§ 3.22 p.m.
§ Debate resumed on the Motion moved on Wednesday last by the Lord Archer of Sandwell—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".
§ The Minister of State, Home Office (Lord Rooker)
My Lords, I am conscious, on rising to make my maiden speech in your Lordships' House from the Front Bench, that I am not subject to the normal conventions on interventions. It is not my intention to provoke anybody and I shall deliberately try not to do so.
I thank Members from all quarters of the House for the incredibly warm welcome that I have received in the past few days as I have been walking the corridors of the House. I debated—sometimes quite acrimoniously—with many noble Lords on both sides of the House when we were in the other place. I am also conscious that, after the introduction of the new Members to your Lordships' House earlier this afternoon, I now have behind me the two Ministers and the senior Whip who were on the Finance Bill Committee in 1977 when, along with Audrey Wise, I made a technical adjustment to the Chancellor's Budget. They have promised not to seek to make a Barnett-Sheldon-Stoddart amendment to any Bill that I may take through the House, but if they did I would hardly be in a position to complain.
One other point that I have to get out of the way so that it cannot be used in evidence against me during future proceedings is that I never expected or had any long-term plans to arrive in your Lordships' House. The proof of that is that, in the early months of 1980, I moved a 10-minute rule Bill in the other place to abolish your Lordships' House. I hope that that issue can now be put aside.
I shall try to speak briefly on the health and home affairs issues raised in the gracious Speech. My noble friend Lord Hunt of Kings Heath, who is to wind up the debate, will deal with health issues in more detail. The Government have proposed three major health Bills in the gracious Speech. The first is the NHS Reform and Decentralisation Bill. As I have learnt in the past four years as a Minister, we do not write titles for Bills; they are laid down for us. That one is a bit of a mouthful, but the Bill will enable front-line health staff to meet the standards expected of them in a way that is best suited to our communities. It will also radically reorganise the current 95 health authorities. We reckon that it will free up about £100 million by cutting bureaucracy. That money can then be devoted to front-line services.
365 We will also devolve more power and resources to primary care trusts. When the provisions are fully in operation, we expect that two thirds of NHS funding will be in the hands of front-line staff—doctors, nurses and other health professionals. That will be a major change from what has happened in the health services over the past 50 years and will bring great benefit to our fellow citizens, which is the most important point.
The Bill will also touch on the self-regulation of the medical profession, with provisions for the modernisation of the running of the General Medical Council. We shall also try to strengthen the public and patient representation bodies that were initiated in the Health and Social Care Act 2001.
The NHS (Wales) Bill will meet the desire of the National Assembly for Wales and the manifesto commitments that were made. By and large, it will provide a framework for the NHS in Wales in line with the NHS Plan that has already been agreed by the National Assembly for Wales. It will improve collaborative working between local and national partners and provide essential statutory functions in public health.
The third health Bill deals with a sensitive and important issue discussed by Members of this House and of another place over many years—adoption. The Prime Minister personally led a review of adoption policy last year. The Adoption and Children Bill will lay the foundations for a better future, putting the child's interests firmly at the centre of adoption processes, cutting delays and making adoption processes fairer. Many of us have been involved as citizens, neighbours or representatives in this place and elsewhere in various tragic cases of people who have been unable to adopt because of the political correctness laid down by some authorities. The Bill will also strengthen safeguards on inter-country adoption and on the advertising of children for adoption. Children who are looked after by local authorities deserve the same chances as any other child. I hope that the Bill will provide an opportunity for a new start for thousands of our most vulnerable children.
In the past two Sessions of Parliament, the Home Office has been responsible for 17 Acts, much to the chagrin of other Ministers who have not been able to gain a slot for their legislation. That has placed an enormous load on Parliament. We are currently seeking to find out what has happened to the operation of those 17 Acts to ensure that they do what this House and the other place intended. Passing legislation is a fruitless exercise if it is not implemented or tracked or if no one checks whether it performs the function originally intended. We do not do that systematically enough in our parliamentary processes. As a contribution, I am pleased that in this Session the Home Office is offering only four Bills. That is a clear reduction.
We are seeing the fruits of some of our first-term reforms in youth justice and the probation service, as well as higher police numbers. However, crime levels are still far too high, even though, according to the 366 British Crime Survey, crime fell by 10 per cent between 1997 and 1999. Legislation to combat crime is an essential part of the gracious Speech.
The first Bill is the Football (Disorder) (Amendment) Bill. Unusually, I have no interest to declare. I am often asked who I support. The last time I went to a live football match, I took half a day off school, and I left school in 1957.
Last year we introduced tough measures to help to combat football hooliganism. There is no question that this is a very serious issue which affects our national sport; it also affects us in many other ways, including internationally. Prompted by the disorder during Euro 2000, the Football (Disorder) Act 2000 refined and expanded existing anti-hooligan legislation. While the Act made provision for the courts to impose banning orders in circumstances others than on conviction of a football-related offence, it was also needed to demonstrate to governments, police forces and citizens across Europe, beyond the UK, that we were taking the issue seriously. Football hooliganism is not something that we are proud to export. It must stop and we must take all reasonable legislative means to ensure that that happens.
A report on the impact of the 2000 Act has been laid before Parliament. By and large, it confirms that the measures have been successful in reducing disorder and that the powers are being used in a targeted and proportionate way. In order to assist the passage of the Bill—noble Lords will remember this—the life span of the key measures was limited to 12 months, extendable for a further year by an affirmative instrument. Thereafter, the measures will lapse unless the sunset clause is removed by primary legislation. The purpose of the Football (Disorder) (Amendment) Bill is to remove that clause. Of course, we shall bring forward the order in adequate time.
Whatever the nature of crime and disorder, the police are in the front line of the fight against them. Our aim is to work in partnership with the police service and to help it to work as effectively as possible. There is no doubt that part of that project is an ambitious modernisation programme, developed together with the police service. I emphasise partnership and developing the programme together. Our vision for the future of policing is a professional and effective police service which has the confidence of the public. Of course, it will need strong leadership and more effective management, a well-trained and well-equipped workforce, and the most modern technological back-up that we can provide.
Additional, enormous advantages are to be gained in helping the police to do their job by making the best use of modern advances in technology. In this Session we shall bring forward a Police Bill which will build on the progress already made as a result of discussions with the service since the autumn of last year. The Bill will make amendments to legislation which are essential in order to deliver the Government's manifesto commitments on police reform.
Briefly, the aims of the Bill are to strengthen the capacity of the police to reduce crime, and to increase public confidence through a new, independent police 367 complaints system. Over the years, many complaints have been made about the process that has been used for police complaints. Therefore, we hope that we can put the matter to bed with a system which will engender much more public confidence. We also want to engender the more flexible use of manpower, the introduction of specialist expertise and more flexible working patterns. As I said, in addition, we want to make better use of the skills and expertise of civilian staff and other specialists.
However, the police are only one key agency; there are others within the wider criminal justice system. Their effectiveness depends on that of the totality. One area which we believe requires urgent reform is the criminal justice system's poor ability to deprive criminals of their ill-gotten gains. The weaknesses were set out by the Performance and Innovation Unit, which reported to the Prime Minister last year.
Earlier this year, the Government published the Proceeds of Crime Bill in draft form. The consultation period has recently been completed and we shall indicate our response to the comments received when the Bill is introduced. I understand that it is quite a weighty Bill. That is not to say that big problems require big Bills; indeed, the very opposite is sometimes true. A big problem does not necessarily need a big Bill, but this is a weighty tome.
The Bill will establish a criminal assets recovery agency, dedicated to tracking down and depriving criminals of their unlawful earnings. Funds have already been set aside for that purpose. The agency will have a new power to recover criminal proceeds through civil litigation in the High Court or to tax criminal gains, drawing on the powers of the Inland Revenue. Its director will advise the Secretary of State on strategic issues in this field, and the agency will provide training and accreditation to financial investigators.
The Bill will reform and strengthen restraint and confiscation procedures in criminal cases and will extend the powers of the law enforcement authorities to trace and investigate suspected criminal assets. It will also modernise the system of dealing with the prosecution of money laundering. However, because I understand the sensitivities surrounding this issue for anyone who cares about the conduct of public policy, I want to make one thing absolutely clear. The legislation will include the best possible practical safeguards that we can devise in respect of human rights.
In his remarks on the Criminal Justice Bill during his speech in the other place this afternoon, the Home Secretary, David Blunkett, will make the point that we want to arrive at as much of a consensus as possible on this issue across the parties and across the divide. There is no reason why the function of criminal justice should be subject to a party political dogfight. An invitation will be extended to noble Lords in this House to take part in the discussions on the approach that we should adopt in taking through the legislation and on what parts we should include. We want to take through the Bill with as great a consensual approach 368 as possible. I hope that that will be fully understood. The invitation will be made at the appropriate time and I hope that the invitations for discussions with Ministers and officials will be taken up.
In some ways, the Criminal Justice Bill will go much further than the Proceeds of Crime Bill. It will pave the way for fundamental reform of the sentencing framework. We shall consult on fully the sentencing review first, but the Bill will provide a vehicle for early legislation to implement parts of the review. It is possible that not all parts will be implemented at the same time.
It is hoped that the Bill will improve public confidence by tightening up bail procedures and by providing for retrials following acquittals in murder cases where there is compelling new evidence of guilt. That, of course, is an incredibly sensitive issue and concerns a fundamental change in our system of criminal justice. We want to get the matter right, but we shall not get it right if we say, "We are the Government; we know best". We want to adopt a consensual approach to this change. A change in this area is needed in order to take account of modern technology and the processes which are now available. I shall not go into detail about those, but everyone is aware of them.
Protection of the public from sex offenders is also high on the list of priorities. The Bill will improve protection by strengthening the registration requirements in the Sex Offenders Act. It will also reform the law on corruption, bringing it up to date and making clear our compliance with international instruments.
I have tried to set out the various points as briefly as possible in order to give an overview of the central Bills that we shall bring forward in respect of the health and Home Office portfolios. I said that there are only four Bills. Previously, during debates on the gracious Speech, I have listened to Ministers list the forthcoming Bills. Then, half way through the Session, Bills that had never been mentioned have popped up out of the blue, all of which seemed a good idea at the time.
Sometimes we legislate in haste and then repent at our leisure, going through the issues again with an amendment Bill. We shall seek to avoid doing that. We shall seek to think through the legislation before we present it to the House and to be as consensual and open as possible in getting it through.
I hope that noble Lords will consider that I have given an overview of our aims. I understand that, according to the rules under which I am operating, I cannot elaborate further by way of interventions. However, my noble friend Lord Hunt will do that. I commend the gracious Speech to the House.
§ 3.38 p.m.
§ Lord Cope of Berkeley
My Lords, my first duty and, indeed, pleasure is to congratulate the noble Lord, Lord Rooker, on three counts: first, on his appointment to this House. He comes with great experience. Your Lordships will know of his 27 years 369 in another place as Member of Parliament for Birmingham Perry Barr. Following his starring role on the Finance Bill, to which he referred, in the previous Labour government, he has served on the Front Bench of his party—in opposition and in government—continuously, I believe, since 1979—22 years and still counting.
Secondly, it may not be so well known that at the age of 16 he was apprenticed as a toolmaker. It is right to point out that toolmakers are the aristocracy of the engineering shop. He subsequently worked with increasing responsibility in several engineering firms and earned a formidable collection of qualifications, including a BSc and MA; he is also a chartered engineer, a fellow of the Institute of Production Engineers—he was a member of its council for a while—a mechanical engineer and a member of the British Institute of Management. This House values experience and the noble Lord brings plenty of it from inside politics and government and from outside them. I am delighted to congratulate him on his appointment to this House and on his maiden speech. We all look forward to hearing him speak again. We can be certain of hearing from him frequently!
Thirdly, I congratulate the noble Lord on his appointment as Minister of State at the Home Office. It is a busy department, although it is not as busy as it was because it has been shorn of a long list of responsibilities. However, before I discuss that in more detail, I take a moment to thank the noble Lord, Lord Bassam, for his work as a Home Office Minister. As the noble Lord, Lord Rooker, said, the noble Lord, Lord Bassam, worked very hard and was hard pressed by conflicts and—the noble Lord hinted at this—ill-prepared legislation. The legislation was usually drawn up by others and given to the noble Lord, Lord Bassam, to steer through this House. He remained throughout a model of courtesy and always tried to respond to every point with care and in writing if necessary. He remains on the Front Bench as a Whip, so I had better not say any more.
I shall concentrate today on Home Office matters. My noble friend Lord Howe will discuss the health aspects of today's debate when he winds up. As I said, the Home Office is not what it was under the noble Lord, Lord Bassani. Almost every other department in Whitehall has taken a bite out of it. Perhaps the Prime Minister balked at the idea of a full ministry of justice but the decks were cleared for it in any case.
The noble and learned Lord the Lord Chancellor has taken from the Home Office responsibility for human rights, data protection and freedom of information. The Department for Transport, Local Government and the Regions has taken from the Home Office the important constitutional responsibility for electoral law and the Electoral Commission; it is also responsible for fire services and Her Majesty's Fire Service Inspectorate but not, I believe, civil emergency planning.
The Department of Trade and Industry has taken from the Home Office responsibility for Sunday trading and for British Summer Time but I notice that 370 it failed to wrest responsibility for bank holidays from the Treasury. The Department for Environment, Food and Rural Affairs has taken from the Home Office responsibility for animal welfare—including. I presume, crimes of cruelty and control of animal experiments—and for hunting. The Department for Culture, Media and Sport, in its desire to regulate the whole of the nation's free time, took responsibility for film and video censorship, alcohol licensing, gambling of all kinds and horse racing.
In exchange for giving away all that, the Home Office has regained from the Cabinet Office full responsibility for drugs policy and it has also taken over responsibility for work permits. The Cabinet Office is being upgraded in other respects, so moving responsibility for drugs policy co-ordination appears to involve downgrading the emphasis on drugs. That is apparently confirmed by the downgrading of the "drugs tsar". If that is so, it is worrying because drugs and their consequences are a massive and growing engine of all kinds of crime. We shall continue to give priority to fighting illegal drugs and we shall press the Government on that.
Work permits are an interesting case. Some think that more immigrants are needed to fill particular skilled vacancies or simply to provide more manpower. A new "green card" system, like that used in America, is supposed to be needed. The relevant American cards are not green any more, but we know what is meant by the phrase, which refers to an arrangement that is very like our own work permit system. Many work permits are for short-term employment—they involve specialists of various kinds, including actors, musicians and those seeking to improve their employment skills—or for those wanting more usual long-term jobs.
Such decisions have been taken until now by the Department of Employment—to use one of the various names it has had over the years—because it knew where the skills shortages were and where spare manpower was or was likely to be. It used that knowledge to assess employers' applications for work permits for overseas employees. In other words, Whitehall responsibility for work permits reflected the fact that it has been job-market based. In future, it appears that it will be Home Office and "immigration control" based. I find it difficult to see that as either logical or an improvement.
The same goes for a good deal of the reshuffling of responsibilities in Whitehall. Such shuffling of departments' responsibilities involves tremendous upheavals. Ministers' responsibilities can be changed at the stroke of a pen and in this country they take effect at once. However, the staff, buildings and computer programmes take months to reorganise and years to settle down in their new conformation. Establishment officers throughout Whitehall who are involved in pruning this once great department face a massive volume of work. It will take time for the many outside people who have to deal with government to chase their contacts around Whitehall and to find out exactly what has happened. Reorganisations of this kind should be embarked on sparingly and should not 371 be rushed into. In an effort to give an illusion of progress and to feed the idea that government is about Ministers and their titles, huge amounts of work are created. In fact, government is really about enabling civil servants, agencies and clients to deliver. I am always conscious of the fact that accountants, like production engineers, are concerned with making things work.
As the noble Lord, Lord Rooker, said, the gracious Speech promised us a police Bill. He also set out its main themes. Throughout the previous Parliament we were promised more police officers, but the numbers in fact fell, largely because of high wastage, which reflects the low morale about which we all know. We will judge the proposals by their effect on police morale and on officers' self-respect and respect for the job. Without such self-respect, the respect of the public is inevitably threatened, standards fall and a difficult job becomes even more difficult. Incidentally, the Home Secretary's intervention in Sussex is an odd start in that respect.
Effective numbers and morale are also linked to the bureaucratic burdens that are placed on the police, and the Bill is potentially important in that regard. Considerable work has been done on the new complaints system, which has consequences in terms of public respect and the bureaucratic load. The work of our police is examined and second-guessed by a great number of bodies, apart from the complaints body in either its present or its proposed form. Those bodies obviously include the Home Office, and Parliament directly observes the police and the Home Office. The police are also supervised by the police authorities in the various regions, Her Majesty's inspectorate, the National Audit Office and, crucially, the courts and the Crown Prosecution Service, which seeks to follow up the work of the police in the courts. That means that a huge number of institutions are effectively looking over the shoulder of every constable as they deal with incidents in the middle of the night. He may be called on within a few minutes to justify his conduct or his superiors may be faced with this huge barrage of groups.
The gracious Speech also promised us a continuation of the special legislation against football violence. Parliament needs an opportunity to consider the way in which those provisions are working in practice because they were necessarily introduced very quickly. They involve the sort of Bill to which the noble Lord, Lord Rooker, referred when he discussed Bills that were squeezed in with a shoehorn at late date. As he said, we will soon have a preliminary opportunity to consider the provisions through the continuation order. The noble Lord told us about his interest in football, which is roughly parallel with my own. The whole subject was and no doubt remains a personal interest of the noble Lord, Lord Bassam, so availability of advice on this matter is not lacking.
The other three Bills mentioned in the gracious Speech are awaiting reports, "remanded, awaiting reports" might be one description. The criminal justice Bill awaits the publication of Sir John Halliday's review of sentencing. The proceeds of crime Bill awaits 372 the publication of the results of consultation. The draft criminal courts Bill awaits Lord Justice Auld's report. This House has taken a particularly strong view on jury trials which will obviously be an important aspect of that when we come to it. Therefore, the draft legislation can expect particularly careful scrutiny here.
I hope that in each case, publication of the necessary reviews, consultation and so on will be in good time to enable your Lordships and others outside to consider what is said, preferably before the Bills are put before Parliament. Those outside reports and reviews are, after all, supposed to help others, not just the Home Office, to consider the issues and get them right in the Bill concerned.
The proceeds of crime Bill will build on measures introduced originally by the Conservative government. The Minister showed that he is already sensitive to the potential human rights problems of the proposals and to some of the dangers in the detail for legitimate businesses for, of course, those provisions will affect not only criminals. They will indirectly affect criminals, but they will also affect a very large number of legitimate businesses too, with the dangers which that might create. But at the moment, we await the results of the consultations.
Criminal justice Bills are now more as less as regular a feature of parliamentary life as Finance Bills. With violent crime still rising, who can be surprised? This year's criminal justice Bill promises to be another mixed collection of measures, as the Minister set out briefly, including the modification of the double jeopardy rule. Your Lordships will not need me to tell you that the controversial aspect of that is the possible retrospection involved.
The gracious Speech promised nothing about another important remaining responsibility of the Home Office; that is, prisons. But fortunately, my noble friend Lord Hurd of Westwell has given us an opportunity to discuss them fully in a few days' time, so we do not need to refer to them today.
The rights of victims, about which we heard so much during the election, have also been ignored in the gracious Speech, but they will not be ignored by us.
The Minister has been given personal responsibility within the Home Office for asylum, immigration and work permits. No legislation is planned in that field but there is plenty of work to do there. There are a great many unfulfilled promises. The Minister concerned has to deal with one of the heaviest caseloads in government. For that reason, if for no other, the noble Lord will be relieved, I think, that he will only have to respond on behalf of a somewhat truncated Home Office by comparison with his predecessor. But in any event, I congratulate him and wish him well.
§ 3.53 p.m.
§ Lord McNally
My Lords, vanity causes me to begin with a direct quote from my remarks made in this House on 13th December 2000, at the end of the debate 373 on the last gracious Speech. I was about to be followed by the then Attorney-General, the noble and learned Lord, Lord Williams of Mostyn. I said:So let us all prepare for the feast to come, knowing full well that everyone in the House will enjoy his speech—everyone except the Lord Chancellor and the Leader of the House, neither of whom are sure which of their jobs he wants next".—[Official Report, 13,12/00; col. 472]Well, they know now. If only that fragile lady had heeded my warnings.
But I have some good news for the noble and learned Lord the Lord Chancellor. I understand that the Leader of the House has taken to consulting the noble viscount, Lord Cranborne, about how his kinsman, Lord Salisbury, managed to be Prime Minister from the House of Lords.
My main task, however, is to respond to the gracious Speech in relation to home affairs. Like the noble Lord, Lord Cope, I associate myself with the tributes to the noble Lord, Lord Bassam, who, although now in pastures new, exhibited enormous fortitude, I should tell the noble Lord, Lord Rooker, as he dealt with the heaviest workload of any Minister in the House of Lords in the last Session.
Like the noble Lord, Lord Cope, I welcome the speech of the noble Lord, Lord Rooker, and congratulate him on it. I know from my own experience that he comes from another place with a well established record both as a Member of Parliament and as a Minister. Even with that experience, the noble Lord, Lord Rooker, will need a little help from his friends. For a start, I know that the layout of this place is rather confusing so I should explain that there is the Official Opposition, this is the real Opposition and occasionally, from time to time, up there is the noble Lord, Lord Hattersley. I hope that the Opposition Front Benches will not be too hard on the noble Lord. Lord Hattersley. Although the Minister is not a footballer, the noble Lord, Lord Hattersley, is a keen football fan and as a supporter of Sheffield Wednesday, he has not yet become used to supporting a winning team.
The Home Office has changed a lot since the general election. In fact, I believe that only the noble Lord, Lord Warner, has survived as a kind of influential spider in the middle of the Home Office web. All the other Ministers are new. I can understand the desire to clear decks to allow the department to concentrate on the core issues of crime and punishment.
I put it on record that I am worried that betting and gaming have moved from the Home Office to the Department for Culture, Media and Sport. There were very good reasons for betting and gaming being kept within the Home Office and in recent years, those reasons—in particular, defence against organised crime—have grown stronger rather than weaker.
Be that as it may, the Home Office refocusing under a new Ministerial team offers the opportunity to take stock. I hope that reports that David Blunkett intends to play the tough guy even more than his predecessor are not true. I have made my criticism of Jack Straw before. He saw as the first priority of his stewardship 374 never to be outflanked by either Michael Howard or Ann Widdecombe. It gives me no pleasure to say that he succeeded in that aim and, as a result, never escaped from the criticism made of him by Phillip Stephens of the Financial Times that he,spoke to the populist illiberalism which is the Government's least attractive trait".If what the noble Lord, Lord Rooker, said today about a new, more consensual approach is to be demonstrated, then on these Benches, we both welcome it and will respond to it.
The question that David Blunkett should be asking himself is whether populist illiberalism produces the solutions to the problems facing a Home Secretary. It is the contention of these Benches that it does not. Gesture politics and, even worse, gesture legislation has been the abiding failure of successive Home Secretaries, Tory and Labour, over recent years.
Let us take prison policy, for example. I was struck by a quotation from Lady Ramsbotham, the wife of the retiring Inspector of Prisons. She said:If imprisoning people was so successful we woulc be needing fewer prisons—not more of them".Yet for over a decade, successive Home Secretaries have proved their macho credentials by the commitment to build more prisons and to put more people in them. The result is that we now have more people in prison than almost any country in the western world. Yet, what do we say when we are faced, as we were faced last week, with the dilemma of two 18 year-olds who had committed a terrible crime? The Lord Chief Justice, the noble and learned Lord, Lord Woolf, when explaining his recommendation that the killers of Jamie Bulger should serve a minimum of eight years said that the alternative—that they should be transferred to one of Britain's young offender institutions—would be,likely to undo much of the striking progress",they had made inside the local authority secure units because the atmosphere in those institutions was so corrosive.
But if young offender institutions were likely to undo eight years of remedial work on Jamie Bulger's killers, what kind of damage are they doing to the young people that we send there? Instead of every Home Office Minister trotting out statistics about new prisons and increased prison numbers, would it not be better to bring forward a real strategy for prison reform and a greater emphasis on successful alternatives to prison?
I do not deny that a real fear exists in the mind of the public in relation to the issues of law and order. However, in responding to crime, it is important to keep a cool head. Knee-jerk reactions are not a sound basis for a system of justice or of punishment. With that in mind, this House has a particular duty to examine measures in the gracious Speech in terms of civil liberties and basic freedoms. I welcome the spirit and the content of the remarks of the noble Lord, Lord Rooker, in that context.
375 The quick fix rarely proves the right solution in such matters and we must eschew the idea that when one draconian set of measures has failed our only response is another turn of the ratchet towards even tougher measures. In recent years successive Home Secretaries have implied that any questioning of their particular solutions means a kind of namby-pamby liberalism that leaves the criminal unpunished and the victims of crime unprotected. Nothing could be further from the truth.
As an example I turn to the issue of drugs, to which the noble Lord, Lord Cope, referred. Over seven years ago, in 1994, the Liberal Democrats called for a Royal Commission on drugs. We were well and truly dumped on by Labour and Conservative spokesmen and lampooned by the popular press as potheads and crackpots. Yet the very first observation of the ground-breaking report of the committee chaired by Lady Runciman on drugs policy, commissioned by the Police Foundation, stated:we have been forcibly struck by the lack of research and the weakness of information base about drugs use in the United Kingdom".This is an opportunity for Mr Blunkett to show that Home Secretaries do more than just grab tomorrow's headlines. Belatedly—so late that even the candidates for the Conservative Party leadership are clambering aboard—there is a call, across parties, for a well informed, well researched debate about drug policy. That is gathering momentum and the Home Secretary should seize the moment to initiate one.
Meanwhile, let us take some real and practical measures against the drug menace. In that respect I welcome the promise in the gracious Speech of urgent action against money laundering. It is clear that action against street-corner pushers has only marginal effect. We must go after organised crime at its roots with measures to track down and to confiscate the proceeds of crime. I welcome the declaration by David Blunkett that one of his primary objectives is a war on traffickers in drugs, people and terrorism. The recent report of the House of Commons Select Committee on International Development called for the establishment of a single government department to provide a focus for current activity, and pointed out that the,lack of focus and co-ordination is hampering efforts to tackle corruption and money laundering in the UK".If the Bill that we are promised addresses that problem, we will welcome it and give it our support.
An added incentive for a country like Britain to take action against money laundering is what I call the BBC World Service factor. Today at Question Time we heard that all over the world people tune in to the BBC World Service in preference to domestic or other international news providers for one simple reason: they believe the BBC.
A parallel can be found in the City of London, which still has a reputation for business probity. I believe that such a reputation is an asset in a global economy, particularly in the area of financial services. But it is an 376 asset that must be protected by tight laws, eternal vigilance and a determination to bring wrong-doers to justice.
I worry whether the National Criminal Intelligence Service is being given the priority or the resources to make a reality of Government intent. The number of prosecutions for money laundering offences is still minute and the co-operation of all but a few major banks and virtually none of the big law firms and accountancy firms undermines the thrust of declared policy.
As the noble Lord, Lord Rooker, indicated, the gracious Speech contains four Bills that are directly within the ambit of the Home Office and I believe that in the past week a fifth has been added—the civil defence funding Bill.
There are also a couple of constitutional Bills, the fox hunting Bill, which has some relevance to this debate, and, of course, the "Harold Macmillans events", the entirely unexpected, which will occupy us during the coming year. I do not intend to give a detailed comment on each of those Bills today, especially as my colleagues, the noble Lords, Lord Dholakia and Lord Phillips, intend to cover certain aspects in more detail in the light of their own vast experience.
I hope that the noble Lord, Lord Rooker, and through him the Home Secretary, takes on board the message from these Benches: basically it is time for a change of emphasis from the Prime Minister's old mantra of "tough on crime, tough on the causes of crime" towards "effective on crime, effective on the causes of crime".
The Home Office is a great Office of State which in the past has championed civil liberties and human rights, as it must do We cannot provide more law and order by undermining the protection for the citizens that over the centuries has been built into our criminal justice system.
We cannot achieve support for the police unless we recognise and remedy the faults and weaknesses that exist. A programme of police reform that brings our police forces closer and makes them more accountable to the communities that they seek to serve will have enthusiastic support on these Benches.
Likewise, the noble Lord, Lord Rooker, has special responsibility for asylum policy, so he will have our support when he seeks to implement a policy that honours our age-old tradition of tolerance and refuge for those in need of shelter from persecution. He will receive support from these Benches if he seeks an asylum policy that fairly shares the burden of reception and absorption in full consultation with local communities and seeks genuine international cooperation in dealing with the matter. However, it will not be acceptable to use bureaucratic delay and inhumanity of treatment as hidden deterrents to those who seek asylum here.
On race relations I shall make only two points. My noble friend Lord Dholakia will have more to say on the subject. First, there is a need to look at the special circumstances that have arisen in some of our old 377 textile centres where the industry that brought communities to this country in the first place have all but disappeared, but they have left behind real social problems. Secondly, all the mainstream democratic parties in this country need to stand shoulder to shoulder against the threat to all our values posed by the British National Party.
We start a heavy work programme with some big issues. I repeat that I welcome both the offer and the tone of the maiden speech of the noble Lord, Lord Rooker, to which I believe we can respond. On these Benches he will find informed criticism and principled opposition when the Government get things wrong, particularly on matters of individual liberty, and civil and human rights. However, he will also find unflinching support when the Government take the road of radical reform. That is how it was in the previous Parliament and so it will be in this.
§ 4.8 p.m.
§ The Lord Bishop of Durham
My Lords, first I must crave the indulgence of the House in case this debate should continue late into the evening. Early tomorrow morning I have to lead into retreat those whom I shall ordain on Sunday morning. My only opportunity to keep that appointment with them is to catch the last train to Durham tonight. I apologise for any discourtesy to the House.
I join other noble Lords in congratulating the noble Lord, Lord Rooker, on his clarity, humour and experience. No doubt all that will stand the Government and this House in good stead in the future. I hope that he will soon be converted to the wisdom that flows from all the Benches in this House.
I welcome the Government's intention to address a wide range of issues relating to the prevention of crime. I welcome the opportunity to make our response to it in terms of police investigations, the court system and the responsibility that we have to the victims and to the perpetrators of crime. Our inability as a society to stem the rise particularly in violent crime should not be blamed only on our police forces. It is a reflection of the instability in society, caused by the erosion of family life and the lack of moral framework that we offer to younger generations.
Crimes which spring from common human frailties such as greed or jealousy are bad enough. But when racial or religious motives are responsible for crime, we have used the positive delights of human variety, dignity and sanctity and turned them into excuses and weapons for violence and destruction.
It is this evolving and unpredictable nature of society which makes it important that legislation is always appropriate to meet the demands of the age in which we live. But in framing new legislation, I hope that the Government will have in mind that in the end we cannot legislate to eradicate the causes of crime nor provide a cure for it. The origins of and responses to crime will be addressed by much broader government policies which deal with the encouragement of marriage and family life, with education and with the eradication of unemployment and urban and rural poverty.
378 No reforms to our judicial systems, no scientific methods of detection, no increase in the numbers and efficiency of our police forces, desirable and necessary as all these things may be, will address the root causes of crime.
When we come to address the details of the new legislation, we must keep those reflections before us. A show of strength and political determination may be welcome, but we must remain aware of the limitations of legislation in itself to provide all the answers to our deep concerns. We should keep in mind four purposes of the criminal justice system: to punish the criminal; to serve those who are the victims of crime; to protect the public; and to restore to their full humanity those who fail.
The system must seek to do all that with clarity, openness and fairness. For example, the double jeopardy protection should not be thrown out thoughtlessly or in a populist knee-jerk reaction to particular notorious crimes. It is important that in the vast majority of cases those acquitted of accusation should be able to put aside that experience for ever; and it is important that we do not provide excuses for criminal investigations to be less thorough because there is the possibility of returning the case to court.
Nevertheless, with the advancement of technology, it is quite possible that new evidence could come to light which suggests that the case could be returned to court. There may be instances where the accused is freed on a technical matter which means that the issue is not fully or satisfactorily resolved.
That suggests that in the most serious or repeated crimes, the abolition or protection of double jeopardy may serve the cause of justice, but we must safeguard the legislation from opening this gate too widely. When we know the details of the review carried out by Lord Justice Auld, I hope that we shall be able to address some current failures of the police and courts system.
One example which was brought to my attention involved the case of a minor fraud which took three years to come to court after arrest. During that time, the defendant lost his job and a number of personal and essential items were not returned to him. He also underwent a nominal sentence of a few weeks, an experience which was totally negative for him. It was his first and I trust only offence, but his whole life was put on hold for an unconscionably long time.
Thankfully, that man had the support of the Church during his long wait, his trauma of court proceedings, his short but devastating prison sentence and his rehabilitation into the community. It is worth noting that the Church's Criminal Justice Forum has launched a resettlement programme under the direction of two Salvation Army officers. It is called "Community Chaplaincy", whereby chaplains work as much with the prisoners after release as when they are in prison. Pilot sites for this programme are now in operation in Swansea, Preston and Gloucester.
I know that any proposals to make it easier for police forces to collaborate and for a revised police complaints system will be welcomed by the police 379 themselves. The complaints system has moved from one of internal accountability to that of accountability to the public beyond the complainant. It must surely be right that we search for more transparency and openness in this sphere.
Finally, I turn to an issue which is a good example of the needs expressed in my opening remarks. The Queen's Speech indicated that legislation will be introduced to extend the life of the Football (Disorder) Act. Sadly, we must now assume that this should be further extended to include cricket and perhaps other sports as well.
For those of us who love our cricket, it seems unbelievable that what is clearly necessary at Highbury is also relevant to Lord's. But the recent happenings at cricket grounds point to something more sinister than high spirits. Let us hope that it involves only a small minority. However, the indicators are that those disturbances are another expression of the racial and perhaps religious motivations of some who have ambitions further to destabilise our society.
By all means, let us give the police and the courts the power adequately to control such behaviour. But we must also take note that the causes and cures of these disturbances reach deeper into our society than can be handled by legislation alone.
I look forward to hearing from the Government that the fight against crime, as well as being tackled by improvements in our police and judicial systems, needs to be engaged on a broad front and among the people who at local level are teaching, counselling and praying that our communities may be safer places in which to live.
§ 4.18 p.m.
§ Lord Williamson of Horton
My Lords, it is clear that the gracious Speech closely reflects the priorities which dominated the election campaign and which represent the key elements of the mandate of the Government for this term. In particular, two of the most important priorities are the subject of our debate today; namely, health, with the objective of the reform of the health services, and justice and home affairs, with the objective of improvements in policing, in the criminal court system, in the recovery of criminal assets and in sentencing.
The noble Lord, Lord Hunt of Kings Heath, who I am very pleased to see back in his accustomed place on the Front Bench, knows that from time to time I intervene on some health matters, in particular those concerning mental health as I am a patron of the National Schizophrenia Fellowship. This is the first time I have intervened in your Lordships' House on issues of justice and home affairs. But what can an ambitious Cross-Bencher do? As the noble and learned Lord the Leader of the House told us last Wednesday:It is now a settled constitutional convention that the Home Office always has a plethora of Bills and nothing has changed".—[Official Report, 20/6/01; col. 23.]380 The noble Lord, Lord Rooker, tells us that it only a little plethora but, all the same, there is a great deal of business and the Government clearly want us to work in this field—and rightly so.
First, there will be widespread support, which I strongly share, for the measures to help the police fight crime and co-operate across boundaries. Sometimes there are moments in a person's life when he wonders what the Government are for. Certainly, that happened to me from time to time when I was a public servant. But surely in this area there is no doubt that government and Parliament must support the police and seek to make them as effective as possible, not only in the detection and arrest of criminals but also in the wider role to prevent crime by their presence in sufficient numbers and the advice that they give to householders and others who are potentially affected by crime.
Most of the measures taken in the community to prevent crime, to make it harder to commit it and to influence the actions and opinions of actual and potential offenders are not so eye-catching as a high-speed police chase, but public resources devoted to preventing crime are generally well spent, and I am sure that the public are well aware of that. I hope that such measures will continue to have priority, whether they are conducted by the police themselves or other organisations. I commend the project of the Howard League, of which I am an ordinary member, called Citizenship and Crime which challenges 7,000 children and young people in 60 schools so far to understand their responsibilities and reject harmful behaviour.
Secondly, there will be widespread support for the Bill to establish a criminal assets recovery agency and to make it easier to recover the proceeds of drugs and crime. I understand that the Bill will change the burden of proof in determining whether assets are the proceeds of drugs and crime so that it is easier to arrive at a satisfactory result. Action in this area certainly responds to public dissatisfaction with cases where criminals have apparently been able to continue a high life style while their victims suffer.
The third main element in the plethora of new legislation on justice and home affairs is the potential reform of the criminal courts system which follows the recommendations of the committee chaired by Lord Justice Auld, which are eagerly awaited on these Benches, and other moves to reform sentencing. The noble Lord, Lord Rooker, referred to a fundamental reform of sentencing, including, according to the press briefing, new style intermediate courts where a judge will sit with magistrates, and a review of sentencing policy with longer prison terms for some offenders.
While supporting much of the Government's proposals, it is on the last point that I express some doubt. It is evident that for some offences, in particular those involving violence, substantial prison terms are necessary for the protection of the public. Subject to that, the situation in our prison population gives rise to serious misgivings. That is indicated by the fact that shortly we shall have a further debate on this matter in the House initiated by the noble Lord, Lord Hurd of 381 Westwell. We must make a serious long-term effort to ensure that the expensive resource of prison becomes less and less a routine response to lesser crime but should be used in exceptional circumstances for those people who are a significant danger to the public.
That is not fully the situation today. We have a very high prison population in comparison with some other states in Europe. More than 200,000 men, women and children experienced prison here in 1999. That was not the prison population but the number of people who passed through prison. Eighty per cent of those who go to prison are sentenced for non-violent offences, and two-thirds of prisoners are sentenced to six months or less. I look forward to the possibility that in relation to the latter point the proposed new system of custody plus, which may come forward in this legislation, will be an improvement.
The present system is very expensive. It costs about £26,000 a year to keep someone in prison. It is also costly because about half of those who experience prison will be reconvicted of another offence within two years of release. In addition, of the very many people in prison on remand half will not be sentenced to imprisonment when their cases finally come to court.
Some of the increase in the prison population in the 1990s is easily understandable; for example, there was a very big increase in the number of those convicted of drug offences. But the growth in the number of prisoners has arisen mainly from longer sentencing, not more crime. For that reason, whatever we debate on these Bills in relation to sentencing is very important.
I believe that the Minister should be concerned about two points. First, at the end of the period covered by the digest published by the Home Office in October 1999 almost twice as many people were in prison for burglary, theft, handling and robbery as for violence against the person. Secondly, the proportionate use of immediate custody for indictable offences, which fell in the 1980s, rose, I believe, for seven years in the 1990s, and by 1997, 72 per cent of those convicted for robbery, for example, were sentenced to immediate custody. In the Crown Court custody was used in 43 per cent of cases in 1990 and 61 per cent in 1997. It may be that more recent events show some reversal of that trend and, if so, I welcome it.
The difficulties are extremely well understood, but it is perhaps wise to use an unhappy expression, which no doubt will appear in the Oxford English Dictionary shortly; in relation to some of our practices on sentencing and the prison population we are in a "SPAD" (signal passed at danger) situation. We need to think carefully how, while fully protecting the public and giving attention to the needs of victims of crime, we can develop for more offenders penalties which do not involve imprisonment.
It is true that in a recent year about 28 or 29 per cent of those sentenced for indictable offences were given a community sentence, but I am convinced that community penalties will be used to greater effect 382 some years ahead. Evidence shows that they are just as effective as prison in stopping crime, and they are substantially cheaper for the taxpayer. Very good work has been done for young people through such measures as reparation orders, referral orders, the probation service and drug treatment and testing orders. There must be greater possibilities, surely, for community sentences for adult offenders. I know that that is easier said than done, but we need to have a realistic objective before us in which imprisonment really becomes the last resort and, in particular, the number of women and children in our prisons decline while community sentences play a bigger role.
Finally, our prisons also hold prisoners with a good number of specific mental health problems. I realise that the Government have decided to defer the major mental health Bill until a later Session and so it is not before us today. I believe that in recent times the Government have done very well in this field with the national service framework and the additional commitments to mental health. But I should like to be assured by the noble Lord, Lord Hunt of Kings Heath, that when the major necessary reforms in the health services which are announced in the gracious Speech take place they will not unwittingly prejudice the £700 million that has been committed to mental health over three years for the national service framework and the £300 million a year by 2003–04 under the NHS Plan. We want full implementation of the funding plans set out in the previous Parliament.
In conclusion, the Government did a good deal in their previous term. In many ways I am very satisfied with their actions on law and order and improving the priorities, effectiveness and funding of mental health. But it is a legitimate concern for a reforming government that the prison overload should be steadily reduced by greater use of community sentences and that the efforts decided on to improve mental healthcare are followed through.
§ 4.29 p.m.
§ Lord Rea
My Lords, I shall use my slot in this debate to discuss two of the most powerfully addictive drugs. Noble Lords will appreciate that in this I refer to important topics which have been omitted from the gracious Speech as well as those which form part of it. Noble Lords may have guessed that I am referring to the Government's failure to reinstate the Tobacco Advertising and Promotion Bill which in the previous Parliament passed through all its stages in the other place and its Second Reading in your Lordships' House.
Your Lordships will be aware that nicotine is now known to be as highly addictive as heroin, if not more so. The means by which it is imbibed—that is to say, through smoking tobacco in the form of cigarettes—is far more lethal in the long term than heroin. I shall say a few words about heroin addiction later because it has recently been in the news and because the Government will be seeking greater powers to curb drug trafficking in this Session through the legislation outlined by my noble friend in his light-hearted but extremely businesslike maiden speech.
383 I imagine that my noble friend Lord Hunt who is to answer the debate is as concerned as all of us in the health professions about the decision to delay the Tobacco Advertising and Promotion Bill. However, being a loyal as well as a highly effective member of the Government's health team, I imagine that my noble friend will not be voicing this disappointment in his speech today.
My noble friend will be aware of the strong and universal criticism of that decision by leading figures in medicine and cancer research. I will quote only from a few; there are more, all equally cogent. First, I repeat the view of Sir George Alberti, president of the Royal College of Physicians. He said:This is a bitter blow for all UK doctors. The children we fail to protect from tobacco advertising today will be our patients with cancer and heart disease tomorrow. We're astonished that the government should fail to implement legislation which will help them meet their own targets for reducing smoking-related disease".Secondly, I quote from Sir Alexander Macara, the chairman of the National Heart Forum. Here I declare an interest because I am secretary of that forum. Many noble Lords will know that he was the previous chairman of the BMA Council and a member of the General Medical Council and the working party on the task force looking at the implementation of the National Service Framework for Cardiovascular Disease. He stated:This legislation simply cannot wait. By the government's own calculations, this scandalous delay will cost at least 4,500 unnecessary deaths from smoking as well as burdening the health services with treating avoidable coronary heart disease, cancer and respiratory illness.It is just six months since ministers were stressing that smoking is the biggest public health problem facing the country and that a law to ban tobacco advertising was essential. Failure to act [on the bill] brings into question the government's commitment to the public health agenda and a proper priority for prevention".Thirdly, Dr Ian Bogle, the current chairman of the BMA Council, said:I am shocked and dismayed that the Government has not made room in its programme for a bill to ban tobacco advertising".Obviously I could go on. I understand why the Government may want to take issue with the profession on matters of remuneration and terms and conditions of service, but here the Government are defying the strongly expressed professional advice of some of the most respected physicians and scientists in the land.
The Government are also eating their own words. Again I will give only a few quotations from the mouths of Ministers. First, I quote from Alan Milburn, the Secretary of State for Health, in his Second Reading Speech in another place. He said that,we honour the commitments that we have made. The Bill will ban tobacco advertising and sponsorship in this country. It will do so to protect public health, to safeguard children and to reduce health inequalities".—[Official Report, Commons, 22/1/01; col. 654.]The Minister for Public Health, Yvette Cooper, in a press release on 11th May, said: 384The majority of the British people, doctors and health professionals all want to see this ban in place. It is the Tories and the tobacco industry who have done everything they can to block this".I quote my noble friend's words on 28th March. He said that,the provisions of the Tobacco Advertising and Promotion Bill, if enacted, could lead to a 2.5 per cent reduction in smoking prevalence and in the longer term a similar fall in tobacco-related deaths, a saving of some 3,000 lives a year".—[Official Report, 28/03/01, col. 273.]On the first day of the debate on the humble Address in your Lordships' House my noble and learned friend Lord Williams of Mostyn said:We shall reintroduce the extremely important Bills on commonhold and leasehold and international development which failed through lack of time".—[Official Report, 20/6/01; cols. 23–24.]There was no mention of the Tobacco Advertising and Promotions Bill which surely also qualifies as "extremely important" since it is literally a measure to save lives, as my noble friend Lord Hunt said on 28th March. I very much hope that the noble Lord can announce when he winds up that the Government have listened to the concerns that have been expressed, some of which I have quoted, and will now include the Bill in this Session of Parliament. That would not only be of great public health benefit, but it would also be a popular decision which would increase the Government's standing. It would bury the suspicion that the Government are succumbing to the pressure of the tobacco industry. Incidentally, that pressure was very well expressed by certain members of your Lordships' House, as my noble friend well knows, at Second Reading on 28th March.
The Government do not need another Formula One or Ecclestone embarrassment. I am sure that the right honourable Kenneth Clarke is chuckling in his "BATmobile" about this matter as he zooms around the world selling cigarettes to developing countries.
In another place my right honourable friend Robin Cook, who will be leading the House, I am sure, on ethical principles, said that proposed future Bills which were not included in this Session were not to be considered as being of lower priority. All I can say to that is, "You could have fooled me".
I now turn to say a few words about other drugs of addiction, particularly heroin. There is much discussion about the possible role of soft drugs such as cannabis acting as the "gateway" to hard drugs such as heroin. However, there is a much higher prevalence of cigarette smoking among both cannabis and heroin users—about 90 per cent—than in the general population—about 30 per cent. It has recently been suggested by researchers in the USA that the effect of nicotine on dopamine metabolism may predispose tobacco smokers to experience enhanced pleasure from narcotic drugs and thus predispose them to becoming drug dependent. Therefore, if cannabis is a gateway drug—that is not proven—it may well be because it is commonly inhaled together with tobacco. So not only would a ban on tobacco advertising save 385 3,000 lives a year, it may also slow down the increase in use and abuse of heroin and other drugs that we are seeing.
Yesterday, I attended part of an international conference sponsored by the Foreign and Commonwealth Office entitled the Global Economy of Illegal Drugs. There is much international cooperation and huge expenditure on attempts to curb drug trafficking. Plans for its improved effectiveness were discussed. It included what was virtually a Second Reading speech by Robert Ainsworth, the new Home Office Minister who is now handling drug issues. He described the new measures to tackle money laundering and recovery of criminal assets, a matter about which my noble friend Lord Rooker also spoke.
But we all know that however successful the legislation is, more drugs will get through than are intercepted. If one drug cartel is exposed and eliminated, another will replace it. As long as the market exists for illegal drugs the international criminal fraternity will find ways of supplying it. Globalisation ensures that more and more goods and people move around the world. It is not economically or technically feasible to strip search everyone or minutely examine every consignment of traded goods.
It is surely clear that a renewed emphasis on "demand reduction" is the only answer. That involves a combination of approaches: first, helping people to come off drugs. That is an almost impossible task, even in prison, if they do not want to come off them. The noble Lord, Lord Williamson, spoke about the drug testing and treatment orders (DTTOs). Now if one is convicted of a crime and is suspected of having been a drug user, one can at least be offered testing and treatment.
However, independent researchers have shown, contrary to the belief of the previous Home Office Minister, Paul Boateng, that DTTOs are not quite as effective as he would like to make us believe, particularly among those who are being pressurised into having the treatment. One cannot expect an addict to come off drugs unless he really wants to come off. But many do want to come off and they cannot get the help that they need. The Runciman report, to which the noble Lord, Lord McNally, referred, emphasised that only 13 per cent of government expenditure on drug abuse supported treatment or rehabilitation but 62 per cent went on enforcement. Much more emphasis needs to be put on treatment and rehabilitation, as many of us pointed out in the debate on 21st February.
I shall skip over the role of education, except to say that there are many problems. The most common introduction to hard drug use is through the activities of small-time suppliers who are themselves addicts and who buy the drug, cut it—that is, adulterate it and dilute it—and sell it on to finance their own habit. They form the basis of the pyramid selling phenomenon. The best way to prevent this happening is to supply the hard core of addicted heroin users with a pure, clean form of the drug that they need through controlled outlets, as used to be the case before the 386 present Misuse of Drugs Act came into force 27 years ago. It would be possible to make them pay for their supplies, but the price must be set at a level to undercut the black market or street price of the impure illegal product now available. Unfortunately, there are now several hundred thousand hard core users who would need supplies, whereas in the early 1970s there were only a few thousand. That is an interesting comment on the effectiveness of our current legislation.
At the end of a Channel 4 series last week, 65 per cent of a studio audience, chosen to be as representative as possible of the population, voted in favour of the proposition that "The drugs laws do not work". One of the clearest messages from that debate was that treatment and rehabilitation facilities are nowhere near sufficient to cope with the demand.
I should like to end by referring to a debate on drug abuse in your Lordships' House in December 1997. Winding up, my noble and learned friend Lord Falconer referred to my speech, which covered some of the same themes as my speech today. He said:His view that to decriminalise drugs, or provide a legal supply through licensed outlets, will get rid of the black market in drugs is, with the greatest respect to him"—one always knows what that means: it means probably "with the greatest disrespect"misconceived and misguided".—[Official Report, 9/12/97; col. 139.]After the debate I suggested to my noble and learned friend that my approach would in time come to be accepted by government. After three-and-a-half years that stage has not been reached, but public willingness to look at this approach, which after all was the official policy until the late 1960s, is increasing year by year. I hope that my noble friend Lord Rooker will persuade his colleagues in the Home Office to take a more open-minded view in the current discussion of drugs and the law. I suggest as a start that they look at the evidence of careful studies in Holland and Switzerland which show that the approach that I have outlined actually works, by helping heroin addicts to regain physical, mental and social health, employability, and in reducing crime.
§ 4.44 p.m.
§ Lord Forsyth of Drumlean
My Lords, I add my congratulations to those given by other noble Lords to the noble Lord, Lord Rooker, on his excellent maiden speech and on his appointment as Minister of State at the Home Office. I held that post myself for a year. Michael Howard was the Secretary of State and Ann Widdecombe was the Parliamentary Under-Secretary. During the course of that year I found that my views became progressively more liberal. I am much closer to the position outlined by the noble Lord, Lord Williamson, in his speech than I was when I started. I do not propose to speak today about home affairs, but it strikes me that addressing that question of how we use prison more effectively for rehabilitation and make better use of resources is one of the big problems that remain unsolved.
387 I was sympathetic to some of the arguments put forward by the noble Lord, Lord Rea. I found myself thinking that perhaps there is indeed a case, as the noble Lord, Lord McNally, reminded us, for a Royal Commission to look at the whole drugs issue. It is a complex issue and one that people find difficult to address for all kinds of political reasons. However, the noble Lord, Lord McNally, likes to present himself and his fellow Liberal Democrats, at least in this House, as the Official Opposition. Where I live, north of the Border, they are in bed with the Government and are part of the Government. It reminds me of the days when I was canvassing: Liberal Democrat policies would vary from street to street. Now, whether they are in opposition or part of the Government varies from one part of the United Kingdom to another. It must be very convenient to be a Liberal Democrat, with such flexibility of mind.
I dare say noble Lords would expect me to begin my speech by criticising the Government for the gracious Speech. We have yet again a series of health Bills that are concerned with reorganisations. The very last thing that doctors, nurses and managers need is yet another set of reorganisations. If there is one criticism I would make of our time in power—I was concerned with health for six years—it is that, largely driven by the Treasury, we were obsessed with the idea that every year we could achieve further efficiency savings and that every year there was, through reorganisation or competitive tendering, something that could produce additional resources that did not demand us to look at the problem of resources in healthcare directly.
If I were being fair to the Government, having criticised them, I would also congratulate them. There is no doubt that over the past 10 years the leadership of the Labour Party has moved forward by a century. It recognises that the market is better than politicians at delivering all kinds of services that were once seen as, unavoidably, state monopolies. It sees that market provision often has defects but accepts that a regulated market does a better job than its own nationalised industries ever did. Yet it cannot bring itself to admit that in the case of health. The Labour Party is completely hung up on the fact that it invented the NHS. Having ceded so much to the market, whether in gas, water, electricity, airports or buses—you name it—its left wing has dug in deep to keep our healthcare system nationalised. So the arch-reformer, the Prime Minister himself, found himself appointing, right at the start of an administration with a huge majority, which regrettably he still has, the left-winger Frank Dobson as Secretary of State for Health simply to appease his old Labour colleagues. It did. But it landed the Government in the floundering mess they are in today on the NHS. A health service run of Dobsonian principles could not work; and it did not.
In business, when you do something that does not work, you pull out the other drawer and implement Plan B. The Government are in such a cul-de-sac on health policy because they did not have a Plan B. When their policy fell to bits, they had nothing other than the old Labour language to hang on to. All they could do 388 was promise more money. Indeed, they have promised a great deal more money. But it is money which the ageing population and medical inflation will soon swallow up. They just could not bring themselves to admit in healthcare what they had admitted everywhere else in the economy—that a nationalised healthcare system inevitably has just the same problems as a nationalised telephone company, a nationalised bus company or a nationalised airline.
To be fair, the Tories—the Conservatives—have also been avoiding this issue for many years. I was fascinated by the criticisms which were made of Mr Hague by some, saying that he did not spend enough time talking about health during the general election campaign. Those criticisms were fascinating because I know that they were made by people who had no enthusiasm for raising the issue of healthcare during the election. They see that the public rather like the idea of a health service free at the point of use, one that delivers the healthcare that people need fairly and without regard to their ability to pay. They fear that any reforms which they might propose as to how the NHS is run will be portrayed as a fundamental assault on that principle and, quite reasonably, will lose them votes.
Of course it is true that the public love the NHS. Every poll confirms that. However, the important point is this: yes, the public love the NHS, just as we all love our children. We would not give them up for anything. But, as parents, we are also fully aware of their many failings. We do not ignore those failings or say that they do not exist: we try to correct them by encouragement and exhortation. Therefore the question which I would ask noble Lords to address this afternoon is this: why cannot politicians on both sides of the House make this simple admission; namely, that all of us adhere to the founding principle of the NHS—the principle that necessary medical care should be available to everyone who needs it, regardless of their ability to pay—but that the precise way to deliver that objective of a nationalised healthcare system now looks increasingly out of date and failing?
The NHS is a huge industry. One million people work in it. It holds assets worth £25 billion in buildings and land alone. Reform would be no cakewalk. But until we accept that there is a problem and that new ideas are necessary, we shall not even make a start on serious reform. The first step in helping an errant child is to recognise the problem. Only then can you steel yourself to take whatever painful or difficult action is necessary to protect that very one you love.
However, the trouble is that while politicians remain in a state of denial or fear, people are suffering. It is an awful thing to be on a waiting list, even if the complaint turns out to be minor. You do not know whether it is minor. You do know that there are risks in surgery. It preys on your mind for the entire duration of the long wait. You worry that the condition may turn inoperable by the time you get treatment as, tragically, has happened recently in more than one case. At the very least, you may be incapacitated and unable to work to support your family.
389 When targets are set for an industry that is unable to cope, the problem simply leaks out somewhere else. So now we have waiting-list targets, but the wait even to see a consultant is getting longer and longer. I have friends with a nine year-old child who developed a hacking cough which became worse and worse. Eventually, they ended up on a waiting list to see the consultant. The list was nine months long. It took the consultant less than a minute to diagnose the cause—just a nervous cough—and to suggest a course of action. But in the mean time, the parents had been driven to distraction by worry. Convinced that it was due to an allergy, they bought a special Hoover, replaced all the bedding, threw out all the carpets and banned suspected foods.
That is just one tiny case among millions. It may seem trivial, but no case is trivial to those who are involved. The inability of politicians to admit the truth is causing unnecessary distress, worry, grief, pain, misery, heartache and even death in families up and down the country. Should not that shock us into an honest debate, however difficult?
I know that on the other side of the House noble Lords worry that if we break away from our traditional forms of delivery, we shall see the development of a two-tier health service. However, the truth is that we already have a two-tier health service. If you have private health insurance, you can see a consultant the week after next, you can have a scan the week after next and you can have the operation when you want it. If you do not have private health insurance, you may have an agonising wait that lasts for a very long time indeed.
When I was a Member of Parliament, my wife dealt with my constituency correspondence. She now works for another Member of Parliament. She tells me that the letters about the health service now coming in to that Member of Parliament are completely different in character from those that I used to receive. Two cases came in this week, one concerning a woman who had her fortnightly chemotherapy treatments cancelled at a day's notice. She expected to stay in hospital, but because they had no bed for her, she was expected to stay in a hotel while the chemotherapy took place. Hundreds of cases like that exist. All noble Lords know of examples from their own experience and every Member of Parliament knows it from their postbag.
Is more money the solution? I certainly believe that it can form part of the solution, but it is not the whole solution. In Scotland, we spend 25 per cent more on the NHS per head than is the case in England and Wales. Everyone acknowledges that the Scottish health service is much better, but no one says that it is perfect. To raise English spending on health by the same proportion would require a vast injection of money, vastly more than the Government have promised to put in. A huge rise in taxes would be necessary to pay for it, although I doubt whether the English would like to see their taxes rise by one-third. Even in Scotland severe pressure will be put on those spending levels as the Barnett formula is reassessed.
390 The Prime Minister has noted that health spending in most European countries is a good deal higher than ours. The clinicians have noted that their records on life-saving treatments for cancer or heart disease, to take two examples, are also a great deal better. So, in his unguarded "Frost interview" moments, Mr Blair sees European levels of spending as a target, an aspiration or whatever.
But Europe spends almost exactly the same as we do on healthcare in the public sector. The difference is that it spends a great deal more privately. If we are to find new money for healthcare, that is where it will have to come from. The Government, or at least their modernising leadership, know this, but are unable to admit it for the reasons that I have mentioned. So we continue to fall behind and people continue to suffer and to die.
Yes, more money would provide at least part of the answer but, no, getting the money from taxpayers and spending it through today's politicised institutions is not the way forward. Whatever is put in will be simply swallowed up. There is no point in pedalling any faster when the chain on your bike is broken—you have to fix the chain. We have to fix the UK healthcare funding and delivery system.
I said earlier that the NHS is a nationalised industry. However, of course it is not only the provision of healthcare that is nationalised: the way that healthcare is paid for is also nationalised. Most of our healthcare spending comes through taxation. The trouble with that is that the money goes straight from Whitehall to doctors and hospitals without patients being given a look in. So the service looks upwards to its political paymasters instead of downwards to its customers.
The customers, meanwhile, quite naturally think that, if someone else is paying, they will have as much healthcare as they can get. Thus, some people will call out doctors for self-limiting conditions or clog up the surgery to get a bottle of Calpol or a prescription—and why not? But all such unnecessary demands put on the system mean that more serious problems go untreated or are treated only after a long and painful wait. Somehow we have to restore the link between paying and receiving so that people realise that healthcare is not free, but that it has a real and often considerable cost. That must be done—I emphasise this point— in such a way that those who cannot pay are not disadvantaged.
Other European countries have found ways to do this. In many there is state funding for the poorest, but those with above-average earnings are expected to insure themselves. In Britain, prescriptions are free for certain groups, including those over retirement age, however rich they may be. But really, why should the Duke of Edinburgh be entitled to free medicine? Other European countries are not so daft. In some, you pay proportionately for your prescription, depending on your income level, by presenting your smartcard at the chemist's. We have endless debates about whether to provide expensive drugs such as viagra free of charge or, more seriously, Interferon, which is now available according to your postcode. Other countries solve this 391 problem by making everyone pay for their drugs up to some set annual limit. After that, it becomes free. So people are induced not to demand prescriptions unless they need them, while people with chronic conditions are fully protected.
European politicians, even in the most socialist of European countries, do not seem to get hung up on this kind of thing. They see its benefits in terms of choking off unnecessary demand and encouraging people to take more of an interest in their own health because they know that there is a cost if they do not. So why are we not honest enough as politicians to explore these options?
I am sure that the Government are right that private insurance is not the answer. Insurance is meant for infrequent but catastrophic events which could wipe you out financially if you had to pay for them. It is no good for common, minor problems because the paperwork costs more than the fix, and because sometimes people volunteer for things they do not really need if someone else, such as an insurer, is paying.
Instead, it seems to me that we need a mixture of insurance and saving. We need the state or private insurers to underwrite the infrequent and "big-ticket" events, but we need people to save for the smaller, common events. Then they will see the true cost. Insurers have been very slow to design such schemes. Some insurers actually give money back for using the NHS. That is a ridiculous state of affairs.
There are a variety of ways in which this issue could be approached. I do not say that I know precisely what is the right answer, but I do say that we should be discussing these models. When people are waiting and suffering and dying, why are we so hesitant?
I appreciate that I have been speaking now for quite some time, but perhaps it is symptomatic that, in the debate so far, few speeches have addressed the healthcare issue. It seems to me that it is by far the biggest problem facing our country. The fact that they saw no leadership in this area may account for the failure of voters to turn up on polling day.
Perhaps I may now say something about the provision side of healthcare. We all agree that an important service such as healthcare must be provided and that, if necessary, the state should pay for it. But that is not to say that the state has to make the actual provision. The state pays for motorways and bridges, but private contractors, not civil servants, actually build them. The state pays welfare benefits so that poor families can buy food and clothing, but it does not run supermarkets, thank goodness. So why should the state run our hospitals? Why not harness the benefits of competition and let private or voluntary groups provide state-funded medical care?
The Government are groping towards this when they accept the need for a compact with the private sector. It is obvious that the private sector can do some things better than the NHS and that the NHS can do some things better than the private sector. So 392 collaboration makes sense. But further down, there is suspicion—even outright hostility—against any genuine collaboration. The spirit of "Dobbo" lives on.
I wish the Government well in their groping. Certainly on this side of the House they will find tremendous support for a genuine partnership, but one which recognises that we cannot use the private sector simply to be dumped on when there is a winter crisis. We need a genuine partnership and a genuine and comprehensive review of how to get additional resources into healthcare in our country.
§ 5.4 p.m.
§ Lord Dholakia
My Lords, I should also like to put on record my thanks to the noble Lord, Lord Bassam. He and I have something in common: we both come from the same stable—that is, the Brighton Council. The difference is that I was there about 15 years before him. The second advantage that we had is that we both supported the same football team. However, during my time they won promotion to the first division; during his time they went down to the fourth division. I do not hold that against him. I have never questioned his judgment and he has always been very helpful. Equally, I wish the new Minister well in his job.
Her Majesty's gracious Speech gives us an opportunity to comment on the Government's legislative programme. It also gives us the opportunity to talk about matters that have been left out. My noble friend Lord McNally has spoken about some of the issues identified by the Home Secretary as being the key plank of the Government's legislative programme.
The words spoken by the new Home Secretary are no different from what we heard from the previous Home Secretary. He states:Tackling crime is our top priority. To do that we need a modern Criminal Justice System with the tools to do the job. Modernisation, both of the Criminal Justice System and the police, will form a key part of that".Those are fine words with which no one would disagree. There is no doubt that if we want to reduce crime and provide justice for all, we need more resources. As the noble Lord, Lord Cope, pointed out, in the previous Parliament we saw a fall in the number of police officers.
Too often, simplistic solutions have been offered. Many are impractical and irrelevant; some have not worked or not been used; and, despite promising to reduce paperwork, the system has become more bureaucratic and some of the measures have undermined civil liberties.
Pursuing a policy on crime which is superficially populist does not mean that it is effective. Look at our prisons, which are overflowing at a huge cost to the taxpayer. Violent crime is on the rise and the number of convictions is down. The money spent on dealing with crime is wholly disproportionate to the money spent on crime prevention.
I agree with my noble friend Lord McNally that we should move away from the knee-jerk reaction to crime. The last Conservative Home Secretary, Michael Howard, famously said that "prison works". He failed 393 to explain that half the prisoners in British gaols go on to reoffend on release. Perhaps I may say here that I welcome the forthcoming debate on prisons in the name of the noble Lord, Lord Hurd of Westwell.
It is important to recognise that prisons have not only become the dustbins of society's ills but that we continue to subscribe to the outdated notion that prison works. When will we accept that our prison system is under serious strain? Why is it that we still find it necessary to subscribe to expensive and unsatisfactory disposals more widely than the rest of Europe?
As Home Secretary, Winston Churchill said in July 1910 that,the mood and temper of the public in regard to the treatment of crime and criminals is one of the most unfailing tests of the civilisation of any country".This must be the starting point in establishing any legislative framework dealing with this subject.
We must also accept that the frenzy generated by the media does not necessarily reflect the public mood, but, in the absence of pronouncements from political leaders, we often assume that such is the case. The controversy surrounding the Bulger case clearly demonstrates this.
The links between social exclusion and crime are crystal clear; we have to look only at the characteristics of people in our prisons. More than half of the young people in custody have been excluded from school; two-thirds were unemployed before imprisonment and 40 per cent have been in care; 60 per cent of prisoners have literacy and numeracy skills at or below the basic skill level; more than 40 per cent have drug problems, and the proportion with psychiatric problems ranges between 40 per cent and 75 per cent. For many prisoners from minority ethnic groups, who comprise about 18 per cent of our prison population compared with 5.5 per cent of the general population, social disadvantage is confounded and reinforced by racial discrimination.
It is easy to fall into the trap of thinking that the country and, in particular, young people are becoming increasingly lawless. That is not true. A large number of our population are law-abiding. It has been proved again and again that the ability of criminal justice legislation to influence the crime rate is strictly limited. If that is the case—and the statistics prove that it is—we have seriously to ask what changes are necessary to reduce offending. I am grateful to the Minister and delighted to hear him say that the Government intend to examine past legislation, because there seems to be an insatiable appetite on the part of the Home Office to promote legislation without due care as to the consequences.
Burnley, Bradford, Oldham and Leeds are clear examples of failure to bring economic and social benefits to all our people. We have the most comprehensive race relations legislation in western Europe; yet it has failed to promote equality for all our citizens. We have strategies to tackle social exclusion; 394 yet it is evident that those policies have failed to remove some of our citizens from the cycle of social deprivation.
Such situations are often exploited by extremists, supplemented by irresponsible political pronouncements which inflame the situation. Politicians should be worried about the role of extremist organisations. Let me make it clear that racial attacks perpetrated by ethnic minorities on whites, or by whites on ethnic minorities, should be condemned. Equally, if we are not careful, we shall find that the recent gains made by the extremists in Oldham and in other constituencies in the North are a clear reflection of the fact that racism raises its ugly head when elements in society set out to exploit race for their own advancement. What are the Government doing about this?
Britain is not a "foreign land". It has always been a nation of migrants. They have contributed to a booming economy and have reduced labour shortages. Look at our health service. Would it survive without their contribution? Would our transport infrastructure survive without their contribution? Look at our small businesses—where do we go for our sweets and newspapers? Look at our post offices—who is running them? Who is providing services in rural areas? Nearly a third of doctors nationally are now non-UK born and nearly a third of all nurses in inner London are non-UK trained. We should never forget that a proportion of today's refugees will be tomorrow's citizens and will make a valuable contribution to the economic development of the United Kingdom.
The UN High Commissioner for Refugees has stated that the protection that is owed to refugees under the 1951 UN Convention on Refugees may be rendered meaningless if persons in search of protection and assistance are unable to reach the territories of states that are party to the convention.
We believe that some of the provisions of the Immigration and Asylum Act are a barrier to human rights protection. The Act seeks to prevent those who are at risk of persecution from fleeing their persecutors. Almost all avenues of entry are now closed. I have yet to receive an answer to a question that I have often posed in this House; namely, how can genuine asylum seekers who are being persecuted enter this country legally? I am still awaiting a reply. Here is a challenge to the noble Lord, Lord Rooker, in his new role. Can he provide an answer?
As I have said repeatedly, immigration and asylum issues are fairly emotive. But that should not stifle discussion and debate on how such matters are to be tackled. Despite the nature and effects of various immigration and asylum legislation, the circumstances surrounding them remain contentious.
There is evidence that fairness has often been sacrificed in preference to a faster and firmer policy. The current asylum policy is in disarray—it is in a mess; and the voucher system is a disgrace. Life under such a system is no bed of roses. Perhaps I may quote from an article that appeared in the South London Press, based 395 on what Donnachadh McCarthy found out when he spent a day as an asylum seeker in Brixton after exchanging some cash for vouchers:Braving staring eyes, he attempted to buy a cold remedy in Boots on Brixton Road with the voucher. Handing it over to the cashier, he mumbled in broken English: 'Do you take?'The cashier took the £5 voucher and looked at it up close, then studied her customer. After a tense pause, she walked to the back of the shop to consult a superior.He took one look at the voucher, rolled his eyes, cocked his head, indicated that they were not valid at the major high street store. Our pseudo asylum seeker received his moribund currency back and left the store in full view of a host of staring eyes.Next, he tried to buy a tube ticket. Again, after a few puzzled looks, access was denied.Taking a bus, the same.So on to Sainsbury's Local for a spot of shopping. Walking round the store he picks up a few essential items that this slimmest of budgets allows, and brings them to the till. But this time a sympathetic cashier smiles and informs our 'bogus' asylum seeker that he cannot give him any change from the £5 voucher. So as the queue begins to gather, he has to rush back around the shop and get a few extra items.Even so, he only makes it up to a £4 total with a few pieces of fruit, which have to be weighed and priced at the till, losing him £1 of his precious £36 budget".That is the reality of the voucher scheme to many asylum seekers in this country. The administration of the system costs more than the relief it provides. We were promised a review. Where is it?
The history of immigration is one of success for this country. The integration of immigrants, refugees and asylum seekers has been truly remarkable. Their contribution is important and valued. Also, we are seeing a labour shortage in key areas of our economy. There are shortages of skilled workers in the IT sector and shortfalls in the health sector. Fruit is being left unpicked for want of the necessary labour. Added to this are demographic changes. Our society is ageing: by 2050, nearly 23 per cent of Britons—14.7 million—will be over 65. Even the Metropolitan Police are keen to seek recruits among those who have applied for asylum. Equally, unless we open the door for the intake of migrants to provide the necessary skills, we are heading for serious trouble in future years. Many Western countries have found this out, to their cost.
There is also serious concern about the asylum process. The Government may have got the initial decision time down to two months, but one way of speeding up the process was to ask applicants to fill in a 28-page questionnaire in English within a week and, if they did not do so, to refuse their application on grounds of "non-compliance". Last year, 27 per cent of refusals were for that reason and not because of any defect in the substance of the application. As a result of a recent court case, caseworkers still have to consider any information that arrives after the one-week period before a decision is taken, but other than that points of substance have to be considered by adjudicators. So the two-month target has been achieved, but at the expense of the quality of decision-taking.
396 Under the Tories, the immigration casework department had been allowed to run down. From 1998 onwards, it had a programme of recruitment and training so that, by the beginning of 2000, decisions had begun to exceed new applications and the backlog was gradually reduced. By the end of April 2001, the backlog had been reduced to what is described as "frictional level" and the number of initial decisions started to tail off. In the meantime, however, the appeals system was unable to cope with the extra workload. The backlog of appeal cases has risen by 11,000 since the start of 2000, or about three months' work. In addition, the appeals support section is simply not sending cases to the Appellate Authority to the tune of 45,000 cases since the beginning of 2000. This delay is not counted anywhere; so the Home Office can say that it is reaching its targets, while applicants are still having to wait in the queue for over a year.
The Immigration Law Practitioners Association, which represents the lawyers who act for asylum seekers, says that, although they are now funded by the Legal Services Commission and that that is working well, they are at the limit of their capacity to deal with cases, particularly appeals. Since the beginning of this year, 3,300 appeals a month have been determined. That figure is still woefully short of the rate that is necessary to cope with the huge increase in decisions. It is even more difficult to increase the throughput of the appeals system than it was to speed up the first decisions. The infrastructure of courtrooms is not there; not enough adjudicators are available; and there are not even the lawyers to act for either the applicants or the Immigration Service. This is a recipe for chaos.
In the meantime, more and more asylum seekers are being detained, most of them in prison despite the Government's official policy that special purpose detention centres should be used. They are in the process of building new centres for 1,800 detainees, the first of which, Harmodsworth near London Heathrow, is due to open at the end of July. In the meanwhile, the Government said that in order to speed up the process of removing asylum seekers who are turned down from 12,000 to 30,000 cases a year, the Prison Service was being asked to provide another 500 places to accommodate those about to be returned. These extra detainees are not wholly, or perhaps even mainly, at the end of the asylum process. The exercise is being used to mask an apparent increase in detention on arrival, coupled with a tougher attitude by adjudicators on applications for bail.
Apart from those technically detained, there are also those who are held at Oakington as a condition of their temporary admission. Again, its purpose is to accommodate 400 asylum seekers. They are processed there in a week, and, if refused—as most of them are—they are either transferred to detention centres or prisons. That must cause us concern. Perhaps the Minister would care to study what I have said and perhaps write to me about the concern that I have expressed.
397 I am concerned that we are going to miss the boat as far as concerns radical reform of race relations legislation. We have seen some progress in amendments introduced from time to time. We need to look at the relationship between the Human Rights Act and legislation relating to gender, race, disability, sexual orientation, religion and discrimination on other improper grounds. Is it not time for the structure appropriate to equality bodies to be examined? We need to know what is being done in this respect.
There are also concerns about the Race Relations (Amendment) Act 2000, which, for the first time, brought immigration control within the scope of the Act. But its impact will be limited if immigration officers are given a blank cheque to discriminate based on statistics that they compile on intelligence that they gather. The noble Lord, Lord Rooker, will be aware that there was considerable discomfort in the other place that there should be such exceptions. Will the noble Lord examine the current authorisations and report back as to whether he is satisfied that they cover only those situations where discrimination is absolutely necessary and justifiable, and when the objectives of the Immigration Service cannot reasonably be achieved by other non-discriminatory means?
Perhaps I may conclude with reference to the retirement of Paul Whitehouse, Chief Constable of Sussex. I am concerned about the wider implications of the way that this matter has been handled. I was a member of the Sussex Police Authority when Mr Whitehouse was appointed. I make no comment as to the handling of the fatal shooting incident. The investigation was supervised by the Police Complaints Authority and a separate inquiry was conducted by Sir John Hoddinott. These recommendations were acted upon and the appropriate disciplinary action was taken.
May I ask why it was necessary for the Home Secretary to dictate to the police authority the action that it should take? The obsession that everything must be controlled centrally must be rejected. This is bound to compromise the operational independence of our police forces. We have been promised a police Bill. We shall resist any more centralised control or, for that matter, a national police force. We shall look at the police disciplinary procedures with great care. That will determine how we should deal with such situations. The last thing that we need to do is to deny justice either to the Ashley family or to Paul Whitehouse.
§ 5.24 p.m.
§ Baroness Kennedy of The Shaws
My Lords, I should like to join in the welcome given to my noble friend Lord Rooker. Just listening to his speech today was refreshing. Of course, he is no maiden speaker, but it was delightful to hear my noble friend express his willingness to listen before pressing ahead with change. That is a style that will he particularly welcomed in this House. I have long been an admirer of my noble friend from afar. He made a very considerable contribution—one insufficiently 398 acknowledged—to the national debates on education. I know that my noble friend's presence will undoubtedly enrich this House and that he will make many friends on all sides of the Chamber in the years ahead.
I am sure that my noble friend has been warned that, as Minister for the Home Office, he will not always have an easy ride in this House—not even from colleagues on his own Benches. I assure my noble friend that any criticism is always made in the spirit of the warmest good will, but I, too, like the noble Lord, Lord Dholakia, have been a critic of the Government's policy of vouchers for asylum seekers. I. too, have been concerned about a penal policy which has seen a continuing rise in the prison population; and I, too, have been concerned about the treatment of juvenile offenders. However, it will come as no surprise to noble Lords that I am here wishing to raise issues concerning civil liberties.
I ask: what is this all about? Why is it that we are seeing an extraordinary draconian assault upon civil liberties happening in the early 21st century? How does it come about that the Labour Party, my party, which has always passionately championed civil liberties and been so vigilant of their encroachment, now so prepared in government to abandon some of its principled positions? I tended to think that, as with the economy, a new government were anxious to prove that we on the Labour Benches could engage rigorously and prove that, in our grip, other areas of government could be handled as effectively as any other government had handled them. Perhaps with the issue of crime we were again wanting to show that we, too, could be tough. When I was feeling less optimistic, I even thought that perhaps it was simply a display of machismo.
But I now think that what we are seeing is something that is, perhaps, more extraordinary; and it is happening without enough discussion. One of the reasons that there is not enough discussion is that citizens are becoming distanced from the processes of government. What I propose and should like to see discussed on other occasions in this House is the claim that somehow we are at this time, in the early stages of the 21st century, reaching what some people have described as "the end of history"—the end, some claim, of ideology. In among all this there is a notion that we now have more or less a degree of consensus politics and that with that a modern state has evolved: a modern state that is somehow benign, a vanilla-flavoured modern state that is incapable of tyranny. Washed clean of ideological conflict, this new form of state is presented as even-handed, as an arbiter between citizens, a state which is itself incapable in its managerial manifestations of any serious abuses of citizens' rights.
At every turn we are told that there are procedures, appeal processes, and opportunities to sue for compensation if anything goes wrong. The drivers of the modern state are cost effectiveness and "pragmatism"—that very popular word—and, of course, the Human Rights Act is evoked as the new mopper-up of the occasional default by state 399 functionaries. To espousers of this new thinking, civil liberties protections may seem out-moded, old-fashioned, unfit for the 21st century, and in need of "modernising"—another of those new words, or frequently-used words. Civil liberties in this context become an encumbrance if you want to reform the legal system; if you want to save money; if you want to speed up the court timetable; and if you want to get more convictions.
We all in this House want to end unnecessary delays and to improve the system. We all want to see wrongdoers brought to justice. So why do civil liberties matter? Is this about clinging to ancient kitchen gods which have outlived their usefulness? I suggest that to understand civil liberties we have to understand the nature of power and to understand the state. We have to recognise that, although the modern state may present itself differently in some facets and although we may be in the process of modernising it, the essential elements remain the same.
It is in the very nature of power that it has a huge capacity for corrupting. Those who acquire power find it very addictive and seek, even unconsciously, to extend it. The state's powers have to be held in check in the interests of the citizen. Carefully calibrated checks and balances have to be created over centuries. I say with conviction that tyranny does not just come in a uniform, it also comes in an open-necked shirt and even in an Armani suit.
Civil liberties are our protection against the state. They are your protection and mine, as I so often say to juries. Encroachments on civil liberties are always sold on the basis that they are designed to convict the guilty, and that decent citizens have nothing to fear. The rhetoric of all governments who reduce civil liberties is that they are doing so for good reason in the interests of the people and to counter disruptive elements in society. The current rhetoric is that these changes are required in the interests of victims. These changes will undoubtedly create more victims. If this is seen as part of a modernising programme, all I need to remind your Lordships is that there is nothing modern about removing rights—governments have always done that.
Civil liberties are not the invention of effete intellectuals who live in Hampstead or Islington and have a soft spot for criminals. Our civil liberties were forged in the painful heat of experience over generations by all sorts of people: "revolting" peasants, the Tolpuddle Martyrs, Clydeside workers, servants vis-à-vis their masters and, more recently, the Guildford Four. To reduce trial by jury to those whom the state decides deserve trial by jury is an encroachment of civil liberties. To put an accused's criminal record before a jury and thereby erode the presumption of innocence is another of those encroachments. To retry offenders who are acquitted until the state gets the result it desires is an assault on fundamental principle.
I refer to what seems to be on the face of it a sensible possible change; namely, removing the double jeopardy rule in murder. The argument is made that DNA may be forthcoming which shows that someone 400 who has been acquitted may well be guilty. Unless one makes that process retrospective, which would be a very serious matter, it is hard to imagine murder trials nowadays where that is likely to happen. Such cases will probably be incredibly rare. The problem is they will probably be highly publicised and notorious. The suggestion is that only a set of senior judges in the Court of Appeal would decide that the new evidence was of such an extraordinary nature that they would send such a case back for retrial. Where would one ever find a jury that would not be affected by the fact that a Court of Appeal of senior judges had decided that the evidence was so compelling that they would throw aside a previous acquittal? How could one possibly expect a fair second trial? The practicality of the matter is the very reason that previous governments have considered it a change that could not hold water.
Defending liberty does not mean being on the side of those who commit crime. Our civil liberties are the mortar in the architecture of our society. Interfere with that glue and there will be a serious price in terms of alienation and loss of trust. Trust is essential to good governance. I make a plea to the Government to think again. Our civil liberties are precious.
§ 5.36 p.m.
§ Lord Colwyn
My Lords, debates on the Queen's Speech seem to move from one subject to another without any specific direction. After the excellent speech of the noble Baroness, Lady Kennedy, I feel a little embarrassed to return to health. However, I do so and I declare an interest in that I am a practising dental surgeon. I wish to comment on dentistry and the National Health Service.
I take this opportunity to thank the noble Lord, Lord Hunt of Kings Heath, for the time he spent in the Department of Health with responsibility for dentistry. While congratulating him on his new role, I hope that he will ensure that the new Minister, Hazel Blears, is thoroughly briefed to ensure that she has a similar comprehensive understanding of the dental profession, which is a vital and essential part of the health service.
In his speech at the BDA conference in Harrogate in May, the Minister paid tribute to the dental profession—something rarely heard from Ministers in recent years. He said that he was impressed by dentists' professionalism and standards and thanked the many thousands of dentists who had stuck with the NHS. He admitted that that support should not be taken for granted and said that he understood why so many dentists had felt unable to continue devoting themselves to the NHS. He stressed the importance of NHS dentistry as a core service matching the fundamental principles that were laid down in last year's NHS Plan—a service shaped around patients, which constantly improves itself and which supports and values everyone who works in it.
The Queen's Speech proposes significant changes to NHS management, with the abolition of regional offices and the streamlining of health authorities to 30 strategic centres, and the passing over of 75 per cent of 401 the NHS budget to primary care trusts, which themselves will be merged to between 250 to 300. PCTs will have responsibility for contractor services, including dentistry.
But PCTs have no experience of commissioning dentistry and have no existing expertise in dentistry. It is imperative for the future health of primary care dentistry, both in the general dental service, the community dental service and the personal dental service, that the reshaped PCTs have a dentist on the trust board to advise at the highest level of decision-making and, moreover, have access to the highest quality of dental advice for service commissioning, quality standards, health needs and outcomes. That is in short supply. There is also the question of how PCTs will interact with the profession. What is the future shape of local dental committees and what areas should they cover?
In March the Health Select Committee reported on its inquiry into access to primary care dentistry in the NHS and the effects of the recent strategy proposals. It stated that the time for talking was over and that NHS dentistry needed action now. There were too many reports, too much talk and too little action. The members concluded that dentistry had never been fully integrated into the NHS and that as a result major health inequalities exist. The present arrangements for accessing NHS dentistry are inequitable, uncertain and getting worse. Patients do not know where they stand. Unregistered patients find it hard to get any form of care and registered patients can lose that status without redress, often without knowing they have done so. Patients do not always get the advanced conservative treatment they need and some vulnerable groups of patients face even more problems.
The Government's paper on NHS dentistry was disappointing to the profession as it seemed concerned with access, to the exclusion of a huge number of other important issues. Can the Minister repeat the assurance that he gave to the profession before the election that the document, Modernising NHS Dentistry, was just the start of the process to revitalise and reinvest in NHS dentistry; and that there is still a need and a commitment to look at some of the endemic problems that have bedevilled the profession for decades?
With a full parliamentary term ahead of them, the Government have a once-in-a-lifetime opportunity to look at a better system of providing primary care dentistry. Are they willing to follow up the conclusions that the Commons Select Committee on Health demanded in March of this year?
I have referred to access and the Government's promise that everyone will have an NHS dentist by September. I am sure the statistics will show that this promise will be met. But a survey of vocational dental practitioners—those who are in their first year after qualification—has shown that 71 per cent are considering a career in private practice; and that only 10 per cent will consider working in a dental access centre or the personal dentist services. The Government need dentists to staff their access centres. 402 The survey shows that that is the last place in which the majority of them want to work unless it is short-term employment before moving on to somewhere permanent. Health professionals have been asked to make their clinical experience evidence based. Perhaps the recently announced fundamental review of the workforce should have been a priority rather than an afterthought.
The Government will fail to stem the flow of dentists out of the NHS if they do not tackle the huge bureaucracy in NHS primary care dentistry. For example, the dental modernisation fund—the £35 million announced for upgrading NHS surgeries—is worth about £1,000 per practice. To obtain that, practices have to wade through a 17-page document which explains all the complications of the process. The Government must commit themselves to simplifying a system which half the time their own Ministers do not understand. The public is confused and the profession is angry that the system regulating dentistry is so complicated. The only people who defend it are the bureaucrats. When it involves a key part of the primary care system, that is not good enough.
The General Dental Council's programme for reform has government support. For several years the GDC has been developing proposals to modernise its outdated regulatory structure, allowing it to strengthen its role in protecting patients, including promoting good oral health and high standards of dentistry. Until recently, those aspirations were frustrated by the lack of parliamentary time needed to amend the legislation.
On 27th April of this year the department published a draft order to amend the Dentists Act 1984. That order is the first in a series and deals with a modernisation of the GDC constitution. It will enable the council to reduce its numbers, increase lay representation and become more responsive and strategic. It will make continuing professional development a condition of registration for all dentists.
These two reforms are only the first in a series. The Government have confirmed that they will be consulting on two further orders which will, among other things, reform the council's conduct and health procedures, introduce procedures for reviewing the performance of dentists and enable the registration and regulation of the entire dental team. The GDC is also working on proposals to put in place robust arrangements to deal with complaints about non-NHS dentistry and the regulation of dental bodies corporate.
It is a formidable programme of reform to which the GDC is fully committed and the Government have agreed. I hope that the Minister will shortly be able to announce a timetable for the reforms., which are essential for the protection of patients and the continued high standards of dentists and the dental team.
I have concerns about a non-NHS complaints system. I hope to be able to make that clear when the relevant order is introduced.
403 The Minister will be aware that the non-consultant dental anaesthetists register is to close shortly. By the end of this year it will be mandatory for all general anaesthetics to take place in hospital. I have repeatedly asked the Government for details of waiting lists for patients who were previously treated under general anaesthetic in dental practices and who are now transferred into the hospital service. It was a great mistake to take away the right of general dental practitioners to treat patients in the way they considered best. It was an even greater mistake to establish a register, known as the tripartite list, of non-consultant dentists, many of whom have spent much of their working lives providing GA and sedation to a very high standard, providing further education and financing essential equipment, but to drop the whole idea now that the surgeries have been set up.
Anaesthesia is lost, but there is now a problem because so many GCPs do not have the skills to provide sedation or the education to consider its provision. Many patients are being referred to hospital for general anaesthesia when they could have their treatment carried out under sedation in dental surgeries. The GDC is addressing the issue and I hope that it will create acceptable standards in the teaching of pain and anxiety control and take advice from those in the profession who have spent many years working with anaesthesia and sedation. Patient safety should be based on education not regulation.
In the debate on the Address last year, I asked the Minister for news on the implementation of fluoridation. He wrote to me confirming the fact that the York University study has shown that fluoridating water helps to reduce tooth decay and that there are areas in the country where better dental health is associated with fluoridation. He said that the Government would be having further discussions with water companies and local authorities and that there should be more good quality research. He referred to the Medical Research Council and a request that it investigates where it is possible to carry out further research to strengthen the evidence currently available. He said that when this action was completed the Government would review the need for legislation.
I suppose it is easier to say this from this side of the House, but surely any government with a marginal interest in public health and health inequalities would have acted on water fluoridation. This Government have claimed to have a serious and major interest in public health. Yet they have completely failed to do anything to progress the most important oral public health measure available to them. Is it possible to get a commitment that the Government will work to address concerns about water fluoridation and will act at the earliest opportunity to introduce fluoridation where there is evidence of greatest need and where local population, local authorities, health authorities and water companies are willing to introduce water fluoridation?
§ Lord Monson
My Lords, I am grateful to the noble Lord for giving way. Does he realise that every other 404 European country, with the exception of the Republic of Ireland, shuns fluoridation? Indeed, some have banned it, considering that the risks outweigh the benefits. Could this be one of those rare occasions when we are wrong and the rest of Europe is right?
§ Lord Colwyn
My Lords, I thank the noble Lord for his intervention. If I had seen him there I might have omitted this part about fluoridation! I shall mention the noble Earl, Lord Baldwin, later.
When debating the Address last year, I reminded the Minister of the general concern about dental corporate bodies, which some dentists saw as a threat to their practices. It may well be that they just provide another way for patients to access services. But I feel that the restrictive practice which prevents other practitioners working together to set up similar environments is probably contrary to European restrictive practice law. In his letter to me, which was much appreciated, following the debate the Minister agreed with my views on corporate bodies and said that the necessary order would be laid once it was possible to amend the Dentists Act following the regulatory reform Bill. Can he confirm that this change is still on track?
I should like to take this opportunity to ask the Minister, or perhaps the Chief Dental Officer, why dental practitioners are prevented by law from prescribing medicines for patients by telephone. During my practising life, I have regularly prescribed simple analgesics or antibiotics direct to pharmacists so that the patients could avoid a journey to the surgery. Unlike the service provided for medical practitioners, I am aware that pharmacists are not obliged to accept telephoned or faxed prescriptions from dental practitioners. In the past most pharmacists have turned a blind eye and helped, but recently dentists have had many more problems prescribing in that way. I had to waste time recently speaking to five pharmacists in Sunbury before I could find one who would provide a simple antibiotic for a patient and save him the journey into central London. It is time that dentists were allowed to prescribe in a similar manner to their medical colleagues and I should be grateful if this simple measure could be incorporated into some appropriate legislation in the near future.
Any speech of mine on health would not be complete without a reference to funding. I stress yet again that the assumption that greater availability of medical services, more hospitals and clinics, doctors, nurses and health-related personnel and the development of a wider range of drugs and surgical techniques will lead to an improvement in health, increased longevity or an eradication of disease is ill founded. A better health service is not all about money. Health promotion is about the maintenance of good physical and mental health. It has very little to do with medicine and disease management and everything to do with how people live and their social and psychological environments.
My final point is about complementary medicine. If my noble friend Lord Baldwin had been here, I know that he would have made a powerful speech on natural 405 medicine and argued vehemently against me—and with the noble Lord, Lord Monson—on fluoridation. He cannot be here today. I know that the House will join me in expressing our deepest sympathy on the recent death of his wife.
In our debate at the end of March on the Select Committee report on complementary and alternative medicine, we thanked the Government for their acceptance of virtually all the recommendations. The Minister announced that he would be asking the National Health Service Research and Development Workforce Capacity Implementation Group to consider research capacity for development needs in complementary and alternative medicine and how they might be met. He also said that the exact amount of funding that may become available depended on the outcome of discussions with those who can take forward such matters. It would be helpful to have some indication of whether those discussions have taken place and whether any decision has been taken on the written strategies from the organisations that suggested ways forward for research.
The concept of integrated medicine, with complementary therapies working hand in hand with routine medicine, is the way forward. I hope that the Government will remain committed to their response. They said:The Government agrees that there is scope for closer integration of CAM and conventional medicine. This is in the interests of all relevant disciplines and, above all, in the interests of their patients".As many noble Lords have said during this series of debates on the gracious Speech, it is virtually impossible for the Minister who replies to cover all the issues that are raised. I hope that the noble Lord, Lord Hunt, who set a most helpful precedent last year, will be able to write to me in due course.
§ 5.51 p.m.
§ Baroness Masham of Ilton
My Lords, I add my congratulations to the Minister on his maiden speech. I also congratulate the noble Lord, Lord Hunt of Kings Heath, on retaining his ministerial position. Those in another place do not always realise how hard some Ministers in your Lordships' House work. I thought that the noble Lord might have moved up the health ladder after his hard work.
I welcome the Government's commitment in the gracious Speech to making health one of their main priorities in this Session. Some form of health crisis can affect many people in many different ways, often when they least expect it. I am told that one of the Prime Minister's favourite sayings is, "What counts is what works". The gracious Speech states:A Bill will decentralise power and direct resources to National Health Service staff, give patients greater influence on the running of the NHS, and strengthen regulation of the health professions".Sometimes, the health professionals do not know how to treat specialised conditions. Conditions such as spinal injury, haemophilia, children's heart conditions, babies with cleft palates, brain injury and many others need treatment in specialised units where the staff know what to do. A lack of expertise in such 406 conditions causes difficulties. If the Government do not listen and do not develop national strategies, there will be more disasters like the Bristol tragedy, when children died because of a lack of expert skills.
Surely there must be a balance. If the Government decentralise too much, there will be cover-ups and national standards will fall. The biggest waste of National Health Service money, which is taxpayers' money, is on large compensation payments in negligence claims. The human heartbreak in many such cases is even more important. Recently we heard of a man who died in agony with a tumour on his tonsil. The last doctor who saw him told him that he had flu. The country has lost a lot of confidence in a profession that was trusted and is vital for the wellbeing of the UK and beyond. Correct diagnosis is all-important. We must have protection for patients over cases such as Shipman. No doubt many shortcomings will emerge from that case.
We need well trained, dedicated doctors. Why is there a blockage in the training and registration of some doctors who come from abroad and want to train to be surgeons? We need up and coming, first-class surgeons with the right skills to tackle the ever-growing needs of the health service. I know personally of two such young doctors who come from South Africa. They have perfect English. How many more must there be? I shall not let the matter rest. The Government say that we need more doctors, yet there is a blockage. Surely the situation should be unblocked. I can send the Minister the names of those two doctors and the hospitals where they are working.
I am also told that nurses coming from such countries as New Zealand and Australia face long waits for their UK registration. Our hospitals and home care situations are crying out for them, but they have to wait. The Prime Minister wants to know what works; speeding up the process of registration will work. Perhaps the Minister can do something to oil the wheels of progress.
I am the founder and president of the Spinal Injuries Association. The association is most concerned when its members who have sustained injury to the spinal cord resulting in paralysis through trauma or illness, with loss of feeling and movement, do not get treatment in a spinal unit. I shall give an example of how important that is. A young man in his 20s broke his neck in a diving accident in Venezuela last year. Because there was no bed at the national spinal unit at Stoke Mandeville hospital for various reasons, he had to be admitted to Charing Cross general hospital, where he had a disastrous time and developed a serious pressure sore. Nobody evacuated his bowels, which is the procedure for paralysed patients. He caught MRSA from having a tracheostomy and was nearly injected in his neck rather than in his leg due to a language difficulty with a member of staff. He eventually went to the spinal unit at Stoke Mandeville, but, due to the pressure sore and MRSA, his rehabilitation has been held up and he has had to spend months in isolation.
407 That is why we need national standards. The Government should not shelve their responsibilities. They must ensure that patients who need it get the correct treatment whatever the conditions and wherever they live.
The gracious Speech says that there will be more patient participation in the National Health Service. That is welcome, but it will not work unless there is a clear, friendly, efficient point of contact. There must not be fragmentation. People who need help and others who are able to give advice need an efficient means of contact and a forum to be heard. CHCs have been good in some districts and ineffectual in others. Whatever we have in the future must be better. I hope that the Government will realise that voluntary organisations collect a great deal of information and represent many different groups that need to be taken into consideration. They need help and support.
The Royal National Institute for Deaf People says that there is a pressing need for an early, unequivocal commitment to and timetable for the national roll-out of the first wave of the modernising NHS hearing aid services project. Audiology services in the UK are facing a cash crisis that threatens to undermine recent embryonic improvements before they bear fruit. NHS audiology services are facing increasing demand from an ageing population, yet they are chronically under-resourced. Audiology services are being pushed to crisis point. Current funding is inadequate to keep up with basic demand. Many vital services for disabled people have been fragmented by contracting out. The wheelchair service is an example of that. Users of the health service need and appreciate a good, efficient service.
I hope that the Government will act on the recent damning report of the Audit Commission. With our excellent British engineering, we should be able to do much better so far as concerns disability. Perhaps the noble Lord, Lord Rooker, will agree on that point. This matter is important for the quality of life of individual people with disabilities and their helpers.
The health of the people is vital. With outbreaks of TB and food poisoning and dangerous hospital infections, I hope that the Government will keep infection control high on the agenda. With more power being given to local health staff, there is a danger that it may become fragmented. Can the Minister give an assurance that infection control will not be submerged at local competition level? It is far too important an issue to be neglected. There need to be adequate infection control personnel in hospitals and in the community. There should be a clear code of practice; the matter should not simply be left to individual trusts.
This debate embraces health and home affairs. It gives me the opportunity to bring to your Lordships some of the devastating problems facing many rural communities. Foot and mouth disease has caused many problems which will have far-reaching effects on the health of individuals and communities. There is isolation, heartbreak, anger, sadness, 408 uncertainty, anxiety—both financial and general—and disappointment, in some cases ending in suicide. Such insecurity may well lead to long-term depression.
Ill and disabled people, for fear of spreading the virus, have done without district nurses visiting them. Children and families have been traumatised by losing their animals. The endless worry continues as the virus still keeps appearing. The way in which some animals have been killed has appalled many people—both farmers and the public. There is a feeling of helplessness, and many people in badly hit areas or nearby feel that they are living in limbo. There is concern about toxic results from the disposal of millions of animals. I hope that the Department of Health will realise that there are health matters which need to be understood.
Sheep were being rounded up to be killed on the moor next to where I live. The son-in-law, aged 40, was helping the owner. He suddenly dropped down dead. That is just one of the many tragedies connected with this scourge. Foot and mouth brings a terrible added pressure on the countryside. Many people in tourism and farming are stretched to breaking point. The lack of knowledge about how the virus is spread is also an on-going worry. Can the virus live in a person's nose, as does MRSA? Perhaps the Minister will write to me about that. Is it not time that vaccination was tried out on controlled groups instead of relying on the horrific killing of valuable breeding stock?
As did the noble Lord, Lord Rea, this week I attended a conference hosted by the Foreign and Commonwealth Office on the global problem of drug abuse. The world-wide problem of illegal drugs increases crime and the human suffering of families. Alcohol also continues to disrupt many people's lives, including those of young children. We heard of the huge problem of the smuggling of alcohol by bootlegging and of children as young as seven and eight drinking alcohol. On Monday, I heard of a new swizzle-stick which detects drinks which have been spiked with drugs. That could be a useful piece of detection equipment for clubs and bars.
There are so many young people in our young offender institutions. I hope that those young people will not be locked up for hours but will be given education and work to help them to get back into a useful routine for life outside.
It is frightening when society gets out of control. When one considers the recent disorder that took place at international cricket matches, is it not time that clear guidelines were given to the police? People who attended those recent matches said that the police did not seem to act when fire crackers were used and flying objects were let off and thrown on to the pitches. It appears wrong that families cannot feel safe and enjoy a day out together.
My husband attended the match at Headingley, Leeds. When I heard on the radio of the uncontrolled rushing on to the pitch, I was concerned. I would support making matches safe by controlling the people and by cutting alcohol consumption and the use of 409 dangerous objects. Is it not time to control the growing violence in the UK before it gets completely out of control?
§ 6.6 p.m.
§ Baroness Carnegy of Lour
My Lords, the noble Baroness has ranged far and wide over the subject matter of this debate. When I first noticed the twinning of the two subjects of home affairs and the health service in one debate, I considered it to be a very bad idea. That was until I heard the deeply thoughtful speeches of my noble friend Lord Forsyth and the noble Baroness, Lady Kennedy of The Shaws. Then I realised that the whole debate concerns human rights. I am sorry that the noble Baroness, Lady Kennedy, is no longer in her place because I wanted to pay tribute to her.
We are talking about human rights in relation to a better health service and justice. Both issues could not be more important. During the election campaign and since, discussion on the future of the National Health Service has centred, albeit somewhat vaguely, on the advantages that private sector ways and private sector money may or may not have for the NHS. Doubtless, once we study the Government's precise proposals on this matter, our thinking will focus more sharply. Indeed, we may move on to thinking in the direction indicated by my noble friend Lord Forsyth.
In the meantime, I want to suggest one thing to the Government. I believe that one single, simple lesson must now be learned from the private sector. If the National Health Service is ever to recover from its increasingly parlous state—a state which, as the noble Baroness, Lady Masham, illustrated, is causing a great deal of suffering, often to the weakest people—a sea change must come about so that the NHS can move, as the Government rightly wish, to providing the best healthcare in Europe.
Sometimes the blindingly obvious has to be restated, and I hope that I shall not be accused of being over-simplistic. But I believe that a sizeable number of your Lordships who have had responsibility for attempting to improve the effectiveness of public services—whether as central government Ministers or as local government councillors, as I myself was when I was in charge of a local education service, or, indeed, as civil servants or local government officers—know the type of special problems that arise in running a public service effectively and cost-effectively. Noble Lords who have also been involved in the private sector or in running a private sector business, large or small—my own was simply a farm—will know all too well the principal difference between the two experiences.
Clearly in both the public and private sectors a business has the same five requirements. It has to have agreed objectives that are known to everyone concerned, the right staff, a suitable management structure, and financial and material resources.
In the private sector, such matters are settled within the business. Shareholder interests are a consideration for some. Workforce and trade union negotiation is needed, and internal management opinions need to be 410 reconciled. However, ultimately—this is the important point—it is the people who are responsible for running the business who decide on the business's objectives, on the numbers, role and training of staff, on the style of management, on the resources that are required and where such resources will come from. All such decisions are made in the light of what management sees as the wishes of customers, on whose opinion of the whole thing everyone's livelihood depends. It is obvious that that is the situation in the private sector.
In the public sector—the National Health Service is an outstanding example—however much is theoretically devolved downwards and however much the customer is supposed to be taken into account and protected, it is in effect an elected politician who takes such decisions. Through legislation, funding deals or so-called "guidelines" politicians set the objectives, decide which staff can be afforded and how training establishments will be funded. Politicians decide on the structures and allocate resources according to their perception of needs. Of course, we all know how politicians behave—for one thing, they keep changing their minds. As someone wrote the other day,Politicians are like windsocks: they change direction with every changing political breeze, and in between they are limp'".So it is in the National Health Service, except that there is not much limpness. Politicians keep legislating, issuing edicts, switching targets and altering structures. The effect on customers—patients or potential patients—is too often subsumed by the desire for a good overall impression. The effect on staff, most of whom went into the service in order to serve patients, is demotivating and may even cause despair.
It may be obvious but we should remind ourselves of the important fact that even when the public sector sincerely tries to devolve downwards, as the Government did in previous legislation when the so-called system of "earned autonomy" was invented under which NHS bodies that do well will be allowed to take more of their own decisions, it is still the Secretary of State who decides the criteria for doing well. His or her ambivalence about where the customer comes in and when public relations must take precedence are important in that regard. For the Secretary of State it is not only patients who form public opinion, but the unions, the Royal Colleges and the BMA, and it is sometimes puzzling for a Secretary of State to know which matters most.
There is an important difference between the private and public sectors—the public sector of necessity has a politician in charge, who has his own priorities. The private sector can make its own decisions and its priority has to be the customer. That almost always works better. The Government have to learn that lesson and explain it clearly to the public. I do not believe that most members of the public see the difference as clearly as noble Lords do.
It is important to remove the local units—I suppose that they are the trusts—within which we manage healthcare. We should so far as possible isolate them from politics and leave them to take their own decisions; that is what is done in the private sector. My noble friend Lord Forsyth discussed that in a 411 sophisticated manner, but I am sure that that, put very simply, is what the Government have to try to do. However we choose to do that, doing so will mean, among other things, that managers on the ground will be far more sensitive to clinical needs than many now are. That is one of the problems with successfully devolving healthcare downwards.
The system will have to ensure in some way that the money that is available follows the patient and that the patient has an element of choice. Unless that is done the value of treating patients will not be apparent to those providing that treatment and the right motivation will not be there. An appropriate element is present in the private sector but not in the public sector. I do not know how that should be done, but it is not my job to tell the Government how to do so. It will not be easy and it will take much courage, but the Government have the strength of their enormous parliamentary majority. They believe that the private sector has lessons to teach. Unless that fundamental sea change is brought about soon, no amount of extra money or ingenious mechanisms for funding or management will work.
§ 6.16 p.m.
§ Baroness Northover
My Lords, the gracious Speech is short and perhaps to the point on health. The Government would, it seems, decentralise power and direct resources to NHS staff, give patients a greater influence in the running of the NHS and strengthen regulation of the health professions. But what does that actually mean? I am afraid that the phrase that immediately leapt to mind when I heard that commitment was "double-speak". Could it be that George Orwell's dictums, "War is peace" and "Freedom is slavery" might apply in this context?
The Government wish to decentralise power. Or do they? Have they suddenly had a change of heart? They want to put more power in the hands of NHS staff. Well, that makes a change. They have not done so up to now.
They wish to put more power in the hands of the patient. Or do they? Do they now regret trying to abolish community health councils and replacing them with some odd mishmash? I take it that we will now have the one-stop shops that are best suited to patients. Or will we? We await the legislation with interest.
What of the third provision, which was about increased regulation of the health professions? We certainly support measures that would ensure that health professionals are trained and work to the highest standards. There have indeed been cases in which that was clearly not so, and it has been exceedingly difficult to ensure that those closest in are dealing appropriately with lapses. The attitude of "There but for the grace of God go I" too often paralyses those who should be taking action. However, more regulation simply does not go to the heart of the problem. The NHS is too often at breaking point because it has too few staff and morale plummets under too much pressure.
412 We know from the largest ever survey of NHS staff—it was of 80,000 people—that the state of mind of those in the NHS is best summed up by the phrase, "Stressed out and over-worked". My colleague in another place, Paul Burstow, analysed the figures. Perhaps the Department of Health could not bring itself to do so. I have previously quoted the figures but they merit repetition in this context because of their importance. They are that 52 per cent of staff in the eastern region said there were insufficient resources to do the job properly, that 60 per cent of staff in the northern and Yorkshire region said that morale was not good and that 77 per cent of staff in the north-west region said that they were not coping with their workload. Why is that? Constant reorganisations—I see that more are coming down the track—long hours, low pay, long waiting lists and the number of dissatisfied patients are contributory factors. But the key factor, time and again, is simply lack of staff. If, as the Conservatives did, you cut training places for doctors and nurses, how can you be surprised at that outcome? The number of nurses recruited fell from 37,000 in 1983 to only 6,000 in 1995. We are paying the price for that now. So where does the gracious Speech address staff shortages and morale? I cannot see.
What else does it omit? There is no reference to mental health reform, even though that was apparently regarded by the Government as badly needed. Wide consultation has already taken place on that issue.
What of PFI? What an indictment of planning within the NHS that that is the only way in which large projects seem to be able to be taken forward, with future generations picking up the tab. What is intended in that regard?
What of care of the elderly? The National Plan stated that,from October 2001 … nursing care provided in nursing homes will be fully funded by the NHS".And now, despite all that the Minister said in our recent debates on the Health and Social Care Bill, we hear that the Department of Health is no longer sure about that but is, predictably, not yet in a position to say whether it knows what it is doing on that matter. How does the Minister feel when he thinks of those older people who trusted what the Government said? Does he feel comfortable with his responsibility in that regard?
I turn now to what, for me, is the most astonishing omission from the gracious Speech; that is, that there is no Bill to ban tobacco advertising and promotion. Why not? I agree wholeheartedly with what the noble Lord, Lord Rea, said on that matter. If you cast your eye over history, it is public health measures which have made the real difference in lengthening lives and improving the quality of life. In 19th century Britain, it was sanitary reform that made the difference.
Professor Sir Richard Peto, of the Imperial Cancer Research Fund, speaking to the third global conference for cancer organisations yesterday stated that 1 billion people world-wide are likely to die this 413 century as a result of smoking. One hundred thousand people die each year in Britain of smoking-related diseases. So why do the Government delay?
I sat at a conference dinner the other day alongside a surgical professor from Northern Ireland who happens to advise the Department of Health. He said to me:Look around this room. One quarter of these people will die from cancer. And the one measure that can at a stroke reduce those numbers in the future is to reduce the incidence of smoking".I do not claim for a tobacco advertising ban that it would right all wrongs. But think of impressionable children, 10 year-olds—and here, I must declare an interest because I have one—who watch every movement of a smoker with keen fascination. Or think of the 12 year-old—and I have one of those too—for whom experimentation may well include smoking. Insidious, ever-present tobacco advertising and promotion has already seeped into their minds and it spells acceptance of something which is so easy to take up and so very difficult to shed.
So what on earth did the Government's cancer czar, Professor Mike Richards, and his group of expert advisers have to say when that Bill, delayed in the last Parliament, was omitted from the gracious Speech? I hope that they made their feelings extremely plain.
We hear rumours that the Department of Health is not happy that that Bill is not before us today. Indeed, I trust that it is very unhappy and that what it has heard in this debate will strengthen in arm in whatever negotiations it is carrying on with whoever is resisting it, and that that Bill will be brought back to us without delay.
So what do we make of this gracious Speech? What is most not able in relation to health is what is missing or what is expressed in a somewhat surprising fashion. We expect swift action in those areas so far omitted, particularly as regards tobacco advertising. Meanwhile, we are surprised and delighted that the Government are committed to a devolved, decentralised health service in which patients have more power. We look forward with the keenest of interest to see in reality the rapid about-turn that the Government must perform in order to achieve that.
§ 6.25 p.m.
§ Lord Mackenzie of Framwellgate
My Lords, I start by joining in the congratulations to the noble Lord, Lord Rooker, on his appointment to the Front Bench speaking on Home Office matters. I read a survey recently which stated that people's biggest fear was the fear of speaking in public. People's second biggest fear is the fear of dying. I am told that there is a third fear; that is, the fear of dying while speaking in public! I know that your Lordships will not allow that to happen to me this evening.
I am delighted to welcome the provisions of the gracious Speech. We hear a great deal in this place about the welfare of prisoners and prison reform. I respect those noble Lords who represent that particular lobby. It is a fine position from which to be coming from a humanitarian point of view, 414 particularly if it prevents reoffending. My noble friend Lady Kennedy talked about the civil liberties of this country being the cement in the foundations of democracy, and I agree with that. But I tend to think that the civil liberties of victims are equally as important as the civil liberties of those who commit criminal offences. However, I am very pleased that with regard to criminal justice, the Bill concentrates on putting victims first. Perhaps I should declare an interest as a patron of the North of England victims' Association.
I start with the proposal to abolish the double jeopardy rule. In 1997, as president of the Superintendents' Association of England and Wales, I addressed the national conference which was to welcome for the first time the new Home Secretary, the right honourable Jack Straw. In my speech in 1997, I called for the abolition of the archaic double jeopardy rule. We had been through a period in which a number of wrongful convictions had been identified for various reasons. Those miscarriages, quite rightly, had been corrected.
I recalled many years previously, long before I was a police officer, the case of a man called Stanley Setty who had been murdered. His dismembered body parts had been thrown from an aircraft into the North Sea. I recall graphically the trial of one Donald Hume for that grotesque murder. He was eventually acquitted.
As a young student of the criminal law at that time, I remember my horror at reading for the first time the gruesome details of the murder by none other than the self-confessed murderer himself, Donald Hume. He wrote his story in a Sunday tabloid—I think it was the Sunday Pictorial, and that shows how long ago it was—detailing the murder, how he chopped up the body and distributed the body parts from a light aircraft. I have little doubt that he earned quite a fat fee for his memoirs.
I was even more disturbed when I realised that for all his admissions, he could not be prosecuted because of that ancient common-law doctrine of autrefois acquit which, in essence, meant that an accused could not be put in jeopardy twice for the same offence. It was a rule which was created in ancient times when the odds were stacked against the criminal. For example, in those days, the accused could not even give evidence in his own defence. It seemed to my simple mind at that time that the interests of justice would be served by accepting the principle that a wrongful acquittal was just as much a miscarriage of justice as a wrongful conviction. Times change, and it seemed to me that with modern forensic evidence and other legal safeguards, the time had come for a change. Justice should reflect the public interest.
There have been more recent cases. In the North East, for example, a man was charged with the murder of his girlfriend, whose body was subsequently found by her mother hidden behind the bath. The man was acquitted and following an indiscreet admission of guilt when in prison, he was subsequently charged with giving false evidence at his own trial. He was sentenced 415 to six years in prison for perjury. Understandably, the victim's mother, as an innocent victim of the murder, has ceaselessly fought for justice.
We have to look no further than at the case of Stephen Lawrence to see that, as the law stands at present, an unwise private prosecution, followed by an acquittal, completely prevents a retrial of those against whom there may be a prima facie case of murder.
In 1997 my plea fell on deaf ears at the Home Office, but I am delighted that those at the Home Office have now seen the light. I hope that the provisions are retrospective so that past miscarriages of justice can be corrected. Justice demands nothing less.
Reform of the police is equally important. In the press there has been much discussion about the police service. Having been in it for 35 years I have some little knowledge of its culture and the way in which things are done. In 1997, for example, medical retirements in the Merseyside Constabulary were running at about 77 per cent, whereas in Kent the figure was 16 per cent. That cannot be right and must have something to do with the way in which sickness is managed in police forces. If some medical retirements are bogus, as is suggested, what about the doctors who are signing the medical certificates? However, do not throw out the baby with the bath water; let us not condemn the many for the actions of the few. Policing is a demanding and dangerous job and we must be sympathetic to those officers who are invalided out of the service in the line of duty.
Exemplary leadership in the police service is extremely important. Those at the top of the profession must practise what they preach. Often we do not require improved management, but improved leadership.
The police force also has people like Detective Superintendent Ray Mallon of Cleveland who has been suspended for three and a half years, originally on serious allegations, resulting in operation Lancet being set up. He has since been cleared of all criminal allegations, but he remains suspended pending disciplinary matters. It would have been the easiest thing in the world for Mr Mallon to walk away from the accusations, suffering perhaps from stress, and taking an enhanced medical pension, rather than face his accusers. He chose not to do that, which shows the difficulty of the situation. Ray Mallon is a prisoner of the police complaints system. In my view, he is a credit to the police service.
Such a case emphasises the need to reform and improve the police complaints system. It is a scandal that a senior officer, of high integrity, is suspended for four years on what now amounts to internal disciplinary matters. It follows that I am delighted that the complaints system will be made more accessible, more open and will not, I hope, allow the disgrace of innocent officers remaining suspended for such a long period. The police too are entitled to justice.
Time does not permit me to deal with other justice matters mentioned in the gracious Speech in great detail, suffice it to say that I welcome the commitment 416 to provide new support to the police in the fight against crime. That is absolutely critical. It is also critical that crime is not seen to pay. Therefore, I applaud wholeheartedly the proposals to attack the proceeds of crime in order to prevent the orchestrators of criminal activity from building up valuable nest eggs and salting them away without having to explain how they came by such ill-gotten gains. In my judgment, that provision will pay for itself from the proceeds that will be gained.
The public are entitled to a reasonable quality of life. Only today in an Underground station at Hyde Park Corner I had difficulty walking past two settees which were clearly the beds of two poor individuals who presumably slept there at night. In 2001 that is simply unacceptable. That is a social problem that needs dealing with. I despair. In this new century I believe that the police and social services should take action to deal with such difficulties. There must be better ways of dealing with people than allowing them to sleep in such places. Tourists were falling over them. It was quite disgraceful.
In my view the provisions of the gracious Speech are positive and ensure that society's crime-fighting capabilities are able to tackle crime in the 21st century. I commend the proposals to the House.
§ 6.36 p.m.
The Lord Bishop of St Albans
My Lords, I thank the noble Lord, Lord Mackenzie, for his speech. It may be of comfort to him to know that the terrors of speechmaking are shared by us all, but medically speaking the time of greatest risk is when a speaker sits down as that is when the blood pressure really rises.
On 10th February 2001 the BMJ gave an analysis of the Alder Hey affair. In that article I came across the following phrase:Doctors must understand that many patients want to relate to health-care providers in a different way—they want to be partners in the decision making process".A couple of weeks later two articles in the BMJ picked up on that theme. The first, concerned with global definitions of patient-centred care, stated:patient-centred clinical practice is a holistic concept in which components interact in a unique way in each patient-doctor encounter".The second article was a report of a research study at Southampton University which concluded its results as follows:Patients in primary care strongly want a patient-centred approach with communication, partnership and health promotion. Doctors should be sensitive to patients who have a strong preference for patient-centredness".I have no competency whatever to comment on the quality of that university's research, but I quote those articles to make a simple point. In each of them the word "partnership" has "hooray" status. In other words, apparently, "partnership" is the kind of concept about which we must all be automatically in favour. But neither article pointed out that if the partnership concept is taken seriously, it is an expensive process; not necessarily in terms of costs of medicines but in terms of time. Is there any reality at 417 all in the notion of partnership if it takes two weeks to get an appointment to see a GP and that appointment lasts for less than eight minutes?
I hope that all that I have said will not be construed as an attack on GPs. My point is the exact opposite. If "partnership", as a concept in medicine, is to have any validity at all it needs time and yet in my experience GPs do not have time. They are now pushed to their absolute limits. Partnership can work as a concept only if there are more GPs—and, yes, I know that more are promised—together with more nurses. But there is a moral question hidden away about whether or not it is right for a relatively wealthy nation to take medical staff from countries which are themselves frequently in desperate need.
Now let me gear the picture up a level. I have spoken so far about GP-patient relationships; they are, essentially, one-to-one. What will happen to the management of medical time if, as I believe is right, power is shifted from Whitehall to the NHS front-line and if that is combined with a political and social emphasis on patient power and on partnership? I venture to suggest that the stress load on management and on medical staff at a local level will be unendurable. We are asking NHS staff to offer more and more time to their patients and we are also asking them to offer more and more time to the efficient running of local services when time is already the factor in desperately short supply.
That kind of impossible demand could lead to serious breakdown in the service because two contradictory messages are being given. The first is, "Give your patients"—and for "patients" read "partners"—more time. The second is, "Give local management of healthcare more time". Meanwhile into the general stream of public discourse slide phrases such as "patient-centred partnership" and when that happens public expectations are raised to extraordinary heights.
Therefore, I suggest that we have some very powerful forces at work in our society. There is peer pressure within medicine to move to a partnership model of patient care; there is raised public expectation of partnership models; and there is a further demand that at a political level partnership must involve the devotion of more time to local management of healthcare delivery.
At the very centre of all these immense pressures are the clinical staff upon whose personal well being the entire system depends. It is a recipe for human and systemic breakdown. I do not need to add to the statistics about staff, so eloquently and forcefully outlined by the noble Baroness, Lady Northover. Those points were well made.
Can Her Majesty's Government assure us that the impossible demands will be carefully monitored? Can they also assure us that the care and well being of NHS staff are genuinely central to the Government's NHS policy? Without that, the anger, scepticism, sadness and despair, which currently exist among NHS staff, will continue to grow and the concept of partnership will be regarded as an idea which is entirely empty of meaning.
§ 6.44 p.m.
§ Lord Dean of Harptree
My Lords, it is customary for a maiden speaker to be congratulated only by the noble Lord who follows. However, I believe that on this occasion an exception should be made. The noble Lord, Lord Rooker, made a highly effective contribution. He and I served together in another place for many years. We were on opposite sides of the fence of course, but I remember how highly effective he was both in Government and in Opposition. Therefore, I believe that I can make an exception to the normal rule and congratulate him on his appointment and on coming to this House.
I intend to refer to health, and I am pleased that the noble Lord, Lord Hunt of Kings Heath, is one of the few Ministers still in the same post. We all respect his deep knowledge of the health service and we look forward to his reply at the end of the debate. It is also nice to see my noble friend Lord Howe on the Opposition Front Bench because his knowledge and experience of the health service are equally great.
I want to spend most of my time talking about the public-private partnership which is developing, particularly in relation to the health services. I decided to speak on the subject some weeks ago and had not then realised how topical and controversial it would be. Nor had I realised that on this very day the Prime Minister would be meeting trade union leaders to try to calm their fears about the way in which government policy is moving. I realise that it may be too early for the noble Lord, Lord Hunt, to comment on the Prime Minister's meeting, but I am sure that the House would be interested to hear any comments he can make.
During the years we have seen a steady development of partnerships. It has usually meant that the private sector has increased and the public sector has decreased. However, in some cases finance has remained with the public sector and delivery has passed to the private sector. An early example of the decrease in the public sector was the sale of council houses to sitting tenants at favourable terms. That was introduced many years ago by a Conservative government. It was at that time opposed by the Labour Party and by Labour councils but it proved to be an instant success. One saw the appearance of new front doors on council houses and other improvements being made. Many people who would otherwise be council tenants were able to have a pride in ownership.
We then saw the return of the nationalised industries to the private sector. That began in a modest way with the Conservative government in 1979 and soon became a flood. We found that many of the industries became profitable and began paying taxes rather than being a big drain on taxpayers. Of course there are problems in some areas, the railways being an obvious example, but they might have been in a worse mess had they still been nationalised.
I am delighted that the principle of public-private partnership is being extended to education and health. Those developments are most important and welcome. The principle is right but the details need a great deal 419 of working out. There are fears and anxieties, particularly among some of the Government's supporters in another place and in the trade unions.
As regards education, it is now recognised that the comprehensive system does not provide the variety and diversity which is required to meet the needs of all children. We welcome the new ways which are being developed in which the private sector and Church bodies can support schools and take over the running of bad schools. We also hear that there will be advanced specialist schools and that firms will be encouraged to sponsor new city academies. That diversity and choice are most welcome and should certainly raise the quality of our education service.
I turn to health services, where I believe the new initiative is most needed, although it is controversial. This matter was referred to by my noble friends Lord Forsyth and Lady Carnegy. When the health service started in the late 1940s it was thought that the cost would become static as soon as the backlog of ill health was dealt with. How wrong those forecasts proved to be. We now know that the demand for resources is insatiable, for which there are two or three obvious reasons. The first is the enormous advances in medical treatment and equipment and, therefore, the requirement for new hospitals and health centres to accommodate them. The second reason is that there are more elderly people in our population. It is a great blessing that people live longer, but inevitably it means more pressure on health and social services. Thirdly, people's demands for higher standards rise all the time.
Inevitably, those three features mean enormously increased pressures on the National Health Service and its staff. Some years ago when I was a governor of BUPA it was always said that the NHS and the private sector should be complementary, not competitive. That was anathema to the Labour government at the time, but the present Government take a different view. I warmly welcome the concordat which has been negotiated between the National Health Service and the private sector which allows the NHS, in appropriate circumstances, to use private hospitals where beds are available. I understand that in various parts of the country there are already good results as a result of this initiative. Waiting times for treatment, which are far more important than waiting lists, are coming down. That still preserves the cardinal principle of the National Health Service that treatment at the point of delivery is free. When someone goes into a private hospital it is the NHS, not the patient, which pays.
We also welcome the private finance initiative whereby private money goes into the building of hospitals. It must be clear by now that we need all health resources, both public and private, working together to improve the quality of services to patients. Of course there will be problems and controversies, but the principle is right and I hope that the Government will pursue it.
420 At the moment my party is not much good at winning elections, but it has persuaded the present Government to follow Tory policies in education and health and I welcome that.
§ 6.54 p.m.
§ Lord Fitt
My Lords, first, I sincerely thank the noble Baroness, Lady Gale, for permitting me to speak at this time, particularly having listened to my noble friend sitting beside me. I have an appointment for a heart scan tomorrow morning. Having listened to my noble friend, I am slightly apprehensive about it. The reason that I take part in the debate is that in London at the beginning of the week of the general election I received a letter from a parent in Belfast who explained that her small daughter was suffering from juvenile arthritis. What she said in the letter really affected me. I jumped on a plane next morning and met the parent. Having spoken to her, I became personally and passionately involved in an issue that had never affected me throughout the whole of my political life.
I found out that there was such a thing as juvenile arthritis which can affect anyone from the age of three right throughout his or her lifetime. The pain and distress that those affected must endure are unbelievable. Since speaking to the mother I have become involved. I rushed out to phone the Minister of Health in the Northern Ireland Parliament who is a member of Sinn Fein. It is well known from the years that I have been in your Lordships' House that politically I do not have anything to do with Sinn Fein. However, I let my misgivings go because I wanted to speak to the Minister about the terrible case about which I had just heard. She was on and off the phone or somewhere else. Perhaps she did not want to speak to me as I am an opponent of her political party. My attitude in this case was determined by humanity, not politics.
I then became more involved and rang a colleague of the Minister to see whether I could arrange a meeting to discuss the particular case. Again, the individual was not available. I returned to Stormont. The Minister was again very busy but I met her private secretary. I explained the case in which I had become so involved.
I contacted the hospital treating the patient. What I found out, and now illustrate, is in total contradiction to every idea of the National Health Service as we know it. It states—I believe that it has been said here as well—that it awaits a report from the National Institute for Clinical Excellence to see the effects of the new drug. There are now two new drugs available in England and the Republic of Ireland: one is Etanercept and the other is Infliximab. These drugs, which produce absolutely no side-effects, have been available in the United States for the past five years. Consultants who are closely involved in the treatment of this terrible condition have confirmed to me that those drugs have absolutely no side-effects. They are quite confident that some time in October or November of this year NICE will conclude that this drug has no serious side-effects.
421 The reason this drug has not been used in Northern Ireland as in other parts of the United Kingdom is that it is expensive: the cost per year is between £6,000 and £7,000. If one sees as I have the terrible consequences of this disease, that would be a very small price to pay to alleviate the suffering. There are now 75 cases in Musgrave Park. Every day, every hour and every minute they wait for the consultant to say that the drug can be made available to ease pain, but they have been told that nothing can be done until NICE makes its report some time later this year.
Today I received a telephone call from a hospital in Belfast about a female patient whose hands are twisted very badly and who is suffering immense, unbearable pain. She told her doctor that she could bear it no longer and her family would get together to see if they could raise the finance to enable her to have the new drug. The consultant to whom I have spoken says that undoubtedly if this patient is given the drug it will help deal with the complaint.
I heard of another young man aged 21 or 22 who worked with computers. He developed arthritis. He was put on a waiting list and was told that it would be a year before he could receive any treatment. His family went around and collected £6,000 among themselves. The drug was given to the young boy. There was a great improvement. I shall not try to say that it was a miraculous cure, but he is back working now because he received that drug.
The position in Northern Ireland is that there are 75 cases of people suffering cruelly because the Government will not prescribe this drug. The reason the Government will not prescribe the drug is because of its cost. I know that in England its prescription depends on where one lives—postcode medicine. If one lives in a certain place one is permitted to have the drug; if one lives in another postcode one is not.
I agree with everything said by the noble Lord, Lord Forsyth. But money should not be the determining factor when people are suffering from such a grievous illness.
I understand that in the Republic of Ireland this drug is readily available. Indeed, I have heard that it is written into the Irish constitution that if one is in need of it, one cannot be prevented from having it.
Yesterday, in answer to a Question in another place, the Minister said:There has been a postcode lottery in these big services—mental health and so forth—and we must try to solve that. In the national health service, people want to know that they will receive treatment according to their needs".—[Official Report, Commons, 26/6/01; col. 499.]The cause of the disease is not known. It is believed to be 25 per cent inherited and 75 per cent acquired. But these two new drugs are having a dramatic effect on easing the pain and perhaps leading to its eradication. If there is a National Health Service, it should be able to prescribe these drugs to do away with the pain. That is why I am still here today.
422 The cost of £7,000 or £8,000 may sound very high, but the drug has dramatic effects. One noble Lord said that the National Health Service in this country was one of the great beacon lights of our democracy. The clinical experts, the local authorities a rid the health service boards will determine whether the requisite finance will be given in order to give a certain drug to any given patient. The people who know more than the local authorities are the consultants, the doctors and the nurses who tend to these people in hospital: some as in-patients and others as out-patients. I have spoken to them. They have issued documentation which states that they are quite certain that if there is adequate finance they will do everything possible to eradicate this terrible disease.
I am here today to try to alert the Government, and in particular to speak of those 75 people who are lying in hospital beds in Northern Ireland, waiting desperately for the consultant to come and say, "The funding has now been agreed to permit you to have this drug".
I thought that this was a disease that came with age. I did not realise that there was such a thing as juvenile rheumatoid arthritis. I now know. The reason I know is because of devolution. The Minister of Health in Northern Ireland may be working to a budget. She may say that there are other authorities, that the state of Northern Ireland under devolution does not have the wherewithal and the finance to pay for the acquisition of this drug. There is nothing more important in Northern Ireland. There is nothing that should be given more priority than the health of the people who are suffering so dreadfully there.
I hope the Minister will make inquiries as to what is happening in Northern Ireland and whether it needs more funding. This is a British Exchequer grant which is given to Northern Ireland under whatever existing financial formula. It is in effect the British Government, the British Exchequer, which will pay for the implementation of this drug to be given in Northern Ireland. I urge the Minister to impress upon the Northern Ireland executive the necessity of granting financial aid to try and cope with this terrible disease.
The Sinn Fein Minister in Northern Ireland now has the reins of power in her hands. I can imagine that the Sinn Fein party before it was in government would have spoken with the same passion with which I am speaking. But now that it is in government it must see the reality and the extent of the cost. I repeat, something should be done immediately about the 75 people who are in this particular hospital in Belfast.
I recently read a letter in the Northern Ireland press which said that an answer was received from the Minister of Health which stated:Well, we have spent all the money that we have in our health budget this year and you will have to wait until we go into a new financial year".That is very sad for the people waiting to see if they can get this drug. I appeal to the Minister to see what can be done to make certain that people who need this treatment are given it.
§ 7.7 p.m.
§ Lord Harris of High Cross
My Lords, I was very much cheered up at the outset of this afternoon's debate to hear from the engaging maiden speech of the noble Lord, Lord Rooker, that the Government occasionally check out whether earlier Acts of Parliament have had the desired effects. I thought that comparing the unchecked flood of legislation year in year out with the, should I say, "patchy performance" must be a rather disillusioning task, although I would very much like to offer my services in the assessment of some parts of legislation.
I shall take up where my former student at St Andrew's, the noble Lord, Lord Forsyth, left off. His clarity, candour and courage were all that I might have anticipated. I shall try to do justice to the theme, although perhaps at somewhat shorter length.
I personally was very disappointed with the grand debate on the NHS during the election campaign. For me, as I watched the television story unfold, it seemed like a twist on the old story of the emperor who had no clothes with a difference. While the three party leaders invited us constantly to admire the fine raiment of this institution, the nurses, the GPs, the consultants and many patients simultaneously blurted out that in practice much of it is in tatters.
I gave up collecting cuttings, but one single month's supply on the health service included the following headlines: "NHS catastrophe in Kent hospitals", "Ministers try to head off NHS mutiny", "Hospital waiting lists rise", "Hospitals move waiting list goalposts", "Milburn abandons waiting list targets", "Labour at war with BBC over NHS expose", "GPs threaten to quit over workload", "Consultants may split with NHS", and "Nurse's leader condemns third world health service". That is not Tory Party propaganda.
It is not easy, even from the Cross Benches, to launch into a full-hearted denunciation of the concept of the National Health Service. I have long thought that the whole of the argument about it being the envy of the world, although nowhere in the world endeavours to copy it, was a spoof, if not a fraud. Of course, many families and individuals pay heartfelt tribute to the personal debt they owe to the National Health Service. But what has mostly saved lives, cured ills and eased pains is the miracle advances in drug therapy by profit-making multi-national companies, about which we heard from the noble Lord, Lord Fitt, and the developments in diagnostic and surgical practices through competitive innovation by dedicated professionals. The unique contribution of politicians of all parties over the past half century has been to hold back progress by confining investment in the health service to finance that could be raised through taxation, thereby suppressing choice, prolonging illness and even allowing premature deaths.
This harsh verdict is not based on hindsight. As the founding General Director at the Institute of Economic Affairs, I am proud to quote from one of our very earliest Hobart Papers, published in 1961. It was written by a young, physically handicapped, 424 though intellectually gifted, lecturer at Keele named Dr Dennis Lees, who later became professor at Nottingham University. The text merits extensive quotation. I shall content myself with a single paragraph. The paper is entitled Health Through Choice, but it is now, alas, out of print. He said:The fundamental weaknesses of the NHS are the dominance of political decisions, the absence of built-in forces making for improvement and the removal of the test of the market. These defects bring dangers for the quality of medical care that cannot be removed without far-reaching reformHe went on to make some tentative, hesitant proposals for improvement. I shall not go into those in detail. He said:My verdict would be that a monolithic structure financed by taxation is ill-suited to a service in which the personal element is so strong, in which rapid advances in knowledge require flexibility and freedom to experiment, and for which consumer demand can be expected to increase with growing prosperityHis recommendations included diminishing the role of political decisions and enlarging consumer choice by moving away from taxation and free services towards private insurance and fees, but always allowing generous direct assistance for those who cannot maintain themselves.
Instead of arguing their case, the defenders of the NHS have gone on claiming the moral superiority of a system that attaches more importance to services being described as "free" than to the fact that the services are not actually available. That moral smokescreen has for too long paralysed fruitful debate on alternatives to the elephantine, politically mismanaged and manipulated monopoly of the NHS. The growth in the private health sector is itself a measure of the failure of the NHS, since millions elect to pay twice over—once in taxes for the service they do not use and again for insurance out of their taxed income.
The easiest way to dispose of this kind of criticism is to dismiss it as the ravings of a right-wing lackey of capitalism in its advanced stages. That strikes the right intellectual note for some of the participants. But that will no longer do. All of those unpriced expectations are now coming home to roost and for reasons quietly anticipated by some socialists of unquestioned credentials.
I have long treasured a second IEA paper entitled Paying for the Social Services. It was written in 1968 by Douglas Houghton, who became a Labour Peer and will be remembered in this House as a wise old bird with the courage of his convictions. In that paper, written more than 30 years ago, there appears the following luminous passage:What is in doubt is whether we in Britain will ever give medicine the priority given to it in some other countries (and America is only one example) so long as it is financed almost wholly out of taxationIt continues:While people would be willing to pay for better services for themselves, they may not be willing to pay more in taxes as a kind of insurance premium which may bear no relation to the services actually receivedThat is my second witness. But, my Lords, I have further delights for you.
425 Lest those be thought the musings of a maverick, I shall now quote one of the great intellectual pillars of Harold Wilson's Labour Party, Mr Richard Crossman. In the introduction to his now long-forgotten panacea of National Superannuation in 1969, he wrote:People are prepared to subscribe more in a contribution for their own personal or family security than they ever would be willing to pay in taxation devoted to a wider variety of different purposesContrast that clear insight with that of the Labour chairman of the parliamentary Health Select Committee, talking in 1999 of the private sector in language as crude as his intellectual processes. He said:I hate the bastards and you can quote meLast year, the Minister himself, Mr Milburn, was quoted in the Hospital Doctor as describing private practice by consultants as,one of the 7 deadly sinsThe logical consequence of the all-party collusion on a tax-financed National Health Service, in contrast with superior European systems, has been to prevent medical care becoming one of the major growth sectors of the economy to match homes, holidays, entertainment and sport, which competitive markets have transformed with rising standards of living. In welfare, the choice is not public versus private but monopoly versus competition. Competition alone can harness private health insurance, mutual aid, direct payment, vouchers, savings, family support, voluntary institutions, philanthropy and all the resources of civil society, with generous state aid for the declining minority unable to help themselves.
It was political monopoly that abolished matrons, introduced mixed-sex wards, manipulated waiting lists and surgical priorities and issued orders to clean up hospitals in areas to which the public had access. A monolithic state monopoly can never cater sensitively for differing and developing personal preferences. I describe it as essentially a Napoleonic, even totalitarian concept best confined to the Armed Forces, the police, the fire service and street lighting, where choice between competing suppliers is less feasible.
Dare I add, after the outbursts which have come from the Liberal Democrat Back Benches, that state dictation is especially inappropriate from a party that now attracts fewer supporters than there are adult smokers?
§ 7.20 p.m.
§ Viscount Goschen
My Lords, like many other noble Lords who have already spoken in the debate, I was particularly impressed by the maiden speech of the noble Lord, Lord Rooker, not only for the fluidity, clarity and brevity with which he addressed such a substantial subject, but also because he had the courage to address what is becoming an ever more important issue; that is, the sheer volume of legislation which is emerging from his department.
I draw particular attention to this matter, not to present an argument about how we use our time in Parliament—although the noble Lord, Lord Bassam, 426 might be interested to learn that, according to the House of Lords Information Office, over the period of the last Parliament we spent 448¾ hours discussing Home Office legislation alone (if that does not put off the noble Lord, Lord Rooker, from his present enablement and new position, I do not know what will)—but to present a far more serious issue. We need to look at the validity with which the Home Office programme can be treated, given that it produces so much legislation, so much of which is then rapidly overtaken by subsequent legislation.
The noble Lord, Lord Rooker, drew attention to the efforts being made within his department to examine the efficacy of previous measures that have been brought forward. I am sure that in due course the House will be interested to hear much more about this, because there is certainly a fear that, as the statute book becomes ever more complex with each Queen's Speech, the question remains unanswered as to whether the system has become any more effective at controlling crime—its primary purpose.
In the last Parliament, some 30 Bills out of a total of 154 government Bills were associated with the Home Office. The Crime and Disorder Act formed an important part of the Government's programme over the last Parliament. It contained a range of provisions which were intended to tackle youth crime and antisocial behaviour. But how effective have those measures been? I understand that, according to figures published last September, by that stage no child curfew orders had ever been applied for and that only just over 100 anti-social behaviour orders had been successfully applied for. Since that time the figures may well have changed, but surely there is a relevant and valid contrast to be made between the enormous resources—parliamentary, official, agency, police and others—which have been poured into those measures with the meagre results which they have brought thus far.
The 1998 Act also established crime and disorder reduction partnerships. Again, the objectives of those schemes were admirable, but where are the results and what efforts have been made to attempt to quantify them?
The Criminal Justice and Police Act 2001 has only recently been introduced, but again a huge variety of measures were introduced relating to police powers and the ability to deal with offences, such as issuing on-the-spot fines for disorderly behaviour and the extension of the curfew scheme to which I have already referred—despite the lack of evidence on the results of the original scheme.
Of course reference has also been made to the Football (Disorder) Act. The Act could be considered as one of those referred to by the noble Lord, Lord Rooker, as having popped up "out of the blue". Indeed, at Question Time only yesterday or the day before, calls were made for additional legislation and measures to be introduced to cope with disorder at cricket matches. If we continue on this path, we shall reach an absurd point. I hope that we shall not see a rugby union disorder Bill, a rugby league disorder Bill 427 or a five-a-side rugby disorder Bill. There will come a point at which we shall have to rely on the statutes already in place and apply those rather more effectively.
Beyond pure criminal justice, we also passed the Private Security Industry Act which, while although a great deal of support was expressed for its original aims, was extremely cumbersome and will bring literally hundreds of thousands of people under a brand new regulatory regime. We hope that it will improve standards in that industry and that, as a consequence, there will be a reduction in crime. However, it will need to be closely monitored.
The noble Lord, Lord Rooker, produced some statistics on the fall in the level of crime. However, statistics can tell different stories. Certainly I have some statistics available which tell a rather different story as regards the overall level of crime. Notwithstanding that, it is difficult to draw specific conclusions from the crime statistics which we have at our disposal: have the measures which we have discussed been efficient at addressing their principal purpose?
There is a very real sense that an attitude has been adopted that one can legislate against crime. But surely the legislative framework is only one part of the matrix of maintaining law and order. Are we not in danger of overloading the police and the courts with an ever-thicker statute book, which I believe has now moved well to the wrong side of the diminishing returns curve?
Under this and under previous administrations we have seen scores of special initiatives, many of which have been developed in great haste as a response to certain current events, but very few of which have been demonstrated to work well over a period of time. I should be interested to know how many additional criminal offences were created over the course of the last Parliament. I do not expect the Minister who is to respond to our debate to have those figures tucked in his inside pocket, but it would be interesting to know in due course not only the exact figure, but also whether that figure easily can be found. Is anyone keeping a tally of what I think is an important issue?
Tough but impractical legislation should not be used as a smokescreen to divert attention away from poor execution and resourcing, although there is a temptation to do just that. All of the legislation which has been dreamt up will not make up for the fact that, for example, there has been a decline in the number of policemen. Surely it is a priority to concentrate on improving delivery and performance.
Having said that, clearly there are areas where the Government can and should make a strong case for introducing fresh legislation to enhance that delivery. An example of that might well be the police reform Bill. It is clear that the organisation of our police forces in this country is something of an archaic legacy from ancient times. A great deal could be done to remove the structural obstacles and thus to enhance efficiency.
428 While on the subject of the police, I feel strongly that it is up to the Government to demonstrate their overt support for the police and to draw attention to their extraordinary work. Only then will public confidence in our police forces be enhanced. All too often we see a tendency for Ministers to associate themselves with the police when things are going well, but under difficult circumstances and in troubled times there has also been a tendency for the police to be allowed to hang out to dry without receiving necessary government support.
The credibility of the Home Office measures which have been brought forward is diminished by the lack of a strategic framework into which they could fit, as well as by the sheer volume of the legislation. A great deal of time in the last Session was taken up by redrafting measures such as the ill thought-out Regulation of Investigatory Powers Act. The reintroduction of the hunting Bill merely reinforces my view that the Government do themselves no favours by diverting attention from the important issues, which undoubtedly they are trying to address, given the programme of Home Office legislation brought forward in the gracious Speech.
§ 7.29 p.m.
§ Lord Phillips of Sudbury
My Lords, I, too, should like to welcome the noble Lord, Lord Rooker, to his hot seat, even if at present he is not occupying it. At the same time I should like to express my—I am not sure what is the most apt sentiment—gratitude, in a sense, to the noble Lord, Lord Bassam. Noble Lords on these Benches did doughty battle with him night after night. It is odd how, as a result, one then develops symbiotic relationships with those with whom one locks horns in that way. I like to think that we always conducted a sensible and respectful engagement. I am sure that it will be the same with the noble Lord, Lord Rooker.
Perhaps I may repeat briefly a comment I made about the last Queen's Speech. I must express a certain frustration that the debates on health and home affairs are hitched together, even though they have nothing whatever to do with one another. It seems to be an unnecessary problem for all concerned and detracts from focus in debate. I am afraid that I do not buy the Government's explanation that it would increase government time on the Front Benches and leave less time for those on the Back Benches.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, perhaps the noble Lord will allow me to intervene. I know that in the usual channels the Government have suggested ways of reforming the manner in which we undertake these debates. Sadly, agreement was not reached.
§ Lord Phillips of Sudbury
My Lords, I am grateful for the Minister's intervention.
I wish to say a few words, first, about the Football (Disorder) Act, and then, more importantly, about the prospective change in the court structure by the interposition of an intermediate tier of courts. I shall 429 say finally a word about the context within which criminal law reform takes place. I identify very closely with most, if not all, of what the noble Viscount, Lord Goschen, said on this point.
The Football (Disorder) Act 2000 was heavily contested at the time and went through at the end of a parliamentary Session. I believe that anyone with an open mind would accept that it is a draconian piece of legislation in comparison with anything that we have ever put on the statute book before. There was a rare coalition of opposition to the Act. We on these Benches will be no more keen to see this Act renewed permanently than we were to see it introduced with its sunset clause.
The report on the workings of the Act—which is not a model of clarity—appears to indicate that in the year and a bit since the Act came into effect, only 44 orders have been issued under its provisions. I take issue with the noble Lord, Lord Rooker, when he justifies the existence of the legislation on the ground that,it demonstrates that we take this issue seriously",and, secondly, that it is "targeted". In my opinion, the words,it demonstrates that we take this issue seriously",in this instance, gives the game away in terms of the real nature of the Football (Disorder) Act. It was very much a public relations measure—populist legislation. It has not been much used and is not likely to be much used.
As for it being "targeted", in my book that is another word for it being extraordinarily arbitrary in the way it is used. Given the extremely low hurdles that need to be leapt in order for magistrates to make a banning order, no one can tell me that the numbers to whom this Act could apply would not run into hundreds of thousands, if not millions, of citizens.
One does not need to prove a conviction for any offence of violence or disorder. Indeed, John Prescott may count himself lucky that he has not been a recipient of one of these orders. One needs to engage only in a gesture or a word which is considered to be insulting to trigger this measure—a word or gesture that is not unlawful, has never been unlawful and is never likely to be unlawful. In our view, this measure should be consigned to where it belongs.
I turn to the issue of a new tier of courts and, most importantly, the impact of such an introduction on the lay magistracy. The Queen's Speech and the new Home Secretary's remarks on this aspect of the forthcoming legislation were somewhat gnomic and sparse. One needs to read the Labour manifesto in order to understand what is at stake. The manifesto states:The current system, split between Magistrates and Crown Courts, needs reformI pause to note that no justification for this assertion is given. It continues:A unified system, including lower or intermediate tiers of court, offers simplicity and flexibility".Again, I cannot resist asking: how on earth can the creation of a brand new tier of justice make for simplicity?
430 The manifesto and the Queen's Speech refer to the forthcoming report of Lord Justice Auld. Last October, Lord Justice Auld issued a progress report—which is the latest intelligence we have from him—in which he stated that there has been widespread support for the establishment of an intermediate tier of jurisdiction to deal with some of the less serious offences currently categorised as "either way" cases. As he put it,It has been suggested that this might take the form of a District Judge"—formerly known as a stipendiary—sitting with two lay MagistratesThe report continues:Whether or not Lord Justice Auld recommends such an intermediate tier, he is considering proposals",and so on.
It is common ground on these Benches that anything which reduces the power and authority of lay justices will be viewed with extreme scepticism. We believe that the introduction of this intermediate tier may have as one of its ulterior purposes an escape from the cul-de-sac into which the Government have driven themselves over the question of a reduction in the right to jury trial.
Secondly, it surely stands to reason that if there is to be an intermediate tier it will suck cases down from the Crown Court and it will suck more serious cases up from the magistrates' courts. The impact of that over time will, in our view, be seriously damaging to the prospects of survival of the magistrates' courts. Let there be no mistake, there is—how shall I put it—a kind of hidden hum which emanates, year on year, from the Home Office which is antipathetic to lay justices as such. Although the Lord Chancellor has made repeated unequivocal assertions as to his support for lay magistrates, a battle is going on behind closed doors. I repeat, we are absolutely committed to lay justices as the very foundation of justice in this country.
Perhaps I may briefly refer to the report of a senior lecturer at Sussex University, Richard Vogler, on the potential impact of the intermediate tier of a judge and two lay justices. He states:Unfortunately, the evidence from other jurisdictions is that the functional role of the lay participants in a mixed bench is virtually nil…The professional judges naturally dominate the conduct of the trial and set the legal framework of decision-making…From Germany, for example, there is overwhelming empirical evidence"—and Germany has a similar two and one arrangement—that their [the lay justices'] role is essentially passive and their influence negligibleHe concludes:The mixed panel is popular with professional judiciaries precisely because it empowers them at the expense of genuine popular participation …evidence from other jurisdictions suggests clearly that Lord Auld's interim proposals"—in fact they are not proposals; Lord Justice Auld has not yet got as far as making proposals—are fraught with potential dangers and may represent a significant step away from democratic trial process431 I come back to the point that, together with juries, lay justices are the only part of our complex legal system that can reasonably be called justice of the people, by the people, for the people. We favour them precisely because they are deeply rooted in the public mind and in their communities. Lay justices and the magistrates' courts are among the few parts of the modern state that the so-called ordinary citizen understands. They have a high degree of public confidence. The number of complaints about them is astonishingly small in view of the fact that they deal with 95 or 96 per cent of all criminal cases.
They are ruggedly independent. We have a certain suspicion on these Benches that the endless desire of central government to have more and more control over the affairs of our society works against these individuals, who take no pay from the state, depend not on the state and are largely self-organising in their areas. In saying that, I make no disparagement of district judges.
Whatever comes out of the Government's consideration of the Auld report—and we hope that there will be an in-depth consultation with the public—we will be extraordinarily sceptical about any move to reduce the powers of lay justices, either directly or indirectly.
Finally, perhaps I may say a word about the context within which I believe criminal law reform should be undertaken at this time. We all, I have no doubt, consider that the turn-out at the general election earlier this month was truly disastrous. I do not think that any of us should try to "spin" it away. By some considerable degree, it was the worst ever turn-out since the introduction of universal franchise in this country. As the noble Lord, Lord Jenkins, made clear yesterday on the "Today" programme, comparisons with the 1918 election are false. However difficult it may be, we must attempt to understand why under six in 10 of our fellow citizens thought it worth while to cast that precious vote.
The underlying causes are elusive and contestable— and unprovable. But I am certain of one thing: in the oft-repeated refrain of this Government that they want to be "tough on crime and tough on the causes of crime", being tough on the causes of crime is a superficial exercise unless it reaches the underlying causes of public disaffection with the state and with most of its manifestations.
I should like to think that we in this House have a better opportunity than do our colleagues and superiors down the corridor to stand back and examine such issues as the rampant materialism of our society, which has as its counterpart the collapse of moral idealism; the rampant greed which I believe seriously disfigures our society, with its counterpart, the collapse of any idea of fairness of reward; the obsessive competitiveness of our society, which is not confined to the economy, and which has as its counterpart a collapse of the balance between public and private affairs and between personal and civic affairs. These and other issues undermine virtuous 432 values: they undermine co-operation and sharing, fairness and moderation, civic pride, public interest and altruism. Anyone who thinks that that has no impact on all the things that we "sweat over" in terms of the level and viciousness of criminality is simply not facing the truth about the society of which, in a way, we in this place are the head.
I hope that, difficult though it may be, we shall try to get at these intractable facts and that we shall attempt to build them into the way in which we deal with legislation. I hope that we shall realise that legislation is often counter-productive of the very purposes for which it is enacted. I hope that we shall understand that the seedbed of our society is being soured and leeched of goodness. However good are the seeds of legislation that we plant in it, however copious are the fertilisers that we bring to it in the form of government grants, projects and initiatives, however much we spread insecticides to choke off criminality, all of that will be useless if the underlying seedbed is incapable of taking all that.
I wish the Government wisdom in the legislation that they bring forward. They can be sure that we shall treat it with rigorous but, I hope, public-spirited criticism.
§ 7.44 p.m.
§ Lord Harrison
My Lords, I, too, welcome the noble Lord, Lord Rooker, to this House. He has proved himself no rookie in his first appearance here.
In the general election there were four categories of citizens who were deprived of the vote: those of us who were detained at Her Majesty's pleasure here in the House of Lords, those in prison, and those in Bedlam—sometimes all one and the same place; and, of course, children.
I do not advocate extending suffrage to children under 18. I am reminding your Lordships that in all senses of the phrase, "There are no votes in children". As a result, too few politicians speak up on their behalf. But children should not have to wait for their voices to break for their voices to be heard. In all deliberations, children should be seen and heard. So today, on my daughter Sara's 16th birthday, I shall concentrate my remarks on children, and on how their welfare may be affected by the content of the gracious Speech. What more appropriate venue is there in which to speak about children than in the House of Lords—for some, the home of our second childhood?
I warmly welcome the gracious Speech, which builds on the Government's substantial record of achievement in the past four years of strengthening the protection and welfare of children in the United Kingdom. The reintroduction of the adoption and children Bill will command widespread support. It has the personal imprimatur of the Prime Minister. However, I hope that the Government, in fleshing out the Bill, will be equally mindful of the advantages of long-term foster care, which can so often be more appropriate for older children. Greater use, too, of family group conferences can markedly increase the opportunities of successfully placing children within 433 the fold of their extended families. I speak feelingly on this matter, for I am eternally grateful to my brother-in-law's parents for informally fostering me some 40 years ago at a time when my immediate family suffered temporary setbacks. In supporting the adoption and children Bill, perhaps I may put in a special plea for continuing training for adoption staff, both on their social work courses and during their employment by local authorities.
As a council member of the NSPCC, I welcome the Government's ambition to tackle the problem of highly dangerous sex offenders through the judicious use of indeterminate sentences for the guilty. Although it goes against the grain to detain our fellow citizens on such a basis, recognition that some seven in every 1,000 men have been convicted of at least one sexual offence against a child necessarily invokes the higher imperative of ensuring our children's protection against the gross invasion of the civil liberties of such offenders.
Apropos children's commissions, I am grateful for the written reply from my noble friend Lord Hunt on 27th February indicating that the Government are watching closely the inception of a Children's Commissioner in Wales to see whether such a departure would be feasible in England. I sincerely hope so.
Less encouraging is the omission from the gracious Speech of proposals to reform the law to give children the same legal right of protection from assault as that currently enjoyed by adults. For the past decade Britain has subscribed to the United Nations Convention on the Rights of the Child. It is time that we put our law where our mouths are and banned physical punishment, as set out in Article 19 of the convention. It is time to break the dispiriting cycle of violence begetting violence within the family.
The other day, I could barely restrain myself from intervening when I saw a clearly inadequate parent gratuitously, indeed metronomically, thrash her child in the street for seemingly the umpteenth time. That demonstration of the futility of the law of diminishing returns in family discipline was tragic fare for us as onlookers. There was nothing comical, however, about this bashed street kid, who in turn, a generation from now, will doubtless be found bashing her progeny in the street unless we act now. Sometimes, I think that there is a lot to be said for the nanny state.
Urgent, too, in the dawn of this new Government, is the need for a systematic review of all child deaths in the United Kingdom, particularly those attributable to abuse and neglect. We need to develop a better snapshot and definition of such child deaths. The reported rate of two fatalities a week may well be an underestimate, but we just do not know. We sorely need a national strategy for reducing such child deaths. Harmonising the collection of relevant data by local authorities would be a good first step. Can my noble friend the Minister indicate whether the Government would be sympathetic to the idea of consulting all interested parties in this matter through a Green Paper or a White Paper to help reduce the incidence of these needless deaths?
434 I hope, too, that the Government will not be too tardy in re-introducing the tobacco advertising Bill. This is a measure that will be proportionately more beneficial for children than for adults.
Perhaps I may now invade the territory of the Department for Education and Skills and make a plea for more and better school-based welfare services for children. As a former member of Cheshire County Council's education committee, I was made fully aware of the debilitating problem of bullying and intimidation which lies like a dead weight across the path of children seeking to pull themselves up by their bootstraps to gain freedom through education. I believe that there is a powerful case for boosting normal pastoral care by improved school-based welfare services. Do the Government agree"
All this may seem trivial when set against the staggering figure of 40 million infant deaths that are reported each year worldwide, as a result of war, famine, malnutrition, disease, natural disasters and drought. My former European Parliament colleague, Glenys Kinnock, rightly reminds us of that depressing statistic. But here, too, I commend the last Government's ambition to help eliminate child poverty in the world of the 21st century. The collaboration between Chancellor Brown and Clare Short of DfID was exemplary.
I should like to make a special plea for children in our own global backyard—Europe. I proudly sport today the tie of the British EU presidency of 1997, the design of which was specially commissioned by the British Government from children working together throughout the European Union. The tie illuminates the importance of children growing up in Europe, but the opportunities and dangers presented to our young people arising from the development of the single market, and from European Union enlargement, have been slenderly calibrated. On a future occasion I hope to enlarge upon this subject, especially about the four freedoms of the single European market—the free movement of goods, services, people and capital—each of which, individually, impacts unexpectedly on children and poses new challenges to the Government, who wish to ensure the protection of children in a deepening and widening Europe.
Yesterday's tragic news of a Portuguese mother, resident in Switzerland and arrested for a minor theft, whose 18 month-old child perished alone and abandoned in the parental flat following a breakdown of communication in social services, all too piteously illustrates the danger to children of a Europe on the move. All of us in Europe must redouble our efforts to ensure that, in opening up Europe, we do not leave children and their families exposed and vulnerable. In building a better Britain, as this Queen's Speech surely does, let us do so in partnership with our friends and families in Europe. For our children's sake, we fight a common cause.
§ 7.54 p.m.
§ Lord Hylton
My Lords, I freely admit to being a grandfather, but I hope that I am not quite yet 435 beginning to enter my second childhood. More seriously, however, I regret that there is much that is wrong in British prisons. This has come out clearly from a number of earlier speeches. The problems have also been well described in the reports of the inspectors-general of prisons, both on individual prisons and in thematic studies covering, for example, women or young people, or suicides in prisons. Against that difficult background, requiring immediate and sustained government action, I should like to speak about two very positive initiatives. I hope that they will influence the whole prison system.
The first is a voluntary and charitable initiative called "Fine Cell Work", which enables prisoners to do embroidery, needlework and quilting. Because these crafts can be done in individual cells and in the prisoner's own time, they do not depend on the nature of regimes or on the availability of workshops and supervisors. The work produced can be sold, with the proceeds saved for the prisoner on his release. The standard of work produced has been very high, so much so that some of it has been sold to leading interior designers. Prisoners can thus learn useful skills, and one man has been quoted as saying:You feel you're supporting yourself. I feel proud I've been given something to achieve, to get pride and self-respect".I believe that that speaks for itself.
I notice that the patrons of "Fine Cell Work" include the noble and learned Lord, Lord Bingham of Cornhill, and Sir Stephen Tumim. Can the Minister say whether the Government are studying the ways in which this initiative works, and whether they will assist it to develop more widely? I believe that there could be many useful lessons to be learnt.
The second initiative is trying to apply some of the principles of restorative justice to sentenced prisoners in custody. It is well known that work has never been available to all prisoners. Quite often it is available for only a few hours per week. The nature of the work varies and does not always help prisoners to acquire skills that will be relevant and useful to them on release and re-entry into the community. Moreover, education is often available in a limited way for only a small percentage of all prisoners.
The restorative justice principles that are most relevant to a prison setting are those seeking to reduce re-offending by helping offenders to re-integrate into community life by taking responsibility for the harm or damage that they have caused and by doing something to benefit their victims, or the wider community. This makes sense when we know that Braille workshops and helping with riding for the disabled (in one prison at least, which is known to me) have always been popular activities with prisoners. They have enabled prisoners to feel useful by helping others, who are obviously disadvantaged.
From this level, it is clearly a huge step forward to bring prisoners into some form of contact with victims of offences, or their representatives. Well documented work of this kind has already been done in both Canada and in the United States of America. I am glad 436 to say that it is beginning in England. Prisons and young offender institutions at Stoke Heath. Huntercombe, Brinsford, Rochester, Springhill and the Mount have all made courageous starts.
It is clearly good when a prisoner stops denying the impact of his offence. It is better still if he becomes willing to apologise or to make some kind of restitution. Such behaviour should be strongly encouraged and rewarded by privileges and remission. I therefore ask the Government to study carefully what has been done, both here and in other countries. I urge them to develop restorative regimes in as many prisons as possible. There is definite scope for involving many volunteers and voluntary organisations in such work. This must be positive, both for prisoners and for society generally.
§ 7.59 p.m.
§ Viscount Bridgeman
My Lords, I trust that your Lordships will forgive me if I do not stay for the summing-up as I have a long-standing engagement. It is therefore with some diffidence that I ask the Minister if he will be good enough to write to me on any points I may raise. It is a pleasure to note that the Minister has retained the office he held before the election.
I wish to speak briefly about the partnership between the National Health Service and the independent sector. I must declare an interest as chairman of an independent charity hospital in central London. I hope that gone for ever is the doctrinal, almost theological, objection by the National Health Service to any private sector involvement which was the prevailing attitude up to comparatively recently. However, when I wrote this speech I was not aware that the Prime Minister would address that very point today. The culture went wider than that. Up to about 30 years ago there was a widespread attitude in the City of London that it was vaguely sinful to make money out of illness. However, happily now the mutual recognition of interdependence between the two sectors can only be to the benefit of the patient.
The independent sector's involvement is significant. The Mental Health Act Commission states that independent advisers deliver more than 55 per cent of the NHS's medium secure provision and 80 per cent of the country's brain damage rehabilitation. The Independent Healthcare Association is confident that over the life of this Parliament it will be able to offer 1 million treatments.
The independent sector trains many thousands of student nurses who spend several months at a time in independent hospitals and nursing homes where they learn about a wide range of specialties, particularly in the care of the elderly, where the independent sector plays a major role. It also provides postgraduate and management training for nurses. Similarly, for doctors there is a wide range of postgraduate accredited study courses.
In my own hospital we have for many years enjoyed a good and mutually fruitful working relationship with the National Health Service. Our hospice, which forms 437 part of the hospital, derives its income in three ways: from con tracts from a number of health authorities; from fundraising and from any surpluses from the acute side of the hospital. That encapsulates the partnership about which we are talking. Therefore, we very much welcomed the concordat initiative. We are taking a number of surgical lists, initially with two teaching hospitals, but we are exploring possibilities of working together with several more.
We have a rotating arrangement with a teaching hospital for the provision of resident medical officers who are studying for fellowship or membership of the royal colleges where they can work away from the stresses and strains of a large hospital. At the same time our patients get round the clock cover of high quality.
One of the great myths is that the independent sector somehow steals nurses away from the National Health Service. The fact is that over recent years less than 4 per cent of nurses who left the NHS moved to work in the independent sector. The remainder simply left nursing altogether, though hopefully for many of them not for ever. The contribution of the private sector is in such fields as human resource strategies as they apply to nurses, return to nursing courses and increased career and training opportunities. The independent sector can indeed regard itself as a partner of the National Health Service.
The independent sector stands committed to the success and constant improvement of the National Health Service. But let us be clear on one thing. The best people to run the National Health Service are National Health Service people. The relationship with the private sector is one of partnership, not wholesale privatisation. Speaking for myself, I have no problem with the recent remarks of the Secretary of State on that matter.
However, I fundamentally disagree with the trend of the service towards centralisation during the regime of the present: Secretary of State. The reforms under the previous Conservative administration have been derided by the present Government. The much vaunted dismantling of the market in the provision of services is largely irrelevant. The central pillar—the creation of the purchaser/provider structure—remains intact. I hope that the Government will study carefully the speech of the noble Lord, Lord Harris of High Cross—who I am sorry to note is not present—on the perceptive article written as long ago as 1961 on just that point. However, the purchaser/provider structure is rendered to a large extent ineffective if with it comes the deplorable trend towards centralisation which I fear has been a feature of the past four years. The dead hand of bureaucracy was ruthlessly analysed in the Virgin report on the National Health Service in July 2000, which stated:Within the Service there is the impression of 'management by cascading paper', of ideas and instructions being passed down from above. The dead hand of bureaucracy seems to stifle imagination and flair and obscure responsibility".Quite frankly, the many thousands of dedicated, caring people employed in the National Health Service deserve better that that.
438 I refer to the contracts of service of newly qualified consultants who under the NHS Plan are contracted to work exclusively for the National Health Service for either the first five or first seven years of their contract and within that period are effectively required to work overtime within those contracts. I appreciate the arguments for that, some of which are more plausible than others. I agree that the National Health Service has invested large sums of money in the training of consultants, in return for which it feels entitled to the exclusive use of their services. A less tenable argument advanced by a highly respected friend of mine in a senior position in the National Health Service is that consultants can expect rich pickings later and a hair shirt at this stage does them no harm. In other words, are these highly qualified men serving a further apprenticeship?
The proposal has been heavily attacked by the BMA, which in my view correctly states that it goes against the spirit of the private and NHS sectors working in harness, quite apart from the clinical experience in a different dimension. Consultants at any age will almost certainly benefit from straddling the two. These proposals appear to run counter to remarks made by the Secretary of State on the "On the Record" programme of 11th June 2000 who said,It would be a pretty odd state of affairs if we said to highly trained consultants, some of the most expert professionals we have in the Health Service, 'You are going to be denied a set of rights that everybody in the NHS has'".I ask the Minister to clarify that apparent inconsistency. I would particularly welcome an assurance that the Government are prepared to think again on the matter, particularly in the light of the meeting which I gather also took place today between the Minister and leaders of the profession to improve communications between government and the medical profession.
This country has a tradition of excellence in the quality of nursing and clinical care which is without equal. In the quality of treatment now offered, on the other hand, we appear to lag behind many other countries. However, it is often overlooked when making these comparisons that in almost all of them there are charges, often hidden and indirect, to the patient from which in the NHS in this country we are mercifully free. Treatment in this country is indeed free at the point of delivery.
In the first 40 years or so of its existence the National Health Service was the envy of the world. It has, however, been encumbered by two factors not envisaged by its founders and for which no one is to blame. The first is the galloping cost of new technology and the second is the increased expectations on the part of patients which arise from the very success of the National Health Service. That point was most eloquently made by my noble friend Lord Dean.
I suppose that if we are to be honest we must say that all the problems of the NHS ultimately come back to funding. I do not propose to go into the many shortcomings which have been outlined tonight except to share with your Lordships the chilling experience of the case of the MRSA patient to which the noble 439 Baroness, Lady Masham, referred and whom I recognised as the son of great friends of my wife and myself.
If there is one thing I ask the Government to achieve during the course of this Parliament it is the restoration of a climate where managements are trusted from above and their initiatives encouraged. In this they can rely on the independent sector to play an increasing role in a partnership, but never, I am sure, an intrusive or challenging one.
I echo the words of my noble friend Lord Forsyth. I am sorry that he is not in his place. This must not simply be an emergency run for cover to get waiting lists down during a hard winter. It must be a true partnership. There will be only one beneficiary of that partnership: the patient.
§ 8.10 p.m.
§ Baroness Gale
My Lords, I, too, give my warmest congratulations to my noble friend Lord Rooker on his maiden speech and ministerial appointment. He will contribute greatly to your Lordships' House.
I was delighted to see in the gracious Speech a reference to women's representation. The measure is long overdue. Since 1918 women have been able to stand for election to the House of Commons; and since 1928 all women have had the right to vote. That right has in the main given women the right to vote for a male candidate and elect a male Member of Parliament. Is that what the suffragettes fought for?
Some people may wonder why, at the beginning of the 21st century, we should need to adopt such measures. They may even express the view that competent women will achieve and be selected if they are good enough. Others will argue that it is the democratic right of a constituency party to select the candidate who is the choice of its members. Who could argue with that? The surprising factor is that exercising that choice nearly always results in a man being selected. It is a strange form of democracy when the result is so skewed towards men. The law of averages should allow some woman to be selected but, generally speaking, that does not occur.
For many years I believed that women would eventually make the breakthrough: that the need was for the provision of training courses for women, the offer of confidence-building and public speaking courses and of ensuring that women were up-to-date with the policies of their parties. I am sure that many women of all parties will recognise this scenario. I went along with that idea for some time. Indeed, I organised such courses for women believing that this was the way forward. But even the best-trained women still could not get selected. As a Labour Party organiser, I was responsible for organising many selection meetings in constituencies. Time after time I saw men being selected rather than the very good, or in some cases excellent, women. Why would constituency parties not select those good women?
440 Eventually I began to question why women were not getting selected. I saw many women putting themselves forward. These were women who had achieved much in their chosen career. They were good speakers. They had confidence. They were bang up-to-date on policy matters and would have made excellent Members of Parliament. But no matter how good they were they could not get selected.
Perhaps one could argue that the male candidates were so exceptional that the women, however good they were, could not possibly match up to their excellence. But that was not the case. So what is the problem? Some political parties have recognised that there is a problem. They have made efforts to address it by bringing in rules which ensure that women get on to shortlists. Different parties adopted different measures. The Labour Party brought in rules which gave women equal opportunities with men; for example, allowing bodies to nominate two candidates, one woman and one man, with an equal number of men and women on the shortlist for final selection. Given this equal opportunity, one would have hoped that women candidates would come through, at least in some constituencies. However, the reality is that constituency members of all parties play lip service to women's representation.
What women want is not simply equality of opportunity but equality of outcome. Perhaps I may give the situation in Wales as an example. Before the last general election, 10 male Members of Parliament announced that they would be retiring. There were seven Labour, two Plaid Cymru and one Liberal Democrat. Male candidates replaced all 10. I am certain that all will make good Members of Parliament. But is it not odd that not one woman was selected in a seat that her party could win? I am pleased to note that in Ynys Mon where the sitting Plaid Cymru Member stood down Labour gained the seat. In the unlikely event of the selection of a woman she would have lost to the Labour man.
That example of men replacing men can be repeated in many constituencies throughout the land, although Wales seems a little more backward in these matters. People may ask, "What are you complaining about?" Wales has led the way. Let us consider the results at the Welsh Assembly elections in 1999. Of the 28 members of the Labour group, 16 are women. Plaid Cymru has six women out of a group of 17. The Liberal Democrats have three women out of a group of six. However, of the nine Conservatives elected, all are men. Nevertheless, women have a good representation in the Welsh Assembly.
How did that happen? In the debate last Thursday, the noble Lord, Lord Goodhart, suggested that the large number of women elected to the Welsh Assembly was the result of using the proportional system for the Assembly elections. However, most of the women were elected in the constituency seats on the first-past-the-post system. Fifteen Labour women, two Liberal Democrat women and two Plaid Cymru women were elected. Nineteen women out of 40 were elected on the first-past-the-post system. Only five women were elected out of 20 on the list system. Owing to the 441 resignation of my right honourable friend Alun Michael, Delyth Evans—she was number two on the Mid and West Wales list—took his seat, making the figure six.
The same thing happened in Scotland. Out of 73 constituency seats, 26 Labour women were elected, two Scottish Nationalists, and two Liberal Democrat women. In total, 30 women were elected out of 73 seats.
Out of a total of 56 seats on the list system, 18 women were elected: two Labour, 13 Nationalists and three Conservative women. Again it demonstrates that more women were elected in the constituencies than on the list system. Therefore I argue that PR is not the solution in order to have more women elected in Wales or Scotland. I accept that the use of the zipping method, for example, in the European elections could help more women to be elected. But that system is dependent on the attitudes of the parties.
How were so many women elected to the Welsh Assembly when they cannot get elected to Parliament? The main reason is that the Labour Party had the courage to instigate a system of twinning. Paired constituencies selected one man and one woman. That ensured an equal number of female and male candidates. As Labour was likely to win the majority of constituency seats it was essential that it fielded a good number of female candidates for this brand new institution; otherwise it would be similar to Westminster where the majority of Members are male. Women are playing a leading role in the Assembly, especially at Cabinet level. They have proved that given the chance they will deliver.
The method of twinning was highly controversial. As the person who had to drive it through the party, I became aware of the prejudice and discrimination that exists toward women. I had, of course, been aware of the situation but it had not previously been so blatantly obvious. Now that women had the opportunity of taking winnable seats to which men had already put their names, the prejudice became more acute. That occurred in parties where attempts were made to redress the gender imbalance. It is certainly not unique to the Labour Party. Prior to the 1997 general election the Labour Party implemented a policy of women-only shortlists to ensure the selection and election of more women. The policy was successfully challenged at an industrial tribunal. Labour immediately stopped the procedure but many women had already been selected. It meant that a record number of women were elected in 1997. Some believed that with that success the mould had been broken. Unfortunately, that was not the case. Fewer women were elected at this year's general election than in 1997.
Without special measures in place, women will not get selected for seats that they can win. Members of all parties have shown a great reluctance to choose women as their candidates. The prejudice and discrimination against women in all parties is a disgrace. That, rather than the inability or weakness of 442 potential women candidates, is what prevents women becoming Members of Parliament or achieving other elected offices.
There is only one answer to the problem, and that is legislation. The proposal in the gracious Speech to bring forward legislation to assist women in public life is most welcome. Although this is a great step forward, similar action has already taken place France. A new law, thought to be unique, was used for the first time at the local elections in May this year. As a result, approximately 48 per cent of councillors are women, as opposed to 22 per cent at the previous elections in 1995. Time does not allow me to elaborate on that law and what it means, but it shows that the French Government are prepared to bring in legislation to combat discrimination and prejudice against women. Where positive action is taken in favour of women, women prove that they are capable of doing the job, as has been shown in the Cabinet of the Welsh Assembly, where women are in the majority. People now say how good it is to have women in such high positions, rather than saying how terrible these women are for trying to get our seats. They are good role models for women in Wales, showing that they can hold tough portfolios and deliver for Wales.
It is essential that the proposed legislation be brought before Parliament at the earliest opportunity, in time for the selection of candidates for the Scottish Parliament and Welsh Assembly elections in 2003 and in plenty of time for the next general election. I am very pleased that Her Majesty's Government have recognised that this is the way forward. In future, political parties will be able to decide for themselves if they wish to have all-women shortlists without the worry or threat of legal action. Equally, there will be no compulsion on parties who do not wish to go down that road. Those who have tried for mans years to assist and support women in their efforts to obtain elected office welcome the proposed legislation to get more women in Parliament. The campaign has gone on since women were first allowed to stand for Parliament.
I have nothing but praise for the Government on this issue. In the future, women will be given an equal chance with men at selection conferences and will have an equal chance of holding elected office. I hope that the Minister can give an assurance that this matter is regarded as urgent and that the legislation will be before Parliament at the earliest opportunity; otherwise there will be another generation of lost opportunities for women.
§ 8.23 p.m.
§ Baroness Stern
My Lords, I shall say a few words about the commitment in the gracious Speech to modernise the criminal justice system and to reform sentencing. In that context, I very much welcome the excellent maiden speech of the noble Lord, Lord Rooker, and his commitment to thin king before legislating. I suggest that before they embark on a reform of sentencing, the Government might want to take a good hard look at what has happened to sentencing in England and Wales in the past 10 years. 443 They might want to reflect on the great changes that have taken place and to measure how far they have helped the Government to achieve their objectives of preventing crime, giving proper redress and satisfaction to victims, improving confidence in the criminal justice system, leading to a change for the better in the behaviour of criminals and, as the right reverend Prelate the Bishop of Durham said, restoring to their full humanity those who fail.
As the noble Lord, Lord Williamson, pointed out earlier in the debate, there have been big changes in sentencing practice in England and Wales during the past 10 years. Our proportionate use of prison sentences has increased substantially. In 1990, out of every 100 men aged 21 or over sentenced for indictable offences, 17 received an immediate prison sentence. In 1999, the figure was 28—a 65 per cent increase. For women the increase has been even greater—a 166 per cent jump over 10 years. Of course the numbers in prison have gone up. On 15th June, we were locking up more than 66,000 people. On the last Friday in June in 1990, we were locking up 45,500.
Our treatment of children—defined by the UN Convention on the Rights of the Child as those under 18—has also changed markedly over the past 10 years. There are now more than twice as many children aged 15 to 17 sentenced and imprisoned as there were 10 years ago. Once again, seeming female wickedness has outpaced that of men. In 1988, 60 girls between 15 and 17 were sentenced to prison. In 1998, the figure was 302.
International comparisons are also interesting. We are moving further away from our European neighbours. Our imprisonment rate is the second highest in the European Union. It is now 64 per cent higher than in France and 21 per cent higher than in Germany. The European Union average for the proportion of the prison population aged 15 to 20 is 8 per cent. The England and Wales figure is 17 per cent.
As we heard in yesterday's debate on the gracious Speech, our spending on education is lower than that of our European neighbours. The same applies to health, as we heard today from the noble Lord, Lord Forsyth. However, our spending on imprisonment is higher than that of our European neighbours. What does that show about our priorities?
I apologise for subjecting the House to so many figures at this hour. I know that it can become very tedious, but I have quoted them to make the point that the changes that have taken place in sentencing in England and Wales in the past 10 years have not been slight or a minor shift in a different direction; they have been fundamental.
In recent years, the Home Office has been concerned that its work should be evidence-based. That description crops up in most Home Office documents about the criminal justice system. The paper Criminal Justice: The Way Forward produced in February this year tells us that,the Government has embarked on a comprehensive evidence-based programme to reduce crime".444 It is rational to look at the evidence. It would be interesting to know what evidence has driven the changes in sentencing over the past 10 years. Those changes have been steadily in the same direction, regardless of the change of administration in 1997. It would be useful to look at the evidence on the consequences of a policy that uses imprisonment not just for dangerous and violent offenders, but for many non-violent or petty repeat offenders.
In the United States, which has 2 million prisoners and the highest rate of imprisonment in the world—more than five times the rate in England and Wales—scholars are now working to measure what they call "collateral damage". What will be the long-term consequences, they are asking, of this high use of imprisonment over the past decade on families which are broken up by imprisonment and on the neighbourhoods from which most of the prisoners come—neighbourhoods where many young men grow up expecting not to go to university but to prison? What are the effects on the many millions of children whose parents are imprisoned?
It is often argued that the negative effects, whatever they are, have been worth it. To some, the matter seems very simple: lock up more people and crime goes down. Certainly the violent crime rate in the United States has decreased steadily. It is claimed that that is because so many people are in prison. The research, which is extensive, suggests that, perhaps at most, 15 per cent of that reduction can be attributed to the huge increase in the use of imprisonment. The research also suggests that if the money that has been spent on that huge increase had been spent on other measures, the crime drop would have been greater than 15 per cent.
The increase in the number of prisoners in England and Wales has also had consequences for the prison system. I hope that we shall discuss that in much more depth in the debate to be initiated by the noble Lord, Lord Hurd, next month.
The Government have high ambitions for the prison system. They want prisons to become places where rehabilitation is the norm, where education levels are improved, employability increased, and drug treatment successfully given. Those high ambitions are excellent, and there is no doubt that many staff in the prison service have the talent and commitment to fulfil them. But such efforts are continually defeated by the pressure of numbers. New prisons are always being built and still prisons are always overcrowded and battling with too many prisoners to do the job that the Government want them to do.
For the Government to fulfil their ambition to make prison a rehabilitative experience for each prisoner, considerable resources will be required. Prison staff will need much better training. They will need more time to give individual attention, time to make links with the community, and time to find employers who are prepared to give ex-prisoners a job. The cost of delivering such a prison system is very high, but it could be done if the number of prisoners were lower.
445 Resources could be used on those who need to be imprisoned for the protection of the public. Such resources could be concentrated on ways to help prisoners to deal with the problems in their lives that brought them there. Work could be undertaken to bring them to an understanding of the harm that they have done and the consequences of their actions on victims. As the noble Lord, Lord Hylton, pointed out, excellent work on those lines is already taking place in a number of prisons.
Published government plans talk of another 2,660 prison places to be built. Rumours circulating in criminal justice circles suggest that the Government are looking for quick ways to build another 10,000 prison places. I sincerely hope that that really is only a rumour. The Home Office's own projections for the future size of the prison population give three possible figures for the year 2008—the highest being 83,500.
Would it now be possible for the Government to look again at the theory that being tough on crime means locking up more people; that public confidence in the criminal justice system is built on a high use of prison; and that what victims mean by "getting justice" is heavy punishment? I wonder whether that is really the direction in which the Government want to go or whether, as the Chancellor said in the other place earlier this week,the best … anti-delinquency and anti-crime policy, is to take the next 1 million children out of poverty".—[Official Report, Commons, 25/6/01; col. 397.]In his very wise intervention earlier today, the right reverend Prelate the Bishop of Durham talked about the limitations of criminal justice legislation when dealing with crime. As legislators, it is salutary for us to remember that.
§ 8.35 p.m.
§ Lord Mancroft
My Lords, I want to ask your Lordships to think for a moment longer about crime— about violent crime, acquisitive crime and drug-related crime, which so often are one and the same thing.
As we have been hearing, the Government have chosen to address the issue of crime in terms of the numbers of policemen on our streets. The assumption appears to be that an increase in police numbers, coupled with a reform of the process by which the criminal justice system operates, will restore confidence in the Government's ability to deliver law and order. Of course, maintaining law and order is one of the primary duties of government.
The single biggest identifiable cause of crime is drugs. The supplying and consumption of drugs, along with the acquisitive crimes needed to purchase drugs, have increased and continue to increase in exact parallel with the levels of relevant crime. Football disorder is clearly very serious, and the Government have addressed it through the gracious Speech. But the drug problem is now probably the biggest social problem facing our society today. However, the Government have not chosen to address it.
446 When it comes to children, it is amazing how parents from every walk of life, regardless of their colour, race, creed or whether they are rich or poor, share many of the same concerns. One of the greatest concerns that they all share is that of drugs. Because my interest in the subject is well known, parents often raise the subject with me.
What every parent to whom I have ever spoken has in common is a real fear of what might happen to their children and the fact that, even now, they have very little idea of what they can do. When they do obtain information from schools or social services, it is very little and often conflicting. They are right to be concerned. Over 400,000 children under the age of 16 now smoke cannabis. Drugs from cannabis to ecstasy to heroin to cocaine are routinely offered in pubs and clubs throughout Britain.
Yet the whole subject was ignored throughout the election campaign and, apart from the establishment of a criminal assets recovery agency, which the noble Lord, Lord Rooker, mentioned in his speech and which was in the gracious Speech and which may have a marginal effect at best, drugs got no mention at all in the gracious Speech.
The low turnout at the general election has worried many people. One reason why people feel detached from politics is, I believe, that they consider that politicians do not seem able to address the issues that people really care about. One of those issues is drugs. However, I believe that when the Prime Minister and Mr Straw appointed the drug czar after the 1997 election, they really did want to address this issue, in exactly the same way as Mr John Major and Mr Michael Howard really wanted to address it in 1992.
Indeed, the policy adopted by this Government is the continuation of the policy announced by Michael Howard in 1994. But that policy has failed and is continuing to fail for two reasons. First, it is based on impossible targets. The new Home Secretary has effectively sacked the czar, Mr Hellawell, because he has failed to reach his targets. But those targets were always unattainable, and to blame Mr Hellawell for failing to do the impossible does not fool anyone.
The targets to reduce drug use and the onset of drug use among young people by set amounts were never possible, particularly when the only real weapon available is the criminal law. They are impossible for a simple reason. Drug use becomes a serious problem only when users descend into addiction. Addiction is a health problem, and one cannot cure health problems using the criminal law. There may well be a role for the courts but not, I believe, the central role that they have now.
The second reason for that failure is that, although the policy of the previous Conservative government and of this Government seems to indicate a shift away from law enforcement towards treatment and prevention, the reality is that the move has been negligible.
447 The substantive point is this. Over the past decade, the quality of treatment for addicts here in the UK has improved enormously, predominantly in the private and voluntary sectors. We now have treatment of which we can be proud and, more importantly, which is economically viable and which produces demonstrable benefits. Extensive research conducted over the past few years, including the very good research carried out by the Department of Health, proves without a shadow of doubt that treatment works for the addict, for the family of the addict and for society as a whole. Twenty years ago there were no ex-addicts but today there are lots of them. I have been involved with treatment for more than 15 years. The Drug and Alcohol Foundation, which I chair, provides high-quality day care treatment here in central London. There is good news—thanks to the development of local authority funding, large numbers of our patients are referred by local authorities. The money really does follow the patient.
In the area of in-patient treatment there are other real problems. The lack of meaningful funding means that the number of drug treatment places has not increased in this country for more than a decade. If drugs is a "young people's problem", as politicians tell us, can someone explain to me why there is only one facility in the entire United Kingdom that specialises in the treatment of adolescent drug addicts? It is clear that that should be changed.
Drug treatment providers are currently waiting to see what the results of the new care standards that will be set by the Department of Health will be. If, as we have been led to believe over the past few months, those standards are to be based on the requirements of care for the elderly rather than for addicts, and that en suite bathrooms will become mandatory and that shared rooms will be banned, the number of places will fall by 20 per cent and I suspect that several facilities will close. I hope that the Minister will give me some comfort on that issue, although he may not do so today.
We know that treatment is only part of the answer. The long-term solution to the drugs problem lies in reducing the number of people who take drugs and, as a first step, in reducing the age at which people start to use drugs. The present Government accept that, as did the previous government.
Mentor UK, of which, for its sins, I am also chairman, is the UK branch of the largest nongovernmental drug prevention organisation in the world. We work with many governments and are very happy to be working alongside the Home Office or the Cabinet Office. As my noble friend Lord Cope said, we assume that moving responsibility for drugs from the Cabinet Office to the Home Office involves a downgrade. But I really hope that it does not and that the Minister can give us reassurance on that point. I believe that drug prevention is one of the keys to this extremely complex problem. However, in order to achieve meaningful results the Government will have to start spending some real money and accept that it 448 may take a long time to get results. Advertising campaigns and reluctant schoolteachers are not the way forward. Michael Howard wrote in 1994 that,teachers will discover that pupils know far more about drugs than they do".He was right. Teaching pupils even more is not going to make them take fewer drugs. We have to have a root-and-branch change in attitude, which must start at the top—in government. However, that has not started yet.
Although the Government's reports, of which there are rather a lot, seem at first glance to be catalogues of success, it is worth noting that as yet not one prevention initiative has demonstrably led to a reduction in drug use within any defined social group.
At the same time that treatment and prevention programmes are starved of resources, we are pouring billions into the attempt to police drugs. The Printed Paper Office was kind enough to supply me with piles of expensive glossy brochures that were published by the Cabinet Office. They contain pages of tables showing the amount of seizures of drugs and the number of arrests and—this seems rather odd—three whole pages were about how to catch a drug smuggler.
I learnt that Customs and Excise exceeded its target of disrupting 5 per cent of class A drug traffickers in 1998. That was obviously felt to be very important because it appeared in bold black print. That really is not impressive. We do not want glossy brochures because we also know the other side of the coin. The illegal drugs industry is now the second largest industry in the world. Although Customs intercepted drugs worth £1.25 billion last year, one senior officer told me that he thinks that drugs worth well over £12 billion got through. When a large haul is intercepted nowadays the price of drugs on our streets remains unchanged and during the past 10 years prices have actually fallen while demand continues to rise. Noble Lords do not need to be professors of economics to understand what that means.
The noble Lord, Lord Rooker, said in his excellent maiden speech, on which we all congratulate him, that violent crime is down by 10 per cent. That is good. Moreover, it is very good that last week was the first week in more than a year in which someone has not been shot dead in central London in a drug-related crime involving illegal firearms. That good news is balanced by the fact that a new and particularly unattractive brand of machinegun was used to murder someone in a similar crime in Manchester. It is all swings and roundabouts.
We were told by the Government that when, following Dunblane, the legal ownership of handguns was banned, that would have a noticeable effect on the figures for the criminal use of handguns. When we voiced some doubts about that, they were brushed aside. However, we were right and the Government were completely wrong. A perfectly legitimate sport was destroyed, the taxpayer had to shell out £90 million in compensation and the provision has made no difference at all. Is it any wonder that politicians are held in such low esteem?
449 The reality is that the war on drugs is a hugely expensive failure and is now arguably causing more harm than good. I know it, noble Lords know it and most parents are beginning to realise it, too. Even the Right-wing media admits it; virtually every serious newspaper accepts the need to look again at the Misuse of Drugs Act. It is apparent that the only people who do not know that are our elected leaders.
Of course, this is an extremely complex and difficult subject. Anyone who tells us that they have all the answers is either very brave or very foolish. We shall have to look hard if we want to make progress and we must be willing to take political risks. In order to achieve any progress the Government will have to show a bit of humility, which they are not very good at.
Last year the Police Foundation produced an excellent report entitled Drugs and the Law. It was well received everywhere except at Queen Anne's Gate. Indeed, the Home Secretary rejected it out of hand within a matter of hours, which, if it showed nothing else, showed that he had not devoted much care or thought to it. It is difficult to have much faith in politicians when they do things like that. It merely serves to alienate people still further.
Perhaps the new Home Secretary knew what I was going to say tonight—he has just executed a policy U-turn by giving his cautious support to the police in Brixton, who announced that from now on they will only caution people who are caught in possession of cannabis so that they can concentrate on other drugs work.
Perhaps my right honourable friend Mr Portillo is canvassing my support—I cannot think why—by suggesting that my party should re-think its drug policy. He is quite right; we should. The Conservative Party and the Labour Party have had virtually identical drugs policies for more than 30 years, when they collaborated over the passage of the Misuse of Drugs Act 1971. That policy is now obsolete and destructive. When Mr Straw said that he would be tough on drugs, he did so in part, I suspect, because he thought that that is what people wanted to hear.
Public opinion is changing, and it is doing so quite quickly. People do not want tough policies or weak policies; they simply want effective policies, and they are not getting them at the moment. That means that change is needed; such change must be debated here in Parliament. I hope that the new Home Secretary will tell the other place what his view of the Brixton experiment is and I hope that noble Lords will also have an opportunity to debate it.
Today's debate, which focuses on health and crime issues, was an ideal opportunity to deal with a subject that straddles both the Home Office and the Department of Health. I presume that the lack of a policy commitment demonstrates a vacuum in the Government's thinking. I have always known that no government would focus on this issue until it rose up the political agenda. It has now started to do so and as Parliament proceeds we shall have to return to this subject in order to fill that vacuum.
450 The Government have a great deal on their plate if they are to deliver their election promises. They will certainly not be able to improve the levels of policing, improve the criminal courts, prevent the prison population from rising, reduce street crime, reverse the decline in A and E departments or deal with a whole host of other issues unless they address the drugs issue. Addressing the problems that are created by drugs use and drug-related crime has now ceased to be an issue that is on the political periphery. It has become a political imperative, and it will impact one way or another on the delivery of the reforms on which the Government will be judged at the next elect on.
§ 8.49 p.m.
§ Baroness Howells of St Davids
My Lords, I welcome this opportunity to take part in the debate on the gracious Speech.
I express some sympathy with the Minister, who by now may feel that every issue of concern has already been raised. I am afraid that I am about to disabuse him of any such feeling by raising a specific issue that is of concern to the black British. I shall, however, be brief.
I begin with racism in the health service. I vividly recall the call that this nation issued after the last war to the colonies to come and assist Britain in rebuilding its public and private services by supplying the much needed manpower that had been lost to Britain in World War II. That call was responded to handsomely and, even though there were several hurdles to be overcome, that generation gave generously, especially to the health service. Britain can be very proud of the work that was done at that time because it certainly gained many plaudits for having such a wonderful service. Those people did that with fortitude and a willingness to serve the country that they regarded as the mother country. Their agenda was simply to ensure a better life for their children, better education and better standards of professional skills as a means of upward mobility.
I pause to read a quote from Desmond Tutu who said:I am not interested in picking up crumbs from the table of those who consider themselves to be my master—I want a full menu of rights".That quote appears in a report called Racism in Medicine: An Agenda for Change. I bring it to the attention of the House because of the intolerable level of racism within the health service experienced by people whose skins are black, brown, red and yellow. The report states that as a result of stress, a significant proportion of black and other ethnic minorities carry a higher burden of poor health, premature death and long-term chronic illness than other groups in the population.
It is not bad health to which I want to direct my few minutes but rather the employment of the second and third-generation black Britons who suffer racism in the service. In the gracious Speech, it was said that the Government will introduce legislation to reform the health service and that they will bring forward a Bill 451 which will decentralise power and direct resources to the National Health Service. My plea to the Minister is that in so doing, I trust that part of the budget will be spent on the thorny issue of eradicating racism from within the service. Racism acts as a major hurdle to health and wealth. It puts a needless burden on the service that we provide by denying professionally qualified black staff equity and parity with the white staff of the service.
A viable commitment must be put in place and monitored to address equal opportunities in employment. There must be a will to tackle harassment and to provide competent and consistent training in recognising the most subtle forms of racism. It does take an extremely subtle form in the field of employment. We must be aware of the time lost through cruel acts of racism within our society. The report to which I referred calls for a whole systems approach. I urge the Minister to ensure that that happens.
Diversity needs to be valued. Challenging racist and discriminatory practices must be part of the whole service. The previous government strengthened the Race Relations Act by the provisions of the Race Relations (Amendment) Act 2000. That placed a duty on institutions actively to promote racial equality. The report to which I referred, Racism in Medicine, gives a clear and direct account of some of the effects and consequences of institutional racism. It goes on to offer some very practical advice on how to deal with racism in institutions in order to deliver a fair and equitable service.
I invite the Minister to ensure that that report is read because the social exclusion of black British professionals could lead us down alleyways which we have not even begun to contemplate. That is not a threat; it is a fact. Our professionals are not happy with the treatment that they are receiving. I did not use the statistics in the report because I hope that every noble Lord will spend some time reading the facts as they are presented in that report by the professionals themselves.
I respect the number of years' service that the noble Lord, Lord Rooker, has given in the other place. I add my welcome and congratulate him on both the wit and seriousness which he brings to this House. I look forward to working with him as I have worked with the previous Home Secretary and the noble Lord, Lord Hunt.
§ 8.55 p.m.
§ Lord Clement-Jones
My Lords, today we have had a very wide-ranging debate, as is customary, and we have had some memorable speeches. I do not plan to stray much beyond my usual remit on the health front but I want to mention in particular two speeches from other Benches which I found utterly lucid and compelling; notably, those from the noble Lord, Lord Mancroft, and the noble Baroness, Lady Kennedy. Both were superb speeches which informed this debate in an extremely helpful way.
452 I too want to add my congratulations to the noble Lord, Lord Rooker, on his maiden speech. I know that he will bring his well-known intellectual vigour and independence to the Home Office where many of us would think that it was sorely needed. I was particularly taken by his evidence-based approach because that is an approach needed in other government departments and I shall turn to that later.
Despite the great anticipation that we all had to hear the first Queen's Speech in this Government's second term, a highly significant event, I am afraid that on these Benches, many of our first and continuing reactions were of great disappointment. First, there is the failure to reintroduce the Tobacco Advertising and Promotion Bill. It is quite astonishing—that is not a word that is often used in this House—because it had already passed through the House of Commons in the previous Session and, indeed, had received a Second Reading in the Lords. Devastating critiques of the Government's decision not to bring forward that Bill were made by the noble Lord, Lord Rea, on the Government Benches and also by my noble friend Lady Northover. I entirely agree with them. Is that another demonstration of the power over this Government of the tobacco companies? It certainly seems to us to demonstrate the Government's lack of interest in preventative health measures since smoking has such a major effect on diseases which are meant to be important government priorities; for example, cancer, heart disease, lung disease and a variety of other respiratory diseases such as asthma.
The second disappointment is the failure to introduce new mental health legislation which is needed to update our very out-of-date mental health legislation going back to 1983. We have had a comprehensive review from Professor Richardson; we have had the Government response; we have had a consultation period. Surely we should now see the colour of the Government's proposals, at least in the form of a draft Bill. Is that simply the Government ducking another difficult issue?
Soon there will be more people in this country diagnosed as suffering from mental illnesses than from purely physical illnesses. That delay seems to demonstrate a complete lack of priority in this Parliament compared with the last when, as the noble Lord, Lord Williamson, made plain, some progress was made in the mental health services field.
Even more disappointing, perhaps, than those two failures is this Government's reaction to their failure to deliver on the health service in their first term of office. At times, the Government's message seems to be that the great salvation of the NHS will be the private sector. I was extremely interested to hear the contributions from other Benches with very similar themes—from the noble Lord, Lord Forsyth, to some extent from the noble Baroness, Lady Carnegy, and other noble Lords, in particular, the noble Lord, Lord Harris of High Cross. It seems a strange set of bedfellows for this Government and I wonder how comfortable they feel in that company. Indeed, the noble Lord, Lord Dean, gave the game away by saying 453 that he believed that the Government were following Tory policies on health and education. At that point I saw the Minister wriggle.
As yet there is no evidence that the private sector has delivered, or that it has the capacity to make much difference to the NHS. In almost every case PFIs have delivered fewer beds than the hospitals that they replace and by closing and reducing services at small local hospitals, they reduce access to patients.
I shall not engage with the Minister in selective quotations from the recent IPPR report, Building Better Partnerships, which was published last Monday, but it is clear that the authors are highly sceptical that so far there have been any benefits in the NHS as regards PFI. The chairman of the commission that undertook the report is a former chief executive of Barclays Bank and the current chairman of W H Smith, so he can hardly be accused of being anti private sector involvement.
The authors say that a cautious approach to the use of PPPs in areas such a clinical services is needed with careful piloting and evaluation. They call for an evidence-based approach; they say that a wider range of procurement models than just PFI is needed. By that I mean procurement models in partnership with the private sector. They further say that accountability models are inadequate and that the public and the National Audit Office should be given greater access to information. The report further states that PPPs should be used to improve standards and not just lower costs at the expense of quality.
I welcome the Secretary of State's subsequent attempt this week to give more clarity to the role of the private sector, but in some ways he has strangely circumscribed the role of the private sector in what he has said. It was almost an over-reaction to the criticism that has been made. We need open information and open debate about the performance of the private sector in such partnerships, so that it can be evaluated properly. This is not a theoretical construct. In that respect I bow to the noble Lord, Lord Harris of High Cross. He is very able to build theoretical constructs; we are talking about practical application and whether benefits are brought about for the patients and the National Health Service.
Ministers extol the virtues of evidence-based medicine. We need hard evidence of the benefit of PFI and other partnership initiatives with the private sector. We are in a strange situation where the vice-chairman of investment at NM Rothschild urges the adoption of a wholly different PPP model, which provides better value and more flexibility for the taxpayer and the Government.
More generally, what kind of impact on morale does the Government believe that they have to extol the extension of delivery by the private sector as the way 454 to meet targets? It is clear that it is a serious deterrent to those contemplating a career in public service—dare I use that phrase—and in NHS healthcare.
We do not have a great pool of untapped talent in the private sector, as the Secretary of State admitted at the weekend, so why are we demoralising those in the public sector where there is such a pool? As the King's Fund has said,enterprise does not have to be the preserve of the private sector".An editorial in a recent health service journal said:A more constructive way forward than chasing a myth would be to capitalise on the talents of public sector managers to improve standards across the service—not ordering in private sector teams to run red-light trusts, but harnessing the skills of the best NHS teams to help the not-so-good do better".On these Benches we could not have put it better.
If, in the face of that, the Government have a privatisation agenda, let us hear about it in the open and not by stealth. A previous Secretary of State for Health, Mr Frank Dobson, certainly seems to disagree with the Government's current approach. He has stressed that taking on the health unions on the subject is not the right approach. No doubt today we shall hear the outcome of today's meeting at No. 10.
A second limb of the Government's response to their failure to deliver is their promised measures to decentralise. My noble friend Lady Northover was absolutely right to be sceptical about the Government's intentions. After all, that commitment comes after several years of relentless centralisation. How will merging the existing health authorities in England into 30 larger authorities constitute decentralisation? What discretion will they be allowed? What will be the acceptable level of variation? In what experimentation can they engage? What impact will all that have on a future English regional devolution programme?
Recently Professor Rudolph Klein summed it up well in the BMJ:The first reaction to Mr Milburn's speech is, however, likely to be one of cynicism. At one time or other all Secretaries of State for Health—Conservative as well as Labour—have rhetorically embraced the notion of devolving power. But this has not stopped a seemingly unstoppable trend towards ever greater centralisation, culminating with the present government".And he is sympathetic. As he suggests, with this target-driven government perhaps we should have a set of devolution performance indicators, then at least we could ensure that the reality matches the rhetoric.
We on these Benches support genuine decentralisation and innovation—the public supports innovation—but it must be for patient benefit. As for improved patient representation—that rather interesting euphemism used in the Queen's Speech—I shall not anticipate the debates that we shall have on the Bill when it emerges, but we shall look at it with extreme scepticism if it bears any relationship to the scheme put forward in the last Health and Social Care Bill.
The Kidderminster Hospital drama is a lesson for the Government. A defeat of a government Minister 455 on a single issue campaign perhaps can be shrugged off when a government have a majority of 166, but this is a cloud that is no bigger than a man's hand that could blow up into a major storm if the Government continue down their current track. How this Government deliver will be just as important as what they deliver. Will they genuinely consult with staff and patients? Will they take their views into account? Will they be open and transparent about the performance of their initiative? Will they genuinely decentralise and empower those who run health services at local level?
In the face of that, noble Lords may ask what our prescription is for the better health of the NHS and what are the priorities of these Benches. First, we believe that more resources are needed than are currently planned. In particular, an increase in staffing levels is needed beyond those planned. We desperately need to build capacity, as my noble friend made clear. No doubt Ministers have studied carefully the recent report that they themselves commissioned from the Policy Studies Institute which graphically describes the stress suffered by senior nurses in particular. Because of lack of staff, they fill the gaps themselves with extra shifts rather than taking on agency staff. Morale in the NHS is at an all-time low. Noble Lords will have heard a debate held before the election. All the evidence during the election supported what we said at that time. We knew then that four out of five doctors would leave the NHS if they could. Now we know that one out of three nurses is contemplating leaving the health service.
There is no substitute for more capacity and more health service staff. Last month the outgoing general secretary of the Royal College of Nursing, Christine Hancock, said,Without enough nurses and other healthcare staff, make no mistake, NHS modernisation will fail".During the election, we made no bones about the need properly to fund the health service and to add further resources, and the electorate responded positively to our proposals.
All that means better recruitment and retention and we cannot achieve that without better pay and conditions. Furthermore, we cannot achieve it without being absolutely clear about the resources that are needed. Primary care, in which there is a gap of some 8,000 general practitioners between what the BMA says is necessary and what the Government are committed to providing, is a case in point. Problems over doctors' contracts arise to a high degree because of excessive workload, and reassurance about levels of recruitment are needed.
Secondly, we need to make better use of existing resources. We want to extend prescribing to nurses and professions allied to medicine and we share the Government's goals in that respect. We see a much greater role for community pharmacists. We see an opportunity for non-invasive surgical techniques and telemedicine to give a greater role to small hospitals. 456 We see the provision of intermediate beds at some of our small hospitals. Indeed, the Kidderminster case clearly demonstrates that we must find a role for these small local hospitals. Some of those proposals represent ways in which we can do that.
Thirdly, we need a major change in management style. The Secretary of State is effectively the executive chairman of the NHS, which belies his decentralisation rhetoric. The purse strings are firmly kept at the centre with trusts in virtually every case having to bid for new money for initiatives. That is all very time-consuming and bureaucratic. Together with decentralisation measures, will the Government undertake to reduce such red tape and reduce the amount of micro-management that is taking place?
Fourthly, we need to define the benefits of public-private involvement. In particular, we need to evaluate the benefits of PFI. We need to use PFI and other forms of PPP where that is demonstrably superior to pure public investment. We need to improve the way in which we have public-sector comparators. We also need to remove the bias so that there is genuine choice for hospital trusts between the different ways of financing. We need to ensure that we introduce more flexible contracts. Above all, we need to define the risk being transferred into the private sector. At present, many contracts are pure fudge and we need to look at different models. We on these Benches are not against public/private partnership in principle, but we need transparency about whether or not they work.
Fifthly, we need to end bed-blocking. Unless we ensure that appropriate arrangements are in place either in the community, in intermediate care or in acute hospitals, we will continue to suffer bed crises, and not just in winter. We have disagreements with the Government on the funding of long-term care, which have been well rehearsed, But the Government now appear to be reconsidering their commitment to fund even the limited amount of free nursing care to which they committed themselves in the Health and Social Care Bill. Will there be a cap on the nursing care provided? We believe that there must be a response to the recommendations of the Future Imperfect report by the King's Fund on the state of support for older and disabled people. If there is no improvement, how will there be any incentive for older people to leave acute hospitals in order to free beds which are necessary for those requiring acute care?
There is a huge agenda ahead of the Government and the Minister is very active in responding to our criticisms and constructive suggestions. We will be constructive in our approach to legislation when it comes before the House. However, we expect evidence not assertion; we expect increases in capacity, not restriction; and we expect consultation, not diktat. On that basis, we shall certainly work with the Government.
§ 9.12 p.m.
§ Earl Howe
My Lords, as we embark upon a new Parliament, it is perhaps appropriate that I should 457 begin my remarks today by congratulating the Government on their success in the general election. The majority which they have secured in another place is by any standards a remarkable achievement. The sense of disappointment shared by all of us on these Benches should not lead us to begrudge the Government their success. I am sure we are all delighted that the Prime Minister saw fit to reappoint the noble Lord, Lord Hunt, to his ministerial position at the Department of Health, a position which he has occupied so ably. I join other noble Lords in welcoming the noble Lord, Lord Rooker, to the Front Bench of your Lordships' House and in congratulating him on his excellent maiden speech.
In remarking on the Government's majority in another place, it is worth saying that by virtue of that mandate the task which falls to us in this House of opposing the Government—by that, I chiefly mean probing them, testing them and calling them to account—is rendered all the more important. I have little doubt that that view is shared by noble Lords on the Liberal Democrat Benches but it is one which during the years ahead I believe we should all bear in mind, regardless of party. It is counter-productive and wrong for an opposition to oppose for the sake of opposing. The Minister knows that I for one will never do that.
Looking back over the previous Parliament, there were many areas in which the Minister and I were able to agree completely, but, as we consider the words of the noble and learned Lord, Lord Williams of Mostyn, last week, we must treat with great caution any proposal to reform our working arrangements if they risk hampering the ability of this House to discharge its duties effectively, particularly in the scrutiny of legislation. I am as passionate about that as I am open-minded about ideas for change.
If there has been one noticeable strand of thought permeating the contributions to today's debate, whether on home affairs or health issues, I suggest that it is humanitarianism. I have in mind in particular the thoughtful speeches of the noble Lord, Lord Fitt, both right reverend Prelates, my noble friends Lord Forsyth, Lord Mancroft and Lady Carnegy, and the noble Baronesses, Lady Masham and Lady Kennedy of The Shaws. I could mention several others. In that vein, it is a considerable pleasure to look forward with the noble Lord, Lord Harrison, to the arrival of an adoption and children Bill. If, as I hope, the Bill is modelled along similar lines to the measure which had to be withdrawn because of the general election, I can tell the Minister that we shall welcome it and give it our most constructive attention. I believe that the Government share our view that legislation on adoption should put the interests of the child at the centre of the adoption process. That was the general principle which underpinned the Children Act. It is terribly important that more parents should be able to 458 adopt children if they wish to do so, not as a means of gratifying their wishes—still less as a means of cutting bureaucracy, however much we may regard that aim as desirable—but rather as a means of giving more children the opportunity to have a loving and secure family environment in which to grow up.
I was interested to read in The Times on Monday a letter from Liv O'Hanlon, head of the Adoption Forum, who has done so much to champion the cause of adopted children over the past few years. She particularly emphasised that any reforms will count for little unless they are backed by adequate funding. I suggest that we call that point to mind with some regularity during the passage of the legislation. I hope that the Minister will personally pursue it as he did the very similar issues which arose from the Children (Leaving Care) Act.
Like other noble Lords, I was surprised and bemused by some of the lacunae in the gracious Speech. As the noble Lord, Lord Rea, among others, pointed out, perhaps the most obvious lacuna is the proposed ban on tobacco advertising. Having been roundly told only a matter of weeks ago by the Secretary of State that the Government were determined to do something about tobacco advertising, and having heard the noble Lord, Lord Hunt, tell us that the Tobacco Advertising and Promotion Bill held out the prospect of saving 3,000 lives a year, it is odd that that measure is no longer the Government's priority that it once appeared to be.
Of equal concern, however, must be the absence of any announcement about a new mental health Bill. That lacuna was mentioned in particular by the noble Lords, Lord Williamson of Horton and Lord Clement-Jones. I hope that the Minister will take the opportunity to reassure us that there has been no weakening on the Government's part as regards their commitment to bring forward legislation to reform the current Mental Health Act. As all of us accept, that Act is out of date in the context of current practice and attitudes. I pay tribute to the Government for a good deal of useful work in preparation for such a Bill. I only hope that we shall see that work bear fruit before too long.
One measure to which we can look forward, no doubt with eager anticipation all round, is an NHS reform Bill. I hope that I do not sound too ungrateful, but it seems only the other day that we finished debating a very substantial NHS reform Bill. I am tempted to wonder how many more such Bills the Government have in store for us over the next five years. I understand the imperatives. From the point of view of the Government, there is a certain amount of unfinished business relating to patient representation. There are also a number of reforms to the GMC which I very much hope will prove to be uncontroversial. But the part the Bill which has received perhaps most coverage in the press and elsewhere is the proposal to devolve 75 per cent of NHS spending power directly to front-line staff. As the Minister knows only too well, I 459 am all for decentralisation. Giving front-line staff the responsibility for local spending decisions is definitely the way to motivate those staff better and to make the NHS more effective and efficient. That was the principle which lay behind GP fundholding, which, regrettably, the Government abolished.
I hope that I may be forgiven for echoing my noble friends Lord Bridgeman and Lady Carnegy, among others, in sounding a slightly sceptical note as to how the much-heralded decentralisation will work in practice. If old attitudes in Whitehall persist and if what the Virgin Group in their review described as "management by cascading paper" remains ingrained in the culture of the NHS, then I am anxious. The Minister and I have been fond of teasing one another on the subject. But he will agree with me that at its heart this is a real and serious issue. Of course there have to be targets set from the centre. The question is what, and how numerous, those targets should be. The trend over the past four years has been to accentuate the role of the department in setting targets rather than the opposite. I believe it would be better for doctors, managers and patients if that trend were now reversed.
In that context, it was with considerable relief that I learned that the Government had abandoned their manifesto pledge from 1997 to bring down the numbers on the in-patient waiting list. If ever there was a recipe for the misallocation of resources and poor clinical prioritisation it was that policy. With the emphasis now on waiting times, I agree with my noble friend Lord Dean that we are certainly moving towards a better kind of regime. However, even here, I would respectfully counsel caution to the Minister. So long as such targets remain in blanket form, they are by their very nature indiscriminate and take no account of clinical need. They are useful as a general benchmark of performance but not, I suggest, as an absolute indicator of efficiency, still less of clinical effectiveness. I hope that Ministers will not try to have us believe otherwise.
The Government know that there is much that needs to be done to improve the delivery of healthcare in our country. We sometimes need to remind ourselves that in trying to improve the health service we are building on a strong base. I am talking now about the men and women who work for the health service and whose motivation in their professional lives lies in serving the public.
I was glad to read the letter in The Times last week from Mr Nigel Crisp, chief executive of the NHS, who reminded us that we need to take a balanced view of the NHS and its problems. But I would suggest to the Government that in reaching a balanced view we should look at some of the indicators that really matter.
It is a sad fact that clinical outcomes in England for many of the major cancers are below the European average, and often very considerably below the best in Europe. Many patients with heart disease are not receiving the best treatment in a timely fashion. 460 Disabled patients are subject to huge variations in service levels around the country. There is a shortage of dialysis facilities for renal patients. Standards of basic hygiene in hospitals have slipped. Trolley waits are too long and too many.
Although I have just counselled caution over the interpretation of waiting times, there are signs that in certain fields there has been a regrettable deterioration in service standards since 1997. One example cited by the noble Baroness, Lady Masham, is audiology, which, despite the Government's welcome initiatives, is now badly under-resourced in terms of facilities and staff. I commend to the Minister, if the noble Lord has not already read it, the RNID's document called Audiology in Crisis—Still Waiting to Hear.
My noble friend Lord Forsyth, in his extremely wise and thoughtful speech, expressed the hope that the Government will not shrink from embracing a genuine partnership with the private sector for the delivery of healthcare. I share that hope. The Government's concordat with the private sector is not, of course, a panacea, but I believe that it opens the way to a real advance in the delivery of services to patients, provided always that Ministers make up their minds to follow it through. What counts for a patient is not where treatment is delivered but rather the quality of that treatment and its timeliness.
I have no doubt that in voting Labour at the general election, many people were implicitly putting their trust in the Government to deliver better services to the public, including healthcare. The next four or five years will be the test of that. It does not require any great insight on my part to point out that the key to success in healthcare will be to lift morale among staff, because on that morale depends the ability of the NHS to recruit and retain the GPs, the consultants, the nurses, the midwives and the other key professionals who deliver care to patients. Many staff are severely overburdened. There are serious shortages in nearly all the main disciplines. The challenges are therefore considerable. But much has been promised. From these Benches, in fulfilling our role as a critical Opposition, we shall nevertheless encourage the Government in their efforts to meet those challenges, and for the sake of us all as patients and as owners of the NHS, we wish them success.
§ 9.25 p.m.
§ Lord Hunt of Kings Heath
My Lords, this has been a debate of very high quality, which we all agree was opened in splendid fashion by my noble friend Lord Rooker in his maiden speech. I am certainly delighted to welcome him to your Lordships' House, not least because he has increased the number of Birmingham Peers in the House by at least 25 per cent, although sadly not the even more limited number of Birmingham City Football Club supporters.
Responding to such a debate in the 20 or so minutes that are given to me is undoubtedly a challenge and I shall write to all noble Lords to whom I am not able to 461 respond during the course of my speech. But it is also a challenge because at first sight it might be thought, as the noble Lord, Lord Phillips, suggested, that health, social care and home affairs have little in common. Although I think that the noble Lord directed his dagger at the wrong source, I agree with him that there is a debate to be had about whether the way we debate the Queen's Speech at the moment is the most effective.
When one looks closely at health, home affairs and social care, I would suggest that there are some strong interconnections between those areas in at least three respects. First, as the noble Earl, Lord Howe, identified, there was a humanitarian theme—a theme of civil liberties and individual rights—running through many of the contributions to the debate. The second is the impact on health and well-being in society of the devastating effects of crime and the fear of crime. The third is the management, direction and leadership of two great public services—the NHS and the police force. Noble Lords have today debated how those services might be improved and the role of government in that. I shall come back to that point in a moment.
The impact of crime on individuals is never less than serious. For some it can be devastating. As the noble Lord, Lord Dholakia, suggested, crime and the fear of crime often affect the most vulnerable in society. It is often the same group of people who also suffer from major inequalities in comparison with the overall health of people living in this country. Like other noble Lords, I listened to the remarks of the right reverend Prelate the Bishop of Durham, who spoke of some of the factors causing serious problems to the very fabric of our society and of the need to tackle the root causes of crime where legislation often has its limitations.
It is surely important to recognise that if we are to have a fair society where everyone in our communities, and not just some, get a fair chance to succeed, then strong public services, the fight against crime and the tackling of health inequalities must be a core part of our endeavours.
In his opening remarks, the noble Lord, Lord Cope, went through the list of responsibilities that have been taken away from the Home Office. I notice that none of them has been allocated to the Department of Health, which is probably just as well. However, I would say to him that the transfer of drugs responsibilities is by no means a downgrading of that matter within government as a whole. The Government will treat these responsibilities just as seriously as they take their responsibilities in tackling crime. As the noble Lord, Lord McNally, suggested, it allows the Home Office to focus on a number of important core activities and within the strategic framework suggested by the noble Viscount, Lord Goschen.
My noble friend's remarks concerning the need to look at previous Home Office legislation to see how 462 effective it has been and what lessons have been learnt certainly struck a chord with many noble Lords. I accept that that is a philosophy which we, too, in the Department of Health need to take to heart If I have learnt anything during my years in the National Health Service, it is that it is a great challenge to move from policy agreement to actual implementation. I certainly agree that we need to focus our attention much more on how policy is implemented and on how to ensure that it is delivered consistently across the field. I noted the offer made by the noble Lord, Lord Harris of High Cross, to help the Home Office in its review. That will receive the attention that it undoubtedly warrants.
That said, it is fair to point out that the Home Office Bills referred to in the Queen's Speech have generally received a welcome. The Government have set out a 10-year plan for reforming the criminal justice system as well as reforming the law to make it more effective in tackling crime. The criminal justice Bill will form the first stage of that programme and is designed to begin the process of reforming arrangements for sentencing. Several noble Lords have referred to the fact that, in the longer term, we shall have the report covering a major review of sentencing. I can assure the noble Lord, Lord Cope, and the noble Lord, Lord Williamson, that ample opportunity will be provided for consultation. We shall also be considering the proposals that will emerge from the review being conducted by Sir Robin Auld.
Like all noble Lords, I listened with great interest to the remarks made by my noble friend Lady Kennedy. She passionately raised the issue of civil liberties. Perhaps I may say that I agree with her comments that state powers have to be held in check. I agree that checks and balances must be put in place. However, as my noble friend Lord Mackenzie pointed out, we also have to consider the civil liberties of the Victims of crime. A balance must be struck here and I believe that the Human Rights Act has enabled us to strike that balance.
As regards the issue of double jeopardy in the criminal justice Bill, I shall refer to the remarks made by the right reverend Prelate the Bishop of Durham and say that this was not a knee-jerk reaction. This followed on from the report on the Stephen Lawrence inquiry and was referred to the Law Commission, which reviewed this area of the law. The Home Secretary asked the commission to take into account our international obligations, including the European Convention on Human Rights. My noble friend Lord Rooker has stated that we wish to seek consensus in this area. We are keen to encourage the closest possible consultation with Members of your Lordships' House on these very important matters.
Likewise, I shall say in relation to the proceeds of crime Bill that it is surely right that we seek to take action against big-time criminals who for too long 463 have lived off the criminality of others and the misery of the law-abiding public. However, again we recognise that there are important issues which have to be considered. We shall welcome the consultation and full involvement of noble Lords in discussions on the Bill.
The noble Lord, Lord Phillips, made some interesting remarks about reform of the criminal courts. He referred to the published interim report. I say to him that, in relation to the magistracy, the Government have said consistently that we see the lay magistracy as continuing to play a significant role in the criminal justice system. I certainly echo his remarks about the valuable role played by lay magistrates in our civic society. I would also say that, from the health service point of view, I regard their position as being similar to that of the non-executives in NHS organisations. They, too, play an enormously valuable role within the community. It is right to say that, although the noble Lord expressed doubts the failing civic responsibilities demonstrated by many people, the fact is that many thousands of citizens in our society make an enormous contribution to public life, and long may that continue.
I greatly appreciated the remarks made by the noble Baroness, Lady Stern, when she referred to a number of issues relating to prisons, the prison population and the rise in the number of prisoners. Let me make it clear that the Government believe that prison should be used to protect the public. Where the public are at risk from dangerous sex or violent offenders, or others who cause real harm to members of the public, it is right and proper that prison should be used. Where dangerousness is not an issue, there should be tough, demanding and focused community penalties which are designed to not only punish offenders but to guide them away from offending behaviour. The Criminal Justice and Court Services Act 2000 strengthened the use of community sentences by introducing a new focus on enforcement. It will be important to ensure that we monitor its appropriate implementation.
I echo the remarks of all noble Lords who have welcomed the future debate on prisons, which will be led by the noble Lord, Lord Hurd. The noble Lord, Lord Hylton, referred to two interesting initiatives in relation to prison. I shall be happy to take them back for the Home Office to consider and to respond to the points that he raised.
It is worth saying that we have invested money in a number of initiatives to improve the regime in prisons, including drug treatment programmes, offending behaviour programmes and injecting more resources into education. My own involvement from the Department of Health in working with the Home Office to improve the prison health service is beginning to pay dividends.
The noble Lord, Lord Dholakia, raised some important points about race relations in this country. I echo his remarks. He will know that the Race 464 Relations (Amendment) Act 2000 is the most radical piece of race relations legislation in 25 years. The remarks of my noble friend Lord Rooker in terms of a review of how we can make sure that such legislation is implemented effectively are important in relation to the questions that the noble Lord, Lord Dholakia, asked about the Government's determination to do all that we can to ensure that this country has excellent race relations. He will know that I very much share that view.
My noble friend Lady Howells made some pertinent remarks about the problems and issues of racism in the NHS. I accept the challenge that she laid down to me in relation to equal opportunities in employment and the need to take a whole systems approach towards tackling racism and harassment in the National Health Service.
A number of comments were made in regard to asylum procedures. My noble friend Lord Rooker, who has responsibility for this issue, has listened carefully to the points that were made. I shall follow up a number of the specific issues that were raised.
A number of remarks were made about the management of both the police service and the NHS which I think it will be helpful to consider together. Although the structures and forms of accountability of the two organisations are very different, I believe that there are certain common themes. There is a need for accurate information by which to judge performance and to make that information readily accessible to the public; there is a need to ensure that value for money and efficiency are watchwords for both organisations; there is a need to encourage best practice and to iron out unacceptable variations in performance, and to intervene if such action is required. My noble friend Lord Mackenzie got it absolutely right when he referred to widespread differences and the need for robust leadership.
I heard what the noble Lord, Lord Dholakia, said about the Home Secretary's relationship with police forces, but I should say to him that our police Bill is designed to strengthen police forces, their efficiency and their ability to fight crime. The proposals for a new complaints system are the result of widespread consultation and have widespread support within the community.
The debates about the police service and its relationship to central government have the air of some of the debates that we have had in your Lordships' House about the relationship between government and the National Health Service. We have spent many happy hours discussing this. The noble Earl, Lord Howe, has returned, once again, to his charge of over-centralisation, which was echoed by the noble Viscount, Lord Bridgeman. I will not debate this issue for too long with the noble Earl. I suspect that when the NHS modernisation Bill comes to your Lordships' House we will have ample opportunity to revisit this question.
465 I believe that it is possible—and since I have been given responsibility for performance management in the NHS it is my job to make sure that we deliver this—to reach a sensible balance between the need for robust intervention where there is undoubted failure in delivery with ensuring that much greater autonomy is given to those who are succeeding, and to give people room to breathe, to innovate and to show the kind of leadership that is required. That is what "earned autonomy" is all about. I am determined to see that we put that into practice. The Bill allowing us to place 75 per cent of all NHS spending power directly to front-line staff will enhance that process.
I assure the noble Lord, Lord Williamson, that nothing will be done to undermine the commitment and the priority that is given to mental health. We certainly intend to legislate to reform the Mental Health Act. We are always subject to the strictures of the parliamentary timetable, but we are determined to make progress in that very important area.
The right reverend Prelate the Bishop of St Albans made some interesting points about partnership. I agree with him: it is an easy word to use. It is very hard to make real partnerships work for the benefit of patients and for the public. It takes time and determination. The good news is that, over the past two to three years, relationships between the NHS and local government, to take one partnership, have improved enormously. We want to build on that. The establishment of care trusts as a result of the Health and Social Care Act is one way in which that will be done.
I accept the right reverend Prelate's concern about the pressures on general practitioners. They are under great pressure. We owe them a great deal. We seek, of course, to employ more general practitioners. We have increased the number of medical education places. We also want to encourage more people to return to general practice where that is appropriate. But I also believe that some of the work that has been done in the primary care collaborative is available to show how GPs themselves can improve their working practices.
The right reverend Prelate raised the issue of overseas recruitment. Our aim is to recruit from those countries that have a surplus of medical or nursing staff and not to do anything to undermine the healthcare systems in those countries.
I listened with a great deal of interest to the noble Lord, Lord Forsyth—first, to his recantation in relation to some of the past structural changes to the NHS in which he was involved. I very much welcomed the noble Lord's intervention, although I do not accept his analysis of our stewardship of the National Health Service. I reject the noble Lord's assertion that a public NHS cannot provide a high quality service. I have always believed that if we get the funding right, with 466 the absolute dedication of the staff and the high quality teaching and research that we have in this country, we shall be able to produce the kind of high quality public health service that people in Britain wish to see delivered.
Our approach has been to develop best practice. It has been to achieve greater consistency—that is why we have national service frameworks: the National Institute for Clinical Excellence, the Commission for Health Improvement. Alongside that, the approach is to increase our capacity, with more beds, more staff, renovated A&E services and new services such as NHS Direct.
The NHS is not perfect, but it is improving. I believe that it will go on to improve. I have great confidence that we shall be able to build the kind of NHS that was the express wish of the public in the general election.
A number of noble Lords referred to our intention in the forthcoming Bill to revisit the issue of patient and public participation in the NHS. There is nothing I should enjoy more than further debates in this area. I have said all along that there is only one test for our proposals; namely, that the public and patients will have a greater say, more influence and better representation in those arrangements than they do at present. I am very happy to be judged and tested on those proposals.
Several remarks were made about our relationship with the private sector. We believe that there is much to be gained from partnership. Unlike the noble Lord, Lord Clement-Jones, I believe that the private finance initiative can bring resources, investment and expertise to help us speed up, for example, our hospital building programme. In relation to beds, I also believe that the noble Lord is missing the point. If one looks at the trend of bed numbers going back over the years as regards publicly-financed hospitals, one will see a similar reduction. With the national beds inquiry that we have instituted and with our determination to increase capacity in the NHS, the equation will be changed both as far as concerns PFI schemes and publicly-funded schemes.
I should tell the noble Viscount, Lord Bridgeman, that we welcome the concordat with the independent sector. I believe that there is everything to be gained from a good understanding at national and local level. Over the past few months, I know that some very, good contracts have been agreed between independent providers that have enabled the NHS to increase its capacity.
A number of comments were made during the debate about morale in the NHS. When I joined the NHS in 1972, I was told that morale had never been lower. I believe that it has always been a characteristic of staff to say that morale is low. None the less, we 467 must always take note of warning signs. It is most important that the staff in the NHS feel that they are part of the change and that they should feel ownership of the change. By increasing the number of staff, by trying to reduce some of the pressures on them and by improving working conditions and their access to training and development, I believe that we shall be able to improve morale. However, there is a tremendous leadership challenge at local level. One of the reasons that we established a leadership centre was to encourage and help leaders—managers and clinical directors—to develop and lead their staff. I am sure that that is one way in which we shall be able to tackle the issue of morale.
My noble friend Lord Fitt mentioned the issue of juvenile arthritis. I certainly took note of what he had to say. In relation to NICE, I shall simply say that we established this organisation to combat postcode prescribing because the NHS had such a poor record in introducing new techniques, treatments and drugs when they had been proven to be highly effective. The point about NICE is that if it makes a judgment that such treatment is effective, we can then speed up its implementation in the NHS. I should point out to my noble friend that I believe the NICE process has been shown to speed up innovation.
I always take pleasure in debating dentistry issues with the noble Lord, Lord Colwyn. I confirm that we are committed to NHS dentistry. We want to work with the profession. We shall shortly be introducing a workforce review. I should tell the noble Lord that the strategy that I published a year ago is an essential foundation for a new working relationship with the dental profession.
The noble Lord, Lord Clement-Jones, the noble Baroness, Lady Northover, and my noble friend Lord Rea raised the issue of the tobacco Bill. I should like to reassure the House that we are committed to bringing back the Bill to ban tobacco advertising and promotion during the course of this Parliament. As noble Lords opposite well know, there will always be pressure and competition as regards places in the legislative programme. However, as my right honourable friend the Prime Minister said during a debate on this very matter in another place, this is a very high priority. If time permits, we shall try to accommodate it in this Session; otherwise, it will certainly be a high priority for a future Session of this Parliament. We shall, of course, take great note of the comments that have been made in your Lordships' House tonight.
I very much enjoyed and respected the speech made by the noble Lord, Lord Mancroft. I want to reassure the noble Lord that the lack of any legislation in the area of drugs and drugs misuse is 468 no indicator that that is not a priority for the Government. The noble Lord referred to the 10-year anti-drugs strategy launched in 1998. We are determined to press forward on all aspects of the strategy: young people, communities, treatment and availability. I agree with the noble Lord that research has clearly shown the links between drugs and crime and that getting drug misusers out of the criminal justice system and into treatment works.
I listened with great interest to what he had to say about the potential impact of the National Care Standards Commission on drug treatment centres. I shall study those remarks to determine whether any problems will arise in that connection. As regards treatment, we have set up a national treatment agency. This is a cross-government initiative which brings together budgets from different parts of government. It will ensure that treatment is available and accessible and that there will be high quality services regardless of the route of referral.
I turn to the remarks of the noble Baroness, Lady Masham. I thank her and the noble Earl, Lord Howe, for their congratulations on my reappointment to the same post. The noble Baroness suggested that I be promoted. I cannot possibly comment on that. However, I agree with her that national specialties constitute a vitally important issue. In decentralising many decisions to the local level we also have to ensure that, particularly with regard to national specialties where there is only limited provision throughout the country, we make sure that there is provision and appropriate treatment and support. That is why we have a national specialties commissioning group. It is a matter to which I shall give full attention.
Last, but certainly not least, I return to the issue of children. Our debate has touched upon social disadvantage in a number of areas and none more important than among children. I very much agree with my noble friend Lord Harrison. He was right to mention welfare, long-term fostering and, of course, the impact of the adoption of children Bill. I agree with his remarks about the training of adoption staff. It is extremely important to ensure that when the Bill is enacted social services authorities will be able to implement it in as appropriate and efficient a way as possible.
My noble friend Lady Gale made some apposite remarks on the involvement of women in politics. As regards legislation being available in time for the Welsh Assembly and Scottish Parliament elections, I cannot give any commitment but I understand her desire for speed in that matter.
I have sought to draw some common threads through what I believe has been an excellent debate, although not, I hope, in any contrived or artificial 469 sense as noble Lords brought so many links to the discussion. The links between social exclusion, crime, fear of crime, health and well-being are so clearly apparent that a cross-cutting approach certainly in central government but crucially at the local level becomes ever more important. I believe that the legislation mentioned in the gracious Speech in relation to home affairs and the Department of Health will help us in that aim. I commend it to the House.
§ Moved, That the debate be now adjourned until tomorrow.—(Lord Filkin)470
§ On Question, Motion agreed to, and debate adjourned accordingly until tomorrow.