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Lord Davies of Oldham: My Lords, the noble Lord would do well to identify these impediments, and then I might indicate how the Government are tackling
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Baroness McIntosh of Hudnall: My Lords, I declare an interest as a member of the board of the Foundation for Sport and the Arts. Is my noble friend aware that the funds that originally went into the Foundation for Sport and the Arts came from the football pools, not the lottery? However, that does not make the work of the Foundation for Sport and the Arts any less effectual, and I am sure my noble friend would agree that it does not alter the fact that funds from the lottery have made an enormous difference to sport in this country.
Lord Davies of Oldham: I am grateful to my noble friend for that correction. She has a long history with regard to these issues and has made a valuable contribution. We were aware that the initial support came from the football pools, but we all know why the National Lottery has had to supplant decreasing returns from the football pools.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): There are more doctors working in the NHS now than there have ever been in its history, and there are 49,000 junior doctors in training. Clearly, it is the job of trusts and clinical leadership to ensure that they are designing appropriate staff service rotas in accordance with the working time regulations and to ensure patient safety at all times, including cover for the inevitable gaps created by things such as annual leave, maternity leave and out-of-hours training programmes.
Baroness Finlay of Llandaff: I thank the Minister for that reply. Does she recognise the results from the BMA survey which show that four in 10 doctors in training are working in understaffed rotas? In accident and emergency that figure is worse at one in six. I declare an interest as my daughter is one of those trainees. More than half of junior doctors reported pressure to work additional, unrecorded hours. They have to toss up between working more than their regulated hours and leaving patients, and they opt to stay with their sick patients. Does she also recognise the need for those trusts that secure derogation from
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Baroness Thornton: My Lords, the survey by the BMA, which supports the implementation of the working time directive, is to be welcomed as a snapshot of the views of a relatively small self-selected number of junior doctors-1,500 out of 49,000. None the less, it provides us with some alerts and concerns, particularly about the training of those junior doctors. The vast majority of the NHS is now compliant with the working time directive and in accident and emergency we now have double the number of doctors and consultants that we had 10 years ago. The noble Baroness will know that patient safety is at the heart of the reorganisation that has taken place. Before the BMA produced its survey, we had recognised the concerns of trainee doctors about their training. My right honourable friend the Secretary of State has asked Medical Education England to review the impact of the European working time directive on doctors in training and the reduced hours that they are working. That will be completed next month and I will be happy to share that with the noble Baroness at that time.
Baroness Thornton: My noble friend raises an important point. We all accept that tired doctors make mistakes and there is substantial evidence to support that. We believe that the working time directive is improving patient care, not damaging it. Trainee doctors in NHS North West recently conducted their own research, which has just been published. I should be happy to put that in the Library for Members to see because it is very interesting. NHS North West, which adopted the European working time directive a year earlier than the rest of the NHS, conducted a survey on whether this had a detrimental effect on the standardised mortality ratios-that is, the number of deaths in hospital-on the average length of stay and on readmissions. I am happy to report that it showed not only that it did not have a detrimental effect but that there were some signs of improvement. As I say, I commend that research to the House.
Earl Howe: My Lords, the noble Baroness did not comment on one aspect of the Question asked by the noble Baroness, Lady Finlay, which was to ask what measures the Government have put in place to ensure that junior doctors are not pressurised by employers to work in excess of the 48-hour limit.
Baroness Thornton: I apologise; I did not deal with that derogation. A very small number of 24-hour emergency care services have a permitted derogation to work an average of 52 hours a week rather than 48 hours. Health authorities have until 2011 to comply with the 48-hour working time directive and that time has to be spent sorting that out. In the department,
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Lord Alderdice: The Minister spoke about the training review that is taking place. There is reason to believe that there may some suffering on that front. I agree entirely with her that a doctor being wide awake is very much in the interests of patient safety. However, there is another important difficulty with the rota changes: continuity of care.
Baroness Thornton: The noble Lord raises a very important point. I was alluding partly to it when I said that this is an issue of clinical leadership and the reorganisation that is needed at a local level. It would appear from the evidence that is emerging that implementation of the working time directive is pointing to where there are gaps, where there is a need to reorganise and where better leadership is required. It is important to strike a balance between doctors not being exhausted, their being able to continue the care that is necessary and their being able to undertake the training that they need.
Lord Patel: Does the Minister agree that if more care, including out-of-hours care, was provided by fully trained specialists, patient care would be safer? Does she further agree that the Government and the profession need to work together to achieve this within five years?
Baroness Thornton: I thank the noble Lord for that question. I welcome his support. I hope that he may help us in taking forward those discussions with some of his senior colleagues in the royal schools. We know that Homerton Hospital has completely reorganised its training for its junior doctors. It offers a very good example of the handovers to which the noble Earl referred and of the need for doctors to have the necessary time to undertake specialist training without being whipped off to accident and emergency. The Homerton seems to have tackled those pressures very successfully.
The Chancellor of the Duchy of Lancaster (Baroness Royall of Blaisdon): My Lords, I remind all noble Lords, both on Front Benches and Back Benches, that, for an effective Question Time and for the Government to be held properly to account, we need short answers and short questions.
Baroness Warsi: My Lords, I rise to move Amendment 1 and to speak to Amendments 2 and 3. It will come as little surprise that we on these Benches still feel very strongly that the public sector duty regarding socio-economic inequalities should be removed from the Equality Bill. As we made clear in Committee in your Lordships' House, it would be very difficult indeed to find anyone who did not think that there were socio-economic problems, and that immediate and effective action should be taken to address these issues.
The problem of socio-economic disadvantage is deeply entrenched, and so it is crucial that action is taken to confront these problems and to have a practical impact on the lives of individuals, families, communities and the country as a whole.
We are living at a time during which the number of children living in poverty has been increasing since 2004. It is expected that the Government will miss their 2010 target to reduce child poverty by 600,000 people. People on free school meals are over 180 times more likely not to get a single good GCSE than to get three "A"s at A-level. The rate of exclusion for violence against a pupil is three times higher for secondary schools in most deprived areas, compared with 10 per cent in the least deprived. There is a very serious problem of socio-economic disadvantage, and that is something which we can all agree upon.
The difference here is that we believe that real action should be taken in order to address the root causes of the problem, and we believe that these clauses are an empty gesture at a very serious problem. Worse still, we are not alone in these thoughts. This has been conceded by the Government in defending the Bill, saying: "What is the harm in it?" We also heard from the noble Lord, Lord Lester, who at Second Reading referred to the duty as,
We share the noble Lord's disappointment. I see that by Committee, however, the noble Lord, Lord Lester-who does not appear to be in his place today-after spending time with his friends, I think he said, had been persuaded that he would no longer support us in opposition to this part of the Bill. This is despite a clear statement to the contrary at Second Reading and his continuing to refer to it as,
I am therefore frankly confused that the noble Lord, Lord Lester, can now accept or even promote the argument against the duty, and yet is suddenly of the persuasion that it would be better not to remove it. I very much hope that political grandstanding is not becoming all the rage. We, on the other hand, stand by our opposition to the clause for the reasons which were presented to your Lordships in Committee. We are concerned that this duty has been inelegantly tagged on to the beginning of a Bill to make an empty gesture to the very serious socio-economic problems embedded in this country. We find it an unacceptable way to make legislation, particularly about a problem which merits and deserves important and real action.
In this House, it is not our duty to create press releases for the Government. We are here to scrutinise legislation and to pass considered and rational laws. I fail to see how Part 1 of the Bill represents these criteria.
I am disappointed that the Government have not acknowledged that there is a qualitative difference between socio-economic disadvantage and socio-economic inequality. I fear that these two categories have been conflated. The result is that we have three clauses at the beginning of the Equality Bill which may represent some cutting back of the weeds of socio-economic inequality, but will do nothing to address the root causes of underlying rot beneath.
The empty gesture is part of the reason why we cannot just sit back and accept the Government's claim that the provisions will hopefully "do no harm". That is not necessarily true. There is the harm of raising expectations about a duty which will, according to the Government's guide to the duty, "do almost nothing". It will not create a new equality strand; or a justiciable right for individuals; or address discrimination against individuals on account of socio-economic factors; or affect or determine operational decisions; or require public bodies to use their resources to remove unequal outcomes in every case that is identified. I am troubled by the fact that people may receive false hope from a clause which will do none of these things. Moreover, to pass legislation which purports to do no harm, as was referred to in another place, while no one can really pinpoint exactly what it does do, raises the concern that there may be unintended consequences.
Will the Minister really still face noble Lords and say that there is no risk of harm in legislating in this way? She will doubtless inform us that the clause is there for strategic decision-making and to force authorities to take these factors into account. I fail to see exactly how this will be the case.
I have spoken at length on this issue and for that I ask for the patience of the House. I hope that your Lordships will understand that we on these Benches
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Baroness Northover: My Lords, I oppose the noble Baroness's amendments on socio-economic duty. We fully accept the principle behind what the Government are proposing, although we have been critical of whether this measure will deliver it. My noble friend Lord Lester of Herne Hill, who is unfortunately not here today because he is at a long-arranged meeting, gave long thought, as noble Lords will imagine, to how this might be done differently. Indeed, he came up with a major improvement. However, the Government indicated that they would not support his changes. He therefore felt that in the interests of time and the far greater merits of the Bill as a whole that he should not press on with it.
My noble friend has worked extremely hard to bring this legislation about in the first place, with his own Bill and with his extraordinary work throughout all the stages of this Bill. He strongly believes that the Bill will contribute to the reduction of inequality. Nothing should be allowed to deflect from that and there should be no delay. We do not think that the Conservatives are right simply to strike this provision from the Bill. It was extraordinary to hear the previous presentation about the prevalence of inequalities and then the proposal that we should strike this out. We look forward in due course to further discussions on how this provision, the substance of which we have always welcomed, will be delivered.
The Chancellor of the Duchy of Lancaster (Baroness Royall of Blaisdon): My Lords, these amendments revisit the debate on the need for the socio-economic duty. Since we have discussed the duty at some length at each stage of the Bill, I will be as brief as possible. The duty will create an overarching legal requirement on central government departments, local authorities and key public bodies to take account of the need to reduce socio-economic inequalities. This measure is necessary because without it we will never fully tackle the underlying causes of many of the inequalities addressed elsewhere in the Bill. Inequality and disadvantage are not only associated with issues to do with age, gender, disability or ethnicity; at the root of many of those inequalities is a much broader one; namely, persistent poverty.
This is not a matter of press releases or gesture politics. It is a reality for too many people in our country. As the noble Baroness says, I know that the Opposition and the Liberal Democrats share our desire to address this issue. At the Hugo Young lecture in November, David Cameron said that,
The comprehensive report from the National Equality Panel, published in January, showed how inequality rose very significantly during the 1980s. It also showed
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