mcconway House of Lords
Thursday, 28 February 2008.
The House met at eleven o’clock: the LORD SPEAKER on the Woolsack.
Prayers—Read by the Lord Bishop of Southwark.
My Lords, border control manages staff deployment on a command basis, ensuring that resources are deployed according to business needs using a recently updated staffing methodology. In line with government commitments, financial resources are increasingly focused on providing staff and front-line activities. The BIA is committed to increasing the use of automated technology to facilitate passengers through arrivals controls without compromising border security. An example is the iris-recognition immigration system.
My Lords, I thank the Minister for his response. It is of course essential that we do not compromise security, but the opening shortly of Terminal 5 provides an excellent opportunity for setting standards for immigration queues across our major airports. Surely it is unacceptable that our overseas visitors should have to wait 45 minutes to clear immigration and that that should be set as the benchmark. What are the sanctions for failing to hit that benchmark? Do we know whether we are hitting the benchmark at the moment? In the Minister’s Answer to my Written Question, he stated that figures were,
“unavailable due to data collection and quality issues”.—[Official Report, 9/1/08; col. WA 199.]
Tesco would not accept that. Does he agree that without figures we do not know whether we are achieving benchmarks or whether we are improving?
My Lords, first, I apologise to the noble Baroness, Lady Valentine, for the fact that we had not responded to her Written Question. I was appalled to find out how long it had taken. I have put in hand some mechanisms within the department to resolve that because it is quite unacceptable. I am very sorry for the delay. I took some advice from the noble Lord, Lord Jopling, on it.
On the specifics, until the middle of last year we did not keep records of numbers, but now we do. I have, for example, some numbers for the year to date. Yes, we are setting a 25-minute target for someone from the EEA, but at Heathrow Terminal 1 the average is six minutes at the moment and the longest we have had is 47 minutes; at Gatwick North the average is six minutes and the longest that we have had is about one hour 10 minutes. I agree that those are too long, but generally we are considerably below the 25-minute target and the 45-minute target for non-EEA nationals.
My Lords, despite the long queues at some airports, on which the Minister has sought to reassure us, we know that in many cases women and children who have been trafficked here are habitually clearing immigration control with no trouble. Will the Government follow Conservative policy and introduce separate interviews for women and children travelling with men who are not members of their family to help to tackle that loophole?
My Lords, the introduction last year of the 100 per cent check and the fact that we check passports mechanically so that they can be compared with records on the Home Office computer allow us much greater control now and the ability to identify such people. With e-borders, we will be able to do even better and I think that that problem will be resolved.
My Lords, my noble friend raises a good point. I have had my eyes done on the iris system because I wanted to try to get through the queues, which were extremely long in the middle of last year, although we have worked to make them better. That gives you a shorter queue to go into. My concern is that, when everyone has their irises done, the same might not be the case and we might need more lines for people to go through. So far, about 172,000 have gone down this route. I will have to get back to the noble Lord in writing with the precise figure if that is wrong.
My Lords, has the Minister seen the figures published by the website UK Airport Delays showing that the average delay at Manchester is 68 minutes, at Stansted 45 minutes and at Gatwick 24 minutes, whereas a number of other airports, including Prestwick and London City, have zero delays? In view of the wide variation between one airport and another, will the Government ask the UK Border Agency to commission regular monitoring to see how best practice can be used to harmonise the delays between one airport and another and to reduce them to the minimum possible?
My Lords, the noble Lord makes a good point. London airports generally have very good times; the average is certainly well below the required level. The provincial airports are not so good. The BIA looks at moving staff around to try to cover this and improve it. We have now introduced a requirement for weekly information on queue lengths, which is compiled in a monthly performance check, along with information on measures that are being taken to make the timings shorter. We are trying to tackle the problem and are recruiting an additional 385 staff to assist with that.
My Lords, does the Minister recognise that the quality of our border control is a disgrace to the Government? There is no routine control over people leaving and the control over people coming in—the swiping of passports—makes no record of those who have come in. Does he agree that the principle of being out of Schengen, because we can do this better outside, is undermined by the deplorable fact that we will not have electronic border control until 2013? Will the Government do something about that?
My Lords, I disagree with what has just been said. We have some very good border controls and the moves that are being made this year are quite remarkable in making the situation better. It is certainly true to say that until we have e-borders in place we will not fully check everybody in and out, but we are aiming for that and moving towards it. When we do that, we will be a lot safer and will have much better control of people. We have done a great deal to make this better. By the end of the year, with the three phases that we are stepping through, the situation will be remarkably good.
My Lords, will the Minister assure me that the layout of immigration desks in the new Terminal 5—there will be two tiers, with four desks at the front and four at the back—has not been specifically designed to make it less obvious when only half the immigration officers are on duty, as compared to the straight-across barrier that makes it very apparent when no one is there to let you in?
My Lords, the noble Baroness clearly has detailed knowledge of this area, which I do not. I am afraid that I may have to get back to her in writing on that, because I do not really know. However, we are constantly in dialogue with the airport authorities to look at better ways of allowing queues to form and people to move through the terminal and to make coming through the airports a better experience. There is constant debate and dialogue to achieve that.
My Lords, has the Minister read the article in today’s Times by Anatole Kaletsky, which canvasses the possibility of relieving the increasing pressure on Heathrow with an artificial island on the Thames estuary, similar to what has been done in Japan, Hong Kong and many other places? Have the Government looked at this possibility? If so, what can the Minister say about their views?
Courts: Rape Trials
My Lords, we have no plans for offences of rape to be tried other than before a judge and jury. However, we will continue to look for ways to inform juries about the psychological reactions of rape victims in order to address commonly held myths and misconceptions.
My Lords, has my noble friend reflected on the comments of the noble Lord, Lord Elystan-Morgan, in a debate on rape late last year? He said that juries’ decisions often have,
“as much to do with a whole package of subliminal prejudices as … with the evidence”.—[Official Report, 29/11/07; cols. 1313-14.]
I understand he was reflecting a view widely held in the legal profession. If juries are so notoriously unreliable, why should we not review the system of jury trials and perhaps even consider specialist juries?
My Lords, I am reflecting rather a lot on the wise words of the noble Lord, Lord Elystan-Morgan, as we gallop through the Criminal Justice and Immigration Bill in your Lordships’ House. I have reflected, and I do not want to criticise juries in the way that my noble friend has because I believe they are a critical component of our criminal justice system. There has been concern that misconceptions among the public in general about the psychological impact of rape and the reasons for delay on the part of a victim in reporting a rape to the police might perhaps be reflected within juries, but the answer to that is better general education.
My Lords, I suppose I have a right of reply. Does the Minister accept that I in no way suggested that there was any institutional perversity on the part of juries in relation to rape cases but made it clear that in the view of many members of the legal profession there are subliminal preconceptions and prejudices? In a situation where very often the only witnesses will be the defendant and the complainant, where a lot of drink has been taken and where the parties know each other well—they may have lived together or may even have been husband and wife at some stage—an objective dissertation is perhaps very difficult.
My Lords, the noble Lord explains very clearly why the conviction rate in this country is so low. There is a fundamental question about whether we wish to move away from the jury system. The Government do not think we should, but accepting the points raised by the noble Lord, we are thinking hard about what information might be given to juries so that they understand some of the psychological implications and the fact that many offenders are closely known to their victim.
My Lords, I am grateful to the noble Lord for the support he gives to juries and to their use in appropriate trials. He talked of offering further education to juries. Does he not think that that is a matter that is best left to the judges rather than to further guidance from the Government?
My Lords, I certainly pay tribute to members of the judiciary and to the expert way in which they conduct hearings. In 2006, a consultation posed a question about whether defence and prosecution lawyers should be able to call expert witnesses. The consensus was rather against that; there was a sense that that might confuse juries rather than help them. Further work is being undertaken to see whether there are other ways in which expert, impartial information might be made available to juries. I am sure that would be within the context of the overall oversight of the individual judge.
My Lords, juries are an essential part of our criminal justice system. We have seen action to ensure that they reflect the full diversity of the communities that they serve. We should acknowledge that they have a vital role to play in public confidence.
My Lords, does the Minister accept that while what happens during the court process is very important, it is significant that large numbers of cases do not come to trial? Will he think about looking at what happens in New Zealand, where the number of cases that come to trial and the conviction rate are considerably higher?
My Lords, I know that New Zealand is often referred to as an example that we might look to, and I would never want to rule out the value of looking at international experience. We have considered it very carefully. As the noble Baroness will know, in New Zealand, there are two different sorts of crimes. Our worry is that adopting the New Zealand system would in many cases downgrade the offence. I am sure that there is more that the police and prosecution authorities can do. We have now made this a priority in public service agreements, and a lot more work is going on in terms of education and the appointment of specialist prosecutors and specialists on forces to improve the way in which these matters are dealt with.
My Lords, I am very pleased that my noble friend mentioned education. Does he agree that we should be working towards getting a higher conviction rate on rape? Does he further agree that trying to reduce the incidence of rape is equally or even more important? Does he support the White Ribbon Campaign, which is a male organisation that works with young boys and men to try through education to reduce the level of violence shown towards women? Does he agree that the Government should fund a long-term, sustained campaign of education of young boys to go on throughout their lives in order to engender respect for women?
My Lords, it is a very attractive invitation to spend the Government's money in front of your Lordships. I will resist that, but I will, without commitment, look into the question of funding and resources. I certainly agree with the general point that the more we can help to educate young people, in particular, in these matters, the better. Schools themselves have a part to play through the education programmes that they are required to undertake, but what my noble friend mentions sounds to me like an excellent programme.
Children: Healthy Eating
My Lords, the Food Standards Agency has set salt reduction targets and is working in partnership with the food industry and others to reduce the salt levels in foods that contribute most of the salt consumed by adults and children. There are of course legal controls and guidance covering salt in infant food and formula and food served to children at school and in care settings.
My Lords, I am grateful to my noble friend for that positive Answer. Has she noticed that manufacturers list not salt among their ingredients in their labelling, but always sodium—or sodium chloride? Does she agree that many parents who are anxious to avoid giving their children food that may lead to high blood pressure, heart attack or even cancer in later life may not know that sodium—or sodium chloride—is common salt?
My Lords, my noble friend is correct and I commend her for her admirable record of pursuing these issues. The Food Standards Agency has been working hard with industry to reduce salt in food. It has set targets for salt levels to be reduced in 85 different categories of processed food. It is also running a major consumer campaign aimed at raising public awareness of the implications of consuming too much salt. It has been running that campaign since September 2004, and towards the end of this year we will see an evaluation of what effect it is having. Early indications are that it is having some effect, and it is being directed at parents, and especially at mums.
My Lords, it is clearly highly desirable that the foods eaten by children have acceptable levels of salt, and of sugar and fat. However, does the Minister agree that ongoing promotion of foods that are high in those nutrients clearly continues to fuel the rise in obesity and diet-related disease in our children? Have the Government now recognised the need for a ban on such TV promotion before 9 pm, which has been discussed? If so, when can we expect such a measure to be introduced?
My Lords, I am pleased to report to the House—and to the noble Baroness—that the UK is recognised as having the most comprehensive programme of salt reduction in the world. We are leading the World Health Organisation’s salt action network, and our approach is now being replicated in several other countries. We have not only reversed a rising trend in salt intake, but we have achieved an average population intake reduction. This is only half a gram a year so far, but that has already saved 3,300 lives. This might not sound like much, but the scale and speed of this reduction is faster than has been achieved in any other country. We are making a determined effort to conquer this issue.
My Lords, does the Minister agree that the fact that we all like a salty taste is demonstrated by the disappearance every day of the free biscuits in the Bishops’ Bar? This taste is cultivated in childhood. Why are the Government taking so long and dithering over forcing manufacturers of prepared food and snacks that children in particular eat to reduce the salt content? The Minister says that progress is being made, but salt in high quantities is toxic. Where is the action? We want it now—or is she afraid of some terrible Pringles revenge?
My Lords, actually, I do not really like Pringles very much. The noble Baroness is absolutely right that a lot of this is to do with taste and habit, and with the fact that we all have salt pots on our table and our children are used to seeing that. Noble Lords should make a commitment to have no salt pots on their table.
The Government’s approach to reducing people’s intake includes several things. The first is the reformulation that will help to reduce the level of salt in foods so that the 85 different categories already referred to include things such as pizzas, snacks, breakfast cereals and convenience products. Those targets are being monitored and, if necessary, firmer action will be taken, as the noble Baroness will be aware. The consumer awareness campaigns mean that the number of consumers cutting down on salt has increased by more than a third. Indeed, there is a tenfold increase in the awareness of the “6 grams a day” message. This does not mean, however, that there is not more to do; clearly there is.
My Lords, does the Minister agree that the European Commission announced the publication of a draft regulation to introduce compulsory front-of-the-pack food labelling, based on guidance on daily amounts? The Conservatives have been calling for the Government to adopt the approach favoured by the European Commission since 2004. When are they going to do so?
My Lords, it is nice to hear that the Conservatives approve of something that the European Commission is recommending. Noble Lords are, I am sure, aware that the recommended daily intake for adults is 6 grams. The recommended daily intake for children is less than 1 gram a day, but there is a sliding scale for children. It is very important that the Government continue their dialogue with food manufacturers to ensure that they recognise that. I feel I should mention that McCain, Heinz and Kraft are actively targeting salt reduction, so great progress is being made.
My Lords, does my noble friend agree that for many parents who want to ensure that the products that they buy have as little salt as possible, the type size used to list the ingredients is so small that most people, even with good eyesight, cannot read it? Could she encourage manufacturers to ensure that the labelling can be read by ordinary people?
Local Government: Cheshire
asked Her Majesty’s Government:
Whether, in accordance with paragraph 11 of the consultation document on local government reorganisation in Cheshire, they will publish the remaining 600 responses of interested parties and the subsequent papers received by the Secretary of State before the decision was taken on 18 December 2007.
My Lords, we received 55,000 responses to the consultation on restructuring proposals. It is simply not viable to publish them all, so we have published a summary. In addition, any person, including my noble friend, can view any of these responses on request. On 25 January this year, officers from Crewe and Nantwich Borough Council were given access to view the Cheshire representations. Which representations they chose to copy was a matter for them.
My Lords, I thank my noble friend not only for that Answer but also for her work behind the scenes to bring clarity to this perilous, parlous and precipitate decision to chop Cheshire in half. But, in the spirit of glasnost, will she publish for the people of Cheshire the 906 responses received, a sample of which she has already mentioned demonstrate 80 per cent in favour of a single unitary Cheshire and only 5 per cent against? Further, in the spirit of glasnost, will she publish the CIPFA report, which undermines the district council’s financial guesses at what will be the consequences for Cheshire if this bifurcation takes place?
My Lords, it would be my great pleasure to welcome my noble friend to my office at the Department for Communities and Local Government to look at the 600 representations he wants to see. The independent financial analysis which we commissioned from CIPFA to look at the affordability of the proposals has not been disclosed because it falls under the exemptions in Section 35(1)(a) and (b) of the Freedom of Information Act 2000. That of course relates to the formulation of the development of policy and ministerial communications, which is consistent with what we have done on other similar FOI requests about unitary proposals. But we have made this information available for the purpose of legal proceedings.
My Lords, will the Minister confirm what the noble Lord, Lord Harrison, has said—that these proposals have very few friends in Cheshire? Will she accept from one who has participated in previous consultations about local government in Cheshire that the public interest is served by the greatest possible transparency?
My Lords, I certainly agree with the noble Lord’s last point but I do not agree that the proposals have very few friends. When you consider that the search for unitary solutions in Cheshire goes back a long way, we are in a unique position because we had two opposing proposals—one for a unitary authority and one for two unitaries. Absolutely predictably, opinion has been deeply divided. Our conclusion was that there was sufficient broad support to make the proposal which we accepted for two unitaries workable in the long-term interests and success of the region.
My Lords, why are the Government insisting on tackling this in such a rush? It is just 63 days until the first elections for these new authorities, yet these orders do not come to your Lordships’ House until next week. Given the number of years that have passed since this was first discussed, why are the Government rushing this so much?
My Lords, I do not think that it is a question of rush. As we have approached this process we have been driven entirely by what local authorities say that they want and can manage. There was a very clear indication from Cheshire that it wanted as little delay as possible. It did not want this to drag on, because it has been an unhappy process for many people. That was made clear when it presented evidence to the Merits Committee. Earlier this week, in another place, local Members of Parliament, some of whom did not agree with the conclusion, have said that this must be made to work and that we must go forward as fast and as safely as possible, which I believe we are doing.
My Lords, does my noble friend agree that there is widespread support for the unitary authority so that citizens and business alike know who does what? Does she also agree that whereas she has said that in Cheshire’s case there are irreconcilable differences between authorities, it is understandable that those who support the proposals, as half the authorities do, believe that they will have abundant time to deliver a successful reorganisation? Inevitably, those who opposed the proposals are calling for more time and more delay; that is understandable but it is not necessarily the wise path to follow.
My Lords, that is absolutely right. What is very impressive is that despite the fact that people do not agree, the implementation process is really going ahead; people are fully engaged and work teams have been set up to look at the future structure of services and new commissioning processes. Our job is to support those committed local authority officers and politicians who are now determined to make it work.
My Lords, it is a matter of regret that the Government’s reputation has been somewhat stained by what is perceived as the selective use of statistics. I accept that there is a difficulty for the Government in this respect because they are damned if they do and damned if they don’t. As it seems highly likely that we will face this situation again, will the noble Baroness give some consideration to how they are going to overcome that very particular difficulty? At the moment, what has happened is not perceived as being based on the sorts of returns that have been published, which makes it very difficult for ordinary people.
My Lords, the noble Lord makes a serious point. In our debates on these issues on various occasions over the past two weeks, we have talked about the nature of polling, the validity of the results and the fact that the Electoral Commission has been involved, but not as it would be when normal voting in a national election takes place. Given that, we would like to give serious consideration to these questions, should the opportunity arise to do so in the future. Transparency in the process is vital if people are going to commit to making a success of the decision.
My Lords, has the noble Baroness received, as I have, a letter signed by all the head teachers of Cheshire schools expressing their great concern about the effects of these changes on the high quality of education in Cheshire? What comfort can she give them?
My Lords, I have not received a copy of the letter, but I know that the Cheshire Schools Forum has joined the debate in, as I understand it, a productive way. I am sure that it wants the best outcomes in the decision that has been taken. We have an opportunity to debate this, at length if necessary, next Tuesday, and I shall certainly try to get more information about it by then.
Business of the House: Debates Today
My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That the debate on the Motion in the name of Baroness Gardner of Parkes set down for today be limited to three hours and that in the name of Baroness Eccles of Moulton to two hours.—(Baroness Ashton Of Upholland.)
On Question, Motion agreed to.
Families, Community Cohesion and Social Action
rose to call attention to the case for strengthening families, community cohesion and social action; and to move for Papers.
The noble Baroness said: My Lords, in my topic for debate today it is not by accident that family comes first. I believe it is that important. The family has always been the backbone of society and remains so. The word “family” has a much wider meaning now than in the past, and society has adapted to accept this. I will not define “family” as each person will put their own interpretation on the word. Each of us knows what we understand the family to be. Multiple studies show that children brought up in a loving family, even if they are financially hard-pressed, grow up to be better adjusted adults. My wish would be that every child could mature in these favourable conditions.
Sadly, this is so. Children suffer neglect, physical and mental, bullying at home, in school or at play, sexual abuse and violence even in their own homes. As a community, we must be on the lookout for signs of these problems and be willing to support and help those families to overcome them. As a society, we must always help those who due to disability are unable to support themselves, and we have a responsibility to their carers, often family members, who willingly undertake a great burden that would otherwise fall on the state.
Major problems arise from addiction, not only to drugs, which have become all too commonly used, but also to gambling and alcohol. Alcohol is rapidly becoming the prime problem for the young. I think that the Government have recognised this and hope to stem the surge in teenage drinking. Police reports confirm that 24-hour drinking has added greatly to the demands made on their time. Debt, both personal and family, has become a major issue. Historically, people bought only what they could afford. The change came with, “take the waiting out of wanting” credit card promotions. Buying or having things you cannot afford is a real addiction for some people, while for others it is simply a lack of understanding that debts incurred have to be met some time. I am old enough to look back to a time when children never drank alcohol and were almost totally ignorant about sex. With increased awareness, young people are sexually active long before the legal age, and I have doubts about the Government allowing pharmacists to supply contraceptives and the morning-after pill to underage persons. Only time will tell whether that reduces the number of teenage pregnancies, for which the UK has an unenviably poor record.
The need for two parents to be in full-time work to afford a modest standard of living amid the rising tax burden can make it difficult to cope with a family. It is wrong that two-parent households need far greater earnings—£240 per week—than a lone parent at £76 per week to move past the poverty line, as shown by Frank Field’s study. Couples should not be penalised for providing two parents for their children, nor should it pay them to split up and thus obtain greater benefits. That is a perverse incentive. Perverse, too, is the benefit trap where taking a job can lose a family money. It must always pay to work. The cost of family breakdown is now more than £20 billion a year.
Poverty and the gap between rich and poor have increased in the past decade. Quality of life is a luxury for those who do not have to fight simply to survive. It is wrong that so many expenses are higher for the poor, such as energy supplies, where obligatory pre-paid meters add £175 a year to the fuel bill.
No one today talks of latch-key children, the major concern when I began dental practice in a non-affluent area of central London. Perhaps we now think “if only” children went home instead of wandering the streets, joining up with others into unsavoury gangs. No longer is the quick cigarette the health hazard; drugs are readily available. Peer pressure often causes youngsters to try these, and then the addictive power of the drugs has them “hooked”.
The formation of gangs of teenagers and young people has created a special hazard for the young themselves and for those who come into contact with them. Individuals who would not dream of attacking anyone on their own, suddenly feel invincible when backed up by a group of others—their gang. In the news every week—sometimes almost daily—we hear of ordinary people being attacked, severely injured or even killed by groups of youths; and they say that gangs of girls can be worse than boys, an unfortunate case of sex equality.
The culture of knife carrying has a cachet of its own. In London and other cities, young people are being killed by their peers wielding readily available deadly blades. Police amnesties gather only a small percentage of the knives that young people now carry as routine.
We need to take back our communities from these young thugs who are found at all levels of society; this is not solely a problem for deprived areas. To hear that the Home Secretary is fearful of walking the streets at night is no surprise but is a sad indication of how things are. A more visible police presence is essential, and not only in patrolling cars. I was shocked to read that the Government are proposing to reduce the number of police at a time when we need them so badly. Why, when the zero tolerance of crime has worked so well in New York, are we proposing fewer police in the UK? David Cameron recently suggested that the community itself needs to be prepared to challenge inappropriate behaviour in other people’s children. Fair enough—certainly we always used to—but in this we must be able to rely on the support of other members of the community and, ultimately, the back-up of our police.
Last Friday in affluent central London, a horde of 75 young people ran riot in a quiet street. Twenty had been invited to a private party; 80 gate-crashed. It seems they discover where a party is to be held and notify one another by mobile phone. Trouble began about 10.30 pm—cars were broken into, handbags stolen. Conditions were frightening and terrified local residents phoned the police. It was one hour before any police arrived and they explained that they had already dealt with 50 incidents that evening. There are simply not enough police to deal with these alcohol and drug-fuelled incidents, especially on Friday and Saturday nights. I thought that was very disturbing, happening very near where I live in London, but then I read in yesterday’s paper that 250 people arrived uninvited at a 16th birthday “bash”, was the word, in Australia, and it took police in 15 cars three hours to restore order.
It is so simple to list today’s problems and so hard to resolve them. When anti-social behaviour orders, ASBOs, were introduced, it seemed that a solution had been found. ASBOs have sometimes worked well but I saw in The House Magazine of 13 February 2008, as quote of the week, the remark of the noble Lord, Lord Tebbit, that,
“if I was 14 years old, I would want an ASBO. It shows you’re a leader and that you can challenge authority”.
Too many of the young have reacted in just this way.
The topic of this debate is wide-ranging and I must return to the family. The present cooking furore about Delia Smith’s advice on nutritious food and the organic food group has right on both sides. Organic food is more expensive and probably is a middle-class luxury. Readymade meals are often less nutritious and more costly. Good home cooking, especially with low salt content, on which we have had a Question today, must be a health benefit. The poorest families often use too many relatively expensive prepared meals that they can ill afford. Teaching cookery and home economics at school again will interest young people in how to prepare and cook healthy and tasty meals at a fraction of the cost.
Nothing unites a family more than sitting together at a dining table for a meal and a conversation, having that as a time without television, a time for communication as a family. Reports say that many homes do not even possess a table at which a family could sit together. The habit of grazing—that is, eating on the hoof—has become common.
The breakdown of family life is sometimes triggered by particular events and can have disastrous consequences. I listened, on the radio, to a sad history of a man whose father died and he lost his job almost at the same time. Desperately upset, almost disorientated, he took to viewing pornography on his home computer and it became an addiction. He went on to be convicted of an offence, his wife was completely alienated and he was not allowed alone with his grandchildren. Now he is undergoing rehabilitation and he spoke about the help he and his family had been getting from the Lucy Faithfull Foundation, without which he thought he could not have survived. I mention that case particularly because Members of your Lordships’ House will remember Lady Faithfull, the former head of Oxford Social Services, as a great source of wisdom in this House for many years.
Charities, the voluntary and community sector, non-governmental organisations—there are many terms to cover these groups—play an important part in supporting those in need or on the fringe of society. Last month, I met workers from Barnardo’s and was most impressed by the changes in the organisation and the work it is now doing. I had not caught up with the fact that it has had no orphanages for 15 years. Its work now is with disaffected young people; to quote one of the workers, “to walk alongside people, not to tell them what to do but to give them a second chance”. She told me that many were hard to like as they were so damaged that they were “not very nice people”, and there was a need for a lot of listening. These young people were angry, with no self-confidence or self-esteem and totally lacking trust in others. Barriers had to be broken down and trust re-established. In Northern Ireland, where she came from, a certain number aged 16 to 20 were taken on as trainees in the organisation for two years and helped to develop their potential and their self-confidence.
Training, or education, is vitally important and each person needs to have some skill or occupation to find employment. Employment skills give people opportunities in life. Motivation is all-important and I know that the Australian experience has shown that you need to retain continuity of occupation from the end of formal education. They have found that if young people leave school and have nothing to do for more than three months, they are almost a lost cause. I believe that there is now a general recognition in the UK that training schemes for the young, rather than a continuing education that is only academic, will make a great difference in retaining interest and the motivation that is essential. Prevention is better than cure, and if voluntary and statutory organisations can step in at an early stage, that must be better.
I have previously spoken in the House about the young offender programme led by National Grid, a pioneering scheme for prisoners that has dramatically reduced the national average of young people reoffending from 74 per cent to less than 7 per cent through employment and the training they have had to give them employment when they finish their sentence. It helps meet industry’s growing need for skilled and motivated labour. To date, the programme has engaged with more than 80 companies, and 1,000 offenders have successfully gone through the programme.
The Commission on Integration and Cohesion has a most impressive title and a difficult task. Its report shows the strain placed on local authorities where there is a high level of migration. The Office for National Statistics has acknowledged that no one really knows the truth about the numbers of migrants. I have in the past raised the point in your Lordships’ House that there are so many “invisible” people in our community, unknown to either the Revenue or the local council, using local amenities and working in the black economy. In addition, new migrants are moving in legitimately. These large extra numbers of people make it difficult to provide the necessary services, and impossible for the Government correctly to assess the grant support that they should give to the local authority. For a successful community to be built, the infrastructure—everything from clean streets to youth sports facilities—needs to be in place. Without properly assessed and calculated national funding to local authorities, government are failing the individuals within those communities.
Iain Duncan Smith’s excellent and comprehensive report, Breakthrough Britain, published last year, extends to almost 700 pages, so one can see that it is quite impossible for me to do more than skim the surface in my allotted minutes. I hope that others will cover other aspects in their contribution to the debate.
The Prime Minister was right in asking the newly formed Council on Social Action to use a one-to-one approach in helping people to help one another. When I chaired an NGO helping the poorest children in the world, we had this approach and it worked well. If one suggests a major onslaught, people turn away: it is too much to consider. If one asks them to help one other person, they will probably do it and the ripple effect will be great.
We, too, must be willing to work with neighbours and other members of our local community to change the climate of our areas, to remove the climate of fear where people are afraid to do anything but look away from unpleasant or dangerous behaviour, to stop bullying wherever we see it, and to recreate a community where aspirations can thrive and people of all ages are motivated to make the most of the most precious thing that each one of us has: our lives. I beg to move for Papers.
My Lords, I congratulate the noble Baroness, Lady Gardner of Parkes, on securing this debate, which could not be on a more important topic. I apologise to the House that, because of a long-standing commitment, I shall have to be absent for part of the debate to host an event downstairs.
I am sure that the noble Baroness would be the first to agree that this topic is extraordinarily wide-ranging. Families and their role in society have been a key battleground in British politics, the central issue being the link between family breakdown and social disorder. Statistics show a correlation between family breakdown and forms of social disorder, but proving a causal link is much more complicated.
I shall concentrate on two small parts of the topic: those families with caring responsibilities and those who have children and are at the point of breakdown. Caring—I declare an interest as vice-president of Carers UK—is one family issue where the story is almost entirely positive. Families do not need strengthening in their commitment to provide care. One may hear rhetoric about families not caring any more, but it is simply not true. The obligation to care for your family is alive and well in our country. Six million people do it, willingly and with love, and nearly 1 million of them do it for more than 50 hours a week, with financial, health and physical consequences and a lot of emotional distress in many cases. In spite of the stress that they undoubtedly feel, however, there is no sign at all of caring families wanting in droves to give up their onerous responsibilities. We are lucky that that is the case, because how would we provide most of our social care if they wanted to give up?
None the less, we have responsibilities to strengthen these families, who are undoubtedly facing more caring problems, because people live longer with greater degrees of disability and with much more time at home or in the community than in hospital. Moreover, we are increasingly encouraging carers to combine paid work with caring, which means that, with longer working lives and people doing two jobs, we may need 9 million carers in future. We have to encourage that, but we may have to look differently at how we provide services.
Much progress has been made in this area in recent years, I am happy to say; I shall speak more on this in a debate in your Lordships’ House next week. We have a Standing Commission on Carers and a new carers strategy is about to be launched. We also have the new agenda on social care, which promises more recognition for carers and caring families. There was a time when I felt like a lone voice on this issue, but I do not feel like that any more, I am happy to say.
The other topic that I want to address is the welfare of children at a time when family breakdown occurs. I declare an interest as chair of CAFCASS—the Children and Family Court Advisory and Support Service. As the noble Baroness said, families today are not made in the image of families in the 1950s. Divorce happens, however sad we may be about it and however hard we may work to encourage lifelong pair bonds. Families are a different shape. I speak as somebody who is divorced, who has three step-grandchildren and a son-in-law older than I am. Many of us have such personal experiences. But if a husband and wife divorce, when there are children there are still family responsibilities, and the family, even if split, must be supported and nurtured, as it resolves its difficulties and moves to form and reform its shape. The welfare of the child must be paramount in that.
There are between 150,000 and 200,000 relationship breakdowns involving children in this country. The majority of children continue and want to have contact with both parents, although the nature and frequency of that contact varies. Children’s experience of that contact varies, as does their experience of the ongoing relationship, according to the quantity and quality of the contact. There are few more distressing things than seeing parents attack each other in court, score points off each other over access sought and denied or engage in domestic violence both verbal and physical, all the time oblivious to the distress of the children.
Mercifully, about 90 per cent of divorcing parents reach agreement, but the 10 per cent who do not have major ongoing problems, which is where CAFCASS operates. Our skilled workers have to try to resolve disputes, some years long in duration, all the time being mindful of the Every Child Matters agenda about children being healthy, staying safe, enjoying and achieving, making a positive contribution and experiencing economic well-being, which is often a difficult matter in these cases. That is what every child deserves and it is what the skilled CAFCASS workers try to achieve.
We have made great strides in developing dispute resolution schemes, whereby families do not come to court at all but resolve their difficulties and reach agreement through family counselling or extended dispute resolution. We now find that 60 per cent of couples who come to dispute resolution can reach agreement—and the figures continue to rise. That is just one part of the whole family justice system beginning to look much more closely at prevention rather than going immediately down the court route. Certainly CAFCASS is increasingly involved in voluntary sector organisations, which the noble Baroness mentioned, and in trying to find other partners to provide a more integrated service where possible.
CAFCASS can contribute to more stable families by providing support to help parents to make contact work. We want to highlight opportunities for universal services, to spot warning signs of relationship breakdown at an early stage and to signpost both parents and children at critical moments. This work should and does place heavy emphasis on listening to children and finding out what their needs and feelings are. That is not an easy thing to do. Devising a feedback system in such sensitive areas as family justice is a complex matter, but we are making progress on that.
We have recently launched an online feedback system called HearNow, which seeks to capture the experience of children and families. It is at an early stage, but we will continue to develop it. A great deal of work has been conducted by our children’s rights team, which has been exploring ways, in partnership with our young people’s board, to ensure that the voice of children is at the heart of what we do. Together, they have devised a needs, wishes and feelings pack, which is used by our practitioners to ensure that children’s voices are put directly in front of the courts and their views are put in their own words. In this and many other ways, we can help to ensure that family ties are continued and strengthened, even if the family itself is no longer in its original form.
My Lords, I add my thanks to the noble Baroness, Lady Gardner of Parkes, for securing this important debate. The debate is timely because families, communities and the need for social action seem already to be the flavour of the year. We have seen frequent government pronouncements, particularly on youth crime and the role that parents and families can play. We have had repeated debates about immigration policies and their impact on community cohesion. There is no lack of advice from politicians, academics and practitioners. Today’s debate gives us the opportunity to bring all these contributors together to see how effectively we can plan social action.
Another concern needs to be reflected. In January 2007, the Government published Strong and Prosperous Communities—The Local Government White Paper Implementation Plan. It is a good read. It will be helpful if the Minister can give a progress report on how some of the key recommendations are being implemented. Let me give an example of why that is important. The Government say that they are,
“committed to empowering citizens and communities—to devolve more power locally and enable more choice, better redress and better opportunity for communities to own and run local services”.
There is no problem with that. However, in some areas of government responsibilities, such as criminal justice matters, I see a tendency not to devolve but to centralise power. Communities and individuals, particularly young people, are less inclined to participate in our democratic process if they feel removed from the decision- making process.
We tend to forget that government can provide leadership, but only people and communities can deliver change. Nowhere is this more relevant than in matters relating to climate change, health, ageing and diet. No longer can we allow Whitehall to be in total charge of such issues. Many local authorities feel impotent, with the result that communities feel isolated, remote and distanced from the decision-making process that affects their lives. Community cohesion is a case in point. Whenever I hear government pronouncements on this subject, I feel that I want to scream. I do not for a moment dispute that the development of a value-driven British identity is a core goal, but you cannot respond to the debate about ethnicity, multiculturalism and immigration if you are not part of the consultative process.
Commentators, both politicians and the press, have pointed to the impact of globalisation, devolution and asylum and immigration issues, as well as to concerns over the growth of fundamentalism, be it Christian, Muslim, Hindu, Jewish or that of other faiths. If the community is not part of the policy-making process, the only people who will benefit are extremists such as the British National Party.
We all accept that the old British spectrum of left and right is less important now and that politicians are competing to be tough on crime and promoting concepts such as community cohesion. However, frequent debates and statements on similar subjects lack strategic thought. They have therefore led to a search for shared values of what it might be to be English or British. Some have argued that it is important to articulate a shared sense of national identity in contemporary conditions of flux and change. If you accept this, how can you reconcile these values with diversity, openness and pluralism of belief and practice? We might add to this mix the destabilisation of the Middle East and the growth of terrorism and, as if that were not enough, supplement it with the alleged death of multiculturalism, which according to some opinion formers leads to separateness and ghettos.
I am quite happy that such issues should be addressed, but not in an atmosphere of hysteria predominantly directed at our Muslim community. We have gone through this phase before. The noble Lord, Lord Parekh, who I am glad to see is participating in this debate, chaired the Runnymede Trust’s Commission on the Future of Multi-Ethnic Britain. Those of us who participated did so with the intention of opening a national debate on the issues that we are addressing today, but the report was greeted with a sustained hysteria instigated by politicians and the media. This is simply unacceptable.
It is right that in a democracy there should be a sensible debate about such issues. It is now more than 30 years since the Race Relations Act 1976 was introduced. Only last year we celebrated the bicentenary of the passage of the 1807 slave trade abolition Act. We have been at the forefront of legislation and other machinery to establish equality of opportunity for all our citizens. There is now a strong emphasis on race, disability, gender, age, faith and sexual orientation, which puts a new emphasis on promoting good relations between different groups.
It is clear that leadership is uneasy when issues of multi-ethnicity and multiculturalism surface. There is a kind of schizophrenia in the state response to immigration on the one hand and community cohesion and a pluralist society on the other. The progress that we have made in achieving some sort of multiculturalism is too valuable to be treated cynically. This is backed up by a perception among the majority population that despite all our history and our pride in tolerance they are somehow not able to live as part of a community of communities.
Cultures do not remain static. Communities change. Conflict often occurs on matters of gender, generation, religion, language and the community’s relationship with the wider society. There is nothing to be frightened about. We are already witnessing fusion in music, the arts and fashion. What is required is the political wisdom appropriate to a multicultural, multiracial and multireligious society. The narrow and often blurred focus on religion undermines an approach that takes into account political and social identities.
I am delighted that the debate has now moved to citizenship. I trust that this move will not be the death of multiculturalism but that we can finally clearly define what the concept of multiculturalism should really be about. It is right that we should celebrate British citizenship and the rights and responsibilities that come with it. If we built active participation of communities into our democratic process, supplemented by a sense of a united community, ethnicity and multiculturalism would be less contentious.
Citizenship means much more than learning English. No one disputes that communication helps to achieve an integrated society, but citizenship is about much more than that. It is a social contract encompassing the whole community. Its aim must be social inclusion, tolerance, equality and a diverse society where human rights flourish. It is also about balancing citizens’ rights and responsibilities. Importantly, citizenship must also entitle individuals to state protection, respect for the diversity of their culture and freedom of expression. These are all encompassed within the framework of the Human Rights Act. It is not for the Government to pick and choose which rights suit them.
If we take this to its logical conclusion, citizenship cannot be divorced from the needs of the individual. The social contract must also include decent public services and decent social support for the weak and infirm, including those who feel persecuted. It must provide the community with a healthy and pollution-free environment. If individuals feel that they are protected from crime, that there is less oppression and that discrimination does not blight their lives, there will be respect towards a healthy, decent society. That is the way to achieve cohesion.
My Lords, I am most grateful to the noble Baroness, Lady Gardner, for giving us the opportunity to discuss these subjects. In the short time available to me, I will talk a little about the role of fathers in our society today. Fathers are, after all, about half the population, and they ought to be a fundamental part of our society. They are therefore most relevant to its cohesion.
In our debates on the Human Fertilisation and Embryology Bill, which we recently sent to another place, the Government were prepared to put on a three-line Whip to remove the word “fathers” from the Bill. I understand that their reason was that the specific mention of a father was offensive to those women who want to form a partnership with another woman to bring up a child. I personally have no problem in accepting that two women committed to the welfare of a child could give that child the supportive parenting that he or she needs, provided that the child, if it is a boy, has somewhere in his life an appropriate male role model. Why do the Government give such priority to the concerns of what must be a very small group of women while putting at risk the something like 150 children every day of the year who are being permanently separated from their fathers? I hope that I am correct in that figure. I understand that the number of children in our society today who have no contact with their fathers is of the order of 800,000 and if you divide that by 365 days it comes out at 150 children a day.
I turn to the obvious question of why fathers matter; and I fear that I may be stating the obvious. US research shows that children, especially boys, need a male role model in their lives. At about the age of seven or eight, boys begin to ask themselves what it means to be a boy and how they are different from all those women who have dominated and surrounded their life up to that age. If the child then does not have a father or some other male role model, he tends to begin to see education as a girly thing and as the sort of thing that no self-respecting boy would indulge in. That is one reason why boys are achieving very much less good results at GCSE than girls.
Fathers also matter because they can take the strain off the mother by helping and sharing burdens and worries. Above all, a father matters because all children need security and love. The noble Baroness, Lady Gardner, mentioned love. However great the goodwill and commitment of one parent, it is harder for a single parent to find time to have that kind of relaxed relationship with the children that they need. Parenting alone, where money is short, is likely to be stressful, and there will be even less time and energy left over for love. Except where there is a breakdown in the parental relationship, two committed parents have an easier job than one and tend to be able together to give their child more security and more love.
All political parties today are concerned to eliminate financial poverty for children, and I wholly endorse that objective. Unfortunately, a small minority of children—although there are too many—are suffering from another kind of poverty; poverty of love. We should also be doing everything possible to eliminate poverty of love. How can that be done? Some years ago, the noble and learned Lord, Lord Irvine of Lairg, on a child maintenance Bill, said to me that you cannot make a law that a father must love his son. That is obviously true, and that is the nub of the problem. However, there are things that we could be doing to increase the chances that he will do so, and I will mention one or two of them.
First, you can reduce the chances that he will unintentionally or recklessly father a child who he does not want or will not accept and will not want to love and care for. Secondly, every boy and young man has to be taught in school and at other times in their lives that in our society today he will be held responsible jointly with the mother for any child that he fathers. He must understand that there will be penalties, including, but not restricted to, paying maintenance for the child.
The problem of teaching these facts is that our teachers of PSHE and citizenship in schools do not have a clearly defined statement by the Government or anyone else of the responsibilities of parenthood in the curriculum for PSHE. The “responsibilities of parenthood” are printed there in heavy type, but when I asked the department and the Minister, “Where do I find the responsibilities of parenthood clearly set out?”, there is no answer. “It is in case law”, they say. Maybe it is in case law, but that is not much help to parents and it certainly has never helped teachers who do not want to start teaching a subject like this if they feel that they are not on firm ground. We have to set firm ground under the feet of teachers of this subject.
All this teaching needs to be repeated to mothers and fathers in ante-natal clinics before the child is born, and by nurses and health visitors in home visiting sessions after the child is born. It is extraordinarily depressing that many health trusts are foolishly and meanly cutting back on ante-natal and post-natal services. Yet those are the most important times of all to offer young couples guidance and support. Those are often the times when the mother and the father are vulnerable.
I shall mention one other of the many things that we could do to help couples to stay together and fulfil their role in bringing up their child. It would help enormously if within a day or two of the birth of their child they were offered appropriate and affordable housing that would enable them to start building a nest together for their new family. Living with your mother-in-law—God bless her—or in a hostel for four or five years before you get a house is almost certain death to any relationship, and certainly provides little opportunity for building a nest for the new family and for the child.
These are just a few of the things that I wanted to mention. Perhaps the most important of all is a change of heart. Fathers in our society need to be valued and encouraged to understand how important their role is. This is not to say that the important job of being a second parent cannot be done by someone else who is not the birth father. It is simply to recognise that without birth fathers it would be impossible to find enough people willing and able to do the job properly. We need to mobilise fathers to show them that we appreciate what they are doing and to challenge them to do more.
If we want cohesion in our society, we want to be clear about what our shared values are. We need a clear and enduring statement from government or from someone as to what the state will provide and what parents and their families should provide for themselves. Perhaps the first thing that society needs to do is to find a way of establishing those shared values about the roles and obligations of mothers and birth fathers in modern society.
My Lords, I too thank the noble Baroness, Lady Gardner of Parkes, for this debate. Much of what I am about to say will seem critical of some recent developments, so first let me be positive as we consider the case for strengthening families, community cohesion and social action. Let us remember that there are many signs of hope in families—the changing role of women and the possibility for fathers to be more involved in the care of their children. More of us are living longer and more children will know their grandparents and, indeed, their great-grandparents in meaningful relationships. That is something to celebrate. Fewer children are stigmatised because they live in one-parent families or are from different ethnic backgrounds.
Along with other organisations, the Church of England and its voluntary agencies such as the Children’s Society or the Mothers’ Union, or smaller diocesan organisations such as Welcare in my diocese, are committed to supporting families through prayer, pastoral care and in other practical ways—and through the provision of education. Many parishes and church schools offer parenting groups or classes for mothers and/or fathers. We try to play our part in strengthening families and building community cohesion.
However, in contributing to this debate I wish to focus on the delivery of family care at local borough level, for here—despite what were well intentioned changes in the delivery of services—it is our experience that the current situation on the ground is chaotic. Most local authorities are struggling with changes: establishing children’s centres, drawing together teams from social services, education and health, coping with changing funding streams and working with new commissioning processes. As a result in my own diocese, Welcare, as a medium-sized voluntary organisation working with vulnerable families and children, is surviving only with difficulty. It had to downsize its services last year. For smaller organisations, it is even more difficult.
Uncertainty in funding is their greatest problem. There was a time when the voluntary sector complained about three-year funding agreements not providing enough security. Today, three-year funding is a luxury that it would love to have. Because local authorities have not been certain about their own funding streams, and have not managed to get robust and efficient commissioning processes established, they continue with roll-over funding. In the Borough of Greenwich last year, for example, Welcare’s funding was initially rolled over for three months, then for another three months, then for six months to the end of the financial year. During that time, Greenwich invited tenders for work with children with disabilities and vulnerable children in need, and their families. Welcare submitted a bid for that—a major piece of work for it, as every tender is. Greenwich has now, in effect, abandoned that process and rolled over the funding again for another year. I do not wish to be critical of Greenwich or to make Welcare a special case; I cite them as typical examples of what is happening up and down the country.
What is the effect of all this on the work? First, there is a loss of experienced staff. During the past year in Greenwich, Welcare has lost all the crèche workers who had been with the charity for several years, and their very experienced social worker. Its centre, a community flat on a housing estate, is now staffed by temporary workers. Those staff, naturally, do not know the families on the estate and have no long-term commitment to make those relationships—and the families suffer. Because the previous staff were known on the estate, women did call in for help when there was a domestic violence crisis and the staff were able to spot changes in children’s behaviour signalling that all was not well at home.
Families in chaos themselves are not helped by chaos in the helping organisations, and the fact that the statutory bodies are in chaos over new arrangements for children’s services and new ways of funding causes a once efficient and reliable voluntary organisation to seem chaotic because of staff turnover and the inability to plan ahead. That is not good for families and children who need stability and routine.
Yet another factor making life difficult for small and medium-sized voluntary agencies, of which Welcare is typical, is that they now have to compete for work with much larger charities. I am sure that the theory behind this was to ensure value for public money. However, the results can be very different. In the Borough of Lambeth, for example, Welcare has been doing work on contract with the borough since the 1970s and delivered excellent services to hard-to-reach families. The borough had contracted work with a number of such voluntary agencies—both large and small—who had worked well together, delivering different programmes to suit different needs and offering some choice to families. Now, the contract for family support in Lambeth for vulnerable and at risk families has gone to one single, large national charity, so ending both the long-standing relationship with the borough’s statutory services and the established network of relationships with local families.
The very process of constant tendering is burdensome and time consuming. A major tender is at least a week’s work for one member of staff, with others contributing, and if the bid is unsuccessful that money is totally wasted. In the past, volunteers did a lot of fundraising and helped with applications to statutory bodies, but the tendering process is now so complex that it has to be done by paid, professional staff. Not many charities can afford that.
Finally, voluntary organisations are concerned that services are now so prescribed that the flexible response to human need becomes nigh impossible. Contracts mean that they can accept only certain referrals from certain sources. Hence the Welcare centre in a local community, which was once a resource known and used by local families and recommended from one family to another by word of mouth, is disappearing.
I have related this saga in some detail because I believe that Welcare is by no means untypical. In the name of efficiency we are seeing chaos and the destruction of many small and medium-sized voluntary caring agencies with previously long-term commitments to family care and support. I realise that this might have seemed a depressing account, but, in my experience, it is an accurate account. Day by day, I deal with people who give their professional lives to attempting to strengthen family life. I trust that our debate today will help to make their life more productive.
My Lords, I add my congratulations to my noble friend on this very timely debate. I shall concentrate my comments on community cohesion. The term community cohesion, like the term multiculturalism, has become a description relating predominantly to ethnic minority communities. That is always the wrong starting point.
Great Britain has been and will always remain a place that attracts people from all over the globe. In view of her history, that is not surprising, as Britain has historical links with large parts of the world—and even today a legacy of Britishness survives in all those lands. And yet we find in our own country that we have to define what Britishness is and what it means; we test people for Britishness. As a child growing up in a Britain where the immigrant population was much smaller than it is now, I did not grow up feeling I did not belong and yet it seems, over four decades on, that suddenly second, third and even fourth generation members of the ethnic minority communities are being queried on this notion.
From multiculturalism—an idea that is, by and large, perceived now as having failed—we turn to community cohesion, a replacement name for what will, I suppose, be another concept that will be regarded as failed unless we get to grips with what underpins the problems facing many parts of Great Britain. Today in Great Britain, many face lack of access to social mobility, poor job prospects and lack of educational attainment. I argue that that creates many of the difficulties facing our communities today. The very nature of our society has changed: more and more people are engaged in under-age drinking, drugs and sexual participation. The number of single-parent households is set to outnumber married or two-parent households and the absence of father figures in many homes has, of course, had an enormous impact on children and young people’s lives both economically and emotionally.
So let us, first, define what we really mean by community cohesion. In my mind, cohesion means to come together and yet we know that cohesion cannot be forced as in multiculturalism. It must be shared; it must have common goals which bring communities together—not, as we have often heard, one being tolerant of another, which identifies us as having an intolerance, or having to put up with something that is different. Having spent all my life striving for integration, at no point have I felt a forced sense of belonging. I find that I enjoy all the positive aspects of my adopted home and still retain a great sense of pride in my historical links with the country of my birthplace and that of my parents. No one has asked me to compromise on that. Instead I feel enriched by a much broader understanding of what exists around me.
I return to the concept of cohesion, today in parts of Britain. Black-on-black crime is increasing, and media headlines regularly highlight the increase in gang membership. Why do those young people resort to believing that belonging to a gang gives them a sense of belonging? Within the gangs they create structures of hierarchy, rules and boundaries, so why, as a society, have we failed to engage them positively in activity that will give them the same empowerment? Why do we now live in a culture where, too often, our streets are taken over by young people who have consumed cheap drink and drugs and display aggressive street behaviour? Let us look at community cohesion not, as is so often the case, along the lines of faith, but as a positive or negative factor of social and economic development. Let us question and respond to the issues that alienate communities and separate them from each other.
To be a successful community, of course, we must be able to communicate and have the knowledge and ability to speak the language of the country in which we live. As a child, I remember that my mother always insisted that we speak English at home so that she could converse easily when she went out. Yet I still come across many people, particularly women from the south Asian communities, who, having lived in Britain for so many years, still cannot speak or understand English. This creates barriers and encourages separate existences. Sadly, in many cases, it has been encouraged by the male members of those households. Millions have been spent on interpretation services. This, I am afraid, has only added to the problem and the funding of groups that have been set up in creating activities to empower so-called community leaders. Handing powers and importance to them has allowed many community leaders to speak on behalf of communities without having to consult the communities they purport to speak on behalf of.
Ted Cantle, in his report following the riots in the north of England, highlighted the existence of parallel lives. Although much has been done to lessen tensions, cosmetic remedies are not the answer. Communities still continue to ghettoise themselves and, in parts of the country, self-created cultural apartheid is beginning to show its head. Of course, we can understand some of the reasons behind the rejections by some communities of aspects of Great Britain today: the decline in values and respect. Civic society must re-establish itself if we are to win the hearts and minds of all who live within it, particularly if some communities feel that they are under attack and need to create communities within communities.
There must be an open and honest debate. I can assure your Lordships that many thousands of people from ethnic minority communities want us to stand up and speak openly on their behalf. They feel voiceless and unrepresented. They want to live in a country that is their home. They do not want to live parallel lives. I know how difficult that is.
Faith has become a dividing factor for many. Yet, as a close friend of mine said, when children play together, eat together and even fight together, they learn to live together. I think that is right. By ignoring the real issues of poverty, lack of opportunity, poor educational attainment and poor access to better social and economic mobility, we ensure that fragile structures become even more fragile. Moderate voices get no airtime, as those who wish to see extreme consequences take over the debate. They shelter under the guise of moderation and yet continue to support separateness away from the glare of the spotlight.
In some communities, we have seen steps taken backwards. That cannot be right. In the 1970s, I, along with many others, fought the rise of the National Front. There was a collective spirit and will. We need that collective spirit and will again to ensure that we have a cohesive community: a sharing of common goals and ambitions. My parents, like many, came from a different land. They were willing to accept that this great country provided them with opportunity and a great welcome. However, they, too, had a duty to accept that it was a different place to the place they had come from, so they had to learn to adapt too. For generations like me, it has been a hard battle to convince people that one never loses an identity, but gains several new ones.
My Lords, I am delighted that the noble Baroness, Lady Gardner of Parkes, has secured this debate, and it is a great pleasure to follow the thoughtful speech of the noble Baroness, Lady Verma. So many good things have happened for communities and families over the past 10 years that I hardly know where to start. Perhaps an appropriate place would be in thanking my noble friend the Minister for his concern, support and ingenuity in dealing with the Children and Young Persons Bill currently going through your Lordships’ House. The noble Baroness, Lady Gardner, rightly asked for social action. What better social action plan could there be for families and communities than the recent Children’s Plan—of which more later—Building Brighter Futures?
I said that much has happened, and perhaps my noble friend the Minister could remind us of the financial and other support which has gone into the early years, maternity and paternity rights, tax credits, increases in child benefit and the establishment of child trust funds. I shall focus today on three issues which demonstrate the Government's commitment to building safer and healthier communities. These are children's trusts, extended schools and the delivery of drug treatment.
The Government have, in the local government White Paper implementation plan Strong and Prosperous Communities, expressed their commitment to empowering citizens and communities, and creating opportunities to run local services. Ownership of community goals is absolutely crucial, not only to delivering services but to how people behave in communities, help each other and protect the environment and public safety.
Extended schools are one way of delivering the Every Child Matters agenda, by working with local providers, agencies—in many cases, other schools—to provide access to a core offer of extended services. This core offer includes a varied menu of activities for primary and secondary schools, childcare between 8 am and 6 pm, where appropriate, for 48 weeks a year for primary schools; parent support; swift access to specialised support services; and community access to ICT, sport and arts facilities. To support the extended schools initiative, £680 million has been made available. Local authorities are major partners, and have a role in identifying local needs, co-ordinating and commissioning services, and championing the needs of children, young people and their families.
I have seen that in action. The primary school where I am a governor has extended its community offering in sport and for parental and community experiences. We are a diverse school in a diverse community, and are particularly encouraging parents to get involved in IT, science days, sports and dietary issues. Local firms have sponsored the very smart kit for our successful soccer teams. This helps to increase the sense of pride and self-esteem in pupils and parents. I ask the Minister what the evaluation of the extended schools scheme has shown so far.
Children's trusts, underpinned by the Children Act 2004, bring together key agencies which deliver services for children, young people and their families. Features include professionals working together, reduction in duplication of effort and better information sharing, and joint planning and commissioning of services and resource allocation. Agencies may include health, social care, the voluntary sector and consultation with schools. The recent Children's Plan, which I mentioned earlier, states that to deliver a vision for children, system-wide reforms will be required. By putting the needs of children and families first, services should make more sense to those using them,
“for whom professional boundaries can appear arbitrary and frustrating”.
How often have we debated that issue in relation to children and families? I ask the Minister for an update on how children's trusts are working, perhaps with some examples of good practice.
On drug strategy, I declare an interest as the chair of the National Treatment Agency for Substance Misuse, the NTA. I shall not ask the Minister any questions about drugs, otherwise he may assume that I am not doing my job properly. The NTA was set up in 2001 and charged with doubling the number of people in treatment by 2008. This we did two years early; the figure has increased from 85,000 in 2001 to 205,000 in 2008. We all know that drugs can not only badly affect individual health but destroy families and have disastrous effects on communities. The Government have focused funding on drug treatment, rising from £300 million in 2001 to £800 million in 2008.
The NTA was set up to help with business planning and monitoring at a local level. This has meant that not only are there more people in treatment, but waiting times for treatment have dramatically decreased from nine to three weeks. In this country, we now have more people in treatment than most other European nations or the United States. There are better services in the criminal justice system, better after-care services, better involvement of users and carers, higher staffing levels and better monitoring services. When I visit services around the country, I am impressed by the success of a variety of approaches and by the many individual success stories from former users of hard drugs. I quote from our latest annual report:
“Although drugs policy and strategy are set nationally, translating these into effective delivery for clients and communities must be done locally. Ensuring this happens is the remit of the NTA's regional teams”.
This essential community ownership of national, as well as local, policy is the key challenge, but it can be done. In Birmingham, for example, a treatment effectiveness initiative pilot was set up involving all 26 drug-treatment agencies and 200 drugs workers and their clients, including criminal justice clients. At the heart of the programme is a care-planning approach that encourages self-evaluation of the clients’ needs, selecting goals and planning their own care and treatment. The new drugs strategy, published yesterday, continues the emphasis on families and communities and on care pathways from assessment to aftercare. My new noble friend, the noble Lord, Lord Patel of Bradford, has developed a brilliant community engagement model at the University of Central Lancashire where members of communities are trained to assess the needs of drug users for services and support in their local areas.
I have given examples today of how government commitment and funding can improve the lives of all families and communities. We have excellent action plans, and I look forward to the Minister’s comments.
My Lords, I, too, congratulate my noble friend on her excellent debate. One would think that her extensive summary of the key issues would have given all the aspects full attention, but successive speakers have raised further areas where there is more we all have to do to ensure that we have the strong families and stable communities that are so fundamentally important to well adjusted, constructive young people.
Following the comments of the noble Baroness, I ask the Minister to comment in particular on the profession of health visiting. In my experience, health visitors have an almost unique opportunity to talk to families when they are being formed about the critical issues involved. With the best will in the world, a social worker has a difficult entrance to a family and can pose a threat, but a health visitor has legitimacy and authority. In the many years that I spent working in the inner city with some of the most disadvantaged families, it was health visitors who could enlighten and educate. If only that enlightenment and education was not just about what a baby should weigh, what it should eat or how many times it should be washed but also about encouraging parents to feel that it is a long-term project with a great number of difficulties along the way. With that, I move on to the many voluntary groups helping parents to be better parents. It is tough being a parent, and children are not always mild, obedient, good and kind. It is very easy for all of us who are rather beyond parenting—most of us, although there are a few exceptions—to have a sentimental attitude, but children can be ghastly even in the most well ordered households. Support and encouragement for parents, using health visitors, is crucial.
I move on to the school. My noble friend Lord Northbourne has badgered many of us in and out of office over many years on the importance of families. I share his views on the importance of fathers, but in many areas young people have no exposure to men. The one place they may have that exposure is at school. I ask the Government, as I asked several years ago, to reconsider allowing all-male shortlists for primary school teachers. When we debated having all-female shortlists for parliamentarians, I made the point that I thought all-male shortlists at primary schools might be as important for the future well-being of our country as all-female shortlists for parliamentarians. That is very important.
I wish to speak about uniformed organisations. I see that the noble Lord, Lord Ramsbotham, is in his place. He has obtained debates about offenders and young people who have no stakeholders or champions. A difficult child may be cared for by his family, his grandparent or his aunt. He may be sent to a special school, or social services may find special provision. My experience as a juvenile court chairman was that children who nobody cared about were the ones who ended up in court. They did not have a stakeholder, a champion, guiding them, caring for them or controlling them. Of all the organisations that can often do an enormous amount with a disturbed and troubled young person, the uniformed organisations have a special advantage because as the child puts the uniform on, he puts on a new persona. It gives him a sense of confidence and identity. Most of those organisations have gradual steps of achievement as children gain their badges. I worked at a time when there was suspicion about whether uniformed organisations were authoritarian and old-fashioned. My view is that they make an incredible contribution, in particular, the Guides, the Scouts and the Boys’ Brigade.
I have a practical point for the Minister. Why can we not have a culture where we have paid leave for volunteers in uniformed organisations in the same way that we do for magistrates? There is no problem about magistrates getting paid leave, but it is incredibly difficult for volunteers in the uniformed organisations. They take their leave out of their own pocket to do so much for young people who are often in very difficult circumstances. We are promoting a culture where employer-supported volunteering is becoming ever more important. I would like to see an experiment where we make it as easy for volunteers as it is for the magistracy to find the time to support young people because what young people need is the continuity and stability of a family. The noble Lord, Lord Giddens, will speak in due course. I do not entirely agree with him about the role of the family and globalisation, but I do think that as family styles change, children need those continuities of relationship even more, so that the person who checks a child at three months, at three years, at nine and at 13 has the legitimacy to have an influence when the child is 16. The people who control and influence are the people who praise us as well as punish us. Just having people in a punitive role is not as effective in bringing out the best in people. Therefore, we need to look again at community people who will give that time, care and commitment.
That brings me on to mentoring. There are a lot of interesting mentoring programmes under way. I consulted the young people who work in my firm, and several of them are involved in projects hearing reading in schools. Others are involved in Adab, a programme set up to help black and minority ethnic youngsters get on, particularly those with a Muslim background. I ask the Minister for more mentoring, paid leave for those working in uniformed organisations, single-sex shortlists at primary schools and more health visitors, but even then there will be much more for us to do.
My Lords, I thank the noble Baroness, Lady Gardner of Parkes, for initiating this important debate and for the good sense in her speech, which echoed some important points made over recent months by Iain Duncan Smith, whom I have listened to with appreciation.
I should like to underline the significance of place—the home and the neighbourhood; in other words, location, location, location. Where you live—your immediate environment—has a huge impact on your life chances, your social mobility and your opportunity and capacity to achieve at school and at work, to bring up your family successfully and to be a good neighbour and a good citizen. Unpopular, troubled places—so often council estates or social housing where past policies have concentrated the poorest households, those without jobs and facing the most problems—not only reflect the continuing inequalities in our society but exacerbate and perpetuate them.
At its simplest, if a family lives in an overcrowded, insanitary place—I recently visited a family of five living in a one-bedroom flat with very little prospect of being rehoused in the near future—normal family life is impossible. It is hard to be a good parent or a good pupil when you are all living on top of each other. Tempers get frayed; there is little chance of doing any homework at home; and children's health and parents’ mental health suffers badly.
The Government's efforts to ensure that there are enough decent homes to go around should certainly remain a very high priority, but outside the home itself, place can exert a powerful influence. If the school's catchment area is a neighbourhood where most children grow up with the attitude that school is rubbish, where truancy is rife and exclusion from school is a badge of honour, there is no point just blaming the teachers. It is the milieu, the prevailing culture of the place, as well as its physical conditions that hamper the capacity to learn.
A Member in the other place recently told me that last year only six people from his deprived urban constituency went to university—that is six people in a year from one parliamentary constituency. In Sussex or Surrey, one small village would contribute more young people to university. The place predicts and determines educational attainment. To me, it follows that we should think about different approaches to education, to school, for different areas. Current systems are failing in some places, so should we think about a different curriculum, different teaching methods, different ways of engaging parents, depending on the nature of the place?
Similar considerations apply to the causes and, perhaps, the solutions to so many other social problems: teenage pregnancy, drug misuse, alcohol abuse, many aspects of health. Of course you will reoffend if you leave a young offender institution and return straight back to the neighbourhood and the influences that led you into the criminal activity in the first place.
The place where you live can bring you down and hold you down. We must take account of that, not only in adapting national policies to fit local circumstances but by tackling the problems of place head on. That begins with housing policies. We must backtrack on the policies for allocating social housing that can lead to American-style ghettos of the dispossessed. Incorporating affordable, subsidised housing within mixed-income, mixed-tenure communities of owners and tenants together changes the image of the place and the self-image of those who live there. In a mixed community, children whose parents are young homeowners with a car go to the same primary school as their neighbour’s children although the neighbour’s home may be rented from a social housing landlord. But their properties are identical and there is nothing to show from the outside that their homes are different. The role models and influences of the school then come from people of a mixed background.
Government must also look at those policies that are specifically targeted at trying to change neighbourhoods. Many of them grew out of the Social Exclusion Unit’s most famous report, which produced the National Strategy for Neighbourhood Renewal at the very beginning of this decade. It led to powerful place-based action, such as the New Deal for Communities and the projects that came under the heading of the Neighbourhood Renewal Fund. Those initiatives do not come cheap, and neither do the excellent Sure Start schemes around the country, but they promote local measures that change a place, they support leadership within local communities, and they promote ways of neighbours doing positive things together. They are slowly but, in many places, successfully transforming neighbourhoods.
I say to the Minister: please tell your colleagues to keep the faith, not to retreat from the commitment made six years ago that no one should be disadvantaged by where they live by 2020, to recognise that place has the power to ruin life chances or, with resources and commitment, to give real hope and opportunity to some of our most excluded families.
My Lords, when I saw the title of this debate, what attracted my attention was the community cohesion part. I may not quite give the same emphasis to families as did the noble Baroness in her opening remarks, but I want to draw attention to something that can help most communities; that is, the structure of amateur sports clubs. I do so not because those sports clubs have a particular virtue in themselves but because they draw on the groups within them and make them come together. I refer to the local sports club and not to the idea of sport generally—that is, a club that has to come together as a unit to achieve its goals. Effectively, the selfishness of those involved is brought together in a group. I refer to anyone who has had the wonderful experience of trying to get a team together for a Saturday afternoon. What is required? First, you must identify those who want to take part with you. You have to do something so that they know that you are there and that you can reach them. That involves identifying people at schools who might eventually want to come to play in your club—if it is for adults—and giving them a reason to participate with you before they have left school. You bring people together in a coherent group. You then have to train them and provide support and organisation to get them to come to join in the activity that you want them to be involved in. You have to have organisation, support, coaching and training.
You also have to make sure that you fund your organisation. I do not know how this fits in with great comments about binge drinking and free alcohol, but that usually means providing a clubhouse and a bar. You also have to man the organisation. You need club secretaries, treasurers and all those other groups. What have you done at the end of it? In order to get 11 like-minded fellows together to kick a ball around—to take a sport that is not my own—you must provide a structure which involves two or three times that number of people. You must interact with another group with the same aims. They must be fairly local because you do not have a great amount of time. You have to interact with each other.
We are effectively covering most of the forms of activity that have been suggested by virtually every other noble Lord, and more widely. I take the health benefits as read. What do we need to try to encourage that activity? We need, for example, public space that is available for sport. We can take as read the usual arguments about playing fields and their history; are the Government going to ensure that there is easy access to public facilities of sufficient quality for use both casually and by sports teams, especially in the start-up period? The idea has been that if you leave something derelict for five years, you can get rid of it. Have much further have we got? Are we making sure that local authorities have the encouragement and advice to enable them to access that local resource?
Are we trying to get people to undertake an activity that brings about interaction with their neighbours on a friendly basis and encourages responsibility, even if it is only the responsibility of turning up? Anyone who has been involved in a local sports club knows that the shaming, shall we say, of someone who is consistently late or occasionally does not make it is quite an impressive force. Take your Lordships’ House. You get tutted if you regularly do not turn up for a debate or scratch your a name off the list. There are also debates that cannot take place at all. That is magnified when it involves your leisure activity. There is a considerable amount of pressure on someone to ensure that they honour their commitments. What are we doing to help?
We are at a very interesting point in sports development in this country. As we have heard, the Treasury is much more involved than it was. Let us face it; when the Department for Culture, Media and Sport bureaucracy cranks into gear, it does not exactly intimidate the rest of Whitehall. The Treasury does. How far is the Treasury trying to guarantee this type of activity?
We have heard, and will hear, a great deal about school sports. Seventy per cent of people, I think, drop out of regular sport when they leave school, so ultimately it makes no difference to the health benefits if you concentrate only on school sports and have nowhere for that to go. What are the Government doing to encourage these local groups, which, without any need for a bleeding heart or any great need to solve the problems of the world, do what they enjoy or indulge in an activity that encourages responsibility and provides role models and interaction with their peers? What are we doing in this area? If the Government make just a little effort here, they may well find that a door will fly open and that many of the goals will be achieved for them. I look forward to hearing some encouraging answers.
My Lords, like many noble Lords who have spoken before me, I begin by thanking the noble Baroness, Lady Gardner of Parkes, and congratulating her on securing this debate. We all agree on the importance of social cohesion. We also share the widespread feeling that, for all kinds of reasons, social cohesion is weakening and that we should do something about it. This question is particularly urgent in relation to ethnic minorities. I shall therefore concentrate on them.
We are told that social cohesion is weakening and is being frayed and undermined because of something called multiculturalism. The answer, we are told, lies in something called a shared sense of Britishness. I have some difficulty with both these notions, and I shall spend the time allotted to me concentrating on these two questions.
Multiculturalism has emerged as a new villain. We are told this by no less a person than Trevor Phillips, who was with me on the Runnymede Trust’s Commission on the Future of Multi-Ethnic Britain and who signed up, at least at the time, to the view that multiculturalism has a lot to be said for it. Of course people are welcome to change their minds, and he is certainly welcome to do that. More recently, David Cameron, the leader of the Conservative Party, has added his voice to this and told us that multiculturalism is the new devil shadowing our community.
I ask myself what is being dismissed or attacked in the name of multiculturalism. There is always a danger of setting up a straw man, knocking him down, and in the process losing some of the important ideas that we might have developed over the years. I suggest that we are in danger of making precisely that mistake. For reasons that I do not understand, multiculturalism is equated with cultural apartheid or, if you are a philosopher, with some kind of cultural relativism, which basically means that every community is a law unto itself and should not be touched. Its customs, practices and beliefs are beyond question because each community is entitled to its own standards of right and wrong. I am surprised that the term has come to mean that. This is not what it has generally meant—the kind of policy that we have followed in this country since the 1960s in the name of multiculturalism—and no one of sane mind contributes to the preposterous doctrine that every community is a moral law unto itself.
Basically, multiculturalism means two things. First, it means that people are culturally embedded and live out their lives from a particular way of looking at the world. Secondly, it means that no culture is perfect and that therefore every culture benefits from a dialogue with others—hence the emphasis on multiculturalism. Obviously not all forms of cultural diversity can be tolerated; everyone recognises this. Even within a community, certain forms of diversity are not tolerated, so there is already the presumption that there are certain universal principles that will help us to decide what cultural beliefs and practices should be tolerated and which ones should not.
There is an agreement, by and large, that we should rely on the principles of human rights, on which there is a considerable amount of universal consensus. This is how we have understood multiculturalism in this country ever since I have known it, which is going back nearly 40 or 45 years. We are all agreed that there are certain principles that will lay down the framework within which there will be relations between different cultures. This is why we have banned certain practices, such as female circumcision or polygamy, without any opposition from any ethnic minority that I know of. No community objected to this because by and large it was agreed that these were unacceptable practices.
This is also how and why we welcomed, or at least tolerated, certain minority practices, such as ritual animal slaughter among Jews and Muslims, or the Hindu practice of scattering the ashes of the dead in our rivers. Initially there was some opposition, but then people said that there was nothing wrong with it because it did not violate any of the basic principles. Then there is the Sikh practice of wearing a turban, Muslim girls wearing a hijab in schools, Muslim and Hindu nurses being allowed to wear their traditional dresses under their uniforms, or the Islamic practice of finance that bans interest.
In all these cases, we have shown respect for certain minority practices and tried to make provision for those that do not violate what we take to be the fundamental values of our society. In all these cases, multiculturalism was a way of showing respect for minority practices when they did not violate certain principles: in other words, when they deserved respect. Multiculturalism was therefore a way of integrating minority communities, not disintegrating them. It was a vital measure toward national integration—a nation-building project. This is how it has always been seen wherever it has been practised, whether in Canada, Australia, India or the United States, where hyphenated identities and multicultural curricula are a common practice.
As far as I understand him, this is also what the right reverend Primate the Archbishop of Canterbury was trying to say in an interesting speech. Of course there were a couple of potentially misleading expressions, but by and large his basic thesis in that lecture, if carefully read, and in the more important lecture which he delivered last year, was that we need to agree on certain common principles, subject to which we should have multiculturalism in the form of intercultural dialogue. Let us not discard multiculturalism or try to demonise it even before we have had a chance to understand it, because it does not mean what it is taken to mean. It has stood us in good stead and allowed us to chalk up a wonderful record compared with France, the Netherlands and many other countries.
I shall briefly discuss the idea of Britishness. We all agree that there must be a shared sense of national identity if people are to live and work together and develop a common sense of loyalty. I am not entirely happy with equating British national identity with Britishness. I do not quite know what the word means. It is also rather striking that we seem to be one of the few countries in the world to use that expression. No one talks about “Americanness”, “Canadianness”, “Frenchness”, “Indianness” or “Germanness”. What we really need to understand is that Britishness is not like redness; it is not a shared, empirically understandable set of characteristics. Basically, being British means two things. First, it means a certain sense of commitment to political institutions and practices that we share, and showing loyalty to them. Secondly, it means some form of identification with our fellow citizens; the recognition that they are my people and that I belong to them just as they belong to me. The question for us is therefore how we foster these qualities; that is, loyalty to the country, and a sense of identification. I suggest that two things are needed. First, the wider society needs to recognise that the minorities in its midst should be treated with respect, given equal opportunities and a stake in the country, and accepted as one of us. For their part, the minorities need to recognise that this is the country in which they have chosen to make their home. It is not theirs by accident or birth; they have made the choice. They must show sensitivity to the feelings of the majority communities, take an active part in them and recognise that their interests and their future are deeply bound up with the future of the country at large.
We have made considerable progress in that direction. Hindus, Sikhs and Jews are a fully integrated part of our society, so are a large body of Muslims. However, one problem which tends to arouse a lot of fear and panic concerns a small section of young Muslims. Alienated from their own culture and wider society, they feel deeply concerned about certain issues. The problem therefore is specific and does not concern ethnic minorities in general where there is no problem. The problem is that one small section of society feels alienated. What should we be doing about this?
I say that because it is important not to panic. When we panic and feel that the cultural fabric that we have built together is falling apart—about which the noble Lord, Lord Dholakia, spoke with great eloquence and about which my noble friend Lord Giddens has written with great passion—and that all we have been doing for the past 40 years has fallen apart, there is always a danger that we will make wrong choices. We may pick on a community and create a climate in which that community feels besieged, which is the surest way to undermine all that we have achieved and to fail to achieve what we need to achieve.
My Lords, I, too, am very grateful to my noble friend Lady Gardner of Parkes for initiating this debate. Its aim is crucial to the future of our country and I am very struck by the sense of agreement on all sides of the House. For generations, all over the world, the family has always been the basic unit of a stable society. Having enjoyed a happy marriage and the loving support of my children and grandchildren now, I believe that more support for life-long marriage needs to be woven into our society. Of course, every marriage has its ups and downs, and rows and arguments, but, as every golden wedding couple says, “A happy marriage is a matter of give and take on both sides”. That is not easy and on occasion may fail, but for the couple and, especially, for the happy and successful bringing up of the children, it is worth the effort to retain the stability of the marriage. We read regularly in the media of the heartbreak of the children if their parents part. Obviously, constant rows are bad, but Relate can help in highlighting what can be done by a couple to restore friendly stability.
As a former chairman of the Equal Opportunities Commission, I believe deeply in equal opportunities for men and women. Such worthwhile schemes as job-share, flexi-time and bridging career breaks, which enable women to combine rewarding work with stable family life and not losing their skills, are essential for the women and their employers. Those sorts of ideas flexibly carried out certainly help to strengthen families over the long term for both fathers and mothers.
I am fortunate to live in a village with a strong sense of community, and a friendly church and chapel. We have an excellent parish council, the scouts, the guides, a women’s institute, a link club for elderly people, keep fit and the Workers’ Education Association. The list is wonderful and they are all supported by enthusiastic volunteers. Last summer, we hosted the Centennial World Scout Jamboree when 40,000 young people visited Writtle from all over the world. No litter was left behind and 30,000 hours of fantastic voluntary work was done locally.
I believe deeply in voluntary work. It is done for love, which gives it a special commitment. I wish that the media would put far more emphasis on the good things that people do. It says, “Bad news sells newspapers” and I say, “Not to me”. We need far more news of the good things that people do, not just news about knifings and muggings. That would bring back into fashion the need for the young to engage their futures in that way, thus making it cool. Most young people are jolly good. They do Duke of Edinburgh awards; they belong to the scouts, the guides, youth orchestras and schools; and they help charities. I do not think there are any reporters in the Press Gallery at the moment, but they should give the work of young people a well deserved boost. “Come on media”, I say.
Recently, I was very interested to read the report by the noble Baroness, Lady Neuberger, on the Commission for the Future of Volunteering. Voluntary work certainly should be encouraged for its help to the disadvantaged and the often unexpected rewards it gives to volunteers. Many voluntary organisations contribute to social cohesion, but my special one is the hospice movement, which is partly NHS-funded and partly professionally staffed, and provides devoted care for the terminally ill. It is also dependent on its enormous number of volunteers who are equally devoted to palliative care, which controls pain and protects quality of life for very vulnerable patients.
Macmillan nurses and Samaritans are wonderful too, as are the organisations specialising in care for the blind, the deaf and the arthritic. As many noble Lords have said, how lucky we are in our country to have the loving work of all those people. I was fascinated to read in the Times last week about Starley Road, a housing co-operative in Coventry. It is run on a voluntary basis to provide affordable homes for those who are in need; that is, single people, families, the elderly, the young and some people with learning difficulties. I had not heard of anything like it before. People put their names on a waiting list and invest £1 in the co-op when they move in. They promise to attend the regular community meetings, which are held to solve problems together. When they have unruly young people or thoughtless, drunken, noisy neighbours, they call a meeting and sort it out among themselves, without calling the police. All ages work together. The partnership really works, and small is beautiful.
I believe that this Government are trying to do too much centrally. The man in Whitehall does not know best: he is too far removed from local communities. Communities are very diverse. Newcastle is different from Essex, and I am an Essex girl. The key to success is locally-elected government, and parish, district and council councils. I am not in favour of too much emphasis on regions or directly-elected mayors. It should be left to the councils to elect their leadership: in fact, leave it local. It will not always get it right, but it will soon find out if it is getting it wrong.
Councillors meet on the street the people whom they are elected to serve. After my 30 years in local government—district and county—and my husband’s 17 years on the parish council, I know what I am talking about. It is not always comfortable. One has to learn from one’s mistakes, must consult carefully if there is to be change, and must learn from the local people’s response, not just from national pressure groups. We must get back to careful integrity in public service from the officers and members at all levels. As long as they are near enough to the local people, representatives will be trusted. In addition, the necessary finance must be provided fairly, which is up to the Government. People locally will be given a sense of responsibility to their community. We need all levels of local government to work in partnership and with local voluntary groups. That is the name of the game. It is worthwhile even when it is difficult, which it will be sometimes, and it is something that we all have to learn.
My Lords, I add my congratulations to the noble Baroness, Lady Gardner, on securing this important debate. I want to focus on how we can enable relationships across the generations to be stronger and, through that, communities to be more sustainable and stable. It is critically important to enable families, however they are structured, to stay together. This is the priority of the Equality and Human Rights Commission, and I declare an interest as a member.
When seeking to protect people suffering discrimination or inequalities, which is one of the primary roles of the commission, we have to take on board the fact that women, despite a great deal of progress in equality at work, still lose out in terms of career, salary and opportunities for promotion compared with men as soon as they have children, and especially if they seek part-time employment. Parenting often exacerbates financial stresses and problems, leading to separation and divorce. We also need to take on board the fact that parenting involves fathers. Their potential as well as their actual role is certainly not seen to be as critical as that of the mother in terms of policies and practice. One example is the differential in maternity and paternity leave. I hope the Minister will agree that the work/home life balance is critical and that we must encourage good parenting by both men and women.
In terms of intergenerational relationships, the role of the wider family, and especially that of grandparents, is of critical importance. I was delighted to learn yesterday that grandparents are going to be given financial support and legal backing to make it easier for them to take over the care of children whose parents are drug users. I hope that we can be assured that this help will be extended to families where other physical or mental health problems can necessitate grandparents taking on a crucial caring role, one still not always recognised as qualifying for financial and other support even though their role is better acknowledged in the Children and Young Persons Bill now going through your Lordships’ House and for which the Minister is responsible. I feel that there is still room for improvement if grandparents are to be recognised and given adequate help in the future.
Turning to the wider community, I warmly welcome the work of the Department for Communities and Local Government, which launched its strategy entitled Lifetime Homes, Lifetime Neighbourhoods this week and on which the International Longevity Centre, a think tank I head, has been co-operating. It is excellent that the Government recognise that building lifetime neighbourhoods is necessary for community cohesion and are introducing a joined-up approach to ensure that housing, shared open spaces and infrastructure are suitable for all. It is essential that people of all ages and backgrounds feel at ease in their local community and that the environment itself is a factor in promoting good relations. This strategy promotes social cohesion from the perspective of an ageing population, but focuses on sustainable intergenerational communities which include accessible transport, information, health and social care where needed in a safe and friendly atmosphere, where people can contribute as well as receive advice and help when necessary.
As the Beth Johnson Foundation has emphasised, older people can provide younger people with positive role models of both engaged citizenship and active ageing, while young people offer a link to the future for those who are older and who can carry out valuable roles such as mentoring in schools, working in playgroups and so forth. One scheme in Liverpool was set up to improve independence for older people and to break down negative stereotypes surrounding younger generations. Teenagers were recruited from local youth groups to tutor older people on how to use their mobile phones. Not only did this provide training for the older students, it also gave them an added sense of “safety”, knowing they could use their phones in an emergency. Their young teachers benefited from developing excellent communication and leadership skills.
At a wider level, if social cohesion is to be taken seriously, we must look again at the way housing is allocated. We must positively foster integration, not separate groups into enclaves based on ethnicity, age or other differentiating factor. Mixed communities are important, and in my view the points system of housing allocation in social housing needs to be looked at again very carefully, as does our planning system, which I hope the DCLG strategy will help to ensure takes place so that together with the new planning legislation, we get a more positive planning role for local authorities and which, in spite of promises of consultation, can be speedier and take into account the genuine needs of the different groups in our multi-ethnic, multicultural and multi-aged society.
My Lords, I am speaking towards the end of a long list of distinguished contributors, but I should like also to join the queue to thank the noble Baroness, Lady Gardner of Parkes, for setting up a debate on this manifestly significant topic and for her elegant introduction to it, even though I do not agree completely with everything she said. It is quite difficult to speak with wit and verve at the end of such a debate and that reminds me of a story about this place. I do not know whether other noble Lords have heard it. Apparently the Earl of Montrose once declared, “I fell asleep and dreamed I was giving a speech in the House of Lords. Then I woke up and by God I was!”. Well, I hope that at least I will be able to stir some attention with what I have to say.
My starting point is that a lot of writing and speaking on the study of the family and marriage is flawed by an historical misunderstanding of past times. The idea that the breakdown of the family is threatening the social cohesion of the wider society is one that every generation entertains. For anyone who doubts that, I suggest they read The Way We Never Were, a book by Stephanie Coontz, which interestingly goes back generation by generation. We learn that each generation thinks that the time before that one was a golden age for the family, but when you go back generation by generation, in every case this is wrong. There never was a golden age of the family and it is therefore a mistake to contrast the issues that we have to deal with today with such a mythical golden age. I would include in this the 1950s as well as previous periods which the author also studies in detail.
The noble Baroness was right to avoid this. We should have no truck with those who say that our aim in family policy should be a return to the traditional family, by which I mean the family up until the threshold of the 1950s. That traditional family might have had virtues—indeed it did—but it also had a serious set of downsides. It was based on the dominance of men over women. Women were the chattels of men in English law until well into the 20th century, the last residue of which, so far as I know, is the law about the impossibility of rape in marriage. I believe that it was repealed as late as the 1960s. The traditional family also did not admit the rights of children. Historians and social scientists have uncovered just how big the dark side of the experience of childhood in the traditional family was, again right into the 20th century and to some extent the 21st century. Levels of sexual and physical abuse of children were much higher than anyone conceived possible until intensive research on this topic revealed them a few years ago. Finally, the traditional family set a double standard in which married women were supposed to be pure and other women were regarded as fallen. In the mean time, men could get on with their philandering. So we certainly should not hold up the traditional family as a model for the past. At the minimum, we should be cautious about the idea that the family is breaking down and as a consequence the wider structures of our society are threatened.
Some of the homilies about the breakdown of the family are to be found in the report by Iain Duncan Smith, mentioned by the noble Baroness. He says famously:
“We are living in a broken society”,
caused for the most part by the undermining of family life. Noble Lords will forgive me if I say that that is pretty much nonsense, and I say that as a social scientist rather than as a Labour Party member. Iain Duncan Smith also states:
“Family breakdown trends are being driven entirely by the increase in unstable cohabiting relationships”.
Hence his support for tax breaks to favour marriage as a core part of the policy programme he suggests. But these arguments do not stand up to a moment’s examination or scrutiny.
One of the key changes in the nature of marriage and the family over the past 40 or 50 years is the tremendous increase in the age at which first marriage occurs. About 30 years ago, age at first marriage was 22 for women and 24 for men; now it is about 29 for women and around 30 or over for men. This means that cohabitation now quite normally precedes marriage and it is quite wrong to cast the two as alternatives. Cohabitation is an important learning lead-up often to the taking of marriage vows and many people get married when expecting a child or a child arrives.
The idea that the rise of cohabitation as such signals the breakdown of society is falsified by the experience of the Scandinavian countries, which have easily the highest levels of cohabitation in Europe. Nobody thinks that those societies are on the verge of breakdown. On the contrary, those societies have dealt best with the social changes affecting the family.
So we are not living in a broken society but in one struggling to adapt to large-scale change. Just as in the sphere of work—here I disagree with the noble Baroness, Lady Bottomley, who is not in her place—a great deal of the strength of the family today has to come from adaptability to change. We cannot expect the family simply to provide a stability which other institutions have largely forgone. Just as it applies elsewhere, the process of having an adaptable outlook to the world and being able to cope with change and diversity applies in the sphere of the family.
It is not true that the family, on the whole, is experiencing breakdown. There are many aspects of family life which are manifestly superior to what they were 30 or 40 years ago, let alone a long time before that. For example—I shall just quote one statistic—a recent study by sociologists has shown that the average amount of time spent by fathers with their children is much higher today than it was in the 1950s, even including the fact that there is a higher rate of divorce today than in that period. There are many other examples of that.
So, to my mind, it is not right to suggest that tax breaks should be given to strengthen marriage. On the contrary, the best way to strengthen marriage is to strengthen cohabitation because it is so often an avenue into marriage.
In conclusion, I should like to suggest to the Minister that the best family policy has three characteristics and ask him to endorse them. First, we have to concentrate on families of multiple deprivation, which is easily the biggest source of family breakdown; secondly, we have to recognise and endorse the diversity of family life; and, thirdly, we also should expect family life to reflect wider democratic principles, above all the equality of men and women. The equality of men and women should be a structural part of family life for the future and we should find ways of ensuring that family life adapts to that democratic principle.
My Lords, it seems to me self-evident that the family unit is the most satisfactory basis for society. It is rather like saying that democracy is the best basis for government; it is not always perfect but it is preferable to anything else.
Nevertheless, however self-evident family values and the advantages of a stable family background may seem, it is good to review the contribution of the family’s role in society and in the community in a rapidly changing world. It may be that by doing this we can produce finally a golden age of the family, despite the reservations voiced by the noble Lord, Lord Giddens.
Even in the wider international scene, where we frequently refer to a “family of nations” or the “family of the Commonwealth”, it is wholly desirable that the qualities of understanding, tolerance and love that unite a happy family should also be the basis for understanding and good will between nations. I therefore add my congratulations to my noble friend Lady Gardner on introducing the debate and on the way she has drawn attention to the family and justified the need to strengthen its role.
It has been a wide-ranging debate and I am grateful to those organisations which have sent information and briefing. For example, the young offenders programme led by the National Grid has, I now learn, improved the prospects of more than 1,000 young offenders, turned prisoners into taxpayers and offered career prospects to individuals. This kind of initiative is very important and much to be encouraged.
It has been fascinating to listen to the many contributions made in the course of the debate, whether on the role of fathers within families—on this I endorse entirely the comments of the noble Lord, Lord Northbourne—or the special needs of multicultural communities, so well explained by the noble Lord, Lord Dholakia, and my noble friend Lady Verma. That is one of the advantages of being close to the end of the speakers list, even though much of what one set out to say originally has already been covered and most eloquently expressed. But, as my noble friend said at the outset, it is easier to enumerate the problems than to resolve them. However, it has become clear that we all hope that some solutions and some practical progress will come out of the debate.
I wish to focus on the role of family carers, who can give an unparalleled quality of care and love to sick, disabled or elderly members of their families, often without any recognition or acknowledgment. The noble Baroness, Lady Pitkeathley, and the right reverend Prelate both spoke with expertise about carers in general, as indeed did many others. Like my noble friend Lady Bottomley I also believe that health visitors have an important role. However, in passing, I draw attention to the fact that since 1997 the numbers of health visitors have decreased.
Replacing family carers by social services is a costly exercise. I believe that family carers should be supported and encouraged and that the role and responsibilities of the family should be applauded and not eroded by what I will call the law of unintended consequences. This can often apply as a result of well intentioned rules, regulations and policies, and sometimes can arise out of political correctness.
Rather than generalise about this I should like to cite an example and refer to the vexed question of inheritance tax, especially as it affects siblings who share a household—here I declare an interest as my sister and I are in that situation as joint owners of our home, our motor car and many other things—or a son or daughter who cares for elderly parents in the family home. For such people, the eventual impact of inheritance tax may mean the sale of that joint household or family home at a stage when the remaining individual, who has given unpaid devotion and care, may be growing old too.
The Civil Partnership Act gave the same exemption from inheritance tax to homosexual couples as has always applied between spouses. In the course of the debates on the Bill, my noble friend Lady O’Cathain tabled an amendment to the effect that siblings and family members in the circumstances I have described could register and benefit from the same exemption. The amendment received substantial support throughout your Lordships’ House but was not accepted by the Government. I know also that a case involving two elderly sisters in these circumstances was due to be brought before the Court of Human Rights in Strasbourg, but unfortunately I have not been able to discover the final outcome of that case in order to cite it as an indication of the way forward.
It would be helpful if the Minister could tell the House whether any further thought has been given to this issue by the Government. I look forward to hearing his reply on this and to the many other questions that have been raised.
My Lords, I congratulate the noble Baroness, Lady Gardner of Parkes, on giving us the opportunity to debate these important matters. I reflect that, alongside the many fine contributions from the female members of the Conservative Party, it is a pity that she was not able to persuade any of her male colleagues to take part.
It has been a wide-ranging debate. We have heard about the problems of fathers from the noble Lord, Lord Northbourne; about family breakdown from the noble Baroness, Lady Pitkeathley; about racial issues from my noble friend Lord Dholakia, the noble Baroness, Lady Verma, and the noble Lord, Lord Parekh; about local sports clubs from my noble friend Lord Addington; about the difficulty of delivering family services from the right reverend Prelate the Bishop of Southwark; about drug addicts from the noble Baroness, Lady Massey; about troubled young people and mentoring from the noble Baroness, Lady Bottomley; about intergenerational issues from the noble Baroness, Lady Greengross; about the history of families from the noble Lord, Lord Giddens: and about family carers from the noble Baroness, Lady Hooper. It occurs to me that there is a thread running through all the problems that have been outlined: a lack of respect for the integrity of other people and for the integrity of their homes, and indeed a lack of self-respect, which leads to all sorts of anti-social behaviour.
In opening her fine speech, the noble Baroness, Lady Gardner of Parkes, referred to the issue of poverty, particularly child poverty, an issue that concerns me. She talked about energy being more expensive for the poor, yet she questioned whether one-parent families should get slightly more benefit than two-parent ones. I must point out to her, having been a single parent myself, that single parents often have to pay for someone else to do things that their partner might otherwise be able to do, if they had one—things such as childcare while they go to work and small jobs around the house. Not all single parents are irresponsible; many are single through no fault of their own and many do a great job of bringing up their family, but they need more of the sort of help that she outlined in her speech for the sake of their children.
Having said that, I agree with a great deal of what she said. The charitable institutions and our schools have a vital job to do, alongside parents and the rest of the community, in helping our children to have ambition, confidence and self-respect. If they have those, they will work towards their goals for their own benefit and that of all of us. From what she said, the noble Baroness, Lady Massey, would agree with that. That, and the fact that this debate is being answered on behalf of the Government by the Minister for Children, Schools and Families, the noble Lord, Lord Adonis, has led me to approach my contribution to this debate from the point of view of the child. If we can get it right for children we can get it right for the whole community, certainly in the future and to a great extent in the present too. The Government have recently put the welfare of children right at the heart of their thinking. Although some of us will always continue to urge them to go further and faster, we all acknowledge and respect that.
I propose to your Lordships a concept that is currently being developed by UNICEF’s UK National Committee, of which I am a trustee, in response to the Government’s child welfare agenda: child-friendly communities. You might ask: why single out children? After all, our environment and our community should be friendly to all of us. In answer, I say that it is helpful to have a focus when planning what sort of community we want to live in. I was interested in what the noble Baroness, Lady Verma, had to say about children. As I recall it, she said that if children play together, eat together, live together and even fight together, they will understand each other and be able to live together well. A community that is child-friendly will also be supportive of, and helpful to, other vulnerable people, including elderly people. If it is a good place for small and vulnerable people to live in, it is going to be the sort of place where all of us would want to live and gain a good quality of life. I make no apology for singling out children, because in doing so we will be benefiting everyone.
What do we mean by a “child-friendly community”? It is a way of integrating the UN Convention on the Rights of the Child into national and local government processes. It is equally applicable to governance of all communities that include children, large and small, urban and rural, and is intended to provide a foundation for adaptation to suit all localities.
The child-friendly communities initiative emerged in response to the rapid transformation and urbanisation of global societies and, consequently, the increasing importance of cities and towns within national, political and economic systems. The initiative promotes the implementation of the convention at the level where it has the greatest direct impact on children’s lives: right in the place where they live. It is a strategy for promoting the highest quality of life—indeed, for all citizens of all ages.
What would a child-friendly community provide? It would guarantee the right of every young citizen to the following nine things. First, they would have a voice. Children in such a community would be able to express their opinion on the community if they wanted and have their views listened to. We all know how we can get better decision-making if we listen to those who receive the service. Secondly, they would have a right to participate in family, community and social life. Communities that welcome families and make them safe and happy places to bring up children will, of their nature, be low-crime communities.
Thirdly, they would receive basic services such as healthcare. Services would be easy for families with children to access, with no discrimination as to race, income or other factors. Fourthly, they would have the right to education and shelter. Those are things we take as read in our UK communities, unlike in the rest of the world, but there are still problems here of poor schools and homeless families being accommodated in places that are quite unsuitable for bringing up a happy, well adjusted child. The noble Lord, Lord Best, might agree particularly with that one.
Fifthly, they would have the right to drink safe water and have access to proper sanitation. On the whole that is an aspiration for less developed countries than ours, but with overseas aid we can help them to reach the standard we are lucky enough to have here. Sixthly, they would have the right to be protected from exploitation, violence and abuse and to walk safely in the streets on their own. We still have a long way to go on that one. Sadly, almost every week there are still terrible stories of children who have been abused and even killed. We have to tackle the very foundation of these problems and bring a full stop to this abusive cycle by giving more support to families in difficulty and giving the best possible treatment science and psychology can devise to the perpetrators so that they never offend again. That is one of the most difficult challenges we face.
Seventhly, they would have the right to meet friends and play. I was delighted recently to hear about how the 2012 Olympics are involving children, but it sad to me when I see a new estate being built with nowhere for children to play. Children need green spaces and playgrounds where they can meet other children and get on with them, and teenagers need meeting places and leisure facilities. I know these things cost money, but they save money in the long run when we consider the cost of the youth crime, drug treatment, alcohol abuse and so on that result from children not being brought up with lots of good activities to keep them busy and use up their energy.
Eighthly, they need to live in an unpolluted environment. There are lots of challenges here in making our cities green, but I do not have time to go into all that now. Finally, children should be able to participate in cultural and social events. They should be equal citizens of their community, having access to every service, whatever their ethnic origin, religion, income, gender or disability. Like the noble Baroness, Lady Platt, I am lucky enough to live in a village—Gresford—that has wonderful community facilities for young and old people. Would that everyone had that.
If all this sounds like an unattainable ideal, I remind noble Lords that a couple of centuries ago it seemed like an unattainable idea that we would all live in cities with clean water, good sanitation and universal education up to at least 16—but today we do. However, it would need a special group of people to focus and plan for such a community. That plan would need to be focused on outcomes and to take account of the views of children and their parents. Those all sound like good ideas to me. Does the Minister agree?
My Lords, I am privileged to sum up from the Front Bench for the first time in a debate on a topic of great importance, in which the contributions from all sides of the House have been wise and thoughtful. The debate reminds me that this House is so important because its talents are immense. I am thankful particularly to my noble friend Lady Gardner for securing it.
Apparent in it has been the fact that families, community cohesion and social action are interlinked. Debate now should focus on how we create communities at ease with each other, where, whatever one’s background, race, age, faith or sexual orientation, we live lives that drive towards a common purpose: strength in unity.
In addressing the challenges facing modern Britain, we must be guided by core values: our commitment to equality under the rule of law, our recognition that as a nation we are all in it together, our attachment to civil liberties, and our determination to tackle racial discrimination and ensure equality of opportunity at all levels, in a belief that our nation is made stronger by the contribution of our different communities.
The report of the Conservative Party social justice policy group—its two volumes are entitled Breakdown Britain and Breakthrough Britain—provides a long and detailed analysis—I wholeheartedly disagree the description of it by the noble Lord, Lord Giddens. It describes and explores how poverty and deprivation have created a vicious cycle of unemployment, addiction, crime and further poverty, diminishing families and neighbourhoods. It refers to the cluster of mutually reinforcing sources of deprivation: worklessness and state dependency, family breakdown, drug and alcohol addiction, low educational attainment and debt. For those caught in such traps, one problem interacts with another eventually to produce a malign spiral of social dysfunction. Lack of qualifications makes it harder to get a job, giving the downward spiral another twist by increasing poverty and opening the door to crime. Partly as a result, young people find it harder to create lasting relationships; teenage pregnancy increases; and children are born into conditions in which the cycle is prone to continue. In short, traps of multiple deprivation are a reality in Britain today.
This side of the House believes that solutions to neighbourhood breakdown have to be local, because the problems are local; they are also complex and delicate, and require a practical and flexible response. I was particularly impressed by the clearly defined and practical solutions explored by my noble friend Lady Bottomley. Ultimately, the solutions need to be bottom up, grassroots driven, and not dictated by bureaucrats sitting in Whitehall. As my noble friend Lady Platt firmly put it, leave it local.
One of the best ways to revolutionise the hopes and opportunities of individuals in the most troubled neighbourhoods, and hence those of future generations, is to help the 55,000 social enterprises that already exist. We should listen to their views and not impose ours on them, thereby taking away that very passion that made them successful. Community groups, too, play an important role in providing solutions to local problems. They are steeped in local knowledge, deeply motivated, flexible and imaginative; and we need to tear down the barriers that centralist government have put in their way, such as the short-term and complex approach to funding to which the right reverend Prelate referred. Only then will we allow them to realise their full potential.
The term “multiculturalism” is again at the centre of a debate in the UK. The noble Lord, Lord Parekh, referred to the former head of the Commission for Racial Equality, Trevor Phillips, who has said that multiculturalism is of another era and should be scrapped. My understanding of multiculturalism is that communities from different backgrounds, cultures and customs can live alongside each other, celebrating their differences but uniting in purpose.
Unfortunately, during the past decade or so, a form of state-driven multiculturalism, however well intended, has helped preserve cultures and languages while failing to unite Britons. It has resulted in people being kept apart, giving them less incentive to learn English, and has been one of the factors responsible for contributing to cultural group solidarity at the expense of broader social participation. The treating of communities as monolithic blocks rather than as equal members of society has been divisive and patronising. I endorse the views of my noble friend Lady Verma, who spoke of self-appointed community leaders who singularly and incorrectly purport to represent large, diverse ethnic communities. I bring it to the attention of the noble Lord, Lord Parekh, that this divisive form of state-driven multiculturalism focuses on things that divide rather than unite us. My right honourable friend David Cameron was right to criticise it.
Although the ease of local communities will ultimately be delivered by local solutions, we must recognise that there are areas where government policies can and do make a difference. Families, however defined, are acknowledged across this House as one of the bedrocks of society, yet where do we find this Government’s record? Couples face financial penalties. A study by Frank Field MP for the think tank, Reform, found that in families with exactly the same number of children, two-parent households need far greater earnings than a lone parent to move past the poverty line. That was referred to by my noble friend Lady Gardner.
The benefits system pays for couples to split up. The Institute for Fiscal Studies has highlighted the example of a couple with children, where the husband earns £15,000 a year while his wife has a part-time job paying £5,000 a year. As a couple, they can claim benefits and tax credits worth £2,317, but if they split up, the wife on her own with the children would receive £7,785 from the state, making them better off by more than £5,000. That again is something that the Government can address. I am pleased that proposals from my party are to give clear and unambiguous backing to families that come together and stay together.
The tax credits system, which is another government responsibility, is in chaos. Fraud, error and overpayments have led to £5 billion being wasted. In the last year for which we have data, more than half of all tax credit payments were incorrect. Almost 2 million people a year receive the wrong tax credit payment and face having money clawed back, putting them in extremely difficult circumstances. This again is something that the Government can and need to address now.
Let us consider the Government’s record on children in care, 20 per cent of whom will still be unemployed in the September after they leave school. Nearly 50 per cent of them will leave school without a single GCSE. They are children for whom local and central government have direct responsibility of care. We cannot shirk it or blame other agencies or families for it.
I turn to an area covered by my own brief: community cohesion. In October 2007, Hazel Blears announced £50 million of investment over three years to promote community cohesion and support local authorities in preventing and managing community tensions. In December 2007, the Department for Communities and Local Government set out proposals for distributing £38.5 million of it, but, only recently, the Government announced that the framework to advise how to deliver this money will not be ready until the summer of this year. Surely this approach is back to front. Surely one needs to work out what needs to be done and then budget for it, not set a budget and then decide how to spend it. I hope that the Minister will enlighten your Lordships' House about this confusion.
In the Government’s response to the report of the Commission on Integration and Cohesion, the Department for Communities and Local Government said that it would be,
“piloting specialist cohesion teams to support local authorities facing cohesion challenges”.
However, I must warn the House that this headline-grabbing announcement is not all it seems. The nucleus of these teams will be neighbourhood renewal advisers, who are already in place.
There is hope. The Department for Communities and Local Government recently acknowledged in its response to the report of the Commission on Integration and Cohesion that this Government’s approach had failed over the past 10 years. It stated:
“We agree that given local complexity, a one size fits all strategy is no longer appropriate, and our guidance in the past may have wrongly taken this approach”.
I hope that the Minister will confirm that that signals a new direction from the Government and some hope for how we deal with community cohesion, social action and families.
My Lords, the House is grateful to the noble Baroness, Lady Gardner of Parkes, for this opportunity to debate a wide range of important issues relating to families and community cohesion. We have had an excellent debate. I am particularly glad to follow the noble Baroness, Lady Warsi, who occupies a prominent position in the Conservative Party on these issues, and we welcome her to our debates.
We have heard a lot about negative aspects of modern society in this debate, about problems caused by drink, drugs and anti-social behaviour, about families causing misery within their neighbourhoods, about instances of youths perpetrating violent crimes, about entrenched social disadvantage, and about poverty of aspiration. These are issues of the utmost gravity, which I shall say more about in a moment. However—and here I disagree with the noble Baroness, Lady Warsi—most of us would wish the message to go from this House that these problems, serious as they are, are not the dominant characteristics of our communities or families.
I do not believe that we are living in a fundamentally broken society. I agree with the noble Baroness, Lady Walmsley, and my noble friend Lord Giddens that Britain is a place where the great majority of families provide a loving and supportive environment for children to grow up in; where in so many aspects of life the present is better than the past; where most parents want their children to get on and succeed in school and at work; and where most communities are safe, friendly and vibrant places to live. Also, as the noble Baroness, Lady Verma, said, most of our immigrant families believe that they belong and are proud to be British. I myself come from an immigrant family and I would certainly say that of my family and community, whatever the continuing challenges that we face in diversity and immigration.
In the 2007 Tellus2 survey, which collected the views of more than 110,000 children, 93 per cent of those children said that they were happy about life, with a similar number having a positive view of their parents and families. Last year’s British Crime Survey showed a 41 per cent fall in the incidence of violent crime since its peak in 1995 and the performance of schools is sharply improving, with nearly 100,000 more 11 year-olds up to standard in literacy and numeracy compared with a decade ago and the number of failing schools halved. That does not lessen the impact of the very serious problems that do exist; it is our duty to tackle those issues, and concerted action is required across government in each area named in the Motion.
We are improving support for parents to bring up their children happy and healthy, with clear values, a sense of social responsibility and high aspirations for their lives. We seek to create more good schools and promote citizenship and community cohesion in our schools and communities, combining targeted support and robust action when appropriate to counter challenges such as drug and alcohol abuse, anti-social behaviour and gun and knife crime.
Before turning to the specific issues, I shall make a broader point about how the Government provide services. First, many issues raised today relate to individuals and families who have complex needs that can only effectively be addressed by support from a range of public services and joint working between agencies at national and local level. Secondly, they vary widely from community to community. We can and must establish a policy framework at national level but, in the end, as the noble Baroness, Lady Platt, so rightly said, these are often inherently local problems, requiring locally designed and driven solutions with local government and the local leadership of public services and voluntary agencies playing a pivotal role.
To take up the remarks of the right reverend Prelate the Bishop of Southwark and the noble Lord, Lord Dholakia, I stress the role of voluntary agencies. As the noble Lord, Lord Dholakia, said, it is people not governments who bring about change; community groups, including the churches and other faith groups, have a vital role to play in terms of local leadership and local service provision. It is to this end that we have promoted the role of local authorities as strategic planners and commissioners and not only as direct providers of community services. We expect them to be open to the full contribution that can be made from the whole range of voluntary local partners in their areas, including the faith groups described by the right reverend Prelate.
Among the most important of the local services are the local health services, including the vital role of health visitors, as rightly emphasised by the noble Baronesses, Lady Bottomley and Lady Hooper. These services are developing further, for all the reasons that the noble Baroness, Lady Bottomley, gave about the vital contribution that health visitors can make, particularly in respect of vulnerable families, with whom they have an almost unique relationship to bring about improvements for the better in how those families operate and in particular in the support available to mothers. I highlight, for example, the family nurse partnership, which tests a model of intensive nurse-led home visiting for vulnerable first-time young parents in 10 areas of England, not only for the early weeks after childbirth, as is traditional in the case of health visitors, but right up to when the child is two years old. A sum of £30 million has been allocated to expand the family nurse partnership scheme in the next three years; this is targeted at the most vulnerable first-time young mothers and their first child, who can benefit from intensive preventive early intervention to improve their life chances. The programme is taken up by 90 per cent of the hard-to-reach families to which it is offered and has been welcomed by the health visitors and midwives in local areas, who see positive changes taking place in behaviour, relationships and well-being. That kind of initiative is exactly the kind of area in which the state in its local capacity can work more effectively with families to ensure that children have a much better start in life and that issues to do with family breakdown are avoided.
A key reform in this area is also the development in each local authority of children’s trusts, which have been possible since the Children Act 2004, as my noble friend Lady Massey said. Children’s trusts co-ordinate the agencies that plan, commission and deliver services for children, including primary care trusts and third sector organisations, to promote better integrated services focused around the individual child and his or her needs. In many parts of the country, these changes have brought about substantial improvements. My noble friend asked for examples. I have been told recently of the success of the Bedfordshire children’s trust in developing a commissioning strategy to focus resources on earlier assessment, intervention and family support leading to radically improved results for children. The number of children in care in Bedfordshire has come down from 441 to 308; attainment in schools and children’s centres has improved and school exclusions have reduced by 25 per cent. Other children’s trusts have similarly positive stories to tell, but I fully accept that some areas are making less progress—and I particularly noted the examples of less effective practice given by the right reverend Prelate the Bishop of Southwark, which I would also wish to draw to the attention of the local authorities that he mentioned.
I note, too, that from June this year new local area agreements will streamline the way in which central and local government interact so that priorities are no longer imposed from the centre but are negotiated locally. An important priority for us in these local area agreements is the promotion of community cohesion. This is not according to any national template; the new national indicator set underpinning new local area agreements includes two cohesion measures—first, the percentage of people who think that their local area is one in which people from different backgrounds get on well with one another and, secondly, the percentage of people who feel that they belong to their local areas. Cohesion measures are therefore being very much generated by best local practice, not by national templates. The noble Lord, Lord Dholakia, asked what progress we were making in establishing those indicators at local level. I am glad to be able to tell him that measures along these lines have already been agreed in 79 local authority areas and others are under negotiation.
On family policy, as the noble Baroness, Lady Gardner, said so powerfully at the outset, effective parenting plays a central role in personal development, social health and community cohesion, outstripping class, ethnicity and even disability in its influence on the path that children take as they grow up. Families are the building blocks of communities so parents are the key partners in improving respect, tolerance and cohesion in society as a whole. Assisting parents in fulfilling their responsibilities towards their children is perhaps the most important thing that we do as a society and a Government, and we have sought to improve support in fundamental ways in recent years. For example, we have increased maternity leave from just 14 weeks to up to a year. We have doubled statutory maternity pay to £112.75 a week. We have introduced two weeks’ paternity leave paid at the same rate and we are consulting on extending this further in order to promote the very role of fathers that the noble Lord, Lord Northbourne, so rightly again emphasised in this debate. We have given parents with children under six or disabled children under 18 the right to request flexible working and to have their request taken seriously, which is bringing about substantial changes for the better in the workplace.
Fourteen million people now work flexibly. We are currently reviewing how much further we should extend this right to request flexible working. We have invested more than £21 billion in early years provision and childcare since 1997, creating an under-fives sector which barely existed before then, so that today every three and four year-old has a right to free nursery education. We are also boosting support for family support services; £240 million will be available in the next three years for local authorities to develop better family support services and to support services for grandparents—a matter mentioned by the noble Baroness, Lady Greengross.
My noble friend Lady Massey asked about the financial support the Government are giving to children and families. From April 2009, when the latest changes come into effect, the average household with children will be £1,800 better off in real terms as a result of the Government’s reforms to the tax and benefit system than they were in 1997.
We seek to bring about radical improvements in support for children in care through the Children and Young Persons Bill, currently before the House, which meets many of the points raised by the noble Baroness opposite. In respect of disabled children—I speak as Minister for disabled children—I am about to table amendments to the Children and Young Persons Bill enabling the Government to set national standards of respite care to be available to the parents of disabled children, so that the extra £430 million we are investing over the next three years, in short breaks and other respite care services for the families of disabled children, leads to a fundamental and lasting improvement in support for many of the most vulnerable families in our country.
So I believe that we have a good record. But it is not enough. We want to accelerate the pace of improvements, so we have, for example, used the recent changes to the machinery of government to create a new department—the Department for Children, Schools and Families—with a specific focus on families. Now, for the first time, one department has lead responsibility for putting the needs of families at the heart of government policy.
In December my new department published the Children’s Plan to set out our strategy for improving the lives of children and families over the next decade, including the vital role of play and better play facilities—a matter mentioned by many noble Lords. The plan sets out two key principles to guide how we work with parents. The first principle is about the need to recognise and adapt to changes in families and family life. As my noble friends Lady Pitkeathley and Lord Giddens so rightly said, families today are not universally made in the image of the 1950s, which was not a golden age for the family or, indeed, in any other respect. Fewer people today are marrying. More are living together outside marriage, and doing so for longer. Since the 1970s the number of single-parent families has trebled while the number of babies born outside marriage has increased fivefold.
While we believe that marriage provides a strong foundation for stable relationships and that both mothers and fathers have important roles to play, it is the quality of parenting and the love and support of parents and carers which matter above all, and we should always put the interests of the child first. It is essential to offer services which help all families, whatever their structure, to sustain such relationships.
Changes in employment patterns add further complexity to modern family life. As the noble Baroness, Lady Platt, said, many more women, and significantly more men, are now juggling family life with paid work. More and more parents are caring for elderly relatives as well as bringing up children. We know that parents want to be able to spend more time with their children. The Government seek to help in this area by continuing to ensure, for example, that childcare is readily and economically available, and that employers give parents the time they need for their children.
The second principle underpinning my department’s action is that the Government should offer support but intervene only in the most extreme cases. Bringing up children is the job of parents not of Government, except in cases of breakdown. But we can do a great deal more than in the past to support parents in that task. I referred earlier to the development of children’s centres. This has been a path-breaking development in sustaining the work of families caring for children in their early years.
We have also invested in the Parent Know How service, which draws together existing and new information and advice for parents and makes it available through telephone helplines, the internet, and innovative channels such as text messaging. It is also why, from 1 April this year, local authorities will have to provide parents and carers with information about childcare and other services through their family information service. It is also why we are expanding the availability of parent support advisers. These currently work with parents in about 1,200 schools to improve behaviour and attendance, and to offer support directly to families at the first sign of social, health or behavioural issues. Over the next three years we will extend further funding so that parent support advisers are available in an average of 10 to 15 schools in every local authority, thus extending the current model significantly more widely.
I turn next to schools. They are perhaps the only institution guaranteed to play a major role in the life of almost all children and families, and, of course, the school is at the heart of every community. In terms of schools’ policy, first, and most obviously, we are seeking to drive up the attainment of pupils—particularly those from less advantaged backgrounds who have traditionally done less well in school—eradicate low-attaining schools and improve the quality of teaching and learning in all schools. We have made good progress in that regard. The number of failing schools has more than halved over the past 10 years. But there is much more to do. We need all our children in school to get up to basic standard in literacy and numeracy. That is a key Government priority, supported by the literacy and numeracy strategies, the literacy and numeracy hours in every primary school in the country, and, for example, the new emphasis on the use of synthetic phonics in teaching all children to read following the Rose review.
We also need much better and more fit-for-purpose employment-related skills taught in schools, as set out by the noble Lord, Lord Best, who emphasised the appropriate education for those not on a traditional academic route through school. Hence the expansion of diplomas and their introduction into new vocational education areas; the expansion of apprenticeships, which we want to restore to their place as playing a central part in the opportunities available to young people; and the importance of sport, mentioned by the noble Lord, Lord Addington, in his remarks. Since 2002 there has been a threefold increase in the proportion of five to 16 year-olds participating in at least two hours of sports each week. In the last survey this figure had gone up from 25 per cent to 86 per cent, thanks to the introduction of sports partnerships with trained professionals leading those partnerships in every local area, and to a big improvement in the quality of sports facilities now available in state schools across the country. Hence also the changes we are making to produce a more modern and relevant curriculum, including the introduction of cooking as a standard part, which has also been mentioned in the debate.
It is also important that schools teach children about their rights and responsibilities as citizens and community members. In 2002, we made citizenship education a compulsory part of the school curriculum, focusing on the rights and responsibilities that apply to citizens as well as the proper respect due to those of different cultural background, as discussed by my noble friend Lord Parekh in his typically thoughtful speech.
From this September we will be introducing a revised citizenship curriculum after the review carried out last year by Sir Keith Ajegbo. There will be a new strand focusing specifically on community cohesion, and the promotion of community cohesion is now a statutory duty on all schools, including all faith schools, nationwide.
We are also expanding Sure Start and Extended Schools, which extend the range and community mission of schools in each area. All these measures, put together in the context of a doubling, in real terms, of education spending over the past 10 years, will address many of the issues which have been raised during the debate, and strengthen families and community cohesion.
Perhaps I may deal quickly with a number of specific issues raised in other parts of the debate. On drug abuse, my right honourable friend the Home Secretary yesterday published the Government’s updated drugs strategy, setting out how we will build on the progress made over the past 10 years, during which time we have seen an overall drug use decline, with more than 1,000 crack houses closed down, and the number of users in treatment doubled. The new focus set out in the strategy relates precisely to communities and families. For example, while continuing to take robust action against drug dealers and drug crime, we will seek to engage more closely at the community level with those who are identified as posing the greatest harm in their neighbourhoods.
In terms of gun, knife and gang crime, on 18 February the Government published their violent crime action plan, setting out plans for tough intervention and preventive measures over the next three years.
The successful work of the respect task force on anti-social behaviour is being continued and broadened by the new youth task force. We will continue to use community-based approaches involving a range of intervention options, including ASBOs and acceptable behaviour contracts. The noble Baroness was disparaging about ASBOs but the National Audit Office report in December 2006 found that after one such intervention 65 per cent of people stopped behaving anti-socially and after three interventions 93 per cent of people did so, so the evidence we have is positive.
In conclusion, we face manifold challenges and the Government are not complacent about them. However, families and young people are mostly succeeding. Most communities in this country are safe and positive. Continued partnership between government and the wide diversity of civil society is generally a force for progress to tackle the problems that we face. We all have a part to play in forging further progress. Today’s excellent debate has focused attention on how we can do so and I end by once again thanking the noble Baroness for making it possible.
My Lords, I thank everyone who has taken part in this wide-ranging debate. The noble Baroness, Lady Walmsley, summed up what each speaker said so I do not need to repeat it but the debate’s wide coverage was impressive. I was particularly pleased that health visitors were covered because I did not have time to do so. I was delighted that the noble Lord, Lord Addington, mentioned sports facilities—I agree with every word that he said—and the noble Lord, Lord Best, spoke about housing.
However, the real challenge came in the speech of the noble Lord, Lord Giddens, which delighted me as I come from a big family where we always argued about things. I accept that he personally—it is a policy decision—is opposed to tax breaks to strengthen marriage; however, my point was not about strengthening marriage through tax breaks but avoiding the present perverse incentive which does anything but strengthen marriage. I support the comment made by my noble friend Lady Hooper about inheritance tax. The noble Baroness, Lady Pitkeathley, made a superb case for carers, as she always does, and explained how many people are willing to volunteer to do that. However, as my noble friend Lady Hooper said, if those people eventually lose their home because they have devoted their life to caring for someone, that is a great disincentive. The Government said that they would reconsider the amendment on that matter tabled by my noble friend Lady O’Cathain although they considered that it was not appropriate for the Bill in question. I hope that they will.
The noble Lord, Lord Adonis, said that the present is better than the past. I agree, but that does not mean that we do not want it to be better still. We should all reflect on the contributions made to the debate and aim to make life better still. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
NHS: Patient Care
rose to call attention to the quality of care given to NHS patients in both hospitals and community settings; and to move for Papers.
The noble Baroness said: My Lords, I am very pleased to be opening this debate on the quality of care provided by the NHS. We have a broadly worded Motion before us and no doubt the speeches will cover many topics. Before I start, I congratulate the noble Baroness, Lady Thornton, on her new position on the Government Front Bench.
Our National Health Service is one of the largest and most sophisticated organisations in the world and we are right to be proud of it. It is also complex and hard to manage. The debate on how best to fund, control and organise the service is never-ending. This is reflected in constant structural change, which can be wasteful, time-consuming and particularly disruptive for senior staff. The situation has been made even more complex in recent years by the rapid and resource-demanding advance of medical technology.
To go back 20 years, there was a movement in the late 1980s and early 1990s, led by my right honourable friend Kenneth Clarke, the then Secretary of State for Health, to semi-detach the management of the NHS from government. Quarry House is a most imposing building, purpose built on a hill in the middle of Leeds. There the NHS Executive directed operations with a board of distinguished executive and non-executive members, the full time board members spending a considerable part of their working life on the train between Leeds and King’s Cross. Those were the heady days when acute, mental health and community services were converted from the directly managed units of the district health authorities into trusts with their own boards of directors.
Now, many years later, the principles of independent management and degrees of autonomy are still recognised. However, there are difficulties in putting those principles into practice. For instance, in his letter introducing the operating framework and PCT resource allocations for 2008-9, David Nicholson, the NHS chief executive, says:
“The conditions are now absolutely right for developing a framework within which PCTs, in conjunction with their local communities, can set more of their own ambitions rather than having them mainly set by the centre: this Operation Framework is the beginning of that journey”.
This must be a very small beginning to a very long journey. The opportunity for PCTs to set their own local targets will be identified in a category called vital signs, which is to be a set of indicators that has not yet been identified. However, even before knowing what these indicators are to be, the PCTs are weighed down with centrally imposed targets. The five priorities in the “must do” category do not look too bad at first sight, but there is a wealth of detail within each priority. These priorities are by no means all, a count of targets in other categories results in an alarmingly high figure. It is hard to imagine where PCTs will find the time or energy to apply to the as yet unknown vital signs. The word “micromanagement” still rings in the ears. If the Government wish to increase local autonomy, they will need to take a more realistic view of the demands of existing targets. Will the Minister please comment?
Aspects of the programme for an NHS IT system, Connecting for Health, need urgent attention. The programme was launched by Ministers in June 2002 at an estimated cost of £12.4 billion. This would carry all patients' records and be available to all professionals working in the service. Contracts were commissioned across the country in 2003. In London and maybe elsewhere in the country, the community services have so far not received equipment which would enable them to access patient records when on home visits. Contributing to Connecting for Health is a new computer system currently being introduced for community staff in London. This system, known as RiO, is running late and will not be fully in place until the end of 2009. At present, it is not expected that RiO will provide portable equipment such as a BlackBerry for staff working in the field to use to access their own community-held records, or the hospital and GP systems. Despite this big investment, paper records are still being widely used, as there is nothing available which will allow field staff to access and record information while out and about.
More seriously, they are not able to react with speed when they visit a patient who needs prompt attention because the necessary information provided by case notes cannot be accessed. Having community staff who are properly equipped is all the more important with the increasing emphasis on early discharge from hospital, and the wish to keep the chronic elderly safely in their own homes. For staff working in the field, it is essential that they should have up-to-date equipment, and that right from the start this should have been high on the priority list. Will the Minister please tell me why this part of the programme is running so late?
To turn to general practice, here are a few thoughts on GPs' ability to deliver good care. First, there is a perceived gap between medical input and social care. The patient is unwell, a clear diagnosis is made, a treatment pathway is established and clinical standards of care are brought into play. The patient is safely in hospital. This is often not the case. The patient is set up at home and, so long as there are no problems, all is well. If however, on a Saturday, the patient becomes confused and it is difficult to find a district nurse or a community psychiatric nurse for short-term crisis intervention, there is no alternative but to admit to the local district general hospital, with all the formalities and costs that entails. There are ways in which the gap could be filled; for example, with cover by trained staff at the weekend to deal with patients at home, or by admission to the community hospital where, as the condition is not acute, the patient can be stabilised and any tests can wait until Monday. Admission to a nursing home is not an alternative when there are no short-term emergency places.
Community hospitals are a valuable resource and they fill an important gap, especially as the demographic time bomb means that there will be an increasing number of frail elderly living in their own homes. Although there are opportunities for GPs to develop practice-based commissioning, these vary across the country. PCT support and input is important. Some of the services set up by GP practices take the pressure off the local DGH, but in some cases they are seen as a threat to its workload and there are fears that it will become a hospital providing emergency services only.
In his report A Framework for Action, the Minister the noble Lord, Lord Darzi, set out the proposed functions of polyclinics in London. In big cities, where there tend to be many poorly equipped, single-handed practices, polyclinics could well provide an improved service. However, there is a danger in undervaluing the importance of the patient-doctor relationship. Much of the GP’s work tends to be with patients who are frail and inarticulate, causing them to be nervous and uncertain. There is a psychological element to virtually every consultation, and if the GP knows the patient a lot of time and expense can be saved in getting to the core of the presenting problem.
I will now say a little about nurse training and staffing levels in hospitals, which are matters of considerable importance. There are not enough training places in the colleges. We need not only an increase in training places but a positive recruiting campaign. Nor are there enough retraining places for nurses who have been out of service for more than five years. In some instances, nurses are required to pay to retrain. Nursing in the acute sector has become much more intensive, and there is a shortage of qualified nurses who can be directed into specialist care, for instance critical care. Nurses are now able to do more specialised work on the wards and work very closely with junior doctors. Excessively long hours are no longer worked by junior doctors, and they have protected teaching time. Highly qualified nurses provide additional skills and support for their junior colleagues at the point of registration.
There is a shortage of midwives, and with a high proportion already in their early 50s it should be made more attractive to temporarily retired younger midwives to retrain. The Government’s announcement last Monday is welcome. The magnitude of the problem is reflected in the numbers; 4,000 extra midwives are to be recruited over the next three years. It is tempting to ask why the shortage was allowed to become so great before the Government took action. Every effort should be made to ensure that the problem is solved within the proposed three years.
Patient-support staff are an essential part of the ward team, as there is so much that they can do for the patient. Nutrition plays such an important part in recovery, and if wards are well supplied with trained support staff, they can do so much towards helping and encouraging patients to eat. Of course, nutritious and appetising food does help.
Before leaving the hospital scene, I will say a word about MRSA. Hospital-acquired infections and the way in which each successive strain of Staphylococcus acquires resistance to current antibiotics make a fascinating study from the advent of penicillin in the 1940s onwards. However, we are where we are, and every effort has to be made to combat this nasty onslaught on our hospitals. It is widely accepted that the main transmission of Staph. is on the hands. Deep cleaning is fine, and it is good to have clean hospitals, but we all know that it is not the only answer. For instance, in countries where they have lower bed occupancy, they are more successful in controlling the spread of infection. Pre-admission screening, allowing enough time between admissions for thorough cleaning, and rigorous hand washing cannot be stressed too emphatically.
I have commented on several specific areas of healthcare, which are a very few among a great many. I will end with a general point of great importance. The Government must always bear in mind David Nicholson’s aim that decisions will increasingly be made at the local level rather than at the centre. For a publicly funded National Health Service, there will always be some targets, and centrally imposed targets have a genuine place in the area of public health. Beyond that, however, national targets should relate solely to outcomes. Of course, any trust or PCT should be free to set its own internal targets if it wishes. The temptation by the centre to micromanage must be resisted. There will be tension between allowing local initiative and enterprise to develop and achieving and delivering the same standard throughout the country. Maybe we should be more relaxed about equality of provision and postcode funding and give more rein to local initiative and enterprise, which would be a great morale raiser. I beg to move for Papers.
My Lords, I thank the noble Baroness for introducing the debate. I find that I agree with almost everything that she said in her very constructive and wide-ranging speech. I am in a difficulty, because I came in thinking that I had 10 minutes in which to speak. In the past half an hour, I have done a rapid hatchet job, so I apologise if my speech is a little disconnected. The noble Baroness has chosen a subject that could occupy a seminar for several days and there would still be much more to say. To measure quality of care is not simple, but the task can be divided into subjective and objective measures.
First, on subjective assessment, population opinion polls fairly consistently show that the majority of people in the UK are pleased with the care that they receive from the NHS. In a speech last year, the Secretary of State mentioned a survey in which 92 per cent of patients described the treatment that they received as “good”, “very good” or “excellent”. Perhaps surprisingly, 83 per cent of people appeared to be satisfied with existing hours of GP availability.
It could be said that most people in the UK do not know any other health system with which to compare the NHS. They do not know that doctors in France give longer consultations, or that hospitals in Germany are better equipped. On the other hand, Americans can hardly believe that we have such a humane and excellent health service, free at the point of use, compared with the heavy financial burden and anxiety involved in obtaining medical care in the USA. Most of my friends and relatives who have experienced NHS care for a serious illness are full of praise for the standard of clinical and nursing care that they have received. That is more than can be said for some private care. Three of my close relatives have received substandard care in prestigious, expensive private hospitals in London.
Of course, the National Health Service has problems, as the noble Baroness mentioned, the higher level of hospital-acquired infections being one. We all know that poor care is sometimes given and that mistakes are made, some of which receive media attention, where too often the problem is presented overdramatically as a “shock horror” story to increase the circulation of the paper, or perhaps as part of an unwritten agenda to undermine the National Health Service.
Turning to more objective measures of health and healthcare—which are not the same thing—I will share with noble Lords some of the information in this fascinating statistical document on the health of OECD nations. I am afraid that we do not do very well. We are eighteenth out of 27 countries in our infant mortality rate and our rate of low birth weight. That is disturbing because the consequence of low birth weight is a higher incidence of cardiovascular disease in later life. We are approximately half way down the list for heart disease and cancer. But we are showing signs of improvement, partly due to the national cancer plan and the NHS frameworks. The trend is towards an improvement in heart disease, but it is too early to judge the effect of the national service frameworks.
It is recognised that many of these disabling conditions are a result of multiple social, economic and nutritional factors well beyond the reach of the National Health Service. Reports by Derek Wanless and more recently by the Foresight initiative on obesity have pointed out that our major health problems have complex causes that cut across the responsibilities of several government departments—not only in health, but in education, transport, housing, employment, trade and industry, and ultimately the Treasury. All legislation by these departments should be subject to a health impact assessment.
In my final minute, it is appropriate to discuss briefly what is in today’s newspapers on the National Audit Office report on the progress of the contract in primary care. In the quality and outcomes framework that forms the basis of this, doctors are given the option of adding to their income by fulfilling certain activities which constitute high-quality care. Many of these concern the identification of patients at risk of developing the kind of chronic diseases that I have described, which constitute our major health burden, and arranging appropriate care for these patients. Examples are diabetes, hypertension, obesity, cancer secondary prevention, heart disease and asthma. Many of these procedures would be carried out in any case by a good medical practitioner, but the less enterprising who would not have carried out this activity have been encouraged to do so. They have been given a cash carrot and most GPs with this incentive have performed beyond expectation—hence earning higher incomes than expected. It has been estimated that the quality and outcomes framework activity will lead to the saving of 9,500 heart-related problems.
However, I am not a wholehearted supporter of the GP contract. The BMA outsmarted the Department of Health in the pricing negotiations. I look forward to reading the full National Audit Office report.
My Lords, I congratulate my noble friend on securing this debate and for the exemplary way in which she has introduced an enormously broad subject. I pay tribute to the expert remarks of the noble Lord, Lord Rea.
The Minister, whom I welcome to her place today, will certainly in her closing remarks—otherwise I shall be very surprised—remind us of the increases in spending on the NHS in the past few years. I expect her to tell us, for it is the case, that annual spending now amounts to more than £92 billion and that the proportion of GDP devoted to health spending has risen to some 9 or 10 per cent of the total. She may also describe some of the welcome policy initiatives introduced by the Government, not least the reduction in waiting times, and she would be right to do so.
However, she will know, as do the rest of us, that while the amount of money spent is all important, the way in which it is spent is also important. Given that it is our money, perhaps it is even more important. Last September’s King’s Fund report pointed out,
“what is clear is that thus far the additional funding has not produced the improvements in productivity assumed in the 2002 review—costs of providing health services have increased and there is patchy and conflicting evidence on the impact on productivity overall, including little information about community-based care”.
This is important for Ministers because while the public hear what they say about extra cash for the NHS, it is the public’s experience of services on the ground which will form their judgment of the Government’s performance. The noble Lord, Lord Rea, mentioned that only today the National Audit Office has confirmed what some of us suspected about the GPs’ contract—that it has given GPs a great deal more money for doing less, or, rather, for doing things in a different way; and into the bargain it overspent by some £1.75 billion. I suppose that Ministers accept that, because they are to renegotiate the contract.
In Norfolk, one of the early effects of the contract was to cut GPs’ out-of-hours services, thus driving a coach and horses through the concept of community care and putting more pressure on A&E services. Norfolk people are also aware of the cuts in beds and staff and some 400 cancelled operations in the past two months at the Queen Elizabeth Hospital, King’s Lynn, giving what one consultant at the hospital called,
“cheap and nasty patient services”,
as the hospital struggles to meet its debts. I hope that the Minister does not feel that these remarks are deliberately churlish. I have paid tribute to the extra funding of the NHS, but I would remind her—and one was constantly reminded of this when one was in government—that, if people pay higher taxes, they expect to see more and not fewer services on the ground. That is the point made by the King’s Fund report.
All of us in this House are particularly proud of the fact that the NHS review is being led by the noble Lord, Lord Darzi, for whom there is enormous respect here. Will the noble Baroness be in a position to lift the curtain a little on what might come out of the review? I ask her these questions in particular: how, if the report stresses the importance of community-based care—as I am sure that it will—can the disparity of funding between NHS and social services funding be reconciled, when dealing with the same client groups? What will be the policy for small community hospitals? The present policy seems to be closure, which is deeply unpopular with the public—and indeed with some Ministers who have campaigned against it in their constituencies. I hope that the review will recognise the importance of these units, not least because of their role in easing bed blocking, particularly in rural areas because they are easy for a widely scattered population to access. What account will be paid to the needs of rural areas, where care in the community is costly, partly because staff have to travel to clients, and patients themselves face ever-increasing expense in getting to health facilities? It is almost prohibitive now, given the costs of fuel and hospital car parking, which are a double whammy for rural populations.
I am limited by time constraints. Unlike the noble Lord, Lord Rea, I had some warning, but perhaps I may sum up: terrific on resources; jury out a little bit on their effective use.
My Lords, I add my thanks to the noble Baroness, Lady Eccles, for introducing this debate and I agree with her themes of devolution and quality. I have experienced recently the best and the worst quality of care for very aged relatives, and I know how distressing it is when it does not work well. I have also given the best and the worst care in my clinical years and know how complex it is to get it right.
Getting quality right is not just a UK problem. Let us face it, there are quality problems—particularly on quality of outcome—and care failures around the globe, including in the much-vaunted US system. But there is no doubt that our directly managed structures in the NHS positively divert clinicians and managers from sick patients’ priorities to feed the beast of governmental process targets which are largely meaningless to clinicians if taken to extremes. We would have to be stupid to think that the recent disaster in the Maidstone and Tunbridge Wells NHS Trust was a one-off; there was nothing unusually poor or wicked about either the clinicians or senior management there, they were just worrying about something else. Things are very bad in other places, but they are not as conveniently measured as C. difficile cases.
I am a board member of Monitor, the NHS foundation trust regulator, and make no apology for talking today about our view on what it will take to improve quality across the NHS. I define quality as safety, clinical outcomes and patient experience. The answer lies not just in providing those incentives for providers, but in changing commissioning. We know that if we get joint commissioner-provider incentives and sustained priorities, we can make significant progress; waiting times are a clear example. Too often, we have had too many inconsistencies, too many themes, and not enough time to change. If we want quality to improve, we have to make it the absolute priority and stick with that. That will require major political support for the sort of reconfigurations that I hope the Darzi review will recommend in order to reduce the variability. We need public support for that, which will be by ensuring that they have the information. Performance league tables in education make it clear to parents how they should choose schools, and students should choose universities, by using multiple metrics. We should replicate these models in health so that the public can exert real pressure on services.
I want to talk about primary care trust commissioners, because they are in a mess. What were the local Maidstone PCT commissioners doing, frankly, when buying such lousy care from the trust? The answer is that they were navel-gazing while being reorganised. PCTs must be held accountable by SHAs for the quality of the care they purchase. It requires performance regime change; instead of focussing on in-year finance and access, they must focus on quality of outcome. That means investing in skills; at the moment we spend half a percent on investing in commissioning skills. Any health insurer in the rest of the world spends about 5 per cent, minimum. A medium-sized health insurer would have, perhaps, 15 to 20 trained actuaries for risk and pricing analysis, but PCTs have none. It is about buying clinical services and yet clinicians are not involved. There is almost no clinical leadership in PCTs; that needs massive development and expansion. About 90 per cent of the 350,000 PCT employees are employed in provider services, even though that accounts for only about 10 per cent of their budgets, while only 2.5 per cent work on commissioning, which accounts for 90 per cent of their budgets. Will the Government now crack on with the separation of provider and purchasers in PCTs, and concentrate on the job that they are supposed to do?
We need outcome and quality standards: probably a mixture of process and outcome metrics, which we already have on mortality rates, readmission rates, patient satisfaction, infection rates and so on. We must have information down to individual clinician level. In fact, much of that is already available. There is also a great deal more that we could get out of patient surveys, although at the moment we do not survey the very patients who are most at risk of poor quality, such as the confused older person entering hospital, nor their carers, who could give us a pretty clear picture of how they felt about their times there.
On incentives, briefly: we know that we have public-funded services such as the HEFCE way of funding, through the research assessment in universities, which is excellent in that respect and which we could easily replicate. I am running out of time, so I will just say that we can address these matters easily if we give priority to quality in the way that it deserves.
My Lords, I begin by congratulating the noble Baroness, Lady Eccles of Moulton, on securing this debate and introducing it so very well. There is no doubt at all that the NHS has improved considerably during the past few years. The infrastructure has improved, staffing is better than before and the basic NHS culture is undergoing some extremely important and desirable changes. I welcome all that and the fact that our expenditure on the NHS is increasingly coming up to the European level—something like £43 billion during the past five years alone.
I have only about five minutes when I had expected to have more, so, having congratulated the Government, I want to concentrate on where the NHS needs to go and how it can be improved even further. I will end with four or five major suggestions, based partly on my experience here and partly on my experience of having lived in other countries where I served as a visiting professor.
First, it is striking that there is a great deal of inequality between different regions and different socio-economic groups in life expectancy, infant mortality and general quality of life. If we are not careful, that will increasingly become a bone of serious contention, even protest.
Secondly, as my noble friend Lord Rea pointed out, the National Audit Office has confirmed that the additional funding that has gone into the NHS has not produced the commensurate and expected level of improvement. Partly that is because too many administrators, as opposed to doctors, have been involved and there has been too much paperwork. There have also not been, I am sorry to say, properly negotiated contracts with GPs. Quite a lot of money has gone into GPs’ pockets; I do not begrudge them that, but at the same time it has not resulted in the kind of improvements that one had hoped for.
My third point is slightly different. The NHS will always be short of resources, but how do we tackle that? One way is to control not just the growing administrative hierarchy but one or two other areas. Millions of pounds-worth of medicine are wasted and we need to find ways of reducing that wastage by greater prescriptive self-restraint on the part of GPs and greater public awareness. We could also, perhaps, ask drug companies to produce drugs so that if I were to use a part, the rest would not be wasted but could be reused. I know that that is being done in some countries.
Equally important, I have always been struck by this: why have we not, during the past 50-odd years, developed the culture of philanthropy that characterised the Victorian age and is to be found in other societies? In many countries, when people die, they are prepared to leave a part of their money to colleges, universities or schools. Why is that practice not extended to hospitals? Why would people not say, “I want to donate for equipment or for a bed, or to build a room, or to endow the post of a consultant or registrar”—when some are in a position to do that? That culture of philanthropy exists in other countries. That is what characterised our own country during the Victorian period and I can say, from some experience, that it is also to be found in parts of India. With suitable tax breaks, it should be possible to encourage a culture of medical philanthropy in our country. I would develop this further if I had time, but I shall rest the general point there.
We should also improve the efficiency of communication between hospitals and doctors. Let us take something simple. A GP refers you to a hospital doctor for an X-ray, a throat swab or a blood test. The hospital report takes days and days to arrive and in the mean time the poor GP is paralysed and the patient continues to suffer. I am sure that it should be possible to organise things in such a way that, within 24 hours of a test being done, the hospital can phone the GP and say, “These are our findings; please treat the patient accordingly”. We also have the increasingly common situation of hospital appointments being cancelled at the last minute, as if doctors’ convenience alone matters and many of us have nothing better to do than to hang on for the appointment to come through.
I have one other point, which is structural. In this country, there is a tendency to think in terms of bipartite structures. We had universities and polytechnics; we have solicitors and barristers. We seem to have transferred that philosophy to hospitals, so that we have GPs on the one hand and consultants and hospital doctors on the other. I do not know of many countries where that kind of division takes place. Why it has come about here is a long story, but I suggest that it should be possible for GPs to become semi-experts in particular areas, if not as expert as consultants. It should then be possible to have, rather than a single GP, a group of GPs working together, with each specialising in such things as ophthalmology, ENT or cardiology, so that in-house GPs are able to provide many of those services before they refer patients to consultants. If they need certain guidance, it should be possible for them to ring up the hospital consultant and ask, “In this case, given my expertise and what I have found, what do you think I should be doing?” rather than waiting for weeks until the patient is referred to the hospital consultant.
As my time is up, and I dare not alienate my Whip, I should stop. I believe that there needs to be some radical rethinking if we are to get maximum advantage out of the money that we are spending to make our system more efficient than it currently is.
My Lords, I am most grateful to my noble friend Lady Eccles for giving me a chance to raise again something very close to my heart. For over five years, ever since the Government blocked my Patients’ Protection Bill, which would have stopped the appalling practice of deliberately withholding food and liquid from sick people in hospital, I have been trying to bring an end to such inhumanity. I am shocked that it seems so difficult, if not impossible, to do so. There is no time now to catalogue the ways in which my frequent requests in Parliamentary Questions, speeches and letters to Ministers have all been stolidly blocked, although initially they have been received courteously by those Ministers.
Last year, I submitted 25 cases, all of which I had checked personally, to the noble Lord, Lord Hunt of Kings Heath, then the Minister responsible. I will detail what happened to just one. An 80 year-old man was admitted to hospital after a heart attack. He was in an advanced stage of motor neurone disease. The staff were told that but never helped him to move at all. When he needed the lavatory, he called repeatedly for help, but was totally ignored. After about two hours he wet the bed and felt ashamed and upset, which saddened me. That was not the only complaint. Food brought to him was always placed out of reach. He begged for the plate to be placed nearer but he was ignored. The food was removed untouched and after quite a short while he became very weak and suffered bed sores, which his wife dressed because no one else did. The family demanded his discharge from hospital and he was sent home in freezing weather, with only a very thin cover, arriving extremely cold. He died a week later.
I will read the trust’s report on that complaint. It says:
“Malnutrition Universal Screening Tool (MUST) being introduced … Red Tray system”—
whatever that may mean—is now in place and there is,
“further work to develop a flow diagram”.
The report goes on:
“Adapted cutlery. Very clear statement about health care professionals responsibilities for ensuring the nutritional needs of patients are met”.
“Very clear cycle of audit programmes. Illustrated Menu cards and menu cards in different languages”.
That was all that was said in answer to my specific complaint. There was no word about help with the bed sores; not a syllable about lack of attention when the patient needed the lavatory; no comment on food being put too far away; and no word about a lack of a warm cover in the ambulance. There was no apology and no acknowledgement of any poor care at all. The final word by the chief executive on all my 25 cases, some of which apparently received no investigation at all, is in the final sentence of a three-page letter, bringing all my complaints to a close. The chief executive said:
“I am assured that appropriate policies on nutrition and hydration are in operation and that negligence has not occurred. In light of the depth of the investigation”—
that is rich—
“and findings I do not consider that a further independent investigation will be necessary”.
If anyone can link any part of the complaint that I made about Mr Smith in that Suffolk hospital with the answer that I received, I will give them a small prize, if not a large one.
Of course, all hospitals hate to admit that they are not always perfect and in a thousand ways, of course, they do an excellent job most of the time. I am not trying to be accusatory, but to ignore unpleasant allegations of bad treatment of sick people and to go on and on because it is embarrassing to admit that it is happening really cannot be permitted. I give warning that such complacent blindness will not silence me or other colleagues in all parts of this House who are concerned about this matter—there are battles ahead. With all my heart I wish the noble Baroness a good and, I am sure, successful time in her office. She has my trust and my admiration. I hope that she will listen to what I have said.
My Lords, I thank the noble Baroness, Lady Eccles, for initiating this debate and for her very important contribution. Today there is much evidence of excellent care being delivered in the NHS. However, there is also evidence, as we have just heard, of poor-quality care that attracts public and media attention as well as published reports from the Healthcare Commission and the professional regulatory bodies. Inevitably the spotlight highlights poor quality.
I declare a background in nursing. My passion in life is to see an improvement in the quality of patient care both in hospital and in the community. Delivery of care is by the multiprofessional healthcare team, each member having an important role to play: doctors, nurses, midwives and the professions allied to medicine. However, evidence points to the fact that 80 per cent of patient care is delivered by the nursing staff.
The noble Baroness, Lady Shephard, referred to the increase in the allocation of funding. Between 2004 and 2007, the numbers of nurses and midwives on the effective register had increased by a total of 26,400, making a grand total of 686,886 nurses and midwives, but we still see shortages. So where does the root problem lie? The recommended ratio of registered nurses to support workers should be 65 to 35, but the recent NHS Healthcare Commission report on the Maidstone and Tunbridge Wells NHS trust stated that 14 out of the 20 wards were below the recommended ratio. Evidence shows that the quality of care to patients suffers if there are insufficient registered nurses delivering care.
I was recently invited to visit a trust in north-east London that had a huge financial deficit, a very high level of nursing vacancies and poor staff morale. During the visit, I met 24 matrons from the trust; I spent two hours in discussion with them. They admitted that they had been demoralised, but things were improving under new management and gradually they are being remotivated. They expressed the view that the background stemmed from understaffing, lack of clarity of roles and lack of authority. They were unable to introduce simple changes to improve patient care because their accountability was to a middle manager who held the budget. They quoted a history of a high incidence of bed sores and traced one of the contributory causes to the very poor state of the linen. That was not rectified until the new director of nursing arrived. Within a short time, 40,000 new sets of linen were ordered. The concern of understaffing was being addressed and an advertisement brought forth 250 newly qualified graduate nurses. All of them were given a simple numeracy task to calculate drug dosages and a short written answer to plan a patient care pathway. The result was that only two passed with 100 per cent, showing that only two were safe to carry out the administration of drugs.
The third person I spoke to was a modern matron in the south of England. He observed:
“Pre-registration training still leaves the newly qualified registered nurse unprepared for the role; the government is playing high on the role of the matron and their ability to drive the infection control agenda and clinical standards. In reality matrons lack a power base. They are, in many cases, structurally below the managers and even when their grade is higher they are still not party to management issues until cascaded to them. Matrons report to care managers when we feel we should be managed and report to the director of nursing”.
A great deal has still to be achieved. There has to be a culture of care from the bed to the board and the board to the bed. Board members need to know what happens to the patients in terms of the quality of care being delivered and not just concentrate on the finance and targets so that the service can be cost-effective and care-effective.
I now speak with great passion on what patients and the public really want to see: an identified person at board level accountable for the performance management of care. Many patients would say “Bring back the matron”. The Government might respond by saying, “We have brought back matrons”. Yes, but with no clear authority or accountability in many places. The trend, yet again, is for some trusts to appoint a nursing adviser to the board, not an executive director of nursing.
The nursing profession has suffered for the past 20 years as the result of the introduction of general management. There must surely be a need for an executive director to be accountable for the performance of care. This could be the nurse, or a psychologist in a mental health trust. Is it not time to right the wrongs of the past 20 years in the interest of improving quality and safety for patients by adopting the recommendations so clearly set out in the report commissioned by the Burdett Trust for Nursing, Who Cares Wins: Leadership and the Business of Caring?
I welcome the Minister to her seat and wish her every good wish. Can she please agree to see that this proposal is forwarded to the noble Lord, Lord Darzi of Denham, for inclusion in his final report? I am sure patients, the public and the nursing profession would more than welcome this important step in taking the NHS forward towards, in the words of Sir John Tooke, “aspiring to excellence”, and the vision of the noble Lord, Lord Darzi, for a world-famous health service.
My Lords, I, too, welcome this opportunity to call attention to the quality of care given in the NHS. My noble friend Lord Rea spoke of the USA. I have recently returned from an extended visit there, where the debate in the primaries is about who can afford to be ill and who can afford insurance. Those that have insurance are concerned about whether it will cover their possible illness. Quality is absent from the debate. So I welcome a debate where a publicly funded service is common ground. The NHS should not be there for opportunist politics. It is part of the progressive consensus which means that policy should be principled, based on our values and aspirations. I congratulate the noble Baroness, Lady Eccles, on setting this tone when opening the debate.
There seem to have been two important recent announcements about our health service: first, the review announced in June to be conducted by my noble friend Lord Darzi; secondly, the announcement in July by my right honourable friend Alan Johnson that there will be no further centrally directed top-down restructuring in the foreseeable future—the kind of thing which concerned the noble Baroness, Lady Eccles. The Minister confirmed that the purpose was to enable the NHS to keep up with the changing demands and expectations of patients: to adapt to change, to the ageing population and to the unexpected rise in childbirth.
My noble friend Lord Parekh and the noble Baroness, Lady Shephard, gave us details of the unprecedented levels of government investment in the NHS. It is only right that this should happen. After all, we have a population that knows what it wants, and wants to choose. We know that we have a population that wants to choose about end-of-life care. Is the health service being responsive to the changing needs, attitudes and expectations of these users?
Noble Lords will be pleased to know that I am not going to go over all the arguments. We debated them thoroughly when we debated the Bill of the noble Lord, Lord Joffe. My point is that if 80 per cent of the population want this choice—and your Lordships’ Select Committee confirmed that figure—then end-of-life care must be included in a review dedicated to responding to the needs and choices of NHS users.
I hope that the Minister will not say that the review will not consider the option of medically assisted dying for terminally ill patients on the grounds that it is currently against the law and that this is therefore a matter for Parliament and not the Government to decide. I congratulate my noble friend Lord Darzi on being rather more open. His response to the Dignity in Dying campaign was to invite its members to get involved in the review; presumably to develop a more patient-centred approach to end-of-life care. If the NHS develops a more patient-centred approach, then Parliament can be more supportive and more willing to change the law.
I put it to the Minister that it is entirely in keeping with the stated aims of keeping up with the changing demands and expectations of the public that there should be a system for recording a personalised end-of-life care plan; a plan which enables people to express the treatment and care that they want, including assisted dying. Of course there should be a co-ordinated, consistent and continuous use of existing best practice techniques. At the end of life, people often have more than one medical condition; it is rarely a simple battle. This choice—with safeguards—is what the majority of the population want. I put it to the Minister that this is entirely in keeping with the stated aims of her department's reform.
My Lords, I had not intended to take part in this debate, so well introduced by my noble friend Lady Eccles, as my inevitable reference to the current situation in the provision of NHS dental services has been on the Minute under “Other Motions for Debate” for some while, and I hope to have a time allocated for more comprehensive debate on this important subject in the near future.
I changed my mind last Tuesday when I saw the headline in the Daily Express which said:
“11 million can't afford dentist”.
Apparently, 11 million British adults have not seen a dentist in the past two years because even a check-up is too expensive. The article then posed the question that I have asked successive Departments of Health for more than 30 years: why can the public have all their medical treatment free, but have to pay for their dental treatment? It is simply not acceptable that dental care has become a luxury for those who can afford it. Dentistry is not, and never has been, “free at the point of delivery”.
The issue that must be resolved is why the Government and the Department of Health believe that NHS dentistry is getting better while the patients, dentists, dental staff, technicians, the British Dental Association, the Dental Practitioners’ Association and everyone connected with the provision of dentistry believes that it is getting worse? The recent survey on access to NHS dentistry by Citizens Advice prompted a warning from the BDA that primary care trusts and dentists must be properly supported if the Government are serious about improving access for patients. Its survey suggested that 7.4 million people in England and Wales have not been to an NHS dentist since the implementation of the reforms in April 2006, with approximately 2.7 million of those patients going without treatment altogether as a result of problems in accessing care.
Perhaps the issue will be resolved by the Health Select Committee in another place, which is currently inquiring into dental services. I welcome its inquiry, although it is clear to me that the members of the committee were almost as perplexed as patients when it came to understanding the systems of charging for dental treatment and for payment of dental practitioners. I remind your Lordships that the previous minimum charge of £6 has risen more than two and half times to £15.90. The dentist is paid according to the number of units of dental activity he does, which does not reflect the amount of work done or the time taken to do that work. The value is set as a reflection of work carried out in previous years and can carry a different value for individual dentists in the same practice or in different parts of the country. The accumulation of a fixed total of UDAs for each year is set, and if the target values are not reached, PCTs can demand repayment. In 2006-07, 48 per cent of practices did not achieve their UDA targets. That is becoming a serious problem for many practices, and I am aware of dentists who cannot cope with the stress of the claw-back and the potential reduction in future funding. That is why there is a continual drift into the private sector.
The department also underestimated the patient charge revenue resulting in a £159 million shortfall in the dental budget. To commission dental services successfully, PCTs must have the right resources in terms of funding and expertise and engage with local dentists and patients. The varying success with which PCTs have been willing or able to do that has resulted in a new postcode lottery of NHS dental provision. The difficulty faced by some PCTs when commissioning dental services results from their budget being based on previous spending levels, therefore areas which were historically underfunded before the new contract continue to be so. The theory is that areas of deprivation could have higher value UDAs to attract practitioners into those areas. The BDA has called for the Government to allocate full dental budgets for PCTs so that they are no longer reliant on patient charge revenue. PCTs were forced to cover the deficit by a combination of commissioning less dentistry and implementing inflexible performance targets for dentists. Reliance on patient charge revenue ensures that PCTs’ dental commissioning budgets remain unpredictable for future years. This funding predicament faced by PCTs comes in the wider context of the chronic underfunding of NHS dentistry, on which less is spent now than in 2002-03.
Most dentists work in a mixed economy, providing both NHS and private care. The relationship between the two is complex, and many practices effectively use private care to subsidise NHS work. The move towards the private sector is prompted by the opportunity to spend more time with individual patients and focus more on prevention. Most dentists do not experience any significant increases in income.
As I have said in previous debates, there are about 120,000 people working in NHS dentistry: dentists, nurses, receptionists, practice managers, technicians and members of the community service. They all want the NHS to work. At a time when £100 billion is going into the NHS, patients should not have to pay for private treatment, travel miles, go without dental treatment or use superglue to fix teeth or pliers to pull out loose teeth. The Government must listen and act urgently.
My Lords, I thank the noble Baroness, Lady Eccles of Moulton, for giving us the opportunity to debate the most important aspect of the NHS: the quality of care it gives to patients. Recently it has become ticking boxes and establishing what the costs will be, not putting the needs of patients first. The Department of Health has asked the noble Lord, Lord Darzi—Professor Darzi—to carry out the NHS review. The Secretary of State for Health said:
“we want to improve patient care, including providing high-quality, joined-up services for those suffering long-term or life-threatening conditions, so that patients are treated with dignity in safe, clean environments.”.—[Official Report, Commons, 4/7/07; col. 962.]
He also said that patients will have a choice of where they are treated. I agree with all that, and I ask the Minister to explain how it will be achieved.
What patients need more than anything when they are treated in hospitals or community settings is the correct diagnosis. Why do many patients have to wait two weeks for the results of a chest X-ray or a blood test in such places as Maidenhead? When my son became ill in Panama recently, he got the results of a blood test within 24 hours. Surely we can do better.
I now speak as president of the Spinal Injuries Association to say that many of its members are concerned about the difficulties that the National Spinal Injuries Centre at Stoke Mandeville Hospital is having coping with the number of patients needing specialised care. I was a patient in that unit at that time of Sir Ludwig Guttman. He pioneered the specialist treatment for paraplegics and tetraplegics, who do not feel from their lesion down and who have special medical needs and nursing care involving bowels, bladders, skin care and the very specialised problems of autonomic dysreflexia—this is to do with blood pressure. Doctors, nurses and physiotherapists came from all over the world to train at that unit. My very good friend Lady Darcy de Knayth had great trust in that spinal unit, as do many others. I was so sorry that she was unable to go there, which was her wish. What does this say about the Government's choice of five hospitals for patients?
After a meeting yesterday with the health Minister, the noble Lord, Lord Darzi, I see a glimmer of hope, as he has promised to look into the problems at the spinal unit. I hope that he can restore it to its former high standard of care with dedicated leadership, which is so needed. At the moment, it seems to have no slack in the system and, with bed blocking, it cannot take emergencies—a very worrying situation.
So many improvements are needed in NHS care, one being nourishing, appetising hospital food to help patients back to good health, and nurses who will give TLC when helping them to regain strength.
I end by saying how horrified many people were when they heard that Jessica Randall of Kettering had died at 54 days-old after 30 members of staff failed to protect her from abuse and murder by her father. Surely someone should have been taking responsibility. The Government have the responsibility. There was a total lack of leadership. Have we learnt nothing from the huge inquiry into the case of poor little Victoria Climbié? We must become a more caring nation, and so many aspects of health care must be improved.
My Lords, the debate of the noble Baroness, Lady Eccles of Moulton, gives the House an opportunity to look specifically at one of the Government’s manifesto commitments: healthcare at the point of need. Like other noble Lords, I thank her for this opportunity.
With the indulgence of the House, I begin by contrasting two stories, one from a poor country and the other from Great Britain. I was in Grenada during the Recess. A young child of six was badly bitten by a dog. Immediately, there was a great panic, with everyone giving a view of what should be done. I joined in and said, “Call an ambulance”—there were blank stares—“get him to the medical centre”. The mother looked at me and said, “I can’t afford it. If I call the doctor, I will have to pay him and pay for any medication”. Needless to say, I paid.
Returning here, on Sunday after Mass at my local church in Greenwich, I entered into conversation with one of the parishioners, as one does. I said, “How is your husband?”. She said, “Did you know that he had a heart attack while you were away?”. “How is he now?”, I asked. She said, “He’s doing very well. The hospital was marvellous. He was there in 10 minutes and they saw him straight away. They were so good to me and my family. The doctor told me that he was a lucky man to be alive”. I asked, “How much did it cost?”. She said, “Nothing at all, it was all on the NHS”. He will be there for at least another week, and we are all relieved to see the great improvement in him.
What a difference between a small developing country and the United Kingdom. Of course, that got me thinking of this wonderful service, the National Health Service. I know that all noble Lords during this debate have told different stories, but let us pause for a moment and consider what the Government are offering the people of Britain and how lucky we are to benefit from healthcare at the point of need.
On 21 February, the Minister, Ivan Lewis, announced a £20 million cash boost to improve palliative care services for children with life-limiting and life-threatening conditions. The funding boost will enable some of the country's very ill children to be cared for. If they are incurable, they will have the choice of saying whether they wish to die in a hospice or at home. There is currently a grant of £27 million over the next three years for children’s hospices and home care. This announcement extends the Government’s support for a further two years, with funding of £10 million a year until 2011.
On 18 February, the department’s target of reducing by 40 per cent deaths from cardiovascular disease for people under 75 has been met five years early. The coronary heart disease national service framework progress report published on 18 February states that the early delivery of the target has been made possible because waiting times for heart surgery have dropped dramatically since the introduction of the framework in 2000. No patients wait more than three months for heart surgery, compared with more than 5,500 patients in previous years. Prescriptions for cholesterol-reducing statins have more than doubled in the past three years, cutting both mortality from coronary heart disease and the yearly number of heart attacks. Emergency care is delivering thrombolysis more quickly for people suffering a heart attack. In early 2001, 24 per cent of patients received thrombolysis within 60 minutes of a call for help. Now it is almost 70 per cent.
We now know that National Health Service funding rose from £69 billion to £92 billion in the financial year 2007-08. Since 1997, when the present Government took over, staff numbers have grown by more than 224,000 appointments, including 1,300 GPs. Job satisfaction levels are at 73 per cent. We now have some truly remarkable figures to back up the claims that healthcare at the point of need is not a slogan, but a fact. It is true that we still have a long way to go—other noble Lords have given us many examples—and that we still have a critical public, but I ask noble Lords to compare this with countries in which sick people have to pay for their care, however large or small the bill. I am sure they will understand that the people in the hospitals or the caring professions are not robots but people who are working at their best. If government funding is well delivered, they will be able to improve the service. I suggest to the Government that it might be useful for anyone who has had medical care to receive a bill that says, “Paid for by your National Health Service”. The people of this country would be able to appreciate the wonderful gift of healthcare at the point of need.
My Lords, I too am grateful to my noble friend Lady Eccles of Moulton for giving us this opportunity to debate this subject. It is the first time that I have ever spoken in a debate of this sort, because the amount that I know about running hospitals and healthcare could be put into a nutshell, leaving ample room for the nut. I have always been lucky to enjoy very good health until last year. I was taken ill shortly after the Recess started, and in the latter half of last year and at the beginning of this year I became an expert in being cared for in a variety of different hospitals, so I shall now give the House my observations as the person at the other end.
When I was taken ill, I was taken to an accident and emergency department in a hospital not in London but in the West Country. I can tell your Lordships only that it is a miracle that I am still alive. It was exactly as the noble Baroness described the hospital down in Maidstone in Kent. I will not tell your Lordships which hospital I was in, but the wards were filthy. Underneath the bed next to me was a piece of dirty cotton wool, and there it remained for seven days; the ward was never cleaned. It was a gastroenterology ward, with lots of people with very unpleasant infectious diseases. The ward, the tables, the beds and the bathrooms were not cleaned. I was extremely infectious at that time and no precautions were taken with me at all. The staff were furious when my wife wanted my bed cleaned when it clearly needed cleaning. I was just lying there, a pathetic person. It was appalling.
The nurses, who probably are the most important people in this complex area, were what I would describe as an accurate reflection of many young women in Britain today. What do I mean by that? I shall now break your Lordships’ rules and read the next bit, because I thought very hard before I wrote it. The nurses who looked after me—not all of them; we should never generalise and there were one or two wonderful ones—were mostly grubby, with dirty fingernails and hair. They were slipshod, lazy and, worst of all, drunken and promiscuous. How do I know that? If you are a patient, lying in a bed and being nursed from either side, the nurses talk across you as if you are not there. I know exactly what they got up to the night before. I know how much they drank and what they were planning to do the next night, and it was pretty horrifying.
My bed was next door to the nurses’ station, so you could see how the whole place was being run. Actually, you could not: I have seen lots of things being run, but after a week, I could not tell you who was in charge. I had absolutely no idea who was telling who to do what. My view is that nobody was telling anybody.
The man opposite me was dying. I imagine he died two or three days after I left. I do not know what he was dying of because he was not doing a lot of talking. But I do know that he virtually died alone. The nurses thought that he was a nuisance. They changed his bottle, gave him his pills, occasionally fed him and propped him up. But basically this man died alone in a British hospital in the 21st century, and I had to watch him do it, which was pretty unpleasant.
I was saved from that and I have a happy ending to this story. My wife very kindly kidnapped me and put me in an ambulance, on the advice of my London consultant. I was brought up to London to the Chelsea and Westminster Hospital, which is where the story changes. I went to the Thomas Macaulay ward, which was completely incredible. The nurses, of every nationality, size, shape and colour, were wonderful. I was discharged from the country hospital. When I arrived in London I had two operations in 24 hours. I am quite certain—as were all the staff, although they would not say it—that if I had not had them I would have died. The hospital in London was wonderful. The nurses were marvellous. I do not know how, but it worked like clockwork. It was spotlessly clean. It was everything that it should be or could be anywhere.
But some things apply to both places. I have queued in many departments and met many consultants over the past six months. It is perfectly clear that there is far too much paper. Everywhere is swamped with paper. Everyone asks the same questions and fills in forms. Every department is covered in completely pointless paper. Last week, I saw one of my consultants. As I was leaving, he said, “By the way, what do you weigh”? I said, “What on earth do you mean, what do I weigh? Why do you want to know”? He said, “I do not want to know, but I’ve got to tick the box on this form or they will make you come for another appointment and weigh you. I run an outside clinic twice a week and 60 of my patients twice a week are weighed. I don’t care what they weigh. They don’t care what they weigh. But the form says that we have to weigh them”. How ridiculous is that?
Dispensing drugs is really simple. You and I call it retailing. Every week when I get my drugs, I watch them doing it and it takes 40 minutes. Over the road, Waitrose, the supermarket, is doing exactly the same thing really well, so why cannot these people do it? It is a shambles. It takes 40 minutes to get a drug which you can see sitting on the shelf. Why is that? It is because they have never been trained.
My last point is about the clerical staff, who probably are the linchpin that holds together these tiny satellites—the departments and areas of a big service in a large hospital. These people make the appointments and make sure that everyone is in the right place at the right time. They are clearly, too, completely untrained. I talked about it with one of my consultants who said that one of the problems is that the junior clerical staff in the National Health Service are desperately keen to help, very well meaning, completely useless and totally untrained. In the past year, I have observed them in 30 or 40 departments and I have come to the conclusion that that is true. The clerical staff are absolutely useless, but very nice.
Of course, this is a difficult situation. There will always be good and bad. In Britain at the moment there is very little that is good enough and too much that is too bad. This Government came in 10 years ago to sort this situation out. It has not been sorted out. It is internationally embarrassing and humiliating that a country of this size and wealth should produce a service which is so horrible.
My Lords, in spite of the fact that older people are the main adult users of NHS services, Age Concern recently pointed out that the policy of care for older people is still not mainstreamed either in policy or practice, and last year the Joint Committee on Human Rights said that a total change in culture is needed if the human rights and dignity of older people are to be protected. I declare an interest as a vice-president of Age Concern.
An obvious example is dementia care. We know that the numbers affected are very large and growing, and yet dementia is only just beginning to feature in the Government’s strategy. Recently I took part in a small inquiry conducted by the All-Party Parliamentary Group on Dementia, of which I am an officer. Its results will demonstrate clearly that the poor and over-use of neuroleptic drugs to treat those suffering with dementia needs immediate attention.
Some 60 per cent of older people in general hospitals suffer from mental health problems, and there is a terrible lack of training among doctors and nurses not just in dementia, but also in depression and acute confusion, which is often not diagnosed. Moreover, many specialists do not get involved in the care of people with these conditions. Pre-registration training in the physical and mental health needs of older people is essential.
We know that the majority of older people are admitted to hospital as emergency patients. Many are vulnerable and nearing the end of life, and the basic standards of care that they need are not always reached. These include privacy when using the toilet, still being admitted to mixed-sex wards and the involvement of their carers not being allowed. We also know that safe and well planned discharge is still only a dream for many. Discharge should be planned either before or on arrival in hospital, and should not be directly to a care home. An example of this was the discharge of a 94 year-old I know well from one of our main teaching hospitals in London. He came in as an emergency in bare feet with pyjamas and a dressing gown and was discharged in bare feet with pyjamas and a dressing gown on the wrong side of the road from his flat. He had to cross that road and get up the stairs. This happened not long ago. Another gentleman nearing 80 was admitted as an emergency to another of our London teaching hospitals and asked for an extra pillow to relieve the pain in his back. It was impossible to find him one all night. Sadly, such problems still arise.
The noble Baroness, Lady Knight, is a champion of better nutrition. We know about malnutrition in hospitals, and many older people are malnourished on admittance, although equally many are not. The noble Baroness, Lady Masham, also made the point that in cases of malnourishment, help with eating is essential. There was a time when nurses did this as part of their routine, and we need to go back to that sort of care. It is essential for those who are frail and vulnerable and who have to go into hospital.
Many people who are terminally ill or nearing the end of their life want to die at home, or if necessary in a hospice, because of the privacy offered and the right to die with their loved ones present, and the loving and tender care they want to be sure they will receive at that point in their lives. Dame Cicely Saunders, who brought the idea of hospice care to the world, would be upset if she knew that so many people who want such an end to their lives are not able to receive it, and die in hospital wards. Again, a great friend aged 102 died a couple of weeks ago in an open ward rather than in a hospice. Around 70 per cent of people still die in that way. This is quite unacceptable. Enormous progress has been made in the development of healthcare, and I acknowledge that and rejoice in it, but there is still a long way to go.
The document, Standards for Better Health, is excellent, but many patients and most of the general public do not know that it exists. Patients need information, so the Department of Health should make information about the standards which patients have a right to expect available for any organisation providing NHS services, whether they are provided in hospital or in the community. We must do that and make sure that people are given the dignified, loving and tender care they need when they are old and frail, and nearing the end of their lives.
My Lords, I, too, congratulate the noble Baroness, Lady Eccles of Moulton, on the eloquent and elegant way in which she introduced the subject, which has turned out to be fascinating. When I was preparing my speech last night I predicted that noble Lords would come at this from a variety of angles, and so it has proved. It is a timely debate, coming as it does at the end of this three-year period of unprecedented financial investment in the NHS and just before the publication of the much heralded review of the noble Lord, Lord Darzi.
The key question running through the debate is how does one determine quality in a service that sets out to meet the needs of 55 million people. Of the speeches today, I would pick out those of the noble Lords, Lord Parekh and Lord Mancroft, and the noble Baronesses, Lady Murphy and Lady Howells of St Davids, as examples of the different ways in which people are tempted to answer that intriguing question.
The problem in the NHS is not lack of quality measures. On the contrary, over the past few years it could be said that the NHS has had an epidemic of quality measures at every level in efforts to demonstrate the justification for finance and the effectiveness of what it does. Core standards, waiting times, four-hour waiting time in A&E, quality and outcomes frameworks for GPs, quality-adjusted life year measures for clinical interventions, NICE evaluations, star ratings and so on. I am beginning to sound like Clement Freud on “Just a Minute”; I could go on and on.
The NHS is a data rich organisation but, as the noble Lord, Lord Mancroft, showed in a graphic way, if your Lordships could do only one thing to help the NHS to be the best organisation in the world that it could be, you would kill the disease of duplication within the NHS. For those who have the miserable job of trying to track information flows throughout the NHS, it must be akin to the children’s game of hunt the slipper; the amount of duplication of information is immense. Who collects the data, where they are held and what happens to them is something of a mystery. Until we can find answers to that it will be impossible ever to truly demonstrate the overall effectiveness of the NHS.
I do not wish to suggest that the development of quality measurements is unimportant—it is not. It is indisputable that in some areas the existence of targets and the development of metrics have led to improvements in care. In cancer treatment, for example, the combination of a national strategy, the involvement of clinicians and charities in the development of research and increased funding has led to new developments such as the introduction of specialist nurses. This has led to better treatment and outcomes for patients. But, at the same time, in one of the flagship services, while there have been improvements with the big four cancers there are still vast areas of cancer treatment where this country lags way behind countries in which there is nowhere near the level of investment that we have.
As a result of listening to clinicians, managers, researchers and patients, my Liberal Democrat colleagues in another place have drawn up our party’s new health policy. We will debate that policy in two weeks’ time. As a democratic party, members still have the ability to decide policy, so I cannot actually say that it is our policy as yet, but I hope that it will be. A key part of that is the understanding that in order to be the best quality health service in the world, patients have to be empowered to improve the quality of care in conjunction with clinicians.
Therefore we have four key proposals within that policy. The first is a pilot of patient advocates dedicated to providing information, guidance and support to patients and carers in navigating the most complex health and social care system in the world. We would replace national targets with a system of universal entitlements, enshrined in the patient contract, which would outline minimum standards of access to primary, secondary and tertiary care services. We would expand the use of individual budgets to specific areas within the NHS, such as core services like treatment for chronic conditions. We would pilot patient-reported outcomes measures that would measure patient experiences while recording the actual benefits, physical and mental, to patients’ health.
There is one key measure by which our proposal will, and should, be judged: the effectiveness with which it enables researchers, policymakers, clinicians and patients to acquire the evidence base that they need for different methods of treatment and care. The real problem we are attempting to solve is the complete disconnect between research proposals, evidence of treatment and cost effectiveness on the one hand and the levels of decision-making within the NHS on the other. That is the key aspect that the system lacks.
The Department of Health has been attempting to make improvements. It has developed the Better Metrics programme, which aims to provide more clinically relevant measures of performance. Will that programme be expanded to other areas of treatment? Through Connecting for Health, which was mentioned by the noble Baroness, Lady Eccles, that programme could be shared with patient groups so that we could continue to develop a policy of putting together patient experience alongside clinical evidence and evaluating the two together.
In the time available to me I wish to mention an area of health services that Members of this House have a duty to address regularly; that is, the provision of services to those people who receive the worst healthcare of all—prisoners. The Sainsbury Centre for Mental Health reported in 2007 that while most English prisons now have in-reach teams and, despite having staffing levels that are less than one-third of the equivalent community mental health teams, they are starting to make a difference to those prisoners who have severe mental health problems. However, the vast majority of patients do not have severe mental health problems; they have lower-level problems such as depression or anxiety. The best that some of them can hope for is to hold out for some Prozac—whether or not it is deemed to be effective.
Last week I spent some time learning about the work of an organisation called RAPt, the Rehabilitation of Addicted Prisoners Trust. It provides a particular form of therapy and support for addicted prisoners, both in prison and in the community. Whereas the majority of services for people with addictions under the Government’s existing addiction strategy, and under the updated strategy as announced by Jacqui Smith yesterday, are dependent on replacement therapies such as methadone therapies for heroin users, the programmes run by RAPt are abstinence programmes. They are intensive and consist of one-to-one help and support for people, based on a policy of abstinence. The organisation’s peer-reviewed results show remarkable achievements; of the people who complete its courses, 30 per cent manage to be completely drug-free. Another 30 per cent are drug-free for a while but may relapse because they return to the difficult situations from which they came.
The programmes are more expensive than replacement treatment such as methadone, but they are highly effective for some people. Will the Department of Health, in seeking to achieve good quality services for some of the most difficult NHS patients, commission a programme of research comparing abstinence programmes with methadone replacement therapies?
We have the most comprehensive health service in the world; we have the potential to have the most comprehensive research base in the world; we have the ability to take different forms of treatment and evaluate their efficacy across different control populations. We also have staff who continue to hold an outstanding public service ethos. They deserve to know whether what they do is effective or, as the noble Lord, Lord Mancroft, graphically showed, could be improved. For their sake and that of all patients, the noble Baroness, Lady Eccles, was right to focus the attention of this House on the key question of what quality is and how we measure it.
My Lords, it is gratifying and perhaps not altogether surprising that my noble friend’s Motion should have given rise to such a wide-ranging set of speeches from all sides of the House, and I congratulate her as much on facilitating that as on her own powerful contribution.
As a number of noble Lords have demonstrated, any analysis of the quality of care given to NHS patients has something of the curate’s egg about it, because we can point to areas where this country leads the world in standards of care and treatment, and other areas where care is poor or even worse. From a political perspective, I have always been ready to give credit to the Government for some of their initiatives during the past 10 years. We now have national bodies whose job it is to oversee and assess the quality of care delivered in our hospitals and care homes. We have a GMC which has undergone reforms whose whole aim is to maintain professional standards and enhance the protection of patients, a process that still continues. We have national clinical directors for many of the key specialties such as cancer, heart disease and mental health. National service frameworks have been developed. Social workers are subject to registration and accreditation. We could add to that list. Nobody can doubt the Government’s commitment to wanting better standards of care for all patients. The large increase in the NHS budget is above all a testament to that.
But intentions are one thing; results are of course another. The whole point of bringing expenditure in the NHS up to the European average was to deliver the kind of healthcare that our European neighbours already enjoy. But we are still a long way from achieving that. Our five-year survival rate in cancer is worse than almost all other EU countries. We are nearly the worst in the OECD for breast cancer mortality. We are well below average in our survival rates for most common cancers, stroke, heart disease and respiratory diseases. When the Government defend their record in health, they tend always to do so in terms of inputs—how much is going into the system. But the test of success is of course outcomes; and we need only look to the words of the noble Lord, Lord Darzi—that passionate advocate of high-quality care—to appreciate how woeful is our record on outcomes and life expectancy in many parts of the country, not least many of the deprived parts of London.
When the Secretary of State took office last summer, he was refreshingly frank about the Government’s record. He admitted that doctors and nurses were fed up with top-down instructions and wanted a sharper focus on outcomes and patients. He spoke about putting clinical decision-making at the heart of service delivery. He talked about making that service responsive to patient choice. These are aspirations to which all of us can surely subscribe.
The sad part is that in so many areas of policy we see Ministers and the Department of Health continue to indulge their controlling tendencies; and the consequences of that are all too often perverse and damaging to patients. Perhaps the starkest example of these controlling tendencies is the target culture, which is still alive and kicking. Targets are blunt instruments: they tend not to distinguish between patients whose need is urgent and those whose need is not. And one creates a distinction between what is targeted and what is not. What is not targeted tends to become a lower priority in the allocation of resources. Patients with chronic conditions, for example, fall outside the scope of national waiting time targets, yet they outnumber elective patients by a wide margin. Clinical priorities tend to get distorted, and the price that we have paid for driving down waiting times has been to compromise standards of care, most obviously in the area of infection control. The Health Protection Agency was quite clear about this in its recent report. The agency identified one factor affecting the management of MRSA as,
“increasing patient movement between wards to meet A&E targets for trolley waits”.
High bed occupancy poses a further risk. The pressures on hospitals to deliver on their targets have undoubtedly led to an increase in bed occupancy rates to levels that are in many cases unsafe. But we should not find it surprising that hospitals are tempted to take these sorts of risk when the operating framework imposed on them by the department contains swingeing financial penalties for breaches of the 18-week target—up to 5 per cent of their elective income, a potentially huge amount of money.
The irony here is that the Government take it as a given that achieving the 18-week target is a cost-effective use of public money. As far as I know, there is no evidence to back up that assumption. The 18-week target is just something that Ministers have seized on as being a good idea. I doubt very much whether the opportunity costs associated with it have ever been evaluated, any more than were the opportunity costs associated with the recent agreement reached on the GP contract.
The Prime Minister has made increased access to GP services his number one priority for primary care. The irony of this should not, however, be lost on us, because it was this Government who, with their eyes wide open, negotiated a contract that has meant doctors have less control than before in delivering Saturday and evening services. The Government are now in the extraordinary position of criticising a situation which they created, yet blaming doctors for it instead of themselves. At the same time, they are flying blind; it was quite extraordinary to hear the Secretary of State say the other day that, despite all the pressure he is putting on GPs to extend opening hours at their surgeries, he has no idea to what extent PCTs are already commissioning GPs to open for longer. How on earth can you gauge the importance of a problem if you do not know its scale?
Many of us wonder whether the policy can in any sense be called evidence-based. The Government's latest GP-patient survey showed that 84 per cent of patients are happy with current opening hours; only four out of every 100 wanted extended opening hours in the evenings and seven out of 100 wanted Saturday surgeries. To force GPs to include opening hours as part of the QOF, instead of clear measures of good patient care, is a seriously misconceived piece of micro-management. The scope for adjusting the QOF in ways that might have improved the care of patients was enormous, not least in the area of brittle bones in the elderly, which costs the NHS a fortune and is an area of care that is not being addressed at all well. But that opportunity has been lost. The QOF has been misused, because access arrangements are not an outcome—and all this because Ministers have lost sight of their own worthy aspirations about devolving commissioning and choice closer to patients.
Exactly the same absence of evidence-based decision-making runs through much of the ideas surrounding service configuration. On maternity units, the Government are looking to centralise care in larger specialist units at the expense of access to smaller units. The claim that is made is that larger units are safer. Absolutely no clinical evidence has been produced to substantiate this; indeed, the Healthcare Commission has given some of its highest ratings to smaller units. What the policy means is that many of these smaller units have closed or are about to. So much for patient choice and easy access. The real reason for these closures is, of course, financial. Very similar issues arise with A&E. Units are being closed, allegedly on clinical grounds, with services being concentrated in fewer centres, but the evidence we have indicates, unsurprisingly, that the further seriously ill people have to travel by ambulance to reach emergency care, the more they are likely to die.
I am fearful that the same kind of top-down approach is going to dominate service reconfiguration more generally. The review of NHS services in London undertaken by the noble Lord, Lord Darzi, contained much good work; but it had a very prescriptive feel to it. He spoke of having a polyclinic in front of every hospital; 150 polyclinics across London; and a GP-led service at each hospital. Polyclinics may well have a place in under-doctored areas. But to make them a universal prescription, at the expense of closing down GP surgeries and perfectly successful hospital departments, really has to be justified in terms of the quality of care delivered to patients. Alternatives—of which there are a number—ought to be evaluated. I do not feel that they have been. What I wish the noble Lord, Lord Darzi, had done was to produce, not a blueprint, or a “template” as he has described it, but a menu of ideas and service models which local commissioners could then take up. Indeed, if I were to think of one message for the noble Lord, Lord Darzi, as he rounds off his nationwide review of the NHS, it would most certainly be that one.
My Lords, first I congratulate the noble Baroness on her choice of topic for today’s debate. She and I are old friends from the Select Committee on Communications; indeed, we have even travelled through the night together. I was not surprised at the quality and thoughtfulness of the noble Baroness’s contribution. We have had ahigh quality debate with a wide spread of different contributions. If I fail to answer fully any noble Lord’s question, I will be happy to write.
There can be few subjects more important than the quality of care given to NHS patients, whether in hospital or in community settings. Indeed, the contributions from my noble friend Lord Rea with his vast experience of the National Health Service and the GP services, the enormous wisdom and experience of the noble Baroness, Lady Murphy, and her work with Monitor, my noble friend Lord Parekh and his remarks about improving communications, and, indeed the noble Baronesses, Lady Emerton, Lady Masham, Lady Greengross, and Lady Knight, and my noble friend Lady Howells present a formidable challenge to a new Minister.
I say from the outset that the quality of healthcare has improved out of all recognition since Labour was elected in 1997. I know it is the job of the Opposition to suggest that this is not the case, but I might say that today the Opposition health spokesman in another place felt the need to honour our enormous progress by making expenditure promises that seemed to, and will be bound to, upset his Shadow Chancellor’s plans, which is a testament to the work and investment of the past 10 years.
I make two points. First, I want to pay tribute, as other noble Lords have already done, to the superb work carried out, day by day and week by week, by the staff in our health and social care services. Every day, 819,000 patients have a consultation at a general practice, 122,500 patients attend an outpatient clinic, and about 60,000 patients are treated as day patients or inpatients in hospital. In the vast majority of these daily encounters with the NHS, as patient survey after patient survey demonstrates, as mentioned by my noble friend Lord Rea, patients receive and appreciate high standards of care delivered by caring professionals who have dedicated their lives to the business of improving health. We should be proud of their achievements, not take delight in knocking them, as some of the most strident of our national media seem to do.
Secondly, I pay tribute to that much maligned breed—NHS managers. Research from around the world shows that high quality organisations do not just happen, they need dedicated and clear-sighted leadership. They, too, have at heart the quality and the safety of the services which their organisations deliver. Furthermore, leadership in the NHS is increasingly being exercised not just by professional managers but also by clinicians, as mentioned by several noble Lords, who have taken on formal or informal leadership roles. As my noble friend Lord Darzi has repeatedly stressed, clinical leadership is potentially the most powerful lever for quality improvement, and we must do all we can to nurture and to celebrate such leadership.
However, I do not want merely to pay tribute to dedicated staff, clinicians and managers; I want to set out a simple proposition: that the best way of achieving even further improvement in the quality of services for NHS patients will lie in the innovation and drive of local clinical leaders, working in partnership with local managers and responding to the needs of their local populations, in an environment which supports and rewards quality. Striving for that quality lies at the heart of the review of my noble friend Lord Darzi, as mentioned by the noble Earl.
I should like to say a few words about the many elements of this supportive environment for quality care that are already in place. Clinical guidance covering most of the significant clinical conditions is now available from the National Institute for Health and Clinical Excellence. We have launched a major initiative to improve capacity and skills in primary care trusts to commission services although I acknowledge that work still needs to be done. PCTs will in future commission services from an increasing range of providers, including providers in the private and third sectors, to meet the health needs of their populations—that was the point of David Nicholson’s letter quoted by the noble Baroness, Lady Murphy—and they will be working closely with councils with social services responsibilities to ensure that people have access to services that are properly joined-up between health and social care.
For instance, a project in Southwark is developing a new approach to help older people who are moving from acute care, providing specialist “step down” facilities to give them time to recover from acute illness while supporting them to make decisions about their future. In this way, more older people are being enabled to return home after a spell in hospital rather than entering care homes prematurely. I think that answers a point made by the noble Baroness, Lady Eccles. That is the sort of programme that needs to be rolled out. Patients already have a choice of provider for acute services, and from the next financial year will have increasing choice when they need treatment for longer term conditions. As noble Lords will be aware, money will follow the patient, providing an incentive to providers to improve the quality of their services to attract additional patients.
The NHS will make increasing use of quality indicators measuring both clinical outcomes and patients’ perception of the quality of the services they have received. Indicators at the level of health communities will enable PCTs, in dialogue with their local populations, to determine the priorities for local quality improvement. The new regulatory regime in the Health and Social Care Bill, which we will shortly debate in this House, will give an underpinning assurance that all healthcare providers are fit for purpose and will place on commissioners a new duty of quality improvement.
However, we fully accept that there is more to do. That is why the Prime Minister invited my noble friend Lord Darzi to undertake a review of the next stages in the development of the NHS. The review team has undertaken a major exercise to listen to the views of patients, healthcare professionals, managers, professional organisations and voluntary organisations on what they see as the new priorities for quality improvement in the NHS and the obstacles to achieving them. The noble Baroness, Lady Emerton, raised important issues concerning quality control at senior level in hospitals. I know that my noble friend Lord Darzi is taking those issues on board in his review. At a more local level, each strategic health authority has set up working parties to develop locally appropriate clinical pathways, as was mentioned. At the end of its work the review team will bring together the experience from each strategic health authority and determine what further work may be needed at national level to support quality improvement. The review expects to publish its findings this summer.
A particular theme of the review will be the role of innovation and the need to ensure the rapid dissemination throughout the NHS of advances in clinical practice. Several noble Lords talked about the need to disseminate information. I will not pre-empt the conclusions that my noble friend will reach on this important topic but I would like to draw to the attention of your Lordships’ House the work of the Innovation Centre which we established in 2005 to ensure that innovative ideas originating in the NHS itself are effectively exploited.
I shall attempt to cover as many points made by noble Lords as I can. The noble Baroness, Lady Eccles, raised several points. Her contention—I will not say “accusation”—was that the operating framework was overly prescriptive and she challenged the increase in targets for PCTs. The 2008-09 document marks the beginning of a new chapter in the journey to transform the NHS and sets out a truly ambitious programme for the NHS over the next three years. This means that local PCTs will control more of the NHS budget than ever before, giving the organisations freedom and flexibility to spend according to the needs of local people. From next year, 82 per cent of the local NHS revenue budget will be in the hands of the front-line NHS. We expect the PCTs to work to the five national priority areas. I would be interested to know which of those areas is not regarded as important, because we regard them all as equally important. We know that is a great challenge for PCTs in determining local priorities and setting local targets to meet the needs of their communities.
The noble Baroness, Lady Eccles, talked about RiO, which is a vital strategic community information system in London. It was selected as a replacement for the existing child health system, but it is being used for considerably wider functionality. Following the start of its rollout, it is now being used in 17 PCTs. Those trusts are already deriving significant benefits, and other trusts will see those benefits. We agree with the noble Baroness that it is essential that members of staff are properly equipped, and we will write to her about the remote access issue that she raised.
The noble Baroness also raised the issue of healthcare-associated infections. She knows that action on healthcare-associated infections is a top priority for the Government. It has been made clear most recently in the NHS operating framework, at a time when we are deliberately trying to reduce the number of central priorities, that we have made this one of the priorities. The measures that have been taken are already having an effect. MRSA infections are on a significant downward trend and have dropped by a further 18 per cent since the previous quarter. For C. difficile, there was a reduction of 16 per cent in the number of cases since the same quarter last year.
Several noble Lords raised the issue of GP access, including the noble Baroness, Lady Shephard, and the noble Earl, Lord Howe. In his interim report Our NHS, Our Future, my noble friend Lord Darzi identified access to primary care as an immediate priority, especially in the more deprived areas, as the noble Earl mentioned. In addition, patient service and public discussions have consistently told us that improving access to GP services should be a priority for the NHS. It is true that a very large proportion of patients are very happy with their GP services, but it showed that 16 per cent of people are unhappy with the opening hours of their GP practice. That is nearly 6.5 million unsatisfied patients. This is being addressed through two major initiatives. First, in October 2007 the Secretary of State for Health announced a £250 million access fund, which will deliver at least 100 new GP practices in the 25 per cent of PCTs with the poorest provision which, as we know, are often in our poorest communities. All health centres will provide core GP services from 8 am to 8 pm seven days a week, offering both booked and walk-in services for registered and non-registered patients.
Secondly, it is our aim that at least 50 per cent of GP practices in each PCT area should offer extended opening hours on weekday evenings and weekends based on patients’ expressed views and preferences. We recently put the proposal to the BMA that would pay for an extra average three hours of work a week and, as noble Lords will know, that is progressing.
The noble Baroness, Lady Shephard, raised the issue of the closure of small hospitals and asked for a peek into the results of the work carried out by my noble friend Lord Darzi. While she will appreciate that we cannot pre-empt the conclusions of the review, we fully recognise the need to provide good access to care to all sectors of the community and we recognise the role of small hospitals. Ultimately, it is for the PCTs to decide for their local populations.
My noble friend Lord Rea raised the issue of low birth weight. It is the case, and he is right, that we in the UK need to address that. We have given a commitment in the next three years to improve the health and well-being of children.
I am aware of the issues outlined by the noble Baroness, Lady Knight, and I have read all the related correspondence. I know that she has been very concerned about this for some time. She has met the Minister, Ivan Lewis, and they have been in communication with each other. My understanding was that each case had been examined and results had been forwarded to the noble Baroness, but if there are further issues that she would like to raise, I would of course be more than happy to discuss them with her. She will be aware of our recent discussions on nutrition, which I will come on to in a moment—in fact, now.
The noble Baronesses, Lady Masham, Lady Eccles, Lady Knight and Lady Greengross, raised the issue of food in hospitals. Noble Lords will know that I spoke about this only a few weeks ago, and we fully accept the importance of ensuring that all NHS patients get the best possible food for their condition. There is no excuse at all for neglect in this area. The Better Hospital Food programme was set up in 2001 to improve hospital food. There are two aspects to this: improving the quality of the food that people eat and, when it has been improved, making sure that they get the opportunity and assistance to eat it. We hope and expect that protected meal times, when non-urgent clinical activity stops on the wards, patients are given space to eat and enjoy their meals, and staff have time to provide help for patients who need it, will make a significant impact on this issue.
More recently the nutrition action plan, Improving Nutritional Care, was published in October last year, following two summits attended by charities, clinicians and nutrition experts. The implementation plan is being taken forward, it is chaired by Gordon Lishman of Age Concern, and I am absolutely confident that if we do not get this right and the situation does not improve, we shall certainly know about it.
My noble friend Lord Parekh talked about communications between hospitals. Most standard tests are back with GPs within 48 hours and further work is ongoing regarding the 18 weeks’ wait. Part of the point is that electronic patients’ records will allow shared records between primary and secondary care.
My noble friends Lord Parekh and Lord Rea, and one or two other noble Lords, expressed views on the National Audit Office report published today. The Government welcome the report and will consider its recommendations carefully. The GPs’ contract, as the report recognises, stems from the haemorrhaging of GPs from the NHS, and it improved quality for the public.
I am informed that I have only one minute left and there are many other things that I wish to say about targets. I am afraid that I shall have to write to noble Lords on all those matters. Perhaps I may say to the noble Lord, Lord Mancroft, that I am sorry that he had a bad time recently. It is important to let the hospital know what happened. I thank noble Lords for their contributions to the debate.
EU Commission: Policy Strategy 2008 (EUC Report)
rose to move, That this House takes note of the report of the European Union Committee, The Commission’s Annual Policy Strategy for 2008 (23rd Report, Session 2006-07, HL Paper 123).
The noble Lord said: My Lords, each spring the European Commission publishes its annual policy strategy—for brevity’s sake, I shall henceforth refer to it as the APS—which summarises the main priorities and orientations that the Commission is looking to include in its annual legislative and work programme, which is published each autumn. Thus, two weeks ago, the Commission adopted its proposed APS for 2009—which we are not examining today—which will now go the European Parliament for analysis and debate. Your Lordships’ Select Committee will be looking at it and is likely to discuss it with the Commission officials who drew it up.
Why do we attach so much importance to the scrutiny of the Commission’s APS and to the subsequent annual legislative and work programme? For national parliaments to scrutinize effectively the development of EU policy, it is essential to engage as early as possible with the Commission’s two principal planning documents. This afternoon, we are looking at the report on the 2008 APS published by the Select Committee on 4 July last year, the first time we have conducted a full inquiry into this planning document. I wish that this could have been debated earlier, but we all know that claims on debating time in this busy Chamber cannot always be met in a timely fashion.
The APS serves as a basis for consultation with the European institutions, and beyond, and its scrutiny therefore presents a key opportunity for influencing the Commission’s thinking on cross-cutting and strategic policy matters. As far as cross-cutting priorities are concerned, the 2008 APS highlights four key challenges: tackling climate change; ensuring the availability of sustainable, secure and competitive energy; implementing the Lisbon strategy for jobs and growth, and managing migration flows to the EU. Interestingly, those four priorities reappear in the just-proposed 2009 APS, which demonstrates the EU’s continuing commitment to action in those important areas.
The other key actions set out by the Commission for 2008 within the framework of the five-year strategic objectives of the Barroso Commission relate to prosperity, solidarity, security and freedom, and Europe as a world partner. It also describes its priorities regarding better regulation and improving the EU’s communication to the world at large, and outlines the Commission’s general framework for human and financial resources for 2008.
In April 2007, our Select Committee issued a call for evidence and subsequently held evidence sessions with the Commission vice-president for institutional relations and communications strategy; with the chef de cabinet of the President of the European Parliament; with the leaders of the British Labour and Conservative delegations to the European Parliament; and with the UK Minister for Europe. In addition, each of the seven policy-based sub-committees examined the APS on the basis of their areas of expertise. At this point, I want to thank the Members of the Select Committee and sub-committees, and their clerks, legal advisers, committee specialists and committee assistants for their excellent work in putting together this report.
While Chapter 3 of this report presents specific points regarding particular proposals, our focus was principally on the nature of the document itself. What are we up against as a national Parliament when we seek to analyse this document? Our report asks some probing questions: what does the APS set out to do? How useful is it as a strategic tool? How well does it serve as a White Paper to the subsequent annual legislative and work programme? Most importantly, what is its relationship to the budgetary process? I want to focus on those questions this afternoon, because, as our report points out, the nature of the document has a considerable bearing on the seriousness with which the content is taken.
The APS currently tries to perform a number of roles at once—as the provider of an update on the current situation of EU policy, as the setter of priorities among previously agreed EU policy areas, and as the proposer of key new initiatives for the coming year. There is therefore some confusion as to its central purpose. Is the Commission putting forward its ambitions for the coming year, or presenting a more factual assessment of the state of play? It is not clear, which makes the holding of a constructive debate on its priorities—and what should later feature in the legislative work programme—that much more difficult. We therefore concluded that future APSs need to be clearer about the purpose of the document and the specific status of each priority or proposal listed. There should be more background provided about those proposals so that the reader can more easily understand whether, in including a particular point, the Commission is prioritising, reaffirming or updating a long-standing objective, or tabling an entirely new initiative.
In its present unclarified form, it is difficult to see the document as a genuine strategy. If it focused on a few key strategic goals, their clear priority would lead to more effective debate and delivery. Moreover, those goals could be more easily communicated and the EU consequently better understood. The APS must, in our view, provide the clear, overarching strategy for the Commission’s coming year, indicating in each area what are to be the key policy intentions to be prioritised for implementation of that strategy.
Details of the legislative work programme should be left to the later document, but the APS, none the less, needs to link the strategy to pragmatic proposals with an explanation of the strategic context in which they are set. We would also like to know why some policy areas have moved up the agenda and why some have moved down.
In our view, this lack of focus in the APS is the inevitable result of the way the Commission constructs it, which is from the bottom up. The Commissioners and their services are asked to present to the Commission President their initiatives and main policy priorities which are then analysed and prioritised by the Secretariat-General, which then prepares the APS for inter-service consultation. This is the period when each directorate lobbies for its own area and point of view. That means that almost nothing is excluded from the final strategy—the old Christmas tree syndrome. Surely, the construction of the APS should be led from the top, with the College of Commissioners deciding on the vision behind the strategy on the basis of a discussion in which the Commissioners select both their strategic priorities and the policy areas which must be demoted to make room for them. The detail could then be provided by the Commission services.
Of course, there has to be some flexibility to allow late-emerging priorities to be taken into account, but a rigorous top-down approach will ensure a more focused, strategic, better structured and more coherent APS. The APS's utility depends crucially on a constructive debate on the EU's priorities for the coming year among the EU institutions. This structured dialogue, as it exists today, tends to focus only on details, looked at from a technical point of view in subject committees. What emerge are nothing more than shopping lists. An APS which is both constructed and deconstructed predominantly by subject committees is unlikely to be strong on the strategic content necessary to provoke the bigger-picture debate which the Commission says it wants. So the committees need to co-ordinate their scrutiny and focus on broad priorities. This calls for a strong political lead generating a more political response to the document.
The present process is further complicated by the fact that the Council—not unreasonably—has its own agenda and priorities, set by the six-month presidencies and based on member states' concerns and the collaborative 18-month programmes. This does not exactly guarantee coherence. There is no tripartite effort among the Council, the Commission and the Parliament to reach an inter-institutional agreement on the priorities following publication of the APS, and the Council's comments on the APS are neither made public nor even shared with the Parliament. That must, in our view, be corrected, and we said so very strongly. The APS should be a presentation of the Commission's strategic thinking to the other institutions, provoking a political debate and providing the Council with options to discuss.
Earlier this week, during the visit of the President of the European Parliament to London, I learnt from his chef de cabinet, who had given evidence to our inquiry, that our advice on this had not been lost on that institution and that it was working with the Commission and the Council towards structuring a tripartite inter-institutional process more along the lines which we were advocating.
Your Lordships' committee has also called on the Commission to provide a clear justification for its key proposals, explaining why the EU should act in these areas and setting out the limitations on such action. We want to know what is the added value envisaged in these key proposals; how they fit into its general strategy and financial framework; and, crucially, how it will ensure delivery of them. That is missing, and it should not be.
The Commission must also explain clearly in the APS the financial constraints around it, and the ways in which the Commission can or cannot change its spending priorities within the financial framework. Political priorities must be matched in budgetary terms, and to do that it needs to declare which areas of action are receiving less funding in order to allow it to prioritise others.
Throughout discussions about what the EU can do, there is always insufficient attention paid to where the money is going to come from and how they are going to get there. The Council is particularly guilty of this. We feel strongly that the Commission, the Council and the Parliament need to forge a closer link between the budgetary and legislative processes.
We do not want the APS to become dominated by a financial bidding process, but the relationship of the APS to the budgetary process must be made clear in the context of the current financial perspective. We recognise that the Commission is caught between the Council and the member states which set out the financial perspective on the one hand, and on the other the Parliament which in most areas now—and in almost all areas if the Lisbon treaty is ratified— is and will be the budgetary authority. Ultimate responsibility lies in the Council, so it is crucial that it assists any effort to increase the correlation between political priorities and financial resources.
We are pleased that, in the 2008 APS, the Commission has included a list of communication priorities for the current year. It seems obvious to us that one important conduit for communicating the Commission's priorities and better engaging the public in a debate on what the EU’s priorities should be is the APS itself. But it needs to be a clearer, more focused document if it is to serve that purpose. We hope that our recommendations regarding the structure of, and explanations behind, the APS will help improve its accessibility.
Finally, the APS 2008 includes a section entitled “Better Regulation—at the Heart of the Commission's Daily Work”. Of course, we welcome this. There is a logic to putting forward its simplification proposals at the same time as its policy priorities, in order that both may be properly discussed before they are integrated into the annual and legislative work programme. But to maintain the strategic nature of the APS, it would do well to publish a separate annual better regulation report alongside the APS.
The Commission has studied our report and Commissioner Wallström has responded encouragingly in most cases, point by point, stating that our recommendations are being taken seriously. She had earlier made it clear that she wanted the national Parliaments to make an input into the process of policy formulation which is based on the annual policy strategy and the annual and legislative work programme. She said:
“It is important that the Commission pay close attention to what you have to say".
Well, we have had our say, and we shall now be looking carefully at the 2009 APS to see to what extent our recommendations have been taken on board. However, in response to our report, she suggested that the extra information we required, particularly on finance and the justification for these proposals, might tend to diminish the strategic impact of the APS because it would become too long a document. I seriously believe that it was wrong there. The length of the document is not the problem: the problem is what is in it. There must be those justifications, and the linking of the budgetary procedure to the building up of the strategy if it is going to be a meaningful and accessible document.
I close by saying that we very much welcome the Government’s helpful response from the Minister for Europe, Jim Murphy, and call on the Government to help ensure that those practical proposals which they can and should support will indeed be implemented by the Commission. I look forward to the Minister's reply. I beg to move.
Moved, That this House takes note of the Report of the European Union Committee on, The Commission’s Annual Policy Strategy for 2008 (23rd Report, Session 2006-07, HL Paper 123).—(Lord Grenfell.)
My Lords, listening with interest and admiration to the words of my noble friend Lord Grenfell, I had the strong feeling that his questions and criticisms—or rather those of the Select Committee over which he presides—are a good deal more significant than the details of the European Union’s annual policy strategy itself. He rightly expressed concern about the purposes of the annual policy strategy and criticised its lack of clarity. His criticism of a lack of coherence and focus seems very well justified. For noble Lords generally, whatever particular interest in European Union affairs we may have, it is really quite difficult to tell what priority the EU attaches to that interest.
Last May, nine months ago, this House debated a report from the committee chaired by the noble Lord, Lord Grenfell, on the subject of enlargement of the European Union. I took the view—which was not generally accepted around the House—that for the time being at any rate, we should be cautious about further enlargement. There should be a pause. On that occasion, however, the European Union Select Committee, in the person of the noble Lord, Lord Grenfell, and Her Majesty's Government, in the person of the noble Lord, Lord Triesman, favoured the European Union continuing to further the aspirations of the Balkan states and Turkey to join the European Union, albeit accepting that it would take some years, particularly in the case of Turkey. The report before us today into the strategy of the European Union makes no mention that I can see of any strategy on the size or extent of the European Union or on further enlargement, except for a quotation from the leader of the Conservative MEPs, Mr Timothy Kirkhope, welcoming the EU’s continuing,
“commitment to pursue accession negotiations with the Western Balkans”.
I would like to think that enlargement is being put on the back burner. But I doubt that it is, partly because in the minds of the Government here and in the minds of many Governments in the continent of Europe, enlargement seems to have a momentum, inevitability and desirability of its own that will withstand the more cautious approach of people such as myself. However, since our debate nine months ago, various events known to us all have reinforced the need for caution.
The declaration of independence by Kosovo, supported by the majority of EU countries, has been strongly opposed by a number of EU countries, so that the EU is divided. The countries that oppose independence are Spain, Greece, Cyprus, Slovakia and Romania—all of which are states with separatist problems of their own and which quite reasonably complain that the European Union seems to have no strategy or policy on where the line should be drawn when claims of self-determination emerge in the EU or in the vicinity of the EU among states that might wish to accede to it.
Following the Kosovan declaration of independence, the Serbian Government—a keen aspirant, as I understand it, for membership of the EU in the near future—have behaved disgracefully in providing no police support against the violence of crowds of people in Belgrade attacking the embassies of the United Kingdom and of other countries that have expressed support for Kosovan independence. I need hardly remind your Lordships of the continuing failure of the Serbian Government to hand over General Ratko Mladic, who has been wanted by the International War Crimes Tribunal in The Hague for some years. Is that the best that Serbia can do to uphold the rule of law?
Then there is Turkey. Last week it invaded northern Iraq with tanks and planes in what the Financial Times called a “ferocious attack” in pursuit of Kurdish insurgents, no doubt highly provoked over a long period but without the support of fellow NATO members, whether the United States or the European members. The Turkish Parliament’s relaxation of the rules against women wearing headscarves in universities is a significant step away from the secularist state that has helped to modernise and democratise Turkey since Kemal Ataturk took power in 1923. Dozens of women continue to be killed in Turkey every year for crimes of so-called honour.
The Lisbon treaty will soon come before this House. There are some fine words in the Lisbon treaty about values, freedom, democracy, equality, the rule of law and respect for human rights. Some of the most recent additions to EU membership—I am thinking of Romania and Bulgaria—were treated very generously by the EU when they were admitted, when assessing their record on the rule of law and human rights. I hope for more robust testing of all future applicants for membership.
Within Britain, the Government have rightly been insisting—this is topical today—on everyone seeking to reside in Britain having to pass certain tests and to demonstrate adherence to the same sort of values that I have just listed, which appear in the Lisbon treaty. To my mind, it is essential that throughout the EU, all members, new, old and aspirant, should adhere to those values. That should be a key part of EU strategy.
My Lords, I join the noble Lord, Lord Borrie, in expressing admiration for the comprehensive nature of the report, as well as the way in which the noble Lord, Lord Grenfell, opened our debate today.
I shall confine my brief remarks to paragraphs 45 to 53 of the report. The paragraphs relate to better regulation and the APS. I shall pose a few questions to the Minister; of course I shall fully understand if he cannot provide answers today, but perhaps he would be kind enough to write to me later.
I stress from the outset that I applaud the president of the Commission's goal to curb regulatory costs to business in both substantive and administrative terms by 25 per cent by 2012. That aim needs to be set in the context of the Prime Minister adding his name to the assertion that half of all new regulations affecting UK business originate in the EU; although some studies, notably in Holland, put the figure higher.
I also draw the Minister's attention to the words of the noble Lord, Lord Jones of Birmingham, when he was director-general of the CBI. He warned that India and China would soon “eat Europe for breakfast” unless drastic action was taken to curb regulatory costs in the EU. Not that the EU has to look just to the competitive edge of the Far East. Other studies point to the compliance costs of regulation at 5 per cent of GDP in Europe, as against 2.5 per cent in the USA.
No one can doubt the imperative to achieve the president of the Commission’s 2012 objective. Alas, several barriers stand on the way of progress. A disjunction still exists between parts of the Commission responsible for enterprise and parts responsible for social affairs. The signs indicate that the gap is as wide as ever. I wonder whether that is the Minister's impression, and what pressures the Government are exerting on Brussels to close that divide.
Of course the Commission, like all bureaucracies, retains a culture of its own. In this case, Commission officials often seem to continue to take as much delight in gaining acceptance for their pet regulations and directives as scientists get from the publication of papers in serious journals. Are the Government confident that the president’s remit on the 2012 target runs among his officials? Although it appears on the surface that the Commission’s regulatory impact assessments are now more intensive, I wonder whether they are extensive. Does the Minister know what percentage of EU legislation is subjected to the full process of assessment, notwithstanding the Commission’s stated desire to weigh the costs and benefits of new draft laws?
I was struck by some of the evidence given to the committee of the noble Lord, Lord Grenfell, by the chef de cabinet to the president of the European Parliament. He claimed that it was the Council that was “the weak link” in impact assessments and legislative planning. He went on to criticise the Council’s approach to co-ordination with the European Parliament on legislative planning. Is this view of the Council’s apparent shortcomings shared by the Government, and if so, what have they done to rectify the position, given Commissioner Mandelson’s warning that the cost of red tape is roughly double the economic benefits of the single market?
The Commission president and the Government have outlined their good intentions and their targets in the EU’s regulatory fields, but more tangible evidence is required of their specific achievements to date. I would be extremely grateful to the Minister for setting them out, if not today then later in greater detail by letter.
My Lords, the question, “What is the annual policy strategy for?”, has already been asked in the debate. Perhaps there is a prior question: “What is this debate for?”. It is only reasonable to draw attention, as the noble Lord, Lord Grenfell, did, to the fact that it might be regarded as untimely, since we have had within the past two weeks the publication of the successor document to the one that we have before us today. Although I recognise the pressures on government and this House to find time for debate, if we are to play a fully effective role in helping, as a national Parliament, to shape the priorities and policies of the Union, we should have come to this discussion rather earlier.
The noble Lord, Lord Borrie, also asked about the scope of the debate. I do not object in the least to his using every opportunity to make his points, which were clearly fascinating, but he discussed enlargement and the structure of the Union post the reform treaty. These matters were not considered by the annual policy strategy, and deliberately so. The explanation is quite clear; it was considered inappropriate for the Commission to put forward its views on structure when the matter was going to be decided subsequently intergovernmentally, and has been. I am bound to say that that was not so much a self-denying ordinance as recognition of the propriety of the Commission’s role in considering the future shape of government decisions. Enlargement also seems to be primarily a matter for the Council and for Parliament to debate, and for the Commission to pick up the consequences and to advise in a technical fashion on these things. None the less, I was very interested to hear what the noble Lord had to say about them.
The content of this document, its appositeness to the issues and the clarity with which it makes its point exercised the Select Committee to which I have the honour to belong. Indeed, the question was put to the then Minister for Europe, Mr Geoffrey Hoon. His response was that it is not so much a Queen’s Speech as a manifesto. The reply given by the Commission, accompanying the letter of Commissioner Wallström to the committee, welcomes our report and our emphasis on making it more strategic and more focused. It also describes the APS as being as far as possible focused on strategic priorities and on providing a vision for the coming year. A vision, by any test, if that is the right focus, is not a series of detailed policy pronunciamentos. It sketches out the perceived priorities for the executive arms of the European Union to focus on.
The document we are addressing seeks to do more than sketch a vision. To some extent, it is trying to flesh it out by indicating some of the priorities of action within the wider scope of the four headings that are being, by common consent, recognised as strategic priorities. Two of them seemed to be of massive importance at this time; namely, climate change and energy security.
The difficulty for the Commission in proceeding in these ways is that it does not work in an abstract way, separate from the changing situation. It is very interesting to cast one’s eye to the new APS published on 13 February and to notice that at the very beginning of the section dealing with these economic issues, it states:
“The impact of the global financial turbulence on the real economy and the hike in raw material prices will require the EU to deepen its structural reforms at both EU and national level”.
That perhaps is not a reordering of priorities, but a deepening of commitment, which may have its effect on the timing of other measures.
It seems that what we have before us is part of an iterative process. It is not a conclusion. It starts the debate annually within the Union. The financial and budgetary context of this is clearly explained by the Commission: it is the multi-annual framework. It goes on to look at the budgetary consequences subsequently. The budgetary decisions of the annual policy statement are sometimes almost negligible, as the Commission points out. Sometimes they result in a gradual process of adjustment. It would be no more appropriate for this document to go into detailed budgetary dispositions than it would be for manifestos, but if questions are asked about the affordability of particular policies, they will have to be addressed.
This is iterative and it is highly desirable that it should be pulled together at the end of the process. It is not a long process. The European Parliament and the Council have had their input, as have national Parliaments such as ours. Interestingly, the Netherlands had a considerable input into the comment on this document. If that is to work effectively, it is surely right that the institutions of government, the Council, should be transparent about its precise reactions to this document, as the noble Lord, Lord Grenfell, said. That is entirely conformable with the view expressed in the reform treaty, which requires the Council also to bring its legislative process into the public to inform debate and to ensure inter-institutional coherence. Considerable progress has been made even since last year in the preparation of this document.
One step that has been notably taken and which goes some way to recognising the concerns of our committee is set out in the annex to the 2009 document. The areas of priority are set out under five headings which go much further in indicating specifically the measures that are anticipated as desirable and the key actions envisaged for the next year. I shall give just to take one example:
“Second Strategic Energy Review with an Energy Action Plan for 2010-14 [and] Extension of the Energy Observatory”.
On climate change there are five bullet points, all set out quite clearly, communicably and helpfully. I think that the words of this committee have fallen not on deaf ears but where it counts, and we should take some satisfaction from that.
My Lords, let me first pay tribute to the committee for this interesting report on The Commission’s Annual Policy Strategy for 2008. I must confess that I had not realised that we have reached the 2009 report. I listened to the noble Lord, Lord Grenfell, with my usual respect, as one who has had the privilege of serving on his committees in the past; I must also say how much I support what the noble Lord, Lord Maclennan of Rogart, said about the delay in discussing such a vital issue.
As usual, wise and penetrating questions were asked, and I wish to comment on two issues. The first is that, as the report recommends that the,
“Commission, Council and the EU Parliament should forge a closer link between the budgetary and legislative processes”—
the relationship of the APS to the budgetary procedure should, it says, be made clear within the current financial perspective. The committee urges the Government to work to ensure that the Council assists any effort to increase the co-relation between political priorities and financial resources. Recognising that, it states that,
“the Commission are caught between the Council and member states who set out the financial perspective, and the Parliament which in most of these areas is the budgetary authority”.
It is hardly reassuring that members of the budget committee in one area of the work of the Commission may only see the accounts in a dedicated room, and may not take notes or quote, and that there are strong indications of incompetence and/or corruption in an institution which has not passed the scrutiny of an auditor for 13 years. The committee says that the Commission should explain financial constraints around the APS and that political priorities must be matched in budgetary terms. The report quotes the wise words of one MEP who testified:
“Throughout discussion about what the EU can do, and the Council are particularly guilty of this, there is always insufficient attention to where the money is going to come from to do it and how you are going to get there”.
Finally, the committee urges HMG to work to ensure that the Council assists in any effort to increase the co-relation between political priorities and financial resources. I think that we have a national interestin that. I should like in particular to have a clear statement on record setting out how the UK contribution first to defence and secondly to foreign affairs is decided, and where. Needless to say, I do not expect that answer on the Floor of the House tonight, but I look forward to hearing something.
Does the MoD have to see some of its hard-won resources diverted to pay for yet another unnecessary and sometimes ridiculous EU venture into defence, for instance? An EU committee report of 2004, HL Paper 76, recorded that the UK paid €2.5 million to the setting up of, for instance, the European Defence Agency. It reported then that from 2006 onwards the UK was expected to contribute €1.5 million per annum and that the money would be paid from the MoD budget. That was just for the EDA. When the famous peace facilities were conceived, DfID, our development agency, made a significant contribution to financing African peace-supporting military operations, “recognising” it said,
“the importance of restoring peace and security in Africa as a prerequisite for development”.
Take, for instance, Galileo, that largely unnecessary satellite set up in response to French pressure and based in France. That agency was originally supposed to cost possibly €2 billion, but the costs have expanded hugely and have had to be met, according to press reports—and this I would indeed like to have checked—from, of all places, the common agriculture and fisheries budget. I never thought I should say in the House, “Where is our own dear Treasury? And does it have any grip on the profligacy of the EU’s institutions and its financial procedures and accountability?” It is utterly wrong that our forces in Afghanistan should go short of equipment and our service families live in disgraceful conditions while we tolerate irresponsible EU spending on defence.
Yesterday’s report on the decision of the budget control committee not to publish its report on the £107 billion EU accounts, failed by the Court of Auditors for the 13th year in succession, is far from reassuring. I find it deeply disturbing that we seem to have no control over EU spending. The EU defence budget was €160 billion in 2003-04—I quote from House of Lords Paper 76—and we were then and are now, with the French, the prime contributors. This cannot but mean that there is less money for our own urgent national needs. What is the position?
Illness and absence have prevented me so far from reading, I am ashamed to say, the strategy itself, but I presume it must have dealt at some length with the EU’s projected Foreign Service, with all its implications for our own international standing. The committee on this occasion evidently concentrated, rightly, on the vital question of whether plans were in any way related to resources and on the need to institute some effective control. I, however, wish to pursue the question of our future representation abroad and the impact on the foreign service of the EU’s strategy. If this has been done by the committee in another report of which I am unaware, I apologise. If not, I hope there are early plans to conduct such an appraisal.
My concerns are as follows. In the common diplomatic service projected—to which we may ultimately find it difficult to contribute effective members if HMG persist in their new proposed policy to abolish oral exams in languages for fear of stressing the candidates—there will presumably be in a typical EU mission a mixed staff of, say, a Bulgarian, a Belgian, a German and a Czech. Will they have authority to issue visas for the UK, use our biometric procedures and our security checks and issue British passports?
We are told the EU mission will take the responsibility for the evacuation of British subjects and, presumably, of all other EU nationals. I have been, as consul, responsible for just such an evacuation. It only works if you have excellent local contacts in both the Government and the rebel side in a chaotic situation. I would not wish to have to rely on an EU mission which would have, necessarily, to do the same for all EU citizens in the country.
Again, how will the costs of the British element of the work in the mission be handled and accounted for, and by whom? What about a crisis which calls for an immediate early defence capacity? What about trade? If there are important contracts coming up in, say, Brazil, do we really expect a mission that may not contain a British representative to negotiate that contact for the UK, or even to support a visiting British trade mission, especially if one of the EU countries in the mission also has an interest?
What about the British Council? We are told that there will be countries where we shall also retain our own mission. Where we do not there will, incidentally, be grave offence. But, in Argentina for instance, there could be a future EU common position requiring us to negotiate over the Falklands. The Argentines would deal with the EU mission on that issue.
It is already provided that the EU should represent member states at the UN in matters where there is a common position. It is surely logical that this will very soon extend to relations between countries and that, for instance, China will effortlessly play the EU card in any negotiations affecting our mutual interest by dealing for preference with the EU mission, whether or not we have our own mission in China.
There are also plans for a new EU foreign policy fund which, under the new treaty, can be approved by QMV—yet another expense outside our control. Not least, what about our overseas intelligence and security operations, particularly in the field of terrorism? There is no way such issues could be delegated to an EU mission.
I feel the greatest anxiety about the future of our country when the treaty comes into effect, and I believe that HMG have utterly failed to foresee the consequences of abandoning control of our future defence and our vital political, commercial and security interests to the EU. I do not think that even the Treasury’s joy at being able to sell some embassy buildings by closing our missions will compensate for our loss of ability to advance our national interests, to maintain our friendships and to retain a respected and well informed voice in world affairs.
My Lords, as a member of the European Union Select Committee at the time of the preparation of this report, I, too, thank the noble Lord, Lord Grenfell, not only for introducing the report so comprehensively but for his chairmanship during this inquiry. At first sight, this may not appear to be the most exciting topic to which the committee could have turned its attention, but it is undoubtedly an important document and stage in the whole process of European initiatives and legislation. It is extremely welcome that the committee has pledged to bring a report to your Lordships in each year following the publication of the annual policy strategy. It is a welcome addition to the report on the annual work programme that follows in the autumn.
The noble Lord, Lord Grenfell, has already pointed out the shortcomings of the Commission paper. The Commission itself seeks to improve the presentation and enhance its clarity, and has, I suggest, responded positively to many of the suggestions made in the report. I will not repeat the shortcomings but merely emphasise how acute they are in the case of the published figures, which are extremely difficult to follow and the presentation of which needs urgent attention. The sub-committees of the Select Committee have made their comments and I hope that the Government will be able to take these forward and keep the Select Committee and its sub-committees informed about progress in the areas that have been commented on.
The Commission is moving on a very wide front. While in any package of proposals there are bound to be some about which one is more enthusiastic, it appears unlikely that everything will find its way through to the annual work programme, but, if it does, whether it will be achieved must be questionable, either because of time constraints or because all these ambitions have to be kept within the limits of the current budget. As so often, there is a need to prioritise. However, we should not lose sight of the entirely creditable attempt by the Commission to publicise its intentions in advance of the work programme. I submit that the challenge is for national parliaments and Governments to seize the opportunities that this presents. It has long been the case that the earlier in the Brussels process one enters and engages with a dialogue, the greater the chance of exerting some influence on events.
It is important that Parliament should know the Government’s views on the strategy and its contents. The Explanatory Memorandum recommended by the committee, going much further than the one submitted with this paper, should help. Are the Government prepared to give a commitment to do that?
This brief debate shows that European affairs can raise interest in a number of different areas. I submit that the case put by the noble Lord, Lord Maclennan, is correct. It is tempting to go into detail on some of the issues that have been raised. Suffice it to say that I cannot resist the temptation in two instances. I say to the noble Lord, Lord Borrie—and I declare an interest as vice-chairman of the All-Party Parliamentary Group on Romania—that in future we should be looking in the Commission programme to ensure that the Commission is adequately continuing its monitoring of Romania and Bulgaria, as it has been doing following accession. We should acknowledge the considerable efforts made by those countries to meet their obligations, and we should perhaps be willing to embrace them as partners in the European Union as willingly as we embrace them as partners in NATO and some of its military exercises.
Regarding the European Defence Agency, my noble friend Lady Park is a great expert in defence matters but, with great respect, I refer her to the report of the European Union Committee on the EDA in which the committee found that it was by and large a good thing and could lead to a better use of our own resources.
I have already said that it is important that Parliament knows the Government’s views on the strategy. A debate in government time, not at 4.30 on a Thursday afternoon, following consideration of the strategy by the European Union Committee and its sub-committees, would bring matters before a wider parliamentary audience. While I understand that the Minister is unlikely to give me a positive answer today, I ask him to consider it, so that we do not in future debate the APS for one year just after the publication of the APS for the next. Will the Government press the Council to publish its response to the strategy before the annual work programme is produced?
If we are prepared to use what we are offered, we can go a long way towards dispelling some of the myths about the way in which decisions are made in Brussels and ensure that we obtain the maximum influence both as a parliament and as a member state.
My Lords, this has been a thoughtful debate on a subject which, as the noble Lord, Lord Bowness, said, is hardly the most exciting theme for us to consider, but which is extremely important. If only the timing of the scrutiny exercise could be arranged for a moment in the year when it attracted the public’s attention more, one would begin the process of making it more political. We could link policy and programme issues with national input and output of ideas on the same subject. Trying to engage the public’s interest in European matters in each member state is a continuing problem, particularly in Britain, which has unusual problems in its domestic political scene in that field, and on the wider European front.
We are once again deeply grateful to the noble Lord, Lord Grenfell, and the members of his Select Committee. Although I have the great honour to be a member of that Select Committee now, I was not at the time of the report. Good work has been done, for which we thank the noble Lord, Lord Grenfell.
As other Members have rightly said today, it is wrong that scrutiny is a year after the strategy was originally promulgated; it has to be sooner than that. There are problems for the UK’s scrutiny of these matters which need to be ironed out in the Commission’s response to our references to the inadequacy of the information that one receives and the modalities of the production of its various programmes.
The noble Lord, Lord Grenfell, said that the APS does not look like a genuine strategy yet. The noble Lord, Lord Maclennan, was right that improvements have been made in recent times, but that we are still far from a satisfactory situation. There is the inevitable conflict between the February timing of the APS and the September timing of the ALWP. Although they are very different, there are inevitable linkages. I was struck by the reference of the noble Lord, Lord Grenfell, to the conflict between the six-month period of the presidencies, the 18-month intervals between meetings of the troika and the seasonality of these two important reports. When one mixes that up with all the budget attribution responsibilities and complications, it gets even worse.
I did not accept many of the arguments of the noble Lord, Lord Borrie, although I was interested in his reference to caution on EU enlargement. Yes, people inevitably were cautious when there was a sudden splurge of additional countries joining—not just the two Mediterranean islands—and when Bulgaria and Romania jointed latterly. Those who have observed these processes in the member states, from the original expansion of the EU from six to nine member states, then beyond that to 12 and 15, and then from 15 to 25 and 27, have seen the justification in each case and just how those individual countries change. From the initial period of entry to the transitional period, when they do not have to accept the full acquis, it is interesting to see just how they begin to change and accept the onerous responsibilities that EU membership imposes on them—both from the acquis communautaire itself and with all those things that in the case of Bulgaria and Romania were deemed essential in creating a civilised civil society after past experiences. Those things include judicial matters, transparency over government figures, the full democratisation of political election processes, judicial matters and police supervision matters and so on. Spain and Portugal, too, are dramatic examples of countries where there were rapid changes when membership began, changes that accelerated subsequently. That is the great blessing of enlargement, because it washes over to the existing older and bigger member states in a remarkable way. We see the extraordinary acceleration and mobility of populations and diasporas in EU member states, putting an end to the American mythology that they were very mobile and Europe was not.
I agreed with what my noble friend Lord Maclennan and other noble Lords, including the noble Baroness, Lady Park, said about the timetable being all wrong. Might there not be a compromise in future so that we avoid scrutiny excess and exhaustion? There is too much to cover in an exercise that—with the House of Lords as the upper House of the British Parliament, apart from the Danish Parliament and the special arrangement in Holland—is probably the most profound exercise in scrutiny, of which we can be justifiably proud. We might consider the possible merger of the seasons, whereby we take February to September for the APS and ALWP clusters and, shortly after that, have a major debate. One day for it might be too long, but we need a major debate in government time, perhaps coinciding with the new Session of Parliament. It could be part of the Queen’s Speech content, along with foreign affairs, common foreign and security policy and European affairs. Those things could be combined so that there is a proper appraisal and scrutiny of those segments. But things have improved, it is fair to say, and, as the noble Lord, Lord Bowness, rightly said, the Commission has made creditable attempts to get its act together in a very complicated field.
I conclude my remarks with a couple of quick references to some sections of this excellent report, which caught the attention of other noble Lords in this debate. As the noble Lord, Lord Grenfell, said with regard to paragraph 18, policy strategy needs to be led from the top, not flowing upwards from all the lower sections of the Commission’s administrative body. The report says that,
“the College of Commissioners should decide on the vision behind the Annual Policy Strategy”.
Paragraph 19 continues that theme, saying:
“It is crucial to the utility of the Annual Policy Strategy that it should provoke a constructive debate within and between the European institutions and parliaments about the European Union's priorities for the coming year”.
There is a link-up with the budgetary developments as well. That is right, although it should not necessarily be taken in terms of some MEPs’ appraisal, as that might mean the insertion of ideological aspects of their own party-political views, both of their national homeland and in the European context. It is more important for this to reflect the promulgation of the balanced series of policies by the Commission, which covers all policy areas and must be dealt with by the European Parliament on a very balanced basis.
Paragraph 25 says:
“One possibility would be for the European Parliament to complement the work it does on the APS in committee by holding a plenary debate and adopting a resolution on the APS in September”.
Has the Minister had a chance to discuss those matters with representatives from the European Parliament? Could he report back to us today on whether any progress has been made in that regard? Forging the links between all that and the budgetary process is quite difficult and remains an open seam as regards proper solutions.
We must also remember that, in contrast to national budgets, which are not virtuous in terms normally of having substantial deficits and therefore requiring both taxation and bond fundraising on an extensive scale, the EU budget, although large now in comparison with the past, remains virtuous in the sense that its payments are equal to its outgoings—and they have to be under the procedures.
Among the evidence given to the committee, that from the City of London Corporation, at the end, was very interesting. I refer to page 49. It said that the United Kingdom would suffer if it was not present at some of the decisions on eurozone subjects because we are not members of the currency and the Central Bank eurozone system. In the bottom two lines, the City of London Corporation says:
“One of the issues arising from the UK’s non-participation in the Eurozone referred to in the research is the fact that although developments within the Eurozone are of direct concern to the financial services industry in London, the industry is not represented in discussions about them”.
At paragraph 17 on page 50, it says:
“The fact remains, however, that combining the UK’s non-participation in the Eurozone with the apparent desire of the Bank of England to confine its role quite narrowly to monetary policy is producing a clear and forceful perception in the City that its interests are in serious danger of being under-represented in discussions within the Eurozone”.
I speak of course against the background of the euro having reached its highest ever level against the United States dollar at over 1.50, and of course it is only four or five percentage points below the highest ever levels reached with the yen and the Swiss franc. So again it is a moment to reflect on how sad it is that the Government have not long since joined the euro, which has now inevitably become the most successful currency in the world. But that is a different subject; I will leave that out. However, I ask the Minister to comment on those matters as well if he has time, because that is a worrying assertion in the City of London’s evidence.
My Lords, we are very grateful to the noble Lord, Lord Grenfell, for yet another very interesting report from his committee. This has been a thoughtful and useful debate, even though the noble Lord, Lord Maclennan, rather penetratingly asked why we were having it at all.
I know that the noble Lord, Lord Grenfell, is anxious that we should concentrate, and that the intention of his committee’s report was to concentrate, on the procedures by which the annual policy strategy is put together rather than on the detailed contents and the issues contained in the strategy, which of course we will be debating at considerable length over the coming months when we deal with the renamed constitution treaty, Lisbon treaty, reform treaty or whatever it is be called. Then we will go over these things until we are all blue, red or possibly green in the face as we deal with them in colossal detail.
Nevertheless, while trying to concentrate on the logistics of this kind of report, it is of course true that the way it is put together explains to some degree the tone of the report and the relative incoherence—that is what your Lordships’ report is really saying—of the APS and its rather other worldly priorities. For instance in the original document, the Commission’s report itself, I noted its statement that 2008 would be,
“a year of consolidation and continued implementation of existing acquis”.
That is way off the frame; it is not going to be that kind of year at all. The reply from the Commission is also interesting; that is the reply that has just been issued to your Lordships’ report. The Commission agrees with the report, rather hastily, that it would like it to present a more unified vision and greater simplicity.
The Commission is rather half-hearted on the budget issue and has slight reservations about the extent to which it should link its observations to the unfolding budget because it says that there is a time problem, that its ideas are way ahead, that the budget is next year and that they do not really match. In its response to the correct plea of the noble Lord, Lord Grenfell, and others that there should be more simplicity and clarity, the Commission comes up with the proposition that its simplification work is programmed within—wait for it—the “multi-annual rolling simplification programme”. I am afraid that does not make my heart leap at all and I should not think it makes anyone else’s heart leap either. I wonder whether my noble friend Lord Grenfell—if I may call him that—sometimes wonders whether all this work is really worth it when that kind of result comes up.
As the noble Lord, Lord Maclennan, asked, what is this report for? Frankly, I should think that one in 10,000 people in the United Kingdom has ever heard of the APS, let alone read the document. Having followed European Union, European Community or Common Market matters in great detail for well over 40 years, I have to confess that the whole concept of the APS is pretty new to me as well. So I do not think this will be a bestseller in the bookshops. It clearly is a document aimed very much at internal procedural assistance and help. The question is posed in our report—is it an aspiration or is it an assessment? Is it meant to be a vision or snapshot of what is going on? Or, as the report of the noble Lord, Lord Grenfell, puts it a shade crudely, is the Commission’s job to juggle balls or to pitch them? These are very good questions and they are all raised by the relative inadequacy of this APS report.
As I promised, I shall not say much on the issues within it except to note that the four key issues that the Commission identifies for 2008 are all areas which are, to put it kindly, very seriously in need of repair. The report speaks of climate change. We all know that the EU’s impulsive strategy on biofuels had to be sharply checked because it turned out to be promoting environmental degeneration and adding to carbon emissions rather than the opposite. We all know that the Commission’s commitments for increasing the energy costs of European industry are running into a political brick wall at this moment. Certainly, they are leading to the absurd outcome, which we should all deplore as should the Commission, that some interests are now saying that taxes should be raised on imports from developing countries—by which their economic growth will be achieved—to prevent unfair competition with the European industries which have all had their costs increased by 15 per cent for carbon emissions reasons. These are “absurdity” areas where we need far greater clarity and there certainly needs to be some concentration on repairing them.
We all pay lip service to competition and a more competitive energy policy, particularly the Whitehall Government here in London. But, of course, others are not playing that game. The monopoly champions of energy in many of our neighbouring EU member states are moving around with more confidence than ever and indeed taking over our own industries. Iberdrola is moving into Scotland and e.on and EDF are moving into England and Wales. This is what is actually going on even while we are talking about competitive energy policy, so that needs a bit of repair.
The Commission says that it will relaunch the Lisbon strategy. I refer to the Lisbon strategy as opposed to the Lisbon treaty. This is the third time that it has been relaunched. Of course, it will be relaunched again and again because it is a fundamentally flawed idea born of top-down thinking on industrial policy, which never produces results. Hope has to come from bottom-up innovation and enterprise. My noble friend Lord Grenfell reminded us that his report talks about the need to formulate the annual policy strategy from the top down. That jars a bit with me. I am not quite sure what top he wants to form it at. If he means drawing on the wisdom of the member states at the top of their Governments, that is fine, but if he means something rather different such as more abstruse ideas from the top of the European Commission, I am not so happy about that. As for the fourth key area in the APS, which is managing migration, the less said about that the better. Clearly, it is not being managed at the moment and there are very serious deficiencies.
One is left feeling that we are dealing with EU institutions and a Commission which are worried about their own legitimacy and reputation, and rightly so. They are not really focusing, as they would if they followed the advice of the noble Lord, Lord Grenfell, on the myriad ideas for co-operation and practical work together in Europe that could carry forward so many of the things that we want to do in the European region without necessarily getting in the way of our wider aspirations in the more important parts of the world such as Asia.
The Annual Policy Strategy, which I confess I read only very recently—I was hardly aware of its existence before—gives me no confidence at all that the realities of the new international scene are really understood by the Brussels officials who penned these words. They certainly give me no confidence that we should entrust our vital national interest to the authors of these documents. I very much warm to the words of my noble friend Lady Park, who said something very much to that effect. The suggestion in our report that there should be proposals for an explanatory memorandum when we look at these things—that is a memorandum from our Government commenting on the Commission’s ideas—is a very important idea indeed, and I hope that it will be adopted next time. I hope, too, that there will be much better communication of the European Commission’s intentions as my noble friend Lord Ryder rightly referred to, because there too there clearly is a big deficiency.
We have heard from the noble Lord, Lord Maclennan, that there is a later document for the coming year—2008-09 presumably—and that it shows some improvements. All I can say, having looked at this very carefully, and having listened to the wisdom of the noble Lord, Lord Grenfell, is that there is plenty of room for improvement.
My Lords, I join other noble Lords who have thanked the noble Lord, Lord Grenfell, for his work and its culmination in today’s debate, which has given us the opportunity to touch on a wide range of issues, some of which were rather wider than the annual policy strategy that we are discussing. That the noble Lord, Lord Grenfell, has been able to bring so much attention and detail to the review of the document reflects a man whose career has been spent in international organisations. He enjoys a dangerous passion, which I understand too well, and almost an unnatural—some might call it a ghoulish—fascination with the inner workings of international organisations. He has found his nemesis in this document and this organisation. By doing so, he shares a lot of wisdom and detail with us.
I have some sympathy for those noble Lords who have implied that this document is more of a carthorse than a racehorse. Let me at least start on the high road, by reiterating that the Government support both the broad aims of this document, the focus on key priorities and the need to produce a cohesive strategy, which were all points made in the report. As Commissioner Wallström commented in her evidence to the House of Lords European Union Committee:
“It is important that the Commission pays close attention to what you have to say”.
But it is clear to me that it is equally important that this House offers input into the debate on what the Commission is trying to achieve. Here, I turn to the point about being more carthorse than racehorse. Documents of this kind are enormously difficult to get right. It is a long process, even without the delays in debating it. We are talking about a document that was prepared a long time ago, because of the inevitable internal processes inside the Commission and the consultations involved in preparing the document. We are left with a situation whereby its communications goals for this year bear little relation to the real discussion of this year. It was as though the Commission had not foreseen the dominant discussion of the treaty in the debate about Europe, not just in this House, but in this country and across much of Europe. The document assumed that the Doha development round would have been finished and that we would be busy discussing its implementation.
So this document is, if you like, dated, not just because of the delay in holding this debate, which I acknowledge, but more generally because it is what it is—a document produced through an extended process of consultation with different stakeholders inside and outside the Commission and it suffers from the inevitable slightly ponderous lowest common denominator of that. But I would argue that that means that while we treat it for the carthorse that it is, we need racehorses as well, and we need sharper, more crystallising ways of setting the objectives of Europe as a whole, which this Commission document is a contributor to, but does not itself provide that answer.
I was struck by the fact that in the previous year, the President of the Commission, President Barroso, who was new to office at that time, set his own objectives and this document did not occur for a year because he had set them. In a sense, they had the power and clarity of being the head of the institution’s priorities for action, but they were weak in not having the same buy-in that a process like the APS allows. So we will continue to struggle with how you get something that represents broad consultation and broad agreement, but does not lose its strategic clarity and has a timeliness which makes it relevant. In that sense, we should seek ways of doing anything that we on the government side can do to advance the time when we debate the APS. Equally, we should consider the suggestion that the Government respond to the document to allow that response to become part of that debate, because the interaction that the noble Lord, Lord Dykes, referred to between European institutions and our Parliament in improving the accountability and democratic transparency of what goes on in Europe is something that all of us, friends and critics of Europe alike, can agree is a valuable and worthwhile objective.
This Commission report, even if it plods a bit, highlights four key challenges that we could all agree are priorities for the institution in Brussels—tackling climate change, ensuring the availability of sustainable, secure and competitive energy, implementing the Lisbon strategy for growth and jobs, and managing migration flows to the EU. These are issues that go to the heart of how to face up to the vision of an outward-looking global Europe and the challenges and opportunities that that brings. The UK fully supports that vision and we are ready to work with the EU to ensure a stronger, more focused approach to our future work. This report on the annual policy strategy is a welcome document that will help our engagement in this annual process—I hope in a more timely way in the future.
The Commission report, as the annual update of policy direction, requires proper parliamentary scrutiny to ensure that its direction continues to dovetail with the UK’s own priorities. We applaud and agree with the priorities set in this report and it is good news to hear that they carry over to the report for next year. It is essential that the EU focuses on delivering recognisable benefits and tangible policies that really matter to its citizens. Obviously, we particularly welcome climate change now being well up the Commission’s agenda. With great respect to the noble Lord, Lord Howell, I hope that Europe’s performance on climate change is more that of an innovator and leader, and not quite as disappointing as he suggests. Along with the Lisbon agenda and better regulation, these are important things to focus upon.
I certainly take the point made by the noble Lord, Lord Ryder, that the best kind of regulation is, usually, deregulation—the cutting of red tape. I will come back to him in more detail, but there is an agreement across most of us in this House that in looking to the future, the European policies of Her Majesty’s Government should put greater emphasis on encouraging growth and making sure that there are more inclusive labour markets across the EU under light regulation. This year will be important for the future of most of those priorities—both for the Lisbon process, and thanks to the EU budget for 2008-09 offering an important opportunity to progress toward a reformed EU, better able to deliver those benefits.
A number of noble Lords raised issues that were, I think, trailing their coats for the debates to come in months ahead; they will, therefore, forgive me if I do not touch upon all of those issues. I say to the noble Lord, Lord Dykes, that while the City of London may regret the lack of UK involvement in some of the financial decision-making in Europe, we nevertheless do extremely well, as the noble Lord knows. For the last year for which we have figures, of the £130 billion of direct foreign investment in the UK, £115 billion of it came from Europe. If we can see further financial market liberalisation in Europe, the gains to London will be even greater—with an inflow estimated in tens of billions of dollars, euros or even pounds.
To my noble friend Lord Borrie and the noble Baroness, Lady Park, I say that in order to do justice to the scope of this debate I do not think that I can answer all of the questions raised, although I will, with great pleasure, brief the Leader of the House on what lies ahead for her as she carries the treaty debate through this House. I had hoped that there would be a better punch-line to the example from the noble Baroness, Lady Park, of a Bulgarian issuing a British visa. While I will not provide that punch-line, I want to reassure her that we very much understand our sovereign responsibilities as the British Government, whether on visa issues or consular protection. There will be the opportunity, in the treaty debate, of debating Article 20, which says that in third countries where states have no diplomatic and consular representation, they are entitled to consular assistance from the authorities of another,
“Member State on the same conditions as the nationals of that State”.
We welcome that, seeing it as extending consular assistance to countries where we have no consular presence, without handing over power over consular matters to others. As I say, there will be an opportunity to return to that at greater length in forthcoming debates on the treaty.
Like all who have spoken today, I recognise that the APS is a good start. It sounds as though it is a work in progress, with perhaps a modest improvement prize for the next issuance, although “Headmaster Howell”, has not yet agreed to grant it that prize. I congratulate the noble Lord, Lord Grenfell, and all the members of his committee on providing us with the interpretation and an elegance of report which avoids the terms that have been pointed to during the debate. At least his report is in plain English, which contributes to our understanding of the importance of European strategy. It is important that we debate it in this Chamber, in a timely, transparent way to contribute to the democratisation of Brussels.
My Lords, I have a couple of comments. This has been a very useful and interesting debate. I return the compliment and refer to the noble Lord, Lord Howell, who is my noble friend. That has no political connotation; we have been friends for a very long time. It is always a pleasure to exchange ideas with him across the Floor of this Chamber. He asked what we mean by top down. The Commission has the right of initiative. It is correct that the College of Commissioners should be at the start of the process, leading to tripartite discussions with the Council and the European Parliament. I think that is the right way to go.
As some participants in this debate have suggested, I hope that later this year we will have a chance to debate the 2009 annual policy strategy and to look at its contents. I make no apology for steering my committee into focusing our inquiry on the procedures. This was the first time that we had looked at an annual policy strategy. It seemed to me that if we could get a grip on the procedures we might be able to influence a little, as I think, in the event, we modestly have. Future examinations of the APS can then concentrate on the content.
I thank all who have taken part in the debate. In the course of my remarks, I was complaining that the Commission was guilty of succumbing to the Christmas tree syndrome. Some of that has been reflected in the debate today. We have covered the euro, the Balkans, consular services, and even the Lisbon treaty. I do not resent that at all; it has all been very interesting and has added something to the debate. What has been said about the procedures here is very helpful to us. I am glad that there seems to be quite a consensus that the Commission has to look seriously at how the APS is constructed in future.
I thank all participants and I warmly thank the Minister for his eloquent and helpful response. He has considerable experience of international institutions. His curiosity about how they work may not extend to being as ghoulish as mine, as he suggested; none the less, he understands the intricacies of dealing with international institutions and the problems that national parliaments face in dealing with them.
On Question, Motion agreed to.
House adjourned at 5.52 pm.