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Baroness Gardner of Parkes: My Lords, can the Minister tell us what proportion of that deficit will be for the London area alone? Is it much worse off than other parts of the country? In view of the fact that no government are able to adequately fund the National Health Service, is it not time to look at new ways of doing so?

Lord Hunt of Kings Heath: My Lords, London has a number of trusts which are facing financial pressures. We are working closely with them to ensure that they take the action that is necessary. In relation to alternative systems of funding, I am not persuaded by the arguments. The system that has been in place since 1948 has served the NHS well. We have the most cost-effective healthcare system in the world. We have shown, by the additional resources that we have

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invested in the service, that we can sustain the NHS, make it fit for the future and have one of the best and most modern health services in the world.

Earl Howe: My Lords, is it not the case that the much publicised new money that the Government announced for the NHS will be largely swallowed up over the coming two years by cost pressures that cannot be avoided? Will the Minister confirm, for example, that additional pension contributions alone are set to absorb an extra £650 million over that period? That is on top of the huge costs arising from new legislation such as the EU working time directive.

Lord Hunt of Kings Heath: My Lords, there are elements which come into the budgets of the health service every year; for example, pensions, pay, the working time directive or indeed the rising cost of generic drugs. That is part of the life of the National Health Service. With a three-year Comprehensive Spending Review, it is not always possible to estimate exactly potential increases in budget. However, within the resources that we have made available, I am confident that we have the capacity both to meet those unexpected pressures and to introduce significant improvements in services.

The Countess of Mar: My Lords, can the Minister say whether awards for damages against NHS hospitals come into that total budget? If they do, can the noble Lord say how much such awards amounted to during the past year and tell us what Her Majesty's Government are doing to address the problem?

Lord Hunt of Kings Heath: My Lords, the noble Countess is certainly right to refer to important and, I think, worrying trends in relation to clinical negligence awards. Within the deficit figure that I mentioned there is certainly provision for the potential future cost of litigation which has been started. The latest figures that I have show that in the 1997-98 summarised accounts for the NHS costs charged to expenditure for clinical negligence amounted to £144 million.

This is a matter of great concern. We have to be very careful in terms of avoiding defensive medicine. We also believe that the more effective clinical governance that we are introducing and the development of evidence-based medicine, will, over time, enable us to tackle these issues.

Lord Pilkington of Oxenford: My Lords, in the allocation of resources, can the Minister say whether he has given attention to the appalling situation of the elderly in many of the hospitals, as has been revealed in recent press reports?

Lord Hunt of Kings Heath: My Lords, we are very concerned to ensure that older people being cared for in the NHS receive a first-class quality service. My honourable friend, Mr John Hutton, has made it clear that the Commission for Health Improvement will, as a priority, focus on services for older people in its first inspection round. We are establishing a national

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service framework on services for older people which will start work next year. It will focus on the very issues raised by the noble Lord.

The Salisbury Convention

2.52 p.m.

Lord Campbell of Alloway asked Her Majesty's Government:

    Whether they favour retention of the Salisbury convention when Her Majesty's Opposition have no voting majority in either House of Parliament.

The Lord Privy Seal (Baroness Jay of Paddington): Yes, my Lords. I am sure the noble Lord is aware that the Salisbury/Addison convention has nothing to do with the strength of the parties in either House of Parliament and everything to do with the relationship between the two Houses. The other House--and, with it, the Government--is elected on a universal franchise and, pace the noble Earl, Lord Onslow, who I am sorry to see is not in his place, no one in this House is elected on that basis. In those circumstances, it must remain the case that it would be constitutionally wrong, when the country has expressed its view, for this House to oppose proposals that have been definitely put before the electorate.

Lord Campbell of Alloway: My Lords, I thank the noble Baroness the Leader of the House for her reply and, indeed, for taking the Question. However, as a matter of principle and leaving aside Wakeham, if we may, for one moment, perhaps I may ask the following question. If the circumstances in which this convention was introduced and implemented no longer exist, can the noble Baroness say whether retention can be justified without further examination? Further, and in this context, can the noble Baroness say whether it is really requisite for the House to determine a self-denying ordinance to replace it? Is it not a matter for the House as master of its own procedures?

Baroness Jay of Paddington: My Lords, if I understand precisely what the noble Lord is saying, he is asking on what principle the Salisbury/Addison convention was established in 1945. Perhaps I may quote directly from the then Lord Cranborne who, in proposing this, said that,


    "we should frankly recognise that these proposals"--

those contained in the election manifesto of the Labour Party at that time--


    "were put before the country at the recent General Election and that the people of this country, with full knowledge of these proposals, returned a Labour Party to power. The Government may, therefore, I think, fairly claim that they have a mandate to introduce these proposals".--[Official Report, 16/8/1945; col. 47.]

I am not sure where the noble Lord sees a difference of principle between that situation, which was enunciated and has formed the basis for the Salisbury/Addison convention ever since, and the situation in which we now find ourselves.

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The noble Lord asked me to ignore the noble Lord, Lord Wakeham, and his Royal Commission, but he will be aware that the Government very precisely put in the commission's terms of reference the need to maintain the position of the House of Commons as the pre-eminent Chamber of Parliament. Having reread the recent constitutional lecture given by the noble Lord, Lord Strathclyde, on this subject, I believe he re-affirmed that point.

Lord Strathclyde: My Lords, the noble Baroness the Leader of the House is very kind to say that she has reread my speech to the think-tank Politeia. I hope that she enjoyed it. However, is it not the case that in 1945 this House was entirely hereditary? There were no life Peers at all and very few Labour Peers. That justified the reason for the creation of what we now know as the Salisbury convention.

The noble Baroness has said that this House has changed, that there is a new dynamic, and that the House has a new authority. Therefore, does she agree with the view that I expressed in my speech--the Tory Party's view--that the time has come to re-examine the Salisbury convention and for discussion to take place before a new agreement can be reached between the parties?

Given the noble Baroness's initial Answer, could she possibly write to me--unless, of course, she has the answer to hand now--with a list of the manifesto commitments that she believes bind the House and this Parliament?

Baroness Jay of Paddington: Yes, my Lords. I shall be delighted to send the noble Lord a copy of the manifesto, which may answer his question very simply. I shall not burden the House by trying from my inadequate memory to rehearse it to him this afternoon. However, perhaps I may remind the noble Lord that he also said in this well-known lecture, which bears more than one rereading, that we should be, in his very felicitous expression, "less grim-jawed" about the Salisbury convention. Frankly, I never regard the noble Lord as being grim-jawed at all, but, when speaking about the changing circumstances--and it is a delight to be able to quote him so extensively--he went on to say:


    "The House of Lords is not suddenly going to change all that"--

that is to say, the Salisbury/Addison agreement--


    "It will always accept the primacy of the elected House. It will always accept that the Queen's Government must be carried on".

Lord Lipsey: My Lords, does my noble friend the Leader of the House agree that the day that this House starts conducting a systematic, frontal attack on the legislative proposals of the elected government, that day this House will be signing its death warrant?

Baroness Jay of Paddington: My Lords, my noble friend puts it in a very exact form and one which I would hesitate to underline in public. However, if

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noble Lords were to trespass very broadly on these understandings and conventions, it is very clear that it would indeed change the dynamic of future reform.


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