§ 6.33 p.m.
§ Lord Brooke of Alverthorpe rose to move, That this House takes note of the reports of the European Union Committee, Reducing Air Traffic Delays: Civil and Military Management of Airspace in Europe (14th Report, Session 2000–01, HL Paper 79, and Supplementary Report: 9th Report, Session 2001–02, H L Paper 63).
§ The noble Lord said: My Lords, first, I thank members of Sub-Committee B for the hard work that they put into the two inquiries. I thank the noble Baroness, Lady Park of Monmouth, who joined us from Sub-Committee C, whose interventions have been much valued by the committee. There were some doubts as to whether we should have this debate, given the consequences for aviation of the tragic events of 11 th September. But for reasons I shall give, we have proceeded. It gives me the opportunity now to thank publicly others who have helped us greatly.
§ Our gratitude goes to all who gave evidence. I especially want to express our thanks and appreciation to our two specialist advisers, Air Vice Marshal John Feesey, of the RAF, and Mr Tony Goldman, CB, formerly of the Civil Aviation Authority, without whom we would have found it impossible to find our way through what seemed like a whole new world to most of us.
§ Our thanks also go to Siobhan Conway, our then secretary, and our invaluable clerk, Patrick Wogan. I also express my personal appreciation to the noble Lord, Lord Faulkner of Worcester. He chaired the session in the second inquiry when I had in the meantime become a non-executive director of the National Air Traffic Services Limited about which I now declare an interest.
§ When we began this inquiry a year ago there 'was severe congestion in the skies over western Europe. That was partly due to the seemingly inexorable increase in civil aviation and partly because of the complex division of airspace over Europe. We were concerned about the areas of airspace set aside exclusively for military use. In some member states, civil aviation had been permanently excluded from such areas. In others, the system known as "flexible use of air space" operated which allowed civil aviation to make occasional use of military zones. The overall effect, however, was to add another factor which produced congestion which in turn contributed to delays which were both costly to operators, damaging to the environment, and irritating (to say the least) to travellers.
§ Congestion and delays to air traffic in Europe first reached crisis proportions in the late 1980s. This prompted the committee to report in 1989. Despite continuous efforts to deal with the problem, serious congestion still prevailed especially in the heavily used areas of western Europe. The committee again reported on the subject in 1996 when we considered the European Commission White paper on air traffic management entitled Freeing Europe's Air Space.942
§ In 1999 Eurocontrol, the Brussel-based Europe organisation for the safety of air navigation. estimated that delays arising from ATM problems had risen by over 30 per cent against the previous year. Undoubtedly, a large element could be attributed to NATO air activity in the Balkans. But in 2000 the Association of European Airlines claimed that such delays were still 25.5 per cent up on 1998.
§ The European Commission recognised that something needed to be done. In December 1999, the commissioner, Madame Loyola de Palacio, introduced proposals entitled The Creation of a Single European Sky. The Commission set up a high level group comprising senior civil and military officials 10 consider them. This group submitted its report to the Transport Council in December 2000. The Commission undertook to prepare draft legislation to implement the recommendations. Basically, those envisaged replacing the patchwork of national civil and military control over western Europe by a single area subject to regulation by the Commission. It was an interesting concept but the difficulty lay in how to graft a new system on to one which had devolved since the Second World War.
§ When we began the inquiry the Commission's proposals had not been published. They were blocked by the Spanish unwillingness to allow any proposals for aviation to be extended to Gibraltar. None the less, it seemed to us important to look at the principles and the way in which the Commission sought to marry its concept of regulation to the pan-European system with what was already operating under Eurocontrol.
§ It is important to remember, too, that Eurocontrol had been wrestling with the problems of air traffic management and had launched a series of technical and institutional programmes to improve delivery of ATM services. In January 2000 European aviation Ministers launched a new phase of these programmes entitled ATM 2000+. The first of those new measures, reduced vertical separation minima (RVSM ) came into effect only last month. When others come into effect in 2005, and if implemented by all member states, Eurocontrol calculate that it will have increased capacity over the core area of western Europe by 60 per cent.
§ We delayed debating our report and the Government's response because we were conscious that change was in the air (if noble Lords will forgive the pun). The United Kingdom and Spanish Governments announced a resumption of discussions about Gibraltar. This led to the UK suspending the application of single sky to Gibraltar until the issue was clarified. This, in turn, cleared the way for the Commission to work up its single sky proposals and to publish them officially on 10th October 2001.
§ However, a more serious event occurred on 11 th September which had a direct impact on this subject. The terrorist outrages in New York and Washington were followed by a considerable drop in civil aviation, particularly over the North Atlantic. That reduction in traffic caused us to ask whether the original purpose of our report had been overtaken. As a consequence of 11 th September, delays were reduced because,943
§ effectively, the decrease in traffic eased congestion. Nevertheless, we decided to take evidence from the Commissioner and to report our findings.
§ While acknowledging that there had been a downturn in aviation, the Commissioner argued that it was only temporary and that the long-term trend would resume, so the issue still needed to be addressed. By that time we were able to examine the Commission's published single sky proposals. Essentially, those did not differ from the unpublished version that had informed our earlier report and went some way towards fleshing out some of the details for us. It went some way, but in our opinion, not far enough.
§ Two areas required careful examination. The relationship between the European Commission's Single Sky Committee, as regulator for EU member states, with Eurocontrol's role as a regulator for 30 European countries, including the 15 non-members of the EU, was one of the topics. We also wanted to look carefully at how to deal with the military.
§ On the relationship between the Commission's Single Sky Committee and Eurocontrol, the European Commission does not have the expertise to inform its regulatory competence. It has no choice but to seek that expertise from the Eurocontrol agency. In effect, the Government say that, first, the European Commission will propose the rules; secondly, Eurocontrol will work them up using its expertise; thirdly, the European Commission will implement them for EU member states only; and, fourthly, Eurocontrol will promulgate them to non-EU states and implement them there.
§ The flaw at the heart of that is that, whereas the European Commission will be able to require EU member states to observe regulations because it has a legal base on which to do so, the Eurocontrol regulatory function will be unable to impose such regulation on the non-EU states because Eurocontrol is an international treaty organisation. It does not operate an international legal system comparable to that which binds EU member states. How does the Minister see that conflict being resolved?
§ A separate issue is that Eurocontrol is both a regulating body and a service provider. We have recommended that the distinction between those two functions be widened. We wonder how the revised Eurocontrol convention will bring about such a separation of functions and how transparent it will be. We should be grateful for the Government's views on that.
§ A subsidiary issue is how the European Commission's Single Sky Committee and the Eurocontrol regulation function fit together with national regulatory authorities. The relationship will vary between EU member states and non-EU states. In short, we see the potential for considerable confusion. Therefore, we believe that it is essential that the European Commission and Eurocontrol focus on determining the nature of the relationship between themselves on those issues. The Commission has 944 assured the committee that a document will be drawn up to demarcate competencies. That will require careful scrutiny. Can the Minister assure us that the Government will also monitor that closely?
§ Turning to the heart of the report, which was how to integrate the military in the management of European airspace, we have a problem with the Government's views. The Commission proposes that the Single Sky Committee, the new regulatory body for EU member states, should also be able to accommodate a routine military input related to the management of airspace. It points to the successful, high-level group study in which both military and civil participants sat together and made an equal contribution.
§ The Commission told the committee that each member state would have two seats on the Single Sky Committee and strongly implied that it would like to see one filled by a civilian expert and the other by a military expert. Naturally, the member states would decide how they should be represented; for example, under the first pillar of the European Union. We see value in that kind of co-operation, particularly in ensuring that concepts such as the flexible use of airspace can be imposed on member states who hitherto have strongly resisted Eurocontrol's recommendation to implement this system.
§ However, the Government cannot accept that any aspect of the military could be subject to the single sky and to European Community legislation and thus fall under the first pillar of the European Union. I can see strong reasons why they should adopt that position. Control of the military is at the heart of national sovereignty, but we have ceded aspects of that sovereignty in other areas. We believe that, for the common good, there is much to be said for ceding a limited amount in this area too.
§ However, like the Government, we accept that there will be military subjects that cannot be dealt with under the single sky proposals. The problem is to find an appropriate forum. Eurocontrol has already encountered a similar problem and has come up with a solution in the form of the Civil/Military Interface Committee. There is a big difference between what Eurocontrol does and what the Commission requires. Eurocontrol is an international treaty organisation and so all decisions must be made on the basis of agreement by all the members. The European Community has its own house rules. We have proposed that whatever organisation is set up under the second pillar of the European Union, where member states meet on a national basis to discuss certain military matters, the membership of such a group be the same as the membership of the Eurocontrol Civil/Military Interface Committee for aviation issues. In that way we believe that it will be possible to maintain a consistency of policy between member states, Eurocontrol and the Single Sky Committee.
§ I return to the additional problem of how to fit in with the non-EU members of Eurocontrol. They will be represented on the Civil/Military Interface Committee in Eurocontrol and that will be the only945
§ way in which they can interact with the military members of the European Community. In our opinion, that reinforces our argument that the EU member states' representatives in the Civil/Military Interface Committee should be the same as those who meet under the aegis of the second pillar dealing with military issues. We should like to know what difficulties the Government see in that recommendation and why they cannot proceed accordingly.
§ In 1996, when we reported to the House, we recommended that the European Commission should not accede to the revised Eurocontrol convention in its own right. When we began the current inquiry we were broadly of the same opinion. However, as the inquiry progressed, we saw that an overwhelming majority of the witnesses argued strongly that the Commission should accede in its own right, in addition to the individual and separate membership of the member states. Only one witness argued against that, so we have been persuaded that that is the right way to go. Once the Commission begins to regulate the airspace of member states it will need to speak in Eurocontrol councils as a full member and for member states in areas that have become part of the acquis commuititaire.
§ We envisage a situation where both member states and the Commission sit at the same table, with the Commission leading on those areas that have already been transferred to its competence. For that reason, we urge the early ratification of the revised Eurocontrol convention, but we do not understand why, so far, only one member state has ratified. Perhaps the Minister can tell the House why and what is likely to happen.
§ Looking to the future, we believe that the Commissioner's evidence to the committee was correct. The current downturn in civil aviation has been severe, but since 11 th September and towards the end of 2001 the civil aviation industry has steadied and it is now beginning to regain some of its traffic. However, many of the problems that surrounded civil aviation antedated the events of llth September and the decline in the larger companies has not been mirrored in the low-cost airlines whose traffic has surged. We conclude that it is not too early to consider how to re-map the heavens over Europe. I beg to move.
§ Moved, That this House takes note of the reports of the European Union Committee, Reducing Air Traffic Delays: Civil and Military Management of Airspace in Europe (14th Report, Session 2000–01, HL Paper 79, and Supplementary Report: 9th Report, Session 2001–02, HL Paper 63).—(Lord Brooke of Alverthorpe.)
§ 6.49 p.m.
§ Lord Clinton-Davis
My Lords, I am very pleased that this debate is taking place, and the issues involved been effectively highlighted by my noble friend Lord Brooke of Alverthorpe.
My remarks are confined to the issue of civil aviation. In that regard I declare an interest as the president of the British Airline Pilots Association, 946 which supports the development of harmonised air traffic management service providers throughout the Continent of Europe. But I also have to declare an interest as a former European Commissioner for transport. I had responsibility for aviation in that respect. I remember only too well how the transport Ministers sought to sideline me, not personally, but as the European Commissioner responsible for that area. I believe that they were quite wrong. I do not believe that the Ministers still adhere to that kind of policy. I hope not.
From the concept of the environment to which my noble referred, but also as regards safety and efficiency, I believe that it is vital that the idea of a single European sky should be pursued with vigour. Indeed, that was made abundantly plain in the evidence given by Captain Steve King of BALPA and by Mr Peter Quaintmere of the International Federation of Airline Pilots' Associations.
The trouble which we are now experiencing is that the system we have is unable to deliver any improved—and I emphasise the word "improved"—levels of service based on the current estimates of 5 per cent annual growth.
The report which this House is now considering stresses the need for enhanced co-operation between the national and the international regulatory authorities and for a revised Eurocorttrol convention. I unhesitatingly support the Government's recommendations that development of the proposals for the future of Eurocontrol should proceed as quickly as possible. They also have to be made binding on all the states which are members of Eurocontrol. I argue, as does the committee, that there is no real conflict between the activities of Eurocontrol and those of the European Union.
Perhaps I may say something about Swanwick. I believe that it is a technological triumph. I am concerned about the development of Prestwick in Scotland as the second major air traffic centre. As we know, post-September 11 th the Government froze work at Prestwick because of the fall in passenger numbers. Thankfully, those numbers are now recovering and the fall, while very serious, has not been quite as drastic or as prolonged as had been feared.
Hitherto, Prestwick has been part of the Government's two centres strategy for safety and efficiency through sustained growth in the 21st century. Is it now? I believe that my noble friend Lord Filkin should tell the House where the Government now stand. I believe that he will since it is very important that he should say where Prestwick stands now.
I believe that it is quite wrong to rely on French and Belgian air traffic control for full coverage in the United Kingdom. My submission is that we need two centres to compete for future air traffic contracts under the single sky when all air traffic control is integrated across Europe. We must have regard also for the erstwhile and future lucrative North Atlantic business. Without the development of the Prestwick centre, the United Kingdom could miss out on millions 947 of pounds-worth of contracts. If I am wrong about that I am sure that my noble friend will put me right, but that is what I am deeply afraid of.
In that regard I speak on behalf of all the United Kingdom air pilots. I call on the National Air Traffic Service and the Government to unfreeze the development at Prestwick. Even if work starts today, it could not be fully operational for some six or seven years. The European Commission will award contracts for the future provision of integrated services to modern—I underline that word—centres which are up and running. Therefore, unless both centres are in the frame we are unlikely to be in a position to bid for this work. Any further delay is bound to prejudice our air services from expanding and providing us with badly needed revenue.
I believe that the work done by the committee is absolutely first class. I congratulate my noble friend and all his colleagues on what they have done. I make no apology if I have emphasised both Swanwick and Prestwick in my remarks. I hope that my noble friend will realise that I am deeply concerned, as I hope is also the House, about the progress we can make in both respects, and the sooner the better.
§ 7 p.m.
Lord Bruce of Donington
My Lords, I congratulate my noble friend Lord Brooke and his committee on the report produced for the House and, indeed, for the whole of Parliament. It was a very high-powered committee. On reading through its proceedings I became aware of the tremendous amount of time devoted to it by each member, many of whom have considerable businesses and affairs to deal with. I am bound to tell my noble friend in advance, however much it may shock him, that I agree with almost 100 per cent of his remarks to us today.
The open skies policy, which one hopes will be brought into operation, is one of my justifications for supporting Britain's role, as I see it, within the European Community. It presents a classic example—the proceedings verify that—of how conversations between people, as distinct from diktats, can arrive at solutions on a friendly basis without any particular reference to the nations involved. The kind of cooperation which was spoken of in the report and by my noble friend Lord Clinton-Davis, whose views and expertise on this subject are well known, is most agreeable.
I was last at Eurocontrol in 1977—it does not seem all that long ago—when I had the opportunity of visiting its headquarters. Those were the days when, compared to this Chamber, its computer occupied a considerable amount of space. It was a colossal installation. I am given to understand—I do not know how authoritatively—that today it is something like a hatbox. I was there because of the matters that had to be dealt with as regards military use of airspace in Belgium, Holland and to some extent France at that time. Those matters were highly sensitive. As is well-known by all parliamentarians, military matters are 948 the one thing that member states, particularly their governments, choose successfully to keep close to their chests.
As I am sure my noble friend will confirm, a way must be found to solve the military problem in this comparatively restricted amount of airspace. That is mentioned in the report. It is well known that it is of considerable inconvenience to civil aircraft to pilot that particular area. I am not taking sides in the matter, which is unusual for me. However, I can see that the military have a point. The whole trouble is that the military, and the secrecy connected with their operations, are not always readily available to the civil governments they represent. That becomes one of the principal problems.
With respect, I endorse the enthusiasm of my noble friend and of the report for open skies. However, there is still this niggling matter to be dealt with, particularly in the area occupied by the French. They have a training area which happens to be in a critical part of the air traffic routes. I do not know how one overcomes that. Military people can be obstinate. I was in the military for a long time; I have almost forgotten it. Military people tend to be obstinate in their points of view and play their cards close to their chest.
The position is now even more complicated. In addition to the normal training facilities for which countries such as France, Belgium, the Netherlands and, to some extent, ourselves require the use of this airspace, there is now another factor to be considered. As is well known, the use of military aircraft will be covered by other arrangements, which will involve defence covering the whole of Europe.
§ Lord Clinton-Davis
My Lords, I thank the noble Lord for giving way. I cast my mind back to 1988 when I was honoured with the task of being Transport Commissioner. There was not a single mention of the military question by the transport Ministers. They sought to relegate the commissioner to the sidelines. They thought that preferably he should not have been there at all. So, it is not only the military aspect which is important—I do not deny that that is very important indeed—but it was considered that the Commission should not have responsibility in the wider area of civil air transport. I think that has changed.
Lord Bruce of Donington
My Lords, I trust that nothing I have said dissents from what the noble Lord has said. However, I cite the report in justification of my remarks. The noble Lord, Lord Woolmer of Leeds, asked Mr McMillan an important question at paragraph 93. He said:David, I think you said that problems posed by the lack of airspace are very significant. Could I just ask about the French situation? Do the constraints upon airspace over France cause any significant difficulties for air travellers commencing or ending their journeys in the United Kingdom".Mr McMillan replied:There is one French military training area which abuts the Dover sector of the United Kingdom, I think it is called CBAO I … and that is a military training area which has in the past caused some quite significant problems to aircraft leaving the United Kingdom or entering the United Kingdom. It is a military949area that abuts one of the main air routes across to the Continent, and I have to say in the past that has been a very significant problem".He goes on:There are now, I am pleased to say, better methods of communication between the French military and London controls. Nonetheless, it is still a military training area that does abut a major route and on occasion we do still encounter some delays there".I rest my case purely upon that.
I should like to warn the House that other difficulties arise from the defence and foreign policy group within the European Union. That particular committee, as we know, carries within it an EU military responsibility towards the whole of the defence of Europe, and covers part of the air forces concerned. We know that there are difficulties precisely because of that issue.
There is a battle going on—I shall not call it an ideological or a sinister one. It is a legitimate battle about how these matters will work out when, under the mutual defence arrangements, aircraft have to be used. That impinges on an area with which Eurocontrol has been involved in the past. There are complications, which I hope will be solved. I am sure that they will be.
The report is extremely comprehensive and covers the Government's responses. It will have great influence. I keep my antennae fairly open and I have yet to see such a thorough report that focuses so precisely on these points. I wish it well, but I must warn Her Majesty's Government on the French fluid position in connection with its part in military matters generally and the Commission's insistence on being represented on the committee. We know that the Commission is never averse to poking its nose in, and not always where it is required.
I issue that warning and repeat my congratulations to the chairman and the committee as a whole.
§ 7.11 p.m.
§ Lord Wilson of Tillyorn
My Lords, as I am the first speaker in this evening's debate who had the pleasure of serving on Sub-Committee B under the wise and thoughtful leadership of the noble Lord, Lord Brooke of Alverthorpe, I wish to say what a pleasant and interesting experience it was. It was doubly interesting for me because, as a newcomer to that committee, this is the first of its long reports in which I have participated.
I derived some personal lessons from that experience. The committee has plenty of expert advice. We have our own excellent expert advisers, very good expert witnesses and several members of the committee who are expert in whatever subject is being discussed. For those of us who do not feel as though we are particularly "high powered", to quote the words of the noble Lord. Lord Bruce, but who are amateurs, our experience is that we come out of the process not pontificating about what should be done but learning what should be done.
950 Perhaps the only thing that someone like myself who is not an expert on this subject can contribute is a degree of looking at the matter through the lens of common sense. There are two points on which common sense should apply.
First, I refer to the report that we produced. Its cover, to make it exciting, showed air traffic routes throughout Europe as a nightmare of cobwebs. That is clearly what they are, and what they will remain even though there has been some diminution in air traffic, as the noble Lord, Lord Brooke, said, following the tragic events of 11th September. The previous density of air traffic will resume very soon, so the respite. if any, is temporary.
I often travel between Scotland and London. Indeed, I flew from Edinburgh to London this morning and had the not unusual experience of being held on the ground for 20 to 25 minutes. The pilot told us very politely that the delay was an air traffic control problem. The advantage of having served on Sub-Committee B is that I now no longer believe that they are United Kingdom air traffic control problems; they come from Brussels. However, it is not the devil figure of the European Commission that is doing this; it is Eurocontrol saying that there is excessive density of air traffic coming into London at a particular time in the morning, and asking whether the air traffic from certain areas, perhaps in the periphery—and perhaps Scotland is in the periphery—will kindly hold back.
That was a great thing to learn because I need no longer blame our own air traffic controllers; I can blame Eurocontrol. The clear lesson is that even if one is flying from Scotland to London, one is intimately affected by what happens in the resit of Europe. We cannot divorce what is happening in the United Kingdom from what is happening in the whole of Europe. In other words, to have effective use of the limited number of air routes, we must have a cooperative relationship with other air traffic controllers in continental Europe.
The second lesson which came across most clearly from my involvement in the report is the one to which the noble Lord, Lord Bruce of Donington, referred. I refer to the relationship between military control and civilian control of airspace. The classic example is the squeezing of air traffic routes out of London, southeastwards to continental Europe by a particular area under the control of the French military. It came across to me most clearly that when there is a pragmatic co-operative relationship between civilian and military air traffic controllers, the system can work if there is flexible use of airspace.
We are pretty good at that in the United Kingdom. It is evident that Germany and the Scandinavian countries are good at it too. It is equally evident that there are a number of countries in continental Europe which are not good at it. The lesson is that if one is to make good use of limited airspace, there must be a cooperative relationship between the military and civilians. That must be achieved.
951 The precise mechanics of how those relationships are worked out and how policy within Europe is carried forward seems to be a matter for the experts to work out in detail. There is a danger of too much bureaucracy through excessive use of the European Commission, as opposed to the expertise of Eurocontrol. The mechanics of all those issues are for the experts to work out. The general lesson that is most apparent from the report and from all the evidence that was given to us is that if we are to spend our time and resources flying effectively from one point to another rather than either sitting on the ground or flying round in circles, the attitude of mind on all these issues must be one of co-operation between nation states, and between civilians and the military.
§ 7.18 p.m.
§ Lord Woolmer of Leeds
My Lords, in welcoming the report, as one of the members of the committee I pay tribute to the chairmanship of the noble Lord, Lord Brooke, and the contributions of all other members of the committee.
The wise words of the noble Lords, Lord Clinton-Davis, Lord Bruce of Donington and Lord Wilson, all find common cause in that this is a classic case of the need for a pan-European Union common policy, as suggested by the noble Lord, Lord Bruce. I totally agree with him and with the conclusions of the report.
As the noble Lord, Lord Brooke of Alverthorpe, said, there has been enormous growth in air traffic in the past 20 years, leading to at least two crises in handling it. By November of last year, 15 per cent of European flights were delayed by more than 15 minutes. As someone who flies around Europe a great deal, not to mention the rest of the world, I am always mildly surprised by the modesty of those delay figures. As a frequent traveller, I am very surprised that only 15 per cent of flights are delayed by only 15 minutes. That was something I never managed to square with the statistics. There was a great deal of fudging of statistics and in my later remarks I shall be making a plea for greater transparency and openness in this market-place. It is becoming, hopefully, an increasingly liberalised market-place where the user will have more power and influence than in the past.
Most of us in this Chamber probably use scheduled flights. But the charter traffic user—the average man and woman in the street—probably experiences much longer delays. If they listened to this debate tonight they were probably greatly surprised to hear that only 15 per cent of flights experience a delay of 15 minutes. So this is a slightly refined discussion compared with the common experience of many users of airlines.
That is looking to the past. Looking to the future we are told that air traffic will increase by 25 per cent over the next four to five years, and probably up to 100 per cent over the next 15 years. What do our users want of the air traffic system? They want speed and lack of delays. That is what is attracting the attention of your Lordships' House this evening. But they also want convenient location of airports. They want a better 952 quality experience in airports, and of course they are greatly concerned with safety—tragically now, safety from terrorism, but more continually the general safety of flying.
I was extremely pleased to hear, and the general public to know, that the reason why we are held on the ground so often, air traffic delays or otherwise, is to ensure that safety is paramount. Users are concerned that safety remains paramount, despite the substantial increase in traffic movements. The ways in which, for the next few years, in Europe, and I am sure globally too, various air traffic control agencies, regulatory bodies, airlines and airports, will be seeking to ensure that we cope with the growth in air traffic are outlined in the report before your Lordships tonight. Those changes appear to be getting nearer to the point where it is difficult to see how much more growth can take place. It might double over the next 15 years, but we have already seen two crises in the past few years; we are struggling to find ways of maintaining that growth.
One aspect that must concern us is how far those changes will eventually reach the point of limited further development. That is relevant because, to a great extent, air traffic movement and air travel is only scratching the surface in Europe. An enormous proportion of people do not fly at all. They want to fly, initially on holidays, increasingly on short vacations and increasingly on business. So the underlying demand for growth is substantial. As the low-cost airlines show, people want to travel at a lower cost. Those lower costs will in turn stimulate growth beyond which incomes alone would not take us.
My underlying question therefore is whether, with all those changes, runway capacities will be able to cope. Will airports cope? Will safety remain paramount? Will the environmental consequences of that amount of air travel be acceptable to the public?
I welcome the moves towards the creation of a single European sky. I learnt a great deal from the committee proceedings about the specific issue of military-civil interface and, beyond that, the wider move towards the involvement of the European Commission and the further changes in Eurocontrol. But over and above that, liberalisation of air traffic management must follow. My noble friend Lord Clinton-Davis touched on that. Liberalisation of airline operations must follow; and liberalisation of airport slots leading to increased convenience and lower fares.
I hope therefore that this report and the underlying support for it will spread over from support for seeing that a single European sky makes a great deal of sense, to seeing that liberalisation of airline operations, airport slots and the bringing down of fares follows apace, while at the same time we ensure that safety indeed remains paramount.
§ 7.25 p.m.
§ Lord Faulkner of Worcester
My Lords, I too congratulate my noble friend Lord Brooke of Alverthorpe, not only on the way in which he opened this debate this evening, but also on his excellent leadership as chairman of the committee which 953 delivered these two unanimous reports. I thank him also for his kind words on the modest part that I played in chairing the one session on 23rd November when we had the pleasure of questioning Mme Loyola de Palacio, the Vice President of the Commission and Commissioner for Transport and Energy. I express my thanks too to our hard-working clerk, Patrick Wogan, and to our specialist advisers Tony Goldman and Air Vice Marshal John Feesey.
This was a most interesting inquiry, as other speakers who took part in it have already said. I learnt an enormous amount about air traffic management and the way in which the European Union institutions work. One of the reasons the inquiry was so interesting was because it is a subject that bears directly on the lives of millions of people, those who travel by air, those whose jobs depend on air travel, and those whose lives are affected by air traffic, aircraft noise and aircraft development.
As other speakers have said, the sub-committee inquiry concentrated mainly on the role of air traffic control in reducing delays and in helping the air transport industry to meet increased demand. In that context I shall examine the case of the so-called "Freedom to Fly Coalition", which was launched on 14th January with the specific objective of increasing capacity at British airports. In my view, which is shared by many environmental organisations, the Freedom to Fly argument is based on a false premise. To use an older transport analogy, it is a classic case of putting the cart before the horse.
The single most important cause of delays is air traffic management. There is a clear equation which says that if you add inefficiency in air traffic management to an increase in demand or capacity, greater congestion will be the outcome.
There are other unacceptable costs involved in increasing airport capacity, and I shall speak briefly about those in a moment. But if we were simply to respond to a greater demand for air travel by building more airports and runways without improving the efficiency of air traffic management, we would inevitably create greater delays and greater congestion.
During our inquiry we learnt a great deal about Eurocontrol and were told that implementing its programme, known as "ATM 2000 + " for increased capacity by 2015, would make a dramatic difference. A combination of reducing vertical distances from 2,000 to 1,000 feet, which happened across 41 countries at midnight on 24th January; increasing flow managetnen providing more radio frequencies for air traffic control; improving ground/air links and flying more directly—particularly by passing through what is currently military air space such as in north-west France, to which my noble friend Lord Bruce of Donington referred and which is no longer needed now that the Cold War is over—all those measures could increase capacity by 60 per cent by 2005 over the core area of Europe if all Eurocontrol's members implemented them.
954 Resolving the dispute with Spain over Gibraltar, particularly over the isthmus on which the Gibraltar airport is sited, would also help greatly. As our report says, the dispute,has become a significant obstacle to the progress of EC aviation legislation".I am sure that at least the members of the Subcommittee would wish the Foreign Secretary every good fortune as he attempts, with the Spanish Government, to resolve the sovereignty issue.
The second stage of ATM 2000+, for the years 2005 to 2010, assumes that the integration process will be accelerated; that it will produce a further increase in capacity of between 20 and 40 per cent and a reduction in the amount of fuel used of between 2 and 3 per cent. The final period, up to 2015, could see another 20 to 40 per cent increase in capacity. By then, says the ATM 2000+ plan,the main limitations on any future improvements will be environmental considerations and runway saturation".This brings us back to the Freedom to Fly campaign. I want to be as fair to it as I can. A number of my friends, both in this House and outside, are involved in or are employed by it. Last week it had what was described as an "exhibition" in the Upper Waiting Hall corridor. I visited this on Thursday afternoon and found some leaflets on a desk and three boards pinned together showing blue sky with the words "Freedom to Fly" printed on them. Unfortunately, there were no staff on the stand when I visited, so I could not put any of my questions directly to them.
However, the campaign did write to me, and I imagine to most other noble Lords, at the time of its launch in January. It described its objective as:To promote positively the sustainable provision of capacity to satisfy rising consumer demand for air travel".It also seeks to encourage the adoption of what it calls certain "principles" by the Government. There are seven of these. Some of these are desirable. such as maintaining high standards of safety and security in UK aviation, and a call to Government to balance the needs of passengers, the economy, society and the environment. But the underlying aim is to ensure that the Government in their aviation White Paper, expected later this year, will give the green light for expected significant growth over the next 30 years. There will be particular pressure for additional runways to be built in the South East of England. Although its literature contains words like "sustainability", and "a balanced approach", its obvious agenda is substantially to increase airport capacity.
According to the Financial Times of 15th January, it said at its launch that, without that additional capacity there would be more delays, higher prices and less choice for travellers. But, as our Select Committee report demonstrates, unless air traffic management is substantially improved, additional capacity will increase delays. Curiously, I could find no reference in the Freedom to Fly literature to Eurocontrol. to ATM, to the European single sky policy, or indeed to any of these matters which we considered would make a real difference in reducing delays.
955 The campaign claims that flying is no longer the privilege of the well-off. That point was made by my noble friend Lord Woolmer. That is true for many. I certainly do not want to see working families being priced off aircraft taking them to holiday destinations in the Mediterranean or elsewhere. But we should remember that frequent air travel is not an option for the poorest people in society, and probably never will be. They are more concerned with finding the money to pay the local bus fare than scouring the page for Ryanair's latest bargain offer.
It is also the case that many of Britain's poorest people live under flight paths, and do not have the means to move away if the number of aircraft becomes intolerably great.
Limiting the growth of air travel would have environmental gains for poor people in developing countries too. It is those countries that are the big losers from global warming, to which emissions from aircraft is a growing contributor. The campaign has been careful not to say just how much growth it is looking for. But it will find that as soon as it quantifies that, it will need to spell out where that growth will take place; how many extra planes will fly; how much extra noise and pollution there will be; which airports will be expanded; and which communities will be affected. Concepts like freedom, equity, prosperity and sustainability all sound fine, but current growth rates are unsustainable and politically untenable.
The last 25 years have seen a trebling in both flight and passenger numbers. Government forecasts—last published in June 2000—show that this trend is set to continue, as growth rates of between 4 and 6 per cent per annum are maintained. To cater for this rate of growth would require the equivalent of four more "Heathrows" by 2020 and nearly six by 2030.
There is no doubt that aviation provides jobs and contributes to the country's economy. But the aviation industry generally over-states its case because it does not allow for the considerable subsidies that the industry receives.
The Freedom to Fly campaign has said little about railways, bar some disparaging remarks about Railtrack. At the launch, Richard Branson said:We don't want aviation falling into the same morass as the railways".I agree with that. But there is scope for modal shift. Germany aims to have no internal flights within a decade as people transfer to high-speed rail. A recent report from the Aviation Environment Federation entitled From planes to trains, points out that nearly half of all flights in Europe are less than 500 kilometres, with 68 per cent less than 1,000 kilometres. It concludes:There is potential for significant environmental benefits from transferring short-haul flights to rail. By 2015, the reduction in the demand for air travel facilitated by transferring all mainland domestic passengers to rail is equivalent to the capacity of one new runway".That is 40 million passengers per annum.
956 The Freedom to Fly campaign makes much of people's freedom to take cheap holidays in the sun. What it does not talk about is aviation's tourism deficit—the difference between what British people flying out of the UK on holiday spend abroad and what foreign people flying into the UK spend here. The economic contribution of the UK aviation industry 2000—a calculation by Ecotec—put the tourism deficit at £4.5 billion in 1997.
The aviation industry often points out that planes have got cleaner and quieter over the past 20 years. That is true. But the increase in the number of planes threatens to offset any improvements. Looking to the future, any further improvements will be cancelled out if aviation grows at the predicted rate. That is according to Arthur D Little, the consultants who have been advising the Government on technical matters as they prepare for the aviation White Paper.
So there are many issues which we need to weigh up before we go down the path of encouraging the unrestricted demand for the growth of air transport. An essential first step will be to sort out the issues of Eurocontrol and air traffic management generally. Here I share the hope of other speakers in the debate that our Select Committee report will make a useful contribution.
§ 7.38 p.m.
§ Baroness Scott of Needham Market
My Lords, I am pleased to have the opportunity of contributing to this debate today on an important piece of work by Sub-Committee B, of which I was a member at the time. I am sure that the report will be welcomed by the industry and by decision-makers in the aviation field alike. It carries on the best traditions of reports from your Lordships' House, containing thoughtful and deliberate consideration of very complex matters.
The remarkable growth of the aviation sector has had profound effects on the way in which we carry out business and enjoy our leisure activities. It is tempting to speculate on the long-term effects of September 11th, but our belief is that the long-term trend towards high levels of growth will continue. The noble Lord, Lord Brooke of Alverthorpe, has referred to the reasons why we believe that to be the case.
We have heard from the noble Lord. Lord Faulkner of Worcester, that the volume of air traffic is set to grow at around 5 per cent per year. It has been interesting to note that in recent years the volume of air traffic growth has far outstripped the amount of investment in the sector. The difficulties that this was causing were reported by the committee as long ago as 1989. Without significant investment in air traffic management processes, it is estimated that a I per cent increase in the volume of air traffic will result in a 7 per cent increase in delays. With recent announcements of many new low-cost flights across Europe, that development alone should give rise to concern.
In Europe, some 70 per cent of air traffic crosses 9 per cent of airspace. It is estimated that within the EC there is a shortfall of between 800 and 1,600 air traffic controllers out of a total of 15,000.
957 Given that background, like the noble Lord, Lord Woolmer of Leeds, I am somewhat surprised that the situation is not far worse than it is. The industry has generally worked extremely well to alleviate the problems; And has a good safety record. The 30 countries that co-operate under the auspices of Eurocontrol have delivered significant increases in our airspace capacity. However, it is becoming clear that the capacity of the industry to continue to make changes at the margin is now limited and the time has come to take a more radical approach.
On reflection, perhaps our report would have been better entitled "Improving the Management of European Airspace". because it address that aspect of the aviation industry, not the wider issues such as runways, passenger handling and separation criteria. Of course. there are fundamental questions to ask about the future of the aviation industry, and I am grateful to the noble Lord, Lord Woolmer. for pointing them out, and to the noble Lord, Lord Faulkner of Worcester, for talking so passionately about the disbenefits of growth in aviation.
Is it appropriate to continue to apply the doctrine of "predict and provide" to air travel when we have abandoned it for roads and house building? How can environmental and social disbenefits be weighed against economic and personal advantages and problems alleviated? For example, should we introduce a Europe-wide fuel tax on airliners so that a contribution is made towards the costs? Had it been Sub-Committee B's task to deal with some of those issues, I suspect that we would still be meeting and that the customary good nature of the noble Lord, Lord Brooke of A lverthorpe, would by now have been sorely tried. As it was, the committee concerned itself with producing a detailed and expert report on one aspect.
The overwhelming sense that I detected from the inquiry was that of fragmentation. There are an enormous number of stakeholders, to use the current phrase: air traffic service providers, airline groups, the EC, industry bodies, Eurocontrol, civil aviation organisations and, of course, the military. I am told that in total about 150 organisations are involved in the operation of airspace across Europe. As an aside, I note that the interests of passengers do not appear to be well represented, but an increasing pattern of delays may cause a rise in militancy and a demand for a more regulated approach to passenger rights.
In that regard, it is difficult to argue against the need fora more unified approach at European level to create a virtuous circle in which we can develop a common approach to air traffic management within both upper and lower airspace and the alignment of civil and military interests. The benefits of such a collaborative approach have been well outlined for us by the noble Lords, Lord Bruce of Donington, Lord Wilson of Tillyorn, and Lord Woolmer of Leeds. Of course, there is already significant collaboration within Europe. for example, in the Maastricht. Transalpine, Balkan and Nordic organisations. Perhaps we should consider standardising some of those collaborative efforts, and it may be helpful to consider a common billing policy for European air traffic.
958 A common thread that runs through the subcommittee's report is that efforts must he made to reduce duplication and that care must be taken not to create more duplication and confusion in any new structures, for example between Eurocontrol and the EC, as its role develops. The relationship between national air traffic management regulators and a new EC-wide regulator must be thought about further and the provider-regulator split should be safeguarded. The noble Lord, Lord Wilson of Tillyorn, referred to the dangers of over-bureaucracy.
The committee did not underestimate the difficulty of aligning civil and military interests in the aviation sector, and considered how second pillar procedures could be used in relation to the military. To make a more compelling case for such a change, we need much more qualitative and quantitative information and analysis of delays caused by military activity and resulting costs to the civil sector. It is worth emphasising that we do not in any way suggest that the military are somehow the villains of the piece. It is simply that the growth in air traffic means that one side cannot afford to ignore the needs of the other. Other than during crises, such as that in the Balkans, military activity does not really affect delays so much as capacity, but that is becoming increasingly important.
We heard that the balance of power between civil and military varies enormously from country to country. The evidence of the French, the Germans and the United Kingdom provided a wonderful vignette of the different approaches. The Germans abandoned their low-flying airspace training in the 1980s and now carry it out in Canada. It is fair to say that the French have been much more robust in maintaining a significant home-grown capacity. The UK military has a fair point when it says that in areas such as the North Sea it has made a significant investment in fixed location instrumentation to make training possible there. It is not easy to imagine that it will he keen to incur the costs of change to make life easier for private airlines.
I close by taking the opportunity to ask two questions. First, does the Minister agree that an early priority must be the corridor into northern France, especially the problems caused by the CBA I military area to which the noble Lord, Lord Bruce of Donington, referred? Secondly, does the investment in new equipment at Swanwick described by my noble friend Lord Clinton-Davis as a technological triumph mean that its field of influence may by agreement extend into the near Continent?
Finally, I thank Patrick Wogan and his team and the specialist advisers, Air Vice-Marshal Feesey and Mr Goldman, for their work, and pay a special tribute to the good-natured and extremely able chairmanship of the noble Lord, Lord Brooke of A lverthorpe.
§ 7.46 p.m.
§ Lord Rotherwick
My Lords, I congratulate the noble Lord, Lord Brooke of Alverthorpe, and his colleagues on the Select Committee reports and welcome many of their recommendations. I come to 959 the debate on this complex subject with great trepidation. I am in somewhat of a spin grappling with the issues as a novice, unlike some of your Lordships who are more experienced. I ask your forgiveness in advance for any mistakes that I feel sure I am about to make.
I come from a background of general aviation. I have experienced only the enjoyable side of aviation, flying as a pilot with the privileges of an instrument rating, as a passenger on commercial airliners and as a passenger on military jets such as the Tornado and the Harrier. Only last week, my local airfield, Oxford Airport, sent out a letter explaining that due to high aircraft movements, the Civil Aviation Authority will in future start requiring all aircraft flying instrument flight rules and, eventually, visual flight rules to start using air traffic flow management, ATFM, ensuring that the traffic controllers manage aircraft and minimise delays rather than just reacting to aircraft movements. I am afraid that those carefree aviator days are going.
In Europe, air traffic management is fragmented. Generally, European skies remain the equivalent of local roads, not the super-highways needed for air travel in the 21st century. We must support maximum co-operation between all member states in developing a safe and efficient air traffic control capacity across the European continent. Eurocontrol's senior director, air traffic management programme, Wolfgang Philipp, said recently:We are convinced that we will overcome the post-11th September decrease in traffic and we still expect traffic to double by 2015 from 1998".As the noble Lords, Lord Clinton-Davis and Lord Faulkner of Worcester, mentioned, on 24th January 2002, Eurocontrol introduced reduced vertical separation minima, which are predicted to result in a 20 per cent airspace traffic capacity gain by the summer. That is achieved by reducing separation from 2,000 feet to 1,000 feet for aircraft flying between 29,000 feet and 41,000 feet.
That is part of Eurocontrol's strategy comprising three capacity-raising periods. Phase I, from 2000 to 2005, is based on increasing the efficiency of airspace use, resulting in a capacity gain of 20 to 40 per cent. The other two phases will take place every five years, with similar hoped-for gains in each phase. We must be proud of the leading role that the UK has played in Eurocontrol. There are many supporters of the single European sky, including NATS, which strongly supports it in principle. However, the proposal is extraordinarily vague about the actual measures that must be taken to resolve identified problems. They should be spelt out, as the report recommends.
There are significant obstacles. For instance, the revised convention signed in 1997 has not yet been ratified, because of the Gibraltar issue. That issue has also crippled the single European sky proposals. It will be interesting to know how the single European sky can be achieved when there are 65 air traffic control centres, 31 different centres, 22 different computer operating systems, 33 different computer language 960 forms and 18 different manufacturers. To add to those complications, there is the question of interoperability; Britain has third generation radar, whereas, in some cases in Europe, it is barely second generation. A rationalisation of all those will be required. The timetable must be flexible to allow for those and other challenging complications, such as separation of regulatory and executive functions.
The main question is whether the United Kingdom has signed up to the creation of a single European sky or merely to the principles. There is little evidence that airspace designers and air traffic managers support the single sky concept. They appear to favour a more practical approach, based on the flexible use of airspace—FUA. The UK approach may achieve the intention for a single European sky, but it is not likely to include the "free flight" concept.
The credibility of the reorganisation of ATM in the UK depends on the active involvement of the military. The future regulatory framework must be clear and transparent, benefiting all users. There should be concern that the EU wishes to become a member of Eurocontrol, effectively bringing it under the control of the Commission. Will the EC be any more successful in developing a common airspace policy than it was in developing a common agricultural policy or a common fisheries policy?
At present available capacity is used inefficiently. The civilian/military interface needs addressing, as the report recommends. For example, the notorious French military airspace CBA I A, which some noble Lords have already mentioned, in the north-east of Paris, causes delays in the areas in which commercial traffic makes high demands on the surrounding airspace.
Although the military must plan to meet several tasks, its use of airspace in peacetime is mainly for training or conducting exercises. Given the level of cuts in military budgets, it is easy to understand why the military would need to get as much as possible from each sortie. That will have its own set of complications, as different types of military aircraft, new and old, move across Europe. The UK military shares one thing with general aviation: a desire for as much class G airspace as possible. Were the military interest to submit to EU regulations, the UK would lose control of its airspace, and the related issues would be subject to the views and wishes of other member states, several of which are not members of NATO.
Sovereignty is one of the main issues, as far as concerns defence and capacity. If the EU were to become a member of Eurocontrol, it would have the power to override the national security interests of the United Kingdom and prejudice our transatlantic relationships within NATO, as well as our bilateral external relations. Military ATM interests should not be covered under pillar one; sovereign states should determine such matters themselves. As the reports recommend, there is a need for other institutional arrangements, outside the first pillar of the Union, to facilitate all dealings in civil/military matters. We are 961 anxious that the Government make their position clear on how they intend to accommodate military interests. The report also recommended such clarity.
Finally, there is a need for a sense of urgency in the response to the recommendations. There are many irritated passengers—from the debate, it seems, there are also many irritated noble Lords, including me—upset by the increasing occurrence of delays in air journeys. My sympathy is with them—for today, along with other noble Lords, notably the noble Lord, Lord Wilson of Tillyorn, I suffered a delay of 20 minutes when travelling home by air.
§ 7.55 p.m.
§ Lord Filkin
My Lords, I thank my noble friend Lord Brooke of Alverthorpe and his committee for their efforts in putting together the two excellent reports and for prompting an excellent debate, in which many important points have been made. The committee's reports show an admirable understanding of the complex issues; the Government recognise and welcome that. Time is short, so I hope that the House will bear with me if I am relatively rapid and staccato in responding to the important points made.
Improving co-operation between Europe's civil and military air navigation service providers is vital, if the long-term forecast demand for air travel is to be met, as the noble Lord, Lord Wilson of Tillyorn, has emphasised. At present, responsibility for enhancing that co-operation rests with Eurocontrol. It is over 40 years since that organisation was founded, and it has played a significant part in the development of European air traffic management systems. Eurocontrol has many excellent technical staff who have recently been instrumental in the successful introduction of the reduced vertical separation minima programme throughout Europe last month. As many Members said, Eurocontrol's institutional and legal structures remain confused, for which member states must share the responsibility. Its revised constitution has yet to be ratified.
The Government believe that the full implementation of the revised constitution will provide significant benefits, such as enabling the European Community to join it and greater use of qualified majority voting, where appropriate. However, that will not, by itself, alter the fundamental problems that exist in the organisation. My noble friend Lord Brooke of Alverthorpe asked why so few states have ratified the constitution. It is essentially because of an unresolved legal argument between the Commission and Eurocontrol. Work is going on to resolve that difficulty quickly and obtain ratification.
Even with ratification, not all the problems will be solved. Eurocontrol is only beginning the process of becoming a regulatory body, as the committee noted. Having Eurocontrol acting as regulator is not consistent with its also providing air traffic services. The Government therefore agree with the committee that there should be a rigorous and clear institutional separation of Eurocontrol's regulatory and service provision functions.
962 As the committee chaired by my noble friend reported, the fundamental problem for Eurocontrol in acting as a regulator is that it has limited enforcement powers, even when the revised convention has been implemented fully. As the noble Baroness, Lady Scott of Needham Market, recognised, a more radical approach is needed. The flexible use of airspace provides one important example of how Eurocontrol's lack of enforcement powers causes difficulties. That concept is about making better use of airspace that is largely used by the military. Eurocontrol members agreed the principles of that concept some years ago, but implementation is still a problem.
Some states have demonstrated that it is possible to fulfil military and civil objectives through closer cooperation between military and civil traffic controllers. However, some states have failed to apply that concept fully, and one way of overcoming that is by pursuing single sky. As your Lordships are aware, that is a vitally important project, aimed at significantly reducing flight delays and their financial and environmental costs. The more efficient routing of aircraft would, for example, reduce the amount of wasted fuel burn by between 10 and 15 per cent, making a massive environmental contribution. Single sky is also designed to provide the airspace capacity required by Europe's future airspace users, as the noble Lord, Lord Rotherwick, affirmed was necessary. It represents an excellent opportunity to improve the European air traffic management system and is supported not only by the Government and other EU member states but by Europe's airlines. The noble Lord, Lord Wilson of Tillyorn, clearly emphasised to the House the inter-connectedness of European states in this respect, and that therefore none of us can go it alone.
As the committee noted, there is a need to clarify the respective roles of Eurocontrol, the Commission and national air traffic management regulators. The relationship between all three must be based on clear complementary roles that avoid duplication and foster synergies between them. Now that we have the single sky legislative proposals we shall be better able to understand the proposed mechanisms. The Single Sky Committee will rely on Eurocontrol's technical expertise with the legal instruments available to the European Commission. With the three-way process that is envisaged, Eurocontrol's own rules, if they are appropriate, will be implemented within the EU using the Community's legal instruments. Single sky rules, which will be largely strategic in scope, will be reflected in Eurocontrol's rules. The national air traffic management regulator will continue to play a vital regulatory role, although further clarity is required on the precise nature of the relationship between national regulatory authorities and the Single Sky Committee. However, we believe that this three-way process can be effected only if there are significant changes to Eurocontrol's institutional structure.
It is true therefore that Eurocontrol is likely to be affected by single sky. The Government want to retain Eurocontrol's invaluable expertise in such areas as 963 defining the technical solutions to air traffic problems and consulting stakeholders through the new Eurocontrol notice of proposed rule-making process.
The real problems in Europe's air traffic management systems lie in the congested airspace in north-west Europe, a point clearly signalled by the noble Baroness, Lady Scott of Needham Market. We understand that single sky will concentrate its initial efforts to overcome the problems that exist in this area. But as my noble friend Lord Brooke pointed out earlier, we must not forget the important contribution that non-EU member states make to the success of the overall European air traffic management system. That is why, as I mentioned earlier, the single sky rules are to be reflected in Eurocontrol rules and non-Community states can participate in the Single Sky Committee. Furthermore, we must not forget that the process of EU enlargement will gradually reduce the scale of this problem in the future, as enlargement and single sky move forward in parallel.
I shall turn now to the military aspects of single sky. The Government have noted the committee's concerns on the military dimensions of single sky. This is an issue that all EU member states are considering in detail. The Government continue to support the need for pillar one to be used for civil regulation, but we do not wish military authorities to be covered by the single sky legislation, which I am sure will be a comfort to the noble Lord, Lord Rotherwick. On the other hand, we favour including the principles of the flexible use of airspace concept in the legislation, subject of course to detailed consideration of the legal aspects, as this will help to ensure its full implementation across the EU.
As noble Lords have said, bringing military authorities within the scope of single sky is difficult. Despite that, we are conscious that the proportion of delays directly attributable to military peacetime use is small. Therefore we believe that a pragmatic solution using inter-governmental treaty arrangements is more appropriate than a pillar one or pillar two option, with all the attendant difficulties. Moreover, we do not consider that military matters such as the location of military training areas and bases fall within the scope of the European Community. The negotiations of the single sky proposals are under way, but at present there is no consensus view on the appropriate way forward on military matters. We have noted the committee's recommendation on the military dimension of the single sky proposal, and we shall keep that in mind in our efforts to achieve a consensus view.
The noble Lord, Lord Bruce of Donington, mentioned that with regard to the military training area, CBA I, in northern France, the two governments and the two air traffic service providers have ensured a greater degree of co-operation and has reduced delays. But the Government appreciate that CBA I is a good example of the problems that exist with the present European air traffic management system which, I am sure noble Lords will agree, need to be overcome.
964 I wish my noble friend Lord Faulkner of Worcester well in his endeavour to persuade the French that CBA I is no longer needed by them.
There are other means to secure military and civil co-operation. As the noble Lord, Lord Wilson, has shown, this can be done. There are several mechanisms to improve co-operation and the Government are keen to ensure that bodies such as Eurocontrol's Civil/Military Interface Committee and Military Harmonisation Group are further developed. We believe that through such mechanisms and via the inter-governmental treaty arrangements we favour, we can secure more effective civil and military cooperation quickly and bring to an early conclusion the discussion on the single sky text. However, we do not dismiss out of hand the Select Committee's suggestion of common membership of CMIC and the Single Sky Committee.
The noble Baroness, Lady Scott of Needham Market, raised a question about Swanwick and inter-operability. In principle Swanwick could provide services to the near Continent. Indeed, the whole of Europe probably could be serviced by five or six such centres, in comparison with the 40-plus centres that we have currently. As the noble Baroness pointed out, the will to co-operate would have to be in place, and this is the kind of future envisaged by the European Commission in putting forward the single sky proposals.
My noble friend Lord Clinton-Davis raised questions about the Government's stance on Prestwick. Prestwick remains a key element in our strategy for air traffic services. We maintain unequivocally the two-centre strategy and work will proceed as soon as it is required.
My noble friends Lord Faulkner of Worcester and Lord Woolmer of Leeds helpfully reminded us of the wider context within which this discussion sits. The demand for increased air traffic also has implications and raises questions about runway capacity, airport capacity and the significant environmental and social costs consequent on air travel and its acceleration. I thought in particular that the point about the importance of seeing transport inter-connectedly, and the linkages with railways, was well made by my noble friend Lord Faulkner of Worcester. However, at this point I shall not answer those points, or the helpful point made by the noble Baroness, Lady Scott, about fuel taxes, because noble Lords are well aware that these are the kinds of issues being considered in the Government's air transport White Paper which we hope to publish towards the end of the year. Prior to that we shall be consulting widely on many aspects of it.
The noble Lord, Lord Rotherwick, was right to mention the wider context of the objectives of single sky. Our discussions tended to focus on the tough and hard issue of civil/military co-operation, but single sky and the committee set up with the task of overseeing it is concerned also with the authorisation of air navigation service providers, the licensing of controllers, the decisions on what technical equipment 965 is to be used and when, the new charging mechanisms for commercial air transport users, the new and more efficient airspace arrangements in Europe and the improved co-operation between civil and military authorities. as we have concentrated on in this discussion. All of those six goals are important and are necessary to put in place the appropriate air traffic system and air transport services in Europe. As was signalled, one can see how we have got to the point where there is a plethora of systems, equipment arid air traffic controllers, but it is clear that we cannot stay at this point in the future. None of us would see that as sane.
I do not pretend at this point that the Government can or even should give specific and detailed answers to every single point that has been raised in our debate. There is an active process of consultation, development and negotiation under way at present. These issues have not been frozen with the publication last October of the four regulations. There is an active working group under way which since January has met four times already. We would expect that some of these issues have to be addressed within that working group and I am confident that this debate will provide useful input to aid their considerations. Without doubt the Government will emphasise those and other points to it.
However, we should not forget that there is a considerable strength of political support, both within this country and elsewhere, for the concept and goal of single sky. The Prime Minister has expressed clearly his very strong support for it—that is important for making progress —while the Spanish presidency of the European Commission has made this issue one of its prime goals for its tenure of the presidency, which we very much welcome. The airline industry in all its multiple facets in Britain has largely supported the objectives of single sky, while hoping to see how these can be realised in practice. Therefore, we are now seeking to do detailed work within Europe and the UK to try to bring to light and to life the important vision shared across the House for single sky and for the better military/civil co-operation which has been signalled.
I again thank my noble friend Lord Brooke and his excellent committee for producing these reports. They have been most useful in developing the Government's policy with regard to Eurocontrol and single sky. This has been an excellent debate in which many valuable points have been made.
§ 8.10 p.m.
§ Lord Brooke of Alverthorpe
My Lords, as ever, our reports have produced an interesting and illuminating debate. As ever, they have provided an opportunity for noble Lords to raise wider issues and concerns than one might have expected. In a sense, if I can tweak my noble friend Lord Faulkner of Worcester, they provide the freedom to fly at any subject under the head of "aviation".
The reports have also provided a surprise for me, as the noble Lord, Lord Bruce of Donington, indicated was likely to be the case. I welcome his contribution.
966 I also welcome the noble Lord, Lord Rotherwick, to his brief. Although I did not agree with everything he said, he is none the less welcome. I thank all who have contributed to the debate. I welcome, particularly. the Minister's comments. I detect that in a number of areas where hitherto we felt the door had been closed on some of the ideas we tried to get accepted, there is now a willingness to reconsider. That is also welcome.
§ On Question, Motion agreed to.
§ Healthcare for Ethnic Minorities
§ 8.11 p.m.
§ Baroness Uddin rose to ask Her Majesty's Government what assessment they have made of the effect of the policies outlined in the Plan (Cm 4818) on healthcare for ethnic minority communities.
§ The noble Baroness said: My Lords, the Government are committed to reducing the inequalities within healthcare provision for all its citizens, and the NHS Plan points to the "inverse care law", whereby those most vulnerable are least likely to receive the healthcare they need. For the first time there is institutional recognition that inequalities and poor health are linked to socio-economic factors such as poverty, poor housing, low income and unemployment.
§ I am deeply hesitant to rise in this debate in case I am accused of a reversal of racism by raising the issue of the needs of minority citizens, given that we are currently in hot pursuit of challenging the status quo of assumptions on who is a citizen worthy of equality. Equally, I hesitate to follow in the Prime Minister's footsteps in saying that I am a great fan and admirer of the health service. Therefore your Lordships will appreciate that discussing equality issues within the health and social sectors is a complex scenario.
§ None the less, it has to be mentioned that, to date. many reports have highlighted an institutional weakness in relation to service delivery, employment and relationships with the voluntary sector. There is almost unanimous agreement that issues of equality in services and access to services have yet to become embedded into the management delivery mechanism and have not yet integrated into the performance measurement indicators. Recent CRE research backs up claims by individuals and groups that in many NHS trusts there is a disturbing gap between equal opportunities policy and practices and the experience of consumers.
§ I have been involved for more than 20 years in my local area, actively trying to change the way in which our local health authority provides care. In doing so, we pushed to the limit for the very little changes achieved in the early 1980s. It meant setting up advocacy projects, ensuring "paper" equal opportunity policies and campaigning on recruitment. The campaign for choice in maternity care came directly out of our own campaign for better provision for minority citizens. The impact was that choice967
§ became possible for all women who used maternity care. Those gains were possible only because of individuals committed to bringing in those temporary changes. What was then fact, and is now evident, is that the needs of minority women remain beyond the reach of the mainstream planning agenda of our maternity services.
§ Some of our experiences were subsequently endorsed, some 10 years later, by a report of which my noble friend will be aware, Action Not Words, which is applicable to today's strategic health planners and commissioners. The current service users and minority staff within the healthcare sector say that there is significant evidence to support the allegation that racial discrimination, direct and indirect, is embedded in the healthcare sector, predetermining and impacting on the health and social care services provided to minority citizens. It has to be said that this discrimination is evident in access to services, within the strategic framework of planning for services and, of course, in employment practices.
§ It is also worth drawing to your Lordships' attention—although I cannot go into details—a survey commissioned by the World Health Organisation, which found that certain groups in the UK, including minority citizens, do not enjoy fair access to the healthcare system. It also stated that there is a significant body of evidence suggesting that health services do not reach people from minority groups, and that lack of information and inappropriateness of care often deprive minority communities of access to a wide range of health and social care.
§ So the question is how the Department of Health can assist positively the impact of the modernisation agenda on minority citizens. While many of us welcome the new structure of localised healthcare provision, the reality for minority patients seems to be business as before. From what has been said by groups such as Social Action for Health in the East End and the King's Fund, the lack of strategic planning of health authorities and primary care groups continues to fail local minority populations.
§ Although recently data collecting has improved, the analysis does not appear to filter into integrating local minority populations into the planning of service delivery. In this way, one can conclude that the modernisation agenda has continued further to disadvantage the local community.
§ There is certainly a deep sense of unease and confusion among service users and staff about the new decision-making process. They feel that it is more unaccountable and unable to influence service delivery. What is the response of the Department of Health to the suggestion that very little has changed for minority citizens and that those services are hampered by institutional racism and by insufficient account being taken of demographic considerations in the planning of healthcare services? What strategy is being progressed for recruiting locally? How is the local minority voluntary sector being assisted and empowered to rival some of the external private sector competitors for contracting services? Not least of all, 968 what specific systems are in place for consulting local communities and ensuring and encouraging their full participation in shaping their local healthcare service?
§ Last week I attended a conference organised by Young Mind and the Trust for the Study of Adolescence. The objectives were to highlight the specific mental health issues of south Asian young people and their families. It concluded that there are massive gaps in services. The health workers present reported that the existing training ill equipped them to deal with specific needs.
§ Perhaps I may share with the House a telling tale. Twenty years ago, as an unqualified social worker in a hospital crisis intervention team, I heard the same call for consistent responses to the needs of minority communities within the mental healthcare system. It is totally unacceptable that this situation should continue. One dare not think about the number of individuals and families who have suffered while we have been contemplating how to define "appropriate care".
§ The danger is that information about the needs of minority communities will remain poor and that we will become besotted with researching only culturally oppressed Asian women and aggressive African-Caribbean men. Many professionals are stuck with their 18th century views of minority citizens. The most illustrious of institutions cannot seem to equate the rise in mental health problems of African-Caribbean and Muslim men and women with the link between poverty, lack of opportunity, racism, Islamophobia and improper diagnosis.
§ One has to recognise that NHS prejudice, misunderstanding, racism and Islamophobia can be at their most oppressive in this area and that the NHS remains excessively unaccountable for its practices. There is too much research to ignore the conclusion that there is disproportionate discrimination in the operation of Britain's mental health system, especially as it is applied to African-Caribbean men and Asian women. I beg for urgent action on this issue. The National Health Service framework suggests everything that requires to be done. It needs only for us to ensure that it is implemented with urgency.
§ However we approach the reality of the health agenda and its impact on the ethnic minority community, we have to agree that, even post-Lawrence. the experience of minority consumers has changed very little in the past two decades. Given that the Lawrence report was commissioned by the Government, I believe that we cannot afford to lose face by failing to translate words into action.
§ I was recently involved in a discussion with the Macmillan cancer group organised by my noble friend Lady Howells, and I was again forced to conclude that services are accessible only to those who are articulate in seeking them out. There is a great need not only for training and awareness, but for a campaign aimed at the large number of patients for whom diagnosis and treatment come too late because they are unable to access services. I have no doubt that there is a similar pattern in relation to every disease. The only969
§ conclusion that one can draw is that although we are up to date in our theory and our paper policies, our performance is nothing short of dismal.
§ The most important point is that, although the NHS is Britain's biggest employer, and despite more than 20 years of race and equality legislation, the NHS has been slow to ensure racial equality in its workforce. Time does not permit me to deal with the CRE's investigation into that matter. However, the Race Relations (Amendment) Act 2000 may be our newest tool to argue for change in health and social care provision. 'The CRE's draft guidelines demonstrate what public bodies will need to do to make immediate progress on the four guiding principles.
§ There is good practice and projects in the health service, often led without adequate resources by individual champions and a vanguard. How will the Government build confidence among minority health service users? To the world, Britain rightly retains the reputation of a free and fair health service provider. With hand on heart, I can say that it is true that the NHS is second to none when care is provided regardless of race, religion or class. However, from all that I have heard, that assertion no longer applies to a significant minority of our citizens.
§ 8.22 p.m.
§ Lord Parekh
My Lords, I thank my noble friend Lady Uddin for initiating this extremely important debate. When I first read the NHS national Plan I was both most impressed and a little disappointed. I was impressed because it is a determined and imaginative attempt to revitalise our health service and raise it to the highest European standards. I was disappointed because of its virtual silence on the great contribution that more than 20,000 ethnic minority doctors have made to our National Health Service and to the ethnic dimension of the health service itself.
The NHS national Plan says nothing, or very little, about the problems of ethnic minority doctors, the low morale of those confined to the cul-de-sac of non-consultant career-grade doctor posts, the differential incidence of certain diseases among the ethnic minorities and the different needs of those communities. Those are important issues because they affect the NHS's ability to sustain high morale among its staff and guarantee equal access to our people. I should like to highlight four or five important issues.
The incidence of diabetes, hypertension, coronary heart disease, stroke and vascular disease is much higher among ethnic minorities than among the population as a whole. The rate of diabetes is 2.2 per cent in the population as a whole, 5.9 per cent among Afro-Caribbeans, and 7.6 per cent among South Asians. The reasons have to do with genetic factors, dietary factors and lifestyle. However, if diabetes is identified in advance, as it can be, the state can be saved a lot of money and people can be saved a lot of suffering. We therefore need more screening and educational campaigns as well as warning and advising those at risk. I wonder whether such screening is carried out on a sufficiently large scale in areas with a high concentration of minorities.
970 The next issue is the sickle cell diseases, which are most prevalent among the ethnic minorities arid can be found increasingly among mixed-race children. Umbilical cord blood tests are vital because they can identify those diseases well in advance. Take-up rates, however, seem to be no higher than 30 to 45 per cent. It is about time that the Government did something about that.
The incidence of high blood pressure among AfroCaribbeans is very high: one in four women and one in six men are affected by it. Those communities need to be educated and advised to have regular check-ups, but I am not entirely sure that that is being done.
Afro-Caribbeans are diagnosed as psychotic out of all proportion to their presence in the population. Although the incidence of psychosis in that group is twice that in the white population, the rate of compulsory detention is about five times as, high. The percentage of people receiving electro-convulsive therapy and drug treatment is also much higher in those communities than in the white population. By contrast, the amount of counselling provided to them is much lower. I should like to know what action is being taken to address those and the other special health needs of ethnic minorities and to redress the apparent inequality in the services provided to them.
Waiting lists are the next issue. We monitor waiting lists, thanks to the Government's initiative, but that is not done in relation to ethnicity and religion. That should be done so that we can have a clear idea of who is having to suffer more. Such monitoring should also be extended to accident and emergency wards, both before assessment and between assessment and the provision of treatment. We could then have a clear picture of whether all our people are receiving equal access to service delivery.
The cultural dimension of ethnic health is the next issue. Significant cultural issues relating to the treatment and care of the ill, the elderly and the dying have gone unnoticed. Attitudes to death vary, as do mourning practices and rituals relating to burial and cremation. Those employed in the health and social welfare services should be trained in cultural awareness and sensitivity.
Ethnically unrepresentative senior administrative staff is the next issue. Every organisation's culture and ethos are established by its senior staff; they set goals, allocate money, discipline staff, interview and process patients and deal with staff complaints. It is therefore of the utmost importance that the staff should he broadly representative of the community whom they serve. I am afraid that that is not the case in the NHS. Although the proportion of ethnic minorities in the national health trusts and health authorities has certainly increased since Labour came to power—-I congratulate the Government on that—the number still falls far short of adequate representation. Barely 2 per cent of chief executives and senior directors in NHS trusts come from the ethnic minorities.
The NHS Appointments Commission, which is in charge of appointing 3,000 non-executive directors of NHS trusts and health authorities, is to be welcomed.
971 I assume that there are ethnic minority commissioners on that commission. I also assume that the commission will ensure that there is a significant ethnic minority presence in the 3,000-odd appointments that it will make.
The lay and professional representation of ethnic minorities on the General Medical Council falls far below the desired level. That issue needs to be examined, as does the issue of ethnic minority representation in the Royal Colleges and specialist training agencies.
A particular concern to many of us is the category of non-consultant career-grade doctors. That category was created a few years ago to accommodate senior doctors who could not move up because of the limited number of consultant posts. Over time, it has become a dead-end and cul-de-sac. Most NCCGDs—between 75 and 85 per cent—are from the ethnic minorities. Some of them are as qualified as the consultants and in fact do their job in their absence. However, they are barred from becoming consultants, partly because the CCST—certificate of completion of specialist training—is not available to them and partly because their experience in current jobs is not taken into account.
Happily, we have amended the specialist medical qualification order to take account of training and qualifications obtained abroad. It is about time that we amended it to take full account of the experience of these doctors in their current jobs for promotional purposes. Many of these doctors—mostly, as I say, from the ethnic minorities—feel terribly demoralised, discriminated against and exploited. Unless something is done soon, their and the NHS's capacity to realise the goals set out by the Government will remain largely weakened.
Thanks to the decentralisation of decision-making, NHS trusts up and down the country are devising all kinds of short-term arrangements to meet their difficulties. Many have created trust doctors, but these doctors are provided with no mentoring and no training. Their working conditions are arbitrary and vary from one part of the country to another. They are in danger, I am afraid, of being turned into cheap casual labourers without stable career prospects. They naturally feel that their skills are inadequately utilised by the NHS.
NHS bureaucracy, although mercifully rationalised in recent years, still remains a nightmare for many ethnic minority doctors. Its decision-making procedures are arcane and depend on networking and informal arrangements. Ethnic minority doctors are generally not terribly good at this, partly because they are not in senior managerial positions. They, therefore, feel marginalised and remain unable to sensitise decision makers to the ethnic minority dimensions of their decisions. That is particularly acute in relation to recently recruited overseas doctors whose navigational skills through the labyrinthine bureaucracy of the NHS are not yet fully developed.
972 To conclude, I know that the Government are determined to achieve the goals of the NHS Plan. They can do so only if the morale of the ethnic minority staff remains high and they are fully involved in determining the quality of service delivery to all our people, including the ethnic minorities. We can raise their morale and ensure their full participation in decision-making only if we rationalise career structures, ensure non-discriminatory systems of promotion, merit awards and discretionary salary rises and make senior administrative staff ethnically more representative than they are today.
§ 8.32 p.m.
§ Lord Chan
My Lords, I thank the noble Baroness, Lady Uddin, for introducing this important and timely debate. I declare an interest as Ethnic Health Adviser to the North West Regional Office of the NHS and to the Commission for Health Improvement.
The NHS Plan published in July 2000 makes only five direct references to ethnic minority communities. Paragraph 2.11 states:We now live in a diverse, multi-cultural society".Three references in chapter 13, Improving health and reducing inequality, all concentrate on access to NHS services and do not mention quality of healthcare. For example, paragraph 13.8 states that,people in minority ethnic communities are less likely to receive the services they need".Chapter 14 describes clinical priorities for the NHS: cancer, coronary heart disease and mental health. Disappointingly, ethnic minority people are mentioned only in mental health in paragraph 14.31 in the context of crisis resolution,by 2004, all people in contact with specialist mental health services will be able to access crisis resolution services at any time. The teams will treat around 100,000 people a year who would otherwise have to be admitted to hospital, including black and South Asian service users for whom this type of service has been shown to be particularly beneficial".No reference is made in the NHS Plan of increased risk of cardiovascular disease among South Asians, especially in Pakistanis and Bangladeshis.
The health of minority ethnic groups was investigated in 1999 in a health survey for England published last year. The following findings are significant. First, South Asian and black Caribbean men used GP services between 1.5 and three times more than men in the general population. Age-adjusted contact rates with GPs were significantly higher in South Asian and Irish women.
Secondly, Pakistani and Bangladeshi men had rates of cardiovascular disease about 60 to 70 per cent higher than men in the general population, while Chinese men had lower rates. The picture was similar for women. Prevalence of cardiovascular disease in black Caribbean women was 33 per cent higher than in white women.
Thirdly, rates of stroke among black Caribbean men were two-thirds higher than in the general population. Indian men had stroke rates 40 per cent higher than the general population.
973 Fourthly, black Caribbean and Pakistani women were over 20 per cent more likely to have high blood pressure. Bangladeshi and Chinese men were 25 per cent less likely than men in the general population to have high blood pressure. Ethnic minority people with high blood pressure were more likely than those in the general population to receive treatment.
Fifthly, I shall not elaborate on diabetes as that was covered by the noble Lord, Lord Parekh.
Sixthly, obesity is a major risk factor for cardiovascular disease, diabetes and premature death. All men in ethnic minority groups had lower rates of obesity than in the general population. But among women, Pakistanis and black Caribbeans had significantly higher rates of obesity than in the general population. Women from all ethnic minority groups, including the Chinese and Irish, had higher levels of central obesity than in the general population, making them at higher risk of type 2 diabetes.
Seventhly, in regard to lifestyle activities, Bangladeshi, Irish and black Caribbean men had higher rates of cigarette smoking than the general population. High fat and low fibre consumption was greatest among Irish and Bangladeshi people.
This national survey shows that the health needs of ethnic minority groups are not identical but vary with specific groups. These at-risk groups and individuals have to be identified in order to address the ethnicity factor in health inequalities. The Government have to their credit published policies promoting social inclusion, racial equality, tackling harassment and setting high standards of healthcare. They include Vital Connections, a National Service Framework for Equalities published in April 2000 and the Race Relations (Amendment) Act of November 2000. Although these policies are most welcome, their benefits can be seen only when policy implementation occurs in NI-IS trusts. But because of the plethora of health policies demanding the attention of management and staff in the NHS, black and minority ethnic patients and carers have so far experienced little evidence of improvement in healthcare. What needs to he clone to improve healthcare for ethnic minority communities? The NHS Plan 2000 indicated the changes necessary for this improvement.
The basis of these changes depends on a cultural change in the attitude of NHS staff working with patients. All must accept that we live and work in a multi-cultural, multi-ethnic Britain. The reality of this is obvious in our metropolitan areas. But ethnic minorities live in all districts of Britain. In more than 80 per cent of districts served by the NHS, ethnic minorities form less than 5.5 per cent of the local population according to the 1991 national census.
A written strategy for improving ethnic minority health is necessary in all parts and organisations in the NHS and in local authorities. This strategy is as important for the welfare of' the smaller number of black and minority ethnic people spread thinly in 80 per cent of Britain as it is for the greater proportion who live in metropolitan areas. Components of such a strategy would comprise training staff in cultural 974 awareness and competence, the provision of trained interpreters for people whose first language is not English, and a policy of equality of treatment for ethnic minority staff.
All NHS staff everywhere, particularly front-line workers in contact with patients, need training in cultural awareness and competence. Ideally, that should take place in our medical and nursing schools. Training should focus on issues including clinical diseases and mental health, health beliefs and the support required by local ethnic minorit) users and their communities. Listening to the experience of patients from local ethnic minority communities would be essential. Cultural awareness training will help NHS staff to avoid stereotypical discrimination such as assuming that ethnic minority patients have a low pain threshold and complain unnecessarily. It will help to overcome prejudice against people who wear traditional clothes or who are not fluent in the English language.
It will also help to overcome intolerance of ethnic minority older people who have not acquired fluency in English and need trained interpreters to use services. In that context, relatives of the patient are not appropriate interpreters because that would breach confidentiality and lead to embarrassment and stress if, for example, a child is the interpreter. People of all backgrounds tend to revert to their mother tongue as they grow older and during periods of ill health. Therefore, the need for interpreters and bilingual staff in the NHS will rise as ethnic minority first-generation migrants grow old in this decade.
Finally, the NHS Plan wants to retain and increase the number of doctors, nurses and other staff who are needed for a first-class service. Ethnic minority people working in the NHS still feel that they are being discriminated against on grounds of their ethnic origin rather than their clinical competence. I hope that the Minister will he as concerned as I am about the excess of ethnic minority doctors—about 40 per cent—who are being asked to stay at home without an official note of suspension while allegations about their clinical competence are being investigated. One could understand that if complaints came from patients, but a significant number are being investigated only because white colleagues have complained about them. I speak from my experience in the North West region.
In conclusion, I ask the Minister to focus on the implementation of policies and to promote an ethnic health strategy for all NHS trusts. The Commission for Health Improvement should be given the task of monitoring the performance of NHS trusts along those lines to improve ethnic health and healthcare.
§ 8.41 p.m.
§ Baroness Pitkeathley
My Lords, I, too. wish to thank my noble friend Lady Uddin for giving us We opportunity to debate this important issue.
I shall concentrate my remarks on patient involvement—that is, on aim three of the NHS Plan, which is about shaping services around the needs and 975 preferences of patients and giving patients and citizens a greater say in the NHS—and on the implications of that for making the voices of patients from ethnic minorities heard in the new-look health service to which we are all so committed.
It cannot be denied that the NHS Plan is aspirational rather than definitive in some of the plans that it lays out, but one thing about which it is very firm is the central place of the patient's voice within the health service. No one could pretend that when the NHS was established patients were seen as its most important focus, strange as that may seem to us nowadays. Lip service has been paid to the importance of the patient over many years but it is only now that it is beginning—I emphasise that word—to become a reality.
I take every possible opportunity to tell noble Lords that my own recent prolonged stay in hospital was made as comfortable as was possible in the circumstances by the concern of all staff—from cleaner to consultant—to put me, as the patient, at the centre of their concerns. They never did anything to me without explaining the procedure and its possible effects and discussing my feelings about that. I am aware that that was perhaps easier to do in my case, as an articulate, well-informed patient who would, frankly, have shouted pretty loudly if they had not done so. But it certainly was not dependent on that. I saw the same care exercised with all patients, and there was particular sensitivity to cultural differences. Problems did arise, though, in the matter of language for patients whose first language was not English, where translators were not available—say, at a weekend or in the middle of the night—especially when family members were unable to accompany the patient. Clearly, more focus and more resources are necessary there, as the noble Lord, Lord Chan, reminded us.
Other issues that must be tackled as a matter of priority have been set before us by my noble friend and other noble Lords. However, the area in relation to which I am most concerned about the needs of ethnic minority patients involves ensuring that their input into policy development will be as influential as possible. The proposed changes to the structure of the NHS, especially those placing responsibility and budgets as near as possible to local communities—that is, at the primary care level—should facilitate that, but only if people from ethnic minorities have the opportunity to be part of the new structures. Membership of primary care trusts must be representative, as must patients forums and patients advocacy and liaison services. Strenuous efforts must be made to ensure that. It may not be enough simply to advertise in the ethnic minority press or broadcast media. Searches must be done in local communities, people from ethnic backgrounds must be appointed as chairs or senior officials so as to provide an example and, above all, training must be provided so that appropriate skills can be developed.
976 I do not myself subscribe to the view that was expressed forcefully in your Lordships' House at Second Reading during the passage of the Health Act; that is, that there are not enough people about who are willing to undertake the onerous tasks of participating in the management of the NHS. However, there may not be enough people available in the traditional places in which we have sought them. That is why the responsibility that will be placed on the commission for patient and public involvement in health, which will be established, to seek adequate representation in lay membership from all sections of the community, will be crucial. It is particularly important that that new body has a responsibility placed on it for training patient representatives. We must never forget how forbidding and mysterious newly established bodies can be to those who are not familiar with committee structures and procedures. If we do not take the time to inform and train people and, more importantly, to change our practices to accommodate the skills and experiences they bring, rather than expect them to fit a prescribed view of how lay members should operate, we will lose the benefits that lay members, no matter what background they come from, can bring. There is more to making processes open than simply advertising in the local paper. I hope that we shall never forget that.
Further, we must ensure that the council for the regulation of healthcare professionals, which is to have a majority of lay members—I am aware that that is another controversial issue—must similarly seek to ensure that the lay membership includes adequate membership from minority ethnic communities.
Finally, I would like to give an example or two of innovative approaches to healthcare for ethnic minorities, which are being put in place. We should not forget the positive action being taken. I refer to the approaches being put in place by the New Opportunities Fund, the lottery distributor of which I am chair, under our £300 million "Healthy Living Centre" programme. For example, almost £1 million goes to a South London health initiative that is led by a partnership of 11 key African organisations. The project will provide health promotion, cultural activities and volunteering opportunities for African communities in South London. Schemes will include health promotion for African men, after-school clubs, a children-and-families project and a health project for African women. There will be training opportunities and information on seeking work. In East London, thanks to a £1 million grant from the New Opportunities Fund, a healthy living centre without walls will benefit the most vulnerable people in Tower Hamlets and surrounding boroughs, including asylum seekers and those from minority ethnic backgrounds. Activities will include a pharmacy programme, mental health work and regeneration and resettlement projects. Information in people's mother tongues will address the language and cultural barriers.
In Sheffield, I recently opened a most inspiring project in one of the deprived areas of the city, where money from the New Opportunities Fund is being used to refurbish a huge Victorian building that houses 977 a library and swimming baths, to create a healthy living centre that will provide, for the mostly Bangladeshi community, not only space for exercise, opportunities for woman-only health sessions and before and after-school activities for children, but also a credit union, careers advice and even a co-operative for growing healthy food. Those projects remind us, as does the NHS Plan, that our NHS should be as much about establishing and maintaining good health as it is about sickness. We must ensure that that aim is fulfilled and that it is inclusive of all members of our society.
§ 8.49 p.m.
§ Lord Desai
My Lords, 1, too, thank my noble friend Lady Uddin for initiating the debate. Last week my noble friend Lord Hunt met a group of us in order to discuss this problem. I was very grateful to him.
I have little to add to what other noble Lords have said. I have no experience of serving on an NHS body, and my experience as a patient is rather limited to the past two years or so. But I want to reiterate what my noble friend Lord Parekh and the noble Lord, Lord Chan, said; that is, that, so far as I know, the cluster of coronary heart disease, high blood pressure, diabetes and renal failure disproportionately affects the Asian population. especially younger men in their 30s and 40s who are not normally aware of such problems.
I had the salutary experience of attending a presentation held by the National Kidney Foundation. The event was sponsored by my noble friend Lord Chandos, who is a patron of the charity. I was very impressed because it was explained that a problem concerning blood pressure and diabetes especially type 2 diabetes—is that patients do not feel discomfort kn the course of their daily lives. Therefore, they say, "What is going on? I am all right and can get about". However, when one sees what happens at the other extreme, with renal failure or stroke being a possibility, it brings home that these are serious problems.
I want to urge, as did the noble Lord, Lord Parekh, a blanket screening of the section of the population likely to be affected by such illnesses. That may enable us to find out where the problems lie. I also urge the need for a good educational programme—perhaps through advertising on various ethnic television channels, such as Zee TV and so on. That would bring home dramatically to people who believe that they are healthy or that there are no problems how serious such illnesses can be.
I end with a somewhat sceptical note. I believe that we should do everything that we can to improve the NHS so that it provides an equitable health service. But it is not easy. We know that, after 50 years, health inequalities persist among the general population. The influence of class is very strong, and the problem becomes much worse when class and ethnicity coincide. We should be aware that the type of problems which we have discussed come from the confluence of class, ethnicity and gender. Therefore, there is much to learn.
§ 8.53 p.m.
Baroness Bendel! of Babergh
My Lords, I, too, thank my noble friend Lady Uddin for asking this Question and for bringing the subject to the notice of your Lordships.
In December 2001 my right honourable friend the Home Secretary said:And just as we need to defeat racism, so we must protect the rights and duties of all citizens and confront practices and beliefs which hold them back, particularly women".The NHS Plan, presented in July 2000, very much predates that speech. It, too, stresses in many places the varied needs and customs of different populations—"particularly women". In Part 1, section 5, the plan states what the NHS should—or rather, will—do to help,people adopt healthier lifestyles",and,tackle the underlying causes of ill health".In Part 2, under the heading of the "Top ten things the public wanted to see", it lists,more prevention—better help and information on healthy living".Listed under the things that NHS staff wanted to see appears,more action to help prevent ill health".The Government's new rules for immigrants, revealed last week, suggest that newcomers to the United Kingdom should pass a test on. British customs before receiving a passport. They would also be required to promise to respect and uphold British rights, freedoms, values and laws. Surely those must include the Prohibition of Female Circumcision Act 1985. Noble Lords know well by now—if only because I persist in raising the matter in your Lordships' House so often—that in the 17 years that have elapsed since then, no prosecutions have been brought. However, that is not because there have been no offences. The law has certainly not been respected by the many who have compelled their daughters to submit to female genital mutilation.
Ethnic minorities in the United Kingdom whose origins are in Somalia, Ethiopia and the Sudan are those principally affected. If there is any difficulty in this country in having them "cut", as the expression is, the practice is to take female children back to their home country, ostensibly for a "holiday". As the NHS Plan stresses that there should be more action to prevent ill-health and more help and information on healthy living, I want to ask my noble friend the Minister whether these measures will extend specifically to female genital mutilation. Will more efforts be made to reach ethnic minority women, particularly older women, who see genital mutilation not only as the norm but as desirable, proper and hygienic? Will they be specifically targeted? And will communities be told of the health risks affecting women in their daily lives, in sexual relations and in childbirth?
Another step forward in this area would be the provision of more clinics, of which at present there are very few, undertaking reversal and repair procedures 979 to mutilated women. Contrary to popular belief, such reversals are very successful. Too few women know of their existence or are aware that, in ideal cases, women may attend them without referral letters from their GP.
The NHS Plan will, as stated on page 13, bring health improvements across the board for patients,but for the first time there will also be a national inequalities target".In order to help to achieve that, says the plan, screening programmes will be introduced for women and children. The plan does not specifically suggest what they will be screened for. However, if, for example, such screening includes pre-natal investigation, that should reveal evidence of mutilation, which causes so much difficulty and suffering in childbirth and severe post-natal complications. Will new mothers who have been genitally mutilated be told clearly in their language of origin of the benefits and availability of reversal? And will the modesty, inhibition and shyness of many young women raised in communities which maintain a traditional Victorian reserve on such subjects be understood?
Can a health service which boasts, on page 4 of the NHS Plan, of shaping,the needs and preferences of individual patients",responding to,different needs of different populations",and reducing "health inequalities" call itself modernised, as the plan aims to do, while that continues? Meanwhile, hundreds and possibly thousands of women living among us have been deliberately and grossly damaged in their essential femaleness and have had their sexual identity virtually destroyed by a cruel and quite useless process.
§ 8.58 p.m.
§ Lord Clement-Jones
My Lords, I add my congratulations to the noble Baroness, Lady Uddin, on initiating today's debate and, in particular, on her broad-ranging and trenchant speech. I was especially interested in the fact that in contributions from the Government Benches noble Lords have more than simply asked the Government for a progress report on the NHS Plan; there have been some extremely positive suggestions which go much further than the NHS Plan itself.
I believe that there has been a very strong symmetry. It has not only been a question of the access of ethnic minority patients to treatment and the quality of that treatment; it has also been a question of the treatment and recruitment of staff and of patient and community involvement in that treatment. I believe that that tripartite approach has very much informed the debate today. Clearly a great many health issues concern ethnic minority communities.
I shall not rehearse again the issues raised in the health survey for England, mentioned by the noble Lord, Lord Chan, and the Acheson report. However, 980 a great number of issues affect different forms of ethnic community, whether heart disease, stroke, diabetes, obesity, TB—it has not been mentioned today—hypertension and so on. I feel strongly about mental health. If anything, that causes greater hardship where there are inequalities, particularly inequalities in diagnosis. I do not think that that has yet been grappled with properly.
Clearly, the issue is wide-ranging. It goes further than simply health. The Acheson report, which was a great milestone, made that clear. It is to the credit of this Government that they commissioned the Acheson report, which in a sense laid down a marker that there was such a thing as society, that this was a new era, and that one was looking for joined-up government. The Government should take the credit for that. The Acheson report highlighted some of the socioeconomic factors which significantly disadvantage ethnic minority communities—unemployment and the proportion living in poverty in different communities.
The report recommended a wide range of policies well beyond the health area: to reduce income inequalities and improve the living standards of households in receipt of social security benefits; and to improve the opportunities for work and ameliorate the health consequences of unemployment. In particular, it recommended improving the availability of social housing for the less well off and improving the quality of housing. The Minister will reply in the context of health. However, it is important that steps to improve health are measured in relation to those areas.
The Acheson report also outlined real problems of access for members of ethnic minority groups—for instance, in finding access to a GP. Longer waiting times are experienced in the surgery. The time spent with the GP was felt to be inadequate. They were less likely to be referred to secondary or tertiary care from the GP.
In another survey, 87 per cent of ethnic minority mental health patients believe that services are "institutionally racist" and have higher admission rates to psychiatric hospitals. The National Surveys of NHS Patients Coronary Heart Disease 1999 published in March 2001 demonstrates higher levels of criticism of treatment in the area of coronary heart disease. In a recent survey, even NHS Direct is underused by ethnic minorities, as the recent NAO report shows. What are the underlying causes for that? That is the large backdrop. This huge issue requires energy and cross-departmental working to overcome the problems.
Although to some degree unambitious, it is difficult to fault the aims of the NHS Plan. It recognised the specific health needs of different groups including people with disabilities and minority ethnic groups. The key initiatives in the plan are specific. When the health Minister replies, we need to know precisely whether those carefully timed commitments have been met. Those targets are that by 2002 a new health poverty index will combine data about health status. Local targets for reducing health inequalities will be reinforced with new national targets. By 2003—we need to know that work is in progress—after the 981 review of the weighted capitation formula, reducing inequalities will be a key criterion for allocating NHS resources to different parts of the country. Personal medical services schemes will be created by 2004. By 2001 local NHS action on tackling health inequalities and ensuring equitable access to healthcare will for the first time be measured and managed through the NHS performance assessment framework. We have the change of management through CHI. The noble Baroness, Lady Pitkeathley, referred to the new Bill. We look forward to seeing whether that measure will be incorporated in CHI'S terms of references.
Where have the Government reached on all those issues? There has been a number of welcome initiatives. I could add to those mentioned by the noble Baroness, Lady Pitkeathley. It was fair to mention them. The Sure Start project—an early set of projects—continues. I hope that my tobacco Bill will add to the smoking cessation strategy. We have the national school fruit scheme. We have the national service framework for coronary heart disease. There are and have been good and valuable initiatives. However, until the Department of Health can track health inequalities and the outcome of initiatives taken, and undertakes regular surveys of patient satisfaction among the ethnic minority communities, there will still be an inadequate evidence base for effective action.
Furthermore, in areas such as mental health the position is not adequate. In December last year, Jacqui Smith stated that high security hospitals have undertaken a range of initiatives to improve the situation of black and ethnic minority patients and that there will be a national strategy in the future. But the pledge is that the mental health taskforce will produce consultation papers in the spring of 2002. If there were no historical context to that, that might sound very reasonable. But it is long overdue. It was promised in October 2000 by the Minister's colleague, John Hutton. Why has there been such an inordinate delay on a matter of such importance?
There are a huge number of issues. We could debate the matter for a much longer period. Monitoring under the Race Relations (Amendment) Act 2000—it has not been mentioned today—is surely important. The department has published a race equality agenda for health authorities, PCGs and PCTs. What consistency is there? How binding is the guidance given? What involvement of local communities will there be, as the noble Baroness, Lady Pitkeathley, pointed out? In a survey published recently in the health service journal, Mohammed Memon showed that the reports from health authorities and primary care groups were very patchy in demonstrating an appreciation of ethnic minority health issues and the actions that need to be taken in response to them. Will there be the resources to ensure that that race equality agenda can be put into effect?
In conclusion, there are many administrative and language barriers which make access to healthcare more difficult Many noble Lords have mentioned the cultural issues as well. The setting up of new translation and interpretation services is of great 982 importance. Increasingly, it is becoming clear, as the King's Fund has pointed out, that health advocacy is an important route to improved access for minority ethnic groups. The Acheson report suggested that health workers should be trained in "cultural competency". Many noble Lords referred to that.
Almost exactly three years ago the Minister, in reply to a Starred Question of mine, accepted the importance of all the above. He pledged implementation of the White Paper, The Nov NHS: Modern and Dependable, so that there would be staff training on cultural issues, interpreter services, advocacy services, translation services and so on. It is important that those early pledges given by the Government are implemented. If they are not implemented, further pledges will have little credibility. I hope that implementation has not been dismal, as the noble Baroness, Lady Uddin, said, but we await with interest the Minister's reply.
§ 9.8 p.m.
§ Lord McColl of Dulwich
My Lords, I thank the noble Baroness, Lady Uddin, for initiating this debate. The NHS Plan is certainly a very long list of wishes. I hope that the Government will concentrate on those areas where there is clearly a great deal of work to do.
I agree with the noble Lord, Lord Desai, that Asians in this country are facing a great danger of developing diabetes. Fifteen to 20 per cent of adults are already diabetic and another 20 per cent already have a technical impairment in the way in which their bodies deal with sugar, which means that they are in danger of developing full-blown diabetes with all its attendant heart complications.
With a problem of that magnitude, we need to screen all those at risk. That was done before in the famous Bedford survey, with which the late Lord Butterfield was associated in the 1970s. Government funding is urgently required to find out the best and the most economic method of screening all those at risk. There is no shortage of enthusiastic medical experts who could start such work almost immediately. At St Mary's Hospital, for example, a detailed survey has been planned which would investigate 2,000 AfroCaribbeans, 2,000 Asians and 6,000 white Caucasians. All they need to start that work are the funds. Will the Government help?
As the noble Lord, Lord Clement-Jones, hinted, there has been quite a lot of controversy in relation to schizophrenia in Afro-Caribbeans and quite a lot of discussion about whether it was being diagnosed too frequently, especially in young Afro-Caribbeans. However, recent research has shown that, by and large, the diagnosis has been correct in most cases. Some useful research was carried out by Dr Mackenzie at the Whittington Hospital, in conjunction with Robin Murray at the Maudsley Hospital, who rechecked the diagnoses. He brought over from the West Indies a West Indian psychiatrist who confirmed almost all the diagnoses.
There was no problem with diagnoses. However, they discovered that abnormalities in the genetic make-up and in the brain scans were present in a large 983 number of white schizophrenics, but the genetic element did not appear to be present in the black schizophrenics. Therefore, we assume that the development of schizophrenia in Afro-Caribbeans has much more to do with their environment, which includes large extended families, poverty, stress, and racism, which may be the kind of stress that would make such matters worse.
The Nile Centre in Hackney has provided an alternative to hospital treatment for Afro-Caribbeans and the centre gives them help without compulsion, which has great advantages. Of course, the problem of these people is aggravated by not having a home, a job or confidence in people. There is no doubt that underfunding is a great problem in London. There is a shortage of key staff, especially community psychiatric nurses who work under very stressful circumstances and find it difficult to afford housing. The London health authorities appear to rely far too much on agency nursing staff which means that schizophrenic patients will see a different person at every appointment, which does not exactly inspire confidence.
However, there is some good news. A number of new NHS medium-secure units in London have been opened. For that we are grateful. Compliance among schizophrenics is actually better than it is in the general population as a whole. It is 60 per cent among the Afro-Caribbeans. The compliance in schizophrenia is better than it is in diabetes. But the problem in schizophrenia is that the result of not taking the pills is of course much more severe. Compliance depends on what sort of medication is being given. The more old-fashioned, the more unpleasant and the more side-effects, the less the compliance.
The treatment of schizophrenia presents problems. During the first episode, on the whole things are for the Afro-Caribbeans as they are for most schizophrenics, but it is with the subsequent attacks of schizophrenia that the problems arise. They then tend to be put on high doses of old drugs. There has been plenty of research into the extent of the problem, but not nearly enough on developing solutions.
I should also like to echo the remarks of the noble Lord. Lord Parekh, about the great debt that we owe to the hundreds of ethnic minority doctors, particularly those who work as GPs in inner city areas. We ought to remember that a very large number of them will be retiring soon. That will leave a huge gap. I wonder what plans the Government have for dealing with this enormous problem.
Perhaps we ought also to remember that it is not just ethnic minorities who have difficulties in the NHS. Often it is the elderly who unfortunately have been described as "crumble", "dross", and "wrinklies". But the good news is that there is a more pleasant name to apply to them. They are now called the "twearlies" because as they wait to board the bus just before nine a.m. when transport is free for them, they say to the driver, "Too early?" At least, "twearly" is better than "dross" and "crumble".
984 Finally, as the noble Baroness, Lady Pitkeathley, has already stressed, surely the emphasis must be on treating every person with respect irrespective of their age, colour or sex. Whoever they are they should be treated with respect, wherever they come from, whatever they believe and however they behave. It is that last part which presents the most difficult variable of all.
A conscientious GP aged 40 sleeps one night a week away from home on the floor of his surgery so he can be near to his patients when any emergency arises. At three a.m. he is rung up by a mother who says, "Can you come to the house and see my son who has ear ache?" The GP quite rightly says, "It would be better if you brought your son here where we have all the equipment so that we can see into the ear and put matters right". "No", she says, "neither my husband nor I can possibly bring the child because we are both completely drunk". The GP goes 10 miles out into the country in the middle of winter and provides the correct treatment. He actually takes the antibiotics. He goes home, goes to sleep and half-an-hour later he is woken up by the same woman who says, "My husband and I are not satisfied with your treatment. We are going to put in a formal complaint tomorrow". From time to time some of the one million people employed in the NHS do need the patience of Job.
§ 9.17 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, I thank my noble friend Lady Uddin for the opportunity of debating such an important issue tonight. I should like to place on record my thanks to her and to the many other noble Lords who have spoken in this debate and who have made such a contribution to the health of many people from black minority and ethnic populations in this country. As the noble Lord, Lord Clement-Jones, said, many positive suggestions have been made tonight about the way in which the Government should take forward their programmes and policies in this area. That is something which I am very happy to consider in the light of our discussions.
It is certainly clear from the Acheson report and other studies that there are very significant health inequalities among people from black and minority ethnic communities. But it is also equally clear that if the NHS is to win the battle to tackle these inequalities, not only must it be determined and focused in its health policies and programmes, but it must ensure that as an employer it invests in improving diversity, tackling discrimination and harassment and takes a holistic view towards the implementation of the policies which have already been clearly set out and which many noble Lords have mentioned.
My noble friend Lady Uddin spoke about institutional weakness in both service and employment and about the need to ensure that action is firmly rooted in performance management. I have no doubt that she is right. One can have all the policies in the world, but unless they are implemented they do not amount to very much.
985 Let us first consider the issue of service. As my noble friends Lord Parekh and Lord Desai suggested in relation to the clutch of diseases affecting many people from black and minority ethnic populations, the statistics are absolutely striking. The death rates from coronary heart disease among first-generation south Asians aged 20 to 69 are about 50 per cent higher than the England and Wales average. The death rate from strokes among those aged 20 to 69 years and born in the Caribbean is more than 50 per cent higher than the England and Wales average. Perinatal mortality among Pakistani-born mothers is nearly twice the UK national average. It has already been mentioned that diagnosis of schizophrenia is three to six times higher among African-Caribbean groups than in the white population. Women born in India and East Africa have a 40 per cent higher suicide rate than those born in England and Wales.
I could quote many other examples. They provide the background and the reason why it is important that we tackle such issues effectively. I believe that we have the right policies. We have the NHS Plan which signals to the service the need to become more responsive to black and minority ethnic communities and to provide services which take account of their religious, cultural and linguistic requirements.
The noble Lord, Lord Chan, was disappointed by the number of references in the plan to black and minority ethnic populations. However, as the noble Lord, Lord Desai, suggested, making the reduction of health inequalities a priority in the NHS Plan, and the promise of national targets for the first time ever, sets the really important foundation on which we address these problems in future.
Alongside that, as again the noble Lord, Lord Chan, suggested, the Race Relations (Amendment) Act is a piece of landmark legislation with practical underpinning to test our commitment to ensuring that our services meet the needs of black and minority ethnic communities, and that the NHS is a good employer. For the first time, public authorities such as the department will be subject to a positive statutory duty to promote race equality. As I have said, it is one thing to have the plans and targets; it is another to ensure that they are implemented.
In relation to service improvement, I believe that the National Service Frameworks present us with the ideal method andl opportunity to target some of these striking and worrying divergences in the illnesses among many black and minority ethnic people in this country.
National Service Frameworks, for the first time, allow us to set national standards for the provisions of services and to ensure that, in setting those standards, we target the people who are the most vulnerable. That applies as much to coronary heart disease as to diabetes. My noble friend Lord Desai raised a number of questions in relation to diabetes. He is right to say that type 2 diabetes is up to six times more common in people of south Asian descent and up to three times more common in those of African and African Caribbean descent. We have published the first part of 986 the National Service Framework. We shall be publishing the second part later. I believe that that will give clear guidance to the health service in relation to diabetes.
As regards screening, we are seeking advice from the National Screening Committee on that very matter. Once we receive that, we shall carefully consider it in relation to the implementation of the National Service Framework. The noble Lord, Lord McColl, made a subtle bid for funds for a particular project. I shall certainly look into that matter and respond to him.
Strokes are another area of great concern. At present we fund stroke awareness through the Section 64 grant scheme for a project to raise awareness of strokes and the associated risk factors among African Caribbeans. There is an information pack which will have fact sheets on high blood pressure, the effects of diet, the risks from smoking and alcohol, and the importance of exercise. But we need to do more than that, just as we need to do more in the area of mental health.
The high rates of diagnosis and over-use of the mental health system were mentioned by the noble Lord, Lord Clement-Jones, and my noble friend Lady Uddin. I was interested in the remarks of the noble Lord, Lord McColl. We recognise those high rates in the targets that have been laid down in the national service framework for mental health services. We have set targets to improve that situation. As the noble Lord, Lord McColl, suggested, part of that is the extra investment in the provision of secure beds—24-hour staffed beds and access to services 24 hours a day.
We have also made progress in creating assertive outreach teams to reduce the possibility of people with severe mental illness opting out of services and having services provided largely in their own homes. My noble friend Lady Uddin made particular mention of the needs of African Caribbean men and Asian women. I should expect the national service framework, as it is implemented, to take account of that.
We have also established a mental health task force which is preparing strategies that are specially designed to meet the needs of black and minority ethnic groups. Professor Sashi Sashidaran, a task force member, chairs that group which has been charged with drafting a strategy. It is in the process of finalising content and aims to ensure that the range of issues across the mental health national service framework and the NHS Plan are addressed in the hope that it will go out for consultation later this year.
A number of comments were made on ethnic monitoring. Information is vital in addressing health inequalities and improvements in health. As a matter of policy, the department introduced the 2001 census categories in its data collections, which provide an opportunity to address broader issues such as quality and use of race information. That is not simply a matter for action at national level. At local level the strategic health authorities and the primary care trusts have to pay close attention to the users of their services 987 and the illnesses from which their users are suffering to ensure that their health promotion and service delivery programmes are targeted on the riskiest areas.
I listened once again to the moving remarks of my noble friend Lady Rendell concerning female genital mutilation. The Government condemn FGM totally and unequivocally. My noble friend is right to mention the Prohibition of Female Circumcision Act 1985 and she is right that no prosecutions have been brought. I understand that that is because of the shortage of complaints and the difficulty in obtaining evidence and finding witnesses. The Government's main approach in this area has been to gain access to the communities involved to help educate them into accepting that FGM is a totally unacceptable practice that must be abandoned.
In answer to my noble friend's specific points, our responsibility is to treat victims of this brutal practice, and we shall do that sympathetically. She raised a number of points concerning the degree of services available to women who have been so mutilated, and I shall explore that within the Department of Health.
I listened with great interest to the noble Lord, Lord Chan, in relation to improvements in interpreting and language support. A number of very important points were made by my noble friend Lady Uddin, the noble Lord, Lord Parekh, and other noble Lords about work force issues. Those issues are vital not only to ensure that we tackle service provision but are important in their own right. The NHS Plan introduced an improved working life standard, which made it clear that every member of staff in the NHS is entitled to work in an organisation that can prove it is investing in improving diversity and tackling discrimination and harassment.
My noble friend Lord Parekh asked particularly about the issue of doctors and race inequality in medicine. The Chief Medical Officer commissioned MORI to run focus groups and one-to-one interviews with black and ethnic minority doctors to seek their views regarding racism, inequality and unfairness affecting their career or career progression. Those results will be incorporated into a report on race inequality in medicine later this year.
I accept also the points the noble Lord raised in relation to the number of black and minority ethnic people in senior positions in the NHS. We have set a national numerical target of 7 per cent to improve representation in executive director posts at board level. We are keen to see that that happens. Through the "Tackling Harassment" programme, the extension of the "Zero Tolerance" campaign and the various other initiatives we have taken, we are determined to ensure that the NHS is a model employer and tackles racism and discrimination in every way it can.
The noble Lord, Lord Chan, raised the issue of suspended doctors. My understanding is that there are currently 29 hospital doctors who have been 988 suspended by their employers for more than six months. We wish and expect NHS employers to treat all staff equally and not to discriminate on grounds of race, ethnicity, gender, sexual orientation, disability, religion or age. It is right that we look at the procedures by which doctors are suspended to ensure that those principles are fully enacted. It is also worth making the point that we established the National Clinical Assessment Authority to improve the handling of doctors who, for one reason or another, run into difficulties within their employing authority. That should reduce the number of long-term suspensions of doctors, but also deal with the issue of whether discrimination exists against doctors from minority ethnic or black groups. We expect the new clinical assessment authority to give expert advice to employers and to help them avoid overreaction in some cases.
An important issue was raised in relation to the involvement of local communities in the development of services and policy. That is vital. My noble friend Lady Uddin referred to local community groups and women's health issues. My noble friend Lady Pitkeathley, in paying a tribute to staff, said that the NHS had to do much more to involve local people in decisions about their future health. That is the context in which the new proposals contained in the NHS Bill, which we shall shortly be debating, to improve public and patient involvement, very much come to the fore.
My noble friend asked whether, within patient forums, advocacy or the national commission, we would ensure that there were sufficient members from black and minority ethnic communities. We will very much seek to do that. Indeed, it will surely be a test of the proposals that we are putting forward, which are much stronger than the present ones, that they cater for the needs of everyone in our community. I certainly agree with my noble friend Lady Pitkeathley that the role of the Commission for Patient and Public Involvement in providing training and support for those involved in patient and public involvement will need to reflect the needs of the whole of our society and will have an important role in supporting and monitoring the performance of many of those local public involvement bodies.
The noble Lord, Lord Clement-Jones, asked about health inequality targets. He will recall that we announced the first ever health inequality targets in February 2001 and gave a commitment that they would build on the local targets for reducing health inequalities. We continue to work hard in that area to make sure that they happen.
At the end of this important debate, no one should he in any doubt that we are determined to ensure that services for the National Health Service are as first rate for members of the black and minority ethnic communities as they are for anyone else in our society. No one can deny that the NHS Plan, National Health Service frameworks and various other policies that we have laid down make it clear that we expect services to be provided in that area.
989 It is worth recognising that many important developments and local projects have taken place, but that there is a long way to go. We must make sure that current pockets of good practice become systematic and mainstream throughout the NHS and in social care. The challenge to the department and to the National Health Service is to ensure that those policies and programmes are implemented in a firm and satisfactory way.
990 The Government are committed to working with all those who want to see full equality in health and social care and to making sure that that happens. My noble friend has done a great service to the House in bringing this important matter to our attention. I assure her that the Government want to proceed and to study carefully the points raised in the debate today.
§ House adjourned at twenty-four minutes before ten o'clock.