House of Lords
Monday, 11 October 2010.
Prayers—read by the Lord Bishop of Chester.
Introduction: Lord Monks
John Stephen Monks, Esquire, having been created Baron Monks, of Blackley in the County of Greater Manchester, was introduced and took the oath, supported by Baroness Dean of Thornton-le-Fylde and Lord Lea of Crondall, and signed an undertaking to abide by the Code of Conduct.
Death of a Member: Lord Acton
My Lords, it is with very deep regret that I have to inform the House of the death yesterday of the noble Lord, Lord Acton. On behalf of the whole House, I extend our condolences to the noble Lord’s family and friends.
Immigration: Detention of Children
To ask Her Majesty’s Government when they will end child detention in immigration cases.
My Lords, I am unable to provide a date for the ending of detention of children for immigration purposes but we remain determined to end this practice as soon as possible. Working with NGOs, we are designing and testing alternative arrangements to protect children’s welfare while ensuring the return of families who have no right to be here. We are making significant progress.
I am grateful to the Minister for that Answer. Will she make available in the Library every week a list of the numbers of detained children, where they are detained and their ages, so that we can end this practice and monitor it if a list is available for us to refer to? Will she accompany three or four of us to Yarl’s Wood so that we can see the situation there for ourselves?
My Lords, it is perfectly reasonable to make these arrangements. We will certainly be glad to arrange a visit to Yarl’s Wood. The number of children in detention is either zero or two. I cannot give an exact figure as it depends on whether the two children in a family who knowingly entered the country illegally yesterday are still in detention; they may have been briefly. However, the numbers are very low.
Is it not time for both parties in the Government to admit that they made promises to the electorate on this emotive issue which they cannot keep because, if they do, they will end up taking children into care or forcefully separating them from their parents? That admission from the Government is long overdue. We all want to minimise this practice to the absolute smallest limit, but let us be realistic and not make promises which we cannot keep, as the Government have done too often on matters such as this.
My Lords, I do not accept that. We are going to keep this promise. We are trying to go upstream of the previous procedures for requiring families to leave by encouraging voluntary return. We are engaged in that pilot with the help of NGOs. We will, and must, honour an undertaking that we have given.
My Lords, bearing in mind that the Royal College of Paediatrics and others have said that significant harm is caused to children detained for immigration control purposes, why has this process not been brought to an end? Will the noble Baroness give a date when the facilities at Yarl’s Wood and other places of detention are to be dismantled so that such detentions cannot happen again?
My Lords, I wish I could give a date. We cannot do that because, as things stand, we are taking seriously the whole business of how we bring about a situation whereby it is no longer necessary to detain children. It requires time to get the right procedures in place and, if I may put it this way, it is an earnest of our seriousness that we are going into considerable detail to get the right procedures.
Will the Minister consider extending from two weeks to three months the window for families to consider voluntary returns? Is she aware that in Sweden in 2008, 82 per cent of families chose to take the voluntary return route?
My Lords, I am aware that this figure of a fortnight has got around to being perceived as some sort of deadline, whereas a fortnight is the absolute minimum period that the families are given to consider voluntary return. I do not want to set a timetable for the other end. We would obviously like to achieve a high rate of voluntary return which would take place as soon as was possible and at the least cost to the taxpayer.
But, my Lords, the noble Baroness has not answered my noble friend. The coalition agreement states that the Government will end the detention of children for immigration purposes. Her honourable friend Damian Green said on 6 September in the other place that the policy was to minimise the detention of children. Why the change in policy?
My Lords, we intend to end the detention of children for immigration purposes.
My Lords, if, in fact, children of school age and their families are still being detained together, will the Minister assure the House that education in outside schooling will be provided?
The emphasis of our policy is obviously on keeping families together. I trust that we will not be in a situation in which children are detained for any length of period at all; but certainly if they were, education would be a very important factor.
My Lords, has the Minister taken a view on whether families should be deported to countries such as Somalia, Afghanistan, Sudan and Zimbabwe, and particularly on the impact, which could be considerable on those being deported, of sending families with children back to those countries?
My Lords, if there are security factors in place, those of course introduce elements which are not necessarily present in all other cases.
Can the Minister confirm that Yarl’s Wood, which was opened on my watch as a Home Office Minister, remains a removal centre and not a detention centre? As she will find out, if people are reluctant to go and they have children, it is not possible to organise removals economically and humanely by knocking on their doors; nor, if one wants to keep the family together, is it possible to do so other than by the family spending a minimum short period in a removal centre. That is not detention in the normal use of the word.
The noble Lord points to some of the difficulties that arise. In our view, it is certainly not humane to knock on people’s doors and require them to go absolutely immediately to a train or plane. Indeed, removal to a centre such as Yarl’s Wood, which has facilities, is sometimes the right procedure. The situation varies from case to case but we entirely accept that the procedure to be followed should be humane and in the interests of the family, and the children in particular.
My Lords, is it possible to persuade the border agency not immediately to deport children, often by breaking into their homes in the early hours of the morning, but perhaps, as was suggested just now, to give the family a little more time to consider its position and return to the country from which it comes so that the children can be brought round to understanding what is going on? There is a great deal of evidence from the Royal College of Psychiatrists and others to show the huge effect on young children of suddenly being forced out of their homes in the middle of the night and compelled to go to a totally strange environment.
My Lords, I entirely take that point. The Government are trying to learn these lessons, and we are piloting this scheme precisely by going down the road of giving families more time and more options, particularly for voluntary departure. The scheme is absolutely in the spirit of the point mentioned by the noble Baroness.
Disabled People: Dementia
To ask Her Majesty’s Government what steps they are taking to help people with impaired faculties, such as hearing or vision, and concurrent dementia.
My Lords, tackling dementia is an urgent priority and the Government are committed to the delivery of better-quality care for all those with dementia. Ensuring that people with impaired faculties or disabilities receive the best type of care that they require is one of the reasons we are accelerating the pace of improvement through a focus on local delivery and accountability.
I thank the noble Earl for that response. Is he aware that people with dementia who are also blind and deaf have a really difficult life? They are trapped in a kind of living hell and require urgent attention. The Minister said that the Government are accelerating the process. To what extent is that happening, and can he guarantee that the Government will support a campaign to provide all the facilities necessary for people of this kind?
The noble Lord, Lord Ashley, as so often, is absolutely right. Those who have dementia and also suffer from sensory impairment have a particularly difficult time. That is why we have signalled, in the recently revised operating framework for the NHS, that improving dementia care will be a priority. However, the noble Lord may also like to know that we have today published a Written Ministerial Statement, which he can read in Hansard, showing that we aim to accelerate the pace of improvement in four ways in particular: by improving early diagnosis and intervention; by improving care in hospitals; by improving the care of dementia patients in care homes; and by reducing the use of anti-psychotic medications. Those are the four priorities that we think will make the most difference.
My Lords, can the Minister inform the House what steps the Government are taking to ensure an adequate supply of community-based nurses who have been specially trained in dementia care, not least to support carers?
My Lords, an informed and effective workforce is clearly central to the delivery of the dementia strategy. The Department of Health has recently published reports which map the current level of training, and these have been widely disseminated to key bodies involved in providing education and training. Professor Alistair Burns, who is the National Clinical Director for Dementia, is chairing an advisory group that will aim to ensure the development of proper education and training for all staff involved, and he will be engaging with all the key organisations in doing so.
My Lords, the Minister will be aware that family carers have two main concerns about dementia services. The first is that they are patchy and are not uniform across the country and the second is that they are not co-ordinated across acute voluntary, independent and family care. How will the Minister ensure that those two issues are better addressed under the proposals in the White Paper?
My Lords, there are several prongs to the strategy which will be needed to meet the concern of the noble Baroness. One is to drive up quality standards through a proper tariff for these services and another is better regulation of providers. As the House will know, the NICE quality standard was published in the summer, which will improve commissioning to deliver greater efficiencies, not simply in a financial sense but also to deliver a better pathway of care for patients, with a focus on outcomes.
My Lords, can my noble friend tell us whether those with special educational needs have a higher preponderance of dementia? What is being done to address those needs and to drive up standards of care, given that the All-Party Parliamentary Group on Dementia concluded that some care being given to dementia suffers is dehumanising? Can my noble friend please outline what is being done for those people with special needs who are diagnosed?
My Lords, my noble friend has hit on an extremely sensitive and important area. My answer to her is similar to the one I gave on a previous question: we must focus on outcomes. That is the main theme of the recently published implementation paper. This morning, I was speaking to a representative of the King’s Fund, which has done tremendous work in this area. This is one aspect of its work, of which I am sure we shall be hearing more.
My Lords, what policy do the Government have for supporting the learning of British sign language?
My Lords, the right reverend Prelate rightly calls attention to the needs of those with aural disability. The Government’s plans for audiology are in gestation at the moment. Unfortunately, it is too early for me to tell him, but I shall aim to write him a letter at the earliest opportunity.
My Lords, in declaring an interest as chair of the All-Party Parliamentary Group on Dementia, I ask the Minister what plans the Government have to reduce the inappropriate length of stay in hospital of many patients with dementia and other impairments. As that would result in quite a lot of savings, I ask the Government to reinvest those savings in community services.
My Lords, the noble Baroness is right. The national dementia strategy quite rightly recognises the need to improve the quality of care for people with dementia in hospital and that is identified in the new implementation plan as one of the key priorities for action. Of course, the main priority has to be to avoid admitting dementia patients to hospital in the first place, if possible. We should admit them only when it is strictly necessary and we should discharge them at the earliest opportunity. We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve the quality of care for people with dementia and to look after the training of staff in hospitals.
My Lords, between a half and two-thirds of people with dementia never receive a formal diagnosis. That could be improved if GP practices, the mental health services and the royal colleges were to develop dementia care pathways. That was a recommendation by the Public Accounts Committee in the other place in 2008. What progress has been made in developing those pathways?
My Lords, progress is being made thanks to the quality standard published by NICE in the summer on dementia care. That will underpin the outcomes framework that we shall look for in the care of dementia patients. He is absolutely right in what he says: two-thirds of people with dementia never receive a diagnosis in the first place; the UK is in the bottom third of countries in Europe for diagnosis and treatment of dementia patients; and GPs do not feel adequately trained in this area. So there is a lot of work to do.
Taxation: Income Tax
To ask Her Majesty’s Government what rate of interest they propose to pay to people who have paid too much income tax because of mistakes by HM Revenue and Customs; and what rate of interest they propose to charge people who have paid too little income tax for the same reason.
My Lords, HMRC interest rates are linked to the Bank of England base rate and are currently 3 per cent on late payments and 0.5 per cent on repayments. The interest position in instances of error or delay by HMRC is considered on a case-by-case basis.
Underpayments arising from the current end-of-year PAYE reconciliation exercise will not attract an interest charge, provided that people who have been notified of an underpayment contact HMRC and agree a payment arrangement.
My Lords, I am grateful to my noble friend for that helpful reply. The situation in Her Majesty's Revenue and Customs is another example of the problems which have been left by the previous Government. My noble friend will be aware of the disturbing and complacent evidence which was given to the Treasury Select Committee in another place on 15 September. Apart from the uncertainty and distress which has been caused to something like 6 million taxpayers and the minimal rate of interest which is being paid to those to whom Revenue and Customs now propose to refund something, a large amount of money has been written off. What is the overall cost of what has happened in the department, against a background of trying to cut public expenditure?
My Lords, as my noble friend points out, this is another part of the inheritance which we are getting on with having to tidy up. On his specific questions, I can only apologise to the taxpayers who are caught up in this reconciliation exercise. We are trying to make the process as painless as possible. The bills for those owing less than £300 are being written off. That will entail a cost of some £600 million. The cost of the overall exercise, in which 90,000 letters a day are going out between now and Christmas to clear it up, will be up to £10 million.
My Lords, in the light of the very low rates of interest involved in this procedure, does the Minister accept that for most taxpayers, what matters most is not the rate of interest but the speed with which repayments are made? Can he give the House an assurance that HMRC is taking every possible step to make repayments as quickly as possible?
My Lords, it is worth reminding ourselves that the great majority of PAYE self-assessments are done online—by 75 per cent of people who are self-assessed. For that largest group of taxpayers, repayments are in the ordinary course made as soon as two to three working days from filing, although there may be a slight delay in the peak in the year around 31 January. For the sort of exercise we are talking about, repayments are normally made within seven working days. That is indeed the thing to focus on rather more than the precise rate of interest.
My Lords, what is the total amount which is owed to the Inland Revenue in unpaid tax which is now due?
The amount of tax which is now due under this reconciliation exercise is some £2 billion from 1.4 million taxpayers, although, as I said, all amounts under £300 individually, which is for about 900,000 taxpayers, will be written off.
My Lords, the House will agree that underlying the interesting question from the noble Lord, Lord Higgins, is the notion that HMRC should be fair. It seems to be very unfair that the rate of interest charged on unpaid balances is six times greater than the rate of interest provided on repayments when the Revenue for some reason or other has made a mistake. Does the noble Lord believe that HMRC should be fair? Given the extensive misuse of that word on the Benches opposite, will he define for us what fairness in taxation means?
My Lords, the previous Government brought in the current interest rate regime within the past year, and after extensive consultation, on the basis that late payments are calculated at 2.5 per cent over the bank rate and repayments are 1 per cent less than the bank rate, subject to a minimum of 0.5 per cent. This regime is similar to that of other countries ranging from Australia to the United States. Indeed, of the six or eight countries surveyed, Japan is the only one that does not apply differential rates to payments and repayments. So, in that sense, the system does reflect a due degree of fairness.
My Lords, can the Minister reconcile his comments about fairness with the reported remarks in the Financial Times of 19 August from Mr David Hartnett, the Permanent Secretary in HMRC, that he proposes henceforth to take a gentler and easier line on tax avoidance?
My Lords, I do not have the precise context in which Mr Hartnett made those remarks. However, in relation to the PAYE reconciliation exercise that we are talking about, the fact that interest is being waived for people who have underpaid, that balances under £300 are being written off and that those who do have to make further payments will be able to make them over a number of years, particularly where hardship is concerned, represents an appropriate response in this case.
Argentina: Falkland Islands
To ask Her Majesty’s Government what discussions they have had with the Government of Argentina about statements made in the United Nations’ Special Committee on Decolonisation.
My Lords, we regard Argentina as an important partner. We have a close and productive relationship on a range of bilateral and multilateral issues, but we will not discuss the sovereignty of the Falkland Islands with Argentina unless the Falkland Islanders so wish.
The UK is not a member of the UN Special Committee on Decolonisation, but we regularly make clear within the UN our support for the right to self-determination of the Falkland Islanders.
My Lords, that is a most informative reply, but the noble Lord will be aware that some time ago Argentina withdrew unilaterally from the joint commissions on fishing and oil. In the light of the rather absurd statements recently made by the President of Argentina on the subject of oil exploration in Falklands’ waters and other matters, can the noble Lord say whether that represents sensible co-operation? It does not seem to me that it does.
The noble Viscount is quite right that in 1995 Argentina withdrew from the hydrocarbons co-operation declaration and subsequently withdrew from the fisheries co-operation arrangements. We can say only that it is a pity. The benefits to Argentina would be there, were it ready to co-operate, but it has shown a determination not to do so. That is Argentina’s loss.
My Lords, at the time of the Falklands invasion in 1982, the then US Administration were extremely supportive to us in terms of reconnaissance and so on. However, the current US Administration have latterly made some rather unhelpful remarks in respect of the Falklands. Have we made appropriate representations?
I can confirm that the US position has not changed, regardless of the allusions to which the noble Lord has referred. The US recognises the UK’s administration of the Falkland Islands. We are in regular touch with the US on this issue, as on many other issues. We expect that dialogue to continue.
Does the Minister agree that the UN decolonisation committee is normally concerned with the liberation of subjugated peoples rather than the transfer of ownership of islands that are largely uninhabited and are liable to be uninhabitable for a long time to come? Surely the role of the British Government at this time, nearly 30 years after the cessation of hostilities, should be to try to achieve a decree of reconciliation between the megaphone diplomacy of the Kirchner Government and the obduracy of many of the islands’ elected councillors, who do not seem to realise that they live in a world in which their nearest neighbour could be a friend rather than a source of hostility?
Except on the question of the Falkland Islands and its right to self determination, which I am sure that the noble Lord would not be against, we wish with Argentina—an important country and a member of the G20—to establish better relationships. But it is very hard if all the time the counterpropositions and withdrawal of co-operation we have described occur. The noble Lord is touching on a relevant point as regards the decolonisation committee, which is rather outdated and full of language about colonies, British imperialism and so on. We have moved far away from that because the Falklands Islands is a self-governing overseas territory under the British Crown and that is what it remains.
My Lords, will my noble friend explain his views on why 12 Commonwealth countries supported the Argentines in the UN committee? Is that not a source of some regret to us?
It is always a pity when there is not full agreement, particularly among our fellow Commonwealth members with whom we operate closely on many issues. But they have their point of view, to which they are perfectly entitled. The debate goes on, but it is not a binding debate as no binding resolutions are involved. I expect that the debate will continue, particularly among not so much Commonwealth countries but other Latin American countries.
My Lords, the Minister makes the point that Argentina is an important partner. When last did the Government seek to re-engage with Argentina, particularly on the outstanding fishery and oil issues, which clearly are of importance? When, equally, has the Foreign Office sought to ensure that our position as a country is understood throughout the rest of Latin America with our Latin American allies?
I mentioned the difficulty of getting co-operation, which we certainly have on offer, over the two items that the noble Lord mentions. But on other things we are engaged. We are dealing with Argentina as an important country, which, incidentally, is a very beautiful country and is, potentially, a country of great wealth and prosperity. We are dealing with it on science, mining, education and energy. This is a very positive agenda, which we welcome. But on these difficult issues involving the Falkland Islands, we have seen the non-co-operation which we deplore and we would like to see it replaced by active co-operation.
My Lords, I declare an interest as someone who appeared before the decolonisation committee many times in the 1970s, defending the World Bank’s position that it could not lend money to the PLO because it was not a sovereign state. Does the Minister agree that the empty-chair policy is not very enlightened? As we have heard, many Commonwealth countries are members of that committee. Would it not be appropriate for at least the United Kingdom to be present?
The noble Lord obviously has considerable experience on this issue. If he is talking about the decolonisation committee, I am not sure that we are even entitled to be on it. Two members of the Falkland Islands Government have a place on that committee and have made their views clear. I am not sure that those views prevail or are the majority view, but they have made them very clear indeed; namely, that Falkland Islanders do not wish to end their present status. They wish to remain as they are. That is the right approach. If the noble Lord is talking about another committee, perhaps I should have a word with him afterwards about that.
Demonstrations in the Vicinity of Parliament (Removal of Authorisation Requirements) Bill [HL]
A Bill to make provision for repealing Sections 132 to 138 of the Serious Organised Crime and Police Act 2005 and for connected purposes.
The Bill was introduced by Lord Tyler, read a first time and ordered to be printed.
Arrangement of Business
My Lords, immediately after the debate set down in the name of my noble friend Lord Bates, my noble friend Lord Freud will repeat a Statement on welfare reform.
House of Lords: Reform
Question for Short Debate
To ask Her Majesty’s Government, in the context of House of Lords reform, what is their view on the purpose of the House.
My Lords, no one would have enjoyed this debate more than my beloved friend and our good colleague Richard Acton. He loved this House and the House loved him. He made us laugh, but his contributions were always telling and to the point. He was immensely proud to have been reappointed to this House as a life Peer after his service as a hereditary Peer. I was proud to have been his friend. Our sympathies go to his wife Patricia, to his son Johnny and to his family and friends. We will miss him very much.
I am delighted that so many noble Lords have chosen to speak in this debate and that we have been promoted to a prime time spot. I want to debate the purpose of our second Chamber both now and in the context of promised reform. I have no doubt as to the vital role of the House of Lords in the revision and scrutiny of legislation. While I do not agree with much of what the noble Lord, Lord Strathclyde, said in his article in last week’s edition of The House Magazine, he was certainly right about this Chamber’s effectiveness. My experience as a Minister for 10 years, with the many defeats that I suffered, confirms that, but I have no complaints because the Lords was doing its job in holding Ministers to account and improving legislation. However, I did not follow the logic of the noble Lord, Lord Strathclyde, when he gloried in the defeats suffered by the Labour Government but warned off Labour Peers from challenging what he called the “clear mandate” of the elected House of Commons. I am not sure what mandate he had in mind: the Conservative mandate, the Liberal Democrat mandate or the coalition mandate? Which of those mandates said that child benefit would be cut and which of the many mandates will hold on tuition fees?
I remind the noble Lord, Lord Strathclyde, and noble Lords opposite that, in its excellent analysis of the conventions, the Joint Committee chaired by my noble friend Lord Cunningham, in its description of the Salisbury/Addison convention, refers to manifesto Bills—but which manifesto? We are indeed in new territory and I suspect that the noble Lord, whom we all admire, is developing a new convention, which in essence says that the coalition Government ought not to be challenged in your Lordships’ House. This House has won a deserved reputation for its ability to cause Governments to think again, but a Government will think again only if they are defeated or believe themselves to be in danger of defeat, and that means making necessary concessions.
We now have the new circumstances of the de facto majority that the coalition enjoys in your Lordships’ House. No doubt the noble Lord, Lord Taylor, when he winds up, will say, “Well, the Government have already lost some votes”. So they have, but let us see what happens when the heavy legislation reaches us. Let us see what happens when a number of substantial Bills have been through your Lordships’ House. If the coalition is determined to win every vote in this place, the work of your Lordships’ House is bound to be devalued. I say to the noble Lord, Lord Taylor, that he should not dismiss this concern out of hand. It is shared by many Members and is highly pertinent to the more substantive reform of your Lordships’ House, because it goes to the heart of what it is that we are here to do.
The Government have made clear their intent to bring forward for pre-legislative scrutiny draft legislation on Lords reform by the end of the year. This is prior to a substantive Bill being presented to the Commons by November next year. The cross-party group under the Deputy Prime Minister is working on a draft Bill, so this is an excellent time to debate the role of the House in a post-reform world.
All too often, discussions on Lords reform have been confined to membership and the form of election and have shied away from an analysis of the impact of democratic legitimacy on the work and nature of the second Chamber, but surely it is time to grasp that nettle. I have no doubt that, with an elected House, the dynamics will change; an elected House will have a major impact on the Commons and on our constitutional arrangements. Vernon Bogdanor wrote in the magazine Political Insight:
“An elected upper house … would replicate the Commons with its confrontational politics and whipped majorities. It would be more powerful than the current House of Lords, because it would conceive of itself as being more democratically legitimate. For that very reason, it would make Britain more difficult to govern”.
As a supporter of reform, I am entirely comfortable with a more assertive House, but I am puzzled as to why many of my fellow reformers are so reluctant to acknowledge it. An elected Chamber will behave differently—and so it should. Otherwise, what on earth is the point of an elected Chamber? I do not fear for the primacy of the Commons; that is reflected in the Parliament Acts, supply and confidence, all of which underpin that primacy. I know that the noble Lord, Lord McNally, has said that the Parliament Acts should continue to be the basis of the relationship but, equally, I have no doubt that an elected second Chamber will use all the powers at its disposal and I doubt that the conventions will hold very long. After all, they are merely voluntary constraints reflecting our current lack of democratic legitimacy. As Cunningham said,
“conventions … are flexible and unenforceable”.
The debate would be much more honest if the Government acknowledged this and opened up a discussion now. We need to discuss and consider whether we want an elected Chamber to be able to use all the current notional powers of the Lords or whether we need to codify or legislate to define the powers that are considered suitable for an elected, though subordinate, Chamber. I am convinced that we need to do so.
What about secondary legislation? In theory the Lords can veto all secondary legislation. Would an elected second Chamber turn that into reality? Ought it to be able to do so? Cunningham said:
“If the Lords acquired an electoral mandate, then in our view their role as the revising chamber, and their relationship with the Commons, would inevitably be called into question, codified or not”.
The noble Lord, Lord Taylor, may think that those who wish to raise these kinds of questions are opposed to reform and see this as a delaying tactic. He will know that I support reform, but, equally, I believe that unless the issue of powers is resolved now it risks unfolding when legislation reaches Parliament and this reform attempt will go the way of many previous reform attempts.
The House of Lords, of course, will debate this in detail when the reform Bill reaches us. I wish to ask the Minister about timing. In a paper slipped out by the Government just before the Recess, it is stated that the reform Bill will go to the Commons in November 2011. I assume that that would mean the Bill coming to your Lordships’ House in or around February 2012. However, the Session is due to conclude at the end of April 2012, so there will be little time to consider the Bill, particularly taking into account half term, Easter and the pressure of other legislation. Under the terms of the Parliament Acts, if a Bill has had longer than a month in the Lords and has not been agreed to, or the Lords has passed amendments that are not agreed between the two Houses, the Parliament Acts could be used to force the Bill through. I do not think that that would be acceptable.
Let us be clear: this House should scrutinise Bills in reasonable time and not procrastinate or filibuster. This Bill will be of immense importance and it is surely right that we should be given sufficient time to deal with it effectively and for amendments to be able to go back and forward between the two Houses. I hope that the noble Lord will be able to satisfy me on that point and on the Government’s willingness to lead a substantive debate on the appropriate powers for a reformed second Chamber.
My Lords, I feel as if I have bumped into a Radio 4 programme, “Just a Minute”, where you have to speak for two minutes without hesitation or repetition on a given topic. The Question before us, on what the purpose of this House is, is the key question that we need to answer. I believe in the supremacy of the House of Commons. I believe that this House is here to reform legislation and to pass it down to the elected House, which is accountable to the voters, for its consideration. In the end, the Commons must have its way.
I enjoyed the speech of the noble Lord. He was honest enough to acknowledge that making this an elected House, or having an elected element, will change the nature of this Chamber. If we are going to have an elected House, I shall stand for election, but I am not going to knock on doors, saying, “Vote for me. I’m very good at reforming legislation but I won’t do anything to upset the House of Commons”, or, “I am going to do this for you and I’m going to challenge the House of Commons”. I certainly do not think that would be appropriate, because it would undermine the authority of the Commons, lead to conflict and, most importantly, mean that no one was here doing the very important job that this House does.
The Deputy Prime Minister is very fond of telling people that he wants to “repair our broken politics” and that we need reform. I say to those in the House of Commons that they should first put their own House in order, for that is the bit of the system that is broken, and leave this place alone. How many people in this Chamber would stand for election? I suspect very few. What sort of people would stand for election, including me? They will be the B team; they will be the people who could not get elected to the House of Commons, or felt that they were not able to. All the expertise and knowledge which come to this House, and the experience of people who have had careers and done other things—all the things that people complain about a lack of in the House of Commons—would be lost. This Chamber works. Leave it alone. It is not broken.
My Lords, I suggest that we do not regard Lords reform as solely about future changes to the membership of this House. We also need to address how the existing House can and should perform its functions better. A week ago, a booklet was circulated to your Lordships on the work of the House in the past year. On page 19 is set out the policy committees’ reports for the year. Vast areas of public policy are entirely absent. There is nothing on any of the public services, education, health, law and order, energy, transport, defence, immigration or on welfare, yet in all these areas Members of the House possess great expertise which is largely untapped. In my entire five years as a Minister in the education and transport departments, I was never once called upon to give evidence to a committee of the House on domestic policy. Our record as a deliberative assembly—if I may differ from the noble Lord—is not much better. In my year as Secretary of State for Transport and as a Cabinet Minister accountable to this House, there were three major government policy decisions: on the third runway at Heathrow, on high-speed rail and on the ending of motorway construction. The House did not debate any one of those three policy developments.
A century and a half ago, Walter Bagehot said that the cure for admiring the House of Lords was to come and look at it. I fear—if I could dissent from what I know is the consensus in your Lordships’ House—that this is still too often true today. Being objective about ourselves, I recognise that we are diligent and public-spirited, that now and then we strike a chord of issues of public interest and that, occasionally, we act as a constitutional backstop. However, we have failed to develop modern procedures or committees for scrutiny or deliberation, and, across large swathes of public policy, we are practically non-existent as a parliamentary assembly. We need to improve our existing House as well as debating a future one.
My Lords, on that theme of improving the existing way in which we operate, perhaps we could have one reform this afternoon on which we all agree: that is, that we should take charge of the time allocated for debates. It is surely ridiculous that this extremely important subject allows only two minutes for individual Members of your Lordships’ House, while the debate on the Olympic Truce permits 10 minutes.
On the timing of this debate, I am bemused by the noble Lord, Lord Hunt of Kings Heath, because he was the very distinguished co-author of the 135-page, 2008 White Paper. If he wanted to spell out exactly what the role of your Lordships’ House should be, why did he not do it in 2008 and why now?
We have had 100 years of discussion about the role of your Lordships’ House, and it is clear that some want it never to end. Some believe that a snail’s pace of reform is the appropriate approach—some very big and important snails have recently arrived from the other place who clearly take this view—regardless of the fact that they presumably stood on successive manifesto commitments for reform, in 1997, 2001 and 2005. I presume that they also took note of the overwhelming majority in the other place in favour of democratic reform. It is extraordinary that those who want to codify the role and responsibility of your Lordships’ House do not want to go the whole hog and introduce a written constitution, because that is what it is.
The noble Lord, Lord Hunt, may believe that, but I do not believe that many of his colleagues who support hastening very slowly indeed also want a written constitution. This is a ploy to paper over party divisions and delay the very proper parliamentary scrutiny of the draft Bill that is now due next year.
Those who believe in the primacy of the Commons should look carefully not only at the White Paper but at all the previous analyses of the best way to elect your Lordships’ House. I believe in evolution not revolution. Those who insist on pinning down precisely what your Lordships’ House should do post-reform are revolutionaries.
My Lords, the coalition is already making heavy weather of its agreement to replace this House with an elected Chamber, so we must be vigilant. The frank account of the Government’s thinking by the noble Lord, Lord Strathclyde, in our debate in June gave fair warning of the dangers of forgetting principles and playing politics. He talked about the Government’s thinking and said that an elected Chamber would do what we do and have the same powers that we have. He said that its priority was,
“how people get here, rather than what they do once they get here”.—[Official Report, 29/6/10; col. 1666.]
I have heard many clarion calls for radical change in my time, but never one as feeble and unconvincing as that reply that he gave to the noble Lord, Lord Rooker. He might just as well have said, “I know this is topsy-turvy but it’s part of our deal with the Lib Dems so we are stuck with it”.
The Leader of the House was more forthright when he was in Opposition. He raised the same pertinent questions that need an answer now. Commenting on Jack Straw’s White Paper, he said:
“Lords reform is like opening the lid of Pandora’s box: who knows where debate might lead if there is no firm guiding principle behind it? So will the noble and learned Lord answer, just this once, the basic question? Exactly what problem is this package aiming to solve? Is the House too strong or too weak? Is the aim to enable us to defeat all Governments more, with “more legitimacy”, as the noble Baroness, Lady Jay of Paddington, used to say, or what?”.—[Official Report, 7/2/07; col. 714.]
Those were valid questions then and they are even more valid now, so I look forward to hearing from the Government later this afternoon what they have to say on those issues. Vague assurances on a vital issue of constitutional reform simply will not do. Until we know precisely what powers a reformed second Chamber will have, we cannot subscribe to the wanton destruction of this House in the interests of a new political class that lacks the acknowledged expertise and cherished independence of this institution.
Three years ago, the noble Lord, Lord Strathclyde, urged the Labour Government to be brave about the powers of a reformed Chamber. I quote his stirring words. He said that,
“this House has been more assertive since 1999, and government has been none the worse for it. Some of us might say it has been a lot better. If a reformed House kept and used its existing powers with even more confidence, things might get even better still”.
He continued—and I ask your Lordships to mark his words—
“as to statutorily containing your Lordships’ procedures or reducing your Lordships’ powers, I can promise the Minister nothing.—[Official Report, 19/7/07; col. 393.].
That was three years ago. We should promise nothing either. If the Government want a serious dialogue, they must pay more attention than lip service to transparency or face unremitting opposition.
My Lords, I support my noble friend Lord Hunt’s call for codification. As noble Lords will know and as we have heard again today, the key issue that has bedevilled House of Lords reform for so long is the potential for challenges to the primacy of the House of Commons if the composition of this House is elected. I understand those concerns, which arise logically from the greater democratic legitimacy of an elected Chamber. But such concerns are not necessarily justified. They could be an outcome, but they are not inevitable.
I believe both in an elected House of Lords and in the primacy of the House of Commons, and I do not believe that they are axiomatically incompatible. The key to resolving any incompatibility must lie in the codification of the functions of this House—to put beyond doubt the respective roles of the two Chambers and their relationship. Convention and custom, upon which we can often rely successfully in our constitutional arrangements, always need to be scrutinised for their adequacy in radically new circumstances—and a wholly or partly elected House of Lords would be radically new circumstances.
I recognise the deep concerns that are felt about codifying our constitution, and to some extent I share them. But we must also recognise that our constitution has in recent years been subject to a creeping codification with no adverse consequences—quite the opposite, in my view. So I do not believe that we need fear such codification of the functions of this House. However, any constitutional codification raises complex and challenging sets of issues, and this debate has illustrated again the importance of fully exploring them so that that debate can be adequately informed.
For that reason, I conclude with a plea to the Government. The previous Government established a working group—a galaxy of wise and distinguished experts from all the main parties and from none, including distinguished Members of this House, to explore these issues without any assumptions about the outcome. The general election intervened before this group could get under way. Please would the Minister commit to getting that group under way? It makes no assumptions about the outcome or its conclusions, and I have no doubt that it will produce invaluable work that will aid policy-making on all sides of the debate. If he will not convene the group, perhaps he could tell the House why not.
My Lords, on 29 June, the noble Lord, Lord Rooker, asked:
“At what point will the House get the chance to debate what a Second Chamber is for, what it is to do and what its powers are? Surely, all we are talking about at the moment is its composition, which seems to be the wrong way round”.—[Official Report, 29/6/10; col. 1666.]
He was right—hence this afternoon’s debate. However, there are some prior questions. What is any Parliament for, whether unicameral or bicameral? What is its role in relation to government and, in a bicameral arrangement, what are the relations between the two Houses, their respective functions and the basis or bases of their legitimacy? Those questions must be addressed in any consideration of the purpose of the House of Lords. Although in life we often have to get on with practical action without answering all underlying questions, there can be times when to do so implies some definite answer to those questions while they are still being debated. I do not need to quote again what the noble Baroness, Lady Boothroyd, quoted from the rather feeble answer that the noble Lord, Lord Strathclyde, gave to the noble Lord, Lord Rooker, on that occasion, or her comments about it.
Reference is frequently made in debates on this subject to democratic legitimacy, and the assertion is made that only election as we have come to understand it can deliver that legitimacy. It is not enough to assert that principle to make it true. Democracy is used to describe many quite different political systems. In our own society, criticisms are often made of a political class that seems to have lost the confidence of the population at large. The evidence for that is the low turnout in elections, and not what is said in cheap and cost-free comments to pollsters on doorsteps. In trying to understand and respond to why the electoral legitimacy of the other place is not quite all that it is cracked up to be, we really do need to discuss long and hard what we believe society to be and how we call our rulers to account. The Prime Minister may be on to something with his talk of the big society, even though it is rather hard to understand. The current enthusiasm for fairness as a guiding principle also has much to commend it, but again raises more questions than it answers. Even my own favourite yardstick of what makes for human flourishing does not automatically translate into specific policies.
Some things are clear, however. In a complex society such as modern Britain, increasingly a community of communities, it is more important than ever that our political processes are genuinely transparent and accountable. What our representatives do is more important than how they get there. No less important is who they are and the extent to which the rich diversity of peoples in our country have people to speak for them and their multiple needs and aspirations. Unless we answer some of those prior questions about the nature of politics and the role of government and parliaments, it is very difficult to engage directly with the narrower focus of this afternoon’s debate.
My Lords, I think that we are all very clear what the purposes of this Chamber are: first, to act as a revising Chamber with regard to legislation, which was tremendously important in the last Parliament because the House of Commons had virtually ceased to legislate and programmed everything; and, secondly, to hold the Government to account. That was, again, demonstrated very clearly in the previous Parliament, when the Government were more preoccupied with passing Acts on terrorism and so on than with human rights, liberty and so forth. We therefore have tremendously important responsibilities.
I do not propose to repeat the very well rehearsed basic arguments about election and non-election, although I suddenly discover that we have great publicity as a result of the noble Lord, Lord Prescott, pointing out that it would undermine the sovereignty of the House of Commons. He failed to mention that it would also undermine the position of individual Members of Parliament in their constituencies. Instead, I want to draw attention to what seemed to me a considerable danger: that some developments since the election may undermine the status of this House, and consequently make it easier for people to say, “We should have an elected Chamber instead”.
I start with two-minute speeches. I do not recall any precedent for them, but I would be rather surprised if the media do not suddenly say, “Well, here they are, all making two-minute speeches at a new rate of expenses”, then work out the cost-effectiveness of those speeches. The arithmetic is not terribly difficult, but this is not a laughing matter. In that context, one should also say clearly that the bureaucracy has somehow come up with a form for claiming expenses where you have to decide each month what rate to claim, whereas we all know perfectly well that we come here sometimes for a short time and sometimes for a very late-night sitting. We ought to have the flexibility to be able to decide the appropriate level within given ranges.
The other thing that somewhat endangers us is that we are clearly in a coalition now and, as a result, it will be more difficult for the opposition forces to defeat the Government by way of persuasion, whereas in the previous Parliament we certainly had the opportunity to do that by persuading the other parts of the House to go along with us. It appears that that will no longer be the case.
Finally, on the size of the House, again there is a considerable danger that we are getting so large as to be open to ridicule. We ought to be gravely concerned about that, because all these recent developments lead to the position of the House being undermined and the call for it to be an elected Chamber.
My Lords, the role of the appointed House of Lords is entirely clear. It is advisory: to advise on policy, to scrutinise legislation and to offer revisions to it. This House is well fitted to performing that role, drawing as it does on the knowledge and wisdom of the two principal groups of its Members: senior and experienced politicians and very distinguished individuals from many other walks of life. This House invigilates the Government and presses and prods them and the House of Commons to think again, to think harder and to explain themselves. It is never a rival to the elected Chamber. An elected second Chamber could not perform the same role, nor would its ambitions be so modest. Its Members would believe that they had a duty to those who had elected them to use their democratic authority not just to advise and advance a point of view but to insist on what they thought was right. The gentle and persuasive critique of an appointed House would be replaced by the clash of two elected Chambers.
It may be that the Deputy Prime Minister has a cunning plan to define and constrain the role and powers of the elected second Chamber. Perhaps he intends to legislate to entrench the existing conventions, or something like them. There would be two possible consequences of that. The parties could use the list system to place pliant individuals in the second Chamber. What benefit would that be to politics and to the country? It would lose the virtues of the existing House and gain nothing worth having. If the governing party were in the majority, it would reinforce the dominance of the elective dictatorship; if the opposition parties were in the majority in the second Chamber, the second Chamber would become a second arena for the party dog-fight, and no more. Or, if people worth their salt did stand for election to the second Chamber, the lid would quickly blow off the pressure cooker. Those people would indeed insist on what they thought to be right. They would strike down legislation, particularly when they and the country thought that the Government have got it wrong. Armed with democratic authority, they would challenge the primacy of the House of Commons. We would risk legislative impasse between the two Houses.
Codification will not work. We have seen how the European Parliament, the Welsh Assembly and the Scottish Parliament have all gradually gained powers. Elected Chambers will always seek to do that. For the umpteenth time in these debates, I ask the essential question: how will the replacement of an appointed House by an elected House improve the performance of Parliament? To say that it will make the second Chamber more democratic or legitimate does not answer the question. I suspect that the Government are not interested in improving the performance of Parliament. All Governments regard Parliament as a nuisance. We must be on guard to ensure that so-called reform does not weaken Parliament, which is—or ought to be—a restraint on executive absolutism and the safeguard of our liberties.
My Lords, the House of Lords, according to our website, is,
“a forum of expertise, making laws and providing scrutiny of Government”.
As we have heard, we are a check and balance for the other place, a wise counsellor and an adviser. Where those in the other place are inexperienced, we are experienced; where they are partisan, we are objective; where—it could be argued—they are lightweight, we are definitely heavyweight. If only the public understood—and if only the other place understood—the work that we do.
When I look around the Chamber, I struggle to think of another legislature in the world with such a deep well of expertise in every field you can think of. We have healthcare professionals, lawyers, athletes, television presenters, journalists and so on. When one looks at the 100 members of the Senate, one sees that 57 list law as their occupational background, 27 list business and 16 list education—real diversity there.
The reason that 40 per cent of amendments made by this House are accepted by the House of Commons is the quality of this House's advice and the level of our expertise. This would be lost were we to be elected. We have heard that we would challenge the primacy of the House of Commons. This House is unlike any other upper Chamber in the world in the way that it is made up. We do not have to copy another nation or nations. This country has never copied; historically it has always created and originated. We have always led the way. The idea of this Chamber becoming a proportionally representative elected House stinks of the European Parliament. MEPs are unknown to their constituents and have no idea who their constituents are: it is a farce.
In building a business from scratch, I have always tried to change things and build through relentless, restless innovation; but with this House, we should heed the old saying: “If it ain't broke, don't fix it”. To change the nature of the House would be completely to devalue it. The whole purpose of this House as a check and balance would be diluted and destroyed. This cannot happen, because—ironically—it is the appointed House that is the guardian of our nation, the unelected House that is the cornerstone of our democracy.
I believe firmly in an elected House, a House elected indirectly on a list system geared to the result of a general election. Some who are of my view believe that the Cross-Benchers would represent those who have abstained. I believe that the problems raised by the noble Lord, Lord Forsyth, can be sorted out in a new constitutional settlement between the two Houses. My only concern is to what extent during the course of the reform debate we are taking into account the agenda that is being pursued in the House of Commons following the Wright recommendations.
The House of Commons has set up a group called Parliament First. Noble Lords should be far more engaged in the work of that group in the Commons, which is currently dealing with the powers of Select Committees, carryover, the treatment of Lords amendments, the treatment of Private Members’ Bills, pre-legislative and post-legislative scrutiny, the taking of evidence by Public Bill Committees, parliamentary commissions of inquiry, the role of the Merits Committee and a number of other issues, all of which would be affected by any change in the constitutional settlement between the two Houses.
My Lords, the late Lord Hailsham used to say that if the House of Lords were abolished, we would have an elected dictatorship. Sometimes I wonder whether this House in its present state would be strong enough to stand up to a House of Commons of the extreme left or the extreme right with a large majority. An elected senate would be a stronger House. It would also be more democratic, with its Members called senators.
We have to separate the peerage from this House. Every photograph of the House in the press shows Peers wearing robes, which cuts us off from another place and the general public. An elected Chamber is some way off, particularly one called a senate, but I think it is the way we should go.
My Lords, despite the views of the noble Lord, Lord Adonis, I believe that this House works remarkably well. Last week, as has already been mentioned, my noble friend the Leader of the House had an article in the House Magazine in which he set out some of our achievements. We saw off the attempt to kill trial by jury; we cut back the scope of identity cards, which we are now—I am proud to say—going to abolish; and we protected freedom of belief and speech. It is clear that this House serves the public interest. The Question of the noble Lord, Lord Hunt, is about the purpose of the House, though he spoke about powers. My answer as to the purpose of the House is simply that it is to serve the public interest. Any reform must not undermine that.
In my brief time today I will say what any reform of this Chamber should avoid if it is to continue to serve the public interest. First, this House must not become just another place of partisan politics in a pale, or even more highly coloured, version of another place. Elections, which will be controlled by the party machinery, will take us firmly in the direction of a politicised House.
Secondly, this House must not lose the wealth of expertise and experience that an appointments system delivers. We see this in particular on the Cross Benches but all parts of the House possess an extraordinary breadth of experience and knowledge. We must not forget the particular contributions of the Bishops’ Bench. Elections simply will not deliver what our current system does deliver.
Thirdly, we must not undermine the primacy of the House of Commons. As has been said today, it is inevitable that an elected upper Chamber will robustly challenge the conventions that preserve the current balance between the two Houses. We must ask ourselves whether it is more or less likely that another House of elected politicians, jostling for position with another place and stripped of the experience and expertise that we currently have, will achieve what we have achieved in the past. Will that serve the public interest? I think the answer to that is clear.
My Lords, I am thrilled to join this succession of tweeters. The abolition—that is what it would be—of the House and its replacement by an elected second Chamber would be a constitutional upheaval, the outcome of which cannot conceivably leave us with an unchanged relationship between the two Houses. The 2008 White Paper advised us that a reformed second Chamber would almost certainly be more assertive, but rather strangely went on to state:
“A second chamber that is more assertive than the current House of Lords, operating against the background of the current arrangements for its powers, would not threaten primacy”.
This position has been swallowed hook, line and sinker by the coalition Government. On what grounds do the Government make the assumption that “a more assertive House” will wish to continue to operate,
“against the background of the current arrangements for its powers”?
Those of us who claim that an elected House would demand more powers are accused of failing to explain how such powers would be granted if they were dependent on the agreement of the primary Chamber. This is the point. There is of course no guarantee that they would be granted. As the noble Lord the Leader of the House told us on 29 June:
“The view at the moment is that the House should continue to have the powers that it holds and do the work that it does”.—[Official Report, 29/6/10; col. 1666.]
What is virtually certain is that an assertive elected Chamber would none the less demand greater powers. If, as is likely, the primary Chamber refused the demand, the scene would be set for a continuing and bitter struggle between the two Houses. The Government and those on other Benches advocating an elected Chamber clearly do not wish to acknowledge that possibility. Such self-deception is worrying and dangerous.
I have not said anything that has not already been said, but the more people who say it and the more often they say it, the greater the hope that the coalition Government may see the light. I certainly hope that is the case.
My Lords, though I had spent a lot of my life on the political fringes, the range of exceptional experience, ability and independence of view that I found on my arrival to your Lordships' House came as a very welcome surprise and has convinced me that the balance and value of what history has delivered to make today’s House of Lords is more than worth fighting for. What we have is a typical British accident, but one that works supremely well.
As your Lordships will know, normally I find myself making the case for equality and non-discrimination, but on this issue I want to strike exactly the opposite note: that is, that the membership and composition of the two Houses of Parliament are, and must continue to be, absolutely different from each other, for that difference makes all that is best out of the partnership between the two Houses. The crucial difference, of course, is that one is elected and the other is not, and that the elected House is the master and has the last word while the other—misleadingly called the upper House—does not. The Members of the first House, the elected House, are recruited, rather like soldiers in a regimental system, and are bound to each other in solidarity, whereas the membership of this House is much more individualistic and independent. Most of us are selected through a very strict process.
In short, we all have independent experience and expertise that are very different from those in the other place, and we must remain so. Why, otherwise, should we need—as others have said—two different Houses? It is because the deciders—the Commons—may well be able to take a broad view but they have to take account as well of the distinct and often different judgments that emerge at this end of the Building. That very difference—the input from two directions—is the fundamental of our Parliament: in other words, vive la différence. If either of the two Houses was to lose its distinctive quality, which is what would happen if elected Members began arriving here, the mother of Parliaments would become a much less effective place and much less of a model to the world, and the British constitution would suffer a gravely damaging blow.
My Lords, were we to move to a wholly elected House of Lords, in my view we would do immense damage in three directions. First, we would make the job of trying to create a Government hugely more difficult for the Prime Minister of the day. When confronted with the results of the democratic process, Prime Minister after Prime Minister shudders and sends people here to complete his Government. We all know that that is true not just of the previous election but of election after election. That is one reason why we have the marvellous noble Lord, Lord Adonis, sitting here—he could not find a position as Transport Secretary in the other House—and we are very grateful to him for that.
The creation of a wholly elected House of Lords would do immense damage to the House of Commons as Members elected to this House, by whatever method, will not replicate the size and number of constituencies of the other House. The respective elections could not be held on the same day: to do so would be utterly pointless. Elected Members of this House could say to Members of the other House, “I have a much better mandate than you, my friend. I was elected by more people and I was elected more recently, so you just listen to me”. Anybody who thinks that the balance between the two Houses will remain as it is today has another thing coming to them. You do not need to know very much about constitutional history to know that the United States Senate was first an appointed body. Then the House of Representatives was foolish enough to allow the Senate to be elected. Who is top dog now? That process did not take very long and will inevitably happen again, whatever restrictions are imposed on the relationship between the two Houses. This House will say, “I want supply—to hell with the Parliament Act—and I want more Cabinet Ministers”.
The third place where the damage would be done is quite clearly in this House. We would lose the Cross-Benchers, and that would be a terrible thing. There would be no military experience to speak of here. There is none down the other end; you can be quite sure of that. You would lose the Bench of Bishops. I think we made a great mistake in getting rid of the Law Lords. There just would not be the experience. You would have just the B team, the failures and the duds who could not even make it there and who were insufficient in number to make a Government. That is what you would get in this place, and then you would get the pernicious influence of the Whips. I have said enough.
My Lords, grateful as I am for this short debate on the important issue of the function of the House of Lords, I hope that at some point before we consider legislation we will have a proper, full-scale, two-day debate, because the most important issue is: what function do we wish the House of Lords to perform? Once we have decided on that, you tailor everything else to make us able better to fulfil that function.
I regret to say that I agree entirely with what the noble Lord, Lord Forsyth, said at the start of this debate as regards the folly of electing a House and hoping that it will stay the same as the present one. The Scottish Parliament has been in business for slightly over 10 years. It is already seeking more powers. If the noble Lord, Lord Forsyth, were to be elected—I would be one of his constituents because we live in the same part of the world—what would be his platform for election? How would I know whether he had delivered on that platform? We do not yet know, simply because the previous Government, I am afraid, used the term “election” as an emotive slogan and shied clear of trying spell out exactly what they meant. That was probably because they knew that the majority of Labour MPs were against election—as indeed were a majority of Conservative MPs. It is only the Liberal Democrats who carried the day in the House of Commons.
You have the choice of either having re-election, in which case you get accountability—undoubtedly there would be people wanting to get the power to demonstrate to their constituents that they had delivered what they had promised—or not having re-election, whereby, frankly, you have no accountability whatever; you elect me on day one and I do precisely what I want for the rest of the 15 years or so for which I may be elected.
We have at the moment a constitutional convention—the Cunningham agreement. It is vital that we decide, first, whether we wish to change that in any way. If not, we stick with what we have, because we change the Cunningham convention at our peril. We are living in very strange times in politics. Things that would have been thought impossible a year ago are now happening. Coalition government is one; changes in the Scottish Parliament are another; and the Welsh Assembly is becoming a Scottish-style Parliament. If we have an elected House, you do not know where that is going to lead.
My Lords, I spoke in the reform debate of 1999 and now speak in a similar debate, having spent the intervening years outside this place. This distance from Parliament has confirmed for me that the purpose and reform of the Lords is too important an issue to be left as a wrangle between the two Houses, between parties, and over primacy. My concern is rather how we should further democratise Parliament as a whole. I should like to see the issue decided much more by the public; but first we need better to engage and inform them about aspects of the current system which we Members of this House know would be lost in a fully elected membership, but that the public might think are worth retaining.
For example, it would be a tragedy not to keep in some form that part, currently 25 per cent of this House, which is independent from party politics—namely the Cross-Benchers. That is attainable through a mixed membership. Independence brings many beneficial features, including the chance for Members to think, act and vote according to their consciences, and to debate freely the contentious topics untouched by the other place. Indeed, a modern reformed House of Lords should recognise that, rather than being a lesser other place, it could be celebration of public involvement in government.
Rather than narrowing down politics to tighter control by professional politicians, should we not be opening up our second House to the British people? If we retain an appointments system to introduce expertise and life experience into the Lords, should it not be decoupled from party-political involvement, perhaps by bringing ordinary citizens into government of their peers through a jury system, and asking—as indeed our Prime Minister might say—not just what Parliament can do for the people, but what the people can do for Parliament?
My Lords, the theme running through the ongoing debate about the future of this House is the ignorance in the other place of the working and—dare I say it?—the effectiveness of this House. It applies to all parties and has certainly, so far as I can recall, ever been thus. One of the effects of this is the unawareness among many of our colleagues in the Commons of just how well they are presently served in the current legislative relationship between the two Houses. To take one example, flagship Bills have been given six times the amount of Committee time in this House compared with the other place. We pose no constitutional threat.
The pros and cons of an elected House have been rehearsed many times during this debate: the expense, and the problems of finding candidates of sufficient quality. However, transcending all that in constitutional terms are the powers that an elected House would seek—nay, demand. There is only one place that those can come from—the House of Commons, and how popular would that be down there?
Much has been made of the present lack of democratic legitimacy in your Lordships’ House. Perhaps I may respectfully suggest that that is precisely how it should be—no challenge to the supremacy of the other place. Rather, we would do well to build on the present structure of our House, which, it can be argued, is probably working more effectively than it has ever done in the whole of its history, but with one major proviso: we must have a strong statutory Appointments Commission and, indeed, one that is proofed from any gerrymandering on its composition.
Finally, there are two bedrocks which any changes in this House must enshrine, so well articulated by my noble friend Lord Forsyth. The first is the ability of this House to get the Government to think again and the second, which to some degree is a corollary of the first, is to provide that in principle the Government should in the end get their business.
My Lords, I thank my noble friend Lord Hunt of Kings Heath for putting down this Question for debate today.
As a new Member who joined your Lordships’ House in June this year, I am fully aware that this is the second Chamber in our parliamentary system. We are the revising House that sometimes asks the other place to think again. No party has a majority and the Conservative Government have to persuade the House of the merits of their case. However, at the end of the day the will of the Commons takes precedence if no agreement can be reached.
If we move to an elected second Chamber, this noble House will become democratically legitimate. No matter what is put in place to guarantee the supremacy of the Commons, the fact that Members sitting on these Benches are elected will change the whole relationship between the two Houses. That may be something that this House wants to do but, if that is where we go, we have to be prepared to face up to the consequences of that fact.
What we will not get away with is having elections at the same time as the local or European elections on some national or regional PR list system, with Members being returned and this House carrying on as before because we have the Parliament Acts and the Salisbury convention. Maybe we will need a Clegg or a Taylor convention so that we codify how the Government would deal with a newly elected House of Lords elected midway through their mandate. The candidates will have stood on their parties’ manifestos and some Members will have been returned to this House with the democratic authority to oppose specific elements of the Government’s manifesto put to the country some years before.
From my few short months in this House, I suggest that there is much here that the other place could learn from. No one likes change and that is as true of this House as it is of any other organisation or workplace. As we begin these discussions, we should do so with caution, proper debate and careful consideration of the consequences of any proposals for change.
My Lords, the purpose of the House of Lords is to scrutinise legislation, especially legislation which the Commons has not had the time or the inclination to scrutinise; to hold the Executive to account from a less partisan perspective than exists in the Commons; to create and sustain a core of men and women of knowledge and experience with a duty to contribute to public debate in Parliament and outside; and to act as an ultimate backstop to prevent a temporary Commons majority riding roughshod over Britain’s constitution and its people’s liberties. A moment’s thought should convince any objective observer that these functions are best discharged by an essentially appointed rather than elected House.
My Lords, I had the privilege of being Chairman of Ways and Means for five years when the noble Baroness, Lady Boothroyd, was Speaker. Both she and I believe totally in the primacy of the House of Commons. Having said that, I hope that the coalition Government will fully take on board the probing questions which she asked earlier this afternoon.
I have one thing to add: the public trust the House of Lords and at the moment it is a fact of life that they do not trust the House of Commons. We have a very strange situation in that the one part which the British public trust is to be removed or dramatically changed and the other part is just to be tinkered with. As many noble Lords have said today, we are here to revise and to challenge the Government of the day and to do that you need men and women with experience of life and experience of how to legislate. In the 10-plus years in which I have been a Member of the House, that is how this House has proved its validity. However, this House has had an opportunity but still has not acted on the Bill presented by my noble friend Lord Steel. The Bill may need some additional elements added to it, but it is there and could be very usefully implemented.
My Lords, speaking at the end, it seems to me that this debate proves that we are a House in transition. Being a House in transition we have to tread very carefully; for instance, during this period there surely must be a balance of party groups. You cannot have an unelected House of Parliament in transition where one group of unelected party politicians has a majority. Not only is it a mockery of democracy, but it also inhibits our current work of revision. The triumphs of the House, listed in the article by the noble Lord, Lord Strathclyde, and repeated in this debate, happened because the Labour Government did not have a majority in this House. A majority in this House also allows the Government to be sloppy—perhaps the Opposition too, but that does not matter so much.
I know that the public’s attitude to the House of Lords is very mixed, but for how long will they put up with unelected Peers, in a majority, with real power over their lives? In my view, it will not be long because the public are becoming more interested and more informed about the work of this House. As Liz Hallam Smith, our Director of Information Services points out in her paper to the Information Committee, if we are to have a reform agenda, the process will be enriched if we have an informed public. The public are becoming well informed and soon they will ask what is our purpose and what are we here for. It will not just be a matter for parliamentary debate. I look forward to hearing the Minister’s response to that point.
My Lords, I wish to speak in the gap, which is somewhat unexpected in this debate. We are debating the function and not the membership of this House, although they are closely related. The essential function of an appointed House in a democracy is to protect the electorate from any structural or systemic failure in the elected Chamber which leaves them exposed to overmighty Government or the leeching away of their freedoms. I wonder how many of the electorate know that if it had not been for this House, any one of them could, on any day, have been told, without warning, that their name was on a piece of paper signed by the Home Secretary and that they were to be put in detention for three months without appeal and without access to a court, a judge or a jury. We stopped that on the day and night of 10 to 11 March 2005. That is what the House is for and that is what it did.
The other House had lost control of the Government, although they had a huge majority, because the Government control candidature and standing again, and Members’ careers depend entirely on pleasing the party. Therefore, when Members’ salaries increase inexorably, that is a sharpened power which the Whips carry. The need to be elected, the need to be approved and the need to be re-elected are the three elements that caused that trouble and they are precisely the three elements which the current Government are now foolishly proposing to introduce in place of this independent, unelected, unpaid House.
My Lords, my party’s manifesto on House of Lords reform stated that we will hold referenda for moving to a democratic and accountable second Chamber. However, as is rather painfully obvious, we are not in power and therefore await the new Government’s draft Bill with eager anticipation. Will it include mention of a referendum, for example? Almost as fascinating will be the reaction of Conservative Peers. As the Leader of the House has so often told us, and as appears so clear from this debate starting with the noble Lord, Lord Forsyth, they are absolutely eager for reform of this House. Indeed, the noble Lord, Lord Strathclyde, has said it so many times and with such conviction that I almost believe him.
In the limited time that I have, I want to ask the Minister two direct questions. One is about the existing House and the other is about a reformed House. First, the here and now. Commentators and experts rightly argue that since the coalition was formed, the Government have a political majority in this House and can get their way at the first time of asking. Labour never sought a political majority. This House lost its political majority with the removal of the vast majority of hereditary Peers, but it is back again. Therefore I raise this question: is the role of the Liberal Democrats in this House now the same as that of the departed hereditaries? In other words, is it to back up a Conservative Government with their votes when necessary? How can the Government justify this state of affairs? How can the House be an effective revising and scrutinising Chamber if the Government have an inbuilt political majority? This is a question not just of political importance but of constitutional importance and I believe that it deserves an answer.
As regards a reformed House, the question posed by my noble friend Lord Hunt about timing needs an answer and I hope that we will get one this afternoon. Is the Minister confident that there will be sufficient time for the Bill to complete its passage through Parliament, having been debated properly in this House in keeping with its significance as a major constitutional change?
The noble Lord has not been asked to answer many questions in this debate. I have asked two and I very much hope that he will answer them.
My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for bringing forward this short debate and I thank all noble Lords for their contributions. It has been a good debate containing a great deal of wisdom, distilled and concentrated through the pressure of time. It is perhaps a good thing that it was moved from the dinner hour business, so that therefore we have had a little longer to speak. I shall just explain to noble Lords that the time constraints are laid down in the Companion. I hope that we will have the opportunity to discuss these matters at greater length on another occasion because the content of the debate has shown how justified that would be. After all, most noble Lords have an opinion on this subject and views are held with passion and conviction. I shall do my best to do justice to the speeches and hope that I shall be forgiven if I fail to cover every contribution and point raised. However, a number of specific ones were made and I hope that I shall be able to satisfy noble Lords opposite on them.
Several Members raised issues that might be described, as my noble friend Lord Elton observed, as commenting on the nature and character of the House and the style and manner in which it fulfils its purpose. Although not strictly speaking the terms of the debate, I understand why noble Lords consider those issues important and hope to be able to refer to them if I have time. The debate is on the purpose of the House of Lords, and many Members have given examples of what they think that is. The Government believe that its purpose can be summed up as threefold: first, to scrutinise legislation; secondly, to hold the Government to account—exactly the words used by my noble friend Lord Higgins; and, thirdly, to conduct investigations. I hope that this tallies with the view of the noble Baroness, Lady Boothroyd. Indeed, I think that all noble Lords have shown agreement with those three principal purposes of the House.
I will say a little more on each of those in turn, but I will do so in a constitutional context which recognises the primacy of the elected House of Commons. That is the cornerstone of this country’s parliamentary system. The work of this House should complement that of the House of Commons. That was widely recognised by noble Lords. I agree with the noble Lord, Lord Campbell-Savours, that it is increasingly important that the two Houses work closely together, whatever the shape of this House.
Let us turn to the purposes in more detail. First, there is scrutinising of legislation. This House shares the role of law-making with the other place. However, this House, rightly, has a reputation for thorough and detailed scrutiny of legislation line by line. In the 2008-09 Session, Members spent 60 per cent of their time debating and scrutinising legislation. We made 1,824 amendments to Bills. It is a matter of pride in which all noble Lords will share that legislation leaves this Chamber much improved as a result of the thorough consideration it receives here.
I should like to tackle the canard laid by the noble Lords, Lord Hunt of Kings Heath and Lord Bach, about the arithmetic of this House. The arithmetic of this House has not been fundamentally altered by the existence of the coalition. After all, those on the Benches opposite greatly outnumber that of any other single party in this House. An argument will be won by winning the support of noble Lords across the House. It always has been so. Indeed, the Cross-Benchers are there to be influenced and their opinions supported. No Government have a majority in this House, even in coalition. It is argument that is sovereign, I like to think, in your Lordships’ House.
The second purpose is described as holding the Government to account. In their speeches, many noble Lords considered it to be key to the House to hold the Government to account. I guess that that is what is happening at the moment. In the Chamber, about 40 per cent of time is spent this way. Through Questions and debates, this House challenges the Executive and holds it to account. In the 2008-09 Session, noble Lords asked 484 Oral Questions and more than 5,500 Written Questions. Many noble Lords have stood at this Dispatch Box and can testify to the rigour with which noble Lords hold the Government to account. The partially reformed House has no doubt become more assertive, defeating the Government on average on 50 occasions per Session. Outside the Chamber, in the Grand Committee Room, a further purpose is conducting investigations. The Committees of this House are one of its great resources. Their membership draws on a wide range of experience, and their reports are influential and well respected.
While respecting tradition, the House of Lords has also been prepared to embrace change and look forward with a renewed purpose. We need procedures which will help us to continue to fulfil our purpose. Over the past 18 months, this House has made a number of changes to improve its ability to scrutinise legislation and to hold the Government to account—for example, the new approach we have adopted to scrutinise Law Commission Bills. I am sure that the Leader’s group chaired by my noble friend Lord Goodlad will look into the working practices of this House and will propose further improvements. The noble Lord, Lord Hunt of Kings Heath, considers that we should be clear about the purpose of the second Chamber before we consider further reform. I reassure him that the cross-party committee on which served my noble friends Lord Strathclyde and Lord McNally and the noble Baroness, Lady Royall, will consider this issue with their colleagues. As part of their remit, they are considering the function and powers of a reformed second Chamber. There is no reason to suppose that their recommendations will impact on the conventions of the House without them being fully considered by that cross-party committee.
The noble Lord, Lord Wills, asked about the working group to consider the constitutional implications of reform. I can confirm that it will be necessary to put the conventions on a statutory basis to reduce the powers of the second Chamber. A reformed second Chamber should have the powers that this House currently holds. The Government are not setting out to reduce the powers of this House. The cross-party group will be considering the conventions and codification as part of its deliberation. I hope that that satisfies the noble Lord, Lord Hunt of Kings Heath, and the noble Lord, Lord Bach, who also asked about that issue.
Can the Minister confirm that on that basis the House after reform will be left with the powers as in the Parliament Acts, as opposed to the codification of the conventions?
I am not a member of the joint cross-party committee, but the advice I have is that that is the case, that the Parliament Acts will not necessarily be changed as a result of this and that the conventions under which the House currently operates will continue to be the framework in which a future House will operate. I hope that satisfies noble Lords’ curiosity on that point.
A further matter for the cross-party committee will be how to handle the potential risk to the expertise of the House in the independent Members. The committee will address outstanding issues, including the proportion of Members who should be elected. If the reformed second Chamber were mainly elected, there would still be a role for Cross-Benchers. As with the current House, Members of a reformed second Chamber could access expertise and experience in a number of ways, including via the committee system. The noble Baronesses, Lady Boothroyd and Lady Howe, and the noble Lord, Lord Gilbert, asked what role there would be. If there is a mainly elected House, there would be a role for the Cross-Benchers.
Several noble Lords suggested that only an appointed second Chamber could continue to fulfil the functions and purposes of the House as the Government have described them. The Government do not accept that. We believe that elections will not undermine the ability of the House to fulfil its functions but will enhance it. There is no doubt that this House will continue to develop its role during its transition to a wholly or mainly elected Chamber. The Government recognise the need for an orderly process of transition from the current House to a reformed second Chamber. The Government are clear that this House performs its role well and can be proud of the work that it does. We strongly believe that there is not a noble Lord, whatever his or her views, who does not want the best for this House. The Government share this view and hope to have a constructive debate when we publish a Bill in draft early next year. I can assure noble Lords that there will be no pressure to rush pre-legislative scrutiny of this draft Bill. I can almost hear my noble friend the Leader of the House saying it in those terms. Indeed, I am sure that there will be many further opportunities to debate this issue, and I look forward to them.
My Lords, perhaps I may take the noble Lord through the timetable. Before the Summer Recess, the Government published a programme showing that they hoped that the Bill would go to the other place by November 2011. There is not much time between November 2011 and April/May 2012 for a Bill to go through both Houses. Can I assume from what he has said that the intention is that the timetable will be lengthier than that?
I can assure the noble Lord that the pre-legislative process is extremely important. We cannot get a satisfactory resolution of this issue unless all parties to the discussion feel that they have a proper opportunity for debate and for giving their input. At the moment, a relatively small group of people is setting about the task with a purpose. The all-party committee is representative of the senior figures of this House and of the House of Commons. Its draft Bill is the material with which Members of this House will be able to debate and the whole process of pre-legislative scrutiny is vital if we are to get a proper solution to something for which I think that many Lords have indicated their support—that is, the reform of the House of Lords and the bringing about of an elected Chamber.
Can the noble Lord be a bit more specific about what form the pre-legislative scrutiny will take because most of us have no idea?
I would imagine that it will take the form of a Joint Committee of both Houses, but I am not in a position to suggest that form. The draft Bill will be debated by this House. It will be up to this House to determine that.
Olympic Games 2012: Olympic Truce
Question for Short Debate
To ask Her Majesty’s Government what preparations they are making for declaring the Olympic Truce accompanying the London 2012 Olympic and Paralympic Games.
My Lords, it is my privilege to lead off in what I am reliably informed by the House of Lords Library is the first time that the Olympic truce has been debated specifically in your Lordships’ House. Perhaps I may express at the outset to the distinguished list of Members who have put their names forward to speak in this debate how grateful I am that they have rallied to the cause at such short notice. In securing this debate and in my enthusiasm to accept the time slot allotted by the business managers, I failed to recognise that many of the distinguished Members who would have wanted to take part are at the Commonwealth Games in Delhi. In particular, my noble friends Lord Coe and Lord Moynihan have asked me to place on record their sincere apologies. They very much wanted to be here to support this debate, but unfortunately they cannot be.
On 7 October, the noble Lord, Lord Moynihan, as chairman of the British Olympic Association, spoke in this House of the importance of the Olympic truce in his excellent contribution to the millennium development goals debate. Following that, he wrote to me saying that he hoped that the Government would respond positively to this debate. In that regard, our chances of securing a positive response are much improved by the fact that my noble friend Lady Rawlings is responding on behalf of the Government, given her intuitive understanding and commitment to international relations.
The Olympic truce resolution, as passed by the United Nations,
“urges Member States to take the initiative to abide by the Truce, individually and collectively, and to pursue in conformity with the purposes and principles of the Charter of the United Nations the peaceful settlement of all international conflicts”.
Despite this UN resolution being agreed to by all member states, it has hitherto been totally ignored at a government level. Today, the Olympic truce is seen purely as symbolic, accompanied by a flag outside the stadium and a peace wall inside the Olympic village, but that was not always the case.
At the outset of the ancient Olympic Games, the truce was not an optional extra; it was its very purpose—it was not symbolic, but sacred. In 776 BC the Greek king, Iphitos, frustrated at the perpetual state of war, consulted the oracle at Delphi, who proposed a sporting competition every four years that would have as its aim the bringing together of military and political leaders in one place where they could seek to resolve their differences peacefully, with athletes competing together as Olympians rather than as citizens of a city state.
The sacred truce was remarkably successful. The ancient Olympics ran for 1,168 years, until they were ended by the Romans in AD 394, and during that time violations of the truce were extremely rare. By contrast, in the 116 years of the modern Olympiad, the Games have had to be cancelled three times due to war, have experienced major boycotts on five occasions and have twice been the focal point of terrorist attacks. In ancient Greece, people stopped fighting to take part in the Games; in the modern era, we stop the Games in order to keep fighting. What is it that we have lost in 3,000 years of civilisation that makes even today the notion that combatants may exercise restraint during a period of truce such a distant dream? I suggest not that the concept of the truce has been tried and found difficult but that it has been found difficult and left untried. To coin a phrase, I believe that we can do things differently next time.
The reason for this optimism is a remarkable visionary, Jeremy Gilley, a British documentary producer who began a campaign in 1997 to get the international community, through the United Nations, to advance one day of global peace—the campaign is called Peace One Day. In 2001, that campaign was endorsed unanimously by the United Nations—like the Olympic truce—and was proposed by the British Government. In 2007, 2008 and 2009, Peace One Day brokered a one-day truce in Afghanistan between warring factions, including the Taliban. The truce allowed health workers from UNICEF, the World Health Organisation and many other agencies to move into areas hitherto unreachable due to violent conflict. As a result, over a period of three years, some 4.5 million children were immunised against polio. It is an utterly inspiring story, which shows what can be done with just one day of truce, let alone the prospect of 20 or 30 days. This reminds us that the value lies not in the truce itself but in what it allows us to do. When the guns fall silent, the voices of reason have a chance to be heard above the bomb and the bullet and, when the guns stop, the delivery of vital humanitarian aid can start.
Specifically, I urge the Government to consider what initiatives they could take to exploit the opportunities presented by the Olympic truce surrounding the London 2012 Games. Could they consider hosting a G8-style summit on the theme of truce? The aspiration would be to seek to advance the case for peace and reconciliation in the same way that the talks at Gleneagles advanced the causes of debt relief and climate change. Could consideration be given to adding a ninth millennium development goal to create a specific target of reducing the current 30 conflicts around the world by 2015? Given the linkage between conflict and poverty, it is bewildering that conflict resolution is not even mentioned among the current eight goals, 21 targets and 60 measures. Could the UK leverage its unique roles in international organisations—the Commonwealth, the UN Security Council, the European Union, the G8 and the G20—to invite some parties currently engaged in conflict to the UK during the Games to undertake proximity talks, which just might advance a peaceful solution? Finally, could the Government work with Peace One Day to extend significantly the initiatives that it has secured for using the window of the truce to deliver humanitarian aid in the form of vaccinations and immunisations in the most dangerous and unreachable parts of this world? Others in the debate will be able to speak with far more experience and authority as to what initiatives may be possible but, where there is political will, I am convinced that our skilled diplomatic corps will be able to find a political way.
On 14 June, my right honourable friend the Prime Minister, David Cameron, made a Statement on Afghanistan to the House of Commons, in which he concluded:
“Insurgencies usually end with political settlements—not military victories … we need a political process to bring the insurgency to an end”.—[Official Report, Commons, 14/6/10; col. 605.]
This reminds us of the supremacy of politics and the deficiency, in the final equation, of violence as a means of achieving the lasting resolution of disputes. I believe that the Olympic truce represents a golden opportunity to advance a fresh vision of an international society, with the alluring prospect that the legacy of London 2012 will be not just sporting venues, medals won and records broken, but lives saved and hope restored. All that is required for that to happen is that, in their ambition, belief and courage, our athletes on the track and in the field are matched by politicians and diplomats in the corridors of power.
My Lords, I thank the noble Lord, Lord Bates, for raising this issue and for making the debate possible. I have little to say other than to support him entirely in his aims. I hope that the Government and others listen.
I will add just two thoughts, which I hope may be helpful. First, as the noble Lord, Lord Bates, touched on, there has been a precedent with UNICEF, whose days of tranquillity—sometimes called the corridors of peace—have been remarkably successful. There have been about a dozen of them since 1985. As the noble Lord said, most recently, in December of last year, more than 3 million children under the age of five were immunised against a particularly virulent form of polio. That was achieved with the support and co-operation of the Taliban. If you can deal with them, I suspect that you can deal with almost anyone. That is important. Certainly UNICEF would powerfully support the argument of the noble Lord, Lord Bates.
My second, possibly more significant, thought concerns the special symbolism that ties the notion of peace to the Paralympics. I know that Paralympians are not necessarily thrilled when they get separated in any way, shape or form from the Olympic Games, but to me the Paralympics are a special, symbolic issue. There is a tragic and all too obvious link between violent conflict and disability. That link is extraordinarily well symbolised by the presence of victims of conflict—most recently in Afghanistan—in the UK’s 2012 Paralympics team. I mention three. Private Derek Derenalagi, a member of the 2nd Battalion, the Mercian Regiment, was injured in Afghanistan in 2007, losing both legs. He is now a successful javelin thrower and part of Team GB. That is quite extraordinary. Lance Corporal Terry Byrne lost a leg in Helmand province and is now a developing Paralympian cyclist. Jon-Allan Butterworth, a former RAF weapons engineer, lost his left arm in 2007 and is now a part of the Great Britain cycling development squad. These are all extraordinary examples—and there will be more. I have no doubt whatever that, when we are watching on Channel 4 the Paralympics 2012, other victims of the violence in Afghanistan will be representing this country. I cannot think of anything more moving or more symbolic to support the argument that the noble Lord, Lord Bates, is making.
Over the weekend I watched a quite remarkable film—I doubt that it will be seen in many cinemas in this country—called “Lebanon”. When I was watching it, it struck me that you had to have a powerful lack of imagination to have any time whatever for the concept of war. For an hour and 40 minutes, you are inside an Israeli tank in Lebanon in 1982. Anyone who can watch that film and come away from it thinking that there is anything to be said for violent conflict has a breadth of imagination that I clearly lack.
This is about having the imagination and guts to do something that many people think is impossible. However, we know that it is not impossible—UNICEF has proved that it is not impossible—and I commend the noble Lord, Lord Bates, for raising the issue. I hope to God that people listen.
My Lords, I thank the noble Lord, Lord Bates, for raising this subject, primarily because it takes people out of the normal boxes in which they think. A few of us will do sport, a few of us will do international development and a few of us will do other things, and we try to look at them across our little silos. I have often berated parts of government for not talking to each other—indeed I have a standard speech for doing so—but we all do it. This has brought home to me the fact that we occasionally think that sport does X, international development does Y and other things do other things. However, it also shows the power of the Olympic Games as an international celebration and how they can go on to mean something else.
The Olympics have clearly grown in most people’s eyes over the past few years. The ending of the Cold War did more for the Olympics than anything else because it is no longer a “them and us” situation and our bloc doing better than theirs. Looking through the history of the ancient Games, I found out that it was not so very different when the Athenians and Spartans competed with one another in internecine warfare. Did one prefer the totalitarian side that treated its women better or the democratic side that ignored its slaves and kept its women at home and under veils? They were appalling states of affairs and appalling peoples. Let us remember that, just because they gave us nice columns and beautiful buildings and discussed things in public, it was not the ideal society.
However, the idea that a mass celebration—it is not just a nation’s celebration, but a worldwide celebration—should aspire to do something more is a good one. We can celebrate something tangible in a sporting context. That by the time you get to the field you should be on even terms and have a chance to interact as equals is probably the greatest idea of sport. Let us assume that we all have the same budgets and preparation, although here I am possibly going back to my normal silo. If the Games can take place and people can watch, they are surely a very good vehicle for taking forward other ideas.
The London Games have set themselves a very high benchmark in being concerned with legacy. An international legacy that can be built on, or at least a model for our country that other nations can follow, is incredibly difficult to achieve. If London gets it right, it will be surpassed fairly quickly because it will have taken the first steps on a difficult road—we are almost guaranteeing that we will take the first step.
The programme for international inspiration is probably the most interesting of the many projects that are emerging at the moment. The organisers are saying, “We will take this abroad, speak to other nations and try to get young people involved in sport”. Are we going to try to develop the idea beyond our legacy and prepare it for the Olympic legacy? Do we want to leave something that will be remembered and which somebody else can pick up, take forward—it will be Brazil next time—and expand and grow? Hopefully, we may even bring it home one day. If we can do that, we will have done something very special.
When we look at the ancient Games, we always forget the other games that went on at the time and how they became a circuit building up to the Olympics as the major event. I suggest that we try to bring in competitions such as the Commonwealth Games and the various world championships and make them more a part. We were talking about silos. The organisers of the Olympics and the Commonwealth Games like to talk to themselves rather than to each other. Indeed, they have squabbled in the past about which has the greatest participation in certain sports. For instance, I heard doubt expressed for a long time about whether Scotland takes hockey seriously in the Olympics because it enjoys the Commonwealth Games more. If one can see the bigger picture, silly interactions of this type will hopefully be cut down, helping sport along the way.
The noble Lord, Lord Bates, has started a very interesting discussion. I feel that most of us are not well enough prepared to go into it at any great length, so I shall sit down in a few moments. How are the Government making sure that we as the host nation are starting something that can be carried on? How can it go beyond the Olympics and be seen as something else? The truce is a good symbolic start, but if we say that it means simply, “Please stop fighting”, it will not work. It should mean, “Please stop fighting so that we do can something and reach for something”. The truce’s original purpose was to allow people to get to and from the Games without being killed. We should remember the brutality of the state in Greece and where the idea for the truce originally came from.
Let us go further. Then, you had to be Greek, not a trouser-wearing barbarian, which I believe is the ancestry of just about everyone taking part in this debate or listening to it. We can go beyond that and reach out to see how we can touch the rest of the world. When the Minister responds, if she could give us an idea about reaching out so that something that starts with the Olympics will go on and be renewed and given greater incentives at various points, we would be doing good here. We have proved that people are interested in the Olympics. They want the Games and will take time out to watch them. Surely, asking people who are taking time out to watch the Games to take time out to stop killing each other with such vigour is not that big a shift.
My Lords, I, too, am delighted that the noble Lord, Lord Bates, has raised this important subject for debate this afternoon. I would like to speak briefly about the inspiration of the truce for young people and artists. Whereas the role of the Government is very important, the role of other organisations such as LOCOG, the Cultural Olympiad and the Olympic Festival are also important. I remind the House that I am chair of the Cultural Olympiad Board and on the board of LOCOG.
My job and that of the team preparing for Festival 2012 is to make sure that some of the best creative talent in the world and in this country can give their best in the run-up to Games time. It is interesting that as we develop the programme with some of the world's greatest artists, including many of the UK's brightest, one theme keeps returning as an inspiration for the festival’s creative commissions. For many artists, the story of the Olympic truce and the idea of what the truce can do is an inspiration.
In ancient Greece, artists were part of the Olympic celebrations, which meant that when everyone in the ancient world agreed to a truce they came to watch not only the sportsmen but the artists. That idea of intertwining sport and art is exactly what we hope we can achieve in this country in 2012. In 2012, artists will have the chance to speak to the world, and the opportunities are greater than ever before in our history if we think about the millions—or probably billions—who will join in by watching digitally.
Of course, artists will do what artists want to do and we all know that the only way to get the very best shows, concerts, performances, exhibitions and events is by giving them the ability to do exactly that. What is so interesting is that so many artists and talented creative and cultural partners are already turning to the idea of peace and truce as a theme that they want to pursue with their creative work preparing for 2012. It is what they want to say to the world. That is not new if we think back to some of the greatest work in the causes of peace such as Benjamin Britten's “War Requiem”, Picasso’s “Guernica” and the war poetry of Wilfred Owen. But what is so great is that London 2012 is giving a once-in-a-lifetime opportunity to look at that whole theme afresh.
Let me give noble Lords a couple of examples of the sort of projects that the idea of truce is inspiring. On World Peace Day this year, the Cultural Olympiad launched a creative collaboration with the charity Peace One Day, whose founder, Jeremy Gilley, has achieved so much through the power of film, as the noble Lord, Lord Bates, reminded us earlier on. The project that we are working on together will involve young people in creative workshops who will then end up making their own short films in our programme called “Film Nation: Shorts”. The best of those films will be shown in the Olympic Park in 2012 and will be showcased by Peace One Day at its World Peace Day concert at the O2 next year. That scheme for young people is sponsored by Panasonic. I mention that only because its company motto is:
“Peace and happiness through prosperity”,
which is a testament to those important themes that we are discussing this afternoon.
Another example shows how these themes of truce and peace are something of which this country has a lot to offer the world in 2012. I am talking about the experience of people in Northern Ireland and the extraordinary and difficult route taken towards resolving that conflict. For all of us, a highlight of the Cultural Olympiad programme so far has been the Pied Piper project in Belfast, a performance bringing together primary school children and their families from across Catholic and Protestant communities, in a powerful example of the way in which music can foster friendship and reconciliation. The Cultural Olympiad and its festival will have as one of its most important partners Derry-Londonderry city of culture 2013, which like us has put the theme of peace and reconciliation at the heart of its creative programme. We share a passion to show how the arts can illuminate and support the process of peace and will be sharing creative commissions to help Derry to build up its programme in 2013, and a legacy beyond.
The inspiration of the Olympic truce is a powerful tradition of the Games and for London 2012. I am delighted that the inspiration will enrich also our education and cultural programmes. LOCOG intends that from September next year schools will be invited to learn about the principles of building bridges, community cohesion and conflict resolution in a major initiative around the idea of Olympic truce. We are working in 15,000 schools in the UK and building up to working with 12 million young people in schools in 20 countries around the world. I hope that the Government will support this wonderful work.
The UK’s creativity was one of the strengths that won us the Olympic Games, and our arts and creative industries are envied worldwide. We want our festival in 2012 to show the UK at its best and to be a springboard for economic growth and cultural tourism. As Boris Johnson’s cultural adviser memorably said:
“Culture is to London what sun is to Spain”.
Culture is what attracts vital tourist income, and London 2012 is our chance to show the world how wonderful our cultural institutions and creative artists are. I hope that the Government think very carefully about how best to ensure that, come 2012, we show off what sets this country apart: its arts, its culture and its creative industries. We also want a festival that raises the bar for artistic commissions, inspired by the themes of Olympic truce, which future Olympics could find hard to beat. We have the talent and ambition, and we hope that we have the Government’s wholehearted support.
Like other noble Lords who have spoken, I am extremely grateful to the noble Lord, Lord Bates, both for introducing this subject and for the way in which he introduced it, as well as the very practical menu that he has drawn up for government comment. I join those who have talked about the role of sport and art in the ancient Olympic Games. Of course, those noble Lords who actually know the site of ancient Olympia will know that it was a combination of Wembley Stadium and Westminster Abbey. There was constant reference to the temple of Zeus and the sacred truce, which the noble Lord, Lord Bates, recalled, was believed to be policed by Zeus himself, protecting travellers to the sacred territory of Elis for the seven-day period before and after the Games.
There is a beautiful Greek word for the truce—ekecheiria. It meant a holding of hands. That was the vision extended to people. But, as the noble Lord, Lord Addington, remarked, we should not be bemused by, or too idealistic about, these ancient precedents. The terms were somewhat limited, as he suggested. The ancient Greeks were notably pugnacious. Aristophanes made his point about “trousered barbarians” in his play, “Lysistrata”, which describes a sex strike by the women of ancient Athens in a “make love, not war” campaign. The women say:
“In no uncertain terms I must reproach you
Both sides and rightly. Don’t you share
A common cup at common altars
For common gods like brothers
At the Olympic Games?
The world is full of foreigners you could fight
But it’s Greek men and cities you destroy”.
So there was very definitely a limitation on people’s sympathies. That in some way should be an enormous encouragement to us, because there has been an expansion of idealism in connection with the Olympic Games, and we should not cease to underline that point. In the medieval West in the 10th and 11th centuries, there was a “truce of God” movement in the area of modern Europe that includes France and Germany in an attempt to curb the endemic warfare among feudal barons. In some form or other, that truce lasted for nearly three centuries. The modern truce movement has already been described by other noble Lords and, inspired by those precedents, More Than Gold—the ecumenical body which brings together all the Christian churches concerned with making the London Olympics a success—has already pledged itself to support the initiative of a truce. Led by a member of your Lordships’ House, the noble Lord, Lord Mawhinney, it has pushed out that message to some of the bodies with which it co-operates. LOCOG, for example, has already set up an interfaith reference group and this is a major item on its agenda.
Speaking as Bishop of London, I am chairman of London Church Leaders; that group represents the 650,000 Christians who worship at least once a week in more than 4,000 churches in the Greater London area. It includes the Archbishop of Westminster and leaders of free and black-led churches. We have already discussed ways of applying the truce to London, where—I make this point particularly—with experience of street-level work and street pastors spreading in various forms throughout the capital, we see the truce as potentially very significant in assembling the enthusiasm and commitment of young people to combat gun and knife crime. We already have bodies working on that, so we have a network which could make a substantial contribution.
Noble Lords have, absolutely rightly, talked of the international dimension. We are focusing on what can be done in the environs of the Olympic stadium itself and looking for ways of co-operating with other agencies to make the truce effective. Internationally, when your Lordships look at the reach and influence of the great world religions, it will be vital to get them on board very soon. I think of the recent visit of Benedict XVI, in the margins of which was an attempt to see how we could work effectively with Vatican agencies internationally, to push some of the agendas in climate change and development which have been promoted to that important sphere of questions and policies which are beyond the partisan battles in which we all participate. It seems to me that this is another candidate for the kind of co-operation with international faith networks that the Pope was talking about.
The ancient truce was proclaimed throughout Greece by three heralds; we shall need rather more. We will need credible heralds to carry the message to every community in the street around the stadium, and will want to proclaim the Olympic Truce and make our small contribution to the general effort. At St Paul’s Cathedral, we intend to organise an event bringing together not only Christians but supporters of all the nine major, recognised religions in London to proclaim the truce. It seems that we will have to work out very carefully a process of commending this and penetrating the community at depth. We hope that the truce will be proclaimed in every one of those 4,000 churches of Greater London and, because we already have solid interfaith relations, we will be working with friends in mosques, synagogues, gurdwaras and temples to ensure that this really exemplifies one of the things which sold the Games to London—our extraordinary cultural diversity and extraordinary experience of cultural and religious harmony. In that spirit, I once again thank the noble Lord, Lord Bates, for initiating this important debate.
My Lords, the noble Lord, Lord Bates, is to be congratulated on having obtained this debate on an Olympic Truce, and to have done so in good time for thought to be given to the question well ahead of the London Olympic Games in 2012. We have heard a lot about the benefits that the Games might bring to London and to Britain; we have also heard a lot about the legacy that they might leave here after they are over; but we have heard nothing like as much about what Britain could do to bring benefits to the rest of the world when the Olympic Games take place in London. I was delighted to hear the noble Lord, Lord Addington, too, speaking along these lines. That is surely where today's debate, and the concept of an Olympic Truce, comes in, although I can see the point made by the right reverend Prelate that the project for a truce in this city is enormously worth while, too.
It is all too easy to decry the idea of an Olympic Truce, which after all was not invariably effective even among the city states of ancient Greece. It is easy to say that it is hopelessly utopian. Attempts to use the concept of an Olympic Truce in the 100 years or more since the Games were revived have tended to fall on deaf ears, alas, and to be ignored by the parties to violent disputes around the globe, but that is no reason to shrug our shoulders and walk away. Rather, it is a reason to be a bit more imaginative and practical in developing the idea in the context of the London Olympics. It is probably utopian to hope that every conflict will cease temporarily for the duration of the London Games; and it can be argued that a mere cessation of hostilities for a few weeks, followed by their resumption, would not bring a huge amount of benefit. However, the idea of an Olympic Truce is in essence a form of conflict prevention, and the scope for improving on the international community's performance in this field is considerable. Hardly one of the conflicts that have broken out since the end of the Cold War—both those between states and the even more numerous ones within states—came out of a blue sky. Most were preceded by plentiful signs that hostilities were going to break out. What was lacking was not forewarning, but any effective action taken to prevent it happening.
We all know that the cost of successful conflict prevention, in terms of resources, is a tiny fraction of that of dealing with the conflict once it has broken out, so would it not make very good sense to use the occasion of the London Olympics in 2012 to reinvigorate the international community's efforts at conflict prevention? I suggest that any such initiative would need to be focused on the United Nations. Its charter enjoins it to rid the world of the scourge of war, and its track record in conflict prevention over the years has been a good deal better than it is ever given credit for. However, it is short of resources and often short also of that indispensable commodity, political will, without which conflicts are seldom prevented.
I hope the Minister will say that the Government will give careful thought to ways in which the UN's capacity for conflict prevention could be strengthened, and to how best that could be achieved by making use of the occasion of the London Olympics and the noble and ancient concept of an Olympic Truce. After all, Britain plays an important role still at the United Nations as a permanent member of the Security Council and as a major donor to help achieve the millennium development goals that the House debated only last week. Can we not put that role to good use and thus make the London Olympics an occasion that will be remembered for more than just sporting achievements?
In conclusion, perhaps I may do something that is virtually unheard of in this House and complain about having been given too much time to speak—a problem that I notice has assailed every other speaker in the debate. Earlier this afternoon, we had a very important debate in which the speakers were limited to two minutes. Last week, we had a debate on the millennium development goals in which the speakers were limited to four minutes: that is, half a minute per millennium development goal. I am moved to suggest that this is not the way in which railroads ought to be run. I am not asking the noble Baroness to respond—I know that these matters fall to those other than her—but I hope that on the Olympian Areopagus where the usual channels have their meetings, they might think a bit about the absurdity that they create by the rigid application of these rules. Perhaps the noble Lord, Lord Goodlad, who is looking into these matters, might think about that, too.
My Lords, I also thank the noble Lord, Lord Bates, for raising this debate and for kindly reminding me that I might have the opportunity to sneak in and make a few comments as time allowed. I have listened to the discussion with interest. I declare an interest as a Paralympian. The idea of an Olympic and Paralympic Truce is a wonderful ambition, but I wonder whether we might widen it to think about the power of sport to change the world.
The Games themselves are about two weeks of competition, but also so much more than that. They are about the influence we have over physical activity and how we encourage young people to think differently about themselves. Sport has such a strong power to influence society and bring about change. We need only to look at the athletes from countries that won medals at the Commonwealth Games to see not just the celebrations among the athletes but those among people at home.
What I know from sport is that young women who do two hours of physical activity a week are less likely to be teenage mothers, more likely to stay at school, more likely to have career ambitions and less likely to be in abusive relationships. This is something that we should want for all young people. Sport helps set the tone to achieve some amazing things. The truce might be a long way off but maybe we should think about baby steps along the way.
The Olympic and Paralympic Games have huge power to influence and bring about change. By hosting the Games in 2012 we have an opportunity to set a mark for the other countries that will follow us to try to reach. The noble Lord, Lord Addington, mentioned International Inspiration. I have huge pleasure in being an ambassador for that charity, which is about the legacy of the 2012 Games. I recently had the opportunity to travel to Jordan to see the influence that London is having on the rest of the world. There, young girls have the opportunity to play together and learn, which helps them to gain confidence. The Games are a once-in-a-lifetime opportunity that we have to grasp. They are the start of a process of working towards, eventually, I hope, the truce.
My Lords, I add my thanks to the noble Lord, Lord Bates, for securing this debate on the Olympic Truce and congratulate all today’s speakers on their excellent contributions. It has been a glittering cast of speakers, who have lifted this debate far beyond the boundaries that I anticipated. This is something of a first for me. I have taken part in many debates. In some I have been full of confidence, knowledge and conviction. In others I have been less informed but have had enough facts at my disposal to make a half-decent presentation. However, when on Friday I was asked to wind up today’s debate for the Opposition, I was flummoxed. I had never even heard of the Olympic Truce—but not any more. Following today’s debate and the contributions from around the Chamber, and some intensive Googling and trawling through Hansard to find previous speeches over the weekend, I am now happy to pronounce myself fully truce-conversant. In fact, I will undoubtedly declare myself to be a world authority on this matter in the time-honoured way of politicians who have always, down the ages, taken such a stance.
What is the truce about? We have heard much this afternoon. We now know that in 776 BC the peace-loving King Iphitos yearned for the warring factions to cease killing each other—a noble thought. He made what can only be described as a grand gesture, using the four-yearly Games in Athens as a catalyst for change. He decreed that for three months around the Games peace would prevail. Furthermore, penalties would be imposed on any nation that broke the truce. Thus, for more than 1,000 years the truce became part of the Olympic legacy. The king was inspired to this plan of action following visits to Delphi, where he witnessed the Games and consulted the oracle.
I, too, visited Delphi some years ago. I was struck by the magical feeling of the place. It is a place of stunning beauty, high on the side of Mount Parnassus, with an area sculpted out of the mountainside. It is breathtaking. I remember sitting on the sun-warmed stone steps around the sporting arena, looking down and imagining the sporting activities there, and looking even further down beyond the arena to the Sea of Corinth sparkling beneath us. It is a great place for reflection, and a visit to the nearby cave of the oracle gives an even more mystical feel to the whole experience.
As we bring ourselves back to the Chamber today, let us evaluate the proposal of the noble Lord, Lord Bates, that the 2012 Games to be held in London should recapture some of the peace and tranquillity that a truce would bring. No doubt there are many merits. As the noble Lord, Lord Hannay, reminded us, the United Nations sets the tone for this and gives us an object lesson in how it can be dealt with. However, my practical intuition has in its mind’s eye a negative thought, for which I apologise but cannot avoid. I have a vision of a meeting between the noble Lord, Lord Bates, the Prime Minister and all the Ministers responsible for immigration, law and order—not forgetting terrorism—to discuss this very proposal. It is not necessary for me to return to Delphi to consult the oracle as to the outcome of such a meeting, nor do I need to speculate on the headlines that would follow in the Daily Mail and the Daily Express. However, those are first thoughts that we need to look beyond. We need to adopt some of the ideas that have come out of this debate as regards applying previous experience to the present day. As the right reverend Prelate the Bishop of London and other noble Lords so rightly tell us, we have a real opportunity here.
It is a pleasure for me to wind up the debate on behalf of Her Majesty’s Opposition and I do so as a keen observer of the merits of the proposal of the noble Lord, Lord Bates, but I fear that my response can only be delphic.
My Lords, I, too, thank my noble friend Lord Bates for tabling this Question on the timely, important subject of the Olympic Truce. Tributes have rightly been paid to him; he has pursued this matter for some time with much passion. I am truly grateful to all the speakers who obviously care and have made such constructive contributions. I say “timely”, not lightly, as the Government are just starting the process of preparing their resolution on the truce for the United Nations. As is often the case, your Lordships’ House is ahead of the game.
The noble Baroness, Lady Billingham, enlightened us about the Olympics, being a great sporting lady herself, as we all know. I had heard about the truce only because I had listened to my noble friend’s impassioned speech this June. I was fascinated then, and am more so now after hearing all your Lordships’ speeches.
This Government take the truce very seriously and will be taking measures to make sure that it is properly observed and promoted in relation to the 2012 London Olympic and Paralympic Games. The IOC revived this concept only in 1992, calling on the international community to observe the Olympic truce for the duration and to table a resolution in the United Nations in advance of their Games. While each resolution reflects the specific ambitions of the individual host country, they represent a consistent ideal,
“to use sport to promote peace, dialogue and reconciliation in areas of conflict”.
The Government believe—as do many of your Lordships—that the benefits of sport can have a positive influence on individuals and nations.
We have used the UK’s hosting of the Games to promote these benefits directly. The London 2012 Get Set programme explains the Olympic values in a new and engaging way. More than 14,500 schools have now signed up to the programme. The International Inspiration programme is active in 13 countries and has given more than 6 million young people increased opportunities in sport. The noble Lord, Lord Puttnam, mentioned UNICEF, which is part of this. I thank my noble friend Lord Addington, who so often enlightens us on sporting matters, for his eloquent contribution to today’s debate, for his close involvement in the establishment of International Inspiration, and for mentioning the importance of the legacy. I also pay tribute to the noble Baroness, Lady Campbell, and my noble friend Lord Moynihan, who are trustees of the International Inspiration Foundation, and to my noble friend Lord Coe for all his efforts in helping to bring the Olympic values to life.
The UK has actively supported the Olympic Truce resolutions in advance of recent Olympic Games to demonstrate our support for the ambitions of the respective host countries. In doing so we have sought also to highlight the UK’s role as host country for 2012, which we must not forget is Her Majesty’s the Queen’s Jubilee year.
As the host country for the 2010 Vancouver Winter Games, Canada sought to promote through the Olympic Truce the contribution that sport can make to peace. The UK co-sponsored United Nations General Assembly Resolution 64/4 of 19 October 2009 to support Canada’s ambition. Canada’s resolution placed greater emphasis on people with disabilities and the Paralympic Games than previous resolutions. The Paralympic Games were inspired by the Stoke Mandeville games in 1948 and the UK may look at disability as a theme for our resolution. The noble Lord, Lord Puttnam, rightly stressed this idea, and the noble Baroness, Lady Grey-Thompson, reminded us clearly of the importance of the truce in this area.
The Olympic Truce was established around 776 BC to create a period during which the athletes, pilgrims, artists and their families could travel in safety to participate in or attend the Olympic Games and return to their respective countries. The right reverend Prelate the Bishop of London, in his most eloquent and witty speech, reminded us of the sacredness of the truce and of his project involving nine religions. As my noble friend Lord Bates pointed out in his speech in your Lordships’ House on 14 June, the truce was very rarely violated during the almost 1,200-year history of the ancient Olympics. Offenders were sanctioned by suspension from the Games and tended not to reoffend.
Following my noble friend Lord Bates’s two suggestions, first that the Government might consider including in the resolution targets, such as the UN millennium development goals on conflict resolution, the Government have not decided on a theme for the resolution and would be happy to consider all suggestions—many of which we have heard today. That is why this debate is so important. Traditionally, the text of the resolution is not controversial, which enables it to attract wide support from the UN membership. Secondly, he suggested that the UK might organise an intergovernmental conference during the 2012 Olympics. All my noble friend’s ideas are very interesting and we know that many heads of state and government will be in London during the Games but it is too early to say what meetings may take place at the margins. However, the noble Lord, Lord Hannay, with his great experience of the United Nations and his many ideas, is right to say that there is a chance to benefit the rest of the world in conflict prevention and that this idea should be considered. Interestingly, though, the Olympic protocol dictates that no political conferences of intergovernmental meetings take place in the margins of the Games.
The noble Lord, Lord Hall, as chairman of the Cultural Olympiad, delivered an inspirational speech involving schools.
As the host country, the UK will be promoting a fresh resolution calling for the continued observance of the Olympic Truce for the 2012 Games, as has every nation since 1992. The UN General Assembly session will begin in late September 2011 and we expect our resolution to be adopted in October or November of that year.
Once again, I thank all noble Lords for all their suggestions in this debate. It has been perfect timing and most helpful in identifying the areas to be considered for the framing of our resolution. Perhaps I may write to noble Lords who have asked questions that fall outside the debate about the truce.
We look forward to hosting the Olympic and Paralympic Games in London in the spirit of the initiative to provide an exciting and memorable experience for the competitors and the spectators, and to foster a spirit of international harmony and co-operation.
My Lords, with the leave of the House, I shall repeat a Statement on welfare reform made earlier today in the other place by the Secretary of State, Iain Duncan Smith. The Statement is as follows:
“Today’s Statement is in three parts: first, the launch today of a new approach for those on incapacity benefit under the work capability assessment; secondly, more detail on the new work programme, which I will set out; and, thirdly, our plans for wider benefit reform as we look ahead to a White Paper and welfare reform Bill.
The economic backdrop is severe. We have the largest deficit in the G20—at £155 billion, the largest in peacetime history. With net interest of £120 million a day, that is £43 billion in 2010-11. Under the previous Government’s deficit reduction plan, which the Opposition now seem not to favour, Labour’s plans had annual debt interest spending rising in only five years to almost £70 billion.
Reform is urgent. We are at a critical point, with 5 million people on out-of-work benefits, 2 million working-age people claiming incapacity benefit, of which 900,000 have been claiming for an entire decade, and a system that has left Britain with the highest rate of jobless households in Europe. These statistics reveal the human cost of leaving our welfare system unreformed.
With this comes an ever increasing financial cost. The working-age welfare budget rose by 40 per cent in real terms from £63 billion in 1996-97 to £87 billion in 2009-10. A staggering £133 billion was spent on incapacity benefits in the past 10 years, with benefit spending forecast to be over £152 billion in 2010-11—about 10 per cent of GDP. Today, we spend £1 in three on British welfare, yet youth unemployment is higher, inequality is greater and there are actually 800,000 more working-age adults in poverty than in 1998-99.
It is in this context that we also announced reform of child benefit. I do not think that it is right to tax the poor to fund child benefits for those above the higher-rate tax threshold. We can save £1 billion, protect 85 per cent of families and secure fairness as we support people into work. This is tough, but it is fair. At the same time, we announced that we will cap benefits for workless households to average earnings, which are around £26,000. This cap will be net of income tax and national insurance, so in practice equates to gross earnings of £35,000 a year. Equally, we will exempt the disabled and those on working tax credit, so we encourage work incentives. This is fair and we will announce the detail in the spending review.
Today, we launch two trials for those on the old-style incapacity benefits under the work capability assessment. My right honourable friend the Minister of State for Employment is travelling to Aberdeen and Burnley today to see those trials get under way. This is about giving many thousands of people the opportunity to move from the margins of society into mainstream employment. This new assessment will put an end to a system that has simply abandoned people to a life of dependency and exclusion. Under this system, we will assess people on the basis of what they can do, not what they cannot do, and thereby support people to meet their aspirations for work. We are determined to get this right, which is why not only will we learn from these trials, but we have also set up an independent experts group to scrutinise the assessment.
We are committed to supporting everyone going through the assessment. For those deemed unable to work, we will ensure that they continue to receive the support that they need and, for those deemed able to work, we will ensure that they are fully supported to do so. People who are found fit for work will move directly to the work programme, an integrated package of support that will provide personalised help based on individual needs, not the benefit that they are on. Using the best of the private and voluntary sectors, this will help people to get into work as quickly as possible. It will operate a true payment-by-results system that pays providers not simply for getting someone into work but, more important, for keeping them there. We have had 790 expressions of interest from providers to join the programme and in December we will invite bids for contracts ready for national rollout next year.
The work capability assessment and the work programme are critical to helping people into work, but alone they are not sufficient. Underpinning this support must be a benefits system that incentivises work. We have to make work pay. That is why the coalition Government aim to bring forward a White Paper shortly and a welfare reform Bill in the new year.
The introduction of a universal credit will restore fairness and simplicity to a complex, outdated and wildly expensive benefits system. As we get the benefits system working, we can get Britain working—the best way to get the deficit down, drive the recovery and get the economy moving. Welfare reform is critical; it is also the right thing to do—to move people into work and create a pathway out of poverty for the 5 million people on out-of-work benefits. This is a cause that should unite this House.
The new leader of the Labour Party has said that he will not be in opposition for opposition’s sake, so let him and his shadow Cabinet colleagues do the right thing and support us in delivering a welfare system finally fit for the 21st century. I commend these welfare reforms to the House”.
That concludes the Statement.
My Lords, I am grateful for this Statement—although, given that Parliament was sitting last week and given the contents of paragraph 9.1 of the Ministerial Code and paragraph 6.35 of the Companion, it would have been much better to have had the Statement last week. I disagree with the Minister’s characterisation of the macroeconomy, but we can debate that some other time. Suffice it to say, given that the UK has one of the lowest debt-to-income ratios in the G7, the pace of reform is a choice and not an inevitability.
As my right honourable friend the new shadow Secretary of State said today in the other place, we are not against reform and much of the reform is a continuation of what we did in office. But there are of course a number of questions. On the migration of incapacity benefit claimants through the work capability assessment, rolling this out nationally is, as I am sure the Minister would agree, a huge undertaking. What is he doing to increase capacity in the market for providers of those assessments? Furthermore, given the bleak projections by the Chartered Institute of Personnel and Development and others of rises in unemployment due to the speed of public spending cuts, what proportion of providers’ income will be paid by results on the basis of job outcomes? What is the Minister’s prediction of the unemployment rate when the work programme starts next summer? Given that the bidders of the programme are, with their financial backers, having to make predictions on successfully getting people back to work, I do not think that he can any longer hide behind the mantra that I used that Ministers are not in the business of making predictions.
What is being done to encourage employers to take on those who have been long-term sick when, with the claimant count now rising, they could take the recently unemployed, recent graduates or highly motivated EU migrants instead? Finally on this point, what will be done differently by providers in this programme from that done by those who deliver the old Pathways to Work programme with such mixed success, where the private sector did not outperform the public sector?
I shall move on to the proposed benefit cap of £500 per family per week. To some, that may sound reasonable, but it will cover not just the main income replacement benefits such as jobseeker’s allowance, not just child benefit and child tax credit, and other benefits such as carer’s allowance, but crucially it will also include council tax benefit and housing benefit. In many of our urban areas and in the south-east, the high cost of rented housing and council tax means that, if you lose your job and have a larger family, it will not be long before you lose your home as well, as you will not be able to afford the rent. Does the Minister think that that is fair and will really help those families back into work?
As regards child benefit, has the Minister seen the report in Thursday’s Guardian where the right honourable Secretary of State for Work and Pensions said that child benefit will be rolled into the new universal credit from 2017 and will therefore be means-tested? Can he confirm that the Chancellor’s new wheeze for clawing back child benefit from higher rate taxpayers is only temporary? What discussions took place between Ministers in the Department for Work and Pensions, especially those responsible for child poverty, and Ministers in the Treasury before the announcement was briefed last weekend? In the other place today, the Secretary of State claimed that the unfairness of the child benefit changes was due to the unfairness of the taxation system. Has the Minister seen the comments of the Institute for Fiscal Studies, which stated:
“Using the means-test in tax credits could be considered fairer to single-earner couples, and would not distort incentives so dramatically”?
Is it just not-invented-here syndrome that prevents the Government from using the tax credits system to do this?
Finally, the Chancellor repeated in the media last week that his proposed changes would affect those paying the higher rate of tax—about 1.2 million families. That was also repeated by the Secretary of State in the other place. What is the Minister’s latest estimate of the number of higher rate taxpayers who will lose out due to the child benefit changes, given the reduction in the threshold for higher rate taxpayers announced in the Budget? Surely, if the higher tax threshold is lowered as part of moving to meet the Liberal Democrat ambition of a starting tax threshold of £10,000, there will be many more than 1.2 million people affected by this measure.
The announcements of welfare reform are in large part welcome in principle, because they follow from what my party, and I, pursued in government. The announcements about child benefit last week were frankly a shambles. I hope that this Minister, whom I know to be a good and noble Minister, will clarify things for the benefit of Parliament.
I thank the noble Lord, Lord Knight, for some general supportive words, although he also asked some specific difficult questions, which I shall endeavour to answer as they came up. He started off by saying that he welcomed the general thrust and claimed that it builds on existing processes. To be fair, we have tried very hard to build on the present system. There is an argument for being radical, but just ripping everything up and starting again can be dangerous.
Let me start with the noble Lord’s question about the work capability assessment process for people on IB. We are indeed taking steps to increase capacity with the provider, Atos. One control of the process, by which we do it over three years, is exactly to take account of the capacity available.
On the noble Lord’s point about unemployment in general, one of the most shocking stories that I read last week was not in the Guardian but in the Financial Times, which stated on the front page that the total number of jobs that had so far been lost in this recession by people living in this country was roughly 600,000. However, people from outside this country had taken 200,000 more jobs. That tells you something about how we have locked people up in inactive benefits.
The whole point of what we are trying to do with the universal credit and the work programme is to take people out of this trap—being defined as inactive and unable to seek work—certainly on a flexible basis. Once we have a universal credit in place, people will be able to take any amount of work gradually and we can have a great deal more flexibility as we steadily get rid of the 16-hour rule and the 30-hour rule. It is not just about the unemployment rate; it is very much about the nature of the employment that is available. The work programme is designed to take people and unleash their capacity by making them available for the particular jobs that are there.
The noble Lord’s next question was: what will be done differently? He pointed out that Pathways was a disappointment, as indeed it was. It was a disappointment because it was a prescriptive programme based on six work-focused interviews and was underresourced to do very much else. The point about the work programme is that it will allow providers to discover and build on the things that are working. The difference between past programmes and the work programme is that past programmes have looked on outside contractors as a price discovery mechanism, whereas this programme looks to providers to unleash their creativity and the competitive pressure to get the things that work copied and used.
The noble Lord asked whether the £500 benefit cap is fair. Many hard-working families do not achieve a rate of £35,000 gross. It puts things into context for them when people on benefits can get more than that. Therefore, our aim is to cap what people can get. This will come in towards the end of this Parliament and we have a lot of measures, including the cap on housing, to work the process through. So, yes, it is fair.
I was asked whether there is a plan to roll child benefit in with universal credit. At the moment, there is no such plan. Within this spending review, the child benefit change will be introduced in the way described using the tax system as a measure. It is clear that beyond this spending review, once universal credit is in place, there can be decisions to use that, but at the moment there is no such decision.
I was asked about the discussions on child poverty. We have done an immense amount of modelling on the impact of the universal credit. The models change on a regular basis, but the effect of the universal credit at the moment is to take some hundreds of thousands of children out of child poverty. The current model—it may not stay at this rate, so the figure is not rigid—would take 300,000 children out of child poverty and would raise others much nearer the line. It has a most powerful effect on poverty. One of the most attractive things about the universal credit is that it takes a lot of people out of poverty.
I am conscious that I need to give other people time, so I will stop and come back to some of the noble Lord’s other questions.
I thank the Minister for his Statement. I am particularly interested in the work programme and the way he announced that it will bypass the jobseeker’s allowance. Can he give us an estimate of the prospects for lifting people out of poverty as a result of this new programme? Will a big attempt now be made to ensure that that happens as a fundamental principle? The Minister mentioned expressions of interest from providers. Will they include people from the third sector or people who can deal with people who are further from the job market? There is a fear that those who are closest to the job market are the easiest to deal with and will be dealt with by private contracts.
The core difference between the work programme and past programmes is that we are determined to put price differentiation into it because otherwise, as the noble Lord pointed out, the financial incentive for providers is to concentrate on the easiest people. To neutralise that effect, we need to give providers a higher reward for helping the more difficult people. That also has the effect of encouraging the consortia which are formed to be rather rich in terms of their capability. As the noble Lord pointed out, the third sector has some of the greatest expertise in the most difficult people to help. Once you pay for that, it encourages consortia to form which include them. That price differentiation mechanism is one of the most powerful aspects of the work programme for lifting people out of poverty into jobs.
My Lords, I very much support the Government’s approach in their 21st Century Welfare paper on making work pay and on the running particularly of benefits alongside low hour working in order to reduce the risk of returning to work. That approach is absolutely right and well done on that point. However, for most people of whom I have had experience the issue is not whether work paid, because people have an irrational attachment to being in work, it is whether you can reduce the risk of returning to work. If the job folds and as a result you have to go back on benefits, which may take three to four weeks to come through, and you are only two tins of baked beans away from not being able to feed your children, you may prefer the security of a low but steady income than the risk of work. I hope that the Government’s approach on that will identify that problem, but it is to be welcomed and very much supported.
I have two key questions, to which my noble friend referred, on child benefit. Perhaps the Minister can help us. One shocking consequence of the proposals is that at the moment, if you are on child benefit, through the passporting of HPP—home protection payment—being a carer of a child until your youngest child is 12 years old gives you credits into the state pension. Women who stay at home to bring up their children—all credit to them—whose husbands earn above £44,000 will lose their child benefit. At the moment, those same mums will simultaneously lose a huge chunk, potentially, of their state pension credits. That is completely and utterly unacceptable. If that is not amended, I am sure that this House may have a view which differs from that of the Minister as at present exposed. It would be good if he could help us on this. To penalise stay-at-home mums twice over with the loss of child benefit and the loss of credits into the state pension is completely unacceptable.
Secondly, I turn to the connection between JSA and HB with the threat that HB will be cut after 12 months on JSA. This assumes that what is stopping people on JSA after 12 months going into work is their unwillingness to work and that, therefore, they need to be sanctioned by an additional sanction of 10 per cent on their HB. On this point, I should declare my interest as chair of Broadland Housing Association. I had the stats done for me by the House of Lords for July. In July in Norfolk, 15,900 people—just under 16,000 people—were on JSA. The number of job vacancies in Norfolk was 3,500. The people who get those vacancies will be those who have been most recently made unemployed because they are the most attractive to the employer. Those of us involved in social housing will have on our books young people, who are sometimes difficult to place in jobs, who will have been on JSA for far more than 12 months by virtue of the job shortages that currently exist. Yet they will face a sanction of 10 per cent on their rent.
As a chair of a housing association, I can either accept that rent arrears will mount or I can evict them. They will become homeless and then they may squat. But if I keep them and their rent arrears go up, I do not have the money to put in the solar panels et cetera to reduce the fuel poverty of elderly people. What choice would the Minister have me make? Should I evict those young people who through no fault of their own cannot get a job where there are 16,000 people unemployed and 3,500 vacancies or deprive elderly people of the opportunity to reduce their fuel poverty? No Government should force socially responsible landlords into having to choose between those two categories. I hope that the Minister today will assure us that that will not be the choice we will have to make.
I thank the noble Baroness, Lady Hollis. Again, I take comfort from her general support for the universal credit. The point I would like to emphasise is that because we have two systems, an out-of-work benefit system and an in-work tax credit system, the risk of moving from one to the other is enormous. One has only to experience doing a job which does not work out, having to fall back into out-of-work benefits with perhaps a delay of three months as the bureaucracy is sorted out and thus not being able to afford the baked beans mentioned by the noble Baroness, to realise that that kind of risk is highly unattractive. We have created a very conservative group of people who should be prepared to take that risk, by which I mean conservative with a small “c”. On child benefit, we have not made a full announcement of what is going to be in the spending review on 20 October, at which point the detail will be revealed, so I am not in a position to answer.
On the second point made by the noble Baroness, noble Lords will be aware that what we are looking at in the numbers is flows. Any work programme tries to balance the disadvantage experienced by people who have been out of the job market for a period and what it takes to get them back into work against those who have only just lost their jobs. Effectively, that is what all programmes try to do. Clearly, we need to ramp up the speed with which we can get people back into work, and this is one measure that is designed to encourage and put pressure on them.
My Lords, one of the Government’s aims is to reduce the number of employment support claimants by around half a million. I respect the Minister’s expertise in this area and, indeed, his commitment to produce a more efficient system. However, can he assure the House that he will not introduce, for example, the time-limiting of benefits to six months or a year, as has been mooted, for people with severe and enduring mental health problems and other long-term disabilities? Has he made it clear to the Chancellor of the Exchequer that the cost of long-term hospitalisation of these people if their benefits are removed will be a great deal higher than maintaining them on benefits? Finally, will he delay the introduction of the new medical tests until the evidence makes it abundantly clear that they are fit for purpose for all, including for people with fluctuating and long-term disorders, most particularly of course for those with severe and enduring mental health disorders?
I thank the noble Baroness for those questions. We do not have a target for the transfer of IB claimants into JSA, but we estimate that 23 per cent will move straight over. However, it is an estimate and one point of the trials that have been launched today is to find out what the figure might be. The process by which we move people over from IB to ESA means that a substantial proportion will move on to unconditional support allowance so that they are fully supported. However, we would like to make sure that the work-related activity group within ESA moves through the process so that it does not become another place to park people. We are therefore looking at ways to ensure that those in the work-related activity group move through so that they go into JSA as fast as possible. The worst thing is for people to remain inactive for a week longer than necessary.
My Lords, my noble friend will not be surprised to learn that I am broadly supportive of the plans he repeated today. However, I wish to ask a specific question about the Atos programme of work capability assessments for those on ESA—in other words, the programme to ascertain which people currently on ESA are suitable to move into work preparation and perhaps into work. My noble friend will have noticed that recently there have been big complaints in the press about the work capability assessment. There was a suggestion in at least one of the papers over the past few days that 40 per cent of people who have been assessed as capable of work or working towards work have successfully appealed. My right honourable friend the Secretary of State said in the Commons that actually around 5 per cent were successful in appeal. None the less, it seems that the assessment needs to be looked at critically. Can my noble friend give me an assurance that it will be?
I thank my noble friend Lord Skelmersdale for his question on the work capability assessment. He will be aware that there has been an internal review of the work capability assessment and that four changes have been made to it. In practice, these changes will come into the work capability assessment next spring. On top of that, in June we employed Professor Malcolm Harrington to review how the work capability assessment worked on an annual basis. He is supported by a scrutiny group, which includes Paul Farmer, the chief executive of Mind, and three others. I mention Paul Farmer in particular because of the importance of mental health and the fluctuating conditions to do with mental health. We are determined to make sure that the work capability assessment does the job it needs to do.
My Lords, I welcome the Statement made by the Minister to the effect that we have to make work pay. I agree—but does that mean that the Government will be inclined to bring pressure to bear on low paying employers to ensure that they are prepared to pay a living wage? I do not see why the taxpayer should subsidise employers who are paying extremely low wages.
As to unemployment, I suggest that there may be particular difficulties in certain areas of the country where manufacturing industry used to exist and does not exist any more and there is a decline in suitable work for people. What steps can be taken in such areas to ensure that there is work available for people who can demonstrate a capacity to work but where there are no jobs available because of what has happened to local industry? Where the local industry does not provide jobs, because there are no jobs, people are simply resigned to spending the rest of their lives on benefit.
I thank the noble Baroness for that. She makes the real point that if we do not get the universal credit right we could encourage underpaying employers. We are fully aware of that and are looking into the situation. On her other point about unemployment black spots, it is always a tragedy when an area loses its economic rationale. However, what makes the inevitable adjustment process worse—and perhaps stops it—is a benefit system which hides people away. The shocking story of Merthyr Tydfil is an example. When the steel plant there closed—I do not have the exact figures—there were approximately 4,000 people working in it; two years later there were 3,800 people on incapacity benefit. That meant that no potential entrepreneur or employer would go to that part of the world thinking there was labour there to be used because the system had locked that labour away. If we can get people back on active benefits, we will at least encourage the necessary, and sometimes painful, adjustment process to happen at the fastest speed possible.
My Lords, perhaps I may return to the important question raised by the noble Lord, Lord Skelmersdale. Does the Minister accept that there is real concern about whether the work capability assessment is fit for purpose? In the pilots established in Aberdeen and Burnley, will Professor Harrington be able to look at the medical versus the biopsychosocial dimensions of the tests? Some of us believe that the tests are far too medical. My experience working with the Wise Group suggests that people have not medical problems but biopsychosocial problems, which do not admit of an easy medical solution. Will Professor Harrington be able to look at that and give advice to the Government on improving the tests?
I thank the noble Lord, Lord Kirkwood, for concentrating on the important issue of what good health and ill health are, which is extraordinarily difficult to pin down. I am sure that he believes as I do that the well-springs of health are around basic social skills and a sense of meaning and community. When we put people on inactive benefits, we are taking away from them the well-springs of health. It is vital that we help people back into work, which is such an important contributor to their psychosocial well-being. We will watch the WCA very closely to make sure that it does its job, so that we can have the opportunity to get people back to work.
My Lords, I apologise to the Minister for missing the beginning of this Statement, but I have listened with great care to what he has said in response to questions. I think that all of us in this House will share the objective of supporting back into work those who are able to work. However, all this is predicated on jobs being available. The Minister spoke about 600,000 jobs having been taken out of the economy already. The Government’s own policies, particularly public service expenditure cuts, are destined to lead at a conservative estimate to about half a million jobs being lost, with an equivalent knock-on effect in the private sector. There is some difficulty therefore in encouraging people to go back to work while the Government are taking away the very jobs that they can do. What discussions has the Minister had with ministerial colleagues? What discussions has the Secretary of State, Iain Duncan Smith, had with his ministerial and Cabinet colleagues not on job cuts, which we know have taken place, but on job creation?
I thank the noble Baroness for that question. The state of the economy is a fluid entity in terms of where jobs are. While jobs may be lost in some areas, new ones are created elsewhere. We have already seen a good pick-up: 280,000 people went back to work in the last quarter. Independent forecasts for the next couple of years from organisations such as the IMF and OBR are for 2 to 2.5 per cent growth. That would create net new jobs. The jobs will be there, but they may be different jobs.
Order. I am afraid that the time is up and we must move to the next business.
Health: Neurological Conditions
Question for Short Debate
To ask Her Majesty’s Government what is their assessment of the role of allied health professionals in maintaining the health and social well-being of people with long-term neurological conditions.
My Lords, the notice of the opportunity for this debate was very short, but the topic is an important one and I am delighted that we are debating it this evening. I thank those who are speaking. I know that in some cases they have had to alter their arrangements to enable them to be here and that many others who also have a particular interest in or knowledge of the subject cannot be here today.
I start by giving noble Lords the Royal College of Physicians’s definition of long-term neurological conditions:
“Long-term neurological conditions (LTNCs) form a diverse set of conditions resulting from injury or disease of the nervous system that will affect an individual for the rest of their lives. They include: sudden onset conditions (eg acquired brain injury of any cause (including stroke), spinal cord injury) intermittent conditions (eg epilepsy) progressive conditions (eg multiple sclerosis (MS), motor neurone disease (MND), Parkinson’s disease (PD) and other neurodegenerative disorders) stable conditions with/without age-related degeneration (eg polio or cerebral palsy). Taken together, LTNCs are more common than most clinicians realise. Some 10 million people in the UK are living with a neurological condition which has a significant impact on their lives, and they make up 19% of hospital admissions”.
Many of us would be glad to learn the precise definition of allied health professionals. There are 15 health professions registered with the Health Professions Council, including speech and language therapists; radiographers; therapeutic radiographers; and prosthetists and orthotists, who mainly make artificial limbs—two different words but the same profession. There are also podiatrists; some still use the word “chiropodist”. A podiatrist is principally concerned with keeping patients steady and supported on their feet. The aim is to reduce falls, which are a main cause of serious injury and hospital admission for people with long-term neurological conditions. It is interesting to learn that Botox injections in the ankle and foot may help patients with cerebral palsy.
There are also physiotherapists. Some call themselves chartered physiotherapists, but they are the same profession whether they are chartered or not: it is just a distinction. There are paramedics. Television has made us all familiar with paramedics and it is interesting to see how their roles have developed and are constantly expanding as new treatments are discovered and put to use.
There are also orthoptists, who look after eye health; occupational therapists; dieticians; art, music and drama therapists; hearing-aid dispensers; practitioner psychologists; and clinical scientists. A clinical scientist oversees specialist tests for diagnosing and managing disease, advises doctors on using tests and interpreting the data, conducts research and devises new therapies.
Each of those professions plays a significant part in the care of long-term neurological conditions. Often, their work is interrelated. It is always to the benefit of the patient and makes the difference between maintaining quality of life and losing that quality. Usually, a multidisciplinary approach is needed and used.
Many Members of the House will know of my personal interest, but I will formally declare it again. My eldest daughter, Sarah, was diagnosed with multiple sclerosis at the age of 21. Now, 30 years later, she continues to make the most of life and plays a full part in the community. She is a patron of the Multiple Sclerosis Trust and only this year became a council member of the Royal Horticultural Society. She knows, as do all of us in her family, the real difference that allied health professionals have made in her life. Under the care of the National Hospital for Neurology and Neurosurgery, she has an excellent consultant neurologist, but the practical help and advice for everyday life is given by allied health professionals.
AHPs are important to people with long-term neurological conditions, as they provide a vital input throughout the whole disease process—I emphasise the whole disease process—from early intervention to prevent disability, through the management of complex symptoms, to end-of-life care. For the National Health Service, they provide effective management of admission and discharge from hospital, thereby minimising hospital admissions and reducing length of stay. Maintaining people at home, thus preventing in-patient admissions, is very cost-effective for the National Health Service; £2,000 is the minimum cost of any admission. The use of specialist expertise to manage specific symptoms including those related to cognition, fatigue, pain, spasticity, speech and swallowing improves quality of life for the person with the condition, enabling people to maintain important life roles, such as working or looking after their family, reducing the cost to UK taxpayers. Interventions also prevent additional complications through treatment.
Allied health professionals enable people to self-manage and to remain within the community, again reducing national health costs. Allied health professionals bridge the gap between health and social services, working with people in home, work and leisure environments. In the current climate of wishing to ensure that health and social services are working together, the allied health professionals are vital. They are well placed to work with the new GP consortia to engineer service redesign and provide leadership for services. Multidisciplinary teams can provide a holistic and co-ordinated approach to intervention.
Professor Alan Thompson at the National Hospital for Neurology and Neurosurgery at Queen Square stated that,
“any model of care for MS has to have both breadth and expertise to address the wide range of problems and the flexibility to cope with variability, unpredictability and changing pattern of need”.
I believe that applies to all the long-term neurological conditions set out in the definition from the Royal College of Physicians.
Physiotherapy is probably the best known of the functions carried out by the allied health professionals. Although familiar to all, it is not always appreciated that benefits are not only physical but psychological and socio-economic. I was rather shocked to learn that there is not a single specialist physiotherapist for the 4,000 multiple sclerosis cases in Northern Ireland, and I wonder why that is so. For people with motor neurone disease or multiple sclerosis, physiotherapy cannot regenerate tissue that has been destroyed, but works to maintain functional strength, endurance and independence. In Parkinson’s disease, physiotherapy helps to maintain general levels of fitness and enable patients to maintain independence for themselves. It helps to prevent or manage falls, for example, by working on specific balance training. A physio usually works with an occupational therapist to look at ways in which to free the home environment of hazards. The Parkinson’s Society refers to the vital role of allied health professionals in neurology in treating the individual patient and not just the condition; it is important that each patient receives the therapies that they need at the right time to ensure the best management of their condition. That will prevent unnecessary deterioration and reduce the burden on the health and social care system.
Radiographers are necessary in diagnosis to provide accurate imaging examinations. The importance and limitation of the short window wherein a scan can benefit a person who has suffered a stroke has often been discussed in your Lordships' House. Speech and language therapists not only help with speech—a most necessary task to restore confidence after a stroke. They can also help patients with swallowing difficulties, which can occur in various conditions due to changes in mouth secretions. Podiatrists provide essential assessment and foot care for a wide range of patients, including those with cerebral palsy and peripheral nerve damage. Those podiatrists specialising in biomechanics are particularly relevant to the elderly. Dieticians are the only qualified health professionals who assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Their input is of great value in hospitals, care homes and the wider community.
Each of the allied health professions plays a vital part in the treatment of people with long-term neurological conditions. I have spoken about some of these professions, but my speaking time is over. I pay tribute to all for the wonderful job they do and recognise that it is the working together of those professions that makes them so effective. As long as people have these neurological needs, they will continue to need and value the great work being done by the members of the allied health professions. The points I have made summarise why all long-term neurological conditions are difficult for the NHS to manage, but the allied health professions are having a real impact.
I have not spoken about dementia but I am delighted that the noble Baroness, Lady Greengross, is here and I hope that she will do so, as it is so important in our lives. I would be glad to hear the Minister confirm that he understands the importance of the role played by the allied health professionals and that their work with patients will continue.
My Lords, I am grateful to my noble friend Lady Gardner of Parkes for obtaining this debate, because the conditions which we are considering are not glamorous. They are not the kinds of thing that excite public interest all the time. It is important that there are thoughtful, committed individuals like my noble friend who, from time to time, bring this back to your Lordships’ House to help us focus on this important area of medicine and health and social care.
I shall pick up from where she finished her speech: paying tribute to those allied health professions who are involved in the care of chronic neurological disorders. It is of course difficult to deal with any kind of serious illness, but particularly when you know that these conditions are chronic and are, in many cases, simply not going to go away. For those of us involved in medical care, a degree of excitement is present when you see a problem, can get involved and know what to do to bring a good outcome. You can receive great personal satisfaction from that, but there is not that excitement when the conditions are generally not of that kind. You know that a long-term, dogged commitment is necessary. I take the opportunity of paying tribute to those allied health professionals who continue on with this kind of work not just week after week, or month after month, but year after year after year. It is extremely important.
From a medical point of view, these conditions induce a certain amount of appropriate humility because the neurological conditions in general are not ones that we know very much about how to cure. We can often diagnose them, sometimes rather accurately, and do lots of tests to demonstrate all the elements of them. Yet at reversing or curing them—relieving the patient completely of the problem—we are not so good. In fact, the truth is that the amount of useful work we can do in diagnosis and treatment is much less than the value of the management that can be provided over a long term by allied health professionals.
In many ways, while is important to have some of the time and expertise of the neurologist it is often more important to have the long-term commitment of the physiotherapist, who is able to help you manage the problem—and here is one of the difficulties. While physiotherapists are vital, there is what we have come to describe as a churn or turnover of them. It is fairly inevitable to some extent, but the long-term care is difficult if you have a lot of turnover. Can my noble friend the Minister say anything about how we can encourage the long-term continuity of care in nursing—particularly community nursing care—and physiotherapy, rather than the rather fast turnover that there sometimes is?
The second thing I will say is about not just the importance of physiotherapists, but the significance of other allied healthcare professionals. It is becoming clear to us that, while it may be more scientifically and technologically interesting to do lots of complicated, high-tech, expensive scans, things like art therapy, music therapy and hydrotherapy—physiotherapy exercises in a pool—often are much more important. They make a difference to people. For example, we know from recent research that people who have had strokes and have music therapy often recover more quickly and more completely than people who do not. We do not always know why, but it seems that some of these other professions are able to help.
The Minister would be astonished if I did not raise the question of counselling and psychotherapy, and of the importance of the input of those professions to those who are suffering from chronic, long-term conditions and to their partners and families. Chronic conditions affect not just the person but everyone with whom they live, and sometimes counselling of a didactic or emotional kind is helpful and necessary to sustain the person with a chronic disorder and their family and partner or spouse.
The noble Baroness, Lady Gardner of Parkes, mentioned music therapists and other health professionals. She rightly said that a large number of them are already regulated by the Health Professions Council. As the Minister knows, that is not true of psychotherapists and counsellors. I will use this opportunity to ask him—because I never fail to use such an opportunity—how we are getting on with the question of regulation, because as we move toward more decisions being made at a local level about which services to commission, commissioners quite properly will want to see regulated professions employed. If we do not have regulation of psychotherapists and counsellors for these kinds of condition, commissioners are likely to be wary of employing them—understandably so.
The third and final area that I will touch on is what is sometimes described as multidisciplinary teamworking. It is clear that an enormous number of people are required to be involved in managing these conditions. The Motor Neurone Disease Association calculated that on average 18 healthcare professionals were involved with any patient. Some of this is terribly important and valuable. There are lots of areas of life that are adversely affected when somebody has a chronic, long-term neurological condition. However—this is a delicate matter, not particular to these disorders—we must be careful sometimes in the health service that we do not simply make yet another referral and add on yet another person who does not necessarily operate with the others as a team. When 18 people are involved, it is not a team but a lot of different professionals.
I found in my own work, until recently, that sometimes I would suggest an out-patient appointment to a patient and they would say, “I’m sorry, I’m too busy to come along that week because I have appointments every other day”. That is not terribly helpful. The Motor Neurone Disease Association rightly says that it is very important to have a key worker to whom the individual patient refers, and everything else goes through them. In medical terms, this is the general practitioner. We do not like referrals being made without the general practitioner being informed because they can act as a gatekeeper. However, it is also important for allied health professionals that one of them—preferably one who knows a good deal about the disorder concerned—acts as the key individual, and that everyone else relates to them. If not there is a temptation, when a patient comes along with a chronic condition and you desperately want to help but cannot do much, to make a referral, sometimes in the desperate hope that somebody else will be able to contribute something.
However, we must not forget that every referral is a resource taken away from another patient; so encouraging colleagues to think about whether yet another referral is necessary, or whether more collegiate teamwork is possible with those who are already being treated, is a very difficult area that I do not expect my noble friend to be able to say a great deal about. However, perhaps he will take this genuine problem back to his colleagues: the notion of multidisciplinary teamworking, which is excellent and important in all these areas, becomes a lot of different people working in a not necessarily terribly co-ordinated fashion. Maybe at a strategic level we must think about some kind of guidance as to the difference between a bunch of people on the one hand, and a multidisciplinary team on the other. Is there an optimum size for this kind of input?
I finish, as I began, with a tribute to those involved in this kind of work. It is by no means easy. It requires strength of character and a commitment to the care of people that is quite remarkable. We are profoundly fortunate in this country to have so many people who are prepared to undertake this, not for a day or a week, but over a long and committed professional career. I am honoured to pay tribute to them.
My Lords, the noble Baroness, Lady Gardner of Parkes, has chosen an appropriate moment to table this Question and I am grateful to her. I declare an interest, as I have a diagnosis—finally—of organophosphate poisoning leading to autonomic dysfunction. I am a patron of several charities and groups that represent the interests of patients with myalgic encephalomyelitis, also known as ME or CFS, but which I will call by its common abbreviation, ME. I am also chairman of Forward-ME.
Arising from my own illness and the battle that I and others had to get the toxicity of the once-ubiquitous organophosphates recognised—a battle that I am sure the Minister well recalls—I became interested in other medical conditions, such as fibromyalgia and Gulf War illnesses, for which there was no diagnosis or treatment, let alone recognition. Foremost among these is ME. ME has been categorised as a neurological condition at least since 1968. It is recognised as such by the World Health Organisation and the United Kingdom Government. However, for all these years, sufferers from this awful debilitating illness have been ignored, derided and mistreated. The soubriquet “yuppie flu”, acquired in the 1970s, has stuck in the minds of the public and, unfortunately, in the minds of far too many members of the medical and allied health professions. Too often I hear statements such as: “Sometimes I felt that the therapist did not appreciate how physical and biological the symptoms are. She said she understood but then suggested that a lot could be cured just by thinking differently. I don’t think she really appreciated how severe the symptoms are, or that when I said I couldn’t do something I really meant that I couldn’t do it. She also talked a lot about needing to get fitter, which I thought completely missed the point”.
Many thousands of peer-reviewed scientific papers from researchers around the world demonstrate that ME is a physical disease which has endocrine, immune and cardiovascular effects, as well as neurological symptoms, albeit with some of the psychological aspects common to many chronic diseases. It is distinct from chronic fatigue which is a symptom of many diseases—depression or cancer, for example. Despite this, there is a school of thought, dominant through the last three decades, that this is a psychosocial behavioural problem, easily dealt with by cognitive behavioural therapy and graded exercise. On many occasions I have spoken about the failure of successive Administrations to recognise ME for what it is: a chronic illness with fluctuating symptoms of unknown or uncertain origin and of variable severity. There are theories that it has its source in a viral or bacterial infection that persists and eventually affects all the major bodily systems. Others think its source may be environmental—caused, for example, by those ubiquitous toxic chemicals such as OPs, which are, incidentally, designed to attack the nervous systems of their target species. The simple answer is that we do not know.
In the UK, funding for research into ME has concentrated on its psychological aspects. There is a school of psychiatry determined to claim the condition for its own, both in the UK and internationally. After many years of working in this sphere, I have observed the means by which any valid arguments for a biological cause are mocked and eventually overwhelmed by the noisier medical opposition. They ignore internationally recognised science on the grounds that it is not scientific. They find every reason to reject small-scale scientific research projects conducted in the UK because they are not representative. Members of their own profession who have a considerable degree of success in treating patients with ME are hounded out of business. By writing numerous papers which, of necessity because there is no one else to do it, are peer-reviewed by their colleagues, they appear to have proved that there is no need for further research and that the doctors responsible for diagnosing and treating ME do not need to conduct any more than the basic range of tests on their patients.
The previous Administration did try to help patients with ME. The Chief Medical Officer commissioned a report, published in 2002, on the subject. It recognised that ME is an illness that is as chronic and disabling as MS. It recognised the shortfall in research and in NHS provision, particularly for children. The Chief Medical Officer recommended the setting-up of specialist centres to diagnose and treat people with ME—£8.5 million was allocated for the purpose. There developed small pockets of excellence where patients were pleased with the provision. These tended to be fine for patients who were able to get to the centres, usually hospital-based, but for the 25 per cent of patients who are housebound and, worse still, bed-bound, there was little help. Some health authorities were so slow that their projects failed to get off the ground before the funding had dried up; others, based on psychiatric units, were regarded with suspicion by patients. What I am saying is that, because of the way that people have behaved over this illness, patients with ME are not getting access to ancillary helpers in the NHS.
Two later reports, the latest published earlier this year by the All-Party Parliamentary Group on ME, of which I was a member, again highlighted the lack of NHS provision for patients with ME. Both reports stressed the failure of the NHS to provide for children and the severely affected. NICE, in its CFS/ME guidelines, also recognised the variable severity of the illness and the lack of treatments available. It recommends that treatment should be tailored to the patient with the patient’s consent and that allied health professionals such as physiotherapists and psychologists must have knowledge of ME and be experienced.
Current NHS treatments depend upon a multidisciplinary approach. I know from experience that a hospital referral can be very unsatisfactory unless the consultant has an open mind and looks at more than just one “bit” of a patient. All too often when a patient fails to respond to the recommended treatment, he or she is blamed for the failure and a psychiatric referral ensues. There is no passing patients on to people who might be able to help them, such as cognitive behaviour therapists. There are an estimated 250,000 people with ME, most of whom are treated by professionals with very little, if any, understanding of their illness. Since specialist services are inadequate, many patients are left to fall upon their own resources. Some are fortunate, such as the patient who said, “By understanding how I could approach my daily activities in smaller chunks and hence planning for this, including fun activities, I ultimately became stable and could build from there”, or another who said, “One-to-one supervision from a very skilled and experienced therapist kept me on track, pulled me up when I needed it and gave me encouragement. They listened to me, believed in me, reflected my progress to me at times when I couldn't see it”.
I cannot say how important being listened to and being believed are. I am pleased to see that the coalition intends that patients should have more say in the NHS provision of services. I also see that it is to discuss professional training with the royal colleges. However, until there is a cultural change among health professionals, patients with ME will continue to find it difficult to find help within the NHS. Until the professionals take time to listen to patients and to believe them, they will never develop the skills needed to enable them to help patients along the road to recovery.
I wish I had the solution to the suffering of people with ME. It seems that, no matter how often Ministers and senior officials confirm their acceptance of the seriousness of this condition, nothing will change until the culture both within and outside the NHS changes. I believe that in this particular case the patients, some of whom have experienced illness for decades while others have made excellent recoveries, have a huge amount of knowledge to impart. The Canadian guidelines to diagnosis and treatment of ME have, for reasons that have never been explained, repeatedly been rejected by health professionals and yet they are regarded by patients as providing the best course of action.
May I ask the noble Earl whether the coalition continues to accept that myalgic encephalomyelitis is a neurological illness as categorised by ICD10 G93.3? If he does, will he say how Her Majesty's Government will ensure that there is sufficient qualified medical and allied professional expertise to treat patients with illnesses such as ME with the effectiveness and dignity they deserve?
My Lords, I am sure that all patients with chronic neurological disease and the allied healthcare professionals who look after them would join me in thanking the noble Baroness, Lady Gardner of Parkes, and congratulating her on securing this important debate. I have to declare my interests as president of the Chartered Society of Physiotherapy, as patron of the Motor Neurone Disease Association, as patron of MS Society Cymru and as a clinician with responsibility for palliative care services in Wales, where we have recently instigated consultant and physiotherapy posts to lead on co-ordination of care for young people’s transition from paediatric to adult services.
As the Every Child Matters report, Transition—Getting it Right for Young People, points out, it is those with neuromuscular conditions who are the worst catered for. They feel as though there is an abyss when they go from children’s to adults’ services. Young adult disability teams are no more expensive than the ad hoc services that they often encounter. This debate is timely because the changes in the NHS present a real risk to the multidisciplinary specialist teams that are key to delivering high-quality care. It is cost-effective care when the teams work well, but given the new commissioning arrangements, I ask the Minister how the Government will ensure that the multidisciplinary teams have the relevant allied healthcare professionals as core members of the specialty team for these patients. These patients in any one diagnostic group with neurological conditions are not in high numbers on a GP’s list. They are not a volume problem in primary care. They have not been subject to government targets and are not at the forefront of commissioners’ minds. They are too dependent to be able to speak up for themselves, and their families are too occupied with care to have the spare time and energy to find out what they should be getting and call for it.
In the short time that I have, let me focus on a specialised area of allied healthcare professionals’ work—the management of failing respiration in patients with progressive neuromuscular disease. As respiration fails, patients do not sleep well, wake with a headache, feel muzzy, function less well and are less likely to work. That is because their lower respiratory effort during sleep means that carbon dioxide levels rise rather than being exhaled, as happens in normal deep breathing. Early non-invasive ventilation at home overnight allows the patient to have good overnight oxygenation, lowers carbon dioxide levels, and the patient wakens refreshed. This means that they can continue to function in society, and that includes working. Indeed, it is no secret that some Members of this House depend on night ventilation and contribute enormously and invaluably every day here in this Chamber.
In acute episodes of respiratory failure, the early intervention of appropriate professional help saves money and lives. Early non-invasive ventilation, or NIV, has better outcomes than intubated ventilation because it has a lower complication rate, particularly a lower infection rate. It is a technique that depends on expert physiotherapy. NIV corrects blood gases, including oxygenation, in about 70 per cent of these patients, so they do not need to go on to be intubated. Intensive care costs about £2,000 a day; 25 days in ITU costs more than the salary, including on-costs, of an allied healthcare professional for a year. It does not make sense not to have them locked in as core members of the team. It is a waste of money not to have them there.
The NICE guideline on NIV for motor neurone disease lists the core members of team as a specialist respiratory physiotherapist, a speech and language therapist and a respiratory physiologist—with others added to the team when needed. They need early contact with patients and they must be core members of the team to establish a baseline and inform patients of what lies ahead. It is often the physio who allows early recognition of symptom deterioration and the functional impacts on activities of daily living. Proactive intervention on advice on seating, limb supports and so on pays for itself over and over again. The physiotherapist can follow up on patients, provide continuity of care and free up consultant time for complex diagnoses. He or she can also allow more time at the point of interaction when people are devastated by a new diagnosis.
The churn that the noble Lord, Lord Alderdice, described occurs just as much with nurses and doctors, so competent teams are absolutely key. A proper team meets regularly, reviews patients together, teaches across the boundaries of the disciplines and develops cross-over skills. However, the psychosocial support of a proper multidisciplinary team is a major part of the specialist role. A Dutch study by van den Berg and colleagues showed that patients seen in an MDT—a multi-disciplinary team—had better aids and appliances, better swallowing support and better quality-of-life scores. The most pronounced differences between them and those with motor neurone disease seen in an ordinary neurology service were in the domains of social functioning and mental health. This was through the better implementation of supportive treatments, better nutrition and better psychosocial support. The Italians found that those seen by specialist teams had 75 per cent fewer acute hospital admissions, and, even if admitted, the length of stay was reduced by a half. The service proved cost-effective to the patients and to the community as a whole. I am quoting from a paper that they published. A Cochrane review of non-invasive ventilation in respiratory failure shows the same benefits of the multi-disciplinary team—fewer infections, better weaning off ventilation, lower mortality and shorter hospital admissions.
I am indebted to the Lane Fox unit at St Thomas’s for allowing me to access its data over the weekend, which support the cost efficacy of a highly specialised centre with a full multidisciplinary team. Such a tertiary centre can link to other units, drive up standards of care and ensure better care delivery nearer to patients’ homes. Even if highly specialised commissioning is done centrally, how will GP consortia know what to commission to ensure cost efficacy from local neurological services? It is at that level that often the really tight multidisciplinary team is not in place. The Motor Neurone Disease Association, in its “Year of Care”, provides excellent information on both the interventions and the costs, but that needs to be taken up at a local level.
Before I finish, perhaps I may turn to the more generalist services. It is the OT and the physio who will get the patient home quickly through improved functioning and appropriate support and aids to avoid pressure sores. Let us not forget that pressure sores can kill patients. It is these professionals who teach families how to support patients safely as they move. It is the physiotherapist who will spot early deterioration in neurological function. For those with stable but severe brain injury, physiotherapy and occupational therapy have led the way in helping people to get back to functioning well in spite of their disability, supported by speech and language therapists, who are in terribly short supply.
For those with a serious disease, nutrition is absolutely key to recovery. Dietetics are complex when patients need assisted feeding. No one should forget the key role of the speech and language therapist in re-establishing communication whenever speech is impaired and in ensuring effective safe swallowing, avoiding aspiration pneumonia. None of these roles can be fully undertaken by healthcare assistants or nurses. They do not have the training to give them the competencies required. However, perhaps I may give a St Bartholomew patient the last word. He wrote in a letter to his consultant at the unit:
“I really can’t overstate the benefit to me of this integrated multidisciplinary approach. It enabled me to play a major part in managing my own condition, with the minimum of time off work. It gave a richer and more thorough diagnosis than could be done by the clinicians working separately and it gave me confidence in the clinical team.
I have subsequently thought about the process from the hospital’s point of view. Some major problems were managed better than I have previously experienced, in fewer appointments and in a shorter time than using the traditional interdepartmental referral process. It has involved specialist clinicians from the outset. I could witness the energy, enthusiasm and collaboration of the clinical team. I can’t help thinking that this is much more cost-effective and economical than the old ways of doing things”.
And indeed it is.
Therefore, I urge the Government to lay out clearly the parameters of a modern service—the minimum required for a service so that the tariff is fixed appropriately. If that is not done, the allied health professionals will be the first to be skimmed off and it will be a false economy. It will rebound with complex admissions that could have been avoided, and let us not forget the cost of those admissions to the NHS.
My Lords, first, I congratulate the noble Baroness, Lady Gardner. I found her initial comments, as always, very informative and very moving. I am so pleased that we are able to have this short debate.
Often allied health professionals are under-recognised but their role is absolutely key to the way in which patients, particularly those living with neurological diseases, are cared for. Many of them with progressive and incurable diseases such as motor neurone disease, multiple sclerosis, Huntingdon’s disease or Parkinson’s disease face very long-term physical and psychosocial challenges, which can last for years or decades with long periods of dependency.
The role of allied health professionals must be better recognised. They can ensure that people with a neurological condition receive adequate nutrition; that their communication skills are maintained; that cardiac and respiratory functions are maintained, as the noble Baroness, Lady Finlay, has identified; and that respiratory functioning, bowel motility and skin integrity can be dealt with. They often co-ordinate care within a multidisciplinary team, which is very important. They are also frequently the first contact practitioner who can access the range of care which a patient needs over a long period.
In community settings, hospitals, residential care or wherever, dieticians also have a key role to play. They can often prevent a problem that can cause significant complications, and can compromise quality of life and lead, as has been said, to considerable cost for the health and social care system.
I am privileged to head up a think tank, the International Longevity Centre, in the UK, which looks at the implications of demographic change and ageing on our society. The IRC has often tried to raise awareness among policy-makers and the general public to the risk of malnutrition and dehydration for many of the most vulnerable members of our society. In the next couple of months, it will publish work on the importance of speech therapists. From a summary of the literature, it is clear to me that the vast majority of policy initiatives relating to speech and language therapy focus on children and younger people, which is terribly important, but despite our growing ageing population only 20 per cent of speech therapists currently focus on older people. I hope that the Minister can look at this issue, as it demonstrates an imbalance.
The IRC will highlight the need for an increased number of speech and language therapists for older people with neurological conditions. I would also like to highlight, as has the noble Baroness, Lady Finlay, the importance of occupational therapists, who very often enable older people who have suffered a stroke or who have dementia to regain some of the skills they previously had in daily living. The importance of that cannot be overemphasised. I declare an interest as president of the College of Occupational Therapists.
Just because we cannot alter the disease progression of many neurological conditions, we must not assume that nothing more can be done. It is because of that inevitability that we must do everything possible to alleviate the symptoms and offer appropriate psychological and spiritual support to patients. Allied health professionals have a key role to play in that respect.
We also need to ensure that we adequately support this group of healthcare professionals. Some neurological diseases, particularly those that apply to older people, can evoke rather negative attitudes. That is perhaps because they are linked to our mortality—we would rather not think about them and rather that they went away. Given the growing number of people who suffer from dementia, it is important that we raise awareness of this type of condition across the sector. It is also important that those who work in the allied health professions have the basic training in dementia care, among other neurological conditions, and know how to manage these difficult diseases as they progress in the huge number of patients who suffer from them. Training in dementia care and in the management of dementia should form an integral component in all the training for allied health professionals and for their career development. We must recognise the crucial importance of their work and ensure that they can meet the difficult situations that they will face with appropriate skills, training and recognition.
My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Gardner of Parkes, on initiating this debate. I suspect that there would have been more takers for it had there been more notice, although it is clear that the quality of the debate has not suffered as a result. On balance, the fact that important issues are getting an airing because the Government do not seem to have got their head around scheduling legislation for the House is definitely of benefit to some of us.
I am grateful to the Motor Neurone Disease Association, Parkinson’s UK and the MS Society for their comments on this important issue. Those organisations and many others care about this issue with great passion and with great experience. It is my understanding that around 15.4 million people in the UK are living with long-term conditions and that of them 8 million have neurological conditions. I note that other speakers have given different figures, but it is a very large number and I am sure that the Minister will have the most up-to-date and accurate figures to give us.
I want to take a moment to look at the vital role that allied health professionals play in the care of those with motor neurone disease. The Motor Neurone Disease Association research carried out between 1996 and 2000 found that having a multidisciplinary motor neurone disease clinic extended survival for people with that disease by 7.5 months. We know that specialist MDT care can significantly improve the quality of life. The complexity of the symptoms presented by motor neurone disease means that a large number of health and social care professionals may be involved in the care of someone. It is common to have up to 18 professionals involved in caring for a person with motor neurone disease at any time. Therefore, examples of good practice in co-ordinating this care take a variety of different forms and different models suit different local situations. The models that work best for the people with motor neurone disease are typically those that involve a designated key worker—often themselves a clinical nurse specialist, a motor neurone disease care centre co-ordinator or other specialist clinician—co-ordinating care across different services. The key worker often achieves the best results by bringing together and co-ordinating a multidisciplinary team to care for the person with motor neurone disease.
That co-ordination of care and treatment is vital. If the treatment is poorly co-ordinated, untimely and without specialist knowledge of motor neurone disease, it can result in treatment being missed, the person’s condition becoming more acute more rapidly—in fact, the kind of issues that the noble Baroness, Lady Finlay, talked about earlier—leading to greater expense and suffering as more intensive treatment and care is then needed.
Parkinson’s UK sent me some case studies which definitely bear repeating:
“With occupational therapists, physios and speech and language therapists, it would be very beneficial to be able to access regular, routine follow-up rather than being ‘signed off’ at the end of a treatment”.
That was said by a person with Parkinson’s disease, who also went on to say,
“I have worked hard to get counselling with a qualified, experienced psychologist … my GP has been very helpful but the waiting time has been many months”.
Parkinson's UK conducted a case study into the value of physiotherapists in the system; as we have already noted, they provide a high-quality, cost-effective service, especially those who specialise in conditions such as Parkinson’s. They offer an immensely important service and patients can often see them in place of a medical consultant, which is a significant cost saving. According to one physiotherapist:
“Condition-specific exercise classes are a wonderful way of maintaining people’s fitness initially and building confidence to then carry on at a gym, or out with the family”.
There is no doubt that, as Parkinson's UK states, providing access to a range of therapies and other services is cost-effective. It helps people with Parkinson's to stay independent longer, preventing costly admissions to hospital and care homes. Existing clinical guidelines, including those from NICE and the royal colleges, of the various therapies recognise how important that is.
Allied health professionals must form part of a specialist, multidisciplinary Parkinson’s team that looks at the full range of therapies needed by someone with Parkinson's. In order to treat the individual patient, not just the condition, it is important that each patient receives the therapies they need at the right time to ensure the best management of their condition. This will prevent unnecessary deterioration and reduce the burden on the health and social care system.
The Multiple Sclerosis Society, along with many other organisations concerned with long-term neurological conditions, supported the NHS outcomes framework and believes that insufficient resources have been dedicated to the implementation of the NSF for long-term conditions, resulting in patchy neurological services across the country. The recent report, Half-way Through—Are We Half-way There?, which considers the progress of the national framework on long-term conditions, shows that there is still a great deal to do. I am anxious that the progress that has been made will be lost under the new regime proposed by the Conservative Government. The previous Government initiated the 10-year strategy and, in January this year, published what I thought was a great document about the commissioning of such services.
I have spent the past few months talking to organisations and individuals about what they think about the Government's proposals for the NHS and how those proposals might affect the issue with which they are concerned. I must say that great concern is being expressed across the piece. I went into some detail about the kind of integrated care required for those neurological conditions because it begs the question: how will it be maintained and developed under the new regime? That is at the heart of my final remarks.
I heard the Secretary of State, Andrew Lansley, on Radio 4 at the weekend saying that although people had raised justifiable questions in the consultation, he could not see that there was real opposition to the Government's proposals. He is behaving something like an ostrich, because every day there are more and more appeals to the Government to slow down. Doctors, nurses, royal colleges and many organisations concerned with things such as long-term neurological conditions are saying, “Please slow down. We are confused and anxious about what is going to happen to the issue with which we are concerned”. When the solution lies, as it does with long-term neurological conditions, in pathways dependent on teamworking across disciplines of health and social care, they are right to be concerned. It is a long process to secure the right services for people with long-term neurological conditions. How will that be maintained within the new structure? It is not clear where and how, for example, the care of people with motor neurone disease will be commissioned and how effective it will be. There are significant risks of deteriorating standards of care and spiralling costs if the wrong choices are made over the next few years.
In conclusion, it is clear that the work of allied health professions is integral to the successful care of and prospects for those with long-term neurological conditions. Organisations that work with those who have such conditions have a right to be concerned about where the funding for those conditions will sit. I note, for example, that in its submission on the White Paper one of them asked whether its condition would be commissioned at a specialist care level by the commissioning board or whether it would be done by GP commissioners, and how the integrated pathways will be assured under those circumstances. I searched the Department of Health website in vain for some enlightenment about those questions. Perhaps the Minister will be able to shed some light on them.
I thank my noble friend for calling this debate and for introducing it so authoritatively. As she indicated, this is a welcome opportunity to outline the valuable role that allied health professionals play in health and social care in delivering our ambition for world-class healthcare outcomes and, in particular, for people who have long-term neurological conditions.
First, let me set out some background about the allied health professions. They are a diverse group of 12 professions—in fact, three of the professions mentioned by my noble friend are, strictly speaking, not classified as allied health professions. These registered practitioners deliver high-quality care to patients across a wide range of care pathways and settings from public health through to recovery, rehabilitation, reablement and end-of-life care. Some of the most well known professionals are occupational therapists, physiotherapists, speech and language therapists and podiatrists.
Over 84,000 allied health professionals are working in the NHS in England and just under 2,000 occupational therapists are working in social services. From day one, these are skilled practitioners in their profession of choice. They assess, diagnose, treat and discharge throughout the care pathway from primary prevention through to specialist disease management and rehabilitation. They often work with the more vulnerable and marginalised in society. They treat some of the least recognised problems—for example, incontinence. I agree with my noble friend that their approach is very person-centred. Their particular skills and expertise can be the most significant factor in helping people to maintain their independence through physical and mental rehabilitation.
Long-term neurological conditions affect children, adults and older people. These conditions cover a wide range of care groups and include multiple sclerosis, motor neurone disease, Guillain-Barré syndrome, epilepsy, cerebral palsy and Parkinson’s disease. We know that an estimated 8 million people in England are living with a neurological condition. They account for approximately 20 per cent of acute hospital admissions. Neurological conditions are the third most common reason for seeing a GP. An estimated 350,000 people across the UK need help with activities of daily living because of a neurological condition and 850,000 people care for someone with a neurological condition.
Allied health professionals work with partners in social care, education and voluntary organisations to support individuals with long-term neurological conditions to manage those conditions and to support their carers to manage them. They focus on achieving clinical outcomes that are about maximising the individual’s functional abilities and participation in home, work and social life—for example, enabling a young mother with multiple sclerosis to manage the physical challenges of family life alongside the impact of the condition on mobility and other activities of daily living, or supporting a person with newly diagnosed epilepsy to return to work, often working with the employer in assessing the suitability of the work environment or facilitating a phased return to work.
People with long-term neurological conditions usually require the services of all the allied health professions at some point during the management of their condition. For example, a person with multiple sclerosis might see the physiotherapist for assessment, diagnosis and treatment of mobility problems and an occupational therapist for assessment, diagnosis and treatment of residual impairments impacting on activities of daily living and to be assessed for environmental adaptation in preparation for discharge. A speech and language therapist would assess, diagnose and treat swallowing and communication problems. The arts therapists would use psychotherapeutic interventions to gain insight into and to promote resolution of behavioural and emotional difficulties, such as depression.
When it comes to a health and social care model for long-term conditions, there are three levels. Allied health professionals work at all three levels and their impact is directed to keep patients in the lowest tier appropriate for their condition. Level 1 is self-management, with allied health professionals supporting individuals to take an active role in managing their condition. Level 2 is disease management and the focus for allied health professionals is preventing complications and promoting well-being. At level 3, an individual will have a case manager, who may be an allied health professional, to co-ordinate a multidisciplinary, multiagency care package to meet complex needs.
Perhaps rehabilitation and reablement is where the unique role of allied health professionals lies. It is important not just for people with long-term neurological conditions but for everyone with long-term conditions and, indeed, those with acute health problems to optimise health and well-being. Rehabilitation is aimed at enabling individuals with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Reablement is intensive intervention to optimise function, often focusing on independence in activities of daily living, including acute exacerbations of a long-term condition.
Allied health professionals deliver rehabilitation and reablement and they may train patients, carers, support staff and others to develop their skills in rehabilitation. Rehabilitation and reablement reduce length of stay and minimise hospital readmissions. Vocational rehabilitation supports individuals to return to work and become economically active.
On 5 October, my right honourable friend the Health Secretary announced that £70 million of extra funding will be allocated to primary care trusts to be spent this financial year across the health and social care system to enable the NHS to support people back into their homes after a spell in hospital through reablement. PCTs will work closely with trusts and local authorities in delivering this.
Allied health professionals also have a broader role in public health and health promotion. It is clear that this is important for those with long-term neurological conditions and other long-term conditions. Some allied health professionals work in public health to reduce the risk factors that may impact on health and well-being. Allied health professionals’ services are actively engaging and brokering services with the third sector. An example of this is in County Durham, where the therapy services are working with the Multiple Sclerosis Society to offer a lifestyle programme, including diet and exercise advice, to improve general health and social engagement.
I now turn to some of the questions that were posed in this debate—I suspect that there were too many for me to answer now—not least the extremely important issues raised by the noble Baroness, Lady Finlay, about multidisciplinary teams, on which a lot of work is currently going on in my department. Suffice it to say at the moment that for all the reasons given by the noble Baroness it is imperative that the future commissioning arrangements ensure wide engagement with all clinical professionals, including allied health professionals. As she said, part of this will depend on the development of tariffs for long-term conditions. We are working to improve the tariffs for community services and mental health, in particular, and I undertake to keep the noble Baroness apprised of our progress.
The noble Baroness, Lady Thornton, spoke about the context of the White Paper and questioned whether the architecture outlined in it could satisfactorily address the need to ensure multidisciplinary and integrated working. Effective GP-led commissioning will require the full range of clinical and professional input alongside that of local people. Nurses, allied health professionals and others will all have a vital role to play, with a real opportunity to develop services and improve the health outcomes of their local populations. As the Government have made clear, healthcare will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients. It is only by putting patients first and entrusting professionals to design and configure services that we will drive up standards, deliver better value for money and, ultimately, create a healthier nation.
My noble friend Lord Alderdice talked about key workers and the need to avoid multiple referrals. He is absolutely right. There are many examples of allied health professionals working as key workers, particularly occupational therapists. Multiple referrals can also be avoided through the greater use of self-referral to allied health professional services. This has been available on the NHS for many years but is an option that is perhaps not as well known as it should be. He asked how we can reduce turnover in nursing and physiotherapy and thus ensure long-term continuity of care. We are concerned to ensure this. Through the new architecture of commissioning, I want to see allied health professionals and community nurses re-engaged with commissioning decisions to ensure that services really are commissioned right through the care pathway and across sectors such as health and social care. My noble friend also asked what news there is about the registration of psychotherapists and counsellors. Strictly speaking, so I am advised, they are not classified as allied health professionals. Be that as it may, the news on this has to reach my ears, so I need to write to him about it.
The noble Countess, Lady Mar, asked whether the coalition accepts that CFS/ME is a neurological condition. The Government accept that it is a neurological condition. In many cases, allied health professionals will have a role to play and it goes without saying that all of them should treat patients with respect and dignity, whatever their diagnosis.
The noble Baroness, Lady Finlay, pointed to a shortage of speech and language therapists. Admittedly the latest official figures that I have are rather historic, but I am advised that the vacancy rate as at September 2009 was 0.6 per cent, which does not sound very large to me. The noble Baroness, Lady Greengross, raised the issue of dementia training. This care is covered in the training of all the allied health professions at an appropriate level for the profession concerned.
I hope that, in the time available, I have illustrated the valuable contribution that these professionals make not only to people with long-term neurological conditions but also in meeting the health and social care needs of the wider population. I recognise that allied health professionals could and should be playing a greater role in service redesign to deliver the true outcomes that people want from healthcare, as well as improving productivity.
House adjourned at 7.17 pm.