My Lords, surely over the past six years we have witnessed the worst period in the history of the National Health Service. I make no apologies that from the outset I will refer in the main to the problems faced in the north-west of England. I am indebted to Dr Kailash Chand, the deputy chair of the British Medical Association, who used to be my general practitioner in Stalybridge. He points out that the problems in the Greater Manchester area are very acute, particularly in the accident and emergency section, which is under record strain, he says, with black alerts being regularly sounded and patients in need of care often being turned away.
In the community, general practice is on life support. GP practices in Greater Manchester are struggling, owing to the failure of this Government to provide the investment needed to match the increasing demand on services. Underfunding, increased red tape and GP shortages have left many patients struggling to get appointments, while 300 GP practices across the country are facing closure. Recent BMA surveys reveal that a third of GP partners in the north-west say that they are unable to fill vacancies in the past year, and 86% said that their workload is affecting the delivery of patient care. Bed shortages, lack of mental health resources, underfunded social care and one of the worst winters on record have left services in the region struggling to cope. Reference in the gracious Speech to proposals to improve the basis of mental health provision is clearly welcome and awaited. Hopefully it will be rather better than the previous promises, which were woefully inadequate.
Mental health is in crisis, and we know that there is no health without mental health. A former medical health director of a mental health trust reports, “Mental health services are now more fragmented than ever, with a serious shortage in beds and community provision. There is parity of mental and physical care simply in name alone”. Moreover, the Care Quality Commission reports that only 14% of patients say that they received appropriate care in a crisis. That is hardly surprising, given that the number of psychiatric beds has dropped by 39% since 1998, 40% of mental health trusts experienced reductions in income in 2013-14 and 2014-15, and the shortage of beds has resulted in out-of-area placements, which are of course inconvenient to the families and friends of patients, and very costly. Meanwhile, detentions under the Mental Health Act have increased every year since 2009.
I have a particular interest in the problems that beset Alzheimer’s disease. On a personal level, a member of my family is currently in a care home, and the carers in those homes deserve better remuneration than currently exists. In 2000, I was fortunate to win a place in the ballot for Private Members’ Bills in the House of Commons, and I opted for a better deal for carers. As a result, my deal is on the statute book as the Carers and Disabled Children Act 2000, which in some degree has helped carers, although much more has to be done.
Last Saturday, I attended a charity function in my former constituency to help a former constituent of mine, Peter Flanagan, who has been diagnosed with dementia pugilistica, a particular form of the disease that affects former boxers and footballers. It is a neurodegenerative disease, which in itself is rare. However, we all know that there are many forms of dementia, which is the biggest killer in the UK. Peter, together with a colleague, is about to walk for six days on a route along the Great Wall of China to raise money for charity, and he will donate the proceeds to the Alzheimer’s Society. The biggest donor should of course be the Government. We should not have to rely on brave people like Peter to do what he is having to do to bring this to the attention of the Government.
Had there been more time, I would have liked to have referred to the excellent work done by the Teenage Cancer Trust, of which I am a patron. That will have to wait for another day, but I will say that it is critical that the Government make an explicit commitment to continue to implement and prioritise the need for the work that is done by the Teenage Cancer Trust. The next generation should be the first that is not afraid to talk about cancer, and the trust is committed to the idea that young persons so affected should be educated about this terrible disease.
Finally, due to the first-class service that it provides us with, the House of Lords Library has given me valuable information: the voting figures for Nye Bevan’s National Health Service Act 1946, which was passed by a majority of 187. Notable among those who voted against it were Sir Winston Churchill, Sir Anthony Eden, Harold Macmillan, Rab Butler, and many other notable Tories. Should there be any doubt which party is the party for the National Health Service?
The gracious Speech promised to,
“strengthen the economy so that it supports the creation of jobs and generates … tax revenues”.
The creative industries, fuelled by our cultural sector, are one of the fastest-growing areas of the economy and therefore crucial to achieving this aspiration. However, the importance of the arts and culture is that they are not simply about the economy. They are a central part of civic and community life and offer a platform for freedom and diversity that we must support and encourage. To quote that great liberal, John Maynard Keynes:
“The artist … leads the rest of us into fresh pastures … to enjoy what we often begin by rejecting”.
That, in the particular times we live in, which are so full of challenges, is so important.
One of these challenges is of course Brexit. It poses a number of problems for the creative sector and industry, so we ask the Government to ensure that the creative industries are at the top table of the Government’s international trade agenda and Brexit negotiations. They must be a key sector in the Government’s industrial strategy, and their needs need to be considered not just by DCMS and BEIS but across other parts of government, such as DfE and DIT. There must be a joined-up, not a silo, mentality. Without the right deal on movement of talent and skills, creatives will face big problems. There are currently 17 creative roles that are on the Government’s shortage occupation list. Freedom of movement must be retained, non-British EU citizens employed in the UK must have the right to stay, and we want to see students removed from the official migration statistics.
On funding, the new UK-EU relationship needs to ensure continued UK access to very important EU funding sources. If excluded, will the Government commit to seeking to replace this through UK-based schemes? My noble friend Lord Clement-Jones will later address IP and the digital aspects of this matter.
I mentioned earlier that no fewer than 17 creative roles are on the Government’s shortage list. Clearly, something is wrong where skills are concerned. A shockingly high number of our most successful artists found art a refuge. They are where they are in spite of school, not because of it, and this is the wrong way round. The noble Baroness, Lady McIntosh, has been very eloquent on this matter, but creative subjects, due to the current EBacc system, are being abandoned by state schools. Preliminary 2017 figures from Ofqual confirm that the number of young people who take creative-related subjects is declining. I will not go into the statistics, because the noble Baroness, Lady McIntosh, already has. Can the Minister say when we will get the Government’s response to the EBacc consultation, which is long overdue? I hope that the promise in the gracious Speech that all schools are fairly funded will mean fair access to funds for creative and cultural activities.
We on these Benches believe in STEAM, not STEM. The fusion of technological and creative skills is what fuelled the industrial revolution and is what fuels today’s tech revolution. The Victorians understood it. They had a Science and Art Department. I therefore urge the Education Secretary to send a clear message to schools and industry that arts qualifications are valuable.
Perhaps her predecessor, Michael Gove, who is now back in government, can persuade her to make good on his promise in 2012 to implement Darren Henley’s review of cultural education. At its launch, he quoted Sophocles: “Whoever neglects the arts when he is young has lost the past and is dead to the future”. Quite. Apprenticeships are a great way to make access to the creative industries more open and diverse. Will the Government confirm that they intend to institute the flexibilities promised in their manifesto to ensure that the apprenticeship levy paid by companies will be used for training in skills identified by them, not by politicians?
It is essential that the creative industries reflect our diverse 21st century UK. On these Benches, we absolutely believe that it is about the aggregate, those behind the scenes as well as the visible. Ofcom must be required to monitor both as part of the BBC regulatory framework. On which topic, Liberal Democrats believe that we mess with the BBC and Channel 4 at our peril. They are linchpins of our cultural health and creative industries. The most recent royal charter was predicated on five-year fixed-term Parliaments. The clear intention that the setting of the licence fee would be out of sync with an election is no longer the case. The spectre of backroom deals has returned, made all the worse by the fact that this Government are in bed with licence-fee deniers, the DUP. Will the Government commit to setting up an independent BBC licence fee committee?
We are glad that the Government have backed off privatising Channel 4, but we are not sure why they are so keen to move its headquarters from London. Channel 4 is a publishing house. The location of its HQ is irrelevant. What is important is that it commissions programmes from production companies across the UK.
In concluding, I agree with the noble Lord, Lord Ashton. We are a creative isle. Our arts and our culture enrich us literally and metaphorically. Hugely successful industries are spawned. Tourism creates friends as well as revenue, and soft power is generated. Unless it is nurtured, we risk losing a great British success story, one that I believe is not “a”, but “the”, jewel in our crown.
My Lords, the decisions on grammar schools and higher education were omitted from the gracious Speech, as was positively noted by many noble Lords. However, my focus today will be on higher education and, in particular, on the positive impact of international students who study in the UK. I declare my interest as chancellor of De Montfort University.
It is fair to say that following the Brexit result a high degree of negativity has been centred on immigration, with a significant part of it emphasising international students. Therefore, I want to convey the benefits of having international students as part of our global society. We too often hear of the negatives and rarely come across the positives. To endorse this, I shall set out some findings from a survey conducted by Oxford Economics for Universities UK in 2014-15 which gave a clear indication of why it is so important for the UK, as a world leader in global education and research, to maintain a lead in bringing in international students.
The UK has been the second most popular global destination for international students after America. However, this number has declined recently, given that other English-speaking countries, such as Australia, New Zealand and Canada, and Europe have increased their number of overseas students. The basis for the decline has been attributed to factors such as changes in student visa arrangements, the net migration target and, more recently, Brexit, although the actual impact of Brexit on EU students in the UK remains unknown. For the moment, the Government have guaranteed to continue to fund EU students until 2019.
In terms of benefits, what are we actually looking at? International students have very much been part of the essence of university life culturally and socially, and the students have always been essential to the UK’s higher education sector and to the country more widely. International students contribute more than £7 billion to the UK economy, and spending by international students supported 206,600 jobs in university towns and cities across the UK. In 2014-15, 437,000 international students, EU and non-EU, made up 19% of all students registered at UK universities. Their contribution to on and off-campus spending has generated £25.8 billion in gross output for the UK’s economy. International students are necessary for the British economy as a whole, being responsible for £10.8 billion of UK export earnings. They also boost other British industries. For example, they add £750 million to the UK transport industry and £690 million to the retail industry.
In my role as chancellor of De Montfort University, I have obtained some facts, and I would like to share with the House a case study on De Montfort students’ impact on the local community via DMU Square Mile. One-fifth—560—of its 2,800 student volunteers are international students. They have done more than 5,000 hours of work in the community this year. Nabeelah Omarjee is from South Africa. Nabeelah’s enthusiasm has seen her benefit hundreds of people by volunteering on a variety of projects in Leicester and abroad. By taking part in projects around cancer, refugee support, diabetes and more, Nabeelah has always been available to give anyone a helping hand. DMU Global is De Montfort’s pioneering international student experience programme, and demonstrates that DMU is committed to ensuring that its students have a global outlook. I must not forget the DMU Love International campaign, which has celebrated the value that international students and staff bring to the UK.
It is very concerning, therefore, that following several reforms made to the immigration system, the UK’s higher education sector as a whole has experienced two consecutive years of falling overseas entrants: 2011-12 and 2012-13. This is not regarded as a dramatic drop in enrolments, but this recent trend challenges the levels of growth witnessed pre-2010. While demand has continued to increase from countries such as China, the number of Indian students commencing courses in the UK has almost halved in two years. The higher education sector as a whole now sources around one-eighth of its income from international students’ tuition fees. Fluctuating demand from prospective students overseas can therefore leave institutions vulnerable or affect their ability to plan strategically in the long term. Therefore, I ask Her Majesty’s Government to recognise that international students are of real and great importance to the UK’s higher education sector and to the country regionally. Although there have been suggestions that a more positive picture is emerging, it is key that an encouraging approach is maintained and narrated to the global society which demonstrates the values and commitment made by the UK to enhance and develop further the huge opportunities available to young people all over the world.
My Lords, I will highlight something that I believe needs careful consideration as we think about education, health and welfare. It is the matter of vulnerable young people making the transition to adulthood. I am grateful for the aspirations I have heard to support families and give children the best start in life. As we strive for the fairness and flourishing of all, I am concerned that we have yet to see any emphasis on our most vulnerable young people as they move into adulthood. I would particularly like to draw the Government’s attention to five specific groups who need help as they transition to adult life: young people leaving care; young people who are carers themselves; young people with severe disability; young people who are refugees and asylum seekers; and young women at risk of offending and being imprisoned.
Each year around 11,000 young people aged 16 and over leave the care of their local authority. They face the challenge of living independently. The Children’s Society has highlighted how easy it is for them to get into debt as they struggle to develop financial independence. For example, it can be very frightening for these young people to find themselves in council tax debt that quickly escalates to a court summons and enforcement action. Surely we need to support these young care leavers as they take on managing their finances for the first time. As noble Lords may be aware, the Children’s Society is spearheading a campaign to ask councils to exempt care leavers from council tax. Encouragingly, 19 local authorities have now taken this step. I wholeheartedly commend this action.
Now let me mention young people who are carers themselves. In my diocese we have a wonderful organisation, Gloucestershire Young Carers, which works alongside schools and other agencies to get these young people the help they need and minimise the impact of their caring role on their adult lives. At present there are 1,000 young carers on their books. One of those is Evie, aged 16, who has struggled with her first year of A-levels alongside a part-time job and caring for her mother, who suffers both physical and mental ill health. She has written off the chance of going to university as it would leave her mother with no support. Gloucestershire Young Carers is helping Evie try to make a plan for her future where she does not put her caring role before her dreams and ambitions. We know that there are others like Evie who are unsupported. As laws are shaped regarding social care and adult carers, we must not lose sight of the needs of young carers.
We must also not lose sight of severely disabled young people who are not being housed appropriately for adulthood. In Gloucestershire we have the amazing National Star College. However, some leavers are now being housed in elderly care homes. We need to find independent living solutions or even appropriate residential care. National Star is doing well in establishing long-term residential accommodation, but so much more is required.
On migration, as mentioned in the most gracious Speech, our young refugees and asylum seekers need to receive the best start in adult life. We know that education allows these young people to integrate and develop as contributing members of society, but refugees aged 15 and above often find it difficult to find school places. These youngsters, including Syrians on the resettlement programme, often do not arrive at a time convenient for the start of the academic year and not enough is being done to ensure that they can enter formal education. In Gloucestershire there are young unaccompanied people who have been out of formal education for more than eight months.
There is one further group of young people I will mention and this time I will be gender-specific: young women who find themselves in prison. Some of these women have been challenged by some of the issues I have already outlined, such as leaving care. Only last week I was in Eastwood Park prison with a number of young women in the early years of adulthood who were about to leave prison. Some of them had nowhere to live and were concerned that they would therefore end up back among those they knew with addiction problems. They were concerned about how they would find support to enable them to make good choices for their lives going forward. More than 50% of women in prisons have been abused in childhood and more than 60% have been victims of domestic abuse.
These young women do not require us to build more prisons, but they need appropriate community support in the form of women’s centres. In Gloucester we are very fortunate to have a fabulous women’s centre run by the Nelson Trust. Its work is inspirational as it works with young women in a holistic way, addressing issues of well-being, education, housing and finance. The Nelson Trust gets just £750 a year to support a vulnerable young woman and not only keep her out of prison, but enable her to make good choices to shape her future for adulthood. It costs £45,000 a year to keep a young woman in prison. This is a ridiculous and expensive situation and something needs to change so that properly resourced work can be done with these young women in the community.
As we reflect on the gracious Speech and look with hope to the future, I implore each of us to hold in mind the needs of the most vulnerable in our society, most especially those young people transitioning to adulthood. May we ensure their voices are heard as government policies are shaped that enable the flourishing of all individuals and communities.
My Lords, I want to speak briefly on the specific health issue of Lyme disease, which is a rapidly increasing health risk in the United Kingdom. If Lyme disease is not treated early, it can cause significant illness and devastate affected patients’ lives. This is what life has been like for my daughter, and I declare this personal interest.
Many noble Lords will be aware that ticks harbour Lyme disease, as well as many other equally serious infections. These infections are passed to humans and animals via the bite of an infected tick, due to and during their method of feeding. The danger is no longer confined to rural areas, with ticks now being found in every county of the United Kingdom, and increasingly so in urban parks and people’s gardens. If Lyme is diagnosed and treated early, the chances of a full recovery are good. However, failure to diagnose early and treat adequately can result in serious consequences to the patient. Tick-borne diseases that are misdiagnosed or neglected result in complicated infections, which have devastating and multisystemic consequences. Patients can be left with extremely debilitating and chronic symptoms, needing a wheelchair or completely bedridden, and enduring intense and relentless suffering.
Despite the increasing threat that Lyme disease poses to public health, there remain no suitable UK official guidelines for diagnosis or treatment. What we do have is outdated National Health Service guidance, relying on guidelines written by the Infectious Diseases Society of America and supported by the CDC. According to the National Guideline Clearinghouse of America, the IDSA-CDC guidelines are not fit for purpose. They are outdated and do not take into account recent developments in the understanding of these complex infections.
The absence of adequate guidelines is closely linked to the fact that insufficient levels of training are available to our doctors. Even if a positive test is obtained, expertise is seriously lacking, both in value of interpretation and in dealing appropriately with the illness. That stark statement is in accordance with multiple testimonies from patients. Expert patient input is crucial in turning the situation into a positive solution, not only for patients themselves but for the National Health Service as a whole.
Failure to meet the challenges of Lyme disease has led to unknown numbers of people becoming infected, but not diagnosed or treated. It could amount to tens or even hundreds of thousands of people. The UK now finds itself in a situation where patients with diverse illnesses and symptoms might actually have unrecognised Lyme disease. In these patients, the infection could have reached a stage where treatment will be difficult and lengthy and will require the supervision of expert physicians, trained and experienced in this complex disease and the frequently occurring co-infections.
The cost to the Exchequer in terms of numbers of patients unable to work and using the NHS for serious health problems must be a truly staggering amount. Neither this country, nor affected patients, can afford this. Early recognition of symptoms and early treatment would save our National Health Service a great deal of money.
Given the huge cost, both in terms of the impact on the patient’s quality of life and, in practical terms, on our health service, it is clear how important it is to prevent as many cases as possible reaching this stage. Improvements in the training available to our doctors should be made a top priority. However, awareness among the general public of the risk posed by ticks should also be prioritised. There are some very simple measures that can be taken to reduce one’s chance of becoming infected with Lyme disease. However, few people have any knowledge of this. How can we safely, and with a clear conscience, encourage children to play outside and make the most of the outdoors if we are carelessly allowing them to risk their health by contracting one of these insidious, infectious diseases?
Outdated guidelines, unreliable blood tests, insufficient training for doctors, a lack of tick-borne specialists of calibre and a widespread lack of awareness among the general public of preventive measures are all factors that are leaving us alarmingly ill-equipped to tackle a problem that poses a rapidly increasing risk to every UK citizen. In the light of this, I ask my noble friend what his department is doing to ensure that GPs receive training in Lyme disease that is mandatory and thorough enough to allow them to make clinical diagnoses. Proper awareness will prevent the number of Lyme disease sufferers growing.
Lyme patients want to regain their health. They want to get back to work. They wish for nothing more than to regain control over their lives and take part in all the activities they enjoyed before they became ill. Most Lyme patients have the will and determination to achieve this. But none of these aims can happen if they are sidelined and hobbled by misguided opinion—which includes the current health system situation, with its constraints and limitations.
My Lords, the gracious Speech was, understandably, dominated by Brexit matters. Disappointingly, little was said about how the Government plan to deal with the persistent and dangerous pressures that face the NHS. I therefore urge the Government to look seriously at the issue of accident prevention as a priority, because by doing so they will significantly improve the prospect of easing the waiting times within the health service and the pressure on those who work in it.
I declare an interest as immediate past president of the Royal Society for the Prevention of Accidents, which this year celebrates its centenary—100 years of leading campaigns for accident prevention.
But while there has been significant progress in reducing injury and ill health on the road and in the workplace, the world of health and safety is now dealing with a new and worrying trend. Accidents to people in their own homes and at leisure are on the increase, particularly for the most vulnerable in society—the very young, the very old and the poor. In the United Kingdom, accidents are the biggest killer of children and young people up to the age of 19. Taking just the under-fives in isolation, at least one child is killed in an accident every week, with more than 75% of those accidents happening in the home.
Additionally, each year at least half of the under-fives who attend A&E have an unintentional injury that could quite easily and cheaply have been avoided. Of these, 100 visit hospital every week because of poisoning, while 60 are hospitalised each week with burns or scalds. Those are shocking statistics, and yet ways of tackling the problem exist. Fewer than one-third of parents think that they are getting enough advice and information on how to protect their children from accidents. RoSPA’s Brighter Beginnings appeal aims to provide new parents with free advice, information and equipment to help keep their kids safe.
At the other end of the age spectrum, even more stark accidental injury and death figures show that, in 2014-15, falls accounted for 282,000 hospital admissions among the over-65s in England, and that there are more than 70,000 hip fractures each year. Remember, many of those who suffer a fall in old age, even after going through the NHS, still end up requiring expensive care. Yet falls are not an inevitable part of ageing. RoSPA is leading on an initiative, funded by the Department of Health’s innovation, excellence and strategic development fund, called Stand Up, Stay Up, which tackles exactly this problem. This project will not only reduce injuries and levels of attendance at hospital, but contribute to the Government’s social care objectives referred to in the gracious Speech.
These are some of the programmes of preventative intervention that could save the NHS millions of pounds each year and allow pressured health professionals to focus attention on others with even greater medical need. But to deliver their full potential, these kinds of programmes need wider promotion and investment by the Government to allow them to be rolled out across the country and sustained over a long period of time. Can the Minister tell us what further plans the Government have to invest in these types of programmes?
Concerning the tragedy at Grenfell Tower, I bring to the House’s attention a recent open letter addressed to the Prime Minister, written in response to the disaster and signed by more than 700 safety professionals. They included RoSPA, the Institution of Occupational Safety and Health, and the British Safety Council. In it, they call for an end to arbitrary rules on the deregulation of health and safety. The letter states that:
“Good, well-evidenced and proportionate regulations in health and safety, based on full consultation, are developed and adopted because they save lives and protect people’s health and wellbeing. They are not ‘burdens on business’ but provide essential protection for the public from identifiable risks”.
I urge the Government to listen to and act on this well-intentioned and well-informed advice.
My Lords, I am afraid that there is precious little to welcome in the Queen’s Speech for our arts and culture and our creative industries. The Creative Industries Federation, in its Brexit report published last autumn, reinforced by its recent report, Our Red Lines on Brexit, rightly stated:
“Talent and skills are fundamental to the UK’s creative success. It is vital we continue to cultivate our own talent as well as to attract the best and brightest from around the world.”
The UK is a creative hub. The freedom of movement of people to work and travel across Europe without the need for visas has both facilitated and fuelled an exchange of culture, creativity and expertise, as well as generating commercial and artistic opportunities. Our immigration system must continue to enable easy access to critical skills and talent from both EU and non-EU countries. Freedom of movement for the sector is essential, as my noble friend Lady Bonham-Carter has emphasised. Brexit must also not be allowed to interfere with an IP regime that has worked well for our creative industries. To date, the UK has worked closely with the EU and its member states to reduce copyright infringement and the proliferation of counterfeit goods. The current standards of IP protection need to be maintained with continuing co-operation on enforcement of IP generated in the UK.
We need to maintain our influence within the EU to ensure the continuation of territorial licensing of rights. We want to see initiatives such as Follow the Money being pursued at both UK and EU level. We want the UK to have an influential role in the development of the EU digital single market, including the new copyright directive. TV channels, too, must be able to continue to operate in the EU on the basis of origin in the UK, and UK content to qualify as EU, otherwise our status as a creative hub is at risk. The creative industries should also be at the heart of the Government’s education, employment and industrial strategies. My noble friend Lady Bonham-Carter has dealt comprehensively with the need for focus on arts education, creative training and skills development, not least in terms of flexibility in the apprenticeship levy.
In our UK industrial strategy, we must support small and start-up creative businesses. Creative enterprise zones should be established to grow and regenerate cultural output across the UK and measures taken to counter the threat posed by gentrification and property development to vital artistic and artisan communities such as the Old Gas Works in Fulham. Grassroots music venues are also under threat. We need to address the barriers to finance faced by small creative businesses. I commend our manifesto proposal for a new allowance to help those starting up a new business with their living costs in the crucial first weeks and reforming entrepreneur’s relief to enable investors to retain more of their money on exit, provided that it is reinvested in new projects.
There are many other important issues being faced by our creative industries and artists. My noble friend Lady Bonham-Carter made clear our views on the issue of Channel 4 as well as on the establishment of a BBC licence fee commission. We still have unfinished business from the Digital Economy Act. I welcome the incorporation of the general data protection regulation into UK law and in principle the proposal for a digital charter, along with the prospect of an online safety strategy. But will the Bill and the charter be guided by the report published today by the Royal Society and the British Academy proposing a stewardship body for data governance?
We also need to respond to the threat of illicit IPTV streaming. What can the Minister say about progress on the call for evidence? Do the Government really understand the need for urgent action in this area? On these Benches, we are extremely conscious of the power of platforms and aggregators on the internet. YouTube’s failure to pay properly for its right to stream music is a continuing cause for concern. Rights holders should not have to send literally hundreds of millions of notices to search engines to remove links to infringing content. We need to ensure that any code of conduct on search and copyright between search engines and the creative industries is underpinned by statutory powers of enforcement. FOBT stakes, mentioned by the noble Baroness, Lady Sherlock, is another matter for action. So much needs to be done in all these cases, but I can see very little that the Government have indicated they wish to do.
I add a few closing words on higher education. I declare an interest as the incoming chair of Queen Mary University of London. The jury is still out on the recent Bill, now an Act, the new regulatory structures which have been created and the TEF ratings, about which I share the reservations expressed earlier by my noble friend Lady Garden. However, I strongly welcome Sir Michael Barber as the incoming chair of the Office for Students. He said in his recent speech to Universities UK:
“We need to transform expectations of what is possible and see universities become ever more powerful engines of opportunity”.
We are facing many challenges in the higher education sector, not least as a result of Brexit, but that is exactly the ambition our universities should be adopting.
My Lords, I declare my interests which are set out in the register. I am a trustee of the Brent Centre for Young People, a mental health service for young adolescents, and two other mental health and child welfare charities. I welcome in particular what the noble Lord, Lord Ashton of Hyde, said in his opening remarks about the forthcoming Green Paper on children and young people’s mental health. It is encouraging to see the work being done on all sides to raise the profile of mental health in recent years and I know that the whole sector is grateful to those members of the Royal Family who have chosen to champion a number of charities that are working with young people with mental health issues. We can see the consequences of this as more and more grant-procuring bodies are choosing to fund this kind of work, and that does make a difference.
I want to ask the Minister about looked-after children and care leavers. The Government have done much good work over the previous years, but the concern is that given the current changes going on, some of the forward momentum in this area might be lost. I seek a reassurance from him on those matters in the form of a letter or perhaps a meeting which his colleague the noble Lord, Lord Nash, might arrange along with Robert Goodwill, the new Minister of State, and interested Peers in order to talk about the issues relating to looked-after children and care leavers.
The Government have been funding the family drug and alcohol court, an innovative system where judges oversee a family over the course of a year. They work with social workers to ensure that parents stay off drugs and alcohol. If the parents succeed in doing so, their children can remain with them rather than being taken into care. The President of the Family Division has recently alerted us to the fact that there is a crisis in terms of the number of children coming into care since the death of Baby Peter. The numbers are continuing to increase so this is very important work. I look forward to receiving a reassurance about the future of the FDAC.
When we were considering the then Children and Social Work Bill the noble Baroness, Lady Tyler of Enfield, who is the chair of CAFCASS, persuaded the Minister, the noble Lord, Lord Nash, that we needed to look at the assessments, particularly the mental health assessments, of young people being taken into care. The Minister undertook to commission six pilots in local authorities to look at different ways of assessing the health needs of young people entering care. Again, a letter and a meeting would be helpful as a reassurance that the work is going forward.
The Government have produced a helpful report of Sir Martin Narey’s review of children’s homes. Unfortunately, I still have some concerns about the care and indeed the safety of children in residential care, and that is another topic I would be grateful to hear about, although it ought to be more a subject of conversation with the Minister.
Out-of-authority placements have always been a difficult issue. This is when a foster child or a child in residential care is placed in another local authority. The danger is that the child may be out of sight and therefore out of mind. Recently a designated nurse for looked-after children raised a concern that young people from her local authority were being placed in another local authority. I shall pull out of the air the names of two authorities, Lambeth and Southwark. Lambeth has a boy who is placed in Southwark. That boy will not have the same rights to mental health and other services which looked-after children from Southwark may have. It is likely that another boy from Southwark will have access to better services. We need clearer guidance on what local authorities should be doing in this area to ensure that children who are given an out-of-authority placement are entitled to the same services as those who are not.
We heard earlier today about the importance of apprenticeships and of opportunity. A young person, Fatima, talked to Peers three months ago about her difficulties. She was in an excellent City apprenticeship with an accountancy firm but was struggling with her housing, which she was just holding on to. She also has a disability. She is very bright. English is not her first language. She was doing well. I heard her speak at a conference. She could not hold on to her housing and lost her apprenticeship. This is the case for many young people leaving care in London and the south-east. They are placed in private rented accommodation and are caught in a trap. If they start working, their housing benefit begins to reduce and they cannot therefore hold on to their accommodation. Edward Timpson listened to these concerns when he was an MP. I want to be sure that consideration is given to that issue. It is another issue for a letter and perhaps for discussion in the meeting. I say in passing how much I regret that Edward Timpson is no longer Children’s Minister having lost his seat at the last election. I had the privilege of working with him when he was chair of the parliamentary group for young people in care. Even at that time, he took great interest in the education of looked-after children. He produced a report on which many of the changes he introduced as Minister were based; for instance, the introduction of virtual school heads. I think that we are all grateful to him for his outstanding work as Minister of State for Children, and I hope that he will return to Parliament soon and be able to continue that work.
My noble friend Lord Kinnoull referred to his colleagues’ report on improving social mobility. Nick Chambers, chief executive of the charity, Education and Employers Taskforce, said that,
“young people’s perceptions … are formed at an early age, even at primary, and they rule out all sorts of routes. It is really important that young people have a wide experience of the world of work”.
I first visited France at the age of 12—a colleague talked earlier about being placed in Germany at the age of 14. As we move out of the European Union, it becomes even more important that we provide opportunities for young people to travel back and forth, particularly between the UK and Germany and France. Germany and France do a much better job of that at the moment. I hope that the Minister and perhaps Mr Goodwill in particular, given his experience as an MEP and a speaker of French and German, might look at what can be done to encourage more such exchanges and ease any safeguarding worries that might inhibit them. I look forward to the Minister’s response.
My Lords, after five days of the debate on the Queen’s Speech, we have finally reached subjects which are of hourly and daily concern to millions of our fellow people—together with housing, which was briefly debated on an earlier day. These issues, from childcare to old age, concern millions of us. I do not feel that the Queen’s Speech addressed them adequately.
There is wide acknowledgement that there is a chronic crisis in the National Health Service. There is general recognition that we are suffering from a long-term affordable housing crisis, and there are serious problems of resources and teacher supply in schools. I therefore share the disappointment of the noble Lord, Lord Kirkwood, and others that in a Queen’s Speech for a two-year Session none of the legislative proposals and virtually none of the speech itself addressed fundamentally any of those interrelated social crises. The Minister was driven in his introductory speech to referring to general commitments and to relatively marginal Bills on patient safety and on money advice for pensioners. Although important in themselves, they did not address any of these fundamental issues.
It is not as if the issues were not acknowledged during the general election; indeed, many of the problems with the Conservative Party’s campaign concerned pensions and social care. It has retreated from its commitments in those areas but nothing has replaced them, and there is certainly nothing in this Queen’s Speech.
It is an indictment of this Government that they do not appear to be addressing those issues, but it is also a wider indictment of this House and the political system as a whole. Here we are on a Thursday afternoon at the end of the debate on the Queen’s Speech talking about these issues when the rest of the country has a rather different system of priorities.
The recent election and the Brexit campaign both revealed the stark divisions that exist in our country. We are not one nation, however much we may claim we are. At both ends of life, there are problems.
This Government and their programme put before the House do not address these issues. The noble Earl, Lord Kinnoull, referred to his committee’s report on social mobility. Coincidentally, a report was issued this week by the independent Commission on Social Mobility. Its conclusions are that 20 years of successive government commitments and some interventions to improve social mobility have failed and that, despite some programmes having limited success, the overall position is that we are going backwards. There is a spatial and regional divide, an income and wealth divide, an educational divide—as the noble Baroness, Lady Stowell, emphasised—and particularly a generational divide.
I shall focus briefly on the generational divide. It was evident in the general election, in the Brexit vote and in the Scottish referendum. The independent commission’s report recognised that those reaching majority in this decade are the first generation post war and probably for 100 years who will be less well-off than their parents at the same stage of their lives, with no prospect of that getting better. It is therefore not surprising that there is a generational divide. Sometimes, we do not acknowledge it. Looking around the House today, we have to recognise that our own position is not that of the country. Most of us here, being of the age that we are, probably received a free university education. Most of us could afford a mortgage in our 20s—not all of us, but most of us. Most of us had jobs or professions that yielded a steady income with reasonable prospect of job security and a fixed retirement age for which we could plan. None of that is guaranteed or even likely for the coming generation, or in many respects for people under 50.
The current generation of pensioners are envied by the young because they have decent private pensions in many cases and at least inflation-proofed state pensions. However, some of that envy is misplaced, because there is also a sting at the tail of our lives. We may enjoy our pensions and in our 60s and 70s our Saga cruises, but if we become ill and infirm the provision of social care, whether in residential homes or in our own homes, is totally inadequate. Conditions are often deplorable, with homes relying on staff who are poorly paid and under pressure to minimise any real empathetic care for those whom they are supposed to be looking after.
At both ends of life, there is a widespread feeling of betrayal, some of which came out during the general election campaign. That we are not concentrating on that cannot be blamed on our preoccupation with Brexit, nor can it all be blamed on austerity, although the end of austerity, which some Ministers have begun to proclaim, raises the possibility of some of these issues being addressed. As my noble friend Lady Sherlock said, we need to remove the ideology of those who see austerity not as a short-term necessity but as an end in itself. We do not need a further retrenchment of the state; we need the opposite: for the state to take on its responsibilities in its spending and in effective regulations and enforcement of them. If recent events show us anything, they show us that.
The yawning gap between the Government’s ambition in the Queen’s Speech and the growing divisions in our society are underlined in the report of the independent Commission on Social Mobility. It states:
“Our country has reached an inflection point. If we go on as we have been, the divisions that have opened up in British society are likely to widen not narrow … The old agenda has not delivered enough social progress. New approaches are needed if Britain is to become a fairer and more equal country. It is time for a change”.
I hope that Ministers are listening and that the legislative programme in this parliamentary Session will eventually reflect the need to address those problems.
My Lords, it is perplexing, given Mrs May’s commitment to mental health, that there is no mental health Bill in the Queen’s Speech, not least given the very strong commitments that were made about the need for legislation and the fact that this would happen. What there is in the Queen’s Speech about mental health is good, though it is vague. I hope that it is translated into more money for mental health, but it also needs to be translated into better delivery and accountability. That is what is lacking and what I want to think about for a moment.
We have been told time and again under Governments of different hues about parity of esteem for mental health and other forms of health treatment, but what happens is that Governments tend to set up bodies to deliver health, whether it is clinical commissioning groups, hospital trusts, NHS England, child and adolescent mental health services or local authorities delivering public health. All these groups are there, possibly they are all needed but it is not clear that they all talk to each other, and when questions and challenges are brought here or to the other place we are told, “That is the responsibility of NHS England”. In recent years, when mental health spending, we are told, has been increased, or allocation of money for mental health increased by government, NHS England has chosen to spend it on other areas of health. When we have asked in your Lordships’ House why this money is not being spent, we are told it is the responsibility of NHS England. This is not good enough. We have a National Health Service and the Government must be in charge of it. Of course, they need to work through other bodies in various ways, but they need to take responsibility and to be held accountable. It is not good enough for the Government, of any hue, to say, “It is up to NHS England”, or, “This decision was made by a clinical commissioning group”, or whatever. If it is government policy, the Government must ensure that it is delivered and must take responsibility for its delivery and not fob that responsibility off on to others.
It is not just a question of delivery or operational responsibility—“operational” is a wonderful weasel word sometimes, a way of saying that other people are going to do it and we are not going to interfere. If you are in charge, you have to interfere sometimes to make sure that it is done. I am not quite sure what “operational” means, other than a hand-washing exercise, I fear. It is not just operational delivery; it is about guidelines. We see all too often in the health sector that the Government give guidelines and local hospital trusts, clinical commissioning groups or whatever have their guidelines to follow. But if they do not follow them, nothing seems to happen.
Take the example of chaplaincy in mental health. I am particularly interested in mental health and I obviously have an interest in chaplaincy as well. The Royal College of Psychiatrists has recently issued a report highlighting the importance of spiritual care—another way of describing chaplaincy—in mental health, and spiritual care providers working with other clinicians to deliver good outcomes for mental health. Yet local trusts, mental health trusts and acute trusts, have guidelines on how many chaplains should be provided, and how many of different religions, faiths, backgrounds, denominations and so on, according to proportions in population, but there is no compulsion on them to employ that number of chaplains or in that proportion; it is simply a guideline. The Department of Health does good work, it produces good guidelines and I do not criticise the guidelines at all, but it then allows other bodies it sets up to ignore those guidelines, or to deliver less than the guidelines require or suggest.
I urge the Government to carry out the commitments, and they are good commitments, for mental health care in the Queen’s Speech, I am delighted to see them there, but please can we see those commitments delivered in such a way that the Government remain responsible and in charge, so that those of us here and in the other place can question the Government and get clear answers when things are not going quite right?
My Lords, the election was announced two weeks after the publication of the Select Committee report on The Long-term Sustainability of the NHS and Adult Social Care, thus denying the House the opportunity for an early debate on the report. It became clear during the evidence taking that social care was impacting on the performance of the NHS. The ageing population presents the greatest challenge to the nation and, between 2015 and 2035, the number aged over 75 is projected to increase by 70%.
The gracious Speech identifies the need to improve the social care system and to put it on a more secure financial footing. The committee considered the funding options for social care and looked for examples around the world. In Japan, citizens aged 40 and over pay income-related premiums along with public health insurance premiums. Germany has a similar system, where the principle is that the costs are shared between the employer and the employee, similar to the workplace pension scheme in the UK. We should encourage those who can afford it to make provision for their long-term care and, in particular, social care, and not continue with a system that looks to the state to always pick up the tab. The Minister may wish to say something in relation to the consultation. As recommendation 23 of our report says:
“The Government should also implement as quickly as practicable, and no later than the first session of the next Parliament, new mechanisms which will make it easier for people to save and pay for their own care. The Government should, in the development of its forthcoming green paper on the future of social care, give serious consideration to the introduction of an insurance-based scheme which would start in middle age to cover care costs”.
These are important questions that need to be dealt with and answers provided.
Public health and prevention gets little press in the world of high-tech medicine, but a recent analysis by the Faculty of Dental Surgery at the Royal College of Surgeons should give cause for concern. It shows that there has been a 24% rise in the number of tooth extractions performed on children under the age of four in hospitals in England during the last decade. This is the first time such a long-term study has been done for children under four. Professor Nigel Hunt, the dean of the dental faculty, appealed to parents and the Government to take stronger action over the effects of sugar on our children’s teeth. He noted that the average five year-old eats his or her own weight in sugar in a year. The sugar tax, much derided by the food industry as a nanny-state tax, was introduced in the Budget this year to combat childhood obesity and tooth decay. The Chancellor described it as one tax which will actually reduce revenue. It seems that the threat of the tax and the Government’s legislation on the soft drinks industry levy, due for implementation in April 2018, has already altered behaviour and the food industry is reformulating its products and reducing the sugar content. I hope that the Minister will say more about this and what plans they have to restrict sugar and promote the use of fluoridation nationally to reverse dental caries and prevent obesity and type 2 diabetes.
On health, the only planned piece of legislation that I came across in the gracious Speech is the draft patient safety Bill, mentioned by the Minister in his opening speech. In July 2015, the Secretary of State for Health, Jeremy Hunt, announced the creation of the Healthcare Safety Investigation Branch, or HSIB, modelled on the successful Air Accident Investigation Branch used by the airline industry. The no-blame culture which that has cultivated has encouraged and led to a learning culture which has significantly reduced air accidents. The Secretary of State hoped that the HSIB would do the same for health but, despite starting in April this year, it lacks legal powers. In order to encourage staff to share information more freely with HSIB, it needs a safe space which prohibits the disclosure of information. People have challenged this, but if we want NHS staff to speak freely, we need to give them that opportunity to do so without the risk of litigation.
The current ministerial directions for HSIB do not make provision to override existing legislation, which would allow organisations such as the police, coroners and other professional regulators a power to compel disclosure of information. The HSIB’s chief investigator, Keith Conradi, recently came here to the House to give a briefing on what it is doing and has asked for primary legislation to secure HSIB’s independence. I know that my noble friend the Minister was at the meeting when that presentation was given. Can he say what the timeline is likely to be for the draft patient safety Bill, mindful that we now have a two-year Parliament? When can we expect the HSIB to have the same legal powers as the police and coroners?
Finally, I have a word about the Private Member’s Bill on cosmetic surgery standards, to be introduced in July by my noble friend Lord Lansley. It would equip the GMC with the power to show on the specialist register which practitioners have the credentials to undertake cosmetic surgery and other procedures. In January 2017, the Royal College of Surgeons launched a new system of cosmetic surgery certification to help patients identify surgeons with the appropriate training and experience to perform specific procedures. The recommendations of the Keogh review on the regulation of cosmetic intervention in 2013, following the breast implant scandal, is long overdue. Can the Minister say when it can be implemented?
My Lords, many argue that tourism should be within the Department for Business, Energy and Industrial Strategy. However, it is within DCMS and that is why I speak on it today. I declare an interest as the chairman of the Association of Leading Visitor Attractions.
I have long argued that tourism is the number one industry in more parliamentary constituencies than any other single industry. Although I did not expect it to be in the gracious Speech—as indeed it was not—I did expect it to figure rather more prominently in the election manifestos of the major parties. Sadly, there was little specific or original comment on tourism; mostly, there were bland comments about supporting the industry. However, I was amused by the statement in Labour’s manifesto:
“Labour will ensure that tourism becomes a national priority again”.
Perhaps someone on the Labour Benches can tell me when Labour made tourism a priority in the past.
Currently, the industry is reasonably prosperous. The Tourism Alliance forecast a 10% increase in inbound tourism for 2017, helped by the devaluation of the pound. But while adult domestic tourism to our cities has held up well post the appalling terrorist atrocities, the latest evidence is that there has been a noticeable reduction in children’s visits.
The turmoil and uncertainty caused by Brexit is bad news for tourism. I sometimes think that Brexit supporters thought that withdrawing from Europe would be just as easy as cancelling one’s membership of the local leisure club, in so far as they thought about it at all. Some 66% of visitors to the UK come from the EU and air traffic agreements are of crucial importance, but the major area of concern lies with the non-British nationals without whom our hospitality industry would collapse. Currently, 4.5 million people are employed in tourism and hospitality. It is our fourth largest industry by employment. A KPMG report for the British Hospitality Association estimated that 24% of this workforce are non-British nationals, including 75% of waiters and waitresses, 25% of chefs and 37% of housekeeping staff. Brexit has created massive uncertainty for these people and the Government should have guaranteed their continued settlement months ago, as so many in your Lordships’ House have argued and voted for.
Most importantly, it is ludicrous that so many job opportunities in this sector are spurned by our own nationals. Frankly, there should be no youth unemployment at all in this country. It is estimated that there will be an additional 7,000 coffee shops by 2025 and that 15,000 hotel rooms are under construction in London alone. In Richmond, Surrey, where we now live, virtually every other restaurant, bar and tea room is advertising for more staff.
One area of job creation opportunity lies within our penal establishments. Our level of recidivism is appalling but Timpson, the retail chain, is to be applauded for its efforts in this area. I was delighted that its chairman, John Timpson, was awarded a richly deserved knighthood in the recent Honours List. Ten per cent of the Timpson workforce are ex-offenders and it runs a range of training operations in a number of our prisons. Why can our major coffee chains and other hospitality players not do the same? There has to be a real opportunity here to provide a career pathway out of a life of crime. The right reverend Prelate the Bishop of Gloucester commented earlier on youth offenders.
I recently wrote to Whitbread about this—its two major divisions being Premier Inn and Costa coffee—and it replied quite encouragingly. Whitbread needs to take on 3,000 people annually to sustain its growth. It has invested £2 million in its WISE programme—that is, Whitbread Investing in Skills and Employment—and 800 people are currently undertaking Whitbread apprenticeships. Costa recently commenced working with offenders and ex-offenders; particularly encouragingly, last month Costa’s UK HR team had a meeting with the National Offender Management Service at the Ministry of Justice. Clearly, it will take some time to establish a proper infrastructure and support system but I wish it well. Other major players in this sector should follow Whitbread’s lead.
I urge the Government to work with hospitality employers, perhaps by providing some form of incentive or resource. There has to be a real human and economic opportunity here.
My Lords, the gracious Speech raises more questions than it answers as far as the NHS and social care are concerned. These questions relate to funding and workforce issues but also to the modernisation of professional regulation and mental health services. I will focus on these issues.
First, on funding, £124 billion a year is spent on health services in England. By the end of this Parliament, the Government have promised to spend another £8 billion. On the Minister’s own figures, this is a real-terms increase of less than 1% per year for five years. This proposed increase makes it impossible to lift the 1% pay cap, given that two-thirds of the NHS budget goes on pay. The Labour Party did rather better: it promised another £11 billion. On present forecasts, it would cost another £13 billion for the NHS to keep up with GDP growth. This was the recommendation of the House of Lords Select Committee’s April report on NHS sustainability, to which the Government have yet to respond. None of these figures, however, matches the OBR forecasts or realistic estimates of the increases in NHS costs and demand. Can the Minister tell us whether the Government will reconsider their position on the £8 billion, in the light of the evidence of its inadequacy from your Lordships’ Select Committee and elsewhere?
Secondly, there is the crucial area of social care, which a number of people have mentioned and which was handled with such crassness by No. 10 during the election. Even after the council tax precept increases and the extra £2 billion for social care over the next three years that the Government have already announced, there will still be a shortfall of at least £2 billion by the end of 2019-20. Publicly funded care providers—residential and domiciliary—are now leaving at scale, as the recent ADASS survey shows.
More than a million older people now have unmet social care needs, which means that the hard-pressed NHS will find its acute hospitals even more full of older patients who should not be there and do not want to be there. We will all be interested to see the Government’s promised consultation paper on the future funding of social care—let us hope it is a bit more convincing than their manifesto. But social care needs more money now—this financial year in fact—to halt the attrition of publicly funded social care providers.
If the Government can produce in a fortnight or so an extra £1 billion for Northern Ireland, which has less than half the population of Greater Manchester, they should be able to do no less for the elderly and disabled people across England. Can the Minister say whether the Government will try to find for the next three years, starting now, at least £2 billion for English adult social care over and above the money already promised? Will they keep on increasing the adult social care budget at least in line with the growth of the NHS, which is another recommendation from this House’s Select Committee?
Thirdly, there are the serious workforce issues caused by Brexit mishandling. There are some 60,000 EU nationals working in the NHS, many of them doctors and nurses, as well as 90,000 working in social care, a high proportion of them in the London area. Registrations of nurses from the EU are falling significantly, and many doctors qualified in EEA countries—who amount to about 7% of the NHS’s medical workforce—are seriously considering leaving the UK. This flight of valued professionals is entirely of the Government’s own making, through their failure to produce any credible reassurances to EU citizens living and working here. The new White Paper looks unlikely to do that, and when the proposed immigration Bill comes to this House, we may have to help the Government do a proper job in this area. In the meantime, can the Minister tell us what bespoke measures the Government will take to give greater reassurance to staff from the EU currently working in the health and care sectors?
Fourthly, there is considerable need for clarification on the gaps between the Government’s manifesto and the gracious Speech on regulatory matters. Legislation to reform outdated laws on mental health, now 34 years old, was promised in the manifesto, but is not in the Queen’s Speech. When are we going to see that legislation, at the very least in draft form? Again, the manifesto promised to,
“reform and rationalise the current outdated system of professional regulation of healthcare professions, based on the advice of professional regulators”.
Legislation is badly needed, by both the GMC and many other regulators. Can the Minister say when we will see the legislation to reform this antiquated system— which is, again, 34 years old, and again as recommended by this House’s Select Committee?
Finally, I draw the attention of the Minister and his senior colleagues to the latest British Social Attitudes survey, published yesterday. This shows that an increasing majority of people in this country support higher taxes for better public services, especially education and health. I remind the Minister that it was penny-pinching on the NHS in the 1990s that contributed to the Conservatives’ landslide loss in 1997, helped of course by a Labour leader who knew how to actually win elections—three on the trot, as I recall.
My Lords, I refer to my various interests in the register. Following on from the noble Lord, Lord Warner, I begin with mental health. As I think others in this Chamber did, I worked on pre-legislative scrutiny of the last set of changes to mental health legislation, before the Bill itself came before Parliament. Although this is a two-year Parliament, I would urge pre-legislative scrutiny, as this is such a complex and very diverse area.
There are two things at the heart of mental health services. The first is the quality and appropriateness of the services that are provided, and the second, perhaps much more important, is accessibility. At the moment, that is patchy, as has been mentioned. I think my noble friend Lady Cumberlege said this, and it is not just in maternity services but right across the piece. But there is good practice, and I hope we do not feel we have to reinvent the wheel every time we look at these subjects, but identify where good practice is, take it up and implement it as quickly as possible. That of course means resources, and accessibility is about nothing if it is not about resources. Some GP practices have community psychiatric nurses attached to them, who can identify, when a patient comes in out of the blue, that the patient needs a much longer time for diagnosis and for a plan to be put in place. No GP can do that in a few minutes. Where they have a CPN attached to the practice, and that happens, you see the results and it is very good. These are the sorts of examples we should be lifting up and encouraging throughout the country.
I hope we will look at where mental health needs are most prevalent, not least in prisons. I am not talking about people who are in secure units, but our general prison population. We have talked so many times about the need for more mental health service inputs there. It is so important before people leave prison, as is continuity when they come out. I recently visited Feltham prison, which has an exemplary practice in the way it manages people on the autistic spectrum. Autism is not a mental health condition, but I like to talk about autism as often as I can, and people will not be surprised to hear me say that people on the autistic spectrum who go without the appropriate support and package of care—both children and adults—very often spiral downwards into very serious mental health problems. The suicide rate is high. The suicide rate in this country, particularly among young men, is too high per se, and we should be looking very critically at what works and what does not. I will just say to my noble friend on the Front Bench that we produced an Autism Act in 2009, which had an autism strategy. The Government have dragged their feet somewhat in making sure that every local authority is implementing that strategy to make sure that people on the autistic spectrum have that support.
I turn now to social care. The guidance produced by the Government says that the number of people aged 75 and over is expected to increase by 70% between 2015 and 2035, so I declare a personal interest here. I am what is euphemistically described as a baby boomer—looking around the Chamber, I suspect I am not alone. Originally baby boomers were those people born either during or in the decade immediately after the Second World War. The noble Lord, Lord Whitty, referred to the way the younger generation now see our generation of baby boomers, and I must say that I am very concerned at some of the divisive language used—not by the noble Lord, Lord Whitty—to describe the difference between the younger and older generations. Back in the 1950s, if your Lordships can imagine that far back, only 10% of young people went to university. We are not talking about the 50% who go now. There is this idea that it was somehow free for 50% of the population, but it was not. The school leaving age was 15, and many people left school and went straight to work without any training, or further or higher education at all. But we made it none the less.
That age group is very important. If you were to ask people of that age today what they would like most, they would say, “To die and be cared for at home”, but the practicalities of that are very difficult. The noble Baroness, Lady Jolly, has drawn to my attention the concern, which I am sure she will raise later, about people living at home who have carers who need to sleep in, for whom the national minimum wage has become a big issue.
I am a vice-president of the Alzheimer’s Society and conclude with the problem of dementia, because deciding how we shall take this forward is quite a serious matter for the country. The Alzheimer’s Society says that dementia has,
“long been the most discriminated against condition, dismissed as ‘social’ rather than ‘medical’. Unlike many other conditions such as cancer or heart disease, where assistance will be provided free of charge through the NHS, dementia care is social care. The current system demands that anyone with even limited assets is forced to pay for their social care. This is unfair and can lead to astronomical costs for the person and their family. It should not be the case that because you develop one condition over another, you can be left bankrupted by care costs”.
I personally feel that we should all make provision for our old age and contribute towards our care costs but, as the Alzheimer’s Society says, dementia can take virtually every penny you have. I am very glad that the Government are to carry out an in-depth study into how we find some action to go with this challenge.
My Lords, in the 20 years that I have been in your Lordships’ House I have spoken in and led many debates on social care. Each time my hopes were raised by the interest in the subject, and subsequently dashed because no real change came about. But the last time I led such a debate, in December last year, I ventured to express some hope. That was because, in spite of the terrible headlines and analysis we were constantly seeing—“Social care is at a tipping point”, “Bed-blocking crisis reaches a new high”; your Lordships will be familiar with the headlines—there seemed at last to be some agreement across all sectors about the extra resources needed and about the fact that healthcare cannot be sorted out and delivered efficiently without the same attention to social care.
Alas, the election and its aftermath have dashed my hopes once again. It was very welcome that the Conservative manifesto focused on social care, even though the proposals were so poorly thought through. The belated pledge to introduce a cap on the lifetime costs of care—also pledged, I remind noble Lords, in the 2015 manifesto—offered the prospect of protection from the catastrophic costs faced by many. Now, though, there seems to be doubt about these proposals, and the agreement with the DUP has apparently taken up all the money that was due to be allocated in this area.
So we are left with a single line in the Queen’s Speech about a consultation on social care—to add to the endless consultations we have already had. The royal commission, the Wanless review, the Dilnot commission, the Barker review—I could go on. Is that what the Government intend: another fruitless exercise, as all of those have apparently proved to be? For heaven’s sake, we know what the problems are; we do not need another consultation to tell us. If we need a consultation at all, we need it on the proposed solutions to the problems.
So I am going to help the Government take a short cut. There is no need for us to spend time finding out the difficulties; I can tell them what they are now, could probably could any Member of your Lordships’ House. I am going to give the Government some simple “dos and don’ts”. I shall start with the “don’ts”. “Don’t” use the consultation as a delaying process; deal with the shortfall in funding now. As we have heard, it is at least £2.5 billion, four out of five councils do not have enough provision and at least 1 million people in urgent need of care are not getting it. That is in spite of the enormous efforts of the dedicated staff who work in this field and of the vast contribution of the unpaid—usually family—carers, whose contribution, I never tire of reminding your Lordships, is worth over £130 billion to the economy.
“Don’t” assume that this is just a problem with an ageing society. Of the people receiving long-term care in the last financial year, nearly 33% were under 65.
“Don’t” rely on a sticking-plaster solution. The Government talk endlessly about the benefits of the better care fund, but I am tired of being offered that by successive Ministers as a solution every time I raise the issue. Of course we should be trying to do more with less and promoting efficiency and collaboration, but basically we manage demand at the moment by ignoring it and putting undue pressure on family carers, 2 million of whom take on these responsibilities each year and are usually shocked to find how little support is available to them.
I now turn to the “dos”. I have only two: do be honest and do be bold. First, on honesty, no Government, of whatever colour or combination, have ever made it crystal clear to the public that responsibility for paying for care and for arranging it rests with individuals and their families, with public funding available only for those with the least money and the very highest needs. As a consequence, no one prepares or plans for care, and they have to scrabble about doing it when a crisis arises and the awful truth dawns on them. In addition, the expectation has grown that savings and the considerable assets now contained in property can be passed on to family without being touched. We must rethink this and be honest about it.
Secondly, we must please be bold. The Conservative manifesto committed to act:
“Where others have failed to lead”— so now is the time for action. Every independent review of the last 20 years has recommended that the future funding of social care, as well as healthcare needs, should come from public, not private, finance. The needs of individuals cannot be divided up neatly into health or social care needs, as those of us who have tried to fathom the difference between a health bath and a social care bath have long acknowledged. Now is the time for us as a society to acknowledge that the funding cannot be neatly divided, either.
To those who say that this is not the time, with public finances in such disarray, all the Brexit difficulties and so many other problems around, I remind noble Lords that our forebears tackled reform in the middle of a world war when the country was pretty well bankrupt and not the fifth-richest nation on earth. We must embark on a frank and open debate about how to fund health and social care on a sustainable basis into the future. We must remind everyone that such a debate will not be settled in a single Parliament, so we need to secure cross-party consensus on shared principles to guide that reform. We have enough research and excellent material to enable us to do so; we just need the will. We know all the questions about social care. We just need the answers and the solutions. Will the consultation consult on proposals and solutions?
My Lords, I would like my response to the gracious Speech to focus on children. As I always say, childhood lasts a lifetime and everything we do affects children. So my mission in life is to create a better world for children, and I believe that the issues I will highlight today help shape their lives.
To feel as though you belong is so important, and the subject of diversity, especially in the media, needs to be addressed continually in today’s society, where everyone needs to feel as though they belong and are part of our great nation. I hope the Government and Ofcom will continue to ensure the delivery of diversity nirvana, so that all the nation’s children grow up confident and happy.
In response to the Lords Communications Select Committee report on the subject of the theatre, the charity Action for Children’s Arts, which campaigns for children’s rights to the arts, believes that affordable and accessible theatre productions should be created for young children to help stimulate their creativity and imagination. It is also concerned about the drift away from arts subjects within the school curriculum. Ministers have suggested that this is not what was intended, so will the Government give much clearer guidance to schools so that practices such as the EBacc do not have the effect of further reducing arts opportunities for children?
Children as young as four are suffering from anxiety and depression. It is proven that gardening and connecting with nature can not only be therapeutic but deliver many benefits in helping them to deal with life, improving academic performance across the curriculum as well as mental processing and ability. It also helps to develop patience and an understanding of the passage of time, increase self-esteem and decrease anger, frustration and anxiety. As an RHS ambassador—I declare an interest—I hope that the Government will support the successful RHS school gardening campaign, with its mission to introduce children to horticulture and nature and to train teachers in how best to deliver these benefits. The campaign has already reached 6 million children, but there is much more to be done.
Organisations such as the Natural History Museum are also helping children to spiritually reconnect with the natural world through its thriving urban wildlife garden, with its meadows, trees and ponds. The social habits of today mean that children are increasingly disconnected from nature. Many are losing access to green spaces, especially in deprived urban areas. But children who feel connected to nature are more likely to care about the environment. So we need to give them opportunities to explore, by providing school gardens, new parks and allotments.
Childhood well-being starts even before birth. Yesterday, the All-Party Group on a Fit and Healthy Childhood, which I co-chair, launched its eighth report. It is on the subject of maternal obesity and it is our latest attempt to address the important issue of how to ensure that our country’s future is safeguarded by enabling our children to live happy, healthy and fulfilling lives. A healthy society is an economically productive society.
It was such a shame to see the absence of any measure to promote child health and fitness in the Government’s Queens’s Speech. Maternal obesity needs serious attention because by the time a child is born, its life course may already have been determined as a joyful path to health and well-being, or a slippery slope towards childhood obesity and possibly adult obesity. Today, pregnant women are bombarded with all sorts of advice, from doctors, nurses, friends and relatives, baby manuals and media imagery. There is great pressure to blossom, bloom and to eat for two—and then they are expected to lose the weight days after giving birth to return to their skinny jeans.
What is needed are clear guidelines, because research, as detailed in our report, shows the importance of controlled weight monitoring in pre-pregnancy, pregnancy and during the postnatal period. Maternal and paternal obesity raises the risk of serious health problems, both physical and mental, as well as the economic pressures on our already overburdened NHS. Our report calls for the UK to establish its own method of body weight measurement as a routine part of antenatal appointments for all women.
This means training so that doctors, nurses and healthcare professionals feel confident in raising the question of weight in a sensitive manner, with clear guidelines that are UK-tailored, rather than relying on American guidelines that may no longer be fit for purpose. We also recognise the key role and responsibility that advertising and the media play in messaging, and suggest that a body such as the World Health Organization might devise a unified international standard of care, to give women the ability to make confident choices, because, most importantly, pregnant women and their partners need to know that they can trust what the professionals are telling them.
We also need a widespread, Government-led awareness campaign about the medical dangers facing both the pregnant woman and her child because of excess maternal weight in pregnancy and afterwards. There is also the role of school and the national curriculum in embedding these messages, together with advice on nutrition, physical activity and mental and emotional well-being. This should take place long before a pregnancy is even a remote possibility.
Can the Minister tell the House what plans the Government have to address the maternal obesity issue? Will they consider the recommendations in our report and meet us? As I said, childhood lasts a lifetime, so let us put children at the forefront of our minds when we make decisions and form policies, to help lay the foundation for a lasting legacy for future generations.
My Lords, it is pleasure to follow the noble Baroness, Lady Benjamin, especially as, unlike some of her colleagues, she has not pre-empted many of my own remarks.
I shall focus on skills and the creative industries. The success of Brexit will depend on the competitiveness of UK business in global markets, which in turn requires access to talent and skills and capitalising on our world-class strengths in sectors such as the creative industries.
I welcome the Government’s commitment to creating a world-class technical education system, building on the generally admirable Technical and Further Education Act passed in the last Session. It is high time for the disparity of esteem between academic and technical education to be finally laid to rest, so that teachers, parents and young people themselves recognise that technical education routes offer opportunities at least as rewarding and valuable as academic ones. That might also help to address the education divide, so thoughtfully described earlier by the noble Baroness, Lady Stowell.
The gracious Speech makes little mention of apprenticeships, but I was reassured by the Minister’s confirmation that the commitment to deliver 3 million new high-quality apprenticeship starts in England by 2020 has not changed, despite the rather surprising appointment of a new Skills Minister, Anne Milton MP, to replace Robert Halfon. I wish her success in progressing the new system for funding and managing apprenticeships, based on the apprenticeship levy, which was introduced in April, and the new Institute for Apprenticeships, and in ensuring that this actually delivers the enhanced skills that we need in terms of quality as well as quantity. I am particularly concerned that the vital role of independent training providers in delivering apprenticeships—over half of the total, I believe—should be properly recognised and supported.
The gracious Speech includes proposals for a new digital charter, aimed at making the UK the best place to start and run a digital business and the safest place in the world to be online. I hope that the first of these aims will include sufficient emphasis on enhancing digital skills. The Digital Skills Committee, on which I served, described this as a make or break issue for the UK and increasingly vital not just for digital businesses but in almost every field of activity. The noble Lord, Lord Baker of Dorking, pointed out in a letter to the Times on Tuesday that the number of students taking GCSE computer science this year is still only 68,000, while a Commons report forecasts a shortfall of 750,000 digital technicians. I remain to be convinced that the scale of this challenge is adequately reflected in the measures outlined in the gracious Speech and supporting documents. I strongly endorse the call made by my noble friend Lord Kinnoull for improving the effectiveness of careers education.
One of the areas in which the UK has the potential to continue to excel is in the creative industries, which represent £87 billion of gross value added. It is one of the UK’s fastest growing sectors and accounts for almost 10% of our service exports. I share the view expressed by a number of noble Lords, including the noble Baronesses, Lady McIntosh and Lady Bonham-Carter, and the noble Lord, Lord Clement-Jones, that the exclusion of creative subjects from the Government’s plans for the EBacc is perverse. The noble Lord, Lord Storey, mentioned the declining take-up of arts and creative subjects in schools, yet these subjects are included as a matter of course in the most successful schools, particularly in the independent sector, and businesses are crying out for skills in just these areas. There seems to be a real risk of pupils in disadvantaged areas missing out on arts and creative subjects, thereby reinforcing the concerns about the potential educational divide mentioned by the noble Lord, Lord Whitty, and others.
The creative sector, as we have heard, acts as a hub for global talent and depends significantly on overseas workers, not just to plug major skills gaps in the domestic workforce but to bring market insight into different territories where it competes. Twenty per cent of orchestral musicians in this country come from overseas. To support the continued success of the sector, a new immigration system should take account of issues such as the high proportion of freelancers in the creative industries workforce, the relatively low pay levels of many workers—below the current thresholds for entering and remaining in the UK—and the importance of touring for many arts organisations, such as orchestras.
For some creative sectors, such as broadcasting, market access is specifically dependent on membership of the EU single market, which enables it to offer services across the whole EU on the basis of just one licence from Ofcom. Some members of the EU Internal Market Committee went on a visit to Discovery Networks, which runs well over 100 broadcast channels from Chiswick, which may involve needing to consider relocation from the UK, if it no longer has access to the market. It is not surprising that 96% of members of the Creative Industries Federation said that they wish to remain in the EU.
I hope the Government will succeed in retaining some degree of access to the EU single market, perhaps through membership of the EEA and/or EFTA, at least during a period of transition. Let me note also that it will be more important than ever after we leave the EU as a member to foster mutual understanding and partnerships with our closest neighbours through continuing to participate in EU programmes such as Creative Europe, Horizon 2020 and Erasmus+. Those issues are key to the Brexit aim of taking British values around the world and need to be at the forefront of the Government’s programme in this session, even during the ongoing process of negotiating Brexit.
When I was anticipating speaking in this debate, I was expecting to talk about the creation of grammar schools, as many other people were who have an interest in education, and I was relieved but also slightly annoyed that it had not got in, because I thought it would be a little way in to looking at how the education system deals with those with hidden disabilities. I had hours of thought about how you would devise a system that selects people for grammar schools, or grammar schools plus, which takes the best, a system that takes into account those with dyslexia, dyspraxia and the other neuro-diverse conditions. How do you have something that conforms to the Equality Act and allows people to get through? Indeed, I got fairly far along this path and further and further away from the idea that a test that you take once should decide your future. But as that is not in the Queen’s Speech, I thought that we could look at another aspect of how the system and the systems generally across government affect this group. Once again, I make the House aware of my interest in this field.
One area that we have not really addressed here and are not going to address in any of the speeches, although there is a kind of second-hand reference to it in the Queen’s Speech, is the Government taking further steps to increase—I am sorry, but I have discovered that having middle-aged trombone eyesight is a bigger problem than dyslexia. I might have taken a step forward. The Speech refers to the idea that we will remove disability in life generally—and we have a two-year Parliament. To go back to the group to which I referred earlier, we have two years to start doing the boring bits: the fine detail in all forms of disability legislation and all legislation that addresses equality.
I say that, because I am undertaking some work with Barry Sheerman MP in the House of Commons through a group called AchieveAbility, whose work is based on dyslexia and the other neuro-diverse conditions such as dyspraxia, dyscalculia and autism. It is about how you get further in life. We are looking at recruitment, and the big thing that we have discovered is that, with modern recruitment practices, big recruitment firms and the larger firms that are dependent on them really do not know how to recruit the best people with these conditions, because they do not have systems that are flexible enough. The modern recruitment pattern asks whether you would do everything to get in, whether you would be thrown if you had to man a phone for the day, and so on. People in that group cannot say yes to the question whether they have all those generic and wide-ranging skills, so either they do not declare their condition and get into trouble, or they declare it and do not get through the process. That was the first revelation. Having dealt with disability for many years, I know that when it comes to the more obvious disabilities, such as movement impairment and wheelchair access, the bigger firms are better, because of investment. But when they suddenly get a group that they do not understand or know about, those people do not get through. Recruitment for people like this is in smaller firms, where you can interact with the person in the first place and get referred along.
So there is this group of people who they do not understand and who do not go through. We need reassurance that the means to get through are readily available. There are examples, such as in education, where the situation is not perfect but is improving for many. There is better awareness coming through, so we will actually be able to take steps. It is when the big machine does not understand its responsibilities that we make mistakes. Also, these larger firms are turning down opportunities, because these groups can do these jobs. The advert at the start usually bears no reference to the actual job. Can you man the phone? Yes, but you are doing something miles away in a big organisation and you probably will not have to do that. There is technology that will help you, but they do not know about it. I therefore hope that over the course of this Parliament we will start to take the small, boring steps that mean that we look at how we implement and get the best out of this group so that they can get through, taking best practice from one section and applying it to another.
AchieveAbility’s most recent discussion was with the DWP. We had one wonderful moment that made me quite worried, because we were told that almost every job centre has one expert on disability. My rather glib reply was, “Well, that’s almost good enough, then, isn’t it?”, which may have been a little unfair to the individual, but the point was made. In education, what we have discovered, which should be applied across the piece, is that having one trained person, a SENCO, who understands this is no substitute for having teachers who have some understanding and who know how to use the SENCO. In other words, unless you get somebody who understands the problem and what somebody is talking about, you will not access the other support.
So I hope that over the next two years when we are not dealing with Brexit that we will take time to look at the implementation of policy that we have all agreed to. Let us get into the fine detail. In the absence of large Bills, and given that we might want some light relief from discussing major changes in international law and trade patterns, we can look at how we implement things that we have all agreed to. The area of disability in which I am interested is only one facet of it, but if we get into this area and take on some activity, we may have a real legacy to take away, which no matter what else we do will make lives better for a large section of our society and, indeed, for those who have to live and work with them.
My Lords, I intend to focus my remarks on an important subject that transcends the policy areas covered by today’s debate: disability equality. Some noble Lords may have heard that I have a new status since last we met: I have been abolished. For noble Lords who missed the piece in last weekend’s Sunday Times, I am referring to the fact that having applied in response to an advert specifically for the position of disability commissioner at the Equality and Human Rights Commission, I was told by its chair, 36 hours before my first board meeting, that the board had decided to abolish the role. In his words, the role was “redundant”. I was then pressured by the chair to accept that the disability commissioner was no more and that I would therefore not chair the commission’s important Disability Advisory Committee. In other words, as the Sunday Times put it, my role as champion of the nation’s 11 million disabled people had been abolished.
I reject what I regard as a retrograde and deeply regrettable decision. Perhaps I can share with the House why I am so concerned. The excellent report produced recently by the ad hoc Select Committee on the Equality Act 2010 and Disability states that there had been,
“a loss of focus on disability discrimination”,
and furthermore that,
“combining disability with the other protected characteristics in one Act”— the Equality Act—
“did not in practice benefit disabled people”.
Nowhere in the report is there the slightest suggestion that one way to reassure disabled people would be to reduce the focus further, which is exactly what the abolition of the disability commissioner post does.
I am also concerned about the commission’s interpretation of equality. As noble Lords may recall, I argued in the last Session that disability equality before birth is fundamental, because unless a disabled human being’s equal right to exist is respected, all other rights are academic. One needs to be born to exercise them. Otherwise, the situation whereby after birth I am somehow good enough to be in your Lordships’ House, but before birth I am only good enough for the incinerator because of my disability, means that discrimination on the grounds of disability is perpetuated.
I have been told by the commission’s chair in effect to shut up on the issue of disability equality before birth. His exact, rather sinister, words were, “I appreciate this approach”—the commission’s approach—“would be a departure from your previous engagement in this field”. What is the commission’s approach? He states that the commission would have to agree its position on disability equality before birth based on an analysis of all relevant rights affected and consider whether and how to act on the issue through a prioritisation process based on strategic objectives.
Since when was equality, and especially a disabled human being’s equal right to exist, based on a prioritisation process and weighed against the rights of other groups? Does this apply to other protected characteristics covered by the Equality Act? Is it okay to deny their equal right to life specifically because of their protected characteristic? I think not. This is inequality. This is disability discrimination perpetuated by the very equality body that I, and every other human diagnosed before birth with a disability, should be able to rely on to defend our intrinsic equality. Yet I have sadly discovered that I cannot do so.
Within the last few hours, the commission chair has rushed out a letter to stakeholders highlighting the commission’s work on equality, presumably in anticipation of my speaking in this debate. That sadly confirms to me that the commission is missing the point: that the volume of activity is no substitute for a nominated disability champion in the form of a disability commissioner. It does nothing to lessen my fear that some non-disabled people see themselves as passionate advocates of equality but equality on non-disabled people’s terms. That has to change, and as disability commissioner I would have ensured that it does change.
Perhaps the most chilling aspect of all this is that no one was meant to know about the situation in which I find myself, because I was meant to acquiesce. Indeed, at one point I was asked not to mention it to other disabled people for fear that it would leak. I am not requesting that the Government get involved. This is a struggle for equality between the commission and me as a disabled person. However, in conclusion, I thank all noble Lords who have encouraged me to stand my ground and to refuse to accept that this is a done deal, and who have asked how they can help. I ask noble Lords to make their support for my position known, because the fact remains that we need a strong disability commissioner, and a genuine Equality and Human Rights Commission, now more than ever.
My Lords, I want to speak up for public servants. I question whether we have the capacity in public services to sustain the enormous workload that is ahead of them and to carry out the heavy responsibility that is expected of them. The gracious Speech makes it clear that public servants are also-rans in the battle to balance the books. They have already had seven years of job cuts and pay cuts and it is clear that it will be more of the same in the next five years unless the Government change course. We need a sustained programme of public infrastructure investment and essential capacity-building for public servants and not just to throw money at emergencies.
It is interesting that a key point in our general election match, which resulted in a painful no-score draw, was the adverse publicity faced by the throwaway Prime Minister over the 20,000 police cuts and 5,000 armed police cuts at a time when the public wanted reassurance. It is interesting because, when Theresa May was Home Secretary, she took pride in taking on the Police Federation and cutting it down to size. These actions have consequences. If I were in the police force right now, I would be less concerned with being called a hero and more concerned that there would be someone to replace me at the end of my shift, that I could stick to the family leave I had planned, with no worry that it would be cancelled, and that I would be properly equipped in uniform and career development.
The background briefing to the gracious Speech states that the Government,
“values the important work that public sector workers do in delivering essential public services”.
However, there is not a single policy proposal as to how the Government intend to support that important work.
One of my areas of interest is health and safety. I worked closely with the Health and Safety Executive when I produced my report on construction fatalities. I have watched with astonishment as the HSE budget has been cut and cut again, with a 25% reduction in the number of HSE inspectors. By the end of this Parliament, the total HSE budget will have been halved. The cuts are still coming. At the same time, the Conservative Government have attacked health and safety legislation, nibbling away at the edges in a series of Bills. It is shameful.
I turn to the Civil Service. Although numbers have increased since December 2016, mainly as a result of leaving the EU, there has been an overall reduction of 20% since 2009. The Department of Health has lost 49% of its workforce since 2010 and the DCLG has lost 42%. Another five departments have lost over a quarter of their staff. Of course, the Cabinet Office, which supports the Executive rather than the country, has increased by 23%.
The workload around leaving the EU and making a minority Government work cries out for increased resources. The brightest and best will be seconded to the exit department, even if some remain within their departments. The numbers are woefully thin. Perhaps the Minister can tell us what will happen to the day-to-day work of government. The DWP has to run universal credit, which requires a heavy and ongoing administrative burden and has not yet been completely rolled out because of its complexities.
Most worrying to me is the capacity of HMRC. The Public Accounts Committee talks of a “catastrophic collapse” in customer service if more operations move online. The PAC was not convinced that HMRC had a credible plan to prevent a “disastrous decline” in service. It also questioned whether HMRC might be,
“painting too rosy a picture”,
of its success in reducing the gap between the amount of tax due and the total collected.
Time does not allow me to mention other services. I am grateful to my noble friend Lord Kennedy, the right reverend Prelate the Bishop of Southwark and the noble Baroness, Lady Pinnock, for their comments in Tuesday’s debate, and my noble friends Lady Sherlock and Lord Whitty for their comments in today’s debate. They encapsulated what I would have liked to say about those services.
In the past seven years, the Government have attacked the jobs, pay and pensions of public servants and have tried to separate them from their trade unions. The country will not run itself. I do not believe that this Government are capable of delivering strong public services. I am concerned about the inevitable collapse in some of our services that will happen in the next five years, and about the cost to the country of such neglect.
My Lords, as the Liberal Democrat defence spokesperson, I would usually have spoken in response to the Queen’s Speech last week. However, I have a social care issue of which I have given the Minister prior warning and would be grateful for a response, so I am speaking now and understand that I will get no feedback on the defence element.
Last week’s defence debate revisited issues that we have raised again and again these past two years: the 2% of GNP spend; concerns about our shrinking fleet; insufficient equipment to maintain capabilities in the face of growing threats; and all this against a backdrop of concerns over Britain’s diminishing position on the global stage.
Whenever our fleet is reduced, whenever a key military capability is lost, there are howls of indignation from all sides of the House. However, the gradual hollowing out of the Armed Forces through reductions in the numbers of personnel must also be of great concern. Last year, there was a deficit of full-time, trained personnel of about 6,400 individuals, a trend which has seen little sign of abating under the current Government. This means more pinch-points in operational capabilities. This pinch is already felt in specialties requiring key skills such as engineering, but it will be felt right across the Armed Forces should the decline continue. This week, HMS “Queen Elizabeth”, our magnificent new £3 billion pound aircraft carrier, put to sea for the first time. But how valuable an investment will she be if we cannot crew her or her supporting fleet?
For the service men and women still serving, the cuts have been felt acutely. The results of the Regular Armed Forces continuous attitude survey published last month painted a picture of low morale, both personal and within units, which, along with the impact on family and personal life, were the key reasons cited for leaving the service.
The recent report of the Armed Forces Pay Review Body noted that this is due to a “perfect storm”—those are its words, not mine—of pay below the private sector, increasing national insurance, changes in tax credits and increases in rental charges under the new combined accommodation assessment system. Beyond that, service personnel feel the pressure of having to perform difficult jobs without sufficient capacity, which leaves them feeling undervalued and undersupported by the establishment. It is small wonder, then, that there has been a deterioration in perceptions of the Armed Forces offer, as compared with that of the private sector.
The Government’s solution, announced in the Queen’s Speech, is the proposed Armed Forces (Flexible Working) Bill, which would enable flexible working arrangements for regular service personnel. This includes part-time service and limited geographic employment within the Regular Armed Forces. The Bill might go some way to stem the loss of service personnel and it might provide measures that would make the Armed Forces a more attractive prospect for some, but the proposals will not necessarily allow the Armed Forces to maintain current levels of functionality.
I would be interested in seeing the evidence that suggests that the measures in this Bill will be effective. Do any NATO members have similar schemes? Is there a great call for this from families? Furthermore, the Bill does not address the major causes of the lack of manpower. As such, it provides measures only to treat the symptoms of Britain’s ailing defence capabilities but fails to address their causes. Failure to address these deficiencies puts more and more pressure on our service men and women, who make sacrifices for our defence, risking their health and well-being. This truly threatens the security of the nation.
In the Queen’s Speech there is a commitment to improve social care and bring forward proposals for consultations. I am sure many noble Lords here today await these eagerly. I declare my interests as set out in the register. For the last 18 months I have been chair of Hft, a long-established charity which provides services to over 2,000 adults with learning disabilities and employs over 3,000 staff. We pride ourselves on our quality service provision and quality approach to staff. To put this in context, I remind noble Lords that one-third of social care expenditure is on adults with a learning disability—a significant number.
That sector is under threat due to the unintended consequences of a series of employment tribunal rulings, coupled with HMRC enforcement activity, relating to the treatment of sleep in shifts for the purposes of the national living wage. This is forcing employers to fund back-payments for a number of years when everyone involved funded on the understanding that sleep-ins are not covered by national minimum wage legislation.
Many in the sector, including charities and personal budgetholders, do not have the money to fund these payments. The total cost to the sector will be around £400 million. My charity is the first to be called to pay, going back six years, and it has a deadline of
The key issue is timing and the urgent need to seek a suspension of current enforcement action to allow space for a considered solution. This would prevent the failure of a significant part of the social care sector but requires swift action from government. It cannot wait until the promised November Green Paper on funding social care or the Government’s proposals for consultation. Can the Minister give the sector some assurance that this issue is very high on the list of urgent actions for each of the four ministries involved, and that there is an understanding that this cannot wait until after the Summer Recess?
My Lords, before I commence, I should draw attention to my registered interests and remind the House that I am a mental health nurse and a lifelong member of the Royal College of Nursing.
I have welcomed in this House initiatives to widen participation in healthcare higher education, such as higher apprenticeships, the regulation and standards for nursing associates and accelerated postgraduate programmes targeted at mental health and learning disability nursing. To meet the Government’s commitment to increase healthcare student numbers by 10,000, we must continue to focus on monitoring what is happening in the higher education sector, and government must support sustainability and growth.
Following the changes to the funding of higher education in nursing, midwifery and allied health professions in England, we have experienced an average 23% reduction in student applications, although it is fair to say that in some areas the reduction is much higher. Universities are reporting a diverse picture across England, with some feeling confident that they are receiving better-quality applications from highly motivated and committed student applicants, while in other areas there are concerns about the viability of specific programmes such as learning disability and podiatry. Although the university sector has welcomed the funding reforms, it is clear that three areas that are fundamental to the success of higher education healthcare courses remain to be resolved.
First, universities need urgent clarification on the situation of placements in England. To enable growth and ensure student choice, the best model for this would be for placements to be linked to the student and for universities to be involved in the selection and quality of the placements, rather than serving the areas in the NHS where there might be care needs. But if students are paying for their placements, they will expect the right level of supervision.
Secondly, the success of education depends on the expertise of healthcare academic and practice staff. This is a wider UK issue, although the situation seems to have worsened in England recently. We must resolve the issue, with nearly 50% cuts to continuing professional development funding announced in March 2016 by Health Education England for each of its 13 local education and training boards across the country. As a result, some regions have faced cuts of more than 45% to CPD budgets, with further reductions expected this year. It is crucial that there is continued investment in building the clinical expertise of the nursing workforce to ensure that staff remain up to date with changes in healthcare, including technology. These cuts are an extremely short-sighted move, as it is only by equipping nurses in health and care environments with professional development, training and support that our existing workforce can help drive service transformation, particularly in mental health, including mental health in schools. Both the noble Baroness, Lady Cumberlege, and my noble friend Lady Masham have outlined the need to invest in mental health, especially in women’s intensive care. We know that recently patients from the south-west have had to travel more than 300 miles for in-patient mental health services. Clearly, we need to resolve these problems. Without continuing professional development, it will be particularly difficult.
Thirdly, nursing, midwifery and allied health professions are evidence and research-based professions. Research outcomes contribute to patient safety. With Brexit negotiations starting this month, we need to find a way to ensure that our universities across the UK continue to participate in EU research funding and networks, while we look at measures to increase research capacity in the healthcare disciplines. Researchers in these areas include less than 1% of the workforce—a figure that needs to improve dramatically.
Finally, since 2011 there has been a real-terms drop in earnings of up to 14% for NHS nursing staff. In May this year, RCN members voted overwhelmingly to take action on nursing pay. Over the summer, members will be protesting to scrap the cap. The cap forces good nursing staff out of the profession and leaves those who remain overstretched and undervalued. This has a profound and detrimental effect on the standards of care provided. While I am aware of the vote in the other House yesterday, I urge the Government to consider further over the summer whether removing the cap would be positive in retaining and attracting NHS staff, helping to resolve the workforce shortage so well outlined by others, and ensuring patient care. I also believe that this would reduce the need for nurses to join agencies to increase their salary and therefore increase the cost to the NHS.
It is estimated that there is currently a vacancy factor of about 11.1%—or 40,000 registered nurse vacancies in England. Under these circumstances, it is understandable that many nurses in the EU do not wish to come and work in Britain because of the extreme, increased workloads and the stress and fatigue that ultimately result from working in areas where there are insufficient staff to deliver high-quality care to patients. Without better pay and conditions, we will fail to secure the nursing and other healthcare workforce for the future. I urge the Minister to consider the issues raised, protect nursing education and enhance morale and recruitment. Even if this requires an increase in taxation, I believe that the majority of our citizens would support this idea.
My Lords, I draw your Lordships’ attention to my long register of interests, most particularly my connection with Pinewood film studios and my position as a trustee of the Science Museum Group.
I make no apologies for introducing a note of optimism into what has been a somewhat depressing debate with a list of worries and concerns, all of them legitimate and certainly well worth listening to. I will talk about social mobility. A year or two ago, Alan Milburn asked whether I would join his Social Mobility Commission, looking at that issue, and I came away as depressed as the noble Lord, Lord Whitty, about the general picture. However, I came away utterly thrilled, delighted and excited by the fact that the sector I represented—namely, the creative sector—is an absolute beacon of social mobility. It is open to anyone and everyone; geography sometimes plays a part as an inhibition to people joining, because so much of the money is in London—more on that in a moment.
I will give your Lordships one example of social mobility. There is an A-list Hollywood director from the north-east of England called Ridley Scott, who commands hundreds of millions of pounds-worth of Hollywood budgets to make movies that people want to see. He is a massive success story. He comes from very humble origins in the north-east; he started his career working in the scenic department of the BBC and ended up directing “Z Cars” and other things. He has made a huge success, together with his late and much lamented brother, Tony. I asked him what his father did for a living and he said, “If you ask my mother, she will say that he was in shipping, but I will tell you that he was actually a riveter in the shipyards of the north-east”. He is only one of many tens of thousands of young, hopeful kids with a bit of talent, who have made their way into the creative sector and made very good livings and contributions, training as technicians, with no training at all, as writers, actors, make-up people and so on. It is great that the sector is advancing.
Unusually from this side of the House, I pay tribute to Gordon Brown, who had the vision to realise the importance of fiscal incentives in the creative industries for us to be competitive internationally. He introduced the fiscal incentives, which successive Governments have increased. Through an era of austerity, the Treasury must finally be convinced that the taxpayer is getting a very good return indeed for the investment they make in the creative industries. Some figures say that the taxpayer gets eight times their money back and others say 12 times, so somewhere in that range is the result. This is therefore a tribute to Gordon for his vision.
We are an expanding sector and we are internationally successful. I was pleased yesterday that the British Film Institute announced a new industry led skills strategy backed by an investment of £20 million of film institute National Lottery funding—a huge boost to our skills shortage, which is up and coming because of the expansion. UK film production contributes about £4.3 billion to the UK economy.
Our museums and arts institutions contribute greatly to civilising and, most importantly, inspiring kids. I go around our museums in our group, four which are north of Liverpool, I am happy to say, including the National Science and Media Museum in Bradford, the advisory board of which I chair. Watching the results of the investment that has gone into those institutions, seeing the school parties going round getting inspired and plugged in—incidentally, to the STEM agenda—is incredibly exciting. I was pleased to see in the Conservative manifesto a recognition that this sector is so incredibly important to us.
One of the key themes that government has finally grasped is that money has to move out of London. I was thrilled to see the Arts Council for England moving money out of London into the English regions recently. There is beginning to be a real recognition that there is talent out there that cannot afford to come to London. We must move the talent out. It is one of the reasons I would support moving Channel 4 out of London. If you move the money and the air time out of London, the talent will follow. Decentralisation is terribly important. Recognising skills and talent in the regions will help social mobility. I have only one caveat to this optimism: contrary to the forecast of the President of the European Commission, this is all dependent on the English language surviving.
My Lords, I welcome some of what the Minister said about education and skills, which are the areas on which I wish to focus. I congratulate my noble friend Lady Sherlock, who is no longer in her place, on her outstanding contribution. She covered the waterfront, and I do not intend to try to match her.
I declare an interest as the recently elected chair of the board of governors of my local primary school. If make one plea, which echoes what many noble Lords have said, it is about the importance of primary education. We know that if we get it wrong there, there is a cost of dealing with that. Sometimes I wonder whether we realise the size of the challenge that schools face. I can talk only about my school. There is a modest number of languages—about 30—where English is the second language. A significant number of children enter the nursery school not toilet-trained and with very few social skills. The school almost becomes a surrogate parent in those early years and has to overcome those difficulties. My school is doing exceedingly well, and I pay tribute to it. It is now in the top 3%, thanks to the dynamic leadership and the quality of the staff. I hope that we recognise the importance of that.
I want to focus on the need for a more holistic assessment of where we are spending money in education. I could not help but look at the staggering amount of money that is now outstanding in student loan debt: £89.3 billion. New lending and interest added outweighs the repayments being made by those borrowers who are now liable to repay. If I thought that all that investment was focused and if any objective cost-benefit analysis showed that we are getting value for money and that the spending is where it needs to be, perhaps we should not worry, but I query whether it is. Students face leaving university with a debt of £40,000 to £50,000, assuming they complete the course. A worrying article appeared in today’s Times, headlined:
“One in ten students from poor households drops out after first year”.
“Almost one in ten students from disadvantaged backgrounds is dropping out of university after the first year. Official data showed that 8.8 per cent of young, full-time undergraduates from poorer homes did not return for their second year of study in 2014-15, up from 8.2 per cent the year before … For middle-class students, the figure was less than 5 per cent. More disadvantaged young people are in higher education than ever before but the dropout rate has risen for the second year in a row”.
You cannot help wondering whether university education was appropriate for all those students. That is the first question that we need to be asking. In many cases, it is not. It is the only career path they are encouraged into because secondary schools have the incentive to get students into their sixth form, whereas they should be pointed towards the vocational path, which I will come to in a bit.
A further comment on university education is that here we are, in 2017, and yet we still focus mainly on three-year degrees. But does it really? Are we getting value for money? Most university students I speak to do not give year 1 much of a tick, other than to say that they enjoyed it—whether they learned much is another matter.
I focus briefly on further education. I welcome the £0.5 billion, but I am not so sure that that will be enough to deal with the challenge of what is needed in vocational education. T-levels are a good idea, and we certainly need to up the standard and status of vocational education. Unfortunately, it is still seen by many as a second-class career path.
There is a need for high-level apprenticeships in STEM areas. The Royal Academy of Engineering estimates that 830,000 more science, engineering and technology technicians will be needed by 2020 to meet the industrial demand. The latest apprenticeships statistics show that we are nowhere near that figure.
To conclude on the subject that arouses my greatest interest, I am not particularly worried that the Government are unlikely to meet their target of 3 million apprenticeships because I still think the focus should be on quality rather than quantity. If you look at the analysis of those apprenticeships, you will see that the vast majority are in care and hospitality. It is not that there is not a need in those areas, but we also need apprenticeships in the STEM areas, such as construction and engineering.
I have two final questions for the Minister—he has only 100 or 200 to answer already in his right of reply. Are we getting an impact from the apprenticeship levy? Can we see the needle on the dial for the number of small and medium-sized enterprises that are actually employing apprentices? In my view, if that number is not increasing, the levy has failed.
I have one final point. I was interested in all the efforts we will make on new technology, et cetera, but I noticed that in all the points made by the noble Lord, Lord Ashton, there was no reference to cybersecurity, which rather baffled me. Apart from the vested interest we have in this House, having suffered an attack ourselves, there were more serious attacks on the National Health Service. We know that the whole of this country needs to up its game. I would welcome some comment on that.
My Lords, in the recent general election we heard quite a lot about the cost of trying to sustain our health and social care systems, but too little about action to make people healthier. The gracious Speech did not provide much hope that the new Government recognise that this is an important and continuing priority. I will focus my remarks on tobacco control. I speak as a former trustee of Action on Smoking and Health, and I am currently a vice-chair of the All-Party Group on Smoking and Health.
Those of us most concerned about this issue have recently had two things to celebrate. The first is the decline in smoking prevalence, which is shown by new data to be just 15.5% of adults in England—the lowest level on record. This is a huge achievement and the effort to bring it about will save many lives over the coming years. Particularly encouraging is the fact that the greatest decline in smoking rates has been among young adults aged 18 to 24. The reduction in smoking rates is testament to the success of the comprehensive approach adopted by previous Governments.
Secondly, in England, we are about to celebrate the 10th anniversary of smoke-free legislation, with Scotland having bravely led the way some two years earlier. This legislation has had a tremendous impact on public health, including significant declines in heart attacks and strokes, and hospital admissions for asthma attacks in children. The passage of the legislation required the efforts of many people to combat the fierce resistance and fundamental dishonesty of the tobacco industry. Since that time, a cross-party approach to tackling tobacco has continued to do much, for example in passing legislation to prohibit smoking in cars with children and putting cigarettes in drab-coloured, plain packaging.
Every step forward has been resisted, but tough tobacco legislation is no longer seen as something for which the tobacco industry can win significant support to block or delay for very long. A public survey for Action on Smoking and Health showed that 76% of respondents supported government action to limit smoking or wanted more to be done. Against that backdrop, the UK has widely been acknowledged as a world leader in tobacco control, and in 2015 received the prestigious American Cancer Society’s tri-annual award for exemplary leadership by a government department, as well as the World Health Organization’s World No Tobacco Day medal last year. The Government then committed £15 million to support implementation of the World Health Organization’s international tobacco treaty, the Framework Convention on Tobacco Control, in poorer countries between now and 2021.
That is a record to be proud of, but we cannot be complacent about the issue of tobacco control. Despite our successes over the last decade, smoking remains a public health epidemic. Every day, hundreds of children start smoking, and tobacco still kills around 80,000 people in this country every year. Smoking is responsible for half the difference in life expectancy between rich people and poor people—a difference of nine years—and that is a burning injustice. The smoking rate among people with a mental health condition is 40% and smoking is the leading modifiable risk factor for stillbirth and sudden infant death. Yet 18 months after the expiry of the tobacco control plan for England, no new plan has been put in its place. That is in contravention of our obligations as a party to the international tobacco treaty, which requires us to have a comprehensive strategy in place.
The obligations are based on good evidence that it is through such strategies that countries can be most effective in driving down smoking prevalence. We have been very effective in the last decade, with a comprehensive approach to tackling tobacco. If we are to be effective in the next decade, the Government urgently need to publish their next plan, with ambitious new targets to reduce health inequalities and lead us towards a smoke-free future.
In answer to a Question from me on
Earlier this week, the Government reiterated the commitment made before the election to publishing a new plan “shortly”, so I hope that today the Minister can go further and confirm a date for publication of a new tobacco control plan before the House rises for the Summer Recess.
My Lords, I rise along with many of my colleagues to talk about education. I should declare my interests as the chancellor of BPP University, a member of the Parkside Federation Multi-Academy Trust and a governor of University Technical College in Cambridge.
Something that went unmentioned in the recent higher education Bill, now an Act, was student fees, which turned out to be hugely important to young voters, as we all found out in the election. I agree that students are heavily burdened. They are finding that the investment in themselves they have been encouraged to make to meet their aspirations has met head-on another piece of important public policy, which is the instruction to mortgage companies to be pretty careful who they lend money to and to ensure that they can actually repay it. Student debt, particularly now that loans are being given at a staggering 6.1% interest rate, lies across many credit lines and inhibits people’s ability, possibly for ever, to get a large enough mortgage to buy a house. This is a real worry for us all. I feel deeply for students, particularly those whose parents cannot afford to house them or help to pay their fees, and I am distressed by it.
I can understand perfectly why the promise made by my party in its election manifesto to abandon the loan system and make higher education free again proved to be so popular with young voters. I would suggest that higher education is already very well funded—grossly so by contrast with schools, against a background where we are not going to be able to do all we would wish to do in education now that no one can possibly claim that Brexit is going to prove to be in any way profitable, at least in the early years. Given the choices we face, I believe that we will have to leave student fees where they stand and try to put the money into schools. Governors in every school and directors of MATs have sought to make economies. We have done as the Government suggested. We have banded schools together and we have made huge cost economies through combining administration and finance and through teaching. In fact, we are cut to the bone, and I speak even of rich Cambridge, where my schools are located. Hereafter we are looking at either increasing class sizes, cutting experienced staff or doing without an extra STEM teacher. I suggest that this is a completely wrong allocation of national resources.
Once people reach the age of 18, they have choices. They can get a job or secure an apprenticeship, which may well be a better course for them than pursuing a degree. Children from the age of five upwards have no options and their ability to make life choices at the age of 18 or later depends critically on the teaching they receive before that point. I use the word “teaching” advisedly. You can have all the IT you like, but in the end teaching depends on personal inspiration. To my knowledge no one has ever been personally inspired by a computer. It can be a useful supplement, but teaching is really all about people. This is a key issue of social justice as well as an economic issue. Universities and employers everywhere complain that many 18 year- olds are reaching them poorly qualified to benefit from a course or from a job. It would be a far better national investment to put the cash in at an earlier stage. I am therefore unable to support the entirety of this element of my party’s policy on university fees, but there are obvious exceptions.
We are in desperate need of well-trained nurses. We all know that up to £50,000 in fees and expenses cannot possibly be a good buy for someone who is going to be on a nurse’s salary unless they go to the USA or somewhere where nurses are paid a lot more. We should put nurses back into the position they always used to be in so that they do not have to pay fees in order to train, as the noble Baroness, Lady Watkins, has urged. I would think that there is a good case to be made for other desperately needed skills, mostly in health services, which people now require degrees to access. These people should not be paying fees. It makes no sense, because we do not intend to pay them well enough to enable them to repay the debt.
In general, however, having lived through two higher education Bills for most of this year, I fear that both attention and funding have become concentrated on university education. When the higher education Bill was under consideration in this House, 180 people spoke at Second Reading—most of us, admittedly, chancellors of universities. About 20 of us spoke in the Second Reading debate on the Technical and Further Education Bill. It sets up the office for apprenticeships and training and is possibly the greatest stimulus to social mobility that anybody could have thought of, because it seeks to enable students via apprenticeships to get good, progressive jobs. All of us, in all parties, have always known that that is the key to social mobility. The small number of us who took an interest like to think that we made up for our lack of quantity with quality. We were much assisted by the noble Lord, Lord Nash, the Minister charged with getting the Bill through, who made himself and his Bill team available to all of us. He held cross-party meetings at which we were able to sort out a lot of detailed argument. I personally benefited greatly from the company of my noble friend Lord Young of Norwood Green, who has just spoken so eloquently, and the noble Baronesses, Lady Garden and Lady Wolf.
We left with a much better Bill than that which we had received, which was concerned mostly with preventing training providers going bust. It is still not that good an Act, and I expect to see some of it again in a year or so, but it at least establishes the office for apprenticeships and states clearly the Government’s intentions. We all considered the goal of 3 million apprenticeships by 2020 far too ambitious and I share my noble friend Lord Young’s hope that the Government will not sacrifice quality for quantity, but this Act is potentially far more important and revolutionary than the higher education Act. I hope and think that all the little group concerned with it will keep a very close eye on it.
I enter a plea again for different treatment of international students. This House voted to insert a clause in the higher education Act which would enable international students not to be included in the list of immigrants to this country, whose number the Government have sought to control. The Government would not yield on the principle, but we need those students: they bring not only cash but skills, intelligence and knowledge to our universities. We should encourage them to stay.
My Lords, I shall talk about the arts, including arts education, and want to say a few words also about Europe.
Our debate in Grand Committee on
The Arts Council is juggling well with less money in real terms than last year. Whenever historically the difference in funding between London and the regions has become an issue, it has always in the first instance been because of cuts overall. I would certainly add my voice to those who wish to see an immediate end to austerity. With local authorities, lack of funding is sadly not the only problem. In recent years, the Government have encouraged councils to act more like businesses, treating buildings and land solely as financial assets and not as public resources and neglecting the very thing they are there for: to support public services. This culture in which austerity has become a mindset, sometimes irrespective of how well-off a borough is, needs also to be reversed.
I am very glad that the Government are continuing with the policy of free entry to the national museums. I look forward to the exhibition next year in Newcastle and Gateshead celebrating art and design in the north.
It would be very helpful to have from the Minister an explanation of the thinking behind DCMS reorganisation. I have always preferred the umbrella term “arts and creative industries” because I have never felt entirely comfortable with one aspect being defined as part of the other. However, the apparent separation between the two is not quite realistic either: there is much crossover between them, and while digital is very important for the creative industries, it does not define them. The Government should not lose sight of the immense importance of the creative industries to this country, not least to its economy. I hope, too, that placing the arts alongside heritage and tourism is not a move away from recognition of the arts as a significant contemporary practice.
If education does not receive adequate funding, which must mean an increase in per-pupil funding, then arts education will continue to receive a double whammy, hit first by, among other things, an increasing shortage of specialist teachers and a lack of resources and secondly, by the continuing effect of the EBacc, which the Government are clearly ploughing on with regardless of the mounting evidence of its devastating effect on school education. In particular, we have the Ofqual figures published just this month showing for the last year alone a decline of more than 8% in take-up of arts GCSEs and more than 10% in design and technology, whose importance in the curriculum the noble Lord, Lord Storey, emphasised earlier. The Government must come to their senses and remove this destructive measure so that children have a rounded education that contains the widest range of opportunities.
I want to say a few words about the European Union. I am not someone who accepts the leave vote because it was the result of the referendum. To leave was wrong a year ago and it is equally wrong today. It is young British people’s citizenship rights that will be lost if Brexit happens—the rights not just of those who are in Europe now but of the many young people in the UK who have yet, perhaps, to travel abroad at all. Then, of course, there are the rights of future generations, such as the freedom to roam across our own continent and the right to travel, work and study abroad—if we leave, these rights will continue to be held by the great majority of European people except the British. Citizens on the continent hold these rights dear. The EU is not falling apart any time soon. Young people in Albania, for example, with its status as a candidate for EU membership, will have greater rights of free movement around Europe if we leave the EEA than young people in the UK will.
The phrase repeated by Ministers that most sends a chill through me—one we have heard in arts and creative industries debates—is, “We will be attracting the brightest and the best”. It is chilling because, as agreements are intended to be reciprocal, all hope that ordinary British citizens will continue to enjoy our current rights to work, study and travel abroad will be removed, as the well salaried and privileged will be the only people able to cross borders with any degree of the freedom of movement enjoyed by all other Europeans. If Brexit is to happen then the proposal by the European Parliament’s chief negotiator, Guy Verhofstadt, of associate citizenship of the EU for all UK citizens who wish to retain their EU citizenship should be part of the negotiations. This already has wide support in the European Parliament, and its feasibility has been further explored in a report by a Swansea University team of experts in international law led by Professor Volker Roeben, for Plaid Cymru MEP Jill Evans, which was launched at the European Parliament last week. A key finding of the report is that UK law in this area is in line with the principle that individuals should not be stripped of citizenship against their will. It might be that this is the only solution that would satisfy both individual leavers and individual remainers. The ball is very much in the UK’s court.
My Lords, at this late hour in the debate I briefly bring to your notice a specific issue which has arisen in the GP sector of the NHS in England. The GP settlement of 2006, a far-reaching measure by the party opposite, introduced two categories of general practice: the General Medical Service, GMS, where practices continued broadly with their existing level of funding; and the Personal Medical Service, PMS, whereby practices could opt for extra responsibilities in return for which they received extra remuneration—typically £15 to £30 per patient per annum. I must be careful not to generalise, but the PMS has attracted the more far-reaching entrepreneurial GPs, while those who are happy with the status quo tended to remain with the GMS. However, the PMS unlocked a whole spectrum of entrepreneurial initiatives on the part of many PMS practices. In particular, one PMS practice that I know of used the premium funding to introduce: counselling for sexual health, alcohol misuse and depression; the management of common mental health problems and enduring mental illness; providing facilities for rough sleepers and homeless people; specialist care for the vulnerable elderly; and, last but not least, walk-in surgeries. In this practice, these have led to high levels of patient satisfaction and, with its improved facilities, it and others like it have encouraged patients to avoid the use of overstretched A&E units, in turn reducing costly but avoidable emergency admissions. All in all, it is fair to say that the vast majority of PMS practices have put the extra funding they received to good use.
For the first 10 years or so, this arrangement has worked very well for PMS practices. However, in the 2013-14 GP contract imposition, NHS England decided that the premium paid to PMS practices was to be withdrawn and redistributed via the local CCGs—significantly, to all practices in their areas. Particularly hard hit have been practices in authorities with a small number of PMSs relative to GMSs, and where they receive back only a tiny fraction of the premium surrendered. The arithmetic is simple: in a not atypical split, an authority may have one PMS practice and 19 GMS practices. The PMS practice will therefore receive only 5% of the funds which it has surrendered.
I agree that this redistribution of funds is for the benefit of general practice as a whole, and that the proposals as they stand will have the effect of providing resources for many GMS practices which need them. Where I take issue is that this redistribution is at the expense of the PMS practices, which as a group embrace many practices that have shown initiative over the past 12 years in expanding their services, for which they have received the extra funding I referred to. I know of one central London practice which will lose £400,000 in funding per year that, after a partial clawback from the CCG, will result in a net loss of £200,000. This is an annual, ongoing figure and clearly cannot be sustained. This, by the way, is a total NHS practice with no private patients and therefore no income from rich private clients. There can only be one outcome from this haemorrhage of funding: inevitably, some of the services built up since the inception of the 2006 agreement will have to go.
However this policy is viewed, it means that many GP practices will be subsidised by the star performers in their sector, at a huge cost to the latter. It is simply wrong that these PMS practices, which simply by the way they were constituted have attracted many entrepreneurial and far-sighted GP doctors, should see a significant proportion of their funding withdrawn. Several GPs I have spoken with who took advantage of the PMS funding are quite simply perplexed that, at this time when the NHS is faced with a massive black hole, NHS England should apparently be pursuing a course of what is effectively the disincentivisation of many leading practices within the sector that are dedicated to taking the strain off the hard-pressed and expensive A&E departments. They also show, as a group, much initiative and enterprise in helping to keep GP practice—what has been described as the jewel in the crown within the NHS—as healthcare providers of excellence.
I wholeheartedly agree that our aim must be to ensure that all patients get a minimum standard of treatment. However, I urge the Minister and his colleagues in the Department of Health and NHS England to look elsewhere for funding and not penalise so many high-achieving practices in the GP sector. I understand that the redistribution is to be rolled out over four years, so I hope it is not too late for NHS England to accept my submission that this imposition on the PMS practices is a basically short-sighted process, and to reconsider the department’s policy on it.
My Lords, as the Minister announced at the start of the debate, we have a Financial Guidance and Claims Bill on which we commence our parliamentary scrutiny next week. Without pre-empting that process, I will use my brief time to talk to some issues surrounding or arising from that legislation.
The Bill’s stated aims—worthy aims—are to increase levels of financial capability, reduce levels of problem debt and improve public understanding of occupational and personal pensions by merging three existing guidance bodies. It also introduces a tougher and welcome regulation regime to tackle the range of conduct issues and problems in the claims management market. But it is all very high level and vague, and we will have to sort this out in Committee. It also has the good ambition of a national strategy to improve the financial capabilities of members of the public.
We will judge the salience of the Bill by its contribution to some of the most pressing problems facing our country at the moment. We will need to consider whether it is a missed opportunity to contribute more to combating financial exclusion, which holds back the life chances of so many of our fellow citizens. We know that levels of financial capability in the UK are low and that many people face significant challenges when it comes to managing money, avoiding debt, building up savings in the short term and balancing this with retirement savings.
The House of Lords Select Committee, very ably chaired by the noble Baroness, Lady Tyler of Enfield, addressed these matters in its recent report, Tackling Financial Exclusion, identifying those most at risk of financial exclusion as including, not surprisingly, those on low income or living in poverty as well as those who lack digital access or capability. Data provided to the committee suggested that one in six struggle to identify the balance on their bank statement, 40% of the working-age population have less than £100 in savings and 23% of adults do not possess basic digital skills. Just yesterday, the press were full of the depressing report of the Social Mobility Commission, setting out what limited progress we had made in reducing inequality between rich and poor over the last two decades—referred to by my noble friend Lord Whitty.
On the same day, we heard dire warnings about the build-up of unsecured consumer borrowing. Evidence provided to the Select Committee suggested that the average UK household now owes some £12,887, and concerns have been expressed by debt agencies about the rise in calls concerning rent arrears, energy and water bills, telephone bills and council tax. Of course, the Government are not without blame in this matter. The transfer to local authorities of responsibility for council tax support schemes, with a starting 10% reduction in resource and subsequent cuts in funding, is having a direct impact on arrears. We know that the monthly payment of universal credit and the introduction of waiting days are further driving people into poverty—the bedroom tax and benefit cap likewise. Perhaps I may digress a bit to ask the Minister to confirm what I thought he said at the start of our proceedings: that the bedroom tax is not to be applied to those families rehoused as a consequence of the dreadful fire in Kensington. If austerity is truly to end, when is all this going to change?
The pensions landscape has been the subject of significant change in recent years, making access to robust guidance imperative, and we might expect more change in the future. We are grateful to the ABI for its briefing, which encompasses some of this. Auto-enrolment continues to generate significant pensions take-up, and of course there is greater flexibility in when pensions can be accessed and how they are taken. The Government have announced the scope of the review of auto-enrolment, with the prospect that its application can be extended. This would be welcome.
The need for guidance and support on pensions is very much relevant to these recent changes, and I hope we have learned the lesson of bringing in radical changes to the pensions system without laying the groundwork of consultations and safeguards, backed by access to robust guidance.
On the horizon is the prospect of the secondary annuity market being advanced, changes to DB schemes and the emerging potential for a pensions dashboard. We await the decision on the state pension age.
The introduction of pension freedoms in 2015 also spawned an industry in scamming, involving fraudulently extracting money from individuals’ retirement savings. Some lost the entirety of their pension pots—an unimaginable trauma for someone whose working life was assumed to have been over. Promoting awareness of the techniques used is essential if we are going to make progress.
As for improvements to the regulation of claims management companies, an independent review carried out by Carol Brady has identified the need for change. The review exposed the depth of the skulduggery that continues in the sector: non-compliance with rules, misleading advertising and speculative and unnecessary claims. In supporting stronger regulation, though, we should bear in mind that CMCs can and should play a role in providing access to justice and can provide a check on the complaint-handling processes of individual businesses.
Our ambition for the Bill is to see it be part of a process of a step change in improving financial inclusion and reducing financial exclusion. The report of the Select Committee has charted the way.
My Lords, in my contribution to the humble Address to the gracious Speech I will focus on health and social care, mainly the latter, and some of the overlapping and invisible problems facing the most vulnerable.
There was much debate during the general election about the funding of our NHS. The Government’s additional funding, announced earlier in the spring, is vital but, as many people, not just politicians, have expressed, it is just not enough. I am proud that my party was brave enough to suggest we should have one penny on income tax for health and social care. I also applaud Labour’s very specific proposals to provide the necessary funding for health and social care. Over recent weeks, with some of the crises and emergencies that we have faced, we have rightly praised the response by the emergency NHS workers, but I praise in particular the invisible unsung heroes who make the NHS, our social care and many people’s lives work without our being aware of it.
Reforming the NHS is vital, but to do so at a time when funding is not just scarce but in some areas—mental health, primary care and for those with long-term conditions—in total crisis sets up these reforms to fail. I congratulate the 50 charities that have recently come together to form the Disabled Children’s Partnership. It has just launched its thought-provoking campaign, the Secret Life of Us. It is those disabled children on whom I want to focus my remarks. Nine out of 10 of the parents surveyed by those charities say that the needs of their disabled children would not be met if they, the parents, could not care for them, and only 10% of the families believe that health and social care services in their area meet the needs of their disabled child. More than four in five of parents of a disabled child face problems accessing the services they need, and over half of them see that this has a negative impact on their child’s health, well-being and ability to make friends. Three-quarters of parents with a disabled child have personally experienced mental health issues, compared with just one in five in the general population.
One example very close to my heart at the moment illustrates all these points and more. I live on the same road as Nascot Lawn, an outstanding facility run by the NHS for disabled children with extremely complex needs. It is in Hertfordshire but it is so good that it is used by other areas as well. Friends of ours have survived—I choose my words carefully—because of the respite care offered by Nascot Lawn. You can get help there only if your child requires hourly attention night and day and their medical needs are complex. They may have tracheotomies, colostomies or regular seizures, or may require feeding by IV tube directly into their stomachs. These children are so sick that they cannot even go to children’s hospices for care. One mum said on television the other day that she could not leave her child on the ward at Great Ormond Street Hospital because that specialist hospital does not have the staffing levels needed to look after her child.
The local CCG has just announced that it will close Nascot Lawn because its work is discretionary. Given that respite and other care provided by Nascot Lawn is specified in most of the children’s education and healthcare plans, and their continuing care plans, some of us think that the CCG has got that wrong. Accountants have decided this without any reference to any of the children’s individual cases.
I am in awe of the commitment, love and dedication of the parents and families of these children. Unless you have seen it first-hand, you cannot understand what living with children this sick and disabled is like. Now imagine if that occasional lifeline is arbitrarily removed by the NHS. Parents say, and I am sure they are right, that it is likely to cost the NHS much more money in the longer run. I also believe that it breaches their child’s rights and, what is more, their rights as carers, working all day and all night, and nursing their children all their lives.
There is something else here, too. A nation’s commitment to its people should be judged by the way it treats its most vulnerable. These children represent the most vulnerable and they are easy targets because they are invisible. My question to the Minister is: will he please meet me and some of the parents involved to discuss why on earth this sort of care could be deemed discretionary?
My noble friend Lady Jolly raised the crisis in social care as a result of employment tribunals and sleep-in shifts. I echo her concerns and agree that that funding must be found to help this problem, but I also want to highlight a further problem. There are now more than 108,000 disabled people with care needs who receive no social care support at all. This is just not acceptable, and the practical problem seems to be that the better care fund is for those who are in hospital and come out, and completely misses out those people living in the community who require long-term continuing care. I ask the Minister: when will there be extra funds for this group?
In conclusion, the Government propose a new consultation on social care. We do not need a new consultation on social care; we need an update on the Dilnot commission and for that to be introduced as soon as possible.
My Lords, I wish to restrict my remarks on the gracious Speech to health. I welcome the new patient protection Bill and the focus on mental health, but in both the Government are not going far enough in driving a quality agenda into the NHS, and do not seem to understand that care quality and the UK’s attractiveness as a destination to industry for clinical research post Brexit go hand in hand.
Moreover, most of the changes needed to drive quality in the NHS can be achieved without legislation, as they are about how we measure quality and encourage a culture of accountability. Accurate, disease-specific care quality data, sometimes called care outcome data, are the missing link that can drive both these agendas. Given that the life science strategy is in the Minister’s portfolio, and Sir John Bell’s committee has had extensive discussion of what it will take to make the UK attractive to pharma, I would like to draw his attention to the connection.
Care quality data are information on how a particular episode of care turned out for the patient. These outcomes have to be defined and measured in standardised ways, or all manner of games get played by clinicians and hospitals to time and choose the measurement to favour themselves. The not-for-profit International Consortium for Health Outcomes Measurement—ICHOM—has done much to define these standards through international consensus building. It now has standard sets that cover about half of disease by burden. The outcomes are rich in patient-reported outcomes that can now be collected cheaply using smartphone technology. Seven European countries, including Wales, have now committed to using those standards. That allows international comparison, which can only accelerate best practice development. However, England has not made as much progress as we should have in defining quality. What clinical audits we do have are slow to report and miss the high-frequency and important complications that cannot be measured in the electronic health record.
A good example of this is the recent maternity audit, Each Baby Counts, under Professor Lesley Regan, looking at stillbirth and major brain injury in 2015. This affected 1,136 babies that year. What is shocking is that about one-half of those deaths and brain injuries are believed by experts to be preventable. The UK is at the bottom of international league tables for maternity deaths, and has been since the Second World War. I applaud the effort that went into the audit as a first step in lifting the UK from 33rd of 35 countries on severe harm to babies. It is great, too, to see the first audit with 100% coverage of trusts, but we are going too slowly.
What can be done about this? Each Baby Counts made a number of recommendations, but I want to bring to the Minister’s attention the most important, following on from the remarks of the noble Baroness, Lady Cumberlege: the need to change team behaviours to create the right culture of safety. An audit that reports back many months after an event is unlikely to do much good, given the turnover in NHS staff. They can legitimately say, “It wasn’t us”.
Changing culture is hard, but we can learn from other industries with strong safety cultures—in particular, the airline industry, as the noble Lord, Lord Ribeiro, mentioned. Through experience, they have worked out that safety cultures that only look at the severe-impact, low-frequency events, such as a plane crash—or, in the NHS, stillbirth—fails to change the culture. The events are too rare; they can be written off too easily as “chance” by practitioners. So plane safety experts innovated to look at high-frequency risks, such as near misses, and creating a culture of learning through appropriate team based discussion of those incidents in close to real time. Reducing near misses works—it has led to fewer plane crashes. That is what we need in the NHS, and is missing from the patient safety Bill.
We need to add these higher-frequency, smaller harms to the metrics. Almost always they are, or could be, patient-reportable outcomes. From their red book, most mothers know how blue their baby was. Mothers also know whether they got good care, and are highly engaged. We do not need costly NHS internal data entry to measure this; we can just ask mothers to give us their outcomes via their smartphone. Those data need to be used in weekly or monthly team discussions to improve care, as part of normal team management meetings. There are enough births that it is meaningful to track these higher-frequency statistics at that frequency, unlike stillbirths and brain injury. Those near real-time discussions and continuous small improvements are what changes the culture, not an audit on a major event that reads out 18 months after the event.
If we really want to half the stillbirth and major brain injury rate—or in any other area of care—we need to change the culture, and manage these near misses. To be clear, this is an “and”, not an “or”; we should still audit in depth the severe, low-frequency events such as stillbirth, just as in air safety we investigate crashes in depth. But we need to add the more common harms. To that end, would officials from the Minister’s department meet representatives of the International Consortium for Health Outcomes Measurement to be briefed on work in the UK and elsewhere and to identify areas such as maternity services, mental health and cancer, where that work can make a difference? That difference is critical. Those same disease-specific, patient-reported outcomes are the dynamite of health economics.
If, as the life sciences strategy suggests, we want the UK post Brexit to be the destination of choice for life sciences research, we need to invest in NHS data, especially care outcomes linked to episode-of-care data. Why? First, because the data that pharma are after come in flavours—some rare, some valuable and some ubiquitous. Any care system with an electronic record can supply activity data; almost none can provide reliable care outcomes beyond death and hospital admissions. Scarcity drives value.
Secondly, to pharma, payers like NICE are now as important as, or more important than, decision-makers as regulators in getting a drug to patient. Large-scale outcome data is gold dust for health technology assessment and performance-based pricing. For example, if the NHS is uncertain that, in the real world, a new $100,000-per-patient wonder drug works as well as its makers say, the NHS can demand, “We’ll pay according to real-world performance”, and measure it.
Finally, it takes 15 to 20 years or so to get a drug from bench to market. Less well known is that it then takes another 15 years to get peak clinical uptake, as care systems are so resistant to change, even for effective innovation supported by a strong sales force. Appropriate real-world outcome data will allow truly innovative drugs—
My Lords, I draw attention to my registered interests. The gracious Speech confirms that the Government,
“will strengthen the economy so that it supports the creation of jobs and generates the tax revenues needed to invest in the National Health Service, schools and other public services”.
I, like many others, wholeheartedly support this. Recently, though, I heard of a forecast that a significant number of retail jobs, as we know them today, will go in the next decade—I think that the number was 900,000 but I may have had a bad moment when I was listening to the number. This is not surprising, really, as people move to a more digital method of shopping. As these jobs decline, new ones will arise which will have a significant digital skill requirement if we are to meet the needs of the retail industry.
We look to our education system to have a curriculum that helps our young people to acquire the skills that they will need in order to become part of a highly skilled and motivated workforce. I believe that the Government have demonstrated a real commitment to ensuring that our technical and vocational education starts to meet the challenges of the labour market going forward but, in the words of one of my most respected leaders, General William Booth, who started the Salvation Army,
“That and better will do”.
I know many people who feel quite inadequate that they were not given the opportunity to attend university, but they run companies that provide vital services to the public when they really need them. Let us hope that, as part of the progress that we need to make, we see academic and technical and vocational education receive equal billing in the future. It should be about meeting labour market needs, not just a target for people going to university.
The FSB has said of technical education that:
“The vote to leave the EU has emphasised the need to future-proof”— the UK’s—
“approach to skills. Our research shows that small employers with EU workers are particularly reliant on mid-skilled workers who often require a technical vocational education”.
So this applies not just to young people but to those in the workforce already. The reforms to technical education must focus on delivering quality skills that are valued by employers and help to address future skills needs.
I do not wish in any way to be negative about the commitment in the gracious Speech that I have already referred to, but let us look for a moment at one industry where growth and opportunity is on the up yet pupils choosing to study the subjects relating to the industry show worrying trends. The engineering, manufacturing and creative sectors are together worth more than £500 billion to the economy, or 29% of the total. However, since the introduction of the EBacc to which the noble Baroness, Lady Benjamin, referred—and I may say to the noble Baroness that, if I was not already on a diet, I certainly would be after what she said—and the introduction, in 2010, of the target for 90% of pupils to study the EBacc at key stage 4, there has been a fall of 140,000, or 21%, in the number of creative and technical GCSE entries. Those are the very subjects that will give young people the skills which are needed in the labour market. Included in this figure was a sharp decline in entries for design and technology, which is crucial in preparing the next generation of engineers and technicians. The fall in these entries is almost 36%. Again, I am not making these points to be negative or difficult. However, if we are to maximise job creation and tax revenues, I suggest that we need to make sure our education system plays its full part in achieving this.
The House has had many debates about good-quality careers advice. I promise your Lordships that I am not going to start another one, save to plead that our young people get the best careers and labour market advice in order that they can make the best decisions about their future working life.
The final area I wish to speak about is the voluntary sector. There are some outstanding high-performing and effective charities that help people to play their full part in the workforce—people who, in their educational experience, for one reason or another have not achieved anything like their full potential. Social justice must be our mantra and here is a way to demonstrate it. The opportunity for these organisations to work in the true spirit of both economic and social partnerships should know no bounds. In nearly all our debates, we talk about money and the lack of it, but we have not had too many where we talk about how we could increase it. However, I am absolutely clear that, if government, business and this sector worked together in a true spirit of partnership, innovation in generating more income through social impact bonds could really help our society. I commend to the House the great work of Big Society Capital, Social Finance, Bridges Ventures and the great work of Mark Fisher and his team at the Centre for Social Impact Bonds. Can we please invest more time in overcoming the barriers to success?
I recently attended a briefing given by a professor who worked on the team that landed a satellite on a comet. I sometimes feel that meeting the challenges we have heard about in this debate will be like landing a satellite on a comet. When the team landed the satellite on the comet, it was on the wrong side and the solar panels could not generate the power that was needed to do all their experiments. However, instead of moaning and falling out with each other, the people involved got together. They were going to have something like seven days to do their experiments; they ended up with about 24 hours. However, the seven countries involved all took less time to do their experiments, they all collaborated in a collegiate fashion and they obtained the information they need. Let us hope that spirit drives our country forward.
My Lords, this has been a fascinating debate with powerful contributions from many noble Lords. It was admirably kicked off by the passionate speech from the noble Baroness, Lady Sherlock, on poverty, public services and a fair welfare state.
Noble Lords have heard from 10 of my colleagues on these Benches whose speeches have ranged far and wide. My noble friend Lord Storey absolutely demolished the Government’s claims that they are protecting school budgets in real terms. My noble friend Lord Kirkwood talked about the importance of exploiting the talents of the whole of the UK. I hope he is right that we are becoming a kinder country. My noble friends Lady Bonham-Carter and Lord Clement-Jones talked about the creative industries and the importance of starting in schools. I often think of your Lordships’ House as being a bit like a school. However, it is clear to me that we in this place understand the importance of arts and culture because we have created so many APPGs on those subjects to enrich our own lives, not least of which, of course, is the famous parliament choir, which reaches its 17th birthday this year. So why should we deprive children of that enrichment?
My noble friend Lord Lee talked about tourism and the important contribution that it can make in helping young offenders. My noble friend Lady Benjamin talked about school gardening. As a keen gardener and somebody who established a school garden herself 40 years ago, I could not agree with her more.
My noble friend Lady Jolly talked about the effect of recent judgments on charities and about defence. My noble friend Lord Rennard asked for a new smoking strategy. My noble friend Lady Brinton talked about social care, and my noble friend Lord Addington spoke about disabilities. I was very interested in all those valuable contributions.
I shall focus my remarks today on an issue that is usually top of the list with voters in a general election. In the last election, health and social care started off as second in line to Brexit, but concerns about Tory social care policy quickly became the turning point. As it happens, I had managed to talk my way in among the Tory faithful when Theresa May did her notorious U-turn in our village hall about 100 yards from my house, so I heard first hand the announcement of the U-turn on a cap on social care payments and the vigorous denial that it was anything of the sort. As it happens, I heard Jeremy Hunt, only four days earlier at the Alzheimer’s Society conference, firmly denying the need for a cap. It was indeed a U-turn and a wobbly Monday for Mrs May.
Other measures, such as including the value of the patient’s home when they apply for help with domiciliary care costs, would put the incentive in exactly the wrong place and discriminate against dementia patients, who often need long-term care. Dementia is a disease. So is heart disease, but you do not have to sell your home for that. I call on the Minister to ensure that the Green Paper announced in the gracious Speech addresses the incentives as well as the funding and quality of the provision of social care.
It amazes me that a Government can publish a gracious Speech with so little about a public service that is in multiple crises. There is a crisis of public confidence, illustrated by a recent BMA survey that showed that for the first time more people were dissatisfied with the NHS than were satisfied with it. There is also a staffing crisis, with vacancies reaching record numbers, despite the Government’s recruitment of more doctors and nurses. A recent BMA survey found that around two-thirds of hospital doctors have experienced rota gaps in the past 12 months and that 48% of GPs reported vacancies in their practices. Clearly, with rising demand, what the Government are doing is not enough.
Your Lordships’ Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care, mentioned by the noble Lords, Lord Ribeiro and Lord Warner, among others, was very critical of the limited powers of Health Education England and the lack of leadership in the Department of Health, resulting in poor planning to provide the workforce needed to keep patients safe in the long term. The committee referred to,
“the absence of any comprehensive national long-term strategy”.
It recommended that Health Education England’s powers be substantially strengthened and criticised cuts to its funding. This is not just a matter of clinical staff. Denmark has three times as many trained radiologists per head as the UK. Such technicians are needed for cancer diagnosis and treatment and are just one example of where we fall behind other developed countries.
The NHS has always relied on international doctors to fill gaps in the medical workforce. Over the next five years, the general population is expected to rise by 3%, while the number of patients aged over 65 is expected to rise by 12% and those aged over 85 by 18%. Given that the medical needs of these patients will grow ever more complex, the demand for doctors and nurses from overseas will continue. Following our withdrawal from the EU, any future immigration system must be flexible enough to allow EU staff to fill the gaps in the health and care services, as well as in university and research sectors and in public health. So will the Government make special arrangements for the health and care workers whom we so badly need?
The Government have announced legislation for an independent health service safety investigation board, but will the Minister accept that the greatest danger to patients is a shortage of properly trained staff with high morale? Until the pay cap of 1% per year for public sector workers is removed and the service is properly funded, the results of investigations by the new body will be a foregone conclusion.
There is also a financial crisis in health and social care. The Public Accounts Committee report on financial sustainability showed that the financial performance of NHS bodies had “worsened considerably”. NHS trusts’ deficits reached £2.5 billion in 2015-16. Two-thirds of trusts were in deficit that year, up from 44% the previous year. Some 40% of mental health trusts saw their budgets actually cut. No wonder the Select Committee concluded that health and social care are underfunded and require a stable and predictable fix, not the short-term sticking plaster referred to by the noble Baroness, Lady Pitkeathley.
I see no attempt to address this in the gracious Speech. Instead, the Government’s response is the capped expenditure process, which is not transparent and in some places risks patients’ lives. I have read that cancer surgery has been cancelled in order for one trust to stay within its financial targets. In another place, £900,000 for mental health was diverted to other services in order to stay within financial targets. This makes a mockery of the commitment in the gracious Speech to ensure parity of esteem for mental health. While there is a need for the NHS to get a financial grip, there is a danger to patients if cuts are arbitrary.
There is also a mental health crisis, despite the marvellous work of my colleague in the other House, Norman Lamb. Last year it was revealed that there had been a 47% increase in detentions under the Mental Health Act compared with 10 years ago. In response, as the noble Baroness, Lady Sherlock, mentioned, the Prime Minister promised to rip up the 1983 Act and introduce new law. However, the gracious Speech instead committed to a review of existing legislation. Actually, I think that that is just as well, as many in the sector call for the Government to exercise caution. The noble Baroness, Lady Browning, was right to ask for pre-legislative scrutiny. The Royal College of Psychiatrists warns against the assumption that the rise in detentions is caused by flaws in the law. Instead, it blames lack of early intervention and of community services. I join the right reverend Prelate the Bishop of Peterborough in asking the Government to ensure that the funding for mental health services reaches them and is not diverted to other services. Timely access to preventive care, a whole-system approach and sufficient funding will do more than any legislative change ever could.
We also need more skilled staff. There has been a 10% drop in trainees for psychiatric specialisms since 2014. Some 41% of trainee psychiatrists come from abroad—the highest proportion of all the medical specialties—and that would be impacted by the £2,000 international skills charge which the Government intend to impose. If the Government are serious about mental health, they should scrap that tomorrow.
In some places, there is also a crisis of standards, according to the CQC, and there is certainly a crisis of health inequality between rich and poor. If you look at all these crises, you have to conclude that there has never been a better time for a cross-party health and care commission, as proposed by Norman Lamb MP, to engage with all interested parties to find sustainable solutions. He has already taken a cross-party initiative supported by nearly 20 MPs from other parties, and I understand that a further initiative is imminent. When opposing parties are able to agree on something like this, surely Governments should act.
Another important proposal from the Select Committee was about public health. It criticised the cuts as being short-sighted. I agreed with it when it said that prevention of preventable disease is the only hope for the NHS, but it accepted that with patient rights come patient responsibilities. But people need help and services in order to look after their own health. I did not expect legislation for this in the Speech but there is a role for health education; cultural, arts and sports facilities; food labelling; and drug, alcohol and smoking cessation services; and these need to be encouraged, not cut, during this two-year Parliament.
I was about to ask for the Secretary of State for Health to reverse the injustice of not providing abortions for women from Northern Ireland on the National Health Service. I was pleased to learn during the course of this debate in your Lordships’ House that the announcement has been made that this will be done. However, I regret that it took the threat of a defeat in another place for the Government to see that they need to do the right thing.
Finally, the Government’s hard Brexit approach cost them the big majority they were seeking. A Brexit that protects the economy is vital for funding the public services we have been debating today. However, the Government’s approach reminds me of “The Wizard of Oz”. Dorothy is happily skipping along the yellow brick road along with her three friends. I will leave your Lordships to decide which one has no heart, which has no brain, and which is the scarecrow. However, off they go, expecting to find a great wizard behind the curtain at the end of the road. But instead of a little man with a megaphone, as in the film, they will find 27 well-prepared EU officials, determined that the UK will not get as good a deal as we have now. How will the Government deal with this while protecting our public services?
My Lords, as we have covered so many subjects, I remind noble Lords of my interests in the register, specifically as a self-employed consultant, president of GS1 and trustee of the Royal College of Ophthalmologists—and my wife is a consultant with the Education and Training Foundation.
We come to an end of a spirited, five-day debate on this Government’s rather threadbare legislative programme. The Brexit election has been followed by the Brexit Queen’s Speech, which, despite the Government’s loss of majority and authority, still, unbelievably, focuses on a crude and unrealisable determination to cut immigration, whatever the consequences to our economy, jobs and public services. Of course, Brexit is hugely important. However, as my noble friend Lord Whitty said, and anyone who campaigned in the recent election will know, many of the matters that really concern the public are to do with the subjects that we have debated this afternoon.
What is so disappointing is the Government’s response to that election. Although they have dropped some of their more contentious proposals, they have not signalled an end to austerity, nor shown any recognition that our young people, schools, hospitals and older people need urgent support. There is no answer whatever to the noble Earl, Lord Kinnoull, noble friend Lord McKenzie and others, who spoke about the need to improve social mobility.
I turn first to education. The Minister promised more money for education. However, the IFS has confirmed that the supposed extra money this will amount to will still leave schools with a cut in per-pupil spending of around 7% between 2016 and 2022. The Education Select Committee has been abundantly clear what this means: larger class sizes and more reliance on unqualified teachers. That is why parents are so concerned.
The Secretary of State for Education has told us that no school will lose out. But she has not said where the money will come from, given the free school meals debacle. I hope it will not come from technical further education, because the one risk of putting that back into the Department for Education is that it has always been targeted within that department as an area regarded as softer than other areas of education expenditure. Given the fall in further education budgets between 2010 and 2015 of 14% in real terms, this is a legitimate concern. The ambitious target for apprenticeships, with which we all agree, is also a concern; my noble friends Lady Cohen and Lord Young made this point. The risk is that the Government will simply go for the numbers at the expense of high-quality apprenticeships. I hope the Minister can respond on this point.
On grammar schools, it would be good if the Minister would confirm that plans to return to the wretched 11-plus and the reinstatement of secondary modern schools are at an end. Will he also reject back-door proposals through the ability of existing grammar schools to open satellite campuses or annexes miles from their original site, as happened in Kent? Will the Minister put an end to that?
I also want to ask the Ministers about exam results this summer. Ofqual has said that schools should expect more variability in exam results this year. What on earth are parents and children to make of that? The fear is that they have become guinea-pigs on the altar of the ideological experiment to satisfy the bizarre notions of Mr Gove when he was Secretary of State.
I also hope that the Minister will respond to my noble friend Lady Lawrence about the value of overseas students to our universities. When, oh when, will we take student numbers out of the migration statistics? It is causing huge concern in our university sector.
I turn to welfare. What is the Government’s policy on the triple lock? The new Work and Pensions Secretary said this week that it is unlikely to last in the long term. I think that Parliament is entitled to some response from the Government on this. My noble friend pointed out their silence on many other aspects of social services. There is nothing to address the falling value of benefits and tax credits, nothing to restore work allowances in universal credit—which, of course, were put in to make work pay—nothing for WASPI women who find themselves in unexpected financial circumstances after a lifetime of work, and nothing for the noble Earl, Lord Listowel, who spoke so movingly about young people caught in the trap of getting a job and then finding they lose their housing benefit. It is a scandal. Let us hope that the Government have an answer to it.
I turn to health. I do not always agree with the BMA. I certainly have not always done so in the past, but I thought that their chairman, Dr Mark Porter, put it well this week when he said that the NHS was at breaking point. Talk to anyone who knows anything about the health service and they will agree. My noble friend Lord Pendry talked about the situation in the north-west. But Ministers seem to be in total denial. Waiting times increase, staff shortages grow, CCGs ration ever more vital services, yet Ministers carry on as if nothing is happening and it is not their responsibility. They have not met their targets for month after month after month. When is the 18-week elective care target to be met, or the 95% four-hour A&E department target? Do those targets stand? The chief executive of the NHS has said on a number of occasions that he does not expect them to be met. What should we understand the Government’s policy to be?
I want to ask the Minister about the internal document of
On mental health, will the new draft Bill be subject to pre-legislative scrutiny? I took through the Mental Health Act 2007 after pre-legislative scrutiny—I shared a little of it with the noble Lord, Lord Warner, who did the Second Reading speech with great eloquence and then quickly disappeared stage left. That legislation gained enormously from pre-legislative scrutiny. I urge the Government to consider the merits of putting a draft Bill into pre-legislative scrutiny. It will certainly ensure the passage of the eventual Bill will go more smoothly, and will certainly be more informed.
The other point to make on mental health was made by the right reverend Prelate the Bishop of Peterborough. It is that over the past few years, Ministers have made very welcome statements about the priority that mental health is to be given. We do not dispute any of that, but it does not happen. We know that clinical commissioning groups are cutting mental health budgets. In the end, Ministers have to take responsibility. They cannot simply say that they have made these edicts and CCGs have been told to do it, and then we have a situation where clearly CCGs cannot do it because they do not have the money, they have conflicting priorities and they are left in an impossible situation. So any further statement by Ministers on mental health will be treated with a touch of scepticism in your Lordships’ House until we get to the point where we see the additional money ring-fenced and guaranteed to be spent on mental health.
My noble friend Lady Donaghy and others talked about the importance of public servants. That applies as much to the defence forces and the police as other public services. NHS pay has been held down for a long time—frozen in 2011-12 and subject to a 1% cap. Why should public-sector workers be treated so badly? Is this not a key reason for current recruitment difficulties? Downing Street yesterday morning briefed that the pay cap was coming to an end, but this coherent Government then similarly briefed in the afternoon that it was not. What is happening to the pay cap and when will the Government realise that they cannot artificially hold down the pay of public sector workers year after year?
A number of very important points have been made about public health, which I endorse. On social care, we have the immediate issue of funding. We need extra funding now. On the dementia tax, I ask the Minister this. The Government, with their Lib Dem colleagues in coalition, set up the Dilnot commission. They accepted recommendations. They then legislated; we spent months in your Lordships’ House legislating for Dilnot. They even said what the cap would be— it was higher than Dilnot at £72,000, but it was accepted as a reasonable response. Even when they then delayed its implementation, they said it would be implemented in 2020. The question remains of why the Government ran away from the Dilnot commission. Why are we having a consultation? What is there to consult about?
The one thing I say to the Minister is this: he will talk about the need for consensus, but he should look back to 2010, to just before the election, when Andy Burnham put forward proposals on a consensual basis for funding long-term care, and Cameron and Osborne and the rest of the crew attacked it as a death tax. He will find that his Government have no credibility in this area. Frankly, any old person who is concerned for the future has everything to fear from this Government’s approach.
I want to finish on culture. I very much warmed to the speech of the noble Lord, Lord Grade. I am sure the Minister would cause great joy in God’s own city of Birmingham if he were to announce this afternoon that Channel 4 is coming—it is the logical place, and I expect the Government to insist that Channel 4 moves out. Given the loss of broadcasting facilities in our city when compared to the great days of ATV, if I may say so, Birmingham is the right place, and I hope that will happen.
We welcome the data protection Bill, and there will be much discussion on it. However, I end by coming back to the point that I link education to creativity. A number of very important points have been made about our concern that, in many schools, creativity has been sacrificed on the altar of what is now an obsession with exam results. Like my noble friend Lady McIntosh, I was hugely impressed by the sensible comments made recently by the Chief Inspector of Schools. She made it clear that, in her view, the obsession with schools chasing exams at the expense of other activities that would give young people a rounded education has to stop. I hope that the Minister will say that the Government accept that view and support the chief inspector in more rounded inspections to ensure that children get a much wider education, in which these cultural issues are given huge importance.
This has been an excellent debate. We look forward to the response from the Minister, but I hope that over the next year or two, or for as long as this rather chaotic Government carry on in a half-light existence, we will get to debate more of these very crucial subjects.
My Lords, in the spirit in which the noble Lord, Lord Hunt, started his speech, I, too, make declarations, not only of my position as a trustee of academy trust Floreat Education, which I set up, but, given that he has brought his family into it, that my wife is also a journalist. I think it is probably worth saying that.
I sincerely thank all noble Lords for this thought-provoking and wide-ranging debate. When I got my marching orders from the Leader’s Office, I thought that, compared with my noble friend Lord Ashton, who opened so expertly, I had perhaps pulled the short straw. But the opportunity to reflect on the wise and incisive comments made by noble Lords has been a privilege, and I am grateful for it.
I am particularly grateful for the speeches from the Front Bench from the noble Baronesses, Lady Sherlock and Lady Walmsley, and the noble Lords, Lord Hunt and Lord Storey, for their as ever searching questions. I also wanted to highlight what I felt were some of the more uplifting speeches. The right reverend Prelate the Bishop of Ely talked about how we could live well with difference and create a society that supports common flourishing. My noble friend Lady Stowell talked about the importance of behaving with dignity and respect for one another. I join the noble Baroness, Lady Masham, in paying tribute to the emergency services. My noble friend Lady Cumberlege mentioned a phrase that stuck with me: “treat me kindly”. The right reverend Prelate the Bishop of Gloucester talked about providing hope for the most vulnerable, and the noble Earl, Lord Listowel, about encouraging exchanges between young people. The noble Baroness, Lady Benjamin, in her fantastic way, gave a wonderful and optimistic exposition of the preciousness of childhood. My noble friend Lord Grade talked about bipartisanship —there is a thing—in praise of Gordon Brown. I may move off that slightly.
Before turning to noble Lords’ specific comments and questions, I would like to reflect on some of the measures in this Queen’s Speech. Some noble Lords have criticised the legislative agenda set before Parliament last week. I believe that that criticism is misguided. This Government are delivering on the British people’s desire to leave the European Union—a desire echoed in the recent general election when more than 80% of votes cast were for parties that supported leaving the European Union—and we wish to do so on good terms. The only magic trick at work here, the only illusion, is the attempt by the Liberal Democrats to pretend otherwise. This has rightly been described as the greatest peacetime challenge ever faced by any Government. Unambitious it ain’t.
Yet beyond that, the Queen’s Speech demonstrates the Government's commitment to broader social reform, and the business of government very much goes on. In the areas that we are discussing today, it includes enhancing our efforts to make the NHS the safest health system in the world, helping people to make more informed financial decisions, correcting 70 years of policy failure to deliver a high-quality system of technical education, improving the quality and safety of our digital economy, and challenging the culture of indifference that ranks mental health below physical health. This is an agenda that will deliver a strong and safe society in which everyone should have the chance to thrive. It is one of which any Government can be proud, and this Front Bench is delighted to be playing its part in delivering it.
The actions outlined in Her Majesty’s most gracious Speech build on a record of success, despite the gloomy prospectuses of so many noble Lords in this debate. I mention in passing that the ONS started collecting self-reported happiness measures in 2012 and, despite the tone of the debate, believe it or not they have never been higher. The ONS only started collecting them in 2012, so in the halcyon days of Tony Blair no doubt they were much higher. However, I believe that the word “crisis” has been used far too liberally. I gently chastise the noble Lord, Lord Pendry, for politicising the NHS in the way he did. The BMA was against the founding of the NHS some time ago, but things change, and the Conservative Party is deeply supportive, as supportive as any political party in this country, of what my noble friend Lord Lawson once described as the closest thing we have to a religion.
We recognise the pressures that our public servants are under, and I would not want to be involved in running down their achievements over the past seven years. We have 1.8 million more children in good and outstanding schools, the best ever health outcomes, low crime rates, record employment, the closing of the gender pay gap, and reductions in income inequality so that they are the lowest since 1984. These have been possible because of the sound economic management of this Government and their willingness to take decisions to restore public finances to order. These decisions have enabled record investment in schools and hospitals despite the need to reduce borrowing.
The Government recognise absolutely the impact these actions have had on public servants’ pay, and I agree with the noble Lord, Lord Storey, that they are our greatest asset. I also know that this period has been difficult for people in both the public and private sectors. That is all the more reason to finish the job so that we can deliver the pay increases that staff want. The alternative, set out in the Labour manifesto is, if I may say so, to promise free things for everyone. But nothing is free. It all has to be paid for by someone, so the question is: by whom? Either, as the Institute for Fiscal Studies has pointed out, by ordinary taxpayers, not just the rich because there is not enough there to soak, or through more borrowing and more debt, loading yet more costs on to future generations.
I do not believe that it is fair to ask the young to continue to support older generations, which is what is happening now. The noble Lord, Lord Whitty, laments the end of the benefits that his generation enjoyed, such as pensions, secure jobs and so on, but I wonder whether he has reflected on the fact that the reason young people do not have access to these things may be at least in part because of the choices made by his generation. Perhaps, as my noble friend Lady Browning hinted, the baby boomers might consider footing the bill to improve conditions for the young. We had some ideas for that in our manifesto. That might satisfy the desire for more taxes, which appears to have been picked up in the British Social Attitudes survey, as the noble Lords, Lord Kirkwood and Lord Warner, pointed out.
I shall move on to education and start where the noble Lord, Lord Hunt, finished: on the purpose of education, if you like—the philosophical element. I agree with him that the purpose of education is to provide a broad, rich and rounded education. At Floreat Education, we use a quote from Martin Luther King, who said:
“Intelligence plus character—that is the goal of true education”.
It is the development of that wider human flourishing that I think we are all seeking. That absolutely includes gardening, as the noble Baroness, Lady Benjamin, pointed out. Indeed, I do not know whether she noticed, but one of her colleagues, the noble Lord, Lord Wallace of Saltaire, is a chief grandparent at Floreat Wandsworth school and has been deeply involved in planting the new garden that has opened there in the past year, so I am a deep believer in it. Indeed, the Government’s purpose is to provide more good school places that are open to any pupil.
I turn now to school funding. We know that the current funding arrangements in England are unfair. That is why we have recently consulted on the national funding formula for schools and we will work with Parliament to bring forward proposals. The core schools budget, which the noble Baroness, Lady Sherlock, and the noble Lord, Lord Storey, referred to, has been protected in real terms since 2010 and is set to rise to £42 billion by 2019-20, albeit with increasing pupil numbers. Teacher numbers have also increased in recent years. There are more than 450,000 teachers in state-funded schools, which is up by 15,000 since 2010.
A great deal of concern has been voiced in the debate about the EBacc and arts education. I agree that every child should experience a high-quality arts and cultural education. Since the EBacc was announced, and bearing in mind that the point of the EBacc is to provide the foundation of a rich and robust academic education for every child, the proportion of state-funded pupils taking at least one arts subject increased from 45.8% in 2011 to 48% in 2016. Noble Lords may be wondering how that squares with some of the facts, but it is quite possible that each pupil is taking fewer subjects but more are taking subjects, meaning that more students are actually getting the balanced education that we want to see.
The right reverend Prelate the Bishop of Ely talked about the importance of character education. I am delighted to say that he has visited one of my schools, and that we continue to invest in that element. I can also reassure him that religious education is compulsory at all key stages and that entries into the RE GCSE full course have been rising each year since 2009.
On apprenticeships, raised by the noble Lord, Lord Aberdare, and the noble Baroness, Lady Bonham-Carter, we believe in the importance of apprenticeships in delivering skills. That is why the £2 billion raised by the apprenticeship levy is being invested. That is being designed by business; it is about having something that fits the needs of businesses.
As we set out in the manifesto, we want to look at the funding of further, technical and higher education to ensure that there is parity of esteem and the right approach so that we have the skills we need. As my noble friends Lady Stowell and Lady Stedman-Scott pointed out, it is vital that we value not just people who have been through the university route. That lies at the heart of our proposals to provide an extra £0.5 billion a year for technical education.
I should take this opportunity to respond to points made by the noble Baronesses, Lady Lawrence and Lady Cohen, about international students. We absolutely value the significant contribution that they make to our universities and our society. The UK remains the second most popular destination globally for international HE students. Our purpose as we leave the European Union is to gain control of, not to end, immigration. It becomes much easier to defend immigration to those concerned about it if there is a sense that the Government are in control.
Several noble Lords, including my noble friends Lady Stowell and Lady Stedman-Scott and the noble Lord, Lord Aberdare, talked about careers advice. The Careers & Enterprise Company is promoting careers education. As the noble Earl, Lord Kinnoull, pointed out, that is a vital part of social mobility. I welcome his committee’s report, which is influencing the way government thinks. However, as my noble friend Lady Stowell pointed out, we need to tread slightly carefully with social mobility. There is a version of social mobility that says simply that the most important thing is to get out of your community, but, as she said, we should provide the ability to succeed in your community; you should not need to leave where you come from to be considered a success.
The right reverend Prelate the Bishop of Gloucester, the noble Earl, Lord Listowel, and the noble Lord, Lord Addington, talked about vulnerable young people with learning difficulties. I can reassure them all that this is still very much a priority for the Government. I share their sadness that Edward Timpson lost his seat. We all acknowledge that he was an excellent Minister who was a truly passionate proponent of the issues relating to such children. I deeply hope he will be back; I am sure that he will be working hard on those issues in some other guise in the meantime.
The noble Lord, Lord Clement-Jones, asked about the data protection Bill and the digital charter, and about responding to and being guided by the reports from the Royal Society and the British Academy. We welcome those reports, which will be a useful contribution to the Government’s work across this agenda. We are looking at measures to share data in a way that is safe but brings benefits to citizens. HMRC holds a lot of data which are highly sensitive. The Digital Economy Act, taken through this House by my noble friend Lord Ashton, allows those data to be used subject to rigorous safeguards. We will bring those powers into force shortly.
The noble Baroness, Lady Sherlock, asked about protection for people using social media. As I have said before, as a parent of young children who are on the brink of getting into that world, what is possible frankly terrifies me. However, I think the manifesto— which, as we know, had some strengths and weaknesses—was commendably robust on those issues. We will bring forward an internet safety strategy to try to make the UK the safest place in the world to be online.
As for Channel 4 moving out of London, I can see that this could become a bun fight between different corners of the country. I do not want to weigh into that and suggest any kind of preference—I was born in Maidenhead, the Prime Minister’s constituency, so there might be a chance.
It is our intention that Channel 4 should move out of London to provide that stimulation to regional creative industries.
The noble Baroness, Lady Bonham-Carter, asked whether we would set up a licence fee committee. I shall have to disappoint her on that front.
There were a number of questions about the impact of Brexit on the creative and digital industries. This is an area where we can talk ourselves into a very negative position. As I stated at the beginning, the Government’s desire is to have a close and deep partnership with the European Union. The mood music we are picking up in Europe from industries—I know it is true in my own area of pharmaceuticals—is that there is that strong desire from the other side as well. It is about reaching for a strong and integrated partnership and not being tempted down a different route. The creative industries are clearly an absolute mainstay of the UK economy and a flagship pillar of the industrial strategy—I can reassure noble Lords that they are very much in our thoughts as the negotiations to leave the European Union go forward.
I have touched on immigration. The noble Lord, Lord Young, asked about cybersecurity. We are obviously under attack all the time in terms of cybersecurity. The Government have done a great deal in this area. There was a particular effect in the health service, as we know, back in May. There are new standards coming, through the Caldicott review for healthcare, which we will publish our response to in due course. The Government take this very seriously and have invested heavily in it.
The noble Lord, Lord Lee of Trafford, asked about tourism, another vital part of our economy which will remain vital.
Moving on to work and pensions, first, I thank the noble Lords, Lord Kirkwood and Lord McKenzie of Luton, for their support for the Financial Guidance and Claims Bill. It will make a big difference to people’s ability to make more effective financial decisions and to deal more competently with financial services.
The noble Baroness, Lady Sherlock, asked about this Government’s commitment to the welfare state. I can tell her that our commitment is as deep and as strong as ever. We believe that there should be a strong welfare state, consisting not only of the social security system but of pensions, care, health and education, committed to helping everyone, with extra help for those who need it. Part of the reforms to the welfare state, to make it fit for purpose, involves universal credit. I believe it is a simplifying rather than a complicating of the system. It has clearly been introduced carefully to make sure that it works, as is right. The current system does not make sure that work pays in every instance, but that is something that universal credit does.
The noble Lord, Lord McKenzie, asked specifically about Grenfell Tower and the passage in the speech of my noble friend Lord Ashton of Hyde. I can confirm that no one will be worse off as a result of rehousing because of the fire at Grenfell Tower if they move into larger accommodation. I think that that provides the reassurance that the noble Lord was after.
Disability issues were raised by a number of noble Lords, including my noble friend Lord Shinkwin. I think we were all very moved and rather shocked to hear of the treatment he had received. I know I was when I read about it and then spoke to him about it. The Minister for Disabled People is taking an active interest in this and I know that my noble friend is talking to her. Improving the lives of disabled people is a core part of this Government’s approach. We had a Green Paper in October last year and a consultation was launched in February. Responses are being considered before we move ahead. The noble Lord, Lord Addington, talked about disability employment advisers and disability recruitment. There is not yet perhaps the coverage he would like, but there are nearly 500 employment advisers across the country and those numbers have been increasing. We will aim to get a million more people with disabilities into employment over the next 10 years. I think the Government have a very good record on that.
Finally, on health, the fundamental question that has been raised by the noble Baroness, Lady Masham, the noble Lords, Lord Warner and Lord Pendry, and others is the sustainability of the NHS. It has been working hard to manage its finances in a challenging period and yet, of course, it has been experiencing real-terms increases as well. Although I do not for a minute underestimate the challenges that it faces, with a growing and ageing population, we are planning to spend £8 billion more in real terms over the next few years to improve it. As a result, there are more people going through treatments, more people being seen in A&E and the targets that the noble Lord, Lord Hunt, referred to are still very much part, as he knows, of the NHS five-year forward view. Clearly, one of the ways we can improve health outcomes is to prevent accidents in the first place, as the noble Lord, Lord Jordan, my noble friend Lord Ribeiro and the noble Baroness, Lady Donaghy, said. I utterly agree with them about the importance of good health and safety. Public Health England works with the Child Accident Prevention Trust on these issues and preventing accidental injuries is part of the public health outcomes framework.
The noble Lord, Lord Pendry, and my noble friend Lady Browning talked about dementia. Dementia Friends has been a core part of the Government’s strategy and we understand just how deeply loneliness can harm health outcomes and cause misery and pain in people’s lives. Addressing that is an important part of this approach.
That brings me on to social care. The noble Baroness, Lady Pitkeathley, encouraged us to be bold and honest. I think if you could say anything about the manifesto promise, it is that it was bold and honest. Nevertheless, the ageing population presents one of our most difficult and profound challenges. As noble Lords know, more money is going into social care to put it on a stable footing in the short term. The proposals on which we will consult will include a floor and a limit on the amount that people can be asked to pay. I hope that provides reassurance to those who asked whether there will be proposals or yet more open-ended questions.
As part of our strategy, we need to think about carers. They do an amazing job in often extremely difficult circumstances—particularly older people looking after a spouse or children caring for their parents. We are considering carefully how to help those people.
My noble friend Lady Cumberlege, the noble Baroness, Lady Masham, and the noble Lord, Lord Freyberg, asked about maternity care. I feel very deeply about this issue. My eldest daughter was born in quite difficult circumstances and had to be delivered by emergency c-section. It was, frankly, a terrifying time. I want to ensure that there is good maternal safety, so that we do not risk what in her case was a strep B infection that had almost got up the umbilical cord—she had a raging temperature within the womb and a heart rate of 150 beats per minute. Your Lordships can imagine what that was like for us all, and for my wife in particular. So I feel that point very deeply and we have a real commitment from the Secretary of State on this issue.
I congratulate my noble friend Lady Cumberlege on her national maternity review. We are taking forward many of the ideas that she is interested in promoting, such as the rapid resolution and redress scheme, backed with more funding so that we can have a safer, more personalised and kinder approach to maternity, and prevent some of the awful injuries and deaths that sadly happen in that environment.
One issue that affects maternity and other areas is when there are staff shortages. The number of midwives has increased over the past few years. We know that there is growing demand from a growing population and we want a workforce that is capable of dealing with the challenges ahead—even more so given the impact of not only Brexit but, as we were discussing the other day, the language tests. That is why we are increasing the number of staff in training and offering new routes into the profession, such as the nursing associate and nursing apprenticeship.
I will touch briefly on the payment of the national minimum wage for sleep-in shifts, which was raised by the noble Baronesses, Lady Jolly and Lady Brinton. Through the living wage we want to make sure that pay is fair in all sectors of social care—but I understand the problem with this issue. We are looking at it and I will come back to update both noble Baronesses on the particular concerns they raised in the debate today.
Regarding mental health, the Government have a better story to tell than perhaps we have been given credit for. There is much more money going in—and, yes, it is getting to the front line, as well as other commitments, including waiting time commitments on treatment. There is an issue to be discussed, at another time, about the extent to which we have ring-fencing and direction, because the whole way the NHS works is predicated on clinical autonomy. Just as with the operational autonomy of the police force, that autonomy is rather important. Of course there should be targets—or goals, if you like—and sometimes they will be in conflict with one another. Nevertheless, it needs to be for professionals to make that decision. We will bring forward the Green Paper on children’s and young people’s mental health that the noble Earl, Lord Listowel, hoped for. I can reassure him on that front.
My noble friend Lady Browning asked about people in prison. They should absolutely be getting the same level of care as those who are out of prison. Patient safety has been talked about, and is at the core of this Queen’s Speech. We have the draft patient safety Bill, and it is our intention, as the noble Lord, Lord Freyberg, and my noble friend Lord Ribeiro, said, to learn the lessons from other sectors such as aviation, to make sure that we have one of the safest healthcare systems in the word. We intend to publish the Bill in draft later this year, ahead of pre-legislative scrutiny within this two-year Parliament.
The noble Lord, Lord Rennard, asked about tobacco control. I am afraid I cannot give him a precise date for the plan, although I know he is itching for one. He will understand that there has been a reorganisation of Ministers in our department since the election, but our commitment to it remains.
My noble friend Lord Astor asked about Lyme disease. There is a public health pathway on this issue, but I realise the seriousness—the growing seriousness—of it, and will write to him on the further work that we are doing.
My noble friend Lord Bridgeman raised the issue of GP surgeries. General practice is changing: partnerships are merging into federations, and there are other things going on, but improving primary care is at the heart of the five-year forward view. The nature of practices will change over time, but I totally understand what he says about making sure we do not punish those who are most entrepreneurial.
I am sure that your Lordships will be delighted that I am about to bring my speech to a close. I have tried to be comprehensive, but we have also agreed on the importance of arts and culture for children, and I am due to take my children to see “The Wind in the Willows” tonight, so I will bring my comments to a close.
Discussions in this Chamber are not always conducted without rancour, and I am as guilty of that as others, but on reflection it is noticeable that the speeches I highlighted to begin with for their uplifting qualities came largely from either Baronesses or Bishops, despite their being in a minority in this House—that is probably a lesson for us male, temporal Lords.
In an attempt to reach the bar that they have set, I would like to close the debates on the humble Address by turning to an idea that has motivated me through my life, and which I know motivates every Member of this House, those in another place and millions of citizens throughout this country. We are here and we serve our country because we believe in Britain. We believe that it has a great past but an even better future, and that our country is at its best when it pulls together in pursuit of an ambitious and admirable goal.
We have seen that attitude at work in response to the tragic incidents of which we have suffered too many recently. These tragedies all hit home in various ways, whether because our Parliament was attacked or because we live with, know or work with people affected. I can see the burned-out remains of Grenfell Tower from a window at home. It is right next to the leisure centre where I take my children swimming—no doubt some of the children who swam in that pool have died. It is a black scar on London's landscape and a dreadful reminder of the importance of looking after one another more carefully than we sometimes do.
However, it should not need tragedy to pull us together. As Brendan Cox, the courageous husband of murdered MP Jo Cox reminds us with great dignity, we have more in common than that which separates us. The task for this Government, and indeed this House and Parliament, is to bring people together. We need to create more and new opportunities for common enterprise—joint endeavours that allow our people to achieve happiness for themselves, their families and their communities. If this is what motivates us all in the years ahead, then, despite the challenges, I believe that we can face the future with confidence.