Skip to main content

Grand Committee

Volume 703: debated on Thursday 17 July 2008

Grand Committee

Thursday, 17 July 2008.

The Committee met at two o'clock.

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) in the Chair.]

It has been agreed that should any of the Questions for Short Debate not run for their allotted hour this afternoon, the Committee will adjourn during pleasure until the end of the hour. Therefore, each of the Questions for Short Debate will start on the hour. If there is a Division, the Committee will adjourn at the sound of the Division Bell and resume after 10 minutes. The 10 minutes thereby lost from the debate will be added to the debate thereafter.

Health: Hospital-acquired Infections

asked Her Majesty’s Government what plans they have to reduce hospital-acquired infections.

The noble Lord said: Healthcare-associated infections affect approximately 9 per cent of in-patients, cause at least 5,000 deaths per year and contribute to a further 15,000 deaths a year. Furthermore, 300,000 or more patients acquire non-fatal infections that prolong their stay in hospital. In England alone, this leads to a loss of 3.6 million bed days, at an estimated cost of £1 billion per year.

Regular headlines in the media such as:

“How dare we let these dirty hospitals kill 8,000 a year?”,

cause a great deal of public concern. It is not surprising, therefore, that patients are concerned about going into hospital for treatment for fear of catching these infections, which may prove fatal.

There are several infective agents responsible for healthcare-associated infections. The two that are currently of major concern are meticillin-resistant staphylococcus aureus—MRSA—and Clostridium difficile, or C. diff. Others are glycopeptide-resistant enterococcus—GRE—which can cause blood poisoning; norovirus, which causes mild, short-lived gastroenteritis, the so-called winter bug; and various pseudomonas species, which cause a range of illness, mainly in the elderly. I have no doubt that unless we have a successful strategy for controlling healthcare-acquired infections, there will be other infective agents in the future, possibly even more deadly than the ones we have now.

Government policy currently focuses on infections due chiefly to MRSA and, to a lesser degree, C. diff. Staphylococcus aureus is a common bacterium, found in skin or mucosa. MRSA is a variety resistant to antibiotics, including meticillin. About 3 per cent of people are carriers. Infections occur when bacteria enter the body or bloodstream, usually via a cut or catheter, commonly during surgery via wounds or ulcers. They can also do so via intravenous catheters or breathing tubes. They cause deep abscesses or septicaemia.

Clostridium difficile, or C. diff, a bacterium found in the gut of 3 per cent of adults and nearly two-thirds of babies, is harmless in healthy people, but in ill, elderly patients, and in conjunction with antibiotic therapy, can cause severe colitis, perforation of the bowel and death. It is highly infectious and, importantly, spores shed in faeces are hardy and survive for long periods on surfaces such as toilets, sheets, beds and floors. Both MRSA and C. diff are transmitted from person to person and may be picked up from environmental contamination.

From what I have just said about the nature of transmission of infection by these organisms, it is clear that simple measures of cleanliness—personal and environmental—judicious use of antibiotics, and a stringent policy of “search and destroy” can drastically reduce the incidence of such infections from 9 per cent of in-patients to as low as 1 per cent.

The UK is one of the worst countries in western Europe for the incidence of MRSA and C. diff infections. So do we have a policy that will change that? To know whether we have an effective policy, we first need good surveillance. Since the introduction of mandatory reporting of MRSA and now C. diff infections acquired in hospitals, the surveillance of hospital-acquired infection is now reasonably good but not accurate. On the other hand, for healthcare-acquired infections acquired in the community setting, surveillance data are poor. That is particularly important, as more healthcare is now delivered in the community, so I ask what plans the Government have to collect information on community-acquired healthcare infections.

Healthcare-associated infection as a cause of or associated with death is also poorly recorded on death certificates, as was the case in the Clostridium difficile outbreak in the Maidstone and Tunbridge Wells NHS Trust. The death certificates did not indicate that the patients had died of C. diff infections.

What is the extent of MRSA and C. diff infections? For MRSA blood-stream infections—so-called bacteraemia—in the financial year 2006-07 the numbers were 6,381. Data from 2007-08 are not yet available, unless the Minister has them today. The trend has been downwards except for the last quarter, October to December 2007, which showed an increase of 0.6 per cent on the previous quarter. The Government have a target of halving MRSA blood-stream infections from 7,700 in 2003-04 to 3,850 or fewer in 2007-08, unless the target measurement was not as I understood it. Will the Government meet that target? Maybe halving the rate of 2003-04 was ambitious, but it is important to maintain the pressure to drive down the rate.

For C. diff, the surveillance data are difficult to interpret due to changes introduced over time. Between 2004 and 2006, the numbers of C. diff infections rose from 44,000 to 55,000. Quarterly data for October to December 2007 compared to the same period in 2006 showed a 26 per cent reduction. The Government introduced a target for C. diff in 2007 of reducing the number by 30 per cent by March 2011—nearly three years away—from baseline 2007-08. Again it is unclear how the target would be measured. I seek clarification from the Minister.

Have we got the policies to achieve the targets and beyond? In 2002, we had the CMO’s Getting Ahead of the Curve strategy, and many other follows. In 2003 there was Winning Ways, in 2004 Towards Cleaner Hospitals, in 2005 Saving Lives, in 2006 Essential Steps to Safe, Clean Care, in 2007 Saving Lives: Reducing Infection, Delivering Clean and Safe Care, and in 2008 Clean, Safe Care: Reducing Infections and Saving Lives. They outline plans to introduce MRSA screening for patients but not staff, deep cleaning and additional specialist staff to tackle infection. In addition, we have the Health Act 2006, requiring NHS trusts to follow recommendations and the Healthcare Commission’s annual checks. There are also financial penalties and incentives. Certainly, there is no lack of commitment to tackle the problem of healthcare-acquired infections.

So are the policies and strategies effective? Despite lack of strong evidence of environmental contamination and infection rates, the policy related to hospital cleanliness and deep cleaning is right. Clean hospitals instil public confidence and a culture of the importance of hygiene in staff. If there are any concerns, it is about whether deep cleaning is carried out in all areas of hospitals, how often it is and should be carried out, and what agents are used.

Countries that have very low levels of healthcare-acquired infections have stringent policies for monitoring levels of environmental contamination and decontamination. While there might be contrasting views of deep cleaning as an effective strategy, there is no doubt that hand hygiene is the single most effective measure for controlling the transmission of infection in all healthcare settings. I declare an interest as chair of the National Patient Safety Agency, which is responsible for the cleanyourhands campaign.

Hand washing with soap and water and use of alcohol gel after each and every patient contact have to be more actively enforced in healthcare, as they are in the food-handling industry. In my view, to cause a death by transmission of infection is in the same category as death caused by wrong diagnosis, treatment or bad surgery. The clinical professions need to accept greater responsibility.

The policy of “bare below the elbows” may facilitate hand washing, but the removal of clean, hospital-provided white coats and nurses’ uniforms on a daily basis is a retrograde step. On the other hand, the wearing of operating-theatre and ward clothing in cafeterias and other public areas in hospitals should be prohibited with sanctions.

The most recent government policy relates to the introduction of patient screening for MRSA for elective admissions in 2008—I do not know when in 2008—and for emergency admissions during the next three years. Countries that have low levels of infection have not only policies of screening all patients and staff but also low bed occupancy, low levels of workload for nursing staff and a strict policy of isolation of infected patients.

Strategies that we are slowly beginning to adopt have still some way to go. The public are rightly anxious about healthcare-associated infections. Patients fear going into hospitals. Any Government who deliver clean hospitals, healthcare in a clean and safe environment and effective infection control policies, followed and adhered to by all, will remove healthcare and the NHS from politics. Would that not be a prize worth having?

I thank my noble friend Lord Patel for this short but important debate. He chairs the National Patient Safety Agency, which campaigns to improve patient safety. What can be more important? One of its projects was cleanyourhands, a national campaign to promote better hand hygiene in hospitals that began in 2005. In 2007, the programme was extended to other providers such as care homes and community clinics. If the campaign does not exist in schools, it should. Children should grow up realising how dangerous it is not to wash their hands, especially when handling food after going to the lavatory. People from eastern Europe whom I employ at home seem to wash their hands much more than British people.

Washing one’s hands with soap and water is the best way of protecting patients, as the gel does not work on the highly infectious Clostridium difficile. I have heard of nurses who have gone from patient to patient while not washing their gloved hands. They think that washing is not necessary if they wear gloves.

The wife of a severely disabled man in Yorkshire who had had MRSA and is fed by a peg in his stomach asked a nurse whether her husband had had a check to see whether he still had MRSA. The nurse said, “Well, if he does have a check and it is positive, it will give us a lot more trouble as he will have to be barrier nursed”. I wonder how many such cases there are across hospital trusts. Infection control nurses should be able to take responsibility and have great support in stopping such dangerous attitudes among such lazy nurses.

Much has been done in the past few years and the Government have tried hard to reduce hospital-acquired infections, but there is much more to be done. One still hears of sloppy practices such as that described to me by the wife of a high-lesion tetraplegic man. Her husband had a chest infection and had gone into hospital. On the Friday, when he went home for the weekend, his sputum jar was sitting on a shelf by his bed, but when he returned on Monday morning it was still there and had not been emptied. In the old days, a sister on the ward would have seen that such things were done and jars not left unclean.

The grandson of one of my friends was admitted to the Freeman Hospital in Newcastle for a serious heart condition, aged one. The operation took many hours and was a success, but unfortunately he contracted MRSA. The family cannot praise the hospital team enough and, after many critical days, little George pulled through. Hospital infections put extra strain on everybody. In this case, a dedicated skilful hospital team and the family had much more anxiety due to MRSA. Does the Minister agree that prevention of hospital-acquired infection should be at the top of the agenda?

It is said that patients should be screened when they come into hospitals or care homes, but should not the medical and nursing staff be screened as well? If they are working with vulnerable patients, how many might become carriers and put patients at risk?

One often hears of bad practice such as clean laundry being brought in and left beside dirty laundry. Surely it is possible with such a large staff to put in a manager who could take responsibility for seeing that good practice takes place.

I am pleased to be associated with the National Concern for Healthcare Infections, which aims to raise awareness, and give support, on patient safety. It asked me to be its patron, and I accepted. Does the Minister agree with the guidelines to tackle hospital-acquired pneumonia? This is the most common hospital-acquired infection in intubated patients, increasing mortality by up to 75 per cent. When hospital-acquired pneumonia is caused by bacteria, treatment will always be with antibiotics. However, the increasing problem of antimicrobial resistance, largely due to inappropriate use of antibiotics, has made its management more complicated and has led to a rise in hospital-acquired infections as a whole.

A key driver in developing the guidelines was to minimise the number of preventable deaths from HAP due to any cause. The new guidelines set out the importance of prevention, diagnosis and early treatment and ensuring the right antibiotic is used at the right time. There should be fast-track testing and results, otherwise wide-spectrum antibiotics will continue to be used. What chance is there of this action happening?

Consideration needs to be given not only to acute NHS trusts which provide general facilities for the public, but to specialist hospitals which treat patients who are susceptible to many other infections, including campylobacter—with almost 50,000 patients affected in 2006.

Many impaired people are susceptible to the development of pressure sores. This presents another avenue for bacteria, such as MRSA, to enter the bloodstream or infect the skin around the lesion. As president of the Spinal Injuries Association, I know the terrible problems pressure sores can have for vulnerable patients treated in hospitals which do not have the correct equipment, such as turning beds and pressure-relieving mattresses. I hope that the new Care Quality Commission will include precautions being taken by healthcare establishments to prevent pressure sores in its assessment and inspection regime.

The terrible problems of the virulent strain of 027 Clostridium difficile have been highlighted by the Healthcare Commission’s reports on Stoke Mandeville Hospital, and Maidstone and Tunbridge Wells. Is C. difficile a notifiable condition? There is some confusion over whether notification is voluntary or statutory. Can the Minister make this clear?

Many infections put patients at risk, such as E. coli, Klebsiella, wound infections other than MRSA and many others. If infection prevention and control measures in hospitals are to be successful, this area of the budget should be ring-fenced, in terms of staff employed in infection control, developing general staff awareness and training in good practice for all staff who directly or indirectly come into contact with vulnerable people. Without adequate finance to support measures identified as the result of professional research, these initiatives will flounder.

Many projects need looking at. I have recently had correspondence with Dartex Coating about the product Silver 3, a coating for hospital mattresses for which it is claimed that tests have shown that it kills 99.9 per cent of MRSA within 24 hours. Dartex believes that Silver 3 can play a major role in combating hospital-acquired infections. I hope that more research will be done on these matters.

MRSA does not like cold conditions. Should hospital floors be washed with iced water? The elimination of hospital-acquired infections would improve the dignity of life for vulnerable patients as well as their quality of life, which can be shattered if they get an infection such as Clostridium difficile. The Darzi report stresses the quality of care. If this is to be taken seriously, infection control must be the top priority.

I also thank the noble Lord, Lord Patel, for giving me the opportunity to get involved in this subject, which I do not normally do. I come from a medical family; my father was a GP, my mother was a midwife and my brother is a GP. I was the black sheep of the family who went into commerce and then, even worse, into politics. At least I now have a chance to make a contribution to the area.

We are all aware as citizens of the astounding statistics, of which the noble Lord, Lord Patel, has mentioned a number: the 300,000 cases of hospital-acquired infection per annum; an estimated 5,000 deaths; the UK’s performance being the fifth worst of 29 European nations; and a potential cost of £1 billion to the NHS. Even more important, as the noble Baroness, Lady Masham, said, is the movement of resources and skilled people into coping with those areas rather than those with which they would rather be dealing. Statistics that came out today include some 10,000 C. difficile cases over a quarter year and, over the past four years, 200,000 cases of C. difficile and 20,000 cases of MRSA.

Although those statistics are staggering and abrupt in their own way, the issue is more important than that. These infections, in particular, bring real fear to those who must deal with the NHS and are not well. Over the past couple of years, people have, for the first time, hesitated about being admitted to hospital. We cite the statistics, but there are people who have decided not to have hospital treatment because of their concern about this area.

As people in politics and Parliament, we must ask ourselves whether that is because of the tabloid press scares, like the scare over street crime, which is a real issue in certain areas but does not necessarily affect where we are and our lives. Is people’s fear greater than the risk? I do not think it is, because even I know a person who died and other people who have been affected by these diseases. It is far less remote than many other things that we get involved in.

What are the issues here? One of the causes is the problem with cleanliness, but I have been aware for some time of the abuse and overuse of antibiotics. When I was a youngster, I was put on tetracycline—I can still remember its name and think it is an antibiotic, but perhaps it is not—for some three years, just in case I reacquired an infection that I had had earlier. I am sure that practice would not now be acceptable. We used antibiotics regularly in veterinary care. We fed animals antibiotics to make sure that they did not stand a chance of getting infections. Clearly, the mismanagement has meant, as the BMA put it in one of its documents, that life-saving technology has become life-threatening. Is the Minister confident that the management and use of antibiotics for humans and animals means that that is no longer a problem? We have that problem with malaria, in particular.

I am sure that my mother would have been concerned by the way that cleanliness got decoupled from medical care in hospitals and similar establishments. I am sure that the focus on that is much better because we have seen the improving figures on these infections over the past year. However, I question whether cleanliness is at the heart of medical as well as administrative practice. Having been in hospitals a number of times over the past year because of a family member, I was struck by how little the washes, which we do not think are completely effective, were used by visitors and medical staff when moving around hospitals.

Does the Minister believe that screening patients as they come in and isolating them if necessary is successful? Does it need to be applied more? Where are we on that?

My other concern, which comes from my management career, is about judging people against targets. It is right in principle, but there are unintended consequences of keeping targets in place for too long and managing people’s performance too carefully. One aspect of that is the bed occupancy rate. What are the Minister’s views on the correlation between hospital-acquired infections and bed occupancy rates? The evidence seems to show that where the rate is above 85 per cent there is a positive correlation with cases of infection. I should like to know whether the Government accept that correlation. If so, surely that means that we have to manage the whole area of bed occupancy, which in every other way is clearly a measure of a hospital management’s efficiency. It can be fantastic but, if patients are killed on the way, that is not quite so good. It is a question of how we should look at those sorts of targets.

A final area on which I should be interested in hearing from the Government is nursing homes and homes for the elderly. Those come outside the hospital arena and therefore may go slightly beyond the subject of the debate, but they carry the same importance in that they have many vulnerable people facing similar threats. What actions are the Government taking and what plans do they have to deal with the problem in that area, which is not highlighted much, or perhaps greatly understood, in the media? Does the Minister see that as a threat to the reputation of healthcare more generally in this country? Most of all, we all want to see hospitals where patients—you and I—can be confident that they are going to be healed and will not feel that they are risking their lives even more by engaging in their services.

I congratulate the noble Lord, Lord Patel, on having tabled this Question and on the extremely powerful way in which he spoke to it. It is a question of the first importance for healthcare in our country. If we want a comparison to put the matter into proportion, almost three times as many people are killed by hospital-acquired infections every year as are killed on our roads. The figures look as though they may be on a downward trend and some encouraging statistics have been released today, which no doubt the Minister will be able to refer us to in detail. However, over the 15 years from 1990, the graph showed a massive rise. The increase in C. difficile infections was fiftyfold, and looking simply at the five years to 2006, deaths from C. difficile went up by more than 400 per cent.

It would be unfair to accuse Ministers of having done nothing. They have actually done an enormous amount. The problem has been that the various levers that they have pulled to try to stem the tide have had only a minimal effect so far. In 2002, as the noble Lord, Lord Patel, said, we had Getting Ahead of the Curve—the first of a whole swathe of strategies and action plans to improve hospital cleanliness, all of them with wonderful, optimistic-sounding titles. There was Winning Ways—Working Together to Reduce Healthcare Associated Infection in England in 2003; Towards Cleaner Hospitals and Lower Rates of Infection in 2004; Saving Lives: A Delivery Programme to Reduce Healthcare Associated Infections including MRSA in 2005; Essential Steps to Safe, Clean Care in 2006; and, this year, Clean, Safe Care: Reducing Infections and Saving Lives. On top of all that, we have had national guidelines, sanctions and targets. Each of these in its own way has been of unimpeachable worthiness, yet last year’s annual health check by the Healthcare Commission found a lower level of compliance with the three main standards in the hygiene code than in the previous year.

The noble Lord mentioned the cleanyourhands campaign. Good hand hygiene has been described as the single most important measure for controlling transmission in healthcare settings. Contrary to all the sound and fury generated on the subject of ward cleanliness, it now seems that there is not a simple or direct association between the visible cleanliness of a hospital and its infection rates. Of course, that is not to say that cleanliness should count for nothing—of course, it should—but it is not the most significant driver, so it appears, in the direction of travel.

Still less is it the case that a hospital’s infection rates can be linked to whether it contracts out its cleaning, or indeed how much its cleaning budget amounts to. Despite that, we recently had the deep clean initiative. There is no evidence that the deep cleaning of hospitals is a cost-effective use of funds. To be quite brutal about it, it is a populist gimmick. Dr Stephanie Dancer, an expert in microbiology, warned last year that deep cleaning would have only a very short-term impact. She was right. The Countess of Chester Hospital, which spent £300,000 on a deep clean, suffered a C. difficile outbreak four days later, when 26 people became infected. When he made the announcement last year, the Prime Minister promised that deep cleaning would be repeated at least every 18 months, but we now know from Written Answers that there are no plans to repeat the first deep clean exercise and no plans to assess how effective the first deep clean actually was. Perhaps that is understandable, because it turns out that the majority of hospitals did not use the key products recommended by the Health Protection Agency, such as hydrogen peroxide vapour. No one should think that deep cleaning of itself will make more than a tiny dent in the statistics.

One real criticism that I have of Ministers is that at intervals they have been guilty of instilling false hope and false expectations in the minds of the general public. I know that at party conferences hyperbole tends to intrude, but last year, when the Prime Minister launched the deep clean programme, he said that it was intended to,

“make sure every hospital is clean and safe”.

He should not have said that. Not only was there no evidence base for saying it, but no work had been done to assess how the £62 million that it cost to carry out the deep clean might have been more effectively spent.

In January, the Prime Minister went on the “Andrew Marr Show” and made an impressive-sounding promise. He said:

“If you go to hospital, you will get screened by next year for MRSA or C. difficile”.

There was no correction of that story from any government source, but two days later the Health Secretary's infection control strategy reported on C. difficile and said this:

“Screening for colonised patients is inappropriate. (Most potential cases would not be identified …)”.

In other words, screening for C. difficile is not going to happen, because it is pointless. Mr Brown should not have said what he did.

By contrast, screening for MRSA in high-risk patients is potentially very worth while. The Government have proposed that MRSA screening should be introduced for all elective admissions in 2008, and all emergency admissions as soon as possible after that. The problem here is that screening in a hospital setting is logistically complicated. For a start, you need enough space in which to isolate the carriers. Many hospitals do not have that, in part because they are constantly chasing the 18-week target for referral to treatment and the four-hour A&E waiting time target. Beds get full. Again, we have had extravagant promises about isolation facilities, first of all in Winning Ways, and then from John Reid in 2004, who assured us that new hospitals being built had more isolation rooms than ever before. But what do we now find? Last November the Health Protection Agency reported as follows:

“Three quarters of trusts indicated that they had problems implementing isolation policies due to inadequacies in the number and fitness for purpose of isolation rooms”.

Isolation cannot just happen at the wave of a wand. As the MRSA working group pointed out, conventional screening takes three to five days. There are rapid screening techniques, but they are expensive and difficult to perform in large numbers. Reducing rates of MRSA by screening is going to be an uphill battle.

The noble Lord, Lord Teverson, referred to bed occupancy rates. I do not think that one can cite them as the prime or only contributor to rates of MRSA infection. But what high bed occupancy often means is that hospitals are left short-staffed and pushed for time, so that hand hygiene is not always maintained. Increasingly, hospitals have had to resort to hiring temporary staff, whose knowledge may be more limited and whose access to sufficient training may be constrained by lack of time and resources. Significant or not—I leave the matter open—it is a fact that the Netherlands, which has a low incidence of MRSA infection, has a bed occupancy rate of only 64 per cent.

The noble Baroness, Lady Masham, spoke of the need for good management and leadership in hospitals. She is right but, as she knows, the issue goes deeper than that. The noble Lord, Lord Patel, was kind enough to give me an article from the recent Bulletin of the Royal College of Surgeons of England, which is called “Changing the Mindset on Hospital Infections”. That title encapsulates it. If we are to crack the problem properly, everyone, from the ward to the board, has to buy into it and see it as their problem, not someone else's. I hope that we will hear from the Minister about some of the ways in which hospitals are moving towards the sea-change in attitudes that is needed if patients are once again to feel confident—as they have a right to do—that hospital is a safe place to be.

I congratulate the noble Lord on securing today’s timely debate. As demonstrated by the passionate and well informed contributions, the topic is of great concern to many, particularly to him in his work as chair of the National Patient Safety Agency—and rightly so, as tackling healthcare-associated infections is a challenge for health services around the world and a priority for our NHS. The noble Earl is completely correct about the need for ownership of the problem.

I would like to make the case that we are making good progress towards clean, safe care for patients in the NHS. That is evident in the latest Health Protection Agency data for January to March 2008, published today. Those figures show that MRSA blood-stream infections are down 33 per cent, and that C. difficile infections in the most vulnerable group—those aged 65-plus—are down 32 per cent compared to the same quarter last year. That is significant progress.

The noble Lord’s work as chair of the National Patient Safety Agency has contributed significantly to that progress. The NPSA’s cleanyourhands campaign is a key element in preventing the spread of infections. It has been shown to make a real difference to hand hygiene, therefore making a real difference to patient care and literally saving lives. The NPSA also announced the 2008 hospital patient environment action team scores last Thursday. Thanks to the hard work of the NHS, 98.5 per cent of hospitals are now rated acceptable or above. But we cannot stop there. Trusts are required to deliver a 30 per cent reduction in the number of C. difficile infections by March 2011. The NHS is on course to hit the target to halve MRSA blood-stream infections by the end of March. We will know the result when the HPA publishes the data in October. However, the latest figures were over 49 per cent lower than the quarterly average in 2003-04, so we are fairly sure that the NHS will meet the target.

However, there is no single solution for reducing healthcare-acquired infections, so we have introduced a range of measures. Our Clean, Safe Care strategy builds on comprehensive clinical guidance and gives an overview of all measures. Good hand hygiene, high standards of cleanliness, effective patient screening and sensible use of antibiotics are vital in the fight against infection, as noble Lords have mentioned. In the last year, we have introduced a “bare below the elbows” dress code to support hand hygiene, increased the number of matrons to over 5,000 and launched a new antibiotics campaign. All acute hospitals have been deep cleaned and we have doubled the department’s tailored support team for infections. We are now in the process of introducing MRSA screening across the country. I shall refer to that again when I answer specific questions.

Those measures are backed by significant additional investment. On top of investment in recent years of over £100 million, the Comprehensive Spending Review settlement for future years includes £270 million a year by 2010-11 to tackle healthcare-acquired infections. That all supports the legal requirement for NHS bodies to maintain proper infection control. The new regulator, the Care Quality Commission, will have tough powers to investigate and intervene, strengthening the regulator’s role in ensuring the NHS meets the required standard. In the mean time, specialist teams from the Healthcare Commission continue to inspect all acute trusts every year.

We are fighting infections on all fronts, but we should not lose sight of the fact that, for all the media hype, the probability of dying from a healthcare-associated infection is relatively low. As the Observer pointed out last Sunday in its feature on “25 things you need to know for a healthy life”, people should not fear hospitals. I suspect that my civil servants would advise me not to use this statistic because I do not know what it is based on. However, that article stated that,

“for people under 65 at least, you've got more chance of dying from a lightning strike than MRSA”.

The NHS treats around 1 million patients every 36 hours and admits 14 million people to hospital each year. If someone is admitted to an NHS hospital, his chance of acquiring an MRSA blood-stream infection or a C. difficile infection is less than half of 1 per cent.

I now turn to specific points raised by noble Lords. The noble Lord, Lord Patel, asked about the plans we have to collect information on community infections. We have set the latest C. difficile targets across health communities to encourage an approach that encompasses primary care trusts, although we have no current plans to collect information about community-acquired infections. However, we will continue to consider that as we update our surveillance systems.

The noble Lord, Lord Patel, suggested that the trend had slowed and we were not going to hit the target. We think the trend has now reversed and that we are on track to hit the MRSA target. The latest statistics show a 49 per cent decease compared with the 2003-04 baseline. However, his statistics were correct, which is why we take this issue so seriously. We are pleased that the action taken to date is having an impact and infection rates are falling. We focused on MRSA and C. difficile, but the measures introduced and promoted, such as good hand hygiene, will have an impact on other infections. The focus that we have encouraged on infection control should have an impact right across the NHS.

The noble Lord asked why we were not screening staff for MRSA and other noble Lords may have mentioned that. The key point is that staff are usually healthy, so they are at less risk of getting or carrying an infection. The problem is not screening the staff, but is the practice—making people behave in a way that means that infections are not carried from patient to patient. He asked when we would introduce MRSA screening for elective care in 2008. We will introduce it by the end of March 2009. Hospitals are now working on how to deliver it.

The noble Lord asked what we were doing to ensure accurate reporting on death certificates. In July 2005, the CMO issued advice to doctors reminding them to record infections accurately on death certificates. The number of death certificates mentioning C. difficile rose significantly the next year, as shown by the latest Office for National Statistics report.

The noble Baroness, Lady Masham, made a good point about the need to make sure that children in schools were taught about the importance of hygiene. She is also right to point to the importance of combating sloppy practices. The key point about healthcare workers is their practice.

The Health and Social Care Bill, which I think became an Act yesterday, makes the prevention of MRSA a priority. We must ensure that specialist hospitals are as rigorous as the best of the rest.

The noble Baroness asked about guidelines on pneumonia. I am not sure which guidelines she referred to, but the suggestion sounded very sensible. We launched a new campaign about antibiotic prescribing in February this year and have highlighted it in department guidelines.

C. difficile is not notifiable in England, but all cases have to be reported on the mandatory surveillance system, which gives real data to the Health Protection Agency and to trusts.

The noble Baroness raised the issue of new ideas, and mentioned mattresses and so on. That is extremely important. We are always looking for new ideas. The Rapid Review Panel was set up in 2004 to review new healthcare-related infection technologies and to provide a prompt assessment of novel equipment and materials and other products or protocols which might be of value to the NHS in improving infection prevention and control, the idea being that you need to look at these things quickly and, if they are effective, roll them out across the piece. We are very much aware that we need to be on top of technology.

The noble Lord, Lord Teverson, asked about antibiotic prescribing. Unfortunately, we are not yet at the stage where antibiotic prescribing across England represents what we recognise is the best practice in the best hospitals. However, we are working very hard to raise awareness. For instance, we are launching an extension of our antibiotic campaign with a poster competition in schools. So far as we are aware there is no read-across to animals. That was not in my brief, as they say.

The noble Lord is right that the logistics of screening are significant. There is no question about that, as mentioned also by the noble Earl. Where are we now on screening? As I mentioned, all elective admissions will be screened by March 2009 and all emergency admissions by 2011. The reason for the time is because we know that the logistics of this need to be right.

The noble Lord, Lord Teverson, mentioned bed occupancy. There used to be a correlation. However, we have issued guidance to infection control teams to talk to bed managers. Now we think there is no correlation. Trusts with high bed occupancy rates have reduced infection numbers as much as those with low bed occupancy rates.

The noble Lord asked what we were doing to ensure that those in nursing homes were as protected as those in hospitals. We will produce guidance shortly for infection control in care homes. This consultation is due to start this summer. With the creation of the new regulator, it will be much easier to roll that out because we will have one regulator looking across the piece from healthcare to social care.

The noble Earl, Lord Howe, asked about deep cleaning and whether it was a gimmick. We need to be clear that the cleanliness of our hospitals is a matter of utmost importance. Clean, tidy and safe hospitals and staff are very important to patients, and are what they expect. Deep cleaning is not different cleaning, but it was a way of galvanising hospitals. It is a concentrated programme, often using new equipment and specialist skills. We are not repeating the national deep clean, but the Healthcare Commission will be looking at this when it inspects.

The noble Earl asked why we were screening for MRSA and not C. difficile. We have considered whether universal screening of patients for C. difficile was the best way forward. It would not have the same clinical benefits as MRSA screening, which is why we only target patients over 65 who have diarrhoea. We are keeping this clinical evidence under review and will act quickly to respond if there is any new and emerging evidence.

Will MRSA screening be cost effective? Available evidence indicates that it can be cost effective due to reduced morbidity and lower NHS treatment costs, but there will be an inevitable start-up cost in the introduction of the service.

I thank noble Lords for the many points they have raised. I apologise if I have missed anything. I will look at the record and certainly write to people. I hope I have demonstrated that the NHS is working very hard and making good progress. I assure noble Lords that we will continue to support and encourage the NHS to ensure that patients receive the clean, safe care that they deserve.

[The Sitting was suspended from 2.55 to 3 pm.]

Armed Forces: Wounded Personnel

asked Her Majesty’s Government whether they will issue medals to all British military personnel who have been seriously wounded in the Afghan and Iraqi campaigns.

The noble Lord said: As a former journalist, it pains me to say that the number of occasions on which I am able to pay genuine tribute to the work of the press are sadly limited. However, this afternoon is a rare exception. I make no bones about saying that I have taken an interest in the subject before Members of the Committee this afternoon—well off my usual beat, as some people will realise—wholly and solely because of the Daily Mirror’s splendid campaign on behalf of our troops.

The Daily Mirror’s work has been in the best traditions of popular journalism: passionate, yet scrupulously researched. I remember the remark of the great Harry Evans, under whom I briefly served when he was editor of the Sunday Times, who said, “Your campaign is only working when your readers start to get bored with it”, in reference to a Sunday Times campaign on cones in roads. The Daily Mirror has been willing to run that risk by persevering with this campaign when others have been satisfied to fill their columns with gossip and girls. That persistence has been most admirable. I also pay tribute to Colonel Richard Kemp CBE, who once led our forces in Afghanistan and who has been as gutsy in this campaign for recognition as he was in that one. They have been not only admirable and gutsy, but successful. My third tribute is to the Government: Ministers have listened. When I first tabled my Question, it called for medals for the killed as well as for the wounded. That is no longer necessary, as the Government have now agreed that Britons who lose their lives in the tragic conflicts in Iraq and Afghanistan should be recognised with an appropriate medal. It therefore only remains to push the door open a little wider, and extend that recognition, as my Question asks, to the seriously wounded.

Of course, anybody who joins our Armed Forces does so in full knowledge of the potential personal costs they may pay for their patriotism. However, it is my contention that the wars we are considering here are different from those we fought in the past in a way that makes recognition more desirable. The fact is that our nation has been divided over these conflicts in Afghanistan and Iraq. Not only have the men and women involved had to face enemy fire, but they have suffered the ricochets of friendly fire from those in Britain who believe these wars to have been misjudged. Are they risking their lives in a good cause?

That is not a situation that troops in most conflicts have had to face. Generally, wars fought by Britain have been those where the nation stood behind its Government’s course. At a time when surveys are showing some problems with service morale—not of the individuals involved but their feelings about how the services as a whole are keeping their morale up—we need to do the right thing. Let us show our soldiers, our airmen and our sailors—let us let their families, their sons and daughters, and their sons' sons and daughters’ daughters know—that we as a nation understand and empathise with what they are going through: a life which few of us have had the experience to appreciate. Whatever our views on the cause—and I think there are different views within this Room—we are, as we have always been, united in our admiration for their professionalism and our sympathy for their sacrifices. We need to show that we care.

I am not sure that the opposition to what is proposed comes from Ministers. Reading the words, I fear that others stand behind the Ministers; namely, some of our senior servicemen. Without making too much of it, I find it slightly ironic that top brass—many of whom like nothing better than to parade with a chest bedecked with medals of all kinds—should be resistant to granting any similar recognition to the men and women who serve under them.

One of the arguments to be heard thundering round the corridors of power is that such an award would be unprecedented. When you come to think of it, so was the first ever Victoria Cross—so is every medal when it is first awarded—and so, very relevantly, was the first Purple Cross, awarded more than 200 years ago, which our American cousins and allies across the Atlantic award to their servicepeople in similar circumstances.

Another argument is that it is difficult to draw a distinction between seriously injured people and others, wounded or not. However, that is implicit in the awarding of any medal. One has to decide what deserves a VC, an MC or any other medal. It requires very fine judgments, which are hard to make. At least this medal would have an objective justification—namely, a serious injury—and I do not believe that that is beyond the power of humankind to resolve. I cannot help observing that very few serious injuries are suffered by those sitting behind large desks in the Ministry of Defence.

In another place, an Early Day Motion arguing for these medals became the most popular in this Session of Parliament, with over half the House signing it. Of course, Ministers cannot sign EDMs but a very clear majority of Back-Benchers did so. I regret that this House does not have an EDM system, more’s the pity. According to the Procedure Committee, to which I put this proposal the other week, that is because Members have other ways of drawing ministerial attention to worthy causes. I hope that that purpose will be served by my Question today and that noble Lords—both those who are here to discuss it and those who are absent for one reason or another but support my proposal—will make their point. Of those who have to be absent, my noble friend Lady Symons has asked me to signify her very strong support—she is at an important international conference on defence—and so has my noble friend Lady Dean of Thornton-le-Fylde, who is currently busily engaged on the Pensions Bill.

I wanted to draw this matter to the Minister’s attention and I hope that it will be given serious consideration. I greatly look forward to the debate. I thank all noble Lords who are taking part in it and await the Minister’s answer with keen interest.

I am grateful to the noble Lord, Lord Lipsey, for introducing this Question for Short Debate. I remind the Committee of my interest as a serving TA officer.

The British Armed Forces have a tradition of being very parsimonious with the issuing of medals. That is partly because we do not want to look like US servicepeople, among whom sometimes very junior soldiers with very limited experience have a chestful of medals. For our Armed Forces, that is a source of amusement, and I suggest that the Minister exercises great caution when responding to the debate.

The noble Lord skilfully explained his proposal. He made an attractive proposition and prayed in aid the media campaign. However, the first problem is that some casualties are unnecessary. Let us suppose that in an operational theatre there are two mine incidents causing casualties. In the first, a soldier is seriously injured by a mine. His comrades do exactly and precisely what they are trained to do: they do not move, if at all possible, and they wait for the Royal Engineers Explosive Ordnance Disposal unit. If they have to move, they do so very slowly, clearing the path in front of them. They may take 30 minutes to move 40 feet, and all the time they will be able to hear the cries of their comrade, injured and needing help, but if they do that, there will be only one casualty.

In the second incident, instead of adhering to their training, they run across the minefield to aid their comrade. It is completely understandable and very courageous, but they set off another mine, thus causing a completely unnecessary casualty. If the Minister follows the suggestion of her noble friend, she will have to explain why the serviceperson who adheres to their training and minimises casualties does not get a medal, while the one who ignores their training, causes additional casualties and exposes others to greater risk does.

The Minister will also have to explain how suicides in operational theatres will be treated—a very sensitive issue, I know. A related issue is psychological and mental injuries. Some may not be apparent for some considerable time after the end of the operation. I take this opportunity to pay tribute to the work of the charity Combat Stress.

The third problem is road traffic accidents—still possibly the biggest killer of members of our Armed Forces. When would an RTA death or serious injury attract a medal? What if someone has a road traffic accident while off duty in the UK? I do not think so. How about a road traffic accident that takes place when someone is on exercise in the UK, when the cause of the accident is the victim’s error, or worse? Probably not. These are very difficult judgments of blame and responsibility.

On Exercise Saif Sareea in Oman in 2001, in poor visibility due to the dust and the sand, a young soldier accidentally killed himself by driving his four-tonne truck into the back of another. How is that to be treated? It was probably his own fault but he did not die in vain; he died helping to give our country an operational capability. By undertaking Exercise Saif Sareea, we learnt lessons that made Operation TELIC in Kuwait and Iraq much easier, more successful and led to fewer casualties.

Some time ago I raised with the Minister’s predecessor, the noble Lord, Lord Drayson, the very poor performance of the Army Medal Office. It is now being operated on a tri-service basis, which is perfectly sensible. My information is that the performance of the Defence Medal Office, as I presume it is now called, is vastly improved. That is very important for morale. The prompt issuing of medals makes servicemen feel that their efforts are appreciated. I am extremely grateful to the Government for making progress on that.

I am sorry to be so negative regarding the noble Lord’s suggestion, but the problems of going down this route are insurmountable.

We are now giving medals for people who have been killed in precisely the same circumstances that the noble Earl has described as requiring judgment. The Government have set up a group to look at those. Is he saying that we should not give medals to those killed in such actions in the same way that he believes we should not give them to the seriously wounded?

I was saying that we should not automatically issue medals to those killed or injured. We could be issuing them to people who, frankly, should not have them, because of the circumstances I have described.

It is very apposite that we are having this debate today, only a couple of hours after the Secretary of State issued his service personnel Command Paper and made an oral Statement in the other place. Part of that Statement says:

“I understand that no amount of money can ever make up for the pain and sacrifice that these brave people have endured. However, we need to recognise the special nature of their sacrifice”.

I very much welcome the Command Paper and the overall improvements in the financial package and similar that are set out today. That phrase from the Secretary of State gives me encouragement and I await with interest the Minister’s reply to the debate. We will keep our fingers crossed.

I congratulate the noble Lord, Lord Lipsey, on inaugurating this debate and on his comprehensive and persuasive speech. I also pay similar tribute to the Daily Mirror for its Honour the Brave campaign, and to Colonel Kemp.

The noble Lord referred to the Early Day Motion in November, which had no fewer than 330 signatures. The EDM says:

“That this House”—

that is the other place—

“recognises the bravery, dedication and sacrifice of members of the armed forces serving in Afghanistan and Iraq; applauds the Daily Mirror's Honour the Brave campaign; and calls on the Government to ensure that all personnel in the Army, Royal Navy and Royal Air Force killed or wounded in enemy action are awarded a medal”.

As has been said, the Government have gone some way towards answering and acknowledging the EDM. Once again the precedent of the American Purple Heart, which was first awarded in 1917, was referred to. In Britain, in the two world wars, wound stripes were sewn on to a soldier’s uniform. Sadly, the practice then fell into disuse. The noble and gallant Lord, Lord Bramall, a former Chief of the Defence Staff, has gone on record as acknowledging his pride in wearing the wound stripes himself.

I fully accept that a service man or woman who was injured would appreciate financial compensation more than anything else, which is why we appreciate what was announced today. But all the evidence is that wounded military personnel would appreciate an extra medal—and I use the word “medal” metaphorically, rather than in an exact literal sense. At a time when our service men and women feel unappreciated, when recruiting is difficult and tours of duty are longer and more frequent, and when, as the Secretary of State and defence chiefs have acknowledged, there is considerable stress on our forces and overstretch, I believe, as does my party, that it is more important than ever to do all we can to acknowledge the debt that we owe our service personnel and honour the covenant. I believe, as the noble Lord, Lord Lipsey, believes, that a medal for the seriously wounded would help and would play a part. I accept, as he accepted, that there are some problems with definitions—with someone’s mental as compared with their physical condition and with those who are wounded and killed in the normal course of combat or by friendly fire. These are possible difficulties, but they could be overcome, given the will, and the balance is very much in favour of awarding the medals to which the noble Lord referred.

How would the noble Lord treat a road traffic accident in an operational theatre such as Afghanistan—especially a fatality?

That is a matter of some difficulty. The noble Earl refers to the final section of my speech, in which I acknowledged that there are some difficulties. There is no argument about that. But the arguments that I have put in favour of awarding a medal far outweigh some of those negative and more difficult points that we would have to deal with. I accept that that type of definition is a problem.

I, too, add my thanks to those offered to the noble Lord, Lord Lipsey, for introducing this debate. He made some very interesting points. I am in complete agreement with him about the bravery and dedication of our Armed Forces and their work in dangerous and challenging circumstances.

I also agree with the noble Lord about the Daily Mirror campaign and with what he said about Colonel Kemp, whom I saw speaking eloquently on the “Breakfast” programme this morning. The noble Lord is quite right that it is essential for the Government and Parliament to do all they can to ensure that military personnel are properly rewarded for their work. Medals are an important tool in their being given recognition by this country.

My noble friend Lord Attlee spoke eloquently. I agree with him that the Government should move cautiously on this issue. I have spoken to a number of service men and women from my former regiment—I am honorary colonel of a TA regiment—and almost to a man and a woman they agree with what my noble friend Lord Attlee said. I also congratulate my noble friend on setting such a good example yesterday by coming to work in his uniform.

My party has promised that when we are in government we will review the rules set out by the Committee on the Grant of Honours, Decorations and Medals. We will set up an honours and decorations committee to ensure that they are consistent and appropriate. We can in this way ensure that the awarding of a medal is consistent and appropriate. Although, as the noble Lord, Lord Lipsey, said, there is a precedent of a medal for the wounded in this country’s military history, new medals should not be awarded on an ad hoc basis.

Meanwhile, we must remember the number of military personnel who have been wounded or killed. No medal will ever make up for the lack of, for instance, body armour that led to the injury in the first place. Death and injury are a tragic but unavoidable part of war; death and injury as a result of inadequate equipment are most certainly not. Two weeks ago, I drew attention at Question Time to the Government’s decision in 2004 to cut the helicopter budget by £1.4 billion, thus necessitating the use of ground vehicles, which are more vulnerable to attack in evacuating the wounded. My concerns are widely shared. A recent Ministry of Defence survey showed that more than 50 per cent of service men and women were dissatisfied with the equipment provided. When reports reach the media that front-line troops have on occasion run out of ammunition, it is clear that the situation needs drastic improvement. The Minister will no doubt claim that the Government have learnt from their mistakes and are now taking the supply of front-line troops more seriously. I hope that that is the case—I think that it is.

I also freely acknowledge another area where the Government have finally listened to my party and say how pleased I am that a new military ward has been opened at Birmingham hospital. I hope that many more will follow. Proper medical facilities for the wounded should not be an optional extra. Like the noble Lord, Lord Lee of Trafford, we on these Benches welcome measures set out in today’s service personnel Command Paper increasing the compensation payments for personnel suffering injuries due to their service.

I have wandered a little from the original topic of the debate, but recognition of the work that our Armed Forces are undertaking and appreciation of the dangers to which they are exposed do not rest on fine words and ceremony. Speeches in Parliament must be backed up by proper support in the field.

This has been a relatively brief debate, but it has caused some strong feelings. There has been a division about what is appropriate. I congratulate the noble Lord, Lord Lipsey, on obtaining this debate and putting his case in such a straightforward way. There are divisions of opinion on this, but we can all agree that we as a country are greatly indebted to those who serve in Iraq, Afghanistan or elsewhere in the world. We should bear their professionalism and dedication in mind at all times. What relatively young men and women are able to do in service of their country is extremely impressive, and it is right that we should give due recognition to the service they give.

I stress what one or two noble Lords have mentioned: medals are just one aspect of the recognition that we need to give to those who serve. I was glad to hear the welcome from noble Lords opposite for the Command Paper The Nation’s Commitment: Cross-Government Support to our Armed Forces, their Families and Veterans¸ which was published today. The fact that we mention families and veterans should be borne in mind at all times. I am sure we will come back to the report and will have an opportunity to debate it because it has some significant elements that should be well known and welcomed, whether they relate to health, housing or the opportunities that we are increasingly going to be able to give to people once they have completed six years in the Armed Forces. All those things will make a difference and will make it clear that we appreciate and want to make a long-term investment in the people who put their lives on the line in the Armed Forces.

As the noble Earl, Lord Attlee, said, the United Kingdom has a well established system for awarding medals. I was pleased that he thinks that the service provided has improved. I am sure that people in the Medal Office will appreciate those comments. Since September 2001, it has issued more than 54,000 Afghanistan medals and more than 115,000 Iraq medals. It has been busy, and I am glad that the noble Earl’s information is that it now deals with these issues more swiftly. That is important, and we should always bear that in mind.

The military chiefs—the people who Ministers listen to on issues such as this—believe that their way of keeping this issue under constant review is the way forward and that decisions should be relevant to the circumstances in which our Armed Forces are operating. Everyone here will know that for every significant campaign or operation, a medal is struck when it is deemed that there has been sufficient risk and rigour for those involved. Service men and women deployed today in Afghanistan and Iraq will receive their appropriate medals once they have completed the qualifying criterion, which is generally 30 days of continuous service in theatre.

This debate has focused on how we recognise those who not only serve but, sadly, are killed or injured in the line of duty. I am sure that everyone has heard of the difficulties and concerns of the families of those who have been killed or wounded. Those who are killed receive their medals quickly. We have a new procedure, which I think will be welcomed, as my noble friend Lord Lipsey said, by those who mounted the campaign in the Daily Mirror. It has helped to ensure that people focus on this issue. However, I stress that our service chiefs have always kept such issues under review and have been keen to ensure that they take the appropriate action.

The changes that were made a short time ago—after my noble friend secured this debate, which I think is why he widened his approach—have been welcomed. It is right to do what has been done. As the noble Earl, Lord Attlee, pointed out, it is extremely difficult to deal with some of the practical issues that arise. He mentioned several difficult situations in which a judgment had to be made about what was appropriate. My noble friend intervened to ask whether these judgments would also apply to those who had been injured. We have not yet been able to finalise all the details regarding the medals for those who were killed on operations because of the complexities involved. There are many others as well, to which the noble Earl referred. We should not regard this as a simple and straightforward issue.

We should always take account of the views of those who are serving. My noble friend said that the opposition to this proposal was from senior servicemen—the top brass bedecked with medals who refuse to allow those who serve under them to get recognition. That was somewhat disparaging; many of the people referred to as the top brass have very distinguished records. We should listen to them and learn from their experience.

It is not just the military chiefs who believe that we should move on this with caution. The overwhelming view among the Armed Forces is that the current medal system is fair and that what service personnel consider most important is that the injured should be properly cared for and supported, and receive the treatment they need. That is one reason why today’s Command Paper is so important—it brings home some of the things that have already been done to improve the situation of those who have been injured in service. It is very important to do that.

Awarding medals is not the only way that we recognise the contribution of our service men and women. There have been lots of developments over recent years. The Armed Forces Memorial at the National Memorial Arboretum in Staffordshire provides appropriate recognition for those who have been killed in action since the end of World War II. Families who have unfortunately lost someone in action find it of some comfort to see their name engraved on that memorial and think it appropriate that that kind of recognition should be made. We have to consider all these issues extremely carefully.

Mention was made by the noble Lord, Lord Lee, of wound stripes, which were introduced in the First World War and, to a certain extent, were in evidence in the Second World War, although I am told that they were not universally popular as a means of recognising people who had been injured. Therefore, these issues are complex and we must, as much as anything else, bear in mind the feelings of those who serve in our Armed Forces. It is true that it is the top brass who report back, but perhaps I may remind your Lordships of the comments of the Chief of the Defence Staff, Air Chief Marshall Sir Jock Stirrup:

“I know that there has been considerable debate about recognition for those wounded on operations. The Service Chiefs and I have thought hard about this, having sounded opinion amongst our people. The overwhelming view is that the current medal system is fair and sufficient, recognising as it does both risk and rigour. What our people consider most important is that the injured be properly cared for and supported”.

The two elements are there: they have consulted other people—they have not simply made this decision sitting in the MoD—and they think that what happens by way of care and support is the predominant concern. The Command Paper has been widely welcomed. Indeed, the Royal British Legion said today:

“The Covenant is being brought back into balance”,

and it added:

“The Prime Minister, the Defence Secretary and the Government all deserve credit for listening to our concerns and recommendations”.

Therefore, I think that we are moving a whole step forward in what we are doing for our servicemen, both while they are in the services and after they leave. This is a very positive and constructive way forward.

I wish to say a final word about the dangers of allowing this decision to be made solely by Ministers. Ministers could very easily be tempted into giving medals or recognition on a whole range of issues because it would always lead to a degree of popularity for them. I think that the present system, in which we take Ministers out of the equation, is probably worth protecting.

[The Sitting was suspended from 3.37 to 4 pm.]

Africa: Strengthening Parliaments in Africa

asked Her Majesty’s Government what is their response to the findings of the report Strengthening Parliaments in Africa: Improving Support prepared by the All-Party Parliamentary Group on Africa.

The noble Lord said: As vice-chair of the Africa All-Party Parliamentary Group, I first acknowledge the support given to our inquiry into Strengthening Parliaments in Africa: Improving Support by the CPA UK Branch, with the help of DfID and the FCO country staff. I also acknowledge the help from local parliamentarians, who shared their insights and experiences with our team. I also thank AWEPA and other international organisations, which provided crucial assistance, and the Royal African Society for its ongoing support of the group.

In the UK and internationally, there is an increasing realisation that parliaments have a significant role to play in development. In DfID’s 2006 White Paper, for example, the UK committed to work more closely with parliamentarians in an effort to,

“put more support for good governance at the centre of what we do”.

Much of this new attention is focused on African parliaments, which have slowly begun to exert the new constitutional powers that have come with the transition away from dictatorships to multiparty politics. The picture varies greatly in practice, but interviews in Malawi and Kenya, for example, showed that parliament was no longer,

“a sub-branch of the executive”,

or a “department of the presidency”. An increasing majority of voters in Africa believe that the legislature should be independent of the Executive and that it is unacceptable for a President to bypass parliament to pass legislation. Gradually, parliaments are becoming more assertive in overseeing financial governance.

African parliaments face acute challenges. Many lack formal powers and agreed clear procedures. They lack institutional capacity. Parliaments, as opposed to governing Executives, lack basic facilities, resources and administrative and specialist support, needed to effectively hold the Executive to account. The reality of African parliaments reflects African politics, history and society. The events in Kenya, Uganda and Zimbabwe, since this inquiry was initiated in 2007, each in their way bear witness to the challenges still facing many African parliaments.

The group’s report, Strengthening Parliaments in Africa: Improving Support, looks at the difficulties encountered in African parliaments and at what the United Kingdom, through aid and other channels, is doing to address these difficulties. The aim is that the report will contribute to and inform current debates over the most effective approaches to parliamentary strengthening. The group was particularly keen to hear at first hand the views of counterpart parliamentarians and their staff in a selection of African countries. Members visited Malawi, Uganda and Kenya and, in addition, 20 submissions were received in response to our call for evidence. I place on record our thanks to my noble friend Lord Steel of Aikwood for his participation in the inquiry and in due course, I hope, for his contribution to this debate. Further evidence came from members' discussions in South Africa on parliamentary strengthening, organised by World Bank affiliates, and at Westminster in collaboration with the ODI.

African parliaments are based on western parliaments and have similar roles. The social, cultural and political contexts in which they operate, however, are contrasting and varied. Informal patronage networks are very influential, coexisting with, overlapping with and sometimes conflicting with institutions and parliaments in the formal political sphere. Only two of Africa's 53 states, Botswana and Mauritius, have a record of unbroken multiparty democracy. In an environment of presidential regimes, one-party states and military rule, scrutiny of the Executive and representation of the electorate was rare.

Development partners have been slow to support parliaments in the democratisation revival that started in the 1990s. Appreciation of the significance of governance for development and poverty reduction is only gradually extending to the contribution of parliaments. Yet many donors, discouraged by mixed results of project-based support and conditional lending, are increasingly opting to transfer aid money directly to Governments of recipient countries. This direct budget support makes it essential that these funds are overseen by in-country institutions, such as parliaments.

Development partners are coming to recognise parliaments as allies in the monitoring of the use and impact of aid money as part of their overall role in the scrutiny of the use of public resources. African parliaments are increasingly becoming assertive institutions that have leverage over legislation, monitor and challenge the Executive and represent citizens’ views.

Although surveys show that there is widespread support across southern Africa for the parliaments’ legislative prerogative, deep-seated challenges remain. Not the least of these are: first, the rules, powers and arrangements that define parliament’s leverage; secondly, parliament’s resources and institutional capacity; and, thirdly, the relationship between parliament and international players.

A recurring theme in the material gathered by the Africa All-Party Group was the limited popular understanding of MPs’ responsibilities and powers. MPs were expected to deliver on solving a wide range of collective local problems and individual needs and bring development in health, education and water, while legislative and scrutiny responsibilities were hardly mentioned. The MPs’ functions in parliament such as legislation and holding the Executive to account were not seen as important. The financial independence of parliament is crucial in this regard. Submissions from Zambia, Tanzania and Malawi underlined that their parliaments were unable to determine and approve even their own budgets.

Our findings demonstrate that African parliaments have begun to exert greater influence on how their countries are governed, but that huge challenges remain. There is insufficient constitutional and other provisions. Problems with institutional capacity continue to constrain parliaments. Even if they enjoy robust powers on paper, the political realities inside and outside parliaments mean that they often fail to exercise effective scrutiny over Executives.

Our inquiry has resulted in close to 50 recommendations in five overarching groups. Broadly, the groups are that: first, development partners understand better the parliaments in their political context; secondly, they must engage in local demand and encourage broad-based ownership, pulled by local participants and not just pushed by the donors; thirdly, co-ordination is essential with development partners working in step with one another, because too many times there are too many partners stirring the broth, so to speak; fourthly, development partners need to learn from evidence-based lessons and apply those results; and fifthly and finally, greater account needs to be taken of parliament in development work, encouraging a full role and avoiding acts that would undermine or marginalise the parliaments that are supposedly being nurtured.

There is a dilemma. While some might say, or admit, that dictatorial Governments can sometimes bring real development to their people through sound policies, it should perhaps be a prerequisite for British development aid that the recipient Government are democratically elected through the expressed will of the people.

We were very pleased to receive DfID’s fulsome response to our report in the general sense. It points out that it has already commissioned studies on parliamentary strength. It acknowledges, however, that where a parliament has already been marginalised, there is little point in promoting parliamentary strengthening.

Where a dictatorial or even repressive Government fulfil DfID’s overall development criteria, it could be argued that development delivered now is jeopardised in the long term by the political instability created by this repression. DfID’s rejection of the proposal that it should present an annual report to the parliaments of recipient countries on the grounds that:

“Aid donors are accountable to the recipient governments who themselves have the responsibility to report to parliament”,

counts for little when the parliament is already marginalised.

In these instances there surely is a case for the Government to adopt a process similar to the extractive industries transparencies initiative—making public aid agreements, so as to enable parliamentarians, both here and in the recipient countries, to hold their Governments to account.

Finally, since the field work and evidence-taking and analysis began almost a year ago, there have been some significant changes in political development in several of the countries studied. I should be very grateful if the Minister could update noble Lords on the Government’s current position reflecting the outcome of perhaps the Kenyan and Zimbabwean elections and the situation in that regard.

I thank the noble Lord, Lord Chidgey, and the All-Party Parliamentary Group for the report. I declare an interest as the chair of the Royal African Society, which provides the secretariat to the All-Party Group.

This report is important in tackling engagement between citizens and their Governments and the role that parliaments can play in ensuring greater accountability and transparency. I am pleased that the Department for International Development has welcomed the five overarching recommendations. In the time available, I shall make some general comments about the progress of democracy building in Africa and, in particular, the equation of elections with democracy.

We have seen huge democratic gains in sub-Saharan Africa in the past two decades, although we still have too many leaders who have been there too long. Our recent focus has been on Zimbabwe, but there are other countries too. The Mo Ibrahim Foundation governance index for 2000 showed that 24 elections in 48 African countries were judged not free and fair. By 2005, that figure had dropped to 15. In 2000, six African countries passed the free and fair criteria; that figure rose to eight by 2005. That is slow progress, but it is movement in the right direction.

For me, democracy is not just about elections, although they are important. It is about accountability and transparency, citizens feeling that they have a right to have a say and to be heard, and Members of Parliament holding their Governments to account and putting the interests of the electors first. That requires maturity and stability. Too often, we have seen the effect of the lack of political stability and basic rights in African countries where political breakdown has been followed by conflict and insecurity. Greater stability and participation are achievable through multiparty democracy, but it will take time to take root and mistakes will be made. Strengthening parliamentary democracy and improving parliamentary scrutiny is crucial to the process of building confidence in political processes.

I agree with the thrust of the argument in the report that it is essential to understand the politics of African countries in order to work with them for sustainable development. Local ownership is essential. It is not just about what donor Governments want. One of the potential problems with the development aid agenda is the focus on Government-to-Government relations. Some African Governments see themselves as being more accountable to donors than to their own people because, through the process of accountability to donor Governments, they know that they will receive aid. It is vital that African parliamentarians and civil society play a greater role. This can partly be achieved through greater transparency in the relationship between donors and recipient Governments, but we also need consultation between donors and recipient Governments and their citizens as well as with business and NGOs. There is an opportunity at the High-Level Forum on Aid Effectiveness in Ghana in September to explore these issues in more detail and, in particular, to look at the need for better analysis and co-ordination between donor and recipient Governments and other actors. This report gives important insight into what needs to be done, and I hope that all of us, including my Government, treat the recommendations with the seriousness they deserve.

I read the report of the All-Party Group on Strengthening Parliaments in Africa with great interest and respect. I had intended to discuss many issues, but there is not time. However, I was struck particularly by DfID’s recognition that:

“Bringing politics squarely into the aid equation takes many development professionals outside their zones of comfort. It also takes us to the outer edges of what some development agencies are equipped, even mandated, to do”.

Parliaments are not aid projects; they are important political entities, especially in fragile states, and I hope that one result of this admirable report will be much greater FCO involvement through our missions abroad, which are best placed to provide an analysis of the political terrain. We should not rely too much on the UNDP, which has its own political agenda. That is particularly true in the case of Zimbabwe for reasons beyond DfID’s control.

However, what is happening to parliamentary government in Zimbabwe is both relevant and urgent. Parliamentarians everywhere must surely do whatever they can—I think that we all agree on this—to protect the MDC MPs who were duly elected in March this year and should be taking their seats today. That includes the handful of MPs elected in the rerun last month despite the violence and intimidation recognised and condemned by all the observer missions—the AU mission, the Pan-African Parliament election observer mission and the SADC mission. No date has been announced for Parliament to sit. At present, one MDC MP is in hospital fighting for his life after a beating on 29 June, two are in jail, one has been abducted and is missing, seven have fled to South Africa, and an unknown number are in hiding in Zimbabwe. One is to be “dealt with” immediately on release. His lawyer is therefore not applying for bail: he is safer in prison. I say nothing of the many MDC supporters and electors, including some of my age, who have been terribly beaten, imprisoned and refused medical treatment in prison.

Mugabe is ensuring a ZANU-PF majority by delaying the swearing-in of MPs until he can wipe out the MDC majority by abducting, arresting, detaining and hospitalising enough MDC MPs to ensure it. Some 10 MDC/Tsvangirai MPs have been arrested in recent weeks and seven more are said to be on a police “wanted” list. Mugabe is also able to pack the Senate. Finally, under Zimbabwe law, any parliamentarian can be dismissed for failing to attend for two days.

Cannot the group urge the parliaments in Africa with which it has many links to make representations through their Governments and Commonwealth Governments to protect the MPs of Zimbabwe and enable them, elected as they were by the people despite every threat during the elections, to enter Parliament and represent those who have no other voice? Some will say that for us to do this is to play into Mugabe’s hands, because he can say that the MPs now being prevented taking their seats are British puppets or that we should not speak for them. We should not allow him to set the agenda. We did not take that view when we spoke out for Hungary in 1956. No one thought that the ANC in South Africa was a British puppet when we spoke for it in the Commonwealth and in rallies everywhere. We should not allow Mugabe to call the tune. We should speak out against oppression. Those MPs risked their lives to stand and be elected, and the people risked theirs in electing them. If we believe in parliamentary government, we should urge all parliamentarians everywhere to do all they can to protect the MPs in Zimbabwe, and the world should condemn the tyrant.

I was in the Congo in 1960 when the new African Government assembled their first parliament. I remember the delegations from Uganda, Tanzania, Nigeria and Kenya bringing ceremonial gifts. Lumumba’s Ministers had to take office in a country where the Belgians had left no professional infrastructure, civil servants, lawyers or doctors. They had none of the skilled professional indigenous infrastructure and civil society which Zimbabwe has had. The Congo has never recovered from that bad beginning. It is cruel that that infrastructure in Zimbabwe is being wasted by a reversion to what the report called “big man” politics—to dictatorship, in fact. Kenya, Uganda and Malawi have in their different ways solved their problems. Zimbabwe could be restored very quickly to a viable free society if the people whom it elected with such courage could be enabled to exercise their powers of governance legitimately. It is in any case impossible to think how any of the proposals for a political solution to the crisis by negotiation can be effected if those whom the people have chosen to represent them are excluded from the process.

I, too, congratulate the noble Lord, Lord Chidgey, the All-Party Group and the Royal African Society on the constructive tone of the report. I strongly support this initiative as someone who has tended to see democracy through the prism of NGOs. This report should reinforce HMG’s new country-governance analysis, which, rather surprisingly, has tended to neglect parliaments up till now, as he said. The donor’s relationship has also largely been with the Executive, but that is now changing.

The report is inevitably UK-centred and I feel that the African dimension still needs strengthening, although there are good case studies. I have long been wary of spreading Westminster democracy for its own sake. Political philosophy from Machiavelli suggests that a form of tyranny can be appropriate in pulling up a failing state. Examples abound in Africa. I pass over Zimbabwe but where would Uganda be without President Museveni? This is one President we do not seem to mind re-electing himself three times.

We tend to become oversentimental about the Westminster model, and I think that the report agrees in recommendation 6. I expect the CPA manual, which I have not seen, to have dos and don’ts such as “Try not to lose your temper”, “Don’t strike an MP from another party, only from your own”, and “Where possible, do not fire guns or attempt to blow up parliament”. These things happen every now and then, and they have happened here. I have visited the Mozambican, Ugandan and, briefly, South African parliaments and have been impressed by their procedures. Some of them are copied. The Ugandan Parliament website shows some remarkable similarities to our own. I clicked on Hansard and found a debate on the inadequacy of the sickle cell anaemia unit in Mulago Hospital, with the PM responding directly to a petition. The Speaker had an endearing quality of engaging directly in the debate, as well as seeking clarification. Our Speaker in another place would enjoy that.

Four of our Clerks have attended parliamentary seminars in Africa based on an exchange of experience and skills, and Edward Ollard says that these are not one-way exercises. The South African Parliament, for example, is keen on outreach to the people and consultative exercises, such as have been advocated here by the Hansard Society.

I agree with much that the report says about the bypassing and even undermining of Governments by development partners, including indigenous NGOs. This is a fact of life in a developing country. NGOs will follow all options that help the poor, knowing that things often do not get done through parliament but by a combination of influences in and outside government. Parliaments must be strengthened but we can expect only gradual change. What happened to NePAD, which is now seven years old? Parliaments were once seen as a vital means of implementing the NePAD peer-review mechanism. Clearly, it is now on the back burner.

My CPA visit to the Mozambican parliament in 2002, led by Andrew Pearson, included a fascinating session with MPs. I congratulate the CPA on all such visits and on involving NGOs as fully as possible in meetings so that MPs and civil society can see that they are mutually valued.

In a post-conflict state, it is hardly surprising that fighters recently turned MPs should still distrust one another, and visitors sometimes help to restore confidence. All noble Lords will know of the partnership between the Westminster Foundation for Democracy and DfID in the important work of strengthening the capacity of parliaments in Africa. There is now to be a special focus on the training of trainers in Uganda and Mozambique, and there will be a university link through a parliamentary study centre. The foundation aims to work closely with individual parties and is naturally uneasy with the situation in some countries where there is a tendency towards one dominant party.

In Mozambique, Frelimo has been so powerful that I remember embassies and donors almost trying to nurse the Renamo MPs into a stronger role, in spite of the bloodthirsty reputation that they still carried from the civil war. The same will be true of northern Uganda if and when the LRA ex-combatants try to stand for elections. Opposition parties are still weak. Let us not forget that when Museveni’s main rival, Kizza Besigye, returned to Uganda from exile to run for the presidency, he was arrested and charged with rape and treason, and was later snatched from a courtroom at gunpoint. The world just watched.

Finally, Sierra Leone is another post-conflict case where a lot of quiet cajoling and encouraging has helped to restore the democratic processes. All those in DfID and other organisations deserve congratulations, for the new Administration is frail and continues to need support in its efforts to secure democracy, attract investment and restore confidence in the economy.

I, too, congratulate the noble Lord, Lord Chidgey, on initiating the debate. I also congratulate the All-Party Group on this valuable and timely report, in which it took advice from real African experts from the ODI, the NDI and, particularly, the Royal African Society. It is timely, as the recommendations are in tune with the new government policy of recognising the importance of good governance in avoiding waste and misdirection of development aid.

Kenya is a good example of where the politics have destroyed much of the good development that has been done—at least, in part. Traditionally in Africa there has been a lack of questioning of autocrats, even before some countries descended into the Bokassa or Amin regimes. I was pleased with the government response of a litany of the phrase “We agree” to the various recommendations. I am impressed with the belated DfID White Paper of 2006, Governance, Development and Development Politics, which drew on the valuable ODI report commissioned in February.

DfID has traditionally been wary of politics and parliaments. Its aim was to train specialists in the executive branch: tax inspectors and so on. It essentially worked only with departments. The Foreign Office has in many ways been slightly better equipped in reporting on parliaments, but it has its own drawbacks. It has relatively few African specialists, and its personnel tend to spend two-thirds of their careers aboard and are often out of touch with what happens in our own Parliament because there is a relatively limited interface with it.

Both DfID and FCO officials need increased training on parliaments, and that is not touched on in the report. Perhaps there is a contradiction, in that DfID has more money to disburse as a result of moving towards the 0.7 per cent target, whereas another arm of government policy is reducing the number of officials to monitor that. As a result of the reduction in DfID officials, the onus is on parliaments to make those officials accountable. I note that recommendation 34 encourages DfID to progress the idea of producing guidance for country officers. Country officers including a portion of their reports on the dibursing of aid might well be a useful tool for African parliaments in holding their Executives to account.

Recommendation 12 stresses that the FCO and DfID should recognise that political parties are a vital component of a democracy and should encourage their development separate from the tribe, region or the “big man”. I shall not go into detail but there is an excellent case study in Sierra Leone, where DfID passed £400,000 to the Westminster Foundation for Democracy to train the various parties nationally. I understand that they even had an “Any Questions”-style session, where the parties had to say what they would do if they were in government; they even trained President Kabbah’s party on adjusting to a time out of office before its defeat.

Recommendation 3 on co-ordination is vital. There are many other players on the field. I have had the honour of being in Somaliland with AWEPA with money from the European Union; of being in Togo with the Parliamentarians for Global Action; and of working with the Friedrich Ebert Stiftung in Ghana. We should seek to co-ordinate the work being done, which was perhaps insufficiently covered in the report. I also had the honour of doing some election monitoring for the IPU and CPA. It is also important to work with France. President Sarkozy has given a clear signal that he wishes to work with us.

My final point is that we are not starting from zero. Much work has already been done in the field. I stress the valuable work done by the CPA in Malawi, for example, where all the parliamentarians were defeated in one election. I was there with others running a seminar. The CPA runs seminars on governance, including a very helpful one in June this year on international parliamentary governance. They include clerks, which is very important not only for Commonwealth countries but for Rwanda, as well as inward and outward delegations. Most significant is its membership of the new Westminster Consortium, which was awarded £5 million over five years from DfID’s transparency fund for a sustained intervention, rather than brief encounters, in the countries selected. I welcome these bold initiatives. In brief, the CPA and others are there already. This is a valuable report and I hope that it will reinforce valuable change.

It is a great pleasure to follow the noble Lord, Lord Anderson of Swansea. I will refer back to his contribution in a moment. First, I join in the congratulations to my noble friend Lord Chidgey on initiating this very useful debate.

My mind goes back to when I first entered Parliament in the mid-1960s. It was the era of transition from colonialism to independence. My noble friend Lord Anderson will remember that in those days a lot of people in the House of Commons knew about Africa. They were either in the Movement for Colonial Freedom and tended to be on the Labour side, or they were in commerce or agriculture and sat largely on the Conservative side. A lot of people had an interest in Africa. Gradually that faded away as the years went by. As my noble friend Lord Anderson will remember, we reached a point where very few knew anything about Africa or took any interest. We used to scrabble around to get names on Early Day Motions, and it was the usual suspects—him, me and about four or five others.

I am very glad to say—and this is the point I want to make—that the situation has now completely changed again. The All-Party Group—ably chaired by Hugh Bayley, the Member for York—which produced this report, has a large number of supporters in both Houses of Parliament. I say to the noble Baroness, Lady Amos, how much we appreciate the support that the Royal African Society gives to that group. It makes a tremendous difference to the impact it has on this Parliament and the interest that we now again take in Africa.

There are 46 recommendations, but in a short speech of five minutes I propose to deal with just one. It is the one that has already been mentioned, recommendation 12. I quote it exactly:

“The importance of political parties to the strength of parliament was a consistent and acutely felt concern throughout this inquiry. DFID should consider working with organisations, such as leading political party institutes/foundations as well as International IDEA, to support the development of political parties”.

In my experience, this is basically the weakness of the parliamentary institutions in Africa. The party-political system has not developed properly, and we need to do a lot more to encourage it. I agree with my noble friend Lord Anderson: we cannot expect FCO officials, or even DfID officials, to be expert in political matters. That is why the Westminster Foundation for Democracy is crucial. It could do with a bigger budget, and it could do with giving a bigger budget to the political parties in this country to enable them to nurture sister parties. Let us be blunt: the political parties in this country—all of them—are naturally using most of their resources for their own purposes. The amount that they put aside for international work is, in each case, relatively limited. Therefore any support that can be given to the Westminster Foundation for Democracy is to be welcomed.

Too many of the political parties in Africa are either personal fiefdoms of an individual or tribal institutions. We really must get away from that. A lot of work needs to be done. I was a founding board member of International IDEA. It was set up largely on the initiative of the Swedish parliament. It is scandalous—and I say this to the Minister with great respect—that the previous Government decided not to be a member of International IDEA. That was a terrible shame. I hope that this Government will eventually join the institution and help it to develop an international concept of standards of democracy. By producing an annual audit on corruption, institutions such as Transparency International have helped to put pressure on that issue, just as Amnesty International has kept up pressure on human rights. However, we have no international democracy audit, and it is time we did so that we can range through the effectiveness of African parliaments—indeed, the parliaments of the whole world. That could be done if a body such as International IDEA had more resources to produce a democracy audit. That would help to increase the pressure for political parties and parliaments to be much more effective.

I agree with the noble Earl, Lord Sandwich, that we have exported some of the appurtenances of Parliament—the wigs and the gowns are there in Zimbabwe—but not, sadly, the basis of democracy. A few years ago, the high commissioner in Lesotho, who happened to be a Scotsman—there is a little bit of prejudice here—thought, rightly, that the Scottish Parliament was a better format than the Westminster Parliament for a country such as Lesotho, which was moving from a single-party to a multiparty system. He asked me to go out and conduct a series of seminars, which I did. I made some recommendations, which were followed, to get away from the imposition of opposing Benches, which is not really appropriate in struggling democracies. I think the Scottish model could be followed elsewhere. My plea is to look carefully at recommendation 12, and I urge the Government to implement it fully.

I join in the congratulations that have been expressed to my noble friend and his colleagues in the All-Party Parliamentary Group on Africa on attracting such a star cast to this debate on what is in some ways a rather depressing report. It highlights the weakness of parliaments in almost every African country, although its three examples are by no means the worst. Parliaments exist on paper in many states without making any practical impact on governance or on the scrutiny of the Executive. The report might have focused more on the connection between authoritarian presidential constitutions and systems of government and the absence of effective parliaments. It does not mention Zimbabwe, which was raised by the noble Baroness, Lady Park, where Mugabe has ruined the Parliament, or Sudan, where, under the comprehensive peace agreement, the National Assembly is an entirely appointed body.

I was particularly interested in the recommendation that a biannual report of the state of parliaments should be produced. From the references, it seems that UNDP would be the right body to initiate the project, initially defining the benchmarks, norms and standards to be used in assessing performance with the aid of the CPA and the IPU, and possibly the SADC parliamentary forum.

The noble Earl, Lord Sandwich, mentioned NePAD's African peer review mechanism, which includes democracy and good political governance in its remit, but only 26 of the 42 AU states participate in the APRM, and it is a desultory process that produces very few reports. In the case of Ghana, which probably has one of the best parliamentary systems in Africa, the APRM was nevertheless told that Parliament is neither effective nor independent of the Executive branch. Can the Minister tell us whether the Government still think of NePAD as the best mechanism for promoting effective parliaments, which is one of the goals of objective 4 of the APRM?

One of the witnesses told the APPG that strengthening parliaments is not simply an issue of capacity, and the report quotes former DfID Secretary of State, Hilary Benn, as suggesting that we should try to work to the plans of a country's people. However, the Government's plans may not accord with the wishes of the people in the absence of free and fair elections. In Cameroon, for example, rigged elections have allowed President Biya to stay in power since 1982, and the tame parliament has recently passed a resolution allowing him to stand for yet another seven-year term in 2010. If he is re-elected, that will allow him to remain in office until the age of 85. How does the Paris declaration on aid effectiveness, which is seen by DfID as needing to be applied more rigorously to parliamentary strengthening work, apply in that situation?

One criticism of the aid programmes in this area, which has been mentioned by my noble friend and by the noble Lord, Lord Anderson, is familiar. It is that multiple development partners with multiple fund management mechanisms overload the recipients. Are we certain that even within our own agencies, and more widely among our EU partners, there is well managed co-ordination, so that all are working to a common strategy? Should there be a formal mechanism for developing common strategies and minimising the burden on African parliaments of dealing with a great many donors with different agendas?

I, too, thank the noble Lord, Lord Chidgey, for initiating this debate. I read with interest the report, which suggests a number of recommendations aimed at improving the effectiveness of African parliaments in their role of representing their people by holding the Executive to account.

On a continent with an unfortunate history of strong leaders or “big men”, I applaud efforts to encourage the confidence of legislatures and the proficiency of parliaments. The report makes recommendations which encourage an unobtrusive form of engagement, so that parliaments in Africa feel that they are “pulling in” changes rather than having them pushed by outsiders, and that development partners learn lessons from evidence and information that they have gathered. That seems sensible to us.

We were, however, disappointed by the Government’s response to the report. They have agreed in the most general way with its recommendations, but while there is plenty of dense jargon, there are rather fewer hard, cold facts. For example, we are told that,

“in the Democratic Republic of Congo, we are contributing £62 million to a five year multi-donor governance programme, led by the UNDP, which includes a DFID contribution of £5.8 million to a £10 million parliaments and political parties strengthening component”.

That sounds very worthy, but what does it mean? Where exactly is the money going? In that example, where is the other £56.8 million going? What outcome is expected and by what measure will it be judged a success or failure?

As the noble Lord, Lord Steel, said, we would like the Government to be much clearer about how this multi-million pound budget is being spent. How is DfID’s outlay for strengthening parliaments in Africa audited? It is one thing to say that it may be a long process—I accept that there will be no immediate result and that our aim is to build up parliaments over time so that they can learn to exercise their roles by evolving their own distinctive legislative personalities—but there must be some way of assessing whether we are spending taxpayers’ money wisely. What outcomes are being tracked? In which countries does the tracking take place, and what exactly is being tracked to assess those outcomes? Will the Minister tell the Committee whether DfID helps to establish transparency within the parliaments which receive direct funding? As well as allowing us to follow as accurately as possible where our money is going, I hope that such a scheme, if presented sensitively, would help engender a culture of accountability and probity in countries where elected office is sadly sometimes regarded as a path to riches.

I am not criticising the goal of strengthening parliaments—quite the opposite. I hope that by building up contacts and support we will be able to achieve a lasting improvement in those institutions. I had the pleasure of the company of His Excellency the Ambassador of Senegal this week. I was very interested to hear that Senegal, one of the most stable, prosperous and democratic countries in West Africa, spends 40 per cent of its GDP on education and has recently added an upper House to its parliament.

In east Africa, there are examples of aid towards education through the Aga Khan Development Network and grants made to civil society organisations. They monitor their own spending very rigorously. If private organisations are able to do that, one might hope that government can follow suit and be much clearer on where and how money is being spent.

Are funds being diverted from embassies towards DfID? The United Kingdom has no direct representation in 23 of the 53 African states. In a Westminster Hall debate on 20 May, the noble Lord, Lord Malloch-Brown, was quoted as saying that the Government were,

“trying to grow our diplomatic footprint in Africa”.—[Official Report, Commons, 20/5/08; col. 55WH.]

Will the Minister indicate how those efforts are coming along?

One country which has expanded its footprint in Africa is China. It appears that it is interested more in trade than aid and is less likely to champion parliamentary democracy in those countries where it is expanding its influence. Is the Minister at all concerned that the softly-softly approach espoused by DfID may get drowned out by the din of Chinese construction teams building roads from mines to ports across Africa? I am not suggesting that we are in any competition for influence with the Chinese, but it is another reason why I would like to be reassured about the efficiency of the schemes that we are supporting.

In February, my colleague, Andrew Mitchell MP, called for 5 per cent of Britain’s budgetary support for developing countries to be earmarked for tracking where our development money is going. Does the Minister support devoting just a small amount to safeguard our overall investment?

I, too, thank the noble Lord, Lord Chidgey, for raising this important subject today. The Government very much welcomed the report that he and his distinguished colleagues on the All-Party Parliamentary Group on Africa prepared. We congratulate them on that report. The star cast that we have in Grand Committee in the Moses Room this afternoon is worth much more than a rather hurried one-hour debate on this subject. Although noble Lords have been fantastically self-disciplined in keeping to their small five-minute blocks, I will have to be pretty disciplined to keep to the 12 minutes that I am permitted and will not be able to answer all the valid points asked of me by various noble Lords. However, I shall do my best to explain to the Committee where the Government stand on this important issue.

First, we believe that this is exactly the right time to discuss parliaments in Africa. Nine out of 10 Africans say they want to live in a democracy. According to Freedom House, half of the 48 countries of sub-Saharan Africa may now be classed as democracies. I heard, of course, what my noble friend Lady Amos said about elections. However, frankly, all is not well. The ongoing situation in Zimbabwe, on which the noble Baroness, Lady Park of Monmouth, concentrated, has shown starkly that the trappings of democracy are not enough. Election results must reflect the will of the people, and robust institutions must represent citizens and provide a check on how power is exercised.

I hope that our position on Zimbabwe is absolutely clear. We condemn the violence and do not recognise the outcome of the second round of the sham presidential election. We call for a new transitional Government who reflect the will of the Zimbabwean people as shown on 29 March, and we call on all members of the international community to work towards the restoration of democracy in that country.

Parliaments must be able to play a full role in democratic governance. Where they need it, the UK should support parliaments. We have made many significant investments; for example, since 2001 we have provided nearly £4.5 million to the Malawian Parliament in support of its five-year strategic plan. African parliaments are holding their executives to account, in high-profile ways, such as in Tanzania, where the Prime Minister resigned because of parliamentary pressure over corruption allegations, and in smaller, everyday ways, such as in Zambia, where in 2007 the Government withdrew an unsuitable Bill on NGOs at parliament’s request. We want to see more of this, and will continue to invest in strengthening the institutions that make this possible. The question is how best we can do that, and it is to that matter that noble Lords have set their minds today.

The report makes some helpful recommendations. It emphasises the need to base support on a thorough understanding of the political context, which, as the noble Lord, Lord Chidgey, said, can be very varied. It mentions the importance of broad-based local ownership and the need for donor co-ordination. It highlights the need to use evidence, learn and share lessons, assess parliamentary performance and evaluate the impact of our support. It urges donors not to marginalise parliaments, but to encourage them to play a full part in development relationships.

Of course, it is almost a statement of the obvious that parliaments are inherently political, as the report clearly points out, and as Members of this House are well aware, whether or not they were Members of another place earlier in their career. Recent events in Africa have reinforced the group’s observation about the importance of the wider political context. We should base our work on an analysis of the political context and focus our efforts accordingly. For example, where a parliament is unable to exercise a check on the Executive, we should encourage the development of civil society and political parties.

However, where parliament plays an important role, or has the potential to do so, support can be beneficial if it is designed to suit the political context. The Foreign and Commonwealth Office, through its network of posts around Africa, makes it its business to understand the political context in individual African countries. DfID’s country governance analysis is helping to improve its understanding of political contexts and to identify where we can support democratisation. FCO political expertise feeds into that process as well.

Understanding the political context also means focusing on how parliaments engage with their public and civil society. In Nigeria, we helped set up a civil society office at the Nigerian Parliament to improve interaction between parliament and civil society. Increasingly, the UK’s support to parliaments is through integrated programmes to promote accountability more broadly. For example, our Deepening Democracy programmes in Uganda, Malawi and the DRC support a range of oversight and accountability institutions to help provide the checks and balances vital for democracy. Wherever DfID missions are present in Africa, we encourage joint political reporting from the head of mission and the head of the DfID office and close co-operation on political and developmental issues. In the Democratic Republic of Congo, we have committed £62 million over a five-year period for strengthening democracy and government accountability, including support to the legislatures, political parties and the electoral commission.

My right honourable friend the Foreign Secretary recently said that democracy has to be “home-grown”. Our experience here in Westminster may be valuable, but that does not mean that it can be transferred elsewhere. That is in line with what the noble Lord, Lord Steel, was talking about when he supported recommendation 12 of the report. When we support parliaments, we look to the parliament itself for direction. In Malawi, Uganda and Zambia, we have rooted our support in the parliaments’ own strategic plans. We have learnt that our assistance achieves more if it is based on demand from parliamentarians themselves.

Donor co-ordination has been referred to. Many of our projects are carried out jointly with other donors and other organisations. We have recently awarded £5 million over five years to the Westminster Consortium for Parliaments and Democracy, a joint venture between the much-praised Westminster Foundation for Democracy, the Overseas Office of the House of Commons, the National Audit Office and the UK branch of the Commonwealth Parliamentary Association. The consortium will support a range of demand-led strategies for strengthening parliaments.

DfID is at the forefront of donor co-ordination on support to parliaments. With partners, we are holding a conference in October at Wilton Park on parliamentary strengthening. DfID will then host a meeting of the donor co-ordination group on parliamentary development to discuss how to strengthen collaboration and increase impact. We agree with the All-Party Group that it is important to assess the effectiveness of our support to parliaments. We are helping to fund the Africa Legislatures Project, which aims to enhance understanding of the ability of 18 case-study legislatures to represent the people, make laws and oversee the Executive. We think that this will also help us to develop a better basis for evaluating the impact of parliamentary strengthening programmes and deciding where such programmes are most needed.

Development assistance should not undermine the role of parliaments but should seek, where appropriate, to strengthen it. Managing development assistance is, for the most part, the responsibility of the Executive. Parliament’s role is to hold that Executive accountable. We believe that it is better to strengthen such domestic accountability arrangements rather than to establish special arrangements for donors to report directly to parliaments. That is where I think we disagree with one of the report’s recommendations.

Our direct budget support already provides a basis for parliamentary scrutiny: it forms part of the country’s government budget, which should be approved by Parliament and subsequently reported on. Where we provide direct budget support, we generally also support public financial management. In Zambia, DfID gives budget support and acts as lead donor for support to the parliament and for a financial management programme, which involves the Public Accounts Committee.

This has been an excellent, if too short, debate, covering many important issues. If I try to deal with the questions that have been asked, that will take me, and the debate, much over the allotted time.

The noble Lord, Lord Chidgey, raised a point about democratic Governments and aid to those Governments. We do not believe that we should confine aid to countries with democratic Governments because, frankly, poor people are not confined to such countries, and a lot of poor people live in countries with poor Governments. Therefore, although it is not easy, we have to see how we can best make an impact, despite the problems. Where a Government are simply not committed to helping their own citizens, we will still use our aid to help poor people and promote better governance, but we will do so by working outside government with the civil societies and with international agencies such as the UN.

DfID’s policy is to make information on conditions attaching to individual programmes available on its website. Putting this into practice requires changes to DfID’s system, and we are working to introduce those changes. As to making public our aid agreements, I am advised that under the Freedom of Information Act a request could be made by a member of a foreign parliament for information from DfID on conditions attaching to budget support or other aid programmes.

The noble Earl, Lord Sandwich, raised the issue of Uganda, where corruption, weak accountability across government and a lack of respect for the independence of the judiciary all need to be addressed. We want to continue working with that Government to ensure that those do not become problematic issues, and through our aid programme, we are helping to establish the institutions required to fight corruption.

I have not answered other questions. My time has run out, so, if it is acceptable to the Committee, I shall write with answers to the various points that I have been asked during the debate. I end by saying that the success, or otherwise, of the democratic process in Africa captures the attention of a watching world. A point made well by the noble Lord, Lord Steel, was that in Parliament Africa is now once again very high up on the interest list of many Members of another place and, clearly from this debate, of this House as well.

In Zimbabwe and Kenya—the noble Lord, Lord Steel, and I were guests at a lunch held by the Lord Speaker for Kenyan parliamentarians just a few weeks ago—we have seen what happens when things go badly wrong. We have seen that African citizens are not willing to tolerate rigged elections and authoritarian rule. That is why we include support for democracy in UK international development programmes. Elections are one part of that democratic process but, for a functioning democracy—as perhaps we know in this country too—states need structures and institutions that hold Governments accountable not just some of the time, but all the time. Parliaments are vital in this, and our support can help them to fulfil their role. Once again, I thank the All-Party Group for producing such an excellent report.

Sport: Go Play Rugby

asked Her Majesty’s Government what is their response to the Rugby Football Union’s Go Play Rugby scheme; and what lessons can be drawn for encouraging amateur participation in other sports.

The noble Lord said: I thank noble Lords who have put their names down to speak in this short debate. I must make a small confession about this scheme. I discovered it properly when it was finished and did not pay enough attention to it when it was building up, so I have a bit of the zealousness of a convert about it. I did not realise how revolutionary its approach was: it attracted adults back into participation. We have often spoken about sport, and there are a series of clichés about it. Everybody talks about children, school sport or school-age sport and then says that we must enhance the club link. However, until now, there has not been a scheme that addresses the primary problem of the huge drop-off in participation between the age of 16 to 18 and adult life. There are other drop-off points when people change their lifestyles; for example, between the end of college or university and the first job. It is clear that people’s lives are organised so that there are points where they break the contacts and the habit of sport.

We then tend to fall into the trap of having schemes where we have lots of children running around a politician and a sports star standing in the middle of a field—at a junior level, I have been that politician—and then the politician goes to another event. I got the feeling that the children might even be bussed from event to event—fresh-faced kids who do not know whether they are holding a cricket bat, a rugby ball or squash racket that afternoon. There were a lot of them. It is true that school sport has gone through something of a transformation and more energy has been pumped into it, but we always seem to miss the fact that getting adults taking part in sport is the most important thing.

There are other good schemes that try to maintain the good practice of keeping people involved from the transfer on, but changes in lifestyle mean that those who are casual participants and not natural first-teamers tend to be lost. That is why this scheme is so important, because it went out to recruit those who had stopped playing the game but were basically sport-literate and brought them back in.

Noble Lords may think that this is not rocket science, and that is its beauty. It is a targeted approach to bring people back. It was done round the greatest spike of attention that Rugby Union would get: the world cup, which comes once every four years. England were defending champions and it was expected that they would do fairly well. True, the expectations may not have been quite as high at one time in the tournament as they were by the time it ended, but nevertheless the team had a rollercoaster ride, lots of attention and the situation was transformed and was well used.

A scheme that was designed to get 6,000 players involved and coming back into the game got 9,500 people. It also inspired a considerable number of volunteers to get back involved with the game, in terms of organisation, support work, referees and coaches. The cross-section included people who had been away from the game predominantly for at least one season. Would the Minister not agree that that was something that many of the government targets aim towards? It fulfils virtually every single government goal; it ticks the boxes; it gets people back involved. Why is this so important to the sport? Because these are amateur sports clubs whose greatest asset is their players—their asset in terms not only of playing the game but also their financial stability. There was an investment of about £1 million and they got 9,000 players, so it was just over £100 each player. That is a conservative estimate for a normal rugby club. True, these are institutions with bars—although I am not sure that the relationship between Rugby Union and beer should be acknowledged, at least at the traditional amateur level. But those are clubs where those people come and spend money and use the leisure facilities. They will probably purchase some of the merchandise and take part in the social events; they will be socially integrated and interacting with a group of like-minded people. That is why this scheme is important.

Having got the ideology in full swing, I turn to the scheme, about which there was one particularly attractive thing. At the previous world cup, which England won, people who did not know how many players there were on the pitch in a Rugby Union game suddenly became rugby fans and there was a great spike—or was that just my feeling as an old hack in the sport myself? According to the first page of the document, there was great attention and lots of activity but in the junior ranks; it did not attract the people who will support the clubs and ultimately support those juniors to go on. There was an admission and acknowledgement that something had not been maximised.

Then there was a pilot scheme in Surrey in 2006. It took a little digging, but I got the RFU to admit that there were problems with it and that it did not get it right first time. It always makes me feel better about a scheme when I realise that someone had to adapt it slightly. Indeed, certain things surprised me on reading the document through; for example, the phone lines did not work for giving out information about where people could go and find a club, which is a very important part of this. The text services did—but possibly my age shows. Also, there was the fact that advertising on buses was a total waste of time. Small things like that meant that it was a targeted audience. Then it was backed up by other forms of advertising later, which were targeted. We can go through what worked and what did not; if the club did not invest in getting people to receive people at the right time and help people as they turned up, it would probably lose them.

Messages of that type were taken into the scheme around the time of the world cup. Once again, it was not a universal success but it was a success across the board. There was a targeted advertising campaign and a better services website that allowed people to know where the nearest clubs to them were, and it was combined with preparing the ground properly and making sure that there were packs and people at the clubs. That apparently encountered resistance from certain clubs that wanted to have their name up, as opposed to rugby. Why people play for amateur clubs is usually down to accidents of geography and who their friends are. The scheme tried to ensure that those things meshed together and gave incentives to get friends to come to the rugby club for a social function and to play so getting people involved in the whole activity.

Another very important factor about this is that it brought people together. In certain cases, small rugby clubs that were in danger of folding found themselves with teams. Remember that most rugby clubs will now have other sports attached to them. Cricket and rugby are an old pairing; one summer, one winter. Rugby League and Rugby Union now coexist on many sites. The fact that you are taking part in one sport, a social activity at a set time, means that you are often prepared to do so for another sport.

A more recent example, closer to home, is that four members of the Commons and Lords Rugby Club were in the House of Lords boat that today beat the Commons in a race outside; I did not count the Commons team. There is interaction; these sports feed off each other. What steps has the Minister taken to encourage this model being adopted by other sports? Rugby itself will probably benefit indirectly if it is, but the agenda of getting people involved and supporting the social function of sports clubs will be enhanced and reinforced by this process. To adopt something where somebody from outside has taken on board the Government’s aims in this way, largely for selfish reasons, is effectively a no-brainer. How do the Government propose to enhance this position and the transfer of information?

I have not given universal praise to my own sport in this House, but this is one time when Rugby Union has got it right. It has something to teach the rest of the sporting world.

My Lords, I begin by apologising; I misread my Order Paper. I was sitting in the Chamber wondering where the noble Lord, Lord Addington, was. Anyway, he is here now. I thank and congratulate the noble Lord on initiating this debate on rugby, and for highlighting the wonderful achievements of the Go Play Rugby programme. As a player of the game himself, it is close to his heart. His contribution showed that clearly. The noble Lord can always be relied upon to take part in any debate on sport in this House and his contributions are always based on a knowledge of sport in general.

I must confess that rugby was not a sport in which I excelled at school myself. I found it a bit brutal, so I reverted to the more gentle sport of boxing under the protection of the Marquess of Queensberry rules. Having said that, I congratulate Sport England for its involvement in the Rugby Football Union’s Go Play Rugby scheme—one of the first funders to do so. Sport England has invested £55 million in Rugby Union since 2002. The campaign aimed to attract 6,000 adult players back to the sport but has in fact actually attracted 9,500 players back to the game. I was given these impressive statistics by Alexandra Russell, the regional PR manager of Sport England.

Only this week, I spoke at the opening of a memorial recreation ground in Newham, east London. As part of a £15 million scheme to improve leisure and parks by next spring, they will have a state-of-the-art facility focusing on two of our country’s national sports, football and rugby. The East End of London is not as well known as the West End for Rugby Union teams, so it was most pleasing to learn of the developments taking place in Newham. Newham School’s tag rugby world cup competition for primary schools was held, and 20 primary schools took part and 200 children participated. Also, Newham Schools world cup rugby competition was held at Memorial Park, where 10 secondary schools took part and 100 children participated. Newham is definitely on the move as far as rugby is concerned.

I last raised the important subject of sport and physical activity in this House on 5 June. It was therefore with great pleasure that I learned of the Government’s announcement the following day—this was nothing to do with my debating skills—on free swimming for the over 60s. Swimming is the most popular participatory sport in the UK. Removing the cost barrier to swimming is an important step forward. After reading the Government’s Olympic legacy strategy at length, it is clear that it was not the only measure to be applauded. For example, I was particularly pleased to note the Government’s pledge to inspire 2 million people to take up sport and physical recreation by the 2012 Olympics.

There is considerable evidence to prove that exercise is the most effective way of reducing the risks of more than 20 diseases at least—diseases which, as a nation, we are all aware of, including stroke, diabetes, obesity and heart disease. I have made the financial case before in this House, and make no apology for doing so again. More than two-thirds of the British public do not reach the minimum level of physical activity. That affects the economy to the tune of £13.2 billion per year in sickness absence costs—the equivalent of 175 million working days. The National Institute for Health and Clinical Excellence has found that work based on physical activity programmes can significantly reduce absenteeism and staff turnover.

The Foresight report on future trends in obesity predicts a cost, at current trends, of some £50 billion a year. In Essex, there is a gym-based programme operating across five primary care trusts called condition management. It focuses on getting people on incapacity benefit back to work. Services include advice on diet and exercise but also focus on career development and helping people overcome barriers to work, whether they are emotional, educational or health-related. The programme works with people with stress, depression and muscular problems, giving practical advice to encourage positive thinking.

It is clear that without these huge investments in sport and physical activity programmes of this nature, the economy and health of this country would be much poorer. We have heard today of an excellent project, Go Play Rugby, which deserves all the attention it has received. These amateur sporting schemes, as the noble Lord, Lord Addington, has said, are very important; they are essential cogs in the vast change we need to endorse across the nation.

We also need increasing national rollout schemes and mass promotion which have cost benefits in terms of economies of scale. It is encouraging to see the Government taking steps in the right direction. I only hope that they will do more to empower those bodies with a presence in our communities to do what they do best in providing opportunities to be physically active.

Go Play Rugby has made a huge impact and we applaud its success. I should like to highlight some other programmes which have been effective in introducing physical activity into people’s lives. Go London is an extension of the national Go programmes which were launched in March 2008 by the Fitness Industry Association to get more teenage girls more active. It is widely known that there is a massive drop-out rate among young girls around the age of 14 who are doing sport, and this can have detrimental effects in the long term, if not for ever.

The Go programme was originally developed in response to the Government’s research which highlighted the fact that teenage girls are a healthcare priority, key to reversing the escalating obesity crisis. The Go London project has given 14 to 16 year-old girls free access to health club facilities, allowed them to participate in non-traditional sporting activities and engage in a range of modern, exhilarating exercise sessions led by professional qualified instructors.

Another programme I commend is Adopt a School. Completely free of charge for the schools involved, Adopt a School pairs up health and fitness clubs with local schools to give kids access and opportunities to engage in fun physical activities.

Last week I received, as no doubt other noble Lords did, an update on the new opportunities for PE and sport programmes: a nationwide £750 million lottery investment in sporting facilities for young people and the wider community. Nearly 3,000 sports facilities have been funded to date, leading to a 70 per cent increase in the number of activities available in the communities in which these facilities have sprung up.

Active at Work is an adult programme that has been running across parts of Britain for over three years and targets inactive employees. The programme lasts for 12 weeks in which a group of up to 30 employees receive complementary gym membership and instructor-led group sessions at least once a fortnight. At the end of the three months, participants are offered avenues to carry on exercising in other ways. The health and fitness industry has a great deal of spare capacity. With more than 30,000 people on the Register of Exercise Professionals, these programmes can be channelled within clubs and leisure centres or out in the community. These are some examples of programmes run by the health and fitness industry. We must support these efforts wholeheartedly if the Government are to achieve their target of getting 2 million people more active more often by 2012.

I conclude by congratulating the noble Lord on bringing another important dimension into the debate surrounding sport. Let us hope that the points that he has made in this debate are heard by the wider public.

I join the noble Lord, Lord Pendry, in congratulating my noble friend on initiating this important debate. Nobody can accuse my noble friend of being an armchair commentator, which is unusual in this House in the sporting area. I particularly appreciate his positive approach to this subject. He has highlighted the RFU’s Go Play Rugby scheme as a great example of how to encourage participation in sport from school through the transition into the community. There is no reason why maximising success, developing talent and encouraging the greatest possible participation should not go hand in hand. They are not mutually incompatible, and they should not be competing priorities. It is clear that ensuring that the transition from school to the community has become the focus of many sports’ governing bodies.

Whatever one thinks about Sport England and its previous priorities and whether it was successful in meeting its targets—I am afraid I do not think it was—it is clear that its new strategy is far more realistic in placing its trust in the major sporting organisations and national governing bodies. I welcome that shift in emphasis in giving the national governing bodies a much greater role and money in return for delivery of key outcomes by means of whole sport plans. In its funding, Sport England has also recognised the importance of a network of modern, accessible clubs for each sport, which we welcome. The new strategy stands a much better chance of delivering its targets and being successful than the previous strategy.

The RFU’s Go Play Rugby scheme will form a template for the future in adult recruitment campaigns. It was remarkably successful. Some 700 clubs took part, which was more than was anticipated. It was centred around the 2007 world cup. At that time, there was a slight dip, and I suspect that at one point the RFU thought “Heavens! This is not going to work out.”. At one stage, it seemed to be a relatively high-risk strategy, but what a triumph at the end of the day.

We now have Play On, which is designed to help players stay in the game as they move between school, club and university. It will take place throughout 2008-09. The RFU has put forward the idea of a pathfinder to help players move through what it calls the rugby journey. Go Play Rugby achieved something like 9,500 recruits against a target of 6,000. The RFU has calculated that from an outlay of £1 million something like £23 million will come back over five seasons. That is quite some achievement.

With the Play On campaign, the RFU has some innovative ways of attracting the attention of the target groups. I recently received an e-mail, which I must admit made me feel as though Tuesday could not come too soon. It said, “Scrum down on the sand. This summer, O2 and the RFU have teamed up to bring you O2 Scrum on the Beach”. That is quite an invitation and I look forward very much to next week, although I may not necessarily be found scrumming down on the beach. It is no wonder that the RFU scheme achieved the accolade of being shortlisted for the Sports Industry Awards in the category of best promotion of a sport by a governing body. I am just sorry that the competition was so fierce that it did not end up as winner of that category, but that demonstrates that it has the accolade of its peers. It was a very professional write-up too.

What is remarkable is not just the nature of the campaign but the quality of the evaluation, which enables us, as opinion-formers, to form a view by very carefully examining some of the outcomes. I believe that it is a great model, as it shows how the Olympics can be used to drive greater participation. I am sure that a lot of very useful models could be derived from that campaign.

Of course, other sports bodies—perhaps not quite as successfully but certainly in a growing way—are also very much engaged in finding new ways of encouraging participation. We have the ECB’s Get Into Cricket campaign, which is resulting in something like £30 million of investment in facilities and in club cricket. There is the Grassroots Athletics roadshow and the Power of 10 scheme. I love the way that different sports use different metaphors in order to encourage participation. That is a very powerful metaphor for athletics. The Get Into Football campaign is funding something like 270 football development officers.

The Lawn Tennis Association’s new work in this area is a particularly good example, and it is interesting that it has come at just about the same time as the RFU’s scheme. It is a condition of funding that tennis clubs have a junior development programme, and there is the Tennis Clubmark condition, in which clubs can apply for loans, grants and programme funding. It is a strategic tool to drive improvement in the sport. There is also the development of community tennis through hot spots, in which, in due course, some 20 specific areas will be funded. There are also beacon sites, which will have dedicated coaches.

The sport governing bodies want to see the Government take various actions. The national alliance of governing bodies, the CCPR, is increasingly clear about the kinds of steps that need to be taken and the benefits of increasing participation in school sports through to community sport. It is committed to extending participation, and there is a remarkable consensus by the CCPR that has, in my view, led to the Sport England change of strategy. It centres around the local club, which, as my noble friend said, is crucial. One of the CCPR’s suggestions is to enhance the community amateur sports clubs scheme by making junior subscriptions eligible for Gift Aid. It has made some fairly careful calculations and reckons that by 2012 this could cost the Government a mere £2 million. The impact of that could be absolutely enormous. In the context of the Olympics, that is very important, but it is not clear what additional funding the Government are making available in order to increase participation in the run-up to the Olympics.

My noble friend Lord Addington and I have a recent, terrific example. It is the inspiring story of a local rugby club where participation by young people has changed people’s lives astronomically. The noble Lord, Lord Pendry, whose speech I very much enjoyed, spoke about rugby in Newham. Well, this is a rugby club in Southwark called the Southwark Tigers. As a result of a profile in the Times, my noble friend Lord Addington and I made contact and we are now helping it identify how it can get a club house, and work with the local cricket club and other sports clubs to improve its facilities. It plays in Burgess Park. It was founded by Vernon Neve-Dunn and has done a remarkable job with very few resources. Some 80 children attend Sunday practices and it has quite a number of teams. The benefits of the rugby training and of playing in the teams have been enormous. It is one of very few examples—the noble Lord, Lord Pendry cited another—of home-grown, inner-city rugby. As a rugby fan, I am convinced that it will be of great significance. Now, off the back of a youth team, it is developing a senior side that will in turn give greater support to the junior side.

I must finish at this point. I shall be extremely interested to hear what the Minister has to say. It is not, of course, just a matter of resources but also of enthusiasm. My noble friend has demonstrated enormous enthusiasm for his sport, and other governing bodies do likewise. The RFU’s example is an inspiring story, and if we can replicate it across other sports we are set for a bright future.

The noble Lord, Lord Clement-Jones, spoke of enthusiasm, and it was wonderful to see the enthusiasm of the noble Lord, Lord Addington, for his sport. It was very encouraging. Perhaps if he has some spare time he could come and give me some assistance with the Castle Rising football club, of which I am chairman, which seems to lurch from one request for a cheque to the next.

I declare an interest as chairman of the National Playing Fields Association, so I am sure the Committee will realise how delighted I am with the contribution to sport that the scheme has made. It is very encouraging, and I am delighted that it has worked as well as it has. Everything about it has been said by noble Lords. There was a request to ask the Minister how far he will extend and encourage these sorts of schemes. Will he get as far as tiddlywinks, darts or ping-pong? One never knows where it is going to stop.

I am grateful to all noble Lords who have spoken in this interesting debate and particularly to the noble Lord, Lord Addington. I appreciate his dash from the successful crew to this Room. I congratulate him on that achievement, which cheered us all. The noble Lord, Lord Clement-Jones, said that the noble Lord, Lord Addington, is no armchair enthusiast and that was proved this afternoon. We know the noble Lord’s commitment to rugby as well as his general interest in sport.

He is right that the Rugby Football Union’s Go Play Rugby campaign was hugely successful. It attracted more than 9,000 players back into the game and identified an issue that exercises us all, which is the drop-out rate in sports. As my noble friend Lord Pendry indicated in his contribution, we are concerned to strengthen the links between school and clubs that ensure that young people come into sport, but tackling the drop-out rate is of great significance, too. We all know how greatly it affects sports. I agree with the noble Lord, Lord Addington, that the Go Play Rugby campaign was in many ways a potential template for other sports to tackle the phenomenon of people finishing in a sport too early when they would often benefit by returning to it. I agree also with the noble Lord, Lord Pendry, that the health of the nation is aided significantly if we can promote exercise and commitment to sport throughout much longer periods of people’s lives.

The noble Lord, Lord Howard, asked how far we will go. The answer is that we will deal with authorised national governing bodies of significant sports. I counsel him, however, that I have no means of assessing how aggressively the tiddlywinks people present their case—although, since they have been mentioned in today’s debate, I expect representations from them. I advise him, too, to be a little careful with ping-pong. Table tennis is a mightily important sport in this country. I am president of a hugely successful table tennis club in Enfield with which I have a long association. I assure the noble Lord that nothing is more effectively and efficiently run than that club. Nothing brings youngsters into sport and into really vigorous exercise more than ping-pong or table tennis. With China hosting the Olympic Games this year, we should be careful to pay due respect to a significant sport which challenges the abilities of young people.

Sport is not just about professionals; it is about reaching out into the community and the grass-roots structure. That is why Go Play Rugby’s success was important. Bringing 6,000 players back into the game exceeded its expectations and was a signal success. As the noble Lord, Lord Addington, indicated, it had a national media campaign which coincided with the excitement around the world cup. Although England did not quite reach the heights of 2003, the team certainly sustained interest throughout the competition most brilliantly. In many respects, people warmed as much to its valiant efforts on that occasion as they had to its success in Australia four years earlier.

The campaign was supported by Sport England. More than half a million pounds went through the National Sports Foundation, which is why we are pleased to recognise the campaign’s success. I agree with the noble Lord, Lord Clement-Jones, that one of its important aspects was evaluation: what have we learned from the campaign and what lessons can we derive that are of value to other sports? The RFU undertook substantial research into the effectiveness of the campaign and helped to set up a model for how things can be done in future. Sport England benefits from illustrations of successful endeavour of that kind. I hasten to add that it has similar expertise available to help other sports with media campaigns. I am quite sure that sports are looking at the success of Go Play Rugby, related to a particularly significant year for the sport, and will organise themselves in the same way.

The Active People survey carried out by the RFU has produced a wealth of data around participation levels in sport. Sport England has built on that and broadened it right across sports in England. We now have data on the participation in sport by adults over 16 for every local authority in England. That gives us a base for progress. The noble Lord, Lord Clement-Jones, paid due tribute to this. These are our essential tools for working out how resources can be directed most effectively. We all know that resources are never limitless—although I assure noble Lords that we will continue, through the sports governing bodies, to direct resources to these targets. We now have a model on which sport is able to build to get a clear analysis of what needs to be done. We can take encouragement from other sports governing bodies which are responding to the challenge of increasing delivery.

The noble Lord, Lord Clement-Jones, indicated his reservations about past work by Sport England. It has changed its priorities. We now regard it as being well placed to deliver a new era for sport. It is an opportunity, which of course is reinforced by the significance of the Olympic Games, to promote sport in England and across the United Kingdom.

We should not underestimate the significance of this year. Once the Olympic flag is handed from Beijing to London, attention switches significantly with regard to the whole Olympic movement and world interest in sport. It is an enormous opportunity for this country. There are still sceptics—not present, I hasten to add, among noble Lords here today—who wonder whether the world will respond, or whether London and the country can respond to the challenge. We should have every confidence. This country is one of the outstanding participative sporting nations in the world. It is not always the highest achiever in every single sport, but that may be a reflection of the sheer diversity of the participation of Britons in sport. Whenever I am assailed by the question how it is that we promote the most significant tennis tournament in the world and yet it is nearly 75 years since we last had a Wimbledon male champion, I reflect on the fact that of course tennis is only one of the great sports in which people participate. It should be recognised therefore that there are counter-pressures in other sports through their sheer abundance and the opportunities which are provided.

The job of Sport England is, through effective governing bodies, to ensure that we increase opportunities. We want those opportunities to be in terms of encouraging people to play sport for life, which was, after all, the essence of the Rugby Union campaign which is the subject of this debate. It is clear that we have to focus on a shared goal with the governing bodies to maximise English sporting success. We are not going to get high-level success unless we expand the talent pool and improve the quality of what we do at every level. The key—and it is well attested through a range of sports—to success at the highest level is the nurturing of the grass roots and the opportunities provided there.

The strategy that Sport England is presenting is a new partnership, which the noble Lord, Lord Clement-Jones, in his contribution recognised, between Sport England and the national governing bodies. It obviously needs more public funding to deliver against the outcomes of grow, sustain and excel. It will recognise that it will be expected to meet targets. Again, the noble Lord, Lord Clement-Jones, emphasised this point, and the noble Lord, Lord Addington, also reflected on the question of achievement. We intend to ensure that those who have pursued successful strategies are encouraged and rewarded by the resources made available to them. Others who fall off the pace have to buck up their game, frankly. It is important that they are incentivised. To obtain grants, support and financial resources, they must have strategies which meet the overall position. This strategy is central to our objectives of increasing participation in sport from grass roots up and allowing everyone to develop their potential. Of course, we look forward to sport gaining from the Olympic excitement in this country once the transfer of the flag has occurred. I have not the slightest doubt that we shall see a significant leap forward.

However, although the rugby scheme is concerned with retaining people in sport, the Government have been committed to developing sport and physical exercise in schools, ensuring that they have the resources to develop young people’s sporting talents when they are at their most creative. There are tough participation targets across the country, which can only be good for sport.

As the noble Lord, Lord Addington, indicated in his remarks, the relationship with clubs is crucial. In the past, our greatest weakness as a sporting nation has been that we have relied upon clubs to operate in an entirely free-market structure within which they sink or rise according to their own strengths and abilities, without any feeling that they encourage participation in the local community. One of the strengths of sport development that we are pursuing is to ensure that clubs get a chance to present themselves effectively to educational institutions and schools, to forge those links that will benefit the clubs. Young people will move on to them once they have left school, but you cannot make progress in sport solely on the basis of a school career. It is important that clubs provide the framework afterwards.

Where we have seen decline in recent years, as clubs have suffered through limited participation and have not sufficiently developed in certain areas because there has not been a close enough link between the sport and the locality, great strides have been made. There is no doubt that the sport has glamour attached to it; it can appeal to young people and do an enormous amount to encourage participation in sport. That has not only societal benefits, it has sporting and associational benefits, as the noble Lord Pendry indicated on health. It may also have the benefit of a better society, in which young people who are active and participate in and value their locality are unlikely to engage in anti-social practices that we all inevitably deplore.

I emphasise that there are hard resources behind this. The Prime Minister last year announced an additional £100 million investment in PE and sport for young people, to ensure that there should be three hours of sport for 16 to 19 year-olds per week.

These are broad issues. The noble Lord, Lord Clement-Jones, said that he was not too sure about the funding. We are committed to spending £783 million on sport over the next three years, bringing the total up to £2.2 billion by 2011. These are big sums of money and big commitments. We must withstand the obvious criticism that money spent in one area is unavailable to another. Members of the Committee will recognise the pressures on the DCMS budget, but the Government recognise the value of sport and are prepared to make significant commitments to ensure that we take advantage of the unique opportunity of the London Olympic and Paralympic Games to increase interest in sport.

I assure the noble Lord that today in this debate he has highlighted one strategy that has proved immensely beneficial for Rugby Union. It is an illustration of what can be done through careful thought, planning and imagination. As we have learnt, Sport England is eager to promote these opportunities more widely. I have no doubt that the spin-off from the campaign that the noble Lord has highlighted will go well beyond Rugby Union and help in the pursuit of our overall strategy of encouraging sporting participation among a much greater number of people at a time when the focus on sport will undoubtedly increase in this country.

That completes our business. Before I adjourn the Committee, I, too, congratulate the Lords rowing team and the noble Lord, Lord Addington.

The Committee adjourned at 5.50 pm.