Immigration
Earl Attlee Excerpts(11 years, 1 month ago)
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Earl Attlee (Con)
My Lords, it is too early to provide such an assessment. We have taken the advice of the independent Migration Advisory Committee, which concluded that it would not be sensible or helpful to policymakers to make predictions about likely volumes. The Government are doing everything they can to ensure that people who come to the UK from the EU do so for the right reasons—to work hard and to contribute to our economy and society.
Lord Balfe (Con)
I thank my noble friend for his reply. Does he accept that migrants from these countries, many of them highly skilled, come to Britain because the expanding, vibrant and welcoming economy gives many opportunities for self-advancement? Secondly, has he sympathy with Romanian Ministers who have pointed out that, with 866,000 persons in the UK being registered unemployed for more than a year, the UK Government might be well employed in reviewing benefit levels for the UK unemployed to a level at which they might be encouraged to apply for some of the vacancies currently being filled by the migrants?
Earl Attlee
My Lords, on my noble friend’s first question: yes, this is one of the benefits of the free movement of labour around the community, so if one country is doing better than another we can get a flow of labour to equalise things. On the second point, on benefit levels, it is not my responsibility to answer for the Home Office on migration issues.
Lord Davies of Stamford (Lab)
My Lords, amid all the unpleasantness in parts of the media over the past few weeks about Romanians and Bulgarians, has the noble Earl had the time to see the study recently published by a team from University College London, which shows that immigrants from the EU over the past 10 years have contributed far more in taxes and national insurance contributions than they have consumed in public services and in benefits, unlike the position of the native population? In other words, they have supplied us with a substantial financial and fiscal surplus, to the benefit of every taxpayer in this country. Is there not every probability that hard-working Romanians and Bulgarians will follow in the same footsteps?
Earl Attlee
My Lords, the answer to the noble Lord’s last question is yes. On his first question, I handled business on that particular report. I cannot remember the precise details, but I broadly agree with the noble Lord’s thrust.
Lord Hannay of Chiswick (CB)
Can the noble Earl confirm my recollection that all three main parties supported the seven-year transition period that expired last week for Romanians and Bulgarians, and gave it wholehearted support when this House and the other place ratified their accession treaties?
Earl Attlee
Again, the noble Lord is right. This is what we signed up to in the accession treaties for these two states. However, we need to stimulate a debate within the community about how best to manage transition in the future.
Baroness Hamwee (LD)
My Lords, is my noble friend aware, as I am, of the benefits of free movement enjoyed in the past, now and, I hope, in the future, by British citizens in the EU? Is it not a case of, “Do as you would be done by”?
Earl Attlee
My noble friend is absolutely right. There is two-way traffic, both to and from member states in the EU. There are great benefits from the free movement of labour.
Lord Howell of Guildford (Con)
My Lords, would my noble friend remind the noble Lord, Lord Hannay, that when we debated the question of former satellite countries joining the European Union, some of us were considerably less than wholehearted. In fact, we queried whether the figure of 13,000 likely new arrivals was accurate. As it turned out, of course, it was nearer a million than 13,000, so our reservations at that time were fully justified.
Earl Attlee
My noble friend may have been talking about the accession of Poland. A very large number of Poles came to this country. I was talking about Romania and Bulgaria, where we expect that the numbers will not be so large.
Baroness Smith of Basildon (Lab)
My Lords, the Minister said in his Answer that it was too early to make an assessment of the numbers. However, some of the language from the Government has been quite alarmist rhetoric. Would it not be better to look at measures to stop any workers being exploited, such as stronger and better enforcement of the national minimum wage, and also to tackle those loopholes that allow agency workers, often from overseas, to be employed at much lower rates than home-grown employees?
Earl Attlee
My Lords, I absolutely agree with the noble Baroness. One thing that we have done is to increase very significantly the fixed penalty for employers for not paying the minimum wage. We also need to look at a number of instances where immigrant labour is being abused—for instance, agricultural workers from eastern Europe. The noble Baroness is right; we need to keep a grip on this.
Lord Elystan-Morgan (CB)
My Lords, whatever reservations we might or might not have had concerning the expansion of the European Union, will Her Majesty’s Government give an undertaking that unless and until we extricate ourselves from the Union, we will loyally and honourably accept all our legal obligations in respect of it?
Earl Attlee
My Lords, I assure the House that Her Majesty’s Government do have a policy of adhering to treaty obligations. That is why we are very happy with the accession of Romania and Bulgaria to the EU, and with the free movement of those peoples, from 1 January.
Lord Forsyth of Drumlean
I am grateful to the noble Lord. Am I having an aberration? The opposition Front Bench complained about loopholes introduced by the agency workers scheme. Will my noble friend confirm that the scheme was introduced by the previous Labour Government?
Earl Attlee
My Lords, the noble Lord is right—but, equally, we must close the loopholes and avoid the abuse of low-cost labour from eastern Europe.
Lord Campbell-Savours
My Lords, if what the noble Lord, Lord Hannay, said about the seven-year accession arrangements was correct, why do Mr Cameron and government Ministers go on television and accuse the previous Labour Government of acting irresponsibly?
Earl Attlee
My Lords, it is important to make sure that we have transitional arrangements for future accessions that work properly and do not have undesirable effects, especially when the acceding state has a lower GDP per capita than the rest of the community.
House of Lords: Size
Earl Attlee Excerpts(11 years, 2 months ago)
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Lord Norton of Louth (Con)
My Lords, the proposition I wish to put to the House is straightforward. In terms of membership, the House of Lords has grown, is growing and ought to be reduced. There is an immediate problem; there is an even greater prospective problem.
My starting point is that this House does a good job in fulfilling functions that add value to the political process. It complements the elected Chamber, not least in carrying out tasks that the other House may not have the time, resources or political will to fulfil. However, the fact that we do a good job does not mean that we could not be even more effective than we are. Enhancing our effectiveness has two elements. One is making changes to how we operate and the other is bolstering public confidence in what we do. Unlike the other place, we cannot take our legitimacy for granted. We have to earn it. The changes that would enable us to fulfil our functions more effectively and enhance public support go well beyond limiting how many Members we have. However, addressing the size of the House is critical because of its relevance to fulfilling the functions of the House and our public standing.
There are two aspects to the size of the House. One is the total membership and the other is the active membership. The total membership is especially relevant to how the House is seen by the public, and the active membership is relevant to the capacity of the House to do its job. In terms of total membership, the House has grown markedly since the passage of the House of Lords Act 1999. At the start of the new Session of 1999-2000, we had 666 Members—in other words, a membership slightly larger than that of the House of Commons. Today, we have a total of 835 Members, making the House more than a quarter larger than the House of Commons. We are the largest second Chamber in the world. That remains the case even if we exclude those who have taken leave of absence or are ineligible. Excluding those who are ineligible or have taken leave of absence, we have 781 Members. However, we have to take into account the fact that ineligible Members, such as those holding judicial posts, will in due course be able to resume their seats. Some of those on leave of absence because of the positions they hold, such as the noble Baroness, Lady Ashton of Upholland, may well resume their seats upon completion of their current posts.
However, even working with the figure of 781, imagine what will happen if a new list of Peers is announced. Then think ahead to the next Parliament and the likely creation of another list. There may be ebbs and flows—we lose some Members each year and there is a lull between lists—but the underlying trend is clear. That is demonstrated graphically in Figure 2 of Meg Russell’s pamphlet, House Full, published in 2011. As she points out, the largest single number of Peers to be created in any one year since 1999 was the 117 who were created in 2010-11.
The number, be it of all Peers or just of eligible ones, is rising and has risen most markedly in the past three years. It is not beyond reason to envisage a House at some point in the next Parliament with a total membership close to, or even in excess of, 900 Members. A House of that size, whether active or inactive, does nothing for the reputation of the House; it is difficult to defend in the public arena.
One can certainly justify a House similar in size to that of the other House, given that we need a large membership to sustain an active House of part-time Members. We benefit fundamentally from Peers having outside links and maintaining current expertise. This House forms an invaluable arena for discourse by civil society. However, the more that we grow in number beyond the size of the other place and, like Topsy, just grow and grow, it is difficult to defend against the criticism of being primarily an expanding repository of political patronage.
There is no obvious justification for the expansion in terms of fulfilling the tasks that are core to our activity. The more that we grow in size, the more that the position becomes indefensible. It would not be bad if there were a rational argument for the growth in numbers, but there is no clear intellectual basis for it. The composition of the new membership in this Parliament bears little relationship to the stated aim of the coalition agreement in terms of membership proportional to votes in the general election. To achieve proportionality now would require a further, substantial injection of new Peers.
There is a more tangible problem in terms of the resources of the House. The growth in membership in recent years has brought in Members who contribute regularly to the work of the House. This is reflected in the daily attendance: the average daily attendance in the Session 2009-10 was 388, while in the most recent session, 2012-13, it was 484. As Meg Russell records, this substantial recent growth in the active membership generates three problems. First, it puts pressure on the limited resources of the House. Secondly, it puts pressure on the work of the House, not least in terms of demands to contribute to Question Time and debates. Thirdly, it has a negative impact on the culture of the House. The more that Members are brought in quickly and in large numbers, the more that this makes it difficult to socialise Members in the accepted norms of the House, and the danger is that the House may become more fractious and partisan.
The pressure on resources is fairly obvious, not least in terms of space. Members have always been underresourced relative to Members of the other place. This is shown in the extent to which Peers are allocated not offices of their own but rather desk space. The pressure is also obvious in the Chamber, in that at various times it is not able to accommodate all the Members who wish to attend. We have a smaller Chamber than that of the other place but a larger membership. The Commons has seating for more than 60% of its Members; we cannot match that, even based on the average daily attendance, and the situation is clearly growing worse.
The increase creates particular problems in a House that works on a fairly lean support base. The cost of this House is notably less than that of the House of Commons. In the previous Session, the cost to the public purse of the House of Commons was £392 million while the cost of the House of Lords was £87 million. We may take some pride in delivering value for money, but making a case for more public money at the present time is difficult. We are expected to make efficiency savings. That will be difficult with an influx of new and active members, each eligible for an attendance allowance and transport costs and adding to the demands on the resources of the House. There is clearly a problem in how this will be seen by the public. There is also the problem of how we can cope within our existing physical capacity and administrative support. The demand is in danger of outstripping the ability of the House to meet it.
So the situation that we are in is clearly problematic, and if there are many more creations then it will likely become unsustainable. What, then, is the answer? There are various steps that can be taken, although in taking them it is important to have regard to certain principles. One is that no party or coalition of parties forming a Government should have an absolute majority. Another is that there should be a protocol, a formula, on the balance between the parties in order to prevent another escalation in membership. Any reduction needs to have regard to the balance between political groupings in the House. A third is that we should work towards a membership that is smaller than that of the House of Commons. That may take time but it is a useful aspiration; it provides a framework for managing the reduction in numbers.
One immediate and rather modest step would be to put a limit on the size of the House. One proposal is to have a moratorium on the creation of new Members. I would propose a cap on membership. That way, one could create new Members but only when existing ones had demised. One could develop a formula of creating, say, only one new Peer for every three who left the House. That would gradually reduce the size of the House; it would be a slow process, but over the course of the Parliament it would reduce the size of the House by at least 50.
Other steps include those embodied in the Bill introduced in this House by the noble Baroness, Lady Hayman, and that in the other place by Dan Byles, such as removing Peers who hardly ever attend. That would not affect the active membership but would have a beneficial effect in terms of public perception. Another provision of the Bill would create a form of retirement provision, which would have the effect of the Members ceasing to be Members of the House, with no provision for retirement to be rescinded.
More radical proposals have been canvassed. These include proposing a mandatory retirement age or imposing a set period for which a new Peer may serve, such as 10 or 15 years. The problem with each of these is that it has the potential to rid the House of Members who are making a substantial contribution to it. There is another proposal that would not have such an arbitrary effect and could be geared to the need to maintain a balance between the parties in the House and allow for some recalibration in each Parliament: to determine the number that each political grouping should have in a Parliament and to allow each to elect from within its own ranks those who should remain within the House—in other words, a scheme not dissimilar from that employed in 1999 to determine which hereditary Peers should remain in the House.
My purpose this afternoon is not to put forward a particular proposal, but rather to emphasise the necessity to address the problem. The more we can get on record the need to act, the sooner we may be able to achieve some steps by government to address the compelling need for some corrective action. Accepting the need for a cap on membership would be a starting point.
Given that, may I invite my noble friend the Leader of the House to focus not simply on where we are now, but on where we are likely to be in two, five and 10 years’ time? In terms of creations already announced, could he give us some indication of the additional costs estimated to be incurred in a full financial year once the introduction of the current tranche of new creations has been completed? Does he accept that a further list of Peers in the current Parliament will create not just additional but significant difficulties in terms of the finite resources of the House? Projecting ahead, would my noble friend accept that the problem will be exacerbated in the next Parliament, especially in the event of the return of a new Government? That will be the case if the new Government is a majority Conservative Government. Would not the new Government expect to create more Peers? If my noble friend accepts that there is a problem, either now or prospectively, what steps does he anticipate the Government taking to address it?
The problem has been touched upon by various bodies in recent years, including the Leader’s Group chaired by my noble friend Lord Hunt of Wirral, who I am delighted to see in his place, as well as more recently by the Political and Constitutional Reform Committee in the other place. My noble friend told the committee that he found that there was a broad consensus among Members that the current House is too big and the overall size should be reduced. Given that there is such a consensus on the problem and what should be done about it, I look forward to hearing from my noble friend, speaking as the Leader of the House, what he plans to do to give effect to the will of the House. I beg to move.
Earl Attlee (Con)
My Lords, may I point out to the House that the timings are very tight indeed for this debate? I can help.
Woolwich and the EU Council
Earl Attlee Excerpts(11 years, 8 months ago)
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Lord Hill of Oareford
My Lords, I am very grateful to the noble Baroness for her overall welcome, and I associate myself very much with many of the points that she made, particularly about the awful situation in Woolwich.
On the noble Baroness’s specific questions on the Statement and the proposals on tax, our view—and it may be hers as well—is that it is best if this is done on an international basis. We can use the G8—as my right honourable friend the Prime Minister is doing—the G20 and the OECD to drive that agenda forward. We need to take action. It is a global problem and it is best to address it in that way.
I agree very much with the noble Baroness’s comments about the overall situation in Syria. I think she said that there are no good options and that we are talking about the least bad option, and I very much take that point.
On Geneva 2, the Prime Minister and the Foreign Secretary—the Government—have always been clear that we are very much in favour of a negotiated political solution, so we welcome the fact that the Russian/American talks will be taking place. That is why my right honourable friend the Prime Minister himself has had talks with Presidents Putin and Obama to try to bring about diplomatic pressure, so that all sides will come to the table.
As for the risks of lifting the EU arms embargo, as the Statement made clear, it would be wrong to deny that there are risks with all courses of action. However, the risks of inaction are also clear to see. As the noble Baroness made clear in her comments about the numbers of those already displaced and suffering and the numbers who have been killed, the price of doing nothing is extraordinarily high.
As for the safeguards on the use of weapons, the framework agreed at the Council made it clear that any provision of arms would be only to the Syrian national coalition, and it has to be intended for the protection of civilians. There are safeguards to ensure that delivery goes to the right hands, and confirmation that existing obligations on arms exports remain in place.
As for the flexibility of the embargo, the Foreign Secretary regularly updates the House of Commons on developments. I know that he will continue to do so. Things can move fast and he needs to be able to reflect and respond to that.
On Woolwich, I associate myself with the noble Baroness’s praise for the local leaders. I agree with her about the three things she set out that we, all of us together, need to do—to bring the perpetrators to justice, to bring people together and to learn the lessons. I am grateful to her for her welcome for the new task force on extremism and, indeed, for the role that the ISC will be carrying out. She made a number of practical suggestions on points to do with earlier intervention and with violent extremism and gangs and the link between them. They are very sensible points. There is no monopoly of wisdom here and we should be open to all kinds of sensible, intelligent suggestions from people who know, and try to take those into account.
As for communications data and legislation, my right honourable friend the Prime Minister earlier this afternoon made clear that we need to have a frank debate about this issue. There is a problem—we know that 95% of serious crimes involve the use of communications data—but it needs to be addressed in a sensitive and careful way. If we can find a way of getting cross-party support to take this forward that would be desirable.
Overall, I am grateful to the noble Baroness for the support she gave for the steps that the Government have taken specifically on Woolwich, and I associate myself with the tributes that she paid to the people involved in that situation.
Earl Attlee
My Lords, perhaps I may remind the House of the benefit of short questions for my noble friend the Leader so that he can answer as many questions as possible.
Mid Staffordshire Foundation Trust Inquiry
Earl Attlee Excerpts(12 years ago)
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Lord Campbell-Savours
My Lords, will the Minister make it clear that brief interventions are required? Otherwise not everyone will be heard.
Lord Hill of Oareford
My Lords, with the leave of the House I will now repeat a Statement made earlier in another place by my right honourable friend the Prime Minister. The Statement is as follows:
“Today Robert Francis has published the report of the public inquiry into the Mid Staffordshire NHS Foundation Trust.
Mr Speaker, I have a deep affection for our National Health Service. I will never forget all of the things doctors and nurses have done for my family in times of pain and difficulty. I love our NHS. I think it is a fantastic institution and a great organisation that says a huge amount about our country and who we are. I always want to think the best about it. I have huge admiration for the doctors, nurses and other health workers who dedicate their lives to caring for our loved ones.
Nevertheless, we do them—and the whole reputation of our NHS—a grave disservice if we fail to speak out when things go wrong. What happened at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 was not just wrong, it was truly dreadful. Hundreds of people suffered from the most appalling neglect and mistreatment. There were patients so desperate for water that they were drinking from dirty flower vases. Many were given the wrong medication, treated roughly, or left to wet themselves and then to lie in urine for days. Relatives were ignored or even reproached when they pointed out the most basic things which could have saved their loved ones from horrific pain or even death. We can only begin to imagine the suffering endured by those whose trust in our health service was betrayed at their most vulnerable moment. That is why I believe it is right to make this Statement today.
There was a healthcare commission investigation in 2000; a first independent inquiry from Robert Francis in February 2010; and, long before that, the testimony of bereaved relatives such as Julie Bailey and the Cure the NHS campaign. They all laid bare the most despicable catalogue of clinical and managerial failures at the trust. But even after these reports, some really important questions remained unanswered. How were these appalling events allowed to happen and how were they allowed to continue for so long? Why were so many bereaved families and whistleblowers who spoke out ignored for so long? Could something like this ever happen again? These were basic questions about wider failures in the system—not just at the hospital but right across the NHS, including its regulators and the Department of Health. That is why the families called for this public inquiry and that is why this Government granted one. I am sure that the whole House will want to join with me in expressing our thanks to Robert Francis and his entire team for all their work over the past three years.
The inquiry finds that the appalling suffering at Mid-Staffordshire hospital was primarily caused by a “serious failure” on the part of the trust board, which failed to listen to patients and staff and failed to tackle what Robert Francis calls “an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities”. But the inquiry finds that the failure went far wider. The primary care trust assumed that others were taking responsibility and so made little attempt to collect proper information on the quality of care.
The strategic health authority was “far too remote from the patients it was there to serve, and it failed to be sufficiently sensitive to signs that patients might be at risk”. Regulators, including Monitor and the then Healthcare Commission, failed to protect patients from substandard care. Too many doctors “kept their heads down” instead of speaking out when things went wrong. The Royal College of Nursing was “ineffective both as a professional representative organisation and as a trade union”, and the Department of Health too remote from the reality of the services that they oversee.
The way Robert Francis chronicles the evidence of systemic failure means we cannot say with confidence that failings of care are limited to one hospital. But let us also be clear about what the report does not say. Francis does not blame any specific policy; he does not blame the previous Secretary of State for Health; and he says we should not seek scapegoats. Looking beyond the specific failures that he catalogues so clearly, I believe we can identify in the report three fundamental problems with the culture of our National Health Service.
The first is a focus on finance and figures at the expense of patient care; Francis says that explicitly. This was underpinned by a preoccupation with a narrow set of top-down targets pursued in the case of Mid Staffordshire to the exclusion of patient safety or listening to what patients, relatives—and indeed many staff—were saying.
Secondly, there was an attitude that patient care was always someone else’s problem. In short, no one was accountable. Thirdly, he talks about defensiveness and complacency. Instead of facing up to and acting on data which should have implied a real cause for concern, Francis finds, all too often, a culture of explaining only the positives rather than any critical analysis. Put simply, managers were suppressing inconvenient facts in favour of looking for comfort in positive information.
That is one of the most disturbing findings. It is bad enough that terrible things happened at that hospital, but this inquiry is telling us is that there was a manifest failure to act on the data available not just at the hospital but more widely. As Francis says:
“In the end, the truth was uncovered … mainly because of the persistent complaints made by a determined group of patients and those close to them”.
The anger of the families is completely understandable. Every honourable Member in this House would be angry—furious—if their mother or father were treated in this way, and rightly so.
The previous Government commissioned the first report from Robert Francis and, when he saw that report, the former Secretary of State, now the shadow Health Secretary, was right to apologise for what went wrong. This public inquiry not only repeats earlier findings but also shows wider systemic failings, so I would like to go further as Prime Minister and apologise to the families of all those who have suffered for the way that the system allowed such horrific abuse to go unchecked and unchallenged for so long. On behalf of the Government—and indeed our country—I am truly sorry.
Since the problems at Mid Staffordshire Hospital first came to light, a number of important steps have been taken. The previous Government set up the National Quality Board and the quality accounts system. This Government have put compassion ahead of process-driven bureaucratic targets and put quality of care on a par with quality of treatment. We have set that out explicitly in the mandate of the NHS Commissioning Board, together with a new vision for compassionate nursing. We have introduced a tough new programme for tracking and eliminating falls, pressure sores and hospital infections, and we have demanded nursing rounds every hour, in every ward of every hospital.
However, it is clear that we need to do more. We will study every one of the 290 recommendations in today’s report and respond in detail next month, but the recommendations include the three core areas—patient care, accountability and defeating complacency—on which I believe we should make more immediate progress. Let me say a word about each.
The first is how we put patient care ahead of finances. Today, when a hospital fails financially, its chair can be dismissed and the board suspended, but failures in care rarely carry such consequences. That is not right. We will create a single failure regime where the suspension of the board can be triggered by failures in care as well as failures in finance, and we will put the voice of patients and staff at the heart of the way that hospitals go about their work.
In Mid Staffordshire, as far back as 2006, there was a survey in which only about a quarter of staff said that they would actually want one of their own relatives to use the hospital they worked in. During the following two years, bereaved relatives produced case after dreadful case and campaign after chilling campaign, but those voices and horrific cases were ignored. Indeed, the hospital was upgraded to foundation trust status during that period. We need the words of patients and front-line staff to ring through the boardrooms of hospitals and beyond to the regulators and the Department of Health itself.
From this year every patient, every carer, every member of staff will be given the opportunity to say whether they would recommend their hospital to their friends or family. This will be published and the board will be held to account for its response. Put simply, where a significant proportion of patients or staff raise serious concerns about what is happening in a hospital, immediate inspection will result and suspension of the hospital board may well follow.
Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards and that a little of them is somehow okay. They are not okay. They are unacceptable—full stop, end of story. That is what zero harm means. I have asked Don Berwick—who has advised President Obama on this issue—to make zero harm a reality in our NHS.
Francis makes other recommendations. Today, you can give hands-on care in a hospital ward with no training at all. Francis says that that is wrong, and I agree. Some simple but profound things need to happen in our NHS and our hospitals. Nurses should be hired and promoted on the basis of having compassion as a vocation, not just academic qualifications. We need a style of leadership from senior nurses which means that poor practice is not tolerated and is driven off the wards. Another issue is whether pay should be linked to quality of care rather than just time served at a hospital. I favour this approach.
Secondly, there is accountability and transparency. The first Francis report set out clearly what happened within Stafford hospital. It should have led to those responsible being brought to book by the board, the regulators, the professional bodies—and, yes, even by the courts. But this did not happen.
Most people will want to know why on earth not. We expect hospitals to take disciplinary action against staff who abuse their patients. We expect professional regulators to strike off doctors and nurses who seriously breach their professional codes, and, yes, we expect the justice system to prosecute those suspected of criminal acts, whether they take place in a hospital or anywhere else. In Stafford, these expectations were badly let down. The system failed. That is one of the main reasons we needed this inquiry.
Now that the recommendations about systemic failure are public, the regulatory bodies in particular have difficult questions to answer. The Nursing and Midwifery Council and the General Medical Council need to explain why, so far, no one has been struck off. The Secretary of State for Health has today invited them to explain what steps they will take to strengthen their systems of accountability in the light of this report, and we will ask the Law Commission to advise on sweeping away the Nursing and Midwifery Council’s outdated and inflexible decision-making processes.
The Health and Safety Executive also needs to explain its decisions not to prosecute in specific cases. Indeed, Robert Francis makes a strong argument that the executive is too distant from hospitals and not the right organisation to be focusing on healthcare and criminal prosecutions in such cases. We will look closely at his recommendation to transfer the right to conduct criminal prosecutions from the Health and Safety Executive to the Care Quality Commission.
Thirdly, we must purge the culture of complacency that is undermining care in our country. This requires a clear view about what is acceptable and what is not. In our schools, we have a clear system of deciding whether a school has the right culture and whether it is succeeding or failing. It is a system based on the judgment of independent experts, who walk the corridors of the school and analyse more than just statistics. The public therefore know which schools near them are outstanding and which are failing. They have a right to know the same about our hospitals. We need a hospital inspection regime that does not just look at numerical targets but examines the quality of care and makes an open, public and explicit judgment.
So I have asked the Care Quality Commission to create a new post—a Chief Inspector of Hospitals—to take personal responsibility for this task. I want the new inspections regime to start this autumn. We will look at the law to make sure that the inspector’s judgment is about whether a hospital is clean, safe and caring, rather than just an exercise in bureaucratic box-ticking. In the mean time, I have asked the NHS Medical Director—Professor Sir Bruce Keogh—to conduct an immediate investigation into care at hospitals with the highest mortality rates and to check that urgent remedial action is being taken.
Complacency in the system has meant that all too often, patient complaints have been ignored. I am today asking the honourable Member for Cynon Valley and the Chief Executive of South Tees Hospitals NHS Foundation Trust, Tricia Hart, specifically to advise how hospitals in the NHS should handle complaints better in future.
I have talked today about some of the systemic failures, but at the heart of any system are the people who work in it and the values and vocation that they hold. As Francis says early on in his report, and it is worth me quoting in full:
‘Healthcare is not an activity short of systems intended to maintain and improve standards, regulate the conduct of staff, and report and scrutinise performance. Continuous efforts have been made to refine and improve the way these work. Yet none of them, from local groups to the national regulators, from local councillors to the Secretary of State, appreciated the scale of the deficiencies at Stafford and, therefore, over a period of years did anything effective to stop them’.
What makes our National Health Service special is the very simple principle that the moment you are injured or fall ill, the moment something happens to someone you love, you know that whoever you are, wherever you are from, whatever is wrong, however much you have in the bank, there is a place you can go where people will look after you and do everything they can to make things right again. The shocking truth is that this precious principle of British life was broken in Mid Staffordshire. We would not be here today without the tireless campaigning of the families who suffered so terribly, and I am sure that the whole House will join with me in paying tribute to their incredible courage and determination over these long and painful years.
When I met Julie Bailey and the families again on Monday, she said to me that she wanted the legacy of their loved ones to be an NHS safe for everyone. That is the legacy that together we must secure. I commend this Statement to the House”.
My Lords, that concludes the Statement.
Earl Attlee
My Lords, I remind the House of the benefit of short questions in order that my noble friend the Leader of the House can answer as many questions as possible, which I am sure he is very keen to do. If necessary, I can help.
Baroness Jolly
My Lords, we, too, welcome the Francis report, and the many recommendations that we believe will strengthen the whole NHS. In particular, we welcome Francis’s recommendation of a statutory duty of candour: the duty of a clinician to explain and apologise when things go wrong. When and how does my noble friend see this being implemented?
Lord Harris of Haringey
The noble Lord the Leader of the House has referred to the fact that there is now to be a contractual obligation of candour on healthcare organisations. Presumably Robert Francis was aware of that in framing his recommendations, feels that it is inadequate and is advocating a statutory duty of candour, which, so far, the Government have resisted. I hope that policy will change. The noble Lord the Leader of the House also talked about the importance of an independent voice for patients. Given the suggestion that has been made about merging Monitor and the CQC, will he accept that it is therefore inappropriate that Healthwatch England, the national voice of patients, should be subordinate to that monster new body? Secondly, does he also accept that it is inappropriate, if you are to have an independent voice, that local Healthwatch is subordinate to local authorities, some of the organisations that they are supposed to monitor?
Baroness Williams of Crosby
Many of us during the course of the debate were obliged to listen to a very great deal of what I might call Twitter propaganda, and I think it is only fair to say that Mr Burnham has a responsibility to respond to this report.
Baroness Williams of Crosby
I am going to continue, so noble Lords had better get used to it.
Earl Attlee
My Lords, I think the sense of the House is that we would like to hear from the noble Lord the Leader of the House.
Lord Wills
My Lords, I welcome the Minister’s emphasis on the importance of involving patients and their relatives more centrally in decisions about their own care. Does the Minister think that principle should be extended throughout the NHS, including the new policy on value-based pricing for new medicines?
Patrick Finucane
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Lord Strathclyde
My Lords, I thank the noble Baroness the Leader of the Opposition for her response to the Statement. She is right that it is essential that we should remember the background against which we operated at that time and, following on from that, she is right to note the enormous changes that have taken place during the course of the past 25 years, most of all during the peace process in the past 20 years. The noble Baroness asked a number of questions, to which I shall try to reply.
Perhaps I can deal with one question relatively quickly, on the Irish Government and their likely position. I can confirm that the Prime Minister spoke this morning to the Taoiseach, Enda Kenny. The position of the Irish Government, that they have been in favour of a public inquiry, has been widely known for a long time. However, they understand why we have taken the decision that we have taken, and they respect that we have been entirely open and frank. I hope that they, like everybody else who has an interest in this issue, will find some comfort in the integrity of the process once they have considered Sir Desmond’s report. The position of the Irish Government is, of course, one for them to determine.
I am well aware that the decision not to hold a public inquiry was controversial. However, our ambition and motivation as a Government was to frame a real question: what is the fastest way to get to the truth and to lay out what happened? We know what has happened in the past with public inquiries; some of them took five or six years, or even longer, cost tens of millions of pounds and perhaps did not even get closer to the truth than de Silva has got in his report today. We therefore very much support our decision to have this inquiry led by Sir Desmond de Silva.
At the time of the general election, this went to the core of the point made by the noble Baroness about confidence in Northern Ireland and in the process that we have conducted. In answer to whether we can say with full confidence that the whole truth has been uncovered, this is a very long report and individual noble Lords will want to review and read with care what has been said. However, it is clear that Sir Desmond de Silva has done the whole nation a tremendous service in trying to get to the heart of the matter and uncover the truth, building on the work that had been done by previous individuals. This was a fast way to find the truth. That is a good thing for Northern Ireland.
With the greatest respect to the noble Baroness, her Government had nine years between Weston Park and the general election to decide to go ahead with a public inquiry. It is not a decision that they took, possibly because they understood as much as we have done the problems of time and expense. The key thing is to get to the truth. I venture to suggest that very few countries would have set it out in so much detail or laid out what went wrong as comprehensively as we have done today. We should all take some pride in a country that is willing to do that. It is an agony in many respects to read what has been said, but it is right to publish and to ensure that people who have been affected can see the work that Desmond de Silva has done. That is very much the basis of the decision that we took and we stand by it.
Earl Attlee
My Lords, I remind the House of the benefit of short questions for my noble friend the Leader of the House, so that he can answer as many as possible.
G20 Summit
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Lord Strathclyde
My Lords, the noble Baroness the Leader of the Opposition is on good form today. Typically, she sees a socialist president being elected in France, looks over the water and believes that everything over there is going swimmingly. However, she has not read what the good president has said. He said that,
“national debt is the enemy of the left and the enemy of France”.
We agree with that. Mr Hollande would balance France’s budget faster than the coalition plans for the United Kingdom. When asked how he would stimulate growth, the French President said, “The means cannot be extra public spending since we want to rein it in”. We can agree with that; the noble Baroness and her party cannot.
We very much welcome the noble Baroness’s support on the Falklands and Syria. The situation in Syria is immensely dangerous, difficult and complicated. We are still discussing with key partners what more we can do, including in the United Nations, to support the Annan plan. There remain differences over sequencing and the exact shape of how a potential transition can take place but we have put in place a strong EU arms embargo, are closely tracking other shipments to Syria and want to work with countries and companies around the world to stop them. We have had useful conversations with Russia but the key thing is to get together, to work together and to try to implement the Annan plan, if at all possible.
I rather admire the fact that the noble Baroness’s research led her to spot that some of the words in this communiqué were the same as those used at the Cannes summit. She read that as signifying that nothing had changed. However, it may also prove some admirable consistency emanating out of G20 summits in that there are still common problems with which to deal, and they are going to be dealt with.
The noble Baroness took a pot shot at what my right honourable friend the Prime Minister did at the EU summit at the end of December, which was not to sign up to the communiqué. As I said at the time, the reason my right honourable friend did not sign that communiqué was because he believed in protecting British interests, which is what he did. The noble Baroness and her party would have signed it and, we believe, would have sold vital British interests down the river.
The G20 was a success in the sense that many of these gatherings are a success as an opportunity for the leaders of different countries to discuss some of the key issues facing the world and to try to come to an agreement. There was no shying away from the fact that one of the most difficult issues facing the world at the moment is the problems in the eurozone. We have come up with what we believe to be helpful and constructive words to try to encourage the eurozone to find a solution in preparation for the European Council later this week. However, in the end, the countries in the eurozone have to make those decisions themselves.
Earl Attlee
My Lords, I remind the House of the benefit of asking short questions in order that my noble friend the Leader of the House can answer as many questions as possible.
The Lord Bishop of Ripon and Leeds
My Lords, I am grateful for the particular stress that the Leader of the House put on support for the poorest countries of the world. As I understand it, there were three strands to that support and to the UK’s part in creating it. The first was an anti-corruption plan. Can he be more specific on how corruption can be tackled within the poorest countries of the world and how the UK can contribute to that? The second strand relates to the inability of the poorest countries to access modern technology. What sort of help can be provided by the UK and does that have implications for our aid budget and aid policy? Thirdly, welcome though the hunger event at the Olympics, to which reference was made, would be, how is that intended to support the poorest countries of the world?
Draft House of Lords Reform Bill
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Lord Ashdown of Norton-sub-Hamdon
Of course the first Chamber is going to have primacy. That is readily established in every other bicameral system in which there is an elected second Chamber. However, on the issue of whether to go to war, in the United States the President has to get the agreement of both Houses of Congress. Has that seriously prevented the United States going to war? Quite the contrary. This is an issue on which this House, as an elected Chamber, should be able to exercise its rights.
The time has arrived to bring this place up to date. The time has arrived when we have to stop what is not only an anachronism but an undemocratic anachronism. We send our young men out to fight and die and, perhaps worse still, to kill others in the name of democracy but we do not have a democratic second Chamber in this country, as is the case with the vast majority of bicameral systems throughout the world. Why can they cope with democracy but not us? Is our democracy so ineffective and immature and are our institutions so weak that we cannot cope with what they can cope with and we have to resort to the kind of principles that operate in Bahrain and Belarus?
This place is an anachronism and an undemocratic anachronism, and I am in favour of a fully elected second Chamber. However, if the proposition put forward by the committee as a compromise is the best one that we can achieve, I shall happily vote for it. By the way, I also believe that it should be supported by a referendum. The reality is that this is a reform that can no longer wait. Our democracy is in danger. We have to start renewing the democratic structures of this country, and the reform and democratisation of the second Chamber is part of that process. We cannot keep this waiting any longer. We have a proposition; we should take it up and do the business now.
Earl Attlee
My Lords, I remind the House that noble Lords are speaking for quite a time. If all noble Lords take as long, we shall be sitting very late indeed.
Lord Stirrup
Before the noble Lord sits down, perhaps he can help me on one extremely important point. I think that he referred to the most important element or principle of democracy as the right of the people to elect those who represent them. Rather, is it not the right of the people to remove those who represent them—something for which I believe there is no provision in this Bill?
Libya
Earl Attlee Excerpts(13 years, 5 months ago)
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Lord Strathclyde
My Lords, I thank the noble Baroness the Leader of the Opposition for an immensely supportive, positive and constructive reply to the Prime Minister’s Statement. I very much agree with what she said at the end of her speech. We should take great pride in the role that we and NATO have played, and that, of course, of the Libyan people themselves who have taken on this appalling dictator and are—if I can put it in such terms—winning, but who are also aware of the tremendous challenges that will unfold in the months and years ahead.
I also very much welcome the noble Baroness’s tribute to the people of Libya and commendation of the Prime Minister. I very much welcome her support. She asked a question about the Gibson inquiry. I think she said that the Gibson inquiry should try to get to the bottom of the accusations that have been made. I entirely agree, which is why I am delighted that the inquiry has said that it will look at these allegations as part of its wider investigation. We must await the outcome of that. The current security situation is fast moving and ever changing but obviously there are still hotspots in Libya that we hope will be dealt with in the days ahead.
As regards NATO, the NATO Secretary-General and the Prime Minister have both made clear that there will be no cessation of military operations until we can be assured that our responsibilities under UNSCR 1973 have been fulfilled. The British Armed Forces will continue to make a significant contribution to that mission. There have been discussions with the United Nations special envoy. The UN special envoy, Ian Martin, is in place. We believe that the UN mission should focus very much on what the Libyans want and not on what we think they want or should have. I gather that that was very clear from listening to them at the Paris conference last week. On oil, of course we should learn the lessons of previous conflicts, as we will undoubtedly and inevitably do from this conflict.
How will the NTC achieve the goals it has set out as it moves towards a more democratic government? We and many others will be with it every step of the way. There are already close contacts between the British Government and the NTC but there is no point in trying to second-guess the process. We have learnt in recent months throughout this process that the NTC always rises to the challenge. It is very effective and there is no reason why it should not continue to do so.
The noble Baroness the Leader of the Opposition also asked a question about the building up of civil society and democracy, and what plans there are to help Libya with the British Council, the BBC World Service, the Westminster Foundation for Democracy and so on. She is right that we have these tremendous assets, which have good international reputations. However, it is hard to see what role they can play until the security situation is considerably better. But there will be a medium- and a long-term role for these organisations.
The one slightly negative note mentioned by the noble Baroness was that of the SDSR and whether we should review this in the light of Libya and the Arab spring. I do not blame the noble Baroness for raising it at all. We believe that the case for what we are doing in the SDSR has been proved. The Tornado decision was right. The Typhoon has come of age. Of course, as I have said, as in any conflict of this kind, there will be a review, an examination of what happened, a lessons-learnt exercise, which will be led by Sir Peter Ricketts. This will include many aspects of the campaign of the past few months.
I hope that I have covered the ground that the noble Baroness covered. If I have missed anything out I will of course write to her. In conclusion, there is nothing easy in these kinds of conflicts, particularly between political parties. I very much welcome the non-partisan nature of the noble Baroness’s response and the support that has existed across both Houses on what has been an extremely difficult situation for the people of Libya.
Earl Attlee
May I remind the House of the benefit of short questions, so that my noble friend the Leader of the House can answer as many noble Lords as possible?
Earl Attlee
My Lords, we have not yet heard from a Conservative Peer. We have plenty of time.
Lord Naseby
My Lords, the noble Lord has made it clear that there have been very few casualties from NATO’s operations, and that is to be enormously welcomed. Does he accept nevertheless that when it comes to assessing the activities overall, the number of civilians who have died on both sides—whether from rebel forces moving forward or from Gaddafi’s forces trying to defend—must be considerable, and it would be appropriate at some point in time for an estimate to be made of what those figures are?
Baroness Morris of Bolton
My Lords, I welcome the Statement repeated by my noble friend the Leader of the House and also his replies to the noble Baroness the Leader of the Opposition and to the noble Baroness, Lady Symons. They are important because the Libyan people feel close to the British at the moment. I chair the Conservative Middle East Council. Our director, Leo Docherty, and my deputy and honourable friend, Adam Holloway MP, have just spent the past five days in Tripoli. They are flying the union jack and Qatari flags at the moment in Martyr Square and asking when the Prime Minister might visit. The Prime Minister undoubtedly made an impact when he visited Tahrir Square after the revolution in Egypt. If he could visit Libya as soon as possible, he would have a very warm welcome from the Libyan people.
Business of the House
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Intelligence and Security Services: Treatment of Detainees
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Earl Attlee
My Lords, I think that we should hear from the Cross Benches—or, rather, the Lib Dems first.
Lord Dholakia
My Lords, I join my noble friend the Leader of the House in paying tribute to those who have lost their lives in recent days in Afghanistan. The torture allegation has been a shameful episode for the good name of our country and we welcome this inquiry. I hope that it will be able to look at why this has taken such a long time and that it will question the previous Administration about why the inquiry was not held much earlier. We are aware of the constraints placed on the coalition Government, as a number of outstanding issues need to be resolved, but I have two questions for the Minister. First, does the payment of compensation before the inquiry has reported compromise it in any way? Secondly, the Statement mentions our co-operation on intelligence matters with other countries, particularly the USA. Would it be possible for the inquiry to take evidence from those countries that are involved in the torture allegations?
Earl Attlee
My Lords, I think we should hear from my noble and learned friend Lord Mackay of Clashfern.
Earl Attlee
My Lords, shall we hear from the noble Baroness, Lady Hamwee, and then the noble Lord, Lord Howarth?