Debate (6th Day)
Moved on Wednesday 3 December by
That an humble Address be presented to Her Majesty as follows:
“Most Gracious Sovereign, We, Your Majesty’s most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty has addressed to both Houses of Parliament.”
My Lords, we are here to debate the health, welfare and children Bills announced in the gracious Speech. I hope to inform that discussion by outlining the key proposals in those Bills.
I will begin with the subject that is the closest to my heart. This year we celebrate the 60th anniversary of the NHS. Just over 10 years ago the NHS was in disarray and chronically underfunded. In 1997, people questioned whether it could survive at all. Now, in 2008, the NHS has not only survived but also flourished. That is testimony to the hard work and dedication of many of my NHS colleagues. Their efforts have been supported by three phases of reform. The first began with the NHS plan in 2000. This marked the biggest investment in the history of the NHS, with more doctors, more nurses and better facilities for staff and patients. Such capacity building was a necessary means to an end, giving the NHS the resources it needed to provide better care.
Alongside that great investment we set some tough targets for tackling immediate problems, such as unacceptably long waiting times. We also needed to set minimum standards for key services, such as cancer and coronary heart disease. National targets, such as that of a maximum 18-week wait from referral to treatment, were not popular but have done their job by providing clarity to the NHS on key priorities.
The second phase was to reform the processes and systems, moving away from central direction by creating incentives to improve and introducing greater transparency and accountability. We needed to give patients real choices about their care through greater diversity of provision, strengthened healthcare commissioning and new incentives for better performance. So we introduced patient choice, payment by results and foundation trusts. Those reforms have coincided with the greatly improved management of NHS resources and further dramatic falls in waiting times.
I had the privilege to lead the third phase of reform, a new and fundamental focus on quality. It is what motivates me and my clinical colleagues. Now that we in the NHS have the resources and processes in place, we can be free to focus on the quality of care we provide.
In High Quality Care for All, the review that I published this summer, I explained that quality needed to become the organising principle of the NHS. If that happens, the NHS will have the necessary foundation for another 60 years. Quality cannot be centrally determined. It cannot be achieved by diktats from Whitehall. It can, and will, occur if front-line staff are instead freed to innovate and make changes that work for people locally. That is why High Quality Care for All is a national enabling document, supporting the local NHS to embed quality.
For patients, the document means that they will be supported in taking responsibility for staying healthy, they will have fair access to the best treatments, they will be kept as safe as possible in clean environments and they will have the right information to exercise real and informed choice. Much of High Quality Care for All can be achieved without legislation, but some of its proposals must be enshrined in law through a health Bill. Previous Bills have marked the stages of reform. Just as the Bill in 2003 that introduced foundation trusts identified the second stage, so the forthcoming health Bill will enable the “quality” phase. It will do so by improving the availability of information about quality for patients, clinicians and managers with the new quality accounts. In keeping with the spirit of my review, the way these are constituted will not be imposed by the Department of Health but will be determined by jointly designing them with those who provide the services.
The Bill will place a duty on all providers of NHS services to produce quality accounts, starting from April 2010. The accounts will contain new quality metrics, providing information on safety, patient experience and outcomes in relation to clinical services. Through the accounts, that information will be available to all, helping people decide where to be treated, giving clinicians feedback on the care they offer and supporting managers in identifying local priorities. This represents a new modus operandi for the NHS and the Government. Its aspirations far exceed what has gone before. We are saying to the NHS, “You have discretion but you are also fully accountable”, with quality accounts a key measure of local responsibility.
The Bill will also reinforce the core purpose and values of the NHS by placing a duty on NHS bodies to take account of the new NHS constitution. The constitution will be published alongside the Bill, and will secure the enduring principles of the NHS and set out the rights and responsibilities of staff and patients. The Bill will commit the Government to renewing the constitution every 10 years, in consultation with patients who use the NHS, the public who fund it and the staff who work in it.
The third commitment from High Quality Care for All, contained within the Bill, is the introduction of direct payments for health services in certain circumstances and with certain constraints. This is one of the ways in which we will explore the use of personal health budgets which have the potential to give people more control and influence over their healthcare. The experience of social care suggests that giving people greater scope to organise treatment and care around their own needs will increase both the quality of care people receive and their satisfaction with that care.
The Bill will also contain proposals not included within my review, but certainly consistent with its principles. Most notably, it will introduce measures to control the selling of tobacco, tackling the biggest single preventable cause of ill health and one which disproportionately affects the most disadvantaged in our society. On 9 December, we announced in the other place the Government’s response to the consultation on the future of tobacco control. The vast majority of the 97,000 responses to that consultation were supportive. The Bill will therefore include provision to ban the display of tobacco by retailers and, via regulation, to prohibit the sale of tobacco from vending machines or to restrict access to those machines to people under 18. This will be a major step in preventing ill health, which, as your Lordships know, is always preferable to treating health problems that have developed.
Finally, the Bill will, as noble Lords asked and we agreed during the passage of the Health and Social Care Act in the summer, extend the remit of the Local Government Ombudsman to deal with the complaints of people who fund their own social care services. I am grateful to the House for championing the voice of this important group of service users.
As a humble surgeon, I am often enough told by other doctors, and to a lesser degree by nurses, that I cannot grasp the intricacy of their particular specialism. So I hesitate to risk the wrath of job centre employees and teachers by heading into their domains. However, as a non-expert, I ask your Lordships’ leave to outline our proposals on welfare reform and improving chances for children and young people.
We announced our intention in the Queen’s Speech to introduce a welfare reform Bill, a Bill that will help hundreds of thousands of people to find and keep work. It will turn lives around. We are offering a fair deal: more support in return for higher expectations. Put simply, the proposals outlined in that Bill will help us to achieve our ambition of ensuring that almost everyone claiming benefits should have the support and expectation to look for work. These measures are more relevant today, in these difficult economic times, than they could have been in the past. Most of all, we cannot afford to waste a single person’s talent.
The measures in the welfare reform Bill will bring about radical change. Our proposals are in stark contrast to the position, just over 10 years ago, when less than a third of claimants had to do anything substantial in return for their benefits. Even that third got only limited support to get back in to work. The rest got nothing. This Government set about putting that right. We created the New Deal. We merged the Benefits Agency and the Employment Service to create Jobcentre Plus. So everyone who signed on for jobless benefits was put on the path back to work.
That was the first phase of reform, deepening the obligation to work so that there is not an option to stay on benefits. As we saw those obligations cause youth and long-term unemployment to tumble, we set about the second phase of reform by widening their scope. We piloted helping those on incapacity benefits with the New Deal for Disabled People and then with the groundbreaking Pathways to Work programme, which increases the chances of someone being in work by about 25 per cent.
Since this April, we have required all new claimants to take part, except those with the most severe conditions. In October, we replaced the incapacity benefits with the employment and support allowance, which focuses on what people can do and not what they cannot. We improved help for lone parents. With the help of New Deal for Lone Parents, over 330,000 more of them are in sustained work. However, we wanted more people to benefit, so we are requiring lone parents of children between seven and 16 to look for work, which we expect to increase employment and lift 70,000 children out of poverty.
The Bill, combined with the measures outlined in the White Paper, Raising Expectations and Increasing Support: Reforming Welfare for the Future, published on 10 December, starts the third phase of the Government’s welfare reforms. Our proposals are based on a simple idea: that no one should be left behind, that virtually everyone should be required to take up the support that we know works.
The reforms will simplify the benefits system to ensure that it offers the right support; devolve power and responsibility to individuals, communities and suppliers to tailor services to local priorities and needs; increase the role of the private and voluntary sector, paying by results to help more people; develop a personalised programme of help for everyone on benefits who can work; increase targeted support and activity for groups most at risk from exclusion from the labour market; expect more of jobseekers and others in return for back-to-work support; enshrine in legislation our commitment to tackle child poverty, which is the biggest obstacle to individual achievement; ensure that housing benefit supports people moving off benefits; provide additional support for disadvantaged jobseekers; clarify rights and responsibilities; and facilitate choice and control. The themes of the health Bill can be seen in our approach to welfare reform. They extend also to the children, skills and learning Bill, which we will bring forward.
Last year, the Secretary of State for Children, Schools and Families published the Children’s Plan, which set out the Government’s vision for making this country the best place in the world to grow up, and making sure that every child, whatever their background and wherever they live, can have a safe, happy, fulfilling and healthy childhood. Today, the Secretary of State has issued a report setting out the progress that has been made over the past year and the challenges that remain in achieving this long-term vision.
There has been some significant progress. We are implementing Dr Tanya Byron’s recommendations on addressing the potential risks from harmful and inappropriate content on the internet; a root-and-branch review of the primary curriculum, led by Sir Jim Rose, is under way; and the Youth Crime Action Plan has been developed, setting out a cross-government approach to reducing youth crime.
The Education and Skills Act, which received Royal Assent on 26 November, established an historic milestone by requiring that, from 2015, all young people stay in education until the age of 18. This has been welcomed by the education sector, business and trade unions alike. As David Frost, the Director General of the British Chambers of Commerce, put it,
“Raising the compulsory age of participation in the education system will help to ensure that Britain has a suitably well qualified workforce in the future”.
The children, skills and learning Bill will build on these achievements and the wider themes set out in the Children’s Plan. It will enhance our efforts to ensure that services to children and their families are locally owned, locally integrated and locally accountable. Children’s trust boards will be placed on a statutory footing, with new responsibilities to drive more effective local co-ordination.
Sure Start children’s centres will be given legal recognition that they are part of the local infrastructure of support available to all parents. Local authorities will become responsible for ensuring that 16 to 19 year-old learners are able to pursue the education, training and apprenticeships opportunities that best suit their needs and aspirations, and local authorities will also have new responsibilities for the education of young people in custody, to help ensure that our most vulnerable young people are given the best possible chance to get their lives back on track.
In education, as in health, more autonomy is being given to local services. Where national bodies exist, they do so to support local service delivery. That will be the case with the Young People’s Learning Agency, there to support local authorities in delivering on their new responsibilities to 16 to 19 year-old learners, and the Skills Funding Agency, responsible for adult skills, which has been designed to be flexible and highly responsive to employer needs and the changing economic demands facing this country. Further support will be available through the national apprenticeships vacancy matching service which we hope will lead to an increase of more than a third more people starting apprenticeships in England by 2020. We are bringing in a new right for those in employment to request time to train. This right will encourage individuals to refresh their skills and businesses to invest in training to boost their productivity.
Certain functions must be retained nationally to ensure consistency. To increase public confidence in the standards of qualifications and tests, the Bill will establish a new independent regulator for England—the Office of the Qualifications and Examinations Regulator, which will be accountable to Parliament rather than to Ministers.
The Bill will continue the drive to ensure that every school is a good school. For the best schools, this will mean a more flexible Ofsted inspection cycle. For those that are causing concern, there will be new powers to require local authorities to take earlier action. Where parents have concerns that cannot be resolved with the school, there will be a new way of handling such complaints. School support staff, including teaching assistants, caretakers and bursars will be recognised for their vital contribution to school life through the establishment of a new Schools Support Staff Negotiating Body, and the Bill will give local authorities and Ministers new powers to ensure that all schools take seriously their responsibilities to provide teachers with time for marking and lesson planning.
Finally, the Bill will support secondary schools in coming together to tackle poor behaviour and attendance more effectively by sharing expertise, resources and facilities. In response to Sir Alan Steer’s recommendations, schools and colleges will also be given extended powers to search pupils for alcohol, illegal drugs and stolen property.
This wide-ranging Bill will be supplemented by the final Bill I want to bring to noble Lords’ attention. This is a Bill aimed at tackling one specific problem—child poverty. In 1999, this Government pledged to eradicate child poverty by 2020. The child poverty Bill will enshrine that momentous commitment in legislation.
I hope that noble Lords can see the common threads running through these Bills. Let me summarise the parallels. I see quality being fundamental, whether it is in a hospital or in a school. I see help for the most deprived, to raise children out of poverty and to make it easier to quit smoking. I see clear rights and responsibilities, whether it is for the NHS worker or for the benefit claimant, and I see more personalised services, whether it is a tailored package of training for a teenager or a personal health budget for a patient. The Bills contained in the gracious Speech are nothing less than a coherent vision for public services for the 21st century and I commend them to the House.
My Lords, it is a pleasure to see the noble Lord, Lord Darzi, in his place on the Front Bench, which he has come to occupy with such distinction over the past 12 months. I know that the House will wish to thank him for his opening speech, which sets the scene for today’s debate helpfully. I shall not attempt to compete with him in ranging over departmental boundaries, but will instead confine my remarks mainly to health-related matters. My noble friend Lady Verma will concentrate on education when she comes to wind up.
Over the years of the current Government, this House has passed no fewer than 11 major Acts of Parliament originating from the Department of Health. The gracious Speech held out the prospect of another tempting morsel from that quarter. The NHS constitution has been in gestation for some time. I am not aware of any principled objection to it as a concept within the health service or within this House. In fact, my party has been quite enthusiastic about the idea of a constitution for some time, since long before the Government made their original announcement. In this respect, for us, the health Bill appears unlikely to turn into a major political battleground.
However, there will probably be some aspects of the Government’s approach that we shall want to examine carefully. There does not seem to be much point in drawing up a set of regulations containing what everyone accepts are already the responsibilities and functions of the NHS and saying that the NHS must have regard to them, unless we see how this will add value to patient care. I need to understand rather better than I currently do what the practical implications of applying, or failing to comply with, the constitution will be for patients and staff and what “having regard to” will really mean.
It is certainly helpful to articulate and assert NHS values. There are those who are apprehensive that, with the private and voluntary sectors playing an increasing part in the provision of NHS care, those values may not always be to the fore and who believe that we need the constitution for that reason if for no other. The trouble is that NHS values, as such, are apparently not to be included in the constitution. Nor are there any proposals to enshrine the principle of independent regulation of healthcare, which is so important if we are to have a genuinely patient-centred service. Rather mysteriously, two of the principles set out in the NHS plan have gone missing, including the principle that the NHS will support and value its staff. I would be interested to hear the Minister’s comment on that.
We are told that one ingredient of the health Bill will be to strengthen public involvement in the commissioning arrangements of primary care trusts. It will be interesting to see what these provisions consist of. I say this with some degree of concern. Noble Lords will remember that, last year, we debated and passed the Local Government and Public Involvement in Health Act, which abolished patients’ forums and made provision for local involvement networks. LINks are meant to be in place and fully functioning across the country by the end of this month. Personally, I would be amazed if that happened. Everything that I and other noble Lords predicted during the passage of the Act has come to pass. There were meant to be transitional arrangements for patient and public involvement following the abolition of forums. Many local authorities have quite simply failed to understand the legislation properly and, in consequence, have failed to put in place those transitional arrangements. Information about the levels of service that host organisations have been contracted to deliver is being withheld, which makes it impossible to assess how well or badly they are doing. Many local authorities appear to believe that once a host is in place they have fulfilled their duties under the law—exactly the misconception that many of us fought so hard to avoid when we persuaded the Government to build transitional provisions into the Bill.
The Government have made public money available to fund such arrangements. Despite that, many local authorities have refused to reimburse volunteers their legitimate expenses. The net result of all this is that many committed and talented people have given up the struggle and are now lost to the system. It is the perception of those who represent LINk members that Ministers are in denial about how bad the situation is in many areas of the country. If the health Bill is to depend on LINks to deliver the promised strengthening of public involvement in commissioning, we really must have greater confidence than many of us do have that they will be up to the task.
I hope that the House will in broad terms welcome the idea of an NHS constitution, but at the same time we know that the main health agenda lies outside the strict confines of legislation. The noble Lord, Lord Darzi, is engaged in implementing his next-stage review. We should be in no doubt of the importance and magnitude of that task. One of the main challenges is to put in place mechanisms for drawing up so-called quality accounts. These in turn will depend on having appropriate quality indicators. I am right behind the noble Lord on this, but much will hinge on the ability of trusts to translate the data that they have into information that is useful and meaningful for patients. Trusts will also need to understand that collecting data and ticking boxes is not the end of the story. What will matter equally is whether they can take the relevant action if the quality of a service is found to be wanting.
Infection control is one area that springs to mind; many argue that without good hygiene and infection control the quality agenda is hamstrung. A recent survey by the Healthcare Commission found that a quarter of trusts are failing to meet at least one standard on hygiene—standards that relate to infection control, decontamination of equipment and the healthcare environment. This represents practically no progress from two years ago. The Government said in 2001 that all new hospitals would have 50 per cent single rooms, which is absolutely key to tackling infections. In fact, 82 per cent of hospitals opened since 2001 do not have 50 per cent single rooms. The Health Protection Agency has said that three-quarters of hospitals could not isolate patients with an infection because they did not have the facilities. Actually addressing shortcomings in quality will be very difficult for some trusts. The Healthcare Commission’s annual health check provides other quality indicators. The overall picture is, thankfully, improving, the notable exception being London, where quality scores are lagging a long way behind those in the rest of the country.
Quality accounts are not the whole story. A big part of what the noble Lord needs to create, as he well knows, is better standards of leadership. It was striking that, in the survey of NHS staff that the Healthcare Commission carried out last April, more than half those questioned did not think that the care of patients was their trust’s top priority. At one trust, only 3 per cent of staff thought that this was the case. How depressing. However, those findings illustrate, perhaps more than most others, what a job of work there is to do to make the values and principles of the NHS live in the minds of staff and how necessary it is for clinical leaders and NHS management to form more constructive working relationships.
We are promised measures in the health Bill to extend controls over the supply of tobacco products. If measures can be taken that will lead to a reduction in the number of young people taking up smoking, I do not believe that any of us could oppose them. However, we have to be satisfied that any measures that are taken are backed by rock-solid evidence that they are likely to achieve that objective. One has to question seriously whether a complete ban on point-of-sale displays of cigarettes will meet that criterion. Contrary to the impression given in the departmental press release this week, the evidence from Canada and Iceland is at best speculative. Evidence needs to be stronger than that if a ban on point-of-sale displays is to satisfy the test of proportionality. There is no evidence that displays of tobacco products have got bigger or more prominent in recent years. When tobacco advertising was banned, the Government made an explicit distinction between advertising and display, display being, in their words, “totally legitimate”.
We have only recently changed the law to make it illegal to sell cigarettes to persons under 18. I supported that change. However, against that background the department needs to explain why banning point-of-sale displays is going to get us any further in preventing sales to minors. Indeed, if you take away the ability of cigarette manufacturers to compete with one another through point-of-sale displays, they will be left with only one other way of competing, which is through price. If a cigarette price-cutting war were to take place, it would have the very opposite effect to that desired. I am open to persuasion on the issue, but as yet I remain a sceptic.
I am sure that I am not alone in looking forward to the coming Session, in which, as ever, we on these Benches will play our part in offering the Government our constructive comment and, where necessary, criticism. I have no doubt that today’s speakers will pave the way admirably across a wide range of issues for our debates in the coming weeks and months.
My Lords, I thank the noble Lord, Lord Darzi, for his customary eloquent introduction to today’s debate. Like him, I see wisdom and valour in leaving DWP and education matters to my very able colleagues, my noble friends Lord Kirkwood and Lady Walmsley. I, too, will confine myself largely to talking about health and social care.
In his introduction, the Minister referred to the 60th anniversary of the NHS. We should remember that it was the work that went in beforehand on the creation of the NHS and the welfare state that was of importance. It was led in large part by William Beveridge, or as he is known on these Benches, “that great Liberal, William Beveridge”. It is my hope that, just as John Maynard Keynes is going through something of a renaissance at the moment, the rest of the world will come to understand what we on these Benches know: that it may take a lifetime for a Liberal to be recognised as being right, but we Liberals are, and we keep going on.
I am not being entirely facetious in those statements, because it is important to state that, although the measures in the gracious Speech are welcome, to discuss them in isolation from the current economic situation would be foolish. Therefore, we need to talk about the gracious Speech with reference to the economic climate, the Pre-Budget Report and the NHS operating framework for 2009-13. The NHS has been through a period of unprecedented funding, but it faces a period of unprecedented demand. The questions that politicians must focus on for the next two years are how in our public services, and health and social care in particular, we can achieve efficiency, we can avoid false economies, we can invest in preventive services that will increase well-being and how we can build a health service that has been designed to meet one set of challenges but which will operate over the next few years in a wholly different climate.
I disagree with some statements made by Conservative MPs over the past couple of months that the recession must run its course and that a recession might be good for the nation’s health. One only has to look at the lessons of history to see what happens to health during a recession. There is a wealth of evidence from factory closures that people who lose their jobs suffer increased illness—both physical and mental—no matter how healthy they were to start with, and that there is an increase in mortality and morbidity. Although some studies from around the world say that some conditions associated with affluence decrease, health inequalities increase in a recession because poorer people are more directly and immediately affected by lack of money. They also have an increased susceptibility to harmful behaviours. It will be different in this recession; we will not have the regional impact of recession that we had in times past, when manufacturing areas suffered disproportionately.
It is quite interesting to look back over history. In the 1970s, the recession gave rise to the Black report on health inequalities, and in the 1980s—to which I refer reluctantly, given how many Members of this House were busily engaged in Government then—a report produced for Mrs Thatcher’s Cabinet, which was leaked, proposed drastic increases in user charges in the NHS and a reversion to health insurance funding for healthcare. Mrs Thatcher rejected that publicly, and saw the value of making continued investment in the NHS.
In a recent edition of the Health Service Journal, the noted economist Professor Alan Maynard gave cause for some hope when he said that in periods where more money is available the NHS has tended to be taken by surprise, causing inefficiency, while when there is less money around the NHS becomes more resourceful, not least because it has to work to clear priorities. Over the coming year, it will be the job of responsible politicians to work with the professions and say what those clear priorities are. Today, I want to set out the view from these Benches: that it should be the job of politicians to ensure that the NHS does not make the mistake of going for quick wins, but continues to invest in underfunded areas—public health and social care—in order that we can prevent some of the causes of ill-health, and tackle others.
The Pre-Budget Report, which was in effect a Budget Statement, set out the Government’s case. They intend immediately to take £5 billion from public service provision, and to achieve greater savings from 2011—the point at which the NHS budget was already going to cease to grow. It is likely that there will be cuts to the NHS of between £1.35 billion and £2.5 billion, and there is already widespread comment that the Treasury has identified the NHS commissioning budget as a ripe candidate for those cuts. Could the Minister say whether the department and the Treasury intend that savings should be achieved in the commissioning process, rather as local authorities have done in social care, or intend to achieve those savings by cutting levels of service?
I also think that the question of how tariffs work within the NHS, which we have discussed many times in this House, will come back with a vengeance. It cannot continue to be the case that some independent providers and trusts build up large surpluses on the basis of the existing tariff system, when there will have to be greater efficiencies elsewhere in the service. I, too, read the Healthcare Commission report with great interest and took two particular points from it, which lead us back to the decisions that need to be made about where NHS expenditure should not be cut. I refer to the continued lack of robust information on how well community services are performing, and on how acute and out-of-hours services integrate with other organisations to ensure that urgent care pathways work both for staff and patients.
Connecting for Health is an obvious and easy target, because it is a massive budget which has overrun. I caution the Government not to make a knee-jerk response by cutting that budget, but rather to conduct an urgent review of the parts of the NHS IT system which have worked well and those which can be speeded up and worked on in the next two years. It is vital that the NHS has an IT system which enables staff to do their jobs and enables patients to have a better service, but generates the data necessary for everyone to make informed decisions about treatments and operating systems.
I wish to make another suggestion. We have talked in this House a great deal about mental health since the passage of the legislation. The Healthcare Commission noted in its report that access to talking therapies is being increased, but still needs to be improved, and that there are still major gaps between the quality and safety of community mental health services in particular. One does not have to be particularly gifted with foresight to know that the mental health of a nation is likely to suffer in a recession. Therefore, I suggest to the Government that they continue to look at that.
It is debateable as to whether the NHS Constitution is a constitution at all. I simply observe that all the pieces of landmark legislation, such as the National Assistance Act 1948, the Children Act 1989, the Mental Health Act 1983, and policy statements such as the Seebohm report in 1965 and the Griffiths report in 1983, were interventions that brought about tangible improvements for patients and social care users. I am not convinced that the NHS Constitution is a document of that magnitude or import, as it was aptly described by the noble Earl, Lord Howe. However, in so far as it clarifies and codifies the rights of patients, he is right, it will have our support.
The other matter which is looming, but has not been the subject of discussion so far, is the adult social care Green Paper. The truth is that we have a social care system that has been chronically underfunded in comparison to need for some considerable time. Since this Government came to power, it has been well known that there needs to be a settlement between individuals and the state about how we will fund social care, particularly that of older people.
I would simply say to the Government again that their own adviser, Sir Derek Wanless, in 2002 set out in detail that for every pound spent on social care, there is at least an equivalent saving to the NHS. It would be terribly tempting in times of economic hardship to make cost savings in social care. Were we to do that, the health impact would be immense.
I wish to make three points about matters that we think should be the subject of continued investment to meet health needs. First, preventive health services such as sexual health clinics are important, as people in times of austerity have a tendency to behave in rather unsafe ways, and that increases the burden of disease. Secondly, I flag up to the Government the point made by Jamie Oliver in his recent presentation to the Health Select Committee in its inquiry on health inequalities that there is a need for co-investment in culinary skills, because a generation of people have lost the knowledge and the art of cooking, and of cooking well on a budget. Not only will that work to further the Government’s set goals for tackling obesity, but it will ensure that children do not suffer by eating bad food. Finally, although it is outwith the subjects of today’s debate, there is a significant health challenge as regards the crisis in social housing, and I hope that government departments will work together to address it.
Boom and bust is not good for an economy and it is certainly not good for the National Health Service. There is much to do and a very short time in which to do it. I hope that by the end of today we will manage to achieve a consensus on where the funding priorities should be and that we will enable the Government to avoid some of the false economies that they might be tempted to make.
My Lords, I, too, am grateful for this opportunity to debate the Queen’s Speech, and I am honoured to follow the Front-Bench speakers. I say to the Minister that I was particularly pleased to hear that the Government are giving further attention to tobacco. When the noble Lord, Lord Hunt of Kings Heath, took important measures on tobacco through this House, we were reminded that if a mother smokes at the wrong time, a baby can experience a lower birth weight and his IQ can be impaired for the rest of his life. We also know of the impact of smoking on the respiratory health of children, so I welcome the further attention in this area and I know that the House will give it careful consideration.
I also welcome what the Minister said regarding the small but important point of giving teachers more time for planning. I am heartened to hear from many people, and to see from the statistics, that teaching is becoming an increasingly attractive profession and is gaining a higher and higher status. It gives me great hope for the future that we are now valuing teachers as we always should have done.
I also wish to refer briefly to what the noble Earl, Lord Howe, said regarding the inattention and lack of priority given to the quality of patient care. It reminded me of research comparing children’s homes in this country with those in Denmark and Germany. Using a vignette, staff were asked about their priorities. In this country, if a child in a children’s home cries in his bedroom at night, the staff’s first priority is to follow procedures. That is no reflection on the staff; it is just where we have got to by giving insufficient attention and support to this sector over a long period. On the Continent, the response would be to care for the child by giving him a hug, and carers would not feel inhibited about doing that.
In the short time available, I want to concentrate on the children’s workforce, which is so important in implementing all the legislation that the Government have brought forward in recent years, particularly on the theme of partnership, with Every Child Matters and Care Matters. The Government’s strap-line for this is: working in partnership to improve outcomes for children. I emphasise how important a strong, professional identity is in the workforce in achieving an effective partnership. It is something that we have worked for and wished for over many years, but again and again we see partnership working, the sharing of information and working together for outcomes fall down in various places.
I was encouraged to hear that at the weekend the Secretary of State, Mr Balls, said that he now wants to give social work the same attention that the Government have successfully given to teachers and that he wants to raise its status in the same way. I was also very pleased to hear Mr Sheerman, the chair of the Select Committee in the other place on children, schools and families, talking to a group on early-years childcare and enthusing about the continental model of pedagogy, which is a specialism with a heavy emphasis on child development, on hearing the voice of the child and on developing vocational skills to engage with children. It seems to be very successful on the Continent and I am glad that the Government are looking at it.
Perhaps I may briefly illustrate what I mean by partnership and by strong professional identities, both of which are important. Some years ago, I visited a hostel in King’s Cross for 18 to 23 year-old drug addicts. On a Friday afternoon, I spoke to a mental health nurse, Gabriella Maceirras. She and two other mental health nurses had been appointed to that setting nine or 10 months earlier, and she explained to me how her two colleagues had burnt out in that period. No thought had been given to what support they might need in working in that environment—their need for supervision and mental health services support. She described how she had to mother all these desperately needy young people who were queuing up outside her door but how she was simply not supported. She also said that she felt she was working blind in that area because of the lack of support and a lack of access to mental health services.
On a more positive note, I had another experience at about the same time when I visited a hostel for young rough sleepers in Olympia in west London. People working with them on the streets were saying that when they sent young people to this setting they stayed there, unlike in other settings. They did not leave and go back on to the streets, and therefore I was very interested in this service. I met two of the young people: a young woman who had scars on both wrists from self-harm, and a young Irish man who had been in the country for perhaps a couple of years but had been on the streets on and off throughout that period. Both were settling down in this establishment. The manager of the hostel said that she put this success down to the very close partnership with a child and adolescent psychotherapist, who visited the setting once a week. He gave the manager an hour and a half of his time and worked with the staff group for an hour and a half to examine their relationships with the young people and to give them the confidence to do their job well and sustain those relationships.
This large organisation was providing support for the most challenging young homeless people but what struck me most was that, when I looked at the statistics, I could see that it had the lowest sickness absence rate. Therefore, if staff are well supported and work in partnership with professionals and with a strong professional identity, they can be far more effective and enjoy their work, even in challenging circumstances. However, such models are very fragile. A year or two later, that service was lost, as it no longer had support from CAMHS. People are very good at looking at the cost of things but not at judging their value. Quality—a matter referred to repeatedly by the Minister—is very important but it has been overlooked in this area.
Over a number of years, I have sought to encourage, and make universal, the notion of partnership with children’s homes. In his report on children’s homes, Choosing with Care, the noble Lord, Lord Warner, said that, when giving evidence to him, psychiatrists said that on the Continent it is the norm for such homes to have a regular, ongoing relationship with a mental health professional at a psychiatric level—that is, a high-level mental health practitioner. The staff get to know him and he deals with the staff rather than with the young people. That is normal, and in children’s homes on the Continent, the level of mental health disorders in young people is far lower than is the case here. In this country, staff are left to deal with a very high level of mental health disorders—the ONS identifies 68 per cent of children in children’s homes as having such a disorder—often without important, high-quality support.
Over the years, I found that a piecemeal approach was taken and often the quality of the input was not as high as it should have been. The reason for that was the low status of staff in children’s homes, their lack of a conceptual understanding of what is necessary in their relationships with the children, their lack of understanding of child development and their lack of confidence, which made it very difficult for them to engage with mental health professionals and to recognise their need for that support.
I move on to the subject of social work. The degree course introduced five years ago is very welcome but there is still an awful lot of work to be done in developing the social work profession. Recently, a social worker told me that his son was accepted on a social work course with an offer of just two D grades at A-level. We want people with strong interpersonal skills and a good experience of social work, but we also need people who are thoroughly able to make good, clear judgments in difficult situations and who can analyse complex situations. After all, some of these people have to decide whether a child should be taken out of its family and placed in foster care, or whatever, which may have an impact on the rest of that child’s life. We need to address that issue.
Professionals working in partnership with social workers tell me that their experience is variable. Social work has become a somewhat unattractive profession for various reasons over the years. I am grateful to the Government for looking at this issue. The Teacher Development Agency has been effective in ensuring that the right calibre of student gets on courses, that courses are of the right quality and that recruitment campaigns are effective. That would be a very welcome model in this area. Even if one is successful in that, the point made by the noble Baroness, Lady Barker, about boom and bust was important. History seems to suggest that many people of great acumen have entered social work but the constant cutting of resources and lack of certainty about the future has driven them out. It is no good addressing just this side of the issue; there needs to be continuity of resources.
I shall refer briefly to health visitors, a profession that has been around for 150 years and which has a strong professional identity. In recent years it has lost its statutory protection; there has been a dilution of health visitors now working with nurses. They have a specialist skill in working with families in the early years but their numbers have reduced by 10 per cent in recent years. When the family nurse partnership, an interesting model used to target certain very vulnerable families, used health visitors to train in this model of working there was a 50 per cent improvement in outcomes. It pays to have high-level professionals in the field. Will the Minister say what guidance is being given to primary care trusts to give more priority to health visiting? Is he considering whether their professional identity might again be protected in statute?
I have gone beyond my time. There is so much to say about the workforce. Commissioning is vital and attention must be given to children’s homes. Unfortunately in the current economic climate the best quality children’s homes, where there is a true partnership with mental health which is more costly, are closing. We are being left with the poorer quality ones. Children’s homes are an important aspect of provision. Foster care is very important, as is adoption, but for some children a residential children’s home is the right place. We cannot afford to let that slip so I hope more attention will be given to that area. I look forward to working on the legislation on children in the forthcoming months.
My Lords, it is a great pleasure to follow the noble Earl, Lord Listowel. He so rightly points out the importance of the workforce involved with children in developing better measures for children.
I welcome many measures in the gracious Speech, set out so eloquently by my noble friend. I shall focus my remarks today on children, and will refer to the children’s skills and learning Bill and the child poverty Bill. I assume that there is still an intention to halve child poverty by 2010 and eradicate it by 2020. We shall want to know how it will be measured and to look at how indicators on health inequalities, education and employment will impact on that. Child health is vital and I look forward to the child health strategy which I assume will be published soon. Perhaps the Minister can tell me when.
I should declare an interest as the chair of the All-Party Parliamentary Group on Children and chair of the National Treatment Agency for Substance Misuse. All children need protection, love and support. Their abilities need to be encouraged and they need to be listened to, enabling them to develop their self esteem. Sadly this does not happen to some of the 12 million children in England today. The Government have done much, and will do more, on child poverty, deprivation and support for families. The development of Sure Start, with currently 2,500 centres catering for 2 million children, is a good example. The Children’s Commissioner for England, Sir Al Aynsley-Green, said at a recent meeting, which some noble Lords attended, that more has been done for children in the past 10 years than in the previous 50. Initiatives continue but some things are still going wrong, as recent incidents and reports point out.
The UK commissioners’ report to the UN Committee on the Rights of the Child lists things that are good about being a child in England and some of the bad things, based on evidence from children and other sources. It says that increasing importance is given to children by the Government through increased investment. The majority of children say that they are happy, and most say that their health is good. They are ambitious, increasingly well educated and feel safe. Most feel engaged, motivated and that they are making a positive contribution.
On the other hand, bad things about being a child in England include the punitive approach to children, with the criminal justice system being used too readily. There are inequalities in income and health, asylum-seeking children experience breaches of their rights and child poverty is still high. Large numbers of children are affected by domestic violence and abuse. Children in care have poor outcomes and they are concerned about violence and weapons in their area. They drink more, engage in early sex, and child obesity has risen by 50 per cent in the past 10 years. They feel pressured by school exams and commercial marketing. I hope that any initiative related to children will take this evidence into account.
I shall address some concerns to do with child welfare and its paramount position as stated in the UN convention. There are 60,000 children looked after by local authorities—55 per 10,000 under 18s. Of those, 12 per cent achieved five A to C grades at GCSE compared to 59 per cent of all children. Apart from academic underachievement, there are other deprivations and risks to these children. There are nearly 3,000 children in custody, with 217 in secure children’s homes, 247 in secure training centres and 2,349 in prison. They are overwhelmingly boys. They return to custody over and over again, sometimes because they cannot bear the thought of being outside and unprotected.
Urgent action is needed and I welcome the commitment to improve these outcomes. Many dedicated children’s charities will be working with the Standing Committee for Youth Justice on the Education and Skills Bill to meet the education needs of these young people before, during and after sentencing. The transfer of responsibility from the education and training of young offenders in juvenile custody to local authorities will be a welcome measure.
The Bill will also transfer funding and responsibility for delivering 16-18 education and training to local authorities and will create a Young People’s Learning Agency. The Bill intends to improve behaviour and attendance at pupil referral units and other alternative provision. There will be a statutory basis for the apprenticeship programme, creating a new national apprenticeships service. I hope that that will include young people with disabilities and learning difficulties.
The children, skills and learning Bill will seek to strengthen the statutory framework by legislating for children’s trust boards to be set up across the country. The proposals in the youth crime action plan to place YOT management boards on the same statutory footing should also be considered. So much has been done to improve outcomes related to Every Child Matters but, as I said before, much needs to be done.
I was concerned recently by the UNICEF report in which we came 21st out of 24 developed countries on child well-being. A Barnardo’s report recently stated that many adults consider young people to be feral—a dreadful word—and dangerous. That is a terrible perception of young people. I wonder whose fault that is. Two other reports make depressing reading. One says that 50 per cent of 4 and 5 year-olds in some parts of the country cannot speak in sentences when they start school. A newspaper headline on this read:
“State urged to help deprived children to communicate”,
to tackle the cycle of deprivation that has its roots in inadequate parenting. These children are also reported as needing lessons in empathy and self-control. Such concerns are not new; they go back many years. I believe it was Sir Keith Joseph who spoke about the cycle of deprivation. It is not enough to say that there has always been mistreatment and neglect of children. We need to do more about it.
A report on child maltreatment in the Lancet, drawing on evidence from affluent countries, concluded that one in 10 children in the UK suffers physical, sexual or emotional abuse and neglect, yet only 1 per cent is referred to child protection services. We know that children who are mistreated are more likely to get involved in crime, do badly at school, use alcohol or drugs, attempt suicide, indulge in early sexual activity and suffer depression.
Following the appalling case of Baby P, the Government are committed to strengthening the serious case review. It is not enough to blame hard-pressed social workers. The NSPCC is calling on the Government to invest in building the skills of professionals working with children at risk. Such professionals, it is pointed out, need sufficient training, experience and courage to tackle parents and carers effectively. They need to have time to spend with families and to talk to children themselves. They need support for their investigations. They need to be paid what they deserve. The welfare of the child is paramount, and we should have the courage to maintain that.
I have just been talking to someone who has worked with children’s services for a long time, and she said that the adult must be at risk, not the child. That should be our mantra. The sensibilities and rights of adults must come second to the rights of the child. The central issue has to be good parenting, and if that is not possible, then good care services, with consistent placements, have to take over. The welfare of the child must be paramount. Bad treatment needs to be reported, picked up and dealt with. If a child's life in the family is destructive, the family has to be consistently supported from the day the child is born or the child should be removed, sooner rather than later, to good care.
Without decisive action, we cannot expect to raise achievement or improve the behaviour of damaged young people. It is a very vicious circle indeed. Violence, crime, drug use, early pregnancy and other cycles of abuse may be set up as a direct result of inadequate parenting. Tackling child poverty is only part of the solution. It helps, of course, but many children brought up in relative poverty succeed in all kinds of ways because they have been nurtured and encouraged.
Children placed with family and friend carers have better overall outcomes than those placed elsewhere, but we do not sufficiently reward those carers. They frequently have to struggle to get paid. The Minister joined me in looking at the plight of grandparent carers and has been very supportive. This issue was raised during the passage of the Children and Young Persons Bill. Could he briefly update the House on progress with supporting family and friend carers or write to me?
I return to the welfare of the child from birth and issues of parenting and care. Money and support need to be thrown at this end of the child spectrum. Support for families and involvement with them by relevant professionals is important, but where families fail, care for children must be of high quality so that there is less reluctance to place them in suitable care. The future well-being of our children is at stake, and we have a duty to speak up for them.
My Lords, debates on the Queen’s Speech have to be rather fragmentary because they can cover four departments with four ministerial responsibilities. They can best be described by an old English word that was first coined in the reign of Elizabeth I, “mingle-mangle”. The Oxford English Dictionary defines it as a “confused medley”. It also has a pejorative definition, which has fortunately fallen out of use, as well as meaning food for swine, but that cannot possibly describe the debate in your Lordships’ House. In introducing the debate, the Minister, who has a reputation well beyond this House for his expertise in health, spoke mainly on that subject. He touched on education, but his heart is in health and he is listened to with enormous respect. He did the mingle and it falls to me to do the mangle, which is education. I am old enough to know a mangle and have turned one, usually after school on Mondays.
I want to talk on education because over the next 18 months the Government are embarking on huge reforms in education and training. Few people recognise the extent of the reform that we are about to enter into, which will put enormous strain on the system. I support many parts of it. Further education colleges will be moved back into local authority control. Diplomas, which I strongly support, are to be introduced in schools next September. In addition, the Government want to expand the apprenticeship scheme dramatically. At the same time, the Qualifications and Curriculum Authority is to be split in two, which is how I set it up in the 1980s. The Learning and Skills Council is to be abolished and replaced by two other bodies.
This is an enormous series of changes and quite a few people say that perhaps they should go a bit slower. Barry Sheerman’s committee produced a report last week on how to reconcile apprenticeships with diplomas and encourage more people to go into apprenticeships. Looking through the report, I discovered that the peak year for apprenticeships in employment was when I was Secretary of State for Education. I was not aware that I was responsible for that record, but now I shall claim a lot of credit for it. Since then, it has been decline all the way. The committee said:
“We urge the Government not to assume that the provisions of the Draft Apprenticeships Bill will play a large part in meeting the needs of young people in education and training during a time of economic challenge”.
That is really saying, “Take it slower and try to get it right”.
I removed further education colleges from the control of local education authorities in the 1980s because they were neglected. They were undervalued and underfunded. When a local authority had a choice between capital expenditure on a primary school or an FE college, the primary school won. Councils ensured that the interests of their constituents would win out. FE colleges were undervalued and undercapitalised. In the past 20 years, that has been revolutionised. Under the previous Conservative Government and this Government, expenditure has been dramatically higher. As a result, the Matthew Boulton College in Birmingham is a superb modern building and the FE college in Middlesbrough is even greater. It is going to win an architectural prize as the most distinguished building in Teesside. That may not be too challenging, but it is the most distinguished building in Teesside and finer than any building on the campus of the nearby University of Teesside. No local education authority would ever have found the money for that. FE colleges are going to be sent back to local education authorities in 2010 and 2011, the very years when public expenditure will have to be cut. Irrespective of which Government are in power, it can be guaranteed that 2010 and 2011 will be the beginning of substantial central government and local government expenditure cuts. Will FE colleges get any priority from local education authorities? I think it highly unlikely.
I hope that the House realises that I am in favour of many of the things that the Government are doing, but it is all coming too quickly. I am in favour of technical vocational diplomas. I have become very familiar with the curriculum of the diplomas in engineering, construction, manufacturing, production and design, IT and agricultural and horticultural services. They will be introduced into schools next September, but no secondary school in the country can deliver diplomas. They have not got the room, the space, the equipment or the teachers for technical education. They do not exist. If a student wants to do a diploma in engineering next September, he will spend two and a half days at a local secondary school doing English, maths, science and IT and another one and a half days at one or two different training institutes, or perhaps an FE college, to which he is taken on a bus. He will spend the last day on day release. That is no way to make the diploma successful.
The Government were absolutely right five years ago to identify the 14 to 19 year-old curriculum. As I was responsible for introducing the curriculum for five to 16 year-olds, I strongly support the curriculum for 14 to 19 year-olds. It has taken five years to work it up. It is central to producing at all levels of education the number of technicians and experts that this country needs. In the next 10 years—again, irrespective of which Government are in office—there will be a massive building programme of nuclear, coal and gas-fired power stations, a huge high-speed rail network, Crossrail and extensive waste treatment plants. We do not have the technicians for this. We simply do not have the element that Germany has in abundance. The education system in our country has failed to produce that degree of technical education and expertise.
What can we do about this? Since Easter, my old friend the noble Lord, Lord Dearing, and I have been promoting a new type of school. We call them university technical colleges. The idea is that they will be what they say they are—technical vocational schools—for 14 to 19 year-olds. They are revolutionary, because the age for selection will be 14, not 11. The noble Lord, Lord Dearing, and I happen to agree that that is the best age for selection. That is controversial in the educational world, but as we have gone around talking about it we have been surprised at how many people in the educational world support us.
We approached first Aston University to sponsor a new school. If it did so, it would have to find £2 million under the academies programme. It jumped at it. The vice-chancellor, Julia King, is a professor of engineering, as is the pro-vice-chancellor, Alison Halstead. They said that this is just the sort of school that they want. They want to get involved with the education of children from 14 in their specialism of engineering, as the university has teachers who can help those children and equipment that they can use. We then spoke to the leader of the local education authority, Mike Whitby, who said that Birmingham would want such a school, as it was and would continue to be the heart of industrial life in our country. He provided a site in Aston Science Park. Last Friday, we were able to announce the first university technical college.
These schools will be for 14 to 19 year-olds and will have 600 to 800 pupils. For those aged 14, there will be two sources of entry: one for apprenticeships and one for students doing diplomas. They are interchangeable. The universities are interested because they see this as a pathway to foundation degrees and even to higher degrees. I am glad to see that the Government fully support them; they certainly have the full support of the noble Lord, Lord Adonis, and his successor, Jim Knight.
We are speaking to eight or 10 universities, and every university that we go to says, “Yes, please, we want to do this”. The school is new and presents problems for the local education authority because of the selection at 14, not 11, which is difficult to achieve, but we believe that this is the future. It also deals with the problems highlighted by the Barry Sheerman report and another report on apprenticeships in the past four days, which both ask how we get apprentices. We get them by taking in half the intake as apprentices. When we have spoken to local employers, they have been immensely enthusiastic. I have been to see the CBI, local people in Birmingham, chambers of commerce and the Institute of Directors, and we have had meetings with several industrialists. They will back these colleges.
This is the way forward. I say in all seriousness to the Government that I very much support some of their initiatives, but the system does not exist in our country to deliver a curriculum for 14 to 19 year-olds. To have such a curriculum you must have institutions for 14 to 19 year-olds, otherwise you will fail. This is therefore an important initiative. I hope that the colleges that the noble Lord, Lord Dearing, and I manage to get off the ground in the next year or so will be prototypes like the city technology colleges, which were launched back in 1986 and have now become the city academies. These new university technology colleges will be immensely popular and will be oversubscribed from day one, because they will serve the needs not only of the students but of the nation.
We must improve our technical education. We should have had technical schools since 1870. We have tried. Butler tried. Butler’s great plan was for grammar schools, secondary modern schools and technical schools. The first ones to go were the technical schools—infra dig greasy rags. That was a huge mistake. The only country that adopted the Butler scheme was Germany, which has grammar schools, high schools and technical schools. A report published this year in Germany on the whole education system said that the most popular and successful schools in Germany are not the grammar schools—that must please some Members on the Benches opposite—but the technical schools. It is about time that we had such schools here in our country.
My Lords, it is a great pleasure to follow the noble Lord, Lord Baker of Dorking, in what he referred to as this mingle-mangle of a debate. I offer him an alternative word for a confused mixture and my favourite: gallimaufry. I agree with a good deal of what he said about the diplomas, which, given their content, might be more appropriately called pre-vocational diplomas.
There is much to say about the Department for Children, Schools and Families portfolio, so I start with the promised children, skills and learning Bill. This catch-all Bill will have many welcome aspects but also others that will cause us some concern. My colleagues in the DIUS team spoke on Monday about the expansion of the apprentices programme, so I will say no more about that. We will return to the matters relating to school improvement and the powers and independence of Ofqual, about which we have some concerns, when the Bill is laid before us. We will look carefully at the proposals for Ofsted. It is key that we eliminate the tick-box mentality, the dangers of which were clearly demonstrated in the inspection of children’s services in Haringey. We also look forward to Professor Rose’s primary review and the broader and more independent Cambridge primary review when those final reports are available for us to comment on.
I welcome the proposal to make children’s trust boards statutory. I hope that this will improve the governance of children’s services. There have been far too many failures to protect the most vulnerable children, so I call on the Government to conduct a full review of the adequacy of our child-safeguarding system. This means reviewing not only the legislation, which is not the salve for all ills, but the resources, the practical implementation, and training and workforce issues.
I have serious concerns about the way in which multidisciplinary working is operating. In particular, the health services are not as joined up with other services as they might be. When a mother has a baby, she always seeks medical help, so medical professionals have a unique opportunity to identify vulnerable babies. I share the concerns of the noble Earl, Lord Listowel, about what has happened to health visitors. If the mother is going to bring the child into an unstable family that does not have the financial resources or parental skills to give that child the life that it deserves, that is when a whole raft of services should be wrapped around that family. Those services should not let go until it is safe for the child.
A great deal is being done for very young mothers, particularly to enable them to continue their education. I approve of that—we all know that education is the best form of contraception—but it does not happen with older serial mothers such as Karen Matthews, who have never worked and who fail their children. Those are the situations in which the state should step in with high-quality care and parental support, for the sake of the next generation.
The Bill also presents an opportunity to improve serious case reviews, 40 per cent of which were recently found by Ofsted to be inadequate, by strengthening the voice of the child. The death of Baby P and other tragic cases have highlighted the need for protection procedures to pay much more attention to seeing and listening to children rather than to deceitful or violent parents. Why have we not learnt that lesson since the Victoria Climbié case? The Bill presents an opportunity to ensure that the local safeguarding children boards have a specific function to ensure that children’s wishes and feelings are obtained and given due consideration. I will seek to add that to the Bill. You have to see a child to get their views.
Noble Lords will recall that we expressed reservations about the use of restraint in schools for maintaining good order and discipline, which was brought in under Section 93 of the Education and Inspections Act 2006. Therefore, we welcome the announcement that there will be measures to increase the accountability of schools on this matter. However, perhaps we should look again at this power in the light of the Court of Appeal’s July judgment, which quashed the Secure Training Centre (Amendment) Rules 2007, and the review of restraint commissioned by the Joint Youth Justice Unit.
The UN Convention on the Rights of the Child gives children the right to privacy, so I ask the Government how they will respond to the recent European Court of Human Rights judgment about the retention of the DNA of innocent children. I am also concerned about the proposals in another Bill to allow police officers on the beat to take fingerprints. I fear that that power will be used disproportionately on children, as the stop-and-search power is already. How will the Government ensure that this does not happen and what rights will children have to ensure that their fingerprints are removed from databases when there are no charges of wrongdoing?
Like the noble Baroness, Lady Massey, I welcome the transfer of responsibility for the education of children in prisons to local authorities. However, the Government should go further and meet the recommendation of the UN Committee on the Rights of the Child by ensuring that all children deprived of their liberty have the same rights to education. Section 562 of the Education Act 1996 excludes children detained under a court order from the right to education.
The proposed equality Bill has been welcomed in many quarters but, for me, it is notable for what it does not include. There is nothing to protect children from age discrimination. This Bill could be used to promote children’s active participation in society in a positive way, but the Government are planning to exclude them from these provisions.
Noble Lords will know of my passion for high-quality early years education. Of course, I welcome the proposals about Sure Start. However, progress in this Session, which is one year on from the publication of the Children’s Plan—I look forward to reading its one-year report—will come not so much from new laws but from more resources and more training. Investment in early years, especially during a credit crunch, is one investment that brings enormous returns. There are not too many investments of that sort around at the moment. UNICEF report card 8 is published today. I declare an interest as a member of the board of UNICEF UK. This series of reports compares various aspects of children’s well-being in OECD countries. Today’s report is about early childhood education. Its aim is to recognise what Governments have achieved and to highlight areas where more could be done.
The rising generation in developed countries is the first for whom care is becoming to a significant degree a public sector responsibility rather than solely a private extended family matter. Today, many young children spend large parts of their day outside their homes in the care of someone other than their parents, who can then work or train. This presents an enormous challenge and a great opportunity to complement the care of parents by providing experiences that will stimulate the child and help him to grow healthy, strong and lively, and for professionals to work with parents to ensure that they gain the skills and knowledge that they need. I cannot overemphasise how strongly I believe that, if we help and support parents when the children are small, we can avoid a lot of the problems and benefit the whole of society. The children who are failed by their parents are those who will become abused, even murdered, suffer from mental health problems or get in trouble with the law, all of which are difficult and costly for the state to reverse.
We have a terrible attitude to children in this country. Like the noble Baroness, Lady Massey, I was distressed recently to read the Barnardo’s opinion survey, which showed how many people in this country believe that “feral” children “infest” our streets and commit 50 per cent of all crime, which is blatantly untrue—they commit about 12 per cent. Early years education is crucial to reducing that figure and to ensuring that all our children reach their full potential. However, if the care is not of good quality, we can do enormous harm instead of good.
Report card 8 shows, as usual, Sweden and the other Nordic countries in the lead, with the UK about halfway down, meeting five of the 10 criteria. The areas that still need attention in the UK are parental leave, the staff-to-pupil ratio, percentage of GDP spent on early years, child poverty and universal outreach of essential child health services. I am pleased to welcome the child poverty Bill announced in the gracious Speech, but I point out that the UN committee recommended that measurable indicators be established to show how the Government’s target is being met. I also welcome the Government’s announcement about extending the rights of parents to ask for flexible working hours, a matter for which I campaigned along with the right reverend Prelate the Bishop of Southwell and Nottingham two years ago.
As with all UNICEF reports, this one is underpinned by the UN Convention on the Rights of the Child, of which the UK has been a signatory since 1989. The 20th anniversary of its signing by this country will be marked in 2010. Yesterday marked a 60th anniversary, apart from that of the NHS: that of the Universal Declaration of Human Rights, which was enshrined in UK law 10 years ago. I should like to press the Government to do the same for children’s rights. Children, because of their special vulnerability, need special laws to protect them and the UN Committee on the Rights of the Child has several times pressed the UK Government to enshrine that convention also into UK law. It is a pity that such a Bill was not among those announced in the gracious Speech.
However, the Government should be applauded for three major steps that they took on 22 September, the day before appearing before the UN committee. They withdrew their two reservations from the convention—on immigrant children and on young people in custody alongside adults—and signed the optional protocol on trafficked children. The Government deserve our sincere congratulations, but now the hard work starts in order to implement those three aspects of the convention.
It is outrageous that the level of knowledge about the convention is so low among children and adults in this country, particularly among professionals. It would be easy, for example, to include a unit about the convention in every initial teacher training course. The convention is lived every day to great advantage in many schools under the Rights Respecting Schools programme, for which I know that the Government have great regard. Teachers, children, parents and school governors love it. Will the Minister tell me whether the DCSF has any plans to encourage or enable more schools to take it up? Its benefits have now been demonstrated from early years right up to the end of secondary level, so there is every reason for the Government to take it on as a national initiative. That would do much more good for school discipline than any further powers about restraint or searching of young people, which I believe we are going to get in the next legislation. For me, the gracious Speech was a bit of a curate’s egg for children but, as always, we on these Benches will make all efforts to improve it and to make sure that it is tasty and nutritious in all the parts.
My Lords, I am very grateful to the Minister for his introduction of today’s subjects. In particular, he strayed beyond the brief of health. He emphasised, along with the noble Baroness, Lady Walmsley, the way in which we need to keep our direction clear through this debate so that it does not become a mingle-mangle, but provides a series of packages which come together to support and encourage those in most need in our society.
Within that context, I want to make a point about the proposed education Bill and then move on to issues of poverty and welfare. Like the noble Baronesses, Lady Massey and Lady Walmsley, I welcome the emphasis on quality of education for young offenders to be proposed in the Bill. In principle I agree with both noble Baronesses in their support of the proposal to move this education provision over to local authorities. My fear, however, is that it will be underfunded and that because it is hidden away from the general population of those local authorities, not much pressure will be put on them actually to achieve the aims that are to be expressed in the Bill.
I hope that there will be particular expression of the ways in which we can provide support and encouragement for young offenders. My own experience from visits to our local YOIs at Deerbolt near Barnard Castle and Wetherby reinforces my awareness of how young offenders suffer from interrupted and occasional education, but also of the opportunities that those institutions could provide for skilled and inspirational teaching which could make a real difference to the future prospects of these individuals, as well as keeping them out of prison in the future. The emphasis in the Bill on 16-to-19 education could provide the basis for very significant improvements in this area, but that education needs to be appropriate to the young offenders themselves. The tragic story of the Barbed project at HMP Coldingley, where the graphic design studio sponsored by the Howard League for Penal Reform has now been closed, while not coming from a YOI experience, gives little confidence that there is enough flexibility in the prison estate and the prison system to fulfil educational and apprenticeship aims. When the Bill emerges, I look forward to seeing not just how those aims are expressed, but also how they are to be enforced and achieved.
I welcome the proposed child poverty Bill and the intention to enshrine in law the duty to eradicate child poverty by 2020. Like the noble Baroness, Lady Massey, I would like reassurance that this will include the commitment to halving child poverty by 2010. I welcome, too, the ways in which children will be helped by bringing forward rises in child benefit and child tax credits, as well as the beneficial effect of the cut in VAT on the lives of those in most need. However, we must be aware of the possible implications of the proposed welfare reform legislation: the answer to child poverty is to force people into work of whatever description. Some 57 per cent of poor households have someone at work within them, and that percentage is rising. For too many families, a move into work does not mean a move out of poverty. We need to beware of the impact of working antisocial hours on those on low incomes and on their families. Moving 300,000 lone parents into employment will not in itself reduce poverty.
I hope that the Government will take this opportunity to affirm their support for family life as part of the support for children and children in poverty, and that nothing in this package of legislation will be detrimental to that aim. It is significant that according to the National Centre for Social Research, workers contracted to work unsocial hours tend to be lower skilled and lower paid. Some 38 per cent of people with no qualifications work at the weekend compared with 15 per cent of those educated to degree level. In opening the debate the Minister spoke of the need for the talents of the whole population to be used in support of the country and our national economy. I hope that the Government will reaffirm that the talents expressed as a parent and the skills used in family life are among the talents that must not be wasted.
The Government are right to assert that work is an important part of our contribution to society and of our fulfilment of ourselves as individuals. That work needs to be sustainable and adequately paid if it is to fulfil the needs both of society and the individuals concerned, and if it is to bring families, and therefore children, out of poverty. In this respect, we must take care not to separate child poverty from all human poverty. I should like the Government to reaffirm their commitment to eradicating all poverty and social exclusion in our society.
We need fiscal changes in order to bring children out of poverty, and I welcome the moves towards them. We also need support for the strengthening of family relationships and in particular of the bond of marriage. The strength of the marriage relationship may at times be derided today, but from this Bench I remind noble Lords of our continued contention that the weakening of marriage has serious implications for the mutual belonging and care that is exercised within the community at large and which is crucial to both welfare reform and the eradication of child poverty—as well as to the whole way in which our society regards children, a point described so eloquently by the noble Baroness, Lady Walmsley. In this context, our support for marriage and for mature relationships in the upbringing of children is itself a response to the need to eradicate child poverty. I welcome the aim and I look forward to the introduction of fiscal measures to achieve it and to the support of family relationships in order to provide security and encouragement for all our growing children.
My Lords, it is a pleasure to have the opportunity to talk about the progress of the NHS under this Government and to say something about what continues to need close attention. I shall concentrate on the delivery of NHS change and improvement, but first let me declare my interests. I am the part-time chairman of the NHS London Provider Agency which focuses on improving performance in London’s NHS providers. I am also an adviser to the General Healthcare Group, Perot Systems and Byotrol, all of which have healthcare interests, so I am reasonably in touch with the current healthcare scene.
The Government are to be congratulated on their investment in the NHS to rectify what I regard as the gross underinvestment of the 1980s and the early 1990s. Alongside that investment they have introduced reform through foundation trusts, targets, choice, competition and political leadership to drive change. However, we need a continuing strategy of investment and reform. We know from the reports of the Healthcare Commission that access, mortality rates and care quality have all improved over the past 10 years. Only yesterday the commission published findings that show improvements in life expectancy at birth since the mid-1990s and a reduction in early deaths from cancers and coronary heart disease. The commission’s rankings of those trusts performing excellently have risen from 4 per cent to 26 per cent over the past three years. But overwhelmingly this improvement in excellence is shown in the foundation trusts rather than the non-foundation trusts.
I now come to the point that those who are listeners to the “Today” programme might call the John Humphrys’s “but” moment: the improvements have not been evenly spread. For example, about 40 per cent of trusts are still classified as “fair” and “weak” by the Healthcare Commission. Overwhelmingly, as I have said, these are trusts that have not obtained foundation trust status and, in some cases, have no prospect in the foreseeable future of doing so. Some of the extra largesse has not been used as well as it might have been and the productivity increases between 2000 and 2005 are somewhat unfortunate and disappointing.
The Government recognise, however, that further improvement is needed. They have announced, in difficult financial circumstances, a fair settlement for the NHS in 2009-10 and 2010-11 and are using sensibly the surplus that has been built up to help the NHS to continue to invest in good healthcare. As I understand the figures published by the Government, that allocation means that, on average, there will be a 5.5 per cent increase in both those years for primary care trusts. Even more significantly, my noble friend the Minister has provided a clear vision of the quality improvement for the future direction of the NHS to which, at least in principle, most people subscribe. The report he provided in London before becoming a Minister offers a real prospect for far-reaching improvement. However, we now need many parts of the NHS to raise their clinical and managerial game, particularly over the next two years before an almost inevitable reduction in all public sector allocations in order to reduce public borrowing. We have a window of opportunity for real change to continue over the next two years.
The proposed NHS constitution is a helpful framework document and has some important aspects in the way it balances rights and responsibilities. I like the emphasis on quality, accountability and choice, which are important drivers of NHS improvement. I am not opposed to giving the constitution some legal underpinning provided that it leads to driving improvement and does not wrap us up in red tape and, much more importantly, does not put the NHS in aspic and make it unable to respond speedily to medical advances and the inevitable increases in public expectations of our NHS. The only thing that is clear from the past 60 years is that medical advances have come thick and fast and that the public continue to expect the service to improve.
We will no doubt explore further the issues I have mentioned when we come to consider the new health Bill. However, the Bill will have not such a great impact over the next two to three years, and the remainder of my remarks relate to some of the areas where the Government and the NHS need to secure real change before the funding flows start to slow considerably.
It is explicit in my noble friend the Minister’s vision for the NHS that there will need to be a major reconfiguration of services, such as stroke and trauma, with many services being provided in different places from where they are now. This will, of course, take time. Quality indicators will make these changes inevitable. Changes of this kind require real clinical leadership and board and management commitment to change. It almost certainly means mergers of struggling trusts and, in some cases, an effective failure regime so that more competent organisations can take over those that fail. Not all of our geese are swans in the NHS. This will require political courage and many elected politicians across the parties will need to cease fantasising about the sustainability of some of the services in their local hospitals. It will require courage from doctors and politicians to stand up and describe the benefits of the changes that need to be made if we are to carry forward the next stage review.
Secondly, we will have to increase NHS investment in IT at the local level; it is no good the NHS continuing to moan locally about the national programme for IT. That programme, despite all the criticism, has delivered some major changes for the NHS. BT is to be congratulated on the work it has done in this country in putting in place a national spine; it is a major achievement of technology. Connecting for Health has brought enormous benefits for patients. Improvements in the transfer of imaging, in electronic prescribing, even in the much maligned choose-and-book system and in secure e-mails are among the advances that have already been delivered.
A great deal of focus has been placed on the failure to deliver as rapidly as most of us would want the electronic patient record. But this is not the time for the Government or the NHS to lose their nerve; we need to press on with getting it delivered. There will inevitably be technical glitches, but they can be overcome. We must understand that the NHS at the local level also has to raise its game on IT investment. It was never the case that the national programme would pay for the training of staff at local level and re-engineer all local systems. Parts of the NHS have failed to step up to the plate in the way they have invested in IT. We lag behind other countries at the trust level in what we invest in IT for a modern healthcare system.
There are two other areas in which resources can be freed up to benefit patient services and NHS development. The first area is in pathology services, where the Government and the NHS need to get behind the proposals of my noble friend Lord Carter of Coles, whose further report in this area is to be published shortly. When I was a Minister with some responsibility in this area I believed that the £2.5 billion or so that the NHS spends on pathology services had the capacity to deliver about a 20 per cent improvement in efficiency. Those kinds of sums would enable the NHS to adapt its pathology services to take advantage of the great advances in genomic medicine which are coming very fast.
The other area is a rather Cinderella area, not only of the NHS but of public services—I refer to the way in which we manage our buildings and land and our facilities management. This has been long-neglected, is very unfashionable and is something in which most politicians do not like to get involved, but the NHS footprint could be seriously reduced to free up assets for other social uses and to secure a capital return for the NHS. In addition, we need to look at what we are good at in the NHS. We are in the business of providing patient care, not managing buildings. Facilities management needs the kind of professionalisation that outsourcing by, for example, the Department for Work and Pensions has used so successfully over the past seven or eight years. There are some real gains to be made which could help with patient services in times of shortage.
I want to end, appropriately enough, with the end-of-life care strategy, on which the Government are to be congratulated. When we come to the health Bill I will want to look further at whether we can secure some stronger legal underpinning for health professionals to have regard to advanced decisions and to ensure that those decisions are incorporated in NHS medical records. We need a debate on that strategy before too long.
My last point concerns the issue of assisted dying, which has been in the media a great deal and will not go away. I do not want to start a debate on that today but the present legal position is untenable and, in the view of some of us, cruel. I should like to see the Government oversee a more robust way of establishing independently what public and medical opinion is in this area, in the way that Professor Mike Richards did so skilfully over the equally emotive issue of top-up fees. This is an area where the Government could help to improve the quality of the public debate.
My Lords, I congratulate the Minister on his opening speech and on his leadership in taking forward the review of the NHS. Its concentration on quality is already proving to be a strong motivating force within the NHS workforce.
I share many of the views and the aspirations of the noble Lord, Lord Warner, as well his concerns, but sadly I do not agree with his enthusiasm for the NHS constitution, on which I shall concentrate today. The constitution seeks to preserve the founding principles of the NHS. Sixty years ago my father joined the NHS and I remember his huge relief at its birth. Its values resonated with his own. His patients were grateful and respectful and they were ready to embrace the socialist ethic of 1948. His only problem was that remedies were very limited. The physician comforted while nature healed.
The NHS was ineffective, safe and cheap. Today it is effective, dangerous and very expensive. The population are not overly grateful, they are not deferential and they expect a miracle. A baby born through IVF is a near miracle. Surgery carried out by the noble Lord, Lord Darzi, is a near miracle—but he knows that his work will be outdated in a decade and we will have moved on to new technologies and innovations, a point also made by the noble Lord, Lord Warner.
One of this country’s leading scientists, in giving evidence to a working party that I chair, told us that by the next generation we will be able to find out the complete genome sequence of everyone, probably at birth. The information will tell us about the polygenic contributions to many diseases, such as diabetes, heart disease and susceptibility to tuberculosis. We will have identified the genes that cause autism and dyslexia. We will know about genetic variation associated with an individual’s ability as to whether they are good at maths, good at reading, good at writing or bad at them. It will be possible to have premarital genome sequencing of couples, with all sorts of predictions based on their genetic make-up. This is scary stuff and is in sharp contrast to 1948.
The year 1948 was a different world. Today the NHS is about the only vestige of pure socialism. Founded on the principle of,
“From each according to his abilities, to each according to his needs”,
the NHS is a vast co-operative. I do not believe that either socialism or the co-operative ethic resonate with people today. The part that might be remembered is,
“to each according to his needs”.
The forgotten part is,
“From each according to his abilities”.
A co-operative is about balancing inputs with outputs, and both are exercises in unselfishness. With the “I want” society, I can understand why the Government are anxious to re-instil the underlying ethic of the NHS. My disappointment is that it has chosen legislation as its tool. With such a fast-changing world we need flexibility, inspiration and dynamic leadership. Legislation is none of those things. It is reductionist and rigid and it kills the spirit. A nurse going into a ward does not think, “I am here to give this patient his rights”; she goes in to give care.
In the NHS constitution almost every right and pledge has its caveat. For example:
“You have the right to access local NHS services. You will not be refused access on unreasonable grounds”.
What is unreasonable? Who is to judge? Certainly not the patient.
“You have the right to expect your local NHS to assess the health requirements of the local community and to put in place the services to meet those needs as considered necessary”.
Who is to judge what is necessary? Certainly not the public. This is in sharp contrast with the Medical Schools Council, which has taken on the Herculean task of defining the role of the doctor. With clarity it states that it is the patient and the patient’s interests that must define the role of the doctor.
The constitution uses the word “strive”, which it explains is a “pledge”:
“The NHS will strive”—
“to provide all staff with well-designed and rewarding jobs that make a difference to patients”.
Why employ people if they are not going to make a difference to patients? That is a banality. I thought that the whole purpose of the NHS was to treat and care for patients. Again:
“The NHS will strive”—
“to provide support and opportunities for staff to keep themselves healthy and safe”.
Surely no employer, let alone the largest in this country involved in the business of health, sets out to ensure that its staff are unsafe and unwell. I use Pledge. It comes in an aerosol made by SC Johnson and omits a thin film of polish. These pledges are a thin film that tries to give a shine to this sad little document.
It seems that the Government are too frightened to declare their roots. More importantly, the constitution abandons the discipline required to make either the socialist or co-operative models work. Do the Government consider that these twin ethics are so outdated and so compromised that the NHS is based on unacceptable, and therefore unworkable, principles? If the Government want to hold to good principles, they cannot declare, as they do in paragraph 4.33 of their consultation document on the constitution, that:
“We have firmly ruled out linking access to NHS services to any sort of sanction for people not looking after their own health”.
I understand what a minefield this is. I also acknowledge that more and more doctors and nurses say, “In effect, you are wasting resources, or are untreatable, unless you get your weight down, change your diet, stop binge drinking and so on. Put your own health in order first”. There is no common sense and no courage within the constitution to absolve people from taking charge of their health. I would have more respect for it if it said, “We will give you a maximum of 10 minutes to tell you how to put your health right. Do it. Come back in six months”. At least we would have some honesty and some grip.
In the section on the principles that guide the NHS, we are told that the NHS aspires to train to the highest standards. Medical schools are now scared to fail pupils for fear of being sued. Those schools receive some of the brightest and best, but common sense says that not all the brightest and best will, regardless of commitment, make good doctors. Pass rates are now nearly 100 per cent. The Medical Schools Council understands this; in its document it states that doctors must have strong intellectual skills and must have the capacity to work out solutions from first principles. Here is rigour. Throughout its document, it uses the word “must”. If the Government are set on having a constitution, they must at least ensure that it says something. How about, “The NHS aspires to the highest standards. We carefully select the best for training and expect 75 per cent to qualify. All trainees must accept the school’s decision as final”. If you want the best, you have to cull the weakest.
I have taken a few examples from what I think is a weak and ineffectual document. Your Lordships may think that I am being too tough, but the trouble with socialism and co-operatives is that they become coupled with inefficiency and lack of commercial rigour and discipline. Perhaps, too, I have got it all wrong. To be fair, socialism and co-operatives get no mention in the constitution. Yet we all know that, deep down in people’s psyche, there is an innate desire for fairness in the NHS.
It would be arrogant to think that the NHS is solely a creature of government. Untold millions of hours are given by carers who put in so much more than they take out. Millions of hours are given by volunteers—directly, or indirectly via charities—for the nation’s health. Most doctors, nurses and people who work in the NHS are generous with their time and want their commitment encouraged. They understand,
“From each according to his abilities”.
They are givers and reluctant takers. Most want the failures out and the NHS to be the best.
The British have an inherent distrust of constitutions. Most recently, regarding the EU, we fought against a constitution. The Americans are rightly inspired by theirs, but the NHS constitution rates alongside the wishes of a seven year-old in Father Christmas’s grotto. It disgraces the word “constitution”. It has no grip, ambition to be edgy or 21st-century determination; it has nothing of distinction. Instead, it strives for somewhere just below average. Neither staff nor people should accept it. We deserve something better—much better.
My Lords, I welcome the opportunity to take part in this debate on the humble Address. I wish to draw your attention to two matters; one concerning education, the other cultural policy. I start by congratulating the Department for Innovation, Universities and Skills on the priority it is giving to skills and training and to increasing the number of apprenticeships available in these increasingly difficult times. I welcome the commitment in the Queen’s Speech to bring forward a Bill to reform education, training and apprenticeships. I also note the intention to continue to work closely with the devolved Administrations in the interests of all the people of the United Kingdom. I welcome that, too, since my first concern is informed by my role as Chancellor of Glasgow Caledonian University in Scotland. Our modern university, founded on the old colleges of technology, domestic science and nursing in Glasgow has a strong social mission. Glasgow Caledonian still works closely with no fewer than 26 further education colleges and a quarter of our students come to us from further education. In fact, the most deprived areas of Scotland supply one third of all our students. In the communities where the number of young people going into higher education has always been low, we have an initiative under way which Ministers might find of interest. Through our Caledonian Club, we sign up and mentor children from an early age as potential future students. They and their families are offered easy access to a friendly campus and culture and the hope is that this early inclusion will encourage the assumption that university education is a natural conclusion to their schooling whatever their background.
My concern is that modern universities such as Glasgow Caledonian, which performs such a vital role through good quality teaching, will lose out to research-intensive universities in the allocation of future funding. The research assessment exercise, whose results will be published this month, carries a danger of ranking blue-sky research above the practical education that may be of more immediate benefit to students and to society in the hard times ahead.
In time of crisis, one of the few consolations is that it forces re-assessment of received wisdom and drives change. Having seen government policy change so purposively in other areas in recent times, I respectfully suggest that our present priority should not be a general switch of resources to allow an elite group of UK universities to compete globally. In Scotland, the research pulling initiative of the Scottish funding council has made a promising start and Glasgow Caledonian has played an active part. I trust that Scottish institutions with their distinctive practical traditions can, with the active support of the UK Government, establish an appropriate balance between research and the good quality teaching which is indispensable for the Government’s skills agenda.
Turning to the Department for Culture, Media and Sport, Ofcom has just completed its consultation on phase two of its public service broadcasting review. I want to remind Ministers of the particular problems facing public service broadcasting in Scotland. Some of these problems are not new, as I know from experience. Before entering your Lordships’ House in 1998, I was chairman of Scottish Media Group which held the licences to broadcast on the ITV network in Scotland. During many years of producing programmes and broadcasting, my longest and least successful campaign was to get a fairer deal for viewers and programme makers north of the border. The same arguments hold for Wales and Northern Ireland.
Surely it is not right that, on the public service networks of the United Kingdom, the overwhelming majority of British programmes in the peak-time schedules are produced in England and sourced mainly from London. While viewers in Scotland, Wales and Northern Ireland make up about 17 per cent of television audiences in the United Kingdom—and 17 per cent of BBC licence payers—the percentage of programming in the peak-time schedules is probably closer to 1 per cent than 17 per cent. In defence of this imbalance, defenders of the status quo often argue that these three home nations all broadcast more local programmes inside their borders than is the case for the regions of England. But surely that is to argue that while England broadcasts across the UK to the other nations, those nations should be happy just talking to themselves, sometimes in Welsh, very occasionally in Gaelic.
The big budget programming, the lavish dramas, ambitious documentary and current affairs series, are almost all produced in England across all the networks, BBC, Channel 4, Channel 5 and ITV. I appreciate that yet again promises are being extracted from the BBC and Channel 4 to source more programmes from outside England and to make the marginalisation of the Celtic nations a little less blatant. Well, we shall see. We have been disappointed before. Little wonder, that after decades of lobbying and continual frustration, the Scottish Broadcasting Commission was set up in Edinburgh and recently recommended a raft of initiatives including the creation of a dedicated digital channel for Scotland.
Since my priority is still to make the UK network output a bit more British, I regret the commission’s failure to propose positive options for Scottish television in the ITV networking arrangements. Having requested a debate on the future of public service broadcasting in Scotland, I hope your Lordships will have an opportunity to discuss early in 2009 the report of the Scottish Broadcasting Commission and indeed the future of PSB in Scotland.
However, my purpose today is to draw attention to immediate problems in the ITV network. Sadly, this once robust federal system of regional producers and broadcasters is now increasingly consolidated into one network company, ITV plc, based in London. Sharing the same Channel 3 network and still independent, but now on the margins of consolidated ITV, are Ulster Television, Scottish Television and Channel Television. There are inexorable commercial pressures reducing both the audiences and the advertising income of ITV. I do not underestimate the threat, and I applaud the efforts made by ITV to maintain its large output of British-made programming.
My concern is that the important national role played by Scottish Television should not be further impaired by attempts to address these, admittedly serious, difficulties at ITV. At a time of potential tension over the balance and fairness of current arrangements between Governments in London, Edinburgh, Cardiff and Belfast, I would ask Ofcom and the DCMS to be prepared to question ITV plc’s demand for a single ITV brand covering all the UK. The interests of viewers in Scotland might well require dedicated programming and opt-outs from the network schedule. That means that it needs the freedom to flex its schedules, which is particularly relevant to STV’s ability to offer a robust alternative option to the news and current affairs output of BBC Scotland. A nation such as Scotland should not be reduced to reliance on a single broadcaster for the television reporting of its national and local issues, particularly with political impartiality being such a sensitive matter. I hope that STV can marshal the resources to do all that well. I ask Ofcom also to examine sceptically the claim that ITV plc subsidises the surviving independent companies on channel 3, which seems to be disputed by my old company, STV, and Ulster Television.
It would also be helpful to ensure continued STV access to the commissioning process for ITV network programming. Ten years ago, we had a thriving production business based in Glasgow, operating on commissions from the ITV Network Centre—“Taggart” is perhaps the sole notable survivor. On the evidence of past ability to contribute useful shows to the network schedule, it is not asking much of ITV today that the door should at least be kept open.
Additionally, Ministers and Ofcom could use their good offices to encourage a further increase in Scotland’s presence on UK screens. At present, STV’s surviving production operation is constrained in bidding for commissions from the BBC and Channel 4 because of its link to a relatively small broadcaster parent. Redesignation as an independent producer would encourage the assembly of a critical mass of creative talent in Glasgow which might compete on even terms with the rest of the independent production sector based largely in London.
I conclude by inviting the Minister to agree that in an area of such cultural, social and political significance as television broadcasting the Government would welcome initiatives calculated to give programmes made in Wales, Northern Ireland and Scotland a proper place on UK screens.
My Lords, as the new welfare reform Bill is, we assume, to be published shortly and is one of the Government’s flagship Bills, I make no apology for returning to this matter today after yesterday's Statement.
We on these Benches have supported the principle of those receiving working-age benefits being given as much help as possible to find work, with sanctions being imposed only as a last resort. However, it has been difficult to discern exactly the Government’s overriding aim with the policy. Is it that unemployed people should no longer get benefits for doing nothing and will otherwise be financially penalised, or is it that people must be given more help than at present to find a job, with the penalties affecting only the few who are genuinely work-shy and refuse to co-operate? The emphasis seems to be different depending on the audience. I suppose that Ministers want to satisfy the red-tops’ need for a tough headline such as “Time's up for those who sponge off the taxpayer”, while sounding as reasonable as possible about extra help for jobseekers to their own supporters.
Why does this matter? One reason is that those of us who raise concerns about the policy are considered to be anti-reform, but I hope that the Minister will accept that that is far from the case. There must be proper debate and scrutiny of the detail of how the policy will work, particularly in the stormy weather into which the country is heading, where jobs will be much scarcer and unemployment is rising fast. Many people who find themselves visiting Jobcentre Plus offices against all their expectations may not have been factored into the DWP calculations. They will almost certainly include young people in their 20s or 30s who still have student debts to pay off, who are heavily mortgaged and who thought that they were in secure jobs but who are made redundant against all expectations. They are highly educated young people with good degrees. In the past, they would have found another job relatively easily, but in the present climate it may be much harder. It is not just young, highly educated people who will be hit but also professional people in their 40s and 50s who thought that they were in settled careers.
I listen to my noble friend Lord Oakeshott of Seagrove Bay when he tells me that this recession will be much worse than that in the 1980s and will be more of a white- collar, southern recession. The recessions of both the 1980s and, much earlier, the 1930s were much worse in the old manufacturing regions. Now, the proportion of public sector jobs is much higher away from the south-east, so poorer regions are less vulnerable. I was interested to read in the Daily Telegraph on Tuesday about the Government setting aside more than £100 million for universities and further education colleges to target unemployed professionals and offer them retraining or careers advice. Will the Minister tell us how this will work? How will those people be targeted? Will Jobcentre Plus offices have all the relevant details?
Will the Minister also tell us whether he considers that the number of extra staff in Jobcentre Plus offices around the country will be anywhere near enough to cope not just with, let us say, lone mothers looking for work for the first time but the range of the newly unemployed in all their diversity? Research by the Liberal Democrats shows that Jobcentre Plus is already failing to cope with an increase in the number of applications. Between June and September, the number of outstanding applications for jobseeker’s allowance was 44 per cent up on the same period last year. It did not help that Jobcentre Plus reduced its staff by 16,450 between 2004 and 2008. Do the Government think that the extra staff being taken on and trained for the increase in unemployment in the coming months will be adequate?
While I am on the subject of extra demand for services, I must mention the Winchester Citizens Advice Bureau, which says that, for Winchester, an area of high employment, its advice queries for employment issues have rocketed. It says that many individuals who have never been out of work are no longer able to find ongoing activity and that advisers are therefore seeing more clients in the middle-income bracket. It says also that many small businesses which over recent years have not had to dismiss staff now have to do so without realising that the law has changed and they have to follow a careful process. Although there is not a mortgage crisis in the city, the CAB is talking to the city council about mortgage rescue schemes and will work in partnership with it. Where would the country be without our citizens advice bureaux?
I turn to the flexible New Deal under which those unemployed for more than a year will be referred to private or third-sector contractors to find a job. One might be forgiven for thinking that the scheme was already under way, but as it is not due to start until next October, there should be time for the Government to take on board some of the comments made by those studying the policy in detail, such as the Social Market Foundation and the Social Security Advisory Committee. The latter makes the key point that how the Government proceed in this area will determine what they achieve. The problem of cherry-picking the easiest clients to help was raised yesterday, but it was not mentioned that those furthest from the jobs market will be expensive to help. Private contractors involved in back-to-work support will need a lot of investment to ramp up their operation to help those furthest from the jobs market. I would be interested to hear how the Government will ensure that the capital is available, given the reluctance of banks to lend at the moment.
Changing the subject now to that of the benefits system in general, we on these Benches are not the first to ask for the DWP and HMRC to work together to tackle the way that benefits and tax credits operate.
The new in and out of work processes for housing benefit and council tax benefit, which are to be phased in from December this year, are welcome and might pave the way for more joint working. The Minister will not be surprised to hear me ask about the progress of the knotty problem of service users and expenses, and whether the DWP is working with BERR to help to solve the problem; allowing disabled people to participate in helping to design services without losing their benefits if they accept expenses. While on the subject of benefits, the incapacity benefit system is now a nightmare of complexity because of the slightly different permitted work rules for incapacity benefit and the new employment and support allowance rules. Even many Jobcentre Plus staff do not appear to know the difference. Could not the rules for those benefits be aligned so that everyone knows where they are?
The changes in welfare benefits have been quite hard to follow in the past couple of years because of the way that policies are announced, then perhaps re-announced with a start date, then legislated on, with maybe the real start date enshrined eventually in a statutory instrument. Are we still expecting incapacity benefit claimants to be migrated on to ESA in April 2010, or will that process happen sooner? Will proper evaluations be carried out before this happens?
My last question about benefits concerns the effect of housing benefit on employment prospects. I note from the White Paper that the internal housing benefit review being conducted by the DWP and the Treasury is to be extended by an external consultation next year. When will the results of that review be published? The impact of housing benefits in places where rent is high, such as London, cannot be underestimated, and for many people affects the question of whether it always pays to work.
This has been a most interesting debate and I am pleased to have taken part in it. So many matters raised by other noble Lords link into each other, although they often seem so disparate. I look forward to hearing the Minister's reply.
My Lords, it would have been a pleasure to follow the noble Baroness, Lady Morgan of Huyton. It is, however, equally a privilege to follow the noble Baroness, Lady Thomas of Winchester. I am even-handed in my views about party groupings. My speech will be brief, and in the brew of today's ingredients it will be cultural. Its brevity is occasioned by the decision of the Government to ditch all their anticipated primarily cultural measures from the Queen's Speech rather in the manner of Russian travellers ditching their baggage from sleighs when pursued by wolves through the forests, in prior centuries—the sort of image that terrified me as a child. But the cultural ingredient obliges me to declare an interest as the president of the British Art Market Federation, a role that I have fulfilled since 1996, and for which, since entering your Lordships' House, I have received a retainer, recorded in the Register of Interests.
The first Bill to be discarded was the heritage protection Bill, which had appeared in draft, was widely welcomed in principle by interested parties and had been the beneficiary of a whole lustrum of preparation. It is a pity that, after such a gestation, the Government felt that the time required for its parliamentary passage implicitly stood between us and national recovery. To his considerable credit, the Secretary of State for Culture, Media and Sport issued an extremely prompt and comprehensive e-mail concerning this setback, although the hard copy which he promised would follow has not so far arrived. Perhaps the wolves have eaten it.
This was reinforced by a further helpful and comprehensive letter from Professor Sir Barry Cunliffe, who is holding the fort as the acting chairman of English Heritage following the sad death of our much lamented colleague Sandy Bruce-Lockhart. Knowing how ill the latter was, I was deeply moved to receive a letter, personally topped and tailed by him, concerning the latest consultation on Stonehenge during the final month of his life.
We all know what happens when a Bill or part of a Bill, for whatever reason, is lost in Parliament. Ministers, who up to the moment of admitting defeat have been telling us how essential the Bill is, in whole or in part, somehow in the aftermath of defeat make a very good fist of achieving their legislative purposes by other means, and there seems good reason to suppose that the same running repairs can be applied to the vacuum of a Bill that has not yet arrived. We must all hope so.
The second relevant Bill to have fallen off the sleigh has been the draft Cultural Property (Armed Conflicts) Bill, which, like the draft Heritage Protection Bill, has been subject to scrutiny by the Culture, Media and Sport Select Committee in the other place. Here, there is a genuine potential bonus from delay. There was a difference of opinion between the Select Committee and the Government on the committee’s recommendation 7, about the necessary provision of a list of occupied territories from which cultural property might have been unlawfully removed. The Government believe that their definition of an occupied territory is sufficient, but where criminal offences are involved on the part of any dealer who is participating in this exercise, it does seem counterproductive to ordinary trade if no list of occupied territories is available for the art market to scan. However, if such a list is not within the Bill's capacity, I suppose we must patiently await parliamentary scrutiny and debate for the Government to defend their stance.
On the Select Committee’s recommendations 8 and 9, concerning the acquisition or acceptance by dealers of items of cultural property exported from an occupied territory, when acceptance, if unlawful, is a criminal offence, the present delay could be profitably harnessed. It could provide time for discussion between the British Art Market Federation and the Bill’s promoters on the practical processes of due diligence through which dealers have to go and which invariably require a facility and ability to study the object close to. Of course, that discussion could also be done during the period of actual parliamentary scrutiny as the Bill goes through the House in due course, but it seems a lost opportunity not to get the drafting right in advance.
If the situation is ambiguous, few dealers will risk criminal prosecution by getting hold of the object; and in the general cultural interest, there seems more than a little virtue in due diligence being facilitated. Such co-operation between the federation over which I preside and the Bill's promoters, in the way that I envisage, worked very well on the Dealing in Cultural Objects (Offences) Act 2003, and it seems reasonable to suppose that it would do so again.
There are implications for the historical environment in both the Marine and Coastal Access Bill and the Local Democracy, Economic Development and Construction Bill, but happily both those Bills are having an introduction to your Lordships' House—indeed their Second Readings are due next week, so we shall return to those shortly. It is also possible that the draft floods and water Bill may have an impact on heritage.
Finally, in the DCMS pantheon there are still the Olympics. Three and a half years separate us from them but, other things being equal, another year will have passed before we get another Queen's Speech, and it seems worth taking this chance to identify one particular and significant opportunity cost that the Olympics are imposing on the elements of the DCMS acronym other than the “S” for sport. I allude to the planned restoration and exhibition space extension of the Sir John Soane's Museum, which is appealing for £6.3 million and has already secured £2 million by its own efforts. To quote the current edition of the Art Newspaper, an application for half the cost made earlier this year was deemed by the Heritage Lottery Fund as “faultless” and “intelligent and high quality”. This application failed only because the Heritage Lottery Fund’s limited funds of £7 million could not stretch that far. At the time of the application, 13 projects were asking for £35 million and only two got through. The situation for this sector of our economy is not only imperilled by the credit crunch and the recession, it remains a prisoner of the Government’s need to use lottery funding as the drip feed for the Olympics. Blood donation is normally a voluntary process.
My Lords, like the noble Lord, Lord Brooke, I shall refer to the Olympic Games, not in detail, but to raise the themes that Britain should present in the London Games. We all know that these Games are an excuse, as they are for every country, for dwelling on national qualities and achievements. We ought now, as there is plenty of time, to reflect on the achievements that we should emphasise, and the themes that the mayor, Minister or whoever should dwell on in London in 2012.
First, this is an important thing to reflect upon. After all, the Baron de Coubertin, the initiator of the modern Olympic Games, was a tremendous Anglophile. There is a moving passage in his autobiography discussing how he went to Rugby Chapel and sat in front of the tomb of Dr Thomas Arnold, whom he conceived of as the inspiration for the British sense of fair play and, indeed, the Games. To mention this is not, therefore, altogether irrelevant.
The mayor, the Minister or whoever it is should raise five questions, perhaps in this order. First, he should emphasise Britain’s greatest achievement: our literature, particularly our poetry. I once had the pleasure of sitting next to the mayor of Oaxaca in Mexico, who showed me the speech that he was planning to make at the end of lunch. It began, “We in Mexico think of Britain, first, because of John Milton and, secondly, because of Portland cement”. There is no doubt that John Milton and other great poets have been the ambassadors of this country’s cultural pre-eminence for many years. I do not know quite how a mayor or a Minister will emphasise that cultural contribution, but it should be done.
Secondly, there is our role as a democracy. For perhaps two centuries, our parliamentary life was a brilliant political work of art, beginning, let us say, in the middle of the 18th century, stretching on until—well, perhaps it would be inappropriate to give a final date. Marvellous debates were held during many generations. They have inspired not only those concerned, but those reading about them afterwards. I was only recently reading how, after the first big debate on the abolition of the slave trade, Pitt’s speech in the early morning was so marvellous and striking that Fox, William Wyndham and somebody else, whose name I confess I have forgotten, walked across Parliament Square in the grey dawn and said that they had just heard one of the most astounding performances it had ever been their pleasure to listen to. There have been many such occasions, and perhaps there will be more in future.
Britain’s third contribution to international culture and civilisation is of course that of the scientific and industrial revolution. Matthew Boulton was mentioned by the noble Lord, Lord Baker, in his admirable speech this afternoon. There is no doubt that many of the visitors to the London Olympic Games will know about Britain’s contribution in this area. It is not easy to distinguish where scientific and industrial contribution ends, but the names are well known to us all; from Newton to Faraday, from Watt to Matthew Boulton and Arkwright.
Speaking as the son of someone who spent his life in the colonial service—indeed, my mother was in the colonial nursing service—I believe that Britain’s fourth contribution was imperial. We should not, at the Olympic Games or on other occasions, feel ashamed of our sovereign achievement in constructing the Empire. I have made a note of the number of ex-imperial countries that will be present at the Olympic Games: 53, at least. That is a substantial percentage of the 200 that will be there. The British imperial contribution was not simply a matter of presiding over the slave trade, as some of our critics believe. On the contrary, the British achievement was associated intimately with the abolition of the slave trade, as Nelson Mandela had the sense of historical accuracy to point out in his magnificent speech a few years ago in Westminster Hall.
These things, and others, should be emphasised in our contribution to the Olympics. The Olympic flame that we shall see in London should be encouraged to burn in their honour.
My Lords, I start by welcoming the fact that culture has finally been allowed into what the noble Lord, Lord Baker, referred to as the mingle-mangle of this debate. Despite the greatness of this country’s cultural heritage—to which the noble Lord, Lord Thomas, referred—and the rich variety of its ongoing creative endeavour, the subject is too often treated as a poor relation in the arena of political debate. Culture is not a sideshow and the creative industries that it fosters are not trivial just because a lot of them have to do with entertainment. In fact, they are a key economic driver, the fastest growing sector of the economy today, notwithstanding the credit crunch.
Two years ago, leading organisations from across the cultural sector published a manifesto, Values and Visions. This pointed out that in the future,
“Britain’s economic prosperity … will not depend on industrial prowess, natural resources or cheap labour but on developing, attracting, retaining and mobilising creativity. In this 21st century, goods, services and industries driven by knowledge and creativity will define Britain’s competitive edge”.
Those words sound even wiser today and we ignore them at our peril.
The UK has the third largest computer and video games market in the world and is the third largest market for music sales. The economic benefits of the visual arts sector are estimated to be in the region of £1.5 billion per annum. So it is to be welcomed that we now have a Minister for Communications, Technology and Broadcasting, with the added bonus that he sits in this House—I refer to the noble Lord, Lord Carter—and that he is undertaking a timely review into how to secure the UK’s place at the forefront of innovation, investment and quality in the digital and communications industries. It appears that the Government have finally grasped how important the creative industries are to the nation’s well-being.
The importance of culture is not simply about generating income and employment. It is, to use those often repeated words of John F Kennedy,
“very close to the center of a nation’s … civilization”.
In the UK, culture is part of the smallest government department, but it reaches into almost all other departments, certainly into all the areas that we are debating today. As regards education, creativity needs to be nurtured from the beginning. Yet it seems to me that creative skills are stifled by a school system that is dominated by exams and league tables. Priority is given to what is measurable, not to open-ended exploration.
Many noble Lords have mentioned the children, skills and learning Bill. One of its aims is to equip people with the skills that they need to realise their full potential. It is vital that creativity is central to this. Will the Minister ensure that culture is at the heart of the Bill from the start and not, as has happened in the past, belatedly tagged on or, worse, overlooked?
The Government’s Creative Partnerships scheme, which I have often mentioned, sends artists into schools to work with teachers and pupils. It helps teachers to teach more imaginatively, crucially across the whole curriculum, and to focus on developing creative skills that are fundamental to success in the 21st century. It has been hugely successful. Ofcom has given it glowing reports and 90 per cent of the teachers involved find that it improves their ability to help young people to reach their full potential, one of the Bill’s stated aims. I cannot think of a greater endorsement than that of young people reaching their full potential.
The Government are to be congratulated on initiating the scheme and on having guaranteed funding until 2011. But why is it that, despite the fact that a report by the House of Commons Education and Skills Committee into Creative Partnerships identified the scheme as “core education”, not a penny comes from the DCSF? The DCMS shoulders full financial responsibility. The annual budget of the DCMS is 4 per cent of that of the DCSF, £2 billion versus £50.4 billion. Can the Minister explain this unjust allocation of resources?
Another area in which the DCMS has been expected to shoulder a disproportionate financial burden is the Olympics. One of the reasons why London won the 2012 Olympic Games was the promise of a cultural olympiad of events to be held across the country from 2008 to 2012. However, when it became clear that the financing of the 2012 Olympics was running into difficulty, which led to the arts and heritage sector being targeted through raids on the lottery that ate into its funding, the then Secretary of State argued that the arts should contribute to the Olympics bill because the promise of a cultural olympiad would leave a lasting cultural legacy. However, as Nicholas Hytner, the director of the Royal National Theatre, pointed out at the time, the money raided from the lottery largely affects small, innovative, experimental organisations and individuals, the very organisations that are expected to be the backbone of this UK-wide cultural festival, for which, by the way, the Olympics organisers have admitted that they are providing very little funding.
A recent survey by Arts Quarter, Impacts of the 2012 Olympics on the UK Cultural Sector, makes for sobering reading. Only a fifth of respondents see a positive legacy for the arts as a result of 2012. A substantial majority think that they will lose out as a direct consequence of the Olympics. The vision, as outlined on the London 2012 website, of a festival celebrating the diversity and richness of culture in London and the UK looks to me as if it is in peril.
We on these Benches, along with Camelot, the National Lottery operators, proposed changing the taxation regime for the National Lottery to a gross profits tax. If that had been introduced this year, it would have put £270 million back into the lottery good causes and raised an extra £120 million for the Exchequer between 2009 and 2019. It is a simple way of replacing money taken from the cultural sector to deliver the hardware of the Olympics and of ameliorating the fall-off in other sources of investment due to the credit crunch. It is very disappointing that the Government have chosen not to do this.
I cannot take part in a debate about culture without mentioning television and here I declare an interest as the associate of an independent production company. The inspired creation of the BBC, leading to ITV and then Channel 4, has played a crucial role in sustaining and fuelling British creativity. As well as nurturing the cultural sector, these radio and television channels have provided virtually free access for all across the creative spectrum. Yet one of the most pressing problems that we are facing in the cultural arena is that of ensuring the future of public service broadcasting. I believe that the digital review of the noble Lord, Lord Carter, will address that. Some argue that he should abolish the licence fee. We on these Benches disagree and so, according to recent Ofcom research, do the large majority of licence fee payers. I am a member of the Communications Committee. On a trip to America we were told by many across the broadcasting, newspaper and political spectrums how lucky we were to have the BBC as a cornerstone of public service commitment.
Today, we have many channels, some dedicated to the arts. This has its benefits but also its risks in that it potentially ghettoises such types of television. In the present economic climate, the fact that they are relatively unprofitable means that they get smaller budgets and broadcast slots outside prime time on the terrestrial channels and increasingly outside terrestrial channels altogether. This means smaller audiences with a more focused interest and the erosion of that great PSB tradition of inheritance, whereby the “EastEnders” fan or news junkie is drawn into a programme about the Emperor Hadrian, or vice versa, because that is what is showing next on the TV channel that they are watching. In the multichannel landscape of the digital future, universality of public service broadcasting must be maintained and so must plurality. There, the future poses particular funding challenges to the commercial public service broadcasters.
We on these Benches do not believe in top-slicing the licence fee. This would undermine the ability of the corporation to do what it does best and, if Channel 4 were to take public money, its unique independence would be undermined. However, we agree with Ofcom’s suggestion of BBC help through “practical partnerships”. Today’s response from the BBC, in the document Public Service Partnerships: Helping Sustain UK PSB, has many things that we welcome, among them that the BBC share infrastructure with ITV to offset the cost of regional news, that it share new technology, such as the iPlayer, and that it open up BBC Worldwide so that it can be used by all PSBs to exploit their content.
Finally, I share the sentiment expressed by the noble Lord, Lord Brooke, that it is extremely disappointing that the heritage protection Bill has not been included in the Queen’s Speech and that there will now be no primary legislation implemented to make the very necessary changes to the system of how we safeguard and preserve our cultural legacy. In these turbulent times, the cultural sector can provide great social, personal and economic benefits. I trust that the Chancellor will not turn to the already underfunded DCMS when looking for targets for efficiency savings.
Soon after becoming Prime Minister, Gordon Brown made a speech in which he said:
“The legacy of any Government has got to be to take culture seriously, as it is at the heart of everything that being British is about … We have an enormous amount of creative work that makes us the great creative centre in the world and we have got to back that”.
Will the Minister assure the House that the Government intend to act on these sentiments?
I cannot make a speech on culture without demonstrating just how cultured I am, so here is a bit of Matthew Arnold. He said that culture is,
“the acquainting of ourselves with the best that has been known and said in the world, and thus with the history of the human spirit”.
Surely that is the entitlement of every British citizen.
My Lords, I welcome much of what is in the Queen’s Speech and I will be supporting it. I want to take us in a rather different direction from the two or three previous speakers and say something about drugs and alcohol public health policy. I shall be speaking as a trustee of the charity Action on Addiction. It is a relatively new charity, formed in April 2007 by the merger of three well established addiction charities: Clouds, the Chemical Dependency Centre and Action on Addiction, from which the new charity has taken its name.
Addiction is one of the biggest preventable killers in the UK. It breaks up families, it damages communities and it destroys lives. In some way, it touches all of us. Action on Addiction takes action to try to disarm addiction. It does so through a uniquely comprehensive approach that encompasses a range of responses from prevention through to recovery. We cover research, treatment and rehabilitation. We also increasingly provide support for families and children, workforce development and education and campaigns against addiction. Like many others, we have been closely involved with the Government’s first drugs strategy, which came to an end last March. While we might argue about its merits and effectiveness, we finally have an alcohol harm reduction strategy. Had I had the opportunity to speak on Tuesday in the home affairs debate, I would have congratulated the Government on some of the steps that they announced then, which they hope will reduce the level of crime, particularly arising from alcohol misuse.
A significant amount of money has been invested over the past 10 years in drug treatment; I believe that it is moving to close on £1 billion. As a result, more people have had access to some form of treatment and, if somewhat late in the day, we are seeing a growing recognition of the need to provide proper support to families and carers, including children. The current strategy brings the needs of families to the fore. I am not sure that the culture of the commissioning and treatment system is yet ready to respond appropriately. In some areas, there have been clear improvements in commissioning and service provision. In respect of the latter, I acknowledge the contribution of the European Association for the Treatment of Addiction in introducing an internationally recognised accreditation scheme. We now need to learn the lessons of the past 10 years and act accordingly. Therefore, I shall focus on the four areas that we believe are key to an effective second stage of the strategy: treatment, research, family support and workforce development.
The predominant mode of treatment for heroin users remains a methadone prescription. There is no argument about the fact that methadone maintenance is a legitimate, evidence-based and necessary intervention if we want to help to stabilise chaotic drug users’ lives and reduce crime. However, we must wise up to the fact that this predominantly pharmacological approach has all too often been deployed as a response to the demand to achieve targets of numbers of people in treatment rather than to secure sustainable long-term benefits and to be the platform from which individuals can make progress to a life free of drug dependence.
Maintenance works when it is provided as part of a meaningful package of support, but I am disheartened to learn that it is common for people on methadone to be seen for as little as one and a half hours a month and to receive evidence-based psychological interventions for less than four hours a year. There appear to be no reductions in alcohol or crack use, and problem drinking is said to exist in 40 per cent of methadone clients.
It appears that to all intents and purposes the goal of a drug-free existence—not for its own sake but because it is something that is known to bring a wide range of benefits to the individual, his/her family and society—has fallen off the radar. This makes little sense when we consider that major outcome studies, including the UK’s own national treatment outcome research study, which was the very thing that gave rise to a treatment strategy, indicate that abstinence is a viable treatment goal achievable by large numbers. It also fails to take into account the fact that, according to one leading researcher, most clients would prefer not to have methadone, and certainly not for life.
The neglect of the abstinence option has resulted in significant damage to the sector providing services working to that model. Action on Addiction is in that field. These are primarily voluntary sector-based organisations and many are residential units. Yet the NTORS stated clearly enough:
“The clients in the residential programmes presented with some of the most severe problems and complex needs and these clients made some of the greatest treatment gains”.
While full cost recovery is seldom an issue for prescribing services, it most certainly is a problem for those providing abstinence-based programmes. Should it really be easier to stay on drugs than to get off them, as presently seems to be the case? Why is it perceived in many quarters that abstinence-based programmes have not been given the same support as chemically delivered programmes have? Maybe that is a misunderstanding—if it is, I will be pleased to hear that from the Government—but there is a general perception that little sympathy has been given in recent years in this direction. I do not want to exacerbate the divide that has grown up between different treatment modalities—quite the contrary. I want a treatment system that encourages and facilitates people to move out of their drug-dependent lifestyle, to experience maximum well-being and to fulfil their potential at the earliest opportunity.
We need intensive and extensive treatment and rehabilitation and in that regard I draw your Lordships’ attention to Action on Addiction’s Working Recovery project in Boscombe, Bournemouth, which operates under the compelling slogan:
“A working recovery is a recovery working”.
That pioneering project helps to build on the gains made in treatment, supporting people to develop life skills and to enter employment and training. Working Recovery, which has depended almost entirely on charitable grants, is celebrating its 10th anniversary. The pride that participants feel when they come off benefits as well as drugs is indeed a moving sight to behold.
People can, I believe, achieve much more than we are inclined to think. We should incentivise progress to the exit from dependence, rather than continue with policies and practices that encourage inertia. Treatment is not only important to one generation. Well over a million children are growing up in households where parental alcohol and drug problems dominate their family life. Seeing that parents have the best chance of recovery is an investment in their children’s lives, too.
On research, if we are to improve our treatment system to achieve the goals to which I have alluded, we need to learn more about what helps people to progress. Momentum is, happily, growing within what has become known as the recovery movement. There are large numbers of people in drug-free recovery across this country. We need to understand the factors that helped them to initiate and sustain recovery, then ensure that our treatment system takes full account of what we learn to make it possible for more to have that experience. That is one direction that research should take. One aspect of the recovery movement that I applaud is the drive to establish local recovering communities, which have the potential to effect a significant cultural and social change on communities blighted by drug misuse. The more we can increase our understanding of how that can be made to work, so much the better for the whole of the country.
On families and children, there are literally millions more people personally affected by someone else’s substance misuse than there are actual substance misusers. The wide and varied range of symptoms relating to the psychological and physical distress that they suffer—anxiety, depression, aches and pains, disturbances—is multiplied by the number of people suffering from them and the treatment received. We should recognise and address that as a major public health issue. Any other condition placing that level of demand on our health service would certainly be viewed in that light.
Action on Addiction’s Families Plus—also celebrating its 10th anniversary—has shown that, with the right kind of economic support, these symptoms can be dramatically improved. If such interventions were widely available, significant savings would be made to the health and social costs associated with the distress caused. Furthermore, Families Plus argues that supporting family members and families in their own right, rather than simply in relation to the treatment of the substance misuse, could well have a significant beneficial impact both on the family members and on the misuser. That is another area that we need to investigate much more thoroughly than we have done so far.
The Moving Parents and Children Together programme, devised by Families Plus, is timely indeed. With alcohol and drug misuse becoming ever more socially entrenched, we are beginning to see several generations afflicted with this problem. The children who grow up in these families are isolated, vulnerable and disadvantaged. They often do not have a voice. Many end up effectively taking care of their parents, losing their childhood in the process. They are at significant risk of developing a host of problems. M-PACT offers these children and their families an opportunity to make collective change, with the help and support of other families in similar situations.
Action on Addiction aims for this programme to become available across the country, so that fewer children go to bed at night feeling that drugs or alcohol are more important to their parents than they are. I hope that, while my noble friend the Minister may not be able to respond on this point, in the context of some of the problems that we currently see in dealing with children he will ensure that the department reviews this again, to see whether we can start to see more work done around the programme that I have been describing.
Finally, as I am running out of time, I will mention workforce development. As so many other contributors have said, particularly when speaking on the health service, it is vital to have people in the field who are not just keen to be there but want to make change. They should be handed all possible support and training, to ensure that their work produces the result that we need. Again, I believe that Action on Addiction has contributed significantly here, by establishing a Centre for Addiction Treatment Studies, where students are trained to degree level on courses that equip them to become addictions counsellors and to work in a variety of settings and modes. The centre has formed a productive partnership with the University of Bath, which awards the foundation and honours degrees. The aim of the centre is to raise professional standards across the UK. I would like to see workforce development promoted much higher up the agenda in the drugs and alcohol field. How else are we to see that the significant sums of taxpayers’ money mentioned as being committed to treatment are being well spent?
My Lords, the gracious Speech announced a new health Bill and made further commitments to providing a healthcare system organised around the needs of the patient. The Minister has explained that the Bill looks to build on his report, to improve the quality of NHS care and services and to improve public health by creating an NHS constitution.
This debate enables me to bring to noble Lords’ attention the state of NHS dental services in the UK, with the progress that has been achieved throughout 2008, and to suggest what needs to be done in the coming year to provide the dental service that the Government clearly realise is needed. Providing quality care and services is something that dentists pride themselves on. I must declare an interest in that I am on the dental register and, although I am not practising, from time to time I offer noble Lords advice on their teeth.
The April 2006 dental services contract had the stated aims of improving access, getting dentists off the treadmill and enabling a more preventive approach to care. Sadly, the combination of a target-driven, treatment-focused contract, with poor commissioning by primary care trusts and a lack of prioritisation by strategic health authorities has made it increasingly difficult for dentists to provide the high quality and personal service for which they have been trained. I look forward to hearing from the Minister how the health Bill will impact on dentistry.
Figures released two weeks ago by the NHS Information Centre showed that not only had access to NHS dentistry not improved, but a million fewer adults and more than 200,000 fewer children have been able to access an NHS dentist in England since the contracts’ introduction—that figure being on top of the 2 million who wanted, but were unable, to access treatment before the new contract started. That leaves the Government even further away from their 1999 election promise of full access to an NHS dentist by September 2001.
In July, the Commons Health Select Committee concluded that, as measured by the department’s own success criteria, the new contract had failed to improve access to dental services or to create a more preventive service. It concluded that it was extraordinary that the unit of dental activity payment system was neither piloted nor tested. The report also noted the variable quality of commissioning of dental services by PCTs, and criticised some of the UDA targets as unrealistic and in need of urgent review. It also commented that an improvement in financial forecasting of dental charge revenue was needed to address their 2006-07 overestimate of £159 million, which resulted in PCTs having to cut dental services or divert money from other areas to make up the shortfall.
The British Dental Association, which represents some 20,000 dentists, has explained that the new contract is too target-driven, with a focus on treatment rather than prevention. It said in its evidence that unless the UDA is scrapped as the sole measure of dentists’ work, access and oral health were unlikely to improve. Many dentists have been unhappy with the contract, some being unable to accept it. The BDA has called for a more flexible way of monitoring NHS dentistry using indicators that emphasise factors such as preventive care, improved oral health, timely and appropriate access, quality and patient experience.
A report in the Times on 25 November highlighted the possibility that NHS dentists will be required to pay back some £120 million to the health service because they were unsuccessful in reaching the targets set by commissioners. Nearly half of dental practices fell short of their targets, and individual practices are likely to have to repay tens of thousands of pounds. This exerts a destabilising influence on dental businesses, whose partners will rely on their NHS revenue to invest in the equipment or resources necessary to treat their patients. It must be remembered that all capital, consumable and staff costs are funded within those UDA targets.
PCTs must provide more flexible contract arrangements and be supported by SHAs in the development of dental health strategies, the collection of local oral health data and improvement of performance management. Dental commissioning should not be viewed as low priority, and I support the Health Select Committee’s recommendation that the department and SHAs should clarify how they intend to improve this performance management.
The noble Lord, Lord Darzi, in his review High Quality Care for All, recognised the importance of dentistry in primary care and noted that access to NHS dentistry is still a problem. He stressed the importance of the delivery of preventive, high-quality care and recognised that target-driven systems are not the way forward. I hope that the noble Lord will be able to address the profession’s great concern over the report’s aspirations and the general concern over the reality of NHS dentistry under the current contract. The Minister set out a commitment to continuous improvement in the quality of care received by patients, noting the recent consultation on the role of the Care Quality Commission in regulating the safety and quality of medical and dental practices, and pledged to spread the Quality and Outcomes Framework approach, noting that some PCTs were already developing “quality scorecards” for dental services.
I welcome the Government’s support for fluoridating water supplies in conjunction with a general oral health strategy, but regret that proposed new legislative options for strengthening tobacco control may now only apply to display rather than use. I am sure that the noble Lord will let me know if that is incorrect. Tobacco use is the leading cause of oral cancer in the UK and, despite improvements in survival rates for many cancers, continues to kill some 50 per cent of those who develop the disease within five years of its detection. As well as the well publicised issues of making tobacco less appealing and less available, dentists must be provided with the time to build trusting relationships with their patients so that they can offer preventive health advice and support—time to explain the importance of not smoking, not drinking to excess, eating a healthy and varied diet and taking care of their teeth. I hope that the Government will raise awareness of oral cancer and the importance of visiting the dentist regularly so that problems can be spotted and treated early.
Looking forward to 2009, I hope that dentists will see a more constructive dialogue with the Department of Health. Progress must be made in the development of new models of effective and innovative commissioning of dental services with a more flexible contract, which, as I have said, should be amended to make way for the more preventive dental health service that I have explained. It is also important in 2009 that steps are taken to guarantee the future of dentistry—the future of aspiring dentists currently studying in, or contemplating application to, dental school. Expansion of dental education in recent years, whether it be the increasing number of students or the opening of new institutions, means that the already stretched pool of dental academics has come under further pressure. The number of dentists opting for academic careers will need to be carefully monitored to ensure that the pool does not diminish to the extent that the quality of dental research and teaching are jeopardised.
In conclusion, I am sure that the Minister will join me in welcoming the formation earlier this week of an All-Party Group on Dentistry, to be chaired by Charlotte Atkins. It is the group’s intention to monitor the progress of the Health Select Committee’s recommendations for NHS dental services while investigating and raising awareness of oral health issues in general.
My Lords, it is a pleasure to take part in the diverse range of debates on the gracious Speech. I shall be concentrating on the children, skills and learning Bill. I want first to emphasise the importance of ensuring that, whatever resources are spent, they benefit all our children, especially the most deprived, and develop the full range of talents that we need in our country.
This Government, with their number one priority of “education, education, education”, have already achieved considerable progress for children from deprived or chaotic backgrounds, with initiatives such as Sure Start, children's centres and so on. The Government certainly also deserve congratulations for their Children and Young Persons Act. That will ensure that a far higher priority is given to the education and well-being of looked-after children, whose lack of educational achievement has, frankly, been a disgrace under successive Governments.
However, on the preventive side, there is certainly more that can still be achieved by early help and support for families. UNICEF’s report today, mentioned by the noble Baronesses, Lady Massey and Lady Walmsley, is critical of the UK’s low standing among developed nations—a view which, I know, the Government reject. Nevertheless, the report makes some telling points. Above all, we need to prevent the still cascading waste of young people's talents. All too often this can develop into a spiral of underachievement and end in a churning life of crime. I will return to that issue later.
The Leitch report has rightly been seen as pivotal in convincing the Government of the need for significant additional educational action and, in particular, the need to raise the school leaving age compulsorily to 18. Leitch demonstrated, beyond argument, the huge gap that has already opened up between the education and skills levels achieved in the UK and those of competing countries such as the USA and Germany. Leitch showed that, for the UK to improve its competitive position, it would require an increase in the percentage of people with level 4 skills to at least 40 per cent by 2020, compared with our fairly appalling 29 per cent reached in 2005. But with a number of countries on track to achieve well beyond 40 per cent by 2020, and another, the USA, already at 40 per cent, reaching that level 12 years from now will still leave the UK well behind. Indeed, just to be competitive with other countries we need to be committed to achieving a minimum of 45 per cent at that level.
Those who reach back to the war years may remember the school year beginning with the confident singing of “There'll always be an England”; equally, we might sing with even greater confidence, as our parliamentary year begins, “There'll always be an education Bill”. There certainly has been one ever since I joined your Lordships’ House. Indeed, as has been said from these Benches, the Education and Skills Bill that we have just enacted would not make sense without the Bill for children, skills and learning foreshadowed in the gracious Speech.
Your Lordships will be delighted to see that my noble friend Lord Dearing, who has so much to give to this whole field, will be speaking shortly. As noble Lords may recall, he and I have a continuing concern that far more adequate provision should be made to remedy the underinvestment of the past, which has resulted in the serious skills deficits of people already at work.
Consistent with that, I particularly welcome action in the proposed Bill to respond to the needs of all our children and young people, and to see them set as learners for life early on. Full details of the new Bill are not yet published. The noble Lord, Lord Darzi, told us part of the story and I hope that we will hear a little more when the noble Lord, Lord McKenzie, replies.
To that end—I hope that this is the Government’s intention—I want to see that children’s trusts are able to deliver the Every Child Matters agenda by putting the children’s trust boards on a statutory footing so that they are able to provide a closely integrated and effective service which draws all the relevant players together.
I should also like to know more about what the Government have in mind for children’s Sure Start centres. I think it has already been said that they are to have a statutory basis, and perhaps that can be confirmed. Will the duties of local authorities include ensuring there is a sufficient number of these centres to meet local needs—again, I stress, especially in the most deprived areas?
Then there is nursery provision—the entitlement of free education for the nought to five year-olds. Will statutory funding now be available for the private, voluntary and independent sector, the PVI, and, if so, how will it operate? As the Minister may know, when day nurseries closed at the end of World War II, there would have been virtually no nursery education for the under-fives except for that provided by the voluntary organisations—pre-school play groups, for example—but now the more generous provision has meant that many of the excellent PVI-run nurseries have either closed or are set to close unless there can be further help for them.
I move on to the young people who are heading for trouble or who are, sadly, already in trouble. I start from the position of fully supporting, as have several noble Lords, the local authority’s role in securing relevant education for all those in juvenile custody, of whom there are far too many. However, there must be no doubt that ultimate responsibility for securing effective delivery of that education lies with the local authority, and in future it must have the priority that we have sometimes seen lacking in the minds of prisoners, prison staff and even prison governors. In future, there must be no question of working in the prison kitchen and getting paid for it, when acquiring basic literacy and numeracy skills and/or beginning an apprenticeship are far more essential if there is to be any hope of post-prison rehabilitation.
Of course, that will not happen without clear lines of accountability and real motivation in prisons and in partnerships with local employers and the third sector. Equally, all this must be backed by a duty on local authorities to promote the individual young person’s educational attainment. As I mentioned earlier, we must be no less concerned with effective intervention before a youngster gets into trouble, and we must provide better arrangements to get them back on track. However, above all, we need to address the problem effectively in the parent schools, drawing on what I hope will be statutory behaviour and attendance improvement partnerships with the full support and active involvement of the head teachers. There must be committed ownership of this kind if they are to deliver their potential, and it must include the constructive involvement of parents. We must see that they, too, get support and encouragement in engaging in, and sharing ownership of, the problem.
I agree with both Leitch and the Government that we need a demand-led education and skills system for the post-19 group. However, once an individual who has clearly been failed by our education system realises the importance of acquiring the skills that are necessary for today’s employment, we owe it to that individual to provide them either free or at the lowest possible price that we can afford, whenever they wake up to the need for those skills. With the current chaotic economic situation and rising unemployment, when the vast majority will be unable to find unskilled work, the Government should put far more resources into this kind of upskilling.
In the longer term, I hope, too, that we will be able to provide the many academic or practical courses that are being cut back for everyone but which particularly benefit older, often semi-retired people. An older generation encouraged to enjoy their retirement by either upskilling for pleasure or acquiring the necessary skills to start a new business makes every kind of business sense. It costs far less than a bed in an old people’s home for those suffering far too early from dementia. I hope that at least, when the economic scene becomes brighter, the Government will think again about restoring and expanding the necessary resources to do this.
My Lords, it is a pleasure to speak in the debate on the loyal Address covering education, health and culture. In doing so, I declare my interest as chief executive of Universities UK.
The loyal Address mentioned three Bills that will have some impact on higher education, and it is on this that I want to focus my contribution to the debate. I shall remark briefly on each of them but I should like to set those remarks in context. This House needs no reminding of either the economic challenges that we face in this country or the role that our universities can play, with the right support, in ensuring the UK’s prosperity in the long term. Universities are the engines of the knowledge economy and creators of cultural wealth and social capital. The central role that they play in meeting some of the grand challenges of the 21st century means that ensuring their continued strength must, and should, be a national priority.
The Government have made a substantial investment in supporting universities in science and research, and as this investment has flowed, the UK has continued to improve its research performance; for example, increasing its share of the world’s most influential papers from 12.9 per cent to 13.4 per cent in two years.
Since 2001 income from business through consultancy contracts has increased by 128 per cent and the total turnover of all active university spin-outs by 240 per cent. All of this shows that UK universities are a unique national resource. We must ensure that this resource can be properly utilised to help the country in the current economic downturn.
The noble Lord, Lord Baker, referred colourfully to the range of issues we are debating today. I want to extend his net a little and draw in some of the comments made by noble Lords on business and the economy on the third day of the debate on the Queen’s Speech. So much of what my noble friend the Minister referred to in his opening speech today is linked to the emphasis on Monday on the maintenance of a highly skilled, highly productive workforce prepared for the future. This is the inspiration driving the noble Lords, Lord Baker and Lord Dearing, in their academies initiative. I, too, am delighted to see the noble Lord, Lord Dearing, who will speak today, looking so well.
It is this imperative that drives the Government in the education legislation to which we are referring today. For example, the Government wish to ensure that professionals made redundant as a result of the current economic circumstances should have opportunities to enter, or in many cases re-enter, higher education. The commitment to supporting people to re-enter education lies at the heart of the children, skills and learning Bill, which seeks to introduce an entitlement to an apprenticeship to all suitably qualified young people by 2013, and to offer workers the right to take time off to train. The Bill is a practical expression of the Prime Minister’s often repeated conviction that the UK cannot expect to compete on the basis of low skills—a conviction fully supported by the evidence produced by the noble Lord, Lord Leitch, in his review when he pointed out that 70 per cent of the workforce of 2020 are already in work, and we should focus on them. Together with the demographic dip which Universities UK has analysed in our recent submission to the DIUS debate on higher education, it is clear that the Government’s emphasis on attracting learners from the current working population is the right one.
However, it would be remiss of me not to point out that this commitment would be most effectively supported by reconsidering the current policy on equivalent and lower level qualifications, known as ELQs. It seems odd that at the same time as arguing the need for more higher education, particularly for those faced with redundancy—the noble Baroness, Lady Howe of Idlicote, referred to this—the Government have effectively frozen additional student numbers on which that expansion is likely to depend, although I acknowledge that that will not affect provision that is co-funded by employers.
With reference to the children, skills and learning Bill, will the Minister expand on that definition of “suitably qualified”? Will the apprenticeships scheme include progression to higher education so that apprentices could achieve foundation degree status or even go on to obtain higher degrees? Also on this subject, will the Minister clarify the Government’s intentions to offer workers the right to take time off to train? Will this entitlement also include higher-level qualifications?
I mentioned earlier the role that universities could play in assisting the economy. I am pleased to inform the House that universities have responded with a will to offer help to small and medium-sized businesses suffering in the downturn. Universities UK, the Higher Education Funding Council for England, and GuildHE have produce Standing Together, which highlights the central role of universities in supporting businesses and individuals with skills, advice, knowledge transfer and know-how. The leaflet offers practical support by giving the contact details of what is known as the front door for business at every higher education institution that is a member of either GuildHE or Universities UK. Of course, many universities are adding to the health and wealth of the economy through their own spin-out companies, to which I referred earlier.
The second Bill I wish to refer to briefly is the borders, immigration and citizenship Bill. International students and researchers contribute extensively to the academic, cultural and economic health of our country. While universities are as committed as any other sector to ensuring the security of our country, they are also trying to balance this with the need to remain competitive with other countries in attracting the best brains—the best students and researchers—to this country. It is vital, therefore, that when any immigration measures are introduced, the impact on higher education as an attractive and welcoming place to study and indeed as an export earner is not compromised.
My final remarks relate to higher education and the health service. The health Bill sets out to highlight patients’ rights and the quality of care they can expect to receive. Central to delivering that is the training and education of medical, dental and nursing staff and those in allied health professions. Most universities are involved in providing training or conducting research for the NHS in some way. However, it is clear that in the synergy between the health service and higher education, particularly in relation to workforce planning and commissioning and the multiprofessional education and training levy, known as MPET, there needs to be better communication between the Department of Health and the Department for Innovation, Universities and Skills. I hope that the Minister who opened the debate, who has feet in the academic and the government camps, will be able to take these points back to his department.
Universities already play a crucial role in the development of our workforce nationally and internationally and are key to helping the country through this economic downturn. I look forward to the debates that will take place on the Bills within the loyal Address and hope that noble Lords will join me in recognising the importance of our universities and the necessity to ensure that they have the right public support to meet the challenges that face us.
My Lords, I start by picking up on something that the noble Earl, Lord Listowel, talked about. Much of what he said about children’s homes applies equally to prisons, and given what was said by the noble Baroness, Lady Howe, and by the right reverend Prelate the Bishop of Ripon and Leeds, I can promise the noble Baroness, Lady Morgan, an interesting time on that part of the Bill when it comes before us.
The particular remark I want to pick up on is what the noble Earl said about practice in children’s homes. He said, in effect, that when a child is crying in the night the continentals reach for the child and the English reach for the form to fill in. That is something that I see in schools, and it is immensely destructive. We have done a lot in our quiet way—I am sure that it was totally unintentional—to undermine the courage of institutions and individuals involved in education. The most shattering example of that was when the Royal Society sacked Professor Michael Reiss, who had done nothing wrong. The terror of the newspapers felt by the Royal Society was such that it had to sack him. One sees that quite frequently in schools. Tim Hastie-Smith was recently sacked twice in two days and had done nothing wrong. It was purely a lack of courage in the institution that he served and the one that he was about to serve. If we are to expect individuals to have courage, it is important that institutions also have courage and learn not to be too bowled over by what appears in the press.
Since Parliament has become so weak and the press has become so short of money, it has become easy for people to run headlines into the press to achieve effect, and we have all become frightened of the consequences of those headlines. A couple of noble Lords mentioned the Barnardo’s survey showing that 45 per cent of people believe that children are feral. That was not what the survey found. It found that:
“45% of people disagreed with the statement 'People refer to children as feral but I don’t think they behave this way’.”
Why was the question asked in such a strange and convoluted way? It was so that people did not understand it and so that if they even half agreed, they contributed to the 45 per cent. If the survey had asked the honest question, “Do you think children are feral?”, it would have received a much lower percentage.
More recently, we have had headlines stating that one in 10 children is sexually abused every year. That is what the Lancet allowed to go out in a press announcement. In the papers behind the announcement, the figure is 0.5 per cent. You might argue that it is actually a lot higher than that and that some studies somewhere have perhaps shown that the figures are underestimates. We have to have the courage of our understanding of the world, our morality and our convictions, stand up for them and not be cowed by the drama of what is happening in the press.
In the schools Bill, we must look at how we can help schools to support teachers, who are in an exceptionally difficult position. If a teacher is accused of doing something that might be interpreted sexually, we have deprived the school of jurisdiction. The school must immediately refer that teacher to outside agencies, and the teacher is likely to be suspended for six months or more. We learnt this week that the Department for Children, Schools and Families will keep that accusation on record even if it is disproved. We are putting enormous pressure on teachers in schools not to hug that crying child. We should have the courage of our understanding that that is not how we want things to be, and we should use this Bill, and, I suspect, the Bills that follow, to try to work back a bit. It is very difficult, but we should try to get there.
I wanted to concentrate on the process of change and innovation in schools. We seem to proceed in education from catharsis to catharsis. Something is proposed and worked up by the department, which is largely cut off from real education. How many senior or even half-senior civil servants in the Department for Children, Schools and Families have actually been part of a senior management team in a school? I do not know that the figure is not zero. It is certainly very small. There is no system at all for interchange between the department and schools, so the department is entirely in the dark about the likely effects of its actions in the real world in schools. Although the department comes up with something that it feels is absolutely the right thing, it will always be a cathartic process to put it into effect in schools.
The QCA should be doing something to moderate this process, but it appears to be interested only in its own dogma. Moreover, the political pressures mean that these changes are dumped on schools all at once before the schools are ready. There is no sufficient system of support for schools when these changes are made. When the schools have recovered from them and are getting used to them, we put through another set of changes. That is what these annual education Bills are about. We are absolutely committed to keeping schools in a state of constant chaos. The results, when we analyse them, are not that good. We have not been making the progress that we should have been making. In fact, the only crumb of comfort that I have been able to draw out of the statistics over the past year or two is that the Scots appear to be doing worse than us, for once, which is a strange way of being cheerful.
There is another way of dealing with these things, which, if the noble Lord, Lord Darzi, were here, he would recognise. If he were to step out of the Department of Health and into the Department for Children, Schools and Families, he would be stepping back to the evidence base and innovation of 25 years ago. He said in his speech that he wants front-line staff to be free to innovate. I got a report the other day from the Printed Paper Office on keeping track of innovation in schools as a result of the Bill that we passed two or three years ago. It was ridiculous. It was so thin you could have rolled it around a cigarette. Most of it was about schools faced with some kind of physical reorganisation asking permission to change their hours or the times of the terms a bit. We have suppressed innovation in schools, rather than encouraged it. If only we could learn from what this Government have done successfully in health. I am cheered by much of what the noble Lord, Lord Darzi, says about that, but if only we could transplant that into evidence-based education, that would be great. We do not have systems for spreading good practice in schools. A good teacher from here or there or one who has gone on a good course is a matter of chance. It is terribly random.
However, there are examples, even in education, of innovation proceeding in the right way. When the international baccalaureate was introduced into this country, at no stage did it cause any pain to the schools into which it was introduced because they took it on as and when they wished. It has caused no disruption to the system and has happened quietly. There is a case for co-ordinated change to outward- looking parts of the system, such as the admissions system or admissions regulations, which clearly ought to be changed centrally and should be uniform. However, inward-looking changes, which look at how schools work and the provision of education, work much better if they are continuous self-evaluated improvement rather than just cathartic and episodic.
I should like to see change, first, as a demonstration when it is initiated by schools, pressure groups or examination boards. Innovation should appear from everywhere in the system, rather than just centrally. The Government could carry out a pilot study which, having been carefully monitored, could be rolled out slowly, again being monitored. Once the process gets to a point of critical mass—perhaps when 30 per cent or 40 per cent of schools are doing it—Ofsted could start to push and encourage, and, 10 years down the road, it could become universal. In that way, schools would take on changes as and when they are ready for them. Through the whole process of developing a new system, there would be continual evaluation and improvement. There would be a continuous flow of people who are used to the new system and who could help to support it in schools. There would be an ongoing foundation of good practice. That would be much easier and more constructive.
The recent interim report on the primary curriculum from Professor Rose promises, in several ways, a complete upset of the way things are taught in primary schools. If we do that in the way we are used to doing, we risk going back to the chaos of the 1960s when a whole generation was just not taught. It may work. I am a great supporter of many of Rose’s suggestions, but bits of them may not work. We should try them out to see their effects. In education, they have to be done at a level where you can afford to carry out evaluation and to provide support to make sure that things are going right. Unless you do that, you have to wait several years, by which time a whole clutch of children will have been failed. If you are engaged in intense and close evaluation and support, things going wrong can be picked up probably within a few months and certainly within a year or so. That would give a chance to adjust things or to get back on to the original track.
Such a system also would be better for Ministers. It would not be the all-at-once grand creation or the big change that Ministers like, but, because changes would be starting small, they would be able to do more of them. They would get more of the headlines they want because more projects would get under way. They would not have the headaches that go with the big changes, with everyone saying, “It’s going wrong. It hurts. It’s not happening for us”.
If one looks at educational history and asks what has succeeded, a pretty good example is my noble friend’s CTCs, which started small. There were a dozen or so of them. It took some time before they got off the ground, but by then we knew how the system worked and how to make them work. Now my noble friend is at it again. He proposes to start at a sensible level with 10 to 12 of these new university technical colleges to show how they work, to have enough of a critical mass and to have a collection of people who will be able to develop them. If they work—I hope that they will because we need them—things will spread from there. That is the way to build a lasting legacy and a good education system. It is the example that we should all follow.
My Lords, I welcome the opportunity to speak in this debate on the gracious Speech, as there are three Bills concerned with children, learning, schools and health. I was interested to hear the noble Lord, Lord Lucas, say that big strides have been made in health provision in this country over recent years. For instance, the Healthcare Commission has applauded NHS improvements, citing the enormous benefits derived from increases in funding, the improving health of the nation, a sustained improvement in achieving government targets and a reduction in waiting times. However, had noble Lords been listening to the BBC this morning and heard its interpretation of the commission’s findings, they would have a completely different idea and would think that the NHS improvements were being criticised. There is a question to be answered here: why is public opinion to a large degree sceptical about the advances made in the NHS? Noble Lords who have received healthcare recently should ask themselves whether they were happy with the outcome. For myself, I have done very well from many wonderful people in the health service. However, when people are asked about their perception of the NHS as a whole, they seem to have a dimmer view of it. Touching again on a point made by the noble Lord, Lord Lucas, this is more to do with perceptions bred in the press, and no less in the BBC, where a certain negativity and lack of balance in the presentation of reports sometimes snares us.
I want to point out to my noble friend the findings of the Economic and Social Research Council, which has also examined public perceptions of the NHS. In an important article published recently, the council points out that NHS reforms are often presented as bureaucratic and budgetary in nature where perhaps greater emphasis should be placed on the Government providing resources for doctors, nurses and all the other staff working in the NHS to provide care to patients and those who wish to maintain good health. Perhaps we have to make progress in this regard because we are not going to get much help from the media.
I want to concentrate on the treatment of diabetes, the condition known as the “silent killer”. I welcome the appointment of Dr Rowan Hillson as National Clinical Director for Diabetes. This week she addressed the Parliamentary All-Party Group on Diabetes. While recording many advances, she declared that there is still much to do. I take just one point from her address, when she asked why the life expectancy for men with diabetes is 17 years shorter than for those without the condition, and for women it is an astonishing 20 years. For all the advances made, why is that the case? We need to recognise that when diabetes is properly treated, people can lead long and fulfilling lives.
I have a series of specific questions for my noble friend, although he may wish to pass them on to my noble friend Lord Darzi. We have seen the establishment of a successful retinopathy screening initiative recently, in which I have taken part, as well as vascular risk assessments, which are so important to diabetes sufferers. However, we need more investment in raising awareness of diabetes. Diabetes UK believes that there are still some 1 million undiagnosed diabetics who, if their symptoms were recognised early enough, could benefit from the success of earlier intervention. The incidence of diabetes may be high in Britain, but it is certainly also very high elsewhere in the world.
Why is the take-up of insulin pumps dramatically lower in the United Kingdom than in other countries of comparable economic standing? This is an important point because pumps provide a better way of controlling the condition. Will he also note that diabetic in-patients are still having considerable problems if they have to stay in hospital? A recent survey demonstrated that only one in four patients in that situation is visited by a diabetic specialist, which is deplorable. Will he also consider training for paramedics and ambulance staff to enable them to better recognise when someone is having problems with diabetes after a hypoglycaemic reaction?
Have the Government considered whether there should be a separate approach towards the treatment of diabetes 1 and diabetes 2? They are both diabetes but in many ways they separate and diverge and perhaps we need greater sophistication of treatment. The transition from paediatric to adult services for young diabetics needs to be planned around the needs of young people and, again, we need more sophistication there.
On the issue of children with diabetes, there was a parliamentary day here on 18 November to which I went along, as did some Ministers. This was in the wake of an excellent paper from DCSF about making all children matter, which has some useful things to say about young diabetics in school. It was an inspirational day, not only for the children involved but also for their parents. I know that the noble Baroness, Lady Pitkeathley, who is on the Woolsack at the moment, has a very strong interest in carers, and those of us who have had the experience within families of seeing a mother—and it often is the mother rather than the father—having to care for a young diabetic and trying to get them to inject themselves with insulin will know that it is a terrible imposition. These people are real heroes and heroines, if I am still allowed to use that phrase within our society.
There are too many bad practices in schools. As someone who is married to a teacher, I realise that teachers have to absorb an enormous amount of knowledge, but I received a letter from a woman with a young diabetic child who had come to see us on that parliamentary day on 18 November. She describes how bad it was in the first school that her five-year old attended. The teacher there stated that she was not aware that the child needed insulin injections, even after she had read the literature. She said that once the child had had a hypoglycaemic reaction it should be treated by an injection of insulin—but it is deadly to get that wrong. There was also a desire to keep from the rest of the children the fact that the child from time to time had to leave the classroom to administer whatever was required for her therapy.
The mother then moved the child to an adjacent school some two miles away and she describes—this is the heartening bit—how astonished she was at how seriously this school took the treatment of the child within the educational set-up. The head took the view that the other children should be involved and know that the child had diabetes and, in time, help to ensure that she was able to have a successful day in school. The mother said that she was absolutely stunned when the teaching assistant thanked her for entrusting the child to her. She also tells me that the head and the other teachers had planned the transition to year two at least one month in advance and had called her in to discuss it. We have contrasting good and bad practices and we should encourage the good practices as much as we can.
I also wish to mention Parkinson’s disease. The Parkinson’s Disease Society, of which I am a vice-president, welcomes the opportunities provided by the welfare reform Bill for helping Parkinson’s sufferers to remain in or to return to work. However, we need more support, resources and understanding of Parkinson’s, which is an unusual disease in that it is complex and fluctuating in nature.
I end with the example of the single equality Bill. Some 17 per cent of Parkinson’s sufferers have had to give up work because of the difficulty in accessing key public transport services, so we support what the Government are doing, but resources must be supplied on the other side to ensure that those who are suffering—from Parkinson’s, in this case—have the ability to remain in work or return to it.
My Lords, it is a great pleasure to listen to colleagues speaking on subjects on which they have expert knowledge to share. I shall respond to a number of points made, beginning with those of the noble Baroness, Lady Walmsley.
I took the noble Baroness’s remarks as a statement that her objective in these deliberations is to help the Government come forward with first-class legislation that will stand the test of time, that will not be met with the groan factor—“Oh, here we go again. How long will this last?”—but which will work, and to which we will be committed. She referred in particular to the new diplomas and described them, perhaps in response to what the noble Lord, Lord Baker, has been saying, as “pre-vocational diplomas”. I understand that, and there is a valid place for it, but the initiative that the noble Lord and I have taken has been to try to complement that approach with an alternative: the opportunity to engage not only the brain but the hand, the eye and the equipment by doing things in a much more hands-on way, because that will appeal to a wider range of people. The involvement of the universities will mean the highest quality and will engender great respect as well as commitment. It will also provide the kind of commitment that the noble Baroness, Lady Warwick, is looking for, from both the apprenticeships and the diplomas into higher and further education. That is what we want to see. There is a narrow focus, too, on how the motivation to be top in maths, English and science, which will be part of the curriculum and will be taught in the context of the subjects those kids have chosen, excites them.
The right reverend Prelate, the noble Baroness, Lady Howe, and perhaps also the noble Lord, Lord Baker, mentioned FE colleges. I am very much in favour of the local authorities’ role being crystallised; indeed, there was a hole in the Education and Skills Act that we have waited for the forthcoming Bill to fill, defining and expressing the role and powers of local authorities so that they could discharge their duties. In the FE colleges, however, there is a real fear that in the change in leadership to the local authority, funds will be at risk. These colleges have emerged as a powerhouse for industry and education, particularly for second chances. They are very important to that 70 per cent who will already be at work in 2020 whom we have to up-skill. We know that powerful FE colleges, standing strong and first rate, can deliver.
I want local authorities to be involved and to have a clear role, but when it comes to prisons, as the noble Baroness, Lady Howe, said, the motivations are different. It is one thing for someone out there to have responsibility to deliver, but how do we ensure that, especially when the juvenile or young person is in a prison well away from the local authority area? There must be motivation in the prisons to deliver, and the local authority must have the power to ensure that there is delivery.
I turn to the remarks of the noble Lord, Lord Lucas. He referred to the report by Sir Jim Rose. I fear knee-jerk reactions to that report. We do not want that; we want careful consideration. When I read that there are six areas of defined study, I could just imagine, as could all of us who remember the experience of the past, a knee-jerk reaction to it. We must proceed reverently, soberly and calmly, through thought and evidence, to gradual change. We have seen too much enlightenment without scrutinised evidence. I am not criticising the report in any way; I am just talking about the approach that appeals to me. We have these children’s future in our hands. We cannot turn the clock back if we get it wrong. Above all, in thinking of Sir Jim’s words, I want teachers to go into a classroom looking forward to the day’s teaching, with kids keen to learn, and us having confidence in the learning outcomes towards which they will be working.
Rather than respond only to the stimulation of others, may I make some points of my own? I want to thank the noble Lord, Lord Young, for a letter to me offering to follow up some points that the noble Baroness, Lady Howe, and I were making on the last Bill, in particular how the Government intend to use some of the powers they are taking to help people, particularly those who did least well at school, to get back into learning and good employment and be assets to their families. This would enable us to deal with poverty among children rather than people being dependent on the state. We must get these things right. I hope the discussions with the noble Lord, Lord Young, will enable us to move forward constructively.
I welcome legislation on apprenticeships as a mark of the respect and importance we attach to an area where we have fallen behind. There are two issues. First, Government are rightly concerned about the numbers taking up apprenticeships. In the scrutiny work in the other place, a great emphasis is placed on the quality of what we do. We could soon damage what must be a very strong brand, something that parents have confidence in. We can reconcile the need for numbers with the need for quality by a pre-apprenticeship programme, that is, to enable people who are not well equipped yet to get into it by going through preparatory stages. Then we can seek to marry the two, but we must have both. I agree with the scrutiny report: this must be written into the legislation.
The next point is that it is not difficult to legislate; it is much more difficult to be sure we are legislating for something that will work in practice. We are creating new bodies, and that gives assurance to the world of teaching that they are there to stay and they can have confidence. But we must avoid any risk that, in establishing themselves, they are equally concerned to make the whole system work as one, articulated to agreed, shared objectives. We need to have in our mind all the time how it is going to work—we cannot legislate for it—in framing the legislation. We have got to get it right.
I am particularly concerned about this issue of reconciling the objectives of people. I was chairman for some time of a body that was created to bring together an organisation responsible for tests and exams and one responsible for the curriculum. There were good reasons for doing so—a gentleman here knows a bit about it. There were problems when they were separate. Now it is proposed to de-merge them: we are going to have one body responsible for regulation and one responsible for the curriculum. One is going to report to Parliament and one is going to report to the Secretary of State. Okay, it can work. There can be advantages, particularly in the involvement of Parliament, but when you get a body such as the Royal Society of Chemists writing a memorandum that the curriculum for chemistry is all wrong, we have to look through it again. There is a mismatch between what has been taught and what is needed. How are we going to reconcile that within the new system? We must be sure that that kind of thing is built into the arrangements rather than the attitude, “Well, we’ll solve that next week” to see if they advance. These curriculum issues are very testy. I came into the job that I have been referring to many years ago, thinking “What a nice, safe subject history is,”. But God! Run for your life! when historians get hold of you saying things like that. There is such great passion. These differences are profoundly argued and felt. What is my share of the bacon of the curriculum? We need to be mindful of these kinds of problems, but I believe it can work.
What really matters is that teachers go into a classroom wanting to teach, knowing that we have confidence in them and will give them the kit to do it. We need to be satisfied that the objectives of learning and the achievement of those objectives are clear. Alongside that is the wisdom to move carefully, to test the ground and to be sure that it will work before we dare to say, “That’s the right way to do it”. We need to be a bit humble, too, and have in our mind all the time that boy, that girl and that teacher.
My Lords, it is a great pleasure to follow the noble Lord, Lord Dearing. I thank my noble friend Lord Darzi not only for his excellent introduction to this debate but for all his work on NHS reform, which will shape the nature of the service for years to come.
It is on this that I wish mainly to concentrate in my brief remarks. I shall concentrate especially on the NHS constitution, which will have far reaching effects for patients and public involvement, which is one of my main interests in the NHS. I make at the outset two declarations of interest. First, I have been appointed as chair of the new Council for Healthcare Regulatory Excellence, an independent body accountable to Parliament whose main aim is to promote the health, safety and well-being of patients and members of the public. We scrutinise and oversee the nine health service regulators and work with them to promote good practice in regulation. Secondly, I chair the Specialised Healthcare Alliance, a coalition of 42 patient organisations which campaigns on behalf of people requiring specialist medical care.
Wearing both those hats, I welcome the move to develop an NHS constitution. It is an important step forward for patients and public, and I look forward to working on the legislation as it proceeds to ensure that it is clear and non-confusing for patients, and as accurate as it can be legally. It is clear that simplifying and codifying the many interlocking rights, responsibilities, duties and pledges which relate to healthcare is a difficult task. For example, as other noble Lords have asked, how will the constitution be used in relation to services which are not provided by the NHS at all but by another agency or third party? The commitment to publish a separate statement of accountability is welcome, but patients must be clear about where accountability lies.
The focus on quality of care, and reflecting the needs and preferences of patients, their families and their carers, is welcome and continues the excellent progress made in the carers strategy. The strategy set out that carers will be treated as expert partners in care. As vice-president of Carers UK, your Lordships would expect me to acknowledge how important that is, but it is important, too, to put in place support mechanisms to help carers develop their skills and confidence.
Informed choice is important to all patients and has become a major determinant of treatment options, but choice is real only where alternatives are available. The formal recognition of patient choice in the NHS constitution and the placement of patient choice as a major determinant of treatment options are very welcome, but to realise this so far as, for example, specialised treatment is concerned, PCTs will have to provide information on the quality of clinical services. There is still a long way to go before accurate, reliable and meaningful data become available that enable patients, working with their doctors, to make fully informed choices about what is available to them. The new legal right to choice is therefore welcome, but we must remember that real choice includes services and treatments as well as providers, and is dependent on the provision of accurate information.
It is also important to ensure that the constitution makes it clear that the Human Rights Act, which confers the right to dignity and privacy, underpins it. This would enable members of the public better to appreciate those rights and to know what to expect in practice when receiving services provided by professionals for or on behalf of—I emphasise “on behalf of”—the NHS. This will empower patients to demand their rights and to seek redress when those rights are not upheld.
I turn finally to the position of carers and I am grateful to other noble Lords for mentioning this. Many of their concerns fit more adequately into yesterday's equality debate, but their needs cannot, of course, be divorced from health and social care issues. Alarming new statistics recently published by Carers UK reveal that the nation's carers are under even more pressure as living costs rise and the economic crisis affects even more families. Nine in 10 of the carers recently surveyed say that their financial position is worse than 12 months ago yet they provide vital support, unpaid, to their elderly, sick or disabled relatives, making a contribution worth £87 billion a year to the UK economy.
Half of all carers are cutting back on food just to make ends meet—more than double the rate of only a year ago—and 32 per cent of those paying rent or a mortgage say that they cannot afford to pay it. The draft NHS constitution mentions carers and states:
“NHS services must reflect the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment”.
That recognition of the importance of carers is extremely welcome. The NHS must, however, start to view carers as partners in care and welcome their knowledge and opinions.
As well as this legislative change, we need a cultural change at local level so that the training for professionals to recognise carers, for example, must proceed much more quickly than it has done hitherto. Improving complaints procedures for people who have arranged their own social care is welcome, as the impact of poor service has a significant impact on carers and their health, income and ability to work. It would give families greater power to demand a good service for the person they care for.
I look forward to taking part in the debates as the legislation proceeds, particularly those around direct payments and personalisation, which will have tremendous significance for those caring families. They are very welcome developments, but it is important that we continue to take account of the 6 million people who provide by far the majority of health and social care provision in our country.
My Lords, it is a great pleasure to follow the noble Baroness and to take part in this well informed debate. I wish to concentrate on two issues: first; how education needs to be much more rounded in order to produce not just academically qualified young people but healthy bodies and healthy minds too; and, secondly, I want to say a few words in support of the state of the good old British pub.
In the gracious Speech, there was mention of the children, schools and learning Bill. When I served in another place, I often visited local schools, colleges and businesses in my constituency. In schools, I was able to see the excellent job that many teachers do in helping young people get to grips with the basic skills that they will need in later life and we should congratulate our education professionals on the work that they do. They are dedicated, tolerant and long-suffering, sometimes in the face of unacceptable behaviour from a minority of pupils and all too often their unreasonable parents.
One issue that concerns me is the reduction in physical activity in schools. The selling-off of school playing fields is a terrible thing and the failing to make maximum use of existing playing fields also adds to problems such as disorder and obesity. I remember meeting some young people one summer who were hanging around on the street corner complaining that they had nothing to do. Less than 50 metres away was a school with a playing field that was unused, crying out for activities to be organised to use up the energies of these young people. I often wonder what happens to sportsmen and women after they finish their sporting careers. Surely, we should make use of those people who have been used to maintaining a fitness regime to teach our young people what they need to do to become fit, stay fit and develop skills that would enable them to take an active part in ball games, athletics, swimming and other activities—activities that would not only keep them healthy, but through which they would also meet people they would otherwise not meet and form friendships which may last a lifetime.
It would be much cheaper for the new Bill to contain provisions for a small budget for each school to enlist the help of sports professionals after they have retired to keep playing fields in use during school holidays and at weekends—far cheaper than the clean-up costs of dealing with bored young people becoming unfit and obese, taking up bad habits such as smoking, drinking to excess, taking illegal drugs and falling into crime. It might also increase the pool of sporting talent from which our national teams can be selected.
At a meeting of the Central Council for Physical Recreation a few years ago, the guest speaker was the great Welsh rugby maestro Cliff Morgan. He told us that a quarter of 16 year-olds show early signs of heart disease. I know a thing or two about heart disease. It costs the nation an absolute fortune. We must help to prevent young people leading a lifestyle which will lead to development of problems of this kind early in their lives.
Thankfully, many organisations outside our formal education establishments invest in our young people. I give my own local football club, Cheltenham Town, as an example, and declare an interest as a vice president. Cheltenham Town is using the power of sport to inspire, motivate and educate thousands of individuals within the local community. Only last weekend, more than 200 youngsters from Leckhampton Rovers, supported by their parents and friends, took over the Whaddon Road ground for a football bonanza. The purpose behind Cheltenham Town's programme is to build a better community. Nelson Mandela once said:
“Sport has the ability to inspire. It has the power to unite people in a way that little else does. It speaks to youth in a language they understand. It is more powerful than Governments. Sport has the power to change the world”.
Let us not forget those who are disabled. We all marvelled at the success of our Paralympians in Beijing. Those who help disabled young people do a wonderful job. The National Star College, located just outside Cheltenham, provides profoundly disabled young people with the technical equipment to develop their skills, including sporting skills. The private sector has a responsibility too, not just in sport, to ensure that it concentrates on our young people during this downturn. I was delighted to read comments by Richard Steer of Gleeds, the construction industry project managers, urging the construction industry not to give up on the graduate. He argues that industry needs to develop local talent in areas such as quantity surveying and project management now, otherwise, when the upturn comes, we will need to import those skills in the future, probably at higher cost, on short-term contracts from abroad. I hope that the Government will bear these factors in mind during the passage of the new Bill.
On the plight of the community pub, I declare an interest as a former chairman of the All-Party Parliamentary Beer Group. Two years ago, the group was concerned to learn that five pubs a week were closing across the United Kingdom. Many of these were in small communities, where the local shop and post office had closed and, apart from the church, the pub was the last social facility in the village.
The group decided to conduct an inquiry to gain a full picture of what was happening. Research took two years and produced some alarming figures. Today, instead of losing five pubs a week, the nation is losing about five pubs a day—it is losing 36 a week. This is a net figure. Beer sales are down 16 million pints a day since the peak of 1979, reaching the lowest level since the Great Depression of the 1930s. More than 40,000 jobs have been lost in the sector in the past five years. A further 43,000 job losses are projected over the next five years.
The pressures escalated further following the Pre-Budget Report. Pubs were denied any potential benefit from the VAT cut because of another hike in excise duties. Beer taxes have increased by 17 per cent this year alone. Not only that, the cost of implementing the VAT change is estimated to be around £30 million, a price which will have to be paid again when VAT is restored to its previous level in a year or so. Further pressure has been put on pubs through the impact of irresponsible high street trading from supermarkets and high volume on-trade outlets with offers of “two for the price of one”, “drink as much as you like for £10” and happy hours. I am pleased that the Government seem to be addressing some of these practices but more needs to be done to prevent the practice of “pre-fuelling”.
A pub does not just sell beer. It is a social centre providing meals and snacks, raising money for local charities and diversifying offerings all the time. Pubs provide a place where the consumption of alcohol is regulated. They use local produce to provide nourishing meals and are a source of great comfort to many pensioners and families. When a pub closes, all that goes, jobs are destroyed and the Treasury is out of pocket.
Prompted by His Royal Highness the Prince of Wales, an organisation, Pub is the Hub, was formed. It has had a number of successes in turning non-viable shops, pubs and post offices into single viable businesses. In places where this has happened, instead of losing all three services, the local community now keeps all these services, and others. Some of the “Pub is the Hub” successes now provide libraries, school meals and centres where pensioners can go and read the papers and get coffee at half price before 11 o’clock.
Yesterday, Michael Turner, chairman of the British Beer and Pub Association, made a speech at the Parliamentary Beer Group and BBPA reception in the House of Commons. He said:
“The British pub is the heart of the local community, the envy of the world, and the home of responsible drinks retailing, where not only the sale, but also the consumption of alcohol is supervised. It is a national treasure, and is a key part of our tourism industry.
British beer consists of a wonderful array of traditional and handcrafted ales, together with world famous lager brands. There is a tremendous diversity of colours, flavours, styles, and textures, and there is something for everyone. It is an industry to be … proud of.
Together these two industries employ 600,000 people; … are responsible for duty and VAT of £6 billion; and are part of an industry that makes total tax contributions of £25 billion”.
It would be a tragedy if, when the Olympic Games come to Britain in 2012, our friends from America, Europe, Japan and elsewhere cannot find a decent pub where they can enjoy traditional British hospitality. I hope that the Government will look very closely at the report produced by the Parliamentary Beer Group and act on the recommendations.
My Lords, I guess that it is an unintended irony that that wonderful eulogy in favour of the British pub should precede an intervention by a Methodist minister. I say amen to the sentiments just expressed.
It is no intended discourtesy to the House that I was absent for much of the middle part of the day. The various strands in my life are demanding a lot of me at the moment. I crave the indulgence of the noble Earl and the noble Baroness on the opposition Front Benches for not having heard all that they said. I trust that the fact that I heard 10 consecutive subsequent speeches will be counted to me for righteousness.
I am delighted to play my part at the fag end of these discussions on the Queen’s gracious Speech. A debate it certainly is not; it seems rather a series of reflections on the speech occasioned by various hanging points on which we can put our thoughts. Certainly, it gives us an opportunity to relate fields that we would normally discuss separately. I wanted to consider health and education, but time will not allow me to do that. However, I shall refer to a health issue, largely because it is so topical this week.
I am in my fifth year of membership of your Lordships’ House. During that time we have considered three Bills on assisted dying. A detailed Select Committee report has been produced and other debates have taken place in which I have taken part. The mind of this House has been made clear on each of the occasions that that mind has been tested. If there is to be any further debate, it should happen in the other place, which needs its mind tested, too. I congratulate the Government on specifically stating that this issue has no place in the end-of-life care strategy. We happen to be world leaders in palliative care and there are constantly developments in that area that will redefine the parameters within which we discuss the whole question of care for the dying. I wanted to interject that remark from what would have been a string of remarks about health, had I felt that there was time to pursue both lines of investigation.
Education is where I want to dwell. I say in passing that I do not envy those who are to sum up the debate. I look forward with some eagerness to assessing their skills in commanding the heights of the summits from which people have spoken. We are heading towards the end of this Parliament and health and education will be battlegrounds as people try to get votes from the electorate. A Bill was promised in the Queen’s Speech—it is not a bad thing to remind ourselves of what was said in the pellucid prose—
“to reform education, training and apprenticeships, to promote excellence in all schools, to improve local services for children and parents and to provide a right for those in work to request time for training”.
All of this is subsumed under the words,
“to further improve school standards”.
Who can be against that? Although I must remark that the phrase that purports to address our needs to improve education includes a split infinitive.
I say hooray for what I heard in the Queen’s Speech, but I listened to what I heard and to the interventions that have been made on education in today’s debate with some dismay. I want to share my feelings about that. I am wholeheartedly in favour of much of what I have heard. I have heard in earlier interventions that the Bill that will come before us will make good omissions from the plethora of Bills that have previously preoccupied us. So why am I a little dismayed? I have heard the proposals, and I have taken part in and listened to previous debates, as a school governor and now as the vice-chairman of a foundation trust that administers quite a significant piece of education in two inner London boroughs, Tower Hamlets and Islington. Hearing these things as a school governor, and being aware of the workloads and of the taxed minds of the teachers who have to deliver what we are so wise about, I register a cautionary note.
It is said that the Government need to seek for themselves powers to ensure the delivery of what we decide. That is fair enough. We do not think that anyone else should have powers to enforce pay agreements. We have heard the noble Lord, Lord Dearing, talk about regulatory bodies accountable either to Parliament or to the Minister of State, and the setting up of an independent regulator of examiners called Ofqual—there is a whole pile of those now. There will be the QCDA, a set of initials that you cannot make a suitable memorable acronym out of, which will be a development agency for the curriculum, assessment and qualifications. We have had a summer of misfortunes in the area of examination results, so it is a good thing to tighten that up, and I am sure that the Government must do it. However, on the remark that the Government will seek to ensure that teachers have enough time to prepare for lessons, I wonder whether we have not transgressed into ground that does not really belong to government at all. Indeed, if the Government were not so active in the field of legislation, there would be plenty of time to prepare for lessons.
In the area of local authorities—the noble Lord, Lord Dearing, and the noble Baroness, Lady Howe, said this—holes are going to be filled that were left dug after previous legislation. Good. These are the holes. I understand that the Sure Start children’s centres will become statutory bodies. Let us rejoice about that. There will be an attempt to reform pupil referral units. If they fail or are seen to be failing, local authorities will have powers to intervene in order to achieve those reforms. There will be a strengthening of children’s trusts and an attempt to join up local services, required by law, while children’s trusts boards will be set up on a statutory basis. Once again, with recent events in mind, joining up services in local authority areas is very necessary. Local authorities will also establish young people’s learning agencies, to support them when it becomes time to implement the provisions for 16 to 19 year-olds in 2010 and 2011. All those things will happen and local authorities will have to carry them through.
As a school governor, I dread the thought of yet more sets of guidelines and regulations. To fulfil one’s duties in the voluntary sector we will have to learn them, go on courses about them, give up another evening for them and miss your Lordships’ wise debates in order to be there and not here. I wish that the noble Baroness, Lady Neuberger, were in her place, as she has some understanding of the demands for the delivery of services that, more and more, are placed on volunteers—people who give their time and skills for the administration of various aspects of public policy. I know how hard it is to get a set of governors together for a tough, inner-city school and to feel confident that, around our table, we can give the attention that we ought to the detailed outworking of the plans and policies before us. When faced with something like 30 or 40 pages of closely typed accounts, I feel totally deskilled. I wish that the Minister, who has skills in that area, were doing it in my place and that I were summing up the debate in his.
At local authority level, we will also be bringing young offenders into mainstream education. Again, I can only rejoice about that, but when I think of the demands that have been placed on schools as they have sought to accommodate disabled children and people with mental and learning disabilities, all of which is necessary—I approve of it 100 per cent—it isn’t half demanding. Bringing in young offenders now will create a heterogeneous classroom situation, which will demand such a range of skills and levels of patience, tolerance, imagination—all those things—that I wish more thought were going into what happens to empower teachers and governors who have to take what we lob to them and make something of it.
I could go on, and your Lordships may think that I have. Schools are to be given powers to tackle disruptive behaviour. They are to be given powers to search pupils. Parents are to be given a more streamlined complaints procedure. I look forward to seeing the legislation before us and hearing the debates about it. I am glad that holes will be filled; I hope that that will bring to a complete circle our consideration of education for a while, to let things settle a bit and take the thinking through and to give some attention to the needs of those volunteers who give their time to school governance and those teachers who cope, year after year, with the latest raft of guidelines and outworkings from our deliberations.
My Lords, I will speak on the subject of human trafficking, which causes a great deal of ill health. Those who are trafficked are deprived of their freedom and, often, of the medical attention that they desperately need for the diseases that they inevitably have forced on them. It was therefore reassuring to see reference in the Queen’s Speech to a Bill that will be brought forward,
“to increase the effectiveness and public accountability of policing, to reduce crime and disorder”,
and to include measures to reduce human trafficking.
Human trafficking is a scourge that affects every country worldwide and may produce revenues of as much as $42 billion, which is equal to those of Microsoft and twice those of Coca-Cola. Human trafficking involves the dislocation of men, women and children by deception or coercion for the purpose of exploitation. The International Labour Organisation says that worldwide more than 12 million men, women and children are in forced labour at any given time and, of those, 2.4 million have been trafficked. UNICEF believes that throughout the world a child is being trafficked every 30 seconds. Approximately 80 per cent of those trafficked are women and girls and the majority come from the poorest countries.
The British parliamentary Joint Committee on Human Rights considers human trafficking to be,
“one of the most serious human rights issues in the modern world”.
It outlines varying forms of enslavement, including children being drugged and forced to fight as soldiers, men bonded or chained in labour on mines and farms, women enslaved in quarries and households, women and girls trapped in the sex trade and boys forced to fish in dangerous waters. Save the Children estimates that there are 5,000 children in prostitution in the UK, nearly all of whom have been trafficked.
Anna’s story is especially harrowing. Her nightmare began in eastern Europe when her father sold her into the sex trade when she was aged 18. Alone, frightened and very vulnerable, she was shipped to Italy, where she was kept prisoner for seven months. From there she was smuggled into the UK in a lorry and then transported to London. Her life became a living hell as she became a sex slave and was required to service 30 to 40 clients every day for five agonising years. She badly wanted to plead with her clients for help, but her traffickers threatened to kill her if ever she told anyone. To show Anna that they were serious, they beat her without mercy, breaking her arm, and then raped her repeatedly. Surely some of the clients must have sensed that she was there under duress—but they clearly did not care. Finally, Anna escaped, but she will never escape the haunting memories or the physical and emotional scars, which she will carry for ever.
It is reckoned that 50 per cent of this trade is fuelled by the demand created through adverts in our local newspapers. If the newspapers cannot put their houses in order, surely carefully crafted legislation should be put in place to outlaw such advertisements. Can the Minister comment on this suggestion?
I quote from the story of another young woman. She said:
“Two years ago everything changed. I was trafficked by a man who forced me to work on the streets, beating me up, force feeding me and turning me into someone with no mind of my own. I had become like a frightened rabbit. I was terrified that he would kill me. Death often felt like my only way to escape. But I survived; I escaped and am now working for the campaign entitled Stop the Traffik. Trafficking isn’t a distant crime. It’s right here. It’s on your doorstep”.
Another tragedy concerns a boy of 12 called Masud. His parents were tricked into thinking that their son would have a better life and greater opportunities if he were taken out of his home country of Bangladesh. He was sold to the fastest-growing industry in the world and trafficked to the United Kingdom. He ended up in an Indian restaurant in the south-west of England. He was not allowed to attend school and his life was controlled by the restaurant owners, who forced him to work and then sleep in a small storeroom between the chutney and bags of onions. After 16 years he managed to escape with the help of the organisation Stop the Traffik. He finally managed to obtain a passport, which enabled him to be reunited with his family, free from the traffickers and the cycle of forced labour that had held him captive for so many years.
Then there was the gang of human traffickers, brothel keepers and pimps who received substantial jail terms over the ordeal of a teenage girl tricked into travelling to the UK for sexual slavery. Their Slovakian victim had cried in court as she described spending nearly a year and a half working in prostitution after being lured to Britain at the age of 16 with the promise of a job in a pub. She was sold from owner to owner, raped, beaten and threatened. Six men received sentences of up to 14 years each for what the judge called a “terrible story of betrayal”. The men were jailed for a total of 53 years for trafficking the Slovakian teenager into the UK. The judge said that the teenager, unable to speak English and in a strange country with no friends, would have been in terrible fear of what would happen if she did not co-operate.
Prostitution is on the increase, which may be one reason for the increase in trafficking. A recent estimate suggested that one in 10 men uses women in prostitution. I gave a lecture on this subject in Atlanta, Georgia, at the end of which I was asked whether I had any suggestions as to how these men’s lives could be changed. The people in Atlanta had tried everything—bringing in laws and trying to persuade or shame the men—but nothing worked. I was not quite sure what to say; this was a secular audience. Then I remembered the noble Lords, Lord Griffiths of Burry Port and Lord Roberts of Llandudno—great Methodist ministers. I remembered that John and Charles Wesley had visited Atlanta, Georgia and had had a profound influence on the activities of the people there. I also remembered what a significant change they had produced in this country. People’s behaviour changed dramatically, turning a violent and unpleasant society into a rather wholesome and attractive land. So I left the people at the lecture pondering whether the same thing could happen today.
A reduction in prostitution should lead to a reduction in trafficking. A country’s response to prostitution has a direct effect, first, on the amount of trafficking and, secondly, on where the women practise. In the UK, they are mainly indoors but in Holland, Germany and Italy they are usually out on the streets. In Australia and Holland, the introduction of legislation has not succeeded in bringing prostitution within a safe, regulated environment because unregulated prostitution has persisted and unfortunately those countries have become more attractive for trafficking. However, Amsterdam is taking firm action and is now closing significant portions of the red light district in an attempt to tackle organised crime and human trafficking.
Following an initiative in the United States, the United Kingdom police have tried to reduce trafficking by a different approach to those caught soliciting. They are told that there will be no prosecution on condition that they attend a course of instruction on the abusive nature of prostitution. Alternatively, they can opt to have a summons delivered to their home, which their wife will see. Those who attended this change course came to understand how degrading and abusive prostitution is for the victim. Its effect was a reoffending rate of less than 2 per cent—19 out of 1,400 reoffended.
There have been some encouraging developments in countries such as Sweden, which was the first to criminalise the demand side of prostitution. Those who buy sex are prosecuted rather than those who sell it. The Swedish Government reasoned that prostitution reproduces gender inequality and they wished to promote equality of men and women and eradicate gender inequality. The Government’s ultimate aim is to abolish prostitution altogether. The effect in Sweden is that human trafficking has been significantly reduced. Norway has now taken this approach as well.
In London, 81 per cent of women in brothels are from abroad and it is highly likely that they have been trafficked, which means that most of the activity in these brothels constitutes rape. The Home Office recently piloted a poster campaign with a picture of a brothel and a slogan underneath:
“Walk in a punter. Walk out a rapist”.
Perhaps the Minister can tell us how that excellent campaign is faring.
One may debate whether criminalising prostitution is an infringement on the civil liberties of women in voluntary prostitution and their would-be clients, but there should be no debate at all about those who are not volunteers but are forced into prostitution. In the debate on the Queen’s Speech, the Leader of the House of Commons and Minister for Women and Equality said that the Government’s proposal to criminalise men who pay for sex with trafficked women was needed because the sex industry had been taken over by serious and organised crime. Doubts have been expressed by a senior police officer, who said that the new law would be difficult to enforce, but is that a good enough reason for allowing the bias against women to persist, as it has done for thousands of years? The bias against women needs to be addressed and the Government’s attempt to deal with it is to be welcomed. It will help to reduce human trafficking, which must be eliminated.
My Lords, I apologise to the House for diving in and out all day. I have been attending and speaking at a government conference organised many months ago. I apologise and will not delay the House long.
I pay tribute to the extraordinary speech of the noble Lord, Lord McColl. For three years, from 2002-05, in my capacity as president of UNICEF UK, I did almost nothing but deal with issues revolving around child trafficking—usually child sex trafficking. It changes you; it changes you a great deal as it is shattering. It left me with two overwhelming feelings. I have a problem even saying this but it left me with a kind of disgust at my own sex. Clearly it is 99.9 per cent a men’s issue that must be solved by men. Interestingly half the people who are attempting to solve it are women. This is not something that women can solve; it is an issue that only men can solve. Every Member of this legislature should be involved in seeking the solution one way and another.
The other factor is the economic one. It is a vast business. I have looked at that UNICEF figure many times. Every 30 seconds, a child is trafficked. The other terrible thing is that I came to hate the name “uncle”. The House will be stunned by how much of this ghastly trade is carried out by relatives. The name “uncle” crops up time and again when looking for the perpetrator, the trafficker, the organiser or the profiteer. These are things that we all have to reflect on very deeply. I thought the noble Lord’s speech was marvellous. I am proud to have been here to listen to it.
That was not the subject that I was going to touch on. Noble Lords as old as me will remember that after “Housewives’ Choice” there was five minutes of a story, a hymn and a prayer. I will be speaking for about five minutes, and there will be no hymn and not much of a story, but there is a reflection and a question I want to put to the House and the Minister. We are living at a moment of extraordinary opportunity. One of the disappointments in reading the media in the past three or four months and in looking at a lot of the activity taking place is that there seems to be a feeling that if we could just push things back to the way they were in 2006, all would be well. I do not want things to go back to the way they were in 2006. Much of what was happening in 2006 was rotten. I hope that we can take advantage of the opportunity presented to us to reappraise, reassess and recalibrate what the future might look like.
One word becomes overwhelmingly important. It is “trust”. This is as much an issue for Her Majesty’s Opposition and the Liberal Democrats as for the Government. In politics, we are no longer in a position to afford one scintilla of mistrust creeping out from what we do, the decisions we make or the thinking that lies behind them. Trust has moved from being a desirable aspect of what we do to being the entire ball of wax. For the past 11 years, my job has been visiting schools up and down the country—I have visited more than 400 of them—and engaging with teachers and young people. My question is, from where are we going to rebuild trust? On what basis are we going to create a new relationship with young people? How are we going to help teachers to encourage the children in their care to believe in civil society?
I made a short list as I was waiting to speak. The banks have turned out to be institutions we can no longer trust. I have recently had an incident, which I shall pursue elsewhere, with Barclays Bank, as a result of which I read the FSA’s paper Treating Customers Fairly—Towards Fair Outcomes for Consumers, which was published in July 2006. When read alongside the events of the past three months, that document takes on a Monty Python aspect. There is no relationship between what the FSA believed banks should do and what banks’ relationship with the public should be, and the reality that has unfolded during the past few months.
The police, who have at times behaved in the most extraordinarily intemperate way, as we all know, have done their job in terms of beginning to break down trust. I am not sure that I dare any more to say to a child, “Don’t worry about it. Just go and see a policeman”, and if I say that to a teenager, I get a very old-fashioned look. The media have come up several times in this debate. The media treat trust as a fungible. It is a matter of convenience. The noble Lord, Lord McColl, asked a good question. What do they think they are doing running advertisements when they know exactly what the result of those advertisements is and exactly what they are encouraging punters to do?
So, we cannot trust the media, we are having problems with the police, and we can no longer trust the banks. Thank God for head teachers and doctors, although they survive purely on the fact that their reputations are so strong that they are able to deal with the worst depredations of the media; the media take plenty of pot-shots at doctors and head teachers. What can civil society do? My noble friend Lord Griffiths mentioned that the Government intend to give new powers to teachers and head teachers. They do not really need powers; they need the support of the whole of civil society to create a bedrock from which they can begin to produce a generation of young people who will reject the values of the past five, 10 or 20 even years and build something better. Why? Because the world that these young people will inhabit will be infinitely more difficult than ours. They will deal with problems, such as climate change, that we have barely scratched the surface of. It will be a completely different world. Equipping young people with the agility, flexibility, imagination and courage to deal with that world is an enormous task. It is not a question of giving teachers the powers to do that; it is a question of civil society getting behind those to whom we look to do that and to give them the encouragement, the self-belief and, most of all, the sense that we all know what we are asking of them and that we will back them to the hilt.
My Lords, I am grateful for your Lordships’ indulgence in permitting me to speak in the gap.
CORESS is a private initiative that is shortly, I hope, to become a charity. It was originally conceived by a group of surgeons who are or have been aviators, and is modelled on a successful and well established body in the aviation industry. Its purpose is to receive entirely anonymous reports from surgeons of near misses in their surgical procedures where an accident has fortunately been avoided. The one condition is that there must be no litigation or criminal proceedings. If the condition is met, an advisory panel examines the report and issues its own comments on the case. These comments are then placed in the public domain and the anonymity—or, to use a word that is fortunately not yet in the English dictionary, disidentification—of the surgeon is preserved. This enables the reporter to share his experience with colleagues.
CORESS is still in its early stages, but the feedback is that members of the surgical profession find these shared experiences to be of considerable value. I should mention that CORESS is complementary to the National Patient Safety Agency, the remit of which is to follow up incidents that usually involve litigation; so there is a fundamental difference between the two.
I could not be present for the start of the debate because, as chairman of CORESS, I was hosting a seminar that brought together other near-miss bodies, representing such diverse activities as aviation, to which I have just referred, marine and civil engineering, and outdoor activities such as rock climbing and potholing. I suggest that surgery is a valuable addition to this near-miss culture, for want of a better word, and I hope that the Minister will welcome this initiative when he replies.
My Lords, it has been a fascinating day. The prize for capturing the essence of the day’s debate must go to the noble Lord, Lord Baker of Dorking, and his use of the epithet “mingle-mangle”. He is a poet, so he has an advantage over the rest of us, but he has obviously been deeply psychologically affected by his strict disciplinarian times in the Cabinet of the noble Baroness, Lady Thatcher. Modern Liberal Democrats speak about four things at once, so it is natural practice. Indeed, they normally all speak at once while discussing four things at once, so mingle-mangle is a way of life. I would therefore like to think that I have no difficulty trying to summate a debate of this kind.
The noble Lord, Lord Darzi, started off the debate well by setting out four themes that the Government are trying to pursue, and I shall try to follow them in the course of my short remarks. I have to say, however, that the oxymoron of the debate came from him when he described himself as a humble surgeon. I have never met a humble surgeon in my life, but the more I get to know him the more I think that he might just qualify. It would be an exceptional position for him to hold, but he is an exceptional person and we are grateful for the way in which he started the debate.
I should be careful, however, because the noble Lord, Lord McKenzie, will follow me and therefore has a right to reply. I have come to know and love him over many hours in the welfare reform area of public policy. Recently, when I introduced him at a conference, it came to me in a moment that the noble Lord is the Duracell bunny. He is the long-life toy that never stops. As your Lordships watch Christmas advertising and the Duracell advert comes on the television, you will always think of the noble Lord, Lord McKenzie of Luton. You are welcome to that observation, which is the least he deserves.
This has been an extraordinarily good debate. The conjunction of the four subjects, important policy areas that they are, captures what successful, multidisciplinary modern government should be about. If we cannot as a House look at these things across a broader canvas, how can we expect government to be effective in delivering services? If quality of public services, which was the first test and theme suggested by the noble Lord, Lord Darzi, is to be developed, we have to expect departments to work together in a complex way.
The noble Lord, Lord Griffiths of Burry Port, made a powerful contribution. He said that the disjunction between policy, the legal statutory process and provisions differs a lot in many cases from the practice at the sharp end. We must not forget that implementation of public policy is just as important as the legislative starting point. Legislation has to be right, but even successful legislation can go wrong in its implementation. This House will have to spend more time, if that is possible, looking at some of those practicalities.
We have looked at equality of public services. A number of distinguished speeches captured the importance of that, particularly in public health. All I would add is that I hope that the department and the Government will pay careful attention to the groundbreaking report produced by Dame Carol Black earlier this year, to which the Government have just responded. It weaves so well into the rest of the health agenda that was so ably set out in the Minister’s opening speech.
Noble Lords talked about well-being in a wider sense and said that a holistic, less medical model is the way forward. There were some powerful speeches about worklessness. Well-being in worklessness is one of the easiest ways to get people back into work because their confidence increases. It is not about just the skills agenda, to which I will turn later, it is also about the health support mechanisms that people often need to get them to the starting line of the labour market. We need to introduce this as a result of this Queen’s Speech if we can.
The second theme suggested by the noble Lord, Lord Darzi, was help for the deprived. There were some powerful speeches, including that of my noble friend Lady Thomas. Welfare reform is very important. My noble friend asked some important questions on the deployment of welfare reform. Creaming and parking in some of these new innovative contracts that are just coming through with the flexible New Deal will need to be watched carefully, not because the policy is wrong, but because implementation could hurt people if it is not discharged properly. We need to focus on that powerfully.
The right reverend Prelate made a compelling speech about low pay. The “no pay, low pay” cycle is a very destructive one for households to get into. We have a very bad record of low pay in this country compared to our sister European nations, despite our new Prime Minister who, for all his political life, has tried to make a point about high productivity and higher pay. After even 10 years of our Labour Government dealing with low pay, we have a very bad record. The cycle of people falling out of benefit into low pay, back into benefit, back into low pay, is very destructive on the confidence that you need to get to establish the well-being I was talking about a moment ago.
Another point about the welfare-to-work proposals that was not directly alluded to is the need to support people in work. Once they have a contract of employment even for temporary, low-paid work, employers need support so that they can help their employees need to develop talents and creativity and so get sustainable, fulfilling work. This is something our American colleagues call the ABC—any job, a better job, a career. The acronym describes exactly what the policy needs to achieve if it is to be successful in the long term.
There was some discussion from colleagues about child poverty and the three measures for it, two of which are absolutely relative. They rise as the economy grows, should it ever do so again in the near future. Colleagues often forget that the uprating system used year after year, although unusually not this year, links benefit increases close to price rises but always leaves the benefit community a few fractions of a percentage point behind. Our system of uprating builds in relative inequality and reduces the efficacy of policies designed to deal with child poverty. We need £3 billion in the next uprating statement to get anywhere near the Government’s own target by 2010. That is a serious challenge in the current financial circumstances.
The theme of the speech of the noble Lord, Lord Darzi, was rights and responsibilities. I am not an expert in the area, but the equality Bill is welcome. My noble friend Lady Walmsley made a powerful point when she said that we must ensure that the under-18s are covered by the legislation. She is absolutely right because it is a potentially powerful tool for dealing with multiple deprivation. Such deprivation compounds the problems encountered by households in financial distress. If the Bill is framed properly so that it can be used as a powerful lever, it could help enormously in dealing with the agenda of inequality. I look forward to embracing the under-18s in the provisions of the Bill when we come to consider them.
The provision of personalised services is an important new dimension in the delivery of public services. The older I get, the more I think that a one-size-fits-all policy does not work. The textbook says that you should put a public service in place and assume that everyone is equally capable of taking advantage of it. That is not true because many people in communities with multiple deprivation just do not get to the starting line in terms of taking up some public services. Educated middle-class people always can, and that is good, but I put the rhetorical question: is it safe simply to put provisions on the statute book and assume that everyone will be better off? I am coming to the conclusion that, while it is a hard thing to do, positive discrimination for the disadvantaged parts of our communities in each public service area might be something we look at. If that is what the Government mean by personalised support, I agree absolutely that it is worth trying to achieve such an aim in the short to medium term.
The powerful speeches of the noble Lords, Lord McColl and Lord Puttnam, both strayed slightly beyond the strict agenda of the Queen’s Speech, but were none the worse for that. Trust is something we should all be concerned about, and it is not at all a party political point. It is a reputational issue for the House. Actually, since I joined it, this House has been doing quite well. Perhaps I should not go as far as saying that. However, we can take a leading role in addressing the reputational issue for politics, and indeed I hope that we will do so in the coming year. The year after next will be a political year because there will be an election. In my experience, no one does anything sensible in an election year. We have the next 12 months in which to try to sort out these issues. There is no point in hiding from them.
There is anxiety, unease, uncertainty and fear out there overlying the situation of lack of trust. Democratic politics cannot be practised successfully unless we engage the people we seek to serve. The press are an important part of the problem. We live in an age of very unforgiving media, but we have to work around that. While I would like to put the editorial staff of the Daily Mail in jail, alas the legislation to achieve that might not pass muster with the Human Rights Act. We have to work as best we can to confront the arguments. The noble Lord, Lord Lucas, said that when these things happen you have to stand up and be counted. It is in all our interests to stand shoulder to shoulder when these issues arise and I hope that we will see more of that in the future.
I wish to make one final plea about something which is not mentioned in the Queen’s Speech but which suffuses everything—it is not one of the themes of the noble Lord, Lord Darzi, but maybe it should be—and that is the question of ageing. The issue of ageing arises in the areas of carers, health and so on; it affects the whole public agenda. When the noble Lord, Lord McKenzie of Luton, celebrates his 65th birthday in three years’ time it will be a red-letter day for a number of reasons. He will have reached a significant part of his life—I shall be a couple of weeks behind him—but in 2011-12, for the first time, the number of people joining the 65 year-old-and-over population will rocket; it will increase exponentially. These are the baby boomers; the bulge coming through. We will have had the benefit of being the earning generation and in 2011-12 we will be going into a significantly different phase of demographics.
This will affect the dependency ratio and will mean that fewer and fewer people will be carrying the load of wealth creation. That is why all the arguments and powerful speeches we have heard today about skills, universities, technical colleges and so on are so important. It is absolutely essential that we should establish these facilities right now because, if we do not, we will have to rely on people working to a much older age. Even with his Duracell capacity, we cannot expect the noble Lord, Lord McKenzie, to work indefatigably for ever. We have got to find ways of getting more people actively into the labour market—even if it is only part-time work—for the creation of good health, well-being and wealth at the end of their lives. If we do not address that agenda now—indeed, some would argue that it is already too late—we will put ourselves at risk. The wealth creation ability of the country will not be adequate to meet the needs of the pensions of the noble Lord, Lord McKenzie, and myself, and that would be a serious situation.
It is an important year for the House and the legislation is important. This legislative agenda can be improved and I hope it will be improved. Certainly those on the Liberal Democrat Benches will seek, as they always do, to do that. In the course of his speech, the noble Lord, Lord Baker of Dorking, said that he thinks we should take it more slowly and try to get it right. I think that that is about right as well.
My Lords, this has been a wide-ranging and most interesting debate. It has been well informed and has once again highlighted the real expertise of your Lordships’ House. It is a great privilege to be part of today’s debate.
Along with other noble Lords, I shall draw attention to the thin legislative programme that the Government have unveiled. The Bills announced suggest an Administration who have run out of new ideas. I have heard it suggested that the Government have such a thin legislative programme so that all business can be fitted into what will be a shorter than usual Session.
Today’s debate has been billed as covering health, social affairs, education and culture. The latter topic seems to have been hollowed out. I see that we are no longer getting the heritage Bill to which the Government referred earlier this year, so I am grateful to my noble friend Lord Brooke of Sutton Mandeville for his expertise and knowledge on the topic. I thank him for his thoughtful and well informed contribution. He has vast knowledge that will serve us well in the passage of that Bill.
My noble friend Lord Howe has covered health and the NHS in his usual trenchant manner and has given us all, not least the Government, plenty to think about. He has rather deftly shown how so much of the NHS reform Bill owes itself to opposition ideas set out in the Conservative draft NHS autonomy and accountability Bill, published more than a year ago. My noble friends Lady Cumberlege and Lord Colwyn spoke with remarkable and in-depth knowledge of the NHS and of the strengths and weaknesses of the Bill. I am sure that their contribution to the passage of the Bill will be invaluable in ensuring that it is a much strengthened piece of legislation as it passes through this House.
My noble friend Lord McColl moved the House with his most superb collection of tales of misery and desperation of the sex trade and child trafficking. My noble friend Lord Bridgeman, with his short but important contribution, raised an important issue and I hope the Minister will respond to it.
The proposals in the Bills set out by the Minister fall into two categories. The first category was not so much a new legislative programme but a weary collection of old government announcements raised again, while the second was a wholesale lifting of Conservative ideas. I am pleased that the Minister and the Government accept that the Conservative Party is driving the agenda.
Sadly, due to time constraints, I will speak only briefly on social affairs, a hugely important area that in recent days has attracted a great deal of the public’s attention. I declare an interest as a provider of social care for adults. We were all horrified at the terrible abuse reported in the Baby P case. It was right that we felt angry at the wholesale failings of all the departments and agencies involved with Baby P. Some 282 children died of neglect and abuse between April 2007 and August 2008. Violent, sexual and mental abuse remain a serious area of concern for many children, so plainly lessons must be learnt from this horrible tragedy. The large majority of social workers work incredibly hard, very often with poor and few support mechanisms and workloads that are quite unreal. There are clearly systems to be changed, challenged and better inspected, from local government all the way to the top. Will the Minister follow the call from my honourable friend Michael Gove for the serious case review of Baby P to be made public?
In its bid to tackle child poverty, Labour appears to be heading entirely in the wrong direction. The Conservatives of course support the aim of ending child poverty by 2020 and will support sensible legislation, but so far under this Government the number of children in poverty stands at 3.9 million after housing costs and is effectively unchanged in five years. The Institute for Fiscal Studies has predicted that on current policies the Government will miss their target to halve child poverty by 2010 by some 500,000.
To address poverty we must look at the root causes of poverty, not just the symptoms. The Government have unveiled, to a great fanfare and press leaks, the reform of the welfare system. I am once again pleased that the Government now agree with the Conservatives that the best route out of poverty is work. Along with that come the added benefits of better well-being, respect, aspiration and self-esteem. Perhaps the reason, once again, for the Government adopting Conservative policies that we announced in a Green Paper in January is that, despite having promised welfare reform since 1997 and despite having made over 30 announcements on the topic since Gordon Brown became Prime Minister, the reality is that he and the Government have done nothing of substance to address the increasing numbers of people falling dependent on the welfare state in the last 11 years or more. As always, even with yesterday’s announcement the devil will be in the detail, and we will look very closely at what the Government intend to do.
My noble friend Lord Baker of Dorking speaks with huge authority and expertise on education. He highlighted with passion the need for good quality delivery of vocational diplomas to meet the ever-changing demands of a competitive economy. I am sure we are all signed up to that. I also thank my noble friend Lord Lucas for his analytical contribution. He is well known for keeping his finger on the pulse in all matters that affect young people.
We believe that academies are making progress in raising educational standards, but much more needs to be done. Achievements are welcome and we applaud tangible improvement. However, the Government now seem to be adrift. The signals in favour of the academy programme seem to be lukewarm. Is that because of trouble at the top?
Will the Minister confirm unequivocally that his right honourable colleagues the Prime Minister and the education secretary, Mr Balls, completely support the academy programme? What are the Government’s plans to further roll out the scheme, to build on it and to improve it? Will the Minister tell your Lordships’ House what number of academies are to be built and in what time frame? Can the Minister also say what information the Government are collecting on individual academies’ policies so as to better understand what makes a particular academy more successful than others, and so that best practice may be incorporated into the way others are run?
In a world where we are constantly challenged to be more competitive, knowledge-based and responsive to global as well as domestic demands, what are the Government’s long-term proposals to drive up standards in schools outlined in the Bill? We on these Benches have argued consistently in your Lordships’ House and elsewhere that the key to helping young people get a positive start in life is to equip them for a career and for the job market. Therefore, we need to make sure that young people and children have a rigorous and thorough education and that they have these vital skills from an early age. Too many children and young people do not. Basic numeracy and literacy still remain a huge challenge.
The Government have had more than 11 years, and billions have been spent, but all the tinkering, the ever-changing targets and the continual interference have done nothing more than add frustrations among the teaching fraternity, with good teachers leaving and, ultimately, children losing out. It is too late to wait until young people reach the cusp of adulthood and then fret about what to do.
During the passage of the Education and Skills Bill—now an Act—in the last Session I, along with many noble Lords, argued that all children and young people should be provided with, at the very least, an adequate education but that our aspirations should be to nurture the great potential all young people bring and provide them with qualifications and skills that can stand the rigour of competition in a fast-changing, demanding world.
Are the Government committed to A-levels or not? It appears that the Prime Minister has pledged his support for A-levels only until 2013. Why not after? Will the Minister suggest what the Government might be supporting in 2014 if not A-levels? We on these Benches supported raising the participation age in education and training, although we differed over the methods; therefore, I can welcome the provisions in the forthcoming children, skills and learning Bill which are designed to supplement those measures. It is rather a muddled approach to introduce enabling powers to an Act which has already been passed, but better late than never.
The Minister has told us that this Bill will be introduced to raise school standards. He has told your Lordships’ House that it will strengthen confidence in qualifications by establishing an independent regulator of examinations and tests. We may assume from this that the Government agree with, and have now vindicated, my honourable friend in another place, Nick Gibb, who said last November:
“This underlines widespread concern about the failure of the Government to police exam standards. It reinforces the need for there to be greater rigour in the system ... The fact that half of school leavers are failing to achieve five good GCSEs including English and maths emphasises the need for urgent improvement”.
I am pleased that the Government have finally adopted Conservative policy in this area as their own. Imitation is, as they say, the sincerest form of flattery, but if they are going to make a proper job of it, they must stop the devaluation of exam standards.
We have also been told by the Minister that the Bill will give schools more powers to tackle disruptive behaviour, including powers to search for alcohol, drugs and stolen items. That it is even considered necessary to spell out such powers is a horrific and damning insight into the extent to which poor discipline and outright threatening behaviour occur in some schools.
As I said previously, we on these Benches have long argued that a good education can be imparted only in a safe and respectful environment. That the Government recognise that there is a problem is welcome, but will not the Minister agree that head teachers should be allowed to conduct the business of educating their pupils in the best way that they, in their professional opinion, see fit? Head teachers must be able to exert discipline over their schools for the safety and well-being of staff and pupils alike, and ultimately be allowed to exclude disruptive and abusive pupils without fearing a weak appeal system that undermines their decisions.
Many noble Lords here today, my noble friends among them, have eloquently set out the shortcomings of current education practices and suggested imaginative and realistic ways to remedy them. The recently published Rose report was certainly imaginative, but I am afraid that I do not agree that it is in any way realistic. The way to drive up standards throughout the schooling system is not to sweep them away altogether for the very youngest. I do not agree that children will receive a better grounding in all the essential skills if subjects as we know them disappear. The report’s proposal to introduce themes through which children will gain knowledge of the world is wrong-headed. For example, to suggest that happiness lessons could be taught is to look at education in the wrong way. The happiness and well-being of the pupil are of course fundamental to their enthusiasm for learning, but that should be a description of the atmosphere of the classroom, not the subject which is being taught. My honourable friend in another place Michael Gove has said:
“The move away from traditional subject areas will lead to a further erosion of standards. This kind of ideology failed 40 years ago”.
I would welcome the Minister’s opinion of the report, because we do not have the time or the luxury to experiment with the education of our children.
The Bill is an implicit recognition by this Government of the mess that they have made of skills funding. They have restructured the system three times since 2001 and are now replacing one cumbersome bureaucracy with three. Without proper support mechanisms in place, the aspiration to offer an apprenticeship to anyone who wants one will remain that: an aspiration. The Government need to look carefully at their approach, which has created a bureaucratic mess and a shortage of quality apprenticeship places. What plans will be put in place to ensure that apprenticeships will be open also to disabled people, and what provisions will be made for them?
There has been no progress on university participation. Despite spending about £800 million on widening participation, it seems that the Government will miss their target of having half of young adults in university by 2010. At current rates, it may take a century to get to that level. Is this because the Government no longer believe that the policy is a good idea, or because they have run out of steam and fresh ideas are needed to see through their pledges?
How many students will lose out as a result of the recently announced cuts to student grants? How can Mr Denham in another place expect universities to spend money that is only temporarily available as a result of VAT reduction when they will face higher costs in NI contributions? Surely, the problem that most people will face in these turbulent times is reskilling, but the Government are insistent about cutting £100 million of ELQ funding. Will the Minister clarify the Government’s position?
I could go on, but I will conclude by drawing an end to this excellent debate and to a whole week of excellent debates. I would like to give the Minister plenty of time to address all the issues that your Lordships have raised.
My Lords, this has been a wide-ranging, knowledgeable and indeed compassionate debate and I would like to thank all noble Lords who have participated. We have covered the affairs of five government departments, including the DWP, my own, which between them account for more than half of all government expenditure each year and touch the lives and affect the life chances of every individual in our country—from the cradle to the grave, as it were. I am bound to say to the noble Baroness, Lady Verma, that it does not sound like a thin programme that we are dealing with here. I hope that noble Lords will forgive me if in the time available I do not respond to all the points raised, but I will cover as much as I can. I will start with issues around health.
My noble friend Lord Darzi explained that the Bill that we will debate will ensure the highest possible standards of care and give more power to individuals to shape the care that they receive. It is about driving up the quality of health services through a duty to produce new, quality accounts. I believe that the thrust of that was welcomed by the noble Earl, Lord Howe, and I thank him for his response. Incidentally, on the issue of recession and what that means for health, I understand that his colleague in the other place opined that recession was good for people's health. I am not sure that the noble Earl shares that view. However, I am delighted for his support on behalf of the Opposition and other noble Lords for the NHS constitution. I was interested to hear that the views of the noble Baroness, Lady Cumberlege, on the constitution were somewhat at odds with that and disappointing given that its development involved a thorough consultation with staff and patients, unlike the Patient’s Charter. I do not think that words such as “sad little document” are appropriate in this case.
The 60th anniversary of the NHS is an opportunity to put in place an enduring constitution that safeguards the future of the NHS. It reaffirms our right to NHS services free of charge and provides an opportunity to reaffirm the core values and refresh them for the 21st century so that they provide a basis for a modern, forward-looking NHS. A number of eminent people and organisations support the NHS constitution.
The noble Earl, Lord Howe, talked about tobacco. Contrary to what the noble Earl suggested, evidence from a number of countries shows that removing tobacco displays could reduce the likelihood of young people taking up smoking and support those people who want to quit.
The department is committed to reducing mixed-sex accommodation to an absolute minimum and single-sex accommodation should be the norm in elective care and remains the ideal for all admissions. It is not the case that local authorities are failing at LINks. Local authorities have been under a duty since 2008 to ensure that LINk activities can take place where it is taking longer than expected to establish the LINk itself. Strategic health authorities across the country will be working closely with their local NHS and local authority organisations, ensuring awareness of the new duty and supporting guidance.
I am grateful for the input of the noble Baroness, Lady Barker, into this debate and in particular for raising the important issues around the links between recession and health inequalities. Indeed, that feeds into the views of her colleague the noble Lord, Lord Kirkwood, about health and well-being and the causes of unemployment and how it all fits together. Narrowing health inequalities is a top priority of this Government. We have put in place the most comprehensive programme ever in this country to address them. For example, we are closing the absolute gap on cancer and cardiovascular diseases. Not only have mortality rates come down in our most disadvantaged areas, they have fallen faster than in the rest of England.
We are not cutting NHS resources. Despite concerns about the need to become more resourceful, the recent 2009-10 and 2010-11 revenue allocations represent a £164 billion investment in the NHS. PCTs will receive an average increase in funding of 5.5 per cent in 2009-10 and 2010-11, a total increase in funding of £8.6 billion.
The noble Earl, Lord Listowel, in a typically thoughtful speech, raised issues and concerns around the need to support staff, particularly those working in mental health with drug abusers and the young homeless, and the importance of carers and the role of health professionals. I shall write to him about the statutory issues he raised on health visitors.
My noble friend Lord Warner acknowledged the scale of investment in the NHS in the past decade, and our clear vision towards quality improvement, stating that we must focus on stroke services and end-of-life care. I thank him for his support for the NHS IT programme, and the major changes it is delivering in providing enhanced accuracy and speedier X-rays through the development of picture archiving and communications. I also thank him for his support of choose and book, which provides patients with a choice of healthcare providers. Patients and clinicians are now beginning to see the benefits that these systems bring to improving patient care.
My noble friend Lord Brooke of Alverthorpe made an interesting contribution and displayed great knowledge about issues of drug and alcohol addiction. He raised a number of detailed points that I will pass on to my noble friend Lord Darzi. The new drugs strategy, covering 2008 to 2018, Drugs: protecting families and communities, builds on the success of its predecessor with a renewed emphasis on elective treatment, supporting drug users in fully reintegrating into their communities through access to housing, education, training and employment. We have invested over £50 million in new capital moneys to expand capacity and support better commissioning of the main abstinence-based activities: residential rehabilitation and in-patient detoxification.
The noble Lord, Lord Colwyn, raised issues within the dental profession. While we acknowledge that there are problems in NHS dentistry, it is in fact growing. The latest statistics show that there were 655 more dentists working in the NHS this year compared to last year. PCTs report no shortage of dentists coming forward when new contracts are offered, in contrast to the situation under the old contract. On the noble Lord’s point about whether the NHS Bill will impact on dentistry, the rights in the NHS constitution will apply for dentistry as for other services.
My noble friend Lord Harrison spoke about the negative public perception of the NHS compared to their personal experience, but it was necessary to concentrate, as we have, on greatly increasing investment and quickly tackling serious problems such as unacceptably long waiting times given the state of the NHS in 1997. These quantitative measures were often mistaken for ends in themselves. We are now free to concentrate on the things that we value most: quality, dignity, control and choice. We hope that perceptions will therefore change. My noble friend spoke also about services for, and care of, children with diabetes. We recognise that these services are variable, and are addressing the problems. The national clinical director at the Department of Health is leading a group taking forward the recommendations of the working group that looked at these issues.
On education, I start by thanking the noble Baroness, Lady Howe of Idlicote, for inviting me to expand on the contents of the children, skills and learning Bill. As has been mentioned, the Bill will allow the Government to continue the next phase of reform and underpins the historic milestone that they have achieved by successfully gaining Royal Assent to the Educations and Skills Act, raising the participation age to 18 come 2015. As the noble Baroness set out, there will be, for the first time, a statutory basis for children’s centres that will, as she asks, allow us to place a duty on local authorities to ensure that there are sufficient children’s centres to meet need.
The noble Baroness pointed out that changes are being made to the way in which early education providers are funded. I am sure that her knowledge of the detail is greater than mine. I shall ask colleagues to write to her on that matter. The legislation is a technical change to the way in which early years provision is funded in order to underpin the aims of the single funding formula. It will enable us to level up the playing field to some extent between maintained and PVI providers and to fund them using one regulatory framework. As she will know, since September 1997 there has been an expectation that secondary schools will work in behaviour and attendance improvement partnerships. Partnerships are based on the principle that by sharing resources and expertise, and by sharing out hard-to-place pupils across partnership schools in an equitable fashion, greater progress can be made towards reducing permanent exclusions, tackling low-level behaviour problems and reducing persistent absence. Early evidence from pilots is positive, with some local authorities reducing permanent exclusions to zero since 1997.
The Government remain committed to informal adult education. We spend £210 million every year on this learning and have conducted a wide consultation on it because we recognise the enormous contribution that it makes to the quality of life, health and well-being of individuals, neighbourhoods and wider society.
The noble Earl, Lord Listowel, made interesting comments about the importance of social workers and the need to ensure that we attract the brightest people into this field and promote their status. We have an ambitious programme of work in place. The Government have committed £73 million up to 2011 to address some of the underlying issues around status. Today we announced the establishment of the social work task force, which will consider this work and where further developments can be made. Within this work, we are strongly committed to a workforce that has the skills and abilities to deliver effective services. The social work task force will make recommendations on how to drive forward long-term reform of social work training and will, of course, work closely with stakeholders in so doing.
The noble Baronesses, Lady Massey, Lady Walmsley, Lady Howe, the noble Lord, Lord Dearing, and the right reverend Prelate the Bishop of Ripon and Leeds referred to what the children, skills and learning Bill will do to transfer responsibility for the education of young offenders to local authorities where the young person is in custody. I can inform them that we are going beyond this. The Bill will bring young people in custody under the remit of the wider education legislative regime, including the Education Act 1996. Our aim is to ensure that education in custody meets those young people’s needs and, so far as is practical, matches that available for young people in the mainstream education system.
My noble friend Lady Warwick of Undercliffe asked me to explain what we mean by “suitably qualified” in relation to apprenticeships. The qualifying criteria will be five GCSEs at A-star to G, or equivalent, plus functional skills in English and mathematics at level 1 or above. I stress that the Government are committed to making it as easy as possible to progress from apprenticeships at level 3 and level 4 into higher education. The Learning and Skills Council and UCAS have recently completed a pilot to arrive at a points allocation for qualifications within engineering and IT frameworks and to develop a methodology for attributing points to each element of the framework. I confirm that the right to time off to train will extend to requests for time off to participate in higher education.
I applaud the undertakings of the noble Lords, Lord Dearing and Lord Baker, to establish university technology colleges. I assure the noble Lord, Lord Baker, that the measures in the Bill are not about a return to a pre-1992 world of local authority control of colleges. Colleges will remain autonomous institutions from which local authorities will commission 16 to 19 education and training. These reforms provide an opportunity for colleges to be part of a more integrated approach to children’s services led by local authorities. Commissioning is not about control, and local authorities will not be responsible for performance managing colleges. The Skills Funding Agency will have overall responsibility for performance management, which will be light touch and built around the framework for excellence. College and provider performance will be monitored on an ongoing basis through minimum levels of performance.
The exception will be colleges that join the newly-designated sixth form college sector. These colleges will continue to be independent institutions but will be performance managed by their local authorities. Nor will this change lead to a diversion of resources away from colleges. The Bill will give local authorities a duty to secure sufficient education and training of a suitably high quality for 16 to 19 year-olds in their area.
I welcome the comments made by the noble Lord, Lord Dearing. He is right that we need to learn lessons from the past and make arrangements to deal with problems between the bodies. I am sure that the noble Lord could provide some valuable insights to those involved in setting up the new arrangements and in this engagement. I reassure him that we are not recreating past problems, which he helped to resolve. Ofqual’s role will be to regulate standards, not to have a view about the details of the curriculum that might be in conflict with the new agencies.
The noble Lord, Lord Baker, referred to the teaching of diplomas. I say to him that the teaching of diplomas is still in the first term, but already we are receiving extremely positive feedback that learners and staff across all the schools and colleges involved are excited by the chance to engage in the new style of learning. As he will know, diplomas are strongly supported by industry bodies, including the British Chamber of Commerce, the Federation of Small Businesses and the Institute of Directors. The noble Lord, Lord Jones, talked about the decline in sports activity in schools. The 2008 school sports survey showed that 90 per cent of pupils were participating in at least two hours of high-quality PE and school sport a week. In 2002, an estimated 25 per cent of pupils were doing two hours of high quality PE and sport a week, so significant progress has been made.
My noble friend Lord Griffiths referred to coming in at the fag end, which I think was his expression. Given our discussion about tobacco earlier, that was perhaps appropriate. He and the noble Lord, Lord Lucas, referred to concerns about pressures put on teaching staff by change and the challenges for governing bodies. The Government share the concern of people who work in schools that they should spend as much of their time as possible on key activities that support teaching and learning and should not be diverted into unproductive bureaucracy or tasks for which teachers are not well suited.
The noble Baroness, Lady Verma, asked about the Government’s commitment to academies. The Government are fully committed to academies, as are both the Prime Minister and the Secretary of State, Ed Balls, and we are committed to a programme of establishing at least 400 academies nationwide.
My noble friend Lady Pitkeathley commented significantly on the role of carers in our society. A forthcoming Green Paper on carers will explore the options for the long-term funding of the care and support system, which will support both carers and those in need of care and support. The noble Lord, Lord McColl, in a moving but harrowing speech, pressed me on questions about what we can do in legislation to address the terrible problems that he highlighted. That is beyond the remit that I have before me today, but I know that it is an issue that particularly concerns the Leader of the House in another place, and it is being addressed. There are issues around access to healthcare for those who have been human trafficked. Perhaps I may write to him on that.
My noble friend Lord Puttnam posed an even greater challenge about what we can do to restore trust in society. Many and varied things can move us from where we are. In this debate, I hope that we will not lose sight of the fact that there are many people out there, including young people, who are connected with society and who engage in a range of highly productive activities. Those activities are focused on progressive campaigns, which engage them whether they are about climate change, health or diversity issues. However, I accept that there are still challenges to meet and agree with the noble Lord, Lord Kirkwood, that as politicians we perhaps have responsibilities to lead the charge on those.
Moving on to DCMS, my noble friend Lord Macdonald raised the disparity between the TV produced in Scotland, Wales and Northern Ireland compared to England. We recognise the importance of programming produced in and for the nations and regions of the UK, which is good for viewers, regional economies and cultural diversity. Much of our best TV comes from the nations and regions. In the Digital Britain project that the noble Lord, Lord Carter of Barnes, is taking forward a key work-stream is provision in and by the nations, regions and localities of the UK. We shall be assessing the impact of the policies on all parts of the UK. My noble friend also asked about ITV crowding out TV companies in the nations, which is fundamentally a matter for Ofcom; however, ITV is a major contributor to public service and has a commitment to regional programming, particularly news.
The noble Lord, Lord Brooke of Sutton Mandeville, and the noble Baronesses, Lady Bonham-Carter and Lady Verma, asked about the heritage protection Bill. As noble Lords will be aware, all Bills have to compete for parliamentary time and we expect discussion on priorities. However, the Government remain committed to that legislation. The heritage protection Bill is in a good state of readiness for introduction and will be brought forward as soon as parliamentary time allows. The cultural property (armed conflict) Bill is also in a good state of readiness to be introduced, and the Government are again committed to that at the earliest opportunity. We are also working towards a government statement on the value of heritage, something for which we know that sector has called for some time. It will state the Government’s vision and priorities for the historic environment, and will properly capture its value across government in the widest sense. We will publish a draft document for consultation next year.
The noble Lord, Lord Thomas of Swynnerton, spoke on the legacy of the Olympics and the nature of the opening ceremony. London clearly has a great opportunity to deliver its celebrations differently, but we are some four years away and detailed planning of those ceremonies has not yet begun. London’s celebrations will reflect our values and be uniquely British; we will, doubtless, take up his points. The noble Baroness, Lady Bonham-Carter, stressed the importance of the creative industries and the creative economy. I absolutely agree. They have an important role in employment, exports and economic growth. On the importance of culture in schools, I simply invite the noble Baroness to come to the Luton schools music service. They do some fabulous stuff there and bring together a range of diverse provision, given the nature of our town. I am sorry to have slipped that plug in.
Briefly, on the DWP—and I am aware that the clock is against me—as my noble friend Lord Darzi outlined, we have modernised the welfare state and, notwithstanding the current economic challenge, delivered high and stable levels of employment, reduced the numbers claiming out-of-work benefits and put an end to the remorseless rise in the number claiming incapacity benefit. A key component of that was raised in the point made by the noble Lord, Lord Kirkwood, about Carol Black’s report and its focus on health, work and well-being. I note again those connections between employment, well-being and health.
The right reverend Prelate the Bishop of Ripon and Leeds and my noble friend Lady Massey asked whether the child poverty Bill will include an interim target. No, the commitment is to eradicate child poverty by 2020. We will, of course, need milestones along the way and are considering the right mix between fixed points in primary legislation and flexibility in interim steps. The right reverend Prelate asked whether the Government will affirm our commitment to eradicate all poverty and social exclusion. We need to distinguish between aspiration and our practical priorities, which are the eradication of child poverty, sustained action against pensioner poverty and welfare reform to help those of working age into the labour market who are at the greatest disadvantage. These appear to us to be the most effective ways to combat poverty and exclusion.
My noble friend Lady Massey asked about the indicators of child poverty. These are essential elements in the well-being of a child, and it is our intention to consult shortly on the exact content of the provision in the child poverty Bill. The essential commitment is to enshrine in statute our ambition to eradicate child poverty by 2020. My noble friend also raised again the issue of carers, in particular the role of grandparents. Perhaps we can discuss that outside. One of the good things that has happened in particular has been changes to the basic state pension, whereby it is easier for carers to be credited national insurance contributions by needing only 30 years of contributions to receive a full basic state pension,
The noble Baroness, Lady Thomas, asked about safeguards in the welfare reform Bill. We agree that during the Bill’s passage and under the specific regulations thereafter we must and will have a proper and full debate on sanctions and how they are to be applied. She asked about the housing benefit review. It is due to conclude and report to Ministers at the end of the calendar year. On the migration of IB to ESA, the intention is to transfer all existing IB claimants to ESA between 2010 and 2013. She asked also about resources for Jobcentre Plus to cope with current circumstances. We were allocated an extra £1.3 billion by the recent PBR, more staff have been taken on and there are other issues which time does not permit me to deal with effectively.
The noble Lord, Lord Kirkwood, was absolutely right to raise issues around the ageing society. It is a key issue for us and impacts on a whole range of policies—pretty much everything that we have been discussing today, including health, welfare, benefits and certainly pensions. I promise to do my best to look after pensions for the noble Lord. The statistic is that in 2050 there will be two people in work for every pensioner. Currently, there are about four for every pensioner.
The children, skills and learning Bill will have at its heart the importance of ensuring that all children and young people realise their potential. It will ensure that local authorities have the tools to make a reality of the legislation, raise the participation age to 18 and establish an apprenticeship place for every suitably qualified young person.
The health Bill will rigorously focus on quality and put in place an enduring constitution to safeguard the future of the NHS. It will give powers to patients and the public by bringing their rights together in one place, and it will balance these rights with new responsibilities.
Our welfare reform Bill, together with the White Paper published yesterday, will complete the transformation of the welfare state, turning it from being essentially passive to profoundly active. It will support more people into work, provide greater support and control for disabled people and strengthen parental responsibility. The child poverty Bill will enshrine our commitment to ending child poverty.
Taken together, the Bills are a manifestation of our common purpose—a purpose based on rights, but responsibilities also—and ensure that no one is left behind, no one’s potential is disregarded and that all should have the opportunity of a fulfilling life. I commend this programme to the House.
Motion agreed nemine dissentiente, and the Lord Chamberlain was ordered to present the Address to Her Majesty.
House adjourned at 5.54 pm.