My Lords, about a year ago, I was talking with a midwife about the safety of maternity services and I asked her what she thought about the proposed increase of choice in maternity services. She answered that she supposed that it would be all right, “provided the mothers choose in the right way”. Her answer is amusing but it also hits a nail on the head: choices have consequences and, in maternity care, poor choices can endanger mothers and their babies. More generally, choices in public services have systematic effects on equalities and inequalities.
Yet we can see high enthusiasm in both political parties for introducing greater choice in public services, and the public endorse that. Many of the more established arguments for greater choice have stressed the supply side. The complaint has been that monopoly providers fail service users, be they patients, parents, pupils or others. The hope has been that choice by service users will empower them, incentivise all providers to do better and sanction the worst providers. Ideally, on this argument, everyone gains except the inadequate providers—and that is all right.
However, these are not the only effects of increasing choice. The more obvious effects are on choosers, not on the chosen—on the public, not on providers. Choices will differ and the subsequent experience and opportunities for those who choose variously will also differ. A child who gives up science early will, of course, not become a distinguished engineer and will not contribute to the innovations that the noble Lord, Lord Broers, stressed in the previous debate. Someone who chooses to smoke will increase their risk of illness and earlier death. These very obvious features of choice suggest that we should expect choice in public services to lead to varied inequalities.
We therefore have to decide which choices matter and should be protected and which equalities matter and should be supported. Inevitably, protecting some kinds of choice will produce inequalities. If individuals are free to choose to work long hours or to pursue the fabled work/life balance, then working hours, earnings and leisure are likely to differ between those who choose differently. Some inequalities will be judged fair because they reflect fair processes and differing choices. In others, we judge equality as more important than choice. For example, we do not allow individuals to choose not to pay the same tax as others in like circumstances.
As we stand on the threshold of new and integrated legislation on equality, we need to aim for a coherent combination of liberties and equalities. In its December 2008 report, the Government Equalities Office stated that the forthcoming Bill will,
“address the disadvantage that individuals experience because of their gender, race, disability, age, sexual orientation, religion or belief”.
Read at speed, this can sound reassuring. It sounds like a commitment to strengthen anti-discrimination, which both protects certain choices and secures specific equalities, above all equality of treatment. Certainly strengthening and integrating anti-discrimination legislation is one central aim of the proposed Bill.
Anti-discrimination legislation seeks to prevent discrimination on irrelevant grounds. However, it also requires discrimination on relevant grounds. Anti-discrimination legislation, for example, requires employers to discriminate on the basis of relevant skills and experience, both in making job offers and in promoting; it requires universities to discriminate among applicants on the basis of relevant preparation and competence.
However, a great deal of discussion around the Bill is not about prohibiting discrimination on irrelevant grounds but about achieving what is called a more representative social and ethnic composition within each line of employment or each profession, or among students or holders of public office. This is well documented in the numerous so-called fact sheets published by various government departments and other public bodies. Groups of employees, students or office holders would be seen as representative when their social composition—judged, one must admit, using sets of categories with considerable deficiencies, but I leave that problem aside—mirrors that of the larger society.
The attraction of focusing on this statistical equality is presumably that it looks like a way of reconciling choice with equality provided that, as the midwife put it, the people choose the right way. But people do not. In a diverse population, choice leads to different outcomes for individuals and for groups. So a question that we shall face in debating the equality legislation is whether a quest for more representative cohorts of employees, students and office holders is compatible with prohibiting discrimination on irrelevant grounds. Is this very abstract statistical equality—equality in the social composition of groups—compatible with genuine commitment either to choice or to substantive equality for the individual members of those groups? The reality is that trying to secure a representative composition within each group neither respects choice nor furthers equality for individuals.
Let us consider for a moment that overworked issue, choice of secondary school by parents. It is said that middle-class parents, being better placed to choose, will choose better schools and—a quite separate point—will be more likely to get what they choose if there is a scarcity. Let us suppose that a particular area has one good and one bad school. Public policy could prohibit choice and avoid the unrepresentative consequences of choice by random allocation of children to schools. As noble Lords will know, that has been proposed in certain places. This would ensure that the social and ethnic composition of each school is representative of the area that it serves. However, achieving this outcome would not in itself increase equality for children; just as many children as before would attend a bad or a good school.
Even the supply-side argument is more promising, for, according to it, parental choice will put pressure on poor providers, so ensuring that in the long run fewer children attend a bad school. A quest for representative outcomes neither respects parental choice nor secures greater equality of schooling for individual children. A preoccupation with representative participation focuses on one very abstract equality at the expense not only of choice but of substantive equalities that matter to individuals.
There are many telling cases where a quest for representative outcomes furthers neither choice nor equality for individuals. For example, secondary schools in England allow an unusually high degree of subject choice. This is, of course, likely to increase with the proposed proliferation of sixth-form qualifications. Those applying to universities and later for employment will have chosen different subjects; they have the choice. The cohorts of applicants for specific courses are not likely to be representative of the population at large. Diversity of culture, background and interests is quite understandably reflected in diversity of interests and ambitions and so in diversity of choices and, down the road, in diversity of fitness for and choice of specific types of courses and employment.
I remember noting over many cohorts of students applying for admission in Cambridge that students from some minority ethnic backgrounds were particularly keen on professional or pre-professional degrees and, correspondingly, rather more reluctant to do any other degrees. One result was an unrepresentatively high number of students from these minorities in professional degrees, presumably to be reflected in the future composition of the relevant professions. Should we worry if some professions have an unrepresentatively high or low number of practitioners from certain backgrounds? Should we seek to correct for choice by preferential admissions—for example, by admitting non-minority students and students from other ethnic minorities on the basis of lower achievement—or should we respect choice and provide equal treatment for diverse applicants by continuing to select only on relevant criteria?
Student choice and fair process—that is, equal treatment on the basis of relevant criteria—are vanishingly unlikely in themselves to produce representative cohorts of qualified students and professionals in each degree, university or profession. In a diverse society, fair treatment cannot produce representative outcomes.
Another case in which choice has led to less representative results can be found in the study of languages in schools in England. Since the abolition of the GCSE modern language requirement in 2004, the proportion of pupils in maintained schools who take a modern language beyond age 14 has fallen. After four years, by 2008, the total number studying French at GCSE had declined by more than a third, from 318,000 to 203,000. This was not compensated for by a very modest numerical rise in some other languages.
The decline has, of course, been uneven. There were 27 schools in England where no pupils took a GCSE in any modern language in 2007. Meanwhile, pupils in independent schools, whose parents presumably saw career and cultural advantages in speaking other languages in a globalising world, have chosen to study more languages for longer. This has altered the representation of pupils from maintained and independent schools on language degrees; it is likely to alter their representation in many lines of employment. So here, too, choice is going to lead to less representative results.
So far, the Government’s response has been to encourage language initiatives in primary schools and to promote languages, hoping to nudge, as we now say, the choices that pupils make. However, if we really want more representative outcomes, we would do better to reinstate the GCSE language requirement and teach languages better, rather than trying to nudge the choices that pupils make in the forlorn hope that they, like their mothers, will end up making the right choices. That, of course, would produce equal representation of all groups among those studying languages.
It is worth asking whether representative participation is an important social aim for which we should be prepared to sacrifice both choice and other equalities. Perhaps the best case that can be made for it is that it matters for policy-makers who are looking at participation levels for some benefit or activity that is expected to be universal. Here population-level evidence is, I think, useful. For example, the United Nations Development Programme looks at the relative proportion of boys and girls in primary education in different regions. However, from the point of view of the little boy or girl who loses out, it does not really matter whether boys or girls are doing better in their region—they have lost out. Public health policy-makers also need to look at the social composition of those who do not receive immunisation. However, information about the unrepresentative composition of the group of children being immunised is, frankly, of little value to the children who lose out or to their parents. What matters to them is substantive equality of treatment.
There are many other choices and equalities that could be used to illustrate these issues. I believe that my noble friend Lord Krebs will say rather more about some of the public health issues. The educational examples that I have mentioned suggest to me that there are many ways in which we can seek a coherent combination of choice and equality for individuals, but we cannot coherently aim to secure what is called a representative participation in all lines of activity without restricting either choice or equality for individuals, or both.
I hope very much that the Minister will be able to reassure the House that the Government’s aim in bringing forward the single equality Bill will be to eliminate discrimination on irrelevant grounds and correspondingly to require discrimination on relevant grounds rather than pursuing the will o’ the wisp of securing representative equality, which is achieved either by restricting choice or by neglecting substantive equalities. I beg to move.
My Lords, it is a formidable task to follow the noble Baroness, who has a distinguished career as a philosopher, when I am a mere economist. But since economists have sunk capital into the notion of choice, I thought that I had better speak in this debate. Before I go any further, let me say that a House of Lords that can hold two debates—one on climate change and one on the level of inequality—is a House of Lords worth preserving.
The noble Baroness raised so many questions that I have a problem sorting myself out. She tried to say that choice per se in a diverse society may lead to inequality. The choice that mothers are likely to have may lead to problems because they may not make the right choice. She then said something very cogent, with which I agreed quite a lot, on the notion of representative uniformity. To go for a representative target using certain broad classifications of gender, race, or whatever, is not likely to be helpful in achieving the goal of equality which the Government have set themselves. Along the way, she made a number of other cogent points.
With regard to the bare bones of Economics 100 notions of choice, given that the distribution of endowments may be, and often is, unequal, economists would argue that, given choice, each person can move to a better position than what the initial endowment gives them. Inequalities are not altered very much by that, if at all, but the level of individual satisfaction or utility is enhanced thereby. That is all that economists ever say. One of the questions about the notion of equality is the end-state that we want to achieve. By what measurable or at least comparable indicator would we judge whether we have achieved equality?
What struck me about British society when I arrived here 44 years ago was the strong notion—partly due to the influence of the Second World War, a very egalitarian experience for a very unequal society—that uniformity is equality. In the field of education, which I know something about, a lot of debate around equality in the choice of subjects and schools is hampered by the fact that people do not discuss the prior condition that career paths are very narrow and very few. We all take it for granted that the only high road to advancement in life is GCSEs, A-levels, university and onwards. If that is the only path involved, certain comparisons are indicated. The first would be to question the narrowness of the path. Why should there be only this path?
The noble Baroness gave an example, which I cannot recall exactly, about how a child will never become an engineer if he or she does not do mathematics at school. That would be astonishing to an American; in America there are other paths to becoming an engineer if you have not done maths at school. Why should children be locked in? In our search for equality, we have to examine whether the structures we have set up, which are an inheritance from the past, are too rigid.
Very few universities and other higher education institutions give a choice. The whole debate about working-class children going to Oxford or Cambridge is, in my view, futile. The point is not that a working-class child should go to Cambridge, Oxford or the LSE but that he should go to where would suit him the best. That may not be Oxford or Cambridge; it may be a further education college, a higher education college or a polytechnic. It may even be that if a child went to Oxford or Cambridge, that child would be stunted because he would have been much better off going to Essex, Warwick or Southampton.
We have to change our notion that there are right royal roads, and only a few of them, to advancement. We have to allow society to open up and create alternatives. The end-state should be that each person—each child—should achieve the maximum they can. Since that maximum is not achieved at the age of five, 11 or 18, we must constantly offer them choice across different facilities and types of education. We must do that even for mature students and late developers, because you never know when somebody might develop—it might even be at 80 or 90. We are talking not just about an individual’s choice on given subjects. Society has first of all to ask whether the number of alternatives we offer is not too limited to begin with, thereby reinforcing inequalities.
The noble Baroness made other cogent points on representative equality which I entirely accept. There is great debate today about reserving jobs in government or places in higher education institutions for people who are deprived by social origin. Again the question is: should you judge an individual by membership of a certain category—you cannot avoid being a woman or black, for example—or should you judge individuals qua individuals? It is often the case that one member of a community which is on average deprived may be less deprived than another member of a community which is on average better off. Therefore, we do not want to subject people to a community label. Most importantly, when women are assigned to communities—a woman can be described as a Muslim or a Hindu, for example —it may often lead to greater disadvantage than if one just treated the person as a person, because the Muslim or Hindu society in question may have its own forms of discrimination which we may want to overcome.
The subject of our search for equality is the individual; it is not communities. We go by communities because they are rough indicators of where discrimination lies, but we have to remember that the subject is the individual and the end-state is how well the individual achieves the maximum potential that he or she can. The measuring of maximum potential may lead to problems, and involve categories such as happiness or income, but we have to be absolutely clear that in searching for equality, we do not restrict either the subject of our search or the end-state by which we define equality. In both, choice is crucial.
My Lords, it is challenging to follow such a distinguished philosopher as the noble Baroness, Lady O’Neill, in her forensic examination of what choice means and does not mean, and no less challenging to follow an—albeit self-styled—“mere economist” such as the noble Lord, Lord Desai, in his economic views on an area where, as he said, the economic profession has sunk so much capital. I wish rather to approach this debate from my own personal beliefs, which underpin my political beliefs. I apologise for introducing politics into the debate. I hope that it will not be judged as the equivalent of spitting in church. I intend merely to clear my throat on the issue.
I very much agree with the noble Baroness when she states in her press release from the British Academy—it is the first time that I have ever seen a press release from the British Academy; it was a treat to read it—that choice has become a mantra for all three political parties and it is widely assumed that more of it will reduce inequality. I am glad that she and her noble friends, such as the noble Lord, Lord Krebs, have chosen to put this contention under the microscope today, because it is critically important for us all to re-examine what seems to be settled at any one time, and periodically to test the mettle of accepted social wisdom. The noble Baroness has done that clearly today and I thank her for it.
That said, I welcome the apparent consensus, for I am a true believer in the benefits of choice. Indeed, if I may be seriously outspoken, perhaps I may say that I am also a true believer in the benefits of competition and would like to see a piece of suitable statuary celebrating competition in Parliament Square outside. However, I said that I welcomed the “apparent” consensus on the benefits of choice—it seems unimaginable that there might have been such a consensus back in the mid-1970s—because the commitment to choice seems only skin deep among some political parties.
Truer colours will be revealed to us all if the electorate—it is up to them—choose a Conservative Government at the next general election, which will have to be held very soon. I say to my noble friend on the Front Bench that, should there be a Conservative Government, the sound of cracking consensus will be as nothing compared with what comes afterwards in terms of the great explosions from the trades unions in the public services, whether in healthcare, social care or education. They have often just paid lip service, or been forced to pay lip service, to the ideas and rhetoric of choice that were laid on them by the once-reformist new Labour movement. We now see only the dying embers of that reformism—in the repetition of language, and only language, and all that talk of markets, competition and choice.
Choice was adopted by the Labour Party for a while, but it used to be the preserve of the old enemy, the Tories. After the next election, to the great delight of the trade union leaders, the Tories may become the new enemy all over again. There will be a lot of early trouble, with demands for the abolition of performance tables, transparency, public information and all the rest, all under the protective and seductive cover of the motif “trust the professionals”. I smell a lot of trouble coming for a new Government, who will be left holding this fast-vanishing consensus. Support so unwillingly coerced during the Labour years will simply crumble if the years turn Tory—but who is to say on that?
I have looked with growing surprise at the Government’s statements on equality, as summed up by something called the Government Equalities Office, particularly in relation to the forthcoming equality Bill. The Equalities Office states:
“The Government is committed to creating a fair society with fair chances for everyone”.
Setting aside the perennial problem of the definition of “fair”, I simply do not think that Governments can ever undertake to create this or that form of society. That is neither the matter nor the business of Governments. There also seems to be quite a bit of muddle in the thinking of the Equalities Office, which, with respect, must reflect ministerial thinking, because the Equalities Office is only the mouthpiece of Ministers. It says on its website—and I recommend noble Lords to spend a moment or two on the website, as much innocent fun can be had reading the words there:
“For society to be fair people must have the chance to live their lives freely”.
I say “hear, hear” to that, because this freedom demands choice by individuals—not the so-called creation by government of some particular form of society in this or that particular shape, which was absolutely explicit in the preceding sentence.
That is probably enough amateur textual criticism from me, except to award a blindingly obvious prize to the triumphant conclusion that:
“Factors like family background, educational attainment, where you live, and the sort of job you have can influence your chances in life”.
Who could dispute that innocent assertion from those in the Equalities Office labouring on behalf of Ministers? Yet, in the end, the most powerful driver to help people—and I promise that this is the last time I shall quote the Equalities Office—to,
“have the chance to live their lives freely”,
as the Equalities Office wants, is the freedom to choose.
That brings me to my third and last point, in praise of choice—recognising that just as men and women are imperfect, so is choice imperfect in the way it plays out sometimes, as the noble Baroness said. Stating that is to recognise that absolute equality is not only impossible to achieve but probably undesirable because of the tiresome unfairnesses inherent in people’s different physical and mental skills.
Can the existence of choice be bad? Can the exercise of choice be bad? I do not think that the existence of choice can ever be bad but the exercise of choice can be, if it leads to personal or social evil and if the decision is to choose to do something that is wrong, not something that is right. Otherwise, it is my belief—it may be an emotional belief that is not well founded—that, at every turn, the more choice there is, the more rungs there are on the ladder to take one over many different pathways. I entirely agree with the noble Lord, Lord Desai, in his assertion that we should value all different pathways to all different institutions in further and higher education. If Governments—or Cross-Benchers, for that matter—try to limit choice, they attempt to fetter free will under the law. Limit choice and the free society is limited. The shackles must never be put on free will.
I never like using that most overworked phrase, “the human right”, which is fired from the hip of almost every relativist self-appointed legal panjandrum at will and, seemingly, just means what they last thought it meant the last time they thought about it. Everything from choice of friends through to the choice of schooling and healthcare, which are subjects central to this debate, are fundamental attributes of individuals. While the midwife cited by the noble Baroness, Lady O’Neill, was absolutely right that the right choice is imperative, choice has now opened up opportunities, however imperfectly, for hard-working families to choose where to live—no longer on the council estate nor in the tithe cottage—just as a century ago or so, little by little, the opportunities came for the poor to get a better and better education to get to the great universities.
There have been some revolutionary changes in the past. Perhaps I may—daringly, in these straitened times—mention the financial services world as an example of the sudden freedoms post-big bang in the City of London in the late 1980s that allowed much more choice in who could enter that hitherto closed world, which had been pin-striped and totally male, and trade there. More choices were suddenly given by that self-generated explosion.
Give them choice and even the most apparently disadvantaged will then have the opportunity to improve their life chances. Whether they are successful or not, I cannot say—but they should never be patronised or engineered. Hence my dislike of Governments shaping or creating some form of society. They should never be peered at as if they were rather interesting anthropological specimens. They should, rather, be given the choices that actually power life’s chances.
My Lords, the title of this debate today referred to,
“the impact of choice on the level of inequality”.
I thank the noble Baroness, Lady O’Neill, for bringing the subject to this House, as it is important and interesting, and for her very thought-provoking introduction to it. Equally, as a fairly simple economist, I interpreted the title in a somewhat different way. The three speeches that we have heard so far seem to have questioned to some extent what we mean by choice and inequality. How do we measure inequality?
Confronted by this title, I turned to Isaiah Berlin’s two concepts of liberty. I will read a quotation from his extended essay. He said:
“The extent of a man’s, or a people’s, liberty to choose to live as he or they desire must be weighed against the claims of many other values, of which equality, or justice, or happiness, or security, or public order are perhaps the most obvious examples”.
Because my brief in this House is to speak on education, I was particularly interested in the issue of choice in education. I shall be picking up some of the remarks made by the noble Baroness, Lady O’Neill, in relation to equity in education. I also was interested in the health issue, which is in a sense another public service issue.
The conclusion I take from Isaiah Berlin is that there are many trade-offs to be made in this world; you cannot have pure choice or pure equality; these are to some extent competing ends; and we have to take decisions as to how best to make choices, or, indeed, to decide between those competing ends.
I also want to turn the question on its head to some extent and look at the issue of equality and choice—how far can you make choices if there is extreme inequality? I shall come back to that at the end of what I have to say.
Let me start. I wanted to look at the whole issue of education. As the noble Lord, Lord Patten, noted, the British Academy press release said that there has been a consensus across all parties—more recently including my own—and that the pursuit of choice in education, by offering a wider range of schools and a greater diversity of choice and allowing parents to choose and pupils to choose, will in itself improve performance in schools, which in turn would raise the game of all schools and offer a better quality of education to all, thereby, since in many senses it is agreed that education is a key to equality, promoting greater social mobility and greater equality.
Of course, it has not worked out quite like that. First, for the market to work people need to be well informed. As we all know, some—the better educated and the more articulate—make it their business to be better informed than others. Good schools are over-subscribed and a rationing process has been introduced via admissions criteria. Again the better informed know how to work the admissions process. The Government step in to lay down a common set of rules and to try to redress the balance by appointing choice advisers to the less well informed. We are back to the midwife who says that as long as they make good choices—choices I would suggest—they are making the right choices. Economists describe this as market failure due to the asymmetries of information. Some are very much better informed than others.
Secondly, the market works more slowly than theory would imply. It takes time for successful schools to expand while unsuccessful schools wither on the vine. Again, those left in the unsuccessful schools are those who for one reason or another—information, transport or a life dominated by other issues such as ill-health or poverty—cannot easily switch their children to the more successful schools. Choice in this respect leads to greater, not less, segregation.
Anecdotal impressions are confirmed by the evidence. A paper published in July 2007 by the IPPR summarised the evidence from five studies and found that although there seemed to be some correlation between school competition and pupil attainment, the causal link was not there. In other words, competition was not necessarily the driver of the improved performance. What did seem, however, to stand up was the link between social segregation and polarisation of results: schools full of high-attaining pupils further pulled up their results; schools full of low-attaining pupils went further down. Moreover, the shift towards independent governance, academies and foundation trusts was exacerbating this trend. Work by the Sutton Trust showed that of the top 200 comprehensives in England, 70 per cent were their own admissions authorities, compared to only 31 per cent across England as a whole. Within those schools only 5.8 per cent of pupils qualified for free school meals, compared with an average of 13.7 per cent in the areas that they represented. These findings were reinforced by a recent study from the London School of Economics. Its authors, Sandra McNally and Romesh Vaitilingam, sum up the conclusions as follows:
“Taken together, these findings suggest that simply offering parents a wider choice of schools and forcing schools to compete does not seem a remedy for poor standards in education: such policies might also exacerbate inequalities”.
Much the same can be said of the introduction of the market in health, which has so far produced somewhat similar results. A joint investigation in 2007 by the Healthcare Commission and the Audit Commission found that those parts of the NHS that had adopted market style reforms most keenly did not perform significantly better than those slower to change. The NHS improved, thanks to record growth in spending backed by targets to reduce waiting times. These were,
“substantially delivered without using the system reforms”.
Interestingly enough, one of the report’s conclusions was that one of the drivers behind improving services was not so much patient choice itself but the fear of the impact of patient choice, which was effecting a change in attitude among providers. The same conclusion was picked up by the King’s Fund, which suggested that some American studies had found that improvement in quality is driven not by patients actually switching providers but by the impact on hospital managers concerned about the public image of their organisation. The King’s Fund briefing states:
“The implication for the NHS is that choice may have an impact even if few patients actually use the information to switch hospitals in practice”.
It is too early for any evaluation of these choice effects on equity but the London choice pilots in the NHS indicated that there was no difference in the take-up of choice by socio-economic groups. On the other hand, each patient was supported by a “choice adviser” who provided individualised support, as has been suggested for disadvantaged families with regard to schools.
I come back to the Isaiah Berlin quotation and the trade-offs between choice, equality and other values. As a Liberal Democrat, I hold liberty, and all that it stands for in terms of freedom to choose one’s own destiny, very dear. However, I must recognise that adherence is not unlimited and that there are trade-offs to be made with other values. Evidence suggests—I have referred to that from education and health—that we cannot have total freedom of choice without exacerbating inequalities. I suggest that equality in itself has value. Britain is today a very unequal society experiencing its most unequal distribution of income since the mid-20th century. Social factors are linked to income and wealth factors. There is a good deal of evidence from the United States that those states that have greater equality in terms of the distribution of income also have not only lower morbidity rates—we see this in the 1980 Black report on the National Health Service—but lower rates of violence, hooliganism and anti-social behaviour. Those factors are all linked to inequalities in income. Distrust of others is also linked to inequality of income.
Tawney says of inequality that,
“opportunities depend not only on an open road”—
I suppose today we would call an open road a level playing field but I much prefer “an open road”—
“but upon an equal start”.
My thesis is that liberty, the freedom to choose and equality are not a zero sum game. The ability to make use of and enjoy opportunities in a democratic society will be enhanced, not curtailed, by a fairer distribution of income and wealth in our society.
My Lords, I thank my noble friend Lady O’Neill for introducing such an important topic for debate and declare an interest as a co-author of a report for the Nuffield Council on Bioethics on the ethics of public health. It is on health that I wish to focus my attention in the next few minutes.
Let me start by giving the good news and the bad news. The good news is that people’s health in this country has improved dramatically over the past century. A boy born today has a life expectancy of about 76 years; a boy born in 1901 had a life expectancy of a mere 45 years. This increase continues today. According to one estimate, expectancy of life is increasing at a rate equivalent to 12 minutes per hour, so even by sitting and listening to my speech, your life expectancy will increase by two minutes.
Now for the bad news; there are still great inequalities in health in this country. The World Health Organisation figures shows that in Glasgow, a boy growing up in the deprived suburb of Calton can expect to live for only 54 years, which is a staggering 28 years less than a boy born just a few miles away in the affluent suburb of Lenzie. We would surely agree that this is unacceptable.
Why has life expectancy increased, and why are there still such large inequalities? I am sure that noble Lords know the answer. Our life expectancy has increased in part because of vastly improved medical treatment once we are sick, and partly because of a wide range of public health measures to prevent us getting ill in the first place. These include vaccination against disease, improvements in our nutrition, the air we breathe, the water we drink, and the general conditions in which we live. The disparities in health that remain are also a result of many factors, but they are generally associated with deprivation, low social class, the certain kinds of employment, or lack of employment, living conditions and lifestyle.
To take just one example of a disparity in risk, in 2005 in England, 29 per cent of manual workers smoked, compared with 19 per cent of those in non-manual groups. Since half of all smokers die prematurely, this difference among social classes—there are also big differences among ethnic groups—is a significant contributor to health inequalities.
The political philosopher Ronald Dworkin wrote:
“No government is legitimate that does not show equal concern and respect for the fate of all those citizens over whom it claims dominion”.
I hope that all noble Lords would agree with this sentiment. The Department of Health certainly does. I quote from its website—although I bear no responsibility for the poor English:
“Health inequalities are unacceptable. They start early in life and persist not only into old age but subsequent generations. Tackling health inequalities is a top priority for this Government, and it is focused on narrowing the health gap between disadvantaged groups, communities and the rest of the country”—
whatever that might mean—
“and on improving health overall”.
How can the Government reduce health inequalities, particularly inequalities in the burden of chronic diseases that are now the major causes of premature death, such as heart disease, cancer, and type 2 diabetes?
The particular challenge of these diseases is that they are so-called lifestyle diseases. Factors such as diet, exercise, smoking and excessive drinking contribute substantially to variation in risk. Any kind of intervention by the Government into people’s lifestyle is almost certain to be branded as the nanny state at work. Here, the familiar trade-off—the noble Baroness, Lady Sharp, referred to it—is between, on the one hand, leaving each of us free to lead the life we wish and, on the other, the duty of the state to reduce inequalities and protect the most vulnerable in society.
That brings me to choice. As has been said, all political parties favour policies to reduce inequalities in health that are based on information and choice. Choice is an attractive policy option, partly because it is the leitmotif of our consumer society and therefore fits with people’s expectations and partly because it is not intrusive. “Give people the information and empower them to choose” sounds very plausible and acceptable.
I argue that much of the choice that we are offered is illusory and, more importantly, that choice alone is most unlikely to succeed in reducing health inequalities. Why do I say that choice is illusory? Because many of the choices that we make, for instance, the kind of food we buy in the supermarket, or whether we cycle to work for the exercise, are constrained by the decisions of others; in these examples, retailers and urban planners.
Their decisions shape and limit the choices and they are motivated by factors such as profit, other than improving our health and reducing inequalities. In fact, the very opposite is the case: those who construct and constrain our environment have conspired to create what the experts call an obesogenic environment, in which the easy choices lead to ill health, rather than good health.
Even with the choices you have, how do you know which are the “right” ones? In his book, The Paradox of Choice, Barry Schwartz vividly describes the impossibility of choosing between the 230 different kinds of soup, 275 varieties of cereal and 15 varieties of extra virgin olive oils in his local supermarket. There is even a further problem with choice. It is a fundamental feature of our nature that we prefer options that satisfy our short-term needs, rather than our long-term benefit. Psychologists refer to this as “failure to delay gratification”, which we heard about this morning in the debate on climate change.
Why do I say that choice will not reduce health inequalities? The problem with information and choice is that the money, the opportunities, the will, and the skill to respond to choice tend to be highest among those who are already doing well, and lowest among those most in need of help. A recent study in the Journal of Health Services Research & Policy makes the point. It states:
“Better educated populations make greater use of information and are more likely to exercise choice in health care”.
So is a more interventionist stance necessary and justified? The Government’s Foresight report on obesity not only documents the rapid rise incidence of obesity, and its huge social-class difference—for instance, the prevalence of obesity is 18 per cent among men in social class 1 and 28 per cent for men in class 5—but the report considers a wide range of policy options and concludes by saying that:
“Our evidence shows that a substantial degree of intervention is required”.
Does the Minister agree with this conclusion? Does she accept that while exhorting people to eat healthily and exercise more, and putting nutrition labels on food, may have some benefit, it is not likely to succeed in reducing health inequalities resulting from obesity? If the Government are serious about achieving their objectives stated on the Department of Health website, they will have to be bolder and, perhaps, more interventionist. Choice may be the easy option, but it will not work on its own.
I end on two points. Where the Government rely on information and choice, they must ensure, if necessary by regulating the groups and interests that shape our choices in the way that I have described, that it is easy for people to choose the options that will lead to better health—nudging in the terminology of Thaler and Sunstein. Secondly, if Government are to fully exercise their stewardship responsibilities in reducing health inequalities, they must be prepared to go beyond choice.
The approach of successive Governments to tobacco is a possible model. A combination of education, legislation and taxation has reduced the overall prevalence of smoking from more than 75 per cent of the population to less than 25 per cent today, although substantial inequalities remain, as I have said. The current Health Bill proposes new and welcome measures to further restrict the ways in which the tobacco industry is able to market and sell cigarettes. If these measures are implemented, they will help to reduce inequalities in health.
Let us hope that in the future, Governments will have the courage to tackle other health inequalities with equal determination.
My Lords, I shall attempt a synthesis between the position of the noble Lord, Lord Patten, and that of the noble Lord, Lord Krebs. I am not sure how successful I shall be.
Choice is potentially a good thing. Freedom, which choice seeks to express, is in some sense central to authentic human experience. It has certainly been part of the rhetoric and inspiration of the British national character and history. One thinks of Churchill’s most inspiring rhetoric, contrasting freedom and tyranny—although the 20th century also demonstrated how freedom that exists simply out of its own strength and for its own purpose can become its own tyranny. One thinks of Sartre’s epithet: “Hell is other people”.
The problem can be put this way. Any society or system that bases itself on freedom and choice without restraint, moderation and, to use an in-vogue word, regulation tends to produce an exaggerated outcome in winners and losers. In society as a whole, the losers can easily slip into becoming an underclass, where poverty and underachievement become endemic, as is the case in terms of health in parts of Glasgow and elsewhere. A symptom of this is a larger-than-average prison population.
If the United States comes immediately to mind, there is a great deal about British history since 1979 that exhibits similar strains and imbalances, with an inexorably rising prison population here, too, and ingrained poverty among certain sections of our people. With that goes the well rehearsed problem of underachievement in the lower educational reaches of our schools. There is more than one way in which a society can sleepwalk into segregation. Arguably, we see the same dynamic at work today in the former Soviet Union, especially in Russia, with the extraordinary, and extraordinarily rapid, emergence of a super-rich elite. I cannot believe that this will be to the long-term benefit of Russian society.
The question that I have puzzled over as I have thought about the topic for this debate is how a society can promote freedom and choice yet avoid the worst outcomes which produce exaggerated winners and endemic entrenched losers. In the year when we especially recall Charles Darwin, I shall try to illustrate briefly how choice emerges in the process of evolution. Scientists tell us that the universe came into existence about 13 billion years ago. For most of those billions of years, no life had yet emerged, but then there was no death either. Death comes as a consequence of the emergence of life. As evolution advanced and plant life came about, so came the possibility of diseases or the deformation of plants, with one organism impairing another. Further up the evolutionary tree came animals, which had a greater sense of choice and meaning—the ability to move around their environment—but then one animal could prey on another. The arrival of human beings also brought the ability to relate to eternal, transcendent values of truth, beauty, justice, love and so forth. However, along with that came the emergence of moral evil. Nature may be red in tooth and claw but in the animal world you do not get the equivalent of a Hitler or a Pol Pot.
The point is that, as the freedom of creation develops, choice emerges, and it brings both the flowering of true humanity and a corresponding threat. So it is that choice and freedom tend to generate winners and losers, and a corresponding increase in inequality. To some extent, that will be inevitable in any society, but I think that society needs to seek to set certain limits to it in one way or another.
This, I believe, has been a major part of the story of Britain, especially over the past 30 years. I do not argue that this has been altogether bad. Indeed, I think that there have been many positive outcomes during this period in terms of choice, opportunity and the benefits of economic liberalism. In relation to the last, there has also been an underlying instability, which is being cruelly exposed in the current banking crisis.
With freedom must always come responsibility and an obligation towards the common good of wider society. Archbishop William Temple put it this way:
“Concentration on acts of choice as the proper locus of freedom … is a blunder. Freedom is not absence of determination; it is spiritual determination … by what is intrinsically good”.
This is an ideal, of course, and in practice both individuals and society as a whole will fall short, but all the more reason for seeking active commitments to moderate or avoid the inequalities that too narrow a focus on choice will tend to generate. These need to be the commitments of government, individuals and the intermediate institutions in society alike.
I follow others who have contributed to the debate by reflecting on what this might imply in the area where choice has been given so much prominence in recent decades: education. There has often been official puzzlement at the stubbornly high and socially unacceptable underachievement in our secondary schools, particularly by those in the lowest quartile of achievement, despite 20 years of being given a priority by government in both planning and the allocation of funds. The built environment of schools has seen a significant and welcome transformation, but that has not been matched by improvements in the achievement of those at the lower end of the scale in particular.
Choice operates in the state system by reinforcing the differences between good and bad schools, or those that are perceived by parents to be good and bad. The academy programme has been part of the response, by rebuilding or replacing schools in underperforming areas with new schools endowed, at least in theory, with new freedoms. In many ways I regard the academy programme as an imaginative response to the educational challenges in more deprived areas, but one consequence has been further to disadvantage non-academies in neighbouring catchment areas, which are often themselves struggling somewhat. I expect that the academy programme will achieve its aims only when all or most schools are organised along those lines and other policies are in place to support the weakest schools and the poorest areas to take account of their intrinsic tendency to fall down the scale where the natural forces of parental choice are permitted to operate—and they will tend to operate whatever restrictions are placed on them.
Of course, although this is rarely introduced into our debates, choice operates in another way between schools, to benefit some and disadvantage others. I refer to the choice of around 8 per cent of the wealthiest parents to send their children to private schools. These schools are usually academically selective, unavoidably socially selective, and the resources spent per pupil are typically higher than in the state sector. We ought to ask much more searching questions about how society can ameliorate those inequalities that so distort school-age education in our country. I say that as a parent who has sent a child with special needs to private school, because it is naturally the instinct of every parent to do the best for their child. I pay tribute to the excellence exhibited in many private schools and to the academy programme, which is an attempt to emulate them.
The educational playing field needs undergirding policies that aim at least to promote levelling out, including a clear plan to match in state schools in this country the spending per pupil in private schools. Interestingly, higher education arguably presents a better picture. Students attend by choice and the Government have a good policy to increase and widen participation. The universities, unlike state schools, are independent institutions, so to achieve their aims the Government have operated through quite a sophisticated mechanism of regulation for home undergraduates—HEFCE, which is, theoretically at least, at arm’s length from government—allocating funded places with some care and moving to support weaker institutions, despite their formal and, indeed, actual independence.
I hear suggestions that new elements of choice may soon be injected into this sector by lifting the fee cap and perhaps by deregulating a proportion of home undergraduate places. Those who have the responsibility for these matters should think long and hard before moving in those directions, with due attention to the law of unintended consequences.
In summary, choice and equality of outcome are inevitably in tension, but it is possible for a society both to respect choice and to develop ways of operating policies and social norms that seek to ameliorate the worst outcomes of inequality.
My Lords, I thank my noble friend for introducing this thoughtful debate and I congratulate my noble friends on the Cross Benches on such a good turnout.
I shall look at the impact of choice and equality in the context of families. The tension between choice and equality is strong for various reasons, but particularly because it tends to be the parents who make the choices and the children who suffer from the inequalities that may arise. In saying that, I should add that there are 11 million children in this country, which is a substantial constituency. My noble friend has already spoken about how parents can entrench inequality by their choice of schools. I shall not follow that train of thought because I want to draw attention to another kind of parental choice, which arguably is even more important. It concerns the kind and quality of family life that parents choose to give their child.
In today’s society, the most important influences on children’s chances in life are likely to be the quality of the family life that they enjoy and their relationship with their parents. We all know that young children need to have a secure attachment to a mother or surrogate mother whom they love. They need to feel safe, to be talked to, to be played with, to be stimulated and to be encouraged. The family support that children get before entering school is a major factor in their ability to integrate into school and to learn. Even in full-time schooling, children spend less than 30 per cent of their waking time in school. That means that 70 per cent of their waking time is spent with or under the influence of their family, so it is their life in their family that should give them the ability and self-confidence to integrate into school, understand what is going on, participate and learn. It should develop their self-confidence and age-appropriate social and emotional skills. Crucially, it should give them the ability and confidence to communicate verbally before they get to school and with adults and other children once they arrive. Without those skills, children arrive in school already at a disadvantage.
A government-sponsored report by Charles Desforges confirms everything that I am saying. In 2005, he demonstrated that a substantial body of research shows the important links between the quality of children’s family life and their success in school and therefore, arguably, in later life. Luckily, most parents, most of the time, give their children the family life that they need, but some do not. We need to explore the ways and the reasons why some children are not getting the parental support and family life that they need.
Some of the reasons are beyond the control of parents. We all know about poor mental health, drug and alcohol abuse, domestic violence, poor housing, single parenthood and poverty. It must be a priority for any responsible Government to do their best to address these matters and help parents and families that have these problems and to do so even more effectively than the Government are at present achieving.
However, when all those factors have been discounted, there remain many cases where parental choice may be a major contributory factor in denying a child the quality of family life that he or she needs. I shall give three examples: teenage pregnancy; a father walking away from his young child in order to form another family; and a mother deciding to have several children by different fathers and then bringing them up in a household where her partner is not the father of any of them. Those are three examples of the enormous number of ways in which parents can affect their child’s future and ability to achieve equality of outcomes.
All children are different, but all young children need long-term, consistent love and security. In this country today, the only effective social mechanism that we have for delivering this love and security is the family, whether it is a birth family, an adoptive family or a foster family. That gives a great deal of importance to parental choice.
For that reason, parental choice can be reconciled with our ambitions for equality if that choice is guided and empowered by parental responsibility and by shared norms of social expectation that are widely understood and accepted. Here, we are talking about nudging. People cannot be compelled by law to love their child or to bring it up in a particular way, but they can be nudged. It is fortunate that today it is recognised that choice, including parental choice, can often be influenced by the establishment of normative expectations, linked to recognition of and support for those who conform to them. As has already been mentioned, smoking and seat belts are examples where the policy of nudge has been effective.
The principal tools that we have to influence behaviour in relation to choices about family life are information and motivation. Parental choices must be based on good information. Frank Field recently suggested a highway code for parents, which is rather a good idea. It is not a law; it is a highway code, a guide. Such a document would set out the obligations that our society intends that it should be parents’ responsibility to fulfil, in return for the many benefits that they get from the state, such as free education and healthcare. Such a highway code would have to be based on the needs of the child as confirmed by research and there would need to be a measure of consensus.
However, information is not enough. Motivation is needed. This is the crux of what I have to say this afternoon. We must find ways to persuade more parents and families to make the choices that will be best for their child. In particular, our society today needs more parental commitment; parents must be committed to the well-being of the child and, where possible, to each other. Parental commitment does not have to be in the form of marriage, but for those who reject marriage we must develop some other way for parents formally to make a genuine long-term commitment to their child.
There are many other things that the Government could do to motivate parents and to promote commitment to family life. I give just two examples. Changes to the tax and benefit system could encourage parents to live together and to make a long-term commitment to each other. Today, in some cases, there are financial incentives for parents to live apart. Another important change could be in housing policy, to make affordable accommodation available to young couples, so that they can begin to build a home together as soon as their first child is born. Today, they may have to wait for years to get a home—even a mobile home would be better than that.
We should now make it clear what our society expects from parents as a minimum return for the support that the state gives them. We should recognise, celebrate and promote long-term commitment by parents and families to their children and one another. Only by doing so can we hope to guide parental choices about family life towards those choices that will ensure more equal opportunities for all the nation’s children, including the most disadvantaged.
My Lords, like other noble Lords, I am grateful to the noble Baroness, Lady O’Neill, for introducing a debate that raises such fundamental issues of both philosophy and policy. I will begin by approaching the subject from an historical and philosophical perspective.
The movers behind the French Revolution of 1789 believed that liberté, égalité and fraternité went together and that, if you achieved one, the others would quickly follow after. They thought that, if only the old feudal legal inequalities were done away with and people were left free to live their own lives, equality would come about and from this would flow fraternity and the true human community. The old order kept people in their place and severely limited their choice. With choice opened up, it was assumed that everyone could prosper equally. In fact, as we know, this has happened only to a very limited extent. Opening up choice for everyone has led to inequalities of many different kinds, most obviously in the division between rich and poor and so starkly in the health and mortality figures that the noble Lord, Lord Krebs, brought before us.
The result is that in our time there has often been an assumption that the values of choice and equality are opposed to each other and there has been a sharp polarisation between those advocating policies for the one or the other. That has been reflected to some extent in this debate. However, it is a grave mistake to think that these values are mutually incompatible rather than complementary. It is not always realised that a market economy depends on the value of equality as well as on freedom of choice, for, in stressing choice, we are stressing the fact that every individual has dignity and worth and is free in principle to exercise that choice.
Ronald Dworkin has put it as follows:
“Under the special condition that people differ only in preferences for goods and activities, the market is more egalitarian than any alternative or comparable generality”.
The qualifying clause is, however, crucial. People not only differ in their preferences but differ hugely in the opportunities open to them to take advantage of those preferences, so although it is important not to see choice and equality as mutually conflicting values, we must always bear in mind the context in which people make their choices.
RH Tawney has already been mentioned once in this debate. Another of my favourite quotations from him is:
“Equality of opportunity is fictitious without equality in the circumstances under which men have to develop and exercise their capacities”.
This means that any Government must properly be concerned not only to enlarge people’s choices but to ensure that they can take advantage of them.
I find a very obvious example of this in my own life. There are now umpteen TV channels to choose from, as well as the opportunity to download, to play CDs, to record, to play back and so on. In our sitting room, there are three remote control devices with umpteen buttons on them. I am genuinely totally flummoxed in a way that my grandchildren are not. To take advantage of the myriad choices now open to me, I have to be re-educated; I have to sit at their feet and learn how to operate this new technology. This is why the idea of computers in schools is such a sound idea. Most children now grow up able to take advantage of much of this new internet technology. That this should continue to be so is, I know, common ground between all the major political parties.
What about education more generally and health and social care? In recent decades, there has been not only inequality but growing inequality in these areas. The noble Lord, Lord Krebs, drew our attention to the stark figures of two neighbouring districts in Glasgow. The figures that I am aware of show that, two decades ago, the difference in life expectancy between those in Glasgow and those in the south of England was about five years. More recently, that difference has grown to more than nine years. So we are talking not only about inequality but about growing inequality.
John Rawls, one of the most influential of the 20th-century philosophers, argued that all citizens should have equality of basic liberties, such as the right to vote, access to the law and freedom of speech. When it came to economic matters, he argued that freedom to compete in the market outweighed equality, because this made for a more efficient system that could benefit all. In short, a degree of inequality was acceptable provided that the poor benefited. A society is just only if its worst-off are better off than they would be under any alternative arrangement.
Rawls justified this view on the basis that, if we all had to choose a society from scratch with no idea as to whether we would be badly off or well off in it—in other words, leaving aside all our present interests and position in society—we would be bound to choose his idea of a just society, for this would be the only one in which everyone could benefit wherever they were born in it. However, the acid test of this is of course whether the worst-off are in fact benefiting, or benefiting enough; according to Rawls’s view, which seems pretty compelling, our present arrangements, which allow for some inequality, are only justified if they are. So, in terms of this debate, the pressing question is whether the choice that has opened up in recent years really has a beneficial effect on the most disadvantaged in our society. What studies have the Government done to show that the most disadvantaged are really benefiting, not just through what the Government have done in a good way through interventionist policies, but through what they have done to open up choice?
In contrast to previous Labour Governments, for new Labour equality has not been a mantra. Just the contrary: the very idea has been viewed with some disdain. This has had some justification. Policies on children, for example, which are so important to the noble Lord, Lord Northbourne, have been devised to enable the most disadvantaged to make a better start in life through such things as Sure Start, and to begin to share in what our society has to offer. This makes sense. Of course, there is no point in an ideology of equality that fails to take into account the differing gifts and vocations that society needs and people have to offer.
Setting light to flat, abstract notions of equality is one thing; growing inequalities in almost every sphere of our life are another. Growing inequalities undermine our society in a number of ways. They offend people’s sense of fair play. They foster resentment. They undermine people’s sense of worth and dignity. They sap the very spirit, for it tempts people to say, “Well, why bother, if it takes me several lifetimes to earn what a financier will get as a Christmas bonus?”.
Most people will recognise that some degree of inequality is inevitable and probably healthy, but gross and growing inequalities, particularly in health and mortality, are mightily offensive. Therefore, any Government who are concerned for the totality of society and the common good of all their people will be concerned not simply to enlarge choice but to ensure that people are in a position to take advantage of the choices that are open to them. The conclusion emphasised so eloquently by the noble Lord, Lord Krebs, is inescapable: some interventionist policies are absolutely necessary.
My Lords, I thank my noble friend Lady O’Neill for introducing the debate and I thank all the contributors. I raise the point that many of us do not have choices. The assumption that everybody can exercise choice is problematic. We are limited not only by class and opportunity, as has been stated, but in particular by race and gender, which open limited pathways for many of us.
Speaking as a woman, I argue that, if you are born as a woman, the expectations of women as a gender and the identities ascribed to women narrow pathways right through. In the education process, the options open to women were until recently limited. When they are opened, women face an inherently gendered labour market. In order to be successful, we must do the man hours at the desk and work as if we were a man.
The most successful men usually have a woman in the background who does the domestic work. However, because the domestic work is not paid and because it is not visible, it is not seen as work. Some might say that, when women come to the labour market, they are always assessed as men. If they are young, they will seem inferior bearers of labour, not because their work is any different but because they potentially would be mothers and carers and would potentially be held back at home. Therefore, they are always placed at the bottom of the opportunity ladder, as if they were for ever mothers and carers. If women choose, as many have, to compete on an equal par, they are thought to be failing their families—they are not obeying the family laws of caring and they are not being good to their children, so they are failing in the other part of their ascribed identities.
If we are talking about choice, we need to qualify that by acknowledging the presence of prejudices and the existence of identities that prescribe particular activities and confine a whole category of population—it so happens that it is the majority of the population—to a very narrow pathway in the job market. Women are seen as suitable for doing the equivalent of domestic work in the labour market because they are women. In that labour market, they are also confined to the bottom ranks. If we look at the general position of cooks, cleaners, hairdressers or beauticians, we see that the top ranks are always occupied by men.
If we begin opening pathways—I absolutely agree with the noble Lord, Lord Desai, that we must have a variety of pathways—one of the first things that we need to do is to recognise the life responsibilities of people and to valorise them. We need application forms for jobs that demand of everyone their familial skills; that is, how good a negotiator they are within the family context or how well they operate within the household. To some extent, we have been successful: Unilever has introduced such an application form because its human resources person is a woman with children who works part-time. If we realise that it is doable, there will be open pathways for the majority of people in this country to access equal opportunities.
Having a different faith or colour is often debilitating. My noble friend Lady O’Neill asked why many minorities train for professions. As a teacher, I rely entirely on the research of my students. I have a student who has just finished her PhD on the plight of Ismaili women in Iran. Ismailis are a minority Muslim community in Iran. They look exactly like all other Iranians—they are the same colour and the same shape—but they have a different creed. My student found that the only way forward for minority Ismaili women was to be trained in professions in which there were shortages and in which it was necessary to employ you whatever your creed, so that entry is easier. I suggest that this is very much the experience of many minorities in this country.
There is also a difficulty when minorities are asked to choose in terms of their loyalty. As a Muslim, I remember after 9/11 suddenly being asked to choose between being Muslim and being British. I must say that I am very grateful to the House of Lords for not imposing such a choice, but I am sure that, if I were to stand as a candidate for election in my locality, my faith would be much more important than anything else and I would be discriminated against.
I declare an interest as a commissioner on the Women’s National Commission. For a long time I have campaigned for quotas and for allowing people to come forward on the basis of their gender. It seems to me that, at least as a means of opening doors, it is the only way. I can cite the example of politics in that the largest tranche of women entering the other place was the result of all-women quotas for selection.
I differ from the noble Lord, Lord Desai, on the question of quotas. I have another student who is working with the gram panchayats in India where quotas for woman have been imposed. She has found that, in the poorest and worst tribal areas where women are uneducated and have to work very hard, when women are elected as local representatives, the policies become very different and start to benefit women. Water is used for drinking rather than for planting. It is essential that we do this.
Unless we have a differentiated understanding of equality and unless we qualify choice, we are going to get stuck. That is because the best choice for women would be to become quasi-men, to come into the labour market and to succeed there—I assure noble Lords that we would—but not to produce babies. The most deskilling activity that any woman can engage in is having children. If a woman does what is right and pulls out of the labour market to look after her children, she finds that she cannot get back in because she is not allowed to. She goes back on to the bottom rung.
My Lords, of course it is not their duty, but it is generally women who do so. We have to be careful about defining choice. It is essential that in our differentiation of choice we think about celebrating difference. We can contribute different things at different times during our lives, so let us please open the pathways.
My Lords, I confess that it took me a while to figure out exactly what this debate was about, but now it is clear that my noble friend Lady O’Neill has begun a debate on the good society, no less. What we call “choice” and “difference” are in fact freedom and equality, and it is on the whole issue of freedom and equality that I want to say a few words.
It was Aristotle who said that entire equals will not build a state. Human beings are not equal. Important statements have been made about differences in endowment, equality and entitlement. In my view, these differences are one of the foundations of progress, and inequality arises from the fact that within human societies, they are put into a rank order. I shall take an extreme case. If we ever come to live in a future society in which computer literacy is the main virtue, I might join the noble and right reverend Lord, Lord Harries, as a member of the new underclass; that is, those who are not engaged in that trade. We live in a society that is sometimes called a meritocracy—and I wish to see a debate in your Lordships’ House about this interesting concept, on which quite different views are held—but it is educational attainment that plays an important part in creating the inequalities of this world. It creates a rank order among the differences which exist between human beings.
I see nothing wrong with that and would go a step further. Many years ago I wrote an essay called Inequality, hope, and progress, in which I argued that because there are inequalities, including inequalities of rank, there are reasons for people to hope to advance themselves rather than just continue with what they have inherited. It is through this desire to advance oneself, through choices, that we create what one might call progress.
After today’s debate, I would add choice to the list of the advantages of inequality. One of the great things about inequality is that it makes choice possible and plausible. But there is one crucial question: what conditions must be met for inequality to become acceptable and bearable? Here I list four important items. They are not the only ones—one could undoubtedly have eight, or perhaps reduce the four—but they seem to me to be of crucial importance.
The first item has been one of the subjects of our debate: that no one must be prevented from taking part in the universe of opportunity. That is easier said than done. Those of us who have been involved in debates about equality of opportunity know that the words sound fine but that in practice it is an enormous task to create anything resembling equality of opportunity. I do not believe that it is fictitious, but it requires a great deal of social action to make citizenship real; to make every person in our society a full citizen, with access to the opportunities which this society has to offer.
The second point has also been a subject in this debate: that in choosing the pathways individuals prefer towards their satisfaction—or, if you wish, happiness, although I do not believe that happiness is either a political or social category—it must be effort and achievement rather than privilege and what my noble friend Lady Afshar called identity which determine where they are going. This is where the issue of discrimination comes in in an important way.
The third point about a society in which inequality is fruitful for the whole, and therefore bearable, was made by the noble Lord, Lord Desai, and it cannot be emphasised too strongly. The different pathways available for people in our world must be interconnected and permeable; they must not be rigid paths from which you cannot escape once you have taken the first step along them. If I may put it this way, closed shops are almost as bad as caste barriers. That is to say that a system in which there is a rigid allocation once initial decisions have been taken, and which is impossible or difficult to change, is wrong. I therefore agree with my noble friend Lady O’Neill and the noble Lord, Lord Desai, about representative groups. The notion that there has to be proportional representation of all groups in all areas of life is absurd. I do not want to live in a society in which such rigidities prevail. It is crucial that those who have chosen a certain path can change it and decide at a certain point in their life to take a different way. That, incidentally, is also a comment on some of the major needs in educational policy, but I shall stick to the principles I mentioned.
The fourth point is topical and, again, might require a separate debate. Inequality is bearable as long as those at the top, in positions of leadership, are not totally remote from the rest. In my view, this is one of the key problems we are faced with today. For reasons which one can speculate about, those in positions of leadership—especially in banking and business but in many other areas as well—have somehow lost touch with those for whom they are responsible, which is a necessary condition of a society which lives with its inequalities.
Beyond those conditions, I believe that it is highly desirable to have a society of differentiation and inequality, where a hundred flowers bloom and people are free to choose the ones they like best.
My Lords, I thank most sincerely the noble Baroness, Lady O’Neill of Bengarve, for introducing this debate. I am grateful to her for giving me a health warning about the single equality Bill, with which I will no doubt be engaged later this year or whenever it appears. She made some extremely interesting and sophisticated statements which, I confess, I shall need to read before I am certain that I follow every word. I am sure that they will become extremely valuable to us all.
Years ago, when I first joined the Liberal Party, I went to a tiny little conference, somewhere in the west country—Devon, I think—where I asked a young MP, “What is the essence of the Liberal Party?” I shall not embarrass him by identifying him—he is now a Member of this House and comes in quite frequently. When I asked him what was the heart of Liberalism, he said, “A Liberal society would be one in which every person had the maximum chance of freedom, consistent with an equal freedom available to every other person in that society”. He concluded, “The Liberal Party exists to bring such a society into effect”. Well, we have not succeeded yet, but you never know.
I confess to finding it difficult to get a handle on this subject and knowing where to begin, and to recognise the potential conflict between choice and equality of outcome. With a good deal of thought, and through listening to what other people have said during the day, I think that I have got, more or less, into the right ball park.
The Government have been overeager, some would suggest, to insist that choice is automatically beneficial for citizens. The example that everyone has used—I am afraid that I will use it as well—is choice of school. Experience teaches those of us who have served as governors, for example, that this exercise of choice benefits in particular those parents who have the self-confidence to work the system on behalf of their own children. That has become more the case since the diversity of school provision has increased.
Meanwhile, it seems that not all students are given the same opportunities. Otherwise, why are so many young people emerging from 11 years or so of full-time education without any useful qualifications? The recent report from the Public Accounts Committee in another place has drawn attention to the underperformance of students leaving school at 16 without any worthwhile exam results to show potential employers. The sadness of it all is that young people who leave school without any of the qualifications required for life and to work in a modern society have been denied a chance to make the most of their lives, as the noble Lord, Lord Desai, vigorously pointed out.
Who makes the choices which limit young people’s futures? Is it the teachers, or the parents who do not know how to use the system, or the government targets which seem to dominate the lives of teachers? Education provides a classic demonstration that choice does not always favour those who need the services most. In theory, everybody has the same chance to see that their child gets to the school of their choice, but some parents are better educated or richer, or more confident, adept and persistent in using the system. It is therefore often the school, and not the family or the pupil, that has the real choice. Meanwhile, the children who come from poor or chaotic families, or whose parents either will not or cannot appreciate the benefits of a good education, may not get the encouragement they need to do well at school.
Yet failure at school has too many dire consequences to allow us to tolerate this. It would be marvellous if the teaching, discipline and human relationships in every school were aimed at ensuring the maximum benefit to each pupil from their 11 years. There might then be a more rational hope for greater equality of outcome than we seem to be able to achieve at present.
Taking a different aspect of the same syndrome, I wonder how many women have the chance to follow the same rewarding career path as men can expect. I am grateful to the noble Baroness, Lady Afshar, for her heartfelt but expert words on this matter, a matter which I have pursued during most of my life in politics. One would suppose that women and men are of equal worth as employees, but now the press is full of stories of the disproportionate risks faced by women in the workforce as a result of recession. It is said that recession could set back the cause of equal treatment of women in the workplace; that employers will use the recession to avoid taking on women who may become pregnant; and that the share of women in the workforce will decline as men move into “women's work”, because traditional “men’s work” will employ less of the workforce. That of course ignores the fact that many—almost all—of the problems of recession were caused by men rather than women, who are poorly represented in the banking and financial sector.
I shall not make a long speech—we have heard a number of excellent speeches which have completed their time—save to say that we need to think carefully about the different strengths and weaknesses of people who have to work the choice system. If you or your parents went to university, if you have lived a middle-class life and if you have always governed your own life, you may then be able to fight for your children in the hospital, school or wherever they need to be fought for; but there are many people, particularly women, who do not have those advantages. It is not a question of money. I have a very poor daughter, but she is very well educated and has fought successfully to get her children to the right schools—they are not paying schools but the right public schools. It is a question not of money but of that innate ability to fight, to contest, to get in contact with other people, to argue with them, to wear them down and to do the things that you need to do in this very difficult and choice-driven atmosphere to get the outcome that you want for you and yours.
My Lords, given that I shall be touching on education in my speech, I declare an interest as a governor of Bolton School.
I, too, am most grateful to the noble Baroness, Lady O’Neill, for introducing this fascinating topic. In conversation the other day, I mentioned to someone that I was responding to this debate from my Benches, to which the retort came back, “That’s the sort of title I used to give my pupils as a punishment”. However, this has been a pure pleasure, with remarkable contributions from fine minds and many different but equal ways of tackling the subject.
Given the breadth of the debate, I shall not be able to comment on all noble Lords’ speeches, which is a pity because they all deserve comment. However, I would just like to say to the noble Lord, Lord Northbourne, that although I agree with him that some parents will make some choices that impact adversely on their children, I believe that the answer lies not in reducing choice but by ensuring that parents can make informed choices, be able to exercise those choices and have a proper range of support to help them. I recommend the excellent whole family intervention programme of my party.
To my noble friend Lord Patten—you keep spitting in church, because I agree with you. I, too, am a true believer in choice because, as the right reverend Prelate the Bishop of Chester said, “choice is good”. I thank the noble Lord, Lord Krebs, for an extra two minutes. Perhaps I could use them in my speech.
This subject has two important but very different arguments. The first is that choice in public services exacerbates inequality. The second is that there is inequality in the exercise of choice by the public. It is important to draw a distinction between those positions. The first argument contends that, since choice exists in many elements of public services, thanks to the efforts of many on my Benches and the more progressive minds on the Benches opposite, and since inequality not only persists but shows signs of increasing, choice must be, at best, an ineffective method of ending inequality and, at worst, a contributory factor in worsening it. Choice has been introduced; inequality has grown—post hoc ergo propter hoc, for the classicists among you; or, as in my case, aficionados of “The West Wing”. It will not surprise noble Lords to hear that I do not agree with that argument.
The second proposition is that there is an inequality in the exercise of choice by the public, since it is mainly the better educated, more privileged middle classes who are able to avail themselves of the choices offered; the less well off are not, and inequality therefore results. That argument certainly has some merit and helps to explain the fallacy of the first.
Before continuing, it is worth considering what we mean by “inequality”. I think that a better word would be “unfairness”, because inequality exists in many spheres of life, often without negative consequences, because people possess different characters, different strengths and weaknesses and have different preferences. So we have to be careful. Denying someone the benefits of their own hard work and achievement simply because it would result in inequality is undoubtedly unfair. Instead, we must focus our efforts on ensuring that everyone has equality of opportunity and that the ability for self-advancement is not restricted to a privileged few but spread as widely as possible.
One of the most effective political messages that I remember from the last Conservative Government was a poster in John Major’s own handwriting of three words: “Opportunity for all”. That simple objective is what drives many of us in politics, of whatever party, and is at the heart of what we are discussing today. If what we seek is equality of opportunity, we must return to the second proposition that I set out earlier—the fact that too many people from poorer backgrounds do not have the opportunity to exercise the choices available to the better off. It is true in a very literal sense that the better off can afford private healthcare, private education and better housing. Some would argue vehemently of the unfairness of that, but they would, I hope, accept that the distinction is at least clear.
More troubling to us all should be the less transparent unfairness in public services funded by the taxpayer. There are the health inequalities mentioned by the noble Lord, Lord Krebs, with shocking disparity and life expectancies between different parts of the country. It has been reported that when travelling east on the Jubilee Line from Westminster, each stop correlates to approximately one year’s reduction in life expectancy in the surrounding area. We all know of horror stories about the postcode lottery in the NHS, of treatments being available in one street and not in the next.
In education, the disparity in the quality of state schools is open for all to see in the league tables, but is no less shocking for that. In fact, it is more shocking when we look at the differences in provision within relatively small areas. For example, in London the highest performing borough at GCSE level is Richmond upon Thames, where 65 per cent of pupils gained five GCSEs, including English and maths. That is a massive 31 percentage points above the lowest performing borough, Greenwich, where just 34 per cent of pupils achieved that level. The value parents put on this evidence is clear to see in the premium attached to house prices inside the catchment area of good schools.
That brings us back to the central argument that people with greater means and resources are able to take advantage of choices, which those from less privileged backgrounds cannot. We could respond by saying that choice works against fairness, so let us stop pursuing choice. That would be a grave error. Instead, surely, we should strive to bring that choice to those who cannot currently make use of it. Opportunity for all, however hard, as the noble Lord, Lord Dahrendorf, said, that task may be.
I put the matter simply: the problem is not that choice creates inequality, but that choice is not equally available. The solution is not to end choice, but to extend it. I will continue with the example of schools. As many noble Lords have mentioned, there has been a gradual introduction of choice into the system. Parents can express a preference for the school they wish their child to go to, but the problem is one of supply. There are simply not enough good schools to go around. As John Prescott once tellingly remarked, the problem with good schools is that,
“everyone wants to go there”.—[Official Report, Commons, 25/1/06; col. 1422.]
He may well see it as a problem, but, to the more optimistic of us, it represents hope. It demonstrates the underlying demand that exists from parents for the opportunity to choose the best services available for their children. That is not just a pushy, middle-class concept, but something that parents from all backgrounds share. The problem is not that too many people want to make the right choice, but that in the current system not all will be able to. The lack of supply has led to the increasingly painful debate on schools admissions policies. The fact that it is now acceptable to allocate places by lottery is a damning indictment of the state system. It confirms completely the lack of any meaningful choice that parents are able to exercise. Local authorities and schools, bound up, as they are, by restrictive guidance from the DCSF, are forced to conjure even more excruciating procedures to ration fairly the limited number of places available.
Fairness does not mean giving everyone an equal chance of a bad service, but meeting the demand from parents and patients for greater choice. When two choices exist, competitive pressure will provide the incentive for a much better service across the board. There will not be equality of outcomes. Some schools will be better than others and some hospitals more efficient. The overall level of service will improve and there will be a vital escape route for those who are badly served. Equality of opportunity and fairness is not harmed by choice; it requires it.
My Lords, I congratulate the noble Baroness on securing this debate. She has brought her customary intellectual rigour to this issue. It has been a thought-provoking debate and, unsurprisingly, each contribution has explored a different aspect of the issue, and each has been as penetrating as the previous one.
It is daunting to answer a debate that includes contributions from the former head of my university, the London School of Economics, the noble Lord, Lord Dahrendorf, and the noble Lord who attempted to teach me economics there, my noble friend Lord Desai. Failures since I graduated are all my own, including this speech.
I might summarise the theme of the debate as “choice or equality”, which if posed in that way suggests that one precludes the other. In general it may be argued—the noble Baroness has, indeed, argued this—that greater choice does not of itself lead inevitably to greater equality.
In the 24 hours that I had to prepare for this debate—I am sure that noble Lords will fully understand why my noble friend the Leader of the House is unable to be here—I found an interview—thank goodness for Google—that the noble Baroness gave in March 2002, presumably when she was in the process of giving her distinguished Reith lectures, to which I listened with great pleasure. The interview stated:
“She is dismissive of campaigning bodies such as the Equal Opportunities Commission and the Commission for Racial Equality”.
It went on to say:
“I think there’s a great deal of muddy thinking in that direction. When people talk about equality, I would ask: equality of what? It’s not helpful to judge equality by some sort of statistical profile”.
The noble Baroness has expanded that point of view with intellectual rigour. I think we can all agree that greater equality means more than the movement in a statistical profile. Greater equality will mean more and improved opportunities. It means lifting people’s ambitions and is fundamentally about creating a shared sense of fairness. It is not about equality by statistics but the core philosophy behind the forthcoming equality Bill. It makes for a more peaceful society which is more at ease with itself and a stronger economy which includes the talents of all.
Before we get to the heart of this debate, to set it in context, it is worth casting our minds back to the days “BC”, before choice, to the days of monopoly provision. We should cast our minds back to the days when the council decided what colour your front door was painted and the design of your kitchen, and when patients had little choice over where they went for surgery. Even in 1998, this meant that 185,000 people were waiting more than nine months for elective surgery. In my mother’s case, for example, there was a distinct lack of maternity choice involved at my birth in 1952 as compared to the maternity choices that were available to me in 1986. We should cast our minds back to the days when parents had little control over which school their children attended despite around 30 per cent of children leaving primary school in 1998 without a basic mastery of English and maths.
As the former general-secretary of the Fabian Society, with its rich tradition of discussion over 150 years of evolving socialist and progressive politics, I am very familiar with these debates, some of which were mentioned by my noble friend Lord Desai, by the noble Baroness, Lady Sharp, in her references to Isaiah Berlin and Tawney, and in the remarks of the noble and right reverend Lord, Lord Harries of Pentregarth.
The absence of choice meant an absence of incentive for providers to improve. We have come a very long way and much progress has been made. My right honourable friend the Prime Minister said in a lecture to the Social Market Foundation when he was Chancellor:
“As Amartya Sen has famously argued, equality rooted in an equal respect and concern for our citizens demands not just greater equality of resources but also equal capability to function and develop their potential. Such capability can be developed through a new approach to public services—one that maximises responsiveness and flexibility to provide services that empower the individual to flourish and one that engages individuals themselves to be active partners in achieving these results.
Because achieving equality of opportunity is a fundamental goal in a progressive society, I believe each person has an equal entitlement not just to high standards of service, but to as equal a chance as another of developing themselves and their potential to the fullest. Because people begin from different starting places, in different circumstances and with different needs, public services need to be personalised in terms of their resources and range of provision”.
Choice of school was mentioned by several noble Lords, including the noble Baronesses, Lady Thomas and Lady Morris. Parents have the right to apply to any school of their choice. We are committed to ensuring that all schools are good schools and that all children should have the best start in life. The Schools Admissions Code aims to ensure a fair and straightforward system that promotes equity and fair access so that no parent is disadvantaged because of their circumstances or background. Therefore, I disagree with the noble Baroness, Lady Morris. We know that this is not perfect, but we are on the right path.
In the health context, the impact of choice can be expected to have positive implications for inequality. Providing all people with a choice of where they seek healthcare, anywhere in England, means that we have created a system in which not only the rich are able to access the highest quality of health services.
In some circumstances, if left in an unfettered state, more choice may well, as noble Lords have suggested, provide more opportunities for some to benefit but at the expense of others. However, in many cases, choice can actually be a driver of improvements in services and reductions in inequality.
I understand that choices can be restricted by a lack of knowledge; low aspirations stemming, for example, from family economic circumstances; traditional expectations; and by young people not fulfilling their potential. However, exercising choice that is informed and supported, as described by several noble Lords, can lead to improved equality and provide opportunities for people who would otherwise have been excluded from choosing a particular path in life.
Also there are those for whom the mere fact of having choice, and therefore independence, is fundamental to a reduction of inequality. Having informed choice has resulted in many thousands of people with a disability who may otherwise have been excluded from the workplace leading fulfilling working lives. The Government’s current specialist disability employment provision helps disabled people with complex barriers to enter and stay in employment.
We are taking steps to ensure that choices are informed and supported and to reduce inequality, for instance, in the field of education. Choices in education are not just issues for school-age children and students; they continue throughout life. As technology develops to expand these choices about how to learn, the Government will seek to ensure that the digital divide—the gap between those comfortable with technology and able to access it and those excluded from it—is reduced. I hope that some noble Lords may benefit from that. We want everyone to have the opportunity to make the best of the new digital opportunities and of achieving their potential.
The solution in education is to move even further towards personalised learning and away from a one-size-fits-all, monolithic approach. That was expressed much more eloquently and expounded on by the right reverend Prelate. From 2010, each child in secondary school will have a personal tutor, someone who knows them well, checks progress and responds quickly if any problems emerge. Children are being supported to make informed choices. The Government are supporting pupils and students to make real and appropriate choices about their education. We are facilitating informed choices, helping to break down stereotypes, contributing to a reduction in inequality and offering real opportunities.
Greater and informed choice to reduce inequality is also at the heart of the reforms in the health service. This Government have taken on professional interests in the health service throughout our time in government. The Government of the noble Lord, Lord Patten, signally failed to challenge those interests on behalf of patients, and I do not feel that we need to take lessons from the noble Lord on this.
Choice in this context means meeting the growing patient demand for more choice and control over their healthcare, giving more incentives to the providers of healthcare to ensure that they are more responsive to patients’ demands, delivering more equitable access to healthcare by giving choice to all patients rather than the well informed who are able to navigate a difficult system, reducing inequalities between patients through better tailoring of services and involving patients in decisions about their healthcare.
The noble Lord, Lord Krebs, pointed to the contradictions in personal choice and public health objectives. We agree—I have always agreed with the noble Lord—about the need for more rigour. He rightly pointed to tobacco as a very good model. On 10 November, the Government launched our campaign on healthy lives, Change4Life, a strategy in which we aim to promote children’s health and healthier food choices, build physical activity into our lives, support health at work, provide incentives more widely to promote health and provide effective treatment and support to people who are overweight and obese.
Research has shown over and over again that there is overwhelming support for having choice in healthcare. In 2005, the London Patient Choice Project found strong support for choice from lower income groups, at 80 per cent, and the unemployed, at 78 per cent. When offered choice, they used it. Research has shown that the ability of people to access information and/or travel to receive treatment may affect how much they will benefit from choice. The challenge for us is to ensure that all people have the information and support that they need to make the most of the choices available to them. We believe that providing these groups with high-quality support and information to ensure equal access is of paramount importance, and we will ensure that choice does not exacerbate inequalities.
By extending the right to apply for flexible working, for example—an issue championed by the noble Baroness, Lady Morris, in her Private Member’s Bill last week, which I am sure we will debate further when the Equality Bill is published—the Government are determined to support people in having real choice, not just whether or not they work, but the opportunity to work, earn an income and balance the other commitments in their lives, offering choice and reducing inequality.
The noble Baroness, Lady Afshar, described many of the challenges and prejudices that women face in the labour market, and I agree with her that a 22 per cent gender pay gap is shaming; there is absolutely no question about that. However, there is hope for all of us if the noble Lord, Lord Patten, is reading the Government’s equal opportunities website. The noble Lord, Lord Krebs, quoted Dworkin, as did the noble and right reverend Lord, Lord Harries. I did wonder whether I should do so. What I had not appreciated was that this philosophy lies behind the NHS website. I am not sure whether I draw comfort from this.
I apologise if I cannot cover all the points noble Lords raised. I will read this immensely meaty debate and seek to write to them if I do not tackle specific issues. The noble Baroness, Lady O’Neill, raised the issues of representation and equality. Unequal representation signifies an unequal society. We should look to representation—for example, in this Chamber and in Parliament generally—to ensure that all voices are heard. Although we cannot of course legislate for a representative society, my belief is that we should offer greater choice to make that more likely.
The noble Baroness also raised the issue about too many children leaving school without useful qualifications. I have a long answer to that, but I will make one point. This year, 129,000 more young people achieved five good GCSE grades, including in English and maths—the foundation of equal opportunities for post-16s— than in 1997. Gaps in educational attainment are narrowing, not widening.
The noble Lord, Lord Northbourne, as ever, brings to the House the fundamental issues about the quality of children’s lives and the importance of supporting parents in their choices and helping them. However, these are challenges, as the noble Lord recognises, and any Government would face challenges in this area. He is right, however, to say that information and motivation are the key factors. The noble Baroness, Lady Morris, and I agree with him that there is a limit to what Governments can do.
The noble Lord, Lord Dahrendorf, was unlike the rest of us who quoted philosophers and thinkers. I took out my pen and made notes when he was speaking. My noble friend joined me in nodding almost all the way through the noble Lord’s speech regarding the conditions that must be met to make inequality bearable. I shall not repeat them, but I shall treasure them, use them and feed back into the system those parts which might address these issues.
The noble Baroness, Lady Thomas, raised the issue of women suffering unequally in the recession. We recognise that, because women are employed in different sectors disproportionately, particularly in retail and financial services, we do, indeed, have to look carefully at the effect of the recession specifically on women. My right honourable friend Harriet Harman has said:
“Everybody is affected by the recession, but women are affected differently, so we need to focus on that”.—[Official Report, Commons, 27/1/09; col. 161.]
I hope that I have gone a little way towards illustrating that the Government are determined to offer informed and supported choice across a wide spectrum of services. We are focused on reaching the groups that have often been excluded or have been passive recipients of the one-size-fits-all monolithic provision of the past. In taking this approach, the Government are giving people the opportunity to make real, appropriate and informed choices. They are reducing inequality and giving people greater control over their lives.
My Lords, it has been an immensely interesting debate and I have learnt from every single speech. I think that in many ways we have come a long way, as was said by more than one noble Lord, in that debates about choice and equality have lost some of the stereotypical quality that they used to have when some people led the cheering for choice and others led it for equality. Now, we look at a broad array of possible choices and equalities, but I think there has been widespread acknowledgement around the House that you cannot have it all. You can have some choices and some equalities but at the expense of not having other choices and having inequalities.
If there is a remaining area where I think that we may not be, as it were, on a level playing field, or a road going forward—various metaphors have been used—then it is the question of where we think public services that embed choice procedures will lead. We can be optimistic, as I think the Minister was by suggesting that we are moving on to that sunlit part of the playing field in which a greater degree of equality is achieved by the process of choice. That was, after all, the very question that I wished to raise. When do procedures of choice lead to greater inequalities and when do they not? If we accept that representational inequality within lines of work or training and so on are signifiers of an unfair society, then I think that we have a lot of delving to do.
The Minister suggested that we need to go for more informed choice and more guided choice, although I think that “supported” is a more elegant word than “guided”. I believe that informed choice will take us a certain way but, where choices are of a very high complexity, there is a certain gestural and unsatisfactory character to pretending that we can make them all fully informed. I believe that that applies particularly strongly in the healthcare area. Then again, it may be that some forms of support and guidance are really ways of crimping choice.
Therefore, these questions remain open. Many have been addressed in wonderful ways and I thank all noble Lords who have taken part in the debate. I beg leave to withdraw the Motion.