§ 3.9 p.m.
§ Debate resumed on the Motion moved on Wednesday last—namely, That an humble Address be presented to Her Majesty as follows:
§ "Most Gracious Sovereign—We, Your Majesty's most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty has addressed to both Houses of Parliament."
§ Lord Hunt of Kings Heath
My Lords, the Government, in the past three and a half years, have laid the foundation stones of a strong economy with high and stable levels of growth and employment. Those are also the foundation of our commitment to strong communities with a sense of responsibility and to investing in modern services which will meet the needs of the individuals and families in those communities.
As my noble friend the Leader of the House said on the first day of our debate, the heart of our programme in the gracious Speech is an emphasis on fighting crime and on improving health and social services. My noble friend reminded us that the insecurity people feel about their lives is too often centred on fear of crime and fear of ill health and the treatment they may receive.
This Government have addressed the economic insecurities inherited from the previous two decades and have begun to make a real difference in reducing insecurity about levels of crime and the health service. We are not complacent, but real gains are being felt from our long-term focus on the economic foundations and investing in services. They include falling burglary numbers, shorter hospital in-patient waiting lists, smaller class sizes for primary schoolchildren, higher literacy scores for our children, the lowest inflation rates for 30 years, an end to long-term unemployment for young people and a minimum wage and other measures to help those on low earnings.
All those gains impact on people's sense of security about their lives and those of their families. Our programme for the next year, set out in the gracious Speech, builds on those gains with further measures to tackle crime and improve health and social services. 370 We have a distinguished list of speakers for today's debate. I warmly welcome the noble Lord, Lord Kirkham, who will be making his maiden speech.
First, I turn to our measures to tackle crime. Increased economic opportunity must be matched by growing social responsibility. The Government do not believe that we can reduce crime by diktat from Whitehall. We know that we have to fight crime together. Building strong communities is a job for everyone in the community. That is at the heart of the five Bills announced last week. They will give greater powers to the police, carry forward our modernisation of the criminal justice system and bear down on those who threaten the community with criminal and antisocial behaviour.
The criminal justice and police Bill will enable the police to deal with crime and disorder effectively. It will give the police powers to issue fixed penalty notices for offences arising from disorderly conduct, such as threatening, abusive or insulting behaviour and causing criminal damage such as graffiti. It will give powers for the immediate closure of licensed premises where disorder is occurring and to prohibit public drinking. It will also modernise other police powers and the training of the police.
The Private Security Industry Bill will provide for the regulation of the private security industry in England and Wales. Its aim is to drive up standards in an industry that has a key role to play in tackling and preventing crime, under the supervision of a new security industry authority.
The Vehicles (Crime) Bill will support the tremendous achievements of the police in reducing vehicle crime. Among other measures, it will introduce statutory regulation of the motor salvage industry to make it difficult for criminals to dispose of stolen vehicles. It will protect the motorist from car theft and protect legitimate salvage traders. It will also enable the recycling of money from speed camera fines to spend on more speed cameras to improve safety on our roads. We shall also continue our modernisation of the criminal justice system with a Criminal Justice (Mode of Trial) Bill to remove the ability to elect Crown Court trial in either-way cases in England and Wales.
Finally, the profits of crime will be the target of the draft proceeds of crime Bill, which, among other measures, will provide for the establishment of a national confiscation agency, which will be dedicated to tracking down and depriving criminals of their unlawful earnings.
The measures that I have set out will continue our programme to make our communities safer and more secure. Communities will also be strengthened by our proposals to invest in modern health and social care services. We set out our proposals in the NHS plan in July and we shall introduce legislation in this Session to take many of those ideas forward.
Those proposals continue the long-term programme of investment and reform of health and social services on which we embarked in 1997. Since then we have abolished the internal market and established new primary care groups and trusts to bring together 371 family doctors, nurses and social services to develop local primary care-based services on longer-term agreements and national guidelines.
We have begun—not completed, but begun—a war on waiting for NHS treatment. We have kept our manifesto commitment to reduce in-patient waiting lists by 100,000 from the level that we inherited. At the last count, the figure is more than 130,000 below that level.
We have kept our commitment that no patient will wait more than 18 months for in-patient treatment. We have kept our commitment to guarantee women with suspected breast cancer an appointment with a specialist within two weeks. We said that that guarantee would be extended to all patients with suspected cancer by the end of this year. Thanks to the hard work and dedication of NHS staff, I am happy to say that it has been.
We have kept our commitment to launch a programme for the comprehensive modernisation of the NHS. It includes the biggest hospital building programme in the history of the service, with 38 schemes approved for construction. Three new hospitals have already opened this year at Carlisle, Gravesham and South Buckinghamshire, with another at Rochdale to follow. Five more will open next year and nine the year after.
We have also set up NHS Direct to provide 24-hour telephone access to health advice from nurses. The service now covers the whole of England and Wales, providing the public with the help that they need to care for themselves at home or to direct them quickly to another service if they need it. We introduced free eye tests for people aged over 60 from April last year. In the first year, more than 2.5 million older people took advantage of free eye testing.
We have begun to tackle the health inequalities that we inherited on taking office by setting tough targets for the reduction of deaths from cancer, heart disease, accidents and suicides. This year we have published a national cancer plan and a national service framework for coronary heart disease to continue the drive towards those targets.
Those measures have begun our transformation of health and social services for the people of this country, but they are only a beginning. We will not be content until the NHS provides the best available modern care for patients as and when they need it and until health and social services can provide integrated care at local level.
The NHS plan published in July contained our practical step-by-step reforms to transform the NHS over the next decade. Under the proposals outlined in the plan, there will he 7,000 extra beds in hospitals and intermediate care, more than 100 new hospitals by 2010 and 500 new one-stop primary care centres, more than 3,000 premises modernised, 7,500 more consultants and 2,000 more GPs, 20,000 extra nurses, 6,500 extra therapists and 1,000 more medical school places on top of the 1,100 already announced.
372 That will be reflected in many ways for patients. They will have a guarantee of seeing a GP within 48 hours. The maximum waiting time for a routine hospital appointment will be reduced to three months and the maximum waiting time for in-patient treatment will come down from 18 months to six months within five years, followed by a further reduction to three months. That represents an end to the waiting culture in our service.
There will be a big expansion in cancer screening programmes. Rapid access chest pain clinics will be established and waiting times for heart operations will be reduced. There will also be more than 300 rapid reaction mental health teams. We shall shortly publish a White Paper with our proposals for modernising the Mental Health Act.
All that will be underpinned by the biggest sustained growth in resources in the history of the NHS—a 6.1 per cent real terms growth over four years, compared with 2.6 per cent real terms growth over the last five years of the previous government. That will mean a 35 per cent real terms increase by 2004 compared with 1998–99.
The benefits from that investment in vital health services will be taken forward by the health and social care Bill. It will unlock £ I billion of new investment in family doctor premises in a public/private partnership through NHS Lift. That will allow the refurbishment of 3,000 family doctor premises, with a particular benefit to inner cities, by renovating, owning or leasing new or existing buildings.
The Bill will also introduce incentives to improve the performance of the NHS by giving greater freedom to the best performing trusts and greater support and intervention for poorly performing NHS organisations. A performance fund, building to £500 million, will be distributed annually on top of standard health authority funding.
We will extend prescribing rights to break down unnecessary professional barriers and deliver better care to patients. We will introduce new and improved arrangements for representing the interests of patients and to provide for local accountability. We will enable the establishment of new care trusts, integrating local health and social care organisations, to provide better seamless care for patients, especially older people. We will provide free nursing care in nursing homes, a measure which will benefit about 35,000 older people each year.
Our Bill to modernise further health and social care will be a significant step towards our strategic goal of rebuilding services to provide the best modern care focused around the needs of the patient. But, as I have been reminded in this House on more than one occasion, health prevention is always better than cure for diseases which are avoidable. And in this Session, we will bring before the House legislation for one of the most significant steps in health prevention that this country has seen.
Approximately 120,000 people die each year in the United Kingdom because they smoke. It is the prime cause of cancer and heart disease and causes many 373 other fatal diseases and chronic illnesses. It is the greatest single cause of premature illness and death in the United Kingdom.
The Government have a comprehensive programme to help smokers to give up and to encourage young people not to start. An advertising ban must be one element of the programme if it is to be as effective as it can be. Our aim is clear; it is to reduce the percentage of the population who smoke, thereby improving and lengthening people's lives.
Other countries—most notably Norway, Finland and New Zealand—have seen a fall in smoking following a ban on advertising which cannot be attributed to other factors. The tobacco advertising and promotion Bill will deliver our manifesto commitment to ban the advertising and promotion of tobacco in this country. We had hoped that that could be achieved across the European Union through directives and we continue to work with European colleagues to that end. But rather than wait longer, we will take action through legislation for the UK. All the devolved administrations support UK-wide legislation on this issue.
The programme this Session will in time have a significant impact on people's sense of security in their communities; on the quality, timeliness and responsiveness of the health services; and on the prevention of premature illness and death. It is a programme to improve the quality of life of all the people in this country and I commend it to your Lordships.
§ 3.22 p.m.
§ Earl Howe
My Lords, it is a considerable pleasure, among today's distinguished array of speakers, to look forward to the maiden speech of my noble friend Lord Kirkham. He is regarded by people of all political persuasions as a beacon of inspiration to young people. I suspect that his speech will tell us something of his life and background. Whether or not I am right about that, I suspect that I shall not be alone in hoping that my noble friend will prove a regular contributor to our debates, in particular those on the needs and wants of young people. That is an issue on which he can speak with authority.
The recent passage of the Children (Leaving Care) Act through this House has brought the subject of children leaving care into sharp focus. It would have been especially good in the current Session to have welcomed a Bill which modernised our laws on adoption. However, we understand that a Bill on that issue remains some way off.
It is something of an irony that the only Bill mentioned in this part of the gracious Speech which relates directly to children—namely, the Bill which extends the power of the Children's Commissioner for Wales—was announced by Her Majesty only days after the Parliament Act was used to force into law a measure which reduced the protection that the law afforded to children over the age of 16. If there were one event during the past year which crystallised my 374 views on the vexed issue of the age of homosexual consent it was the publication of the Waterhouse report into the appalling catalogue of sexual abuse of children in care in Wales.
Nevertheless, the Government have taken their firm stance on the age of homosexual consent in the interests of equality and because they do not believe it is right to be judgmental on a matter which, as they see it, relates largely to the way in which private citizens lead their own lives. That is why I cannot help finding it odd, to put it at its mildest, that at a time when rural communities are buckling under the strain of the worst crisis in agriculture for 60 years the Government should choose to bring to the top of their parliamentary timetable, ahead of any measure on health or law and order, a Bill designed to bring about a ban on hunting with hounds.
The Government have made great play about their concern for communities. We need be in no doubt of the damage to rural communities, both social and financial, that a ban on hunting would bring. The electorate can draw its own conclusions on the Government's sense of priorities, but it can also draw its own conclusion on exactly which minorities and whose private lives the Government believe we ought to be judgmental about.
With every ban proposed in legislation, the question that we must also ask is whether it is justified in a tolerant and free society. Since this Government came to office, Parliament has been asked to approve bans on a number of activities which were previously legal. Now it is the turn of hunting with dogs. It is also the turn of tobacco advertising. I do not propose to make a Second Reading speech today on tobacco advertising, but I suggest that when the Bill comes before your Lordships we shall need to juxtapose two sets of questions. The first set will relate to the strength of the evidence which connects tobacco advertising to the prevalence of smoking. The second set must surely bear on whether in a free society it is justified to impose a blanket ban on the promotion of a legal substance.
Just as doctors believe in evidence-based medicine, so surely it is incumbent on legislators to believe in evidence-based policy. I am not sure about the extent to which the Labour Party's manifesto pledge on tobacco advertising owed its origins to scientific evidence or to an instinctive urge to regulate and exercise control from the centre. However, we on this side of the House will want the Government to convince us that a ban on tobacco advertising will have a direct and measurable impact on smoking prevalence. We shall also want to be convinced that the Bill as drafted will not leave open a range of exploitable loopholes, such as sponsorship and product placement, which would serve seriously to weaken the effectiveness of the legislation. However, having said all that, I undertake that we on the Opposition Benches will retain an open mind on the issue and listen very carefully to what the Government have to say.
I mentioned what I regard as the partiality of the Government for exercising control from the centre. We see that tendency in evidence in their whole 375 approach to the National Health Service. The NHS is an industry with 1 million employees. It is an industry whose sheer size, if mirrored in the commercial world, would preclude any attempt to micro-manage from the centre. Yet time and again, whether through the woefully misguided waiting list initiative or the abuse of the appointments system so graphically highlighted in the report by Dame Rennie Fritchie, the Government continue to interpose themselves between managers and hospitals and between doctors and patients. If we cast our eyes down the list of health-related measures foreshadowed in the gracious Speech, we see exactly the same tendency emerging afresh.
One example of it comes with the formation of care trusts. I do not believe that anyone can seriously argue that the closer integration of health and social services is a misguided objective. We supported the measures in the Health Act 1999 which were designed to give effect to that aim. But the background note issued by the Government on care trusts is very telling. The first paragraph states that,Care Trusts would be largely set up voluntarily",in response to local needs. However, in the final paragraph one is told:The Bill would provide the Secretary of State with the power to require a care trust to be established".My mind goes back to our debates last year on the Health Bill when the noble Baroness, Lady Hayman, took trouble to assure the House—I paraphrase her words—that she could not conceive of circumstances in which the formation of a primary care trust would take place without the backing of a majority of doctors in the area affected. She accepted my point that for a new venture of this kind to work properly, the professionals involved had to have some sense of ownership of it. Yet since the passing of the legislation the Government have done exactly what they led us to believe they would not do; namely, to approve the formation of more than one PCT against the express wishes of a majority of doctors in the area.
As to care trusts, the danger of forcing through a marriage of health and social services is one to which the BMA has drawn attention; namely, that a forced marriage does not necessarily lead the parties involved to live in harmony with one another. Often the result is just the opposite, as it may well prove to be in this case, and the marriage brings about the union of two very different cultures.
Both the BMA and the King's Fund have had some interesting comments to make about another matter on which the Minister touched: the introduction of a national health performance fund. We understand that the operation of the fund will depend on a traffic light system which will rate all NHS organisations green, yellow or red. The best performing organisations will have an automatic right to payment from the fund, while those which are judged yellow and red must agree special plans or have their spending supervised centrally. The King's Fund has pointed out that the traffic light system risks giving an unfair 376 picture of underlying performance, because hospital trusts coded red will tend to be concentrated in the most deprived areas.
The BMA makes a different point and says that it could be,seriously counter-productive to label a hospital red as this would damage recruitment and retention of staff".I suggest that the Government would do well to take those warnings seriously.
Interestingly enough, the BMA added that its members had strong reservations about the traffic light system as it contained—wait for it—too much emphasis on micro-management from the centre".Just so. I am far from sure that the NHS performance fund is a conceptually well-founded idea, and I look forward to exploring the proposal in greater depth when the Bill comes before us.
I shall also require a very great deal of persuasion—I doubt that I can be persuaded—that the abolition of community health councils can conceivably be right for the NHS. It would perhaps be discourteous of me to repeat everything that I said in the recent excellent debate about CHCs initiated by the noble Lord, Lord Harris of Haringey. However, perhaps I should re-emphasise one or two points. The key characteristic of CHCs is that they are independent of the NHS. As a result, they are trusted in their role as watchdogs and they are also trusted by patients to act as neutral advocates on their behalf. To replace community health councils with patient advocates who are both employees of the NHS and located within NHS trust premises is to dilute, if not negate, that crucial quality of independence on which patients rely. That cannot possibly be conducive to greater patient empowerment.
Only last Session the Prime Minister personally endorsed the work of community health councils in a letter to the South Durham CHC. On 15th November he told another place that the proposals to abolish CHCs were being consulted upon. However, one CHC has recently written to my party to say:We are gratified that William Hague has … raised the question during Prime Minister's Question Time. The truth of the matter is [that] there has been no consultation either before or since the NHS Plan was drafted or published… We are concerned that the Government have announced the intention to abolish CHCs as a cynical attempt to silence any negative publicity during the winter and in the lead-up to the general election as they know they are most vulnerable in regard to the NHS. What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public have for the NHS?".That letter came from none other than the South Durham and Weardale Community Health Council which covers Sedgefield, the Prime Minister's constituency.
We embark on what is likely to be a curtailed legislative programme at a time when the NHS faces up to another winter. We all hope, no one more than myself, that the planning and preparation undertaken by the NHS in anticipation of winter pressures will prove to be effective. However, the Prime Minister has issued a prudent warning that not all may go smoothly between now and next spring. I doubt whether many 377 of us need such a warning. In my own area, the Chilterns, Wycombe Hospital has for the first time been obliged to close its accident and emergency department on repeated occasions during the autumn because of a shortage of beds elsewhere in the hospital. The winter crisis in Wycombe and many hospitals up and down the country is no longer confined to the winter months.
It is sad, but perhaps unsurprising, that of all the reasons commonly cited for this situation there is not one for which the Government appear willing to accept even a degree of responsibility. Yet for me at least there is absolutely no doubt that one of the principal reasons for the pressures experienced by hospitals can be laid directly at the Government's door; namely, the growing shortage of beds in the intermediate care sector. In 1999 alone, 760 care homes closed their doors with the loss of 15,000 beds. It is no good the Government saying, as they are wont to do, that there are surplus beds in the system. That may be true across the country as a whole, but it is not true in the home counties, the West Midlands, North Yorkshire and many other areas.
The main reasons for the contraction of the sector are twofold: the uncertainty brought about by the Government's threat of compulsory, but as yet undefined, minimum standards for care homes, and the fact that local authorities have been obliged to continue to pay fees to care homes at a level which has not kept pace with the increase in costs. Chai Patel, chief executive of Westminster Health Care, one of the largest providers of healthcare for the elderly, pointed out that,it costs more to stay in a Travelodge than in a nursing home. But in a nursing home we don't just provide a bed—we provide full care. And we are expected to do it for £47 a day".There was no crisis in the care homes sector when the Government came to office; now there is in many parts of the country, and it is this Government's doing.
In looking forward, as I do, to constructive engagement with the Government in the forthcoming legislative programme, I am sure that we all wish to express gratitude to the doctors, nurses, management and staff of the NHS in their unstinting efforts to maintain standards of service of which we can be proud.
§ 3.38 p.m.
§ Lord Clement-Jones
My Lords, I join with the Minister and the noble Earl, Lord Howe, in looking forward to the maiden speech of the noble Lord, Lord Kirkham.
I shall not engage in a commentary on the two preceding speeches of the Minister and the noble Earl. However, I place on record my total disagreement with the noble Earl's view on one particular piece of legislation. I believe that by invoking the Parliament Act the Government took a very principled stance in lowering the age of homosexual consent to 16. We on these Benches commend that legislation and believe that, contrary to the views of the noble Earl, it will be a liberating influence of great benefit to young people.
378 With Christmas so close, I do not believe that it is out of order to recommend some holiday reading to noble Lords. The book that I have in mind is Andrew Rawnsley's Servants of the People—the inside story of new Labour. The book is an authoritative account of the first years of this Government. The following passage, which deals with the events of 14th July 1998, is particularly interesting in the light of today's debate:With an infant school as symbolic scenery for his speech. Blair described it as a turning point… 'This is the biggest ever increase in resources for education and health: £40 billion over three years'.The people would actually wait longer for delivery. These increases were nothing like as significant as they had been made to sound, and in as much as there was extra money. it would not begin to kick in until nearly a year later…This phoney total had been manufactured by rolling up the increases so that the first year rise was counted three times and the second year's twice. Strip out this creative accountancy and account for inflation, then the actual sum was much smaller. Allowing for the two-year freeze, by some measures real spending would barely compare with the Conservatives' in the previous Parliament. As this reality gradually became evident, it fed suspicion and cynicism about all government announcements, genuine or not".The legacy of that still lives on today in public scepticism about government pronouncements on the health service. No wonder there has been so much controversy recently about the target figures in the National Plan for nurse recruitment. The Government are still receiving the backwash from their failure to invest properly in the health service in their early years of office and their overexciting of expectations that early improvements would be made. With regard to the additional resources coming through this year, the medical director of Epsom and St Helier Trust said:If only somebody had given us the cash a year ago. At this level to receive a cheque is great. But what the hell am I going to do with it?".It is hardly a surprise, therefore, that last week's MORI/BMA poll demonstrates that despite the National Plan and the announcement in the March Budget of significant additional resources for the NHS, there continues to be a steady erosion of public confidence in the National Health Service. In particular, there are still significant worries about winter pressures and the lack of capacity.
Those saying that they are fairly or very dissatisfied with the NHS have risen from 17 per cent to 28 per cent, while those satisfied have fallen from 72 per cent to 58 per cent; only 13 per cent are now very satisfied, which is a fall from 24 per cent; and 94 per cent said that the NHS is in need of much or some improvement. In addition, it is clear from the same opinion research that the public are beginning to realise that the shortcomings in the NHS are the responsibility of the Labour Government.
The fact is that the Government, despite the further funds allocated this year, have done too little too late to address the key issue of capacity in the health service. Even on government spending plans, the share of GDP devoted to health will be 7.5 per cent in 2004 compared with an EU average of 8.7 per cent. We have half the number of hospital beds per 1,000 population as in France or Germany.
379 As regards outcomes for many cancers, such as prostate, testicular and breast cancer, we are at the bottom of the European league tables alongside Estonia and Poland. There is still enormous doubt whether the NHS will see the winter through in good order without media horror stories of trolley waits, neglect and cancelled operations.
Recent surveys by my own party and the RCN demonstrate that there is a current shortage of 22,000 nurses—5,000 greater than last year—with London particularly hard hit. Many more recruits are needed because of those retiring in the near future. The RCN predicts that there will be a shortfall of some 50,000 nurses. As Ministers admit, we have to recruit nurses from abroad, especially from the developing world. At the same time we are spending some £350 million on agency nurses. We have a massive shortage of midwives and many maternity units are threatened with closure.
The Government have started to address the shortage of consultants in a number of areas. They have increased the number of doctors in training and they have set targets in the National Plan for nurse and doctor recruitment. But the lead times for recruitment and training are extremely long. Those issues should have been addressed on day one of the new Labour Government. Furthermore, there are huge shortages in the professions allied to medicine, such as occupational, speech and language therapists and pathology technicians, without whom the national screening programmes cannot be carried out.
The situation with regard to beds is, if anything, worse. Not only are there too few acute beds, despite claims that these have increased over the past year, but those acute beds are blocked in many areas by too few beds in the community. Last year some 13,000 care home beds were lost as care home owners decided to leave their businesses. Some 21,000 beds have been lost over the past two years. The cause is not the new standards, as some will claim, but under-funding of social services budgets. The 445 critical care beds which have been provided over the past year are welcome but more are needed.
Against that backdrop it is clear that the Government have little chance of demonstrating much more than modest work in progress at the next general election. How much should we welcome that work in progress? Are the correct actions being taken to restore the NHS to the premier league? The Liberal Democrats generally supported the thrust of the National Plan and in particular its patient-oriented approach.
We welcome and support some of the contents of the Queen's Speech this year. We welcome strongly the proposals to ban tobacco advertising in the UK in the face of the legal action of the tobacco companies to prevent the EU directive being adopted. It is quite amazing that tobacco companies such as Philip Morris are only now admitting in public that their products are addictive and cause death. Those products cause 120,000 deaths each year. I hope that in that legislation there will be no Formula 1 exemption.
380 We welcome the creation of care trusts to provide care in the community in an integrated way between local authorities and primary care professionals. We have long urged greater integration between them. We welcome and wholly support legislation to allow the extension of prescribing rights. It is vital that decisions on the categories of those entitled to prescribe are made quickly and help to use the expertise within primary care to best effect.
Furthermore, in principle we welcome moves to improve the performance of hospital trusts; but will green light status be largely confined to southern health trusts? Will there be a north/south divide as many managers and clinicians fear? Will there be too much centralisation of decisions? We must await the legislation. We also welcome other recent developments: the intention to create a national cancer institute; the impact of NICE in beginning to end postcode prescribing in certain areas; and the debut of the Commission for Health Improvement as a valuable instrument to improve corporate governance.
However, despite its pre-election nature, there are more health minuses than pluses in the Queen's Speech. The Bill to modernise the NHS will provide for the abolition of CHCs after 26 years of useful life. It will also create patients' forums and patients' advocates. The latter are welcome in principle but they will operate under the auspices of the hospital trusts. How will anyone regard them as independent? Why cannot reformed CHCs be given responsibility to run them?
As the Minister mentioned, there will also be provisions to allow PFI for primary care. In its report on the Queen's Speech The Times, with unconscious irony, said:It aims to do for the family doctor what the PFI is doing for hospital building".There is a huge need for better premises for surgeries, particularly in inner-city areas. But all the evidence to date is that PFI in the acute sector is providing fewer beds at greater cost than would have been available under conventional public financing. To add insult to injury, the process of evaluation of PFI is opaque. True comparisons between PFI and public financing are buried beneath a welter of suggestive factors. With an unprecedented Buclget surplus, why cannot primary care facilities be funded by straightforward public funding?
It is with regard to long-term care that the Government's proposals in the Queen's Speech are truly disappointing. Stewart Sutherland's Royal Commission report on long-term care of the elderly was a milestone in the development of policy towards older people, and yet the Government have chosen to pay for nursing rather than personal care. As a result we will still have many of the problems of definition and extreme financial hardship that we have seen to date. What a contrast with Scotland which seems set to adopt the Royal Commission's proposals, which would place a very high priority on allowing older people to retain independence despite ill health; that means paying for personal care.
381 There are some missing ingredients in the Queen's Speech: first, the failure to include primary legislation to change time limits and disability thresholds for compensation for vaccine damage, despite a clear government pledge to that effect; and, secondly, the issue of age discrimination. The issue of discrimination against older people in the health service will not conveniently go away. A recent survey conducted by Age Concern, "Speaking Out", about the way in which complaints about older people are dealt with amplifies further the findings of previous studies that there must be a proper complaint system. There are some heartrending anecdotes in Age Concern's survey, but the attached statement sums up the situation:It was only because I spoke out that I got the treatment I needed. But most older people won't, and that worries me a lot. Many people of my generation see doctors as gods and would never contradict them. Or they're just frightened".The anecdotes in Age Concern's survey emphasise, as we have done on every possible occasion, including in the debate on last year's Queen's Speech, that there must be a statutory duty on public authorities in the NHS not to discriminate against older people. Are the Government aware of how much they are letting down older people in the health service?
There are other omissions from the Queen's Speech. I note the Minister's promise of a White Paper on mental health. Mental health is a subject of which the Government make much when they are in popular mode, yet it features nowhere in the Queen's Speech. It is high time that care in the community was not only resourced properly but that mental health service users are given the benefit of a revised Mental Health Act. Their rights need bringing up to date in accordance with the Human Rights Act. They should be given at all times the right to proper assessment and treatment.
Such treatments should include the right to access to modern atypical drugs necessary for treating conditions such as schizophrenia. NICE is shortly to carry out an assessment of these new drugs. We welcome that. But I hope that this will be a fast process and I hope that NICE will also look at the impact of older drugs as well and make the appropriate comparisons as they affect patients, in particular the side-effects, which have such an impact on patients' willingness to take them and hence on the risk posed to the community.
Finally, the next few months will be vital for the shape of the regulation of doctors, nurses, midwives, health visitors and professions allied to medicine. That is no longer subject to primary legislation as a result of last year's Health Act and the shape of regulation of the various professions can now be determined by Order in Council and passed by affirmative vote. The General Medical Council is clearly making good progress, with the introduction of its fast-track procedures and changes to its committee structures and their composition, and further valuable reforms are in the pipeline. However, there are signs that the Government are inclined to minimise the differences between other health professions, such as midwives and nurses and the professions allied to medicine, and 382 prefer to lump them together when considering such matters as standards of conduct and education. That is not a helpful way forward as far as concerns most of those professions,
I hope that the Minister will carefully heed the very strong views of the professions in drafting the new regulations. I join the noble Earl, Lord Howe, in paying tribute to all the health professions. The morale and job satisfaction of our health professions is key to improvements in the health service, and the way in which they are regulated goes straight to the heart of both those aspects.
§ 3.52 p.m.
§ Lord Kirkham
My Lords, 56 years ago—56 years ago tomorrow to be more precise—a child was born in a hospital on the outskirts of Doncaster, South Yorkshire. I am sure that several children were born that day. I want to talk about just this one. The healthy bouncing baby boy did not stay very long with his natural mother and within a few weeks was adopted.
The adoptive couple had no children. They were Tom, a coalminer and verger of the local church, and Elsie, a housewife. They lived in the mining village of Edlington just a few miles away. They did not have a great deal to offer on a material basis. They lived in a typical mining village, in rented terraced property with an outside toilet and no bathroom. However, benefits did exist in the form of no telephone, no television—I am not sure whether television had then been invented—and a tremendous amount of love and affection.
We all know that growing up can be a hard and tortuous journey and all young people are very vulnerable as they make that journey. But Tom and Elsie helped a great deal. They provided the environment, they set the standards and, by example, taught the values that allowed Graham—that is what they called their son—a fair chance to enjoy life and fulfil any potential he might have.
I know Graham quite well—I think I know him quite well—and I believe wholeheartedly that because he had someone to look after him, to counsel, protect and direct him, to support and care for him, and to love him, he did grow up okay—arguably. Certainly, he was never excluded from school, he was never involved in drugs or violent crime, and he never became a suicide statistic. Noble Lords may not know that suicide is the second biggest cause of death among young men. Indeed, that lucky and privileged upbringing ensured that Graham—now Lord Kirkham—enjoys the privilege and pleasure of addressing your Lordships today. I am quite sure that Elsie and Tom—my mum and dad—would have been very proud.
But what is the purpose and relevance of all this background? I can say that it is not to elicit a gift on my birthday tomorrow, although anything I am fortunate enough to receive will be graciously accepted. Rather it is to elicit your Lordships' support in helping to provide care, protection and direction, if we cannot make it love, to those less fortunate than I was. I think 383 in particular of those young people in local authority care; the children society does not seem to want to hear about; the children we seem to concern ourselves with only at the time of those increasingly regular high profile media headlines and crises.
I want your Lordships' help and support in providing a better deal for all those children and young people whose voices, not amplified by having a vote, are often unheard or are perhaps simply ignored, although it is really hard to hear anything when your head is buried in the sand. Over the years, government have not been good at dealing with the needs, interests and concerns of young people, particularly those in care. We have to get better at listening to them and to those who speak on their behalf, or be prepared to pay an increasingly heavy price.
Our young people, be they in family homes, living alone or in local authority care, will clearly determine the shape of our society and the quality of our lives and those of our children and grandchildren in the future. These young people are tomorrow's secretaries, carpet fitters and hairdressers; tomorrow's leaders, doctors and lawyers; even politicians, pop stars and captains of industry—tomorrow's pimps, drug pushers and muggers. If we want to improve the ratio of one to the other, we had better do something about it right now.
The moral case is overwhelming—a "no-brainer", as the kids might say. But if we remain unconvinced of the moral case, then on the proven business concept that prevention is better than cure—in this instance, prevention is cheaper than cure—we should act now. The neglect of investment in the care system is not a financial saving. It simply transfers a bigger cost to another system—it is called prison.
Perhaps I may give a few statistics. Compared to the general population, children are four times as likely to be unemployed when they have been in care; they are 60 times more likely to be homeless when they have been in care; over two-thirds of child prostitutes have been in care; and a quarter of the adult prison population, as children, have been in care.
I do not think that we or the state have been very caring. Do you, my Lords? I do not think that we or the state have been very care-ful or wise. I checked the definition of "care" in the Library. "Care" is defined as,troubled or concerned; to have regard or consideration; to provide help or comfort".Even on my very best day of self-deceit, I am unable to see how society as a whole can tick any of those boxes. To paraphrase St Ignatius, the founder of the Jesuits:Give me a child to the age of seven and I will give you the man".I agree with that. I believe that environment is at least as important as genes.
Even at my tender age I know—I have seen it and experienced it—that if you can get into the lives of young people early enough, you can make a difference. It is not just the difference that helps to sustain a civil society, fundamental as that is, but the difference to move forward. So let us help to give these children a 384 purpose in life; let us unlock the huge potential that in so many cases is, at best, probably repressed or, more generally, is negatively focused.
While I was trying to get some background for these few words, I heard people describe our children's homes as the scandal of our society, calling them the primary schools for prisons. Two weeks ago on the Radio 4 programme, "File on Four", they were even portrayed as recruiting grounds for child prostitutes. Perhaps they are the scandal of our society, and perhaps they are not. However, it is certain that those in our care are the most disadvantaged, distressed and alienated of any group.
However, in my view, the good news is that if we and the Government decide to do something, I believe that something can be done. The tide can be turned. This Government and the last government have proved that in education. By focusing attention and money, standards can be improved and headway can be made. A similar effort, focus and investment would do the same for our children in care. I think that we should do that because they desperately need help.
Since my introduction, I have spent 13 months sitting on these luxurious, deep-buttoned, diamond-pleated Connolly hide Benches with beautiful hand nailing, before making my maiden speech. My noble friend Lord Ashcroft took four weeks. I have been entertained and educated. As noble Lords may imagine, over that time I have experienced the full gamut of emotion, from sheer pleasure to frustration and anger. I think that on one occasion I was momentarily a little bored, but that was entirely my fault. My principal contribution has been to rise as instructed, to walk across the House and to cast my vote. That mattered nought because no Division that I voted in was either won or lost by one vote. But all that has changed. After today, I have the authority to speak, the desire to lobby and the clear and avowed intention to make a difference to the lives and futures of young people in care, to change their world. But I know, and noble Lords know, that passion alone is not enough. Please, please, will you help me?
§ 4.2 p.m.
§ The Lord Bishop of Southwark
My Lords, perhaps I may first congratulate the noble Lord, Lord Kirkham, on a fine and moving maiden speech and wish him many happy returns for tomorrow. The noble Lord's reputation in supporting the Prince's Trust is well known. That experience, together with his own life experience, some of which he has shared with us today, has well equipped him to speak on matters of children and youth, in particular children and young people in care. The noble Lord has given your Lordships' House the first of what I trust will be many interesting, informative and challenging speeches. I hope that it will not be another 13 months before we hear the next speech from the noble Lord.
I wish to follow the noble Lord by speaking on a subject which very much affects young people; namely, the matter of law and order, in particular on inner-city estates. I speak as a bishop whose diocese probably 385 contains more such estates than any other in Britain, including the estate of North Peckham, some five miles down the road, where Damilola Taylor was recently murdered. It will not surprise noble Lords to learn that it is in that context that I shall review the proposals contained in the Queen's Speech to tackle crime and disorder.
Perhaps I should first put on the record the fine work undertaken by the head and staff of Oliver Goldsmith Primary School, where Damilola was a pupil, to turn around a school which, a little over two years ago, was put on special measures. It is awfully unfair that that school has been tarred with the accusation of bullying when in fact it has one of the fiercest anti-bullying policies of any school in the borough. The staff have my sympathy and support as they now help to support children grieving the loss of a classmate. Let me also express my deepest sympathy for the Taylor family and say how moved I have been by their deep Christian faith. A similar tribute could be paid to the family of Stephen Lawrence, killed on another estate in my diocese. Again, their Christian faith has been an example to us all.
What unites these two deaths is the fact that they are both the result of street violence. In London in particular, street crime, especially personal attacks and muggings, continues to rise. Some of this is driven by drugs. People in some parts of London and no doubt elsewhere are becoming alarmed at the increasing boldness of gunmen. But some urban disorder is created by the trauma of inner-city life, and in this raft of street crime, both the villains and the victims are likely to be teenage boys and young men. It is the pensioner who locks herself into her flat, fearing the streets outside, but in fact it is the young man who is most at risk. The Government are therefore right to focus attention on such unacceptable behaviour. However, I am not at all sure that as yet they have come up with the right formula for combating it.
I believe that the most significant component in tackling the problem of street crime is the presence of the police, policing the streets with the support and co-operation of the public. I repeat, both of those elements are necessary: the presence of the police and the co-operation of the public. However, this is easier said than done, in particular in multi-ethnic areas where it is vital that the police attract the support of all the ethnic communities. That is why the Macpherson report, following the death of Stephen Lawrence, is so important. It addresses some of the real issues regarding the mutual suspicion, or even hostility, which in the past has marred relationships between the police and black young men in particular. I believe that no institution in Britain is paying more attention to the question of institutionalised racism than the Metropolitan Police, and the fruits are beginning to show. However, there have also been less helpful consequences.
At present, the police in London are some 2,500 officers under strength. Many reasons can be given for this, including pay and conditions and the high cost of 386 housing. However, it should be said that there was some loss of police morale following Macpherson. It is not altogether surprising if some police officers responded to the report by not wishing to get involved in sensitive street incidents involving black young men in case they were accused of racism. But the truth is that, in urban London, members of minority ethnic groups are very often the victims of crime. They know that they need a good, effective police service which is even-handed in dealing with all ethnic groups. I hope that one positive outcome from the horror of the Damilola murder will be a new determination for the police and local people to work together in bringing law and order to the urban community.
I occasionally go out with the police at night and thus I know that there is another reason why the visible presence of the police on the streets is thin. The fact is that if a police officer makes an arrest, the officer is then taken off the streets for several hours while the case is processed in the local police station. We face a great dilemma here. Obviously, the courts demand clear lines of evidence before they will convict, but the result can be that police officers are spending the bulk of their shift in the police station rather than patrolling the streets.
One can see, therefore, the attraction of the proposal in the Bill on criminal justice and the police to introduce on-the-spot fines, with minor misdemeanours being dealt with immediately on the streets. The police themselves, however, seem to be less than enthusiastic about this. One can see the problem. A police officer weighing into a group of rowdy young men, perhaps the worse for drink or drugs, trying to impose an on-the-spot fine, could well turn a difficult situation into a mini-riot. I suspect that what the officer would do is haul the miscreant to the nearest police station and impose the fine there. But that is not totally different from the present practice.
Effective policing takes place only with the consent and support of the community. Anything which increases the hostility of the local community to the police therefore works against good policing. Teenage boys and young men disproportionately fall foul of the law, but most of them grow out of it and grow up to be good citizens. The yobs of today are often the good fathers of tomorrow. A bad experience with the police as a teenager can leave a legacy which means that an older man will be less than supportive of the police in later life.
With this in mind, I turn to some of the other proposals in the Queen's Speech. I understand the political imperative to deliver results—particularly with a general election on the horizon—but I believe that there are reasons for patience at present. The Inner London Probation Service, along with other services, is undergoing massive change. It is carrying out what has been called the biggest research programme in the social sciences in western Europe, seeking to find what actually works in preventing young people from reoffending. The results will take two or three years to come through but the effect could be enormous.
387 The Probation Service works with the youth offending teams that have been set up on a multi-agency basis as a result of the Crime and Disorder Act 1998. Again, these will take time to settle down, with the need to establish new joint patterns of working and to experiment with schemes of justice in which offenders can make amends. In a similar way, the Metropolitan Police has established community service units in every borough to tackle "hate" crimes of domestic violence, racism and homophobia.
This means that the Government have set in chain already some of the biggest changes in criminal justice—especially youth justice—in the past 50 years. Given the severity of the problems in some areas of my diocese, that is all to the good. But I plead for time. I am not sure that the criminal justice system needs yet more legislation until it has absorbed all that has been delivered since 1997.
There are serious issues of disorder and the Government are rightly tackling the root causes of school exclusion, poverty and lack of employment skills. I do not condone the behaviour of young criminals at all—my parish clergy and their urban congregations encounter its effects repeatedly—and it is important that the sensible measures taken in the past few years are made to work. But I confess that I have doubts about whether the proposed new measures will do anything more than place greater burdens on hard-pressed services.
Finally, I turn to the matter of the proposed youth curfews. Many of the measures concerning young children, including curfews, in the Crime and Disorder Act 1998 have hardly been used. Certainly, without a much stronger police presence there would be no way in which new youth curfews could be imposed, even if they were thought desirable. The professionals I talk to are very dubious about them. Indeed, they could alienate a whole generation of young people from the police.
We should judge all these proposals not only on the basis of whether they will help to deal with the problems of street crime in the here and now, but how they will increase mutual respect between police and public in the long term. Only then will they be contributing to the creation of a safer society.