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Grand Committee

Tuesday, 1 February 2011.

Arrangement of Business


3.30 pm

The Deputy Chairman of Committees (The Countess of Mar): My Lords, it has been agreed that, should any of the Questions for Short Debate not run for their allocated hour this afternoon, the Committee will adjourn during pleasure until the end of the allotted hour. Therefore, each of the Questions for Short Debate will start at half-past the hour. If there is a Division in the House, the Committee will adjourn for 10 minutes and, if necessary, time will be added for the Question for Short Debate.

Children: Sexual Exploitation


3.31 pm

Asked By The Lord Bishop of Leicester

The Lord Bishop of Leicester: My Lords, following the recent cases of child sexual exploitation that we have seen in the media, I am glad to have this opportunity to raise this important topic today. I very much look forward to hearing contributions from all those who are here. What I have to say arises partly from my own pastoral experience as a parish priest and a bishop and partly from my more recent experience as the chair of the trustees of the Children's Society.

As noble Lords will be aware, child sexual exploitation, as defined by the Department for Children, Schools and Families in 2009, is sexual exploitation of children or young people under the age of 18 that involves putting the child or young person in exploitative situations, contexts or relationships in which they receive something, whether it is food, accommodation, money or drugs, in return for performing and/or having others perform on them some form of sexual activity.

Sexual exploitation can occur through the use of technology without the child's immediate recognition of the exploitation, such as being asked to post sexual images on the internet or on mobile phones without immediate payment or gain. Recent reports by the Child Exploitation and Online Protection Centre and Barnardo's have indicated the use of the internet in child exploitation as a growing issue. The Barnardo's report, Puppet on a String, which I commend to your Lordships, has highlighted that a number of primary school children have admitted to meeting someone whom they previously met only online.

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In all these cases, the person doing the exploiting exercises some form of power over the child or young person by means of their age, gender, intellect or other factors. Violence, coercion and intimidation are common and can involve the child or young person being plied with gifts, alcohol and drugs, which often form part of the grooming process. This all helps to explain why it is often very difficult for some children or young people to accept the true nature of their relationship and to take the risk of exposing the perpetrator.

Any child or young person may be at risk of sexual exploitation, regardless of their gender, race or social background. However, we unfortunately know that factors such as living in care or being runaways or having mental health problems all increase a young person's vulnerability to sexual exploitation. In particular, we know that the link with running away or going missing is an extremely strong indicator of risk. I shall return to that point later.

As we know, child exploitation has devastating consequences for the individual being exploited. It has an extremely damaging effect on a child's or young person's self-esteem, mental health and, indeed, lifelong ability to form secure relationships, yet, in spite of this, there are no national statistics to map the prevalence of child sexual exploitation. This lack of data works against the children of our country, as it keeps a vital child protection issue somewhat obscured.

I want to draw attention to five issues in particular. First, children of course have a right to be protected from sexual exploitation. This is enshrined in law at national, European and international levels. In this country, local safeguarding children boards are responsible for co-ordinating local responses to child sexual exploitation, yet initial research from the University of Bedfordshire has demonstrated that many local safeguarding children boards still do not consider child sexual exploitation as a priority and have failed to identify resources or plans to address this, with less than a quarter of the boards even having a protocol for child sexual exploitation. This leads to a group of very vulnerable young people being left without adequate and timely services and the support that they so desperately need. I urge the Minister to look into this issue seriously and to let us know what measures he can put in place to rectify this situation.

Secondly, I want to mention the inadequate training for professionals across the front line. Many professionals who work with young people remain unfamiliar with the risks or indicators of sexual exploitation and show little understanding of the issue. Indeed, they often do not know how to support a young person in an exploitative situation who is going through the courts with a case against their abusers. This situation is often exacerbated by the fact that many young people are not willing to identify themselves as being exploited or even to recognise that they are at risk of harm. In keeping with this lack of understanding, the behaviour of children and young people affected is often identified as disruptive rather than indicative of need and they are often met with punitive rather than welfare responses. Research from the Children's Society has shown that victims aged 16 and 17 are particularly unlikely to receive a safeguarding response. These are the young

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people who are often seen as a low priority, despite the law stating explicitly that they should be responded to and safeguarded as children until they are aged 18. The lack of data and awareness of the issue of child sexual exploitation has led to a significant lack of resources for specialist support services for children and their families.

Thirdly, I take this opportunity to raise the issue of the inadequacies of current law enforcement and police responses to child sexual exploitation cases. These remain primarily reactive rather than proactive. The prosecution relies heavily on the young person to make a complaint and to give evidence in the court against their exploiter. The process of grooming to which children are subjected and the use of threats and coercion make it extremely difficult for them to go through the criminal justice process. The sexual exploitation of children is, of course, a form of child abuse and should be seen as a child protection issue. It is extremely important that investigations are carried out by officers who are trained in child protection procedures with families showing risk indicators for child sexual exploitation. It is vital that the police work closely with partner agencies to develop a co-ordinated response to ensuring that the welfare and safety of the child is paramount. What is most ironic is that children aged 10 years or over still remain criminally liable for the commission of a prostitution offence such as loitering or soliciting. This is clearly at odds with the intention to make it clear that sexually exploiting children is a form of child abuse. Often it is the fear of being prosecuted under this legislation that prevents children from coming forward to seek help to get out of exploitative situations. I urge the Minister to ensure that it is explicitly clear that any child who has been sexually exploited is supported through the justice system, which is meant to protect them, and that their exploiters are dealt with accordingly.

Fourthly, I want to make a point about the importance of co-ordination and joint working between local authorities and police forces to tackle child sexual exploitation across boundaries. Effective cross-department and multidisciplinary working can make a huge impact on safeguarding children, especially those in care, who are often failed due to a breakdown in communication between different agencies or who get lost in the gaps between them. The Government and local authorities have a duty, of course, to protect all children, especially those who rely on them as corporate parents.

Finally, I urge the Government to respond to the needs of these vulnerable children. I call on the Minister to take the necessary steps to ensure the safety of children, especially those in the care of local authorities, from being groomed for sexual exploitation. In particular, I hope that the Minister will pay close attention to the link between running away and sexual exploitation. I fear that, despite great efforts in recent years to develop statutory guidance and an action plan on runaways, this issue has fallen down the list of political priorities at the DfE. I hope that the Minister will reassure us that this is not the case and that action is being taken to prevent children from being exposed to such horrific abuse, which is happening in far too many of our towns and cities today.

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3.40 pm

Lord Hodgson of Astley Abbotts: My Lords, I congratulate the right reverend Prelate on securing this debate on this important topic and at the same time congratulate the noble Baroness, Lady Hughes, on making her debut as opposition spokesman today.

Like other noble Lords, I have received the briefings from the Children's Society and Barnardo's on what they rightly describe as a horrendous crime. The reference in the Barnardo's report to the special challenges posed by out-of-area residential care strikes a particular chord with me, yet I find myself impelled to sound a note of caution, lest in our efforts to reduce child exploitation we have the unintended consequence of discouraging individuals from working with children and so impoverish the physical and intellectual lives of the very children whom we are seeking to protect.

I am chairing a task force looking into the regulatory and other burdens that impede the growth of small charities and other groups. We have had a good deal of evidence that well meaning efforts are discouraging people from volunteering to work with children. In my three minutes, I cannot develop my argument at length, so I shall read four paragraphs of a letter that I received from a lady in Manchester. She said:

"About 8 years ago, I decided to get involved in a local Manchester Drama group ... whose members range from seven years to 80 years old. A number of us assumed responsibility for teaching the children and preparing them for the annual pantomime and other productions. Naturally we were CRB checked-a process I had no issue with and wholeheartedly support ... However-having been CRB approved, we were invited to a session of the local Child Protection Officer. I came away from that meeting with a number of very serious questions as to whether I should in fact get involved with this sort of group. The talk left me feeling I would potentially be placing myself in situations of real risk ... The Child Protection Officer focused the session on ensuring no adult put themselves into a vulnerable position i.e. if a child requests to go to the toilet-in no circumstance should an adult accompany them. If a child (with particular reference to girls) falls and cuts her knee, whilst wearing tights-under no circumstances should any adult remove the girl's tights and help stem the bleed ... No adult, whatever sex, should ever be alone with either one or more children ... I came away from the session questioning the sense in many of the messages conveyed. As a caring, responsible adult (who as an adoptive mum ... has the highest level of CRB clearance) I did not feel at all comfortable with the prospect of not being able to help an injured child".

I would like to tell the Committee that this was an isolated example, but we have had many letters along these lines. Of course, child protection is an important issue, but thousands of our fellow citizens find it enjoyable and rewarding to work with children. We have to avoid a situation in which, if someone says that they enjoy working with children, they are immediately treated with grave suspicion.

3.43 pm

Baroness Massey of Darwen: My Lords, I am very pleased that the right reverend Prelate the Bishop of Leicester has brought this topic of sexual exploitation to our notice. His interest in child welfare is well known. I want to focus on trafficking, an issue that many noble Lords have raised recently in your Lordships'

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House. It is a horrific practice and one that we should do all in our power to tackle. Local authorities and safeguarding are important and essential.

We have some figures on trafficking and sexual exploitation of children, but they are likely to be severe underestimates. Nevertheless, some things are clear. Childline reports that 8 per cent of all calls are about sexual abuse-an increase of 42 per cent in two years. The reason for the increase may be that children are becoming more confident in speaking out about such abuse. I hope that they are and that they feel supported to do so. The Barnardo's report, Puppet on a String, has been referred to already. I want to underline the fact that children who are particularly vulnerable are those in care, those excluded from mainstream education and those using drugs or alcohol. Such children need a great deal of co-ordinated support, as the right reverend Prelate said.

I shall now focus on trafficking. It is estimated that at any time more than 140,000 persons are victims of trafficking; 84 per cent of them are trafficked for sexual exploitation and most are women and girls. The UN Office on Drugs and Crime shows that trafficking in persons is one of the most lucrative illicit businesses in Europe, generating €2.5 billion a year. Some of these children go into care but are recycled into exploitation. Some are not discovered. That is another example of where local authority protection services should intervene.

ECPAT, the umbrella organisation fighting trafficking, recommends that central government should provide funding to local authorities to ensure that child victims of trafficking are provided with safe accommodation, such as foster care, and that social workers should be trained to identify and support children who may have been trafficked. It is vital to address gaps in provision, such as the lack of co-ordination and the lack of someone who can understand the wishes and feelings of children.

What can we in the UK do? First, I hope that the UK Government will take note of the Barnardo's report, Puppet on a String, and the ECPAT recommendations. It is difficult to see how cuts to local services can engender more funding to do this and to focus on child trafficking and sexual abuse, but I hope that the Minister will reassure us. I hope that the Government will eventually sign the European directive on human trafficking. I know that progress has been made but, if the Government signed up to this directive, that would be an important symbol of our commitment as a country to fighting this modern-day slavery. I look forward to the Minister's response.

3.46 pm

Baroness Walmsley: My Lords, child sexual exploitation has devastating consequences, despite the fact that children's right to be protected from sexual abuse is enshrined in national, European and international law. We have heard that only 20 per cent of local authorities have access to specialist services, even though it has clearly been shown that cases are more easily identified when specialist services are available. This was emphasised recently in an article in the Guardian by Carlene Firmin, who pointed out that, if local

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authorities do not take proactive steps to identify cases, they think that there is no problem to address and, if they do not think that there is a problem, they do not identify the resources and put them in place to address it.

This debate follows the recent notorious Derby case where many young girls were abused, two of whom were in public care. In order to find out what lessons had been learnt, I looked at the serious case review. These reviews have been patchy in quality in the past, but since Ofsted has been looking at them they have improved and are well worth looking at. I understand that the Munro review, published this morning, suggests that Ofsted inspection should now cease, so I hope that the raised quality and value of these reviews continues. I am concerned about how safeguarding will be enshrined in the new slimmed-down Ofsted inspections of schools. Can the Minister tell us something about that?

I turn to the Derby case. The serious case review reveals that concerns about the welfare of the two young women in care, who were among those abused, emerged at a very early stage-one from birth and the other from primary school age. From 2008, they were engaged in disturbed and risky behaviour, including criminal activity, absconding and drug and alcohol misuse. Practitioners in health and education and in children's social care all failed to recognise the significance of these behaviours in terms of abuse and they failed to intervene effectively.

Often when I am faced with speaking about issues such as this, I turn to the coal face. The coal face in this case is my friend Carol Runciman, who is the lead member on children's services in York. I asked her what she thought about these issues. She said:

"It doesn't take a lot more money-what it takes is training and understanding of how things happen and how both young people and carers and parents can be alerted to the dangers ... getting warnings out via social networking sites and sites, like school networks, that the young people use. Having a clearly identified point of contact is important-a designated teacher or teaching assistant in school who is trained to know what to do ... having information in drop in centres for young people-youth clubs, young people's drop in centres, even health centres-that all helps".

We should listen to the coal face.

3.49 pm

Baroness Masham of Ilton: My Lords, I am most grateful to the right reverend Prelate the Bishop of Leicester for raising this topic today. Coming from the north, as I do, I know that there is great concern about children being sexually exploited. A short time ago, a group of predators, all of whom seemed to be of Asian origin, were sent to prison. They came from West Yorkshire, Derby and Blackburn. They had groomed young people with drugs and alcohol and then threatened them so that they obeyed these evil men. The young people were driven to prostitution.

If the Minister can find out, it would be interesting to know how many of these children had come from care. Will there be a cross-departmental inquiry on grooming vulnerable children for the purpose of sexual exploitation? I assume that there was cross-departmental working when the predators were found guilty and

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sent to prison. That is what is needed, as well as cross-boundary co-operation and cross-country co-ordination.

West Yorkshire used to abound with industry. People were brought in with their skills to work in the mills. Now this work has mainly gone to China, which has left many people unemployed years later. Some of them have preyed on children to make money out of sex. I also hear that Asian men may not be satisfied with forced marriages and so look elsewhere for sex.

Many children from care seem to have low esteem and become vulnerable, as do young teenage girls, who rebel and leave home for various reasons. They all become easy prey. Will the Minister give an assurance that the cutting of so many police will not affect child protection? How much child awareness is taught in schools to make all children aware of sexual exploitation, so that when they are at risk they can spot the dangers? I know that this awareness is taught in schools in Australia.

All professionals working with children and within the criminal justice system should be trained to understand issues relating to child sexual exploitation. Some of the children are very young. They are at risk of sexually transmitted diseases, including HIV. Surely it is time to stop being complacent and to act now to protect these very vulnerable children.

3.52 pm

Lord Brooke of Sutton Mandeville: My Lords, there are nine working days in your Lordships' House in the first 15 days in February. On two-thirds of those nine days, the first Oral Question is in the name of one of the right reverend Prelates on the Bishops' Bench. I do not know whether it is a convention of your Lordships' House that the Bench of Bishops always takes the top of the Order Paper if a right reverend Prelate has a Question to ask or whether that is an index of the enthusiasm of right reverend Prelates straining like greyhounds in the slips to be the first away. On top of that, on Thursday the right reverend Prelate the Bishop of Chester has the first two-and-a-half-hour debate, which is on the role of marriage and marriage support.

This episcopal procession is led today by the right reverend Prelate the Bishop of Leicester, with his Question for Short Debate, which is itself a harbinger of the similar top Oral Question to be posed on 10 February by the right reverend Prelate the Bishop of Ripon and Leeds. We are all in the debt of the right reverend Prelate the Bishop of Leicester for having triggered all this activity and for the skill with which he has launched it. Having used more than a third of my allotted span with this willing obeisance to the Bishops' Bench, I shall use the final strait to make one observation and to ask one question.

My observation is that, when these matters were brought dramatically to public attention and general concern by a series of articles in the Times, the thought was aired that the police had been inhibited from raising the profile of these matters for fear that they would be liable to charges of racism. I can understand that inhibition. I had to ponder a similar dilemma more than 50 years ago, although in a different context

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and to a different degree. I chose then to make indiscretion the better part of valour. However, I hope that the climate will have been so changed by recent developments that this inhibition will be lifted. I share the views of my noble friend Lord Hodgson of Astley Abbotts, as a consequence of eight years as president of St Andrew's Youth Club, half a mile from this Palace, whose reputation is that oxymoron, "the oldest youth club in the world".

There are lots of questions that one could ask, but, in a debate of short speeches, my noble friend the Minister is liable to be reduced to a St Sebastianic barrage of questions and one must not be self-indulgent. Mine relates to trafficked girls, an issue that has already been mentioned. I am aware of the Christian organisation thus concerned that goes under the name of Chaste-for the benefit of the Hansard writer, I spell that title with "te" rather than "ed"-but how far is the fact that prostitution among such girls is a criminal offence at the specified age an obstacle to the resolution of such traffic?

3.55 pm

The Earl of Listowel: My Lords, the previous Government appointed Sir William Utting, the former director of the Social Services Inspectorate, to do two reports into the safeguarding of children in local authority care. One of his chief conclusions was that an environment of overall excellence is the best safeguard for children. The Barnardo's report, Puppet on a String, which has already been referred to, states:

"We also know that some groups of young people are more vulnerable to targeting by the perpetrators of sexual exploitation. These include children living in care, particularly residential care".

I should like to concentrate on children's homes.

I hope that the Minister may take the following questions to Tim Loughton MP. Will he consider undertaking a review of children's homes? Will he consider approaches from John Diamond, chief executive of the Mulberry Bush school, who is leading a group of tier 3 specialist providers in residential care to talk to the Government about how we can ensure that high-quality specialist residential care continues? Does he recognise the need to ensure that the current climate does not have the perverse effect of driving out high-quality provision as commissioners look for the cheapest residential care that they can find in the circumstances?

In my experience visiting children's homes, I have heard staff talk about girls in their care being approached and given gifts by men. They have expressed concern about their limited ability to intervene. I have heard of girls being called out at night by an elder girl in the home and of staff rewarding in the morning those girls who did not respond to that pressure. It is a very difficult environment in which to work. While 90 per cent of children's homes in Denmark, and 50 per cent in Germany, have degree-level qualified staff, only 20 per cent of homes in this country do, yet the children in those residential settings often have far higher levels of need than they would in Germany or Denmark. This area needs careful attention and I hope that the Minister will review it.

To see the difference that excellence in provision can make, your Lordships need only visit Hackney social services, which last year achieved 25 per cent

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access to university provision among their care leavers-the highest proportion in the country. This was a local authority that used to have an appalling reputation for its provision. It has done this by insisting on recruiting the very best social workers using the Reclaim Social Work model. Consultant social workers lead small teams supported by systemic therapists who have eight years of training. I look forward to the Minister's response.

3.58 pm

Lord Faulks: My Lords, although I very much welcome this debate, I come to it from a slightly unusual standpoint as a barrister who has spent the past 20 years or so acting in claims against local authorities, social services departments and children's homes for failures to protect children from sexual abuse. I, of course, share the concern of all noble Lords for the victims of sexual abuse. Anyone who has heard adult survivors of sexual abuse give evidence in court can feel nothing but horror for the way in which their childhood has been ruined by the breach of trust. Often, they come from very unpromising circumstances and their lack of faith in adult figures is confounded by their experiences. Anything that the Government can do and can continue to do to protect such children from abuse and exploitation is, of course, welcome.

I wish to sound a note of caution, however, although this must be seen in the context of my experience as someone who has spent many hours sitting round tables with social workers who are alleged to have been negligent in failing to protect children from sexual abuse. Social workers have a very hard job. There is no lack of guidance; indeed, a preponderance of guidance is now available. However, the inquiries that take place and the hearings that occur in the studied calm of the Royal Courts of Justice are a world away from the real fog of social work, with the difficulties of obtaining information and the changes of files and personnel.

It is a considerable worry to social workers that they are exposed to litigation and the risk of litigation. Previously, the courts had decided that social workers were not so to be exposed; it was considered that this was a multi-agency task and that it was unfair to single out social workers for responsibility. However, the Human Rights Act has altered that and we are now in a position where social workers face these allegations.

Of course, the Government will be anxious to make sure that social workers are properly trained and do all that they can to take on board the recent thinking about improving the way in which they do their job. I know that the Government will be taking note of Professor Munro's report in particular. However, I ask the Minister to bear in mind the fact that social workers are dedicated individuals who do an unglamorous and not very well paid job in often difficult circumstances. They are pilloried by the press when things go wrong and, although I am sure that all of them have children's best interests at heart, we should be careful that, in our understandable urge to protect children, we do not confound matters by putting them off doing that job well.

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4.01 pm

Baroness Howe of Idlicote: My Lords, I join others in thanking the right reverend Prelate the Bishop of Leicester for securing this debate on a subject that is of growing concern. The prevalence of child sexual exploitation is growing and the age of exploitation is getting younger. With rapid technological advances, the grooming of children has become more sophisticated, as abusers are using the internet and mobile phones to find and groom children. A recent report by the Child Exploitation and Online Protection Centre found a 16 per cent increase in the number of cases in a year, with a quarter of these from online grooming. Children are unwittingly putting themselves at extreme risk through internet usage.

Despite these shocking statistics, in most local authorities child sexual exploitation apparently is not, as we have heard, recognised as a mainstream child protection issue. Certainly more attention and resources must be focused on child protection on the internet. Studies suggest that almost 60 per cent of children aged nine to 19 have viewed online pornography and the rate of unwitting exposure is increasing. It is clear, therefore, that filtering software to control access to pornographic material needs to be improved. The onus seems to be far too heavily left to rest on parents, teachers and carers. Surely internet service and website providers should share a greater responsibility for keeping our children safe and be made much more accountable in this regard.

We need to make it a lot more difficult for our children to come across inappropriate adult content and images of child abuse on the internet. Are the Government engaging with internet service and website providers to ensure that steps are taken in this direction? I am especially concerned with the increasing ease with which internet content can be viewed through television. I believe that the BBC, whose age ratings are known and respected by parents, are already helpfully involved with some guidance to broadcasters, but will the Government's next communications Act address this problem statutorily? Given that internet videos are not currently subject to the same rules as television, this convergence could threaten to expose even more children to inappropriate content. If legislation is not the Government's intention, what measures are in place, or at least being explored, to protect children from the result of these technological changes? In short, what are the Government doing to address this?

I hope that, when he replies, the noble Lord will be able to reassure your Lordships that child sexual exploitation is indeed a priority for the Government and that he will tell us something about the actions that they are proposing to take to deal with this situation.

4.04 pm

Lord Sheikh: My Lords, the sexual exploitation of children is one of the worst challenges facing our society. A report last year for the Child Exploitation and Online Protection Centre revealed a 16 per cent increase in reported cases of sexual exploitation. Perpetrators of this heinous crime are using more sophisticated channels to lure their victims, often plying

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them with gifts, drugs and alcohol, specifically targeting vulnerable children. These children are groomed then abused, leaving them with deep emotional and psychological trauma.

Two of the young girls who were abused by a gang in Derby were in the care of Derby City Council. A serious case review into these victims' cases revealed that if they had been taken into care earlier they would have been less vulnerable to the exploits of their abusers. A 2009 report published by Barnardo's entitled Whose Child Now? revealed that 80 per cent of councils did not have a service dedicated to supporting victims of sexual exploitation. A greater focus on the training of professionals who deal with children is needed to improve the chances of early identification in cases of sexual abuse.

I turn now to a sensitive issue. The facts speak for themselves: 50 of the 56 perpetrators who have recently been convicted of these abhorrent crimes are from the Muslim community. However, any attempt to draw a parallel between these crimes and one ethnic or religious group would be not only wrong but particularly unwelcome. Child sexual exploitation is not exclusively carried out by one community. The recent focus on race in the media could have an adverse effect on the wider ability of the agencies to detect cases of abuse among all communities and in the country generally.

Barnardo's, the children's charity, has launched a report called Puppet on a String, which examines the nature and scale of sexual exploitation. The report states that the incidence of trafficking of children around Britain for sexual exploitation is rising, with children as young as 10 being groomed by predatory gangs. The report also reveals that the average age of victims has fallen from 15 to 13 in the past five years. Will the Government heed the advice of key figures in appointing a Minister with specific responsibility for dealing with this issue? Child exploitation is a deeply unwelcome phenomenon in our society. Our duty lies with providing victims with all the support that they require to rebuild their lives. We must also ensure their safety and prevent them from becoming innocent victims.

4.08 pm

Lord Laming: My Lords, I, too, congratulate the right reverend Prelate the Bishop of Leicester on initiating this debate on this important subject. Most parents want the best for their children but, when parental responsibility is transferred from parents to the state, the state carries a huge responsibility to help those vulnerable children. I hope that the Minister will do all that he can to remind local authorities of the responsibilities that they carry, because many of these children have experienced chaotic lives, have been deprived of a normal childhood and have low self-esteem and poor educational attainment. The responsibilities carried by the state are huge and local authorities need to be constantly reminded of that.

Secondly, we need to recognise that predators on these young children have developed more sophisticated ways. Unfortunately and understandably, many of these young children crave affection and confuse the giving of affection with that of sexual favours. Therefore, it is

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particularly important that we not only are vigilant but help young people to recognise the dangers and equip them better to withstand those dangers.

Does the Minister recognise that many local authorities have a tendency to place young children far from their locality? I fear that that often leads to an attitude of "out of sight, out of mind", which exposes these young children to even more danger. Because local authorities are sometimes more committed to a policy of ethnic compatibility, rather than of securing a normal family life for young children, many of these young children are allowed to languish in care for many years. I hope that the Minister will do all that he can to reduce the length of time taken in court proceedings and ensure that drift is eliminated from childcare practice. These children should be helped to have a more secure future, because childhood passes all too quickly.

4.10 pm

Baroness Hughes of Stretford: I, too, congratulate the right reverend Prelate the Bishop of Leicester on securing this debate on this very important topic. It is a privilege to speak after the knowledgeable contributions of so many colleagues.

While recent cases have brought this issue to the fore, there has in fact been a growing awareness of this problem for some considerable time. In a previous life, I spent some years as a research fellow investigating what was then called organised sexual abuse of children-paedophile gangs, trafficking and so on. I was a senior lecturer at Manchester University and spent many gruelling hours reading the transcripts of children's evidence and interviews. Like other Members here, I know what a vile predatory crime this is, targeting the most vulnerable children.

This is also a challenging issue for professionals-possibly one of the most challenging-as well as one of the most dangerous for children. The crime is becoming increasingly sophisticated, as modern communications technology makes it easier for paedophiles and perpetrators to keep their tracking and contacting of children hidden from parents and carers.

There has been progress over recent years but, as the Children's Society and Barnardo's have reported, the implementation of government guidance, best practice and so on is patchy as regards local safeguarding children boards and local authorities. The extent to which progress has been made is variable. It is clear that, for an effective local response, we need a child-centred approach that is sensitive to listening to children, the capacity for early intervention and identification, close integration and interagency working-as was reinforced again today by the Munro interim report-the capacity of professionals to share information easily and early, and the dissemination of knowledge and best practice.

As well as adding to the calls to the Minister asking what progress he is going to make, I should also like to express some concerns about decisions that the Government have already made, which I think will create new and unnecessary barriers to that progress. The first relates to the cuts to local authority budgets. I have to raise this issue, because the worst levels of

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cuts are being experienced by the local authorities with the highest children-in-need scores; they are in exactly those places where most vulnerable children are going to be.

Secondly, why has the Minister distanced himself from Every Child Matters, the acclaimed multi-agency framework that is making it much easier for agencies to work together? Under the Education Bill, schools will now be absolved from the duty to co-operate with other agencies locally. Thirdly, the abandonment of ContactPoint will make it much harder for professionals even to know who else is working with them, let alone how to contact them. Finally, absorbing CEOP into a national crime agency with border control, immigration and all those things will harm the dissemination of the best practice that CEOP has been achieving.

4.14 pm

The Parliamentary Under-Secretary of State for Schools (Lord Hill of Oareford): My Lords, I, too, congratulate the right reverend Prelate the Bishop of Leicester on securing this timely debate. It has been a good debate and a good advertisement for speed dating. I shall try to crack on. I welcome the noble Baroness, Lady Hughes of Stretford, to her new role. I look forward to working with her. I know that she is experienced in this area and was herself a Minister for Children and Families in my department.

This debate is timely because, as we have discussed, today sees the publication of the interim report from the Munro review and because of the attention that there has rightly been on this issue following the series of reports in the Times and the publication of the recent thoughtful and helpful report by Barnardo's, which I have read with care.

In his speech, the right reverend Prelate spoke with authority and experience about a subject that all noble Lords who have contributed today clearly care about deeply. It is hard to think of a greater responsibility or duty that we have as a society than to keep our children safe. We have a particular responsibility to care for those children who are the most vulnerable-those without families who are looked after and live in children's homes or in foster care, a point that the noble Baroness, Lady Massey of Darwen, underlined. On her specific point, it is the case that we can opt into the EU directive if we want to, once we have seen how it works.

As a number of noble Lords have said, it is impossible not to read the horrific stories that we have all seen recently and not be appalled. The Barnardo's report published in January underlined the youth of many victims of child sexual exploitation, suggesting that children as young as 10 are being targeted.

The fact that most of us find such behaviour inconceivable is, in some ways, part of the problem. Having been involved in the past in a minor way in some historic child abuse cases, I know that there is often a reaction that an allegation simply cannot be true, either because it is so shocking or because an alleged offender has been a colleague for many years. Yet some of those allegations were and are true and I believe that that is the frame of mind in which we have to tackle this issue. However, I accept the points made

1 Feb 2011 : Column GC326

by my noble friends Lord Hodgson and Lord Faulks about proportionality and the need not to undermine inadvertently the important relationship that we want to encourage between adults and children, particularly in the context of encouraging volunteering. That lies behind our proposals for reviewing the vetting and barring scheme.

As was said in the debate, knowing the scale of the problem is one of the challenges that we face. I therefore welcome the fact that the Barnardo's report and the Times articles have drawn attention to the problem and brought things out into the open. Research commissioned in 2002 found that children were known to suffer sexual exploitation in 111 of the then 146 child protection committee areas. Work carried out by Barnardo's in 2005 found 507 cases across London boroughs. A more recent survey by Barnardo's showed that in 2008-09 it worked with 1,059 children and young people and that this had risen the following year to 1,098.

However, apart from a sense that we all have that this is only part of the story, we almost by definition do not have hard and fast data. I hope therefore that noble Lords will support the announcement in January that the Child Exploitation and Online Protection Centre is carrying out a thematic assessment, which, among other things, will look at establishing whether there are any patterns of offending or victimisation, consider the effectiveness of existing processes and make recommendations to reduce risk. CEOP is looking to make its findings on this research public within a timescale of three to six months.

I know that there has been a lot of media debate around issues to do with ethnicity, a point that a number of noble Lords have raised. My view on that is very simple: while we should not make generalisations-we know that child sexual exploitation affects boys as well as girls and occurs across the country, involving people from a range of ethnic backgrounds-we should not turn a blind eye to wrongdoing for fear of rocking the boat. Indeed, rocking the boat is often precisely what we will need to do in this area, a point made by my noble friend Lord Brooke of Sutton Mandeville.

I turn to the current framework. The Sexual Offences Act 2003 is intended to protect young people from sexual exploitation. It extended the scope of the law to include a range of new offences, including meeting a child following sexual grooming and paying for the sexual services of a child. In addition, the police and Crown Prosecution Service are able to convict using other sexual offences, such as rape or sexual activity with a child under 13 or a child under 16, or they may use other legislation to disrupt this activity.

The statutory guidance on safeguarding and promoting the welfare of children, Working Together to Safeguard Children, was first published in its current form following the 1989 Children Act. Since then it has been regularly updated and in 2009 separate statutory guidance on the sexual exploitation of children was published. I believe that the noble Baroness, Lady Hughes, was involved in producing that guidance. The main objective of the guidance is to encourage local safeguarding children boards, practitioners and others working with young people and local agencies to prevent the sexual

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exploitation of children wherever possible, protect those children who are most vulnerable to exploitation and take appropriate action against anyone who is intent on abusing young people in this way.

Because looked-after children-children in care-are most vulnerable and more likely to be at risk of harm, local authorities have a specific statutory duty to safeguard and promote their welfare. In practice, that means that local authorities must allocate the child a social worker, who will assess their needs and draw up a care plan that sets out how the authority intends to respond to the full range of the child's needs, including their education and health needs. I take the points that have been made about the importance of training in that regard. If there is any suspicion that the child may have been trafficked, whether or not for the purposes of sexual exploitation, the social worker must assess the child's vulnerability to the continuing control of his or her traffickers. The local authority must then place the child with a carer who has the necessary skills and experience to support and protect them.

I understand the point that was made about the danger of criminalising the victim. Points were made about the way in which the police operate and I will relay those to my honourable friend Mr Loughton. I shall read an extract from the statutory guidance:

"The Government remains clear that children and young people who are sexually exploited should not be regarded as having bad or criminal behaviour; they are the victims of sexual abuse. The responsibility for the sexual exploitation of children or young people lies with the abuser ... The focus of police investigations and of prosecutions should be on those who coerce, exploit and abuse children and young people".

However, I will follow up the point that was raised.

I ran through that at quite a pace, but I wanted to make the point that the legislative framework is broadly in place. The issue that we have is that its application is patchy. As has been said, early findings from research carried out by the University of Bedfordshire show that there are low levels of compliance with the 2009 guidance, suggesting that only a minority of local authorities are prioritising child sexual exploitation as a child protection issue.

I turn to the steps that the Government are taking. The Barnardo's report talks about the need for a lead Minister. That role is being carried out by my honourable friend the Parliamentary Under-Secretary of State for Children, Tim Loughton, who has the cross-government lead role on this issue as part of his child-safeguarding responsibilities. I assure the noble Baroness, Lady Masham of Ilton, that he understands fully the need for a collaborative and cross-departmental approach to these issues. He is clear about that and he is involving Ministers from a range of departments, including the Home Office, the Ministry of Justice and the Department of Health, as well as local authority children's services, local safeguarding children boards and organisations such as CEOP, Barnardo's and others, and other voluntary organisations. He is already working with the Parliamentary Under-Secretary of State at the Home Office, James Brokenshire, to develop a joint approach, and I know that they have both recently met Sheila Taylor, who runs Safe and Sound Derby. Mr Loughton has also recently met the chief executive of Barnardo's.

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It will be my honourable friend's job, working with others, to consider what further action may need to be taken to safeguard children and young people from sexual exploitation.

I will be certain to ensure that my noble friend reads today's debate and I am happy to relay to him any further specific concerns that noble Lords may have. I will ensure that there is an answer to the questions raised by the noble Earl, Lord Listowel. I will also follow up separately the important points made about the spread of technology by the noble Baroness, Lady Howe, and respond to her. I am not an expert in these matters, but common sense says that the ready availability of pornography has a desensitising effect, while the way in which technology can be used by people to work together to share images and to co-ordinate activity suggests that there is a growing problem there.

The Government share with the right reverend Prelate and other noble Lords a recognition of the problem of child sexual exploitation and of the particular vulnerabilities of looked-after children. It is almost impossible to comprehend the suffering that some of these children and young people have endured and are enduring at the hands of their exploiters. Like all noble Lords, we are determined to do all that we can to stop this terrible abuse.

4.26 pm

Sitting suspended.

Human Fertilisation and Embryology Authority/Human Tissue Authority


4.30 pm

Asked By Baroness Thornton

Baroness Thornton: My Lords, it seems appropriate that we are having a short debate on the proposed abolition of the HFEA and the HTA, as one might say that it is a sort of warm-up for the debates that we will be having when the Public Bodies Bill restarts its Committee stage, which I hope will be soon.

This morning, the British Heart Foundation announced that it is spending £50 million on stem cell research in the hope that one day it will be as easy to recover from a heart attack as it is to repair a broken bone. A year ago, the groundbreaking partnership was announced between the Multiple Sclerosis Society and the UK Stem Cell Foundation to pump-prime and speed up stem cell research. This perhaps reflects science's fast-moving progress in relation to stem cell research and the wonders that it might bring to medicine over the next few years. Right now, the HFEA is conducting a consultation on the ethics of sperm and egg donation.

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This issue is often in the media, which is unsurprising given what donation involves-that is, making children who may not be genetically related to their parent or parents.

As medical science advances, there seem to be more, not fewer, ethical issues to address in this area. To underline this point, not long ago-in fact, in March last year-the noble Earl the Minister and I were dealing with the regulations arising out of the Human Fertilisation and Embryology Act 2008 relating to the disclosure of information for research purposes and parental orders regarding the adoption of children born of surrogate mothers, among other matters. These are both highly sensitive and important issues concerning ethical and safeguarding matters and both rest in the hands of an HFEA accountable to the Minister and to Parliament.

In preparing for this debate, I used as my starting point what both organisations do and I tried to work out how these functions might be undertaken in the new regime that the noble Earl kindly outlined to some of us not long ago. The HTA licenses and inspects organisations that store and use human tissue for purposes such as research, patient treatment, post-mortem examinations, teaching and public exhibitions. It also approves organ and bone marrow donations from living people. Its work covers anatomy, stem cells, cord blood, public display-that is, the public display of human body parts in various forms-post-mortems, coroners and transplants. It is clear to me that the HTA covers a wide but related range of competencies, as well as the ones that were behind the organisation being established with such care some years ago.

The ethical issues that arise all the time as a result of the advances in science throw up new and sometimes very complex issues. Public indignation at the cavalier use of body parts for research without the knowledge or consent of patients and their families was huge and many in your Lordships' House will recall the thought and time that were given to creating a regulatory framework that would command public confidence. The Bill was given more than 100 hours of direct parliamentary scrutiny in both Houses, not counting pre-legislative scrutiny or investigation by Select Committees. I fail to see what has changed that can allow any slackening off of the responsibility that the HTA bears for the uses of human tissue.

The HFEA is the UK's independent regulator of treatment using eggs and sperm and of treatment and research involving human embryos. It sets standards for and issues licences to centres; provides authoritative information for the public, particularly for people seeking treatment, donor-conceived people and donors; and, very importantly, determines the policy framework for fertility issues, which are sometimes ethically and clinically complex. The Human Fertilisation and Embryology Act 2008 includes provisions for research on different types of embryos and changes the definition of legal parenthood for cases involving assisted reproduction. More than 200 hours were spent scrutinising this and previous legislation in both Houses, not counting the need for Select Committees and pre-legislative scrutiny. I make this point to emphasise that Parliament

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took its time to get these things right. It seems to me that, if Parliament is going to change the HFEA and the HTA, it needs to take time to do that also.

The Government argue that the HFEA's licensing function could be moved and that its very sensitive records should become a responsibility elsewhere. I remind noble Lords that, on every occasion that Parliament has discussed human fertility since the 1980s, it has agreed that human embryos have a unique status and that their use for treatment and research requires special oversight.

Some say that IVF treatment has become so common that its regulation should be normalised in some way. I point out that, although public opinion has indeed moved, there are still powerful forces wishing to stop or limit the use of assisted conception and there are still the unscrupulous who would wish to profit from, for example, the longing of parents to have a baby. In addition, there is a very real danger that important research will be frustrated by people who have strong and hostile views should the responsibility for ethical review be removed from the responsible but supportive environment fostered by the HFEA.

The HFEA plays an important role in actively improving standards by, for example, being responsible for several consultations on issues of best practice, such as the ones to which I have referred. Reducing multiple pregnancies by limiting the number of embryos transferred has been and remains an important part of its work. My question is whether the Care Quality Commission will take on the important role of ensuring that clinics' results are not achieved regardless of the perinatal mortality associated with multiple pregnancy.

The Human Fertilisation and Embryology Act is the focus for interactions between doctors, nurses and scientists. I suppose that these interactions could take place elsewhere. However, all the disciplines have vested interests and I point out, with the greatest respect, that organisations such as the Royal College of Obstetricians and Gynaecologists, the Royal College of Nursing, the Association of Clinical Embryologists and the British Fertility Society do not have the same impartial image enjoyed by the HFEA. The public have learnt to trust the HFEA and, indeed, the HTA. These bodies act as a bulwark between the sensational headlines in the less responsible press and those who are working in the field. Who would take on that role if either of these bodies was abolished? Would Andrew Lansley, or indeed the noble Earl, be prepared to act as that bulwark?

UK legislation on these matters is the envy and the blueprint for the world. In Australia, for example, the states of Victoria, South Australia and Western Australia have legislated to establish statutory oversight bodies. In 2000, the Singapore Cabinet appointed a bioethics advisory committee to examine the ethical, legal and social issues arising from biomedical research and development. Again, that is not a government department but a stand-alone, arm's-length body.

I am not opposed to change and improvement and I am not opposed to these proposals for the sake of it. I support change to make organisations more effective-for example, by sharing back-office functions or other facilities, by changing regulatory functions or by testing

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to see whether functions could be performed more effectively elsewhere. It might be that the proposals that the Government have suggested so far for the HTA and the HFEA will provide efficient regulation of some of their functions through the CQC and possibly through the still-to-be-created academy of medical science. However, none of the proposals answers the question that is the subject of this debate: where would the ethical and safeguarding issues that are at the heart of the work of both these bodies sit?

I am aware that the Government have said that there is no intention to revisit the ethical and safeguarding provisions in the HFE Act or the principles of consent underpinning the HTA, but they have so far failed to address how the ethical and safeguarding functions might satisfactorily be carried out were these organisations not to exist. I cannot see the CQC or an academy of science being an appropriate body. That leaves us the Secretary of State and the Government, which is where we came in all those years ago with Alder Hey and the challenges posed by the new embryo and fertility advances of the 1980s. I suggest that public confidence in this area is best established through the independence of the bodies that regulate-the HTA and the HFEA-and that the Government need to rethink their proposals.

4.40 pm

Lord Mackay of Clashfern: My Lords, I congratulate the noble Baroness on securing this debate at this time; it is perhaps an important interval, which we might not have expected to have but for other activities in the House. As your Lordships will know, I had the privilege of introducing the HFEA legislation all those years ago, so I feel a certain parental responsibility towards the authority that prevents me from wanting to see it perish. However, as children grow up, the needs surrounding them can change and it may well be asked whether all that the HFEA was set up to do needs to be done in quite that way now. For example, when it was set up, IVF was comparatively rare and it would be fair to say that people were somewhat afraid of it. We had the benefit of the report of the noble Baroness, Lady Warnock, suggesting what should happen.

Since that time, IVF has become a much more regularly occurring clinical process. Undoubtedly, there have been questions-for example, about the number of embryos to implant-but these processes take place in other areas as well; there are important risks in many clinical processes and we have authorities that are responsible for monitoring them. There may well be a case, therefore, for considering whether the control of the practice of IVF should continue with the HFEA. Research, too, happens in many areas. It involves important ethical issues, even in other branches of medicine and scientific research. I think that the HFEA was set up primarily from the point of view of that research and its control. Although there may be room for modification, that should continue.

I have had no direct concern with the Human Tissue Authority-I am glad to see its chair taking part in our debate-but I had the privilege of sitting on the Select Committee that looked at the draft Bill.

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Many questions relating to the Human Tissue Act were raised there. The answer of the then Government was: "If these are mistakes, it is too early to correct them". I have always thought that the sooner you correct a mistake that you have made, the better. I have no particular concern about the Human Tissue Authority. Our Joint Committee raised the possibility of a degree of co-operation between the two authorities that had not until then existed, although the situation may well have improved since we completed our deliberations. However, it is absolutely clear that the committee found no basis on which these two authorities could properly be put together as a single authority. We were absolutely unanimous and strongly of that view.

4.45 pm

Lord Alderdice: My Lords, we are all grateful to the noble Baroness for achieving this short debate-and it is short; one has only a few minutes. For that reason, my noble friend Lord Willis of Knaresborough will address the HFEA, my noble friend Lady Williams of Crosby will have an overall look at the issue and I will focus my attention on the Human Tissue Authority. I declare an interest, because my wife is a consultant histopathologist in the NHS in Northern Ireland. She does not do any forensic or coroner's work, but I declare the interest in any case.

The assumption in the noble Baroness's Question is that these bodies-I will refer now only to the Human Tissue Authority-have increased public confidence and patient safety. I am not at all sure that that is in fact the case with the HTA. When I was much younger in medicine, I remember that one government requirement was that 10 per cent of deaths that did not require a coroner's case PM would be post-mortemed. Why? Because the final judgment about whether or not clinical judgment was correct comes in the court of the full and rigorous autopsy of the pathologist. There is no other way of being certain. Even then, one may not get a final answer.

What has happened over the last few years is that we have achieved not the 10 per cent figure but the almost complete disappearance of such post-mortems. Many histopathologists, especially those who are newly qualified, will no longer carry out post-mortems. The Royal College of Pathologists is looking at whether it should allow pathologists to qualify without having proper experience in post-mortems, because so few of them are being done. One cannot talk about increased public confidence in post-mortems if the outcome has been that almost nobody wants permission for them to be done. That expresses a lack of confidence in post-mortems, not increasing confidence.

I will be more specific. In February of last year, the president of the Royal College of Pathologists wrote to the then Secretary of State, the right honourable Andy Burnham MP, with an eight-page letter-for obvious reasons, I cannot quote it in any detail-expressing the Royal College of Pathologists' deep lack of confidence in the work of the HTA. He began the letter by saying that the fall-out of the HTA's actions risked destabilising the provision of post-mortem examination services in England and Wales. He wrote about the concerns not only of the royal college but of

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the coroners' service. He talked about the lack of efficiency, citing the work of the CPA, which undertakes external quality assessments for full laboratory services-in other words, histopathology, haematology, microbiology and clinical chemistry. The fee that the CPA requires for inspecting the entire laboratory service is half that which the HTA requires for inspecting just the mortuary. Even in terms of efficiency, therefore, there are serious questions. When the HTA was established, it had a lot of experienced people who had conducted post-mortems, but that is no longer the case.

If the new Government understand that this is the relationship that has developed between the professional bodies-to the point where pathologists are no longer eager to carry out post-mortems-they would not be responsible if they did not take this issue seriously. Should the Government not ask whether the HTA is the best vehicle to carry out what are undoubted requirements for proper procedures to scrutinise this professional work?

4.48 pm

Lord Alton of Liverpool: My Lords, the noble Baroness has laid before us a Question that rightly draws attention to two issues: public safety and public confidence. They are the issues that the Minister rightly addressed last week when he kindly and courteously invited us to be given a briefing about the Government's intentions.

For me the jury is out on these issues. I would certainly want to see, at the very minimum, a reform of the HFEA. The Minister will recall, as other noble Lords will, the debates that we had during the passage of the Bill, when a number of us argued for the creation of a national bioethics commission to oversee some of these ethical issues. I suppose that I subscribe to the cautionary verse of Hilaire Belloc, who said,

"always keep a-hold of Nurse

For fear of finding something worse".

I would like to see the colour of the Government's money. I want to see precisely what they have in mind before coming to a conclusion.

It is worth going back, as the noble and learned Lord did in his remarks, to the creation of the HFEA. As the noble Baroness, Lady Warnock, has said, it was necessary to create it-these were the words of the Warnock report-

She said that it needed to be an "independent body", that the membership was,

and that its membership was to include,

She also laid great emphasis on what she described as the,

I have a Question on the Order Paper at the moment asking the Minister to update the figures given to us by the noble Lord, Lord Hunt of Kings Heath, during the passage of the legislation two years ago, but the figure that was given then was that some 2 million embryos had been destroyed or experimented on since the passage of the 1990 legislation, so these are not

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trivial questions. The question of the status of the human embryo has always struck me as central to this argument.

I note that the chair of the HFEA, Professor Lisa Jardine, said in the Guardian on 5 January that,

if the HFEA is abolished. In an article in the journal Nature last August, it was suggested that,

The article on Professor Jardine adds that the HFEA,

Perhaps the Minister could tell us whether he has asked how many embryos have been thus spared; surprisingly, the HFEA, via Parliamentary Questions, says that it cannot tell.

Whether it is the unnecessary destruction of human embryos, the dangers caused to women by hyperovulation syndrome-before the Committee met today I passed the Minister a new paper from a German medical magazine about this question, because it goes right to the heart of patient safety-the ethics and mercantile nature of exploiting poorer women through the sale of eggs, an issue that the HFEA is currently considering, or the extraordinary way in which the HFEA has, for instance, pursued Dr Mohamed Taranissi, requiring it to meet legal costs of nearly £190,000, it is obvious, as the current HFEA chief executive stated in a memo, that,

At the very minimum, I think that reform is needed.

I would therefore be grateful to hear how Her Majesty's Government propose that there should be what the Minister himself has described as a "lighter touch". Is that something that people such as me should be fearful of, or should we welcome it? Does it mean that in any sense there will be less regulation? Will the status of the human embryo be diminished further? How will the exercise of the HFEA's powers through this lighter touch be done? Also, how will the Government ensure that the requirements of the Human Fertilisation and Embryology Act, which stand in place, will be adhered to if the HFEA ceases to exist in its present form? Who will be responsible for the transfer of sensitive data that the HFEA holds? How will independence, freedom from undue influence or sectional interests and a diverse range of views be upheld?

4.53 pm

Lord Winston: My Lords, I most grateful to my noble friend Lady Thornton for introducing this debate. It is rather delightful for me to be able, on this rare occasion, to support the Government's position and to support the Minister-at least, I suspect that I will be supporting him. It is a particular delight to see the noble Lord, Lord Wigley, attending this debate; it was he who, in 1985, broke the Speaker's Chair in the debate when the Private Member's Bill came in as part of Enoch Powell's attempt at legislation. I, of course, can declare an interest as an ex-poacher in this area-I no longer run an IVF unit-and I note that I am followed by a noble Baroness who was a gamekeeper.

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I must say that I was open-mouthed at the quality and the succinctness of the speech of the noble and learned Lord, Lord Mackay of Clashfern, when he introduced the HFE Act. It seemed like a model of what should happen. It is fair to say that at the time it was an essential piece of legislation, which has now passed its day. It is no longer necessary; the research that it regulates is not really suitable for regulation by the HFEA. I believe that other areas of medical research, such as paediatrics, obstetrics, geriatrics and assisted dying, in many ways raise much more important ethical issues on a day-to-day basis. With stem cell research, the HFEA is inadequate for the purpose. A completely different body is needed, since stem cell research is ubiquitous and affects every tissue in the body, including the brain and the liver, and will clearly be an important replacement therapy in future. If it is to be regulated, it needs a different kind of touch.

As for clinical regulation, frankly the HFEA cannot prevent accidents or errors. It has not done that and it cannot do that; no regulatory authority can do that completely, any more than any other way of inspecting laboratories can. It does not prevent exploitation of women, who pay massive fees-in my view unreasonably-and has not helped in the costing of IVF treatment. It is unable to prevent fertility tourism, which goes around British legislation on a regular basis, and has not prevented clinics from collaborating with overseas units in allowing their patients to go to places such as Spain and Russia to seek treatment that they cannot offer themselves-with what kind of relationship, I am not sure.

There is a repeated assertion that the HFEA has always assuaged public concerns about IVF. I think that that was true 20 years ago but it is not true any longer. The public are pretty mature about this area, as was shown clearly by the hybrid embryo Bill. Things have moved on and the public are rather more sophisticated.

Lastly, one of my concerns about the HFEA is that it is extremely costly for men and women who are already paying for these services. I have just checked on the cost at Hammersmith Hospital, a clinic that I used to direct. Effectively, the HFEA requires two extra salaries to be paid and individual patients will pay on average around £300 for the use of IVF licences for their treatment. That seems an unfair burden in an area of medicine that is already extremely burdensome for the patients.

4.57 pm

Baroness Williams of Crosby: My Lords, I also congratulate the noble Baroness on securing and introducing this debate. One thing that she pointed to, which concerns many of us, is the extent to which there are huge commercial pressures in this field, which have led in other countries to an almost complete abandonment of what one might describe as the ethical limits that are widely understood in the medical profession. With an issue such as whether a grandmother's frozen eggs should be used for the purposes of fertilisation, one has to say that the difficulty in reaching a proper conclusion rises daily.

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I wish to raise the issue of inspection and the issue raised by my most admired poacher on the question of medical research. First, there clearly has to be some inspection of the clinics that fall under the HFEA. I would be grateful if the Minister could tell us his view of how that inspection will function. It may be more limited than it used to be, as the noble Lord, Lord Winston, and the noble Baroness, Lady Thornton, said, but it must be maintained at the level of day-to-day practice. It is very important that that should be so in order that patients can have some sense of the safety of the enterprise.

On the much bigger issue of medical ethics, raised by the noble Baroness and the noble Lord, we are looking at a tremendous multiplication of the issues around ethics and the massive advance of life sciences. I accept that that cannot be dealt with by the HFEA, with its rather limited terms of reference. We must try to bring together a much more significant body to look at the whole issue of the relationship between ethics and life sciences. In that context, may I sweeten that pill by suggesting to the Minister that one way in which one could develop the great idea of a great society would be to look at a marriage between a body that had status in government terms with the other great bodies that look into these matters-the Nuffield Council on Bioethics, the Royal Society and others? In that way, one might get a genuinely wide spectrum of opinion, including great scientists and ethicists, on the issues that now confront us with life sciences. I believe that, unless we do that, we will quickly run into real problems where dogmatic forces take up resistance to any advances or other dogmatic forces look at the commercial elements as the way to guide our consideration of biological and biochemical ethics in future years.

5 pm

Baroness Deech: My Lords, I declare an interest as the former chair of the HFEA. For most of my tenure I was paid the princely sum of £8,000 per annum, but it was a burden-nearly a full-time burden-that I undertook with pride and viewed as a privilege, grateful that infertility had not affected me. I wished to help others safely and with respect for their dignity, avoiding exploitation, and I remained in awe of the achievement of the scientists.

This debate, for which I am grateful, is about public confidence. It is not about confident, or self-confident, doctors; nor is it about how wonderful and trustworthy our doctors and embryologists are. If that were the issue, we would not need regulation in many walks of professional life and the controversy surrounding the Public Bodies Bill would fade away. It is easy in these surroundings or among researchers and specialists to forget how sensitive the issues of IVF and embryos are, and how very concerned the public are. The most vivid event during the passage of the Human Fertilisation and Embryology Bill three years ago was the hundreds of members of the public protesting outside this Palace about the possible extension of embryo research to animal hybrids. If your name, like mine, is associated with embryo research, you are the recipient of hundreds of letters about it, and not always peaceful or unthreatening ones. As the noble Baroness, Lady Warnock, said in her esteemed report of 1984, the

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public want to know that some principles are involved. It is also not to be forgotten that most of the treatment in this country is private, and therefore a great deal of money is involved and the need for protection is all the greater. European law, as referred to by the noble Lord, Lord Winston, is a weakness in that protection but unavoidable.

Any analogy with the progress of science in the US, which is largely unregulated, is false. The US has been home to some of the scandals that have echoed around the world, whether it was a clinician using his own sperm, octuplets or the sale of eggs and sperm by needy college students for large sums of money. That is not a road that we wish to risk going down, but we are not risking it under the Government's proposal. Those who want to see the HFEA abolished seem to think that there will then be no regulation and that they will be free to do what they want, and quickly. But no-the law will be the same; consent will be needed exactly as before, and so will licences. Taking the processes into other organisations can be guaranteed to be no faster, no less bureaucratic and no cheaper; just worse. IVF is not routine because, although it is practised very often, any one treatment can throw up not only ethical issues that are known to us, such as saviour siblings, but also new ones, as the science progresses every day. One cannot separate the collection of embryos and eggs from patients from their storage, their storage from donation for research, donation for research from new research and stem cell work, and none of that from the great database, patient guidance and reliable statistics and health screening of donors. The risks will be too great and the gains from the government proposal nil, and our international reputation will suffer.

We are talking about an annual expenditure of £7 million, of which only £1.5 million to £2 million comes from the Government, and even this, I am told, could be reduced. Certainly patients will still have to pay for regulation if the tasks of the HFEA are dismembered, so it will be no cheaper for them either. Placing the regulation with the CQC is misguided. This is a new organisation. There have already been hints that it is overburdened and its operations have not always been met with praise. There is no improvement in public confidence there; nor will the public be persuaded that embryos will be treated with respect and that there will be bounds on embryo research if it is handed over to unknowns and not the accountable and expert figures of the HFEA. Review, yes; reversal, no.

5.04 pm

Baroness Warwick of Undercliffe: My Lords, in congratulating my noble friend on the timeliness of this debate, I must declare my interest as chair of the Human Tissue Authority.

As my noble friend said, the authority was set up as a result of the organ retention scandals at Alder Hey and Bristol. The retention of children's organs-including in some cases their hearts-without the consent or knowledge of their parents, rightly created outrage. It resulted in a crisis of public confidence. At the time, David and Hazel Thewlis, representatives of those affected, said:

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"The Human Tissue Act has provided a new foundation for the people of this country ... consent was the cornerstone of the Act, and this must colour all of the work of the Human Tissue Authority".

The authority has put informed consent at the centre of everything it does, and by doing so it has ensured the safe and ethical use of human tissue. I can confidently say that it has turned around the crisis in public confidence. However, it would be misguided to be complacent. The improvement is by no means universal or fully embedded. The reasons why we were set up have not gone away.

I am not hidebound or precious about which bodies should do the work, nor are my authority members. What we are concerned about is ensuring that the advances we have made are not lost, particularly the hard-won confidence of the public in the proper use of organs and tissue. We believe that the current proposals to transfer our functions to three or possibly four different organisations risk undermining the progress that has been made.

Paula O'Leary, of the Alder Hey parents' support group PITY II, said recently:

"We fought hard for 10 years ... who is to say this is not going to start up all over again?".

Roger Goss from Patient Concern said:

"Dividing would be diluting. That would be going back down the hill in terms of protecting patients' rights to exercise informed consent".

The best way of making sure that does not happen is to maintain a clear focus on the safe and ethical use of human tissues and organs across all our sectors. To do that, we need to keep our functions together. That way, we maintain a consistently rigorous approach to consent, and guarantee an individual's right to decide, in life and in death, what happens to their bodies and the bodies of their loved ones.

The HTA is a small organisation with a broad remit. Our activities are interdependent. There are pathologist researchers, and researchers treating patients with tissue. Researchers study organs to improve the success of transplants. They are all regulated by the HTA and the ethical issues are common to all the sectors that we regulate. The gift of organs and tissues is a special one, giving rise to special ethical considerations. During the passage of the Human Tissue Act, consent was described as the golden thread through all our activities. That is why there is a single set of core standards across all the sectors that we regulate under the Act.

We are a lean organisation. The money that we get from the Department of Health is £1 million a year, about one-sixth of our total cost. We have to earn the rest. What we do makes a difference. Last year, we approved 1,100 organ donations from living people. Since we began regulating, these numbers have increased year by year. We work to give more people the gift of life offered by organ transplants. When tissue is used in medical treatments-such as the use of bone marrow stem cells in cancer treatments, or skin for burns victims-people can be confident that they are safe and good quality and have been donated with consent. If stem cells are collected from umbilical cord blood for potential future use, we safeguard the safety of

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mother and child and the quality of the cells. Our regulation of mortuaries means that individuals and their families can have confidence that their loved ones are treated with dignity and respect. In research, too, people can know that tissue will be kept only with their consent or the consent of their family, so they can be confident that their wishes will be respected.

I have no quarrel with the Government's intention to simplify the regulatory landscape. My plea is simply that we do not jeopardise the gains that the HTA has made by spreading its functions across a number of disparate organisations and losing the coherent overall approach that has been so successful in promoting public and professional confidence in the safe and ethical use of tissues and organs.

5.08 pm

Lord Willis of Knaresborough: My Lords, I congratulate the noble Baroness on this debate. Indeed, it is-as the noble Baroness, Lady Deech, said to me when I came into the Room-like Groundhog Day: we are back again debating exactly the same things. I thought that we had put these issues to bed. I do not, in fact, oppose my noble friend's proposals on principle. It is right that we constantly look at the organisations and that we constantly review their procedures to make sure that they meet the times. Nor do I claim infallibility for either the HFEA or the HTA. They are not infallible and are in constant need of reform and refreshment. However, it is the lack of clarity over what is proposed, the lack of any consultation on the proposals, and in particular the lack of any public involvement in these proposals that makes me concerned about the future functions of both the HTA and the HFEA.

On 13 October last year, in response to a Question from the noble Baroness, Lady Deech, the Minister said that,

He went on to say:

"Times have moved on".-[Official Report, 13/10/10; col. 512.]

However, it was not 20 years ago that Parliament discussed this issue; in fact, it was three years. It is three years since the Joint Committee on the Human Tissue and Embryos (Draft) Bill, which I was privileged to chair-four members of that committee are in the Moses Room today-carried out detailed scrutiny of proposals to amalgamate the HFEA, the Human Tissue Authority and the MHRA into a single authority, RATE. The unanimous view of the committee and of Parliament during debate on the successor Bill was to retain separate regulators. No one proposed amendments to change that during the passage of the Bill. There was unanimity in both Houses that the use and practice of both tissue and embryos should remain separate and that they should in fact have separate regulators. What is more, that was the overwhelming view of the medical and scientific community, including the Royal College of Obstetricians and Gynaecologists, the BMA, the Royal Society, the Association of Medical Research Charities, the Academy of Medical Science, the Royal College of Nursing, the Wellcome Trust, the MRC and the Royal College of Pathologists. What has changed since 2008 to mean that all that is no longer appropriate?

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The Joint Committee also carefully considered the regulation of research using not only human embryos but also admixed embryos, including cytoplasmic hybrid embryos. The fact that a single regulatory authority could make decisions in the round-recognising that groundbreaking research was but a short step away from clinical practice-appeared to us at the time to be a distinct advantage. I believe that it remains a distinct advantage today. Indeed, it is because a single authority, independent of the Government, was able to exercise its regulatory duties over all activities involving the human embryo that confidence in this extremely sensitive, ethical and emotive area of human science has progressed with support from the public. Also, because there was an experienced independent regulator, science was able to triumph over the reactionary views of the then health Chief Medical Officer, who regarded admixed embryos as "Yuk".

Crucially, where is the evidence that such change as is being proposed will benefit science and clinical practice and improve public confidence? Of course, there is a strong argument-the noble Lord, Lord Winston, made it in our committee-that fertility treatments using embryos are now commonplace and should be regulated like any other medical procedures. If the Minister believes that, let us have a public debate about it. Likewise, if the recent report of the Academy of Medical Sciences into the broader issue of the regulation and governance of medical research is going to be the blueprint for the new proposals, let us have a public consultation and a public debate on it. Let us not rush into removing organisations that have huge public confidence and the confidence of clinicians, as it would be rather like throwing out the baby with the bathwater.

5.13 pm

Baroness Wheeler: My Lords, I, too, thank my noble friend Lady Thornton for initiating this debate, as well as other noble Lords who have spoken with much experience and in-depth knowledge on this matter. It is particularly timely as the Government consider their response to the major concerns about the inclusion of the HFEA and HTA among the bodies to be abolished under the Public Bodies Bill, whose Committee stage discussions we are set to resume.

As has been stated, we on these Benches can speak with some authority on this matter, having, as the House will be aware, closely examined the case for merging the HFEA and HTA into a single body just over two years ago while we were in Government. We came to the firm conclusion that two distinct independent regulatory bodies needed to be retained to oversee the areas of human tissue and assisted reproduction.

As the BMA has stated, the UK has been well served by the HFEA and the HTA, and both have been used as models for other jurisdictions in dealing with extremely technical and legally complex areas of practice. The RCN has said in respect of the HFEA that the current high level of expertise and experience within the body is extremely valuable and that it would not be in the public interest to transfer regulatory functions to other organisations, as this knowledge might be lost to the detriment of patient safety. The

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HFEA's chair, Professor Lisa Jardine, has described areas covered by the HFEA as the most controversial area of medicine apart from assisted dying, the most morally difficult and carefully legislated-for area and the most tightly regulated.

The HTA, born out of the terrible events at Alder Hey and Bristol hospitals, and the crisis in public confidence over unauthorised retention of babies' organs and tissues, has in our view established hard-won trust and respect among the public and professionals. My noble friend Lady Warwick is right to express concern that this will be lost if the current clear focus of the HTA is diminished in the transfer of its functions and role.

This does not mean that we do not recognise the scope for review and change within either body, or how the regulatory framework may be developed in the future. Both bodies themselves acknowledge this. We also recognise that many in the key professional groups involved are supportive of such changes as bringing all medical research regulation, including embryo research, within the remit of a single medical research regulatory authority, as recommended by the Academy of Medical Sciences. However, time and space would be needed for independent examination and review of this and the broader issues of how functions should be delivered in future and the risks, benefits and costs, rather than just the current focus on how functions are to be transferred.

We are concerned that the Government's process is to transfer functions to bodies that are as yet undeveloped and untested in this area of expertise. The Care Quality Commission is very much an organisation in transition and development, as it plans to take on a range of new duties and work envisaged in the Health and Social Care Bill. The role and possible functions of the new medical research body, and of the health and social care information centre, need much more work and development. All this is in the context of the Department of Health having its work cut out, taking on a huge volume of work, responsibilities and functions that will come its way from the abolition or reorganisation of many of the other bodies due to be axed in the Public Bodies Bill.

This is also at a time when the Government themselves are committed to large-scale staff reductions in the Department of Health. There are also key issues of accountability and independence at stake. Professional bodies and clinicians directly regulated by the HFEA, for example, of course have a key view of the changes needed, but they are not the only stakeholders, as speakers in this afternoon's debate have underlined.

Dismantling the HFEA and HTA, diluting their accountability and handing over their powers to Ministers and civil servants on such sensitive issues needs public involvement and stakeholder conversation, as speakers have pointed out. How would the new organisations be independently scrutinised and accountable? How much money would be saved from transferring the functions of the HFEA and HTA to the CSQ and new bodies? Will the Minister explain in more detail the timetable that he is currently working to for consultation and development of the new framework?

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We on these Benches again urge the Government to reconsider their position and remove the HFEA and HTA from the bodies to be deleted under Schedule 5.

5.17 pm

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): I start by expressing my thanks to the noble Baroness, Lady Thornton, for tabling this debate, and to all speakers for raising their concerns on this very important set of issues. Let me say immediately that the need to maintain public confidence in every part of the NHS is absolutely vital, particularly in areas as delicate as embryology and human tissue.

I can offer your Lordships absolute reassurance today that our plans do not represent any threat to patient safety, nor to the safeguards held within the legislative framework of provisions within the Human Fertilisation and Embryology Act and the Human Tissue Act.

The Department of Health carried out its review of arm's-length bodies and published its recommendation in July 2010. We recognise the important role that the Human Fertilisation and Embryology Authority and the Human Tissue Authority have played in the regulation of their respective areas over the years. We thank them sincerely for it. Our recommendations in respect of these bodies took account of the complexities and sensitivities attached to the particular areas in which they operate.

We are not rushing. We have allowed for the full length of the planned Parliament to take these changes to their conclusion. That is far longer than any other change proposed within the department's review, a decision that reflects both the importance of the two bodies and a recognition that we need to consult fully on, and settle, the detail of all the changes. However, we are clear that a more joined-up system needs to be formed.

With the establishment of the Care Quality Commission, and the Academy of Medical Sciences' recommendation for a new health research agency, new alternative structures have become available to ensure a more cohesive system for both healthcare and health research regulation that will benefit patients, health professionals and researchers. It is therefore our intention that the healthcare-related licensing functions of the HFEA and HTA will transfer to the CQC.

The CQC already regulates a wide range of NHS and independent healthcare providers. It registers them and ensures that they are meeting essential standards of safety and quality. It takes action if services drop below these essential standards and acts quickly if people's rights or safety are at risk. It undertakes investigations where there are concerns about quality, seeks the views of people who use services and informs people about the quality of those services. Noble Lords will recognise that this is similar to the roles undertaken by the HFEA and HTA, on a smaller scale, in respect of the regulation of infertility treatment and activities involving the use of human tissue.

We estimate that about 80 per cent of the centres currently licensed by the HFEA are either regulated by the CQC or in premises that it regulates. The CQC

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also covers 60 per cent of the centres licensed by the HTA. It therefore seems wasteful, and indeed unsustainable, to continue to have these regulatory systems running in parallel. It makes sense to streamline, and ultimately to trust the CQC with the responsibility. There is no reason why the CQC should not be able to fulfil that responsibility as effectively as do the HFEA and HTA now.

The noble Baroness, Lady Thornton, asked about the multiple birth policy. That is an issue that concerns the safety of patients and their children, and it would fit very well into the CQC's remit.

Noble Lords will be aware of the Academy of Medical Sciences' report on the regulation and governance of medical research. The report has made recommendations for simplifying the complex framework of regulation. In particular, it suggests the introduction of a new health research agency. The report has been embraced by a wide range of groups and experts. It recognises that there are significant benefits in bringing all medical research regulation, including embryo research, within the remit of a single medical research regulatory authority. The Government welcome the report and are considering their response.

The noble Lord, Lord Alton, referred to Lisa Jardine's comments about the threat to the status of the embryo. I emphasise that the intention is to co-ordinate health research regulation better so that the system is streamlined without changing or compromising the safeguards. Current quality and ethical safeguards for research involving the use of a human embryo, for example, must be necessary for the research to be approved, and will remain very firmly in place. It is worth reflecting that, although the statutory requirement that the use of embryos is necessary and that the research is necessary or desirable will remain in place, a research regulatory authority with a broad outlook across medical research would be well positioned to make that assessment.

The noble Baroness, Lady Thornton, asked who would be the keeper of ethical safeguards. I would say simply that the ethical safeguards are laid out in legislation, as agreed by Parliament.

The noble Baroness, Lady Deech, suggested that those in favour of the Government's proposals think that they will not be regulated at all. I have not gained that impression. The letters from professional bodies-the British Fertility Society, the Royal College of Obstetricians and Gynaecologists and leading clinicians-show clearly that they understand that regulation and legislative provisions will remain firmly in place.

There are three key points that I want to make at this juncture. First-I say this especially to my noble friend Lord Willis-my department is planning to undertake a public consultation exercise this summer about where HFEA and HTA functions are best transferred. We regard this as a key part of the process. We will consult on any subsequent use of powers agreed in the Public Bodies Bill to effect those transfers. Effectively, therefore, there will be two consultations.

The noble Lord, Lord Alton, understandably said that he would like to see the colour of the Government's money before reaching a view on these issues. As yet, no final decisions have been reached on exactly which

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functions will go to the CQC, the potential health research agency, the Health and Social Care Information Centre or elsewhere. The exact detail of how the powers in the Public Bodies Bill might be used will be considered further and in detailed discussion with the HFEA, HTA, CQC and key stakeholders and in public consultation.

Secondly, our plans are about streamlining the functions of the regulatory bodies concerned. I regard that as the precursor to the lighter touch referred to by the noble Lord, Lord Alton. The lighter touch itself will revolve around the design of systems, which will ensure that the burden of bureaucracy is lessened overall for the NHS and other organisations. The CQC and the HFEA will play a leading role in the development of an efficient approach.

I stress again that, despite what some commentators have said, there is no intention to revisit the ethical provisions and safeguards in the HFE Act, the principles set out in the Warnock report, or the principles of consent underpinning the Human Tissue Act. The proposed powers in the Public Bodies Bill could not be used to do any of those things. The noble Baroness, Lady Thornton, asked what had changed regarding the principles that were debated at length in both Houses of Parliament. The answer is: nothing. The HFE Act provisions that recognise the special status of the human embryo will remain in place, entirely as they are now, as will the provisions in the Human Tissue Act that ensure that donors' and families' rights and safety are protected.

The noble Baroness, Lady Thornton, said that she did not have a closed mind to some sort of reorganisation of functions, and I am hope I am right in detecting the same message from the noble Baronesses, Lady Deech and Lady Warwick, and my noble friend Lord Willis. That is welcome. All would say, as I have explained on previous occasions, is that if we cannot secure a place for the HFEA and HTA with the Public Bodies Bill then we will have to look to a future health Bill to support the transfer of functions, however we decide that that transfer should be conducted. However, to move into primary legislation would mean that the safeguards enshrined within the HFEA and HTA Acts would then be open to parliamentary scrutiny and vulnerable to amendment. I know that very few noble Lords would relish that scenario.

Thirdly, we envisage that our proposals should offer benefits to patients, healthcare professionals and researchers. We want the streamlining of regulation and reduction in the number of regulators to mean a less burdensome and bureaucratic system, both for the NHS and for the independent sector. We will work with the HFEA and HTA to try to ensure that those with the necessary expertise will follow their functions to the new arrangements so that it is not lost.

We have received significant numbers of representations from professional bodies and clinicians who are directly regulated by the HFEA, expressing support for the Government's proposal to include the HFEA in the Public Bodies Bill. Many also expressed concern about the HFEA's current approach to regulation. I have placed these in the Library.

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My noble friend Lady Williams asked about legitimate public concerns about patient safety. I point out that the EU tissues and cell directive sets out robust provisions for safety and quality, covering assisted reproduction and the human application of tissue and cells. The role of competent authority to regulate against the requirements of the directive and standards for quality and safety will remain in place to ensure that patient safety remains a key consideration.

The noble Lord, Lord Alton, asked where the Government saw the information functions going. We will have to consult on that issue carefully with all the bodies concerned. We will give due regard to the sensitivity and confidentiality of the nature of the information currently held by the HFEA and HTA, and we envisage that it will be a key area on which we will consult.

My noble and learned friend Lord Mackay and my noble friend Lord Willis referred to the proposal two or three years ago to form RATE. This is a completely different proposal; RATE simply involved replacing the HFEA and HTA with a single organisation that would undertake all the functions of the two bodies in their entirety. The proposal was rejected because the benefits of doing so for embryo research, for example, were not apparent. The current proposal to indentify where individual functions might best be placed is a different approach and has more potential obvious benefits, such as more streamlining and cohesion.

My noble friend Lady Williams asked why the Government did not set up a national bioethics committee. The consideration of specific ethical issues by bodies such as Nuffield and parliamentary scrutiny committees remains the preferred approach.

Education: Children with Diabetes


5.32 pm

Asked By Lord Kennedy of Southwark

Lord Kennedy of Southwark: First, I declare that I have type 2 diabetes, having been diagnosed with the condition nearly two years ago. I am a member of the charity Diabetes UK and actively support its work.

I thank the Minister, the noble Lord, Lord Hill, for being here to respond to this debate. I am sure he has a busy diary and his attendance is very much appreciated. I am delighted that my noble friend Lady Young of Old Scone is also taking part. She is the chief executive of Diabetes UK, and I think it is fair to say that we are all looking forward to her informed contribution to this debate. I also look forward to the maiden speech of the noble Lord, Lord Lexden.

Too many children with type 1 diabetes get a raw deal at school. Many of our children are excluded from school trips or social events; they are excluded from PE lessons; they are prevented from eating the

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snacks they need when they need them; they are denied access to their medicines when they need them because they are "safely locked away"; and they experience bullying. Many young children are also left to inject insulin themselves, leading to increased fear and anxiety for their parents. It is therefore not just the children with diabetes who get a raw deal; their parents do too.

As well as the worry that parents feel for their children, many are forced to give up work because schools refuse support if a child is unaccompanied by a parent. Diabetes UK continually hears from parents who are unable to work because they have to go into school to administer medicine. Diabetes UK also continually hears from parents who have to fight for basic support from a school and they do not always get it. Some children have even been forced to move schools. They have heart-breaking stories, and there is an emotional and financial strain on families.

At this point, I congratulate Diabetes UK, which has established an advocacy service offering vital help for families struggling with these issues. Diabetes UK deals with around 100 enquiries a month. I also commend the charity for its long-running efforts to improve the lives of all children with diabetes at school.

Noble Lords may ask: why does this issue matter when only a small number of children live with type l diabetes? However, it is not a small number. More than half of our schools have children with diabetes. In recent times, childhood obesity and poor food choices leading to type 2 diabetes have been the focus of attention. While these issues should not be ignored, only 1,400 children in the UK have that form of diabetes. However, 20,000 children under the age of 15 have type 1 diabetes. Its incidence is increasing, particularly in the under-fives, where the number affected has increased fivefold over the past two decades. Two thousand children are diagnosed with type 1 diabetes every year.

Children with diabetes have as much right as any other children to a decent quality of education and school experience, yet their school experience varies greatly from no school support and very patchy support to good, child-centred provision. Many of our schools are failing to help children with diabetes to participate fully in learning and school life. Worse still, a lack of education among pupils, parents and teachers leads to bullying and children struggling to fit in. That increases their anxiety about being "different"-a feeling which could affect their confidence level in school and throughout life.

David, a boy from a school in Northamptonshire who was diagnosed with type 1 diabetes when he was three, got upset when a girl told him that she was not allowed to play with him in case she caught his diabetes. Another boy used to call him "Diabetes Boy". He remembers how he was not invited to play at his friends' houses, as their parents were scared that they could not deal properly with his diabetes if they needed to.

Children with type 1 diabetes are at risk of heart disease, blindness, amputations and kidney failure, so proper control of their condition is imperative. It is vital to keep their blood sugar regulated, avoiding fluctuations. Regular blood-sugar tests and injections, sometimes up to four or five times a day, are necessary

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to avoid life-threatening complications. These tests and injections have to take place during school. It is not a choice; it is a necessity. Insulin, via injection or pump, sometimes several times a day, is vital for life. At a school in Warwickshire, Jane, a young girl, was diagnosed with type 1 diabetes at the age of 11. She was told not to inject herself in public as it was "disgusting", but these injections have to take place during the school day.

Too many schools are uncomfortable about dealing with children with diabetes. Another school was not treating a six year-old's "hypos" when they occurred, nor telling the child's parents. It also refused to do the blood glucose monitoring test because staff felt too squeamish.

Many schools lack knowledge and have a fear of liability. In one school, although it had a nurse to assist children with diabetes, children were excluded when the nurse was on leave or absent, and pupils were made to wait outside the school gates until the nurse arrived each morning. There are some reports of schools expecting parents to ignore clinical advice and change a child's testing and injection regime to suit the schools' scheduling. Surely this should be the other way round.

Five year-olds banned from school sports days; schools refusing to hold supplies of insulin or blood-testing kits; worse still, schools refusing to have children with diabetes in their classes; a nurse refusing treatment to a toddler-the list of shocking accounts goes on. Some schools believe that administering medicine is not their responsibility. A Diabetes UK survey showed that, although more than half of schools were aware that they had pupils with diabetes, 70 per cent required either that such children injected themselves or that their parents came in to do it. Only 16 per cent allowed staff to test and give medicines to pupils.

That is why more than 80 per cent of five to 11 year-old children with diabetes are failing to achieve good control of their condition. This is the worst level in Europe. It means increased health problems for our children and worsening health as they enter adulthood. It is a preventable strain on the resources of the NHS and a preventable level of suffering.

We should have policies and procedures that protect our children, not put their health at risk. Too many children struggle to keep their diabetes under control. Schools need to be part of the solution, not the cause of the problem. They have a vital part to play in supporting the daily management of diabetes in children.

There are some great schools which support children with diabetes very well. The right attitude and leadership at a school can make a huge difference. Their good practice needs to become standard practice in all schools. All children with diabetes should be known to the school, with individual care plans prepared with the child, parent, doctor and teacher. Good practice involves a positive school attitude, a child-centred approach and a high level of training for the staff. The aim in every school, or at least every school with a child with diabetes, should be to train all teachers and support staff. Government need to be proactive and strengthen existing legislation so that children with

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diabetes or any health condition are recognised as a vulnerable group and their well-being is properly supported.

The plight faced by children with diabetes at school exemplifies fundamental failings in public policy, bringing health and education together at a national and local level. Effective partnerships need to be built, and schools need to be required to provide staff training so that teachers have the confidence to support children with diabetes properly and ensure that the guidance is followed. Inspection is the key to ensuring the proper implementation of policies and procedures. We need to establish standards in schools for the support of children with specific health conditions and place a duty on Ofsted to monitor whether that is provided.

Do the Government know the number of children in our schools with long-term conditions and the numbers for each condition? It is only with accurate information that the Government can know the amount and type of support needed to plan accordingly. As Ed Balls, Labour's former Secretary of State for Children, Schools and Families, said, we want this to be the best place for children to grow up. That is why Every Child Matters. Every child needs the chance to fulfil their full potential.

In conclusion, I ask the Minister to agree to meet the delegation from Diabetes UK and myself to explore what can be done to improve the situation. I do not believe that this involves huge costs; rather, it involves a willingness and a desire to see the situation improved. As Daniel at age five said: "I like school, but school doesn't like me".

5.41 pm

Baroness Walmsley: My Lords, the recent report from Diabetes UK published last November claims that inequalities in support for children with diabetes in England's primary schools could be putting the health of up to 84 per cent of five to 11 year-olds with the condition at risk. It found that only 16 per cent of schools that have such children on the roll have a medication policy and administer vital insulin. This issue is not confined to diabetes; it is broader than that. There are other serious but manageable conditions which children have for which this is an issue.

I was surprised to read that this is not really a minority issue, since 52 per cent of primary schools have at least one child with this condition and, of course, other schools have epileptic children and those with serious nut allergies and so on. All require special attention to the needs of the child. I was horrified to read in the report that, when the school cannot administer insulin during school hours, often the parents have to come in to do so, jeopardising their opportunities to hold down a paid job.

When considering matters such as this I always turn to my bible, the UN Convention on the Rights of the Child, to which this country has been a signatory for 20 years. There are five articles in the convention which are relevant to this issue and, taken together, enshrine the rights of diabetic children as well as all others. Article 4 on the protection of rights says:

"Governments have a responsibility to take all available measures to make sure children's rights are respected, protected and fulfilled".

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Article 6 on survival and development says:

"Children have the right to live. Governments should ensure that children survive and develop healthily".

Article 23, on children with disabilities, says:

"Children who have any kind of disability have the right to special care and support, as well as all the rights in the Convention, so that they can live full and independent lives".

We do not normally consider diabetes as a disability but, for these purposes, these rights are relevant. Then there is Article 24 on health and health services, which says:

"Children have the right to good quality health care",

the best possible in that country. Finally, Article 28, on the right to education, says:

"All children have the right to a primary education, which should be free".

It also says that any form of school discipline should take into account the child's human dignity. Excluding the child from school just because a nurse is not on the premises flouts their rate to an education. Certainly asking a child to inject their insulin in the school toilets flouts their right to dignity.

In this country, as with all other state signatories, every child has the same rights as every other. I therefore support Diabetes UK in some of its demands on the Government. It wants diabetic children to be viewed as vulnerable children. It wants the forthcoming child health strategy to spell out how the Government will ensure implementation of relevant policy in schools. This becomes particularly difficult when we have so many state-maintained independent academies, some of which will be primary schools. Being autonomous makes them a little more difficult for the state to control. That is the whole point of academies; they are not controlled by the state. How will we ensure that they take adequate care of these vulnerable children? Perhaps the Minister will tell us.

Diabetes UK is calling for Ofsted to routinely inspect whether schools have clear medication policies, but how can they do that when their remit is to be slimmed down to four planks? Which part of the Ofsted inspection will cover the health of children with long-term life-threatening diseases? The charity also asks for partnership working between schools, local authorities and PCTs. However, PCTs are being abolished, and academies will not have such close relationships with local authorities as those of community schools. How will diabetic children fare under these new regimes? I will be interested in hearing from the Minister on this.

It is a national disgrace that we have the highest number of children with diabetes in Europe and the lowest number attaining good control of blood sugar. As we have heard, only some 20 per cent do. Questions have to be asked about why we have such a large number of children with diabetes, and I assume that for some of those children the answer lies in obesity and lack of exercise. What are the Government doing to address childhood obesity and ensure that all children have the opportunity for enjoyable sport and other forms of exercise, such as dance and cheerleading, which do not always have a competitive element? If we do not address these issues, we will store up health problems and cost for the future, as the noble Lord, Lord Kennedy of Southwark, said in his excellent

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opening speech. Children with diabetes should not be excluded from lessons such as PE-they actually need exercise to help them to control their blood sugar-to extracurricular activities and school trips. Their human dignity requires that they have proper opportunities for injecting insulin, where necessary, in hygienic conditions.

I am pleased that the Education Bill published last week retains the duty on schools to promote the well-being of their pupils. In some cases, such as those of children with disabilities and conditions such as diabetes, that requires special measures because these are special children. Is that duty enough, or does the Minister think that other measures are required to ensure that schools take that duty seriously?

5.47 pm

Lord Lexden: My Lords, Tories above all love traditions. A new Member of this House, deeply conscious of the privilege of entering it, immediately encounters one of its most agreeable traditions. I refer of course to the immense warmth of the welcome given to the new arrival by noble Lords on all sides and by the ever-helpful officials who provide a kindly answer to every question. I am deeply grateful.

Sir Lewis Namier, the great historian of the pre-1832 unreformed Parliament, once declared with playful and light-hearted exaggeration that,

"In the eighteenth century peers made their tutors under-secretaries; in the twentieth under-secretaries make their tutors peers".

I wish that Namier was still around to make a merry quip about the fact that in the 21st century a Prime Minister has elevated someone who acted as his political tutor, if only in a minor respect. I stress the word "minor" because my right honourable friend the Prime Minister, with his instinctive grasp of politics, needed little guidance as he passed through the Conservative Research Department, which I helped to run in the 1980s and 1990s.

The Conservative Research Department, now as then, is refreshingly free from ideological fervour, as every true Tory institution should be. That has enabled it to supply recruits for the Labour, as well as the Tory, Benches in this House. It nurtured the late Lord Longford, and 30 years ago the Conservative Research Department was adorned by the noble Lord, Lord Howarth of Newport. Two former members who did not defect, my kind and noble friends Lord Cope of Berkeley and Lord Black of Brentwood, have guided my prentice steps in this House as my sponsors.

I have lived my life thus far as Alistair Cooke. Long shadows have fallen on me, cast first by the world-famous writer and broadcaster and now by a fine England batsman. Re-emerging as Lord Lexden, I am liberated from what could have been a lifetime's sense of inferiority.

Lexden, on the outskirts of Colchester in Essex, was where I was born and brought up. My father, a much loved GP for some 40 years, took a deep interest in the welfare of all children, but particularly of those with diabetes.

Lexden was the scene of a notable engagement between the Roman invaders and the ancient Britons. Every day on my way to school, I passed the earthen

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defences that the Romans had overwhelmed before making Colchester one of the principal centres of their power. This was the genesis of the historical interests that have always mattered to me more than anything else.

One other place is never far from my thoughts: Northern Ireland. I taught for some years at Queen's University in Belfast before becoming political adviser to Airey Neave in 1977. At that time, Britain often gave the impression of wanting to wash its hands of Ulster altogether. Today there is a lesser, but still grave, danger: indifference. The Province has a devolved Government. Why not leave it entirely to its own devices? I believe strongly that progress in Ulster will be greatly assisted if its affairs feature in a wider British context rather than being relegated entirely to a purely local one. I hope to play a part in achieving this.

The subject of today's debate illustrates the point. The recent formation of an all-party diabetes group in the Northern Ireland Assembly creates a new focus on the issue there, while the highly regarded national organisation, Diabetes UK, embraces Northern Ireland within its work. One complements the other.

There are today some 20,000 children of school age in the United Kingdom with diabetes, of whom around 1,000 live in Northern Ireland. During my time as general secretary of the Independent Schools Council, in the course of which I visited many excellent Ulster schools, such as the Royal Belfast Academical Institution and St Malachy's College in Belfast, I had numerous opportunities to admire the resilience and determination with which such children strive to reach high standards and so lay the basis for success in their subsequent careers. I have always been greatly struck by the indomitable spirit shown by children with diabetes as they make their way through the various rounds of the Northern Ireland Schools Debating Competition, of which I have the honour to be president.

Children with diabetes and their families have in Diabetes UK a formidable champion of their interests. Naturally, its overall aim is to encourage all schools to follow the practice of the best, where, every day, children with diabetes enjoy a full school life because they receive the support they need. But in some schools there are undoubtedly problems to be overcome, as the detailed surveys and inquiries conducted by Diabetes UK show-the noble Lord, Lord Kennedy of Southwark, referred graphically to them. Staff are sometimes reluctant to help with insulin injections, a point to which the noble Baroness, Lady Walmsley, referred. That undoubtedly adds to the great burden on families. In a Diabetes UK survey in 2009, 35 per cent of the young people who responded said their parents either had to give up work or reduce their hours of work to support them with their diabetes in school. This is a matter of particular concern to the Northern Ireland representatives of Diabetes UK.

The problems could often be swiftly alleviated if schools followed the advice that Diabetes UK has provided in its excellent publications. Perhaps the most important is the admirably succinct Children with Diabetes at School: What All Staff Need to Know. It lives up to

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its title. To ensure that staff indeed know, governors and heads need to establish and enforce arrangements that are appropriate for their individual schools. In this, they face a particularly urgent challenge that emerges in so many areas of school life today: to reverse the intense pressure that teachers have felt for far too long to keep their distance from their pupils in case a close association is misunderstood. That simple, yet profound, factor has impeded progress in our school system. The Government have recently made clear their support for change to overturn this harmful trend. That would do an immense service to children with diabetes who, along with others suffering from serious health problems, need a close association with dedicated and sympathetic teachers.

I hope that this important debate in the House will assist the start of that urgently needed process. I am very grateful to the noble Lord, Lord Kennedy of Southwark, who initiated this debate, for giving me this opportunity to address the House for the first time.

5.55 pm

Baroness Young of Old Scone: My Lords, I congratulate the noble Lord, Lord Lexden, on his dextrous maiden speech, which I suppose is an appropriate term for someone who bears the name of a batsman. He is of course steeped in the history and politics of the Conservative variety. Before he came to your Lordships' House, he was instrumental in writing a history of 175 years of the Carlton Club and 80 years of the Conservative Research Department. I am sure that his historical perspective on politics will come in useful in these days of new experiments in government. As the noble Lord said, the Conservative Research Department was the cradle in which many illustrious Conservative Members of your Lordships' House and the other place cut their teeth. I thank the noble Lord on behalf of your Lordships and on your behalf, if I may, wish him a fulfilling time in this House.

I also thank the noble Lord for cutting his maiden teeth on an important issue regarding diabetes. I of course declare an interest, which has already been revealed by other noble Lords, in that I am the chief executive of Diabetes UK. I thank the noble Lord, Lord Kennedy, for initiating this important debate and for his kind words about Diabetes UK, and I thank other noble Lords who have spoken and who will contribute on this heart-rending issue; 20,000 children under 15 have type 1 diabetes, another 1,400 have type 2 diabetes and an increasing number have both types. Noble Lords have given us many statistics and told heart-rending stories, and although many children every day enjoy a full school life, others struggle with control of their condition, without having to deal with the other disadvantages that other noble Lords have mentioned.

Every child with diabetes should be entitled to the full opportunities of education and not be dependent on parents, many of whom, in these straitened times, simply cannot afford to give up work. I want briefly to add my voice to calls for what is needed to allow that to happen. There should, in particular, be an end to inadequate and variable levels of funding for support in schools. If statementing is inappropriate for these children, what mechanism is? There needs to be more

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access to diabetic teaching assistants and to proper education for teachers, and fellow pupils, to gain an understanding of diabetes and other support that pupils need from time to time.

Can the Minister assure us that the Government will put clear and specific duties on schools and local authorities to ensure continuity of care, in order that children with diabetes can benefit from a proper education? We need an end to the postcode lottery. I hope that there is no increased use of the phrase which struck terror into my heart when I was in conversation about the postcode lottery in healthcare-that this was "no longer a postcode lottery but postcode democracy". I hope that the excuse of decisions being made on a local basis is not used to support very uneven standards of care and support for these children in schools. I ask the Minister to ensure that all schools be required to have a medical policy to define how they support the health needs of children with long-term conditions; there are more than 1 million children with long-term conditions in schools. There needs to be clarity of responsibility for funding support for children with diabetes in school and an end to the ping-pong between health and education authorities, which are both anxious to pass responsibility for support for these children backwards and forwards. There needs to be clarity on who is responsible and who can be held responsible.

Ideally, we would like to see a full-time qualified nurse for each secondary school and for each cluster of primary schools to help support children with diabetes. Also, as the noble Lord, Lord Kennedy, said, we need an individual healthcare plan for each child that is prepared jointly between the child, the parents, the doctors and the teachers, and regularly updated. I hope the Minister can tell us how appropriate healthcare can be assured in educational settings, because it is not just about supporting these very vulnerable and often heavily challenged children in their school lives. It is also about reducing the long-term financial costs of the condition to the NHS, reducing the adverse economic costs and emotional impacts on families, and ensuring that these children have a less tough time than they currently do, as well as achieving physical and economic well-being later in life.

6 pm

Lord Harrison: My Lords, I, too, congratulate the noble Lord, Lord Kennedy, on being our cheerleader today in this debate. I congratulate the noble Lord, Lord Lexden, on his excellent maiden speech. Is he sure he is not a batsman with that maiden over? There are moves to bring together the parliamentarians of the four nations of the United Kingdom; in fact, I think we propose to travel to Belfast to meet our colleagues there and perhaps learn more about what happens in Northern Ireland.

I congratulate the noble Baroness, Lady Young of Old Scone, who is clearly now well into the job of being executive director of Diabetes UK, and I declare an interest as vice-chair of the all-party group.

I contracted type 1 diabetes at the age of 21, and a few months later my nephew, then aged seven, contracted type 1 diabetes. His mother is my sister. When that happens in a family it affects the child and the parent

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or guardian, but also the wider family and the community. For the child in those days, when you had to do an insulin injection with all the equipment that existed then, it was a terrible business. These days we have wonderful insulin pens which you can get in many colours, and which at least look interesting when the child is with other school children.

The parent of a diabetic child is particularly affected, because they have to work even harder. Parents are always zealous to ensure that the education of their children is secured, but it means that they have to work out a balance within the family. There may be other children, a partner and so forth, and the wider family is also affected. I felt guilty that my nephew, a seven year-old, had contracted diabetes, when I had contracted it at the age of 21 just a few months earlier. I somehow felt that it was a responsibility of mine. Of course, it affects the wider community, which is why the noble Lord, Lord Kennedy, pointed out the effect on schools receiving children who are diabetic.

I want to talk about something positive. Some two or three years ago, the noble Baroness, Lady Young, might like to know, Diabetes UK put on an absolutely wonderful event in the House of Commons which brought together about 100 children with 100 carers to meet us as parliamentarians. I was exhilarated that day, and I felt absolutely humbled, not only to meet these youngsters of seven, eight or nine but also to meet the parents. One of the things that I observed was that, for a change, the children were meeting other children who were in the same boat, and the mothers-and they were principally mothers-were meeting other mothers and carers. That is my great worry. That occasion was thrilling, but so often within the school context the child, the carer or parent is isolated. We must redouble our efforts to remember that and to give further and greater help.

I refer to another event which the noble Lord, Lord Hill, might like to find out a little more about. Two or three years ago, a school from the West Country came up to address parliamentarians in the House of Commons. What was unique about the visitors was that they brought all the children from a particular class who had grown up with children who developed diabetes during their school years. These children had a better understanding of diabetes because the school had made an effort to teach them about it. Their rallying round was thrilling and clearly provided a wonderful support service for those with diabetes. I do not know whether that school still exists and whether we can find out more about it but their experience should be replicated. For the children who were not diabetic it was not a burden; it contributed to their better understanding of treating people who are afflicted by this disease.

Although I think that the noble Lord, Lord Hill, has already been asked this question, I want to ask him about the clarity of responsibility in placing specific duties on schools and local authorities through upcoming legislation to ensure that there is support and continuity of care at schools for diabetic children, as that is crucial. There needs to be a thread running through the legislation to provide that protection. We need to

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end the current patchwork quilt of varied support up and down the country, and we also need sufficient and accessible funding to help all those who are involved in looking after diabetic children. Again, schools, local authorities and health authorities need to work together. We need to ensure that all schoolchildren with diabetes can take part in all aspects of schooling. Never again must kids be excluded because of the misunderstandings that exist. Would the Minister care to say something about the possibility of having a full-time nurse in all secondary schools, or at least a full-time nurse in a cluster of primary schools? She-it normally is a "she"-can be crucial in spreading the news to teachers about looking out for the child who is diabetic and who perhaps is suffering a hypoglycaemic reaction, or "hypo". That needs to be better understood.

We need better healthcare planning within schools. We need to ensure that each school has a medical policy for children with long-term medical conditions, who I believe number something like 1 million in the community. Each diabetic child should have an individual and regularly updated healthcare plan with the involvement of the child, the parent and the doctor. Diabetes UK is rightly worried about the education and children's Bill, which is coming up, in that it removes duties on schools to co-operate with local planning arrangements, which are so vital. The growth of academies, where there is no direct link to local authorities, fractures that important complementary approach. It is unclear from the Health and Social Care Bill how schools fit in with the new framework. Perhaps the Minister could say more about that.

In the final minute or so available to me, I should like to refer to something that the noble Baroness, Lady Young, may be able to take up in her role, supported by the Government. I may be wrong but I am not aware that any of the school dramas on our TV screens show diabetic children. More importantly, if they do, I am not sure whether they show them as a positive image, rather like my example of the schoolchildren supporting the members of their class who had diabetes. I wonder whether the noble Baroness could explore that through her agency. It was done recently with regard to someone with Parkinson's disease. I recall a film which had a positive image, where the heroine had acquired Parkinson's at a very young age. There are interesting and inspiring stories to tell about this and we should take every opportunity to do so.

6.10 pm

Baroness Crawley: My Lords, it is a delight to follow my noble friend Lord Harrison, who is such a great ambassador for people living with diabetes. May I add my thanks to my noble friend Lord Kennedy for bringing this complex and important issue before the House with such clarity and commitment? I also welcome the informative and humorous maiden speech of the noble Lord, Lord Lexden. We look forward to hearing many more of them in the House.

In preparing for this afternoon's debate, I looked at the 2008 report of the UK Children with Diabetes Advocacy Group. I found several case studies of children who have type 1 diabetes but who, beyond that, should be leading happy, fulfilling and productive lives at

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school. It is to our shame that that is not the experience for a large and significant group of children with diabetes across the country.

In the case studies, Matty's mum said:

"Matty decided that he wanted school dinners this week. At the end of last term I went in and saw the cook and the dinner lady and explained that he would need to go to the front of the queue. This morning he told me that he didn't want school dinner because the dinner lady had told him off for walking to the front of the queue and made him wait until last."

Charlie's mum said:

"When Charlie started reception we had a major fight on our hands with the headmaster who expected Charlie to do all his own blood testing, choose an appropriate snack and go and get it from the store cupboard - all at the age of 4 and only having been diagnosed 4 months previously!"

In case we form the impression that the fault always lies with the school or with the local authorities, the next case study will put us right. I quote the case of Anthony:

"Unfortunately, when we had a meeting with the school and our DSN, (who we thought was there to support us) made matters worse. The DSN seemed to do her utmost to discourage the school from taking on procedures such as testing, her attitude being that schools should not have to take on such levels of care. We were quite surprised and hurt at her attitude. It made us feel very much on our own in the pursuit of a good standard of care for a young child starting school".

The obstacles were not just raised for families through PCTs in these case studies. In another study, the health and safety officer told a teenage boy with diabetes at a secondary school that he could not carry his insulin and self-monitoring equipment with him at school. This meant that if he felt unwell he would have to go a considerable distance to the school's reception area to carry out tests, which would have put him at risk.

Obviously, as my noble friend has said, there are children with diabetes who enjoy a full school life because of the support their school gives them. But the sad little stories from desperate parents that I have quoted tell us that by no means all children have that opportunity in 21st-century Britain. Why does the Minister think that such inconsistency of policy and practice across local authorities exists, despite guidance being offered by the last Government, and what are his Government's plans for dealing with this inconsistency? I am certainly not making a political point here, because things could not have become so much worse for this group of children during the eight months of the coalition Government. We all have questions to answer as far as these children are concerned. However, I am concerned by the scale of future local authority spending cuts, as well as by the demise of PCTs and the reorganisation of the NHS. Both these coalition Government policy commitments will throw an already complex picture for children with diabetes into sharper relief.

How does the Minister respond to Diabetes UK's concerns, shared by this side of the House, and mentioned by the noble Baroness, Lady Walmsley, that the changes proposed in the education and children's Bill, which will remove the duty of schools to co-operate with local planning arrangements, together with the growth of academies with no direct link to a local authority, risk further fragmentation of services for this group of

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children? It would be helpful to learn from the Minister how schools are expected to fit into the new framework envisaged in the Health and Social Care Bill.

I know that the Minister, who I have a great deal of respect for, will agree with me that it is intolerable for parents and children who have this condition to be treated so differently in so many different schools, different LAs and different PCTs, under different head teachers, by different nurses and different staff. These children and young people do not deserve such a cruel lottery of treatment in their schooling. We know that all schools have a common-law duty of care. They also have a duty to promote pupils' well-being. What does the Minister feel is the current legal framework for ensuring school support? I know that under the previous Government's Every Child Matters policy, of which I am immensely proud, all schools were required to have a disability equality scheme. Does the Minister believe that further guidance is required?

What is the Government's response to Diabetes UK's recommendations? They are ably set out by the noble Baroness, Lady Young: that there should be multi-agency working across schools; that there should be proper training for staff in schools, to feel confident when dealing with children with diabetes; that there should be an individual healthcare plan for every pupil; and that there should be one full-time qualified school nurse for each secondary school and cluster of primary schools, as noble Lords have said.

I would be happy for the Minister to write to me on some of these points. As I have said, our own record in this area is not so burnished that I demand answers from him. I know that all noble Lords who have taken part in this important debate will want to see an end to the confusion, alienation and misery that too many children with diabetes and their carers are currently experiencing.

6.17 pm

The Parliamentary Under-Secretary of State for Schools (Lord Hill of Oareford): My Lords, like other noble Lords, I congratulate the noble Lord, Lord Kennedy of Southwark, on securing a debate on this important issue. We have already heard a significant number of points that the Government will need to reflect on. I pay tribute to the work that he has done, both here in Parliament and as a member of Diabetes UK, to raise awareness of the problems that diabetes sufferers endure. I was glad to have the chance in the small hours of the morning last week to discuss some of the issues that he has raised; it was one of the few benefits that I could see of the Parliamentary Voting System and Constituencies Bill, but we must be grateful for small mercies.

I join other noble Lords in congratulating my noble friend Lord Lexden on his excellent and entertaining maiden speech. I could not work out where I sit on his Lewis Namier scale-probably somewhere near the bottom. It was my noble friend who offered me a job at the Conservative Research Department after I had been turned down by a number of no doubt wiser people in the CRD. So it was he, perhaps inadvertently, who set me on my way, and whom indirectly I should thank-or blame, I sometimes think-for my being

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here today. I think that I speak for all noble Lords in saying that we look forward to his contributions to debates in the future.

I shall briefly recap on some of the figures that we have already heard and, in doing that, I welcome very much the comments made by the noble Baroness, Lady Crawley, and the tone and way in which she approached this issue. This is not a political issue, and the approach and the legislative framework taken by the Government follows the one taken by the previous Government.

We have heard some of the figures showing the scale of the problem. There was an audit in 2009 which showed that there are an estimated 23,000 children with diabetes, the vast majority with type 1. The peak age for diagnosis is between 10 and 14 years, but type 1 can affect children in their preschool years. No one would want a child with a long-term medical condition such as diabetes to miss out on school life or be treated less favourably because of it. We have heard a number of powerful examples and personal testimony that make that point.

It is also true-and this lay behind some of the remarks made by the noble Lord, Lord Harrison-that there are many examples where schools provide very good support to pupils, especially in primary schools, where they are working closely with parents and the local NHS. There is one example in Nottinghamshire, which other noble Lords may also know, where the county and city councils and the local NHS trusts run training for school staff. They allow heads to apply for reimbursement towards funding staff, and run a network of diabetes specialist nurses to cover primaries and secondaries. So there is good practice, and one issue that we need to reflect on is how we can make that good practice more universal. I accept the point made by a number of noble Lords that provision is currently patchy. We know that there are cases in which parents do not feel-and not only do they not feel it but it is obviously true-that they get the support that they need. We heard today of children with diabetes having to miss classes or be excluded from school trips or being left to inject themselves unsupervised, with parents feeling that they are forced to reduce hours or give up work or move schools because they do not trust staff to carry out blood tests or carry out insulin injections.

I acknowledge the picture that has been painted by Diabetes UK in its report, State of Diabetes Care in the UK 2009. While there is excellent practice out there, in other areas it is patchy. I also understand the strength of feeling behind its Children's Charter report. It is a view that has been expressed by noble Lords today and by my noble friend Lady Walmsley, in looking at it from an international perspective. There should be equal access to treatment, high-quality medical care and support in schools for children and young people.

I shall briefly summarise the legal framework and then move on to talk about some of the other issues raised and address directly the request put to me by the noble Lord, Lord Kennedy of Southwark, about meeting and how we might take things forward.

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Schools are responsible for drawing up their own policies in the light of their statutory responsibilities-for example, health and safety legislation or the Equality Act 2010-and local needs. The department recommends that schools and their employers should have policies in place on the management of pupils' medicines and on supporting pupils with medical needs. There is no legal duty on school staff to provide medical support, to administer medication or to supervise a pupil taking it. Like the last Government, we do not have plans to change that. However, as has been pointed out, there is a common-law duty on all staff to act in loco parentis when children are at school.

To encourage schools to provide support for children with medical needs, the DCSF, as it then was, jointly with the Department of Health, published guidance on managing medicines in schools and early years settings back in March 2005. The DFE, together with the Department of Health, is currently reviewing that guidance. Perhaps that provides us with an opportunity to reflect on some of the points that have been raised. I invite Diabetes UK, perhaps through the noble Lord or through the noble Baroness, Lady Young-I am spoilt for choice-to speak to my officials about that. We also hope that we can use the review as an opportunity to draw attention to good practice. Again, I hope that Diabetes UK can help us to champion that good practice.

It is sensible for schools to have clear general policies in place to support pupils with medical needs. For pupils with serious medical needs, it is sensible for schools to draw up individual healthcare plans setting out in black and white the level of support that is needed, and clarifying for staff, parents and pupils the help that will be provided. Our guidance makes it clear that any volunteers, usually school support staff, who carry out such duties on a daily basis should be properly supported in doing so.

Staff who volunteer to assist with any form of medical procedure should be given reassurance that they will not be sued for any action they take in providing the vital support that pupils with medical needs may require. We know, once they understand the reasons for the injections and blood tests, and have been adequately trained in practical skills and provided with reassurance that they are acting within the scope of their employment they are generally keen to help individual children.

As has already been discussed, the Government are reforming the way in which the NHS deals with public health-in particular, how it works with local children's services. The White Paper, Healthy Lives, Healthy People, published last November, has a clear principle at its heart: that prevention is better than cure. It sets out a clear plan to reduce health inequalities and causes of premature death and illness.

That means making sure that there is a major role for the NHS, particularly for school nurses and community healthcare teams as well as paediatric diabetes specialist nurses. School nurses will continue to have a vital role in providing training and support to schools, in developing health reviews at school entry and in managing pupils' well-being and medical and long-term conditions.

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I reassure noble Lords that we are listening to the concerns that have been raised and are working closely with the Department of Health to ensure that no child misses out because of their long-term medical condition. We are also working closely with the department to enable schools to draw on additional expertise from local health professionals and children's services to meet the needs of their pupils. We seek in particular to develop a new vision for school nurses that reflects their broad public health role in the school community. I would again invite Diabetes UK to talk to the Department of Health about this work.

Perhaps I may respond to some of the specific issues that were raised. I will write to the noble Baroness, Lady Crawley, if I have failed to respond to all her points. I was asked about academies. It is the case that academies have to meet independent schools standards regulations. They require them to have regard to the Department for Education guidance, Health and Safety: Responsibilities and Powers, which sets out the key elements of a health and safety policy, one of which is supporting pupils with medical needs. Having visited a lot of academies, I do not think that there is any intrinsic reason to believe that they will carry this out less well than any other school. Heads of academies who I have met care about their children just as much as the heads of any other school. Academies are free to buy back services from a local authority.

I was asked by my noble friend Lady Walmsley about competitive sport. PE remains compulsory from the age of five to 16. The Government are keen to encourage competitive sport. I agree with her that it can play an important part in dealing with the issues. I am very happy to discuss with her further the slimmed-down Ofsted regime. Of the four categories that we have outlined, one is to do with behaviour and safety.

In response to questions about funding and as noble Lords might expect, there is little specific that I can say, but I was struck by the point made by the noble Lord, Lord Kennedy of Southwark, who said that this not a matter primarily of money and that it is much more to do with finding ways of working sensibly together.

Like, I think, all noble Lords, the Government are committed to ensuring that all children and young people with long-term medical conditions get the help and support that they need while at school. We will work closely with the Department of Health to ensure that. I would be delighted to meet the noble Lord, Lord Kennedy, to discuss this further or perhaps to point him towards my honourable friend Sarah Teather, who has departmental responsibility for these matters. I am grateful to him, as are all other noble Lords, for giving us the opportunity to debate these important issues.

Railways: Heritage Sector


6.32 pm

Asked By Lord Faulkner of Worcester

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Lord Faulkner of Worcester: My Lords, I am grateful for the opportunity to draw attention to the importance of heritage railways in Britain and I thank all noble Lords who have put their names down to speak in this short debate. I declare an unpaid interest as president-elect of the Heritage Railway Association, a volunteer body that brings together the heritage railways in the United Kingdom and Eire. I have also recently been appointed by the Prime Minister to the board of trustees of the National Museum of Science and Industry and shall be serving on the advisory board of the National Railway Museum.

The heritage railway movement covers over 111 working heritage railways and tramways, as well as 60 steam museum sites. Indeed, laid end to end, our heritage railways would stretch for some 500 miles, reaching from King's Cross to Dalwhinnie in the Highlands of Scotland. There are over 399 stations on these lines-more than on the Underground network-and there is a fleet of around 800 preserved steam locomotives.

Apart from the preserved lines, steam is still alive and well and earning money on the national network, too, with many steam excursion trains being run each year, as well as regular services on the West Highland line, the Cambrian coast line and between York and Scarborough. I pay particular tribute to the work of the specialist team at Network Rail as well as the train operators who co-operate to make this possible. As a number of noble Lords may be aware, in the past few years a brand new A3 steam locomotive called "Tornado" has been built by volunteers to the original LNER design. That is in revenue service as well.

I should also mention the value of the work of the Railway Heritage Committee in designating historic railway artefacts and directing their disposal, when no longer required on the main line, to heritage railways or museums. This approach has been actively supported by Network Rail, the train operating companies and the rolling stock leasing companies. As a result of their working harmoniously together, people can see and appreciate many of these historic pieces of equipment in daily use.

The status and role of the Railway Heritage Committee is about to change as a result of the Government's decision to include it in the Public Bodies Bill. I shall not anticipate the debate that we are due to have in Committee on that Bill, other than to say that we are very close indeed to agreeing a way forward that would provide for the statutory powers and duties of the committee to be transferred to the Science Museum.

Your Lordships may ask why all this matters. The main answer is that heritage railways give a huge boost to the local economies of the areas that they serve and that we lead Europe and America in the development and presentation of our heritage railways. They are a source of inward tourism as well. To underline the point, the Heritage Railway Association took the lead in establishing a federation of heritage railways across Europe, called FEDECRAIL. Our expertise is keenly sought by other members, particularly in eastern Europe. Those members also look with envy at the statutory powers exercised by the Railway Heritage Committee and wish that they had something similar in their countries.

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The value to tourism is enormous. The National Railway Museum attracts almost a million visitors annually, more than any other museum in England outside London. Heritage railways attract more support than almost any other part of the heritage sector, with the exception of the National Trust. While historic ships, aircraft and classic cars have their adherents, no other transport mode attracts anything like this level of interest, with direct benefit to the tourist economy.

This has been confirmed in independent studies undertaken for a number of lines, notably the West Somerset, Severn Valley and Welsh Highland railways. I think that we may hear something about the Welsh Highland Railway from the noble Lord, Lord Wigley. The West Somerset study was undertaken by Manchester Metropolitan University and indicated a value of £1.90 to the local economy from every £1 of fare income to the railway. This means that the value of the railway is at least £4 million to the local economy. I say "at least" because this excludes the considerable spend by volunteers on accommodation, food, fuel, restaurants and so on. These are significant sums of money. Each year, 6.7 million people are carried on heritage railways, whose earnings in 2009 amounted to £81 million. Not only does this point to a value of over £150 million a year to the economy, but it is a figure that is growing year by year as lines are extended.

The other major economic benefit of heritage railways is in employment. Altogether almost 2,000 people work in the sector, some part-time, and often in areas of high unemployment-heritage railways frequently provide high-quality engineering jobs in areas where little alternative skilled work is available.

Then there are the health benefits of providing easy access for walking, as well as the environmental benefits of car-free access to the countryside. While most railways offer a steam-train ride as their main attraction, an increasing number also fulfil a useful transport role. The Swanage Railway, for example, provides a park-and-ride service to reduce congestion on the A351 through the picturesque village of Corfe Castle. The Welsh Highland Railway provides sustainable transport to sensitive areas in the Snowdonia National Park, particularly the village of Beddgelert. Also, what better way is there to visit the Brontë Parsonage Museum at Haworth than by the Keighley and Worth Valley Railway?

We may add to this the benefits to education that are offered by many railways, with their information packs for schools linked to the curriculum, as well as visits to depots and signal boxes. The range of subjects covered by the railway is wide-ranging: history, of course, as well as geography, economics, social history and politics. Indeed, there is almost no area of life in Britain that is not touched by the railway. It was Benjamin Disraeli-or the Earl of Beaconsfield, as perhaps we should call him in your Lordships' House-who, writing in his novel Sybil in 1845, correctly predicted that,

None of the achievements of today's heritage railway movement would be possible without the support of volunteers, of whom more than 17,632 are recorded in the returns made annually to the Office of Rail Regulation,

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quite apart from those who help in other ways such as fundraising. The range of activities that they undertake is astonishing, from safety-critical work such as driving trains or signalling, to developing specialist skills for locomotive restoration, to straightforward labouring to keep the railways in good shape and safe for passengers.

What better example-and I address this point to the Government particularly-of the big society at work could there be than a heritage railway, with volunteers working alongside paid staff, bringing a boost to the local economy and a range of societal benefits without recourse to the taxpayer? The level of volunteer input means that heritage railways run without subsidy and raise their own capital. A number have also been successful in securing Heritage Lottery Fund grants.

Some people find it hard to understand why there is such a high level of interest in railways and railway heritage among British people-an interest increasingly shared by many overseas visitors. Go to any bookstall and you will see a huge range of magazines and periodicals devoted to this subject. I have seen a total of 16 magazines about railways or model railways in my travels and I understand that these have a combined circulation of around 360,000. When we add in the electronic magazines and the fact that magazines are handed on to friends, we have a regular railway readership of about a million.

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