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Debate on the Address

My Lords, I apologise to my noble friend Lord Darzi for missing the first part of his speech, for transport reasons that were totally beyond my control. It is a pleasure to participate in the debate secure in the knowledge that I will not have to wind it up and think of something sensible to say in response to the diverse contributions that your Lordships will no doubt make. I readily sympathise with the position of my noble friend the Minister, so I shall try not to add to his burdens in that respect. As someone who has a long-standing interest in social policy and a commitment to the interests of children and young people, I thought that the gracious Speech and its legislative programme were a good blend of the visionary and the practical. It is an ambitious programme, which extends education and training to 18 year-olds, provides mechanisms for increasing social and affordable housing, improves services for vulnerable children, especially those in care—I shall speak about them in a moment—strengthens workplace pensions, uses unclaimed money in bank accounts to improve youth facilities and helps to improve the balance between work and family life. Those on the opposition Benches in another place who suggested that the programme lacked vision were really saying that they do not like the vision of a Government who are concerned with social justice, fairness and opportunity. I welcome particularly the measures to improve services and, I hope, outcomes for children in and leaving care. For far too long, and under successive Governments, their life chances have been poor when compared with those of their contemporaries outside care—I know that from my six years as a director of social services. I hope that the Government will commit the resources necessary to ensure much more stability in the placements of young people and the stability of the key workers and mentors who support them during their time in care. Those young people, who never chose to be in care, hunger for greater stability and continuity in the significant adults who work with them. We know from the expansion of youth facilities how much those services and activities can contribute to reducing crime and anti-social behaviour among young people. I saw that during my time as chair of the Youth Justice Board, when we used the money provided by this Government to expand preventive programmes. I hope that measures in this area will enable us to take those preventive programmes much further. There is one area of the legislative programme, affecting another group of children, where I hope—although I have fairly low expectations—that it is not too late for the Government to think again. This group consists of the as yet unborn children who will be affected by a proposed change in the Human Fertilisation and Embryology Bill. That the Bill retains the duty in the 1990 Act to take account of the welfare of children in providing fertility treatment is welcome. Less welcome is that the Government are, it is believed, proposing to remove the words, "““including a child's need for a father””," from the concept of children's welfare in the 1990 Act. I understand the pressure that the Government have been under on this issue; I know the power of some of the lobbies that have argued on it. However, children are not accessories to adults' preferences. I hope that we in this House will think again about retaining the words of the 1990 Act on a child's need for a father. On a happier note, I turn to the Health and Social Care Bill. I should acknowledge that I was heavily involved in the Bill as a Minister, so it will come as no surprise that I fully support the Government's approach in it. On the changes to the healthcare professional regulatory bodies, there are already rumblings from BMA House. When the Bill is in this House, I have no doubt that your Lordships will be briefed to the effect that civilisation as we know it will end if there is a change to the civil standard of proof in professional disciplinary cases. I urge noble Lords to use their well honed powers of scepticism and capacity for detecting the whiff of self-interest in considering these aspects of the Bill. The Government deserve our support on this issue in the interests of patients, as the General Medical Council well recognises. On the other main measure, a new integrated system of health and adult social care regulation, we shall no doubt have many discussions in this House. A lot of the devil will be in the detail. The noble Earl, Lord Howe, and I are veterans of earlier discussions on some of these issues in the 2003 Act, and I am sure that we shall dust off our campaign medals and volumes of Hansard to return to some of those issues during debates on this legislation. All that I should like to do today is to offer two pieces of advice to my noble friend the Minister to pass on to his colleagues in Richmond House. First, a new regulatory system in this area must be totally even-handed and operate on a level playing field between service providers, whether from the public, private or third sectors or from social enterprises. I include in that the important point made by the noble Baroness, Lady Barker, about the application of the Human Rights Act provisions to all providers of public services, including health services. That approach is critical to the promotion of choice and competition, as the Government recognised in their original consultation document and recently published response to that consultation. If we are to have the personalised healthcare system that the Prime Minister rightly wants, choice and competition with a mixed economy of providers, in an open and fairly regulated market, are critical to success. I believed that as a Minister and shall continue to do so as we take the Bill through this House. We need to make market entry and exit as equivalent as possible for all providers of NHS services. The second key issue is the coverage of the registration of care providers, to be included in the new regulatory system. The Government are rightly consulting further on the issue. I remind them, as they consider this further consultation, to remember the January 2006 White Paper, Our Health, Our Care, Our Say: A New Direction for Community Services. This demonstrated that the traditional boundaries between primary care, community services and secondary care were being blurred rapidly with advances in medical technology and changes in patients' preferences. That point is well understood and has been well argued by my noble friend Lord Darzi in the work that he has done in reviewing the NHS in London and elsewhere. Any registration system that excludes significant elements of primary care and community services will not produce a fair regulatory system and will ossify the development of more patient-responsive services. Whatever the pressures from vested interests to be excluded from the regulatory system in this area, I hope that the Government will see them for what they are and ignore them. I have resisted the temptation in this speech to respond to the criticisms that the noble Earl, Lord Howe, made of the Government's stewardship of the NHS, including no doubt my part in that stewardship as a Minister. He will be surprised to hear me say that I believe that over the 10 years of this Government we have made some mistakes—but we have also tried to correct them. However, those mistakes pale into insignificance compared with the failures by the party on the Benches opposite to invest in the NHS in the two decades before we took over responsibility; that party left the NHS on its knees and with a deficit that in percentage terms was higher than has ever occurred under this Government. In conclusion, I congratulate the Government on a visionary and practical gracious Speech and legislative programme, which continues public service reform in the interests of fairness, opportunity and service-user responsiveness, and on their continuing good stewardship of the NHS.