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Address in Reply to Her Majesty’s Most Gracious Speech

My Lords, we have had a wide-ranging and well informed debate this afternoon and evening, which sets the scene for the detailed work on some of the important Bills that we will be considering this Session. As others have said, we have heard some most thoughtful maiden speeches. I for one hope that   the speech on pensions from the noble Lord, Lord De Mauley, will be the first of many that we will hear from him on that particularly important issue. We can guarantee that the House will hear   many more speeches from my noble friend Lord   Adonis, whose excellent maiden speech combined inside knowledge, if I may put it that way, self-deprecation and a strong philosophical context. I begin by mentioning two Bills that my noble friend did not have time to cover: the National Lottery Bill that was introduced in the previous Session, but did not receive a Second Reading, and a possible London Olympics Bill. The first of these establishes the big lottery fund with a new single good cause for charities, health, education and the environment. This replaces the three existing distributors, and will deliver £6   million to £12 million a year of administrative savings to add to the funds already available for good causes. I hope everyone here will be delighted if the Government have to introduce a Bill for the London Olympics in 2012. There are now just 42 days until the 2012 host city election in Singapore. There is a real sense that London can win the race, particularly with the public and cross-party support that the London bid has received. I am sure all noble Lords hope that our colleague, the noble Lord, Lord Coe, can produce one of his trademark last-minute sprints to achieve the outcome many of us would like to see. If he does, we will introduce a Bill to set up an Olympic delivery authority that will manage the public money to be used, grant the Mayor of London an Olympic-specific power to fulfil his obligations to prepare and stage the Games, and ensure that we can meet the commitments in the London bid. I should now like to respond to some—I fear that I shall not be able to respond to all—points raised in the debate. Before doing so, however, I would like to take the opportunity to correct factually the personal attack that was made on me yesterday in another place by the Conservative Front Bench health spokesman Andrew Lansley over healthcare acquired infections, which is a subject relevant to this debate. He said:"““It is particularly surprising that it is the Minister who showed a conspicuous failure to act on health care-acquired infections in the course of the last Parliament who now, ironically, is to be in charge of NHS delivery””.—[Official Report, Commons, 25/05/05; col. 561 ]" I have to tell noble Lords—and I hope that the honourable gentleman will read this—that the facts are that I joined the health team in June 2003. The Health Protection Agency’s surveillance data on MRSA for the period April to September 2004 showed a drop of just over 6 per cent compared with April to September 2003. That is a strange way of not making an impact. The Government have taken a wide range of measures to tackle MRSA. Strategies include mandatory surveillance, which was not in place before, a national hand hygiene campaign and, as has been noted already, there will be hygiene provisions in the Health Improvement and Protection Bill, unlike the previous system, under which MRSA rose from 4 per cent to 30   per cent of staphylococcus aureus infections between 1993 and 1997. But we know that arithmetic is not always a strong point on the Conservative Front Bench in another place—except in the case of the noble Earl, Lord Howe, who is always impeccable in his researches on data. Perhaps I may say to the noble Earl that I shall not be going in for too much sunbathing. It is of course frowned upon by health Ministers. The noble Baroness, Lady Buscombe, raised a number of points. I cannot respond to them all. On the issue about whether heads have enough authority in relation to exclusions, they can remove pupils from schools, but there is an appeals process. We have not heard from heads that they wish to change this appeals process, although no doubt the new commission will be looking at that in terms of discipline. It is always a risk that without the appeal process heads could be challenged in courts. The noble Baroness raised the subject of truancy. The facts are that—again I have to correct something—that attendance is at record levels—since September, 34,000 more pupils regularly attend every day. That is 87,000 more than in 1997. Truancy and unauthorised absence has remained essentially unchanged for 10 years. So that situation is not getting worse and, indeed, regular attendance is getting better. A number of noble Lords raised issues on city academies. The evidence is that they have been a success. I certainly welcome the support from the right reverend Prelate the Bishop of Portsmouth and the noble Lord, Lord Mitchell. The Church of England has become a major provider in these academies. It is worth bearing in mind—I draw this to the attention of the noble Baroness, Lady Walmsley—that in 2003 the average five-plus A* to C GCSE results in the first three open academies were 24 per cent, compared to an average of 16 per cent in their predecessor schools, and in 2004 academies achieved close to 30 per cent, outstripping the national average. That seems to suggest a measure of success. My noble friend Lady Jay raised the issue of assisted dying. I shall resist the temptation to go too much into that area. Your Lordships will consider the matter when it returns to this House. I recognise her thoughtful remarks, but I also recognise the strong views expressed by the noble Baroness, Lady Finlay, in this particular area, and I hope they will both understand that it would not be appropriate for me at this point to make any comments on those particular Bills. The noble Baroness, Lady Walmsley, asked why there was no youth justice Bill. I am advised that there will be one and that not all legislation was referred to in the Queen’s Speech. The noble Baroness also asked whether there would be practitioners on the new working party commission on discipline. The group will include 12 practitioners with experience in the area. The noble Lord, Lord Dearing, talked about value-added measures. The Government accept the use of those measures but recognise the need for improving the performance of lower achievers. We will look at all ideas for catch-up. The contribution of the noble Lord, Lord Pendry, is very welcome. The Government share his concern to strengthen sport in school. However, the Government’s report entitled Choosing activity: a physical activity action plan, published last November, highlighted that many women and girls often prefer other kinds of physical activity, such as aerobics, dance or self-defence, to sport. It is a question of finding what people want to help to engage them in more physical activity. There were well thought-out, well informed, constructive contributions on pensions from the noble Lord, Lord Oakeshott, my noble friend Lady Hollis, and the noble Lord, Lord De Mauley, in his maiden speech. I am sure that my noble friend Lord Hunt has been assiduously listening and taking notes on those contributions. I, too, pay tribute to the work of my noble friend Lady Hollis. I shall not even attempt to respond in detail to her points. Although we agree with her on the position of previous generations of women, I gently say to her that in future there will be less difference in the way that men and women accrue state   pensions. The position of current and future generations of women in this regard has changed, but that does not invalidate many of my noble friend’s important points. All these contributions have provoked my immense sympathy for Adair Turner, given the problems that he must try to tackle. I am grateful for the support of the noble Lord, Lord Blackwell. There are plenty of spaces on this side of the House if he wants to join us. The noble Baroness, Lady Warwick, talked about visa charges for overseas students. My understanding is that UKvisa is required to meet the full cost of providing visa services from those who use the service. The amount charged is a matter for UKvisa. The noble Earl, Lord Listowel, made important points about deprived children. No official decision has yet been taken on whether a new statutory duty for youth provision will be placed on local authorities. The noble Baroness, Lady Morris, talked about spending on the family resolution pilot project. The figures are not quite as she adduced: the pilot has a budget of only £300,000, not the £1 million that she said, and so far there have been 43 referrals to the pilot, not the six that she mentioned. The noble Lord, Lord Colwyn, made his usual constructive contributions on dentistry. I cannot respond to all of them. He chided us for not being radical enough, but I thought that we had been pretty radical in setting up a new personal dental services contract. Over 25 per cent of dentists have now adopted that new way of working. I understand his concerns about oral health among children, but, according to my information, 12 year-old children in the UK have the best oral health in Europe. We recognise that there are serious dental access problems in certain hotspots—the south west, Yorkshire, Cumbria, Shropshire and parts of the north west. However, 68 Polish dentists are already working in England and 45 more will arrive at the end of May. Some 170 graduates will come out soon from the expanded undergraduate places that we have provided. There is a lot of giggling from the other side, but, as I remember, they closed two dental schools in 1992. The noble Lord, Lord Chan, made a number of important points. We recognise that MRSA is a complicated issue, but it has to be tackled. In big tertiary care centres, such as Guy’s and St Thomas’, we have seen huge improvements when they have tackled the problem seriously with everyone getting behind it. We are trying to ensure that those who have been a little more laggardly can achieve the best practice. The noble Lord asked about preparation for a flu pandemic. We have about 100,000 anti-viral doses available, with some others around the NHS. We are working according to the plan drawn up by the Chief Medical Officer to build stocks of about 1.4 million doses over the next year to 18 months. My noble friend Lord Rosser made an important speech on discipline and respect in schools. For the troublesome pupils we have doubled the number of places in pupil referral units and have made the programmes full-time. We do not think that that is the total solution, but it has made a contribution. The noble Baroness, Lady Sharp, and others asked about the evidence on the performance of the pilot academies. We will be publishing the latest PricewaterhouseCoopers evaluation of academies shortly. We will make a full statement about how we intend to proceed. I hope that that reassures the noble Baroness and others who were a bit sceptical about that issue. My noble friend Lady Wilkins raised the important issue of independent living for people with disabilities. The Government fully support the spirit of what she said. She mentioned our Green Paper, Independence, Well-being and Choice, which will give people who need social care the opportunity to make decisions about how they lead their lives. That, along with the Strategy Unit report that my noble friend mentioned, will be an important part of taking forward the reform of services outside hospitals. We will be publishing a White Paper after widespread consultation on those services outside hospitals later this year. A number of noble Lords have concerns about the mental health Bill. I can best say that our current position is that we are studying very carefully the prelegislative scrutiny committee’s report. We will publish a response to that in the summer. I would encourage people to wait to see that report. Any Bill that is introduced will not be introduced until after that consideration is complete and our response is in the public arena. The noble Baroness, Lady Howarth, and the noble Earl, Lord Howe, raised the merger of the Healthcare Commission and the Commission for Social Care Inspection. I am sure that they will remind me from time to time of some sterling speeches that I made on that subject in the Health and Social Care Act proceedings. All I would pray in aid is that some of those speeches were made at about 4 am. However, despite the remarks that were made, there is an important issue on how we strike the right balance between social care and healthcare in the way in which we provide services and support to people. If we are absolutely honest—I can say this, having spent six years running a big social services department—one sometimes has a sense of social care being a slight Cinderella to healthcare. If we merge those two inspectorates, we will see that help to strike the right balance in the way in which those services are provided and the quality of those services. I recognise that there is uncertainty and concern among staff and people working in those areas. I, too, pay tribute to the very good work of the Healthcare Commission and the Commission for Social Care Inspection, but we will take this forward in consultation with everyone. It is certainly our intention not to disrupt the important work that they do. My noble friend Lord Mitchell raised the difficult and important issue of the boycott of Jewish universities by the AUT. I assure my noble friend that we deplore any acts of racial or religious intolerance in higher education. We are concerned by the reports of an increase in anti-Semitism in the UK and are committed to tackling any form of anti-Semitism and racial intolerance. The DfES is committed to encouraging the higher education sector to ensure that discrimination has no place in any of its policies or practices. We welcome the fact that the AUT is due to reconsider its position on 26 May. We fully support academic freedom, and we appreciate the independence of the AUT. But, as friends of both Israel and Palestinians, we can best encourage both sides to take the steps needed to progress through close engagement. I hope that there will be a peaceful outcome to that problem. I listened with some amazement to the tutorial on legislation from the noble Baroness, Lady O’Neill. I do not agree with her about the Human Tissue Bill. I am not sure that this is the debate in which to examine the framing of legislation in general. I have not been able to respond to all the points that have been made. I shall address a few of those made from the Front Benches. I was glad to hear from the noble Baroness, Lady Barker, that the acceptance of targets has spread to the Liberal Democrats’ inner workings. That was reassuring. My noble friend Lord   Adonis will write to her about Emmanuel College. The noble Baroness made a couple of other points. Bradford made its own decision to apply for foundation trust status. No one forced them to apply. I should add that, although she may not have heard choice being mentioned on the doorstep, when we consulted the public before the choice White Paper, the public overwhelmingly wanted more choice over the way that their health services were delivered. As we always say, we are a listening government. We listened to the voices that were raised in that consultation. I say to the noble Baroness, regarding the use of private sector services, that they are still a small proportion, even after the new contracts that were announced by the Secretary of State last week, to which the noble Earl, Lord Howe, referred. When those contracts are completed, the independent sector will be spending about 1 per cent of the NHS budget in elective surgery and diagnostics. That is a pretty small proportion of the total spend, so we need to keep some type of balance. The noble Earl, Lord Howe, made an extremely important and thoughtful speech about the effect of some of the reforms on the NHS. I take seriously his points—they are matters that we are concerned about. We want to ensure that the reforms gel together, that they are introduced in a manner that does not damage the NHS and that they are taken forward in an orderly manner, with consent in the NHS and without damaging the services that are provided to patients. I am sure that we shall return to such issues as the Session proceeds. The issues of choice and contestability were raised several times. The issues raised were not just about diversity and community. Giving patients more choice and control over their healthcare and making that care more personalised are at the heart of our NHS reforms. By the end of this year, patients will have a choice of at least four to five providers when their GPs refer them for hospital care. From next year, they will be able to choose from an extended range of providers. Alongside that, we have committed ourselves to reducing waiting time to no more than 18 weeks from GP referral to hospital treatment—that is, with no hidden waits for diagnostics. We simply cannot do that—we cannot achieve that improved access—without some involvement of private sector providers, particularly in the area of diagnostics. That is not a criticism of the NHS but a facing of the reality that if we want to improve patients’ access to services, we have to bring in that additional capacity. We can have a debate about whether it has been done in the right and proper way, but if you look at the arithmetic, you can see that there is not much chance that you can actually improve services for patients without bringing in that extra capacity. That is why we need to use the independent sector in elective surgery and the areas of diagnostics. All I would say to people is that, if they do not like that, they should go and talk to some of the elderly people who have had their cataract operations done much quicker as a result of some of those provisions. In education, the same policies of contestability and choice apply, with alternative providers. But again, as with health, that does not amount to privatisation. The new providers are all working to provide public services in education and health, free to their users. That greater diversity and choice will continue to be a key feature of   this Government’s programme, legislatively and otherwise. But we recognise that improvements in health and education that are being made are very much down to the hard work of the doctors, nurses, teachers and many other professional and support workers who are working in our public services—and, dare I say it, managers as well. On Question, Motion agreed to nemine dissentiente; the said Address to be presented to Her Majesty by the Lord Chamberlain.