House Of Lords
Wednesday, 28th October 1987.
The House met at half-past two of the clock: The LORD CHANCELLOR Oil the Woolsack.
Prayers—Read by the Lord Bishop of Liverpool.
— Took the Oath.
— Took the Oath.
The Right Honourable Francis Leslie Pym, MC, having been created Baron Pym, of Sandy in the County of Bedfordshire, for life—Was, in his robes, introduced between the Lord Carrington and the Lord Home of the Hirsel.
The Right Honourable Sir Keith Sinjohn Joseph, Baronet, CH, having been created Baron Joseph, of Portsoken in the City of London, for life—Was, in his robes, introduced between the Lord Young of Graffham and the Lord Vinson.
River Lea: Improvements
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government what steps they are proposing to take to improve the quality and appearance of the River Lea, particularly in its lower reaches.
My Lords, the primary responsibility for maintaining and improving the quality of the River Lea rests with the Thames Water Authority. The quality of the river upstream of Tottenham Lock is generally satisfactory but downstream some stretches are of poor quality. I understand that the water authority's aim is to bring the lower reaches up to at least class 2 in the national classification scheme. It would then be of fair quality and should be capable of supporting reasonably good coarse fisheries as well as having some general amenity value.
My Lords, I thank my noble friend for that partly encouraging reply, but is he aware that when I went along this waterway in July, I could hardly see the surface of the water because of floating rubbish and water weeds, that there were reeds encroaching from the banks and that it was silting up at various places? Is my noble friend aware that this could and should become an attractive waterway for thousands of people? Will he pass on to the Thames Water Authority our strong feelings about this matter?
My Lords, I very much appreciate my noble friend's comments and I shall certainly pass them on to my noble friend the Secretary of State. The British Waterways Board is making every effort to keep the waterway free from litter and has instituted a clean-up campaign. It is now experimenting with a newly designed refuse collection vessel.
My Lords, although it is encouraging to hear that the British Waterways Board is going to clean up, is the Minister aware that no single authority is responsible for clearing the rubbish out of this or any other river, unless the water flow is impeded or unless there is pollution? Does he not think that in urban situations such as this it would be a good idea for the Department of the Environment to take on some responsibility? I stress this particularly for urban rivers because the riparian owners can scarcely be expected to look after their bit in these situations.
My Lords, I fully accept that there are quite a lot of authorities involved with this particular river. However we believe that they are capable of coming together and providing satisfactory results. I draw the attention of the noble Baroness to the fact that the British Waterways Board is at the moment viewing a joint development with a private undertaking in the Limehouse Basin which will include a housing complex with a marina and other facilities. This is now subject to ministerial approval for the British Waterways Board capital investment provision. It is a good example of positive action taking place to improve localities.
My Lords, is the Minister aware that for many miles the new river meanders along the same terrain as the River Lea: for instance, through Enfield and Edmonton? Is the Minister aware of proposals by the Thames Water Authority to create a new waterway and thereby make the new river redundant? Will the Minister undertake to have conversations with the Thames Water Authority to persuade it not to proceed with that proposal but to enhance the already historic character of the new river by making more investment in it and thereby creating better management?
My Lords, I am interested in the noble Lord's remarks but I feel that they are rather wide of the Question on the Order Paper.
My Lords, perhaps I may ask a question as one who on occasion navigates the River Lea. Is the noble Lord aware that a great deal has been done of late to improve the banks, although a great deal still needs to be done both to the banks and to the water? Is the noble Lord further aware that what this waterway really needs is to be used for the purposes it was built for—for commercial cargo? That is what should be established on this waterway. It is ideally situated for this purpose but this use is inhibited by the dock labour Acts.
My Lords, the noble Viscount has a distinct advantage over me in his knowledge of the water. I can confirm to him that last year a 1·3-mile stretch of the towpath was restored.
Nicaragua: Us Action
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether they have made representations to the United States Government to cease their action in Nicaragua.
My Lords, we regularly discuss the situation in Central America with the United States Administration, and they are fully aware of our views.
My Lords. I thank the Minister for that reply. Does he not agree that it is perfectly obvious that we are not having much luck with the Americans in sustaining the hopes expressed by every knowledgeable political commentator in Great Britain? Does he not further agree that the entire situation with regard to the Contras and to that part of the world has had some distasteful ramifications in other places? Would it not have helped the American Government if they had accepted the Central American peace accord which was signed by President Ortega himself and by four other presidents who are noted as tremendous supporters of President Reagan and the United States of America? That could be the beginning of an end to this issue.
My Lords, we have consistently advocated a peaceful negotiated solution to the region's problems. We therefore warmly welcome the Central American peace agreement and will continue to encourage the Central Americans to resolve their problems peacefully.
My Lords, will my noble friend ask his right honourable and learned friend the Secretary of State for Foreign Affairs to make equal representations to the governments of Cuba, East Germany and the Soviet Union to cease their intervention in Nicaragua? Without such intervention there would not have been action of the kind the noble Lord, Lord Molloy, complains about.
My Lords, I very much note my noble friend's remarks.
My Lords, we welcome Her Majesty's Government's support for the Guatemalan peace agreement. Will the Minister go one step further and say whether Her Majesty's Government are prepared to press the United States Government to initiate talks with the Nicaraguan Government to see whether this unhappy matter can be settled?
My Lords, as I said, we believe that the problems of the region cannot be solved by armed force. We have consistently urged restraint on all sides and the United States has been kept aware of our views. I do not think there is anything else I can add to that.
My Lords, I am very much obliged. By "restraint on all sides", does the Minister mean restraint on the United States Government as well?
My Lords, it means precisely what I said—restraint on all sides.
My Lords, does my noble friend agree that recent press reports concerning the possible talks between the Sandinista Government and the Contras give rise to some cautious optimism?
My Lords, anything we can find that gives cause for optimism is worth looking at. I have not seen those particular reports but I am sure my noble friend is right.
My Lords, have the Government extended their congratulations to President Arias of Costa Rica on winning the Nobel Peace Prize for the Central American settlement plan of which mention has been made? Are the Government aware that this plan calls on all the Central American countries to set up internal reconciliation commissions? Are the Government aware that Nicaragua was the first of those countries to do so and that Cardinal Obando, commonly regarded as the leader of the Right in Nicaragua, has accepted the chairmanship of that commission? Will the Government—
invite the United States to abide by the ruling of the International Court and stop its intervention?
My Lords, the answer to the noble Lord's first question about congratulating Arias is, yes.
My Lords, in his earlier answers the Minister said that Her Majesty's Government have made it quite plain to the United States Government what their policy is. What is the policy of Her Majesty's Government? In particular, what is their policy towards United States support and finance for the Contras in Nicaragua?
My Lords, that question has been answered innumerable times from this Dispatch Box. I have said that we have consistently advocated a peaceful negotiated solution to the region's problems. That is why we welcome the Central American peace agreement. We will continue to encourage the Central Americans to resolve their problems peacefully. There is a limit to the number of different ways in which that can be expressed.
My Lords, will the Minister take on board the valid point made by the noble Viscount, Lord Montgomery, that there seems to be a changing attitude of mind? The peace accord is being welcomed in the United States. Even President Reagan has made some remarks to encourage it. Why do not our Government now say that he ought to encourage it, and indeed do more than that and be prepared to sign the treaty, which would achieve so much? The American people think that that ought to happen in Nicaragua. The restoration of many freedoms is guaranteed by that treaty.
My Lords, I really do not know what else I can say other than that we warmly welcome the Central American peace agreement.
Middle East: Nuclear Weapons
My Lords, I beg leave to ask the second Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Govenment which countries in the Middle East are carrying out tests on thermo-nuclear warheads and neutron bombs and have not signed the Nuclear Non-Proliferation Treaty.
My Lords, we have no evidence that any countries in the Middle East are carrying out such tests.
My Lords, if the noble Lord will make further investigations into specific journals in the Library he will see what is not unreasonable evidence that some four or five countries are preparing to go this way. As a leading nation which always has been sane and sensible in its approach to very many things, we could indicate to the United Nations that we should try to get these nations which are now starting this business to sign the nonproliferation treaty.
My Lords, certainly signing the non-proliferation treaty would be a valuable confidence-building measure to improve stability in the Middle East. It would also help to encourage other non-signatories in the region to sign and thereby reduce tension and reduce the chances of a nuclear arms race in the region. I can assure the noble Lord that Her Majesty's Government have called upon Israel, for example, to sign the nonproliferation treaty.
My Lords, what will happen if these nations tell us to go and take a flying leap?
My Lords, in that case we shall continue to pressure them, persuade them and do whatever we can to encourage them to sign that treaty.
Anc: Prime Minister's Description
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.
The Question was as follows:
To ask Her Majesty's Government whether the Prime Minister's description of the African National Congress of South Africa as a terrorist organisation represents their collective opinion.
My Lords, the ANC proclaims the legitimacy of the armed struggle. We can only be opposed to that.
My Lords, that is hardly an answer to the Question. Is it not the case that both the Foreign Secretary and the Minister of State at the Foreign Office have officially met representatives of the African National Congress and that therefore the Government recognise the African National Congress as one of the participants in what we hope will be a dialogue leading to a peaceful South Africa?
My Lords, when my right honourable and learned friend the Foreign Secretary met Mr. Tambo my right honourable and learned friend was president of the EC Foreign Affairs Council. The proposal for a meeting with Mr. Tambo stemmed from the mission to Southern Africa which was entrusted to my right honourable and learned friend by the heads of government at the June 1986 European Council. My right honourable friend the Minister of State at the Foreign Office met Mr. Tambo as part of our policy of dialogue with a wide range of parties in South Africa.
My Lords, at Nassau Her Majesty's Government supported, as I recall it, the declaration to revoke the banning of the ANC and strongly supported the declaration to release Nelson Mandela. Do Her Majesty's Government still support those two proposals?
My Lords, certainly Her Majesty's Government stand by the declaration at Nassau.
My Lords, that really is a vague answer even for a Minister. Would the noble Lord be good enough to be more specific and say whether Her Majesty's Government are still in favour of revoking the ban on the ANC in South Africa, and are they still as strongly in favour of releasing Nelson Mandela as they said they were at Nassau?
Yes, my Lords. I do not think we have ever said anything other than that we support the release of Nelson Mandela. We stand by what was said at Nassau and we will continue to do so.
And the revocation of the ban on the ANC?
This is crucial.
My Lords, I do not think I can go further than say what I have just said, and that is that we still stand by what was said and what the Government committed themselves to at Nassau.
My Lords, are the Government not in some danger of falling into a deep schizophrenia in this matter? Either the ANC is a terrorist organisation, as the Prime Minister says, or it is an organisation fit to be met by the Foreign Secretary, fit for the Foreign Secretary to demand the revocation of the ban on it, and fit to maintain a legal office in London. Which is it? Is it not obvious that it is the latter?
My Lords, I should have thought that what really counts is what the ANC itself says and does. Perhaps I may refer the noble Lord to the statement made by Mr. Makatini of the ANC. When talking about ANC violence, he said:
I think that says it all."The violence could only include attacks on British and other Western companies refusing to disengage and hasten the collapse of the apartheid system".
My Lords, is the Minister aware that the ANC for 50 years practised nonviolence and that at the end of that 50 years the result of their policy was apartheid? Does the noble Lord recall that his noble friend Lord Whitelaw, the Leader of the House, last Thursday spoke in his Statement of the need for internal discussions within South Africa? Will the noble Lord say categorically that the British Government regard the ANC as one of the legitimate representatives of African opinion who should take part in the dialogue leading to a peaceful South Africa?
My Lords, I do not think that I can go into a subject as complex as this in any greater detail than I have already set out to do. We believe that the armed struggle in South Africa impedes rather than promotes the cause of fundamental change in South Africa, and obviously violence can only entrench white attitudes. We have always condemned unequivocally indiscriminate acts of terrorism such as car bombings wherever they occur. We understand the frustration of the black community but we believe that change must come about by peaceful means.
My Lords, with the leave of the House, I should like to say a word about the two short debates standing in the names of the noble Lords, Lord Lovell-Davis and Lord Carter. As is customary in short debates, the mover is allowed approximately 15 minutes, and the Minister should rise to reply not less than 20 minutes before the scheduled end of the debates. In the case of the short debate in the name of the noble Lord, Lord Lovell-Davis, this means that all other speeches should be limited to a maximum of 10 minutes and in that of the noble Lord, Lord Carter, to six minutes. If any noble Lord should speak at greater length, it would inevitably be at the expense of later speakers in the debate.
Income And Corporation Taxes Bill Hl
My Lords, I beg to introduce a Bill to consolidate certain of the enactments relating to income tax and corporation tax, including certain enactments relating also to capital gains tax; and to repeal as obsolete Section 339(1) of the Income and Corporation Taxes Act 1970 and paragraphs 3 and 4 of Schedule 11 to the Finance Act 1980. I beg to move that this Bill be now read a first time.
Moved, That the Bill be now read a first time.—( The Lord Chancellor.)
My Lords, I must take this opportunity to congratulate the noble and learned Lord, Lord Mackay of Clashfern, upon his accession to the Woolsack. We came to know the noble and learned Lord when he was Lord Advocate. We found him able in debate and reasonable in his reactions, always ready if necessary to reconsider the position in the light of the argument. We like Ministers who are prepared to take things back for reconsideration.I am personally delighted to see an identifiable Scotsman on the Woolsack. I understand that it is very many years since a Scottish lawyer assumed this high office. Indeed, I understand that it is possible that he is the first Scottish lawyer to become Lord High Chancellor. We regretted his translation to the Bench, and we are glad to see him back. Campbell, in his Lives of. the Lord Chancellors, says of Brougham:
All of us feel that the noble and learned Lord can do better than that, and we much look forward to what we feel sure will be a constructive tenure on the Woolsack. Perhaps I may say finally that we deeply regret the departure of the noble and learned Lord, Lord Havers. The noble and learned Lord was well liked in the other place and in this House and we are very sorry to lose him. We hope that he will continue to attend this House as often as he can and give us the benefit of his experience. We wish the noble and learned Lord, Lord Mackay, good fortune in his great office."Although born in Scotland he had not been endowed with the second sight, or coming events casting their shadow before".
My Lords, perhaps at this point I may be permitted to say that, as the great, great grandson of Hal Dundas, the first Viscount Melville, I particularly welcome the appointment of a Scot to the office of Lord High Chancellor of this kingdom, thus emphasising, as I see it, the essentially federal nature of our constitution.I should also like to say, in addition to what the noble Lord, Lord Cledwyn, has said, that we on these Benches also deeply appreciated the all too brief services of the noble and learned Lord, Lord Havers. We much regret his departure on the grounds of ill-health and wish him a very happy retirement.
My Lords, I should first like to thank the noble Lords, Lord Cledwyn and Lord Gladwyn, for their generous remarks about my noble and learned friend Lord Mackay, the new Lord Chancellor. I am extremely grateful to the noble Lords for what they have said. I should like to associate my noble friends with that same welcome to my noble and learned friend, who is not unknown to us and with whom many of us have worked with great pleasure in the past. We should also like to be associated with the congratulations to him.We also wish to be associated with the kind remarks that the noble Lord, Lord Cledwyn, has made about my noble and learned friend Lord Havers. Obviously for me, as one who as served with the noble and learned Lord in many capacities in another place, this is a painful experience. I deeply regret the circumstances which made my noble and learned friend feel that the burden and stress of the job of Lord Chancellor was too much for him. I am sure that the whole House would wish to be associated with me in hoping that his health will be fully restored at the earliest possible moment.
My Lords, we on the Cross-Benches are proud that one who graced our Benches is now established on the Woolsack. We send him all our good wishes on his appointment and look forward to hearing from him.
My Lords, I am extremely grateful for the kind words that have been spoken. It is particularly sad for me that I am here because my noble and learned friend Lord Havers felt unable to continue. He was an extremely good friend and close colleague while I was in government as Lord Advocate. It is with great regret that I knew that he was too ill to continue. It is typical of his generosity, and it is heartening to me in taking on this position, that he spoke so generously of my appointment when he learned of it.I was encouraged to assume this important and arduous office by my experience of this House in the past. I knew that I could expect, not only from the Government but from all sides of the House, understanding if not always agreement. It is a great honour for me, and also a fitting honour for Scotland, that at this time this office has come to me. Thank you. On Question, Bill read a first time, and to be printed.
Copyright, Designs And Patents Bill Hl
My Lords, on behalf of my noble friend Lord Young of Graffham, I beg to introduce a Bill to restate the law of copyright with amendments, to make fresh provision as to the rights of performers and others in performances; to confer a design right on original designs; to amend the Registered Designs Act 1949; to make provision with respect to patent agents and trade mark agents; to confer patents and designs jurisdiction on certain county courts; to amend the law of patents; to make fresh provision penalising the fraudulent reception of programmes; to make the fraudulent application or use of a trademark an offence; to enable financial assistance to be given to certain international bodies and for connected purposes. I beg to move that this Bill be now read a first time.
Moved, That the Bill be now read a first time.—( Lord Beaverbrook.)
On Question, Bill read a first time, and to be printed.
Consolidation Bills: Joint Committee
My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That the Lord Ackner be appointed a member of the Joint Committee on Consolidation Bills in the place of the Lord Mackay of Clashfern.—( The Lord Chancellor.)
On Question, Motion agreed to.
Child Health Services
rose to call attention to the state of child health services in the United Kingdom, with reference to the recent report Investing in the Future: Child Health 10 years after the Court Report (Policy and Practice Review Group; the National Children's Bureau); and to move for Papers.
The noble Lord said: My Lords, the Court Report was published over 10 years ago in December, 1976. Entitled Fit for the Future, it was the first review ever undertaken of child health services in this country. The group of knowledgeable and dedicated people who, under the chairmanship of Professor Donald Court, one of this country's leading paediatricians, devoted three years of hard work to its production, unlike some committees, looked forward optimistically to its major recommendations being taken up by government and the professions. That was its only error of judgment.
Ten years later, in the foreword to the report that we are now considering, Investing in the Future, the chairman of the Policy and Practice Review Group of the National Children's Bureau, Professor Philip Graham, states:
"There is good evidence that children's needs have been given lower priority over the last 10 years than previously".
So much for all the experience, expertise, time, trouble and devotion freely expended by the members of the Court Committee, and so much for our children. The fact is that within the National Health Service children and young people (13 00BD; million or 27 per cent. of our population) are not a priority group even though in their 1981 document Care in Action the Government identified services for children as a priority and repeated their concern that health authorities should develop plans for an integrated child health service.
One of the principal recommendations of the Court Committee was for an integrated service to help parents care for their children so that they could perceive the services as being relevant, all of a piece, with prevention as the main thrust and close ties between the preventive and curative elements. However, since the Griffiths reorganisation of the National Health Service in 1984 the management of children's services has become increasingly fragmented. There is no such thing as an integrated health service.
I welcome the report of the review group. It may be disheartening but it is timely. When I first saw its sub-title, Child Health 10 Years after the Court Report, I was pleased because I had been intending to ask for a debate on that very subject, because in February, 1977, I had the privilege of initiating the first debate on the Court Report in your Lordships' House. I am also delighted that one of the participants in that debate, the noble Baroness, Lady Faithful, is with us this afternoon, not least because of her role as president of the National Children's Bureau.
Investing in the Future looks at the pattern of child health services in the mid-1980s and compares it with the situation when the Court Committee reported 10 years ago. Ten years after the Court recommendations this latest review points out that since then we have lived through two major reorganisations in the National Health Service, tighter financial constraints have been imposed on the health, education and social services, and there have been changes in family formation and in the social structure, with greater levels of unemployment and individual financial hardship. All those factors have influenced the health and development of our children.
The report continues:
"Meanwhile disenchantment with the way that the child health services are working has grown among many of the professional groups concerned".
In pointing out that there has been no lack of committees, reports and studies on the subject, the review group states bluntly:
"We have been most unimpressed by the action that has arisen as a result of these studies and deliberations".
And, my Lords, well they might be.
The Court Committee recognised the crucial need for effective working relationships between the health, education and social services. The Policy and Practice Review Group set its report, just as Court did in 1976, firmly within a social and economic context. In doing so, it gathered a wide range of views from health, education, social work and voluntary services. It decided that, instead of attempting to cover all the many areas considered by the Court Committee, it would concentrate on preventive services, the school health services and services for adolescents. Those cover the three broad divisions of early life; the very young child with its parents, the school child and the adolescent. They are also the areas which the review group considered to have been most neglected.
Before taking off into the rather grey skies of the review group's findings and reaching the clearer air of their recommendations, it is fair to point out that the
report acknowledges some local improvement in the direction that Court indicated, principally, that there is:
"greater awareness amongst parents and professionals that parents can and should take greater responsibility for their children's health."
The report then moves on to identify key points of special concern and it is hardly surprising that it first refers to one of the most grim scenes in that distressing panorama; namely poverty and disadvantage. We are constantly being told that we are living in a booming, economically stronger society. If that is so, it is all the more reason why we should be ashamed of the fact that the proportion of our children living in poverty has increased, that many more children live in families deemed homeless, with all the accompanying ill-health and misery that that implies, that more children today have unemployed parents and more face unemployment themselves as young adults. Our inner cities are violent, racist, unsafe and frightening places for all children. Children from ethnic minority groups, who are among the most disadvantaged, present new and formidable challenges to the health and social services.
Then there is family breakdown which, irrespective of material conditions, means that more children than ever before will face the trauma of having to cope with the divorce or separation of their parents and the prospect of living in a single-parent family or adjusting to the new partners of their divorced parents.
Finally, the review group turned to the changes in health problems and changes in the health services themselves. The health service problems have changed little in the 10 years since Court. In fact, many of them have grown worse. Immunisation rates remain unsatisfactory, physical abuse is still a major problem, and it is clear that sexual abuse is a far greater and infinitely more complicated problem than most of us have ever realised.
More children and young people today are dying from solvent abuse and drug addiction—indeed more are committing suicide. The young are drinking more and it is a sad reflection on the effectiveness of our efforts at prevention that they are even smoking more. Teenage pregnancy is still a serious problem and the only major change is that today there is actually an increased risk of morbidity in the young mother and her baby.
In the face of those terrible facts, what progress has been made in the integration of health services for children, as the Court Committee recommended over 10 years ago? The depressing answer is "very little". In fact, the present report even states that:
"In some respects there has been a decline in those very areas in which the Court Committee hoped to see improvement".
It is at this point that the Policy and Practice Review Group addressed itself to the areas which it considered of particular concern. That is the heart of the report and I shall devote the remainder of my speech today to those priorities and the recommendations made by the group.
As I indicated earlier, services for young children and their families were chosen as one of the three major areas of concern. A family has two main requirements from the health services, the first of which is to get help in a crisis. That is the area of acute medicine, involving general practitioners or hospitals or both. The second need is based on a long-term relationship between parents and the child health services. Parents must get the support and help that they need to raise healthy children or to bring up a chronically sick or handicapped child. At certain times they will want access to immunisation, developmental check-ups on hearing and sight tests. Those are the areas of preventive medicine. Where are they to obtain these services? Court estimated that about 10 per cent. of children are never seen by a doctor except when an emergency takes them to hospital.
The Court Committee looked at the problem from the point of view of the family and recommended in favour of one first-line source of advice for preventive and acute medicine; namely, the general practitioner in combination with the health visitor and the social worker—that is, the primary health care team. They emphasised the need for special training for all those dealing with children. What progress has been made in 10 years in integrating preventive and acute medicine?
That brings us to the core of the problem—the so-called "turf problems" which bedevil not only child health services but the National Health Service as a whole. The Court Committee did not expect its recommendations on prevention instantly to be put into effect; Donald Court said that it might take 20 years to implement them fully, but I am sure that neither he nor the members of his committee expected that the professions would still be arguing about their territorial rights and practices 10 years later. The children cry out for attention and all that the grownups can do is squabble about who does what. The question is: who in the Government is supposed to be doing what? What is needed here is a strong lead from the Government and an end to the present arguments and confusion.
The second area of particular concern identified by the review group is the school health service. Way back in 1976 the Court Report stated:
"There has been growing concern about the school health service [and] its ability to meet the current needs of the children in school and their teachers and parents".
Ten years later the only discernible change is in the wording of the review group's comment:
"There is a widespread view that, in many areas of the country, the quality of the school health service fails to meet the needs of children, parents and teachers".
There is still no national or local policy aimed at achieving rational and efficient co-operation between GPs and school doctors or resolving the underlying dichotomy between promoting health and treating illness.
Among the recommendations made for the school health service in both Court and the report before us are that every school should have an appropriately trained and named doctor and nurse; that there should be a comprehensive examination of all primary school entrants at about the age of five with parents present; that there should be "open door" personal health counselling for all children in secondary education, with independent access to doctor and nurse; and that there should be a routine health interview between the age of 13 and a year before the pupil leaves school. The group also points to the need for a clear definition of the work of the school doctor and nurse and an agreed code of conduct to guide the professional activity of family doctors, school nurses and school doctors.
The last review of the school health service was carried out in 1974, even before the Court Report. Does the Minister not consider that it is time for another look at the service?
The third area of special concern to which the review group turned its attention was adolescents. The Court Report, which devoted a full chapter to adolescents, stated:
"In recent years it has become increasingly evident that adolescents have needs and problems sufficiently distinguishable from those on the one hand of children and on the other of adults to warrant consideration as a distinct group for health care provision".
So, how have the children's health services been adapted to meet the problems and needs of that special group? The short answer is that they have not. It appears from the review group's report that:
"There has been virtually no movement to improve services for adolescents who are ill, or healthy but experiencing life problems, and rather slow movement to improve services for the chronically handicapped".
One of the Court Committee's recommendations was that there should be provision for small adolescent units in hospitals or, failing that, for a partitioned "adolescent area" in a children's ward. The report before us repeats, 10 years on, that:
"An adolescent ward should he established in each health district".
The present situation is perhaps most graphically illustrated by a recent report from The Caring for Children in the Health Services Group, entitled Where are the Children?, which shows that 62 per cent. of adolescents are in mixed adult-children wards. Most adult patients in hospitals are older people so that adolescents are being nursed in wards where most of the patients are over 65.
Now, the main problems of adolescents are not those of ill-health but of emotional adjustment to the adult world. Those problems will be found in a high proportion of adolescents admitted to hospital. It is for this reason that they need, above all, their own environment, treatment from understanding and appropriately trained doctors and nurses, and readily available services from psychologists, social workers and child and adolescent psychiatrists.
The problems for the handicapped adolescent, unable to take part in normal teenage activities, as he or she tries to negotiate this period of intense emotional and intellectual ferment, are hard to imagine. That they need special care and support is undeniable, not least, as the report says,
"to counter the marked reduction in the quality of both health and welfare services available to disabled teenagers as they enter adulthood".
The report calls for the establishment by 1990 of district health teams to provide the services needed by the young/adult handicapped. Will the Government respond to this and address the overall health problems facing adolescents?
I referred earlier to the major areas of concern, but there is one more which is highlighted in the review group's report. This fourth area is headed "Responsibility for Children". They might well have put a question mark after it, for where is the integrated child health service which Court recommended over 10 years ago?—where the extra paediatric training, the general practitioner paediatricians, the specialised health visitors, the consultant community paediatricians?
The new body recommended by Court, the children's committee, set up by the Labour Government in 1978 was abolished by the Conservative Government in 1981. Ministers have no statutory duty to report to Parliament on health services for children. The effect of these 1974 and 1982 reorganisations of the health service, which among other things took out the area health authorities, was to remove even the obligation on health authorities to employ a senior nurse and doctor whose first responsibility is for child health matters. Consequently, at no level in the National Health Service can responsibility for child health he identified.
Why are we not looking after our children's health as we should be, or providing them with the services they so desperately need? In Investing in the Future the review group identify two main contributory factors. The first is all too frighteningly familiar in our health and social services: lack of resources. Apparently, this country cannot afford even to look after its children properly and this of course, as the report says, is,
"linked to a lack of commitment to the care of children at government. local authority and health authority level".
The second contributory factor must seem incomprehensible, if not reprehensible, to the layperson: the
"unwillingness both by government and by the professions to come to firm decisions about who should have responsibility for different aspects of the preventive services".
With the Government apparently washing their hands of the whole affair, the professionals are left to quarrel among themselves and nothing gets done.
Why, as a country, do we seem unable to recognise and accept the importance of investing in our children? They are our future. Quite apart from having to shoulder in adult life the heavy responsibilities imposed by a complex and difficult world, we should realise, simply as a matter of self-interest, that they are also going to have to look after us and discover how to deal with a large and growing number of very elderly people.
Professor John Tomlinson, a member of the Policy and Practice Review Group and also of the Court Committee, in a recent article in The Times Education Supplement writes:
"The Review Group throw out a challenge to those who manage health and other services. How are children's services planned, delivered and monitored? Who is responsible for coverage? Why do differences exist between districts? Why, for example, after correcting for differences in child population, do some districts run five times as many child health clinics as others?"
This afternoon I hope that other noble Lords on all sides of the House will join me in demanding that the Government, the DHSS and the professions take up this challenge—and provide our children with the services they desperately need.
The report contains a number of important recommendations, many directed to district level. I should like to ask the Minister whether he will tell the House what the Government intend to do to give the leadership called for in this report. Also, do the Government intend to monitor and report on progress? For years there has been talk about making children a priority group. I ask the noble Lord: when are children going to be made a priority group? Also, do the Government intend to use the machinery of the review system to ask for a report on progress towards the integration of child health services, and the setting up of child development and young/adult handicapped teams? Government have a responsibility, which they cannot devolve, to care for the next generation.
In this shockingly materialistic society we are constantly being exhorted to invest in British Gas, British Airways, British Telecom, British Petroleum. Why are we not investing in British Children; investing in the future? My Lords, I beg to move for Papers.
My Lords, first, let me say that the noble Lord, Lord Lovell-Davis, has performed a public service in putting down this Motion. He has given your Lordships' House the opportunity to focus on a very important question—that of child health. I can certainly agree with the statements made in both of the reports named in the Motion, that there can be no more important investment for the future than healthy children.The Court Report, as the noble Lord said, was the first of its kind. Before this there was little organisation, but much disjointed activity about child health matters. The report called for an integrated service:
and that is a direct quote from the report. It emphasised many ways of doing this, but basically it tried to link up all those existing services through the family practitioner service, through primary and secondary care functions, and recommended a number of other developments, such as the development of so-called general practitioner paediatricians—I suppose you would call them semi-specialists—in this field to co-ordinate it. It also recommended special provisions for the disabled, the disturbed and the mentally deficient. Over the last 10 years quite a lot has happened, if not enough, between these two reports, not least the very considerable development of medical technology in this field, such as the development of neonatal intensive care units, special care baby units, neonatal surgery, and so on. These developments, however, are also criticised in the later report on grounds of their rather impersonal approach to the child, the child's parents and the events surrounding the admission of a child to such units. Time does not permit me to discuss in detail all these various recommendations and comments that are made in the report, and I should like to concentrate upon three—the health service changes, professional inter-rivalry, which has already been referred to, and the fundamental and underlying question of poverty and deprivation. First, there are the changes in the health services concerned. Over these last few years, and indeed even more so before, child health has been something of a football, for whereas, for example, the area health authorities, as we have already been told, had a statutory responsibility to set up a chain of responsibility, it is true that the newer district health authorities are not obliged to do so and often do not have them. But Court set a target, and, between the time that Court reported and today, there has been a change from some 10 per cent. to some 66 per cent. of districts that have some form of child care team in operation. There are great variations in their actual activities. Court recommended the specially trained GPP to take primary responsibility for child health, and of course advocated various supporting functions of child health visitors and nurses, school nurses and the like. A great many differences in these variations have taken place, and with considerable enthusiasm these have been promoted in certain areas; for example, Oxford, Dorset, Nottingham and Sheffield. I am sure that many of your Lordships know of many other places where this has happened. The child development teams, as they are now called, and the district handicap teams, as they used to be called, have functioned in a somewhat patchy way and, unfortunately, some one-third of districts are still without such teams. Much is made in the National Children's Bureau report of the structure that could help to push forward the development of child health. It speaks of liaison teams, community paediatricians, links with the district nursing officers, the training of paediatricians, district teams and so forth. I certainly laud those aims, but I challenge the means. Elsewhere the report states:"to facilitate the ability of parents to care for their children",
I regret to see, however, that much of the report's recommendation is to do with setting up further teams or committees. I have had a lot of experience of such teams. To borrow the report's own words, I have been unimpressed. I think that the Warnock Committee in 1978 was much nearer the mark when it said:"There has been no lack of committees … We have been impressed by many of them. We have been unimpressed by the resulting action".
It might seem to your Lordships that the obvious one is the consultant community paediatrician, who should make it his or her business to be in touch with all the appropriate services and who could guide parents and their children and arrange for any help. By all means let us recommend this, but not, I hope, too many teams and committees. I have been a member of too many such teams, including child abuse teams, and I have felt very frustrated. Nowadays the mere name "multidiscipliniary team" conjures before me the image of wasted hours of waffle, often in the best technical jargon but with little to show for it at the end. This leads me to the second point on which I wish to comment—the interprofessional disagreements. There is perhaps a lack of understanding here, which I am sure the Minister would rapidly point out. The basis upon which the health service was set up in regard to practitioner services was that every citizen should have a family doctor with responsibility for the care of that patient. This of course includes children in all respects. It is indeed the basis of the so-called independent contractor status of the general practitioner. He often sees any other involvement as an invasion of his territory, yet, wearing the hat of a school doctor, he may do the same to one of his own colleagues without realising the paradox. Worse still, the general practitioner may in some way feel that there is interference from someone called a clinical medical officer or a district community physician, whom he would often regard as some form of administrative doctor. The whole charade goes on in reverse if it is the clinical medical officer who intervenes. This, I am afraid, is a responsibility that must rest with the profession. I know who will be blamed and the Minister knows who will be blamed: it is the DHSS and therefore indirectly the Government. I have only one suggestion for my noble friend the Minister in this connection. It is to see that every district appoints a consultant community paediatrician of sufficient rank and standing with appropriate sessions at the district general hospital, or, if there is one, a children's hospital to create the necessary machinery and to forge the necessary links. I suggest that these people should be instructed to make an annual report on progress not only to their own district health authorities but also to the DHSS. I believe that the DHSS could form out of its family division or whatever a special interdepartmental organisation with the Department of Education and Science and the Home Office and should present a report to Ministers on a three-yearly or five-yearly basis, to be laid before Parliament. I accept that this is not easy for there are interdepartmental rivalries in the Civil Service as indeed there are in the medical profession. If there are responsibilities for the hold-ups, these two suggestions might go some way to assist in the development of the child health service. Finally, I turn to the question of poverty and deprivation. Nearly 40 years ago in a well-known election speech on the improved health of the nation, the Radio Doctor, Dr. Charles Hill, made a famous comment in which he said that it was not MPs but penicillin that was responsible. I would not wish to deny the valuable contribution of penicillin and other antibiotics to health, but actually Lord Hill had it the wrong way round. If by MPs he meant what Parliament does, or the social or economic state of the nation over which it presides then he was completely wrong, for there is now overwhelming evidence that socio-economic factors influence health. In stark terms, people in social class 5 lose on average six years of life to people in social class 1. That is a very important fact. It overshadows all the medical activities, discoveries and successes over the past 40 years, however much we doctors might like to think that any change was due to our own skills. This applies particularly to children, and is manifest in all the parameters that one cares to mention—physical health, mental health, disturbance rates, educational achievement, and possibly the crime rate. Between social classes 1, 2 and 3A. there is little difference. From social class 3B through to 4 and 5, there is a sharp and progressive decline. I do not wish to widen the discussion—rather, I do, but I shall not—but it is a fundamental factor in many of the problems that we discuss in other debates, whether on the inner cities, education or whatever. There are all sorts of unfortunate reactions to the publishing of these figures. That is why I listen with a degree of cynicism to some comments made on the health service, social services or employment. I believe that the fundamental problem must be targeted correctly; it is of course people. I hear all about the ancillary measures, be it housing, change in benefits or the development of small businesses and so forth, which I believe to be important but secondary. Many years ago I made a maiden speech in another place—nobody listened, I might add—but I am afraid that I have not yet seen the evidence to change my mind. Depending on how one counts them, there are 50 to 400 different possible grants, benefits, supplementary payments, pensions, rebates and the like. All these should be amalgamated into one benefit payable through the tax system and graduated to avoid the poverty trap. An axial point of requirement can he calculated on the basis of age, marital status, number of children and the like. One knows that the level of change is between socio-economic classes 3A and 3B. By means of negative income tax, this can be adjusted. Thus, if your income was above your requirement, you would pay tax; if it was below your requirement. in or out of work, you would be paid. Incentives can he built in, but there is no time now to discuss that. That to my mind would be a true social contract between government and people, and all the ancillary engines of public or private origin could still be used to accelerate the development. It should be the next great social reform of the coming years. It has always been talked about but has been deferred on the grounds of cost, difficulty of introduction or because it is too radical. I believe that it is a necessary step to achieve the social contract that I mentioned. While it is not a be-all and end-all answer, it will certainly provide a more just and fair foundation upon which to build."there should be a named person who will provide a single and continuing point of contact".
My Lords, as the noble Lord, Lord Trafford, has implied in a truly splendid speech, there is nothing more important to the nation than the health of our children. Indeed, it is upon our children's health—and incidentally, upon their education—that our social future depends. We should all be grateful to the noble Lord, Lord Lovell-Davis, for giving us an opportunity to discuss the matter, even though he exceeded his time by seven minutes, for which the rest of us will do our best to make amends.The Court Report was a wise and perceptive document. Its recommendations were widely acclaimed; but, as this new report by the National Children's Bureau makes clear, too few of those recommendations have been implemented, in a short debate such as this I shall merely pick out three specific aspects of this subject in which I have some experience and about which I have some knowledge and some suggestions to make. First I shall comment on the need for integration, for links as the noble Lord, Lord Trafford, said and to which the noble Lord, Lord Lovell-Davis, referred. In both reports it is stated that children very often receive their health care from a wide variety of sources such as the community consultant paediatrician, the general practitioner, the school medical service, the hospital service and others. It has been my experience from many years spent in medical practice that when many people are responsible for a patient's health there is a tendency for no one person to accept the responsibility. I found that with the elderly and it is now true with children. I too should like to see a named individual in each area with specific responsibility to monitor the adequacy of the provisions for child health care in that area. In some areas there is such a person because people with initiative, enterprise and qualities of leadership have taken up that position; but we cannot wait for that to happen. We must make sure that it happens in every area. I wish to highlight and underline what has been stated in both reports and in the two speeches that we have heard today about the socially and economically disadvantaged. Section 6 of the latest report dealing with patterns of mortality, morbidity and handicap seems to me to echo the words of the Black Report, Inequalities in Health, and the later report of the Health Education Council. I listened with great interest to a debate that took place here last week on inner cities. I did not take part in that debate, but it is perhaps of some interest to noble Lords that the week before I spent a day in Moss Side in Manchester in the company of a social worker and a consultant venereologist trying to talk to a number of 12 year-old girls many of whom were regularly engaged in prostitution and most of whom were riddled with venereal disease. That is a child health problem. It is not a problem to which I have any immediate solution; but in the light of this debate, and the debate on inner cities, it is right that I should have mentioned that particular very sad and distressing experience that I had only a fortnight ago. I now move on to the subject of nutrition. This is a subject about which a junior Minister in another place has said a great deal in many places. When I first entered the other place many years ago as a member of a small party, sometimes we voted with the Government (which was a Labour Government at that time) sometimes with the Conservative Opposition. I soon learnt to tell which party was which because on average the Conservatives were three inches taller than the Labour Members. I was able to confirm that fact scientifically as a doctor in the House during the years that followed. That difference arises on the one hand from centuries of good nutrition, and on the other hand from centuries of inadequate nutrition. Improved nutrition for our children in deprived areas is absolutely vital. I now wish to say something about a substance which perhaps the noble Lord, Lord Trafford, and I daresay the noble Lord, Lord Rea, who will be speaking presently, will regard as dangerous. That substance is milk. There are doctors who think that every bottle should carry a government health warning. I am well aware of the potential dangers of excessive ingestion of cholesterol and animal fats, but I believe that milk as a source of nutrition for under-nourished children is very valuable indeed. I believe that the disappearance of free school milk was a very sad step. Only a year ago on the 5th November 1986 I asked a Question of Her Majesty's Government. That Question was:
The Answer that I received from the noble Baroness, Lady Hooper, was:"What would be the cost of restoring free school milk to all children attending state primary schools?"
That is chicken feed. I believe that the restoration of free school milk would help nutrition in some of the underprivileged areas. I have no doubt that it would receive enthusiastic support from the dairy farmers but that is another matter. I refer briefly to the sections on immunisation which appeared in both reports. This is a vital subject and there is no doubt that adherence to the immunisation programme has effected radical changes in the health outlook of our children. Noble Lords will know that the immunisation programme has been damaged from time to time by rumours about the potential dangers of certain vaccines, in particular pertussis or the whooping cough vaccine. After the case of Johnny Kinnear, the case of Susan Loveday is coming before the courts. She claims that the whooping cough vaccine left her brain damaged. The judge in the case has wisely decided that first he must decide whether or not the vaccine does or does not cause brain damage. Not long ago I introduced a short debate on an Unstarred Question on this subject asking the Government about steps that had been taken to introduce and develop a wholly safe and yet effective vaccine. The noble Baroness, Lady Trumpington, who was replying told the House that work was going on with a new acellular vaccine and not the whole cell vaccine. The noble Baroness also said that the vaccine had been pioneered and developed at Porton Down and that it was now ready for clinical trials. However one of the scientists at Porton Down told me that the vaccine had been ready for two years. That is water under the bridge and I make no complaint about that but it is a fact that that acellular vaccine has been in use in Japan, in Sweden and in the United States for some time. It is high time it was in use here. I hope that when the noble Lord replies he can tell us about those clinical trials and when, if at all, we shall have the advantage of that new, safer and effective vaccine because that will do much to ensure that the immunisation programmes throughout the country is adhered to. This is an important debate and I hope that Ministers are listening to what is said."The annual cost of offering one-third of a pint of milk free to all children attending state primary schools in the United Kingdom on each school day is estimated at £10 million".—[Official Report, 5.11.87: col. 1175.]
My Lords, I should like to thank the noble Lord, Lord Lovell-Davis, for giving us the opportunity of discussing this report today. I bring to your Lordships a few relevant matters concerning sick children which are of the greatest concern to many at this moment.Chapter 4 of the report Developments in medical knowledge and technology states that:
I wish to tell noble Lords about the problems of children with two of the conditions mentioned in the report: cystic fibrosis and leukaemia. In one of the biggest hospitals in Europe, if not the biggest, St. James University Hospital in Leeds, is a paediatric ward which is the most crowded and active ward that I have ever seen. I visited that ward some weeks ago. In it are children from all over the Yorkshire region and beyond who have cystic fibrosis and leukaemia as well as the general sick children from the local health district of Leeds East. In the last few years there have been encouraging advances in the treatments of these specialised conditions. The ward was packed with the most appealing children, some of whom were walking round with their transfusions attached. At either end of the ward there are playrooms which are so small that much movement is difficult. The doctors and nurses had to write up their notes squeezed into the ward and had no privacy. One of the greatest concerns is the low staffing levels and the changing nurses, which is due to the stress under which they are working and the difficulty of recruiting nurses at this time. It is well known that children prefer to have continuity of care, especially those who have a condition which means frequent return visits to hospital. After my visit I wrote to our regional chairman telling him of these circumstances and stressing the need for further facilities so that all children who need treatment can be treated without the stress of waiting, which could mean life or death. The specialised regional units such as the Leeds Oncology Unit need the security of specialised funding. Yorkshire has pockets of high leukaemia numbers. The parents are grateful for the treatment that their children receive. They have raised about £250,000 over the last few years for research and equipment but some of that has had to be spent on staff wages. It seems to me vital that all children who need specialised treatment should have it in a centre of excellence where the expertise and equipment are concentrated. It also seems unfair that the districts where the units are situated should have to find most of the funds. I wonder, should these units either be funded with money coming from the patient's home district or be funded by the regions themselves? All specialised units perhaps have this problem across the country. With the medical advances in treatment and the greater demands on the National Health Service, somehow more money must be forthcoming from whatever source it can be retrieved. There is nothing so important as good health and the correct treatment when a child is ill. Should districts have to pay the bills to the specialised units outside their own district there would have to be a safeguard that they would do this: otherwise, should they refuse to do it, the child might die. One must never let an argument between districts cause an unnecessary death. Some weeks after I had visited the children's ward at St. James's, Yorkshire Television showed some programmes including this ward, and there has been much public support for it. However, for long-term funding we must find a satisfactory way of ensuring on-going support for all such units, which give such excellent and life-giving treatment. Another problem which has recently arisen in the other Leeds Western district—I received communication about this—is that a paediatrician who was treating various handicapped children has been taken off to work on child abuse. Children's appointments have been cancelled and there are some very worried parents. The concern about child abuse must of course be tackled with the utmost care and good practice, but growing handicapped children who need expert over-seeing should not be left out in the cold or neglected because of this. One of the greatest modern tragedies must be the infection of haemophiliac children with the HIV virus from infected Factor VIII serum and from their mothers who have been infected. On page 40 of the report it says that it is uncertain whether these challenges can be met effectively. I have visited the haemophiliac unit at Newcastle-upon-Tyne. I have read in the press that the Government are to give extra money to the London health districts most affected by AIDS, and I should like to ask whether the haemophiliac unit in Newcastle will be helped too. The staff at that unit are excellent; but one can see the emotional stress and the cramped facilities which the staff have to suffer. I hope that the Government will not forget the North, which seems to have been badly hit by infected Factor VIII. Will there be any compensation for these families which are now having to cope with HIV? I end by quoting from page 73 of the report:"medical advances have occurred in the management of most chronic disorders".
Having chaired a committee on young people and alcohol for the past few months, I can wholeheartedly agree with that. Realistic health education should be given to all young children and their parents on the dangers of alcohol, drugs and cigarettes. Also, concerted efforts to crack down on the problem of under-age drinking should take place in every local community, such as has been done in Driffield. A youth worker who runs a popular club is quoted in the Yorkshire Post of 22nd October as having said:"More and more children are known to drink alcohol and there is evidence that alcohol-related health and social problems in young people are rising".
Children are now searched for drink when entering the premises and warned that anyone found either drunk or in possession of alcohol can expect to have their parents informed. There is also co-operation from the town council and the police. The results sound encouraging. There is a great deal to be done to stop children ruining their own lives and to make them realise how important a healthy lifestyle is for a successful future."We had very young children arriving at the club drunk. One girl was in such a bad state that she had to be taken to hospital. I felt something had to be done urgently".
My Lords, I am limited by time and therefore I shall concentrate on the particular aspect which I see from the point of view of a general practitioner with an interest in child health, working at clinical level in a National Health Service group practice in a health centre, with very much a team approach to the problem. I am not talking about the administrative teams who talk about things; I am talking about the teams who actually do things on the ground.I am fully aware that many general practitioners in this country do not have any training in paediatrics and do not have a particular interest in providing preventive services and surveillance for the child population on their list. But it is also true that the number of general practitioners who have had some experience in curative paediatrics and who are holding a child health clinic in their practice setting is increasing. However, it is perfectly clear that another group of medical practitioners—the clinical medical officers—will need to exist for some time to fill in the gaps which are not provided for by the general practitioners, however much one might favour an eventual solution in which general practitioners will be the sole providers of the primary care branch of an integrated child health service. Court recognised that the clinical medical officers would be needed for some time and suggested that they should become child health practitioners. It was suggested that their more senior colleagues, the senior clinical medical officers, should in many cases be upgraded to become consultant paediatricians with a special interest in community child health care, alongside a new generation of specially trained consultants in that field. I was delighted to hear the noble Lord, Lord Trafford, come out so strongly in favour of the further strengthening of this group of professionals. This consultant community paediatrician should take overall charge of the community aspects of child health care in the district, particularly the preventive aspects, and would supervise the arrangements for the care of children with special needs. There are now some 80 of these specialists appointed around the country, but it must be remembered that there are some 190 districts and it is thought that in some cases two or even more specialist community paediatricians will be needed for each district; so there is still a long way to go. Since the first reorganisation of the National Health Service in 1974 the clinical medical officers, who were formerly led by the often much-lamented medical officers of health, have not been a happy group. I think it is reasonable to say that one of the main obstacles to implementation of the Court recommendations has come from that body, sometimes known as the third force. But general practitioners themselves could not accept the concept of the general practitioner paediatrician which was put forward by Court and which created a general practitioner who was a different kind of animal from other general practitioners who were providing a comprehensive service, so they said. It has been said that the Court recommendations, admirable though they were, represented an ideal solution and were ahead of their time. It has also been said that they were possibly out of touch with the reality on the ground and the feeling of "the troops". But in fact the basic soundness of the proposals has been borne out by a number of joint committees and fora—numerous, as the noble Lord said—which have subsequently considered where to go from here. The general practitioner paediatrician was not acceptable as such, but there is general awareness that all general practitioners should be better trained in paediatrics, and this is now being steadily accomplished by the vocational training programme for new principals in general practice which has become mandatory since 1981. Ideally, all vocationally trained general practitioners should have spent six months in a hospital paediatric post, since children's health forms a very large and absolutely vital part of the work of all general practitioners. Sadly, there are not enough senior house officer posts to go round, so that of the 1,200 or so GP trainees in any one year, rather less than 80 per cent. manage to find junior paediatric hospital jobs. I believe that the Government should address that problem and I suggest that additional senior house officer posts in paediatrics should be created. Those need not necessarily be in hospital paediatrics, although I think that sound training in clinical paediatrics is an essential part of the training of all doctors who are going to provide family care in the community. I suggest that the problem might be accommodated by the creation of an additional 100 or so posts in community aspects of child care throughout the country. I should like to see all paediatric senior house officers spend part of their time in such jobs so that they have the equivalent of perhaps four to five months in hospital paediatrics and one or two months in community paediatrics. In the long term, that course need not result in any extra expenditure because the rundown of numbers of clinical medical officers, coupled with the increase in GPs competent to undertake child health care in the full sense in their own practice, will result in savings which will more than offset the additional cost. But as with any new development, to start with additional moneys may have to be found. However, in the long term a financial saving might well result. Perhaps I may remark in passing that in their anxiety to cut expenditure in all fields, this Government do not necessarily take sufficiently into account the fact that sometimes a little extra expenditure now may result in not only a better service in the future but also in less expenditure and possibly considerable profit, particularly in other fields. That is certainly true with regard to the Government's attitude towards scientific and medical research. Too often one hears remarks, not only about selling the family silver (even though that looks a bit more like pewter just now), but also about eating the seed corn. With the forthcoming White Paper concerning primary care, the Government have a good opportunity to put forward proposals which will encourage GPs to provide the sort of comprehensive primary care for children which is suggested in the excellent paper which we are discussing. There is little doubt that where curative and preventive services are integrated, better coverage of the child population is achieved both in screening and in immunisation. Many group practices have achieved a far better immunisation rate than that achieved by child health clinics held apart from the familiar GP who provides curative services for the child and its family. In actual practice the major part of screening, health education and preventive services, including immunisation and the collection of statistics, is carried out by health visitors. It is valuable for health visitors to work with the doctor with whom the family is familiar. I agree with other speakers that the intraprofessional and interprofessional disagreements are beginning to be cleared up. I suggest that it is up to the Department of Health and Social Security to take a lead both centrally and by encouraging districts to come up with working plans for the implentation of a comprehensive health service within a set period. I strongly support all the main recommendations made in Investing in the Future. I particularly like the suggestion that parents should hold their children's health record. Fewer such records are lost with that system than if they are filed and brought out at each attendance. For instance, practically no records were lost, even in a primitive and illiterate Nigerian community, when such a system was first begun on an experimental basis by Professor David Morley in the early 1960s. On the other hand, in hospital outpatient clinics it is true that regularly 5 per cent. to 10 per cent. of hospital records cannot be found when they are needed. Another point which I strongly support is the need for continuing research on methods of surveillance of young children. Many of the procedures now in use have never been fully evaluated. I endorse the suggestion which has been made about school health services. There should be one doctor and one nurse per school. Like the noble Lord, Lord Trafford, I am convinced that the future lies in a service which is consultant-led in each district and in which the actual care of children is carried out by suitably trained general practitioners in conjuction with health visitors. I hope that the Government will take action along the lines which are suggested in this excellent report.
My Lords, I should like to take the opportunity of congratulating the Policy and Practice Review Group for the production of this report under its distinguished chairman. Professor Graham, the Dean of the Institute of Child Health at Great Ormond Street Hospital, and the 17 members of that committee, drawn from the statutory and voluntary sectors of health, education and social services. The noble Lord, Lord Lovell-Davis, introduced a debate in this House on 17th February 1977 following the production of the Court Report in December 1976. I am not going to list what has been done—and well done—since then, and much that needs to be done. Other noble Lords have referred to those matters.However, I should like to cite four points on which there is overlapping between different ministries and different local authority departments and health services. I shall also touch upon what I think should be done about those matters. First, I cite the position of families who are living in bed-and-breakfast accommodation. That means that the family lives, sleeps and eats in one room. The effect upon children, who have no place to play, is absolutely appalling. In 1972, as director of social services in Oxford, I called a meeting in the town hall to bring to the notice of Members at Westminster, civil servants and local government officers the position with regard to homeless families and the effect that it had on children. I regret to say that the position now is worse than it was, rather than better. Secondly, school dinners are no longer served except to those on supplementary benefit and family income support. I am told that in some areas—particularly the inner city areas—children do not have a nourishing midday meal. That is very understandable. Furthermore the positive social help which a school dinner provides is not given to children. No allowance is made for supervision of such meals. That is an example of the difficulties we find between education and the Department of Health and Social Security. Thirdly, I am concerned with the matter of disturbed children. I am the governor of two schools for maladjusted children and I visit a third school. The staff of all three schools say that children show signs of deeper emotional disturbance than ever before. In addition, the policy of the education department is to deal with those children so late in their lives that in adolescence they have real problems. Had they been given specialised help at an earlier stage, perhaps such difficulties would not occur. My fourth point concerns the uneasy relationship between education, social services and health services. That uneasy relationship exists not only at a local level but also at government level. In Chapter 16, paragraph 9 of the Court Report, it is recommended that:
My noble friend Lord Trafford has already referred to that matter. What is most worrying is the fragmented, uncoordinated and overlapping services given by the Department of Health and Social Security, the Department of Education and the Home Office. May I suggest, first, that the Policy and Practice Review Group of the National Children's Bureau, who produced this excellent report, should remain in being and it should be resourced at any rate in part by the Government. Secondly, at local government level there should be produced every three years—I think my noble friend Lord Trafford said one year, and perhaps he is right—a joint report from Health—that is, the general manager, the district medical officer, the consultant community physician, the social services, the education department—and this report should be produced and referred to the local authority, the government departments and the regional health authority. Thirdly, at central government level there should be produced, possibly based on local reports, by the Department of Education and Science, the Department of Health and Social Security, the Home Office and the Department of the Environment, which covers housing, a joint report covering the services for children. This joint report should be presented to Parliament. Thus the services for children could be monitored and recommendations made, and perhaps the present fragmented services could take a unified look. Perhaps such an exercise would bring together those working for children in the different areas. Until people at local and central government level come together we shall be unable to get satisfactory service for children. The social services departments in local authorities, the health departments and the education departments are coming closer together but I contend that if they had to report together and produce a report together this might bring them together. The noble Lord, Lord Lovell-Davis, said that investment in children is a positive investment, and it is one which the nation cannot afford not to make."The Secretary of State for Social Services in England and Wales should have a statutory duty to lay before Parliament from 1979 a triennial report on all aspects of their responsibilities for children together with relevant reports from the Department of Education and the Home Office".
My Lords, I should also like to thank my noble friend for introducing this debate, the more so because I do not think that children's issues are debated often enough in the House. For that reason we are doubly grateful to him.The Policy and Practice Review Group, which in my view is a body nearest to having an Ombudsman for children and a Minister for children, and about which I have spoken in this House, is of enormous importance in integrating all the interests of children from one central position. The report shows the importance of greater integration of all services concerned with children's health. The noble Baroness, Lady Faithfull, made this point very strongly, saying that there should he an effective working relationship between the health service, the education and social services and all voluntary organisations concerned with children's health. The report makes some very important recommendations which have already been commented upon. I should like to mention briefly three of them. First, I should like to comment upon the recommendation about the psycho-social aspects of child health. The report says that family doctors, community-based nurses working with children, paediatricians and clinical medical officers need more in their training about the psychological and social problems they meet and the impact that these have on the health of children. Surely, this must be of enormous importance. We really do not know the effect on the health of a child of having an unemployed father although we have quite a good idea now what homelessness means to a child's health. As the noble Baroness, Lady Faithfull, said, we shall soon know what effect the loss of nutritional value in school meals is going to have on the health of a child. All these aspects really must be considered by family doctors and by all other groups mentioned in the recommendation. Secondly, I comment briefly on immunisation. I am interested in this subject through my work with UNICEF, especially the idea that parents should provide evidence that a child entering school has been immunised. The report says this should enable us to reach the immunisation level of 90 per cent. by 1990. I hope very much that this will be so because China, which is a poor country where a quarter of the world's children live, has the objective of 85 per cent. nationwide immunisation for the same year. This objective has the support of both UNICEF and the TUC. The recommendation regarding greater care for adolescents is, I feel, very important. From my knowledge of adolescents and my own children in particular, it is a very difficult time for parents to involve themselves in the health care of their child. Adolescents are becoming more and more independent. Parents are not allowed to involve themselves although adolescents are not really adult enough to care for their own health. Many health risks confront adolescents. These have been mentioned today—abuses of drink and drugs, the abuse of glue and the danger of anorexia which seems to be a growing illness among girls. There are other health risks which seem to affect young people. I do not believe that we are taking enough precautions to help adolescents through that very difficult time. I give a personal example. It concerns my daughter who is a serious asthmatic. She has just gone to university leaving her parent in a great state of anxiety. On arriving at university she found that there was a clinic specially designed to look after young people with chronic illnesses such as asthma. The young people were made to feel that they were not making a fuss. A young person is very worried about seeming to make a fuss about an illness. The clinic made her feel that she was responsible for her health and her asthmatic state and that it wished to support her and to do everything possible to help her. This is a real example of how adolescents need extra support. They are out of the reach of their parents for all sorts of different reasons even in families where everything goes very well. A very important area of child health is what happens in hospital. I was going to refer to another important report. It is called Where are the Children? It is a joint report from Caring for Children in the Health Services of which the National Association for the Welfare of Children in Hospital is one representative. They base their report upon four standards. The first standard is that children should be admitted to hospital only if the care they require cannot equally well be provided at home or on a day basis. This seems a very important standard. The most common stay for a child in hospital is two days. This means that an enormous amount of extra responsibility will be put onto the parents. They will need greater support in looking after a child returned home earlier than would previously have been the case. There must also be greater support in the community, with a greater number of registered sick children's nurses to help parents whose child is returned to them still ill and who will be looked after at home instead of in hospital. The next standard is that children should be cared for in hospital with other children of the same age group. This again seems very important. Yet this report comes out with a figure which is worrying—namely, that in 1984 as many as a quarter of the children discharged from hospital had been in adult or mixed wards. It is important from every point of view, including the psychological one, to keep children together in a ward. It is worrying for them to see grown-ups who are ill. I am again thinking of an asthma case. It is worrying for a child to see a grown-up asthmatic. If children are kept together in a ward, their play, education and special visiting can continue. A further standard is:
Accommodation should therefore be offered to parents if they wish to stay the night. Visits by relations or parents to a child should not be seen just as a social visit but as a truly therapeutic and preventive occasion. Although some hospitals allow parents at any time, they do not welcome them and include them as part of the child's treatment, which would seem to be the best way in which to involve parents in the care of the child when the child is released from hospital after a short stay. The fourth standard is:"Children in hospital shall have the right to have their parents with them at all times provided this is in the best interest of the child."
A child will go to an X-ray department, which for a child is again a frightening experience. The radiologist will not be trained in the care of children, and the child will therefore be upset at being X-rayed. All staff involved with the care of children in hospital should have special training in the care of children. I was pleased to be able to point out this important report on the worrying time in a child's life, which is when they spend a little time in hospital. It suggests how they could leave without any trauma, and how at the same time their parents could he involved in their care. Parents could be initiated into how best to look after their children. I should like to congratulate the authors of this important report. I hope that the Government will view its recommendations favourably."Children shall enjoy the care of appropriately trained staff, fully aware of the physical and emotional needs of each age group".
My Lords, I also add my thanks to the noble Lord, Lord Lovell-Davis, for initiating this interesting debate. The 19th century public health movement in this country depended for its success in coping with infectious and deficiency diseases upon a range of local government activities beyond medical ones. Some were legislative and some were regulatory; for example, with regard to housing and the workplace. Many of their activities were involved with the care of children in school.In these respects we led the world. An important central figure of great influence was the medical officer of health. He co-ordinated all efforts. In the 1974 reorganisation of the National Health Service, as has been mentioned, local authorities handed over to the health service a number of important functions. The medical officer of health disappeared, leaving a number of his staff in limbo between local government and the National Health Service. Child welfare and school health services were brought within the NHS, so general practitioners were responsible for the children. However, the primary care service did not statutorily include developmental assessment, previously the responsibility of the local authorities. After 1974, the child services continued to be the responsibility of the community health doctors employed by local authorities. Clearly, as has been said, the 1974 reorganisation gave rise to much overlap, confusion and inefficiency in the child health services, and the children suffered. Child patients had to attend too many clinics and there was a great deal of friction and confusion in the running of the service. Conscious of the unsatisfactory fragmentation of child health services, the Government set up the Court Committee in England and the Brotherston Committee in Scotland. They both came to the same conclusion; namely, that the National Health Service should provide an integrated child health service. Both reports envisaged the phasing out of local authority based staff, and that the basis of an integrated service should be the traditional primary care services provided by general practitioners and secondary care by consultants and supporting staff. Local authority staff were substantial at this time. They consisted of 650 senior clinical medical officers and 1,100 part-time clinical medical officers in England and Wales. General practitioners were not happy with the Court Report because the proposal for a general practitioner paediatrician—a principal recommendation—seemed to them to undermine the general nature of general practice. And many of the original functions of local government medical officers were to become the responsibility of the emerging specialty of community medicine. The community medicine committee of the British Medical Association proposed an arrangement called a third force which was unacceptable to the royal colleges and to the Central Committee on Hospital Medical Services. The Government have consistently said that they cannot proceed with reorganisation until there is agreement within the profession. I understand that the point has now been reached that there is agreement within the profession. A substantial debt is due to the British Medical Association, which set up a forum of all those involved to discuss these matters. The idea of a third force has been abandoned, and the general principles of the Court Report have been accepted. Two of the important agreements are that clinical medical officers will work with general practitioners and provide the child surveillance service within general practice. Local government senior clinical medical officers have accepted that they will either be promoted to consultant rank, if they meet the required criteria, or while enjoying a good deal of autonomy will he under the general supervision of consultant paediatricians, with special interests and training in community child health. Thus at last the prospect of an integrated child health service, so widely recognised as necessary, seems hopeful of achievement. It is now agreed that curative and preventive children's services should be part of the one service. Because there are so many special problems involved with schooling—psychological, dyslexia, dysgraphia, specific learning difficulties, the education of the physically and mentally handicapped and others—the school health service requires to remain a separate service. The consultant staff should be provided by clinical paediatricians, but each school should have an indentifiable medical officer to whom the teachers at that school can relate. That point has been stressed by a number of speakers. The payment of general practitioners for undertaking assessment duties will have to be resolved. They will also require special training. Unfortunately, the Cumberlege Report on nursing in 1986 runs contrary to the Court Report. It envisages general duty neighbourhood nurses working only in the community and divorced from the hospital. If children are to be allowed out of hospital as soon as possible, it is essential that specialised nursing should be available at home. This should be in two forms: children's nurses working in the community, and nurses from specialised paediatric departments going to the homes of children who have been discharged from hospital. Many speakers have stressed the importance of this aspect of the care of children. It has taken 10 years to get agreement within the profession, but integration of all children's services, curative and preventive, is necessary and it is to be hoped that the Government will pursue with vigour this policy agreed by the profession. However, as the noble Lord, Lord Trafford, has said, our central problem remains. Until it is resolved chaos will continue in spite of many of the committees that the noble Baroness, Lady Faithfull, has mentioned. Who is to be the person who conducts the orchestra in a district? Who is going to be the co-ordinator of the service? If the medical officer of health had continued, he would have done it beautifully. Should it be the community paediatrician? Is this the job for a good, experienced, senior clinical medical officer versed in the ways of local government and the National Health Service? Should the responsibility be discharged by the community medical officer or by an administrator? I suspect that the solution could vary according to the circumstances, but I make a plea for no more national inquiries.
My Lords, perhaps I too may say how indebted we are to my noble friend Lord Lovell-Davis for introducing this excellent debate. I also say in particular to the noble Baroness, Lady Faithfull, how much I agree with everything she had to say.One central theme of the debate goes back a great many years to the early 1960s when the pressure group, Mothercare for Children in Hospital, was founded. Several of our wives were involved in the foundation of that pressure group. In those days most medical staff were antipathetic to parents, telling them little, keeping visiting hours to a minimum, and assuming that parental presence was inimical to the child's recovery. Since those days great victories have been won, especially with regard to visiting and patient information, in both cases adding to the effectiveness of treatment and reducing the trauma of hospitalisation. However, it is apparent from the NAWCH Report Where are the Children?, to which the noble Baroness, Lady Ewart-Biggs, has referred, and the National Children's Bureau Report that there is still a vast amount to be done. There are still far too many examples of young people, even the very young, not being in separate wards. It is a theme of the moment. With the number of beds being so drastically reduced, for example, in London hospitals, the position is likely to deteriorate. We cannot expect that children's beds will be exempt from the cuts being forced by government on the health authorities, who must keep within their budgets however inadequate those budgets are. We also say that there is a danger, I understand, that the specialist teams of nurses that have been built up to care for children will be split up, again as a result of these cuts. The main point is that it is necessary continuously to involve the parent much more in all this. Let me say how much I agree with the noble Lord, Lord Rea, in underlining that particularly useful recommendation in the National Children's Bureau Report that there should be a standardised health record kept by the parent. In quoting that report, I support the suggestion that the record card should include space specifically to record the parent's own observations about the child. It is important that the parent should be correctly informed about the child's medical problem and the course of treatment to be employed. Let me say in agreeing again with the noble Lord, Lord Rea, on training in paediatrics that I hope that some aspect of that training would be to advise doctors that they ought to treat parents as adults and that where there are risks in the treatment these should be made clear; and that should be especially true of the risks with the use of drugs. Regarding drugs, an important technical point is that there should always be paediatric doses of the relevant drugs available. I understand that the way in which small doses for children are dispensed is currently under review. I am not sure whether the Minister can add anything to that. I am bound to say, because of my interest in pharmacy, the community pharmacist has an important role to play here. It should never be forgotten that he or she is much more likely to be the first contact that the parent and child have with the medical team than anybody else and his or her counter prescribing is immensely important, as is his advice and counselling. We hope that one consequence of the Nuffield reforms, when they are implemented, is that the pharmacist will be able to perform this role so much more effectively. Reference has been made to social and material deprivation and the health problems from which children suffer as a result of that. With regret, that is unavoidable. The National Children's Bureau Report states::
as the noble Lord, Lord Trafford, pointed out. The report continues:"We do wish to point out that there is a clear-cut link between … deprivation and many of the health problems from which children suffer. Rates of perinatal and infant mortality, child abuse, cigarette smoking and drug addiction all go up in direct proportion to rates of unemployment, homelessness and poverty. Poor perinatal care and immunisation failure are also more common among the most socially disadvantaged groups"
There is little doubt, for example, about the correlation between unemployment and ill-health, including especially mental health. Where the doubts arise are about what causes what. One view is that unemployment causes ill-health and therefore affects the health of the children of the unemployed; of course unemployment could be regarded as directly damaging in this as in so many other ways. But the alternative view of this correlation is that the causation runs the other way; that those who are more prone to ill-health are more likely to be made unemployed. However, if anybody tries to find comfort from that it merely serves to underline even further how unfair unemployment is, especially for the children of those who are affected. It is sometimes said that everybody is sympathetic. No doubt the Minister in his reply will say that. But the words are always added, "This is all a matter of resources". That is somehow supposed to provide an excuse for doing nothing, given the sympathy. Resources are scarce; Lecture 1 in every economics course starts that way. But we are told—in particular from the Front Bench opposite yesterday—that this country is now doing extremely well economically. If that is true, surely we can afford a much enhanced health service especially for the children of this country."We would be failing in our duty if we did not point out that improvement in social conditions would make a greater impact on child health than is likely to occur as the result of any reorganisation of professional work".
My Lords, I am also very grateful to the noble Lord, Lord Lovell-Davis, for initiating this useful debate. I should like to say that I entirely agree with what the noble Lord, Lord Peston, has said about the relationship of parents and children. I entirely agree, as always, with everything that my noble friend Lady Faithfull has said.Before I speak perhaps I should declare an interest. Like many of your Lordships I am a parent; and like all your Lordships, I have been a child. It never occurred to my parents (nor indeed to my husband and myself) that, having brought children into this world, we were not the people responsible for giving those children as healthy and happy a childhood as we could, which for anyone is the most secure basis for a happy and healthy future. Neither I nor my children were particularly grateful for all the immunisation injections we had nor the visits to the dentist. But they obviously prevented what was called in the 18th century "kink-cough and total toothlessness". During the past 30 years there has arisen a feeling that "they" should do something. "They" should pay. "They" should look after our children. "They" should absolve us from all responsibilities. Everybody has a "they" in his life, sometimes not altogether desirable. My grandmother had a "they" who stole her sugar and butter so that she kept it locked in her wardrobe. But in reality there is no "they". "They" is us. It is we, the parents, who are responsible for our own children. One of the main points made by Professor Graham of the National Children's Bureau in his report is that parents are the most important primary healthcare givers. The report suggests that children's health records should be kept by the parents because they are less likely to lose them than the public authorities. There should be much closer co-operation with parents who can sometimes observe when something is going wrong with a child. Parents should also see about immunisation. In France, East Germany, Saudi Arabia and the United States non-immunised children are not allowed to attend state schools. Something on these lines on a voluntary basis might encourage British parents to see about the immunisation of their own children. Of course, sadly, there are families without love; there are families in very poor circumstances; there are one-parent families and there are orphans. In all of these cases the children are at risk and need the help and support that can be given to them by doctors and by professionals. Not only do some children require professional help but sometimes in the case of a severely disabled or disturbed child it is the parents who do. Parents, being closer to their children, can always detect something that is not quite right and which, being caught in time, may be cured that much more easily. The policy review group of the National Children's Bureau has laid much stress on the involvement and responsibility of parents in the health of their own children. It is particularly keen for parents to keep the health records of their own children. Inside each of us is the child we once were and the loving care which we received from our own parents. How important it is that that same love and care should now surround each and every child in Britain today.
My Lords, I, too, should like to congratulate and thank my noble friend Lord Lovell-Davis for initiating this important debate on a vital report. A number of Members have naturally mentioned the fact that it was very sad to see free milk go from our schools. It is a remarkable coincidence. Winston Churchill said that to give British children free milk was a noble idea. Mrs. Thatcher thought so much of that statement that she abolished free milk.Here we are today discussing the problems of children and only this week Mr. Moore, masquerading as a minister for health, said that he would not increase child allowances. I find that rather distressing. What is this peculiar Conservative quirk to have these orgiastic attacks now and then on British children? We have witnessed it on milk; we have this vital debate today and this is the day that the Minister tells us "No more money for children's allowances". The report by the National Children's Bureau, a private organisation on child health service, is long overdue. But why did not the DHSS undertake the review? Perhaps when he replies the noble Lord, Lord Skelmersdale, will tell us why. The review has found a lack of commitment by Government, by health authorities and by local authorities to be concerned for the care of children. I find that to be a devastating comment in this day and age. In 1982 the area medical and area nursing officers for child health were abolished by this Government. That is care for children for you! Just abolish that important group of specialists. At the same time there was a reduction in the child health budgets which caused professional disenchantment among child health specialists. These are all very serious charges which cannot be denied or explained. All the Government have to do is to reinstate the situation that pertained before they inflicted these appalling cuts and attacks on British children. The Government give the impression that they have no role to play in improving social conditions. Bad social conditions are a danger to anyone's health; bad social conditions are especially a danger to children's health. I agree that parents throughout the country should, as is recommended in the report, possess standardised records of each child's health. There is also a very important submission in the report from the Health Visitors' Association. Health visitors play a vital role in all facets of health, particularly in children's health. Their record before the First World War was admirable. I have to declare an interest. I am very proud to be a vice-president of the Health Visitors' Association. Its report stressed the importance of the school nurse and the need for a policy statement on her role and function. I hope that the noble Lord, Lord Skelmersdale, will also comment on that. I turn briefly to the remarks of the report on adolescents who, it says, are in need of improved services. I do not have time to go into what all those improved services may be, but I am sure that most Members of the House understand what they are. The report underlines that there are not enough hospitals with special units and special wards for adolescents. How do the Government intend to tackle that? They have a smashing idea—they want to abolish all the wards, or as many as they can. That is the way in which they tackle these problems. The cuts are bound to worsen the situation that this vital report says exists and is dangerous. The Government's policy is simply to make matters worse. Pregnant mothers and their children, wherever they live and whatever their economic circumstances, are entitled to the best facilities and treatment within the National Health Service. Here again the report points out that there are ways in which we could improve on the situation for mothers having their children and bringing them up for the first few months, but nothing is being done about it. That is not true. Something is being done about it: the situation is being made worse again. The Government are doing so much in this field, but it is always the wrong thing and above all it is a bad thing. Preventive and curative medicine are in need of improvement. It is, despite all we have to draw on, important that a register of immunisation should be provided at school entry to ensure protection. I repeat, a register of immunisation should be provided at school entry to ensure protection. We do not do it. In the United States it is the law. I hope the noble Lord, Lord Skelmerdale, will comment on that as well. We should make much more use of computers, particularly as regards surveillance and preventive procedures carried out on children. By all these endeavours we contribute to a good caring society and hence the cultivation and enlargement of individual life. If a child is neglected in its early years it sometimes carries that neglect throughout the rest of its life. We should take much more advantage of preventive and curative medicine, for that is the base for all other health endeavours. Preventive medicine is health by collective action. Long before I was born—indeed in the latter part of the last century—a massive contribution was made to the health of this nation, and especially to the health of children, by sanitary inspectors and by medical officers of health. For a century they have played a vital role. Their work meant the creation of social codes that have collective well being as their aim. The sanitary inspector and the medical officer of health recognised the magnificent contributions of people such as Pasteur, Simpson, Jenner, Lister, Semelweis, Fleming, Domagd and RÖntgen. We have a wealth of knowledge, ability and endeavour to draw on to protect our children in matters so vital to the future of our nation. I should like to make an appeal before I sit down. Let us join with the report and reaffirm that henceforth our purpose will be to promote optimal health for all children living in the United Kingdom for their future as well as for their children's future.
My Lords, I too should like to start by echoing the gratitude which other noble Lords have expressed to my noble friend Lord Lovell-Davis for giving us this opportunity to debate this challenging report by the National Children's Bureau. The bureau, its policy and practice review group, Professor Philip Graham and Dr. Kurtz are to be thanked for their valuable contributions. We have heard that this report is the first review of health services for children since the Court Committee reported in 1976. It has been produced by professionals involved with children's health and their voice is therefore authoritative. Thanks to the report we now know that it was high time that the whole field of child health was reviewed.The broad picture which emerges is that, nowithstanding the progress made in some sectors of child health care—and ante-natal and perinatal care were mentioned by the noble Lord, Lord Trafford—health care for the children of the poor and the needy has not improved during the past 10 years and indeed has declined for many such children. That I believe is the report's main conclusion. It is a matter of considerable sadness that the authors of the report were driven by the evidence of their own eyes and ears to draw this appalling conclusion. We are entitled to ask the Government where they stand in relation to this finding. The review group makes a large number of recommendations, but their significance has to be adjudged against its central message (which emerges on page 10 of the report) and which has been referred to more than once this afternoon. That central message is that improvements in social conditions would make a greater impact on child health than is likely to occur as the result of any reorganisation of professional work. In our submission that message overshadows all the other recommendations although they are excellent recommendations. Again we are entitled to ask: when will the Government listen to this message? When will they do those things that need to be done and can only be done by government. Surely there must be some limit to the Government's inactivity in this field. It is in a sense a matter of commitment. This key word is used by the authors of the report. On page 9 the authors identify the existence of a lack of commitment to the health needs of children at central government level, local authority level and health authority level. If the Government have created the impression that they have no real commitment to improving health services for children, it is not surprising that there should also be a lack of commitment lower down the line and that children are to be found at the tail end of planning. This in turn produces the disenchantment which the review group found to have grown among many of the professionals involved with children's health. Limited by time and resources the review concentrated on the three main areas outlined by my noble friend Lord Lovell-Davis but even so it produced about 40 detailed recommendations. The press has already highlighted the recommendation that a personal medical record card should be maintained by parents in respect of every child. This recommendation has been supported by many speakers in your Lordships' House this afternoon and we fully support it for two reasons. It involves the parent with the health of the child. Parent involvement is right and we are glad that it is slowly happening. We agree with the review group and with the Health Visitors Association that this recommendation would give further encouragement to parent involvement. My noble friend Lord Peston is right to emphasise that professionals too must change their attitudes towards parent involvement. This would help them to do just that. We support it for another reason. As health authorities are finding it difficult to keep track of the medical records when parents move from one health district to another and change doctors and clinics, the personal medical record card held by the parent would be an invaluable aid. I have been sent the child record book produced by the community unit of the Nottingham health authority. It has a column for vaccination records, a column for details of hospital treatment; and a page for recording illnesses. It seems to me that this is just what the review group had in mind. This recommendation could be adopted quickly and cheaply by all health authorities. Does the department propose to ask the authorities to implement this simple recommendation. The report urges a strong push on vaccination and this has also been well supported by the press and in the House this afternoon. Far too many children are still unprotected from measles and whooping cough. Avoidable deaths are still occurring. A Welsh Office health Minister addressing a health conference in Cardiff in September told his audience that this was the time for action. Do the Government have any action in mind apart from exhortation? I have read that the Health Visitors Association has suggested that it would be helpful if the Government could introduce a no fault compensation scheme for vaccine damage. Is this matter receiving Government consideration? I will be interested in the Minister's answer to the question posed by the noble Lord, Lord Winstanley, as to when a safe vaccine will become available. We have heard that the report contains a number of important recommendations on surveillance and prevention. A great deal has been said about the recommendations and I want to touch on two of the detailed recommendations under this heading. It is recommended that the primary health care team should take over complete responsibility for the delivery of surveillance and preventive procedures. Professor Philip Graham has subsequently explained that he has in mind that it may take about five years before this recommendation can be fully implemented. We clearly recognise that the GPs have an important part to play in child health. I am sure that the department will pay careful consideration to what has been said by my noble friend Lord Rea and by the noble Lord, Lord Hunter, in relation to this recommendation. Nevertheless there could be difficulties with this recommendation at least in the short term. I make no apology for referring once again to the Health Visitors Association. My noble friend Lord Molloy is right to point out that they are very much in the front line. I understand that the association is somewhat concerned about this recommendation in the short term, fearing that some of the GPs may not be competent to provide a service comparable in quality to that provided by the health authority, child health doctors in partnership with health visitors, and health workers. I believe that the Health Visitors Association is here saying something important. I have just been looking at a profile of 214 GPs working in an area covered by one of the inner London health authorities. Of the 214 GPs so employed, 29 are over the age of 70, 54 are over the age of 65, while only 21, who have recently been in the medical schools, are under the age of 34. Moreover, 91 of those GPs are in single-handed practices. That being the position, I would gravely doubt whether many of the doctors in this particular profile would be in a position to undertake training to enable them to carry out the new responsibilities assuming that they wish to be so involved, and that may be an important assumption. I would not generalise on the basis of this particular profile. We appreciate that the DHSS has commissioned a national project to consider all aspects of the organisation of community child health services, and they will no doubt deal fully with the GP perspective on child health. I should mention that I have read with considerable interest and sympathy a summary of the Secretary of State's statement to the Society of Family Practitioners Committee on 16th October. We just wonder how he proposes to encourage greater GP involvement in child health. I welcome wholeheartedly the emphasis placed by the review group on the role of the consultant community paediatrician. This consultant was recommended by the Court Report. It has been recommended in your Lordships' House this afternoon. He has a valuable role to play. Without having a committee at his command he would be a link between the hospital and the community. He would go out to the community, attract other professionals concerned with child health services, and together they could generate the necessary driving force and get things off the ground. This has not happened to the extent hoped for. We understand from the report that there are about 75 such consultants in post whereas ideally we would require about 350 in post. In Wales we have merely one such consultant in post who provides merely half his sessions to community paediatrics. Can the Minister tell the House why so few appointments have been made? Is it the case that the department is at the mercy of the district authorities and that it cannot insist that these appointments should be made? We support another major recommendation that the school health service should be revitalised. The review has produced at least nine recommendations under this heading. Travelling around the country we hear of dissatisfaction among teachers with the school health service. We hear that there is inadequate communication between teachers and doctors, and vice versa. If the Government cannot today accept the majority of these recommendations then, on the evidence of this report and on the evidence of the report on inequality in health published earlier this year, and notwithstanding what the noble Lord, Lord Hunter, has said, we would urge the Government to investigate the school health service in depth. The other major recommendation relates to the inadequate health services for adolescents, and here we speak of the young people who, through some misfortune or some difficulty in development, cannot fit themselves into the world we live in, and who need treatment and guidance to help them on the road to maturity. There has been virtually no movement to improve health services for adolescents during the past 10 years. My noble friend Lord Lovell-Davis has gone into the details of this recommendation and I do not propose to add anything to what he has said so eloquently. I am glad that my noble friend Lady Ewart-Biggs referred to the report, Where are the Children? That is a report that is worthy of the department's consideration. I am grateful that the noble Lord, Lord Winstanley, has referred to nutrition. This is not referred to in the report. We should be interested to know what role school meals will henceforth play in a nutrition policy. The noble Baroness, Lady Faithfull, who is so clearly associated with the National Children's Bureau, and whose commitment to the welfare of children and young people is deeply and widely respected throughout the country, has come up in the course of the debate with another major recommendation. She recommended that periodically the three major departments of state involved with child health should produce a joint report on the impact of their policies and present it to Parliament. We wholeheartedly support that recommendation. It seems to me that the report would do at least three things. It would identify the problems which are the cause of concern; it should help to ensure that the three departments are not pursuing conflicting aims; and it would help also to ensure the convergence of policies and the co-ordination of policies. We hope this recommendation from the other side of the House emanating from the noble Baroness, Lady Faithfull, supported by the noble Lord, Lord Trafford, and supported by ourselves should be acceptable to the Government, whether or not it is acceptable to the three departments. The report presents a considerable challenge to the Government and to the professionals concerned. In ending my speech I am left wondering whether there can be any significant advance in the short term unless children's needs are bracketed together with those of the other three priority groups: the old, the mentally ill, and the mentally handicapped. However, this is a point that has already been made by my noble friend Lord Lovell-Davis.
My Lords, at 5.38 p.m. on 16th February 1977 the noble Lord, Lord Lovell-Davies, rose to call attention to the Court Report on child health services. Today, 10½ years later, it falls to me to congratulate the noble Lord on providing the House with a valuable opportunity for a much overdue discussion on child health—I agree with the noble Baroness, Lady Ewart Biggs—and to do so in the context of the timely report from the National Children's Bureau on this subject. I should like to congratulate the bureau for what, by any standards, is a comprehensive look at a number of aspects of children's health services.Let me say at the outset that the Government remain fully committed to the principles of the Court Committee's findings. As everyone agreed then, full implementation of the proposals would be achieved in the longer rather than the shorter term. But it would be wrong to say that nothing has happened. The Court Committee reported at the end of 1976. There was consultation; then a departmental circular was issued in 1978. Credit is certainly due to the last Labour Government—when it is due, I think it oughtto be respected—and to this Government, too. We have not been idle, as I shall seek to show. In the following year district handicap teams were set up and there were other developments to which I shall come later. The central recommendation mentioned this afternoon by virtually every noble Lord has been consistently rejected not only by this Government but by that of the party opposite. Nothing in that respect had changed. But this afternoon something did change. We heard a most interesting and thoughtful speech from my noble friend Lord Trafford, who asked, why bother with a joint report? Why not have a report from my noble friend the Secretary of State for Social Services, contributed to by whoever my noble friend thinks appropriate? I shall examine that proposal most carefully. In the last Parliament we gave additional impetus to progressing the report's philisophy by the funding of a number of projects about which I shall speak later. A great deal has been achieved since the committee reported. Today's debate gives the Government the opportunity to put on record what these achievements are. Prevention has always been an essential part of this Government's policy. I certainly agree with the noble Lord, Lord Rea, that—and I précis—prevention is cheaper than cure. The Court Report was particularly significant in that it sought for the first time to change people's attitudes and to emphasise the importance of prevention rather than later treatment. Early detection of treatable conditions is vital if the full benefits of services available are to be used to the best effect. 1980 saw the DHSS paper Prevention in the Child Health Services which outlined the Government's policy in this area and suggested a basic programme of child health surveillance for health authorities from birth to school leaving age. The importance that the Government attaches to these services was further re-affirmed in 1981 when Care in Action was published. I do not agree with the condemnation by the noble Lord, Lord Lovell-Davis, ofCare in Action which sets out in detail the Government's policies and priorities for health and personal social services in England. The functions ascribed to the various posts which were described in Care in Action are still excellent. Each district health authority assigns the functions to a senior doctor and nurse according to its own individual needs. The report of the National Children's Bureau recommends the appointment of consultant community paediatricians. My noble friend Lady Faithfull is right in saying that the primary front line in child health care, as in adult health care, is the general practitioner. I am sure that I have indicated the wrong noble Baroness, but never mind. Many health authorities have made such appointments in recent years and there are now at least 100 in post. I am able to inform the noble Lord, Lord Molloy, that there were none in 1979. The job descriptions vary from authority to authority reflecting differing local situations. The appointment of consultant community paediatricians can considerably help in co-ordinating health authority services for children with those provided by social service authorities and education departments. The report states that what is needed is a doctor who is in charge in a district, whatever one calls him; someone to whom the social services and education authority could turn in the first instance to ask for health support. I agree with my noble friend Lord Trafford and I was delighted to be reminded by the noble Lord, Lord Hunter of the refreshing attitude of the BMA to the whole problem. It is necessary to have someone but I am not still convinced that it should necessarily be a doctor. The noble Lord, Lord Winstanley, called for the re-introduction of free school milk. I have not time to develop the arguments fully but there is a contrary medical opinion, as he will know only too well that it is pre-school and not free school milk that is needed. The Government are studying this opinion. Already, supplementary benefit claimants, families receiving family income supplement who have children under five or handicapped children up to the age of 16 and expectant mothers in receipt of supplementary benefit, receive milk tokens which can be exchanged for milk or powdered baby milk. I think it would be right on another occasion to discuss the changes made by the 1986 Social Security Act. It gives me great although, as noble Lords will perhaps agree, slightly unusual pleasure to agree with the noble Baroness, Lady Ewart-Biggs, on the subject of immunisation. It is obviously an important aspect. In this country there is a comprehensive and, it should not be forgotten, free childhood immunisation programme. We have targets of 90 per cent. immunisation uptake by 1990 for immunisable diseases. While we have already achieved 85 per cent. for diphtheria, tetanus and polio, the level of whooping cough immunisation was only 71 per cent. in 1986. We cannot therefore afford to be complacent, and renewed effort is needed to reach the targets set. I hope that that will be helped by the proposed introduction of a combined vaccine against measles, mumps and rubella in the near future. It will be given to children in the second year of life as the measles vaccine is now. The Government have set their target high and I shall be addressing a meeting of National Health Service staff responsible for immunisation uptake on 10th November to discuss this subject. In reply to the noble Lord, Lord Molloy, immunisation has never been compulsory in this country except, I am reminded, in the case of smallpox just after the war. There is no present intention to change that situation. A requirement for children to have been immunised, or to be exempted, before school entry, would not therefore be an appropriate step for a district health authority to take on its own. However, responsible officers in health authorities have been asked to assess the immunisation state of all children about to enter primary school and to offer immunisation to unprotected children. Although the training of staff is primarily under the responsibility of the professional bodies the Government have funded a number of projects aimed at providing training and training materials on the delivery of child health services. Since 1983, approximately £400,000 has been spent on a variety of such training projects. The Government attach great importance to an effective school health service. Since 1978 we have actively encouraged major improvements in the training of school health nurses. I am aware that there is concern that the full potential of this service is not being realised in all health authorities. The department is keeping the situation under active review and will take any further action that seems appropriate. Adolescents are recognised as a separate group and since the Court Report teenage wards exist as a feature of children's hospitals and some district general hospitals. However, many others use partitioned areas to meet the needs of that group. Recognition of that recommendation is steadily growing, but I admit that progress in some respects falls short of what we would wish. I believe that the right way ahead is a renewed effort by health authorities to identify areas where improvements are necessary. Part of this subject is parental involvement. I do not know whether one can be described as a professional parent but, if so, then my noble friend Lady Strange could be so described. She put forward the position of parents very strongly and the House will be grateful to her. We are aware of initiatives which are being taken at this time, for example research on parental child health records which was a point made by one noble Lord. While I initially thought that that proposal was unlikely to work, it appears, on first analysis, that parents take care of their child's health records. It is early days but we shall be watching closely the outcome of that work. We are all aware that community child health services are complicated and difficult to organise. They are provided by a larger than usual number of professional staff through home visiting, health clinics, health centres and general practitioner surgeries. Effective delivery is far from easy and requires co-operation between health and local education authorities, family practitioner committees, general practitioners, social services and voluntary organisations. Health authorities in particular provide an important input to social services on matters concerning child abuse, adoption, foster services and the health of children in care. Obviously, circumstances will vary and the means of collaboration for each locality needs to be worked out locally, not by central government—here I certainly agree with my noble friend Lord Trafford—so that services are both responsive to the needs of the local population and as cost effective as possible. Inevitably, there will be problems of communication and varying degrees of co-operation between the groups. As a result the Government have recently funded a two-year project to seek ways of resolving problems which have been identified in various work by the department on the organisation and delivery of those services. The project is currently under way in four health districts and associated FPCs. The results of the project will be available in about 18 months' time and it is hoped that this will enable us to make available additional guidance and advice on the organisation, management and planning of child health services to the relevant authorities. The noble Lord, Lord Prys-Davies, mentioned the form and content of child health surveillance. This is under active consideration by a number of professional groups at present, and I welcome the debate. The process of child health surveillance must be set in the context of services to the family, and if I am to look to the future I would see, as did the consultation document on primary health care, an increasing role over time for general practitioners in dealing with the medical component of this activity for the under-fives. We have no reason to doubt that that is the right course. I do not want to pre-empt anything which our White Paper on primary health care may want to say about this subject, but I hope that we shall hear from the noble Lord, Lord Prys-Davies, in the light of his remarks today. I am pleased to be able to say that in the past year the professional bodies most concerned with child health have made considerable progress. We have heard today about the BMA forum which earlier this year reached agreement on consultant-led community service. We have not heard about the Faculty of Community Medicine, which has a working party on the integration of child health services. Its report is expected soon. Again, the British Paediatric Association has called together a working party involving a number of medical and nursing professional bodies, and is looking at child health surveillance for the under-fives. Our own child health service project in four districts will also look at the problems of integration. We shall draw all those threads together Integration of services is important and the Government will play their full part in helping to achieve it. I agree most certainly with the noble Lord who said, "For goodness sake, we do not want any more working parties and reports".
My Lords, does the noble Lord intend to answer my specific question about the statement made by the noble Baroness, Lady Trumpington, with regard to the new acellular pertussis vaccine developed at Porton Down which he told the House was ready for clinical trials? Have the clinical trials taken place, and when will that vaccine be available for general use?
My Lords, I am sorry, but I must have skipped that part of my notes. I shall make an opportunity to write to the noble Lord on that subject.We have covered a lot of ground this afternoon, during which time I have tried to explain as comprehensively as I can in the very short time available how seriously the Government takes the issues raised by the House this afternoon and the action that we are taking to make progress on them. I appreciate that there are many points, not only that of the noble Lord, Lord Winstanley, which I have not been able to address. Therefore, with the leave of the House, I shall take the opportunity to write on those points which I have not been able to answer. I hope I have been able to show that the action that we are taking and have taken is coherent and logical, although I am the first to admit that we still have a long way to go. Finally, let me once again express my thanks to the noble Lord, Lord Lovell-Davis, for providing the opportunity for this important debate, which I hope your Lordships will agree has been constructive.
My Lords, I believe that this has been a very valuable debate and I should like to thank all noble Lords who have taken part and made such important contributions to it. I should like to apologise for exceeding my allotted time by about two minutes, but I mistakenly understood that I was permitted to speak for 20 minutes.As was pointed out during the debate, child health services are not reported on and are seldom debated either in your Lordships' House or in another place. I hope and feel sure that what has been said this afternoon on all sides of the House will be heard not only in your Lordships' House and within government circles but also by a wider audience of professionals, parents and others of our people. I should like to thank the Minister for replying to the debate and for the courtesy of his reply. We must all welcome what he said about the more encouraging aspects of the Government's view of child health services, limited though they may be. It is good to know that the Government are looking at matters raised in this debate, such as the reporting proposal made by the noble Lord, Lord Trafford, and that they are looking into pre-school milk and immunisation. I was particularly interested to hear what the Minister said about the school health service, and also that the Government will be looking closely at the recommendation for child health records for parents. I wish to thank the noble Lord, though I could wish he had gone somewhat further in assuring us that amore positive lead in child health services will be taken by the Government. I am grateful to him for what he said. This has been a timely opportunity to raise a vitally important subject. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
rose to call attention to the needs and problems of people with disabilities; and to move for Papers.
The noble Lord said: My Lords, I should like to begin by thanking the considerable number of noble Lords who put their names down to speak in this debate and who have demonstrated the very considerable interest that this House has always taken in problems of disability.
When we debated the gracious Speech at the beginning of the Session I spoke on the topic of the needs and problems of people with disabilities. In my speech, coining a phrase, in which I take no particular pride, I referred to the "disabled divide", which I defined as the gulf in the quality of life, income and expectations of people with disabilities compared with the rest of society. That is what today's debate is about: the disabled divide. Because of the number of Peers who put down their names to speak—and I know that they will all be covering different aspects of disability—I should like to concentrate on the needs of the disabled, particularly in the light of the announcement only yesterday in connection with the Social Security Act, which we have been told is the biggest review and reform of social security since Beveridge. I should like to examine that Act to see whether the needs of the disabled will be met.
To begin with, we should remember the central and shameful fact that of the 3 million disabled in this country, 2 million are living in poverty or on the edge of poverty, and that 60 per cent. of disabled people are living in poverty compared with 28 per cent. of the non-disabled population. I was looking for a statement of the kind of aims for which we should be striving and I saw one which seemed to be an admirable statement:
"Our aim is to provide a coherent system of cash benefits to meet the costs of disability so that more disabled people can support themselves and lead normal lives"
That was in the 1979 manifesto of the Conservative Party. This Government introduced the 1981 Act, on which they should be congratulated. They introduced the concept of allowances to cover the cost of disability, assistance to enable the disabled to live at home and help towards the cost of coping with incontinence, a special diet, heating, laundry and baths. In the new Act, all this is swept away and replaced by a flat rate premium and the social fund.
The effect is that for those who are in receipt of cash benefits now, the level of the benefits will be frozen in April 1988 until the level of income support catches up with those benefits. In some cases disabled people will have to wait for 10 to 15 years for this to happen. After April 1988 newly disabled people will be much worse off as a result of the operation of the Act. It has been estimated that up to 45 per cent. of newly disabled pensioners, and up to 18 per cent. of the newly disabled under 65s, will be worse off.
In fact, all disabled people who are now in receipt of supplementary benefits and allowances will be worse off, because the new rates which will come into effect in April 1988 will not take account of inflation of 3 to 4 per cent. up to that time. Also, for the first time ever, the disabled will be required to bear 20 per cent. of their rates on the less than £1 per week allowance that the Government have made. If the rates of the disabled are more than £52 a year they will be worse off.
This is a complex subject, and I thought that the easiest way to explain it would be to take three examples of people who are in receipt of allowances today and see what would happen if they were newly disabled after April 1988. The first example is that of a man who is totally paralysed, whose benefits and allowances are today of the order of £130 per week. After April 1988, if he were newly disabled in the same condition, his income would be reduced to £71 per week—a reduction of £59 or 45 per cent.
The second example is that of a married couple, with a wife who is disabled and a husband who is the claimant for the two of them. If the husband leaves her or dies before April 1988, her income will drop to £65 per week. After April 1988, it will drop to £46 a week—a reduction of £19 or 20 per cent. The third example is that of a woman living alone, who is in receipt of a severe disability allowance. At the moment her income with benefits and allowances is £109 per week. Like so many severely disabled people, she may have go to hospital. If she is there for more than 15 weeks, under the new scheme her protected income, as it is now described, of £109 will drop to £71 per week—a reduction of £38 or 35 per cent.
We have been told by the Government, correctly, that they have introduced a scheme of transitional protection to protect the level of cash benefits. The regulations in themselves are enormously complex. The intention is to freeze the existing level of benefits until the levels of income support catch up. That just proves that income support is worth less than the income which the disabled are receiving now. In the Statement which the noble Earl made yesterday, he referred to £200 million that has been injected in order to secure this result. Presumably that is the measure by which income support is less than the level of the supplementary benefits and allowances today. The noble Earl looks puzzled, but that is the case.
In some cases, severely disabled people will have to wait 10 to 15 years, depending on the rate of inflation in the future, for an increase in their income, and the Government refuse to uprate the levels of transitional protection in line with inflation. The reality of the new system is that after April next year the newly disabled will not only lose; they will lose the most.
The more severely disabled they are, the more they need, but the less they will receive.
Early this year there was a late night television programme called "United In Fury" which examined the anomalies and the injustices of the new scheme. I am told that after that programme the producers received no fewer than 7,000 letters from people who were severely concerned about the effect on their income after next April. Only last evening, on the "In Touch" programme for the blind on the BBC, there were harrowing stories of the elderly blind who have to manage now on what is literally a pittance and about the effect on them after next April.
There are some gainers and I am sure that when the noble Earl winds-up he will be briefed to tell us about them. When he is quoting the number of gainers under the new scheme who are in receipt of the disability premium, will he say how many people who are off work through sickness for more than 26 weeks will be in receipt of the premium under the new scheme? These are people who are not disabled in the normal sense of the word. They do not have to cope with any of the extra costs of disability. I feel that there is some degree of creative accounting in the figures of the department.
I think that we are entitled to ask the Government to explain the rationale for these anomalies and injustices. We are entitled to know why this has to be. Mr. Nicholas Scott, the Minister for the Disabled, admitted at a fringe meeting in Blackpool that some severely disabled people will be worse off. Mr. John Moore admitted as much yesterday in his Statement in the other place. The Ministers have not tried to deny that, in effect, these benefits are being redistributed from the most severely disabled to the less severely disabled. In fact, from next April we shall see a redistribution of disabled poverty.
What is the reason? Is it a lack of resources? This spring in the Budget the Chancellor had a total of £6 billion to use for tax cuts and for a reduction of public borrowing. We are told that the forecast for next spring is £7 billion. We are talking about comparatively few people, probably fewer than 5,000, who are severely disabled and who will be most affected.
The all-party disablement group met the Minister and we presented him with what seemed to me to be a sensible proposal for a dual system to ensure that these people are looked after. The Minister said that the dual system was out of the question, though I believe we are to have one for the poll tax, which will cost millions to operate, and which is intended to ensure that the electorate do not feel the full effects of the poll tax before the next election.
The noble Earl who is to reply may well say that the severely disabled can rely on the social fund to look after them. I saw a story in the Guardian just after the appointment of Mr. John Moore, when it was reported that he wished to do away with the concept of the social fund completely. He has been overruled on higher authority, which I suppose means the Prime Minister.
I think that the best comment on the operation of the social fund has come from the Government's own Social Security Advisory Committee, which stated:
"We cannot support the social fund as it appears in the draft manual. It is dominated by a need to keep within the budget. It strikes what we regard as the wrong balance between loans and grants and between discretion and entitlement. We remain unconvinced that it will meet many of the genuine needs of some of the poorest members of society or command the confidence of agencies whose co-operation the manual itself sees as necessary. It sets awesome tasks for social fund officers. We urge the Government to reconsider their approach to the social fund in the light of the comments which that committee has made; and there are others from many other organisations which have made representations about the draft manual."
When the severely disabled are to be left to the mercy of an arbitrary system and at the discretion of the social fund officers, this has to be compared with the allowances that they receive today as of right under the law. We are told that the system has been simplified. In fact, I can only say that, if you look at the guidance manual on the social fund regulations and the transitional protection, had Franz Kafka and Mr. Gradgrind sat down to devise a social security system they could not have done a much better job than the DHSS.
To repeat my earlier question: what is the rationale behind what can only be described as this calculated meanness? I think that the answer may lie in two interviews that the Prime Minister gave on television during the election. In the first she was asked to describe her philosophy. She said that she wanted a family man to be able to buy his own home, to pay for his children's education if he so wished, to buy health care for his family if he so wished, and to own a few shares. Then, almost as an afterthought, she said that, if he had a surplus, he could give it to charity to help others.
As to the other interview, for once, the mask of the image-makers dropped for a second when we heard about the people who drool and drivel about caring. I fear that that attitude has bitten deep into the making of government social policy and has resulted in a system of social security that will attack the standard of life of some of the most vulnerable members of society. The Government seem to have embarked on an ideological crusade in favour of simplicity and against scroungers, and have discovered, we hope not too late, that the disabled are likely to be crunched between the millstones of simplicity of administration and cost-saving.
I should like to ask the noble Lord who will wind up the debate for an explanation. Why will the Government not agree now to uprate the present levels of benefit—the transitional protected figures—in line with inflation after April next year? How will the severely disabled who are living alone obtain the money they need to keep them out of institutional care? How do the Government propose to deal with the problem—which they admit and recognise—of the newly disabled who will be much worse off after April 1988 in comparison with the present level of benefits? What is the Government's response to the criticisms of the social fund by their own Advisory Committee on Social Security?
At the beginning of my speech I referred to the "disabled divide". I think that future Conservative Governments may look back with great sadness to what this Government have done to the disabled. It is a great sadness to realise that the Government's long-awaited reform of social security may make the disabled divide even wider.
My Lords, the House will be grateful to the noble Lord, Lord Carter, for introducing this subject, which is of great importance. When the noble Lord refers to the needs and problems of disabilities, most of us know what he has in mind.Most people suffer from disabilities of some kind. Some people suffer from the disability of being stupid, some from the disability of intelligence or lack of it. But usually one considers disabilities to refer to mental disabilities and physical disabilities. We are all affected in certain ways as we go through life. Many Members in your Lordships' House know of the constraints of physical disabilities and the difficulties they can produce. My experience has tended more towards mental disabilities. I have a child with some handicap, and when one meets that kind of problem, one does not know quite where to turn. The extraordinary thing is that not many families in the country are unaffected by disability in some form or shape. One great advantage to have come about in the past 20 years is that people are prepared to talk about it and discuss it and, in doing so, oddly enough, one finds that one is not quite as lonely as one was before. In that respect some organizations—and I am bound here to declare an interest as I happen to be president of the eastern region of MENCAP—have done a great deal to make people feel that there is a commonality of problems. That does not alter the fact that, when individuals suddenly realise they have a child with a disability, they ask where to go and to whom they can turn. Automatically one tends to turn to local authorities because one thinks that they know best; and, indeed, they have certain expertise. One tends also to turn to governments and suggest that they should do more because everybody turns to governments when looking for a way out of a problem. The important thing is that people should somehow find the avenue down which to go. The danger is that children who may be disabled in some form or shape are given tests and, when found not to achieve the right IQ, they are described under the all-embracing bracket of "educationally subnormal" and are shot down a sideline that may be quite inappropriate for them. People who have been described as educationally subnormal may eventually be found to be suffering merely from some kind of understanding disability: they cannot tell the time so they are always late, and so forth. It is a problem. Most parents, if only they could find the appropriate key of the appropriate door to unlock, would have the answer to their problems. Instead they spend their lives searching for what it is they ought to be doing and they have not done which, if only they could do it, would enable the child to be in a better position. Professionalism is of course important. There has been a great increase in professionalism. However, understanding is important, too. Understanding often comes from people who are not professionals. There are professionals who are understanding—that is expected. There are people who are not professionals who are understanding—that is excellent. But once one has the professional who is not understanding, that is disastrous because that person can carry all the panoply of the authority of his professionalism without in fact being understanding either to the child or to the parents. There must obviously be a mixture of the professional and the non-professional. People ask the Government to do more. I believe that one thing they could do is to give their support substantially—obviously not wholly—to the voluntary organisations, who do a great deal. Consitutional care is important, but so too is voluntary care. I spoke only this week to someone who is described as a co-worker. She had been working with handicapped people in the Camphill Trust, I understand, for some 40 years. The trust helps handicapped people and says that it is helped by handicapped people. I asked what she did if she wanted to go on holiday and whether she was paid a salary. She said she was not and that she went and asked the community whether there were sufficient funds. She then said, "But, of course, when I go, everyone else wants to come too". Such people spend their lives helping others in this way. It is a life of dedication. They are as dedicated as are nuns and other such people in their way. It is astonishing to realise what some people are prepared to do. The National Health Service too does a great deal. I was surprised to learn only this week from a person whom I had not met before of his son who is unable to speak. The son is now in a home with about five other severely disabled people. There are 13 people looking after them—presumably not all at once. That home is run by the National Health Service. Hitherto the son was in a hospital ward from the age of six for about 30 years. He has now been transferred to a home. The Government are therefore doing a great deal; but there is a great deal that the voluntary services could and should do also. They need all the support that they can get.
My Lords, I too should like to thank the noble Lord, Lord Carter, for initiating the debate today. This is a subject where we must continually be taking stock and continually measuring such progress as is achieved. I wish to ask the Government four questions this evening.First, what assistance will the Government provide to extend the Dial-a-Ride system in London? I understand that at present there are 50,000 members of that scheme and that they are provided on average with one return trip in 11 weeks. The cost of that operation is £6 million. However, the assessed potential is that there are 250,000 potential users and that to provide one trip a week, which seems a very reasonable ration, would cost £50 million. How far will it be possible to close that gap? Secondly, will the Government think again about their exclusion from assistance through housing benefit of emergency alarm systems for elderly people who are not living in sheltered, specially adapted or purpose-built houses? Why should these people who through no fault of their own live in other types of accommodation not receive the same assistance? My third question concerns the introduction of the new social security regime to which the noble Lord, Lord Carter, referred. The organisations which speak for the disabled—the British Council for Rehabilitation of the Disabled, the Disablement Income Group, the Disability Alliance, the Royal Association for Disability and Rehabilitation, the Royal National Institute for the Blind and the Spastics Society—acknowledge that there will be some gainers under the new arrangements. But they have reckoned that 345,000 disabled people will lose, including 315,000 disabled pensioners. That was based on the illustrative figures. It may be that there should be some adjustment to take account of the actual figures which were published yesterday. However, it remains true, as the noble Lord, Lord Carter, said, that there will be many losers. He pointed out that those who are at present claimants will not suffer any reduction because they will receive transitional protection. But that transitional protection, as the noble Lord, Lord Carter, again said, is not index linked. The organisations which I have just mentioned have made two requests to the Government. The first is that transitional protection should be index linked so that those who are at present on a particular level of benefit which is higher than the one in the future will not eventually be reduced to that level through the erosion of their transitional protection by inflation. Secondly, they asked that for new claimants there should be a dual assessment; that people should be assessed both under the present supplementary benefit rules and the new income support rules. That would mean retaining the supplementary benefit additional requirements paid on grounds of ill-health or disability. That would not be too difficult to do because many are flat rate, they do not require individual assessment and they are based on easily understandable criteria. I understand that the Government have turned down those two requests and I should be grateful if the noble Lord who is to reply could explain the reasons the Government have taken that position. The fourth and last question concerns the longterm future. My party is committed to the concept of a disability income for people with disabilities. That is something which would fit into our plan for a tax credit system. The disability income would replace earnings lost through disability and it would also have a second portion which would be an expense allowance to make a contribution towards the additional expenses of being disabled. Are the Government committed to that as their ultimate aim? What is their current thinking on that question? I should be most grateful if the noble Lord who is to reply could answer those four questions.
My Lords, the debate this evening is being listened to by some of the blind in our midst. This evening I intend to concentrate wholly on the deaf-blind and not discuss the numerous other forms of disability.The problems of the deaf-blind are truly great. Their paths are fraught with difficulties. The first real problem to be realised by others is that they suffer from deafness as well as blindness and are not necessarily at all mentally disabled, although they may give that impression. It can take a long time to diagnose them as children. I understand that the DES is trying to find out the numbers of children who are so handicapped. Will the Minister say what progress is being made? The problems of education for these children has always been patchy. In some parts of the country it is good; in others it is not so good. SENSE, The National Deaf, Blind and Rubella Association is very concerned about adequate training for teachers of these children. The blind must be taught by a teacher who is qualified to teach the blind and the deaf likewise, but not so the deaf-blind. They are unable to copy others and learn as children without these disabilities do. Although they are now able to stay at school until they are 19, by which time many of them are able to communicate by the deaf-blind manual alphabet and can make their wants known, they can only do so to others who can understand them. Thus they really do need continuing care. They quickly lose that ability if not encouraged continually. SENSE has set up centres for further training but there is a desperate need for adequate hostel care or homes where these unfortunate people can go. What future provision are the Government making for the training of teachers of deaf-blind children? Do they consider it satisfactory that there is no training course at the moment for teachers of deaf-blind children in this country whereas other countries recognise this need? There is wide concern among the blind that with more handicapped children being successfully integrated into ordinary schools there will be a reduction in numbers needing special schools. That will no doubt mean the closure of those special schools. Will the Minister say what future provision is envisaged for the multi handicapped? The blind find that there is a lack of formal training for disablement resettlement officers. A social worker for the blind also finds that there is a lack of trained officers, particularly in jobcentres. Perhaps the worst aspect of deaf-blindness is the isolation it imposes upon people. In both Scandinavia and the USA broadcasting time overnight is used to send out abridged versions of newspapers which are read onto tapes. These are scrambled to protect copyright and the recipient has a decoder. This form is only of use to blind people. In response to the Home Office Green Paper Radio Choices and Opportunities the RNIB and the Talking Newspaper Association of the United Kingdom have suggested the allocation of a frequency specifically for disabled people. In Sweden a smaller scheme is in operation to transmit newspapers in digital form overnight to recipients in their own homes and have them stored on a computer disc. Next morning the recipients can hear the newspapers using a synthetic speech facility on the computer or they can have the information translated into Braille. Those are very interesting developments and I trust that the Government will keep their eyes upon them. I wonder whether the Minister heard the BBC's programme "PM" on Radio 4 after the "5 o'clock news" on Tuesday 20th October last when Mr. Jan Ingvar Lindstrom was talking on the topic of talking newspapers. Perhaps it would be helpful to the Minister to get a transcript from the BBC on that. When I last spoke on this subject in 1986 I said how concerned I was about the discriminatory result of the way in which the mobility allowance is administered. As things are the test of being virtually unable to walk looks only at a claimant's ability to use his or her legs and feet in order to walk. Many deaf-blind claimants fail under current regulations to qualify for mobility allowance because there is nothing wrong with their legs or feet. In harsh fact many if not all of the deaf-blind and multi handicapped blind are incapable of independent mobility. They require a skilled guide at all times when walking out of doors. They cannot hear vehicles or other persons approaching. They cannot orientate themselves. If the deaf-blind are in difficulties they cannot ask those passing by for assistance. They are entirely dependent upon other persons who can use the deaf-blind manual alphabet. Thus even for the simplest journey they need to be put into taxis or be able to meet the travelling expenses of a travelling companion. It is demonstrably absurd to limit the mobility allowance simply to persons with defective legs or feet. The absence of sight and hearing is just as much a disability that limits mobility. I would ask the Minister most urgently to consider what is an anomaly. At the Wilberforce Home for multi-handicapped blind in York, the superintendent tells me that he has blind and deaf-blind people there, some of whom have a mobility allowance while others do not. All these people have more than a single disability. The test given is such that any person who can take two or three steps forward is disqualified for mobility allowance; whereas, in brute fact, neither the deaf-blind nor the blind who suffer from some other disability are able to go out by themselves. The difference between those who receive a mobility allowance and those who do not is in the order of £20 a week. That means that those who do not receive the mobility allowance often find that they cannot afford to go on outings in the coach that the home provides. I may say that the home makes sure that they do not miss these outings, and pays any shortfall. Out of 24 residents, we are considering just six who do not receive the mobility allowance. In a small community, differences of this kind are a cause of unhappiness. I have visited this home in order to see the problems. I am sure the superintendent would be delighted if the Minister would come and see for himself what I can assure him, for all its inevitable problems, is a very happy and indeed model home. I should like to thank the noble Lord, Lord Carter, for initiating this debate.
My Lords, a short acquaintance quickly establishes the basic need which people with disabilities wish to see fulfilled. It is to control their own lives and to live them as independently and ordinarily as possible. A longer acquaintance shows the problems which they have in achieving that. They have problems, many of which arise from what can almost be described as a lottery, for those with the same needs due to different circumstances can have widely different entitlements and opportunities. The entitlement to benefit can vary by as much as £140 per week. The ability to live independently is affected by the widely different levels of local authority provision.However, the point on which I want to concentrate is that job opportunities are determined by the proximity of sympathetic or discriminating employers or by the availability of sheltered employment. The Snowdon Report 10 years ago stated:
. However, the size of the problem is still not sufficiently appreciated. People with disabilities suffer a higher unemployment rate for a longer term. Over a quarter of job seekers with disabilities have been out of work for two years; and while nine out of 10 of those with severe spinal injuries work before their injury, after injury only every other one of them works. The causes are many: employment discrimination, the decline in quota compliance, a sheltered placement scheme which needs expanding, and the failure of some government programmes to accommodate people with disabilities. The discrimination by employers was shown in the Report of the Spastics Society on Discrimination in Employment in 1986—a discrimination which argues that people with disabilities should be given, through suitable anti-discrimination legislation, the same protection as women and ethnic minorities. However, legislation in itself does not change attitudes. This must come from both sides of industry, for there have been examples of discrimination by trade unionists. While this is changing, it would be a useful first step in the right direction if the TUC and the CBI could join together, perhaps through a permanent committee, to encourage more positive attitudes and to stimulate both sides of industry so that there is co-operation in the workplace. They could bring the subject on to the agenda of negotiating bodies; they could promote the argument that a workshop unsafe for the disabled is unsafe for all; and they could spread the message that employment of people with disabilities is in every sense rewarding. In the meantime compliance with the quota under the Disabled Persons (Employment) Act 1944 has, because of the easy availability of exemptions steadily declined since 1979. In the absence of other legislation the quota must be maintained and supported by ensuring more difficulty in obtaining exemption. A new dimension for the 6,000 severely disabled unemployed has been introduced by the Sheltered Placement Scheme. But demand for places still outstrips supply and there is still confusion as to its exact purpose. The Government must expand the scheme more rapidly and the whole field should be reviewed so as to develop a clear consensus on the function, scope and activities to be undertaken in the sheltered employment sector. The Government must also cease to introduce schemes which fail to meet the needs of disabled people. The youth training scheme was initially totally unsuitable. The community programme excludes people with disabilities who need to make a phased return to work. To ensure that that does not happen in the future the Department of Employment needs to establish a specialist team which ensures that all new schemes are accessible to those with disabilities. There is also a need to establish essential interdepartmental co-operation—a need important enough to suggest that (as existed before 1979) a Cabinet subcommittee, with its interdepartmental Civil Service committee, should be created. For those with severe disabilities in particular, support services are essential if they are to work. To ensure uniform local authority support, consideration should be given to creating a system of statutory standards to ensure that the needs of disabled people covered by the 1970 Act are met. I should like to thank my noble friend Lord Carter for initiating this debate. I await with interest the reply on the Government's intentions, for most of us are puzzled as to why the circumstances I have described continue to exist."The integration of those with disabilities must include the right to work"
My Lords, I, too, would like to add my thanks to the noble Lord, Lord Carter, for raising this matter. It is important that every now and again we should talk about disability. The noble Lord has chosen to look into the future with a rather jaundiced glance which I do not have sufficient knowledge to follow. But I think it is also important to look back and to see how the laws that have been made in the past are working today.There are areas in which your Lordships have special knowledge. If I have any special knowledge, it is in the area of dyslexia, the unseen disability, where there is a language difficulty, a writing difficulty and a reading difficulty, all combined often with a perfectly adequate—sometimes more than adequate—IQ. I should like to stress that this concerns about 4 per cent. of the population going through our schools. They then go out into the world—I make this point now—to cost the nation money for the rest of their lives and to cause trouble, either through delinquency or perhaps through causing accidents because they do not know their right from their left, and that sort of thing. It was quite a long time ago—about 1970—that this particular disability started to be acknowledged. Probably it was properly acknowledged in the Warnock Report and then dealt with in the 1981 Education Act. Six years have passed since that Act. I should like to consider how it has been working. The linchpin of the 1981 Act, as I remember it, was that parents who felt that there was something wrong with their child could demand a multidisciplinary assessment of the child. When the child had been assessed and something was found to be wrong, it then became the obligation of the local education authority to deal with the situation and to teach the child in the way in which it should be taught having regard to the particular disability. The problem now is that the delays over assessments are quite unreasonable. I have heard of delays of 18 months and even longer. In some areas, therefore, the system is not working well. I believe that if the delays go on long enough, the child must go back to the beginning of the whole exercise. We should enquire into why those delays happen. There seem to be two reasons. One has to do with funding and the other with the fact that because dyslexia has only recently been recognised, there are few facilities within local education areas to teach such children. I believe that in 1981 we made a law which it was impossible to bring to any sort of sensible fruition. That must mean that funds will have to be put towards such facilities at some point. I believe that it would be cost-effective to spend money now rather than spend a great deal more money later in dealing with all the difficulties and ills that an increasingly illiterate population, such as we have, brings with it. I do not wish to be completely negative and I want to ask one particular question. A number of voluntary societies teach dyslexic children in the way in which they should be taught. Such societies are spread fairly evenly over the country. The difficulty is that local education authorities frequently will not release children from schools so that they can be taught in special institutes and places of learning. At times, when the children are released, the local authority will not pay for the lessons. That is a bit hard on voluntary societies who are raising money in a charitable way to deal with the situation. My question to my noble friend is this. If a local authority with one or a number of children with specific learning disabilities does not have facilities within the authority to deal with such needs, would it break the law by refusing to send those children to institutes such as those I have mentioned where facilities are available? Would it break the law if, having sent children to those places, it refused to pay the costs? It is a slightly hypothetical question. However, I think it is important. A large number of local education authorities are doing their very best and doing a very good job indeed, as is the Department of Education. But the point which I have raised should be considered.
My Lords, I too should like to thank the noble Lord, Lord Carter, for introducing the debate. He speaks with particular personal experience of the problems we are discussing. There is a young lady in the gallery who is totally deaf and for whom our debate is being interpreted in sign language by a qualified interpreter. There are only 62 such interpreters in the whole of the United Kingdom, apart from Scotland. That is obviously far short of the number who are needed. I should like to ask the Government what they are doing to encourage a better supply and training of qualified interpreters for the deaf.I shall concentrate this evening on access and mobility. First, I should like to say how grateful we are for the improvements which have taken place in recent years; for the new building regulations which recently came into force and which will improve access to new buildings; for the greater number of dropped kerbs, although we should be even more grateful if they came at a faster rate and came as twins rather than as singles; and particularly for the mobility roadshow at Crowthorne which was put on by the Department of Transport and by Miss Ann Frye. The roadshow was a marvellous opportunity for disabled people to try out vehicles with hand controls and to find out which was the most suitable for them. Finally, I and the noble Baroness who sits next to me are very grateful for the way we are looked after by British Rail. I have four practical suggestions to make. Would it not be a great help if, at each district council, there was someone to whom disabled people could turn for advice and pressure as regards particular access problems? I know that some councils have already designated somebody with such responsibilities. However, a great many have not done so. I ask the Government to encourage those councils who have not done so, to do so. The post does not need to be full time, but there should be somebody to whom disabled people can turn when they have an access problem with a particular building. Secondly, would it not be helpful if local authorities were given the power by an amendment to the local government legislation to contribute to the cost of adapting buildings to which the public have access but which are not owned by the local authority? I am thinking particularly of theatres, cinemas, sports grounds and places of that kind. I am very much in favour of pedestrianisation schemes. However, unless adequate parking is reserved for the disabled within a reasonable distance, they may become no-go areas for the disabled. I ask the Government to give disabled people's organisations a right of appeal to the Secretary of State in such cases. Finally, perhaps I may suggest an annual award for the council which has done most to improve access.
My Lords, it is a privilege to follow the noble Viscount, Lord Ingleby. He and the noble Baroness who sits beside him, together with other noble Lords who are disabled, set us a shining example. We feel better when we have listened to them; whether we are better is another matter. However, we learn much from them and from many people outside the House, such as Peter Large and others.We have listened to a series of notable speeches, beginning with that of the noble Lord, Lord Carter, and I shall be brief. In 1970 I had the honour of carrying through the Alf Morris Act and in 1983 I took up a Bill which had been stymied in another place by procedural tactics. That Bill sought to make it illegal to discriminate against the disabled. The Bill got a long way forward and it was then defeated at the last minute. I therefore wish to take the opportunity of saying that I believe more strongly than ever that discrimination against the disabled, like discrimination on the grounds of race or colour, should be outlawed. I wish to deal with one objection which was made during past debates by some other people who have more right to speak on disablement that I have. I am not talking about money—that never seems to have arisen to block the Bill—nor the technical problem of defining discrimination. So far as concerns public opinion it seems that now, according to recent polls, 69 per cent. of the public would like to see discrimination against disabled people rendered illegal. The objection that I wish to raise certainly exists in the minds of one or two disabled people themselves and certainly in the minds of some people who have done a lot to help them. To put it in my words, although it was not expressed this way in the House—and perhaps it never would be—there is the feeling that any measure of this kind to outlaw discrimination by law would be to render a disservice to the disabled. It would make them seem like second-class citizens. To me that is absolute nonsense. It would bring home a new outlook to anybody who is so concerned. I am talking about high-minded people and possibly the disabled and friends of the disabled. I want to tell one anecdote which I must wrap up a little I am afraid. It may lose half its point. As it stands I think it has enough point to make it worth telling. A clergyman said not long ago to a distinguished person: "What about saying something about compassion?" After a pause, the distinguished person said: "I always think that is so patronising." The clergyman said "Well, that is to misunderstand the nature of compassion. It is not a kind of pity from above. It is compassion—suffering with, suffering alongside. If those who work with the disabled or who are possibly disabled have any lingering doubts about whether some sort of patronising element is present in what I am proposing I hope that will help them to see the light. Personally, I think that at this stage the great thing is to set up a Select Committee; but the noble Lord, Lord Henderson, is far better qualified than I am, and I am sure that he will deal with that later on. Something must be done because discrimination against the disabled is wicked. It is only just short of that to do nothing about it.
My Lords, the House is very much indebted to the noble Lord, Lord Carter, for initiating this very timely debate. To cover a subject like this in the compass of six minutes is indeed an exercise in self-discipline.I urge two topics: one is speech and the other is blindness. For at least 25 years of my life I had an uncontrollable stammer. Your Lordships will have noticed that I still have at least a trace of it. In particular stress and exhaustion bring the stammer on very noticeably. As a child I had speech therapy treatment but it was my commanding officer in the Army during my national service in Austria, who had a son who stammered, who did far more for me than anybody else. He ordered me to say my words twice as slowly and to sing them. For some reason or other it was very largely through him and also due to the encouragement of my dear wife that my stammer has at least partly disappeared. I should like to ask my noble friend the Minister what is being done to combat this very distressing condition among children. It is something which hopefully can be dealt with at an early age, if the facilities are available. Are there sufficient speech therapists within the National Health Service? I believe that much can be done now to combat this very distressing condition. Children who stammer have a particularly difficult problem because other children are unkindness itself. I remember being teased as a stammerer. It did not worry me unduly at the time, but looking back it was not an easy thing to face. The other matter I wish to deal with is that of eye complaints. Last June I attended a luncheon of the organisation Fight for Sight, of which His Royal Highness the Duke of York is the patron. His Royal Highness attended this luncheon. He takes an enormous interest in this particular organisation, which operates from the Institute of Ophthalmology and which has some very distinguished people as members. Many of the eye complaints originate in the third world—particularly glaucoma and trachoma and diseases of the retina. This organisation does a marvellous job—Moorfields Hospital and Clatterbridge Hospital in particular have done an enormous amount of work in this area. All families have members with sight problems. Two of our children have to wear glasses all the time. They are, of course, far less disabled than many people who are totally blind or who face blindness. I urge the Government to give all the support they can to enable more research to to be carried into sight problems. The noble Lady, Lady Kinloss, mentioned those who have both sight and hearing problems. Deafness is a terrible complaint but although loss of sight is not quite as awful as deafness, it is still a very distressing complaint. I urge my noble friend to urge the Department of Health and Social Security to look into these twin problems—namely, stammering and other speech defects and problems of sight. These are not the kind of physical disabilities from which a large number of Members of your Lordships' House and others suffer. They are undoubtedly far worse, but these are two areas which I believe need attention.
My Lords, like other noble Lords, I am most grateful to the noble Lord, Lord Carter, for having given me a timely opportunity today to draw your Lordships' attention to something which is causing concern to various people and organisations involved in the care of the elderly and the disabled. The draft Housing Benefit Regulations destined to come into force in April 1988 will change the rules applying to the provision of emergency dispersed alarms for frail, elderly and disabled people.At present those requiring alarms who are on low income can get help through housing benefit with the service charges levied to cover the cost of providing an alarm and warden support, whether they live in sheltered housing or in their own homes in the community. The noble Lord, Lord Banks, touched briefly upon this but I should like to elaborate. Under paragraph 1(c) of Schedule 1 of the draft regulations, help through housing benefit will be confined to those living in purpose-built sheltered housing or disabled persons' housing, and will no longer be available to those who live in ordinary flats and houses—that is to say, in their own homes. Emergency alarms linked to peripatetic wardens or to a computer are an effective way of enabling the frail and disabled to call for help when living alone in their own homes. But many have low incomes and cannot afford the cost of these alarms. It is perfectly true that under Section 2 of the Chronically Sick and Disabled Persons Act 1970 local social service departments have a duty to provide disabled persons with various forms of asssistance in the home where need has been determined. But some local authorities have already said that after the new regulations come into force next April, they will be unable to provide alarms for those who cannot afford to pay for them because the local authorities are short of money. St. Helens, Durham, North Devon, Basildon and Ryedale are among them, and some London authorities will have to cut back on alarms because they have to spend so much on child abuse. Those who cannot afford to pay for their own alarms will therefore have three choices: first, to stay in their own homes without alarms which they need to enable them to do so in reasonable safety; secondly, to go into sheltered accommodation, if it is available, which often it is not; or, thirdly, to go into residential or nursing home accommodation. An alarm costs up to £5 a week for its rental and service charge. Sheltered accommodation is much more expensive, although I do not have the figures, and nursing home accommodation costs up to £175 a week. I wrote to The Times the week before last about this, and today there is a letter in The Times from the chairman of the Care Trust pointing out that there are many cases where hospitals are willing to discharge patients for convalescence provided that they have alarms in their own homes. If patients do not have alarms in their own homes, they have to stay in hospital which, again, is unpleasant for them and much more expensive. The Government say that they are committed to care in the community—quite rightly, for expert opinion and common sense show that as long as it is possible, this is in the best interests of the recipients who are happier and live longer. So why take a step which is in danger of driving them instead into institutional care and which will cost far more? I do not care how the Government pay for these alarms—whether through housing benefit (which apparently they no longer wish to do), by providing local authorities with funds earmarked for the purpose, through income support, or by any other means—as long as they do it. I hope that they will look at this question again because I believe it is important.
My Lords, it is obvious from the remarks made by noble Lords that the needs of disabled people are many and complex and that existing problems are severe and difficult to solve. Having listened to the debate, I am aware that the future for many people will be bleak.I fully agree with the reasoned points put forward by my noble friend Lord Carter, and I support the employment issues outlined by my noble friend Lord Basnett. Disabled people are doubly disadvantaged. First, they are disadvantaged as individuals by the loss of normal functions that the nature of their personal handicap may bring about. Secondly, they are disadvantaged by the neglectful and often unwittingly insensitive society in which we live. Indeed, my noble friend Lord Carter referred to the "disabled divide", which is very real. The time constraints on this debate prevent our putting forward the relevant arguments for the adoption of basic rights and reasoned, active administrative remedies to meet proven needs and known problems. Today, we are obliged to make pronouncements only on the specific issues involved. We are prevented from dealing in a practical way with the details of areas of concern such as discrimination, the gaps and anomalies in the existing legislation on disabilities, and the lack of information and research into the number of, and the extent of, the disabilities suffered by disabled people in the United Kingdom. There is a dearth of relevant information on how to deal with such people in a practical way. However, there is sufficient evidence to enable us formally to declare that there is widespread discrimination against our disabled fellow citizens throughout the United Kingdom—in England, Wales, Scotland and Northern Ireland. The needs of disabled people are related directly to the special problems they have as individuals. The noble Earl, Lord Ferrers, has already mentioned some aspects of different individual needs and problems. The issues which give rise to special problems, have been dealt with to some extent by noble Lords. I shall summarise what I consider to be some of the special problems. There is a need for health care and social security, adequate housing accommodation, education and training, and access to many private and public buildings, shops and amenities. The noble Viscount, Lord Ingleby, said that there had been progress in this direction, but there are still huge gaps in meeting what is required. There is a need for suitable public transport and recreational facilities. I am glad to say that in Northern Ireland our Sports Council tends to help in that respect. The crucial need is for equality of employment opportunities. Employment could give many disabled people a great sense of dignity and the ability to live independently without direct support from their families or social services. Although my remarks about equality of employment opportunity are directed to the whole of the United Kingdom, I hope to pinpoint the situation in Northern Ireland as I know it. The Northern Ireland Council on Disability is a voluntary organisation which represents some 70 bodies in Northern Ireland concerned with every aspect of human disability—physical, mental, sensory, and hidden (the unseen) which has been mentioned in this debate. As part of its normal work for the disabled, the council responded in March this year to a Government consultative paper entitled Equality of Opportunity of Employment—Future Strategy Options. The interest shown in that document can be well understood. In Northern Ireland, the unemployment rate for disabled people is over twice the rate of that for the able-bodied, and the rate for the able-bodied is chronically high. The Government's paper raised expectations among the organisations concerned with disabled people. It suggested separate legislative measures for Northern Ireland to provide equal employment opportunities. Since early this year there have been a number of exchanges of papers and meetings with the Northern Ireland Department of Economic Devlopment, the Minister, Mr. Peter Viggers, and the Northern Ireland Council on Disability. The council is anxious to set up an equal opportunity unit within the functional structures of the organisation which should be resourced by the department. The council considers that this type of unit would be a positive, constructive and helpful innovation in the interests of the disabled, of the Government and of the well-being of the general community in the Province. The proposal has been well supported throughout the Province. On Wednesday last, when the Minister, Mr. Viggers, launched two new publications aimed at helping disabled people into employment, he expressed concern about employment opportunities. He said:
This debate shows that they have a great deal to contribute to society. I ask the noble Earl on the Government Benches, Lord Arran, whether he will kindly use his good offices to invite the Minister, Mr. Viggers, sympathetically to review this request of the Northern Ireland Council on Disability for the establishment of an equal opportunities unit—a very modest request, I believe, in financial and administrative terms. I end with the remark I heard from a disabled youth when he was politely turned away from a job. He declared, "I do not want pity; I want opportunity". I hope that this debate tonight will open up many opportunities for the disabled."These brochures will help to ensure that we get across the message that disabled people have a lot to contribute to society."
My Lords, the noble Lord, Lord Banks, mentioned that disabled people want to be as independent as able-bodied people. It is not easy for disabled people who rely upon the public purse for their income to obtain full independence. I shall illustrate that point with the story of a young married couple, both with cerebral palsy and with severe spasticity as a result, and the way in which the problem will be overcome within the next few weeks by getting round the system. However, I hope that the Government will take note of my story and will bring greater flexibility into the funding of disabled people.At the present time this young couple are in a home run by John Groom's Association for the Disabled. I should declare an interest because, as many noble Lords know, I work for that organisation. The couple are about to move out of the home into a house provided and adapted by Surrey County Council. However, because of the degree of disability they need between them something in the region of eight hours' assistance a day, Theoretically this could be topped up by the county council, but in practice such topping up would mean an increase in their own personal income which would wipe out supplementary benefit which they need to live. They therefore cannot have the topping up. The problem is being surmounted not by giving them the topping up but by giving it to the voluntary body currently looking after them, who will then help them by paying the 12 part-time staff that they will employ to help them during the week. The noble Earl, Lord Ferrers, earlier gave the impression that he was surprised at the number of people needed to look after some disabled people. The load on those who help to look after disabled people is very heavy and a lot of it can be done by part-time people. Despite the fact that it will cost some £200 a week in topping up, the saving to both central and local government is of the order of 25 per cent. of the cost being paid from the public purse today. The Government should look into this matter to see whether they can learn from what the association and this young couple are doing and apply it to other people. On topping up, there are a number of voluntary bodies who need to be topped up by local authorities on the costs of the residential homes that they are running for severely physically disabled people. It is the experience of a number of these bodies that local authorities are topping up with the greatest of reluctance at figures well below those required, and there is a danger that some of the smaller voluntary organisations will have to stop providing the residential care that is absolutely essential for some severely physically disabled people. I hope that my noble friend will bring this to the attention of the Minister and that it will be looked into. Finally, perhaps I may follow the noble Viscount, Lord Ingleby, on the point about signing for severely deaf people. Can we have greater provision of teaching in schools for profoundly deaf children? To try to teach them through the medium of spoken English is to my way of thinking like trying to teach a totally blind person by giving him only ordinary printed books from which to study. To a profoundly deaf person who learns sign language, English is a second language, it is not a primary language. The primary language of such people is sign language and it is essential that teaching takes place in the language that they will use for the most of their lives.
My Lords, it is most encouraging to see a debate concerning the problems of disability engendering so much support and it is excellent that the noble Lord, Lord Carter, as a relatively new Peer, has joined the ranks of those of your Lordships who understand the wide problems that disability brings to families and individuals throughout the country. I thank him for introducing this debate.On returning to Westminster this Autumn my noble kinsman and I were very pleased to find the pavements around the area where we live had had dropped kerbs inserted. To your Lordships this may seem a small point. To one who uses a wheel chair it is of immense importance. As my noble friend Lord Ingleby understands, I can tell him that there are some twins. As a founder member and now President of the Spinal Injuries Association—an organisation which helps and advises the families and the people who have broken their backs and necks—we are concerned at the escalating costs of care in the community. A tetraplegic, someone with four limbs paralysed, needs a great deal of help. The noble Lord, Lord Basnett, will understand this as his son is a young doctor who broke his neck. One of our many activities is to run an emergency care service so that a member may employ a trained care attendant for a period of up to two weeks. As well as other help, spinally injured people need assistance with their paralysed bladders and bowels. This specialised service is most valuable. What happens if their normal carer becomes ill or goes away? They will have to go into hospital (an expensive exercise) and there may not be a bed readily available. We have heard that we may be losing the grant we have had to help run this service which is subsidised to our members. Much fund raising goes on throughout the year but this does not cover the whole cost. Some members can pay, and do. Others cannot. There is a dilemma. With so much emphasis having been put on the elderly and the long-stay mentally handicapped and ill patients coming out of hospital, the physically disabled have come a long way down the list of priorities. One day, while watching television, some patients and nurses heard that their young disabled unit was to close. What can they have thought, my Lords? These are the very severely disabled who may have multiple sclerosis, rheumatoid arthritis, motor neuron disease or brain injury. And where will they go? If it is to a geriatric ward that is against any principle of the 1970 Chronically Sick and Disabled Persons Act. I hope that the Government will look very closely at the needs of the severely physically disabled patients as well as the other groups. At the London Hospital the occupational therapy department was told to give up their daily activities room—where they taught stroke patients and others such skills as getting in and out of a bath—so that it could be used for counselling for HIV (AIDS). This has been bad for morale and frustrating for the staff as the room has remained empty. One should not rob Peter to pay Paul as both are equally important. I end by saying that there is extreme concern about the difficulties disabled, people are having with parking their cars. Can the government take this seriously? They are lagging behind. If all the present badges were scrapped and new ones of a different colour allocated and disabled people carried an identity card with a photograph—as is now done in the City of York—this might halve the badges and solve the problem. Also much credit must be given to Dial-A-Ride schemes, a most admirable service which needs expanding so that severely disabled people can have a better quality of life.
My Lords, before turning to the remarks which I have prepared, I feel obliged to refer to the powerful and, in my opinion, important speech of my noble friend Lord Carter. It is not too much to say that I was deeply shocked by what he had to say about what is happening to the real income of the severely disabled. One may argue backwards and forwards about possible social security reforms but it seems to me that as a minimum condition of a civilised society one would certainly insist that the real income of the severely disabled should never fall and at the very least should rise in line with the prosperity of the rest of the society in which we live. I do not expect the noble Earl, Lord Arran, to give us any assurances on that at this moment, but I hope he will tell his right honourable friend the Secretary of State that some of us are more than unhappy to be told that this is the state of affairs that will rule in our country. Since occasionally we understand that Ministers are willing to think about matters, I feel he really ought to consider this again.I should like to say a little about speech therapy and to declare an interest in that my wife was trained as a speech therapist. There are a wide variety of problems and defects concerned here: cleft palate, dyslexia, stammering, language difficulties of all sorts, strokes and cerebral palsy and a multiplicity of physical handicaps, as noble Lords are aware, with which are associated speech and language difficulties. One thing I should like to say in general about this whole area is that I do not regard these disabilities as a subject for amusement or derision. I strongly deplore comedians who do not have that much talent, who think that making fun of the deaf or those who stammer is somehow a suitable subject. I also deplore the media who are quite happy to show that kind of material. I say that en passant, but it is a serious matter. In this general area treatment is more effective than it used to be. We know that a lot of good can be done for stroke patients, although in that case the earlier and more intensive the treatment the better the prognosis. There have been many other considerable advances in therapeutic methods: the use of artificial larynxes, for example. There are many computer aids which enable people with multiple difficulties now to communicate. But many of the computerised audiovisual techniques make increasing demands on the speech therapists' time. This is not true only of stroke patients but at the other end of the age spectrum there is now a great deal that can be done to help all sorts of young people who have language and related difficulties. The problem is that there is a general shortage of therapists. I ask the Minister to tell us whether he is satisfied that enough speech therapists are being trained. Does he feel that their pay is adequate? What about their career prospects? Or do we have here, as we have in many other areas, yet another case of a devoted body of people being appreciated by the public but exploited by the authorities? Having said that, I hope we all agree that more funds must be found for the NHS and one must keep up continuous pressure to find those funds. I also add that within the given budget, whatever its size, it is always necessary to emphasise the needs of the handicapped and also to argue that at the present time they certainly deserve a higher priority than they are getting, even if this might have to be to a limited extent at the expense of what at the moment is more fashionable in other parts of medicine.
My Lords, I should not like to be the only person to speak who does not congratulate the noble Lord, Lord Carter. I do so wholeheartedly and thank him for introducing this debate. The noble Earl, Lord Longford, and the noble Lords, Lord Basnett and Lord Blease, have all spoken about the need for anti-discriminatory legislation. This is a subject that is absolutely germane to this debate. Disabled people need, so far as possible, to be treated on terms of equality with other people. Disabled people need, so far as possible, to be integrated into society. They also have most frustrating problems which are often partly or wholly soluble, in a wide range of activities—I quote the Bob Wareing Bill—including
—across the board. This great question was raised in the Bob Wareing Bill in 1983. The Bill failed in the House of Commons, and as the noble Earl, Lord Longford, has reminded us, he took the Bill up in this House. After a good deal of argument it was defeated in its last stage on the Motion, That this Bill do now pass. The Bob Wareing Bill went for a full-blooded disablement commission, comparable to the Race Relations Commission and the Equal Opportunities Commission with wide powers of investigation and enforcement. This was not acceptable to the Government. A much more modest Bill was introduced by the noble Lord, Lord Campbell of Croy, who has an abiding interest in the subject of disablement. His Bill sought to establish a commission with much more modest powers, merely to consider matters concerning the treatment of disabled people and to make reports and recommendations from time to time. This Bill passed this House after the failure of the Bill of the noble Earl, Lord Longford, but the Government gave no hope of finding any time in another place and so it never came into force and effect. So we reached a parliamentary impasse in 1983–84. I recall that there was a most unpleasant and rancorous atmosphere between the parties on those occasions. I know it is not possible to keep party politics out of any subject and disability is no exception; but I feel that every effort should be made to find a consensus view on a subject so important as discrimination especially in the field of employment, as particularly mentioned by the noble Lord, Lord Basnett. Where there is a parliamentary impasse it is fruitless in my view to introduce again and again a Bill which one knows will not be received favourably by the Government. We have now a five-year Parliament ahead. I feel it cannot be a good thing for disabled people. I know that Mr. Wareing disagrees with me and I know that Mr. Jack Ashley disagrees with me. They would like to continue to reintroduce the same Bill over and over again. I beg to differ from them. My advice in this case—as in all such cases—is to resort to the well-tried procedure of a parliamentary Select Committee empowered to hear all the evidence as to discrimination and, in the light of that evidence, to make recommendations for statutory or perhaps non-statutory remedies, or a combination of both. The disabled organisations have come together and feel very strongly about this. They operate under an acronym, VOADL. Please do not ask me what those initials stand for. VOADL is an active body and presses for legislation of one kind or another. It favours a Select Committee and has asked me to do what I can to secure a Select Committee. I put this notion to the All-Party Disablement Group and secured its agreement to pressing for a Select Committee, although Mr. Jack Ashley said that this should be without prejudice to any attempt to bring in Bob Wareing's Bill again. So there is a considerable degree of support for the notion. As a matter of fact I made approaches to the Leader of the House and he was very receptive to the idea of having such a committee. I made those approaches in the last Session of the last Parliament and he quite rightly pointed out to me that that was a most inappropriate time to have a Select Committee on the subject; and of course I agreed. This Session the Infant Life (Preservation) Bill Select Committee has been re-appointed. I cannot fault that as an appointment; but there is simply not the capacity in the House to have more than one such special Select Committee running at the same time—in addition, that is, to the EC Select Committee and the Science and Technology Select Committee. However, I am assured by the Leader of the House that my proposal for a Select Committee will receive every consideration when the Infant Life (Preservation) Bill, Select Committee has finished its deliberations. I hope that support for such a Select Committee will come from all quarters of the House. My Lords, I see that my time is up. I would only ask that when the time comes my attempts to get a Select Committee on this subject will meet with success and that we might thereby get a consensus view on the way forward in cases of discrimination against disabled people."employment, education, recreation, the provision of goods, facilities and services, insurance, transport. property rights housing and accommodation, occupational pension schemes, membership of associations and clubs and civic rights and duties"
My Lords, it will not surprise the noble Lord, Lord Henderson, to know that I am in broad agreement with him in that I favour the idea of a Select Committee. Early in this debate my noble friend Lord Ferrers referred to the fact that there is now a better understanding of mentally handicapped people in this country. He was good enough to say that MENCAP as a voluntary organisation had something to do with it. I hope that it is in order and proper for me to point out that for the past nearly seven years Sir Brian Rix has been secretary general of MENCAP and this is his last week in that post. He as much as any other individual has done such a lot to help towards that better understanding mentioned by my noble friend.The next speaker in the debate is the noble Lord, Lord Allen of Abbeydale, chairman of MENCAP, of which I am president. I shall shorten my speech so as to leave him more time. There are a few minutes spare, thanks to the brievity of some of the earlier speeches. I hope that he may use some of them. I want to mention one important MENCAP matter. It is our policy at MENCAP, as well as the Government's, to get mentally handicapped people, especially the younger ones, out of those enormous long-stay hospitals and into the community. But it is vital that they should not leave hospital until suitable arrangements have been made for them to live in the community in one way or another. I would be grateful if my noble friend Lord Arran could give us a progress report as to how many have been discharged from these long-stay hospitals and what proportion of them have not been settled in the community. There has been a certain amount of wild talk about people being sent out into the world without proper arrangements. I think that those reports have been exaggerated, but perhaps my noble friend can enlighten us. Another matter I wish to mention is the difficulty many disabled people have in using public transport. It was touched on by my noble friend Lord Ingleby and by the noble Baroness, Lady Masham. I wish to follow that up. The Greater London Association for the Disabled has made a most interesting and valuable survey called "All Change". It is a survey of the difficulties disabled people have in using public transport. The survey points out that one Londoner in 14 is "transport handicapped"—that is to say, unable to use buses, tubes or trains. It may not surprise the noble Lord, Lord Carter, to whom we owe so much for having initiated this debate, to know that a very high proportion of those who are transport handicapped are people on low incomes. They cannot afford taxis or cars. Therefore there is, as the noble Baroness, Lady Masham, said, a great need to expand the Dial-a-Ride scheme. I would mention also the taxi-card scheme. Both of them are already overworked. The invalid car scheme which started many years ago, mainly after the war to help disabled ex-servicemen, although expensive would be worth developing as funds become available. Perhaps I may ask my noble friend on the Front Bench whether the Government have received the GLAD Report on transport and the use of public services by the disabled and whether he can yet say what the Government will do about it. It is extraordinary that in days gone by access to buildings was made so difficult. I refer to access to great churches and even to getting up to the Central Lobby of the House of Commons. If one reads back in history one realises that there was a custom of having strong men carrying what they called "litters". They were simple sedan chairs. This was before the days of stretchers. A couple of strong men would be needed to take a disabled person up the steps of St. John's, Smith Square. I do not know whether it is wildly impracticable for those who wish their churches and other public buildings to be filled to arrange to have two strong men with litters.
My Lords, I have indeed been chairman of MENCAP for some years, in succession to my illustrious predecessor who has just spoken. I propose in my few minutes' contribution to this timely debate, for which we are all grateful to the noble Lord, Lord Carter, to concentrate on the mentally handicapped.There are in Britain something like 1¼ million people with mental handicap and, although many of them are not significantly afflicted, some need support and guidance throughout their lives. For them the watchwords of independence and self-help are not all that meaningful. I take it that the Government accept the desirability of seeing that as far as possible people with mental handicap are able to develop their full potential to live in the community. I go along with the noble Lord, Lord Renton, in the hope that when he replies the noble Earl will be able to give us a progress report on what has been happening about closing down the long-stay mental handicap hospitals. I know that the noble Lord, Lord Renton, would be the first to agree that that is not the end of the story by any means. For a start, the vast majority of people with mental handicap have always lived in the community, but at the cost of hardship and sacrifice on the part of thousands of carers and their families. Then again living in the community does not of itself ensure taking part in the life of the community. For too many it has so far meant isolation, public prejudice, poor living conditions and inadequate income, and for parents there is the constant anxiety of what will happen when they are no longer able to care and when they are no longer here. I have long been uneasy about the way in which public resources are used to support community care, and I very much welcome the setting up of the Griffiths Review, following the strictures of the National Audit Commission. I hope that that review, to which MENCAP was able to give evidence quite recently, will go some way towards solving some of the problems such as the gaps which exist between the services. I am afraid that co-operation is not really as good as it might be. Behind the Griffiths Review there are, I fear, some grounds for anxiety about the Government's own attitude to community care. Of these I shall briefly mention four. First, there are the issues already touched on by the noble Lord, Lord Carter, and referred to by the noble Lord, Lord Peston, about the prospect of certain disabled families being considerably wose off under the new social security provisions next April than they are at present. There is the decision of the Government's own advisory body on social security to go on record as saying that it cannot go along with the decision to continue with the social fund. All this is causing grave concern. Secondly, there are looming up problems about education, additional to those which are being rather more widely canvassed. The effect of the Education Act 1981—albeit, as the noble Earl pointed out earlier, it can hardly be claimed to be functioning perfectly—is to require local education authorities so far as possible to make special provision in the ordinary schools for children with special educational needs. These children, as I understand it, will be exempt from the core curriculum, but what I do not know—and I suspect that I am not alone in this—is what is to happen if a school exercises its right (which is forecast) to declare itself independent from the local education authority. Will there be any obligation on that school to provide for the special needs of children with learning difficulties, and to furnish any necessary equipment? Or are these children always to be dependent on the local education authority? If so, where is the freedom of choice, for them and their parents? Thirdly there is the poll tax. In the Scottish legislation, in response to representations in this House, a provision was inserted exempting the severely mentally handicapped, but we still do not know how it is proposed to define what constitutes severe mental handicap. Anyway it does nothing for the parents with say, two mentally handicapped sons or daughters who are over 18 and living at home, who do not qualify under whatever criteria are in the end laid down to define severe mental handicap. I am far from happy about the forthcoming Bill as a whole, but I wonder with particular apprehension what will be in the Bill about the mentally handicapped and still more, my Lords, what will not be in the Bill. Lastly there is the Disabled Persons (Services, Consultation and Representation) Act 1986. This Act received Royal Assent 16 months ago, but so far absolutely nothing has been done to implement the provisions which will make a real difference. In one respect there is indeed something of an absurdity. Section 8 has been brought into effect. That section requires a local authority, when deciding whether to provide welfare services for a disabled person living at home, to take into account the abilities of the carer. But Section 3, which provides for an assessment of the needs of the person being cared for, has not been brought into effect. It simply does not make sense. The failure to take action on this Act, on which such high hopes were placed, is really rather a disgrace and accords ill with the Government's professed support for the policy of care in the community. We have heard many fine words from the Government about choice and their desire to see that resources are devoted to those in greatest need. The areas I have touched on present splendid opportunities for them to demonstrate that they have in mind more than words.
My Lords, I want first warmly to congratulate my noble friend Lord Carter on introducing this debate, not only for the manner in which he did so but also because his Motion has attracted so many noble Lords. I never cease to be inspired and moved by the degree of experience which exists in your Lordships' House. I doubt whether there is a Chamber in the world which could bring together a group of people with such experience, all addressing themselves to the Minister who is to reply.We have heard of experience with the deaf-blind—one of my sons works for SENSE—with sufferers from dyslexia, those who have housing problems and those who are in institutional care. We have heard about mental handicap and mental illness—I speak as chairman of MIND—and about employment, speech therapy and occupational therapy. I am president of the College of Occupational Therapy. There is an enormous breadth of experience. Not only was it started so well by my noble friend Lord Carter but it was brilliantly followed by the noble Earl, Lord Ferrers, who brought in his experience. Again, we are co-vice-presidents in the same organisation. Secondly, I want to say how much I agree with the proposal made by the noble Lord, Lord Henderson. I would have wished, as he would, that the Bill against discrimination had been carried through this House and another place. But the issues raised today are not ones that can be dealt with in a two-and-a-half-hour debate with so many speakers and a reply from the Minister. I agree that we need a Select Committee so that we can bring in all our experience. I hope that the Minister will respond to that practical proposal. The only other general remark I want to make is to say how much we should pay tribute to the voluntary organisations. So many noble Lords and noble Baronesses who have spoken have done so because of their connection with voluntary organisations. If you took away those voluntary organisations and relied only on the statutory bodies with the financial restraints that they are facing, I am afraid the situation which today is distressing would be desperately more distressing. Of course I agree with the noble Viscount, Lord Ingleby, that there have been improvements. Of course there is better access, and of course there is greater understanding. That is clear from our debate. We have the common objective to see that disabled people, whatever the nature of their disability, can play as full a part in life as possible. That may mean a great deal of sacrifice not only by families but by taxpayers in providing the funds to enable the Government to carry out their responsibility. We want to see the maximum number of disabled people able to live at home and not in institutions. We recognise that some must live in institutions but our objective is to have people at home. At a time when Ministers are proclaiming the strength of our economy, it is an extraordinary indication of the priorities of the Government that they are involved in a number of initiatives which in some cases—I do not say in all cases—make the plight of disabled people more difficult to bear while the young and upwardly mobile are pushed ahead. I have time to give only three or four examples. First, the results of the Government's 1986 Social Security Act are beginning to be understood. In many debates in your Lordships' House, I and my noble friends, and noble Lords on all sides of the House including the Cross-Benches, have expressed concern, as was expressed so movingly a moment ago by the noble Lord, Lord Allen of Abbeydale. We have argued that there would be a damaging effect on disabled people. The Government promised transitional protection for existing disabled claimants whose level of income would be lower under the new income support scheme than under the supplementary benefit scheme. In cash terms their level of income will be frozen at the supplementary benefit level until the incomes support level catches up. That point was well made by the noble Lord, Lord Banks. As a result, over a period of time, income will be eroded by inflation and the standard of living of those disabled people will fall. I believe that the noble Lord, Lord Carter, stated that overall 340,000 disabled people will lose from the transition from supplementary benefit to income support. I find that fact appalling and I believe that the Minister must justify how it is that this proposal can be carried through. The noble Lord, Lord Carter, also raised the point that disabled people who will be claiming for the first time after April 1988 will not receive any transitional protection. Many of them will immediately be worse off than people with similar disabilities who claimed before 1988. The Government have said that provision can be made for severely disabled people from payments through the social fund. Disability organisations are opposed to that. As a point of principle they are concerned that claimants who previously received benefit payments as of right may now have to rely on discretionary payments from a limited cash fund with that money available only as loans. How will they repay those loans in view of the problems of unemployment so well brought out by the noble Lord, Lord Basnett? The voluntary organisations have also pointed out that it is not practical for disabled people to try to lead lives in the community without a secure, regular income. None of us here, from whatever side of the House, can doubt the truth of that statement. In spite of pleas from so many responsible voluntary organisations we are left to conclude that the Government know that disabled people will suffer severe financial loss and yet they are not prepared to do anything to protect them. The second point I should like to make is that one of the most important measures passed into law during the past 20 years—as referred to by the noble Lord, Lord Allen of Abbeydale—was the 1986 Disabled Persons Act. It is better known as the Tom Clarke Act or, in this House, the Sue Masham Act because it was the noble Baroness who carried it through your Lordships' House. The staggered introduction of the Disabled Persons Act is proving extremely difficult for many local authorities because no extra resources have been made available for its implementation. The Act seeks eventually to improve the lot of mentally or physically handicapped people and their community carers by ensuring that their needs are thoroughly assessed and that necessary services are provided for them by their local authorities. The failure of the Government to provide any additional resources for the practical enforcement of the Act is clearly against the intention of Parliament. In the passing of that Act, with all its implications, Parliament could not have intended that somehow or other it should be implemented for nothing or only at the expense of rate-capped local authorities. The Association of County Councils suggested that the cost of putting the Act to work, and therefore ensuring a far better deal for disabled people, would be approximately £25 million a year for assessments and up to £100 million for extra services. The Government say no. Dealing with another part of the Act, the Association of Municipal Authorities estimates that only one-third of disabled school leavers claim the services to which they are entitled and that ordinary schools do not always correctly identify the needs of young disabled people. That point was well made by the noble Lady, Lady Kinloss, in relation to the deaf-blind. In an effort to establish the possible cost of these proposals, negotiations are now under way with a view to the commencement of the identification of children who are in their final two years at school at the earliest possible date. I understand from the AMA that it has agreed with government officials a figure of £5 million for identification and assessment of disabled school-leavers in 1988–89 and a further £20 million per year for services to those children. Therefore, the full year cost of each cohort of leavers will be £20 million starting in 1989–90. As a part year, the cost will be £14 million. I should be grateful if in replying the Minister will confirm that that agreement has been reached, because it will be some way forward and I should like to have something to welcome at the end of this debate. Thirdly, we are faced with another cost-saving social security Bill. We hear that we are to have another Bill which will be the greatest review since Beveridge. That is exactly what was said by Mr. Norman Fowler when he was appointed Secretary of State for Social Services after the previous election. He said that his review was the greatest since Beveridge and he introduced what he considered to be the requirements of the nation. Now a new Secretary of State is appointed under the same Government by the same Prime Minister, and he says, "We are going to do it all over again". Can the Minister confirm that part of the Bill will overturn the Court of Appeal ruling that could lead to thousands of the 348,000 epilectics, diabetics and mentally and physically disabled people in receipt of the lower rate of attendance allowance receiving the higher rate through needing care at night as well as during the day? If the Bill is to block that gap to the disadvantage of 348,000 severely handicapped people we are beginning to see the large number who will suffer if the Government's intentions are carried through. The final point I should like to make, because I want to leave the Minister the maximum time to reply to the many points that have been raised, concerns community care on which so much voluntary effort is being concentrated by so many different organisations. Of course, I am acutely aware of what MIND is doing in this particular field for those with mental illness or recovering from mental illness. Although, largely thanks to disabled people themselves, there has been an improvement in attitudes toward disability and the responsibility of society for its disabled citizens. Far too often people are forced to choose between institutional care or a degrading life in their own homes because the service they need is either not available at all or not available at the time they require it. We have been reminded that the Audit Commission in its report, Making a Reality of Community Care, described the "perverse incentives" which so often mean that, despite the community care policy, it is easier to obtain cash for admission to residential care than for remaining in one's own home. To give one example, the DHSS is empowered to pay up to £230 per week for nursing home care for disabled people with few obstacles or checks, but only up to £48 to £70 a week for personal care at home, and that is paid only in the most exceptional circumtances. In my view there is now a ridiculous situation in which, because of the need to draw up some sort of priority system, services are actually being targeted to those who need them least. I believe that any expenditure is likely to miss out completely the most disabled and the most dependent. Changes which are to take place next April under the Social Security Act will make it even more difficult for newly disabled people to remain at home. Already acknowledged to be among the very poorest in society, many disabled people will find themselves worse off by up to £60 per week as a result of the loss of additional payments for heating, laundry, diets and domestic assistance. Once again, practice is in direct conflict with policy. I hope that, in view of all the points that have been made with great sincerity from all sides of the House by people with great experience, the Minister has not only been listening to what has been said but will convey to his right honourable friend who takes these decisions, and indeed to the Cabinet, the depth of the concern and anxiety that have been expressed in your Lordships' House today.
My Lords, I should like first of all to congratulate the noble Lord, Lord Carter, on his choice of subject for today's debate; namely the needs and problems of people with disabilities. It is of course far from being a subject new to your Lordships' House. There have been a number of excellent debates on various aspects of disability over recent years. Today's debate has at least matched the quality of its predecessors and, as usual, noble Lords have spoken with immense knowledge and sympathy about the wide range of problems which disabled people face and the best ways in which their needs can be met.In these circumstances, I am the first to realise that many noble Lords who have spoken this afternoon possess very much greater knowledge and experience, much of it personal, than I do. However, I like to think that my sympathy is just as great. Although we may differ about means, I am sure that we can all agree about the ends we want to achieve, that is, to give disabled people the maximum possible access to the opportunities which able-bodied people have, so that they can develop their potential to the full and thereby make the maximum contribution to society. Before I try to deal briefly with particular points made by noble Lords, I hope the House will allow me to say a few words about the measures which this Government have taken to help disabled people. As your Lordships are quite rightly swift to point out, many tasks remain to be done, but it would be wrong to lose sight of the things which have already been accomplished. One important initiative which this Government have taken is one that has not yet borne fruit. We commissioned from the Office of Population Censuses and Surveys the first major survey on disability in the population since 1968. The first results of this will be published next year and will provide up-to-date information about the numbers, circumstances and needs of disabled people. Unlike earlier studies, it will include children and people in non-private households, and sensorily impaired and mentally handicapped people will also be covered. As the results of the survey become available, we shall of course be examining very carefully the implications for our policies. At the same time, we shall be taking account of any other developments affecting people with disabilities. One such development is the inquiry into community care which Sir Roy Griffiths is currently undertaking. In view of the importance of community care for the Government's strategy for the health services, personal social services and social security, it is crucial that help and assistance is delivered effectively and economically. Sir Roy will be making his recommendations to my right honourable friend the Secretary of State at the end of this year, and I look forward to his report with considerable interest and keen anticipation. Another extremely important milestone in the field of health and personal social services has been the passing last year of the Disabled Persons (Services, Consultation and Representation) Act, to which a number of noble Lords have made reference today. This measure originated in another place as a Private Member's Bill introduced by Mr. Tom Clarke. As the noble Lord, Lord Ennals, has mentioned it was skilfully piloted through your Lordships' House by the noble Baroness, Lady Masham of Ilton, and noble Lords played a notable part in ensuring that it reached the statute book in a sensible and workable form. The passage of the Bill through Parliament was a tribute to the co-operation achieved between voluntary organisations, the local authorities and the Government. As was mentioned by the noble Lords, Lord Allen of Abbeydale and Lord Ennals, there is much concern about the pace of implementation of the Act. I sympathise wholly with that concern. Ever since the Act received Royal Assent, the Government have consistently made it clear that in their view it is a worthwhile piece of legislation which they would like to see in operation, and working for the benefit of disabled people, at the earliest possible date. Commitment to the principles of the Act has been demonstrated by the fact that four sections—4, 8, 9 and 10—were already implemented in April this year. The Government have also consistently made it clear that those sections of the Act which have significant resource implications can only be implemented when the necessary resources can be made available. I am sure that they have been right to do so. Making a commencement order is in itself a simple enough operation. It is much more difficult to ensure that local authorities have sufficient resources to enable them to meet the additional demands which the requirements of the Act place upon them. We are talking here largely about additional trained staff and the costs of providing them. Those resources cannot be conjured up overnight. Some noble Lords reminded the House that the Government originally expressed the hope that Sections 5 and 6 of the Act, which are very important sections dealing with the assessment of the needs of disabled school-leavers, would be in operation by now. That was on the basis of the original estimates by the local authority associations during the passage of the Bill—necessarily hasty ones, given the pressures of the parliamentary timetable—that those sections would not have a significant extra cost for them. But when the associations subsequently revised their estimates and said that Sections 5 and 6 would indeed have significant resource implications, the Government had no choice but to decide to postpone implementation until issues surrounding the resources could be sorted out. There have been two meetings with the local authority associations at ministerial level to discuss further progress in implementing the Act, the last of which was on 16th September. There have also been a number of meetings between the DHSS and local authority association officials, the last of which was held some 10 days ago. Latterly we have concentrated on the issues on Sections 5 and 6, although we have not lost sight of the need to make progress on other sections as well. As the noble Lord, Lord Ennals, has indicated those discussions have been going well. At its meeting last Friday the Association of Metropolitan Authorities social services committee agreed the figures on the costs of Sections 5 and 6 which emerged from officials' most recent discussions, and indicated that on that basis they wanted the implementation of Sections 5 and 6 to go ahead as quickly as possible. I understand that the Association of County Councils is also considering the matter urgently. When he has heard from them, my honourable friend the Minister for the Disabled should be in a position shortly thereafter to make an announcement on the implementation of Sections 5 and 6. I now turn to social security matters. We have heard in the debate about some aspects of the benefits which are provided to meet both the day-to-day needs of disabled people and the additional costs arising from their disabilities. Some noble Lords have argued in support of further extension of these benefits. I would remind them that this Government have in fact found the resources to increase expenditure in this area very significantly. In 1986–87, we spent some £6 billion on disability benefits. an increase of about 70 per cent. in real terms since we took office in 1979. Far more people are getting disability benefits now, and there has also been a considerable increase in the amount being paid. Overall, expenditure reflects a considerable amount of new money which we have been able to find for this purpose. There have been important changes affecting individual benefits. We have extended the availability of invalidity care allowance; introduced the new severe disablement allowance; and increased the rate of mobility allowance in real terms, as well as taking it out of taxation. The development of our policies on disability benefits has been hindered by a lack of reliable and up-to-date information about the numbers, needs and circumstances of people with disabilities. That is why we commissioned the OPCS survey of disability to which I have already referred. We shall be considering what conclusions can be drawn from the results of the survey in relation to the provisions we currently make for disabled people. I now turn to supplementary benefit and its successor, as from next April, income support. We have, since we took office, been able to improve the help that goes to disabled people receiving supplementary benefit. There has been an improvement in the value of the scale rates compared with inflation. In 1980, we reduced the qualifying period for the long-term rate for disabled claimants under pension age from two years to one year. As a result, the latest data shows that nearly 34,000 living in the community either in their own or other people's homes are receiving extra help a year earlier. We also tackled the invalidity trap so that periods in receipt of long-term incapacity benefits now count towards the qualifying period for the long-term scale rate. Some 55,000 sick and disabled people benefited from this change. In approaching next April's reforms, we therefore start from a higher base of support than that when this Government came to office. A number of noble Lords have raised questions about the effect of the new arrangements on severely disabled people living in their own homes. Let me put the issue into perspective. An increase in financial help is planned for those who will receive the disability premium. This increase will more than match the £50 million illustrated in the technical annex to the Government's original White Paper published in 1985. And, on top of that increase, it is estimated that a further £8 million will go to people who qualify for the severe disability premium. The great majority—85 per cent.—of sick and disabled people under pension age will gain or be unaffected by the changes. The illustration of the effect of the reforms shows people receiving the disability premium gaining £4.80 on average in real terms. And no disabled people at present receiving supplementary benefit will be worse off. Transitional protection will help existing claimants who would otherwise lose at the point of change. This is not just protection in cash terms. We have provided real terms protection for those with very high domestic assistance additions—an important safeguard. Because in assessing income support we will continue to ignore mobility allowance and attendance allowance for most purposes, we will have a more varied system of state financial help than is visible in the disability premium itself. It will also enable significant entitlements to be built up by way of the personal allowance, disability premium, mobility allowance and attendance allowance where relevant, with in certain cases either the severe disability premium being paid direct to the person or invalid care allowance paid to someone else providing care and support. To give an example, a single disabled person aged more than 25 getting higher rate attendance allowance, the disability premium and the severe disability premium will receive £104.15 in benefits. In addition, he or she would get maximum housing benefit. Given the obvious constraints there always are, I really do not think that this could be labelled either mean or uncaring. In addition, the benefit system will continue to give help with rent and rates. There will therefore continue to be significant support through the benefit system for severely disabled people living in the community. We have carefully considered the alternative proposals produced by the voluntary organisations for extra help for very severely disabled people. But these would either have produced very substantial extra costs—up to £300 million— or have implied a system so complicated that local offices would not have been able to operate it without an unacceptable degree of confusion and uncertainty. We are, however, conscious of the needs of a very small number of severely disabled people whom we would wish to help to stay in their own homes. My honourable friend the Minister for Social Security and the Disabled is trying hard to find a way to assist this small group. I now turn to particular points which noble Lords have raised in this debate. The noble Lord, Lord Carter, asked about the social fund. Supplementary benefit is too complex, so weekly benefit will be provided by a new, simpler income support scheme, but exceptional one-off needs will be handled separately by the social fund. This help will provide more flexibility than now. Vulnerable groups, such as the disabled, will be able to get community care grants to enable them to rejoin or stay in the community. We believe that it is better for special help to be provided in this flexible way rather than under the existing regulated scheme. I agree very much with what my noble friend Lord Ferrers said about the importance of co-operation between professional and non-professional sectors. I am sure that everybody in your Lordships' House joins him in his tribute to the important role of the Voluntary sector. The noble Lord, Lord Banks, reminded us of his party's interesting proposals in this area. These seem similar to those put forward by the Disability Alliance and Disablement Income Group. The costs of the latter proposals—£2 billion to £3 billion—must constitute a serious obstacle. The noble Lady, Lady Kinloss, raised questions on deaf/blind people. The noble Lady is right to highlight the special problems of this group. She referred particularly to the question of mobility allowance. Many people who are handicapped in this way already qualify for the allowance and there are legal and financial problems in amending the regulations to make specific provision for them. We are therefore looking at the way in which the current regulations work to ensure that as many as possible get their proper entitlement. The noble Lord, Lord Basnett, raised a wide range of issues on the vital question of employment of disabled people, on which he speaks with much expertise. Perhaps I may respond briefly by pointing out that we have achieved a good deal in the area of employment and training. In 1986–87, over 80,000 people with disabilities were placed into jobs or into community programme projects. In the same period, the number of people with severe disabilities in sheltered employment increased by 1,033 to 17,400. The number of people with disabilities entering training schemes also increased to nearly 13,000, of whom nearly 9,000 were young people entering the Youth Training Scheme. The noble Earl, Lord Radnor, raised the issue of resources for the 1981 Education Act. The Government are already providing substantial resources. The average expenditure bill in special schools has risen by 14 per cent. in real terms between 1982–83 and 1985–86, compared to a 5 per cent. increase in primary and secondary schools. In the current year, the Government's plans for total local authority expenditure on education represent a cash increase of 18·8 per cent. over 1986–87 plans. Other funds are being provided for teacher training, educational psychologists and electronic aids. The noble Viscount, Lord Ingleby, raised a number of interesting issues about access and mobility. Perhaps I may comment on what he said about pedestrianisation. The Government believe that pedestrianisation schemes can bring significant benefits to the community as a whole and that it would not be right to circumscribe local authorities' freedom to provide them. Local highway authorities have general duties to secure and maintain reasonable access to premises and are in the best position to take account of local needs and conditions, including the interests of disabled people in their areas. My noble friend Lord Auckland raised the question of speech therapy and eye clinics. Speech therapy services have increased at a rate faster than the general increase on national health expenditure. The number of speech therapists has doubled since they have all been employed by the NHS. The noble Lord was right to draw attention to the importance of proper provision for blind people. The noble Earl, Lord Longford, raised a question concerning discrimination against disabled people. We are completely opposed to discrimination against disabled people. That said, we are not convinced that widespread discrimination exists; nor, indeed, that generalised legislation will be the best way of tackling it. The noble Lady, Lady Saltoun, mentioned alarm systems for elderly and disabled people. All that the Government are doing is to clarify the present position on the availability of housing benefit to help people with the costs of alarm systems. No one should be affected provided that local authorities have advice from the department. The noble Lord, Lord Blease, raised a question about general funding and the Equal Opportunities Commission in Northern Ireland. The Government are still consulting on the subject of the Equal Opportunities Commission in Northern Ireland and will study with great interest a report of the Northern Ireland Council on Disability. My noble friend Lord Swinfen raised the issue of flexibility in financing residential care for disabled people. The Government will need to consider this issue carefully when we have received Sir Roy Griffiths' report on community care. The noble Baroness, Lady Masham of Ilton, was concerned about people with spinal injuries and other physically disabled people somehow slipping down the list of priorities. I assure the noble Baroness that the Government continue to treat physically disabled people as a priority group. We do our best to ensure that their position is protected, given the other demands which are properly made in other areas. The noble Lord, Lord Peston, raised the question of what the Government are doing to support speech therapy. There is no evidence of widespread vacancies in this expanding profession although the position will vary from place to place. The noble Lord, Lord Henderson of Brompton, spoke about a Select Committee on discrimination against disabled people. My noble friend the Leader of the House will no doubt carefully note the points made by the noble Lord, Lord Henderson. To attempt to cover the needs and problems of the disabled in a debate lasting two and a half hours is of course an impossibility. Because such constraints limit us to merely scratching the surface of a few of the problems, we must inevitably rely upon good faith and a generous attitude in terms of the general spirit of the debate. This has been a good debate in which the Government for their part, I trust, have clearly shown that they are not an administration who, in the face of the infirm, cast down their eyes and pass by on the other side. The Government wholeheartedly accept the problems of the disabled. However, while accepting that there is much yet to be done, as indeed will always be the case, the Government are never less than realists when it comes to the resources that can be directed to the needs of those who suffer from disability. Those resources, as we all know, can be determined only by the economic development of the nation, for the greater the wealth the greater the amount of that wealth that can be directed towards the problems and needs of those who are disabled.
My Lords, I thank all those who have taken part in what has been a wide-ranging and excellent debate. I thank the noble Earl, Lord Arran, for his courteous response on behalf of the Government. I must say that I was disappointed. I took the trouble to tell the noble Earl before the debate that I would be concentrating on the 1986 Act. I asked the noble Earl a number of specific questions on the operation of the Act. The House will have to draw its own conclusions from the fact that he declined to answer any of them. It remains only for me to beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.
Air Defence In The United Kingdom
rose to ask Her Majesty's Government whether they are satisfied with the current and planned improvements to United Kingdom air defence.
The noble Lord said: My Lords, I tabled the Question because in recent months there has been a certain amount of ill-informed criticism on the United Kingdom's air defence. This culminated in Granada television's programme "World in Action" on 5th October. The programme is seen by some 6.5 million people. I wanted to give the Minister an early opportunity to set the matter right. As a keen follower of the televising of the House, I am surprised to observe that the "robes" are being put on the cameras in the Chamber at this moment so that not much of this debate will be seen on television, which is the subject of the Question!
The clear object of the programme was to undermine confidence in the air defence abilities of the UK and NATO. Some points can be dealt with by the Minister; some fall within the areas of responsibility of the regulatory authority, the IBA, and behind that of course stands the Home Office. Granada's "World in Action" series provides the flagship of the ITV companies current affairs programmes. "Panorama" is the equivalent programme of the BBC. We have had reason in recent years to complain of imbalance in this field. We touched on this very much in the debate of 21st July initiated by the noble Lord, Lord Chalfont.
Since seeing the programme on 5th October—at the time I made some notes—I have borrowed a video from the IBA, which I have been through in detail with a number of my noble friends. Thus I was able to see yet again the intention of the producers. It was the clear intention to set up a hatchet job. In fact, the introduction to the programme said:
" 'World in Action' looks at the scandal whereby hundreds of millions of pounds have been wasted on radar which did not work".
Then, as happens in such programmes, the so-called experts are called in for interview. It seems that sometimes they are most desirable experts if they live in sunny climates far away from this country, which
gives excuses to travel and interview them. To underline the programme's intention and the theme, one brings in so-called experts. In this case a Dr. Tom Amlie was called in. By hostile and loaded questions the interviewer seeks to produce from the expert the result he wants. The broadcasting company goes as far as to describe Dr. Amlie as one of,
"the world's greatest experts on missiles".
Perhaps they should have said the greatest expert of the free world. That is quite an achievement but I cannot find any reference to him in any UK or US reference book. However he did his best to destroy all faith in the Boeing E3 AWACS aircraft on which NATO relies currently and which we now have on order.
Another witness who is much quoted is Dina Rasor. Clever stuff is used to describe her. She is shown coming down a hill with the Congress building and Capitol Hill pictured behind her. She is described as working on Capitol Hill. That is meant to give weight to her form. We are told that she is monitoring a project concerned with military procurement and expenditure. She duly sings the right tune and seeks to rubbish AWACS too.
Many parliamentarians in both Houses have been at the receiving end of such treatment. If they do not sing the producer's tune either their contribution is cut or totally eliminated and generally they are not asked to appear again.
After seeing the programme I wrote to the chairman of the IBA. With his usual courtesy Lord Thomson replied. It is important that his reply is put on record. He writes:
"It is normal practice for current affairs programmes to edit interviews. But in so doing the IBA's guidelines lay down that the objective is to express clearly and fairly the views of the interviewee and not to suit the views of the producer".
If that is the aim the actual result is very different.
I turn to another witness who was interviewed, Sir Keith Williamson. He was Commander in Chief of the UK air forces from 1980 to 1982 and he was Chief of Air Staff from 1982 to 1985. He is also a Marshal of the Royal Air Force. Sir Keith told me that he was interviewed for no fewer than 2.5 hours and that on many points the interviewers insisted not just on the take but on the retake and on the re-retake and so on ad infinitum. That was done presumably in an effort to get Sir Keith to make the points which the producer desired.
I can only say that in the end, after 150 minutes of interview, Sir Keith's contribution was cut to 1.5 minutes, which is 1.5 per cent of it. The other 98.5 per cent. was presumably discarded. As a senior officer of Her Majesty's forces who has had great responsibility he must have been extremely astute in his replies.
How do the rules which I have read out and which are laid down by the regulatory authority come to be carried out? What are the sanctions of the IBA? If a sportsman transgresses whether he be a jockey, a cricketer or a footballer he is stood down and temporarily banned. I asked the IBA what happened if a broadcaster transgressed. The IBA replied that if the case was proven it was in a position to censor the programme company. I may not have been reading my papers as assiduously as I should have been but I do not recall any person being censored in public or in print in recent years. Perhaps I have overlooked such a case.
Of course, the extreme sanction is to deprive a programme company which continues to disobey the rules of its licence. But it is no good cutting off a chap's head if one wants to cure the ill. I think that the IBA should examine whether the regulatory authority has enough teeth. I understand that that is a matter for the Home Office but as we shall be considering the whole future of broadcasting in due course perhaps that matter should be looked at. If regulatory authorities are to be effective they must have usable sanctions.
I now come to the question to which I seek a reply. Are our air defences as vulnerable as the 6.5 million viewers are led to believe? If they are so vulnerable is it true that several times in every week our fighters intercept Russian long-range bombers which are probing our air space? Did my honourable friend offer to help with this programme in any way so that Granada more closely carried out the terms of its licence and those of the IBA directive concerning impartiality and balance in programmes?
Today I came across a most apt quote by happy coincidence. It comes from Alan Whicker's book which was published in 1983. It is the paperback version. The autobiography is called Within Whicker's World. All noble Lords will know that Whicker is one of the doyens of television commentators and journalists. He said of the series:
"These topical programmes, which presume to give objective truth unalloyed by the personal idiosyncracies of a reporter, are in fact the most opinionated and politically slanted of all television series. 'World in Action' is clearly a sort of Marxist party-political".
Those are not my views but those of one of the doyens of commentators.
I hope that when my noble friend comes to reply he can do something to restore the faith in Britain's ability to design, manufacture and operate the air defences of this country.
My Lords, I would first like to congratulate my noble friend Lord Orr-Ewing on raising this subject tonight, and on his comments on the TV programme which took place recently. I wish to intervene briefly for several reasons. In the early 1960s I spent some time as Parliamentary Private Secretary to the Secretary of State for Air and therefore I worked for two years very closely with the Royal Air Force at that period. Subsequently, I spent two years as Parliamentary Private Secretary to the Minister of Aviation. At that time we were playing a part in the build up of the procurement operation which we see today and which is handled by the Ministry of Defence.That was the beginning of sophisticated weapons systems coming into our defence procedures. It was interesting to see at that moment of time the development of many of the problems which we faced then which have got more difficult and sensitive as time has gone past. We may say that that was a long time ago and ask why on earth I am talking about it today. However I must now declare my interest as a member of the board of the Westland Group plc. I have been on that board for two years and therefore in more modern terms I have seen something of the procurement difficulties which are faced by the Ministry of Defence and by industrial companies at today's date. That is 20 to 30 years later than the time when I was first involved in the early 1960s. I have nothing to add to the comment made by my noble friend this evening. That needed to be made and I look forward to hearing the Minister's reply. I have some sympathy with the difficulties which have been faced with the Fox Hunter radar which is carried by the Tornado Aircraft. I understand that as a result of the actions which have been taken, of which I hope we shall hear more tonight from the Minister, the Royal Air Force is well pleased with that aircraft which provides a major increase in the capability of the defences of the United Kingdom and those of the NATO northern sector since the early difficulties over this radar have been overcome. I look forward however to an update on that from my noble friend this evening. Moreover, I hope also that my noble friend will be able to say a word about the timescale and what is happening on the major modernisation of our ground-based radar system or UKADGE, because this is obviously extremely important to the defence of the United Kingdom. I think that an authoritative statement by my noble friend would be very helpful at this time. The main point I wish to make tonight, in my very brief intervention, I must confess is to the credit of my noble friend the Minister. It is the fact that he and his team have created a gradual change in the MoD/industrial contractual system. This has been stimulated and encouraged by my noble friend. It was much needed as many of our foreign competitors, that is competitors of British defence contractors, enjoy domestic government support. This often gives them an unfair advantage and is something that worries us. In the past the procurement system has been rather like a disconnected body—an arm here, a leg there and the head elsewhere—with the result that the body is thrown together at the end of the day out of phase and probably out of the timescale. This may be followed by a major political row because the weapons system does not appear on time or has something wrong with it. My noble friend and his team in the MoD have now put together a new approach, which really hands over total responsibility to a prime contractor in the defence field instead of having disparate elements all doing their own thing and being out of touch with each other. This new approach, with a controlling contractor handling a programme at a desired price and within a desired timescale, is beginning to work quite well. I should like to express appreciation regarding this welcome development, which I think is important. Of course it will only continue to work if the goalposts are not moved half-way through the game. I am sure that my noble friend will make certain that does not happen, though it has happened in the past. I remember 25 years ago seeing the goalposts moved around by the then Ministry of Aviation. In those early days it caused great difficulty to defence contractors who were trying to carry out instructions and deal with proposals put forward by the Air Ministry of the day. The other point I should like to make—I do not think it came over clearly enough, though perhaps it was not the fault of the producers of the programme—is that we are dealing here in electronic areas at the very frontiers of knowledge and scientific endeavour. I personally regret, for instance, the decision by Her Majesty's Government—though this has nothing to do with my noble friend because it concerns another department—to pull out of the European space programme. I believe that there are areas there which are of great importance to us and that there is great scientific benefit to be gained from being part of that programme, even though 1 recognise that it is expensive. Nevertheless I think it is a great pity that we opted out. However, we are not alone in dealing in areas at the frontiers of knowledge and science. Other countries are doing it: the Americans are doing it. I have been round some American electronic factories quite recently and they are facing problems very similar to those which our electronic developers are encountering here. So we are not alone; other nations and not just Britain, sometimes get it wrong. I think that we in the West are continually breaking new ground in an attempt to give our weapons a competitive edge on the battlefield. That is what we are all trying to do to help our respective ministries of defence. Here in this country it is the MoD; in the United States it is the Department of Defense; and I have no doubt (although I have no direct knowledge) that our allies in Europe are also facing the same problems. I believe that my noble friend the Minister of State and his department are getting it right for industry and the nation. There will be more problems in the future, but I believe they are trying to get it right and I think that the Government should be congratulated and not derided. For that reason, I welcome the fact that my noble friend has brought forward this question tonight, which has enabled us to talk about the matter in public. I look forward to hearing my noble friend's reply.
My Lords, I want to thank most sincerely the noble Lord, Lord Orr-Ewing, for giving us an opportunity to have what I believed was going to be a debate on the United Kingdom's air defence. Yet I am bound to say I was most surprised that the overwhelming proportion of the time taken by the noble Lord did not deal so much with air defence as, perhaps fairly, with the criticism of a certain programme. I hope very much that the Minister has come along to deal with the Question that appears on the Order Paper and not the question which has actually been posed; because if one wanted to pursue the content of the opening speech, the Question really should have been: "To ask Her Majesty's Government whether they are satisfied with the current and planned improvements and the standards of fairness and lack of bias in certain television programmes". That is not even dealing with television in general.It was a fair peg and I cannot dispute anything that was said on the programme. We on these Benches start from the premise that of course we are fully committed to having the best possible air force that money and national security imperatives can buy. What we want to hear from the Minister tonight are not only the assurances which, quite fairly, the noble Lord asked should be given as a rebuttal to what he alleges was the bias and the slant in that programme. We also feel that from time to time—not too frequently—the nation is entitled to hear from the Minister an update on various things. Certain announcements are made and various programmes are entered into which are accepted. Then one hears about slippage and other problems. We do not want the House to be informed every time there is a slight change; but we think that from time to time we ought to be told frankly whether we are on course for producing that which the nation believes is in the programme. I do not think you can look at the present and future state of the air defences of this country without looking at the overall defences of the country. I am not for a moment going to enter into the arguments for or against nuclear weapons or unilateral renunciation of them. However, in my view we have to look at what the Tories said in 1979 when they came into government. They said that defence was going to be the first charge on our national resources. I make the charge that in 1987 Britain's conventional forces are in a worse state now then they were before the Second World War. The Government of course have adopted a defence posture that has tried to maintain neither strategic credibility or economic sustainability. They are hoist between those two points. We know the Government are committed to £9·3 billion for the Trident project and we assert that the conventional response this nation can make, as a consequence of that, suffers. We say that the armed forces are denied the resources and equipment that they need to maintain a credible conventional defence. In other words, bluntly, the weapons of first resort are being sacrificed to pay for the weapon of last resort. We are entitled to be corrected and entitled to be accused of either not being in possession of the full facts or of misusing them, but that is the lot of any Opposition in any Chamber of this kind. The Government must be in possession of them and all we can do is to ask certain questions. I want the Minister to deal, among other things, with what I have been told is, if not the crisis, the position of the loss to our air force of trained pilots and trained navigators. I am told that it cost about £3 million to train a jet pilot in 1987 and almost £1 million to train a navigator. We are talking about large sums. We are told that those people are leaving to work, for instance, in Saudi Arabia or for commercial airlines. I know that the answer to my question will probably be that they are not leaving and that the Government are satisfied with the progress of recruitment or that we have the position all wrong. However, my information is that we are losing pilots and navigators at an unacceptable level. We know about wastage and about better offers. However, if what we are doing as a nation is to use taxpayers' money to train people and then lose them, then we need an answer. Perhaps the Minister can tell the House whether such wastage is anything to do with the overseas allowance for servicemen living in Germany which was cut to save £17 million. Will the Minister comment on the fact that up to 70 per cent. of RAF married quarters are substandard? Will he tell the House whether the effect on morale, which must lead to a reduction in pilots, has anything to do with the late receipt of new equipment upon which air force morale must undoubtedly depend? Perhaps the Minister can also tell the House about recent press reports from defence correspondents. I am looking in particular at the Independent of 5th October. That newspaper contains an article by Mr. Mark Urban which says:
"But cuts amounting to several hundred million pounds are still likely to be imposed over the next three years.
we all know that that is a euphemism for some sort of briefing.Defence Ministry sources"—
In other words, there would be a policy of equal misery."said cuts would be spread through the department rather than falling heavily on one service".
I should be grateful if the Minister, who is always well briefed in these matters, can give us an indication of the situation in that regard. Perhaps the Minister can also tell us, as we are looking at the state of our air defences tonight, about the state of the United Kingdom air defence and ground environment, known as UKADGE, and how it is progressing. I am told that original estimates were that that environment would cost £400 million but that the cost now exceeds £1 billion. When the air defence studies of the 1970s took place, they did not consider the threat posed by Soviet cruise missiles. As a result, the UKADGE project was not designed to cope with the new generation of small, low-flying Soviet cruise missiles which are now being developed. Will the Minister say whether those problems, which could not have been foreseen, can be dealt with satisfactorily from our state of preparedness as far as the Government are concerned? Will the Minister comment on moves which have been taking place to integrate communications and data transmission? I am thinking particularly of the airborne early warning aircraft, the interceptor aircraft, ground radars and operational centres. I know that we in this country have been developing our own co-ordination system for those very essential strategic elements in our air defence. But from what 1 have read, I understand that there may be conflicts between our preparations and those of NATO, not least because in some areas there is a lack of comparability and of interoperability. Perhaps the Minister can also deal with the issue of identification of friend and foe. I understand that concerning IFF there are still difficulties in getting agreement. As the Minister well knows, that might lead to shooting down a friend if the method of identification is not absolutely clear. Will the Minister say something about the point made by the noble Lord, Lord Fanshawe, in respect of the European fighter aircraft? That aircraft is absolutely crucial to the ability of this country to give adequate air cover, particularly on the central front. We are promised that it will be with us and in service by 1995, which is the date fixed for complete delivery of the system. Is everything going to plan or is there slippage in respect of that date? Finally, I hope that the Minister will be able to deal with the problem of low-flying aircraft. The issue of low flying has been raised, often in a local context. Tragically it is often discussed when, as a result of low flying, terrible accidents occur. I subscribe to the view that we need an air force which is well practised in the stratagems of low flying. However, concern has been particularly evident in areas such as Cumbria where there have been one or two nasty accidents. Can the Minister say whether anything is being done to minimise risk to pilots and the general public? We are far from satisfied in this House that the state of our air defences is commensurate with our needs or the amount of money spent. I shall be grateful to hear what the Minister has to say to reassure us on those points."The Royal Air Force's request for two more Boeing E3 AWACS early warning planes is likely to be affected. Senior RAF officers have suggested, as a compromise, that only one be bought to supplement six already ordered".
My Lords, I should like to add my words of thanks to the noble Lord, Lord Orr-Ewing, for raising this matter and for giving me the opportunity to set the record straight with regard to the state of the United Kingdom's air defences, not least because media coverage in recent months has presented a very distorted and misleading picture of our capabilities in this extremely important area.With your Lordship's permission, I should like to remind the House of a number of developments in the United Kingdom's air defences since the Second World War. In the late summer of 1940, the air defence of the United Kingdom assumed vital importance in the Battle of Britain. Your Lordships will not need reminding that the victory then gained by the Royal Air Force played a major part in saving our country from invasion, enabling the war to be carried back to the enemy. While much in the world has changed since those days, the vital task of the defence of our air space and its crucial importance to the defence of our country has remained unaltered. Throughout the past 40 years, the Royal Air Force has striven to maintain the highest possible standard at all times. That this has been achieved is, in my view, itself a tribute to its skill and professionalism. It is, however, true to say that there have been times since the Second World War when the priority accorded to our air defences has been lower than it is today. In the aftermath of the defence White Paper of 1957 and the then prevailing NATO trip-wire strategy, with is heavy reliance on nuclear weapons, the forces dedicated to air defence had been run down by the decision not to proceed with the development of manned interceptor aircraft. The only project to survive this decision was the Lightning, which was originally intended as a research vehicle and went on to serve with distinction for some 30 years, and is only now being retired. For many years the Lightning, together with the surface-to-air missile force and of course radar, were the mainstay of the defence of the United Kingdom. While missiles have a key part to play in the defence of specific areas, they cannot offer comprehensive cover for the range of potential targets likely to be threatened. Subsequently, the Phantom aircraft, purchased from the United States, replaced most of the Lightnings and, in turn, some of these Phantoms will be replaced in the near future by the air defence variant of the Tornado, about which I shall have more to say in a moment. The Phantom will continue to serve into the 1990s, when it is planned that the remaining aircraft will be replaced by the European fighter aircraft. It is not, I believe, properly understood that this Government are in the process of driving through one of the most significant upgradings of the United Kingdom's air defences ever undertaken. Press and media commentary tends to focus on the fact that this is not yet complete and on the difficulties which any programme with this degree of sophistication and complexity is bound to encounter. There is a failure to acknowledge either the magnitude of the resources allocated to the programme or, more importantly, the quantum improvement in capability which will be achieved as a result of this Government's commitment to the success of the programme. I should like to underline that message tonight. Only yesterday (as your Lordships will have seen in this morning's papers) the press were able to inspect the latest step forward, the formation of the first Tornado air defence squadron at RAF Coningsby. As the reports correctly state, the Royal Air Force is delighted with the performance and reliability of this aircraft, which gives it significantly better performance and range than the older Phantom interceptors. Seven operational Tornado air defence squadrons will form as a result of this programme. The defence of the United Kingdom air defence region—which comprises not only the sovereign airspace of the UK but also large areas of international airspace over the Atlantic and North Sea—is essential not only to this country but to NATO's ability to withstand any Warsaw Pact attack on Western Europe. The United Kingdom is not only our own homeland but also provides a forward base for maritime operations in the north-east Atlantic and north Norwegian Sea, a rear base for operations on and over the Continent, and a main operating base for maritime operations in the Channel and eastern Atlantic. Furthermore, the United Kingdom would play a crucial role in war as a staging post for reinforcements from North America. In the United Kingdom, RAF Strike Command has the main responsibility for air defence both of our islands and of the surrounding sea areas. The importance of this role to common defence has been recognised in NATO by the creation of a special NATO Command, the United Kingdom air defence region, held by the commander-in-chief of RAF Strike Command; and by the investment of substantial funds from the NATO infrastructure budget both in a new automated regional air operations headquarters at the commander-in-chief's headquarters at High Wycombe and in an extensive programme to provide hardened operating shelters and facilities for the command's most important assets, its aircraft, their crews and support staff. In peacetime, the Royal Air Force is tested regularly, not only in national and NATO exercises but also by those aircraft of the Soviet Union which fly into the UK air defence region. My noble friend Lord Orr-Ewing referred to this fact. We should perhaps pause to contemplate just why those aircraft fly so often so far from home. Incoming Soviet aircraft are regularly detected by UK or allied radars and, when they reach the UK air defence region, our quick reaction alert fighters—Phantoms or Tornadoes, supported as necessary by air-to-air refuelling aircraft—are there to meet them. On average, three or four times a week it is necessary to intercept, identify and shadow these visitors until they leave our air defence region. This is all done in a disciplined and professional way, maintaining contact with our NATO partners as necessary. Whenever the RAF is judged formally in NATO exercises and tactical evaluations, the very high standards attained confirm its readiness and ability to "do it for real". In war, the task of the Royal Air Force is to restrict an enemy's ability to mount a successful air attack by inflicting significant losses on an attacking force before they can release their weapons. To achieve this objective we maintain a layered air defence system. Longer-range defence is provided by fighter aircraft on combat air patrol or ground alert, supported by tankers and directed by airborne and ground-based radars. Medium-range defence is provided by other fighters on shorter-range combat air patrol or scrambled from ground alert, supplemented by Bloodhound surface-to-air missiles, while close-in defence is provided by Rapier surface-to-air missiles and Skyguard radar-controlled guns. However, the threat facing us has steadily increased with the continued update of the Warsaw Pact's air forces, with the introduction of new fighter, bomber and support aircraft. There is a need therefore to develop our own modern conventional weaponry to enable us to stop and, if possible, repulse an attack. We are now engaged on a major modernisation programme which is well advanced. The Royal Air Force's air defence capability will greatly increase in three key areas over the next few years. First, airborne early warning is a key component of our air defence system, providing timely information to ensure that our fighters would be directed to where they were most needed. As the Warsaw Pact develops its capability for operations at low level, so the ability of the AEW aircraft to look down on potential targets becomes more and more important. The Government's decision last December to purchase the Boeing E3 will ensure that the Royal Air Force has a modern and effective airborne early warning system for the 1990s to replace the ageing Shackletons whose continued operation in service owes much to the devotion and dedication of their crews. In view of recent misleading media speculation about the vulnerability of the E3, which was indeed referred to in the programme to which my noble friend Lord Orr-Ewing drew attention, it is worth while commenting briefly on that. While, like any aircraft, the E3 is not invulnerable to attack, it is assessed to be highly survivable in performing its operational tasks. Before an attack can be mounted, an attacker must get close enough to deliver a weapon. The E3's radar currently outranges, by a large margin, all other airborne radar. I can, moreover, personally attest to your Lordships the powerful range of the radar which I experienced at first hand when I flew in an E3 last year. Once potential enemy aircraft are seen taking off or entering the E3's radar cover, the E3 has the option to move, at speed, to a safer area while continuing to monitor all air movements or to direct friendly fighters to deal with any potential threat. There are thus a wide range of tactical options. Considerable work has been done on developing appropriate tactics and in refining likely E3 orbit locations to reduce the aircraft's vulnerability. Its radar range is such that it can be positioned in protected airspace and still carry out its airborne early warning tasks. This capability to carry out its primary functions from within defended airspace is one of the aircraft's main assets. It is thus possible to retain both the early warning and battle management functions of the E3 while minimising vulnerability to current and postulated future threats.
My Lords, is the noble Lord in a position to respond to my query as to the delivery of the two which are either outstanding or programmed? Can the Minister comment on the report I read in the press, which I accept could be wholly inaccurate, that there is some dispute as to the date or whether in fact they will be delivered at all?
My Lords, I am not sure what dispute the noble Lord is referring to because I know of none. The fact of the matter is that we have ordered six of these aircraft. We have currently an option for a further two and we shall be making up our minds very shortly how we shall proceed in accordance with that option.The second key element of our major modernisation programme is the introduction of the Tornado ADV, a superb aircraft whose excellent range and loiter capability make it ideally suited for the longer-range air defence role. Of the air defence variant of the Tornado 165 have been ordered to date. The build-up of the new ADV force is proceeding according to schedule in both the formation of units and of the numbers of aircraft on those units. The operational conversion unit which trains pilots on the new aircraft, formed in 1985, was declared to NATO last year as an operational unit. As I have already mentioned, 29 Squadron RAF, the first ADV squadron, has now also formed at RAF Coningsby and will be formally declared to NATO as operational—on schedule—on 1st November, just four days from now. The Tornado ADV is armed with the highly effective Skyflash medium-range air-to-air missile and the shorter range AIM9L Sidewinder system. Although, as we have made clear on a number of occasions to Parliament, the aircraft's sophisticated Foxhunter air-intercept radar does not yet meet all the requirements of the Royal Air Force, action is in hand to deal with this problem. Radars to an agreed interim standard have been delivered and are already providing an operational capability superior to that of the aircraft they are replacing. We are currently negotiating with the company new, firm price contractual arrangements for a programme of modifications to bring the radar up to the standard required to meet the threat of the 1990s. The third key improvement is the comprehensive modernisation of our command and control system and ground-based radars now being implemented, which represents the most radical improvement to the United Kingdom Air Defence Ground Environment since the early 1960s. The core of these improvements, which are known as the Improved UKADGE, as the noble Lord, Lord Graham, said, comprises a network of operations and reporting centres covering the United Kingdom air defence region from the Faroes to the South of England, backed up by a chain of advanced technology transportable radars which will provide the primary source of information collection. This Improved UKADGE will be fully integrated with the NATO air defence system from which it will receive early warning data. It will also make full use of data provided by AEW aircraft and ships at sea. It will provide essential and continuous air defence information to such command and control centres as the new UK AIR Regional Air Operations Centre. As part of this latter development at Strike Command, your Lordships may be aware that we have also recently awarded—after an international competition—a £37 million contract to a British consortium led by International Computers Limited to provide a Command and Control and Information System. This will provide the NATO Commander in Chief, UK Air Forces, with a substantially improved capability for the control of UK and other air forces. The Improved UKADGE is being developed under fixed or firm price contracts let after very rigorous competition. Since the system will make a major contribution to NATO's overall defence capability, there has been considerable financial support from the NATO infrastructure budget. The gross cost of the core system and the transportable radars, together with associated communications and works services, is estimated to be about £500 million, of which about half will be recovered from NATO, thus representing extremely good value for the British taxpayer. The bulk of the equipment has already been built and installed and some elements are already in service use. The remaining elements will be introduced into service during the next few years. I am convinced that this improved system, when fully operational, will be one of the best of its kind in existence anywhere. In addition to these three major programmes, our air defences will also be strengthened by the running on of two squadrons of Phantoms and improvements to the Rapier surface-to-air missile system; 72 Hawk trainer aircraft are also being equipped with Sidewinder air-to-air missiles which will provide a valuable enhancement to our air defence capability at relatively low cost. With such a major modernisation programme at the very forefront of technology, it is hardly surprising that there have been a few technical difficulties. We have not tried to conceal them. We have all learned lessons from the Nimrod saga. But these difficulties need to be kept in perspective against the major improvement programme we are undertaking. When this is complete, we will have achieved a radical transformation of our air defence capabilities, well equipped and—thanks to the high professionalism and dedication of our personnel—well able to cope with the challenge of the next decades. I believe that we can now look forward with confidence to the successful completion of the current modernisation programme to reshape the UK's air defences and to restore them to their prime position in our overall defence posture. It must not be thought that our efforts stop there, for we must continue to assess the threat and look to ways of meeting it in the future. We are therefore participating in the collaborative advanced medium and short range air-to-air missile projects to provide our air defence forces with the enhanced weaponry they will need to meet the growing Soviet threat. And finally, we are, of course, participating in the collaborative EFA project to provide the Royal Air Force with an advanced combat aircraft for the 1990s and beyond, with a close-in agile fighter capability that will supplement the longer range air defence capability of the Tornado. The Government are making substantial investments in our air defence systems. Major improvements are well advanced in the three key areas of airborne early warning; the build-up of the Tornado ADV force; and the modernisation of our ground-based radars and command and control systems. At the same time we are of course pursuing improvements both in efficiency and in procurement policies and I thank my noble friend Lord Fanshawe for his kind remarks on this, in order to achieve the best value for money spent on air defence. Throughout this period of change, I am confident that the highest operational standards are being and will be maintained and I am sure that your Lordships will support the Government's view of the importance which we have attached, and will continue to attach to the air defences of the United Kingdom. Several noble Lords raised a number of points. The time is now late but I am happy to undertake to write to my noble friend and to the noble Lord, Lord Graham, with answers to the points they raised.
House adjourned at six minutes past nine o'clock.