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Debate on the Address

My Lords, it is, as ever, a privilege to open this part of the debate on the gracious Speech on behalf of those on these Benches. I, too, congratulate the noble Lord, Lord Darzi, on the eloquence with which he introduced what I imagine are for him some very wide-ranging and new subjects. He did so with great authority. These occasions provide a rare opportunity to consider key policy themes, as well as giving your Lordships a chance to probe the Government's wider intentions behind their legislative programme. This year, it is particularly difficult to do so, in part because much of the attention has already been focused on the detail of the substantive issues in the two pieces of legislation mentioned by the noble Earl, Lord Howe—the Human Fertilisation and Embryology Bill to regulate embryology and the Health and Social Care Bill to merge health and social care regulatory bodies—which have already provoked a great deal of detailed debate. One can, however, detect two themes that have run through the commentary on the gracious Speech. The first is trust: trust in the integrity of science and scientific research; trust in professionals, whose responsibility it is to apply that scientific knowledge to the difficult physical and mental conditions in which human beings live their very different lives; the trust which professionals, clinicians, social workers and teachers place in government to provide the resources that enable them to do their jobs; and, above all, the extent to which people and communities trust government to steward public resources to meet emerging demographic needs. The second theme is the extent to which professionals have the freedom to pursue what they know to be right for those whom they seek to serve. Those two key issues are difficult to assess in this gracious Speech for two reasons: first, because of the reform of the NHS proposed by the noble Lord, Lord Darzi; and, secondly, because of the future funding of social care. Neither is addressed anywhere in this speech or in this legislative programme. Those two matters are the key backdrop to all that we will discuss over the coming 12 months. Therefore, it is difficult to assess exactly how much the Government can be trusted to deliver high-quality public services. Resources are the other issue. The Comprehensive Spending Review for 2007 was the worst settlement for local government for 10 years. Although it is true that there was 1 per cent real growth, most of that will be used to meet PFI liabilities. The projections in CSR07 assume efficiency savings in local government expenditure of £5 billion. In the last spending review, local authorities managed to find savings of £3.5 billion. Local authorities currently spend £7.8 billion on social care, but with a growing number of older people and people born with severe disabilities who will have a lifelong need for high levels of social care, there is a real crisis. The crisis is most evident at local level. For the past four years Sir Derek Wanless has told us that we will not be able to assess the state of the NHS and future demand for services until that issue is satisfactorily addressed. I was interested that the noble Earl, Lord Howe, did not mention the White Paper that the Conservative Party published last week, in which the main proposal is to establish an independent health board for the NHS. I am sorry that he did not mention it because that is an interesting idea—although it would not work. The idea that any Government would give £92 billion of public expenditure to a body of people who would be wholly independent is unworkable. Nor would the idea find favour with practitioners or users once they had worked out that although it might be called an independent management board, it would in fact be responsible for the allocation of NHS resources and promotion of patient choice, for involvement in health and the provision of safe, high-quality health services. It would be another layer of performance management. We on these Benches have realised that the centralised model of public services is exhausted. Now it is the job of politicians who are committed to finding ways of increasing the quality of public services to find ways of enabling the politicians responsible for the resources, the professionals with the scientific and professional knowledge and the people who use the services to engage in a debate about strategy and the deployment of the resources to meet the emerging needs. My colleagues and I are therefore pursuing the idea of establishing local health boards which would be democratically accountable to local communities and would provide a forum in which social and health care needs could be properly addressed. That is the model in other parts of the world, such as in New Zealand, and the idea has much to commend it. It has proved to be successful in tackling health and social inequalities—politicians' key role in health. I shall deal with the health and social care aspects of the gracious Speech and my noble friend Lady Sharp will address those on children. As someone whose maiden speech in this House was on the subject of young people leaving care, delivered in a debate initiated by the noble Earl, Lord Listowel, I am delighted to see the inclusion of a Bill dealing with children in care. I know that many noble Lords, not least the noble Earl, will give the Government a hard time over any legislation that falls short of delivering the means necessary to equip these young people for life well after they have left care. As we are beginning to realise from research, those needs continue throughout their lives. The Health and Social Care Bill has long been trailed, ever since the then Health Secretary, John Reid, announced the merger of the Healthcare Commission and CSCI just after CSCI opened its doors. Many of the Bill's provisions were debated in your Lordships' House on 18 April, in a very good and crisply focused debate on the document, Good Doctors, Safer Patients. We on these Benches will support measures to improve professional standards and increase public confidence in the medical profession. It would be regrettable, however, if Parliament were to undermine professional self-regulation, which in all but exceptional circumstances is a powerful force exerting discipline on highly skilled professionals and goes far beyond that made possible by formal lay involvement. There has been much discussion about the Government's proposal to change the standard of proof for medical practitioners from the civil standard of ““on the balance of probability”” to the criminal standard of ““beyond reasonable doubt””. We on these Benches will question whether the Government's proposal will deliver better outcomes for patients and staff than the current practice, under the case law in McAlister v GMC, where in practice both standards of proof are used and the question of which standard of proof is given most force will depend on the severity of the issue at hand. We will probe the Government hard on this issue. I turn to the merger of CSCI and the Healthcare Commission. As Ministers will be aware, there is widespread concern that this body will be medically dominated and that social care will be the poor relation. Like the noble Earl, Lord Howe, I want Ofcare to be well resourced and to do a good job. In particular, I hope that the new body will be able to clear up one anomaly—that although independent-sector social care providers are subject to regulation, they are not subject to the Human Rights Act. This loophole affects many in residential care and the House should pay due attention to that. It is self-evident that the system of pre-legislative scrutiny, which we welcomed when it was introduced, has proven its worth in the field of human fertilisation and embryology. I am glad that the Government accepted almost all the recommendations of the Joint Scrutiny Committee. However, one topic remains to be further explored in detail. Individuals have an overwhelming right to know their identity, including their genetic identity. Although this may be a very small part of one's overall social identity, it is important. We will therefore need to spend considerable time on the issue of how those conceived by means of donors can find out who their genetic parents are. We should not stray from the absolute right of donor-conceived children to know their genetic identity, should they choose to find it. It is ironic that much of the commentary on the gracious Speech has focused on abortion, an issue that was not mentioned in the gracious Speech and is not actually part of the legislation. The noble Earl, Lord Howe, indicated that there will be a free vote on this issue for those on the Conservative Benches. There will be for us, too. This is one of the most contentious issues and everyone comes to it with their own predisposition. Some are implacably opposed to any measure that would change the law, and others take the completely contrary view. I suspect that many noble Lords, like many members of the public, do not approach the issue from a position that is hard and fast but wish us do something important—once every generation, to consider the changes in science and technology, and to decide the ethical and moral framework within which these developments are evaluated. I commend to noble Lords the report of the House of Commons Science and Technology Select Committee, which examines only the scientific aspects. Noble Lords, particularly those concerned about the crucial issue of foetal viability, will find evidence in the report of which they should take note. It is also ironic that today we will not be discussing the most important health measure in the Queen's Speech—the Climate Change Bill, the one measure with the greatest potential effect on the future health and well-being of children in the United Kingdom and around the world. However, welcome though the Bill is, we believe that it does not go far enough. It should include all greenhouse gases and matters such as shipping and aviation. If we as politicians really are to earn the trust of the public, the public will have to know that we are worthy stewards of the planet's natural resources.