using them, and one does not have to be an expert on AIDS in sub-Saharan Africa to know that. But the situation is more extreme in
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countries where there may be greater cultural resistance, where women are less able to insist upon their use and where some of the women are still girls who feel unable to insist, with older men, that they should use a condom.
I agree with noble Lords who have already spoken that among the younger age group it is crucial that AIDS education programmes address in an appropriate way what "safe sex" is and how it should be practised. Teachers, especially in the more rural areas, desperately need the material that will enable them to present a sex education programme in an effective way. The UN document on "How to use the right condom the right way" has 19 lengthy bullet points and not one diagram. I do not imply that that document is meant for use in schools, but nevertheless it is on the Internet.
Condoms need to be free and freely available. If you walk down the street in the capital of Botswana, Gaborone, you will come across boys who have bought 10 oranges and are selling them individually to make a profit. Would we seriously expect that they would spend the extremely small profit from their day's work on one condom? I think not. Nevertheless, many couples in sub-Saharan Africa have obtained and used condoms and it has been a bitter irony for some of those couples who did practise safe sex to find that the condoms they relied upon were faulty. British embassies and aid organisations in the region have been proactive in trying to insist on, and maintain, standards, but the history of condom distribution in the region makes very depressing reading. Hundreds of millions of condoms are paid for and tested by international aid agencies, but last year alone 4 million were returned to India because 48 of 200 in some test batches broke.
There has been no worldwide study of faulty condoms and I understand that there is no agreed worldwide strategy for making them more acceptable to use. National governments in the region are up to their ears in the problems of buying and distributing a sufficient number of reliable condoms. They tend to opt for a standard size and type. No wonder many men will not use them. I do not believe that a standard size is applicable. An international "comfortable condom" conference may sound like a joke, but actually it is a matter of life and death.
I should like to reinforce the following two points that were made by other noble Lords. In the rural areas a programme of home-based care is essential and a large volunteer force will be needed to help put that in place. The development of the kind of expertise needed to do this outreach work on a multi-sectoral scale will be an enormous challenge.
I should like to hear the Minister's response as to whether the department has estimated the likely number of orphans in the region by the year 2005. I gather that in Zimbabwe alone it is estimated that the figure will be about 80,000. Who will care for this generation? I am sure that other speakers will touch upon the longer term, but I should like a response on the short-term question of what we are going to do about condom provision.
3.45 p.m.
The Lord Bishop of Wakefield: My Lords, I am grateful to the noble Earl, Lord Sandwich, for initiating this debate on the world's greatest tragedy of this generation. As yet unpublished figures from UNAIDS point to a situation even worse than had been feared. The infrastructure of countries is being decimated. I know best the countries of central Africa. In Malawi half the teachers, nurses and police are expected to be dead within 10 years and already 10 per cent. of the population are orphaned children. Yet of the global total of 2.6 billion dollars being spent on controlling and preventing AIDS only 13 per cent. is being spent in the developing world, where 92 per cent. of all cases are located.
This imbalance means that enormous responsibility for control, prevention and care continues to rest, as I and others who have visited these African countries have seen, on locally based initiatives, many of them spiritually motivated. The Islamic Medical Association, working through Imams in the mosques, is doing significant work in Uganda. The Christian Churches, strong in sub-Saharan Africa, are responsible, especially in the rural areas, for the bulk of health provision. When urban dwellers are struck by HIV, they often go back, sick and dying, to their families in the villages. As a result more than 50 per cent. of the beds in many mission hospitals are now occupied by sufferers of AIDS-related diseases such as TB. These mission hospitals now face a major funding crisis which is seriously undermining their ability to control these diseases. All over Zambia there are now health centres and hospitals with no supplies, no drugs, no gloves to protect against infection and no syringes. At one rural health centre which I visited injections have been given with one unsterilised needle.
I am grateful to the noble Earl, Lord Sandwich, for his reference to the Churches' role in preventive education work. Sixty per cent. of rural primary schools in Malawi and Zambia are now run by the Churches. But, as the noble Viscount, Lord Brentford, indicated, however hard people try with preventive education programmes, there are always huge gaps. I underline the point made by the noble Baroness, Lady Miller, about the need to emphasise condom use, and I am glad that some of the stricter Christian denominations and Moslems are now approaching this matter with reasonable pragmatism.
I hope we shall not let tragic statistics deflect us from noting the often unspectacular, small but together considerable and significant efforts at control and prevention being made at the grass roots. The Mothers' Union in Africa is doing outstanding work in prevention and care among all age groups. That body and bodies such as the Medical Missionaries of Mary and the local anti-AIDS clubs need our encouragement because there is strong evidence that such local projects help behavioural change, and prevention, and are highly cost-effective.
In no way do I wish to promote the work of Church-related bodies above the outstanding work of others. As the noble Lord, Lord Judd, said, the NGOs
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and governments need to work together and support one another, not least for the sake of better co-ordination and targeting. It is for that reason, I assure noble Lords, and not to score any points, that I say that it is astonishing that the DFID's excellent country strategy papers give little mention of the massive contribution made by the Churches in health and education, and yet workers with other NGOs tell us that those sectors could not now function in most of those countries without the Churches. I hope that that will be taken into greater account in future DFID strategy and included, where appropriate, in sector funding.
I refer also to the Jubilee 2000 campaign and the way in which world debt has so adversely affected these countries, as Oxfam and Christian Aid have so dramatically demonstrated. I repeat a point made earlier. In Africa AIDS is more a symptom of poverty than of vice.
The SAPs encouraged migration and caused low nutrition both helping the spread of HIV/AIDS. The poor countries' initiatives, well intentioned, have led unfortunately to cuts in health and education in all those countries—at the very moment when 87 per cent. of all children in the world with HIV are in Africa.
The Secretary of State made a welcome commitment at the General Synod of the Church of England to the reduction of world poverty. I know that debt relief will not magically end all poverty. I know that one cannot read off economic policies directly from the Book of Leviticus. But the ageless biblical rebuke to those who chain others in debt and poverty has in sub-Saharan Africa rarely had so pertinent a ring.
3.52 p.m.
Lord Rea: My Lords, I, too, congratulate the noble Earl on attracting such a large body of distinguished speakers. There is one snag. A few days ago one's speech was to be 12 minutes long. However, today I may speak for no longer than seven minutes, so there has had to be some last minute truncation and I apologise to noble Lords if my speech is somewhat disjointed.
The noble Earl outlined the severity and extent of the problem; others have amplified and will amplify his account. Some noble Lords may have seen a recent Channel 4 programme. It was called "The Forgotten Plague" because AIDS has slipped from the headlines in the UK. But in parts of the developing world the situation is so disastrous that no less a word than "plague" can describe it. As the noble Earl said, in some parts of southern Africa 25 per cent. of the population are known to be HIV positive. In some areas, the expectation of life has fallen from some 60 years to only 40 years, a decrease of 20 years. The impact of the epidemic has swamped already overstretched healthcare systems and is seriously disrupting development by decimating the brightest and best among the younger population, and among the professionals, as the right reverend Prelate pointed out.
It may be more appropriate for me to talk about some clinical aspects. The HIV cannot usually penetrate normal intact mucosa or skin. It passes from one host to

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another through blood products or broken, infected or ulcerated skin or mucous membranes. These lesions are often caused by another sexually transmitted disease.
In developed countries such as the UK, there is a relatively low prevalence of those "old fashioned" sexually transmitted infections because we have a healthcare system which treats most cases as they occur. In this country the main routes of transmission of the HIV have been through shared needles, contaminated blood products and anal intercourse among gay men, when a small abrasion or split in the anal skin often occurs. But in many developing countries there is a high prevalence of those "old-fashioned" sexually transmitted diseases, largely because of the lack of an effective health infrastructure to provide treatment. As the noble Earl pointed out, many carriers of those STDs are unaware of their condition because they have no symptoms. They are unaware that they are particularly vulnerable to HIV infection. That is probably the main reason why heterosexual transmission is uncommon in developed countries but is the norm in developing countries.
Because effective treatment of HIV infection is so expensive (as well as being only partially effective and difficult to administer) it is not a feasible option for sub-Saharan Africa, as the noble Earl pointed out. The accent clearly has to be on prevention and the care of affected patients, including support for their families. But prevention requires change in customs and behaviour, which is particularly difficult in traditional societies with low levels of education and literacy.
In the UK 12 years ago, a concerted programme of very explicit health education, led by a high-level Cabinet committee, was very effective. But in many developing countries, despite rhetoric, not enough priority is being given to the need for co-ordinated government action across many sectors to tackle the problem effectively.
The excellent UNDP Human Development Report for Namibia states that as well as the Ministry of Health and Social Security, the Ministries of Education, Information, Youth and Sport, Defence, Home Affairs, and Tourism should all be involved, as well as non-governmental organisations, private sector employers, parliamentarians and regional and local councillors. That across-the-board approach is necessary because, despite presidential appeals, until now it could be said that there has been denial at a high level. That does not only apply to Namibia; nor does it apply only in Africa. There is still a reluctance to accept the role of promiscuous behaviour in spreading the infection, in particular if it affects the freedom of action of the person concerned. In many communities an unjustified stigma attaches to HIV/AIDS patients instead of the compassionate attitude which would help them. In South Africa, a woman who "came out" as an HIV-positive patient to help to warn others was stoned to death by other members of her village. The human rights of those afflicted with HIV/AIDS are frequently abused. Last year that matter was the subject of a UN-sponsored consultation on HIV/AIDS and human rights.
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The noble Earl and other noble Lords described the home care programmes which have developed in Uganda and other countries in Africa. There is simply not room in the hospitals for all the AIDS patients, but their terminal days can still be made more comfortable through home care. It is not a cheap or easy option. Good home care requires trained and dedicated people, as has already been pointed out. It is important that those who have TB as part of their AIDS—and there are many—should be treated. Although they developed the infection due to their immune defence system being weakened, they can nevertheless pass it on to others. Often, the TB infection may be due to a multiple drug resistant organism.
Perhaps I may say a final word on vaccine development. I know that DFID was a pioneer in funding vaccine research and intends to provide more resources. Can my noble friend give any news on that front, both about the progress of research to date and future funding? Can she also give any information on the development and use of a very useful new idea: a vaginal antimicrobial preparation which kills the HIV virus in the vagina before it can cause an infection? This is extremely useful for women to use where condoms are not acceptable or available. I know that there are currently trials of this antimicrobial preparation.
4 p.m.
Baroness Masham of Ilton: My Lords, I thank my noble friend for bringing this horrific problem of HIV/AIDS in sub-Saharan Africa to the notice of your Lordships today. In recent years there has not been so much publicity about HIV/AIDS; but to the individual who loses a loved one from this dreaded condition, wherever it may be across the globe, it is devastatingly tragic and sad.
As education is so important, perhaps I may list what the initials HIV/AIDS stands for. Human—it only affects humans; immuno-deficiency—enters and takes over the immune system; virus—capable of entering a body's cell and making new viruses; acquired—cannot be caught passively; immune—prevents immune system working effectively; deficiency—body becomes easy target for illnesses; syndrome—collection of illnesses. No one dies from AIDS. They die because their body cannot cope.
There are 7.8 million AIDS orphans in sub-Saharan Africa. One of the dilemmas is that HIV can be transmitted from an infected mother to her child during pregnancy, during delivery and in breast milk; but in most countries the risk from not breast feeding is greater than the risk of HIV infection.
I commend to your Lordships the work that NGOs are undertaking in some of the African countries. ACET, which stands for AIDS Care, Education and Training, has been working in Uganda since 1990. One in eight people is already infected, with the figure rising to a staggering one in three in high-density urban areas. Though the numbers are very high, HIV infection in Uganda seems to be being contained. Health education campaigns across Uganda are cited as being responsible for this. ACET's Uganda health education programme

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has been awarded major new funding by the United Nations Development Programme. In 1996 it was given £100,000 to duplicate its education programmes and support income-generation projects in the north of the country.
ACET's team sees thousands of children and students face to face to give them education on HIV, and have trained over 100,000 community AIDS workers. ACET is a Christian organisation and finds that, even with large-scale health education campaigns, there is still a place for simple acts of Christian compassion when they are called to help by an individual family. I had the pleasure last year of meeting some of ACET's Uganda team at a reception at Lambeth Palace. It is important that these dedicated and splendid people continue to have our support.
The HIV/AIDS pandemic is threatening Botswana's development. The introduction of drug cocktails to prevent pregnant women from passing HIV/AIDS to their unborn children, home-based care, orphan care and feeding schemes for destitute patients are desperate measures that add to welfare costs. Kenya has been placed among six countries with the world's highest infection rate, along with Botswana, Zimbabwe, Namibia, Zambia and Swaziland. Migration and rape, linked to Rwanda's 1994 genocide, increased the cases of HIV in that country sixfold.
HIV/AIDS is a changing picture in many of these countries. It is thought that some 2 million people in South Africa are unaware that they carry the virus. In recent years tuberculosis cases have rapidly increased. In Zambia it was found that between 50 and 70 per cent. of TB patients were also infected with HIV.
In Zimbabwe governmental organisations are calling on the country's rural communities to end the tradition of men taking over the wives of their late brothers, in an effort to stem the spread of HIV. The practice of wife inheritance, which was originally expected to provide continuity of responsibilities and security for a widow, has been cited as a prime source of HIV transmission.
During 1998 Africa held 5,500 funerals a day for people dying from AIDS, but the death rate is set to increase. At a conference I attended I heard a missionary doctor tell of a grandmother who had buried 19 of her family. My Lords, education in African villages is vital. There may be suspicions that children orphaned due to AIDS are helped by bad spirits—spirits which prevent those who try to help from doing so. Good schemes for the children need encouragement and education is vital.
Back here in England, over three-quarters of the residents presumed to have been infected with HIV heterosexually acquired their infection whilst in Africa. Denial is still a problem amongst African men living in the UK. There is a reticence to be tested and to be treated. African men tend to keep working until they become very seriously ill or even die. There is a need for both prevention and care to be targeted at the African community in Britain. The women can be left holding the baby.
There are some wonderful people helping. I hope the Minister will visit to see the work being done in Great Ormond Street—not the hospital—by a small voluntary
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organisation called Body and Soul. They give day-to-day support to many African women and children.
Many of your Lordships have mentioned the vaccine. Could the Minister tell us what progress there is on this? It must be the solution for world-wide prevention.
4.7 p.m.
Lord Ponsonby of Shulbrede: My Lords, I too should like to thank the noble Earl, Lord Sandwich, for introducing this extremely important debate. It is difficult to exaggerate the devastating effects of AIDS, particularly as regards sub-Saharan Africa. Africa continues to dwarf the rest of the world on the AIDS balance sheet.
Like a number of the noble Lords, I have been searching through the Internet and have come up with probably the same documents as a number of other noble Lords. I shall resist the suggestion of the noble Baroness, Lady Miller, not to repeat statistics, as I think it is worth repeating some of the enormous statistics with which we are dealing.
Seven out of 10 newly infected people live in Africa. Among children under 15 the proportion is nine out of 10. Of all AIDS deaths since the epidemic started, 83 per cent. have been in sub-Saharan Africa and 95 per cent. of all AIDS orphans are African children. The sheer numbers involved are overwhelming. Thirty-four million people living in sub-Saharan Africa have been infected by HIV; of these some 11½ million have already died, and a quarter of them are children.
When I was preparing for my contribution to today's debate I was very conscious of how we must seem worlds away from the problems which we are debating tonight; and how each of those statistics which we repeat, and I have repeated again, represent individual human tragedies on a scale which I for one find quite impossible to comprehend.
For some outside this House, this debate may be seen as an exercise in hand-wringing with no real purpose. I believe that that impression would be wrong and I hope that three central messages will emerge from this debate. First, the Government's response has been appropriate in that the types of programmes which the Government are supporting are having an impact and their support for the various multilateral agencies is appropriate, although there is undoubtedly a need for a greater sense of urgency.
The second message which I hope will come from the debate is that there are examples of countries in Africa which have contained the growth of AIDS. The key to their success has been early and vigorous action in education campaigns. The third message which I hope will come from the debate is that the time to act is now in order to stop that epidemic spreading through eastern Europe and central Asia.
The noble Earl, Lord Sandwich, referred to Uganda. That is a good example of a country which has gone a long way towards combating the crisis. When President Museveni became president in 1986, he literally flooded the country with leaflets about AIDS. He forced

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government departments to take the issue seriously and to implement their own plans to fight the virus. Most significantly, he gave free rein to the various internationally-financed NGOs to educate people about the consequences of risky sex.
One story which I read in the Economist magazine was that a group of AIDS workers visited Uganda from South Africa and Zimbabwe. They were astonished to find that the NGOs in Uganda were distributing extremely explicit sex education material which had the approval of the Ugandan government. The implication of that is that both South Africa and Zimbabwe have been slow to act by comparison.
Another country where firm government action has led to stable and relatively low infection levels is Senegal. There, brothels have been regulated since the early 1970s. A vigorous education programme has led to soaring condom sales which have increased from 800,000 in 1988 to 7 million in 1997. Most significantly, homosexual behaviour is not denied as is the case in so many other countries. There is a denial among many African men in relation to that fact within their own societies.
In the successful education programmes about which I have heard and been briefed in the past few days, one theme is recurrent; that is, the position of young women in African society. That was a point referred to by my noble friend Lord Judd. One voluntary sector worker said to me that the most dangerous thing that a young woman can do in Africa today is to get married. That exposes her to the risk of infection which is very difficult to control. The key to that is empowerment through education but in the general context of broad reproductive health. Certainly from the reports which I have read, there is nothing to be gained from dithering and prudishness.
However, while this debate is looking at sub-Saharan Africa, it is worth reminding ourselves that AIDS is still an emerging epidemic in eastern Europe and central Asia. The virus appeared in those regions only in the late 1980s, 10 years after Africa and Western Europe. The reports that I have read are pessimistic. They say that it is only a matter of time before AIDS increases in those regions. Most alarming is the global rise in TB referred to by my noble friend Lord Rea.
I hope that those reports are unduly pessimistic and that the lessons of Uganda and Senegal can be learned in other regions of the world. I am a rapporteur for the Migration and Refugee Committee of the Council of Europe. I am currently working on a report which looks at the health implications of migration in Europe. While that is wide of the theme of today's debate, my report will make it clear that the uprooting and displacement of people has a tremendously detrimental impact on their health, both for the migrants themselves and their host communities. The growth of AIDS is perhaps the starkest example of that phenomenon. As a result of today's debate, I shall ensure that the examples of Uganda and Senegal are included in my report so that that information can be more widely circulated within Europe.
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This has been an important debate. I do not believe that it has been an exercise in hand-wringing. The Government should take heart because they have addressed the issue in a constructive and methodical way. In particular, I hope that the lessons learnt in sub-Saharan Africa can be applied elsewhere in the world.
4.15 p.m.
Lord Hardinge of Penshurst: My Lords, I too would like to thank my noble friend Lord Sandwich for initiating a debate on this crucial subject. One of the few advantages of slow catastrophes over sudden catastrophes is the possibility of planning for their consequences, and in this case there will be no excuse if we fail to do so. This debate is an excellent opportunity to investigate the possibilities open to us.
In a real sense, the catastrophe has already happened. Only the consequences remain largely in the future. This is not to say that action now cannot ameliorate those consequences, or that lack of action will not permit them to become even worse. But events that have already occurred make terrible results extremely likely.
Others can speak—and have spoken—far more knowledgeably and eloquently than I of the immediate effects. I want to concentrate on the secondary, economic consequences, and on what can be done to ameliorate them. First, I should say that I do not for a moment suggest that the factors I am about to discuss should take precedence over simple humanitarian imperatives. I simply wish to illustrate the nature of the economic effects, which we need to address at the same time.
Those effects are very much accentuated by the fact that AIDS kills people slowly rather than quickly, so that illness becomes a direct and indirect drain on social and administrative networks. Ill people inevitably consume more resources than they can generate. In relation to subsistence agriculture, for example, the sectoral AIDS brief on the University of Bordeaux website draws attention to the domestic-farm interface—the way in which totality of activity in a household or group is far more closely intertwined than in a wage economy. The extended family in sub-Saharan Africa has proved an extraordinarily resilient institution, but it is not infinitely resilient. Family disintegration is clearly an increasing problem: noble Lords have mentioned the 8 million orphans. The pressure on those who are still well will obviously be very great indeed.
Again, national infrastructure in even the poorest countries is quite complex by historical standards, and AIDS attacks its maintenance in a variety of ways. In most countries it is over-stretched already, and may quite possibly collapse.
For other sectors of the economy, the prognosis is equally gloomy. For example, manufacturing is threatened in three main ways: first, illness and death will affect production, training will become an increasing burden and absenteeism an increasing problem; secondly, the same factors, together with the pressures on people looking after, or anticipating looking after, the ill will reduce demand; thirdly,

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taxation is likely to rise, as a result of pressures, generated by the pandemic, on the exchequers of the countries concerned. All of these factors will tend to depress investment and will affect competitiveness.
So what can be done? I think it evident that any extra resources that can possibly be spared should be thrown at the front line of AIDS care, which has been described by a number of noble Lords, and AIDS education. The suggestions I shall now make are, therefore, aimed largely at the reordering of priorities within other existing programmes, to make them more responsive to the situation created by the level of infection, to reinforce the effects of direct intervention, and to help people deal as well as possible with the secondary effects of their situation.
First, structural adjustment and related programmes often impact significantly on health spending. It is doubtful whether this now makes any sense, even in the narrowest economic terms, and it is critical that such programmes take full account of the impact of HIV infection when looking at the control of spending. Formal mechanisms for this would be desirable.
Secondly, priorities can be adjusted in aid programmes aimed at poverty. Programmes which save on labour will move up the scale of importance, and here I point particularly to the provision of ready access to clean water. Significant amounts of time are spent fetching water in many societies, and this time competes with other demands, including those created by the epidemic. It may also be important to give special assistance in countries or regions with a short sowing season, or other labour peaks in the agricultural cycle.
Thirdly, high risk sectors should be targeted. Migrant labourers are an important example. More intensive education for them and their dependants should be a high priority. Supporting them in bringing their families to live with them will, apart from the humanitarian benefits, repay the investment many times over. Employers can be helped and encouraged to provide or support counselling for both infected and affected individuals, and to encourage them to continue working if possible.
Fourthly, the maintenance of public provision will be critical. The health sector will require particular attention as it will be weakened by illness and mortality at the same time as demands on it increase. We need to aim at over-provision of qualified personnel to deal with the double effect I mentioned. Finally, the introduction and encouragement of intermediate labour-saving technologies in agriculture, manufacturing and the home will be important.
Disaster tends to strike hardest at the most vulnerable, and never more so than on this occasion. The challenge is very large. The resources available to wealthy societies have proved more or less sufficient, so far, to contain the spread of the disease in their own populations. The proposition before us now is to assist in repeating this partial success on a far larger scale, and among our far poorer neighbours, with far less educational, communications, and health care infrastructure available, and with the pandemic already quite far advanced. There is no time to be lost if we are to have any chance at all.
4.22 p.m.
Baroness Gould of Potternewton: My Lords, I too express my appreciation to the noble Earl, Lord Sandwich, for initiating what is a crucial debate. For too many years AIDS was an invisible epidemic, HIV spreading silently. It is only now, after two decades, that the repercussions of AIDS are stripping off the cloak of invisibility. But not absolutely. Silence continues to reign, even when people with HIV are ill or dying.
Nor has the epidemic been overcome anywhere. During the course of today 16,000 people will be infected—10 per cent. more than a year ago. That does not include those people who will not acknowledge or who are unaware that they are actually suffering from HIV/AIDS infection. The figures have been quoted so I shall not repeat them. They all show, when one looks at them in detail, that in all countries women appear to be heading for equality with men and there is no indication that that trend will reverse, the majority of infections being the result of the sexual behaviour of their husbands or partners, through exploitation, coerced sex, often with older men, or because poverty has driven them to engage in commercial sexual transactions in order to survive.
But children are the saddest victims of all, as the noble Earl said in his opening address. As has been said, there are now around 8 million orphans, many of whom are themselves infected. However, some communities are rising to the challenge. In Zimbabwe community leaders and church groups are providing for them so that they can stay in the community and not be institutionalised. But, overall, the number of children with HIV is up to 1.2 million; one tenth of newly infected people are under the age of 15. Most of them acquired the virus from their mother before or at birth or through their mother's milk.
Breast feeding is protective against some diseases but does not protect against AIDS, leaving African women faced with a terrible choice: do they continue breast feeding with the related risks or do they consider feeding formula to their babies after years of being warned of the dangers from possibly mixing the formula with unclean water? And water is something of a luxury. Formula feeding can also send mixed messages about the value of breast feeding to uninfected women.
A further problem is that too many women do not know whether they are infected or not; they have never had prenatal care, nor had a blood test. While considerable progress has been made in the development, of anti-retrovirals which would help to reduce mother-baby transmissions, the high costs—£10,000 per patient per year—put them outside the reach of the poorer countries in the region. For instance, drugs for 25 per cent of all HIV infected people in Malawi would use 84 per cent. of GDP. It must therefore be worthwhile to find appropriate ways of introducing short-course ARV for pregnant women. However, this relatively cost-effective intervention requires to be accompanied by well developed health systems as well as breast milk substitutes which can be expensive.
In those circumstances, prevention has to be the top priority, be it the accessibility of condoms and family planning services, education of school children or

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projects to change behavioural patterns. And although HIV infection does not respect the artificial boundaries between "high" and "low" risk groups, targeted interventions for high risk behaviour groups can work.
Young people are especially at risk. A recent study in Zambia showed HIV infection is more prevalent among young girls, being reported in 12.3 per cent. of girls and 4.5 per cent. of boys. But prevention can also have a greater chance of success among younger people. While the majority are still engaging in unprotected sex, education campaigns and condom promotion in Uganda and Tanzania have resulted in dramatic declines in infection among teenagers. Perhaps the Minister could indicate what support DFID is specifically giving to NGOs and others working on such projects and to the already over-stretched health systems of the hardest hit countries.
But, the long-term hope has to be the development of a preventive AIDS vaccine. Praise must be given to the Government for being the first country to give financial support to the International AIDS Vaccine Initiative and to the World Bank for its 1 million dollar donation. But it is not enough. Other countries have to be mobilised to put money into vaccine development and research. It would be useful to learn from the Minister what progress is being made in persuading other countries to follow our example.
One of the major problems to prevention is the stigma of being identified as being infected. It is hard to measure stigma but it is a real obstacle to both prevention and care. While it affects both sexes, for women exposure can have severe consequences, given their social and economic dependence on men. They risk being beaten or even thrown out of their homes or being blamed for the death of their children, even when the husband is the source of infection. Adjoa, a Ghanaian woman with HIV, a mother of two, lives in fear of her family finding out. She believes—I paraphrase—that if her sister discovered her state she would poison her. She is adamant she will tell no-one. She sees the example of another woman in her village, Abena, whose husband and family abandoned her and her children while she was in hospital.
Fear of acknowledging HIV can stop a man from using a condom or his wife from giving her baby replacement feeding. And so the disease spreads. Few remain unaffected, either directly or indirectly. While the Government have to be commended for budgeting £100 million directly to support sexual health and HIV/AIDS activities in many of the African countries, the urgency of the epidemic requires us to do more, more quickly and more effectively. But we cannot meet that challenge alone. Global co-operation is essential to free Africa of this horrendous disease.
4.30 p.m.
Viscount Hanworth: My Lords, perhaps I too may express my appreciation of the noble Earl, Lord Sandwich, for raising this issue in the House. An excellent book on the subject of AIDS and the HIV virus by the geographer Peter Gould was first published in
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1993. It is remarkable not only for its clarity and the quality of its research, but also for its passionate nature. Its title is The Slow Plague. One might well startle at such a title in view of the speed with which the devastation of AIDS has swept through the world and the continent of Africa in particular.
When I visited Zimbabwe in 1982, there was still no hint of the impending disaster. That was the year in which the discovery of the human immunodeficiency virus, HIV, was first made public. It has taken only 15 years to reach a stage where, in many parts of central and southern Africa, the proportion of the sexually active population which is infected by the virus equals or exceeds 30 per cent. over wide geographical areas. In the continent at large, there may be as many as 40 million infected people. The number of deaths to date probably exceeds 10 million—and there is little sign of any abatement.
If this is a slow plague, by what standards is its speed being judged? The answer must be by the standards of other pandemics which have hit the human race in recent years. We are inclined to think of the influenza pandemic of 1918–1919. It is estimated that some 30 million people died in that short period as a result of the influenza, but the eventual mortality from AIDS will far exceed that figure. The flu epidemic was highly contagious. However, the world-wide plague was brief and only two years were necessary for the human population to produce an immunological response.
The HIV virus, by contrast, is only weakly infective. It can be passed from one person to another only by the interchange of bodily fluids: by blood, by semen or by vaginal secretions. It is doubtful even whether it is transmissible by saliva. However, once the disease has been contracted, there is no immunological response which will save the victim from eventual death. In the absence of drug therapy, the victim has at most 10 years to survive before dying of AIDS. In conditions of poverty, such as characterise most of Africa, they are more likely to be granted only six or eight years.
There is no medical cure for AIDS and there is unlikely to be one in the foreseeable future—certainly not one which will be affordable on a wide scale. In the absence of an immunological response to HIV, the only thing which can defeat it is a sociological or behavioural response in the populations which are at risk. Such a response is already under way in many parts of Africa. However, its speed is comparable to the so-called demographic reaction of family limitation, which is a universal but highly variable response to the survival of increasing numbers of children. Measured against the speed of a "slow plague", this is too slow to avert widespread suffering and disaster.
It is not entirely idle to wonder why Africa is so affected by the disease; nor to ask why the response appears to be markedly less rapid than in other parts of the world. It helps in combating the disease to know the answers in detail. We might ask, for example, whether there is something in the cultures of Africa or in the sexual mores of its populations which is conducive to sexually transmitted disease.

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I raise those cultural allusions only to dispose of them. I do not believe that one needs to give a very detailed exposition in order to do so. It is perhaps enough to remind ourselves that in the absence of penicillin the war-ravaged Europe of the late 1940s would have been devastated by epidemics of gonorrhoea and syphilis. That threat was the natural outcome of the concomitance of men without social constraint and women without any means of support for themselves or their families except prostitution or something close to it. Rape would also have played a part.
Africa continues to be ravaged by war, by drought and by the displacement of large numbers of people. Many parts of the continent have been afflicted by bands of marauding soldiers. For years, there have been congeries of migrant labour passing up and down the length of the Rift Valley. Throughout the century, there has been a rapid migration of displaced people into urban slums, seeking refuge from war or drought or simply leaving a countryside which cannot contain them. The rate of this migration has increased.
Among the principal vectors of the infection have been the migrant workers, the truckers and the prostitutes; but the disease knows no occupational or class boundaries. Particularly affected have been the African urban élites and the military personnel—those who have the disposable income to demand the services of prostitutes. Untold harm is done to the economic prospects of Africa by the decimation of its urban élites. As Gould remarks, we know very well what tends to happen when armies, depleted of their leadership, are taken over by corporals.
It is not upon exhortation and advice that we must rely primarily in the struggle against AIDS. The one device which can most effectively block the transmission of the HIV virus is the condom. Condoms should be included in pay packets by every Western firm operating in Africa. They should be freely available in bars and shabeens, in bus depots and railway stations and in prostitutes' parlours. They should even be made available via schools.
The solution to the problem of the AIDS epidemic and the solution to the problem of birth control are one and the same thing. There is a hopeful example which suggests that a country undergoing a rapid demographic transition can quickly and effectively counteract the AIDS epidemic. The country in question is Thailand, where it once seemed that the circumstances were optimised to assist the spread of the HIV virus. Now there is the expectation that it will be held in check.
It is exactly 200 years since the Reverend Thomas Malthus published his dismal Essay on the Principle of Population. In it, he classified the checks to the growth of population as either preventive or positive. He would, no doubt, have classified the AIDS epidemic as a positive check in the company of the other checks of war, famine and pestilence. Malthus doubted whether the preventive checks which he envisaged, such as the deferment of marriage and the abstinence from sexual activity or resort to prostitutes, were ever likely to be effective in stemming the growth of population; and he foresaw widespread misery.
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The pessimism of the Malthusian doctrine and its moralising tone invoke a strong aversion in many of us. We like to think that there is a far greater scope for human amelioration than Malthus allowed. Nevertheless, the Malthusian spectre is one which confronts us today in Africa no less than it confronted an English clergyman in this country 200 years ago. To people of goodwill and optimism, it is surely clear that there are immediate actions which demand to be taken if we are to help in defeating the spectre of AIDS in Africa.
Last week the Government announced a budgetary provision of £100 million for combating AIDS in Africa and elsewhere. We on these Benches are proud of that, and I personally hope that it is only the first tranche of an ongoing subvention to combat this deadly disease.
4.36 p.m.
Lord St. John of Bletso: My Lords, I have just returned from a month's visit to South Africa, where the AIDS epidemic continues to spread at a horrifying rate of around 1,600 new infections every day. With well over 3 million South Africans living with HIV and with nearly 50,000 new infections a month, South Africa has one of the fastest growing HIV epidemics in the world. Even though medical science has come up with several drug therapies that offer some hope of arresting the virus's programme, South Africa is sitting on a pandemic that threatens explosive consequences for the country and its economy, as well as being a major burden on the health service and the welfare system.
Like other noble Lords, I am extremely grateful to my noble friend Lord Sandwich for having given us this opportunity to debate this most topical and critical subject today. I personally commend my noble friend for all the work that he has done on trying to promote the development of awareness of what is happening concerning many problems affecting southern Africa. The harsh reality, which was highlighted in a recent article on 2nd January in the Economist, headed A Global Disaster, is that in most of the rich countries AIDS is no longer a death sentence. Expensive drugs keep HIV positive patients alive and healthy, perhaps sometimes indefinitely. But in most of the developing countries the disease is spreading, in the words of the Economist,
"like a nerve gas in a gentle breeze".
The poor cannot afford to spend the 10,000 dollars a year on these wonder pills. Certainly the World AIDS Day in December last year, as well as the recent reports from the joint United Nations programme on HIV and AIDS together with the World Health Organisation, has raised public awareness of the problem. However, there certainly needs to be a lot more government support. Many of the reports point out that few political leaders treat the global disaster of AIDS as a priority.
I wish to focus my few remarks on a number of the positive initiatives taking place in South Africa to help reverse the tide of AIDS spreading throughout the country. With the general election in May this year, the South African Government will need to show how they are tackling not just the escalating unemployment and

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crime in the country, but also how they are addressing the social and health needs of the nation. The fights against disease and poverty are inextricably interlinked.
In 1995 the South African Government adopted the widely hailed National AIDS Plan, but unfortunately bungles and lost opportunities made them lose sight of the larger picture. However, in October last year, Deputy President Thabo Mbeki formally launched the Partnership Against AIDS initiative, hailed by the Health Minister, Dr. Zuma, as the turning point in the country's new phase of the struggle.
The objective has been to promote a mass mobilisation campaign to encourage all sectors to come together to combat HIV. In his speech to the nation, when he launched the initiative, Thabo Mbeki admitted,
"For far too long, we have closed our eyes as a nation, hoping that the truth was not so real".
He referred to the partnership as being a partnership between,
"Youth, women and men, business people, workers, religious people, parents and teachers, students, healers, farmers and farm workers, the unemployed and professionals, the rich and the poor".
In brief, he referred to it as a problem of all of us.
The Partnership Against AIDS initiative has specified what each sector of society can do, not just to raise awareness of the problem but also to assist those infected with the disease and those many thousands and millions of orphans who have been left without their families and often without any home.
Clearly, if this initiative is to have any success, it needs on-going government and financial support. So far the South African Government have committed their support in launching the initiative but have not given much financial support. Certainly, in South Africa, NGOs and community-based organisations which command a high level of credibility in the country have played a major role over the years in assisting the cause.
The South African Government have also promoted another initiative called "Beyond Awareness Campaign" targeted specifically at the youth in South Africa. My noble friend Lord Sandwich referred to the NGO International AIDS Vaccine Initiative, based in New York, which has so far invested over 9 million dollars in promoting a vaccine development initiative led by an immunologist in Oxford in conjunction with an immunologist in Kenya, as well as the medical department of Cape Town University. All those initiatives desperately require international support.
In conclusion, there is no doubt that the HIV/AIDS epidemic represents one of the greatest threats to South Africa and, indeed, the world, while at the same time offering unique challenges and opportunities to recognise and address the inequities found in South Africa. For the campaign to be successful, it needs broad-based and multi-sectoral support. Following the Prime Minister, Tony Blair's, recent visit to South Africa and his announcement that Her Majesty's Government have increased their aid package to the country, I hope that the Minister, when she winds up the debate, can elaborate on what plans Her Majesty's
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Government have to promote and assist the initiatives in South Africa to stem the HIV epidemic, not just in that country but in all other countries in the region.
4.44 p.m.
Lord Graham of Edmonton: My Lords, like other noble Lords, I feel that it is right and proper to pay tribute to the opportunity created for us by the noble Earl, Lord Sandwich, in initiating the debate. The noble Earl has not been active in the House for as long as myself, but from the moment he arrived he brought with him rich experience of this subject. One of the great assets of this House is that we can benefit from the experiences of practitioners in various areas. The noble Earl has also stimulated a number of his colleagues in all parts of the House to contribute to the debate.
Stunning statistics have been quoted by the noble Earl and others. There is no need for me to repeat them. If one wants to be depressed by the enormity of the task in hand, one simply has to watch television or read Hansard on this subject. I become very depressed indeed. I hope that the Minister will be able to tell us, when she replies, not only that the Government are well aware of their responsibilities, but that to the extent that it is possible when balancing budgets and allocating resources, they recognise that Britain in 1999 has a part to play.
The noble Lord, Lord Judd, made a powerful speech based on his own experiences. My noble friend Lord Hanworth told us of his experiences, which enlightened and enlivened the debate. In debates such as this, one finds out about the background of one's colleagues in the House of which perhaps one was not previously aware. I respect people who can tell it as it is from where they have been.
I do not have solutions or very much experience on this subject. For a period, I assisted the Prison Officers' Association in getting its case heard in this place. In that capacity I visited many prisons. Throughout the 1980s and 1990s, I saw the rise of this disease and its manifestation in the tiny communities and estates which form our penal institutions. Fortuitously, in comparison to the staggering and calamitous statistics of other countries, the problem in this country is minute. However, we know that at one time the problem was minute in those other countries yet the powers that be failed to stimulate, legislate, encourage and educate—especially children—early enough. We know of the enormous cultural and religious difficulties which have to be overcome in communities and nations. The Minister should recognise that there is not only an understanding of the problem but a willingness on the part of those who have spoken and among the British people to provide more assistance to tackle this scourge—and it is a scourge. The Government should recognise that this issue is not a vote-winner. It is not one of those issues about which one can say to the people of this country, "Vote Labour and we will spend more money on tackling the AIDS crisis". It is not "sexy"—I can see noble Lords opposite correcting me—as an attractive political proposition or something that people will willingly want to tackle. A major responsibility rests on the Government and Ministers to

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recognise that a lead must be taken and encouragement given. When I force myself to listen to the statistics and to watch television programmes on this, I ask myself, "What on earth can we do to assist?".
I make no party point in saying that this country has politicians, a government and a people who recognise their responsibilities to others. Such remarks as, "Am I my brother's keeper?", "What does it mean to me?" and, "Why should I spend my hard-earned cash to educate and to elucidate?" may come to mind, but I believe that the British people would respond to encouragement by the Government to provide even more financial support in the future than they have in the past. All that I can say to my noble friend the Minister is that I wish her well when she reports on this debate to her colleagues in government.
4.50 p.m.
Lord Redesdale: My Lords, I should like to begin by thanking the noble Earl, Lord Sandwich, for initiating this timely debate. I shall talk about something which is now taken for granted by looking back at how our first experience of AIDS came to this country. Listening to the debate today, I feel that it is probably a debate which could not have taken place 10 years ago. Indeed, if it had been held 10 years ago, I believe that it would at least have caused a sensation in the press.
Today's debate shows that our attitude to AIDS has changed remarkably. Many of the taboos that we held quite dearly 10 years ago have since disappeared. That is due to a great extent to the lead taken by the previous government in actually publicising AIDS and taking the bold step of going forward and drawing to people's attention the dangers associated with it. However, I should perhaps remind your Lordships of some of the images that were used then because they were so insensitive. I have in mind the crashing icebergs; indeed, that is an image which I still do not understand.
The reason I mention the latter is that, from my own experience in Africa, it was something which did not happen. Many noble Lords have talked about the stigma attached to the discussion of AIDS. My first awareness of discussion on AIDS in Africa was in Zimbabwe. I walked into a local police station and read a rather interesting article which discussed how one could contract AIDS. The point of the article was that you actually contracted AIDS from sleeping with foreign travellers. That was the main source of infection and worry. Of course, it seems quite incredible now.
The silent spread of AIDS was mentioned by the noble Lord, Lord Ponsonby, and that is one of the reasons why it has spread so quickly. I found the stigma attached to having AIDS to be incredible. I went to visit a hospital in Malawi back in 1990. There was a women in the hospital and it was quite obvious she was dying from AIDS, but no one was willing to admit that fact. Indeed, if anyone in public life died of AIDS, no mention of that fact was ever made. A code was developed, especially in the Zimbabwe press, which would state that the person had died "after a long illness". One could read into that the fact that AIDS was the cause of death.
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The spread of AIDS has been commented upon, but one of the most effective ways of transporting AIDS around the sub-Saharan continent was the truck/trade route. The trucks went from South Africa to Zaire and visited all points in between. They were very effective in the promotion of AIDS. I remember travelling to Malawi from Zimbabwe. The cheapest way to get there was to hitch a ride for about 25 Zim dollars on a thing called the "gun run", which was a convoy route which went through the Tete corridor. It was usually made up of about 100 trucks with an armed Zimbabwe escort because it used to get fired upon on a fairly frequent basis by Renamo rebels. However, the image that has always stayed with me was of a particularly uncomfortable night which I spent on the border in incredibly hot conditions watching prostitutes going from one truck to the next right down the line. They did so because the truck drivers had money. Of course, some of those truck drivers would then travel to Malawi, but others would go all the way up to the former Zaire. Studies carried out later on infection rates in communities on the truck routes revealed an incredibly high percentage of infection—indeed, sometimes as high as 90 per cent. or 100 per cent.—in people living close to the truck corridors.
Mention has been made of the two lines of defence against AIDS. The first line has to be education. I have seen some of the effects of education in the form of drama projects in Zimbabwe. I have in mind particularly fine groups of actors. In one case, I remember a quite frightening character which portrayed death. Considering the illiteracy in many villages, that was a very effective form of education. I should also like to mention the work carried out by the Churches. As the right reverend Prelate pointed out, some attention should be drawn to that fact.
The second line of defence is condoms and prevention. The free distribution of condoms in Uganda has been one of the reasons why the latter has had some success in turning the tide on the AIDS epidemic. However, it also has to be linked to education. I remember walking along a road in Malawi and being asked by a young Malawian how he should avoid contracting AIDS. I said, "The answer is you must use a condom". He replied, "Oh, that's alright then; I used one of those once". Unfortunately, that attitude was quite prevalent.
While considering prevention, another measure would be the use of AZT for pregnant mothers. However, the cost of the drug in Africa is prohibitive. I very much doubt that it is a measure which could be used on a wide scale. The noble Baroness, Lady Gould, mentioned the issue of mothers changing back to bottled milk, with all the inherent risks that that involves. However, the prevalence of AIDS means that it is almost a preferable option, which is quite frightening. The cost to the African countries is staggering because the first groups affected by the HIV virus have tended to be the intelligentsia, those with enough money and those with training.
I remember being in Zimbabwe and talking to a woman who worked for the Standard Chartered Bank. She had come from the north of the country but had had

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training in Britain. That was back in 1991. She said that the worst thing about the epidemic was that she very much doubted that she would actually see her children grow up. What I found so frightening about that comment was the assumption she made that she would contract the disease because it was so prevalent.
It is difficult to see whether this epidemic can be reversed. I believe that inroads can be made through education and prevention. However, when such a high proportion of the population has contracted the virus, it is difficult to believe that major inroads can be made in the future just through education and prevention. I speak bearing in mind the rather frightening statistics which have been put forward. I remember being in Lilongwe when a study was published which revealed that 34 per cent. of the population were HIV positive. It showed just how risky things could be if you were a young person looking for a wife or a husband. The only really effective cure for the disease would be a cheap cure, or, more appropriately, a cheap vaccine. Many noble Lords have spoken about the latter, including the noble Baronesses, Lady Masham and Lady Gould.
One of the diseases prevalent last century which led to some of our social attitudes towards sex was syphilis. It is worth remembering that syphilis wiped out a large proportion of Europe's population during the last century. That is probably why the Victorians developed such attitudes. It was only the discovery of penicillin that countered that threat. A sexual revolution has been mentioned. However, the advent of AIDS in Africa has reintroduced stigmas and the idea that sex cannot be taken for granted and is not the safe option that we would like to believe it is.
I have an important question to ask the Minister. How much money is being spent on the development of a vaccine? This is a major problem in the making. Pharmaceutical companies are prepared to spend enormous sums of money on treatments for AIDS. It is easy to understand the economics of this matter as it has been estimated that it costs up to £10,000 a year to treat someone in this country who has HIV or AIDS. I know that last year the Government contributed £200,000 to the development of a vaccine but that constitutes only the treatment for one year of 20 people with AIDS with the drugs that are now available.
The noble Lord, Lord St. John of Bletso, mentioned initiatives that are being taken to find a vaccine. Can the Minister give some indication of how much money will be allocated to try to develop a vaccine? This is an area which is being neglected by private companies as there is no profit motive involved. I very much hope that the Minister can give us some good news on that matter.
5.1 p.m.
Lord McColl of Dulwich: My Lords, I, too, wish to thank the noble Earl, Lord Sandwich, for calling our attention to this great tragedy in Africa. At the outset I should declare an interest in that I am chairman of the board of governors of Mildmay Hospital in the East End of London, which was the first hospice in Europe devoted solely to the care of those dying of AIDS—men, women and, unfortunately, children.
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We have also become heavily involved in many countries abroad, particularly Uganda. As has already been pointed out, Uganda was the first African country to acknowledge publicly in 1985 that the HIV epidemic was causing serious problems in that country. This was due to President Museveni, who first realised the seriousness of the situation when some of his troops were sent abroad and were routinely tested. Some of the armies in Africa have an infection rate of up to 70 per cent. As soon as he realised the seriousness of the problem he made sure that the government took the threat seriously. The Ugandan AIDS control programme was developed and supported many effective educational preventative programmes. It appears that the mortality rate is beginning to plateau and even to fall in certain key areas.
However, prevention must always go hand in hand with care if it is to be effective. The Ugandan Ministry of Health therefore invited Mildmay International to set up a centre for AIDS palliative care and training in Kampala. The noble Baroness, Lady Chalker, was instrumental in providing funding from the British Government through ODA. Later this support was continued by Clare Short through DFID. That is a great credit to them. The Mildmay Centre was opened recently by Princess Anne. It is worth noting that when she arrived at the centre at 11 a.m. she had already completed four previous engagements that morning. I ask those who criticise the Royal Family to take note of that.
The patron of the project, President Museveni, in his keynote address said something which I do not think has been mentioned today. He is an honest and, in my opinion, a great leader in Africa. He said,
"There is no cure for AIDS, therefore it must be prevented. This means no sex before marriage, no sex outside marriage and those who cannot keep to this policy need to take precautions realising that precautions are not always successful".
I have not heard any other national leader spell out the matter in those clear terms because I suppose that is not politically correct. However, this directness and honesty has paid off in that country and there are now signs that the mortality is beginning to fall in some places, as I said.
The tragedy of this epidemic is that there may never be a cure for AIDS. The virus keeps changing its nature, making the production of a vaccine well nigh impossible. This makes even more relevant President Museveni's courageous statement. I do not wish to repeat all the statistics, but I want to draw attention to the fact that of the 12 million people who have already died since the beginning of the epidemic, 25 per cent. were children. The number of those orphaned since the beginning of the epidemic amounts to more than 8 million. One of the problems in controlling this epidemic is the totally inadequate data, and much more money needs to be put into research in this field urgently.
Heterosexual contacts and mother-to-infant transmission of HIV account for the majority of infection, but injectable illegal drugs, such as heroin, and infection through unscreened blood transfusions are severe problems. I shall give noble Lords some idea of the statistics. In 1995, 2.5 million blood transfusions

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were given, most of them to women and children, and 25 per cent. of these had not been screened for HIV antibodies. Funds are desperately needed for this essential and simple screening technique.
Canada's High Commissioner to Zimbabwe, Ann Charles, has been doing her bit in the preventative field. She has stressed the need for preventative measures and has urged high school students to start to make choices that will keep them safe from HIV infection and give them the chance to live a normal life. I think it has already been mentioned that Zimbabwe has become the centre of the world's AIDS epidemic. It is probable that it may have the highest AIDS infection rate in the world. The evidence is that the virus is still spreading rapidly in Africa, despite already high levels of infection. In Botswana the proportion of adults living with HIV has doubled over the past five years: 43 per cent. of pregnant women tested HIV positive in 1997 in Francistown. As I think has already been mentioned, in Zimbabwe one in four adults in 1997 were thought to be infected. In a major commercial farming centre in Harare HIV prevalence in pregnant women rose rapidly from 32 per cent. in 1995 to 59 per cent. the following year.
As regards prevention, perhaps the most effective course is President Museveni's honest educational approach. We should be honest and open about the whole thing. Further changes in attitude and behaviour are essential. In case anyone is inclined to be critical of the sexual behaviour of Africans, perhaps we should remember that in California the AIDS epidemic spread like wildfire due to the fact that some people were having a thousand different partners per year. Changing that behaviour was crucial in reducing the incidence of the disease there. In this country as many as 10 per cent. of children may be subjected to sexual abuse. A change in moral standards would make a very great contribution to this whole subject.
I have witnessed in Africa attempts to educate children in schools and adults in the villages. It was interesting that when the thought was put forward at a conference in Africa that people had to change their attitude, many of those attending laughed their heads off. But that was some years ago. They have now learnt better ways. I have witnessed attempts to put on plays in schools, villages and prisons. A common technique is to use professional actors, but also to get the children themselves, and in prisons the prisoners, to act in the play. The plays were performed with great professionalism and humour. I found them very moving indeed.
Both the Conservative government and the present Government are to be congratulated on their support for all the efforts being made in Africa, especially through NGOs. We very much hope that that will continue.
5.11 p.m.
Baroness Amos: My Lords, first, perhaps I may join other noble Lords in thanking the noble Earl, Lord Sandwich, for introducing this important debate. The noble Earl's commitment to development issues is well known in this House. I should also like to thank all other
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noble Lords who have made such valuable contributions. I shall seek to respond to all the questions raised, but will write to any noble Lords whose questions I am unable to address in detail in the time available.
HIV/AIDS represents a human tragedy, particularly in sub-Saharan Africa, where a number of factors continue to influence the shape of the epidemic. My noble friend Lord Hanworth made reference to some of the factors, as did the noble Lord, Lord Redesdale, the main ones being migrant labour, and people in conflict and refugee situations, who have little control over their exposure to HIV. But poor public health systems and the widespread existence of untreated sexually transmitted infections are also major contributors.
HIV/AIDS is playing a significant role in reversing many of the gains made in development since the Second World War. And it is jeopardising the achievement of some of the international development goals to which Britain has committed itself. For example, it is impacting on life expectancy. The decline in life expectancy is due not only to the deaths of adults, but also to child deaths. In Zimbabwe, life expectancy will fall from 61 years to 39 years by the year 2010.
Unfortunately, rapid advances in treatment in rich countries have switched political and media attention away from HIV/AIDS. That has masked the growing seriousness of the epidemic in many parts of the developing world. While there is sporadic evidence of a slowing down of the epidemic in some countries, few have succeeded in developing a sustained national response.
A number of noble Lords made reference to the scale of the problem. The statistics defy belief. As we are on the cusp of the new millennium, five young people every minute are being infected with HIV, and half of all new infections are to young people between the ages of 15 and 24. We need to pause and consider what that means for the first generation of adults in the new millennium.
The situation in Africa is appalling. Of the nearly 34 million people in the world living with HIV/AIDS, 70 per cent.—or 22.5 million—are in Africa. One million of that total are children. There are about 11,000 new infections in Africa every day. The noble Baroness, Lady Masham of Ilton, made reference to the number of people in South Africa who do not know that they have the virus. A staggering nine out of 10 people are unaware that they have the virus. Health and demographic data show clearly that HIV/AIDS represents a massive addition to the global disease burden which is concentrated, and flourishing, in poverty and inequality. As usual it is the poor who suffer most. In the worst affected countries of southern and eastern Africa infection has reached levels of one in four of the adult population. And it will get worse before it gets better.
A number of noble Lords made reference to the costs to business. They were mentioned by the noble Viscount, Lord Brentford; the noble Lord, Lord Hardinge of Penshurst, focused on economic effects; and the noble Lord, Lord Redesdale, made reference to

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the cost to African countries. The impact goes far beyond health. It is the single biggest threat to the prospects for reducing poverty and improving living conditions in developing countries. It is having an enormous impact on economic development and sustainability. The most productive members of the population are dying. It has cut a swathe through a generation of Africa's brightest and best in government and industry. It is killing the prospects for a better future as it kills the generation of skilled people on whom that future depends. In Malawi, between one-quarter and one-half of urban-based teachers and health workers will die by the year 2005. AIDS is denting agricultural output and company profits as skilled human resources spend long hours ill at work or off sick and eventually die. A study in Kenya in 1995 showed that over the period of the next 20 years the gross domestic product would be 14.5 per cent. smaller than it otherwise would have been had AIDS not occurred.
The noble Lord, Lord St. John of Bletso, spoke in particular about South Africa. There, UNAIDS estimates that one in seven civil servants is infected with HIV. South Africa needs all its skilled capacity to maintain the momentum of economic and social transformation. HIV/AIDS has increased poverty and malnutrition. It has reduced access to schooling as children are obliged to work. And AIDS orphans have increased beyond the ability of most communities and countries to care for them.
HIV/AIDS has reduced the ability of individuals, communities or governments to save and invest for a better future as resources are absorbed in caring for the sick now and replacing lost income. For example, the annual cost to African health systems of caring for someone with an AIDS-related illness could have paid for 10 years' primary schooling.
We must stop seeing HIV/AIDS only as a health issue. It is a most serious issue of development. The response must be multi-sectoral and it must be long-term. As my noble friend Lord Judd mentioned, HIV/AIDS must be mainstreamed through national strategic planning into ongoing development interventions and must feature prominently in policy and programme discussion. DFID is seeking to do that.
So what practical action needs to be taken? Perhaps I may start by repeating the words of the noble Lord, Lord McColl of Dulwich: there is as yet no cure for HIV/AIDS. Until one is found that is affordable and feasible in developing countries, the key to arresting the epidemic has to be to prevent HIV infection.
So, first, and perhaps most importantly, as part of a long-term strategy, we need better information. Lifestyle behaviour change is the key to cracking this problem. To change behaviour, the right information needs to be communicated through the right channels which is persuasive enough to change behaviour, particularly of young people, and particularly of young girls.
The noble Baroness, Lady Miller of Chilthorne Domer, and the noble Lord, Lord McColl, made particular reference to what is happening to young women and girls. Armed with the knowledge, means
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and a supportive community, people with high risk behaviour do act to reduce their risk of contracting or spreading HIV. But transferring the knowledge to make sustainable change is very difficult. The message is not yet getting through clearly enough in sub-Saharan Africa. We need to develop prevention campaigns that are targeted and relevant to the local environment. It is here that civil society has a particularly key role to play. Churches, community based organisations, NGOs and youth groups are often best at organising prevention programmes which reach their target groups most effectively. I shall say more about their role later.
Secondly, we need condoms. That was mentioned by a number of noble Lords. Thirdly, we need treatment for sexually transmitted infections. Greater understanding of the connection between HIV transmission and STIs has been a major boost to efforts to reduce transmission. That point was made by the noble Earl, Lord Sandwich, and my noble friend Lord Rea.
Fourthly, and perhaps most obviously, we need safe blood. I agree with the noble Lord, Lord McColl, that reliable, safe and uncontaminated blood supplies are essential to prevent accidental transmission of HIV.
Of course, there is the overarching issue of leadership and in particular the key role which political leadership has in relation to the HIV/AIDS issue. Strong leadership and commitment of those with political power and responsibility—mentioned by a number of noble Lords—is critical to sustain the reduction in the incidence of HIV/AIDS.
In some countries with severe AIDS epidemics, politicians and policy makers have often denied that the behaviours that spread HIV exist in their culture and they have tended to blame the epidemic on others. HIV/AIDS has become a disease of denial and blame. This must change. Denial robs society of precious time during which early and focused action can avert an epidemic.
Uganda was mentioned by a number of noble Lords as an excellent example of a country which has shown that it is possible to reduce infection rates by a well targeted campaign of prevention. It has been critical that this has been led by the highest level of government. My noble friend Lord Ponsonby also mentioned Senegal where 40 per cent. of women under 25 and 65 per cent. of men used condoms with non-regular partners in 1997, compared with less than 5 per cent. for both sexes at the start of the decade.
The noble Earl, Lord Sandwich, also mentioned the issue. Last year's World AIDS Campaign which focused on Young People—A Force for Change, was an important campaign in relation to that. We recognise the absolute importance of addressing children as a cohort, as one of the only effective ways of slowing down the epidemic.
We have learnt from Uganda and Senegal and from other success stories that strong leadership of people in power really makes a difference. We can also learn from our experience in Asia where we must not forget the epidemic is still emerging. Among certain populations in India, for example, it is spreading as rapidly as it did

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in Africa early on. Thailand is another good example where concerted action taken by the government to promote total condom use and to remove the stigma attached to HIV infection had a major impact on the transmission of the virus. Incidence rates in Thailand are falling.
But too few African governments have taken a strong lead on the issue. We must call on all political leaders to accept responsibility and to show strong and committed leadership.
Many noble Lords mentioned the British response and my noble friend Lord Graham asked about the Government's response. I start by saying that we see it as a global problem which requires a global response. Britain has a responsibility to contribute and we wish to contribute as part of a bigger, more effective international effort.
When he visited an AIDS hospice in Cape Town last week, the Prime Minister announced that Britain would be spending £100 million on HIV/AIDS activities in the next three years. The bulk of the money will be spent in sub-Saharan Africa.
Overall, DFID is spending between £30 million and £35 million of its annual health spend of £200 million on sexual health. We are supporting national responses directly through STI/HIV/AIDS activities in 39 countries, intensively in eight sub-Saharan African countries. Programmes focus on ensuring that information, condoms and sexual health services are available for all those who need them. We are also helping governments to implement programmes which develop sustainable forms of care. A key element of our work is to lead co-ordination in all health sector work.
More generally, the Government are increasing their level of assistance to Africa and working with others to increase its impact. In July 1997, the Prime Minister announced that we would commit 50 per cent. more for basic education, basic health and clean water in the first three years of this Government than in the last three years of the previous government. We are well on the way to doing that. I hope that that addresses the points made by my noble friend Lord Judd in relation to basic health care and the noble Lord, Lord Hardinge, who mentioned access to clean water.
We are also making a significant contribution to the work of the UN co-ordinating body, UNAIDS. We believe that the international community has a vital role to play in combating HIV/AIDS. We also have high hopes for the role of a re-vitalised World Health Organisation and want to help UNICEF and the UN Population Fund to do more. Our influence with wider international agencies—the World Bank, the International Monetary Fund and the UN—has never been greater.
On the point of co-ordinating international activity, I add that we used our presidency of the G8 last year to raise the issue of HIV/AIDS among our OECD partners. We will continue to encourage Germany in its current presidency, both of the G8 and the EU, to emphasise the importance of a developed country response.
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Research too is important and DFID supports work by the UK Medical Research Council on the development of AIDS vaccines. The work conducted by the London School of Hygiene and Tropical Medicine and specific research projects such as those on the relationship between HIV and TB and on paediatric AIDS have been supported.
I wish to make particular reference to the issue of an AIDS vaccine. Many see the development of an AIDS vaccine as a long-term hope. We agree. A vaccine is scientifically within our grasp, but the best estimate is that we are at least five to 10 years away from one which is effective, available and affordable to people in poor countries. One problem in working towards this is the lack of industrial investment.
A number of noble Lords mentioned that Britain has taken a lead in the development of a vaccine. We were the first and so far only government to have contributed to the international AIDS vaccine initiative. We made a modest contribution in 1998, as mentioned by the noble Lord, Lord Redesdale, but we are building a long-term strategic partnership with IAVI to which we expect to contribute substantially more in the future. I shall write to noble Lords who have asked specific questions about the amount when decisions have been taken in relation to it.
IAVI is not only doing the science but is also helping to establish the vital support mechanisms to take vaccines onto the market in a way in which developing countries can afford them.
Mention was also made of AZT, particularly by the noble Viscount, Lord Brentford. I do not have time to go into it in detail. Not only is the cost a deterrent but also using it effectively requires a well developed health system to deliver the treatment safely. It also requires the use of breast milk substitutes for at least three months. Some of the problems associated with that have already been raised by my noble friend Lady Gould of Potternewton.
We are also particularly concerned about the impact of HIV/AIDS on women and girls. We know that women and girls are increasingly affected by the HIV/AIDs pandemic. Research, prevention and care activities for women have been slow to develop, and more is needed. Socio-cultural factors increase the risk by promoting behaviours which favour the sexual transmission of HIV and constrain women's ability to adopt HIV preventive behaviours.
Many noble Lords made reference to the important work of NGOs. I echo that. The role of civil society is particularly important in the work which is being done on the ground. I would like to pay particular tribute to the work of the churches, a point which was raised by the right reverend Prelate, the Bishop of Wakefield. I will of course take back his concerns about the country strategy papers and the need to more fully reflect the partnership element in those.
Of course we are keen to promote partnership, not only with NGOs but with the private sector. It has an important role to play. Many companies have grant-aided NGOs to assist with counselling, AIDS awareness and prevention work to assist people living with HIV/AIDS to help themselves.

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In closing, I reassure noble Lords that Britain is playing its part in the global effort to respond to the human tragedy which is HIV/AIDS. But we all need to do more, far faster and far more effectively. We need to keep the spotlight on the crippling burden of HIV/AIDS in poor countries. We all have a role to play in this. I hope that all noble Lords will keep this issue high on the agenda. Strong political leadership and commitment is essential to reverse the appalling trend we are seeing and, ultimately, to remove the threat which HIV/AIDS continues to pose to the developing world.
5.33 p.m.
The Earl of Sandwich: My Lords, when I first came to this House a few years ago I was advised that every debate should have the essential ingredient of good humour. In this debate I despaired of this ingredient arriving until the noble Lord, Lord Graham, supplied the most magnificent tribute and the best joke about this being an unsexy debate, for which we were all grateful. I thank all noble Lords who have taken part. I must mention that others would have put their names down to speak if they had been able to be present. We have had a splendid attendance and support for this subject. I hope that we will commit ourselves to that again in the future, because no subject can be encapsulated in 150 minutes, let alone in 15 minutes.
I acknowledge that I have a strong bias towards NGOs. I was therefore grateful to the Minister for correcting the bias by reminding us that governments are there to look after this problem and that they are doing something. We are all encouraged by the amount that she is doing on behalf of her Government. We heard from the noble Lord, Lord McColl, about work that had been started a few years ago. It is encouraging to hear that, for example, spending is increasing and that clean water and sanitation is now a bigger priority than before.
I would like to thank in particular the noble Baronesses for introducing the ingredient of family decisions and the difficulty of making decisions when one of the family has contracted this terrible virus. I am sure that that brought a real sense of immediacy to the House. The question of gender and equality in Africa is one of the major problems, as the noble Baroness, Lady Miller, mentioned.
I also thank the right reverend Prelate the Bishop of Wakefield, who has experience of Africa. The fact that only 13 per cent. of the money for controlling AIDS is being spent in the developing world where 92 per cent. of the problem exists remains with me. He was kind enough to mention the work of the mosques. Certain aspects have been left out of this debate. We have not covered what is being done in Islamic Africa and francophone Africa, although the noble Lord, Lord Ponsonby, gave us that splendid example from Senegal. There is plenty that has not been said, but I am grateful to those who have said what they have. I beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.

Leisure Activities
5.35 p.m.
Lord Walpole Lord Walpole rose to call attention to increased time for leisure activities and the pressures and problems this causes; and to move for Papers.
The noble Lord said: My Lords, the noble Earl, Lord Sandwich, and I had a competition to see who could attract the most people to our debates. I know that he won, but I am very pleased that so many noble Lords have chosen to speak today so soon after the Christmas break—indeed, so many noble Lords who may find themselves with more leisure in the near future than perhaps they thought a few years ago.
Following the previous somewhat traumatic debate—the parts that I listened to left me very depressed although the noble Earl, Lord Sandwich, said that it was possible to introduce some humour—this debate should be enjoyed and taken slightly more light-heartedly.
What is "leisure"? I was put up to this by my fellow Cross-Benchers, so I asked one or two of them yesterday what they thought "leisure" meant. How about this? Leisure is the time that people spend when they are not working or sleeping. That is probably as good a definition as we have at the moment.
There is no doubt that the amount of time available for leisure is increasing, and it is important for it to be spent sensibly. In yesterday's Mirror I read that we spend two whole years of our lives shopping, looking for houses and booking our holidays. That is surely not right.
Changes in patterns of leisure cause problems, and government intervention is needed. We hear a lot about the nanny state, but nanny is needed to provide leisure and a structure for it because the devil finds work for idle hands. I want to mention a few topics which concern me. I hope that what is now called "joined-up" government, which presumably means that departments talk to each other, will take my concerns in hand.
Perhaps I may refer first to Sundays. I am sorry that no right reverend Prelate is present. Sunday was traditionally the day for people to have leisure—after they had been to church, it was hoped. Sunday shopping has changed all that for ever. Shopping on Sundays produces work. Heaven knows how many days a week it makes people work—not only in shops but in car-parks, as traffic wardens, in street cleansing, in rubbish disposal and so forth. We are seeing a change in leisure patterns, both in time of day, in days and in seasons.
I understand that the Department for Education and Employment is discussing a five-term year. That is an interesting concept. I remember that when I was the chairman of the East Anglian Tourist Board it was proposed that a four-term year might be appropriate. Strangely enough, my executive minuted me that it was very upset about that, but it did not do a great deal about it. When one thinks about it—and people must think about it given that a five-term year is being proposed—one must question how that may affect people's leisure

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movements. There may be a lot to be said for it, but I am not sure. I believe that the two departments concerned must get together to discuss it.
There have been big changes in leisure patterns, with people working flexi-hours and women and students working. Unlike in my day when I received a grant to have a holiday—not in the long vacation but in the other two—today not only is there no grant for the holidays at Christmas and Easter, but most students work during that time. This may well lead in future to students taking their degrees in modules over longer periods and working in between. Sunday shopping has a great effect on the pattern of leisure activity.
I should like to touch on one other topical matter: the active participation in and the watching of sport, and television. If enormous sums of money are floating around, as in the Premier Division, that money must filter down not only to the other divisions, but also to schools and clubs to encourage people to participate in sport at an earlier age. We must consider sport at the weekends and in the evenings, linked with family obligations and transport. In rural areas, and probably also in the cities, all of this movement and flexibility will have a tremendous effect on transport systems and on the number of cars and vehicles on the roads generally.
It is somewhat ironic that many of my friends who enjoy rambling drive into the country in order to go for a walk. That does not seem right. We should be considering the provision of buses that serve circular routes; that is, they pick people up in one place to go for a walk and later pick them up again in another place. I am aware that my county is thinking about this. Norwich has a very good park-and-ride system. Perhaps that can be reversed so that the citizens of Norwich can park in the park-and-ride area and take a bus to the country.
On a slightly more frivolous note, I observed in my diocesan newsletter the suggestion that children should be taken to school by a "walking bus". This takes a bit of thinking about. Two parents do it: one leads a crocodile of children over a short distance and one goes to the back with a trolley carrying all the bits and pieces. They go to the school, pick up the children and afterwards take them home. That is a marvellous way of getting rid of one motor bus. I fully appreciate that parents do not want to allow their children to walk to school even for a distance of two miles. It is not just because of the fear of paedophiles; it is because of the sheer volume of traffic.
One other subject has come up recently: television and computers. I refer to an article in the Independent on 15th December last. There is no doubt that we are watching less television. The more there is, the less we watch. But more and more people use computers and become computer literate—and rightly so. The importance of computer literacy in the future cannot be underestimated. People must be computer literate if they are to enjoy themselves. It is also essential that people do not simply look at the screen to consult the net about what they can do, but that they go out and actually do what they learn about on the net.
I am very pleased that a good number of NGOs work abroad. We have heard a good deal about them this afternoon. In what may be called the "traditional charities"—I do not quote any in particular, but noble Lords will know what I mean—the volunteers are ageing and find it very difficult to get young enthusiastic replacements. It is very important to find ways to encourage younger people to volunteer to work for some of our major charities. Perhaps the Government can encourage people to do it. Noble Lords who read The House Magazine last week will be aware that my noble friend the Convenor suggested that the quality of regional, district and county councillors should be improved so that they can take a good deal of the workload from the overworked people at the other end of this building. I believe that they are overworked. If 40,000 pieces of paper arrive on their desks every day, something must be done about it. I suggest that we need more and younger councillors at all levels of local government.
Next, I turn to use of the countryside for recreation. Today's Guardian contains an article which, frankly, I do not understand. I refer to page 3. I am sure that the Minister has read it and will tell me exactly what it means. I believe that the problems of access to the countryside are often exaggerated. I have been deeply involved in opening up over 25 miles of walks and other areas in Norfolk. I believe that the fact that people walk around my farm helps with security and in the prevention of vandalism. I can assure noble Lords that members of the public very quickly tell us of problems such as sheep and cattle dying. Furthermore, we suffer no litter problems whatsoever.
However, if people are to appreciate the countryside, more education and understanding is required. Some wildlife require protected areas. Farmers and landowners need payment for looking after particular habitats. I know that a good number of them are subject to stewardship agreements, as indeed I am, but these matters must be linked to access. If one receives money for preserving something, it must be available to the public. But it is essential that this does not mean access all the time and for all the people. Wildlife requires to be managed, and at certain times of the year it must be left undisturbed.
I cannot be precise about the number of people who go for walks around our farm because we do not charge for that. We simply charge for car parking. However, it is a very large number. The British Trust for Ornithology and the RSPB have remarked that there are 1,000 nesting pairs of barn owls. I was told yesterday that we have nine nesting pairs within range of our farm. This does not just happen; it is due to the management of what I call "owl food": voles, mice and nasty little things that must be encouraged in order to keep the owls going. We also have skylarks, otters and kingfishers. Referring to the recent NFU list entitled "Have You Got on Your Farm?", I believe that there are only two species of wildlife that we do not have. We have them tame but not wild. That is in spite of thousands of people walking around and looking at them. It can be done; it does work, with a little management.
Finally, I wish to ask the Minister two questions. He knows one of them: can he tell us what the future of the English Tourist Board is and what is happening about it? The second question is purely frivolous: what does the Minister suggest that I do with my extra leisure time? My Lords, I beg to move for Papers.
5.50 p.m.
Lord Haskel: My Lords, I congratulate the noble Lord, Lord Walpole, on moving this Motion. What attracted my attention and interest in the noble Lord's Motion was his reference to increased leisure time.
I remember some 10 years ago reading many learned papers and articles about the increased leisure that we would all have thanks to the new technologies that were being introduced. Unfortunately, this was not to be. New technology replaced unskilled work but created many new jobs requiring new and more complex skills and equally long hours.
Those who obtained the increased leisure were those forced into unemployment or early retirement because their skills were inadequate or obsolete. Many people in unskilled jobs have had to take second jobs in order to make ends meet, which virtually eliminates their leisure time. Those in work have had no increased leisure.
This picture is painted quite vividly in the national statistics. I quote from the 1998 edition of Social Trends, page 82:
"There has been a small change in the distribution of hours worked by employees since 1992, with small rises in the percentages of both men and women working over 40 hours and those working 30 hours or less".
Those in work have less, not more, leisure time, if one accepts the definition of the noble Lord, Lord Walpole, that leisure time is the time that one spends not working or sleeping.
Again, according to Social Trends of 1998, page 216, people who are retired or who are not working spend most of their leisure time on TV and radio, with women from all social classes spending more than three times longer than men on cooking and on routine housework and more than twice as long on caring for children and adults. I am not sure where all this increased leisure which so concerns the noble Lord is coming from.
The noble Lord mentioned various changes in leisure patterns. However, there are other aspects which seem to me to be equally important. The first is lifelong learning. Working life has become more complex and more demanding than anyone anticipated. To maintain one's income level, continuous improvement applies as much to people as to products. That is why this Government and employers pay so much attention to education, as to a certain extent the previous government did. They recognise that this is a key factor in our competitive future. Indeed, the title of the competitiveness White Paper published last month is Building the Knowledge Driven Economy. Computer literacy, which the noble Lord mentioned, is an important element in this.
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Learning is becoming an important leisure-time activity, not only to improve people's skills and employability but also as education for learning's sake. Indeed, if I have a criticism of the Government's policy, it is that they have not abolished Schedule 2, which stops government funding for learning not leading to a qualification.
Learning is also important to retired people, who do have more unoccupied time. Together with increasing good health, this means that they can look forward to some 20 years of active retirement. Learning provides access and opportunity for retired people to be of service—the voluntary services which the noble Lord mentioned. It is difficult to over-emphasise the contribution made by the voluntary services provided by retired people in their leisure time. They voluntarily look after the very old and the very young; they help in teaching and education; they help to look after and maintain the environment; they are active in schools, in hospitals, in charities in towns and in the countryside, in churches and in homes.
The noble Lord, Lord Walpole, mentioned the need for younger councillors and volunteers. I agree. But they do not have the leisure to devote the necessary time if they are in work.
Perhaps the factor which really gives rise to the noble Lord's concerns is not increased leisure but increased disposable income. To many of those in work their time is more precious than their money. If time is at a premium, people want to get more value from it. This has given rise to what the leisure industry calls—I hate to use their awful word—"edutainment"; that is, doing or learning something of value while enjoying oneself.
The attraction in Britain which charges for admission which has the most visitors is Madame Tussauds. That is because people have a history lesson and enjoy themselves at the same time. That is why people visit stately homes and gardens and similar attractions in such vast numbers. They learn about our history, our geography and our culture and at the same time enjoy a day out. This is not necessarily because they have more leisure time; it is because they wish to use their valuable time well and can afford to do so. I agree that this is not something we should seek to curtail. Surely we want to encourage access to our heritage in order to give people pride in what we have in this country. If the numbers become too great, we must work out how to share the facilities. I agree with the noble Lord, Lord Walpole, that we must learn to make agreements which are environmentally sustainable, such as "walking buses".
In summary, those in work use their increased disposable income to get more value out of their leisure time. The unemployed are encouraged to use their spare time to obtain the skills and education to get them back into work. Thanks to better health and more disposable income, retired people give much of their leisure time to voluntary service. Many seek to combine education and enjoyment.
I do not believe that these really are undesirable pressures and problems. To me they seem to be benefits gained from a successful society and a successful economy.
5.57 p.m.
Baroness Sharples: My Lords, the noble Lord, Lord Walpole, has introduced a truly apolitical subject today, which is most welcome. Many people welcome leisure, but equally there are those who dread facing retirement. The latter include their partners, who have been used to a pattern of life which will inevitably be disrupted.
During their working lives people should make time to take up a hobby or a sport which should last them through their lives. I feel saddened when I see so many of my age group giving up the many activities which they enjoyed when young. At almost 76, I still play golf and tennis and work in the garden, in spite of arthritis, and I have found new interests in joining local adult classes over the years. With the assistance of grandchildren, I am endeavouring to master my laptop computer, e-mail, and so on.
I wonder why more of your Lordships do not attend the gym or indulge in a massage, reflexology or one of the other treatments which are available within the Palace. Maybe some of your Lordships do not know about these. Bridge, which I took up again after 50 years, is available and encouraged in this House by the noble Lord, Lord Gisborough.
We are fortunate in this age to be able to avail ourselves of so much leisure, whether active or passive. Please make time before it is too late and retirement means inactivity and consequently boredom which affects not only yourself but those around you.
5.59 p.m.
Lord Addington: My Lords, the debate calls attention to increased time for leisure activities and the pressures and problems it causes. The noble Lord, Lord Walpole, described leisure as time when one is not working or sleeping. I would describe leisure as a period of time when one is not working or sleeping, and has the energy or inclination to do something. Some people I know would describe leisure and activity as a contradiction in terms. One of my university tutors said that when he had the urge to exercise he lay down and waited for it to pass. Leisure is not the same concept for everyone.
On a more serious note, those who have money have leisure options. To those with disposable income, the choice of leisure activities is vast. At under £300 a year, the cost of using the gym in the Houses of Parliament is comparatively cheap, but not to those with a standard or below average income. In such circumstances, we can see why there is such a problem of obesity among the lower stratum of society. For those people, the habit of taking exercise is not an easy option. They cannot simply throw money at the problem, buy the right designer kit, allow someone to shout at or cajole them, and feel guilty because they have paid someone to do that, in order to become fit.
There has to be motivation. Our society requires good public gyms to be made available. We need good leisure activities and good halls. We need easy access to the countryside if we wish to encourage walking, as the noble Lord, Lord Walpole, mentioned. The noble Lord, Lord Haskel, drew our attention to the fact that money
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is important. If one has money, the main problem is cultural. Throughout the 1980s it has become fashionable—"sexy" if you like—to work the whole time. That great curse/boon of modern society, the mobile 'phone, means that your office travels with you; and everyone has to be on the 'phone all the time. I know many who believe that work is merely being on a 'phone. I am glad to say that most did not stay long in one employment but tended to move around quite a lot. They were always doing something new, and talking on a 'phone. In such cases, that is probably an over-rated activity.
If one has money, one has only to decide which leisure activity to take up. There are few jobs where one is not more efficient if one is rested, ready and alert, as opposed merely to being at the job for hours. That is a cultural problem which runs through society at present. For many people, the climb up the career path involves being seen at the office an hour early and leaving an hour late. They tell me that their skill at crosswords is improved and their telephone bills at home are reduced because they make all their calls to friends at work. It is quite easy to justify doing so; it may be to another business. That is a factor we must bear in mind.
We must consider those who do not have money available to solve the problems associated with increased leisure time. I have some knowledge about the area of sport, as one who has slipped from being an active sportsman to an occasional sportsman. While I may be a younger Member of your Lordships' House, I am an incredibly old rugby player at 35! Having attempted initially to be a top flight sportsman, and then to reach personal goals, I am now a recreational sportsman. The vast majority of people are recreational sportsmen. If we encourage that aspect, we shall probably save on health bills because the problems relating to inactivity are addressed. But we must make sure that there is a supportive environment. If there is insufficient funding within local structures, with encouragement through schools, the problem will continue throughout the lifetime of any generation. If we do not address the issue properly, we shall always be hit by extra costs for social services and the health service.
We need a culture in which people are encouraged to try sports at an early age—for example, at school—with support services to follow. Temperament and culture are the two determinants of the sports we take up. Unless we have such a culture, we shall always have the problems associated with couch potatoes. I suggest that we can have a healthier life and an enhanced social life at the same time as saving the Exchequer money. Surely a little investment is well worthwhile.
6.6 p.m.
Lord Gladwyn: My Lords, in considering this problem of our time, appositely raised by the noble Lord, Lord Walpole, my first thoughts were for the pressures on our countryside as agriculture declines and leisure replaces it, with acres of car parks, golf courses, country clubs and theme parks, with crowded lines of traffic-choked roads, or trails congested by walkers, horse riders, scramblers and cyclists.

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I then thought of the pressures imposed socially by the pursuit of happiness, that elusive goal which the American founding fathers chose to enshrine in their constitution. To many this has become an absorbing and even exhausting preoccupation which, among other things, has served to loosen the conventional fabric of daily and weekly life, keeping people constantly on the move and awake or asleep at all hours.
However, I should like to devote my allotted time to the pressures of leisure that impinge, not externally in space or time, but internally within the human ear, namely, excessive noise. In a mechanical age some mechanical noises are inevitable, though they are rightly controlled by legislation and have often been reduced by technical innovation. Strict laws govern the levels of noise in the workplace, though it has to be said that at several places of entertainment, such as pubs and restaurants, such laws are quite often ignored. Individual motor-vehicle and aircraft engines are quieter than they used to be, though various sorts of engines, used mainly for leisure—such as lawnmowers and other garden instruments, motorbikes and mopeds, and low-flying microlight aircraft—still cause annoyance, and many would welcome stricter controls on them. But the greater aural menace of leisure today, I suggest, is not so much from mechanical engines as from the amplification of music.
The facts relating to amplified sound as an adjunct to leisure make disturbing reading. It is generally accepted that prolonged noise above 85 decibels is dangerous to human hearing. But the 1990s have witnessed the widespread breaching of this barrier by those who provide entertainment. Personal stereos can rise to 110 decibels at maximum volume. A nightclub dance floor can be subject to constant sound at 120 decibels. The film industry has recently released blockbusters such as "Lethal Weapon 4" and "Godzilla" with soundtracks above 100 decibels, and the climax of "Armageddon" registered 110. Those respective decibel figures may at first sight seem only marginally different but the scale is in fact logarithmic, so that in fact sound at 120 decibels is eight times louder than sound at 90 decibels. What is more, it releases a thousand times more energy into the eardrums. There is increasingly recognition that those who expose themselves frequently to such levels may well suffer noise-induced hearing loss and will enter middle age with degrees of deafness normally experienced only by very old people, just as used to happen in the bad old days in noisy factories. Recent research at Keele University has already provided proof of this. It is depressing to learn that the incidence of tinnitus, which had been on the decline, is now on the increase.
Some have suggested that these amplified sounds are less dangerous than other noise of equivalent levels, for the reason that they are "musical". We have come a long way, however, from the heavenly harmony from which Dryden imagined this universal frame began. The sound of hard rock is as harsh as its name implies and a "pop" concert, though an abbreviation for a popular concert, is also an appropriate term for the popping of eardrums.
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Why have these unprecedented levels been attained? Obviously because there are millions of young people who derive a thrill from the tremendous impact of those overwhelming sounds, inducing an unthinking form of trance. Those who are already high on alcohol or drugs are even less likely to be concerned at the bombardment of their brains.
What is to be done? Legislation could be introduced further to reduce the maximum decibels permitted in films or stereos; the latter has already been done in France. Even rave clubs could be restrained. I fear, however, that as with teenage smoking, drinking and drug-taking, we are up against a form of youth expressionism which can be discouraged but never effectively suppressed.
Natural music, whose sound reaches the ear direct from larynx or instrument, cannot attain the sound levels of amplified music other than instantaneously. For instance, a loud movement of an orchestral concert may produce around 90 decibels to the audience in the stalls. Many years ago, the late Kabaka of Buganda escorted me to the hut where his drummers were playing, and it was a most exciting experience; but, thump and sweat away as they did, even their decibels were nothing like those of a rave concert of today.
Natural music, seen as a leisure activity, can of course be aggravating to close neighbours if excessively loud or prolonged. People next door can make life hell by all sorts of audible intrusion. All the same, it would be ridiculous to condemn all neighbour noise and to suggest that modern society could be conducted in monastic silence. I was relieved when the Garsington Opera was permitted to continue, despite the objections of some of their neighbours. I was dismayed when Cocky the cockerel was silenced for waking up his neighbours in the village too early. I also remember long ago being annoyed when a fellow student attempted to get the authorities to stop the chapel chimes at night.
Looking back over the century that is about to end, it is evident that one of the greatest changes to society has been the ability to record and amplify music. It has enormously enhanced the quality of life and widened human perception. As with other products of the microchip, however, it can now be so readily produced from such infinitely small devices that it is all around us all the time. Many are tempted to have it as a sort of semi-permanent background to their lives: something not really listened to but just there in a comforting sort of way, requiring no mental attention. Many stores and places of entertainment pander to this feeling. Even top people indulge in it. The most frequent form of recreation listed in Who's Who is "listening to music". It used to be "reading". I would also say therefore that music can be misused for leisure, not only by excessive volume but also by excessive use.
It is said that Attlee once reproved John Strachey, who had been monopolising some Cabinet discussion, with the words "A period of silence from you, Strachey, would now be acceptable". In taking my cue from that, I conclude with the thought that longer periods of silence—periods without the TV, the radio, the

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telephone or the canned music—are, as much as anything, what is most needed to ease the pressures and problems of leisure today.
6.14 p.m.
Lord Cowdrey of Tonbridge: My Lords, I should like to express my thanks to the noble Lord, Lord Walpole, for opening up a wide-ranging subject and such a spread of ideas, although, speaking personally for a moment, learning for the first time from my noble friend Lady Sharples that there is a gym in the Palace has rather spoilt my evening because my conscience tells me that I should be using it!
For the purpose of this debate I shall confine myself to the field of sport, which offers so many opportunities to fill leisure time. My thoughts go out to the unemployed—tens of thousands of them, an alarming number, many in their prime—who, for one reason or another find themselves put out of work and, worse still, with only slight prospects of moving into something else reasonably quickly. For them, time sits very heavily. There are 27 year-olds, 35 year-olds and those in their early forties. One week they are pottering along, supporting a young family, in a seemingly secure job, and then the hammer blow falls and, with it, the loss of pride and self-respect. As the hunt for fresh work is met with one closed door after another, the trauma of it all heightens the gloom and despair. The family look on helplessly. Each one of us here this evening will know people who have suffered this and will have done our best to bring encouragement and support.
My point is that if that person has a natural love of sport, better still if he shows a talent for it—but this is not vital—sport, as run by local authorities across the country through leisure services and leisure centres, with enlightened sportsmen and sportswomen around him, can throw out a valuable lifeline.
I had a rewarding experience just a few months ago. I am the president of the National Association of Umpires and Scorers. Watching a keenly contested local game, I was pleased and rather surprised to find a young umpire in his thirties who carried all the badges to show his qualifications. At tea time I greeted him and asked how he had come to be an umpire so young. He explained, very dramatically, that he came to this as a result of a very unhappy, traumatic period of redundancy from a job that he enjoyed. Luckily for him, very soon fellow sportsmen in the locality were putting an arm around him and persuading him to become involved in a range of sporting activities. This got him out of the house with a little more enthusiasm, as he wrote off for endless interviews in the relentless search for appropriate work. It helped to keep him out of the pub and from squandering time and money in the betting shop—money which he could not afford.
The period of redundancy dragged on and he was persuaded to take various courses to learn how to umpire at lower levels and to referee football matches, all at minimal cost. This proved to be the breakthrough for him. Very soon he made his mark locally. The telephone never stopped ringing. Suddenly he was wanted again, called in at the last moment to stand in to
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umpire for someone who was sick. From his new-won links and friends came a part-time job and, not many months later, he found himself in a rewarding full-time job. Here, you may say, was the happy family man again, waking each morning and looking forward to the new day, self-respect restored.
The cynic will say, "A one-off. It would not happen very often". Perhaps so; but I do not think so. I think all of that is worth pursuing, because we are well organised in this country, much better than we give ourselves credit for. I am encouraged by the work of the local authorities, their leisure services, the centres, and the increasing number of volunteers and paid folk around—enlightened sportsmen and sportswomen.
My message is therefore for those of us in sport to pursue this, but not with a huge hullabaloo, because of the sensitivity with regard to people out of work. I urge closer co-operation between the local social services and leisure services in identifying the unemployed, and the dispirited too, and preparing enlightened, welcoming sportsmen and women to seek out those people with the warmth of genuine welcome. There is so much time for leisure, especially if you are out of work.
6.20 p.m.
Lord Beaumont of Whitley: My Lords, the noble Lord is absolutely right to say that there is so much time for leisure for the out-of-work. We must increasingly face the problem of trying to help people fill their leisure time. Under the present capitalist system, as long as we strive to achieve efficiency in production all over the world by saving on labour rather than any of the other factors in production, we shall save labour. All over the world there will be less and less paid work and more and more people out of work, either voluntarily or involuntarily.
That is a very sad state of affairs. It does not look as though we shall be able to reverse that trend for a very long time. This evening I do not have the time or the opportunity to discuss that aspect of the matter. In this debate the noble Lord, Lord Walpole, called upon us to concentrate on leisure. He made an extremely good speech. I was extremely fascinated by his account of what happens on his farm.
The more that we have the industrial set-up which we have at present, the more it will be difficult, necessarily, to talk about leisure without talking about how leisure leads back into work. It is not just as the noble Lord, Lord Cowdrey, said—although he is absolutely right in what he said—that being involved in a leisure activity which is creative and purposeful gives one the morale to get back into work. It is also that one learns skills which are useful for work. That do-it-yourself attitude can lead to an increase in craftsmanship.
The craftsmanship in this country has increased enormously over the past few years. The fires at Uppark, Hampton Court and Windsor Castle have resulted in the most extraordinary collection of skilled craftsmen working together and getting to know each other; in some cases we have seen revived crafts which had almost died out in this country. I am almost tempted to suggest that we should look around for a couple of

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arsonists to set the next fire. There are some buildings which I should not mind burning down but then I should not wish to rebuild them again, so that would not answer the question at all. It is extremely important to encourage people to learn crafts and skills in their leisure time.
The noble Baroness, Lady Sharpies, reminded me at tea time that I should say something about allotments. I am very sad that she used only two minutes of her time to make her speech and did not herself say something about allotments. Allotments are a very useful, productive and skilled use of leisure time which we should do our best to encourage. I know that local authorities say that there is no take-up of allotments and that there are too many of them. However, not enough has been made of trying to popularise the use of allotments. A television programme like "Gardeners' World" dealing with allotments would be an extremely useful and helpful step forward.
Then there is the whole question of being in the countryside—walking and learning how to appreciate the countryside which we desperately need, given that ours is a society which is badly divided between city and countryside. The national parks—and I have the honour to be a vice-president of the Council for National Parks—serve an extremely useful purpose. They draw an enormous number of people into the countryside all the time. Any body which tries to encourage that is also to be commended.
I draw particular attention to the work of Nicholas Albeury who works for the Fourth World Trust, of which I have the honour to be a trustee. He organises a whole list of walks within easy reach of London with a book telling you how to get there. Every weekend there is a suggested walk, with walks for those who are fit and able and for those who are less fit and able. In each case, one can be set down at a railway station connecting with a London terminus and after a walk and an opportunity to have a sandwich, or perhaps a visit to a pub, one then returns. We all remember seeing films and reading novels about how cyclists used to do that at the turn of the century. That is now being encouraged a great deal for walkers, and it is very good that that is happening.
There are all sorts of leisure activities like that which should be encouraged. Last night I saw for the third time on video tape that splendid film "The Full Monty". I am not advocating that we should all learn to become male strippers in our leisure time. However, the film was an extremely interesting study of how people who are out of work get encouragement to do something different. To a certain extent that is what the noble Lord, Lord Cowdrey, was talking about. That is very important. Six ex-steelworkers put "The Full Monty" together. Small groups of people working together will have a major effect over a wide area.
There are many other areas in which we should encourage voluntary work. I was extremely lucky to spend a large part of my schooldays at Gordonstoun where work in the services was encouraged. I do not
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believe that this is the right moment at which to cut down on the Territorial Army and it is not the right time to discourage anyone joining in service activities.
I could talk about this subject for a long time but my eight minutes is up. This has been an extremely good debate. The noble Lord, Lord Walpole, made an extremely good speech in introducing it. I hope that the Minister and the Government will pick up some crumbs from it in order to encourage the better use of our leisure time.
6.28 p.m.
Viscount Mersey: My Lords, I echo the remarks made by the noble Lord, Lord Beaumont, in congratulating the noble Lord, Lord Walpole, on initiating this debate. I wish to concentrate on the subject of rambling. The noble Lord will be pleased to hear that I do not use a car because I am fortunate enough to live in the middle of the South Downs in the Sussex Downs conservation area, the board of which is chaired by my noble friend Lord Renton of Mount Harry. Those downs are hemmed in to the north by Horsham, Crawley, Haywards Heath and to the south by a huge conurbation all along the south coast for about 100 miles from Hastings to Bournemouth. There is a lot of pressure therefore on their use. They represent in miniature the problems that we ramblers face and, let us face it, cause, the length and breadth of the country.
There is a basic question: who are the South Downs for? Farmers who earn their livelihood from them, and foresters, can be annoyed by us ramblers who use them for enjoyment. But the counter-argument is that, since more people live in the town than in the country, the "townies'" will should prevail and the whole area should be one of recreation.
But it is more complicated than that. Recreationists are divided among themselves. Walkers dislike mountain bikers; bikers dislike horses; all of us dislike off-road vehicles. However, we all live together in reasonable harmony due to a splendid network of tracks of differing status. There are footpaths for walkers, bridleways for horses and mountain-bikers, and green lanes for off-road vehicles. I should like to ask the Minister one question about motorbikes on bridleways. They certainly spoil one's day; they create ruts and throw up mud, besides making a lot of noise. I am not sure as to the law in that regard. Are motorbikes allowed on bridleways or should they be confined to the byways open to all traffic, otherwise known as green lanes?
That apart, the planning of a country walk on varied rights of way is a fascinating exercise. There is some skill in following a route, particularly in mist. But we have extremely good maps. The pathfinder 1:25,000 series is very good and one should not go wrong, provided one also has a compass. It follows therefore that I cannot see any point in the "right to roam" as there is no skill in it. Furthermore, bulldozing one's way through country that may contain bulls—forgive the pun—is foolhardy, and crossing a mixture of bramble and barbed wire is painful. It is more satisfying to navigate the twisting green dotted line on the map and to discover the stile that leads out of the field or the plank that bridges the stream.

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While on the subject of the right to roam, I must refer to the sentence in the Guardian report which confused both the noble Lord, Lord Walpole, and myself. It reads,
"Proposals are being brought forward to prevent ministers being embarrassed by a private member's bill being introduced today which would expose the Government's failure to honour its manifesto promise to create the right to roam over mountain, moor, heath, down and common land".
To me that is a candidate for Pseud's Corner! Perhaps the Minister could explain it to me, or better still, explain what is happening in another place today.
I have been dealing with short routes, but must now refer to long-distance paths and that greatest of all pedestrians, A. Wainwright. For instance, we have the Pennine Way of nearly 400 miles and the Coast to Coast—a wonderful route—running from St. Bees in the West through the Lake District, over the Pennines and the Cleveland Hills to Robin Hood's Bay. Fifteen years ago, those were the only two known to me but now there are many such paths; for instance, the Ridgeway, the Pilgrims' Way, the Mariners' Way, the Southern Uplands Way, the West Highlands Way and the coastal paths in Norfolk and Suffolk. The best of them all is Pembroke and the longest is the Cornish Coast Path which, surprisingly, is 480 miles long.
My point is that those paths did not just happen. Someone worked away to establish them and to obtain permission from landowners to open rights of way. It is obvious that on a coastal route, one unco-operative landowner or farmer can jeopardise the whole. In fact, I have found landowners remarkably willing. Surely the right way forward is for ramblers to work out new routes with them rather than claiming blandly that the whole countryside belongs to us. We should negotiate specific routes. In his guide to the Coast to Coast Walk, Wainwright offers the surprising advice that we should not walk it as it will become eroded. He says that we should use our initiative and work out our own routes on rights of way, using a load of maps.
I conclude by offering a tribute to a great Englishman who died recently and who was known mainly for leading the first ascent of Mount Everest. I refer to Lord Hunt. When I first joined your Lordships in 1981 we were debating the Wildlife and Countryside Bill and the problem of the long-haired conservationist. I remember Lord Hunt jumping up and describing himself as a short-haired recreationist. At that time, rather quietly, he was creating a splendid 190-mile route along the English-Welsh border called the Offa's Dyke Path. For those few noble Lords who may not have walked it, I point out that it does not actually follow Offa's Dyke because the dyke exists for only some 25 miles and its course goes through the middle of Wrexham! That is all very well, but it is not as good as the Hunt route which goes over the Clwyd Hills—a wonderful route—and leads south through Montgomery to the hills above Tintern Abbey, ending at Chepstow on the Severn.
I offer that route as an example of how the rambler can coexist with the farmer, of how it is possible to establish a right of way anywhere, provided that one works at it and, finally, as a tribute to Lord Hunt whose greatest quality was his modesty.
6.35 p.m.
The Marquess of Bath: My Lords, I should declare a personal interest. In running a stately home my business lies within these leisure industries which we are discussing, tourism in particular. Rurally based leisure industries are emerging very much as the occupational inspiration of our day, which finally reverses a trend which became established at the start of our industrial revolution. That optimum organisation acquires an increasing importance within the economic welfare of our society. Indeed the significance of tourism has risen so high that it now ranks among the foremost of our national industries in the earning of hard currency.
This is a trend which the whole of society can welcome. The over-dependence of any region upon its big cities was always undesirable, in that it encouraged population shifts which left the countryside depleted and sometimes impoverished. So the present switch of emphasis upon the usefulness of activities which can be based at home, and even in the heart of our rural countryside, transforms the very character of that region in a manner that should be encouraged.
Individually, these leisure industries are small, and they are vulnerable in what for them is a difficult economic climate. Tourism relies to a large extent upon the natural beauty of the local countryside, but also upon the historical and architectural interest that is aroused by the listed buildings that the region contains. Because of their age, however, most of these buildings require constant attention and repair to conserve them for what they are.
One of our biggest headaches in this task is the additional cost of the VAT incurred when the work is to be classified as "repair". There is VAT to pay, for example, if there is an outbreak of death-watch beetle in the roof. It would help us considerably if there were to be zero rating for any such repair work, bringing it into line with those alterations which are categorised as new building work.
My other plea is that simplicity should prevail in the introduction of any new directives concerning such matters as employment, health or safety: much of which emanates from Brussels. We have found it difficult to be economically efficient while the administrative burden is so heavy. Much inconvenience is involved in conforming with all the directives and regulations handed down to us, which needlessly distract us from the task of obtaining optimum performance in these relatively new industries. So simplicity in the legislation (especially from Europe) in establishing the standards to which we must conform will always be appreciated and found beneficial to these enterprises.
But in more important ways the need to focus upon the European influence is becoming ever more apparent. We in Wessex are well aware of this where tourism is concerned, in the approaches that are being made to us from regions outside Britain, the most significant of which has recently come from the Pays de la Loire. They seek partnership with other tourist regions in Europe, as far afield as Germany and Italy, to discover the best means for mutual benefit. But they are now

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seeking partnerships on this side of the Channel too. I believe it was Somerset they approached at the start, but they were looking for something broader-based than any single county—until they came to appreciate that the concept of Wessex embraces Somerset and various other counties: so that here was a unit with which the Pays de la Loire could more properly do business.
The Government should encourage this tendency for the leisure industries of one region to commune and communicate with all others throughout Europe, to promote the mutual interest by augmenting the flow of tourists around the continent as a whole: because tourism only works at its best if it becomes a general habit, where we go to visit European regions as much as they will be coming to visit ours. And the Government should be setting up a framework wherein the regions of Britain can emerge as their own tourist identities, to communicate directly with other regions on that basis.
It is essential that the leisure industries of each region should start to be promoted from a unified regional tourist board, whose purpose will be to project the full creative individualism of the region as a whole, so as to attract the maximum number of tourists into their fold. But for this purpose the boundaries between the existing tourist boards need to be redrawn, so that larger territories are encompassed than are envisaged today. I believe that the Government should be marking out these tourist regions, with a view to identifying where the borders of the political regions will subsequently be drawn. The creation of these amalgamated tourist boards will set the ball rolling in this most significant direction, and is a step which should be taken without delay.
Once these tourist boards have been given the clout that I am anticipating for them, they will apply direct for the European funding of what is becoming an increasingly widespread European concern. The leisure industries are perhaps in the best position to front this trend, to the benefit (while not at the cost) of our national Exchequer. And by their co-operation with such Euro-regions they will be assisting to set up the pattern of a Europe of regions that will see us into the next century: whereas to omit to do so would involve us getting left behind, and then subsequently out of touch with the way in which our European culture is working out in practice.
6.44 p.m.
Lord Rowallan: My Lords, I too should like to thank the noble Lord, Lord Walpole, for bringing this subject before us. I must declare an interest as a director of one company, the prime role of which is running an activity centre, and of another which is developing an hotel, a golf course and leisure centre, and as a professional commentator on leisure sports.
Leisure is taking more and more time in our lives. Not only are we living longer, but we are retiring earlier. We are working shorter hours; the latest directive being for a 35-hour working week, down from 48 hours when I was a bit younger. Personally, I wish I could remember the last time I ever worked fewer than 70 hours a week,
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but then I am part of that rare and rapidly-facing-extinction breed of human, at least in relation to your Lordships' House: an hereditary Peer born supposedly with a silver spoon in my mouth. If anyone knows where that silver spoon is, perhaps they could they let me know!
Leisure, if used properly, can keep you fit and keep you active. Idle hands, they say, make for a dulled, unambitious mind and more time for gossip and causing strife. Too much time on your hands leads to drink and drug problems, to hanging around street corners, to holding down the sofa in the TV lounge and to acquiring square eyeballs from watching too much TV.
What we need to do is to educate our young, our employed and unemployed, and especially our elderly in what to do with their spare time. They have plenty of time for leisure and many do not know what to do with it. It is like the poor man winning £18 million on the lottery: all too often he finds that it totally ruins his life, as he cannot cope with the changes in his circumstances that have been brought about. Over the Recess, we in the West of Scotland had gales, which destroyed everything in their path. At home, we had no electricity for a very long time, but we learned as a family, and with 12 friends staying, to converse and to play games. Having no TV and living with candle-light really made the holiday.
My main interest is equestrianism. I am a director of the British Showjumping Association. Over the years, hundreds and thousands of children have been kept off street corners by looking after Dobbin and other faithful ponies, because a pony, like all other animals, needs to be looked after for 365 days a year. Many other popular sports carry on the same role of keeping people off the streets and keeping them fit and well.
However, too many members of our population are bored. How many times have we heard children cry, "What is there to do? I'm bored; I'm fed up"? They have stagnated watching television and cannot think what to do. We have lost the art of creating things to do. Local and central government have spent millions of pounds building leisure centres, play-parks and so on, but some set out to destroy those facilities, sadly, rather than use them. Television has given us the perfect excuse to vegetate in our own homes without speaking. Children and adults are not encouraged to read at home, and the local library has all but disappeared. That is a tragedy, I think, because one learns so much by reading.
Why has this happened? We have more choice of what to do now than ever before, and more time to do it in. Why, when all these facilities are there at an affordable price, are there still so many at a loose end, lounging around at home, standing on the street corner, taking drugs, smoking and all too often causing trouble? Why have we lost the art of conversation in the home? That is one of the primary reasons for the high number of broken marriages today. How can we educate the population to enjoy and make the most of their leisure time? That is the question this debate asks, and as succeeding governments all seek to increase employment by cutting working hours, this is a question

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which must be looked at very quickly and very closely. Modern technology has done much for our society, but modern education leaves much to be desired.
The strange fact is that if you live in a rural area you are less likely to encounter crime. We must remember that 34 per cent. of the total population were victims of some sort of crime in 1997 and 1998. That is a frightening statistic. Also, if you live in a rural area you are likely to live longer than if you live in a town. Is there something to learn from those facts? Is not an outside leisure pursuit more beneficial than an indoor one? What are we going to do about all our inner-city schools, which sold off their playgrounds for development and now have no sports programmes at all?
Surely if we teach the young how to use their leisure time, that will follow through to their old age. We are rearing a generation who have never known what team spirit is in their school lives. Can that be healthy for our future? Have we lost the urge to go en famille for a day trip to the country with a picnic basket, beside some pretty river or on top of a mountain, as a I did when I was young? We can think only of going to places where everything is laid on for us, such as Alton Towers or even the home of the noble Marquess, Lord Bath, Longleat, or on a package tour to some foreign centre where it seems there is fun, drink, touristy tours and sex on tap. The days of the deckchair on the beach and of the beach changing hut have gone.
However, there is plenty of scope to do things which cost nothing. Therefore, I disagree totally with the noble Lord, Lord Addington, who said that money helps people to do things. There is so much that people can do for absolutely nothing. Why have our habits changed in that we all want to do things where we spend money? Are we unable to make our own enjoyment any more? Walking and jogging seem to be enjoyed by only a very few. The majority want to use a car, if only to go to the shops a few yards down the road. We sit in traffic queues and become frustrated. As trains and planes are often late, we now have road rage, air rage and many new human phenomena. We all love to moan and groan.
I therefore hope that we can help the population to enjoy their leisure time by teaching them to think for themselves, to create ideas and novel thoughts on what to do and to become involved in sports—not necessarily as participants but as judges, administrators, umpires and so forth, many of which roles can be performed by the old and relatively unfit. One thing is certain: if one keeps busy, one will keep out of trouble and will not have time for excesses of drink, drugs and so forth. How often is there a full-blown fight on the golf course, the athletics track or the ski slopes?
If used properly, leisure leads to a better standard of life, better enjoyment of life, better understanding of the meaning of life and better relationships with one's family and friends. We must have leisure to recoup spent energy and to recharge our batteries; but we must learn to appreciate our leisure for what it is—a time for unwinding and relaxing. I venture to suggest that leisure is rather like housework; it vacuums the aches and pains from our brains and bodies, lifts the dust and cleans the cobwebs from our minds. It clears our minds of today's problems and invigorates us for those of tomorrow.
6.52 p.m.
Lord Broadbridge: My Lords, increased leisure time can be a great joy but, as the wording of tonight's Motion implies, it can also be something of a misery, indeed a great burden.
We live in a society where leisure time has increased in two areas. First, the working week has progressively shortened since the war, leaving men and women with more leisure time during the working week. Secondly, retirement ages have fallen from 65 for men, often to 60 or 55 on early retirement. That means that people more and more find themselves at home. If married, a fully-occupied person comes homes stimulated by the day's activities or, at least if not stimulated, with something positive to talk about. However, with decreasing occupation, or no occupation, the conversation can soon run out and, to put it bluntly, the typical wife finds the husband getting in her way while she does the cooking and chores. Worse still, they have little to say to each other. If single, the position is, if anything, worse, with loneliness and isolation creeping in.
There is probably little profit in a speech in this debate in listing all the leisure activities that a man or woman might undertake, from golf to darts, cribbage and shove-halfpenny. I believe it will be more valuable to try to get at the mechanism by which people with time on their hands may find something absorbing to do.
A new occupation can be a slightly frightening or nerve-racking undertaking, with creeping doubts about its usefulness or likely outcome. It is unfamiliar territory, a new experience. For that reason, I believe it is a positive benefit if our leisured person starts an activity with a friend or former colleague. That tends to lend confidence to the new experience. There can be discussion and note-swapping which help to overcome initial sheepishness.
Where a new activity comes from may be as diverse as the sands on the beach. I would strongly recommend local authority classes. For some reason, many have cynically written those off as consisting only of pottery and flower arranging. Nothing could be further from the truth. At the beginning of each academic year, local authorities publish a lengthy, glossy booklet of courses available, usually for a modest fee. Some, such as lectures, are non-participative, while others, such as learning a musical instrument, are participative. The diversity is enormous and, from my knowledge of one authority, range from a history of the Inca peoples to female brass band playing. My wife, for example, has learnt, to varying levels, French, German, Russian, Greek and Arabic, and is learning to play the flute. New friendships are made. She is still in regular touch with three people she met at Greek classes 20 years ago.
What may first appear as a diffident and desperate attempt to do something may develop, perhaps surprisingly, into an absorbing passion. The essential move is to dip one's toe into the water. By doing something, an interest may be started, but it is essential to do that something.

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I have had experience of how an unlikely "doing something" may develop into a passionate absorbtion. Twenty-five years ago I bought two aquamarines while on a consultancy assignment in Egypt. Wanting to have them set, one each for my two daughters, I approached a local silversmith. He said, "Come to my workshop and do it yourself'. I did. It worked out well and one thing led to another. I have had a silver hallmark registered at the London Assay Office for over 20 years and am a passionate silversmith, attending two evening workshops at Sir John Cass College in Whitechapel. All that was the result of dipping my toe in the water and doing something. I suppose my point is that the most modest initiative can be the acorn which gives birth to a large oak.
One of the great impediments to leisure activity is a tendency to sit at home and watch endless television, as we have heard. TV is excellent on a selective basis, but mindless watching is futile and a conversation killer. It is probably the greatest single barrier to constructive leisure activity. Many leisure activities can be conducted at home, although maybe after an initial start outside. There is no need to go out if you want to build a model of the Houses of Parliament in matchsticks, except perhaps to buy the matches. However, it is essential to break the mould of slumping down in front of a television set day in and day out.
Increased leisure should be a joy. However, because of the sombre terms in which the debate is cast referring to pressures and so forth, noble Lords have rightly concentrated on the worrying aspects of the subject. To end on a lighter note, one person in literature had no problem and found a somewhat unusual leisure activity, namely Old Father William in Alice's Adventures in Wonderland:
""You are old, Father William', the young man said,
'And your hair has become very white;
And yet you incessantly stand on your head—
Do you think, at your age, it is right?'"
Not, perhaps, a universal role model, but it is a start.
6.58 p.m.
The Viscount of Falkland: My Lords, this has been a most enjoyable debate. If I understood the noble Lord, Lord Walpole, correctly when he introduced the debate so entertainingly, that is exactly what he intended it to be. I do not think that he has been disappointed so far.
He opened his remarks with a definition. I went to the Library and looked through the dictionaries. "Leisure" was well covered, particularly in the Oxford English Dictionary. There are various definitions of leisure in its different aspects. The shortest and perhaps most appropriate, at least to this debate is,
"The state of having time at one's own disposal to use as one pleases".
I believe that that fits in well with the remarks of many noble Lords. Lower down, the definition states that a "lady of leisure" is a woman who has no regular employment and is free from obligation to others. I do not think that we can call the noble Baroness, Lady Sharples, "a lady of leisure". She has clearly used her
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leisure time most productively and in a positive way. I am always uncomfortable with that phrase because it seems to me to have a sort of jocular and rather unkind connotation which is not far removed from music hall jokes about mothers-in-law, and so on.
I recently read some memoirs of a French émigré from the time of the revolution who was much struck in England by the cruel way in which affluent families treated poor widows who often had to move out of the familial house to make way for the daughter and son-in-law. They often had to move into a smaller residence in relative poverty, with few obligations or indeed employment. Of course, depression often ensued. Therefore, I would avoid using the term "a lady of leisure". I am very glad to have the example from the noble Baroness, Lady Sharples, that women do like obligations and responsibilities. Indeed, she is a fine example of someone who uses her time well.
I had a 17th century ancestor who made a very simple remark; indeed, he must have repeated it many times for it to have gone on the record so often. He said:
"I pity the unlearned man on a rainy day".
When one examines that remark, it has a certain charm and philosophical resonance. It is also a very compassionate remark because very few people in the seventeenth century had the leisure time to become learned in the sense that he meant. I suppose he meant literate—that is, people who were able to read. Most people in that century found it hard to survive in conditions of extreme discomfort and pain.
Of course, the history of leisure is interesting. As affluence grew, so the nature of leisure changed and it became wider in the eighteenth century. Various of the pastimes, games and sports that we know so well today developed at that time; for example, cricket, shooting, fishing and other such occupations.
There is something very curious about the 19th century at the time of the Industrial Revolution. I was reminded about it when I noticed the noble Lord, Lord Murray, who was a trade union leader, sitting opposite me. Unfortunately, he is no longer in the Chamber. However, the first concern of many of the great industrial leaders, who were often self-made men who created great enterprises, was to ensure that their heirs got out of the business and into leisure. They wanted them to become gentrified and to be country landowners with leisure time. That probably had a very good effect on them and their descendants in some ways; but I suggest that it had a very detrimental effect on the competitiveness of British industry, which is not the case in some other countries. So leisure has always had an attraction for people in our islands.
As we come to the present day, more and more people have leisure time made available to them. This is where the worries, which many speakers have mentioned, begin. We owe a great debt to those who used their leisure in the past in the field of ideas and inventions. There was an ethos which had much to do with the influence of the Church and other institutions; namely, that it was considered absolutely necessary for leisure time to be used productively. Thus, so many people became accomplished watercolourists, musicians, and so on.

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However, at present I am very worried about the use of leisure and the way in which we define it. Indeed, we seem to confuse recreation with leisure in the way that we recreate ourselves. One of the most worrying aspects is a sort of all-pervading narcissism which brings in compulsive exercise, body-building and, I am afraid, jogging. Indeed, one noble Lord referred to the latter as being something to which we should pay attention. A jog around the Palace of Westminster might be good from time to time, but to be doing so all the time and spending all one's money on special shoes, and so on, shows a certain eccentricity.
I am also worried about gambling. In his excellent speech the noble Lord, Lord Cowdrey, referred to an umpire. If I understood him correctly, I believe he said that someone had been taken away from his gambling and put into the excellent field of being an umpire and a referee. Of course, in the eighteenth century we created horseracing as it is presently known. It was a leisure activity indulged in by relatively few rich people who matched their horses one against the other. However, over the years it has become a huge industry and a sport which provides great entertainment for many people; but it is also a way of losing a lot of money, as I know to my cost. The public policy on gambling which, again, was connected with the influence of the Churches, seems to have almost disappeared without any comment. Indeed, it was scarcely referred to when the National Lottery was introduced. I do not think that there is anything wrong with putting a pound on a horserace occasionally, but it gives rise to an area of concern when people do not know how to control something which can become an addiction.
When talking about addictions we must include television, as mentioned by some speakers today. There is a headline in one of today's tabloid newspapers, which noble Lords may not have noticed because there is a picture of a very pretty young lady right next to the article. It refers to a woman who watched television for 16 hours a day. It is possible that people are watching less television and I accept what the noble Lord, Lord Walpole, said in his opening remarks. However, for those who become addicted to it, it is extremely dangerous. I have been accused by my wife of being a couch potato for watching one-and-a-half hours of golf on a Sunday evening. Sixteen hours does seem to me to be a bit eccentric, and I no longer feel like a couch potato. Nevertheless, it is an area of concern.
There are other addictions which are often associated with leisure which is not properly used, including drugs and alcohol. I should like to make one comment that I have wanted to make for a long time. I am most concerned about the way in which people label certain drugs which seem to me to be specifically for certain clinical ailments. For example, some drugs are referred to as "recreational drugs". Indeed, I have even heard it said that the intention of Viagra is that it should become a recreational drug. At 63 years of age, I have to say that I am happier on my 180 mile-an-hour motorcycle than I would be on taking Viagra. That is quite a serious and worrying matter. Moreover, in certain circles, cannabis is also referred to as a recreational drug. In my view, no drug should be labelled as recreational. I find
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the whole issue extremely worrying. It is extraordinary to think that my small six year-old son, who is showing great promise as a watercolourist, runs the risk of being attracted in his teens to something described as a "recreational drug".
This is a most complex subject, but I have enormously enjoyed listening to the debate. I had intended to refer to one or two other remarks that have been made but my time is now running out. I shall conclude by saying that the Government obviously have a responsibility in such matters and the Minister who is to reply responds very well to such issues under his responsibility for the arts. Obviously the arts form an important part of people's recreational lives. Leisure spent watching ballet, listening to opera, music, and so on, and visiting galleries is a most important part of our lives. The Government have a great responsibility in that respect.
I should like to end with a quotation from the father of my noble friend Lord Russell. The great philosopher said:
"To be able to fill leisure intelligently is the last product of civilisation".
I could not agree with him more. Indeed, one might study that remark. Surely it is the job of all of us as parents or grandparents to ensure that those within our responsibility fill their leisure time with intelligent activity. It is also a responsibility of the Government to encourage the nation as a whole to view leisure time as a time in which they can realise themselves in a profitable way.
7.9 p.m.
Baroness Anelay of St. Johns: My Lords, I should also like to congratulate the noble Lord, Lord Walpole, on introducing the debate with such expertise and good humour. That goes well in this first week of our new approach to work, although I am not sure whether noble Lords would define it as such, given the definitions of leisure put forward earlier. Perhaps the work of all those Members of your Lordships' House, except those on the Government Front Bench, is leisure time, as other noble Lords are not paid. However, we shall have to discuss that issue on another occasion.
"The cost of idleness and boredom is incalculable, yet the reward for giving people a real chance to shape their community is immense".
That is a statement by the National Playing Fields Association. I declare an interest as I am an appeal patron of its millennium appeal. It is a statement with which I wholeheartedly agree.
Some might argue that it is misguided, even pretentious, to treat hobbies, recreation and sport as serious and important matters. That is not so, as they affect vast numbers of people, as we have heard during the debate today. Many people now spend more time at leisure than they do at work, and research shows that leisure can have enormous consequences not only for our happiness but also for our health, longevity and mental stability. I wonder whether the good health and great age enjoyed by so many Members of your

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Lordships' House is because Members participate in such a diversity of leisure activities, as has become apparent during the debate this afternoon.
This debate about the use of leisure time goes to the very heart of the debate about the nature of society itself and about how society should function. I propose that it is the role of government merely to create the conditions in which individuals can flourish, exercise choice and seize opportunities. Government should not direct behaviour. Government have an enabling role. The Department for Culture, Media and Sport is ideally placed to enable individuals to exercise choice throughout their lives in their enjoyment of the arts, tourism, education, sports, media and recreation in general. This is a particularly relevant topic for debate in modern society where the perception of one's identity by others is so often determined by the answer to the question, "What do you do?"
This is also the age in which people have more free time at their disposal than at any time since the Stone Age. We are assured by social scientists that there will be much more of it too as people live longer after retirement, and computers and automation do more of the repetitive work. I listened with interest to what the noble Lord, Lord Haskel, had to say on that matter. Certainly government statistics released in the previous Session indicate that in the future there will be more leisure time as a result of the increased use of computers and automation. The proportion of people's incomes that they need to spend on the basics of life is declining. The British now spend more on leisure and tourism than on food, rent and their community taxes combined.
The extended leisure time that is now available should be seen not so much as a problem but more as an opportunity. I listened with interest to what my noble friends Lady Sharpies and Lord Rowallan had to say about the importance of making time for leisure and also about making the most of that time. I certainly listened with interest to what my noble friend Lady Sharples had to say about the importance of using the facilities of this House with regard to the gym. I promise my noble friend that although I have not yet got there this new year—as is evidenced by my girth—my new year's resolution is to climb the 53 stairs to my desk on the second floor rather than use the lift. So far I have managed to keep that resolution but we are only three days into this year's Session. We shall see what happens.
It is certainly important to use our leisure time to enjoy and to improve ourselves intellectually—whether that is through lifelong learning or through using the Internet—physically, through sport and exercise, emotionally, socially or materially. Indeed voluntary work can be used as a bridge into paid employment. That has been the experience of the national citizens advice bureaux. I declare another interest as president of my local CAB—that is, of course, a non-pecuniary position—which has a strong tradition of enabling people to find a way back into employment, or into employment for the first time, by providing strong interviewing skills and IT skills.
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I argue that overall the key to making a success of any leisure activity is to make everyone feel welcome to participate. Inclusiveness is not merely a matter of abolishing entrance fees or the costs of getting into leisure activities, nor of trying to force owners of private museums to provide free or cheap admission. That may be part of the process if one believes what the Government have to say about that. I may disagree on that matter but I believe that inclusiveness involves including all kinds of people in activities and welcoming them whatever their age or physical or mental ability and whether they are elderly or young.
Those who run Welsh bowls have long been at pains to point out that theirs is not an old man's game or an old woman's game. We should congratulate the organisers of the Welsh under-25 women's indoor international championships. They have included in their team Rebecca Shore, who celebrated her ninth birthday in November 1998. She will be surrounded by a clutch of other girls who are still at primary school. The Shore sisters ventured down to the bowls club at the invitation of their maternal grandparents and have subsequently persuaded their paternal grandparents to take up the game for the first time. The telling comment of the family was, "We found the club very welcoming".
I appreciate that including children in sports clubs is good business and an investment for the future, but it depends strongly upon the good will and activity of their parents as participants or organisers. The NIKE research entitled, "If You Let Me Play", points out that:
"The most exemplary role models of all are parents. US research suggests that fathers who participate in sports increase daughters' sport participation by 11 per cent. and mothers' sport participation can increase daughters' sport participation by 22 per cent.".
I wish that in future when people compile research they might make it easier for me to read it out! That quotation was something of a tongue twister.
I pay tribute to the legion of parents who give up their own leisure time to ensure that their children benefit from access to leisure activities, whether it is by spending two hours on a wet, cold day marking out football pitches with hydrolysed lime and hoping that it does not wash away before the match takes place, or, more commonly, by ferrying their children and others to and fro, whether it be to matches or to museums. I also pay tribute to voluntary organisations and the vital role they play in promoting social inclusion, especially in inner cities.
The National Playing Fields Association launched its millennium centres project to provide a series of community facilities rather like village halls in high density urban areas throughout the UK run by the community for the community. By next year there will be 10 centres across the UK from Glasgow to Hackney. Noble Lords will also be familiar with the work of the NABC for young people. It is one of the largest, longest established national voluntary youth organisations in the United Kingdom. It is a club and activity based organisation supporting over 2,000 affiliated clubs serving the needs of more than 350,000 young people. Even though the participation of girls and young women is relatively new to that organisation, they already form over 30 per cent. of the membership. Its diverse

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programme of youth work helps its young members take their place in society as responsible citizens, whatever their ability, having realised their full potential. The work of such organisations is surely invaluable to the welfare of society now and in the future.
But what of the future? When the children born in the year 2000 grow up, what can they expect? Current forecasts suggest that when they retire at about the age of 55—that will be the normal retirement age, not early retirement—they will have about 35 years of full-time leisure ahead of them. How they, and we, use our leisure will become more and not less important.
In the meantime what should be the task of the Opposition in debates on such matters throughout the remainder of this Parliament? I believe it is proper for the Opposition to examine whether government activity is promoting or hindering individuals' opportunities to make effective choices in their use of leisure time. For example, how does government activity affect levels of unemployment? My noble friend Lord Cowdrey spoke with great sensitivity and insight about the impact of unemployment on individuals and the importance of their establishing a sense of self-esteem.
It is important for us to ask whether the Government are intervening in private lives in an inappropriate way. It is right that we should apply these questions as a litmus test to examine government legislation across a whole range of government departments. Of course we shall first focus on the work of the DCMS. My noble friends have referred to matters which will be covered by other departments, such as the DETR. My noble friend Lord Mersey spoke with great expertise about the problems that may arise as a result of introducing a right to roam. However broad the task, I assure the House that I and my colleagues look forward with great relish to taking part in it.
7.20 p.m.
Lord McIntosh of Haringey: My Lords, while expressing gratitude to the noble Lord, Lord Walpole, for introducing the debate and to all those who have taken part, I must confess that I approached it with a certain degree of trepidation. That was not just because of my doubts about my own abilities in this matter, but because the noble Lord saw fit to include in the Motion a reference to the pressures and problems caused by increased leisure. I was afraid that I should hear a whole series of moans about pressures and problems, and was hoping to respond in a different way by being somewhat positive and upbeat. But I have not heard much in the way of moans. Everyone has been pretty upbeat about leisure and the opportunities it introduces. I invite the noble Lord, in withdrawing his Motion, to consider whether he ought not to have amended it first and included a more positive form of words, more appropriate to the debate that has taken place.
I was afraid that we should hear modern day repetition of what the distinguished composer and conductor, Constant Lambert called "the appalling popularity of music". I think he meant a lot more than the noble Lord, Lord Gladwyn, in his passionate plea for more silence. Of course, Constant Lambert was
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talking about the ability to record and amplify music. But he was talking much more about a characteristic of the 20th century.
Those who take up minority activities and enjoy them turn very sour when they find a large majority of people taking up the same activities. They remind us that it used to be fun to drive around the roads of England in the 1930s, when there were very few cars, and indeed on the roads of Ireland in the 1980s when there were few cars. They deplore, as Constant Lambert deplored, the fact that that hoi-polloi take advantage of those activities that are really the preserve of the aristocracy. But we have not heard that in the debate, and that has been very nice. I am grateful.
In the Department for Culture, Media and Sport we see the use of leisure time as a measure of the quality of life in this country, both for individuals and for society as a whole. I was grateful to the noble Viscount, Lord Falkland, for quoting Bertrand Russell on that point. Perhaps I may in turn quote Bernard Shaw, who said of amateur leisure that if a thing is worth doing at all, it is worth doing badly. That is one of my favourite anti-aphorisms. It is clearly a measure of quality of life. The possibility of creative and enjoyable leisure is one of the objectives of education and social change.
Although many government departments are involved in the subject matter of this debate, the Department for Culture, Media and Sport is concerned with the cultural, sporting and creative life of the nation, as well as with tourism. I deliberately mention the two together. It is interesting that the debate has been much more about tourism and sporting activities than about some of the cultural and creative aspects of leisure to which I was prepared to respond but now do not have to. Nevertheless, all of those are reflected in the principles that the department set out as a result of its departmental spending review: first, that there should be access for the many and not merely the few—I shall come to the upsides and downsides of that in due course; secondly, that there should be the pursuit of excellence and innovation; thirdly, that we should always be aware of educational opportunities; and fourthly, that there should be a fostering of the creative industries.
In setting out those principles I acknowledge that the noble Baroness, Lady Anelay, is right in saying that, fundamentally, the role of government is an enabling one. It is not for government to create leisure activities; however, it is certainly its role to make sure that they exist and flourish.
There is a strong economic case for the effective use of leisure. The economics of the tourist industry are well known. However, perhaps I may briefly mention the economics of the creative industries, which have only recently been mapped by my department.
In pursuit of the objectives of the department we achieved at the time of the spending review an increase in resources—taxpayers' money—of £290 million over the next three years for the Department for Culture, Media and Sport alone. Of course, there are many ways in which other departments, for instance, the Department for Education and Employment and the Department of the Environment, Transport and the Regions, are contributing to the enhancement of leisure.

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I shall not be tempted into definitions of leisure. I rather liked the first provided by the noble Lord, Lord Walpole, but then it was built upon by the noble Lord, Lord Addington, and the noble Viscount, Lord Falkland, to such an extent that I thought I had better leave well alone. There were many ostensive definitions, with speakers giving surprising listings of activities that should be included under the heading of leisure. Allotments was one, and I entirely agree. I thought that the noble Lord, Lord Beaumont of Whitley, was suggesting arson as a leisure activity, but the noble Lord was taken up on that by only one other noble Lord, who volunteered to undertake that form of leisure! Certainly a number of speakers, including the noble Viscount, Lord Mersey, and the noble Lord, Lord Rowallan, mentioned the importance of walking. The noble Lord, Lord Rowallan, seemed to think that it was in decline. In statistical mode, let me reassure him that there were 400 million walks taken last year by 15 million regular walkers. I do not think that walking is in decline at all. I shall come to the points raised about rambling by the noble Viscount, Lord Mersey, shortly. If we can be given such examples as silversmithing by the noble Lord, Lord Broadbridge, and the avoidance of exercise by the noble Lord, Lord Addington and the noble Viscount, Lord Falkland, then we are reasonably in agreement about the matters that will be covered.
My first duty, given the weight of the debate, should be to mention tourism. I wish briefly to refer to the organisation of tourism. I was asked specifically about the English Tourist Board. The board will continue as a strategic tourist body which will be responsible for a national framework, including in particular standards in tourism. Tourist services will be delegated to the regions and the regional development agencies. The Department for Culture, Media and Sport will have representatives in each of the Regional Government Offices. More funding for tourism will go direct to the regions.
I realise that that is a small step to the "Europe of regions" that the noble Marquess, Lord Bath, is looking to see. I also realise that that does not resolve the problems of boundaries to which he referred. It is true that economic regions are not necessarily the same as tourist regions if one is doing what is technically described as destination marketing. However, I hope that he will feel that even that small step is worth while.
At the same time, when talking of the reorganisation of tourism, I wish to pay tribute to the work of local authorities referred to in the debate and to the work of the voluntary organisations mentioned by the noble Lord, Lord Walpole, the noble Baroness, Lady Anelay and others. Our tourism strategy will be published later this year, probably in the summer. It already has broad objectives which it is worth setting out briefly. We hope to encourage career opportunities in tourism, access to tourist activities for families, the elderly and disabled people and those on low incomes. I say that in response to the noble Lord, Lord Addington. We look for better information about tourist activities, in particular about the sustainable development of tourism in the countryside. We look to enhance the quality of "tourist experiences" and to improve the support structure.
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The department includes a responsibility for both heritage and tourism together, which emphasises the importance we place on sustainable tourism. The objectives of government cannot be achieved if tourism is allowed to destroy the heritage. Up to a point, it is pure advantage. The more visitors we have, the more money becomes available. That can be translated into more and better tourist attractions, with the spin-off perhaps of more public transport in rural areas, better food and drink provision, more entertainment and more local economic activity.
It is true that stresses can take place and we are aware of that. It is why we shall publish our tourist strategy following our White Paper last year entitled: Tourism: Towards Sustainability. The Department of the Environment, Transport and the Regions will publish its own White Paper on a UK sustainable development strategy.
Before I leave the point, I say to the noble Marquess, Lord Bath, that I recognise his point about value-added tax and work on buildings. However, it has been a matter of public controversy for a long time and I have answered a number of questions on the point. We are constrained by our obligations to the European Community. VAT is the one area of taxation where the Community is able to tell us that certain changes will not be possible. I am afraid this is one of them.
I turn to rural matters. There will be a White Paper in the summer this year from the Department of the Environment, Transport and the Regions, as well as MAFF, about how existing policies can be directed towards sustainable rural communities, towards the development and regeneration of deprived communities in rural areas and towards conserving and enhancing the countryside. I was glad to hear from the noble Lord, Lord Walpole, that in his view problems of access have been somewhat exaggerated. However, either he or the noble Viscount, Lord Mersey, said that there was no need for the right to roam. Our attitude on it has not been changed by the fact that Mr. Gordon Prentice is proposing a Private Member's Bill on the subject. It is that we would prefer to achieve the right to roam by agreement with landlords. We shall only resort to legislation if agreement with landlords is not available.
I do not know the answer to the noble Viscount's question about motorbikes on bridleways. I did not expect it, but I will write to him on the subject. I do not entirely agree with him that it is undesirable to lose skill in walking in the countryside. Those who wish to walk around the estate of Mr. Nicholas van Hoogstraten, such as neighbours of his in Sussex, might find some of the difficulties he places in the way of walkers. The Open Spaces Society, if not the Ramblers' Association, are determined to overcome them.
Viscount Mersey: My Lords, perhaps the noble Lord will allow me to say that I in no way wish to associate my views with those of Mr. van Hoogstraten; he is breaking the law by blocking footpaths.
Lord McIntosh of Haringey: My Lords, I am grateful for that observation. I should love to follow the noble Viscount and talk about Wainwright and

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long-distance paths but time will not permit it. However, even though there has been little reference to it, I wish to say a word about the creative industries. Our mapping exercise is the first that has ever been conducted about the economic and cultural significance of the arts, design, music, the media and publishing. It has produced quite startling results. Sixty billion pounds worth of activity in the economy is generated by the creative industries; £8 billion of exports, which is 16 per cent. of the global market for exports of the creative industries; 1½ million employees are involved. Employment in the creative industries is growing at 5 per cent. a year.
It is something to which we have for the first time given the searchlight of government attention. We have set up a cross-departmental or "joined up"—I apologise for the jargon—Creative Industries Task Force. It will look at a sectoral approach to the need for government intervention in encouraging exports, in providing finance for creative ventures and in dealing with issues of intellectual property.
There is a link which I do not wish to neglect from that subject to education. It has been properly a theme of the debate this evening. We are determined to promote lifelong learning. I must emphasise that the lifelong learning we wish to promote is leisure learning as well as vocational learning. I do not remember who criticised Schedule 2 to the education Act 1988 but that Act allowed the Further Education Funding Council to fund leisure courses as well as vocational courses. I believe my noble friend Lord Haskel mentioned it. We do not need to abolish Schedule 2; we have already taken the necessary steps.
We have an education unit within the Department for Culture, Media and Sport. We are concerned to raise standards of cultural education and training in schools and places of learning. I entirely agree with those who say we must start in the schools. I know it was suggested in reference to sport, but we must encourage those working in creative leisure and sports activities to strengthen lifelong learning and fight social inclusion.
In the limited time available, I can speak only briefly about sport, then I shall say a word about social inclusion. Those were themes of the debate.
It is clear that we recognise the enormous importance of sport—especially participation rather than spectator sports—in the spectrum of leisure activities. We value sport not only for itself but also for the contribution it can make to social cohesion and what it can do in particular for young people in taking them away from the disadvantages of living in deprived neighbourhoods. We have already taken serious steps, of which I can pick only one or two; for example, the protection of school playing fields. If any school wishes to sell its playing field, it must obtain the Secretary of State's permission before that can be done, rather than, as in the past, simply considering commercial factors.
My honourable friend Tony Banks, the Minister for Sport, heads a policy action team which is dealing with school sport in particular, sport and art as a means to combat social exclusion.
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Let me say a word about the cost of gyms. I understand that the Westminster Gym costs £300 a year; the gym at the Department of Culture Media and Sport costs only £15 a year. It may be that I should not have said that; there might be some tacit subsidy going on somewhere, I do not know. But what noble Lords have said is entirely right.
What noble Lords have said about the theme of unemployment—and the noble Lord, Lord Cowdrey, was particularly eloquent on this point—is enormously important. We do see arts, sports and leisure activities as a whole as being very important in neighbourhood renewal. Our plan for a new deal for communities, which has been allocated £800 million over a three year period, is directed particularly to that. We have set up 17 pathfinder districts and we have a sure start programme for young people in deprived neighbourhoods, which includes provision for childcare, primary health care, play, sport and support for families. My reference to communities brings me back to what was very wisely said by the noble Baroness. Lady Anelay of St. Johns.
This has been a very positive debate which has covered a lot of ground. Much of it—like noise levels—was entirely unexpected and, I am afraid, has remained unanswered. I hope that I have said enough to indicate the passionate concern of the Government for a good resolution of the issues which have been raised in the debate this evening.
7.41 p.m.
Lord Walpole: My Lords, I would like to thank everyone who has spoken in the debate. Having introduced the subject, once I sat down I really enjoyed the debate.
The Minister has not told me what I am going to do. Has he forgotten my last question?
Lord McIntosh of Haringey: My Lords, this is an enabling government. I would not dream of being prescriptive.
Lord Walpole: Thank you.
My Lords, there were some interesting and surprisingly varied speeches. I would like to thank everyone individually but that would take too long.
I will say, quite honestly, that I have two disappointments. I shall not put them in any order of importance. I am sorry that the noble Lord, Lord Haskel, did not mention anything about cycling; I am also sorry that the Leader of the Opposition, who was some form of a Minister in a previous government, did not come and speak today. I thought he looked extremely nice as a Minister for tourism when he was bouncing around in various things in the early 1980s.
I thank all noble Lords very much indeed. I thank the Minister for the answers he has given. I asked quite a lot of questions and I think I got the answers. If, having spent nearly 10 years in this House, the one thing I do achieve at the end of this debate is to get departments talking to each other and realising that the decisions that individual departments make have an enormous effect

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on other people, I feel that I may have achieved something. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.

Hospital Disciplinary Procedures
7.43 p.m.
Baroness Knight of Collingtree Baroness Knight of Collingtree rose to ask Her Majesty's Government whether they will consider the case for changes in the procedure to deal with alleged disciplinary misdemeanours by hospital doctors or consultants, particularly to speed up the process.
The noble Baroness said: My Lords, the situation I raise tonight causes gross injustice. Hospital doctors in Britain today can be suspended from duty and locked out of their hospitals without being told why. They can be left on the rack for months or years with no appeal. Sometimes they are not even informed when an innocent verdict has been reached. Their rights to justice, as defined in international human rights laws, are totally ignored.
Sometimes patients also suffer, not only because of shortages of staff, but when the suspended doctor is the only one who can give a specific treatment. I have at least three letters on my desk at the moment pleading the cause of these particular patients.
I certainly do not support doctors who behave wrongly, incompetently or unprofessionally, but of the 201 doctors suspended since 1986 only 25 have been judged to have acted wrongly. Of the 176 others, some had to wait years to be found innocent; others had to wait for many, many months—but every single one of them has suffered. Make no mistake, suspension in these circumstances involves very great suffering.
Some 13 years ago a resident in my former constituency came to my surgery. She told me that her husband, who was a consultant at the Queen Elizabeth Hospital in Birmingham, had been suspended some 18 months previously and sent home on full pay. She wept as she told me that both she and her husband felt it immoral to take money which had not been earned. And yet bills had to be paid; there was no other source of income and the doctor could not earn money elsewhere as a doctor.
Added to that, suspension has a devastating effect on honest professional people who have status and reputation in their area. Friends, neighbours, acquaintances and, where there are children in the family, even schoolfellows get to know all about it, and a heavy cloud of suspicion and shame hangs over the whole household.
After seeing that poor lady, I contacted the health Minister and the local health authority. I am afraid that little or nothing was done. Two and a half years after that man was suspended he was found to be totally innocent of all the charges against him. But by then his wife had died. I believe that her death was directly
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caused by the stress, worry and upset that she had to undergo. I have never forgotten that lady. I often remember her with shame.
The injustice of that case has been duplicated many times, and it is still going on. What often amazes me is the triviality of the charges made against the doctors. One consultant was suspended because he wrote a repeat prescription for his ward sister. Another one tidied up his patients' files and, in order to slim them down a bit, he took out several of the notes that he himself had made on the many, many visits the patients had made because those notes were repetitious. That was sufficient—he was suspended and accused of wrongdoing. A third consultant, with full official consent, had helped with a charitable appeal for funds for a piece of equipment which was needed in the hospital. His crime was that he actually spent the money which had been raised on the equipment which the hospital needed.
There are scores of instances. I have not the time to mention more than very few. I will mention one more. It concerns a doctor accused of over-claiming for petrol which he had used on official duties. The whole machinery was involved and he was suspended. Finally, checks were made which showed that, far from over-estimating, he had substantially under-estimated the petrol that he had used—in fact by several thousands of pounds. Of course, the local health authority then had to pay the money back—and quite right too.
The situation that I have described costs the health service millions of pounds. Consultants do not come cheap. All consultants who are suspended get full pay throughout the months or years of their suspension. One estimate I have seen calculates that it has cost the taxpayer at least £100 million, not only in salaries that are being paid but in the cost of the inquiries. Expense is involved in setting up panels of inquiries that comprise three people who act as judges. Sometimes compensation or damages are paid because, quite understandably, some doctors sue.
Guilty doctors must be dealt with, but there is no doubt that a great deal of public money, that could be far better spent on patient care, could be saved if settlement was expedited. Whether the doctor is innocent or guilty, the procedure should be speeded up. I do not argue that inquiry should not be made, but a process that may extend over years and years is far too long.
For 13 years I have been raising this matter in letters to Minister and others, in debates in the other place and in parliamentary Questions. I have also taken delegations to see Ministers. There has been a small improvement but cases drag on and too many quite unnecessary cases are brought. The BMA has written to me twice since the announcement of this debate. Its second letter, which I received only on Monday, gives a glimmer of hope. The BMA is making proposals to the Government to alleviate the situation. I know not whether those proposals will bear fruit. Will the new National Health Service Bill help? Perhaps the noble Baroness, in replying, can tell us something about that.
Some doctors pin faith on the Human Rights Act passed by Parliament last year. They may be right to do so but I am not very optimistic. New rules will certainly help if they are adhered to, but some that are already in place are ignored. For example, I understand that where professional incompetence is alleged there must be at least two doctors on the panel to judge the matter. I know of one current case where that rule is being flouted, and there may be many others. Who checks who is on the panel? Is it right that the health authority that normally brings the case also selects the panel to judge it so that the accuser is both judge and jury? That is positively Gilbertian. Justice may or may not be done but in such circumstances it certainly is not seen to be done.
Surely, there should be a rule that any such panel must inform the accused if he is found to be innocent. One doctor believed that he was still suspended and was forbidden to enter his hospital nearly nine months after the panel had acquitted him of all charges. Nobody told him. That cannot be right.
Another worrying aspect is that suspended doctors are normally forbidden to enter the hospitals in which they work. That is usually their local hospital. If they become ill—many do given the pressure on them—they cannot be treated in their local hospital. One consultant was treated and as soon as that was discovered he was packed off elsewhere neck and crop. I do not know whether or not he got a bed. I believe that to be wrong. If a member of the doctor's family is in hospital that doctor may not visit that relative. I am aware of one case where a doctor's wife was dying of cancer in a hospital and he was not allowed to visit her. That is inhuman.
For a hospital doctor suspension is a terrible event. His present as well as his future is blighted. Obviously, it will be very difficult if not impossible for him ever to get back on the career ladder if he has not been practising medicine for a year or more.
Finally, I believe that the situation that I have described is in breach of human rights as defined in the UN Declaration and the section of European law that deals with this matter. I remind noble Lords that that section has been agreed by the British Government. These doctors enjoy far fewer rights than criminals in ordinary courts of law. Suppose that after a defendant has waited three years to have his case heard the stipendiary magistrate and two other lay magistrates listen to the evidence for five solid weeks and, because there is no case on which they can convict him, they adjourn the matter and then personally go off to seek further evidence which they hope will be sufficient to convict. Let us suppose that after that nothing further is said and the case continues to this very day four and a half years after it began. However black his crime, no criminal can ever be used thus in a British court, but that has happened to a hospital doctor whose case remains unresolved.
I hope that I have made a case for these ill-used men and women and that your Lordships will agree that the procedure must be overhauled and speeded up because the present situation is intolerable.
7.57 p.m.
Baroness Kennedy of The Shaws: My Lords, I hope that it will be recognised that the noble Baroness raises an issue of substance tonight. She has highlighted the current problems in the disciplinary procedures operated by our hospital trusts. It is right and proper that all professionals should be subject to scrutiny in the performance of their role. It is in the public interest that the highest standards are maintained. It is the duty of the Royal Colleges, professional organisations and hospital trusts to ensure quality of performance. However, the current procedures are ineffective in producing that outcome.
We all want to see bad doctors removed from harm's way, but doctors are being suspended for reasons other than their medical competence. Very many of the cases that come before the panels described by the noble Baroness relate to matters that are totally unconnected with medical competence. Too often, complaints and subsequent suspension derive from all kinds of friction between members of staff, from personal clashes and for other reasons that can be dressed up as harassment and so on. That may mean that the very people from whom we want to protect patients are not subject to discipline, but that those who are competent are subject to unacceptable processes.
Why do the procedures not deal with incompetent doctors? I suggest that there are inadequate review procedures of clinical competence and inappropriate appraisal systems. There is no central procedure to review skill and ability. With respect to the colleges, I believe that self-regulation has not quite got to grips with those problems.
One of the difficulties is the unwillingness of doctors to point out the incompetence of colleagues; yet the best people to judge the skill of a medical practitioner are his or her fellow practitioners. It is sometimes only when the failings become truly gross that doctors steel themselves to act against a colleague.
I have recently had drawn to my attention the case of a consultant who called into question the conduct of a younger colleague. He was concerned, among other matters, about her wearing of earphones in the operating theatre so that she could listen to music on her personal stereo; yet he, having raised that issue and others relating to her conduct, ended up being the one suspended.
My concern is that trusts can suspend without full disclosure of the case against the doctor. There are also no time constraints on the delivery of the details of the complaint. It is therefore difficult to get legal advice to rebut the case before an outcome. This offends profoundly against the principles of natural justice. The doctor is not entitled to representation before a trust panel. There is no agreed national procedure and therefore trusts can deal with complaints in very idiosyncratic ways and by internal procedures. Where a trust is acting against a doctor, which it can do within six months and it can suspend a doctor for periods which are often very much longer, because the procedure is an internal one there is no person from outside the trust on the panel. As the noble Baroness, Lady Knight.

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indicated, this can mean that the complaint coming from the trust is heard internally by members of the trust. There are unconscionable delays, as the noble Baroness indicated, from months to years, and there are no rights of appeal.
All these matters fly in the face of the principles of justice that we would expect in every other area. As a lawyer, unlike the noble Baroness, I imagine that these actions by trusts fly in the face of the Human Rights Act which will come into force next year and I expect that there will be many hearings before our courts calling into question the acceptability of such procedures. It seems to me that this is an opportune time for the Government to put in place national guidelines and proper procedures which adhere to the principles of the Human Rights Act.
The effects of such hearings on the lives of doctors who are eventually cleared of any failure on their part are considerable. It does not take much to imagine the effect. Stigma can often remain, even though a person has been cleared. There is always the horrible business of people imagining that there can be no smoke without fire. Career momentum is interfered with when many months out of action can be involved. The stress is considerable and is felt not just by doctors, but also by their families.
The cost to us, the community, is also considerable, in precisely the way that the noble Baroness outlined, not just financially but because in many cases we then lose the performance of able and committed practitioners.
We are talking about something substantial: the existence of procedures which are unacceptable. Although it is right that there must be ways of bringing to book people who behave badly within the professions and that that should be done with alacrity, it is only right and proper that doctors, like everyone else, are given the opportunity of having the case put before them clearly and of defending themselves, that that is done with speed and that they are able to have proper advice as to the conduct of such hearings. It is also right that at an early stage when a complaint has been made they should be allowed to have an independent adviser with them at any disciplinary step.
I hope that, on hearing these concerns, the Government will put proper procedures in place with speed before the Human Rights Act comes into force.
8.4 p.m.
Lord Colwyn: My Lords, I too should like to thank my noble friend Lady Knight for asking this Question this evening and to congratulate her on her persistence with this subject. In view of the extensive publicity given to medical problems recently, her timing is perfect and I hope that it will give the Government a chance to clarify the position and assure the medical profession that there is not a national campaign against consultants and doctors.
I should declare an interest in that I am a council member of the Medical Protection Society, which provides indemnity for tens of thousands of doctors in
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this country and all over the world, and chairman of Dental Protection, which looks after over 40,000 dentists worldwide.
The medical profession is—and I am sure, will remain—subject to more systems of accountability than any other. One clinical incident may give rise to investigations under the NHS complaints and disciplinary procedures, perhaps including the health service commissioner, a coroner's inquest, a clinical negligence claim, a General Medical Council inquiry, a criminal prosecution and, if the doctor is in the Armed Forces, a court martial. The Secretary of State repeatedly tells us that the vast majority of health professionals are doing a good job, often in difficult conditions. It is the responsibility of all of us to ensure that those circumstances are not more difficult than they need be. In the wake of the recent Bristol inquiry, the Secretary of State for Health, the right honourable Mr. Frank Dobson, appeared on the television programme "Newsnight" to say that, in his view, all three surgeons should have been struck off the medical register. Leaving aside the effects of this injudicious comment on Mr. Dhasmana—he was the one surgeon whose name remained on the medical register—and the doctor's employment difficulties, Mr. Dobson's comments appear to have precipitated a rash of suspensions, special leave and other euphemistic alternatives for enforced absence from work.
In employment law suspension is meant to be a neutral act, but when a doctor is suspended his colleagues and the rest of the hospital staff inevitably discover the fact soon after his departure. As the noble Baroness, Lady Kennedy, said, believing there to be no smoke without fire, the doctor's reputation is already tarnished. The news is likely to reach patients and the press, where coverage damns the doctor's conduct before any investigation has commenced, let alone concluded.
Doctors should be suspended from work only when patient care is jeopardised. Periods of suspension must be minimised by ensuring that the doctor concerned is immediately informed of the reason for suspension and given access to all documents on which the trust relies or that are necessary for preparing the doctor's defence. A timetable must be agreed, rather than imposed, as soon as possible. Following assessment—and assuming, as is usually the case, that the doctor will return to work—return to work must be properly managed. Colleagues must be made aware of their own responsibilities to facilitate the doctor's return.
The current zeal for suspending doctors from their work, often for considerable periods, militates against the efficient running of the National Health Service and the public interest by diverting funds from patient care to payment of legal costs and, in some cases, payment of compensation. Furthermore, it lowers the morale of the medical profession—already at a low ebb due to resource shortages—further exacerbated by suspensions.
But the rash of suspensions is just one way in which doctors are being treated unfairly. Last week, two junior hospital doctors who had been working at Great Ormond Street Hospital were acquitted of the manslaughter of

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Richie William. Richie's death is a tragedy. His family, and in particular his mother, have, I am sure, the deep sympathy of this House and the entire nation. The headline in the Daily Mail the following day read:
"Shameful—Hospital blunders killed this little boy but these doctors won't say sorry".
A photograph of the two doctors was also featured on the front page. The facts of the case were set out in detail in court. It was reported that Richie's death was considered to be due to a number of procedural problems within Great Ormond Street and in fact no criticism was made of Dr. Murphy at all. Yet in a factually inaccurate report, the Daily Mail took it upon itself to castigate the doctors. Like lawyers, politicians and anyone else one cares to mention, doctors make mistakes. The nature of their work means that those mistakes may result in permanent injury or death; and, should a doctor be at fault, that doctor must live with the results of that error for the rest of his or her life.
Morale in the medical profession is low. The time has come to replace the rhetoric with action and educate the public, and those who manage the NHS, away from the current blame culture to more realistic expectations and the creation of a more supportive environment in which doctors can care for their patients without constantly having to look over their shoulder. Doctors must be accountable, but there is no point in allowing investigations to linger on for interminable periods, undermining the efficient delivery of healthcare.
8.10 p.m.
Lord Rea: My Lords, I, too, congratulate the noble Baroness on her persistence in beavering away over the years at this thorny problem. In all cases, as all noble Lords have said, whatever the outcome, to be suspended has a serious and lasting effect on the career of the doctor concerned. Although suspension is supposed to be a neutral act and not a disciplinary procedure, there is a natural tendency to regard it as an accusation of some wrongdoing which has a basis in reality.
Although the noble Baroness's Question applies particularly to medical staff, many of the points she raised could well apply to the suspension of other professional staff in the National Health Service, in particular nurses. Although I do not have details of cases against nurses and suspension of nurses, the position could well repay scrutiny.
At the outset I should say that as a doctor I am perfectly well aware that the work of some in my profession is not up to standard and that action needs to be taken to remedy that. The noble Lord, Lord Colwyn, mentioned the Bristol case; and during our discussion we must bear in mind all the points he raised. However, I am also aware that the Government are not satisfied with the current situation of disciplinary procedures in trusts. In October they announced that they were undertaking a review of the procedures. I am not clear whether that review is now under way. Perhaps the Minister can give us a progress report and, even if the review has not started, perhaps she can tell us what the remit of the inquiry will be and how the Government are intending to conduct it.
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It might be helpful to mention some of the points raised by the BMA's Central Consultants and Specialists Committee—the noble Lord, Lord Colwyn, referred to it—as matters which should be considered by the review. I quote directly some of the comments made by that committee. The first is this:
"Suspension … should be seen not as an automatic response to a problem, but as a step to be taken only when other possibilities have been considered. For example the doctor might well agree to cease certain areas of work during an investigation"—
but carry on in other areas. Secondly,
"There is a need for uniform and clear criteria on when suspension is or is not appropriate, for example when patients are clearly endangered"—
as the noble Lord, Lord Colwyn, said—
"or when investigation would otherwise be seriously hindered".
The third point is this:
"There is undoubtedly a lack of expertise in many trusts on the handling of such issues, and there is a strong case that medical directors and/or chief executives should be required to seek advice"—
that is, outside the trust—
"before taking unilateral action. It might be possible for example to establish central or regional units within the NHSE, which would be the repositories of the kind of experience and knowledge previously held by Regional Medical Officers, when disciplinary matters were handled at region before 1990".
The committee believes that,
"there is a strong case for a return to national guidance on disciplinary procedures, which would … bring greater uniformity and fairness to the handling of these problems".
The committee continues that,
"There is a need for readier redress for doctors whose cases are mishandled by employers … land for those] subsequently exonerated compensation should be automatically available.
When problems are identified facilities for remedial action need to be more readily available and more widely understood. Retraining in particular is an area which has hardly been developed".
And in a number of cases if such a system were in position there may well be no need for suspension. The committee states:
"The profession is aware of the practical difficulty involved in providing a supply of appropriately experienced external assessors who can be rapidly called in to advise. There may need to be a more co-ordinated approach to the provision of this service, which is currently handled in a piecemeal way by a variety of organisations. Employers must also play their part by releasing consultants to act in this capacity".
Here I assume that it means other NHS trusts, and possibly private employers. I should have thought that most unbiased people would accept those points as entirely reasonable.
It is not clear at present how frequently suspensions arise. The National Health Service only holds information centrally on cases lasting more than six months. On 5th October there were apparently only 11 cases still unresolved, according to a Written Answer by my noble friend. To my mind 11 cases lasting more than six months is still 11 too many. The noble Baroness, Lady Knight, has given details of the case of Dr. Bernard Charnley, whose case has taken more than four years to date. That may be a record; I am not sure. The BMA says that it is aware of 25 cases in England alone where it is playing a

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supporting role. There may well be others involving those who are not BMA members or who have gone directly to a defence organisation of which the BMA is not aware.
It seems to me wrong that each trust has its own procedures. In a national service, surely national procedures should apply. Trusts should not act arbitrarily. Giving them that power in 1990 was a mistake by the former government. Why do not this Government put that right?
I also feel that unless there is a gross error or very persistent clinical incompetence, suspension should be a last resort, as the consultants' committee says. If there were speedy procedures, with an outside, independent assessor, together with some system of remedial retraining and/or conciliation, not only would suspensions be less frequent, but some clinical staff might be guided towards better practice, and recalcitrant or over-zealous management could be guided into more constructive dialogue with clinicians at an earlier stage.
I take this opportunity to raise the issue of the so-called Henry VIII powers in relation to the profession's regulatory body, due to be introduced in the forthcoming NHS Bill. Has my noble friend any extra preliminary information she can give us about the contents of the forthcoming Bill?
I conclude with the remarks of the BMA, which states:
"While speedier processes would of course be helpful, a balance must always be struck between speed on the one hand and the need on the other hand to provide for rigorous examination of the evidence, representation of the parties and an appeals process where appropriate.
Dismissal of a consultant is an extremely serious matter which can effectively end a professional career, and it has always been acknowledged that the processes involved must be seen to be fair and legally robust".
8.19 p.m.
Lord Clement-Jones: My Lords, I add my congratulations from these Benches to the noble Baroness, Lady Knight of Collingtree, on raising this debate. It is not only extremely well timed. What was also impressive was her detailed examination of the disciplinary process and also some of the case histories that she went into. I must bow to the intimate and detailed knowledge which has been demonstrated in this debate by a number of your Lordships.
It is a difficult area. Changes clearly need to be made to the regulation of the medical profession and medical practice in the light of the Bristol case and the Ledward case; but, by the same token, there is great anxiety in the medical profession with changes coming down the track, especially when proposals such as the idea of individual naming and shaming by the Committee for Health Improvement are expressed by Ministers. There are some, and I do not agree with them—it is somewhat of an exaggeration—who have even written about a McCarthyite culture taking root.
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As has been clearly expressed today, a great deal of anxiety centres on the act of suspension by hospital managements. There is first of all the issue of cost. It has been put to me that the NHS spends something like £2½ million for every senior hospital doctor it finds guilty of misdemeanour. I find that a staggering figure. I am not sure whether it can be relied upon, but it has certainly been mentioned. One case in Wales which has been documented cost the NHS over £½ million pounds to determine.
It is not only the cost which is cause for concern, however, but the length of suspension. From the most recent figures which I have been able to obtain, between March 1995 and 30th September last year some 44 suspensions lasting for over six months have been reported. In one case it appears that suspension ran for 11½ years. Reinstatement becomes quite impossible after long periods of suspension. Huge personal distress is caused, in some cases leading to suicide.
One of the allegations made is that suspensions come first and investigation then follows. It is also alleged that premature suspension is becoming increasingly the case. The rate of suspensions appears to be greatly on the increase since the Bristol case, although there are as yet no hard figures. It is also important to ensure that formal suspension is not substituted by informal suspension, with the use of devices such as gardening leave, which also appears to be on the increase.
I welcome the Government's review announced in October, but I would echo some of the questions asked previously. Has that review body been set up? Who is on it? When is it planned to report? All those concerned with the current situation agree, however, that for a disciplinary process to be fair there needs to be new and clear guidance as to what first of all constitutes an offence justifying dismissal; what is professional incompetence; what should or should not be included in a tribunal hearing, and when suspension is appropriate. Above all, there needs to be a clear understanding that the rules of natural justice or due process must prevail. Your Lordships have mentioned the extremely important right to representation and advice, and also the issue of the selection of the disciplinary panel.
It is also alleged that the current system does not accord with the Human Rights Act. I was most interested to hear what the noble Baroness, Lady Kennedy of The Shaws, mentioned. Have the Government obtained legal advice on the subject of the Human Rights Act and as to whether current systems accord with it?
Is part of the problem now that local codes apply and not, as before, a national code of disciplinary procedure? In my view, the BMA does make a strong case for a single national code of hospital disciplinary procedure.
Other aspects also need to be considered as part of the disciplinary process. We need to make sure that there are proper mentoring arrangements, especially for

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younger doctors. There is a seeming conflict, for example, between one principle in the GMC's Good Medical Practice code and another. For instance,
"Doctors should do nothing to make any patient doubt a colleague's knowledge or skill",
yet there is a clear duty in the code to inform about colleagues who they believe are incompetent. Information about processes such as "the Three Wise Men" should be readily available in hospitals.
On the wider issue of the governance system, there appears to be somewhat of a tangle of regulation. There is the GMC; the National Institute for Clinical Effectiveness setting standards; the new Commission for Health Improvement providing external audit; monitoring for our performance tables; new duties on hospital trusts; the medical colleges, where the Academy of the Royal Medical Colleges is drawing up outcome measures against which performance can be assessed; the Audit Commission, which will still have a role in external audit, and the national service frameworks, which will be rolled out year by year.
I welcome this drive towards quality, but the Government need to ensure that there is clear guidance in order that the system is fair both for the patient and for the doctor. At the end of the day, we have to remember that the whole purpose of the disciplinary and quality framework is to ensure that quality is guaranteed in the health service and that public trust and confidence are restored and maintained for the individual patient.
It means achieving standards so that whistle-blowing is not necessary. It is not just about checking competence, but about making sure that at every stage quality improvement is achieved across the whole workforce and not just hospital doctors. Importantly, the disciplinary process and the standard setting process must mean that natural justice is not lost for the doctors who are involved. That is the clear message coming through this debate today.
8.25 p.m.
Lord McColl of Dulwich: My Lords, I too add my thanks to the noble Baroness, Lady Knight, for drawing our attention to this difficult problem and for persisting in her campaign. She is a great fighter for just causes.
From what has been said so far, it is clear that many health authorities are in a somewhat confused state on this issue. It reminds me of a number of soldiers wandering round in a desert, completely lost. They suddenly caught sight of a general. They rushed up to him and asked, "Do you know where we are?" He was angry that he had not been properly saluted, and so on, and replied, "Do you know who I am?" The soldiers said to one another, "We are in dead trouble now. We don't know where we are and he doesn't know who he is"!
One of the problems with the NHS is that it is a monopoly employer, so that if a consultant is suspended he cannot work. Even if he were in private practice, it frequently follows that the private sector also suspends that consultant. Not only is the consultant totally deprived of work; his income may be halved or more than halved. As has been mentioned, if a clinician is
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suspended, his skills soon diminish and his reputation too. If after several years he is completely exonerated, his practice is very difficult to re-establish. Having a monopoly employer has its disadvantages: it can be a rather unjust tyrant.
Some consultants have been suspended for as much as four years or even longer. This is totally unacceptable. What kind of justice is that? Furthermore, the question of compensation does not arise unless some litigation follows.
Some people are completely broken by the experience. It may quite literally kill them. It has long been known that people can die of grief, and this has now been scientifically established. Such is the trauma of unjust accusations and suspicions that the immune system of that person may be so severely impaired that they become susceptible to severe infections, and even to cancer, and may succumb. The noble Baroness, Lady Knight, has already given us an example of this.
The noble Lord, Lord Rea, quoted a figure of 11 outstanding cases. On this side of the House, we believe that that is a great understatement. I should be grateful to the Minister if she would enlighten us about that. It is probably a much greater number than that.
I too emphasise that if a doctor is incompetent and if he has done something to warrant suspension, clearly that must occur. It is quite unacceptable for doctors not to be accountable. It is reasonable to suspend a doctor if the employing authority genuinely feels that he is a danger to his patients. No one will argue with that.
So far in this debate we have not mentioned the private side, where the situation in many respects is even worse. There are no nationally accepted procedures in the private sector for dealing with complaints from patients and no accepted procedures for investigating a private practitioner's professional conduct or performance. There do not seem to be safeguards in place to protect patients or doctors in the private sector. Therefore, the only option available to private hospitals is to refer a complaint or concern to the GMC. Occasionally a private hospital may suddenly forbid a consultant to use its premises and need give no reason for so doing. The Royal College of Surgeons has been helpful in encouraging the private sector to accept one of its advisers to do a quick investigation into an alleged irregularity. That may later lead to a complaint to the GMC.
The Medical Defence Union has drawn attention to more than a dozen cases where the doctors have been advised by their senior partner, chief executive or medical director that they must not work or else they will be suspended. Others have been ordered to take study leave, special leave, sick leave or gardening leave, which sounds attractive at first sight. That is to enable undisclosed allegations to be investigated.
Not only are those investigations not spelt out, but those doctors were denied any of the other courtesies specified in the NHS Executive's guidelines HSG (94)49; for example, regular updates on the progress of the investigations. Some were kept in the dark for up to six months until they faced formal suspension and disciplinary proceedings. Others were

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asked to retire, not knowing what had precipitated the request. Others went back to work and were never told why they had been on leave. The Medical Defence Union's request for details of those allegations were refused on the basis that they were confidential. They rarely come to light because the doctors affected are reluctant to go public because they are, quite naturally, keen to co-operate as they believe that that is the best way to be exonerated. As the Medical Defence Union rightly said, a doctor who is prevented from working without specific reason is effectively condemned unheard. He naturally feels guilty until proven innocent. That is incompatible with natural justice.
We have dwelt at length on the injustice and the devastating effect which those procedures have on consultants, especially if they prove to be unfounded. But what about the enormous cost? Suspension on full pay for four years will probably cost the taxpayer as much as £0.25 million. That is a complete waste of money. Surely the procedure can be speeded up.
As my noble friend Lady Knight mentioned, a consultant who is suspended from a hospital is forbidden to visit the hospital. In industry, I can understand that an employee who is suspended should not be allowed to enter the building again because he may do commercial damage. Someone working in a situation where either industrial or military secrets were involved would naturally be excluded from the premises. But what is so secret and special about a hospital which should make it essential to exclude a suspended consultant from the premises and unable even to go to his desk?
Clearly what is required is a much more adult and just solution. Suspension is such a potentially serious matter that it should not be the automatic response to a problem. It should be taken only when it is clearly essential. If, for example, a consultant is criticised in the performance of only one type of operation, surely it would be reasonable for an agreement to be reached whereby that particular operation is excluded from his repertoire until the matter is sorted out. The noble Lord, Lord Rea, has already mentioned that.
We need clear criteria on which to determine whether suspension is appropriate; for example, when patients are actually endangered or when the investigation in the circumstances would be seriously hindered in the absence of suspension. It is clearly important that reasons for suspension are given to the doctor and that the continuation of the suspension be reviewed regularly. I agree with the BMA statement quoted by the noble Lord, Lord Rea. The British Medical Association has been absolutely right to press for speedier processes to sort out those problems.
The situation is getting out of hand and it certainly needs to be put right. I hope that the Minister will be able to supply the answer to that very unsatisfactory state of affairs.
8.36 p.m.
Baroness Hayman: My Lords, I too am grateful to the noble Baroness for raising this important issue. We have had a number of extremely well-informed and
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deeply-felt contributions. Perhaps it is appropriate for me to say at the outset that I do not underestimate the stress that suspension can put on an individual doctor and on his family and how that is felt particularly strongly in cases like those raised this evening when later it is found that there has been no wrongdoing on the part of that doctor.
Equally, the length of time that the process may take is unsatisfactory from everybody's point of view. While the stress and distress caused to the individual doctor has been the focus of most contributions this evening, noble Lords have also referred to the cost to the service, both in terms of payment to the individual doctor and the opportunity costs of service that is not being provided to patients. Therefore, there is a fair degree of unanimity in relation to that.
Perhaps I may restate the Government's policy that suspensions should not be used inappropriately. They should be used primarily when a doctor continuing to practice poses a danger to patients or where it is necessary to facilitate a quick investigation into serious allegations. As I say, it is essential that we look at making those suspensions quick. At the moment, some suspensions still last an unacceptably long time at a very great cost to the NHS and to the individuals concerned.
The noble Lord, Lord McColl, asked me about the figures. Because of the particular concern over the length of suspensions, cases lasting longer than six months are reported to the regional offices of the NHS Executive. Since 31st March 1995, a total of 44 cases of suspension lasting longer than six months have been reported. As at 30th September 1998, the latest date for which figures are available, 14 hospital and community medical and dental staff, including nine consultants, have been suspended for more than six months. That is based on the information which we request centrally but the review, to which reference has been made and about which I shall say more later, will undertake further fact finding to establish more exact figures because, as I say, at the moment, we have no figures available for suspensions lasting less than six months.
I should like to reiterate too that suspension is not a punishment; it should be used only as an essential tool to ensure quality of care and a level of protection to patients. The need to protect patients, though for obvious reasons it has not been uppermost in our debate tonight, is acknowledged and has been acknowledged by speakers. It must be at the heart of government responsibilities.
However, we must strike a proper balance between our responsibilities to protect the interests of patients with that of ensuring that doctors are treated fairly, humanely and with the minimum of delay. The current guidance to the health service aims to ensure that avoidable suspensions do not happen and that, if practitioners are suspended, it is for the minimum necessary period of time. But, of course, as contributions tonight made clear, there is dissatisfaction with the achievement of those objectives.
In answer to the specific question from the noble Lord, Lord Clement-Jones, as to whether current suspension procedures meet the human rights

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requirements of the European convention, the legal advice is that they do. But we are currently discussing with the General Medical Council the implications of the Human Rights Act on its procedures; NHS procedures, equally, will have to be compliant with the ECHR.
It was because of the recognition of the problems and concerns raised tonight that my right honourable friend, Mr. Alan Milburn, in October 1998 asked for a review of current procedures. I have been asked about the aims and remit of that review. It is to produce clear guidelines on when suspension is appropriate; to reduce the time that doctors are suspended before a decision is made; to avoid the issue to which the noble Lord, Lord McColl, referred—the unnecessary costs of long suspension—and to seek to strengthen local capacity to deal with complex cases. That issue was raised during the debate. It is not an outside and external review; it is being carried out internally, but will consider the evidence submitted to it. The BMA's contribution, to which reference has been made, will obviously be particularly useful in that area.
I am always nervous of giving a date by which reviews will be completed or announcements made. I certainly hope it will not be the length of time that some of the suspensions to which reference has been made tonight have taken and that it will be within the next few months.
Many of the issues raised are ones at which the review will have to look. As I said earlier, many issues need to be resolved: the grounds on which suspension is instigated; the information given to a suspended doctor; the issue of the composition of any panel; the timetable during which specific stages of the process have to be completed; and the issue of the perception of the problems that arise as a result of the body which undertakes the review being one that is appointed by the accusing body, the NHS employer. I do not say that that will be simple because some areas are quite complex; but they are the areas on which the review is focusing.
Reference was made to the lack of natural justice inherent in the current processes. The noble Lord, Lord Colwyn, referred also to the varying different processes to which a medical professional who is considered not to be performing properly may be subject. We must recognise that we have a primary duty of care to the patient; and that when a patient goes into hospital he or she needs to be properly protected and their health and safety safeguarded. It is an irony of the present tangle of regulations, to which the noble Lord, Lord Clement-Jones, referred, and to that variety of disciplinary processes that, despite them, we do not always achieve the high standards and public protection that we seek.
Baroness Kennedy of The Shaws: My Lords, can my noble friend say whether, in answering this Unstarred Question, it is her position that suspension would be wholly inappropriate in cases which involve personal differences between staff? It seemed to me that the Minister was saying that suspension should operate only where there is a risk to a patient or where patient care is involved. Therefore, issues such as those
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mentioned by the noble Baroness, Lady Knight, in opening, would not be appropriate for suspension; nor, for example would attempting to raise the standards of young colleagues and that creating some friction.
Baroness Hayman: My Lords, my noble friend is attempting to draw me into passing judgment on circumstances in specific cases where it would not be appropriate.
Baroness Kennedy of The Shaws: My Lords, in speaking to this matter the Minister said that the priority has to be patient care. No one in this House would disagree with that. But I ask again: is it right that that should be the primary consideration and that matters which are of a different order should not merit suspension?
Baroness Hayman: My Lords, I have to say to my noble friend that there is central guidance covering suspension on clinical matters. That central guidance makes clear, as I stated, the areas where serious accusations have been made which need quick investigation and where patient protection is essential.
I did not wish to be drawn because the grounds for thinking that those circumstances may arise can come from a variety of factors and I do not want to pass judgment on what may be individual circumstances. Guidance exists at the moment. I accept that it is not satisfactory, but on disciplinary hearings which cover non-clinical matters—this was a matter to which my noble friend Lord Rea referred—they are the same for all members of staff within the NHS organisation.
As I said earlier, it is important to see what we are attempting to do in this area and to differentiate suspension from a specific post by an employer from suspension from the register of the General Medical Council. A NHS employer can suspend a doctor from clinical practice only within the confines of the employment contract and while the specific allegation is investigated. Of course, that in turn gives rise to certain other problems, as the noble Lord, Lord McColl, pointed out and we perhaps do not have a satisfactory procedure in the private sector. He saw it as one side of the coin; I have to say that it also works the other way when people can continue to work in the private sector after being suspended for good reason and with good proof from the NHS. The message that that gives, particularly to me, is that it is absolutely essential that the mechanisms to deal with poor professional performance which are held by the General Medical Council, the colleges and other professional bodies, are integrated carefully with those of the National Health Service.
My noble friend Lord Rea asked me a little about the health Bill that will shortly come before Parliament. He is not going to tempt me into disclosing the contents of a Bill that is not yet published, but I think we have made it quite clear that we shall be looking to have order-making powers to enable us to update more effectively and more speedily the arrangements for professional self-regulation. I think that that will be to the benefit of the professionals and patients alike.

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The NHS procedures have not proved adequate to deal with the complex problems of professional practice and conduct which have emerged, and they need to be modernised. We recognise that, and my right honourable friend the Secretary of State for Health has asked the Chief Medical Officer to produce for consultation a set of proposals to address poor clinical performance, concentrating on presentation, early recognition and problem resolution. I think that that goes to the heart of some of the issues about there only being suspension and nothing else as a weapon with which to deal with concerns that need to be addressed but which do not need to be addressed in a way that means you take away someone's professional status and their way of working completely. We would envisage a retraining and
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differentiation of what sort of work is done as being absolutely appropriate and necessary for the protection of patients.
I hope that, in replying to your Lordships this evening, I have made clear that we recognise that there is a problem, and that we are taking firm action to produce solutions and improvements in the current system. However, I must reiterate that that has to be done as part of an overall commitment to improving the quality of care and protecting patients. The systems in place at the moment have not served either some suspended doctors or some patients well in the past. It is our responsibility to change them as part of the modernisation of the National Health Service and to ensure consistently high standards of care for all patients.
House adjourned at eight minutes before nine o'clock.