House of Lords Reform Bill [HL]

Lord Wills Excerpts

Friday 3rd December 2010 Lords Chamber

[Lord Wills]

My Lords, I, too, salute the indefatigability of the noble Lord, Lord Steel, on bringing this Bill forward again. His admirable persistence has become one of the enduring characteristics of this debate. If the Bill could be considered independently of the wider context of a debate about the future of this House, its proposals are sensible and they are welcome. But as we have heard over and over again in the speeches today, the Bill cannot be viewed independently of that wider context. I have to say, however, that it is a measure of the ingenuity, creativity and indeed the long legislative experience of the noble Lord that his Bill can be viewed with equal plausibility either as a bridge towards further reform or as a block to it. It can be seen either as an important attempt to tackle the issues that need to be dealt with as a prelude to the great battle over fundamental reform—and we have heard many times that it will be a great battle—or as a tidying-up exercise which, by absorbing legislative energy, will postpone for even longer a fundamental debate about the future of this House.

I have said it before, but I believe that the great battle should be joined without further delay. Fundamental democratic reform of this Chamber has been pending for over a century, and whatever the merits of the way that the House currently functions—they are clearly considerable and we have heard them rehearsed again in the debate—there can be no substitute for the accountability of legislators to those whom they serve. That is the fundamental and irreducible question which lies at the heart of this debate. For all the arguments for appointment, again rehearsed powerfully in, among others, two important maiden speeches, the question of democratic accountability by legislators is fundamental.

At every stage of this country’s long journey towards an effective representative democracy for all citizens there have been compelling arguments against reform. On reading Hansard, one can see that in the great debates about democracy in the past these arguments were powerfully advanced. However, in time, they were all overcome: all adult males eventually got the vote and then all adult women; and the democratically elected House of Commons became the pre-eminent Chamber. Who today wishes to revisit the arguments advanced at the time against those changes and say that our predecessors made the wrong decisions? We should have their courage and take the next important steps towards making those in power—including all of us in this Chamber in this instance—properly accountable to those we serve. For all its merits, this Bill does not form part of this fundamental process.

The coalition Government have set out their view of this process in their coalition agreement. They said:

“We will establish a committee to bring forward proposals for a wholly or mainly elected upper chamber”.

I agree that that is where the debate over reform of the House of Lords should be located, but the agreement went on to say:

“The committee will come forward with a draft motion by December 2010”.

So, on 3 December, I ask the noble Baroness who is to reply on behalf of the Government: where is it?

I am sure the noble Baroness is aware of the widespread belief that when in opposition the Prime Minister put a comradely arm around the shoulders of the Leader of this House and assured him that he had no need to fret because reform of the House of Lords was, “a third term issue”. However, despite repeated attempts by me and others before the general election to get Conservative Front-Benchers in the other place to confirm or deny this comradely agreement, they wriggled away from it; we got no answer. So, when the noble Baroness replies, I would be grateful if she would now confirm or deny that the basis on which the coalition Government are operating is that whenever proposals are produced, delivery of them will be postponed until such time—if ever—as there is a third term of this Government. I am sure her answer will be scrutinised with great care.

I hope also that the Minister will at some point set out how she intends to address the serious concerns that have been frequently rehearsed in this House by my noble friend Lord Grocott, and by the noble Baroness, Lady Boothroyd, today, on the issue of how a democratically elected second Chamber—which would, without any doubt, acquire greater legitimacy—might challenge the pre-eminence of the House of Commons. As I have said previously—I am pleased that my noble friend Lord Brooke referred to this today—I believe that the way to resolve this important issue is to codify the functions of this House; to put beyond doubt the respective roles of the two Chambers and their relationship. I hope the noble Baroness will forgive me if, once again, I renew my plea to the Government—I join with my noble friend Lord Brooke on this—to reconstitute the working group set up by the previous Government to look at the issues around codification. It would be a great help to the Government and I do not know why they have not yet done so.

Finally, I remind the noble Baroness—although she probably does not need reminding—that the current situation is untenable. Again, my text on this occasion is the coalition agreement, which states that, before fundamental reform,

“Lords appointments will be made with the objective of creating a second chamber that is reflective of the share of the vote secured by the political parties in the last general election”.

Quite apart from the signal that this sends about the determination of this Government to aggrandise power to the Executive, this commitment is ludicrous unless it is unbreakably a one-off measure and coupled unbreakably with rapid movement to an elected House of Lords. Otherwise, following through this principle, enunciated with such conviction in the coalition agreement, we are faced with the proposition that either the House of Lords will grow ever larger at every general election—and the larger the swing at the general election, the larger the Chamber will swell; 1,000, 2,000 and so on and on; or, alternatively, large numbers of existing Peers will be summarily ejected after the general election. Incidentally, how will the victims be determined, an issue on which, along with so many others, the Government have so far been silent? Or will we see some equally arbitrary and equally profoundly unsatisfactory combination of the two?

In their first six months the Government have, I am afraid, displayed an insouciance towards constitution proprieties which is malign, reckless or both. I hope they will take time over this Christmas break to reflect on this approach, and come back refreshed in the New Year and produce a comprehensive and principled approach to reform of this House.

Health: Cancer

Lord Wills Excerpts

Thursday 11th November 2010 Lords Chamber

[Lord Wills]

My Lords, I, too, congratulate the noble Baroness, Lady Finlay, on enabling the House to discuss a subject of such importance to so many people in this country, and on her most impressive and comprehensive speech. I cannot lay claim to her professional experience and wisdom but, in the short time available, I will make two points about early diagnosis, which is so crucial to outcomes for people with cancer, as the House has heard so often today in so many moving speeches.

First, I ask the Minister about the Government’s plans to scrap the Labour Government’s commitment to reduce waiting times for cancer tests to one week. There is a legitimate debate to be had about the place of targets in the NHS, but it must be rooted in fact. The Government’s July White Paper states:

“Success will be measured, not through bureaucratic process targets, but against results that really matter to patients—such as improving cancer and stroke survival rates”.

This is a caricature of the previous Government’s health policy. It misses the point that these so-called process targets have been focused on outcomes and have played a significant role in the improvements in clinical outcomes in recent years. Moreover, it is not clear exactly how the Government’s theological position on targets has determined them to scrap the one-week waiting time for tests while retaining the two-week target for seeing a specialist. I hope everyone accepts that reducing the time that patients and their families have to wait anxiously for results must, axiomatically, be welcome. I also assume that it is accepted that the prompter the test results, the sooner any necessary treatment can begin.

So I would be grateful if the Minister could explain exactly why the Government have kept the Labour Government’s two-week target to see a specialist but scrapped the one-week target for test results. All I have heard by way of justification are vague words about there not being enough clinical evidence to support it. Can the Minister provide the detailed reasoning for this assertion and for retaining the two-week target?

My second point is about prostate cancer. Here I associate myself with the powerful speech by my noble friend Lord Kinnock. Prostate cancer is the second largest cause of cancer death in men and has seen no significant improvement in mortality rates. As the House will know, there are specific problems with early diagnosis of this cancer. There is poor awareness of it. Many men, for whatever reason, have been squeamish about discussing possible symptoms with their doctors. There has been a particular problem with the reliability of diagnostic procedures. The PSA test is a blunt instrument. In addition to producing false negative results and a relatively high level of false positive results, it cannot accurately distinguish between aggressive and indolent forms of the disease. This has created doubt about its suitability as the basis for a screening programme. As we know, screening has proved very effective in the successful treatment of other cancers.

On the other hand, last year the European Study of Screening for Prostate Cancer, which surveyed 182,000 men aged 50 to 74 in seven European countries, suggested that PSA-based screening can reduce the rate of death from prostate cancer by 20 per cent, although it also suggested that it was associated with a high risk of overdiagnosis. The Minister will be aware that the Prostate Cancer Charity has been working to develop the concept of universal informed choice to overcome these difficulties. With universal informed choice, it would be not for the Government to make the decision on screening but for the individual, on the basis of properly informed choice. The Government’s role would be to create the circumstances and conditions in which everyone was enabled to make such an informed choice by ensuring that every man over 50 and younger men at higher risk would have access to balanced information about the PSA test.

The charity has suggested three models: one that is GP-led, one based on community walk-in clinics and one based on roadshow clinics. The Minister will I am sure be aware that these are not necessarily alternatives but could well be complementary. Whatever model is adopted, it would, as my noble friend Lord Kinnock pointed out so powerfully, have to be supported by regular public awareness campaigns and consciousness raising among healthcare professionals.

I should be grateful if the Minister could say whether he believes that this approach could play an important role in at last reducing mortality rates of this cancer. If he does not agree, I would be grateful if he would explain why. But if he does agree, can he say what steps he will take in the next year to implement this new approach? For example, will the revised cancer reform strategy endorse the need for universal informed choice in relation to prostate cancer screening?

I recognise that this debate has already been wide-ranging, so the Minister may not have the answers to hand or have time to address all these questions fully. In that case, I would be grateful if he could write to me with the answers.