---

Queen’s Speech

My Lords, it is an enormous privilege to sum up on the whole of the gracious Speech from these Benches. I am particularly pleased to do so today when we heard two outstanding and memorable maiden speeches. I congratulate the noble Lord, Lord Aberdare, on reminding us of the power of education to liberate the potential of individuals for the betterment of the whole of society. The speech made by the noble Lord, Lord Sacks, was thoughtful, witty, incisive and longer than when he is on "Thought for the Day", and we will remember it. He alluded to the strong tradition within the Jewish faith of education by means of question and argument. It has long been a mystery to me why the whole Jewish community is not therefore Liberal Democrat. After all, Liberal Democrats were once memorably described in the Guardian as people who would go to extraordinary lengths to have a good argument. When I came to this House 10 years ago, something that was extraordinarily helpful, and very moving, was the way in which people from all parts of the House freely and kindly gave me their experience and wisdom. I will therefore in the same way pass on something to the noble Lord, Lord Sacks. It not just that people in this place listen—how they listen—but that they listen to the proposals that we make on these Benches and then they go away. After a while they announce these as their own proposals or policy. I share that with the noble Lord as something for him to mull over. The noble Lords join us on an unusual day. Normally we debate questions, but today we are not debating a question but a series of topics. In fact, we have talked about two questions, one overtly and one slightly less overtly. The first is, from our different political standpoints, what we believe to be the key priorities on the major issues of education and health. One need not look any further than the speech of the noble Lord, Lord Freud. The second is what we want the electorate to hear from us for the next six months. Sadly, I cannot go into a number of the interesting topics that were raised. The noble Baroness, Lady Howe of Idlicote, talked about prisoners and the noble Baroness, Lady Nicholson, gave us good news stories from Iraq. There are many topics that I would like to follow up, but I have to remain with two. On equalities, my noble friend Lord Lester set out well the need for equalities legislation. In response to some of the other speeches, we have spent the past 40 years setting out in legislation why people who are different have the right to be treated as equal citizens. It is now time for our diverse society to have a legal basis for that which is common to us all. It would be not least to the benefit of our country economically if we could make that agreement on what our diverse society should be and what we believe to be fair and equal ways of treating our fellow citizens. We all know that the general election issue will be the economy. The public are not stupid. They know, as well as any of us, that the recession and the huge levels of public debt mean that inevitably there will be a public spending squeeze from 2011. We have not talked much today about the NHS and its future, but it is reasonable to state that the NHS has had unprecedented levels of funding. This Government have funded the NHS to a level not seen before. But it is reasonable to believe that from 2011 the NHS will at the very least have a budget which stands still. In all likelihood it will have to be cut. Indeed, the NHS chief executive, David Nicholson, for one, has openly stated that the NHS will have to look for efficiency savings of around £15 billion to £20 billion from 2011 to 2014. Therefore the timing could not be worse to embark on radical change in the social care system, a system which we have all known for so long is in urgent need of care. I shall pick up a little on the Conservatives’ pledges. They have pledged to increase the NHS budget in real terms after 2011, a pledge which, according to the Institute for Fiscal Studies, would mean real reductions in other departments of up to 16 per cent over six years. We will need to consider carefully what our Conservative colleagues say not least about education if they wish to fulfil that pledge on health. Similarly the Conservatives have returned to a proposal that they first unveiled in 2006: to turn the NHS over to an independent board. They made that announcement in 2006 but have since then been very quite about it. I would simply observe that it is rather strange, at a time when politicians on all sides are promising a bonfire of the quangos, to propose establishing what would be by far the biggest quango of them all and giving it responsibility for a tenth of all government funding. We on these Benches have, like the noble Lord, Lord Darzi, long realised that the space in which there will come about real transformation, real savings and real efficiencies within the NHS is at local level. That is why we believe that there should be a patient contract that guarantees a minimum level of health care to everybody. Beyond that, we would wish to see devolution of power and decision-making down to local health boards. I should hope to see not just hospitals but also local authorities pursuing that agenda of quality, care and change that the noble Baroness, Lady Wall, spoke of so eloquently. I want to talk a little about the Green Paper. The noble Baroness, Lady Morgan of Drefelin, described the Personal Care at Home Bill as a bridge to a national care service. It seems a bit more like a coach and horses being driven through the proposals which the Government set out in the summer for a national care service. We should not lose sight of some of the very good things that were in that Green Paper—it contained lots of examples of innovation in personal social services. Unfortunately, however, the only commitment it contained was to a ministerial group that would look at taking those examples forward. I would rather like to see the Government commit to rewarding all health boards and social care boards by giving them incentives to innovate in delivering good care. There is one other point. The Green Paper also talked about having a social care equivalent of NICE. That is perhaps one of its most important proposals, as social care is always desperately trying to find evidence bases for practice. I hope that that proposal does not go. One of the unfortunate by-products of the publication of the Personal Care at Home Bill is that the costings—the financial models for the options in the Green Paper—have been delayed. The Minister in another place, Phil Hope, said that they would be published this month, but they have not been. I know that this is not the field of the noble Baroness, Lady Royall, but I hope that someone on the Government Benches will be able to tell us at some point when we will see those models. I should point out for the educationalists present that, at the moment, people seem to be coming up with figures for different options for social care without showing how those figures have been worked out, which is crucial. When a proposal is made to spend a particular sum on an aspect of social care, none of us knows from which other budget that amount will come. From where will the sums necessary to implement the proposals for an insurance-based service come? On the Personal Care at Home Bill, I want to make only one observation. It is not clear where the money going into that, which will be directed towards those in the most urgent need according to the fair access to care services criteria, will come from. The Government have already said that some of it will come from local government efficiency savings. Under the Gershon principles, which have been in existence for the past four years, local authorities have been meeting their targets in a way that central government have not. They have already saved at least £5 billion, much of which has come from their social care budgets. I want to know exactly what it is that central government believe local authorities have to give. Frankly, much though I might agree with the aims of the Personal Care at Home Bill, if they can be afforded only by taking away wardens or some elements of carers’ respite, I am not sure that I would choose them as a priority. It would not necessarily do the best for older people. We on these Benches remain convinced that despite all the work that has been done during the time of this Government, and indeed going back to the time of Sir Roy Griffiths and the community care legislation, the most thorough and robust analysis was that conducted by Sir Derek Wanless for the King’s Fund. It is therefore our belief that we should base any future system on a guaranteed entitlement as set out in his report. All older people would know that they had a basic entitlement which they could then top up. It does not matter what system of funding one goes for, whether a private insurance fund or a compulsory element, what matters are the criteria under which it would operate. More than that, consistency of criteria between any state funding and private funding are essential. Put simply, individuals cannot know what their care needs are likely to be, but if they do not know what funding will be available from the state, they have absolutely no hope of being able to make the correct provision. We have already recognised that in pensions and it is now time to do so in social care. Throughout my years in this House, Members on all sides have sought to answer one question: how do we have a system of social care not just for older people but for all adults who need it that is fair, that supports preventive measures and stops people from developing ever greater needs, that recognises diversity and dignity, and is sustainable. We would not have chosen to embark on such a great task when the economic circumstances are so grim, but I suggest that in the light of a general election, for once we might have a debate on social care that truly does lead to dramatic change. I am sure that your Lordships’ House will help that process along considerably.