House of Lords
Introduction: Lord Gardiner of Kimble
Introduction: Lord Maples
Government: Savings
Lord Eden of Winton
To ask Her Majesty’s Government what savings are being made in the administration of Government.
The Commercial Secretary to the Treasury (Lord Sassoon)
My Lords, the Government have announced savings in the current financial year of £6.2 billion, of which £360 million will be made in the administration budgets of central government departments, and £400 million will be made in the administrative costs of quangos. The Government have also announced in the Budget £3.3 billion of savings from freezing public sector pay for two years from 2011-12 for those earning above £21,000. A portion of these savings will be made within administration budgets. The Government are committed to reducing the administrative costs of Whitehall and of arm’s-length bodies by at least one-third. Further details and spending plans will be set out at the spending review on 20 October.
Lord Eden of Winton
That was a good Answer. I suspect that there are masses of people like me who are fed up with the monitoring, hectoring and intrusion by government agencies and quangos. Can my noble friend confirm that every department has been required critically to examine the justification of and the value for money of every activity in which they are engaged? Can he confirm that they have been given a clear timetable by which to report, and is he able to say what will be the likely impact on front-line services of any subsequent cutback?
Lord Sassoon
My Lords, I want to read some words that my noble friend may recognise:
“I am most concerned about the people who are hardest hit ... They have been trying to deal with their own responsibilities themselves, and … to take the burden off the State and look after themselves. The wasteful money-spending policy of the Socialist Government has virtually ruined their little nest eggs”.—[Official Report, Commons, 13/3/55; cols. 2158-59.]
Those are the words of my noble friend in another place some 55 years ago, so I applaud him for the consistency of his concern that the size of the public sector be reined in. It reminds your Lordships that such reining in has, regrettably, had to be done in the wake of successive Labour Governments. Therefore, this time round, I can absolutely confirm everything that my noble friend asked for. In particular, we will ensure that departments completely meet their commitments on reducing admin spend. This, as I said, will be done by a cut of at least one-third, which is committed so far. That is a starting point and we may look to go further.
Lord Brooke of Alverthorpe
Can the Minister say whether the Palace of Westminster is classed as one of the arm’s-length bodies? Will there be a savings of one-third here? What plans does he have for implementing them and what is the timetable? If he does not have such plans, can he explain why?
Lord Sassoon
My Lords, I have not been here very long but I know that I would be foolish to get into off-the-cuff answers on admin costs for the Palace of Westminster. Rather than waste time giving the noble Lord a definition of what is included, I shall write to him.
Lord Newby
Will the Minister ensure that, when looking for savings, he does not only do so within departments but seeks to reduce duplication of function between departments and quangos by implementing the principles of the Total Place programme more generally across government?
Lord Sassoon
My Lords, I thank my noble friend for that; we will indeed look right across government in the way that he suggested. The definition of what constitutes admin costs will itself be considered in the spending review and reported at that time.
Lord Pearson of Rannoch
My Lords, did the noble Lord see the recent article in the Daily Telegraph which estimates that up to 2,000 Eurocrats are paid more than the Prime Minister? Why do we go on sending some £8 billion in cash every year to support these people, who then go on to inflict such ruinous over-regulation on our economy?
Lord Sassoon
I thank the noble Lord for his concern about the costs of bureaucracy in Brussels, about which we, too, are of course very concerned. The Government will be taking steps to make sure that the budget contribution to Europe fully reflects the need for Europe to restrain its costs. So far as concerns Eurocrats, we want to make sure that the best-quality British officials play their part as senior officials in Brussels.
Lord Morris of Aberavon
My Lords, what is being done to reduce the number of civil servants of the rank of Permanent Secretary in the Cabinet Office and Downing Street, of whom there are six in number?
Lord Sassoon
My Lords, while there are those six Permanent Secretaries in addition to the Permanent Secretaries in each department, we have over 600,000 civil servants in total. The main question is how we reduce the total number of civil servants, which increased by 28,000 under the previous Government.
The Lord Bishop of Bath and Wells
My Lords, while recognising the need for child protection and health and safety matters, will the Minister also recognise that at present over 4 million volunteers are being lost to the system due to what one might describe as overzealousness in these areas? Can serious attempts be made to focus on what is absolutely essential in these matters, rather than on that which seems to be ongoingly pervasive?
Lord Sassoon
I thank the right reverend Prelate for that question. I would stress that by having a target of a one-third reduction in administration costs, which we hope to exceed, we will be able to target the expenditure on where it really matters, including in the ways that he has described.
Lord Marlesford
My Lords, given that the cost of compliance with government regulations by the business sector is tax-deductible and therefore a net cost to the Exchequer, will my noble friend seek to bring under better control some of the quangos whose regulatory functions appear to lack both proportionality and common sense? Will he ensure that if they are to continue at all, they are brought under much tighter discipline?
Lord Sassoon
I simply confirm that that will be done, in line with my noble friend’s suggestions.
Lord Maxton
My Lords, is not the introduction and development of smart-card technology for all our citizens the best way of improving the quality and reducing the expense of public services generally? If that is so, why on earth are this coalition Government abolishing the ID card programme?
Japanese Knotweed
(13 years, 10 months ago)
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Baroness Sharples
To ask Her Majesty’s Government what plans they have for preventing the spread of Japanese knotweed.
The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Henley)
A controlled release of the highly specialist psyllid—Aphalara itadori—is currently under way to help control Japanese knotweed. If successful, this should restrict its growth, slow its capacity to spread as vigorously and enhance the effectiveness of management effort. It would not eradicate it altogether.
Baroness Sharples
I thank my noble friend for that reply but is he aware that it is more than 20 years since I first asked about knotweed and nothing seems to have happened since then? Should psyllid be released and the genie is then out of the bottle, how can we ensure that it is safe? Is there not a problem for people trying to get mortgages? When it is proved that they have knotweed in their gardens or on their land they cannot get a mortgage.
Lord Henley
My Lords, we are all aware that my noble friend has been pursuing this matter for about 20 years. This is an experiment worth doing. We have put a great deal of research into the safety of the psyllid that is being introduced to ensure that it will not eat anything other than Japanese knotweed. So far, as far as we know, it does not. If we find any evidence that the psyllid moves off, we will quickly eradicate it to ensure that it does not cause the damage that uncontrolled releases of biological agents can cause.
Lord Campbell of Alloway
What has been done about it over the past eight years?
Lord Henley
My Lords, a great deal has been done about it. I notice that the noble Lord, Lord Hunt of Kings Heath, is laughing, because he has had to address these questions before. I am grateful for the work that the previous Administration did in this area in introducing research into the said psyllid, the—let us get the name right again—Aphalara itadori. We hope that it will do the appropriate job in due course.
Lord Davies of Oldham
My Lords, we on this side wish the Minister well in the attempt to control Japanese knotweed. Will he emphasise that it is not just gardeners and people who own cultivated land who are concerned about it, but our public services? Knotweed represents a heavy cost on our railway system because of the threat that it represents.
Lord Henley
My Lords, the noble Lord is right to emphasise the costs, as did my noble friend in her supplementary question. It can cause major structural damage. We estimate that the costs of managing it are about £150 million a year but, as the noble Lord will remember from when he had to deal with the matter, back in 2003 the cost of total eradication was estimated at £1.5 billion. Now, obviously, it would be a great deal more. We should wait to see what this psyllid can do and whether it leads to a much better control of Japanese knotweed.
Lord Greaves
My Lords, first, I congratulate the noble Baroness, Lady Sharples, on her persistence in pursuing this matter over many years—even before I was here. It is now coming to some fruition. If the present small-scale release tests in the real world prove successful, what is the next step?
Lord Henley
My Lords, if those tests are successful, obviously we would want to take it on, on advice from the appropriate scientists, to lead to greater control of Japanese knotweed. I have to say that it will take a considerable time before we know whether it will be effective; it is thought that it could be five to 10 years before we see any evidence of greater control.
Baroness Gardner of Parkes
Can the Minister tell us exactly what this mysteriously named thing is? Is it an insect, is it like the Hawaiian cane toad in Australia, or is it bacterial?
Lord Henley
My Lords, the psyllid known as Aphalara whatever it was, is a very small bug, of the order of two to three millimetres long. It is difficult to see with the naked eye, and a magnifying glass may be used better to see it. I have some pictures, which I could show to my noble friend after this Question if she wants to see whether she can identify that bug.
Baroness Quin
My Lords, I, too, pay tribute to the noble Baroness for her persistence in raising the issue. Is it not potentially a good news story that after so long, given the problems and great expense which this has caused to people in both urban areas and the countryside, that some of the cost incurred by this plant may be limited in future? I know that the Labour Government had also commissioned research into another method of control of Japanese knotweed, a leaf fungus, which also did not appear to attack other plants. Can the Minister confirm that that research is continuing and what progress is being made?
Lord Henley
My Lords, the noble Baroness is quite right to say that it is a good news story. That is why I was trying to offer some praise to the party opposite for the work done, particularly by the noble Lord, Lord Hunt of Kings Heath. We will continue our research on the fungus that the noble Baroness mentioned and, in due course, I hope that I will be able to tell her how that is getting on. I have nothing further to add to what I have said today, but we will continue with both avenues as appropriate.
Lord Skelmersdale
My Lords, would it not be quite a good thing if this bug, the name of which I cannot pronounce either, were to mutate and attack the oilseed rape seedlings that are desecrating our waterways and creating quite a large eyesore around the country?
Lord Henley
My Lords, my noble friend has a point, but we would be rather worried if the highly specialist psyllid mutated because that could cause considerable damage in areas that we would not be aware of. If we saw any signs of it mutating, we would have to stop these experiments.
Parliament: MP Numbers and Constituency Review
(13 years, 10 months ago)
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Lord Roberts of Llandudno
To ask Her Majesty’s Government what consultations they plan to hold with local authorities and the Boundaries Commissions on reducing the number of Members of Parliament and reviewing the size of parliamentary constituencies.
The Minister of State, Ministry of Justice (Lord McNally)
My Lords, Ministers are taking advice on the details of proposals, including on consultation, and, as I said in the House on 15 June, we will of course seek to frame the legislation in a way that ensures that the Boundary Commissions complete their task in a timely, fair and thorough way.
Lord Roberts of Llandudno
I thank my noble friend for that response. Will the Government assure us that when the Boundary Commissions consider this, they consider not only the electorate size but the geography and the local authority boundaries when reporting on the new constituencies? Will they also discuss thoroughly with the devolved Administrations any effect that the new boundaries for Westminster might have on, say, the Cardiff Assembly or the Edinburgh Parliament?
Lord McNally
My Lords, my noble friend will know that the sole objective of this exercise is to bring greater fairness to our electoral regulations and equal weight to votes. He is right, of course, that common sense and a sense of history and of geography will have an influence on this, and we will consider the implications for Wales and the other nations and regions of this kingdom when we come forward with our proposals.
Lord Bach
My Lords, the noble Lord, Lord Roberts of Llandudno, is quite right; local consultations, representations and involvement in boundary reviews, particularly this boundary review, are vital. The Liberal Democrats have always been proud of their commitment to local democracy. My question is: will this commitment survive? If promises such as the ones on VAT can so easily be shredded, how can the Minister convince the House that this commitment to local democracy will not be sacrificed in due course?
Lord McNally
These proposals will strengthen local democracy and enhance the whole quality and culture of our democracy by giving fairer votes and votes of more equal weight.
Lord Forsyth of Drumlean
My Lords, I congratulate the coalition Government on their plan to reduce the size of the other place in order to achieve economies, but will the Minister explain why they propose at the same time greatly to enlarge the size of this House at considerable cost, and in doing so, as he himself has pointed out, perhaps bring this House into some disrepute in the country?
Lord McNally
My Lords, I could not agree more with my noble friend. If he comes to the debate next week, as I am sure he will, he will hear my noble friend Lord Strathclyde and me speaking at an appropriate length about how we think the numbers and the costs of this House could be radically reduced.
Lord Elystan-Morgan
I suggest to the Minister, I hope without impertinence, that these proposals are spawned by cosmetic considerations and indeed by populism, and that it is utterly absurd to consider a reduction in the number of Members of the House of Commons to a lower level than at the time of the Great Reform Act when the population of this kingdom was only a third to a quarter of what it is now. Indeed, all that will be achieved is an enhanced distance between the ordinary voter and the ordinary representative, which cannot be good for democracy.
Lord McNally
On the contrary, one of the things on which we can again pay tribute to the previous Administration is the progress that they made in devolution. We intend to carry forward the process of devolution so that more responsibility is given to the Parliaments and Assemblies of the nations and regions of this country. If you do that, it is absurd to continue with a House of Commons of the same size as when it had the responsibilities that have now been devolved. That is part of the sensible consequences of devolution.
Lord Howarth of Newport
My Lords, is the Minister entirely confident that it is a wise course on the part of the Government to attempt to reduce the number of constituencies at the same time as introducing AV? Does he accept that it is one thing, and pretty difficult at that, to persuade Members of Parliament to vote for an electoral system other than the one that brought them to Westminster, but that it is an altogether more desperate undertaking to ask them to agree to a game of Russian roulette, which will ensure that for significant numbers of them there will not be a seat in the next Parliament? Will all this not stretch the tolerances of coalition Back-Bench MPs?
Lord McNally
These are matters of political judgment. The twin objectives of the coalition are to bring greater fairness to our electoral system and equality of weight to each vote. At the same time, we would wish to go with the flow of what we have been doing in recent years, which is to move power to the devolved Parliaments and Assemblies.
Lord Rennard
My Lords, does the Minister accept that special provision for island communities would need to be made in the guidelines given to the Boundary Commissions? Does he further accept that without special provisions, it would, for example, be very difficult for a single Member of Parliament to represent, say, a part of the Isle of Wight and a part of the mainland, or for a single Member of Parliament to represent the 20 populated islands in the Orkney and Shetland constituency, and the large geographic constituency of Caithness, Sutherland and Easter Ross?
Lord McNally
That is a fair point. The integrity of the Boundary Commissions and the way in which they go about their work have never been in doubt, thank goodness. Because this is constitutional legislation, it will be taken on the Floor of the House in the other place and we will have in this place experts such as the noble Baroness, Lady Gould, my noble friend and others who have great experience and will put their input into the deliberations as this legislation goes through.
Lord Grocott
My Lords, two weeks ago, when I asked a similar Question, the Minister was good enough to acknowledge that the Answer provided by his civil servants was wholly inadequate. He was also rather disappointed that the answer with which he attempted to improve the efforts of his civil servants was not that good either. Now that he has had a fortnight to think about how long he estimates the Boundary Commission will take bearing in mind that the last review took six years, and now that the finest brains of the civil servants in his department have been focused on this for the past couple of weeks, can he give any improvement on the wholly inadequate Answer that he gave me last time?
Lord McNally
I very much regret that the noble Lord has raised that. I was severely reprimanded by the department and it was a couple of days before any of the civil servants talked to me. As I said in answering this question, Ministers are taking advice on the detailed proposals and will bring forward legislation and a timetable as soon as possible.
Daylight Saving Time
Baroness Miller of Hendon
To ask Her Majesty’s Government whether they have plans permanently to move clocks in England, Wales and Northern Ireland forward by one hour.
The Parliamentary Under-Secretary of State, Department for Business, Innovation and Skills (Baroness Wilcox)
My Lords, we are aware that there are a range of views on this subject. While the Government do not propose to change current summer time arrangements, we continue to listen to representations we receive and consider any evidence presented to us.
Baroness Miller of Hendon
I thank the Minister for that not terribly helpful reply. Repeating facts that have been known for many years, is she aware of research done at the University of Cambridge which suggests that moving forward one hour from GMT would be equivalent to taking 200,000 vehicles off the road? That cannot be something that can just be overlooked in a brief reply.
Baroness Wilcox
I am aware of the campaign and in particular the Elizabeth Garnsey report, to which my noble friend has referred. It is important to stress that evidence on this issue has not always pointed in the same direction. In particular, it is suggested that the change would save a significant amount of CO2 emissions. However, work undertaken in 2005 by the Building Research Establishment for Defra indicated that putting the clocks forward an additional hour in winter and summer would lead to a net increase in carbon dioxide emissions corresponding to around 1 per cent of total UK emissions.
Lord Rogan
Does the Minister agree that British business, especially manufacturing, would greatly benefit from the introduction of this time change by affording us at least two if not three extra hours in a trading day to communicate with our mainline European customers and suppliers?
Baroness Wilcox
I have been in this House a few years now and I have heard the arguments for and against doing this. Always we come back to the same thing: certain parts of the country would benefit while other parts certainly would not because the time zone would not be helpful to them. There would be an impact on the City, for example. As we are at the moment, the time works very well for us. We are there when Asia is online and we are still there when the United States starts trading. I am not sure that the arguments for and against are as clear as we would like them to be.
Baroness Wilcox
Yes. Evidence from the Department for Transport suggests that road casualties would be reduced, with a reduction in road deaths by around 80 per year and serious injuries by 212 per year out of a total of 3,000 and 28,000 respectively. Those are not enormous benefits, but benefits none the less.
Lord Howe of Aberavon
Does my noble friend recognise that the central European time zone extends very widely from Berlin to Madrid; that the People’s Republic of China has one time zone that stretches from east to west in its entirety; that the people of Wales and Haverfordwest can live in a time zone stretching from Greenwich to Haverfordwest; and that it should not be impossible for us all to live in a time zone stretching from Greenwich to Oban?
Baroness Wilcox
That is very interesting and goes back to my original Answer, which I am afraid that I still have to give. While we do not propose to change our summer time arrangements at the moment, we continue to listen to representations and will consider any evidence presented to us, including what has just been said.
Lord Faulkner of Worcester
My Lords, is the Minister aware that the answers she is giving are as disappointing as those which used to be given by Ministers in the previous Administration? The problem we had then was that this Question was being answered not by the Department for Transport, which has a concern for saving life, but by another government department. Could those two departments talk to each other and look at the evidence? The noble Baroness has referred to the lives that would be saved. I cannot believe, and surely she must accept this, that the saving of lives is not more important than any other consideration. The evidence is overwhelming in this area.
Baroness Wilcox
That is why we continue to look at these matters and consider the evidence that we have rather than the feelings that we have. The two departments talk to each other; they both briefed me today.
Lord Oakeshott of Seagrove Bay
My Lords, following the point so well made by the noble and learned Lord, Lord Howe, does the Minister accept that it would protect jobs for Britain as a whole if we were in the same time zone as 374 million people in west and central Europe, who are our main trading partners, and not 15 million in Ireland and Portugal?
Baroness Wilcox
I am afraid we do not have evidence that agrees with that completely. If we did, we would act on it immediately and change the time zones. People have been trying to get this right for a very long time and we will continue to do so.
Lord Hunt of Wirral
My Lords, I declare an interest as deputy president of RoSPA. I congratulate the Minister on her brilliant start to handling a difficult departmental brief. She inherited this issue from her predecessor, who we knew under several titles, including Last of the Time Lords. Does she accept that there is now a feeling that the campaign for lighter evenings—the Lighter Later campaign—would cut energy costs, save lives, cut emissions and should now be carefully considered?
Baroness Wilcox
That is exactly what we are going to do. I have referred to the Lighter Later campaign and said that it has made a persuasive case for change on environmental, safety and well-being grounds, and we will consider all the evidence. I thank my noble friend for his kind remarks.
Business of the House
(13 years, 10 months ago)
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Lord Strathclyde
To move that the debate on the Motion in the name of Viscount Montgomery of Alamein set down for today shall be limited to three hours and that in the name of Lord Mawson to two hours.
Procedure Committee
The Chairman of Committees
That the First Report from the Select Committee (HL Paper 10) be agreed to.
The Chairman of Committees (Lord Brabazon of Tara)
My Lords, the purpose of the report is to seek the agreement of the House to expediting the introduction of new Peers between now and the summer Recess. I hope the report, which was unanimously agreed by the committee, is self-explanatory. If agreed by the House, it will mean that from next Monday until the Recess up to three new Peers will be introduced on each Monday, Tuesday and Thursday. This will be in addition to the introduction of up two new Peers on Wednesdays. On days when there are three introductions scheduled, the House will sit 15 minutes earlier than usual— that is to say, 2.15 pm on Mondays and Tuesdays and 10.45 am on Thursdays.
Lord Brabazon of Tara
That is a very good question from the noble Earl, which will be addressed—in part, in any case—by the Administration and Works Committee next week.
House of Lords: Financial Assistance to Opposition Parties
(13 years, 10 months ago)
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Lord Strathclyde
That, in the opinion of this House, the resolution of the House of 30 July 2002 (Financial Assistance to Opposition Parties) should have effect, in relation to the giving of financial assistance, with effect from 12 May 2010, as if—
(a) in paragraphs (1) and (2)(a) the references to the second largest opposition party were omitted, and
(b) paragraph (8)(b) were omitted.
Baroness Boothroyd
My Lords, this is an important resolution. It is cloaked in technical terms and it affects the way in which opposition parties are funded in this House to help them perform their parliamentary duties. Sadly, no one would know that without recourse to Hansard and to the resolution of 2002 that the Government seek to amend. I regret that. Where public funds and parliamentary accountability are involved, the Government need to be more transparent.
I believe that the Motion before us is more than a tidying-up operation. Rightly, it recognises the changed fortunes of the Liberal Democrats; wrongly—unless I am corrected—it implies a severe cut in the distribution of Cranborne money to the opposition parties in this House by no less than 30 per cent. At the same time, it does less than justice to Cross-Benchers, whose independence will always disbar them from office and who operate on a shoestring.
The Cross-Benchers came late to the party when Cranborne money was distributed for the first time in 1997. They had to wait two years. By that time, the cake had been cut and they were handed the smallest slice—a meagre slice, some would say. Cross-Benchers received £10,000 out of a total allocation of £291,000. Our relative position has improved slightly, but it remains at a subsistence level. I am really quite shocked at the disproportionate way in which Cranborne money has been divided during the past 13 years. To some, the Cross-Bench share was almost a joke.
Eight years ago, when Lord Williams of Mostyn increased the Cross-Bench allocation to £35,000, he laughingly remarked:
“I stand amazed at our generosity”.—[Official Report, 30/7/02; col. 820.]
My colleagues were grateful all the same.
Last year, the Cross-Bench Convenor, the noble Baroness, Lady D’Souza, received the princely sum of £61,003—a substantial percentage increase, you might say, but that was only because the starting point was so low. Cross-Benchers had trailed so far behind they were almost out of sight.
The £60,000 a year allows our Convenor to employ one full-time and one part-time assistant to administer her office and respond to the needs of the 187 Cross-Bench Peers. She also represents us in consultations with the Government and other parties. She sits on some nine House committees. I pay tribute to her fortitude, but it is wrong that she should have to bear so heavy a burden without adequate support.
In contrast, the Conservatives and the Liberal Democrats last year shared the rest of the Cranborne money on a 2:1 ratio. In 12 months, they received £770,000. If that is not lop-sided, I do not know what is. Sinn Fein received more than the Cross-Benchers for its non-performance in the Commons. Despite the refusal of five Sinn Fein Members to take the oath of allegiance, Sinn Fein netted £96,000 to finance what the previous Government described as “representative business”, a term capable of many interpretations. I take these figures from an excellent research paper on the public funding of opposition parties produced by the Commons Library. The section on the way in which the Cranborne money operates makes eye-popping reading.
Sadly, unless the Leader of the House enlightens us otherwise, this Motion makes matters worse. In the absence of further information, the Government appear intent on returning to the Treasury the funds previously allocated to the Liberal Democrats. If that is right, the total amount of Cranborne money available to the Opposition will be reduced by nearly a third, all without reference or explanation to this House.
A clever lawyer might argue that the Cross-Benchers are entitled to all the Cranborne money that went to the Liberal Democrats—not that I would think such thoughts, of course. But the pecking order set out in the resolution of 2002 is clear. Then, the Cross-Benchers were in third place; now, they are in second place. It is a position that the Government choose to ignore to save money and—who knows?—perhaps to reassure their junior partner that its entitlement to Cranborne money is secure if the coalition fails. I do not challenge Labour’s entitlement to the £475,000 which the Conservatives received as the Official Opposition last year—that is, of course, on top of the salaries paid to their Leader and their Chief Whip. Nor do I begrudge Ministers the command of resources needed to formulate their policies, run their departments and present their case as persuasively as possible. I do, however, believe in fair play and hope that the Government do too.
As the House knows, we on these Benches belong to no party. We have no common platform or agreed policies, and no leader. We speak and vote according to judgment and conscience, without the discipline of Whips to guide us through the Lobbies, and we may be swept away if this House is replaced by an elected Chamber. However, while we are here Cross-Benchers will, I know, do their duty to Parliament and to the country. They need adequate resources to do so. We are not partisans but share the same principles and, I believe, perform a useful role.
These Benches do not need the hundreds of thousands of pounds that routinely go to opposition parties. Your Lordships may be surprised to know that during Labour’s period of office, the Conservatives received over £4 million in Cranborne money, the Liberal Democrats £2 million and the Cross-Benchers £400,000. I was a Whip in Harold Wilson’s Government when the first public funds were allocated to opposition parties in the Commons. The aim was to improve the parliamentary effectiveness of parties and groups not in government. I hope that the noble Lord the Leader of the House will agree that the need to do so has not changed. He is long experienced in the travails of opposition, and I hope that he will review the allocation of Cranborne money in the light of my unashamed appeal for a better deal for these Benches. I do not seek generosity; I seek fairness. Fairness will do for me.
Viscount Tenby
My Lords, I support the powerful and persuasive words of my noble friend Lady Boothroyd. I promise not to detain the House for long. I have had the privilege of being closely associated with a number of distinguished Convenors in recent years. I have also had the personal experience of working in the office of the Convenor. I can testify to the difficulty of serving so many noble Lords in such a confined office area and with slender personnel resources. Indeed, it is a testimony to the professional skills of the present personal adviser and his assistant that we get the excellent service we do but, as the noble Baroness has said, the figures speak for themselves. It is surely an anomaly from the bad old days that a grouping combining over 25 per cent of our total only receives disproportionate sums of money. I should add that we are grateful for any crumbs that fall from rich men’s tables.
My guess is that the reluctance to put us on a footing with other political groups is that to do so would somehow disturb the delicate framework of our independence and make us more like the other political parties. Yet to anyone who has studied the pattern of voting in recent years, as I have, those fears can be allayed. In over 25 years, I cannot recall an occasion when Cross-Benchers have voted as one and—believe me—a 50:50 breakdown, or near those figures, is all too common. This appears to be an open season for reviews. I suggest to the noble Lord the Leader of the House that, with his customary generosity of spirit and instinct for doing the right thing, he might set up such a review—it may be in conjunction with the usual channels—to look into this whole matter so that it can be addressed and so that we can look forward to a fairer deal.
Lord Alderdice
My Lords, when I was charged with putting together the Northern Ireland Assembly I came to the other place and consulted with the noble Baroness, Lady Boothroyd, who was extremely helpful and generous in her guidance. I also drew on the experience of Clerks, Attendants and the Members and procedures of your Lordships’ House—particularly the respectful way in which Members treat with each other, because that seemed to me a very important aspect of parliamentary life.
One thing I did not draw upon was the grossly inadequate resources provided for all the Members of this House in the conduct of their business. When the Northern Ireland Assembly was brought into being, we ensured that all parties, on a per capita basis, had funding for staff for research purposes. If there is to be proper consideration of our work—policy work holding government to account and legislation—then the undoubtedly greater talents of your Lordships’ House have to be conveyed properly in the House and indeed beyond the House. It is not necessarily the case that money should be provided to groups, but resources of personnel need to be provided. Therefore, on the question of whether it is money or whether staff are employed and allocated to groups, there are various ways in which to achieve the same purpose. But the purpose must be to provide Members of your Lordships’ House with the opportunity of doing their work.
It is sometimes thought that it is purely a matter of policy research and producing amendments for Bills, but it is not. It is necessary for the groups to organise themselves in an orderly and proper fashion and to keep each other advised and informed of what is going on. But there is another purpose that has increasingly become important. At both ends of this building, we have been concerned about our relationship with the wider community, with non-governmental organisations and charitable bodies, with special interest groups and campaigns of various kinds, as well as with individual citizens of our country. One way in which your Lordships’ House has become particularly successful is that these groups have found your Lordships accessible. Very often, they have been brought together with members of different groups in your Lordships’ House by the very researchers paid for by Cranborne money. That has been the case not just with Liberal Democrats but with Cross-Benchers and members of other parties in your Lordships’ House.
As long as we have the adequate resources in all the parties—it is not a question of the Government and the Opposition in this regard—as in Northern Ireland, where money is allocated to parties whether in or out of government, on a per capita basis, that will enable us, as it has in the past, to engage properly with those charities, NGOs, interest groups, professionals and ordinary citizens who want to convey their message to Parliament. One great satisfaction that the community has found with your Lordships’ House in recent years has been with its accessibility and openness on a non-partisan and non-constituency basis to these important issues.
I support what has been said in the appeal to my noble friend the Leader of the House, that he gives consideration to this question. Of course, it is especially sensitive at a time of economic difficulty, when we are asking for cutbacks in all sorts of circumstances—that is absolutely the case. But at least at this time we might consider what kind of mechanism and formula might be possible so that at a time when it was more affordable we would be in a position to provide for your Lordships’ House the kind of resources necessary not only for our internal functioning and operation but for our relationship with the rest of the community.
Lord Dholakia
My Lords, I ask for clarity in this resolution. Will the Leader of the House confirm that this resolution applies for the duration of this coalition Government? Now that there is the arrangement with the fixed-term Parliament, would he not consider it necessary to have a sunset clause for the termination of the arrangement?
Lord Strathclyde
My Lords, I am very grateful to all noble Lords who have spoken, especially to the noble Baroness, Lady Boothroyd. I am certainly one who would never want to cut across what she says. I am glad that what she said was said with her customary elegance and force. There was also an element of logic behind it. I shall try to deal with all the points that the noble Baroness raised—no mean feat.
I do not share the view of one of my predecessors, Lord Williams of Mostyn, that it was an act of great generosity. I have always taken the view that parties that are in opposition or on the Cross Benches should receive support from the taxpayer so as to fulfil their functions. The noble Baroness said that it was a disproportionate way in which to do things. Her main point, I think, was that there was an unfairness between how the main party in opposition and the Cross Benches were dealt with.
This lies at the heart of how I think the House views the different roles of the Opposition and the Cross Benches. I was in opposition for a long time, so I know perhaps more than anyone else that the Opposition have a difficult task to do. In an unpaid, part-time House, they need to provide a substantial number of Peers to act as shadow Ministers and they do not have the benefit of the Civil Service to provide them with the papers and amendments that are required for the Opposition to function. As I have said many times, it is important that there should be a strong Opposition. That is why a substantial amount of support is provided to the party of opposition in this House, which is now the Labour Party. I do not think that anyone would believe that the nearly £500,000 given by the taxpayer to the Labour Party is overgenerous. It is probably about right and it allows the Opposition to do the work that they are asked to do.
Those conditions do not apply to the Cross Benches. The Cross-Benchers—I say this with the greatest respect—do not have a Front Bench or a central office. They are not involved in the formulation of policy. They do not need to negotiate with their colleagues in another place, because they do not have any colleagues in another place. As the noble Baroness pointed out—and I cannot disagree—the Cross-Benchers come together as a loose alliance for administrative purposes, but they are all individuals, with individual views of how things should be done. It may be that there is not quite enough money to help the Convenor to do her job. I do not wish to be in the least bit flippant about this and I pay the greatest tribute to the work that the Convenor of the Cross Benches does on behalf of her whole flock—indeed, I pay tribute to her predecessors, too. It is faintly shocking that, 10 years ago, the Cross Benches received nothing at all. The amount was reviewed only two years ago and was increased by 48 per cent—a substantial increase—to £61,000. The current amount is, I think, £63,000. I know that that was from a relatively low base, but I am always happy to receive representations from the Cross Benches and from the Convenor about whether that figure should be increased.
My noble friend Lord Alderdice raised an entirely different question, which was about the funding of political parties when they are in government. I am not enormously attracted to that idea. The purpose of Cranborne money, which is the subject of the Motion, was to support the parties of opposition. There is now only one party of opposition. Naturally, consideration was given as to whether the one party of opposition should receive all the Cranborne money, but wise counsel prevailed on both sides of the House. We took the view that, as the Liberal Democrats had joined us in coalition government, both we and they should give up that money. There is a good reason for that. We now have the resources of the Civil Service at our disposal to create policy and to do all the administrative work. We recognise that the civil servants do an excellent job.
Other Parliaments and Assemblies have created different traditions, particularly those that have almost inbuilt coalitions. I have no idea how long this coalition will last, although I hope that it will last for a long time. That leads me to the question raised by my noble friend Lord Dholakia. He rightly said that, if a second party of opposition should re-emerge, the whole situation should be reconsidered and the position reviewed. I cannot conceive of circumstances in which such a review would not be done in a most positive light, with Cranborne money reapplying to a second party of opposition.
Although the Motion on the Order Paper is slightly opaque, I think that it has now been clearly explained, not least by the noble Baroness, and I hope that we can now agree it.
Viscount Tenby
My Lords, the remark of the much lamented late Lord Williams of Mostyn has twice been referred to today. For the record, he made that remark in response to a rather carping comment from me; I was speaking for the Convenor on that day. It was ironic, and there was a twinkle in his eye when he said it.
Latin America
(13 years, 10 months ago)
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Viscount Montgomery of Alamein
To call attention to recent developments in Latin America; and to move for Papers.
Viscount Montgomery of Alamein
My Lords, we now turn to more interesting and international affairs. My thanks are due to the Convenor, my noble friend Lady D’Souza, for allocating me time for this debate. It is four years since our previous debate on Latin America and a great deal has happened since then.
Although retired from all business activity for 10 years, I remain a vice-president of Canning House, the Latin American focal point in London. I am glad that two of my fellow vice-presidents—the noble Lord, Lord Garel-Jones, and the noble Baroness, Lady Hooper—will speak. The president of Canning House, the noble Lord, Lord Brennan, is unfortunately away, so we will miss him.
We welcome today the maiden speech of the noble Lord, Lord Liddle. He comes from a think tank background, and will add a great deal to our deliberations. I hope that I can recruit him to the Latin American cause, which needs a lot more members whenever we can get them. Whether we will agree entirely on the method of achieving this is another matter.
It is just over 55 years since I first went to live and work in Latin America, and I have been continuously involved, in a variety of capacities, ever since—especially after I returned to live here in 1962. During this time, there have been huge changes and I will highlight a few. Fortunately, with the number of speakers we have today, we should be able to cover most aspects in the time allocated.
Latin America is a vast geographical area, growing in importance, with the mainland stretching from the US border with Mexico to Cape Horn. It contains over 500 million people, spread across 20 republics. Brazil, the largest country—slightly bigger than the USA—has 200 million people alone. It plays a leading role, which is an added responsibility. Brazil, Mexico and Argentina are all G20 member states. The GDP of Brazil is greater than that of India. The combined GDP of Mexico and Argentina equals that of India. The combined GDP of Latin America is equal to China. Given that China and India have populations in excess of 1 billion, one can see that individual purchasing power—GDP per capita—is much greater in Latin America, making its countries significant markets to which we should pay attention.
In April last year, President Obama made a powerful speech at the Summit of the Americas in Trinidad. He engendered a great deal of enthusiasm and there was much optimism that the US would start to take its southern neighbours seriously after many years of neglect. The continent was expecting some rapprochement with Cuba, and President Chavez of Venezuela even shook President Obama’s hand warmly. Sadly, nothing happened subsequently.
The same malaise has been the norm in this country. Sadly, the Labour Government never took Latin America seriously. They closed embassies, downgraded others, and the region ceased to be a priority area while we slavishly followed the US into eastern wars. I like to think—indeed, hope—that the new coalition will turn over a new leaf and take a different line; in other words, they might like to turn the Foreign Office back into the policy-making department that it once was. That would be valuable, instead of having policy decided in No. 10 Downing Street.
I turn now to a few ideas by way of encouragement. In the debate four years ago, I suggested that UKTI should be closed and the promotion of trade overseas done by commercial officers in British embassies, who would be involved in what was happening on the ground and therefore able to offer practical advice to businessmen. Unfortunately, this proposal fell on stony ground. In parallel, DfID, which has a ring-fenced budget, could be transferred back under the Foreign Office. It would be much better able to identify technical assistance projects overseas from on the ground, and stop spending funds through international organisations, which is extremely wasteful. This is very important in these hard-pressed times. Indeed, one wonders whether—with such a huge national debt—charity should not begin at home. Under current rules, most Latin American countries are middle-income countries and not aid recipients. However, there is a case for aid in certain countries, where microfinance would be highly productive in starting new small businesses in an extremely entrepreneurial environment. I appreciate that the suggestion I have just made is highly controversial. It fell on stony ground four years ago. It is now even more worth while, hence my recycling of it today.
I turn now to Latin America itself. When I first went there to live, it was mainly run by military Governments, with central planning, multiple exchange rates, import restrictions and inflation. Gradually, nearly all the countries returned to democracy, with market economics, huge investments and rapid development. Sadly, poverty, which is prevalent in the region, has not yet been eradicated and is still a major challenge. However, perhaps the most significant development of recent years has been the development of what is known as ALBA—the Alianza Bolivariana para los Pueblos de Nuestra América, which translates as the Bolivarian Alliance for the Peoples of our America. This is the brainchild of President Chavez of Venezuela. It originally had two member states, namely Cuba and Venezuela, and was based on an exchange of Venezuelan oil for medical staff and teachers from Cuba. Subsequently, Bolivia joined, followed by Nicaragua and Ecuador. Some smaller Caribbean states also joined.
Essentially, the aim of ALBA was an alternative to the US-led free trade area of the Americas known as LAFTA. Oddly, the Venezuelan wealth which is dispensed and accounts for the country’s dominance of ALBA is almost entirely derived from oil exports to the USA. This form of authoritarian socialism—which is how I loosely describe it—involves the nationalisation of companies, the loss of independent media, manipulation of the constitution to provide continuous re-election of the President and the intimidation of opponents. Argentina is not a member of ALBA, but the Kirchner husband and wife team—who seem to alternate in power—follow the same precepts and policies as Chavez. Like it or not, ALBA is a reality. We need to understand it in this country, come to terms with it and work out how we can relate sensibly to it and do business there.
Fortunately, there are plenty of bright spots to compensate for the rather gloomy picture that I have painted. We have a strong relationship with Brazil, where President Lula will stand down in October after a most successful presidency, which included an important visit to Britain. As and when the UN is reorganised, surely Brazil should be one of the permanent members of the Security Council. I wonder when this will happen. Chile is a great success story, as is Peru. Colombia has just elected a new President in a huge turnout, with a massive majority in the second round. President Santos is no stranger to this country, where he lived for many years. I am sure our relations with Colombia will continue to prosper.
Mexico, the second most important Latin American country, is in a strong economic situation, but has major security problems due to infighting by the warring drug cartels. Central America is also extremely interesting as it is developing an integration process called Sistema de la Integración Centroamericana, or SICA for short, with a rotating presidency every six months. Currently, this is Panama, which will be succeeded by Belize on 1 July. In this country we have an all-party group which reflects this arrangement, which is very satisfactory.
I would like to go on, but wish to make one last general point. This year, 2010, is the bicentenary of the start of the independence movement in Latin America in 1810, in which Britain played a major role. Both Simón Bolívar in the north and San Martín in the south derived their philosophical ideas from the French revolution and their political support from Britain. With the exception of Portuguese-speaking Brazil, which did not become a republic until the late 1880s, all countries in Latin America are holding commemorative celebrations at various times, as are the Latin American embassies in London and the various bilateral Anglo societies.
The dream of Bolívar was of one great united Spanish-speaking region. It remains a dream and is, indeed, the aspiration of President Chavez of Venezuela. However, I contend that it will never be achieved through the imposition of authoritarian socialism. It may come eventually when all the Americas, north and south, unite in a common cause freely given. It also remains my dream, but I doubt that it will happen in my lifetime although it is a very worthwhile aspiration.
In my short speech I have tried to touch on a few aspects of this huge and fascinating subject—rather controversially, I fear, but that is the norm given my position in this House. I am happy to stand corrected by others who have different views. I will listen with very great interest to all that follows. I beg to move.
Lord Garel-Jones
My Lords, I begin by paying tribute to the noble Viscount, Lord Montgomery, not just for initiating this debate but for his life-long promotion of Latin America in your Lordships’ House. He is, as they would say over there, “un amigo leal y constante”.
All of a sudden Latin America is in fashion. In my day job in the City, I am frequently approached by leaders of industry with the question, “Do you think we ought to be looking at Latin America?”. The answer is yes, and it is hardly surprising if you look at what is going on down there. I wish to give a few snapshots. Peru’s economy is expanding by more than 6 per cent and foreign direct investment will double in the next five years. It has investment-grade status. Colombia’s GDP is expected to grow by 5 per cent in the next four years. It has never defaulted on a sovereign obligation and should recover investment-grade status any time soon. Chile has investment-grade status, no public debt to speak of, is a member of OECD and has a level of economic, political and social development which rivals that of most European countries. Growth is projected at around 4.5 per cent. Brazil is predicted to be the sixth largest economy in the world by 2015 and is the guardian of one of the largest reserves of natural resources in the world. Growth is predicted at around 8 per cent. Mexico is a member of the G20, is the eleventh largest economy in the world, a member of OECD and has a growth rate of 4.2 per cent. Even in these times of unprecedented difficulty, Argentina is tackling its debt overhang with the firm intention of returning to the international markets at the earliest opportunity. It has a growth rate of 5.5 to 6 per cent. I pick out just one of a whole host of smaller countries, Uruguay, with projected growth of 5.1 per cent this year. It is a small country but about as serious and proper a place as you could hope to find along with other smaller states such as Panama, which has investment-grade status, Costa Rica, which may become the first carbon-free country in the world, the Dominican Republic and others.
That economic success, as the noble Viscount pointed out, has been accompanied by democratic consolidation. In Brazil, the transfer from President Cardoso to President Lula has been exemplary and the upcoming elections will be hard fought, but with one certain winner—the democratic process. In Chile, the deservedly popular left-of-centre President Bachelet handed over to the centre-right President Piñera. It was a real sea change after 20 years of centre-left government. In Uruguay, there was no such ideological shift, but impeccable behaviour by both candidates. As the noble Viscount pointed out, this very weekend Colombia, a country that has been challenged by criminal terrorists for more than 30 years, has upheld its position as the most longstanding democracy in Latin America. There were two interesting and intelligent candidates; there was a proper campaign, a proper process and a President-elect Santos who is eager to build on President Uribe’s record.
Noble Lords might think that people such as myself would be deeply satisfied. Well, not quite. Why, I ask myself, does this great continent with a gross domestic product, as the noble Viscount pointed out, that is almost twice that of India and only a tad short of China’s, remain no more than a bit player in world affairs? Is there some congenital deficiency? By no means. If one steps outside the political world, in almost every other field of human endeavour, we are talking about first division players.
In literature, there are Octavio Paz, Neruda, Vargas Llosa, García Márquez and Borges. The only surprising thing is that only three of them have a Nobel prize. In art there are Botero, Diego Rivera and Oscar Niemeyer. In music, there is what is known as El Sistema in Venezuela, which is perhaps the most exciting classical music experiment in the world, embracing every town and village in the republic and showcased by the Orquesta Sinfónica Simón Bolivar, led by Gustavo Dudamel. The recent appointment of Sonia Sotomayor to the US Supreme Court is just the latest example of citizens of Latin American origin occupying the highest positions in the public, industrial and intellectual life of the United States. We are talking first division here.
So what is wrong? Why is Latin America no more than a bit player? Latin American countries are prisoners of the 19th-century Westphalian model of the nation state—as we all are, up to a point. Here in Europe, after the loss of 60 million lives in two world wars, we have begun to move on from that model. But it is difficult. How does one identify those areas where the pooling of sovereignty with others is the most effective way of advancing our interests and values without losing that all-important and underlying sense of belonging and social cohesion that the nation state provides? It is no easy task.
In Europe, we are moving in that direction. I will not dwell on our successes or many failures. Suffice it to say that Latin America has yet to embark seriously on that journey. For all the Mercosurs, the Andean pacts, the ALBAs, the ALCAs, the CAFTAs, the FTAAs, the bilateral free-trade agreements, and Brazil's membership of the BRICS, the continent remains a collection of 19th-century Westphalian states competing macho-like against one another. It would be impertinent of us here in Europe to lecture Latin America on how to go about its business. There are a number of senior prestigious former presidents— Bachelet, Lacalle, and Zedillo, who are soon to be joined by Lula and and President Uribe. My hope is that they might come together to start the process of really bringing this continent together, because we need them.
In another place, I was sometimes described by political foes as the “Member for Madrid Central”. It was a badge that I wore with some pride. Spain and Portugal have led the effort to put Latin America on to the European agenda. However, as the noble Viscount pointed out, we British have a history there, too. The British Legions fought with distinction in the battles of Boyacá Carabobo, Pichincha and Ayacucho—earning for the British the title of “saviours of my country” from Bolivar. It was here in London that Bolivar, along with Miranda and others, planned the struggle for independence.
There are encouraging signs. The European Union has agreed to set up the EU-LAC Foundation, whose aim is to strengthen EU-Latin American partnership and to encourage further knowledge and understanding between us. The new coalition Government have appointed the honourable Member for Taunton as Minister of State for Latin America, and I know that he is approaching his responsibility with all the relish and enthusiasm that the noble Viscount could wish for.
No doubt, Canning exaggerated a little in 1825 when he famously claimed:
“I have called the New World into existence to redress the balance of the Old”.
That balance has yet to be redressed and I call on our Latin American friends to do just that, and on our Government and the European Union to support them in that endeavour.
Baroness Gibson of Market Rasen
My Lords, I thank the noble Viscount, Lord Montgomery of Alamein, for instigating this debate. Unlike the noble Viscount and the noble Lord, Lord Garel-Jones, I do not have their in-depth knowledge of Latin America. However, like both the noble Viscount and the noble Lord, I have a great love for Latin America and its people.
I fell in love with Latin America when I attended Essex University in the 1970s as a mature student. I joined the school of comparative government, and because I knew very little about Latin America, I chose to compare the Government of the UK with those in Latin America to learn more about the region. Brazil was the major country that I studied, but I also covered Chile, Argentina, Peru, Mexico and Colombia. After my first lecture, I was hooked on the glories of this continent, and I remain so today. I am pleased to see the Minister on the coalition Front Bench to listen and respond to this debate. As the former chair of the All-Party Parliamentary British-Latin America Group, and now one of its vice-chairs, I sincerely hope that Latin America will move higher up the political agenda.
Despite the efforts of a number of very good and knowledgeable Ministers in the previous Government who had responsibility for Latin America, including the noble Lord, Lord Triesman, in this House and Chris Bryant in the other place, it was not as high a priority as many of us would have wished. Of course I recognise that the wars in Iraq and Afghanistan took—and in the latter case, continue to take—a great deal of government time, energy and resources. However, I was disappointed at what I felt was a lack of recognition of the potential of this continent, and how investment and closer working relationships could benefit the UK and individual Latin American countries. I know that a number of their ambassadors based in the UK felt as I did. I am hopeful that the present Government will wish to build on the relationships which exist currently, with the aim of even closer working relationships in the future.
I have been lucky enough to visit Bolivia in 2009, and Cuba in 2009 and earlier this year. Both countries are progressing, despite the difficulties that they face. Bolivia is a fascinating country where the Evo Morales Government came to power in 2006 in a blaze of glory. For the first time, the indigenous peoples of Bolivia were included in the Government and they look forward to greater involvement in all walks of Bolivian life. As I have said previously in this Chamber, when our delegation met the Bolivian people last year we realised that their expectations may be higher than any Government could satisfy in a relatively short space of time. To some extent, this has proved to be accurate. Despite the fact that Bolivia’s economy has managed to perform well during the global economic downturn—a point to which I shall return—there have been signs of unrest among the working people in Bolivia.
On May Day this year, the Central Obrera Boliviana—the COB—Bolivia’s trade union confederation, called an indefinite strike and organised a march on the city of La Paz. This followed a dispute over salaries and new pension laws. The march began in Caracollo, 200 kilometres from La Paz. The Government were offering a public sector pay rise of 5 per cent—well over the current level of inflation—but the COB rejected this and also called for the retirement age to be reduced to 55. The large march consisted mainly of factory workers, miners and teachers. The powerful peasant union did not participate; instead, it supported the Government. An agreement was reached to lower the general retirement age to 58 and to 51 for miners, although their pensions are still under discussion. Does this seem a little familiar?
There has been tension in Bolivia between the La Paz regions and those in and close to Santa Cruz since the Morales Government took power. The governor of Santa Cruz, Rubén Costas, is the main political opponent of President Morales. When we visited in 2009, the tension was almost tangible. However, there are signs that things may be improving. This month the two leaders have met, in both La Paz and Santa Cruz, and the President has promised to help to facilitate new loans to the department responsible for road building and development projects. It is hoped, therefore, that a warmer and more positive relationship will develop between these two vital regions for the Bolivian economy.
I mentioned the economy earlier, and this is proving a positive force in Morales’s political and social reforms. He came to power promising a rise in living standards for the majority of the Bolivian people. Although Bolivia remains a poor and unequal country, the rates of relative and extreme poverty have, over recent years, shown improvement. Political and structural reforms appear to be working.
Bolivia recorded the highest rate of economic growth in the western hemisphere in 2009 in the midst of the global economic downturn. According to figures from the Bolivian National Institute of Statistics, economic growth in 2009 was 3.36 per cent. This compares favourably with other countries in the region that are much larger than or equally as large as Bolivia and are possibly more forward-going, such as Brazil and Mexico. That is an impressive achievement given many of the external conditions affecting the economy, mainly as a result of the financial crisis. These include falling remittances, limited foreign investment, the cancellation by the United States of trade preferences and export prices declining for part of the year.
That follows a trend of sound macroeconomic management that has seen Bolivia’s economy perform consistently well since the Morales Government came to power. In 2008, for example, Bolivia’s GDP grew by 6.1 per cent. The country also managed to keep inflation low in 2009, at 0.26 per cent. This follows higher inflation rates in 2008, partly due to trends of rising global food prices and high oil prices.
One of the first major reforms carried out by the Morales Government on taking office was the nationalisation of the oil and gas industry. The Bolivian state took ownership of all oil and gas reserves, and foreign investors were asked to renegotiate their operating contracts. The new contracts increased taxes paid on income from sales of gas from 18 to 50 per cent, thus returning to the situation prior to privatisation. Indeed, our 2009 delegation visited BG Bolivia, as it is now called, and its relationship with the Bolivian Government seemed to be both constructive and working. This nationalisation continues. In May this year, an electricity generator owned by a British company, Rurelec, was nationalised. The Bolivian Government have given assurances that adequate compensation will be paid, and in a statement that he made on 2 June the Rurelec chairman, Jimmy West, expressed confidence that that would happen.
I turn now to the other country that I have recently visited—Cuba. One of the more important things about Cuba is that its constitution gives the Cuban people certain rights, including the right to work, to a house, to education, to health and to safety in their environment. I want to speak briefly about Cuba’s healthcare system and share a little anecdote about it. Its health service is renowned throughout the world for its advanced medical capabilities. Cuba exports its doctors, in particular, to many other countries in Latin America and further afield, and is rightly proud of so doing. However, it is the healthcare of its own people that is quite outstanding. The health of its people, and especially its young people, is obvious to anyone who travels around Cuba. This is because, although the adult population faces the problems of food rationing—mainly because of the continuing American blockade, which the UK Government do not support—the young in Cuba get a regular supply of eggs, milk, cheese, meat and vegetables to ensure their fitness.
On my first visit to Cuba, I visited a healthcare centre in a tiny village in the centre of the island. Cuba provides a healthcare centre in each small grouping of houses. The doctor and his family lived in the upper apartment, and the nurse and her family in the lower one. On the whitewashed walls of the waiting room, there were graphics explaining how women should examine their breasts for the first signs of breast cancer. There were also a great many leaflets about other medical conditions. After talking to the medical staff, we were asked whether we would like to see the garden. Slightly puzzled but not wishing to appear rude to our hosts, we agreed. What the nurse wanted to show us were the herbs that they still use for some ailments, just as we used to do. So, from the specialist hospitals in Havana—for example, those dealing in eye or brain surgery—to the smallest medical house in the countryside, the Cubans have a wide degree of medical care, including their herb gardens. Perhaps somewhere along our way of providing medical care, we have thrown the baby out with the bath water.
We will be hearing a great deal about this diverse continent in the debate and, as always, I will learn a lot. I am well aware of the darker side of Latin America: the drugs and human trafficking; the political corruption, which has to be fought and sometimes fought again; and the potential for natural disasters such as floods and/or earthquakes, which is ever present. However, today I have chosen two more positive examples of Latin America and I hope that they have added to the debate.
The Lord Bishop of Liverpool
My Lords, perhaps I may say how delighted I am to be the prelude to the maiden speech of the noble Lord, Lord Liddle, and how much we look forward to his contributions to the House and admire the alacrity with which he has engaged with the business of the House today.
The noble Viscount, Lord Montgomery, is famous for his championing of Latin America, and today is an opportunity for us to share in his enthusiasm. It is excellent that within the first weeks of the coalition Government, we should have had a debate on the millennium development goal of universal private education and now, today, a debate on developments in Latin America—a continent where, in spite of its great economic progress and cultural achievements, 44 per cent of its population still live in poverty.
Although Brazil is one of the fastest-growing economies in the world and an increasingly important player on the international stage, Latin America is a region of marked contrasts and extremes. Seventy-five per cent of the population of Latin America live in expanding urban areas. The urban poor live in vast cities with low incomes and poor access to clean water and sanitation. The rural poor live in remote areas with inadequate infrastructure and little law enforcement.
I was very heartened to read the coalition Government’s paper, The Coalition: Our Programme for Government—Freedom, Fairness, Responsibility. In it, we read this commitment:
“We will support reform of global financial institutions such as the World Bank and the International Monetary Fund in order to increase the involvement of developing nations”.
That work is long overdue.
Travelling in Latin America and central America, I have come across stories of the developing nations feeling disempowered by the international bodies. In Honduras, I listened to local people resisting the pressure from international bodies to divide up their forests under the slogan of land rights, saying that they would rather keep them in common ownership and live their traditional way of life owning the forest as a community. I have sailed up the Patuka river in a dug-out canoe; I have flown over the Mosquitia rain forest; and I have seen the courageous resistance of native people resisting both the illegal logging and the international pressure to change their way of life fundamentally. What is the Government’s strategy to ensure that the voice of developing nations is heard in these international bodies, such as the World Bank and the International Monetary Fund? It would be wonderful if in 2010, as we mark the bicentenary of the independence movement, we could see real progress in that direction.
In the past 50, years central America has lost 80 per cent of the rain forest. Globally every minute we lose an area of rain forest the size of 15 football pitches. Whatever view noble Lords take of the changing climate, this is simply unsustainable. One of the most forest-ravaged regions of the world is Latin America. A few years ago I was in Brazil on a symposium with leading scientists and religious leaders looking at the future of the Amazon rain forest. Under the leadership of President Lula, much is being done to protect the biodiversity of the region and to ensure that the rain forest is preserved as a global utility. This cannot be done by Latin America alone; it requires international agreement. We came very near to it at Copenhagen but then fell short of securing such an agreement. Our eyes now turn to the UNFCCC in Cancun later this year but the voices of Latin America must be heard as loudly as the consuming nations.
I pay tribute to His Royal Highness the Prince of Wales for his rain forest initiative. He visited Latin America last year, and his insistence on bringing them to the table as equal partners in his initiative offers a model for international co-operation and agreement. Will the Government approach the Cancun conference with a full briefing from those involved in the Prince’s rain forest initiative? I believe that that would be a major contribution to the development and well-being of Latin America. The forests are worth more alive than dead. If they die, so will Latin America, but if they live, that continent will flourish as will the whole world because the forests are indeed the lungs of the earth.
Lord Liddle
My Lords, I thank the right reverend Prelate the Bishop of Liverpool for his kind remarks and I am delighted to deliver my maiden speech in this debate, which I believe the noble Viscount, Lord Montgomery of Alamein, has pushed so hard to have.
Before my introduction on Monday, I felt that I sort of knew the House of Lords quite well. Until his death two years ago, my father-in-law, George Thomson, Lord Thomson of Monifieth, had been a Member for many years. My brother-in-law, the noble Lord, Lord Newby, speaks for the Liberal Democrat Front Bench from time to time. When it comes to the debate on the composition of the House, if I am not exactly strongly in support of the hereditary principle we have at least tried to keep it in the family. For good measure, my history tutor at Oxford, my noble friend Lord Morgan, is also a new colleague, which I am delighted about.
Still, on Monday, I was rather like a nervous school boy—the 11 year-old on my first day at Carlisle grammar school with all the fears of the mysterious rituals and initiation rites that were to follow. My nervousness has been much allayed by the kindness and warmth with which I have been greeted—not just by my fellow Peers, but from the House staff whose courtesy and helpfulness in dealing with new Members is quite wonderful. I want to put on record my heartfelt thanks to them.
Some may be surprised that I have chosen to make my maiden speech in a debate on Latin America. I spent 10 years of my early life in local government as a councillor in Oxford and then Lambeth. I remain a firm believer in local democracy and am against overcentralisation. I am passionate about economic development of the regions. As a lad from Cumberland whose father was a railway clerk and grandfather a miner, it is matter of great pride to me to be the chair of our local economic partnership, Cumbria Vision, and I hope to join a strong Cumbrian contingent voicing the needs of Cumbria in this House.
From my work in No 10 and Brussels, I care deeply about the future of the European Union. I believe that all of Europe, Britain included, is the winner if we can work together to build a strong, integrated and dynamic single market, revitalise a social model to which many in the rest of the world aspire, and become an effective force for good in our new multipolar world.
That brings me to Latin America. I was brought up on Tip O’Neill’s famous political adage, “All politics is local”, but I now believe that all politics is also global. The task is to build a new politics of sustainable globalisation. Think how the banking crisis, immigration and terrorism shaped the debates at the recent general election. Think what the coalition Government have decided in the past week or so. I am not trying to make a party point but simply wish to offer a reflection. They have no alternative but to obey the dictates of financial markets to bring down the public deficit quickly. In other words, we have no sovereignty as a Government or a people to challenge the need for 25 per cent cuts in our main public services. That is what Latin America suffered at the hands of the IMF under the Washington consensus in the 1980s and 1990s. We all have to strive somehow for a better global way.
I first became interested in Latin America as a result of an initiative that Tony Blair and President Clinton took to set up an international network of progressive centre-left leaders in which key Latin American countries took a keen interest. The think tank, Policy Network, that I now chair and which was chaired previously by my noble friend Lord Radice, is about helping to build that progressive network. In 2003, we had a conference in London which Presidents Lagos of Chile, Kouchner of Argentina and Lula of Brazil came as honoured guests. In the past three years, I have twice been to events led by the Chileans and President Bachelet.
For progressives, Latin America has made impressive strides in the past decade. Democracy has replaced dictatorship, the ballot box and the military junta, and remarkable social progress has been achieved. While the Governments of progressive Latin America are not slaves to the market, they have come to terms with the market and shown how they can redistribute its rewards in progressive ways. When Pinochet left office in Chile, 40 per cent of Chileans lived below the poverty line. Now the figure is only 12 or 13 per cent. The number of young people going to university in the past 20 years has risen from 10 per cent to 40 per cent. When the right-wing candidate for president won the election this year, there was a peaceful transition marred only by the calamity of that awful earthquake.
In a way, the Latin American progressives are the perfect exemplars of my noble friend Lord Giddens’s third way. In foreign policy, they do not wish to be the lackeys of the United States. They are never going to sign up to some modern version of the Monroe doctrine, and they may even be a bit wary of President Obama's more sympathetic multilateralism, as we see from Brazil's recent vote in the Security Council on sanctions against Iran. Domestically, however, they are searching for means of social progress that avoid the painful injustices and extremes of American free-market capitalism.
In my experience, that makes them very interested in the European model. I agree with the noble Lord, Lord Garel-Jones, that they have not made a lot of progress beyond the nation state, but I have found many Latin Americans who are interested in the possibilities of regional integration on the European pattern and are trying to learn from our experience. I believe that Europe has a real opportunity for influence there, but, as in so many areas, the European Union has yet to fulfil that potential. Part of that is about getting our act together in Europe and recognising that as nation states alone, we have limited power in the new world that is emerging. We have to get our act together. That is particularly true in diplomatic representation, given the huge economies which are having to be made in the British embassy network as a result of the present financial crisis.
When we speak the language of multipolarity, we as Europeans must recognise that that means a shift in the balance of power in the world. Let us take the IMF. If we are to tackle the global imbalances that still threaten financial stability, we desperately need to bring all the emerging big economies of the world on board within the IMF structure to make it truly representative of the world as it now is. The EU member states’ insistence—this is not just a problem of Britain, it is a problem of all the big member states—on maintaining their gross over-representation on the IMF's councils stands in the way of that necessary power shift
Let us take free trade and Doha. The Latin Americans hesitate to lower their tariffs on Europe's high value-added exports while their food exports are denied access to European and American markets. Brazil is hugely competitive in agricultural products such as sugar and beef, but the US and EU are both reluctant to adjust to that, although the overall impact on our growth prospects and economies would be favourable.
Finally, let us take climate change. We simply cannot lecture the Latin Americans on their growing carbon emissions and destruction of forests while we in the industrialised world fail to tackle the problems of industrialisation that are our legacy and our responsibility. The EU must make itself the global leader in low-carbon transition. I believe that that would be a sustainable platform for recovery.
In conclusion, it is a great privilege to speak in this House for the first time. If I may express a personal regret, it is that my parents narrowly missed being alive to see it. I hope that for all my time in this place, I will continue to speak truly to the values of social democracy and internationalism that they imbued in me.
Lord Giddens
My Lords, I join the queue of other noble Lords in congratulating the noble Viscount, Lord Montgomery, on instigating this debate and on all the work that he does to improve the relationship between the UK and Latin America. I especially congratulate my noble friend Lord Liddle on his wonderful maiden speech, demonstrating such intellectual power and coverage. He does not hang around, as he has only been formally inducted into your Lordships’ House for three days. Perhaps I may say, given his impetuous nature, “Why did you wait so long?”.
I have known and worked with my noble friend for many years and I can vouch for his collegiality and for the power of his intellect. He has enormous in-depth knowledge of British politics and of the European Union—qualities on display in his maiden speech—having served in the European Trade Commission and having been for some years adviser on the European Union to the former Prime Minister Tony Blair. He has also written widely in those areas. He will be a marvellous addition to your Lordships’ House, and I hope that your Lordships will join me in offering him a very warm welcome.
I shall talk about climate change policy in Latin America with especial reference to Brazil. Climate change poses massive threats to the Latin American subcontinent. To take one example, rapid tropical glacier retreat is observed in the Andes, with enormous implications for future water supply for the countries affected. Brazil is a front-line country for climate change. Even in the short term, it faces significant adverse changes in its ecosystems. As the right reverend Prelate rightly observed and discussed in a most interesting way, it is home to much of the Amazon basin, one of the world’s greatest natural resources, but one under threat should periods of prolonged drought become more common—and they seem to be becoming more common, especially given the big drought of about four years ago. Deforestation in the Amazon is a major source of humanly created carbon emissions.
Brazil is an extremely interesting country in terms of climate change policy. It has quite a different energy profile from most other countries—not only in the developing but in the developed world. Forty per cent of its energy, and twice that proportion of its electricity—more than 80 per cent—come from renewable sources. Virtually no other country in the world has a profile like that. It famously launched an ethanol programme in 1975 as a response to worries about energy security. More than half the cars in the country are flexi-fuel—they can run on 100 per cent ethanol or petrol, or a mixture of the two. The use of biomass for energy production, involving wood pulp and other sources, is highly advanced in Brazil. It therefore has a very interesting and almost unique energy profile.
President Lula introduced a comprehensive national climate change programme earlier this year. It was an ambitious set of policies. It marks the first time that a large developing country has set itself stringent carbon reduction targets, although they are voluntary rather than legally binding. The stated target is to cut emissions by between 36 per cent and 38 per cent by 2020, which propels the country right to the vanguard in world society. It is a target beyond that offered, for example, by the European Union. Crucially, Brazil’s mitigation activities will be quantifiable and verifiable, making them open to international scrutiny—something that the other large developing countries, India and China, have so far not put into practice.
Brazil therefore has the opportunity dramatically to influence international negotiations on carbon reduction. It was one of the five countries that made up the so-called BASIC group that created the Copenhagen accord following the conference in Copenhagen last December. The others were the United States, China, India and South Africa. The large developing countries are often seen as blocking effective international policy on the control of carbon emissions, but Brazil shows otherwise.
The success of the country in meeting its targets will depend significantly on how far it can effectively tackle land use and deforestation. These count for the large bulk of its greenhouse gas emissions. Brazil has a distinctly patchy record in this respect, but there are signs of progress. The country is involved in a number of bilateral relations with other states in which deforestation is a vital issue, such as in Indonesia. It has also signed up to a climate policy dialogue with the United States.
Hillary Clinton’s interesting speech in Quito earlier this month marked a significant shift in the United States’s policies towards Latin America. She spoke of creating what she called a community of the Americas. It is entirely appropriate that a climate change strategy should be a key part of this new approach, and in such a dialogue the US has at least as much to learn from Brazil as the other way around.
Lord Hannay of Chiswick
My Lords, for many decades now, Britain has not been giving the priority that it should have done to its relations with the countries of Latin America. Diplomatic posts have been closed and thinned out, ministerial visits have been few and far between and at a junior level, and our trade and investment have fallen behind those of our main competitors from both Europe and elsewhere. Latin America has become a group of far-away countries of which we know little—and this in a country that played, as other noble Lords have said, an important role both politically and commercially in the first century of every one of Latin America’s states’ histories—so the excellent initiative taken by my noble friend Lord Montgomery of Alamein to debate our relationship with Latin America is really timely, all the more so as it comes just after a new Government have come to office and a new ministerial team has been installed in the Foreign and Commonwealth Office.
Britain’s relative neglect of its relations with the countries of Latin America is all the more regrettable in that it has coincided with the rise in world economic and political rankings of a number of those countries. Not only does Brazil supply the “B” in the acronym BRICs, which has become synonymous with the leading emerging countries, but there are three Latin American countries—Brazil, Argentina and Mexico—in the G20, which now has the principal co-ordinating role on global economic issues.
A good number of Latin American countries have paid the painful transition from military-dominated authoritarian regimes to relatively stable democracies with much improved human rights records. There have also been some remarkable economic success stories: Chile and Brazil prominent among them. We are therefore missing a lot of tricks, and we have quite a lot of catching up to do. Some of that catching up surely needs to be done through our membership of the European Union, and here I welcome the maiden speech by the noble Lord, Lord Liddle, and what he had so say about Europe in general and its relationship with Latin America in particular, with which I agree wholeheartedly. The establishment of the EU’s External Action Service provides an opportunity to thicken up and to strengthen Europe’s, including our, overall relationship with Latin America. It is high time, surely, to dust off the trade negotiating file between the EU and Mercosur and to try to bring those negotiations to a conclusion.
Of course Europe will not provide us, or anyone else, with a soft option. The days when the elites of Latin America looked almost automatically towards Europe as an alternative to their fraught relationship with the United States are past or passing, as indigenous leaders come to the fore in a number of Latin American countries and as new players—China and India—muscle in on Latin American markets. However, Europe will continue to matter to Latin America, if only it can learn to speak with a single voice and to make itself heard.
Any strengthened British relationship with Latin America has, I suggest, to begin with Brazil—the regional giant, if not a superpower—but, economically and in world politics, that country is on the rise. This October, a new President will be elected, and we need to build a new, broader and more mature relationship with her or his new Administration. It will not be entirely easy or straightforward, as reactions to Brazil’s recent efforts to broker a deal over Iran’s enriched uranium have shown. Reactions to that deal have tended to be either dismissive or submissive. Neither is the right response. The deal itself if Iran were to implement it, which now seems highly unlikely, could have bought some time, but it did not address effectively the wider issue of Iran’s nuclear programme as its centrifuges continued to spin, so it was a bit unwise to suggest that it did or that it precluded the need for another round of sanctions. We need a much deeper, broader and ongoing dialogue with Brazil that covers the whole range of international politics, and I hope the Minister will say that we intend to build that up.
I will say a few words, if I may, about our aid efforts in Latin America. Here, I declare an interest, because one of my sons runs an activity centre for deprived children in one of the most poverty-stricken parts of greater Sao Paolo. It is quite right that the main thrust of our aid effort should be poverty elimination, but I hope that we will not be persuaded by any general statistics that demonstrate rising economic growth in Latin America into thinking that there is no need and no justification for a continued effort by us in that continent. The plight of deprived and abused children, which I have seen at first hand, is truly terrible in many parts of Latin America. With our skills, our experience and well-directed resources, we can do something to make a difference, and I trust that we will continue to do so.
I have one final thought. In recent years, the developed world has found it more difficult to work with Latin American countries at the UN and in other international organisations than in the past. On human rights, our agendas seem to have drifted apart. We really cannot afford simply to accept that as a continuing trend. If we cannot work effectively with Latin American countries across a wide range of global issues when that region is less troubled by security and governance problems than pretty well any other part of the developing world, we really will be in poor shape as we search for global solutions to the global challenges that face us. I so much agree with what the noble Lord, Lord Giddens, had to say on climate change, which is a perfect example of that issue. I therefore hope that we will put our backs into this relationship in a way that we have not done in recent years.
Baroness Coussins
My Lords, I, too, congratulate the noble Viscount, Lord Montgomery, on his determination and success in securing this debate. I also congratulate the noble Lord, Lord Liddle, on his impressive maiden speech.
I will raise two issues: first, the contribution that some UK-based NGOs are making to human rights, anti-poverty and development programmes in Latin America; and, secondly, the importance of encouraging the learning of Spanish and Portuguese in our schools and universities if we are to maximise our business opportunities in Latin America.
The economic ascendancy of Brazil is impressive, as we have heard from a number of noble Lords. It has the lowest unemployment figures since 2001, growth is expected to be at least 6 per cent this year, its economy is predicted to become one of the five largest in the world in the next 30 years, and it will host the 2014 football world cup and the 2016 Olympic Games. However, this success in one country masks a very different picture elsewhere in Latin America, where human rights abuses, poverty, discrimination and corruption inhibit economic and democratic participation. I will give just two examples to illustrate what UK NGOs are doing to help.
First, I pay tribute to the work of the UK section of Peace Brigades International, PBI. It sends trained volunteers as human rights defenders operating as observers, accompanying vulnerable individuals under threat and acting as a kind of information go-between for representatives of the international community, the civil authorities and those involved in conflict. It has volunteers in Colombia, among other places, providing protection in a region riddled with internal armed conflict involving killings, kidnapping, torture and extortion. Between 1999 and 2008, Colombia had the highest number of landmine victims in the world, higher even than Afghanistan. The UN special rapporteur on indigenous peoples has reported the extreme vulnerability of such groups, who are at risk of total physical or cultural extinction. The human rights defenders routinely face hostility, including death threats which are sometimes carried out. Similarly in Mexico, where Amnesty International has put on record its particular concern about the widespread discrimination against women, PBI has volunteers who are at risk.
I am sure that the clock should not say nine minutes.
In October last year, the then Foreign Secretary, Mr David Miliband MP, acknowledged the important role played by human rights defenders and called on the Colombian Government publicly to support their work and to provide a sufficient and secure level of state protection for those under threat. I should like to ask the Minister in his reply to reassure the House that the coalition Government will also actively pursue this policy. As regards Mexico, I should like to know what bilateral and multilateral initiatives the Government are planning to take to ensure that human rights defenders receive greater protection from the Mexican authorities. Will he also say what steps the UK is taking to ensure the full implementation of the EU guidelines on human rights defenders?
I also pay tribute to the work of VSO, which since 2008 has operated in five Latin American countries—Bolivia, Honduras, Peru, Guatemala and El Salvador—in addition to its programme in Guyana which has been in place since 1964. Its volunteers help to promote the employability of young people, the sustainability of natural resources, and the access to justice for the poor and marginalised, particularly women and children. In Peru, for example, 29 per cent of the population is aged under 15, 35 per cent do not have access to justice for a variety of reasons, and human rights abuses of certain racial and ethnic groups have resulted in many thousands of deaths, disappearances and acts of discrimination.
One of the many contributions of VSO has been the anti-discrimination training it has supplied to public authorities and the police. This helped to pave the way for local anti-discrimination legislation. It is easy to miss the actual, real-life impact of such a development at such a distance when we are so used to debating and legislating for every last detail of discrimination. There follows an example of what it changed in Peru: before the legislation, no one could enter a public building without a national identity card. People from distant villages whose mother tongue was not Spanish often had no means to obtain their ID card, so they had no access to basic services. Now, that requirement to have ID as an entry ticket has been swept away and the measure has been so successful that other regions are copying it.
That mention of the Spanish language leads me to my other point and here I declare an interest as chair of the All-Party Group on Modern Languages. If UK businesses are to take advantage of emerging markets in Latin America, they will need people who can speak Spanish and Portuguese. Sadly, the lack of language skills in the UK workforce and the general decline in foreign language learning is undermining our international business competitiveness.
It has been estimated that up to £21 billion is being lost to the UK economy every year because of our languages deficit. Currently, the UK does only half as much business with Brazil, which has a population of 200 million, as it does with Denmark, which has a population of 5 million. Brazil is the world's fifth biggest country but only our 30th biggest export market. Even so, that makes it the UK's biggest market in Latin America. Mexico is next, but no other Latin American country is in our top 50. Will the Minister say what is being done to promote trade between Mercosur and EU countries? UKTI has pointed to the importance of networks in promoting bilateral trade and this is precisely where and why knowledge of the relevant languages comes in. English is important, vital even, but it is not enough. UK export businesses which have proactively valued and used language skills have reported a 45 per cent increase in sales.
Interestingly, Spanish is the one European language bucking the trend at GCSE, with take-up increasing instead of declining. This is good news and businesses should be aware of it and more up-front in advertising their wish to recruit people with Spanish or other language skills. Spanish is the fourth most widely used language on the internet and is the second most spoken language in the world after Mandarin. Yet the value of UK exports to the 19 Spanish-speaking nations of Latin America is only £1.9 billion. There is a great deal of potential waiting to be tapped.
London alone has nearly 12,000 schoolchildren who speak Portuguese. That language now figures prominently on the employers’ list of languages that they would like to see among their staff, as confirmed in the CBI’s latest survey published last month. There is a campaign to add Portuguese to the list of the six official languages of the United Nations. If that is successful, there will be even more pressure than there is already on the UK to produce more linguists to work as interpreters and translators.
The popularity of Latin America as a gap-year destination has undoubtedly added to the interest in learning Spanish and Portuguese, but our shortfall in this area is so shameful that it really needs some firm, clear leadership from government to ensure that we are properly equipped to contribute to and take advantage of the economic benefits arising from emerging markets in Latin America, as well as the intercultural understanding needed to sustain relationships and success.
Baroness Hooper
My Lords, I, too, congratulate the noble Viscount, Lord Montgomery, on securing this debate at this particular time. It is now, as he said, a few years since we held a dedicated Latin America debate in your Lordships’ House, but the interest and contributions from your Lordships today underline the value of holding such a debate. This is a particularly interesting time in the affairs of many Latin American countries. Like others, I rejoice in the results of the latest elections in Colombia. Former President Uribe is a good example to everyone in not having tried to stand for a further term, as he must have been tempted to do.
I also represented Her Majesty’s Government at the inauguration of Evo Morales for his second term in office. The noble Baroness, Lady Gibson, talked in detail, and most interestingly, about Bolivia. However, I believe that we should not only look closely at what is happening in the energy sector in Bolivia; we should also remember the changing role of indigenous people in Latin America and the cross-boundary/cross-border effects that this increasing alignment may have. That could well be the subject for a further and separate debate.
This debate is timely also because of the recent developments in relations between the United States and Latin America, to which reference has already been made. I am rather concerned about the attitude of President Obama and Hilary Clinton as regards, for example, our relationship with Argentina over the Falkland Islands. However, this is also an excellent moment to underline for the new Government the significance of Latin American countries in world affairs and the value of our special relationship.
I do not need to repeat, but would like to emphasise, all that has been said about the historic links that bind us, whether we are talking about the independence movements, the bicentenaries of which we are currently celebrating, or the other historic links that include the founding of the navies of Chile and Brazil by Admiral the Lord Corcoran—who has a special association with your Lordships’ House since, until 1998, a direct descendant of Lord Corcoran sat on the Red Benches.
I would also emphasise the importance of the ongoing trade and investment links which British companies have maintained in Latin American countries. Amazingly, these links survive despite the focus and priority that, I am sorry to say, successive Governments have given to other parts of the world. Perhaps I should declare interests as a former president and current vice-president of Canning House and as vice-chairman of the Institute for the Study of the Americas. While the right reverend Prelate the Bishop of Liverpool was speaking, I reflected on the fact that the reason I learnt to speak Spanish and take an interest in Latin America, following a postgraduate course there, is that my mother came from Liverpool. Liverpool is the port of the Americas and my mother realised the importance and significance of the Spanish language. I am happy that the noble Baroness, Lady Coussins, was able to emphasise that point so well.
Like the noble Viscount and others, I deplore the way in which the official British presence in Latin America is diminishing through the closures and downsizing of our embassies and the British Council. In the Evening Standard last night, I noticed a rather caustic comment to the effect that the high life enjoyed by British diplomats abroad faces the axe. The Foreign Office already has a £55 million efficiency programme that includes spending less on consultants, closer working with other departments, increasing the sell-off of embassy space and cutting low-priority programmes. We must all regard this with grave concern because it builds on the many cuts and downsizing programmes that have been carried out in the past. I can only hope for and seek reassurance from the Minister that the axe will not fall inordinately heavily in Latin American countries.
Fortunately, our relations with Latin America are not just bilateral. The European Union is the channel through which many of our activities in overseas development, and our policies in relation to the American, Caribbean and Pacific group of states, have an impact—in the latter case, particularly in the Spanish-speaking Caribbean countries. It may well be that in the future the lack of bilateral representation in Latin American countries will be replaced by EU representative offices. I would be interested to hear the Minister’s comments on that possibility.
Reference has already been made to the trade agreements between the European Union and Mexico, Brazil and Chile, as well as negotiations with the Mercosur countries and so on. I would be interested to know if any reviews or analyses have been undertaken into the effect of these trade agreements. Can the Minister give us any information about this? If I remember correctly, as far as the first of those trade agreements—I believe it was with Mexico—is concerned, the effect was to increase greatly the importation of European Union goods into Mexico but not the reverse, which should be the object of the exercise. In all this, I hope we may also have an assurance from my noble friend that the United Kingdom will play its part in European Union policy formulation with regard to Latin America and not leave it to Spain and Portugal, perhaps the traditional colonial powers in Latin America. But we are also increasingly working together, particularly with Brazil and Mexico, within other international organisations such as the United Nations, the IMF, the OECD, the G20 and the G8. All these links have been referred to and it is important to remember them in our efforts to improve our bilateral relations.
When faced with a debate in the broad terms of the noble Viscount’s Motion, it is often difficult to know where to place the focus. The countries we are talking about have diverse populations, different contributions to make and different needs to fulfil—from Mexico in the north, through the Caribbean and central American countries, to the furthest reaches of Patagonia bordering on Antarctica—with, as the noble Viscount said at the outset, a combined GDP equal to that of China. Nevertheless, because of the common colonial history of those countries, the two mainly used official languages—rather than the indigenous languages—the many cultural links and the apparent common risk of natural catastrophes which seem to afflict many countries, particularly the hurricane and the volcano zones of the west coast, we are tempted to regard Latin America as more of an entity than the countries themselves would wish. Rather than concentrate on individual countries, I have decided to deal with certain common issues.
I shall start with one of the difficult ones, that of drug trafficking. This remains a huge problem throughout Latin America and the Caribbean. Only last night, a BBC news programme highlighted the emergence of problems in Monterrey, Mexico’s most advanced industrial centre and a thriving and prosperous state-of-the-art city. That was sad news to me. Peru, we are told, has now overtaken Colombia as the main producer of the coca leaf. Interestingly, Colombia’s output has dropped by some 16 per cent, which shows what can be achieved. I believe that the United Kingdom, as a consumer country along with the whole of the rest of Europe, has a duty to do its part in the fight against drugs in order to lower demand. Here I refer back to 1990 when my noble friend Lord Garel-Jones, then Minister of State with responsibility for Latin America, attended the important and successful drug summit. Leaders of many of the Latin American countries most concerned, together with representatives of the consumer countries, got together and tried to look at both sides of the issue.
The environment is another area in which developments have taken place. Increased awareness of the causes of climate change is leading to positive action. In Bolivia, it is high on the agenda. President Morales travelled to New York to deliver to the United Nations the results of the World People’s Conference on Climate Change held in Cochabamba in April. Mexico, as well as supporting the dialogue on sustainable development, has proposed the creation of a green fund to scale up the amount of resources available for climate change litigation and adaptation activities.
Like the noble Baroness, I am amazed at the way the clock seems to be racing ahead, and I apologise if I am over-running my time.
On his visit to the United Kingdom last year, the President of Ecuador, President Correa, spoke here in Parliament about the Yasuni project. In Brazil, as the principal guardian of Amazônica—the lungs of the world—a great deal of activity is taking place. This is another huge area for co-operation on a bilateral basis as well as within the European Union.
I may have outrun my time. I seek confirmation that the clock is correct.
Baroness Hooper
Oh dear. I had hoped to talk in a little more detail about energy, education, the issue of visas and the need to review the work of the UK Borders Agency in this respect, and the role of students from Latin America in the UK. However, I shall wind up as quickly as I can.
In my view, Parliament and parliamentary relations are as important as intergovernmental relations in all this, particularly in regard to the strengthening of democracy, and the role of the Inter-Parliamentary Union has to be encouraged and built on. As the newly elected chairman of the All-Party Group on Latin America, I hope we will see far more inward and outward visits.
This debate underlines the importance of Latin America and Latin American countries. We have got to get our act together, as the noble Lord, Lord Liddle, rightly exhorted us. Let us start that today, not mañana.
Lord Griffiths of Burry Port
My Lords, I am delighted that my noble friend—although he is sitting on other Benches he is still my friend—has brought this issue to our attention and given us this opportunity to debate it. When our newspapers this morning tell us that England must dispose of Argentina and Brazil if they are to lift the world cup, clearly it is a topical and timely debate.
I congratulate the noble Lord, Lord Liddle, on his maiden speech. We are sitting at the same level and I hope that my speech will attain something like the same level as his.
Others have spoken in general terms about the economic aspects of our relationships with Latin America; I want to speak in a more particular way. If it is a long time since Latin America has figured in our debates here, it must be forever since Haiti figured in them. This is a rare opportunity for me to hang some thoughts about Haiti on the back of the debate, with the permission of the noble Viscount, Lord Montgomery.
Latin America and the whole world owe far more than they think to poor Haiti. We celebrated recently the abolition of the slave trade 200 years ago, but not much was said about the fact that the slaves in Santa Domingo took their freedom from the mighty French armies by their own efforts under the leadership of Toussaint Louverture. That needs to be lauded as having set the scene and created the atmosphere for later and rather more timid efforts on our part.
However, it is only when the first President of Haiti was approached by Simon Bolivar as part of the drive for independence in Latin America that we see the linkage between Haiti and the great continent beyond it. Simon Bolivar found himself without provisions and called in at Port-au-Prince, where the President at that time, Alexandre Pétion, supplied him with victuals and materiel for the struggle in Venezuela and other places. Bolivar was duly thankful but did not express his thanks practically when, at the Congress of Panama in 1826, which was intended to give some kind of unity to the newly emerging free nations of the Americas, he colluded with the United States of America in excluding the President of Haiti from that congress because he was black. Simon Bolivar therefore has, I am afraid, a bad mark in my book as well as all the obvious good ones.
Then there was a grudging recognition of Haiti’s independence—from Denmark, the United Kingdom and eventually France—but with a huge indemnity that Haiti went on repaying until the early part of the 20th century. After that there was recognition, even more grudgingly, from the Vatican in 1860 and from the United States in 1863, but only because the civil war had caused a re-evaluation of the place of black people in society there. Haiti was the first black republic in the world.
For the remainder of the 19th century Haiti endured gun-boats and an assassination of character. The Germans, the British, the French and the Spanish all had their go at poor Haiti and perpetuated its image as a primitive nation. This culminated, of course, with the arrival in July 1915 of the USS “Washington” and the 20-year occupation by the American, black-hating Marines—rednecks—to look after Haiti’s affairs, but really to safeguard the approaches to the Panama Canal. So much is owed to Haiti that the deprecatory words which so easily fall off the tongues of all kinds of commentators need to be qualified against the facts of history. The weight of history hangs heavily around the shoulders of those who deprecated a country which got rid of its slaves at a time when the nations around it were anxious to keep theirs, We need to re-evaluate history in the light of those circumstances.
There was then, of course, puppet government after the occupation. The creation of an intellectual black hole was bound eventually to be filled by a dictator who looked something like Papa Doc Duvalier, and in the end resembled him exactly. I went to Haiti and lived there in the time that he was the dictator. I met him a couple of times and he died a month later. I do not think there was a causal relationship.
After the Duvalier dynasty in the 1980s—Baby Doc had gone in 1986—at a time of great turmoil when Haitians were looking for some kind of accountable government, what happened? The IMF came in and insisted on an economic package that eventually crippled and stifled the new revolution at birth. It was so irresponsible.
After a meeting in Chile, in Santiago in 1991, all the Foreign Ministers and Heads of Government of the Americas came together to promise themselves that if there were military government in any of their territories thereafter they would all rally round the cause and win back the lost independence. Three months later, a junta displaced the democratically elected President of Haiti and for three years and two months he was in exile in the United States. What did the Latin American continent do? Nothing. The Organisation of American States appointed an envoy, who came and went—leaving a carbon footprint the size of 40 football pitches—and nothing was done. Proximity talks in New York eventually secured some kind of future for Haiti but meant the end, effectively, of accountable government with the departure of President Aristide and the rebellion that came thereafter.
I rehearse these facts to secure on the record of the British Parliament the nature and the extent of the indebtedness of the rest of the world to the trail-blazing activities of Haiti. I hope that does not get either a sneer or a laugh. I have laid out the case, but it will not end there because there are some very encouraging things happening now.
I was in Haiti in February, just two or three weeks after the earthquake there. It was as bad as the news media showed it to be. People whom I had taught had been killed; the whole population of the university was decimated. I talked to survivors and people who were dreadfully mutilated. To know where to begin to reconstruct or to develop a future for Haiti in the light and the aftermath of that disaster is very difficult for the imagination.
But what did I find? In earthquake-stricken Port-au-Prince, I found that the lights worked and the electricity was 24 hours a day. I thought, “That was never the case on my previous visit. What on earth has happened?”. I found that the Government of President Chavez, much reviled by many in Venezuela, had seen to it that a power station and cheap oil was ensuring that the Haitian capital had its electricity. It had survived the earthquake and was still supplying its energy as appropriate to those properties that were not destroyed. Then, I was on air myself, being interviewed about Haiti and my impressions of it after the earthquake in a studio with people from Médecins Sans Frontières. We all admire them; they get there first and they like to tell us they get there first. But there were hundreds of Cuban doctors there before them who never got interviewed anywhere. That those two countries—Cuba and Venezuela, which do not count for much in the eyes of many commentators—should practically have reversed Simon Bolivar’s denial of the Haitian president all those years ago seemed to me to be an extraordinarily wonderful and generous thing.
I am delighted to say that a man whom I introduced to Haiti and provided with a network of friends is now taking it much further himself. One of London’s finest architects, a specialist in urban regeneration, is taking on responsibility for much of the reconstruction of Port-au-Prince. Seriously good things are happening there: an expo is about to take place in the next couple of months, from which tenders will be invited to provide model communities and rehouse displaced people around the capital of Port-au-Prince. He himself, our London architect John McAslan—I am proud to mention his name and honour it here in this assembly—has approached the private sector to gain the necessary funds to rebuild the marketplace in downtown Port-au-Prince. He has started not with the presidential palace but with the place where everybody goes to get their supplies. It is wonderful thing. We hope that, by December or January, that will be up and functioning, and all that trading will take place again. So there are signs of hope.
What do I want Her Majesty's Government to take note of as I mention Haiti in this way? Her Majesty's Government, whatever party is in power, are not known to take much heed of what happens in Haiti, but I shall offer my five-pennyworth. It is that Haiti should figure a little in the councils of our Government, and that we should see in Haiti an opportunity to do something that might have practical and beneficial outcomes. I go further and say that if we cannot crack the problem of Haiti, there is not much hope for some of the more problematical areas in the world that worry us to death.
I am very glad to ride on the back of the noble Viscount, Lord Montgomery of Alamein, and give my five-pennyworth of hurrahs for Haiti, and hope that perhaps it will figure a little in our thinking in the future.
Lord Avebury
My Lords, I join others who have expressed thanks to the noble Viscount, Lord Montgomery, for once again leading us in a debate on Latin America, a subject which has been seriously neglected over the past few years. I also join those who have congratulated the noble Lord, Lord Liddle, on a notable and informed maiden speech. I look forward very much to hearing him again.
The noble Lord mentioned the huge economies having to be made in British embassies, a subject taken up also by the noble Baroness, Lady Hooper. The previous Government’s FCO change programme was said to be focused on the modest ambition of changing the world, but, to do that, the aim was to have more of its resources abroad. Latin American countries suffered a round of cuts several years ago, when we closed the embassies in Honduras, El Salvador and Nicaragua. How does the current number of staff in the region as a whole compare with that in, let us say, 1997, when the previous Government came into office? When President Zelaya of Honduras was ousted in a coup a year ago, the Foreign Office Minister, Chris Bryant, had to issue statements through our embassy in Costa Rica, which must have lessened their impact in the country where the coup occurred. Does the Minister have an opinion on the reinstatement of Honduras as a member of the OAS, which was proposed by Hillary Clinton at its meeting a fortnight ago? We cannot have as direct a knowledge of the events in Honduras as we would have had if an embassy had been there.
Our ability to monitor drug trafficking through central America, referred to by the noble Baroness, Lady Hooper, must also be impaired by the reduction of our presence. Only last week, members of a gang who had been convicted in Bogota were reported to have been smuggling 30 tonnes of cocaine a month through Honduras and Costa Rica. But when my honourable friend Jeremy Browne was asked last week about staff levels at embassies for the three years 2010-13, he said that we would have to wait until the Comprehensive Spending Review, which is not expected until six months after the start of the period to which it relates. Surely we are entitled to know whether budgets for embassy staff in the region are, at worst, going to be maintained at their present levels. I hope that the Minister will comment on that in his winding-up.
When Chris Bryant visited Colombia last September, he spoke about the harm being done to the people by cocaine production, with 8,000 hectares of rainforest destroyed in the previous year, the widespread threat of kidnapping by the drug gangs, and innocent members of the public being maimed or killed by landmines. He pointed to the success of Colombia’s shared responsibility scheme—to which the UK is a substantial contributor—in helping to reduce coca cultivation in Colombia and to increase by 25 per cent the wholesale price of cocaine in the EU. Why are not more European states, and the EU itself, supporting that scheme?
In Peru, it is a different story, with the UNODC reporting, as has been mentioned already, that production of coca and cocaine are on the rise. The Government have made some effort to eradicate the business to keep in Washington’s good books, but the main areas of production are in remote valleys on the eastern side of the Andes, in some of which the writ of state institutions and the rule of law do not operate. In those areas, Sendero Luminoso calls the shots, in spite of recent successes against individual SL leaders. There is also some collaboration between SL and the Colombian terrorist organisation FARC, according to the Brazilian federal police. Would not Peru benefit from an international effort such as the shared responsibility scheme, and are there not any Andean regional measures to combat the narcotics industry that could be usefully supported?
As the FCO’s Annual Report on Human Rights says in a chapter on Colombia,
“the activities of illegal armed groups and drug traffickers continue to have a severely negative impact”.
But this is equally true for other countries of the region. Colombia at least invites the UN Special Procedures to visit and reports quarterly on what is being done to comply with the recommendations of the UN’s recent universal periodic review of Colombia. Here again, a wider regional approach would be welcome. Colombia is the only country in Latin America covered in the FCO’s human rights report. The reader might be unaware that the human rights problems cited—vulnerability of human rights defenders and civil society groups; impunity; internal displacement; and extrajudicial killings—are common also to Peru, for instance.
The FCO report mentions the UN rapporteur’s commendation of all the initiatives taken by Colombia on the health and education of indigenous people, but also the massacres of the Awa people in February and August 2009. Also in Peru, 33 people were killed in the Bagua incident in June 2009; the leader of the indigenous people fled to Nicaragua, where he was granted asylum, after being accused of responsibility for the clash. The special rapporteur visited Peru after the event and made a number of recommendations, including the establishment of an independent commission of inquiry to clarify the events of 5 June and the following days. Could Mr Anaya be asked to review the progress made in complying with his recommendations, 12 months on? As a signatory of ILO Convention 169 and a supporter of the UN Declaration On The Rights Of Indigenous People, enacting the ley de consulta and agreeing a process of implementation with representatives of indigenous people would go a long way toward fulfilling those obligations.
The ley de consulta does not give indigenous peoples the right of veto over exploitation of natural resources on their lands, but the ILO has asked Peru to suspend both exploitation and exploration affecting peoples covered by the convention until their participation in consultation on the processes is ensured, in accordance with Articles 6, 7 and 15 of the convention. Yet the state oil and gas agency, Perupetro, is going ahead with the auction of 25 new blocks, making only one that overlaps with a reserve for uncontacted tribes off-limits. Representatives of Perupetro were in London recently looking for bids, contrary to the advice of the national organisation representing indigenous people, AIDESEP, which called the bid process,
“a new provocation against indigenous peoples”.
It is also a breach of chapter V of the OECD Guidelines for Multinational Enterprises, which says that enterprises should,
“engage in adequate and timely communication and consultation with the communities directly affected by the environmental, health and safety policies of the enterprise”.
In their response to the JCHR report Any of Our Business on 10 February this year, the Government said that they continued to encourage the wider use of tools such as the OECD guidelines, so I would be grateful if the Minister could say what advice they have given or would give to companies thinking of bidding in this auction, and whether they will encourage other member states of the OECD to follow their example.
There could be one other way to leverage our efforts on human rights in both Peru and Colombia. If the draft EU trade agreement with those two countries is what is called a “mixed” agreement and not purely commercial, it would have to include a human rights clause. The noble Lords, Lord Grenfell and Lord Hunt of Wirral, both asked for assurances on this matter when the noble Viscount, Lord Montgomery, asked a Question about the agreement in January. Can my noble friend assure us that this Government will insist that the agreement contains clauses on both human rights and environmental protection?
Finally, Peru’s national human rights plan comes to the end of its five-year mandate this coming December and the president of the national council on human rights, CNDH, has asked the international community for assistance in carrying out an evaluation of the initiative. In the meanwhile, the Ministry of Economy and Finance has announced a cut of 70 per cent in the CNDH budget. I would be grateful if the Government could consider this with our EU partners, with a view to making up the deficiency. There are hundreds of cases of human rights abuse arising from the internal armed conflicts between 1980 and 2000, and there continue to be hundreds of cases still of social conflict—no fewer than 255 being reported by the ombudsman in May alone. Peru can ill afford to cut back on human rights, and I hope that it will be one of our concerns, and that of the European Union, to raise that higher in our priorities.
Baroness Kinnock of Holyhead
My Lords, first, I add my words of warm welcome to my noble friend Lord Liddle. As many other noble Lords have said, he has enormous experience, knowledge and understanding, which he clearly showed in his very impressive speech today. I have known my noble friend for many years and in many lives, in British politics and in the European Union when I sat in the European Parliament. I certainly know and admire his intellect and his total refusal ever to deviate from the fundamental principles and priorities that have guided his political life. I am sure that his parents would have been extremely proud of him in maintaining that strong position on values and principles in what he said. I know that he will bring all of that knowledge and experience to our work in this House.
To state the obvious: Latin America is a continent, as others have intimated. This excellent debate, instigated by the indefatigable and noble Viscount, Lord Montgomery, has again made clear that the variety of developments and interests which we have tried to cover is limitless. Indeed, it would be unwise for anyone to try to cover the spectrum. I will therefore limit my remarks to considering some of the salient and most recent developments in Latin America. One of those has been the interest and commitment shown by the Obama Administration in that continent. On her latest—indeed, her seventh—visit to Latin America as Secretary of State, Hillary Clinton said:
“If I told you 10 years ago that the leaders of the United States and Europe would be taking some well deserved advice on economic management from some of our Latin American counterparts, many people would not have believed me. But today, many of the region’s governments have navigated steadily and responsibly through the global economic crisis and are on their way to recovery”.
The noble Lord, Lord Hannay, referred particularly to the importance that we should attach to building a really strong relationship with Brazil. Time magazine recently named Lula da Silva as one of the world’s 100 most influential people. By 2050, Brazil will be the world’s fourth largest economy—and that will bring with it enormous diplomatic clout.
In the past 20 years, Latin America has gone through extensive political, economic and social change, but simultaneously with that social change taking place, as we have seen, the centre of global gravity has steadily moved to the east and the south. Now we know that we cannot ignore the power and influence of the emerging economies of Latin America—or, of course, emerging economies in other parts of the world. As others have alluded to, the continent contains a mix of ideologies. There is both market orthodoxy and a subscription to what many leaders would choose to call 21st-century socialism, but because of that situation it is not possible to make generalisations about the economic success or otherwise of countries in Latin America. The reality is that of the 15 most unequal countries in the world, 10 are in Latin America. The continent has endured two centuries of deeply entrenched inequality, which is of course not easy to change.
It is a continent which has been defined, too, by its commodities. It has a huge number of valuable commodities: gold and silver, coffee, copper, coal—and now oil, the black gold. In the past 10 years, the important changes that we have seen and the improvements in economic performance are directly related to the income generated by those commodities. Latin America exports many of those commodities to the European Union—again, many noble Lords have described that situation—but the European Union is the biggest investor in the region, with Spanish corporations leading the field.
The EU is also Latin America’s second largest trading partner after the United States. However, not many noble Lords have described China’s involvement in Latin America, which would be appropriate as it is fast catching up on issues of trade. Many European companies participate in banking and privatised services such as electricity and gas, as well as in mining and other export sectors. Negotiations with Mercosur have been referred to. This has stalled over a number of years for many of the reasons described by noble Lords, but the other reason given is the pending Doha decision, which it is felt prevents any progress being made.
Does the Minister believe, as I do, that more needs to be done about our relations with Latin America? I accept that in the past there needed to be and in the present there needs to be a bolder and more innovative approach to Latin America. We need to change and adapt to the evolving circumstances that we see there. These are critical times, particularly since the United States is clearly ratcheting up its interest, and when China has had such an important role as a trading partner. Interestingly, China’s huge hunger for commodities has done more over the decades than western aid and countless Marshall plans have been able to do.
All the fine words need to be fleshed out by the European Union and the United States as well as the UK. We need more joined-up thinking—we need to get our act together and to think more coherently. For instance, as members of the European Union we need to pay more attention to the emphasis that Brazil and other emerging economies are placing on what is called south-south diplomacy. They are not looking to the north for diplomatic contacts; they are looking for their southern allies to work with. In my view, they are punching above their regional and international weight in an unprecedented way. Brazil has recruited hundreds of new diplomatic staff and is strengthening relations with China, India, Russia and South Africa. Brazil now has more diplomatic missions in Africa than does the UK and, with other emerging economy allies, is crucial to making progress, as many noble Lords have said, on climate change, trade and financial regulation. It seeks a seat on the Security Council and argues that the UN must, sooner rather than later, reflect the make-up of the modern world. Would the Minister care to comment on these Brazilian aspirations? Does he agree, too, that progress has been made by a number of burgeoning Latin American democracies, which should be more positively recognised? P5 members such as the United Kingdom must be ready to respond that all permanent members and nuclear powers now face new and unprecedented challenges.
Another country to touch upon, as other noble Lords have done, is Venezuela. We take note of the purchase of £4 billion worth of Russian weapons and the Chinese loan of £20 billion. Those are surely clear reasons to up our game in Latin America at a time when its new allies are preparing to pour in still more dollars.
Noble Lords will be aware that a growing number of Latin American countries are making serious attempts to tackle some of the human rights abuses that have been raised by many noble Lords, including impunity, and to recognise increasingly that peace and reconciliation depend on truth, justice and reparation. Six countries in Latin America now have comprehensive laws on violence specifically against women, covering domestic violence, community and state violence. However, violence against women and girls remains endemic in many countries in Latin America and discrimination against women, according to Amnesty, still lacks vigorous discrimination. Meanwhile, discrimination against the indigenous people continues, as the noble Baroness, Lady Coussins, has said. They face intimidation and harassment across the whole continent. However, Bolivia has made substantial progress, including the elevation of indigenous jurisdiction, making it equal to current judicial process. As the noble Baroness, Lady Gibson, pointed out, in many ways that country is making a great deal of progress.
Would the Minister clarify what the UK position is on the European Union trade agreements with those countries, particularly Columbia and Peru, alluded to by the noble Lord, Lord Avebury? Will the Government insist, as the noble Lord asked, that there be consultation with and ratification when appropriate with the Parliaments of those countries? Will there be subsequent monitoring of any clauses relating to human rights and environmental protection? These are important points; the commercial interests are important, but they have to be seen in tandem with the leverage that it gives us on human rights.
In conclusion, we all know the stereotypes of Latin America have been transformed, but there are still structural constraints on economic growth and on political and social systems, which are in need of radical overhaul. There is insecurity stemming from the narcotics and arms trades, but this House should agree that partnership and engagement are the only way forward.
The Minister of State, Foreign and Commonwealth Office (Lord Howell of Guildford)
My Lords, this has been a rich and deep debate. We have to thank the noble Viscount, Lord Montgomery, for initiating the debate, which he did quite excellently, and for giving us the opportunity to let our minds range over this increasingly important area of the planet. When listening to a debate such as this, the Minister arrives with a wheelbarrow full of briefing. However, the task is not merely to try to share with noble Lords the contents of my files; it is to share with the Foreign and Commonwealth Office the contents of noble Lords’ minds. In this debate, there has been a magnificent briefing for all those that care to read Hansard and study the expert views of many noble Lords. There is a massive amount of material of immense value. I shall greatly enjoy studying it further and discussing it with Jeremy Browne, my excellent colleague in the Foreign and Commonwealth Office, who has immediate responsibility for this area in the pattern of responsibilities that we share out in the Foreign Office. In a way, that involves some slightly unrealistic silos, but we all have to take an area of the planet to look at, and I am very pleased that Jeremy Browne is doing just that.
The debate was also marked by the remarkably comprehensive and profound maiden speech from the noble Lord, Lord Liddle. First, he told us about his dynastic connections with this House, and we really feel that he is one of us already—if that is not too offensive a phrase. It was a delight to hear his deep mind at work on the great issues. He is a committed internationalist, and I know that we will enjoy hearing much more from him. I shall come to some of his specific points later.
The noble Baroness, Lady Kinnock, is absolutely right. To try to generalise about this colossal area of the world and this vast pattern of diverse and different countries is a dangerous thing anyway, but to do it in 18 or 20 minutes at the end of a debate such as this verges on the absurd. However, I will try to cover a great many of the points that have been made. I will not cover them all, of course, but I will write to noble Lords about some aspects that I omit.
Let me start where the debate started, with the excellent introductory speech of the noble Viscount, which immediately struck the central point of our debate: Latin America is a changed scene. We have stereotyped ideas about the Latin America of the past—inflation, dictatorships, juntas and appalling poverty. The poverty still exists to some degree, but the stereotype is no longer valid. A completely new pattern of interrelationships weaving with the rest of the planet has emerged. If we have no other message from this debate for the wider world, I hope that that one will stick.
In the words of my noble friend Lord Garel-Jones, the issue is now in fashion. It is right that it should be, as entirely new influences, trends and interests for this country are now at work, which we have to study closely, grasp and adjust our policy to. My noble friend pointed out that, in many ways, Latin America is a continent full of prisoners of nationalism. Well, we are all prisoners of nationalism to a degree, but we also have to adjust to global trends and interdependent forces which are bound to require that nationalism to be modified. The dilemma remains of how to combine loyalty—in the sense of belonging to one’s local community and nation, in which one wants pride—with the facts of globalisation and interdependence. I thought that my noble friend put that extremely well.
The noble Baroness, Lady Gibson, spoke with great knowledge and detail about Bolivia and Cuba. I do not think that I have anything to add to her knowledge; indeed, it would be almost an impertinence to do so. She rightly said that we are not in favour of the continuation of the blockade of Cuba. I believe that minds in other capitals take the same view, so we could be moving to a better era, although I hardly need to tell your Lordships of the difficulties.
The right reverend Prelate the Bishop of Liverpool talked about new international bodies. It is a profound thought. The 20th-century platforms that we inherited need repair and refurbishment and, although they still have immense value, we may have to think about new prospects as well. He mentioned the central issue of the rainforests, which are one of the keys to both adjusting to and mitigating the effects of global climate change. I can assure him that, as we move towards the Cancun gathering, that will be very much in our minds. We shall give considerable emphasis to the whole issue of rainforests, on which a great deal of work has been done both under the previous Government and under this one. There is no question but that that is a central issue.
The noble Lord, Lord Giddens, turned to an area that interests me very much and rightly illuminated the issues relating to the power of Brazil, about which we heard a great deal in the debate, as it emerges as a major global player. Underpinning that power is the effective policy on renewable energies that Brazil has developed with great courage over many years. I say “with great courage” because, throughout the 1990s, when oil prices dipped right down to $6, $7 or $8 a barrel, many people said that Brazil had backed the wrong horse in going for renewables—the ethanols and so on—which it would find more expensive, as indeed they were for a time. However, the Brazilians stuck to their policy and now it has paid off handsomely. Brazil is now one of the greatest producers not just of ethanol but of commercial and clean ethanol of the highest quality, which puts it to the forefront as a great energy nation. That is quite aside from the fact that Brazil has now discovered so-called pre-salt oil deposits at considerable depth, which make it a major oil-producing power as well.
One way or another, quite aside from natural resources and energy, Brazil is emerging as a key player. It is a country with which we intend to establish close and closer relations. Indeed, we would be foolish not to do so, as the voice of Brazil can be heard very clearly on the international scene. The noble Lord, Lord Hannay, rightly reminded us that not only Brazil but Mexico and Argentina are members of the G20, which is the new motor of global policy-making. It is not the only one, but it is very powerful, and three countries in our purview today are at the centre of it. He referred to the deal that Brazil recently offered, alongside Turkey, to Iran over enrichment. That caused a number of queries around the world, because it was a surprise to many people that suddenly Brazil and Turkey should be players on the international stage. We have to look carefully at that and perhaps have second thoughts about what they were proposing and what contribution it could make in unravelling the hideous jigsaw of Iran’s nuclear weapons ambitions, which we all fear.
The noble Lord and the noble Baroness, Lady Kinnock, mentioned the influence of China and, indeed, Japan on Latin America. We are all sitting here thinking that Latin America lies somewhere to the west of us, but of course in Latin America there is just as strong a perspective going westwards around the world to China and Japan. Chinese investment and interests are spreading all over Latin America, while Japanese interests are strong, too. These are major factors in assessing our own relationship and how best we can build on it. The noble Lord also mentioned what we all recognise, which is that we may get a little carried away with the rhetoric of the new dynamism of these great economies, as poverty remains in massive quantities. The need for effective and well targeted aid and development programmes—the kind of aid that leads to development, which not all aid does—remains vital.
The noble Baroness, Lady Coussins, concentrated on human rights in Mexico and Colombia. I have extensive notes and briefings on these, but I may need to write to her. However, I will say now that, although we have all read about the ugly drugs wars and the heavy casualties in Mexico, we take all reports of human rights abuses seriously wherever they occur. Human rights are a key part of our bilateral political dialogue with Mexico. The noble Baroness asked whether we regard human rights defenders and NGOs as important for Colombia. Yes, we do. The work in Colombia of civil society groups, human rights defenders and trade unions is very important. We want to promote the strengthening of Colombian civil society and, in our view, human rights defenders need to be seen as part of the solution to human rights difficulties and should not be stigmatised officially or otherwise as part of the problem. Are we undertaking practical work to help? Yes, we are. Our embassy in Bogota frequently meets those under threat to discuss the situation and how we can carry it forward in a positive way. There is much more to say on that but, frankly, there is no time to say it.
The noble Baroness also asked how the EU fits into all this. There is the EU-Rio Group and the EU/Latin America/Caribbean group, a meeting of which my right honourable friend the Secretary of State and my honourable friend Jeremy Browne, whom I have already mentioned, attended within the first few days of taking up their posts in the department. They had considerable, detailed and constructive discussions with Latin American leaders, demonstrating the seriousness of our commitment behind the words and generalities about stronger relations with Latin America.
My noble friend Lady Hooper, who is extremely well acquainted with these issues and has considerable knowledge and understanding of Latin American developments, spoke on the sensitive question of our representation there. There have been closures, and concern has been expressed both under the previous Government and recently. Our intention is that there should be no further retreat in these matters. We have no plans for further closures of embassies. There may have to be reallocation of resources—we are all in the business of trying to adjust to a tighter resource allocation—and details about how we will react to the pressures on us will be spelt out fully and clearly to both Houses of Parliament at the right time. However, in general we are concerned to see no further retreat in our diplomatic capacities and representations in the area. Changes to meet new conditions may be required, but the shrinkage is something that we hope to put behind us.
The noble Lord, Lord Griffiths, gave the sort of classically valuable speech that can emerge in your Lordships’ House. He spoke with enormous and detailed expertise on Haiti. Most of us think of Haiti only in relation to the horrific earthquake that happened recently, and to what we could do thereafter. We have done a good deal—we have cancelled all Haiti’s debts to the United Kingdom—and it is encouraging to hear from the noble Lord that there are signs of recovery and development brilliantly emerging out of the ruins and horror that we saw reported in the papers only a few months ago.
My noble friend Lord Avebury spoke, as I expected him to, on a range of detailed issues concerning drugs and human rights. In Colombia, the work of the British Government with the Colombian authorities has been much appreciated and is seen as very successful. This is a very positive and effective story in a difficult area. Generally, we try to encourage—this is a different issue from drugs, but the noble Lord mentioned conflict with indigenous peoples—any kind of conflict-reducing talks and developments. We have encouraged all kinds of negotiations. The noble Lord mentioned Honduras, where our non-resident ambassador and her staff have just visited and met NGOs to hear concerns about human rights. The clear aim is to normalise relations with Honduras and that is what we will do. I will write to my noble friend about the Peruvian situation, because I must devote a few minutes to some general remarks.
The noble Baroness returned, as I expected, to the salient issues of the rise of Brazil as a great nation; of the vast power of Mexico, which is now the 11th largest manufacturing nation in the world; and of Argentina, with which, despite the colouring of our relations over the Falkland Islands issue, on which there is no change in our policy, we want to have warm and effective relations, as historically we have had. We will continue to work to achieve that, despite the Falklands problem. The Government intend to build on these newly established relationships with Latin America across a whole range of foreign policy areas. A deeper understanding, which this debate has certainly assisted, will enable the UK not only to be a true friend of the region, but will also allow us to extend the hand of partnership, which will be in the best interests of our own citizens and society as well as of those in the region.
Noble Lords have said in the debate this afternoon that the centre of gravity, and the balance of power and influence, have shifted away from traditional 20th-century patterns, and global decision-making has moved away from the narrower North Atlantic duo of European and North American influence to the broader and more representative G20. Many wise voices have pointed to the rise of the BRICs: Brazil, Russia, India and China. That has become a shorthand for describing the shift in the economic climate, which includes not just the BRICs but such large and influential countries as Mexico. It is absolutely right that countries such as Mexico, Brazil and Argentina are members of the G20 and at the heart of global economic decision-making today. Not only is it important that our international economic framework reflects the global economic reality, but many of our Latin American friends who suffered great financial turbulence in the 1980s and 1990s, which we all remember, learnt early lessons about strict financial discipline from which we could all benefit—as Secretary Clinton rightly pointed out the other day when she spoke about these matters. The markets of Mexico and Brazil may seem far removed from the bread and butter of our domestic issues, but intensifying our engagement with emerging economies will be critical in helping us tackle the issues that we face at home. The same is true if we are to make our views count on the global challenges central to our security and well-being. I include in those challenges concerns about climate change. Latin American countries are more important than ever to the achievement of these objectives.
We have all had the opportunity in this debate to discuss briefly where some of our shared interests lie. The examples that have been raised show that our relations with Latin America are multidimensional: not one of them can be defined by just one issue. A stronger relationship between the UK and Latin America would benefit us all, and I leave noble Lords in no doubt that that is the view of Her Majesty's Government. Our posts in the region raise human rights issues with host Governments and ensure that the European Union takes these matters seriously. We are pleased that many Latin American countries are participating positively in the UN’s universal periodic review process, and we look forward to ongoing co-operation with them in this process.
In conclusion—because my time, too, is up—the fortunes of Latin America and the UK are very much intertwined. Although we may not agree on everything, we understand how important it is to remain engaged with each other, and we look forward to the future. It is the Government's intention to shape a distinctive foreign policy that protects and promotes our national interests, strengthens our economy, makes the most of the opportunities of the 21st century and upholds the highest values of our society—namely, political freedom, individual aspiration, democratic choice, human rights, free trade and the eradication of poverty. I look forward greatly to working with my noble friends in the House, and with our friends and partners in the countries of Latin America, to achieve those goals.
The central message remains that Latin America has changed. In the words of the noble Baroness, Lady Kinnock, we need bold and innovative approaches to the new conditions. The role of the United States, our great ally, is no longer so dominant. The Washington consensus is no longer the ruling rubric of the area, as was pointed out in the debate. Countries such as Brazil and Mexico have their own agendas and are reaching out to parts of the world in new ways, including to the United Kingdom. The noble Lord, Lord Garel-Jones, reminded us that Mr Canning talked about the new world being called in to redress the balance of the old. Perhaps we should turn that on its head and say that the time has come when the old world should be called in to redress the balance of the new. I thank noble Lords for a superb debate. We all have a right to feel that we have made a contribution to understanding this vast and important issue for our nation.
Viscount Montgomery of Alamein
As two noble Lords have withdrawn there are theoretically a few more minutes for me to sum up, but I do not propose to take many of them. Fortunately, the noble Lord, Lord Howell, has summarised everybody’s speeches succinctly, so I do not have to.
We have this afternoon had an amazing range of opinion and views. I cannot fail to mention the maiden speech of the noble Lord, Lord Liddle, with which I agreed almost entirely. He will be a valuable asset not only to this House but to the cause of Latin America. His policy review organisation will no doubt produce many interesting papers of value on the subject.
The themes that came though in this debate were, obviously, human rights and environmental concerns, which were mentioned by so many. The one thing that I thought was particularly striking was the idea of unity—the noble Lord, Lord Hannay of Chiswick, expressed this—in Europe and Latin America; in other words, the dream of Bolivar. There are obviously a lot of differences of opinion and different ideas about how to achieve unity in these two great continents that must work together. In coming back to that in other debates, as the noble Baroness, Lady Hooper, said, we may need to address many aspects of this immense problem.
I am extremely grateful to all those who have taken part. I have learnt an enormous amount from this debate. One never stops learning. Even though I have been at it for many years, every day I learn something new. Today has been no exception. I beg leave to withdraw the Motion.
Health: Primary and Community Care
(13 years, 10 months ago)
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Lord Mawson
To call attention to practical lessons from changes in primary and community care during the last 10 years; and to move for Papers.
Lord Mawson
My Lords, it is a privilege to be able to lead this debate on the future of primary and community care at this early stage in the new coalition Government. The vision that the Government have set out for primary care, where resources are deployed in the hands of practitioners close to the ground, has significant risks but is full of opportunity. As a social entrepreneur, I welcome this bold step.
As noble Lords will know, over the past 13 years in an area of great deprivation and health need, where the health authority had left a gaping hole in primary care provision, we, with the local community of Bromley by Bow, have set up a health centre which is integrated with housing, education, businesses and the arts. I declare an interest as the founder and, now, president of the centre, and that, in my professional life, I am increasingly working across the country advising on this area of health development.
The Bromley by Bow Centre is about health, not sickness, which is reflected throughout the building. You enter through a beautiful cloistered garden, recently full of purple wisteria. There are no gruesome pictures of human bodies on the walls greeting our patients, the kind of images that used to haunt me as an imaginative eight year-old at our local doctor’s surgery in Bradford. Instead, you walk into an art gallery and open-plan reception made of natural timbers and bathed in natural light. A high-quality environment, a focus on human relationships, open communication and customer focus are the keys to the Bromley by Bow approach. Doctors come out into the reception to chat and greet their patients in person. In the consulting rooms, patients and doctors sit side by side around curved wooden tables, looking at the computer screen together. At Bromley by Bow, doctors, nurses and patients work in partnership together.
Patients are not merely prescribed pills, referred and sent on their way. The drug we give to a patient with depression is only part of what our GPs prescribe as a fully comprehensive care programme. At the centre, we can offer on-site career advice; support to overcome debt; vocational training qualifications, and even a university degree programme; business support, including the opportunity to set up your own business; and practical housing and legal assistance.
Over the past 13 years the Bromley by Bow Centre has become an exemplar of an integrated approach to health and social care. It inspired the £300-million healthy living centre programme, run by the then New Opportunities Fund, and the £2-billion NHS LIFT initiative, which is of course the public/private partnership programme for building primary health and social care centres in the most disadvantaged areas across the UK.
Others have developed integrated approaches to health in other parts of the country. Dr Angela Lennox built a police station in her health centre in Leicester and reduced crime in the housing estate where it is based. The Westbank Community Care Centre in Exeter promotes healthy living across Devon. The Gracefield Gardens health centre in Streatham works in partnership with Lambeth PCT and Lambeth Council to deliver better healthcare. We ourselves now run three health centres for over 18,000 patients and are the largest primary care provider in the London Borough of Tower Hamlets.
I apologise for not being able to speak last week in the debate on the big society, but are these not all examples of where, in the micro, a big idea like the big society might take root? If integrated models of health and community care were encouraged in every community up and down the land, and the necessary local relationships and partnerships brought together, this important idea—the big society—might not become subject to yet further cynicism and be seen as more meaningless government spin with little substance underneath. It might actually become the fertile ground within which a wholly new definition of what it means to be a healthy society—a thriving community—took root. Of course, such an approach would need to be given time and consistent leadership.
There is a wealth of untapped social entrepreneurial talent in our country. Many of these entrepreneurs have it in them to generate creative and innovative approaches to primary and community care. There are hundreds of latent and undernourished third-sector organisations in this country with the capability to become like Bromley by Bow and take on the task of transforming how public services are delivered in communities up and down the UK. Our task is to find these people and organisations and put the wind in their sails. Over the past 10 years I have travelled up and down the country and discovered social entrepreneurs who are massively frustrated at how hard it is to be trusted and resourced to take on public contracts, including in the areas of health and social care. Despite the positive rhetoric from successive government Ministers, it has been intensely difficult for dedicated and talented social entrepreneurs to develop creative solutions.
My noble friend Lady Finlay and I offer the Minister a visit to some of these centres and the opportunity for him to see in detail what a successful integrated approach to health and community care actually looks like in practice, and what conditions need to prevail if it is to grow exponentially and to take root. The sad fact remains that these examples of an integrated health model are still few and far between. Despite all the rhetoric and promises, there has been little practical encouragement for these integrated approaches to health. It was ironic that our approach, which everyone now thinks is a great idea, was physically blocked by a boulder across our road to delivery back in the mid-1990s. The boulder was not local people but the local health authority at that time.
I am not convinced that things have moved on much. Yes, money has been spent on building new buildings and, yes, there has been investment in services, but the principle of broadening the base of primary and social care delivery and engaging social enterprises has barely been understood. I am aware that the language of social enterprise is spoken inside Whitehall, but I am profoundly doubtful as to whether it is understood. Indeed, the evidence is that it is not. Our public services need to be known for doing and achieving, not just endless talking, restructuring or writing yet another new stack of policy documents. In a modern enterprise economy, we are nowadays returning to the sensible practice of “learning by doing”. The idea that we learn much through the writing of endless documents that are out of date within weeks can seem rather outdated. There is nothing better than getting your hands dirty in the practicalities to really understand what is going on. When I spoke to the recently departed chair of NHS London, he told me that his mission was to build stand-alone “medical model” health centres without what he called “the distraction of social and community care”. Evidently, the complications inherent in the lives of disadvantaged Londoners were outside the brief of the chair of NHS London.
Similarly, the vision of the noble Lord, Lord Darzi, of a network of polyclinics, announced in your Lordships’ House, was in practice another missed opportunity. When you get into the practical detail with those of us who are practitioners, you see that it was not at all a vision of polyclinics, but of monoclinics—that is, health centres that are almost solely about the clinical model of healthcare. It is a sophisticated clinical model and, invariably, these clinics are full of state-of-the-art equipment and procedures. However, I am vexed to say that they pay scant lip service to the lessons many of us have learnt about integration and the bringing of different disciplines together in the way I have described—that the route into addressing the pressing and underlying health needs in some of our most challenging communities in this country lies in getting GPs to work with their non-health colleagues. It is as simple and as complicated as that.
We need our health service to be open to working in partnership with the third sector and social enterprises in integrated schemes which address the real, practical day-to-day issues that face patients. These include poor social housing, underachievement in education, credit card debt and fear of bailiffs, concern over street violence and anti-social behaviour, and the lack of opportunities to take control of their lives. We are not asking the NHS to solve all these problems. We are simply asking that the health profession be willing to work more collaboratively with others who have the tools to change our communities for the better, including by addressing their physical and mental health needs.
What those of us who have had real experience of running successful integrated health centres found was that the definition of a polyclinic changed on a six-monthly basis, and each new definition was communicated by NHS London with such clarity and certainty that real players and practitioners in the field were left totally paralysed. This meant that important health centres still remain not built, with enormous potential abortive costs. I know of one health centre that has had to go through so many NHS London-inspired redesigns that it has incurred over £1.5 million of design fees and still sits in NHS London’s in-tray. I truly wish I could say that this is the only example I am aware of in London but it is not. I am afraid that the last Government were rather fond of initiatives that never in practice happened, and of trusting the reports of young consultants at McKinsey rather than those who do the job.
I welcome a world envisioned by the coalition Government where resources are put in the hands of practitioners on the ground with a real understanding of their neighbourhoods and local needs. However, this vision is far from straightforward. Not all GPs will deliver the integrated model of healthcare that I described earlier. Many GPs who support an integrated approach tell me that their colleagues who do not support it fear loss of status and title, without realising that real status in communities is based on the strength of their relationships with patients. Often in deprived areas there is a stark lack of GPs with the capacity to rise to the challenges that they now face. This new approach has important implications for the ways in which doctors are now trained.
The Government need to ensure that GPs are encouraged not to resist change, nor protect an expensive biomedical model of health. We need to show our doctors that an integrated approach to healthcare will address the profound problems that people in disadvantaged areas face, with considerable savings to the public purse. At Bromley by Bow, we run our health centre like any successful customer-focused business. For example, 20 per cent of consultations are conducted on the phone, which saves not only the patient’s time but the GP’s as well. What we all have to realise is that the NHS has access to people across the country which any business would die for. Eighty per cent of consultations in the NHS take place in general practice, and 90 per cent of the population is seen in any one year. If we encourage entrepreneurship in the world of health, then the more capable practitioners will step into these gaps in the market and ensure successful delivery of care.
As the new Government begin to formulate their health policy, I have three questions for the coalition and the Minister, who I wish to thank for a very helpful discussion earlier this week on this subject. First, what is the Government’s vision for the future make-up of primary and community care? Will they simply leave it to the marketplace? Will they promote the standard medical model or the integrated approach of the type I have described? A clear approach is essential for the dedicated medical staff, who have had to suffer countless changes in direction over the last decade and now feel disillusioned, confused and frustrated. Secondly, once the Government have clarified what their future model of primary care and community care will be, how will they deliver and develop this approach effectively? This has simply not been happening. Finally, who in the coalition Government will lead with consistency and longevity, and pursue this course? Under the previous Government, we saw a succession of initiatives and restructuring led by “here today, gone tomorrow” Ministers, which has left the health service, frankly, in ill health. Who will be the leader? That is my key question.
The Government are rightly opening up a world of opportunity and I welcome that. However, the devil, as ever, will be in the detail and perhaps most importantly in consistent leadership not from civil servants but from practitioners—GPs and others who have done the job and understand the practical details on the ground. I encourage the Minister and his Government to lessen their reliance on academics and theorists, who have often never built anything, and to embrace the world of the practitioner and the social entrepreneur; to create a culture where we learn by doing, and not by talking and writing endless expensive documents and papers. We cannot afford this expensive, rather old fashioned way of doing things any more. Let us support—and learn from—people who do the job.
Lord Colwyn
My Lords, I congratulate the noble Lord, Lord Mawson, on securing this debate. I listened to his speech with great interest. He has a splendid vision for future healthcare and should be congratulated on all that he has done. I hope he will forgive me for not following directly his line of thought. I am not used to speaking so early in a debate; normally every subject has been covered by the time I get to my feet. I must concentrate on matters that have affected and will affect my dental colleagues. I have no need to declare an interest. I was in dental practice for more than 40 years but I have now been retired for two or three years.
As I said in the debate on the Queen’s Speech, the past 10 years have seen fundamental changes to the provision of dental services. We have been left with unfinished reform of NHS dentistry and must now work to deliver a better system both for patients and dentists, even at this time when the Government are making complex financial decisions which will affect us all. Alongside the challenges of oral health promotion and NHS dentistry, general dental practitioners face mounting challenges in the management of their practices. The creation of the Care Quality Commission, with which both NHS and private practices must be registered by the end of March next year, imposes a further layer of regulation on dental practices.
Why this current explosion in the evaluation, accreditation and remediation of health professionals? The CQC emphasis is on the registration and inspection of practices, rather than the assessment of individual performance. This will probably be followed by the General Dental Council’s proposed revalidation processes, focusing on individual registrants rather than the environment in which they happen to be working. There will be areas of overlap, which will need to be looked at to avoid duplication and possible misinterpretation.
The British Dental Association’s Good Practice Scheme recognises the practice, not the individuals within it, and Denplan Excel has, for nearly a decade, been independently auditing dentists against a full range of quality and oral health measures, regularly visiting the practices and de-accrediting those found wanting. The BDA has identified a significant surge in the demand for advice on regulatory issues. It says:
“It is clear from our analysis that the challenges facing dentists are increasing and changing”.
Paramount to its concerns is the growing burden that changes to professional regulation are placing on its practices and the impact it is having on the delivery of patient care. The BDA continues:
“Recent years have seen a significant and disproportionate elaboration of the regulation of dentistry, with the publication of new decontamination guidance and the advent of the Care Quality Commission. We hope that the (recent) announcement of the halting of the proposed vetting and barring regulations signal a fresh approach to regulation that puts patient care before bureaucracy”.
Dental Protection, the dental branch of the Medical Protection Society, which I used to have the honour of chairing, reports an unprecedented demand for its advisory services. It says:
“The controls are out of control”.
There is a widespread feeling in the profession, and a growing sense of anger and frustration, that there are too many hoops for practitioners to jump through, often resulting in a duplication of effort and with no real justification in most cases. The evidence base for many of these new requirements being imposed on dental practices is sketchy or non-existent. We desperately need a more balanced, logical and measured approach whereby any additional layers of governance are scientifically based and targeted where they are justified and most needed, rather than being applied across the board. The current environment is wasting the time, energy and money of many practitioners who are already doing an excellent job for their patients.
At a time when the new Government are proposing that high-performing schools should be inspected less often and freed from unjustified bureaucracy, the current excesses in the regulation of dental health professionals are impacting upon morale, deflecting effort and resources and ultimately not serving the best interests of patients. Now that many NHS practices are effectively operating on fixed incomes, any unnecessary expenditure in one area needs to be funded by cutting back on more constructive expenditure elsewhere.
I have received many letters from dental colleagues. I wish to quote from one that I received from Caroline Thornton, who practises in Gloucester. She comes from a family of dentists. Her grandfather was a dentist, as were her father, her brother and her husband, and she wants her 16 year-old daughter to become a dentist. She writes:
“We are trying very hard to conform to the avalanche of regulations piling up every day. However, in a recession, this is proving to be very expensive! We have spent thousands on a new sterilization room, paid for the nurses to be trained, registered, and their CPD up to date, CRB Checked, even though 2 are pregnant. We are having one of the surgeries revamped in August to make sure it is up to date with the HTN 1-5 regulations at a cost of £20,000, and even completed a clinical waste audit, amongst many other trivia, all at our own expense. At this rate we will have a lovely practice but be bankrupt!”
I could quote many other letters.
One detail that seems to be overlooked in this eagerness to be seen to be monitoring, documenting, auditing and acting is that when assessing the risk presented by an underperforming dentist, it pales into insignificance when compared to an underperforming medical practitioner or surgeon. Before all this monitoring, documenting, auditing and acting became an art form, how much actual damage was being done to how many dental patients? How often and how serious were the consequences? Medics can kill people. Even at the very worst, dentists are unlikely to do so. I am tempted to wonder whether we are creating an entirely new industry and spending an awful lot of money “fixing” an illusory problem, or heading off the hypothetical threat of a “virtual” problem that may not even exist in reality.
Lord Rea
My Lords, I thank the noble Lord, Lord Mawson, very much for raising this important topic, and particularly for his inspiring description of his Bromley by Bow project. It reminds me of the Peckham health centre from pre-war days, which was a concept ahead of its time. It is now, sadly, closed. There is much we can learn from the noble Lord’s project and his words this afternoon.
The noble Lord has worded his Motion constructively, concentrating on recent changes and the lessons to be learnt; basically, what has worked; what has not worked; and what might work better. If we were to start with a blank sheet, we would need first to look at the kind of health and social problems which the population presents—of course, the two are inseparable—both nationally and locally and then try to fit services best to tackle these problems. However, we have to build on what we have. As the noble Lord has described, this is far from ideal, but I am an optimist and I think that it is getting better. It is already a lot better than in many other countries.
Of course, we have an age pyramid typical of a western developed economy, getting top heavy with older people such as myself—there are more and more of them—and they are living longer and, sadly, becoming increasingly disabled, needing more care. Other than this demographic problem, the other main public health problem, which we share with the rest of the world, is the difference in health status between the best off and the worst: health inequality, in other words. This gradient applies throughout the social spectrum from top to bottom. We need to improve the health not only of the poorest but also of the middle of the range who have worse health than those on the next rung of the ladder and so on, as Professor Michael Marmot has recently re-emphasised. To restrict services such as Sure Start to the really poor and deprived does not tackle the relative health problems that exist, for example, between skilled and non-skilled manual and non-manual workers. There is work to be done right across the board.
Ideally there should be a gradation of health and social service funding taking into account the age and social structure of each community. To be fair, there has for many years been a serious attempt to do this, but the inverse care law still persists and it needs an even greater share of resources than we have so far allocated to it to reverse it. This might be politically difficult since if this was done on a tight budget, as now, and was in some years past, relatively well-off communities might have to accept a reduced budget. These communities know how to fight their corner, so it is a difficult situation. The health problems of ageing and inequality are deep-seated and have their root causes in the nutritional, physical and social environment of early childhood, which is largely outside the scope of the community health and social services. Even so, it is these services that have to cope with the lasting legacy: the social problems of young adults, including drink, drugs and crime and the chronic ill health of older adults.
Though those with chronic degenerative illness often need periodic admission to hospital, most of their care is appropriately and better done in the community. In a minority of cases “hospital at home”, including procedures such as intravenous drips, is sometimes possible, avoiding admission or enabling early discharge rather than treatment as an as an in-patient. However, the Royal College of Nursing is concerned that the development of specialist home nursing teams such as advanced nurse practitioners, community matrons, specialist nurses, and consultant nurses concerned with managing serious illness at home is having a knock-on effect in reducing the recruitment of community nurses and health visitors, who are still vital in overall community care, particularly for the disabled elderly at home, and in providing mother and child care and preventive services. The transfer of much hospital care to primary and social care at home has long been part of government policy but is not always cheaper. Patients may be discharged too early and need re-admission—a process perhaps encouraged by the payment by results scheme, which can result in a hospital being paid twice, once for each admission.
For many years, GPs have increasingly come to accept that they need to work in teams—not all, I agree, but the trend is there—including other health and social workers to give a really effective service. There are still a few Dr Finlays out there who prefer to work on their own. They are very different from my noble and professional friend on the Cross Benches. The primary care team is now the norm and is encouraged by the National Health Service. As the noble Lord said, my noble friend Lord Darzi proposed a network of polyclinics in which there were more services and links with hospitals than in most group practices, but this proved to be a bridge too far for many GPs and their professional organisations. However, the concept has become more acceptable, provided that the centres are GP-led and tailored to local needs and development. Many GPs are concerned, however, that the polyclinic concept will lead to primary care groups being taken over by private profit-making healthcare companies. This has occurred already in some PCT areas. The one that I know is in Camden PCT, where the contract for practice was awarded to United Health in preference to a local GP group which was offering a better and fuller service, but at a slightly higher price. The results have not, as far as I am aware, been fully evaluated, but the local feedback is unfavourable.
The new contract for general practitioners brought about major changes, as well as a rather generous package for most GPs. The BMA had a sharp negotiating team and the Government needed the GPs to be on board. The biggest change was to remove the obligation to provide 24/7 out-of-hours clinical cover for registered patients. PCTs had to take on this responsibility. They have not found it easy and have often farmed the work out to private companies. Patients are not always happy to be seen by a strange, often foreign, doctor who does not know the area; and of course there has been the occasional tragedy, as we all know. This is a far cry from the days when I was a general practitioner, when we were responsible for after-hours care. Our group made it tolerable by collaborating in a consortium or rota, with other local GPs. In fact, the BMA negotiating team was prepared to continue with the responsibility, if the money had been right. In the end, however, the cost to the PCTs of providing the service was much higher than estimated; in fact, according to my information, it was greater than the amount that the BMA had originally asked for.
The other important part of the new contract was the QOF—the rather grandly named “quality and outcomes framework”—whereby GPs receive a payment for each procedure in a list of measures which assist in monitoring, and thus improving, the health of their patients. They include weighing, taking blood pressure, keeping disease registers and so on. I and some of our colleagues were sad that GPs had to be paid for measures which many of us regarded as part and parcel of good practice, and should have been part of any contract. However, it is clear that this carrot has increased the capacity of general practice to anticipate serious illness. The standard of practice has improved and some lives may well have been saved through, for instance, control of blood pressure and weight reduction. However, I am sceptical about the accuracy of some of the numerical extrapolations that have been made about lives saved. It would be good to know whether, without the financial incentive, this exercise will result in permanently better practice by GPs.
An alternative or addition to the polyclinic model has been suggested by the Royal College of General Practitioners. It proposes primary care federations, which are associations of primary and community care teams, as a legally binding enterprise. I am sure that that concept is not unfamiliar to the noble Lord, Lord Mawson. The college cites three examples: the Croydon Federation, consisting of 16 practices; Lincolnshire General Practices, which has14 practices; and Epsom Downs Integrated Care Services, where 20 practices are collaborating. These hold considerable promise, but I should like to see more involvement of social services and mental health teams, as well as appropriate parts of the voluntary sector. This is very much in line with the proposals of the noble Lord, Lord Mawson. As it is, these projects provide better-integrated primary and community care as well as more emphasis and better facilities for preventive medicine and health education. They could also help to form, through their PCT, a nucleus for practice-based commissioning, which so far has had little impact on services provided by hospital trusts.
Local collaborations such as this, which very much fit the ideas of the noble Lord, Lord Mawson, including voices from all the caring professions, are more likely than top-down decisions to provide or commission good services for their communities.
Lord Alderdice
My Lords, like other noble Lords, I commend the noble Lord, Lord Mawson, on obtaining this debate, particularly in this area of healthcare—the bringing together of primary and community care and learning practical lessons from the work that has been done.
Until my retirement from psychiatry and the NHS at the end of March this year, I had worked for many years in healthcare in Northern Ireland. As some noble Lords will know, we have had a fully integrated health and social care system since the early 1970s. This has been enormously beneficial. Let me give noble Lords some idea of what it means. When I was working as a psychiatrist, a patient would be referred to me by a general practitioner in the same trust. I would see the patient as an out-patient, and I would have at the clinic, as part of the multidisciplinary team, nurses, social workers, psychologists, as well as junior medical colleagues. Indeed, secretarial and administrative staff were very much regarded as part of the team because they would meet the patients. How the staff related to patients on the telephone or in reception was an important part of managing them. If they needed to be admitted to hospital, the same team would be able to work with those involved in patient care and the patients. All these teams included social care. Social services staff were as fully involved in the trust as the medical or other professional clinical staff.
With regard to the management of the trust, a manager of doctors might have been a doctor but they might also well have been a social worker, an experienced nurse or some other professional within healthcare. It meant that people were able to work together right across the disciplines with the single concern of ensuring the best possible health and social care for patients, whether they were at home or a daycare facility or whether they were short or long-stay in-patients.
My noble friend need not be concerned; I am not proposing that there should be structural changes in the healthcare system in England, but that structure facilitated us in working as multidisciplinary teams. However, we discovered that there was a limit to multidisciplinary teams, because after a time it became apparent that there still had to be an element of leadership. It was not enough to get the professionals to work together as though everyone had the same role and the same responsibilities; it became apparent that there was a need for leadership. Whether that came from the medical side or from social work, psychology or nursing was much less important than the skills that the individual had as a leader. Being a leader is not a particularly professional qualification; it is a personal one.
I say to the noble Lord, Lord Mawson, that for many of us a medical model is biopsychosocial. The notion that it is only about the physical and does not include the mental, emotional and relational is, from my point of view, a rather perverse idea of what medicine is really about. However, I accept that there has been a tendency for doctors and others outside medicine to push medicine in that direction, and it is down to those of us who believe in something different to open up the windows and to help people to understand that we are talking about not just the whole person but the whole person in their relationships with others. That is all part of good medical work.
We did not just find a limit to the notion of multidisciplinary teams; we also found a very definite limit to the notion of managerialism. Of course, as things became more complex and finance became involved, it became necessary to have managers and administrators. At the start of the process, they were seen as serving the requirements of professionals and patients. However, it was not long before they began to regard themselves as the bosses of the clinicians—and indeed sometimes of the patients as well. They would be far less concerned about the professional and clinical requirements or the requirements of the patients than about balancing the books or having a growing managerial empire. Every time there was a reorganisation and restructuring, the one group that never seemed to reduce in number was the managers. There always seemed to be places for them to go and none of them ever seemed to be made redundant in restructurings.
The truth is that an arrogance began to develop whereby the people at the centre, whether they were managers or in Whitehall, felt that somehow they had more real interest in, concern about, knowledge of and expertise in what was good for patients and patient care than the people who had committed themselves to that work from the beginning of their professional lives. Some of the managers came from business and had no real understanding of the complexity of healthcare. However, they were encouraged by Governments who saw a market model as being the way to run a healthcare system. That never seemed to make much sense to me because, if the bottom line was important for you, the best thing you could do was to let many of the patients die as quickly as possible so that they would not be a charge on the state.
The market principle just does not work when you apply it to healthcare. In fact, if you apply it too energetically, you provide perverse financial incentives to do absolutely the wrong things. I do not mean that there is no place for the market but I have always felt that a menu was better than a market—yes, there is choice, you make decisions and you understand that different approaches involve different costs; nevertheless, there is some kind of informed choice that is based not just on the cost but on the value of what you are trying to obtain for yourself or your patients.
Therefore, there is a limit to multidisciplinary teams that have no leadership; there is a limit to the notion of managerialism as the way to run a healthcare system; and there is a limit to the market as a model for running a healthcare system. Those are some of the things that we have learnt in healthcare over the past 10 or more years.
However, there are also a couple of major challenges that we need to address, one of which is the enormous change in the social patterns of the lives of the people with whom we are working. The noble Lord, Lord Rea, mentioned that we have an older population, and that brings with it increased challenges of all sorts—ethical and management problems and clinical difficulties. For example, certainly for a period of time, we were largely successful in getting rid of infectious diseases, and that let people live longer, so they lived longer in order to develop cardiovascular disorders. When you dealt with those, they then lived long enough to develop cancers of all kinds and, when you dealt with those, they then lived long enough to develop dementia. It is not as though when you deal with a whole set of problems they all go away. We live longer and experience other kinds of problems.
That does not mean that we give up but we have to be realistic that all sorts of changes need to be addressed. There are changes in social patterns, including the size of families, the type of family units and a range of people from all parts of the world with all sorts of different dietary backgrounds and physical backgrounds, infectious disorders, and so on. We have to deal with all those things. We have to be alert and aware of change, which is quite a challenge. As such patients come into your practice, whether it is a hospital or community practice, you have to become aware, if you were not before, of the complexities that they bring. That is not easy. There are cultural issues in dealing with patients that are very sensitive and difficult. It is not all about those in the community welcoming folk in from outside. It is not only about them understanding and changing; it is also about helping people who come in from outside to understand the community they are joining and the culture and requirements that that community has.
Those are challenges but there are also opportunities, many of which are provided particularly by information and communications technology. They change the way in which young people in particular—though not just them as many older people are increasingly adept at the use of information and communications technology—react to things, receive messages, relate to each other and the way in which we educate our clinicians. It is now possible to educate clinicians at a distance. For example, a skilled surgeon in one part of the country can assist someone conducting an operation on the other side of the world by using telemedicine. We can be in contact with patients in the community by staff using ICT.
Some but not all of this is extremely successful. Just because you have a new gadget does not mean that it is better; just because something works faster it does not mean that it always works better. A colleague told me about a wonderful new system that he wanted to put in that would ensure that immediately the general practitioner made a referral it would be in my inbox. I said that it was no use whatever because the waiting list is still six weeks. It does not matter whether the referral comes in today, tomorrow or the day after, it will still be six weeks before the patient is seen.
Not every piece of technology or new gadget is appropriate, helpful or an effective use of resources. Some approaches can be extremely helpful in allowing us to move on and to learn the lessons about what actually works, which was the whole theme of the noble Lord’s introductory speech. That is crucial but let us not dismiss the importance of research and academic work. It is not just about managerialism, although I do not dismiss that, as in a complex community management is extremely important. I have been encouraged by our new coalition Government’s commitment to get decision-making and responsibility back to the patients, their families, the communities and clinicians of all kinds with whom they deal—it should not be held back at the centre whether that is a management centre, a Whitehall centre or even a governmental centre.
Baroness Finlay of Llandaff
My Lords, I must declare an interest as a true Dr Finlay. I am a practising clinician; I am president of the Chartered Society of Physiotherapy; I work in palliative medicine; and I have links with many hospices around the UK. I hope that I have made all the declarations before I start.
We are facing change and I am sure that the Minister is inundated with advice and pressures but in the time preceding change, I hope that he will be cautious so that we do not have change while ignoring the potential unintended consequences of such change. One of the difficulties is that often we do not know what we do not know, and in the rush to bring about change we may not do the background research or explore the issues. I want to address the specialist services providing care for patients, the role of the third sector, particularly for terminal and palliative care, and the needs of patients out of hours.
In 2006, in England and Wales there were 503,000 deaths. That figure is anticipated to rise to 586,000 in 2030, which is a massive increase. Only about 20 per cent of patients die at home, so we have to think how the needs of all these patients will be accommodated. With that there has been pressure to move patients out into the community. The need for integrated care pathways for complex conditions increases as high levels of expertise are required to meet patient needs and there are more patients with complex conditions. I am concerned that in trying to save money substitution has been looked at but it is not without its dangers.
Despite a priority of providing care closer to home, the Audit Commission report, More for Less, found little evidence to show that PCTs have been successful in removing care from hospitals. There is little evidence that patients with rare, complex conditions are not prepared to travel to get expert care, because they know that they need accurate diagnosis and a really good management plan. The challenge is: how do we get patients seen by the right person at the right time in the right setting, as well as trying to move care out into the community? That is a stark cultural challenge that needs multiprofessional teams working in managed clinical networks to encourage collaboration and co-operation between primary, community and secondary care. That must also cover other aspects of home care provision, including social care.
The new commissioning arrangements must cross traditional NHS boundaries. The publication by the Royal Colleges of Physicians and General Practitioners, Teams without Walls, identified the need for integrated systems, clinical leadership in commissioning and aligned incentives, underpinned by patient involvement in commissioning systems, especially for those with long-term conditions.
The current problem is that payment-by-results tariffs in their present form incentivise against integrated care. The current tariff-based system encourages hospitals to treat more patients while, simultaneously, GPs are under pressure to refer fewer patients. That creates a tension that can work against the development of integration and against quality in patient care. It works against earlier diagnosis, particularly in recognising rarer and complex conditions. One way to rebalance the disincentive is to introduce payment by pathways or payment by conditions, to ensure that high quality generalist and specialist care have a sustainable future, for the benefit of patients.
Patients must enjoy equitable access to specialists when required. I have just chaired a joint report on allergies for the Royal Colleges of Physicians and Pathologists, and we have found a stark inequity in provision around the country. Specialist resources must be at the heart of any clinical network or community-based service. It is essential that we have services available 24/7. The current five-day provision does not meet patient needs. That service does not respond to the true, seven-day need of those who are really ill, including at night. In Wales, we have moved from five-day to seven-day working by clinical nurse specialists in palliative care, and we have shown in a short space of time a dramatic change, because problems that occur on Saturday will be dealt with on the Saturday or Sunday. By the Monday, it would have been too late to address them.
There are some specialist service needs where integration is essential. There needs to be a one-to-one relationship between the GP, the patient and the specialist in secondary care to ensure patient safety and that people understand the complexity of the patient's background. Repeated handovers do not work well. We know that information is being lost in a kind of conveyor-belt hand-over between clinicians. We need to restore patient safety and quality of care and ensure that the lead clinician has a comprehensive understanding of the patient to reduce complications and near misses, particularly in surgery.
Some things should be done only in places well equipped to do them. An increasing amount of so-called minor surgery has been done in general practice, but there have been some awful situations where melanomas have been removed, the margins have not been adequately marked, the resection was inadequate and the subsequent surgery was much more extensive and expensive than if it had been done in a specialist dermatology surgery centre at the outset. The Anaphylaxis Campaign has sent me horror stories of GPs giving advice to parents about children suspected of having a peanut allergy that was completely inappropriate and would have jeopardised the child’s life, not just their health. It was just as well that the parents phoned the campaign with their anxiety.
There are real problems out there, and there are risks as well as opportunities in moving towards a largely GP-commissioned framework. Academic GP is essential to driving up the standard of evaluation. We need to evaluate patient outcomes in any change. This is not about having a fashion for one model or another; an evidence base must underpin commissioning. As PCTs are divested of their commissioning responsibilities, GP consortia are expected to take up the mantle, but their skills and background knowledge, and even their willingness to do this, are really deficient in some places.
There needs to be a national view on minimum access rates and the provision of highly expert services to avoid a postcode lottery, particularly where there is a low critical mass in a smaller population, otherwise you get a bidding war between GPs and consultants that works against quality. If you do not have adequate dual provision, community-based services will have fewer places to turn to for training specialists for the future, for continuing professional development and for research. Driving that forwards will drive up standards of care in the future, particularly for those with more complex conditions.
I ask the Minister to consider some specific things: that promoting the idea that engaging doctors in the spirit of collaboration is required for successful commissioning; that commercial loss leaders might appear at first sight to be useful but may lose expertise and undermine quality in the long term; that the repudiation of unhealthy forms of competition is essential, as is encouraging jointly commissioned models for integrated health services; that choice for patients means the ability to access specialist scientifically based clinical excellence to diagnose and plan their management, which can then go back for ongoing care in primary care if there are good pathways; and, lastly, that the incentives and disincentives of payments by result need to be rebalanced to bring integrated generalists and specialist care closer to the patient’s home.
I am grateful to the noble Lord, Lord Alderdice, for flagging up the importance of the whole person and the whole family, because the third sector provides that par excellence in hospice care. There is a need to specify minimum levels of service, such as in hospice care, across the UK, and to have centrally agreed three-year contract with an agreement on how the service is delivered locally. At the moment, Marie Curie has to negotiate 200 separate contracts across the UK. That is a waste of time and a duplication of effort when models such as the fire service or the police demonstrate that you could have a national framework with local agreements on implementation.
Hospice grant money has to be negotiated at a local level by small hospices that often do not have much expertise in negotiating with all the different people from whom their patients come. Competitive tendering is punitive to the third sector, because it does not have the resources to tender or the expertise of larger bodies. Punitive contracts in the third sector can really work against them. If they miss a level in their service they may incur a penalty, yet they provide a key service to the NHS.
Commissioning must become outcome-related, as much in hospice care as anywhere else. Currently, it seems to be process-related. It has to be integrated across the whole pathway, and this need to commission across the whole pathway means that the professional competency framework needs to be driven up to promote higher levels of competency. There is a real concern and a danger that private companies will come in and commission against a whole pathway, and one questions why they are needed as an intermediary. The danger is that increased income will go in profits to shareholders and not be reinvested in the not-for-profit third sector that the hospices epitomise.
In summary, there needs to be 24/7 provision, which should be addressed urgently. There is a large shortfall in district nursing. Only 53 per cent of PCTs have 24-hour district nursing, which is grossly inadequate if you are trying to care for critically ill patients at home. There has to be a closer link between health and social care. Care assistants can often be the key people to keeping patients at home.
On incentives, we should remember that healthcare professionals are proud. They want to deliver a good service. If you embed direct patient feedback into the system, as we have in Wales for palliative care using iWantGreatCare, it can become a powerful driver to quality improvement. One team does not want to perform less well than another, but patients need to provide feedback in an anonymised way so that they are not fearful that their comments might antagonise the clinicians looking after them.
There have been unintended outcomes from the current arrangements where financial incentives or punishments drive provision rather than need. Patients feel particularly lost out of hours and it is really important in commissioning healthcare that we get it right. There is a steady stream of horror stories coming through. It is not simple; it is not like shopping for shoes; and I hope that the Minister will think carefully about the unintended consequences of change.
Lord Crisp
My Lords, I, too, congratulate my noble friend Lord Mawson on inviting us to reflect on primary care over the past 10 years and more. I know he is hopeful that his timing is such that the Government’s policy is not yet so rigid that they cannot listen to new ideas and the practical lessons that he and others want to mention. I have to declare an interest. Most people know that I was chief executive of the NHS in England for six years. There is a lot that I could say, but I will concentrate on the same areas as my noble friend; namely, the integration of care, particularly thinking about social care, education and other boundaries around the whole person.
The other day, an American friend said to me, “We love you in England because you keep changing the way you develop primary care. You are a wonderful laboratory. You have tried out lots of different ways of doing it”. I guess that that is true. But I guess that there is a reason for that, which is not just a wish to meddle. It is that, as other noble Lords have mentioned, a lot has changed in the 70 years since the 1940s, when we set up the primary care system we have now. The three big changes have been referred to by others. The diseases are different. Seeing patients is much more about dealing with non-communicable diseases. They are about elderly people with complex or multiple problems. The patients have changed. They are much more demanding, but their behaviour is much more important in so many ways in terms of the management of care for diabetes or whatever. In addition, technology has changed. All those changes mean that our old model has led to shift. As we have noted, there have been many ways in which people have tried to make that shift. It is really important that we learn the lessons from those attempts to change and to make improvements.
Before this debate, the Royal College of Physicians wrote to me and, I suspect, to others saying that it was really important that we did not lose sight of the fact that primary care, secondary care and tertiary care need to join up. We need to have that all within the frame. It is interesting to reflect that the separation between primary care and secondary care is largely in legislation that is about 70 years old. It is not writ that a GP shall be this and a consultant shall be that. It was an organisational change. The way in which parts of the medical profession relate can change and some organisations, as I think that the noble Lord, Lord Alderdice, mentioned, employ or involve both. There is nothing rigid about this.
However, I want to talk about integration around the patient. Let me go back to the simple point that most patients today in richer countries are people whose needs often may be clinical, but alongside that there is a need for independence. I think that I have mentioned in this House before that my elderly father fell and broke an arm. Clinically, it was very easy to deal with, but the real issue was whether he could remain independent and live at home by himself. That is the sort of situation we are talking about in terms of many of the patients that the NHS deals with. Indeed, many patients with the highest expenditure in the NHS are those with complex problems that span clinical, social and other needs. So it is welcome to see primary care playing a major role in prevention and in helping patients find their way around the system.
Primary care is not just about GPs, and it is important to keep the two separate. There are different roles for many different people. One of the saddest pieces of research I have seen was published some years ago. It concerned young people suffering from depression and how they were treated in primary care and whether they were able to be taken seriously. There were too many accounts of people going to GP surgeries and being told to come back in three months if it was getting worse. In effect, they were being turned away. We need different routes in primary care for those who sometimes find it difficult to express their needs.
That takes me on to the issues raised by the noble Lord, Lord Mawson, about health and social care, and other areas such as health in education. He asked how far we should go to ensure that we have health provision in schools, whether in the form of health services or whether they are designed into the architecture of schools. He also asked if we should have local partnerships that are able to focus on what is needed. The noble Lord concentrated on social entrepreneurs, but I know that he, like me, is interested in how local partnerships made up of the right groups of people can have an enormous impact on a local environment in terms of health benefits and the related issues that go alongside them. By local partnerships, I am not just talking about individual organisations that bring health and social care together, but about partnerships that bring together everyone who has something to offer in this area. These can be quite difficult to conceptualise and describe in order to determine the policy that will promote them, so I would encourage the Government to look at some of the ones that work.
As I said, the noble Lord, Lord Mawson, referred to a number of social entrepreneurs and one or two exceptional GPs who have set up extraordinary practices that go way beyond what we would traditionally think of as healthcare. But I think that some of our PCTs have done exceptional things in trying to address inequalities, particularly in areas like mental health where we know that among the best things you can do for patients is help them to get jobs and housing. Among the range of entrepreneurial PCTs let me mention one particular group I know of and declare an interest in. Something like 20 UK PCTs are part of a group called Triple Aim. They are working alongside similar organisations in Scandinavia and the US, facilitated by an American organisation called the Institute for Healthcare Improvement. Here I declare my interest because I am working with the organisation in Africa rather than in this country. It would be interesting for the Minister and the Department of Health to look at what these PCTs are trying to do by taking on a triple aim—to improve the health of the population, improve the care given to individuals, and reduce costs. They are doing so by trying to integrate with local partners. There are some good examples that we can build on and, taking a completely different example, a number of schools in this country have health facilities within them. So I urge the Government to look not just at the social entrepreneurs referred to by the noble Lord, Lord Mawson, but at the organisational people working within the system who are trying to make these things work; they go very much together.
Finally, I come back to the issue of primary care trusts and GPs. I have seen some statements from the Government about giving GPs and doctors more control. I understand and appreciate that. One of the great merits of the NHS that shows up in any comparison with other systems around the world is its primary care. This is one of our great strengths, among others, and we must preserve it. But however wonderful some GPs are, not all of them are. They are not all capable of taking on all the roles that we might think we would like them to. I pay tribute to the last Government because they were concerned about variations in performance between hospitals and did a great deal to bring the performance of the poorest up to the best. Among GPs, not surprisingly because there are so many of them, that range of variation is much wider. Sometimes we talk about GPs as if they are all the same, but to me that feels like something of a mistake.
Another issue in developing policy around GPs in the context of primary care is the potential for conflicts of interest, and again I suspect that the Department of Health has good examples of where, by putting more money into primary care decision-making hands, potentially and only in some areas you end up with conflicts of interest about how the money is spent. But—and it is a very big but—we have also seen great benefits from having primary care and GPs taking a lead. In particular, it is interesting that in a number of practices where the GPs have budgets and have taken a bigger lead around commissioning, they have changed the services they provide and the job roles of people. Increasingly you see people other than individual GPs when you attend a GP practice. That is all for the good, in both quality and cost terms.
I am reminded that 15 years ago we were trying to get more GPs into east London and tried to do so by recruiting salaried GPs—in other words, by moving away from the current model of GPs being self-employed. We were told we could never do that: it was not what GPs were about and it was essential that GPs were independent. I see the noble Lord, Lord Rea, nodding his head. However, we succeeded to some extent in making that happen but now it has all changed. Today, in practices where GPs are responsible for budgets and direct care, there are many salaried GPs and many people doing different kinds of jobs. That would not have been possible had you tried to make those changes from above. Indeed, GPs in London complain that they cannot get jobs as partners any more; there are now salaried jobs but the partnerships are being kept in fewer and fewer hands.
While that may be a downside, the important point is that doctors, as part of the entrepreneurial culture to which the noble Lord, Lord Mawson, referred, have the ability to make changes that mere managers, politicians and others from outside would find it difficult to make. It is important to build on that.
I hope that, like the noble Lord, Lord Mawson, the Government will look back on the years of change and development and learn the practical lessons. I should like to ask two specific questions. Will the Government look at innovative PCTs as well as innovative entrepreneurs, and perhaps consider Triple Aim as an example? How will the Minister clarify the relationship between PCTs and GPs in the future? I suspect this is one of the areas in which there is some confusion in the service at the moment over how primary care will be led, planning will be done and life will move on over the next few years.
Baroness Emerton
My Lords, I, too, warmly congratulate my noble friend Lord Mawson on, first, introducing the debate but, more importantly, on demonstrating through his entrepreneurial approach what has been achieved in managing change of this magnitude in what at first sight must have seemed an impossible task.
We have had put before us lessons taught in managing change through people to provide a community service in every sense of the word. Like many other noble Lords, I found my visit to Bromley by Bow Centre a manifestation of real entrepreneurial skill— second to none in demonstrating holistic care in the most imaginative ways—which became not only productive in outcome but engaged the patients and community members in a non-conventional way. The emergence of a true community was evident. I found my noble friend’s book very gripping, for no punches were spared in the description of both the barriers and the successes.
I declare an interest as a retired nurse. Over the past 10 years, much progress has been made in community services to encompass a wide range of services, including public health and prevention services, but despite many primary care and community initiatives we still have a long way to go on early identification of disease, risk factors, reduction of health inequalities and the promotion of child health. In the development of urgent care, acute care at home and end of life care services, community services work in close partnership with the GPs, hospital services and social services to support the independent living of older people and the safeguarding of vulnerable adults. They also work with children’s trust partnerships. Currently, 200,000 staff are employed to meet these services, requiring £10 billion from the NHS budget. There is considerable evidence of widespread variation in productivity, which, if addressed, could generate a substantial direct improvement in service quality and sustainable efficiency, thereby reducing costs.
During the past 10 years, attempts had been made by the previous Administration to improve services through the recommendations in the NHS Plan, published in 2001, the general medical contracts in 2004, and the White Papers, Our Health, Our Care, Our Say in 2006 and Transforming Community Services, published last year. The Nursing and Midwifery Council, its regulator and its predecessor, the UKCC—of which I declare an interest as a former chair—have long supported the provision of healthcare in the community. During the previous decade, they introduced specialist community practice awards and created a specialist community health nursing part of the register. These measures acknowledged the shift in expertise needed to ensure safe community practice. While not yet enforced, the emerging standards for pre-nurse education will require pre-registration students to spend 50 per cent of training in practice-based settings, which will increasingly be within the community as services are reconfigured. This represents a sea change in nurse education and will herald a major improvement in healthcare delivery at the point of registration. The planned 4,200 increase in the number of health visitors is admirable. They play an important cross-professional, co-ordinating role, leading skill mix teams in delivery, postnatal, early-years and family healthcare.
However, it is important that health visitors retain a grounding in basic nursing and/or midwifery skills. Knowledge of diabetes, associated obesity, childhood ailments, immunisation, prescribing and disease management are all essential to ensuring safe delivery of patient care pathways. The Nursing and Midwifery Council is looking for the best way to take forward the preparation of health visitors. Will the Government support this initiative?
The introduction of matrons, advanced practitioners, specialist nurses and consultant nurses in the community has resulted in many patients with complex, long-term conditions being expertly cared for without the need to frequent their local hospital. Community matrons in particular are striving to help people with long-term conditions become more self-reliant and better informed about their health and how to improve it. This reflects a shift in emphasis towards nurses helping to empower patients to look after themselves and manage their conditions better.
The programme to support practitioners to transform services and deliver high- quality care and productivity set out evidence for best-practice care within community services through a series of six transformational reference guides entitled, Health, Well-Being and Reducing Inequalities; Services for Children, Young People and Families; Acute Care Nearer to Home; People with Long-Term Conditions; Rehabilitation Services and End of Life Care. All of them provide a guide to high-impact changes and are intended to enable practitioners to give high-quality care.
The continuing work is looking particularly at the needs of frail, elderly patients with complex health conditions. They are the main service users of community healthcare and now occupy the majority of acute hospital beds. Increasing evidence points towards a wide variation in the care offered to the elderly. Studies indicate that up to 30 per cent of people in hospital at any one time, many of them frail and elderly, could be safely cared for in the community with the right access to community services and appropriate support. There are efforts to mobilise staff using evidence to create a “social movement” among front-line staff and empowering clinicians to lead change and innovation. This leads to the use of care pathways to increase care co-ordination and best practice for patients. Combining primary, community, hospital and social care to increase efficiency and provide high-quality care, it is best described as “care without walls”.
At present, a high proportion of residential nursing homes employ healthcare support workers and social care workers. Evidence from a study conducted by Ian Kessler at Oxford University shows that many undertake aspects of care traditionally done by nurses but that they are not trained to do it safely. If there is to be an increase in community care, increasing the level of social carers and healthcare support workers, there must be an increase in safeguards on the roles undertaken by those staff. With no form of regulation in place, it is difficult to track and prevent those unable to provide safe levels of care. The move to community-based care poses a significant risk to patient safety.
Against a background of the demographic growth of the elderly population—requiring an increase in both long-term and acute home care—of the care of vulnerable children in pre- and post-natal care and of changes in the pattern of commissioning services, it will be important to ensure that at every level a nursing voice will be able to ensure the safety of patients as well as the delivery of high-quality care in the most cost-effective way. It is imperative that the new systems of commissioning primary and community services enable the voice of an experienced nurse to ensure that the resources and training facilities in clinical placements are sufficient to meet the need.
The Royal College of Nursing continues to express its concern over the lack of investment made into the community nursing workforce. A particular concern is the problem of the ageing nursing workforce, as 27 per cent of nurses working in community services within the UK are aged over 50. Over the next 10 years around 180,000 nurses will be eligible for retirement, leaving a huge hole in the workforce which, at current levels of commissioning, will not be met by future recruits. There are concerns that the problem will be magnified through the current period of financial constraints by recruitment freezes and the deletion of posts as a result of efficiency savings. There has also been evidence of an active reduction in student places being commissioned, despite a record number of applications to enter the nursing profession. This, it says, is a great disappointment and a blow to all that has been done to improve the attractiveness of nursing as a career.
The leadership skills required are of paramount importance and it is through people rather than policies that change can be effected. The challenges of overcoming the barriers between various services are enormous but the opportunity to grow community services must not be lost. Just as my noble friend mentioned, it takes time to break through the barriers and that cannot be rushed. Certainly, in my experience of leading and managing a project relocating 1,500 and then a further 1,200 learning disability patients from two large hospitals, it took 10 years to ensure that every patient was individually assessed, relocated according to their needs and placed into the most appropriate accommodation. That involved seven London boroughs and two county councils—none of which was keen to take back its residents—while ensuring that staff were appropriately trained to care for residents in the community, which was completely different from being within the large hospital and a big culture change for them. There were relatives reluctant about their relatives transferring from the safe environment provided by the large hospital to an open community and there was the receiving communities’ reluctance to receive learning disability clients.
While there was an overall strategy accompanied by a critical path analysis setting target dates, that project really required hours of careful negotiation through the barriers to result in a changed culture—one providing a more meaningful style of life for clients in a safe environment, while delivering high-quality care and management. Managing such an innovative project, as with those that we have heard described this afternoon, was certainly a huge learning curve for me—and, I am sure, for others. I believe that there is an urgent need for nurses and all healthcare professionals to gain the necessary leadership skills to be equipped to meet the challenges and opportunities of the future’s reconfigured community services.
Baroness Thornton
My Lords, this is an interesting subject for debate, as the debate has proved. Learning the lessons of the past 10 years at the moment when great change is about to be unleashed on the whole way in which healthcare is delivered in the UK seems appropriate, and I congratulate the noble Lord, Lord Mawson, on his usual entrepreneurship in the timing of this debate and the passion that he brings to the issues of innovation in providing public services—in this case, healthcare—as well as his hopes for less bureaucracy, less political change but not, I hope, less accountability. The noble Lord has been making this kind of wonderful speech for as long as I have known him. Rightly, he blames bureaucracy and politicians in his passion to roll out the models that he knows so well and that work so well. As he knows, I have a great commitment to social enterprise and entrepreneurship, but I think that he needs to give some credit where it is due about the progress of the past 10 years.
I remind the House that some progress has been made. I should like to look at two issues—the LIFT programme and the development of social enterprise in the past 10 years. The LIFT programme, delivered through community health partnership, is there to create, invest in and deliver innovative ways in which to improve health and local authority services. I know that the noble Lord, Lord Mawson, is familiar with the LIFT programme and has tales to tell about the difficulties of this bit of the bureaucracy. But it is there to deliver and provide clean, modern, purpose-built premises for health and local authority services in England. The reason why the programme is so important is because 90 per cent of patient contact with the NHS occurs in general practice. The research shows that primary care in the inner cities, where healthcare need is the greatest, may have suffered from a disproportionately high number of substandard premises in primary healthcare. That is why we instituted the LIFT programme. We knew that the condition and functionality of existing primary care estate was variable, with current facilities not meeting patients’ expectations and quality and access often being below an acceptable standard—and, therefore, service development sometimes very severely hampered by the limitations of the premises.
As a Government, we made an investment in primary and social healthcare facilities. We made it a priority in inner-city areas. It was clear to us that new buildings were required to provide people with modern, integrated primary care services. When we came to power, there is no doubt that the creation of new facilities was fragmented and piecemeal. Developments tended to be small scale and focused on more affluent areas; they tended not to integrate social care at all. The landscape has been transformed in the past 10 years. If I add to this the review done by my noble friend Lord Darzi, it is clear that we have made some progress.
I shall mention some of these outcomes and particularly draw them to the attention of the noble Lord, Lord Mawson. He said that he was tired of words and no delivery. Well, there has been a huge amount of delivery—in fact, £2.2 billion worth of delivery of new schemes. I take for example the centre at Church Road, Manor Park in Newham, which the noble Lord may be familiar with. It brought together three GP practices and contains district nursing as well as health visitors, dentistry, pharmacy and many diagnostic services. Then there is the Thurnscoe primary care centre in Barnsley, which has, among other things, eight GPs and traditional primary care services; it is able to do blood tests, ultrasound scans and minor procedures, which means shorter hospital waiting times. It also includes an ICT training suite, a GP training room, an audiology clinic, a podiatry clinic, district nursing and physiotherapy.
The one that I like best is the Kenton Resource Centre in Newcastle, which was built on the site of an old clinic on Hillsview Avenue. It has a new health facility, including the relocated GP practice, but it also includes community health professionals, Newcastle City Council and voluntary services, a local customer centre, which provides housing and benefit advice, a Newcastle City Council library, which serves three neighbouring districts, and a Northumbria Police office for local beat officers.
I could go on. In fact, the most recent centre was opened last week in Dudley—the new multimillion-pound state-of-the-art Brierley Hill centre. Therefore, I think that we can say that we have been delivering local community centres in the last 10 years, but I ask the Minister what the fate of the programme will be. How will it fare in the reconfiguration of the NHS that we are told is on its way?
Let us turn to social enterprise. I declare an interest as a serial offender in social enterprise. I have spoken many times in your Lordships’ House about the development of social enterprise and I have sponsored things such as the community interest companies Bill. I think that it is worth saying for the record that social enterprise is a business whose objectives are primarily social and whose profits are reinvested back into its services for the community, with no financial commitments to shareholders or owners—it is free to use its surplus income to invest in its operations to make them as efficient and effective as possible. Well known social enterprises include Turning Point, the Eden Project and the Big Issue.
The Department of Health has been promoting social enterprises through the initiatives that the Labour Government took, as we saw the advantages of them for patients and service users. We instituted the right to request as part of our broader vision for the NHS. I know that the first phase of the right to request has been enacted and I think that the second phase is about to be enacted, but I should like confirmation of that from the Minister. I should like to know what will happen to the social enterprise investment fund and to the right to request.
I should specifically like to know from the Minister what will happen to contracting, although he may not be able to give me an answer right now. The Labour Government made a commitment through the department that, when a social enterprise had been established in the health service, had gone through the right to request and was contracting for services, that enterprise would have a three-year or possibly a five-year contract, which would be guaranteed once it had gone through the whole process. Will that continue under the new regime? If the Government are serious about developing social enterprises to deliver primary healthcare and other services within the health service, a contract of three to five years will be vital for those businesses.
The noble Lord, Lord Mawson, talked about the Bromley by Bow Centre, which is a tremendous achievement. I should like to mention the Big Life centres. The Big Life is based in Manchester. It grew out of the Big Issue and works with people completely cut off from health, housing and employment services. There are now eight or 10 centres providing holistic services to the communities in which they are based. The Kath Locke Centre combines the best in conventional NHS healthcare with complementary therapies. It is well built and a good place to relax, and is extremely well used by its local community.
The Big Life Group issued a manifesto for the last general election, which I commend to the Minister. It states:
“We believe, developing a market in the NHS has really only meant opening up to large private sector companies and has largely missed the opportunity to bring in innovation through the social enterprise sector”.
I do not agree completely with that: it may be as unfair as some of the comments made by the noble Lord, Lord Mawson. However, the Big Life Group may have a point. We as a Government did not succeed as much as I wish we had. The challenge is now there for the coalition Government. If they are serious about having an innovative marketplace, they must address the issues raised by organisations like the Bromley by Bow Centre and the Big Life Group.
I agree with the noble Lord, Lord Mawson, that the department must encourage more entrepreneurship. Like him, I have been frustrated by slow progress across the piece. As the founding chair of the Social Enterprise Coalition some 10 years ago, I think we should blow our own trumpet. Where there was one Bromley by Bow, there are now many. Social enterprise was mentioned in every party manifesto, and is now part of the coalition Government's programme. We have made great progress. However, there are still huge challenges.
I have some questions for the Minister. It seems that in two years’ time, £60 billion of NHS funding might be funded through local commissioning, as the noble Lord, Lord Crisp, mentioned. What will happen to these schemes and programmes if this reconfiguration of the NHS is going to be so profound? How will the Bromley by Bows and the Big Life centres be developed under those circumstances? How will this entrepreneurship be taken into account in the new commissioning scheme? The noble Baroness, Lady Finlay, made a valid and wise point: the rush to change might jeopardise what has already been achieved through partnership and innovation. I agree with the noble Lord, Lord Crisp, that we do not want to lose some wonderful examples of PCT innovation in the forthcoming reorganisation. How will the coalition Government build on the platform that we created—or do they intend to dismantle the platform, with all the risks that go with that?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I begin by expressing my gratitude to the noble Lord, Lord Mawson, for the opportunity to reflect on the changes to primary care over the past decade. Perhaps I should start by confirming the basic principle that the Government will uphold the guiding values of the NHS; that it should be available to all, free at the point of need and based on need and not ability to pay.
For more than 60 years, our system of primary care—the local family doctor—has been the bedrock of the health service. When we are ill, our GP is our first and often only port of call. They are the prescriber, the referrer and the gatekeeper to the vast and often complex labyrinth that is the NHS. Few things are as local as your GP practice. By definition, GPs are of the community and perfectly placed to reflect and respond to the needs of the community. The problem that they face now is that they serve two masters; the patients whom they see every day and the targets imposed from above. However, we believe that, freed from central control, incredible things are possible, as we can see from the rise of the social entrepreneur.
Earlier this month, my right honourable friend the Secretary of State visited the extraordinary Bromley by Bow Centre, of which the noble Lord is the founder and president. Based in one of the most deprived parts of the country, it demonstrates what can be achieved with vision, determination and commitment. It helps people to overcome poor health and unhealthy lifestyles, to learn new skills, to find work and to create an enterprising community. It has been an inspiration to many in Bow and it is an inspiration to this Government.
The noble Lord, Lord Mawson, is right. By responding to local people and by being led by them, the Bromley by Bow Centre and other social enterprises are transforming communities in a way that the state cannot. This is the big society in action. Far from supporting them, however, the state has too often acted as a barrier to social entrepreneurs, limiting what is possible. This needs to change.
A damaging recent development has been the introduction of “preferred provider”; in effect, preferring adequate care delivered directly by NHS organisations over excellent care provided by others. We will encourage “any willing provider” to compete to provide the best outcomes for patients. We will give public-sector workers the right to form employee-owned co-operatives so that they can then bid for and deliver services themselves. We will support the creation and expansion of mutual organisations, co-operatives, charities and social enterprises. These will have a place, above all, in the provision of community services, with the quality of those services driven by innovative approaches to delivery.
Rather than preventing social renewal, government should be a catalyst to encourage and galvanise it; “putting the wind in people’s sails”, as the noble Lord, Lord Mawson, put it. As he said, there are some excellent examples of where the state already does this without working in silence. In Southend-on-Sea, the St Luke’s Healthy Living Centre, in partnership with a local primary school, local residents and a wide range of grassroots representatives, provides counselling services, an allotment and food co-operative, advice services and a business support unit. Another social enterprise is Open Door in Grimsby. Open Door works in partnership with local public services, voluntary organisations and Santander bank. Most of all, however, it works with those it supports—the homeless, drug users, refugees—to give them the help they want rather than the help that others assume they need. Both have enjoyed the support of the Department of Health’s £100 million Social Enterprise Investment Fund, one practical example of where the state can help. The noble Lord, Lord Crisp, mentioned the work being done by some PCTs under the triple aim barrier. Like him, I commend those initiatives.
The crucial thing is what is delivered—the clinical outcomes and the benefits to patients and residents—not who delivers it. As the noble Lord, Lord Mawson, said, it is about doing, not just talking. This is all part of a massive redistribution of power and control away from the centre to individuals and local communities.
While at the Bromley by Bow Centre, the Secretary of State described our approach to healthcare. These principles are not plucked from thin air but, rather, are garnered from the experience of those parts of the NHS that already deliver truly excellent care. First and foremost, because decisions that include the patient lead to better clinical outcomes, we will place the patient at the heart of everything the NHS does. As the Secretary of State put it, there will be,
“no decision about me, without me”.
Secondly, because what matters most to people is that they receive the very best quality of care, not that their hospital can jump through bureaucratic hoops, the NHS will focus on constantly improving clinical outcomes. We will hold the NHS to account for what it achieves, not how it achieves it.
Thirdly, because there is a limit to the improvements that can be driven from the top down, and we have long ago reached that limit, we will empower professionals. Over the past decade, the NHS has been showered with money, which is marvellous. However, it has also been drowned in red tape and bureaucracy. The Government intend to set the NHS free, not shackle it with centrally imposed process-based targets.
Fourthly, preventing disease will be as important as curing it. What has really improved the nation’s health? Is it the National Health Service? Of course it is. Mass immunisation programmes and more recent things, such as the smoking ban, have also saved lives and helped well-being. Beyond a narrow focus on health, improvements in housing and sanitation have been just as important. Health cannot be placed in a silo. That is why public health will play a significantly greater role.
Fifthly, people do not differentiate between healthcare and social care—they just want help. Better social care can often prevent the need for expensive healthcare. For example, fitting a hand rail costing £70 can prevent a fall that would require a hip operation costing £7,000. Therefore, we must properly integrate health and social care, especially if we are to deal with the effects of an ageing population. These are the principles that will underpin our approach to healthcare, but to improve health outcomes we must bring these principles to life.
The Quality and Outcomes Framework initially helped to raise standards, especially in more deprived areas. However, it did so at significant cost and the improvements have now stalled. I was in considerable sympathy with much of what the noble Lord, Lord Rea, said about this. We will reform the QOF to reward GPs for improving health outcomes. We will also discuss with the profession how patients can help to shape the care they receive. We will also look again at the GP contract. Taxpayers must get value for money in return for the massive investment that they have made in primary care, and the contract must properly reflect and reward what we are asking GPs to do.
Whoever provides health services, high quality commissioning is essential and should be done as closely to the patient as possible. GPs and their primary care colleagues are in the best position to know what services their patients need and will have the power to commission them. In this way, they will also take ownership of the financial implications of their decisions, leading to better value for money. That is not something that they can do in the fullest sense at the moment. This requires leadership. As commissioners, GPs and their colleagues will become the leaders of a more autonomous NHS, supported nationally by a new NHS commissioning board.
Twenty-four-hour urgent care is currently unco-ordinated and of variable quality. We plan to overhaul that system. Nor should we overlook the role of the pharmacists. Every day millions of people visit their local pharmacy. With the right incentives and support, pharmacies can deliver both clinical and public health services. We will also build on the progress that has already been made in recent years.
The noble Lord, Lord Rea, in his excellent speech, pointed to the differential funding of primary care trusts and urged the Government to take account of differing health needs and deprivation. The noble Lord raises an important point. We are committed to ensuring a fair allocation of resources to the new GP commissioning consortium when it is formed. We also want allocations to be made based on the health needs of the registered population for these groups, so that those with the greatest need have their fair share of resources.
The noble Lord referred to the document produced by the Royal College of General Practitioners, which proposes GPs’ practices working together in a federation to support each other in the provision of care to serve the local population. These are sensible proposals and we want to build on them, for GPs not only to provide a wider range of care and services to their patients, but to commission wider health and care services for the population. It is right that GPs’ practices themselves decide on these federations. We are not prescribing those nationally from the centre.
This very much brings us to the concerns voiced by the noble Lord, Lord Crisp, and the noble Baroness, Lady Finlay, relating to the varying capabilities of GPs and how those who feel less confident and keen about commissioning can be supported. It is very much about GP collaboration. Everything that the noble Baroness said about this was absolutely right. The new GP commissioning system that we are proposing will be led by groups of doctors at a local level and overseen nationally by an independent NHS commissioning board. This is not about trying to turn GPs into managers; it is about placing the financial power to change health services in the hands of those NHS professionals whom the public most trust. Giving more responsibility and control over commissioning budgets should help GPs consider the financial consequences of their clinical decisions. This will lead to reducing waste and bureaucracy. Much will depend on the size of GP consortia, but I am confident that the necessary leadership will emerge from those consortia to facilitate the spread of best practice.
The noble Lord, Lord Crisp, sought clarification on the arrangements and the roles of GPs in commissioning services from primary care. We will be bringing forward proposals for change to the roles and responsibilities of GPs before the summer through a White Paper. Shortly after that we intend to publish a consultation document on GP commissioning arrangements. That consultation document will set out in a lot more detail the roles and responsibilities that we are proposing for organisations. We will welcome views and comments from all interested parties.
The noble Baroness, Lady Finlay, referred to the unintended consequences of change, the challenges posed by patients with complex conditions and the requirement to treat those patients in the right settings and along the right care pathway. She is spot on in all that she said. She referred specifically to payment by results acting as a barrier to integrated care. The work that we are doing to underpin our drive to an outcomes-based model of commissioning includes work to refine the tariff to embrace long-term conditions, co-morbidities and complex cases. This is a major undertaking but it is essential that we get there.
My noble friend Lord Alderdice remarked that there is a limit to managerialism. I am right with him on that. The Government are committed to a patient-led NHS, strengthening patient choice and patients’ management of their own care. That will involve pro-active, preventive and personalised care planning with a focus on shared decision-making. That will apply especially to the care of people with long-term conditions, a theme pursued very powerfully by the noble Lord, Lord Crisp, and one which brings us back to the wise advice of the noble Baroness, Lady Finlay, on the management of change. We are developing a national support programme aimed at accelerating improved long-term care management. The aim is to realise the benefits of improved quality and productivity more rapidly through a large-scale change management programme that will disseminate good practice.
Front-line staff are, of course, crucial to the delivery of personalised care planning. More needs to be done to support the wider culture change that empowers people with long-term conditions to take more control so we plan to support the workforce with guidance and training resources. There is a clear message here: personalised care planning underpins good management of long-term conditions. The care planning process is about involving people with long-term conditions in discussions about their own goals and outcomes for the way they want to live their lives and then agreeing a plan with them on how their care will be managed. It is about addressing their full range of needs: personal, social, economic, educational, mental health and others. That is the way that we will empower people and get them to understand what choice really means.
The noble Baroness, Lady Emerton, in a speech to which I cannot possibly do sufficient justice in the time available, referred to the essential role of community nurses. We are determined to address health inequalities and improve public health. Nurses are key to this, as are health visitors working with families, communities and Sure Start and school nurses working with school populations. They will make skilled and significant contributions to this. We are committed to increasing the number of health visitors in the workforce to provide the best health, well-being and support services for all children and families and to improve services for those who need additional support. The noble Baroness was right in all that she said about the skill set of nurses. Health visitors in particular combine a nursing or midwifery and public health education which gives them the ability to put together a medical and psychosocial knowledge with an understanding of the health system. That is a unique strength.
The noble Baroness, Lady Emerton, referred to the challenges to the nursing workforce and its role in providing community services. She will know that four years ago the Modernising Nursing Careers initiative was launched jointly by the four UK chief nursing officers, with clear priorities. Those priorities were developed to ensure that nursing careers supported health reforms. The programme developed national tools and levers to enable local transformation of the nursing workforce. We will follow that theme.
The noble Baroness, Lady Finlay, referred to a 24/7 service. We are committed to providing universal access to high-quality urgent care, whereby people can have the care that they need whenever they need it. I anticipate that we will shortly make further announcements on that theme.
The noble Baroness, Lady Thornton, asked about the LIFT initiative. I agree with her that much good has emanated from it, and it has the potential to continue delivering. There are a possible 144 new schemes in the pipeline, worth £1.2 billion in total. There are also two new express LIFT companies in procurement that are due to become operational in this financial year. She also asked about social enterprise. I hope that I have said enough to convince her that we are serious about this. A number of initiatives, including using funds from dormant bank accounts to establish a big society bank, will be helpful. This is also about training. We need a new generation of community organisers to support the creation of neighbourhood groups across the UK, especially in the most deprived areas.
My noble friend Lord Colwyn moved us to the subject of dentistry and specifically the regulation of the dental profession. Dental practices will be required to register with the CQC from April next year—the date set by the Health and Social Care Act regulations. I recognise the fear of overregulation that dentists may have and I am well aware of the importance of good morale. My clear understanding from the CQC is that it will look at evidence that outcomes are being met, rather than adopting a tick-box approach to compliance. Where possible, the CQC will use existing information held, for example, by the Dental Reference Service, to minimise the demands on dentists. The CQC is agreeing a memorandum of understanding with the General Dental Council. Perhaps I should point out that plans to include in the registration system primary care providers such as dentists were consulted upon in spring 2008, and the majority of respondents supported the decision—including the British Dental Association.
In view of the shortage of time, I will write to my noble friend about the HTM 01-05 guidance, because there is rather a lot to say about that. I have convinced myself in the past fortnight that we are on the right path. I know that there is a lot of concern among dentists about cost, but I believe and have been persuaded that the guidance is the correct way to go.
Primary care is the bedrock of the NHS. It provides some excellent services but is capable of so much more. The balance of power within the NHS will undergo a fundamental shift—away from central control and away from restricted provision. The noble Lord, Lord Mawson, asked: who will lead? It is probably obvious from what I have said that, above all, we want clinicians and professionals rather than the politicians to lead. My noble friend Lord Alderdice spoke powerfully about that. We will give the NHS the freedom to innovate and a mandate to achieve excellence. We need a new can-do and should-do attitude. We need a dramatic improvement in productivity and efficiency. Most important of all, we need to see a significant improvement in the health and well-being of patients.
Lord Mawson
My Lords, I have found all the contributions to this debate particularly helpful. In many ways, the issues raised provide the raw material on which we all need to work as we move forward to the next stage of the development of primary and community care. I am only sad that there is not more time to debate some of those issues, but I want to make just a couple of points.
I agree with the noble Baroness, Lady Thornton, about the role of LIFT. In the early days, I tried to persuade GPs and others all over the country to get behind LIFT. It has created a very different kind of world. Indeed, my colleagues in east London won the first £35 million contract and began to demonstrate how it might work. My plea to the Government is that they should stay with LIFT, as I think they will. I suspect that, as a structure, it is achieving only 55 per cent of what could be achieved and that it could do a great deal more, as I pointed out earlier.
Some of the points that I made reflected conversations that I have had with colleagues who run the Big Life Company and with others with whom I am very much in touch. We are all aware that we have come a very long way but that we need to go further. That is the key point.
I thank the noble Earl, Lord Howe, for clarifying some of the issues that I raised. There is a great deal to do, and a lot of practical details that underlie this debate need to be addressed. However, I welcome what I have heard and am certainly willing to play my part in helping some of this thinking to take root.
Finally, if I have any further advice for the Minister, it is the following. First, as I know he is doing, he should decide what his vision for the future of primary and community care is and stick to it. At a time of limited financial resources, I encourage him to embrace the integrated approach to health that I have been describing. It is about more than just the medical profession. Not only does it make good health sense for patients and put flesh on the bones of the concept of the big society at a local level, but it may well enable the Government to get more for less from the limited resources that are now available to them.
Secondly, in deciding their vision, the Government should also take great effort to understand the practical details of how it will work in practice in different contexts within the United Kingdom—particularly in some of our more challenging areas. I very much agree with my noble friend Lady Finlay that we should be careful about unintended consequences. For example, the policy to create free schools, which I welcome, may have real benefits in some affluent areas of the country but may well create social havoc in multicultural areas of London, with which I am very familiar.
Thirdly, the Government should make sure that the people they ask to run these programmes are practical, businesslike people with in-depth experience.
As an entrepreneur, I say that we should back success and let 1,000 flowers bloom. I look forward, together with others, to seeing how the direction of travel develops in the months ahead. In the mean time, I beg leave to withdraw the Motion.