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Grand Committee

Volume 765: debated on Thursday 22 October 2015

Grand Committee

Thursday, 22 October 2015.

Lyme Disease

Question for Short Debate

Asked by

To ask Her Majesty’s Government what action they are taking to combat Lyme disease and other tick-related illnesses.

My Lords, Lyme disease, or Lyme borreliosis, is an infectious disease transmitted to humans and other animals by bites from infected ticks, which are small blood-sucking arthropods related to spiders, and I can tell you that they are pretty nasty things. Ticks occur throughout the UK. They live on vegetation, particularly damp areas of vegetation such as bracken. They are found throughout the countryside but they also appear in towns—in parks and increasingly in suburban gardens—and they appear to be increasing in number.

Lyme disease can cause debilitating conditions, both acute and chronic. Basically, it can knock people out, producing symptoms similar to ME, migraines, neurological symptoms and persistent flu-like symptoms—symptoms both physical and mental—so it is pretty serious stuff. At the moment, the only test for Lyme disease is a blood test, which is not wholly reliable since it produces many false negatives. The levels of knowledge about this disease within the NHS are inadequate—some would say woefully inadequate.

I thank all noble Lords who have put their names down to speak. The noble Countess, Lady Mar, would very much have liked to be here, but she is poorly; I am sure that we all wish her well.

My interest in this disease came originally from outdoor activities—from a life spent mountaineering, walking and climbing. My interest in it was rekindled about a year ago by an article I read in Le Monde, which led me to put down a number of Written Questions last January, which I trust have been circulated by the Library. The point that I got from that article was that knowledge of Lyme disease is not only insufficient but very controversial in health services in different parts of the world. I pay tribute to Lyme Disease Action, a small charity, which provides assistance to people with Lyme symptoms and with Lyme disease. It also campaigns for improved services within the NHS and provides some extremely useful material, both in pamphlet form and on its website. Without its resources, I think we would be in an even more difficult position.

After I tabled this Question, I spent three weeks last June—skiving off, as they say—in the French Pyrenees, in the mountains. One morning, I woke up in bed to find this nasty creature burrowing deeply into my stomach. It was the first time that I had been head to head with a tick—or should I say her head and my belly?—and it was not a pleasant experience.

Too little is known about Lyme disease, and there is controversy over its incidence, its diagnosis, its treatment and the relative success of different treatments. There is also confusion because there are other tick-related diseases which we appear to know even less about than Lyme disease, and which we might well be talking about in this way in a few years’ time.

Things have been improving. The understanding and importance that the NHS gives to Lyme disease has improved in the past year or two. However, ticks are spreading; there is no doubt that there are more of them. The question is: can anything be done about that, or do we simply have to accept that it is part and parcel of the wildlife out there and we have to live with it?

Information and public education are not as good as they ought to be, although happily this debate coincides with quite a lot of publicity in the media about ticks and Lyme disease largely because a number of celebrities appear to have caught it. John Caudwell, the founder of Phones 4u—I confess that I have never heard of it before—and his family are running a campaign and other celebrities have been found to have this. So, this is causing a useful outbreak of publicity and one which I hope the Government will take advantage of.

I have one or two high-level questions for the Government. First, is it time for a major Government-sponsored inquiry into the growing incidence of ticks in the environment and tick-related diseases? It is not just the countryside—it is happening in people’s gardens. Secondly, is there a need to promote much better knowledge of ticks and Lyme disease among doctors, nurses and health professionals generally? I think it is obvious that there is a very great need for this. Certainly, an increasing number who know about these things, but there are many doctors whose knowledge is woefully inadequate.

Thirdly, what can be done to make the general public more aware? I am talking about the outdoor fraternity, organisations such as the Ramblers and the British Mountaineering Council—I declare an interest as a vice-president—as well as farmers, gardeners, and schools that take their children out into the countryside. There is scope for much better information and understanding out there. Lyme Disease Action has asked for five things to be done and I would like to put these on record and ask the Government for their response to them.

First, it stresses the need to find out how many people in the UK are infected and affected by Lyme disease. We need to know the true scale of the problem and, at the moment, we do not know that. There are something like 1,200 positive test results a year in the UK. The NHS believes the number of people infected with Lyme disease each year is about 3,000, but it might be a lot more. There is a lot of misdiagnosis. People are diagnosed with Lyme disease when they have something else and a lot of people who have Lyme disease, whether it is the immediate form or the chronic form, are not being diagnosed.

Secondly, there is a need for the NHS to acknowledge the uncertainties with diagnosis and treatment. There is a lot of anecdotal evidence of being people being told, frankly, nonsensical things. A classic case was somebody who was told they could not have Lyme disease because they lived in London. People are also being told that the tests are accurate and reliable, and they are not. Too many consultants are saying the blood tests are perfect and the treatment always works. Neither is true.

Thirdly, there needs to be a better working partnership between LDA and the NHS. One of my daughters’ partners has a lot of Lyme-type symptoms and has been passed from pillar to post by doctors, consultants and clinics in different places in North Yorkshire, where they live. The problem is that nobody is taking responsibility for sorting out what is wrong with that person. That is a typical experience in a lot of places.

Fourthly, guidance for UK health professionals needs to be developed, especially for those in secondary care. I am aware that Public Health England and NICE are working on this, but some interim guidance is needed urgently. Fifthly, regional centres of experience need to be established so that the burden does not all fall on one small charity.

I shall finish with a quote from LDA:

“The current level of knowledge is appalling. Doctors do not understand the tests, the epidemiology or the disease itself”.

I am impressed by the number of people who have been in contact with me since this question was tabled. I would love to read out a lot of what they say, but I have not got time. There is a serious problem. I look forward to the debate and to the Minister’s response.

My Lords, ticks are a tiny blood-sucking species which feed on animals including humans. They have been around a long time: they belong to the family of arthropods that began to evolve 500 million years ago. Despite this longevity, however, most of the UK population is still unaware of how nasty these little creatures can be.

Last month the London School of Hygiene and Tropical Medicine published its research into ticks to establish to what extent they carry the bacterial pathogen that causes Lyme disease. Its team of experts conducted research in south London parks, including Richmond Park, a nature reserve of some 2,360 acres. There they collected more than 1,100 ticks. A quarter of these were tested for the infectious pathogen and about 3% were found to be carriers. Their report, however, considers the potential risk to humans to be much more significant than the statistics might suggest, because almost all the infected ticks were found in open grassland in areas frequented by the huge number of visitors. According to a 2015 Ipsos MORI survey, Richmond Park receives 5.5 million visitors each year. It is no wonder that the London School of Hygiene has called upon the royal parks to encourage visitors to take preventive measures, by increasing public awareness.

However, this just is not happening—either in Richmond or elsewhere. I walk most days in Richmond Park and much work is done to keep it so beautiful. It has large herds of fallow and red deer, which are ideal tick hosts, but there is little information alerting people to the risks or suggesting what to look for, what to do and how to take sensible precautions, such as stay on paths, avoid dense vegetation, and cover arms and legs. I often see people and very young children with bare arms or legs walking through the dense ferns and long grass, and their parents are oblivious to the risk they face.

I suffered a tick bite, with its bullseye rash, a few weeks ago. My GP at the nearby Sheen Lane Surgery responded quickly and prescribed antibiotics. Other GPs may not be so alert, yet early diagnosis is key to preventing the disease progressing to more serious stages. Public Health England estimates that there are up to 3,000 new cases of Lyme disease in England and Wales each year. The British Society for Immunology confirms that cases have risen steadily, as they have in Europe. Apart from a rash, early symptoms can include fatigue, fever, and headache, y et there appears to be no consensus on the complexity of the disease or the many clinical outcomes that it can produce. The problem of observable clinical features is exacerbated by the difficulty in confirming a diagnosis. As Public Health England confirms, cases left unaddressed or belatedly treated with antibiotics can lead to very serious problems, such as Lyme arthritis, myocarditis, and meningitis.

Testing does not confirm the actual presence of the bacteria, simply the body’s immune reaction to having encountered that bacterium at some previous time. It takes several weeks for an infected person to produce the relevant antibodies, so an early test may produce a false negative result. Treatment by antibiotics can slow or stop the production of the key antibodies altogether. The charity Lyme Disease Action complains that many clinicians remain unaware of the extent of the limitations of laboratory investigations. Tests can help to confirm Lyme disease, but no blood test can completely rule it out. Yet some GPs treat test results as definitive.

The British Society for Immunology is right to call for the funding of further research to establish more accurate diagnostic tests. More research is also needed on the disease itself. No vaccine is available. Protecting against tick bites can help to prevent Lyme disease. Even if, like me, you take great precautions, you can still get bitten. This takes us back to the importance of greater public awareness and of information alerting people to the risk of tick bites, what to look for, what to do, and how to take sensible precautions.

My Lords, we should thank the noble Lord, Lord Greaves, for raising this issue. I think I am right in saying that this is the first time that it has been raised in Parliament. That would not be surprising because compared to other diseases it is relatively new, and so little is known about it still. The noble Lord, Lord Greaves, has highlighted the scale of the problem. My interest is not that of an expert. I must underline that point straight from the beginning. I am looking forward to hearing what the experts here have to say and, indeed, what the Minister has to say about this.

I speak as someone who knows a number of people who have Lyme disease, and I know how unpleasant it is. It is clearly very complex, as the noble Lord, Lord Greaves, has highlighted. It has spread to many parts of the United Kingdom. It is the largest tick-borne disease in the United Kingdom and it is also a serious problem elsewhere, including the United States and parts of the continent. It is a relatively new experience for us in this country.

To me, the key point made by the noble Lord, Lord Greaves, is the lack of knowledge on the parts of both the public and most of the medical profession. Indeed, it has been suggested that as far as the public are concerned, one in three people does not realise that they have a tick on them, or have had a tick. They would not know that they had this particular disease, or what caused the symptoms. We are told that earlier diagnosis and treatment is very important. If this can be achieved, the disease may still not be 100% safe but at least it is better than the second stage.

There are two areas where I would like to add to the points made by the noble Lord and ask the Minister to comment. The first is the position of the medical profession. As someone who campaigns on the issue of chronic pain, I have every sympathy with GPs, who very often are overwhelmed by pressure and demands. Here we are with another issue which we are asking them to pay attention to. Some of them probably never see, or have not yet seen, cases of Lyme disease themselves, so it is not surprising that many of them do not know much about it and may misdiagnose. I very much want to support Lyme Disease Action. The question of a regional service with specialist GPs was raised by the noble Lord, Lord Greaves. A regional service with specialist nurses and disease consultants could provide services and support for GPs in that region. Would that help the GPs to do their job more effectively? I would be interested to hear what the Minister has to say.

My second point has also been touched upon. How do we help those who are not diagnosed early enough, or who for the reasons we have already discussed have fallen through the net and received no treatment whatever? We do not know how many are in this category, and I hope that more information will be made available in due course. We have already heard about the kind of symptoms that people face when they have had this disease for some time: flu-like symptoms, persistent fatigue, pain, and impaired memory. People can be affected for a large part of their life, or for many years. Indeed, they may lose their job—it is that serious. It seems to me that the great uncertainty is what is the most effective diagnosis and treatment for those who are suffering from this in the longer term. We ought to acknowledge the work of the Public Health England Porton Down laboratories, which provide specialist expertise in Ebola and Lyme disease. We should not underestimate what they do for us.

There seems to be a considerable dispute as to whether chronic and persistent Lyme disease actually exists at all. I know that some doctors can be dismissive of the idea and dismiss people with the symptoms we have been talking about. They quite often lash around spending money on researching what to do about the symptoms, perhaps without realising that it is Lyme disease, thus incurring quite a lot of expenditure for the National Health Service. I look forward to hearing from the Minister on that issue as well. Could we fund extensive research in order to find out more about it?

My Lords, I thank the noble Lord, Lord Greaves, for this short debate alerting your Lordships to a topical issue. Last Thursday, the Evening Standard had a double page headed, “The Ticking Lyme Bomb”, and yesterday the Daily Mail had a large article entitled, “So what IS the truth about the Lyme disease ‘epidemic’?”. I come from North Yorkshire, which is one of the areas listed as having a particularly high population of ticks. Lyme disease is transmitted by the bite of a tick affected with Borrelia burgdorferi bacteria. Ticks do not jump or fly but climb on clothes or skin. The bite does not itch or hurt, so the tick can remain on the skin for longer than 24 hours, which is dangerous.

Gamekeepers who walk in heather and bracken are always well protected as they are dressed in thick tweed plus-fours and jackets, thick stockings and boots, but nowadays I see more and more people running in shorts, sometimes with no socks, or having picnics in parks in hot weather wearing little clothing. Could this be a reason for the increase in tick bites? I know of a woman from the Czech Republic who got a tick bite picking mushrooms in a forest. She got a rash and went straight to her doctor. She was given the appropriate antibiotics and did not develop the problems which can be associated with Lyme disease. Can the Minister tell us whether enough people know what to do when bitten?

I am told there are three vaccines for dogs but none for humans. How much research is taking place? Are we sharing research with other European countries, Canada and the USA that have the problem? The Health Protection Agency is very important. Can the Minister tell the Committee what research is being undertaken into complications resulting in long-term damage to the nervous system, joints and heart issue? Could there be any danger of Lyme disease being passed on by body fluids, such as infected sexual fluid which is lingering on and being found in people with Ebola?

Now the problems have been highlighted, results should be made public and help should be made available for those who need it. I hope this debate will help to make more people aware of what infected ticks can do.

My Lords, I thank the noble Lord, Lord Greaves, for introducing this debate and for his continued commitment to bringing this complex disease to our attention. As we have heard, many of us know someone or of someone who has experienced the distressing symptoms of Lyme disease. That is certainly what sparked my interest in the topic. The high public profile of some sufferers has meant that their stories and the controversies surrounding the disease have been widely reported in recent weeks.

Lyme disease has been in the UK since the late 1970s, but over the past decade cases of the disease have quadrupled. Public Health England suggests that there are some 3,000 new cases each year, although others put the figure much higher. We know the disease is transmitted by infected ticks, often on deer and mice, and they like grassland and leafy areas, so we are at risk whether we are walking on the Yorkshire moors or in London’s deer parks.

Lyme disease is on the increase across the UK, yet it is not diagnosed easily and there is a lack of adequate treatment. A common thread of the many cases we read about is that the doctors know very little about Lyme disease or have ruled out the diagnosis. Perhaps that is not surprising, given how new the disease is to the UK. Many doctors will simply never have come across a case. However, there is also division within the medical community on just about every aspect of this disease. Some think it is rare and easy to treat with a few weeks’ of antibiotics and that there is no such thing as long-term Lyme disease; others believe that it is becoming more prevalent and is much more difficult to treat than previously suggested, and that it can lead to severe chronic illness. Medical opinion in the UK has tended to the former view.

One complication is that symptoms can vary; not everyone bitten by an infected tick will display the so-called bull’s-eye rash. If this is the case, then what the doctor sees could be just a range of flu-like, non-specific symptoms, such as tiredness, muscle and joint pain, headaches, fever and chills, before more serious neurological or heart problems develop much later. Reliance on a diagnosis has almost exclusively rested on the blood test which detects antibodies to the disease. Yet these tests, as again we have heard, are too often inaccurate or unreliable, and even if antibiotics are prescribed the dose may not be strong enough, or the course long enough, to deal with the Lyme bacteria. UK cautiousness about overprescription of antibiotics is blamed for this.

It is good news that US researchers are making progress on developing a vaccine-like treatment, which would provide immediate protection against Lyme disease for the six months when the ticks are active. But until that emerges, the only way in which to prevent the disease is to avoid getting bitten. So it is vital that people are shown what they can do to protect themselves, and that GPs are given more information about the growing prevalence of the disease.

I am encouraged that the charity Lyme Disease Action and the Public Health England Lyme disease reference laboratory are now able to work together on difficult cases and equivocal test results. But more GPs need to be made aware of the testing facilities and expertise at the Government’s Porton Down laboratories. Public Health England currently recommends guidelines published by the Infectious Diseases Society of America, but we need UK and European guidelines to provide GPs with the full range of scientific evidence and medical opinion available. So will the Minister, on behalf of the Government, ask Public Health England to produce national guidance? We also need better diagnostic tests, more surveillance and more information about the scale of the problem. Can the Minister tell us what consideration is being given to whether Lyme disease should be given notifiable status by medical practitioners? Until we have greater GP and public awareness, more testing and earlier diagnoses, we will continue to have more chronic, life-changing cases of this complicated disease.

My Lords, I thank the noble Lord, Lord Greaves, for introducing this debate and I have pleasure in contributing to it. First, I want to talk about personal experience. My wife, Helen, whose chosen full-time occupation would be gardening, is continuously bitten by these things and is always pulling them out using sharp tweezers, except for the places that she cannot reach, in which case she has to wait until I get home. The year before last she had a tick bite and removed it. Unfortunately, a week or so later she developed some symptoms when I was not there—I was away. Fortunately, our resident young doctor, the partner of my son, realised that, having pulled out a tick a few days earlier, the symptoms could well have been those of Lyme disease. She found a GP and suggested that Lyme disease be considered as a possible diagnosis. The GP prescribed antibiotics and my wife was fine. However, it is a nasty disease if not treated properly.

Diagnosis is based on the so-called classical bull’s-eye rash, although it does not occur every time; nor can you find the tick on each occasion. Diagnosis can also be made through blood tests; the first is an antibody test. Antibodies do not develop until the bacteria have been in action for a while and the body responds to them—hence, if the initial test is made too early, it often gives a false negative. Another test is the Western blot test, which is much more reliable but has to be done much later. If you wait for that test without treatment, the question is whether the treatment is likely to be less satisfactory, particularly if the bacteria have progressed—because the disease is caused not by the tick but by the Borrelia bacteria. The vector is the tick but the primary reservoir is not the tick; it is either a mouse or other rodent, and it is carried by other mammals such as deer or even dogs, although they do not get infected. When the tick sucks blood from your body, the bacteria are transmitted. If while removing the tick you crush it or try to burn it off, the bacteria will spread and get into your blood, where it causes the different symptoms of the disease.

There are two aspects to this, one of which is prevention. In prevention, the key factor is that those who are likely to be exposed to the risk of tick bites should be aware of that and take precautions to avoid being bitten, which includes wearing clothing that may be impregnated with something like DEET, which is a powerful insecticide. The other is the need for heightened awareness among health workers of the likelihood of a diagnosis of Lyme disease. It is easy to diagnose when the patient has a history of a tick bite and there is a rash. However, while the guidance produced by NICE, which was revised in February 2015, is good, where I differ from it is that the guidance states that if you do not have a rash and there is no sign of a tick bite, antibiotics should not be prescribed. I think that if there is a history of a tick bite and the symptoms fit with those of Lyme disease, treatment with antibiotics should begin. If it is not treated early, the antibiotic treatment has to go on for a long period. Once the bacteria get into the spinal fluid or the nervous system, the disease is difficult to treat.

So the key issues are prevention and heightened public awareness, along with the need for greater awareness among health workers. They should think about Lyme disease if there is a history of tick bite and the patient presents with symptoms which, while they may seem flu-like, typically progress to other symptoms. Those are the key points which are reported. Why is it called Lyme disease? Because it started in a small town called Lyme in Connecticut.

My Lords, I too thank the noble Lord, Lord Greaves, for bringing forward this timely debate. As someone who for much of their professional life has researched and taught on tick-borne diseases, I never imagined that I would be speaking on this subject in your Lordships’ House, but I would say that my students might have preferred it had my lectures been limited to four minutes, as are today’s contributions. I may be the only person here who has actually been to Lyme. During a road trip down the eastern seaboard of the US some years ago, I dragged my wife on a detour to visit the lovely New England village of Lyme in Connecticut with white clapboard houses. It is where, in the 1970s, the first outbreak of the disease was thoroughly investigated, which led to the discovery of the causal organism and much of the characterisation of the disease. However, the first important point to appreciate is that this is not a new disease. The characteristic skin lesion was first described as far back as 1909.

Looking at the data from Public Health England, it is not clear whether there has been a big change in incidence, but there is certainly a big increase in concern. There is certainly some evidence of increased distribution and abundance of the tick vector, Ixodes ricinus, and in recent years we have seen an increase in the number of wild animal hosts, particularly deer and game birds, both of which are extremely good hosts for ticks. There is also an increase in human contact with ticks, not only in rural areas but also in peri-urban and suburban areas.

As I say, it is well known that deer are excellent hosts for the tick. Like the noble Lord, Lord Patel, I live in Perthshire and I regularly have to pick ticks off myself that I contract in the garden, which is frequently visited by deer. But—this is an important point—the ticks are almost always at the larval stage; they are tiny, pinhead-sized larvae which do not transmit Lyme disease. It is during the larger nymphal and adult stages when the disease is transmitted, and these ticks are much less abundant than the larvae.

There are risks, but I would like to make the point that it would be a tragedy if people were dissuaded from enjoying the great benefits of the outdoors for fear of Lyme disease. Having said that, there is no doubt that it is a severe and debilitating disease if it is not diagnosed and treated early. In the absence of a vaccine for humans, I suggest that the key to controlling it, as has been said by a number of noble Lords, is to ensure that GPs are aware of the threat and are thus able to instigate early diagnosis and treatment.

It is a fact that in western medicine GP training in zoonotic infections and parasitic diseases is very limited. That is for understandable reasons, and I am fully aware of the pressures on curriculum time in our undergraduate medical courses. None the less, what are the Government doing to encourage awareness among GPs of tick-borne infections? This is of course a matter for continuing professional development but there is also a role for the state, which bears the costs of undiagnosed and misdiagnosed cases that lead to severe and chronic disease.

Lyme disease is a good example of the “one health” concept, which recognises the connectivity between human and animal health, and indeed plant and environmental health. It is a concept embraced well by vets but, I suggest, is understood much less by our hard-pressed GPs. Pathogens do not recognise differences between humans and animals. With regard to zoonotic infections, those infections specifically transmitted between animals and humans and vice versa, such as the agent of Lyme disease, we need to ensure that our GPs are adequately aware of the hazards. That way we can prevent serious illness in people and reduce burdens on the hard-pressed NHS.

I add my thanks to the noble Lord, Lord Greaves, for calling this important debate. It is clear that cases of Lyme disease are increasing across Europe. As someone who, like the noble Lord, Lord Trees, is passionate about the countryside and encourages people to go out and enjoy it, I think we need to address the problems that this disease is causing but in a way that does not stop people going out and getting the health-giving benefits of being in the countryside. The noble Lord, Lord Greaves, is right to focus on the need for better understanding of the level of the disease, as many noble Lords have said, on the necessary improvements in diagnosis and testing, and on the critical importance of some speed in getting clear guidance for our health professionals.

I come to this debate today, with the short time allotted to us, to make one point, which was first raised by the noble Baroness, Lady Drake: the need for far better public awareness of this issue. In looking into the research for this debate over the weekend, I was at the same time packing my eldest daughter’s kitbag for her Duke of Edinburgh award. She was off to the South Downs. Like the noble Baroness, Lady Masham, I was looking at the lists of where the most infected ticks are: it is not just North Yorkshire but also the South Downs. I asked my daughter, as we were packing an increasingly large amount of kit into her bag, what she would do if she encountered a tick. My daughter is a fairly intelligent 15 year-old but she had no idea what to do. I asked her whether they had talked about it in her D of E training but they had not. When I went back through the information that I had been sent—you get voluminous lists of kit that you as a parent need to provide—there was nothing about ticks. We were sending off these girls for two nights and three days on the South Downs, and not one of them would have known what to do.

The great thing about the Duke of Edinburgh scheme is that it gets our children out into the countryside and teaches them great skills of leadership; it is growing, which means more children are taking part, and that is to be encouraged. However, it is quite clear that it has no engagement with a fundamental problem that these young adults, who are going to be the young parents and young leaders of the future, might encounter. It strikes me that we need to address that, and I urgently ask the Minister to talk to Public Health England about what it is doing to encourage greater public awareness, looking particularly at organisations. The noble Lord, Lord Greaves, mentioned organisations such as Ramblers; I would add the Duke of Edinburgh scheme, given the number of children going out into areas that might be affected.

It amazed me, when I was looking through the fantastic pack that the Library has provided, to find that there is the Big Tick campaign. I thought, “Fantastic! Someone is doing something”—and it is the vets. They have a high-profile celebrity, Chris Packham; they have a very good website; and they have resources going out to the veterinary profession that are then being cascaded down to pet owners, telling them all about the dangers. There is nothing with an equivalent status for parents. So while I applaud the work of LDA, which does a good job on very limited charitable resources, it is time, given the scale of this problem, that we did more on this subject and had far better public awareness.

My Lords, I, too, welcome the initiative of the noble Lord, Lord Greaves, in securing this debate, which we hope will play a helpful role in raising awareness and understanding about Lyme disease and facilitate the real progress and action that is obviously needed. Although we are talking about a relatively small patient population, it is important to underline that cases of the disease have quadrupled over the past 12 years, taking into account the latest NHS data and the fact that, as we have heard, many cases are not formally diagnosed or clear up without any treatment. It has been a comprehensive and expert debate and I look forward to the response from the Minister on the number of issues that have been raised. I do not intend to repeat them.

I also pay tribute to the work of Lyme Disease Action. Its developing work and improving relationship with the Department of Health and Public Health England is a sign of hope for the future and is to be welcomed and commended, as is its partnership with the Royal College of General Practitioners in working on, for example, online training for GPs. In particular, LDA’s help desk for patients and medics, helping to document cases, including test information, talking to laboratories about test results and offering GPs a conversation with the medical director, has led to the successful treatment of patients. Surely it is a model that needs to be taken forward across the NHS as it uses the expertise and knowledge built up by the LDA over many years and, if more widely adopted, would go some way towards addressing the lack of awareness about Lyme disease among many GPs and hospital doctors.

As we have heard, early treatment of Lyme disease is almost always successful but the best treatment in late-diagnosed cases is unknown and the resulting disability can become very severe and lasting with, frustratingly, no consensus on approach or treatment. I recently watched a DVD from the charity Canine Partners which showed how an assistance dog helped and supported a wonderful woman called Sue, who was diagnosed with Lyme disease 17 years ago and has suffered chronic fatigue, painful and stiff joints and muscle and back pain since then. I watched it because my partner had a major stroke seven years ago and he has an assistance dog, so I know first hand how helpful and vital assistance dogs can be for people with disabilities in supporting their independence. It would be good if we could all see that DVD now because it underlines the terrible cruelty of the disease for patients in the chronic state. Sue’s assistance dog is trained to wake her up in the morning because her extreme fatigue means that she has no time awareness of how long she has been sleeping; and, if she needs to rest during the day, the assistance dog is trained to keep an eye on her. It supports her in so many ways—by passing clothes to her for dressing, picking up the phone and so on. It is very good to watch that DVD, which shows the impact this terrible disease can have.

Noble Lords have commented on recent press coverage. One of the articles I read as background to this debate commented that,

“few diseases have aroused more emotional attention in the press and the public than Lyme disease”.

We saw this in the recent publicity, with the all main problems identified: the ongoing problems with diagnosis; patients going to private clinics for tests or travelling abroad to seek tests not available in the UK, or desperately searching for countries with greater knowledge and expertise on the disease than in the UK; and the firm conviction by patients that the disease can be transferred from human to human despite the strong scientific evidence so far that it cannot. These patients all felt that treatment for the disease had not worked for them and that is important. The major themes of this debate are about the overwhelming need for more data and research and I look forward to the Minister’s response on that.

On the issue of guidance for UK health professionals, I understand that there is a general acceptance by both PHE and LDA of a need for guidance for health professionals covering secondary care in particular. What discussions has the Department of Health had with PHE and NICE on this and can the Minister commit to ensuring that a work programme and timetable for such guidelines is produced in the near future?

I was interested to learn from someone who has a particular interest in the provision of specialised care—I do not have time to say why—that paediatric Lyme disease is within the scope of specialised commissioning whereas adult Lyme disease appears not to be. Can the Minister shed any light on the background and reasoning behind this situation and agree to look into the matter?

My Lords, I echo other noble Lords in thanking the noble Lord, Lord Greaves, for raising this important issue. I, too, have read a lot in the media over the past two or three weeks; that has been good in raising awareness of the whole issue, and I hope that this debate today will also do so. A big theme in the contributions from noble Lords has been the need to raise awareness, not just with the public but with GPs and clinicians.

I seem to be almost the only person in this room who has not had—if I may put it this way—a head-to-head relationship with a tick, but I can imagine that it was not a happy occasion for the noble Lord, Lord Greaves, or for others.

The briefing by the Lyme Disease Action group was excellent. It was measured, well-informed and very constructive, so I thank the group. Secondly, I know that Dr Tim Brooks, the head of the Rare and Imported Pathogens Laboratory at PHE at Porton Down, is very happy to meet with noble Lords or others who are interested outside the Chamber to discuss this in more detail.

I would like to deal with two issues before I talk more generally about the importance of awareness, treatment and research. First, the noble Lord, Lord Greaves, raised the issue of a national inquiry. I do not think that we will go down that route at this stage. Secondly, on the point raised by the noble Lord, Lord Patel, about the NICE guidelines on how early we should start treatment with antibiotics, I will take that up separately with NICE.

We recognise that Lyme disease is overwhelmingly the most important tick-borne infection in the UK, and we are aware that its incidence has risen severalfold over the past couple of decades. Even so, the UK has a much lower incidence of tick-borne diseases than the rest of Europe or North America—indeed, I believe it was in Lyme in New England where it was originally discovered. Many of the more deadly diseases do not occur here at all. However, as noble Lords have mentioned, Lyme disease can be acquired almost across the country now—in Richmond Park or in North Yorkshire. Therefore, it is important that doctors across the country can recognise the features of these diseases even if the patient lives in an area not hitherto associated with Lyme disease.

I will talk first about public awareness, an issue that all noble Lords have raised, particularly the noble Baroness, Lady Parminter; she described her daughter going off on a Duke of Edinburgh’s Award trip, which is a good illustration of the need for public awareness. To raise awareness among the public, the first line of attack should be on the tick. Public Health England is working with Liverpool University and others to survey tick populations and the organisms they host to determine risk areas across the UK. PHE, the charity Lyme Disease Action and various local councils and national park authorities produce public information leaflets on how people can protect themselves against tick bites and on what to do after a tick bite. Noble Lords might like to look on NHS Choices, for example, where they can see what a tick bite looks like, and if anyone would like any materials on this horrible disease, I would be very happy to distribute them later.

Early diagnosis and treatment of Lyme disease is the best way of limiting complications once a patient has been infected. GPs are, of course, at the front line of this. NICE and Lyme Disease Action produce guidance and training modules for GPs, and PHE has a helpline for doctors, as well as running GP training days. Specialist doctors have access to the literature on Lyme disease and are trained in the recognition and management of the disease within their higher professional training and continuous professional development. There is clearly much more that we can and should do in raising awareness. Of course, one of the difficulties is that many GPs never—or very rarely—come across a case of Lyme disease. Nevertheless, we can and must do more to raise awareness. That is possibly the most important thing that we should be doing.

Public Health England has a long and distinguished history of diagnosing infectious disease and developing tests for this purpose. A key principle is that the test should be able to recognise true cases of the disease and distinguish it from other conditions that might cause the same symptoms.

In Lyme disease, current tests rely on finding the organism, which is rarely present in the blood and so it would be looked for in tissue samples taken by a biopsy. This is impractical in general practice and, of course, not popular with patients. Rather than finding the organism, looking for the antibody response is the most productive diagnosis. The body produces the antibodies as it tries to clear the infection. If a patient is treated early, there will be insufficient antibodies in the blood so the test will also be negative. Tests taken early in infection, before enough antibodies have been made, also will be negative. Therefore, doctors should be aware that if symptoms persist a second sample should be taken at a later date when the antibodies have developed.

There is a routine test used by PHE of a commercial product used by many other national laboratories across Europe. Through an international, external, quality assurance scheme, the performance of these tests is compared regularly against more than 70 other state laboratories in Europe and meets the current high standard. Tests used by private laboratories may not be subjected to the same rigorous quality control and I think this is an important issue that has been obscured in some of the reporting by the media. There is no requirement for these labs to demonstrate the evidence base for their test and some tests inevitably will give a very high rate of false positive results. This is why some GPs and infectious disease specialists frequently will not accept test results from independent laboratories because they wish to avoid unnecessary or inappropriate treatment. Of course, I can totally understand how frustrating and upsetting that is for individual patients. PHE recognises limitations in the present tests, especially in early disease and in the subset of complicated cases, and is working with national and international partners to develop and evaluate new testing methods. It is a complex disease, it is a difficult disease and I do not think we will be doing ourselves any favours if we try to oversimplify it.

Turning to treatment, oral antibiotics are the mainstay of treatment for Lyme disease and are successful in the majority of cases. Of course, the earlier that the bite or disease is treated, by and large, the better. However, it is becoming increasingly apparent that in complicated disease, especially where there are significant neurological symptoms, more than one course of antibiotics may be needed and a course of intravenous antibiotics may sometimes be indicated. PHE has published a referral pathway for GPs to follow to ensure that problem cases are seen by appropriate NHS specialists.

Some patients suffer debilitating illness with symptoms that persist after treatment for several months or longer. What therapy is appropriate for these patients depends on whether symptoms are a function of persisting pathogen or a legacy of damage that the pathogen has left behind. More research is needed to identify the basis of these persistent symptoms and define effective treatments. As the symptoms may be non-specific, a key part of management is a careful investigation to ensure that other serious conditions are limited. I am reminded by a question this week in the House of Lords about post-polio syndrome. It seemed to raise very similar issues.

Patients need to have access to physicians with an interest in Lyme disease. Since the disease can be present in many different ways and can be confused with other more life-threatening conditions, in future this could be best done by establishing a network of interested NHS practitioners across the country with multidisciplinary experience. This issue was raised by a number of noble Lords and clearly is important.

On research, PHE has a long track record in infectious disease research both through its laboratories at Porton Down and in partnership with universities and international groups. This provides PHE with deep background knowledge and specific expertise and techniques. With the University of Liverpool, PHE is looking at new markers of Lyme disease infection and this is supplemented by work in the Czech Republic to evaluate potential test methods at different stages of disease by accessing a large clinic with a high throughput of Lyme patients. PHE is also exploring new concepts for both diagnosis and treatment through its relationships in the United States. Having a network of interested professionals across the country will enable further clinical studies to be undertaken if funding can be secured. Funding is clearly going to be extremely tight within the NHS. If we could secure funding from private sources as well, that would be a very sensible way forward.

This has been a very good debate. Just having the debate itself helps raise public awareness. A lot is being done but clearly there is a lot more that needs to be done. I reiterate the offer from PHE that if noble Lords would like a more detailed discussion with it, perhaps along the same lines as the discussion the noble Countess, Lady Mar, had at Porton Down with members of Lyme Disease Action, we are very happy to organise that.

Before the Minister sits down, will he comment on the suggestion that the pressure on the small charity LDA to provide help and advice in individual cases might be lessened by some sort of regional organisation: clinics, groups of GPs or whatever?

I think I mentioned that the intention is to have people with specialist knowledge of Lyme disease around the country. We feel that that would be a better approach than having a single centre.

Sitting suspended.

Universal Declaration on Human Rights: Article 18

Question for Short Debate

Asked by

To ask Her Majesty’s Government what steps they are taking, if any, to promote Article 18 of the 1948 Universal Declaration on Human Rights.

My Lords, today’s short debate enables us to return to issues raised on 24 July, when we last debated Article 18. I am grateful to all noble Lords for participating, and especially to the noble Baroness who will reply.

The gravity of the situation is underlined by events over the last few days. Following the beheading of a group of Eritrean Christians and the execution of Assyrian Christians, last weekend Islamic State in Libya released a video showing the beheading of a Christian from South Sudan. That ideological hatred of difference is driving on a systematic campaign of deportation and exodus, degrading treatment, including sexual violence, enslavement, barbaric executions, and attempts to destroy all history and culture and beliefs that are not their own. Pope Francis has described these events as a genocide of Christians, and many others of course suffer too.

At last week’s launch of Persecuted and Forgotten?, a report by the charity Aid to the Church in Need, on whose board I serve, we heard from the Archbishop of Aleppo. We learnt of other executions on 6 October in a village outside Aleppo, including a 12 year-old child. When his father refused to renounce his faith, ISIS tortured the child, with two other Christians, and crucified them to death. In an attempt to force his father to convert, the boy had his fingertips cut off. Their bodies were left hanging on crosses for two days under signs reading “Infidels”. If that is not genocide, what is?

In the same week, another 20 people were killed for refusing to convert to Islam, including two women. The 29 year-old and 33 year-old women were first brutally raped. Eight of the captives were beheaded. That is of a piece with the violent assault on the Yazidis. A former Yazidi MP told parliamentarians that 3,000 Yazidi girls are still in Daesh hands, suffering rape and abuse. She said:

“The Yazidi people are going through mass murder. The objective is their annihilation ... 500 young children have been captured, being trained as killing machines, to fight their own people. This is a genocide and the international community should say so”.

In a message read out at the launch of that report, the Prime Minister, the right honourable David Cameron MP, said:

“No believer should have to live in fear … Now is not the time for silence. We must stand together and fight for a world where no one is persecuted because of what they believe”.

And outright persecution there is. Since the beginning of the war in Syria, it is estimated that the number of Christians has fallen from about 1.5 million in 2003 to maybe fewer than 200,000 today. This is a genocide that dares not speak its name, and I ask the Minister when our Government will join with Pope Francis and others and name it for what it is. Either there is a genocide under way or there is not; either there is worldwide persecution of Christians or there is not; either someone is being killed, imprisoned or tortured every few minutes for reasons of faith or belief, or they are not. If we accept the evidence that they are, why are the resources which we devote to these issues, and the priority which we give them, so pitifully inadequate?

In our debate in July, I was critical of the Foreign Office’s failure to increase the one full-time desk officer wholly dedicated to freedom of religion or belief. Since then I have been troubled by exchanges in the House of Commons Foreign Affairs Select Committee about the importance that the Foreign Office attaches to human rights. Sir Simon McDonald, Permanent Under-Secretary at the Foreign and Commonwealth Office, was reported as saying that “although it”—that is, human rights—

“is one of the things we follow, it is not one of our top priorities”,

adding that,

“right now the prosperity agenda is further up the list”,

a remark which Crispin Blunt MP, the committee’s chairman, rightly said would cause concern.

That worrying exchange comes on the back of the Foreign Secretary’s admission that the department’s annual human rights report is being drastically cut back. The prosperity agenda and the lives and fundamental freedoms of people must never be part of a cynical trade-off. In former times, that sort of thinking justified the commercial interests of the slave trade and the opium wars.

Two days ago, I chaired a hearing on Eritrea. Witnesses cited a United Nations report which concludes that the Afwerki regime’s tyranny probably constitutes “crimes against humanity”. We were told of deaths, torture, arbitrary detentions, enforced disappearances, indefinite military conscription, forced labour and, as we heard on Tuesday, persecution of religious believers. The country’s population is haemorrhaging as those who are able to do so try to escape.

Every month up to 5,000 people leave Eritrea. More than 350,000 have done so so far—around 10% of the entire population. Forty-six per cent of those who try to make the perilous Mediterranean crossing from Libya come from either Eritrea or Syria. Therefore, unless we tackle the root causes of the exodus, including fearful violations of Article 18, we are never going to see an end to the refugee crisis. I will just say in parenthesis that many of those who have tried to escape are outside refugee camps, which I hope we will take into account in selecting refugees for resettlement.

Article 18 and human rights violations are inextricably linked to the catastrophic movement of populations, to refugee policies and to issues such as the development aid that Governments such as our own pursue. How is the European Union aid package of $300 million to the Eritrean regime or the £405 million of UK aid this year to Pakistan—£1.17 billion since 2011—being used? Is it used to leverage fundamental Article 18 reforms or to help those who are persecuted? A mob of 1,200 people in Pakistan recently forced two children to watch as their Christian parents were burned alive. Pakistan has imposed a death penalty on a mother of five, Asia Bibi, for so-called blasphemy; it has still not brought to justice the murderers of Shahbaz Bhatti, the country’s Minister for Minorities; and it is a country where churchgoers have been murdered in their pews and different minorities—Shias, Ahmadis and Christians—have experienced discrimination and outright persecution. While Pakistan has been receiving vast sums of money, the response of the state has been at best indifference, and at worst, the complicity of some of its agencies.

In September, after visiting Burmese refugee camps I went to the detention centre in Bangkok, a city which the UNHCR says more than 11,900 Pakistani Christians have fled to. Over two days, I took evidence from escapees. One witness recounted how his friend Basil, a pastor’s son, was targeted by Islamists attempting to convert him. After Basil reminded them that there should be no compulsion in religion, they set fire to his home, and he, his wife and daughter, aged 18 months, were burned alive. Following their deaths the assailants turned their attention to his friend, who was attacked and beaten. After reporting this to the police, instead of protecting him and bringing to justice those who had been responsible for those deaths, the police informed the assailants, who told him they would kill him. He, his wife and his little girl fled the country and, after arriving in Thailand in 2014, applied for asylum. They have been told by the UNHCR that they will be interviewed in 2018. It could then be a further two years before they are resettled. Only 400 cases have been processed so far this year. This is an intolerable delay. Meanwhile, he and his wife and child live in fear of being arrested and incarcerated in the detention facilities, where they would be separated into segregated cells, sharing a space of 18 feet by 36 feet with up to 100 other prisoners, including children. Witnesses told me that detainees have devised a rota to enable half the inmates in these cells to sleep at night and the other half to sleep by day. As one witness told me:

“We just lie side by side, including our children … force-fed poultry in battery farms are treated better and in more humane conditions than these”.

This is an international scandal.

When I met the UNHCR, staff quoted British Home Office guidance that asylum claims cannot be accelerated because escapees were subject to discrimination, not persecution. However, on 11 September, the Minister of State for International Development, Desmond Swayne, said in a parliamentary reply:

“The Government of Pakistan has publically recognised the problems facing minorities, and the need to bring an end to religious persecution”.

Mr Swayne is right: there is outright persecution. So why does the Home Office guidance, Pakistan: Christians and Christian Converts, state that,

“the evidence does not indicate that Christians are, in general, subject to a real risk of persecution or inhuman or degrading treatment”?

The All-Party Parliamentary Group on International Freedom of Religion or Belief will hold two days of hearings on Pakistan on 10 and 11 November, and Dr Paul Bhatti, the brother of the assassinated government Minister, will address Members of both Houses on 17 November. I hope that the officials who drafted the Home Office guidance will attend, and will agree with Mr Swayne to accurately describe events in Pakistan as persecution.

Finally, there was another event in Westminster this week. On Tuesday, while the President of China addressed both Houses of Parliament, in Zhejiang province alone more than 1,500 churches were having their crosses forcibly removed by the authorities. The noble Baroness, Lady Anelay, has just answered a Question on the Floor of the House about the brave human rights lawyers who have been at the forefront of trying to defend many of those who have been persecuted. Some 280 rights lawyers have been detained or disappeared in China since 9 July. The lesson for China is that without freedom of conscience and freedom of belief, no society will prosper and there can never be harmony. There is a direct correlation between those countries which are the most prosperous and those which uphold freedom of religion and belief. This is a lesson for us, too. Article 18 is a core value which is being systematically attacked and it is our duty as parliamentarians in this great democracy to say so.

My Lords, the noble Lord, Lord Alton, is an extremely doughty campaigner on behalf of freedom of worship throughout the world and it is a privilege to follow him today. He may even be aware that it was Queen Elizabeth I who in 1558 famously declared that she had no desire to open “windows into men’s souls”. It sounded like a magnanimous promise of tolerance and religious freedom after the persecution presided over by her predecessor. Sadly, however, events made her tolerance wear thin by the end of her reign. Now, some 450 years later, men and women in many countries continue to suffer terribly as a result of their deepest-held religious convictions. Windows are still being opened into people’s souls, often with brutal consequences and a shocking disregard for freedom of conscience.

The Universal Declaration of Human Rights, adopted by the United Nations in 1948, urged nations to guarantee freedom of thought, conscience and religion. Organisations who now have experts in this field agree that attacks on religious freedom have increased in recent years. Christians have been caught up in the revolutionary turmoil which has swept through many countries in north Africa and the Middle East in the last few years, and they have suffered especially as a result of the murderous extreme groups such as ISIL, and Boko Haram and al-Shabaab in Africa, which kill Muslims as well as Christians. The great Sunni/Shia divide is another source of persecution, and there are warnings that those of the Jewish faith are facing a fresh surge of anti-Semitism.

It is shocking that only last week the Catholic charity, Aid to the Church in Need, reported that the number of countries in which those who practise the Christian religion are suffering extreme persecution has risen to 10. In one of those countries, Eritrea, it is estimated that in 2013 a total of up to 3,000 people, the majority of them Christians, were imprisoned for their religious beliefs. In Pakistan, the blasphemy laws often have adverse consequences for religious minorities. In Nigeria last year, around 276 girls were kidnapped from their school in Chibok by Boko Haram, and it is reported that many of them have been forced to convert to Islam. In a message at the launch of the report, the Prime Minister said:

“Now is not the time for silence. We must stand together and fight for a world where no one is persecuted because of what they believe”.

In view of the shocking statistics on religious persecution and the levels of human suffering they indicate, is it not time for the British Government to examine how they can take stronger measures to support those who are being persecuted for practising their faith? Religious liberty is a universal human right, and democratic Governments who believe in the rule of law should have the moral courage to raise the issue wherever such rights are flagrantly abused in breach of the UN charter. If the West can impose sanctions on Russia over its Government’s aggressive actions in eastern Ukraine, could not overseas aid, or rather the loss of it, be used to bring pressure to bear for a change of policy? Where a country’s Government are behaving intolerably, and the Government are turning a blind eye, we should act in a principled way and, where necessary, consider withholding aid. Our overseas aid budget was £11.7 billion last year. Can the Minister assure us today that with the provision of bilateral aid, the Government will insist that the Governments of the countries concerned should show a definite commitment to freedom of worship?

The noble Lord, Lord Alton, who instigated this debate, and others have called in the past for the Government to establish the position of a high-profile international ambassador for religious freedom. Previously, the Government have said that our Ministers and ambassadors are sufficiently active in promoting freedom of religion and belief. Can the Minister tell us why the Government are not adopting a bolder stance, as the United States of America and Canada have? The US Congress has passed the necessary legislation and Canada has already appointed a religious freedom envoy.

My time is up. I will just say, finally, that we must redouble our efforts to raise this matter higher up the agenda of democratic Governments around the world. I look forward to the Minister’s reply.

My Lords, first, I express my appreciation to my very good friend of many years’ standing, the noble Lord, Lord Alton, for initiating this debate. To be rather more home-based, I remember that when I was a child, we used to say in school, “Sticks and stones can break my bones, but names will never hurt me”. The truth of course is that names can hurt and can lead to abusive and destructive actions. We should take great care what we say in our speeches—not only the content but the tenor and the tone of our voices. It is difficult to hide behind the words that are expressed. I suggest that even Home Secretaries, sometimes, could think about what they are saying and the effect it will have, especially on vulnerable and sensitive people or on those who are in uncertain situations. The press, too, can sow seeds of anxiety in pursuing its own agenda. Think of Germany in the 1930s and the papers, and the daubing on the windows of shops: “Jews out”. That led to Kristallnacht and the Holocaust. Words can break our bones—millions and millions of bones.

Of course, the first need is to respect those who differ from us and to not make scapegoats of them, for any reason whatever. Sometimes we or others might do this to further a religious cause or to advance our electoral or political prospects. We should avoid doing anything that causes people to lose their respect and dignity or that is a step towards them not achieving their potential. A massive step forward is how we teach our children. We can teach them, when they are in schools, churches, mosques and so on, to respect one another.

A subject that is causing a great deal of controversy and leading to a great deal of bitterness at the moment is immigration. Some of our newspapers especially are guilty of not always quite telling the truth. We have to look at that. When they talk about “swamping” Britain with asylum seekers, the truth is that of the EU countries, Britain stands 10th when it comes to the number of asylum seekers per head of population. You have to present facts that are real and true and can be respected. The Association of Chief Police Officers has stated that,

“ill-informed, adverse media coverage … has contributed to heightened local tensions and resentment of asylum seekers”.

However, when the facts are presented positively, that can increase the respect that communities have towards one another and reduce tensions before they come to the breaking-bones stage.

We should imagine what we could do. I suggest to the Minister that we could try to include the facts on immigration and emigration in the school curriculum, in the history or geography classes, so that people know what is happening. When that happens, people will be able to think, “This is the truth; this is something we can rely upon”, instead of having to rely upon stories that are often exaggerated or totally unhelpful. To reduce tensions we must stop shouting the names before we start breaking the bones.

I just remind the Committee that we would be grateful if noble Lords could adhere to the three minutes.

My Lords, I warmly congratulate my noble friend on this important debate and his powerful introduction. I will focus on the violations of religious freedom in two countries largely ignored by international media but in need of urgent attention. In northern Nigeria, attacks on those who do not adhere to Boko Haram’s ideology occur almost daily. Since October 2014, nearly 4,000 people have been killed and around 2.2 million internally displaced.

Last week, suicide bombings on the outskirts of Maiduguri in Borno state targeted two mosques, with at least 39 Muslims killed. When I and my colleagues from my NGO, HART, visited the area, we learned that the scale of slaughter and abduction far exceeds that reported by the media. For example, the horrific plight of the Chibok girls, already mentioned by the noble Lord, Lord Selkirk, is internationally known, but the fate of more than 1,000 women and girls taken by Boko Haram—which also abducts and forcibly recruits boys as young as 12 years old—is not. Christian communities have been subject to regular attacks for decades in northern Nigeria, but these have escalated with the rise of Boko Haram. A reign of terror persists there, as described powerfully last week by Victoria Yohanna, who herself escaped from Boko Haram.

I turn briefly to Azerbaijan, which has been classified as “not free” by Freedom House. The Government there restrict the religious practices of most non-Shia Muslim communities. Leaders of unsanctioned religious services have been imprisoned, and many mosques and Muslim schools have been closed. Churches must be registered, but none have been able to do so since January 2010. Those gathering to study religion have been jailed and some deported. A junior State Committee official has claimed:

“We forbid religious books—but this isn’t religious discrimination”.

Police raids of Muslim prayer and study meetings continue. A raid of a home in September 2015 left 85 people taken for questioning, 3,000 religious books confiscated and two Turkish scholars deported. On 7 October this year, five Sunni Muslims were jailed following their arrest during a raid of an Islamic study meeting. Their lawyers were not allowed to attend the final hearing. What representations have Her Majesty’s Government made to the Governments of Nigeria and Azerbaijan concerning these serious assaults on freedom of religion and belief?

My Lords, I, too, am very grateful for this debate. I will focus my comments on the interface between religion and national identity, and the theological and political dangers of too close an alignment between them. Too often, the abuse of religious freedom arises from a false collusion between religion and national loyalty. We saw it once in our own land and, yes, in my own church. We see it now in the “gozinesh” criterion for state employment in Iran, in the treatment of the Rohingya in Myanmar, and in the actions of the so-called Orthodox Army in the Donbass region of Ukraine.

Religions, which at their best seek to serve all humanity, find themselves yoked to a form of patriotism that is insecure and sees minorities as the enemy within. Religious leaders go from trying to influence their society responsibly to denying that others have a place within it. In the worst of cases, the great faiths become like ploughshares beaten into swords, with their messages of life betrayed and turned into instruments of death and persecution. Such a toxic mixture of the abuse of theology and the rejection of human rights will only be defeated by the combined efforts of secular and religious leaders. For this end, the Inter-Religious Platform for Article 18, IRP18, was launched in June. It brings together religious leaders from various faiths and serves as a catalyst for these religious leaders to campaign together for global religious freedom. It is deficient both theologically and practically for religious leaders to speak for the persecuted from their own religions alone. All faiths must defend all faiths. If one faith does not have the freedom to worship, no believer can feel secure.

The aim is not for all religions to see each other as equally true. This would be unachievable. Nevertheless, as the Dalai Lama recently noted, there is now a special responsibility for religious leaders to affirm the place of the other as the other. This principle can unite people from all faiths and beliefs while maintaining theological integrity. Our goal is to unite not only individuals but religious communities and networks that extend across the world. The efforts of IRP18 and other such organisations mirror in a very small way the good work of the International Panel of Parliamentarians for Freedom of Religion or Belief in connecting political leaders. Both political and religious groups need to act together if we are to convince the persecutors that their actions serve neither their faith nor their nation.

I conclude by asking the Minister what the Government’s assessment is of the role that interreligious initiatives can play in strengthening the commitment to Article 18. What steps might the Government take to support and foster more such initiatives? Does she agree with me that, in a way unparalleled in other human rights issues, public policy on freedom of religion or belief is intrinsically linked to theological understanding?

My Lords, I thank the noble Lord, Lord Alton, for securing this debate. I am particularly grateful for his advisory board membership on the University of Birmingham’s recently launched Commonwealth initiative on freedom of religion or belief, which I co-direct and declare as an interest. I shall begin with a quote:

“free to practise a faith or to decide not to follow any faith at all. We are free to build our own churches, synagogues … and mosques and to worship freely”.

No, this is not from the FCO human rights report but from this week’s Home Office counterextremism strategy. In this global village, what is happening overseas may be connected to our domestic context, and the question, “Does religion influence human beings to commit violence?”, has to be tackled by Governments, not just students writing essays. The UN special rapporteur, Dr Heiner Bielefeldt, has said:

“The relevance of the issue with respect to freedom of religion or belief is obvious since violence in the name of religion is a source of many of the most extreme violations of this human right”.

The Department for Education has announced that human rights are to be added to the school curriculum in the UK. I would be grateful to hear from the Minister how freedom of religion or belief is featuring as part of that change. With this domestic background, I am sure that the Minister will be reassuring this House that a change from specific priorities to thematic values in the Foreign and Commonwealth Office has not downgraded the importance of freedom of religion or belief.

It is vital that the plight of persecuted Muslim minorities around the world is not neglected. While the Foreign Secretary said on Tuesday in the other place that he does not expect the Shia Muslim Ali al-Nimr, a juvenile, to be executed, is the Minister concerned about the recent spate of killings of Shia Muslims in eastern Saudi Arabia? Although perpetrated by people linked to IS, could the Minister undertake to investigate allegations that Saudi government clerics are calling Shia Muslims infidels on TV stations such as Wesal, and specifically investigate to confirm that these stations are not being broadcast here in the UK?

The international headquarters of the Ahmadi Muslims is here in the UK. It was such a relief that last month’s suspected arson attack on the Baitul Futuh mosque in Morden took place while it was unoccupied. However, many of the claims for asylum here in the UK are from Ahmadi Muslims fleeing persecution in Pakistan. This Commonwealth country is going through much communal tension and violence, often in the name of religion. For a Commonwealth country to deny the right to vote unless Ahmadis declare that they are non-Muslim is unacceptable. I would be grateful if the Minister could look at raising this at the forthcoming Commonwealth Heads of Government Meeting in Malta.

My Lords, four times this year writers and bloggers variously identified as humanists, atheists or freethinkers have been murdered in gruesome machete attacks in Bangladesh: Avijit Roy, the popular science author, who was hacked down outside the renowned international book fair; Washiqur Rahman, whose satirical blog identified the many topics on which Islamist extremists demand silence on pain of death; and, most recently, Niladri Chatterjee, the organiser of a local science and rationalists’ association, who had posted on Facebook aligning himself with atheists and sceptics of religion, and who was killed in his own home by intruders who locked his wife on the balcony while they butchered him. We pay tribute to them for their courage and for standing for what they believe in, but I am shocked that the Bangladeshi authorities have brought no suspect to trial. Meanwhile, astonishingly, the Bangladeshi police and government officials have threatened to arrest other secular bloggers under the ICT Act, presumptuously declaring that their output is hateful, a move that surviving Bangla secularists and human rights groups have called a victim-blaming mentality.

Article 18 pertains to thought, conscience and religion or belief. This right is unstintingly and unapologetically clear that political thought includes both the expression of religious devotion and the voicing of objections to religious institutions, religious leaders and religious beliefs and practices. We must be clear that Article 18 applies to everyone, whether religious, humanist, atheist or, indeed, simply secular. What are the Government doing to present and champion to the world the full understanding of Article 18 as it was intended and as the international human rights consensus understands? What are the Government doing to protect atheists such as Alexander Aan in Indonesia, liberals such as Raif Badawi in Saudi Arabia and humanists such as Avijit Roy in Bangladesh?

Finally, we must be sure that we too in our daily lives do not discriminate against atheists. Why is it that the DCMS persistently refuses to allow on Remembrance Day the Armed Forces Humanists Association from being represented? It is a disgrace and the Government should take it up and do something about it.

My Lords, I intended today to speak in the debate of the noble Lord, Lord Farmer, on palliative care but a rather happy slip of the cursor entered my name for this debate—fortunate, because the topic of the debate of the noble Lord, Lord Alton, is of the utmost importance and because I shall have the opportunity to speak on palliative care in the debate on the Private Member’s Bill of the noble Baroness, Lady Finlay, tomorrow. I declare interests relevant to this debate, both as chair of the Equality and Human Rights Commission and on account of publishing and lecturing on this and other rights.

There is a great deal of confusion about Article 18 rights in the United Kingdom at present. This is not because the UK is a society in which there is flagrant violation of this right. We do not criminalise apostasy and we are, in the main, a tolerant society. However, confusion has arisen about the proper interpretation of the phrase “religion or belief” from a number of cases in the lower courts dealing, it must be said, mainly with employment issues. A central confusion is about the meaning to be given to the term “belief”. On the one hand, courts have held:

“A belief must be a belief and not an opinion or viewpoint based on the present state of information”,

and on the other, that any belief that is to be protected by this right should,

“attain a certain level of cogency, seriousness, cohesion and importance”.

Peter Edge and Lucy Vickers conclude in their recent Review of Equality and Human Rights Law Relating to Religion and Belief that the,

“broad definition of belief currently being applied by the courts is unclear, and some rulings appear inconsistent with others”.

Their views are widely shared. It is puzzling to find opposition to fox hunting classified by one tribunal as a religion or belief, but support for fox hunting not classified as a religion or belief. Things would be much clearer if the courts noted that Article 18, like Article 9 of the European convention, yokes religion and belief, suggesting that the kinds of belief that count must be life orienting rather than bearing on a single aspect of life—a Weltanschauung rather than a specific political or ethical position. More occasional or disjointed beliefs and their expression are properly protected by rights to freedom of expression. I suggest that this troubling confusion about Article 18 rights in the UK can be settled only by further legislation or—but it is probably too slow—by the accumulation of further court decisions that do not simply point in contradictory directions.

My Lords, this debate is timely because the Parliamentary Assembly of the Council of Europe recently recognised how churches and faiths contribute to peace and human solidarity. It called on Governments to protect freedom of religion. I trust that today’s debate will reinforce that appeal, which I commend to the Government.

In March I was in Lebanon where more than 1 million refugees from Syria had already been accommodated without using a single camp. I doubt whether that would have been possible had Christians, Muslims and Druze not shared common traditions of welcome and hospitality for their neighbours in distress. In May, with church leaders, I visited the Kurdistan Regional Government. In the capital, Erbil, and near the city of Dohuc, many people displaced from Mosul and Nineveh were being cared for. I went on to the Jazira canton of north-east Syria. It had already taken in many people from other parts of Syria. In the late summer last year, it received even more people fleeing ISIS/Daesh attacks. Once again, I urge the Government to visit Jazira and the other two cantons, which they have so far refused to do.

Of those driving Iraqis and Syrians from their homes, ISIS/Daesh has been the most fanatical. Its true believers include some seeking an austere and ethical life, but it also attracts some psychopaths. A combination of idealists and thugs is dynamic and dangerous as well as being totally intolerant. Military means alone will not be enough to defeat ISIS. Muslim minds must be won over by showing that better ideas can work in practice. I am glad to note that the Catholic Church and many other churches, together with Muslim and other groups, are now meeting the needs of refugees and the displaced. This is true all the way from Calais and the Mediterranean to Baghdad.

Pope Francis and many other leaders have appealed for practical help and for the resettlement of the most vulnerable. These are all reasons why human rights and religious freedoms must be upheld.

My Lords, my name was also destined for another other topic, on which I am speaking tomorrow. The Universal Declaration of Human Rights is undoubtedly the most important document of the past 70 years. The four freedoms, and the associated rights they uphold, are a cornerstone of the liberal democracy that has come to dominate Western politics.

We are here to discuss one of those freedoms: freedom of religion, as enshrined in Article 18. This right, I am glad to say, is widely recognised and respected in the UK. It can be possible to underplay the importance of this right. It can seem somewhat less salient when compared to the humanitarian necessity of freedom from fear and the lofty idealism of freedom of speech and expression, but it is one of the most precious liberties we have in our society. There is something lacking about countries that do not allow freedom of religion or freedom to leave religion. In religiously homogenous societies where religion is a condition of citizenship, such as the Maldives, or those where apostasy is punishable by death, such as Indonesia, one loses the multicultural essence that has helped drive on many societies.

Britain’s long history of religious tolerance, stretching all the way back to the 19th century, is codified in this document and has helped to attract and nurture the diversity that makes us stand out in the world. This country has been actively welcoming towards my own Sikh community and has been extremely accommodating towards our beliefs.

Freedom of religion, when all is said and done, is about the individual. If we believe in the primacy of the individual, we believe in allowing such individuals to exercise their judgment in choosing or, indeed, rejecting their faith. If we believe in that, it is down to us to allow them to make that decision knowing that they will be safe making it and that the full force of the law exists to deter those who would seek to interfere in it.

My Lords, like other noble Lords, I am very grateful to my noble friend Lord Alton of Liverpool for bringing this debate to us and introducing it with his usual passion and eloquence as he spoke about the problem of religious intolerance and intolerance of belief across the world. I am grateful, too, as I am sure others are, for the slip of the cursor that ensured the noble Baroness, Lady O’Neill of Bengarve, made a contribution. Indeed, I want to pick up from her contribution where she spoke about the troubling confusion that seems to be around in the UK about these matters. It seems that there is now a pervasive lack of knowledge and understanding of what religion is about. Indeed, the religious affairs correspondent of the BBC said in one of the broadsheets some months ago that it would no longer be possible to successfully make a satire like Monty Python’s “Life of Brian” because there are not enough people around now who understand what the satire was about. That seems to me to be something of a condemnation of the BBC, in that it has failed in that aspect of its educative mandate and to ensure that people do understand the importance of these matters. But the result has been that many in the establishment—our universities, our Government and our Civil Service—do not really understand what religious faith is about and what it means. They then lack sympathy for these matters, so that freedom of religion is relegated much further down the pecking order than freedom of many other principles, orientations or interests. It is not considered as a serious matter by many of those in authority.

Much of this is to do with a lack of understanding of the psychology of large groups and how they function and, in particular, of how groups think. For example, people will talk about all religions talking about the same thing or having the same views. They do not. That is just nonsense which can be maintained only by somebody who does not know anything much about any of them. Religions are different and have very different results in the lives of the people who believe and follow them. However, there is another fundamental difference, between fundamentalism and other ways of viewing religious faith. This question of how religious faiths are held and the way in which people think, whether they are religious or not, is perhaps the most important one, because there can be atheistic fundamentalists just as much as religious fundamentalists. In many ways, those with different religious faiths who hold their beliefs in a non-fundamentalist way are often closer in understanding than so-called coreligionists. The failure to understand this and that fundamentalist ways of holding religious belief are not actually congruent with multifaith and multicultural societies means that we have, in many ways, been much too tolerant of intolerance, including among some of our allies.

I want to finish by remarking on this question of whether or not economic freedom is now regarded by the Government as more important than religious freedom. Our tolerance of the intolerance of our economic partner, Saudi Arabia, led to massive amounts of money going into fostering fundamentalism in the Islamic world, and the price we are paying is horrible. Can the Minister tell us whether or not Her Majesty’s Government regard economic freedom as being of a higher and more significant order than that of religious freedom?

I thank the noble Lord, Lord Alton, for initiating this timely, albeit brief, debate. Sadly, many cases mentioned today and highlighted in the FCO’s Human Rights and Democracy Report 2014 show the harsh reality of the world today. I have heard speculation that the annual report may stop. I hope the Minister will be able to refute that by committing today to continue to publish it every year for the rest of this Parliament. Countries that do not respect religious freedom invariably do not respect other basic human rights. That is why, as a humanist and a gay man, I share all of the concerns expressed today. The Minister has said she wants the Government to focus more strongly on making freedom of religion or belief part of the answer to extremism across government. The noble Baroness, Lady Berridge, mentioned the Home Office counterextremism strategy. How will this link up with FCO activities? Will it involve further engagement with Saudi Arabia, whose record on human rights and religious freedom, as we have heard in the debate, is absolutely appalling? I do not understand how it will counter extremism.

I am also grateful to the Minister for repeating the Statement in the Chamber today. The Chinese state visit this week gives us an opportunity to evaluate the impact that our relationship has had on human rights in China. The Prime Minister’s spokeswoman said that developing a strong and engaged relationship,

“means we are able to talk to them ... frankly and with mutual respect”.

Yet the campaign group Human Rights Watch has documented, over the last three years, a rapid deterioration in human rights in China, as we also heard during the debate on the Statement. George Osborne said during his visit to China that he addressed the issue of human rights privately,

“in the context of also talking about issues like economic development”.

Perhaps the Minister can tell us precisely what steps he took while in western China to raise the treatment of the area’s minority Muslim community, which faces restrictions on religious observance under the guise of anti-terrorism measures. Despite the importance of the relationship with China, we must not shirk from raising human rights issues if it fails to adhere to domestic and international law.

My Lords, I congratulate the noble Lord, Lord Alton, on securing this debate and thank him for giving us another opportunity this year to debate an issue of crucial importance not only to us but to the whole country. I take into account very much what the noble Lord, Lord Alderdice, said. There is often a misunderstanding about the fact that religions are different and that we cannot treat them as all the same. It does not mean that one is discriminating just because one is treating people differently. I was particularly gripped by the words of the noble Baroness, Lady O’Neill, when she talked about confusion in the courts about the way that they address belief. Those are matters that I would like to consider further.

This Government remain firmly committed to promoting and protecting the right to freedom of religion or belief around the world. Under our new strategic approach to human rights, we have refocused our work around three new themes; I made some reference to this on the Floor of the House a short while ago when I answered the Urgent Question on China. Our new approach will be set out in the annual report that will be published—as its very name is “annual report”, I certainly expect it to continue to be just that. I appreciate that most people get hold of these things online rather than in print, but we provide access in various ways.

The three themes are: democratic values and the rule of law; strengthening the rules-based international system; and human rights for a stable world. Our work on freedom of religion or belief has an integral place under each of them. Just a short while earlier in the Chamber, I explained clearly that one needs to read the full transcript of the PUS’s exchange with the Select Committee because it made very clear that the work on freedom of religion or belief is integral to what the Foreign Office does. It is embedded—as I was able to reassure one NGO, not buried but embedded—and vibrant across the FCO. For example, only where freedom of religion or belief is protected can we expect to see democratic values and the rule of law being fully implemented.

To the noble Lord, Lord Harrison, I say very strongly that freedom of religion or belief must include the right to have no belief, or, indeed, to change one’s religion, and we certainly make that clear. We are shocked by the brutal murders of four secular bloggers in Bangladesh this year. The British Government have been unequivocal in their condemnation of those murders. There must be space for free speech in Bangladesh. These incidents must stop, and we have made that clear to the Government. All this is why we fund targeted projects and lobby on individual cases of discrimination or persecution.

Our second theme, making a strong contribution to strengthening the rules-based international system, is why, in the United Nations, for example, we ensure that there are regular resolutions that focus on the full definition of freedom of religion or belief, as set out in Article 18, rather than on the narrower focus on religious intolerance as put forward in the parallel resolutions tabled by the Organisation of Islamic Cooperation. We also use the universal periodic review to raise issues with individual countries.

Under our third theme—human rights for a stable world—freedom of religion or belief is central to so much of what we do. In societies where freedom of religion or belief is protected, and where discrimination against others on the basis of their religion or belief is seen as unacceptable, it is much harder for extremist views to take root. Governments need to learn from that lesson. In all our work, we continually make the case for freedom of religion or belief, and we implement it in practice through our project work. With regard to aid, of course our aid relationship with any Government is based on an assessment of their commitment to our partnership principles, which include human rights. DfID and the FCO continue to raise the rights of minorities at the highest levels of government. When we give aid, we feel we have a responsibility to see how effectively the Government are able to deploy it. To that end, we are funding a project to develop lesson plans for primary school teachers in the Middle East that will help them to teach the values that are important. I agree entirely with the noble Lord, Lord Roberts of Llandudno, on this. The key to success in all these matters is education. We need to ensure that children appreciate from the earliest stage that for society to be stable and fair, everyone must be valued equally, regardless of their religion or belief or the fact that they have no belief.

I mentioned a moment ago a project we are undertaking in the Middle East. Speaking of that area, I want to express the Government’s horror at the attacks being carried out by ISIL against those who do not acquiesce to its brutal ideology. It does not discriminate. It has committed atrocities against Christians, Yazidis, Muslims, Turkmen and others. I recently had a meeting in New York with very brave Yazidis who are trying to assist people in their communities. ISIL is persecuting individuals and communities on the basis of their religion, belief or ethnicity, and its murderous campaign has resulted in the most appalling humanitarian crisis of our time.

The noble Lord, Lord Alton, referred to the fact that some have called for this slaughter to be called genocide. As I have remarked on previous occasions, UK support for international criminal justice and accountability is a fundamental aspect of our foreign policy. The International Criminal Court plays the key role in entrenching the rule of law and acting as a deterrent to atrocities, placing a spotlight on individual responsibility, supporting victims and helping to establish an historical narrative of accountability. We will continue to work through the ICC to take forward the important commitments made by PM Abadi to investigate all human rights abuses and violations. Those who seek to block our efforts with regard to Syria—the Assad Government—will find that we will not give up; neither will we give up when Russia opposes us.

I was also asked in particular about countering violent extremism. The strategy was launched by the Home Office, but we are already looking very carefully at how we work cross-departmentally, and I hope to be able to give further information as we develop that work. However, cross-departmental work is key to it.

Before the Minister leaves that important passage of her speech, might I press her further? Although I appreciate the work that she has done with the International Criminal Court, and she is of course right that upholding international law falls within its remit, nothing stops a sovereign Government, such as that of the United Kingdom, nevertheless saying that what is occurring is genocide, which would place further pressure on the international authorities and perhaps be a counterbalance to the Russian veto in the Security Council. Will she reflect on that further?

My Lords, I will certainly continue to reflect on that. There have been other occasions when people have asked us to refer to something as genocide where one can see brutality. We have always been very firm in ensuring that we follow the path of saying that we accept as genocide what the international judicial system determines as genocide, but I would never refuse to reflect on the views of the noble Lord, Lord Alton, as I have far too great respect for him.

We have recently launched a project promoting legal and social protection for freedom of religion or belief in Iraq. This project aims to prevent intolerance and violence towards religious communities by inspiring key leaders in Iraqi society to become defenders of freedom of religion or belief. The UK continues to encourage influential religious leaders in Iraq to speak out publicly and condemn sectarian violence.

The best defence against radicalisation, the best guarantee of stability and sustainable growth the world over, is inclusive and accountable government. That means government that guarantees the right of every individual to follow the religion or belief of their choice, or no belief, both in private and in public. It is a fundamental freedom that underpins many of the others. Building inclusive, accountable government in the Middle East is going to take some long time, but we are determined to stay the course.

Since we last debated these matters in the summer, the Government have been working on a number of specific areas. I will mention one or two, but I want to leave time to refer to matters raised by noble Lords. First, we have been working actively with our international partners to ensure that discussions about extremism take account of the role of religious repression as a motivator. Secondly, we strongly supported the meeting of the International Panel of Parliamentarians for Freedom of Religion or Belief that took place last month in New York at the United Nations General Assembly. I was delighted that this House was well represented and that we were able to provide support by offering a reception to delegates. On that note, I commend the international work of my noble friend Lady Berridge on freedom of religion and belief. Thirdly, last month in Paris, we took part in the French-led workshop on religious minorities in the Middle East. We want to build on that work, and my FCO colleague, Tobias Ellwood MP, and I will be hosting a further workshop next month on the situation facing Christians and other minorities in the Middle East. It was part of our manifesto commitment to look specifically at Christians in the Middle East, and that is what we shall do. We are continuing to explore how we can work more closely together with our US counterparts—one example being taking part in a transatlantic dialogue in Washington earlier this month.

On a related matter, we have been working with faith leaders from all communities to build a safer and more secure world. I agree entirely with the right reverend Prelate the Bishop of Coventry about the importance of inter-religious work. The critical role of faith leaders was brought home to me during my visit two weeks ago to eastern DRC. I was honoured to be able to visit a UK-funded programme outside Goma, run by the NGO Tearfund, that works with local faith leaders to build community support groups for sexual violence survivors. Importantly, the project draws on the influence of the faith leaders within their communities to challenge some of the attitudes to victims of sexual violence and address the stigma many survivors face after their attack. I pay heartfelt tribute to those local Anglican, Catholic and Muslim leaders who spoke with one voice about the importance of working together in such difficult circumstances.

I was appalled this week to learn that there have been further attacks by armed groups on two of the communities nearby which host Tearfund’s work. It brings it home to us when communities have once again been subject to rape, kidnap and assault. That was in DRC, but we heard movingly from other noble Lords, such as the noble Baroness, Lady Cox, who spoke about Nigeria, where Boko Haram carries out its horrific attacks. That must give us all the strength to continue. It gives the Government the strength to argue the case to Governments around the world, without hesitation and without feeling that we are inhibited by any economic relationship, because it is the right thing to do.

My Lords, the Minister referred to an annual human rights report. Can she at least ensure that an opportunity arises for noble Lords to debate that report in Government time?

Armed Forces: Reserves

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of the present and future strength of the reserves of the British Armed Forces.

My Lords, in the interests of noble Lords, who may not be able to hear me because of my croaky throat, I shall keep my remarks reasonably short. I am sure the Deputy Chairman will appreciate that that might allow a little more time for some of my colleagues. I am pleased that my noble friend Lord Howe is to reply to this Question for Short Debate. The Minister has been in place for only a short period of time, but I think that there is general agreement on both sides of the House that he has grasped his portfolio with alacrity, calmness and a great deal of courtesy. We look forward to his reply.

There has been some very poor press over at least the past six months, and the House has been paying close attention to recruitment levels in the Armed Forces. Recruitment into the Reserve Forces has received a bad press and has caused alarm among a number of noble Lords on all sides who hold the strength of the Reserve Forces dearly. I hope very much indeed that, to the extent that there is going to be some better news, the noble Earl will be kind enough to brief colleagues around the table, not only for the record but to instil a greater degree of confidence in the press.

In 1986, I became a junior Minister, serving my noble friend Lord Trefgarne, who was the Minister of State and who is in his place today. I had responsibility for the Reserve Forces at that time. A little later when I had left Parliament, Lord Younger, who was a very distinguished Secretary of State for Defence—I had the pleasure of serving twice in the ministry, partly under his stewardship—who had also left, rang me up to ask me to come to see him. He was then in the private sector, so I went to very palatial premises. He did not enter into a discussion; rather, he issued a very polite instruction, which was that he wanted me to take over from him as president, in 1999, of the Council of Reserve Forces’ and Cadets’ Associations. I served in that post for 12 years, and I pay tribute to my successor, my noble friend Lord De Mauley, who has taken up that responsibility with great energy and enthusiasm. When I first became the president, the Army contingent of our Reserve Forces numbered more than 50,000. I think that my noble friend Lord Trefgarne is nodding his head in agreement with my recollection.

That shows that my noble friend had better mathematical training than me, but that figure probably includes all the Reserve Forces. It was certainly a very much larger number than we have today. What we need in this different era, one in which we face different threats because they no longer come from the continent but from around the world, is satisfactory size Reserve Forces—and in that I include the Maritime Reserve and the Royal Air Force Reserve. However, I shall concentrate my brief remarks principally on the Army. I believe that the strength of the Reserve Forces depends on a number of key factors, of which I will cover only three. However, there are many more to which your Lordships may wish to refer in due course.

The first factor is recruitment. Recruitment responds to the prospect of deployment. It is a natural desire of those joining any of the three reserves to serve the country, and the opportunity to do it in practice and reality is extremely important. That prospect is vital. I understand that there has been some progress—I look forward to hearing from the Minister about this later—towards meeting the target of 30,100 trained Army reservists by 2020.

In my judgment, there are three specific categories of recruitment needs. First, we have to attract young officers, coming principally from universities or colleges of further education, because they are there to lead their men. Records—certainly over the past 10 years, to my knowledge—have shown great difficulty in recruitment, particularly when the economy is growing. It is very important that we concentrate on that, working in tandem with those in higher education institutions who share that view. Secondly, recruitment figures from the medical profession are not brilliant at the moment. In my limited experience, the medical profession responds to a call for reserves if it understands the need and the threat. Nothing could be more dramatic than the service of reservists and regulars in Sierra Leone during the Ebola outbreak. That is one example, but there are many others around the world where those coming from a medical background to join the reserves have a real contribution to make. Thirdly, on ethnic minorities, we still have a lot more to do in persuading all the sections of our ethnic minorities in this country that it is a noble and worthwhile demonstration of citizenship to join the reserves.

The second factor is the prospect of deployment abroad. I think that as young men and women we all enjoyed the prospect, at university or in higher education, of being able to travel abroad. That is particularly relevant for reserves. So I appreciate that we have had deployment in Kabul in Afghanistan, Cyprus, Ukraine and the Falklands over the past 10 years—I may have my figures slightly in error—but the thrust of that deployment seems to have been working. I hope that that opportunity will continue to encourage recruitment. When deployed, it is very important that the reservist has the same kit, weapons and accoutrements as regular soldiers, and there has to be proper training beforehand with the regulars so that they feel part of one combined armed force.

The third factor is the recognition that the population at large sometime does not give to those who have served in the reserves. According to the records that I have looked at, we have had 70 decorations for conflict abroad over the past 10 years, I believe. That recognition is extremely important. Thirty-one reservists made the ultimate sacrifice and died in Iraq or Afghanistan. How many people, even in this great Parliament, would be able to recognise that even that small, but real, number had made that sacrifice?

I have taken heart, and I encourage others to read the excellent report from General Brims, who was chairman of the review. I shall paraphrase one quote for reasons of brevity: General Brims’s excellent report came to the conclusion that solid progress was being made. His comment about the cultural disconnect between regular and reserve components is important, and we have to do something about that. That is the next challenge which we have to face. I look forward to the other contributions to be made by noble Lords, particularly the Minister.

My Lords, I am grateful to my noble friend Lord Freeman for introducing this Question for Short Debate. I have a couple of interests to declare. First, General Brims was my divisional commander in Iraq in 2003, so of course I have to say nice things about him, but there are plenty of nice things to say. Secondly, I am still commissioned in the TA, but this is my last year of service and I am no longer training.

I welcome the noble Lord, Lord Touhig, to his position as opposition spokesman. He has of course been a Defence Minister in the past, so I suspect that he will be able to give my noble friend Lord Howe a run for his money.

I still think that the plan for volunteer reserves is deeply flawed—in particular, in trying to suggest that volunteer reservists will be identical to their regular counterparts. They cannot be. They may be interchangeable and they can certainly be interoperable, but they are never going to be the same. There is simply not enough time for training to get to that level of proficiency. The problem is not with the actual role but with their wider experience. For instance, before I was commissioned I was a recovery mechanic and I operated a heavy recovery vehicle. In fact, because of my civilian experience and knowledge and everything else, I knew far more about that recovery vehicle than my regular counterparts. I had deep engineering experience and understanding of the vehicle. However, if I was asked to reliably identify a Soviet armoured fighting vehicle, I would not be able to do so. A regular would be able to, because on a wet Thursday afternoon he would not be able to go home until he could identify to his staff sergeant every single Soviet armoured fighting vehicle. Those in the TA do not have the time to do that.

My noble friend Lord Freeman talked about the problem of officers. It is a big problem, especially given that the average age of an Army Reserve officer is about 44. That is far too old. Given contemporary employment patterns, I am not sure how the Minister will be able to increase recruitment of the direct entry junior officers. Late entry officers are very good but, as soldiers put it, you need a proper Rupert.

We need to be careful about the term “trained strength” when we look at the recruiting and strength figures, because they can be misleading. “Trained” presumably means that the serviceman—the volunteer reservist—has passed their basic training and their basic trade course. In the case of a simple trade such as a driver or the logistics corps, that is not much of a problem. A REME vehicle mechanic in my own corps has an “A” trade, which requires much more training, but there is only the same amount of training time available—a few weekends and a two-week trade course. It is not possible to make a proper vehicle mechanic in two weeks. A lot of work has been done in the REME to address this problem, and there is a need to be careful, as far as possible, to recruit civilians with appropriate experience. Being trained or not trained is not a binary condition.

We have better news on recruiting. There is time to meet the targets, but the problem will be retention. When I had what I must say was a very small command, I concentrated relentlessly on retention and I did not worry about recruiting. In fact, I hated it when I was told to run an open day because my soldiers did not want to take part in an open day; they wanted to go and do something. I always concentrated on retention and at some points in my TA career I got in trouble because I was over establishment. I had more people than I was supposed to have. I was told to reduce the numbers and I said, “Which ones am I supposed to get rid of, because they all turn up?”.

We will have to concentrate on retention so that we do not lose the recruits we have. During the Cold War days in BAOR, every so often there were massive exercises. In the run-up to those exercises no one would leave the TA because we knew we had a fabulously interesting exercise to go on, but those days are gone. There are other ways in which we can damage retention, including by not funding accommodation improvements. I have some helpful questions for the Minister that I know he will try to answer.

My final plea is about the scale of Exercise Saif Sareea. We need to have brigade deployment, not a battle group, and we need to make sure that there are a lot of opportunities for the TA in that exercise.

My Lords, I, too, thank the noble Lord, Lord Freeman, for tabling this Question for Short Debate. I do not come to this as a former Defence Minister or as somebody who has served in the reserves; I am very much a novice. I am now on the Armed Forces Parliamentary Scheme. So far, I have only six days’ experience, so I am not pretending to speak as somebody who has been involved, but over the years I have been involved in Liberal Democrat policy-making on defence. Somewhat like the noble Earl, Lord Attlee, we had concerns about the reserves policy that was adopted after the last strategic defence and security review, and in particular we had questions about recruitment.

It appears from debates we have had in the Chamber in the past few months that recruitment seems to have improved, but I want to look at three related issues on the medical side of things. I will draw, to some extent, on the RAF, so we will move away from the Army briefly. The three things I want to touch on are recruitment medicals, the Defence Medical Services, and mental health and other provision for reserves.

In particular, recruitment medicals were touched on in the excellent report by the Reserve Forces’ and Cadets’ Associations. That came up on a visit where I met a dozen recent reserve recruits who said, “If you want to understand what we’re doing, you should be a reserve”. They shared real frustration. Ten of the 12 of them said it had taken an inordinately long time to get their medical appointment. There seems to be a bit of a disconnect. If RAF bases have medical centres, which they do, and those centres are able to do recruitment medicals for regulars, why can they not do them for reservists as well? At the moment, medicals are out to contract with Capita. It seems to take an inordinately long time to get appointments and there is a danger of appointments being shifted. That sort of frustration causes a real problem right at the start. There are people who are enthusiastic about becoming reservists but they are told, “You can’t have that date”, and they are messed around, but those people have other jobs and do not necessarily have the time to be messed around because Capita cannot schedule their appointments. Could there not be some rationalisation of the medical aspect of recruitment?

The second issue was highlighted to me by the BMA in an email yesterday and is also in the report. It is about the Defence Medical Services. At the moment, there is undermanning of the regulars, which means additional demand on the reserves. While the reserves are clearly able to step up to the mark, and there is no question that they are absolutely able to do the job, one of the issues about more regular deployments is what employers feel about it. The slightly worrying thing is that the BMA seems to be suggesting a growing concern among NHS trusts about doctors being deployed. If our own ministries are not able to facilitate the deployment of reservists, that raises some serious questions. Does the Minister know whether this is more a systematic problem or whether it is only in the medical area that reservists are having problems being released for deployment?

The final issue is medical provision for reservists—in particular, in respect of mental health issues. Again, if you are a regular, you have access to the Defence Medical Services. If you are a reservist on a base, or during training and deployment, you have access to those services; but when you are back in your community, there may be issues that are not spotted because you are not working with your peers on a day-to-day basis. NHS doctors, despite the Armed Forces covenant, may not be looking for the sort of health issues that military doctors would be looking for. Is the Minister able to pass this back to the NHS and look at ways of improving those synergies so that our reservists have the same strength of medical provision as the regulars?

My Lords, I share our gratitude to the noble Lord, Lord Freeman, for this Question for Short Debate. The Whole Force Concept is journeying from theory to reality. It is a tricky journey, it seems to me, not because the Government set the wrong course five years ago but because of the scale and complexity of the task. It is true that many essential defence skills, and especially many essential national security skills, reside in the private sector as well as in the Armed Forces. To bring these together coherently and effectively requires both strategic direction and effective management.

I will turn first to the scale of the challenge and then briefly to the complexity. The recruiting of reservists in substantial numbers, with a target of 35,000 across the three services, is frequently discussed. Less often, as far as I can see—here I echo one of the points made by the noble Earl, Lord Attlee—is the issue of retention addressed. However, it is surely the key not just to meeting the target for the numbers of reservists, but for delivering trained and skilled men and women to serve in defence and security. Can the Minister pay more attention to employer engagement to help with retention?

Despite our hope, which I know is very widely shared, that employers consider it good and beneficial as well as right and a source of pride to have reservists in the workforce, I would suggest that the reality is not always so encouraging. It has not been unknown in the past for reservists to hide their military service, using annual leave for training for instance, until circumstances demanded disclosure when deployment occurred. Even today employers need help, with better consideration of the challenges of timing and back-filling that arise when a reservist moves into active service. Particularly with small and medium-sized enterprises, but also with the household names at the middle management level, challenges are faced and pressures must be met. The risk of failing to pay attention to this engagement is that the reservist finds that he or she may be less inclined to remain available. They know their mobilisation is causing problems and that the military do not always appear to understand business needs and pressures, but that flexibility and consistency is essential. Late requests for training leave in the build-up to deployment, for instance, can aggravate the situation. Retaining recruited reservists demands more attention to employer engagement, especially as more frequent mobilisation exacerbates the complexities for the individual, the family and the employer. Can the Minister indicate what additional measures Her Majesty’s Government will take to improve retention?

The Armed Forces covenant has a central role to play in emphasising commitment across the community to all parts of the services, including reservists. Next month a covenant training day at Lambeth Palace will consider a variety of issues, including reservists, and I am delighted that the noble Earl, Lord Howe, will be speaking at it.

I will add a brief second point about the journey that we are taking. There are dangers in slipping into free-wheeling, as others have called it. Good intentions and motivation are not enough. Strategy and management must be robust. Two commentators have written that it is as if a new and exciting belief system has emerged without the enabling architecture of churches, priests and congregations. Your Lordships will appreciate that the analogy and argument attracted my attention. The point is clear, I hope, that the sheer complexity of blending Regular forces, reservists and civilian contractors will not just happen. The stated aims of reservists providing extra capacity at somewhat lower readiness, skills not otherwise available to the military, and rebuilding the connection with wider society are laudable, but the task of building this capacity is great and the risk of failing is a capacity gap that our defence and security must not bear.

My Lords, I was inspired to add my name to speak in this debate after having the privilege of attending a dinner on Monday evening at the Honourable Artillery Company in the presence of His Royal Highness Prince Michael of Kent. Those attending included a small number of senior representatives of the corporate world, together with representatives of the Honourable Artillery Company and a head teacher at the local academy in that area.

These dinners are held twice a year and are known as “employers’ dinners”. The purpose is to focus on the enormous value of reservists in the Armed Forces. Although it was very much Chatham House rules, I have to say that I was totally inspired by our principal host and by General Sir Richard Barrons, Colonel Commandant and President of the HAC. The latter spoke with amazing force and commitment about the need for and worth of the reserves. If every young person and their employer could hear General Barrons speak, I think we would meet the numbers overnight. However, I took away an important question from the event, one which I have thought about for some time. What proportion of the reserves come from a military background and how many people who are not from a military background are attracted by the current rather formulaic advertising campaigns?

In common with fellow guests at the HAC, I do not come from a military background. Mine is the legal profession and the corporate world. So, from my perspective, even the language of the Armed Forces, including all those acronyms, is quite different from my own. This was a common theme among the guest: if you do not come from that kind of background, how do you relate to what being a reserve has to offer? Which part of the Armed Forces would suit which type of applicant? Indeed, with great respect, the word “reserve” is not exactly enticing. In other words, the branding and the clarity with which the opportunities out there are articulated to potential candidates are crucial. Is enough being done to address this?

The 77th Brigade, based in Newbury, which I learned about on Monday evening, is a great example which I am convinced would—and, I hope, does—attract some excellent candidates. As many of your Lordships will know, it was originally set up as the Security Assistance Group, formed following the Army 2020 plan. The name was changed to reflect the independence of mind of the Chindits—I am extremely pleased to see my noble friend Lord Slim in his place. Branding anything as related to the Chindits should in itself be enough to attract the best young volunteers. The importance of how we explain to young people what is possible—what they can achieve as a result of this, what contribution they can make in terms of learning leadership skills, the ability to cope in difficult conditions and so on, and what that can then lend and contribute to their world of work—is immeasurable.

The 77th Brigade attracts a mix of regulars and reserves who are specialists in their fields, influencing attitudes and behaviours in other countries. There is expertise for security capacity building and for training foreign security forces. There will be many young people in the private sector and the professions with the requisite skills—including, for example, social media, marketing and public relations—who, with the right approach, would be attracted to making a contribution in this way. In addition, the Joint Cyber Unit—again with the right approach—would attract many with technology skills who would be excited by the challenges and the contribution they could make to this joint cyber reserve.

There is a further and final sticking point. The best spooks out there, who I suggest, if they knew about it, might be willing to give of their time to contribute to our national security, will probably not want to run up and down hills on Dartmoor and the Brecon Beacons or want to do drill. I hope that this is no longer a prerequisite. Can my noble friend confirm that a spook can remain relatively physically unfit while mentally keen?

My Lords, I am delighted that the Chancellor, George Osborne, has committed to the 2% target that Britain was instrumental in implementing at NATO. Our doing so was a crucial step in maintaining our capability to respond to unknown and unforeseeable circumstances, and yet the current plans the Ministry of Defence maintain for the reserves severely reduce our capabilities to respond to threats. I believe it is being used as a cost-cutting measure rather than as a means to improve our Army. It is means before ends, once again, just as it was in SDSR 2010.

The need to update our Reserve Forces is crucial. When the independent commission first investigated the Armed Forces, it noted that in 2005 the Army Reserve—then called the Territorial Army—was no longer required to support large-scale operations. Despite this, the reserve was not modified to reflect this, leaving 80 major units configured for operations. It is difficult to compare our military to America’s, given the wholly different size and nature of the Army Reserve, but in the United States, reserves make up 32% of the current army. In Australia it is 30%, and yet here in the UK it is only 16%. The Future Reserves 2020 consultation paper makes clear that the Canadian reserve force is far more prepared for active combat than our current force, drawing attention to the nature of graduate recruiting into the Army as preferable to that within our own Reserve Forces. The paper points out the effectiveness of Australian reservists in providing military aid to the civil authority for events such as the Olympics—as was required over here—in a manner instructive to the UK Army.

I thank the noble Lord, Lord Freeman, for initiating this important debate. I think the whole House would agree that reforms to modernise and upgrade our reserves are paramount. Yet I am concerned that the strengthening of the Army Reserve is primarily a cost-cutting measure rather than a military one. The integration programme has been poorly executed, to the extent that 65% of Regular Army members surveyed believe that reserves are currently not well integrated. Does the Minister recognise this? Given that the aim of the Army 2020 programme is to create a fully integrated force, this is worrying. These statistics demonstrate that the overall priority of the Government has not been to maintain the quality necessary within our Armed Forces. This is a real worry, because reserves seem to be making up for cuts in the Regular Army. For me, reserves taking the place of the Regular Army is an oxymoron. Surely the increase in reserve strength and capability should be something designed to complement the Regular Army, not replace it. Would the Minister agree?

Even with the course the Government have chosen to go down, it is essential that at no point are we left with an incapable force. Unfortunately, the current nature of the replacement programme leaves us threatened with just that. It is especially dangerous and leaves us vulnerable as a nation while the necessary transition to a more integrated force is being completed. As the noble Lord, Lord Freeman, said, the timeline of the recruitment and training of the reserves should be a cause of concern to us all. It was initially the case that the number of Regular Army members would not fall until the number of reserves had risen to compensate for the demand. Yet the projects set out in the Army 2020 plans are being used to cover for increasing weaknesses in the body of our Regular Army. The National Audit Office showed that recruitment of reserves is 67% down on required figures, and the figure for regular personnel is below target at 34%. Would the Minister confirm those figures? The figures confirm the fears that I and others have that the redevelopment of the reserves is primarily for budgetary reasons rather than military ones. Projections in this report have shown that we will only reach the 30,000 figure for reservists in 2025. In the years before achieving that objective and completing the transition to a fully integrated Army, we will be significantly less able to respond to threats. Would the Minister accept that? Such a reduced Army will mean that we are unable to exert ourselves significantly in the world or to cope with the so-called black swan events that are impossible to predict, and without the capability to respond swiftly in future years.

The United States Defense Secretary said, just recently, that Britain has always punched above its weight when it comes to our Armed Forces. Today is the 75th anniversary of the Royal Engineers’ bomb disposal unit. Today I heard Warrant Officer Karl Ley, who was awarded the George Medal for clearing more roadside bombs than anyone else in history—139, including 42 in a single village. He said that the British Army is the best-trained in the world, and he said it with pride. He said that because we are the best-trained in the world, “We train hard, we fight easy”. The British Army has to retain that culture and reputation of excellence as the best of the best in the world—something that is a matter of pride for all of us. The reform of our reserves to form a more integrated force is necessary to achieve that goal, but it should be pursued as a method to strengthen our Army capabilities, not as a method to save money and thereby weaken our capabilities.

My Lords, I declare interests as colonel commandant of the yeomanry and colonel of the Royal Wessex Yeomanry, a regiment that I commanded early in the millennium, which might make me what my noble friend Lord Attlee calls a “proper Rupert”. I am also president of the Council of Reserve Forces’ and Cadets’ Associations, in which latter capacity I succeeded my noble friend Lord Freeman, to whom I am extremely grateful for bringing this debate.

In those capacities and in my efforts to research for myself our progress towards our targets for 2020, I have recently visited the Scottish and North Irish Yeomanry in Scotland, 7 Rifles in London and 622 Squadron RAF at Brize Norton, as well as my own regiment in the Royal Yeomanry at annual training in Sennelager, and a magnificent event to mark the unveiling of a memorial to Trooper Potts VC, hosted by 94 (Berkshire Yeomanry) Signal Squadron.

Listening to this debate, one could be forgiven for going away with the understanding that things are not going quite as they should be for the reserves. The reality is that they are generally going considerably better than they have been for very many years. I should pay tribute to the unprecedented support given to the Reserve Forces by the Government, emanating from my right honourable friend the Prime Minister himself. I would also single out for thanks the Minister for Reserve Forces, my honourable friend Julian Brazier, who is doing an outstanding job.

The Defence Reform Act 2014 gave the Reserve Forces and cadets’ associations a statutory responsibility for reporting annually on the state of the reserves. In that regard I draw noble Lords’ attention to this year’s external scrutiny team’s annual report, all of which is worth reading. I know the Government have taken care to note it.

Time is rationed, so I must focus my remarks on recruiting, although I would have liked to speak about several other matters, such as capability, integration and the reserves estate. I will not have time either to talk specifically about officer recruiting, to which my noble friends Lord Freeman and Lord Attlee referred, except to say that they are right and that this is a particular area of concern.

On the issue of numbers generally, I hope that my noble friend the Minister will confirm that the Royal Navy and the Royal Air Force are making good progress and will achieve their targets, give or take a little, by 2018. The Army has the biggest challenge but is making progress, and I expect it to take a little longer, but I emphasise that, from the reports I hear, this is often because units have found workarounds rather than relying on the system in place.

Focusing on the Army, bearing in mind the aim of 30,000 people trained, in round numbers there were 21,000 in April this year—the Minister may be able to give us more up-to-date figures—with 4,400 more under training. However, this looks better when one appreciates that the trained strength is up by 1,000 since the year before and, more significantly, the figure for those under training is up by a further 1,000 since the year before. Aspects of the recruiting process remain cumbersome—too many applicants have been dropping out while in the pipeline because it has taken too long—but now the services have got a grip and are enlisting candidates conditionally while still awaiting their final medical clearance, which is eminently sensible and partly answers the very real problem identified by, I believe, the noble Baroness, Lady Smith.

The Army is suffering on both regular and reserve recruiting, so a red light is flashing about how well the Capita recruiting group contract is working. There is a systemic problem with the way in which the process is set up, but there is a reluctance to acknowledge it and it would bear ministerial investigation. As ever, there is no substitute for units taking direct responsibility for individual recruits, making them feel part of the team immediately and managing each of them through the pipeline. That is now happening and things are improving.

Three of the recommendations in the external scrutiny team’s report are crucial for recruiting, and they bear repeating. Recommendation 15.3, to which I have just referred, proposes a review of,

“the separate roles played by the national call centres, the Armed Forces Careers Offices, the recruiting field forces and Reserve units to ensure that they are clearly optimised for Reserve recruiting”.

Recommendation 15.4 states that there should be a review of,

“the medical entry standards required of recruits”,

and that the MoD and the services should,

“ensure that the screening contracts are appropriately incentivised and assured to achieve success”.

Recommendation 15.5 states that we need to,

“determine the recruiting resources necessary to ensure steady state manning of the Reserve beyond the FR20 period”.

On a couple of specific matters, perhaps I could ask the Minister how the Civil Service 1% challenge is progressing. When I was at Defra, we made significant efforts to draw to the attention of civil servants the benefits of reserve service. It would be good to know how that is going because it seems a bit awkward for the Government to ask private sector employers to encourage their people to become reservists if the Government do not do the same, and more.

Finally, on the grounds that we need to recruit everyone bright and fit enough that we can, I ask my noble friend whether foreign and Commonwealth nationals can be recruited into the reserves, and what progress there has been on recruiting ethnic minorities, who historically have been underrepresented, so that major efforts have been made to attract them.

My Lords, I thank the noble Earl, Lord Attlee, for his kind welcome. As to my relationship with the Minister, I am sure that we each give as good as we get, but I rather suspect that much more unites us than divides us in how we should defend our country.

When I served as a Defence Minister my mission statement, put simply, was, “We will value our service men and women and do everything in our power to care for them”. Our most valuable resource is not the latest piece of kit but our people, and nowhere is that more important than in the Armed Forces. The first duty of any Government is to care for the welfare and well-being of their citizens, and I believe that that must include the defence of our nation.

The noble Lord, Lord Freeman, in opening this debate, has articulated well the important role that our reserves play in the defence of Britain. For more than a decade now we have seen the regulars and the reserves working more closely together, although there is clearly much more to do. Indeed in the Army, as a result of Army 2020, there is even greater demand on our reserves than ever before. This brings me to a particular worry: the mental health of our reservists.

The annual report of the Reserve Forces external scrutiny team, helpfully provided to us by the library, gives cause for concern. It points out that the protracted exposure of reservists to intense operations makes the matter of their mental health very important indeed. The team have a statutory duty to report on this matter, but they struggle to do so because of the paucity of data available and they doubt that UK Defence Statistics is in a position to provide them with anything better. What are the Government doing about this? Without adequate data, the external scrutiny team cannot be expected to carry out their duties properly. I appreciate that it is a big ask because the team themselves say that the department’s ability to track individual cases is very limited. I would suggest that one reason for this is that reservists’ first point of contact on health matters is the National Health Service. One problem there is the lack of signposting.

In late spring 2006 I was still a Defence Minister, and I was due to speak at the annual conference of the BMA. The telephone rang and it was Prime Minister Tony Blair, who said he was giving me the DCM—“Don’t Come Monday”—and I was no longer a Minister. Had I gone to the conference, my remarks would have been about signposting, urging GPs, whenever a patient presented with a mental health issue, to ask: “Are you ex-service?”. If the answer was yes, in addition to treatment the GP should point them in the direction of the Veterans Agency, as it then was, or organisations like Combat Stress. Is that being done now? If not, will the Government take it up with the BMA? I understand that GPs are encouraged to refer those patients with service connections back to the military healthcare system. Is that happening? Of course, such signposting should apply to our reservists, too. The scrutiny report recommends that the Armed Forces covenant team look at this. Can the Minister give us an undertaking that this will be done?

Many reservists who may be suffering with mental health problems may be inclined towards denial in case it affects their full-time employment. In terms of the ongoing duty of care, if a reservist has a mental health problem, what is the MoD doing to help with their domestic and employment concerns? Does the Minister’s department collect data from the Armed Forces charities that work in this field?

I spent a day with a Combat Stress counsellor, after I had ceased to be a Minister, visiting veterans and their families, discussing health, financial matters and domestic worries. What I experienced that day has been with me ever since. I visited homes and saw photographs of strong, healthy, young men proudly in uniform. In one particular case, sitting alongside one such photo, I saw a shrunken wreck of a man who will never be the same again. I met his wife and children, struggling to cope, living with someone they now hardly knew. I witnessed the care, attention, sympathetic understanding and practical advice that Combat Stress offered the family that day. After a couple of hours we left that home where the atmosphere and hopefulness was in marked contrast to the despair I had witnessed when I arrived. I have nothing but admiration for the Armed Forces charities that go that extra mile to fill the gap that we as a country are not filling.

Finally, the external scrutiny team offered to work with the MoD to determine how reservists’ mental health reporting can be made more effective. Can the Minister say something about this in his reply? Can he give us an assurance today that his department will act upon this request? Perhaps he can come back to us at a later stage with an update, perhaps as a Written Statement. We, and more importantly our reservists, should not have to see the external scrutiny team come back next year, unable to make progress because of a lack of information to protect and help in their welfare.

My Lords, I am most grateful to my noble friend Lord Freeman for the opportunity that this short debate has provided for me to speak about the strength of our Reserve Forces. We are addressing this matter head on by means of the Future Reserves programme. In the 2013 reserves White Paper we described the changes that we planned to make to the Reserve Forces as substantial, as requiring a shift in the way that we thought of the Reserve Forces—both in the country and in the Armed Forces themselves—and as requiring changes to the way that we support them. We also said that the plans were eminently achievable. The expansion of the Reserve Forces under the Future Reserves programme is critical to our ability to deliver defence on a sustainable financial basis. It will enable us to ensure that the Armed Forces are structured and resourced to meet the challenges of the 21st century. The Government are now restructuring and revitalising our Reserve Forces, investing in new equipment and training, and reversing a long period of decline and underinvestment.

The programme is about doing defence differently. I say to the noble Lord, Lord Bilimoria, in particular, with considerable emphasis that it is not about swapping regular personnel for reserves, and it is certainly not about providing defence on the cheap. It is about changing the way that we deliver defence to make the best use of our resources, to better harness the talents of wider UK society and to help restore the links and understanding between the Armed Forces and the communities that they serve. We should be in no doubt that whatever the size of the Armed Forces, we must always have reserves.

My noble friend Lord Freeman asked about recruitment, which has been a running theme in this debate. I am pleased to be able to report that our programme to grow the reserves is on track, with a huge amount achieved already, although we are not complacent and recognise that significant challenges remain. In the year to 1 September, more than 8,300 people joined the volunteer reserves—an increase of nearly 70% on the previous 12-month period—taking their total strength close to 33,000. Most notably, more than 6,400 people joined the Army Reserve, an increase of 81% on the equivalent period in the previous 12 months. All three services have already exceeded their end-of-year trained strength targets. However, that does not mean that we can relax. We must and will work to maintain this progress to meet our commitment to creating a force of around 35,000 trained volunteer reserves by April 2019.

I can also say with confidence that the offer we are now making to reservists and potential recruits is the best it has ever been. In the two years since the White Paper was published, we have made substantial improvements to the support that we provide to them. For example, we have invested in new equipment and better training, including more opportunities to train alongside regulars and on exercises overseas; we have given reservists access to the same pension scheme as regulars; and we have given them a paid annual leave entitlement, as well as other significant benefits that I shall not list.

We are also offering reservists a greater range of interesting and challenging opportunities than before. New call-out powers enshrined in the Defence Reform Act have allowed us to use reservists in the same way as regulars, and reservists have taken up the challenge. In the past 12 months, they have supported defence engagement activity overseas, including providing vital training to indigenous forces in Afghanistan and Ukraine; they have been deployed as formed elements to our bases in the Falkland Islands and Cyprus; they have provided specialist help to deal with the Ebola outbreak in west Africa; and they have taken part in counterterrorist and counterpiracy operations alongside their regular counterparts. All told, around 600 reservists have been called out for service since the Defence Reform Act took effect.

The right reverend Prelate the Bishop of Portsmouth asked about the issues arising from working alongside regulars and contractors. Our recent experience in operations such as in Afghanistan and Iraq has shown that reservists and regulars can and do work together seamlessly, and they both work very closely with contractors, as well as with allied forces and other government departments and agencies. Almost two-thirds of regulars who have served alongside reserves rate them as professional. That comes from the recent Armed Forces Continuous Attitude Survey.

However, we are not just making wider use of reservists on operational service; we are offering them more and better training opportunities as well. In the current training year, the services have planned more than 50 overseas training exercises involving reserves, including a series of Army exercises in Kenya involving integrated companies of regulars and reserves. We are also giving reservists more recognition for their contribution to defence. In June, the first ever Reserves Day was held as part of the build-up to Armed Forces Day. This provided an opportunity for the whole of the UK to celebrate our Reserve Forces and for reservists to show pride in their service. Reserves Day will be an annual event from now on.

My noble friend Lord Attlee and the right reverend Prelate emphasised the importance of retention. The changes that I have described are all part of improving the experience of being in the reserves, which is vital in enabling us to motivate and retain people with the right skills. They are having a positive effect. Around a year ago, it became evident that we had turned a corner and that more people were choosing to stay in the reserves than were choosing to leave.

My noble friends Lord Freeman and Lord De Mauley asked about the recruitment of ethnic minorities. Despite some very good work in recent years across defence, there is a clear need to do more to increase the recruitment and retention of women, black, minority ethnic and other minority communities. This is a defence priority. To help achieve that aim, we have established a defence diversity inclusion programme within the MoD that covers civilian and military employees.

My noble friend Lord Freeman and the noble Baroness, Lady Smith, asked about recruitment to the medical reserve. The majority of medical reservists undertake their primary careers within the NHS, as we know. The Defence Medical Services and the NHS have developed a close working partnership to promote the benefits of reserve service which is supported through engagement events, myth-busting information and a dedicated reserve section on the NHS employers’ website. This collaborative approach is undoubtedly a factor in the increased success in recruiting into the three single-service medical reserves, but we are not complacent on that score either.

My noble friend Lord Attlee asked about problems recruiting direct-entry officers. The services are aware of that issue and have begun to put programmes in place to attract officers and to shorten their training pipelines. My noble friend Lady Buscombe asked about 77 Brigade recruiting and fitness standards. Fitness standards for some elements of 77 Brigade are different from those of most other formations.

I should also mention, to the right reverend Prelate in particular, our continuing work with employers. In the White Paper we said that we want to build relationships with employers that are tailored to reflect their individual circumstances, open and predictable and based on mutual benefit. We understand the commitment that employers of reservists are asked to make, and we are immensely grateful for that commitment. We consulted extensively with employers of reservists before the White Paper, and we have responded positively to the observations they made. For example, we have established the Defence Relationship Management organisation, which provides account management services for the most significant employers and employer organisations at the national level and information and support for reservists and employers through its website and helpline. We have increased the financial assistance available for employers and introduced new incentive payments of up to £500 per calendar month per reservist for small and medium-sized employers when their reservist employees are mobilised. There are other things as well that I could mention but I do not have time to do so.

We launched our employer recognition scheme in 2014, and gold and silver awards emanate from that. The 700th corporate covenant was signed in September and more have been added since. Central government is playing its part too, with a challenge set by the Cabinet Secretary for 1% of members of the Home Civil Service to become reservists, a point mentioned by my noble friend Lord De Mauley. As at July this year, there were more than 1,250 Civil Service reservists, which reflects a 7% growth in the preceding nine months. That challenge remains a high priority within government.

I hope I have illustrated the significant number of strategic measures that we have put in place to help us to grow the reserves and develop their capability. We have also taken some important practical steps. We have overcome a number of technical challenges that were affecting Army reserve recruitment. I say to my noble friend Lady Buscombe that by making more imaginative use of various advertising media and methods, so that more people can see our messages about what the reserves can offer, there has been an increase in advertising recall and resonance among those who have seen or heard the advertisement.

I am conscious that my time will shortly be up but I cannot fail to address very briefly the issue raised by the noble Lord, Lord Touhig, about the mental health of reservists. Incidentally, I warmly welcome him to his new position. More than £14 million is being invested to deliver a significant change in occupational health services for reservists. There are programmes in place to make sure that mental health briefings and preparations for reservists are aligned with those of regular personnel. The veterans and reserves mental health programme is open to current and former members of the reserve services. There are conditions attached, but treatment will be offered by the Defence Medical Services to individuals whose mental health is assessed to have suffered primarily as a result of their operational service as a reservist. This care can be accessed for life as long as it is clinically indicated.

My time is up. I regret not having addressed all the points raised, but I hope this has been a helpful résumé of where we are with this important agenda.

Palliative Care

Question for Short Debate

Asked by

To ask Her Majesty’s Government, in the light of the Parliamentary and Health Service Ombudsman’s report Dying Without Dignity, what steps they are taking to ensure that everyone who needs it has access to good palliative care and a level of social care that ensures the end of life is valued.

My Lords, I am sincerely grateful for the interest you have shown in this issue. To be honest, this is not least because it is the first Question for Short Debate which I have asked in your Lordships’ House, and one is always slightly nervous that it might end up being just oneself and the Minister. I am also appreciative because many of you will be here again tomorrow to discuss the Private Member’s Bill of the noble Baroness, Lady Finlay, on the same deeply important subject.

I hope that our debates will be complementary and not duplicate each other, because I want to range somewhat away from a legislative approach and focus more on the cultural and social aspects of palliative care. Indeed, I am particularly pleased that we have been joined by the right reverend Prelates the Bishop of Rochester and the Bishop of Carlisle because I hope they will touch on the area of spiritual care and comfort, which is sorely neglected in many policy discussions. After all, Jesus spoke more of eternal life than anyone else in the Bible.

This is not a fringe issue but very much at the heart of what it means to be sensitive to the needs of the patient and their family as death draws near. Let us be clear from the outset about the profundity of what we are dealing with here, as individuals approach the moment when they are coming to the end of their human existence in this universe. We might be surprised by how many want this to be acknowledged and are grateful when they are offered spiritual help. “Do you want me to pray for you?” is a question that recognises the fears many are feeling about what is happening.

In my preparation for this debate, I talked at length to palliative care clinicians who have been with many at the end of their lives. One said, counterintuitively, that it is not those who have an active faith who appear most in need of spiritual comfort. The last words of one woman who died a very painful and prolonged death from cancer but who was a fervent Christian were, “God is good, all the time”. It is the people who have a nominal faith, who suspect there’s something out there but have never quite nailed what it is, who often seem to feel confused, anxious and abandoned. Having someone there who can help them make peace with their maker—if that is what they are seeking and, obviously, nothing should ever be imposed— can be incredibly beneficial. In our secular society it is all too easy to brush over this, perhaps especially for clinicians who have so many other aspects of patient care on their minds. The World Health Organization’s definition of palliative care refers to the need for,

“impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”.

Earlier this month, the Economist Intelligence Unit placed the UK at the top of its international league table for palliative care, and I do not want to gloss over the very good work that many are doing across the country. However, this Question for Short Debate highlights the Dying Without Dignity report, which summarises investigations by the Parliamentary and Health Service Ombudsman into complaints about end-of-life care. It identifies important themes that I will touch on here.

The number one priority for improvement, because it is the prime mover of palliative care, concerns the lack of recognition that people are dying and the poor response to their needs. For many people that will mean changing the way they are cared for to focus wholly on relieving pain, but also making sure that they have a real choice about where they are going to die, and about how and with whom they would want to spend their time if they had the foreknowledge that death was close. It would enable families to prioritise and mean that symptom control could become the top priority, with care being better planned and co-ordinated. This, perhaps most importantly, can mean that the wish of many patients to die at home can be respected.

Hospice UK believes that the number of people dying in hospital could be cut by 20%. Can the Government do more to help make it possible for more people to die at home, which is the first choice for so many? Sometimes there is only a very short window of time, but being at home for even the last 24 hours can make all the difference.

In one area in the north-east, a clinical commissioning group is contracting with a hospice to support community teams so that district nurses and GPs can ask them to assess patients within two hours. These hospices are acting as one-stop shops in the community—and, if noble Lords will forgive the phrase, “death hubs”. They do not just help those who come through their doors—and only 5% of people in this country die in hospices—but they take their expertise out to people in the area so that people’s closeness to death can be established and proper care can be given.

This approach has kept people out of hospital—always the most expensive place to be—and could be the answer to inadequate out-of-hours services. Even in hospitals, palliative care teams may not come on duty until 9 am, so extremely ill and dying people may be forced to see out the dark watches of the night while suffering in severe pain, with profound nausea and in an agitated state.

I cannot overemphasise the importance of attentive care, not least because basic nursing care can, in some cases, lead to recovery. The inappropriately applied Liverpool care pathway—or lack-of-care pathway—meant that there were many desperately sad cases where people did not receive this. Earlier this year, the Royal College of Nursing and Macmillan Cancer Support reported that some hospitals had not changed their practices, despite the Liverpool care pathway being officially phased out. A distinguished neurologist who first sounded the alarm about the LCP said only a couple of months ago that he regularly hears from relatives who are desperately trying to obtain “active” care for very ill relatives who have been denied it because they are deemed to be dying.

A compassionate approach asks what will make a dying patient make the most of the life remaining to them and how clinicians can work with family and friends to ensure that that happens. Good-quality and honest conversations between GPs and their elderly and sicker patients are essential. Many clinicians who routinely work with very ill patients are reluctant to commit themselves, either to relatives or patients, as to how long someone probably has left, even though this would enable them and their families to make plans. Surely this has a lot to do with our cultural aversion to talking about death.

Your Lordships may have heard of the Dying Matters Coalition’s community initiatives to help people,

“talk more openly about dying, death and bereavement”,

and to make these issues,

“accepted as the natural part of everybody’s life cycle”.

Until I prepared for this debate I had never heard of these, yet the role of the community is incredibly important. When communities, volunteers and families take on more responsibility for care, the costs associated with hospital stays and emergency admissions can be significantly reduced. I therefore have a specific question for the Minister. What, if anything, is the Department of Health doing to create the incentives and support systems needed to encourage more community involvement?

When a dear friend of mine died recently, his loved ones were able to say that he had a comfortable death. I think that that is what all of us would want for those who are close to us, and obviously even for ourselves. I look forward to hearing from the many other speakers in this debate and from the Minister about how we can get this right as often as possible so that a badly handled death becomes almost like a “never event”—incredibly rare because it defies belief that it should happen in a modern and compassionate healthcare system.

My Lords, I am glad to be able to thank the noble Lord for introducing this debate and giving us the opportunity of a pre-run to the Second Reading debate tomorrow. With all his experience, it has been great to hear from him. Having said that, I should give a word of explanation for why I will not be in the House tomorrow. Paradoxically, the reason is that after several years, tomorrow I will complete my service as president of Hospice at Home West Cumbria. Most unfortunately, our annual general meeting is to be held at exactly the same time as the debate, and of course not only am I expected to preside at that meeting, I want to do so.

What have I learnt from my years as president? They have been fascinating, cheering and, while very challenging, deeply reassuring. One thing I have learnt is that death, a safe and secure death, is very much the responsibility of us all; it cannot be delegated to anyone. We all have our part to play in creating an atmosphere of support for the feelings and morale of everyone concerned. That covers the staff, the volunteers, the supporters and the wider public. What is great about the Hospice at Home charity in West Cumbria is that the staff are all volunteers who work way beyond what could be expected from them in a contract. But I have also learnt that the volunteers are determined to be professionals. They want to maintain the voluntary spirit, but they want all the time to train and improve so that they can make the best possible contribution. Given the opportunity, members of the public love to feel a sense of responsibility. They want to feel that the hospice is their hospice: it belongs to them. The one point I wanted to get over is that this movement depends upon an awful lot of people.

It also depends upon a dynamic working relationship between the hospice and the health service. There has to be a great deal of flexibility and vision. I hope that a message can go out from the leadership of the health service that this is a good thing because it helps the health service to do its job properly. We have had very good experiences of this in West Cumbria and I want to commend it to the hospice movement throughout the country. It also helps to ensure that people really are striving for the best standards in palliative care. About the care, commitment and love there is no doubt, but some careful training and preparation is needed for palliative care, and one wants to make sure that it is happening all the time and that it is available to all the volunteers so that they can do their work properly. From that standpoint, I endorse what the noble Lord said about it being essentially a community affair. Both the community and the cared for can derive great joy and benefit from that spirit.

My Lords, in preparing for this debate, I talked to a friend who had recently been affected by the shortcomings in end-of-life care. Her mother did not have an identified terminal illness, but deteriorated slowly from multiple conditions. She had several stays in hospital and had agency carers at home. She had several assessments from social workers and occupational therapists, but no longer-term planning was done for her inevitable future decline. Care was reactive to the immediate situation only.

In her final few weeks she deteriorated rapidly and her carers struggled without additional equipment, but it took several days to get further assessments. By the time the occupational therapist arrived to assess the suitability of her room for a bed with a hoist, which would have allowed the carers to handle her, the family were at crisis point. My friend, at her wits’ end, tried to get the bed, but it was a Friday morning and she was told that no equipment could be delivered before Monday. By the evening, her mother became unconscious in her chair. The out-of-hours service suggested an ambulance to take her to A&E. The family declined. They were then on their own. My friend’s mother died during the night, but had she survived into the weekend it would have been almost impossible to care for her properly at home.

My friend’s reflections from this episode are as follows. In contrast to the planning following a terminal cancer diagnosis, from which we need to learn, there is a lack of co-ordination and forward planning for the care of elderly people with multiple conditions. Home assessments are time consuming. Using modern technology such as iPads and Skype and a simple assessment sheet, any sensible person could have assessed the room and had direct contact with professionals for instant advice, rather than waiting for a home visit. Essential equipment should be available in much fewer than four days. You can now order almost anything from Amazon online and have delivery the same day.

There needs to be greater support for those caring for the dying person, especially in the evening, the night or at weekends. No professional or other care support was offered to my friend in the final few hours of her mother’s life, so it is not surprising that many people do not feel competent to care at home, even though they do not want their loved ones to die in hospital. If someone cannot be cared for at home, transfer should be directly into a hospice, rather than admission through A&E to a bed on a busy acute ward.

In the July 2014 report Choice in End of Life Care it was recommended that each person approaching the end of life should have a fully interoperable electronic health record to help to ensure their preferences are recorded and shared with everyone involved in their care, and that people should be able to access and add to their own records. Will the Minister say what progress is being made towards having this in place by 2020?

My Lords, I begin by welcoming the report from the Economist Intelligence Unit that was released earlier this month. As my noble friend Lord Farmer pointed out, along with the WHO, it puts the UK ahead of every other country in the world for providing end-of-life care, as it did in 2010. The report praises the “strong hospice movement” in this country. The work of our hospice movement is something for which we can and should be very thankful. I feel passionately about palliative care. Indeed, I have raised it on several occasions in this House. It is important to say that, as a Christian, I believe that every single human being has an intrinsic value and the right to live the life that God gave them, no matter how old, ill or disabled that person may be. God gave us that life, and I believe that God has the ultimate say in when it will end.

Dame Cicely Saunders, who is widely regarded as the founder of the modern hospice movement, shared this Christian outlook. She became convinced of the paramount importance of combining excellent medical and nursing care with holistic support that recognises the practical, emotional, social and spiritual needs of those who are dying. I constantly quote the second great commandment, where we are commanded by God to love our neighbour, and that means in whatever circumstances they find themselves in. Dame Cicely also used another expression, which was quoted at her memorial service:

“You matter because you are”,

who you are,

“and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die”.

It is often said that a society is measured by how it treats its frailest and most vulnerable members. I want the UK to be a nation that prizes every citizen, not one that treats those coming to the end of life as useless and a waste of resources. I very much welcome the overwhelming rejection of the assisted suicide Bill last month by the other place, and I trust that the vote settles the matter for a long time to come. If assisted suicide or euthanasia were ever legalised, many people would be put under pressure to end their lives for fear of becoming a burden upon friends, family or the healthcare system. Instead, as I have said before in this House, the really humane solution to suffering lies in improving palliative care, not in helping people to kill themselves, as some would have us think.

There is no doubt that much more work has to be done to make our provision of palliative care better, especially in the NHS. The World Health Assembly resolution last year urged its 194 member states to recognise the importance of good-quality palliative care and to ensure its funding. End of life care may be expensive, but the reality is that almost no patient is beyond the help of pain-relieving medicine. If we want to be a nation that truly values every citizen, not just because of their contribution to society, then good care at the end of life is imperative. It can help people who are experiencing physical or mental pain to see that they are valued and that their life is worth living.

My Lords, today’s debate, for which I am also most grateful to the noble Lord, Lord Farmer, has prompted me to take a fresh look at some of the numerous documents on palliative care that have been produced over the past two years, including of course the ombudsman’s report, Dying Without Dignity. As I read the documents, I was struck and impressed by their general agreement that palliative care at the end of life involves more than simply the relief of physical pain, crucial though of course that is. Suffering is not always the same as pain and it is often more difficult to ease, which is why the word “holistic” is often used to describe the kind of care that is needed. I cite as an example the NICE quality standard which is regarded by NHS England as,

“a comprehensive picture of what high quality end of life care should look like”.

In particular, as we have been reminded by the noble Lord, Lord Farmer, reference is made to spiritual and religious support not only for patients but for relatives, carers and staff. Such support is an essential element in end of life care. Religious needs are those experienced by people with specific beliefs, such as Christian, Jewish or Muslim. Spiritual needs are more generic; they are experienced by everyone regardless of belief, and since the early 1990s there has been a growing recognition of the importance of spirituality in palliative care, not least in most of our hospices.

So, at a time when some are questioning the need for healthcare chaplains, I suggest that recent reports actually make a compelling case for their retention. Their special training and expertise equip them to offer compassionate spiritual care to everyone, as well as religious care to those who need it; and “everyone” includes relatives and staff. Compassion is something of a buzzword in the NHS these days, and it has very close links with spirituality. For that to be effective, though, it is essential that chaplains should be included in end of life plans for patients and are treated as full members of multidisciplinary care teams. In many trusts that is already regarded as standard practice. Last week, for instance, I was talking with a palliative consultant who is the end of life lead in a large hospital in the north of England. She mentioned the electronic order sets which automatically trigger requests to the chaplaincy team and to the end of life nurse. That, she said, has made an amazing difference, and has meant that every patient dying in that trust has access to a chaplain. There are also a growing number of chaplains attached to health centres who are able to care for dying patients in the community, which, as the noble Lord, Lord Farmer, reminded us, is where most people want to die, but where at present 50% do not.

However, that is not a universal picture. As the ombudsman’s report indicates, the quality of end of life care is patchy, and that is true spiritually as well as physically. As we have been reminded, there will of course be a further opportunity to consider this tomorrow, but meanwhile I am very grateful for this opportunity to pay tribute to the contribution made by chaplains and their army of volunteers to end of life care in this country, not least by promoting compassion and respecting the dignity of everyone involved. So, may I ask the Minister whether he agrees that it is desperately important that we should take their work seriously if the holistic care we offer to all is not only to remain at the top of the league, but also to go on improving in the years to come?

My Lords, sadly, the ombudsman’s report documents many instances of poor care, poor communication, a lack of active review of cases and inappropriate discharge from hospital. However, I take issue with a statement in the conclusion:

“How we die is part of the core business of the NHS”.

As one who practises medicine and surgery I do not recognise this, as the core business for me was to save lives and prevent death. Death and dying should ideally take place in quiet surroundings with people we love and care for around us. That is at home or in a hospice, as has already been mentioned. We should do more to increase financial support for the nation’s hospices. What are the finances? In 2010-11 we spent £460 million on adult palliative care and end of life care, but there are wide variations with some areas spending £186 per death on specialist care and others £6,213 per death—a wide variation, as I have said. Some 61% of the PCTs at that time spent less than £1,000 per death. Will the Minister say what the latest costs are and whether the variations have been ironed out?

Another issue is that of training for all healthcare workers—doctors, nurses, care assistants and even porters—in dealing with patients who are terminally ill. For doctors, breaking bad news can be a challenge for many. The Royal College of Surgeons in its MRCS examination has a communications bay marked, “Breaking bad news”, where we use actors to simulate patients or relatives so that we can put the trainees through a process where they have to break bad news to patients and react when the patients react adversely. It is important that this is not limited to examinations but is refreshed as part of continuing professional development.

Finally, all of this care must be delivered on a seven-day basis, and preferably with access to specialist palliative advice 24/7. The challenge is how to achieve this without the introduction of a seven-day service, and we know the deliberations that are going on at the moment vis-à-vis the junior doctors’ contract. It was a common occurrence to have dying patients referred by their GPs for admission on a Friday. I recognise that many of the people who were admitted on a Friday would subsequently die. So when we are considering mortality at the weekends, it is important that we bear this in mind. As has been said, one of the drivers for seven-day working is to try to reduce mortality at weekends. Hospital admissions in the last year of life cost the NHS £1.3 billion for adults and £18.2 million for children. Transferring some of these costs to the community and commissioning more hospice care may not only generate savings, but provide for the kind of death that 74% of patients desire. But as the right reverend Prelate said, 58% find that they end up in hospital. I therefore support the words of the noble Lord, Lord Farmer.

My Lords, end of life care must encompass body, mind and spirit. Minimising suffering in the final days, weeks and months of life once a cure is no longer possible is not just a medical task, it is also the chance to support each person to let go of life and experience a sense of completion, which may require support with physical, psychological, cultural and/or spiritual concerns.

If a palliative care service is to be available in every kind of healthcare setting seven days a week, there will need to be changes to the current system. Continuity of support will also be an important ingredient in the recipe, just as it is in the support needed at the beginning of life. In birth and in death, there is a comfort that comes with knowing that the person who is caring for you knows what is important to you. The Liverpool care pathway was an attempt to standardise and improve end of life care. The intention was good but, as we have seen time and time again both inside and outside medicine, where initiatives are not funded properly and are without sufficient training and supervision, protocol-based practice becomes a tick-box exercise and stifles creative thinking. End of life care needs to be flexible and creative. It is about responding to the needs of an individual. Some of those needs will be unexpected, requiring access to 24-hour support, be that telephone advice or access to a doctor or nurse.

There is no doubt in my mind that accessible and equitable palliative care services are required across England, just like other services that are fully NHS-funded. This morning I received some advertising material in the post from Macmillan. It made the point that in the south-east of England, it has only enough nurses to help around 25% of people with cancer. It is raising charitable money to subsidise the care provided for people with cancer at the end of their life.

Wales is a trailblazer and is already providing seven-day specialist care services, but it is critical that geographical equity also translates into equal access for all individuals in our society, not just for those who are better informed or who can shout the loudest. People with learning disabilities, children, individuals with severe mental illness and all those who do not at first come to mind when thinking about someone who is dying need to be explicitly considered. I was teaching some GPs in a hospice, one of whom said, “But people with learning disabilities don’t get cancer, do they?”. There is still quite a lot of ignorance, as the Minister is well aware, and the needs of some people in society are overlooked. Will he reassure us that the needs of these groups will also be taken into account in any new health policy about end of life care?

My Lords, I understand that the noble Lord, Lord Suri, is not able to be present for this discussion, but I promise not to extend my contribution by the minutes thereby freed. I am grateful to the noble Lord, Lord Farmer, for initiating this debate, and I apologise that I am not going to touch on matters that are directly to do with spirituality. I shall leave that to those who have done so—my right reverend friend and others—because I want to focus on one particular aspect of end-of-life care: what goes on in Her Majesty’s prisons, for which I am bishop.

The Justice Committee of the other place produced a report at the end of the previous Parliament on older prisoners. It highlighted a number of matters associated with an ageing prison population, of which palliative care is one. I am glad to say that that report had a generally positive response from the previous Secretary of State, and I have every hope that the current Secretary of State will build upon that.

This is not just about older prisoners, because the health profile of offenders is such that we have within our prison estate a fair number of younger prisoners who are in the end-of-life phase, so it is a matter of significance within the whole of the prison estate. As I visit prisons fairly regularly in my role as bishop to Her Majesty’s prisons and talk to people in the sector, it is clear to me that this is an area of growing concern within the prison estate and that this concern is shared between the Ministry of Justice and the Department of Health. There is some good work going on. I have come across good involvement of voluntary sector agencies, among them Age UK and Macmillan, working across and through the prison gate in various ways. There is also the work of healthcare departments in prisons—I speak as the spouse of a former head of healthcare in the Prison Service—and the chaplaincy, alongside their regular work, is an important aspect of this.

We now have 10 palliative care suites in prisons up and down the land. Last night I was speaking to the governor of a prison about the importance of the palliative care suite in his prison. This leads me to ask the Minister two questions. First, do Her Majesty’s Government intend to report at some stage on progress arising out of the report into older prisoners and the issues that arise as a result of an ageing prison population, and are some of the things that the previous Secretary of State for Justice indicated might happen indeed happening in response to that ageing prison population, with palliative care as one of those elements? Secondly, do Her Majesty’s Government have plans to establish further palliative care suites within prisons such that a sufficient number of prisons have end-of-life care available to prisoners who need it, bearing in mind that for many of our older prisoners, sadly, prison is the place that they regard as home?

My Lords, it is with great pleasure that I offer my support to the noble Lord, Lord Farmer, and thank him for initiating this very interesting debate. Access to the best possible care at the end of life is surely the test of any civilised country and the value it puts on the life of its citizens.

I, too, pay tribute to the splendid work of the hospice movement. My own dear mother died in the Bournville hospice in Birmingham and it was then that I learnt just how important and effective good palliative care can be. Dying without pain and yet retaining full consciousness and the ability to speak to one’s loved ones, as she did, is truly a priceless gift. It gave her peace as she left us and eased the pain of loss for those of us who loved her. As the right reverend Prelate the Bishop of Carlisle said, good palliative care in a Christian hospice such as the one where my mother died deals with much more than physical pain; it deals with the spiritual issues that the dying person is still wrestling with. I also very much welcome the growth of the hospice at home movement and the wonderful work of Macmillan and Marie Curie nurses, which allows people to die with good palliative care at home.

I wonder why the gift of good palliative care is too often denied to those who die in hospital. Too often proper pain relief is not given, or given in such a way that the patient is at best semi-conscious. A death like that lacks dignity and causes lasting painful memories for the bereaved. I cannot see any major obstacles to providing the training and tools for all doctors and nurses, and all hospitals, to raise standards of care for the dying. It is a case of asking not for more money but simply for a change in training and in attitude.

I understand what my noble friend Lord Ribeiro said. Hospitals are about saving lives, not losing them, and in the long term I would love to see a move away from dying in hospital to dying at home or in a hospice. But in the mean time it is apparent that many of us will end our lives in hospital. So while we work to change this, we cannot delay the work of changing the experience now of those who will still face a hospital death.

I have been very moved by the briefing that most of us have received about the needs of children with fatal illness. I have huge respect for the doctors and consultants who must deal daily with such tragic cases, and they need every ounce of support and training to enable them to give the best care to their young patients. Every paediatrician and paediatric nurse should have specialised knowledge of palliative care as, sadly, all will encounter children who cannot be cured. I know that for many who work with children, death is seen as a dreadful failure. It can, however, be turned into a triumph of the human spirit if those last months and days are made into a rich, pain-free cherishing of a young life, every moment of which, to parents and siblings, is, and remains to the end, infinitely precious.

The way in which we die is perhaps the most important part of the way we live. I hope that every action of those who run the health service and the related care services will demonstrate the value of every life to the end. No better way can be given than by ensuring that universal palliative care is available to all.

My Lords, I too congratulate the noble Lord, Lord Farmer, for his immaculate timing in having this debate and for his very wise words. There is little doubt that hospices do a wonderful job, and I for one am lost in admiration for the way they go about caring for dying patients. However, hospices care for only about 3% or 4% of dying patients, and more than 50% finish up in acute hospitals. These hospitals often do a very good job, but they have some problems. For one, they have young doctors and nurses who are ill prepared to deal with death. Too often they have not yet gained the confidence which is needed to give the care and compassion which are so vital. On top of that, they have to deal with their own sense of inadequacy when faced with dying patients. It is not easy. It is no help that they are distracted by having to rush around to deal with seriously ill patients and that they have to focus on saving someone’s life rather than helping someone else to die.

None of that is an excuse for the failing standards, and it is not possible to read the ombudsman’s report with any degree of equanimity. Indeed, as someone who has spent much of his life trying to educate medical students and train post-graduates in the proper practice of medicine, I feel deeply ashamed. As an aside, I should say that there is a peculiar fear that giving adequate doses of morphine for pain relief is somehow dangerous. The correct dose of morphine is that which relieves a patient’s pain, and there is no excuse for withholding it when it is needed. I feel some sympathy for Woody Allen, who said, “I don’t mind dying, but I don’t want to be there when it happens”.

Despite the fact that there is absolutely no shortage of guidelines on how to care for the dying, there is still a huge gap between what we can do and know should be done, and what is actually achieved in too many places. First, it is clear that many patients would prefer to die at home, as many have said. It is obvious that too few social services and primary care facilities can cope with the heavy demand that this sort of care puts on them. Hospices at home can be very successful—as they are in several places, as the noble Lord, Lord Farmer, and my noble friend Lord Judd mentioned—but we need to provide more resources to spread that good practice.

Secondly, we must face an obvious lack of the leadership that is needed in hospitals to ensure that palliative care services are provided in a timely and effective way. We need someone with clout to take responsibility to oversee this service, somebody everyone knows and can turn to when needed. Thirdly, we must place much more emphasis on education and training. This is an area of clinical practice which you cannot just pick up as you go along. You need high-quality training by experts, and it is good to see that tomorrow’s Bill emphasises this. Finally, we have to make sure that CCGs, trusts and those with the money take responsibility for these services being funded, delivered and monitored. Are the tariffs for palliative care adequate? Are these services monitored, and by whom? Many questions are being raised in this debate, and we have to answer them if we are to be judged to be a society that cares for its most vulnerable citizens. I very much look forward to the Minister’s response.

My Lords, first, I congratulate my noble friend Lord Farmer for raising this debate. As my noble friend Lady Perry of Southwark said, the way we die is as important as the way we live. Nothing can be more important. Dying Without Dignity, which was produced by the Parliamentary and Health Service Ombudsman, shed light on a number of cases which were unacceptable and quite shocking, but we should take some comfort from the fact that we have a high degree of transparency. We are prepared to reveal things when they go wrong, and only by doing so can we learn from them and do better.

There are 350,000 expected deaths in England each year. Of this group, many people will require high-quality generalist end-of-life care, and 170,000 will require specialist palliative care. Many of these people receive good care at the end of their life. The fact that there are 12 unacceptable instances in the PHSO’s report should not lead us to believe that that is normal for most people. The most recent National Survey of Bereaved People (VOICES) report showed that three out of four people—75%—rated the overall quality of end-of-life care for their relative as outstanding, excellent or good. I accept that that 75% figure means that 25% of people did not have a good end of life.

Research by the Economist Intelligence Unit, which noble Lords have referred to in this debate, showed that the UK came out top of all 80 countries that were surveyed. Sometimes I feel that those of us who work closely with the NHS tend to beat ourselves up a bit more than we should. However, the fact is that end-of-life care is incredibly difficult. It is very difficult to manage; each case is very different. Therefore, that we come top in that world ranking is very important. One interesting part of that report is that,

“The biggest problem that persists is that our healthcare systems are designed to provide acute care when what we need is chronic care. That’s still the case almost everywhere in the world”.

The CQC has recently begun inspecting hospices. The chief inspector for the CQC said:

“I know from what my inspectors are finding”,

that,

“hospices provide amazing care and support for people at the end of their lives”.

More than 90% of hospices that it has inspected have been rated as good or outstanding.

It is quite easy to think that all deaths in hospital are bad and that somehow all deaths in hospital should be moved to a hospice or to people’s homes. It may be true that that is where most people want to go. However, I can give my experience of my mother, who died quite recently after 14 days in hospital. I can hardly imagine how someone in her state could have been treated at home. She needed constant changes of her oxygen levels, she had to be switched from dry to wet, and her pain relief—diamorphine—had to be changed constantly. You could have that care at home, but it would require 24/7 care at home from trained nurses with a doctor on call. My noble friend Lord Ribeiro referred to seven-day care, and there was seven-day care. In many of our hospitals we provide seven-day care. She had seven-day care with a senior consultant present throughout her stay, including over the two weekends she was there.

Last year, we introduced the five priorities for the care of the dying person to embed these principles in all end-of-life care settings, and we have seen widespread engagement from clinicians across the system to make those priorities a reality. This new approach replaced the use of the Liverpool care pathway, which was comprehensively phased out in July 2014. I echo the words of the noble Baroness, Lady Hollins, who said that many nurses and doctors implemented the spirit as well as the letter of the Liverpool care pathway. Of course, she is right that protocols and tick-boxes can sometimes drive the spirit out of what was originally intended. However, I know from experience that many nurses—Macmillan nurses and palliative care nurses—used the Liverpool care pathway in the way that it was originally intended to be used. On the other point that the noble Baroness raised about inequalities—she referred to people with learning difficulties—the CQC will undertake a thematic inspection that will report next year to look at inequalities and variations in the way that end-of-life care is administered, so she may wish to speak to the CQC and contribute to that.

I know that spiritual concerns, as raised by my noble friend Lord Farmer and other noble Lords, are particularly important to people at this time in their life, and the priorities reflect that importance. They rightly emphasise that care planning at the end of life must take account of the dying person’s spiritual and religious needs as well as their physical, emotional and psychological needs. If we are honest, we do not do dying well, but that is because it is extremely difficult to do well. It raises all kinds of emotions, such as guilt, as well as the sadness that is inevitable around a person’s death.

The right reverend Prelate the Bishop of Carlisle raised the incredibly important work that chaplains do in hospitals, and I agree with him wholeheartedly. Not just chaplains but the whole mass of volunteers who work with them give comfort and support not only to relatives and those who are dying, but also to the staff in hospitals who have to work closely in very distressing circumstances.

I would also like to highlight the work being done by the Dying Matters campaign, which focuses on raising awareness of issues around death and dying and encourages people to plan earlier and think about what is important to them at the end of life. I wonder how many people in this Room have realised only when someone close to them has died that there were things they wanted to say, but never said, and by then, of course, it is too late. I suspect it is part of the human condition.

We know high-quality care relies on good care co-ordination and planning tailored to individual needs and preferences. Electronic palliative care records, “e-packs”, which the noble Baroness, Lady Walmsley, referred to are a very important part of that, so that when someone has expressed a wish it is recorded and does not have to be repeated umpteen times to paramedics, A&E doctors, geriatric doctors and the like. I would like to come back to this in more detail if I can, but I am told that some 70% of CCGs have now got this programme under way.

I am also encouraged by CQC’s new approach to inspection and its welcome focus on end-of-life care. All CQC inspections of hospitals include looking at end-of-life care. Already a number of care providers have been inspected, including hospitals, hospices, care homes and GP practices. Not only has this identified areas for improvement, but it also allows CQC to highlight and celebrate excellent care where it exists. I reiterate that transparency is a very important part of the approach of this Government to all aspects of healthcare.

My noble friend also raised the important issue of guaranteeing access to a level of social care that ensures that the end of life is valued. We recognise the vital role that social care support plays for many people approaching the end of life and their families and carers. Timely access to a high-quality and responsive social care system is critical in supporting people to die in their setting of choice at the end of their life. It also helps to avoid traumatic and unnecessary admissions to hospital. Interestingly, the Economist Intelligence Unit report says,

“People have woken up to the fact that we may be able to save money overall to society by investing in dying better”.

We should perhaps not be talking about saving money. Nevertheless, it is often not only better for the individual, but can be cheaper if we provide better care outside acute hospitals. That is true, of course, in the treatment of many chronic conditions as well.

We want to give people more control over the health and care services they receive, including end-of-life care. We have been promoting greater personalisation in how services can be accessed. This means building support around individuals and providing them with more choice, control and flexibility in the way they access and receive care and support.

Once again, as I conclude, I thank my noble friend for highlighting this vital issue. I think there is a huge measure of cross-party agreement in this area and I look forward to discussing it further in the debate tomorrow with the noble Baroness, Lady Finlay, who is in the Room today. I end by saying that the Government are fully committed to improving standards across palliative and end-of-life care services.

Sitting suspended.

Nuclear Technology

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of the relative merits of different forms of nuclear technology.

My Lords, it is a pleasure and an honour to introduce this debate on the merits of nuclear technologies, and I thank other noble Lords in advance for taking part in it.

I start from a position of great perplexity. I read and hear a lot about different nuclear technologies—fission or fusion, uranium or thorium, light water or heavy water, salt or metal, water or gas, pressurised or boiling. Although I can follow some of the details, I have not really the foggiest idea which one to recommend or champion. I do not expect the Minister to banish my perplexity, but I hope that this afternoon we may suggest a way to let the answer emerge through a sort of bake-off, if you like.

This topic is important because there is both a strong case and an urgent opportunity for the UK to regain its technology leadership in nuclear power. The only way we will bring down the cost of nuclear technology is with new designs and new ways of regulating them. New technologies change the world not when they are invented but when they get cheap. Computing and air travel have been around for a very long time, but it is only when they became dramatically cheaper that they noticeably increased living standards.

In this respect, nuclear power stands out as a glaring exception. It was invented 70 years ago but has failed to get cheaper. That is why it is currently declining—yes, declining—as a percentage of world primary energy. Imagine if we could make nuclear power genuinely cheap. We would make fossil fuels obsolete, we could stop spending billions of pounds a year on futile and regressive renewables subsidies and we would eradicate fuel poverty and all emissions.

Building stations such as Hinkley Point will not make nuclear power cheaper because we are locked into a very high price for a very long time for the electricity, a price that looked reasonable if you assumed very high oil prices, but in fact oil prices came down. Because Hinkley is one of a kind, there is virtually no chance to get the price down by learning by doing. However, this is not a debate about Hinkley, so I shall stop there.

How do prices come down in other areas of technology? In a phrase, innovation through trial and error. That is what brought down the price of shale gas, semiconductors and air fares. Therein lies the problem. We cannot allow errors in nuclear power, so we cannot allow trials. We build excessive safety in from the start and we overengineer and underinnovate as a result. However, that is not a problem unique to nuclear power. Aeroplane manufacturers have faced essentially the same issue and, thanks to complex system analysis, they have cracked it. They innovate without accidents. So something is wrong with the way we are regulating nuclear.

As Professor Eric McFarland of the University of Queensland wrote in the Wall Street Journal earlier this year,

“what holds back nuclear power is its high cost, which is almost entirely due to government regulations and restrictions that have kept the industry confined to minor yet expensive improvements to existing reactor designs. Out-of-the-box thinking on new reactor concepts that could be far cheaper and safer is systemically discouraged … Today’s light-water nuclear reactors are constrained by government regulations and agencies appropriate for the 1950s to look much like those built for the production of isotopes for weapons—not because these are the lowest-cost power-reactor designs or the best and safest fuel cycles, rather because these are what we have built a gargantuan regulatory framework to accommodate”.

That does not mean that we should lower our safety standards, but it means that the Government should recognise that misregulation is preventing the invention of inherently safer, as well as dramatically cheaper, designs. Whichever country unleashes that nuclear innovation will reap rich rewards. The world is awash with potential designs for better nuclear power plants—molten salts, accelerator driven, thorium, small modular, fast, and so on—but hardly any of them gets beyond the design stage. They remain PowerPoint reactors, in the joke terminology. That is because of the immense cost of getting to the stage of building a reactor, in particular the generic design assessment cost of about £100 million in this country.

I shall focus now on small modular reactors, which hold real promise of getting costs down because of the ability to roll them off the production line and not make each one a unique project. In theory they can slot into egg crates at sites, so as to build up a large capacity in small steps. They can be up and running within a few years, allowing a return on capital and bringing the finance costs within reach of normal capital markets. They can also be located inland rather than on coastal sites.

We are going to hear more, I think, about small modular reactors from a number of noble Lords this afternoon, including the noble Lords, Lord O’Neill and Lord Rees. In short, small modular reactors could do for nuclear what Samuel Colt did for firearms. Interchangeable parts have done amazing things for the affordability of other technologies and they could do the same for nuclear. They could also possibly allow us to experiment with other technologies, because in some ways small modular is not itself a technology but a vehicle for technologies.

However, here is the obstacle. A 300-megawatt small modular reactor faces almost the same general design assessment as a four-gigawatt leviathan, and the same ludicrously long time to qualify—four years or so. That is the hump that the Government have to help them to get over, and that is what is keeping small modular reactors in PowerPoint form. In their response to the House of Commons Energy and Climate Change Committee last year, the Government promised to look at the generic design assessment process for SMRs. What fruit has that investigation born?

The National Nuclear Laboratory, in a report last year, concluded that there is a significant global market for small modular reactors valued at £250 billion to £400 billion. It reckoned that there are four technologies for PWR SMRs that could be viable within 10 years. They require £500 million to £1 billion to reach production-level maturity over a period of five to seven years. The report identifies,

“an opportunity for the UK to regain technology leadership in the ownership and development of low-carbon generation and secure energy supplies through investment in SMRs”.

As Candida Whitmill of Penultimate Power wrote in a paper for Civitas last year, we should look at what the US is doing. In January 2012, the Department of Energy in the US announced a competition to incentivise the first commercial SMR, offering $452 million over five years on a 50% match-funding basis for successful projects. It also provided the site at Clinch River free of charge.

Instead of spending £100 billion by 2030, forcing poor people to disproportionately subsidise the incomes of wealthy investors in fringe technologies like wind and solar—I know that the noble Baroness, Lady Worthington, was expecting me to say that—let us spend a chunk of money on bringing forward SMRs and on proper, well-funded research into the alternatives, including molten salt reactors, thorium and accelerator-driven designs. We could potentially win a commercial jackpot for the British nuclear industry.

I add one final note on fusion. I know that fusion has been 40 years away for 40 years, but there is good reason to think that may be changing. There is exciting new science, which we heard about at the Science and Technology Select Committee, suggesting that a far lower field strength is necessary because of spherical tokamaks and high-temperature superconductors. Here again, the vital thing is surely to let a thousand small flowers bloom. There is a rash of exciting new start-ups, which threaten to do to public sector fusion what Craig Venter did to genomics 17 years ago—that is, dramatically cut the costs and accelerate the progress. I suspect that we will hear more about this from the noble Lord, Lord Hunt of Chesterton, so I will not go on. We are as well-placed as almost any nation to benefit if we take the plunge into new technology in nuclear, but we must consider taking that plunge.

My Lords, I am happy to follow the noble Viscount, Lord Ridley; I do not always say that, but on this issue there is a fair measure of agreement. There is a sense of hand-wringing on the nuclear issue. Somehow Britain has lost its way in respect of reactors. I just want to make the point that we are still among the leaders in safety—although it was suggested that we may be overegging the pudding. We are also probably better placed than anyone else to offer decommissioning services. In matters of regulation, you might say that the Nuclear Installations Inspectorate has a status akin to the FDA in the United States in relation to medicines and drugs. We are regarded as the gold standard.

There are therefore a number of positives. The UK produces reactors and our nuclear submarines use Rolls-Royce reactors. They are not necessarily the ideal reactor for what we are talking about in terms of small, modular kit but I am sure that the company’s skill base reflects its ability. If Rolls-Royce was put to the task, I am sure that it could respond. I think we are all aware that a very active part of the longer-term Rolls-Royce strategy is to get involved in this area. It is also an interesting strategy because it addresses one of the fundamental concerns that people have about nuclear power—namely, that it is somehow linked with nuclear weapons. We would be talking about an exclusively civilian technology. In the case of Rolls-Royce, it would be a classic example of turning swords into ploughshares. For these reasons, it would be a great opportunity.

We have this capability. The Chinese have recognised our regulatory capability, which is one of the reasons they want to get involved. If we can produce kit that is meeting our standards, it will be acceptable pretty well across the globe. Let us face it, we are not talking here about UK consumption of this kit in a big way. We are talking about an export market, which at the most fundamental level could transform sub-Saharan Africa. We could have these small pieces of nuclear equipment placed beside the sea, for example, where it could be used for desalination purposes, which could assist in the transformation of the agriculture of the area. They could be placed as they are in remote communities. At the moment, the Russians put reactors on ships. In the area south of Vladivostok they link them into isolated communities that are not capable of being linked to any Russian grid. There are a lot of opportunities, and there will be some for use in the United Kingdom of a limited character.

In conclusion, the nuclear industry is normally associated with gigantism. Frankly, I favour large 3,000 megawatt stations, which can do a very important job in sustaining baseload electric requirements in this country, but the fact is that we need to have a diversified portfolio of production. For my money, this affords us a great opportunity. I should like to hear what the Government have to say about the medium term in this area. I do not think that at present there is any great political divide on the issue. We had the anxieties at the beginning of the coalition period over the lost opportunity at Sheffield that a number of us felt, but the foundry issue is a thing of the past. We are now looking at taking advantage of the new metals and the new carbon technologies to bring together high-quality engineering that can be placed at the service of the power industries. Today’s very short debate gives us an opportunity to give an airing to this, and I hope that in the course of the Session other opportunities will arise.

My Lords, I should make it clear that I am speaking in an entirely personal capacity, neither as chair of the EU Energy and Environment Sub-Committee nor as a spokesman for my party. Energy policy clearly needs to be based on three pillars, the so-called energy trilemma: the balance of security of supply, affordability and environmental considerations. As my committee’s 2013 report made clear, the interests of all those are best served by having diversity in sources of supply. Unlike the noble Viscount, I am a fan of renewables and I should like to see much more emphasis on energy efficiency, but I believe that non-renewables will have to provide the baseload for our electricity supply well into the foreseeable future.

As a councillor in Suffolk in the 1990s, I opposed new capacity at Sizewell but in the intervening years I have changed my view. I am far more worried now about the threat of climate change, and I cannot see a decarbonised future for this country which does not involve nuclear. For me, Fukushima and the subsequent stress tests which were carried out across Europe have made me more confident about UK capacity in nuclear, not less.

Despite the fanfare of recent days, I am not at all convinced that Hinkley Point C will ever lead to new plant at Sizewell and Bradwell. I think that they are too large, too expensive and too uncertain. Similar designs in France and Finland are now years overdue. There are also questions around whether it is sensible to put all your energy security eggs into one foreign country’s basket. It is a questionable policy, particularly in a country that is lacking in transparency. It seems that, in this as in a number of other things, we have become beguiled by size. Projects on this scale require huge capital investment and are difficult to control in terms of their costs. Local people have to endure an enormously disruptive period while construction takes place.

Last week the Institution of Mechanical Engineers published the results of some polling. It was encouraging from our perspective to note that 56% expressed themselves as being in favour of nuclear energy, but 44% said that they would protest if anything was built within 10 miles of their homes. I have often wondered whether people would feel quite so strongly if we could think about these things on a rather smaller scale. So, like other noble Lords, this has brought me back to the question of small modular reactors, which have already been mentioned. The 2015 World Nuclear Association report describes how SMRs are built in factory settings in modular forms, and I think that that is where the real economies of scale come in; they are economies of volume rather than of size. The Nuclear Industry Association describes the delivery of 16 gigawatts of new build as its key priority. The fact that SMRs can be co-located with existing nuclear structures is a huge advantage in terms of working with communities that are used to nuclear facilities; there is a local and regional supply chain and skills base; and of course there are big cost advantages in being able to connect to the grid. As a win-win, the significant amount of heat that is generated can be used to supply local district heating for the community. Moreover, the “passive safety” features, which mean that little human intervention is required in the case of an accident, are a real plus.

For decarbonisation, particularly as our coal-fired stations come out of commission, light water reactors have the potential to be a really important replacement. I note key developments in the United States from Babcock and Wilcox with a 180 megawatt pressurised water reactor and Holtec with a 140 megawatt plant. I would be interested in the Minister’s comments about integral fast reactors, which in effect reprocess existing waste not just from plants but also from weapons. Hitachi has told the Government that it could have a plant up and running in Sellafield within five years, and I would like to hear a little more about that. I am also very interested to learn how the Government are moving forward with regard to small modular reactors. The chief scientific officer at Rolls-Royce believes that they could come onstream in five to seven years. The Chancellor recently announced a £50 million research programme and I would like some more detail about that, particularly with regard to the development of a robust regulatory framework and design assessment. There really is no need for us all to keep reinventing the wheel.

My Lords, I congratulate my noble friend on initiating this important debate in the week we have signed a deal with China to permit the EDF nuclear reactor at Hinkley Point to go ahead. If we are to reduce carbon emissions by 80% by 2050, as far as electricity generation is concerned, it means doing away with all hydrocarbon-based generation: coal, gas and oil. The only carbon-free electricity generation is from renewables, which means wind farms and solar, and from nuclear. Currently, nuclear supplies 20% of UK electricity. Some 16 gigawatts of new nuclear is being planned by the Government, but that is largely to replace our existing nuclear power stations. We therefore need a large influx of new nuclear to provide for our needs. Renewables cannot do it on their own.

I welcome the deal to build the huge 1,600 megawatt behemoth at Hinkley Point. The design is based on the reactor being built at Flamanville in France, which was initially costed at €3.3 billion and due to open by 2012. Earlier this year, EDF said that it would be operating by 2018 and would cost €10.5 billion, but it has now said 2020 and we have no idea what the cost will be. When I first looked at Hinkley Point, it was costed at £10 billion; then it was £12 billion, then £16 billion. The latest reports all state £24.5 billion, but yesterday the deal officially stuck with the figure of £18 billion. This is not a criticism of EDF in any way but an inevitable consequence of trying a new design for a massive reactor and of a nuclear inspectorate in France rejecting many of the build components. Nor will Hinkley be built any faster than Flamanville in my opinion, since our nuclear inspectorate will also, rightly and naturally, be slow, careful and ruthless in checking the build. I am afraid—if I may say so mischievously—that we might be in the era of President Corbyn of the British Islamic Republic long before Hinkley Point is ever opened.

Small modular reactors are the only nuclear resource we can call upon to solve this problem, by providing reliable, relatively cheap power from about 2025 onwards. They can be factory built and installed where we need them, as well as exported into European markets and into Africa, Latin America and Asia. They will be built using the UK nuclear supply chain, unlike wind turbines. They will provide UK jobs, not French, Japanese or Chinese jobs, and long-term contracts for businesses, giving them confidence to invest in people and resources. Andrea Leadsom, the Energy Minister, said last year that these SMRs,

“have the potential to drive down the cost of nuclear energy and make financing easier through shorter construction times and lower initial capital investment requirements”.

I agree entirely, so I say to my noble friend the Minister, “Let’s get on with it”.

I understand that DECC is undertaking a second phase of work to establish the evidence base to inform government policy decisions. This includes commissioning a technical economic assessment that will run until March 2016. The assessment would be used to inform any decision on SMRs, the various designs and the commercial approach to developing them. That sounds all very well and good, but all my experience of government is that every research project concludes that more research is needed as bureaucracies seek to protect their back by never making a decision. There is a generic design slot for one SMR which could start in 2017. We must not waste too much time and we should crack on and get that slot.

It is not as if this is a radical or dangerous concept. As the noble Lord, Lord O’Neill, said, Rolls-Royce has been building off-the-shelf small nuclear reactors since 1965 for our nuclear submarines—the PWR1 and now the PWR3, which is roughly 50 megawatts. The latest US aircraft carriers will have two Bechtel A1B nuclear reactors, each capable of producing 300 megawatts. That is phenomenal power for a big boat. In other words, the new US aircraft carrier, the “Gerald R. Ford”, will produce 600 megawatts of power—36% of the output of Hinkley Point—at a cost of $10 billion for the whole boat, not just the engine. Surely to goodness that tells us something about off-the-shelf small modular reactors.

In over 60 years, there has never been an accident with either a US or British nuclear ship or power plant and they are all modular. I am told that we cannot just hoick one of these engine designs and stick them on land, because the ships use 95% enhanced uranium—near nuclear bomb level—and our land-based civilian reactors use about 5%. I do not know whether those figure are right, but my point is that we have more than 60 years of experience of building small modular reactors using one type of fuel. We would simply be asking Rolls-Royce to change from making diesel engines to petrol if we ask them to make a different type of fuel reactor. It should be a piece of cake for our engineers to build those.

Finally, I must make this point to the Minister. As Conservatives, we have gone out on a limb in backing nuclear power. If we want to deliver on this policy and show that we can create new nuclear power stations within a reasonable timescale, we have to crack on with small modular reactors. We can deliver these quickly and cheaply. It will be a huge political embarrassment for the Government I support if we do not get our first new nuclear power station operating before 2030. I commend my noble friend’s Question.

My Lords, I thank the noble Viscount, Lord Ridley, for introducing this debate. I am very pleased to be sitting next to a Lib Dem espousing the nuclear case, on which we have had different debates in the past.

Nuclear power makes a vital contribution to the electrical power around the world. At Dunkirk it also provides heat, which I believe helps the fish farming company of the noble Baroness, Lady Wilcox. As has been said, the heat from nuclear power stations is also important in the Arctic.

The IAEA estimates that nuclear fission provides 50% of all non-fossil power in the world, excluding hydro-electric. In France, 80% of the electrical power is nuclear, although for political and environmental reasons they want to reduce that to 50%. However, it is still a very high percentage.

Over the past 10 years, there has not been strong public pressure in the UK to maintain the UK as a country with advanced fission technology. That is a great pity. Now, the question for the Government is whether they want to choose nuclear fission for the future. In a sense, they have done so with the announcements made this week. However—this has always caused difficulty for many people who are concerned about nuclear power—they have not been very clear on the question of what to do with the radioactive waste. The current position is that, as in Sweden, radioactive waste will be stored in such a way that it can be retrieved and transformed into a state with a short lifetime. That would be the ideal solution. We should also recall that, as the noble Lord, Lord Blencathra, said, there have been remarkably few casualties from nuclear accidents around the world, and the number is absolutely minuscule compared with the endless effects of coal, sulphur and particles.

Meanwhile, other technologies with lower levels of waste are being developed. Fusion is the favoured option supported by the UK and Europe. The ITER project is going to cost a lot of money, at $10 billion or $15 billion, but it will be an enormous device. Last week a presentation was organised by the French embassy at the Royal Institution, where we saw a film of this extraordinary great structure already being made. The inner core measures something like 30 metres by 30 metres by 30 metres, and it will produce many thousands of megawatts of power. However, as Professor Cowley, director of the Culham Centre for Fusion Energy, said at this public occasion, this is an experiment. Of course, it has to be an experiment when it is supported by our German colleagues, who do not want nuclear power. Professor Cowley went on to say, as did his French colleague, that this experiment would turn into practical generation in around 2040 or 2050, which of course are the dates being cited by colleagues in Europe.

An alternative is to produce modular fusion. The early idea from Culham is to have a spherical reactor with a radius of the order of 1.5 metres. To answer the question about power, new physics shows that, as a device, this should be able to produce positive power before 2020 and practical power generation perhaps by 2025. We should remember that there are now a number of small companies in the United States and Canada which are aiming in the same direction, so it is not as though this is a strange British brainchild.

In the UK we have Tokamak Energy Ltd, and I declare an interest as an advisor. This is funded by largely private investors, including, recently, the Institution of Mechanical Engineers. This is not a PowerPoint; it is a real project which can be found at the Didcot industrial park, where there are two devices. It is an experiment which is running continuously, thanks to the use of high-temperature superconductors. The point about the ITER project is that it involves low-temperature superconductors, and the amount of energy required to keep the device at an incredibly low temperature is much higher. If a high temperature can be used, the dynamics are very different.

I have a major point to make to the Minister. It is extraordinary that here we have a world-beating British company but DECC does not allow this to be displayed at the IAEA annual conferences. There will be a big one next year on fusion and we are asking him for support, particularly as it is supported by the Government. Of course, there are sensitivities attached to this in that it is a small device compared with the larger ones, but I hope that the Minister can get round it.

The other point that everybody is concerned about is the fact that the UK has a very large amount of fissile material or radioactivity. I believe that in the future we should be motivated by the possibility of having hybrid fusion-fission.

My Lords, we should be grateful to the noble Viscount, Lord Ridley, for introducing this debate. It is timely because the medium-term need for nuclear power is becoming more evident and because new reactor designs are attracting more worldwide interest. It is a timely wake-up call because the UK’s indigenous expertise in relevant technologies is becoming dismayingly thin. There is strong advocacy now to enhance R&D into other kinds of low-carbon energy generation—solar, for instance—so that these become more economical and come on stream more quickly. However there is surely an equal imperative for more research, development and demonstration in the nuclear power arena, in hopes of rendering it a more economical and acceptable base-load generator than it now is.

Fifty years ago, the UK was a world leader in nuclear technology. We developed Magnox reactors in the 1950s and gas-cooled systems during the 1960s and 1970s. Thereafter, the UK played a minimal part in developing new reactor designs. Our first PWR, Sizewell B, came on line in 1995, but it was also our last. In the mid-1990s the nuclear industry was privatised with the break-up of BNFL. Government funding for nuclear R&D then fell precipitously. Research on advanced reactor designs was shelved. Indeed, the focus narrowed to maintaining the existing fleet, decommissioning and waste management. Moreover, as we are all too aware today, any of our currently commissioned power stations will be state owned—but by the French or Chinese state and not by us.

There are some bright spots. As the noble Lord, Lord O’Neill, said, we have ongoing expertise to build nuclear-powered submarines and we are international leaders in fusion research, which involves many issues in advanced materials, irradiation damage and so on that are relevant to fission as well.

Overall, however, the picture that emerged from the House of Lords Science and Technology Select Committee’s report four years ago was a deeply depressing one. The UK has a small and ageing population of experts. Our committee was told that it would be hard to replace the present generation of safety experts, who are highly regarded and widely consulted internationally, as the noble Lord, Lord O’Neill, emphasised. Even worse, we were told that our scientists and engineers would have a mere “watching brief” over developments of SMRs and Generation 4 designs—hardly an inspiring enticement to young people making a career choice. It would surely seem imprudent, and a missed opportunity, for the UK to be so sidelined. There must surely be a step-change to reverse this trend. This is in large measure because, if we are serious about achieving 80% reductions in CO2 emissions by 2050, as mandated by the Climate Change Act—as I think we should be—then nuclear power should be part of the mix. In fact, this conclusion is strengthened because the prospects for large-scale carbon capture and storage from fossil fuel-powered plants seem less bright than many of us hoped. Indeed, the DECC projections indicate that 30 to 40 gigawatts of nuclear power may be required—far more than the 16 gigawatts that current plans envisage. Were that to happen, the economics would surely need to improve. Standardisation would help and so, perhaps, would a revision of the presently over-stringent clean-up requirements.

Surely, however, innovation is key. I am not competent to assess the rival claims of the various designs; but there is no other high-tech area where one would be satisfied with 30 year-old designs. Even though the UK is one of many players, we should surely aspire to spearhead some of the developments. If we are to expand nuclear power by mid-century, we will need to make the optimal choices among the options. We are spending £2 billion a year in decommissioning Sellafield’s dreadful legacy of nuclear waste. In that perspective it is surely imprudent that the National Nuclear Laboratory cannot spend more than the current few tens of millions on R& D.

In its report the Science and Technology Committee described as “troublingly complacent” the ministerial view that the need for R&D capabilities and associated expertise in the future can be met without government intervention. I hope the Minister will comment on this.

Adapting Churchill’s famous aphorism about the Americans, one can surely hope that having made almost all possible mistaken judgments on nuclear issues over the decades, this country will at last do the right thing. This would be to spearhead enhanced R&D into fourth generation technologies so that when we really need them there is a chance that there will be an acceptable and safe option available.

My Lords, the demand for electricity is highly variable. It varies throughout the diurnal cycle of 24 hours and over the weeks, the months and the seasons of the year. The need to satisfy a demand on a large scale first arose in this country in the 1920s and 1930s. The nation responded rapidly by gathering the electricity generators into a centrally controlled system that was supported by an integrated network of electricity generation known as the national grid. The result was an ample generating capacity that was exploited effectively by the ability of the grid to supply power to the places where it was most needed, by transmitting it at high voltages with minimised losses.

Our national system served us well in this manner until the 1990s and became the envy of the industrialised world. In the 1990s, our electricity supply industry was privatised with the intention of creating a competitive market. The perverse outcome was that, very soon, the industry fell into the hands of a few large producers and into foreign ownership. In this era, the problems created by the variable demand were met by a new technology of gas-powered generation that was sustained by an ample supply of North Sea gas. It seemed to the proponents of privatisation that a centralised control of the nation’s electricity supplies was no longer needed and that the market system was appropriate to the purpose.

These fortunate circumstances are at an end. We no longer have an ample and cheap supply of gas that can be relied upon to fuel a flexible electricity supply. If we are to meet our targets for decarbonisation, we cannot continue to satisfy the base load demand with the output of coal-fired power stations. Nowadays, our demand for electricity is being met increasingly by the intermittent supply of wind power and by other renewable resources, including solar power. The problems of intermittency might be overcome if we could expect the sun to shine when the wind ceases to blow. However, the inverse correlation between these two sources is a weak and an insufficient one. Moreover, this Government seem to be intent on destroying our solar-powered resources by the removal of the subsidy incorporated in the feed-in tariff.

We might be able to mitigate these problems of an intermittent supply if we could depend on supplies from beyond our national boundaries. For these to be available, there would need to be a super grid that could transmit the power from remote locations at very high voltages. Under the conditions of a free market and given the difficulties of international co-operation, such a facility is unlikely to materialise within the foreseeable future. In such circumstances, it is difficult to see how we can easily satisfy our demand for electricity. Nevertheless, we can speculate about the ways in which the Government are intending to address the problem.

To supply the base load, they appear to be relying on the new nuclear facilities which they are hoping the French and Chinese will create for us. To meet the peak demand, they may be hoping to rely on supplies of gas that might be purchased on the international market or magicked out of the ground on which we stand by the process of fracking. At present, neither of these recourses seems to be viable. The gas from fracking is not yet available and it is doubtful whether it ever will be available in a significant quantity.

The plans for the French nationalised electricity company to build a massive nuclear power station at Hinckley Point is mired in problems, both of a political and of a technical nature. The project is exorbitantly expensive and it is likely to be affected by considerable delays. We are told that we may have to wait until 2033 to see the commissioning of the power station at Hinckley Point.

The proposals to place our nuclear future in the hands of the Chinese fills many people with grave anxiety. What other recourses are available to us to meet the demand for electricity and for power more generally? It is plausible that we should be able to meet the needs by deploying our own technical resources and by reinvigorating our nuclear industry. With sufficient government support, and possibly in collaboration with the industry of a partner nation, we should be able, within a reasonable period of time, to realise a programme for developing a small modular reactor that can be manufactured in a central location and installed on the sites of existing and defunct nuclear plants. It has also been suggested that, if these reactors were more widely dispersed and located close to centres of population, they could provide district heating via pipelines of up to 30 kilometres in length. This would greatly reduce our reliance on gas for heating, thereby contributing significantly to the process of decarbonisation.

The ability to design and construct small modular reactors within the UK has existed for many decades within Rolls-Royce and its supply chain. Rolls-Royce has produced nearly 100 reactor cores for UK submarines with an outstanding record of safety and performance. These have been conventional pressurised light-water reactors of a tried and tested design. We need to embark upon the development of such a reactor immediately while there is an opportunity to do so in advance of our competitors.

If time were available, I would also talk of the need to embark upon the development of a further generation of reactors capable of disposing of the nuclear waste of the previous and of the current generations of reactors. These would be fast breeders and thorium molten salt reactors. The next speaker might touch on these matters.

My Lords, I am extremely grateful to the noble Viscount, Lord Ridley, for securing this debate; at the time he could not have known how timely it would be. However, as he said, this should not be a debate about Hinkley, despite the temptations.

The title of the debate is very appropriate. It concerns how we assess the merits of different nuclear options. Like the noble Viscount, I have come to know about a whole range of different nuclear fuels and reactors in the time that I have been interested in this topic, and I certainly do not feel qualified to make decisions about their relative merits and which ones UK plc should pursue. It is a task for the Government to work out a way of doing this. I am intrigued by the noble Viscount’s suggestion of a nuclear bake-off; we could even get that televised. It is a very good analogy for something that needs to happen: some real-world experience with some of these reactors to see which ones can prove that they can safely bring down the costs and deliver a sustainable and competitive nuclear industry.

Like the noble Baroness, Lady Scott, I have a conversion story of having once been anti-nuclear. In fact, I was Friends of the Earth’s anti-nuclear campaigner for a period, until I realised that that was a silly idea. I then became very interested in nuclear power and deeply explored the different options, and I then became interested in novel or alternative nuclear. I am currently a patron of probably the world’s first pro-nuclear charity, the Alvin Weinberg Foundation, which I declare as an interest in this context.

I believe that there is a version of nuclear out there that has not yet been made commercially available to us and which we as a country, with such a rich heritage in R&D, ought to be involved in bringing into being, not just for our sakes but on a global scale. It is clear to me, as again the noble Baroness, Lady Scott, said, that the risk of climate change is so great that it should now be our overriding focus in decarbonising our energy systems. It is absolutely clear that nuclear can play a huge role in that. In fact, the two countries in the world that have demonstrated huge decarbonisation successfully have been France and Sweden, yet we seem to ignore that and instead look to Germany, which, through shutting down its nuclear, has made the carbon intensity of its power worse. It is evident that nuclear should be part of this.

The role that the UK can play is very important. In this case, the UK must see itself as part of Europe. Unfortunately, it does not appear that we will ever get consensus across Europe to pursue nuclear, because Austria and Germany have certainly set their minds against it. However, there will be at least nine other countries that we can collaborate with, and I think that we should now be asking Europe to enable us to do a process of co-ordinated co-operation with those member states which have pursued nuclear, to bring about harmonised regulatory standards.

When we think about novel nuclear and bringing new reactors to commercial reality, there will be absolutely no point in doing that if the total market for those reactors is in the region of 60 gigawatts in the UK. We have to have shared regulatory licensing so that we can sell into a bigger market, and we must be able to sell into other European countries. What can the Government do—and what are they doing—to pursue common regulatory standards across Europe so that we can open up a market that is far greater? The UK’s regulatory arrangements are world-class, which has been referenced by a number of noble Lords. We have a great reputation, which is why countries such as China want to come here to prove their reactors, and we have a wonderful regulatory system, which is based on outcomes, not on a tick-box approach to what a nuclear reactor ought to have, as is the case in the United States. The United States finds it very difficult to bring new designs forward because it has very rigid tick-box regulatory standards, so in fact US vendors are now looking to the UK as a place to have their new reactor designs tested. That is probably after they have done a prototype far more cheaply in China; but if they do it in China, they will still want to have it signed off and approved by a country such as the UK, which commands such international respect.

Therefore, I think that the UK has a huge role to play in bringing about a new wave of nuclear reactors. It is not fair to say that it is just regulation that has held this back. There has been quite a high level of conservatism within the industry and a tendency to stick with what it knows. The attitude of “if it isn’t broken, why fix it” has prevailed for a long time. It is now evident that certain things about the nuclear industry are not optimal. There is definitely a need to bring the cost down and to think again about the right scale on which to build our next fleet of nuclear.

I think that we have still not answered the question posed by the noble Viscount, which is so important—namely, how we are going to evaluate our options? I hope that this Government will start to do so, and that they will do so in a transparent and open way, and not start with any pre-judgment about what the answer might be. When it comes to scale, we can do anything from 3.5 gigawatts down to 10 megawatts if we want to, but what is going to be the optimal scale? Let us not rule out something at around a scale of 500 to 600 megawatts, which would slot in nicely behind coal units as they are coming offline and, indeed, would stick with the same scale as that of the Magnox reactors that we have seen closing. I do not want us to rush down to micro-scale in a vain hope that that will answer our problems. There is a whole range of options that we should evaluate. Indeed, there is a whole range of coolants that we can look at, including molten salts. In such a short time, we cannot get into the delights of molten salt coolant, but I am a great fan and I believe that it has huge merits.

I look forward to hearing from the Minister what the UK is doing to bring on R&D. I have one specific question. In the discussions with China that took place this week, was R&D mentioned? China is undertaking a huge amount of R&D. Can we collaborate with China on that?

I thank all noble Lords for an extraordinarily rich debate.

My Lords, I thank my noble friend Lord Ridley for bringing forward this debate. It is good to see so much consensus on some of the important issues that we face, particularly after yesterday. I also welcome his idea of the nuclear bake-off; I shall be speaking later to the noble Baroness, Lady Worthington, because I see a definite commercial possibility in going forward with what she suggested on television.

I will first say a little bit about Hinkley and then try to deal with the contributions made by noble Lords. At the outset, I will say that given the time constraints, I would like either to make a Written Statement on the nuclear position or alternatively, if that is not possible, to write setting out the position of what we have touched on today, and on things we have not, given that there is an awful lot that we have not touched on. I want to be able to update noble Lords on what the department is doing, which is a considerable amount.

As has been said, the debate is timely given the signing of a strategic investment agreement this week in relation to Hinkley. Let me say a little about that because it is a significant step forward in the development of the first new nuclear power station in the United Kingdom for two decades. However, that is just the beginning. As has been suggested by some noble Lords, and in particular by my noble friend Lord Ridley, this is not an either/or situation. We can have Hinkley, and, indeed, we do need Hinkley, and we can have small modular reactors. It is my belief that they are not mutually exclusive in any way. The technologies for the next tranche of nuclear power are coming forward with Hinkley, Bradwell and Sizewell.

I thank the noble Baroness, Lady Scott, for what she said about her personal view on nuclear energy, and I also thank the noble Baroness, Lady Worthington. As I say, it is very good that at least within this forum we are able to have such unity, which is important. I say that, but I will not say any more about what is happening down at the other end. Clearly, it would be very useful to have some investment certainty on the nuclear power programme as we go forward. That is important.

The decommissioning and clean-up of the United Kingdom’s civil nuclear legacy also remains a national priority. Many noble Lords touched on this and, indeed, touched on the high hazard of Sellafield and the very high costs associated with it. I believe that we have learnt the lesson of that. It remains a massive part of the budget of the Department of Energy and Climate Change, and will do so for a considerable time into the future because of the particular hazards associated with it.

Many noble Lords also raised points about research and development, including the noble Lord, Lord Rees. That is crucially important. Research and development in this area was largely halted in the middle of the last decade. The department regards this as a high priority and views it as money well spent. I will say something about that in a minute in the context of the spending review. As noble Lords are aware, the spending review process is under way and we are at a crucial period. More will be able to be said when we are on the other side of it, but substantial work has been undertaken by officials in the Department of Energy and Climate Change, the Department for Business, Innovation and Skills, the Treasury, and the Nuclear Decommissioning Authority in relation to the nuclear decommissioning issue. We are also, of course, looking at the position of research.

Looking to the longer-term future, while technologies such as fast reactors and molten salt reactors and vehicles such as small modular reactors are still a significant time away from commercial deployment, we maintain a very close interest in their development. We are not starting from scratch. The United Kingdom, as has been indicated, has a rich research and development history which covers many of these reactor technologies and fuel types. We have previously designed and operated a diverse range of research and demonstration reactors, from the fast reactor programme at Dounreay to a number of interestingly named research reactors at Winfrith in Dorset. These include Zebra, Nestor, Zenith, Hector, Juno and, indeed, Dimple. Winfrith was also the home of the high-temperature Dragon reactor which provided some of the earliest experimentation with thorium-based fuels. I know that the noble Baroness has an interest in this.

The United Kingdom is also a leading nation in fusion research, which was touched upon by the noble Lord, Lord Hunt. I will get a specific answer to him about the position regarding the International Atomic Energy Agency. I was unaware of that, as officials were as well. If there is any particular information that the noble Lord could give us after the debate, we will certainly look at it to see what is holding up or preventing a demonstration at the annual event next year. If the noble Lord could come forward with that we would be very pleased to look at it.

There is also the Culham Centre for Fusion Energy. That part of Berkshire is becoming a sort of nuclear energy hub and it is very important to foster that. The Culham Centre is the United Kingdom’s national fusion research laboratory and forms a crucial part of the worldwide fusion research programme. It hosts the Joint European Torus, which is currently the world’s largest and most powerful fusion reactor and the focal point of the European fusion research programme.

The Government can help to create the environment and the frameworks required to support nuclear development and deployment, and the department is keen to do that. We also need to underpin the regulatory framework. I note what my noble friend Lord Ridley said about the long periods of time it takes to get these projects off the ground, but I also note the comments made by the noble Lord, Lord O’Neill, in relation to our first-class safety record. Clearly, we would not want to prejudice that, so we need to try to get the right balance between the two. Safety must come first.

However, I agree that we need to march forward, specifically on small modular reactors, which was mentioned by all noble Lords and has wide backing. The Government recognise that these could offer cost reduction and massive commercial benefits to the United Kingdom, particularly through factory production processes—the egg box point—and the reduced cost of capital needed to finance projects. There is also a big advantage with siting them. Potentially they do not need to be near the sea and the process of selecting sites could therefore go forward very quickly.

An initial feasibility study was completed in December 2014 and this made a start in building the evidence base we need to take it forward. This is being further developed, as my noble friend Lord Blencathra said, through a more detailed techno-economic assessment which is to be completed in March 2016, so that is not long to wait. I know that there is an urgency about this and I will ensure that as soon as we have the information, it is relayed on to noble Lords. This assessment will enable the United Kingdom Government to understand the opportunities for delivery, including industry views on strategic partnerships if Ministers decide to support small modular reactors. The department is sympathetic to the case. We are waiting for that evidence and then we will clearly assess it. This evidence will help to crystallise the Government’s objectives for SMRs by building our understanding of how the potential for SMRs could be unlocked.

Picking up on the point made by the noble Baroness, Lady Worthington, about the need for agreement on the harmonisation of regulation, we are engaged in discussions with our European partners about this and I will try to cover it in more detail in the letter that I send to noble Lords. It is a point well made in terms of the market. Obviously we need to march forward hand-in-hand and with the same considerations.

On the points about small modular reactors made by my noble friend Lord Blencathra in relation to marine nuclear propulsion reactors, certainly they are a part of the evidence base for looking at how they could be deployed However, there are particular problems with them. As the noble Lord said himself, they are not an automatic translation to land base. They have shorter serviceable lifetimes and the relative size of individual marine reactors is much smaller—they are at the smaller end of the scale of small modular reactors. Nevertheless we are looking at that and considering it.

As to the other points that have been made, I have picked up the point about the safety standards. I should perhaps have covered earlier a point relating to Hinkley. There will be what I understand is at least a 60% supply chain for UK business, which is important. I have covered the research programme. I have covered the point of the noble Lord, Lord Hunt, on Tokamak and the position with the IEAA. If the noble Lord could bring forward more detail on that we will certainly look at the conference in 2016 to see whether we are able to help. It sounds like a very good point.

The issue of CCS was raised and it is an important part of the mix. We spent a long time on it in the Energy Bill and there has been a degree of consensus around the Chamber and with the different parties which I am anxious to keep. However, again, it is not mutually exclusive with nuclear power. It is understood and agreed that we need a diverse mix.

The noble Viscount, Lord Hanworth, quite rightly talked about some of the challenges faced and the very good record of Rolls-Royce, with which I definitely concur. The noble Baroness, Lady Worthington, raised the record of France on nuclear, which, at the moment, as other noble Lords, including the noble Lord, Lord Hunt, have pointed out, is 80% nuclear. This is declining a little to diversify but what France does is significant and we are studying that.

Perhaps I may undertake to write with more detail on some of the points that have been covered and on some of the points that were not covered on the different technologies. In closing I should thank the Nuclear Innovation and Research Advisory Board for the advice it gives to the department. It is chaired by Dame Sue Ion and provides the Government with assistance and expert advice on the R&D needed for nuclear energy, which is significant. We need R&D in order to develop our nuclear future and to be competitive. It published its first annual report in January, which recommended an R&D programme of up to £250 million over the next five years. We are considering its advice. It is a vital part of the current spending review and I hope that the Chancellor will see a copy of the record of our proceedings today.

Committee adjourned at 6.01 pm.