House of Lords
Thursday, 11 November 2010.
The House observed a two-minute silence for Armistice Day.
Prayers—read by the Lord Bishop of Derby.
Death of a Member
My Lords, it is with great regret that I have to inform the House of the death on 9 November of the noble Baroness, Lady Carnegy of Lour. On behalf of the whole House, I extend our condolences to the noble Baroness’s family and friends.
My Lords, the Government believe that it is important for the media to reflect different viewpoints so as to safeguard democratic debate. In order to have a level playing field, undue concentration of media power is prevented in three main ways: first, there are statutory media ownership rules, which are enforced by Ofcom and provide absolute restrictions of ownership; secondly, mergers involving newspapers and media enterprises, like all other mergers, are subject to competition-based regulation by independent competition authorities; and, thirdly, the Secretary of State has an exceptional power to intervene in media mergers if necessary.
My Lords, I thank the Minister for that reply. In last week’s debate on media power, all 20 speakers on the list supported the decision to refer the News Corp attempt to take full control of BSkyB to Ofcom. Does the Minister agree that this shows the great concern that there is on this issue? Does she also agree that, in safeguarding the media in this country, it is absolutely essential to retain a strong and independent BBC?
My Lords, I am delighted that my noble friend Lord Fowler, who is always ahead of the game, had already tabled his Question before the debate last week in the name of the noble Lord, Lord Puttnam. During the debate, I set out the process for public interest investigation in respect of News Corporation’s proposed purchase of BSkyB. Clearly, there are merits in doing so again. The Secretary of State intervened in this merger last week and asked Ofcom to provide him with an initial report considering its potential impact on the public interest concern with media plurality. This came at the time of the debate. On receipt of Ofcom’s report—I wish to spell this out clearly, because it was a theme that went through the debate—the Secretary of State might need to decide whether to refer the merger to the Competition Commission for a more detailed investigation. If such a reference was made, the Competition Commission would report within 24 weeks and the Secretary of State would need to make a final decision on what action to take within 30 days.
My Lords, given the importance and the independence of the bodies to which the noble Baroness has referred—Ofcom and the Competition Commission—why are they given this huge level of uncertainty through being listed in various schedules to the Public Bodies Bill?
The noble Lord, Lord Borrie, asked this question in the debate. I thought that I had assured him that Ofcom is not going on to the scrapheap, but it will be reviewed. I can assure him that, although changes will be made to the economic network regulatory functions of Ofcom, it is not being scrapped.
In reference to the third part of her Answer, does the Minister recall that, at the end of the excellent debate last Thursday, the noble Lord, Lord Puttnam, referred to a phrase used about the coalition by my noble friend Lord Razzall in saying that for some of us this issue would be a “significant marker”. Will she recognise that my noble friend was understating the case and that the transfer of ownership of a major television news station into the hands of the owner of four national newspapers, regardless of whose hands they are, would be an illiberal media outrage and wholly unacceptable?
After being examined by the Competition Commission and Ofcom, it will go to DG4 of the European Commission. Only when the Secretary of State has heard the representations from all those bodies will he make the final decision. It has to go through all those three stages, which will take until the end of the year.
My Lords, in view of yesterday’s peaceful protest by the students, which, as I understand it, was hijacked by an anarchical and violent element, leading to police injuries and damage to property, can the broadcast media be reminded that they should take the utmost care to ensure that they are not open to the charge of encouraging further violence by their comments or in any way whatever?
Even so, my Lords, will the Government encourage the BBC to fulfil the single promise that it made in the wake of the Wilson report in 2005, which was to explain to the British people how the institutions of the European Union interact and their effect on British life?
The European Commission will have a role in this because it is wide-ranging. DG4 is examining whether the merger may result in a loss of effective competition in the market. It must decide by 8 December whether to clear the merger or to proceed to a full second stage of investigation.
Treasure Act 1996
My Lords, I refer the noble Lord to the Answer given to him on 20 October:
“The Department for Culture, Media and Sport plans to”,
conduct a consultation that will,
“review the Treasure Act Code of Practice and … the definition of Treasure contained in the Treasure Act 1996. This … will provide the opportunity to consider whether it would be appropriate to extend the definition of treasure to include items such as the Roman parade helmet found”,
“at Crosby Garrett”.—[Official Report, 20/10/10; col. WA 186.]
My Lords, I thank the Minister for that helpful Answer. It is strange that a national treasure can be sold at public auction by an anonymous vendor to an anonymous buyer. Can the noble Baroness tell us where the Crosby Garrett helmet is now and who bought it? If not, will the Government consider reviewing the law on antiquities at sale by auction in favour of some transparency?
My Lords, I acknowledge the expertise of my noble friend Lord Renfrew on the subject of antiquities and greatly appreciate his long-standing dedication to this area. I understand his concern that the buyer and the seller may remain anonymous. However, I am told that it would be a breach of the principles of confidentiality and data protection for information about buyers and sellers to be released into the public domain without their consent. I am afraid that I cannot tell him where the helmet is.
My Lords, does the Minister appreciate how disappointed the people of Cumbria are that they have lost this fine artefact? Will she join me in congratulating the staff of the Tullie House Museum in Carlisle, who led a campaign that raised £1.96 million to try to purchase it? I understand that the buyer is based in the UK, which means that an export order was not required. Will the Minister assure the House that, if the artefact were to be exported or transferred abroad, an export order would be required?
I thank the noble Lord for that question. I understand that there have been calls for an export licensing ban to be placed on the helmet. I cannot speculate on what will happen next. However, the general position is that, if the Secretary of State decides that an object of cultural interest is of national importance and the owner has applied to export it, he may impose a temporary export ban under the Waverley criteria, as the noble Lord will know. That would quite rightly give an individual or institution time to raise the money to make a fair and matching offer to try to keep the object in the United Kingdom.
My Lords, my noble friend will be aware of the valuable work of the Portable Antiquities Scheme in recording important archaeological information about finds under the Treasure Act, such as with this helmet. Can she give the House any assurances about the future funding and management of the Portable Antiquities Scheme?
The Portable Antiquities Scheme is very important and I thank the noble Lord for that question. I appreciate that there is concern over the future of the scheme in the light of the announcement that the Museums, Libraries and Archives Council, which currently provides most of the scheme’s funding, will be wound up by April 2012. I am pleased to confirm that the scheme will continue. Discussions are taking place about the best way for it to be managed and funded.
My Lords, can the Minister offer any comfort to archaeologists, faced as they are with cuts to funding for museums, universities, English Heritage and local authority archaeological departments and, indeed, the collapse of archaeological businesses that are dependent for their funding on developers? Do the Government have any policies to support archaeology?
The noble Lord, Lord Howarth, is very much involved with this subject and I understand his concern about the cuts, which will be across the board and which we all know about. Measures included in the Coroners and Justice Act to improve the treasure system will be implemented. Ministers are still considering the feasibility of a coroner for treasure. DCMS and the Ministry of Justice are working together to assess the extent to which measures on treasure may be implemented within current financial constraints.
My Lords, are moves afoot to look at the practices of the auction houses, given that this helmet was found in many pieces and an enormous amount of archaeological information was lost when conservators put the pieces back together without consulting archaeologists? Is that a practice that auction houses should undertake, given that loss of information on a very rare artefact? Are the Government looking at sales of antiquities through internet sites such as eBay? That is becoming a real source of worry, as much of our heritage is disappearing abroad without any record whatever.
My noble friend Lord Redesdale makes interesting points on the pieces and on eBay. It comes back to provenance. It is in the interests of both auctioneers and dealers to check that the provenance of items is acceptable to reduce any risk of prosecution for handling stolen goods or dealing in tainted or mended goods. However, the Government consider that the existing offences adequately satisfy the United Kingdom’s obligations under the 1970 UNESCO convention and would be wary of introducing further legislation unless there was a proven need to do so.
My Lords, I declare an interest as chairman of the Reviewing Committee on the Export of Works of Art. Bearing in mind the Minister’s reply to my noble friend Lord Renfrew, can she confirm that the review of treasure will include wide consultation, not least with my noble friend?
Energy: Nuclear Safety
My Lords, the Government attach great importance to the ongoing robust, effective and efficient regulation of the nuclear energy sector in the UK and expect to make a full announcement on the future of nuclear regulation very shortly.
I thank my noble friend. He may find himself slightly surprised to be answering questions about nuclear safety, but is he aware that this legislative reform order is essential now if the inspectorate is to meet all the challenges with which it is faced? Is he also aware that this has been going on for months and months and that the order has the full support of the whole industry, the unions and the inspectorate? Forgive my impatience, but how much longer are we going to have to wait?
My Lords, as I said, we are hopeful of making a full announcement in the very near future. The two options under consideration for reform of nuclear regulation are, first, for a discrete agency within the Health and Safety Executive, which could be achieved rather rapidly without legislation, or, secondly, for a stand-alone statutory corporation, which could be delivered on a slower timescale either through the drawing up of a legislative reform order or through primary legislation. Both legislative routes offer potential advantages and disadvantages. As I said, I hope to be in a position to announce our decision very shortly.
My Lords, can the Minister assure the House that the independence and expertise of the Nuclear Installations Inspectorate—I declare a long-ago interest as a former planner there—will be maintained under any new arrangements, since this is surely what has kept our nuclear industry safe over the years since that inspectorate joined the Health and Safety Executive?
I thank the noble Baroness for that question. Yes, it is absolutely at the centre of any decision going forward that we keep an effective safety regime—a regime that has indeed been congratulated on being a world leader. We would absolutely aim to keep that objective front and centre.
My Lords, given the vital importance of this order to the nuclear programme and therefore to the future of environment policy—and, indeed, of energy security—should not effective control over and responsibility for such matters, given the delay that there has already been, be transferred or, in effect, ceded to the Department of Energy and Climate Change?
I thank my noble friend for that question. The inspectorate is kept separate for very good reasons, which are connected to my last answer. If you have one department whose job is to put nuclear resources on the ground, so to speak, it is important that another, independent department is ultimately responsible for making sure that that is done in the safest possible way. That is the rather peculiar reason for my standing here discussing nuclear energy, as my role in this House is to look after nuclear safety in this country.
My Lords, the county of Somerset is experiencing a considerable reduction in employment at present, but with the proposed nuclear power station being currently planned on site, does the Minister agree that it is imperative for the future of the labour force in Somerset and for encouraging people to find work that these regulations are very quickly and immediately put into practice?
My Lords, I thank the right reverend prelate for that question. What is absolutely imperative is that we get rid of any uncertainty that there may be in the nuclear industry, so that it can go forward at speed to produce the facilities that we need in order to cover the energy position in this country which, as your Lordships know, is pretty tight as we look at the decade ahead.
My Lords, will the Minister’s plan ensure that it will be easier for retired inspectors to return? I know that some of them are younger than me and I am sure that that is part of the plan. Will he also ensure that these arrangements will ensure that what was called the National Radiological Protection Board, which was a world-famous organisation for ensuring safety around our nuclear power stations, will have its important status restored? The board became part of the Health Protection Agency, which is now being changed, so it is very important that this aspect is also maintained.
My Lords, I thank the noble Lord for that question. The important thing that we need is to have a body that is regarded as totally independent by the industry and that the industry can interact with it. Clearly, if the body is independent in that way, it will make its own decisions on who to recruit, whether they are retired, from abroad or from wherever. What is needed is an efficient capability.
My Lords, a consequential benefit of the proposed change of status of the NII would be that it would be outside the Treasury pay remit, which obviously could potentially help with the recruitment of specialists and progress on the generic design assessment. Will the Minister update us on issues around recruitment for the NII and whether that is still a problem?
My Lords, the nuclear inspectorate has been able successfully to fill some of the gaps that it has had in the past couple of years, so it is now much more strongly staffed. That is not a problem. The issue, looking forward, is whether it will be in a position to recruit people of the calibre that it needs. Whatever form it goes forward in, whether as a discrete agency or as a statutory body, it is essential that the inspectorate is able to make the appropriate recruitment.
My Lords, I ask the Government, through the Minister, to reassure us that they realise the urgency of the situation. There is a limited capacity for making nuclear plants and the suppliers of nuclear plants already have their order books filled. China is currently building four or five new plants. We must get on with this, as it is extremely urgent. We must take safety into account, but please reassure us that the Government realise the urgency of the matter.
My Lords, the elections on 7 November were a sham. They were neither free, fair nor inclusive and they do not represent progress. We have heard reports of voter intimidation and irregularities in the results. Over 2,100 political prisoners remain in detention, including Aung San Suu Kyi. Many ethnic groups were excluded from the process. It is clear that the military is determined to maintain its grip on the country. An opportunity for national reconciliation has been missed.
My Lords, I thank the Minister for that reply, with which I entirely agree. Is he aware that, while the sham nature of these elections has been widely and appropriately reported, less widely reported are some of the abuses in remote areas, such as the intimidation and arrest of Chin and Rohingya people and military offences against the Karen, which have led tens of thousands to flee into Thailand? Will Her Majesty’s Government consider some humanitarian assistance for the newly displaced and ensure that all the ethnic nationals, comprising 40 per cent of the population of Burma, are fully involved in all future discussions and dialogue?
I am grateful to the noble Baroness, who is second to none in her grasp of these developments; I believe that shortly she will once again be travelling to the Chin state area to see for herself some of these very bad conditions. The broad answer is that we are monitoring the situation and looking carefully all the time at whether additional aid and support can be mobilised for these ethnic groups. Among the refugees on the Thai border there are now reports of unpleasant developments in Chin state, northern Rakhine and other areas. We are looking at these things closely. It is a little early to say whether additional international aid is required, but we stand ready to examine in close detail the points that the noble Baroness has rightly made.
My Lords, after the rigged and fraudulent election in Burma, is it not now time that we sent a clear signal to the military junta that it can no longer enjoy impunity for its war crimes and crimes against humanity over many years? In that respect, the United Nations special rapporteur has recommended a commission of inquiry into these crimes. The UK has supported that view. Will we therefore, in the United Nations Security Council, in the United Nations General Assembly and at the European Union next week when the election is discussed, support that view and press for a commission of inquiry?
The noble Baroness is quite right. This is our policy, as she well knows, having administered it herself. As she also probably realises, the problem is that of gathering the appropriate international consensus. If we rush in too soon and fail to get the consensus, that will merely send a signal to the generals in Burma that the international community cannot do anything. We want to get the timing right, but the policy is exactly as the noble Baroness says. We support the idea of a commission of inquiry and the rapporteur’s proposal, but it may take quite a time to build the broad consensus that is needed to make this a success.
Should we not make it crystal clear to the Government of Myanmar that, if Aung San Suu Kyi is released on Saturday, that will be grossly insufficient to meet the many criticisms in the special rapporteur’s report, which is now before the General Assembly? Have the Government pressed for a UN-led dialogue on all the recommendations in that report, including for a commission of inquiry, which was mentioned by the noble Baroness? Is it in the EU recommendations to the General Assembly for discussion in December?
My noble friend is right: merely releasing Aung San Suu Kyi from her detention is only part of the story and certainly not a full response. There is a need for far greater pressure on Burma to begin to return itself to democracy. The EU has a tough sanctions policy, as my noble friend knows. We all have an agreed EU position on Burma, which the British Government are entirely consistent with and support. As to the policy at the UN, the position is as I described to the noble Baroness. It is a question of building the consensus and getting the timing right so that we and our EU colleagues can press ahead successfully and get full support for a commission of inquiry. It is no good if we rush in and find that we cannot get adequate support for it.
My Lords, on this day will the Minister recall that, in the Second World War, principal among the quarter of a million Burmese who fought alongside us or supported us as civilians were the Karen people, whom Lord Mountbatten of Burma described as our bravest allies? Will he also recall that, following what he has called sham elections, 30,000 Karen people have fled from the new upsurge of violence described by my noble friend in her question to the refugee camps along the border, where there are also 150,000 refugees? What aid and support can we give to these, our forgotten allies?
The noble Lord is right. I have a slightly smaller figure of 20,000 but, really, who cares? Thousands upon thousands of desperate people have fled across the Thai-Burma border to escape clashes between troops and the ethnic Karen rebels. We are deeply concerned about the reports of this fighting, which serves only to underline the fact that flawed elections will not create the national reconciliation that noble Lords have rightly urged and called for. As to assistance for refugees, I will have to write in detail to the noble Lord. We are looking at it and thinking about the possible focusing of additional assistance, but I will supply the precise details in a letter.
Equitable Life (Payments) Bill
The Bill was brought from the Commons, read a first time and ordered to be printed.
My Lords, I am delighted to have secured this debate at this time. We are facing a huge upheaval in the way the NHS functions. The good news is that cancer deaths are falling. Cancer control is key as cancer becomes a chronic disease. However, cancer still kills more than 150,000 people a year—a quarter of all deaths in this country. It cuts many off in their prime; 23 per cent of those who die are aged 18 to 64. They often leave behind young children, who carry the details of their parents’ death emblazoned on their memory. Unlike many others in Europe we have excellent registration data that allow us to progress year by year and monitor that, but the EUROCARE study data suggest that we lag behind Scandinavian countries, which are the best in Europe, probably because of delayed diagnosis.
We must improve time survived as well as quality of life for patients, so let us look at the cancer journey, the problems on the way and the issues that the planned NHS reorganisation throws up. Smoking is the biggest single risk factor for cancer. A third of all cancers, and nine out of 10 lung cancers, are attributable to smoking. Cancer prevention through tobacco control strategies is already having an impact; the peer pressure to smoke is less. Tobacco control is cost-effective and a public health success. There is evidence that even once one type of lung cancer has occurred, stopping smoking slightly improves survival time. Can the Government assure me that the planned regulations to ban point-of-sale displays will come into force soon?
I turn to early diagnosis through screening. The breast screening programmes are improving their information to patients to provide a more balanced view on early detection. Bowel screening through faecal occult blood has been rolled out to those aged 60 to 75, but adding flexible sigmoidoscopy at 55 years of age should detect many more early cancers. It is being assessed through pilots already, but in the new NHS how will new screening programmes be advanced, commissioned and progressed? What will happen about the increasing calls for PSA tests for prostate cancer and the problems of interpreting results? How will biopsies be commissioned? As other early diagnostic tests emerge, such as viral testing for cervical cancer, how will they be rolled out nationally?
The biggest challenge we face overall is that of delayed diagnosis. Patients are seeing cancer specialists too late in their disease. The target of diagnostic testing within a week has been abandoned. Patients wait terrified, believing that every day's delay lessens their chance of survival, so if we are to have a patient-focused NHS why has that one-week wait been dropped? In the new NHS, whose responsibility will it be to ensure early diagnosis? Public health should encourage patients to come forward to the GP, who is in turn responsible for diagnostic testing. If the delays worsen, who will be held to account? Currently, GPs act as gatekeepers, sometimes holding the gate too tightly closed. I know only too well that having the right “index of suspicion” is not easy, but who will ensure that GPs examine and investigate, and if in doubt proactively bring patients back in two weeks for review, rather than become overzealous gatekeepers at a time of pressure to limit referrals?
In the GP consortium, what sanctions will there be against primary care if diagnostic delays continue or worsen? Will there be greater powers to counter clinical underperformance? It is not enough to say that a patient can change GP; for the patient subject to delay that is too late. People with suspected or proven cancer want to see a specialist. They will travel to an expert in a centre of excellence with good outcomes, whose team personalises treatment with good information to meet a patient’s individual needs.
Specialist oncology services peer review—the CQuINS report—shows that, despite many recent improvements, 5 per cent of teams are underperforming and some patients are not being referred readily enough to specialist centres. The report shows the impact of national benchmarking, quality assurance and specialist centres. It highlights the adverse patient outcomes when complex surgery is undertaken outside a specialist centre, when there are gaps in the core multidisciplinary team membership, when data use is suboptimal and when communication across organisational boundaries is poor.
The Government have stressed the need for good outcome measures in mortality, morbidity and patients’ reported experience of care. The National Cancer Action Team report illustrates the importance of collaboration, but when each hospital is a foundation trust how will cross-referral be assured? Decision aids are being developed to help patients access information about treatments when various options are available. These are particularly important in conditions such as bowel cancer, where laparoscopic surgery for an early tumour may be the best choice. However, if the hospital does not offer that option, who will be responsible for ensuring that the patient is referred, and what sanctions will be in place if a trust hangs on to patients inappropriately? What will stop competing trusts dabbling in oncological surgery or chemotherapy, especially if the Patient Safety Agency monitoring is cut back? How will the CQC's responsibilities link with Monitor and who will determine whether a local service should continue? What if the GP consortium, the CQC and Monitor's conclusions suggest different decisions?
There is always a balance between locality and centres of excellence, but real choices need to minimise risk. Commissioning along disease pathways will require secondary and tertiary care to be at the table with primary care in planning a whole service to optimise outcomes across the population. Individual needs vary. Cancer management is not an off-the-shelf package. It is complex, involving close collaboration between many experts from different fields to personalise care for patients. Patients cannot possibly know the ins and outs of each option. Choice per se can be a red herring. The choice that is important to patients is the choice of appropriate treatment, with people working together, driven by clinical quality assurance not financial gain. The previous Government instigated quality standards development by the National Institute for Health and Clinical Excellence. Can the Minster assure us that this work will continue to inform the national outcomes framework?
When it comes to non-surgical cancer treatment, radiotherapy and chemotherapy are the mainstays. Where will the levers for building capacity lie? Radiotherapy will have to be centrally commissioned, given the need for major capital investment. Techniques such as intensity-modulated and image-guided radiotherapy reduce toxicity by ensuring accurate targeting of the tumour at every dose. CyberKnife, which was featured in the news yesterday, and results from the prostate radiotherapy trial in my own centre in Cardiff, have shown remarkable results. Other super-targeted techniques are developing apace. We know if radiotherapy is poorly targeted; there is a 20 per cent deficit in two-year survival. How will the commissioning board ensure that the ongoing functioning of a modernised unit is not starved of funds locally by a consortium?
As chemotherapy also becomes more targeted, new genetic tests indicate who is likely to respond. For example, colon cancer patients with the K-ras mutation have a much higher chance of responding to Cetuximab, which costs about £1,000 per dose. The test costs £140. It is really good value for money. In 4 per cent of non-small cell lung cancers, the presence of a specific fusion protein indicates likely drug response, allowing far better patient selection and avoiding inappropriate chemotherapy for those who will get only side effects without a response. Quality control and economies of scale suggest that it is better to invest in a few laboratories to do all such tests nationally. Will these be centrally commissioned or left to the randomisation of market forces?
There is evidence that patients treated in research-active cancer centres have better outcomes overall, whether or not they are in a clinical trial. The National Cancer Research Network has increased patients entering trials from 4 per cent to 18 per cent over the past decade. The investment is reaping rewards for everyone going through these services, so will research-active units be commissioned as accredited centres nationally? Major advances occur, often sporadically, in a research-rich environment. The human genome project revealed that the B-Raf mutation is a key trigger in melanoma, with a B-Raf inhibitor showing a short-lived but dramatic effect in 60 per cent of patients with the mutation.
The cancer drugs fund was welcomed, but now that it has been handed out to local SHA decisions a postcode lottery has emerged. Avastin for bowel cancer is funded in Newcastle for first-line therapy, in London only for second-line therapy, and in Wales and Scotland not at all—in line with NICE’s recommendation. Rather than abandon NICE’s decisions, with its rigorous processes, would it be useful to discuss variable parameters around their QUALYs assessment mathematics, or will litigation eventually set a precedent before NICE’s role is reconsidered and reinstated?
Palliative care has a role during active treatment, not just at the end of life. Recent research published in the New England Journal of Medicine showed that early palliative medicine interventions in patients with lung cancer improves the quality of life and mood of patients, including lower depression scores. This was a proper randomised controlled trial, analysed on an intention-to-treat basis, so the data are very robust. The surprising finding was that those who had prospective palliative care lived longer, with an average of three months’ extra life of better quality, than those in oncology who were referred only as the clinician saw fit. Given the impact that my discipline—I declare an interest—of specialist palliative care services has across the UK, will the Government ensure that such services are commissioned at a local level in line with national guidance, with stated minimum levels of specialist palliative care staff everywhere, recognising the enormous contribution of charitably funded hospice inpatient, daycare and home services?
For the 150,000 people who will die of cancer this year, whose preferred place of care is often home, seven-day services are essential. However good the cancer care, it is a disaster if it falls apart over a weekend. All the good is undone. I suggest that England should follow Wales's example of seven-day working by dedicated palliative care teams, with consultant advice available 24/7 everywhere. I declare my interest here, too. It is proving very effective at low cost. If the local supermarket is open seven days a week, why is our NHS fully operational for only 30 per cent of the time? Seven-day working would be a more efficient use of valuable resources in primary, secondary and tertiary care.
We face a huge upheaval in GP commissioning that raises more questions than it answers. I was privileged to be part of the original Calman-Hine committee that recommended cancer centres and units, with national standards. Cancer services have come a long way since then. Multidisciplinary teams and tumour site-specific groups are firmly embedded across the UK's NHS services. There is real anxiety that market forces may fragment this progress. Services from screening through primary care to secondary and tertiary care must be planned and integrated. The cancer journey will be a far better pathway if there is integrated planning. Patients will live longer and better. Independent living allows them to return to economic activity. If young patients die early, it is their children who carry the scars and burden of bereavement for the rest of their lives.
Delivering high-quality care depends on co-operation between professionals. The idea of any willing provider, and competing hospitals, is anathema to the collaborative model of delivering stable, high-quality healthcare. We cannot promote fragmentation if patient outcomes in cancer are to continue to improve, as they have done so dramatically over the past 10 years. I beg to move.
My Lords, the whole House will be grateful to the noble Baroness, Lady Finlay of Llandaff, for securing this important debate. In her speech she once again reminded us of the leadership that she continues to give in this field, which is of continuing urgency. I declare an interest as a former chairman of St John’s Hospice in St John’s Wood, central London.
I will speak briefly on care at home in the context of cancer sufferers. A joint report by Healthcare at Home and Dr Foster estimates that delivering end-of-life care services at home could save the NHS £160 million, yet only a quarter of patients are able to die at home. It is worth talking through what a well organised hospice—and I am happy to say that there is a gratifyingly large number of them—is able to achieve with Hospice at Home.
The totem words are “hospital avoidance”. The core of the home service is a close relationship with community nurses and GPs. However, the important point is that there is also a team of carers without formal qualifications who are given basic training at the hospice. They will look after the patient's basic needs such as washing, bed-making and shopping. Often, they become effective counsellors, which is particularly important to long-term cancer survivors as it can restore their confidence to get back into the world around them. These carers not only provide a valuable human resources augmentation, but they can at any time call on the community support team of trained professionals and on the resources of the hospice. It has been said to me that the fact that the patient can be cared for at home is in itself one of the most valuable and effective palliative treatments. So it is, if one can use the term respectably in this context, a win-win situation. The patient, often very confused and terrified of any form of hospitalisation, has all the familiarity of home surroundings; at the same time, hospice and hospital beds are freed up and, significantly, Hospice at Home is a cost saving for the health service.
I have referred to long-term cancer sufferers, for an increasing number of whom life expectancy has been prolonged thanks to new and effective drugs. The noble Baroness referred to clinical developments in palliative care which are assisting this extension of life, which is of course pertinent to the subject of this debate. This extended life expectancy will provide additional demands on community and palliative care nurses.
The Government’s commitment to 24/7 community nursing is to be welcomed. More of concern, however, was the announcement in the comprehensive spending review that the Department of Health will no longer financially support the previous Government’s commitment, given by the then Prime Minister personally in a speech to the King’s Fund on 8 February, to provide one-to-one nursing services for every cancer patient. That said, however, I was encouraged by the remarks of my honourable friend Paul Burstow, the Minister for care services, in another place on the debate on rarer cancers on 27 October. He said that the Government are re-examining the question of one-to-one support. I shall very much welcome any further reassurance that the Minister can give on the current position and on one other small point. Can any initiative provide for the requirement that, wherever possible, a terminally ill patient’s preferred place of death is recorded? I do not need to point out how useful this information is in planning the care of cancer patients.
My Lords, I naturally join the noble Viscount, Lord Bridgeman, in thanking the ever-vigilant, ceaselessly campaigning and profoundly knowledgeable noble Baroness, Lady Finlay of Llandaff, for initiating this debate. In my contribution, I want to focus on the need for improved measures of information, advocacy and treatment relating specifically to prostate cancer.
In the UK, around 36,000 men are diagnosed with prostate cancer every year, making it the most common cancer in men. More than 10,000 men die each year from the disease—about 12 per cent of the total number of men killed by cancer. Only the rates of lung cancer exceed those figures among men. Prostate cancer mortality rates have remained almost constant for the past 20 years in the United Kingdom.
Against that background, I offer the argument that this major killer, which on average takes the life of more than one man every hour, should be a high-priority target of policy-makers and medical practitioners, as it is a disease which, if diagnosed early, can be very effectively treated and even cured in many cases. The requirement of early diagnosis is therefore vital. To fulfil it properly, however, several barriers of ignorance and cultural diffidence have to be dismantled, advances have to be made in the knowledge and practices of general practitioners, as my noble friend Lady Royall has emphasised on previous occasions, and far stronger efforts must be made to implement policies which have been approved by successive Governments but have not been applied with the necessary vigour.
The need for the first development—combating public ignorance—is graphically illustrated by the fact that, while at least 10,000 families, neighbours and workforces every year suffer the loss of a male relative or friend, seven out of 10 adults do not know what the prostate gland is or what it does. Forty-six per cent of respondents to a reputable survey earlier this year were unaware of the prevalence of prostate cancer. The same survey also showed that 70 per cent of the men questioned were not aware of the existence of the prostate specific antigen blood test, which so far is the only easily administered test that can identify a prostate abnormality and, helpfully and indicatively but not unerringly and conclusively, show the presence of cancer.
As a result of these factors, the simplest of measures to improve the quantity of life of men with prostate cancer would be hugely to increase printed and broadcast publicity about the nature and incidence of the disease, the need for the earliest possible diagnosis and treatment, the existence and the limitations of the PSA test and the right of men—recognised and accepted by the current and previous Governments—to make an informed choice about whether to have a PSA test, and to get the test on the National Health Service if they want it.
That established entitlement to make an informed choice is crucial. Indeed, I would make the argument that the full and effective exercise of that right requires the introduction of a national programme of screening that is comparable with the programmes for detecting breast, cervical and bowel cancer. The National Screening Committee has, I know, been consulting on this matter, and I would be grateful if the Minister could now say what, if any, conclusion has been reached on those consultations. I would also like the Minister to respond to the following questions.
First, it is now three years since the Department of Health’s cancer reform strategy recognised the need to explore new approaches to improving the information about prostate cancer and the PSA test. No new approaches have been introduced or even piloted. I would like to know whether action is going to be taken.
Secondly, the Government’s worthy and continuing policy—explicitly expressed by the Chief Medical Officer in July 2009—of recognising men’s right to make a universally informed choice about having a PSA test, and to be tested on the NHS if they want it, is commendable. However, that policy must be embraced by the cancer reform strategy, supported by much more resonant and widespread publicity, and communicated more directly and rigorously to general practitioners.
Finally, I emphasise the irreplaceable role of GPs in achieving improved knowledge about the diagnosis and treatment of prostate cancer. But I also underline the need to deepen and widen the awareness of GPs—a need which is made emphatic by the following survey results. 75 per cent of the 250 GPs surveyed by the Prostate Cancer Charity this year were not aware of government guidelines for delivering information to men about the PSA test. 75 per cent of those surveyed said they never or only occasionally had unprompted discussion about the PSA test with asymptomatic men aged 50 to 70. 15 per cent of the surveyed GPs said that they do not support the right of asymptomatic men to have access to the PSA, even if requested by the patient on the basis of an informed decision. These findings are cause for concern. I do ask the Government, forcefully, to take their responsibilities seriously, to implement their policies and to secure a new level of awareness and action, particularly among GPs.
My Lords, I, too, congratulate the noble Baroness, Lady Finlay, and pay tribute to her for her tireless campaigning on cancer services. At the outset, I want to recognise the great progress made in cancer treatment and survival rates under the previous Government. I welcome the coalition Government’s commitment to refresh the cancer reform strategy. I also welcome the other actions that they are taking and the additional resources being made available to cancer services, such as the cancer drugs fund announced in the comprehensive spending review and committing the funding needed to deliver 1,200 additional specialists involved in cancer services by 2012. I welcome other measures to expand access to certain therapies and the raising of cancer awareness, but as the noble Baroness, Lady Finlay, so ably put it, more needs to be done.
Given the time available, as vice-chairman of the All-Party Ovarian Cancer Group and a former trustee of Cancerbackup, whose cancer information service is now part of Macmillan Cancer Support, I want today to concentrate essentially on the implementation of information prescriptions on issues relevant to ovarian cancer diagnosis and treatment. Research by Macmillan Cancer Support shows that 93 per cent of cancer patients want to be “very or fairly involved” in decisions about their treatment and care. My late wife, Dr Vicky Clement-Jones, who founded Cancerbackup, rightly described,
“knowledge as the antidote to fear”.
Information is the key to realising the vision of a patient-centred NHS. To make informed choices, a patient must be enabled and empowered with the right information at the right time. The creation of information prescriptions was announced in 2006. These would be designed to offer cancer patients high-quality personalised information and support at key points through their treatment. The pilot schemes for information prescriptions have shown the significant improvements they can make to the delivery of information. If every cancer patient received an information prescription as standard and was supported in understanding the information given, it would also help to tackle health inequalities. So it is extremely heartening that the coalition Government have made,
“no decision about me without me”,
the central theme of their health reforms.
But despite progress on information prescriptions in general, we are still awaiting the publication of the Department of Health implementation plan for cancer information prescriptions. The implementation plan needs to be launched as quickly as possible to guarantee that every cancer patient in England has an information prescription by 2012. Information prescriptions should be routinely offered to all cancer patients so that everyone can receive high-quality personalised information at key points in their cancer treatment.
I now come to issues relating to the less common cancers such as ovarian cancer. I pay tribute to Target Ovarian Cancer, the Eve Appeal, Ovacome and Ovarian Cancer Action variously for their work, information and advocacy in this field. After breast, lung and bowel cancer, ovarian cancer is the fourth most common cause of cancer death in women. It is estimated that at least 400 women’s lives could be saved each year if the UK matched the average European survival rates for ovarian cancer. England has the lowest ovarian cancer survival rates in Europe, and the UK as a whole is very close to the bottom of the table.
I have welcomed the Government’s commitment on spending on cancer drugs, but before treatment it is important to ensure early detection. Currently, 75 per cent of women with ovarian cancer are diagnosed once the cancer has already spread and successful treatment is much more challenging to achieve. Improving early diagnosis for women with ovarian cancer is essential in order to give them the best chance of survival. It is imperative that action on symptoms awareness and access to diagnostics is taken as a matter of urgency. To do that, women in the general population must be made aware of the symptoms of ovarian cancer, and of the importance of acting on frequent and persistent symptoms. Awareness of ovarian cancer is much lower than it is for symptoms of breast, lung and bowel cancer. In 2008-09 the Department of Health accepted that there is now robust evidence on symptom patterns for ovarian cancer that distinguish it from other conditions. I understand that NICE guidance on recognition and initial management of ovarian cancer will be published in April 2011.
I welcome the signs and symptoms campaign recently announced by the Department of Health, but it will focus essentially on breast, lung and bowel cancers. There do not appear to be plans to invest in ovarian cancer. GPs must also have prompt access to the diagnostic tests that help them to decide who should be referred urgently, and they should be updated on new developments in symptoms research. In autumn 2009, it was announced that all GPs would have access to urgent diagnostic tests for bowel and ovarian cancer within a week. That commitment to one week was removed in the CSR, but it is not clear whether there is still a commitment to make sure that all GPs have access to these tests. I would very much like to hear the Minister’s response on that matter.
I turn briefly to another site-specific cancer, lung cancer. Despite improvements in service provision, the UK still has one of the worst lung cancer survival rates in Europe. The recently announced awareness campaign will cover lung cancer, and I welcome that, but there is still a need to develop screening programmes because it is the only cancer among the main common cancers which does not have such a programme. The National Lung Cancer Audit shows that only 51 per cent of lung cancer patients receive any form of active treatment. I join with the British Lung Foundation, which states that more lung cancer patients should be considered for active treatment, with all centres learning from best practice, in order to bring about better patient outcomes.
Finally, I wish to express concern about the impact on world-leading cancer research of a cap on immigration for tier 2 migrants. My noble friend Lord Ryder, as president of the Institute of Cancer Research, expressed this extremely well in the debate in October on immigration controls. His fears are well founded and I hope the Minister will reassure us that exemptions can be put in place, along with answers to the other issues I have raised. I look forward to his reply.
My Lords, I thank the noble Baroness, Lady Finlay, for securing the debate. No one is more fitted to lead such a debate, and it is a privilege to take part. It is a privilege, too, to speak in your Lordships’ House from personal experience. It is even more of a privilege that, thanks to the expertise and dedication of NHS staff at many levels, I am alive to participate, as I have twice recovered from cancer—although on the second occasion it was a very close run thing.
As well as to that expertise and dedication, my recoveries—in the plural—can be put down to two things: early diagnosis and proper follow-up care. On early diagnosis, I am delighted that I share the view of the noble Baroness and of Professor Mike Richards, the cancer tsar. He was recently quoted as saying:
“if you wanted to sufficiently change outcomes from cancer I would not spend £200 million on expensive cancer drugs; I would spend it on earlier diagnosis and involving GPs”.
That was certainly my experience.
The first time that I was found to have cancer was due to the vigilance of my GP, as I had virtually no presenting symptoms; he just had an uneasy feeling that something was wrong so he sent me to see a consultant. The second diagnosis was made no less than 14 years later as a result of the screening that I was still having, although, admittedly, only occasionally. On that occasion, another primary cancer was detected in another part of my colon. I was considerably more ill the second time and spent a long time in hospital, but the important thing was that all the cancer was removed. Although I was constantly back and forth between intensive care and the ward, there was excellent liaison among all parts of the system.
In this context, I want particularly to mention the work of patient emergency response teams, which are now often referred to as critical intensive care outreach. My team was based at the Middlesex Hospital—it now operates at UCH—and ensured the liaison between teams that is so important to patients. The period of transfer between intensive care and the ward is often difficult for patients. I commend those teams.
I have mentioned the elements that I believe led to my recovery and to the excellent health that I now enjoy because, like the noble Baroness, I fear that they may at this moment be under threat because of the spending programme that is being implemented. We keep hearing that the money for the NHS is ring fenced but, as a 0.1 per cent real-terms increase is nowhere near enough to keep pace with demand, I wonder how these services will continue. As the coalition has abandoned the one-week target for cancer test results, literally more people will die as a result of late diagnosis. That figure is currently estimated at 10,000 per year.
Much late diagnosis is due to patients not seeking treatment until it is too late, so I hope that the Minister can assure the House that the Government have no plans to scrap screening programmes or those promotional activities designed to ensure that people seek consultation. As a result of there being a possible hereditary element to the cancer that I had, my son and daughter also have regular colonoscopies. Will such services fall victim to the “must do more with less” mantra? Sadly, there are still too many people who find a possible diagnosis of cancer so frightening that they put off consulting a doctor until it is too late. I am sure that every one of your Lordships could name a friend who has ignored obvious symptoms such as weight loss, unexplained bleeding, coughs and so on. That is one reason why those of us who are fortunate enough to have recovered have an urgent responsibility to say so and to help remove the fear that gets in the way of seeking help.
I do not see how, in these hard financial times, we can possibly be thinking of spending £3 billion on an NHS reorganisation, which few seem to want, without it further affecting the services that are so vital to early diagnosis. Moreover, I fear that giving the bulk of the resources to GP consortia will run counter to the liaison between hospital and locally based services, which proved so helpful to me. GPs will have to decide whether treatments are necessary, affordable and the cheapest option, but the care will be in the hands of the hospital consultant. How is that likely to benefit the patient? At the very least, it seems to provide much opportunity for delay and little encouragement for the integrated services that cancer patients often need. We must be wary, too, about GP consortia becoming so overloaded with their commissioning functions that they cease to have as much interest as they should in promoting lifestyle changes, such as smoking clinics and exercise clubs, which are so important in the prevention of cancer.
I finish with a plea to remember the families and carers of those with cancer. They, too, need to be involved in the process and fully informed, as they will often provide the bulk of the care. I know that confidentiality of information is an issue, but that can usually be resolved. If families do not know, they cannot help. Cancer affects the whole family and we need to remember that.
I, too, congratulate my noble friend Lady Finlay on raising this debate and on so eruditely setting out the complexity of the integrated care plans for patients suffering from cancer. It is important to ensure a seamless service to patients who, together with their families, as the noble Baroness, Lady Pitkeathley, said, are filled with trepidation by the word cancer.
I shall highlight the importance of specialist cancer nurses. A recent report from the Royal College of Nursing entitled Changing lives, saving money states that evidence to date demonstrates that specialist nurses play a vital part in a range of ways in assisting patients through a complex pathway by delivering high-quality specialist care. They frequently help avoid unnecessary admission or readmission to hospital. They reduce post-operative hospital stays, thereby freeing up consultant appointments for other patients. They provide treatment at the point of need, so reducing patient drop-out rates. They assist in the education of health and social care professionals, provide direct specialist advice to patients’ families and ensure rapid referral if necessary to other medical treatment, so reducing waiting times.
A survey conducted by health advocacy groups nationally demonstrated that patients consistently rate the specialist nurse higher than any other healthcare professional in understanding patients’ needs. Specialist nurses provide a lifeline to many patients and families, the patient having gone through incredible physical and mental upheaval. While the good news is that survival rates have increased, patients will continue to need to access expert care and support. It is also proven that specialist nurses’ expertise keeps patients safe and exposes them to less risk.
The noble Viscount, Lord Bridgeman, mentioned the recent announcement in the comprehensive spending review that the right to one-to-one nursing care for patients, having been promised, is to be rescinded. I have heard that further consideration is being given to this decision. Will the Minister confirm that? Evidence points to unequal access to cancer specialist nurses across the country, and it is also reported that one-third of them are supported by the Macmillan Cancer Support.
Commissioners need to address as a priority whether there are enough specialist nurses to meet patients’ needs. Local management needs to ensure that the skills and expertise of specialist nurses are not deployed to fill gaps in ward or department staffing, as this is a waste not only for patients but also in economic terms. Another study shows that if provision could be made for administrative support for specialist nurses it would save 6.6 hours per week per specialist nurse. Specialist nurses are highly qualified and educated mostly to masters level and are too precious to be deviated from their dedicated programmes which would result in a loss of care to patients.
It is a known fact that patients prefer to be cared for at home where at all possible. Obviously early diagnosis is vital in order that treatment starts immediately; the majority of patients starting with surgery. With the least invasive approach, the length of stay in hospital is reduced and then the requirement is for expertise in the home by specialist nurses and experienced nurses in post-operative care. The Marie Curie and Macmillan nurses provide a very good service.
The noble Viscount, Lord Bridgeman, also spoke about the Healthcare at Home service as a leading provider of home care to cancer patients. The service has developed over the past 15 years and continues to grow, and now includes the administration of highly cytotoxic chemotherapy regimes to patients at home by highly skilled experienced nurses. The service delivers 24/7, 365 days a year and has improved efficiency and safety by investing in bespoke industrial leading infrastructure and new technology. It continues to develop outcome measures.
The service works in partnership with the Department of Health. The important thing is that the patients who have received Healthcare at Home are still maintained by their clinical teams, who retain ultimate responsibility for patients and with whom Healthcare at Home maintains close contact. Evidence so far shows improved outcomes, as has already been mentioned by Dr Foster Intelligence, and that a considerable amount of money has been saved.
Innovations as described by Healthcare at Home certainly cannot be ignored in taking forward the ways to increase the quality and quantity of life for cancer sufferers. I mentioned the good news of improved survival rates and much work is being developed in Living with Cancer. Emphasis on this work needs to continue with education to patients and the public as mentioned by the noble Lord, Lord Clement-Jones. This is an important point for all patients, their families and their friends. Healthcare professionals are taken up with the actual delivery of care, but there needs to be healthcare provision by experts in setting out the information that is so necessary for the understanding of the general public as well as patients and their friends.
My Lords, I rise with some trepidation to make my maiden speech in your Lordships' House. It is, after all, more than 27 years since I last made a maiden speech, so I am certainly out of practice. I am also cognisant of the many warnings I have been given about the differences between your Lordships' House and the House in which I was privileged to serve for those 27 years. It may take me a little time to adjust, but I assure your Lordships that I shall do my best.
I am most grateful for the welcome I have received in your Lordships' House, to the staff for their unfailing helpfulness and, particularly, to those in the information technology department who laboured so long to ensure that I was properly connected.
Before I turn to the subject of this debate, perhaps I could be forgiven for saying a word or two about the place from which I take my title. The spelling of the name, of course, bears only a passing relationship to its pronunciation, which is a frequent cause of confusion, but I suspect that it shares that distinction with many other places from which your Lordships’ titles are taken.
Lympne is a village in my former constituency where my wife and I have the pleasure and privilege of living. It dates back to Roman times when Portus Lemanis was built to protect the Roman ships in the harbour, which then existed below where the current village is situated. It also features frequently in books by HG Wells, who lived nearby. It is mentioned in both “The First Men in the Moon” and “War of the Worlds”, which may have something to do with the fact that, more recently, several observers have claimed to see unidentified flying objects in the vicinity of my house. I am afraid that I have never seen them or been in any way aware of their existence, so I cannot confirm, but nor of course can I deny, the veracity of those accounts.
It is a privilege to be able to take part in today's debate. I do so for two reasons. The first is the kind of personal reason that I know touches so many of your Lordships. My father died of breast cancer 44 years ago at the young age of 49. This coming Saturday would have been his birthday. He died at home and was wonderfully cared for in his last days by a dedicated group of nuns whose selflessness far exceeded any praise I could bestow on them.
The second reason is that, in a few days’ time, I shall have the honour of succeeding my noble friend Lord Newton of Braintree, who I am delighted to see sitting beside me this afternoon, as chairman of Help the Hospices. I am conscious that my noble friend’s shoes will be very difficult to fill, but the opportunity of helping this great movement in however small a way was one that I could not turn down.
For the hospice movement, to which tribute has already been paid in this debate by, among others, the noble Baroness, Lady Finlay, and the noble Viscount, Lord Bridgeman, is surely one of the finest jewels in our healthcare crown.
“We lead the world in quality of death; many developed nations must work to catch up”.
These are not my words; they are the words of an independent report commissioned recently by the Economist Intelligence Unit, which went on to say:
“The UK has led the way in terms of its hospice care network and statutory involvement in end-of-life care and ranks top of 40 countries measured in the index”,
which that report drew up. It quotes Sheila Payne, Director of the Institute of End of Life Care at Lancaster University as saying:
“The UK has perhaps had the longest period of sustained charitable development of hospices and, more recently, limited statutory involvement and investment”.
I am of course conscious of the fact that today's debate is about cancer patients and about the quality and quantity of the life of those patients. Although hospices increasingly care for patients suffering from conditions other than cancer, it remains the case that a large majority of the people they look after do have cancer. Indeed, local hospices support almost 28 per cent of all people diagnosed with terminal cancer. What is perhaps less well known is that access to high-quality hospices and palliative care is important not only at the very end of life but often from the point of diagnosis. Many hospice patients are supported by their local hospice for many months or even years, benefiting from a suite of flexible services that are tailored to meet their own individual needs.
Something else that is not very well known is that 70 per cent of hospice care is provided in people's own homes through a range of community and home care services, including hospice at home, day care and out-patient care. In recent years there has been a dramatic increase in the number of hospice patients supported in their own home. In fact, between 2004 and 2008 it increased by 58 per cent, and this trend is continuing.
What is most remarkable about all this is the extent to which it has been achieved with a minimum of financial help from the Government. Health services are funded separately by the devolved Governments in each nation of the United Kingdom. In England, the Government contribute an average of 32 per cent of running costs for adult hospices, predominantly through primary care trusts, and about 15 per cent for children's hospices. The rest has to be found by charitable fundraising. Together hospices raise £1 million pounds a day to pay for the services that they provide. Almost 100,000 volunteers work in hospices throughout the United Kingdom, and the hospices could not do the work they do without them. It is hardly surprising therefore that my right honourable friend the Prime Minister, answering a question in another place from the honourable Member for Worcester, said on 30 June that,
“the hospice movement ... has been one of the great successes of the big society that we have in this country. I think we all cherish what the hospice movement does”.—[Official Report, Commons, 30/6/10; col. 859.]
Of course, challenges lie ahead, and we look forward to the Demos report on those challenges which is to be published next week. I hope to have something to say about those challenges on future occasions. For the moment, conscious of the need in this speech to eschew any hint of controversy, I content myself with commending to your Lordships the enormous contributions made by the hospice movement to the quality and quantity of life of people with cancer.
My Lords, it is a matter of great honour for me to follow the maiden speech from the noble Lord, Lord Howard. It stands out as a unique piece of thought and vision, for which I am sure we would all want to congratulate him and to wish him many great and productive years in this House, in the ongoing contribution to this country, its Parliament, leadership and democracy which he has made over the years from the other place.
Turning to the debate, I was given some statistics by Cancer Research UK which I would like to share with your Lordships. More than one in three people will get cancer at some stage in their lives. Nearly 300,000 people are diagnosed with cancer each year in the UK and one in four people will die from the disease. However, cancer survival rates have doubled in the past 40 years, and now half of people diagnosed with cancer survive for more than five years. Yet outcomes from cancer diagnosis in the UK remain behind the best performing countries in Europe. The diagnosis of cancer in the UK is often late. This is one of the primary factors in the UK’s survival rates being behind those of other countries. This tendency for late diagnosis has a negative impact on both the quality and quantity of life of people with cancer because if cancer is diagnosed early, treatment is nearly always more likely to be effective. Estimates suggest that up to 10,000 deaths could be avoided each year if we diagnosed cancer earlier and ensured access to appropriate treatment.
Cancer prevention is the most cost-effective approach to saving lives. Extensive research indicates that alcohol is definitely a cause of cancer. In particular, alcohol consumption increases the risk of oral cancer and cancer of the oesophagus, or food pipe, the oral cavity, pharynx and larynx, as well as increasing the incidence of bowel and liver cancer. Vegetables and fruits contain antioxidant nutrients such as vitamin C and carotenoids, folate and a range of phytochemicals. Studies indicate that each daily portion of 80 to 100 grams of fruit or vegetables halves the risk of oral cancer, reduces the risk of squamous cell carcinoma of the oesophagus by approximately 20 per cent and of stomach cancer by about 30 per cent.
Surgery cures more patients than any other type of treatment. It is another strong argument why early diagnosis is so imperative. With late diagnosis, surgery becomes less feasible and effective. Further progress should be made in rolling out new surgical techniques, such as laparoscopic surgery, robotic surgery and radio surgery across the United Kingdom. Radiotherapy services in the UK lag some years behind those in other, comparable countries. Planning should incorporate the need to replace radiotherapy machines once they have reached the end of their working life.
Improvements in research mean that the treatment of cancer with the use of chemotherapy and other systemic agents is rapidly changing. The rate of introduction of new drugs is accelerating and the number of patients benefiting from such treatments is rising. Patients are increasingly being treated closer to home, while chemotherapy is becoming much more targeted and tailored to individual cancers.
Providing patients with access to high quality information is a prerequisite for them to be able to participate in decision-making about their care and reduce their fear of cancer. Individual patients will want to acquire information in different ways. For many, face-to-face communication with a health professional they trust is of paramount importance. Many people wish to be cared for and to die in their home, but the number of people able to do so varies significantly with age, geographical area and by condition. The key challenge facing all of us who are committed to caring for people at the end of their lives, and their families and carers, is making sure that even in times of economic uncertainty, high quality palliative and end-of-life care is available to those in need.
An independent evaluation of Marie Curie Cancer Care by the King’s Fund found that there was an increase in the proportion of deaths at home and a corresponding decrease in deaths in hospital. It was shown that the proportion of those able to die at home could be doubled. Evidence therefore shows that this can be done through providing good quality services in people’s homes, at no extra cost to the NHS. These changes can only be brought about through partnership between health and social care agencies and professionals, local authorities, voluntary organisations, community groups and individuals working together to mobilise a community to meet the need of their local population. This allows more people at the end of life, with their families and carers, to choose what is best for them.
My Lords, I come to this debate two years after my wife was diagnosed with inoperable bowel cancer and with secondaries in her liver and lungs. I therefore hope that your Lordships will bear with me if I speak in a more personal vein than is perhaps usual in debates in your Lordships’ House. My wife was diagnosed after some months of suffering from constipation. Her GP did not refer her to a cancer department—despite there being something of a family history—although in all fairness, as it turns out, it was probably too late in any event. But it is quite significant that constipation is not always recognised, even by some bowel cancer charities, as a significant symptom. It is to be hoped that that matter can be addressed in alerting the public in future to the need to seek advice.
I join most of the speakers who preceded me in paying tribute to the noble Baroness, Lady Finlay, for securing this debate and in particular for her emphasis on the quality of life. My wife was very realistic about her prospects. She did not chase after alternative treatments. She did not seek second opinions. She was determined to make the most of what time was left to her. Within a couple of months of being diagnosed, she made an acclaimed documentary for BBC North East and Cumbria about her condition and about the need for people to seek advice. She even wheeled on a footballer who had previously captained Newcastle United and Scotland to participate in that programme. Indeed, only last week I was approached by somebody quite unknown to me while shopping who had seen that programme and who had, as a result, sought advice and undergone a colonoscopy.
Not only that, my wife subsequently underwent a caecostomy in 2009, which made her a stoma patient. Of course, stoma patients have suffered from a variety of conditions, not just cancer, but together with other stoma patients she went on to make a DVD called “Have Bag, Will Travel”. It was trying to explain to both patients and their friends and, indeed, to practitioners about how to cope with stoma. That is also now being much used. It is available on YouTube and is being used and disseminated in hospitals, universities, medical schools and the like. She had undergone chemotherapy; at first, it seemed to be successful but the tumours began to grow again. She then had a second course of chemotherapy, which did not work; finally, she was treated with cetuximab. She passed the gene test, probably marginally, but alas the treatment did not work. However, NICE did its job. It was an approved treatment and, with some more luck, she might have been able to benefit from that.
However, she went on in her efforts to promote information. As a life coach and counsellor, she then organised a group counselling course for a number of other women who were cancer patients. That has been written up in a booklet called Moving Forward, published by Coping With Cancer. The aim of the booklet is,
“to provide tools to help people who have experienced cancer to reassess their present situation and move forward with their lives”.
That also is now being quite widely disseminated.
In the mean time, she received excellent treatment and support from the new cancer unit at the Freeman Hospital in Newcastle, from her district nurses and from Macmillan nurses. These were all very helpful. In her last weeks, a series of aids and adaptations were installed extremely rapidly. She did not in fact live long enough to gain the benefit from them, but close collaboration between the adult services department of the local authority and the PCT led to those being installed. There are considerable advantages to the close collaboration of those two organisations. Finally, she went to a hospice and received excellent treatment there. As she wished, she was sedated so that her last two or three days were spent without pain.
A number of policy issues arise from this and, of course, from many other similar histories. The first is to promote a better understanding of symptoms, not only among patients but among practitioners. The second is to welcome the improved screening; I am now speaking particularly about bowel cancer. The previous Government instituted tests by faecal smears. The present Government have promoted flexible sigmoidoscopies, although it should be pointed out that my wife had a sigmoidoscopy but it was not able to detect the tumours; the process does not go far enough, as it were, whereas colonoscopies do. I understand it to be the case, certainly in America and maybe in other places too, that more regular colonoscopies are available and are almost treated as routine. That could have a significant effect on detecting cancer early. Although I would not of course expect the Minister to make any kind of commitment, perhaps he would like to comment on the possibility of going beyond the further use of sigmoidoscopies. I would also like the Minister to comment on the provision of stoma nurses because it was apparent, certainly in our area, that there was a limited number of stoma nurses in the community. It would be helpful to have more of them.
A further issue is psychological support, which is the subject of the booklet that I have just mentioned and which again perhaps needs further emphasis. There again, GPs really must be encouraged to have closer contact with cancer patients.
There is also the question of support for the charities that the noble Lord, Lord Howard, so eloquently referred to: Macmillan, Marie Curie and the hospice movement. It is of course wonderful that so many people devote time to, and raise funds for, those hospices, but surely it is time to recognise that perhaps a greater degree of government funding and support is necessary.
Many patients, and my wife was one of them, would like to die at home. It was not possible in her case and perhaps not appropriate, but for many others it would be. I endorse the views of noble Lords who have called for further efforts to ensure that that is available to more patients.
My Lords, I, too, congratulate the noble Lord, Lord Howard, on his excellent maiden speech and on his new important role in leading the hospice movement. I also thank the noble Baroness, Lady Finlay, for securing this debate and for the leadership that she shows in this subject.
All people who have cancer want high quality services and want to be involved as equal and active partners in decisions about their treatment and care. I welcome measures to improve cancer services in the UK over the years. Attitudes towards cancer care and quality of life have changed, and many want to ensure, as has been mentioned, that cancer care and early diagnosis are given the same priority as research into treatments and cures. Improving quality of life matters as much as improving quantity of life.
Dealing with a cancer diagnosis is difficult for both the patient and their family and friends. Being given the right information and support, whether that is someone to talk to, information about specific cancers or advice on benefits, can make a difference and make living with cancer a little easier.
More than 109,000 people of working age are diagnosed with cancer each year. The impact of this usually means people making changes to their working lives or leaving work. The effects of cancer and treatment can impact on people’s lives in many different ways and can affect them for weeks, months or even years after treatment has ended. Fatigue—extreme tiredness—is a very common and frustrating problem, with 65 per cent of cancer survivors saying that they have to deal with fatigue following treatment. Then there are the practical problems when people who are diagnosed with cancer need to take time off from work for treatments or check-ups. Practical problems such as these can make a person’s working life difficult, especially if employers are not supportive or understanding of their needs.
I was interested in what support is currently given to people with cancer to help them remain in work or return to work. The truth seems to be that too many people do not receive enough help or support. There is a lack of information available for people who want to remain in work, and there seems to be a lack of knowledge of legal responsibilities. A supportive employer can be vital in helping someone with cancer return to work. However, new research shows that the majority of employers do not know about their legal responsibilities towards people with cancer—for example, fewer than half of employers know that cancer is covered under the Disability Discrimination Act. Equally, employees also lack knowledge of their employers’ legal obligations to them, and so will often not request the support they are entitled to.
Fewer than 40 per cent of people with cancer know that cancer is covered by the DDA. From 1 October this year, all disability discrimination legislation falls under the Equality Act, as we know. Under the Equality Act, employers must consider requests such as flexible working hours or physical adjustments to the workplace from someone who has cancer. If they meet these obligations, they can avoid potential discrimination charges along with damage to their reputation, legal fees and lost time. Employers who support an employee with cancer will generally foster a greater sense of loyalty from them and improve engagement and morale. Seeing a colleague supported in this way can also reinforce other employees’ sense of fairness and trust and fosters a positive image of that particular employer. Sometimes it will take a minor adjustment to help that employee to remain in work. I ask my noble friend the Minister what can be done to address the lack of information to patients on this matter.
I turn to an issue that, sadly, is not consistent across the UK. Overall, England spends 5.6 per cent of its healthcare budget on cancer, compared with 7.7 per cent in France and 9.6 per cent in Germany. Spending on cancer services has increased by an estimated 36 per cent over the past five financial years, but survival rates have not improved at the rate they should have done, given the increased investment. In January this year, research found that patients from deprived areas in England were more likely to have a late cancer diagnosis and be admitted to hospital as an emergency, as a study suggests. Women and older people also fare worse in getting a prompt diagnosis, as a study team from University College London found. Patients from deprived areas were also less likely to undergo key procedures for rectal, breast and lung cancer, despite the good news that there was a downward trend in the proportion of patients with breast cancer admitted as emergencies. In all, though, patients from deprived areas, older people and women are more likely to be admitted as emergencies.
We know, as has been mentioned, that good-quality palliative care, which helps the most seriously ill and terminally ill to make the most of the time they have left, can provide a period of quality of life for terminal cancer patients. A recent study found that patients who started, soon after their diagnosis, on palliative care along with usual cancer care lived nearly three months longer than people given only standard cancer care, even though this second group had more chemotherapy. I touched on my own experience in a recent debate in your Lordships’ House when my own late father had a very late diagnosis followed by an extremely poor standard of care. This seems to vary from hospital to hospital. Older people are also less likely to receive appropriate pain control than their younger counterparts. This is especially so for patients with dementia.
We need to focus not on the question of additional resources but on ensuring consistency across the country. Older people in particular should be given the same treatment as a young person.
My Lords, I thank my noble friend for raising this important matter today. I am a member of the All-Party Group on Cancer and I know there are many improvements that should be made.
I know two people who went to our local GP’s surgery for help, only to be told to come back later if they did not feel better. For Lucy, had there not been a three-month delay the outcome might have been different. She was diagnosed with bowel cancer eventually. She had a very hard struggle, which she fought bravely until she died. My other friend went three times to the surgery but was not diagnosed. It is often said that men are loath to turn up at doctors’ surgeries but he did. In the end, with no diagnosis, Mike was taken by his son to a clinic here in London and was diagnosed with prostate cancer straight away. Unfortunately, the delay meant the cancer had progressed to his bones. He is now having hormone treatment. If I know of two late diagnoses from the same surgery, how many must there be throughout the UK?
I read in the Times on Monday that hundreds of people could be saved by a new mix of prostate cancer therapies. It is found that the results in Canada, the USA, Australia and Germany in the treatment of prostate cancer are better than those in the UK. We should find out why this is so. Does the noble Earl agree that when the GP consortia are in place, they should have access to the expertise available to cancer networks to help the effective commissioning of cancer services? Cancer is a set of 200-plus different diseases, most of which have highly complex care pathways. Understanding is needed for both the clinical and longer-term needs of people living with and after cancer.
The NICE appraisal system is inappropriate for dealing with ultra-orphan treatments. It seems appropriate for the remit of the National Specialised Commissioning Advisory Group to be extended to include the commissioning of all ultra-orphan cancer treatments. It is essential that any new decision-making process should be transparent, fair and speedy. There is fear that, with a new organisation within the National Health Service, there might be extended postcode lottery prescribing. Can the Minister assure us that this will not happen? Many pharmaceutical companies are not interested in orphan drugs since they are not cost-effective. However, to the individual patient they are vital.
This week it was announced that an NHS hospital has a cyberknife to treat difficult cancer tumours. This is excellent news. However, last year, on a visit with the health group to the London clinic that had installed a cyberknife, we were told that Turkey has seven. At a drop-in session at St Thomas’s Hospital a few weeks ago, it was shown how the incidence and mortality rates for both prostate and breast cancer in different regions of the country have wide variations. There is a pledge which I hope all Members taking part in this debate will sign. It is:
“I support the UK’s fight against cancer and urge the government to continue in its efforts to bring our survival rates in line with our European counterparts”.
I have been told by a man who has an elderly mother living in south-east Kent, who has cancer and is treated at two different hospitals, that the voluntary drivers who give friendly support to the patients have been told they will no longer receive help with the cost of their petrol. They have also been told that they can no longer have the use of a room with a kettle to have their sandwiches and a drink. These budgetary cuts seem to hit the most vulnerable patients with grass-roots needs. In so many ways throughout a patient’s journey with cancer and other long-term conditions, volunteers—who have often gone through treatment themselves—give great support. This can be lost and dismissed in the costs of high-tech treatment by managers who forget the human needs of a patient’s journey.
My Lords, I, too, congratulate the noble Baroness, Lady Finlay, on enabling the House to discuss a subject of such importance to so many people in this country, and on her most impressive and comprehensive speech. I cannot lay claim to her professional experience and wisdom but, in the short time available, I will make two points about early diagnosis, which is so crucial to outcomes for people with cancer, as the House has heard so often today in so many moving speeches.
First, I ask the Minister about the Government’s plans to scrap the Labour Government’s commitment to reduce waiting times for cancer tests to one week. There is a legitimate debate to be had about the place of targets in the NHS, but it must be rooted in fact. The Government’s July White Paper states:
“Success will be measured, not through bureaucratic process targets, but against results that really matter to patients—such as improving cancer and stroke survival rates”.
This is a caricature of the previous Government’s health policy. It misses the point that these so-called process targets have been focused on outcomes and have played a significant role in the improvements in clinical outcomes in recent years. Moreover, it is not clear exactly how the Government’s theological position on targets has determined them to scrap the one-week waiting time for tests while retaining the two-week target for seeing a specialist. I hope everyone accepts that reducing the time that patients and their families have to wait anxiously for results must, axiomatically, be welcome. I also assume that it is accepted that the prompter the test results, the sooner any necessary treatment can begin.
So I would be grateful if the Minister could explain exactly why the Government have kept the Labour Government’s two-week target to see a specialist but scrapped the one-week target for test results. All I have heard by way of justification are vague words about there not being enough clinical evidence to support it. Can the Minister provide the detailed reasoning for this assertion and for retaining the two-week target?
My second point is about prostate cancer. Here I associate myself with the powerful speech by my noble friend Lord Kinnock. Prostate cancer is the second largest cause of cancer death in men and has seen no significant improvement in mortality rates. As the House will know, there are specific problems with early diagnosis of this cancer. There is poor awareness of it. Many men, for whatever reason, have been squeamish about discussing possible symptoms with their doctors. There has been a particular problem with the reliability of diagnostic procedures. The PSA test is a blunt instrument. In addition to producing false negative results and a relatively high level of false positive results, it cannot accurately distinguish between aggressive and indolent forms of the disease. This has created doubt about its suitability as the basis for a screening programme. As we know, screening has proved very effective in the successful treatment of other cancers.
On the other hand, last year the European Study of Screening for Prostate Cancer, which surveyed 182,000 men aged 50 to 74 in seven European countries, suggested that PSA-based screening can reduce the rate of death from prostate cancer by 20 per cent, although it also suggested that it was associated with a high risk of overdiagnosis. The Minister will be aware that the Prostate Cancer Charity has been working to develop the concept of universal informed choice to overcome these difficulties. With universal informed choice, it would be not for the Government to make the decision on screening but for the individual, on the basis of properly informed choice. The Government’s role would be to create the circumstances and conditions in which everyone was enabled to make such an informed choice by ensuring that every man over 50 and younger men at higher risk would have access to balanced information about the PSA test.
The charity has suggested three models: one that is GP-led, one based on community walk-in clinics and one based on roadshow clinics. The Minister will I am sure be aware that these are not necessarily alternatives but could well be complementary. Whatever model is adopted, it would, as my noble friend Lord Kinnock pointed out so powerfully, have to be supported by regular public awareness campaigns and consciousness raising among healthcare professionals.
I should be grateful if the Minister could say whether he believes that this approach could play an important role in at last reducing mortality rates of this cancer. If he does not agree, I would be grateful if he would explain why. But if he does agree, can he say what steps he will take in the next year to implement this new approach? For example, will the revised cancer reform strategy endorse the need for universal informed choice in relation to prostate cancer screening?
I recognise that this debate has already been wide-ranging, so the Minister may not have the answers to hand or have time to address all these questions fully. In that case, I would be grateful if he could write to me with the answers.
My Lords, I, too, congratulate my noble friend on securing this debate, with its focus on patient experience, and on her forensic presentation of the risks of fragmentation. I am sure that we are all looking forward to hearing the Minister’s response.
As many Members of your Lordships’ House will know, I was the chief executive of the NHS for some years. However, I want to use these few moments to talk about the experiences of people with private health insurance who are seeking treatment for cancer. It is clear that the NHS is the priority, and it is important to get it as good as possible for everyone. Where drugs are proven as effective, they should be available to everyone, and I absolutely take the point about early diagnosis. However, this is not the whole story. I understand, too, that private medicine or insurance have their place for some patients, and any debate about cancer care needs to take account of this.
I have learnt about some of the practices of some insurers thanks to the sad experiences of a friend who has cancer. In a nutshell, people who thought they had bought complete cancer care funding find out, sometimes in the worst of all possible circumstances, that they have bought partial cover at best. I was shocked when my friend told me that his insurer was setting limits on his treatment options which were not referred to in his policy documents and, even worse, proposing to change the terms of their agreement after he had started to claim. My friend is a lawyer, who has great determination and a very loving and supportive family. He decided to fight, and got his MP and me involved. We met the insurers and won some concessions which have prolonged his treatment. It should not be like that.
Having made some inquiries, I find that my friend is not alone. I have spoken to a number of consultants who have told me of patients faced with similar problems who are now paying their own way or have given up. I know of one woman who has to make that decision this week.
These would be sad stories but understandable if it had been clear at the outset what their policies covered. It was not. The fundamental problem is a lack of transparency. Insurance policies are all too often vague and confusing. They do not tell people precisely what they have bought or give them the certainty they need at the time they need it most. Patients find themselves in a negotiation where the insurers hold all the cards. The vagueness of the policies allows the insurers to make decisions entirely on their own terms. I have heard some say that this allows them to exercise compassion and to cover treatments that are not really covered. I am sure that they are compassionate people but they also have a financial bottom line, and such vagueness also allows them to be less compassionate.
The Association of British Insurers has a mandatory code of conduct which sets out the information patients should be given. However, even on its publication it was subject to criticism in the industry, with one source saying that it is very difficult to get any clarity over what is and is not covered. It is not just a question of picking up the policy document; we have to consult the medical advisers and heads of claims in each insurer, and even then it is not clear.
Private health insurance is a financial product, and individuals can complain to the Financial Ombudsman Service. By all accounts, this service works well although of course it can be very difficult for patients to pursue lengthy complaints when they are ill. Nobody, however, appears to be looking at complaints or problems which affect groups of patients or the whole industry. The Financial Services Authority has the power to do that, but has not looked into this in any depth, and I believe that the regulatory system is not working.
Cancer research is developing rapidly, with many new diagnostics and therapies. They offer hope but often bring extra costs. I can see that this makes it difficult to provide cover, but it also makes it all the more important that NHS and insurers’ policies develop equally rapidly.
When I was NHS chief executive, I was very familiar with the criticisms that we did not pay for new and expensive cancer drugs and that patients were subject to a postcode lottery, with access to treatment depending on where they lived. We tried to deal with these problems by setting up the clinically led National Institute for Clinical Excellence to assess scientifically how effective the drugs were. Decisions were made in public; NICE is accountable to the public.
More recently, I have campaigned with others for patients to be able to pay for additional drugs which did not meet NICE’s criteria on the understanding that this field is developing very fast and new treatments are being introduced. In 2008 I was delighted and honoured to co-author a piece to this effect in the Lancet, along with the noble Baroness. I am delighted that the previous Government agreed to do this, and I congratulate the current Government on increasing funding for cancer drugs.
The NHS continues to develop its policies and to improve. It could go further, but what about the private insurers? Let me be clear that not all insurers are as bad as those of my friend; when I talk to consultants, they name the same two or three which they believe are very good and the same two or three which they believe are very poor. But the reputation of all of them is damaged. The industry needs to get its act together. The Financial Services Authority needs to act and the Government need to ensure that they review this whole area.
In the mean time, I would advise any patients in this situation to do the same as my friend—to get their MP involved and to fight. I know that this is not the Minister’s responsibility and that he will refer this matter to his colleagues. However, the Department of Health has a responsibility for looking across this whole territory—we have been given wonderful voluntary sector examples of hospices—and at the impact on the NHS of private insurance and private healthcare. My complaints about clarity also apply to the NHS. It is very important that the NHS spells out what treatment people can expect and therefore, by implication, what space may be available for private insurance.
My experience is that people want clarity and certainty. Whether they are NHS or private patients, they do not want to wait around for decisions. The private insurance industry is failing on this, and I believe that the Government and the NHS could do more.
My Lords, despite the fact that successive Governments have generally maintained funding, modern medicine is, I believe, experiencing an economic crisis that has brought changes that have alienated patients and eroded the job satisfaction of physicians. It has become too expensive. The resultant managed care system is making the lives of both patients and doctors difficult. One of the attractions of medicine as a profession was the promise of autonomy. Today, few doctors can succeed in solo practice and most must work in group practices or corporate settings, where they are told how many patients to see in an hour, which treatments are authorised and which are not.
The very success of modern scientific medicine has been partly responsible for this situation. Eliminating infectious disease—the major killer of the early 20th century—has left us to deal with chronic degenerative illness. The success of medicine has also contributed to the ageing of the population. Of course, medical expenses increase the more elderly people that there are.
Another reason for the expense of conventional medicine is its extreme dependence on technology. Medical technology is inherently costly, and unless we change that dependence, there is little hope of cutting costs. Another powerful economic force impacting on medicine is the still-growing consumer movement that is demanding low-tech options for preventing and treating illness. Consumers are very clear about their desire for natural, complementary and alternative therapies. This is not a passing fad but, rather, a sociological trend with deep roots and a great economic significance.
Patients want greater empowerment in medical intervention and they want doctors who share their views about health and healing. They want doctors and specialists who have time to sit down with them and help them understand the nature of their problems rather than just promote drugs and surgery as the only possible treatment. They want doctors who are aware of nutritional influences on health and who can answer questions about the complex array of dietary supplements and natural therapeutic agents in health food stores. They want doctors who are sensitive to mind-body interactions, who are willing to look at patients as mental-emotional beings as well as physical bodies and who will not laugh at them for inquiring about Chinese medicine or therapeutic touch.
Those are all reasonable demands. A problem is that medical schools are not training doctors in the ways that consumers want and many patients are turning elsewhere. At a time when healthcare institutions are economically pressed, medicine cannot afford to ignore where the market is moving.
It is possible to teach both patients and practitioners about the strengths and indications of standard medicine without in any way rejecting its real achievements. Alternative, complementary medicine is a rich mixture of wisdom and folly. A few alternative therapies are dangerous, more are ineffective and still more are unproven, but many conventional practices are also unproven and many are dangerous as well as ineffective and costly. The use of complementary medicine in the treatment of cancer has attracted particular attention because of the fear among oncologists, radiologists and cancer surgeons that patients may be denied effective and potentially life-saving treatment because of a reliance on unproven fringe techniques. This issue arouses strong feelings among orthodox and complementary practitioners and their patients.
A 1984 study by Cassileth et al found that, in their beliefs about illness and treatment, cancer patients using complementary medicine differed substantially from patients using only conventional therapy. Patients using complementary medicine were more likely to believe that their cancer was preventable, primarily through diet, stress reduction and environmental changes. They were also more likely to believe that disease in general is caused mainly by poor nutrition, stress and worry. Almost 100 per cent of the patients interviewed believed that they should take an active role in their own health as compared with 74 per cent of patients having conventional therapy only.
The challenge is to sort through all the evidence about all healing systems to extract those ideas and practices that are useful, safe and cost-effective. Then we must try to merge them into a new comprehensive system of practice that has an evidence base and addresses consumer demands. The most appropriate term for this system is “integrative medicine”. That term is neutral, accurate and acceptable in academic discussion and it avoids the misleading connotations of “alternative medicine”, which suggests a replacement of the standard system, and of “complementary medicine”, which suggests retention of standard therapies as central and primary.
Integrative medicine is not simply concerned with giving physicians new tools such as herbs in addition to, or instead of, pharmaceutical drugs; rather, integrative medicine aims to shift some of the basic orientations of medicine towards healing rather than symptomatic treatment, towards a closer relationship with nature, towards a strengthened doctor-patient relationship and towards an emphasis on mind and spirit in addition to body. These shifts should make for better medicine in addition to greater satisfaction for patients. I should declare that I am president of the All-Party Parliamentary Group for Integrated and Complementary Healthcare.
Integrative medicine offers the promise of restoring values that were prominent in medicine of the recent past, cutting healthcare costs, improving health and renewing consumer confidence and satisfaction. I hope that my noble friend will confirm that the White Paper will enable and promote patient choice, and that cancer patients and those patients who wish to access complementary therapies will have that access and will not be discriminated against in any way.
My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for giving us the opportunity to debate this important subject. It is a subject which, in one way or another, touches the life of every member of our society. My husband was diagnosed four years ago with an aggressive, inoperable tumour on his tonsils but manages to have quite a good life and is looked after very well within the NHS. There can be few, if any, members of our community, rich or poor, young or old, who do not know someone who suffers from one of the many forms of this diverse condition or, sadly, has suffered, or suffers, from it themselves, for cancer in its various forms is no respecter of class or status.
Even among those of us who have not been touched in these ways, the fear of this condition has probably been with us for some time. We hear much about the war on cancer, but in truth the treatment of these conditions is a campaign, one in which the outcome may be determined at many stages, sometimes, sadly, by the disease itself, but increasingly and positively by the exertions of staff at all levels within our health service. I declare an interest in that I am the chair of Barnet and Chase Farm NHS Trust, which delivers the greatest volume of cancer-related healthcare of any trust in north London. It is clear to those who work in the NHS that enormous strides have occurred in the management of cancer, aided by the investment in funding and purpose of the NHS by the previous Administration. There is therefore both a heavy burden and an expectation on the new Government to maintain and, indeed, increase this commitment. When he responds to the debate, I am sure the noble Earl will assure us that this will be the case.
It is of vital importance in the maintenance of services to our patients, particularly in the present economic climate, that these resources are used wisely and are not dispersed on ill-considered schemes of centralisation, which, while appropriate for some areas of management, often provide an expensive service of no greater quality—often the quality is less good—at a place remote from the patient’s community and friends. Noble Lords are aware of these issues, which are mentioned in the White Paper.
As we seek to improve the lot of those who suffer from this disease, it is important to realise that the greatest possible impact that we as a society can make in improving outcomes is by investing in the education not only of our clinical staff but of society as a whole. As many noble Lords have said today, early diagnosis is undoubtedly the key to better prognosis. In this, much may be gained by ever closer integration of primary and secondary care services that fit together “like a jewelled bracelet”, as Winston Churchill said of the services at D-day. Will the noble Earl assure us that this is the Government’s policy and that it will continue to be so?
However, this will be of little avail if we do not continue the previous Administration’s investment in high technology diagnostic techniques and continue to press forward with the new and innovative surgical and oncological methods now available. It is the experience of my trust, which is among the UK leaders in the application of minimal access and robotic technologies, that these can be applied safely, economically and effectively in the setting of a large district general hospital, with improving patient outcomes and reduced length of hospital stay.
It is impossible to overstate the importance that our patients ascribe to maintaining the highest quality of care for these conditions. However, contrary to the views often expressed by those on committees charged with organising services, our patients are clear that for them one of the most important aspects defining quality of service—let us not forget that they constitute both consumer and paymaster—is local provision. It seems to me that too often current agendas display an arrogance which serves to cover for the self-interest and vested interests of some central institutions in that they believe the service they provide is more important to patients than patients themselves believe.
I should be failing if I did not bring to the attention of the House the concerns felt by our clinicians and patients about the lingering effects of postcode prescribing. We have discussed that in the House before. Nothing can be more corrosive to the local community and its health services than the fear that the quality of your treatment is determined not by your clinician but by your postcode. I therefore welcome the recent announcement by the Secretary of State with regard to the setting up of a limited fund to allow the prescription of some of the recently introduced and very expensive pharmaceutical agents. However, in the individual prescribing, I ask that we make sure that the bureaucratic opportunity is removed and that the clinician is the absolute and ultimate person to ensure that the treatment is applied wherever it properly needs to be.
Other noble Lords have referred to the hospice movement and the choices that people are sometimes able to make at the end of their lives. I endorse and encourage whatever our Government and the noble Earl can assure us about the hospice movement being supported in many ways.
My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for having secured this important debate. I congratulate the noble Lord, Lord Howard of Lympne, on his excellent maiden speech, defined by the strong values that have characterised his contribution to public life over three decades.
I propose to contribute today on the subject of thrombosis blood clotting, which is common in cancer patients, and in so doing refer your Lordships to the entry in the register of interests where I state that I am a practising cancer surgeon; that I am director of the Thrombosis Research Institute in London, where I lead a large programme of research globally on the problem of thrombosis in cancer patients; and that I have a scientific advisory role to a number of pharmaceutical industry organisations involved in thrombosis research.
We have heard about the important advances in clinical outcomes that have attended many cancers over the past two or three decades; that is welcome. That has been achieved through a better understanding of the biology of many cancers, which allows us to characterise them in more detail and to ensure that targeted therapies can be provided to patients, so improving both survival and quality of life. As we have heard, improvements in the outcomes for patients with malignant disease have also been achieved through earlier diagnosis. That is critical, because many of the advances in surgical practice can be applied only to those patients who present with earlier-stage disease, where radical interventions can in some cases cure, and in other cases ensure long-term palliation.
Advances are available beyond intervention in surgery, through new therapies. One of the exciting developments over the past five to 10 years is targeted biological therapies, which definitely improve outcome and survival but are frequently associated with a high frequency of unintended complications. The agents will improve outcome but can be associated with problems such as infection/febrile neutropenia and, of course, thrombosis blood clotting. Blood clots in any patient population develop in the deep veins of the legs and can often grow up the venous system of the leg, break off and pass to the lung, where they occlude the circulation from heart to lungs and can frequently be fatal. In the United Kingdom, the Health Select Committee of the other place in 2005 undertook a report into thrombosis and blood clots in hospitalised patients—a world first for a parliament—and identified it as a problem, with 30,000 deaths a year associated with thrombosis unnecessarily after hospital discharge.
As a result, we now have a system available throughout the NHS of risk assessment for patients coming into hospital, so that those at the highest risk of developing a blood clot can be provided with appropriate interventions to prevent them. One of the most important risk factors for developing a blood clot is the presence of malignant disease. Some 20 per cent of the total burden of thrombosis is seen in patients with cancer and, regrettably, cancer patients who develop a thrombosis are three times as likely to develop recurrent blood clots during the course of their natural history. Even though they are provided with anti-clotting drugs, they are twice as likely to develop major bleeding complications as a result of their use, so it is a problem.
While cancer patients are in hospital, they will be subjected to risk assessment in the perioperative environment or if they are admitted to a hospital bed for other management of their malignant disease. However, the management of cancer patients extends well beyond a short period in hospital. There are important opportunities to improve clinical outcomes through extending risk assessment into the other care environments where patients with malignant disease are managed. As we have heard, that is at home, potentially in hospice, or in other care environments such as ambulatory care for receipt of chemotherapy in the community. The National Institute for Health and Clinical Excellence has excellent guidelines at the moment on the prevention of venous thromboembolism in all patient populations. When it reviews that guidance, will it take the opportunity to look specifically at the problem of thrombosis in patients with malignant disease outside the hospital setting, and undertake some review of the available evidence with regard to risk assessment in the out-of-hospital environment and the potential use of anti-clotting drugs to prevent thrombosis and potentially improve clinical outcomes?
I ask that of the Minister because cancer patients who develop a thrombosis regrettably have a much poorer prognosis than those patients who never develop one during the natural history of their cancer. With so much emphasis directed rightly on early diagnosis and the provision of surgical intervention or chemotherapy and biological interventions to improve clinical outcomes, we also need to pay attention to avoiding unnecessary complications and to ensuring that the whole spectrum of supportive care for those with malignant disease means that they can benefit from increased quantity and quality of life.
My Lords, I ask the leave of the House to take a couple of minutes to speak in the gap. In doing so, I declare an interest as the patron of the Breast Cancer Campaign and a founding fellow of Breakthrough Breast Cancer. Perhaps more relevantly, given today’s debate, I also declare an interest as someone supporting both my sister and my niece through their own cancer treatments at the moment.
This has been a truly fabulous debate in which noble Lords have touched on almost every aspect of concern around cancer. It has thrown up some significant and challenging questions for the Minister to address, so I do not want to impinge on his time. However, I am particularly concerned about the whole question of the reorganisation of the NHS. Why are focusing our resources—£3 billion in estimate—on that? As the noble Lord, Lord Colwyn, pointed out, it is a time when there are challenges for the cost of care going forward.
Many speakers talked about breast cancer and the improvements that we have seen in outcomes for the 45,000 patients diagnosed with it every year. The noble Lord, Lord Howard, spoke eloquently about his father’s breast cancer. He has personally raised awareness of breast cancer among men; 300 men are diagnosed with it every year. Those improvements have come about because of early diagnosis and awareness-raising by thousands of charity activists. However, also important have been screening and improvements in treatment, most notably because of progress in research but also because of a greater focus on improving service delivery.
I have two questions for the Minister. The first is very much about screening. In the 2007 Cancer Reform Strategy, there was a commitment to ensure that all breast screening units in England had at least one digital mammography set by 2010. I hope that he can update me on progress with delivery of that new technology, which is much more flexible. Secondly, how will the Government continue to work in partnership with charities and voluntary sector organisations to continue to improve the development of infrastructure research projects such as the Breast Cancer Campaign’s national tissue bank—a proposal made following a gap analysis which looked at the barriers to research and how to improve outcomes for people with breast cancer?
My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Finlay, on initiating this important debate. We have had a debate of exceptional quality, but that is only to be expected in your Lordships’ House on this subject. I also join others in congratulating the noble Lord, Lord Howard, on his maiden speech. I am sure that it is the first of many sparkling contributions to your Lordships' House.
I shall start by echoing the remarks of the noble Baroness, Lady Finlay, on tobacco regulation. This seems to be a question that I ask every week. What exactly is happening to the implementation of vending machine bans and point-of-sale tobacco regulation?
The timing of this debate is most appropriate. It is a snapshot of where we are after the previous Government’s work and investment, which have so improved the prospects for cancer patients, and of what still needs to be done. It is also an acknowledgement that change is coming, and poses questions to the Government about what that will mean for cancer patients and their families. It has also provided some suggestions for inclusion in the refreshed, new Cancer Plan.
I was moved by many of the speeches, not least that of my noble friend Lord Beecham, who I am delighted to have as a member of our small but perfectly formed opposition health team. My noble friends Lady Pitkeathley, Lord Kinnock and Lady Morgan made contributions that were enhanced by personal experiences, and my noble friend Lord Wills brought to the House’s attention his forensic ability, which I am sure we shall benefit from as we move forward.
We know that the most effective way of improving cancer survival rates is through prevention and early detection. That is why as a Government we invested in improved cancer prevention and diagnostic services. Breast screening for women, for example, means that 14,166 cases were diagnosed in women aged 45 and over—a figure which is similar to the one the previous year and nearly double that of 10 years previously. The Labour Government also rolled out the NHS bowel screening programme, the first screening programme targeted at both men and women. As a result of cancer screening and the two-week requirement for a specialist to see the patient, survival rates for breast cancer, as for bowel cancer, are improving for those getting this early screening and diagnostic.
The premature mortality rate for cancer is the lowest ever recorded, saving nearly 9,000 lives in 2006 compared with 10 years previously. A recent study by the International Agency for Research on Cancer found that breast cancer mortality rates in the UK were reduced by 30 per cent during the period 1989 to 2006, more than in any other European country. We are on the right trajectory, and it is important to keep moving in the direction in which we have started.
I should like to make a related point to the Minister. It is important to stop allowing this issue to be used as a political football. Andrew Lansley’s continued suggestions that the previous Government somehow failed cancer sufferers is not appropriate. I would be the first to admit that this was work in progress and that there was much more to do, but Mr Lansley does not need to attack the previous Labour Government to justify keeping cancer high on the healthcare agenda.
The Government have, for example, recently used data from EUROCARE that compare UK survival rates of patients diagnosed between 1995 and 1999 and between 2000 and 2002. The data show that the UK has lower survival rates for the most common cancers—lung, breast, prostate and bowel—than other countries with a similar health experience. However, there are two problems with this comparison. Few other European countries have the fully comprehensive cancer registry—referred to by the noble Baroness, Lady Finlay—that England has. Cancer data in Germany, for example, relate to only 1 per cent of the population. This information comes from the King’s Fund. It is also worth keeping in mind that there is a five-year time lag associated with five-year survival rates and that, at the end of this Government, EUROCARE will be measuring the experience of patients diagnosed during the early part of Labour’s Cancer Plan 2000. We know that five-year survival rates for the 21 most common cancers improved for both sexes between 2003 and 2007, compared with the period between 2001 and 2006.
The noble Baroness, Lady Finlay, raised some important questions about the cancer fund. I am still unclear about how the decisions to use this fund will be made and about what will happen if it runs out of money, as it surely will. There are various estimates about the inadequacy of the fund to meet the need. The British Oncology Pharmacy Association has estimated that the real cost of funding treatments will be £85 million this year and £120 million in a full year. We have to ask questions about the fund, which are linked to questions about NICE.
Can the Minister tell us which is likely to save more lives—investing in early diagnosis, or in cancer drugs not approved by NICE? Linked to this is the Government’s intention to downgrade NICE’s work in this area. It is extraordinary that the Government are removing NICE’s authority. It is the one outfit designed to prevent the Secretary of State having to take responsibility for unbearable rationing decisions. As the Guardian reported recently, and as the Minister said, NICE will become “somewhat redundant”. That week we saw the Daily Mail crowing about victory for its campaign. Under the headline “‘Penny-pinching’ NICE stripped of power”, the article stated:
“The scandal of patients being denied drugs just because the NHS rationing body decides they are too expensive will end”.
There is a serious problem here because, regardless of whether the NHS budget is increasing, it is vital to preserve NICE’s integrity and to ensure that the use of all drugs and treatments on the NHS is approved on an equal and fair basis while ensuring that they are cost-effective to the taxpayer. I do not understand why NICE cannot be the body that undertakes the new value-based system which the Government have been outlining. At the end of the day, if the changes go through, how will the Government help those GP commissioners who will be targeted in local campaigns by newspapers and patient groups to prescribe expensive drugs for rare conditions?
I shall return to the issue of waiting lists which I raised in an Oral Question to the noble Earl in the past couple of weeks. I asked about the lengthening of waiting lists for diagnostic tests and its impact on the diagnosis of cancer. Waiting lists for diagnostic tests have almost doubled since Andrew Lansley got rid of the 18-week target. Those are the Government’s statistics, not mine. I clearly did not put my supplementary question to the noble Earl correctly because he told me that I was completely misinformed and wrong. I was pointing out that if diagnostic tests are being delayed, it seems likely that cancer patients will be in that cohort, and that the two-week target—which I am not disputing; I am glad that the Government are keeping it in place—therefore begs the question: how will the Government monitor the consequences of increasing waiting lists for cancer patients and other conditions? Is it acceptable for waiting lists to be lengthening in this manner? How will GP commissioning deal with this issue, and how will the two-week target be maintained under the new regime?
I shall conclude with two questions, one of which picks up on the remarks of the noble Baroness, Lady Hussein-Ece, about people with cancer in the workplace. I am also grateful to Macmillan Cancer Care for sending me a briefing which calls for a set of initiatives to deal with people who want to work and who have, or are recovering from, cancer. Will such initiatives be included in the new Cancer Plan? Macmillan is calling for every patient who wants to work after cancer to be given back-to-work information; explicit outcomes on cancer patients remaining in and returning to work to be included in domain 3 of the NHS outcomes framework; vocational rehabilitation services to be included in cancer quality standards and the NHS Commissioning Board's guidance; and the Department for Work and Pensions to promote employers' awareness of the employment provisions of the Equality Act and their impact on disabled people, in particular those affected by cancer.
Finally, I return to an issue that I have raised before with the noble Lord, namely, the impact of excessive hospital parking charges for those with cancer and other conditions. The average cancer patient pays £325 in travel costs and hospital car parking charges while travelling 53 times to hospital in the course of their treatment. We know that the department's guidance is not working because it is not enforced. Around 60 per cent of cancer patients still have to pay the full price for parking during their treatment, even though DH guidance recommends that hospitals offer free or concessionary rates. Excessive car parking charges are too often the final straw that breaks the camel's back during a highly stressful, emotional and financially challenging time for the patient and their loved ones. We have had a full and fascinating debate and I look forward to the Minister's response.
My Lords, I begin by expressing my gratitude to the noble Baroness, Lady Finlay, for securing today’s debate and I pay tribute to her for the expertise and leadership that she has shown as chair of the All-Party Parliamentary Group on Dying Well. It is also a particular delight to welcome my noble friend Lord Howard of Lympne and to congratulate him on the not unexpected excellence of his maiden speech.
Cancer, regrettably, touches many people’s lives. In England, more than 250,000 people are diagnosed with it every year. One in three of us will develop cancer in our lifetime. One in four of us will die from it. Today’s debate comes at a timely point, as the Department of Health prepares a new strategy to improve cancer care in this country. While survival rates have improved over the past 25 years, we still compare unfavourably with other leading European countries. We believe that up to 10,000 lives a year could be saved if we could bring cancer survival up to the standards of the best.
One of the main reasons why we languish behind is that we diagnose cancer at a later stage, partly because British people typically present later with symptoms. Cancer Research UK’s cancer awareness measure suggests that only one in three people can recall common cancer symptoms. I agreed with everything that the noble Baroness, Lady Wall, said on that issue. We need to do better, which is why the Government are investing nearly £11 million in new campaigns to alert people to the symptoms of bowel, breast and lung cancer—three of the biggest killers. These will not be the conventional, one-size-fits-all campaigns that we have seen in the past. Most of the funding will go into tailored, local approaches—genuine grass-roots campaigns—firmly evidence-based and using the best marketing techniques to raise awareness.
Once a person presents with suspect symptoms, fast access to diagnostic tests is crucial. The noble Baroness, Lady Finlay, my noble friend Lord Clement-Jones and the noble Lord, Lord Wills, referred to the one-week commitment. The previous Government proposed this policy with considerable fanfare, although they were a little quieter about how it would have been paid for. The price tag attached is very considerable, reflecting the serious practical implications that the policy entails. The coalition’s view is that a blanket one-week access target would not be the best use of the resources that we have and that the proposed target was not based on clinical evidence.
Patients with suspect symptoms are already placed by their GPs on the two-week urgent referral pathway. On average, that pathway is being adhered to. My noble friend Lady Hussein-Ece rightly emphasised early diagnosis. The cancer reform strategy review is looking at what we need to do to tackle late diagnosis of cancer, such as encouraging patients to recognise and present cancer symptoms, supporting GPs to diagnose cancer earlier and improving primary access to diagnostic tests for cancer. The new outcomes framework will give a consistent set of measures and expectations for the NHS to follow. GPs will make their referral decisions based on the best clinical evidence on what achieves the best outcomes.
Of course, good information is the key to this. If commissioners can see what others are spending their money on and what results they are achieving, they are in a better position to make the right choices for their patients. The department is already helping commissioners to interpret the data that they have in order to support better decisions. This includes the latest information on access to cancer services. The noble Baroness, Lady Finlay, asked whose responsibility it will be to ensure that early diagnosis happens once the reforms have taken place. In future, the new public health service will have an important role to play in promoting awareness of symptoms of disease and in encouraging early presentation. Of course, the public health service will need to work closely with the NHS, which will be responsible for having the services in place. We continue to publish diagnostic test and referral-to-treatment waiting times so that service commissioners and providers can address any long waits and variations in waiting times and so that patients can take this information into account in deciding where they want to go for their diagnostic tests. Patient decision aids are one way of helping patients to make better decisions with their doctor about their care and treatment. We are seeking views on the use of patient decision aids as part of the consultation that is under way on greater choice and control.
The noble Baroness, Lady Finlay, asked about the sanctions and levers in the system. The NHS commissioning board will be responsible for ensuring that consortia are accountable for the outcomes that they achieve, for their stewardship of public resources and for their fulfilment of the duties placed on them. The board will intervene in the event that a consortium is unable to fulfil its duties effectively or where there is a significant risk of failure.
Screening is another key way of detecting cancer earlier. As noble Lords will know, NHS screening programmes save many thousands of lives each year. Breast cancer screening alone saves 1,400 lives, making it one of the most effective programmes in the world. However, people should go into screening programmes with their eyes open, aware of what the procedure involves and what the risks and benefits are. Concerns have been raised about overdiagnosis and overtreatment of breast cancer due to screening. We are now redrafting the leaflet that all women receive prior to screening so that those risks are made clear. The new leaflet will be published in the near future.
The noble Lord, Lord Wills, spoke about prostate cancer screening and we heard a powerful contribution on prostate cancer from the noble Lord, Lord Kinnock. As both noble Lords will know, the Government work closely with the Prostate Cancer Charity—as did the previous Government—through the Prostate Cancer Advisory Group. Overarching the advice on screening that we receive is the work of the National Screening Committee, which advises on, and continues to review the evidence for, screening programmes. The noble Lord, Lord Wills, asked whether we would introduce screening for prostate cancer. The NHS constitution states:
“The NHS … commits … to provide screening programmes as recommended by the UK National Screening Committee”.
We have said that we will support the rollout of screening programmes for common cancers where the evidence supports this. On 22 October, the committee’s consultation on screening for prostate cancer came to an end and it will make recommendations to Ministers in due course.
We believe that the new flexible sigmoidoscopy for bowel cancer could save up to 3,000 lives a year. The National Screening Committee met yesterday to discuss how this procedure could be used to deliver best results. The noble Baroness, Lady Finlay, spoke about this, as did the noble Lord, Lord Beecham, in his very moving speech. The National Screening Committee has just met to review the evidence for a bowel cancer screening programme using flexible sigmoidoscopy. The recommendations will be in front of Ministers shortly. The noble Lord, Lord Beecham, also referred to stoma nursing. The Government recognise the valuable role that specialist nurses, including stoma nurses, provide. The noble Lord may wish me to write to him on that subject, which I am happy to do.
The noble Lord also spoke about colonoscopy. I have it on good authority—that of the noble Baroness, Lady Finlay, who has kindly passed me a note—that colonoscopy is helpful but looks only at one point in time. It is not a pleasant procedure and it is not risk-free either, so overall many clinicians believe that there can be better approaches to diagnosis.
After diagnosis, surgery tends to be a key part of the clinical response. New and less invasive surgical techniques are being developed, notably keyhole surgery, but of course access to the new techniques requires trained, specialist surgeons who treat enough patients to keep their skill levels up and the safety risks down. As NICE guidance tells us, this may mean consolidating specialists into regional centres of excellence, where there are sufficient volumes of patients.
The noble Baroness, Lady Wall, spoke about postcode prescribing. I agree that this has been a worry for some time. We need to expand access to cancer drugs in particular. That is why last month the Government launched a consultation on the cancer drugs fund and confirmed that from next year the NHS would receive £200 million a year on top of the £50 million provided for the rest of this financial year. Patients are already benefiting from the interim funding. The Rarer Cancers Forum has said that the fund could help more than 2,000 patients this year alone.
For 2011-12, the cancer drugs fund will continue to be run through strategic health authorities. We believe that that is the best way of balancing responsiveness to patients with consistency and fairness across the system. The noble Baroness, Lady Thornton, questioned whether this was a wise use of NHS money. I simply say to her that I do not see this as an either/or situation with regard to early diagnosis; we need to do both. We believe that, from 2012 onwards, the fund should be taken over by the NHS commissioning board, which will look at how it administers the fund locally. Although the noble Baroness, Lady Finlay, suggested that a postcode lottery was emerging in the cancer drugs fund, we do not have any evidence that that is the case. However, if she has that evidence, I should be very glad to hear about it.
Of course, treatment is not just about chemotherapy; radiotherapy is another key area. We are putting an extra £43 million into proton beam therapy treatment over the next four years, which will benefit up to 400 patients a year by the end of the spending review period. We want patients to benefit from the most sophisticated techniques, such as intensity-modulated radiotherapy. Some services may be more appropriately commissioned by the NHS commissioning board than by GP consortia—again, an area raised by the noble Baroness, Lady Finlay—where large populations are needed for planning and commissioning. Radiotherapy could well be an example of that. I say to the noble Lord, Lord Hameed, that improving cancer awareness and early diagnosis is likely to increase demand for radiotherapy. We need to ensure that capacity is in the right place and that the most effective use is made of existing capacity. We are planning ways in which to boost services so that we can offer radiotherapy to all those who would benefit from it.
Sadly, even with a focus on improving survival rates, some patients lose their battle against cancer. In these sad circumstances, we need to do everything that we can to improve the palliative and end-of-life support that they receive, improving pain relief and emotional support and joining up acute and community services so that more people can die at home rather than in hospital.
My noble friend Lady Hussein-Ece mentioned the recent medical paper on palliative care for patients with metastatic non-small-cell lung cancer. The Lung Cancer and Mesothelioma Advisory Group is currently reviewing this study and will consider its findings as part of its advice to the Government.
My noble friend Lord Howard, in his excellent speech, took us right to the heart of the issue of palliative end-of-life care. The Government recognise the valuable role that hospices play in delivering end-of-life services, in particular for cancer patients, and their good work of course extends far beyond the buildings that they occupy. We demonstrated our commitment to supporting hospices when the Treasury reconfirmed the £40 million capital grant scheme for hospices in the current year, originally announced as part of the end-of-life care strategy. We are concerned to improve the quality of end-of-life care for everyone, regardless of diagnosis, and we look forward to working with the hospice movement to achieve that aim.
My noble friend Lord Bridgeman also spoke on that theme. Too often, a person’s needs and those of their family and carers are not adequately assessed and addressed, including finding out a person’s preferences for the type of care that they would wish to receive and the setting or location in which they would wish to be cared for at the end of life. I agree with my noble friend that advanced care planning is a helpful way of addressing these issues. That was highlighted as a key area within the end-of-life strategy. We recognise the need to ensure that the care that people receive at the end of life is compassionate and appropriate and that it supports the exercise of choice. We confirmed our commitment to improving quality and choice in palliative and end-of-life care in the White Paper that we published in the summer. This includes the commitment to move towards a national choice offer, supporting people’s preferences about how to have a good death.
The noble Baroness, Lady Finlay, asked about cancer centres. The NHS commissioning board will provide leadership for quality improvement through commissioning. This will include setting commissioning guidelines on the basis of clinically approved quality standards developed with advice from the National Institute for Health and Clinical Excellence. However, we recognise the excellent work that is currently done by cancer centres and indeed by cancer networks.
The noble Baroness also asked about foundation trusts and the possibility of the inappropriate retention of patients in certain circumstances. Our long-term vision for the benefit of patients and taxpayers is that care will be provided by responsive autonomous providers who will be accountable to Monitor and the Care Quality Commission. Where specific control mechanisms are needed for providers, these should take effect through regulatory licensing and clinically led contracting rather than through hierarchical management by regions or the centre.
A number of noble Lords, including my noble friend Lord Bridgeman and the noble Baroness, Lady Emerton, whom it is a great pleasure to see back in her place, raised the issue of one-to-one support for cancer patients. We want every cancer patient to have access to appropriate care, support and information, but this must be affordable and sustainable for the NHS. We are reviewing the evidence to see whether one-to-one support can improve care for people after a diagnosis of cancer, as well as ensure the efficient use of NHS resources. We are working with Macmillan Cancer Support to understand the costs and potential benefits of one-to-one support. The results of that work will be made available as part of the review of the cancer reform strategy later this winter.
I return to the powerful speech of the noble Lord, Lord Kinnock, on prostate cancer. He was right in so much of what he said. Survival rates for prostate cancer in England still lag behind those of comparable countries in Europe. Late diagnosis is likely to be a significant contributor and, again, the cancer reform strategy will be looking at what we need to do in this area. I should be delighted to have a one-to-one conversation with the noble Lord if he would find that helpful. I simply add that the prostate cancer risk management programme is in place and that the intention behind it, as I am sure he is aware, is that men without symptoms of prostate cancer should be able to have a PSA test free on the NHS.
My noble friend Lord Clement-Jones raised the important topic of lung cancer. Once again, our survival rates for lung cancer are low compared with those in Europe. We are committed to improving outcomes for those with lung cancer, which is one reason why we have asked the national cancer director, Professor Sir Mike Richards, to lead the review of the cancer reform strategy. I am pleased to learn that the British Lung Foundation contributed to the consultation on the review. We will be publishing in the strategy a future direction for lung cancer care. We know that early surgical intervention can be critical for lung cancer patients, but that is often not possible if the cancer is too far advanced. We have to look carefully at why there is variation, although I think that the low rate of lung cancer surgery is likely to be due in part to late diagnosis.
My noble friend also spoke about ovarian cancer, to which many of the same messages apply. Our public awareness campaign is focusing on the three biggest killers, but the Department of Health has worked with ovarian cancer charities to develop the key messages on the signs and symptoms of ovarian cancer.
The noble Lord, Lord Kakkar, raised the important issue of risk assessment for thrombosis during treatment in a range of settings. I can tell him that that will be an important issue for NICE to consider as it develops quality standards for cancer care.
The noble Baroness, Lady Emerton, powerfully emphasised the importance of chemotherapy at home. The NHS operating framework for this year confirmed the direction of travel towards having more services closer to home. Where there are skilled and experienced staff, chemotherapy in community settings can help to meet increasing demand and provide greater choice for patients.
The noble Baronesses, Lady Finlay and Lady Thornton, asked about our tobacco policy. At the moment, we are considering options for the display of tobacco in shops. We seek to balance public health priorities with reducing burdens on business. Those matters are under consideration by Ministers. It is probably premature for me to discuss the details of the options that we are considering, but an announcement will be made in due course.
I am aware that time has run out. Suffice it to say that I believe that this has been an excellent debate. I undertake to write to those noble Lords whose questions I have not been able to cover. I think that we all agree that advances in medical science mean that cancer is no longer the death sentence that it once was. That is a cause for satisfaction and for congratulating those cancer specialists in the NHS who do such wonderful work. We want to build on those achievements to take cancer care to new heights, to ensure that those beginning treatment for cancer do so with confidence and hope.
My Lords, I thank the Minister for his reply and all noble Lords who have spoken in this outstanding debate. I particularly thank the noble Lord, Lord Howard of Lympne, for having decided for his maiden speech to contribute to this debate. He raised the tone even higher than that set by everyone else in this House.
There are some very clear messages here. People want the choice to be treated well at all times and, to cite the title of the book by the late Lady Beecham, to be moving forward with their cancer and living with it. Integration, not fragmentation, must be the way that the changes take us in the new world that we face. Outcomes can and must improve. Prevention must continue. We must not lose sight of tobacco control.
I finish simply. There has been a call for information from around the House. In the words of the late Vicky Clement-Jones, whom I had the privilege to know, knowledge is the antidote to fear. This debate has demonstrated that.
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.
“In this House, in October, I set out our resolve to secure a welfare system fit for the 21st century, where work always pays and is seen to pay.
Following consultation, a broad positive consensus has emerged—from Citizens Advice to the Institute for Fiscal Studies, and across the political divide. The White Paper that we are publishing sets out reforms to ensure that people will be consistently and transparently better off for each hour they work and every pound they earn. We will cut through complexity to make it easier for people to access benefits. We will cut costs, reduce error and do better at tackling fraud. The detail is published today and the White Paper is available in the Library. Let me take this opportunity to thank all who have helped build and write these reforms.
Let me remind the House of the problem that we are trying to solve: 5 million people of working age are on out-of-work benefits; 1.4 million people have been on out-of-work benefits for nine of the past 10 years; 2.6 million working-age people are claiming incapacity benefits, of which about 1 million have been claiming for a decade; and almost 2 million children are growing up in workless households—one of the worst rates in Europe.
Some have said recently that it is jobs—not reform—that is important, but in doing so, they miss the point. This is a long-standing problem in this country. We have a group of people who have been left behind, even in periods of high growth. Even as 4 million jobs were created over 63 quarters of consecutive growth, millions of people in Britain remained detached from the labour market. Four and a half million people were on out-of-work benefits even before this recession started. These reforms are about bringing them back in. I want them to be supported and ready to take up the 450,000 vacancies that are currently available in our economy. If we solve this problem, we begin to solve the wider social problems associated with worklessness.
The measures in the White Paper get this process under way. They are the first key strand of our welfare reform. By creating a simpler benefits system, we will make sure that work always pays more than benefits. By reducing complexity, we will reduce the opportunities for fraud and error, which currently cost the taxpayer more than £5 billion a year.
Work is the best route out of poverty. At present, some of the poorest who take modestly-paid jobs can risk losing £9 or more out of every £10 extra they earn. The universal credit puts an end to some of those perverse disincentives that make it so risky for the poorest to move into work. The highest marginal deduction rates for in-work households will fall from 95.8 per cent to 76.2 per cent. That is the absolute maximum, incorporating both tax and the withdrawal of benefits. There will be a single taper rate of about 65 per cent before tax. That means that about 1.3 million households facing the choice to move into work for 10 hours a week will see a virtual elimination of participation tax rates of more than 70 per cent. With single tapers and higher disregards, the system will be simpler and easier, and people will keep far more cash in their pockets when they move into work.
Our guarantee is crystal clear: if you take a job, you will receive more income. Some 2.5 million households will get higher entitlements as a result of the move to universal credit. The new transparency in the system will also produce a substantial increase in the take-up of benefits and tax credits. Taken together, we estimate that these effects will help lift as many as 350,000 children and 500,000 adults out of poverty. That is our analysis of just the static effects of reform. Analysing the dynamic effects is not easy, but we estimate that the reforms could reduce the number of workless households by about 300,000. Let me also provide assurance about the transition. We will financially protect those who move across to the universal credit system. There will be no losers.
A far simpler system that operates on the basis of real-time earnings will also reduce the scope for underpayments and overpayments, which we all know can create anxiety and disruption and can prove very difficult to correct. This simplification and reform will help end that problem. As well as reducing official error, these changes will also make life far more difficult for those who set out to defraud the system—they are a small group, but nevertheless they are there. The system will be simpler, safer, more secure, fairer and more effective.
That will require investment, with £2.1 billion being set aside to fund the implementation of the universal credit over the spending review period. I have been assisted in this work by my right honourable friend the Chancellor, who has agreed to this investment programme. This is not just expenditure but investment, and investing to break the cycle of welfare dependency is a price worth paying. The universal credit will provide a huge boost to the individuals who are stuck in the benefit trap by reducing the risk of taking work and lifting 850,000 out of poverty in the process.
This investment will produce a flow of savings, as a simpler system helps drive out over £1 billion of losses due to fraud, error and overpayments each year. In the wider economy, dynamic labour supply effects will produce net benefits for the country as greater flexibility helps business and fuels growth, particularly in the high street. We are investing £2.1 billion in spending review 2010, and we are seeking a multibillion pound return.
That is how we will make work pay, but that is not enough on its own as we also have to support people as they make their move back to work—the two issues cannot be separated. That is why we are moving ahead with our new work programme, which will provide integrated back-to-work support, and that is why we have already started a three-year programme to reassess 1.5 million people who have been abandoned for years on incapacity benefit—something that the Opposition started before the election for the flow of new claims. We are now trialling that programme in two cities in the UK.
This is our contract: we will make work pay and support you through the work programme to find a job, but in return we expect you to co-operate. That is why we are developing sanctions for those who refuse to play by the rules as well as targeted work activity for those who need to get used to the habits of work. This work activity will be targeted at those who need it most: those who face the most significant challenges engaging with the labour market. Furthermore, evidence from the work capability assessment—36 per cent of people have withdrawn their application before reaching the stage where they are assessed—underlines the effect this could have on those currently working while claiming benefits.
This new contract represents a fair deal for the taxpayer and a fair deal for those who need our help. I commend these reforms and this White Paper to the House”.
My Lords, that concludes the Statement.
My Lords, I thank the noble Lord, Lord Freud, for repeating the Statement that was given in another place today and acknowledge his personal and detailed engagement in the development of these proposals. On this side, we are grateful for advance sight of today’s Statement. Beyond the normal courtesy of being sent an advance copy and being able to hear it in the other place, we have of course been able to read about it in the newspapers over the past couple of months.
On the substance of the Statement, we have always been clear that we agree with the broad principles of what the Government are doing. We made good progress through the introduction of tax credits and the minimum wage to make work pay, and we made good progress in reducing the number of workless families by 350,000 and the number of unemployed lone parents by a similar amount, but there is plenty more to be done. The system is too complex at present.
The right honourable Secretary of State and the Minister have on more than one occasion gone on the record in acknowledging the work that we did in government that they are building on. We agree that work is the best route out of poverty and we agree with strong conditionality in the welfare system so that benefit recipients get something for doing something. We agree with the principle of a single welfare-to-work programme—we were introducing the personalised employment programme to do just that but at a much more modest pace than the Government are proposing in the work programme. In successive policy, we set out our long-term aspiration for a single working-age benefit papers that would simplify the system, as the universal credit seeks to do. Attaining that would be a significant technical as well as policy achievement, so on our part there is no opposition for opposition's sake.
On this side, we will offer constructive opposition to try to help the Government make their principles a successful reality. It is in that spirit that I raise some concerns. First, it is right that there should be a contract setting out the expectation between the state and the claimant to enshrine the something-for-something nature of things, but as well as providing benefit is there not an obligation on the state to grow employment? Will the Minister agree to publish, perhaps with his friends in the Treasury, targets for employment growth and unemployment reduction? I notice the claims in the media, which we have heard repeated today, that the tougher conditionality will reduce unemployment by 350,000. I would be interested to see the evidence supporting that.
The noble Lord, Lord Freud, will recall our extensive debates on conditionality during the passage of the Welfare Reform Act 2009. In particular, he will recall the consensus that lone parents, particularly mums, should not have to be available for work outside school hours, that there needs to be affordable childcare and that transport costs should be taken into account in assessing availability for work. Can the Minister confirm that tougher conditionality is not to weaken these protections and that good cause will still apply? What is proposed for the protection of children when benefits are withdrawn? Will hardship payments still be available and, if so, at what level of benefit?
Through the future jobs fund and the young person’s guarantee, we found that offering a real job on the minimum wage lifted people's aspirations and got a lot of really good work done for the community. That is what the unemployed—all the way back to the “Boys from the Blackstuff” in the 1980s—have always wanted: they want a job. The new work programme is dependent on successful job outcomes, so they need this too. When will the Government publish a credible plan for jobs growth? The Bank of England said this week that the prospects for growth are highly uncertain, but it is certain that more than 1 million people will lose their jobs as a result of the comprehensive spending review. Can the Minister give hope to those who are currently unemployed that the number of vacancies will start increasing again?
The benefit of work is in building self-confidence and self-esteem. How will the work experience proposals offer that and other gains such as something on the CV and a good reference? How will it be different from the community payback work that we successfully introduced in government? Will it just look like another form of punishment? How will he find these work placements and guarantee us and the work programme providers that the scheme will not just displace other jobs that are needed to get people permanently off benefit? In our experience, as with apprenticeships, it is easy to announce the policy and the funding, but it is much harder to persuade employers to take them up.
On universal credit, there are many points of detail that we wish to explore about how the credit will operate, but those questions are mostly for other occasions. We recognise that the proposal is ambitious, but can the Minister comment on the reports that, in order to fulfil the commitment that no one will be worse off under the proposals, up to an additional £2 billion a year will be required after 2016? Given the time that will be taken to introduce the universal credit, has any thought been given to utilising the better-off-in-work credit in the interim?
We will need to explore the detail in the White Paper on what is included within the credit. Can the Minister say today whether DLA is in or out and whether it is to be subject to the taper? Given that the previously announced decision that council tax benefit—with a 10 per cent cut, of course—is to be devolved to local authorities will potentially lead to differential arrangements up and down the country, what is the Minister’s understanding of what that will mean for the universal credit?
There has been much debate about the draconian changes to the housing benefit regime. In due course, we will want not only to unpick the evidence base on which that is predicated but to look for answers, which to date have not been forthcoming. Will the universal credit allow the separate net identification of components of the credit, given the possible combination of overall caps, individual rent caps and the standard tapers? Does that preclude the direct payment of rent to RSLs and landlords in the private rented sector? If child benefit is to be included, how does the Minister respond to the point that one consequence will be potentially to reverse the hard-won campaign that such support should be a resource that transfers from the pay packet to the purse?
I reiterate our concerns about what is being cut to pay for the proposals. The arguments setting out our opposition to the unfair and damaging cuts to housing and child benefit are well rehearsed and will be made again and again. I should also say that the noble Lord could avoid these damaging cuts by taking more time and, in doing so, he could possibly lower the risks around the delivery of the proposals. We can achieve political consensus on this and agree a programme that goes beyond a single Parliament. That would allow time to build employment in the economy, get reassurance about the success of the IT upgrade on which the universal credit is dependent and allow a smoother transition from the flexible New Deal to the work programme, thus avoiding a damaging gap in provision that potentially will hurt contractors and, more important, vulnerable job seekers.
Let me be clear that we support the strategic direction of the proposals, but what counts is the decency with which they are implemented. We will work constructively with the Government to seek to ensure that that is the case.
My Lords, I thank the noble Lord, Lord McKenzie, for his gracious speech. I welcome his overview that this transformation is going in the right strategic direction and that he and his party are prepared to make sure that we get the very best out of it. There is much consensus around this issue and, as anyone who has looked at my career over the past few years will recognise, it may be that I almost personalise some elements of that consensus. I do acknowledge, as the Secretary of State has acknowledged, that we are building on elements, but we are making them truly transformational by ensuring that people will be able to understand that it is always worth working in a way that, because of the complexity of the current system, it has been impossible for them to do.
The noble Lord put a series of questions to me and I shall do my best to answer all or virtually all of them. He queried the obligation, as he put it, in the contract to grow employment at the same time. I want to make it clear that two separate things are happening here. In the 16 or 17 years to 2008 we had the longest boom in growth that this country, in common with the rest of the western world, has seen. However, we still ended up with a lot of people trapped on out-of-work benefits. What is key here is to untrap them because during the boom we were sucking in labour from abroad which proved to be much more flexible. Before we worry about anything else, we must unlock the people who are living here so that they can play their part in the workplace. That is what these reforms are about.
On the noble Lord’s question about lone parent conditionality, we will of course maintain the good cause provisions that are agreed. We are very sensitive to the school hours measures and so forth, and they will be taken through. Hardship payments will be available, and the exact levels will have to be determined. He made the point that people need self-confidence and good self-esteem to be able to get back into work. The whole point of the work programme is to put in place a structure where providers are incentivised to get people back into the workplace whatever it takes. My own expectation, for what it is worth, is that one of the things that work providers will spend a lot of time on is rebuilding the self-confidence that people need to get back into work. So I expect that to be happening.
We have talked about mandatory placements. They are not a punishment, but are to be used for those for whom working for four weeks will be transformational in how they interrelate with work and in getting used to the basic disciplines of work. The placements will be designed for those people for whom we think they will be of the most value. Clearly there is a secondary issue, which is that making people do something for four weeks when they actually have another job anyway is a useful winnowing tool.
The noble Lord queried the costs and mentioned stories about an extra £2 billion in the next Parliament or at the next spending review. Frankly, we are talking about a very complicated series of movements, and any figures at this stage would be simplistic. The point is that by the next Parliament, the new system will be locked in, so that in the next spending review we will have to take account of what that system is, along with its costs.
I am not sure whether we will be running ahead with the “better off in work” credit because there is so much to do in bringing forward the universal credit. We need to concentrate on the big picture rather than amelioration of bits and pieces of the existing system. The plan is to bring in the universal credit from October 2013 and then start to move as soon as we possibly can the people for whom those incentive effects will work the best. They will be the earliest people to move across.
I can assure the noble Lord that the disability living allowance is out of the universal credit because we accept the reason for the allowance, which is to provide for all people with disabilities who need help with the costs involved in their support, whether they are in work or out of work. Those costs do not change in line with levels of wealth. They represent a basic strapline of expenditure according to an individual’s disability, so we have decided to leave DLA out. On council tax benefit or rebate, depending on what we call it, we are looking to devolve this so that local authorities can start to shape where it goes. We are also determined to make sure that it works with the incentive structure of our taper on the universal credit. This will ensure that we do not have something working against that set of incentives.
I turn to housing benefit, which is effectively one element of the universal credit. We have some work to do on exactly how it will go in and at what rate, but in practice the universal credit is a basic credit with disability add-ons, child add-ons, housing add-ons and so forth. We aim to see the portfolio of an individual’s universal credit build up depending on who they are. On the question of direct payments to RSLs, we will make sure that the risks to RSLs in terms of getting payments are not increased. Their anxiety is that their ability to finance will be undermined, but we are determined to ensure that, whatever we do with this, it does not undermine that ability. We are looking at quite a few options where we can achieve our aim without necessarily having direct payments.
Is child benefit included? No, it is not. As to the noble Lord’s concern about wallet and purse, which would apply also to the universal credit—he did not ask the question but I am happy to answer a question he did not ask but should have—we want to ensure that the credit gets paid to one member of the household, although we will explore ways of dividing it. One hundred per cent may well go to the purse or to the wallet, but we need to consider the middle and whether we should make special arrangements for those people who would like it there.
The noble Lord asked me to take more time. This is a big project and we are doing it at the speed we can. Nevertheless, it will take a long time. We will have the system ready to roll in October 2013 and people will migrate steadily on to it; we will not throw everyone in at the same time. Up to half of the people involved—particularly those who are most incentivised by being in the system—will be in the system by April/May 2015, and the remainder in the next two years. It is a longish process.
I welcome the noble Lord’s closing words—that this will go beyond a second Parliament—but one never knows what will happen in an election. I welcome the fact that the party opposite has indicated that it will be supportive and co-operative because you never know who will be in charge in 2016.
I congratulate the Minister on the Statement, particularly on him and his team securing £2.1 billion of expenditure to overhaul a system that has had many epithets, including “complex”, “cumbersome” and “inefficient”. I am sure that if we wrote a dictionary of the problems of the current system, we would see the need for making progress towards change.
I am keen to explore the key area of the Statement—that 850,000 people in our land will be lifted out of poverty as a result of these measures. That would be a tremendous achievement for the Government, one which we have not seen in the past. Can the Minister explain how that figure is arrived at and the Government’s direction of travel? It is an aim worth achieving in itself, although it is not the only ambition they have.
Given that there will be a long period of transition, how will the existing benefit structure begin to look to the new benefit structure? Clearly you do not want to continue the old system and change rapidly; you will need to ensure that the sense of direction is towards the new structure. I am sure the House will wish the Government every good speed in doing this, but “crawling” is not the epithet that I would use at the moment.
I thank my noble friend Lord German for raising the issue of the impact on poverty. I have a much shorter word on record: it is not “complex”, “cumbersome” or “inefficient”; I call it a mess.
How will this work? In effect, by having more generous tapers and disregards we are putting money into the pockets of people doing small amounts of work. So there is the direct economic impact of that money going in. There will be a second order impact, which will be twice as large because we will simplify the system and have only one form. This will encourage a much higher take-up rate and, in practice, will almost eliminate the scourge of in-work poverty. So that is where the figure of 850,000 comes from.
There will also be the dynamic or incentive effect of always knowing that it is worth working, and being incentivised to work will reduce the number of workless households by about 300,000. We have not put that poverty impact in the Statement; it is in addition to it. Some households will be pulled above the artificial 60 per cent median line, and we expect the poverty impact to be even greater than the 850,000 we have referred to. These are big figures. I remind the House that, on conventional analysis, the reduction in child poverty during the 13 years of the previous Government was about 600,000 children, so we are looking at making a big relative effect in one go.
I wish I could share the Minister’s optimism. I believe that immense difficulties will arise in practice.
I wish to ask about handicapped people. Are any changes envisaged in this approach in regard to those claiming to be handicapped? Will they have a right of appeal if they are turned down—after all, experts can be wrong—and will legal aid be available in the vast majority of cases? If it is denied, that will not be fair—and, after all, fairness goes to the heart of what we are talking about.
I thank the noble Lord, Lord Clinton-Davis, for his question. I hope I am not being too optimistic. On the handicapped issue, there are a few concepts buried in the question and I shall try to disentangle them.
First, how does the universal credit look to a disabled person? In the present system we have a conflation between disability and inactivity in the labour market. It is one or the other; you can do a little work, but not much. The beauty of the universal credit is that people on disability benefit will be on the same taper as others, with generous disregards, so that they are not in the desperate position of being inactive on disability benefit or working. We should remember that 40 per cent of people with disabilities are in the workforce—they want to be in the workforce—and that some of the most heavily disabled people want to work. We want to build up a system to help them to do so.
The second element of the noble Lord’s question deals with the work capability assessment process that we are now trialling. There will be an independent and elaborate tribunal process through which people can go. They can bring in legal support if they want but, in reality, most people do not need it because it has been accepted as a relatively balanced process, and robust systems will be in place to make sure that people do not get put into the wrong category. However, putting the money aside for one minute—clearly one likes to have more money than less and to be on a higher rather than a lower benefit—the reform will unlock the inactivity that we are in effect forcing on too many disabled people.
My Lords, I served on the New Deal taskforce for many years and then on the National Employment Panel for seven years. I am delighted and heartened by many of the initiatives in the Government’s programme for welfare-to-work reform, in particular tackling the benefits trap.
We used to talk about the Australian experience. I spoke to John Howard after he stepped down as Prime Minister and asked him about Australia’s welfare-to-work experience, which we used to look to as a great success. He said that he did not want to remove the safety net but to get people back to work. One way in which his Government had sought to do that was a programme whereby people were made to do some community service. He thought that it would be a very unpopular move; it turned out to be very popular, because people who worked and paid taxes did not like to see people, quite a few of whom could have worked, not working. As a result, the Australian Government got public support for it. Have the Government looked at the Australian experience? Have they learnt from it? Do they think that it was a good and effective scheme, and will their scheme be as effective?
My Lords, I thank the noble Lord, Lord Bilimoria, for that question. We have spent a lot of time looking at the lessons from abroad. When I was doing an independent report three and a half years or so ago, Australia was one of the places that I looked at very closely. I had someone who had been working there to inform me about what was happening. Australia and Holland are two places from which we learn a lot of lessons. There is a debate about whether action should be mandatory or voluntary. Voluntary action works if people have the self-confidence to say, “Yes, I want to try something”, but when you have been out of work for a long time, one of the first things that goes is your self-confidence. That is why mandatory action is not cruel. You need to pick people up and make them do things, because they do not have the self-confidence otherwise. That is one of the main lessons to be learnt from the Australian experience.
My Lords, perhaps I may say how many of us appreciate the fact that, in trying to unlock lives and aspirations, the Minister is focusing on allowing people to keep more of what they earn and trying to build self-confidence. There may be two other locks that he needs to unpick. The longer someone has not been in employment, the more inadequate or perhaps absent altogether will be their education and training. It would be my guess that those locks will need to be unpicked for very many people. Does he share that view? If so, who will have responsibility for addressing proven lack of education and training, and who will pay for it?
My Lords, I thank the noble Lord for that question. I not only share his concern but am very firmly on the record as being very concerned about the division between the Work First strategies that we have been adopting in this country and skills and training. One of the mainstream drivers of the work programme philosophy is an attempt to pull training and employment strategies together. It does that partly by price differentiation, so as people become tougher to put into work, the price goes up. We need to find the right mechanisms to make sure that we price up. It does it also by ensuring that the payments system in the work programme is based on sustainment in work, which can be for one, two or three years. You do not sustain someone in work for a long time unless you pull in the whole training and education element. That kind of change should be going through.
My Lords, I, too, welcome the direction of travel of the Government. If there is a doubt, it is about whether, after the comprehensive spending review, their growth strategy is coherent. The Statement referred to 450,000 vacancies, but that is before we have seen the impact of the comprehensive spending review. The Minister has just mentioned skills. We have concern about the Government’s abolition of the Train to Gain programme and the funded NVQ programme.
I shall focus on two areas on which I would welcome some further explanation. As I think the Minister would readily acknowledge, matching people to jobs will in some cases require an awful lot of support. In the other place, the Secretary of State talked of mentoring, not only to get people into work but to provide support when they are in work. The Minister has spoken of integrated back-to-work support. Who will provide this support and will it be resourced and properly costed?
The Secretary of State denied in the other place that the Access to Work grants had been cut, saying that they had just been refocused on larger employers. However, on other occasions, the Minister has stated that job growth will come from SMEs. That is a contradiction. If the Government want people with disabilities to get back into work, Access to Work grants are an important part of creating employment opportunities.
My Lords, I thank the noble Lord, Lord Young, for that question. We have an integrated strategy. Measures in the CSR will ensure that mentoring takes place; there is also the new enterprise allowance and so on. We are building those packages and will announce details in due course. Our main change to Access to Work is to make sure that when someone goes for a job they have the funding required. No one will take someone if they do not know whether they will receive Access to Work. That is the main way in which we are refocusing Access to Work, which we think is a good programme.
My Lords, I, too, warmly welcome my noble friend’s repeated Statement today. I have one very simple, fundamental question to which I do not know the answer. How much discretion will decision-makers at Jobcentre Plus have about the sorts of work that jobseekers will be compelled to take? We hear that the conditionality rules will be tougher than those set by the previous Government. Let us suppose that a graduate or a highly qualified person can find only a cleaning job. Will they be compelled to take it and does the decision-maker have any discretion about that?
My Lords, I thank the noble Baroness, Lady Thomas, who has been incredibly involved and interested in the development of the universal credit. Jobcentre Plus is structured in such a way that there is a very light touch in the early months which becomes gradually firmer and starts being a heavy hand on the shoulder after six months. There is a reality period. Most people look after themselves and find a job, but some need to have the reality of their position in the marketplace brought home to them, so that they match what work they can realistically expect to do with what is out there. You are much better off being in work and looking for a better job from an in-work position than from an ever longer period of inactivity.
Thank you very much. I am very grateful that you allowed me in. I have two related points. First, the welfare legislation that did not get final approval put the welfare of children at its centre. It was the first thing that was stated. Can we hope that the current measures will begin with that statement?
Secondly, there are minority women, particularly Muslim women, who would find it very hard to front up and be consulted by a man who told them what to do. We need to have much more appropriate arrangements, because jobcentres have targets to meet. A specific woman may not want a job that staff think is appropriate. We need leeway and I wonder whether there will be room.
I thank the noble Baroness, Lady Afshar. Children are at the heart of this. In our view, intergenerational poverty and joblessness are the basic reasons for the much too great child poverty that we have. This measure is designed with children in mind—right at the heart.
I take the noble Baroness’s point about cultural differences. One of the things I expect to see in the work programme—I know it is not in Jobcentre Plus—is quite sophisticated addressing of particular cultures. It is designed to force individualisation. In the work programme at least we will see start the kind of responses the noble Baroness is looking for.
I am not giving away after the 19th minute. I have tried four times.
Following the question asked by the noble Lord, Lord Mawhinney, will the Government produce proposals to deal with the situation that is bound to arise where the number of unemployed far outstrips the number of jobs available, which is particularly the case in the north? Will the Minister confirm that the Government have carefully considered ILO Convention No. 29, which Governments of this country have supported for 80 years? Is what the Government doing in accordance with that?
My Lords, what we are announcing today is a structure that will encourage people to take the jobs that there are. A snapshot figure of 450,000 vacancies in Jobcentre Plus does not show the whole picture. There were 1 million vacancies in jobcentres in the past three months. In devising this strategy we will have looked at all conventions to make sure that we comply with them.
Public Disorder at NUS Rally
My Lords, I beg leave to repeat a Statement made earlier in the other place by my right honourable friend the Minister of State for Policing and Criminal Justice. The Statement is as follows:
“With permission, Mr Speaker, I would like to make a Statement on yesterday’s public disorder at the National Union of Students rally.
The House will be aware that yesterday, following a peaceful demonstration organised by the National Union of Students, a violent faction directed a series of criminal acts against the office complex on Millbank, which houses a number of organisations and businesses.
This Government have been clear that we are committed to supporting peaceful protest. Indeed, we included the restoration of the right to peaceful protest in our coalition agreement. However, as the Prime Minister said this morning, we are equally clear that when people are bent on violence and on destruction of property, that is completely unacceptable.
The operational response to the violence is quite rightly a matter for the Metropolitan Police, but I want to give the House an early indication of what happened yesterday, the action taken by the police and the follow-up action that will now be necessary. This information was provided at 9 this morning by the Metropolitan Police Service.
The NUS had predicted that yesterday’s protest would attract around 5,000 demonstrators. This estimate was then revised upwards to 15,000. The police had planned to deploy around 225 officers to the protest. As the situation developed during the day, an additional 225 officers were deployed.
In the initial stages, the march passed the Palace of Westminster in an orderly manner. However, this meant that vehicle access to the Palace was not possible for around two and a half hours.
At about 1.10 pm, the front of the march reached the rally point at Millbank. At the same time, a group of protestors ran towards the Millbank office complex, which houses the Conservative campaign headquarters. Protesters from the main march then seemed to be encouraged by a number of individuals to storm the building and throw missiles. Windows were broken and significant damage to the property was caused. Some protestors also managed to gain entry to the building and some got on to the roof.
At its height, it is estimated that about 2,000 people were around Millbank, though many appeared not to be directly involved in violence. It is now clear that a small hard core within this group were intent on violence. Additional officers were then deployed in public order protective equipment. The Department for Business, Innovation and Skills was also attacked by a small number of protesters.
At about 3 pm, the police were informed that members of staff within the Millbank complex were concerned for their safety. They advised them to stay in the building. Officers were deployed to make contact with the staff and secure their safety. This took some time to achieve. By 4 pm, police officers had located the staff members and, over time, arrangements were put in place to escort them from the building.
The police then undertook a search of the office complex and made 47 arrests for criminal damage and aggravated trespass. The British Transport Police also made three arrests. Around 250 individuals were also searched, photographed and then released pending further investigation. Forty-one police officers received injuries. A small number were taken to hospital for treatment and were subsequently released.
The police are committed to bringing the criminals who carried out this violence in front of a court. The whole House will join me in condemning the minority who carried out these violent and criminal acts. There is no place for such behaviour in Britain’s democracy. I would also like to thank the police officers who were deployed to the scene and who helped to protect innocent bystanders. They acted with great courage, particularly those who were holding the line until reinforcements arrived.
Yesterday, during the violence, the Home Secretary was in contact with the Metropolitan Police Commissioner, Sir Paul Stephenson. The Home Secretary also spoke to the Mayor of London and I spoke to Kit Malthouse, the chair of the Metropolitan Police Authority, which has responsibility for the governance of policing in London. I would like to praise Sir Paul for his swift and candid response to yesterday’s events.
I spoke to Sir Paul this morning. He confirmed to me that the Metropolitan Police will also be undertaking an immediate and thorough review of their operational response to the incident. This will include an examination of why numbers and violence on this scale were not anticipated.
The police have to strike a balance between dealing promptly and robustly with violent and unlawful activity on the one hand and allowing the right to protest on the other. Clearly, in this case the balance was wrong, but these are difficult decisions and they are not taken lightly.
Let me finish by saying this. Yesterday did not go according to plan and the police will learn the lessons, but the blame and responsibility for yesterday’s appalling scenes of violence lie squarely and solely with those who carried them out. I commend this Statement to the House”.
That concludes the Statement. In the course of questions afterwards, my right honourable friend the Minister for Policing and Criminal Justice corrected himself. The Home Secretary did not in fact speak to the head of the Metropolitan Police yesterday. However, my right honourable friend did.
My Lords, I am grateful to the noble Baroness for repeating the Statement and for the further clarification that she has just given regarding the Home Secretary.
I start by agreeing with the Minister’s right honourable friend, the Police Minister. The right to peaceful protest is a fundamental part of our democracy, supported on all sides of this House. Tens of thousands of students and lecturers came to London from across the country yesterday to exercise that right and to make their voices heard. However, the Police Minister is right to say, as the Prime Minister said last night, that the vandalism and violence that we saw yesterday were completely unacceptable. They were perpetrated by a small minority of thugs who hijacked what was planned to be a legitimate and peaceful demonstration and in so doing denied tens of thousands of students the right to have their voices properly heard.
The Metropolitan Police have told us that the National Union of Students worked closely and co-operatively with them before and during yesterday’s events, as it has done in the past. The president of the NUS rightly said yesterday that the actions of a small minority were despicable and designed to hijack a peaceful protest. We on this side of the House are clear that there is no excuse whatever for such criminal behaviour and that those responsible must be brought to justice. We note that 50 arrests have been made. It is the job of the police not only to tackle crime and protect the safety of all our communities but also to keep public order as they ensure that the law-abiding majority can exercise their democratic right to protest and make their voices heard. The police ensure that thousands of major events and demonstrations pass off peacefully each year, often in difficult and challenging circumstances. I am sure that all noble Lords will want to join me in commending the hundreds of individual officers involved in yesterday’s events, particularly the small number outside 30 Millbank and Millbank Tower early yesterday afternoon, for their bravery and dedication.
When things go wrong, it is vital that we ask questions, find out what happened and learn lessons for the future, so we welcome the urgent investigation that was ordered later yesterday afternoon by the commissioner of the Metropolitan Police and his straightforward and responsible admission that these events were “an embarrassment for London” and that there were lessons to be learnt. The Metropolitan Police have acknowledged that there was an operational failure and it seems sensible and appropriate in this instance that the investigation be conducted by the police themselves quickly and reported to the independent police authority.
I am sure that this investigation will look at a number of operational policing issues, including: whether sufficient officers were on duty to police what was expected to be a peaceful demonstration; why, when estimates of the size of the demonstration were revised up from 5,000 people to 15,000 and then 25,000, the Metropolitan Police made the judgment that this would be a peaceful demonstration; and whether there was any intelligence to suggest that violent actions were pre-planned. We also need to know whether sufficient back-up was available, how quickly it was able to be deployed and how operational decisions were made about which buildings and public spaces to protect.
However, wider questions were raised by yesterday’s events, which go beyond the direct operational responsibilities of the commissioner and the Metropolitan Police and which are rightly also matters for the Home Secretary and the Government. Given the failure of intelligence in this case, will the Home Secretary assess whether the gathering of intelligence by the police and security services was sufficient and sufficiently well co-ordinated? Will she discuss the procedures for assessing risk and intelligence in advance of protests of this kind to ensure that the full risks are understood in advance? Given that yesterday and on previous occasions mobile phones and social networking have been used during demonstrations to co-ordinate actions and build momentum at short notice, what work are she, the Home Secretary and her ministerial colleagues doing to support the police and others in responding to this new challenge and what wider public order issues does this raise?
Given that this was a demonstration against a controversial aspect of government policy and that police officers were deployed outside the party headquarters of the Conservatives and the Liberal Democrats, did the Home Secretary or her advisers have any advance discussions of possible risks with the Metropolitan Police and lead party officials? At what time was the Police Minister alerted to the risk of elements in the demonstration becoming violent? What plans does the Home Secretary have to update the House following the conclusion of the Metropolitan Police investigation and the wider investigations that are now taking place?
Yesterday’s events were at root the fault of no one but a small minority of violent demonstrators, whom we all roundly condemn. They are a timely reminder of how all of us are reliant on the police to maintain public order and ensure legitimate and peaceful protest. Is the Minister confident that the police will have the resources that they need in the coming years to deal with threats to our national security, to tackle organised crime, to ensure a safe and successful Olympic and Paralympic Games, to continue to provide visible neighbourhood policing in all our communities and to ensure public order at major events?
My Lords, I am extremely grateful to the noble Lord for his endorsement. I think that it is the shared sentiment of the House that we do not accept violence as an accompaniment to the right to demonstrate. He was correct to commend the officers who were involved in dealing with the violence in Millbank Tower. Of course it is right that the police will want to learn lessons; the head of the Metropolitan Police has made that clear and has himself said that there was an operational failure. I have no doubt that it betokens a serious and detailed investigation that he will want to take place and I am confident that we can expect that. Of course, he will be reporting to the Metropolitan Police Authority.
As for the questions that the noble Lord put to me, in the first instance it is clearly for the police to decide how it was that a failure of intelligence arose. They were clearly not aware of the faction that appears to have come to the scene. It will be for them to assess why that was the case. There is no reason to suppose that it was in any way a result of a failure of resources. If the head of the Metropolitan Police decides to come to talk to the Home Secretary about some of his findings, I have no doubt that my right honourable friend will wish to listen to him and see where, if anywhere, the Home Office can offer help. However, in the first instance, it is clearly for the Metropolitan Police to make these judgments.
On the noble Lord’s other points, I do not know whether there was advance discussion about Millbank Tower. It is clear from the dispositions of the police that they were aware of some of the sensitive buildings along the route. The Police Minister was certainly in touch with the Metropolitan Police during the demonstration, although I cannot give the noble Lord a precise time. As for the resources available, this is not a resource question; it is very clear that that was not the issue yesterday. I am confident that the measures that the Government have taken in relation to policing will not in any way impede an adequate response to all the various points that he mentioned in his list of issues, which undoubtedly we will need to take care of in future years.
My Lords, there will be criticism no doubt that the policing was too light on this occasion and there was criticism that the policing of the G20 demonstrations was too heavy. Does the Minister agree that it is important that the pendulum does not keep swinging and that we seek the right level of policing for such demonstrations?
My noble friend puts the point, which I am sure we all appreciate, that these decisions are difficult. Getting the balance right between protecting the legitimate right to peaceful protest and safeguarding the public against illegitimate activity—and certainly violence—is precisely the issue that the police face. She is also right to say that in the past the police have been criticised for being too heavy-handed, whereas this time there was clearly not quite enough resource immediately available. However, once the police had learnt the nature of the situation, they were pretty fast in bringing the right sort of people in protective gear to the scene. I am sure that this is the aspect that the head of the Metropolitan Police will be looking at with great care.
My Lords, yesterday I was rushing to get to the House for our weekly Cross-Bench Peers meeting at 2 pm, but I was stuck on the Embankment for an hour. I eventually made it to just below Big Ben, where a policeman kindly let me through after I showed my pass and I drove, very slowly and carefully, through the mass of protesters. In front of the House of Commons, I was then surrounded by demonstrators with placards, who started to get violent and then lay down in front of my car and refused to let me move. The police standing around immediately came to my rescue. Four of them removed the demonstrators and I was able to proceed. When I made it here into the House the doorkeeper, when he heard my story, said, “My Lord, either you are the bravest Peer in this House or out of your mind to drive through that”.
Only afterwards did I learn of the violence that had taken place, but when I was in that car I did not feel scared. I just thought to myself, “You’re not doing any favours to your cause. There is no place for violence”. There is every place for peaceful demonstration and I have every sympathy for the students who were demonstrating peacefully. I want to place on record my thanks—I request the Minister to convey them—to the police who saved me yesterday.
My Lords, I am sure that the police will be extremely grateful for what the noble Lord has just quite rightly said. I am sure that one of the points that the head of the Metropolitan Police will be looking at is the question of access to the House, which was not available to vehicles for rather more than two hours. I am sure that he will want to look at the whole question of how you combine the right to peaceful protest with continuing to enable Members of the House and, indeed, members of the public to gain access to the Palace of Westminster during protests. Perhaps I might say that the president of the NUS, to do him credit, has written to the head of the Metropolitan Police saying in formal terms that he is willing to co-operate with the police in their investigation, which shows a good sign of responsibility on the part of the NUS and its president.
My Lords, I join in praising the police for their efforts yesterday and in condemning those demonstrators who resorted to violence, thereby weakening their case. I am pleased that the Government have committed themselves to the right of peaceful protest, as we all do. However, I have one difficulty with what the Minister said: that it was not a matter of resources. If the police are using what intelligence they have to assess the likely amount of trouble that may be associated with a demo, the pressure on the police will be to have police officers in reserve and sitting in their vans in case trouble should develop. The difficulty for the police is that keeping those officers there is pretty expensive in overtime. I should like an assurance that the pressures on police finances, through the Government’s decisions, will not be allowed to affect the right and the ability of the police to have officers in reserve, should they seek to do so.
My Lords, I should perhaps have been more specific when I commented that it was not a matter of resources. It was not a matter of the availability of resources. This was not a case where the police were constrained from having the necessary resources available. I think that it was an operational decision that they were not necessary but, as regards the future, that is obviously going to be very important. I am sure that the police will wish to make sure that in the resources available to them are the resources necessary for policing this kind of demonstration.
My Lords, I first declare an interest as somebody who, perhaps surprisingly, was once elected deputy president of the National Union of Students. The Official Opposition spokesman raised the fact that the estimates of those who were going to attend rose steadily in the 48 hours before the protest. Do the police have a figure for those whom they believe to have been involved at the end of the day?
My Lords, I think I am right in saying that the figure is 40,000 involved. Certainly, there was a relatively late surge and the figures rose. I am sure that is precisely the point which the Metropolitan Police Commissioner, when he is investigating how they did their planning, will want to look at—including whether they had enough regard to possible, last-minute additional numbers joining the demonstration. Until we have had the results of that investigation, it is quite hard to go any further in examining the whys and wherefores or the lessons that we need to draw.
The Minister was quite right to underline the fact that most students conducted themselves in a seemly manner and that it was a minority who misbehaved, but will she also direct her attention to the way that the press—some of the press, not all of them—have depicted the view that a large section of the protesters encouraged riotous behaviour? It was unseemly of that section of the press to so behave.
Well, my Lords, we have a free press, do we not, and we may not always agree with either what they say or do. This is not quite so germane to the noble Lord’s question, but it turns out that the correction I made was erroneous. The Home Secretary did not speak to the mayor; I had said it was the Metropolitan Police Commissioner, so I apologise to the House. However, as is clear from the Statement, there was contact between the Government and the police. There has also, obviously, been extensive contact today as a basis for giving accurate information to the House.
My Lords, yesterday when watching television I had a sense of déjà vu watching the disgraceful events in Millbank Tower. The déjà vu was: 1996 in Seattle with the World Trade Organisation, where I was one of the people inadvertently suffering from pepper gas and tear gas, because the police were seeking to protect the delegates but had the Seattle sound with a 30 mile an hour wind to put up with. The thing that was in common was watching people dressed entirely in black and wearing hard hats, smashing into Millbank Tower then encouraging young people to go in and themselves, noticeably, not necessarily going in but walking away. That is exactly what I saw when a Starbucks coffee house was burnt out in Seattle. The gentleman who threw the brazier in—he had lit a whole pile of rubbish—then walked away, taking off his black shirt and putting it underneath his other T-shirt.
It is therefore not necessarily just a question of students, because I suspect that some of the people have nothing to do with being students. I trust that the investigation will therefore look at that. More particularly, there was intelligence about Millbank Tower, where I used to work. It is a large building with lots of staff who must have been very terrified when that happened. If there was such intelligence, was the management of the building informed of the likelihood of such dangers?
The noble Lord makes some good observations about what went on. The Statement was rather careful in just referring to a “faction”, because at this stage we simply do not know exactly who was involved. He is quite right, and anyone who viewed television saw what he saw, that there was obviously preparation; you do not come along with a mask without the intention of doing something, or indeed with, I believe, a hammer. Clearly there was premeditation.
The noble Lord is also right to say that this must have been pretty frightening for those who were in the building. I would say that one of the first cares of the police when they arrived in that building was to secure the safety of those in it and, thereafter, to begin to eject the intruders.
I cannot answer the question about the information to the management. I would hope that because of the route, and given that the police were there, the management of the building had some forewarning.
My Lords, I am sure we all agree that peaceful protest is a crucial element of democracy and that the right place to protest against Parliament is Parliament Square. Unfortunately, Parliament Square is barely available now to protesters. Because of the misuse of the whole green area over a long period, it has all had to be closed off, and now the pavement in front of that area is occupied by a permanent camp. Will my noble friend recognise that Parliament Square should be kept as an open space, available for protest, and that the way of achieving that is to say that there should be no permanent camps in the square? I suggest that at some stage in future—I do not know whether it needs legislation—all impedimenta is removed between midnight and 6 am. People can come and protest any time they like but, between midnight and 6 am, anything that has been left behind is removed by appropriate vehicles. That at least will mean that Parliament Square is then available for protest, which is such an important aspect of our liberty.
The noble Lord is right to say that we need to have Parliament Square available for protest. The House had a big discussion of this issue a few days ago and I repeat what I said then: we entirely agree that that is the case. At the moment the grass is being reseeded, which is why the square is not available. The Government intend to bring forward a first Session Bill not so much directed at in any way limiting or trying to curtail the right to organise a protest but to deal with those things that get in the way of and frustrate the right to peaceful protest, which will include encampments.
My Lords, I commend to the Minister the wisdom of the late James Callaghan, whom I had the honour of serving in the Home Office some 40 years ago when there were some very robust protests, as she will remember. He used to say, “It is far better to have a surplus of officers on the scene rather than the other way round. The more officers you have, the less likely will be the need to resort to violence”.
I have no doubt that the head of the Metropolitan Police will heed those words. It is obviously not just the number of policemen that is important; it is how they manage the protest as well. It is clear, though, that one has less chance of being able to police it satisfactorily if the numbers are not adequate.
My Lords, the demonstrations yesterday were about tuition fees. Today we have the announcement about welfare reform. Next year we will start to see the consequences of the housing benefit changes being introduced and there will be a growing mood, as I am sure most people will agree, of dissatisfaction in many quarters. Do the Government have appropriate resources available, following on from my noble friend Lord Hunt’s question, for the appropriate intelligence research to be undertaken?
As a side issue, I draw attention to what happened in Newcastle when there was the debacle with Mr Moat. We saw that a substantial website was quickly established, with thousands of people signing up to it and supporting him, quite contrary to the view expressed on behalf of the public by the Prime Minister. We then saw a funeral that literally hundreds of people attended, contrary to what most people would have thought would happen. There is a distinct possibility, with the technology that is now available to us—we see this when surprise parties are called by teenagers and thousands of people descend on their home for a party—that in 2011 we will see a different mood entirely, with a different technology available that could lead to demonstrations of a nature that we have not previously experienced. Are we geared up for this when we face substantial cuts in the Home Office?
My Lords, as I said previously, I am confident that this is not a question of whether the numbers and resources are available for the acquisition of intelligence. The noble Lord makes a good point when he says that modern technology—mobile telephony, combined with the use of the internet—can produce situations that can change rapidly, as in the immediate run-up to a demonstration of this kind. That is clearly something that the police will need to take into account in how they use their intelligence resources with the help of other agencies, and how they plan for demonstrations. I am confident that the police have both the resources and the capability to do this.
My Lords, the timing of this debate on the case for Britain to have an active and well resourced diplomacy is fortunate, not just fortuitous. If we had been holding this debate in advance of the comprehensive spending review, it could easily have been dismissed as a piece of special pleading on behalf of one of many government departments about to face deep cuts—all the more so since I have to declare an interest as a former member of the Diplomatic Service. But now that the comprehensive spending review is out on the table, the opportunity is there to focus not on the overall quantum but on how best to put it to good and effective use in the national interest—how to ensure that doing more with less is not just one of those meaningless and infuriating mantras but is a reality.
It was well over a century ago that Lord Salisbury gave his often repeated prescription for British foreign policy—that it should be like floating down a river, fending off the bank from time to time. In fact, this classical description of a passive, purely reactive foreign policy was out of date even when it was coined. As the country found at the time of the Boer War, it could well lead to splendid, or rather not so splendid, isolation; and that discovery led to a hasty scramble to acquire allies in the failed attempt to stabilise Europe, which culminated in two world wars. Out of date then, any such prescription is a great deal more out of date now.
The hard fact is that a country that is a global superpower, as Britain was then, needs an active diplomacy less than a middle-ranking power with worldwide interests, such as we are now. Everyone beats a path to the door of a superpower, which can take its time in responding because it is so indispensable. But a middle-ranking power has to work actively to further and protect its interests if they are not to go by default, and it needs to have strong alliances and networks in good working order for when they are needed. That is a lesson which was very clearly drawn in the recent national security strategy and in the defence and security review.
Such networks and allies do not simply drop effortlessly into our lap; nor can their policies be shaped to fit our as well as others’ interests without ceaseless diplomatic work. Add to this the fact that multilateral diplomacy, which now makes up so much of the foreign policy mix, is a labour-intensive industry necessitating work not just where a particular organisation is headquartered but in the capitals of each of the members of that organisation, and you have a lot on your hands. It was considerations such as those which led the Callaghan Government, some 30 years ago in the midst of an earlier period of cuts and austerity, to reject the view of the Berrill report that Britain could no longer afford what was charmingly described as the luxury of a first-class diplomatic service. Those considerations are even more compelling today than they were then.
If we are successfully to do more with less then we will have to increase the coherence of the foreign policy instruments at our disposal and the way they are deployed. We will need to marry our hard power—now considerably diminished—to our soft power and ensure, as we have not always done in the recent past, that together they are up to the demands we are putting on them. We will need to break down the stovepipes in which policy is formulated at home and executed abroad—security, diplomacy, development, energy, climate change and so on. We must also ensure that the practitioners—the diplomats, the military and the development aid experts—understand each other’s work much better and gain experience of each other’s work and how to work together and not in competition with each other.
We will need, too, to make the best possible use of the new European External Action Service, which is gradually taking shape in Brussels and around the world. To treat it as, at best, a tiresome and duplicative nonsense and, at worst, a competitor would be to miss a golden opportunity. We surely need to be thinking imaginatively about what the European External Action Service can do collectively for us and for the rest of the EU and what we should therefore no longer be trying to do individually ourselves. We need to second good people to the EEAS and support its efforts to reduce turf fighting between the European institutions, to achieve greater policy coherence among the EU’s external policies, to increase its own professionalism and to extend its outreach so that less time and effort are spent on cobbling together tortuous internal European compromises, and more time is spent on persuading third countries of the value of the EU’s policies and on public diplomacy.
Let me turn to the issue of resources, without which all that I have said previously in general terms could just remain empty words. Here are a few suggestions. First, I hope that we will avoid falling into the false dichotomy of thinking that there is a choice to be made between bilateral and multilateral diplomacy. One does occasionally hear echoes of that sort of approach in ministerial statements and briefing. But this is surely not an either/or matter but, rather, one of both/and. The two forms of diplomacy are now inextricably linked and need to be mutually supporting if we are to further our interests successfully.
Secondly, on the exchange rate risk to British diplomacy’s overseas expenditure—that is, most of it—I do not wish to delve too deeply into the background to the decision a few years ago to remove the existing policy of compensating losses as a result of exchange rate fluctuations. It reflects credit on neither the Treasury, which imposed it, nor the Foreign and Commonwealth Office, which accepted it. The result when sterling dropped sharply in 2008 was a double whammy for the Foreign and Commonwealth Office of external and internal cuts. Can the Minister tell the House that this will not happen again?
Thirdly, I hope the temptation to save by closing more diplomatic posts will be resisted. Multiple accreditation—having a mission in another country that serves the country in which you have closed down on a very random basis, visiting once or twice a year—is not a viable alternative to a presence, however small, on the spot. I still remember the helplessness I felt as ambassador at the UN when we had no post in Kigali when the Rwandan genocide broke, no post in Kabul in the years after the Soviet withdrawal and no post in Mogadishu through the UN’s troubled experience there. If very small posts have to operate somewhat differently from larger ones, and we have to accept that we can get fewer services from them, I would say “So be it”. We will just have to get used to that, but let us avoid ending up with a diplomatic cloak full of holes. I hope the Minister can say something on that aspect too.
Fourthly, my view is that the decision to shift the funding of the BBC World Service from the Foreign Office budget to that of the BBC should be a plus, at least in presentational terms. I have to admit that I never managed to persuade a single foreign interlocutor of the BBC World Service’s total editorial independence every time I had to admit that it was in fact being financed from the Foreign Office budget. That should be easier to achieve now. But how are we to be sure, under the new arrangements, that the World Service is not being bled to meet the BBC’s domestic demands? How, too, is the World Service’s coverage and editorial autonomy to be protected from interference by the BBC’s management, as it was from interference by the Foreign and Commonwealth Office? I wonder whether the Minister could give us a bit more detail on this; not very much has been said so far about this really important aspect of our foreign policy and our soft power. Could he also say something about that other crucial part of Britain’s projection of soft power, the British Council?
Of course, the resources that really matter in diplomacy are the Diplomatic Service’s human resources. I have the impression that in recent years those resources and their morale have been under considerable stress. Recent losses through early retirement, while perhaps unavoidable, have resulted in the departure of many top-class diplomats whom Britain could hardly afford to do without. I am, however, struck when travelling abroad by how well the morale and quality of our diplomats is holding up. But it is surely time that a bit more effort was put into reducing the stresses on them. We often speak, quite rightly, in this House about our admiration for Britain’s Armed Forces; not so often about our admiration for our diplomats, who also run very considerable risks. We should not forget what the Duke of Wellington said when asked, towards the end of his life, what he would have done differently. He replied, “I should have given more praise”.
I hope I have managed, in opening this debate, to set out a compelling case for Britain having an active and well resourced diplomacy. If we are successfully to meet the challenges of the increasingly multi-polar world in which we now live, that is what we will need. If we are to work effectively for an increasingly rules-based world, which I believe it is in our interests to achieve, that, too, is what we will need.
I conclude with a perhaps slightly eccentric plea for less frequent use of the phrase, “Britain punches above its weight”. I admit that I may have been partly responsible for its entry into our diplomatic lexicon but it tends to play to a strain of post-imperial nostalgia which I believe we must now leave behind us. Like courage, it is surely one of those characteristics which are better noted by others and not bestowed on ourselves. I beg to move.
My Lords, it is a privilege to speak in this debate. I congratulate the noble Lord, Lord Hannay, on securing it and on the way in which he has introduced it. He has certainly made the case for an active and well resourced diplomacy.
Had the great minds who organise the sequence of speakers known something of the content of the contributions, mine would probably have come a little further down the list as it is more esoteric in nature and focuses particularly on an instrument called the Olympic Truce. The noble Lord, Lord Hannay, will be familiar with the subject as we had a debate on it in this House on 11 October. I want to place it in the context of public diplomacy and the comments about soft power.
In a speech in the Foreign Office on 1 July setting out the new direction of foreign policy under the coalition Government, my right honourable friend the Foreign Secretary said that the coalition Government’s goal was to,
“deliver a distinctive British foreign policy that extends our global reach and influence”.
That is absolutely right. Influence matters in the modern world, as the ability for nation states to act alone is severely constrained in the modern era—and many of us would say rightly so. Modern diplomacy, like politics, is now the art of persuasion, and as in any exercise in persuasion, reputation is vital, hence the unarguable importance to the Foreign and Commonwealth Office and to British diplomacy of the BBC World Service, the British Council, the Chevening and Marshall scholarships and Wilton Park. They set the mood music around which the negotiations, discussions and diplomacy are conducted.
There has been some discussion about whether it was right to separate DfID from the Foreign and Commonwealth Office, as the valued work that DfID does around the world is phenomenal. I am immensely proud to be a member of the coalition Government who will increase overseas aid to the 0.7 per cent figure to which we have aspired for so long. We should be very proud of that.
The Olympic Games are referred to on the Foreign and Commonwealth Office website under the heading “Public diplomacy”. It states that it is:
“A once in a generation opportunity”,
“As 2012 approaches, the London Olympic Games will focus the world’s attention on Britain. The Games offer unique stimulus to invite people from around the globe to re-examine their views about the UK.
The FCO and our Public Diplomacy Partners view this as a remarkable opportunity to demonstrate the open, connected, dynamic and creative country that is Britain today”.
Nobody would argue with that. It is absolutely right that the eyes of the world are on London. The success that the Olympic Games are having is amazing. The stadium will be finished a year in advance. The velodrome, one of the largest facilities, will be opened in a few months. When the Chinese were doing that sort of thing for the Beijing Games, we all stood in awe; when the British do it, somehow we do not take the same pride, but it is a tremendous tribute to the reputations of the people who have worked on the Games and the leadership of the noble Lord, Lord Coe.
The Olympic Truce is a convention stretching from the original Games which says that, during the period of the Games themselves, the member states will,
“take the initiative to abide by the Truce, individually and collectively, and … pursue … the peaceful settlement of all international conflicts”.
That truce is moved in the United Nations General Assembly by the host nation, so it will be moved by the Government at the 65th session of the United Nations, next year. Her Majesty’s Government, like any previous Government in this country, have no intention whatsoever to take any initiative for peace or reconciliation during the Games at all. For not doing so, Britain will not be regarded as a pariah state because none of the other 191 countries that signs up to the Olympic Truce at the UN General Assembly, saying that they will pursue initiatives for peace and reconciliation during the Games, will do anything either.
I am trying to make the case for this being a great opportunity for British diplomacy. It can show us at our best. It is a once-in-a-generation opportunity to do something worth while. The United Nations truce will be the only element of the Olympic Games that falls directly within the bailiwick of the Foreign and Commonwealth Office. It is therefore astounding that there is no mention of it on the website. Yesterday, the Foreign and Commonwealth Select Committee in the other place had a hearing on public diplomacy at the London 2012 Games. During that, Jeremy Browne, the Minister, gave evidence for an hour but did not mention the truce once. In advance of that meeting, there was a 50-point statement as to what the Foreign Office would do on public diplomacy surrounding the Olympic Games, but it made no mention of the Olympic Truce.
I urge my noble friend to consider the Olympic Truce and give it its right place so that it can be an important element of how Britain is seen around the world, and in promoting good around the world.
My Lords, I have just excised from my speech the phrase “punching above our weight”.
Britain's Diplomatic Service is a centre of excellence admired worldwide and the noble Lord, Lord Hannay, is an outstanding example of the service at its best. I have had close contact with the FCO since 1960, when I entered as a third secretary. Traditionally, the service has been able to take a major share of the available pool of talent and, from my experience even over recent years, I am convinced that it still attracts high-quality personnel. The question, therefore, is whether that will continue as the CSR cuts bite. What will be the effects on recruitment and morale?
There are some welcome features in the CSR, such as the new foreign currency mechanism that will increase stability, but the settlement overall will have a disproportionate and negative effect on the service, with 25 per cent in cuts over four years. By 2014, the FCO budget will be £1.3 billion, which is only just above the UK's contribution to the European External Action Service. By then, DfID will have £11.56 billion—nine times as much as the FCO. DfID officials will not easily substitute for FCO officials.
Of course, traditional diplomacy has its faults. The “déformation professionelle” results in excessive caution and a yearning for the quiet life, but officials are immensely competent and loyal to the Government of the day, even when they feel under fire from that Government. For example, it was claimed that the noble Baroness, Lady Thatcher, in the 1980s said that the Ministry of Agriculture represented farmers and the FCO represented foreigners. Echoes of this arise in the talk of a cull of faceless bureaucrats in London. Is it right that over four years there will be a reduction of 10 per cent in the number of diplomats overseas? How many compulsory redundancies are planned for? Given the number of redundancy payments, how long will it be before the savings actually begin? Will the payment of school fees for diplomats’ children continue after the redundancy of their parents?
Even within the reduced total, the traditional diplomatic role will be reduced. That is, a larger share of the reduced budget will reflect changes in our society and mobility worldwide, such as the increase in consular and visa work. Will the Minister give an assurance that personnel, building security and counterterrorism will not suffer, and that language training will not be reduced? Our hard language ability is much admired and, of course, costly. I am sceptical about the claims of a revolution based on the new emphasis on trade promotion. For many years, the path to promotion has lain through expertise in trade. Trade envoys—yes, but ambassadors from the business community—no. Apart from the reduction in salary, the job is very different.
How do we mitigate the effects? I have time to give only some headlines. On the selling of the FCO estate, much has already been done, for instance, in the Lisbon and Vienna residencies. Is there a threat even to the Paris residence? As the noble Lord, Lord Jay, will evidence, it is much used for trade promotion. More locally engaged staff can have only a limited effect because there is clearly a ceiling for their promotion. If there are more jobs in London and development of the hub concept, we may lose the value of personal contacts cultivated over time and the facilitation of networks and alliances. As for co-location and overlapping subject areas with DfID, there is some scope in the fields of governance and conflict prevention.
On greater co-operation with allies, now that there is new Franco-British co-operation in defence, why not in foreign affairs? There are potential benefits in premises and personnel, particularly in west Africa. Co-operation with the European External Action Service includes the co-location of embassies and delegations and long-term personnel secondment. It is an interesting paradox that, by these cuts, a Conservative-led Government will lead to the posts in the European External Action Service, with its budget of £8 billion, having greater weight than our own diplomatic personnel.
Clearly, the role of diplomacy is misunderstood and undervalued. If we want a still substantial global role, we will have to pay for it. Development aid cannot be effective if there are problems of governance, as we have seen in Somalia. It is odd that a Conservative-led coalition is reducing our strategic strengths and promoting a “littler England”. Is this our “east of Suez moment” in foreign affairs?
Finally, the Independent of 8 July stated that after the FCO leadership conference, which was attended by more than 200 ambassadors and high commissioners, the Prime Minister addressed business leaders at Downing Street. The newspaper said:
“Mr Cameron laughed: ‘We made them all travel economy class, wherever they came from, I'm pleased to say’. The assembled audience laughed”.
Is the aim, or at least the effect, of these cuts to reduce a first-class service to an economy-class service?
My Lords, I, too, thank the noble Lord, Lord Hannay of Chiswick, for initiating this debate. It is now nearly 50 years since Dean Acheson said that Britain had lost an empire but had not yet found a role. In many ways, this is still true today. We continue to have tremendous reach. Senior membership of the United Nations Security Council, the EU, NATO, the Commonwealth and a host of other multilateral institutions are all admirable roles. However, alongside our desire to sit at the top table, there seems to be a lack of vision about how this middle-sized country on the edge of Europe can project its capabilities in a fashion commensurate with its ambitions.
The record of the recent past is poor in vision. Mr Blair's Chicago speech of 1998 on liberal interventionism seems as anachronistic as Britain's rhetoric at the time of Suez. Through our use of force, we have lurched from the positive power projection of the 1990s to international criticism and domestic cleavage. I say to the noble Lord, Lord Anderson, that if we have a “little England”, it is partly due to his Government's extravagances rather than to anything that was planned or preordained. This Government have moved with admirable speed to come to grips with what a national security strategy should look like. However, a security strategy inevitably does not cover the central question of how the Diplomatic Service should serve our national interest.
Despite the Foreign Secretary's excellent speeches in recent months, we are not yet clear about the shape and form of our Diplomatic Service in this period of austerity. While financial savings can and must be found, they will be least damaging if we have a clearer sense of our priorities. Building Britain's prosperity and safeguarding her security are not always compatible or obtainable in equal measure. The two require very different skill sets and capabilities in policy and diplomacy. The balance between them becomes ever more important in a democracy in which every citizen, through the internet and news media, becomes a freestanding and engaged foreign policy expert. On the high street, the exigencies of national interest are not always understood or supported. A recent YouGov poll, in advance of the Prime Minister's visit to China, showed that nearly 64 per cent of people were less concerned about our security, trade and economic interests there than in the plight of Tibet.
The national security strategy highlights how we find ourselves in a world that is more uncertain than it has ever been. Globalisation is in a “long crisis”, according to a recent Chatham House paper. This extended period of volatility, where demographic, economic and security challenges extend across the globe and where nationalism and interdependence are rising together, opens up a fresh set of challenges. Our values and outward-looking posture mean that we are better suited than most to confront these new trends, yet the comprehensive spending review has left our foreign policy capabilities rather weaker. In these circumstances, perhaps we need to define our power and those capabilities rather more narrowly than our ambitions would suggest.
Alongside the national security strategy, we need a more pragmatic view of our foreign policy priorities. Principal among these must be a realistic assessment of our global reach. I suggest that it should be somewhat more limited than the fully adaptive posture that the strategic defence and security review suggests. In these austere yet unpredictable times, we may well have to make a case for defining our international mission more accurately as managing global risks on behalf of British citizens. In practical terms, this should result in our lending more support to the EU's External Action Service than we have given to date to allow it to do more representational work for us while our own independent presence is reduced.
While there may be some specific differences in foreign policy among our EU partners, overall our values and priorities are surely more aligned than divergent, and we should consider how we might use the External Action Service as an opportunity rather than view it as an inconvenience. The vision of our strategic reach must nevertheless not be constrained merely to our commercial or national security imperatives. DfID’s budget and objectives should rightly be more closely aligned with our Foreign and Commonwealth Office-led interests, and indeed with the MoD’s capabilities, particularly in conflict-afflicted states, and I welcome the direction of travel in that regard.
The projection of our soft power is the reason why we are still well regarded in the world. Our language is spoken across the Commonwealth and beyond, our universities are worldwide centres of excellence, and the BBC and the British Council are almost as important for projecting influence as our military is for projecting power. Although the CSR has been “creative” in spreading the costs of these institutions across other bodies, they have all undoubtedly been rendered more vulnerable with the cuts. The danger is that years of success will be lost over a short period, with a cost to the nation over the longer term.
Therefore, we now find ourselves with these substantial reductions in budgets, which necessarily will have been arrived at without forethought. What is now needed is a hard-headed judgment of what we can achieve and, where these goals are more limited than those we have aspired to in the past, we need to set out and prepare for them in a more considered and coherent manner. That should be the basis of an active diplomacy that has risen to the new challenges, and I hope the Minister will be able to give us an indication of how he intends to achieve that.
My Lords, I thank my noble friend Lord Hannay for placing this debate on the agenda. I have to declare an interest because I shall be speaking about Iran. I was born and raised in Iran and I worked there as a journalist. However, what I really remember from my past is the extraordinary influence that Britain had on Iranian politics during my childhood—so much so that I remember whenever anything happened to the soup, our cook would immediately say, “Poltiqueh inglissas”. It took me a while to understand that she meant, “It’s because of the politics of the English”. It seemed to have an influence right across our lives.
I suggest that the BBC in particular retains the kind of punch that it has had for a long time. In Iran at the moment, with many of our journalists languishing in prison, it is regarded as one of the most reliable sources of information there. I can tell your Lordships that the BBC has been listened to and watched by Iranians for ever. I remember, as a young student, giving an interview to the BBC and inadvertently admitting that I was helping behind the scenes of the local pantomime. I was suddenly hit by an avalanche of calls and letters from irate aunts and uncles telling me how I should not be mixing with thespians. They had all heard the programme, in which I had thought I was just having a chat in an interview.
I find that appearing on BBC television has exactly the same impact. Iranians watch it. The Iranian Vice-President is on record as admitting that he does not like BBC Persian Television, although he has watched it during a Cabinet meeting. Therefore, it seems to me that Britain is punching above its weight in the case of Iran. That is not surprising, particularly as BBC Persian Television is run by people who have been largely recruited in Iran, including many young journalists who have found the situation there impossible. Therefore, not only to avoid imprisonment but also to have a voice, they have come to work for the BBC, and I assure your Lordships that their voice is being heard loud and clear in Iran. It seems to me that, in response, the Iranians provide the BBC with an enormous amount of information.
Interactive connections exist with the BBC, and I understand that at some point eight videos per minute were sent to the BBC during times of crisis in Iran, when no one in Iran could broadcast them but the BBC could. It became a source of information for many news agencies around the world. That interactivity is feared by the Iranian Government but respected by Iranians, because they do not see the BBC as the voice of the British Government. Often, the BBC reports the unheard voices of Iranians, and many of us rely on the BBC reports because our e-mails are checked and we do not get phone calls that are not controlled. Therefore, it is crucial that the BBC retains its ability to broadcast to Iran. We know that the Government fear it by the number of jammings of BBC programmes that have occurred again and again.
Given this important impact, given that Britain needs all the friends it can possibly get in the Middle East in general and in Iran in particular, and given that the nuclear debate has been very counterproductive in its impact on the popular mind in Iran, the BBC—radio, bbcworldnews.com and television—is the most effective informal channel not only to influence Iranians but to convey Iranian views abroad. It is therefore a matter of great regret that, as I understand it, the Foreign Office has taken a 10 per cent cut in its budget but the BBC World Service is about to take a 16 per cent cut. Does the Minister consider that there is any room for reconsideration?
My Lords, it is a pleasure to follow the noble Lord, Lord Hannay, in a debate on diplomatic questions because of his immense knowledge and experience of world diplomacy. I lay claim to some experience, if not expertise, in that field; I currently work in Brussels for the European TUC as general secretary. The UK diplomatic representation, inelegantly called UKRep, is generally admired as the classiest operation, the top team, around the town—even by the French.
I do not always agree with what UKRep does on behalf of Her Majesty's Government. It has blocked progress on some important social issues dear to my heart, such as insisting on maintaining the working time opt-out. Why is it that UK workers can be pressed to work what are on average the longest hours in the European Union? On posted migrant workers—the category of migrants who are brought with an employer to fulfil a contract—why do only the minimum rates need apply in the UK, not the rate for the job? They often undercut British workers, and then people are surprised when there is some anti-migrant feeling.
Why do successive UK Governments continue to oppose a social clause in the single market and downplay the need for the single market to have a social dimension? Without such a dimension, hostility is likely to grow against free trade and the single market. That will encourage the protectionism that we saw in last week's American elections.
These are questions on which I battle weekly with the UK representation. Ruefully, I have to subscribe to the chorus of admiration for the skilful way in which it plays its cards. It is a powerful agent for UK government policy, and diplomacy is truly an area of British excellence.
I am conscious that I am very privileged to join this House. I hope to bring some insights, especially into economic and employment policy and European affairs. Eighteen years, first as general secretary of the TUC—it is good to see a quintet at least of former members of the General Council of the TUC, including the trio in front of me—and another eight years after that as general secretary of the European TUC, have strengthened a deep commitment to trade unionism as a force for good in our society. I hope that the economic crisis that we have at the moment will be rather like the 1930s in one respect in that people in difficulties will turn again to the union movement in democracies and that it will take its full and proper place in the national life of the country, not just as the awkward squad but as a real force for constructive engagement, especially on promoting greater equality, skills, productivity and, critically, higher standards of performance and governance in many of our companies.
I was addressing a City audience not long ago and making the case for more long-termist perspectives from investors and entrepreneurs. One financial executive smirked and said, “I have some long-term investments; they were short-term investments, but they have gone wrong, and I can’t sell them”. Short-termism is a British problem. It is a major reason why so many of our private sector companies, not just Manchester United and Liverpool, are carrying so much debt, why our manufacturing sector has shrunk to worrying levels and why foreign companies are able to pick up household names at bargain prices.
I certainly do not knock foreign companies generally. Some are exemplary long-term players, and they show up the weaknesses in too many of our own firms, but we need more home-grown companies that can hold their own in the world and do not sell out at the first whiff of a big cheque for shareholders and top executives. How company boards run themselves, which interests are included on the board, whether shareholder value should be the sole goal of companies, how to organise takeovers, and, if necessary, block them, and what to do about the often excessive levels of boardroom pay that risk directors being regarded, in Richard Lambert's memorable phrase, as “aliens”, and in my words as the Bourbons of our age, are all questions that are ripe for powerful scrutiny and new thinking. I am watching carefully the right honourable Vincent Cable, who has expressed himself strongly on these issues, to see whether he will maintain his interest and not get swamped by urgent, but not more important, questions.
Today is Armistice Day, and we remember all those who made and make the ultimate sacrifice for the country. The European Union was born out of the wreckage of the Second World War and has been a major part of ensuring that any repeat now seems a remote prospect. That is a huge achievement in a continent scarred by too many bloody battlefields and haunting cemeteries. Britain's place is in Europe, not just for reasons of the past, but for the future too, as new, major, formidable economies emerge to take a prominent place in the world. It is not just aircraft carriers that will need sharing in our corner of this world if European influence is to be sustained. Indeed, as the noble Lord, Lord Hannay, said, the European External Action Service, under the capable leadership of the distinguished former Leader of this House, the noble Baroness, Lady Ashton, is recognition that diplomatic efforts can usefully be shared in many parts of the world. I am sure that British diplomats will flourish on this particular European stage.
I finish by thanking noble Lords, the Clerks and, indeed, all the staff of the House for the friendly welcome that has been extended to me from all sides. I am very much looking forward to making my contribution to the work of the House.
It is a great privilege to follow the maiden speech of the noble Lord, Lord Monks, on which I congratulate him. I also congratulate him on his—in the American phrase—non-remunerated endorsement of UKRep and its excellence in Brussels. As he reminded us, he speaks with a lifetime’s experience of industrial relations in this country and throughout Europe, not least in his service with ACAS, so he speaks about diplomacy as a practitioner. Offering the possibility of reflecting on the Stürm und Drang of professional life in the relative tranquillity of the British senate is one of the ways in which your Lordships’ House plays a unique and valuable role in our constitution. The speech of the noble Lord, Lord Monks, was a notable contribution to this tradition and I know that the whole House hopes that his voice will be more frequently heard in the future.
I am grateful to the noble Lord, Lord Hannay, for introducing this debate and for doing so in a way that acknowledged the alliance between the traditional actors in diplomacy and others who represent a multitrack approach. The dissolution of the Soviet Union brought to a close the period in which a single international conflict dominated the international system. Instead, we have seen intra-state rather than inter-state conflicts, ethnic conflicts, secessions and struggles often, alas, fortified by religious rhetoric and symbols become the norm. As we speak, the turbulence and the suffering in Iraq continue, not least on the part of the ancient Christian community, which has suffered grievously in recent days.
During the Cold War, international relations were largely the preserve of the professionals, the diplomats and the politicians. I think that we should pay tribute to a number of pioneers in the US and Europe who saw the potential of applying approaches that were being developed in the setting of industrial relations. These have played an enormously important part in the development of a multitrack approach and in community mediation work through their application to conflict in general, including civil and international conflict.
At this point the question arises as to whether, in addition to being part of the problem, the faith communities may have a contribution to make in the field of conflict prevention. It is a question that has aroused some academic interest in the Anglo-American world ever since the publication, well before 9/11, of Professor Samuel Huntingdon’s book The Clash of Civilizations and the Remaking of World Order. It is evident that many of the violent conflicts in the modern world are rooted in threats to identity. Religion in many parts of the world is crucial to social cohesion and is therefore likely to be co-opted in any struggle that centres on identity. Folk wisdom easily understands how the highest ideals are bent to the most malign purposes. Jonathan Swift, that Irish dean and the author of Gulliver’s Travels, lamented:
“We have just enough religion to make us hate, but not enough to make us love one another”.
However, are there positive resources within the traditions and institutions of the world’s faith communities capable of making a contribution to conflict prevention and peacemaking? Is it possible that, as the title of an influential book from the Washington-based Center for Strategic and International Studies suggests, religion is a missing dimension of statecraft? It seems obvious now that US monitoring of Iranian politics ought always to have included the religious dimension, but a report from CSIS reveals:
“The one recorded attempt to do just that within the CIA, before the revolution, was vetoed on the grounds that it would amount to mere sociology, a term apparently used in intelligence circles to mean the time-wasting study of factors deemed politically irrelevant”.
No one, so far as I am aware, is calling for the call-up of platoons of clerics and mullahs to shuttle between capitals like ersatz diplomats, but we must try to be practical.
Here I must declare an interest as the founder and current chairman of St Ethelburga’s Centre for Reconciliation and Peace. St Ethelburga’s is a little church that survived the great fire of 1666 and the blitz but not the effects of an IRA bomb in 1993. That bomb, from a conflict that has a religious dimension, made us determined, encouraged by the late Cardinal Hume, to rebuild the church as a centre for reconciliation and peace. Over the past two years, 20,000 people have participated in our programmes.
I make a plea that, as we enter the dangerous second decade of the 21st century, where even the editor of the Economist has written a book suggesting that God is back, we should look to develop our active and well resourced diplomacy by making deeper alliances with the new resources for conflict prevention that the faith communities, not only the Christian ones, have developed.
My Lords, I welcome the debate introduced by my friend—if I may call him that, as he is my friend—the noble Lord, Lord Hannay. I was in the UKREP office referred to by the noble Lord, Lord Monks, on the very day that David Hannay’s name was in the papers—I think it was the Daily Mail—as being appointed a people’s peer. The people in UKREP said that they had not heard anything so funny in their lives.
I add my thanks to the right reverend Prelate the Bishop of London, about whose diplomatic experience, in the broadest sense of the word, we have just heard. I have witnessed the remarkable outreach job that he does in the St Paul’s area and in London generally—a job that the Anglican community does in many countries around the world.
My noble friend Lord Monks—John Monks—is the fifth former general secretary of the Trade Union Congress to come to this House. He joins an illustrious list: Walter Citrine, who had an historic reputation in the trade union movement, including for his short book, The ABC of Chairmanship, which is used from the Pacific Islands to the Falkland Islands; Vincent Tewson, who followed Lord Citrine; and Victor Feather—George Woodcock must have declined the invitation, but I do not know that for a fact—who took the TUC through the difficult years of 1969 to 1973, from the proposals of Donovan and In Place of Strife to Ted Heath and all of that.
John’s only fault is that he is too fond of irony. At a meeting with Mrs Thatcher in 1980 on the issue of red tape—too much regulation on small firms and so on—John asked, tongue in cheek, “So why not exclude small firms from the 30 miles an hour speed limit?”, at which point Mrs Thatcher turned to a civil servant and said “Take a note of that”. The white van man has certainly taken a note of it.
There is another similarity between working for the TUC and the Diplomatic Service. I was reminded of this only yesterday when the noble Lord, Lord Hannay, chaired a meeting with senior American diplomats on Afghanistan through the All-Party Group on Multilateral Nuclear Disarmament and Non-Proliferation, of which I am the secretary. One of them remarked that it might be useful to distinguish process from outcomes. I recognised that distinction and noted that trade union officials do that every day of the week. Before John mentioned the trio—now the duo—sitting in front here, I thought that perhaps the TUC should do some job swaps with the Foreign Office, but I think that they are probably already doing it.
I have given the Minister—whom I admire without always agreeing with him—notice of this question: what is the headcount of the FCO and DfID at the present time, both in Britain and overseas? In the latter case, there is also the separate category of locally employed staff. We need to be able to track where, when and how this transition takes place, with the position before the cuts being the benchmark or starting line.
I know from experience that, if there are missions from five, six, seven or eight different European countries in a small African or South American country giving different advice about auditing, project finance or whatever, the messages from London, Berlin, Paris and Stockholm and so on are different, no matter that they get together once a week. Reality stands all this talk about defending the national interest on its head, because small countries often have only one man and a dog to listen to all the conflicting advice. That can be counterproductive and give a totally wrong impression. I have seen countries in many parts of the world waste the time of a very small number of competent people.
Someone should, therefore, challenge the doctrine of keeping all the UK missions quite separate. As we have very distinguished diplomats, we should—here I follow the message of the noble Lord, Lord Hannay—be on the front foot in the European External Action Service.
Coming to my final sentence, I have some sympathy with the argument about the cuts—
I thank the noble Lord, Lord Hannay, for introducing and securing this debate. I, too, congratulate the noble Lord, Lord Monks, on his excellent speech.
The work of the FCO is fundamental to the work of this Government. I consider it an honour to have worked with the FCO on a number of projects and programmes. The work ultimately involved promoting British interests abroad.
We as a nation have much more to work towards in dealing with conflict in too many parts of the world, so the FCO will be key to ensuring a safe, prosperous and strong Britain. The FCO's consular services have an enviable reputation across the world as being among the best. Their support, advice and guidance are second to none and are essential if we bear in mind the huge number of Britons who travel abroad. During a time of hardship, the FCO is also essential in bringing in inward investment and exporting our goods and services.
I have been privileged to have been asked to lead FCO delegations to Egypt, Malaysia, Indonesia, Sudan, Pakistan and Bangladesh among others. The work of those delegations was to engage in dialogue and to highlight what Britain has to offer—its diversity and equality of opportunity being two key themes.
In 1999, the UK was the first non-Muslim country to send a delegation to Saudi Arabia for the hajj pilgrimage to cater for the approximately 25,000 British pilgrims who attend over a two-to-four week period. Since 2001, I have led this delegation. The work involves providing consular, medical and support services to British pilgrims. The cost of the delegation is almost insignificant when compared to, let us say, a state dinner.
An FCO-commissioned independent evaluation published in 2006 clearly demonstrates that, for the cost of £120,000, the benefit to the UK of that delegation is estimated at more than £1.6 million. The benefits that the report identified were in four key areas: economic productivity lost as a result of illness back in the UK; reducing NHS hospital consultations in the UK; reducing in-patient readmissions in the UK; and reducing GP consultations in the UK.
I am sure that noble Lords would all agree that saving one life is valuable enough. Over the past 10 years, the delegation has saved thousands of lives. For example, a female British pilgrim was going into a coma at 2 am when a doctor from the delegation went to her tent. He was able to stabilise her while Saudi authorities responded. She would otherwise have died.
This year, without any formal consultation, the delegation has been cut. That is in spite of the fact that the delegation saves the UK money and works because of volunteer doctors. It is a true example of the big society, in which individuals give up their time to help others and ultimately the state. As stated, more than £1.6 million a year is saved. Given the monumental scope of last month’s comprehensive spending review, the cut is just not logical.
Despite the reasons presented by the FCO and the noble Baroness, Lady Warsi, in her letter to me, Saudi medical services have improved, but given the high level of demand, more than 3 million pilgrims are still relatively inaccessible save in the most serious cases. The examples that I have stated rely heavily on early intervention to prevent serious or life-threatening cases from developing—a stitch in time saves 10 in the future.
The value of British doctors is great. They know and understand the diseases and symptoms that are particular to British pilgrims. For example, the delegation was successful in convincing Saudi medical authorities not to amputate a British pilgrim’s leg because of infection and instead insisted on a course of drugs that removed the life-threatening infection.
Why did no public consultation take place? More importantly, why was there no consultation with Muslim organisations given that the service of the delegation in Saudi Arabia positively benefits British nationals? Was the Department of Health consulted? The FCO report of 2006 stated that the work of the delegation formed part of the FCO’s race equality scheme to demonstrate its statutory duty under the Race Relations Act. Was a race equality impact assessment undertaken for the decision and, if so, what was the outcome, or is the FCO in breach of its statutory obligations?
Finally, I understand but do not agree with the rationale to abolish a delegation that saves more than £1.6 million per annum to the state. Did the FCO undertake a cost benefit analysis before it decided to end the delegation? Will it finalise figures to demonstrate how it came to that conclusion? Thank you.
My Lords, I add my thanks to my noble friend Lord Hannay for securing this Motion for debate today. I, too, declare an interest as a former member of the Diplomatic Service, although it was of a more humble status and variety than that of my noble friend.
This is a Motion of major importance and it is perhaps appropriate to be discussing it on Remembrance Day. If ever there was a reason to have a properly resourced and active diplomacy, it is to try to solve the world's problems, in Churchill's memorable phrase, through “jaw, jaw” rather than “war, war”. Beyond this, many of the other reasons for speaking in support of this Motion have been eloquently put forward by others, including in particular the importance of soft power, the World Service and the work done by the British Council.
I share many of the views expressed and particularly welcome the noble Lord, Lord Monks, and commend his maiden contribution today. I shall add my voice on two points—the issue of resources and the importance of retaining an active global network. On the issue of resources, I recognise that many government departments contribute to our diplomacy, but I should like to focus on the FCO's resources. This to my mind is the budget which is so crucial to the orchestration of our diplomatic activities overseas. The FCO's departmental expenditure limit in 2010-11, including the World Service and the British Council, is £1.6 billion. This represents less than 0.5 per cent of the Government's total budget. If you take out the new arrangements for the World Service funding, the FCO budget is to be cut by 10 per cent over the period of the spending review. Are we able to say now, “Thus far and no further”?
I do not doubt that there might still be some efficiency savings to make, but anything more than limited savings should in my view be strongly resisted, for two reasons. First, the Diplomatic Service has recently had to reduce its budget savagely in the light of exchange rate fluctuations, as my noble friend Lord Hannay reminded us. I welcome the spending review commitment to introduce a new foreign currency mechanism to manage exchange rate pressures. This must surely be right for the proper management of our diplomatic effort. I welcome anything that the Minister can tell us about this mechanism. Secondly, and most obviously, we are talking about really small amounts of money in overall government expenditure terms. Squeezing even limited savings out of the FCO budget will have a major impact on our diplomatic effectiveness; it will have precious little part to play in reducing our wider national budget deficit and we ought to recognise this.
This brings me to our global presence. We could trim our diplomatic reach to fit an ever smaller budget, but is this really the moment to do that? The world order is shifting; we have moved from superpower duopoly to G7/8 and now G20. The politics of globalisation, the economics of the emerging markets and the international consequences of climate change are shaping our diplomatic agenda. We have moved on from BRICs and are already looking at the emerging markets of tomorrow, including South Africa, Turkey, Indonesia, South Korea. The map of diplomatic and economic power is changing fast. We need to respond to the opportunities and the challenges of globalisation, not by withdrawing in on ourselves but by playing to our huge historical advantage of being an outward-looking trading nation with global links.
It is only by having a global network that we can be in a position to deal with the unexpected in this increasingly globalised world. We cannot know now what will be the future threats to our security, the opportunities for our business, or indeed the new pressures on our consular services. A properly resourced global presence must be part of the answer to dealing with the uncertainties of the future.
This brings me to my final point. Regardless of the internet and instant communication, it is only by having people in post and active on the ground around the world that we can continue to build and retain that deep political insight, that economic knowledge and that cultural perspective along with the language skills and the lasting, reliable contacts which are of real value to government and business. We need to retain that global network because once you close a mission, you lose it.
In conclusion, I pay tribute to the many men and women serving at home and overseas who are part of our national diplomatic effort. Many of them work in difficult and dangerous circumstances and they are certainly often the subject of admiration around the world. I am pleased to have this opportunity to speak in their support this afternoon.
My Lords, the Foreign Secretary’s speech delivered in July outlined the coalition Government’s diplomatic vision. Britain’s foreign policy is to be shaped around a number of key geopolitical challenges. Foremost among them is the establishment of stronger links to emerging economic powers, in order to gain influence and an improved foothold in the burgeoning markets of countries such as China, India and Indonesia. Britain’s need to generate wealth through trade is paramount, so few would argue that this kind of relationship-building should not be a top international priority. The process behind it is both complex and demanding, so the case for Britain to be equipped with a properly resourced and active diplomacy should be universally apparent. The reservation I have lies in the terms on which Britain’s future is articulated.
A pertinent question for debate centres on what, substantively, our diplomatic approach should be. When we talk of the need to build relationships with emerging economic powers, it effectively translates into a process of engagement with their Governments in the hope that mutually beneficial trade agreements can be established. The greatest challenge surrounding this endeavour is often identified as being that many of those countries do not share the same historical development as the UK and its counterparts in western Europe and North America, and that therefore they do not possess the same priorities and world views. Commitments to human rights, gender equality and political liberalisation, for example, may not be as strong in these societies as they are in our own. Such a diagnosis can indeed seem intuitive in light of the prevalence of misunderstanding and antipathy that is identifiable across the world today.
That is not a new problem. Experience has taught us that it is neither advisable nor feasible to expect another country to accept automatically that, in order for it to gain entry into the family of leading nations, it must embrace what we and others understand as the pillars of acceptable governance. For Britain, therefore, a dilemma presents itself—one that I am certain we will encounter increasingly in the future: that balance between the importance of our own economic prosperity and the well-being of the citizens of the countries with which we do business. Like the noble Baroness, Lady Falkner, I feel that we need to establish with greater clarity our international priorities.
There is no straightforward blueprint for the encouragement of social freedoms. I do not, however, subscribe to the view that certain cultures are intrinsically resistant to liberalisation. On the contrary, I believe that the universality of democracy and human rights lies in their universal appeal. We must avoid the adoption of a “clash of civilisations” world view that inadequately explains the international environment, portraying it as a series of rival and largely incompatible systems. This only serves to reinforce the already robust barriers that divide nations and ferment antagonism. If we are to learn anything from the global events of the last decade, it is that we must develop a more nuanced understanding of the world around us—one that avoids assumption, cliché and stereotype.
If it is to be lasting, the respect for human rights must be organic and possess credibility within the society concerned. Achieving this will be extremely difficult. There will be times when we should acknowledge that we have no political or indeed moral right to get our own way, especially when it is at the expense of ordinary people of other nations. While we continue to promote the introduction of democracy and human rights in tandem with economic pursuits, the temptation to relax the former for the benefit of the latter will always remain.
Actively building relationships with new economic powers is an opportunity to develop novel and lasting international alliances that cement Britain’s reputation as a country that operates globally, according to an intelligent mix of pragmatism and principled action. To achieve this, though, we need not only to build bilateral partnerships but to promote multilateral action. In the face of unpredictable geopolitical circumstances, we must alter our outlook from one that focuses on what divides us from these other nations to one that emphasises the inherent and shared interests and characteristics identifiable in all human beings. Our diplomacy must be properly active.
Britain’s future and international priorities must be articulated and pursued in such a way that our efforts to encourage liberalisation within the societies of new global partners are not rendered perfunctory by the pursuit of our own economic interests. For real results to be achieved, the freedoms and safeguards that we value must be framed in such a way as to appeal to as many different parties as possible. I argue that this is a diplomacy that is also properly resourced in its psychology, and one that is more likely to meet with success.
Like my other colleagues, I take this opportunity to add my thanks to the noble Lord, Lord Hannay, for securing this debate.
My Lords, I, too, thank the noble Lord, Lord Hannay, for securing and introducing this debate. As he rightly said, we are a middle-ranking power with limited resources but, thanks to our history, we have a global presence and a good reputation. Although our uncritical support for the US-led invasion of Iraq did us great damage, we are widely respected for our commitment to certain values and our ability to blend political realism with moral idealism.
Being a middle-ranking power, our hard power is limited. So far as what is called “soft power” is concerned, I am not sure that the term really makes much sense. It is a metaphor based on “hard power” and, like all metaphors, it is indeterminate and ambiguous. I have debated this with the father of the phrase, Professor Joseph Nye, and he takes it to mean “the ability to get others to think the way that we do”. I am not sure why we would want to do that; it has an element of intellectual seduction and manipulation, and I should have thought that diversity of view had much to be said for it. I would rather think that our concern should be to ensure that others think well of us, take care of our interests, are concerned about us and wish to be close to us. In other words, rather than talk about power, soft or otherwise, we should be thinking of building bonds of interest and affection with other countries.
If that is the goal, and it ought to be, there are three or four things that we should be aiming at. First, as a country, given our history and geography, we stand for certain values like human rights and mutual respect between nations. We ought to be able to display those values in our foreign policy. We should also encourage them in other countries, but never in a hectoring or arrogant spirit. The banal dichotomy of either intervention or indifference is not an option. I would like to think that the Prime Minister has shown how this can be done in his recent talk to students in China, talking about human rights, not as if it were a western export but rather something that China itself should want in order to create a stable and vibrant society.
Secondly, we live in a world of free and proud nations with different cultural traditions. It is extremely important that we should conduct our relations with them in a manner that does not offend or alienate them. There have been hilarious examples in recent years of how we can easily end up offending them. I was told—I hope this is not true—that one of our Foreign Secretaries, on a visit to India, addressed the Indian Prime Minister by his first name. You do not do that kind of thing. I was also told that the first Indian Prime Minister, Pandit Nehru, once complained to Sir Isaiah Berlin that, although he found American diplomats brash and full of themselves, he could handle them, while he had some difficulty with the British, whom he thought were rather patronising with an effortless air of superiority. He said, “I can’t handle that, having suffered it when I was a student at Cambridge”.
Having talked to Indian diplomats in recent years, I am told that things have changed considerably but, nevertheless, there are occasional glimpses of that effortless superiority. We ought to be careful about that. In other words, I am suggesting that we make sure that our diplomats are multiculturally literate and able to talk to people in other countries in the terms of the language and traditions that they share.
My third point has to do with the fact that the Foreign and Commonwealth Office should be open to new ideas and long-term perspectives. I am thinking not simply about tactical responses to this or that crisis, but rather about the deeper factors that influence a situation so that our response to a crisis is grounded in a long-term analysis. That will require that more of our academics and journalists are involved in the formulation of FCO thinking. In that context I ask the Minister: how many of the senior personnel in the FCO and in our diplomatic missions come from the ethnic minorities? My feeling is that, despite being a multiethnic society, we tend to present a rather monocultural, mono-ethnic profile to the world outside.
My fourth point has to do with our educational institutions, which play a crucial role. Overseas students are attracted to our great universities, and they are tomorrow’s leaders in government, business and the arts. It is very important that we should attract them, fund them and invest in them. The Chevening scholarships should therefore not be reduced. They are one way in which we invest in our own future.
In that context, we must also take a second look at the BBC World Service. It is widely respected as a source of unbiased information. As the noble Baroness, Lady Afshar, pointed out, the BBC’s Persian service, for example, is widely respected. It is striking that President Obama chose to give an interview to the BBC’s Persian service to reach out to the people of Iran and to refute President Ahmadinejad’s comments before the United Nations General Assembly in September. It would be a great mistake to deprive the BBC of this capacity to reach out to many people.
Finally, I greatly welcome the fact that the Prime Minister has set his heart on having special relations with India. The two countries have had close ties over the centuries, not just because of the imperial connection but going back further. This does not mean that Britain should be silent in those areas where India is wrong—for example, over Kashmir. I have protested strongly over the years that India’s policy in Kashmir is to be deeply faulted. At the same time, this can be done in different ways. Given the presence of the Indian diaspora, it is important that its people should be involved in formulating Britain’s policy and liaising with India.
My Lords, I also express gratitude to the noble Lord, Lord Hannay, for securing this debate. Effective diplomacy is paramount in dealing with the emerging and existing challenges facing our nation, including tackling the effects of climate change, promoting free trade and protecting human rights. It is important not just to focus on our historic relationships but to seek avenues for building new friendships and influence with emerging players.
First, our diplomacy should recognise the importance of greater dialogue between the Department for International Development, the Ministry of Defence and the Foreign and Commonwealth Office. These departments are paramount in achieving progress through active and efficient diplomacy. The challenges facing our nation and the world at large require a multifaceted approach to how we conduct future relations. I was surprised to learn that officials from different government departments operating abroad do not work together routinely and are often located in different buildings. That is unsatisfactory and can only add to the expense while also undermining our effectiveness in projecting foreign policy abroad. I am pleased that the Government appear to have this in hand and hope that the Minister will be able to offer clear assurances on this point.
While strengthening existing relationships, we must forge greater ties with emerging economies such as the BRIC countries and the Gulf states where economic growth is likely to be considerable. During the year I visited Russia, Turkey, Qatar, Kuwait, Brussels and the United Arab Emirates, where I spoke at international conferences on boosting trade and achieving sustainable development. I recently visited Sri Lanka as a member of the Commonwealth Parliamentary Association delegation. I was impressed with the quality of our high commissioner and his staff but feel that there are business opportunities which we can pursue. We can also consider providing resources to aid in rebuilding the country.
I am pleased to note that the Secretary of State has undertaken to overhaul our network of foreign embassies, turning them into engines for trade that support our ambitions for an export-led recovery from the current economic situation. I see no reason why leading business people should not be appointed to diplomatic posts, and I commend the Secretary of State on his vision in making this announcement and undertaking to deliver on it. This accords directly with my experience of travelling across the world and speaking with key figures. The recruitment of senior business people should provide a new impetus for us to maximise trade opportunities, to deliver economic and political benefits to all parties.
I have established and maintained good relationships with the ambassadors and high commissioners of a number of countries and their diaspora. There is good will towards the United Kingdom but we need to build on these relationships further.
I support the Government’s effort to strengthen our economic strategy and commercial relationships with China and India. I was very pleased that our trade delegation to both countries was headed by the Prime Minister. We need to rectify the difficulties caused by our present economic situation. We can achieve this through spending cuts and raising taxes but we need also to look at ways of strengthening our business activities overseas. By increasing our trade with overseas countries, we not only generate wealth but also strengthen our political, social and cultural ties with them. Diplomacy has a key role to play in achieving these objectives.
I have spoken on several occasions and led a debate in your Lordships’ House on the importance of the Commonwealth. The linguistic and administrative legacy of British rule suggests that it costs less to trade within the Commonwealth than outside it. We need to work towards building closer business and social links with Commonwealth countries. However, we should not embark upon this at the expense of building wider alliances. We cannot use the opportunity to look at the issue of diplomatic activities without also considering the impact of the European External Action Service. A consequence of the Lisbon treaty, this approach could have a profound impact on our diplomatic footprint. We should not allow our footprint to diminish at the expense of European infrastructure that may be less efficient or effective.
I believe that the European External Action Service, now that it exists, should be harnessed to exert maximum influence. We should be proactive in helping to shape its agenda so that it can contribute positively on the international stage.
I would welcome further proposals to expand the United Nations Security Council. The emerging global order suggests that such an expansion is inevitable. I acknowledge that this will indeed result in challenges to our diplomacy as it will require efforts to extend and increase our influence among a larger group of countries. Effective diplomacy is necessary in order to secure our international prosperity. Our diplomacy requires a flexible and steadfast approach to how we further our interests in the emerging world order. This will undoubtedly contribute towards the reinforcement of British influence and prestige in global affairs.
Finally, I have been on pilgrimage to Saudi Arabia several times and agree with all the points made by the noble Lord, Lord Patel of Blackburn. I might add that I chair the Conservative Muslim Forum but there was no consultation on this with me or my members.
My Lords, I congratulate the noble Lord, Lord Hannay, on initiating this debate. I agreed with most of what he said and was particularly pleased that he sought further clarification from the Minister on our response to the EAS. I am glad that those remarks have just been echoed. I was also particularly pleased with his comments on cross-departmental co-operation, a subject to which I shall come back in a moment. I congratulate my noble friend Lord Monks. I do not know how many noble Lords noticed that he managed to slip in a reference to Manchester United in a debate on diplomacy. We may hear other such interventions in future but I am sure that they will be welcome, even on the part of those who do not support that team.
I wish to take up the final point made by the noble Lord, Lord Sheikh, who referred to the remarks of my noble friend Lord Patel of Blackburn. My noble friend spoke about a topic that he knows well. I suspect that few noble Lords have experienced the difficulties to which my noble friend referred in connection with hajj pilgrimages. When representing my former constituency in another place I was very well aware of those problems. I congratulate my noble friend on the very significant improvements that he has made. It is important to recognise that these are very real problems, not least because of the language difficulties that sometimes arise when people attend this important event. I hope that the Minister will look at that issue again as it is very important.
The noble Lord, Lord Hannay, said that this debate was timely given the announcement of the comprehensive spending review. It is also timely as tomorrow we will debate the strategic defence review. While that debate will rightly concentrate on aircraft carriers and Harrier jets, the two issues need to be considered together as we want a joined-up approach. It is important that we concentrate on that. In that context I remind the House of the Ministry of Defence Green Paper published in February this year entitled Adaptability and Partnership, which is a very important reference document for today’s discussion and tomorrow’s. Today’s theme is active diplomacy. One of the questions posed in the Green Paper is how we can deploy the Armed Forces more effectively to support wider efforts to prevent conflict and strengthen international stability. In the section of the Green Paper on adaptability and influence, mention is made of the work carried out by the Foreign and Commonwealth Office, the Ministry of Defence and DfID in order to understand better the contribution that defence diplomacy and security co-operation can make to wider government efforts.
My purpose in intervening today is to underline how important it is not to lose sight of the very important, sometimes critical, and often unique, role that defence diplomacy can play. During my time at the MoD I saw many examples of this work. I understand that we cannot always talk openly about this but defence diplomacy makes significant contributions across a wide field that people sometimes forget. I shall mention just one. The British Military Advisory and Training Team, based in the Czech Republic, works with it and others to provide multinational training courses both on peacekeeping operations and on the wider basis. It is important to realise that we are not just working with NATO allies in that; there are 31 partner countries, from central Asia, the Caucasus, the Balkans and north Africa. Indeed, when I visited, I was impressed to see someone from Azerbaijan sitting next to an Armenian, which you would not get in most circumstances. That approach shows the influence of soft power and the fact that this country can be extremely important in making sure that such things happen.
Time is short, so I shall just say that I think that those working in aid are sometimes apprehensive about people in military uniform providing advice in a country. However, as the DfID White Paper of last year pointed out, unless you have security and stability on the ground, it is often impossible to provide aid. Very often, people in fragile states who are in uniform will take advice only from other people in uniform. It is important that we build on that sort of thing.
I emphasise a significant step forward—the establishment of the stabilisation unit. That brought together not just funds from the FCO, MoD and DfID, but many of the personnel who now work together in a productive way.
I hope that the Minister will confirm that, in this compelling case for an active diplomacy, there is also a compelling case for defence diplomacy, and that the words in support of that uttered by Ministers will not just be words but will be translated into very direct and very positive support.
My Lords, I thank the noble Lord, Lord Hannay, for securing this important debate. He has great experience in the field and has made an unanswerable case today for a properly resourced and active diplomacy. I congratulate the noble Lord, Lord Monks, on his maiden speech. It is some years since he and I marched shoulder to shoulder with many others—including the noble Baroness, Lady Symons, the noble Lord, Lord Brett, and probably the noble Lord, Lord Lea—in support of GCHQ trade unionists in Cheltenham. He made an excellent speech today and I hope that we will hear more from him soon. I make him this offer: if Cheltenham Town are drawn at home to Manchester United in the FA Cup this year, I will make sure that he gets a ticket. If we are drawn away, I hope that he will do the same for me.
I want to make three points. The first is to thank those diplomats I have met in this country and overseas. The second is to give some anecdotal examples of the work that I have seen them do. The third is to express frustration that in recent years we have undervalued and underresourced our diplomacy.
One of the most challenging projects on which I worked before entering Parliament was in Iraq during Saddam Hussein's era. My task was to ensure that new British computer systems installed at Baghdad University did what was required of them. At the time I did wonder why we were selling computer systems to the Iraqi regime, which was at war. I was more concerned when I was asked to provide support to British systems in the Iraqi defence department. British Ministers gave their approval to those exports; the logic was that Iraq’s being opposed to Iran meant that Iraq was on our side. How things change. These systems were mentioned in the Scott inquiry into arms for Iraq.
I wonder what advice our diplomats in Baghdad gave to our Government of the time on whether those “sales” were advisable. A properly resourced diplomacy can and should give timely advice to the Government on commercial, cultural and security issues, and the Government should take notice of that advice before taking decisions which could have far reaching implications. I know that our diplomats gave advice on new missile systems produced by Iraq when I was there. The al-Hussein missile was powered by a lawnmower engine. The later al-Samoud missile was similar in design, but powered by an uprated lawnmower engine. The guidance system was such that the launchers put their fingers in the air to judge the strength of the wind, made a calculation and filled the device with the appropriate amount of fuel. When the fuel ran out, the missile dropped out of the sky onto whatever lay beneath. They were not the most accurate of missiles.
I know that our diplomats fed back information on Iraq’s military capabilities, so I wonder how the infamous “dodgy dossier” prior to the second Gulf conflict came into being to justify the claim that Iraq posed a threat to the United Kingdom and could launch weapons of mass destruction in 45 minutes. Why was advice from our diplomats in Iraq not heeded? A lot of lives, as well as a lot of money and Britain's reputation, could have been saved if we had avoided that unnecessary conflict.
I take a special interest in Africa and have visited many countries where I have seen the work of our diplomats. I have literally been saved by several of them. On a Commonwealth visit to Malawi, our vehicle was in a collision with a passing cyclist. Immediately, we were surrounded by a huge and angry crowd demanding vengeance on our driver. It was a very nasty situation. One of the diplomats, a lady, shepherded the MPs to another vehicle, ordering, “Get the VIPs out of here”, before calmly dealing with the crowd, taking the cyclist to hospital, where it was discovered that he was drunk and not badly hurt, and she arranged for a new bicycle to be delivered to him.
While observing elections in the Gambia, our delegation came across a riot in which at least one person had been shot dead and a Minister’s house set on fire. After listening to what the crowd had to say, we returned to our vehicle and shots rang out again. It felt as though we were being shot at. Fortunately, the British high commissioner and his staff helped us to recover.
Another incident occurred while observing elections in Ghana at the end of Flight Lieutenant Jerry Rawlings’s presidency. On the eve of poll, the British deputy high commissioner explained that there had been trouble in northern Ghana. We went to an independent radio station, Joy FM, which, through its sister station, Love FM, confirmed that a melee had taken place and a dozen or more people had been arrested, including an opposition candidate. When this news was broadcast, a group of large, uniformed, armed men arrived and told the radio station to stop broadcasting. I found these men from the Bureau of National Intelligence to be intimidating, but they were nowhere near intimidating enough for the deputy high commissioner who pointed out: first, that democracies do not close down independent radio stations; secondly, that international election observers were present and would include this incident in their report on the conduct of the elections; and thirdly, that if they did close down the radio station, the elections might well be judged not to have been free and fair, and it would all be the fault of the men in uniform. Eventually the men turned and left. If we had not been there, and if that diplomat had not taken calm and considered action, Ghana 2000 might well have joined a long list of failed elections around the world. As things turned out, there was a peaceful change of Government, which was a credit to the growing maturity of Ghana’s democracy.
That diplomat—now no longer in the service—was Craig Murray, who became our ambassador in Uzbekistan. During his time there he discovered and reported back on appalling incidents of torture, implicating the United States, which was believed to be receiving information obtained under torture. Instead of acting on the information provided by one of his most senior diplomats, the Foreign Secretary recalled him to the UK and dismissed him. That was a great injustice.
In many of the places I have visited, diplomats have told me of their frustration that the United Kingdom could and should be doing so much more if only our diplomatic services were properly resourced. The advantages are self-evident in terms of trade and in relation to human rights and progress. Recent reductions of British diplomatic presence in certain parts of the world give the unfair impression that we cannot be bothered any more. In his reply, I hope that the Minister will set our minds at rest that the coalition Government understand what has been said in this debate and will ensure that in future we have a properly resourced and active diplomacy.
My Lords, I am grateful for the suggestion that the Diplomatic Service be open to new ideas. While there is apprehension about the cuts, active diplomacy in certain areas can deliver mechanisms to achieve results with less. The way forward might be to recognise that the role of government in bilateral relations, and by extension diplomatic endeavours, should be to create the environment to allow all the sectors that make up those relations to thrive, and that the United Kingdom is essentially a private sector-driven economy and that it is not the role of government to deliver for the private sector a better structured public sector/private sector partnership, whether for the benefit of trade or for the myriad other benefits that make up relationships.
Much of this type of initiative could be self-funding, thereby freeing government financial resources. Has a full review taken place to consider how non-critical outsourcing could play a role in the diplomatic world? Consular activities have always seemed to be a natural candidate. The parallel-to-trade objectives of advocating the benefits of democratic principles—good governance, transparency and accountability, freedom of the press and human rights standards—could all be addressed in a similar manner by appropriate specialists in order to make diplomacy effective.
Resourcing diplomacy in the context of today's debate must also be about bolstering abstract diplomacy with concrete and figurative measures. Leaving aside the complexities of whether the ECGD could be privatised, for trade diplomacy to be successful three components must converge. The first is on-the-ground preparation by ambassadors and their staff. The second is the fullest engagement, at Secretary of State level and above, regularly to lead missions overseas and to leave more diary space for meeting incoming leaders in London. The third component—I declare an interest as I am on the advisory board of the newly formed Central Asia and South Caucasus Association at Asia House—is the formulation of a well-defined partnership between the UK's public and private sectors, made up of trade and industry councils and umbrella self-funding representative organisations. This structure could create cost savings and replace anything other than support in strategic emerging markets. The money saved could be used to resource more effectively overseas posts’ commercial endeavours, with the remainder moved over to the general Foreign Office budget.
I congratulate the Prime Minister on leading two recent successful missions to China and India. I also welcome the Foreign Secretary's initiation of policy reviews of relations with priority strategic countries such as Brazil and Turkey. However, these endeavours need to be replicated many times over. Leaders such as Chancellor Merkel and President Sarkozy regularly travel around the globe signing bilateral trade MOUs and cutting megadeals in out of the way places. Secretary of State Clinton has even been supporting American interests in Papua New Guinea, where I happened to be this week. It is a country of crucial strategic regional importance to the UK, but our diplomatic financial resource is close to zero.
My concluding thought is that the Minister might wish to look at more speedily matching to requirements the qualifications of FCO London-based staff. Diplomats often find themselves in the corporate pool on their return from overseas postings. This human resource should be put to more immediate use and not be left to stagnate.
My Lords, in requesting permission to speak in the gap, I should like to draw attention to the fact that in the past locally employed staff sometimes made major contributions to the work of an embassy. I recall, for example, travelling in Spain in the 1950s. The ambassadors, who were men of great distinction, had the benefit of the services of a former schoolmaster called Bernard Malley, who knew everything about the country in which he was serving. He had an honorary position and did not allow his loyalty to his Spanish friends to cause any difficulties with his loyalty to this country. He ended up with a CMG, which he greatly deserved. I believe that there was a similar person in Paris in the shape of Sir Charles Mendl. Malley in Madrid, however, was a wonderful example. I believe that in future we should consider this sort of appointment in many other countries than those that I have mentioned. For example, I recently went to a Latin American country where the only person who remembered the previous elections was the ambassador’s chauffeur. He was a very good source, although I am thinking of someone more distinguished.
My Lords, I, too, thank the noble Lord, Lord Hannay, for introducing this very timely debate today. The noble Lord has rendered the House two services: first, in his excellent speech he comprehensively and skilfully outlined the issues concerning a properly resourced and active Diplomatic Service; and, secondly, he has reminded us of the importance that we should attach to such proper resourcing by being the embodiment of active diplomacy himself.
I also add my congratulations to my noble friend Lord Monks. I thank him, too, for choosing a foreign policy debate for his powerful maiden speech. In another life, my noble friend and I used to sit around the same meeting tables, and I am happy to say that he has lost none of his highly persuasive and cogent powers of argument. He will be a huge asset to your Lordships’ House, as his speech today clearly demonstrated.
I begin by acknowledging that we on this side of the House know that all departments, including the FCO, must take some share of the impending cuts. As the G20 meeting in Seoul is acknowledging today, the international downturn is a global issue, in spite of what is sometimes said in our domestic politics. As a colleague of mine remarked to me in the Middle East a couple of weeks ago, the only countries unaffected are the ones that are not part of the global economy.
In looking at resourcing effective diplomacy in this country, I turned to the FCO’s business plan, in which the Foreign Secretary says that he has organised his department’s work with three overriding priorities: safeguarding Britain’s national security, building Britain’s prosperity, and supporting British nationals around the world through modern and efficient consular services. I say to the noble Lord, Lord Bates, that these bear a striking resemblance to the priorities that the late Robin Cook articulated when Labour came into office in 1997, proving that very often there is nothing new in foreign policy. To any sensible person, they must be the cornerstone of what the Foreign Office is there to do.
The Foreign Secretary also spoke of harnessing,
“the appeal of our culture and heritage to promote our values”,
including on human rights. I suspect that for many of us that is a bedrock point without which achieving security and prosperity on a sustainable long-term basis would be absolutely impossible, as my noble friend Lady Drake suggested.
I agree with the noble Lord, Lord Waverley, that the Government’s energy in relation to trade is very much to be welcomed, but I know that there is concern that the Foreign Secretary’s great emphasis on trade and investment runs the risk of undermining the FCO’s work on human rights. Amnesty International and Human Rights Watch have both warned us about that. Promoting human rights is not just right in its own terms; it is a matter of self-interest, too. Even countries where there is acute poverty see access to information and international communications as very obvious. Young people in all parts of the world have access to mobile phones and cameras, and of course televisions. They see injustice as it happens, and they see repression, the results of torture and the horror of innocent civilians caught up in warfare.
They have their own opinions about what is fair, just and decent. Working for human rights to protect those who cannot protect themselves is another hugely important factor in our efforts to maintain our security. It is part of how we develop our agenda on counterterrorism and counter-radicalisation. When I looked beyond the opening headlines in the business plan to see how the FCO would be maintaining and expanding its work on human rights, in the 24 pages that follow those opening headlines, the subject was not mentioned once. Can the Minister explain why not? How is that to be delivered if the business plan does not offer us a mechanism to do so?
One way in which the previous Government sought to deal with that kind of outreach, both at home and abroad, was through our support for the hajj. My noble friend Lord Patel has argued that the cut in support for British Muslim pilgrims is damaging. Like the noble Lord, Lord Sheikh, and my noble friend Lady Taylor, I strongly agree with him. I declare an interest, because it was on my watch as consular Minister that the hajj support was introduced. Apart from the huge cut to the much-valued services to thousands of British pilgrims every year, does the Minister not realise what an appallingly negative signal that sends to the very countries that the Foreign Office is trying to impress in increasing our trade?
Do Ministers really not understand that many countries in the Middle East want a rounded relationship with the United Kingdom? They want a partnership with mutual respect and mutual understanding. I hope that concentrating so hard on trade, as the Government are doing—which I understand and, in many ways, support—does not lead to some of our friends in the Arab world to feel that we are not engaging as we should in politics and in seeking their views on interfaith issues, on the peace process, on Iran, Turkey and Somalia, and on the many multilateral institutions. If we really want trade, we have to do politics properly. That is what marks a real partnership that respects opinions as well as wealth.
I agree with my noble friend Lord Anderson that at the heart of what we are discussing today is an active diplomacy, which means people. We need active diplomats, and they need to be spread around the globe. I notice that the FCO business plan says that we shall have an enhanced partnership with India and closer engagement—I am not quite sure how that is different—with China, Brazil and south-east Asia. We shall need diplomacy campaigns, apparently—can the Minister please tell us what those are? I see, too, that the education conferences launched under the Labour Government will go global to get more students into the UK. All of that needs people and resourcing. My concern is that the commitment to review the UK's bilateral relationships and to look at something that we are calling the overseas footprint is in fact code for shutting down embassies and consulates in countries in which we do not have huge commercial interests.
The noble Lords, Lord Hannay and Lord Janvrin, are right: shutting our embassies is simply not sensible, because events catch up with us and stuff happens. By the Government’s yardstick, it can backfire very badly commercially. As the noble Lord, Lord Hannay, emphasised, we need embassies to maintain our intelligence networks, for our security and to build confidence—and, yes, at a very basic level, to be ready for those commercial opportunities when they arise.
One of the passages in the business plan that I find most perplexing is what was said about consular services. The headline objective of supporting British nationals around the world is apparently to be achieved through cutting our consular services. Consular resources mean FCO staff being trained to deal with a huge variety of problems, from lost passports to natural disasters and terrorist outrages. It is hard, painstaking work, and sometimes it is heartbreaking.
In 1997, the consular services were the poor relation of the FCO, and when I was first a Minister, I was astonished that Ministers did not meet the victims of terrorism or the families of people who had been taken hostage. Officials were told to increase the numbers and provide a better service to the British public. Let us face it; most people in this country do not wake up in the morning wondering what is going to happen at an EU summit or the UN General Assembly. They are much more concerned if they cannot get consular help when they or their families need it abroad.
Let me turn to soft power. The noble Lords, Lord Parekh and Lord Hannay, emphasised its importance. The business plan states that there should be a strategy to enhance the impact of the UK contribution on conflict prevention by looking at the UK’s educational scholarships, but in a Written Statement from the FCO on 10 July, a £10 million cut was announced in this year’s programmes of scholarships. There are no Chevening scholarships in 2010-11. Soft power, so brilliantly described by the right reverend Prelate the Bishop of London, is an enormously important building block in reconciliation and outreach, and we cannot have soft power without good networks. It all comes down to people and relationships. Often, we need our good diplomats to undertake that sort of soft power, and to do so they have to be properly resourced.
The World Service and the British Council have also been mentioned. I agree passionately with what the noble Baroness, Lady Afshar, and my noble friend Lord Parekh said. The BBC World Service is a huge asset. It is envied by so many other countries, particularly the United States, Germany and France. It is trusted, it is editorially completely independent of government, and it has a huge reach that is unrivalled by that of any other country. The important point is that we distinguish between the editorial independence on the one side and the responsiveness of the UK’s national interest to talk to parts of the world that are so hard to reach otherwise. Similarly, the work of the British Council is the bedrock of our national interest. It is important that its functions are recognised and properly resourced because that allows us to have the contact in helping development in many countries in the world, particularly among young people and women.
To sum up, I was enormously pleased to have the business plan. It is very much to the Government’s credit that they have published it. It is a real mechanism for accountability. It will help us and give us a real opportunity to ask questions and to get the answers we need. I appreciate the Minister’s experience and his willingness to give answers to the questions that we pose—I sometimes wish that more of his colleagues followed his example—and I look forward to what he has to say.
My Lords, like other noble Lords, I begin by warmly congratulating the noble Lord, Lord Hannay, on initiating this interesting debate. He has enormous experience from his previous profession as one of our country’s leading diplomats. I also extend warm congratulations to the noble Lord, Lord Monks, on his maiden speech. He brought to our Chamber his vast experience in matters of organised labour and unions and tactfully applied that experience to the world of diplomacy in a kind and understanding way.
I shall start my comments in the limited time available by concentrating on the people, the diplomats. I start by paying tribute to the work of all our diplomats overseas and at home and our locally engaged staff, who number about 10,000 overseas in FCO posts worldwide. A third of UK-based diplomats working overseas are in hardship posts, and this debate comes only a few days before the seventh anniversary of the Istanbul bombing on 15 November 2003 when 11 colleagues lost their lives in the service of our country. As recent events in countries such as Yemen or Iceland have shown, those working on Britain’s behalf continue to do so in the face of terrorist threats as well as of natural disasters. This creates extremely difficult conditions, as noble Lords have been good enough to recognise. The safety of all our staff is paramount, and our spending settlement, which I shall come to in some detail in a moment, will allow us to invest sufficiently in our overseas estate and in the security and safety of the staff. We continue to seek to upgrade our posts to meet modern-day threats, particularly in high security environments. We expect to complete all outstanding high- and medium-risk security projects by the end of this year, and our spending-round settlement, as I shall explain, contains adequate provision to allow us to continue this work over the next few years.
I apologise if I am putting excessive emphasis on the threat from terrorism, but it is very serious. The threat arises because terrorists are empowered with new weapons technologies, as well as emanating from other non-state groups and cells. It represents the biggest danger to the safety of our staff today. The number of posts where we assess the terrorist threat to be critical or severe has increased threefold since 2006. The nature of the terrorist threat is constantly changing and indiscriminate, as we saw in the two attacks on our staff in Yemen earlier this year. Fortunately, our security procedures worked in both cases and there were no casualties. However, it is not just Yemen, as although it is the latest place where our staff face a high threat to their personal safety, there are also acute terrorist threats posed in other locations such as Iraq, Afghanistan and Pakistan. Moreover, the threat of violent crime on top of terrorism is also serious and growing. Over recent months, several of our staff and their families have been the victims of armed robberies. Overall, our diplomatic network is operating today with much higher threats to the personal safety of its staff. It is a testament to them and their families’ resilience that staff are ready to live and work with these risks. I wanted to put that on the record right at the beginning of my remarks in closing the debate.
I turn now to our objectives, which rightly have been discussed by a number of noble Lords on both sides of the House. The Government understand that to promote and safeguard Britain’s priorities, we must have a firm picture of what we want to achieve in a very fast-changing world. We must properly resource our diplomatic effort to make this vision a reality, and have a clear understanding of our national priorities and positioning in today’s global order that goes hand in hand with our internal sense of unity and purpose inside this nation. I have no doubts about that at all.
From the outset, this Government have brought a strategic basis to our overseas relations. The National Security Council was established as a centre of decision making on all international and national security issues. It oversaw the development of the National Security Strategy and the Strategic Defence and Security Review which, taken together, cement the position of the Foreign and Commonwealth Office at the centre of delivering the Government’s international priorities. The FCO played a lead role in setting the context for the National Security Strategy through its work on the changing threats and opportunities that the UK faces, and ensuring that the capabilities and structures set out in the Strategic Defence and Security Review were fit for the purposes required. I can tell your Lordships that the FCO will be instrumental in taking forward the strategic defence and security goals of tackling threats at source, bringing all of the UK Government’s influence to bear in order to achieve our objectives both at home and overseas, and working more closely with our key allies and partners, both old and new. The FCO will give the lead that allows foreign policy to be supported by other government departments.
As we have heard in the debate from the noble Baroness, the high-level foreign policy priorities have a lasting and enduring continuity. As she rightly says, they are to safeguard Britain’s security, to build Britain’s prosperity and to provide—which we will do—full and effective consular support to British nationals around the world. Those are the overarching objectives, and within them I want to discuss various policy issues.
First, however, I turn to the spending settlement itself and how it fits in with those overarching and broad objectives. After a lot of pessimism in the press and elsewhere about cuts at the Foreign Office and so on, the settlement we have secured is an extremely good one. Like everyone else, of course, we have to take our share of the austerity package because of the overriding need to cope with the budget deficit that certain people left behind that we have to clear up. That is our problem and we have to grapple with it.
The noble Lord, Lord Anderson, seems to have got the wrong end of the stick on this matter. The net outcome is not a 24 per cent cut but a 10 per cent cut in real-terms spread over four years—2.5 per cent a year. It works out as a flat cash settlement which, given some of the difficulties that have to be faced, is not a dramatic change. It gets better than that: we have secured the restoration of the foreign currency protection mechanism and we will move the BBC’s World Service funding over to the BBC in 18 months’ to two years’ time, which will take 14 per cent off our budget expenditure straightaway.
I do not know where the noble Lord gets that figure from. I shall talk in a moment about personnel, but what he has said does not fit with what I am about to say.
What I have said means two things. First, we are reversing the previous Government’s disastrous decision to abandon the foreign exchange protection which wiped overnight 10 per cent off FCO budgets—it was an appalling decision. We now have a major boost, with the restoration of that mechanism freeing us from exchange rate gyrations. I hope that the shadow Secretary of State in the other place, who was a Treasury Minister at the time of that terrible decision, now welcomes what we have done to put it right.
Secondly, the BBC World Service move will enhance its independence—I agree with the noble Lord, Lord Hannay, about that—and it gives the BBC, at the same time, a flat-rate licence fee. The objectives will still be set by the Foreign Secretary and his approval will be required for any language service closures. The BBC has given solid guarantees that it will safeguard the World Service and I am quite sure that will be done. Your Lordships raised worries about this issue, but the position is absolutely secured.
That is the story of our comprehensive spending review outcome and it does not match some of the gloom that has been perpetrated all around. Indeed, there is still more good news to come because, in addition, our budget is being reinforced by new funding from the Treasury—I emphasise from the Treasury—which recognises the increased development work that we are now promoting in line with OECD rules. It does not come from DfID; we are not draining funds from the increased DfID budget, which is very large. It is a subvention which for us, on our scale of expenditure, is of a very pleasant kind, to match the increased development work which is undertaken in the Foreign and Commonwealth Office.
Several noble Lords raised the issue of posts, closures and postings around the country. In the coming weeks we will take strategic decisions on how to live within the settlement I have described. They will not lead to the kind of conclusion the noble Lord, Lord Anderson, has suggested. Our decisions—including on what we do, what activity we stop or scale back and whether our network of posts adequately meets the new realities—will be taken; none has been taken yet. I concede that this might mean closing some subordinate posts and consolidating in some capitals. Equally, in emerging markets or countries critical to UK security, it might mean opening new posts. We need a global diplomatic network to help bring the UK economy back to long-term health. The skills and expertise of our staff are vital to delivering active diplomacy. The settlement will allow us to invest in our staff, create a renewed focus on international policy and high-priority languages, and ensure that our diplomats are economic ambassadors for Britain, as all your Lordships wish them to be. The noble Lord, Lord Lea of Crondall, asked for total staff figures. There are approximately 4,500 UK staff working at home and abroad, and 10,000 local staff, all overseas.
I turn to the other theme which ran through your Lordships’ debate: soft power; that is, the capability required to match the hard-power resources that we have to maintain as a nation. We have provided the means to resource properly our diplomatic work. However, that was not the only part of the Question of the noble Lord, Lord Hannay. He also called on the Government to ensure that our diplomacy would be active. We will certainly be so in the security, conflict prevention and peacekeeping fields. If we accept, as I certainly do, the notion that our prosperity provides the foundation for our power, we must seize the openings available to us. This means developing much deeper links with key centres of influence such as Japan, South Korea, Malaysia, South Africa, Brazil, Turkey, the Gulf States and particularly, as the Foreign Secretary and the Prime Minister have made clear several times, China and India.
China may be the new giant market, and one must not forget that Japan is often seen as our best and most reliable friend in Asia, but perhaps the best gateway to the great new markets of the world is the network that is the modern Commonwealth, as my noble friend Lord Sheikh rightly pointed to. Today’s Commonwealth embraces at least six of the world’s fastest growing economies and markets, providing access to emerging powers where wealth is accumulating and purchasing power soaring. Stretching across continents and faiths, and covering almost 2 billion citizens, it is a soft-power network par excellence which Britain needs to serve our interests in, and give us access to, the new global landscape—obviously, that is a matter of great interest to me personally.
Deepening our links with these countries will have multiple benefits for British citizens. We accept that diplomacy is no longer just a government-to-government business. We must and will engage all sectors of society as well as multilateral and regional bodies. Links forged through trade, education—my noble friend Lord Bates pointed to scholarships—culture, sport, science and an active global diplomatic network will help not only to secure our economic future but to guarantee our future peace and stability.
Where combined EU action works best, we will use it to the full—the noble Lord, Lord Hannay, made a very good point here. We see the European External Action Service as a useful additional tool for our common purposes in key areas, lightening and assisting our nationally resourced activities. My noble friend Lady Falkner made the same point.
Both the British Council and BBC World Service—on which I have touched already—will remain fundamentally important parts of Britain’s presence in the world.
All parts of the FCO family will have to contribute to the cuts in public spending. I am quite clear that they will have to face budget restraints. Details have already been published. The British Council plays an important role in helping spread the UK's culture and values, and its charitable status and ability to raise a significant part of its budget through commercial and full-cost recovery activities give it independence from HMG’s policies. I was enormously impressed the other day in Kuala Lumpur to see how the British Council runs its programmes, including intercultural dialogue and promoting the UK's creative and knowledge economy, which supports our foreign policy objectives. The settlement that we have secured protects that fully.
In the face of great uncertainties and novel challenges, we need to deploy this nation's talents and resources with new agility and skill.
I can give the noble Lord a comment on the hajj and will certainly do so, but it will take the last of my precious minutes.
When the hajj delegation was first conceived, local Saudi medical facilities were not of a standard that we would like to see. Since then, this situation has changed significantly. In the light of that, the Foreign and Commonwealth Office conducted an objective review of the delegation's medical element. The number of people treated for minor ailments was 5,967 in 2007, 2,965 in 2008 and 254 in 2009. I hope that helps my noble friend.
We will pave the way into emerging markets to ensure Britain’s prosperity and our security. We will deepen our engagement with the rising powers and wealth centres and the great new markets of the modern and transforming world. We will steadily uphold our belief in human rights, political freedom, open trade and poverty reduction wherever we can. To reply to the noble Baroness, Lady Symons, I see no conflict between that commitment and the commitment to our access into markets and our new commercial drive.
People say that the age of the Atlantic and the West is passing, but our own age certainly is not so far as the UK is concerned. On the contrary, I see huge new possibilities for this nation as the pattern of world power and wealth shifts. We will move forward on to this new stage by working more closely with our partners across the world, because that is good for our own national interest and for all our citizens. I am confident that the spending settlement set out for the four years ahead enables our diplomatic community, despite all the challenges it faces, to play a full and highly effective part in this national strategy. I believe that we can have a resourced and active diplomacy of the sort that the noble Lord, Lord Hannay, has wisely called for and we can do it with great effect.
My Lords, I thank all noble Lords who have contributed to this excellent debate. I have served long enough in your Lordships' House to know that it is not my place at this moment to mention everyone who spoke. If I did, I would be way outside the limits. I have also learnt that it is not wise to refer selectively, so I will simply congratulate the noble Lord, Lord Monks, on his maiden speech and say what pleasure it gave me personally to know that the UK permanent representation in Brussels is still the best team in town, as I hope it was when I left it 20 years ago.
One thing that startled me most about this debate was the absence of any reference to that phantom beloved by newspapers—the special relationship. Not one single Member who debated mentioned it. I do not say that as someone who believes that our relationship with the United States should be downplayed—quite the contrary—but I have fought all my life against what I call the false choice between Europe and the United States. Having a debate today in which we were able to look at the whole world in the round and not obsess and agonise about the special relationship shows a great deal of wisdom and a healthy approach.
On a final point, a lot of noble Lords spoke about realism. I am sure that we must have it, but we must not confuse it with that dreadful concept, declinism. There is no reason for us to think that we cannot look after our interests in the world we now live in, if we are ingenious about it and apply the resources we have in an effective way. I hope that when we talk about realism we will mean seizing new opportunities, not retreating into ourselves. I beg leave to withdraw the Motion in my name on the Order Paper.
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