asked Her Majesty’s Government:

What is the role of Her Majesty’s Armed Forces in Basra.

My Lords, our forces still have a vital job to do in Basra. Their primary focus is now on training and mentoring the 14th Division of the Iraqi army until it is fully operational. They also support Iraqi-led operations when requested, as they did during the recent successful Iraqi operations in the city. In addition, our forces facilitate economic reconstruction—in particular at Basra’s international airport—and lead the training of the Iraqi navy.

My Lords, I am grateful to the Minister for that reply. As we know, strong evidence suggests that most of the weapons being used by the Iranian-backed group there, including mortars, rocket-propelled grenades and ever more sophisticated roadside bombs, are of Iranian origin. What are we doing diplomatically to counter the threat to Iraqi stability and to the lives of our troops, and how successful have we been on the ground with Iraqi troops in preventing the transfer of those weapons into southern Iraq and the Iranian training of the insurgents?

My Lords, it is quite right to say that a great deal of the weaponry that is coming in and being used by insurgents in Iraq either originates from or comes through Iran. It is a topic of great concern to us all. We are taking action diplomatically in a number of ways, including by trying to involve influential countries in the region as well as exerting our influence directly. We are supporting the Department of Border Enforcement in Iraq, and our fast jets help and assist in that. That is very important. Everybody involved recognises that the problem of weapons coming in to the insurgents from Iran is very significant.

My Lords, in view of the fact that the Americans seem to have been called on for assistance last time that the Iraqi forces were engaged in Basra as a first port of call, why are we there in such large numbers in combat units if we are there primarily as training support?

My Lords, there is a slight misapprehension there. The Americans did go to Basra, in somewhat limited numbers, in support of the extra Iraqi troops that went into Basra, because the Americans were monitoring those divisions. Similarly, when Iraqi troops have been moved into Baghdad, British advisers and support people—those who were mentoring and training those divisions—did go with them. So it is nothing exceptional for coalition forces that are mentoring specific divisions of the Iraqi army to go with those divisions when they are on operations.

My Lords, is there any indication of when this training programme is likely to come to an end? What progress has been made on it? I seem to recall Ministers indicating earlier a stage when they thought the training would be completed. Does the Minister have a forecast?

My Lords, the noble Lord, with his experience, will know that the training of any armed forces is not a single one-off event: it is training, mentoring and additional support where that is requested. The recent events in Basra city proved very successful in attacking the militia and criminal elements. The Iraqi forces took the lead but they had support and help from elsewhere. That was important. On that basis, it would be wrong to try to set a target date for when that training and mentoring could come to an end.

My Lords, bearing in mind that this year marks the 100th anniversary of the foundation of the Territorial Army, will the Minister say what proportion of the troops in Basra are being drawn from the Territorial Army?

My Lords, I cannot give a figure at this moment but I will certainly write on that matter. The Territorial Army and our reservists generally have a significant role to play. They have been very valuable in the work that they have done.

My Lords, does the Minister agree that few graver criticisms can be made of any Government than that they should undertake greater military commitments than they can produce the resources to meet those commitments? Is it not clear that there have not been adequate forces to best achieve the missions which have been so brilliantly performed by our Armed Forces in Basra and Afghanistan? Would it not be better to switch the Basra forces to Afghanistan? Will the Government overall make up their mind on whether they will adjust the resources to the commitments or the commitments to the resources?

My Lords, the commitments which the Government have given to the operations in Iraq and Afghanistan have been substantial indeed: £10 billion in recent years, and from the Treasury, not the MoD budget. I acknowledge the noble Lord’s praise for the work of the Armed Forces and the fact that he says that they have been brilliant in what they do. But at this stage it would be somewhat premature and somewhat irresponsible to go for a simplistic solution such as switching troops from Iraq to Afghanistan.

In this week commemorating the 60th anniversary of the creation of the state of Israel, and thus the Naqba—catastrophe—in Palestine, will the Minister agree that it would have been much, much better to have put huge efforts into solving the Israel-Palestine question instead of making war on Iraq?

My Lords, I do not think that work on a solution of the Middle East problem in terms of Israel and Palestine is mutually exclusive with the operations that we have undertaken. The Government still put a great deal of effort into trying to get a settlement of the Israel-Palestine situation that will suit everyone.

My Lords, pursuant to the point made by the noble Lord, Lord Astor of Hever, about the flow of arms from Iran into Iraq, can the Minister tell the House when we first became aware of the flow of these arms into Iraq; what representations we have made to the authorities in Tehran over the years since they first started to flow; and what response have we had?

My Lords, I do not think that the Iranian authorities are very keen to acknowledge the scale of the problem. We have made it clear to the Iranians that supporting groups responsible for violence—there are a number of insurgency groups in Iraq—is totally unacceptable. We have done that directly. As I said earlier, we have also been seeking to influence the Iranian Government diplomatically by encouraging other countries in the region to put pressure on as well and face up to the difficulties that will arise if this kind of activity continues.

asked Her Majesty’s Government:

Why the Aggregates Levy Sustainability Fund has been reduced while the aggregates levy has been increased.

My Lords, Defra plans to spend £24 million on the Aggregates Levy Sustainability Fund in 2008-09. That is more than we spent in 2007-08.

My Lords, does the Minister agree that proposals were put forward to reduce the Aggregates Levy Sustainability Fund and that that would have a massive impact in local communities? Will he assure the House that the Aggregates Levy Sustainability Fund will be increased in line with the fact that the aggregates levy has increased quite dramatically? This is a tax on the extraction of aggregates, but the Aggregates Levy Sustainability Fund has been set up to help local communities deal with the environmental impact of such extraction.

My Lords, we will certainly sustain the Aggregates Levy Sustainability Fund. As I indicated, we are spending more in this coming year than we did last year. However, there is no direct correlation between the levy and the sustainability fund. The levy is not a hypothecated tax, and it goes to many other purposes beyond the sustainability fund. The sustainability fund has a significant role to play and we are increasing expenditure accordingly.

My Lords, where a former gravel pit has been converted into an attractive water feature or amenity for local people, has that been funded by the sustainability levy or by the industry itself?

My Lords, the industry would be quick to point out that it contributes more than the allocation to the sustainability fund, but the sustainability fund is the instrument whereby targets are identified for support. It would be rash of me to say that in every case the sustainability fund has been the decision-taker, but of course the fund produces those benefits in crucial respects, and it is important to the environment. There is a broader issue. We need price signals to be sent out to the industry in order that it goes for the recycling of materials rather than the constant exploitation of natural aggregates.

My Lords, in the parish of Gresford in the 1930s a castle disappeared, together with the hill on which it stood, in order to provide aggregate for the Mersey tunnel. What proportion of the £24 million to which the noble Lord referred goes to archaeological sites for the preservation of our history in a way that did not happen in the past?

My Lords, that is part of the remit of the Aggregates Levy Sustainability Fund, but National Heritage also has a role to play in exactly the area the noble Lord has identified. The question of aggregates covers so many issues with regard to the land and, I might say, with regard to marine resources. One of our major projects is to look at the impact on the seabed and marine life of the withdrawal of aggregates from the sea. All these issues have to be taken into account, which is why there has to be a relationship between National Heritage and the sustainability fund. A great deal of research has been carried out in recent years to enable the fund to target successfully.

My Lords, according to Defra, the aggregates levy raises more than £300 million a year. I am sure the noble Lord would not wish it to be seen as a stealth tax, but £24 million into the sustainability fund does not sound like a particularly robust use of that money in environmentally sensitive ways. To what extent has the pattern of spending changed over the years? The noble Lord told us that the planned spend this year was an increase. Could he give us figures for the previous three or four years, just to give us the pattern of spending?

My Lords, I would not want to exaggerate the issue of spending in percentage terms, but we spent about £19 million the year before last and we have budgeted for £24 million this year. The House will recognise that the levy is not a hypothecated tax. It is there to sustain aspects of the industry as well and to send out a price signal, for which the noble Lord is likely to offer his support, that the aggregates industry has a particular responsibility regarding the environment. That is why the levy is in place to the level it is, although it has been increased this year only as an inflation index.

My Lords, I think that the noble Lord misheard my noble friend’s question. My noble friend asked whether he would give the figures for the past three or four years. Does the noble Lord not have them, or does he not want to give them?

My Lords, I would certainly give as much information as I have to hand. The noble Lord is indicating the Box, which has limited uses on occasions such as this. We have not spent as much as £24 million in the past two years and we are therefore making provision for additional spending. In the year before last, the figure was £17 million; and last year, it was £19 million. Those figures may not be precise. I was not being evasive; but merely indicating that there should be no suspicion that the Government are about cutting expenditure: we are not.

asked Her Majesty’s Government:

Whether they support the European Union food supplements directive.

My Lords, the UK Government support the EC food supplements directive and its broad objectives of ensuring safe supplements that are accurately labelled to facilitate consumer choice and of creating a level playing field for trade in these products throughout the European Community.

My Lords, I thank the noble Baroness for that somewhat surprising Answer and congratulate her on her courage in responding to this awkward Question. Perhaps it should have been answered by the Foreign Office, which got us into this mess in the first place. Do the Government not appreciate the damage that this directive, together with 10 similar pieces of EU legislation, is already doing to our health food sector and the havoc and suffering that this legislation will cause if the Government cannot alter it radically in Brussels or escape from it altogether? Secondly, I ask a question that I have asked before: why can we not deal with this matter ourselves? What has happened to subsidiarity?

My Lords, there are certainly a number of pieces of legislation that apply to the supplements industry. All these are designed to protect consumers and to ensure that they are not misled by the information given about products. Each piece of legislation has a sufficient lead-in time to enable the industry to collect the necessary data. The UK Government negotiated hard to make the food supplements directive as flexible as possible in order to allow substances to remain on the market while undergoing a safety assessment by the European Food Safety Authority. The website of the Health Food Manufacturers’ Association says:

“The HFMA supports the creation of a harmonised European regulatory framework that recognises industry’s excellent safety record and permits the use of dietary supplements … The absence of harmonised legislation will hinder the free circulation of these products within the European Community and create barriers to trade”.

My Lords, will my noble friend assure the House that the Government will continue to make every effort, in negotiations with the Commission and other member states, to ensure that the maximum permitted mineral and vitamin supplements will be in accordance with scientific assessments of risk made by expert bodies within the United Kingdom and endorsed by the United Kingdom Food Standards Agency?

My Lords, the directive created an obligation to set maximum levels for vitamins and minerals in food supplements on the basis of scientific risk assessment. Work is under way on this and proposals from the European Commission are expected in January 2009. The Food Standards Agency, on behalf of the UK, has been actively engaging in the Commission’s work on setting maximum levels through discussions. As noble Lords will appreciate, other member states in Europe take a different view from that of the UK. We have the most liberal market in this respect. We are working with member states to ensure that the levels set are flexible and risk-based, to balance consumer protection with the impact on UK business.

My Lords, does the Minister not find it bizarre that everybody wants a single market but that, when the Commission tries to create one in certain special products, everyone is against it, particularly in the UK, for various reasons? Was not the recent answer by Commissioner Kyprianou on the proposed tabulation system for maximum amounts for food supplements a perfect balance between the legitimate special interests of member states and the need for a genuine single market that gives strong guidance to users in an increasingly mobile European Union?

My Lords, the noble Lord is completely correct. As I said, many UK food supplement manufacturers wish to expand their markets across Europe and we are keen that the food supplements directive should enable them to do so. At the same time, we are working hard with the industry to ensure that the domestic market is protected and allowed to grow and develop.

My Lords, will my noble friend remind the noble Lord, Lord Pearson of Rannoch, that it was the Government led by the noble Baroness, Lady Thatcher, who in their wisdom created the single European market and that the European Union has an obligation to oversee that market, not only for the protection of consumers but also so that entrepreneurs—in this case, food supplement businesses—can operate freely and successfully within it?

My Lords, I probably do not need to remind the noble Lord, Lord Pearson, of these issues. The UK Government, supported by the FSA, are indeed negotiating hard to make the supplements directive as flexible and workable as possible.

My Lords, can the Minister confirm that the Government are working to establish a liberal rather than a restrictive market in these products, not least bearing in mind the fact that European citizens of whatever country are subject to the same general physiological laws relating to poison?

My Lords, that is absolutely correct.

My Lords, the latest figures from the Department of Health indicate that some 5,000 people have died from adverse drug reactions. Can the Minister give a comparable figure for the number of people who have died as a direct result of poisoning from food supplements?

My Lords, I am afraid that I do not have those figures but I shall endeavour to find them and let the noble Countess have them.

My Lords, in view of the renowned energy and determination of the noble Lord, Lord Pearson, can the Minister encourage him to tell us what supplements he is on?

My Lords, I would not dream of encroaching on the noble Lord on such a matter.

My Lords, as the noble Baroness was good enough to mention me, perhaps I may respond. I cannot believe that it is of interest to the House, but I have to confess that I am not on any food supplements or any medication. However, a very good friend of mine will suffer seriously if this directive goes through. As there is a minute left on the Clock, perhaps I could ask the Minister whether she has consulted another website, that of the National Association of Health Stores, which says that these directives are on the verge of overwhelming the whole industry and that it wants,

“upper levels which are indicated as safe by the scientific consensus, not levels which are going to be whittled down in order to achieve a shu-thru in the Council of Ministers”.

My Lords, I did indeed look at that website. The UK Government and the FSA share the concern that the maximum amounts are set at levels based on risk; in other words, we do not wish to encroach on the liberal regime that we have in the UK.

My Lords, at the moment some 300 nutrient sources are not on the Commission’s positive lists but have temporary exemption from prohibition. However, the derogation lasts only until 2009 and for many ingredients the cost and work involved in providing further and detailed information prior to the deadline will be prohibitive. Is there not a case for encouraging the Commission to agree a rolling extension of those derogations for key ingredients, unless of course they are deemed unsafe?

My Lords, the noble Earl’s last point is the key one. My information is that there are some 120 outstanding submissions relating to nutrient sources that currently do not have adequate scientific assessment, but that does not mean that they will not have that assessment. If some of them are deemed unsafe, there are substitutes for almost everything on that list.

asked Her Majesty’s Government:

What additional measures they propose to ensure that all workers at Heathrow Airport are fully security cleared.

My Lords, all airside staff must pass stringent physical screening and searches every day. As part of the layered approach to security, all airside pass holders at UK airports, regardless of their nationality, are also subject to extensive pre-employment background checks, and those engaged in security activities must also pass a counterterrorism check. A fundamental review of personnel security screening across the transport sector was commissioned last December and will report in the summer.

My Lords, while I thank the Minister for that reply, can he explain why foreign workers from inside and outside the EU are not checked for possible crimes committed in their countries of origin, especially those who work—as the noble Lord mentioned—airside?

My Lords, it is obviously very difficult to check on the criminal records of those overseas; I am sure that the noble Baroness accepts that. We cannot currently do that for applicants. The Criminal Records Bureau is developing agreements to exchange data for employment vetting purposes with other EU member states and jurisdictions, and these measures will complement the checks that employers undertake to satisfy themselves about potential employees.

My Lords, can the Minister have a discussion with the Security Industry Authority to see whether it can be of any help in this matter, particularly with regard to looking at people from overseas who apply for jobs? I find it extraordinary that, because we are not within the Schengen information system, we do not get the information we need about people who should not be here taking on those jobs.

My Lords, we already work very closely with the Security Industry Authority, which has been doing extremely valuable work. I asked for some of this data. The right-to-work checks have thrown up many cases that are now subject to a challenge process, ensuring that we have greater levels of security. The Security Industry Authority is also working very closely with the UK Border Agency.

My Lords, does the noble Lord agree that the distinction between airside and non-airside workers is somewhat artificial? Surely there is mixing of personnel in certain common areas. Has the vast quantity of commercial vehicles entering airports been adequately taken into account from a security point of view?

My Lords, I think it has. I cannot agree with the noble Lord that the difference between airside workers and non-airside workers is blurred. Airside workers have to be physically searched. A whole range of physical security measures is in place for staff and used daily; that is clearly not the case for those working non-airside. Staff are subject to detailed security checks in much the same way as the noble Lord or I would be as passengers. They have to go through those very rigorous checks whenever entering airside, so there is a very clear distinction.

My Lords, I am delighted at the information that has come to light on this. Would the noble Lord, in his capacity as Minister for the Home Office, say what action the UK Border Agency is now going to take to ensure that people who are working airside at airports are not in fact illegal immigrants?

My Lords, right-to-work checks are made. All non-EU nationals must prove their right to work in the UK. Staff have to go through a background check that looks at their work history over the previous five years. You would have to be a long-term sleeper in an organisation to get past that check. Those checks are very rigorous and full references have to be taken up. If there is any hint of failure to match those checks, that person is rejected as a potential employee.

My Lords, does the Minister recognise that, if we are asking other Governments for information on the potential criminal background of people, we have to provide information ourselves? That needs some form of international regulation, and that is one of ways in which the European Union provides a rather useful multilateral framework for exchanging data under safeguards. That is one of the arguments that the noble Lord, Lord Pearson of Rannoch, has so far failed to recognise in our very lengthy procedures over several days on a related matter.

My Lords, the noble Lord makes a perfectly reasonable Euro-enthusiast point; I am sure that noble Lords will appreciate that. We obviously have data-sharing protocols and arrangements in place. We are trying to work with many other jurisdictions to ensure that we can share that data on a like-for-like basis. It is complicated because different offences are treated differently in different jurisdictions, but we need to have that. That is an issue that the Magee review and the Stephen Boys Smith review will be looking at together.

My Lords, for how much longer are the Government prepared to tolerate the poor administration carried out by the British Airports Authority at Heathrow, which is doing real damage to our competitiveness as well as causing great inconvenience to travelling public? Is it not time that we applied the big stick of competition to BAA’s position in respect of its ownership of this airport?

My Lords, that is rather wide of the Question, but I know that that point often comes up in your Lordships’ House. The noble Lord was a member of an Administration who carried out that privatisation some years ago. No doubt he probably feels the weight of responsibility for some of that.

My Lords, the Minister has not answered the Question on those with criminal records in foreign countries.

My Lords, I answered the Question, partly in response to the comments of the noble Lord, Lord Wallace of Saltaire. I accept that it is an issue; we are looking at it and want to tackle it. As I said earlier, trying to have common standards for the nature of convictions in foreign jurisdictions is not an easy issue. However, we are mindful of it, and very much on the case. We cannot afford to have weakness and porous borders. We must ensure that staff working in airports and in the transport sector are rigorously checked. Everyone accepts that.

My Lords, progress yesterday on the European Union (Amendment) Bill was not quite as swift as we had hoped for. Therefore, following discussions between the usual channels, the Committee stage will resume at around 7 pm on Monday 19 May. This additional three hours—the House will not sit later than 10 pm on Monday evening—will ensure that the Committee stage will finish as planned, on Tuesday 20 May.

rose to call attention to the case for improving arrangements for feeding patients in NHS hospitals; and to move for Papers.

The noble Baroness said: My Lords, noble Lords will be aware that I have raised this question on a number of previous occasions and they may wonder why I am doing so again. I regret to state that it is because I have never, in answer to numerous Questions, letters to—and even interviews with—Ministers, as well as several speeches in debates and an attempted parliamentary Bill, had any real indication that the wrong I seek to address is being effectively tackled. Yet that wrong is not a minor one. We are talking about sick people in hospitals being deprived of food, liquids and care to such an extent that, sometimes, they do not survive.

When I first raised this matter, some Members of this House and, of course hospital trusts, rubbished my allegations and refused to accept that any of it was happening at all. They really cannot do so today. There is a mass of hard evidence that my claims are only too true. Television programmes have highlighted it. There is hardly anyone who has not heard of the familiar allegation of nurses placing food or a cup of tea too far from a bed-ridden patient for the plate, cup or tray to be reached. The nurse bustles in some 15 minutes later, exclaiming, “I see you don’t want that, then”, and whisks it away before the patient can say a word.

People have given me explicit examples of their relatives or friends not being given any food or liquid at all, with no explanation or excuse. Others have reported that if they do not take food in, the patient will either get nothing or be given totally unsuitable or inedible food. Some patients get cheese slices, wrapped in something that they cannot undo; sandwiches are also wrapped that way. Some get hard-crust bread with which their dentures cannot cope. Of course, this does not happen in every hospital, as thousands and thousands of really exemplary nurses are caring devotedly for their patients. I make no criticism whatever of them, but we deceive ourselves if we think that standard is universal. It is not. We must recognise the truth and seek to be effective.

Last summer, my noble friend Lord Patten and the noble Lord, Lord Carlile, both of whom, by the way, wrote to me this morning greatly regretting that they were not able to attend or speak in this debate, came with me to see the then Minister, the noble Lord, Lord Hunt, about my complaints. Perfectly reasonably, he asked for some solid proof—names, addresses, dates, hospitals and all of the relevant details.

I had a large file of cases, and spent some two to three weeks contacting every single such complainant personally, by phone and letter. I asked whether they minded my reporting, and possibly making public, the details of their experience. A large number did mind. Quite frankly, some of them were scared, which worried me. They knew what happened to whistleblowers and feared facing unpleasant consequences if they needed hospital treatment themselves. Some said that there was really no point at all in complaining, as the relative or friend about whose treatment they had complained had died of it and was gone. As for taking legal action, that is never really possible unless someone is very rich. The NHS is the biggest and mightiest business in all of Europe, and it is difficult indeed to take a case up against it. In fact, I am told that it is nearly impossible to find a lawyer who will do so.

With the agreement of some complainants, however, I was able to give the Minister a dossier of 22 cases where bad nursing and no feeding were alleged. Names, ages, addresses, dates and hospitals where deficiencies occurred were all accurately listed. I do not blame the noble Lord, Lord Hunt, for what happened next. He passed on the cases for investigation, perfectly properly. I blame those charged with investigating; their arrogance and blindness to the facts was absolutely appalling. Not all—a few hospitals tried hard to respond properly, the health authority in the north-east being one, although I still do not quite understand why or how the families’ sworn allegations to me were not judged to be evidence. However, most authorities did not respond as they should have. Eight out of my 22 cases, so carefully detailed, did not get one word of comment. Other authorities commented on only parts of the complaint but totally ignored other parts.

Allegations about lack of feeding were hardly ever referred to, although one or two mentioned a rather mysterious red tray—but no explanation of what that meant was ever made to me. I have since found out that, if a red tray comes along carrying the food, it is meant to signal that the patient needs help to eat. The authorities did not tell me that, and gave me no clue at all whether, or how, or to what extent the red tray signal actually results in help being given. Nurses are extremely busy and do not have time to spoon-feed people. I recognise that difficulty. Yet complaints are coming in all the time about lack of feeding, red tray or no.

An old MP friend and colleague of mine in the other place visited his wife, who had cancer. He sat by her bed as long as he could. After three days, he thought, “That’s strange; I haven’t once seen this girl being fed”, so he asked the nurse, “When do you feed my wife.” “Oh, we’re not feeding her”, the nurse said. “Not feeding her”, he said, “Why? Who said that? Did she ask for it? Did I ask for it?”. He created an awful row, and the result was that his wife was fed and things got better. I listed all this carefully in my complaint. The response was, “In this case, communications failed”. That was it, nothing else. The authority admitted the allegations were true, but there was no explanation and no apology.

Other allegations of poor care, in addition to lack of feeding, which were totally ignored included two examples of deaf aids being removed and never returned because they were lost. If you are reliant on a deaf aid and you cannot hear what is being said to you, you give rather peculiar answers, you are immediately put down as being a bit gaga and therefore your feeding is not normal. Nothing of that was ever referred to, although I think it is a very serious complaint. A man who was told to arrive at the hospital no later than 7 am when no bed or food was available until 10 pm was another complaint not mentioned. A husband who had to dress his wife’s bedsores because nobody else did was not mentioned either. There may be perfectly reasonable reasons why all these things happened. If so, the reports I received failed to respond to them.

The letter from the health chief executive summing up the whole matter said:

“I am assured that adequate policies on nutrition and hydration are in operation and that negligence has not occurred. In the light of the depth of the investigation and findings, I do not consider that a further investigation will be necessary”.

How could he possibly say that in the light of what I have told the House? Considering that eight of my cases were never investigated or commented on and a number of specific complaints were not referred to in the responses made, I find those words from the chief executive astounding in their complacence and arrogance. They are also extremely depressing because they obviously show that he is perfectly satisfied with the situation as it is and will take no steps to alter what is going on.

Further examples are coming up all the time. In the past 24 hours, I have received lengthy communications from Age Concern, the Stroke Association, the Royal College of Nursing, Help the Aged and others concerning up-to-date cases of this happening. A headline in the Daily Telegraph of 8 February 2008 read:

“One in five patients leaves hospital malnourished”.

An earlier headline read:

“Thousands of patients are being allowed to starve on NHS wards”.

I admit that some patients come into hospital undernourished before they ever step over the threshold, but the Department of Health’s own figures show that the nutritional condition of at least 8,500 patients a year worsens while in hospital.

I believe that Ministers acknowledge that when patients are in the care of the National Health Service a clear responsibility lies on that service to give them the ordinary essentials of life. There are no more basic essentials for the business of living than food and liquid, as well as medical care. Ministers must be less trusting of the reports they sometimes get from chief executives and trusts that flatly refuse to see that anything is wrong.

There is a very great deal wrong. All of us have a duty and an obligation to see it righted. There are many ways to do that. Hospitals could ask patients’ relatives if they would be able to come in to help feed them, which would save the nurses a lot of trouble. They could ensure better quality meals to which a patient can address himself and eat. They could arrange for help for patients with immobilising conditions such as multiple sclerosis or motor neurone disease. I had complaints about that that were not addressed. They could order that meals must be put in reach of patients. Since the May elections, government spokesmen have repeatedly assured us that they will listen. All right, then—listen. I beg to move for Papers.

My Lords, I congratulate the noble Baroness on securing today’s debate, and on her tenacity in pursuing this important issue. Hospital food and the nutrition of patients is an extremely important issue. I have more reason than many people to know that, because I have more experience of hospital food than is desirable for anybody. As someone who has spent a considerable part of recent years in NHS hospitals, once for a continuous period of almost seven months, I know only too well what important punctuation marks in a hospital day the mealtimes are, and how important the food is. The ordering, expectation and eating of it acquire an importance way beyond that of simple nutrition, important though that is, as the noble Baroness has reminded us.

Before I turn to some of the specific points I want to make about food, I mention nutrition more generally. The nutrition of patients goes wider than the food they receive. For four and a half months of my longest stay in hospital I could take no food whatsoever, and was kept alive, as many patients are, through intravenous Hickman lines, which had to be put in under general anaesthetic, constantly monitored and renewed each day with a bag of artificial food. This had to be done with great skill by specially trained nurses and at huge cost to the NHS. I believe every bag of food cost at least £75. I am enormously grateful. Because of the way I received this food, I never tasted it, but I am very grateful that it kept me alive. I mention this only because we must remember that the nutrition of patients is a wide issue, which engages many skilled and experienced staff in our hospitals. Once I had the Hickman line removed, I had to learn to eat again, which was not easy. At that point I was very well supported by dieticians, special calorie-laden items and very close attention. There are not many times in one’s life when one asks for more calories.

That was all on an acute ward. I know that many people are concerned about the nutrition of patients on acute wards and in long-term care, where perhaps not enough attention is given, not only to the food, as the noble Baroness has reminded us, but to helping people eat it. We should rightly be concerned about that, but we should also keep a sense of proportion. In that regard, I quote from the Healthcare Commission’s report, which came out yesterday, in a timely fashion. A higher percentage of patients said that the quality of food was now very good. Only 18 per cent said that in 2002, and 19 per cent in 2007, but yesterday’s report said that over half said that the food was either good or very good.

However, there was certainly far too much variation among those who need help with eating. In the lowest-scoring trusts, 42 per cent said that they did not receive enough help with food, while in the highest-scoring trusts the figure was only 3 per cent. The commission’s chief executive, Anna Walker, said:

“The government has made absolutely plain that it wants the NHS to listen to the views of patients and respond to their concerns”.

That is very important in light of what the noble Baroness said about the professionals’ response. These reports are based on the views of patients. Anna Walker goes on to say:

“It gives the most comprehensive picture available of how patients feel about NHS hospitals … Overall, it’s encouraging that a steadily increasing percentage of patients say care is excellent. It is good to see advances on issues like the quality of food … and team working between doctors and nurses.

But the survey also shows that in some hospitals the NHS is struggling to deliver on some of the basics of hospital care … Those performing poorly must learn from those who perform well”.

I am sure all noble Lords will agree with that. She goes on to say:

“It is crucial that trusts take this information on board. The patient voice must be heard loudly on the boards of trusts across the country”.

This annual assessment, as the voice of patients, is very important. It is clear that some progress has been made, but we all acknowledge that there is a lot more to do.

Let me point out some of things that the Government have done in regard to nutrition. Improving Nutritional Care was published in October 2007 and the programme is monitored through a delivery board chaired by the head of Age Concern, a very important point. That board is accountable to my honourable friend in another place, the Minister for Care Services. There will be an in-year progress report this summer, which we should all watch out for, and then an update in December.

We will all remember the Better Hospital Food programme, which was set up in 2001, if only because of the involvement of Lloyd Grossman, who chaired it. It made great progress in improving the quality of hospital food.

I should also mention the introduction of ward housekeepers to look after the basic non-clinical needs of patients, some of which have been mentioned by the noble Baroness, Lady Knight. Nurses have a responsibility for food service but they now have someone to support them in delivery. By the end of 2004, housekeepers had been introduced into 53 per cent of all hospitals. In larger hospitals, where the majority of patients receive treatment, that figure rose to 70 per cent. These figures continue to rise.

Given the reputation that some hospital food has it may seem odd to think about an NHS recipe book, but hospital meals have been redesigned to introduce better ingredients, to improve flavour and to include patients’ favourites such as curry and other kinds of world cuisine. Many patients find it difficult to identify the name of the dish when choosing from menus, and important progress has been made by introducing photographs of what the food looks like to help patients choose.

From my own experience, I know that important progress has been made by making proper food available 24 hours a day. As the noble Baroness reminded us, it is not acceptable for you to wake up from surgery to have only a sandwich—still less a bit of cheese in wrapping that you cannot deal with—available to you. Eighty-nine per cent of hospitals have introduced ward kitchen services to provide light snacks, 80 per cent have snack boxes and 84 per cent also provide extra snacks during the day. Again, it is very important that patients can choose a hot meal in the evening—before there was only soup or a sandwich—and 94 per cent of hospitals now provide this service.

Progress has been made in quality. However, we have to understand that providing food in large quantities to a large number of people on a necessarily limited budget is never going to be easy. We always have to remember that when we consider food in hospitals.

As nurses and ancillary staff are so important in monitoring eating in patients, we should also acknowledge that the huge increases in funding for the NHS and the increase in nursing staff—there are now 80,000 more nurses than in 1997—has played an important part. But, of course, an increase in nurse numbers will not help if nurses do not see helping patients to feed themselves as part of their essential duties. We must therefore ensure that nurse training includes this as a priority. Where hospitals have reintroduced matrons, it has had the effect of helping nurses to remember that nursing is about caring as well as about technicality and targets. I do not in any way downgrade the importance of the technical side of nursing because I have reason to know how very important that is. We must remember, however, its caring side as well.

I do not think this is too much of a digression, and I also want to mention that, though we are concentrating on food in hospitals, we must remember that this issue is also of concern in residential care homes and nursing homes where many elderly people are cared for. People with dementia, learning difficulties or severe physical disabilities would have the same problems the noble Baroness set out for hospital patients. We must remember how important food is in these places, too. The Commission for Social Care Inspection has always made that part of their inspection process. We must make sure that that inspection and regulation is carried forward to the Care Quality Commission which is now being considered under the Health and Social Care Bill currently passing through your Lordships’ House. I believe that the menu improvements that have been made in hospitals must be included in care homes.

Some of the difficulties raised by the noble Baroness could also have been circumvented in hospitals and in care homes by the use of volunteers. Many hospitals and community facilities, not to mention hospices, have excellent teams of volunteers who help out at mealtimes. They can collect the menu choices, help with serving and, most importantly, sit with patients to see that they can eat the food served. Some health and safety issues have to be addressed, but often all the patient needs is someone who will not feed them but sit with them while they eat. Most of us expect mealtimes to be a sociable occasion and volunteers can alert the staff if the patient is not eating.

The recent excellent report on volunteering by the noble Baroness, Lady Neuberger—I declare an interest as president of Volunteering England—pointed out the potential of volunteers in situations such as this. As someone who used to be a voluntary services co-ordinator for a health authority, I certainly commend the idea and I hope that this debate will focus more attention on the potential of volunteers in this regard.

I certainly would not want to suggest a lack of seriousness in the complaints the noble Baroness has brought to our attention in this debate, but we should also acknowledge that a lot of progress has been made. Certainly there are still shortcomings and we must continue to tackle these with urgency and with determination for the sake of all patients in our hospitals and outside.

My Lords, I welcome the opportunity to join in this discussion and I thank the noble Baroness for initiating it. In Wales, we have our own regime, as health is devolved. One thing that has followed from that is that a nutrition catering framework was produced by the All Wales Catering/Nutrition Group for the Welsh Assembly Government some years ago. The aim was to improve patient nutrition and hospital catering services. NHS trusts in Wales were required to implement the framework at all hospital sites. This framework emphasised the importance of nutrition to in-patient care in NHS hospitals in Wales. As we know, this can impact on the speed with which a patient recovers and contribute to an early discharge from hospital. It is most valuable.

The framework also stresses the importance of choice of meals for patients, assistance with eating their food, if that is required, and uninterrupted time in which to eat. It also recommends the availability, as has been mentioned, of meals and snacks when mealtimes are missed. The framework covers issues such as allergy, feeding problems and measuring intake of food and fluid. It also covers language, because in parts of Wales Welsh is the first language and the most homely language for patients, nurses and staff to discuss things together. It also deals with nutrition adequacies, patient-feeding assistance and menu structure.

In 20 years or so as a hospital chaplain I have often spoken to patients in different hospitals. The situation regarding hospital food has varied tremendously from hospital to hospital. I do not in any way condemn the majority of hospitals. What they provide is good and the way they provide it is totally acceptable. Those that receive complaints are in a minority. Only this Monday I was in Glan Clwyd hospital—a large hospital in north Wales—where I met members of the community health council who were carrying out an inspection visit. The response was favourable and positive, as I suggest is the case in most hospitals, at least in Wales.

Do community health councils have sufficient input? When they visit hospitals, can they make recommendations and, if so, are they accepted? What standard of food are they expecting? In the Grand Committee debate on the Health and Social Care Bill on 6 May, the noble Baroness, Lady Knight, mentioned that hospital meals cost about £2.65 each. Given rising food prices, is that sum adequate for the needs of patients, who need the best food possible? I was speaking this morning to catering staff in this very establishment. Poor-quality meat is likely to be unacceptable, especially to those who are frail and need special attention.

If I do not have a boiled egg available I am lost, but some folk are expert at making meals out of hardly anything. With a low allocation of funds for food, catering staff are sometimes in a dilemma about how they can best meet the needs of the patient and still remain within their allocation. How much training is there for the staff involved in preparing hospital food? Do our catering colleges have a special course in feeding patients for people who will be involved in hospital nutrition? Surely this is a specialised area that we should consider. What is the standard of those who come from our catering establishments? Is it appropriate for today’s needs?

If patients are frail and a tray of food is placed out of their reach, it could be the best meal in the world and it would make no difference. Also, plastic knives and forks are not easy implements to handle. When I am sitting in a plane—and I always travel economy, if I travel at all—I wonder how on earth I will be able to cut any meat with these plastic implements. If you are frail, it is a problem in itself.

Some patients need help with their meals and even assistance with feeding. Most of the hospitals provide this; the nurses go out of their way to meet this need. The University Hospital of Wales in Cardiff has had a volunteering scheme for some time—the noble Baroness, Lady Finlay, might mention this. I was told this morning by the previous Minister, Jenny Randerson, that having volunteers and family coming in at mealtimes to help patients had improved the situation 100 per cent. It involves families and the community in supporting their local hospital. We need somehow to increase the number of hospitals and perhaps even care homes that have this facility so that no patient is unable to access a good meal and make the most of it.

What assessment is made of the eating needs of patients when they are admitted to hospital? People can sometimes be embarrassed. Hospital meals might include chocolate, cheese and heavy cream, which people with migraine, for instance, are unable to touch. What assessment is made of people with migraine and with allergies, such as those who cannot eat wheat in any form? What are the alternatives? As we become a more multicultural society, what assessment is made of the religious needs of those from other faiths in our hospitals? I am sure that such assessment takes place but I would like to know exactly how much is done in this area and what the difficulties are.

Certain other things can be embarrassing, such as ill-fitting dentures. You cannot easily tackle a meal unless you are able to chew it. When people come into a hospital, an elementary basic assessment should be made. Are there any problems? Are there any things that might increase embarrassment? That would help tremendously, so that stage one of a patient’s introduction to hospital food is at least knowing that his requirements have been considered.

Finally, let me say a word of tremendous appreciation to all those involved at every level in providing food in our hospitals. In my experience over many years, they do a tremendous job. As has been said, they have come a long way and many improvements have taken place. Much more needs to be done, but we should encourage the staff and not discourage them with any words of condemnation.

My Lords, I, too, thank the noble Baroness, Lady Knight, for securing this important debate and, as has been mentioned, for her tenacity in following though this subject. It is fitting that this debate should fall the day after the service in Westminster Abbey filled by 2,000 people—mostly nurses, midwives and health visitors—to commemorate the life of Florence Nightingale. She died 98 years ago but is still remembered for her valuable contribution in establishing the nursing profession and promoting basic nursing care. One of her well known sayings comes from 1863:

“It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm”.

Here we are in 2008, 145 years later, and, although I acknowledge the progress that has been made, as the noble Baroness, Lady Pitkeathley, described, we are faced with evidence that some patients are harmed through poor nutrition and some are suffering from malnutrition.

I was fascinated to read some recently discovered manuscripts about a 2,000-bed hospital in Jerusalem in 1099. A list of basic care was given, with one item relating to nutrition. There were two kitchens—one general and one for the diets of patients suffering from digestive disorders. Fresh meat was served three times a week, with plenty of bread, water and a wide range of fresh fruit.

Some 10 centuries later, however, we are faced with evidence of poor nutrition. Only this week, I heard of a patient suffering from coeliac disease who had informed the hospital prior to admission that she required a gluten-free diet. Joy oh joy, as she travelled down the corridor to the ward, a large poster advertised coeliac disease and the importance of a gluten-free diet. She thought that all was well but, as she went though the ward door, all was not well. No gluten-free diet appeared and the nurses were unaware of what coeliac disease was or of the need for a gluten-free diet.

One could spend the whole length of this debate repeating anecdotes of patients’ experiences, but we are all familiar with hearing and reading of hardships suffered by patients. I declare an interest in that my profession was nursing for 40 years and I spent eight years as an NHS trust chairman. I am currently president of the Florence Nightingale Foundation.

The Royal College of Physicians states that nutrition is “a doctor’s responsibility”. The nursing regulatory body states that it is the qualified nurse who is responsible for ensuring that food is provided appropriate to patient care. I was a nurse in training in the 1950s. In our introductory course, we were given instruction in invalid cookery. In those days, each ward had a kitchen and nurses could supplement patients’ diets by cooking boiled or scrambled eggs, for example. We were taught nutrition and the importance of diets. We served breakfast—and what a nightmare that was, with two nurses serving 30 patients. There was a choice of cereals or porridge, or a cooked breakfast with each egg cooked for a different number of minutes. Then there was toast and marmalade—and this was just at the end of rationing.

Lunch was the main meal of the day. The ward closed at 11.45 am and patients prepared for the meal, which was served at midday by the ward sister or the staff nurse in charge. Nurses helped to feed those who needed assistance; any meals left were reported and if necessary a supplement was given. Patients were weighed weekly. The ward reopened at 1.30 pm, the patients having had a rest time after their meal. Supper was served at 6 pm, consisting of a light meal followed by a hot milk drink of cocoa, Horlicks or Ovaltine at 8.30 pm. Today, mealtimes are not always well spaced and there is not always a protected main meal.

There is available to the NHS a great deal of guidance, from NICE, the Healthcare Commission, the Food Standards Agency and the Department of Health, to name but a few. Yet we learn year on year that more people are being discharged with malnutrition. Evidence shows that good nutrition aids recovery, healing wounds and preventing infection, and therefore is cost-effective in discharging patients earlier than those suffering from delayed wound healing or infection.

Why is it, then, that guidance is not being followed everywhere and why are patients’ complaints about food escalating? The Healthcare Commission is reporting improvements, but in a survey conducted by Which?, the consumer watchdog, 250 patients out of 1,000 said that they were reliant on relatives or friends bringing in edible food. Some food served was still frozen in the middle or congealed on the plate and most were unhappy at the presentation of food to a point of repulsion. Dietary needs were not met.

Some 13 million meals, mainly untouched, were thrown away last year. In answer to a Question in the other place last year, the Health Minister said that £162 million of taxpayers’ money was thrown away by the NHS in the past five years. The average cost of an NHS meal was £2.65 in August 2007. Malnutrition is common, but it is often not recognised, not prevented and not treated. What an indictment, when it is known that good nutrition is a cost-effective method of treatment.

Within the NHS there are pockets of good practice, where leadership usually comes from the director of nursing, who pays great attention to the practice of serving meals in an orderly way and with great determination introduces protected mealtimes. This often requires shift patterns for nurses to be changed, as well as the routines of other healthcare professionals, to ensure that the patients’ mealtimes are sacrosanct. I know of one director of nursing who has introduced a weekly meal-tasting routine, visiting wards at random and not only tasting food but monitoring the serving of meals and the patient care given. A few directors of nursing have been given responsibility for the catering services.

The noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Roberts, referred to the use of volunteers. I could not support their views more strongly, having been a volunteer myself. It is important that they are used.

Within a few weeks, the noble Lord, Lord Darzi, will publish his final report on Our NHS, Our Future. His most recent report, Leading Local Change, which was published last week, ahead of nine local strategic health authorities’ visions, to set them in the context of the next-stage review, emphasises the importance of clinician-led services and evidence-based change and sets out the principles governing local service change. I pay tribute to the work of the noble Lord, Lord Darzi, who has led the many healthcare professionals and stakeholder groups that have been working with him over the past year. The number of working groups and consultations that have taken place and continue to take place is absolutely staggering, covering not only the clinical pathways of all specialties but future education and training requirements, workforce planning and career developments.

Last week’s report contained a section entitled “Our Pledges to You”, which states:

“Change will always be to the benefit of patients. This means that they will improve the quality of care that patients receive—whether in terms of clinical outcomes, experience, or safety”.

The context of this debate is to call attention to the case for improving arrangements for feeding patients in NHS hospitals. We take that as an excellent example of where nutrition ties into the quality of care in terms of clinical outcomes, patient experience and the safety of patients. There is enough evidence to indicate that change is necessary in meeting nutritional standards, which affect clinical outcomes in terms of healing and the prevention of infection. There will be a need to see local service changes that ensure that patients have a choice of edible food in suitable portion sizes and attractively presented. Patients should have regular meals served and supervised, with assistance given with feeding where needed and with adequate reporting.

The clinical pathways led by the clinician will need to be designed to include the nutritional content determined by the clinical condition. The patient’s weight should be recorded and monitored regularly to prevent malnutrition. Menus should be reviewed regularly and the patient experience should include attractively served meals that are well cooked and nutritious. Patient safety should require health and safety regulations to be followed for the preparation and serving of food.

However, none of those changes will happen unless there is leadership in the organisation concerned with the delivery of high-quality care. Evidence from the number of complaints and the increase in the number of patients with malnutrition demonstrates the lack of attention paid to nutrition. As has been mentioned, guidance is available in abundance, but in many instances it is not applied.

I am sure that the Minister and Members of this House will expect me at this stage to re-emphasise my passion to improve the quality of care to patients. That requires accountability from the patient to the board and authority and accountability from the board to the patient. Unless that is brought about, nothing will change. There must be an officer at board level with authority and accountability for the performance management of care delivery. Nutrition is but one aspect of many. Unless there is a culture change within the NHS with regard to the delivery to the patient of the care required for good nutrition, again, nothing will happen.

The noble Lord, Lord Darzi, has repeatedly said that change must be determined locally according to circumstances, but surely there must be some central requirements for governance, accountability and authority. Otherwise, nothing will change. Current arrangements are often too comfortable to introduce changes, as those might present problems, but this is where culture change is required. Indeed, board members—executive and non-executive—need to re-examine their governance arrangements to ensure that attention at board meetings is not constrained to matters relating to finance and government service targets, but is balanced with the inclusion of performance management of care and patient satisfaction.

I hope that the Minister will refer to the noble Lord, Lord Darzi, the example of nutrition, which clearly demonstrates the need for performance management of care with accountability and authority from the patient to the board and the board to the bed. The Minister should note the need for central requirements with regard to governance issues, requiring culture change and education and training, from the board through the whole NHS organisation. That would ensure improved quality of care, patient experience and patient satisfaction, endorsed by safety regulations. Again, I thank the noble Baroness, Lady Knight, for raising this issue.

My Lords, I thank the noble Baroness, Lady Knight of Collingtree, for this most timely debate, and congratulate her on winning the ballot. The debate is timely because your Lordships are scrutinising the Health and Social Care Bill, and I hope your Lordships can see the need for a good standard of nutrition to be written into the legislation.

The Royal College of Nursing says that the body’s immune system is highly dependent on nutritional status, and research shows that malnourished medical and surgical patients experience higher rates of complications and stay in hospital 30 per cent longer than nourished patients. With the great concern most people now have when being admitted to hospital of the dangers of hospital-acquired infections, that serious problem may have overshadowed the need of some hospital trusts to consider the importance of having good standards of food and beverages for their patients.

The noble Baroness has continued to bring to the notice of Parliament the need for good standards of food and feeding. She has cited some terrible cases in the past of neglect and downright cruelty to patients who have been denied food and drink in hospitals. I congratulate her on her humane persistence on this matter. Now is our chance to raise standards across the country. That will be done only by getting that enshrined in legislation.

I declare an interest: I have been a patient at Stoke Mandeville Hospital on a few occasions. For years, patients’ food has never been a high priority. Patients on the spinal unit are there for long periods, and food becomes more than nutritional need: it can lower or raise morale, depending on its quality and desirability. When patients are in spinal shock and at risk of pressure sores, good nutrition is essential. Also, spinal patients who have been waiting for a bed in a spinal unit because there are not enough beds often arrive in a terrible condition as there has been lack of knowledge about how to treat them in a general hospital. They have to be built up, because of the effects of infection, sepsis and terrible pressure sores. Nutritional needs are vital for these patients’ recovery.

When I broke my legs and was on the spinal unit for several weeks a few years ago, I found the food bland and uninteresting. That is not surprising, as I think it comes precooked from somewhere in Wales. I craved fresh vegetables, and my late friend Baroness Darcy de Knayth, who visited me in hospital, brought me raw carrots and celery, which kept me going. Some years ago I became friendly with a young man from Kuwait who had broken his neck and was paying an enormous amount of money for being a private patient in that hospital. The food was so unsuitable that his mother brought him food every day from the embassy. There were also many patients who sent out for takeaway food, which was delivered to the hospital. The problem was that some of the patients then got into debt and had to borrow money.

One of the porters at my block of flats has recently been a patient at St Thomas’s Hospital. His operation was a success, but he said the food was so awful that he lost weight as he could not eat it. He asked me to bring the matter up in your Lordships’ House. I told him about this debate, and he said, “I hope it comes up soon”. I will give him a copy of Hansard.

I have a physiotherapist who comes to me periodically. She told me that this year, her husband had a serious skiing accident and smashed his jaw, which had to be wired up. The accident happened in France and while he was in a French hospital, he was given suitable soft food. However, when he returned to England, he was given food that he could not chew or eat. Surely we could do better.

Much has been said about suitable food and care for elderly patients; but everybody, whatever their age, needs suitable food for their individual condition. Some very ill patients sleep at different times. We need a flexible approach, as they will need nutrition when they wake up. This flexible approach is often used in hospices. However, many people do not go there and their needs, too, should be catered for in national health hospitals.

Hospital trusts throughout the country vary in their standards of feeding patients. I heard praise for the Brompton hospital in London, so I contacted the hospital to hear about it first hand. It might be useful in helping to raise standards throughout the country—and, I hope, of interest to your Lordships—if I say something about the Brompton hospital. The trust has recognised the importance of how good-quality fresh food and drink contributes to the recovery of patients, especially those who have undergone surgery. The trust also believes that, when patients are well fed and enjoying their meals, they are happier and therefore more receptive to treatment by medical and nursing staff.

The hospital is fortunate in having a full production kitchen, which operates like a hotel kitchen. Chefs are allocated to areas—for instance, to the pastry section, where they make a cake daily for the patients’ tea. There is a larder section for daily salad production, a main area and a special-diet kitchen. Every dish on the menu is made on site. The hospital purchases 24 per cent of food locally from Kent farmers and small suppliers—making it fresher, tastier, seasonally British and more nutritious. Purchasing direct from the farmer is cheaper and therefore gives value for money to the trust. All milk in the hospital is organic, from a dairy farm in Bedfordshire; and commodities for children—for instance, beef burgers and chicken nuggets—are 100 per cent meat and are organic, additive-free and dairy-free. Emphasis is put on a healthier diet and staff try to educate patients in the importance of a healthy diet and lifestyle.

Hospital catering managers and dieticians also meet patients regularly to ensure that the service meets their requirements, and to make changes to the menu to ensure satisfaction. All meals are served at ward level by the catering staff—hosts and hostesses—and this personal service ensures that patients have a choice. The ward hostess service means that the catering department is responsible for ordering, preparing, distributing and finally serving the food. Staff feel that this is a significant factor in ensuring that a quality product reaches the patient.

I end by saying that, with many severely disabled patients—including blind patients—with frail, elderly patients who need help with feeding and with nurses saying that they do not have enough time to do this, it seems that there should be trained volunteers who could be mobilised when needed to help with this time-consuming but vital need. There is nothing worse than rushing the feeding of patients when there may be a swallowing problem—and a swallowing problem can become a choking problem. Volunteers would have to be trained and they could also become a very important befriending service, as some patients do not have much family support and live far from friends.

My Lords, I, too, congratulate the noble Baroness, Lady Knight, on giving the House the opportunity to discuss this important issue, which has such an effect on the quality of care for patients in our hospitals. I declare an interest as chair of Barnet and Chase Farm NHS Trust. It is a two-district general hospital trust, so the position is quite challenging.

I was delighted that the noble Baroness said that the experiences that she was sharing with us, horrendous as they were, were not typical; and that she was aware that people have much better experiences elsewhere. I will share with the House some very good experiences that patients who attend Barnet and Chase Farm hospitals go through. I agree with other noble Lords that nutrition in hospital has been a very important subject over several national campaigns. The noble Baroness, Lady Pitkeathley, raised the issue of the Government’s Better Hospital Food initiative in 2001, which was a real landmark for hospitals to move on from.

I am very proud of the Barnet and Chase Farm hospitals; and, having listened to some of the experiences that noble Lords have shared, I am even more proud to share with the House the best practice that goes on in them. All patients, within 12 hours of entering hospital, have an interview with a member of the nursing staff. That involves a scoring system. I know that we are not supposed to have props in this House, but I have a form here and I would like to mention the procedure that leads up to the red tray. What happens as a result of that discussion is that this form is completed. This form has a series of headings, underneath which are a series of questions. That dialogue between the patient and the medical staff ascertains where they are. They may have an issue around how they swallow or how quickly they can eat; or other issues that are specific to their nutritional needs, and where we may have to help them by referring to dieticians and the like. A red tray identification only results if that dialogue goes on consistently. The noble Baroness has made the point that this needs to happen everywhere and not be a stroke of luck. That is what happens in my trust.

It is important for all of us to respect and value the patient’s comfort and experience—not just in eating, but with surrounding issues that pertain in the ward. The national recommendations regarding nutrition in hospital have moved on from the purely practical issues about what food to serve and how this is done—again, that has been referred to by my noble friend Lady Pitkeathley. I think that the 2006 report Hungry to be Heard was a move forward for us in understanding how important this issue is.

At Barnet and Chase Farm, we have undertaken some excellent work to improve food and nutrition. We now have a food and nutrition steering group, which has patient involvement, which is very important—other noble Lords have referred to that. It is The important to involve patients because they have experienced—we hope—good things, but also things that are less than good, and it is most important to learn from that. Among the initiatives introduced through the work of that group is the red-tray system, to which the noble Baroness referred. I started to tell the story of how red trays are identified as the key way forward in supporting someone who needs extra care with feeding. Certainly no tray—whether it is red or, in the case of my trust, cream—should be too far away for the patient to be able to reach it, as the noble Baroness described. I agree that that is an incredible and unforgivable practice.

A couple of days ago, I visited a ward at Barnet and Chase Farm with a couple of nursing colleagues to refresh my memory about how the system works. That is something you do when the trust is set up to ensure that you know everything, but I also went round one of the wards ahead of this debate, to which I value the opportunity to contribute. The nursing staff and volunteers were delighted that this interest should be shown and they enthusiastically showed me what happens there. As noble Lords probably know, there is a white board in all wards, and when a patient at Barnet and Chase Farm has been identified as needing a red tray, a little red mark is put on the board. It does not identify anything to anyone who is not involved in the red-tray system, but it immediately brings to the attention of those who are involved that so-and-so needs a red tray and that they must ensure that all the facilities are in place for that to happen.

The process of observing is something to which the noble Baroness, Lady Knight, referred. We take for granted that certain things will happen to our loved ones, friends or neighbours when they are in hospital but we must ensure that we also keep an eye on what takes place. For me, besides identifying the need for a red tray, evaluation is most important. Having a red tray is great but if, for different health reasons, the individual does not get much nutritional value from the food, although it is not as bad as not having a red tray, it certainly becomes a cosmetic rather than a real exercise.

Therefore, in our hospitals we keep a checklist of every single meal throughout the day, whether it is a snack or a main meal—breakfast, lunch or dinner. Alongside that is a score which indicates whether individuals have eaten a quarter, a half or three-quarters of their meal. At the end of each day, when the score is looked at and the information gathered, if they have had not had the necessary nutritional value to keep them going, build them up and help towards their recovery, they receive a supplement, which may be a vanilla-flavoured or soup-like drink. This contains all the nutrients that they need for a whole day. The supplement, in fluid form, ensures that, even if the patient has not been able to eat what has been in front them, despite being cared for, fed and so on, then we can be assured that at the end of that day he or she will have received the nutrition about which everyone who has spoken so far has been concerned.

I have shared with noble Lords what happens at Barnet and Chase Farm hospitals, but surely all the best practice cannot be in just one trust. I agree with the noble Baroness, Lady Masham, that we need to ensure that good practice exists in all places. An example of that is food service assistants and ward housekeepers, who are to be found in my trust. Their priority is to ensure that the meals are identified correctly for the patients and that they are correctly delivered.

Other speakers mentioned the environment in which patients eat. My noble friend Lady Pitkeathley referred to something with which many of us would agree—that eating is also a social event, although that possibility is often limited in hospital. However, what is important in hospital is the environment in which the food is served, and something can be done about that. In my trust we have introduced, as I am sure others have too, a system in which there are no interruptions during mealtimes. Lunchtime, for example, is advertised outside the wards as being between noon and 1 pm or 1.30 pm, and not only are visitors not allowed but non-essential ward rounds do not occur. People are not taken for blood tests or X-rays, because the priority is for the patient to have the opportunity, with support if necessary, to sit quietly to eat a meal, just as the rest of us do. Perhaps we do not all do that too well—we interrupt our meals to answer mobile phones and so on—but in hospital mealtimes are very important private times. That is a new concept in hospitals and it has an important part to play in the whole cultural change that we need to see happening across the piece.

The other important issue, to which the noble Lord, Lord Roberts, and other noble Lords referred, is that there should be an opportunity for people to eat at different times. If you are poorly, you do not always feel like eating at the set time when lunch or dinner is served, or perhaps you are asleep. In my trust, we have introduced—I hope that this happens elsewhere—the “steamplicity” system. It sounds complex but it is very effective. The meals are cooked and plated off-site and are then regenerated in microwaves. That may not sound very appetising but the meals are steamed in a microwave using a patent system whereby a special valve is put into a container which keeps the moisture inside. Therefore, when the meal is delivered to the patient, it is nourishing and, one hopes, enjoyable. That means that if at any time a patient wakes up or feels hungry, he has the opportunity to have a proper meal rather than just a sandwich. A menu is also available, which, again, is great. Meals are described with photographs—something that was referred to earlier—so that individuals can say, “I really feel that I would like some of this”.

Therefore, lots of good things are happening, as the noble Baroness and other noble Lords acknowledged. A lot of issues surround providing everyone in hospital with tasty food, but that is very difficult to do. It is a question not just of what can be afforded but of people’s different tastes, and we need to debate that in this House. Places that are not up to the mark have a long way to go. Barnet and Chase Farm Hospitals NHS Trust will be very happy to share our ideas on best practice. Importantly, as the noble Baroness, Lady Emerton, said, we ensure that patient care is the first thing on our agenda at board meetings. We put the patient experience before finance and everything else, and I am very proud that that ethos has been introduced since I became involved as chair of the trust. It leads every other thing that happens to patients when they walk through our gates or are driven in by ambulance.

My Lords, like other noble Lords, I congratulate the noble Baroness, Lady Knight of Collingtree, who has been a tireless champion for the welfare of patients and, in particular, for ensuring that they are fed when they are in hospital.

In some ways, I am sorry that the debate is confined to hospitals, because real concerns also exist in relation to care homes and to patients who are isolated in their own homes and are reliant on care coming into the home. These are people who can suffer long-term malnutrition over many years. Indeed, it is long-stay patients who are at particular risk if their feeding fails. During the debate, we have heard about examples of good practice, and I hope that they will be taken up and rolled out by other hospitals and areas.

I want to address the important issue of a patient’s nutritional status for treatment response and healing, and how feeding is a human instinct in caring that we may be failing to recognise. Our failure to address nutrition may reflect a cultural issue in our society—perhaps we do not value the quality of our food as much as we should. I have been particularly struck by the quality of food for patients and staff in hospitals in France, which has much more of a food culture. There, mealtimes are sacrosanct for both patients and staff. I am not sure that a glass of wine at lunch is always such a good idea, and it is not something that I would recommend for staff.

To return to nutrition, it is important to differentiate between starvation, which is food deprivation and results in death after days, weeks or months—usually weeks or months—and malnutrition, which occurs when there is a paucity of lean body mass that can exist for years and years undetected. The commonest form of malnutrition is protein energy under-nutrition where patients suffer from a lack of protein. The other big problem is dehydration, from which people die within days, irrespective of their nutritional status.

I do not think nutrition and hydration should be lumped together without very careful thought. Chronic dehydration is the most common cause of clinical deterioration in frail, elderly patients. Through poor perfusion of the kidney, patients slip into acute renal failure and, as a consequence, they do not excrete drugs very well. They often have other metabolic disturbances, become confused, drink less and enter a cycle of rapid decline. This process was dramatically seen in 2003 in the heat wave in Paris, where an estimated 15,000 mainly elderly people died. I am glad to see that the noble Earl, Lord Howe, is having a drink at the thought. Chronic dehydration is quite a big problem in our society. Urinary incontinence is common as people get older, afflicting about 40 per cent of women over the age of 40. People often think that if they drink less, they will leak less, so they tip into a downward spiral of chronic dehydration. That undermines their appetite, meaning that they do not eat well and have long-term poor nutrition. When they finally go into hospital, they are already malnourished.

There are lots of reasons why people lose their appetite when they are ill, including the side effects of many drugs, a loss of taste, a loss of smell, the disease itself, depression and social isolation. Anorexia compounds a malnutrition that already exists and causes under-nutrition. Malnutrition is a really serious issue in our hospitals and increases the patient’s risk of infection, affects the function and recovery of every organ system, increases the risk of pressure sores, extends the stay of patients in hospital and makes readmission more likely. Last year it was estimated that more than 130,000 patients were malnourished when they were admitted to hospital. That was an increase of 12 per cent on the previous year. The data for patients leaving hospital are no better, with estimates that malnutrition levels have risen by 85 per cent in the past 10 years to almost 140,000 patients last year. So the problem is not being addressed while they are in hospital, and indeed, many are only there for a short time. It seems that almost as many enter hospital malnourished as then leave hospital malnourished.

These figures become even more worrying when you consider that malnutrition is undiagnosed in about 70 per cent of patients. It is difficult to diagnose because blood results become altered by disease processes, making interpretation difficult. Most worrying of all was the survey from Age Concern that reported that nine out of 10 nurses think that they do not have time to help patients who require assistance with eating. The Healthcare Commission’s national survey of inpatients, as already referred to, reports 20 per cent of patients saying that they did not get enough help from staff to eat meals and another 20 per cent saying that they got enough help only some of the time. It seems from that survey that the quality of food is good but physical difficulties are just not being seen to.

Malnutrition does not only affect the thin. On admission to hospital, many obese patients are severely malnourished. They have eaten badly for years and they lack the essential trace elements and nutrients to cope with their illness. So what is the answer to the problem? The five-step Malnutrition Universal Screening Tool is easy to use and has been validated in most patients’ groups. Furthermore, NICE has stated that every patient should undergo nutritional assessment and monitoring. I should like to ask the Minister how successfully the 2006 NICE guidelines have been taken up in screening for malnutrition and whether she has any idea how many hospitals have audited their malnutrition screening and management processes.

For most patients in hospital, loss of appetite is part of their disease process. They need encouragement to eat, with nutritional balance being presented in an appetising format. It has already been said that around 13 million perfectly good meals in hospital are thrown away of the 300 million meals prepared each year. This comes to around £34 million of wasted food. Some of this is understandable—for example, if the patient has gone home, died or deteriorated—but if it is because the patient cannot feed themselves, then that wasted meal represents meal deprivation.

Many patients have culturally diverse dietary habits, such as being used to eating highly spiced foods or very bland foods. Unfortunately, health and safety regulations seem to have been overinterpreted in many hospitals, so families are not encouraged, or even allowed, to bring in food for a patient, even when it would match the patient’s appetite far better than the standard hospital fare. Health and safety regulations also get quoted when relatives want to use the microwave to heat up food. It seems that in some hospitals the only thing that you can get is toast, and the large number of times the fire alarm goes off means that toasters have been removed because of the bill when the fire brigade gets called out.

Relatives are a wonderful resource at mealtimes, yet sadly they are often underused for patients and visiting hours sometimes actually exclude mealtimes. Nevertheless, families need to be taught about effective food intake and they may need to learn new feeding techniques for patients who, for example, have had head and neck surgery. Families themselves are keen. I am often asked, “What should I give him or her to eat? What would be the right thing to prepare as food?” Actually, for many patients, any food is good food. Eating is a social activity and it is so much easier to eat when others around you are eating with you. I am grateful to the noble Baroness, Lady Pitkeathley, for referring to hospices, which have done a great deal to ensure that food is presented in a pleasant way, using volunteers to sit and encourage patients to eat. I am also grateful to the noble Lord, Lord Roberts of Llandudno, who cited the University Hospital of Wales, where some years ago my own registrar did an audit and found an appalling number of times that meals were not within reach of patients; for example, meals being put on the disabled side of someone who had had a stroke. That has been picked up by management and addressed. I feel quite proud of what Wales has done to address nutrition in hospitals.

So why do we not encourage more families to bring a snack in with them to eat? If you visit a hospital in India and many parts of the world, families are camped outside, preparing food for their relatives. Make no mistake, I am not advocating Primus stoves in the car parks, but I wonder whether we have gone a bit too far the other way and forgotten the interpersonal importance of meals. Eating with people around stimulates the appetite. In my own hospital in the cancer centre we have protected mealtimes. The patients get meals from an old-fashioned trolley and one of the advantages is that there is a nice smell to the food. Quite often the patients’ food is a lot more appetising than the food that I find in the staff canteen. There is also help to encourage these patients to eat and patients can choose how much they want.

What about those patients deemed unable to eat? A sign saying “Nil by mouth” is readily put up over a patient’s bed and yet an assessment of their swallowing may not happen that day or, in fact, for some days. I wonder whether the Department of Health knows of a hospital that has audited their use of “Nil by mouth” signs for patients other than those who are going for an anaesthetic.

When food is made on site and kitchen staff come to the wards and know that patients and relatives approve of and enjoy what they prepare, they become aware of how important their job is. That is something that can happen in small units, small hospitals or hospices and helps kitchen staff to value their job.

Families really want to show love through feeding and often when the patient has lost their appetite or just cannot eat, families become very distressed. Even when someone is clearly dying, families still want to feed them. Let me illustrate this. Some years ago I was asked to visit the only son of a family of ice-cream makers. He was dying, could not swallow and was barely responsive to anything. His parents were understandably overwhelmingly distraught. His mother said that she could accept him dying of his disease, but not of starvation. After careful explanation of the risks, I put down a nasogastric tube there in the house so that she could feed him. After he died, his mother remained very grateful. Her comment to me when I met her some time later was, “We put our best ice cream down the tube, so I know that he was still being fed and died of his disease”. In reality he probably would have died at the same time, whatever I had done, but the family had to live with it afterwards. It just demonstrates how families want to be involved.

When someone is clearly dying, investigations and treatment, including many drugs, become inappropriate and of course should be stopped. Trying to push nutrition becomes futile, but that does not mean that fluids become futile. Fluids can be given as sips by mouth, carefully and gently, to dying patients. However, some people need to have a drip. This can be done at home; patients do not have to be admitted to hospital. They can have a subcutaneous line put in through a tiny butterfly needle and a drip-bag hung from a picture-hook in the wall; indeed, I have done that myself. Then the district nurse can change the bag every 12 or 24 hours, which might be enough to maintain comfort.

Nutrition is terribly important in people who are ill. It cannot be considered in isolation from all other aspects of patient care. I wonder how many hospital boards have nutrition as a specific item on their agenda. The attitude must improve at grass-roots level. It is a sad indictment of the professionals that we, as doctors and nurses, have failed to say, “This is our responsibility”. We have the resources of dieticians, but this is a core part of the clinical care of every patient. We must address the nutritional needs of every patient. If the professions address this, inappropriate blame will no longer be dumped at the Minister’s door.

My Lords, I, too, thank the noble Baroness, Lady Knight of Collingtree, for her assiduous attention to this issue. It is important, and requires people like her to keep it on the agenda and moving forward. I very much thank her for doing so.

The issue of food and medicine is not easy; it is quite complex. We have concentrated a lot today on the poor old NHS, but it is more complicated than that. I know a gentleman, a practitioner of complementary medicine, who told me about being in an Ayurvedic—traditional Indian medicine—hospital in southern India. He and a bunch of other students were being taken around by an Ayurvedic doctor. They stood by the bed of a very ill lady and were asked to make their diagnoses. As is often the case in groups of students, they tried to outdo each other with their smart diagnoses. They were all way off. The doctor said, “No, what wrong with this lady is that she is starving. She needs some food. Once we do that, she will be fine”.

Equally, the story of the noble Baroness, Lady Finlay, made me think about an incident that I know of. A gentleman was admitted to a major American hospital because he had high levels of arsenic in his blood and, unsurprisingly, was feeling very ill. For the first few days in hospital, he showed a remarkable recovery, but then the arsenic levels kept going back up. It was something of a puzzle to the clinicians until they discovered that the cakes that his wife was bringing in to him were the source and part of her long-term plan to poison him and collect on his insurance. So relatives are not always good news.

I was most interested to think about why so many people go into hospital malnourished. In a debate like this, it is important to say that things which happen in the community can always have an impact in acute hospitals. Many older people suffer malnutrition for two reasons, one of them alluded to by my noble friend Lord Roberts. Lots of older men, principally, think that kitchens are dangerous places into which one should never go. They do not know how to cook. They may eat—rather well; they might go out to eat—but can still end up malnourished, as the noble Baroness, Lady Finlay, said. Other people simply do not like eating on their own, and do not bother. We cut the funding to lunch clubs at our peril.

Like the noble Baroness, Lady Finlay, I too was interested in the article in the BMJ about malnourishment. As she said, 70 per cent of people with malnutrition in hospital are undiagnosed. Today, we have concentrated, perhaps understandably, on those who wind up, say, in surgical wards and so on for some time. The noble Baroness is right that people who are in hospital for a long time often suffer the most. The people who are in hospitals most are those with mental health problems. We would do well to remember that when people are receiving compulsory mental health treatment, they are often being given very toxic drugs, the side effects of which are often to make them put on weight and so on. It would be understandable if, in those circumstances, people were reluctant to eat. We should not confine ourselves to looking at this in terms of physical health.

We have also not looked at another obvious area: accident and emergency. I happened to accompany somebody who was diabetic to A&E at three o’clock in the morning. By 8 am, it was only when a nurse was perceptive enough to ask, “Are you diabetic?”, that we realised that that person could have had some complications had a very simple thing not been understood.

The article in the BMJ alluded to the fact that clinicians can use quite a number of different practices, such as the MUST—malnutrition universal screening tool—that has been devised. I say to the noble Baroness, Lady Knight, that the Social Care Institute for Excellence has also gathered together a number of different models—not just red trays, but having knife-and-fork symbols by people’s beds. Crucially, the Alzheimer’s Society has produced a training video to enable staff, without being patronising, to deal with people who cannot eat. Sometimes being fed can be a very undignified process if it is not done properly.

A strong point made in the BMJ editorial was that nutritional support should be an enforceable requirement, and universal throughout the health system. Nutritional support should be on a par with how medication is treated within the health service. Additionally, the BMJ article made the worthwhile point that nutrition should be recognised as a discrete discipline which all medical graduates ought to have studied to a basic level. I understand that a formal sub-group of the Academy of Medical Royal Colleges has established a course on human nutrition, which is mandatory if you are to go into certain medical disciplines, particularly gastroenterology and metabolic medicine. However, as we have heard today, nutrition is important across a whole range of conditions: cancer treatment, cardiology and diabetes.

I do not wish to go over many of the points which other people have made, but the noble Baroness, Lady Masham, talked about the scheme at the Royal Brompton Hospital. I was intrigued to discover how that change in its food regime came about. Its new director of catering discovered that it was serving people with food that had absolutely no food whatsoever in it. It had no nutritional value at all and was made up just of colouring, which prompted that big rethink.

The NHS is a major purchaser of food in this country. It purchases 300 million meals, so it has a role to play in developing sustainability. The scheme that I read about and was impressed by was that of the Royal Cornwall Hospitals Trust, which, in conjunction with the Soil Association, has gone through a process of growing, buying and sourcing its food locally. That has meant a great increase in locally produced and organic food, which has helped not only with nutritional standards in its hospitals but with the health economy of that area.

There were some really interesting examples of what that trust had done. The noble Baroness, Lady Pitkeathley, talked about powdered, nutritional drinks, which I know are important as I have relatives who are alive because of their availability. Yet the Royal Cornwall, in its scheme, looked at using locally made clotted cream ice-cream for people who needed calorific intake. Let us be honest; who, given the choice, would go for the powdered milk drink in that circumstance?

Having a whole strategy of concentrating on locally produced fruit, vegetables, eggs and milk has made an enormous difference there, and has been achieved within the budget of £2.50 per patient per day. That is the trust’s rough figure for expenditure on patients. More than that, it has managed a 67 per cent reduction in food miles, which has to help the environment. Although that may be a return to the days of 1947, when the health service started, there is much to be said for it as an approach for the whole NHS. Indeed, other hospitals, in addition to the Royal Brompton, are beginning to do the same.

I want to pick up on two other points that people have made during this debate. Noble Lords have talked about the use of volunteers, and I understand their wish to do so. It is, obviously, preferable that a volunteer spends their time rather than a highly skilled medic, but I caution your Lordships that the use of volunteers should be additional. Important here is making sure that food and nutrition takes a more central place throughout all NHS processes—from governance to management and right through to practice. Never mind what the Healthcare Commission does; if the board of the trust will not eat the food in a hospital, that is the biggest indicator anybody needs. We need to see the role of food becoming much more central in medicine.

Finally, I agree with the noble Baroness, Lady Finlay; as ever, the French have much to show us in the area of food. I would not take on everything that they do as an approach—giving pregnant women red wine seems uniquely French—but in the French health system, it is realised what a role food plays in patients’ recovery and in the maintenance of good health. With the National Health Service, we really should be able to take some of their best practice and adopt it.

My Lords, the whole House will, I am sure, hold my noble friend Lady Knight in the highest regard for her unwavering commitment to the issue of hospital nutrition and her staunch defence of the dignity and autonomy of seriously ill patients. I welcome the debate that she has initiated and congratulate her on her powerful opening speech.

Malnutrition in hospital is no longer a subject relying on anecdote or hearsay in order to prove its existence. The hard evidence for it is unfortunately all too abundant, as we have heard from all speakers—it is not simply the findings of occasional consumer surveys but the hard data collected by trusts and government agencies, all of which tell the same story. As my noble friend said, we are talking about wards and hospitals where the food is unappetising, unsuitable, insufficient or inaccessible—sometimes all four. It is right to pay tribute to Ministers, particularly Mr Ivan Lewis, for the frank way in which they have acknowledged the scale and gravity of the problem. That acknowledgement is surely the first step towards solving it.

Of course, things are not all terrible. There are shining examples of good practice, such as the Royal Brompton, which, as the noble Baroness, Lady Masham, described, serves wonderful, fresh organic food as well as additive-free, gluten-free and low-fat food for those who need it. As we have heard, hospitals in Cornwall serve locally sourced food so delicious that one almost sees people who are perfectly well queueing up to eat it, while the Barnet and Chase Farm Hospitals NHS Trust also sets a fine example—I congratulate the noble Baroness, Lady Wall, on her part in bringing that about. Yet inevitably it is bad practice on which much of the focus rests. That is as it should be, because serving unappetising or inadequate food in a health service that professes to be world-class should be enough to eliminate you in round one of the competition.

The noble Baroness, Lady Finlay, gave us the statistics. In the 10 years to 2006-07, the number of people admitted to hospital with a diagnosis of undernutrition has gone up from 70,000 to 130,000, an increase of 85 per cent—and those are only the people whom we know about, because by no means all hospitals screen patients for malnutrition as they are supposed to do. NICE guidance recommends that all patients should be screened for nutritional risk on admission to hospital. However, NICE itself has estimated that only about 30 per cent of patients are screened and a recent survey by the British Association for Parenteral and Enteral Nutrition found that more than one in 10 hospitals did not have a nutrition screening policy in place.

The Age Concern campaign Hungry to be Heard highlights, among other things, the greatly increased prevalence of malnutrition among hospital patients over 80 compared to those under 50, which chimes in well with what we heard from the noble Baroness, Lady Finlay. In many of those people malnutrition is often not identified. The most shameful fact of all is that more people are discharged from hospital in a malnourished state than are admitted. Those figures are an indictment not only of the care given in certain hospitals but of the way in which malnutrition goes unrecognised in the community.

The strange thing is that hospitals have every reason in the world to make sure that patients are properly fed. The effects of malnutrition are well documented and we have heard many of them today. They are prolonged bed occupancy, delayed recovery, an increased risk of contracting healthcare-associated infections and poor respiratory function. In some studies, undernourished patients are estimated to have a mortality rate up to eight times higher than that for well nourished patients. Yet that condition is relatively easy to diagnose.

The malnutrition universal screening tool, or MUST, which the noble Baroness, Lady Barker, mentioned, is available for healthcare professionals’ use. Once hospital patients are identified as being at risk, they can be supported in their nutritional needs by a variety of measures. Some are simple: noble Lords have mentioned red tray schemes and protected mealtimes. Specially formulated foods can also be taken by mouth or tube. Once the diagnosis is made, as long as there is good nursing, the tools and remedies are there.

After doing very little for a number of years, the Government have now, to their credit, taken some useful steps, not least in publishing the nutrition action plan in October last year. The implementation of the plan is being overseen by the Nutrition Action Plan Delivery Board, which includes dieticians and representatives of charities, CSCI and the Healthcare Commission. That is all very positive, except that, as I understand it, the board is going to exist only until December 2008 before being wound up. If that is so, it would be helpful to hear from the Minister what, if anything, is going to replace it.

Nutritional care is also prioritised in the core standards monitored by the Healthcare Commission. Core standard C15b shows that an individual’s nutritional, personal and clinical dietary requirements are being met. That ought to ensure that we know exactly how good or bad the picture is. Unfortunately, it is not quite like that, because hospitals are left to assess themselves on how well they are doing in adhering to the standard. The reliability of self-assessment is seriously questionable: in 2006-07, none of the 34 NHS trusts that discharged the highest number of patients in an undernourished state failed the Healthcare Commission’s core standard C15b.

A similar point could be made about overreliance on what patients say. The noble Baroness, Lady Thornton, said in last week’s Grand Committee debate on the Health and Social Care Bill that the Government are tackling undernutrition through the NHS operating framework, which now takes account of the patient experience. The patient experience is important, but I question whether in this context it tells us much. Many people at risk of undernutrition are not going to know it or will be unable, or too frightened, to report that they have had a bad experience. There are 63 targets flowing from the operating framework, classified into tier 1, tier 2 and tier 3. Nutrition is not listed in any of them. I find that extraordinary. I am no fan of having too many targets, but the tier 3 indicators are designed essentially as internal management tools and nutrition could easily have been included in them. I ask the Minister why it was not. I am advised that there is a readily available published indicator that could act as a good proxy for the quality of nutritional care commissioned by PCTs, but it is not made use of.

There are other missed opportunities. One of them relates, again, to nutritional screening. Even though screening is one of the most basic tools in nutritional care, historically the Government have not collected data on how many hospitals actually do it. That changed last year when, for the first time, the National Patient Safety Agency asked each hospital whether it nutritionally screened all its patients. Do we have the results of that questionnaire? No, because this component of the inspection was aggregated into a more general score about the quality of hospital food. The various components of the score, we are told, cannot be disaggregated. I ask the Minister why the basic data about screening have apparently been destroyed and whether she will use her good offices to ensure that the NPSA does not do the same thing again this year. The information would be useful for commissioners in performance-managing their providers.

However, we know from the NPSA that the uptake of screening in hospital is often hindered by lack of equipment, such as weighing scales. It is also hindered by less tangible but equally serious things such as a lack of leadership at ward level, a lack of staff training and a culture that does not place enough importance on the weighing of patients. I was heartened to read the brief sent to me by the Royal College of Nursing, which brings home how seriously it is confronting the issue of malnutrition and how much emphasis it is placing on nurse training and education in this area. This field is likely to become ever more sophisticated as hospital treatment becomes more complex, not least in areas such as intensive care, kidney disease and cancer, where the needs of patients can be very specialised.

I hope that the Minister will agree that the Government, the Healthcare Commission, the NPSA and, when it arrives, the Care Quality Commission need to keep their eye on the ball. There is a good case for conducting a national audit. We simply cannot have an NHS that fails to recognise and treat a condition as basic as malnutrition. When we return to this issue in future, as I do not doubt we will, we must all hope that the efforts that so many people are now making to improve nutritional care in the NHS will have resulted in some visible and substantial progress.

My Lords, this has been an excellent debate on a crucial subject, both the good and the bad, and I am grateful to the noble Baroness, Lady Knight, for enabling the discussion to take place. I agree with noble Lords that we owe her a debt of gratitude for her determination to keep this issue up the agenda, and she is right that only by constant vigilance will improvement be achieved.

The nutrition of hospital patients, so clearly described by the noble Baroness, Lady Finlay, has been a major concern for this Government. We know that malnutrition predisposes individuals to disease, delays recovery and impacts negatively on clinical outcomes, personal health and well-being. It also impacts on the length of stay, delays discharge or transfer and causes enormous distress if not got right. It is therefore something that hospitals must get right.

We know that in the general population people over 65 are at higher risk of malnutrition and that this risk can be increased when people are living in institutional settings or at home alone. This means that some patients will be malnourished when they are admitted to hospital, as many noble Lords mentioned. Poor nutrition can also arise when responsibility is diffuse and when there is a lack of integrated infrastructure within hospitals and between healthcare organisations.

It is tempting to hark back to the good old days, but we should not fall prey to the myth that this is a recent problem brought about by a “generation of uncaring nurses”. The noble Baroness, Lady Emerton, reminded us of the history and the challenges that nurses have faced over time. Many studies dating back to the 1950s show that nurses struggled with the same issues then as they do now. A 1963 study that examined food intakes in 153 hospitals reported that the preparation, cooking and service of food was regarded as a second-rate activity, an unfortunate necessity and an inconvenient intrusion into the real work of the ward. There was no excuse for poor nutritional care then and there is none now. We should not fall prey to the idea that this is a recent problem. Feeding an anorexic or confused patient or one who cannot swallow is extremely difficult and ensuring adequate food consumption can sometimes feel impossible. It is easy to identify poor care, but we should not underestimate how difficult good care can be. We may call it “basic care”, but it is anything but simple, as has been recognised by several noble Lords.

We know that there have been some significant achievements in improving nutrition. That can be seen in the HCC adult in-patient survey referred to by my noble friend in which 54 per cent of respondents rated the food as good or very good and just over three-quarters of respondents—79 per cent—were always offered a choice of hospital food. However, despite the sterling efforts of dedicated catering and care staff and increased staffing levels on the frontline of care, reports from key organisation such as Help the Aged, in its Hungry to Be Heard report in 2007, and observations from patients and visitors show that there is still more to do.

I shall mention some of the things that we are doing. Patient environment action teams now evaluate the quality of hospital food every year. The Better Hospital Food programme introduced 24-hour availability of food, snack boxes and daily snacks and, in partnership with the Royal College of Nursing and the British Dietetic Association, introduced protected mealtimes to create an oasis of calm where unnecessary activity gives way to allow patients and staff to concentrate on enjoying good food.

In 2001 we launched the “Essence of Care” benchmarking toolkit for front-line practitioners to evaluate aspects of the care given to patients. Food and nutrition were identified, unsurprisingly, as among the first fundamental areas of care to be benchmarked. That has had a big impact on the quality of care that patients receive, including nutritional screening of patients on admission to hospital, regular weight monitoring for at-risk patients, and discreet ways of identifying patients for extra assistance by means of coloured trays.

Last October we published the nutrition action plan Improving Nutritional Care, which is monitored by a delivery board chaired by Gordon Lishman of Age Concern. The board’s work is progressing very well and the chair is due to report in the summer, as part of the mid-year progress update, to my honourable friend Ivan Lewis, Minister for Care Services, on how far the plan has been implemented. I thank the noble Earl for his remarks about my honourable friend’s commitment. Indeed, he has shown great determination in taking this issue forward. As a result of all this activity, statistics are improving, although I absolutely acknowledge that there is still a way to go. The PEAT assessments show year-on-year improvement since 2002, so we have much on which to congratulate NHS staff. I take this opportunity to thank hard-working doctors, nurses and other health professionals for helping to bring about these welcome improvements.

However, we are not content to rest here; of course we are not. There is still work to do. Having installed what we hope will be a robust framework for raising the quality of food for patients, we have turned our attention to how we can make sure that they eat it, and in sufficient amounts to ensure that they are well nourished. While this is not entirely a nursing responsibility, good healthcare is always a team effort, as referred to by my noble friend Lady Pitkeathley. I know that nurses consider the nutrition of patients a central tenet of their work, so much so that the Nursing and Midwifery Council has included this as an essential core skill, which all nurses must master before being admitted to the register.

We have heard today that events can conspire to prevent patients getting the help they need at the right time. We must help our nursing staff to fulfil the key role of ensuring that all patients have the food and drink they need. My noble friend Lady Wall has described the model in her hospital. I congratulate her and agree that that hospital is not alone in this excellence. However, it is totally unacceptable that any patient in our NHS hospitals should go without food they can eat when they want it, or that untouched food goes unnoticed and is not acted on. I agree with the noble Baroness, Lady Masham, in her praise of the Royal Brompton Hospital. We cannot underestimate the importance of food and drink in aiding recovery. That is why proper nutrition of patients remains high on our agenda. I was struck by the perceptive remarks of the noble Baroness, Lady Barker, about the mentally ill and the problems faced by accident and emergency departments. I remember being in an accident and emergency department at 3 am with one of my children, thinking that I was about to expire with hunger. If I were diabetic that would, indeed, be a huge problem.

Turning to further activity, we are now working with SHAs to roll out the Productive Ward: Releasing Time to Care programme, which encourages staff to review the ward environment and working practices to find ways of releasing time to spend on patients. Ministers have visited wards involved in the scheme, and have been impressed by the improvements that they have seen. This is being led by the nurses and sisters on those wards, with front-line staff finding that by making such small changes as altering patient handover times, reorganising storage facilities, and making better use of data, they can double the time that can be spent with patients, reduce time spent on paperwork, improve the accuracy of patient observation and minimise food wastage. The vital component of this programme is that it is inspired and led by those nurses who are implementing the changes. The Secretary of State announced on 8 May that £50 million is to be made available to enable all patients in all wards, across the NHS, to benefit.

Nurses have to find time to nurse. We are trying to reduce unnecessary pressures on them, but this is not all. We realise that one of the most important factors in improving nutritional standards for patients is what they are actually fed. We have to make sure that nurses and staff providing direct care have the skills and knowledge they need; the leadership to help them; are there in sufficient numbers to meet the needs of patients; and can access the support they need from others. My noble friend Lord Darzi is leading a programme on how we can maximise the contribution nurses make to the quality of care. This will strengthen nurse leadership so that such issues as patient nutrition become a matter for all. I will raise the points raised by the noble Baroness, Lady Emerton, to ensure that they have been included in the noble Lord’s survey.

I move now to some of the points raised by noble Lords. The noble Baroness, Lady Knight, raised the issue of patients saying that they have not been fed. I apologise if she felt that that the response of the Chief Nursing Officer, and Ian Phillips, who reviewed the investigations into the allegations, were not satisfactory. I have also reviewed that correspondence. I suggest to the noble Baroness that we meet and review it together, to make sure that she is satisfied. If she is not, I undertake to raise those issues again. The noble Baroness also raised the issue of patients leaving hospital in a worse state than they were in when they went in, as did the noble Earl, Lord Howe. Patients have a diagnosis recorded on admission and every time they see a new consultant. If they do not have a separate diagnosis recorded on discharge it means that doctors have built up a picture of a patient’s illness during their stay, so the last diagnosis may record something that has not been picked up earlier. It does not necessarily mean that that condition developed as a result of their care.

I undertake to look into the issue raised by the noble Earl and the noble Baroness, Lady Finlay, of the NICE guidelines and how effectively they are being rolled out. That is a legitimate area of concern. I also undertake to find out whether it is possible to disaggregate the information to which the noble Earl referred. We have to emphasise the importance of screening for nutritional needs on admission. That is absolutely right. Identifying a nutritional problem is the first step towards solving it.

The noble Baroness, Lady Knight, and the noble Lord, Lord Roberts, raised the issue of nursing support for eating and drinking. It is important to remind noble Lords that the level of trust in nurses’ competence remains extremely high at 96 per cent. When patients were asked whether they received enough help from staff to eat their meals, 79 per cent said “always” or “sometimes”. That is an improved figure, but is certainly not good enough. It means that 21 per cent possibly did not feel that, which is a large number of patients. I accept that.

There is little that I need to add about how the red tray system works. I apologise that it was not explained to the noble Baroness when she heard it for the first time. My noble friend Lady Wall has given us an adequate explanation of how the red tray system works and how it is helping to improve patient feeding. My noble friend Lady Pitkeathley raised the issue of the Better Hospital Food programme. I was pleased to hear mention of the value of housekeepers in supporting patients to eat. This, along with the other improvements of the Better Hospital Food programme, has made a real difference.

Central initiatives can go only so far. Funding previously allocated centrally is now being passed to the NHS to allow it to develop the services that are right at local level. The noble Lord, Lord Roberts, and the noble Baronesses, Lady Knight, Lady Emerton, and Lady Pitkeathley, all mentioned volunteering.

And I did.

I do beg the noble Baroness’s pardon. The noble Baroness, Lady Masham, also mentioned volunteering. I am pleased to say to all those noble Lords that we fully support the proposals raised in the Age Concern report about the use of volunteers. They perform an important role, not only in helping patients to eat, but in keeping them connected to life outside the hospital. My noble friend Lady Pitkeathley and the noble Baroness, Lady Masham, both referred to the wide variation in the surveys about helping people to eat. This is not acceptable, and the worst definitely have to learn from the best.

Noble Lords who have been with me in the Grand Committee considering the Health and Social Care Bill will be aware that the draft registration requirements for the new Care Quality Commission, which are under consultation at the moment, include at point 5:

“Ensure, where meeting nutritional needs is part of the service, that people have access to safe and sufficient nourishment. This includes: the provision of support for eating, drinking or feeding where required; the provision of a sufficient choice of palatable food to meet religious or cultural needs; and the prevention of harm through lack of access to sufficient nutrition and hydration”.

That final point was mentioned by the noble Baroness. That requirement, or a version of it, will be part of the registration that the new Care Quality Commission will establish.

My noble friend Lady Pitkeathley was right to mention the issue of food in care homes. It is important that people in care homes also get good food. That is why we have included a representative from this sector in the nutritional action plan.

The noble Lord, Lord Roberts, referred to the cost of food. I am constantly impressed—this was borne out by the story told by the noble Baroness, Lady Masham, and my noble friend Lady Wall—by the high quality of food that so many hospitals manage to produce on a relatively small budget. Indeed, the Audit Commission 2002 found that there is no relationship between spending on food and its quality. It showed that excellence can be achieved within the current budgets; it is to do with the will to do it and the leadership to produce it.

Several noble Lords referred to the issue of screening for nutritional needs on admission. More than 80 per cent of trusts have a policy for nutrition screening. This includes attention to food needs, such as vegetarianism and wheat-free, and issues such as dentures. It includes an assessment of the nutritional state, including weight and recent weight loss.

The noble Baroness, Lady Emerton, raised an issue about the past. She mentioned that wards are closed at lunch-time—this was also mentioned by my noble friend Lady Wall—which shows that a modern hospital is also now adopting the system of closing wards, and quite right to.

The noble Baroness, Lady Masham, and other noble Lords raised the issue of the quality of hospital food. The Better Hospital Food programme has accomplished some very specific things: it has made sure that food is available around the clock, including snacks at all times; it has ensured that modern dishes are introduced alongside traditional ones; it has ensured that patients can choose a hot meal in the evenings; it has ensured that meals have been redesigned, using better ingredients to improve their flavour and nutritional content.

On the issue of relatives bringing in food, the NHS strives to provide food suitable for all—it is one of the central planks of the Better Hospital Food programme—but we should not assume that it is always a bad thing for friends and relatives to bring in food. When staff and family are working together they are able to provide a truly personalised service.

The noble Baroness, Lady Finlay, referred to the problem of dehydration in healthcare, which is important. The National Patient Safety Agency, with the Royal College of Nursing and the Hospital Caterers Association, launched a hydration best practice toolkit in September last year and support a hydration best practice award, which this year was won by the Salford Royal NHS Foundation Trust.

The noble Baroness, Lady Finlay, also raised the issue of protein energy malnutrition and its effect on recovery. We know that a malnourished patient takes longer to recover and a recent screening survey by the British Association of Parenteral and Enteral Nutrition shows that more than a quarter of patients are at risk from malnutrition when admitted, and the number is even higher among older patients. There are many reasons why sick people become malnourished, as so eloquently described by the noble Baroness.

The noble Earl, Lord Howe, and the noble Baroness, Lady Finlay, mentioned the implementation of NICE guidelines, which provide a clear set of instructions to inform clinical care. Although we do not audit them directly from the centre, we have a strong system for holding the NHS to account. This shows how seriously we take this issue.

I have covered many, but not all, of the points raised. I shall write to noble Lords on the issues that I have not mentioned. Perhaps I may say in winding up that, without the staff, good intentions remain at the hospital gates. We have increased the number of staff working in the NHS, especially in nursing. There has been an increase of more than 25 per cent since 1997.

I should like to finish by speaking very briefly about the multidisciplinary team and the contribution of the allied health professionals mentioned by my noble friend Lady Pitkeathley. As I said earlier, feeding patients is not solely a nursing responsibility. Dieticians assess patients and design treatment plans that may involve modified diets and nutritional supplements; speech and language therapists may need to assess whether patients can swallow; and occupational therapists may need to assess whether patients need adapted cutlery. Together with physiotherapists they can advise on the correct positioning of patients and equipment. This multiprofessional approach to feeding supports nurses to feed patients and identifies patients at risk of malnutrition. These are real, positive improvements for those in our care. We shall not stop in our efforts to secure the very best for our patients—whether in numbers, working practices, paperwork, knowledge, skills and leadership—so that no one leaves our care malnourished physically or mentally.

My Lords, I warmly thank the Minister for what she has just said. Clearly she is sincere and cares very much about the matter we have been discussing. I am grateful for the clear indication that she will continue to act in the way we have all been pressing her to.

I thank everyone who has spoken in the debate. I have been struck by the fact that, in a small way, the debate is indicative of the service that this House gives to the country. What we do, on the Back Benches and outside, we do for nothing—we receive no kind of pay—and yet we have in this Chamber a wonderful collection of knowledge and experience through the people who serve the House. We have heard some wonderful speeches, particularly from the noble Baronesses, Lady Emerton and Lady Finlay. Between them they have so much knowledge of being a doctor in the present health service and being a nurse for many years and seeing so much. The House is grateful for what they have said. The noble Baroness, Lady Masham, who is perhaps one of the favourites on all sides of the House, spoke from her experience and her knowledge.

I particularly thank the noble Baroness, Lady Wall. My complaint about that part of my dossier was that the words “red tray” were written without the slightest indication of what they meant. I am not a nurse or a doctor—I never have been—and I needed an explanation for any of it to make sense. It was that kind of attitude towards the complaints I made that prompted me to go on and make sure that the complaints go through. Without the knowledge of Members such as the noble Baroness, Lady Wall, and the noble Lord, Lord Roberts, who knows and visits his hospitals, we would have been much poorer in the debate today. I am most grateful.

Of all the information that I have had sent to me over the past couple of days, only the document from which the noble Baroness, Lady Pitkeathley, quoted freely and fully suggested that everything was all right and that the food that people in hospitals received was always absolutely perfect. My mind goes back only a very short time—perhaps two or three months—to when the Minister in the other place, who has already been referred to and complimented, said:

“A spoonful of mashed potato on a plate is not a sufficient meal for a hospital patient”.

Nor is it.

In thanking all noble Lords for their adherence to the problems we face and their universal determination to make things better, I have pleasure in begging leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

rose to call attention to the development of the international arms trade treaty, and the actions required to ensure that it is robust, effective and properly enforced; and to move for Papers.

The noble Lord said: My Lords, I am delighted, after several months of effort, to have secured this debate. It is only proper to say that the timing is absolutely relevant to negotiations that are taking place or will shortly take place at the United Nations in New York. There is a long history of attempts to achieve some sort of control of the arms trade. I do not want to go into the details of that except to say that if ever there was a time when this was particularly important it is now.

The British Government have done well but there is a need to push even harder to achieve the outcome that is wanted—a fully comprehensive arms trade treaty. A few years ago, we signed up to the Ottawa treaty on anti-personnel landmines, which was an important breakthrough. Next week, a conference on cluster munitions will start in Dublin; I hope that a comprehensive treaty to ban cluster munitions will be signed there. Many eyes are on the United Kingdom Government because support for such a treaty by our Government will put us in a much stronger position to persuade other countries to adopt a proper international arms trade treaty.

Having said that, there is an awful lot of support already: 153 states have signed a resolution in support, with only the United States voting against, although there were important abstentions, including Russia, China, India and Pakistan. The United States apparently claims that it has sufficiently tight controls over its arms trade not to need to take part in an international treaty; I entirely reject that proposition. It is—I hope that the Government will listen to this—important to use all methods of persuasion on the Governments who are currently blocking progress towards a treaty. It is also important to gain maximum support from the Governments of the south, whose people have all too often been the victims of uncontrolled arms sales.

There are currently no effective global legally binding controls on the arms trade. There are a number of poorly enforced regional agreements which are easily evaded by the unscrupulous arms dealers that are proliferating. There can be no doubt, therefore, about the need for such a treaty. It is estimated that 1,000 people a day are killed as a result of armed conflicts in the world. Many others are tortured and forced to flee their homes or even their countries. My contention is that many of these deaths and other tragic events would be significantly reduced if there was a proper treaty controlling the arms trade.

The world is currently awash with arms—there are more than ever before. There are unscrupulous countries or arms dealers who are seeking to make money out of this trade. Let me give one or two examples. The most well known is the recent incident concerning the shipment of arms to Zimbabwe from China. Fortunately, the dockers in South Africa refused to unload the ship and its whereabouts are currently unknown. It is still possible it will seek to find the shore somewhere where these arms can be unloaded. It is perfectly clear that those arms, if they get to the Government of Zimbabwe, would only be used against their own people. Surely that is part of the basis of seeking to have a treaty.

Let me quote a few other examples; if there are any doubts about this process, examples certainly sharpen one’s mind to it. I am grateful to Amnesty International for some of the very diligent documentation that it has produced. I turn to the Democratic Republic of Congo. In July 2005 it was revealed that,

“large quantities of weapons and ammunition from the Balkans and eastern Europe were flowing into Africa’s conflict-ridden Great Lakes region, despite evidence of their use in gross human rights violations”.

Let us examine this. Amnesty has revealed that,

“arms dealers, brokers and transporters from many countries”,

have played a part in this trade. These countries include,

“Albania, Bosnia and Herzegovina, Croatia, Czech Republic, Israel, Russia, Serbia, South Africa”,

the United States and the UK. I am not saying the British Government did that or that the arms left Britain. However, by quoting Amnesty, I am saying that arms dealers and brokers, who may be British operating but elsewhere, have taken part in this trade. It also mentioned a particular Russian arms trafficker who, with his close associates and using local operators, has secretly armed all sides in the conflict in the Democratic Republic of Congo.

In Rwanda, there have been hundreds of tonnes of,

“mostly surplus Kalashnikov ammunition shipped from Albania and Serbia to Rwanda with the involvement of Israeli, Rwandan, South African and indeed UK companies between the end of 2002 and mid 2003”.

There are other examples from Rwanda.

There are apparently arms-for-diamonds agreements involving the Democratic Republic of Congo Government and companies in the Czech Republic, Israel and Ukraine. One can go on.

I turn briefly to Uganda. The Ugandan Government have apparently failed,

“to report to the UN imports of weapons and ammunition from Croatia and Slovakia worth over US$1 million in 2002 … Donations of military vehicles from China in 2002 and attempts by the Ugandan government to import more arms from Israel in 2003”,

also apparently took place. There is also evidence that,

“the Ugandan military authorities repeatedly supplied arms, ammunition and military support to armed opposition groups in the eastern DRC”.

I want to quote two more examples. There is evidence that Russian-supplied weapons were deployed in Darfur by the Sudanese Government and there is a wealth of evidence about Myanmar—a country that is facing a tragic situation as regards its own people and the consequence of the monsoon. Many countries have supplied arms to Myanmar: China, Russia, India, Serbia and Ukraine. It is perfectly clear that the Myanmar Government are using these arms to suppress their own people. That is the reason they have them and that is surely a very clear reason why we should not be party to supplying them; no country should. I am not saying that we are supplying them but we should not be part of a world where these things happen.

I am not against arms industries per se, provided that they are responsible and properly controlled for defence, policing, peacekeeping and other legitimate purposes. The important thing is there should be agreed criteria that should be the basis of how an arms trade might operate and therefore prevent the rather nasty examples that I have quoted.

I propose the following suggestions. States should not authorise international transfers of conventional arms or ammunition where they are likely to have one of the following five consequences: first, where they may be used or be likely to be used for gross violations of international human rights law or serious violations of international humanitarian law; secondly, they should not be authorised where they would have an impact that would clearly undermine sustainable development or involve corrupt practices; thirdly, they should not be authorised where they would provoke or exacerbate armed conflict in violation of obligations under the UN charter and existing treaties; fourthly, arms exports should not contribute to an existing pattern of violent crime; and, finally, there should be no risk that these arms exports might be diverted to one or other of the outcomes I have mentioned or indeed for acts of terrorism. Some of the difficulties are that arms sales may be made to a country that seems okay and then they are diverted from that country for other purposes. That involves real seepage and we need pretty tight controls to avoid that.

It is important that any treaty should cover all aspects of international arms transfers, including import, export, transit, transhipment, overseas production and arms-broking activities. It is not good enough for a company owned, say, in a country that is prepared to sign up to a treaty to have an operation in breach of the treaty elsewhere. It has to be pretty tight. The scope of such a treaty should cover all conventional weapons, ammunition, components and, indeed, the technological skills which would assist other countries in making or developing such weapons or ammunition.

It is also important that the treaty should apply not only to Governments but to non-state organisations. Some of the examples that I cited—no doubt there are many others—will reveal that the seepage of arms and ammunition to non-state organisations is a serious cause of many deaths and conflicts. We must be clear that a treaty would be not only between Governments; it would also cover non-state organisations. It is crucial that any treaty should be tight enough to prevent loopholes. I appreciate that it is difficult; there are arms dealers who can evade controls and who know how to work the system, such that Governments have to be particular to catch them. We need a treaty which is not just all right on the face of it but is binding and effective.

In conclusion, I thank the NGOs and others who have been helpful in providing information not only to me but to colleagues. It is perfectly clear that there is an urgent need for an international arms trade treaty which is effectively enforced. I believe that the Government have a key role to play in getting such a treaty agreed by as many countries as possible. I beg to move for Papers.

My Lords, I am extremely grateful to the noble Lord, Lord Dubs, for introducing this debate but I have a slightly heavy heart. When I spoke last time about his wonderful suggestion about pardoning people who were in the First World War, I was almost crying—my eyes were welling up—because I was thinking about life and death. That is the subject I shall speak on today, without being in conflict with what the noble Lord has proposed.

If we are talking about defence and the arms trade, ultimately we are talking about human life and human death. It is appropriate that much of this revolves around the subject of the previous debate—food. People fight for food. I was brought up to go back to the past, and I return again to my grandfather, who was the director of restriction of enemy supplies during the First World War. If you are selling arms, where is the enemy? Who is attacking whom, and how long has this been going on? What worries me is that it is not the arms trade that is killing people; it is not the war from without but the war from within. Whether it is a case of one tribe fighting to eliminate another or death by starvation, I do not really know.

When I was a young boy at the end of the war, the one thing I loved more than any other was my sheath knife. I could throw it into the middle of a circle on a soft redwood tree. I loved that knife. I even tried to kill a rabbit once by throwing the knife at it. Naturally, I cut myself many times. This made me go back to the origins of the knife—the knife in the back, the knife which is the origin of almost all wars—to the panga and the machete. I was a great fan of the machete, which was perhaps the most effective weapon that man had ever seen, other than, of course, the khukri of the Gurkhas. When our Armed Forces were trying to take over or extend the empire, and they had just managed to replace their muskets with the bayonet—which came from the French city of Bayonne—they got rid of the club on the base of the musket. They were not using knobkieris any more, or even baseball bats or pickaxe handles. But the Gurkha learnt about the bayonets and, with his khukri, he would advance upon our soldiers, dive down under the bayonet and do them in by taking their limbs off.

This strange weapon, this piece of metal, was responsible for the genocide in Rwanda. Fear, to me, is the greatest enemy of all. I have been to most of the African countries and some others where there have been trouble and conflict and I find that what is feared is not the bullets that come from outside or the RPGs or the mortars, but the man on foot coming in, beating you up, killing or raping your wife and causing damage in that way.

What is the purpose of the arms trade if it is not to defend human life? Perhaps it is related more to conquest, territorial gain or protection. The despotic and non-despotic regimes of the world usually have one thing in common, whether they are imperial or colonial—they do not have that many deaths. The deaths seem to occur when the stability of the regime breaks up. If that regime is dictatorial, as has been the case in many countries, where the enemy or the opponents are wiped out, it often goes back to the conflicts before boundaries between tribes were clearly defined. There was the phrase, “The host took the field and there were no survivors”. Naturally, you would kill every man over the age of 15 and under 60, but you would take the tribe into your own and increase your strength.

I find it extremely sad that we have not bothered to estimate the number of deaths that are taking place. The noble Lord, Lord Dubs, pointed to the arms problem regarding Zimbabwe. Is it not terrifying that the leader of a former Commonwealth country can, when a democratic situation has arisen, threaten to send in a form of unarmed brigade to frighten people at the polls? That ability to frighten may help to destroy a form of democracy.

I spent a lot of time in eastern and central Europe and should like for a moment to dwell on one of my favourite countries, Albania, whose alphabet has 50 per cent more letters than ours and whose people are highly intelligent. I was asked to go there—I always get a bum steer but I became very fond of it. When I arrived I was put in a government villa and slept in a bed where a rather strange-looking lady wearing one laddered stocking and a sock on the other foot showed me, with pride, that I was sleeping in the bed of Enver Hoxha. That was where the bullet had gone through and that was the very sheet upon which he had slept.

Yet, during the war, the godfather of the noble Lord, Lord Astor, was actually in Albania protecting Enver Hoxha and blowing up bridges. There is another interesting thing about the Albanians, which is possibly why they were so active in the arms trade. In order to remain united, they had to create fear of the regime. That is normal policy in any form of government—to be frightened of the Prime Minister or the president. That has never happened in this country. But then you have to create fear of an enemy which will unite the country. With Albania, the enemy was the United States of America. To defend themselves from the United States of America, they had 600,000 bunkers scattered throughout Albania in vineyards and everywhere else, looking rather like large Daleks from “Doctor Who”. In the front there was a slit which was pointed always to the direction from which the Americans would invade. Every one of these 600,000 bunkers had issued a Kalashnikov to the responsible head man. Kalashnikovs were made in China and many of them did not work but no Albanian had any ammunition. So when things became peaceful, Albania had the world market in Kalashnikovs, which is one of the reasons why the Albanian ex-arms are still there.

I move on to the Soviet Union and most of the Islamic countries whose names end in “-tan”. They have had struggles and strife controlling problems that arise, and you effectively end up with revolution. That usually manifests itself initially with a revolt and the killing of people. I refer to the CMEA states and their external relationships. I will use Angola as an example because I was an economic advisor to that country. When I was in Cuba I asked the Cubans why they had armed forces in Angola, paid by the Soviet Union. They said it was part of a sugar deal of some form or another, with much interchange.

My worry is that this proposal of restricting arms sales is not going to do anything to save lives. Moving round this world, we find that strange bit of metal: the parang from Malaya, the bolo, even the jitte—the Japanese metal club with which you could beat people over the head—the assegai, which I think was originally a Berber tool, and the shaka of the Zulus. These ancient tools cause deaths—or murder, if so you call it—and there is nothing one can do about that.

Jamaica is one of my favourite countries. I was conceived on a beach there and we were its economic advisers. I was given a machete and told what I should do with the handle. As I wrapped the cord round it—the cord should be plaited from a particular type of palm leaf—I was told to put the hair of one of my family within it, because when you go out to fight, you fight for your family first, and then for your country. I have said before—it is one of my favourite stories—that they opened a wonderful restaurant just after the troubles there, where the cooks and chefs were given all the latest equipment but they used their machetes to turn the eggs over and to whip everything up. At the end of the evening, the senior man was the one who, the night before, had thrown his machete nearest the centre of the dartboard.

These old tools are worrying. If we look at the deaths that are caused worldwide, the majority by far—I estimate about 80 per cent—are from within. Then we look at ourselves, with the latest armaments and kit that the world has ever created, but we are unable to subjugate a group of people who sometimes have nothing more with which to arm themselves than home-made explosives. We should look to that great man Mr Molotov and the Molotov cocktail, which has many different components in different countries. A Molotov cocktail costs approximately 60p—prices vary from £1.50 down to 45p. It can take out a tank or a personnel carrier. It has been used by the Finns to defend themselves against the Russians, and by the Japanese; it has been used the world over.

We have always had that strange word “resistance”. Is it armed conflict when you are resisting an enemy, wherever he might be? Look at the resistance in the last war, where even undoing the bolts on a railway line was, you could say, an act of aggression, in relation to which hostages were taken and killed. I am not sure of the answer; in my own mind I am confused by all this. I support what the noble Lord, Lord Dubs, is proposing, and I know what the noble Lord, Lord Judd, is likely to say after me. We should think seriously about why people are killed and what they are killed with. I do not believe that the maximum level of deaths is caused by armed conflict from without.

I am not saying that, had we not gone into Iraq or Afghanistan, lives would have been saved—of course not. Ultimately the one thing one wants in life is a stable regime. There are really only two countries in Europe and the world that are prepared to lose lives in fighting—France and the United Kingdom. The United Kingdom Commonwealth countries contain 1.9 billion people in 54 countries. The French and ourselves have 15,000 troops working abroad but we have forgotten about them. A lot more could be done if, instead of pushing hard with the UN for treaties of this sort, there were bilateral discussions with those who may formerly have been imperial or colonial countries, or with the Soviet Union. All of us want stability in all countries. The biggest enemy of all is the enemy from within.

My Lords, at the outset of my remarks I should declare an interest as a trustee of Saferworld, as a former director of Oxfam and as a member of the Friends of Oxfam. I warmly congratulate my noble friend Lord Dubs on having achieved this debate. He has brought great diligence and commitment to this area, particularly in the context of the Oslo process. He brings to that work—I hope he will forgive my reminding the House—his personal family history, which must have shaped him considerably in his concern, and his practical experience as a former director of the Refugee Council.

The noble Lord, Lord Selsdon, always brings an original and challenging approach to these kinds of deliberation. As ever, I was interested by his speech. I will take what he said as an opportunity to acquaint the House with an experience of mine at the time I was director of Oxfam. It was in the late 1980s, in that strife-riven—even then—country of Sudan. I was down in Juba, in south Sudan. Our field director was a courageous man, the sort of member of staff who would be where the bullets were flying. He said to me, “Come on, Frank. I want to take you out early tomorrow morning to see something”. I thought, “All right”. We rose before dawn and, going through the defence arrangements for Juba, picked our way to a cattle camp.

It was a wonderful, almost biblical scene. In the faint light that was developing, these distinguished men—women were not so evident—were moving gently and gracefully about, dressed in a kind of woad, with the cattle moving and lowing. I was caught up by the romance of this in the early morning. Then my colleague pointed round the perimeter of the camp, and there were the AK47s hanging up around the perimeter.

The noble Lord, Lord Selsdon, is absolutely right to draw our attention to the machete and the improvised weapon—even the making of guns of a primitive kind. We shall never have stability and peace simply by an arms trade treaty. Of course governance, human rights, education, culture and value systems are all relevant. Yet I believe, with all my experience, that an arms trade treaty is a priority on the road to progress.

We live in a volatile, unpredictable and dangerous world. Yet still, extraordinarily, the prevailing culture seems to be that arms are an acceptable part of export drives, to be encouraged in all sorts of ways unless there is an overriding specific need not to do so. By contrast, sanity demands an approach that sees arms as, by definition, lethal, maiming, destructive and potentially economically ruinous. Too easily, they can also reach the hands of criminals, terrorists and those who perpetrate state terrorism. Surely sanity demands that arms should never be exported unless there is an overriding specific reason for doing so, to ensure security and stability, and even then only with the strictest enforceable conditions and close monitoring.

Similarly, the economic and employment rationalisations are repeatedly overplayed. Objective, reliable studies have repeatedly demonstrated that the validity of such arguments is highly questionable. If the rigours of the market, so generally applauded, had been applied to much of the arms industry, much of it would never have survived. The hidden subsidies, not to mention the corrosively corrupting dangers, can be immense. The opportunity costs are considerable, not least in the deployment of technological research and expertise. By contrast, if the same resources had been expended in other directions, real and substantial benefits could have been generated. There has been a lamentable absence of tough long-term analysis and strategy.

The contradictions can be bizarre. I remember, in my own ministerial days, being appalled by the legal arguments put forward by some that our Memorandum of Understanding with Chile on arms supplies meant that we could not cut off the continued supply of spare parts after the coup against Allende and the arrival of the cruel regime which followed.

Our present Government are to be congratulated on many of the initiatives on the arms trade which they have already taken. They were pioneers of the European Union code of conduct which, with its limitations, provides a base on which to build. They have been leaders in the drive for an international arms trade treaty. To be fully effective, it is essential for all of us to support them in strengthening the consistency of their own performance—the need to be able to say, “Do as we do”, rather than simply, “Do as we say”. It is commendable that the Government have made improvements in transparency by disclosing the end-uses of certain equipment, particularly where that is for a humanitarian end-use such as mine clearance or for peacekeeping activities.

However, the Government’s arms exporting reports still do not allow for meaningful scrutiny of their declared commitment not to send arms to destinations where they could be used for human rights abuses. There should be a far more coherent explanation of their export licensing decisions to countries listed as of major concern in the Foreign and Commonwealth Office's own human rights report. It seems that, in 2007, the Government issued export licences to 18 of the top 21 countries identified in that report as major countries of concern for human rights abuses. Afghanistan, China, Colombia, Israel, Iraq, Russia, Pakistan and Saudi Arabia were among those. Equipment covered by the licences included armoured vehicles, pistols, machine guns, sniper rifles, components for combat helicopters, components for air-to-surface missiles, body armour, riot control agents and military communications systems. Therefore, I ask my noble friend, when replying, to deal with how all that can be reconciled if the Government’s stand on the arms trade treaty is to have full credibility.

By the same token, does my noble friend agree that the welcome leading support of the Government for the Oslo process on cluster weapons, with the final treaty negotiations taking place shortly in Dublin, and on which my noble friend Lord Dubs has been doing so much committed and valuable work, is undermined by their insistence on exemptions designed to retain the cluster weapons held in UK stocks?

I make these points in support of those within the Government who are determined to make policy on this front effective and not open to the charge of inconsistency or of tokenism. As we come to a crucial stage in the arms trade treaty negotiations, I ask my noble friend, when he replies, to be certain to answer the following questions. Do the Government agree that the treaty must be comprehensive, applying to all conventional arms, means of transport, spare parts, ordnance and ammunition; that it must be robust, effective and properly enforceable with convincing arrangements for implementation; that it must be rooted in international law; that it must enshrine the core principles of international human rights, humanitarian law, all other relevant non-proliferation norms and standards, and sustainable development; that it must cover all aspects of international arms transfers, including import, export, transit, transport, overseas production and arms brokering, wherever it takes place—points very well emphasised by my noble friend in opening the debate—and that it will allow for the responsible production and transfer of weapons where that is specifically essential for legitimate defence, policy, peacekeeping and other legitimate purposes, with the emphasis on essential and legitimate?

The Government deserve warm support in reasoning with the United States Administration, and with any contenders to be the future Administration in the United States, that this treaty is indispensable and vital to the cause of security. They, likewise, deserve full support for engaging with other states which remain unconvinced and which could block progress—Russia, China, India, Pakistan, Egypt and, inexplicably, South Africa are prominent examples. At the same time, supporters in the south, such as Kenya, Nigeria, Liberia, Ghana and Tanzania, should be given all possible encouragement in their support for the treaty.

Recently, events in Zimbabwe, Burma and China have added to the all-too-long list of places across the world which emphasise the urgency of delivering a tough treaty. As my noble friend said, the will of 153 states across the international community must not be thwarted. A dynamic contribution, based on consistency, by the UK Government will remain vital and that should run throughout government at all levels, in all departments, from the most senior to the more modest. It must continue to include the Prime Minister and the Foreign Secretary.

On average, 1,000 people die every day as the result of armed violence. Thousands more are injured, maimed, tortured, displaced from their homes, prevented from making a living, or bereaved. Humanity can wait no longer. The present situation is, quite simply, intolerable.

My Lords, the obvious reason for most of us to line up behind the redoubtable noble Lord, Lord Dubs, besides supporting him, is to give the Government some encouragement for their efforts to secure this important treaty, which, after all, they were the first to support at the Security Council less than four years ago. It is a UK baby that will require a lot of nurturing.

It is a pleasure to follow the noble Lord, Lord Judd, many of whose arguments I have enjoyed over the years. For those of us who were discussing the millennium development goals two weeks ago, this treaty is a sine qua non. All states have the inherent right to self-defence under the UN charter, but armed conflict is the constant enemy of development. It costs Africa alone about $18 billion a year, which is about as much as it has received annually in aid in the past 15 years.

As some of us said two weeks ago, we cannot begin to achieve the millennium development goals on poverty reduction, health, education and the environment unless more urgent efforts are made on arms control, disarmament and non-proliferation. Nevertheless, I hesitated to join this debate, because arms control is one of those subjects where high-flown phrases of intent disguise the reality of failure and incapacity on the ground.

We would all—or nearly all of us would—like to see a treaty, but when and how? The Government already say in their submission that there is no universally effective way of preventing an illegal arms trade. Forty states are not party to any regional arrangements that regulate weapons. Until now, there has not even been a list of the world’s conventional arms agreements. The Government say that a treaty will take some years to become a reality, but they are referring only to the negotiations behind closed doors. What about the treaty’s implementation by the member states? It may work in Europe, in parts of Latin America and even in India, but in countries such as Afghanistan, Sudan, the Democratic Republic of Congo and Somalia it will take decades.

Yet it is the conflict countries that are causing the problem and are least likely to co-operate, because they have been so incapable of controlling their own regions and ethnic minorities. Who can blame some of them? They have vast territories to control. The very existence of their states is in question and their ability to set up any systems at all is therefore up in the air.

Last night, I watched an excellent short film, made by Channel 4, about the Janjaweed in Darfur. It showed how the various militia change sides and how easily small arms are traded and captured. In this case, the arms were rifles supplied to Khartoum by China, which is a member of the GGE, the committee working on this treaty. In such a vast region with many divided loyalties—Somalia is another such country—discussions at Westminster seem a bit academic.

Of course, if hostilities end, we can do a certain amount internationally or through the UN, as we are in Afghanistan and southern Sudan, to disarm the militia, to train national armies and to create zones in which development can take place to a limited degree. We are slowly building the capacity of government departments to back up these strategies. However, these will remain limited operations. We have to accept that states, whatever they believe when they sign treaties, may sign them as half-states or quarter-states, which are legitimate perhaps at the UN but lack the confidence of an entire nation. We in the West are always recommending these provisions and formulating the phrases of disarmament from the relative luxury of unified states.

This is where I and, I am sure, many of us have some misgivings about the effectiveness of this treaty, important as it is in the UN agenda and in the armoury of international development. Pursuing non-state organisations, for example, seems quite impracticable. One does not want a convention that is unenforceable and ineffective, as my noble friend Lord Hannay said last week. Without monitoring and proper implementation, it is only a theoretical arms control programme. I feel the frustrations of people on the ground who desperately need good governance and conflict resolution, both of which would have to be in place long before they could ever hope for an amnesty even on small arms.

I acknowledge the pioneering work of NGOs and others that has already gone into this treaty. I accept that, if the treaty can be confined to small arms and light weapons, it may be possible to achieve its objectives in some regions. Other, more limited agreements, some of which have been mentioned, on landmines and cluster munitions have successfully passed into law.

I come to the area where we can make a difference: keeping our side of the bargain and controlling our own arms exports. The noble Lord, Lord Judd, reminded us that we continue to export strategic goods to 18 countries of concern. I hope that the Minister will comment on that. I have briefly studied the Government’s response last November to the Quadripartite Committee on strategic export controls and was glad to see it confirm that states must,

“subscribe to the highest standards”,

in their efforts to tackle bribery and corruption in arms transfers. That is of course true. However, as the public have learnt from the aborted BAE investigations, the highest standards must apply to both sides of the bargain. Even the commendable efforts of the Woolf committee, which has recommended to that company new ethical standards that would make offset contracts subject to the process of due diligence, have not been enough to uncover the whole truth about that programme. The 1997 OECD convention on combating bribery has had considerable effect, as will the new UN Convention against Corruption, in the pursuit of some of the worst offenders, at least within larger corporations, even if it cannot catch the minnows.

Stronger emphasis on conflict prevention will also assist in the process of arms control and disarmament. I was glad to see reference in the latest FCO human rights report to the need to address tensions arising from social exclusion and human rights abuse, which were described earlier by the noble Lord, Lord Selsdon. There have been notable successes recently in countries such as Uganda and Sierra Leone, as well as in Burundi, where the new UN Peacebuilding Commission has been working. That commission needs much more support.

Nepal is another example of a country where swords are turning into ploughshares, or machetes into kitchen equipment, whichever way one looks at it. A fragile conflict state has apparently been transformed into one emerging from civil war towards a reasonable level of governance and stability. I am glad to say that the UK, as I have seen for myself, has been an active player in this process. Elsewhere, DfID has provided expertise on a range of subjects, such as children in armed conflict. The FCO supports the fostering of civil society as a means of bringing Governments to account. In all those countries, we must acknowledge the critical and indispensable role of non-governmental organisations, as we do of Governments.

There are some signs of hope in a globe apparently torn by conflict on all four continents. We must pray—I think that that is the right word—that the arms trade treaty will eventually find a place in the panoply of international agreements designed to ensure a safer world.

My Lords, I, too, congratulate my noble friend Lord Dubs on initiating this debate. I congratulate him also on his other work in this field. Despite its brevity, this has been an interesting debate because of the divergent opinions expressed and the thoughtful nature of the contributions.

Efforts to establish an international arms trade treaty are an example of how a few enlightened individuals, together with and followed by a large number of NGOs, can hope to influence world events. Simultaneously, they are an example of the difficulties and frustrations of reaching concrete and tangible outcomes. Of those individuals who have been involved, I mention especially Dr Oscar Arias, the former President of Costa Rica, which is a country famous for not having an army. He won the Nobel Prize for his efforts to stem the tide of civil war in central America. We can claim a piece of him, because he studied for some time at the London School of Economics—like most people of eminence in the world, I have to say. He also got a PhD at the University of Essex, hence his title. He has had an enormous personal impact on the evolution of thinking about the possibility of the treaty.

As someone who is deeply immersed in writing a book about climate change and energy security, I see interesting similarities between attempts to establish international agreements on climate change post-Kyoto and post-Bali and attempts to establish an arms trade treaty. In both cases, many nations are joining in with the best of intentions; in both cases, a few key actors are not signing up or are actively seeking to exploit others with their own interests in mind. In the mean time, the phenomenon that is supposed to be addressed by these two sets of international negotiations goes on relatively unchecked. Noble Lords will probably have seen in the newspapers a couple of days ago reports of the recent studies from the observatory in Hawaii, which suggest that world emissions are rising much more quickly than we thought and already are not far short of a dangerous level.

In the case of small arms and light weapons, exports to countries have continued and have grown in number over the past few years, including to countries that are known to have committed serious human rights violations. This is part of a general swelling of the world arms trade. The proportion of countries with significant arms industries has doubled since the early 1990s. The current volume of the global arms trade is estimated at a value of $1.1 trillion, according to the Stockholm International Peace Research Institute. Of course, the proposed arms trade treaty would cover only a proportion of the arms trade. Some people have, not without some accuracy, called small arms the real weapons of mass destruction. Far more people have died from small weapons in recent years than from the larger ones of so-called mass destruction.

It is helpful that there is something close to a world consensus on the desirability of an arms trade treaty. As all noble Lords know, in October 2006 the UN voted to start the process towards an arms trade treaty by a vote of 139 to one—and everyone will know who the one was—with 24 abstentions. As other noble Lords have said, the EU has played a strong part in this process and has produced a series of documents on what a treaty might look like and the obligations that might be within it. We owe a vote of thanks to our Government for their efforts in promoting the treaty.

However, critics have had a field day with the attempt to establish an arms trade treaty. A prominent American political writer says that,

“a meaningful arms trade treaty is a pipe dream”.

He says that it is just,

“another hollow UN treaty that makes promises that it can’t deliver”.

Critics have raised the same point as the noble Lord, Lord Selsdon, did—that death occurs in wars and that it is not weapons, as such, that kill people. However, I think that there are clear limits to that kind of argument, which is used domestically in the United States, for example, to argue that everyone is safer if they have a gun in their house because they can protect themselves. It is important that the world should try to reach agreement on an arms trade treaty.

I have four questions for the Minister, which follow on from what the noble Earl, Lord Sandwich, said about the reality behind the possibility of a treaty. First, how would the Government see the process of reconciling the divergent interests involved? As with Kyoto and post-Kyoto, when a lot of nations are trying to reach agreement, if they manage to do so it tends to be at a very low level—and anyone who is outside can exploit the rest. How can those things be avoided when there are clear divergences of interest between countries? For example, some of the developing countries feel that an arms trade treaty might discriminate against them in much the same way as they feel that attempts to control nuclear weapons have done. The states that have nuclear weapons keep them and try to prevent other states from acquiring them. There is a morass of different interests involved and I should like to find out how the Government think that they could be reconciled, with a strong statement of the kind that noble Lords have rightly been calling for.

Secondly, the United States might refuse to sign up, even if a Democrat presidency succeeds the current one. Again, I should like to hear the Minister’s view on this. At least some writers on foreign policy have argued that in the short term it might be a good thing if the United States did not sign up because some countries, as mentioned in my first question, might see American leadership in this area as an attempt to dominate the world arms trade and substantiate its own position of dominance in it. At some point, the United States has to sign up if the treaty is to be effective, but there could be a case for saying that it should join in later, as it has done with other treaties in the past.

Thirdly, will Russia ever sign up? Russia is one of the main exporters of arms and many of those arms get to countries with noxious regimes. There are two reasons why Russia stands in a specific position in relation to the world armaments industry, which might lead it to find it difficult to be involved in the process. First, the armaments industry is one of the only industries in Russia that is competitive on a world level and in which the country can sell successfully across the world. Russia has put a lot of money into its armaments industry and armaments exports. Secondly, Russia, at present anyway—and this is likely to continue under the new leadership of Mr Medvedev—is not closely aligned with a multilateral view of the world and still takes a view of international relations that puts states and their interests first. That might make Russia an awkward partner in such international legislation.

However, I should like to end on a more idealistic note, because I hope that this is an area in world society in which idealism and realism can coincide. Oscar Arias, who was one of the initiators of the idea of a world arms trade treaty, said in 2007 that,

“all of us should be proud of this process, proud of how far we have come, but it is time to move forward from principles to practice … It is time not just for declarations but also for treaties; not just for politics but also for law”.

So here is an easy one in conclusion for the Minister: will he endorse those sentiments and find it possible to set out a position that would allow us in a world society to reconcile necessary idealism with on-the-ground realism in the construction of a treaty?

My Lords, we on these Benches strongly support proposals for an international arms trade treaty, while also recognising that it would in no sense be a panacea and would have only a fairly limited effect. Of course, that is not unique to this issue; we pass laws in this House against drug crime which do not eliminate such crime but help to control it. In an international market in which, increasingly, brokers selling second-hand arms are playing a major role, the effort to control the international arms market is going to be a very long-term one. But an arms trade treaty that provides additional mechanisms for control, ideally for monitoring and reporting and that provides a global framework for tighter regional frameworks—and I hope that the Minister will tell us a little about whether we can work into an arms trade treaty the strong objective of trying to reduce the level of arms traded—would be a useful step forward.

As a number of noble Lords have already said, this process cannot be the north telling the south what to do, for many reasons. We need to engage the countries of the south as major purchasers and, increasingly, as competitive suppliers. There are many obstacles to this; we all know from our own country the arguments about employment and exports. When I was standing in a constituency in Yorkshire, I was staggered to discover how many small businesses in Shipley were subcontractors to the Vickers tank factory in Leeds and therefore did not want me to say anything about the British Army not needing another 1,000 tanks. The same is true of the aircraft industry. It is interesting that under the Thatcher Government we were supposed to abandon an industrial strategy, which was not a good thing, but we still have a defence industrial strategy, because that is an exceptional area kept out from the free market. If Britain wants to reduce its arms sales, there are clear implications for the future of our defence industrial strategy.

The arguments for employment and exports are even stronger in some other countries. The noble Lord, Lord Giddens, mentioned Russia. I recall going to a conference in Ukraine shortly after Ukraine became independent, and a great deal of time was spent by our Ukrainian opposite number saying, “Tell us how we can sell anything which comes out of our defence industry”. It was almost the only viable industry that it had. It asked whether it could put up satellites for us, convert military aircraft into long-range transport aircraft or whatever, because it was desperate to keep people in business.

New producers complicate the matter even further. The noble Lord, Lord Judd, said that he was surprised at the South African attitude. I was in South Africa two years ago and happened to talk to someone who worked in the South African arms industry. He told me about the difficulties that it had in finding export markets and how much tighter the competition from India and Israel was getting. Brazil is also a new supplier. China, as we have heard, is a major new supplier. This is much more complex than it used to be and there are markets out there and countries desperate to find foreign exchange by supplying them.

The noble Lord, Lord Selsdon, remarked on the broad problem of what a weapon is. We have all struggled with the question of dual use. The forces from Darfur that reached the outskirts of Khartoum the other day arrived in Toyota Land Cruisers and Land Rovers. That is how they got across Kordofan. Those are clearly dual-use weapons. We export a lot of Land Rovers from Britain. That is part of the shady area that we are in. Helicopters are very important to international aid, but of course they are very much dual-purpose. The machetes that were used in Sierra Leone as well as in Rwanda were used to frighten and wound people, but the AK47s did more damage and killed more people.

We face the increasing problem that arms are getting smaller. Tanks and fighter aircraft cannot be hidden, but unmanned aerial vehicles can much more easily be hidden and smuggled. There are in the world a large number of shoulder-held ground-to-air missiles left carelessly behind by the Americans from the support for Afghans fighting the Soviet Union. Again, they are relatively easy to smuggle. Some major problems are getting more difficult as arms get smaller—not to mention explosives. I have just been reading the chapter in Misha Glenny’s new book McMafia in which he talks about the Bombay/Mumbai explosions some years ago in which the Pakistani intelligence services provided small amounts of very effective explosives to criminal gangs working for terrorist associates to operate in Mumbai. We have a set of markets in which states are players, but there are all sorts of terrorist, non-state, criminal and other actors. It makes things extraordinarily difficult.

There is a large second-hand trade with surpluses dashing around the world and with brokers and entrepreneurs everywhere. In the Gulf states, Viktor Bout made Dubai one of his major centres. Brokers occasionally use offshore financial centres under British sovereignty—there have been one of two cases in the Channel Islands, as the Minister will know—and Switzerland.

Then we have the problem of the United States itself, which has been remarkably careless in providing large quantities of arms to conflicts elsewhere in the Balkans and in Afghanistan and then leaving them behind to be traded elsewhere. If any noble Lords have seen “Charlie Wilson's War”, they will have a sense of how careless the United States was in providing weapons to the Afghan resistance. We also know that the freedom of the American market provides a fair amount of leakage elsewhere. We are told that criminal gangs in the Caribbean get their heavy weapons privately within the United States. After all, you can purchase fairly heavy assault weapons in various American states if you know how to do it, and then smuggle them out of the country. There is a huge problem of internal conflict, arms and criminal smuggling of arms as well as trade between states.

What can Britain do and what are Britain's responsibilities? Clearly, we should tighten our own controls further to make sure that we have greater transparency about our arms exports. I am glad to see that the Government have taken some steps in that direction and reduced what used to be the almost automatic export subsidies for arms transfers. We would like to see more reporting to Parliament. Indeed, a working group from my party recommended that all significant arms sales should be overseen by a parliamentary committee. It seems to us that there are questions about a new defence industrial strategy based on the assumption that we will maintain a major domestic industry by selling abroad. After all, that is what took us down the road to the Al Yamamah contract, keeping the British aircraft industry going by selling an enormous amount of weapons to Saudi Arabia under circumstances which we all know were rather dubious in terms of how much money went where in commissions—some of which flowed back into Britain through some British universities, although I think not yet the LSE.

The UK certainly needs to ensure that none of our offshore financial centres are involved in the financing of arms sales or arms brokers. As a member of the European Union, we should be working as far as possible to strengthen a common EU position and to make sure that those negotiating with the European Union and those wishing to become closer associates of the European Union also raise their standards. Croatia has been mentioned. It is negotiating to become a member of the European Union. What is it still doing in the arms trade in such a dubious fashion? We have some influence over Switzerland in the same way and perhaps also Ukraine.

Lastly, the British Government and others need to work to tackle the surplus of arms in circulation—above all small arms and the illegal networks that trade them. The arms trade treaty would be a useful contribution to a major problem, but we should have no illusions that it would solve this very complex and partly criminal activity.

My Lords, I add my thanks to the noble Lord, Lord Dubs, for giving the House an opportunity to debate the international arms treaty. He gave an impressive overview of some of the problems of the arms trade, with examples of the different countries responsible for some of the worst cases of irresponsible arms exports and human rights violations.

This issue is a good example of persistence paying off. Without the efforts of Amnesty International, Oxfam, and others such as Alex Vines at Chatham House, the issue of controlling the trade in small arms and light weapons would not have gained the public awareness and sympathy that it now has; nor without their dedicated lobbying would the draft Bill have got as far as it has.

I am very happy that the UK has not been backward in its support for this treaty. Our representatives at the United Nations have been at the forefront of measures to promote it, and, just as important, our defence industry operates to some of the highest standards in the world. We should be proud of the UK's efforts to reduce the illegal arms trade and the horrors to which it contributes. I congratulate the Government on their contribution to progress on such a treaty.

However, as the noble Lord, Lord Dubs, said, progress has been very slow. The issue has been on and off the table since 1995. We have now reached a point where a group of government experts has been appointed and is sitting as we speak in one of the three sessions planned for this year. What indication can the Minister give the House of how long it can be expected to take for the process to be completed?

There are other problems ahead apart from the interminable workings of international bodies. Despite the enormous support for the resolution in both July and December 2006, there was the notable opposition of the United States and, as the noble Lord said, 24 abstentions. These included both China and Russia, which are themselves heavily involved in the international arms trade at all levels. It is clear that persuading these countries to make a positive contribution is necessary for the success of the treaty. As we are all aware, China was the source of the shipment of ammunition and rocket-propelled grenades to Zimbabwe last month.

The intentions of a treaty are only as effective as the subsequent actions of its signatories. Without the active support of these countries, little can be done to mitigate the death and destruction that follow from the indiscriminate and criminal use of light weapons. Does the Minister have any confidence of being able to change the abstaining countries’ minds? We can hope that the support given by other countries will exert some pressure, but our examples of how to maintain a successful defence industry that still meets higher standards will be the key to reassuring them that the treaty will not harm the legitimate defence industry or the responsible export of munitions.

I also hope that the Minister will be able to confirm that the Government will not support any suggestions that the treaty should be watered down to make it more attractive to these reluctant states. If the treaty is not sufficiently robust, it will be meaningless. Will the Minister give a commitment that the Government will not attempt to increase the number of signatories by sacrificing provisions?

Another concern that I believe we all appreciate is the question of enforcement. How do the Government expect the treaty to be policed? It is of course the illegal trade in small arms and light weaponry that leads to the most harm around the world. We cannot rely on dock workers to hold up every suspect shipment en route to unstable countries. How do the Government intend to target the non-signatory countries and organisations that actively and knowingly participate in the illegal arms trade? Who will take responsibility for identifying and prosecuting those breaking the treaty’s provisions? And how will the Government stop the costs and burdens of enforcement from falling primarily on those states that already run their arms industries responsibly?

I agree with the noble Lord, Lord Giddens, that this has been an interesting debate. I listened carefully to—and, as always, was enormously impressed by—the words of my noble friend Lord Selsdon, who made the point that it is not just heavy weapons that are a threat but often the knife, the machete and the kukri that kill people.

I am pleased with and proud of what this county has done so far to promote the treaty. I am hopeful that we will eventually achieve success with a comprehensive, robust, fair and effectively implemented treaty. I therefore encourage the Government to continue their efforts towards that goal, and I look forward to hearing what the Minister has to say in answer to the questions that I and other noble Lords have raised.

My Lords, I, too, congratulate my noble friend Lord Dubs on securing this debate and on starting such an interesting and worthwhile discussion on this important subject. Before I address the points that have been raised, I remind noble Lords that I was Minister for Defence Procurement from 2001 to 2005 with responsibility for defence exports and that later on, while out of government, I worked for a time in the defence industry.

As my noble friend made clear, the debate could not be more timely. As we speak, the second in a series of three UN group of government experts meetings is under way in New York to discuss issues of direct relevance to those discussed in this House today. We are pleased to have been at the very forefront, as the noble Earl, Lord Sandwich, reminded us, of initiating this UN process towards an ATT in 2006, pleased to be working closely with our partners in the NGO community and with industry to take that process forward, and pleased to remain fully engaged internationally in strong support of the United Nations process towards an arms trade treaty. Together we have achieved success in taking the process forward towards a treaty. It has not always been easy to convince sceptics, but I believe that our innovative co-operation is beginning to yield results.

I remind the House that this country, along with six others, introduced a resolution into the United Nations in December 2006 calling for work towards an arms trade treaty. One hundred and fifty-three countries voted in favour of the resolution, 24 abstained and only one voted against. In 2007, as part of the first phase of the UN process authorised by that resolution, an unprecedented number of countries submitted their views on an arms trade treaty to the Secretary-General. More than 100 submissions have now been made, giving views on the treaty. The norm is fewer than 20.

The second phase of work arising from the resolution began in February this year, with a meeting of a group of government experts from 28 countries, selected by the United Nations Secretary-General to consider the feasibility, the scope and the draft parameters of such a treaty. There will be three meetings of the group during 2008, the second of which is under way while the third session will be in July this year. The experts include representatives from countries that voted for this process, from those countries that abstained and from the United States, which voted against it. The debate will therefore cover the full spectrum of views on a treaty, and I suggest to the House that that is a good thing.

Our disarmament ambassador from Geneva, John Duncan, leads our team. We will of course press for high standards and appropriate coverage to make a treaty effective, but this series of meetings is considering only the mandate given it by the Secretary-General on the basis of the agreed resolution, so we will also be listening carefully to the views of others with a view to building consensus for the chair to report back to the Secretary-General at the end of the summer based on sound expert advice.

My noble friend Lord Judd said that this was a high priority matter, and we agree; such a treaty is a high priority for the Government. However, we will not settle for anything less than a robust treaty. What do I mean by that? I mean a treaty that is effective in preventing the irresponsible trade in arms, which is the source of much of the weaponry that finds its way into the illicit market and which is used in attempts to undermine democracy, human rights and development. We want a treaty that has globally agreed high standards against which states assess whether to authorise arms exports. That includes assessment against high standards of human rights, international humanitarian law and taking into account the impact an arms export might have on sustainable development or conflict. There is widespread international support for such a treaty, both among states and in civil society. However, some states have reservations and many questions that I have been asked relate to those states. These reservations include whether a treaty will raise standards or simply legitimise lower standards. There is also the question of whether we can achieve the same ends by strengthening existing mechanisms.

The Government’s view is that these concerns are legitimate and must be explored if we want to see an effective treaty. However, there can be no question of agreeing a weak treaty: we would not legitimise lower standards. As we see it, a treaty of this kind is fundamentally new ground. It is the first time that the international community is taking forward this level of debate about global standards for arms export controls. The aim is to plug the gaps and inconsistencies that exist between the patchwork of regional and national arms export control arrangements.

An arms trade treaty would not affect domestic legislation on arms ownership. Nor would it affect a state’s inherent right to purchase arms for self-defence. The treaty would establish common standards that each country would use to assess arms exports. With common standards, there would be a greater consistency of approach and more objectivity in assessing arms export licences. This would create a more certain environment in which legitimate and responsible arms trading would become more straightforward and international collaboration between defence industries on investment, production and the chain of supply would become more attractive.

We are committed to moving forward quickly within the UN, so that a robust and effective treaty can be achieved as soon as possible. However, it is important, if we are to be successful, that we take full account of the views of our international partners. We have to listen to their views on what they need from an arms trade treaty and we need their help in making sure that a treaty is as effective as possible in addressing the irresponsible trade in conventional arms. This will take time, but it is better to invest time now in achieving a robust and workable treaty that states will want to implement, than to rush ahead and not take into account the needs of those countries that will be affected.

In achieving the high standards that I have referred to, we need to balance a number of issues. We need to ensure that the legitimate and inherent defence needs of individual countries are respected. The task of protecting society is complex. Defence and security capacity underpins the ability to protect civilian life and to maintain democracy and development. We need to be sure that the steps that we want to take to protect human rights, security and development with an arms trade treaty do not have unintended consequences. The UN consultative process will help to identify these issues and will inform further debate. For example, if we claimed that no defence exports at all were legitimate—the British Government never make that claim—we would never get a treaty signed at all.

Despite the complexities of these issues, I hope that our message remains clear. We want an arms trade treaty that will be effective in preventing irresponsible arms trading and transfers. We want this because it will help to prevent weapons getting to terrorists, insurgents and armed groups that threaten human life and the values that we hold dear of democracy, freedom and humanity. Those are fundamental rights not just for us, but for all members of our global society. We want this treaty because we believe that it will help to take guns out of the hands, for example, of those who target our troops when they defend those fundamental rights in places such as Iraq and Afghanistan.

I was asked a number of questions. Some I have answered in my speech, but let me be more specific. My noble friend Lord Dubs made the point that time is of the essence—we must not take too long over this. He has heard me say that, for the treaty to work effectively, it must be agreed by as many countries as possible, and must cover agreed parameters. The noble Lord, Lord Giddens, hinted at the fact that this is an incredibly complex process that must take into account the views of all 192 members of the United Nations, and so will take time. I make two points: that the process is on its way; and, very importantly, that support has been overwhelming.

I was asked about ammunition parts and dual-use items. This is an area where there is a legitimate range of views. Our aim is to secure a treaty that will reduce the suffering of those affected by prolonged conflict or by the tyranny of human rights abusers. Ammunition parts, technology to produce armaments and related dual-use items in the wrong hands can and do contribute to that suffering. We therefore believe that dual-use items and ammunition parts should be controlled as part of the treaty. We acknowledge, again, that this will need careful handling to prevent unintended consequences that impact on legitimate development or trade.

My noble friend Lord Judd asked me six questions and was kind enough to give me advance notice of them. I say, in short, that the answer to all his questions is “yes”—we agree with what he put forward. He also referred, as did the noble Earl, Lord Sandwich, to the issue of UK defence exports to human rights abusers. We believe that we ourselves should uphold the highest standards. The suggestion has been made that, when dealing with countries of concern, we should go for a presumption of refusal in all cases. I remind the House that all export licence applications are rigorously assessed on a case-by-case basis against the consolidated EU and national arms export licensing criteria, taking account of the circumstances prevailing at the time and other announced government policies. Those criteria clearly set out our commitment to take account of the risk that exports might be used for either internal repression or external aggression. We assess exports on a case-by-case basis, taking into account the nature of the equipment and the country for which it is destined. When assessing licences, we look closely at all the specific evidence relating to each individual export application, including the circumstances at the time that the application was made. Where there is a case to embargo a country because of its human rights record, we act, and I give as examples Zimbabwe and Burma.

The noble Lord, Lord Wallace, and my noble friend Lord Dubs asked about ammunition and dual use, and I think that I have already replied to their point. Such a treaty needs to be comprehensive, covering dual-use items, ammunition and parts.

My noble friend Lord Giddens asked a number of important questions and I start with the one about the United States. Both we and the United States, together with a large number of other countries, have the common aim of seeking to prevent the irresponsible proliferation of conventional weapons. The United States is participating in the UN meetings and its views will be taken very much into account, along with the views of others. The US is particularly concerned, first, that this may be an attempt to legitimise low standards and, secondly, that it may introduce domestic gun ownership controls. We share US concerns about the first point and we would not sign up to a weak treaty. On domestic gun controls, the treaty that we are proposing concerns exports and does not cover national policy. We are working with the United States to ensure that it recognises that its concerns on the second point are unfounded.

Russia is a sceptic, and I was asked by my noble friend how we can bring it on board. The countries that abstained include China, India, Pakistan and Russia. Obviously, it is right that their views are taken into account and that they are part of the process, rather than left outside the tent, in taking forward expert discussions on the feasibility, scope and draft parameters of such a treaty. I shall not pretend for a moment that it will be easy to satisfy every country, but it is vital that we do everything that we can. That is why the current process is designed in the way that it is.

My noble friend asked how we can avoid the lowest common denominator. If we secure a treaty that is too weak to have any real impact, it will not have been worth the candle. We need a strong agreement that will make a real difference to the lives of those who are impacted. As a country, we will not agree a weak treaty or one that does not support the legitimate trade in defence goods. Our best hope is the inclusive and ongoing consultative United Nations process, which we believe should be able to do the trick in addressing concerns without producing a weak treaty that is not worth the paper on which it is written. I have already told noble Lords about our next steps.

I take on board the terms “idealism” and “realism” used by my noble friend Lord Giddens in quoting an expert. This is not a bad example of where the idealistic and the realistic can, if approached properly, both be realised. We work closely with our partners, NGOs, industry and our international colleagues, and we value their advice and support. We think that we have achieved significant progress in working towards a treaty at the United Nations since we started on it in December 2006. We look forward to continuing this success by taking the UN process further forward towards the conclusion of a robust arms trade treaty that has a significant and lasting impact in preventing irresponsible trade in conventional arms. We know that it will not be easy but it must be worth the effort.

My Lords, I thank all noble Lords who have taken part in this interesting debate and I welcome the Government’s response. They have been very positive and if they give effect to the positive stance they have described, the world will become a safer place.

There has been a welcome broad measure of agreement throughout the debate that we need such a treaty, that we need a treaty which is going to be enforced effectively and that we need a robust treaty—in other words, there must not be a compromise in order to get more countries to sign which would make the treaty weak, flabby and ineffective. I would say, by way of encouragement, that the treaty against antipersonnel landmines—the Ottawa treaty—has been pretty effective, even though the United States has not signed it because it is not using such weapons. There will be more authority in having a robust treaty with one or two signatories not there than in making the treaty weak in order to get all the names on board. We can exert pressure on the non-signatories better in that way.

There is a difficulty about non-state organisations and it will be a challenge to make sure that the treaty is enforced on non-state organisations. I believe that our Government can speak with authority in persuading other countries to go along with this. They will speak with more authority if we sign up to an effective treaty against cluster munitions because that will show that we are consistent across the piece.

Having said that, I am encouraged by this debate and I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

rose to move, That the draft regulations laid before the House on 26 February be approved.

The noble Lord said: My Lords, I shall also speak to the Gambling (Geographical Distribution of Large and Small Casinos Premises Licences) Order. The Categories of Casino Regulations define the large and small categories of casinos by reference to the minimum and maximum gambling area each type of casino must offer. A casino will be a large casino if the combined floor area of those parts of the casino used for providing gambling is not less than 1,500 square metres but does not exceed 3,500 square metres. A casino will be a small casino if the combined floor area of those parts of the casino used for providing gambling is not less than 500 square metres but does not exceed 1,500 square metres.

The principal purpose behind establishing new minimum and maximum size criteria for the new casinos is ultimately to prevent a proliferation of small casinos. Separately, the new casinos are required by mandatory premises licence conditions, approved by the House last year, to set aside minimum non-gambling areas where customers can take a break from gambling. These regulations will not apply to casinos previously licensed under the Gaming Act 1968. Many existing casinos will be below the minimum size for a large or small casino under the Gambling Act 2005. Existing casinos licensed under the 1968 Act, regardless of their size, are subject to special transitional arrangements under which they have been granted a converted casino premises licence. This will enable existing casinos to continue to trade with their current gaming entitlements. The operators of existing casinos will, of course, be free to bid for the new casino licences permitted by the Act.

The geographical distribution of casinos order specifies the 16 authority areas where the eight large and eight small casinos permitted by the Gambling Act are to be located. The 16 licensing authority areas are those that were originally recommended by the independent Casino Advisory Panel, chaired by the late Professor Stephen Crow. They were included in the first geographical distribution order, which this House rejected in March 2007. Despite that rejection, which, as the House will recall, centred on the location of the single regional casino, there was, nevertheless, a broad consensus across all parties in both Houses in last year’s debates that the eight large and eight small casino licences should be awarded to the 16 licensing authorities identified by the panel.

In the rejection of the order last year, the amendment of the noble Lord, Lord Clement-Jones, adopted by this House called on the Government to incorporate the 16 areas in a fresh order, which is precisely what we are doing today. We continue to believe that the Casino Advisory Panel did a good job and that, in recommending the 16 areas, the panel exactly met its remit. The areas represented provide a good spread and different types of location, from large urban areas to town centres and seaside resorts. That is what we set out to achieve in our December 2004 national policy statement on casinos. When the time comes to carry out an assessment of the social and economic impact of the 16 new casinos, the areas will provide a good test in a broad range of different locations.

Of course, I regret that my noble friend Lord Filkin’s Merits Committee, which I hold in the highest regard, came to the conclusion that the order may imperfectly achieve its policy objectives. My right honourable friend the Secretary of State for Culture, Media and Sport wrote to my noble friend to explain why we did not agree with the committee’s conclusion. The committee was kind enough to publish a copy of the Secretary of State’s letter in its 15th report of the current Session. It may be helpful if I deal with the two principal concerns that the committee raised. I reiterate that we take the committee’s view seriously and recognise the serious work that it does under my noble friend Lord Filkin’s distinguished chairmanship.

My Lords, with yet another gambling order, there is an awful sense of déjà vu and I am sure that many of the comments that noble Lords have made on previous occasions are still relevant. These Benches are not going to oppose these instruments, but it would still be nice to know why there are different classes of casino based purely on the date of application for a licence. I am sure that there is a reason for that, although I have yet to hear a good one. With the amount of discussion and parliamentary time given to this subject, it remains a mystery why it was not possible to achieve consistency with the legislation. Seaside arcades are another form of establishment that could suffer because they were operating before the new Gambling Act.

In a previous debate, the Minister commented that he did not wish to discuss Treasury matters. Nevertheless, the tax on gambling, as my colleague in another place pointed out, is high. In an industry where the opportunity for wrongdoing is so great, there must be a question over how sensible it is to tax to a level that might create a temptation to cheat. I do not know what that level is, but the Minister might give the matter some thought.

The issue of problem gambling remains cloudy. I have read a great deal on the subject and the things that appear to be lacking are a clear direction and a set of criteria to deal with it. There has been much talk, with many sensible ideas, but there does not seem to be the concentrated focus that will be needed if the figure of 250,000 problem gamblers is not to grow significantly as the number of casinos increases. Her Majesty’s Government talk much about regeneration, but there is a danger that what will actually be achieved is degeneration. Perhaps the Minister will comment on advertising in the United Kingdom by overseas-registered companies that are not subject to British safeguards and regulation. I look forward to hearing what he has to say, but there is no opposition to these instruments.

My Lords, I must apologise for my late arrival. I hope that I did not miss too many of the Minister’s words, and I thank him for those that I did hear. I suspect that we may have heard some of them before, but I would not wish to predict that, and I hope that the questions I ask the Minister have not already been answered in his introduction. As elsewhere, we are in difficult territory for the Government. I would sum it up by saying, in the words of the old joke about the man who is asked directions, “I wouldn’t start from here, guv”.

All of us in this Chamber are only too well aware of the history of the Government’s supercasino proposals that have led, in the space of three years, for proposals for an unlimited number, then eight, then one and now zero. Over a year ago, the Liberal Democrats succeeded in persuading this House to adopt the proposition that a review of the decision to site a supercasino in east Manchester should be undertaken and that there should be a separate order enabling the eight large and eight small casinos identified by the Casino Advisory Panel, under the late Professor Crow, to go ahead. It is incomprehensible that the Government have delayed for over a year in considering the implications of that vote and coming to a decision. That is dither and delay brought to a fine art.

The climate in the casino world has changed dramatically during those 12 months. There have been drastic changes in gaming duty. The abolition of the bottom bands at no notice has forced the casino operators to pay millions more in duty. The Government have decided that so-called Section 21 terminals, which were permitted in the 1968 Act casinos, should be categorised as machines, which has substantially reduced the gaming that existing casinos can offer, and it must be admitted that the smoking ban has led to a reduction in income for existing casinos. As a result, a number of casinos are closing, including establishments in Glasgow, Nottingham, Scarborough, Liverpool and Manchester, with many staff redundancies. One key operator, Ladbrokes, has indicated that it will not be applying for new licences.

It has also become apparent that a large number of casinos could open in this country under the 1968 legislation. This has gone well beyond the numbers that Ministers originally said would be in existence. The former Minister, the right honourable Member for Sheffield Central, Mr Caborn, said on 11 January 2005, when referring to the total number of casinos that were expected following the 2005 legislation:

“We can say with certainty that there will be no more than 150 casinos”.—[Official Report, Commons Standing Committee B, 11/1/05; col. 718.]

I recently asked the Gambling Commission and have been told that there are 144 licensed and operating casinos, including two card clubs, under the 1968 Act, with 46 casinos, including one card club, licensed but not operating. Nineteen applications have been rejected by local licensing authorities but are subject to appeal. Fourteen casino certificates of consent have been granted and are waiting for a hearing by magistrates, including three card clubs, and three casino certificates of consent are pending determination or issue by the Gambling Commission. Ten of this total of 82 are extensions to, or replacements for, existing licences.

My Lords, it is good note in these draft regulations and in the report the seriousness with which the Government intend to monitor and review the social and economic impact of large and small casinos. The regulations imposed by the Government have already ensured that the casinos demonstrate a high degree of social responsibility, especially towards those vulnerable to addiction and to the young.

The Government have been sensitive to the public mood in at least deferring the decision on supercasinos until a proper evaluation can be carried out on the impact, especially in areas of high deprivation. Some of the authorities which may issue large casino premises licences include places of multiple deprivation and areas of consolidated poverty such as Kingston-upon-Hull. Before going to Liverpool I was the Bishop of Hull. It is a city for which I continue to have a great deal of affection. If I were still its bishop I would, from a pastoral point of view, express great concern at the prospect of another casino full of 150 machines, some offering the prospect of prize money of £4,000 at the press of a button costing £2 a go. To use the words of the Explanatory Memorandum, such casino gambling in places of poverty,

“does carry some risks of personal and social harm”.

I recall an earlier debate which was introduced by a Minister with the words, “The people want to gamble”. That is of course true of some people but differentiating what the people want from what the people need and from what the people ought to have is the high calling and heavy responsibility of those called to govern.

I wish to put down a marker of hope in this debate. If the assessment of the social and economic impact proves that casino gambling is detrimental in areas of deprivation, I hope the Government will act swiftly to remove them from the area and to rule them out of their strategy of regeneration.

We live in a time of unprecedented personal debt—over £1 trillion. Future historians may well say that we made the indebted poor even more vulnerable by putting gambling within easier reach. I know that local authorities have invested considerable time, money and energy into mounting the case for casinos in their areas as part of their strategy for regeneration. I know, too, that they, like the Government, take seriously the need to minimise harm and to protect the vulnerable. I know that some boroughs have engaged local people in local consultation.

However, the earlier debate and consultation and the earlier preparatory work took place in a very different economic climate. We have not only higher degrees of debt but increasing negative equity in the housing market, with more people at risk financially. This sets a rather different mood and a rather different social context for today’s debate. In an earlier debate, my friend the most reverend Primate the Archbishop of Canterbury voiced his concerns about our social well-being. We on these Benches urge the Government to proceed with caution, with prudence and with a due sense of responsibility for the weaker members of our society.

My Lords, I am very pleased to follow the right reverend Prelate. He reminded us of the social dimension that is contained within not only the regulations but all the provisions of the Gambling Act. Thanks are also due to my noble friend Lord Davies of Oldham for introducing the regulations. He is getting a rather easier ride with this order than he did in March last year with the order that contained the very controversial proposal for the one regional casino, as well as the 16. The noble Lord, Lord Clement-Jones, could have been a little more gracious in acknowledging that the Government have done what he and the majority of this House voted for in that debate last year.

I do not take the view that the implementation of the 2005 Act is going nearly as badly as other noble Lords suggest. The role of regulation and the work of the Gambling Commission have been exemplary so far. They have tackled the task with vigour and, to begin with, with fairly low resources. The indications I get from talking to people in the industry—I have a number of interests which are on the register related to what they do—is that they are tackling it well and that the quality of the regulation is now substantially greater than it was before the Act came in.

The noble Lord, Lord Howard, was right to refer to some of the problems of offshore advertising. I have referred in this House on more than one occasion to the difficulties that are caused by the poor standards of regulation in Gibraltar and its reluctance to adopt the same standards as the Gambling Commission and the white-listed authorities. Putting that aside, however, the work on the regulation of online gambling and the other aspects of the industry are working well.

I do not underestimate the scale of problem gambling. The prevalent study indicated to the surprise of many that it had not grown markedly over the past few years. It will be very interesting to see whether those figures are sustained in the next prevalent study after the expansion in gambling can be measured.

I will share with the House details of a visit I paid a couple of weeks ago to Gordon House, the only residential centre for problem gamblers in the West Midlands. The residents of Gordon House are men at probably the very bottom of their lives. I spoke to between a dozen and 15 of them and discussed their problems and addictions. What impressed me was the willingness of the authorities at Gordon House to help these men through their addiction, remove them from gambling altogether and get them back into society. It was also interesting to learn where the men saw the origins of their problem starting. Many first became addicted to gambling in the seaside arcades which they went to as children. I was attracted by the recommendations by the Budd committee which effectively proposed the elimination of gambling by children. I think we are the only country in Europe that allows youngsters to go into arcades and spend money. They are not spending money on the same scale as people do in the adult arcades, but there is considerable evidence that problem gambling starts in childhood and then continues.

By far the worst manifestations of the problems of the residents of Gordon House lay in the fixed-odds betting machines; almost without exception, they admitted that they had become addicted to them. I hope very much that my noble friend will be able to say something about the Government review of the FOBTs, which have effectively created electronic casinos in so many betting shops.

On the casino regulations, I and a number of colleagues who I can see in the Chamber were members of a joint scrutiny committee. The noble Lord, Lord Clement-Jones, is right that the original proposition was for a free market, which was then slimmed down to eight plus eight plus eight, and then, in the dying days of the previous Session, the eight became one. It was the view of all the members of the joint scrutiny committee that if there were to be only one, the logical and best location for it would be Blackpool. When we visited Blackpool, we were impressed by the strength of support that we found among the local community, the local council and businesses. The only exceptions were a self-seeking organisation that already runs a gambling operation on the seafront which the noble Lord, Lord McNally, knows very well, and, I am afraid, one Liberal Democrat councillor who was fighting a lone crusade.

The joint scrutiny committee took the view that Blackpool had argued the case and had thought through very carefully the way in which regeneration of that very depressed town centre and the surrounding area could be assisted—not created—by the establishment of a regional casino or a resort casino, as we originally called it. That was supported by the evidence from Professor Peter Collins; there was also evidence from Australia that the one place where you avoid having large casinos with attractive machines is in deprived urban areas. It is much better to have an area to which people have to travel as a day trip or for a weekend holiday, such as a seaside resort, not in a city centre. So it was with utter astonishment that I read the report of Professor Crow’s inquiry, which turned down Blackpool and went instead for east Manchester. It seemed almost that he had turned the argument of the joint scrutiny committee completely on its head. He argued that a resort should not be chosen as it would not be possible to measure the social impact because the people going there would be visitors. Those are exactly the sort of whom that one would want in order to avoid the social problems. A consequence was the report of the Merits Committee, to which other speakers have referred, which contributed to the defeat of the order that we debated in this House in March last year.

As is well known, I was one of those who voted against the order with 12 of my noble friends. I have to say that I have not lost a moment’s sleep since. The judgment that we exercised on that day was vindicated very quickly by the announcement by the new Prime Minister that the plans for the regional casino would, first, be put on ice and then, latterly, were killed altogether.

The outcome is the statutory instrument before us. I still regret that Blackpool is not being given the opportunity to demonstrate whether regeneration can flow from the activity that a regional casino can create. It is unfortunate that the local authority is not one of those named in the order; perhaps it was short-sightedness on its part not—as a sort of each-way bet—to apply for one of the 16 as well. I am sure the noble Lord, Lord McNally, will say have more to say about this, but I hope my noble friend is able to say more about the package of regeneration which is in prospect for Blackpool. A number of promises have been made to that town and it is important that they are fulfilled.

If there is a decline in interest in the number of large and small casinos under this order, the Government could also give an undertaking that, if a local authority does not want to take one of these, an authority such as Blackpool should be able to come forward and take their place. I suspect that may be difficult; perhaps my noble friend can clarify that situation.

I certainly do not intend to vote against the regulations. It would be extraordinarily perverse of me to do so, having voted the way that I did in March last year. I wish the regulations well but hope that my noble friend will take on board some of the concerns expressed from all parts of the House.

My Lords, my view has not changed since the regulations were introduced. The Minister was unduly provocative when he announced that the Casino Advisory Panel did a good job. As the noble Lord, Lord Faulkner, indicated, for many of us it was a bizarre outcome—almost as bizarre for the Ministers who opened the envelope as for the rest of us. As the noble Lord pointed out, this process was looked at not by just one committee but three: the Royal Commission, the Joint Committee of both Houses and by Casino Advisory Panel. As the noble Lord indicated, there was much conflicting evidence against what that panel did.

Taking the lead from the noble Lord, Lord Clement-Jones, who analysed very well how the Government have handled this, we will not divide the House. I assure the right reverend Prelate the Bishop of Liverpool that this is not because, on the last occasion, I had the most reverend Primate the Archbishop of Canterbury here on our side. I do not count replacing Canterbury with Liverpool as any kind of demotion, but we are not going to divide this evening.

I remain convinced that PhDs will be earned by studying this process as a way not to legislate. Frankly, it has been a shambles—I will turn to that in a moment. I want to make two points. First, the Government have a moral duty to Blackpool. Had Blackpool been allowed to do what it requested eight years ago, and had tested the idea of a resort casino as a means of regeneration for a seaside resort, we would now be able to see the first outcomes of such a pilot project. Instead, Blackpool is faced with real problems. As the Government’s own regeneration task force said,

“Blackpool is in urgent need of comprehensive regeneration”.

The town has not sat quiet, waiting for something to happen. The task force has put forward a five-point plan for regeneration, but requires help and support from the Government. I will not delay the House by going into detail on the five-point plan but I want to highlight the idea of upgrading Blackpool and Fylde Further Education College, in co-operation with Lancaster University, into a university of the leisure industries. It makes a perfect fit for Blackpool and has no better endorsement than the Prime Minister himself. When he mentioned that he was no longer enthused by the idea of supercasinos, he referred to higher and further education as possible alternatives in a place such as Blackpool. I hope that the Government look seriously at that.

I hope the Minister has in his brief some indication of when Blackpool can expect action, not just words, on some of the proposals that have been put forward; for example, we are waiting for a decision on whether the theatre museum can be moved from the V&A, so that the funding can help to connect the Blackpool Tower and Winter Gardens complex with the seafront development. Those practical decisions need government action.

Secondly, there are regulations. In the previous debate, I made a guess, not with a great deal of expertise, that we would end up with about 300 casinos. That provoked the noble Lord, Lord Steinberg, from these Benches—he knows a thing or two about casinos—to see me afterwards and say, “No, you are completely wrong. I shall tell you why: casino operators do not operate casinos where they will not work and there are not 300 places in the country where they will work. I shall tell you something else: one of the results of this flawed legislation is that the 16 places, which are to have these new casinos inflicted on them, are the wrong places”. He mentioned two areas where he did not think there was a chance in hell of any respectable casino company wanting to operate. I checked with the noble Lord, Lord Steinberg, who unfortunately is absent—he had to be in Belfast today—and I believe that I fairly reflect his view that not all 16 may be taken up.

That prompts the question raised by my noble friend Lord Clement-Jones and the noble Lord, Lord Faulkner; that is, that if all 16 are not taken up, is there enough flexibility in this legislation, or can the Government use enough common sense, to reallocate those licences to areas that come forward? Secondly, as my noble friend asked, what is the scope for the Government responding with flexibility to the requests by the British Casino Association that, where there is a willing transfer of licences, 1968 licences could be transferred from one area to another?

I believe that some of the benefits, which would have come from a resort casino, could still be won by Blackpool, by attracting willing casino investors who would operate not just a stand-alone casino operation, as they would in many of the towns that are mentioned, but a resort casino, which, as I have seen operating in other parts of the world, would operate as the nucleus of an entertainment centre, a retail centre, a leisure centre and a restaurant centre. That is why there was such a strong argument for resort casinos. If we could have some action on those requests for regeneration and flexibility in licensing policy, Blackpool would be on the way to getting the help that it deserves.

In a previous debate, the Minister suggested that there was a difference of opinion between me and the two Members of Parliament for Blackpool. Perhaps I can put on record that I strongly support and admire the way in which Joan Humble and Gordon Marsden have fought for their constituencies. I pay tribute to their courage and determination—I know how government Whips operate at the other end of the building—in serving the best interests of the town.

Of course, there are problems with problem gambling. However, I am worried that this is a typical piece of legislation which has been drawn up by civil servants and Ministers who operate in a world a million miles away from the reality of casinos and how they operate. Most people’s only idea of a casino is seeing George Raft in an ancient B movie. As a result, this House and the other place have nodded through relaxations of our gambling law which need closely to be studied. As I said in the previous debate, you can drive through some of the poorest parts of our towns and cities, and pass betting shops that are now open until 9.30 pm and contain four gaming machines. They are there not to collect money for betting on horses, but because they take money out of the poorest areas of the country. They pose a far greater threat of problem gambling than the well regulated, closely watched ambience in which casinos operate.

I hope that we put these matters in proper perspective. One hundred years ago, Blackpool had the imagination and vision to establish the most successful seaside resort in Europe. It now needs a little help from its friends and it can do so again.

My Lords, I reiterate what was said by the noble Lord, Lord Faulkner of Worcester, and thank the noble Lord, Lord Davies, for the manner in which he has brought forward these instruments. It is so nice to see him at the Dispatch Box with a proper brief. If noble Lords throw their minds back to the previous occasion when we threw out these instruments, they will remember that he had to work off a letter, most of which we had all seen before the House sat, and cobble together a deal to try to salvage the Government’s casino policy.

It gives me great pleasure to be able to say that, for the first time in my parliamentary career, I completely agree with everything that the two speakers from the Liberal Democrat Benches said. That is an unusual comment from an old Tory dog like me. When I came into the House, I thought that the debate would take about five minutes as I had forgotten your Lordships’ capacity to dig up and chew an old bone. As the noble Lord, Lord Clement-Jones, pointed out, this is a classic example of a policy of the Government being in complete tatters: this is the end of the Government’s casino policy. If noble Lords take the trouble to look at the instruments in detail, they will see that they are confirmed by Section 175(4) of the Gambling Act, which carefully lists the one regional and the eight-and-eight casinos. That one regional casino, which, as noble Lords have said, was originally the flagship of the Government’ policy, no longer exists. What is left is a rump which, as the noble Lord, Lord McNally, quite rightly told the House, has been immensely damaging to Blackpool. I hold no brief for Blackpool, but I remember visiting it as a member of the scrutiny committee, as did the noble Lord, Lord Faulkner. I hold no brief to condemn Manchester for its bid. But they have both been treated appallingly by this Government. They were encouraged to bid for the regional casinos. As the noble Lord, Lord McNally, pointed out, in being rejected for the one regional casino, they have had no ability to bid for either the eight or the eight. So they have been doubly damned for doing an extremely good job—which is what happens in practically every area of this Government’s policy. It is pretty unpleasant and unsatisfactory.

As the noble Lord, Lord Clement-Jones, said, there has already been a significant growth in the number of casinos under 1968 Act. He gave quite a lot of figures; I am sure that they are very accurate and better than mine—I had worked out that it had been about a 30 per cent increase. One should put that in the context of what the Minister said in opening the debate. One of the primary purposes of the Act was to prevent the “proliferation of small casinos”—the Minister used those words—but that is precisely what we are seeing. It is therefore a complete and utter failure of government policy.

We passed the Gambling Act in 2005. Here we are implementing it three years later, or trying to implement it in a rather shambolic way. However, since 2005, the economy has turned significantly. Quite a few casinos have closed because the economic climate has changed. The smoking ban has led to a reduction in income of between 10 and 15 per cent. These are difficult times for any industry without it having a Government climbing all over it at the same time.

I, too, draw your Lordships’ attention and the Minister’s attention to the debate in the House of Commons on 25 March. My honourable friend Mr Malcolm Moss and Mr Don Foster from the Liberal Democrats both pushed the Minister, Mr Gerry Sutcliffe, very hard. It is clear from reading the debate—and I commend it to the House—that the Minister appeared to give an undertaking to work with the British Casino Association on its proposals to correct this. I hope that in winding up the noble Lord, Lord Davies, will confirm to the House that the Minister is going to do that. We have heard from all sides of the House—from this side, from the Liberal Democrats, from the government Benches and from the spiritual Benches—that this is a muddle, and a muddle of the Government’s making. They have an obligation to go a bit further to sort it out, which means talking to the industry that they have damaged.

The Gambling Act 2005 is now a fact—we have got it. The noble Lord, Lord Faulkner of Worcester, to whose judgment I bow, talked about the quality of regulations. There is no doubt that we have quality in our regulations. But I ask your Lordships to think back to the rich origins of this policy, in Sir Alan Budd’s report. He made it perfectly clear that we had, at that time, an extremely well regulated industry in this country. We still have one—the quality is there, but, my God, the quantity is there too. The amount of regulation that we have! The old Gaming Board did a very good job with 46 employees; I wonder how good a job the current Gambling Commission is doing with 200 or 250 employees. And at what cost! Who is paying for it? The industry is getting the same quality of regulation but at what an increase in cost. The consultation is now out from the commission on those costs, which are considerable. The industry is hurting from that, and I hope that the Government will take that into account.

While we are here, we may as well talk about the other primary purpose of this legislation, which was to regulate the most dangerous part of gambling, about which we knew little at that stage—internet gambling. The right reverend Prelate talked about the social damage that can be done when gambling gets out of hand. There is no more difficult area to regulate than internet gambling, and one of the singular purposes of this Act was to do that. However, thanks to old “Prudence”, our current Prime Minister, racking the tax rate up, not one single company has come from offshore to onshore to be regulated. That is another complete area of failure in this Act—a policy failure almost without parallel.

Again, we need to think about this in the context of what is going on at the moment. We have witnessed in the past 18 months a very significant collapse in the bingo industry, for a variety of reasons—one of which is smoking and one of which is the way in which the Government have treated slot machines. It is an important industry in lots of ways, especially social ways. A lot of old people spend their afternoons there, which they will not do any more because a lot of the clubs are closing. A lot of them have closed and more will close. Some of your Lordships may not like the slot machine industry in pubs, but slot machines paid the rent—and one reason why pubs are closing at the rate of 25 a week is because of the way in which the Government have handled slot machines. They need to look at that.

So we should not look only at casinos in this debate. We should look at these instruments as part of an entire policy—and one that is in complete tatters. It is another example of poor old Britain with a third world regulation system. That is pretty embarrassing for all of us—a major industry so damaged by this Government’s policy. We cannot do anything about that today, but we can help casinos. The Minister has the opportunity in winding up the debate to put at rest some of the concerns raised on all sides of the House today. I hope that he will do that.

My Lords, I was prompted to take part in this debate by a brief remark made by the noble Lord, Lord Clement-Jones, on the Liberal Democrat Front Bench. He remarked that Luton had three casinos. In 1968, when there was legislation on casinos, I was the Member of Parliament for Luton, at which time we had one casino—which was called, rather grandly, Caesars Palace. I think that that was perhaps overdoing it, but I used to go there on a Friday night, though to the cabaret, not the casino. I can say that because I am not really a gambling man. My parents were great race goers and would go to the races throughout the Scottish circuit, to half a dozen or so races. When I became a teenager and likely to follow my father in his footsteps he said, “Look Willie, don’t go to the races”. I said, “Why not, you go?” He said, “You may have noticed that it’s the bookie’s wife who has the fur coat, and not your mother”. So I am a reformed non-gambler. I buy a lottery ticket now and again in the hope of being able to join the opposition Benches, but that is another matter.

When the 1968 legislation was going through Parliament, the proprietor of Caesars Palace—who was not a Roman—came to me for assistance. He explained all the good things that his casino did. It was rather like drawing in the argument—quite a relevant one—about regeneration. Regeneration had not been invented in 1968, but he would have used it had it been so. Casinos did good work for old age pensioners and that kind of thing. His name was Ivor. I said, “Look here, Ivor. I'm on your side. The vast majority of my constituents in Luton like gambling and they like going to casinos. This is an enjoyment of theirs with which we should not interfere”.

Caesars Palace was at that time threatened with the hatchet. As noble Lords will remember, because of threats from the Malta Mafia who were thought to be overwhelming the casino and gambling operations in this country, the number of casinos was to be reduced. I managed to persuade Jim Callaghan, who was the Home Secretary and who I knew quite well at the time—my old friend the noble Lord, Lord McNally, did too. He was persuaded that good work should be allowed to continue—not the good work of quasi-regeneration, but of allowing my constituents the enjoyment they wished for, which was to gamble and have a lot of fun. The British people have been doing that since time immemorial. Why should they not?

The gambling business has been tightly regulated. The noble Lord, Lord Faulkner, drew attention to the small group who suffer from gambling, but the great majority do not. It is a public enjoyment that should be allowed to be publicly enjoyed. The less regulation there is the better. I think that about many other aspects of our society as well, but let us not get into that.

I make only one further observation, which is irrelevant and nobody should really listen to it. The Minister will recall the late John Maynard Keynes. Does it rhyme with cleans or canes?

Canes.

Milton Keynes rhymes with cleans and John Maynard Keynes rhymes with canes. Anyway, he described the Stock Exchange as a casino, and he was right. I know that I am a little wide of the regulations, but describing the Stock Exchange as a casino affects the entire finance industry where people bet on things. It is now described as betting on things, but it did not used to be. Would it not be more sensible to apply casino-type regulations to the Stock Exchange and the finance industry than to casinos and gambling?

My Lords, I first apologise for my late arrival to the Chamber. I often wonder at the consequences of massive investment in the west coast main line. I wish to make a brief contribution on behalf of the city of Manchester, because if an overwhelming case has been made for Blackpool, the case for Manchester is absolutely overwhelming.

The right to license a regional casino was the subject of one of the most intensive national competitions for many years. The recommendation that Manchester should be awarded the right to license a casino followed an independent review, which was fully endorsed by the Government. All the bidders for the regional casino licence promoted their proposals on the basis of the significant economic benefit that would be generated by the proposals. Manchester indicated that the total employment benefit would be between 2,700 and 3,500 jobs, with the vast majority being made available to local people. This level of economic impact was also validated through the independent process.

The decision to change policy where the regional casino is concerned has been, to say the very least, a major disappointment in the city of Manchester. Two issues have caused particular concern. First, the report produced by the Secretary of State for Communities and Local Government, which is often quoted by Ministers as the reason why the regional casino will not go ahead, did not consider the specific impacts of a regional casino in Manchester. It also did not conclude that other means of regeneration would be a better way of meeting economic and social need. Most of the evidence base quoted in that report was available to the Government and others before the Gambling Act was enacted. In my view the report does not provide any justification for the regional casino decision.

Secondly, it has also been stated that the regional casino decision is what Parliament called for in March 2007. In my view, that is not the case. The Commons agreed the recommendations and, while by a small margin the Lords did not, the resolution that was passed criticised the terms of reference of the Casino Advisory Panel and its concerns applied with equal force to the large and small casinos, given that the same terms of reference applied to all the casinos.

The House of Lords Merits Committee drew the particular attention of the House to the grounds on which it may imperfectly achieve its policy objectives. The reason for the report is that the Merits Committee was concerned in 2007 about the process for arriving at a recommendation in relation to all 17 authorities, and no new process was conducted to arrive at this list of 16 authorities. The report draws special attention to two factors in particular: whether the Casino Advisory Panel’s interpretation of its terms of reference and the list of authorities it recommended as a result sufficiently reflected the 2005 Act licensing objectives, and the fact that the locations chosen in the 2008 order may not necessarily provide the,

“best test of social impact”.

The House of Lords demanded a review of the process, not the abandonment of a regional casino. That review should apply to all casinos, large and small, as well as the regional casino, and we have heard supporting comments for that today. Not to do so would be to say that large and small casinos are acceptable but regional casinos are not, without any evidence to support that position. I hope the Minister will reflect on that in his closing statement.

The Government have endorsed legislation to implement small and large casinos and a regional casino. However, they are trying to pick and choose which parts of the legislation they are willing to implement. For the people of Manchester, that is not acceptable. As a result, Manchester is being denied the opportunity to create up to 3,500 jobs for some of the most deprived communities in England. We have always accepted that if the regional casino was to be dropped, there was an obligation on the Government to put back the jobs they had taken away. As we have heard, a ministerial task force is in place to work with the city council to evaluate the opportunities, but it must come forward quickly with concrete proposals for investment and the jobs that go with it as a matter of urgency.

If the case has been made for Blackpool, as I understand it has, then it equally applies to Manchester, particularly because Manchester actually won the competition to have a regional casino. If the Government do not follow that route, they will be reneging on their commitment to the people of Manchester. I assure the Minister that unless the task force comes forward with proposals in the near future, this matter will not be left but will be vigorously pursued in both Houses.

My Lords, perhaps I may be allowed to chew—for the last time, I hope—on what the noble Lord, Lord Mancroft, called “this old bone”? Those of us on the Joint Scrutiny Committee have been chewing away on this bone and there is not much meat left.

If I may take a subjective view, I was on the Front Bench, now ably replaced by my noble friend, who has spoken so well today, I was on the Joint Committee, and I have done a bit of gambling in my life. I have rather grown out of it now. It is more a young person’s affair. I think that you can grow out of it, as long as you do not go completely bankrupt. On a sad note, two days ago I went to the funeral of a friend who had committed suicide. Gambling was a large component of his despair. It was compounded by drink and matrimonial problems, but gambling was definitely an important part of that tragedy.

Gambling has always been with me. When I was a boy at school, I had a penchant for gambling. That continued to my boarding school days, where I enjoyed the only profitable time in my gambling career, as the school bookmaker. In those days, it was a risky path, because public policy—this is very much relevant to what is before us today—came from the Victorian period and probably before, and decreed that gambling was a fact of life, but one that had to be watched carefully and indeed discouraged. That was public policy and it has now completely changed without anybody realising.

One piece of evidence for that is that gambling is now controlled by the Department for Culture, Media and Sport, rather than by the Home Office. When the department took on the weighty role of deciding what to do with gambling, it had to get some ideas. One idea was that gambling should be looked at in a modern way, because new Labour has always told us how modern it is—we have a somewhat jaundiced view of that now. We were told that gambling was a pleasant recreational activity; that a few people got damaged, but not very many; and that a committee under Sir Alan Budd would be given the task of guiding us forward.

Sir Alan Budd, without knowing a great deal about gambling, I gather, had the very good idea that what we should do, if we were going to encourage gambling, was at least get some regeneration out of it. One problem of the Government’s abject failure on this gambling legislation is that they have not managed to get precision on any idea. I could go through a list of aspects of the legislation where there is no precision, but I will take just two that struck me, and which have been mentioned today in the House.

One concerns harm to the vulnerable and the young. The young are particularly vulnerable. I have mentioned this outside the Chamber to the Minister and he listened very attentively. It has always been the Government’s contention that statistics show that the incidence of gambling harm in this country is one of the lowest in Europe. I asked him how they knew that. They know that because they have looked at some statistics. However, my friend who committed suicide was not a statistic—he had a gambling problem. By “problem”, I mean that you conceal things from your family, you spend money that you do not have and you lie to people—all aspects of addiction. Most people’s gambling problems are not recorded. I reckon that in this country we have a serious problem with the young and gambling. This can be seen in betting shops with what are actually gaming machines. They are called “fixed odds betting terminals”. What a British thing that is—to disguise a gaming machine with a completely unintelligible term. They are gaming machines.

There is so much to tempt young people. As was mentioned by the right reverend Prelate the Bishop of Liverpool, we are now reaching the stage where people—particularly those on low incomes—will have to budget very carefully for their normal costs. They will not have a surplus with which to gamble. The problem is that once you gamble and lose, you get caught up in a terrible vortex—I know; I have been through it. The Government have not been precise about that. I would not go so far as to say that they have tried to deceive anyone; I just think that they have been gullible. The worst legislation is that which goes on to the statute book as a result of the Government being gullible and uninformed, and I am afraid that that is the case with this measure.

The other aspect of the legislation that I want to mention is the lack of precision in relation to regeneration. Sir Alan Budd thought that regeneration would come about in seaside resorts as a result of them having casinos. However, with plenty of flexibility and so on, the change was made from seaside resort casinos to regional casinos. The idea of going for a weekend with a limited amount of money to a casino in a resort was swept aside, and the principle of not having gambling where people would come upon it accidentally on the street seems to have been forgotten. That was a major principle when we started our work in the scrutiny committee, and at the time it was agreed by the committee and the Government.

I agree with the noble Lord who said that the list of casinos is now very strange, although I shall limit my remarks to Torbay. I was brought up around Torbay. People used to call it the English Riviera. Torquay was built, like Rome, on seven hills. It was covered with trees and developed in the Napoleonic period as a naval station, but it is now one of the most depressed resorts in England. I do not know any resort that has deteriorated so much. Because of the seasonal aspect of life there, many people who run boarding houses and hotels are very short of money during the winter, and a lot of people who do occasional work for them lead a very low quality of life. What are they going to do in a casino in Torbay? I agree with the comment of the noble Lord, Lord Steinberg, a point to which my noble friend Lord McNally referred. I would not be at all surprised if that was one of the casinos that the noble Lord said he would not bother to operate—at least, I hope that he does not.

There is no regeneration to be had from gambling. Can anyone tell me where there has been any such regeneration, other than from an Indian casino in the United States? There is a special tax regime in the US, for reasons that I shall not go into now. The benefits do not filter down. In any case, the Government were unable to define regeneration. Even the Office of the Deputy Prime Minister did not seem to have any idea when it gave evidence to the committee, and local authorities did not know either. American companies, which know a thing or two about this subject, said that we would not get any regeneration out of gambling. They said, “Forget about gambling. Go for entertainment and put a bit of gambling in if you like. That might add to the mix but it’s entertainment that will regenerate if anything does”.

I have had my chew on the bone and, as usual, have enjoyed it. I think that this is a deplorable piece of legislation. The lists are ludicrous and the Government’s arguments are ill-informed, but the Minister who is to respond will, as always, be good-natured and pleasant to hear, and I look forward to his comments.

My Lords, I shall be brief. I apologise that I arrived late. Unfortunately, I had been led to believe that the debate would start somewhat later and therefore I apologise to the House. I have just three or four points to make.

I have never gambled and I loathe gambling. When I was chairman of the planning committee in the city of Leeds many years ago, throughout the duration of my office I never gave approval for any gambling outlet. Times have moved on and there is now all-party support in Leeds for the large casino that is the subject of this instrument, along with others.

On the question of regional casinos—in a sense, the dog that does not bark today but has barked although it is not here—I feel that Manchester was very shabbily treated, in part by your Lordships’ House. It was this House which effectively spelled doom for Manchester, not because of the desire not to have one in Manchester but rather the desire to push the case for Blackpool and so on. That is not a good way to take decisions. Rather than get on our high horse and blame the Government, we should examine our own selves on occasions. I hope Manchester is able to come back at some point.

A great deal has been said about destination gambling and regeneration. I firmly believe that gambling, as part of a major entertainment industry, is entirely capable, as the noble Lord, Lord McNally, said eloquently, of providing the basis for a major entertainment centre that includes cinemas and concert halls, with retail and restaurants and so on to support it. Your Lordships’ Merits of Statutory Instruments Committee, while quoting other research and by implication supporting that research, itself seemed to be very confused on the whole question of the best location for casinos. The idea that casinos should not be in urban areas—one could almost draw that conclusion—seems absolute madness. Blackpool would be an urban area in any case, and Manchester and Leeds certainly are. Whether they should be in a city centre or outside depends entirely on the nature of the urban area. To have a prescriptive view, as your Lordships’ Merits of Statutory Instruments Committee almost appeared to, seems inappropriate. The committee twice referred to the fact that the large casino in Leeds would be in the city centre. That decision has not been made and the city council asked me to bring that to the attention of the House. Whether or not the casino is in the city centre seems to me to be entirely a question of what is an appropriate location to have genuinely regenerative and developmental effects. That should be the criterion, not sitting in committees arguing about the fine points of different principles to apply.

Despite my opposition to gambling in any form, we are where we are now. I regret that Manchester has been badly let down and I hope that it is able to come forward again. I hope the Minister is able to give some reassurance that as and when a major proposal for regional casinos comes forward in future, this will be looked at in a way that gives Manchester a fair crack of the whip. Meanwhile, I shall certainly support these instruments.

My Lords, I owe an apology to your Lordships’ House, in the same way as has just been confessed, as a result of the railway system. I had an appointment at 3.15 pm today of a long-standing nature in relation to Northern Ireland which I was unable to break. Therefore, what I have learnt about the debate, I have learnt in the relatively short time that I have been in the House since I arrived, but because of history, I would be sorry not to make a small contribution to this debate. I see a number of former colleagues in the House from the pre-legislative scrutiny committee. When we assembled, I can recall feeling, in a spirit of all honesty, that I ought to declare an interest as the holder of a telephone account with Ladbrokes, and I do so again today. It is an account which I use only for the Grand National and the Derby and an occasional political bet. In the aftermath of our pre-legislative scrutiny committee report, the Daily Mail made me out, on the strength of this account, to be some form of gambling degenerate. All is fair in love and war and you take these things in your stride.

My own involvement in the story goes back nearly 50 years, when my late noble kinsman was Home Secretary and felt that it would be desirable to have the opportunity to make a disguised visit to Soho. He was taken around for about a hour by an inspector from the Saville Row police station, seeing all aspects of Soho life. At the end, my late noble kinsman said to the inspector, “It did not seem to me that we were recognised anywhere. The only place I thought that we were recognised was that shiny cellar, where it seemed a game—whatever was being played—had a strong resemblance to gambling”. The inspector said, “I feared, Home Secretary, that you would notice that. We think it is probably gambling, too, but the game is so complicated that we are absolutely convinced that we would not be able to explain it to a metropolitan magistrate. Since money is only changing hands within the Chinese community, we think it is all right to turn a blind eye to it, particularly as it is below ground”.

As I say, I have lived with the narrative of these dramas for a long time. I fast-forward to my 24 years as Member of Parliament for the two Cities, which obviously included Soho. In the constituency, 4,500 were then employed in the gambling industry. That would make it a major constituency employer in most constituencies; in the two Cities, it is 0.6 per cent of the total employed population and therefore very much a case of business as usual. Nevertheless, it has given me an insight, through my constituents, into the industry.

After joining your Lordships’ House, I was conscious, both from the constituency and the continuance of the narrative, that government policy not only on gambling but also on alcohol licensing—obviously a related matter to come extent, which in the course of the narrative transferred from the Home Office to the Department for Culture, Media and Sport—seemed to be taking a long time to work out what it wanted to do. We were constantly being asked to respond to consultation papers; I include the Home Office in that. There was therefore a certain discontinuity in the narrative.

We had a debate in your Lordships’ House where the proposition was put forward that there was a lack of philosophical principle behind the present Government, a Motion moved by my noble friend Lord Patten. I said in that debate that leaders of the Labour Party have historically and correctly said that there was much more in the history of the Labour Party from Methodism than from Marxism. That was at exactly the moment that the larger-scale ambitions of the Government for the gambling industry were emerging. It looked as though the Methodist elements of the Labour Party’s history were becoming a little diluted.

The pre-legislative scrutiny committee was then set up. One of the immense pleasures of serving on it was the company of a number of people in this House, including the noble Lord, Lord McIntosh, whom we were able to cross-examine as a Minister within the procedure. The confusion and discontinuity to which I was referring were further compounded at that stage by the fact that the Office of the Deputy Prime Minister had clearly not got its planning policy together in conjunction with the work we were doing. That of course produced the unique precedent that we actually had to sit again once it had got its policy together, after we had initially reported.

On the past 10 years—obviously not on the circumstances that led up to 1968 and the decisions taken then—all I can say is that the discontinuity and the fact that decisions have been reversed and there have been changes of policy may all have been for the good, but have actually imposed considerable strain on the gambling industry because of the uncertainty with which it has had to live.

My one plea to the Government, in the decisions taken from now on, is to have sensitivity and, indeed, charity toward the industry given its experience.

Obviously, I share the response to Blackpool; equally, I can understand the problems in Manchester but other places around the country have been the victims, too, of this uncertainty. May the Government bear that in mind, so that we can have a happy end to this story rather than one that has not been altogether tidy along the way?

My Lords, I am grateful to all noble Lords who have participated in this fascinating debate, although I feel that I am dealing somewhat with Winston Churchill’s famous pudding. I am not quite sure where the theme is, particularly when I hear it suggested around the House that all sorts of noble Lords who usually disagree with each other are agreeing on points today. Those points all seemed fairly narrow at that stage; they do not lead up to a general theme to which I can so readily reply.

If I may, I will concentrate on responding to the discrete points that have been made, and through that I hope to portray a thread of consistency on the Government’s position. After all, I have already outlined that in my opening statement and do not have a great deal to add to how I began the debate on the virtues of that position. The criticisms that have been voiced do not lead to a conclusion in any way, shape or form, so this regulation and the order ought to be supported.

I agree, of course, with what the noble Lord, Lord Brooke, indicated a moment ago; it was reflected in the debate that the issues regarding gambling are complex and challenging. He was, after all, buttressed by my noble friend Lord Woolmer indicating some fluctuations over the years among certain local authorities. That was one consistent theme; while it is all right for noble Lords to say, “Well, it’s absolutely clear what the nation wants”, in rather a negative stance on some of these issues, that is not the voice of the people as represented by their local authorities. Where do your Lordships think that the applications have come from, if not from a succession of local authorities representing their people?

It is important to respond to that aspect of the disappointed position on Blackpool that the noble Lords, Lord McNally and Lord Clement-Jones, reflected. My noble friend Lord Bradley also indicated that Manchester was disappointed with the decision. Let us get one thing clear: the legislation allows for only one regional casino, so there is no compromise suggesting that the Government could think about it and produce two answers to which should be chosen. They could not, for the legislation binds us to one.

Did this Labour Administration only ever want one regional casino? No; we had proposed more than one, but in the famous wash-up period prior to the 2005 general election it will be recalled that the Conservative Opposition insisted on there being only one. Let me be clear: if it is suggested that the Government lacked a policy in this area: there are a number of significant constraints in the legislation creating our difficulties.

I am not going to discriminate between the rival claims of Manchester and Blackpool. Talk about going over the old bones that the noble Lord, Lord Mancroft, referred to! That would be something to chew. I agree that it is important that Manchester put forward its case to obtain the regional casino and that Blackpool was unable to sustain its case, even though we all knew it had advantages in its need for regeneration and its strategy to address it. On both those cases, I am in agreement. So are Ministers who count more than I do in the Administration, and they are determined to ensure that Blackpool gets the resources it needs.

My Lords, the Minister has half-interpreted the proposals of last March correctly, but he has to admit that there was a second level to the proposal, which remitted the decision on the supercasino to a joint Select Committee. The Government have acted in a way which means that no supercasino goes ahead.

My Lords, as I have indicated, I am not prepared to go back to the statement that the Secretary of State made. We are going over enough old ground now.

My Lords, with all due respect to the Minister, that is exactly what he was doing.

My Lords, my arguments were somewhat different from that expressed in the statement, but I accept the chiding from the noble Lord. I have strayed on to that ground and it would be better, and probably safer, if I went no further down that road.

The noble Lord, Lord Mancroft, indicated that he thought the Government needed to talk to the British Casino Association because there are outstanding difficulties. I assure the House that we recognise that fact. We are continuing discussions. There are a number of issues on which we need to make progress. I assure the noble Lord that Ministers are in regular contact with the British Casino Association. The noble Lord also raised the thorny issue of regulating internet gambling. It is difficult. After all, we all recognise anything to do with regulation of the internet as a challenge to all societies when the internet provides for the development of activities about which there may be strong reservations. I indicate to the noble Lord that only three internet gambler organisations have permission to advertise in the United Kingdom. We are able to regulate advertising. The advertising that appears indicates that those bodies meet certain criteria. However, I recognise the warning signs that he has given with regard to internet gambling and I have referred to his points about the bingo industry.

My noble friend Lord Howie delighted us with his account of Luton and its provision. He indicated that Luton casinos are fairly modest but also the source of much benign entertainment in their locations. My noble friend is right: the whole of this debate inevitably is about the area of greatest difficulty—gaming and casino action—but casinos attract people as places of broader entertainment. We should not underestimate the extent to which many of our fellow citizens are eager to go out and enjoy themselves at casinos, with gambling playing a relatively small part in the evening.

I have mentioned that my noble friends Lord Bradley and Lord Woolmer both thought that Manchester had been treated badly. There has been a consequence to that decision to which I give an assurance that the Government will respond. That is why we have established the working group. I do not know the site as well as my noble friend, who was a representative for central Manchester for so long, but east Manchester is an area which needs significant regeneration and huge resources and it is important that the Government give support to Manchester in its rightful ambitions.

The noble Viscount, Lord Falkland, suggested that regeneration was scarcely the theme of casinos. If that was so, local authorities would not have applied for casinos. I went to several presentations in the company of representatives of local authorities, one or two of which eventually made the list. Many fell by the wayside. There were more than 100 applications, as I recall—I am speaking from memory—and the local authorities would grill experts on the gambling industry and economists about the potential regeneration opportunities. They carried out that exercise with the full responsibility of being elected councillors and they reached their conclusion that their bids were right for local people.

I reiterate the fact that much sporadic criticism has been made of the Government’s position with regard to this order. The House knows that this is not the order the Government first presented and will recall the occasion when the original order was rejected. The Government are responding to the proper applications of 16 local authorities to present their cases for casinos in their areas for the benefits they have identified. We are responding to that with this order. The Government are also placing an emphasis on the other issue before us today and are determined that the Gambling Commission and the legislation should protect the vulnerable. Problem gambling is showing no significant increase since the passing of the Gambling Act. Indeed, it looks as though there is a marginal improvement among young people. I am well aware that I am basing such propositions on limited evidence over a short period of time, and therefore cannot be held to them to any great extent, but I emphasise that the Government are concerned that gambling should be carried out responsibly and within a framework where opportunities occur for mature people—not children—to enjoy themselves while at the same time safeguarding those whose interests need to be safeguarded.

My Lords, the Minister has put on a bravura performance this afternoon but there are many questions raised by noble Lords that he has not answered. I refer to the issue of flexibility for Gaming Act 1968 casinos and the whole question of the review of stakes and prizes, to name but two. If he cannot answer now, will he undertake to write to noble Lords who have raised questions?

My Lords, I hope that the Minister will not answer those questions, which are nothing to do with the instruments.

My Lords, Ministers ancien should stay ancien and Ministers present should deal with questions as they are put to them. The Minister was also asked whether there was any flexibility about what happens if any of the 16 change their mind. What happens to those as well?

My Lords, I thought I showed great restraint.

My Lords, I am grateful for help and advice from whichever quarter in the House it comes. It just tends to come more frequently from the Benches behind me and perhaps more pertinently.

Inevitably with this debate, it went wider than the two issues in the order and regulations. I want to suggest to the noble Lord, Lord Clement-Jones, that in our discussions with the British Casino Association it is exactly the issues he has raised which need to be considered further. Ministers are exercised about these matters because the representations have been made and we are aware of the points that have been made in this debate.

With regard to the question of whether a 17th can be added to the 16th the answer is no. The order names the successful authorities. If there were a question at all of one being substituted for another we would have to bring a new order before the House. There is no more an easy sleight of hand with regard to this order than there was any suggestion that one could easily substitute Manchester for Blackpool in the previous order; and look where that left us.

On Question, Motion agreed to.

My Lords, I beg to move the Motion standing in my name on the Order Paper.

Moved, That the draft order laid before the House on 26 February be approved. 12th report from the Joint Committee on Statutory Instruments, 14th, 15th and 19th reports from the Merits Committee.—(Lord Davies of Oldham.)

On Question, Motion agreed to.

House adjourned at 5.18 pm.