asked Her Majesty's Government:

My Lords, the key conditions remain as set out by allied leaders at the 1999 NATO Washington summit. We want the alliance to extend invitations to countries which are willing and able to assume the responsibilities and obligations of membership; whose inclusion would serve the overall political and strategic interests of the alliance; and whose inclusion would enhance overall European security and stability.

My Lords, I thank the Minister for that reply. However, she did not explain the overall political and strategic interests of the alliance. Some large questions underlie that. For example, does she consider that it should be a condition of membership that applicant states should be able to make a substantial contribution to NATO military forces—which would imply a limited enlargement—or, rather, that their inclusion would contribute to the broader security of the European region as a whole, which would imply a much broader enlargement?

My Lords, it is the security of the region as a whole that is crucial, but within that some specific issues may be discussed alt the Prague summit in November this year. It is a fact that threats of terrorism and weapons of mass destruction are key security challenges for the West—for us in Europe as well as for our allies in the United States. So, at Prague, as well as considering the broad strategic issues, we shall consider ways to maintain levels of interoperability between allies; we shall focus on the capabilities most needed to deal with those threats; and, of course, we shall look for new ways for Europe and the United States to work together. The threats are not just in Europe or the United States, so interoperability between the two sets of forces will be crucial.

The noble Lord should not read too much into numbers at present. The numbers, and the countries themselves, will be decided at Prague.

My Lords, is it intended that new members will subscribe to all of the articles of the NATO treaty, or will they be selective? For example, will they adhere to Article 5, which states that an attack on one of us is an attack on all of us? That was invoked after September 11th.

Yes, my Lords, they will be expected to abide by all the articles of the NATO treaty. I can also tell the noble Lord that the accession of each and every country will be a matter for ratification by member Parliaments—by this Parliament as well as by other parliaments of current member states.

My Lords, have the Government given thought to the problem of frontiers? Many of the new members—such as Poland and Hungary—have large elements of their population living outside their frontiers. The European Union demands strong frontiers. I gather that about 1 million Poles live in Belarus and Ukraine. How will the Minister explain the Government's policy with regard to a strong frontier to people who have been used to crossing frontiers to visit graveyards, attend memorials, funerals and so on?

My Lords, those issues are covered by NATO's membership action plans, which vary with individual aspirant countries according to discussion on their possible membership. Those action plans were launched at the 1999 summit and have included a clear programme of work towards meeting the standards for membership required by NATO. As the noble Lord would expect, there has been some extremely candid feedback, but the plans cover political, economic, defence, resource and security aspects, which comprehend issues about borders.

My Lords, what will be NATO's response if an applicant country points out that some existing member states may not be able to make the sort of contribution that equity would suggest is reasonable?

My Lords, that is an interesting hypothetical question. The fact is that we expect all members of NATO to live up not only to the articles of the NATO treaty, to which the noble Lord, Lord Trefgarne, referred, but to all the obligations of NATO membership. I am not sure what my noble friend has in mind in asking his question, although perhaps I may guess, but I assure your Lordships that it will be important for all countries to abide by the same standard.

My Lords, does the noble Baroness agree that, while enthusiasm among central and east European countries for EU enlargement may be a bit wobbly at the moment, their commitment to enlargement of NATO is strong, provided that NATO is not undermined by duplication, talk of autonomous forces, and so on? Did she note the speech by the chairman of the Military Committee of the European Union, General Häggland, yesterday? He rightly asked whether it made any sense for there to be parallel crisis management organisations within the region; he deplored duplication and suggested better ways to develop NATO that would be more appealing to both applicants and its present members. Is it not time for a change of policy in the direction suggested by General Haggland?

My Lords, I do not entirely accept the noble Lord's surmise about some EU countries being wobbly on enlargement. There are certainly those within countries who express some difficulties, but I do not think that EU governments as a whole are "wobbly", to use the noble Lord's word.

As for NATO, I agree that current members of NATO want it to expand, because it is vital to our collective defence. But the essential point is that NATO must adapt further if it is to continue to be relevant. In answering the supplementary question from the noble Lord, Lord Wallace of Saltaire, I mentioned interoperability and how we need to focus NATO's capabilities in new ways. But we should not view the European common security policy arrangements as either rival or duplicate arrangements. The arrangements should harmonise with and complement each other.

My Lords, will the Minister think again about the answer that she gave to my noble friend Lord Wallace of Saltaire about ratification? Is it, in fact, the case that either the United Kingdom or Canada must ratify NATO enlargement? Is that not a prerogative act in those countries?

My Lords, I specifically asked about that point and was assured that all the Parliaments of current NATO countries would be required to ratify accession. That is my understanding, but, if that is not the case, I shall write to the noble Lord and place a copy of my letter in the Library.

My Lords, does the Minister recollect how Field Marshal Lord Ismay famously described the purpose of NATO as keeping the Americans in, the Russians out and the Germans down? What is the purpose of NATO now, in the eyes of the Government?

My Lords, quite a lot has happened since those remarks were made. However, there is a serious point about the purpose of NATO. Does NATO still have a relevance today? It certainly does.

NATO's invocation of Article 5 of the Washington Treaty after 11th September sent the strongest possible sign of allied support to the United States. NATO redeployed its Mediterranean standing naval forces to the eastern Mediterranean and an airborne early warning system to the United States, freeing up United States assets for operations elsewhere. I could not give the noble Lord stronger arguments for the continued existence of NATO than those.

asked Her Majesty's Government:

My Lords, we are determined to reduce disruption from works in the street. Last April, we introduced powers allowing highway authorities to levy charges on utility works that are not completed to deadline. We are also piloting powers allowing authorities to levy lane rental on utilities for the duration of the works.

My Lords, I thank the Minister for that reply. Do Her Majesty's Government concur with the conclusion of the Institution of Civil Engineers, which recently reported that the backlog of necessary maintenance work had reached record levels, in excess of £7 billion? It was calculated that the problem would take more than eight years to rectify, ignoring any new holes in the road.

In the light of the Minister's reference to lane rentals and fines, is it not curious that local authorities and highway authorities, which together represent more than 50 per cent of those who make holes in the road, are under no financial strictures? Fines and lane rentals are paid to local authorities. Who will check up on the authorities themselves?

My Lords, I am not acquainted with the figures that the noble Lord gave for the amount of maintenance required. However, as he knows, the Government are providing over £30 billion for local road maintenance over the time-scale of the 10-year transport plan. That is £9 billion above the funding level for the previous 10 years. There is an important issue to deal with there.

As the noble Lord knows, there are lane rentals and there is overcharging, both of which are designed to improve co-ordination and reduce disruption as much as possible. That gets at some of the offenders. It is important that co-ordination improves and that the Government should set out examples of good practice and put pressure on local authorities to improve standards.

My Lords, does my noble friend agree that one of the difficulties is that the roadworks are there, causing disruption, but there is nobody doing any work? Sometimes, I think that workmen on those sites are an endangered species or a collector's item. Can we find a way of ensuring that, when the necessary roadworks are there, people get on with it?

My Lords, like my noble friend, I have seen such roadworks on many occasions. Pressure should be put on, and there should be a sense that the works must be done in the most efficient way possible, as quickly as possible. Otherwise, people get utterly fed up.

My Lords—

My Lords—

My Lords, this is a constitutional occasion. The noble Lord, Lord Peyton of Yeovil, always asks a question about holes in the road.

My Lords, as always, I am deeply obliged to the noble and learned Lord.

I thank my noble friend Lord Geddes for raising the matter. Is the Minister aware that such efforts as I have been able to make to diminish this important nuisance have, so far, had the notable but totally unwelcome effect of stimulating those responsible into digging more holes and leaving them unoccupied for longer than ever before? Can the Minister advise me on what I can do to persuade the Government to join the right side—for once—and attempt to curb that increasing nuisance?

My Lords, most of my oral briefing on the question related to the gargantuan efforts made by the noble Lord, Lord Peyton of Yeovil, to deal with the problem.

What can be done about it? The more the issue is kept to the fore, the more pressure there is on the people engaged, the local authorities and the utilities to do the work as quickly and efficiently as possible.

My Lords, bus operators are summoned increasingly frequently before the traffic commissioners to explain the unreliability of their service. Will the Minister ensure that local authorities are also summoned to explain what they are doing about roadworks and other causes of unreliability, such as traffic congestion?

My Lords, like other noble Lords, I share the noble Lord's concern that local authorities are major players in the extent to which roads are disrupted. I will pass on the noble Lord's suggestion as regards delays in relation to local bus companies.

My Lords, while sympathising with the question asked by the noble Lord, Lord Peyton, is not the real answer to his question that if he is in a hole he should stop digging?

My Lords, I sympathise with that advice.

My Lords, willl the Minister accept that not only are we talking about a nuisance but that once again motorists are being treated with contempt by the Government and those responsible? No one ever gives advice on where the works are being carried on and stopping traffic. It is not necessary to provide printed notices: all that is required is a blackboard and a piece of chalk to put a notice on public display in the right place and at the right time.

My Lords, I do not believe that the Government are displaying any contempt towards motorists. However, I entirely agree that notice is important. It is important to inform people about what is happening, why and how long it will take.

My Lords, does the Minister agree that roadworks cause traffic jams, which do not help the greener environment but cause pollution? We need to get that message across to the public in general and to the local authorities in particular so that they do not set up so many roadworks at the same time.

My Lords, I agree that roadworks almost invariably cause traffic congestion and that that is bad for a variety of reasons, including the pollution it causes. However, we are introducing charges for over-running the timetable and lane rentals in order to try to reduce what we all agree is a terrible problem.

My Lords, does the Minister agree that in Oxfordshire at present twice as many deaths are caused by pollution coming mainly from traffic as are caused by road accidents?

My Lords, I was not aware of the figures in relation to Oxfordshire.

asked Her Majesty's Government:

My Lords, the contiguous cull was legal and was carried out using powers contained in the Animal Health Act 1981. The European Commission was at all times aware of the UK's culling policy and approved of the approach. The operation of the cull was tested and upheld in the English and Scottish courts.

The number of permanent veterinary staff at the beginning of the outbreak was broadly similar in 1997. Following confirmation of foot and mouth disease in 2001 the department moved rapidly to deploy additional veterinary resources.

My Lords, does the Minister agree that the Animal Health Act 1981, which he cited, begins by stating that the Minister may, if he thinks fit, in any case cause to be slaughtered various animals and it goes on to list the categories in which the power may be exercised? Does that not imply that if in legal terms he is to be reasonable and in compliance with the Wednesbury rules on evidence, particular circumstances must be considered in each case? If that is so, how can he take the Westerhall and Winslade judgments, which the judges admit were considered on particular evidence, to apply to the blanket three-kilometre cull?

My Lords, the Question was about the contiguous cull and the Scottish judges included the three-kilometre cull. On the two occasions when the contiguous cull was tested in the courts it was upheld. There was no challenge to the general operation of the cull; therefore, all precedent indicates that the cull was legal.

My Lords, does the Minister agree that the most important aspect is that he has powers to act quickly and so contain the outbreak? Does he have those powers now?

My Lords, the Animal Health Act 1981 provides a number of powers which the Minister can use. There are some gaps in those powers which were brought to the attention of the House at the time of the the Animal Health Bill but regrettably the House rejected the proposed remedy. There is therefore some gap in our armoury.

My Lords, with respect to the third part of my noble friend's question about the shortage of veterinary personnel at the outbreak of the recent epidemic, will the Minister consider setting up an organisation, similar to the Territorial Army, of reserved trained veterinarians drawn from retired personnel from the ministry, practices and universities to supply that manpower need when an emergency such as the recent foot and mouth outbreak demands it?

My Lords, there is already such an arrangement. We were able to deploy 2,500 temporary veterinary inspectors during the course of the disease and had the help of a further 650 people from overseas. However, as the noble Lord implies, it may be sensible to put that on a more formal and mechanistic basis. We will be examining the matter in the course of the current inquiries into the conduct of the disease.

My Lords, does the Minister believe that it is now appropriate to put on record the sterling work of the veterinary service and others in the profession who in difficult circumstances did a first-class job on behalf of the British people?

My Lords, I thoroughly agree with my noble friend. I believe that the whole House will endorse what he says. In very difficult circumstances, sometimes subject to serious local pressures and criticisms, the men and women of the State Veterinary Service performed an absolutely sterling job, as did those who were temporarily deployed to tackle the horrendous disease.

My Lords, is the Minister's department now staffed to a level which could actively and effectively implement a contingency plan? How many staff of his department have taken leave of absence due to post-traumatic stress syndrome arising from the foot and mouth outbreak since November last year?

My Lords, I am not aware of statistics regarding absences. A number of people have been absent but I shall need to consult my personnel staff if it is appropriate to give a reply to that question.

The current staffing levels are as indicated in my Answer; they are broadly similar to what they were five years ago. There are some vacancies which are being filled. Indeed, we have filled a substantial number over the past four years. The interim contingency plan is operable with the number of staff provided. We can also trigger the deployment of additional resources from the private veterinary service, from students and from retired vets.

My Lords, the Minister said that he relies on theWinslade case to justify the contiguous cull. Can he tell the House what scientific evidence was made available to the court in the case which was brought at short notice, as I hope he will be able to confirm? For example, were the papers written by Professor Donaldson, of the Pirbright Institute, made available in evidence to the court before judgment was passed? If not, how can the Minister possibly say that that case justified the contiguous cull?

My Lords, I can clearly say so because that was the decision of the judge and the court on the only occasion in the English courts on which the validity of the cull has been challenged. We were successful in resisting the contiguous cull challenge. In regard to the evidence, I would need to check the books, but it was effectively the same evidence which was received by Ministers and was available to veterinary surgeons on the spot in determining exposure to the disease. That is the whole basis of the contiguous cull.

The noble Lord and those who pursue this question are raking up potential difficulties which understandably existed among those most directly involved but which hide the fact that the cull was necessary in order to contain the disease. The legality was never in question. The appropriateness of the strategy is for others to judge; nevertheless it was carried out most effectively by the State Veterinary Service.

My Lords—

My Lords—Noble Lords: Next Question!

My Lords, we must move on. There is a most important Question to come and we need to be fair to all questioners.

My Lords —

Order! Sit down!

My Lords, I know that the noble Earl is pointing at the clock. We are in the 24th minute and the noble Lord, Lord Alton, has a very important Question on the Order Paper. The noble Baroness, Lady Byford, courteously gave way.

asked Her Majesty's Government:

My Lords, Her Majesty's Government attach great importance to ensuring access to holy places throughout Israel and the Occupied Territories. We remain concerned at the continuing stand-off at the Church of the Holy Nativity in Bethlehem. Some progress has been made through negotiations, including the release of a number of civilians and the provision of food. There are indications that a formula has been found which may be acceptable to the parties. We hope to receive further news on that soon.

I should also point out that Her Majesty's Government have condemned the further appalling loss of civilian life as a result of the suicide bombing yesterday evening in Rishon le Zion. The cycle of violence has to stop. Both sides must demonstrate, through their actions, their commitment to peace. That requires a withdrawal, a sustainable ceasefire and the resumption of dialogue.

My Lords, I welcome what the Minister has said this afternoon in your Lordships' House. I agree with her that the cycle of violence will only be deepened by the appalling deaths yesterday of 15 Israeli citizens in a suicide attack. Such actions retard the objective of achieving the goal of peace. Neither the blind violence of terrorism nor the violence of war in revenge can create a way forward.

As the siege at the Church of the Holy Nativity enters its fifth week, can the Minister shed any light on the debacle which took place yesterday when the careful arrangements agreed for the removal of 13 Palestinian militants from the church and the subsequent release of the remaining captives were reduced to chaos? Can she tell noble Lords how that occurred and whether Her Majesty's Government are now playing any role in brokering a way forward? Furthermore, can she shed any light on the condition of the captives who remain in the church? What access do they have to food and water?

My Lords, the suicide bombing incident yesterday was truly appalling. We recognise that President Arafat has condemned the attack, which is welcome. However, I think that Israel has a right to expect more. President Arafat has demonstrated unequivocally that he is prepared to take action against those responsible and to try to put in place measures to prevent further attacks.

With regard to the position in Bethlehem, I understand that this matter is still under discussion. Various newspaper reports have been written about what went on yesterday. What I can say to noble Lords is that Italy is a possible final destination for some of the armed Palestinians in the church. I cannot confirm the number because that is still a matter of dispute. Secretary of State Colin Powell has been in touch with various parties and the Italian Government are considering a request to take the Palestinian militants.

At this stage, I am not in a position to comment any further. There is still a certain amount of confusion as regards who said what to whom yesterday. No doubt that confusion will unravel in due course. We must hope that a solution is found as quickly as possible. As I came into the Chamber this afternoon, the most recent update was that we still do not have a definitive position.

My Lords, we on these Benches wish to associate ourselves with the Minister's condemnation of the recent suicide bombing incident which has led to terrible casualties. We express our profound sympathy for those who have been affected.

Turning to the Question before the House, perhaps I may also ask the Minister whether, in the slightly longer term—given the peace conference that is to take place—any consideration has been given to the proposals raised at the Camp David and Taba negotiations; that is, giving international standing to the square mile which constitutes almost all of the most crucial holy places within both Israel and Palestinian territory: the Temple Mount, the Church of the Holy Nativity, the Wailing Wall and so forth? Discussions at the time turned on agreeing a form of "Vatican" settlement; that is, an area that would be neutral and guaranteed by all the great powers.

Although I realise that the Minister will not be able to respond at the moment, would she consider whether some form of international control and even some possible "internationalisation" of that small area of holy places in Jerusalem might help to move away a little from the genuine horror of the events at the Church of the Holy Nativity and, before that, the conflicts which arose over the status of and access to the Temple Mount?

I am sure that the noble Baroness knows that the status of Jerusalem and its environs which comprise and embrace the holy places mentioned by the noble Baroness has been a matter which the parties had decided would be for "final status" talks. It is a great sadness to note that, given where we are at the moment, those final status talks now appear to be little more than a remote dream. However, I hope and believe that these issues will be revisited once more.

The noble Baroness is quite right to remind the House that the United States has proposed an international conference. We very much support that proposal because we want to re-establish the political process. We do not believe that anything can be solved through this unending cycle of violence. In the course of the next few months, but before the conference is due to be held, we shall be considering all the items that should be included on a conference agenda. I am sure that the status of the holy places will form a part of those considerations.

My Lords, we on these Benches also endorse the words of the noble Baroness, deploring the senseless and appalling slaughter outside Tel Aviv last night. It represents one more swathe of blood in this ghastly scenario. However, in even uttering such words, one wonders what good it is doing: we go on wringing our hands while the situation gets worse and worse.

Following on the comments made by the noble Baroness, Lady Williams, I wish to put to the Minister one question on the matter of the holy places. Did not the Barak plan propose quite detailed arrangements in Jerusalem for safeguarding the holy places on an international basis? The plan would have assured access for all those in the four quarters of Jerusalem. Is not that the kind of plan for which we should now be striving? Regrettably, and for reasons that I still do not fully understand, Chairman Arafat and his colleagues turned the plan down.

My Lords, the fact is that the negotiations held at Camp David on the Barak plan fell short of the permanent status settlement which all parties had sought. Of course the noble Lord is right to note that both the Israeli and the Palestinian people continue to suffer as a result. However, unfortunately the issues with regard to permanent status were simply not negotiable at the time.

I think that the noble Lord was a little unfair to say that all we are doing is wringing our hands on this issue. I can assure noble Lords that my right honourable friends the Foreign Secretary and the Prime Minister are in constant touch with their opposite numbers on this issue. They are doing everything they can to argue for a peace process to be taken forward. I hope that noble Lords do not doubt my noble friends' sincerity in that endeavour.

My Lords, I beg to move the Motion standing in my name on the Order Paper.

Moved, That the debates on the Motions in the names of the Baroness Pitkeathley and the Baroness Billingham set down for today shall each be limited to two-and-a-half hours.—(Lord Williams of Mostyn.)

On Question, Motion agreed to.

My Lords, I beg to move the Motion standing in the name of my noble friend Lady Hollis of Heigham on the Order Paper.

Moved, That it be an instruction to the Grand Committee to whom the Tax Credits Bill has been committed that they consider the Bill in the following order:

• Clauses 1 to 26,
• Schedule 1,
• Clauses 27 to 32,
• Schedule 2,
• Clauses 33 to 43,
• Schedule 3,
• Clauses 44 to 47,
• Schedule 4,
• Clauses 48 to 55,
• Schedule 5,
• Clause 56,
• Schedule 6,
• Clauses 57 to 65.—(Lord Bassam of Brighton.)

On Question, Motion agreed to.

rose to call attention to the Government's 10-year plan to improve service quality in the NHS; and to move for Papers.

The noble Baroness said: My Lords, it is both a pleasure and a privilege to open this important debate this afternoon. I cannot but begin by telling your Lordships what a terribly important date this is for me personally. Exactly one year ago today, almost to the hour, I was in an operating theatre at the Middlesex Hospital undergoing the last in a long series of life-threatening operations from which, as your Lordships will see, I have made a miraculous recovery.

Hear, hear!

My Lords, so today, on this very important anniversary, noble Lords will not be surprised to learn that I come to praise the NHS, and I have every reason to do so.

On 8th May last year, I was surrounded by the most skilled of surgeons, the most well equipped of intensive care units, the most able nurses and the most committed ancillary staff that any gravely ill person could wish for. The care given to me was extended to my family, who were always kept fully informed, consulted and involved in the procedures. That care was exemplified perhaps by the nurses who came in to sit with them and me while they were waiting to see if I would recover consciousness, even they were supposed to be off duty.

Visitors who came in to see me as I began to recover were apt to say that this was the NHS at its best. It was certainly the NHS at its most magnificent, but at its best? I do not think so. Most people, I am glad to say, do not need to see the NHS as I did, but every one of us sees it constantly in our lives, and most of the time we see it at its best.

For example, we have experienced the GP who listened to us when we needed it; we may be one of the 85 per cent of people who receive free prescriptions; we may have an older relative who has received tender and loving care, as well as a hip replacement, which transformed their lives; we may be one of the 30,000 people who get a free eye test every week, and so on, and on. This is what the NHS means to most of us. My anecdotal evidence—in spite of what the media tell us and in spite of the odd bad experience which all of us could quote—shows that most people have good experiences of the health service. If they did not, would the institution be held so dear in the hearts of the majority of the population?

Most people now do not remember what life was like without the NHS but I shall never forget the story my grandmother told me which first made me realise its value. A young widow, just after the First World War, she had two small children ill with whooping cough, a killer disease in those days. She called the doctor, who came to the door and asked her before entering if she had his fee. She replied that she did not. The doctor turned and walked away. That was the situation which in 1948 the Labour Government vowed to remedy. We should all be proud of the huge progress which has been made which allows us, in some ways, to take for granted that the NHS is always there for us.

But at the beginning of the 21st century it is not enough to have a health service which provides life-saving procedures at moments of great crisis and a GP on hand when our children are sick. We must have an NHS which is fit for purpose for our life now and in the foreseeable future.

It must address the needs of an ageing population where illnesses are increasingly complex; where treatments which were once pioneering have become common place; where new drugs are constantly being developed; where access to technology has transformed all our lives; and, perhaps most of all, where patients are no longer content to be passive recipients of whatever the NHS is prepared to provide but are increasingly well informed and demanding.

The Government's 10-year plan, drawn up with patient and public involvement and endorsed by a very wide-ranging group of healthcare professionals and patient and care representatives, is a plan for delivering a health service for the 21st century. It sets out important principles—for example, that the NHS must be a universal service for all based on clinical need, not ability to pay; that it must be a comprehensive service which covers not only treatment for illness but self-care, health promotion and prevention; and that it must tackle inequalities in society. Most importantly, in my view, it also endorses the principle that the NHS must shape its services around the individual needs and preferences of individual patients, their families and their carers.

Following on from this 10-year plan, the recent Budget of my right honourable friend the Chancellor of the Exchequer provided unprecedented amounts of funding to deliver these important commitments. While we must acknowledge that decades of underfunding cannot be easily rectified, it is clear that measurable improvements will result from the huge amount of extra investment to which the Government are committed—investment which will provide 35,000 extra nurses, 15,000 extra doctors, 100 new hospitals by 2010, 500 new primary care health centres, and 7,000 extra beds in hospitals and IT.

The fact that this massive investment and the means of raising the money to pay for it have found such widespread public approval—with some 74 per cent of the population expressing approval for the decision to raise national insurance contributions to fund more spending on the NHS— shows that the basic health of the health service is seen to be good and widely supported.

I imagine that many of your Lordships were as amused as I was at the sight and sound of TV and radio reporters trying rather desperately on the days following the Budget to find people to interview who disapproved of the proposals, and for the most part failing miserably. Certain sections of I he media have, as we know, for some time now tried to promote the view that the NHS is beyond repair, that its disintegration is inevitable. This is clearly not a view endorsed by the majority of the population.

What was universally endorsed, however, by government, by NHS staff, by patients and everyone else, was that investment alone is not enough, no matter how large that investment. Money has to be accompanied by modernisation, and it is this vision of the new NHS which is set out in the document, The NHS Plan, and in the subsequent document, published on the day after the Budget,Delivering the NHS Plan.

Time is too short to cover here all the plans for modernisation, but by far the most important one, in my view, is the intention to move the bulk of the funding—75 per cent eventually—to the primary care level. I welcome this for two reasons. First, it will recognise that primary care, in your own community, in your own home, is where most healthcare happens. Almost 1 million people visit their general practitioner or the surgery every day. For most people it is their first contact with the NHS, for many their only contact, and yet we habitually talk of, and too often think of, the NHS in terms of hospitals and secondary care.

My second reason for welcoming this new emphasis on primary care is that it will enable the rhetoric of patient involvement to become reality. Patients forums and patient advocacy and liaison services are welcome innovations, but we must remember also that patients will be decision makers as non-executive directors of primary care trusts. They will also have the choice about accessing services through NHS Direct, e-mailing or phoning the practice nurse or the GP for advice, and they will be able to book appointments on line. Round-the-clock medical care will be available for minor ailments and accidents near your own home, while electronic patients' records will enable therapists and doctors to maintain continuity of care and knowledge of their patients. As someone whose medical records now stand more than a foot high in four manila folders, your Lordships can imagine that I am particularly pleased with that.

These changes in primary care will ease the pressure on hospitals so that they can concentrate on providing specialist care. In addition—what a relief this will be to patients—appointments at hospitals will be pre-booked to suit patients and tests and diagnosis will usually be carried out on the same day.

Plans which I welcome especially are those which encourage greater co-operation between health and social services to ensure smoother discharge from hospital and greater home support for those who need it. Rigid institutional boundaries between health and social services, between business and community organisations, have done no favours for patients over the years. They have particularly inhibited the ability to work productively on prevention and to tackle health inequalities.

The virtues of promoting such partnerships and the positive effect they can have on the health of a community has been very much brought home to me in my work as chair of the New Opportunities Fund, the largest of the lottery distributors. By this summer we will have allocated money for 400 healthy living centres, targeted at the most disadvantaged areas in the United Kingdom. Partnerships between the local authorities, the NHS, the private and voluntary sectors and with the communities themselves is enabling a sea change in the health of those communities, encouraging people to take responsibility for their own health, to take more exercise, to grow their own food and to deal with stress and local community problems in a way which will have a profound effect in the future on the way they use the health service.

People who are less than fully committed to the continuation of the NHS are fond of saying that however much money you put into the service itself it can never deliver adequately as the needs are too great ever to be satisfied. There may be a grain of truth in that if we continue to think of it only as a sickness service. But I know that the Government are committed to ensuring that public health features very highly on the NHS agenda, and especially to tackling the inequalities in health which continue to mar our record. Only when lifestyle, housing, education and, above all, poverty are seen as factors affecting health, and when cross-cutting approaches are adopted by all interested agencies, will we be able to bring the needs and the provision to meet the needs into balance. This is the approach the Government are adopting. Their courageous commitment to measurable improvements in both the treatment of illness and the fostering of good health will surely bring results.

But commitment to modernisation in these and many other areas is, in turn, not enough. The NHS is to be provided with much clearer incentives to encourage better performance. There are of course existing incentives to improve performance, but until now they have focused too much on efficiency and getting more for the same amount of money. Ask any doctor or nurse how they feel about those and they will mostly tell you that what is needed are incentives which encourage quality services and responsiveness to patients. This is the success that the NHS Plan says must be rewarded, not the throughput.

However, the public must be assured that the extra resources to be put in provide value for money. That is why new forms of inspection are to be introduced. The introduction of a commission for health care audit and improvement and the merger of the Social Services Inspectorate and the National Care Standards Commission have been widely welcomed as a means of driving up standards and strengthening accountability to the public, although some of us might have wished that the timing of these reforms had been a little more tactfully handled.

I hope that other noble Lords will be able to speak in more detail about some of the reforms to which I have been able to refer only briefly, and about those which I have not had time to mention.

In conclusion, we stand on the threshold of what may prove to be the most exciting of times in the long and proud history of the NHS. We should never forget that the major changes that we are making require even more than money and even more than modernisation. They require a huge cultural change in the attitudes of those who serve the health service and those who use it. Empowerment of patients is easy to pay lip service to, but is perhaps harder to make a way of life both for staff and for patients themselves since it requires a reassessment of fundamental relationships which were in existence even before the National Health Service began.

Few people are as aware as Members of this House that changes in culture are more difficult to bring about than changes in organisation or structure. I am, however, convinced that the will and determination exist to make these changes. At the beginning of my remarks I referred to the NHS at its best. Aneurin Bevan said that the aim of the NHS should be to universalise the best. I believe that that is what the NHS Plan will do. My Lords, I beg to move for Papers.

My Lords, I am pleased to be only the second speaker in the debate, because I intend to speak about dentistry—and rarely does it ever receive high-level rating in debates. I have looked through the 144-page NHS Plan: a Plan for Investment, a Plan for Reform and can find nothing in it about the future of dentistry. It certainly contains nothing to give general dental practitioners any hope of an ongoing future in the National Health Service.

In opening the debate, the noble Baroness, Lady Pitkeathley, applauded the fact that 75 per cent of funding has moved to primary care. General dental services are a basic part of primary healthcare, but the funding is definitely not going towards such services—and the funding that is going to them is badly used. In an attempt to support the Prime Minister's pledge that by autumn 2001 everyone in this country would have access to national health dentistry, the Government developed catch-all access centres. The centres cost over £1 million each to set up and they cost a great deal more money to run. They are prohibitively expensive, they are not working as intended, and some centres are advertising to attract patients—I refer in particular to the centre in Penge. So it is not the case that NHS patients are looking to the access centres as the answer in terms of dental treatment. At present, most people will tell you that they simply cannot get NHS dental treatment. At lunch today, I sat next to a Member of Parliament from the North East of England, where I spent time last year. I remarked how much better dental services were in that part of England. He said: yes, they were, but even in the North East the situation was giving great cause for concern because NHS dentistry there was gradually vanishing.

One of the problems relates to quality, which is the subject of this debate. Dentists have no problem 'with wishing to deliver the best quality of service and one standard of treatment for all patients, but they cannot afford to do so. NHS fees are so bad that practitioners cannot cover all the new restrictions and demands placed on them.

My experience in NHS dentistry goes back 35 years. I can even remember the days when we did not have sealed injections for patients; we dropped a pellet into a bottle of sterile water and that was considered safe to inject into patients. Nowadays, people would have a fit if that kind of thing happened. Now, there are water regulations, amalgam separation, sterilisation to prevent cross-infection, all to standards that were never in place in the past. Indeed, there was even a suggestion that each instrument would have to be identified with the name of every patient on which it was used so that it could be identified subsequently. I gather that the whole dental profession has risen up in protest against the idea and it is not going ahead.

Dentists do not in any way oppose regulations to improve standards, but such regulations must be taken into account in terms of funding. Unless the funding is available, how can people suddenly be asked to carry out all these additional practices—which are presumably to be paid for out of their own pocket? That is where the ethical dilemma arises for practitioners. They want to do their best for everyone, they want to provide first-class National Health Service treatment for patients, and yet it is totally unviable and they are unable to do so.

The point that emerged from the NHS review group, NHS Dentistry: Options for Change, was that there must be extra funding. None of the proposals salaried system, capitation, sessional fees—are viable unless it is known how and when they are to be funded. The Government must state whether they intend to retain an NHS dental service. They must decide whether it is to be a universal service, free to all at the time the service is delivered—at present there is no free dental service, except for a few priority classes—or whether it will be a service provided only for exempt patients.

I have spoken to representatives of the General Dental Practitioners Association, the body most representative of grass-roots dental practitioners. Its information is that there will be not a penny more for dentistry and that the Government are looking at a core service only. If that is true, the Government should come clean and say so. Why are we trying to fool people that everyone will receive top-line National Health Service treatment in every part of the NHS if that is not the case? That is just trying to deceive people.

Every year dentists are asked to comply with more and more new regulations. A great deal of new registration will be required. Later this year, the registration of technicians and dental nurses will be a requirement, and dental nurses will have to undergo further training. All of this may be very good, and very helpful for patients; but it will be very helpful for patients only if they can actually get to see a dentist who has those facilities and receive the treatment that they deserve.

Whatever field of the National Health Service we are in, we must protect people against every conceivable risk, and the Government have gone to a great deal of trouble to try to do that. But we can protect only against risks that are reasonably foreseeable. New problems can arise all the time. If we think back a few years, none of us envisaged the hazards of HIV/AIDS or hepatitis. I am thinking of the days when needles could be re-used, and when one of the biggest dangers was broken needles. No one ever has a broken needle now; needles cannot be re-used, because they cannot be sterilised against hepatitis. One risk has been removed, but it has been replaced by a new risk.

The General Dental Practitioners Association believes that all dentists should be able to provide one standard of care to all patients—the highest standard. But it believes that certain criteria are important: first, the standards must be set; then they must be delivered; they must be monitored; and they must be paid for.

Will the Minister tell the House whether the Government are prepared to make a commitment to make adequate National Health Service dental treatment available to all patients in this country? Or do they intend to make NHS dentistry simply a core service? If the intention is to provide a service to all patients, will the Minister assure the House that the funding that is required to provide that service to the proper standard and quality will be made available? I emphasise that this debate is about quality. It is very wrong—and it is a terrible ethical choice for a dentist to have to make—that he can offer the service, but not up to the proper standard. It is unfair to ask that of any practitioner. I ask the Minister to think seriously about this matter. I hope that he will be able to give us an assurance that National Health Service dentistry will continue to be universally available to people in this country, at a fee or not, but at least adequately funded to enable the service to continue.

My Lords, I add my thanks to the noble Baroness, Lady Pitkeathley, for initiating the debate. I recognise her personal experiences that have led her to raise this subject. However, I am rather baffled by the title of the debate, especially as the NHS Plan was published in 2000. This debate is about the future. It has a slight flavour of a petition to the First Secretary of the Supreme Soviet congratulating him on his far-sighted plans for tractor production in the next 10 years or the superb expected growth in the grain harvest.

One of the reasons for bafflement is that the plans set out by the Secretary of State never seem to stick. He is perpetually chopping and changing targets and methods of implementation. We have moved from traffic light systems to stars and from earned autonomy to foundation hospitals in quick succession. Now we are expecting a new NHS Bill before the ink is dry on the current one.

Despite that, on these Benches we shall treat the debate as an opportunity to mark the Government's scorecard on their progress so far on the NHS Plan and to make a few humble suggestions about where it should go in the future. We have the great benefit of having not only the recently published chief executive's report commenting on NHS performance under the NHS Plan and targets, but also the King's Fund's Five-year Health Check, the January report of the Modernisation Agency and the Department of Health's report, published at the end of last year. They all deal with different issues relating to the NHS Plan in different ways.

From the outset it must be acknowledged that the Government are making a massive commitment to the NHS, unlike the Conservatives, who are not prepared to publish their alternative proposals but seem content to sit about like a vulture, waiting for the NHS to weaken. I regret that it does not appear that we shall hear any concrete proposals in the short term from the Conservative Party.

I hope that this debate will not be purely about targets and whether they have been met, although they deserve a mention. There are far too many targets in the original NHS Plan. There are also targets in the Department of Health public service agreement following the Comprehensive Spending Review for 1999-2002.

However, one set of targets, on recruitment and retention, is paramount. As Derek Wanless acknowledged in his report, capacity in the NHS is the key issue. There is a need for an extra 15,000 consultants, with 7,500 needed by 2004. We also need 35,000 nurses, midwives and health visitors, with 20,000 of them needed by 2004. Facilities are also key. We need 7,000 new acute and intermediate beds by 2004. The noble Baroness, Lady Pitkeathley, also mentioned the important target of 100 new hospitals by 2010. Those are all noble targets.

I suspect that the chief executive's report on progress, published last month, is intended by and large as a good news document. It touches lightly on recruitment and retention issues and does not highlight the failure to meet the target for the number of outpatients waiting more than 26 weeks or the delays in meeting ambulance response time targets by 2001. It also fails mention the fact that only 47 per cent of people in England were registered with an NHS dentist in 2001. I share the concerns of the noble Baroness, Lady Gardner of Parkes, in that respect. It does not even highlight the fact that outpatient numbers have risen sharply.

Where are we on the 35 public service agreement targets following the 1999 Comprehensive Spending Review? By my calculations, only eight have been achieved. Another five appear to be on course, but many of the remainder have been fudged or failed and many have been changed in mid stream.

Some might think that that casts doubt on the value of targets. The Government risk being hoist by their own petard on targets. In a recent study, Professor Nicholas Bosanquet says that he believes that the six months waiting time target will not be met by 2005.

Despite the myriad targets, we need to remind ourselves of the really important targets—not only the capacity targets, but the outcome targets, on which we need to reach European standards. Ambitious targets have been set for cancer, circulatory diseases and mental illness, but it is far too early to tell whether they will be met, as they should be.

However, it is clear that the Government badly need to learn from their stewardship of the NHS so far in the broader sense of whether they are managing the process of reform correctly. The best study so far is the King's Fund's Five-year Health Check published last month. It gives the Government positive marks for the increase in funding, for not having flirted with alternative funding mechanisms and for having started a pattern of closer integration of health and social care. It cites the good start made by CHI and describes the national service frameworks and NHS Direct as positive developments.

In other areas, the report is not so positive. It agrees with critics that policies on waiting lists for NHS treatment threaten to distort clinical priorities. It points out that, despite NICE, there are many unresolved rationing dilemmas in acute care. In primary care, too much is being attempted too quickly. In workforce planning, the report is positive about some of the new processes adopted by the Government, but it is not clear that the NHS can hold on to its current staff.

I could go through a catalogue of individual comments from the report. It also makes some important overall observations. It cites tension between central and local management and the unwillingness of the centre to let go, despite the stated aim of decentralisation. It cites the secondary billing given to tackling health inequalities and social care. The latter has been left with junior Ministers to date and has been woefully underfunded, as the Help the Aged report published today makes clear. A holistic approach between health and social care and in tackling health inequalities, combined with the NHS, is clearly needed.

The report also cites the tension between radical and conservative philosophies, particularly in pursuing a preventative health agenda as opposed to one that concentrates purely on the NHS. In that context it criticises the Government for locking themselves into PFI, which commits them to traditional patterns of acute care for 30 years or more. The report reaches the damning conclusion that there has been no substantial risk transfer from public to private sector.

As we have done on these Benches, the King's Fund also criticises the Government's hyperactive approach to quality assurance and improvement in the NHS, risking confusion and delaying real changes to service provision. It says that the NHS is being overwhelmed by a torrent of well meaning initiatives and managers, and clinicians are buckling under the weight. Above all, it says that Labour has not yet developed a coherent and principled set of criteria to guide its decisions. Its rhetoric is often radical, but its actions are essentially conservative.

That is quite a charge sheet. We recognise that the NHS is a massive organisation with 1.2 million employees, but along their five-year pilgrimage this Government have made a major contribution to its problems. Waiting list targets have badly skewed clinical priorities, as have central initiatives.

I could go on with a number of particular aspects, but in conclusion I hope that the Government will listen and learn from reports such as hat of the King's Fund. I hope that the recent Gallup poll—which shows that only 13 per cent of the public think the NHS is getting better and 40 per cent believe it is getting worse—represents only a passing trend and not a continuing public attitude.

We must all acknowledge that this will he a long haul. The Government have a mountain to climb. The paradox is that patients' expectations are very high. We cannot expect results overnight, but we can expect the Government to act on evidence, to empower those who work in the health service, to make fewer promises and to set fewer targets. As a senior member of the NHS Confederation said this morning, the NHS needs a period of getting to grips with some of the changes that have been thrust upon it. I thought that he put it rather well when he said that the motto should now be, "Don't just do something; stand there".

My Lords, I am grateful to the noble Baroness, Lady Pitkeathley, for giving us the opportunity to have this important debate. I want to share with your Lordships some concerns I have about the nature of our public discourse on health.

I want to take your Lordships first of all to the north of Mozambique, which I visited in 1998, to a small town which had been badly affected by the war. The hospital there was in a fairly derelict state, with no fresh water or electricity, but it had a rather good antenatal clinic. The health priorities in the town were concerned with re-establishing the peace, clean water throughout the town, education for the children and, above all else, improving the capacity of families in the community to grow good and wholesome food.

In the public mind and in our public debate on health issues in this country I believe that we have so united the notion of health with the National Health Service that we have come to believe that the only solution to the health challenges of the 21st century lies in better funding and better management of the National Health Service. I served on the late John Smith's Social Justice Commission. Some fairly Left-wing researchers suggested to us, deliberately provocatively, that we would not improve the nation's health while we continued to pour endless funds clown the open throat of the National Health Service. That was a provocative remark, not that I thought that they believed that we should not properly fund and manage the service. However, they wanted to make us think about what we were trying to achieve in healthcare.

I am concerned about public understanding. My fear is that as our community continues to prosper demand for health services will increase and in five to 10 years' time we shall face a similar challenge of not enough resources to meet increasing demand; or, worse, we shall enter difficult economic times and will not be able to afford to sustain the level of service upon which people have come to depend. I say with my international development hat on that there is not a ghost of a chance of those kind of healthcare facilities being available to vast numbers of people in our world.

I have a question on which I should value some ministerial comment; that is, what are we doing about public expectations? There are two ways of tackling the challenge of health. One is to increase resources—I support, if I may say so, the proper resourcing of the health service and welcome what the Government have done—but the other is to get some control over demand. The unacceptable way of tackling the latter difficult problem is to provide high quality services for those who can afford them and not for the rest of the community.

Our aim should surely be to strengthen the capacity of people to assume greater responsibility for their own bodies, minds and spiritual growth. The provision made in the public forum is there to support individuals, families, households and communities to be successful in carrying out their own responsibilities. Whose life is it? Whose bodies, minds and spirits are we talking about? I refer to those of the people, not those of the service.

Nye Bevan created the National Health Service in the context and vision of values designed to increase, and spread the possibility of, a responsible society for all. The institution of the National Health Service was rooted in a long development of ideas and values about the common good and the way that would strengthen the capacity of ordinary people to accept greater responsibility for their own lives. Archbishop William Temple, R H Tawney and many others contributed to that debate in the 1930s and 1940s.

Two things follow from that: first, the blocks have to be removed that make it difficult for people to assume that role. Many years ago the Black report examined issues of poverty, inequality and aspects of social class and exclusion. As I stood in a queue in a store to buy groceries I noticed that the woman in front of me who had two small children filled her basket with the cheapest sliced bread and the cheapest tinned food. There was no fresh food in the basket. However, the basket of the person behind me was filled with enough alcohol to have lasted a number of years in my childhood home and with top quality foods. In that context I ask myself: what are the health issues in our community and the public attitudes towards it? Secondly, we have to try to create a different culture and to encourage the assumption of values which promote personal responsibility in society. The policies, language and discourse we pursue must promote that debate.

The House will be aware that at least 30 million people in the continent of Africa are HIV positive. In Uganda the infection rate has been reduced from 30 per cent to under 9 per cent. That has been achieved by a concerted programme of action undertaken by government, voluntary agencies, community leaders, Churches, families and schools working together in a common cause. As people are learning in South Africa, which has been a little slow off the mark in these matters, part of that strategy involves ensuring that the right healthcare facilities exist to back up that process. Part of the strategy requires dedicated professional health services but much of it, however, requires education and the changing of attitudes and lifestyles aimed at helping people take control of their own bodies, their own lifestyles and their own choices.

I submit that until we in this more prosperous and materialistic society face those questions ourselves, we may find ourselves pouring ever increasing resources into bodies such as the NHS in a self-defeating strategy and asking of the National Health Service a role it was never designed to undertake and cannot possibly fulfil.

My Lords, I, too, congratulate my noble friend Lady Pitkeathley on introducing this important debate and on doing so in such fine form. We ought to be grateful for the NHS.

When the NHS Plan was first published two years ago it was seen as a very ambitious programme. The vision it set out was widely supported by the public and the professions. However, it was not until the Chancellor committed the Government to repairing the enormous funding deficit in the NHS that we were given this marvellous opportunity to change the health service in the UK in what I believe is a fundamental way. So we have the vision and we have the potential funding to make it happen; all that is left is for us to decide on the tactics.

I have never believed the "bottomless pit" argument, which seems to have been one of the excuses given by previous governments for not putting money into the health service. There are at least two reasons why I believe that. First, one has only to look at countries around the world where patients are satisfied because they are seen by a doctor or other health professional at a time and a place which suit them and receive the treatment they need, in hospital or outside, in a timely way to realise that it is entirely possible to fund all reasonable needs. In Australia, New Zealand, France, Sweden, Canada and Germany patients do not seem to have a major problem with services. The doctors and governments of those countries may complain from time to time, but by and large the patients do not. Secondly, although I am no economist, it seems to me that the more affluent we become and the bigger our GDP, the bigger the proportion of our GDP we can afford to spend on healthcare. I believe that not only can we afford to pay for better services, we just have to do so.

Having got that off my chest, I should like to focus on some of the mechanisms through which the Government might be able to achieve their vision. There is some hope that the new administrative framework with PCTs, strategic health authorities, the proposed health protection agency, coupled with the quality and inspectorate agenda of CHI, NICE and so on will be helpful but, of course, only time will tell. In any case, if history is anything to go by, further reforms will occur in due course. But there are more fundamental things that can be done that patients themselves will recognise more immediately.

While we wait for the increases in the numbers of doctors and nurses and hospital beds that are promised but which cannot, with the best will in the world, appear overnight, there are many steps that can be taken that could have a more immediate effect.

First, as we increase the numbers of medical students entering medicine, which we are doing, we should also do more to retain doctors who are leaving. The average age of doctors leaving the NHS in the hospital service is between 55 and 60, depending on the specialty, at a time when they could still contribute much to the NHS. They leave for a number of reasons, among which is an increasing difficulty in coping with the considerable pressures that are placed on them, and which increase rather than decrease as they get older. There are also more services for patients, more teaching and more administrative tasks. The part of their work that they seemed to enjoy most and for which most would give their eye teeth to do is simply looking after their patients.

The Department of Health has gone some way to try to encourage trusts to offer more flexible contracts to doctors at the end of their careers so that they can continue to contribute their clinical skills and knowledge in the last five or 10 years of their careers. They could perhaps do so part time and in different ways. On the ground, it is difficult to see that much progress has been made on that front. What a waste of talent and expertise at a time when we are desperately short of doctors. I hope that the Minister will consider whether more could be done in that regard.

There is yet another need for flexibility in the employment of doctors; that is, not only because 50 or 60 per cent of our newly graduating doctors are women but also because the male graduates, too, are looking for more flexible lifestyles. We have some way to go despite much effort by the Government to persuade trusts to do more to produce flexible contracts for staff. That applies particularly to women but also to men, and not only to doctors but also to nurses and other healthcare professionals. Will the Minister consider whether that initiative could be made to work a little more effectively?

There is another hurdle that again needs to be looked at critically; that is, the so-called "workforce planning" system, by which the numbers of training posts for medical specialties are strictly controlled centrally. We are desperately short of consultants but we have strict limitations on the number of doctors who are allowed into training posts. We now have the odd situation in which there are increasing numbers of young doctors coming out of medical schools at one end, a clear need for more trained consultants at the other and a tight, restricting hand on the number of training posts in the middle, preventing many who want to train from doing so. Of course this whole process of manpower planning has to be managed—I can see that—but it is time to re-examine the whole process, which is becoming somewhat ridiculous.

There are many other actions that could be taken with the extra resources that are coming on stream and which would have an immediate effect. Investment now in medical secretaries, ward clerks and porters—the basic infrastructure of hospitals—would allow for much greater efficiency in the use or nurses, physios, doctors and others.

In the last minute of my speech, I want to put in a plea for help for poorly performing hospitals. We have heard much about the need to reward hospitals that perform well by giving them greater freedoms and funding—we do so quite rightly in my opinion. However, I am concerned about the "name, blame and shame" culture in which poorly performing hospitals become embroiled. That is somewhat inappropriate. It is like blaming the patient for being sick. Those hospitals need understanding and support—understanding through an analysis of the reasons why they are underperforming and support to help them to improve. Only the patients suffer if we do not do that.

I suggest that we need an analogue of CHI that concentrates on helping hospitals to remedy their difficulties. I propose that the Government should set up an organisation that could perhaps be called CRI— the commission for rescue and improvement—for ailing hospitals.

We have an excellent plan for the NHS and we are now being given the resources to achieve it. We must ensure that we look critically at how we can best use those resources to achieve the plan in the immediate term as well as in the more distant future.

My Lords, I regard this issue as probably the most significant political, economic and social issue that I have encountered in almost 40 years in your Lordships' House. I am very grateful to the noble Baroness for giving us a chance to discuss it.

These days, the honourable gentlemen in the other place are somewhat neutered—an operation that is freely available on the National Health Service. In general, we are not given the time to discuss in Parliament issues of great import. We have thrust on us ideas from government and sometimes, when a major Bill comes up, we are told, "Please do not speak on this; we do not have enough time". We have enough time today to discuss an issue that means much to me. However, I am not qualified to speak at first hand. Unlike the noble Baroness, I have suffered in that I have no experience of the NHS. I had my tonsils out many years ago and I have spent probably a few hours in bed in my life but I have never been in a hospital bed.

I was brought up in a strange world. My brother-in-law was the militant Irish leader of the young doctors, a cancer specialist who regularly appeared on television 30 years ago saying that they were underpaid, overworked, overstretched and—he was Irish—over here. My uncle was a consultant for many years at St Mary's. Having had polio, he could not fight in the war and always felt slightly ashamed of that. Another relation was a GP in the country where he doubled as a vet where necessary. He set up the pain clinic in King Edward VII Hospital.

I spend most of my time abroad. Like the right reverend Prelate the Bishop of Guildford, I believe that man has a duty to be healthy if he possibly can be. To provide the noble Baroness with great encouragement, I echo what she said and advise her that your Lordships' House, as I have said previously, has the longest life expectancy of any body of its kind in the world.

I pay tribute to the NHS as a result of an incident that happened only two weeks ago. A member of my wife's family who had been ill for many years fell downstairs in the middle of the night. He had been treated previously in Bart's and Westminster and Chelsea. A panic phone call to me got the ambulance out. It was there in four and a half minutes, and I made it in eight, not being very far away. The ambulance crew could not have been more helpful and competent. The accident and emergency department was not particularly crowded that night, but the stress and strain on the young doctors who had been working for 12 hours or more was evident. Sadly, the person died but everybody in that hospital was so competent and kind. A blind eye was turned when we came in with his favourite tipple and managed to dribble it with a sponge into the corner of his mouth. After death, the help that was provided to the bereaved was outstanding.

I compare that experience with the previous hospital where I had visited the same patient—Bares, the "St James Robertson Justice and Hattie Jacques" of the ancient world. The building is now virtually condemned and very depressing, although great skills exist there.

I raise the problem of bringing together the inherent skills and ambitions with the resources that are needed. I have spent much of my time working abroad developing hospitals and financing medical equipment. I know about the situation from the overseas side. When I look back, I see that we have one of the worst health services in the world for a nation with our history—back to Scutari and Florence Nightingale. The reasons are strange. I found a report from 1948 that said that we must make a change. I believe that that was the time when my great uncle, Stafford Cripps, was Chancellor.

We have needed change all along. The question is: do we look for revolution, which is regular change, or a revolt? A revolt is always dangerous because it causes problems. We can consider the matter with what we used to call a resource triangle. Three things are required: human resources, physical resources and buildings, and the money and the ability to complete them.

I cannot discuss human resources and I shall not explain how difficult it is when a soon-to-be member of my family—a very bright young man who has just qualified as a surgeon—says that he cannot see a career for himself in the NHS, which is sad. It is sad, too, that we have to recruit so many from overseas to fill posts. Let us assume that this great revolution of people and changes—worth the multi-billion-pound mergers of large corporations—will produce a structure that is reasonable and understandable. I worry about the size of the change that is proposed and the human stresses and strains that that may cause.

I now turn to the physical side. I declare an interest as a director of one of the contracting groups— Gleeson. At present we are building six hospitals under the PFI with a total of 600 beds at a cost of £150 million. One is just over the river. I do not speak on behalf of the group but I want to mention a few problems and difficulties based on past experience.

It seems to me that in the plan the Government have simply produced a wish list. In the financial world we would say, "Take it back and come back again when you have a prospectus or a business plan". It is not a business plan, but it is full of everything that one could possibly wish to see. Therefore, naturally I and others have a duty to support the proposals.

My concern lies with the realisation of the proposals. Often in the international world one starts with conceptualisation—a wonderful word—and ends up with realisation. But between the two is the lovely word "animation", which is Walt Disney orientated. How do we bring this concept alive? How do we build 100 hospitals by the year 2010? How do we re-equip 3,000 GPs' premises and find the GPs to use the equipment, the technology and the services? How do we build 500 one-stop care units?

Today the situation is not bad. Nine new hospitals were built or commissioned last year and another nine will be built or commissioned this year. But to date none of the hospitals commissioned under the PFI has been able to cope with the problem of transfer of resources or people. I believe that it is called "transfer of employment". We have a problem with Unison. It is difficult for people who have worked for the state and the National Health Service to transfer to a new body—a new organisation with a new name. It is difficult to achieve that.

We have a further problem. At the beginning, PFI in whichever sector, whether it was water, transport or health, caused problems because it was new. We were surrounded—not surrounded, outnumbered—at meetings by the lawyers who represented the banks and others, all charging large amounts of money to advise people how not to do something. I believe that, to some extent, the problem has been solved thanks to the competence of the Government's PFU, the Private Finance Unit, whose chief executive has done an extremely good job. Standard contracts are now being advanced. But it has taken time, and it will take time, to achieve objectives. I would not say that it is not possible to achieve them, but I believe that it is highly doubtful.

That is where my concern arises. It is wrong to raise expectations too greatly and not to be able to deliver. There is nothing wrong with the plan. It may be the timescales that are difficult. Often there have to be six bidders for a hospital project, but not too many of those outside in the construction world are competent to handle large-scale activities. We are short of labour and we are very short of resources. The risk placed upon a contractor when his margin may be only 1 per cent is very high. There are risk-takers out there, but it is a difficult time. The objectives are good, but I doubt very much whether more than 50 per cent of them can at present be achieved. That is a personal, not a corporate, view.

I turn to another matter of concern. When one moves from the public to the private sector, a change of culture is necessary. Very seldom has a civil servant managed to move on to a successful career in the commercial world, and vice versa. Therefore, as we set up these new structures, who will be the people in charge? Who is the client, and who is the boss or gaffer? And what risks are they taking?

I want to raise a warning with the Minister in relation to the new proposals. These days, every accountant, lawyer and professional person has professional indemnity insurance. Are the Government guaranteeing and providing cover for those who may have jobs as the non-executive directors? I know not. However, I wish the whole project well. I believe that the wish list is extremely exciting, but there is a long, long way to go.

My Lords, I thank the noble Baroness, Lady Pitkeathley, for initiating this debate. The noble Baroness knows from personal experience the importance of expert medical care and the need for clean hospitals in order to prevent infections such as MRSA. Yesterday my voice disappeared, so I hope that I shall be able to say a few words in the debate today.

The 10-year plan has some important points. But one never knows what may happen during that period, and priorities may have to change. Paragraph 1.16 on page 19 of the plan states:

"Where patients have the most complex illnesses and conditions, such as the need for a heart operation, they will be referred to centres with the best equipment and the staff with the most appropriate expertise—even if that means travelling to a specialist centre".

Yesterday I received a postcard from Harefield Hospital. It said:

"Please help us to save this world-famous hospital from destruction. Neither its staff nor patients will relocate to the expensive and polluted area of Paddington in London".

The reputations of hospitals which are renowned world-wide cannot be built up overnight. Perhaps I may ask the Minister what the plans are for Harefield Hospital. The NHS Plan that we are discussing today stresses that the wishes of patients and staff are important. Shutting hospitals is not something that the public or NHS staff want to see. Perhaps today the Minister will say something in general about shutting hospitals.

The plan says that all patients will have a TV and telephone by their beds. That is the icing on the cake. However, where a complicated condition is involved, the vital priority should be that the patient receives the correct treatment and goes to the appropriate hospital. I declare an interest as I have been treated in a spinal injuries unit. I give as an example spinal injury resulting in paralysis. Many severe problems can arise for newly spinal-cord injured patients treated in general hospitals. They are at risk from life-threatening medical complications which general hospitals lack the facilities, expertise or specialist teams to recognise and treat—for example, autonomic dysreflexia, which is unique to the spinal-cord injured.

Admission to general hospitals can spell disaster, while appropriate spinal injury treatment and ongoing care can offer a good quality of life to a paralysed person. It is very worrying that several of the spinal units have beds closed due to staff shortages.

I applaud the appointing of modern matrons, as stated in the plan. The spinal unit at Stoke Mandeville is looking for such a person—thus far without success. I hope that the hospital will find someone who is dynamic, has strong leadership and can attract staff, and who will ensure that the unit is clean, that infections are under control and that patients enjoy their food instead of having to send out for take-aways.

The Spinal Injuries Association, of which I am president, feels that there should be a bed bureau covering all the spinal units in England and Wales so that it is known throughout the country when beds are vacant. In that way, patients will receive the correct treatment without delay. In this day and age of modern technology, that surely should be possible.

At Oswestry, the spinal unit has set up some halfway houses, with care provided, so that paralysed patients waiting for their homes to be adapted or for new ones to be made available do not block the acute beds in the hospital. That is an excellent example or the NHS, social services and the voluntary sector working together.

The title on page 50 of the plan is "Investing in NHS Staff". One sub-title refers to improving the working lives of staff. Last Saturday I heard of a nurse who had come from abroad and was working and resident in a hospital in Wakefield. Her car was vandalised within the hospital grounds and, in addition, hospital windows were smashed. Many people no Ionizer seem to respect hospitals and the people inside them as they did in the past. If staff and patients are to feel safe, security will have to be stepped up.

Investing in NHS staff must be one of the biggest challenges. Yesterday I chaired a meeting of the Associate Parliamentary Group on Skin on the manpower crisis in dermatology. There are some serious black spots where posts are vacant. Registrars becoming consultants replace those retiring. More women doctors are working part time. There is not a flood of doctors coming from abroad and it takes four extra years to train a dermatologist. Children in agony with serious eczema are waiting months for treatment. The same story is heard about rheumatologists and the lack of rehabilitation facilities for long-term disabilities.

Specialist nurses in diabetes, Parkinson's disease, dermatological and other conditions are a great help, but one needs the whole team for a successful outcome. The Government should be given credit for trying but I hope that they will listen to the patients and the staff nearest to them who really understand the problems, which I hope will be overcome.

My Lords, I thank my noble friend Lady Pitkeathley for initiating this debate today. I thank her also for the first part of her speech in which she mentioned her illness, which I found moving. Many of us were praying for you, Jill, this time last year.

I always find it easier to criticise than to praise but today I want to praise the National Health Service. Like my noble friend Lady Pitkeathley, I believe that the NHS is one of Britain's greatest achievements. The Government are on record as believing that the NHS should be free at the point of need, that it is the best insurance policy in the world and that a taxpayer-funded NHS is best for all concerned.

When the King's Fund reported earlier this year, it opened its discussion paper by saying:

"The NHS has a history of underfunding and the consequences are that the UK suffers a lack of capacity—in terms of both staff and facilities—in comparison with its European neighbours".

It identified the need for greater freedom for providers to respond to patients and purchasers of care and for incentives to retain and attract staff, including financial incentives and rewards.

A further report, the Wanless report, stressed two particular needs: greater public engagement and local flexibility in delivery. It stated that that would provide a health service fit for the 21st century. I was very pleased indeed with the Government's proposals in their 10-year plan. They have shown that they mean what they said in that plan; that is, to continue the improvement in the health service. In the latest budget there was the largest ever sustained increase in NHS resources: an increase in real terms of 48 per cent by 2008.

The Government have pledged that resources will be matched by reforms. Key elements of those reforms are that there should be a national standard; that there should be modernised, flexible professional people working within hospitals; that the staff should be rewarded adequately; that the needs of patients should be at the forefront; that there should be improved health services, especially for the poorest; that there should be intermediate care to build bridges between hospitals and homes; and that there should be a radically different relationship between health and social services to develop one care system.

On a personal note, the latter two elements are particularly welcome to me, having faced difficulties over recent years. When my mother, who is now 89, became ill, I had to sell her home and ensure that she was settled in a care home in Market Rasen. I came across the hospital, the social services, and the health services, all of which were helpful. Everyone wanted to help but there was overlap in some areas and gaps in others. I believe that one care system for the future is essential.

The Government are also committed to fundamental changes in job design and work organisation; to change in working practices, to decreasing arbitrary demarcations, and to front-line staff being given more authority. One example is that of ward sisters in charge of ward budgets. Who knows what is needed in terms of budgets better than the ward sister?

It is right and proper that staff in hospitals are praised for the work they do. So many of our lives depend upon them. Both the Prime Minister and the Secretary of State for Health are on record as paying tribute to all staff in the NHS; to those in different medical disciplines, and to those who are ancillaries, secretaries, receptionists, porters and cleaners. They all play their part and are among the best of our British public servants.

I am proud to say that during my trade union career I met many NHS staff and saw at first hand their expertise and devotion, both to their work and to those whom they administer. I often felt humbled as I listened to them speak with such enthusiasm about their work. It would be a tremendous waste of knowledge and expertise not to expand the opportunities for hospital staff. For many, their work is a cause rather than a job and we, the patients, are all the luckier for that.

NHS staff at all levels are vital to reform. The need to increase their numbers is acknowledged openly by the Government. Already, we have 2,000 modern matrons in place with the authority necessary for them to succeed. We hope that there is more to come. There is an aim to have 15,000 GPs and consultants and 30,000 more therapists and scientists under local control. I particularly welcome these developing opportunities. The professionals with whom I worked in MSF—I declare an interest; my former union, now known as Amicus, had many NHS members including clinical psychologists, radiographers, speech therapists, and so forth—emphasise the need for constant training and retraining.

The Government are committed to enhancing the role of therapists and nurses and to increasing the training of all staff, including the new health professionals. They are committed to more flexible working patterns and—vital for women in particular—to better child support. As 79 per cent of NHS staff are women, that is, indeed, an important support. Other noble Lords with far more experience than me in the health service have spoken of what is needed in relation to those commitments. I am sure that the Minister listened.

The monitoring of how the NHS is supporting and involving staff—including in personal development—to underpin progress in recruitment and retention is extremely important. It is a worthy aim, but it must be one which takes place with the involvement of those who work within the NHS. The Government also propose new contracts of employment, including for hospital consultants. Those are aimed at liberating and rewarding NHS staff.

Whenever changes are made, even if the stated aims are good, some feelings of apprehension are felt by working people. We need to be totally open with the staff if new contracts are to work. Consultation is obviously the key. Consultation means discussions with staff and their representatives before decisions are taken, not after. It means listening to what the staff and their representatives say and using the workers' knowledge when alterations are being made. It means a flow of information up and down any chain of command so that all workers know what is happening and, above all, why it is happening. After all, the staff are in the best position to know about local needs, local differences and local responsibility. If the proposed investment and incentives are implemented with the betterment of the staff in mind, then the NHS will be better for workers. More importantly, it will also be better for patients, which must be our ultimate aim.

My Lords, I thank the noble Baroness, Lady Pitkeathley, for giving us the opportunity to discuss this enormously important subject. The speeches so far have been outstanding. I hope that the Minister will forgive me as I am a relative novice when speaking on health matters.

It was interesting, encouraging and moving to hear the noble Baroness, Lady Pitkeathley, give the reason for her speech on the occasion of her debate. I am delighted to see that my noble friend Lord McColl is on the Front Bench. Eleven months ago I had my first non-orthopaedic visit to a hospital. Alas, something happened to me, which is often mentioned here: a dreadful thing called a hernia. I am sure that my noble friend and your Lordships will be aware that this month is the season for professional footballers getting hernias. I do not know why, but they are all rushed into hospital with them. If noble Lords put their noble noses into the "boulevard "press they will see that every week and month players from every club run in for these types of operations. Indeed, it happened to me, so it seems that I am not entirely alone.

The report that we are discussing has been admirably covered by the noble Baroness, Lady Pitkeathley, and other noble Lords. One of the first excerpts that I noted was in the introduction. It stated:

"More money is, however, only the starting point".

The speeches that we have heard so far take that issue into account. No doubt we shall hear more about it. But there is a great deal more to the matter than that. My noble friend Lord Selsdon referred to the tripod—that is to say, money, facilities and, above all, the people who are involved. That aspect is beautifully covered in the report.

Page 10 of the report is classified as the "Executive summary". I hope that that is not aimed at the more novice-like and perhaps—I would not hesitate to say—idle Members of your Lordships who would glance through the "Executive summary". I am delighted to see that it mentions the National Institute for Clinical Excellence.

The report refers to what is a kind of dreadful postcode success regarding cancer. About 10 or 12 years ago I had a colleague and friend in Kirriemuir— my hometown—who suffers from multiple sclerosis. It was agonising explaining to him why a similar sufferer, with whom no doubt he was in contact, just across the water in the Kingdom of Fife, was able to receive treatment. The medicine was called beta-interferon, which apparently provides excellent relief for intermittent sufferers of multiple sclerosis. If he had lived or attended hospital in Fife he would have received it. He did not receive it in Angus and in Tayside. That was purely a clinical judgment, although I suspect that the cost-effectiveness of the drug had something to do with it. Happily, that matter now seems to have been resolved. That was in Scotland. However, at some stage I hope that the Minister can reassure me that similar cases are covered. He does not need to do that today. Perhaps he will write to me.

In chapter 2, paragraph 2.16 in the report, I was delighted to see the excellent comment that,

"the top 25% of hospitals get nearly double the output from their consultants as the bottom 25%".

For someone who has only been passive—luckily—in hospital, it struck a chill through my heart that somewhere, somehow there would be a hunch of supervisors in the operating theatre chasing up—if I can put it tactfully—the consultants, saying, "Get a move on with that. There are others behind. Look sharp with that scalpel. Come along. There are people waiting". I wonder what was being aimed at in that paragraph. I hope that the quotation was comparing like with like; for example, regions and types of disease. As your Lordships will know, some diseases are found to be more endemic in some areas than in others.

I looked at page 31 of the report. It did not seem to be classified as a chapter. It is headed, "An under-invested system". I noticed there the interesting but stern quotation that between the years 1979–1997,

"the average annual increase in Government spending on health was … 2.9%".

That dropped a penny with me. I wondered whether your Lordships might care to look at earlier periods—perhaps 1960 or 1964–1979 or since. It has been an ongoing thought today that however much one spends on the National Health Service we need to look at how those funds are spent.

Chapter 3 is headed "Options for funding healthcare". I was fascinated to find in paragraph 3.14 that the United States and Switzerland have two systems of funding their health service. The wicked word "regressive" was used. I have two points to make about Switzerland. First, one will not find a more egalitarian country; and, secondly, I have considerable personal experience of it. I am delighted to see my noble friend Lord Astor of Hever in his place. We share considerable experience of Swiss medicine and healing. Indeed, he is a perfect example of how fit one can be.

In paragraph 3.25 there are two figures which equate more with my discipline as an accountant. In France 3 per cent of health expenditure was on generic medicines whereas in the United Kingdom the figure was 60 per cent. That is interesting, particularly in view of chapter 11 where the report refers to changes in relationships between the NHS and the private sector. There is a particularly helpful comment dealing with the pharmaceutical and the bio-pharmaceutical industries. Two figures are mentioned which are useful to accountants and to businessmen, such as my noble friend Lord Selsdon. There is a helpful quotation in chapter 11.11. The Minister agrees with me on this matter. It states that the,

"National Health Service has a major role to play in ensuring that the UK remains an attractive base for the industry".

I must conclude. In chapter 13 there are considerable and helpful references to what I would call "preventive medicine and good health". I look around the House and hope that noble Lords are examples of that. But there are references to smoking, diet and nutrition, but above all to drugs and to alcohol.

I am a little worried by the lack of emphasis in chapter 16 and the final summary on the prevention of drug and alcohol abuse. That is certainly a drain on resources. In view of what the right reverend Prelate pointed out, I hope that the effects of drugs and alcohol will not replace other ancient diseases–the noble Baroness, Lady Pitkeathley, mentioned whooping cough. No doubt we shall hear more about such matters from the Minister. I once again thank the noble Baroness, Lady Pitkeathley, for initiating the debate.

My Lords, I am most grateful to the noble Baroness, Lady Pitkeathley, for allowing us to debate the NHS Plan today.

I shall concentrate my remarks on one aspect of child and adolescent mental health services. I begin by welcoming the addition of 335 mental health teams to provide an immediate response to young people undergoing mental health crises, which is announced in the plan. I welcome the announcement of a significant increase in the number of midwives and health visitors to be trained each year by 2004. They play an essential role in ensuring the good mental health of our infants and children.

In the same spirit I welcome the major expansion of Sure Start projects to cover one-third of children aged under four years living in poverty. Sure Start seems to have been one of the great successes of this Government as regards vulnerable families.

By reducing child poverty, the Government are also removing some of the stress on our most vulnerable families, particularly lone parent families, giving their children a much better prospect of growing up feeling well nurtured and ready to take on the world and enjoy it. In that context I hope that I can persuade the Minister that funding for child and adolescent mental health services should take the highest priority when decisions are taken about the use of the revenue from additional national insurance moneys.

I am advised that mental health services for children have suffered from the Government's decision not to ring-fence last year's grant of £10 million to child and adolescent mental health services. I am very disturbed to learn from the Royal College of Psychiatrists of the shortage of appropriate in-patient beds for children and young people with mental health problems. This shortage is a chronic problem and is deeply unsettling. One would have expected more to have happened by now. However, I understand that the Government are now in the process of closing child and adolescent mental health service beds in the South East.

My chief concern, however, is the dearth of mental health professionals in the multi-disciplinary teams increasingly serving our children and young people. Can the Minister say whether this need for qualified mental health professionals to participate in these multi-disciplinary groups is recognised; whether an appropriate qualification is being formulated for them and when; and in what numbers these professionals will be delivered? I apologise for not giving the Minister warning of these detailed questions. Perhaps he would be good enough to write to me if that would be most convenient.

Last night I met a young woman in a hostel for the homeless. We recognised each other from an earlier visit that she had paid two years previously when she was 16. She was a gifted gospel singer due to record with a celebrated popular singer this coming weekend. She was attractive and seemed intelligent. Why then was she doing a second stint in the hostel? It may well have been that there was an aspect of her experience which a mental health professional might have been able to identify and address. Without adequate mental health input young people like her are unlikely to receive the more emotionally aware attention they need. The Connexions service, the youth offending teams and other schemes are seriously handicapped without a mental health input.

I recently met with head teachers from Newham, Peckham and other London boroughs. One of the conclusions of our meeting was that teachers and head teachers need to receive training in the management of challenging and vulnerable children. The Prince's Trust has produced a report involving interviews with children excluded from school. Very often children reported that their schooling broke down as a result of a poor relationship with a particular teacher. We really cannot expect our secondary school teachers to befriend and parent every child in their class. There is the danger of overburdening them with pastoral responsibilities. But we can equip them to be emotionally intelligent enough to deal tactfully and effectively with challenging children. Mental health professionals would be very well placed to provide this training and support.

I was very pleased to learn that Centrepoint has employed for this year a mental health professional to review all its services from the mental health perspective. Clearly, if we wish to deliver to our children and young people the help they need to keep them in school, out of prison and on the path to employment, independence and a healthy family life of their own, we must ensure that the Government's 10-year plan and its national service frameworks for children and mental health allows sufficient investment to procure the mental health professionals, the Connexions service, the youth offending teams, the care and education systems and all their needs.

A couple of weeks ago a hostel manager described to me the helpful advice that he had received from a trainer with a psychology degree. He said that last year he had seen a young man who had stabbed his wrist repeatedly with a fork until he had made a nasty wound. The other residents were very concerned. It was very hard to know how best to react to his action, which was in the context of the frustration of his desire to go beyond the rules of the hostel. He wished that he had known then that this action could be understood as a call for attention. That may seem obvious to your Lordships, but in the heat of the moment, when there is so much chaos in the environment, it is perhaps less easy to understand and react appropriately. The appropriate response, therefore, was to deal with the wound in a calm fashion and to maintain one's sang froid.

Of course, one's immediate reaction is to show a great deal of concern and interest in the young man. However, this response amounts to encouragement to the young person to repeat the self-harming activity whenever he feels distressed. It is better to be calm and make sure that he is very well aware that there are other means of his raising his concerns. One has to steer a careful path between neglect and hysteria. That was the advice, as I remember it, that the mental health professional gave. He wished that he had been more aware of it at the time and that he had had that advice before. We cannot allow staff, working with our most vulnerable young people in all settings, to work in the dark. Their work needs to be illuminated by proper psychological input.

My Lords, it is always good to be the last speaker because most of the things I wanted to say have been said. Therefore, I had to think of something new to say.

My experience as a patient has been very typical of the NHS. I had very good service when I tore ligaments in my knee late one evening before Christmas Eve about seven years ago. I got an ambulance to St Thomas's hospital. I had to wait a few hours on a trolley. But it is a very comfortable existence lying in bed in a room. There is nothing to complain about. I got very good treatment and there was no problem. We have excellent service from the accident and emergency services.

But recently I said to my GP that I had a hearing problem and that I should have my hearing tested. He said that that would be no problem and that he would write off for an appointment. I have one in nine months' time. That is appalling. I know that everyone has to wait and I know why. I know the consequences of 20 years of under-investment. We have many shortages and so forth. We love our NHS.

But while it is excellent in dealing with acute emergency problems, as regards elective surgery and normal health concerns, the service is falling down. I believe that is because we started with very good intentions, which were that it should be free at the point of use and universal. Those are very good values and we should stick to them. But those values have prevented us from thinking innovatively about different ways of doing things. The 10-year plan is a very good opportunity; but all 10-year plans are a farce and a total waste of time because the detail changes. No 10-year plan should be the same 10 years on otherwise life would be very dull indeed. A 10-year plan states what is to be done for the next 18 months or so and then everything moves on. That is what 10-year plans are about.

But I believe that there are certain central principles to look for. I can claim only to have been a patient in the NHS. I have not been a member of a health trust, I am not a doctor; I have no relations who are doctors; nothing like that. As a patient, I am not at all sure that I feel that the NHS belongs to me. It belongs to nurses. I should add a word about nurses, because morale has never been lower—I have to say that, as it is part of the national debate. The NHS also belongs to consultants, who want more money and better contracts; it belongs to GPs; and it belongs to a range of administrators, who are all doing their best. However, it does not belong to the patients.

We must think of more creative ways of ensuring that the NHS belongs to patients. I do not mean patients' councils, or community health councils. They are bureaucratic structures to which people who are interested in making a career strive to be elected, and so on. I have never belonged to any such bodies; they are a ghastly waste of time. Let us just imagine what would happen if we set up a national bread service. People would not be able to buy a chapatti of choice: they would only be able to buy white bread, sliced or unsliced. That would be it. We buy our food from Tesco stores, and do not expect questions to be asked in Parliament if we get an addled egg.

I turn to the document The NHS Plan, and draw noble Lords' attention to paragraph 10 of its preface, which begins with the words:

"The NHS will respect the confidentiality of individual patients".

Nevertheless, we had the Rose Addis case a while ago—something that is still considered one of the great disgraces of recent times. A patient's case was discussed in Parliament, with no one pointing out that it was not correct to do so.

Similarly, on page 15 of the report, in the "Introduction by the Secretary of State", we find the following words:

"At its heart the problem for today's NHS is that it is not sufficiently designed around the convenience and concerns of the patient".

Hurrah! So let us do something about that situation. But we have to wait until we reach page 89 of the report before patients are discussed. Under the heading of "Changes for patients", we find a suggestion that is much to my liking and one that I should like to commend; namely,

"smart cards for patients, allowing easier access to health records".

I should like everyone to have a smart card.

If, for example, I wanted to change my GP, it would not be easy to do so. I live in Hastings at the weekend, and live in London during the week. I should love to have two GPs, but I can assure noble Lords that it is complicated to find a GP who will take you on his books on that basis. Why? The system that we have established is producer led. However, a smart card system would not be difficult to introduce. You do not have to violate the principles of universality, or those relating to services being free at the point of use, in order to give every patient a smart card. Patients would feel that they had choice. They could use the card to telephone someone and gain access to their health records. We can do that in every other walk of life; but we cannot do so in the service that belongs to all of us.

I remember the debate surrounding council houses—namely, that they should not he sold. Similarly, council tenants were not free to choose the colour of their front doors, because the council would not allow them to paint doors any way that they liked. Indeed, members of my party used to think that it was a socialist principle that council tenants should not be able to choose the colour of their front doors. So I know what I am saying. That was trivial. But, thanks to the party opposite, it was subsequently decided to sell council property. In doing so, people became aware of choice.

In the next 10 years, if not before, I should like to see the development of a real sense of ownership by patients. They should genuinely feel that they can take their identity and go somewhere, plug into the system, and be able to call up someone to access a service. It should not be a top-down system. I do not believe that we need patients' advocates in hospitals. Patients need access: they need to be able to call up different people to gain access. If we can provide that kind of service and combine the free-at-the-point-of-use and the universality principles with patient ownership, that would be a brilliant 10-year plan—except that I hope it can be achieved in four years. All good 10-year plans have to be achieved in far less time.

My Lords, I am grateful to the House for allowing me to speak in the gap. I promise that I shall be brief. I should also like to thank my noble friend Lady Pitkeathley for sharing her health experiences with us; and, indeed, for initiating today's debate. Mary Seacole, who was a nurse at the time of Florence Nightingale, would say that my noble friend is a credit to good ministration. That is what reform of the National Health Service is about.

This morning I spent two hours with a group of senior citizens, who did not share the doubts about the reform of the NHS. They want a good, reformed National Health Service. Their past experience of it has not been very good. Their expectations are genuine and realistic.

There can be no doubt in anyone's mind that the Government inherited an NHS that existed almost only in name. Hospitals throughout the country were closed and those still standing were under-staffed. Medical and social care moving into the private sector was the expectation. A few years on, we know that there are relatively few issues in the nation that command more public attention, induce more fear and frustration and pose a greater threat than healthcare. Daily, we see highly publicised cases of horror stories throughout the country.

Therefore, it must be a matter of public interest that the Government have set out a 10-year plan of reform to bring the health service to the people—a service that is free at the point of use. No matter whether one is rich or poor, healthcare is available free of charge. The plan is one of reform and investment, with clear national standards: devolution of resources, more choice for patients, and greater flexibility for staff. The Government's investment will provide more nurses and doctors, new and improved hospitals, and primary care centres. All this will work only if we are both bold and swift with such reforms, which is what the elderly people with whom I spent time this morning wish us to be. That is why the Government's plan to establish a commission for healthcare audit and inspection is vital to ensure that higher standards of care for people in this country are easily achieved.

We know that the proposed commission will be independent of the NHS, so that it can objectively assess every part of the health service. Her Majesty's Government have acknowledged that the health service can no longer be run from Whitehall. They recognise that it serves different communities, and that to serve them well there must be a devolution of power. The services must be local at every point of need to patients, to his or her doctor, and to the local community. Those working at the local hospital must be the ones who are making the real decisions, thereby providing local accountability. That is why the establishment of local primary care trusts is such a bold and brave move in the reforms.

There is also a radical change in nurse training. The new powers given to nurses will enhance their standing and free up doctors to do the things that doctors do best. I welcome the reform of the National Health Service.

My Lords, I, too, am most grateful to the House for letting me speak in the gap. I also congratulate the noble Baroness, Lady Pitkeathley, on her anniversary and thank her for introducing this important debate. In the words of my grandmother, I wish her health and happiness—health must come first, for without health, it is difficult to have happiness.

I passionately believe in the NHS. I do not want to work in a system where I must send the bill to the bereaved or cease treatment because insurance runs out. No government can be unaware that, as we drive up standards in primary care, we increase pressures on secondary care. In my university hospital, open access to MRI scanning from primary care has now meant that neuroradiologists cannot cope. They are drowning under request forms. Capacity is a major problem. It was previously identified in intensive care units and studies have shown that pre-intensive care admissions management of patients significantly alters outcome.

We need concrete milestones to mark the ambitious changes that are planned, but it is through training and retraining that standards will be driven up. I have just come from an exciting study day on ethics at the Royal Society of Medicine, and I reassure the noble Lord, Lord Desai, that patients' views and wishes in planning their care were absolutely at the centre of the debate and taken as a given. There was no dispute that patients' views must be paramount.

But research is also needed and must be safeguarded in our new NHS. It identifies the root causes of disease and evaluates service changes that have been introduced. A recent example of great importance is the awareness of nutrition to the foetus: smaller birth weight babies are at greatly increased risk of developing diabetes. So care at one point avoids storing up problems for the future. But research needs support. Only 8 per cent of cancer patients in this country are in trials. The proportion should be much greater—I should like it to be nearer 80 per cent—if we are to make major breakthroughs. That research must be collaborative. The recent research assessment exercise has sadly done little to promote research and has ended up with departments that scored lower than a five feeling demoralised and risking losing funds.

We hear about the increased number of students to provide the workforce of the future in medicine, nursing and other healthcare professions. That education needs protected resources: teaching premises, equipment and clinical academics to teach. It must be a duty on all providers to promote education, training and research. I know that there was great jubilation at the reassurance given by the noble Lord, Lord Hunt of Kings Heath, that there will be university representation on strategic health authorities. I sincerely hope that the same will be reflected in Wales.

The noble Lord, Lord Turnberg, highlighted the damaging bottlenecks in training that will continue to demoralise keen young doctors who are unable to pursue the career to which they feel inspired. Another problem is early retirement. We are losing enormous wisdom that could do much to help the clinical teaching, ongoing training and research that are so important. I urge the Government and the Treasury to consider how to encourage flexibility in retirement, so that people could retire without their pensions being jeopardised and their wisdom used in the NHS for another five to eight years to meet those education, training and research requirements.

My Lords, I, too, would like to thank the noble Baroness, Lady Pitkeathley, for so effectively introducing this excellent debate. Please excuse my sneezes and sniffles, but I know from the Government's excellent public health campaign that there is no point my going to see a doctor. Perhaps my expectations are suitably low and the right reverend Prelate the Bishop of Guildford will approve.

We can examine the issue on two levels. The first is from the principle of the National Health Service free at point of need and available to all. It is clear from the contributions to this debate that there is overwhelming commitment here to that. We must remember that that has not always been the case, and is not always so even now. I welcome the fact that the principle is widely shared here. The noble Baroness, Lady Pitkeathley, is right to emphasise the value and worth of the NHS. My experience of other health systems is that they are often excellent for the haves but hopeless for the have-nots. That reinforces my support for our NHS.

The noble Baroness, Lady Gardner, is right to highlight dentistry. That should stand as a cautionary tale of what can happen when services are not universal. Dentistry was never properly integrated into the NHS, and now only 47 per cent of people are on an NHS dentist's list. Given the vital importance of dental care in preventive care, dentistry should surely be far higher on the Government's agenda. That would show a real commitment to universal service.

The second level of the debate refers not to the principle of the NHS but to the National Health Service as it is today. Here, as we have heard, the picture is much more complicated. When, in his most recent Budget, the Chancellor finally agreed to give increased funding to the NHS, a large majority thought that that was the right thing to do. However, only a small minority thought that it would make any difference.

For years, the Conservatives underfunded the NHS and, timidly, when first elected, the Labour Government followed Tory spending plans. It is not surprising that things went from bad to worse in the health service, and the Government seem surprised at how long it takes to turn things around. We seem to have initiative after initiative, reorganisation after reorganisation, in the hope that that will achieve rapid improvements in the quality of service provided by the NHS.

As my noble friend, Lord Clement-Jones, argued, those initiatives may be well-meaning, but constant change becomes in itself disruptive. Organisations are set up to report on parts of the service and visit after visit has to be prepared for. Targets must be met and budget deficits filled.

So what is required for the NHS to flourish? Funding, certainly, and I trust that we are now moving into a more positive era. I welcome that. But the NHS also needs stability and consistency, which has been remarkably lacking. Right now, in the last stages of its progress, there is a Bill which is intended to achieve things that have already been overtaken by a new document with new plans for organisations that have barely come into being. Can the Minister tell us whether stability and consistency will ever be recognised as themselves having value?

Most importantly, we must address the issue of NHS staff and their morale—a theme that has run through our debate. Surveys have shown how far morale has fallen. With insufficient staff there is too much pressure on those remaining in the service. The Government have necessary and ambitious plans to expand the number of doctors, nurses and other staff. But we know that there are insufficient clinical academics to teach the new medical students. As the noble Lord, Lord Turnberg, and the noble Baronesses, Lady Gibson, and Lady Howells, have said, we must address the needs of the staff. We need more flexibility, less central control and more involvement.

The time has surely come to focus on people, not structures: the people who staff the NHS and, most importantly, as the noble Lord, Lord Desai, said, the patients who use the NHS. No one has yet cracked that problem. The paternalistic but so welcome NHS of 1948 must move into a different era—one that is more patient-centred and finds ways to involve patients. Like the noble Lord, I am sceptical whether the myriad structures to which we have agreed in the Bill and which are about to slot into place will achieve that—although of course we made major improvements on the way.

It is excellent that we all share a commitment to a universal NHS. We differ on how to deliver an improved service for the 21st century.

My Lords, we can agree that it has been a particularly good debate on a subject in which all of us, in one way or another, have a personal and abiding interest. There can be few better among your Lordships to introduce such a Motion than the noble Baroness, Lady Pitkeathley. I congratulate her on having done so in a manner that enabled her balanced perspective and experience to shine forth.

Listening to the speeches today, I have been conscious of something that, perhaps, we concede too seldom. Although there is much in health policy that divides one side of the House from the other, there is also a good deal—perhaps, an increasing amount—that unites us. One such issue is the critical importance of service quality in all branches of healthcare. I agree with the noble Baroness that we have world-class physicians and some state of the art facilities. Our staff are hard working and dedicated, and most patients get good treatment and good care. The trouble is that people must wait, sometimes for a long time, for elective surgery. Even more seriously, outcomes in Britain for the killer diseases, where they really matter, are poorer than in other European countries—not just slightly poorer, but a great deal poorer. For cancer alone, it is estimated that if Britain could achieve the survival rates of the best countries in Europe for each cancer, over 25,000 lives a year would be saved.

Two years ago, the NHS Plan represented, by any standards, a sweeping and ambitious blueprint for change in the National Health Service. It contained an impressive array of targets for more facilities, additional staff, new systems of standard setting, new ways of working, better access for patients, better health outcomes and so on. However, it had one common and obvious aim—namely, to enhance quality and to make the NHS more responsive to the needs and wishes of patients. The objective of creating a patient-centred health service, which delivers the highest standards of care, is not something about which government and opposition have any need to argue. The argument begins only when we consider the means to achieve the end.

I have no doubt that the Government are right to say that there are two basic ingredients to improving the health service: one is money, and the other is reform. The trouble is that on the basis of what the Government have done—or said that they would do—I am on both counts something of a sceptic. In fact, one could say that I am something of a wet blanket. I do not like being a wet blanket. The recent Budget set out the Government's commitment to raising substantially the level of health spending over the next six years, over and above the levels previously announced. The White Paper published the following day laid out more of the landscape of reform as the Government envisage it. It is a landscape of greater devolution from the centre, greater patient choice and tighter accountability. What could possibly be wrong with that?

What is wrong with it is that, in key respects, the reforms do not look to go far enough. For example, despite devolution of the NHS budget and the much-vaunted shifting of the balance of power, the system itself is still, in essence, the centralised Bevanite structure of old. Strategic health authorities will, I fear, be the instruments of Richmond House in most key areas of decision making. The multitude of centrally driven targets and directives will still be very much a feature of NHS life.

The NHS Plan says that,

"For the first time, patients will have a real say in the NHS".

However, if we analyse what is on offer, we find that choice for patients will not be genuine choice, merely an ability to express their views and hope somehow that they are heard. We shall still be light years away from the sort of real choice open to patients in other European countries, who can freely elect where they wish to be treated and by whom. The White Paper, Delivering the NHS Plan, talks the language of patient choice, but the conditions necessary for a genuine diversity of provision are not being created, and the inefficiencies and waste in the system will not have been tackled. Even at the end of the reform process, patients will still wait to receive treatment for what, in other parts of Europe, would be regarded as an unconscionable time. The Government have not recognised that the retention of a command and control structure is not compatible with real patient empowerment, nor with the need to give professionals the freedom to get on with the job that they are qualified to do.

Of course, I am delighted that the Government have recognised some of the basic building blocks of patient choice. One is the establishment of a system in which the money follows the patient. Another is the creation of additional capacity. Ministers are fond of rubbishing the internal market created under the last Conservative government. I would not argue for the re-creation of that system in all its glory; it had obvious faults and shortcomings. However, the least that we should do, in a mature debate, is understand and acknowledge what the internal market tried to achieve. It tried to make the system more responsive to the wishes of patients and, in the process, deliver better care. It could have been done better and less bureaucratically, but the central principle was valid. It was certainly not something wicked or immoral, as Ministers have sometimes painted it.

I do not know precisely how the Government will see to it that money once again follows the patient, as they have promised, or that there really will be a plurality of healthcare providers. However, assuming that both aims are somehow met, it would take a linguistic contortionist to deny that the result was a market in all meaningful senses. It is a pity that Ministers will not admit that; it would lead to a more grown-up discussion if they did.

An integral part of a patient-centred service is patient representation. It really is extraordinary that in the White Paper, Delivering the NHS Plan, no mention is made of the Commission for Patient and Public Involvement in Health. That makes me wonder how high the issue of patient representation is on the Government's agenda. Today is not the time to repeat the arguments that we had in Committee and on Report on the NHS reform Bill, but, unless the provisions in the Bill for patients councils are retained and other improvements made, we are likely to end up with a patients' voice much weaker than it is at the moment. There will be no lay overview and no ability to lobby or speak out—or, indeed, to get anything done. To the noble Lord, Lord Desai, I say that my logic on the matter is simple. If there is a state-funded monopoly provider of healthcare, the system is very powerful, and the dice are loaded against the consumer. To counterbalance that, the least that we should do is ensure that the consumer's voice is properly heard.

I am not a complete wet blanket. I do not, for a minute, belittle the improvements to service quality that the Government may achieve. All such improvements will be welcome. But how soon will they be delivered? If we examine the targets set out in the NHS Plan, we see that the pace of progress is worryingly slow. IT is an essential part of delivering the plan. The target was for 35 per cent of trusts to have introduced electronic patient records by April 2002. Only 3 per cent of trusts had actually done so. Money is so tight that supposedly ring-fenced IT budgets have been raided for other purposes. On hospital cleanliness, we are still a long way behind every other European country, as regards the prevalence of drug-resistant bacteria. On GP recruitment, where the target is to have another 2,000 doctors in post by 2004, the increase in both 1999–2000 and 2000–01 was precisely 18.

The Government say that they have already achieved their target for nurse recruitment, but a high proportion of new recruits are not full-timers, and there is still a big problem with nurses leaving the NHS. In mental health, the picture is very worrying. Practically no progress has been made in, for example, putting crisis mental services in place or recruiting new staff to help carers. The Audit Commission recently described the task of delivering the national service frameworks for mental health as great.

Overall, the number of patients being treated by the NHS is not increasing. The waiting list figures focus on in-patients, where there has been some progress, but conveniently ignore the considerable rise in out-patient waiting times. I could continue because there are some worrying areas. We all know that easing those pressures will depend critically on an expansion of capacity in both acute and intermediate care.

The Government are placing a lot of reliance on the private sector to provide the extra capacity. However, the private sector needs confidence to invest and I am afraid that the Government are simply not giving it that confidence. For example, there is still no agreement on one of the key building blocks for capacity growth—the consultant contract.

I have concentrated on some of the problems merely to point out that, with the best will in the world, the targets in the NHS Plan are difficult ones. The Minister may find it odd that I should be wishing the Government well in their efforts. I do so genuinely because the NHS, despite what may have been said today, does belong to all of us. However, the Government will be judged not on their efforts but on their success against the objectives they have set. Time will tell whether the route they have chosen is the right one.

My Lords, I, too, congratulate my noble friend Lady Pitkeathley on her initiative and, indeed, the high quality of her opening remarks. She said that it was the anniversary of her miraculous recovery and all noble Lords were delighted when she returned to your Lordships' House. The benefit today has been for all to see and hear.

I agree with my noble friend Lady Gibson that the NHS is one of our greatest achievements. I also agree with my noble friend Lady Howells that the expectations of the public are very real and very genuine and that they represent an incredible challenge for all those working in the National Health Service at the moment. The Government have clearly defined the direction of travel for the NHS. The NHS Plan, published in July 2000, is a 10-year programme. I believe that it provides the context, the stability and consistency that the noble Baroness, Lady Northover, asked for.

I say to my noble friend Lord Desai that in a sense I disappoint him because it is a genuine 10-year plan. One simply cannot turn around the NHS overnight. So much depends on getting the infrastructure right that I believe we are justified in setting out a long-term plan in the way that we have done. When it was published the Government made it clear that radical improvements in the NHS would require both a sustained programme of investment and reform. That is surely the message of the Budget and the implementation of the plan programme that my right honourable friend the Secretary of State announced.

There is, of course, much more to do. The effect of decades of under investment still take their toll on services. However, investment and reform are delivering benefits to patients. I say to the noble Earl, Lord Howe, that the figures show that health outcomes are improving. In the past year alone, death rates from cancer are down by 2 per cent and from heart disease by 5 per cent. Of course, we have to do more, but at least we are moving in the right direction.

Waiting times are falling. A number of noble Lords have mentioned that patients are seeing the benefits of booked admission systems which give them greater choice and convenience. Capacity constraints—not enough staff, inadequate facilities and equipment—have bedevilled the NHS for years. We are beginning to put that right. Staff numbers are increasing. The noble Earl, Lord Howe, was a little negative about the increase in the number of nurses. The number has increased by over 20,000 in just two years, achieving the NHS Plan target two years early. The number of doctors is increasing as well.

As my noble friend Lord Turnberg says, and I accept, we need to do more to retain nurses and doctors. Our approach to more flexible working practices is surely the right way forward and we will need to invest more in flexible working and child support. As the noble Baroness, Lady Finlay, suggested, we are looking at ways in which we can prevent the unnecessary early retirement of doctors. As my noble friend Lady Gibson also suggested, in so doing we have to listen to staff. We are working with them. We are in important discussions about new contracts for GPs, consultants and the rest of the workforce. It is important that we take the staff with us.

Extra investment, coupled with the work of the National Institute for Clinical Excellence, is helping us eliminate the post-code lottery for prescribing of drugs. In primary care, prescribing of cholesterol lowering drugs is up by one third. Tens of thousands of patients are receiving the latest drugs to combat cancer, heart disease, arthritis and Alzheimer's. I say to the noble Lord, Lord Lyell, that in relation to beta interferon, the National Institute for Clinical Excellence has reported that while it found that the beta interferon drugs were not cost effective, they did recommend discussions between the department and companies. The issue has been resolved. Patients coming into the agreed guidelines can now receive the drug, consistent with the guidelines published by the recognised professional association. That will lead to consistency across the country.

For the first time we have seen an increase in the number of hospital beds. The go-ahead has been given to 68 major hospital building projects since May 1997. Thirteen have been completed and a further 15 are under construction.

I listened with great interest to the noble Lord, Lord Selsdon, describing his experience in the building of six hospitals under the PFI scheme. I would say to him that the original problems with PFI have largely been resolved. He is right; the PFI unit is issuing very good guidance to the NHS. Certainly, from my visit to a number of hospitals where they are embarking on major capital schemes with private sector partners, I believe that the NHS has learnt a lot and has considerably more expertise to act as an effective partner with the private sector.

Certainly, we want to encourage the public sector to be entrepreneurial in the way it conducts its business. That is why, when I talk about foundation trusts later, I shall say more about how we can get the conditions right so that those kind of public private partnerships do become as effective as possible.

The noble Lord, Lord Lyell, also referred to the pharmaceutical industry. I agree with him. Making the NHS an attractive base for the industry to work in partnership with is very important. The research-based pharmaceutical industry in this country is responsible for approximately one third of all commercial research and development investment in the United Kingdom. It is essential that we provide the right competitive base for that industry to thrive.

I agree with the noble Baroness, Lady Finlay, that part of a responsible effective partnership is to ensure that the incentives are there so that clinical trials can take place in this country and, in fact, to ensure that there are more in the future. That is one reason why the Government have produced new guidance in relation to research governance to try and clear up some of the problems in terms of obstacles to getting good clinical trials under way in England.

The noble Earl, Lord Listowel, raised a number of important points concerned with infant and child mental health services. We accept the importance of those services and of recruiting the professional people required. We also accept that our workforce planning mechanisms must take that into account as much as they would take into account other professionals, whether in acute services or in primary care.

The noble Baroness, Lady Gardner, knows that dentistry is a subject dear to my heart. I, too, pay testimony to the quality of our dental profession. It is a high quality profession. I believe that the dental strategy sets the right tone, consistent with the NHS Plan, for taking forward the progression of the service to the public. I believe that dental access centres have proved popular and effective. I say to those members of the public who have problems with access that their immediate course of action should be to ring NHS Direct, which will do everything it can to refer them to a dentist performing NHS services.

Very important discussions have taken place between the profession and the department looking at some of the issues that the noble Baroness raised in relation to fees, workload and the treadmill, as dentists are wont to call it. Those discussions have been most fruitful. It was recently announced that demonstration sites will be set up to test out some of the ideas and a final report is expected to be published in due course. As regards the noble Baroness's specific question, perhaps I may assure her that we remain fully committed to ensuring that the full range of dental treatment necessary to restore good oral health will remain available on the NHS.

Dentistry is but one of the many significant developments taking place. All of that is underpinned by new arrangements to enhance service standards, accountability and devolution of power to frontline staff. That is why national service frameworks are so important. That is why the Modernisation Agency has been established to set up and encourage good practice systematically.

Those are all significant developments. The NHS Plan is working, but no one could kid himself that everything is now perfect. The importance of the extra resources for the NHS and social services announced in the Budget is that they allow us to go further in driving forward the programme of reform. As the noble Lord, Lord Clement-Jones, said, that is a massive commitment to the NHS.

What improvements will that extra resource buy? The scale and significance of the investment demands as a minimum that we address two issues. First, we must set out clearly what the extra money will buy in terms of improved service quality. Secondly, my noble friend Lady Pitkeathley spoke of the situation pre-NHS. We have also to recognise that an NHS built in the 1940s must be reformed, as my noble friend so recognised. Without radical action now, we will not gain the maximum benefit from high and sustained levels of investment.

Perhaps I may deal with the first of those two issues. People will see tangible improvements in the quality and convenience of services. We will focus special effort on reducing waiting times for treatment because that is clearly the public's principal concern about the NHS. Faster services will support our objective to improve the nation's health and tackle health inequalities. We aim to reduce deaths from cancer by implementing the cancer plan's improvements to the prevention and treatment services. We aim to save around 25,000 lives by 2008 by investment and reforms in prevention and treatment services for coronary heart disease. We aim to improve mental health by ensuring that by 2008 every patient who needs it will have access to round-the-clock crisis resolution and assertive outreach services. We also aim to support a further 100,000 older people each year by 2006, enabling them to live independently at home, through extra intermediate and home care services. We are not putting aside public health. There will be greater focus on prevention and health inequalities. The extra money will allow a step-change in capacity for which many noble Lords have called.

The scale of reform goes wider. I want to flag up the key points of the programme and answer many of the substantive points made by noble Lords. I turn first to patient choice. As capacity expands, so will patient choice. From this summer, patients who have been waiting six months for a heart operation will be able to choose from a range of alternative providers who are able to offer quicker treatment. We will roll out this new approach to other clinical conditions, beginning in London later this year. By 2005, all patients and their GPs will be able to book appointments at both a time and place that is convenient to the patient.

The noble Earl, Lord Howe, tempted me to respond to him on the internal market and I shall do so. Living through the internal market, I have no doubt whatever that its fundamental precepts were fatally flawed. It was very bureaucratic. The money did not follow the patient; the patient followed the contract. It was blatantly unfair to non-fundholding, practices and it was done in a complete absence of national standards and information on which patients could compare one hospital with another.

That is the big difference. We have provided national standards through NICE, through national service frameworks and through an independent inspectorate. We are providing information to patients. We are providing choice for all patients and not just a lucky few. Our proposals for foundation trusts will surely provide the right kind of freedoms and flexibilities within the proper ethos of the NHS.

The second point I want to make is that choice will be underpinned by new incentives. The problem with the NHS over so many years is that the hospitals which do best are often seen to be penalised by the funding regime put in place. That is why we want the hospitals which have the capacity to do more to be able to earn more resources as the money follows, not the contract, but the choice made by the patients. Over time, we intend to develop a system in which the price of individual treatment is based on a regional tariff, allowing local commissioning to focus on the volume, quality and appropriateness of care.

Of course I understand the points made by my noble friend Lord Turnberg about poorly performing hospitals. Of course they need understanding and support. That is why we have the Modernisation Agency. However, we must also root out poor performance. We cannot remain in a situation in which we tend to think that all NHS hospitals are similar and that all NHS hospitals must be treated in the same way. We must distinguish and provide the right incentives for good performance.

As regards the devolution of power and resources to local level, I shall not respond to the issues of patient empowerment. We have debated the matter frequently and I look forward to debating it again when the Bill comes back from another place—as assuredly it will! However, I want to respond to the point referred to by both the noble Lord, Lord Clement-Jones, and the noble Earl, Lord Howe—their allegation of centralisation.

At the weekend, I spent an interesting day analysing the amendments which both noble Lords tabled on Report and in Committee during debates on the NHS reform Bill. I found that the majority of their amendments, far from decentralising power, centralised power, giving more to the Secretary of State or to strategic health authorities. I must say that the experience of the NHS under the previous government was not of an administration hell-bent on decentralisation. I well recall the study by the Oxford Regional Health Authority which discovered that the previous government in their priorities for the NHS had 57 different ones—which meant that there was no priority.

I believe that the NHS Plan gives us the right condition for setting out the core priorities for the NHS. Taking that with the national standards and with an independent inspectorate, we can allow so much more freedom at local level. That is what foundation trusts are all about. We want greater local ownership of those organisations and we believe that that is the best way to incentivise performance.

Within those organisations, we too want to see devolution. My noble friend Lady Gibson and the noble Baroness, Lady Masham, referred to modern matrons. The reason for developing those roles is to give to nursing staff more authority at the level of the ward so that they can run the ward in the interests of patients.

I suppose that that response is also the answer to the question posed by my noble friend Lord Desai: whether the NHS belongs to the patients or to the staff. There is no question about it: the NHS has often displayed the characteristics of a producer-orientated health service. However, I think that the new services such as NHS Direct, booked admissions and the rapid chest pain clinics demonstrate that the NHS can provide services which focus on the individual patient. My noble friend Lady Finlay suggested that professionals are also responding to the need to do so.

We also wish to break down the barriers between health and social care, which is why we have introduced these new incentives. As my noble friends Lady Pitkeathley and Lady Gibson pointed out, we have to break down rigid organisational barriers. We must also ensure that accountability is strengthened, both nationally and locally, as well as ensuring that the ethos under which the NHS conducts itself is conducive to the everlasting fundamental principles of the NHS, while allowing much greater room for manoeuvre and leadership at the local level.

The right reverend Prelate the Bishop of Guildford put the debate into perspective when he spoke of his experiences in Africa. There people desire peace, clean water, education and to be able to grow good and wholesome food. It is necessary to reflect on just how well off we are with our National Health Service when compared with so many other countries. But that does not mean that we can be complacent. And, as was suggested by the right reverend Prelate, in turning around the National Health Service and in making it much more responsive to the public, we in turn have a right to expect the public to be responsive to and responsible for the service. We want to stress patient responsibility.

In addition, we want to utilise other areas of the NHS to provide services where they are most able. For example, I am convinced that our high street pharmacists could do a great deal more in giving advice to the public. I also believe that the establishment of NHS Direct, conferring greater responsibility on nurses and giving more responsibility to the other professions, will ensure that we provide the responsive service to meet those extra demands.

Our debate has centred on the Government's programme of reform, and rightly so. I had hoped that it would also shine a little light on the proposals of the party opposite on health. Alas, that was not to be. So we have concentrated on this Government's approach: that of matching investment with reform.

I have no doubt that this is the right approach. The signs of improvement are already showing. We have the commitment of the NHS behind our proposals. I have no doubt that, given the Budget announcement and the resources and the commitment being brought to bear on the service, we can deliver the NHS that we all want, an NHS that gives a world class service.

My Lords, it has always been apparent to me that the NHS arouses great passions: positive, negative and, sometimes, even sceptical ones. That has been made clear once again in our debate today. I am most grateful to all noble Lords who have spoken. The quality of their speeches has been outstanding. I was struck by the wide-ranging nature of the contributions, in particular by the fact that so many noble Lords put health into a wider, societal context, reminding us that improvements in how we treat illness must in the end be dependent on how we nurture and cherish the health of our society.

On that last point, I was also struck by the links between the two debates set down for today. It has been my experience that usually our Wednesday debates address totally disparate topics. However, some of us will go on to debate the relationship between sport, health and social inclusion. Again, that marks a recognition of the links between lifestyle and quality of life.

I should like to thank noble Lords on the Opposition Front Benches for permitting the inclusion of two extra speeches in the gap. Furthermore, I should like in particular to thank my noble friend on the Front Bench for his full and thoughtful response to our debate. His skill and experience are much admired on all sides of your Lordships' House. His response today has given a clear indication of why he is so admired.

Once more, with my thanks to all noble Lords who have spoken in the debate, I beg leave to withdraw my Motion for Papers.

Motion for Papers, by leave, withdrawn.

rose to call attention to the importance of sport in Britain both for the promotion of health and social inclusion; and to move for Papers.

The noble Baroness said: My Lords, the little girl who sat next to me in primary school had callipers on her legs. They clanked as she walked and in the winter her boots rubbed her ankles. The prettiest girl in my class had dark curly hair, bright blue eyes and lovely rosy cheeks. They should have been a warning sign, for when she died, we all had patches stuck on our arms to see if we had been infected. The rest of us went through the usual batch of standard childhood diseases.

Today, more than 50 years on, those diseases of polio, TB, measles, mumps and rubella have been all but eradicated. Our children and grandchildren should be healthier and fitter, but they are not. What else was different then from now? Well, the rest of the children in my class were a scrawny bunch—I ask noble Lords to believe that. We were post-war children fed on post-war rations, walking a couple of miles to and from school every day and playing outside each night at games of football, cricket or tig—whatever the season demanded.

But somehow during those 50 years, the old, deadly communicable diseases have been replaced by new, insidious attacks on our health. The ailments are largely self-inflicted, with young and old, male and female, rich and poor succumbing to their debilitation. The facts are stark. Today, most adults are overweight—more than one in five, while around 8 million of us are technically obese. In England, obesity has trebled over the past 20 years. Unless effective action is taken by 2005, 20 per cent of men and 25 per cent of women could be obese. The outcome is horrendous: heart disease, high blood pressure, osteoarthritis and type 2 diabetes are all conditions which can and do lead to premature death.

And of course the incidence of obesity in children is growing at an equally alarming rate. The "couch potato" syndrome is rife. Anxious parents no longer let their children walk to school, much less play outside in the evenings. Sadly, the groups facing the highest risks are those from poorer communities and families. The problems associated with being a "couch potato" are higher in girls than in boys, and in the ethnic and minority communities.

Obesity is not only about personal poor health, it carries a huge price tag for society as a whole. In terms of treatments and lost working days, overall in Britain the loss to the economy totals some £2 billion per year.

Crime is not new and nor is social exclusion. But the scale, the type of offending and the age groups involved are new. We have a major problem. The Prime Minister has promised to cut levels of street crime by the autumn, but levels of youth crime continue to rise. Shoplifting, street theft, burglary or offences against the person are all serious offences and are being carried out by ever younger children. Many of those offences can be linked to the drug culture.

It is at this point that the vehicle of sport, both as an antidote to obesity and a way of overcoming crime and encouraging social inclusion, comes into play. The Government are acutely aware both of the problems and of the value of sport, not only for young people, but for everyone. It is salutary to note that only 37 per cent of men and 25 per cent of women meet the current government guidelines for physical activity, which comprises just 30 minutes of moderate exercise on at least five days a week.

What is also obvious is that no single project can overcome these twin problems. In recognising that, the Government have set up a whole network of progressive programmes, some of which are already having an effect, while others are coming on stream in the future. Sport is now at the centre of a network of government departments, from the Department for Culture, Media and Sport to the Department of Health, the Department for Education and Skills, the Department for Environment, Food and Rural Affairs, through to the Department for Transport, Local Government and the Regions and, finally, to the Food Standards Agency. All those departments are working coherently towards the common objectives of developing not only more healthy lifestyles, but also lives which are happier and more dynamic. The earlier we tackle these problems the greater the chance of success. In order to move forward we have to take stock of where we are now in relation to sport and where we need to be in the future.

Here I turn to school sport as perhaps the most obvious opportunity to make a real difference to young lives. We have a huge backlog to clear up. The legacy of the neglect of school sport is quite appalling. I cast my mind back to when my two daughters were at their local comprehensive school in the mid 1980s. It was an amazing time. The school was a sporting dynamo. The girls' tennis team became the first, and probably the only, comprehensive school to win the Aberdare Cup, not once but twice. Alongside this were sporting triumphs and a huge participation in all sports by boys and girls of all abilities.

But that of course was before the "stand-off" between teachers and the government of the day—and prior to the feeding of sport to the mercy of the academic barons in schools under the fig leaf of the national curriculum, in effect sweeping PE away from the school curriculum. So not only was PE all but eradicated from the school day in state schools hut, with the loss of teacher good will, with it went the extra-curricular activities too. By the beginning of the 1990s, that same comprehensive school could barely field one team of any standard in any sport. A whole generation was deprived of its sporting rights in school.

But that has changed. The first underpinning of sport is the Government's intention of guaranteeing a minimum of two hours PE per week, a fairly modest beginning but a welcome one. At last we are to have PE specialists coming into primary schools and decent facilities for them. The new opportunities for PE and the sport programme is the most exciting initiative yet established. It offers key innovation for sport which will integrate and support wider local strategies to improve PE and school sport, linking sport, education and health. The funding alone signifies its priority—£581 million from lottery funding, a huge boost and a step change for sport.

As my noble friend Lady Pitkeathley is among the speakers due to follow me, I have no doubt that she will share her expertise in this area when she speaks later. I look forward to her contribution.

The School Sport Alliance, established in November 2000, has set up the school sports co-ordinators who will deliver high quality PE in schools and link primary and secondary schools and sports clubs in their localities. Five hundred co-ordinators are now in place and many more are planned.

With teachers go facilities. The tide of the sale of playing fields has been stemmed but not yet cured. We await the DTLR's new guidelines with great interest. They must be robust enough to stem the haemorrhaging of playing fields with strict criteria for any sale.

For the first time primary schools are included in new facilities. The Space for Sport and Arts Fund has allocated £150 million for projects to be shared by school and community. Add to this the huge investment by the Government of between £1.5 billion and £2 billion on community sports facilities, many in the form of local authority facility projects, and it is clear that the Government really mean sporting business.

Specialist sports colleges are being established, combining full-time education and training for our talented young people. The next generation of sporting heroes are the role models of the future.

As part of the inter-departmental strategy, the Department of Health is tackling obesity in a variety of ways. Health action zones, the inclusion of fruit into the school diet and a greater emphasis on GP co-operation are crucial innovations in the goal of more healthy communities.

The roles of other key players cannot be overestimated. Sport England and the CCPR are the eyes, ears and hearts of sport in our community. There are 110,000 voluntary clubs which offer a huge range of sporting disciplines, aided by the governing bodies and of course lottery funding from Sport England. No government intervention has been more welcome than the Chancellor's recent announcement of tax and financial assistance to these community amateur sports clubs. We await with enormous interest the take-up of that financial recognition.

Positive Futures, a dynamic partnership between the Home Office, Youth Justice Board, Sport England and NACRO, with the Football Foundation, seeks to divert 10 to 16 year-olds from drugs and anti-social behaviour. As my noble friend Lord Pendry is speaking today, I need say no more, leaving this topic to his immense expertise.

Individual projects are specifically targeted on minorities. Girls in sport need a special approach and my noble friend Lady Massey will doubtless enlighten us in this area, as will my noble friend Lady Howells in regard to youngsters from the ethnic minority communities.

I have outlined, in brief, but some of the Government's initiatives for putting in place an imaginative and robust programme to ensure the future health of our society. More will follow. I hope that the Government will accelerate the audit of sports facilities by local authorities. Perhaps the Minister can reassure us on that.

We also need to ensure a wider coverage of sport in the media. With public sector broadcasting, is a sports channel still a possibility? By "wider coverage", I mean sport for all, for those with disabilities and for women and girls. Dare I mention at this point Title IX? Perhaps not. That is an item for debate on another day.

Whatever the answers to those questions, I am confident that the Government will continue to underpin sport in our communities, bringing with it greater health, happiness and a chance to belong, thus helping to eliminate those twin scourges of obesity and crime. My Lords, I beg to move for Papers.

My Lords, the noble Baroness, Lady Billingham, has opened our proceedings with an excellent speech that highlighted the kaleidoscope of interests and initiatives which are involved with the subject under consideration today. I hope that she will find that some of the contributions—present company excepted—from these Benches equally add value to what is sure to be an interesting and informative debate.

I should like to concentrate, first, on one aspect of the Motion—that is, the concept of social inclusion, which is critical to the subject under consideration. I shall concentrate on the role that sport and recreation can play in inner city regeneration policies and the wider context of social inclusion in our country. So perhaps I may say a few words on social inclusion—or, perhaps more appropriately, social exclusion.

Social exclusion and social capital are closely linked. Social exclusion, by definition, results in a paucity of social capital. Increasingly it is being recognised that economic activity and social activity both take place within and with reference to a social context. While social relations can act as impediments, as classical theories assume, they can also be a medium for, and catalyst to, economic activity.

Social capital is broadly described as an asset embedded in relationships—between individuals, communities, networks and societies, and between sports associations, teams and clubs. It is an asset which must be managed correctly if its value is to be realised. Social exclusion does not represent good management of this asset.

Policies to tackle social exclusion are rightly assuming increased priority, and sport and recreational initiatives should play a key role in this process. For example, the European Union states that,

"the fight against social exclusion is of the utmost importance for the Union".

This is by and large owing to a better understanding of the fact that social exclusion carries high costs, or reduced social capital. These costs are borne not only by the individuals who experience social exclusion but by society as a whole. They take the form of reduced social cohesion, higher crime and fear of crime, a less skilled workforce and the cost to the public finances of social failure. It follows that if social exclusion is reduced, then society as a whole will benefit.

If we recognise that analysis of social exclusion, it is incumbent on us to recognise the role that sport and recreation can play in addressing the causes of social exclusion. We need only to look at the significant advances that football clubs have made in communities and in community relations to see the value of targeted measures addressed to the promotion of sport as well as to the promotion of social inclusion in their communities. So, in the short time available, I intend to propose a number of initiatives to the Government which would build on the work that I had the privilege of undertaking when considering this issue as Minister for Sport.

I propose that the Government should give every encouragement to local education authorities and individual schools to devote an increased proportion of curriculum time to physical education. This is critical to the goal of a healthier nation. It is critical to wider participation, from whose roots we nurture and culture the excellence and the champions of tomorrow in a healthier society.

Secondly, the Government should establish more practical links between schools, local sports clubs and local education authorities, enabling children to receive coaching in particular sports and to make use of club and community facilities in school time and outside school hours. We have to do more to build the bridges between school sport and ongoing participation in sport and recreation outside schools and in communities as a whole. We have a long way to go to become competitive with other countries in building that bridge, which is essential to a healthier society.

We have waited far too long to see progress on effective dual use of facilities in inner cities and in the country as a whole. Progress is being made, but a major new initiative to boost dual use is required. More sport and recreation elements are needed at the heart of the inner-city initiatives which the Government have proposed and on which they are working. Perhaps we should ask the Treasury to consider within its fiscal policies the possibility of incentives—including tax incentives—for inner-city sports buildings which offer a full range of services to the local community.

We shall hear of many more initiatives in the course of the debate. Perhaps I may refer to one unusual one. I believe that the Government should work more closely with the British Olympic Association and consider with it what further work the BOA can do in ensuring that the aspirations of youngsters generated by the Olympic Games are encouraged. Something akin to the International Olympic Committee's patronage scheme for events and projects has potential for development. It is by taking these measures, and many more, that we can promote health and tackle the vitally important issue of our time; namely, social exclusion, particularly in inner-city areas.

My Lords, I am grateful to the noble Baroness, Lady Billingham, for initiating the debate. I believe that the role that sport can play in developing individuals and communities has been underestimated by governments over many years—although I accept the noble Baroness's point that this Government are at long last beginning to make some progress.

The case for promoting sporting activities is obvious: sport promotes healthier bodies and a healthier lifestyle. For those who participate in team sports, it promotes the development of team skills and communication skills, which have wider benefits for the participants throughout their lives. Sport promotes self-esteem and a sense of well-being. Any parent with a child who is keen to take part in sport or to join a team knows that this is a matter of huge importance. If children do get into a team and if they perform well, their self-esteem rises and their outlook on life becomes more positive. This spills over into their school work and into their relationships more generally.

The power of sport to motivate and inspire can, however, help individuals and society more generally to achieve broader goals than those that are simply related to sporting prowess. I want to concentrate my remarks on the ability of sport to promote educational and personal development goals, and in so doing to promote social inclusion. I declare an interest as chairman of the Prince's Trust football initiative and as an adviser to a number of sporting bodies and clubs on their corporate responsibility programmes.

Perhaps I may take two examples which demonstrate the scope for sport in this area. The first is the Playing for Success programme, which is part of the Government's national framework for study support. First referred to in the Labour Party's 1997 general election manifesto, this programme now operates across the Premier League football clubs. At Leeds United, for example—I declare an interest as a Leeds United supporter—it operates from within the ground and is targeted at schools in deprived areas in south Leeds.

The results of this work, based on 10-week courses in the ground, are truly spectacular. For key stage two pupils, the improvement in raw attainment scores in just 10 weeks was as follows: for boys, in reading the figure was 30 per cent, in maths 40 per cent, and in IT 90 per cent. For girls of the same age the improvement in reading was 24 per cent, in maths over 60 per cent and in IT skills over 93 per cent. Those are amazing results. They are possible partly because all the learning is based on football modules, and partly because the parents are suddenly energised in a way that they are not when the children are simply working at school, and because the pupils want to learn. Attendance levels rocket up and truancy levels plummet because of the attachment to sport and because of the power, in this case, of the most important sport in this country—football.

The second example is the Prince's Trust football initiative. This consists of a 12-week personal development programme for teams of 16 to 25 year-olds in association with football clubs. Some 85 per cent of participants are unemployed, and the clubs provide a range of support which varies from club to club but includes the use of the name, the involvement of players, the use of facilities, publicity and match programmes and so on. The Premier League makes a very substantial grant, as does the Football Foundation.

This initiative currently operates at 48 professional football clubs in England. In the current year, some 1,700 young people will have been involved. The initiative is particularly successful in recruiting disadvantaged young people and in leading to successful employment outcomes. For example, 20 per cent of the participants are from the ethnic minority communities, compared to 15 per cent of participants in similar Prince's Trust teams not linked to football. No less than 45 per cent of unemployed participants go straight into a job at the end of the programme, a significantly higher figure than for similar schemes not linked to football. Again, the reason for that has to do with the power of sport to motivate young people, to inspire them, to get them out of bed in the morning, and to get them doing positive things for themselves and for the communities in which they live.

The key characteristics of these and other similar sport-related projects are the commitment of clubs and their representative bodies; partnership with local authorities, which, for example, provide teachers; and partnership with government, which has provided funding and a co-ordinating role.

We are still at an early stage of what is possible in this area. There needs to be wider recognition within government of the value of such programmes. We need greater development of such initiatives in the clubs and sports where they already exist. Such schemes need to be extended to other sports which currently do little in terms of community development. I believe also that we can take a lead in developing best practice internationally.

As with so many other issues, it was Nelson Mandela who most eloquently encapsulated the importance of sport to society. He said:

"Sport has the power to united people in a way that little else can … it breaks down barriers. It laughs in the face of all kinds of discrimination. Sport speaks to people in a language that they can understand".

That is true in South Africa, but it is equally true in Britain.

My Lords, I join in thanking the noble Baroness, Lady Billingham, for having introduced this most topical debate. All too often, sport has been set to one side while the major issues of state—health, education, law and order, defence and the economy—take centre stage. But sport does matter, partly because it helps to define the spirit of the nation and partly, as the Motion correctly identifies, because it contributes so greatly to the promotion of health and public inclusion.

It is sad that we no longer have the wisdom of the late Lord Cowdrey of Tonbridge in this House. He cared so passionately for sport and was a convincing advocate of the cause.

I join other noble Lords in acknowledging the great value of the National Lottery, which has raised more than £3 billion for sport—funds that have been distributed to more than 3,000 projects across the country, covering more than 60 different sporting codes.

In sport, as in gardening, the best long-term results are gained when effort is put into the roots rather than the more visible, familiar blooms. In that context, I wholeheartedly endorse the line taken by the Minister for Sport in another place that the Government will support a London bid to host the 2012 Olympic Games only if it can be shown that the event will benefit sport at grass roots and community level. That is the correct approach to the sports debate.

It is obvious that sport contributes to much more than just physical health. It can teach young people lessons that will serve them well for the rest of their lives, such as the importance of teamwork, of respect for the rules and of winning and—just as importantly—losing with good grace. I am encouraged to note the increasing trend in thinking away from the old consensus that competitive sport in schools is somehow a bad thing and to be discouraged. It is crucial—I stress that word—that sport is made available to children of all abilities, both strong and weak, but we should not discourage genuine sporting competition among young people in our schools. This country has often tended to celebrate a gallant loser—my memory goes back to Eddie the Eagle—rather than a winner, but I hope we are beginning to realise there is nothing wrong, vulgar or unfair in sporting success.

It is alarming to note the ever-increasing amount of time that young children spend playing on computers rather than taking physical exercise. I say that as the father of four children under the age of six. In that regard, I welcome recent government initiatives mentioned by the noble Baroness that, among other things, support the entitlement to two hours of high-quality PE and sport per week, as well as the development of more facilities and more opportunities for intra-school and inter-school competition. I was schooled in South Africa, where it was compulsory to play at least two hours of sport each day, let alone each week. I also welcome government moves to reduce the number of school playing fields sold to developers. That is an old passion of the noble Lord, Lord Taylor of Blackburn.

The Government are making all the right noises for sport. I warmly welcome the specific commitment of £750 million of National Lottery funding for school sport. I very much hope they deliver. The signs are generally good. There appears to be a new determination within the Department for Culture, Media and Sport.

Sport is much more than healthy minds and bodies. Nothing can so effectively bond the nation. Recent history is full of examples of how sport has sensationally brought a nation together. I was fortunate to attend the FA Cup final at Cardiff last Saturday. I was struck by how the occasion had brought together people from all walks of life. In that stadium, in support of their teams, everyone was equal and everyone felt included.

There have been many innovative projects, such as the launch of football leagues to include and motivate youngsters who might otherwise have been tempted to become involved in crime. To be successful, such schemes have to have long-term funding. These are long-term problems that require long-term solutions.

The quality and quantity of funds for sport is important, but it is also crucial to focus on how those funds are spent. I would be interested to know what innovative proposals the Government are considering to promote sport throughout the country. Britain's approach to sport needs to be fresh and innovative. We need to challenge old methods and accepted ideas to realise our goals. There are always new ideas and the options are endless. Using the Internet to spread modern methods of coaching is just one proposal. Using sporting heroes as positive role models is another. We need to be positive and bold, not only in our words, but also in our actions.

My Lords, I am delighted to have the opportunity to speak in today's debate. Over the years I have contributed to many debates in the other place, often with my old sparring partner, the noble Lord, Lord Moynihan, and more recently in this Chamber. I suspect that today's debate could well be one of the most appropriate for the simple reason that my noble friend Lady Billingham has included in the title the reason why sport should be at the centre of all policy-making thinking: its contribution to health and social inclusion. My noble friend is well qualified to lead in this vital debate. I am not sure how many noble Lords know that she has considerable sporting prowess, having played—and is still playing—tennis, badminton and hockey at county level.

Sport is not just for sport's sake; it has a real end to its means and has an invaluable role to play in the social fabric of our country and the regeneration of our communities. It should become a central pillar in government thinking. I am aware that the Minister for Sport is well versed in the role that sport plays in our communities and the terrific impact that it can have in achieving the Government's aims of reducing crime and promoting health and as a vehicle for education and learning. I thank the Minister for Sport in particular for bringing sport to the top of the political agenda.

Before I start in earnest, I must first declare an interest in today's subject matter, as I have the good fortune to be chairman of the Football Foundation, which was established almost two years ago to invigorate the grass roots of the nation's most popular game, to give everyone in the country regardless of age, race, ability or gender, access to decent facilities and to widen the opportunities that the game has to offer Our partnership of the Premier League, the Football Association, the Government and Sport England is revolutionising the funding process of grass roots football by pooling resources into a huge fund for redistribution throughout the game. We are delivering a multi-million pound investment programme for football's grass roots facilities in schools and parks.

Promoting the importance of sport in shaping our society has been a recurring theme of my political life. That message has never been more important than it is now. I am encouraged that progress is being made, but we need much more of it.

The Chancellor's Budget contained two proposals that are central to today's debate and which I intend to cover briefly. The health service was rightly the centrepiece of the Budget. I welcome the tremendous boost of resources to be put into the National Health Service. I ask the Minister to ensure that some of those resources are spent on prevention rather than cure.

One of the simplest ways to achieve that is to widen access to sport and to exercise. Our nation and, dare I say, the political parties, are only just waking up to the realisation that the "couch potato" generation we have allowed to flourish faces real health risks and to the importance of sport in countering those. Indeed, one of the criteria Derek Wanless mentioned in his report on Britain's health needs was levels of obesity. The message from the report is clear—we ignore the role that physical activity can play at our peril. It is therefore heartening to see that the Fitness Industry Association together with the Department of Health is pioneering the principle of "fitness on prescription" to ensure that where appropriate patients can be prescribed exercise.

There is an issue here on which I must chide the Minister. It has been the intention of the Government for I think at least two years in their sports strategy to appoint a special adviser who would work jointly with the Department for Culture, Media and Sport and the Department of Health. That is a good initiative. It is a shame, therefore, that it has been neglected. I should welcome hearing the Minister expand on those proposals.

Our next message to the Minister is that there must be a real and substantial increase for sport in the Comprehensive Spending Review. I hope that the Minister will make that point forcefully to colleagues. There are many reasons why that should occur. I have already covered the health of the nation, social exclusion and the priority of tackling crime and social nuisance in our society. In our communities the provision of sporting facilities for young people has proved remarkably successful in reducing the type of anti-social behaviour that the Government are rightly determined to eradicate. I should like to illustrate that point by referring to a project that the Football Foundation has supported. I refer to the Leyton Orient Football in the Community scheme which has led to a reduction in crime and anti-social behaviour of over 70 per cent. There is no point in the foundation or anyone else simply building better pitches and improving changing rooms without encouraging participation from those groups. We have to get our kids off their couches and on to those pitches.

For the first time in history football is coming together to fund the future. That is a pattern that we hope to see developing throughout the sporting world in the near future. I look forward to discussing with the Minister for Sport how the foundation can play a part in that. Never before have we had this opportunity; let us not waste it.

My Lords, it is a pleasure to follow the noble Lord, Lord Pendry, who does so much as chairman of the all-party sports group at Westminster in addition to his work for the Football Foundation. I congratulate the noble Baroness, Lady Billingham, on introducing this important debate. I shall not add to the misery of the Minister who is to reply to the debate by referring to Wembley after yesterday's announcement except to say that after reading the detailed exchanges that took place in both Houses I am still mystified as to how we shall fit athletics into the new stadium.

No one doubts the value of sport as regards health and social inclusion, as has been highlighted by all noble Lords who have spoken. However, there are many other reasons why sport is so important to this country. I refer not only to our international standing and to our national competitions but also to the position of the average man and woman at club and school level. That must be a key issue in our debate today.

I shall not address the issue of school playing fields as the Government's statistics conflict to such an extent with those of the National Playing Fields Association that one cannot begin to produce an argument. However, one hopes that the Government are serious about preventing the sale of school playing fields.

As regards sport, the top of the pyramid will not thrive without a broad base, nor will it thrive if sport is not seen to be fun, beneficial to health, interesting and if facilities are not readily to hand for those who want to participate and compete. There are too many organisations over and above the governing bodies all competing for money from the Government. I refer to sports councils, local government councils, the CCPR, which produced such an excellent manifesto, the strangely named CASC in connection with amateur sports clubs, the National Playing Fields Association and the National Association of Clubs for Young People. They are all doing their best to impress upon the Government how important their position is. I know that the Government respond whenever possible. It is disappointing that the Government altered the good causes arrangements drawn up in the National Lottery legislation so that sport now receives less funding than hitherto due to the demands of the additional good causes. However, I appreciate that substantial extra money has been allotted to schools. I do not forget that a Conservative government introduced the National Lottery legislation which has done so much for sport since its enactment.

Many sports in our country show good results relative to our population. However, performance fluctuates. We had tremendous success at Sydney compared with our disappointing performance at Atlanta. At the recent Winter Olympics we were a little disappointed to receive only one splendid gold medal on the part of the curling team and two bronze medals, one of which, sadly, had to be returned. I hope that that will not undermine our efforts to ban the use of drugs wherever possible.

It is often said that success breeds success. However, I am not always convinced that that is the case. We have had tremendous success in ice skating with John Curry, Robin Cousins and Torvill and Dean, but it is now on a plateau. What middle distance runners do we have now? I refer to former competitors such as Sebastian Coe, Steve Ovett, Steve Cram and David Moorcroft. Example is not always crucially important but somehow or other we must bring our athletics back into the limelight. Much more money is now available for facilities which are improving. It is now for competitors to respond to the opportunities that are now available to them to develop their sports.

I shall now focus my remarks on the lower rather than the top level of sport as the top will look after itself. It is up to the Government, and rightly so, to set the climate for the development of sport, particularly in schools and clubs. I welcome the recent announcement on tax breaks. However, as I indicated in the Chamber when the announcement was made, my discussions with sporting organisations reveal that they are still finding it difficult to interpret the system. The alternative route of charitable status is expensive and equally hard to fulfil. I believe that it would be much better for local authorities to give a blanket, 100 per cent mandatory rate relief. Such a system would be straightforward and would save a great deal of effort.

We have already discussed the heavy classroom workload of schools which leaves little time for PE which we all agree is important. I refer also to the absence of free time between the end of the school day and the departure of the school bus. I hope that some compromise can be reached to allow pupils time to participate in sporting activities. We must improve the bridge between schools and clubs. I refer to the move from participating in sport at school to club sport participation. Clubs must seek out those with sporting talent and include them in their membership.

I agree with the noble Lord, Lord St John of Bletso, that it is terribly important to encourage team games. They breed leadership and develop character and a sporting spirit, as was evident in the late Lord Cowdrey. They also give pupils confidence. I hope that we shall continue to encourage outward bound activities which do so much to develop young people's characters. There have been some unfortunate court cases in that regard but we must strike a balance between unacceptable foolhardiness and stretching children to the limit, which is so important to their future development.

Much is going on in this area at the present time and I have great hopes for the future. However, much more needs to be done. To sum up, let us try to simplify procedures on the financial and education sides. If we succeed in that, we can progress much more quickly than we are. There is a great deal of marking time and awaiting the decisions of committees. I hope that we shall try to speed up processes to help sport develop as quickly as possible.

My Lords, I join other noble Lords in thanking my noble friend Lady Billingham for raising this debate. It provides me with an opportunity to discuss the achievements of the Caribbean British in sport and the impact that that has had on the community as a whole. I shall direct my few words to the social inclusion aspect of that.

The overriding ambition of the settlers of the 1950s and 1960s, who came to Britain from the Caribbean islands, was to secure self-development for themselves and to acquire a good education as a vehicle for upward mobility for their children. Sport was not considered a means of upward mobility; rather, it was regarded as a setback to their aims and plans. Sport was considered to be a waste of time and teachers were suspected of keeping children playing sport at the expense of academic subjects. To those people, there could be no semblance of a balance between academic and sporting endeavours. Engaging in academic achievement was seen as the only means of upward mobility and the creation of an economic base. That was regarded as outweighing any other activity.

Parents worried about children wasting energy on non-essentials to the detriment of getting a degree and learning the skills that could maximise their earning potential. Living in a hostile environment, that concentration by parents seemed to be teaching children to walk so steadily that they would be better than those with whom they competed. With hindsight, it could be argued that parents were in danger of hewing paths that were too straight and narrow through difficulties seen through their own eyes, not realising that their children had to carve out their future.

Against that background, clubs were unwilling to embrace the sporting prowess of young British Caribbean people. However, those people first emerged in sport in the field of athletics—in track and field events—where it was evident that individuals' hard work could pay off. The superior performances of Arthur Wint, Tessa Sanderson, Linford Christie, and Denise Lewis slowly emerged. Today's track and field events are made up of 40 per cent black British.

Another relevant area of sport is boxing, although I have a horror of the sport myself. It has been a high earner for many young black men. As a consequence, children have benefited from the financial successes of their fathers. Their success has made them household names in this community. Everyone has heard of Bruno, Chris Eubank and Lennox Lewis. Their new-found wealth has raised their standard of living and that of their families and they have used their wealth to fund opportunities for many in their community. Sadly, some of that money leaves this country because people are sent to America to study, where they feel more welcome.

Those who showed talent in football in the 1960s and 1970s found that professional clubs were unwilling to embrace their talents, and many drifted away disillusioned. Club managers went on record as saying that black players could not perform when football pitches were covered in snow and that black players could play only in positions that depended on speed. Today we know that to be a fallacy. However, it took young men such as Garth Crooks and John Barnes and many others to show the athletic success of black performers. That and the attitudinal change among new club managers in football created new opportunities for black young people. That made them role models to black young people and to the whole community.

The combination of hard work and flair on the part of young black footballers and the greater open-mindedness among football managers led to an increase in the numbers of black footballers in the past 20 years. Today, all clubs in the Premier League have two or more black players in their squad. In the lower divisions, the numbers are greater still. Their earning capacity has been much enhanced. Perhaps their greatest contribution to community relations is the fact that they are role models across the race divide. The Let's Kick Racism Out of Football initiative has been good. I urge the Minister to extend it to all sports.

My Lords, I, too, thank the noble Baroness, Lady Billingham, for instigating this debate. We have had a number of such debates during the years that I have been in the House. Several noble Lords have already referred to the debate on sport about three years ago, when Lord Cowdrey—God bless him—opened the batting and the noble and right reverend Lord, Lord Sheppard, responded from the Labour Benches. That was a poignant moment when the two openers were reunited.

I want to say a quick word on social exclusion. Other noble Lords have dealt with that effectively, including my noble friend Lord Newby, the noble Lord, Lord Moynihan, and the noble Baroness, Lady Billingham. We live in an age that puts great pressure on community life—it seems to force us apart. I sometimes think that that almost leads to voluntary ghettoisation. In that context, community amateur sports clubs are a preeminently powerful tool for organic and natural community involvement across all barriers—age, class, gender, race, occupation and geography. Those clubs are wonderful. They have been underestimated in the counsels of government hitherto. I can think of some reports that scarcely refer to the extraordinary role that sports clubs play.

I am immensely grateful to the Government for taking on board the protestations made in this House, in the other place and outside these walls about the need to at least provide a favourable tax regime within which community amateur sports clubs can function.

Before discussing that, I point out that community amateur sports clubs provide experiential learning that is in diminishing supply in the world these days. There is a brutal egalitarianism about being in a rugby scrum. One buttock is the same as another. Does it function effectively? Does it brace itself and lurch forward at the right moment or does it not? Colour, race, occupation and wealth are immaterial—and how wonderfully immaterial.

I turn to playing fields, which have been briefly mentioned. I urge the Government to do something about the continued disposal of school playing fields. I am told by the National Playing Fields Association that since 1st October 1998 there have been 185 disposals of school playing fields and only six refusals. I am told that in the financial year 2000–2001, compared with the preceding financial year, the number of planning applications for building consent for playing fields has risen by 45 per cent. One problem with tracking that is that planning authorities currently have no obligation to report the outcome of those applications.

During my few remaining moments I shall turn to a matter to which I have devoted myself assiduously these past two-and-a-half to three years; namely, the attempt to obtain tax concessions for community amateur sports clubs. I believe that it is a credit to the Treasury and the DCMS that a twin track has been provided to the world of sports. They can follow either the charity route or the route of registering with the Inland Revenue. In the latter case, they receive a lower level of concessions but very important ones none the less. At the same time, they do not have to comply with all the requirements of charity law.

One issue that continues to perplex the sporting world is why the mandatory 80 per cent rating exemption for CASCs—community amateur sports clubs—which are charitable is not to be made mandatorily available to clubs that do not go the charity route.

I also believe that it is a little counter to common sense to cap the amount of fund-raising which a non-charitable club can undertake in any year to £15,000 of money raised. That figure is gross; it is not net of expenses. I do not see the point of that. Of course, a club that is not registered as a charity will not have the option, as charities do, of setting up a trading company which can then covenant back all the profits into the charity free of tax. I hope that the Government will reconsider that matter. Any change will obviously not happen this year but it may next year.

The same applies to rental income. No limit is placed on the amount of rental income that charities can receive free of tax, but there is a £10,000 limit for CASCs. That provision will not apply to many of them, but some will have some significant rental income which could be the backbone of their club income.

Perhaps I may refer briefly to the guidelines for charitable status which the Charity Commission set out at the end of last year. Let us make no bones about it. The pressure from this place and the threat, if I may express it in that way, of the Inland Revenue route for tax exemptions undoubtedly made the Charity Commission gird its loins and come forth with something with which it had not come forth hitherto—that is, a means of obtaining charitable status for a community amateur sports club.

I believe that there are deficiencies in the guidelines that the commission has produced; for example, it considers that sports such as angling, gliding and snooker may well not be able to come within the charitable definition, although I believe that many in this House may wonder why. That is partly because it does not give physical dexterity, as opposed to physical health and fitness, any degree of importance in that judgment. I also believe that the arrangements that the commission proposes with regard to social membership of charity sports clubs are unrealistic, as are those regarding team selection and the limitation of the exemption itself.

My time is up but, in closing, I hope very much that in the years to come there may be a coming together of the twin tracks to provide one track. Frankly, I believe that they are so close and that the conditions for membership of each are so near that we could avoid much undue complication by working towards that goal.

My Lords, as my noble friend Lord Pendry reminded us a few moments ago, my noble friend Lady Billingham is a distinguished sportswoman in her own right. I, too, congratulate her on the way in which she introduced this debate and on giving us the opportunity to discuss this important topic.

In the few minutes available to me, I want to concentrate on how football—our national sport—can, and should, realise its potential in the community and combat social exclusion. This subject was the third to be tackled by the Government's Football Task Force, on which I had the honour to serve as vice-chairman. That report contained 13 main recommendations, and it is to the credit of the Government and the football authorities that the majority of them have been taken seriously and implemented.

We paid tribute in the report to the extent and sophistication of the community programme in English football—how players at all levels give freely of their time carrying out thousands of community visits every year. Charlton Athletic is just one example of a club with a highly developed football-in-the-community programme. Other clubs have already been mentioned by other speakers. Anyone who studies the Charlton dub website will see that it carries out excellent work, from the Learning Through Football educational initiative to tackling truancy and estates and probation programmes.

The sponsor of the national football-in-the-community project is, perhaps unusually, Railtrack. That company has been much criticised in other contexts but here it is certainly getting something right. It sees the programme as fitting in with its own efforts to reduce the 20,000 or so railway crimes committed each year, involving trespass, vandalism, placing objects on the track, stone throwing and criminal damage. The reason that it is such a good fit is that the main culprits of those crimes are eight to 14 year-old males—the same target age group for much of the football-in-the-community programme.

Much excellent work is also being carried out at other clubs. West Ham United, for example, is making a particular effort to encourage people from the Asian community to participate in football. That includes a programme of coaching beginners in local schools' PE sessions, the provision of Football Association teaching certificate courses, a coaches' development scheme to help young Asian players to learn appropriate skills and to go on to an FA coaching certificate course, and, for the really promising players, the opportunity to be integrated into what one might call the "mainstream" of the West Ham United club.

The Football Task Force's second report on racism drew particular attention to the disproportionately low numbers of Asians taking part in football as both players and supporters. Therefore, we should welcome every initiative that is now being taken to put right that deficiency.

The All-Party Football Group in another place received a presentation on 23rd April from Leeds United—a club referred to by the noble Lord, Lord Newby, a few moments ago. That club's commitment to the "Kick it Out" anti-racism campaign is indisputable and highly commendable. But I suspect that Leeds knows better than any club how an excellent reputation for anti-racism initiatives can be damaged by the throw-away remarks of a so-called "comedian" at a sportsmen's dinner or by inappropriate behaviour on the part of high-profile players.

The responsibility of players to set a good example is enormous. For the players at the highest levels, the scale of the transfer fees and the sums of money that they earn are beyond the comprehension of almost everyone. And now, with the collapse of ITV Digital, the situation has changed—certainly for the clubs below the Premier League. This is not the moment for an inquest into how such a contract could go so drastically wrong. However, many people will want to know whether an offer of £74 million was made by ITV Digital over the weekend of 13th and 14th April, and, if so, why it was rejected now that it is clear that the clubs are likely to receive nothing.

In the crisis caused by the ITV Digital collapse, the Professional Footballers Association—the players' union—appears to be taking a responsible attitude and is willing to negotiate more realistic contracts for many of its players. Nevertheless, according to a survey published in the Guardian yesterday, more than 600 players will be out of work this summer as a direct consequence of that. And, following the collapse, it is unacceptable for the fans alone to be made to pick up the bill through higher admission charges at clubs which over-stretched themselves with budgets and wage costs that they could not afford, spending the television money before they received it.

High admission charges were the principal grievance of the football supporters who gave evidence to the task force, and we welcomed the subsequent establishment of consumer relations departments by the Premier League and the Football League. Those activities are now to he monitored by the Independent Football Commission, recently set up by the Government under the chairmanship of Professor Derek Fraser, whom I had the pleasure of meeting a couple of weeks ago. The members include the noble Lord, Lord Taylor of Warwick, and my right honourable friend Mrs Ann Taylor, MP. The supporters' expectations are very high, and I hope that Professor Fraser and his colleagues will not allow themselves to be deflected from acting with genuine independence in defence of football's customers.

Many people in the game talk about the "football family"—an all-embracing concept which covers players ranging from Premier League stars, such as David Beckham, down to the Halifax Town goalkeeper. It also covers the competitions in which they play, the governing bodies which regulate their activities and the supporters who follow them. The football family is a fine idea. What good families do in times of trouble is to stick together and rally round to help the relatives in difficulty. I hope that we shall see some evidence of that over the coming weeks.

My Lords, it gives me great pleasure to follow the noble Lord, Lord Faulkner, in this debate. Not so long ago I spent seven hours in his car travelling back from the League Cup final. We put sport, the world and everything else to rights in that time.

This is the fourth occasion in less than three years that I have taken part in a debate on sport in your Lordships' House. Nevertheless, I am extremely happy that the noble Baroness, Lady Billingham, initiated today's debate. Does not that make the point that the Government are not yet getting it right? We are not satisfied that sport is run, managed, funded—or anything else—adequately in this country. We have a long way to go. I do not say that we have not got anywhere; but we still have a long way to go.

I am not talking of sport in the sense of football, football and football, which, in my opinion, is sometimes too much at the centre of everyone's thinking, in particular government's. I am thinking much more of sport for all; of all the recreational types of sport which are often not so glamorous, such as walking, hiking and bicycling. To take up a point made by the noble Lord, Lord Pendry, sport needs to be at the centre of parliamentary thinking because of the very title of this debate.

In this country we have a serious health problem, a serious youth crime problem and—I do not mean to be too pessimistic—a falling overall standard of achievement in sport broadly, world-wide. We are not quite meeting our expectations. To some extent, sport is not being taken seriously enough for the good things that it can do. If sport is at the centre of government thinking and understood on the broadest basis, it can do much good.

As I mentioned on the last occasion I spoke, we have the highest ever obesity rate in this country. Something like 20 per cent of the country suffer from an obesity problem, particularly young people. Surely, sport should be better organised and better managed, especially in schools, so that there is not less than two hours per week in the curriculum for compulsory physical education. I prefer to call it that rather than sport. It used to be called games, but whatever it is, it is a form of physical recreation.

As I have mentioned, we have community problems. As many noble Lords have said, sport is a wonderful vehicle for bringing together people of all creeds, colours and classes. That has been proved time and again, as mentioned by the noble Lord, Lord St John of Bletso. He mentioned South Africa, the wonderful example of what was achieved there and how sport has been used as a vehicle to bring together communities and break down barriers. One of the great things in life which we should try to do—I have certainly done so in my little part of the world—is to break down barriers. One thing the Irish have never fought about is sport; they play together.

Having said that, where are we now in the funding of sport? I have heard people say that the Government have done a lot to date. However, before the debate I checked with Sport England against some figures I used in a speech in December. The facts are that Sport England's share of lottery money in 1995–6 was £300 million. It is estimated that by 2004 it will be down to £185 million. Direct grants and the like are also falling. At the same time grants to the Arts Council have increased from £237 million to £254. Clearly, sports funding is not at the centre of government thinking. My purpose and message today to government, as the noble Lord, Lord Pendry said, is "Put it at the centre of your thinking. Co-ordinate your officials and get the best value for money from sport and recreation". I sincerely believe in sport. I have spent my life in it, in one way or another, as noble Lords will know. I believe it is seriously under-used as a tool for the betterment of society.

My Lords, I join those noble Lords who have offered their congratulations to my noble friend Lady Billingham. She is to be commended not only for her initiative in securing the debate but for the relevant and interesting speech with which she introduced it. I agree with a large part of the remarks made by the noble Lord, Lord Glentoran. Most people have referred to football, and I shall too, but there are many sports. We invented most of them in these islands, whether it is curling or badminton, cricket or rugby. It is a pity that we do not do better at the very sports which had their birth in these islands.

My reason for speaking in the debate is as much because of the reference to social inclusion as to health. Over the past three or four years I have watched a gang of boys in their early teens, of the kind of age I would have taught a long time ago, engage in crime, vandalism and hooliganism almost without pause on every fine summer's day. Then, a small group of people set up a football club. There was not enough for those youngsters to do. I wrote to our parish council only last week to say that that initiative has been one of the best things to happen in our community for years. It has achieved enormous success. There are four teams of boys and a team of girls. The boys have something with which to identify and are now part of the community. They turn up for training. They have had to promise not to drink, take drugs or live unhealthy lives. The initiative has certainly helped to transform the community, which is a cause of great relief.

However, at the same time I recognise that we are not about gearing the nation to create professional sportsmen. We want to see a healthy nation, not necessarily a nation with a few people earning vast sums of money while everyone else sits and watches them. My noble friend referred to the priority given to young people's health in the post-war government. To some extent that was a legacy of the enormous anxiety which was generated in this country in the first years of the 1900s when it was found that the vast proportion of people seeking to enter the Armed Forces were not fit enough.

The health of young people in the early part of the last century was bad. However, that was because of poor housing, poor diet and poverty. The bad health with which we are now concerned is not caused by poverty, although it may be caused by a poor diet of junk food. It is perhaps a pity that we did not give continued priority to orange juice, milk and school dinners of a nourishing kind. Too many people buy chips and chip butties and then go home and watch television, cheering on football clubs from their seats.

My reason for speaking is also because of a letter I read a few days ago in one of our local newspapers. It was from a citizen in a parish a few miles from my own and expressed deep regret and sadness that organisations for young people in that parish were about to end because there were no volunteers. However, there are plenty of people who will moan about the crime and irresponsibility that will develop because the kids have nothing else to do.

I look at one organisation with which I am most closely connected. I refer to the Air Training Corps. I am involved with an absolutely superb squadron. It is one of the best in the country. This year we will complete more than 50 Duke of Edinburgh's Awards. The boys and girls in the squadron will play a whole variety of sports and achieve a great deal in them. The kids are good, but we do it because we have a group of extremely good—both uniformed and civilian—instructors. They set high standards. The kids are given great challenges and stimulus and they achieve a great deal. But without the leaders they would probably not achieve very much.

I think back to a visit I made to East Germany in the early 1970s when the East Germans were doing well in a whole range of Olympic activities. It was an austere society. It was an uncomfortable and uncomforted society in many ways. If one went into the stores there was little to buy, except sporting goods of high quality, high standard and relatively low price. The East Germans achieved a great deal because the whole of society was geared—as a political distraction perhaps—to achieving success on the sporting field.

Those who are calling for a higher priority to promote health and social inclusion and to generate greater national pride are to be commended. For that reason, I trust that the Government will listen carefully to the comments made by my noble friend and by a number of other noble Lords—and not merely about football. Perhaps I may also suggest that those of us who are older and were once engaged in active sport might have an opportunity to watch test cricket. Young people might see good skills and entertainment but it would bring comfort and consolation to those of us who would regret that omission.

My Lords, sport is not a topic on which I have ever addressed your Lordships' House before. Aside from the odd game of tennis and an awareness of the problems created by having both Arsenal and Manchester United supporters in my family—and more of that tonight no doubt—it has never been at the top of my interest list.

All that changed when the New Opportunities Fund (NOF), the largest of the lottery distributors, of which am chairman, was given a £750 million programme to deliver. The figure quoted earlier by my noble friend was the figure for England only. So our physical education and sport in schools programme is £750 million in total. That is by far the largest of our round 3 programmes and by far the biggest single investment in school and community sport ever made.

Through this programme we intend to bring about a step change in the use of PE and sports facilities for young people and for the community in general throughout the United Kingdom. But—and this is the reason I am so delighted to focus on my noble friend's debate today—this step change is intended not just to offer sporting opportunities but to have long-term impacts on key issues facing local communities, such as health, education, crime and drug use—all the things, in short, which contribute to social exclusion.

Our programme will modernise existing and build new indoor and outdoor sports facilities for school and community use. Up to 20 per cent of the funding will be available for revenue to support the development and promotion of the new facilities for use by the wider community. It will modernise existing or build new outdoor adventure facilities.

The primary beneficiaries will be children and young people but wider community use will also be essential for most projects. Like all NOF's programmes, the money will be targeted at the most disadvantaged areas.

Funding will be allocated to local authorities on the basis of their level of deprivation and existing disadvantage in terms of facilities. Local education authorities will act as the lead organisations, but they will only receive funding if they involve a range of other partners, such as sport development and leisure departments, sports governing bodies, the NHS, both primary healthcare trusts and NHS trusts and key voluntary sector organisations.

There is, unsurprisingly, with that amount of money available, tremendous interest in the project. I am grateful for the positive response and co-operation which we have received from sports organisations and all local partners. We hope that some fast-tracked projects will be launched this summer.

In our previous debate today in your Lordships' House, in which I also took part, we focussed on health. Much attention was given to public health issues and to prevention, as again has been given attention in our debate. The major benefits to health which increased physical activity brings are well known, but we should remember that they are not only physical but mental. There is twice the risk of coronary heart disease and threefold risk of a stroke if one does not take physical exercise. But research repeatedly shows that physical activity has an impact too on one's emotional state, lessening stress and increasing self-esteem.

We need to learn the habit of, and benefits of, physical activity at an early stage of life. Once learned they are likely to stay with us.

We must also fully understand that the advantages of team games may be hard to see for some young people, compared with the delights of the play station, which is why we need to be innovative in our approach. We need to include dance, walking, climbing, skateboarding and so on in our plans. It is not the level of performance which matters but the participation. We must ensure that facilities provided for exercise of all kinds are fit for the purpose and accessible and available at all times that they are wanted. It is most important to encourage community participation so that families may use them together.

We know that this programme will provide special opportunities for schools to build good relationships with other agencies and groups in their communities. For example, working in partnerships with the National Health Service, schools can develop exercise and leisure opportunities which benefit the whole community and so cut the risks from heart disease and some forms of cancer. They can also provide opportunities for adults to become engaged in some form of leisure or recreational activity, not only as members of the pupil's family but also as teachers, coaches, officials or administrators.

The promotion of social inclusion is a key outcome which our programme seeks. Funding for the programme has been allocated so that more is available in the more deprived areas. We expect that the programme will play a major part in funding facilities and activities which can improve the quality of life for the whole community.

Several reports, and several of your Lordships, have already highlighted the positive effect which sporting activity can have on social exclusion factors, such as involvement in crime and in reducing drug and substance misuse. Young people can also use the experience of physical education to assist in their work in other subject areas, to enable them to gain increased benefits from their education, alerting them, we hope, to the benefits of life-long learning. In addition, it can help young people develop self-esteem, pride in their achievements and a consciousness of their responsibilities as citizens.

Your Lordships may feel that these are ambitious claims for a physical education programme. But I am confident they can be achieved through the excellent partnerships which have been established and the commitment of the agencies involved in delivering this important initiative.

My Lords, I welcome the opportunity to speak in this debate presented to us by the noble Baroness, Lady Billingham. I want to talk about the role sport can play in helping to foster social inclusion. I shall do so from the perspective of chairing the Youth Justice Board for England and Wales. I declare that interest at the outset.

I should make it clear that this is my début speech from the Cross-Benches. I find myself in a rather curious position as a result of being embroiled in a number of tangled events, which we need not go into here. I hasten to add that this is not as a result of, as some newspapers have said, a bad falling out between the Government and I.

Many of those young people who offend live on the most rundown estates in our society. They often have problems at home, live in households with one parent or no or a single wage earner, and are regularly not in school. When one asks these young people why they started offending one often gets the simple answer "Boredom". It was much easier to go out with their mates on the streets, involve themselves in offending and antisocial behaviour, simply because there was nothing terribly interesting to do in the area in which they live. For these young people social exclusion and offending go together.

That is why for the past two years the Youth Justice Board has funded about 70 youth inclusion programmes for the 50 to 60 youngsters most at risk of offending in some of our highest crime estates. We also fund about 100 school holiday schemes called Splash which provide activities for at least 100 13 to 17 year-olds, many of whom run a high risk of offending. A common feature of all these projects is a significant amount of sport involvement—football, cricket, climbing, canoeing, swimming and even rugby. There is also a considerable emphasis on outdoor activity, recreation and keep fit activities.

The results of the year 2000 projects are extraordinarily encouraging in terms of crime reduction. For example, they range from a reduction in crime of about 32 per cent in Doncaster to 14 per cent in places like Wrexham and Gateshead. A youth inclusion programme in Sunderland, for example, has produced a 15 per cent reduction in juvenile crime, a 55 per cent reduction in the number of arrests of 13 to 16 year-olds and a 75 per cent reduction in permanent exclusions from school.

The evaluation of the 2001 Splash schemes will soon be published and will show an even more encouraging view than those for the year 2000 projects. We are now working closely with DCMS and DfES Ministers and the New Opportunities Fund to roll out many more of these summer activity programmes this year in the police force areas where there are high levels of street crime. The Premier League and the Football League have been involved in this work.

I wish to pay tribute to the Premier League for the help and support that we are receiving in these programmes and for its willingness to open up its community programmes to many young offenders being dealt with by youth offending teams.

I believe that we have gone through a rather bad period over the past two decades when many of our young people in deprived areas have had diminishing access to sport and outdoor activities. The number of organised games in schools has been reduced, the number of open spaces has shrunk or become unsafe and the number of adults organising and supervising games in many of these deprived areas has diminished. Many of our young people who are socially excluded have drifted into crime as a result of this movement away from access to sport and recreation in their areas.

I believe that we are now coming out of this dark period with great encouragement from the Government and bodies such as the New Opportunities Fund. We all tip our forelocks to the noble Baroness, Lady Pitkeathley, in the hope that some of the funding will move in the direction of some of these projects.

However, what we need to understand with the socially excluded youngsters I have been speaking about is that we have to go to them: they are often unable to come to us. That is a big change which we need to address in the way in which we provide opportunities and programmes for many of these youngsters. I welcome the fact that the Government have linked the social exclusion agenda with sport and have called on our sporting bodies and many of our sporting icons to play a fuller role in tackling social exclusion and the offending agendas. We need to go further and faster along the path we are now following, with more sports and recreation opportunities in our most deprived areas and with sustainable funding over the long haul.

My Lords, I thank my noble friend for moving this Motion because it gives me the chance to speak about a sport which I have enjoyed for over 50 years; a sport learned at an early age, as my noble friend Lady Pitkeathley advised.

Noble Lords have spoken of health. Yes, my sport is healthy. It is outdoor, regular and fairly gentle without the sudden shocks and knocks which can do so much damage. It is good for the heart and lungs and it is also good for the waistline, a need powerfully expressed by my noble friend Lady Billingham. I read recently that 51 per cent of adults in the UK are now fatter than is good for them, the "couch potatoes" referred to by my noble friend Lord Pendry. My sport provides the gentle exercise which prolongs life expectancy and improves health by dealing with this.

My noble friend's Motion speaks of social inclusion. I have engaged in my sport with young and old, men and women, rich and poor. Indeed, it crosses all the social barriers mentioned by the noble Lord, Lord Phillips. My sport is the ultimate in social inclusion. One can engage in it with one's spouse. But my sport is a lot more than this: it is also an important means of transport. I speak, of course, of cycling.

Unfortunately, when cycling is discussed in your Lordships' House it is usually in terms of transport. Noble Lords complain of cyclists riding on the pavement or being aggressive and a danger to pedestrians. Of course, I have never done any of those things, but my attitude is that where there is traffic congestion of any kind the role of all—pedestrians, cyclists and motorists—is to practise tolerance, consideration and good manners, and that describes cyclists.

Sadly, that does not seem to be the attitude of all road users. Cyclists are sometimes forced on to the pavement by cars travelling or parking in the cycle lanes. Cyclists can be forced off the road by cars whizzing past very close by. The answer, of course, is to have proper cycle lanes separated from the traffic by a kerb or by a barrier, instead of just a line painted on the road; or indeed there could be special cycle paths. Fortunately, some local authorities are now providing special cycle paths to enable children to ride safely to school or for commuters to ride safely to the station while at the same time taking the physical exercise which noble Lords consider to be so essential.

These paths are for cyclists and pedestrians only and go some way towards reducing traffic congestion. Indeed, I congratulate the DTLR on organising a cycling projects fund to encourage more people to cycle. As John Spellar, the Minister for Transport said recently,

"Cycling is excellent exercise and people who choose to cycle rather than use their car play an important role in reducing pollution".

I am glad that he mentioned exercise because, as well as being a means of transport, it is also a sport. One can race or one can tour. Racing has all the thrills, excitement and pressures of competitive sport. Touring is different. There is something very liberating about touring by bicycle. One is nearer the landscape, and freer to roam. Indeed, it is a sport of free spirits. It is also healthy exercise. Cycling does all the things that the Department of Health is trying to get us to do and which, as my noble friend Lady Billingham told us, we ought to do. The Department of Health tells us that riding a bike is more likely, by a factor of five, to prolong one's life rather than shorten it. So much for the dangers of cycling.

That is why cycling is so popular. There are several million bicycles in Britain. Many people in your Lordships' House cycle, such as Law Lords, chairmen of Select Committees, Back-Benchers of all parties; senior and junior staff and officials, even political advisers and spin doctors. Surely that is inclusive.

But very few Ministers cycle. After all, we need them to be fit. So perhaps I can persuade my noble friend and her ministerial colleagues to take up cycling. Not only would they enjoy better health and fitness, but just think what it might do for their ministerial careers. After all, the absence of emissions and the sustainability of cycling will make Ministers very popular with the Prime Minister because he is personally leading Britain's delegation to Rio + 10 this summer to discuss this very matter.

Cycling Ministers would be actively demonstrating joined-up government not over two but over three departments. It would be helping the DTLR and the Department of Health, as well as DEFRA, to achieve their objectives. So not only would they be pleasing the Prime Minister, but also the Deputy Prime Minister. They would also be pleasing the Chancellor, not simply by reducing the cost of the government car pool, but just think what it would do for Minister's productivity. Cycling is invariably faster in central London. And, of course, cycling is very new Labour: both are socially inclusive, both have been established for some time and both have recently reinvented themselves with great success.

So there is the magic of cycling. Not only is it healthy, good sport and efficient transport, it is also an activity which supports and incorporates so many facets of government policy that cycling and supporting cycling must do wonders for anybody's political career. I rest my case.

My Lords, before the noble Lord sits down, I wonder whether it would surprise him to know that the Minister who is to reply to the debate is a familiar figure striding the hills of the Stour Valley.

My Lords, I look forward to hearing more about that. However, I should like to begin my remarks by thanking the noble Baroness, Lady Billingham, for instituting this debate. Not only has it brought out a panoply of stars; indeed, although I was already aware that the noble Baroness was a great tennis player, the debate has also made me aware of how much she has organised for her family, and of how much more she has achieved.

A debate like this in your Lordships' House brings out not, perhaps, a glittering array of stars, but gold medallists—one of whom, my noble friend Lord Moynihan, has temporarily fled the coop. Perhaps he realised that I was about to speak; I do not know. My noble friend Lord Glentoran's record goes back to 1964. I remember him 50 years ago at school, when he was known as "Mr Dixon". I enjoyed hearing the noble Lord, Lord Phillips, on the question of which buttock, but certainly in Eton field games, size mattered. As I left school at the age of seventeen-and-a-half weighing just nine stone, noble Lords can imagine that I was not exactly one of the most successful young sportsmen. Never mind, we have tennis players; and, I understand, a cricketer to follow. We also have a notable skier among us, the noble Lord, Lord St John of Bletso, and an archer, namely, my noble friend Lord Monro of Langholm, who is a member of the Royal Company of Archers, Queen's Body Guard for Scotland.

Before my noble friend sees fit to take the mickey out of me, he may recall that in 1975 both he and I, as well as a group of other parliamentarians, visited the Sobell Sports Centre in Islington where we found the most marvellous state-of-the-art sports centre run by Mr David Hemery. Many noble Lords may remember him in the 400-metres hurdles in, I believe, Mexico in 1968. The centre is a marvellous place for young people to practise sport. However, I understand that the main problem there—as, indeed, is the case with many other centres—is the human element; that is, people to run such centres of excellence. As the noble Lord, Lord Hardy of Wath, pointed out, in many cases human effort is needed to ensure that young people can use the facilities in safety, and, at the same time, be encouraged to participate.

We have also heard that teachers must be much more professional these days. They have very little spare time; indeed, much more of their time is spent attempting to ensure, for example, that the four children of the noble Lord, Lord St John of Bletso, actually manage to achieve the qualifications that many of your Lordships struggled so hard to attain. I was particularly taken by the comments of the noble Lord, Lord Faulkner of Worcester, who referred to the ITV Digital problem, and the possibility of many professional footballers in England and Wales either losing their jobs or having their status in life changed.

I noticed mention in some of yesterday's broadsheets of the idea that some of these footballers might be trained as PE instructors. Quite rightly. It is not that cold water was poured on the idea, but there would certainly be a need for them to gain qualifications in order to become fully fledged PE instructors. I wonder whether there is some merit in that idea. Perhaps those footballers, and other young people, might be encouraged to become what one might call "assistants". They already have some knowledge of what is required, but they could study to gain the qualifications by way of a form of sandwich course.

I was delighted that the noble Baroness, Lady Billingham, included "the promotion of health" in the title to her Motion. I look around the Chamber and wonder about the description "obese". Perhaps the noble Baroness would care to accompany those of us who belong to the Lords and Commons Ski Club in the first week of January to see who is obese, and who is reasonably healthy. My noble friend Lord Glentoran sustained a particularly severe injury, but I do not believe that it was as a result of his sport of bob-sleighing. I understand that it happened while he was water-skiing. Nevertheless, he has certainly retained his fitness.

For myself, I broke both a leg and an ankle in Switzerland, but that was not while I was in the company of the parliamentarians. I have dislocated a shoulder, broken a hand, and have now damaged the other shoulder. All those injuries were sustained while practising one sport in one location. When the noble Baroness said that sport promotes health, I do not necessarily think that she was pointing in my direction.

The noble Baroness talked extensively about "social inclusion", as, indeed, did many noble Lords. For my part, I must declare one interest. I hope that my noble friend Lord Monro will not hammer me, but I am honorary president of Forfar Athletic. We lost three/nil to his team—Queen of the South. I do not know what the average gate is for his club in Dumfries, but they brought 300 spectators to Forfar. However, when the team members were presented with the prize, perhaps my noble friend can tell me why they had a total of 6,200 spectators. I do not know whether my noble friend was among them; indeed, I am not too sure whether he paid to go in. I am also a patron of the Kirriemuir Boys' Club. But, in my tiny little town in Scotland, I am afraid that that is the one sport that they do not practise. There are five or six gentlemen in Kirriemuir who put day and night into that club, and I pay tribute to them tonight.

I realise that sport is a devolved matter, so my remarks may be a trifle distant from the subject. However, I am very glad that the noble Baroness gave us the chance to ask the Government what is going on in this area. Before I sit down, I respectfully ask my noble friend Lady Anelay and the noble Baroness, Lady Pitkeathley, not to crow too much: they should just wait until 10 minutes to five on Saturday to see whether or not their beloved club does, indeed, win the title.

My Lords, speaking as the "cricketer to follow", I am grateful to my noble friend Lady Billingham for securing tonight's debate and for introducing it with such knowledge and passion. Like me, my noble friend is a sports fanatic. In the privacy of the women Peers' room, we have often sorted out the fortunes of England teams in a variety of sports. I shall avoid our discussions on rugby scrums.

I define "sport" as any physical activity that leads to improved fitness. Team games and competitive sport are important and inspire many qualities, but, as the noble Lord, Lord Glentoran, observed, they are not the whole story. Some young people are put off physical activity—often for life—by being forced into team games for which they have little aptitude or interest. Attention to fitness, rather than winning or losing, seems to me to carry wider benefits for health and for social inclusion.

Today, coming in at the tail end of the debate after some prolific and stimulating batting, what else is there to do? The answer, I hope, is plenty, because my contribution will be about girls and women in sport. I shall look at the benefits to women of participation in sport, reasons why they may not participate, and how we might encourage them to do so. It is a fact that many girls feel excluded from physical activity, yet such activity would benefit their health, their confidence, and their positive inclusion in communities. I am grateful for help with my contribution to Sport England, the CCPR, especially its director Margaret Talbot, the Women's Sports Foundation, and the Youth Sports Trust.

What are the benefits of physical activity for women? First, for their health. Women are now at increased risk of stoke, heart attacks, and chronic bronchitis. Older women may be at risk from osteoporosis. Exercise decreases that risk. Younger women who take part in sports are less likely to smoke, take drugs, or become pregnant while in their teens. They are also, as are boys, more likely to achieve academically. This may be connected to the fact that taking part in sport increases self-esteem and involves women in community activity with peer support. Research shows that a physically active mother is a good indicator that the children will take part in sport.

Women surely have the human right to take part in sport, and achieve in sport; too often, they are put off sport or denied access to it. Participation in sport by women has increased over the past 15 years, but it is still less than men's participation. Women tend to drop out of sport on leaving school; working-class women participate less than middle-class women; and culture and religion also have an impact. It is estimated that only 19 per cent of Bangladeshi women take part in sport, compared to a national rate of 34 per cent. Girls and women are more likely to care for other members of the family, and, generally, have less personal time. Moreover, girls and women may have less money to pay for membership of gyms, or for other sports facilities.

There are too few positive role models for women in sport. The sports press is overwhelming male orientated. After the excellent FA Women's Cup Final, on Monday I saw a newspaper headline that read "Not Bad - for girls". Need I say more? Senior positions in sport are almost exclusively filled by males. If we could make change in those areas, perhaps it would influence women into feeling more included in sport.

So how can we encourage girls and women to participate more in sports? Matters are improving, with fast-growing enthusiasm for playing football and cricket among women and attending gyms and fitness classes. The Nike-Youth Trust "Girls in Sport" project researched initiatives that may further encourage girls' participation. One conclusion was that traditional forms of delivery of physical education and sport to young people were in need of urgent reform if girls were to participate more. For example, a mix of competitive and recreational activities, such as dance and aerobics, could be provided—an issue touched on by my noble friend Lady Pitkeathley.

Girls in school are more enthusiastic if they are involved in deciding how the physical activity programme is designed. Displays in school of girls of all shapes and sizes involved in and enjoying physical activity are motivational. In one school I know, a fitness club before school encourages girls to take part willingly in activities.

Government departments such as the Department for Education and Skills, the Department of Health and the Department for Culture, Media and Sport should develop policies focused on women in sport. Schools could try to raise the profile of sport for girls by supporting a wide variety of opportunities for girls to take part in PE—perhaps by collaborating with local sports facilities such as gyms. Local provision, such as in youth clubs, could encourage a greater width of sports facilities for young women. School and youth provision could be tied in with health education programmes. National bodies, local authorities and coaching agencies could consider why women are poorly represented at senior management level. The media could be encouraged to report more on women's sport and increase coverage of good female role models. I should like to hear from the Minister whether any current or likely government initiatives focus specifically on women's sport.

Women's health is important. The social inclusion of women is important. Sport and physical activity can enhance both.

My Lords, this is one of those debates that I have looked forward to with trepidation. A great deal of thought and expertise has been pumped into this debate. When one is trying to wind-up such a debate, one always finds that much of what one wanted to say has already been said—and probably said better. But to return to the basic premise of the debate—that social inclusion and health are benefits of sport—yes, they are. We have always known them to be. I congratulate the Government on starting to deal with the problems. This is one of the few areas in Parliament where party politics does not have that great a bite. There is a far higher degree of coherence across the parties because we are dealing with a real set of problems.

I think back to the great debate about whether competitive sport was bad. When I first heard that, I turned round and said, "Sport without competition is exercise". The reason why people do not universally exercise—we all know that it is good for us—is because it is fairly boring. That is the fact of the matter. Merely exercising is boring. If we ask any sportsman whether he actually enjoys doing the same exercise X number of times to keep himself fit, he will say no, he does not. It is dull. It is painful. It is boring. There is always something better on the TV. But he does it to get involved, because he gets a buzz out of sport. I do not know whether it is competition or co-operation—I cannot properly define it—but there is a certain buzz that people get out of sport that they do not get just from exercise.

The noble Lord, Lord Haskel, mentioned cycling. I pull him up slightly on that point. Cycling may be an efficient, environmentally friendly and beneficial form of exercise, but it is not sport as I would define it. I accept that there is competitive cycling, but I think that he was talking about something else. Sport is a series of invented obstacles that we get a buzz from overcoming. That obstacle is often one's opponent. That is about as close to a definition as I can get.

Let us consider what the Government have done. They have started to tackle one of the major problems: the low level of school participation. That was an unforeseen knock-on effect of the Education Act 1988. It is as simple as that. It was not planned; it was just overlooked. Education establishments tend to concentrate on their primary business, which is education. Thus, it was not surprising that an education-driven Act unintentionally squeezed something else out. Once that happened, the knock-on effect throughout the entire sporting structure was radical. That initial contact was removed because teachers were counting their hours and not going out for X hours at lunchtime and after school.

There has never been a sufficient number of PE teachers to provide a broad spectrum of sport education. At best—and we should move much further towards this—they can provide a sampling board from which to push off in other directions. It is fair to say that the Government's school sports co-ordinators have started promisingly, but the jury is still out on whether they are sustainable or are driving people away from the qualified PE teacher base—whether they are doing more than taking steps in the right direction. I do not know whether they will be able to address the problem, but I suggest that we should seriously consider cutting away some unnecessary red tape by allowing teachers to qualify as PE coaches. Under the old system, someone who played for someone's third team in any given sport 20 years ago might well find himself in charge of a team of youngsters.

Almost all sports in this country have developed ways of teaching youngsters how to play the game—Rugby Union, cricket. Everyone has given it a great deal of thought. If we can encourage teachers to get properly qualified to teach young people, they should be rewarded in some way—preferably financially. I hope that the Minister will take that idea on board, because even with the best will in the world, school sports co-ordinators and PE staff cannot do the job because there are not enough of them. That is a simple matter of fact.

Of course, the great change that has come across the sporting world is the National Lottery. That goes to show that what government get wrong somewhere they get right somewhere else. We are now benefiting from the great achievements of the lottery, but it may already be entering a long dotage. The number of people taking part and the amount of money raised is dropping dramatically. The initial buzz is gone. Whether those who are running it can re-invigorate it we do not know, but it would seem that the best that they can do is to check the rate of decline.

Much work has been done to improve facilities. We will soon reach the point where we have the facilities that we can reasonably expect. That will always be an ongoing process—projects will fail, there will be replacements and new needs will arise—but we will soon have nearly all the infrastructure going.

A declining amount of money is available. Can the Minister give us a commitment that no more good causes will cut in to that decreasing cake—that the number of slices will remain as it is and that sport can be guaranteed to receive its current proportion of the income? That is important to allow sport to build. Will the National Lottery be allowed to start to take on the on-costs of sporting projects? That would mean that it would not have to come in with huge dollops of money for reimbursement and to try to ensure that it has new projects that meet new needs. In future, we shall need to consider refurbishment and general maintenance projects, even to the point of paying for staff. It is important. We have enjoyed success with—if you like—the sexy projects, and we are now heading towards smaller projects. We must consider providing grants for the maintenance of such projects, especially in areas that are least capable of providing facilities themselves. If we do not, if government—national or local—is not prepared to step in and support them, they run a high risk of collapse.

I must also raise the health issue. The noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Lyell, mentioned the connection between our earlier debate on health and this debate. In the area of sports medicine, we must look to the department to do its usual job of chasing others around to get more funding. At the moment, people are often frightened of playing sport because of injury or work commitments. Also, people do not know what to do if something goes wrong. Will the Government ensure that, if they are putting money into sporting projects, they tie in with that the development of sports medicine for recreational sportsmen?

The élite has been taken care of and has access to such medicine, but recreational sportsmen need to know that there will be sufficient numbers of physiotherapists attached to doctors' surgeries, that they will not have to wait for ever for an appointment and that the staff will he there to support them. There should also be greater emphasis on training GPs to deal with sports injuries.

Every sportsman of my age will have a story about going to the doctor and saying, "I've got such-and-such wrong with me. What should I do?", only for the doctor to say, without thinking, "Rest for two weeks". When the sportsman says, "Surely, that will just weaken muscles and shorten tendons", a look of panic crosses the doctor's face, and he says, "Rest for four weeks". If we can encourage spending on sports medicine in the National Health Service, we will help the sports bodies to do their job.

My Lords, the noble Baroness, Lady Billingham, was right to direct us to this subject today. Sport matters, and we must all work to ensure that no one is excluded from enjoying it on the grounds of disability, race, gender or background. As the Central Council for Physical Recreation pointed out in its briefing to your Lordships, we should also recognise that sport is not just a means of delivering wider government objectives, it is valuable in its own right. The contributions made by noble Lords made it clear that they hold true to that in their personal life.

I commend campaigns such as Sporting Equals for the work that they do throughout England to promote racial equality in sport and for the way in which they do it. Sport England funds the project and works through the CRE with the governing bodies of various sports and key national umbrella organisations. I wish them every success and invite the Minister to do the same tonight.

Sport is vitally important to the physical health of the nation. At its best, it is exciting, passionate and hugely enjoyable. It can help to improve our quality of life. As my noble friend Lord Lyell said, volunteers make a massive and invaluable contribution to the organisation of sport in the community. My noble friend Lord Monro of Langholm and the noble Lord, Lord Phillips of Sudbury, said that, although the Government made changes to the tax regime in the Budget this year, they failed to deliver on their commitment to give community amateur sports clubs, which are not charities, the 80 per cent mandatory business rate relief for which most of them have asked. I hope that we will hear from the Minister that there will be a second-stage move towards such a regime.

Community spirit and national identity are fostered by sport. When the UK performs well, it boosts morale; we all want to "Bend It Like Beckham". To the individual, sport can offer a sense of personal accomplishment, as well as health benefits. It teaches people how to win and—certainly for me—how to lose, without, it is to be hoped, losing one's temper. It can improve cognitive skills such as literacy and numeracy. For society as a whole, sport can help to reduce the level of crime. The noble Lord, Lord Warner, is involved in valuable work in that regard. It can help to channel aggression and play an important role in diminishing social and ethnic barriers. Sport can also provide delinquent youngsters with a welcome diversion and can act as a deterrent to the use of illegal drugs, something that Sport England's Positive Futures scheme aims to address.

Sport also plays a part in encouraging the economic regeneration of local communities. We should pay tribute to local authorities, which play a major role in providing and delivering sport. They make available to their communities about 1,200 swimming centres and 1,500 sports centres and maintain about 5,000 parks, playing fields, open spaces and pitches for sports-related activities. Those facilities provide communities with a healthy social focal point.

My noble friend Lord Moynihan made a series of proposals to the Minister on how the Government could tackle social exclusion at local government level. I listened carefully to his list, and I thought that it was an innovative and practical list. I look forward to hearing the Minister's response to those proposals.

Most of us first experience sport at school.It is vital that children are introduced to sport and PE at an early age. Teaching children to play sport is essential to a rounded education. I listened with care to what the noble Lord, Lord St John of Bletso, said about the value of competitive sport. I agree entirely with him. Is the Minister aware of the valuable work done by the British Schools Tennis Association in fostering, competitive sport? It runs a business-sponsored, nationwide programme of school competitions, involving about 33,000 children between the ages of nine and 15 in team events each year. That is a valuable contribution. The undermining of competitive sports in schools has had a detrimental effect on the standard of school sport. Such sports teach students values such as teamwork, leadership, loyalty, courage, respect and patience. We neglect them at our peril.

Just as sport teaches children life skills, it helps to keep them healthy. Noble Lords have given persuasive evidence of the problems that ensue when children are introduced to obesity, rather than sport. Research by the Leeds Community and Mental Health Trust showed that the number of obese children had reached record levels and that, by the age of 11, one third of our children are overweight and one fifth of boys are obese. As noble Lords have said, that should he little surprise, given that one third of primary schools have reduced the time for sport in the past year and children spend twice as much time watching television or playing computer games as they do exercising or playing sport. Indeed, the annual sales turnover for computer games exceeds that the film industry in this country.

Research conducted by the University of Exeter has shown that most 11 to 16 year-olds get fewer than 20 minutes of meaningful physical activity a week. The number of PE specialists in training has dropped by about one third in the past three years. Primary school teachers may receive as little as 10 hours of initial PE training in four years at teaching training college. We must address those problems.

The issue of girls in sport was raised capably, as always—that sounds condescending, but it is not meant to be—by the noble Baroness, Lady Massey of Darwen. The noble Baroness knows all about the subject; I know only a little. Research has suggested that participation levels in women's and girls' sport are disproportionately low. It is true that they participate in greater numbers than before, but still they do not do so as often as men. The Conservative Party recognises the existence of gender inequality in sport. I note that the next world conference on women in sport will be held in Canada next week, from 16th to 19th May. Can the Minister tell us which Ministers will attend the conference? What are their precise objectives? How will they report directly to this House on progress in Canada?

The Conservative Party endorses the national action plan for women's and girls' sport and physical activity, launched by the Women's Sports Foundation in conjunction with Sport England. Can the Minister tell the House what the Government have done to encourage sporting bodies to sign up to the National Action Plan and make a determined effort to put them into practice?

My noble friend Lord Glentoran pointed out how important it is for the Government to recognise the immense and positive contribution which sport brings to communities across the country, ensuring that the requirements of sport are properly taken into account across the whole spectrum of policy and funding decisions.

The noble Lord, Lord Pendry, reminded us that the Government have not yet acted on the recommendation of the Health Select Committee of another place in ensuring that there is a joint special adviser shared between the Department for Culture, Media and Sport and the Department of Health. When do the Government intend to take up that recommendation—without increasing the overall number of special advisers since this Government have increased those numbers vastly over the past six years already?

The same report highlighted evidence to show that only 11 per cent of general practitioners recognise government guidelines on the amount of physical activity to be undertaken by adults. What measures are being taken by the Government to make the health case for physical activity, including sport, to GPs and health professionals?

Finally, Peers have made it clear today that there is much that the Government can do to ensure that sport plays its full part in promoting health and social inclusion. So far the Government have talked a good game, but they have not delivered a result. No doubt we shall return to the subject to press the Government for a progress report. I must say that, unlike Wembley, I shall not accept the lack of a final date on this. There has to be a result.

Perhaps we shall even press the Minister for a personal progress report if she takes up the challenge of her noble friend Lord Haskel to take up cycling. Coming from the family that used to manufacture Anelay cycles into the middle of the last century, I look forward to hearing a positive conclusion that she has taken it up.

My Lords, from all that we have heard today, it is clear that there are a great many in your Lordships' House, and beyond, who feel truly passionately about sport—including cycling. Although I am in favour of cycling, whenever I take to a bike the chain comes off. Therefore, I am going to stick to valley walks and the tennis court and—dare I say on such an auspicious day—supporting the Arsenal football club.

I am grateful to my noble friend Lady Billingham for raising an issue which has generated such an interesting debate. We have had many expert speakers, including two former Ministers of Sport. I am also grateful for all the ideas that have been put forward.

As my noble friend said, there is increasing concern about our "couch potato" culture and the rising level of obesity in our population. The statistics are indeed shocking. We know that physical activity levels, as well as dietary factors, are significant determinants of body mass. We know that levels of activity have a significant impact on health. Figures from the United States show that lifetime healthcare costs are 30 per cent lower for the physically active than for sedentary people. That is a statistic we should all take seriously in how we run our own lives.

I agree with my noble friends Lady Billingham and Lord Pendry and the noble Lord, Lord Glentoran, that there is a very clear role for sport in encouraging people to be more active. In this country, compared with others in the European Union, there is certainly a great deal of scope for this. The average percentage of adults who regularly participate in sport in the UK is only 46 per cent, as against between 60 and 70 per cent in Scandinavian countries. We also need to target our efforts. Non-participation rates are higher among ethnic minorities and women where the prevalence of obesity and associated morbidities is growing fastest.

The Government are heeding those indicators. My department is working closely with the departments of health and education and skills to use sport to encourage participation in active recreation. For children and young people we are building a national network of 1,000 school sport co-ordinators to encourage sport in schools, out of school hours and beyond schools through links with sports clubs. They are 'lasing; with healthy schools co-ordinators to ensure that the message about the impact of active lifestyles on long-term health is part of a broader preventive healthcare strategy.

Adults are harder to reach. For those at risk from sedentary lifestyles we need to develop new approaches. In partnership with the Department of Health and Sport England, DCMS will pilot a Leisure Credit initiative to offer exercise on prescription for targeted adults in some of our most disadvantaged areas. I hope that the proposed scheme will empower the user rather than just subsidising the provider, as in the past. We will provide more details of that scheme soon.

My noble friends Lady Billingham and Lord Hardy of Wath raised a second area of concern—that of the rising tide of street crime committed by young people. The Prime Minister has pledged to bring street crime under control in the 10 police areas responsible for 80 per cent of such offences. That will require action not only within the criminal justice system but also by departments, including my own.

As the noble Lord, Lord Warner, said, we are working with the Department for Education and Skills and the Youth Justice Board to establish a coordinated preventive programme of summer and longer-term activities in the target areas. The Government accept what has been said in the debate. Sport can help engage disaffected young people and help them find their way into a more constructive use of their leisure time.

Evidence from the Summer Splash schemes, which were described by the noble Lord, Lord Warner, is encouraging. For example, in areas where schemes were run in the year 2000, the total crime rate fell by 6 per cent, compared with a national rise of just under 4 per cent. Criminal damage fell by 14 per cent, against a national rise of 8 per cent. Domestic burglary fell by 26.6 per cent. The national fall was only 8 per cent. The criticism commonly levelled at such schemes is that they are merely diversionary. They channel energies which might otherwise go into criminal activity but fail to address the underlying attitudes which lead to bad behaviour. Can sport do both? Evidence to show that it can is beginning to emerge. Where sustained sport-based programmes are and have clear goals, they can achieve remarkable results. For example, there has been a 75 per cent reduction in arrests and offences of young people involved through the Youth Inclusion programme in the Plymouth Positive Futures project. The Government will continue investing in long-term schemes like that and will use sport to engage hard to reach young offenders. We shall learn lessons from longer-term evaluations.

Those health and community safety issues are formidable problems which require a comprehensive, sustained and intelligent approach. While it is right to explore the potential of sport to bring about change for the good, it is important to be realistic. While sport can be part of the answer to individual and social malaise, sport in itself is no Holy Grail. I am sure that Members of your Lordships' House will agree with that.

Sport can provide role models. It can inspire; it can provide healthy and enjoyable exercise and social contacts. It can teach young people about team working and the importance of rules. Involvement in sport, in the right environment, can indeed be a powerful tool for the transformation of individual lives and of communities.

Sport will need help to achieve all that potential. I want to refute what was said by the noble Lord, Lord Glentoran; that funding for sport is not part of our agenda. The Government are investing in sport at a level never previously seen in this country. Perhaps I should set that out for him and for the noble Lord, Lord Addington, who also asked about it.

Exchequer funding for sport in the current year is £83.7 million rising to £135 million next year. That represents an increase of £80 million over the figure for 1996—97. Many speakers mentioned the lottery. Since 1997, almost £1.5 billion has been awarded in lottery grants for community sports facilities and acute athletes under the world class programme. In addition, £31.5 million from the New Opportunities Fund Green Spaces and Sustainable Communities programme is enhancing playing fields and play areas. During the current spending round, £73 million is being invested in specialist sports colleges by the DfES. And investment in school sports facilities through the New Opportunities Fund and Space for Sport and Arts amounts to £855 million. I am most grateful to my noble friend Lady Pitkeathley for all her work in the chair of the New Opportunities Fund. That amounts to a package of more than £2 billion for sport.

Last month, the Government recognised that amateur sports clubs, rooted in local communities, need more support. That help is now forthcoming and I am grateful for support for that move from the noble Lord, Lord Phillips of Sudbury.

In April, the Minister for Sport announced that the majority of amateur clubs will now be able to apply for charitable status. The potential benefits run into tens of millions of pounds. Through that new status, clubs will gain the mandatory 80 per cent relief from business rates; tax exemption for fundraising income; and payroll giving, Giftaid and other tax reliefs.

As the noble Lord, Lord Monro of Langholm, claimed, of course clubs will need help in understanding the changes. A regional Sport England helpline will be available to help them make the most of the new tax benefits very shortly. I know that the Charity Commission is aware of the need to be helpful in that respect.

In addition, as the noble Baroness, Lady Anelay, and the noble Lord, Lord Phillips of Sudbury, pointed out, the Chancellor announced a package of tax benefits in the Budget for clubs which are unable to benefit from charitable status. We will keep the effectiveness of those arrangements under review, including the specific points raised by the noble Lord, Lord Phillips of Sudbury.

An extra boost for clubs was also announced by the Chancellor in the form of £20 million from the Capital Modernisation Fund for sport. Clubs will also benefit from the Government's plans for coaching and volunteering. Coaches play a key role in motivating competitors and improving their skills. That applies to the school playground and the local playing field as well as to major international events.

We need to develop and support coaches more. We also need to encourage more people to enter the profession and to ensure that good coaching is available at every level from the grass roots to the top. At the grassroots level, action is already underway. The Come into Coaching campaign is a national recruitment drive in partnership with the BBC to encourage parents and others to enter coaching in local schools and clubs. Some of those people will be paid as sessional coaches. Others will be volunteers.

My noble friend Lord Hardy of Wath mentioned volunteers. It is estimated that our 110,000 amateur sports clubs are sustained by an army of more than 1.5 million volunteers. Those dedicated people range from skilled coaches to the mothers who wash bags full of muddy kit for junior teams. All of them give their services week after week and we must acknowledge the work that they do.

One of the most inspiring elements of preparations for the Commonwealth Games is the Millennium Volunteers programme. My department will continue to lead in advocating the value of volunteering in sport. And the benefits will spread beyond our schools. Many will progress to higher awards and will be placed in community sports clubs. Alongside them, adults will also have the opportunity to gain awards and recognition for the volunteering they already do.

To underpin that work, Sport England will develop a comprehensive volunteering database to match local placement opportunities to the experience and qualifications of volunteers.

A key issue for clubs and for the public is access to sports facilities and in particular playing fields. The noble Lords, Lord Monro of Langholm, Lord Phillips of Sudbury and Lord St John of Bletso, mentioned the concern felt about the loss of school playing fields. While there is no room for complacency, the picture is nowhere near as black as is sometimes painted. The Government have dramatically reduced the overall number of sales of school playing fields by introducing legislative changes and checks to the planning system. Controls set up to stem the flow are now beginning to bite.

In response to particular questions raised about that issue, Sport England has followed up all the planning applications affecting playing fields to which it has objected as a statutory consultee. We expect soon to be able to publish an authoritative set of figures agreed with the National Playing Fields Association to put an end to the confusion over data to which the noble Lord, Lord Monro, alluded. There is more that I could say about that issue, but I fear that I shall run out of time. I want to move on to the issue of trying to improve what we do for school sports.

First, £201 million Sport England lottery funding has been awarded to school sports facilities as well as funding from the Department for Education and Skills and funding through Space for Sport and Arts. All facilities which are funded through those programmes must also open their doors to local people out of school hours to benefit community health and promote social inclusion. We know that professional white males are four times as likely to participate in regular activity than working-class women of Pakistani or Bangladeshi origin. That discrepancy is being addressed. Forty-three of the 45 county-based sports partnerships have worked out equity policies with clear targets for engaging women, ethnic minorities and people with disabilities in sport.

In order to extend the benefits of participation beyond the traditional social boundaries, we are channelling sports development funding into areas of multiple deprivation. Sport England's community capital programme is supporting projects which encourage participation by groups less likely to be regularly involved in sport and active recreation.

School is where most children are introduced to sport. At school, pupils either develop a lifelong love of sport or an equally lifelong aversion to it. As my noble friend Lady Billingham pointed out, school sport declined throughout the 1980s and 1990s. However, the message we are now trying to get across is that time spent on PE and sport does not detract from academic achievement. Indeed, the opposite is true. My noble friend also mentioned the specialist sports colleges where GCSE results have improved, as they have in other specialist schools. Longitudinal studies currently being undertaken further support the improvements being brought about in the achievements of their pupils.

For a whole variety of reasons, including the improvements that I have just mentioned, the Prime Minister is committed to embedding sport at the heart of school life. In response to the noble Lords, Lord Moynihan and Lord Addington, to ensure that that is brought about, both the DCMS and the DIES have agreed a detailed project delivery plan which aims to improve the quality of PE and sport in schools. The project aims to ensure that all pupils can benefit from a minimum of two hours per week of high-quality PE and school sport; to encourage schools to foster links with sports clubs; to provide a wider range of opportunities and to encourage school leavers to remain involved in sport. Ultimately, the project seeks to increase the number of children enjoying playing and participating in sports and related recreational activities.

To achieve that transformation of school sport, we are planning an expansion of the existing infrastructure of sport co-ordinator partnerships and primary link schools centred on specialist sports colleges. Once the delivery contract targets have been agreed, they will be made public. However, I can assure noble Lords that they will be ambitious. We believe that our plans for school sports provision will have a long-term impact on sporting and educational achievement, the health of the nation and on the social fabric of our communities.

A number of specific questions were raised during the course of the debate to which I shall not have time to respond in detail now. I shall write to noble Lords with answers to those questions. Perhaps I may conclude by saying that many of us count participation in or spectating sport as one of the great pleasures of life. I certainly do so. I hope that I have been able to demonstrate that sport can help to achieve much wider goals for society and for individuals. Sport has a magnetism that is capable of drawing out the best in some of our most disaffected and disadvantaged people. The Government are determined to focus that power sensitively and effectively.

My Lords, this is the first debate that l have initiated since becoming a Member of your Lordships' House. It has been a most stimulating experience. Your Lordships' House is packed with so much expertise—a galaxy of stars if ever I saw one. Today's debate has been positive, creative and dynamic with every contributor giving remarkable insights. I hope that the debate will he widely read and acknowledged and that many of the aspirations of noble Lords will become reality. I believe that we have witnessed genuine consensus on the value of sport to our society. Let us retain that united front and encourage the Government to place sport even higher on their agenda so that it can play its key role in ensuring a healthier and more inclusive society.

I thank all noble Lords for their contributions. I beg leave to withdraw my Motion for Papers.

Motion for Papers, by leave, withdrawn.

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—(Lord Faulkner of Worcester.)

On Question, Motion agreed to.

House in Committee accordingly.

[The DEPUTY CHAIRMAN OF COMMITTEES (Baroness Turner of Camden) in the Chair.]

Clause 1 [Amendment of the Sex Discrimination Act 1975]:

moved Amendment No. 1:

I have added my name to the amendment. I should like to say a few words in support of the noble Lord, Lord Borrie. In doing so, I offer my thanks to him. He spotted that the Bill may have slightly wider implications than its promoters and many noble Lords who spoke at Second Reading thought. I was somewhat remiss not to speak at Second Reading. I may have to say a few words at this stage, without making a Second Reading speech—I have no intention of making a Second Reading speech—to set out my position on the Bill.

Before I do so, perhaps I may ask the noble Baroness, Lady Scotland, who I presume will be speaking for the Government on the Bill—her noble friend Lady Farrington spoke on the previous occasion—whether she can help on this issue. On 13th March, the day of the Second Reading, my noble friend Lady Blatch put down a Question for Written Answer asking Her Majesty's Government what plans they have to bring in a Bill to ban all clubs from excluding female membership. That Question was put down on 13th March and I gather from the Companion that it is recommended that the Government normally answer Questions within a fortnight of them being put down. One would therefore have hoped that the Question would have been answered by 27th March. As far as I am aware, the Question has not yet been answered.

It seems to be a fairly straightforward Question. It was dealt with to some extent by the noble Baroness, Lady Farrington, at Second Reading when she said:

"The Government have made no criticism of genuine"—

I stress the word "genuine"—

"single-sex clubs".

She then went on to discuss what she thought were single-sex clubs, which seemed to include the Women's Institute, the Girl Guides or Business and Professional Women UK. She went on to state:

"Nor would one expect to hear complaints about support groups for male single parents or for men who are the primary carers of pre-school children within a family".—[Official Report, 13/3/02; col. 934.]

She did not mention any other kinds of clubs. I would be interested to know what are "genuine single-sex clubs". Perhaps the noble Baroness will address that issue and tell the Committee when the Question put down on 13th March is likely to be answered.

Like the noble Lord, Lord Borrie, I declare an interest. I am a member of two clubs in St James's, one of which, I understand, possibly will be affected and the other possibly not. It depends very much on the interpretation of the Bill. That is a difficult matter which we will discuss when we get to later amendments or at a later stage of the Bill.

Interpretation is very important. I sat down with the noble Lord, Lord Borrie, and another, equally eminent, QC. We discussed the Bill for an hour or more. As I understood it, the views of those two eminent lawyers seemed to change during the course of that hour, then changed back and then changed again. If eminent Silks such as the noble Lord, Lord Borrie, and his colleague could change their views, I suspect that the whole Bill will need to be looked at further.

As I said, I am currently a member of two clubs in St James's. I was also a member of the Carlton Club, which was mentioned on a number of occasions at Second Reading. I was an honorary member of the Carlton during my time as Chief Whip. I understand that as I am no longer Chief Whip I am no longer an honorary member of that club. But in my time as a member of the Carlton I took part in the vote as to whether or not women should become members. I can assist the Committee by saying that I voted for women to become members, as did the then Leader of the Conservative Party, Mr William Hague. Sadly, we were unsuccessful. But that is a matter for the Carlton Club and the Conservative Party. It is not a matter on which legislation should necessarily impinge.

I should make it clear that I have no terribly strong views about whether any club of which I am a member should or should not admit women, or whether it should discriminate on the grounds of what is now called "gender" but which the Bill still seems to refer to as "sex". However, I do have strong views about being told what to do by other people or by Parliament on matters that are not necessarily matters in which Parliament or the state should involve themselves.

Having said that that should apply to clubs of which I am a member, it should also apply to golf clubs, with the possible distinction of the kind of golf club referred to by the noble Lord, Lord Borrie, which is the only club in an isolated area and the only way that one could play golf is by being a member of that club. But I do not have strong views about golf clubs, working men's clubs and so on. I believe it is a matter for private associations to decide what their membership should be—and only for those private associations.

Perhaps I may give a small analogy. I seem to remember being told years ago that one should try absolutely everything except incest and morris dancing. Quite rightly, we have laws against incest, but we can leave people to decide for themselves what they wish to do about morris dancing. I have not yet taken up morris dancing—I have no intention of doing so—hut it is not a matter on which we need to legislate.

For those reasons the Bill is a deeply illiberal measure. I hope that its creators will think again, very carefully, before taking it any further.

As to the amendment itself, the noble Lord, Lord Borrie, has set out very clearly what we wish to know from the noble Lord, Lord Faulkner. Exactly what kind of club is he trying to get at? He has arbitrarily chosen a limit of 25; the noble Lord, Lord Borrie, has, quite rightly, suggested another figure. After discussions, we chose our figure—again quite arbitrarily—of 2,000. Where does one draw the line? At what stage does a genuinely private club become so large that it becomes something public in which the state or Parliament ought to intervene? For myself, even 2,000 may not be the right figure and we may need to come back to it at a later stage.

But, as the noble Lord, Lord Borrie, said, this is a probing amendment. I hope that when he comes to respond to it the noble Lord, Lord Faulkner, will let us know why he proposes a limit of 25. If, in the light of the submissions made by the noble Lord, Lord Borrie, he considers that the figure of 25 is too small, will he consider raising that limit to make the Bill marginally less pernicious than it is at the moment?

I support the amendment, moved most effectively by the noble Lord, Lord Borrie. First, I declare a non-interest. As it happens, I do not belong to any of the kinds of clubs against which the Bill is aimed. I am a member of a couple of small dining clubs which meet once a year and whose dinners I attend perhaps two years out three at most. But these clubs are not the subject of the Bill.

Like the noble Lord, Lord Henley, I believe that the Bill is illiberal in the true sense of the word, and that it is a threat to freedom of choice, freedom of contract and freedom of association. I would have said as much at Second Reading, but there is a limit to the number of evenings one is prepared to sacrifice in discussion of Private Members' Bills.

A club is not a public place; it is a private place. Existing members should, therefore, have the right to be as perverse and eccentric as they like in the rules that they apply. If people do not like those rules—and I fully understand why quite a few do not; although, equally, quite a few women members, I understand, are happy with the status quo, especially if it means substantially reduced subscriptions—they have a simple remedy: to resign forthwith and go elsewhere, or possibly start up a club more to their liking. This amendment would at least reduce the scope and impact of the Bill, and I support it for that reason.

I was unable to be present at the Second Reading of this moderate Bill, but I am delighted now to be able to congratulate the noble Lord, Lord Faulkner of Worcester, on having introduced it and to add my support to the great support given by the many noble Lords who have spoken in its favour. I shall make only one speech: I shall speak to the first three amendments, all standing in the names of the noble Lords, Lord Borrie and Lord Henley, so that Members of the Committee do not have to hear me again and again.

I begin by declaring my interest. I am a member of the RAC, which admits members of both sexes, but some of whose activities may be affected by the Bill if it becomes law. I refer, for example, to the exclusion of women members from using overnight accommodation or providing equal access to the Turkish baths in the club. Men and women are members of the RAC but there are still those elements of the past.

I have other antecedents which I shall declare presently, including the fact that I was an architect of the Sex Discrimination Act and of the Race Relations Act, both of which—if the noble Lord, Lord Borrie, will forgive my saying so—were greeted with similar arguments: in respect, for example, of the small employers' exemption and of the fact that we outlawed colour bars in clubs of more than 25 members. I have heard those arguments for 30 years and I am slightly surprised to be hearing them from the noble Lord. I remember, when I was younger, reading some of the great works that he wrote, including .The Consumer, Society and the Law, which we regarded as a most progressive and reforming work. However, I fully respect the view that he and others have expressed.

Since the beginning of the year, the Equal Opportunities Commission has received some 70 complaints about sex discrimination in private clubs, many of them relating to the practices of golf clubs. I should also mention that l am a member of a golf club in Ireland which cannot any longer, I am glad to say, discriminate against women because the Irish Government would cut off funds. That has had a tonic effect on the other side of the Irish Sea.

The EOC's consultation found overwhelming support among the public for a measure on the lines of this Bill. One of those who responded to the consultation commented that she had entered a business golf day to discover that the organisers had planned for registration to take place in the men-only lounge. She was not allowed to register, but had to shout her details from the doorway.

Like many Members of this House, for many years I was also a member of an all-male London social club, which I greatly enjoyed; namely, the Garrick Club, which excludes women from its membership, although not as guests of members. As the noble Baroness, Lady Howe of Idlicote, revealed at Second Reading, one day when she and I lunched together at the Garrick we naughtily protested against the archaic rule that forbade women from walking up the main staircase by climbing the stairs together without requiring the noble Baroness, Lady Howe, to use the back stairs and to meet me on the landing above. Together with others, I tried to change the club's rules by opening membership to both sexes.

The Garrick Club is not only a private social club; it is a social club for members of the literary, theatrical and legal professions: writers, actors, judges and lawyers—distinguished lawyers such as the noble Lord, Lord Borrie. It seemed to the minority of reformers to be unfair and absurd to bar from membership the likes of Dame Antonia Byatt, Dame Judi Dench, and Dame Elizabeth Butler-Sloss solely because of their gender.

Among the judges and lawyers belonging to the Garrick Club there was overwhelming support for the removal of the gender bar. Only one disagreed. But our attempt to change the rule was rejected by the great majority of the membership as a whole, by no means all of whom were misogynists or male chauvinists. I resigned, not because of some grand principle but simply because I no longer felt comfortable in a club whose membership had voted in that way. I should not dream of criticising those who feel happy to remain as members, enjoying their freedom of association, and to exclude the other sex from membership.

When he spoke in general opposition to the Bill at Second Reading, the noble Lord, Lord Borrie, suggested that legislation was unnecessary because so-called gentlemen's clubs had a "come a long way over the past 20 or 30 years". That is true of some of them, but I am not aware that many, including the Garrick, have modified their rules or practices since I resigned more than a decade ago, although I believe that the noble Baroness, Lady Howe, if invited by the noble Lord, Lord Borrie, could now walk up the main staircase.

The Equal Opportunities Commission found, on the basis of the evidence obtained in the consultation, that there had been "very little voluntary change" and that there are a,

"variety of discriminatory rules and arrangements which seek to perpetuate stereotypical images of men and women; and which limit women's participation in club activities in a number of ways".

The Bill is much less far-reaching than, for example, the Hong Kong Sex Discrimination Ordinance, which for several years has forbidden sex discrimination against non-members as well as members of almost all clubs—there is not even a 25 member cut-off. The Bill is also much less far-reaching than New York City's human rights law, which, since 1984, has forbidden sex discrimination in any club with more than 400 members that provides regular meal service and regularly receives payment, directly or indirectly, from or on behalf of non-members for the furtherance of trade or business—rather as the Garrick Club used to take money, for example, from my chambers through me to organise a Christmas party for chambers as part of its important revenue.

For those who say that the New York measure is a violation of fundamental rights, I point out that, in the land of liberty itself, the United States, it was unanimously upheld by the American Supreme Court in 1988 as being entirely proper under the constitution of the United States. Interestingly, the preamble to that New York law explains that,

"one barrier to the advancement of women and minorities in the business and professional life of the city of New York is the discriminatory practices of certain membership organisations where business deals are often made and personal contacts valuable for business purposes, employment and professional advancement are formed".

The Bill before the Committee is not intended to forbid single-sex clubs, but to provide that clubs whose membership is open to both sexes must treat applicants and members equally without sex discrimination; and that clubs that admit women as well as men as guests must again treat them equally without sex discrimination.

In my view the drafting of proposed new Section 29B is imperfect. It is rather ambiguous, and I am sure that that is what has led to some agitation in this Chamber. It may well call for clarification at a later stage to make it absolutely clear that a club like the Garrick is not caught in terms of membership by this Bill.

If the probing amendments that the noble Lord, Lord Borrie, has fairly put forward for debate were to be pressed and accepted, women would continue to face sex discrimination as guests—and not only as guests—in medium-sized and small clubs, whether a club had male and female members or only members of one sex. I find it difficult to understand the justification for perpetuating sex discrimination against, for example, a woman who comes to the Garrick with the noble Lord, Lord Borrie, but who cannot go up the same staircase, if that was the rule, or cannot have a drink with him at the bar at the top of the stairs. The same applies to a woman golfer who is a guest at a golf club, but cannot enjoy the club's facilities together with her host.

I greatly cherish personal privacy. Objections on those grounds can be dealt with by amending the Bill along the lines of the exemption already in the Sex Discrimination Act for other bodies. I have tried to do that in amendments that we shall come to later. They are not ideal amendments, but they are an attempt to deal with personal privacy.

I very much hope that noble Lords will not divide the Committee and will not press the amendments in the light of the debate.

I shall say a word or two about some of the arguments that we have heard from the noble Lords, Lord Borrie and Lord Henley. Equality has to be balanced with liberty. That is not an issue. It has to respect freedom of association and personal privacy. That is not an issue. The question is where the line should be drawn. What exceptions are needed to respect those other important rights and interests? The Bill does not interfere unduly with freedom of association. If it is amended, it will not interfere unduly with personal privacy.

The members of single-sex clubs can enjoy their freedom of association if they wish by maintaining them as exclusive clubs. However, if they choose—and this is their choice as members—to admit members or guests of both sexes, the Bill says that, having made that choice, they should do so on equal terms. If, on the other hand, they choose to revert to being exclusive all-male preserves, as the noble Lord, Lord Borrie, indicated, that is their right.

However, I do not understand how it can be right to distinguish between working men's clubs, which have more than 1 million members throughout the country, and clubs such as Brooks's, the Garrick or any other social club, which in form are exactly the same and are regulated as private clubs. I can see no argument, except a class-based one, for the view that it is impermissible for working men's clubs or golf clubs to discriminate against women or black people, but it is permissible for Pall Mall social clubs to do so. I see no practical distinction between the two. The only justification is that Members of this House do not belong to working men's clubs, but they belong to Pall Mall social clubs. To that extent, we are self-interested. That is not a justification for the distinction.

As long as we do not legislate to prohibit virtually all single-sex clubs, as happened in Hong Kong, we are respecting the other fundamental rights that need to be respected and maintaining a fair balance. In doing so, we are advancing the position of women as well as men. As someone who joined an all-male set of chambers, I reassure those who belong to all-male clubs that it is ever so much more enjoyable when both sexes are members on equal terms than when we go on as our fathers and grandfathers did.

Does the noble Lord accept that the Irish Government's withdrawal of financial support to golf clubs that discriminate against women, to which he referred, is not unreasonable? It is no doubt reasonable to exert financial pressure on people who discriminate, but the Bill is much more draconian than that, by imposing an outright ban.

I have tried to explain that the Bill does not impose an outright ban. Properly drafted, it will leave untouched the right of private member's clubs to be all male or all female. The only way in which it intrudes is by saying that if a club chooses to admit members of the other sex, as the RAC does, for example, or to admit guests of the other sex, they must be treated equally, subject to safeguards for matters such as personal privacy.

In speaking to the amendment. I wish to put down a marker that I intend to ensure that a potential flaw in the Bill is addressed on Report. I participated in this afternoon's debate on sport, but I regret that I cannot be with your Lordships throughout this Committee stage, for which I have already apologised to the noble Lord, Lord Faulkner, and for which I sincerely apologise to the Committee.

The amendment covers the point that I wish to make only for clubs with a membership of fewer than 2,000. That depends on the success of my noble friend Lord Henley and the noble Lord, Lord Borrie. As I read it, many sports clubs, such as the London Rowing Club, of which I am a member, effectively face the prospect of closure if the legislation as drafted is enacted in the near future. That is not because the club currently objects or has in the past objected to women's membership—on the contrary, at a previous AGM the membership passed a resolution to move that successful, outstanding historic club in the desired direction on women's membership. However, voluntary clubs committed to building necessary and new state of the art facilities, many of which already have a class of women's membership but wish to move to the ideal and clearly defined principles set out in the Bill, face the problem of having to raise substantial funds, agree designs within budgets and implement the necessary development plan. All that takes time, which is not permitted on the face of the Bill. If the Bill is to be enacted, I simply ask noble Lords to recognise the importance of the issue when it is raised on Report. The issue will be all the more serious if the amendment is not carried. We need delays in implementation built into the Bill if it is to proceed further.

Is the noble Lord aware that Section 44 of the Sex Discrimination Act contains an exception in relation to sport, which would cover the London Rowing Club in any event? I used to row from the London Rowing Club at school, so I know it well. Nothing in the Bill will compel the London Rowing Club to admit women members.

I am grateful to the noble Lord for drawing my attention to Section 44 of that Act, which I have yet to read and consider. The noble Lord has clearly benefited from his many years of rowing from that great club on the Thames. If he is right, the provision overcomes the concern held by many clubs in the circumstances that the London Rowing Club currently faces. I shall study that section carefully. If I agree with the noble Lord on the issue, it will not be necessary to raise it in further proceedlings on the Bill. I hope that he will allow me to reserve judgment on the issue until I have clarified it further, but I hope that he is right.

I regard this as a very mild and encouraging Bill. The amendment would exclude almost all the clubs at which the Bill is aimed. I am reliably informed that it will encourage clubs such as the Garrick to move rather quickly to a more liberal approach. Having said that, as long as they allowed the same facilities to men and women guests, there would be no problem.

What I like about the Bill is that it makes specific provision for those clubs that have two levels of membership. That is the aspect that needs attention. We have heard that the Equal Opportunities Commission has regularly received—and I know continues to receive—complaints from women with regard to the discrimination they experience at the hands of golf clubs and others.

All that is being asked in the Bill is that both sexes should be treated the same so that if you are willing to be an associate member and be prevented playing golf on a Saturday because it is assumed that you are at home doing nothing all week and able to be on the golf course then, whether male or female, you may opt to apply for the same associate membership. It is up to you, whether male or female, to apply for that associate membership. That is one aspect of what in today's world continues to be a completely unjustifiable use of the exemption that some people believe exists for club activities.

It is particularly sad that having successfully passed the Sex Discrimination (Election Candidates) Act 2002 which allows political parties to use their discretion to take whatever form of positive action they feel is appropriate to encourage more women to be adopted as parliamentary candidates, nevertheless the Conservative Carlton Club—I argue that this is where the private and the public aspects cross over—is still very much living in the Dark Ages; and it cannot be the only one. That is despite the valiant efforts of the leader of that party and his principled personal refusal to become a club member until it changes its rules to allow equal membership for men and women.

I refer to a female associate member who clearly gave valuable service on that club's political committee and was its deputy chairman. By virtue of her office she was also a member of the Carlton Club's general committee. I believe that she had greater political ambitions, perhaps to become a Member of Parliament. She attended five monthly meetings of the general committee without challenge. Apparently, the general committee is rather grander than the political committee. However, some three weeks ago she was challenged because, apparently, no woman, however capable—and she clearly was capable—is allowed to sit on that all-powerful committee. She was unanimously voted off the committee. What kind of message does that send out to aspiring young women and, indeed, men who want to be part of our democratic process in the modern world in which we live?

I very much hope that the noble Lord, Lord Borrie, for whom I have, and always have had, enormous respect, will not press his amendment. As I said earlier, it would exempt practically all the clubs that we are considering. The Bill is moderate to a degree and I hope that it will persuade some clubs to move rather more quickly to adopt a more liberal and modern attitude towards the lives that men and women live.

It is rare for me to disagree with the noble Baroness, Lady Howe of Idlicote, and it gives me no pleasure at all to do so. However, I rise to support the amendment which the noble Lords, Lord Borrie and Lord Henley, have tabled. I suppose that we should all declare the interest of membership; but perhaps the fact of leaving membership is at least as much of an interest as being a member. I have the same club membership as the noble Lord, Lord Borrie, and therefore noble Lords will not be surprised at my view. That view is a simple one and I shall not require more than two or three sentences to explain it. It is important that we draw a line up to which we legislate and beyond which we do not legislate. It is crucial that we do not appear to the public to spend our time legislating on matters which are essentially private.

I do not want to drag in a totally different subject at any length, but I voted as I did on the hunting Bill not because I like hunting—I detest it—but because I believed that it was not a proper subject for legislation as it interfered with areas in which people should be free to pursue their own objectives. In my view, this is a fortiori the case for the Bill which is now before us. It is for that reason that I believe that we should not follow the route recommended to us by the noble Lord, Lord Faulkner, but should follow that recommended by the noble Lords, Lord Borrie and Lord Henley.

Like the noble Lord, Lord Lester, I did not participate in the Second Reading debate for the simple reason that I could not be in London that evening. However, I greatly welcome the Bill. I did not expect to speak to the Bill at either Committee or Report stages as it seems to me that it is simple and straightforward. It attempts to take one more logical step towards providing equal facilities for men and women. That is the basic provision of the Sex Discrimination Act; namely, that where goods and facilities are available, they should be available on equal terms to both sexes.

As has been said, there is an exception to that; that is, that private clubs can provide facilities for one sex only. That was accepted perhaps as a compromise when the Sex Discrimination Act was passed. Nevertheless, it still provides for single-sex organisations if members of those private organisations so wish. But once they admit both sexes to the club, the underlying principle of the Sex Discrimination Act should apply; namely, that the facilities are available to both sexes.

I was surprised to read the amendments tabled in the name of my noble friend Lord Borrie. I am sure that he will recall that the noble Baroness, Lady Howe, was deputy chairman of the commission and I was chairman when we set it up in 1975 and welcomed my noble friend as a member of it. He made a valuable contribution for about a year before he had to move on to another public appointment. I am sure that my noble friend Lord Borrie will recall the many complaints we received about facilities not being available to both sexes. Sometimes those complaints involved private clubs but very often they involved facilities that were in the public domain which the Bill had stipulated must be made available to both sexes. There was a parallel, which my noble friend Lord Borrie will recall, in the El Vino case. That involved a public house that was covered by the legislation. The rules of that public house were that men could sit down or stand at the bar to enjoy their drink but that women could only sit at the back of the room. They were not able to participate in the full discussions that took place. Those full discussions largely involved a journalist and therefore had some kind of professional importance. The principle was the same as that in this case—that women were not able to enjoy the same facilities.

I am surprised by some of the comments that have been made this evening—they were also being made way back in 1975. I thought that we had made tremendous progress since then. In many ways we have done, even with regard to private clubs. I refer to the number of private clubs that are now admitting women to full membership or partial membership. Full membership certainly represents a move forward. If only partial membership is involved, that is not a move forward because it does not provide the same facilities. As the noble Baroness, Lady Howe, mentioned, if one wants two classes of membership in an organisation, one can have that, but they must be open to both men and women. We must remember the principle that lies behind the Sex Discrimination Act and apply it to the Bill.

I turn to the figures of 25 as opposed to 2,000 members. Using the figure of 25 is logical because it is also used in other parts of the Act in relation to exceptions. That figure involves consistency. I ask the Committee to reject the amendment and ultimately to pass the Bill.

I was very glad to hear the noble Lord, Lord Borrie, say that his was a probing amendment. I hope that he has heard, from wiser heads and tongues than mine, a good many arguments that he finds very reassuring. His three amendments, if taken together, would drive a coach and horses through the Bill. He will be aware that I support the Bill. I am sure that he will not be surprised to hear that I oppose his amendments. I hope that they will not be agreed to and that he will be reassured by this debate and that which will follow it.

I am desolated to find myself in disagreement with my noble friend Lord Dahrendorf. For the whole time that I have been in politics, he has been a shining light of rationality and liberalism for myself and many others. However, I disagree with him in this regard. I concur entirely in his attitude to hunting and I have voted consistently in that regard. However, we are talking not about hunting but about the treatment of different sexes within the same establishment. I am fairly certain that the Act covers private schools, for example, which can be single sex. However, if they are not single sex, they must treat boys and girls equally. That is all that the Bill will do. As the noble Baroness, Lady Lockwood, said, the Bill applies the principles of the Act to a new area—that in which goods and services are provided. That extension is logical within the terms of the Act.

It has been suggested that the voluntary system is working. I shall give one example of where it does not work. When the EOC did a consultation a couple of years ago on equal membership—on what that meant and on women's rights as members—one person wrote saying that she bitterly resented the fact that, being a fully paid up, voting member of a golf club, she still was not allowed to use the same dining room, bar or lounge as the men. That is a perfect example of the sort of discrimination that this little and useful Bill is designed to eliminate.

I shall he extremely brief. I follow in the footsteps of the noble Lord. Lord Lester of Herne Hill, in speaking, in effect, to the first three amendments, which stand in the names of the noble Lord, Lord Borrie, and my noble friend Lord Henley.

The noble Lord, Lord Borrie, said that there is a strong case to be made before the law intervenes in the private domain. I entirely agree. Indeed, I said on Second Reading that there is a limit to how much we should interfere with the rights of individuals who are acting in a private capacity. However, I also agree that there is a very strong case for equal treatment between the sexes when both sexes are invited or are able to join a club.

The noble Lord, Lord Monson, said that the Bill was somewhat illiberal. As a woman, I find it liberating. That said, my noble friend Lord Henley referred to difficulties of interpretation. That is important, particularly with regard to Amendment No. 3 and the proposed Section 29B. There is a need for further clarity in order to give the objectives of the Bill legal certainty.

In contrast, Amendment No. 1 is clear—it is a wrecking amendment. On that basis, we oppose it. I, too, am pleased to learn that the amendments are probing amendments. We are therefore confident that the noble Lord will not pursue them. I hope that he will give the Committee the time to amend somewhat the way in which some of the clauses are interpreted. There is still a certain amount of disquiet outside your Lordships' House because there is a sarong belief that the Bill will affect single-sex clubs. That is not the case.

I find myself in agreement with the comments of the noble Lord, Lord Lester, the noble Baronesses, Lady Howe, Lady Buscombe and Lady Thomas of Walliswood, and my noble friend Lady Lockwood. Perhaps it is not entirely surprising that the noble Lord, Lord Lester, finds himself in such good female company.

The effect of the amendment would be to limit considerably the impact of the Bill by reducing the number of clubs to which it would apply. As my noble friend Lady Lockwood rightly said, a threshold of 25 members reflects a similar provision in other legislation. Members of the Committee will recognise that figure from the Race Relations Act. They will also recognise the need to draw a line at the level of very small private groups. We would be reluctant to depart from that figure without further reasons for doing so and without further consideration. It would be even more artificial to choose a number that was different from that used in the Race Relations Act.

Moreover, while no one knows the typical size of clubs, a figure of 2,000 seems to be so high as to reduce significantly the effect of the legislation. All those Members of the Committee who made that point did so wisely. While some clubs may be above that figure—for example, some golf clubs—many other clubs will fall far below it. It might also encourage the introduction of arbitrary limits on membership. We see no reason to depart from the current figure.

I shall answer the question raised by the noble Lord, Lord Henley. I apologise for the fact that the Question raised by the noble Baroness, Lady Miller, has not been answered.

I thank the noble Baroness for giving way. The Question was put in the name of my noble friend Lady Blatch and not in that of my noble friend Lady Miller.

I beg the noble Lord's pardon. I apologise for the failure to answer that Question. I shall certainly make inquiries and ensure that it is answered speedily. However, I can reassure the noble Lord that the Sex Discrimination Act defines "sex clubs" as those which can show their main object and essential character to be for the benefit of one sex only. The Government have no intention of removing the exemption in the Sex Discrimination Act which permits single sex clubs. I endorse all that has been said by Members of the Committee in this debate with regard to the fact that single sex clubs need not be imperilled by the proposed Act.

I wonder whether the noble Baroness can again address the first part of her answer. She said that she would hope to produce an Answer to my noble friend's Question speedily. I remember on many occasions when speaking from that Dispatch Box using words such as "soon" or "speedily" or some other adverb. Often "soon" or "speedily" could be stretched quite some way.

I believe it is important that we all know exactly what the Government's intentions are, particularly in relation to this Bill. Therefore, I consider it important that we have an Answer to that Question before we reach the next stage of the Bill. Perhaps I may have an assurance from the noble Baroness that we shall have an Answer to that Question before the Bill reaches its Report stage.

I am very happy to give that assurance. But I should have thought that the comment that I just made was the answer that the noble Lord required. I am quite clear that a Written Answer to the Question raised by the noble Baroness, Lady Blatch, needs to be given and then recorded.

I find myself in the position of replying to a debate in which many of the questions raised by Members of the Committee at the beginning have been answered by subsequent speakers. I am conscious that I am in the presence of some extraordinary experts in the fields of both race relations legislation and sex discrimination legislation, together with former commissioners and chairs of the Equal Opportunities Commission. I hope that my noble friends and other noble Lords who have raised questions will feel that many of them have already been answered.

I believe that the question raised by my noble friend Lord Borrie in relation to the figure of 25 has been answered on a number of occasions. That figure has been proposed because the purpose of this Bill, which I am also pleased to regard as a modest little Bill which is a tidying-up operation rather than a massive piece of social legislation, is to bring the law as it relates to sex discrimination into line with that of race relations legislation. The figure of 25 as a threshold appears in Section 25(1) of the Race Relations Act 1976.

I turn to the question raised by the noble Lord, Lord Henley, who referred to single sex clubs and the drafting of Section 29B. I am happy to give an assurance that we shall look at the drafting of that, and if I have the help of the noble Lord, Lord Lester, in doing so, that will be of immense assistance. I am willing to accept that the drafting may not be perfect and can certainly be improved at a later stage to make the intentions of the Bill absolutely clear.

The main question asked by my noble friend Lord Borrie, which he also asked at Second Reading, was: is it really necessary to have the Bill at all? I believe that one needs to go no further than to look at the report of the Equal Opportunities Commission, Equality in the 21st Century—A new sex equality law for Britain. In that report the commission says that the evidence available to the EOC indicates very little voluntary change in the sector. It also states that complaints reinforce the view that the exclusion of such clubs results in a variety of discriminatory rules and arrangements which seek to perpetuate stereotypical images of men and women and which limit women's participation in club activities in a number of ways. A number of speakers—in particular, the noble Baroness, Lady Thomas of Walliswood—referred to the evidence that the EOC has gathered in relation to golf clubs. There is much more that can be said about that along much the same lines.

The one area of private clubs which has not been addressed in the debate but where the need for change is probably greater than in any other is working men's clubs. I suppose that that is the third leg of the Bill. It is here that the proposal to raise the threshold from 25 to 2,000 would have, as the noble Baroness, Lady Buscombe, said, a completely wrecking effect. More than 99 per cent of the 2,700 CIU clubs have fewer than 2,000 members. Only 15 to 20 in the country have more than 2,000. The average membership of CIU clubs is approximately 900. Therefore, my noble friend's amendment would exempt virtually all the working men's clubs from the provisions of the Bill.

The lack of voluntary reform has been illustrated by the failure of working men's clubs to implement the internal reforms which the people who run the CIU—the executive and the full-time officers—have been desperately trying to push through at successive annual general meetings. They tried most recently on 6th April at their last annual general meeting. A motion to delete the infamous Rule 12(e) was tabled for the fifth time. That rule states that:

"Associate and Pass Cards may not be issued to lady members".

If that had been passed, it would have allowed the female members to enjoy the same use of facilities as guests in other clubs. For the fifth time it failed even to get a simple majority, let alone the two-thirds majority which it needed to pass under the rules of the CIU.

Another motion was put to amend Rule 12(e) to read:

"Associate and Pass Cards may only be issued to members who have full and equal rights".

Thus, women who already enjoyed full and equal rights in their own clubs would be able to obtain an associate pass card allowing them to use the facilities in other clubs which gave women full membership rights. But that motion also failed to get a majority. They even failed to pass a motion which would have changed the name of the CIU from the "Working Mens Club and Institute Union" to the "Club and Institute Union Limited".

Therefore, I believe that we have waited long enough. The noble Baroness, Lady Howe of Idlicote, talked at Second Reading and again tonight about her frustration when she was chair of the EOC and about how she expected change to take place. She was amazed that neither the law nor the clubs had changed. The truth is that they have not. Indeed, if some people have their way, some of the changes which have taken place may be reversed. A piece in the Daily Telegraph today, for example, says:

"A group of renegade traditionalists"—

I quote from the Diary piece—

"is attempting to regain control of the Oxford and Cambridge Club, with the specific aim of reversing recent 'improvements'. To this end, eight senior members are standing for election to the club's ruling committee next month".

In the article the traditionalists are quoted as saying:

"'Women were allowed in here five years ago and standards have been slipping ever since', chunters one moustache. 'Not only do these new female members wander round the place in trouser suits, chatting on mobile telephones, but the committee has also seen fit to revamp the club with non-gender-specific furniture. As a result, the bar looks like a Holiday Inn"',

and so forth.

It is time that the law was changed. I shall happily listen to suggestions for change at later stages, but in the mean time I hope that my noble friend will withdraw his amendment.

Before the noble Lord, Lord Borrie, responds to the noble Lord. Lord Faulkner, perhaps I may make a point in response to that made by the noble Lord. Lord Lester. The noble Lord, Lord Lester, implied that I— and, for that matter the noble Lord. Lord Borrie—was interested only in the clubs in St James's and was not interested in working men's clubs. I was pleased to hear from the noble Lord that the amendment, should it be passed, will also assist all working men's clubs.

I made clear in my remarks that I was speaking not just for the clubs of which I am a member but for golf clubs, working men's clubs and all clubs. It is a point of principle that those clubs must decide what they should do and how they should govern their business and not be told to do so by the noble Lord, Lord Faulkner or, for that matter, the noble Lord, Lord Lester of Herne Hill.

Before the noble Lord, Lord Henley, sits down, I wonder whether he is aware that the CIU, the union of working men's clubs throughout the country, was, in the end, made to abolish the outright colour bar that it had only because of the Race Relations Act 1976. Does he not agree that that indicates how hopeless it is to think of voluntarism in that area?

I believe that race and sex are completely different matters. As regards the voluntary approach, I also believe that this is something that is likely to happen both to working men's clubs and to St James's clubs in due course. I made clear that when I was a member of the Carlton Club I voted for women members. I believe that it is likely that that will happen in due course to a great many other clubs. The noble Lord has only to go into some of them—I could take him—to see how dead some of them are in the evening; whereas the club of which I am a member, which allows women in the evening, is busy and full. The economic forces are beginning to have an effect.

My understanding is that much the same is happening with a great many working men's clubs. This is a matter which is far better left to gradual processes, rather than to interfering busy-bodies in Parliament or wherever else, trying to promote their own views about what is right or wrong.

I must come back on the last point made by the noble Lord, Lord Henley. The official view of the CIU is that it wants this legislation to pass. The general secretary was happy for me to quote at Second Reading:

"The union's National Executive firmly believes that the future of clubs in our organisation is tied up with giving women full equality".—[Official Report, 13/3/02; col.917.]

It has tried five times to get it through at annual general meetings and has failed hopelessly each time. As the noble Lord, Lord Lester, said, the same sort of resistance to removing race discrimination in those clubs had to be removed by legislation after 1976.

That might be the official view of the governing body of the CIU. I am talking about the individual clubs. I believe that it is a matter for the clubs to decide on their own future and on how they should operate. It will happen in due course, but let them do it without the noble Lord forcing them to do it.

The noble Lord, Lord Faulkner, has prayed in aid the Race Relations Act 1976, as did the noble Lord, Lord Lester. I wonder whether he is aware that the Conservative Party totally opposed the inclusion of clubs in the scope of the 1976 legislation. Indeed, Clause 25 was thrown out by this House—I have the Division List in front of me—as the noble Lord, Lord Denham, would be able to testify if he were still in his place, as he was a teller in that Division. It was reinstated in the House of Commons, but once again against the wishes of the entire Conservative Party. I thought that I should mention that as a matter of historical record.

It is also a matter of historical record that the Conservative Party was in power for 18 years after 1979 when presumably it had endless opportunities to take the provision of the private clubs out of the Act and did not do so.

I express my thanks to all those who have taken part in a debate which has lasted several times as long as I thought it would or perhaps should. Perhaps I may be forgiven for saying that some noble Lords were making Second Reading speeches. However, that was justified by their not having been present at Second Reading.

I am particularly grateful to the noble Lords, Lord Monson and Lord Dahrendorf, for addressing points which others did not concerning the key concept of freedom of association and how far down the line to the very small and medium-sized clubs a new law of this kind should intervene. My noble friend Lord Faulkner has given no indication of an answer to filling the gap between the number 25 and the number 2,000 beyond telling me what I naturally knew; that is, where the number 25 emanated from in the legislation. He has not given any indication that the number 25 could be 250, 500 or whatever. I found that to be an unsatisfactory aspect of the answer given by my noble friend and the Minister. If the Government and the proposer of the Bill intend rigidly to insist that every private association of 24 or more members is to be told how to deal with different classes of membership and so on, then I feel that I must take the matter further at a later stage of the Bill. Clearly, I shall not do that today as no one has been pre-warned. I am happy now to withdraw the amendment.

Amendment, by leave, withdrawn.

moved Amendment No. 2:

My Lords, I support the amendment of the noble Lord, Lord Borrie, to which I have put my name. As I said earlier, I am a member of two clubs. One of those clubs is for men only. Women never come in at all. It would not be affected by this legislation. The other club—Brooks's—is also a men only club but lets in guests on different bases according to gender, as we now must put it. In other words, I can bring in a male guest for luncheon, but in the evening I can bring in men and women. Men and women are therefore treated differently.

Under subsection (4) that would become illegal unless the exceptions in new Section 29B exclude Brooks's. I am unsure as to whether that is the case or whether it excludes working men's clubs, golf clubs and so on. Perhaps the promoter of the Bill can advise me on that in due course.

I make a simple practical point. Earlier I said that I thought that it was likely that a great many clubs—working men's clubs and so on—over the years would gradually move and become mixed in all senses. I think that at Second Reading someone gave the example of the Reform Club. That is now totally mixed. But for a time after it went mixed it reserved one small room for the old reactionaries who had given away much in allowing women in, just so that they could feel at home for a while. After a while it was discovered that that was no longer necessary. If this measure is introduced it would be much harder for any club to take that gradualist approach. Certainly, a club such as Brooks's would have to consider very long and hard as to what it should do. It might be that it and, for that matter, any golf club or working men's club, might want to go in a backward direction, as the noble Lord, Lord Faulkner, and the noble Lord, Lord Lester of Herne Hill, would put it, and exclude women as guests entirely. For that reason I suspect that subsection (4) would do absolutely nothing to promote the purposes of this Bill.

Therefore, it is really in a spirit of being helpful, I suspect, that the noble Lord, Lord Borrie, and myself are promoting this amendment. We shall certainly be very interested to hear what the noble Lord, Lord Faulkner, has to say about it.

I had not intended to take part in this part of the debate having spoken earlier. However, as the noble Lord, Lord Borrie, has quoted what I said at Second Reading, I should like to take a moment of the Committee's time. The noble Lord is quite right in that I did say that I could have an affection for or an interest in being a member of a club which admitted women only. There is nothing in the Bill which prevents such a club existing. However, if guests are brought into the club, they should be treated the same whether they are men or women. That is all that is provided for in the clause which the noble Lord, Lord Borrie, is attempting to change. It does not provide that they have necessarily to use the same bar as the members, but if they use a different bar, then they should all do so. It should not be divided by the sex of the guest as it can be at the present time.

I had not intended to speak to this amendment until I heard the speeches of the noble Lords, Lord Borrie and Lord Henley. I agree with the noble Lord, Lord Henley, that there is a problem in the drafting of new Section 29B. I have already said that as has the noble Baroness, Lady Buscombe. The problem is that it does not clearly state that Brooks's, the Garrick or another single-sex club is outside of the scope of new Section 29A as regards discrimination against applicants for membership or existing members. It needs to do that; otherwise the Bill will not achieve its objective properly.

The noble Lord, Lord Henley, made the perfectly fair point that if we are right in saying that new Section 29B is intended to leave out Brooks's then on its face it seems illogical that Brooks's is caught by new Section 29A(4) in relation to guests. The promoters of the Bill need to make it quite clear, as I believe is the intention, that it does cover guests but it does not cover applicants for membership or existing members if it is an exclusive single-sex club.

I do not say this with any irony or sarcasm at all— I am speaking perfectly straight—as regards the argument as to how to encourage the members of Brooks's to move forward to admit women as members. The old members of my chambers gradually got used to the idea of women being members on equal terms. We now have a woman as head of chambers and the practice manager is a woman. The majority of the outstanding members of my chambers are probably women. It took time, but we found that the presence of able women transformed the attitude even of the older generation. So it may be that when women are admitted to Brooks's as guests on equal terms with men in a club which I much enjoy visiting, it will convince the old and young codgers of the club that it is less terrifying to their traditional practices to admit them as members. That is not what this Bill is designed to do. It is not designed to be coercive in that respect. Therefore, while agreeing that we shall have to look at the drafting at Report stage, we would be opposed to the amendment as it stands.

Following the remarks just made by the noble Lord, Lord Lester of Herne Hill, I am now even more confused. Is the noble Lord saying that a club such as Brooks's would be bound by subsection (4) of new Section 29A, and that we would have to treat our guests in the same way? That is what I object to doing. Is it possible that Brooks's would then have to think about giving up lady guests altogether. I do not believe that that would be a step forward.

I am saying that that is what the Bill should do; but, at present, it does not do so because it has not been aptly drafted in that respect.

I hope that I shall be able to make a short comment on the amendment. I endorse what has been said about the drafting. Indeed, I associated myself with the comments made in relation to the previous amendment, and I do so again. The drafting is not entirely fortuitous. I hope that we shall be able to cure those difficulties by the time that we return to the matter on Report.

If such legislation is to cover the treatment of members and associate members of mixed sex clubs, the Government see no reason why guests should not also be covered by the Bill. Therefore, we do not support the amendment proposed in the name of my noble friend Lord Borrie, and that of the noble Lord, Lord Henley. However, we are of the view that this amendment will need some very careful crafting.

I believe that I can give my noble friend Lord Borrie some comfort in relation to the drafting of the amendment. However, I do not think that I can give much comfort to the noble Lord, Lord Henley. If the noble Lord is saying that he objects to any club being told that it has to treat guests alike, I am afraid that he and I will have to differ on that issue. Part of the aim of the legislation is to encourage clubs to behave in a civilised way towards everyone. It does not make any difference whether it is men or women, or, indeed, to which race people belong.

The Bill is a civilising measure designed to ensure that clubs should not discriminate against people simply because of their gender. It is certainly my intention that the legislation should clearly state that if people are guests in a single sex club they should be treated similarly. As I said in response to the earlier amendment, I shall be very happy to take away the drafting of new Section 29B in order to make that absolutely clear.

The difficulty with my noble friend Lord Borrie is that we are both at odds on whether or not the legislation is either necessary or desirable. I have no doubt that it is. I am pleased to have received support from my noble friend the Minister, who clearly also wants to see this Bill pass through the House. None the less, I hope that my noble friend will withdraw the amendment, because we shall return to the matter on Report.

Despite the helpful remarks of my noble friend the Minister, I fear that the remarks of my noble friend Lord Faulkner may result in the Bill being more restrictive when redrafted than it is now. Indeed, it may get at single sex clubs at least as regards the way in which they treat their guests. If that is so, it will be an inhibiting factor that may lead one to be more concerned about the Bill on Report than is the case at present. However, for the time being, I am happy to withdraw my amendment.

Amendment, by leave, withdrawn.

moved Amendment No. 3:

I agree with the noble Lord, Lord Borrie, that the drafting is defective. I think that the draftsman has borrowed from a provision in the Race Relations Act 1976 that was designed to allow clubs that did not practise a colour bar but promoted, for example, the interests of Bangladeshi elderly people—an old people's home, or something of that kind, a proper and benign ethnic purpose connected with social, welfare or educational purposes—not to be made unlawful. Unfortunately, using such a definition in the clause will expose the Garrick Club to the risk of litigation on precisely the basis that the noble Lord set out.

Indeed, when I was a member of the Garrick Club, it occurred to me when reading the Act that one could have brought a court case to say that, under the rules—the contract of membership—women should be admitted because the rules are not phrased in a way that states that it is an exclusive male club. That is perfectly right.

I suggest that the way to deal with the matter is to clarify on Report exactly what should be the definition—for example, considering Section 34 of the Sex Discrimination Act 1975, which exempts voluntary bodies in a much clearer way—and then to deal separately with the vexed question of guests. In other words, I agree with the noble Lord, Lord Borrie, that the Garrick and Brooks's need to be absolutely clear that as regards applicants for members and members they are outside the scope of the Bill. We can then have a no doubt lively debate about guests, but if I may say so, I do not think that it would be right to press the amendment today, as it will not clarify in the way that is needed the right test to be used.

The noble Lord, Lord Lester, is right when he says that the language has been borrowed from the Race Relations Act 1976. One can see the attraction of doing so to the extent that that uses tried and tested wording that is generally understood. But we would certainly interpret the Bill to include the "essential character" element. That would accurately provide a rubric into which single-sex clubs would fall. We consider that that matter could be clarified in the drafting. However, there is some attraction in retaining the phrases "main object" and "essential character" because of the way in which they have been identified in the past 30-plus years. They are terms of art that are well understood, in a legal framework.

I need not detain the Committee long. I agree with the noble Lord, Lord Lester of Herne Hill, that the matter can be best sorted out with some skilful drafting before Report. In the circumstances, I hope that my noble friend will agree to withdraw the amendment.

I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

moved Amendment No. 3A:

We support Amendments Nos. 3A and 5 in principle and look forward to the amendment of the noble Lord's amendments.

We too support the amendments in principle but look forward to the perfected versions that will, in due course, be submitted.

I am also happy to accept in principle what the noble Lord seeks to achieve through the amendments. I can reassure him that my faith in his infallibility has not been shaken by the minor drafting errors. The amendments are helpful, and they will improve the Bill. We look forward to considering them properly on Report.

I thank noble Lords for not making me blush more than I am. I say to the noble Lord, Lord Faulkner, that the definition of a liberal is someone who recognises human fallibility. Therefore, he is always aware that the spirit of liberty is the spirit that is not too sure that it is right. I am not at all sure that I am right and, therefore, I shall try and do better the second time. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

moved Amendment No. 4:

It is a great pleasure to follow the noble Baroness, Lady Buscombe. I agree with her amendment entirely, but I would like to take the opportunity, since she has read out Section 44, to say how unfair I find it as an extremely had golfer. The average male golfer is meant to be able to drive a golf ball further than the average female golfer. Unfortunately, I find myself playing with extremely able female golfers who seem to be teeing off 100 yards nearer the hole than I am able to. I find it very hard even to reach the female tee, still less to get beyond it.

I remember that when Chief Justice Taft who, while President of the United States, made the mistake himself of being about to tee off from the ladies' tee, the captain of the club came up to him and said, "Mr President, you realise that you are not allowed to play off that tee?". The President turned and said, "It is my second shot". I find it a great handicap and I wish that equality would enable me to beat women golfers. However, I am afraid that on any terms I am unable to. I fully support the amendment.

The Government, too, would support the amendment. This is an area in which the Sex Discrimination Act has always recognised that the differences of treatment may be justified. The existing Section 44 of the Act therefore permits single-sex competitions in circumstances where men would enjoy an advantage as a result of their physical strength, stamina or physique. I say that irrespective of the beguiling statement made by the noble Lord, Lord Lester. I am sure that with greater application he, too, will reach the goal to which he strives.

This is the last amendment that we shall debate today and I want to take the opportunity of thanking the noble Baroness, Lady Buscombe, for the support she has given to the Bill not only today but on Second Reading. It cannot have been easy for her given the views which may exist behind her on her Benches, but her support is very much appreciated by me and by other supporters of the Bill.

The provision which she seeks to delete was originally included in order to meet the objections of the promoters of larger sporting events while at the same time securing some elements of equality in smaller club competitions, which were defined as those with prize money below £1,000. In view of the fact that it is a complicated area and, is perhaps outside the mainstream of what we seek to do in the rest of the Bill. I am happy to accept the amendment that the noble Baroness has moved.

Before my noble friend responds, and as the noble Lord, Lord Faulkner, made reference to what I take it was a reactionary element behind my noble friend, perhaps I may make one or two comments. I am completely and utterly confused about the purpose of new Section 29C. Furthermore, as the noble Lord, the Government and the noble Lord, Lord Lester of Herne Hill, so glibly accept its removal, I fail to understand why the noble Lord included it at all.

However, having listened to the wise words of all Members who said that it obviously must be removed, I would like to read carefully what has been said by my noble friend and by the noble Lords, Lord Lester and Lord Faulkner. I may return to the matter at a later stage. I accept that the noble Lord will allow the provision to be removed at this stage, but if I find further problems I reserve the right to table an amendment at a later stage should that be necessary.

I hear what my noble friend Lord Henley says. That said, I have heard the opinions of other Members of the Committee. Given the overwhelming support for the amendment I have decided to move quickly and test the opinion of the Committee.

On Question, amendment agreed to.