Queen’s Speech - Debate (6th Day)

– in the House of Lords at 11:40 am on 29th June 2017.

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Photo of Lord Forsyth of Drumlean Lord Forsyth of Drumlean Chair, Economic Affairs Committee

“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”.

Photo of Lord Ashton of Hyde Lord Ashton of Hyde The Parliamentary Under-Secretary of State for Culture, Media and Sport

My Lords, I am delighted and indeed honoured to open this final day in support of the gracious Speech. No doubt, as on previous days, we will have a robust and informative debate—and with that in mind, I thank my noble friend Lord O’Shaughnessy, who will wind up today.

The gracious Speech covered a wide variety of policy areas. Today’s debate will concentrate on five particular topics: education, health, welfare, pensions and culture. I will start, appropriately, with children. All children, no matter where they are from or where they live, deserve a first-rate education—one that expands their horizons and increases their opportunities. So we must increase capacity in those parts of the country that have been left behind. We will build on the success of our reforms so that there are enough school places and so that schools have the necessary support to be able to drive up standards.

Last year the Government consulted on how best to harness the resources and expertise of those who run successful schools and universities. Such institutions made it clear that they were willing to think afresh about how they can help raise attainment in state schools. We will work with them to do just that. The core schools budget has been protected in real terms since 2010. It will rise from £41 billion in 2017-18 to more than £42 billion in 2019-20, with increasing pupil numbers. We recognise that schools are facing cost pressures, so we will continue to advise them on how to use their funding in cost-effective ways.

Current funding arrangements in England are unfair and we will change them. The system is based on decisions and data that are more than a decade old. Consequently, schools teaching children with the same needs get markedly different amounts of money. A school in Barnsley, for example, could receive 50% more funding, all other things being equal, if it was situated in Hackney. That is why we recently consulted on a new national funding formula for schools. We are now considering more than 25,000 responses, and we will work with Parliament to bring forward proposals that can command a consensus. In doing so, as we outlined in our manifesto, and as the Secretary of State for Education confirmed yesterday, we will ensure that no school has its budget cut as a result of the new formula.

The Government also plan reforms for post-16 education, building on our ambitious target of 3 million apprenticeships by 2020 to help meet the needs of a growing and rapidly changing economy. We are investing an additional £0.5 billion a year in our technical education system, raising its prestige and making it more attractive to potential students and employers alike. The Government will work with employers to develop robust, credible and comprehensive T-levels. They will radically overhaul our national skills system.

This is all part of building a country that works for everyone. So, too, is working to eliminate the gender pay gap. There are more women in work than ever before and the gender pay gap is the lowest it has ever been—but we have more to do. Closing the gender pay gap makes good business sense. McKinsey estimates that closing the gender gaps in work could add £150 billion to the UK economy by 2025. That is why we have introduced shared parental leave, extended the right to request flexible working and enhanced the childcare offering. Moreover, we are one of the first countries in the world to introduce mandatory gender pay gap reporting for large organisations.

Another major priority for this Government is to help the NHS become the safest and highest-quality health system in the world. We will increase health spending by a minimum of £8 billion in real terms over the next five years. Funding per person will be higher in real terms in each of the next four financial years, and will rise 4.7% in real terms over the course of this Parliament. We will also publish a draft Bill on patient safety, to improve how the NHS investigates mistakes and embed a culture of learning and safety improvement throughout. The draft Bill will propose the establishment of a statutory health service safety investigation body that can undertake independent and impartial investigations into patient safety risks in England. Staff and others will be able to share information with the new body, helping the NHS to learn and adapt.

On the treatment of mental health in the NHS, we are supporting an ambitious programme for reforming the system. We will look at the mental health Acts and work with stakeholders to make sure the law is working for people when they need support for their mental health. Later this year, we will also publish a Green Paper on children and young people’s mental health to make sure that best practice is used consistently and that access to the right support is available. On social care, as we look after an ageing population, we have to ensure that all adults can live well and find ways of caring properly for older people. The Government have already invested an additional £2 billion to put social care on a more stable footing, but more needs to be done, and we are listening to people’s views on how to reform the system.

This Government will seek to leave no one behind. With the employment rate at a joint record high of 74.8% and the female employment rate also at a joint record high of 70.2%, we are working effectively to get people into work. Universal credit, meanwhile, represents a generation-changing culture shift in how welfare is delivered and how people are helped, creating a system that allows people to break free from dependency, take control of their lives and move into work. The behavioural effect we are seeing is remarkable. People are responding to the clear incentives, looking for work longer and moving into work faster. The rollout continues to deliver to plan, safely and securely, and this revolutionary system will be available to all new claimants by September next year.

The gracious Speech contained provisions for helping people with their finances. The financial guidance and claims Bill will create a single financial guidance body to provide debt advice for people in England and pensions and money guidance for people throughout the UK. By bringing together the services of the Money Advice Service, the Pensions Advisory Service and the DWP’s Pension Wise, we will ensure that people are able to access the financial guidance they need and improve their ability to make informed financial decisions.

The Bill will also transfer the regulation of claims management companies to the Financial Conduct Authority, to clamp down on rogue businesses that bombard people with nuisance calls and encourage fraudulent claims. A stronger FCA regulatory framework will hold senior managers to account for the actions of their businesses and introduce new fee-capping powers to protect consumers from excessive fees. Finally, the Bill transfers complaints-handling responsibility to the Financial Ombudsman Service. Between them, these measures will protect consumers against malpractice and ensure that they can access high-quality claims management services.

Following the Grenfell Tower tragedy, we have been working to alleviate the pressures on many of those affected. We have relaxed benefit rules and claims are being handled with sensitivity, understanding and flexibility. Guidance has gone to local authorities, making it clear that residents should be treated as a priority for extra payments to make sure that they are no worse off if they are rehoused in a larger property.

I turn now to those parts of the gracious Speech that referred to some of the work of my department. The UK has a world-class cultural sector, and the Government are committed to ensuring that our arts and culture are available to everyone. There is a great economic, social and—in the broadest sense of the word—spiritual imperative for doing so. Culture can have a transformative effect on places and people alike. The Government will continue to invest in culture and working with our arm’s-length bodies and others to explore innovative ways in which culture can foster economic growth, and more people can be encouraged to participate.

My department has governmental responsibility for digital technology. This is one of our country’s great strengths; we have been at the cutting edge from the very beginning and we remain there. New technologies can provide jobs and business opportunities in abundance, as well as revolutionising public services. Inevitably, however, innovation brings with it new challenges and new threats. The Government will not shy away from tackling harmful behaviours and content online, whether it is extremist, abusive or harmful to children.

We are developing a digital charter, which will create a new framework that balances security and freedom. The charter has two core objectives: making the UK the best place to start and run a digital business and making the UK the safest place in the world to be online. This naturally requires a world-leading digital infrastructure. By the end of this year, 95% of UK premises will be able to access superfast broadband, and a broadband universal service obligation is being developed so that no one is left behind. There will be £1.1 billion of investment to help industry build digital networks; £740 million of this will go towards 5G trials and stimulating investment in full fibre networks, and £400 million will help fibre developers access finance. Meanwhile, new legal measures will let consumers have access to better information, switch providers more easily and receive compensation if things go wrong.

Another challenge that we face in the digital age is the responsible handling of data. Personal data are generated at a faster rate than at any time in our history. Businesses are generating more and more data and using more powerful machines to process them—and we all contribute to the phenomenon every time we send emails or undertake transactions online. The data protection Bill will ensure that the law continues to protect us. The right to have information deleted will be strengthened, especially to protect children who have posted information online or had information posted about them that should not define their future and ought instead to be forgotten. The Bill will further regulate the data used by law enforcement agencies, so that victims, witnesses and suspects will have their data managed in a fair and transparent way.

The gracious Speech described a plan for identifying and seizing the opportunities for every community in our country to benefit as we leave the European Union. It made it clear that this Government shall deliver the will of the British people with a Brexit deal that commands the greatest possible public support. It also outlined plans for a stronger, fairer Britain, through strengthening our economy, tackling injustice and promoting opportunity and aspiration for all. I am now very eager to listen to your Lordships’ views.

Photo of Baroness Sherlock Baroness Sherlock Shadow Spokesperson (Work and Pensions), Opposition Senior Whip (Lords) 11:52 am, 29th June 2017

My Lords, I thank the Minister for his introduction. I should first draw the attention of the House to my registered interests, particularly as a former chair of Chapel Street charities and the current senior independent director of the Financial Ombudsman Service.

Today’s debate spans some crucial areas of government policy but underpinning the detail lies the much deeper debate—one about the role of the state versus the individual, the extent to which we are responsible one for another, our tolerance for inequality, and the nature of the safety net to protect those in greatest need. During the general election, I met too many voters who believed that they had been left behind: public servants who had not had a pay rise for years; people who had waited for hours in A&E, for weeks to see a GP or for months for surgery; parents whose schools had made teachers redundant, or sent begging letters home with the kids; disabled people who had lost Motability cars; working people using food banks; older people denied social care—people who felt that nobody was listening and the Government did not understand their lives or take their concerns seriously. This is a profound challenge for all of us. It needs addressing, and I fear that the Queen’s Speech is not equal to that task. To get there, we first have to acknowledge the scale of the problem, and that is our task here today.

On education, on the upside, I was pleased to see the absence of grammar schools in the Queen’s Speech and I hope very much that this means we will not see a new wave of secondary moderns sweeping England. I was glad also that there was no sign of the Tory manifesto plan to snatch school lunches away from infants; I am glad that the Government thought better of that as well. But that is where the good news ends. Put simply, there is no vision for education in the Queen’s Speech, no commitment to ensure that schools are fully and properly funded, no strategy to deal with the crisis in teacher recruitment and retention, no plan to help the half a million children being taught in classes of over 30.

There are aspirations. The Government want to,

“make sure all children … get a world-class education”, and for,

“every child to go to a good or outstanding school”.

That is excellent, but how will it be achieved when we have an unprecedented funding crisis in our schools? There is no point simply saying that we are protecting the budget or repeating record funding when the IFS has pointed out that the current plans would mean a further 3% fall in real-terms funding per pupil, bringing the total figure to 7% by 2022.

There is no cheer in the further and higher education areas either. The adult skills budget is down 32% since 2010. FE has been cut from the beginning of the coalition Government and the current promises simply freeze that cut. And where is the hope for HE students, when students face 50 grand’s worth of debt, drop-out rates for poor students are up again and even nurses have had their bursaries dumped in favour of student loans? The Labour manifesto by contrast offered a positive vision of a national education service fit for modern Britain. We committed to address class sizes, free school meals, funding for schools and post-16, student support and fees. But beyond the money is a deeper sense that education is a public as well as a private good, that we do not want just some kids to succeed—those whose parents can pay fees or hire tutors to help their children pass the 11-plus. We want everyone to be able to fulfil their potential, but we know that means investment, as it does in health and social care.

I should perhaps thank Theresa May for finally getting social care right back up the political agenda. But having done so, she needs to do something about it. All the key stakeholders have stressed repeatedly the crisis in social care. ADASS reports a £4.6 billion reduction in adult social care budgets in the five years to 2015-16. A quarter of a million fewer people get a social care package from their council than five years earlier. Over a million people over 65 do not get the help they need for essential daily activities such as washing, dressing or eating—up by half since 2010.

There is rising pressure on carers, many of whom are old themselves, and an increasingly fragile residential care system, with self-funders subsidising local government placements. We need a fair solution to funding social care which is sustainable in the short, medium and longer term. The Conservative Party manifesto announcement on social care was a huge shock to many people who were seriously worried about what would happen to them if they needed serious care at home as well as in a residential setting. And it wiped out in a few short paragraphs the three years spent in both Houses of Parliament poring over the then Care Bill, discussing what Andrew Dilnot’s care cap might mean and how that might work. That plan at least provided some clarity on care costs and had a hope of addressing the crisis in residential care. But even though it passed into law, the Queen’s Speech now pledges yet another consultation. I am glad the Government are listening; people have been talking for quite a long time. Listening is not the problem, it is doing something about it that is. And now the consultation goes out with another care cap of an unknown level. I ask the Minister: please, how will he hurry this along? Could he also tell us what happened to the £6 billion promised by the Government for implementing the Care Act, first for 2015-16, then postponed till 2019? Is that going to be repledged when the consultation document comes out?

Things are no better in health. Patients are enduring ever longer waits in A&E. The four-hour standard has not been met since July 2015. Waiting lists are back with a vengeance. The 62-day standard for starting cancer treatment after an urgent referral has not been met for three years, and the 18-week target for elective care has not been met for more than a year and has effectively been downgraded. It is getting harder to see a GP. Mental health provision remains desperately inadequate, despite all the warm words. And as for funding, hospitals in England ended 2015-16 with a £2.45 billion deficit—the worst on record. So what is on offer from the Government to deal with the worst crisis since the founding of the NHS? There are some non-legislative measures on mental health. Those are welcome. The Prime Minister said on 7 May,

“today I am pledging to rip up the 1983 Act and introduce in its place a new law”.

Since there is no mental health Bill in the Queen’s Speech, can the Minister tell us when the Prime Minister plans to rip up that Act, and act on the alternative? And there is a draft patient safety Bill. We welcome any measures to improve patient safety in the NHS, so we will look carefully at that.

But our health service needs more than that. Obviously it needs money, and the £8 billion is welcome, but, as the IFS pointed out, it is no more than was announced in the spring Budget. The health service needs investment in preventive work and public health, and it needs the proper joining up of health and social care, but crucially we have to deal with what the King’s Fund calls the “complex and fragmented” arrangements resulting from the Health and Social Care Act 2012 and the fact that we now have a legal framework designed to promote competition, when it is increasingly obvious that what the NHS needs—in fact, all that will keep it together—is ever more collaborative working between different NHS bodies. Labour has always believed in the NHS. I have a challenge for the Government today: if the Conservative Party really believes in it, will it put its money where its mouth is and take some strategic action on NHS structures now? We need no less than that and we need it now.

I turn to social security. As wages have stagnated, the welfare state has failed in its duty to protect poor working families. Four million children have lived in poverty in the last year—two-thirds of those in a household with a working parent—and food bank use is at epic levels. And what is in the Queen’s Speech? There is nothing to address benefit cuts and delays or the escalation in sanctions, which are driving people to food banks and payday lenders. There is nothing to deal with the falling value of benefits and tax credits. In May, CPI inflation was 2.9%, but when inflation rises the poor just get poorer. Since the Budget in 2015, almost all benefits and tax credits means tested for working-age people have been frozen in cash terms, so when inflation goes up, nothing else happens. What is someone living on £73 a week meant to do when the gas bill and the price of food go up? How are they supposed to cope? There is nothing to restore work allowances in universal credit, which are there to make work pay—the whole point of this expensive and complicated reform. There is nothing for the WASPI women, who suddenly find themselves in reduced circumstances after a lifetime of work. Bizarrely, the only reason all pensioners are not facing a cut is because of the DUP.

There is nothing on the bedroom tax, Motability or the work capability assessment. There is nothing for bereaved families, nothing for kids with terminal conditions and nothing for people who need help. That is because this Government have no vision for the welfare state. People want to work, but simply telling them that work is the best route out of poverty does not change anything. The reality is that, because of cuts and changes to in-work benefits, work is no longer a guaranteed route out of poverty. Quite often, it is a route to a cul-de-sac marked “in-work poverty”. That does not work. Labour believes in the welfare state, we believe in a system that helps people to get and keep decent jobs, and we believe in supporting those who cannot work with dignity, and we will fight for that.

Finally, I turn to the DCMS. The Labour manifesto included a commitment to help young people easily remove content they shared on the internet before they were 18, so we will look carefully at government measures in this area. We will also look at the data protection Bill and the proposals for a digital charter. There was a Tory manifesto proposal for a levy on social media companies and service providers to support prevention and counter internet harm. Can the Minister give us some detail on that when he comes to respond?

There are other areas which I hope will get picked up in the debate concerning digital infrastructure, a fair deal for arts and culture, funding for grass-roots sport and, crucially, the review of gambling stakes and prizes, where I really hope we will see immediate action to cut the maximum stake in fixed-odds betting terminals from £100 down to the £2 that it clearly ought to be.

Enough, my Lords. I have given a catalogue of failures but they are more than a list: they are data points that describe the contours of our public services at the moment. Taken together, they send a message about the kind of country we are living in and the kind of country that we want to live in. The EU referendum and the general election revealed that too many of our citizens believe they do not count and feel that the system is stacked against them—people who are just about managing or are not managing at all. That is a problem not just for them but for all of us. A good society is one in which the flourishing of each depends on the flourishing of all, but getting there means taking inequality seriously.

As I said in a debate led by the most reverend Primate the Archbishop of Canterbury last year, Michael Sandel says:

“The real problem with inequality lies in the damage it does to the civic project, to the common good”.

That is partly because, as inequality deepens, the rich and the poor live separate lives. The rich use private, not state, schools, and private healthcare, not the NHS. They take out private insurance rather than relying on the welfare state, and use private gyms, not council swimming pools, and thus towns and cities get segregated by wealth. Addressing income inequality and guaranteeing decent public services matter because people matter, but they also matter because they are a prerequisite to our once again building a nation at ease with itself. Surely that is something we can all agree on.

Photo of Lord Storey Lord Storey Liberal Democrat Lords Spokesperson (Education) 12:05 pm, 29th June 2017

My Lords, when we refer to staff shortages, a crisis in funding, creeping privatisation and a lack of morale among the staff are we talking about the NHS or our schools? Sadly, it is both. My noble friends Lady Walmsley and Lady Brinton will focus on health and social care. Since 2010, 140,000 fewer pupils are taking creative and technical GCSEs. That is a 21% fall in the very subjects that prepare our future engineers and creative minds, and we want to see the continued success of our creative industries. The arts and cultural industries in Britain are of huge and underrated importance. We are a global creative hub and need to remain so. My noble friends Lady Bonham-Carter and Lord Clement-Jones will be demonstrating later in the debate how best the terms of Brexit and our education and training policy can be designed to mitigate the impact and do the maximum to ensure the continuing development and growth of our creative economy in the future.

Most of your Lordships’ time will be taken up with Brexit, and there will probably be very little time to discuss other subjects, such as education. Talking about Brexit, one fact has already emerged. There has already been a 6% reduction in the number of EU nationals coming to UK universities. Imagine the millions of pounds lost to UK universities as a result.

Now that the general election dust has settled and the billion-pound deal has been sealed with the DUP, I suppose we can also breathe a collective sigh of relief that minority government realism has set in and some of the Government’s planned policies are no more. How pleasing it is to know that now the coalition policy of the pensions triple lock is safe, the coalition policy on free meals for key stage 1 primary school children is safe and the coalition policy of no more grammar schools is safe. Indeed, that news was slipped out by the Government on Tuesday.

The gracious Speech had little to say on education. There were just two lines:

My Government will continue to work to ensure that every child has the opportunity to attend a good school and that all schools are fairly funded”.

Is there any noble Lord who does not want children to attend a good school or indeed to see all schools funded fairly?

Turning to education, which is my main area of interest, I shall begin by accentuating the positive. I congratulate the Government on the total lack of any reference to selection in schools. It is interesting to note that the word “grammar” did not appear in the Conservative manifesto. Even having bought the support of the DUP—which, by the way, also approves of selective education—there is no grammar school Bill. This underlines the fact that, even with such support, the Government are unwilling even to try to introduce their flagship education policy.

The Government’s education clothes in the manifesto were pretty threadbare, to say the least. After calling an election which secured a minority Government, there is, as I have said, just one fig-leaf paragraph on education in the Queen’s Speech, and it reveals neither imagination nor competence.

I shall focus on two issues which are significantly absent from the Queen’s Speech, but are two of the most critical facing our schools. The first issue, which will surprise no one, is funding. In spite of an attenuated consultation period, the fairer funding about which the Government have made such great claims has turned out to be unfairer funding, with schools having to reduce teaching staff, reduce non-teaching staff, cut subjects from the secondary curriculum and ask parents to pay for the free state education which we used to be proud of. The average primary school will lose £74,000 in real terms over the next four years, which is equivalent to two teachers, and the average secondary school will lose £291,000 in real terms, which is equivalent to six teachers.

To plug the funding shortage in our schools, an increasing number of heads are using the pupil premium—money that should have been spent on the most disadvantaged children. The Sutton Trust found that schools with the most disadvantaged intakes were more likely to make cuts to staff: almost half—47%—of heads in the most disadvantaged fifth of primary and secondary schools said they had cut teaching staff, compared with a third, 35%, in the least disadvantaged fifth of schools.

If we really want to give our children the best possible start in life, we cannot let the Government stretch our schools to breaking point. In the manifesto, the Government pledged to spend an additional £4 billion on schools to ensure that no school lost money as a result of the new formula. They intended to find this money by withdrawing free school meals for key stage 1 and giving every primary child toast for breakfast. Having achieved a minority Government, where will the Government find this £4 billion? Will they find it in the same place as the £1 billion sweetener they found for the DUP? Perhaps the Minister will enlighten us in his reply.

The Government repeatedly claim that school budgets have been protected and that they are spending more on schools than ever before. There are two flaws in this claim. The first is that while schools may have received more income, the increases do not match the additional costs they have to bear for teachers’ pensions, national insurance, oncosts and the apprenticeship levy. The second is that the school population is increasing and more pupils and students are having to be educated. You do not need a C in GCSE maths to work out that more pupils cost more to educate.

The second issue concerns the recruitment and retention of high-quality teachers. As far as I can see, the word “teacher” does not appear in the Queen’s Speech at all. The crisis in teacher recruitment has now reached the stage where students are expected to take their GSCE in maths without ever being taught by a maths graduate. The national shortage of physics teachers is hardly likely to be solved by offering bursaries to graduates or trying to entice PhDs in physics into the classroom. There are few vacancies for design technology teachers—a subject vital to the creative industries and the economy and attractive to students—but the subject is disappearing from the curriculum as head teacher after head teacher shuts down his or her design and technology department. Even in subjects where, overall, there might be sufficient teachers, the lack of a national strategy in favour of “let the market decide” has created teacher recruitment cold spots. In September, some of our English coastal towns feel more like the tundra than the season of mellow fruitfulness.

The Government must take action to ensure that every child in every school is taught by well-trained and well-qualified teachers. Being well taught should not be a postcode lottery. This is one burning injustice on which the Government should act immediately.

I speak from personal experience when I say that our teachers are our education service’s greatest asset, as we said in our manifesto. However, we seem to find it easier to damn them with faint praise, if we praise them at all. It is time to establish a rapprochement between the Government and the teaching profession and a proper consensus about the way forward. The Government talk a lot about a world-class education system, but a Rolls-Royce cannot be made without top-class materials, state-of-the-art machine tools and high-quality technicians. Our schools need sufficient resources, state-of-the-art facilities and, above all, high-quality teachers.

Photo of The Earl of Kinnoull The Earl of Kinnoull Crossbench 12:13 pm, 29th June 2017

My Lords, it is a pleasure to follow the noble Lord, Lord Storey, with his typically thought-provoking points on this important set of policy areas. I remind the House that I was a member of your Lordships’ Social Mobility Select Committee, and will today restrict my remarks to areas related to this. That committee reported in April last year. We received the response in July and debated the report in late December. It was very heartening to me to hear Her Majesty in the gracious Speech talk of what the new Government aim to do educationally,

“to ensure that every child has the opportunity to attend a good school and that all schools are fairly funded”.

Later on the Speech states that the Government,

“will work to ensure people have the skills they need for the high-skilled, high-wage jobs of the future”.

The Explanatory Notes state:

“We want to make sure all children, regardless of where they live or their background, can get a world-class education that unlocks talent and creates opportunity”.

No one in this House, I am confident, would disagree with such aspirations. The issue, therefore, is how to convert intentions into successful actions. Some part of the road map to fulfilling these admirable aims was laid out by the Minister in his opening speech, for which I am grateful. I want to make further suggestions about the road map and just three points this afternoon.

My first point relates generally to the Social Mobility Committee report. The report was wide ranging and made a number of important findings and recommendations. It is an excellent start for a successful road map. Will the Minister agree to revisit the report with a view to implementing some if not all the recommendations? To encourage him, I submit that this year we have seen evidence of some remarkable attitudinal changes among our fellow citizens here in the UK, particularly the young. I cannot help but feel that one of the causes is to do with inadequate social mobility. Many other commentators have said that. The gracious Speech rightly aspires to address that and our report is also aimed at this, which is why I feel that it is a rich source of potential thoughts for the road map.

My second point relates to data in this area. In our report we said that,

“data is the foundation of any policy. Without good data, these problems will be impossible to understand and then solve”.

There are two main concerns about data. The first was simply ensuring that we collect the right amount of data—not too much or too little—of sufficient purity and over a long time. Secondly, we should ensure that bona fide research can be undertaken on all relevant data by any verified bona fide researchers.

Our report set out only some of the current mechanisms for collecting those data. Gosh, it is complicated, as so many institutions at local and national level collect data, always for sound reasons. Some of the most valuable source data lie within HMRC. But we felt strongly that there was no magic bullet for dealing with data. One simply wants an approach that is constant and determined for seeking ever-better data. The data issue that concerned us more, however, was the ability of our best minds to get access to the data and analyse. The Government, where HMRC data sharing was concerned, said in their own written evidence to us,

“only researchers working on behalf of the Secretary of State can have access to this information”.

In other words, access to vital HMRC data remains very restricted and that needs to change.

Accordingly, does the Minister agree with me that measures to ensure “ever better data” and an “ever better research regime” are things that the government road map should include?

My third and final point concerns our urging the Government to commission a cost-benefit analysis of increasing spend in careers education in schools. The issues are simple. Currently, this is an area of not so much spend or attention in schools. Indeed, we heard from Sir Michael Wilshaw, then of Ofsted, that careers advice does not form a core part of its grading of schools, so obviously schools pay less attention to it. Evidence suggested that many people head off to university and then discover after a short period that the academic route is not for them. That is no doubt preventable in at least some cases with better careers advice. Someone in these circumstances suffers a reversal that is damaging to morale and at the same time may have run up big student loan debt. That in turn causes loss to the Exchequer not only because clearly some of the loans will not be repaid, but there is a natural likelihood of a government cost in relaunching a career.

It was not just us in the committee who felt this. Sir John Holman, in his excellent report for the Gatsby Foundation, looked into the same matter. He conducted his own fairly limited cost-benefit analysis and concluded with PWC’s help that some spend in this area would in fact represent a saving to the Exchequer. Cost-benefit analysis would no doubt help decision-making here and I know that careers advice is not expensive. Sir John Holman also concluded that just £54 per pupil would make a substantial difference. In closing, I ask the Minister if he would agree to look again at the suggestion of a cost-benefit analysis with a view to including it within the road map.

Photo of The Bishop of Ely The Bishop of Ely Bishop 12:20 pm, 29th June 2017

My Lords, like many in this House, I am sure, the events of the past few weeks have been very much on my heart and in my prayers, and in the aftermath of the terror attacks in London and Manchester, it is unsurprising that the Government have placed such an emphasis on counterterrorism and counterextremism measures in the gracious Speech. The Government are right to look at reviewing specific measures to tackle extremism and the places where extremist ideology is able to spread, but stopping extremist ideology where it already exists cannot be all that we do. Although we in this House may divide debates into topics and the Government into departments, as we know, in reality society is not just a series of policy areas, it is a rich fabric of connected life experiences of which education is formative for all. Its value in developing and defining the kind of society we want to become should never be underestimated.

It seems to me that extremism is bred in vulnerability, exclusion and isolation, insecurity and low esteem. To tackle this, we need to provide greater opportunities, in particular in what are already disadvantaged areas of the country, so that there is much greater access particularly to skills-based learning through technical and vocational education which is regarded as being of equal value in society as any academic path that might be followed. So the development of life skills for our young people needs to be attended to even more urgently than it is currently.

It is also the case that that we want to build in our children and young people life skills that go beyond the practical; that is, the skills that build character and purpose so that children and young people not only know about the community in which they live but care about it and thus want it to grow and flourish. In the past month, a significant character education conference was held at the University of Oxford about developing virtue among undergraduates, and only yesterday an excellent conference on character education was held in Gateshead in the north of the country. What we need to be doing is addressing more seriously character education in all of our schools so that children and young people feel that they have a stake not only in the community but in the narrative of their own life story.

Only recently, I was on an official visit to a Church of England school in Blackburn where 96% of the pupils are Muslim. Three young ladies in year six gave me a very good lesson in Christian doctrine as they showed me around. They were young people in a setting where their own faith is honoured, they find themselves valued, and they therefore have the confidence to reach out and explore other things.

We are proud that Church of England schools provide an environment that is hospitable to all faiths and where faith is respected and explored, but it is important that all schools, even those without a religious character, should strive to ensure that children are given the opportunity to develop their understanding of faith, which motivates more than 80% of the world’s population. The answer to perverted theology in any faith is not to ignore the theology but in fact to encourage good theology in response to combat the bad. Religious literacy is more important than ever and all children should be offered the opportunity to explore and understand faith. However, the decision not to include RE in the English baccalaureate, as well as the way it is being treated in the Progress 8 measures, means that we are seeing a reduction in the number of students taking RE at GCSE. Head teachers are predicting that this number will drop off significantly in the coming years. More and more schools are not offering RE at all, with 28% offering no RE in year 11. This number is far worse in academies, with 42% not offering RE at key stage 4. These unintended consequences of accountability measures in education policy can lead to an inability properly to address the important issues facing wider society.

Teaching children to live well with difference of any kind is extremely important. It will not serve our children and grandchildren well if we bequeath them an educational system that limits their ability to think and learn about all these important areas of life. We need to teach them how to disagree well and to live well together. Children, after all, absorb information from the world around them, from what is modelled for them in their families and by their teachers. The narrative of division and fear must not be the primary narrative with which we ask them to live. We should help them properly to understand faith so that they can see and understand the incredible generosity of spirit and self-sacrificial love that has motivated people of faith in their remarkable response to the tragedies that we have all witnessed recently.

Photo of Baroness Stowell of Beeston Baroness Stowell of Beeston Conservative 12:25 pm, 29th June 2017

My Lords, it is always a privilege to speak in your Lordships’ House. Today, I want to discuss one of the big social divides exposed by Brexit and all the other major political events of the past year. That is in education. In the EU referendum, the difference between the way in which graduates voted and non-graduates voted was stark, with nearly two-thirds of postgraduates and four in five of those still in full-time education voting to remain and 64% of those whose formal education had ended at secondary school voting to leave.

I feel that we are a long way off understanding this. Notwithstanding what has been said by some noble Lords in the debate today, we might also be looking in the wrong place. There are no data on how many of your Lordships are educated to degree level, but I do not think that I would be far off if I guessed that a good number, or the majority, of Peers were graduates. I think that that is the case among most people in leadership positions in all walks of life—that is good; we want people in positions of power to be well educated and to know what they are talking about.

However, that means there is a lack of diversity at the top when it comes to understanding this big social divide. Perception of people who are not educated is sometimes a little warped. When Brexit and the referendum are debated, it is not uncommon to hear it said that the so-called uneducated were “duped”. Although it is sometimes whispered, the word “stupid” is used about people who voted to leave. When the presidential elections in the US are talked about, it is often said very loudly that President Trump is stupid. Obviously, when you get to become a President, you should be big enough and ugly enough to take any kind of insult, but we have always to bear in mind that if you dis someone like the President, whoever they may be, in hostile terms, you are effectively dissing the people who supported and voted for that person.

I should declare at this point that I did not go to university. I was the Leader of this House—some of your Lordships may say that you could tell that I did not go to university when I was in that role. It is important for me to share that fact. One of the worst feelings for any human being is that of being misunderstood. One of the worst things for any human being to do to another is not to take them seriously. When I was Leader of this House, I used to make it my business to make sure that I and the rest of my ministerial team took your Lordships’ House seriously and that we represented this House back into government. We need to remember that that sort of thing is important to us in powerful positions, those of us who are highly educated, and so it is equally important to those who are not.

Often, when we talk about those who are uneducated when we think about these big political events, we use phrases such as “left behind”—the noble Baroness, Lady Sherlock, did so earlier today. She painted some parts of the picture but I do not think she painted a full picture, because I think we are in danger of thinking that people who are not educated to degree standard are all failures, and that is just not true. Many people who are not educated to degree level will have set up and run their own business, they will be skilled tradesmen and tradeswomen, they might do important jobs, managing other people, and they have things to contribute to society—and they do. A better way of thinking about them is as being cut off and left out, sometimes. They are not left behind; they are right here, right now. What is happening is that the educated side of the divide have decided that everything is so complicated that only the educated people can come up with the answers, and this has been going on for a long time. That is okay if the answers that the educated people come up with are right. However, it seems now that they are not, so that is where we have a bit of a problem.

Let me take the House back to 2010 and remind noble Lords of the incident between Gordon Brown and Mrs Duffy. The reason I highlight that is not to rehearse again what he said about Mrs Duffy but to point out how Mrs Duffy responded when told what the then Prime Minister had said about her. She had all these journalists gathered around her and she said: “I’m very upset. He is an educated person. Why has he come out with words like that?”. The point is that someone like Mrs Duffy—I have no idea how far she went in her education—feels that, if those who are educated do not understand them, then who the hell will? That is what we need to think about. I know we talk about a better education system and of course that should always be part of the solution; of course, truth is a good thing and I know that we sometimes like to point to different things in different campaigns as being outrageous and misleading, but we need to reflect the fact that the people who need educating right now are not necessarily those that we think of as uneducated but those of us who are very well educated and in positions of power.

There is much more I could say but I have run out of my time, so I have to conclude. But I want to leave noble Lords with one thought about how we proceed over the next few months in our various debates, particularly about the European Union. The biggest thing that motivated how people voted at the general election a couple of weeks ago was other people’s motives. They were looking at the different parties and party leaders and judging their motives. That is why, when we were discussing the Article 50 Bill, I was vocal in those debates about the way we were trying to engage in that very important topic—not that we should not engage in that topic but that we needed to be clear in our own mind that other people are looking at our motives in judging what it is that we say and do and how we are contributing to these very important matters. Whether it is debates about the single market, the customs union or whatever, we have to remember that, for a vast majority of people, the reason they voted to leave the European Union was because they wanted things to change. We need to remember, when we talk about the pros and cons of the ways forward, that as a result of all of this things should be different at the end of this process for those who felt so angry and fed up that they forced this disruption upon our country.

Photo of Baroness McIntosh of Hudnall Baroness McIntosh of Hudnall Deputy Chairman of Committees, Deputy Speaker (Lords) 12:34 pm, 29th June 2017

My Lords, as has already been noted, the gracious Speech does not say much on the subject of education. It says:

My Government will continue to work to ensure that every child has the opportunity to attend a good school and that all schools are fairly funded”.

It goes on to say:

“My Ministers will work to ensure people have the skills they need for the high-skilled, high-wage jobs of the future”.

As the noble Lord, Lord Storey, has observed, it is pretty hard to take issue with any of that, but it is not exactly substantial. It is more what we might call motherhood and apple pie, and rather less meat and potatoes.

However, passing quickly over the sad truth that most of the jobs created in the recent past have been low-skilled and low waged, let us consider what it will take to deliver on these apparently uncontroversial aspirations. My question is: who decides what defines a good school? Noble Lords will not be surprised to hear that I believe no school can properly be regarded as “good” if it cannot, or will not, provide adequately for the creative development of its students. In his opening remarks the Minister said, and I could not agree with him more, that arts and culture can have a transformative effect—I think I quote him exactly. Nowhere is this truer than in education.

This is why I find the continuing omission of arts subjects from the EBacc for secondary schools so dispiriting, and why it is equally depressing that provision of creative education in primary schools is so shockingly variable—depending, as it does, on the willingness of head teachers to find time and to use what are, I fear, diminishing discretionary funds. The best of them do so, of course, but just as many do not, partly because they pick up on deep ministerial ambivalence about the value of creative subjects. This is revealed in a rather strident emphasis on SATs. I observe at this point that my seven year-old grandson, who is in year 2 at primary school, told me a couple of days ago about how everybody is tremendously anxious for the year 6 students as they are doing their SATs. Everybody has to creep around the school and be quiet because it is so desperately important. Should a seven year-old really worry about that? I really do not think so. It is also revealed in the strong emphasis on STEM subjects, which are of course very necessary and important—but not sufficient.

Last week, the newly appointed head of Ofsted, Amanda Spielman, reportedly said:

“Yes, education does have to prepare young people to succeed in life and make their contribution in the labour market. But to reduce education down to this kind of functionalist level is rather wretched”— a nice turn of phrase. She went on:

“The idea that children will not, for example, hear or play the great works of classical musicians or learn about the intricacies of ancient civilisations – all because they are busy preparing for a different set of GCSEs – would be a terrible shame. All children should study a broad and rich curriculum. Curtailing key stage three means prematurely cutting this off for children who may never have an opportunity to study some of these subjects again”.

These are very welcome words. I hope that Ms Spielman will make good on them by ensuring that Ofsted does not in future award “Outstanding” status to any school, primary or secondary, which cannot demonstrate a comprehensive range of creative opportunities for its students, no matter how good the rest of its work may be.

Many arts organisations such as the Royal Shakespeare Company, where I am proud to be a board member, are working hard to provide schools with a range of support and opportunities. The RSC has extensive education work, including a highly successful and oversubscribed associate schools programme. But recent evidence from Ofqual of a significant falling-off in the take-up of arts-based subjects at GCSE—drama down 9.23% between 2016 and 2017; music down 7.41%; and performing arts down a massive 17.63%—shows how quickly ground can be lost.

A rounded, creatively stimulating education should be the birthright of all our children, not just those whose parents can afford to pay for it. Let us recall that often what the parents who can afford to pay want for their children, in addition to good academic standards, is precisely those so-called extra things, such as music, art and drama, which civilise and enrich individual lives and the life of a school community.

The Prime Minister has often spoken—admittedly mostly when talking about grammar schools, which are of course a welcome absence from the gracious Speech, as my noble friend Lady Sherlock has already said—of the need for all young people to have the chance to fulfil their potential. The noble Lord, Lord Ashton, in his opening remarks made similar commitments. Recognising one’s potential and then finding ways to fulfil it require as much as anything an act of imagination. Imaginations need to be fed a rich diet—to continue the food-based metaphors—and not kept on short commons. I really hope the Government will take this into account as they develop their education policy through the next Parliament.

Photo of Lord Kirkwood of Kirkhope Lord Kirkwood of Kirkhope Liberal Democrat 12:41 pm, 29th June 2017

My Lords, it is a pleasure to follow the noble Baroness, Lady McIntosh of Hudnall. Her speeches are always wise and repay careful study. This is my 34th Queen’s Speech—and they do not get better as they go on.

I listened carefully to the speech of the noble Baroness, Lady Stowell of Beeston, and I feel her pain. It is not easy to do this in six minutes on the Queen’s Speech, but we need to have a conversation about what is happening more widely and strategically between the various parts and communities of the United Kingdom. That is important, as we are not in steady-state politics at all. My first complaint about the Queen’s Speech is that I get no sense that the proposals are adequate for the purpose. We are in a period of substantial change, and we need political management of that change, which is absent.

Of course, a lot of activity is going to be devoted over the next two years to withdrawal from the European Union, but there is a parliamentary opportunity cost to that, in that we may not be able to go back and look at some of the other pressing and increasing pressures within our domestic agenda. I do not think the Government have a plan, and I commend to noble Lords who were not here to hear them the words of the noble Lord, Lord Kerr of Kinlochard, who spoke powerfully about that yesterday. He made a lot of sense to me when he was saying that we really need a plan. Like him, I think that this Queen’s Speech is not adequate for that purpose.

The second thing is that part of the Queen’s Speech sets out to establish proper stability and co-operation within the United Kingdom, and obviously I support that. We are in great danger, partly because of the opportunity cost in withdrawal negotiations of forgetting what is going on in the other constituent nations of the United Kingdom. I will say as neutrally as I can that the £1 billion going to Northern Ireland makes that worse. It makes it worse in Scotland and worse in Wales. Why? Your Lordships will recall that Northern Ireland has a population of 1.8 million. If you take £1 billion and scale that up throughout the United Kingdom on a per capita basis, my Twitter feed told me yesterday—from Chris Giles, whose judgment I trust about these things—that that would be equivalent to £35 billion spent in the United Kingdom. These things get noticed north of the border.

It is not that there is no precedent for this or that it is a unique occasion. I remind the House that in 2015, Sinn Fein was complaining that it was not getting enough money for its Fresh Start proposals. In the Stormont House agreement, the then Secretary of State for Northern Ireland, Ms Theresa Villiers, “underpinned” the Fresh Start proposals with £500 million of taxpayers’ money in the United Kingdom, and people in Scotland noticed that. So we have to be very careful about keeping the channels of communication open and making sure that we are actually a United Kingdom in the course of continuing these negotiations within Europe.

The gracious Speech fails to recognise that there has been a signal change in the public’s attitude to the generosity or otherwise of welfare state provision—the safety net—in the United Kingdom. I absolutely support those passages in the speech made by the noble Baroness, Lady Sherlock, and—this is not something that I expected ever to say—Jeremy Corbyn deserves some credit for exploring and exposing some of that during the election campaign. There has been a response, and if colleagues are ever in doubt about that there is evidence every day if they want to look for it. Yesterday NatCen’s 34th annual report on British social attitudes showed that the country clearly has a wish to become kinder. It stated that,

“after 7 years of government austerity, public opinion shows signs of moving back in favour of wanting more tax and spend and greater redistribution of income. We also find that attitudes to benefit recipients are starting to soften and people particularly favour prioritising spending on disabled people”.

That is everywhere in the press, if noble Lords want to find it. There is another example in today’s Independent: an Oxford University research project commissioned for the Trussell Trust shows that four out of five households that use food banks are deemed to be severely food insecure. That is the country we are living in.

In my final minute I will say that it is all right for Ministers to come to the Dispatch Box and say that universal credit is a fix for this because it is transformational. It is transformational for the top two-thirds or more of our community who can handle a very complicated system that has some design faults that are becoming more and more evident, but the bottom 15% in insecure, low-wage jobs are now having their lives manipulated by the rules within universal credit. That is something that we should watch very carefully. If the Minister would be kind enough to take that message back to the DWP, I would be very grateful.

I do not have time to pursue my concluding point but I thought I had better say something beneficial about the Speech. I think that the financial guidance Bill has opportunities and I look forward to taking part with the noble Baroness, Lady Buscombe, to try to make it work and to make financial guidance better in future for citizens of the United Kingdom.

Photo of Baroness Masham of Ilton Baroness Masham of Ilton Crossbench 12:47 pm, 29th June 2017

My Lords, the devastating episodes of the killing of Jo Cox MP and PC Keith Palmer, the deaths and injuries of innocent people on Westminster Bridge, the tragic bombing of the arena in Manchester, the horrific knife attacks at London Bridge and Borough Market, the disastrous inferno in Kensington and the hate crime at the London mosque have all driven me to say a few words about education and health in this debate on the gracious Speech. All these victims needed first aid, and some needed the highest emergency life-saving surgical and medical attention.

One never knows when serious injury or disaster will occur. I have the greatest admiration for the work of major trauma centres. They are the best option for saving life when it is at the highest risk. With Parliament on red alert nowadays and so many visitors descending on Parliament and Westminster Abbey and photographing Big Ben from all around the world, and many people from all over the country visiting their Member of Parliament, I wonder whether there should be a major trauma centre near Parliament. The nearest one is three miles away and, with the incredible volume of traffic in London, it must be very stressful for the ambulance crews trying to battle their way through to reach their destination. The air ambulances do a wonderful job but cannot fly at night.

I feel that with the increasing number of accidents and gun and knife crimes, first aid should be taught in all places of education. Norway is one country that does this, and it not only prepares people to help others but can encourage young people to work in the medical professions.

Last week a report from the Royal College of Obstetricians and Gynaecologists said that three-quarters of babies who died or were brain damaged at birth could have been saved had they received better care. Mothers have been urged to seek help if they notice that their unborn baby is moving less, and hospitals have been pressed to improve heart monitoring and staff communication. But one hears that mothers have not been listened to when they have alerted staff. The Times of 22 June stated:

“NHS culture must change to prevent deaths of babies. The failure to learn from errors is the greatest error of all”.

To prevent the deaths of babies should be paramount. I have very recently met some devastated parents who lost their babies from severe combined immunodeficiency disease. If SCID is recognised as a disease, it should be listed for newborn screening by the UK National Screening Committee. Appropriately treated, SCID can be cured and the child will have a normal life and grow to adulthood. The UK is at risk of falling behind other countries if it does not adopt newborn screening.

There are many difficult problems to solve at this time, but it would be very wrong not to treat the crisis in the NHS as one of the priorities that has to be tackled. We have a serious problem of a shortage of doctors, nurses and care workers. I ask the Minister on behalf of many patients and vulnerable people: does he realise that when there is a shortage of skilled staff things will go wrong? One of the dangers is not being honest about the situation and owning up to it.

On Sunday 19 June, Channel 4 showed a programme, “BUPA Care Homes Undercover”. An undercover person who worked as a care assistant found that the patients were being mistreated. Did the Minister see the programme? If not, I hope he will. This is what happens when the wrong people are employed, and it is quite unacceptable.

Young and older doctors have been leaving the NHS. This is a disaster. Many developed countries spend far more on their health services than the UK. There are 40,000 unfilled nursing vacancies in England and the shortage is one of the most serious issues facing the NHS. Figures published this month showed that the number of EU nurses was down by 90% since last summer’s referendum. Many of our nurses are also leaving, looking for greener grass elsewhere. I read that the NHS is looking to bring in more nurses from India as hospitals struggle with the exodus of staff from the EU.

The idea would be to bring nurses from India for a fixed period on an earn-learn-return basis. Surely this would put patients at risk. Safety should be paramount and I do not think that this could be guaranteed, as nurses would be learning on our sick patients. Trained nurses from the EU on the whole have an excellent work ethos and their exodus is a great misfortune. There is great variation of care across the country. The whole situation needs a fast-track royal commission, but royal commissions seem to take too long. This has to be tackled now—and a workable, fit-for-purpose, safe NHS has to come out of it.

Photo of Baroness Cumberlege Baroness Cumberlege Conservative 12:54 pm, 29th June 2017

I start by declaring that my interests are in the Lords register and saying what a pleasure it is to follow the noble Baroness, Lady Masham. In the gracious Speech, I was delighted to see that the Government are determined to address mental health. Fifteen months ago, I was commissioned by NHS England to review maternity services for England. In undertaking the review, my team and I visited every corner of England, listening to women, their husbands, their partners and health professionals. A conversation that I had with a particular father made a deep impression on me. He told me that when his baby was 10 days old he realised that his wife had just gone out for a moment when he was listening to the radio; he then heard that there was trouble on the trains—she was under the train. He had lost his wife and the mother of his newborn baby. Postnatal depression had taken its toll.

All the groups that we met around the country told us that mental health care for women during pregnancy and after the birth is not good enough. There are a few pockets where high-quality mental health care is provided, but it is rare. So mental health conditions are not identified and, in some cases, that has led to harm for the baby and suicide for the mother. One-quarter of maternal deaths between six weeks and a year after childbirth relate to mental health problems and one in seven of those women will have committed suicide. What a terrible tragedy for mothers, babies, friends, families and the nation.

Of course, not every suicide is preventable, but if we can provide continuity with the same person looking after the woman through pregnancy, birth and postnatal care, we can detect issues early and give the woman and her family the support that they need. Having the same midwife and obstetrician builds a positive and in some cases very precious professional relationship; it builds trust. Yet we heard from women that they could see between 20 and 30 health professionals during the course of their pregnancy, the birth and postnatal care. The research is clear and unequivocal: continuity of the carer prevents 24% of premature births and means that 19% of women are less likely to lose their baby before 24 weeks’ gestation and that 16% are less likely to lose their baby overall. So continuity of care is a no-brainer. It provides safer care—and, what is more, it is what women want and are asking for. The difficulty is that it requires a change of culture. Midwives will need to work differently, in small teams of four and six, and need to be dedicated to give total care to the women and their families. It can be done, and we have seen it working in a few places, but on the whole it means a very different approach to the shift systems in which the midwives work now.

I have heard the noble Baroness, Lady O’Neill of Bengarve, say that you can get the tone at the top and an echo from the bottom, but it is the “muddle in the middle” that is the challenge—the challenge of changing the culture. We also know that women are seeking choice about where to give birth and the type of service that they receive, but 33% get no choice at all. Many of them would prefer to give birth in a midwife-led unit or at home, and all the evidence shows that those choices are as safe as a hospital birth for healthy women who are not expecting their first baby, but those choices are being denied. One woman wrote to me:

“Please listen to me. Don’t overwhelm me with your paperwork. Treat me kindly, and with respect. Let me decide what is important to me. Don’t patronize me. It’s my body, my baby and my new family that I am creating with my partner. It’s our decision. Please honour that, and wrap your services around us”.

Sir Cyril Chantler, my vice-chairman, has worked tirelessly in the last 15 months to work up a scheme that will compensate parents. Last year the NHS spent £560 million on negligence claims, and the amount increases year on year—money which we cannot afford and which could be spent on providing better services. We have devised the rapid resolution and redress scheme, which will make a real difference, but it requires a change in culture, whereby blame is not the motive and saving the lives of babies is the prime and sole objective. The learning has to be passed on.

Outside observers have noticed that the culture of the NHS is too top-down. It stifles innovation, it is obsessed with blame, there is too little forgiveness, and it is overregulated. As Professor Don Berwick has written:

“The outsider can judge care, but only the insider can improve it”.

Nevertheless, in maternity services there are some remarkable achievements. NHS England, with energy and commitment, is implementing our report, Better Births. We believe that we can make maternity services as good as any in the world and, in five years, better births will become the order of the day.