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Lord Campbell of Alloway: My Lords, before the Minister sits down, may I ask whether his threat to have resort to the Parliament Acts means that this Government are not ready to entertain any reasonable argument?

Lord Bassam of Brighton: My Lords, our Government are always happy to entertain reasonable argument.

3.33 p.m.

Earl Howe: My Lords, today, as the Minister said, we shall be concentrating our gaze on health issues and on home affairs. In the process we shall have the pleasure of listening to no fewer than seven distinguished maiden speakers. The gracious Speech

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brought us, as is customary, a mixed plateful of the reasonably edible and barely digestible. And taken together, it is a giant helping. Whereas the legislative programme emanating from the Department of Health is on the light side, at least in comparison with last year, the same certainly cannot be said for the Home Office programme. Indeed, it is difficult not to be pole-axed by the sheer weight and number of Bills in the gracious Speech that fall under that department's aegis, many of them, I have to say, covering controversial and sensitive policy areas.

I do not intend to dwell too long on the difficulties that we on these Benches face in approaching some of these proposed measures. However, let me point out one very disappointing feature of them. At a time when many areas of the country are witnessing, for the first time in years, a rise in the levels of serious crime, there is practically nothing in the gracious Speech designed either to combat crime or to tackle the causes of offending. The Government's flagship measures to tackle crime, such as local child curfews, and antisocial behaviour orders, have made absolutely no impact whatever.

Instead of fresh ideas on ways to tackle crime, we have, in the Criminal Justice (Mode of Trial) Bill, an attack on one of the fundamental rights of the citizen. That Bill proposes to bring to an end the right of a defendant to elect for trial by a jury in the Crown Court for offences that may currently be tried "either way".

To justify such a measure by the financial savings it will lead to, and by the reduction in inconvenience that it will bring, is to belittle two principles that we have upheld in this country for many years: first, that jury trial offers a better model of justice than any other; and, secondly, that a defendant accused of more than just a trivial offence should be able to choose to be dealt with by a jury.

In February 1997, it was argued in another place:

    "Surely cutting down the right to jury trial, making the system less fair, is not only wrong, but short-sighted, and likely to prove ineffective".--[Official Report, Commons, 27/2/97; col. 433.]

Those were the words of none other than the present Home Secretary, Mr Straw. I shall find it interesting to see how the right honourable gentleman attempts to resile from that very clear statement of principle uttered less than three years ago.

When a proposal on exactly the same lines was discussed in 1993, a letter appeared in The Times which included these words:

    "This would be madness. I hope that Parliament will refuse to countenance legislation of this kind".

Those are the words of none other than our much respected Attorney-General, the noble and learned Lord, Lord Williams of Mostyn. I hope that we shall hear from the noble and learned Lord whether he has had cause to revise the views that he articulated so forcefully some six years ago and, if so, why that is.

I give notice to the Government that we shall be opposing this Bill, not just on principle but because we believe that the pragmatic arguments purporting to underpin it are unsound. We shall also be pointing up

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what we see as serious flaws in the freedom of information Bill, which is so drafted as to make more information secret than is the case at the moment. In the race relations Bill which implements the recommendations of the Macpherson inquiry, we shall seek to ensure that nothing in that measure has an adverse impact on the operational effectiveness of the police. While we welcome the long-awaited implementation of the Neill report, one of our aims when that Bill comes before us, will be to ensure that fairness in the conduct of referendums is not compromised by rules that favour one case at the expense of the other.

Let me turn now to the measures announced in the gracious Speech that fall under the wing of the Secretary of State for Health. We shall await with interest the arrival of the care standards Bill. At this stage I would only say this: that regulation of healthcare and social services, wherever it is introduced, must have as its aim nothing else but the interests of each individual old person, each and every child in care and each individual patient. It should not be defended as a way of boosting the status of this or that category of service provider. It should focus on outputs not inputs. When we come to debate the regulation of the private healthcare sector, I hope that we shall keep continually in our minds the key, central aim of ensuring minimum standards of clinical care that are on a precisely equal footing with those provided by the NHS.

I welcome in principle the Government's proposal to confer a continuing responsibility on local authorities for the physical and emotional welfare of young people between 16 and 21 who leave the care system. There is an abundance of compelling evidence that young people who, for whatever reason, begin their lives in care find it difficult to adjust to independent adult life. The incidence of unemployment among such individuals and frequently their failure to attain any useful professional qualification are only half the story. Equally worrying is the number of young men and women who fall into a cycle of homelessness, drug taking and crime. It is right in principle for the Government to have recognised that there is a need to place those younger care leavers under the wing of a responsible public authority until they have reached an age where they can find their feet more securely.

If I have a concern about that Bill, it is that many social services authorities are struggling to discharge their existing obligations, never mind any further obligations. What assurances are we to be given that this additional burden will be properly resourced throughout the country?

However, while the principle of that Bill is not a matter for disagreement, I shall tell your Lordships an interesting fact about it. It is its juxtaposition with another Bill that tries to argue precisely the opposite case. For one group of children within a certain age range, the Government are saying that, by virtue of their age, there is and should be a continuing role for the state to act in loco parentis. But in the same breath, they are seeking to argue that children of precisely the

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same age need not, and should not, have the protection of the law when it comes to determining the age of homosexual consent.

The Minister may put forward all kinds of arguments in his usual skilful way to try to demonstrate that I am comparing chalk with cheese. However, in my personal and respectful view, the pass has been sold on the question of whether vulnerable young people between the ages of 16 and 18 need and deserve quasi-parental protection conferred on them by Parliament.

Lord Warner: My Lords, I am grateful to the noble Earl for giving way. Will he confirm his understanding that if the Government do not amend the age of consent for homosexual young men to 16, this country will be in breach of the European Convention on Human Rights and by reference in breach of their own Human Rights Act?

Earl Howe: My Lords, I am not in a position to confirm that before we have a chance to debate it. As the noble Lord knows, we have debated the issue on a number of occasions and that question remains decidedly open.

The sad thing about the gracious Speech is what is not included in it. Last year, many of us felt that the Health Bill--now the Health Act--represented a giant missed opportunity. It focused far too much on the structures of the NHS and not enough on the big issues that really matter: proper resourcing; improving access to specialist services; transparency in the setting of priorities; workforce planning. Instead, what we were given was a recipe for a gigantic upheaval. I said then that we owed it to all concerned, not least the patient, to try to make the reforms work successfully. But now, nearly eight months on, what do we have?

We have a health service which is reeling under the pressure of forced and rapid change. We have doctors who feel alienated by primary care groups, who feel left out of the decision-making process and who, perhaps most seriously, are having to tolerate cuts in services to patients. In a recent survey conducted by the National Association of Primary Care, 54 per cent of the 408 practices surveyed said that their primary care group was not supporting them and more than half said that they had not been consulted on major decisions affecting their future. Four out of 10 practices reported that they had lost services because of the introduction of primary care groups. Nearly six out of 10 said that they found it more difficult to help patients and that the new systems were more bureaucratic than those they had operated previously. So much for the loudly trumpeted aspiration to level up services, to bring the profession together and to jettison bureaucracy.

For the first time in its history, the NHS finds itself having to cope with cash-limited drugs budgets. This has coincided with a sudden and sharp rise in the cost of generic medicines. The result in some PCGs is budgetary mayhem. Ministers have admitted that the generic drugs crisis will cost the NHS £160 million in this financial year, or £5,200 for every GP. But what is

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their proposal to remedy this? Nothing! Their message is that health authorities have somehow just got to manage. But in GP surgeries, the squeeze is being felt. Money earmarked for the development of primary care, for premises and for management costs has been siphoned off to fill the gaping holes in the budget. Referrals are being cut. Even that much-raided pot of gold, the NHS Modernisation Fund, is being plundered yet again to pay for the overspends. Ironically, the pain is felt worst in those PCGs which have been most successful in increasing their percentage of generic prescribing--a poor reward for a lot of effort. I fear--and it is not an idle fear--that before the end of this financial year we shall see PCGs having to introduce conscious, deliberate cuts in prescribing levels.

In June last year, the Secretary of State said:

    "As now, no one will be denied the drugs they need: that is a guarantee".

Yet today, the Government are simply shrugging their shoulders. The message is the same in hospitals where the Government have refused to countenance any extra money to cope with expected winter pressures or to pay junior doctors a reasonable overtime rate for working over the millennium. The Government say that the Comprehensive Spending Review has already allowed for this. But the unmistakable signs are that many hospitals will be struggling desperately to maintain a satisfactory level of cover this winter.

Then there are the waiting lists. There is ample evidence from around the country that the Government's fixation on bringing down waiting list numbers has distorted clinical priorities. There is a major backlog of complex surgical procedures which have been postponed to rush through a disproportionate number of straightforward procedures. A pernicious system of penalties and incentives is in operation to force hospitals to do this. The sickest patients are waiting longer simply in order to make the headline figures look better.

It is of course, as we have said all along, waiting times, not the numbers on the list, that really matter. The Government are still defending the waiting list initiative, even though they have been told by just about every Royal College, by the BMA, by the RCN, by the King's Fund and others that it is a nonsense. They are even saying, as the Secretary of State said recently, that as in-patient waiting lists come down waiting times will come down, too. That claim is a self-evident non sequitur: the number of people waiting more than a year for an operation has risen since May 1997. But the Secretary of State's claim is doubly wrong when one considers what has happened to referrals. Since Labour came to office, the number of people waiting more than 13 weeks to see a consultant for the first time has risen by 230,000, or nearly 100 per cent. There is only one conclusion to draw from the Government's rhetoric: politics are being put before patients.

The Prime Minister may blame the doctors for being too conservative, but it is not the doctors who have brought about the NHS's current problems. Not only are clinical priorities being distorted by Ministers, but

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we are seeing money being directed in ways that may not bear any relation to local needs. One health authority chief executive put it like this:

    "Some GPs would rather see money spent on five extra health visitors than on treating 50 extra patients who've been waiting 18 months for plastic surgery.".

That puts into a nutshell the kinds of distortion that the Government's policies are leading to: policies that have as their root an almost irresistible urge to interfere with local and clinical autonomy.

It is time that the electorate woke up to the gap that exists between the Government's rhetoric and what people are actually experiencing in their daily lives. In doctors' surgeries, as in hospitals, as in police stations, as in the courts and in the homes of the victims of crime, the credibility gap is becoming a yawning chasm.

3.48 p.m.

Baroness Williams of Crosby : My Lords, first, I am grateful that the Leader of the House is to reply to the debate because in my remarks I intend to go wider than home affairs and health. I do so because I believe that the general issues of the Queen's Speech will be brought together at the end of today's debate.

Secondly, as was said by the noble Earl, Lord Howe, we have greatly benefited from some brilliant maiden speeches. They show that the new reformed House, in its deliberations, will bring to bear the kind of wisdom and experience which we remember from the old House at its best. We look forward to hearing from our maiden speakers again in the future.

The Queen's Speech is something of a parson's egg; that is, it is good and bad in parts. I want to refer briefly to some of the good things and some of the bad things and to say that my noble friends will be addressing more precisely specific issues relating to home affairs and health.

First, it is greatly to be welcomed that the Government are committed to removing the barriers to an enterprise society. There are proposals to modernise the laws of bankruptcy, to give greater freedom to investment trustees and to bring in a business services Bill. This Government are bringing in an e-commerce Bill and have done their very best--I congratulate them--to ensure that people from poorer families and young people in the more deprived parts of this country will have access to computers so that they too may be part of the information revolution. However, in their passionate devotion to modernisation, they have only carried their commitment so far. A truly e-state or e-country--that is, one that understands and fully appreciates the information technology revolution--must be committed to clear, open freedom of information and must recognise the problems of procuring computer advances in a sensible and co-operative way.

Throughout government, departments are stumbling over difficulties arising from the attempt to adapt themselves to the technological revolution. Had there been much more consultation, had there been a much wider willingness to involve all parties enough in

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the study of these systems, I believe we would not now be facing the near disasters seen in the Home Office and, to a lesser extent, in the Department of Trade and Industry. For the purpose of this debate, I want to underline that while we welcome the Government's new commitment to discuss laws in draft before they become committed to them--that is extremely sensible and long awaited--there really must be a complementary commitment to freedom of information that recognises the right of every individual citizen to have information of the kind that he or she seeks.

Secondly, I congratulate the Government on the steps they are taking to set up a strategic railways board. However, this country is parlously badly off in respect of public transport. Indeed, the situation in any less patient country would be regarded as a public outrage. There is wide-scale exploitation of the quasi-monopolies represented by the railways and the public utilities. For example, would it not be nice to see payment by performance in those industries rather than payment seized simply as a reward for having very little competition in the areas where they work? We, on these Benches, believe that there must be more and urgent investment in public transport, in railways, in cycleways, and in all the other ways in which people may move about. While we fully accept and support the Government's proposal for road congestion taxation, we believe that it can be introduced in a democracy only when there is adequate public transport to enable alternatives to be used.

Thirdly, I point to the huge challenge that now faces local and regional authorities. I refer, of course, to the Government's plan for a massive expansion of new housing. If that new housing is to be attractive, if it is not to intervene too far in the countryside, which is one of our great inheritances, local government must be allowed to exert initiative and imagination in the ways that the whole issue is handled. I felt a chill go through me on seeing in the gracious Speech reference to yet another reform of local government, for every reform under both governments so far has been one that takes away more discretion and power from local government.

One sees from the amazing renaissance of regional government in countries like France and Spain and the architectural achievements of cities like Barcelona, Grenoble and the area around Munich what can be done by enthusiastic and energetic local government. If there is any single criticism which to me most spells out my concern about this Government, it is the insistence on centralising in the hands of Whitehall and Westminster almost all powers in areas where local government should be free.

We see the same process again as the attempt is made to centralise regional development largely in regional development authorities, which may indeed do a good job but which in no way mobilise and harness the enthusiasm and good work of local people. Sooner or later, we have to look to the resurrection of this country not just around London but in the north of England, in the west of England, in the east of England, throughout this whole country, in order to be

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able to mobilise the forces that will bring genuine modernisation and a better quality of life in those parts of the country that even today are profoundly neglected.

The noble Lord, Lord Bassam of Brighton, said that the Government are committed to good public services. The reason we cannot support the amendment today in the name of the noble Lord, Lord Strathclyde--we will be inviting colleagues on these Benches to oppose the amendment--is that the last thing this country needs at the moment is a reduction of taxation.

Taxation has fallen in this country and it may be said properly so, but there comes a point at which the balance between public services and taxation must be struck in a way that recognises the serious impoverishment of many of our public services. I say to the noble Lord, Lord Bassam of Brighton, that I do not believe rhetorical commitments to the public service make up for what one can only be described as the relative decline in areas such as those to which the noble Earl, Lord Howe, referred in respect of health and to which I shall now briefly refer in respect of education.

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