To ask Her Majestys Government what proposals they have to extend the free travel schemes that operate in England, Scotland, Northern Ireland and Wales in order to make them valid for travel throughout the United Kingdom.
The Minister of State, Department for Transport (Lord Adonis): My Lords, we do not at present have the resources to introduce reciprocal arrangements for concessionary bus passes with the devolved Administrations. However, discussions have taken place about how such cross-border concessionary travel could work.
Lord Roberts of Llandudno: My Lords, I thank the Minister for his Answer. This really applies to border areas: Hadrians Wall and Offas Dyke in particular. Will he initiate new discussions to try to put an end to any restriction on travel in those border areas?
Lord Adonis: My Lords, the noble Lord will be pleased to hear that there is no restriction on travel across the border areas: at least, none that the Welsh Assembly Government or the Scottish Executive have informed me of this morning. The noble Lords point is whether there could be reciprocal arrangements in border areas. Although, as I have indicated, we do not have the wherewithal to make reciprocal arrangements between whole schemes that operate in England, Wales and Scotland, a number of local authorities in the border areas have reciprocal arrangements between them, making it possible for those over 60 to travel free of charge on cross-border services. Local authorities in Wrexham, Torfaen, Cheshire, Herefordshire, the Forest of Dean, south Gloucestershire and Shropshire, for example, have reciprocal arrangements, which should go some way to meeting the noble Lords concern.
Lord Faulkner of Worcester: My Lords, speaking of reciprocal arrangements, is my noble friend prepared to discuss with the train operating companies the possibility of their accepting that local authorities concessionary bus passes give identical benefits to those enjoyed by holders of senior rail cards?
Lord Adonis: My Lords, mandating that bus passes should be accepted in place of rail cards would require a renegotiation of the franchise agreements, and so is
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Baroness Maddock: My Lords, will the Minister be a little more forthcoming, particularly about my own border area between Berwick-upon-Tweed and Scotland. Has his department done any research into the effects on market towns that are very close to the border? If you go down into Berwick-upon-Tweed on any day, half the people shopping there come from across the border. We have one of the lowest average wages in the country and a lot of retired people in the area. Although the local council has made some agreements on some routes, travel is still quite difficult, so I would appreciate it if the Minister could confirm that he will do a little research to see how this has affected the border towns. I declare an interest as a pass holder.
Lord Adonis: My Lords, the noble Baroness underestimates me if she thinks that I have not done research in advance of her question. Some reciprocal arrangements of the kind she has mentioned are available across the Scottish and English border; for example, the Scottish National Entitlement Card may be used on services to and from Carlisle, and to and from Berwick-upon-Tweed, from anywhere in Scotland, and other such arrangements are in place. However, far more important, I believe that I have to congratulate the noble Baroness on her birthday.
Lord Davies of Oldham: My Lords, English Heritage and the Homes and Communities Agency have provided advice and funding for the development of the Bletchley Park site. In 2008, English Heritage provided a grant of £330,000 towards buildings conservation repairs and has offered to provide a further £300,000 in funding for the area. The majority of the Homes and Communities Agencys investment is towards the purchase and redevelopment of land on the site and related infrastructure.
Baroness McIntosh of Hudnall: My Lords, I thank my noble friend for that response. I should declare an interest in that my parents met at Bletchley Park; so,
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Lord Davies of Oldham: My Lords, I am glad to hear yet another commendation of Bletchley Park, about which we hear nothing but good for its wartime record. But I had not realised it had such significance on the membership of your Lordships House and I am glad that my noble friend is able to ask me this Question. Support to Bletchley Park is a complex issue. The Bletchley Park Trust receives no external support, but, as I indicated in my Answer, there is substantial support for the areas of architectural and historic interest such as the mansion and several of the key huts in Bletchley Park. I assure my noble friend that, although I cannot answer in the affirmative to her particular suggestion, the department is well aware of the necessity to ensure support for such an important, historic site.
Lord Clement-Jones: My Lords, this might not commend itself so much to the Minister: my parents met in Hut 3 at Bletchley Park, as did the parents-in-law of the noble Lord, Lord Wallace. So there are nests of Bletchley Park supporters surrounding the Minister. He has given a lukewarm reply. Is there not some form of scientific heritage funding that could be found for a short period to assure the revenue funding of Bletchley Park before it becomes financially viable? It could then turn into one of our major tourism attractions, demonstrating the full wartime history and the importance of computer science in this country.
Lord Davies of Oldham: My Lords, the Bletchley Park site is important not only for computer science but also for its record of code-breaking in the Second World War, for which it has subsequently received world recognition. English Partnerships has invested money in the core site and is putting in substantial resources. It supports the Bletchley Park Trust by contributing funds for the revised ticketing facilities, the completion of works to the new entrance and roundabout, and by financing works to some of the blocks. Along with that support the local authority, Milton Keynes Council, has put in £300,000 in recognition
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Baroness Trumpington: My Lords, is the Minister aware that the father of the noble Baroness, Lady McIntosh, was one of my bosses? When I went to Bletchley I was one of 400 people, and when I left I was one of 6,000. The place when I left was in pretty good order, and in a way that has not changed. Does the Minister agree that those people who have taken a long time using their expertise to replace the vital machinerywhich, curiously, Churchill decreed should be destroyedshould have our wholehearted congratulations and thanks?
Lord Davies of Oldham: My Lords, I am happy to join the noble Baroness in offering our congratulations to those who have ensured that the machinery is preserved. Significant investment is going into the site, and this summer an exhibition will be held to which people from abroad will contribute their resources to put on displays, which will be an added dimension. Bletchley Park is often celebrated for the contribution made by outstanding women to its work and I am delighted that the noble Baroness is one of those outstanding women. I am also glad to hear that from time to time men, too, played a part.
Viscount Montgomery of Alamein: My Lords, I declare an indirect interest in that my father was a beneficiary of the Ultra intelligence derived from the work done by the noble Baroness, Lady Trumpington, and others. To go a bit further than what other noble Lords have proposed, does the noble Lord not think that Bletchley Park should be turned into a full-scale national museum on the same terms as the Imperial War Museum or many of our other national museums? As has been alluded to, the work was of vital importance to what happened during the war and was the foundation of the entire computer industry in this country, which is now a worldwide phenomenon.
Lord Davies of Oldham: My Lords, the noble Viscount has succinctly identified the significant historical position of Bletchley Park; I want to assure the House that government departments and agencies are fully aware of this, as indeed is Milton Keynes Council. We have no plans at present to associate it with the Imperial War Museum. The House is all too well aware of the significance of designating any area in association with a museum of that rank, but I want to give an assurance that Bletchley Park will continue to develop under the resources made available to it.
Lord Selkirk of Douglas: My Lords, does the Minister accept that, as well as my noble friend Lady Trumpington, the noble Lord, Lord Briggs, played a key role at Bletchley Park? Will he recognise that subsequent generations believe that invaluable work was undertaken there and it was not merely a collection of the public explanation given at the time that they were gathering government statistics?
Lord Davies of Oldham: My Lords, because of the nature of the work, it was a long time before the nation appreciated what had been achieved at Bletchley Park. Plays, television programmes and general information have now become available so that all generations now appreciate it, but perhaps none more so than the one represented in this House most fully.
Lord Lea of Crondall: My Lords, given that the Freedom of Information Act was not in operation during the Second World War, would it now be possible to make inquiries about the drug invented at Bletchley Park which enabled these people to clone their staff with such success in such a short period of time?
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, the National Cancer Action Team is working with cancer networks and cancer charities to develop an electronic delivery system that can be used by professionals to deliver information prescriptions to patients at any point during their cancer journey. Eleven tumour-specific information pathways have been developed and are being piloted across 71 sites in England. It is planned that the full system will be available and that all cancer patients will receive an information prescription as part of their consultation from 2010.
Lord Clement-Jones: My Lords, I thank the Minister for that reply; it is welcome news. The pilot scheme is obviously taking slightly longer than anticipated; the cancer reform strategy promised the information prescription in 2009. Nevertheless, I welcome the news. Can the Minister say whether, along with the information prescription, all patients will have the assistance of a healthcare professional in helping them to understand and act on the information prescription made available?
Lord Darzi of Denham: My Lords, that is correct. The information prescription pilots are addressing, first, the concept of the dispensing of patient prescription information by a clinical nurse specialist who has all the competencies to explain the content of such prescription information. In addition, a written consultation discussion will be recorded and explained by the consultant; prescribing and dispensing information with a palliative care setting will be given; and there will be patient self-prescribing, with an explanation of what the content of that prescription means.
Lord Patel: My Lords, I am sure the Minister is well aware that in obstetrics these information prescriptions are more appropriately referred to as patient information notes. In fact, obstetricians were the first to pioneer such notes. How do such notes help the patient-professional relationship? Should these notes record the performance of the surgeonor the robot, as appropriatein terms of outcome?
Lord Darzi of Denham: My Lords, the reason these are called information prescriptions rather than notes is because they contain evidence-based information. As to what this process does to the relationship between the clinician and the patients, I personally think it is transforming it from an era of paternalism into an era of partnership between the patient and the clinician.
Lord Bradley: My Lords, does my noble friend agree that specialist cancer hospitals such as the Christie in Manchester, where I am a non-executive director, already provide excellent information for specialist services, as evidenced by the fact that the hospital came first in the country in the recent in-patient survey for overall care? Does he further agree that the Christie charity provides invaluable additional support through specialist nurses and counsellors to provide disease-specific information, and that that is why the Governments support to get compensation for the failed UK subsidiary of an Icelandic bank is so essential?
Lord Darzi of Denham: My Lords, I commend Christies and many specialist hospitals around the country. I work in one, the Royal Marsden, which provides services not dissimilar to the ones provided by Christies. I have little expertise in the banking arrangements of specialist hospitals, but I shall be more than happy to write to my noble friend about the issue.
Lord Darzi of Denham: My Lords, we are working with a large number of charities. I acknowledge the championing and pioneering impact of the work of the late Lady Clement-Jones, who introduced this concept through Cancerbackup and, more recently, Macmillan Cancer Support. We are working with CRUK, the biggest cancer charity in this country, supporting research and the evidence base for these information prescriptions. In addition, at least 32 other charities that deal with cancer are helping us with the content of such information prescriptions.
Baroness Barker: My Lords, the evaluation of the information prescription pilots suggested that PCTs needed to be given guidance about commissioning charitable and voluntary organisations to provide support to people to enable them to understand the prescription they have been given. What guidance does the Ministers department give to PCTs about commissioning information and support services?
Lord Darzi of Denham: My Lords, we give guidance to PCTs about the information prescription. As it stands, we are running the pilots to learn more from them but, while we are doing so, we also have 25,000 patient questionnaires seeking patients views about the information. One thousand, two hundred and fifty patients will be part of the participating pilot while the other half will be the control group without the information prescription, and those are the comparative data on which we hope to build the system in 2010.
Lord Walton of Detchant: My Lords, I am grateful that the Minister expressed support for the concept of specialist nurses working in this important field. Specialist nurses are making an increasingly important contribution across many fields in the National Health Service, particularly in supporting and helping patients suffering from a variety of progressive diseases such as Parkinsons, epilepsy, multiple sclerosis and many more, as well as cancer. May I have an assurance from the Minister that the development of specialist nurse services, not just in cancer but in other fields, is likely to be high on the agenda of the National Health Service?
Lord Darzi of Denham: My Lords, I agree. I can say that patients satisfaction and experience tremendously improved when I started to work for the specialist nurse in my colorectal team. I could not agree more; we need to develop specialist nurses and the roles that they will play, but that needs a significant mindset shift, certainly on the part of many of my nursing colleagues, as well as the development of competencies in providing that type of service.
Baroness Gardner of Parkes: My Lords, will the Minister tell me, for the benefit of other Members of the House also, quite simply what the information prescription will be, how it will be decided which people will get itin the pilot, he said, half will get it and half will notand how you will discover that you are one of the ones who will? Will it just arrive out of the blue in written form, or in another form?
Lord Darzi of Denham: My Lords, this is an academic evaluation so there is a random control trial going on. Patients will be selected at random. That is one of the pilots looking at the impact of this. Our aspiration is that every patient with cancer will receive an information prescription throughout the whole of their pathway, whether that is the referral from the general practitioner to the specialist centre, the diagnosis, the treatment, the long-term follow-up or the prognosis. We believe in empowering patients because many will say that an empowered patient will get through the cancer pathway at a speedier rate and feel much more confident in the treatment they are receiving.
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