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Address in Reply to Her Majesty’s Most Gracious Speech

My Lords, it is a real privilege to begin to sum up at the end of this debate. I thank the noble Lords, Lord Adonis and Lord De Mauley, for two excellent maiden speeches that not only showed us what they will contribute to the House in the future but, together with the speech of the right reverend Prelate the Bishop of Portsmouth, gave me what I always need on these occasions and never have; that is, a theme. That is what one needs on an occasion such as this. The theme that they gave to me was diversity and community. The ways in which they talked about their backgrounds and the way in which the noble Lord, Lord De Mauley, talked about older people, several hours ago sparked some thoughts that have run all the way through this afternoon’s many and varied contributions. I thank them all very much for that. I also welcome the noble Lord, Lord Hunt of Kings Heath, back to the Front Bench. In his previous incarnation as health Minister one of the achievements of which he and I were most proud was the Adoption and Children Act. The noble Earl, Lord Howe, should also be proud of it—I refer to his former role as spokesman on children and families—even if he is not. There was a bit of unfinished business with that Act; that is, inter-country adoption and private fostering. I am very pleased to see in the Queen’s Speech that that matter is back on the agenda. I hope that I may offer the noble Lord, Lord Hunt of Kings Heath, a bit of advice or let him into a secret. The DWP team on these Benches has a performance target. If you can rattle the DWP Minister as much as did the red haired Baroness who used to sit on the Benches behind them, who knew as much about pensions as they do, you are doing terribly well. That was something which we used to watch when Lady Castle was in the House. I mention it in passing to the noble Lord. Diversity and community are the two themes that have run through most of the contributions that have been made today. I want to start by going back to what the right reverend Prelate the Bishop of Portsmouth said about schools. I listened to his description of a good faith school and I agreed with it wholeheartedly. From what he said, I took it that the most important part was that a faith school has to be within a community and be reflective of it. However, as my noble friend Lady Walmsley said, we on these Benches have grave doubts about city academies. One of the main reasons for that can be summed up in two words—Emmanuel College. For those of your Lordships who do not know, Emmanuel College is a city academy in the Newcastle area, run and funded by a private sponsor, which prides itself on teaching, among other subjects, creationism. I find it most alarming that children should be subjected to that very narrow interpretation of faith. Were I in charge of the curriculum in that part of the world, I think that I would obtain a bulk order of ““Inherit the Wind””, starring Spencer Tracey, and make it compulsory viewing. Interestingly, it is a school that has an extremely high level of exclusions—more than other schools in its area. It seems to me that the danger with city academies is that if they are outwith their communities and outwith the rest of the healthcare planning systems, they risk becoming very narrowly inward and introspective institutions, which I would not wish children to attend. For many members of your Lordships’ House, this is a very rare chance that we have to debate legislation in the light of what people have said to us on the doorstep. Unlike the noble Lord, Lord Sutherland, many of us were out on the doorstep recently. For me, the key moment in the election campaign was the Prime Minister’s look of complete incomprehension when Diana Church asked him about the system of booking an appointment at her local GP surgery, where, in order to ensure compliance with the 48-hour rule for making appointments, pre-booked appointments have disappeared entirely. That the Prime Minister did not know what an individual GP practice does is not remarkable. That, of course, is how it should be, because booking systems should be decided by practices locally to meet the needs of their client groups. But that the Prime Minister did not know the consequences of a policy determined and centrally imposed by the Department of Health is, quite rightly, the subject of disparaging comment. Throughout the campaign, we Liberal Democrats put our case that management and planning of both the Health Service and the Education Service is best done most effectively at local level. I believe that the eloquent remarks of the noble Lord, Lord Sutherland, about having area focuses for public services were absolutely right, and I echo them. During the election, I kept coming across the unintended consequences of centralised target setting. As a consequence of the out-of-hours contract, the GPs in the north-east have subcontracted emergency out-of-hours services to a GP who arrives every weekend from Germany. They are the same GPs who have outside their surgery doors at 8.30 in the morning ever-lengthening queues of people who have deferred presenting themselves for treatment until they could talk to their own GPs. From talking to the nurses involved in that system, it was quite clear that the lack of records and the doctors’ lack of knowledge of the patients had led to an overall poorer quality of service. The people who lost out most were the elderly—people who did not have very much wrong with them but who needed some reassurance and support to regain their confidence and get back on to their feet. I wish that I could adequately convey the anguish of the carers that I met in Bradford. Their foundation hospital is £11 million in debt, and as a cost-cutting measure some bright spark decided that they would stop carers using non-emergency patient transport. The consequence is that every two weeks elderly people with Alzheimer’s are dropped at the hospital door by the driver where they have to wait until their carers, who are equally elderly, can get there using taxis at their own expense. Anyone who doubts that centralised political targets are inefficient and ineffective and simply serve to distort medical care should spend an afternoon canvassing; they will have their illusions shattered. I thank the noble Lord, Lord Blackwell, for telling us from which of the two manifestos he was quoting; it was not immediately apparent on the substance alone. I say to him and to the Minister that I went from the West Country up to the Borders in Scotland, and not once was the word ““choice”” mentioned by anyone. People do not want choice in the sense in which it has been presented to us; they want services that were local to them, that were adequate, that were safe, that had standards that they could trust and that were free. Anyone who did spend much time on the doorsteps during the election will have one phrase ringing in their ears: ““I am not a racist, but . . .””. As a consequence, perhaps unintended, of the campaign run by some people in the election, some electors felt that they had permission to speak about immigration in an opinionated fashion. I say opinionated because there were precious few facts around. Time and again I heard claims about immigration that simply could not be true. High on the list were absolutely fantastic claims about people coming to this country to abuse the services of the NHS. While it is true that a minority of people will always exploit public services, there is as yet little evidence of systematic or widespread abuse. I therefore hope that the plans, which we are told are on the way, to tighten up entitlements to NHS care are based on sound evidence and not on a knee-jerk reaction to what was a shabby campaign. I hope that as responsible politicians—as Members of your Lordships’ House unquestionably are—our response to what we have heard in the past few weeks will be to celebrate the distinguished and dedicated contribution that people from other countries have made to the NHS ever since its inception. I hope that your Lordships will say loud and clear that immigration has been to the health and benefit of all citizens of this country. We are proud of that, and we will not be ashamed of it. I note that part of the health improvement Bill will   seek to modernise community pharmacy and ophthalmic services. We welcome the recognition that those are some of the most valuable health services, again not least because they are often rooted in communities. I have often talked to older people whose first language is not English whose reliance on pharmacists, particularly those who have their language skills, has been immensely important to them not only in health promotion but in assisting them with the management of long-term chronic conditions. I hope that in that case modernisation will not turn out to be strangulation by regulation. Other noble Lords in this debate have spoken about MRSA, and I take the comments made by the noble Lord, Lord Chan, as being some of the best that we have heard on the subject. We have heard from the gracious Speech that a Bill will be brought forward to support patients who wish to seek redress should they experience problems with their healthcare. The reform of clinical negligence systems should follow the proposals made in the Chief Medical Officer’s report, Making Amends, and will be welcome. We will study with great care the proposal for an NHS litigation authority to oversee a scheme and manage compensation. However, given the Government’s love of all things American and their increasingly bold moves towards private methods of healthcare delivery, we on these Benches will resist anything that fosters a compensation culture in the NHS or anything that prevents practitioners from undertaking procedures that they believe to be right but which contain great risk. I believe that it is in the best interests of patients that bad practice should be uncovered in the NHS. I remind Members of your Lordships’ House that my colleagues in another place, such as Nick Harvey, the MP for North Devon, have been instrumental in uncovering bad practice in the NHS, such as the Bristol paediatric surgery scandal. To uncover bad practice and enable individuals to seek explanations and answers and bring about justice for themselves and others is one thing, but to soften up the NHS as easy prey for insurance companies is another. We on these Benches will be watchful for anything that smacks of that. The Prime Minister famously said that he was listening. The new Health Minister does not seem to have the same disposition. Her first announcement that she is going to provide further investment in the private sector against the advice of many health bodies, including the BMA, speaks volumes. It is one thing to enable private providers to pick off the operations that are cheaper to perform and the patients who get better quicker and are therefore cheaper and require less rehabilitation, but it is wrong to deny the NHS something extremely important—the opportunity for people in the NHS to gain skills, particularly in surgery, by carrying out less complex work. Given that it covers only elective surgery and not the complex, difficult and unsexy stuff in which the private sector is not interested, I question the Government’s approach. During the gracious Speech, one word made me sit straight up: the use of the word ““compulsory”” in relation to mental health treatment. I had the privilege of being a member of the Joint Scrutiny Committee that considered the draft Mental Health Bill under the expert chairmanship of my noble friend Lord Carlile. I am extremely glad that I did: it was an immensely interesting experience. We received 450 written submissions; 124 carers and service users came as witnesses; and we made 107 recommendations, of which 30 were about the rights of, and safeguards for, patients, carers and their relatives. We produced a report of which I am holding but one of three volumes. It was an extremely thorough scrutiny. What was remarkable about it was the degree of unanimity across parties at the end of that long process. The committee came out with a statement that I will draw to your Lordships’ attention:"““We accept the merits of having a broad definition of mental disorder, but the Bill needs to have clear exclusions ensuring that the legislation cannot be inappropriately used as a means of social control. A broad definition of mental disorder also necessitates that the conditions on the issue of compulsion are tightly drawn. We have recommended a range of changes that would tighten the conditions and ensure that this legislation cannot be used inappropriately. In particular, we have proposed that the threshold for risk of harm to others should be raised and that compulsion should only be used where a treatment is available which would be of therapeutic benefit to the patient””." We also said that the Bill needs to be significantly rewritten. Everyone accepts that the 1983 legislation is largely out of date. What we did not accept was what was placed in front of us. We wished to see a Bill that contained principles, rather than them being left to a code of practice, and a Bill for which there had been far more extensive thinking about the level of resources that would be needed to implement it. The noble Baroness, Lady Howarth, talked about the CAMHS service and the great strain that it is under. We could see that only being exacerbated in the future. We scrutinised the Bill for more than six months. It had only two friends in the world—the Home Office and the King’s Fund. When the Home Office starts making health policy, you had better beware. Having sat through pretty well all the debates on it, I have to say that, if the scrutiny had been a boxing match carried out under the Marquis of Queensbury rules, it would have stopped long before it did. Out there are many thousands of people who have mental illness and many hundreds of people who work with them. They are deeply fearful of what is in that draft Bill—a Bill that is a reaction to one or two limited incidents and that would criminalise thousands of people who live successfully in the community. It is our job in this House to make sure that the Bill, whenever it comes to us, is radically different from that presented to us. Much has been said about this being an historic third term for the Labour Government. I ask them to make it historic by acknowledging that, in healthcare, the national service frameworks have driven up standards and made a difference because they have provided evidence bases and a means for local people to engage with experts. As many speakers, such as the noble Baronesses, Lady Sharp and Lady Jay of Paddington, have said, when the Government look at the experience of the legislation that they have already passed, they will see that we will have delivery only when we start to enable local decisions to be made.