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Baroness Symons of Vernham Dean: My Lords, I do not believe that I gave that impression. I have gone out of my way to preface virtually everything that I have said with phrases such as, "in the event of war" and "we hope that war will be avoided". A moment or two ago, I stressed again that we all hoped that there would be peace. I referred to the noble Lord, Lord Wallace of Saltaire, because he made a passionate point to noble Lords and I was responding to him in debate. It seems entirely reasonable to do so. The noble Lord said that I should deny his suggestion; I do deny it, but I do so because that is true.

The noble Lord referred to the use of an unreasonable veto. We are negotiating now. There could be no more crucial time in our international relations—certainly not in my experience, as a Minister of nearly six years' standing in your Lordships' House. We maximise our chances of success, which I, as a Government Minister, wish to see, by wishing our negotiators well and not by trying to predict failure of individual parts of this negotiation. I will stick with my colleagues; that is the right thing to do and that is my responsibility. It may not satisfy the noble Lord, but my answer to him is that my approach is far more likely to help to deliver the answer that I believe all noble Lords want.

The Earl of Onslow: My Lords—

Baroness Dean of Thornton-le-Fylde: My Lords—

Lord McIntosh of Haringey: My Lords, I said that the noble Earl, Lord Onslow, would speak next, followed by the noble Baroness, Lady Dean of Thornton-le-Fylde.

The Earl of Onslow: My Lords, the noble Baroness, Lady Dean, should speak first and I shall speak after her.

Baroness Dean of Thornton-le-Fylde: My Lords, my mother often said that gentlemen are born, not made.

As the noble Lord, Lord Howell of Guildford, said, we live in dangerous times. We all want to see the United Nations come through this dire situation intact for the future. On no fewer than three occasions during her responses, the Minister spoke of negotiations taking place on the second resolution. I wholly agree with and support that. If what the newspapers say is true, I gather that the noble Baroness, Lady Amos, is, as we speak, on her second visit to Africa as part of such a negotiation process. Therefore, does the Minister agree with me that it was most injudicious, possibly even reckless, for a Minister in the Department for International Development to undertake such a trip in the knowledge that the Secretary of State for International Development has said that she would resign if a second resolution were not signed? Surely that takes away some legitimacy,

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integrity and ability of the noble Baroness, Lady Amos, to negotiate a peaceful solution to this dreadful situation. We all know that Hussein will not back down until we are knocking on his door.

Baroness Symons of Vernham Dean: My Lords, I agree with my noble friend Lady Dean that this is a dangerous time and that negotiations on a second resolution are at a crucial stage. I am sure that the whole House joins me in wishing my noble friend Lady Amos Godspeed in her discussions with colleagues in three African countries. She has great experience in Africa; she has good relationships with those in Africa; and I believe that she will be able to talk to people in terms of partnership based on experience and on her relationships. I do not believe, as I have read in some newspapers, that she will try to induce support through unwarranted pressure. I am sure that my noble friend will make an excellent case to those to whom she speaks.

I am sure that my noble friend, Lady Dean, will understand if I say that I do not wish to add to the column inches on discussions on her second point. However, I agree with everything that she said about unity of purpose at this difficult time.

The Earl of Onslow: My Lords, does the Minister agree that there would be catastrophic effects on the future peaceful behaviour of the world if America were forced to back down by an unholy alliance, a French self-seeking movement? For the French Foreign Minister, whose views on Napoleon are, "What a pity he did not succeed at Waterloo", to be giving lectures to the rest of the world on American behaviour strikes some of us francophiles as rather unpleasant. The consequences of the Americans being forced to back down will mean allowing a man to get away with starving babies to death, letting them wither at the breasts of their mothers and then shooting their mothers—that is Ann Clwyd speaking, not me. I am also reminded of the speech made by the noble Baroness, Lady Nicholson, on the Marsh Arabs. Those messages should be brought home to the French and the Russians time and time again. The consequences of doing nothing are far worse than the consequences of doing something.

Baroness Symons of Vernham Dean: My Lords, I believe that we are at a serious juncture, not just in terms of what is happening in relation to Iraq, but also in terms of the future health of international relations, as the noble Earl said. It is a crucial, difficult time. I have not read the French Foreign Minister on Napoleon, although from previous discussions with the noble Earl I know that he has—I believe he may have learned it off by heart. That makes the position of my right honourable friend on the United Nations Security Council last Friday so important; it was important for him to answer the points raised so forcefully by Mr de Villepin. He did so clearly in his excellent speech, a copy of which is in your Lordships' Library. I commend it to your Lordships.

Lord Chalfont: My Lords, does the Minister agree that in some of the comments made about the

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problem, far too much emphasis is placed on the present, dangerous and real as those dangers may be, and not enough emphasis is placed on the future? As the noble Lord, Lord Howell of Guildford, said, surely we shall be faced with a grave danger in the future if weapons of mass destruction, which we now know to be in the possession of Saddam Hussein, come together with international religious fanaticism, making the world a hideously more dangerous place than it is now. Then it will be too late to do anything about it. Is the Minister aware that despite some of the demonstrations and other protestations that have been made about the policies of the Prime Minister, many people closer to the matter believe that the Prime Minister is behaving with great intellectual clarity and great political courage?

Baroness Symons of Vernham Dean: My Lords, I thank the noble Lord, Lord Chalfont, for those closing remarks. The noble Lord is concerned that there is too much emphasis on the present. There is bound to be such an emphasis at the moment because we are facing a situation in which Saddam Hussein has to decide whether he will disarm his weapons of mass destruction peacefully or whether he will force a military conflict on the rest of us.

Of course, there are concerns about the spread of weapons of mass destruction and fanaticism, as the noble Lord characterised it, or the terrorism spoken of in other parts of your Lordships' House. The great worry must be about weapons of mass destruction slipping into the hands of groups who have allied themselves with the destruction of the United States or with attacks upon the United States and this country. Those issues are important. I also believe that an enormously important issue is the future of Iraq, as the noble Lord, Lord Howell of Guildford, mentioned. The integrity of the state of Iraq, its future stability, the immediate humanitarian needs of the country and the longer-term reconstruction are all matters that my right honourable friend has discussed not only in New York last week, but also, as one would expect, in contingency planning, as we discussed in our debate on Iraq about 10 days ago. They are important issues for the future.

Community Care (Delayed Discharges etc.) Bill

5.29 p.m.

Consideration of amendments on Report resumed.

Baroness Barker moved Amendment No. 4:

    Page 2, line 10, at end insert—

"( ) a patient has limited mental capacity, a procedure exists to appoint an independent advocate."

The noble Baroness said: My Lords, we now make the transition from important international matters to rather more mundane domestic matters. Nevertheless,

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I believe that we return to an issue that is important and which deserves the fair consideration of this House.

With Amendment No. 4 we turn to an issue that was debated, although not to any great extent, during Committee stage—mental incapacity. Frequently, noble Lords make the point that in this country we do not have comprehensive legislation about the care of people who have reduced mental capacity—legislation that would enable a health or welfare attorney to be involved in decision-making when people are mentally frail and cannot take decisions for themselves.

Amendment No. 4 attempts to ensure that people who lack the capacity to make an informed decision are not just automatically referred to social services. Currently, there is a gap in the legal definitions of "capacity" and "protection". This is one of many instances where we address that gap. At present if a patient is unable to give consent—and I am very glad that the House took the decision that consent was required—relatives can be consulted, but no one can consent on the patient's behalf to such a referral. It is good practice to consult with relatives and carers about their knowledge of what a patient might want.

The amendment allows for existing statutory procedures for advocacy and surrogate decision-making to be brought into the framework of discharge planning. As we have said previously, fines will make a significant change to the context in which decisions about discharge take place. We on these Benches are concerned that the most vulnerable people in our society do not become—in the words of many noble Lords—"commodities".

Most patients and many carers do not realise that if they disagree with a decision they have the right to request a panel review, in particular, when the decision is that they no longer require NHS continuing care and that their discharge will be "safe". We debated the matter in Committee. Ministers talked about the issue being addressed by guidance and by common law pre-suppositions. However, the majority of good practice issued by the Department of Health is general guidance, which is not issued under Section 7 of the Local Authority Social Services Act 1970. There is no specific provision in the National Health Service Act 1977 which clarifies the status of such guidance.

As regards the issue of consent, in Committee, the noble Baroness, Lady Andrews, said that informed consent is a legal doctrine that has been developed by the courts over a number of years, particularly in the context of medical experimentation. It is hard to see how it applies to the situation of delayed discharges and the patient's onward journey into further care. It is therefore important to remember, as the noble Baroness said, that the NHS does not have the right to force services on to a patient. That is correct in so far as surrogate decisions can be made when a patient lacks the required mental capacity.

We all know in this country that there is a growing incidence of dementia, in particular of Alzheimer's disease. It is important that those people are subject to specific protection when the complex issue of

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discharge and future care is being considered. That is important because the Alzheimer's Disease Society has reported incidents of patients being discharged from hospital having suffered a lack of personal care.

The Alzheimer's Disease Society's report of, I believe, two years ago, cited incidents of people with Alzheimer's leaving hospital malnourished. It was not that they had not been given food, but they had not been fed. The food would be brought and left at the end of their beds. It would be assumed that because they had not touched it they did not want it. They did not touch it because they did not know it was there and what it was. That occurrence is not widespread but is on the increase. In that context it is important that we should consider having a requirement for an advocate for someone who does not have the mental capacity to make the informed choices that they would otherwise make. For those reasons, I beg to move the amendment.

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