Debate (5th Day)
Moved on Wednesday 27 May by Baroness Bottomley of Nettlestone
That an humble Address be presented to Her Majesty as follows:
“Most Gracious Sovereign—We, Your Majesty’s most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty has addressed to both Houses of Parliament”.
My Lords, it is an honour to be asked to speak in support of the gracious Speech this afternoon, and a privilege to be back in government. I look forward to the many valuable contributions I know noble Lords will make during the course of this debate, and I also thank my noble friend Lord Freud, who will be winding up today.
Her Majesty the Queen underlined the core principles of the programme of legislation set out in the gracious Speech, which is,
“a clear programme for working people, social justice, and bringing our country together”—
as my right honourable friend the Prime Minister said—
“a One Nation Queen’s Speech from a One Nation Government”.
Today’s debate brings together four key topics: health, welfare, culture and education. All are vital to a strong economy and a secure future for our country.
The Government’s vision is for a modern NHS that provides high-quality, joined-up care for patients seven days a week. We welcomed the NHS Five Year Forward View, a plan developed by the NHS for its own future. It shows that the NHS can continue to make dramatic improvements, but only if it continues to implement important reforms and is supported by a strong economy.
The Government are committed to securing the future of the National Health Service. We increased spending in real terms every year in the last Parliament, and we will increase it in real terms every year in this Parliament, too, rising to at least an extra £8 billion a year by 2020. The Government are also committed to ensuring that patients have consistent, high-quality hospital care, which means all those services patients need urgently, or to get the same standard of care as they would during the week, being available on Saturdays and Sundays. The Government are committed to ensuring that people with mental health problems can get the right care at the right time, and we are committed to integrating health and social care through the better care fund, which enables better joined-up care, closer to home.
Work is the best route out of poverty, and the Government will continue welfare reforms that help people into jobs, make work pay and deliver fairness for the taxpayer. It is essential that the welfare bill is sustainable and is fair to the taxpayer. The Government will therefore introduce a full employment and welfare benefits Bill, which will freeze working-age benefits and lower the benefit cap to strike the right balance between incentivising work, fairness for working households and supporting the most vulnerable. To fulfil our commitment to have the highest employment rate of any major economy we are also introducing statutory duties to report annually on full employment, the creation of apprenticeships and the progress of the troubled families programme. We will introduce a package of measures to further reduce youth unemployment by providing young people with the support they need to gain employment.
We will continue to increase the basic state pension through the triple lock, and support saving by introducing the new state pension above the basic level of the means test. We will give people the freedom to use their pension savings as they want, and to pass them on tax-free. Those measures together strike the right balance between work incentives, fairness and ensuring a safety net of support for those who need it.
By driving growth and enriching lives, the Government will also make Britain a great place to live, work and visit. We will build on the strength of our cultural and heritage institutions, keeping our major national museums and galleries free to enter, and securing the protection of our heritage sites. We will also continue to support tourism in this country, boost sport in our communities and build on our Olympic and Paralympic legacy.
A free media are the bedrock of an open society, so we will continue to defend the operation of a free press and deliver a comprehensive review of the BBC royal charter, as well as supporting our world-leading creative industries. We will also take action to protect children online by requiring age verification for access to all sites containing pornographic material and age rating for all music videos. We will enable economic growth by securing the delivery of superfast broadband to provide coverage to 95% of the UK by the end of 2017, and by releasing further public sector spectrum to the private sector. We will also ensure that mobile coverage is boosted, including by holding the operators to their binding agreement to provide coverage to 90% of the UK by 2017.
In the last Parliament, we strengthened the academies programme, building on the trail blazed by the noble Lord, Lord Adonis. Since 2010, our sponsored academy programme has meant that sponsors have taken on more than 1,100 failing and struggling schools. There are many examples of such transformation up and down the country, such as Charter Academy, in Portsmouth, sponsored by ARK since 2009, which has been totally transformed. Some 83% of pupils achieved five good GCSEs, including in English and maths, in 2014, compared with 22% in the school’s last year before becoming an academy five years earlier. Queen’s Church of England Academy, in Nuneaton, has been sponsored by the Diocese of Coventry Multi Academy Trust for just over a year. In that time, a record improvement in the school’s SATs results saw the percentage of pupils achieving level 4 and above go from just 19% in 2013 to 70% in 2014. Wyndham Primary Academy, in Derby, sponsored by the Spencer Academies Trust, has seen a spectacular increase in results. In 2014, 90% of pupils achieved the expected level in reading, writing and maths, up from 64% at the predecessor school in 2012. In 2014, 70% of pupils at the Ryecroft Primary Academy, in Bradford, sponsored by the Northern Education Trust, achieved the expected level in reading, writing and maths, up from 43% at the predecessor school. Outwood Academy Portland, sponsored by Outwood Grange, has seen results increase from 41% of pupils achieving five good GCSEs in 2011, to 76% in 2014. REAch2 Academy Trust sponsors the largest number of primary academies in the country. Results in seven of its schools have improved by more than 20% since joining the trust, and across the trust REAch2 schools have improved on average at three times the rate for the national average.
We want to build on these and many other success stories, and bring about that dramatic improvement in standards to many more schools. There are still too many pupils in failing schools, and we have seen many instances of obstruction and delay, where a sponsored academy solution is needed to bring about improvement. Indeed, the average time it takes for a school to become a sponsored academy is 13 months, and that is just too long. Every day a school spends in special measures is a day too long for its pupils. Sadly, these delays are often about putting the interests of adults ahead of the interests of children, preventing pupils in those schools from getting the quality of education they deserve. The Education and Adoption Bill will strengthen our ability to deal with failure much more swiftly by making it clear that for any school that Ofsted has judged inadequate, there must be a sponsored academy solution.
Downhills Primary School, in Haringey, was a high-profile case in which a national union-backed campaign put up barriers to the process through a series of repeatedly unsuccessful appeals and reviews, causing ongoing delay to our transformation of a school that had been failing pupils for more than a decade. Under the sponsorship of Harris, the academy group sponsored by my noble friend Lord Harris of Peckham, the school has been judged by Ofsted as good with outstanding leadership, and reading, writing and maths results have soared by a quarter. The Education and Adoption Bill will give us new powers and will help to prevent these obstacles in future, including by requiring governing bodies and local authorities actively to progress and facilitate the conversion of failing schools into academies.
The Bill also provides new powers for us to intervene in not only failing schools but coasting schools—those that consistently underperform and do not support their pupils to make the progress they should. We will now be able to identify additional support for these schools—for instance, from national leaders of education. Where necessary, we will be able to progress academisation for these schools, bringing in new leadership where it is needed.
To be clear, this Bill will not impact on schools that are performing well or on schools that are already on a good trajectory of improvement. In schools where head teachers have the capacity to improve sufficiently, have a credible plan and are working effectively with their governors to make progress, we will give them the time to do that.
Your Lordships will know that reforming schools so that every child, whatever their background, has the best possible chance in life is a major priority for this Government, as well as being my personal passion. I look forward to debating these important reforms with your Lordships and will ensure that draft regulations and guidance, including on the definition of coasting schools, are available before the Bill reaches your Lordships’ House.
We spent significant time in this Chamber considering adoption during the passage of the Children and Families Bill. Since then, there have been significant improvements in the adoption system. These include: establishing a national Adoption Leadership Board, bringing together leaders from across the sector; investing £200 million in local authorities and a further £17 million in the voluntary adoption sector; and launching a £19.3 million Adoption Support Fund to provide therapeutic support for adopted children. All those things have led to significantly more children finding permanent, loving homes through adoption. The number of adoptions has increased by 63% in the last three years. Children are also spending less time waiting to be adopted, with the average length of time between coming into care and being placed with a family down by nearly four months, according to the most recently published quarterly data.
However, it is still the case that the adoption system is highly fragmented, with most agencies operating on a very small scale. This prevents children being matched quickly with the best parents for them, and it means that support services are not commissioned on a sensible scale. This is starkly illustrated by the 3,000 children who are still waiting, despite there being enough approved adopters.
That is why the Conservative manifesto committed to the introduction of regional adoption agencies. These agencies will work on a much larger scale, across local authority boundaries, to match children without delay. We want to work with local authorities to deliver these, providing financial and practical support, and we have been delighted with the enthusiastic response with which our proposals have been met from across the sector. However, if some local authorities are unwilling to rise to the challenge, government needs a backstop power that can be used to direct local authorities which do not get involved voluntarily. That is why we are bringing this legislation forward now.
As I have mentioned and as we discussed today at Questions, a core principle of this Government’s programme of legislation is a clear programme for working people and families. The second Bill—the Childcare Bill—will extend one of this Government’s most successful schemes by doubling the number of hours of free childcare on offer to working parents of three and four year-olds to 30 hours per week. The two year-old entitlement remains for the most disadvantaged of families so that every child, regardless of background, has a fair start in life.
The additional hours for working parents of three and four year-olds will be implemented from September 2017 but, in confirming the Government’s commitment to support working families with the costs of childcare, on Monday the Prime Minister announced plans to introduce the changes for some families a year earlier than planned, with some areas offering the new, additional 15 hours from September 2016.
It is important that the hourly rate for the childcare entitlement strikes the right balance between being fair for providers and delivering value for money to the taxpayer. To get this right, we will conduct a review of funding for the entitlement, and the Government have committed to increase the average amount per hour by which each free place is funded.
The Government understand how important childcare is to parents and families and we have already made more high-quality provision available for parents through our reforms, introduced 15 hours a week of free childcare for disadvantaged two year-olds, legislated for tax-free childcare and given families flexibility and choice.
The gracious Speech sets out a clear programme for taking this country forward. It is no doubt challenging and ambitious but this Government are committed to achieving it. I welcome the debate today on these important matters.
My Lords, it is a great pleasure to respond on behalf on the Opposition. I start by declaring my interest as president of the Healthcare Supplies Association and of GS1. As we are discussing culture, I should say that I am also a patron of the CBSO and the Birmingham Contemporary Music Group.
We have once again heard from the Minister the extravagant claims made by the Government for this year’s Queen’s Speech. We are told that they will adopt a one-nation approach, support aspiration and give new opportunities to the most disadvantaged. I have to say that, listening to the Minister, I hear scant evidence of that in the subjects that we debate this afternoon.
Although economic growth is returning, its benefits are not being shared, the economy remains fragile, Britain’s productivity lags behind, tax revenues have fallen and the trade deficit is growing. The Government’s claim to bring the public finances under control is surely inconsistent with the many uncosted pledges in their manifesto. Who can doubt that the price to be paid for that irresponsibility will fall heaviest on the very disadvantaged people that the Government claim to want to help? That certainly characterises the Government’s welfare policies. We of course will back measures to help people get into work. However, it is now even more important that there are decent jobs for people to move into, that childcare is affordable and available, and that there are adequate funds for discretionary house payments; otherwise, the Government’s reduction in the cap will, tragically, put children into poverty, increase homelessness and end up costing more than it saves.
On welfare, the overriding question is where the promised £12 billion of welfare cuts will fall. The Government have been silent on this; not surprisingly, since they are clearly in disarray about what to do. Wherever the axe eventually falls, inevitably it will be on the independence of disabled people and on working-age families, who will face an even tighter squeeze in the years ahead. It is hardly inspirational to further penalise working people who are in receipt of welfare subsidies because their pay is so poor. I ask the Minister to listen to Steve Hilton, Mr Cameron’s former adviser. He said recently:
“It is outrageous that people should work all hours of the week and still have to live on benefits because they don’t get paid enough”.
He said that it is,
“a really big problem both economically, socially and morally”.
Quite, my Lords—quite.
On education, we will hold the Prime Minister to account for his latest promises on free childcare for 3 and 4 year-olds. The rhetoric might be promising, but the reality is that children’s centres have closed and the cost of childcare has soared. The average family now pays £1,500 more per year for nursery fees than it would have done in 2010. The National Day Nurseries Association says that fees will rise to subsidise the cost of free places because the Government have miscalculated the costs. The noble Lord, Lord Nash, was hardly reassuring on this in his Answer to an Oral Question earlier.
Talking of value for money, it is surely a scandal that, with a severe school place shortage in many areas, the Government are ploughing hundreds of millions of pounds into building new free schools in other parts of the country where there is already a surplus of places. As Simon Jenkins put it, it is all on a par with their,
“covert project to nationalise all schools”.
New primary and secondary schools, together with those schools defined by Whitehall as failing or coasting, are to be brought under regional tsars. It seems to me that that is all on the basis of the rather selective evidence that we heard from the noble Lord, Lord Nash, this afternoon. The latest centralising absurdity is the intention to remove the duty to hold a public consultation before a school converts to an academy. So much for parental involvement, of which the noble Lord’s party made so much in the years behind.
The noble Lord, Lord Nash, did mention culture this afternoon, and I am grateful for that. However, he will have noted that the Queen’s Speech was absolutely silent about the brilliance of the cultural heritage of this country. I wonder whether that silence reflects the way that support for the arts has been decimated by this Government, both directly through Arts Council funding and indirectly through the impact of reduced local authority support.
Perhaps, too, that silence reflects the threats made by the noble Lord’s party to the BBC. I hope that the noble Lord, Lord Freud, will say in winding up that the long-term future of the BBC as an independent and vibrant organisation is assured. Already, it has suffered a budget cut of about 25% since 2010. The rush to decriminalise non-payment of the licence fee and cut funding further is bound to impact on the quality and range of programmes.
There can be no doubt that many arts organisations face huge pressures. I will take as an example the City of Birmingham Symphony Orchestra, which I know best. In very difficult circumstances, the city council has done its best to protect funding, but, inevitably, there has been a loss of grant. With all the imaginative fundraising in the world, an orchestra such as the CBSO is now very vulnerable, as are many of the best arts organisations in our country. I would like the Government to encourage the Arts Council to do more to redress the imbalance in funding between London and the rest of the country. I remind the Minister that the 2013 report, Rebalancing our Cultural Capital, showed that per capita spend in London was 15 times that of the rest of the country, and I ask him what the Government are going to do about it.
So there is silence on the arts in the Queen’s Speech, and I rather thought that the Government might have liked to keep silent on the NHS. The Minister has no doubt read, as I have, the recent King’s Fund independent analysis of the wretched 2012 health Act. It concluded that it had produced an unwieldy structure, with leadership fractured between several national bodies, a complex regulatory system and a strategic vacuum in leadership. It is on that rocky ground that the Government now promise the integration of health and social care, implementation of the five-year forward plan, seven-day working, more resources for mental health and more funding generally—at least until the Secretary of State said yesterday that no more was needed.
How is integration of health and social care to be achieved when social care continues to take such a heavy burden in local authority cuts? Does anyone believe that the hapless clinical commissioning groups will take any notice of pleas to spend more on mental health? They certainly have not done so far.
No one could argue with the desire to reduce higher mortality rates at weekends, but is a true, seven-day working model deliverable given the scale of the financial challenge in the NHS, which is formidable? Already, we have seen performance deteriorating. The four-hour waiting time target for major A&E departments has been missed every week for nigh on two years. Cancer waiting time targets have been missed for five consecutive quarters. Ambulance waiting times have deteriorated. Lack of access to GPs is a source of considerable public concern. It was reported that 160,000 patients in the last two years have had to find new doctors because their practice has closed. Seven-day working in hospitals needs seven-day working in the community. How is that to happen when primary care is under so much pressure at the moment?
We know that employment agencies are taking the NHS to the cleaners, and the Government have belatedly acted by placing a cap on payments—I think that they found that the free market does not seem to work—but is not the real cause of agency overspend the lamentable decision that the noble Lord’s Government took to cut nurse training places? What are they going to do about it?
Seven-day working is hardly credible without recognition of the financial consequences. We had a provider deficit of nearly £1 billion in the last financial year; it is now estimated to double in the current financial year. The Minister mentioned the mystical £8 billion, but that is promised for 2020. It is clear that the NHS needs resources now, and it is clear that the £8 billion is credible only if the NHS drives up its efficiency to a level never achieved before. I would like to hear in the Minister’s winding-up speech exactly how he thinks that is going to be done without impacting on safety and quality of patient outcomes, remembering that clinical staffing costs are the biggest spend in the NHS budget.
The Government have such little confidence in their stewardship of the NHS that they are refusing to bring any NHS legislation to Parliament. Because of that, the professional accountability Bill, which is a Law Commission measure to enhance public protection through professional regulation, has been killed off. The Royal College of Surgeons has warned that one consequence will be that doctors will continue to perform cosmetic surgery without the necessary additional training or qualifications. Why is that going to be allowed to happen?
The Queen’s Speech certainly does not want for rhetoric. However, we shall judge the Government on their ability to deliver so that the benefits of economic growth are enjoyed by all rather than just the wealthy; that welfare policies will support rather than penalise working-age families; that schools and teachers will be encouraged to do their best for young people; that the huge contribution of the arts is recognised and appreciated; and that the NHS will be properly funded to respond to the extraordinary pressure it is under.
From these Benches we will be rigorous in our scrutiny of the legislative programme. We have made clear that, within the bounds of the convention, we will not hesitate to seek to defeat the Government when the occasion demands.
My Lords, in stark contrast to its emphasis in the gracious Speech, the NHS was one of the biggest issues in the recent general election, with an auction of all sides promising increased funding. The Conservative Party promised to provide all the money the NHS needs to carry out its five-year plan and yet, as we have just heard, we have had no details of where this money is coming from and we still have not. This has to be the biggest question to be asked today and I hope the Minister will be able to answer it.
Our health service is the envy of the world and is precious to all of us. We on these Benches are proud of our record on health in government, in particular the contribution of Paul Burstow and Norman Lamb on mental health. I will leave further comment on that subject area to my noble friend Lady Tyler of Enfield. Suffice it to say that we will continue to scrutinise the Government’s plans in this Parliament.
The NHS is only as good as the quality of its staff and management and there are major problems ahead. Nigel Edwards, the NHS chief executive, recently said:
“The NHS needs to hit very ambitious efficiency targets, at the same time as fundamentally changing the way care is delivered and moving to a seven day service. That can only be done if it has the right staff in the right places. Yet there are not enough staff to fill gaps in key areas, and we are seeing clear signs of stress and disengagement”.
This must be addressed. There is a demographic time bomb waiting for us, with doctors, nurses and midwives nearing retirement without an adequate supply in the pipeline. It is all very well promising 24/7 GP services but there are not enough GPs now. Patients in some areas wait weeks for a GP appointment. No wonder they resort to A&E. How will the Government monitor how HEE plans to train the staff needed to fill this yawning gap?
Qualifications are also an issue, especially among care workers. The Liberal Democrat manifesto called for a Bill to regulate the qualifications of health and care professionals. This would improve patient safety as well as reduce the burden and cost of an outdated regulation regime. Does the Minister recognise the need for this and have the Government any long-term plans to address the issue?
The Conservative manifesto promised integration between health and social care and yet the gracious Speech was silent on the matter. The pressure on hospital beds has made this matter all the more urgent. The first section of the Care Act began its implementation last month. Can the Minister say whether it is going according to plan, and what are the plans to learn lessons to ensure that phase 2 goes well?
Every relevant patient has an entitlement to a care assessment but how portable are these across the borders between England and Wales and England and Scotland? I happen to be a resident of Wales and have in the past year had experience of the health service in both England and Wales. Although my own care has been good, it is horrifying for residents of Wales to read every week of the failings of the Labour Welsh Government and poor standards of care and extended waiting lists. We even have calls for the inspection system to be scrapped and a health board to be put in special measures because of terrible failings in the treatment of elderly, vulnerable people at the Tawel Fan unit. That is just the latest of many problems. This is of course a devolved matter but if the problem is funding the people of Wales will want to know if a fair amount of the proposed increased NHS funding announced by the Government will come to Wales. They will hold the Welsh Labour Government to account for spending it all on health and for spending it wisely.
There are serious cross-border issues which should be of concern to the Westminster Government as well as to the devolved Administration in Cardiff. The House of Commons Select Committee on Welsh Affairs rightly maintained that access to healthcare should be on the basis of need, not which side of a border you happen to live. Yet Welsh patients referred to English hospitals have had their treatment delayed, regardless of their clinical need, because the Welsh Government wanted to save money. That cannot be right. What assurance can the Minister give me that the Government will work with the Labour Government of Wales to prevent this discrimination against Welsh patients?
Of course, it is often wise to invest in order to reap rewards later and health is a very good example of the truth of this rule. Health promotion and sickness prevention programmes must go hand in hand with treatment of disease. Indeed, the undoubted pressure on the NHS could be alleviated if there was more focus on health education and on ensuring that everyone has a safe, warm home and access to good fresh food. Both of those are causes of ill health. These issues are now mainly devolved to Public Health England and local health and well-being boards. Will the Minister say how the Secretary of State will use his mandate to ensure that the NHS is a health service and not a sickness service?
There has been much talk in recent days about the use of agency nurses as part of the debate about privatisation in the health service. From my point of view, delivery of services to everyone free at the point of delivery is the absolutely top principle. In order to ensure the best interests of the patient, if this can be delivered in a small minority of cases by a private organisation, that is acceptable as long as it provides good value for the taxpayer and gives no advantage to the private company over NHS providers.
Agency nurses are not the answer and neither is a cap on their remuneration. To me, the crucial challenge is the quality of management and planning within the NHS, the public service. I was recently in a ward with two patients and nine members of staff. That was poor planning when the procedures concerned were elective and not emergency. At the same time, there were other wards where the staff were run off their feet. Hospitals which plan their staffing well make little use of expensive agency nurses. It is fashionable for some politicians to make a big thing about cutting managers and increasing the number of nurses and doctors but I believe we must not forget that good management allows the nurses and doctors to do their job better. That has to be our aim in the interests of the patients.
Seven lines and one word in the gracious Speech summarise the programme to be undertaken by the Government, behind which lies a tremendous amount of work, as set out in the forward view programme for the NHS. It sets a formidable number of changes to be effected by many currently in post, requiring tenacity of purpose in the management of change, which is set out clearly. Again, there is no mention of where the money will be found.
The public want the NHS to succeed. It is very precious to everyone. That is recognised by the Government, who included it in their manifesto and in their five-year forward view programme. But the plans to create a first-class NHS are facing many difficulties. Having been involved in the NHS since 1953, I can recall similar agency nursing problems, staffing issues and winter pressures, to name but a few, but the NHS has survived—and survival is what is required now.
Survival is dependent on professionals pulling together, and on every single employer and employee in the health service. Breaking down professional and organisational boundaries under good leadership will provide the public with the evidence-based care that is safe and of the highest possible quality. This requires investment in leadership preparation for front-line practitioners from the top management roles to first-line management—right the way through the organisation—as well as investment in research, revisiting the NHS constitution, the nurturing of staff, and the establishment of a culture of care values so that everyone appreciates the care being given.
How can I talk about investing when so many cutbacks are being planned? I believe that vast sums of money can be saved if we look at the various ways forward, particularly in the area of waste in the NHS of food, drugs and equipment.
I wish briefly to raise three things on behalf of the nursing and midwifery workforce. The first is safe staffing levels, which remain an issue and were of concern during the previous Government, although much progress has been made. However, there is remaining uncertainty that requires more work in order to provide guidance that will ensure the highest-quality patient care that is funded to agreed levels. This will involve accurate workforce planning so that rates of admission to training are sufficient to meet needs.
The cuts in intake over the past three years have resulted in the lowest level of qualified nurses entering the profession for the past 10 years. Interestingly, the drop in intake seen over the past three years and today’s entry to the professions equate to the escalation of agency fees in the past three years. This, of course, presents financial problems, and perhaps the funding of nurse education should be revisited with regard to NHS grants and a possible change to the loan system, as for all other students in higher education. This idea caused considerable controversy in the professions when people began entering nursing graduate training professions, but the grants system continued.
We need to overcome the very high rate of employment of agency nurses and midwives, which is not only expensive but uneconomical. There is lack of continuity of care and in many cases a consequent delay in the discharge of patients. Radical action must be taken in order for workforce plans to equate with patient demand. This work must be done by Health Education England, NICE, the financial bodies, NHS England and the Nursing and Midwifery Council in consultation with the professional bodies, staff organisations and employer organisations.
The functioning of the regulatory body for nurse midwives and health visitors has been the subject of criticism over the time it has been taking for the fitness-to-practise system to consider cases from start to finish. There is great disappointment that the Law Commission Bill that was expected this Session has not been included. This is causing considerable problems. The changes would allow for a faster and more efficient process and save money for the overstretched NMC budget, as well as the part met by nurses’ fees. For too long, the NMC has suffered the criticisms of the fitness-to-practise system, and now there has been criticism of the supervision of midwives. These issues need to be addressed as soon as possible through legislation so that the NMC can reduce the time for the fitness-to-practise systems to be worked through and allow the NHS to address the supervision of midwives.
Two important pieces of work are being carried out: one, under the chairmanship of the noble Lord, Lord Willis, is to look at the shape and future of care reviewing, and the other, by the noble Baroness, Lady Cumberlege, is to look at midwifery. One report is out for consultation and both look to the future. I hope that the Minister will be able to take account of this. Where there is a will there is a way, and I believe that NHS staff have the will to do the care that is required, provided that resources are made available.
My Lords, the stated intention of the Education and Adoption Bill is to,
“give all children the best possible start in life”.
Of course we all want this, so we must scrutinise carefully whether the proposals on adoption will produce it for children for whom adoption is the best route. Given that some of the most successful adoption agencies are small, localised ones, care will need to be taken in any move to regional agencies—which certainly has its strengths—so that the smaller agencies’ special skills and experience are not lost, particularly as they are often the most effective at placing and maintaining adoptions of the most hard-to-place children. Durham Family Welfare in my own area is a fine example.
Childcare, we all recognise, is vital to ensure the best start in life. For most children, the very best childcare in the early years is given by the child’s own parents. The bonding and trust that is built is vital to long-term well-being. Nothing replaces the love of parents in the healthy development of a child. The extension of childcare offered to 30 hours a week must not create the impression that both parents, or the single parent, must go out to work. There is no harder, more socially valuable or more important work given to those able to have a child than raising that child well.
For many, though, work will be wanted or necessary, so increased provision in childcare is welcome, provided that the quality of what is offered is high. This can happen only with properly trained staff paid at a decent rate. The living wage for childcare workers needs to come in soon. It will be important, too, that the wide range of provision available is not reduced by the 30-hour allowance. Much childcare is provided in premises such as church halls, where an extension of hours by this much may not be possible. We need to take care that some of the highest-quality provision does not get lost in the extension of hours. I also ask whether it is appropriate for extended provision to be free for those on higher wages, who are well able to afford their childcare.
I welcome the inclusion, in the full employment and welfare benefits Bill, of the troubled families programme. Its success in helping families and children in difficult circumstances has been impressive. Since the programme also appears to deliver savings to the public purse, the case for its continuation is strong. Indeed, I urge Her Majesty’s Government to adopt a similar joined-up, personalised approach to helping individuals with multiple and complex needs.
Some of the preparatory work has already been done. Simple Change for Troubled Lives, rather than troubled families, is a recent publication by Framework housing association. It offers a blueprint for a troubled lives strategy. I commend it to your Lordships as a document that can be read quite quickly and summarised in five key actions: first, the extension of the troubled families programme to at least 60,000 individuals with most complex needs who need intensive long-term assistance; secondly, to ensure that others with multiple and complex needs have full assessments under the Care Act; thirdly, to ensure that people with multiple and complex needs have suitable housing; fourthly, to engage them in structured activity, leading wherever possible to paid work; fifthly, to align the various activities of government in this area so that they complement, rather than conflict with, each other.
The coalition Government made firm commitments to improve the help offered to people with multiple and complex needs as recently as the 2014 Autumn Statement and the 2015 Budget. I hope and pray for a strategy to deliver.
I have to express concern that the best start in life for every child will not be best served by freezing child benefit and child tax credit for the poorest families, particularly those in low-income work. Therefore, I support the proposal from the Children’s Society and others that child benefit should be excluded from the benefit cap as it is intended to support the costs of raising the child; it is not simply income to the parents. I also fear the long-term impact of more children being moved into poverty through the benefits freeze. Child poverty has long-term impacts on the health and development of those children, creating long-term increased costs for the whole of society. There is a danger of achieving short-term gain but long-term cost.
Child poverty is not remedied simply by child benefit, of course, but it is one important brick in the wall alongside preventing family breakdown, good education, helping people into good, meaningful work and tackling debt and addiction issues, which are recognised as critical to eradicating poverty in which children are caught. We all want the best start in life for every child in our nation. There is much to scrutinise in the proposals in the gracious Speech that affect the lives of children. We need to be assured by the Government that their proposals will truly give the best start, when it appears on first reading that some may well do so while others may actually harm children.
My Lords, I congratulate the right reverend Prelate on his speech and welcome my noble friend Lord Prior to the Front Bench. We very much look forward to his contributions.
In opening the debate on the gracious Speech, my noble friend Lady Bottomley was kind enough to recall a period when I ran a department that covered both health and social security. One result of that is that I have a certain trade union solidarity with the two Secretaries of State who now carry those responsibilities, particularly when it comes to public spending and the Secretary of State for Work and Pensions. If my experience is anything to go by, Cabinet discussions on public spending go something like this. Ministers in other departments unite in saying, “We must tackle this social spending, grasp the nettle, kill the sacred cows”, and, worst of all, “It is just a matter of presentation”, the implication being that people will rather enjoy having their benefits cut.
However, if you go forward a few weeks to discussing the actual savings to be made and you put forward proposals such as the abolition of the universal Christmas bonus and the death grant, which at that stage cost more to administer than to pay out, the reaction is, “No, no, no”—and that was just from the then Prime Minister. The poor old Secretary of State is left trying to find savings in a smaller and smaller pool, because it was already the rule that pensions and help for the retired could not be touched. That remains the case today. If we believe the reports that we have heard this week, we are now to be constrained by a pledge not to fundamentally tackle child benefit.
Benefits for the over 60s and over 65s, such as the cold weather allowance and bus passes, march on untouched. We cannot even put an age qualification such as 70 or 75 on the bus pass. I declare an interest in that those two age limits would exclude many but not me. So I am not going to lay into the Secretary of State, who has a difficult task, but I will just say this: to announce £12 billion of cuts without saying where they will fall is a perilous venture—I could put it more strongly. Certainly, in my day, the Government would not have got away with such an approach; Michael Foot would have been on to us in a moment.
More importantly, I challenge the assumption, as I did 30 years ago in my social security review, that the elderly are by definition those most in need. Some are, but some are certainly not. I am equally concerned about the position of poor families with children, hence my proposal for a family credit. My hope is that any reductions in spending should proceed from an analysis of need. We should also make as much progress as we can with universal credit, which I think is one of the great pluses of this Government.
Turning very briefly to health, a whole range of issues fill the newspapers daily, from cancer treatment to the promotion of better health, but above the individual issues is the crucial financial question of how all this can be afforded; we have touched on this in the debate. The Secretary of State says that for the immediate future, and with the extra resources going in, the National Health Service should be able to manage, and I believe him. What I am not convinced about is whether in the decades ahead we can go on in the same way, financing health predominantly from general taxation. We should be clear about the consequences of this protected policy. Inevitably, public spending in other areas will be reduced. The Treasury will have to look elsewhere for economies. It will have to look at reducing spending on the police and on defence—incidentally, reversing the priorities of the Thatcher years.
There may be no option but to follow that course, but before we settle on it we should look at the options of financing health. I emphasise that the present model may be best, but let us at least look at the other options and set them out. That does not commit us, the Government or anybody else to a particular course, but it allows a foundation to be built upon which we can base policy. For example, we should look at whether a separate health tax has some advantage in connecting the public more directly with the cost of health. We should look at some kind of health insurance along the lines of what is done in France or Germany and see whether that is practical. We should look at whether patient charges could make a greater contribution, and we should look at whether the private sector could make a meaningful contribution to the training of the health staff it uses.
Those are all difficult questions and there is only one time they can be properly addressed: at the beginning of a new Government with five years to go. I would favour a royal commission, which incidentally was a private proposal made to me by Lady Thatcher, but one that was demonstrably independent, working openly and relying on the skill of organisations such as the IFS and the King’s Fund. The aim would be to show the options, to inform not just the Government but the public. In my view, we have a once and for all opportunity to carry out such an investigation. Timing is everything and that timing is, frankly, now. We will not be forgiven if we ignore that opportunity.
My Lords, I will speak on the arts and broadcasting. Over the past 70 years there has been what could be called a combined effort to structure the arts in this country—from the Labour Party, the Arts Council and the Open University to the Conservatives, Channel 4 and the independent sector, and the lottery. Labour increased investment, provided free museums and supported libraries. Rather bewilderingly, over the past few years this has fallen away. I would like to look over the longer term to show how the arts have grown to great strength, most unexpectedly, in this country.
The growth of the arts is connected with the rebirth of great cities such as Glasgow, Cardiff, Leeds and others, which discovered that their identities and economies, which had been all but erased by the wipe-out of the 1980s, could be rekindled by a hub of activity the nucleus of which was the arts. Surprisingly, the arts moved to the centre of urban development. By then, we were growing a forest of festivals: 350 literary festivals, some attracting more than 200,000 visitors in a fortnight; music festivals of several varieties; and arts, dance, documentary film and ethnic festivals. There is nothing on this scale anywhere else.
The arts are efficient. They are crucially relevant to this country and to our larger economy in the world. The arts, broadly speaking, provide more than 2 million mostly highly specialised jobs and deliver an economic sector—about 7% at the moment—which has grown every year since the 1950s. Why not encourage this? Why cut a flourishing sector? It makes no sense when £1 of government money invested—not as subsidy—in the National Theatre, for instance, can facilitate the return of £16 into the economy. This example can be multiplied throughout the arts.
We are good at the arts. This comes not from innate national genius, alas. It comes from early nourishment, talent and opportunity. That is why our well-drilled drama, music, dance, film and art colleges are so vital. They are why we are so good but need to be well resourced. That is why we have to bring the arts as strongly as possible into schools, where they are not an add-on but a must-have. It has been proved again and again—how often does it have to be proved?—that schools which have choirs, orchestras and drama groups do better across the whole curriculum, in discipline and in examination results. The good start young and the arts provoke the imagination. We need to stimulate the imagination. All of us have it and none of us knows where it is, but we know what it does. It came before language and changed our species forever. It has altered our lives radically again and again, and is doing so now at an astonishing speed. Applying imagination is how we will take control of the future.
On broadcasting, I shall speak about two areas in what is now an extraordinary forest, or jungle, of hyperactivity around the planet. First, Sky Arts, for which I work as an independent, is the only TV channel in the country exclusively devoted to investing in, and making and presenting, the arts. It commissions plays by our finest playwrights, starring our best actors; it sets up national events such as the portrait-painting competition; it invests in classic arts programmes. It has also set up an academy for young artists, but it is no fig leaf. Sky is a commercial company and sees the arts as an integral part of the audiences who it wants to reach, which is a great recognition for the arts.
Then there is the BBC, for which I also work as an independent. This wonderful British invention, which has sealed itself into the country’s character and provided education, information and entertainment, often brilliantly and life-changingly, since it was given its Magna Carta by the Caledonian colossus, John Reith, in the 1920s, is in danger. It is incomparable and its Britishness is stamped right through that Caledonian rock but it is now faced with threats to its future authority. The licence fee could be the first casualty at the charter renewal next year. I hated the fact that people could be sent to jail for not paying it, but the consequences of abolishing that criminal charge could be substantial non-payment—with no sanction, there is no need to pay. There is also an increasing number of people who do not watch television on a television set, and therefore are outside the jurisdiction of the licence fee.
In my view, the BBC is the sum of its programmes, which are primarily directed towards us in the United Kingdom. It has got that right in area after area so often through the decades, and it still does. The BBC does many programmes that no other broadcaster would attempt. It never ceases to struggle to keep its—and our—independence, and now it needs positive support from those who it has served so widely and well for so long: that is, from us. Under the leadership of the noble Lord, Lord Hall, it has the will and the talent to put its case forcefully. I am sure that many in your Lordships’ House are eager to hear it. The BBC is too good to lose. It is unique to us. The BBC is not so much the family silver as the family itself.
Chris Smith—now the noble Lord, Lord Smith—coined the phrase “the creative economy”. It clumps a bit but it is a good and memorable phrase. We should be proud of it, look after it and build on it. It is the best thing we have got.
My Lords, let me start on a positive note. I was delighted that the gracious Speech, for the first time ever, I believe, contained a specific commitment to improving the plight of people with mental health problems. This demonstrates how much attitudes to mental health are changing. It is hardly a niche issue if you consider that one in four people in the UK is affected by mental health conditions, so pretty much every family in the land is touched by the problem. The commitments in the Conservative Party manifesto and the gracious Speech build on the ground-breaking work undertaken by Liberal Democrat Ministers in the coalition Government. I particularly pay tribute to the great work instigated by Paul Burstow and driven forward with such passion and commitment by my right honourable friend Norman Lamb.
Real strides were taken in the last Parliament by enshrining parity of esteem for physical and mental health services in legislation, and then starting to make a reality of it by the introduction of new waiting time and access standards for mental health services, crucially backed up by an injection of much-needed cash. We finally saw a real recognition of the links between physical and mental health issues.
Much more must be done to ensure that the historic underfunding of both adult and children’s mental health services is properly addressed. The Conservative manifesto commits to increasing spending on the NHS by at least £8 billion by 2020, although as other noble Lords have already said, it is far from clear where that money is coming from. The Government have also committed to take mental health as seriously as physical health and to increase funding for mental health care, which is very welcome. The big question for me is how much of this £8 billion will be spent on mental health services. In our manifesto, the Liberal Democrats pledged a total of £3.5 billion additional funding over the Parliament, covering both children’s and adult mental health services.
Can the Minister say what figures the Government will be committing to mental health over the lifetime of this Parliament? What proportions of that money will be spent on the commitments in the Conservative manifesto to ensuring that there are therapists in every part of the country, that new access and waiting times standards are enforced, and that women have access to mental health support during and after pregnancy? Of course, once the money is secured, we need to ensure that there is strong political and managerial will to make these things happen. Can the Minister confirm that in the next version of the NHS mandate, there will be a clear commitment from NHS England to publishing a comprehensive timetable for the introduction of new access standards and maximum waiting times across all mental health services?
It is noticeable that there was no mention of the pressing needs of people from black and minority ethnic communities, who have for too long been poorly served by mental health services, being both more likely to be diagnosed with mental health conditions and less likely to be able to access appropriate services and therapies. Will the Minister say what plans the Government have to address this wholly unacceptable state of affairs?
As a country, we must do better to support the one in 10 children and young people who have a mental health problem. Half of those people who go on to have lifetime mental health problems first experience symptoms by the age of 14, and 75% of children and young people experiencing a mental health problem do not access treatment. The consequences of failing to support these children and young people are profound.
Schools have a golden opportunity to protect and promote children’s mental health and at the same time help children attain good educational outcomes. So it is vital that the Department of Health works hand in glove with the Department for Education to promote good mental and emotional health and, in particular, to ensure that all schools offer good resilience and well-being education.
It is widely acknowledged that children’s mental health services have been seriously neglected and starved of cash in recent times. The Children and Young People’s Mental Health and Wellbeing Taskforce Report, Future in Mind, published in March by the Department of Health and NHS England, was an excellent piece of work with strong cross-party and sector support. It would be a travesty if it ended up gathering dust on shelves. It contains important recommendations on access and waiting time standards, on lead commissioning arrangements and on expanding IAPT services for children and young people, among many others. Will the Minister restate the commitment made in the March 2015 Budget to increase investment in mental health services for children and young mothers by £1.25 billion over the lifetime of the Parliament and make a firm commitment to respond to the task force recommendations?
It is totally unacceptable that hundreds of children experiencing a mental health crisis are held in police stations, and I therefore welcome the announcement in the gracious Speech that police cells will be eliminated as places of safety for children. This is long overdue. However, a change in the law alone is not enough. The current excessive use of police cells as places of safety is mainly the result of operational and commissioning failures, which lead to crisis care services for children being poorly developed in comparison to those for adults. It is vital that clinical commissioning groups prioritise investment in this area.
Finally, I strongly welcome measures outlined in the gracious Speech to expand access to early education and childcare, as they have the potential to improve child development and promote social mobility. I say “potential”, because it is vital that childcare and early years provision is of a high standard and that quality is maintained and improved, particularly to help children from disadvantaged backgrounds. That policy objective is as important as making it easier for parents to work. Both are critical, but sometimes those two objectives pull in opposite directions. The proposed extension of provision for 30 hours’ free childcare, while very welcome, raises many questions. I have no doubt that other noble Lords will raise those questions in their contributions, but I want particularly to ask whether additional help will be offered to disadvantaged parents, as recommended by the Lords Select Committee on Affordable Childcare, of which I had the privilege to be a member, or whether it will be a flat-rate scheme which, in effect, favours the better off. I look forward to hearing the answers to these and the other questions I have posed.
My Lords, I shall limit my remarks to two very important areas in the gracious Speech and its impact on the lives of disabled people—health and welfare. This year marks the 20th anniversary of the Disability Discrimination Act. I would ask for a round of applause, but I hear that that is frowned upon. It was followed a year later by the Community Care (Direct Payments) Act. Both laws were enacted by a Conservative Government, liberating millions of disabled people in the UK. We became visible in society. I was actively involved in campaigning for those laws and then working with the Government on their detail and implementation.
My apprenticeship began with the late, beloved Tony Newton. He developed the disability living allowance, which for the first time acknowledged the extra costs of being a disabled person. I then became a critical friend of subsequent Ministers: Nicholas Scott, John Major and William Hague, who called me his big sister because, he said, I was so bossy. So I have great expectations that the current team of Ministers will want to work in the same collaborative way as their illustrious predecessors.
The mid-1990s was a period we can all look back upon with pride. It was a time of great optimism among disabled people. But now is not such a good time. The Independent Living Fund has been closed, independent living care packages are being cut and disabled people really fear where the £12 billion in welfare cuts will fall. The gracious Speech referred to,
“giving new opportunities to the most disadvantaged”.
That is excellent news, since 52% of disabled people remain out of work and one-fifth of disabled people under 65 live below the poverty line. The number of disabled people who believe that they have choice and control over their lives has fallen from 76% in 2008 to just 66% in 2014. So I am pleased that the Government will increase the health budget and integrate healthcare and social care. Too often, social care is thought of as a concern only for older people, yet one-third of those who receive care are disabled adults. They, too, rely on these services to live independently.
Only 14 of the 91 local Better Care Fund plans approved in October 2014 include a focus on working-age disabled people. The Government must now look much more closely at how the Better Care Fund can support people of all ages, if they want us to work and participate in society. Crucially, they must also look at how the additional £8 billion to be invested in the NHS by 2020 will support social care. Otherwise, without significant financial investment, it will not deliver its vision for personalised independent living support. An estimated 97,000 fewer disabled people receive support, compared to five years ago.
Cutting social care is a false economy. Research shows that for every £l spent on support for disabled people with moderate-level needs, an average of £1.30 is saved by the NHS and local and central government. Social care enables disabled people and informal carers to become more socially and economically active, avoiding expensive residential care and hospital admissions.
I urge the Government also to integrate welfare support planning with health and social care. Each impacts on the other. Disabled people continue to be assessed for different support by different departments, wasting public funds on bureaucracy and appeals. We know this from the torturous transition from disability living allowance, DLA, to personal independence payments, PIP—largely due to lack of understanding of what it pays for and how it complements other health and social care services. If these extra costs are not met, independent living grinds to a halt.
A recent research report by the disability charity Scope estimates that, on average, disabled people spend £550 a month on disability-related expenditure on things not available through the NHS, welfare benefits or social care. These include buying specialised equipment, higher heating bills, paying for taxis to get around and covering higher insurance premiums. My annual budget for disability-related costs is £12,000. I did not do that calculation; it was done in my social care assessment.
I asked the last Government to consider triple-locking PIP in the same way that pensions are now protected. That would certainly enhance PIP, as the Prime Minister promised during the election campaign. It was referred to again at Prime Minister’s Question Time today. No answer was forthcoming, but I really hope for one later tonight.
Disabled people have a strong history of working closely with Conservative Governments to find integrated solutions to the barriers we face in society. I urge the new Government to work more collaboratively, as their illustrious predecessors did 20 years ago, so that disabled people do not slide back to the bad old days of dependency, isolation and poverty.
My Lords, I should like to comment on some implications of the digital revolution for healthcare and medicine, and I would like to ask the Minister to take some of these implications on board for future policy.
We are living through a period of probably the greatest technological innovation in human history, including even the original Industrial Revolution. It is driven by the digital revolution. When the telephone was invented, it took 75 years to reach 50 million people. The first iPhone was produced only in 2007. There are already close to 1 billion iPhones and something like 3 billion smartphones in the world, and there are as many mobile phones as there are people in the world. There has never before been a period of innovation of this speed, intensity and global scope.
The digital revolution is often misunderstood because it is identified with the internet. The advance of the internet is quite incredible because it has conquered the world in a period of less than 20 years. But the driving force of the digital revolution is the relationship between the internet, supercomputers and robotics. In studying these phenomena, I have come to see supercomputers as the prime driving force.
Supercomputers can already do many things that we cannot. The IBM computer Deep Blue beat the world chess champion in 1997. Most people can understand that—after all, chess is a sort of mathematical enterprise. Much more interestingly, though, much more recently another IBM supercomputer called Watson beat the two world champions at “Jeopardy!”. “Jeopardy!” is an ordinary language and general knowledge game. No one anticipated, even a few years ago, that computers would be able to do that. Supercomputers can compose poetry at least on a par with many human authors, and can compose music. This is a true revolution that has massive consequences for many areas of our lives. The iPhone you have in your pocket is more powerful than a supercomputer of only about 15 years ago. This had quite a big impact on the election, I think, because when you have an iPhone in your pocket you feel empowered, and indeed you are: you can get information on people whenever you want it, and you live a kind of just-in-time life. That is one of the reasons for the lateness of the result of the election and the fact that it was not anticipated.
My main point is that this is going to have unprecedented consequences for breakthroughs in medicine, and these must be incorporated in avant garde government policy. There are three reasons for this. The first is that for the first time in history, scientists can communicate with one another directly across the world in a way that was not possible before. There are vast volumes of accessible medical information on massive online sites that can drive medical advances in a way that was simply not possible until this generation. The second reason is that radical advances propelled by the computing capacity of supercomputers are simply unlocking areas of medicine that we had no idea we could conquer: you can decouple genetic chains, for example, and there have been massive advances in stem cell research. Many people will have seen material in the newspapers recently about breakthroughs in cancer. This is the cutting edge of advances that will become much more profound, and we must embody them in policy. The third reason is the breakthroughs everywhere in monitoring self-care and preventive medicine.
I wonder whether the Minister has read the book by Eric Topol, the celebrated American heart surgeon, called The Patient Will See You Now, which was a New York Times bestseller. We know what ordinarily happens when we go to A&E: we get there, we wait for five or six hours and they say, “The doctor will see you now”. The point of the title The Patient Will See You Now is that we will see a period of radical empowerment of patients through a diversity of digital technologies. This is not the future but the present, and there are many examples of how it is already working. We might think it will happen only down the line, but this is a period in which whole industries have been wiped out overnight and the same thing could also happen creatively in most areas of medicine and science. Technology might appear to be, as it were, the antithesis of the human—of living along with other people in a personal and direct fashion—but it is not.
I conclude by mentioning the example of Denmark, which is one of thousands that one could quote from around the world. In Denmark, remote monitoring and video conferencing are playing a huge role in end-of-life care and have transformed it. Over half the deaths in Denmark used to occur in hospital, with many people suffering in isolation. Now 90% of people pass away at home in the company of loved ones, even if some are on the other side of the world. No one working in the health service or in medicine should misunderstand the huge waves of change, which are not in their later stages but in their early stages and will radically transform what hospitals are and what medical care is. Eric Topol says that hospitals will eventually disappear. I do not think that that is a stupid idea; it is down the line.
Can the Minister comment on whether the Alan Turing Institute, which was being set up before the election, will come into being? It will be a cutting-edge institute for advanced maths and algorithms. I think some £42 million was supposedly dedicated by the Government for that institute, and five major British universities will be involved. Can the Minister confirm that that money will be there and the institute will devote a substantial proportion of its work to frontier medical research?
My Lords, I was delighted that the Minister referred to tourism and heritage in his opening contribution, because for many years, through successive Governments, tourism has been regarded as a Cinderella industry. In the 2010 election none of the major parties mentioned tourism at all in their manifestos. However, tourism is the number one industry in more parliamentary constituencies than any other single industry. It represents about 9% of GDP, and a third of the new jobs created between 2010 and 2013 have been in tourism—the gracious Speech talks very much about the importance of creating jobs.
I declare an interest as chairman of the Association of Leading Visitor Attractions. A number of us came together, determined that the 2015 manifestos of all parties would mention tourism. We lobbied, held a series of meetings, and I am glad to say that that came to pass: all the parties mentioned tourism in their manifestos. However, the majority of the commitments that were given were fairly bland and were very much of a generalised nature. The Conservatives, for example, said:
“We will set challenging targets for Visit Britain and Visit England to ensure more visitors travel outside the capital”,
“We will invest to boost tourism in the South West”.
Perhaps the noble Lord in his reply might give an indication of just what that means. It goes on:
“We will make it easier to access our beautiful landscapes, by providing free, comprehensive maps of all open-access green space”.
Once again, perhaps the noble Lord might tell us where those maps are—I am sure we are eagerly awaiting them.
The Labour Party talked of creating,
“a Prime Minister’s Committee on the Arts, Culture and Creative Industries, with a membership drawn from all sectors and regions. The Committee will bring issues of concern direct to the attention of the Prime Minister”.
Well, we have all been spared that, thankfully.
I am sorry to say that my own party’s commitment to tourism was equally disappointing:
“We will work to make sure the British tourism industry is able to compete with other major world destinations and be a key generator of growth in the UK economy”,
“Give higher status to tourism within the Department for Culture, Media and Sport”.
I must say that a number of the minor parties were more specific.
However, perhaps of greater importance were the conclusions and recommendations of the Commons Culture, Media and Sport Select Committee, which reported in March. It drew attention to a number of problems: the mistake in abolishing the RDAs without putting in place adequate arrangements for tourism promotion; the disparity in funding between VisitEngland’s funding compared with VisitScotland and Visit Wales; and that too many regulations are ill-fitted to the world of small businesses that characterise much of the tourist industry.
The Select Committee report made a number of recommendations, virtually all of which have strong industry support. It said that funding for the GREAT campaign should continue for a longer period, to give certainty to the industry, and that the Government should,
“make the cost of UK visas competitive, for example by moving towards the issue to bona fide tourists of more multiple entry, long term visas”.
It urged that the Government should,
“respond quickly and decisively to the Howard Davies review”,
once it reports, and recommended that the Government analyse the impact of air passenger duty on the United Kingdom’s tourism industry and monitor developments in Scotland and Wales closely for any impact on England. The Select Committee wants the merits of the claims of the Cut Tourism VAT campaign to be thoroughly assessed, and a vigorous cost-benefit analysis of daylight saving time. The Tourism Alliance calculates that double summer time could generate between £2.5 billion and £3.5 billion of additional revenue and some 60,000 to 80,000 new jobs.
The report concludes:
“We believe tourism should have a more visible profile in, and be more vigorously promoted by, its sponsoring Department”.
I believe that tourism should immediately be brought into the title of the DCMS—nothing would send a clearer message of support to the industry. Two members of the Select Committee are of course now in ministerial office at the DCMS: Tracey Crouch, who has ministerial responsibility for tourism, and John Whittingdale. Importantly, John Whittingdale, who chaired the committee, is now Secretary of State for Culture, Media and Sport, so he has a great opportunity to deliver on many of his own recommendations. As an industry, we wish him every success.
I want to confine my remarks to the question of pensions and retirement savings, but first I want to extend a very warm welcome to the new pensions Minister, the noble Baroness, Lady Altmann. Many of us have known her for many years. She is a lady with a formidable reputation for independent thought and advocacy of the rights of older people, and I very much hope that she continues in that vein in her new job at the Department for Work and Pensions.
The noble Baroness has a very large agenda to occupy herself with. Of course, very little was said in the Queen’s Speech about pensions or retirement savings. I am aware that the gracious Speech is a programme for one Session and that there will be many more before we reach the end of the life of this Parliament, but this issue is not going to go away. We are not done with getting and setting the right framework, and maintaining a consensus about how we can encourage more people to save more for their retirement.
I say that with some regret, because the last few years have seen a massive change in pensions policy in the UK—but those changes have been necessary for one overriding reason: we are facing a tidal wave of demographic change that is affecting our society and others like it. To put it into context, the recently published latest estimate from the Office for National Statistics of longevity in the UK is quite extraordinary. What was once exceptional is going to become the norm. Today in Britain, about 2,500 baby boys and girls will be born. That is fantastic for their parents, but for their pension plans and their pension trustees, it is probably not so good. Nearly 40% of those young boys and girls will reach the age of 100—something that was quite exceptional when I was born, when the figure might have been nearer 2% or 3%. What was exceptional is now going to be the norm.
Those changes have been broad in their scope and range in the last few years. We have changed the very concept of the basic state pension—it is now a single, flat-rated pension that is designed to encourage more people to save. We are enrolling millions of people in the workplace in new defined contribution savings plans, and many of them are saving for the first time. Importantly, age discrimination legislation has been introduced to make it illegal for employers to terminate people’s contracts of employment simply on the grounds of age—encouraging, we hope, more people to stay in work for longer.
In the dying days of the last Parliament, we had perhaps one of the biggest changes to pensions policy in a century: the sweeping away of the statutory requirement, dating back to 1921, on people saving in defined contribution plans to annuitise their pension pots when they cease working, guaranteeing them—we hope—an adequate stream of retirement income. However, as we know, for many, that stream horribly dried up as interest rates crashed.
Against that backdrop, surely people will curl up into the foetal position when people like me say, “Actually, we are not done with this yet”. To those who say, “Surely we are done with it”, I say, “We are definitely not”. In essence, the last Government and the previous one tried to do two things to deal with this change. We had a great deal of legislative reform, and welcome though it is, it is early days for most of it. We were trying to do two things. We wanted to encourage more people to save more for their retirement; and, wherever possible, we wanted people to work a few more years before they drew their pension. Of course, that was needed to ensure the long-term financial stability of the public social security pension, and the financial viability of their workplace pension schemes.
I think we can say, “So far, so good”. We are entitled to be reasonably optimistic that Britain slowly but surely is becoming a nation of savers. We have to be a nation of savers because the taxpayer can no longer underwrite the inadequate retirement savings of people in the workplace. There is now good evidence that people are beginning to retire later, and we should welcome that, too.
However, none of the manifestos of the main parties—and we now have to add another to the three established parties—set out any plans at all to encourage more workplace saving. Again, a bit of context might help us. A Lloyds Bank report in 2013 showed just what a mountain we have to climb. It confirmed that nearly a third of all UK households had no savings of any kind at all—zero savings—and that a further 14% of households had savings of less than £1,500. So nearly half of all UK households are just not prepared to deal with the force of these demographic changes.
Sadly, the savings ratio, although it goes up and down, has been more down than up; we are simply not saving enough. I would say to the new Minister, in whom I have a lot of confidence, that she probably has three substantial challenges ahead of her. The really big questions are: are people saving enough today and do they know how much they should be saving if they are properly to prepare themselves for what could be 30 or 40 years of retirement? We are talking about people spending almost as much time in retirement as they spent in their working lives. That is an extraordinary change.
I am afraid that the answer to both those questions is a resounding no. We are definitely not saving enough and people do not know how much they should be saving. Therefore, in this Parliament we are going to have to give some consideration to the adequacy of retirement savings. It is a public policy challenge of first-order significance. It is probably too early to think about changing the primary legislation on automatic enrolment. We need to get everyone in before we start changing anything else, and auto-escalation needs to settle down. However, I think that Ministers should now give urgent attention to setting a national retirement savings target and to helping people understand the sort of amounts they need to save now if their expectations for retirement are to be fulfilled.
I remain profoundly concerned that all the main parties are now looking at pension tax relief as a cash cow to spend on other priorities. Billions of pounds are maybe being inefficiently spent—I think that they probably are—encouraging people to save. Perhaps people would save anyway—they almost certainly would—but these are billions of pounds that we could redirect to encourage others to save more for their retirement, and we are not doing that. We are taking that money and spending it on other priorities, and that is a mistake.
Secondly, the Minister would be very well advised to do everything she can to try to retain the consensus that has been built since 2005, established by the noble Lord, Lord Turner. The annuities market reforms of 2014 have fractured that consensus to a considerable extent. Personally, I think that the reforms were justified; I do not think that it is acceptable any longer to tell people what to do with their money. None of us wants to be treated like an idiot, and we have to be given at least that sense of control. I have no problem with that. However, there is a very real risk that people will deplete their savings and the next generation of retirees and pensioners will find themselves impoverished—the curse of every previous generation. We have to avoid that.
Therefore, I hope that the Minister will give active consideration to the one outstanding recommendation of the report of the noble Lord, Lord Turner, that was not enacted by the last Labour Government. I hold my hand up and say that I was responsible for that. We now need to give active consideration to establishing a new, independent pensions commission, because auto-enrolment is at a critical stage. We have major decisions still to face but sometimes Ministers—bless them—are not the people to forge and build a national consensus; sometimes they need a bit of help. We certainly did and I am pretty sure that this Government will, too.
Finally, I hope that the Minister does not let go of her predecessor’s agenda of looking at the whole question of defined ambition pensions, which can improve the outcome for people who save in defined contribution pension schemes. If the Minister wants a steer, she need go no further than the extraordinary analysis by Bob Merton, the Nobel prize-winning economist, who has made a devastating critique of the inadequacies of defined contribution schemes. Basically, we are managing the wrong risk. When it comes to DC schemes, the most important thing for a saver to know is what sort of retirement income they can expect. At no point in the entire regulatory envelope surrounding defined contribution pension schemes is anyone addressing that fundamental question. The language of DC is one of asset valuation; it is not about retirement income. That is the strength of defined benefit, which is now, sadly, part of the history of pensions in the UK. However, for those millions of people now saving in defined contribution schemes we have to keep our focus on the adequacy of their retirement income. No one today is doing that. The defined ambition pension agenda began to give us the prospect that we might at last do that and I hope that we do not lose sight of it.
My Lords, I would first like to pay tribute to the noble Earl, Lord Howe, who worked so hard for the NHS and took a great deal of trouble answering many of your Lordships’ questions, including my own. I hope that the incoming Minister will pick up the many challenges surrounding the NHS.
I will quote what was said in the Queen’s Speech about,
“ensuring the National Health Service works on a seven-day basis. Measures will be introduced to improve access to general practitioners and to mental health care”.
I hope that the Minister, when summing up the debate, may tell your Lordships what these measures will be. Can this really happen or is it a pipe dream?
I live in a rural area where the surgery is open only four and a half days a week. My GP does not work on a Friday and my previous GP went to Canada. A lady who had a stroke some time ago recently telephoned the surgery when it was open as her medication was of a different brand from the one that she was used to. The surgery never rang back. When her carer telephoned 111, an ambulance was sent and she was taken to A&E. I feel that the Government’s idea of the NHS working on a seven-day basis would be of great benefit to patients but, if communication was better now, it would be at least a start towards better care. Communication and quick answers are so important between all medical services and patients, between NHS England and hospital trusts, and between Public Health England and social services.
There is no doubt that, in the rural area of North Yorkshire where I live, the veterinary out-of-hours service is far superior to that of the medical service. A vet rings back far quicker. Usually, it is a local vet who knows the area and is on an out-of-hours rota who attends.
How can England retain the doctors that we have? Are there going to be more medical schools to train more doctors? Should there not be a system so that they would have to stay in England for a said period after training?
Physiotherapists and occupational therapists are very important for rehabilitation. I know that some of those posts have been cut in hospital trusts that are in debt. This is a dilemma. Specialist nurses are vital for supporting such conditions as stroke, Parkinson’s disease, tuberculosis, spinal injuries, HIV, diabetes and so many others. Without enough specialist staff, the standards of the NHS will fall.
I ask the Government whether they agree with me that patient safety should be the top priority. We must stop tragedies happening where there is neglect and fear, as happened in the Mid Staffordshire NHS Foundation Trust; in Morecambe Bay, where babies and mothers died through inadequate care; and in Stepping Hill Hospital near Manchester, where patients were murdered by a rogue nurse injecting insulin into saline bags.
One drain on the National Health Service is the employment of agency nurses and doctors. I am glad that this is being addressed. We need well-trained, honest staff. Without doubt, this is one of the challenges facing the NHS.
As president of the Spinal Injuries Association, I am concerned about the very specialised treatments covering spinal injuries—neurology, orthopaedics, urology and sociology—being classed as rehabilitation only. It should be a specialist subject in its own right, which might help in getting good-quality medics, who are so badly needed, and would be an investment for the future.
It is of great concern that so many patients are misdiagnosed and that GPs do not send them on to the appropriate specialists quickly enough. This has been found to be the case so often; for example, by patients with multiple sclerosis who have to go three, four or five times to their GP before being sent for the appropriate tests and to a neurologist. This problem was highlighted last week by a young cancer patient who was diagnosed as having dietary anaemia because she was young, even though she had symptoms of cancer. She had aggressive cancer and died soon after finally being diagnosed. The Teenage Cancer Trust said:
“Sadly this story is not uncommon and is something we see time and time again in this age group … one in four young people with cancer have to visit their GP four times or more before being referred to a specialist”.
Surely something should, could and must be done to improve this unacceptable situation.
I cannot go without mentioning the wheelchair service, which is so important to so many seriously disabled people. Its slowness to achieve its objects needs looking at urgently.
It is estimated that 3.5 million people will be affected by a rare disease at some point in their lives. There are many examples of excellent practice for those with rare diseases throughout the UK, but unfortunately they are more often the exception than the rule. I ask the Government what progress is being made on the UK strategy for rare diseases. To meet the needs of people with rare diseases there needs to be collaboration between industry, healthcare professionals, universities and patient organisations.
I shall mention briefly mental health—it is such an important subject, but time restricts me. What are Her Majesty’s Government doing to help prison staff deal with the many people with the combination of having committed a crime and suffering a mental health condition? I do not think that prison staff are trained to cope in an unsatisfactory environment with mental health conditions.
Finally and by no means least, I feel that infection control should come high on the list of priorities. We should not be complacent because matters have improved in some situations. The global rate of drug resistance to antibiotics is increasing. Recently, I attended the showing of a film on resistance produced in the USA which illustrates what a vital aspect of living antibiotics are. We desperately need new ones as resistance increases worldwide.
One of the new Members of Parliament lost her father in a Yorkshire hospital to MRSA. She will campaign on these matters. They are of the utmost importance in safeguarding society.
My Lords, the gracious Speech said that the Government intend,
“to improve schools … and create more academies”.
I declare an interest as one of the sponsors of the first academy in Norfolk, the Open Academy, set up under the last Labour Government. It is now part of a thriving diocesan academies trust committed to school improvement. So I support the Government’s overall aim to improve schools, but there are areas where the direction of travel needs a few extra signposts.
The annual investment of the Church of England in our educational system runs into many millions of pounds. There are 4,500 Church of England primary schools and around 200 secondary schools. But direct responsibility for school improvement lies with the Church of England only in its academies. We do not currently have the power provided to local authorities to intervene where our voluntary schools do not perform as they should. Diocesan boards of education work closely with such schools, supporting them in a host of ways, but have no formal power when a school’s performance causes concern. So I ask the Minister whether his department will grant diocesan boards of education such powers, because dioceses are sometimes criticised for failing to take action without the capacity to do so.
The original aim of the academies’ programme was to improve the educational opportunities for young people in areas of social deprivation. That is how I got involved. The Open Academy in Norwich, which I mentioned earlier, has just been rated good by Ofsted and is on a journey to becoming an outstanding school. Not long ago the police noticed a remarkable drop in the recorded crime rate within a half-mile radius of the school and an even more striking reduction in ASBOs. The local population talks of a greater calmness on the estate. It is equally important that scarcely a pupil has left the academy in recent years without going into further or higher education, employment or training.
However, the recent Ofsted inspection, good as its outcome was, did not suggest much analysis of the school’s social context or its social and economic impact. Something profound was missed. I would be grateful to know how our schools are seen by the Government as agencies of social and community transformation.
Only once was there a change of gear in that inspection when, as governors, we were asked what we were doing to promote British values. I inquired, politely, what British values were and was told that tolerance was among them. Yet we do not tolerate bullying, disrespect, violent behaviour, possession of drugs and a good deal else. We need to get our language right if we are to impart the right values in our schools.
Language matters. During the election campaign we heard a great deal about hard-working families from all sides of the political divide. This always seemed to mean families whose members were in employment. Back in the 1990s, when I was involved in poverty hearings, I vowed never to equate hard work only with employment and jobs again. I remember a young woman at a poverty hearing in Cornwall describing how she had been seeking a permanent job for more than two years and saying that it was very hard work indeed being poor and unemployed and attempting to make ends meet while also sending off applications for jobs when, time after time, no one responded. She had had some temporary employment but said that it was much harder work being unemployed than it was in a job. I am not sure that the language we use about the poor and unemployed is always sensitive to this basic truth.
If language matters, so too does culture. In relation to education, it is altering the culture of a failing school which is the hardest thing to do. It is about reshaping expectations and nurturing creativity but also building the right ethos. I remember being told years ago that as a diocesan bishop I could delegate almost everything to suffragan bishops, archdeacons and other members of my staff. However, there was one thing I could not delegate—the ethos of the diocese. Ethos is very hard to pin down, especially the ethos of a nation. The Prime Minister of the day helps to shape the ethos of the country and I am glad the beginning of the gracious Speech invoked the one-nation approach and governing in the interests of everyone. It struck exactly the right note and the legislative programme will be judged in this light.
One of the strongest shapers of the ethos of our nation continues to be the BBC. It is truly British. Its range and reach seem to irritate some people but it is one of the most socially cohesive of all our institutions—as one would have seen at Norwich over the recent bank holiday weekend when 50,000 young people gathered in devotion to Taylor Swift and many of the pop stars of our time, only a few of whom I have heard of. Many others in Norwich—indeed, rather more—were on pilgrimage to Wembley on a quest to get Norwich City back in the Premier League, a happily successful mission.
The range and reach of the BBC stretch well beyond these shores, of course, and I have never understood why the World Service ceased to be financed from the Foreign Office. In terms of soft power in the world we have a treasure which is the envy of other nations, not least because people in every part of the world regard the BBC as impartial and trustworthy. In a world in which cultures of trust need building—desperately in many places—to possess such a building block in the BBC should be something we cherish. I hope we will remember that in the run-up to the renewal of the charter.
My Lords, little is more important to the future of this country than the education of our young people. It is entirely right that the Government should take action to improve “failing and coasting schools”. However, in their commitment to,
“give every child the best start in life”,
I urge that we do not focus simply on academic excellence, on constantly improving exam results to ensure that we get greater numbers of young people into university and on being bent on attaining ever more and better degrees. There is so much more to a fulfilled life than simply passing exams. I do not say that because it never featured highly in my own skill set.
While we have been working so hard to cram our kids with academic knowledge, I fear that we have neglected vital, non-academic employability skills, and important social and interpersonal skills, including what my parents would have described as good manners. There is no point in preparing a child for the world of work, with straight A grades in English and maths, if he or she turns up for their first job interview unaware of basic business terminology, etiquette and presentation skills or any idea of how to address a potential employer—should it be Mr, Mrs, Miss, Madam, sir, mate or a first name? How could they know that if no one has taught them? They may have no concept of basic, common courtesies, such as a handshake and how to execute it, the impact of a smile or whether to look directly into the interviewer’s eyes. Some may be ignorant of the relevance and importance of their appearance, including, for example, whether it is okay to wear a cropped top or ripped jeans, to wear trainers or polished shoes, or to wear a tie.
Very often a young person shows absolutely no evidence of an interest in the company or the job for which they are being interviewed. That evidence would have been easily provided if they had only known to do some elementary research into the business and prepare a list of questions. However, there is every chance that tomorrow’s potential movers and shakers would have missed the interview completely, having never been apprised or taught the vital importance of timekeeping and punctuality. Our country cannot hope to fulfil its potential if we fail to turn out young people who are not only well educated but also employable; that is, work-ready. A confidence-building basic education in communication, presentation and social skills, which has been the cri de coeur of the CBI for many years, surely should be part of the school curriculum.
However, it also can be developed most powerfully outside the classroom. Here, I declare an interest as chairman of the Duke of Edinburgh’s Award and deputy patron of the Outward Bound Trust. For nearly 60 years, those organisations have been proving that we can enhance the life chances of young people, particularly those from disadvantaged backgrounds, by giving them skills that are relevant and appealing to employers. Those skills, which are beyond the academic curriculum, include teamwork, communication, self-discipline, initiative, adaptability and leadership. The ability to take on and complete a challenge such as the Duke of Edinburgh’s Award creates resilience, confidence and a can-do attitude, which will take a young person far—perhaps one day even to membership of your Lordships’ House. We often quite rightly express concern about the social disengagement of our young people; yet getting young people involved in social action is not impossible. Volunteering, for example, is a proven way to capture their interest, and can break through the barrier and persuade them to care.
Hands-on volunteering is a win-win situation for the young person taking part and for society as a whole. At the Duke of Edinburgh’s Award we have experienced many decades of not just helping young people achieve awards but also encouraging them to volunteer for a huge range of activities, including helping in charity shops, working in urban conservation, supporting people in need, working in animal welfare, improving the environment and raising money for a whole range of charities. We achieve that by communicating with young people in language they understand and through channels they can relate to, particularly online. We do it by working closely with a growing number of schools and by tirelessly raising money to make our opportunities available to as many young people as we can.
I am not standing here to deliver an advertisement for the Duke of Edinburgh’s Award or the Outward Bound Trust, proud though I am of their many great achievements, but to emphasise that all the skills they teach and the positive attitudes they encourage are every bit as relevant to the success of our children and grandchildren as the academic skills that are taught in schools. They should be core standards in every school curriculum. My heartfelt appeal is that we should seek ways to integrate this approach more fully into formal education for all, and in doing so we can look forward to producing a more rounded, confident and capable generation—a generation that would undoubtedly create better furniture salesmen, perhaps more popular bankers, better hairdressers, lawyers, mums and dads, politicians and even Secretaries of State.
Formally teaching in our schools these important soft skills, proven by the Duke of Edinburgh’s Award and others, is a simple concept that I believe could contain the makings of a truly virtuous circle, and that really would help to give every child the best start in life.
My Lords, I should like to comment on the parts of the gracious Speech that deal with education and children’s policy. In doing so I welcome some of the measures in the gracious Speech and other measures which the Government have indicated they will take forward in the coming months. I welcome the principle of extra childcare, although as we have heard today there are a lot of questions that need to be asked. The changes to the adoption process are well intentioned and will probably mean a better deal for more children. I certainly welcome the Government’s intention to continue with the pupil premium, and I hope that they will continue their work with vocational qualifications, where I think they had a good record in the last Parliament.
In particular in the debate today, I share with the Minister, the noble Lord, Lord Nash, the ambition to raise standards in schools. Whatever else may divide us, I do not doubt any noble Lord’s wish to make sure that every child receives a good-quality education and leaves school with the skills and attitudes they need to survive in the world, to contribute to society and to flourish. It is perhaps timely to recognise the progress that has been made. I always say that the noble Lord, Lord Baker, started the revolution way back in 1988. Since then it has been non-stop change. In that time we have seen every measure of success improve: twice as many children achieve five A to C grades, including in English and maths.
It also behoves us to remind ourselves that when we are talking about improvement, whatever we do here the real difference lies in the quality of the teaching and leadership in our schools. That is how we should measure the proposals that have been put forward. Anything politicians or Governments do must be judged by whether it is likely to improve the way head teachers lead schools and the way teachers teach.
I turn to the legislation on the extension of academies. This is important legislation, but let us be clear: it is not about whether individual academies are good schools. I could join the noble Lord, Lord Nash, in citing many academies that have done a good job and I have been delighted to visit many of them. I have seen the extra capacity that a sponsor brings. I have shared in the joy when schools have been turned around, and we can only rejoice that more children have more life chances. I could also give an equally long list of non-academy schools that have done exactly that.
However, I do not take away from the successful performance of many individual academies. The proposed Bill in the gracious Speech is not about that; it is about whether academies should spearhead the next stage of school improvement and in effect become the predominant school structure, particularly for secondary schools. The Bill is looking at an education system that is at a tipping point. More than half of our secondary schools are already academies, and the Bill will contain proposals to limit the right of people to object to schools changing to academy status. They are the very same parents who are being told in different legislation that they are the people who know best what is good for their children, but no doubt we will return to this during the passage of the legislation.
If we are to take that step and have academies spearhead all school improvement, which would be a pivotal step and a big moment in the development of education policy, the Government have to give evidence and assure us on three counts: first, that these schools deliver better results for more children than any other type of school; secondly, that it justifies the expenditure and human resource that will need to be put into making the transition; and, thirdly, that it does no harm to other already successful parts of the school system. Although I admire individual academy schools, I am not persuaded that any of those three criteria can be met. Despite the individual success stories, there is no evidence that the success of academies as a group justifies them being given the pre-eminent position in our education system that the Government suggest.
I put forward this evidence. Five years ago we passed legislation in this House that set up what were known as stand-alone academies: academies that were judged by Ofsted to be “good” or “outstanding” could convert very easily from maintained to academy status. One in seven of those schools was subsequently categorised as “requires improvement” or went into special measures. Ofsted has found that we do not just have a postcode lottery in maintained schools: more than eight out of 10 sponsor-led academies in London are “good” or “outstanding”; only just over three out of 10 are in the east of England. Academies have not got rid of that postcode lottery; whether you get a good school depends on where you go to school.
Although the Sutton Trust noted the very high performance of academy chains such as Harris and ARK, it concluded that most academy chains,
“are not achieving distinctive outcomes compared to mainstream schools”.
That is why the Select Committee that looked at academies and the evidence behind them concluded:
“Academisation is not always successful nor is it the only proven alternative for a struggling school”.
Quite frankly, there are still too many unanswerable questions and points of weakness in a school system that would be made up only of academies. Oversight of these schools by the Department for Education leaves a lot to be desired. It is still not clear what happens when an academy fails, and we have still not sorted out how much local authorities’ responsibility for standards is then matched with giving them powers to intervene in academies.
That is why I am worried about this Bill and why it will need very special attention when it comes to the House. Quite frankly, the Minister and his department have lost their ability to think critically about academies. The phrase “the emperor and his new clothes” comes to mind. I cannot ever recall seeing a Select Committee report where the responsible government department disengaged from the issue and the debate as much as the Department for Education did with the report on academies. In the words of the Select Committee,
“the DfE failed to address our terms of reference and instead presented a sustained paean of praise to the success of the policy”.
That is no way to develop policy on one of the most important services that we provide and that ensures for all of us the next generation that we would want.
The Government are making a mistake that many of their predecessors have made: they wish to find a school structure that can give all the answers to all the problems that we have. I have counted 17 different school structures since the end of the war in 1945; none has managed to deliver all the improvement that we want. I only wish it was that easy. I look forward to the debates on the Bills that have been in outlined in the gracious Speech when they are presented to the House of Lords. They will indeed cause debate, but there are many serious questions that the Government will need to answer.
My Lords, before turning to my remarks on the welfare part of the gracious Speech, I will pay tribute to the former Minister for Pensions, my erstwhile colleague Steve Webb, who played such an important part at the DWP. His knowledge of the complex worlds of both benefits and pensions was unparalleled. I also mention Mark Harper, the most recent Minister for Disabled People, who has now risen to the giddy height of government Chief Whip in another place. He was very good at listening to those of us who are disabled here and I hope that his successor, Mr Justin Tomlinson, will be found similarly approachable by some of us here. After all, this House probably beats the other place in its number of disabled Members—although one must never forget those with hidden disabilities.
Before going on, I declare my usual interest in receiving DLA. The noble Lord, Lord Freud, who I am afraid is no longer my noble friend but I hope is still a friend, will not be surprised that those of us who focus on welfare in this House are understandably fearful of the £12 billion of planned cuts in the unprotected parts of the DWP budget. This will be a recurring theme this afternoon for those of us speaking about welfare, as the noble Lord, Lord Fowler, did. We do not know nearly enough about where these cuts will come. Might this mean taxing or means-testing disability benefits? Even the Times called this a “nightmare policy”. All we know, I think, is that some research was commissioned on this, but I note that it has not been ruled out—as was, two days ago, the limiting of child benefit. We will, almost certainly, have to wait until the Budget next month, and then the comprehensive spending review in the autumn, to find out the full details.
The only policies in this area which have been announced are a reduction in the benefit cap and the freezing of child benefit and a number of working-age benefits and tax credits. What we do not know at this point is what impact these policies will have on some of the most vulnerable families. More of them will have to move out of expensive housing areas such as London, and the pressure on local welfare assistance schemes and food banks is likely to increase.
The whole subject of local assistance schemes, and how they should be taken forward, is worthy of a separate debate, such are the questions it throws up, but there is no time for that today. I commend the Social Security Advisory Committee’s report on this, published recently. I am glad that the Government are keen to get more disabled people into work by halving the gap between disabled and non-disabled people. That is a very ambitious aim and I hope that we hear more about how it is to be achieved. I hope that the noble Lord can give us a commitment not to cut the Access to Work budget, which is surely a key part of getting disabled people into work. I am very pleased to hear that the referral process has been made simpler and that the mental health support services contract appears to be secure. What is now needed is another push to publicise the mental health part of the scheme and the whole Access to Work initiative, but there is no point in this unless the budget is safe.
Under the same heading, I am afraid that I make no apology for mentioning yet again how concerned I am at the move from 50 metres to 20 metres in the personal independence payment assessment, which is extraordinarily harsh and will mean that thousands of disabled people are likely to lose the enhanced rate of mobility allowance, and thus their Motability cars, when the bulk of reassessments start in October. This will surely not help the Government’s stated aim of getting a lot more disabled people into work, and will particularly hit disabled people in rural areas. I know that PIP guidance is now statutory, but I wonder whether that is really making a difference. I am not holding my breath that the descriptor will be changed, as I think it should be. All I can hope is that the healthcare assessors working for Atos and Capita who do the PIP assessments are diligent in reading any supporting letters from a claimant’s doctor, consultant or physiotherapist, and that they closely question the claimant about whether they can walk the short distance in the test even if there is a gale-force wind blowing, an icy surface, or they have to cross a busy road with kerbs—and, of course, whether they can walk this distance, not too slowly, several times a day if necessary.
Lastly, I look forward to the work of the post-legislative scrutiny committee on the Equality Act 2010 as it affects disabled people. Many people think that anything enshrined in law is done and dusted, which is why it is necessary to see exactly how the law is working, and whether some more dusting needs to be done.
My Lords, we all know that government faces massive tasks in education. Demographic changes demand a great deal of school building as well as a big expansion in the number of teachers trained to fill existing and projected shortages. In April this year, Tessa Jowell estimated a shortfall by 2020 of 40,000 secondary and primary places in London, with more than 3,500 of them in Lambeth alone.
Then there is the gross unevenness of provision across the country. In the north of England, only a quarter of pupils sit for high-value GCSEs as compared with the south-east. No wonder Sir Peter Lampl is so horrified. Nor must we forget our need for a dramatic expansion and improvement of vocational education, an area in which the noble Baroness, Lady Neville-Rolfe, noted:
“England has had a historic weakness and where we continue to lag behind the performance of other developed countries”.
She doubtless had in mind Germany and its famed Berufsschulen.
But there is more. In the New Statesman last month, the noble Lord, Lord Adonis, recalled that, in his first Administration, Mr Blair set up a “standards and effectiveness unit” whose,
“main responsibility was the implementation of national literacy and numeracy strategies, intended to ensure that all 11-year-olds demonstrated the competence expected of their age in reading, writing and maths”.
It is deeply frustrating that today, nearly 20 years on, we still cannot achieve even these modest aims. The despairing complaints of employers are as loud as ever. International comparisons are as gloomy as ever as they chart this country’s humble progress. The latest example is the lengthy OECD report Universal Basic Skills, published last month. Our distance behind Hong Kong, Singapore, Korea and Taipei is, of course, familiar and not particularly dismaying. Education is deeply embedded in, and inseparable from, the whole social, familial, behavioural and political nexus. We could not, nor would we want to, buy into the co-occurring value systems of China or Korea. What is far more serious and relevant is that we also lag behind our European neighbours whose social and political liberalism we share, and whose education systems we could and should regard as models. The OECD report shows us behind no fewer than 11 countries of the European Union, including big ones such as Germany and Poland. The lag includes mother-tongue literacy, where we are no match for our neighbours in, for example, the field of lexicology, which plays a prominent role in schools from Calais to Moscow but which is largely ignored in this country, with dire consequences such as the communicational poverty with which we are all too familiar among British school-leavers.
During the recent consultation on the national curriculum, the Department for Education was sent copies of the mother-tongue curricula operating in the biggest of the German Länder. These insist on vocabulary study being at the heart of linguistic communication for the understanding of all school subjects. Lexical systems are taught in carefully planned stages, together with the essential understanding of semantic structures such as polarities and hierarchies. Yet when the new curriculum was published recently, almost nothing had happened, and it seems that at the highest level in the DfE it is believed that vocabulary is something that can be picked up randomly. This was of course precisely the case with spelling and grammar in the bad old days of “anything goes”. Welcome action was taken and the Government now issue pages and pages of detailed spelling rules and a modern exposition of grammar—but not so with vocabulary.
Earlier this year I put several Written Questions to the noble Lord, Lord Nash, asking him to explain why the extensive curriculum framework document had a lengthy section entitled—note the order—“Vocabulary, grammar and punctuation” but with literally nothing in it on vocabulary despite it being the first named. In response, the noble Lord, Lord Nash, confessed that there was no separate programme of study for vocabulary but that there was “a clear expectation” that teachers were required to develop students’ vocabulary “actively” and “systematically”. Despite further Questions during the last days of the coalition, I have still not been informed on what this “clear expectation” is based or where teachers can learn of the systems on which they are expected to be building. Will the new Government now address these issues seriously and urgently? After all, English and maths are rightly identified as the core subjects and we must have curricula in both that are fit for purpose.
Finally, I will say a brief word on higher education. Will Ministers address the steep decline in part-time student numbers? Are they fully alive to the vital needs of our foremost research universities, such as UCL and Imperial? Will the ring-fenced science and research budget continue to be protected? What is going to happen to the resource and capital budgets of the Department for Business, Innovation and Skills? Will the Government pay heed to the role of the EU research funding into which our universities have been tapping so successfully? Lastly, may I remind Ministers that every pound of public money spent on research attracts the generous support of foundations such as Wellcome and Wolfson?
My Lords, I wish to speak on education. I was heartened to hear the prominence the Minister gave to education in his opening remarks—within what must have been a ragbag of possible subjects—especially since it seemed to have been lost or marginalised in the recent general election campaign. I am really delighted to follow so closely on from my noble friend Lady Morris in front of me. If ever there were a subject that deserved the best and the most dispassionate energies of our Parliament as a whole, regardless of party, it surely has to be education.
How many years ago was it that the clarion call was, “Education, education, education”? Surely we must restore the subject to that level of importance. We heard in the Queen’s Speech that:
“Legislation will be brought forward to improve schools and give every child the best start in life”—
who could be against that? There will be “new powers”—when we have witnessed the flooding of powers to the Department for Education and the accumulation of executive authority with the department and with the Secretary of State for Education—
“to take over failing and coasting schools and create more academies”.
I need not repeat the points made by my noble friend Lady Morris about 17 different school structures and the lack of ability of any single one to deliver all the objectives we wish for them. Pragmatism, variety and approaching issues according to the needs of a particular locality have to be in our minds as well as a one-size-fits-all, monochrome approach, which I sometimes feel the ideologisation of the question of academies has done for the debate on education. Like my noble friend, I have no hesitation in recognising the real qualities of good academies but I hope we can all agree that time has not yet lapsed sufficiently for us to take an objective, proper and balanced view of their contribution to the total scene we are seeking to provide. We must recognise that.
I note that in his speech the Minister itemised and named a number of successful academies—good for them, but I could name a similar number of schools in local authorities that are as successful. Since the Minister was bold enough to cite particular examples, I am going to boast. I am the chair of trustees of the Central Foundation Schools of London. When I became a governor of the boys’ school some 12 or 15 years ago, both schools were in special measures but now 85% of our kids doing GCSEs get A* to C, including in English and maths. The Central Foundation Schools of London can match any academy, in the most putrid and awful buildings and premises that one could imagine. I am proud of our headmaster and proud of our staff, and I will not have it that it is only academies that can register this degree of success. It is not fair to the discussion that education deserves.
What is more, we must look a bit more critically at the question of academies. The lawyers we retain at the Central Foundation School have just held a very high-level forum. Out of it all they noticed the following. This is a trend, not yet a final position, but your Lordships should note it well. It is about multiple academy trusts. MATs are not simply partnerships of schools. There are economies of scale. We can take advantage of shared experience. We can teach subjects across our schools and have a fantastic ability to harmonise a good result out of our disparities. But the report says that there is,
“also a danger that, with the imposition of rules and regulations across the chain, MATs might increasingly reproduce the bureaucracy of local authorities. Such bureaucratization might endanger the innovative character within MATs; standardisation of practice might also hinder the ability to respond to community needs in different schools or localities”.
I do not offer that quotation as a judgment on the whole experiment but I urge this House to look seriously and in a balanced way at the pluses and the minuses—the good things and the bad things, the dangerous trends as well as the wonderful accomplishments—of academies. They do not of themselves spell a future that is success. They must be looked at with more dispassionate eyes than that.
Because I am going to observe the time limit, I just want to mention that we are operating on budgets in our schools which will see a reduction in real terms as we face extra costs. We are looking at a reduction of 7.6% because of extra insurance and pension contributions, and savings of a considerable nature have to be made. Ring-fencing does not make sense when we are looking at budgets that have to be reduced in this way. We will of course look for greater efficiency and productivity but let us be honest about the fact that our schools are under great pressure at the moment. Let us not limit our attention to the academies, all of whose successes we laud but which are not a panacea for the educational needs of our country at this time in our history.
My Lords, when I put my name down to speak in this debate, I must admit that it was to make a general point about something that has been missed. However, it fits into the last few speeches because the noble Lord, Lord Griffiths, and the noble Baroness, Lady Morris, spoke about the confusing state of education and the organisation of schools. This has also led to a slightly confusing state when it comes to teacher training, with various levels of qualification going in and out, and leads directly to the point that I shall make. Here, I come to my more familiar ground and if the rest of the House wants to put itself into doze mode as I talk about dyslexia and other special educational needs, I would not hold it against any of your Lordships.
Teacher training has one great hole in it: the fact that it does not train people properly to deal with those with special educational needs through specialist training. Dyslexia is reckoned by everybody outside government to affect 10% of the population, while the Government reckon that it is 8%. Let us compromise on 9%, so that in a standard classroom you will normally get only two point something or three such people in there, although getting four or five will be as common as getting none. We have accepted that we need to do more work here. Indeed, from the previous Government I pay tribute to Sarah Teather, who set up the process of the special educational needs bit of the Children and Families Act, to David Laws, who saw it through, and indeed to the noble Lord, Lord Nash, who got that Bill through this House. I understand that it is a busy day but I hope that the Government Front Bench will convey the fact that I appreciate the work that the Minister did on the process of that Bill, because he listened.
If we are to go through a process where we extend the time over which people need to be trained, would it not be sensible to make sure that teachers—the initial people you are talking about—have the skills to identify those with different learning patterns from the rest of those in their classrooms? I was thinking of another way of describing this but I am afraid that I have come down to only one: it is the bleeding obvious. Three of your normal class do not have the same learning pattern because they are dyslexic. Their brains do not process information in the same way and they have bad short-term memories. When chalk and talk are used—that is, to convey information to them—they cannot absorb it in the same way. We then come to those with dyscalculia or dyspraxia, who will have other problems. Once again, they will not be able to process the information in the same way as the norm. Then we could put in people with things such as autism, most of whom are at the high-functioning end. They will have other social problems, which will mean that they will not relate to the classroom properly or absorb the information. If the teacher cannot spot this, he cannot make any adaptations to their learning style. You are effectively asking somebody to make bricks without straw.
Who has said that it would be a good idea to bring this in? I have a list of reports from the past few years and I have excluded from it all those with “dyslexia” in the title. We have had the Rose review, the SEND code of practice and the Driver Youth Trust with its lovely report, titled The Fish in the Tree. There was the Every Child a Chance Trust report and the Carter review. There was a report from the Communication Trust—the list goes on. Everybody has agreed that this is a huge hole because you are asking the professional to do something which they are not trained to do. The result is that we have people who cannot join in the process of education because they have problems processing.
The Government could turn around and say, “Let’s have a few more specialists”. That falls down quickly because if you do not identify the person to be put in front of the specialist, you cannot get the help—and the people who always end up getting the worst deal are those just on the edge, who are not very obvious. Dyslexia in particular is called the middle-class disease but that is wrong. It is the exam-passing classes’ disease because what happens now is that a parent says, “Why is my child not achieving?”. They take it to the teacher and then the teacher goes, “Oh, I’m not sure. Do you think that it could be dyslexia?”. There is then a legal struggle to get that person assessed. I want, in the course of this Government, to get a little closer to where the teacher turns round to the parent and says, “Your child is not achieving because I think they could have one of these hidden disabilities”. If we do that, we will address many of the problems and make the job of the teacher, and the whole process, much easier.
I come back to my point: it is the bleeding obvious. Unless we are prepared to take something along the lines that will improve the situation, we will be guaranteed a continued amount of failure—and the costs that go with it in those who cannot find employment or access the norms of procedure, as we have heard about before. Why should they, since it does not apply to them? Unless we start to do this, we will be storing up more trouble. I encourage all in this House to pay attention to this because one small change—an extra week of training, in a course of about a year—could have massive, positive results for the whole of society.
My Lords, I shall speak about the NHS and fully endorse the deep concerns of a number of noble Lords at how promises in the gracious Speech such as closer working integration, seven-day working and better access to GP and mental health services can be met in the light of the scale of the huge financial and quality challenges facing the NHS, and while social care continues to take such a heavy burden in cuts.
Today, however, I shall speak about NHS specialised services and rare diseases, which present a major challenge to the NHS on no lesser a scale than some of those already referred to. In so doing, I declare an interest as chair of the Specialised Healthcare Alliance, a cross-party coalition of more than 100 patient-related organisations supported by 16 corporate members, which campaigns on behalf of people with rare and complex conditions. The alliance works closely with Members across parties. The noble Earl, Lord Howe, the former Lord Speaker, the noble Baroness, Lady Hayman, the noble Baroness, Lady Jolly, and my noble friend Lady Pitkeathley are all past chairs or vice-chairs of the alliance, so I am part of an illustrious bunch. They have all been strong advocates for quality and coherent specialised healthcare services. Of course, this House has a proud record of pioneering the development of national commissioning and standards for specialised services, under the Health and Social Care Act 2012.
Collectively, tens of thousands of people call on these services for conditions such as HIV, cystic fibrosis, multiple sclerosis, muscular dystrophy, epilepsy, haemophilia, leukaemia and other cancers and renal dialysis, among many others. Alliance membership thus ranges from the larger charities such as Macmillan and the Cystic Fibrosis Trust through to smaller charitable organisations, established by people with close personal experience of a condition and covering such diseases such as Niemann-Pick and Guillain-Barré syndrome. Medium-sized charities in the alliance’s membership support patients requiring complex but not uncommon care. The Terrence Higgins Trust, the National AIDS Trust, the Brittle Bones Society and Roald Dahl’s Marvellous Children’s Charity are just some of these.
Specialised services are a vital part of the NHS, affecting large numbers of patients and their families and often providing the last resort in the care pathway. The annual budget is £14.6 billion, accounting for more than 10% of the overall NHS budget. Services include some of the most advanced technologies and procedures, playing a crucial role in fostering innovation in clinical expertise and service provision. The challenges and opportunities facing specialised services reflect those facing the NHS as a whole. Commissioning and accountability for standards of care are the main two of these.
First, there have been considerable financial pressures on NHS England’s specialised commissioning budget in recent years, arising principally from inaccurate budget-setting based on flawed assumptions about historic spending prior to the last NHS reforms, alongside an overspend in the cancer drugs fund and some increase in specialised activity on the part of providers. Fortunately, the budget is now in balance, but deep concerns remain that new and not-so-new service developments have stayed in the long grass of NHS England’s decision-making structures for an unforgivably long time. In April 2013, NHS England promised a rapid review of the principles underlying its investment decisions in specialised care. Two years on, a not-so-rapid review is belatedly nearing completion, but it took a legal challenge to prompt NHS England into action. In the mean time, patients have been unable to access a whole range of treatments, causing huge concern and anxiety, and in some cases jeopardising their health. Moreover, in future, patients will still need to await the deliberations of NHS England on new services and treatments. I hope the Minister acknowledges that NHS England needs urgently to refine its policy-making processes and ensure that they become robust, timely and efficient, as per the wishes of the patient and the clinical community.
Secondly, and fundamentally, the Health and Social Care Act made NHS England accountable for prescribed specialised services following the confusion and inertia that previously surrounded local budget-holding and accountability, which was vested in primary care trusts. NHS England is now pursuing “collaborative commissioning” for specialised services with local CCGs. Its March guidance on this subject contained mutually contradictory statements, endorsing the role of mandatory national service specifications but also a direction of travel towards place-based—that is, local—commissioning. Although the need for collaboration between NHS England and CCGs to ensure integration between services is fully recognised, this must not be at the expense of NHS England’s clear accountability for the specialised commissioning budget and prescribed services.
We know from NHS clinical commissioners that CCGs will not be bound by national specifications or commissioning policies where they hold the budget for specialised services. IVF, where less than 20% of CCGs commission in accordance with NICE guidelines and an increasing number do not commission at all, shows the potential vulnerability of specialised services in this region. No assurances have been given as to where the budget will lie in 2016-17. NHS England has confirmed that it will develop proposals for place-based budgeting for 2016 and onwards for consideration later this year. This stands in stark contrast to the endorsement of national standards in the earlier commissioning guidance. It is also fundamentally counter to the wishes of the patient community and cross-party consensus under the 2012 Act.
I hope the Minister can reassure the House that the provisions of the 2012 Act will be adhered to in the future provision of specialised healthcare. Pooled resources and expertise must be retained for specialised commissioning at national level. This is absolutely essential to the maintenance of national service standards and clinical access policies across the country, and to providing the services that patients need, depend on and deserve.
My Lords, a new Government and a first gracious Speech provide an opportunity for us to revisit some of the most intractable of our problems. My particular hope is that the Government think long and hard now about how better to reform our public services, especially those which we are debating today.
Few people do not believe that reform is still needed. Successive Governments have tried, but what really matters is that, from the citizen’s perspective, the user’s perspective and the patient’s perspective, the results have been disappointing. It is true that, recently, the lack of resources has made the task even more difficult, but the problem is not primarily one of resources. Too many of the services that we provide are unnecessarily complex and therefore very difficult to access—we have heard many examples of that already today. Too many make more sense to the providers than they do to the users, too many provide poor value for money and some just do not work very well. If that sounds too pessimistic, your Lordships should take an honest look at the availability and quality of much social care, take a look at the extent to which the NHS is truly patient centred, and ask themselves whether improvements in educational attainment have kept pace with our international competitors.
So why have we not been more successful, in spite of all the effort and good intentions? Perhaps we continue to place too much emphasis on changing the structures of our institutions. Few people now would deny that the Health and Social Care Act 2012 was a classic example of that. As the noble Baroness, Lady Morris, pointed out, quite rightly, all the evidence suggests that structural change does not make that much difference to quality; in fact, it often demotivates the staff who can make the difference. At the end of the day, it is the quality of teaching in the classroom and the quality of nurses and clinicians that make the difference.
Perhaps we have continued to place too much reliance on regulation and inspection, which can only ever describe services, never improve them. Perhaps, in spite of all the protestations, we are still too fond of centralisation, prescription and intervention when things just do not go according to plan. Perhaps the many targets we have set from the centre have served to confuse rather than to clarify priorities. It may be that creating ever more specialist agencies has made it more difficult for teams to work effectively together at a time when few, if any, of our social problems can be resolved by one department or agency working in isolation.
What I am sure of is that if all we do is to continue with these same approaches, then we will get the same disappointing results. Is there a better way, a way we could do things differently? I think that there is, and that some of the things that we can do are really quite simple. For example, instead of constantly beginning any process of reform by thinking about how departments, agencies and authorities should change, we might start by looking more closely at the experience of users and what they really need. Having spent more time understanding that better, we might try and design services and policies around users’ needs rather than around our bureaucratic boundaries. We might try and make those services more accessible, seamless and reliable.
We could certainly do much more to involve users in the design of services and the development of policy at an early stage, instead of leaving it to belated and sometimes meaningless consultations after decisions have already been taken. We could, in other words, seek to achieve a genuine process of co-production. In doing all that, as the noble Lord, Lord Giddens, suggested, we could do a lot more to integrate technology into the design of our public services, building on the excellent work of the Government Digital Service: using technology as a way of giving people more power but also as a way of giving them greater personal independence and improving the quality of our services. We could and should be much more imaginative in drawing on and supporting the potential which I believe exists in every place and community, so that people become less dependent on the state and more able to provide together for their own needs.
Am I optimistic? There is some hope. The Care Act, which came into force only on 1 April, does seek to build around the needs of clients, not the convenience of providers. It talks about building on users’ strengths, not just assessing their weaknesses, and points towards the need for co-production. It needs more resources, and I for one cannot understand why we always talk about protecting the health resource, but never the health and social care resource, which is what we actually need to do. This is a piece of legislation which I hope the new Minister will give real priority to, because it will not only bring benefit to the users of these services but could offer a new model for our public services.
However, in ending, I contrast the ambitions of the Care Act with the way in which we provide financial support for those in need of care. They, or more usually their dependants, have to struggle still with a complex, confusing maze of bureaucracy, involving: the Department for Work and Pensions, which provides lower and higher-rate attendance allowance; local authorities, which provide or commission domiciliary or residential care; and the NHS, which provides continuing healthcare. This is a system full of perverse incentives and different assessment arrangements, some means-tested and some not. It is a system designed by bureaucrats for bureaucrats and makes no sense at all to users. If you look on the internet, you can see that the system has spawned an industry of companies that are offering paid-for advice to vulnerable people on how to obtain the best deal from those bureaucracies. On top of all that, it wastes taxpayers’ money. If we really did design services with users around the needs of users, we would never end up with such an unsatisfactory set of arrangements. Beacons of light are all very well, but we need user-led services to be the norm.
My Lords, I am sure that the aspiration in the Queen’s Speech to improve schools is one which we all share. It is a sad fact, however, that our schools system has to rely too heavily on the further education sector to remediate poor literacy and numeracy skills in 16 to 18 year-olds. This type of FE work has to be done extensively at present, but we look forward to a time when it ceases to distort the central and foremost aim of FE institutions, which is to provide young people with high-quality technical skills, to give them lifelong chances of employment.
In 2012, I was privileged to chair a government review of professionalism in further education, which produced the so-called Lingfield report. During our work, we visited many providers of further education, in both the public and private sectors. I was struck by the huge variation among them in their provision, one of the sector’s strengths, and the huge variation among them in their quality, one of the sector’s weaknesses. I saw teaching and learning of the highest standards, but was aware of rather too much that was mediocre—and there are, of course, a few colleges that are simply not up to the task of providing what is required of them.
I started my investigation into further education by speaking to young people in schools, and to parents. It became obvious that, virtually all 16 to18 year-olds know that a university will, if they can pass the entry requirements, provide them with either a BA or a BSc degree course in a large choice of subjects. Employers know too what a graduate is and what a degree, for instance, from an institution in membership of the Russell group of universities is likely to be worth. On the other hand, confusion reigns about qualifications in vocational education, what their standards are and how much an employer can rely on each one. In 2014, there were an incredible 21,000 FE qualifications available from 161 awarding bodies, and thus bewilderment is caused to students, parents, lecturers and, especially, employers. The time has come for a simple set of pre-eminent benchmark qualifications, recognisable by all, and proof to employers of high-quality vocational skills.
It is an important part of the Government’s strategy that, as with schools, further education providers should become as autonomous as possible, with their priorities set by the professionals on the spot to suit local employment needs, and not by government. This is the only way that we shall drive up standards in the sector. To that end, I was requested last year to start the process of founding a new royal chartered body, the Institution for Further Education. I pay tribute to officials from the Department for Business, Innovation and Skills, who have been extraordinarily helpful to me in this quest. I am delighted to say that we now have a council drawn from among the best practitioners in the sector, an office in London and a chief executive appointed. This month, I am told, the Privy Council will consider our petition for a charter; it would be wrong for me to attempt to pre-empt its decision, but we are very hopeful that we shall be able to go ahead shortly.
The new body will admit new member institutions, using a series of criteria concerned with governance, financial probity, high quality of teaching and learning and success rates in current qualifications. Above all, those would-be members will have to submit the highest references from local and other companies on the employability of their students. FE providers will be judged for admission by a committee of their most distinguished peers and colleagues. There are various privileges of membership, which above all will confer a special new status and a high-quality assurance mark on those colleges and other institutions, public or private, which earn them. Membership will be a guarantee to students, parents and employers alike of the high standards of the courses on offer. It is our hope that, in time, all FE providers will aspire to qualify for membership. As with other chartered bodies, those who let standards slip will risk exclusion. One of its early aims will be to further the development, with the various awarding bodies, of the limited set of benchmark qualifications that I mentioned earlier and which will ameliorate the present confusion. We want these to be as well known and valued as if they were university qualifications.
In 2005, Sir Andrew Foster in his review of further education called it “the neglected middle child” of education. That is still, alas, the case, and the situation ought not to be allowed to continue any longer. It is our hope that this new sector-led chartered body, at arm’s length from government, will drive up standards throughout further education and, as an innovative and dynamic entity, assist it to provide for the nation the highly qualified, technically able workforce on which our country’s economy in future decades will depend, as the noble Lord, Lord Quirk, has just reminded us.
My Lords, I was pleased to see that education had been grouped with culture in today’s debate on the gracious Speech, but I wish that I felt convinced that the Government accepted the need for them to keep equally close company in the development of education policy. That is what I want to talk about before touching briefly on two other matters. Last month, a letter from a head teacher appeared in the i newspaper, which I think would be of particular interest to the right reverend Prelate the Bishop of Norwich, who is sadly not in his place—and, indeed, to the noble Lord, Lord Kirkham. I understand that, at this hour in a long debate, the call of the dinner table becomes very insistent, but I am sad that neither of them is here to hear it because it very much goes to the points that they raised. It says:
“As the headteacher of a 1,000-pupil comprehensive school in the West Midlands I have mixed emotions as I look back over the school year.
At Christmas the school choir sang in a hauntingly beautiful carol service in the local church. Following a recent charity week, my pupils presented more than £4,000 to national and local charities. My Year 8 boys have just won the English Schools’ National Under-14 Football Cup. While walking in the Shropshire hills last weekend, I met 20 of my Year 10 pupils who were trekking as part of their Duke of Edinburgh Award.
The mixed emotions I feel are delight and despair: delight that all these activities are what a school is all about, helping pupils become well-balanced young adults able to take their place in society—and despair because nothing I have described to you counts a jot in the school league tables by which all schools are measured”.
That was from a head teacher in the West Midlands.
Those words precisely encapsulate what many of us find so troubling about government attitudes to education over the past five years and about the tone of the gracious Speech in promising further legislation, with its references to “failing and coasting”. The relentless focus on testing, the slow but unmistakable downgrading of arts subjects in the curriculum, the insidious undermining of teachers—my family is full of them, so I see the effects at first hand—all contribute to a good deal of anxiety and despondency in the classroom, in the playground and at the school gate. The determination of many schools to provide, in spite of everything, a creative environment for their students, which I see, for example, when I take part in the Peers in Schools programme, is almost a miracle in the face of a Government apparently bent on draining the joy that is so essential to effective learning out of education.
Polly Toynbee, writing recently in the Guardian—I know she is a leftie, so she will be ignored by a large number of people in this House, but none the less—said:
“Research shows how the arts improve attainment in all subjects: drama improves literacy, music improves maths and early language. The arts make most difference to children from low-income families—those who get arts teaching are three times more likely to get a degree and a job … but the English baccalaureate excludes the arts altogether, leading to a sharp fall in arts subjects, especially in deprived areas. I would bet both Gove and Morgan”—
her nomenclature, not mine—
“would reject any school for their own child that had abandoned arts teaching”.
I leave that one to stick to the wall, as they say.
I want to say a brief word on mental health care. Those of us who have had mental health problems know how frightening and lonely the experience can be. Appropriate and, above all, timely intervention is essential. Parity of esteem was the key mantra of the last Government. I noticed that it was absent from today’s speech from the Front Bench. It is a fine phrase, but the problem is that fine words, as we know, butter no parsnips. I do not know why parsnips, but proverbially they butter no parsnips.
Recruitment and retention of mental health professionals is still a huge challenge. Psychiatric beds, so vital for acute mental health crises, are being closed all over the country, and access to invaluable talking cures, such as cognitive behavioural therapy, is subject to long waits and significant rationing. Most disturbing of all, services for young people are under more pressure than ever, which is particularly worrying when we hear today, for example, that the incidence of anorexia nervosa is rising sharply. Given these realities, will the Minister explain exactly how the Government intend to deliver on the promise in the gracious Speech to improve access to mental health care?
Finally, I shall say a word on the BBC. I was amused to read, immediately after the appointment of the new Secretary of State for Culture, dark threats from some quarters about how he was plotting revenge on the BBC for its partisan coverage of the election. It amused me partly because the right honourable gentleman is an experienced politician and a cultured man and I have no doubt that he will plough his own furrow without assistance from headbangers in the press or elsewhere who see the BBC as an obstacle to their interests. I was also amused because I, too, spent quite a few hours during the election campaign with my pen hovering metaphorically over the green ink bottle ready to rail at the BBC for its partisan coverage of my party. It has often been said, and well said, that if we all feel ill-used it must be getting it pretty much right.
The BBC is not just another broadcaster in a competitive marketplace. It is one of this country’s most significant cultural achievements, and we have quite a few to our name. The original mission to inform, educate and entertain—the words carefully arranged in that order—has, of course, been tested by the passage of time, the evolution of technology and societal change, but it stands up pretty well. The funding model which supports it has been challenged many times but still bears scrutiny when compared with other possibilities.
Over its long history the BBC has, of course, made many mistakes and infuriated many people, but that should neither surprise nor dismay us. However grudgingly, most people acknowledge that, with all its faults, it is a unique feature of our heritage, our future and our currency in the world. The Secretary of State should act as a critical friend, not an asset stripper, as he goes into the charter negotiations. He will not be forgiven if he gets it wrong.
My Lords, it is pleasure to follow the noble Baroness, Lady McIntosh of Hudnall, and I agree wholeheartedly with the majority of her speech, particularly her final point supporting the BBC. I am very pleased to take part in this debate. I am deeply relieved. The ministerial appointment that I was looking for most after the election was that of the noble Lord, Lord Freud, because without him universal credit would be in a much worse place than it is now. He still has a job on his hands, but I am really grateful for and encouraged by his return. I was even more encouraged—if I can put it that way—by the addition to the ministerial team of the noble Baroness, Lady Altmann. She must not give up her campaigning zeal in her Twitter feed. If any departmental official tries to turn the noble Baroness’s gas to a small peep—and knowing her as I do I know it would be a brave person who did that—they would doing the nation a great disservice. I hope she will continue to inform her followers as she has been doing over the past few years. She has an important role in pensions, and we look forward to working with her in future.
I want to lay down a couple of markers about things that I think are really important. The theme of the Queen’s Speech that came through to me was the desire of the new Government to develop a one-nation approach, and that is correct. It is certainly correct coming from a Scot who experienced the election. I have done 10 now, one way and another, and it was in many ways one of the hardest, and not for just the most obvious reason. I found the tenor of the background environment very difficult, and there are some problems there that the Government will need to deal with.
I want to spend my restricted time looking at how a one-nation approach can be applied to low-income families. It is true, and the noble Lord, Lord Freud, knows this, that active labour markets are the obvious first port of call for getting people off benefits and into work, but there are now many more working households in poverty. We must not forget that, and I fear that sometimes we do. I am looking the Minister straight in the eye when I say that the prospect of £12,000 million cuts annually over a two-year period when we still do not know the full cumulative effect of the cuts in the previous Parliament is deeply worrying.
In 2012, the Minister oversaw the Committee stage of the Welfare Reform Bill in a masterly way which improved the Bill, but it was not helped by financial privilege being thrown at us from the other place. I hope he will adopt that approach—as much as he can because I am not stupid and know that all this is Treasury-driven—in trying to explain in good time to Members from all sides of the House the options that are being canvassed and give us a chance to think about them, reflect and give him both publicly and privately our views about how they can be done. I think two years is impossible. Trying to do this by 2017 is just impossible. In a powerful speech, the noble Lord, Lord Fowler, referred to the fact that there is a smaller pool of benefit recipients from which we are deriving this saving. It just is not safe. I promise the Minister that my colleagues and I will work with him as energetically as we are allowed. The leader of our group, my noble and learned friend Lord Wallace of Tankerness, was right to say that of course the Government have a manifesto commitment to make the saving, but they do not have any Salisbury protection for individual benefit cuts. So I say to the Minister that I will be looking to him to return to his positive and consultative approach to try to make the best of what I think will be a very bad job.
As I said earlier, I do not think that universal credit would have got past the first reset if the noble Lord had not been the Minister in charge, and I know that he is still engaged in it. People forget that the 2010 coalition settlement was based on the idea that universal credit would already be in place and helping low-income households at the margins of worklessness and benefit receipt. At the moment it is available to only 50,000 families; I know why that is, but too often we forget—certainly as far as I was concerned—that by 2015 the 2010 deal should have seen hundreds of thousands of families benefiting from universal credit, and they are not.
I urge the Minister to make as much progress as he can. People are losing confidence in this programme. The department has managed 30 significant policy changes over the past five years, with 18% less resource in the departmental expenditure limit. Most of that has worked, but universal credit is still at risk and, sadly, coming from Scotland, I know that people are beginning to lose confidence in it. We really need to concentrate on universal credit.
My final thought is that I look again to the noble Baroness, Lady Altmann, to work with the Treasury on this. I have just finished a fascinating session with Sir Sherard Cowper-Coles on the need for financial inclusion, and an element of that is necessary to deal with the digital divide in universal credit. Can the department please work with the Treasury in future to try to get financial inclusion more broadly based across the United Kingdom so we can ensure that people can get the full advantage of universal credit when it is rolled out across the country?
My Lords, I join the noble Lord, Lord Kirkwood, in welcoming the noble Lord, Lord Freud, back to the Front Bench. Perhaps there is no more important mission than getting as many of our people into work as possible. I remember that the primary mechanism for the success of Louise Casey, when she was the tsar for rough sleeping, was getting those people into purposeful activity. It is so important for all of us to feel that we are doing something purposeful and useful.
I declare my interest as a landowner. From the age of 15 I remember visiting my tenants. The property that I was to inherit was held in trust for me until the age of 21, but I had been visiting it since the age of 15.
I welcome much of the Queen’s Speech. I particularly welcome the legislation on psychoactive drugs. More and more of our children are growing up without fathers in the family; we will soon overtake the United States in the numbers of boys and girls who grow up without a father in the home. It really cannot be helpful to young people to have powerful drugs easily available to them and then to say, “Well, they’re legal”. It is hard for them to know what to do when perhaps they are not getting the guidance at home that they need.
I take this opportunity to thank the coalition for what they did for looked-after children and care leavers in the last Government. It was extraordinarily good work. We have heard today about the work around adoption. In particular I praise the encouragement of the voluntary adoption agencies, which have been so powerful. Edward Timpson MP, the Minister, introduced virtual school heads to promote the education of looked-after children and put it on a statutory basis. We had pupil premium plus. All these things are so important for these young people.
The Government introduced Staying Put, which enables young people in care to remain with their foster carers past the age of 18 to the age of 21, where they choose. Until recently, one-quarter of young people in care were leaving care at the age of 16. That went up to one-third fairly recently. The Government realised the importance of making a change to enable them to stay past the age of 18. In the first year of their attempts, only 5% were staying on and the figure was the same the next year, so clearly something had to be done and the coalition Government did it. I commend them, particularly Edward Timpson, the Minister for Children, the noble Lord, Lord Nash, who took the Bill through the Lords, and the Secretary of State at the time, Michael Gove.
I have some concerns. Last night I read with great interest the speech by the noble Lord, Lord Best. He called for the Government’s plans around housing to have a pause and for them to think deeply. I second his concern. Housing has been overlooked for so long in this country—I say this as a landlord—and the need for affordable and social housing means that the issue must be carefully thought through, so I support his call. I ask the Minister to take my request back, if he would, to the Minister responsible.
A recent case of a woman, which I have been following for the past year, brings this home to me. Her daughter was raped at the beginning of her adolescence, about a year ago. The man who raped her lives nearby in the local high street. The police have said that she and her daughter should be moved, as has their psychologist. The baby has been born and still they have not been moved. There is a severe shortage of social housing; in some boroughs it could take decades to get back to the supply that is needed. I welcome what the Government are proposing with regard to 275,000 units of new affordable housing but often, although the aspirations are large, we need to triple, quadruple or even quintuple the effort to get the affordable and social housing that we need.
In past visits with health visitors, I have been dismayed at seeing water running down the walls and mothers sharing a bed with maybe two young children in the most insanitary conditions. The landlords are clearly neglecting their care. There are no places for the children to play. They have to share facilities with several other families, sometimes arriving to find that the front door is open. There is isolation: a young mother with her first child, her husband or partner not in this country, can hardly speak the language, and the only people she knows are the local church people who visit her from time to time. The health visitor has to try to help her in the few minutes that she has while the mother is crying. I praise the Government for resurrecting and investing in health visiting—that was a triumph of the coalition Government.
I ask the Health Minister, the noble Lord, Lord Prior, if he might be prepared to consider visiting with a health visitor and myself, and seeing these conditions. A recent report on perinatal mental health emphasised that it costs the nation £8.1 billion a year not fully to address the mental health needs around perinatal care—£10,000 per birth. There is clear evidence that poor housing and homelessness impact on the mental health of mothers. I would be very grateful if the noble Lord, Lord Freud, would take that invitation back to the noble Lord, Lord Prior, or indeed any Minister. These housing issues have a strategic impact on all departments, and I would very much welcome the opportunity to meet with any Ministers and take them along with a health visitor to speak to these mothers about their experiences.
If I saw the conditions that I have seen and I were the landlord, I would want to shoot myself. If my mother were in such a situation, I would be heartbroken. I urge your Lordships to listen to the request from the noble Lord, Lord Best, for deep thought before progressing.
My Lords, I welcome the opportunity to speak in this debate on the gracious Speech. I am delighted to follow the noble Earl because he has paved the way for me in reminding us of some of the contributions which were made in yesterday’s debate on matters to do with housing and the proposed housing Bill. He has illustrated the points rather more graphically and personally than I might be able to do. I make that connection between yesterday and today because I think it is very clear that issues to do with housing have a real relevance to the matters which are our main focus in today’s debate in your Lordships’ House. For example, research over decades has underlined the point which has just been so graphically made—that there is a clear connection between the quality and conditions of housing on the one hand, and people’s mental and physical health and well-being on the other. There can be very little debate about that; I do not need to labour the point.
In relation to education, it is just common sense to note that housing stability and the stability of households have a marked impact on the educational achievement of children from those households, not least when we are thinking about the most vulnerable children in our communities and in our society. Put very simply, if a child moves home frequently because the family is in insecure housing, for example, that cannot but have an impact on the educational outcomes as far as that child is concerned, however great the efforts of those who are charged with the education of children in those circumstances. I will not labour the points, but in those and other respects, the provision of good, appropriate and affordable housing is clearly vital if we wish to achieve our best aspirations in the areas before us today of health, education and welfare.
Yesterday there was considerable attention given to the proposal in the Queen’s Speech and in the proposed housing Bill in relation to the extension of right to buy to housing association tenants. I will spare noble Lords my thoughts on that particular thing, because all the points were well and ably made by different noble Lords in yesterday’s debate. However, if time allows, I will comment on three related matters.
Housing associations—and I declare my past membership of various housing association boards—are much more than providers of housing. Reference has already been made in today’s debate to housing associations as providers of welfare and care services. Among other things, in different places they offer debt and welfare advice; many work with the most vulnerable in our society in offering different kinds of social and health care. Many housing associations have initiated schemes around employment, training and employability. They are very well placed to do this because of their integration into local communities in many cases, and they do it very well. They have a noble history of innovation and enterprise, and capacity to integrate housing with social and community well-being. It is therefore vital that we do not in any way undermine the capacity of housing associations to make their contribution in those ways.
When we come to look at the proposals in the proposed housing Bill I hope that we will look very carefully at those things, including right to buy, which could undermine the stability and sustainability of those organisations. I therefore support the call, which has just been echoed to the Government, to think carefully about the legislation to make sure that we do not have any unforeseen consequences for the capacity of those organisations to do the things that they do beyond the provision of housing plain and simple.
I turn to our rural communities. In many villages we have five or six affordable or social homes, and often the planning permission was granted for those on the assumption that they would remain available for social rent in perpetuity. The diversity of tenure which they represent is vital for the economic and social vitality of those places, including sometimes the sustainability of village schools. There is an exemption under the current legislation with regard to right to buy when it applies to smaller communities, and I urge the Government to consider the extension of that exemption when the new legislation comes forward in relation to right to buy for housing association properties. It is vital for the sustaining of these rural communities in our midst.
My third comment is on the private rented sector, which is becoming of increasing importance in our housing landscape. However, it is a sector which, at times at least, is marked by short and insecure tenancies—and insecurity, therefore, in family situations and household life. I have already made the point that stability of housing has potential good effects in terms of children’s education and in terms of health and well-being more generally. I hope, therefore, that at some point in the life of this Parliament it might be possible for legislation to be framed which will offer the possibility of longer-term secure tenancies in the private sector. It can be done—it has been done in other nations—and it would have profound good effects for our communities and for the well-being of families and individuals. It has benefits not only for tenants but also for landlords.
Lastly, because the time is ticking away, I underline the willingness of churches and faith organisations to play our part, not least in places where considerable new housing development is being brought forward, not least in my own diocese of Ebbsfleet and other such places. We have the will to engage positively, not least so as to play our part in creating the kind of community infrastructure that is necessary for the delivery of good health, education and welfare in our communities. In Ebbsfleet we are already in conversation with developers and with the development corporation about possible schools, childcare initiatives, community provision of one kind or another, and the placing of workers on the ground early in the day to help build communities. We want to work with government and with all concerned to ensure that collections of houses become places where people wish to belong and where their true and full welfare may flourish.
My Lords, I wish to raise the issue of pregnancies affected by neural tube defects. Neural tube defects are serious birth defects that include spina bifida, and are a consequence of a vitamin deficiency.
It is well known that taking folic acid—vitamin B9—before conception reduces the risk of an affected pregnancy by over 50%, the exact percentage depending on the level of folic acid intake. Research on the issue by the Medical Research Council-funded study in 1991 has not been in question, and the United States of America changed its policy on folic fortification of white bread flour to mandatory in 1998 as a result of that UK research. Today, over 70 countries have mandatory fortification of flour with folic acid. The principle of fortifying part of the diet of a nation based upon science is not an issue. The United Kingdom has for decades been fortifying wheat flour—except wholemeal flour—with calcium, iron, niacin and thiamine. The cost is borne by the milling industry.
For many years, the Department of Health’s advice to women “planning pregnancy” has been to take folic acid supplements. The snag here is that the UK, to its international discredit, has the second-highest rate of unplanned pregnancies. The neural tube closes at 27 days, hence the Department of Health advice for women “planning” a baby. Many women are not aware of a pregnancy until after 27 days, by which time it is too late.
In 1996, the number of women in England and Wales taking supplements was 40%. In 2012, it was 28%. The Department of Health “advice” policy is not working. Affected pregnancies can be discovered at the 20-week scan, and around 80% are terminated. The use of this large percentage of terminations is the Department of Health “policy instrument” for dealing with neural tube defects—there are around 15 to 18 per week.
I was present earlier this year at a meeting of the All-Party Parliamentary Food and Health Forum, when, as the minutes record, the chief executive of Shine, the spina bifida charity, said:
“It looks to Shine as if the Government is avoiding acting. A senior civil servant told me that the Government’s view is that the issue of folic acid deficiencies leading to spina bifida is ‘well managed through terminations’”.
There are about three live neural tube defect births a week in England and Wales—that is 150 a year. In 2012 in England and Wales there were 908 affected pregnancies—only 28% of women were taking folic supplements.
Independent scientific committees such as the Scientific Advisory Committee on Nutrition and the Food Standards Agency have given advice to government to fortify white bread flour. Chief Medical Officers have come and gone, but they have never really collectively—there are four—taken the issue seriously to Ministers because they have always found something else to wait for by way of research; I will refer to two.
I arrived at the Food Standards Agency in 2009 after it had advised the Government that flour should be fortified, although I was aware of the issue from my days at Defra. I therefore knew of the claim that colon cancer would, or might, increase. Research was commissioned and in 23 March 2013 a paper by Vollset et al was published in the Lancet which found “no significant effects” of folic acid on the incidence of cancer on any specific site.
Folic acid in the form of supplements or fortification in flour is remarkably safe. More than 70 countries follow the fortification policy, and there have been some spectacular reductions in the number of babies born with disabilities, and of course reductions in terminations.
Earlier this year, the United States Centers for Disease Control and Prevention published an update on neural tube defects prevented by mandatory folic acid fortification between 1999 and 2011. Over the period, the number of births occurring annually without the defects that would otherwise have been affected is approximately 1,326. A long paper showed an overall reduction of 28% of affected births, and it estimated a net saving of more than $500 million in total direct costs for the affected births that were prevented. The United States still has a national birth defects prevention month and a folic acid awareness week. There have been substantial reductions in Chile, which has used a higher level of fortification than the US. Leading scientists say the Chile level should be used worldwide.
Turning to the second cause of delay, in response to a series of Oral Questions that I asked in 2014-15, the noble Earl, Lord Howe, indicated that the Government were awaiting the latest blood folate information from the national diet and nutrition survey. After a very long delay, the blood folate results became available at 9.30 am on Friday 20 March this year, showing that many women had low blood folate levels. The Government now have all the evidence they have been waiting for. Is the policy going to change? The UK has the highest level of neural tube defects in Europe, so neighbouring nations do not see a need for action. It is the UK population who are affected, so we need to act.
Taking the results of the US evidence I mentioned earlier and applying them to the statistics for England and Wales, scientists say that in the period 1998-2012 there would have been about 1,800 pregnancies without, instead of with, a neural tube defect. That is a very substantial potential reduction in distress all round.
Folic acid intake levels of 5 milligrams per day or more have no known adverse effects. While folic fortification is necessary to prevent neural tube defects, there is no need to set an upper intake level, and no need to limit voluntary folic acid fortification at the same time as instituting mandatory fortification.
During the recent parliamentary Dissolution period, I did not completely waste my time campaigning on electoral matters—I wasted a lot of it, but not all of it. I joined Sir Nicholas Wald and Sir Colin Blakemore on two visits, to the food supplement manufacturers trade body and to the Food and Drink Federation, to discuss the industry aspects of mandatory folic fortification. Sir Nicholas, of the Wolfson Institute of Preventive Medicine, led the Medical Research Council research in 1991, and more recently published, with colleagues, a study of more than half a million women who had been antenatally screened and had provided details on folic acid supplementation. It concluded that the current policy is failing and has led to health inequalities. Sir Colin, a former chief executive officer of the MRC, is professor of neuroscience at the University of London.
We genuinely believe that putting public health first and joining more than 70 other nations in fortification will take a major step towards ending the distress caused by the large number of avoidable terminations, stillbirths and cases of permanent serious disability in surviving children. A change will take time to implement, but Sir Nicholas, Sir Colin and I are ready to help Ministers in advocating and implementing such a policy.
On 19 May, I asked the reappointed Public Health Minister, Jane Ellison, whether she would meet me, Sir Nicholas and Sir Colin. If she does not want to listen to me, she should, I believe, meet the scientists. We are dealing with a vitamin deficiency-induced birth defect, and we are using abortions—more neutrally, terminations—of 80% of affected pregnancies as an instrument of policy. This cannot be right. It is not right and what is more, it need not happen.
In Her Majesty’s gracious Speech, we heard that her Government intend to,
“secure the future of the National Health Service”.
There would be widespread dismay if this intention were not honoured. However, the NHS is limping. That is not helped by an overdose of bureaucracy, and is made worse by a grave shortage of general practitioners and nurses, continuing shortages of mental health professionals, and serious underfunding of mental health services.
However, Her Majesty’s Government have recognised some key areas for investment, notably the need to introduce measures,
“to improve access to … mental healthcare”.
This is a very welcome promise, because during the last Parliament, funding for mental health services was cut in real terms by 8.25%—almost £600 million. I join the noble Baroness, Lady Tyler, in asking the Minister how much of the additional £8 billion committed to the NHS by 2020 will go towards these measures to improve mental health care.
For too many years, mental health has been considered the poor cousin of physical health—something I know all too well as a past president of the Royal College of Psychiatrists. A staggering 7 million people experience mental illness at any one time, touching an estimated one-third of all households. A further 2 million British people are expected to experience mental illness by 2030. We need public mental health prevention strategies, not just better access to treatment.
During the last Parliament, the burden of mental illness was at last recognised, in part because of the courage of Members in the other place in speaking about their own mental illness, and in part because of my own amendment to health and social care legislation, which defined health as mental and physical health, and illness as mental and physical illness. The principle of parity of esteem for physical and mental illness was adopted, with parity of outcomes becoming a policy objective. Effective legislative and funding decisions will be needed as levers to sustain a government focus on parity over the coming years, as well as investment in developing the evidence about what works best.
Only 5.5% of the UK health research budget is spent on mental health, despite mental illness accounting for 25% of all illness. I was pleased to hear that an overarching goal of the Government is to promote social cohesion through legislating in the interests of everyone in our country. There was no specific mention in Her Majesty’s Speech of how the needs of people with learning disabilities, a particularly vulnerable group, will be protected in the legislative programme. This is a significant group, numbering about 1.5 million people in the United Kingdom—people who live their whole lives with a learning disability.
I worked clinically as a psychiatrist for more than 30 years with people with learning disabilities, retiring from the NHS in 2008. People with learning disabilities have six times the risk of mental health problems and three to four times the risk of developing dementia, so when talking about mental health problems, we are also talking about issues that particularly affect people with learning disabilities. These issues are all the more pertinent to me, as the mother of an adult with a learning disability. I have lived experience, through my son, of the challenges arising from the lack of integration of health and social care, limited personalisation of commissioned care packages, the lack of nurses specifically qualified to care for people with a learning disability, and the lack of doctors and nurses who know how to use their skills for the benefit of this patient group.
The coalition Government’s Green Paper of March 2015, No Voice Unheard, No Right Ignored, proposed to strengthen the rights of disabled people and their families, and in particular to challenge hospital admissions and to support people with learning disabilities to live independently in their local communities. The consultation period has ended. Can the Minister confirm the timetable for reporting on this consultation?
Simon Stevens, the chief executive of NHS England, has placed,
“support and care for people with learning disabilities”,
as one of the four priorities in the NHS business plan for 2015-16, alongside mental health, cancer and diabetes. In February, he also committed at the Public Accounts Committee to begin a closure programme of assessment and treatment units for people with learning disabilities. This followed Sir Stephen Bubb’s report, Winterbourne View—Time for Change, which highlighted the outdated and inappropriate practice of keeping people in long-stay institutions a long distance from home.
Care and treatment reviews undertaken by NHS England in the last few months are beginning to bear fruit, with the number of discharges beginning to reduce the number of people inappropriately placed in in-patient hospitals. The Government’s intention to integrate health and social care is welcomed and is expected to improve the lifelong mental and physical health and well-being of people with learning disabilities—a seamless service, co-created with each service user, as envisaged by my noble friend Lord Bichard.
Mencap highlights the need for training on learning disabilities for all health professionals. In the last Parliament, I introduced two debates on inequalities in healthcare for people with learning disabilities. The confidential inquiry reporting two years ago found that 37% of deaths were considered avoidable had there been an adequate health response. This equates to more than 1,200 people across England dying every year because they do not get the right healthcare. Therefore, there is a huge training agenda if we are to address some of the gaps in service provision.
Slow progress was made by the coalition Government in both learning disability and mental health care. I intend to focus my efforts in this Session on scrutinising legislation and progress in these two areas.
My Lords, I, too, pay tribute to the gracious Speech, which provides an opportunity for the House to reflect on the Government’s performance in the field of welfare. I hope that the experience gained from legislation in the last Parliament will be used to inform the Government’s approach in this Parliament.
I take the view that the structure and values of welfare define a society. They define our common humanity, our collective compassion and our sense of social justice. I believe that they should also provide a moral compass for the Government and, indeed, for society as a whole.
We can all agree that the underpinning culture of our welfare system should be to enable those in need to attain personal independence. However, reform of our welfare system over recent years has been underpinned by a culture of fear and bureaucracy. There is now a popular belief, built on the experience of those claiming benefits and those who support them, that the culture of the DWP is not to enable but to punish. Of course there is a need to cut down on benefit cheats. Who could disagree? Certainly not this House. I believe in punishing any fraud, whether by benefit recipients or by those who run our financial system, yet there is a belief that we concentrate on the former and the latter go free.
Most people involved in the financial sector are honest, hard-working citizens, and so too are most benefit recipients. Some benefit recipients, due to ill health or caring responsibilities, are unable to work, and some cannot find work. Two-thirds of those who found work last year earned less than the living wage, leaving their families in poverty, according to a report from the Joseph Rowntree Foundation. Under the new universal credit system, benefit claimants are at risk of sanctions if they do not apply for or accept zero-hours contracts.
When the bedroom tax was introduced, the Government said that it would have no negative impact on health or well-being. However, a study published in the Journal of Public Health in March concluded that the bedroom tax has increased the level of poverty and is having an adverse effect on health, well-being and social relationships. Those deemed to have a spare room have a choice: pay extra for their housing and have less for food and heating or they have to move. The Tory flagship council of Wandsworth is reported to have moved families 120 miles to Birmingham. I had to ask myself: what on earth have these families done to be treated in this way? I concluded that this must represent the worst form of social cleansing.
Last year, these policies and others led to 1 million users of the food banks run by the Trussell Trust, which believes that this is just the tip of the iceberg in relation to food poverty. The Government told us that people use food banks only because they are there. That is arrogant complacency at its very worst.
A story from Cheshire links the effects of these policies and demonstrates the vindictiveness of our benefits system. It also shows us why food banks are a vital lifeline to more than 1 million of our fellow citizens—like Robert, whose only crime is poverty. Robert had been working full-time but was now receiving employment support allowance due to a leg injury which required his attendance at a DWP work-related activity group. He was on his way when he collapsed with a serious blood clot and was rushed to hospital. As a result, he missed the appointment and his benefits were stopped for five weeks. To manage, he naturally had to turn somewhere and he turned to the food bank.
That is not an isolated case; it is yet another example of a vindictiveness which creates fear. What has happened to our common humanity, our collective passion and our sense of social justice? We now have a new Government, a new Parliament and new policies. Among those, I hope we can find a new moral compass.
My Lords, I was delighted that Her Majesty’s gracious Speech referred to our Government’s commitment to give new opportunities to the most disadvantaged through education and welfare reform. I want to use my time today to talk about our responsibility and commitment to help young people, particularly, but not exclusively, if they are leaving the care system: helping them make a good transition to adulthood by preventing them from becoming NEET—or, if they are already NEET, helping them to get and keep a job. This is essential if they are to lead a fulfilling life, fulfil their potential and achieve their aspirations. One thing that the election made clear was that, in order to achieve this, our country needs a thriving economy and a complete commitment to ensuring that everyone gets a fair crack of the whip.
Welfare reforms have been implemented and—yes—more needs to be done, but it has to be right that work must pay. None of us can be in a party, a Government or a society that appears soft on people who do not want to do anything, but we all want to be part of a party, a Government and a society that wants to be strong in its resolve to help those who need our help. Abraham Lincoln made many speeches, which are quoted often. He is credited with the following:
“You cannot strengthen the weak by weakening the strong … You cannot lift the wage earner by pulling down the wage payer … You cannot help the poor man by destroying the rich”.
After those points were made and the phrases coined, it turned out that they were said not by Abraham Lincoln but by an obscure German vicar 50 years after Lincoln died. However, whoever said them, they have complete resonance with us today.
Time is short, but, suffice to say, strengthening and stabilising communities and families has to be a major priority for this Conservative Government if we are to begin to make the much-needed progress in the battle to improve social mobility.
A child who grows up without the safe, stable and nurturing relationships that are usually provided in a loving family is at a significant disadvantage when they try to make their way in the world. When they have been removed from their parents and been in the care system, the state’s major responsibility as the corporate parent must be to ensure that they benefit from other close relationships that can help them forge a strong sense of identity and security.
I join the noble Earl, Lord Listowel, in congratulating the Government on the progress that they have made on adoption for young children. However, only this week we learned the extent to which teenagers in care are moved from placement to placement, undermining any chance that they have to settle and build secure relationships with those who care for them. One-quarter of teenagers in foster care are now on at least their fourth placement. I know that the Government will be as committed to this group of young people as they have been to others and I really look forward to progress being made for them.
Although the adoption reforms announced in the Queen’s Speech are welcome, we must not forget that this is largely a solution for younger children, as I have said. Last year, there were 40,000 children aged 10 to 18 years old in care. Of these, only 70 were adopted. We must take this opportunity to raise our game here.
Sadly, outcomes for those who have recently left care are often poor. As the former chief executive of Tomorrow’s People, I know just how important a job is to provide young people with a sense of purpose and self-worth, and with a structure of routine. Therefore, I remain deeply concerned that at least 38% of young care leavers are NEET.
Almost always, what is necessary for young people to reach their potential is someone who believes in them and will push them to achieve. I am a fellow at the Centre for Social Justice, which recently published the Finding Their Feet report on improving outcomes for care leavers. This emphasised the central need for continuity of relationships. There is a clear, proven and effective way for disadvantaged children to get that one relationship with someone who believes in them and will push them to achieve in life: by introducing a highly trained coach to work with them. I have spoken about this many times and am so sorry to tell noble Lords that I have got no intention of letting this one go.
An initiative called ThinkForward, which is delivered through Tomorrow’s People in partnership with the Impetus Private Equity Foundation in Tower Hamlets, Islington and Hackney, is right now transforming the lives of young people. Young people can go there if they are at risk of becoming NEET, are in care or are vulnerable. They get a coach at the age of 14, and many young people have been the beneficiaries of this service. Some 96% of them have not gone on to become NEET. This is a grand way of proving our commitment to those on the margins, to love them and get them through so that they can indeed have a job. A coach for all who need it is a worthy aspiration and one that I will continue to pursue. I am absolutely convinced that we may not need to spend more money but instead spend what we have in a better way.
I am looking forward to my Government doing a number of things, and I completely support them. I am an optimist. With fervent intent, we can have a very strong economy. We are going to reform the welfare system with diligence and care and, with passion beyond anything, make sure that we nurture those on the margins of our society to give them opportunity and aspiration to make sure that they can succeed.
My Lords, I want to concentrate on the care agenda and especially on the contribution of the 6.5 million people who are caring for older, sick or disabled loved ones. Your Lordships will be familiar with the figures that I never tire of quoting—that their unpaid care saves the state £119 billion a year and that, without their contribution, health and social care services would completely collapse.
Let me begin by being positive. The commitment in the gracious Speech to integrate health and social care, which many of us have been banging on about for many years, is very welcome, as is the proposal to increase the NHS budget by £8 billion a year. Looking back at the work of the previous Parliament, no one could have welcomed more than I did—and indeed the whole carers’ movement did—the introduction of the Care Act, enshrining as it does the rights for carers, for which many of us have been fighting for many years, and the very important changes made in the Children and Families Act, which also benefited parent carers. So far, so positive, but there is no explicit commitment to increase spending on social care and consequently much worry about how the positive changes introduced under the Care Act may be undermined.
Historic underfunding of social care has left thousands of older and disabled people without access to the care that they need and vastly increased pressure on family carers, who are stepping in to provide care—as families always do—at great personal, societal and economic cost. ADASS and the Local Government Association suggest that £3.53 billion has been taken from adult social care budgets over the past four years and that:
“Contrary to what the Government has said repeatedly since the 2010 Spending Review, its injection of an additional £7.2 billion for adult social care over the last four years has not solved the social care funding question”.
The number of carers’ assessments has been falling steadily since 2008, with a drop of 7% over the last seven years, despite the significant growth in the number of carers. Higher eligibility requirements mean that 500,000 older and disabled people who would have got care in 2009 are no longer entitled to it, placing extra pressure on carers. This is reflected in Carers UK’s most recent State of Caring survey, done this year, where almost one in three respondents said that they or the person they care for have experienced a change in the amount of care and support that they receive and, of those, 42% said that the amount of care and support arranged by social services has been reduced. Half of all carers responding to the State of Caring survey are worried about the impact of cuts to care and support services over the next year.
The Government need urgently to commit to a sustainable settlement for social care and the NHS that sets out the funding mechanisms that will deliver the money that is needed to implement the Care Act, tackle the existing gap between need and supply, and keep pace with the growing demand that we can never ignore.
Let me turn now to social security. It is deeply concerning that the cumulative impact of welfare reform measures will affect carers. The prospect of a further £12 billion in cuts to the social security budget, which we have heard about a lot today, is causing fear and anxiety among carers. We need urgent reassurances that carers’ benefits will be protected from further cuts.
Almost half of carers who responded to the State of Caring survey are struggling to make ends meet: 41% are cutting back on essentials such as food and heating, 26% are borrowing from family and friends, and 38% are using their life savings to get by. This squeeze on carers’ finances is not sustainable in the long term. Over half of carers responding to the State of Caring survey—it was completed, by the way, before the election—are worried about the impact of cuts to social security over the next year. As a result of the changes that the Government have already made, carers will see a cut of over £1 billion to their incomes between 2011 and 2018.
Let me turn specifically to carer’s allowance, which is the main benefit for carers. It is not means tested. The benefit is worth £62.10 per week or £3,229 if claimed for a year. It is the lowest benefit of its kind and provided to those providing at least 35 hours of care a week. Almost 700,000 people under the age of 65 receive the allowance and 72% of those recipients are women. Although it may be the lowest benefit of its kind, carer’s allowance means a great deal to carers and provides important recognition, as well as income. Any cut to carer’s allowance would be severely detrimental to carers and take policy back at least 30 years to when women were dependent on their partner’s or parents’ income. Again, we need urgent reassurances from the Minister tonight that carer’s allowance will not be cut or restricted to those entitled to universal credit only. I conclude by reminding the Minister of what I am sure he knows: as well as it being morally unacceptable not to support those who provide so much care, it is also economically short-sighted.
My Lords, I declare an interest as chair of the Association of Medical Research Charities and I will speak about medical research and the NHS.
The United Kingdom is a world leader in medical research. More than 75% of clinical research in the United Kingdom is rated as world-leading and internationally excellent. Every morning on my way here, I drive past the magnificent new Crick Institute, which is a tribute to our commitment to leading the field in biosciences, a tribute to the Government’s support and, of course, a tribute to the drive and vision of Sir Paul Nurse.
The Crick Institute is a reminder of what we have achieved in medical research and a token of what we hope and intend to achieve in the future. But all this requires funding and that raises some questions. The ring-fencing of the science budget by the previous Government certainly provided welcome stability and certainty for planning purposes, but it did not allow for inflation, resulting in an erosion in real terms of more than £1 billion during the past five years. Given the leveraged investment that the science budget brings, do the Government have plans to increase and to ring-fence the science budget for this Parliament?
As the Minister will know, a vital part of our spending on medical research comes from charitable donations. Last year, the members of the Association of Medical Research Charities invested £1.3 billion in research in the United Kingdom, which is more than was invested by either the Medical Research Council or the National Institute for Health Research. Ninety per cent of this £1.3 billion research funding is spent in our universities.
The Government help significantly with this via the Charity Research Support Fund. This fund was introduced in 2005 to cover the universities’ broader infrastructure and general operating costs associated with charity-funded research. That means that the Charity Research Support Fund ensures that the money so very generously donated for research is spent directly on research. Unfortunately, the fund has failed to keep pace with the very welcome increase in charity spend. The fund was frozen in 2010 at £198 million. Since then, eligible charity funding has grown by 17%. So my second question for the Minister is: are the Government planning to increase the Charity Research Support Fund so that it keeps pace with charity spend?
There is also a question about funding for the National Institute for Health Research. It is generally recognised that research in the NHS has undergone a renaissance since the establishment of the NIHR, but its budget is less than 1% of the overall NHS budget. Most knowledge-based organisations spend between 5% and 30% of turnover on R&D. There is also a clear business case for increasing research spending via the NIHR. Every £1 of government and charity investment in health research returns between 37p and 40p through health and economic benefits every year in perpetuity. The Government have committed an additional £8 billion of funding for the NHS. Will this result in an increase in the budget for the National Institute for Health Research?
I turn now, in a little more detail, to the NHS itself. The report entitled Every Patient a Research Patient?, commissioned by Cancer Research UK and published two weeks ago, paints rather a mixed picture of the research landscape within the NHS. Professor Dame Sally Davies said in response to the report that,
“there is considerably more to do to improve the commitment, culture, capacity and capability of the NHS to promote, support and conduct research”.
However, I regret to say that evidence seems to suggest that support for research from NHS England remains lukewarm at best. In fact, apart from reference to the 100,000 Genomes Project, research is barely mentioned in its business plan for 2015-16.
The Prime Minister’s own aspiration, espoused at the launch of the strategy for UK life sciences, was that every patient would be a research patient. Could the Minister say how the Government plan to achieve this? How will they deliver on the NHS constitution’s pledge that service users will be informed about research studies in which they may be eligible to participate? The door is open here, surely. We have clear evidence of wide public support.
Finally, there is the question of patient data. The UK has a proud and pioneering record of using epidemiological data to support public health. Successive Governments have outlined ambitious plans to realise the enormous potential in patients’ data. But the current situation is far from satisfactory. Failure to record, link and share data for care and for research has damaging consequences. This failure compromises the safety of patients, reduces opportunities for efficiency gains in the NHS and reduces opportunities for the research which could transform our ability to predict, diagnose and treat disease. Furthermore, the confusion and uncertainty following the care.data debacle have resulted in a significant deterioration of the environment for health records-based research. This is not a satisfactory situation, as I am sure the Government are only too well aware.
There are things that we need to do urgently. We obviously need a simple way to enable patients to opt out of sharing their personal records, if that is what they want, without impacting on their care. We need clarity on which organisations will have access to data and for what purposes. We need clarity on secure storage and on the handling and dissemination of patient data, and we need sanctions—real sanctions, with teeth—for those who mishandle or misuse patient data. And we need, most of all, to get on with all this. I very much hope that the Government feel the same way. I look forward to discussing all these issues in the near future with the noble Lord, Lord Prior, whom I am very glad to welcome to the Front Bench.
My Lords, in the gracious Speech it was welcome to see a commitment to seven-day working. Indeed, in my own Access to Palliative Care Bill, which has now been introduced, I have included a requirement for seven-day services. Like the noble Lord, Lord Sharkey, I welcome the noble Lord, Lord Prior of Brampton, to his position and look forward to working with him closely on this matter.
However, when we talk about seven-day services, we must not forget the nights, because disease does not respect the clock or the calendar. When patients are at home, it is the family who carry the full responsibility for whether to phone somebody and what to do, and that burden of responsibility on them can be huge, particularly if they do not have adequate social care support.
In its report, What’s Important to Me, the National Council for Palliative Care—I must declare an interest because I am taking over as its next chair—has shown just how many patients recognise that they need seven-day services. The appalling findings in the report, Dying Without Dignity, from the Parliamentary and Health Service Ombudsman demonstrate what happens when you do not have seven-day services.
In 2010, the Royal College of Physicians called for such services, with 68% of physicians supporting the move, but physicians are already working on average 50 hours a week. So there is a need for a remodelling of what they do, decreasing bureaucratic burdens on them and ensuring that there are proper roster reviews, otherwise they will not be able to cope and the system will collapse.
An analysis from the Manchester Centre for Health Economics, published last week, looked at the additional risk of death from weekend admissions—it is not just greater on a Saturday but it is even greater on a Sunday. It costs the move to seven-day services at between £1.07 billion and £1.43 billion. Why are those deaths happening? Fewer senior staff are on duty at weekends, with fewer support services, especially in pathology, radiology and pharmacy, and there are fewer allied health professionals, who are so important. There is a higher disease burden in those admitted at the weekends as an emergency, making them less likely to respond well to treatment. The NHS was founded on a principle of equitable care. Failure to provide equity across each day of the week must be considered a failure in one of its fundamental obligations.
For patients who are at home, the need for community support becomes the mainstay of their being able to stay at home. However, they need not only carers but physiotherapy and occupational therapy to maintain their independence. Fortunately, the number of physiotherapy training places has gone back up, having dipped previously, but is not keeping pace with the demand for physiotherapy.
Social care integration is to be welcomed if we are going to use our resources widely. The emergency services, of course, already provide 24/7 cover but the winter funding put in by the previous Government did not reach front-line emergency departments. Only just over 1% of the £700 million went into those departments. The remainder was meant to cut back the pressure on the departments but that seems to have failed. There was an increase in attendances by 500,000, an increase in admissions by 7% and a doubling of delayed discharges.
In its document prescribing the remedy, the Royal College of Emergency Medicine has solutions. Through its future hospital programme, the Royal College of Physicians wants to help the Government to achieve better equitable care, and the Royal College of Surgeons is supportive. However, we must take the administrative pressures off front-line staff to free them up to do the clinical work that we need them to do.
There is a commitment to increasing GP numbers and the Prime Minister, I believe, has said that he wants one in two medical graduates to go into general practice—but how? It will not happen quickly. The time from entry to medical school to being fully trained as a GP is, on average, nine years. However, the shortfall of GPs is already 3,300 and estimated to go up to 8,000 by 2020. Sixty per cent are already providing extended opening hours and 17% are open at weekends.
A Citizens Advice report, Registering Frustration—which was issued after the start of this debate—shows that GP registration is so complex that one in 10 patients finds that it takes them more than two weeks to register; when they cannot register they are directed to walk-in centres; and one in seven GPs has felt that their only option has been to redirect patients to A&E. We should look again at the skill set of those people noble Lords might feel are the least trained and the least qualified—the care assistants and social carers—because, with better training, we will be able to empower them to provide better care.
The UK has a low doctor-to-patient ratio. We are 24th out of the 27 European nations. The Government must re-engage with those who will bring about change— including re-engaging in negotiations with the BMA—to find solutions to work patterns and to the ways that people work.
The noble Lord, Lord Giddens, is right to say that IT must be used imaginatively. We cannot just transfer lengthy paper records on to IT systems and expect that that will do anything other than increase the bureaucratic burden.
As to the threat that comes from the Transatlantic Trade and Investment Partnership, on 28 May the European Parliament’s trade committee agreed a resolution backing the TTIP for the full Parliament to vote on this month. This controversial initiative reintroduced investor state dispute settlements. It would allow corporations to sue the UK for laws protecting public health and represent a destructive force to our NHS. Can the Minister clarify what the Government’s position was in the trade committee and what it will be in a future vote on TTIP? It would be tragic if we undermined our NHS by such a move.
I wish to talk about two aspects of health—the health of the NHS and the health of the population which the NHS serves. The health of the NHS was summarised recently in a letter to the press by David Nicholson, the former chief executive of the NHS, and nine distinguished clinicians, including my noble friend Lord Turnberg, as in early terminal decline and in dire financial straits.
Social care is at the heart of the problem due to savage cuts. This is leading to queues in A&E, delays in discharge, lack of community services and joined-up care, and increased difficulty in getting access to GPs. Overall the share of GDP spent on health has fallen from 8% to 7%, below that of many other developed countries. I remind the Minister and the noble Lord, Lord Prior of Brampton, that it was the decision of a Labour Government in the early years of this century to match the EU average of 8% of GDP spent on health. That allowed long waiting lists to fall and public satisfaction with the NHS to rise to its highest ever level. One per cent of GDP is in the same area as the £22 billion per annum extra calculated by Simon Stevens, in his five-year forward view, to be necessary to keep the NHS working. To raise this sum through savings is pie in the sky without decreasing effectiveness and patient safety.
There are ways of raising this sum which would be politically acceptable—for instance, an earmarked health tax. This was mentioned by the noble Lord, Lord Fowler, and should certainly be on the agenda even if the Treasury might not like it. It should be remembered that several international studies have pointed out that the NHS is very cost effective. It will become less effective if it is not adequately funded.
Central to the role of the NHS is the state of health of the nation. It is well known that chronic non-communicable diseases—obesity, diabetes, heart disease, stroke and cancer, to name the most common—cause the greatest burden on the health and social services of developed, and now less developed, countries: “Hunger persists but the world as a whole got fat”, to steal a quote from Margaret Chan, the director-general of the World Health Organization. These conditions are seldom curable because they are part of a degenerative process although their symptoms can be alleviated and life prolonged by a galaxy of medical and surgical treatments that are now available.
However, as we have discussed before in your Lordships’ House, this is expensive and is one of the main reasons for the relentless increase in the costs of the NHS. To prevent or delay the onset of these diseases must be the way forward. We now know many of the underlying causes or risk factors for non-communicable disease—physical inactivity, unsuitable diet leading to obesity, excessive alcohol consumption and, particularly, tobacco smoking. The list is familiar but repeated health education campaigns aimed at informing people and helping them to avoid these risk factors and live more healthy lives have so far been disappointing—apart from tobacco legislation, which has had beneficial results.
Campaigns to encourage people to alter their behaviour are, of course, counteracted by promotion of unhealthy products as well as other less easily assessed social factors. These are well described in the House of Lords Science and Technology Select Committee’s report of 2012, Behaviour Change. The food and tobacco industries fully understand the power of these subtle, sometimes subliminal, factors in shaping behaviour and huge resources are put in to promoting their often unhealthy products. Margaret Chan—as you can see, I am a fan of hers—has spoken of the influence of not only big tobacco but “big food, big soda and big alcohol” on behaviour and of the need for,
“all sectors of government to consider the health impact of their policies”,
“The determinants of health are exceptionally broad”.
It is a matter of regret, therefore, that the cross-departmental Cabinet Committee on the impact of policies on health has been allowed to wither on the vine. It was perverse of the Government to ask the food and alcohol industries to join a Responsibility Deal to advise on measures to make their products healthier when their least healthy products are often the most popular and profitable—for example, carbonated soft drinks. However, it is perfectly possible for the food industry to make healthy products while still making a profit. But without regulation it is very unlikely that they will at the same time stop marketing their profitable less healthy products.
A recent study has shown that so far, after four years, the Responsibility Deal has had no overall effect on improving the nutritional quality of the food that is marketed. I join many voices in calling for Her Majesty’s Government to seriously consider bringing in regulations to restrict the sale and promotion of these obesogenic food and drinks.
The humble Address promised a data Bill and a British Bill of Rights but said nothing of the digital rights of children and young people. I declare my interest as the founder of iRights, a coalition of organisations and individuals which supports the introduction of digital rights for those under the age of 18. I congratulate the noble Baroness, Lady Shields, on her ministerial appointment. Her work in protecting children from sexual exploitation is exceptional and hugely admired, particularly by me.
However, the protection and safety of children must be balanced with rights and responsibilities, about which I shall make three points. The first I raised in a debate on 20 November last year, the substantive arguments of which can be found at col. 567 in Hansard, so I will be brief. The United Nations Convention on the Rights of the Child is the gold standard for children’s rights. It is designed to articulate their rights and our responsibilities in every possible context. In the 25 years since it was inaugurated, a technological revolution has impacted immeasurably on the lives of children, but with no corresponding change to the provisions of the convention. Young people spend an ever increasing proportion of their lives online and it is imperative that the UNCRC reflects that reality. Therefore, I ask Her Majesty’s Government to advocate for a new protocol that describes how the rights embodied in the UNCRC should be interpreted in digital environments. The idea of making the convention fit for the digital age is gathering steam among other nations and it would be fitting for the UK to be at the forefront of this thinking.
Turning to my second point, we have existing legislation that could, if implemented, do much more to support children online. I acknowledge the privacy law firm, Schillings, for its excellent work in exploring this. I cannot do justice to the Schillings’ briefing as it interrogated vast swathes of consumer legislation, two decades of data and telecommunications regulations and a dozen or more Acts of Parliament, and we simply do not have the time tonight. But I shall give two glimpses of what it has been looking at.
Section 7 of the Data Protection Act 1998 provides the right to make a “subject access request”—that is, request the precise reasoning behind any decision made by “automated means”. Few subject access requests are made by or on behalf of our young people. The mechanism is relatively unknown and operates on an ad hoc basis, website by website. Each automated decision has to be challenged individually, which is a time-consuming business for something that seems, in most instances, relatively benign.
However, how about when an online search of a disease by one member of a household creates a mark on those with the same ISDN address? Might that mark impact on a young person’s future employment, or ability to get a mortgage, or in ways that have not yet been invented because they have wrongly been marked a health risk? How might they reasonably be expected to challenge something they do not yet know has happened?
In another example, Schillings points to Section 5 of the Defamation Act, which goes some way to providing a legal framework for identifying anonymous online posters. But unless the perpetrator, once contacted, voluntarily reveals their identity to the victim or expresses a desire to take the offending material offline, the only recourse available is the court. Which young person has the confidence or the cash to defend their reputation in a courtroom? The young suffer reputational damage disproportionately, often without support, in bedrooms and classrooms all over the United Kingdom. I ask Her Majesty’s Government to build on the work that has already been done and to seek ways in which existing legislation can be routinely implemented on behalf of children and young people, and in doing so support a more responsible and transparent online culture.
Finally, the ubiquitous sight of young people’s eyes on a screen is not simply modernity in action but the result of billions of dollars spent gathering their data, creating a picture of their behaviour and their psychological DNA, and re-engineering it to extend their use and to deliberately keep them online. Sites whose content may in itself be innocuous use the same sort of techniques that keep gambling addicts on slot machines, with small random rewards to keep them hooked. The debate around children and young people cannot be about content alone. Age rating has a valuable place, most particularly for the youngest users, but we must also start to determine what level of compulsive technology, data gathering and personal profiling is acceptable as a method of orchestrating the online behaviour of minors.
Digital technology brings with it such vast opportunity but it is not entirely neutral. It is imperative that where the Government are considering the safety and well-being of children online, these considerations are at the forefront of the debate. There are many actors in the digital world—tech companies, corporations, parents, teachers and young people themselves—but if we are to deliver in the digital dimension the rights young people enjoy offline, the Government too must play their part.
My Lords, it is very good to see the noble Lord, Lord Prior of Brampton, on the Front Bench. I am just sorry that he will not be crossing swords with me this evening, but no doubt there will be occasions in the future when we will have an opportunity to argue. I must say that he replaces a wonderful man, the noble Earl, Lord Howe.
I want to draw the House’s attention to a matter which most people regard as trivial, although it is not trivial to the people concerned. There are around 900,000 pregnancies a year in this country, and something like 20% to 25% of those end in miscarriage or pregnancy loss. One in eight couples in Britain has failure or problems in getting pregnant. What is happening at the moment is absolutely shocking and the National Health Service should be doing much more about it. I would like to describe a model that can be used on a wider basis in the NHS. In his introduction, my noble friend Lord Hunt pointed out that the NHS has, unhelpfully, been used as a political football. I ask noble Lords to forgive me for saying that but it is not directed at the Government as it has happened on all sides. We tend to make all sorts of financial claims which are very difficult to justify. I will say no more than that.
It is not understood how serious a matter it is for those who are trying to conceive. Initially there is a degree of anxiety and then there is a loss of self-esteem. People who are infertile, or having difficulty with miscarriage, start to have a great deal of pain. It is not a physical pain but a pain which erodes their relationships with their parents, with their partner and with other people—so much so that it is very common for people having difficulty getting pregnant to be unable to socialise with their peers. For example, they do not go to dinner parties or do the usual things because the discussion is about children and schools. They become increasingly isolated.
One aspect of that isolation is, of course, the effect on their sexual relationship. I must tell your Lordships that in my experience it is extremely common to see men become impotent and women suffer loss of orgasm as a result of this condition. What is worse, of course—it happens frequently to those who are having difficulty getting pregnant—is that they are likely to miscarry, and they are treated abominably when it happens. They go into hospital to have their uteruses scraped out. Normally they have to wait until the end of the list, sometimes overnight, because the staff are too busy to deal with them. Because it is so common, most people do not see what a tragedy it is for the individual. I should say that it is very common for a woman who has miscarried, and sometimes her husband as well, to remember the date of the miscarriage in the following years and, while not celebrating it, recognising it as a date when something significant happened. I have seen people with infertility problems who have miscarried 10 or 15 pregnancies, and that loss is massive. In a way, that is what happens during in vitro fertilisation as well, because once a woman has had an embryo transfer, she will fantasise that she is pregnant. When her period then comes, it is a shocking psychological injury.
At the moment, as your Lordships know, provision in the National Health Service is inadequate. I think that it is about time we were honest. We should decide which treatments are actually going to be provided and which are not. It is important to recognise that the way we account for so much in the health service, including in vitro fertilisation, does not seem to be justified. For example, in one area IVF treatment costs £1,000 to the health service while in another it costs £6,000. I would like confirmation that this really happens, but it is what I have been told. Several people in senior positions in the health service have said to me that IVF treatments and abortions pay for pregnancy care because the budget is not big enough. There is a curious irony in that.
The NHS website covering infertility is really quite shocking. In the first sentence, women are advised that they should not worry about getting pregnant until they have had unprotected sex for at least two years or 12 months of artificial insemination and have not yet got pregnant. There is no evidence that artificial insemination is any use at all in the treatment of infertility. In fact, the Dutch figures suggest that people who are having sex naturally are just as likely to get pregnant. Much mention is made of lifestyle, but generally it is not really important. Further, we screen people for conditions like chlamydia. I would like to know how much that screening is costing the National Health Service, because in my experience as someone who has worked with infertile people for 40 years, I have seen no serious evidence that chlamydia definitely causes infertility in its acute stages. It may occasionally be possible for it to leave scarring.
There is a conflict of interests. People go to an NHS clinic, and they fail. Overall, there is a 25% chance of getting pregnant, so most people will fail. The same practitioners will then be operating in a private clinic where the same patients will then go afterwards for continuity. It is therefore not in everyone’s interests to see success. It is a massive issue and we need to address it. Sadly, however, the regulatory authority—the Human Fertilisation and Embryology Authority—has been extremely bad at regulating the cost of IVF treatment in the private sector, where at the moment the prices are escalating. People are paying as much as £9,000 or £10,000 for a cycle of treatment, particularly if there are added diagnostic procedures, most of which are of unproven value. Examples are biopsy of the embryo and immunological procedures that are not justified, along with a whole range of other issues, which the NHS actually licenses, but in fact they are research procedures for which I do not believe people should be charged.
It is important for us to consider what the real costs of procedures are throughout the health service. I do not think that we know the figures, and what is happening in in vitro fertilisation is probably happening on a much bigger scale in a whole range of treatments. Because we now have a considerable private practice sector providing treatments within the National Health Service, it is extremely important that the service should understand precisely what the cost of an individual treatment should be. Unless we know that, we will continue to see spiralling costs, as well as the problems of all the people who are not getting treatment. Imagine having one cycle of IVF and finding out that you are no longer eligible for any more, which is the case in many health authorities. The chances of success are 25%. Would we give up a cancer therapy after administering 25% of the drugs, or perhaps 25% of the treatment required for arthritis? We continue with treatments until they are successful. That must be the standard that we need to consider.
My Lords, I do appreciate the gracious Speech. The subject of education is a most important one that concerns us all. Education, which is the ability to read and write, was necessitated for the general masses by the Industrial Revolution almost three centuries ago. Since then, great strides have been made in bringing education at the higher levels in engineering, medicine and the humanities within the reach of many, especially with the introduction of the social welfare system and, in recent years, with the introduction of information technology and the great advancements made in the field of science.
Education has become even more important not only to get a decent job in order to earn a living, but also to cope with daily life and indeed with the machines which surround us in every sphere of living. For the economic development and economic progress of any community or country, education and the learning of skills are most important. In the UK, the old system of apprenticeships is nearly all gone, and there is not enough focus on skills to develop entrepreneurship. To grow more businesses, there has to be an emphasis on skills development. In other parts of the world, especially the poorer and developing countries, there are large populations which have little or no opportunity to access higher education and to learn skills. With modern information technology, it should be possible to reach young people growing up in the rural areas of developing countries by providing them with online learning and training opportunities.
In countries like Northern Ireland, where education in many cases is essentially segregated, young people while they are growing up do not have the opportunity to interact with those from the other part of the community until, for the more fortunate, they get a job or go to university. Segregation creates misconceptions and mistrust, and Northern Ireland has suffered from this divide. There has, however, been an effort to bring young people of school age together through the development of integrated schools, but a lot more needs to be done. The Government should focus their efforts on promoting integrated education in schools. That would be the best and most certain way of creating a trusting and harmonious society in a place such as Northern Ireland. The current proposals for shared facilities between schools is very much second best when compared with genuine integrated education.
Whereas the emphasis is increasingly on teaching science and technical subjects, there is hardly any form of education for citizens on how to lead their lives, how to interact with each other, and how to cope in the multicultural, multireligious society we live in today. Both this year and last year we have been commemorating the centenary of the First World War when millions of people died in that horrible war. One hundred years on, we still live with the threat of war. There are wars going on, whether in Afghanistan or in various Middle East countries, with the great mistrust of those involved being so apparent. There is the grave global threat of terrorism and suicide bombers. A serious matter for all of us to consider is how young people growing up in an advanced and civilised part of the world such as the United Kingdom may somehow become involved in terrorism. One must question what we may be doing wrong or what is missing in the education and upbringing of young people in our society that makes them resort to such abhorrent activities.
Learning is a lifelong process. This is more important now than at any time in the past. There has to be greater emphasis on teaching young people about various religions, customs and rituals, and the means of achieving a better understanding and trust in each other. The world is suffering from acute poverty in many parts and sections of communities—indeed, even in some rich, developed nations, where there are people who are also unbelievably rich. In countries such as India, the caste system is nearly at an end, but in parts of the world there is some form of class system that is equally bad. To create a more harmonious, tolerant and caring society, you need to educate not only young people: even the grown-ups need to be re-educated to overcome their misconceptions and prejudices.
As I said earlier, education—the right education—is the ultimate key to peace, understanding and prosperity. We must all focus on this issue and provide appropriate facilities designed to educate people to meet the demands of living in the present-day world.
My Lords, I must declare my interest as a now fully retired dental surgeon. Single-minded as my focus on dentistry has been, and may be, it is no mere quirk or niche focus, but rather a genuine concern for an area of health that deserves much more attention over the course of this Parliament.
The election campaign demonstrated the importance of all health issues. The parties tried to outbid each other on spending, but where does dentistry sit in that health debate? When it comes to issues the public care about, oral health is conspicuously absent. I was flattered to be included in meetings with my noble friend Lord Howe and with the Secretary of State to consider likely health issues for the manifesto, but it was telling that, of all the major parties, only the Greens and Plaid Cymru mentioned dentistry in their manifestos. It was conspicuously absent from the manifestos of my party and that of the Opposition Labour Party’s policy platform.
This is in spite of some worrying figures. In the 2013 Children’s Dental Health Survey, nearly a third of five year-olds and nearly half of eight year-olds had obvious decay experience in their primary teeth. Under a Government led by a one-nation vision, we must feel deep concern about oral health inequality that sees a fifth of five year-olds eligible for school meals with severe or extensive tooth decay, compared with 11% of those from more privileged backgrounds.
Dentistry is too readily seen in aesthetic terms and so perhaps more easily dismissed, but at its core is a commitment to good health that has holistic benefits for individuals’ overall health, including mental health. More than a third of 12 year-olds and more than a quarter of 15 year-olds reported being embarrassed to smile or laugh due to the condition of their teeth.
The 2010 Conservative manifesto promised to,
“introduce a new dentistry contract that will focus on achieving good dental health, not simply the number of treatments achieved”.
Beyond a few pilot schemes, the dental profession is still waiting for any conclusions. A contract that ends perverse incentives to undergo more costly interventions and instead rewards improving oral health can only be to the benefit of patients and dentists. I sincerely hope that we can finally implement the promise from 2010.
Worldwide scientific evidence, including three systematic reviews of studies comparing children from fluoridated and non-fluoridated communities, indicates that water fluoridation reduces the amount of tooth decay experienced by children and increases the proportion of children who do not experience tooth decay at all. A fourth systematic review found that adults who have lived mainly in fluoridated areas have lower tooth decay rates than those who have lived mainly in non-fluoridated ones. Water fluoridation has made a significant contribution to oral health improvements in communities where it has been introduced. Fluoride has the greatest efficacy in preventing caries, so it was with disappointment that I noted Southampton’s recent rejection of water fluoridation. Hull is currently undergoing a consultation to fluoridate its water supply to deal with an epidemic of poor oral health. More than 43% of children aged five in Hull have fillings and tooth decay; fluoride would play a vital role in combating that. Last year, Birmingham celebrated 50 years of water fluoridation—a great success that saw the number of children with tooth decay halve in six years. Other cities could learn from that example.
Many dentists will also hope that this Parliament will have a rethink as to how the profession is regulated. The dental profession has expressed grave concerns with its regulator, but also a willingness to move to a better model for all. It is therefore disappointing that the gracious Speech made no reference to the Law Commission’s recommendations for health regulation—something health regulators and unions are all keen to scrutinise with a move to implementation.
The gracious Speech called for integration of health services, as well as devolution across the UK and within England. It is essential that dentistry is factored into integrated healthcare and “devo-Manc” style devolution of health budgets and priorities. More than 25,000 children were admitted to hospital in 2013-14 because of tooth decay—the single largest reason for admission across all the National Health Service, and up from 22,500 three years previously. This cost about £30 million. It is clear that dentistry cannot be considered in isolation: the interplay between oral health and general health, dentistry budgets and other NHS budgets, must feature in any discussion on healthcare provision over the next five years.
Dentists are not by nature the most militant of professionals, but there are worries among many that the trade union reforms set out in the gracious Speech will impact on them. Many have called for the introduction of electronic balloting, so that should unlikely industrial action ever take place it could be done with a legitimate turnout, meeting the threshold being suggested by the Government and proving that these reforms are about legitimacy, not diminishing the right to withdraw labour.
In conclusion, I thank my noble friend Lord Howe and his team for their long and important contribution to dental politics, and more recently my honourable friend Dr Daniel Poulter for his time at the Department of Health. I also welcome my right honourable friend Alistair Burt as the new Minister of State for Care and Support, with responsibility for dentistry. There are many challenges ahead and real opportunities for dentistry in the UK. With a Conservative majority Government, we should show what we can do to end inequalities and improve oral health for all.
My Lords, despite advancements in technology, with instant connectivity around the globe, referred to expertly by my noble friend Lord Giddens, there is a general feeling that communication is breaking down everywhere. Nationally and individually, people can hardly talk to each other without fighting or becoming offended. We do not really communicate at all, except in shallow, superficial ways. There is a deepening crisis and what is required in government now is a paradigm shift. People say that to change the system, each one of us, individually, needs to attempt to change ourselves for the better. I certainly know that I need to change: I have behaved in the past from ego, without intention, in a way that has hurt people.
So it surprises and delights people that here in Parliament we have an All-Party Group on Mindfulness. Most people know that mindfulness is a state of mind that helps us to be present in the moment, and aware that we are all connected. It enables us to experience something greater than our habitual selves and thereby live and work more compassionately. I will talk about individual change first and then mindfulness and the legislative programme.
First, on individuals, I spent a week last month with politicians from 10 different countries, including the UN, discussing wiser government. The Brahma Kumaris in its global retreat centre invited its spiritual leader, Dadi Janki, in her 100th year, to travel to be with us. Our main conclusion was that good governance would entail engendering individual self-sovereignty. I was proud to be able to report to them that here in the United Kingdom over the past two years 115 parliamentarians have all completed an eight-week course on mindfulness practice here on the estate. Fellow Peers and Members of the other place of all parties and their staff have accepted that changing oneself not to be in a state of constant anxiety, aggression and pressure is a first step to changing the system, with each of them now relating to colleagues on all sides of the House in a different way.
So how does this all relate to the gracious Speech? In addition to spreading these practices to millions of individuals, we must also change the way our society works in health, education, the criminal justice system, the workplace and international affairs. On health, the National Health Service is expanding the provision of mindfulness-based cognitive therapy as a treatment for many mental and physical conditions and has proven to NICE that it is more cost-effective and longer-lasting than other, more expensive interventions.
Furthermore, last month I was with the new chief executive of Great Ormond Street Hospital, Peter Steer, and his enlightened senior team. I then met Julia Samuel from St Mary’s Hospital with Dr Bob Klaber and Dr Hyde, who are paediatricians. They are all convinced that mindfulness, when used effectively among healthcare workers, is a way to reduce stress throughout their hospitals, improve care and attentiveness and engender compassion and kindness. This is a way for a Government who wish to integrate health and social care and improve our National Health Service to help patients, professionals and carers by engendering compassion.
On education, soon Professor Patrick Pietroni at the University of Chester is to set up an international institute for the study of compassion, which could help compassion across government and society. In the criminal justice system, His Royal Highness Prince Charles gave us a great example of compassion last month by agreeing to a very difficult face-to-face meeting. The Forgiveness Project, where I declare in interest as a patron, has for more than 10 years brought together criminals and perpetrators and victims and their families to face each other personally, often transforming the lives of both. This can reduce anger and release grief, stop the cycle of reoffending, allow victims to lead more active lives and thus save the Government money and resources spent on supporting broken lives.
In the workplace, mindfulness is a way to improve resilience, reduce stress and anxiety and develop creativity. Managing organisational learning and engendering insightful collaboration within organisations helps people to enjoy their work, and as a result the objectives of the organisation are better met. In this way a Government can raise productive potential and increase job creation.
Finally, in international relations, education and culture, the Abrahamic religions all began with contemplative practice, often in silence. From this emerged great compassion. We have seen what can happen in the Middle East when the essence of compassionate contemplation is replaced by religious fanaticism. Some 25% of the people in the MENA region live in Egypt. Now is a vital time for us to help them tackle their major economic, humanitarian and international security challenges. We admire the courage of the Egyptian people over recent years and their pragmatic determination to play a central role in Egypt’s political future, restoring its historic tolerant identity. Long-term stability and prosperity for all Egyptians can be achieved only in a climate of trust and inclusion. Flourishing opposition movements are integral. They provide accountability and offer a political voice for all. However, these movements must be untainted and peaceful and seek to influence not via acts of violence or terror but with the tools of democracy and free speech.
I suggest that our Prime Minister should invite President Abdel Fattah el-Sisi to the United Kingdom as soon as possible. Rather than wringing our hands from the sidelines, we must take the opportunity to serve and help shape Egypt’s democratic cause and history. The wise and noble Lord, Lord Howell of Guildford, spoke here in March about soft power and the UK’s potential to use it to influence the modern world. We could discuss with President el-Sisi, who commands significant support across society, how we might continue to assist the Egyptians. They want to develop a first-class secular democracy with improved civil liberties, education for all and human rights. They have now completed the first two stages of their four-stage road map: a new constitution; an elected President; and now, thirdly, later this year, a brand new Parliament with a judicial framework to monitor its elections. Finally, they plan to create better economic conditions for all their people.
France, Italy and Russia have all hosted President el-Sisi in the last year. Germany has done so this month. They have seen the value to the region, to the world’s safety and security and to themselves of engaging now with the new leadership in Egypt. Our industry should be encouraged and helped to engage there, too. Coming back to education, we are already linking our great universities with theirs. The 10 year-old British University of Egypt now has 6,000 students in Cairo learning and researching in collaboration with UK universities. Now a new Knowledge City in Cairo of more than 200 acres is to be developed with an ambition of having 30,000 students in 10 years. It is now forging links with some of our greatest centres of research and education.
In closing, I ask the Minister to ask Her Majesty’s Government to invite President el-Sisi here for talks soon. In general, how will Her Majesty’s Government apply the relevance, importance and urgency of mindfulness to all that they do? Are we using these proven methodologies to begin to make Britain a mindful nation, so that the United Kingdom can evolve as a centre from which we may spread this, our education and compassion to other countries?
My Lords, not for the first time, I find myself in full agreement with the good intentions in the gracious Speech and the sound purpose of a Government’s health policy. It seems to me that the desire to improve health outcomes for patients and to do that more efficiently and effectively are laudable twin goals and ones with which few could argue. However, I want to reflect on matters beyond these good intentions. In my case, it is not to question Her Majesty’s Government’s underlying purposes with their health policy but to challenge their narrow definitions of health and social care and, indeed, to suggest that they are simply not being radical enough.
Professor Sir Michael Marmot published his seminal report Fair Society, Healthy Lives in 2010. It was a comprehensive review of the causes of health outcomes and contained a damning indictment of health inequalities prevalent in many of our most deprived communities in the UK. One of Sir Michael’s key contentions—one that has not been seriously challenged—is that positive health outcomes are significantly more influenced by social determinants than clinical determinants; indeed, that our health is 70% driven by social determinants and only 30% by clinical factors.
Over the past few years I have been astonished by how little mainstream health policy takes the findings of the Marmot review and seeks to turn them into a new and radical approach to how we define health and deliver better services. Indeed, it feels like our attention has been deliberately drawn into an important but none the less constrained conversation about the merging of health and social care. It seems to me that this narrowly defined health and social care debate has had two consequences.
First, it has enabled the principal focus to remain—not exclusively but largely—on how the public and statutory systems talk to each other. I am constantly hearing about earnest initiatives that will pool health and social care budgets and force a new way of working. To my mind, this focus keeps us away from a more radical debate. Secondly, the health and social care debate has kept us away from the conclusions of the Marmot review. It has kept us away from the fundamental questions that inextricably link health outcomes with their social determinants. It keeps us from asking the awkward questions about how we unshackle the central control of health and unleash it into communities.
I am frequently reminded that the vast majority of health interventions happen in communities, not hospitals. They happen in primary care. Some 20 years ago, a young East End mother died of cancer in tragic circumstances. Her name was Jean and her death has had profound consequences for both my life and my work. There were two sides to Jean’s story. The first was that she fell through all the nets of statutory provision that we reasonably expect to be there for us. The health system did not work for Jean. The social care system did not work for Jean or her family. In short, everything that could go wrong went wrong. Jean was badly let down by the state.
However, the other side of Jean’s story was more life-affirming. Just as the state was busy letting Jean down, something very interesting—and very normal and human—happened. Suddenly there was a rota for going down the launderette and doing her washing, and people were going off to Tesco to get her shopping. Jean was inundated with offers of help. Jean was being cared for, not by professionals but by young mums like herself. She was being cared for by the community in the community. She was having the social determinants of her health addressed.
Some months later, there was an inquiry at the Royal London Hospital into the circumstances of Jean’s death. That in turn led to the building of the first healthy living centre in Britain in Bromley-by-Bow—the first health centre in Britain to be owned by the patients and rented to the doctors. Something had shifted in who owned health in that community. Critically, the initiative was supported by the noble Lord, Lord Mawhinney, who helped to navigate the tricky waters of an NHS for which this approach was radical and difficult.
My belief is that we need a different approach to health, creating centres of heath in our communities that address the full range of health determinants. We need a big purpose in our pursuit of a healthy community. Today the Bromley by Bow Centre—I declare an interest as founder—offers a vast array of services to its local community. These stretch from conventional healthcare for local residents to opportunities to set up your own business; from support with tackling your credit card debts to becoming a stained glass artist; from learning to read and write to getting a job for the first time or a helping hand up the career ladder. The centre hosts visits from thousands of visitors and health leaders every year from across the world who come to learn from its experience and who want to see the model in action first-hand. One health leader recently asked, “What do you think we learn from the Bromley by Bow Centre’s experience about how we should build health centres in the future?”. Our CEO Rob Trimble’s answer was very simple: “Do not build health centres”.
This is not an argument that denigrates clinical health. On the contrary, it positions it within a broad range of services that drive well-being in communities by creating a locally blended offer, where doctors sit alongside others, including patients and local residents, in high-quality buildings to provide what people need. Creating buildings which act as centres of the community, not just health centres, makes sense for so many other reasons, not least financial ones. Our friends who run successful businesses such as John Lewis will tell you that the idea of a well-run department store where you can offer a whole range of products makes complete sense for the customer and complete financial sense for the business. You can capture the customer and have the opportunity, in the convenience of one place, to offer myriad products and services. This is the same principle in integrated holistic centres, where health is about life and living, not just disease and illness. It is about sweating our community assets and ensuring that one investment in a new set of buildings creates benefits and savings across a whole range of Whitehall departments, not just the Department of Health.
I am led to believe that there are few avowed disciples of the silo approach left, yet in many parts of Whitehall it seems to remain the prevailing culture. We need more of the department store approach and less of the citadels of health and social care approach. I urge Her Majesty’s Government to be brave and back dynamic and radical local solutions—more human solutions—and to move on from old-fashioned silo thinking in Whitehall.
My Lords, I have to admit that this is not the Queen’s Speech I had hoped to be debating today but the electorate have made their decision and we are where we are.
For me, raising academic standards is clearly of the utmost importance in any education policy. However, the Government should also recognise the essential role that schools play in children’s broader development. Schools must be given the freedom to prepare pupils for adulthood. This means teaching about the importance of strong and positive relationships, educating children about respect and tolerance, and safeguarding children through clear messages about online safety and bullying.
Church schools make up a third of the maintained sector in England. They are popular with parents and play an important role in educating children from deprived and minority backgrounds. In light of this, it is important that measures in the Education and Adoption Bill take account of the views of education leaders in the church sector. Their expertise is invaluable and I hope that the Minister can confirm that they will be consulted in advance of the Bill being brought before Parliament.
This would also be an appropriate point for the Government to remove the arbitrary restrictions on school admissions, which are currently preventing many new church schools being opened. The Minister will be aware that in areas of the country, there is a strong demand for new Catholic schools. However, the church is not able to meet this demand through building free schools because they are subject to a 50% cap on faith-based admissions, which means that some of the Catholic children needing places would be turned away. I am sure that noble Lords will agree that parents should have the option of sending their children to a church school, if they wish to do so. I hope that the Government will review this situation at the earliest opportunity.
Turning to health, the interaction with migration policy is likely to re-emerge as a prominent issue in the coming months. During the last Parliament, steps were taken to restrict the availability of free healthcare for people from overseas, particularly those with irregular immigration status. Striking a balance between protecting the finite resources of our National Health Service and protecting the most vulnerable migrants is a significant challenge to any Government but should legislation be introduced to implement new charges or strengthen eligibility checks, it must be handled with sensitivity. I am sure the House would agree that medical professionals should never be expected to act as immigration officers. It is also important that migrants receive clear information about exactly what they are entitled to.
Particular concerns have been expressed about migrants who experience trafficking, domestic abuse or female genital mutilation. No one wants to see the recent advances in tackling these horrendous crimes undermined by inadvertently restricting victims’ access to medical care, especially considering the crucial role that doctors and nurses play in identifying those affected. Above all, we should not allow the exaggerated perceptions of so-called health tourism to obscure reasonable discussion about eligibility for NHS services. It is of course essential to address the very small number of people who seek to exploit our system, but never at the expense of those genuinely in need. Will the Minister outline what changes the Government are considering to affect how migrants can access healthcare, and what safeguards will be included?
The Government have announced a full employment and welfare Bill. As a vice-president of the National Autistic Society, I welcome any proposal that addresses disability employment. Certainly, only 15% of people with autism are now in full-time employment. The Government have exempted benefits relating to the additional costs of disability from their freeze, but I am not sure as to the status of the employment and support allowance. The Bill will also freeze working-age benefits, tax credits and child benefit and reduce the level of the benefit cap. I know that the National Autistic Society hoped that the Government would use this opportunity to honour their manifesto pledge and halve the disability employment gap. Unfortunately, there is no mention of this in the Queen’s Speech. If the Government are to achieve their stated aim of full employment, reducing the disability employment gap will be crucial to doing this. According to the Office for National Statistics, the employment rate currently stands at 73% but for people with disability it falls to 48%. Can the Minister tell the House whether measures will be brought forward to address the disability employment gap?
The Bill will also contain changes to welfare, in particular a lowering of the welfare cap and a freeze on the majority of working-age benefits. The National Autistic Society tells me it understands that the personal independence payment will be protected, but what about employment and support allowance? As well as being given to those with a disability who cannot work, this allowance is a crucial benefit for those who are able to work but need additional support to stay in employment. Does this mean that the personal independence payment is exempt and can the Minister confirm whether the employment and support allowance is also exempt? More broadly, I hope that the Minister will be able to clarify what steps will be taken to prevent people being forced into poverty as a result of lowering the benefit cap. While no one denies that difficult spending decisions have to be made, the escalating levels of child poverty, food poverty and housing insecurity demonstrate that the impact is all too often falling on the most vulnerable. Ultimately, the savings achieved will be of marginal significance to overall deficit reduction. If the cap is to be lowered, would this not be the appropriate point to look at some flexibility to account for variations in family size or regional housing costs?
I have no doubt that the House will give the most careful and positive scrutiny to the Bills that the Government will bring forward from the Queen's Speech. We will support them where it is justified to do so but seek to amend and improve them if we think it necessary. If I may conclude by being presumptuous, I say to the Minister: do not reject a good idea which improves a Bill, simply because the Government did not think of it first.
My Lords, there is a fundamental belief that every child deserves the best chances in life. It is such an easy belief to hold, but it can be a very difficult one to convert into reality. However, difficult though it is, this is a task the Government must try to undertake. The Government must ensure that the most vulnerable children are not left behind. First, the Government need to address children’s academic success, which is determined before they even set foot in the classroom. I am proud to say that the Lib Dem policy of the pupil premium provides vital extra funding for schools so they can support these poorer children and help them catch up with their peers. The next step is to extend extra support for the poorest three and four year-olds, and not just those on free school meals.
The gracious Speech contained some welcome proposals for young people, with the promise of 3 million more apprenticeships. But employment provision also needs to offer realistic opportunities for young people who have been in care, those who have a disability and those who care for a family member at home. The full employment and welfare benefits Bill is an excellent opportunity to transform the road to employment. For the first time, we could have a system where the most vulnerable and the most in need of support are at its very heart.
One of the major challenges we face today in relation to children is child sexual exploitation and child abuse. These are horrific crimes, and the effect they have on children is unimaginable, on both girls and boys, from all areas of the UK and from all social, cultural, ethnic and religious backgrounds. Thankfully, we are finally beginning to wake up to the reality of this horror, but there is still a long way to go according to the charity Barnardo’s, because more and more children are seeking its help. Much more must be done to ensure that joined-up help and support reach those who need it.
Easy access to online pornography is causing children as young as 10 to inflict sexual abuse on each other. I have been told of victims as young as four. The Government must ensure that all schools provide age-appropriate sex and relationship education, and must keep their promise to provide better online protection, coupled with stringent penalties for those who flout laws designed to protect children and their innocence. We must encourage children to speak out, and tell them they are worthy and that the abuse is not their fault. I say this when I go into schools, and once an eight year-old boy put his hand up and said, “Floella, my dad comes into my room at night and pulls my pants down and does things to me I do not want him to do. Can you make him stop?”. Does that not bring a tear to your eye?
It is great to hear the Government’s decision to place children at the top of their priority list and to continue to make progress to give every single child the best start in life. The All-Party Group on a Fit and Healthy Childhood, which I am proud to chair, has promoted this vigorously. Our reports have been widely influential, and the group believes that prioritising the health and welfare of children makes social and economic common sense—both in the long term by protecting and safeguarding our future and in the short to medium term by tackling the problem of childhood obesity, which has become the plague of today’s society. Among its 100 recommendations, the group’s early years report argued that it is crucial to extend the excellent measure of universal free school meals to all children of school age, because food plays an essential part in their learning and concentration. However, most importantly, the report highlights the need to ensure that policies are co-ordinated at the very highest level by a Cabinet Minister with specific responsibilities for children and a remit to ensure that all departments form policies that are truly child centred.
I have spent my entire working life making this argument: making the case for all our children and campaigning to help families reach their full potential. What is so encouraging is that I am no longer a voice in the wilderness. More and more people are beginning to get it, so I am now asking the Government to help us make the group’s policies a reality. I would welcome a meeting with Ministers to begin the most important dialogue we can have, so that together, and from a genuinely cross-party basis, we can protect every child’s right to be fit and healthy, both physically and mentally.
Finally, I turn my attention to one of my favourite subjects, children's television—and of course I declare an interest. Much progress was made by the last Government around supporting and investing in children’s television. I worked with the Producers Alliance for Cinema and TV, the BBC and others to secure changes to child performance regulations through the Children and Families Act, which now ensures that equal opportunities as well as performance and development opportunities in a safe environment are available to all children across the UK. We also secured animation tax credit, as well as the introduction of a tax relief for children’s live action television productions. But despite these positive steps forward, there is a crisis looming—a crisis in investment in children’s public service content. Over the last 10 years, there has been a dramatic fall of 95% in spend on original content on all four main television channels. They now show less than two hours per week of first-run children’s programming, down from 12 hours in 2003. Is this what our children deserve, endless repeats of content that is years old and does not originate from the UK? Interestingly, only 1% of new UK productions are made here in this country.
The children’s television industry has become heavily reliant on the BBC for new productions, which reduces diversity of programmes and competitive stimulus and creates risk, given the threats to BBC budgets and the licence fee. We should be creating content that is rich in cultural terms for children. Childhood lasts a lifetime, and we all remember our children’s television programmes—so they, like us, deserve their own cherished content that is relevant to them. Therefore, we need more commercial PSB investment in children’s television. Will the Government encourage Ofcom to report on this issue in their next PSB review? Also, will they encourage broadcasters to take a voluntary approach to improving their investment in children’s content? If they fail to do this, will the Government consider applying some form of quotas for children’s content?
Children deserve the best we can provide for them, and the Government have a responsibility to do just that. We must not stand by and let down our children—we have a duty to protect, love and nurture all children. So let us get on with the job.
My Lords, listening to the various topics debated this week, I could not help but think about how interrelated so many of them are. Indeed, these days of consideration of the gracious Speech provide a valuable opportunity to foster joined-up thinking where, in the coming months, we may sometimes suffer from tunnel vision. I am always exhorting students to look beyond their own sphere of interest and at other disciplines to help to clarify their own.
Why is this pertinent to today’s debate, particularly on culture? Let me give some examples. My greatest concern in this field is the provision of music in schools, which has suffered dreadfully over the past 15 years. Not only should music-making be the right of all and not just the privilege of the wealthy few, but research has shown that music and choral singing lead to a more cohesive society, one where the individual’s ability to express personal turbulence through an artistic outlet acts as a release of internal pressure. Improvements in behaviour and academic achievement follow, as the noble Lord, Lord Bragg, pointed out earlier. So culture, education and health are all stakeholders in this.
I accept that everyone has to take their share of the current cuts, and many small and large arts companies are really struggling. The noble Lord, Lord Hunt of Kings Heath, told us about the difficulties facing the City of Birmingham Symphony Orchestra, and if a world-renowned organisation such as the CBSO is struggling, just imagine what is happening to chamber groups, small theatre companies and the like. Yet it is precisely here that we find the seed bed that feeds talent into our international successes, which bring a fortune into the Treasury, as we have heard. So we must fight for the arts at grass-roots level, but the primacy of the need for children—our next generation of artists and audience, after all—to be versed in the arts seems to me of paramount importance.
There is, too, an aesthetic element involved in planning. In my area of mid-Wales, which, incidentally still does not have efficient digital coverage let alone high-speed broadband, there is considerable rejoicing that the Government are set to strengthen the representation of local communities in deciding about onshore wind farms, since one threatened Offa’s Dyke and a Repton grade 1 park. This issue is not confined just to energy, which we discussed yesterday; it also embraces agriculture, tourism, landscape and culture. I sincerely hope the Government will give this proposal real teeth.
We failed lamentably in the previous Parliament to curb, let alone stop, female genital mutilation. We simply must do better in this Parliament, even if that requires more draconian action by the state, as in France. It is a national disgrace that this appalling practice has been illegal since 1985 and, as the late and much-missed Baroness Rendell consistently pointed out, we have still to secure a single conviction. Part of the problem is cultural and part is educational, while the implications for health are truly shocking—I am sure the noble Lord, Lord Winston, would confirm this—including loss of sensation, sepsis, haemorrhage and complicated childbirth, to name but four.
Finally let me touch on the BBC and its future. I must, of course, declare an interest here, but I speak not just as a broadcaster but as someone who has been educated, entertained and enlightened by the BBC. Several noble Lords, especially Conservative Peers, mentioned this week their pride, which I share, in your Lordships’ record of scrutiny and improvement in this Chamber, and urged the Government not to overreact to constructive criticism in this place. I would say that, inevitably, parties in power, of whatever hue, are going to feel got at by an organisation such as the BBC if its journalists are doing their job properly in reporting the workings of Westminster, as we are charged with doing our job of scrutiny—but not, in the final analysis, of obstruction—in this Chamber. From my vantage point, I see and feel the huge cuts that have been made in the BBC. Many arts programmes have been cut to the bone. The noble Lord, Lord Hall, in his role as director-general of the BBC, is gradually turning this huge vessel in the right direction, but it cannot be done overnight. So I would counsel Ministers and the Government to tread carefully and sensitively when looking at the licence fee. Once lost, valuable and much-loved aspects of public service broadcasting, not available anywhere else, will, I fear, be very hard to retrieve.
My Lords, I welcome the new Health Ministers, the noble Lord, Lord Prior, and, in her absence, the noble Baroness, Lady Chisholm. I wish them well. I wish them good health and that they will be able to improve the health of the nation in their new roles. I hope that they will seek to apply to themselves and, in particular, to their senior officials the statutory duty of candour for the NHS which the Secretary of State introduced in the previous Parliament.
Notwithstanding that, and the unsuccessful attempts of some of us parliamentarians to gain public access to the official activities of former Health Minister Andrew Lansley in the run-up to the Health and Social Care Act 2012, it was pleasing to hear in the Recess that the High Court had ruled that there should after all be disclosure. In doing so, Mr Justice Charles said that the two senior civil servants were “unimpressive” witnesses and concluded that their evidence had fallen,
“way below the standards that the public and the FTT are entitled to expect of government departments and senior civil servants in advancing public interest arguments”.
So if the Minister cannot answer me this evening, I would be grateful if he would subsequently write to tell me whether the Government have decided to submit a further appeal or are willing to accept the judgment and go public. I hope that they will go public; then we can put this behind us and it will be the end of the episode. In future, though, when we talk about candour it should apply right across the board, not just to civil servants but to government Ministers. Looking at the noble Lord, Lord Prior, I am sure that he will endeavour to ensure that.
Having got that off my chest, I welcome the Government’s commitment in the gracious Speech to implement the National Health Service’s own five-year plan. My health interest is mainly in public health policy, well-being and lifestyle. I focus particularly, as many noble Lords will know, on the health problems arising from alcohol abuse. The NHS five-year plan calls for,
“a radical upgrade in prevention and public health”,
and specifically calls for,
“hard-hitting national action on obesity, smoking and alcohol”.
More recently, the NHS CEO, Simon Stevens, has stated that obesity is now becoming a bigger killer than smoking. That must be of huge concern to all of us, particularly to the Government as they continue to struggle to get public spending and the deficit under control. It is true that the coalition made some progress on those items, but in one area, obesity—and they could not point to the Labour Government prior to them failing—they failed badly. All the records indicate that during the period of the coalition being in power, the waists and weight of the nation grew, and obesity expanded. That needs to be reversed. It is now one of the major health issues facing us, and over the course of the coming months I will be looking to see just what the Government intend to do to address this problem.
I make the point that the problem arises not solely from food, as many people seem to believe, or from a lack of exercise, but also from drinking alcohol. Alcohol is a significant but generally unrecognised and unknown contributor to obesity. Most alcoholic drinks contain sugar, some in very large amounts indeed. A relatively small number of producers and distributors show calories on their product labels, but most do not—and few, if any, show the sugar content. Noble Lords may think that this is a relatively minor or indeed trivial issue but I do not; I believe that it is one of several factors on which action needs to be taken to start to improve the nation’s health, particularly with regard to obesity.
It worries me that so far the Government have not been able to get any movement on this front. I have been chasing them on it for five years. We have had some retailers making changes voluntarily, but the overwhelming bulk of them still do not show anything in this area. It worries me that if the Government cannot resolve relatively minor or trivial issues, as some people refer to them, what chance is there that they will face up to the really tough decisions that they will have to take in respect of obesity, given their failure to move on the smaller topics?
I shall give the House an example of where the Government ran away from taking a tough decision in the last Parliament: minimum unit pricing. The drinks industry itself, however, knows that pricing works. That is why it lobbied the Chancellor so aggressively before the last Budget, a couple of months ago. The industry lobbied for a freeze or reduction in excise duties and won—and it is very pleased indeed with the out-turn from that, because it means that it will be able to maintain or increase its market share and sales.
However, when it comes to the Government introducing minimum unit pricing to reduce the sale of alcohol, the industry pretends not to be convinced of the case and the evidence that it would work. On the one hand we have the industry itself, which knows that it works, and on the other hand the Government are still unconvinced. I put it to the Minister that he needs to address this topic early on. Alcohol affects people’s health in a whole range of areas, as well as obesity. I am patron of the British Liver Trust, and we have seen in recent years that liver disease and deaths caused by it have been increasing, and there is a whole range of other topics where health is affected by alcohol. However, this evening I am speaking in particular about our major problem of obesity.
Given that the five-year plan and the CEO of the NHS have been so specific about the urgent need to tackle this issue, and that past policies—certainly over the last five years—have failed, can the Minister say when he will come to the public and to the House to set out the programme that now needs to be implemented, to truly start to tackle the fundamental problems that arise which relate to obesity, certainly on the drinks side, but also in other areas, including food? We need to see a truly hard-hitting programme put in place that we can all come together around, to make sure that we can reduce the number of deaths that are likely to arise in the future, and in turn reduce the costs that arise for the National Health Service.
My Lords, there is much in the gracious Speech that we on these Benches welcome: the mention of social care, apprentices, child protection and, of course, childcare provision. On childcare provision, however, it is not just about the extra resources or extra finance; it is also about the quality of that provision. But we need to look closely at the financing issues as well. We also welcome the proposals on adoption, which further develop the coalition’s Children and Families Act. Various people have been praised. We should not forget the incredible work that Sarah Teather did on that particular legislation.
Every child deserves only the best education that we can provide. As I have said on many occasions before, a pupil cannot repeat a year or a subject, so the professionalism and quality of teachers is paramount, and the leadership of those schools is hugely important. I hope we will see the coalition’s proposals for a college of teachers taken forward by this Government.
We all want our children not only to get the best from their schooling but to achieve the best. We used to extol the virtues of the Finnish system when worrying about our position in the PISA international league tables but in Finland, of course, they do not have league tables or an endless battery of tests. Children start formal schooling at seven-plus and, most importantly, teachers are qualified to the highest standards, having to have a master’s degree. We seem to have gone instead for a sort of Asian model of name and shame, and constant testing and league tables. Sometimes I hark back to a time when children could enjoy their childhood and their schooling. The model of a top-down approach to education, with continual testing and targets—brought to us by a Labour Government—is stifling learning and creativity.
I am delighted that the noble Lord, Lord Nash, has decided to stay on, and I am sure that in education matters he will bring his inclusive and constructive approach to this House. He said that the new Education and Adoption Bill will speed up the academy programme, with up to a further 1,000 schools in England being turned into academies. He also said that the legislation will sweep away bureaucratic and legal loopholes, which includes consultation with parents. Heaven forbid that parents dare to have a view. What happened to the Conservative view of listening and trusting parents? Will the Minister say why parents should not be consulted on whether a school should become an academy?
The onward march of academisation will continue apace, so at the end of this Parliament we will be left, presumably, with a small rump of excellent, non-coasting maintained schools. If the new-found freedoms and financial rewards enjoyed by academies are so beneficial and pupils thrive so much more, I wonder—tongue in cheek—why it does not make sense to make all secondary schools academies, rather than endlessly chipping away at the maintained sector, which cannot be good for the morale of governors, teachers and parents.
Primary education should remain part of the local community and part of the maintained sector. Some of our academy chains have become bigger, in terms of the number of schools, than the smaller local authorities. Sir Michael Wilshaw is right to say that, like local authorities, these academy chains should be subject to inspection, and their finances regularly audited and made available for public and parental scrutiny.
As a number of noble Lords have mentioned, the BBC is a jewel in our nation’s cultural crown: it is the engine of innovation. In partnership with its commercial broadcasters, it provides a service that is the envy of the world. When listening in the last Parliament to the debate on soft power, I was taken with how many times the BBC was mentioned. I am sure that the review will be genuine, and not an attempt to emasculate Auntie. Can the Minister look at whether the money that was top-sliced for the ill-fated local TV could be used by the BBC? Why do we need to have a charter review every 10 years? Leaving the BBC to the whim of a particular Government cannot be a good thing.
My noble friend Lord Lee of Trafford raised the important issue of tourism. As he rightly pointed out, it creates 9% of our GDP, and has created a third of the new jobs that have been created. Indeed, my own city was turned round by tourism.
My noble friend Lady Tyler, along with other noble Lords, raised the issue of mental health. Three children in every classroom suffer from a diagnosable mental health problem. As with so many areas of education and health, early intervention is crucial. If we detect and treat early on mental health problems that children are facing, they do not become severe, chronic or life-threatening later on. Half of adults with mental health problems have the symptoms by the age of 14, yet there is often little urgency in getting a child into treatment or getting support. Would we tolerate such a response with other health issues? Of course we would not. Families and schools should not have to battle for weeks or even months to get treatment. The notion that teachers are not able to identify such conditions is shocking. If every teacher, as part of their professional training and development, had mental health awareness training, just imagine the impact on the lives of those children, the benefit it would bring to society as a whole, and the savings made in scarce NHS resources.
My Lords, I should like to thank all noble Lords who have spoken in today’s excellent debate, and I apologise in advance that time will not allow me to reference them all individually. I should also like to welcome the noble Lords, Lord Nash and Lord Freud, back to the Dispatch Box. I look forward to some robust debates in the months to come.
It was not so long ago that the noble Lord, Lord Nash, was claiming that the Children and Families Bill was the first, and the last, education Bill that he would steer through this House. He has obviously decided that he enjoys it rather more than he, and we, thought. And who would have thought that the noble Lord, Lord Freud, would still be occupying the welfare brief? His defence of the bedroom tax and of the previous welfare cuts has surely led him to be branded the most unpopular Minister in the Lords. He obviously has a thicker skin than we ever imagined. The £12 billion of welfare cuts to which the Government are now committed risks making the noble Lord and his Secretary of State, I regret, even more unpopular.
A number of noble Lords have raised concerns today about the scale of the planned welfare cuts. The cuts already identified—freezing the level of working-age benefit for two years, disqualifying most 18 to 21 year-olds from claiming housing benefit, and reducing the household benefit cap from £26,000 to £23,000—will raise only an estimated £1.5 billion. We all want to know where the remaining £10.5 billion will come from.
What we can anticipate is that the cuts will disproportionately hit the poor, the young, the sick and the disabled. There will undoubtedly be a rise in the level of child poverty, a further decline in living standards for the poorest and further demands on the good will of food banks. Can the Minister clarify how these further monumental cuts will be decided? Will there be a detailed analysis of need before any further steps are taken? Will the charities working on the front line with these groups be properly consulted, and will the proposals be piloted before they are rolled out universally?
Another area where the sums do not add up is the health proposals. Again, sadly, the Government have some form on this. A number of noble Lords have referred to this matter: the subjecting of the NHS to a massively bureaucratic reorganisation while, at the same time, patient services have deteriorated. As we heard, it is harder than ever to see your GP; the number of patients waiting for more than four hours in A&E has quadrupled; the number waiting longer than 62 days for cancer treatment has nearly doubled; and the number waiting more than 18 weeks for an operation has more than doubled.
Meanwhile, the Government have pledged to find an extra £8 billion for the NHS by 2020, and obviously that is to be welcomed. However, as my noble friend Lord Hunt made clear, the NHS needs these resources immediately. Therefore, can the noble Lord give an indication of the likely budget increases in the coming year and future years to address the growing pressures on these services? Further, does he accept the point that was very well made in the debate today—that the funding needs to be focused on social care as much as on healthcare? Does he also accept that the Government’s plans for a seven-day NHS are simply not credible without extra resources and an urgent plan to address the workforce shortages, particularly the supply of trained GPs and consultants, and, equally importantly, to reverse the cuts in training places for nursing staff?
Another area where a lack of properly trained and qualified staff threatens to derail the Government’s proposals is childcare. Obviously, we welcome plans to extend childcare, and we had our own plans in our manifesto for a more radical extension of childcare. However, the fact is that since 2010 there are more than 40,000 fewer childcare places, and six in 10 councils do not have enough childcare available for working families. Therefore, increasing childcare entitlement without tackling the supply side does not make sense. How will the Government address the concerns of the Pre-School Learning Alliance and others that the current childcare subsidy system is being provided at a loss and is simply not sustainable in the longer term? How will the Government’s proposals address the education inequalities that start in the early years and are currently exacerbated as children progress year on year through school? Perhaps the noble Lord can tell us how we can ensure that the necessary quality resources are targeted at very young children of preschool age.
We also look forward to debating the new schools Bill later this year. We agree that new interventions are needed to address coasting schools, and we should not tolerate underperformance. However, my noble friends have rightly raised concerns about the disadvantages of having a monolithic school structure and the need for a better evidence base of what works.
We also recognise that raising standards requires a strong focus on the quality of classroom teaching, support for head teachers, greater collaboration between schools at a local level and more devolution of decision-making and oversight to a local level. Can the noble Lord the Minister reassure us that in future the Government will stop demonising the teaching profession, which is having the effect of driving good teachers out of the profession and is exacerbating the staff shortages that already exist? Does he also agree that the funding of new schools should be prioritised in areas currently facing shortages of school places?
Finally, my noble friend Lord Hunt highlighted the glaring absence of policies on culture in the Queen’s Speech. Again, a number of references have been made to this. There is so much to be said and done, given its importance to our economy, heritage and well-being.
One area where we know that action will need to be taken is the review of the BBC licence fee. I very much hope that the disparaging remarks made by some of the Minister’s colleagues during the election are not a foretaste of things to come. A number of noble Lords raised the fantastic contribution of the BBC to British culture and soft power in the world. I very much hope that the review will recognise that the BBC delivers high-quality services and programmes for everyone in the country and, indeed, brings the nation together. It is a vital part of our creative industries’ success story. In this sprit, could the noble Lord, Lord Freud, confirm that there will be a widespread consultation among viewers and listeners before any changes are made?
We look forward to scrutinising the government Bills with duty and diligence in the coming months. The Prime Minister has adopted the mantle of one nation and this will be a useful tool for us against which to measure future detailed proposals as they come forward. In this spirit, I very much look forward to hearing the noble Lord’s response this evening.
My Lords, among the many excellent contributions this evening, I was heartened most by that from the noble Lord, Lord Stone of Blackheath. His description of the impact of mindfulness training on many Peers means, as I understand him, that their kindliness has increased. Therefore, I am expecting a much warmer ride in Oral Questions in future—except perhaps from the noble Baroness, Lady Jones.
I will begin with the Full Employment and Welfare Benefits Bill, which is a necessary and important part of the Government’s commitment to ensure that it pays to work rather than to rely on benefits, and to deliver fairness to the taxpayer while continuing to provide support for those in greatest need. The noble Lord, Lord Touhig, made a point about the anti-poverty impacts around lowering the benefit cap. The cap has had the effect of increasing the incentive to work. Where we have already introduced it, capped households were 41% more likely to move into work than a comparable group—and work clearly is the key route out of poverty.
Many noble Lords referenced welfare reform and the cuts. The noble Lords, Lord Hunt and Lord Kirkwood, my noble friend Lord Fowler, and the noble Baronesses, Lady Pitkeathley and Lady Thomas, all asked where the cuts will come from. Clearly, as all noble Lords know perfectly well, I am not in a position to tell them that. We are looking at how to make those savings and will set out those savings when the work is complete.
The noble Lord, Lord Kirkwood, raised the issue of universal credit. He has understood that important reform more, I think, than virtually any other noble Lord here. He said that he would like it go faster. I have promised in the past to make sure that I communicate what is happening with universal credit to noble Lords and I am just looking for the right way to do that. It is the most important reform that we have seen in this area, not just for a generation but for some generations. Therefore, it is important that this House understands it, and I will make sure that that is done to the fullest of my ability.
The noble Lord, Lord Morris, talked about welfare helping people to obtain personal independence. As my noble friend Lady Stedman-Scott said, we need to ensure that work always pays. Indeed, research on universal credit has already found that people who are on that benefit enter work more rapidly and earn more than do their JSA equivalents.
The noble Lord, Lord Hunt, asked whether enough funding would be available for discretionary housing payments. Total payments remain at more than £100 million, which is six times their level at the beginning of the coalition Government. Mid-year returns showed that the majority of local authorities were spending below the 50% level: that is, below the full amount that they could.
Both the noble Lord, Lord Hutton, and the noble Lord, Lord Kirkwood, gave some interesting food for thought to my new colleague, my noble friend Lady Altmann, who I think is sitting on the Front Bench for the first time. Your Lordships can imagine how pleased I am to have a colleague of her calibre covering this important part of DWP responsibility. She will be thinking about those comments from the noble Lord, Lord Hutton, in particular, who has direct experience in this area, and I know that she is grateful for the support that has been given to the reforms that the last Government brought in.
On financial and digital inclusion, referred to by the noble Lord, Lord Kirkwood, we are working hard with local authorities and relevant charities to ramp up both of those, and clearly we have had a breakthrough with the deal between the Treasury and the banks to ensure that safe basic bank accounts are available to all universal credit claimants. We are still working with credit unions—it has been a big programme—to make sure that they are in a position to deliver low-cost credit to those who need it.
Let me turn to the Childcare Bill. A number of noble Lords queried who would be eligible for the new benefit, would it support those who could afford it already, and would it be targeted at the most vulnerable—the noble Baroness, Lady Jones, asked whether it would be targeted at the youngest. There were questions, too, from the noble Lord, Lord Hunt, the right reverend Prelate the Bishop of Durham and the noble Baroness, Lady Tyler. We will consult on detailed eligibility criteria, and this information will be available in due course. We want the scheme to be as simple as possible for both providers and parents. Children from disadvantaged backgrounds are able to access their 15 hours of entitlement early at the age of two, and lower-income families also receive support through working tax credits, which will increase through universal credit.
The right reverend Prelate the Bishop of Durham asked a rather direct question about why we are forcing parents to work. We know that childcare costs can be high. We want to help make childcare more affordable for families and to make it easier for parents to return to work if that is what they choose to do.
On the living wage, the market is more than 80% privately run, and it is for those businesses to decide what to pay employees in a competitive labour market. However, I can assure the right reverend Prelate that, according to the 2013 providers survey, the average hourly wage in full-day care nurseries rose by 7% between 2011 and 2013 to £8.40, which is above the UK living wage of £7.85.
The Education and Adoption Bill will ensure that all children have the opportunity to attend a good school. It provides powers for us to intervene to secure swift action in schools that are not providing children with a high quality of education and that cannot demonstrate the capacity to improve. There was a challenge from the noble Baroness, Lady Morris, and the noble Lord, Lord Griffiths, who asked, essentially: why academies? Sponsored academies have played a significant role over many years in improving many failing and underperforming schools. The evidence has shown that schools in sponsored academy arrangements improve their performance faster than maintained schools. The Government greatly appreciate the work of my noble friend Lord Lingfield to create the Institution for Further Education, and we look forward to its continued growth and development.
The same two noble Lords asked about how we will deal with failing academies. We want all schools to be good or outstanding, and this includes academies. Where an academy underperforms we shall take swift action to tackle this. Decision-making has been devolved to a regional level through eight regional schools commissioners, critically supported by outstanding head teachers.
As to the question raised by the noble Lords, Lord Hunt and Lord Storey, about removing consultation on academy conversions, there comes a point when children’s education has to be paramount—and we are talking here about schools that have been failing children for years.
The noble Lord, Lord Hunt, asked about centralising education. Systems across the globe are shifting power and responsibility to leaders of education and the Government’s education policies effectively embody that trend. We believe that education professionals know best and that is why we have appointed the eight regional schools commissioners.
The noble Lord, Lord Touhig, and the right reverend Prelate the Bishop of Norwich asked about the role of diocesan schools. Church schools and academies play a crucial role in the education system and we will, of course, engage with the church and other faith groups as the Bill progresses. As to the point raised by the noble Baroness, Lady Jones, new school places will be a priority in areas of need.
The noble Lords, Lord Addington and Lord Storey, asked about the training of teachers for pupils with special educational needs and mental health needs. It is vital that there is appropriate training for those working with children with those needs. That is why we have developed specialist resources for initial teacher training, funded development of the SEND Gateway online portal, funded 11,000 new SENCOs, funded 1,000 staff to take postgraduate qualifications, and supported the highly successful Achievement for All approach.
The noble Lord, Lord Kirkham, asked about the need to create well-rounded pupils. Clearly excellent teachers already do that. Our Character Innovation Fund is an example of this support. As to the related issue raised by the noble Baroness, Lady McIntosh, and the noble Lords, Lord Bragg and Lord Berkeley, about the role of arts subjects, our new progress 8 performance will, from next year, further incentivise schools to offer arts subjects at key stage 4.
As to the Government’s commitment to ensuring that everyone can get the care they need seven days a week in their hospital services, our priority is to ensure that the services which patients might need urgently are available seven days a week and that hospital patients get the same standard of care on any day of the week. We are still working with NHS England and others on the detail of this implementation.
A number of noble Lords raised the issue of funding, including the noble Lord, Lord Hunt, and the noble Baronesses Lady Jones, Lady Emerton, Lady Tyler and Lady Walmsley. I thank the noble Baroness, Lady Finlay, for her support for our commitment to invest at least £8 billion to implement the NHS’s own vision for the next five years. This sets out plans for delivering seven-day services where it will make a clinical difference to outcomes. The exact budget for future years will be determined in the spending review, taking account of our ambitions to achieve the best possible care for everyone whenever they need it.
As to the other points on the NHS, the noble Lord, Lord Hunt, and the noble Baroness, Lady Emerton, asked about the spend on agency staff. We agree that this requires urgent action. Last year, the total agency bill was £3.3 billion, which would pay for every one of the 22 million accident and emergency attendees last year. We have ordered a clampdown as part of a package of tough new financial constraints to cut down waste in the NHS, including setting a maximum hourly rate for agency doctors and nurses, banning agencies that are not improved and setting a cap on total agency staff for each NHS trust.
My noble friend Lord Fowler asked about alternative methods of funding. A review of evidence has been gathered. It was included in the comprehensive review by Derek Wanless a few years ago. It showed that general taxation is the most fair and efficient method. Indeed, evidence suggested that other systems seemed likely to prove more costly. The noble Baroness, Lady Walmsley, mentioned the English-Welsh border. I assure her that Welsh residents are able to access primary care services in England on the same basis as English residents.
We will continue to take mental health as seriously as physical health, and to hold the NHS to account for achieving the objectives set out in the NHS mandate; that is, to ensure that mental and physical health conditions are given equal priority. A number of noble Lords, including the noble Baronesses, Lady Masham, Lady Tyler, Lady Hollins and Lady McIntosh, the noble Earl, Lord Listowel, and the noble Lord, Lord Stone, asked what we are doing for mental health sufferers. We are providing significant additional investment of £1.25 billion over the next five years to boost the mental health of children and young people, and investing more than £120 million to introduce for the first time waiting time standards for mental health. We will also trial the collocation of IAPT staff in jobcentres to help improve health unemployment outcomes. The Department of Health and the DWP are working together to explore innovative ways to improve employment and health outcomes for people with common mental health problems. This year, 75% of people who need psychological therapies will be able to access treatment within six weeks and 95% within 18 weeks.
We recognise that mental health support and care for offenders and those in prison can be improved, which is why various departments—including the Department of Health and the Ministry of Justice as well as NHS England, NOMS and Public Health England—are working together to reconfigure services so that mental health needs are identified and to ensure that a range of services are available to support the mental health needs of prisoners and to prevent them escalating. The noble Baroness, Lady Hollins, asked about learning disabilities. We expect to publish a response to our consultation in the autumn.
The noble Lord, Lord Hunt, mentioned integrating health and social care. With the £5.3 billion better care fund we are finally doing what has long been talked about but never delivered: joining up the two systems. It is vital that we make systematic changes in a way that is safe. We therefore cannot demand them overnight but will ensure that we build on the progress that local areas have made to date. The noble Lord and the noble Baroness, Lady Emerton, asked about the regulation of plastic surgery. The Department of Health is working closely with stakeholders to implement recommendations from the Keogh review. The Royal College of Surgeons has set up a speciality committee to look at standards for training and certification of cosmetic surgeons. Health Education England is developing standards of qualifications for non-surgical interventions such as dermal fillers.
The noble Baronesses, Lady Walmsley, Lady Emerton, Lady Campbell and Lady Jones, asked about nurse training. For 2015-16, Health Education England has increased the number of adult nursing training places and there has been a growth over the past two years of 13.6%. However, we recognise that more can be done and we will continue to ensure that we recruit and retain the staff we need to deliver health and social care for the future.
There was a question about the professional accountability Bill. I recognise the disappointment expressed by the noble Lord, Lord Hunt, and the noble Baronesses, Lady Emerton and Lady Walmsley, that there is no Bill on this issue in the Queen’s Speech. However, the Government have been clear about their commitment to take forward the recommendations made by the Law Commission on this issue and to bringing forward legislation as soon as parliamentary time allows.
I shall pick up the points made by the noble Lords, Lord Sharkey and Lord Giddens. The total budget for the National Institute for Health Research for 2014-15 is more than £1 billion. Further funding will be subject to the spending review this year, so that is a slightly standard response on questions of money.
I turn now to the subject of the BBC. The noble Lord, Lord Hunt, asked whether we will reduce the BBC’s budget. All aspects of the BBC, including how it is funded, are up for debate as part of the charter review. This is one of many issues that will need to be looked at. The charter agreement, including the level of the licence fee required to deliver on the BBC’s public purpose, will be reviewed before the end of 2016. On the issue of the decriminalisation of non-payment of the licence fee raised by the noble Lords, Lord Hunt and Lord Bragg, the open, independent and evidence-based review into TV licence payment enforcement is due to report to the Secretary of State by the end of this month, and until that review is completed we should make no presumptions about its conclusions. A number of noble Lords, including the right reverend Prelate the Bishop of Norwich and the noble Lords, Lord Hunt and Lord Storey, talked about the value of the BBC. I can assure them that this will be borne in mind in the context of the forthcoming charter review.
The noble Lord, Lord Hunt, talked about the funding disparity in the arts between London and the regions. In the current financial year, 55% of Arts Council England’s national portfolio funding will go to organisations outside London. The noble Lord, Lord Bragg, emphasised how valuable the arts are. The Government agree with this policy and it is being continued through, for instance, the cultural elements of the northern powerhouse, the new Factory theatre in Manchester and the designation of Hull as the UK City of Culture for 2017. I also share the noble Lord’s view on the importance of the arts in schools, which is why the last Government invested funds in cultural education and music hubs.
The noble Lord, Lord Lee, asked about investment in tourism. My new ministerial colleagues are closely focused on tourism and will reduce the barriers faced by the industry in line with our manifesto commitments.
The noble Baroness, Lady Kidron, raised issues around young people online. I commend the noble Baroness’s work and agree with her on the importance of empowering children to make the best use of the internet, and I will ask colleagues across government to look at the Schillings report in more detail.
Debate adjourned until tomorrow.
House adjourned at 9.48 pm.