HL Deb 20 October 2003 vol 653 cc1271-94

3.13p.m.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

Moved, That the House do now again resolve itself into Committee.—(Lord Warner.)

On Question, Motion agreed to.

House in Committee accordingly.

[The CHAIRMAN OF COMMITTEES in the Chair.]

Clause 49 [Annual reviews]:

[Amendment No. 281A not moved.]

Earl Howe moved Amendment No. 282:

Page 17, leave out line 37.

The noble Earl said: In moving this amendment I shall speak also to Amendments Nos. 341, 347 and 360. I make no apology for returning to the issue of star ratings. We see in Clause 49 that, in each financial year, CHAI will have to conduct a review of the provision of healthcare by and for each English NHS body and each cross-border strategic health authority and must award a performance rating to each such body.

There is, to my mind, a distinction to be made between performance indicators and star ratings. I have no objection to a hospital being measured against a range of performance indicators. That is often a useful exercise for management in driving up standards across the board. When the process gets corrupted, however, is in the translation of those indicators into crude star ratings. Under the system devised by the Government, star ratings determine a great deal. A three-star rating is currently a prerequisite for a hospital if it wants to apply for foundation status. More generally, it is the goal towards which the management of a hospital strives in order to win the prizes distributed by the Secretary of State under the banner of so-called earned autonomy. But there are wider dimensions as well. Whether a hospital gets three stars, two stars, one star or none can affect the whole range of its activities; chief among which is the ability to recruit and retain good staff. There is no doubt that star status directly affects morale, and it is inevitably the measure by which that hospital is perceived by its patients and the wider public.

Given that so much depends on it, the one thing that we should look for in a star rating system is for it to be a true and fair indicator of performance. Yet that notion was completely blown apart by the report of the Audit Commission earlier this year. The report showed that, in very many instances, a hospital's star status had almost no bearing at all on how good a hospital it was from the point of view of patient care. That is partly because of unreliable data collection; and partly because star ratings are much more to do with internal processes than with the things that most of us would associate with good care and treatment.

Managerial competence is hardly reflected in the figures at all. Indeed, in a revealing section of its report, the Audit Commission states:

"There is a statistically significant relationship between performance and managerial adequacy. The number of DH stars awarded is only weakly related to either".

That is the nub of my objection to the current system. One well-known example of zero star status is the Bath Royal United Hospitals NHS Trust, yet the respected health management consultants, Dr Foster, goes out of its way to praise that hospital as excellent in the treatment it delivers to patients.

Equally, a high star rating need not necessarily indicate good care. That is because the target indicators can often be selective. For example, waiting times for outpatient appointments relate only to the first appointment and not to subsequent ones, although there are twice as many follow-up appointments as first appointments. Similarly, with cancelled operations, only those operations cancelled on the day are counted in the figures, not operations cancelled on the few days preceding that.

The following shows how blunt an instrument a star rating is. One specialist acute trust was rated by the Audit Commission as very good on achieving NHS Plan targets and on most measures of financial and performance management. Another acute trust performed poorly on NHS Plan targets and was rated poor managerially, including significant financial management failings and no signs of imminent improvement. Yet both those hospitals achieved a two-star rating from the Department of Health. The Audit Commission found that, on average, three-star trusts were likely to achieve only 69 per cent of NHS Plan targets compared with 66 per cent in two-star trusts—3 per cent separating two-star and three-star ratings. That small difference hardly seems enough to warrant the very favourable treatment that three-star trusts receive and two-star trusts miss out on.

Star ratings ought to be abolished and I therefore do not think CHAI should be required to award them every year. They are profoundly misleading; and their knock-on effects, whether good or bad, are unwarranted. Exactly the same argument applies to CSCI and the star ratings of local authorities that it is required to award under Clause 77. For the same reasons, those ratings are also unrepresentative and misleading. If we must have targets, the language of performance of those targets should be devised by CHAI and CSCI themselves. It should be a linguistic rating, not a crude numerical one. The Minister will need to do an exceptional job in defending this element of the Bill if he is to start convincing me that these provisions have a value. I do not believe that he can do that. I beg to move.

The Chairman of Committees

If this amendment is agreed to, I cannot call Amendment No. 282A.

Baroness Barker

I rise to support the noble Earl, Lord Howe, on Amendment No. 282 and to speak to Amendment No. 284.

Earlier this year, not long before the House rose for the recess, I spent several hours in the A&E department of a large hospital. It was perhaps one of the most informative experiences I have had and has informed me extremely well for our debates on this Bill. At seven o'clock in the morning, when the newspaper shop opened, 1 went to buy a copy of the

Guardian, as one would, and saw that the A&E department that I was visiting had achieved a low star rating. I was profoundly glad that I did not have the job of telling the people in that department, in the middle of their twelve and a half hour shift, that they were not doing a good job. That is one of the reasons why my noble friend Lord Clement-Jones and I are happy to put our names to Amendment No. 284. The current star performance rating takes precious little cognisance of what patients, other users and clinicians actually feel. It is a management, target-driven process.

I live in an area where people can go to one of two hospitals, both of which offer some of the same services. Given my age group, I know people who will sing the praises of the gynaecology and maternity unit at one of the hospitals but not set foot in the other. Others hold an entirely different opinion. I am not sure how they have reached their conclusions although I am sure that they have good reasons. There is perhaps one main reason why these amendments should be accepted and it relates to the provision of specialist services. I have taken part in various debates in your Lordships' House on specialist services, particularly neurological services. Many neurological patients say that locating good services simply by means of word-of-mouth recommendation is one of the most difficult tasks that they face.

Hospital star ratings do not meaningfully reflect that information. Star ratings by themselves are a crude target. Like the noble Earl, I should like to see the back of them. If they are allowed to continue, they should be the product of consultation with those who really know how hospitals work or do not work and what is wrong with them. I am therefore very pleased to attach our names to Amendment No. 284.

Lord Peyton of Yeovil

I should like very briefly to support as warmly as I can the amendment which was moved in such reasonable terms by my noble friend. I have just one question to ask. Who will actually award the performance rating of each body on behalf of CHAI and what training will they have for dispensing what amounts to a very serious measure of power in this instance? We have to be very careful about giving the power provided in this clause to people who have not had very meticulous training. I hope that the noble Lord will at least take the matter seriously. If he does not, I hope that my noble friend will return to it on Report.

Lord Turnberg

I must admit to sharing some of the concerns behind Amendment No. 282. I share the concern about the reliability of the star system, which I, too, believe is rather a blunt instrument for assessing the abilities and facilities to deliver care for patients. I fear that the correlation between stars and what patients want may not be anywhere near exact. However, I think that there is a need for some form of performance rating. After all, what is CHAI about if it does not try to assess how care is provided in those hospitals? I should like to see not star ratings, but a performance rating that takes a much broader and much more sensitive look at how care is delivered. I am not sure that removing the phrase "award a performance rating" will change anything. I think that one can change the star system without removing that phrase.

Baroness Cumberlege

I should very much like to support what the noble Lord, Lord Turnberg, has just said. I know that it is very difficult for the Government to reverse once they have gone down a particular line. In this instance, however, is there not a case for trying to get back into the National Health Service some real confidence in the present system? Perhaps we will have to change the words and reinvent the assessment. However, as the noble Lord, Lord Turnberg, and my noble friend Lord Peyton rightly asked, who is going to do it? Nevertheless, the present system lacks such credibility. There is so much cynicism about it, not necessarily so much among members of the public who I do not think quite understand all the nuances, but certainly among members of staff who are being judged by the system and think it unfair.

Lord Hunt of Kings Heath

As I had ministerial responsibility for performance rating I am overwhelmed by the level of support that noble Lords have shown for both the concept and the practice. I hope that the Committee will excuse me if I rise to defend performance rating, but I do not recognise some of the complaints that noble Lords have made this afternoon.

There is a huge variation in performance between individual organisations within the National Health Service. For far too long, for years, those organisations were allowed to carry on as they were without any external pressure at all on how they were performing. I do not pretend, as I did not when we debated this matter on Thursday, that the current performance ratings are 100 per cent perfect. Of course I recognise that it is very difficult to create an accurate performance measurement which goes across the whole of the work in each individual NHS organisation. However, I think that the key targets and the range of benchmark figures that will inform those targets provide a pretty fair reflection of how well the organisation is doing.

I have been to NHS trusts that received a poor rating and to NHS trusts that received a three-star rating. I have been struck by the positive attitude that many people have taken towards the ratings. There was real pride in the organisations that achieved a three-star rating and a determination to do better in those that did not do so well. Surely that is the attitude that we want to engender in the health service, an attitude in which everyone is committed to improving overall performance.

I understand some of the concerns that have been expressed, but surely we should allow Sir Ian Kennedy and CHAI to take on board those concerns and to come up with new proposals. Sir Ian has already indicated that he wishes to make changes and we should welcome that. Please, however, let us not leave the concept that it is right to rate NHS organisations and to provide the public and staff with an indication of those that are doing well and those that are doing not so well. After nearly 50 years in which the public have had very little opportunity to assess their own local hospital, we now have such an opportunity. We should show our confidence that this is the right way to go forward in the future.

Baroness Carnegy of Lour

I am sure that we have all listened to the noble Lord, Lord Hunt, with interest. He knows why the rating system was invented in this way and he knows how he considers it to be working. But the Audit Commission disagrees with him. It is fairly devastated about how it is working. My noble friend's Amendment No. 282A does not suggest that the rating system should be done away with; it suggests that there should be rating, but that it should be in a form to be determined by CHAI.

A difference of 3 per cent between a three-star and two-star rating, with all its implications, must be shocking to the people who work in the hospitals and shocking to the locality and to patients. It is very unnerving. It clearly is too blunt an instrument. The Government should accept that it needs sharpening up very much.

My mind turns to Which? magazine and how the Consumers' Association tackles assessing comparatively simple products, such as motor cars. It looks at endless categories. Within each category, a great many ratings are considered—even for a motor car—before reaching a conclusion. I bought a car that was top of the pops in its range and it goes beautifully. The Consumers' Association did rather well on that, but it was subdivided into a great number of elements.

If the CHAI is to operate the system successfully and, above all, fairly, in a way satisfying to the public and to patients, it must make it much more complicated and subdivided than it is at present. The Government should not turn the amendment down flat. Amendment No. 282A is an extremely good one. I hope that the Government will accept it, or something very like it.

3.30 p.m.

Lord Warner

The noble Baroness spoke about Which? reports. I am old enough to remember that when they were first produced, there was outrage from many providers of goods and services. I am not sure that that is a particularly good experience of which to remind people. Perhaps it is a remarkably similar position to now.

My noble friend Lord Hunt eloquently reminisced about his experiences in this area. I suspect that after I finish speaking, I shall join him in the dock as I make the case for not accepting the amendments. Let me be clear at the outset: we are unapologetic about targets, as such. We are not claiming that all the targets have been perfect. We are not claiming that the present system is perfect. But targets have helped to cut waiting lists for patients. They have increased the number of coronary heart disease operations from 41,000 to 56,000 between 2000 and 2003. They have taken us to a point where 97 per cent of patients with breast cancer are treated within 31 days of diagnosis. They have reduced delayed discharge of patients from 7,000 to 4,000 between 2001 and 2003. That is just a sample of big improvements for patients.

I am not saying that that is just the result of targets, but targets and ratings concentrate people's minds. They change the focus in many areas where there have been considerable concerns about performance on the part of patients and, in many cases, on the part of many NHS staff. Performance ratings also help to hold people to account. It is worth bearing in mind that we have listened to some concerns about the number of targets. We know that they can cause concerns, not just to managers, but to clinical staff too. The Government have made great strides to address the concerns.

Through the priorities and planning framework for 2003 to 2006, we have set out in a single document a much more streamlined and focused set of targets—62 in total—for the whole of the NHS and social care for the next three years. Before Members of the Committee say that that is still over the top, let us put it in context. It is fewer than one target for every £1 billion of planned expenditure in health and social care over the next three years. I suggest that that is not out of proportion, given the huge sums of public money being developed for patients' concerns.

Performance ratings are only one of the criteria for applying for foundation trust status. We have not made them the be-all and end-all of the application for that status. They also provide an important means of informing the public about how their local NHS hospitals are performing. It is worth bearing in mind that under the present system, for example, the star ratings system published by the Commission for Health Improvement in July 2003 had 10 indicators with a clinical focus, which included outcome indicators such as death rates and emergency readmissions. It is of interest to the public to know how many emergency readmissions there are after discharge. That tells us something about performance in local areas.

It is no good just sweeping the system away as a totally irrelevant system in terms of telling local communities about the performance of their particular hospitals. We have always acknowledged that the system is not perfect, but it is improving and will continue to improve. We certainly have every confidence that, under the leadership of Sir Ian Kennedy, CHAI will make—it has committed itself to make—a proper analysis of the system so that it can propose changes which more adequately meet some of the concerns expressed by the noble Earl and other Members of the Committee.

We must bear in mind that we have come a long way quite quickly. Therefore, it is not surprising that some improvements can be made. However, we must not deny that the targets and performance rating system have brought real improvements for the users of the health service. Amendment No. 282, which would remove the obligation on CHAI to issue performance ratings after its annual reviews, is not appropriate. That would deny the public information about the performance of their local trust.

Amendment No. 282A allows CHAI the freedom to determine the form of performance ratings. Of course it is up to CHAI, as the independent commission, to determine expressly how the performance ratings will look and feel. That has always been our intention. We expect CHAI to do that. We know that it is thinking about changes that it would like to see, but that is covered already by existing wording. The amendment is unnecessary.

Amendment No. 341 would remove the obligation on CSCI to issue performance ratings after its annual review of local authorities. The star rating process has now been in place for some time, operated by the Social Services Inspectorate. To our knowledge, few local authorities have raised concerns about it. The majority of local authorities have seen the process as helpful in determining what they need to do to improve their services—whether three star councils or councils with lower ratings.

Performance ratings are an important means for CSCI to inform service users and the public at large about how local authorities are performing in the provision of social care. Another key consequence of removing the power for CSCI to award a star rating, as the SSI does now, is that it would not be possible to complete the annual comprehensive performance assessment process of all local authority services. That would make it difficult to judge which local authorities deserve freedoms to build on good or excellent performance.

I would not expect the Audit Commission to be thrilled about sweeping away star rating systems in relation to CSCI. Amendment No. 347 would prevent CSCI using the lowest level of rating as a measure of poor performance for advising the Secretary of State of the action to be taken to improve such services. That is an important means by which decisions can be taken to improve the quality of local services.

Amendment No. 360 would remove the power of the Welsh Assembly to award performance ratings as a result of an inspection. That would significantly weaken the framework for review and inspection of social services in Wales and would mean less robust arrangements in Wales than in England. That would be unacceptable to people in Wales.

So, as I have outlined, we think there are good grounds for keeping the present system in place while allowing, as the Bill provides, CHAI to make improvements following the process of thought and consultation that it will be undertaking.

Lord Peyton of Yeovil

I am sorry to detain the Minister once again. I thought that I had asked him what kind of people are to make these assessments on behalf of CHAI and what form of training they will be given. Before we give people powers of this kind, I think that we ought to be satisfied that they will be properly equipped to use them. While I do not want to go into all the arguments, there is an increasing army of people in this country whose role is to check up on other people working in sharp-end jobs. Only a limited number of people in the health service are capable of making anyone better at what they do, and it is doubtful how many of those would be included in the ranks of CHAI; indeed, it would be a waste of their time if they were.

I return to the question I asked the Minister earlier. If he does not answer it, rather than simply responding in accordance with his official brief stating "reject", he ought at least to leave it open until the Report stage and offer to reflect on it. The summary advice headed "reject" mutilates argument and does not do anything to convince Members on this side of the Committee that the noble Lord is really taking seriously what is being said.

Lord Warner

I reject the noble Lord's last comment. On a number of occasions I have offered to take matters away and to consider amendments in regard to particular issues.

The noble Lord must have the arguments on his side. As regards the present arrangements, we have the Social Services Inspectorate, whose representatives are well trained. They have not been criticised on any lack of training or on how they carry out the inspections which will be used to form the basis of the future CSCI ratings. There will be transfers of staff there.

The Commission for Health Improvement undertakes the star rating system, based to a great extent on information provided by NHS trusts themselves. That work is undertaken by well trained and knowledgeable staff who will be transferring to CHAI. It will then be for Sir Ian Kennedy and his colleagues to decide, as an independent body—noble Lords have made great play of its independent status—what further training may be required. It is not for the Secretary of State to lay down the skills and competencies required by this independent body.

Baroness Barker

May I ask the Minister to give his response to Amendment No. 284?

Lord Warner

Amendment No. 284 seeks to specify those groups that CHAI must consult in determining criteria for determining the award of performance ratings. I certainly do not agree that we need to specify which groups, if any, CHAI, as an independent body, may wish to consult in developing its performance rating methodology. Clearly, CHAI will wish to engage patient representatives and those experts, clinical or otherwise, that it feels will be appropriate in developing such review criteria, but we do not think it would be proper for us to place in the Bill a duty on it to do so.

Again, I come back to the point that noble Lords cannot have it all ways. If an independent body is being set up and people are concerned about its independence, it is right and proper that that body should be given a degree of freedom of manoeuvre in how it consults. We must trust it to do that in a sensible way.

Earl Howe

This has been a useful debate and I hope that the Minister will want to reflect on the concerns expressed by my noble friends Lady Cumberlege, Lady Carnegy and Lord Peyton, as well as the noble Baroness, Lady Barker, and, from the Minister's own Benches, by the noble Lord, Lord Turnberg.

I agree with the noble Lord, Lord Hunt, that there are variations in the performance of NHS bodies and that those variations do need to be identified, and I agree with the Minister in what he had to say in that regard. I have no difficulty with the concept of performance indicators; it is the star rating system which is too much of a blunt instrument. What I sought to suggest in Amendment No. 282A—to which I am not sure whether I said I was speaking, although I hope the Committee will realise that I was doing so— is that performance ratings should be formulated by CHAI itself in a more sophisticated way than is the case at the moment, and that perhaps a linguistic form of rating would achieve the kind of sensitivity described by the noble Lord, Lord Turnberg.

I agree with the noble Lord, Lord Hunt, that we want to motivate staff, but you simply will not do that if those members of staff have no confidence in the way that their star rating was arrived at. The trouble is that the targets on which star ratings depend are, in many cases, artificial. I mentioned targets for out-patient appointments and cancelled operations. Another is waiting times in A&E, because the performance is assessed on the basis of a snapshot in a particular week. In-patient waiting times targets take no account of clinical urgency and so are unrelated to what really matters. A huge management effort is put into chasing such targets and that effort could, I believe, be better used.

My noble friend Lady Carnegy said that star ratings could learn some lessons from car ratings, and I think she has a point. By no means do I want to sweep the whole system away, but it does need to be refined and I hope very much that Sir Ian Kennedy will be allowed complete freedom to devise systems in which everyone has confidence and which really do indicate the variations that exist in the health service. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 282A not moved.]

Lord Grocott

I beg to move that the House do now resume for the Statement.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.

3.47 p.m.

The Lord President of the Council (Baroness Amos)

My Lords, with the leave of the House, I should like to repeat a Statement made in another place by my right honourable friend the Foreign Secretary. The Statement is as follows:

"I should like to make a Statement about the European Council which the Prime Minister and I attended in Brussels on 16th and 17th October. I saw the Prime Minister earlier this afternoon and am pleased to be able to report that he is fine and has totally recovered.

"EU Heads of State and Government had their first substantive discussion of the draft constitutional treaty, focusing on the size of the Commission, the role of the Chair of the European Council, changes in the rotating presidency and the weighting of votes after enlargement. The Prime Minister set out the United Kingdom's position in the terms of our White Paper published on 9th September.

"The Council discussed the European economy and agreed a number of measures to encourage growth. I have placed a copy of the conclusions in the Library. These stress the EU's commitment to structural reform, flexibility of capital and labour markets, and innovation and investment in research and development.

"But between now and the Spring Council on European Reform work needs to begin to reform European competition policy, to make the new system of regulatory assessment work effectively, and to take forward the ideas of the recent report by a leading Belgian economist, Professor André Sapir, on how the EU budget can be focused on economic reform priorities. The reform agenda remains a high priority for the Government. We are working closely with the Irish Government who, as EU Presidency, will chair the economic summit in the spring.

"The European Council discussed defence at a Heads of State and Government dinner. The EU has mounted two ESDP military operations this year, both of them with UK contributions. In March, an EU-led military mission took over from NATO in the stabilisation role in Macedonia. And in June the EU deployed troops to the DRC to support UN activities there. Both operations followed the approach agreed by the Prime Minister and President Chirac in launching the European Security and Defence Policy initiative at St Malo in 1998, that the EU will act militarily only, where the Alliance as a whole is not engaged". "In Macedonia, NATO has decided to terminate its mission and to support an EU successor force through the Berlin Plus arrangements. In the case of the DRC, the EU decided to deploy a force after consultation with NATO and once it was clear that NATO did not intend to engage militarily in the Congo.

"It makes sense for EU nations to strengthen Europe's contribution to the alliance and to enable Europe to act in circumstances where NATO does not want to. What would not however make sense and is unacceptable to us would be for the EU unrealistically to aspire to provide a territorial defence commitment. That remains for NATO. Three years ago in Nice, the European Council recognised that, in approving the permanent arrangements for ESDP, NATO remains the basis of the collective defence of its members". "The Government believe in a strong Europe and a strong NATO. Our leading role in European security and defence policy has been based on these twin commitments. They are widely shared across the enlarging European Union and the Atlantic alliance. They will be at the heart of the development of European security and defence policy in the Intergovernmental Conference and beyond.

"Let me now turn to Iraq. The European Council welcomed the unanimous adoption of UN Security Council Resolution 1511 on Iraq on 16th October. Its successful passage by 15 votes to nil reflects weeks of intensive negotiations and is also a testament to the tireless work of the US Secretary of State, Colin Powell.

"The resolution sets a deadline of 15th December by which the Iraqi interim governing council should provide a timeline and programme leading to an Iraqi constitution and democratic elections. We want to give control of Iraq back to its people as soon as possible and practicable. Iraqi Ministers are already heavily involved in much of the day-to-day business of the country.

"The resolution confirms the central role of the UN and encourages UN member states and international bodies to support the reconstruction of Iraq. The next step will be the Madrid donors' conference at the end of this week. There the UK will pledge a further £300 million assistance over two years. Together with money already committed this will bring the UK assistance for the three years from April 2003 to £550 million. This is on top of the contribution we are making through our commitment of British troops.

"The security situation, especially in the Baghdad area, is not satisfactory. But since Saddam Hussein's downfall the coalition has made huge efforts to rebuild the infrastructure of Iraq. Power generation is now exceeding pre-war averages. Last week, oil production reached 2 million barrels per day for the first time since military operations ceased. Nearly all schools and hospitals are open. Iraq has a new currency. Banks have reopened and businesses are coming to life. Security sector reform remains a key focus for the coalition. The challenge is to put Iraqis in charge. Iraq now has 40,000 police, and this number will rise to 70,000 within a year. The first battalions of the new Iraqi army have graduated. Training for additional Iraqi military continues and there is now an independent judiciary. The Prime Minister asked particularly that I emphasise his personal tribute to the UK servicemen and women, other UK personnel and other coalition partners who are working selflessly in difficult and dangerous circumstances for the good of the Iraqi people. Much still needs to be done. But much is being achieved.

"The European Council also discussed Iran and again urged the Iranian Government to co-operate fully with the International Atomic Energy Agency. Resolving the doubts surrounding Iran's nuclear programme is of grave concern to the EU and to the wider international community. Immediately after this Statement, I will be travelling to Tehran to join my French and German colleagues for talks on the issue at the invitation of the Iranian Government. We will be pressing on the Iranians the urgent need for compliance with all of the requirements of the resolution passed last month by the board of governors of the International Atomic Energy Agency. That means we shall be seeking full co-operation and transparency to enable the agency to resolve outstanding questions and pressing the Iranians on key issues raised by the resolution. These include the early signature, ratification and implementation of an additional protocol to Iran's existing safeguards agreement and the suspension of all enrichment and reprocessing activities.

"The European Council considered the worsening situation in the Middle East, condemning the intensification of suicide attacks and other violence, in particular the attack that killed three US citizens in the Gaza Strip on 15th October. The European Union called again on the Palestinian Authority to do all it could to fight against extremist violence. It also expressed particular concern over the route of the so-called "security fence". Apart from the humanitarian and economic hardship this is already bringing to many Palestinians, this project could make the two state solution impossible to implement.

"We shall work hard to achieve a successful outcome of the Intergovernmental Conference under the Italian presidency this year. We are very grateful to the leadership of the Italian Government in this negotiation.

"The draft constitutional treaty is designed to improve the way the European Union works after enlargement by reform, clarification and consolidation. The claims made by the Opposition and others that this treaty would undermine Britain's independence are absurd. These are, in truth, arguments not against the draft treaty but against British membership of the European Union. Their logic would be to take Britain out of the European Union altogether.

"The European constitutional treaty has got to be one based on independent sovereign nation states co-operating together, not some federal superstate—and so it will be. A constitutional treaty embodying these principles will contribute to a strong and successful European Union. That is essential for our economic prosperity, our security

and for Europe's stability. We believe that this patriotic approach is in the interests of this country and I recommend this approach to the House".

My Lords, that concludes the Statement.

3.57 p.m.

Lord Howell of Guildford

My Lords, I thank the noble Baroness for repeating the Statement. The House, of course, will be united in wishing the Prime Minister a rapid return to complete full health. I am very happy to hear that that is indeed the situation. I combine what I suspect are your Lordships' feelings with friendly advice, such as that offered with amazing prescience last week by my noble friend Lord Hurd in a newspaper article: that in future it probably will be wise for the Prime Minister to go a little slower in his activities, carrying, as he does, enormous burdens.

We applaud some aspects of the Council's conclusions, such as its robust views on addressing the unending Palestine tragedy; the combined approach to the Iranian nuclear programme, which the noble Baroness described; and the latest UN resolution on Iraq, which is welcome.

Despite the desperate security situation in some parts of Iraq—which our troops are handling with their customary skill and superb qualities and bravery—I agree that clearly there has been progress. However, not many of the advances—for example, the fact that oil production is now back to 2 million barrels per day; the currency reform; the new investment and so on—get reported. We welcome the progress that has been made and hope that the donors' conference in Madrid next weekend will be successful. We acknowledge that the £550 million already committed by the United Kingdom is a good start, as is the 1.5 billion US dollars now committed by Japan and a number of other commitments. It is a start and a move in the right direction.

However, we are far less impressed by the communiqué and the Statement, which contain endless paragraphs and presidential conclusions full of tired "Oldspeak" references to "relaunching Europe", "growth initiatives", government plans for somehow magically producing jobs, and even to that old chestnut "industrial policy". I thought we had seen the last of that kind of thing. The drafters of the communiqués and conclusions do not seem to realise what the public long ago grasped—that nowadays the most effective and innovative economic and social change comes not from more central government plans and initiatives but from outside central government. It comes from market competition and deregulation; in the social case, it comes from non-governmental organisations, from the private sector, from voluntary groups and even from the media.

It is a pity, too, that the summiteers did not pay more attention to the robust rubbishing given to all this kind of thinking by the Chancellor of the Exchequer, Mr Gordon Brown. He said in last Thursday's Wall Street Journal, the policies of trade bloc Europe are not just out of date but counterproductive". He added that Europe, must conclusively rule out tax harmonisation" and, resolve that tax competition is the basis on which Europe can compete". I presume that can only mean that he would like to see lower taxes. Of course, he does not practise what he preaches in that respect, but that is a debate for another time. But at least he is speaking along the right lines.

We are, frankly, left mystified by the twists and turns of government policy on defence and security, although the noble Baroness sought, in the Statement, to explain the position. What exactly have we agreed to? Last week, the US Ambassador to NATO, Nicholas Burns, described the EU plans as, one of the greatest dangers to the trans-atlantic relationship". The Americans—and my friends confirm this—tell me they believe they are being kept in the dark. We need some more illumination about what is happening. Are we falling in with the increasingly explicit French and German plans, just confirmed in the German Ministry document, for a European army with its own command structure, or are we not? The Prime Minister, of course, assured President Bush a few weeks back that there would be a joint command between EU forces and NATO. Is that still the policy or have we shifted? How does that fit in with Monsieur de Villepin's recent lecture to us about, expanding German and French ambitions to use his slightly chilling phrase.

Thirdly, we come to the constitution plans, which the noble Baroness mentioned. What do the Government say to the Italian Government's proposal to table a "take it or leave it" document on the constitution next month? Have we been consulted on this procedure, or will we just be caught by surprise again, as often seems to happen?

As for the nature of the draft constitution, how can Ministers say with a straight face that the constitution will not fundamentally change the European Union or our relations with the rest of the Union, when it places the new constitution above our own, when most of Europe's leaders describe it as an absolutely major constitutional change—amended or not—and when at least six other countries are having referendums on it? Is it any wonder that the Prime Minister's closest advisers are now said to be cautioning that the Government's dogmatic rejection of a referendum here is an untenable position?

Constitutions are supposed to be about checks and balances to prevent too much central power and the tyranny of the majority. Are we going to inject any of our national experience on these matters into the draft, which is at present devoid of all such considerations? If so, when are we going to speak up?

Finally, this country used to be seen in central and eastern Europe—I am referring to the enlargement development—as the champion of the smaller states. Did we, this past weekend, stick up for them and their deep worries about not having commissioners in Brussels, about a centralising presidency or about anti-Americanism in Paris and Berlin? Or did we just side with the big powers against the small? It would be nice to think that our country was on the side of democracy and a more equal kind of Europe—in fact, a better Europe. But in the presidency conclusions, and in today's Statement, there is no sign of that at all, and I wonder why.

4.4 p.m.

Lord Wallace of Saltaire

My Lords, we on these Benches also extend our best wishes to the Prime Minister after the unfortunate incident yesterday and hope that he will be fully recovered.

We welcome the Statement. I note that the conclusions had a good deal more on the Lisbon agenda and the growth initiative than is provided in the Statement. If I may make a marginal correction to the Statement, the recent report of the Sapir group was by not only leading Belgian economists but a multinational group of experts, including a British expert, Professor Helen Wallace, whom I know moderately well.

The growth initiative talks about trans-European networks and their funding. The Belgian, Luxembourg and French Governments were particularly concerned that these should be in the centre of Europe. Could the Government assure us that they are pushing hard for funding for transport initiatives to be in the peripheral areas where possible, particularly in the new states, and not across the Alps and between Brussels and Strasbourg, as has been suggested?

Can the Minister tell us a little more about what is planned on the research expenditure of a major element of European knowledge in the Lisbon agenda? May I ask, for future reference but not now, that, at some point in the near future, the Government will come to the House and tell us what is happening among higher education institutions in what is known as the Bologna process? I note that communiqués from Ministers of higher education, all part of the Lisbon agenda, have not, to my knowledge, yet been reported in any way to this House.

I am happy that the better regulation initiative is being extended from Britain to the European level, and I hope the Government are pushing that very thoroughly.

There is very little mention of the border management issues, as covered in the presidency conclusions. They make a reference to a border management agency, with maritime and air components. Do Her Majesty's Government intend to take part in that, particularly given that the presidency conclusions say that the outline of this border management agency is due to be agreed in principle before December's European Council?

Much of the Statement covers defence. We welcome the Government's insistence on a European pillar in NATO, but are puzzled by the extent to which Her Majesty's Government appear to have been giving incoherent messages to their different partners over the past few weeks.

We were strongly in favour of the St Malo initiative of 1998, and I am glad to see that the Government are back on track. Some of us remember that 40 years ago or more, John F. Kennedy talked about a European pillar within NATO, and it seems to us that that is the direction in which we should be moving. There has always been deep American ambivalence about what that European pillar should be. Yet again, each time the Europeans move in that direction, Americans question whether we will be as loyal as we should be.

We are puzzled by the depth of the Government's opposition to the inclusion of a territorial defence commitment in the constitutional treaty. We lived fairly happily with the Western European Union treaty and its strong territorial defence commitment among European states for many years. It is inconceivable that there should be an attack on any member of the European Union without all members of the European Union, whether in NATO or not, being engaged. Perhaps we are being over-loyal and theologically purist about NATO in resisting that.

We welcome the emergence of EU forces in eastern Congo and Macedonia. I know that there have been some discussions about the use of peacekeeping forces in Moldova and whether the force in Bosnia will transfer from NATO to the EU.

Finally, there is a certain amount in the Statement on the constitutional treaty. We on these Benches welcome progress towards the constitutional treaty; we do not intend to discuss it in depth here, beyond hoping that the Standing Committee, which will be meeting at 5 o'clock, will attract a large attendance from your Lordships' House. We welcome the fact that the Foreign Secretary will be there. Discussions should be actively pursued over the next few weeks and months in that forum.

4.10 p.m.

Baroness Amos

My Lords, first I thank both noble Lords for their comments about the Prime Minister. He has now recovered. However, I have to say to the noble Lord, Lord Howell, that it would be a very brave person indeed who advised my right honourable friend the Prime Minister to go a little slower. Perhaps I shall send him a copy of Hansard rather than raise the matter with him myself.

The noble Lord, Lord Howell, asked specifically about tax. Our position remains as set out in the White Paper, which was published by my right honourable friend the Foreign Secretary in September. Paragraph 66, on page 32, makes it absolutely clear that, we will insist that unanimity remain for Treaty change; and in other key areas of vital national interest such as tax, social security … key areas of criminal procedural law", and so on. Our position remains exactly as set out in the White Paper.

Both noble Lords asked me a number of questions in relation to defence. After the Brussels summit, our position on European defence is the same as it was before. I should like to quote the Prime Minister in Brussels on Friday, when he said: We need of course strong European defence, but nothing whatever must put at risk our essential defence guarantees within NATO". That remains the position.

In response to a question asked by the noble Lord, Lord Wallace of Saltaire, we have said that collective or territorial defence is for NATO, and that remains our strong position. We see European defence being on a basis fully compatible with the NATO agreement. In our view, European defence has no future as a competitor to NATO.

In relation to the constitutional questions, particularly the question of a referendum, let me repeat what has already been said in this House. Under our constitutional arrangements, Parliament makes the law. In certain circumstances, Parliament has decided that particular laws should come into operation only after a referendum has been held. In practice, they have been held only where there is a wholly new constitutional structure proposed, and not otherwise. Referendums have been held in Scotland, Wales and Northern Ireland, so that the people there could decide whether they wanted a parliament or assembly. Only one UK-wide referendum has ever been held—in 1975, when the question was whether the UK should stay in or withdraw from the European Union. The Government are committed to holding a referendum on the euro. The position on referendums remains the same. A number of European countries have come to a different decision, but that is in line with their own constitutional arrangements.

The noble Lord, Lord Wallace of Saltaire, asked specific questions about funding for transport arrangements and research expenditure on higher education institutions. I hope that the noble Lord will allow me to write to him on those points. I shall put a copy of the letter in the Library of the House.

The answer that I have on Moldova does not answer the noble Lord's point. My brief states that the European Union reiterates its continued support for the OFC efforts for a comprehensive political settlement in Moldova, but it does not go to the heart of the points that the noble Lord raised. If I can find further information about that, I will be happy to write to the noble Lord. I should add that my right honourable friend the Foreign Secretary will unfortunately not be attending today's Standing Committee, as he will be on his way to Teheran, but he will try to attend all other sittings.

4.14 p.m.

Lord Tomlinson

My Lords, is my noble friend aware that, while I welcome the Statement that she has repeated, the Statement is vastly preferable to the presidency conclusions, which we have had more chance to read? Does she accept that many Members of this House, having read the presidency conclusions, will agree with the extremely critical comments made by the noble Lord, Lord Howell? In future, perhaps they should wait until after a Council meeting before writing presidency conclusions. Occasionally, instead of continuing to repeat the promises of the past, they should give an evaluation of how far they have gone in achieving some of those things.

I should like to ask a specific question arising from the presidency conclusions, under the heading "Iraq". Paragraph 63 refers to the conference to be held on 24th October in Madrid and how the European Union "will announce a pledge" of 200 million euros. Does my noble friend agree that that represents a somewhat obscure sense of priorities, when one contrasts that paltry figure with the 1 billion euros that is the annual subsidy in the European budget for tobacco manufacturing?

Baroness Amos

My Lords, my noble friend's proposal that we wait to write presidency conclusions until after the meeting is a somewhat novel one. It would have our officials and others in the international community somewhat concerned, but I shall pass it on.

With respect to the issue of Iraq and the 200 million euros that will be pledged by the EU later this week, individual European member states will also be pledging in relation to that. The decision was taken by the Commission on behalf of European Union countries.

Lord Hannay of Chiswick

My Lords, I thank the noble Baroness for the Statement from another place that she has repeated. On the defence issues that she raised, will she confirm that the relationship between the European Union and NATO continues to be based on an agreement reached last December, known as the Berlin Plus agreement? Will she also confirm that nothing that has been said or proposed within the European Union involves going outside, cutting across or undermining that agreement? In those circumstances, some of the excitement leaked to the press by the representatives of the US Administration seems a little premature, to put it mildly, and is not likely to produce the best reaction from the European side.

Unlike the noble Lord, Lord Wallace of Saltaire, I entirely support the view that territorial defence should not be included in the treaty. This country has never given a territorial guarantee to anyone who is not a member of NATO. The arrangements under the Western European Union were limited to countries that were also members of NATO. To go outside that would be a big innovation, and one that I would not welcome. If one considers the implications of giving a territorial guarantee to Cyprus, for example, one immediately understands why it is not a wise course.

Will the noble Baroness confirm, on the size of the Commission, that the most important issue is the number of portfolios rather than the number of members of the Commission? If the number of members is to meet the concerns of smaller member states and is going to start on a rising trend again— which I, personally, would deplore—it is crucial that the Commission is not subdivided into little penny packages of portfolios so that members are quite unable to represent the views of the European Union when it is their responsibility to do so.

Baroness Amos

My Lords, I totally agree with the noble Lord, Lord Hannay. Berlin Plus remains the agreement governing the EU/NATO strategic partnership and is at the core of the EU/NATO relationship.

I agree with the noble Lord, too, on territorial defence. I repeat that the Government's view is that collective or territorial defence is for NATO.

The issue of the size of the Commission is still under discussion as part of the process. 1 take the noble Lord's point about the number of portfolios. One issue for which we argued strongly in the context of the IGC was the placing of development in the Commission. Those discussions will continue.

Lord Waddington

My Lords, can the noble Baroness the Leader of the House help me? Why do the Government continue to say that the logic of those who say that the draft treaty would undermine our independence involves taking Britain out of the EU? Is that not entirely illogical because the new constitution cannot come into effect without the agreement of all? If we object, the constitution will not come into effect but the EU will continue, as will our membership. So it is absolute rubbish to talk about the logic being that we shall leave the EU if we object to the constitution or any part of it.

Baroness Amos

My Lords, I do not agree with the noble Lord. One of the reasons that these new constitutional arrangements are coming into effect is because the EU is expanding to some 25 members so there is a process of simplifying and pulling together the rules of the European Union to make it easier for 25 members to operate in a situation where currently only 15 operate. One of the reasons it is so important that that is done by unanimity is to ensure that those issues that are important for individual member states are kept outside these proposals so that they are contained within the treaty arrangements that already exist.

Lord Maclennan of Rogart

My Lords, will the noble Baroness robustly reject any implication that the convention produced a constitution which favoured large nations over small nations, and note that the Spanish Government, who have raised some objections, recently said that the Nice settlement was not cast in stone? Will she note also that a number of small member states, or states to be members after May, have, subsequent to the publication of the draft treaty, held referenda which massively supported adhesion to the European Union in the full knowledge of the terms of the draft treaty? Will she also accept that reduction in the size of the Commission is no more against the interests of small countries than it is against the interests of large countries? It enhances the efficiency and, indeed, the accountability of that executive body which in any event is supposed to be independent of national representation.

Baroness Amos

My Lords, the noble Lord is quite right that the convention process seeks to ensure that those countries that will join the Union next year as well as existing members of the Union are able collectively to discuss these issues. Part of its purpose is to ensure that small and large nations can make decisions on the future shape of the European Union. I entirely agree with the noble Lord that the effectiveness, efficiency and accountability of the Commission are very important indeed. That is one of the reasons that we feel strongly that this exercise of seeking to simplify and make more straightforward the various treaties of the Union is so important.

Lord Stoddart of Swindon

My Lords—

Lord Campbell of Alloway:

My Lords—

Baroness Crawley

My Lords, we have plenty of time. I suggest that we hear the noble Lord, Lord Stoddart, and then other noble Lords.

Lord Stoddart of Swindon

My Lords, first, I remind the noble Baroness the Leader of the House that in 1975 the country voted to remain in a common market. The European Union did not come into being until after the Maastricht Treaty had been signed. That is an important point. Secondly, will the noble Baroness confirm whether under the defence arrangements there will be a European army which will support a European foreign policy? I hope that she can clear that up. Thirdly, can the noble Baroness say why the Government have now agreed to a number of items which they would not agree to, or said were not relevant, following the Treaty of Nice? I refer to the semi-permanent president of Europe, the European Charter of Fundamental Rights—which they assured us would not be contained within any treaty and which is now to be contained in the new treaty—a legal personality, which we were assured would not be agreed to, and a European Union foreign minister. The latter will obviously be a powerful post which will give membership not only of the Council but also of the Commission, making that position extremely powerful, and probably greater than that of any of the Prime Minister.

Baroness Amos

My Lords, on the question of the charter, we support a clear statement of the rights, freedoms and principles that EU institutions should respect. The noble Lord is quite right that we supported the European Charter of Fundamental Rights at Nice three years ago but we did so as a political declaration; it was not clear enough for legal use. We shall make a final decision on incorporation of the charter into the draft constitutional treaty only in the light of the overall picture at the IGC. Therefore, that decision has not been taken with respect to incorporation.

With regard to defence, we consider that the discussions on ESDP were extremely valuable. We welcome the proposals to develop a capabilities agency to update the Petersberg tasks and to create a solidarity clause. With respect to all of the ESDP proposals, those matters are still under discussion. The noble Lord will be aware that, for example, the force that went into the DRC was a French-led force with other European countries contributing to that force. There was no European standing army as such.

Lord Campbell of Alloway

My Lords, this side, I think. Thank you.

Does the noble Baroness agree that one of the priorities in considering this draft constitution is to deal with the ritual plunder of the financial resources of the EU, as it is, and to get to the root of these fraudulent practices which have been going on and on? If the noble Baroness agrees with me, was that discussed and, if so, what was said about it?

Baroness Amos

My Lords, I am not aware of that particular issue having been discussed over the weekend. However, the noble Lord will be aware that for many years there has been a reform agenda within the Commission not only looking at issues of financial probity but also seeking to improve the overall effectiveness and efficiency of the Commission.

Noble Lords

This side!

Lord Lea of Crondall

My Lords, as regards counting sides, the noble Lord, Lord Stoddart, for whom I have great respect, is not now on our side. But be that as it may, the noble Lord, Lord Stoddart, referred to the referendum of 1975. It was the only referendum on Europe that we have had but it was not about the European Union. We should have had a referendum on the European Union that came into being after the signing of the Maastricht Treaty. Were not the party opposite in power at the time of the Maastricht Treaty? Therefore, is it not a bit much for them to get on their moral high horse and say that it is absolutely essential to have a referendum now?

Would it not be much better if noble Lords on all sides of the House were clear on the Government's main negotiating lines in the intergovernmental conference? I have not heard any of them being unpicked. However, we do not hear from all sides of the House that this country is united behind a great deal of the Government's negotiating position on the intergovernmental conference which we want to see succeed, not least because of the need to make provision for enlargement.

Baroness Amos

My Lords, my noble friend is quite right. The single European Act and Maastricht involved changes in the operation of the EU greater than any likely to flow from the IGC. We need to repeat that point, so that people understand the processes. He is right that we need to ensure that the realities of such changes are understood.

Lord Pearson of Rannoch

My Lords, when the Government say that claims by the Opposition and others that the treaty would undermine Britain's independence are absurd, surely it is that statement that is absurd. In the Giscard proposals, we are looking at a new and superior legal personality that means that national parliaments will be able to make laws in virtually every area of our national life only when Brussels cannot be bothered. That is what the exclusive and shared competence is saying, is it not?

The noble Baroness refuses yet again to give the British people a referendum on whatever constitution emerges from the IGC. I think that she said that under our constitution Parliament makes the law. Does she agree that the real position is that the British people have given Parliament—the House of Commons and this place—the power to make their laws and to take their decisions for them, except the power to give that power away?

Baroness Amos

My Lords, the noble Lord may wish to look historically at the situation regarding international and national law. It is an established principle of international law that a state may not plead its national law to escape its international law obligations, including its treaty obligations. The UK has given effect to the principle of the primacy of Community law through the European Communities Act 1972. That is not recent and not new.

Lord Grenfell

My Lords, the Statement that the noble Baroness was kind enough to repeat to us stated that the Government would work hard to achieve a successful outcome of the inter-governmental conference under the Italian presidency this year. That reflects the wording in the presidency conclusions, where the Council, recalled its support for the approach and timetable put forward by the Presidency in line with the conclusions of the European Council meeting in Thessaloniki". In light of the facts that there are probably less than 10 weeks to go, that the Italian presidency appears to be quite relaxed at the prospect of the treaty being signed some time in the new year—at least before April 2004, which is the absolute deadline—and that the Italian Government do not seem too concerned about the treaty being signed in Rome during their presidency, will the noble Baroness assure us that, in the IGC, Her Majesty's Government will be on the side of the angels and opt for getting it right rather than done early?

Baroness Amos

My Lords, the noble Lord is right that it is anticipated that we will conclude at the end of this year. However, I assure him that we want to get everything right. The IGC should complete its work and agree the constitutional treaty, to allow it to be signed by the member states of the enlarged Union as soon as possible after 1st May 2004 and in time for the June 2004 elections for the European Parliament.