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My Lords, the Queen’s Speech will deliver EU exit alongside an ambitious programme of domestic reform that delivers real change to the people of this country. It is my pleasure to update noble Lords on the Government’s plans for the next Session for the Department of Health and Social Care, the Department for Digital, Culture, Media and Sport, the Department for Work and Pensions and the Department for Education.
I turn first to the Department of Health and Social Care. In September, the Government announced the health infrastructure plan, the biggest and boldest hospital building programme in a generation. Six new hospital schemes will start immediately, and another 21 schemes have been given the green light to develop their plans. It was also announced in the Queen’s Speech that new laws will be taken forward to help implement the NHS long-term plan in England. The Government have already committed to a multi-year funding settlement that will see a £33.9 billion per annum increase in the NHS budget by 2023-24.
In September the NHS published a set of recommendations for legislation changes that would enable our health service to go faster and further in realising the ambitions set out in the long-term plan: to improve integration, reduce bureaucracy and promote collaboration. We are considering the recommendations made by the NHS thoroughly and we will bring forward detailed proposals shortly. In due course we will publish draft legislation that will accelerate the long-term plan for the NHS, transforming patient care and future-proofing our NHS.
Legislation will also be taken forward to establish the health service safety investigations body. This will be the world’s first such body, with powers to investigate incidents that occur during the provision of NHS services that have or may have implications for the safety of patients. Drawing on the approaches used in other safety-critical sectors, investigations by this new body will be independent and professionally led. This will transform the way that patient safety incidents in the NHS are investigated.
A medicines and medical devices Bill will capitalise on opportunities to ensure that our NHS and patients can have faster access to innovative medicines while supporting the growth of our domestic sector. The Bill will give powers to remove unnecessary bureaucracy for the lowest-risk clinical trials, encouraging the rapid introduction of new medicines, and it will ensure patient safety by implementing a scheme to combat counterfeit medicines entering supply chains and a registration scheme for online sellers. This will ensure that the UK remains at the forefront of the global life sciences industry after Brexit, giving patients faster access to innovative medicines and supporting the growth of our domestic sector.
We will also bring forward substantive proposals to fix the crisis in adult social care, giving people the dignity and security they deserve. Putting social care on a sustainable footing is one of the biggest long-term challenges facing society. The Government have given local authorities access to up to £3.9 billion more in dedicated funding for adult social care this year and made available a further £410 million for adults’ and children’s services. In the recent spending round, the Government announced that councils will be provided with access to an additional £1 billion next year for adults’ and children’s social care. The Government will consult on a 2% precept that will enable councils to access a further £500 million for adult social care. This funding will support local authorities to meet rising demand and will continue to stabilise the social care system.
We will continue to work to modernise and reform the Mental Health Act to ensure that people get the support they need and have a much greater say in their care. In 2017 we commissioned the independent review of the Mental Health Act to look at rising rates of detention, the disproportionate number of people from black and minority-ethnic groups detained under the Act and processes that are out of step with a modern mental health care system. The findings made it clear that we need to modernise the Mental Health Act to ensure that patients’ views are respected and that patients are not detained any more than is absolutely necessary. By the end of this year we will publish a White Paper setting out our response. This will pave the way for reform of the Mental Health Act and will tackle issues addressed by the review. We will ensure that people subject to the Act receive better care and have a much greater say in that care. Patient choice and autonomy will be improved—for example, by enabling patients to set out their preferences around care and treatment in advance. The process of detention, care and treatment while detained will be reformed, including by providing patients with the ability to challenge detention.
The Government also announced new legislation from the Department for Digital, Culture, Media and Sport. This includes new legislation that will help accelerate the delivery of fast, reliable and secure broadband networks to millions of homes. We will roll out gigabit-capable broadband across the UK to achieve nationwide coverage as soon as possible, so that people can reap the huge benefits of the fastest, most secure and most resilient internet connections. Faster speeds will boost productivity, drive innovation in our public services and give people the fast connectivity they need to reap the benefits of the digital revolution.
The legislation will create a cheaper, faster, light-touch tribunal process for telecoms companies to obtain interim code rights or access rights for a period of up to 18 months. This will mean that they can install broadband connections where the landlord has failed to respond to repeated requests for access. Amendments to the Building Act 1984 will require all new-build developments to have the infrastructure to support gigabit-capable connections. There will be a requirement for developers to work with broadband companies to install gigabit-capable connections in virtually all new-build developments, up to a cost cap. As well as this, the Government have recently pledged £5 billion to support the rollout of gigabit-capable broadband in the hardest-to-reach 20% of the country.
The Government also announced that Ministers will continue to develop proposals to improve internet safety. Britain is leading the world in developing a comprehensive regulatory regime to keep people safe online, protect children and other vulnerable users and ensure that there are no safe spaces for terrorists online. The Online Harms White Paper published in April set out the Government’s plan for world-leading legislation to make the UK the safest place in the world to be online.
The proposals as set out in the White Paper include a new duty of care on companies towards their users, with an independent regulator to oversee this framework. We want to keep people safe online but to do so in a proportionate way, ensuring that freedom of expression is upheld and promoted online and that businesses do not face undue burdens. We are seeking to do this by ensuring that companies have the right processes and systems in place to fulfil their obligations, rather than penalising them for individual instances of unacceptable content. A public consultation on this has closed and we are analysing the responses and considering the issues raised. We are working closely with a variety of stakeholders, including technology companies and civil society groups, to understand their views.
Turning to the Department for Education, we will ensure that all young people have access to excellent education, unlocking their full potential and preparing them for the world of work. We are giving schools a multibillion-pound boost, investing a total of £14 billion over three years, so that the annual core schools budget is £7.1 billion higher by 2022-23. The IFS has said that this investment will restore schools funding to previous levels in real terms per pupil, also by 2022-23. We will level up minimum per pupil funding for primary schools to £4,000 and for secondary schools to £5,000, while making sure per pupil funding for all schools can rise at least with inflation.
We are also spending around £3.5 billion on early education entitlements this year alone, and next year we are planning to spend more than £3.6 billion. Our focus in this area is on delivering positive results. A record proportion of children are starting year one with a good level of development. More than 1.4 million children are taking advantage of funded early education in 2019. Over 850,000 disadvantaged two year-olds have benefited from a 15 hours early education place since the programme began.
We also have a world-class university sector. We are home to nearly half of the top 10 universities in the world. Since 2012, total income for universities in England has increased by around £6 billion and we have frozen the maximum tuition fees rate and increased the threshold for repayments, now worth up to £425 a year for graduates.
Looking ahead, T-levels will represent a once-in-a-lifetime opportunity to reform technical education in this country, put it on a par with the best in the world and offer young people a real choice of high-quality training that is equal in esteem to traditional academic routes. We are on track for the first teaching of three T-levels in 2020; a further seven will be rolled out in 2021, and all 25 courses by 2023.
Finally, I would like to talk about the work the Government are doing on employment and pensions, in particular the Pensions Schemes Bill. The purpose of the Bill is to support pension saving in the 21st century and to help people plan for the future. It provides a framework for the establishment, operation and regulation of collective money purchase schemes, commonly known as collective defined contribution pensions. These schemes will provide more options for employers and offer members a target benefit level. The Bill will protect people’s savings for later life by strengthening the powers of the Pensions Regulator to tackle irresponsible management of private pension schemes. This will include introducing new criminal offences, with the most serious carrying a maximum sentence of seven years’ imprisonment and a civil penalty of up to £1 million. It will also create a legislative framework for the introduction of pensions dashboards. With record numbers of people saving for retirement, it is more important than ever that they can easily access information about their pensions. Pensions dashboards will mean that for the first time, people will be able to view online in one place all their pension information.
As the Prime Minister said last week, this is a programme that will set our country on a new upwards trajectory. At its heart is a new vision for Britain, a vision of a country happy and confident about its future, a vision of the country that we all love. The mission of this Government is nothing less than to make our country the greatest place on earth, the greatest place to live, work and do business, and this Queen’s Speech will set us firmly on that course.
My Lords, I thank the Minister for that introduction. She need not worry about repeating herself; I do that all too often—and I write my own speeches, so she has my sympathy. I am really looking forward to hearing speeches from around the House, but it is a disappointment that we will not get to hear the valedictory by the noble Baroness, Lady Emerton. I simply want to say for the record how much we on this side, especially my colleagues in the health team, have valued her contribution to the House, nursing education and the NHS more broadly. She will be greatly missed.
It feels slightly strange and unreal to be here discussing the details of Bills when out there, the Government only have eyes for Brexit. Indeed, the Prime Minister is champing at the bit to dissolve the Parliament which Her Majesty opened only last week with this gracious Speech. However, here we are, so we must do our job. The Minister has ably set out the Government’s vision for the future of Britain. As she said, the Prime Minister claims it is an ambitious programme which has at its heart a new vision for Britain and that the Government want to make the UK the greatest place to live, work and do business. This cannot be the greatest country to live in unless it is a great place for all our people to live in. We are interdependent, and the true flourishing of any of us depends on the flourishing of all of us, so my test of this speech and this programme is whether it can deliver on that vision.
The welfare state embodies a vision of Britain as a country where we take care of each other. We all pay into it and for it, because we all need it at some point. Some will need it more, but we do not know who that is going to be or whether it might be us. It supports those raising the next generation. It helps all of us at key life stages or in times of need—in pregnancy, sickness, unemployment or bereavement. It gives extra help to those who need it most: those with long-term illnesses or disabilities, or who care for others. It helps make work pay, and it supports us all in retirement. However, our system is increasingly losing its way. The past decade has seen massive cuts to benefits, damaging reforms, especially of disability benefits, and the awfulness that is universal credit. It has seen the demonisation of claimants and an explosion in benefit sanctions, often for the most minor infractions, which have combined to drive people into poverty and to take away their dignity. More and more people are struggling to make ends meet, dependent on food banks or even sending their kids to school hungry.
What, then, does the Queen’s Speech have to say about that situation? As we heard, there is one DWP Bill, the Pension Schemes Bill. We are in broad agreement with the stated aims of the Bill and we will crawl over the detail. My noble friends Lord McKenzie of Luton and Lady Drake will speak more about pensions later, but that is it: there is nothing on social security and the word “poverty” is mentioned nowhere, even though 14 million of our citizens—4 million of them children—are living in poverty. In-work poverty is on the rise and most poor children now live in working households.
What did Ministers think was going to happen when they set out to cut £37 billion from our social security system? The benefit freeze alone will have taken £4.4 billion from our poorest families by the time it ends next year. I was horrified recently to hear the Secretary of State for Work and Pensions refuse to rule out extending the freeze still further. To do that would be to deliberately and knowingly drive more people into poverty and deeper poverty, so I hope the Minister can reassure us that that will not happen. I trust that she will not say that that is a matter for the Budget, because while Ministers have been quite happy to trail tax cuts—there is always money for tax cuts—it is strange that there is never as much money when it comes to benefits for the poorest.
Labour has committed to a £3 billion programme to reverse the worst of the cuts, including the disgraceful two-child limit, and to begin to unpick the disasters of universal credit. A Labour Government would seek to change the culture and create a system dedicated to dignity, universalism and ending poverty. That is our vision of a country where everyone can flourish. Will the Minister tell us what the Government’s vision is?
Our welfare state pools risk across our population and across lifetimes. It is the companion service to the NHS, which also works on the basis that we pool our risk because any of us can get sick. It is because of that underlying vision that the NHS is more than just a public service: it embodies how we as a nation see ourselves as an interdependent community. I am sorry to say, however, that our NHS is struggling and there was not much comfort in the Queen’s Speech. Most of the funding announcements had previously been announced and most of the proposals—for example, for a long-term plan, reforming the Mental Health Act and addressing social care—are very much in the future. Right now, across the NHS, services are missing financial and performance targets. People are waiting ever longer for treatment and a shortage of staff threatens the quality of patient care. Where is the urgent concrete action to deal with these problems?
Meanwhile, social care is in crisis: adult social care is badly failing those who rely on it, with high levels of unmet need and providers struggling to deliver the quality of care that vulnerable people need and have a right to expect. However, the funding announcement on social care had previously been announced and £500 million has to be raised by councils themselves, even though those in the industry had made it clear that that was, in their words, a “short-term sticking plaster”. Without more funding or a detailed plan as to how we get there, older and disabled people will continue to be left without the care they need, and carers will increasingly buckle under the strain.
Labour has set out its vision for a national care service, but we do not know what the Government’s vision is. The Prime Minister promised us that he had a plan to fix the crisis once and for all, but I see no plan, just endless consultation. One has to assume that the ever-delayed Green Paper has perhaps finally bitten the dust. If so, we are left with no proposals and no legislative timetable for a social care Bill in this Parliament. I hope the Minister can contradict me because, if not, that simply is not good enough.
Mental Health was too often addressed in similarly broad terms. It is now almost a year since the independent review of the Mental Health Act was published, but we still do not have a White Paper. Ministers announced a mental health Bill in December 2018 but we still do not have one. There are urgent problems: mental health beds are closing; the mental health estate is crumbling; the CQC has recently reported chronic staff shortages and deteriorating services; children and young people are waiting more than a year for mental health services and many have been turned away because they were not yet bad enough. Can the Minister tell us when will we see some action? My noble friend Lady Wheeler will say more about social care in her contribution.
I am afraid that that pattern of revisiting old promises with slightly vague offers of new ones permeates the Queen’s Speech. In education, again, we are short on commitments to new legislation or policy. Even previous ministerial commitments that need legislation have not made their way into the Queen’s Speech. For example, Ministers said they would introduce a schools’ level-funding formula “as soon as possible” but where is it?
Only a few weeks ago the Secretary of State said that he would,
“put the school uniform guidance on a statutory footing”, and will do so when a suitable opportunity arises. School uniform costs are rocketing and something is needed, but where is the legislation? Where is the guidance? Furthermore, despite specifically consulting on primary legislation to regulate home education, there is no sign of it in the Queen’s Speech. Can the Minister tell us why and when it will be brought forward? My noble friend Lord Watson of Invergowrie will talk more about education across the spread in his contribution.
The DCMS is the final area covered today but the key announcements on broadband rollout and online harms were covered in part by my noble friend Lord Stevenson of Balmacara on Thursday and my colleagues will pick that up later, so I will not dwell further on it here. However, I want to note the widespread disappointment that Ministers did not use the Queen’s Speech to commit to reverse the cuts to BBC funding for the over-75s licence fee. That should never have been dumped on the BBC in the first place and I urge the Government to review it. Labour will; will the Minister please do likewise?
We have looked at this programme through the lens of some of our most important public services and the welfare state as a safety net for all of us. Does that vision stand up to scrutiny? I do not think that it does. It is not enough just to declare that you want to make Britain great again. If we want a country where all our people can flourish and where they can fulfil their potential and contribute to the flourishing of the nation, government must will the means as well as the end.
We do not need another decade of cutting taxes for the better-off while slashing benefits for the poorest, of letting our most important public services lurch from crisis to crisis and of abandoning vulnerable people to the care of friends and family. We need a new era characterised by mutual care and by a determination to tackle inequality, protect the vulnerable and give every child the best possible start in life, wherever they live and however unwisely they chose their parents. That is the vision that I want to see and I urge the Government to follow that instead.
My Lords, I want to confine my remarks to the area of education, of which the Queen’s Speech says basically, “Motherhood and apple pie”. Could anyone have cause to disagree with the statement that all young people will,
“have access to an excellent education, unlocking their full potential and preparing them for the world of work”?
Perhaps the Minister will shed some light on the actual Bills that the Government will bring forward to make that happen. I hope that it will not be a further narrowing of the curriculum—we have seen how that stifles creative talent—and that it is not the further expansion of unaccountable free schools, when many parts of the country are urgently in need of building new schools to provide for much needed school places. Can we hope that the important Augar report on 16 to 18 year-olds will be translated into a Bill? After all, it was very close to the heart of the former Prime Minister. Can we also hope that the Government will bring forward changes to the EBacc?
By narrowing the curriculum, we have seen creative subjects decline in the state system year on year while flourishing in the independent and private schools sector. This year, we have seen GCSE entries decrease even further in design and technology, drama, media/TV studies and music at a time when the creative industries have become hugely important to our economy. Employers are consistently clear that the biggest drivers of success for young people are attitudes and attributes such as resilience, enthusiasm, and creativity. As the Edge Foundation says, young people need,
“a truly broad and balanced curriculum, linked directly to the real world and focused explicitly on developing the wide range of skills required to succeed in the twenty-first century”.
It has always fascinated me how Governments of the day and so-called spin doctors manipulate certain situations to persuade the media to follow a particular news agenda. Do your Lordships remember when Michael Gove, the then Secretary of State for Education, told us repeatedly how badly as a country we were performing in the international league tables in maths, English and science? They are called the PISA tables—the Programme for International Student Assessment. Mr Gove used the PISA tables constantly to show how badly we were performing against our overseas competitors. Finland and Singapore were heralded as shining examples. Our failure in the PISA tables became the raison d’être for Mr Gove’s cataclysmic changes in education policy. So what about looking at the PISA tables, 10 years on, to see how we are performing? Singapore still heads the tables in maths, science and reading, and Finland is still among the top European countries. In fact, 14 European countries outperform us in maths and 13 in reading. Over that 10-year period, the UK saw schools drop in all those subjects. Need I say more? I do not think we will hear much from the Government about the PISA tables any more.
Never mind our failure in the international tables, figures released by the Department for Education reveal that, this summer, 35.6% of pupils did not get grade 4 or above in GCSE English and maths, while half—57%—failed to get a grade 5, which is considered a strong pass. That 35.6% of pupils did not achieve a grade 4 might not mean anything to noble Lords, but it means that 190,000 young people were judged to have fallen short after 12 years of teaching. At the other end of the education system, the Department for Education also revealed figures that show that over a quarter—28.2%—of children are already falling behind in their education by the age of five.
Time is always tight in these debates, and I want to quickly mention two other issues that are close to my heart. Children in care and children who have struggled with schools and schooling are often placed in what is called alternative provision. These are the most vulnerable people in our society, and they need all the support and protection that we can possibly give them. Yet a large number of these pupils are put in unregistered schools which, because they are unregistered, are not subject to inspection and scrutiny. In many of them, the most unacceptable educational practices take place, including for example a lack of proper child protection procedures. Why are we allowing this to happen? Why, for example, are local authorities placing as many as 2,600 pupils in these unregistered schools and paying for them to go there? Why is the Department for Education unable to say how many unregistered providers there are? And why do the Government not listen when their own chief inspector of Ofsted, Amanda Spielman, warns that inspectors and the Department for Education do not currently have the powers to shut down unregistered schools, even when they are breaking the law? Does the Minister agree that we should give them those powers?
Another area that I have been concerned about for a few years is essay mills and contract cheating. This is when students pay for their essay or dissertation to be written by someone else. It is a flourishing, multi-million-pound industry that preys on the vulnerability of students. The problem is growing year by year and affecting the academic integrity of our higher education system. When I put down an amendment during the passage of the Higher Education and Research Bill, I was assured by the then Minister, Jo Johnson, that the Government would try to deal with this problem by working with universities and the National Union of Students, and that if they failed, they would consider bringing in legislation. They have failed. The problem is getting bigger and bigger every year, with some 50,000 students using essay mills and contract cheating. More than 40 university vice-chancellors have written to the Education Secretary asking for essay mills to be banned. Will the Minister now give an assurance that these actions will be taken?
We all want all our children and young people to have the best possible education, and none should be left behind. When bringing forward legislation, I hope the Government will consider the important points that all your Lordships make in this debate.
My Lords, I propose to speak about social care for disabled and older people, which of course impacts on their health and well-being. This area has been deeply neglected in recent years. We are, sadly, looking at a series of failures in this sector: failure to invest in older and disabled people’s participation in, and contributions to, families and communities; failure to make decisions about how to secure long-term funding; and failure to create a positive narrative around the fact that we are living longer—I know I do. The result is poor-quality and inadequate support services which we would not want for ourselves or those we love.
Users of care and support services are deeply fed up with successive Governments’ “all talk and no action” approach to social care reform, and the general reference to social care in the Queen’s Speech adds little to restore public trust. It is not acceptable in a modern society, and as one of the largest economies in the world, to limit social care to life-and-limb services. This is about all of us: our families and ourselves, not mythical “others”.
While we need the Government finally to act on ensuring sufficient investment in social care, which is so important to the health and well-being of our society, we must equally look beyond government to bring about the transformative change necessary to reshape care and support. Many people and groups are trying to take action to make things a great deal better. Their common aim—our common aim—is summed up by Social Care Future, a network of people receiving, providing and commissioning social care. As it says:
“We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us. That’s the #socialcarefuture we seek”, not life-and-limb services.
Government financial investment to achieve this is critical, but it has to be done differently. Currently, it is targeted at propping up creaking services that most of us fear having to use. As noble Lords know, my area of greatest knowledge is disabled people, who account for 50% of social care expenditure, yet they say this does not give them what they want or need to live and participate effectively in the community. This group is completely unable to accumulate wealth to pay for their own care, yet Governments continue to raid their meagre benefits and entitlements, which they need to survive, for this purpose. This is wholly unfair, counterproductive and highly questionable financially.
Only person-centred support to live as others do, funded through central taxation, will break the cycle of fear and inaction. There is great public support for this. I and others are proposing new ways to invest in support for people of all ages. We must move away from institutional practices by shifting power to people and communities. We must recognise the case for realistic investment in a fundamental right to independent living, as argued for by the Reclaiming Our Futures Alliance, a growing movement of disabled people’s organisations.
This year, the Independent Living Strategy Group, which I am privileged to chair, will embark on an independent inquiry into current support for disabled people, with recommendations for progressive change. This will underpin a Private Member’s Bill which I hope to table in the near future. I intend to call it the “access to living Bill”, because, after all, that is what everybody wants and deserves. They just want a life: they do not want a service and they do not want to live by handout to survive. They want a life and they want to participate. I will look for support for the Bill from the Government and from across the House, because I believe that this is the new future that we want for older and disabled people.
My Lords, it is always a privilege to follow the noble Baroness, Lady Campbell, in these debates. I shall to try to draw on her remarks as I make mine. I draw the House’s attention to my entry in the register of Members’ interests.
I welcome the proposals in the Queen’s Speech. It is refreshing to be devoting a day to these crucial areas of domestic policy. Of course, Brexit hangs over this debate. Be one a remainer or a Brexiteer—thinking back to the debates that we had in this very Chamber on Saturday—one lesson from the referendum is that millions of people in this country feel left behind and do not feel that they have participated in the economic growth of the past decades. Regardless of whether one thinks a sensible response to that is to vote for Brexit, there is a message for all of us in the importance of the domestic policy issues that we are focusing on today.
I want to begin briefly on education. The Minister referred to technical education and T-levels, one of the notorious weaknesses of our education system. I very much hope that T-levels are a success. There are, however, some significant doubts about how well they will do. They appear to depend on unrealistic expectations of employer participation and contribution. There are already stories around that if T-levels do not secure the level of support we hope, one reaction from Ministers will be to try to close down the alternatives such as BTECs. It would be marvellous if we had an assurance from the Front Bench that existing provision—which is popular and which young people go for—will not be an unexpected victim of any problems that may face T-levels.
It is also important that people have the opportunity to participate in university education—again, I welcome what the Minister said on that. Going to university is a widespread aspiration. There is a narrative around at the moment that too many people go, but at every stage of the growth of participation in higher education, from 5% to 50%, we have had this narrative. If too many people go, it is a social problem concentrated in some rather unusual parts of the country. It is an acute problem in Winchester and Guildford, but, fortunately, in Hull and Bolton they are successfully resisting the dangers of going to university. The Government have committed to spread access to university with some bold ambitions for increasing participation from disadvantaged groups. This raises an interesting challenge. Are these extra students to go at the expense of the middle-class students from advantaged areas who are already going? If so, what steps are Ministers taking to reduce this excess rate of applications from some of our most affluent areas and most prestigious schools? Or does it mean in reality that more people in total will be going to university in future? Will the Minister confirm that one estimate is that simply achieving the Government’s own objectives for more participation from disadvantaged backgrounds, together with demographic change, would mean 300,000 more students by 2030?
I want briefly to touch on welfare and employment. The Government have a fantastic record of increasing employment. There is of course a striking contrast between the generosity of benefits and welfare for pensioners, protected by their triple lock, and the freeze in the value of working-age benefits. The working-age population does not have an advocate as eloquent as the next speaker in this debate, the noble Baroness, Lady Bakewell. Will the Government look at the way that benefits for working-age people work, in particular universal credit? When universal credit was designed, the preoccupation was with workless households, and it was designed to incentivise the first person in the household to go into work. The good news is that the number of workless households has fallen, but the problem is poverty and low incomes in families where someone is working. Here, universal credit has exactly the wrong effect: it penalises the second earner and people who increase their hours. A reform of the work allowance would help tackle that problem.
Finally, I very much welcome the pensions Bill. A particular proposal in it—the regime for collective DC pensions—is an excellent compromise between the generous, old-fashioned final salary schemes, where all the risk was borne by the employer and the pension scheme, and the pure defined contribution scheme, where individuals find themselves taking all the risk, with no sharing across fellow workers or other generations. I support this excellent initiative. The evidence from the design work that has been done on the Post Office CDC scheme—the most ambitious proposal—is that it is important for these schemes to be generationally fair. The danger is that the rights of existing pensioners are protected and the adjustment is all borne by younger workers. The regulatory regime set out in this legislation needs to tackle that problem.
Overall, I welcome the Government’s proposals in this Queen’s Speech. I have not had time to reflect on the social care proposals, apart perhaps from taking another lesson from the Brexit debate: just get on with it.
My Lords, I regret the cursory reference in the gracious Speech to the social care needs of the old in this country. The Minister’s statement this afternoon has been confined to sums of money, some of which have already been announced. It was money that she spoke of; there was no substantial commitment to make changes to the system at a time when so much needs to be done. I will make two points which apply to the core issues of the care of the seriously old.
First, when I served as the Voice of Older People between 2008 and 2010, I received many letters asking for help with a problem concerning residential retirement homes and villages: many elderly people had come to rely on the expertise, availability and friendship of the wardens appointed to their care. These wardens were being phased out in favour of electronic alarms, buttons and telephone responses. Years later I sat on this House’s committee looking into AI and its potential. It became clear that artificial intelligence and robotic systems would increasingly offer an efficient and economical way of caring for the isolated old. I wish to issue a warning: old people want and need human contact; it helps them fight depression and loneliness in a way that machines cannot. I ask that future provision, while making strategic use of mechanics, has written safeguards about sustaining human contact with the old and isolated.
My second point is on a larger scale and concerns the business model that underpins the provision of residential care homes across the country: this needs a major rethink. I can only hope that the repeated delay of the long-promised Green Paper is because someone somewhere has woken up to the fact that the system is broken. The well-being and sense of security of frail, old people is at the mercy of the private equity-style business model, with the risk of companies carrying heavy debt burdens and paying extremely high interest rates.
The care home market, as noble Lords will know, is currently dominated by four major care providers: HC-One, Four Seasons, Care UK and Barchester. Between them, they operate some 900 of the country’s 11,000 care homes. Some 95% of the country’s care beds are provided by the independent sector, catering for self-funders and the local authority-supported. Recent austerity cuts to local council funding and the introduction of the living wage have added to pressure on all these companies. Between 2015 and 2019 the big four declared losses totalling £900 million. In their 2017 published accounts their total debt was £2.2 million—I am quoting figures from their own statements as reported by Opus Restructuring. Noble Lords will remember that Southern Cross collapsed in 2011. Currently all four companies are up for sale. A deal for the sale of Barchester collapsed in July this year and Four Seasons put two of its top companies into administration in April this year. Now I am not a banker, and for all I know this is a really healthy state of affairs in the City, but it is not a safe, reliable model for the ongoing care of our older people.
Let us consider it from their point of view. The need for a care home often hits a family very suddenly: the death of a married partner may leave the children looking to provide for the survivor as soon as possible; a frail old person living alone may sustain a sudden injury or a sudden deterioration in health. They need to find somewhere quickly and to meet the complex financial arrangements that have to be made. There is now evidence that companies prefer to set up care homes in the country’s most affluent areas, where there will be more self-funders in their potential market. The market will thus fail to supply the needs of the poorer old, and sudden changes in company finances can leave old residents suddenly bereft and bewildered. Family decisions made quickly in the shadow of bereavement or illness can be the wrong choices, but making complaints or seeking redress is not easy when you are dependent on the staff of the care home. I hope the Minister will address the issue of embedding consumer law in the regulatory regimes of care homes.
Growing old is not an option we can exercise: the alternative is worse. No sector in our society is crying out for reform more than our care of the elderly—and, incidentally, their dedicated and underpaid care workers. Will the Government address these concerns with the greatest urgency, and can they give us a timescale?
It is a great pleasure to follow the noble Baroness, Lady Bakewell. As a former council leader, I am very familiar with some of the issues she raised here today, but I shall confine my remarks to the worsening conditions of the least well off in our country. They deserve consideration, although sadly they are not a priority of the Government in the gracious Speech. There is ample evidence that conditions are getting worse for the poorest, whether in the form of research and reports, or in the daily experiences of children, families and individuals. Reports from the UN rapporteur, the Joseph Rowntree Trust, the Children’s Commissioner, the Child Poverty Action Group and a host of others provide shaming testimony in a country that once led the world in the social welfare of its citizens.
The gracious Speech makes reference to unlocking the full potential of children, yet we hear that teachers are buying food, clothing and equipment out of their own pockets for children who are too ashamed to come to school because their families cannot afford clothes and basic needs. The number of children attending food banks in the last year has doubled. Some 4.1 million children are in poverty, and 70% of them are from families where at least one parent works. Single parents, of whom 90% are women, are twice as likely to be in poverty as married couples. Half the children in one-parent families are in poverty. Furthermore, as far as housing is concerned, there has been a surge in homelessness, which was up by 320,000 in November 2017. Rough sleeping has shot up by 15% in a year; this is because of the paring back of housing benefit and the freezing of local housing allowance.
Nearly 50% of those in poverty—6.9 million—are from families where someone has a disability. On this I support the speech of the noble Baroness, Lady Campbell, and some of the examples she gave us. The crisis in PIP assessments whereby 75% of appeals are upheld requires attention. Even if the Government were concerned only with finance it would be sensible to look at a better way of doing this; in terms of the suffering it inflicts on people who already have to face financial penalties in various forms, it is just unforgivable. Families with disabilities are projected to lose £11,000 a year by 2021-22, more than a third of their income.
Indications also show that the worst off and most vulnerable will suffer more under Brexit. I understand from talking to those involved that very little assessment of this has been done, yet already the depreciation of the pound, rising prices and inflation are making things very difficult for those on fixed income. Unless the full uprating of benefits and low incomes takes place, there will be a crisis and the poorest and most vulnerable will not be protected. Indebtedness has already reached pre-2008 levels, yet little appears to have been done in terms of emergency support.
The gracious Speech states:
“My government will bring forward measures to protect individuals, families and their homes”.
The Government really need to look at the evidence of how they are protecting families and their homes. The two-child limit and the four-year benefits freeze both directly affect children. If what people are saying about the effect of Brexit is right, emergency payments would be indispensable, but they are going to be lost. In the past they have prevented families falling into destitution; they need to be reinstated. The sanctions imposed by the Government are a source of destitution and debt and are particularly damaging to people with disabilities or health conditions such as heart disease.
Payments to young people of £250 per month are not enough to live on for those who do not have supportive homes. Split payments need to be made so that abused women are not kept under the control of their abuser. As the noble Lord, Lord Willetts, has already mentioned, the disincentives to work, the effect of sanctions and flexible working need to be thoroughly investigated and action needs to be taken.
There is ample evidence of the worsening lives of the poor and vulnerable. Our priorities must be to build an effective social safety net nationally and locally, to address the issues that lead to low pay and insecure employment and to ensure that measures are in place for the least well-off, the least protected and the most vulnerable so that they do not slip through the holes of an insufficient safety net and drift into destitution and poverty.
My Lords, many noble Lords will know that I have a background in health, and I continue to be a great supporter of the National Health Service, so they will not be surprised when I address my comments to health and social care. In doing so, I recognise the contribution of the noble Baroness, Lady Emerton, to nursing and to this House.
I thank the Government for their work to support and strengthen the National Health Service, its workforce and its resources. However, increased investment and reform does not guarantee getting to the root of the problem. Our health and social care issue is what you might call a “village problem”. Our flourishing, mentally, physically and emotionally, occurs best in community. More than that, as Sir Michael Marmot’s research from the Institute of Health Equity indicated, our economic, social and emotional circumstances all play a part in our health and well-being.
As a Christian, I believe that every human being is created in the image of God. We are not made in isolation. We belong together in creation, which should be cherished and not simply used and consumed. This is the starting point for the Church of England’s engagement in society, nation and the world. We are most human when we know ourselves to be dependent on each other. It is therefore no surprise that when communities mobilise and environments are improved, it benefits everyone and reduces the strain on our National Health Service. Here lies, in part, the power of social prescribing. Churches have an integral part to play. The Church is a builder of and a presence in communities, and is well placed to support people as they journey through life, and in fact towards death.
Within the diocese of London, the work of the Posh Club run by St Paul’s in West Hackney is just one example. A weekly cabaret-style party for the over-60s, it combats isolation and loneliness in the community. It provides a unique way to experience connection, laughter and physical activity. Father Niall Weir, rector of St Paul’s, says:
“If there was a Posh Club in every town in the UK, I’m certain the numbers of elderly on GP waiting lists would go down hugely”.
In other words, this kind of community partnership can potentially be used to ease some of the unsustainable pressure on our National Health Service. I would be grateful to hear from the Minister what steps are being taken to ensure the deployment and distribution of social prescribing link workers, as outlined in the NHS Long Term Plan, to ensure that there is a level playing field right across all parts of this country.
What of the social care system? Some 1.3 million children—10% of all children—in England have needed a social worker in the past six years, and their prospects are not always good. For example, just 17% of them get GCSEs in maths and English. The social and economic cost of failing to help children is immense. In addition, as we heard from the noble Baroness, Lady Bakewell, the elderly are being burdened with the huge cost of their care homes, while parents struggle to pay for essential care services for their disabled children.
A great deal of thinking has been undertaken about how we might best improve adult social care funding. The Church of England has been consistent in its advocacy of integrating health and social care to ensure the most efficient and effective use of people and resources; we need to see effective integration taking place on the ground in all the communities of this country. The King’s Fund has pointed out that the NHS long-term plan is fundamentally flawed precisely because it isolates the NHS from both social care and public health. Once again, this is not merely a social care problem but a village problem.
While we are waiting for the Green Paper on reform of social care to be released, we still have the Dilnot report, published almost a decade ago. It had cross-party consensus and tackled the very issues that we still face today. It understood the value of community and the importance of shared responsibility. What plans do the Government have to revisit the Dilnot report and its recommendations?
Although I welcome the Government’s commitment to reforming the Mental Health Act, and despite the commitment made five years ago to closing the gap and the crisis care concordat, there continue to be alarming disparities in minority ethnic mental health provision. I welcome the change in legislation, but it needs to be supported by policies and practices that increase cultural competence among professionals and are developed in partnership with minority ethnic communities.
In conclusion, I remind noble Lords that health and social care depend on the wider collaboration of the community as well as internal change. To tackle the deep-seated inequalities that we face in this sector, we need to work together in partnership. Although I welcome the Government’s commitment to do more, I hope that the Minister will bear in mind the role of communities in delivering positive health outcomes and say something about how that can be done.
My Lords, first, I say to the right reverend Prelate how much we appreciated her speech today and on other occasions. It takes me back 25 years, to when I was Leader of the House and invited the then Archbishop of Canterbury to have dinner with me, because I thought the Bishops were very good at saying Prayers but never made much of a contribution afterwards. I felt that many of them had a lot of useful things to say, if only we could persuade them to do it. I must say that it is vastly different today, and the right reverend Prelate is a fine example of someone who has something to say worth listening to.
Tonight, I shall raise the issue of standards in our universities and say something about my concern about the associated issue of grade inflation and the awarding of degrees. There is nothing about this in the Queen’s Speech, but I think I have found out why, and I shall come to that in a minute. First, I should declare my interest. I was for 15 years chancellor of a university, and I have awarded degrees to a considerable number of noble Lords over the years. One was in his place a few minutes ago, but I cannot see any just at the moment. If I have missed someone, I am frightfully sorry.
Looking back over those years, the occasion I always remember was, during the Olympic Games, awarding an honorary degree to Roger Bannister. He had to confess that for many years his wife thought he had run four miles in one minute, and he had to explain to her that he had run only one mile in four minutes.
The issue of grade inflation is certainly not unknown to either the Government or universities. There are many published examples of the results of awarded degrees showing a marked increase in recent years. For instance, 27% of all graduates last year obtained a first-class degree, up from 16% a few years ago. There has been a big increase in the percentage of students obtaining upper degrees. One quite well-known university seems to pride itself that 50% of its graduates get first-class degrees. Standards are vital, not just for the universities but for wider society and our place in the world. Of course, students and their families are frightfully keen, but employers also want to know that the degrees potential employees hold are of value and the appropriate standard.
The position is far from being all bad. As the Minister said, four of our universities are among the 10 best in the world. Many universities are of a high standard, but some, if only a few, are letting standards down and that is of great concern. The previous Secretary of State called for an end to grade inflation and said that,
“the OfS should directly challenge institutions where they find clear evidence”, of it. The Economic Affairs Select Committee of this House, which I had the honour of chairing some years ago, said in a recent report that it was,
“concerned that the replacement of nearly all grant funding by tuition fees, coupled with the removal of the cap on student numbers, has incentivised universities to attract prospective students onto full-time undergraduate degrees”, when perhaps they should not be. It went to say:
“This may also explain the striking increase in grade inflation”.
Professor Buckingham, president of Universities UK and an outstanding vice-chancellor of the university of which I used to be chancellor, is clear that there is a problem. She said in her presidential address that universities are concerned to protect the value of their degrees and must take action to grip the issue of grade inflation. The consensus is clear that the increase in first and upper second-class degrees cannot be attributed entirely to students’ higher academic performance but is, in the eyes of some, a doubtful means of reputational enhancement.
I was going to say that the response of the Government to all this is not as adequate as it ought to be but, like the US cavalry, help came at the last minute. Four days before the Queen’s Speech, Universities UK issued a substantial initiative with comprehensive proposals to protect the value of degrees and to achieve transparent, consistent and fair academic values. If this is followed through, it is a very sensible way forward, so I very much welcome the initiative and look forward to being kept fully informed of its progress. It does not let the Government off the hook, but I expect the Government to keep a very watchful eye on it.
My Lords, children and health have been mentioned in some very eloquent speeches already. I want to talk about young people’s health, particularly early inequalities in health due to many of the factors expressed so eloquently by my noble friend Lady Sherlock.
The gracious Speech did not refer to the needs of children directly, but it referred to domestic abuse, which affects children and who may be victims in their own right. This will no doubt be considered as we go through the Bill. I am reminded that over the past three years or so we have not considered issues such as children and the elderly; we have been talking about Brexit considerations. I regret this and we should now emphasise issues such as the health and well-being of children and the elderly. We must re-address our priorities and examine what, as a nation, we should urgently consider important, such as children and the elderly.
This is a crisis for young people’s health. Decreasing funding for children’s services and a rising demand and legal requirements to provide statutory services has meant that there is a gap between what local authorities need to spend and the resources available. This is calculated to be £3.1 billion by 2024-25. Between 2010-11 and 2017-18, central government funding for children’s services fell by 29%. The most deprived areas suffered a fall of 37%, compared to 21% in less deprived areas. This makes no sense at all, as pointed out by many in the children’s voluntary sector. It affects social mobility, so emphasised by the Government in recent years, and is an economic nonsense. Early intervention in child health and well-being has been shown to save millions of pounds in the long term.
The Private Member’s Bill of the noble Lord, Lord Bird, on the welfare of future generations is a welcome intervention, which calls for long-term sustainable thinking. Will the Government look at the success of Wales when we consider this Bill?
I shall now refer to an excellent report from the Association for Young People’s Health, of which I am a patron. The report gives key data for young people aged between 10 and 24 in the UK. Sadly, the message is that inequalities are disturbing and on the increase. The gap in health between rich and poor is already apparent in young people aged between 10 and 24. In some cases, health inequalities are widening. Of course, the 10-to-24 age group covers a time of huge change, when many influences coincide. For example, there are the transitions from childhood to adolescence, from adolescence to adulthood, from education to employment, and from reliance on family to—we hope—being independent and peer group interaction becoming more significant. For some young people, without sustained support, life is difficult and leads to vulnerability, including the dangers of poor mental health and anti-social behaviour. I am aware that the Government have promised a greater focus on mental health.
Let me give some examples of the impacts of deprivation. Severe obesity rates for 10 to 11 year-olds in the most deprived areas of England are four times greater than those in the least deprived. That gap rose from 8.5% in 2006-07 to 13.5% in 2017-18. Young people living in the poorest areas are twice as likely to be admitted to hospital with asthma and have much worse diabetic control. There are also inequalities in smoking rates, under-18 conception rates, mental ill-health prevalence and rates of road traffic injuries.
Information on health has consistently pointed out inequalities in health related to income, education and where people live. The problem is that the situation is becoming worse. We need to examine the social determinants of health, such as those pointed out by my noble friend Lady Sherlock. I support Action for Children’s call for a national childhood strategy. I called for a young people’s strategy in another debate and will follow this up with the Department for Digital, Culture, Media and Sport, as recommended by the noble Lord, Lord Agnew. Will the Department for Education and the Department of Health and Social Care also examine the urgent need for such a strategy? Will they call for a cross-government approach to this? Only by combining forces will we serve our children and young people well.
My Lords, I want to focus the attention of the House on an industry that brings £127 billion a year to the UK economy, attracts £24 billion of spending in the UK from abroad, contributes a further £7 billion a year in tax and provides 3 million jobs in the UK. That industry is tourism. It is therefore regrettable once again to see no mention of the industry in the Queen’s Speech, especially since urgent reform of regulation around failed airlines is now needed.
The tourism industry has great potential and I want to set out some specific proposals to harness that potential. Hospitality is, by definition, both international and hierarchical. It provides jobs all over the world, the majority of which are entry level. We therefore want to see the Government work with industry to help young people, in particular, by doing two things. First, we want them to use access-level jobs, say in a McDonald’s or a Burger King, as a gateway to international placements in those businesses, enabling young people without the means to “go travelling” to work for the company in another country. With a guaranteed job to go to and an income, they would have the opportunity to learn a language and experience living in another part of the world—an opportunity they would never otherwise have.
Secondly, there should be clear ladders and pathways for young people working in the industry to progress. Someone decanting chips into cardboard containers today should have the chance to become a chef tomorrow, if they wish. Someone cleaning bedrooms in a hotel today should have the opportunity to learn about the economics of the business and to progress into management. Initiatives like these could be life changing for those people who benefit, but it will take a concerted effort by government to get the big companies engaged in the agenda. The tourism sector deal is welcome, but it does not go anything like far enough. What is needed is a real partnership between business and the state.
UK tourism brings great benefits to host communities and for many places in Britain it is the very life-blood of the economy, but it comes with challenges. Populations increase exponentially during the summer season, placing a strain on local infrastructure. Some seaside towns with an excess of cheap property have become home to the very difficult HMO market. On the other side of the coin, some local housing markets are distorted by second home ownership and short-term lets. Both increase property purchase prices and put local rents beyond the reach of people who grew up in the area.
I therefore urge the Minister to consider three proposals: first, creating a planning use class for second homes so that young people can remain living locally and contribute to the local economy; secondly, allowing councils—as the Scottish Government are allowing in Edinburgh—to introduce a tourist levy on hotel rooms, with the money raised being ring-fenced for the benefit of the visitor economy; thirdly, and most substantively, legislating for councils to run a statutory registration scheme for all guest accommodation, which would permit both control over the number of short-term lets in a given place and a revolution in consumer safety.
It might have gone unnoticed that Airbnb, a principal player in the guest accommodation market, is trying to play both poacher and gamekeeper by launching a “voluntary” registration scheme of its own. This will allow the good players to opt in, leaving the bad ones free to opt out. By proposing this, Airbnb has acknowledged the problem but is avoiding a genuine solution; what we urgently need is a mandatory scheme administered by councils and funded by fees from the accommodation platforms. Registration and spot inspections would drag up standards, ensuring, for example, that every property marketed to the public has a working smoke alarm. The fact that it is legal to let properties without a smoke detector is nothing short of a scandal and a tragedy waiting to happen.
It is time to upgrade the status of tourism within the Government themselves by reorganising DCMS as a department for tourism, culture, communications and sport. That would give the industry, which has had 15 tourism Ministers in 20 years, a consistent senior voice at the Cabinet table, speaking up for this vital sector of our economy. I urge the Minister to consider all of these proposals as a package which would work together and show clearly that tourism in the UK is thriving and that our country is open for business.
My Lords, it is a pleasure to follow the speech of the noble Baroness, Lady Doocey. I have of course been deprived of being able to congratulate the noble Baroness, Lady Emerton, on her valedictory speech, but nevertheless I would like to put on the record some points because I think that she might have been amused by what I have to say about her.
I never referred to the noble Baroness as “Baroness Emerton” or “Audrey”—I always called her matron. I think she enjoyed the idea that I, as a perhaps one-time senior doctor, was petrified of matron, as I always was. She is a formidable lady and was referred to as such by the noble Baroness, Lady Cumberlege, on the day she made her maiden speech. I say to the noble Baroness, Lady Watkins, that three nurses spoke that day: the noble Baronesses, Lady Emerton and Lady Cox, and Lady McFarlane of Llandaff—three formidable ladies, you might say. We all know that the noble Baroness, Lady Emerton, has contributed an enormous amount, quite forcefully, and has championed the causes she felt strongly about—particularly the health service and, within it, the important role that nurses play. I was interested to see that her motto is “Pro fide, pro utilitate hominum”—quite appropriate for a nurse, you might say. A more appropriate motto for her might have been “Cibum non est mecum”. I hope my Latin from a long time ago makes the point. For noble Lords who cannot translate: “Don’t mess with me”.
The Queen’s Speech said:
“Measures will be brought forward to support and strengthen the National Health Service”, and its workforce. Furthermore, it said that legislation will be brought forward to establish,
“an independent body to investigate serious healthcare incidents”.
It also said:
“My Government will bring forward proposals to reform adult social care”.
It has been said enough already that there is, as yet, no Green Paper on reforming adult social care; we all await that.
Furthermore, the Speech said that:
“My Government is committed to establishing the United Kingdom as a world leader in scientific capability”, and that there will be,
“a more open visa system”, to encourage and recruit talented individuals from overseas to support our science. We have no workforce strategy as such. We have repeated comments that we are recruiting more nurses or doctors, or that we have more places for medical students or nurses. But the challenge of the NHS and social care workforce is far too great to be dealt with by those policies. I do not criticise the Government; I just say that more needs to be done.
The report following the House of Lords inquiry, The Long-term Sustainability of the NHS and Adult Social Care, made the point that the greatest challenge the NHS faces for its sustainability is its workforce. We need to do more about it. Let me give a small example. I thought the Government would bring in legislation to regulate health professionals following their July report, Promoting Professionalism, Reforming Regulation, but that did not happen. The legislation that governs the UK’s medical regulation is not fit for purpose. Noble Lords might be shocked to hear me to say that, but it is true. It is the regulation that followed the Medical Act 1983. It does not allow the flexibility to easily put on the registers GPs and specialists, particularly fully trained senior people. It has no flexibility and legislation is needed to change that. The General Medical Council is very open to this and wishes it would be done, but it is not in the Queen’s Speech.
Making specialist and GP registration more flexible could make it more accessible to doctors to join both registers and would go some way to dealing with the workforce required. We are trying to recruit more doctors because we are short of psychiatrists—as we heard yesterday—geriatricians, radiologists and many others. There is an enormous shortage of nurses, too. Change here would be helpful, and I hope the Government will bring in legislation through another Bill; otherwise, I will be minded to put forward an amendment at some stage to do this.
I now come to the science side. Two-fifths of the UK’s academic workforce in science and technology are from overseas, and 50% of postgraduate researchers are overseas staff, so we need to make sure our visa system is more flexible.
My Lords, it is a pleasure to follow the noble Lord, Lord Patel. We enjoyed his deferential tribute to the noble Baroness, Lady Emerton, and I shall pick up in a moment what he and other noble Lords have said about social care. My noble friend who is replying to this debate has a long frontier to patrol, so perhaps I can make her task easier by saying that I want no mention in her wind-up speech.
I want to make three brief points on health. First, the Department of Health has set a great example to every other government department in that, since 2010, it has had only three Secretaries of State. Contrast that with the eight Secretaries of State at DCMS, seven Secretaries of State at both DWP and Justice over the same period, or indeed the nine Housing Ministers over nine years.
Why is this important? It takes time for a Secretary of State to build an effective team of Ministers; to understand and, at times, change the culture of a department; to build relationships with the external stakeholders, often crucial to the success of the department; to build a relationship with the parliamentarians and Select Committees who are holding that department to account; and to build a political base for support for reform. You simply cannot do that if there is a constant churn at the top of a department. No other organisation— commercial or voluntary—would tolerate that instability, and nor should a government department which spends billions of pounds, employs thousands of people and provides key services to the country. So, if Ministers cannot match the excellent continuity of service of Her Majesty the Queen, perhaps Prime Ministers should strive for greater stability, such as we have seen in health.
My second point concerns the balance between curative medicine on the one hand and preventive medicine on the other. Like other noble Lords, I welcome the commitment to extra funding for the NHS. The CQC report last week, State of Care, underlines the pressure on A&E and the staff shortages—the justification for the extra resources—and I welcome the Bills in the Queen’s Speech.
However, we are now reaching the point of diminishing returns from investment in curative medicine. The major improvements that we all want to see in the nation’s health will come from lifestyle changes and public health measures. My noble friend the Minister, in the department in a previous capacity, was responsible for public health and took some commendable decisions, which I applaud. I hope that she escapes my fate when I was Public Health Minister in 1981 and Dennis Thatcher persuaded his wife to transfer me to another department because of my aggressive stance towards the tobacco companies.
Against that imperative of focusing on public health to achieve real improvements, noble Lords will understand my alarm at reading in the Telegraph on
It went on to say:
I assume that he has subsequently relented, as he now refers to himself as a one-nation Tory leading a one-nation Government. As a former chairman of One Nation in another place, I am delighted that he is now one of us. However, one-nation Conservatism embraces a benign paternalism that is prepared to take public health measures in the national interest. We are suspicious of neoliberalism, with its overreliance on the free market with minimum state intervention, as implied in the quotation to which I referred.
Noble Lords may recall the cries of “nanny state” whenever people make this speech. I remember hearing it when we debated the compulsory wearing of seat belts—which was introduced by a Conservative Government—with crash helmets for motorcyclists, with health warnings on cigarettes and with the banning of smoking in public places. No one would now go back on those reforms, which have saved countless lives and reduced demands on the NHS.
However, we need to build on them, giving adequate resources to Public Health England and to local authorities for their public health responsibilities. Making England smoke free by 2030, which is the objective of the prevention Green Paper, will require introducing measures so far turned down, some of them based on the polluter pays principle.
Tackling tooth decay will involve revisiting the regime for introducing fluoride. Tackling obesity, which was mentioned by the noble Baroness, Lady Massey, will involve more radical measures than those so far introduced, such as a sugar tax. We should look again at minimum prices for alcohol, where the initial response in Scotland has been positive. So, although it is controversial, I want to see more emphasis on preventive medicine and a willingness to take decisions that may initially be unpopular with the right-wing press but that are right for the nation.
My final point is about social care for the elderly, and this is not a happy story. The Queen’s Speech says:
“My Government will bring forward proposals to reform adult social care in England to ensure dignity in old age”.
Noble Lords may ask where they have heard those words before. In 1997, the then Health Secretary, Frank Dobson, said that the arrangements for long-term care of older people were so unsatisfactory that they,
“cannot be allowed to continue for much longer”.—[
The Queen’s Speech in December 2000 said:
“The legislation will also take forward my Government’s response to the Royal Commission on Long Term Care for the Elderly”.
That was the Sutherland commission. Nothing happened. At the end of their time in office, the Labour Government were back where they started with the July 2009 Green Paper Shaping the Future of Care Together. The coalition agreement echoed what Labour said in 1997:
“We will establish a commission on long-term care, to report within a year”.
The Dilnot commission, which was mentioned by the noble Baroness, Lady Bakewell, suffered the same fate as Sutherland. The Queen’s Speech in 2017 said:
“My Ministers will work to improve social care and will bring forward proposals for consultation”.
They are still awaited.
This makes the negotiations with the EU positively streamlined—and in this case we are negotiating with ourselves. I recognise that in the fag end of this Parliament we are unlikely to make progress, but at least let us have the promised Green Paper, narrowing the range of options and building a consensus, so that when we next debate the Queen’s Speech we can welcome measures, rather than proposals, to ensure dignity in old age.
My Lords, I am focusing on health and social care. My noble friend Lady Sherlock’s excellent speech made clear the context in which the Government’s recent rush to show their concern and commitment to the NHS needs to be seen. There have been swingeing cuts since 2010—just to remind ourselves how long this Government have been in office—staff vacancies in key areas such as GPs, nursing, psychiatrists and vital specialities such as radiography are at a record high, and there is still no specific funding allocated to implement the NHS staffing plan, which was finally published earlier this year after a two-year wait. There are some 4.4 million people on NHS waiting lists, nearly 65,000 people have been left stranded on hospital trolleys for four hours or longer, and thousands are waiting in anguish and distress for cancer treatment. Five out of eight of the cancer waiting-time targets were missed in August, including the 62-day waiting-time target which has not been met since December 2015.
The CQC’s state of care report warns of a perfect storm across health and social care, where people cannot access the services they need or where care is provided too late, pushing the NHS and social care nearer and nearer to the tipping point it warned of last year.
We know that two definite health Bills are promised. One is on patient safety investigations and the other is on medicines and medical devices, to try to pick up the pieces after we fall out of EU regulation on clinical trials and access to medicines post Brexit, and to develop new ways of regulating personalised medicine and medical AI. We welcome both Bills and will work constructively with the Government and noble Lords across the House to ensure the vital improvements to patient safety and the access to innovative treatments that are so urgently needed.
“to free up different parts of the NHS to work together and with partners more easily”, but in reality to dismantle the heavy, laden and bureaucratic structures set up under the Government’s flagship Health and Social Care Act 2012, which have proved such a huge and costly disaster for the NHS. We currently have the ludicrous situation of authorities across the country desperately working around the 2012 Act to try to build the integrated primary and acute care and multispeciality community systems across local authorities and NHS and community settings which implement the NHS long-term plan. Can the Minister tell the House what work has been done with NHS England to develop legislative proposals on a new statutory framework? What is the proposed timescale for the Bill? Is she confident that the work currently being undertaken through CCGs on integrated care system, PACs and MCPs will proceed effectively within the legal and statutory authority contained in the 2012 Act?
I remind the House, too, that it was this Act that abolished the National Patient Safety Agency, against strident opposition from noble Lords across the House. From an initial reading of the Bill, many of the functions of the proposed new Health Service Safety Investigations Body were undertaken successfully by the NPSA. Does the Minister accept that abolishing that body has proved to be yet another damaging retrograde step under the 2012 Act?
On social care, we have had shameful and inexcusable inaction and delay since the Government abandoned the Care Act and the Dilnot provisions for capping the costs of care in 2016, despite strong cross-party support. Successive Prime Ministers and Health Ministers have all given hollow pledges about “getting on with the job” and have told us that a Green Paper is “imminent”. Now Boris Johnson has promised to fix it all, “once and for all” with the “clear plan” that he has prepared. But we now see that there has been no preparation: he has nothing new to offer. Indeed, recent press reports have revealed that No. 10 is still mulling over all the familiar options, including going back to the care cap and free personal care to match Labour’s long-standing commitments on this.
Meanwhile, the social care crisis continues to get worse. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down; nearly 1.3 million have developed an unmet need for basic care support such as washing, dressing or going to the toilet. Macmillan research shows that 8% of people living with cancer who have a critical or substantial need and who should qualify for council support receive no practical help at all, with 60% of their carers experiencing stress, anxiety or depression.
The Alzheimer’s Society estimates that, over the past 26 months, there have been more than 500,000 delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Where is the PM’s “clear plan”? Does this mean the Green Paper has actually been drafted? What is holding it up? The recent IPPR report showed that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs.
Your Lordships’ economic committee produced an excellent report on what it recognised as the “national scandal” of social care, advocating free personal care for the over-65s. Surely this is one of the first steps to solving the care crisis. What plans are there in place to fulfil Mr Johnson’s pledge to provide older people with the dignity and security they deserve and prevent them from having to sell their homes to meet crippling care costs? In the Minister’s response, I hope she will not simply repeat the Government’s stock answer that we have heard today on so-called extra funding. The King’s Fund, Nuffield Trust and Health Foundation have independently identified both the huge scale of government and local authority social care cuts and the £2.5 billion investment needed just to keep the system afloat in the short term. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for their future care needs.
Finally, on a more positive note, we welcome the pledge to continue the work on the reform of the Mental Health Act following the excellent review last year. However, we are very disappointed not to see a detailed timetable for the actual Bill that has been promised. The CQC State of Care report is again a sharp reality check on the deteriorating state of mental health care. Can the Minister explain why the Government’s NHS capital announcements so far have failed to mention or include urgent funding for mental health hospitals and trusts, which the review has made clear are the worst estate in the NHS?
My Lords, I have recently had cause to be very grateful to the NHS and its dedicated staff. However, a service that leaves a vulnerable elderly patient in A&E waiting seven hours to see a doctor and, on two other occasions, waiting in A&E for a bed in a ward for 12 hours and overnight is a service that is either inadequately resourced or inadequately staffed, and probably both. Patients are well named in the health service of today.
The health service relies on a thriving economy to provide its funding. This Government have played fast and loose with the prospects for our health service by their relentless pursuit of the hardest of hard exits from the European Union, within which our economy has thrived for more than 40 years. Brexit has already cost our economy £70 billion. It has also hit NHS staffing hard, with many well-trained and well-motivated staff either going home or not coming here at all.
Why are so many A&E departments not reaching the target of seeing 95% of patients within four hours? It is not because the staff are not working hard. Clearly the reasons are complex, and demographics play a part. There are people who go to A&E who could have used other services. Here, I stress that all three visits I mentioned earlier were made after all other sources of help had been tried.
However, two elements of the problem are outside A&E. One is delayed transfers of care, meaning that beds are occupied by patients who would be much better off at home with support or in social care. The second lies in primary care. Therefore, when I heard the Prime Minister’s headline-grabbing claim that his Government will build 40 new hospitals, I looked at it very closely and found that it is really only six new hospitals and a bit of seed corn money for the rest. More importantly, I realise that this unelected Prime Minister has no idea what the problem really is if he thinks that the solution is six new hospitals.
Patients who cannot get to see their GP will go where the lights are on, and that is A&E. It is very common for patients to have to wait three weeks to see their GP, and that is unacceptable. In many parts of the country, there are not enough GPs. In some places, this problem has been tackled by GP practices taking on other professionals to lighten the load on the doctor. This is an enlightened approach but it requires forward planning, funding and suitable premises. In the case of my local primary care services, that is not happening. There are no suitable premises for a modern all-service primary care facility, and that can make it hard to attract GPs. Therefore, to move to an efficient primary care service and reduce the pressure on A&E, we need funding and planning, but we are unlikely to get that from a Government intent on damaging our economy and promising not to increase taxes. Of course, the best course is to avoid damaging our economy and our health service by remaining in the EU.
The other way to reduce pressure on our health services is to prevent ill health, and I absolutely agree with the gist of the speech of the noble Lord, Lord Young of Cookham. I welcome the focus on prevention in the NHS Five Year Forward View. However, I would like to mention a preventable cause of illness which the noble Lord, Lord Young, did not mention and which is linked to another of the Government’s stated objectives—that is, action on climate change.
Outside this building for the past two weeks, thousands of citizens have demanded urgent action on the climate change crisis. They did so while breathing air that has 50% more of the most dangerous small particulates than the WHO recommended maximum. In London, the average level of PM2.5 is 15 micrograms per cubic metre, while the WHO recommended limit is 10. Polluted air kills about 40,000 people a year. It causes respiratory and cardiovascular illness and affects the brain development of babies and young children. There is evidence that older people who breathe polluted air have a steeper reduction in cognition with advancing age compared with clean air breathers. Research from the University of Warwick shows a significant reduction in memory, equivalent to ageing 10 years, in those who breathe polluted air. Polluted air therefore attacks our thinking power as well as our health.
Tackling climate change from the health perspective is also the right thing to do for the planet. It is bad for your health and tackling it is the healthy option, but the forthcoming Environment Bill needs to go further. It promises legally binding limits on air pollution but we have not been told what those will be. Actually, we already have them within the EU but have continually failed to reach them. What is required, as called for by the All-Party Parliamentary Group on Air Pollution, is much more than painting the number plates of electric cars green; it is a phased reduction in the legal limit for PM2.5 to 15 by 2020, 12 by 2025 and 10 by 2030. This would provide the incentive to government and local councils to reduce car use and speed up the introduction of non-polluting electric and hydrogen-powered vehicles, while bringing forward the phasing out of those powered by fossil fuels to 2030. We need radical action on charging and refill infrastructure. This would help the UK meet its climate change commitments, which it is otherwise unlikely to do.
The proposed office of environmental protection also falls short. We need an independent body capable of rigorous scrutiny, with powers to investigate and gain access to data and the ability to monitor and force compliance and take Ministers to court if they fail to address these issues. We need these things for our health’s sake and our planet’s sake. So will the Government support the Private Members’ Bills introduced today by my noble friend Lord Tope and the noble Baroness, Lady Jones of Moulsecoomb? That would be a step in the right direction.
My Lords, I thank the Minister for introducing this debate and reminding your Lordships of the elements of the Queen’s Speech relating to healthcare provision and the science sector in our country. I remind noble Lords of my interests as professor of surgery at University College London and chairman of UCLPartners. It is a pleasure to follow the noble Baroness, Lady Walmsley.
I would like to pick up on some points made by my noble friend Lord Patel. I reiterate the tremendous regard and respect that all Members of this House, and I in particular, have for my noble friend Lady Emerton. She has made a remarkable contribution to your Lordships’ House and is one of its kindest and most thoughtful Members. It has been a great pleasure and privilege to come to know her since I was fortunate enough to join the House.
The Queen’s Speech rightly identified Her Majesty’s Government’s commitment to healthcare and the NHS. Clearly, safety is vital and the Government should be congratulated on introducing legislation to establish the health service safety investigations body. However, there are a number of potential concerns. A number of other organisations in the broad structure for the delivery of healthcare and other regulators already have a safety responsibility—NHS trusts, professional regulators, the Care Quality Commission, NHS Improvement and so on. All these bodies have statutory responsibilities. How will Her Majesty’s Government ensure that there is not regulatory overreach, which can have a detrimental effect on openness and transparency and impede the objective of ensuring that safety is at the heart of healthcare delivery? It is a very important question. Further regulation without consideration of what is already available could be very harmful.
There is also a clear commitment to ensuring that the additional funding already identified for the provision of healthcare in the NHS is appropriately applied. In this regard, are Her Majesty’s Government satisfied that the current landscape and the disposition of NHS England and NHS Improvement are appropriate, or do they present something of an impediment to the establishment of proper integrated care? This must ensure that the community base, rather than hospitals, is the focus for the management of chronic diseases, and that we have a system that facilitates the appropriate management of patients with established disease and ensures that prevention is at the heart of our ongoing healthcare strategy.
The adoption of innovation is also absolutely critical. The landscape, populated by many bodies, is particularly defined by the academic health science centres and health science networks. Are Her Majesty’s Government content that that structure is appropriate to facilitating the adoption of innovation at pace and scale, or is it necessary to look at those particular designations, and indeed other elements of the system, to ensure that they are better co-ordinated to deliver the adoption of innovation? Innovation will be critical to the sustainability of our NHS; we need innovation not only in novel therapies, medical devices and technologies but in how we develop the workforce to respond to the challenges of the next two decades.
We are also particularly privileged in our country to have a unique ecosystem defined by the National Health Service, our universities—we have four of the top 10 in the world for biosciences and life sciences—a remarkable pharma industry sector and, of course, a biotech and medtech sector. Those sectors commercially provide some £63.5 billion of turnover to the UK economy, employ more than 200,000 people and represent some 5,000 companies. That is of huge importance, not only for ensuring that innovation is established quickly, discovered and brought to bear to manage the diseases of our fellow citizens, but for its economic contribution. This has been well recognised by recent Governments, who have shown important commitments to this area.
However, in a report published in September, the Institute for Public Policy Research identified that whereas in 2011 our country enjoyed 10.5% of global spending on life sciences R&D, that figure fell to just 7% in 2016, despite an important commitment by the Government. The circumstances around Brexit have caused further uncertainty in the life sciences sector. It is a matter of deep regret that there might be further delay in delivering Brexit.
The implications of this are substantial for this important part of our economy, but they are also vital because if we fail to sustain the pace of innovation in life sciences, we will not deliver an NHS that can provide the most important benefits for our fellow citizens. That NHS will not be able to contribute to the growth of the economy and to increased wealth creation in our country because patients and individuals will be less healthy and less economically productive, and the broader benefits of this important sector will be lost to our country.
My Lords, it is a pleasure to follow the noble Lord, Lord Kakkar, who always speaks with great authority and wisdom on health, and on scientific research and innovation, which are key to our future and the whole health service. I normally burden your Lordships with my views on international and overseas affairs and the shifting world order, having had the privilege to be the first chair of your Lordships’ Committee on International Relations. I chose to intervene instead on this present set of topics for three reasons.
We are living on an angry planet, to pinch a heading from the Times leader this morning. From Chile to Hong Kong, Lebanon to Venezuela, every part of the Middle East, every European capital to our own streets, e-enabled protest, organised on an unprecedented scale and driven through communications technology that is constantly changing rapidly, has become the norm. This anger affects all the issues we are discussing.
Oddly, there is little or nothing in the gracious Speech about turbulent outside world events, except of course the eternal Brexit, despite their major impact on our lives and issues here at home. In particular it is a great pity—indeed, I find it rather shocking—that there is no mention of the Commonwealth in the gracious Speech, considering its central importance to the UK’s future world role, our internal and domestic cohesion, our care systems and many of our public services, and the importance to Her Majesty personally of the modern Commonwealth network. To have included a reference would have been no more than good manners, but manners, courtesy and vision seem all to be victims of the present Brexit debate.
My second reason for seeking to speak today is that the internal good health of our democracy and society, aspects of which we are discussing, is essential to our external impact and influence, and safeguarding of our world interests. The inner health of our society is currently, as several speeches have emphasised, not as good as it should be. We really cannot go around pressing on other countries our Westminster model, our welfare state model, our elderly care model or our education model if they do not work well here. As my noble friend Lord Dobbs said in a brilliant speech at the beginning of our debate on the humble Address,
“if we are to offer lessons to others, we must relearn those lessons ourselves”.—[
A third reason for my intervening today is that it had passed through my mind that our situation, both nationally and internationally, would be rather different this week from last week and the gracious Speech, which now seems rather a long time ago. I thought that, by now, the deal would be settled. Foolish me. I should have realised that frustration is the name of the game, and I am afraid that it is going to go on. I read that Mr Jacob Rees-Mogg wants it settled in three days. It occurs to me that we should perhaps consult the Bible to learn about getting things done in three days.
The issue that I want briefly to discuss out of today’s list is pensions, workers’ benefits and employment. I extend that to savings, workers’ benefits and rights and security generally. These have all come into the Brexit debate, especially workers’ rights: there is a constant fear, vocalised much by the Opposition, that they will be watered down if we are outside the European Union. In an interview on the “Today” programme this morning, Nick Robinson reached a new low in ignorance combined with interruptive boorishness with Mr Jenrick, the Housing Secretary. The subject was rights and benefits. I also watched a much more polite and effective Andrew Marr on this issue. Neither Robinson nor Marr have grasped the difference between the big business, corporatist type of legislation for workers, mostly coming from the EU, and the small-business-friendly social and employment legislation that we need and which is far better suited to both workers and business in the digital age. In the digital age and a service-dominated economy, we can do far better for working people, employer-employee relations and secure retirement than the old corporatist model, which is shaped largely by big companies’ lobbies, philosophies and pressures in Brussels. It is not a question of watering down but of a different and far better deal for millions of workers in the highly disruptive age we are living in, which will become more disruptive still. We must break away from the heavy, big-business, corporatist approach of the old EU.
The pensions system is very much part of this story. I welcome the new safeguards, as have some of my colleagues, but I fear that pensions reform of this kind does not go half far enough for what is needed in a modern and unified society. We talk about an economy which works for everyone, but it is simply not happening and my own political party needs, as do all major parties, to redesign its stances from the bottom up to meet these fundamentally democratic needs: a genuine sharing of capital ownership and the security and dignity that go with it, on a scale not hitherto contemplated. We cannot build a party of the future on out-of-date and out-of-relevance ideologies from the past.
We will thrive only as an open nation committed to and interwoven with an utterly interdependent world. We must have our own modernised and flexible welfare and support arrangements for a disruptive and dangerous world which is being totally transformed. The gracious Speech had ambitions, but it seems drafted with too little of this in mind. We have to up our game if we are to meet the colossal challenges coming fast towards us.
My Lords, the Minister in opening quoted from the gracious Speech, stating that Ministers would,
“ensure that all young people have access to an excellent education, unlocking their full potential and preparing them for the world of work”.
This is a worthy aim, but given government policy, it is unlikely to be achieved. I expected the Minister to tell us that funding for schools would increase as a result of spending round pledges. She told us about the budget for early years, too, and for universities, but further education, as so often, did not even get a mention.
The position in further education is dire: its funding has been slashed by £3.3 billion since 2010. At least in the spending round the Government have recognised that FE colleges do need more money, but an extra £400 million is a paltry sum against the magnitude of the cuts. The Chancellor said that he had attended an FE college and knows how important they are. That is good news—he is one of the few Tory politicians who has done so—but come on, Mr Javid, that sum will not be nearly enough for FE to unlock the full potential of young people and prepare them for the world of work.
Before I discuss FE colleges’ resources, I will comment on the curriculum for 16 to 19 year-olds across school sixth forms and colleges. In this country, we have a disastrously overspecialised learning environment for young people taking school-leaving examinations at 18. No other education system has anything like the specialisation associated with A-levels. Like the noble Lord, Lord Storey, I will mention Mr Gove. As Secretary of State for Education, he took a step backwards when he returned to the three-subject A-level norm, dropping AS-levels which have encouraged the study of four subjects in the first year of the sixth form. If only he had made the progressive step of going in the other direction, towards five subjects at AS-level, followed by four at A-level. Even this approach is some way from the hugely preferable international baccalaureate, which allows the study of six subjects. The universities must share some of the blame, because their conservatism in sticking rigidly to offers of three A-levels has discouraged a broader range of subjects.
Many people lament the dramatic decline in the study of foreign languages. In a world where English has become the global language, it is harder to motivate young people who have English as their mother tongue to study them after the age of 16. They are also unlikely to be chosen when competing with a range of science subjects and mathematics, or with English and the humanities, when students are so constrained in their choices. The three-subject straitjacket also means that many able young people are not studying the important subject of mathematics after 16; many others are studying no humanities subjects either. We are forcing young people into a horribly unbalanced education at a time in their lives when they should be learning more broadly. I challenge the Government to do something about this, and I hope to hear about it in the Minister’s reply.
I turn to further education colleges which, as well as providing A-level programmes, are the vitally important institutions for the development of vocational skills for 16 to 19 year-olds—as well as for adults, which I will not touch on today. Many people welcomed the Government’s industrial strategy and their wish to tackle our low levels of productivity with more emphasis on skills training. How are we going to make any inroads into this problem if we starve the institutions with a central role in developing these skills? After cuts averaging 30% per annum between 2009 and 2019, the Institute for Fiscal Studies called FE the “biggest loser” in the austerity programme, and so it was.
To cite another important commentator, the Children’s Commissioner’s recent report showed that, by 2020, real-terms spending per 16 to 18 year-old will drop to the level it was 30 years ago. This means that we are spending the same amount per student aged 16 to 19 as we were in 1990, despite rising costs. It must be remembered that the spending review increase for FE is for one year only, in 2020-21, whereas the schools have a three-year settlement. Why should there be a difference? Why is the promised extra funding for FE so small? I ask this against a background where 16 to 18 year-olds in England get an average of 15 hours of contact time a week, compared with 25 for students of that age in other OECD countries. This amounts to 600 fewer hours over a standard two-year course—hardly the way to improve our relative productivity position and, thereby, our competitive success.
There is also a failure to meet another government priority: to promote greater social mobility. Many of the most disadvantaged young people do not stay at school after 16, and many will never gain a university place. FE colleges can have a vital role in providing a route to the skills needed for a rewarding career and to becoming socially mobile.
In conclusion, funding is a fundamental challenge in FE, as the Augar committee made clear. Will the Government now make a firm commitment to the sector of £5,000 per student per annum? Only then will FE teachers receive the pay they deserve and students get the quality of education and training that they need.
My Lords, the great Freddie Trueman once played in a match against Oxford University. The young student coming out to face him was immaculate in his whites and absolutely perfect in his approach to the delivery to come. Trueman bowled and hit the middle stump; the wicket went clattering down. The young man adjusted his cap, walked past Trueman and said: “A damn fine ball, Trueman”. “Aye; it was wasted on thee”, said Freddie. I feel a bit like that speaking today, because this gracious Speech is a sham. The Times gave it away the day after the Speech, with its headline:
“Queen’s Speech sets out PM’s election manifesto”.
We are playing charades while the real battle takes place down the Corridor in another place. Even this afternoon, the Prime Minister, acting like Violet Elizabeth Bott, is threatening to pull the Brexit Bill if he does not get his way. The Government’s media claque grows ever more hysterical as Parliament resists being bounced into agreeing to a Brexit which is light years away from what was put to the country in 2016. I understand the desire of the noble Lord, Lord Willetts, to get on with things, but this decision will have an adverse impact on the prosperity and well-being of the people of this country for decades to come. It has been presented to the country with all the integrity of a second-hand car salesman trying to flog a car with a dodgy milometer and no logbook. To make the first priority of the Government, in the first line of the gracious Speech,
“to secure the United Kingdom’s departure from the European Union on 31 October”, is no way to deal with the deep divisions Brexit has caused. On these Benches we will continue to argue for a people’s vote, with a clear choice between the Johnson deal and remain.
Noble Lords’ contributions today have been of high quality, exposing the gaps in this election manifesto in disguise. I will refer to one or two of these. The online harms Bill was not directly mentioned in the gracious Speech, but a parallel statement assured us that a draft Bill will be published shortly and be subject to pre-legislative scrutiny, which I welcome. In the meantime, I urge the Government to reconsider their decision not to provide immediate protection for children from online pornography. I was astounded to see in last Sunday’s Observer an article quite out of the blue and with no explanation, with the headline:
“Farewell the ‘porn block’—a PR exercise and lousy policy”.
That did no justice to the work that has been done by my noble friends Lady Benjamin and Lord Clement-Jones, the noble Baroness, Lady Kidron, and others. It is a strange article for the Observer. There has also been an ambiguous attitude on the Labour Benches. I look forward to a clear statement of Labour’s policy on protecting children from porn. There is a real risk that we will talk for years while the danger is immediate. I urge this House to do what we can while we can, then get on with the pre-legislative scrutiny.
The gracious Speech, because it is designed to give some red meat to the Tory law and order campaign, has lots of promises of tougher and longer sentences in the fight against crime. But there is no mention of the strategy espoused by Michael Gove when he received the report on prison education by Dame Sally Coates in 2016, and endorsed by David Gauke less than a year ago, which determined to,
“put offenders on a path to employment as soon as they set foot in prison”.
The approach mirrors the attempt by my successor as chairman of the Youth Justice Board, Charlie Taylor, to run an education-led facility for young offenders. I make this reference because I believe that within our education policy rest a lot of the solutions to the problems facing the criminal justice system.
There is no mention in the gracious Speech of the need to extend the powers of the Freedom of Information Act to cover private companies carrying out outsourced public functions, as recommended by the Information Commissioner. Likewise, the gracious Speech is silent on the ongoing failure of the Conservative Party to carry out the recommendations of the Leveson inquiry into our press. The recent treatment of Ben Stokes, Gareth Thomas and the Duchess of Sussex is clear evidence that the press is still up to its bad old ways.
Finally, and returning in a way to education and to the theme that the noble Lord, Lord Howell, mentioned, we have to set in train the education and training to allow all our citizens, but particularly our young people, to be able to handle new technologies and new ways of receiving and giving information. I very much welcome the announcement today of the House’s Democracy and Digital Technologies Select Committee, under the chairmanship of the noble Lord, Lord Puttnam, but here again there is a real, live and present danger to our democracy. What worries me about the point the noble Lord, Lord Howell, made is that although we may say that small is beautiful, the power is still in the hands of the big corporations and they are misusing that power.
My Lords, like the noble Lord, Lord McNally, I too have found myself having to change what I had intended to say today, following an announcement by the Secretary of State for the Department for Digital, Culture, Media and Sport last week that the Government no longer intend to implement Part 3 of the Digital Economy Act 2017. The profundity of this announcement and its political implications for the Government have not yet made their presence felt, for the simple reason that the announcement was made, probably on purpose, in the epicentre of the Brexit storm. The simple political reality, however, that the Government cannot escape, and the consequences of which they cannot circumvent, is that the 2015 Conservative manifesto stated, on page 35, that,
“we will stop children’s exposure to harmful sexualised content online, by requiring age verification for access to all sites containing pornographic material”.
That was a simple, profound, high-profile manifesto commitment that brought hope to parents up and down the country and to children’s charities. You simply cannot make this kind of commitment, introduce the legislation, appoint a regulator, ask the industry to prepare for the law change and then suddenly make a U-turn and not expect serious political consequences.
The Government may have to face an election, and therefore they may want to think again too. The actions of the Secretary of State suggest that even seminal Conservative manifesto commitments cannot be trusted, so I gently ask the Minister why anyone should believe what they say after some of the events of last week. How will we know that key commitments will not subsequently be swept away because the Government claim to have better plans?
On the subject of better plans, one of my difficulties is that the Government have not really said what these better plans are, other than that they will find expression in the context of their work on online harms, further to the White Paper. This is particularly problematic because, although I have spoken to children’s charities and parents, no one has been able to tell me of a better way to prevent children accessing pornographic websites than through the introduction of statutory age verification enforced by a regulator IP blocking non-compliant sites. Moreover, no one can imagine a more efficient way of facilitating children’s access to pornographic content online from the day that statutory age verification would have come in than abandoning this commitment so that it does not come into force.
Hopes had been expressed that the online harms White Paper process might extend that protection to social media but, let us be clear, nothing can take the place of statutory age verification in relation to pornographic websites. The best way to deal with pornographic websites is not necessarily the best way to deal with pornography on social media platforms, yet the Government seem to be using a rather crude one-size-fits-all logic to justify not introducing the most effective mechanism for protecting children from pornographic websites, in favour of some vague commitment to an undefined mechanism that can address everything. All this is simply not credible. In the world of online safety, there are no one-size-fits-all solutions. I am pleased, of course, that the Government want to do more to prevent children accessing pornography through social media platforms, but they should not use this as an excuse to justify jettisoning the most effective and efficacious way of protecting children from pornographic websites—statutory age verification—especially having made it a manifesto commitment.
I wonder whether whoever came up with this idea actually reminded the Prime Minister that they were recommending that the Conservative Party renege on a headline manifesto commitment—better, surely, to have never made that promise than to make it, introduce the legislation, prepare industry and then change their mind.
I also think the Government should think very carefully about how it looks to have people vote for a manifesto containing a simple, clear commitment to introduce statutory age verification and to then subsequently go back to them and say, “We know you voted for this but now we have a better idea”. In the context of Brexit, where they are saying that the political class should take care to respect how people have voted and not come back and tell them that they know better, they should apply the same logic to themselves.
The other consideration in all this which should not be overlooked is Britain’s influence in the world. The Government were leading the way in this space and multiple jurisdictions were watching with the greatest interest, including within the EU. If the Government recover their nerve, Britain will still have the opportunity to play a key role in setting global standards on statutory age verification. It seems bizarre that we should invest millions in developing world-leading legislation and technology and then, through an apparent loss of nerve—and with no moral compass as far as honouring manifesto commitments is concerned—turn our backs on a great opportunity for Britain to help protect children, not just in the UK but across the world. I very strongly suggest that if the Government do not want to alienate parents up and down the country, they should rapidly reconsider their strategy and lay the BBFC age verification guidance before Parliament as soon as possible.
My Lords, please let us try to keep to six minutes; otherwise, when we come to the wind-up speeches, they will be galloping, rather than being able to give noble Lords the answers they want.
My Lords, I welcome entirely the aspiration in the Queen’s Speech that,
“all young people have access to an excellent education … preparing them for the world of work”.
I will speak briefly today about the education and training of those who are not in the youngest quartile and who need as much investment in their needs as students in their teens and early 20s. I remind your Lordships of my registered interest as chairman of the Chartered Institution for Further Education.
Adult learners can belong to a number of different groups: those who did not do well at school but now wish to make up for time lost; those who have decided, or been forced by redundancy, to seek a different career and need to be retrained; those who wish to be trained at a higher level in their present skills to help with promotion in their employment; and those who want simply to acquire new accomplishments. One criterion is nearly always present across these groups: that they are very well motivated to learn.
Yet it appears that we have been failing these adult learners for a very long time. During the past 10 years adult enrolments have diminished from 5 million to under 2 million annually, a fall of 62%. For those taking IT qualifications, for instance, the drop is a huge 89%. It would seem from these figures that many would-be adult learners can no longer find the courses they require from further education. Yet the Education and Skills Funding Agency tells us that there has been a national underspend in the adult skills budget in the last few years of £63 million in 2016-17 and £76 million in 2017-18. This is money allocated and available for adult education but unspent. Clearly, there is something wrong.
One obvious problem was that caused by the funding agency’s changes in recent years to the funding criteria. These changes in effect reduced the number of people who are eligible for courses. For example, those aged 24 and above could be funded for only level 1 or 2 courses, whereas we know that level 3 courses have the biggest impact on individual progress and therefore on national productivity. An inflexibility in the system has meant that, although funding has in principle been earmarked for adult education, the rules have often made it impossible to access for a large number of people. Thus many who would like to take those level 3 qualifications to improve their skills or chances of employment have increasingly had to pay for them themselves, which many find impossible, or take on a student loan, which can be very worrying for those on a low wage.
Hence, I welcome this year’s policy of devolving the adult skills budget to six combined authority areas and Greater London. This started to take effect on
The combined authority areas have about a third of all further education colleges and account for about half of the adult skills budget. For the other two-thirds of the country’s FE providers, government funding policy is still far too restrictive and can allow would-be adult students to be trapped in low-level jobs from which they cannot break free because they cannot afford to pay for the qualifications which would allow them to do so. Hence, it is imperative that the experiences of colleges and their adult learners in the combined authority areas are studied very carefully in the next year and that every effort is made to devolve more resources to individual vocational colleges and providers outside those areas in future. This could establish a far less rigid regime which trusts the professionals involved to know what is best for their students and to produce funded courses for them, suited to their needs and those of local employers.
It is absolutely essential that we get this right if we are to develop here in the United Kingdom the flexible, skilled and well-trained workforce we shall need to meet the productivity challenges that the next years will certainly bring to this country. I hope my noble friend will be able to reassure me on some of these issues.
My Lords, I declare my membership of the GMC, trusteeship of the Royal College of Ophthalmologists and presidency of GS1, the barcoding association. I too pay tribute to the noble Baroness, Lady Emerton; she was an undoubted tour de force over decades of leading the nursing profession. I particular remember her kindness in attending the badge-giving honours at the Heart of England NHS Foundation Trust, which I chaired; she came and spent about three or four hours with the nurses before travelling on to a meeting in Leeds. She is an extraordinary woman who gave so much to our health service.
The Queen’s Speech promised a Bill on the long-term plan, which I suppose is really a cover for getting rid of the calamitous Health and Social Care Act 2012. Any of us should welcome that, but the problem is that it does not answer the much more substantive question of how we will fund and develop a sustainable health and social care system over the next three decades.
The NHS has done wonderfully well in meeting many of the challenges it has faced over the last nearly 70 years or so, but no one can be in any doubt that, with the growing number of older people with comorbidities and the kind of good pressure that new technology and invention bring, the health service is struggling hugely. The CQC’s annual State of Care report, published only last week, shows that there is huge pressure on all health and care services. Waiting times for treatments are going up, and I fear that we will return to the bad old pre-1997 days unless we take decisive action. We have the wholly unstable adult social care market, which noble Lords have already referred to, and there seems to be general agreement that about 1.4 million people who ought to be receiving care at the moment are not.
The question is how we will respond to this issue. The Government’s immediate response is their own long-term plan, a new five-year settlement of around 3.4% growth per annum. That is of course welcome, in contrast to the years of austerity; when the demand was going up, adult social care was being reduced in real terms and for five years the health service received its lowest ever funding level since its foundation. Obviously, 3.4% real-terms growth is a great improvement on that. The problem, as anyone reading the IFS report on public finance going ahead will know, is that this is a temporary blip—we will return to austerity.
The report of the Long-Term Sustainability of the NHS Committee, excellently chaired by the noble Lord, Lord Patel, was very clear that we cannot go on having this short-term upfunding followed by reductions without any serious attempt to solve the real problem of funding health and social care over the next 20 or 30 years. There are no easy answers: it is pretty clear that the public and the political class as a whole will not see any change in the basic premise of a publicly funded service free at the point of use as far the NHS is concerned; it is also clear that public opinion does not favour any increase in charges. One way or another we have to persuade the public to pay more money through taxes to get us back to a sustainable growth figure.
The only possible way that we can do this is through some kind of hypothecated health and social care tax. It is probably not popular with the Treasury, or with many noble Lords. National insurance is the obvious way to do it; the UK take for national insurance roughly equals the amount we spend on health and social care in England, so it is probably the easiest way to do it. There would have to be changes—as my noble friend reminded me just now, the fact that many of us do not pay national insurance any more while still earning is clearly unacceptable. However, we have to think radically about whether we seriously want to go on funding our health service and whether we want a sustainable, excellent health service.
The committee of the noble Lord, Lord Patel, did not quite recommend a hypothecated tax, although I think that perhaps it was trying to get there. However, it recommended that we set up an OBR for health and social care as well. That is an excellent idea: an independent body giving advice on the long-term funding needs of the health and social care system, alongside workforce projections and demographic challenges. If you put the two together, that would be about the only hope we have of maintaining an excellent health and social care system in the future. The alternative is a long period of austerity with a little bit of growth, no certainty and a continuation of some of the pressures we see at the moment.
My Lords, children should not be able to see pornography. Sadly, there was no mention of this in the Queen’s Speech, but the Government need to act now to ensure this. It should be added to the same category as the introduction of seat belts and banning smoking, as mentioned by the noble Lord, Lord Young of Cookham.
I have been campaigning for over eight years to try to prevent childhoods being damaged by pornographic content. Eventually, in 2017, the Digital Economy Act was successfully passed to impose age verification controls to prevent children stumbling across and accessing pornography online. Last month, on
I have had concerns about the many delays in bringing in this legislation, such as the Government not notifying the European Commission of the BBFC’s guidance on age verification arrangements, which was an avoidable and unforgivable blunder. Interestingly, I was also told in confidence back in January that there were those in influential positions who did not want this legislation to happen. But I had faith in the Government that they would not let our children down.
By the Government’s own statistics, every month that passes, 1.4 million children access pornography. Therefore, every month this regime is delayed, millions more children will stumble across pornography. We are talking about violent sexual content, gang rape, real and close-up images of sexual acts, all just one click away because there are no age restrictions. The results of this cause children as young as four to be excluded from nursery school because of their sexual actions towards other children. Recently, a father contacted me to tell me how traumatised his eight year-old daughter, who loves horse-riding, was, after she typed in the word “stallion”.
Pornographic content is traumatic for children to watch and can directly impact on their adult relationships, including their understanding of consent and their long-term mental health. How can this Government justify any delay in preventing children facing this trauma on the grounds of “coherence”? Any new legislation is years away. But even if it was months, why wait? I visit Rye Hill prison in Rugby, which houses over 680 sex offenders. Many tell me that they wish they had never seen pornography as children. It has destroyed their lives.
All the child protection charities believed that this legislation is vitally important. Yet the Minister Matt Warman in the other place suggested that the NSPCC supported this decision. I cannot understand this claim, and I believe it should be withdrawn. I have here a letter sent on
The world is watching us, and this decision potentially has ramifications far wider than the UK. We had the chance to change things for the next generation of children so that their first concept of sex is not at the age of seven, stumbling across images of violent sex acts on their computers. The argument that children are clever enough to get round the age gate is ludicrous. We are not talking about 15 year-old computer wizards but about six and seven year-olds inadvertently accessing porn. In addition, the idea that, as an alternative to age verification, we should teach children about porn at such a tender age is completely outrageous. The notion that the privacy of adult visitors to porn sites will be compromised is misleading and untrue. Personal data will not be shared with porn sites.
I therefore plead with the Minister to speak to the Secretary of State and ask her, as a moral duty, to reconsider her decision so we can see this ground-breaking child protection standard in place in the UK by the end of the year. Childhood lasts a lifetime, so let us ensure that all children’s innocence is protected for as long as possible.
My Lords, I am very pleased to participate in this debate, which underlines the need for action to be taken to maintain our health provisions and to keep them—despite sometimes expressing to the contrary—among the best in the world. I speak as a founder lawyer member of the multidisciplinary Mental Health Act Commission, so I hope that noble Lords will understand if I concentrate on the issue of mental health this evening.
One in four of us will suffer at some time in our lives from some form of mental illness. I do not believe that that statistic is properly understood or appreciated. Other types of illness are easier to accept, and sympathy is more likely to be extended. Proportionally, the percentage of health spending on mental health is only 10%, despite a clear need for greater and more comprehensive resources in that sector. The needs are extensive but are still unmet.
Back in 1983, one of the aims of the new commission was to protect patients’ human rights and examine the legality of detention in appropriate cases. However, we were also obliged to suggest improvements in the system. As a result of our work, which dealt mainly with previously detained patients, we wanted to make sure that when they rejoined the wider community, proper social care and support was available for them. We were also charged with providing a report every two years, and in initial and successive reports we were obliged to point out the inadequacy of the social care in the community situation. That was over 30 years ago, and successive reports and comments that have taken place in the interim have suggested that we have not done nearly enough to put things right.
Since then, society’s attitudes towards those with mental illness have undoubtedly improved, but there remains a level of stigma, at worst, and disinterest, at least, in the subject. Luckily, we now have a much broader understanding of what mental illness may be. Many acknowledged conditions do not appear to fit within the strict category or interpretation but which are either close to it or have the effect of contributing adversely to the mental health of an individual. Obsessive compulsive disorders, depression, anxiety through stress and PTSD are clear examples. The mental health of those who are autistic is also often overlooked. The incidence of mental illness in this group is substantial. All this requires a more individual approach tailored to specific needs. This should include not only sharp-edge treatment and resource but, in appropriate cases, obtaining suitable employment, where discrimination and other obstacles are in the way.
I therefore hope that the Government’s promise of 1,000 more staff—which, if one divides that across the country, I suggest is still inadequate—and the £2.3 billion of extra investment proposed in mental health will be not only implemented but used in a really effective way, and in such a way that the individual needs of more people can be sympathetically and effectively met, along with a greater understanding of mental health issues, which I think we all agree as necessary.
My Lords, I add my appreciation to that of others for the contribution of the noble Baroness, Lady Emerton, to your Lordships’ House. She has been not only a spokesman for nursing but a stalwart in maintaining standards in the profession. We will miss her wise counsel in our proceedings.
The humble Address refers to new laws to establish an independent body to investigate serious healthcare incidents—no, not health service incidents, as in the new Bill. I will come back to that later.
“There is an acute need for the Government to follow through on its commitment to turn the NHS in England into a learning organisation; an organisation where staff can feel safe to identify mistakes and incidents without fearing the finger of blame”.
The Bill achieves that objective, but its remit needs to be wider. The Joint Committee’s report, in its recommendations 4 and 5, was clear that the legislation should be called the healthcare safety investigation Bill, and consequently should establish the healthcare safety investigation body—the HSIB—in statute. Indeed, it was originally referred to as such. The committee wished the remit of the HSIB to be extended to the provision of all healthcare in England, which of course includes the private sector. The Government in their response agreed to look at that in both the title and the extent of the remit of the new body to investigate independently funded healthcare in England.
I make that point because, in the recent Sellu case, in which a surgeon was sent to prison on gross negligence manslaughter charges and later exonerated on appeal, there was evidence that the root-cause analysis of the surgeon’s work at the Clementine Churchill Hospital, a private hospital, which showed evidence of system failures, was effectively buried and not made available at the original trial. Extending the legislation to the private sector would prevent such failures in future and ensure equal standards between the NHS and the private sector. Can my noble friend confirm whether that recommendation will be accepted? If it is not accepted now, will an answer be provided during next week’s debate on the Bill?
Another area of concern in the Bill relates to the safe space, an approach used for many years by the air accident and other transport safety investigation bodies, which has contributed to improved safety in those industries. This approach has been challenged by coroners and other groups but is strongly supported by the Joint Committee. I am sure we will discuss this at length on the Bill, but assurances from the Government at this stage would be welcome and would give participants in the Healthcare Safety Investigation Branch confidence that information they share candidly will be investigated and protected. I declare an interest as chairman of the Confidential Reporting System for Surgery. We have supported the work of the Healthcare Safety Investigation Branch, and look forward to working collaboratively with the new body in future.
Another area of the Queen’s speech relates to shortages in the workforce and the need for more investment. Nowhere is this more urgently required than in mental health—we have heard much about that already today. It is encouraging to read of the pilot scheme to recruit 1,000 additional staff as part of the £2.3 billion extra investment in mental health in the NHS long-term plan. However, Sir Simon Wessely, previous president of the Royal College of Psychiatrists, in his independent review stressed the need for capital spending to restore the fabric and conditions of many of our institutions. I hope that will be part of the £1 billion boost to NHS capital spending promised for 2020-21.
My Lords, the first question one should ask about any Queen’s Speech is: what is the overall objective of government policy? Is it the nation’s wealth? Is it the well-being of the citizens? What is it? To have coherent government, you must have an overall objective against which to measure policy. More and more people worldwide are demanding that the objective should be human experience—the well-being of the people—and I agree with that.
How does the Queen’s Speech stack up against the objective of well-being? Not well, I fear. To see this, let me compare the Speech with a recent report from the All-Party Parliamentary Group on Wellbeing Economics. The report addressed the key issue of what priorities for public spending would be if it were targeted at the well-being of the people—at the things that people really worry about. It concluded that the top four priorities were: better mental health services, which many noble Lords have said; secondly, child well-being and schools; thirdly, further education and apprenticeships—the transition to work; and, fourthly, social care. Of those four objectives, none of the first three appears in the Queen’s Speech, although they are things that parents—and all adults—are crying out for positive action on. Instead, the Speech is full of punishments of all kinds and the new strategy for the nation’s physical infrastructure. Those are the main priorities in the domestic part of the Speech.
What about the social infrastructure of our country? Over the past 10 years, we have closed hundreds of children’s centres, youth clubs and community centres. We have produced a crisis in child mental health. What is the sense of spending what new money we have on, for example, building high-speed rail, before we have rectified the desperate shortcomings of our social infrastructure? Many argue that the top priority must be physical infrastructure because that is what the market is willing to fund, because it gives a financial return, but so does social infrastructure. I shall give some examples from the field of mental health.
The NHS programme for improving access to psychological therapies has been found, within two years, to save more in reduced welfare benefits and reduced physical healthcare expenditure than the total amount spent on the programme. The net cost of the programme is zero. Similarly, if you are worried about adolescent knife crime, a proven method is to train the parents of badly behaved youngsters when the youngsters are aged five to seven. This training has been shown to reduce anti-social behaviour 10 years later by well over half, and it costs very little. Remarkably, we used to have such training. We had 4,000 people trained as parent trainers but, under the coalition Government, those services were cut as part of the general cut to social infrastructure. Those people are still there and are ready for re-employment—if only we put our next available money into that kind of provision.
As has been said, we have to upgrade and accelerate the general rollout of mental health services in schools, and the teaching of life skills in the school curriculum. These are key to producing a happier generation of children, and a generation that causes less trouble to adults. What is so depressing about the Speech is its almost totally punitive approach to any kind of behavioural problem. The word “rehabilitation” appears once and “prevention” never appears, yet there are good psychological treatments and preventive programmes for all kinds of behavioural problems, such as domestic violence, which is rising in priority, and family conflict. Only small sums of money are needed to make major inroads into these problems. How much more important to do this than to build yet another bit of high-cost physical infrastructure.
On further education, I had high hopes of the Government because they said it would be a priority. Very little money has been provided so far—only one year of it—and no programme has been announced for how to deliver the universal rights to level 3, which the Augar report recommends, which in turn requires that we remove the cap on further education, just as we have removed the cap on university and higher education. All these deficiencies come from there being no clear overall objective of government policy to influence priorities. The time has come for every political party to commit to the objective of well-being and to support that with a social infrastructure strategy. I very much hope that the next Queen’s Speech will do just that.
My Lords, yesterday my noble friend Lady Bonham-Carter covered a range of aspects of arts and creative industry policy, so I will focus on digital policy during today’s debate—but I hope my noble friend will have the benefit of a reply to her questions from the Minister at the end.
Digital technology and communication are now prevalent throughout our society and economy and are having a profound impact on all our lives, but it is clear that major differences with this Government of timing and priority for action are now emerging for many aspects of digital policy. This is the case above all on age verification. The Secretary of State has announced a huge delay in a policy which we debated in this House at length. I strongly agree with my noble friends and the noble Baroness, Lady Howe: this is a truly shocking and unfortunate decision. All the adult sites were preparing to install these robust mechanisms. What is the Government’s real aim? Is it to let these adult sites off the hook? Have they somehow decided that age verification is not workable? If that is not the case, when should we expect the introduction of this crucial policy? How will this impact on the anticipated age-appropriate design code when age verification is used as the default protection mechanism? How will the Government respond to the obligations of the revised Audiovisual Media Services Directive, which will enter into force in September 2020? The Government need to urgently reconsider this matter.
As regards online harms, it is widely agreed that tech companies should no longer be able to avoid responsibility for content on their sites. We agree that a statutory duty of care, properly framed, can protect the safety of the user and, at the same time, respect the right to free speech, allowing for a flexible but secure environment for users. The task of regulation in this area should fall to Ofcom. With its clout, experience of drawing up codes in sensitive areas affecting freedom of expression, understanding of how technology and content converge and experience of co-operating with other regulators, it is the most sensible choice. Given the complexity of the issues, and the need for clear definitions, we welcome the prospect of pre-legislative scrutiny of a draft Bill setting out the new regulatory provisions. Indeed, on these Benches, we suggested it. How do the Government intend that this is carried out? When can we expect the draft Bill, and will it designate Ofcom as the regulator so that it can start preparations?
Competition regulation for the digital industries needs to be substantially strengthened so that the importance of data as an asset is recognised and we prevent data monopolies that form barriers to innovation. We need to build on the recommendations in the Furman review, which recommended a new digital markets unit to ensure that we are abreast of these issues. When is the Government’s response to that report going to emerge? With which regulator will the new unit sit? Have the Government made a decision?
Online gaming and e-sports are becoming immensely popular hobbies for individuals of all ages, especially for our younger generation. They provide a positive outlet for creativity and a level of global communication the likes of which have not been possible for the generations before them. But we must also consider the negative consequences of new forms of online gambling for young people, such as loot boxing. What are Government doing in response to the loot box phenomenon? How are they responding to the Digital, Culture, Media and Sport Committee’s recent recommendation for a ban on these for children? Will they carry out a review of their impact?
In recent days, live facial recognition technology has been described as potentially Orwellian by the Metropolitan Police Commissioner, and deeply concerning by the Information Commissioner. The Home Office’s own Biometrics and Forensics Ethics Group has questioned the accuracy of live facial recognition technology and noted its potential for biased outputs and biased decision-making. The Science and Technology Select Committee recommended an immediate moratorium on its use,
“until concerns over the technology’s effectiveness and potential bias have been fully resolved”.
In this light, will the Government support my Private Member’s Bill, shortly to be introduced, enforcing a moratorium on this technology—pending a review—to assess the right form of regulation?
Even more prevalent than this technology is the use of algorithms in decision-making by public bodies. One in three councils is now using computer algorithms to make decisions about benefit claims, despite evidence emerging that some systems are unreliable. Are we not endangering public trust in artificial intelligence in a major way? When will this Government regulate this kind of decision-making by algorithm?
Fear and lack of trust in technology are very strongly related to the future of jobs and skills. AI in particular will have significant implications for the way in which society lives and works. The future.now initiative, recently launched by the Lord Mayor, Peter Estlin, recognises that there are some 17.3 million people in the UK without the necessary skills for work—but, despite this, the Government’s national retraining scheme is only at pilot stage. What can the Minister tell us about the rollout of the national retraining scheme?
In terms of the skills we should be nurturing, as a number of noble Lords have said, it is very clear that these should be not just tech skills, such as maths and coding, but social and creative skills. Are the Government taking on board the recommendations of the Durham commission, which so cogently set out the case for creative skills?
Above all, the black cloud of Brexit looms over the thriving tech and digital sector. What can the Government tell us about their preparations to seek data adequacy, which is so important for the tech and digital industries?
My Lords, in my brief speaking time, I will focus on three important issues: first, the Government’s proposals to reform adult social care; secondly, the NHS long-term plan, prioritising prevention in an ageing world; and, thirdly, the Domestic Abuse Bill.
While I welcome the additional funding that the Government have announced for social care, what legislation can this House expect to scrutinise in this Session—or, perhaps I should say, the next Session of Parliament? Over the past 25 years, we have seen a lot of policy reports on how to reform adult social care but little substantive action. The problem has not gone away and will not do so until it is solved, which is why I hesitate to recommend another report to the Minister. She will no doubt be aware that, in July this year, the Intergenerational Fairness Forum, which I chair, published a cross-party report, Sustainable Funding for Social Care & Intergenerational Fairness. It put forward a range of recommendations seeking to build consensus through the prism of intergenerational fairness. In brief, the report recommended a Dilnot-style funding system built on a national pooling of risk, with a means-tested threshold for personal contributions and a cap on overall care costs. This would be partly paid for by a 1% social care insurance contribution for those aged over 40 until they retire and the replacement of higher-rate pension tax relief with a new, flat-rate relief below 40%, along with other tax and benefit changes to meet the existing, unmet demands for care. I hope that the Minister will consider these suggestions.
On the NHS long-term plan and prevention, I welcome the commitment to strengthen our NHS by addressing workforce shortages and improving service delivery, building on the set of recommendations published by the NHS last month. According to projections by the Nuffield Trust released this year, there is a current shortage of one in 12 NHS staff. Strengthening the NHS is especially important in the context of an ageing society, as recognised by the Government’s healthy ageing challenge. We know that there are currently 10 million people aged 65 and above living in the UK; that number is expected almost to double, to 19 million, by 2050. This means that we will see greater strain on health services still, and a growing number of limiting co-morbidities that require more costly and complicated secondary and tertiary care services. To ensure the future sustainability of our NHS, and to support people to lead longer, healthier and more productive lives, the prevention of ill health is crucial.
Therefore, I welcome the fact that,
“The Long Term Plan sets out how Government will improve the prevention, detection, treatment and recovery from major diseases, including cancer, heart attacks and strokes”.
However, the ambition should go further and be global, which is why the International Longevity Centre UK has launched an international programme of work, entitled “Prevention in an ageing world”. It is estimated that, in 2017 alone, 27.1 million years were lived with disability due to largely preventable diseases; that number is projected to increase by 17% in the next 25 years if we do not prioritise the prevention of ill health right across the life course. It was therefore welcome that the G20 leaders’ summit in Osaka this summer—and the G20 Health Ministers only last week—pledged to promote prevention across the life course. I hope that the Minister can help ensure that the UK positions itself as a world leader in the prevention of disease.
On the Domestic Abuse Bill, I am largely pleased that the legislation has now been carried over from the last Session, and I look forward to this House’s scrutiny of the Bill when it reaches us. However, I am concerned that the Government did not accept the recommendations of the Joint Committee, which considered the draft Bill, regarding the definitions of the “same household” criterion and “personally connected”. We may also wish to clarify further how abuse by carers is covered by the Bill, because domestic abuse is more than just abuse by a spouse. Depending on what amendments the other place makes to the Bill, I suggest to the Minister that we may wish to amend the Bill particularly in this respect.
My Lords, given that the Queen’s Speech was little more than a poorly disguised election gimmick, it is surprising that there were no new proposals for legislation or policy on education, never mind higher education. To recap: the Government have failed to respond to the Augar review, published in May 2019, or to bring forward their own proposals for a sustainable model for HE funding. The Conservative-led coalition Government trebled tuition fees, overseeing a system in which the average student now graduates £50,000-plus in debt, while students from the most disadvantaged backgrounds graduate with an average debt of some £57,000. The system urgently needs to be reformed. Labour has committed to scrapping university tuition fees so that education is genuinely free for all and students do not face the prospect of a lifetime of student debt simply for seeking a decent education.
On HE funding, this is all the Government have to say:
“We are committed to making sure that higher education funding reflects a sustainable model that supports high quality provision, maintaining our world-leading reputation for higher education and delivering value for money for both students and the taxpayer”.
In a nod to parental concerns about what good value looks like, they added:
“We want to ensure we deliver better value for students in post-18 education, have more options that offer the right education for each individual, and provide the best access for disadvantaged young people”.
As part of a search for the safety of the long grass, they added finally:
“We are undertaking a review of post-18 education to ensure we have a joined-up education system that is accessible to all”.
Who can argue with much of that? However, it is clear that the current funding system is not working for students, nor for those in FE and HE providers.
Meanwhile, universities are struggling to manage the impact of successive real-term cuts in their budgets. In the face of wage inflation and increasing pension contributions, not only does this have an impact on teaching, vital services and staffing, as costs outpace income, but it also makes forward investment planning more difficult, storing up problems for future generations and for students themselves. The system urgently needs to be reformed, yet the Queen’s Speech made no reference to the Augar review—no doubt in fear of raising expectations that cannot be met, as I said.
At the time, the previous Education Secretary promised that the Government would,
“come forward with the conclusion of the review at the end of the year, at the spending review. That has always been the plan”.—[
In the absence of the Government’s response to the Augar review, will the Minister set out a timetable for bringing forward proposals? Surely we have waited long enough. Universities need us to end the uncertainty, not least because our universities have to compete for students in a global market to ensure funding.
On widening participation, the Government say that they want to,
“provide the best access for disadvantaged young people”.
However, their decision to abolish grants worth £3,500 and replace them with additional loans that will have to be repaid was a mistake—a mistake that has left some of the poorest students saddled with a lifetime of debt. The Queen’s Speech was an ideal opportunity for the Government to announce the reinstatement of grants and a policy that would have been warmly welcomed across the House. It is therefore disappointing to see such a glaring omission at a time when income disparities are rising and are at their widest ever. In visiting universities over the past few months, I have been impressed by the steps that many of them are taking to change their demographic and widen participation. Birmingham is a particularly good example, with its dedicated support to students from hard-to-reach communities. Why are the Government not making this happen as standard?
Immigration policy is also an area of concern for the higher education sector, given that universities are dependent on overseas students for financial support and because of the tie-ups on international research projects. The Government’s Queen’s Speech pledged to introduce,
“a more accessible visa system to attract global scientific and research talent”.
This rings a bit hollow. It is worth reminding ourselves that 12% of the world’s international students attend UK universities and, as other Peers have noted, four of the top 10 global universities are here in the UK. We welcome the Government’s policy on work-study visas offering international students a two-year visa after graduation, up from the absurd situation they inherited under Theresa May. Can the Minister advise us of when the new system will come into play? Will it apply to entrants starting in 2020 or for students who are currently here, and how has this change been promoted? Given that the restrictions on post-study work visas was blamed for a drop in international student enrolments, communicating the U-turn will be key to reversing this trend by ensuring that prospective overseas students see the UK as a possibility.
On research and development, the Government said that they would be setting out plans in the autumn to significantly raise and boost public R&D funding. The statement has attracted support, but the other statement on introducing a US-style advanced research projects agency has alarmed the research community as it seems to miss the key point about research in UK universities. We need stability and certainty, something which at present is sadly missing. According to the Royal Society, since 2015 funding for Horizon 2020 has fallen by 28%, or €0.5 billion, and UK applications have dropped by a third. It is understandable that leading researchers do not want to gamble with their careers when they have no sense of whether the UK will be willing and able to maintain its global scientific leadership.
Through the Queen’s Speech, the Government announced plans to create a UK equivalent of the US Defense Advanced Research Projects Agency and to cut down on research funding bureaucracy. Over the past two years, UK scientists have already witnessed a huge reshaping of the funding landscape with the formation of UKRI. With this in mind, how will such a new body complement the work of UKRI? Moreover, does the Minister share our concerns and those raised by academics that the research and innovation communities—
I am conscious of that and I am coming to a close. Does the Minister share our concerns and those raised by academics about the creation of a new and different process running alongside the current one?
Finally, we have uncertainties about the future of research funding in the universities that help to drive the innovation that is vital to our economy. This fictional Queen’s Speech is a missed opportunity to answer hard questions—questions that will not go away.
My Lords, I want to use the opportunity of the humble Address to raise the issue of disability. It touches on many government departments, most of which are the subject of today’s debate. There was a moment in the glory and glow of the 2012 Paralympics where we got it as a nation: it felt inclusive and it felt wonderful. We were super proud of our athletes’ achievements and then, well, not a lot happened. That window seemed to close.
Throughout my political life, I have always been an equalities campaigner. In the 2005 to 2010 Parliament, I led for the Liberal Democrats on the Equality Act. During the coalition, as well as being a Home Office Minister, I was the Minister for Equalities. There, as some of your Lordships will know, I was the originator and architect of the same-sex marriage Act. I produced the first transgender action plan in the whole world and then I was reshuffled to DfID where I spearheaded and introduced the Government’s work on FGM. However, the work I am perhaps most proud of is the inclusion of disability at the very heart of DfID’s work across the developing world, ably helped by my noble friend Lord Bruce of Bennachie, who was then chair of the Select Committee.
The first lesson I learned when I made disability my priority as a DfID Minister was, “Nothing about us without us”. Key members of the disability lobby became my incredible advisory board. I took Ade Adepitan, the gold medal wheelchair basketball player, with me to Uganda on my mission to mainstream disability into DfID. He played basketball with the local Kampala team. The side he was on won by about 100 to one, which was not surprising because he was amazing. At the end of the game, the players were able to ask questions. They said that they could not play properly because their wheelchairs were so bad. Ade gave them what for. He said, “I practise for eight hours a day shooting 600 baskets. That is why I am good. Practice is what makes you good, not your wheelchairs”. That evening, both he and I gave speeches to the invitees at a vast party. Afterwards, a guy from the World Bank came up to me and said, “I’m building 300 schools here. I had not thought about this, so I will go back and change all our plans to make them fully accessible”. A guy from G4S came up to me and said, “I have a budget for corporate responsibility in Kampala, and I am going to buy the whole team new wheelchairs”, so they got them anyway.
What I have learned from my campaigning and my work is that, where there is political will, there is a way, and now disability is embedded in the DfID framework. While I have campaigned on women’s rights, trans rights, gay rights and international disability rights, it is glaringly obvious to me that there is one protected characteristic in the United Kingdom that is lagging behind in the equalities agenda, and that is disability. We in this House are fortunate to have amazing disability champions. I cite the noble Baronesses, Lady Campbell and Lady Grey-Thompson, my noble friend Lady Brinton, the noble Lords, Lord Low and Lord Shinkwin, my noble friend Lord Addington and many others, as well those who have unseen disabilities. There are others, and I offer my apologies for any omissions.
But how do you or I make the Government make this a priority? When it happens to you or someone close to you, you suddenly understand the hideous unfairness of what life deals out and the inequality that follows. The world may say the right thing—it may even have an Equality Act and a Disability Discrimination Act—but the lived experience is one of struggling. Some of your Lordships may know that two weeks ago, my noble friend Lady Ludford lost her husband, Steve Hitchins. She has given me permission to raise this here. Steve made an incredible contribution to political life as leader of Islington Council and more recently as chair of the Whittington Health NHS Trust, a role from which he had only recently stepped down. Three years ago, following a near-death illness, he had to have his whole leg amputated. Steve and my noble friend discovered, as have many before them, just how bad so many things still are when disability touches you or yours. I know that my noble friend will herself have much to say on this when she returns, particularly about transport.
There are of course many wonderful charities which fight this corner: Scope, Disability Rights UK, Leonard Cheshire, the RNIB and literally hundreds of others, all fighting for equality. The noble Lord, Lord Low, has said that:
“We must get away from the perception that disability rights are something that we in society out of the goodness of our hearts give ‘them over there, those poor disabled people’”.
He went on to say that,
“The advancement of disability rights is a shared task for all of us … for the rest of society no less than disabled people and their organisations”.
I could not agree more.
I am grateful to have the opportunity to say to the Government and to the Minister, who has just taken her place again, “Not good enough—not nearly good enough”. There is nothing in the Queen’s Speech that would remedy the lack of enforcement of the Disability Discrimination Act, help further with levelling the extra costs of disability, right the wrongs of the benefit system for those with disabilities or address any of the other campaigns of the disability charities. So I say to them: if you want to restore any semblance of decency to a Government which have in recent times appeared to be harsh and uncaring, perhaps making this resistant inequality a priority would help.
My Lords, it is a pleasure to follow the noble Baroness, who made a powerful and important speech. There are six themes on offer in today’s debate and I have chosen to speak about the one that is conspicuous by its absence from the gracious Speech, in order to fill the void where I believe that culture, creativity and the arts ought to be. I start by welcoming the announcement prior to the Queen’s Speech of a £250 million cultural investment fund for infrastructure improvements in regional museums and libraries. It is a timely response to a cri de coeur from museum leaders who have warned of a quiet crisis in infrastructure brought about by a decade of cuts to local and government funding. As welcome as this money is, though, it begs a question. In shoring up our museums, galleries, libraries and theatres for the future, are we doing enough to ensure that every citizen has an equal opportunity to access and enjoy them?
In 2015, the Warwick Commission on the Future of Cultural Value revealed a worrying lack of social, economic and cultural diversity in audiences and participants across arts and culture, with the higher social groups accounting for 87% of all museum visits. Cultural organisations up and down the country are working hard to address this imbalance through innovative programmes, marketing and the use of technology, but they do so with one hand tied behind their backs—trapped by the narrowing over the past decade of cultural education in schools. Report after report has detailed the reductions in hours and teacher numbers and the number of students taking arts subjects at GCSE and A-level, yet Ministers are still reluctant to acknowledge that there is a problem.
Like other noble Lords, I welcome the ambition to,
“ensure that all young people have access to an excellent education, unlocking their full potential and preparing them for the world of work”, but I regret that it does not explicitly include a commitment to reversing the decline in arts provision in state schools.
This is not just about providing the encounters with arts and culture that would diversify audiences of the future, nor even ensuring equitable access for every child to the rich cultural heritage that is their birthright. No, it is about social mobility, unlocking potential and the preparedness for work to which the gracious Speech refers. Evidence shows that learning through the arts develops core personal and employability skills —confidence, collaboration, communication, problem-solving and resilience—and builds the cultural capital that is crucial in determining who gets into the elite professions and who rises to the top. Independent schools have long understood this, selling themselves to parents on the basis of high-quality arts provision. Meanwhile, art is squeezed out of education for 93% of the population.
Studying arts subjects is also one of the most effective ways of developing creativity, a skill that experts predict will be the most valuable we can offer the next generation. We miss the point if we imagine creativity to be the preserve of artists alone. Without creativity there would be no innovation, no technological breakthroughs and no scientific discoveries.
Of course, science has its place in the Queen’s Speech, with a commitment to establish the UK as,
“a world leader in scientific capability”, to tackle some of the greatest challenges facing society. It is a laudable ambition, but it ignores the role of the arts and humanities in addressing these complex questions—the historians, anthropologists, ethnologists, philosophers, ethicists and artists who can provide the context, culture and understanding of human behaviour that will be key to driving sustainable change.
This prioritisation is not surprising. The Prime Minister’s most senior adviser has a long-held passion for science, advocating back in 2014 for,
“a civilian version of DARPA aimed at high-risk/high-impact breakthroughs in … energy science … quantum information and computing”.
The reference to this in the Queen’s Speech raises questions about the Haldane principle and the systems in place to separate government from decisions on which research gets funded. Perhaps the Minister can clarify whether this new agency is intended to sit within or outside the UKRI umbrella.
The Speech closes, as will I, with the aspiration for the UK to continue to play a leading role on the global stage. Our artists and creative organisations are among the UK’s greatest ambassadors, but their international standing has been built on the freedom to move people and equipment across borders without carnets, tariffs or visas. It is a sector dependent on importing specialist freelance talent and in which even the brightest and best can earn less than the £30,000 salary threshold proposed in the immigration White Paper. Its number one priority post Brexit is continued and reciprocal mobility to protect the sector’s success and the substantial contribution it makes to the economy, exports and employment across the UK.
Given this, perhaps the Minister might take away the suggestion that the more accessible visa system promised for scientific talent might reasonably be extended to cultural and creative talent too. As we work to rebuild our global reputation after Brexit, the soft power our artists and cultural organisations generate for the UK will be more important than ever before.
My Lords, when I hear the noble Baroness speak like that, I want her contribution to end with the word “Discuss”, that we might form ourselves into a seminar and take the subject further. But I must be disciplined and stick to the subject I have chosen rather than engage with the fruitful ideas we heard a moment ago. It is to do with the whole question of DCMS, the online harms process and pre-legislative scrutiny—we are promised a Bill eventually—and all the issues that we have already begun to discuss here but that are coming forward again in greater detail later.
The metaphor of the cliff edge has been in wide use in recent times. They are down the other end at the moment raising the possibility, or probability, of a cliff edge in the Brexit debate. In a speech over the weekend, a former Governor of the Bank of England said we may be “sleepwalking” towards another cliff edge of a financial nature. The cliff edge to which I will refer is the one that I believe exists in the whole world of developing technology and the use of the internet; we have discussed this at length in various debates. The exponential rate of the expanding reach of social media, the internet and information technology vastly outpaces the capacity of a legislative chamber to promulgate a piece of legislation that deals with something that is already yesterday’s story before we put our thoughts together and make it enactable.
Because, I have to admit, I start from a rather low base, I began this year by reading Martin Moore’s Democracy Hacked: Political Turmoil and Information Warfare in the Digital Age. It was a frightening read—very well researched, empirically based and threatening the very foundations of our democracy. The remarks I have heard about Russia’s readiness to interfere in the American election in 2020 just confirm the feelings I got from reading that book.
“a new economic order that claims human experience as free raw material for … extraction, prediction, and sales”.
I am about 250 pages in and almost having nightmares from what I read.
I am certain we have to do something, and the online harms process is the first instrument available to us. The noble Baronesses, Lady Howe and Lady Benjamin, and the noble Lords, Lord Clement-Jones and Lord McNally, have spoken passionately and eloquently about the age-verification aspect of what is now to be incorporated in the online harms Bill rather than to flow out of the earlier Act. That is certainly one aspect of it but from the conversations I have had, it seems to me that there are very serious matters for us to consider when we do this work together.
I would love the Government to assure me that the gracious Speech was more than just an election manifesto for a forthcoming electoral exercise by telling me what the timetable will be for producing the material that would lead to these debates. We had a consultation period that finished in July. When will all that material be processed and available to us so that we can put our minds to it, as well as the Government looking at it? What about this pre-legislative scrutiny? When? What is the critical path? As I say, we do not have time on our side. Developments in these fields of endeavour are threatening the very foundations of our society. We must have a sense of urgency about this. I have read enough to know that. I look forward to the contribution later from the noble Baroness, Lady Kidron, who will say it with much more astute and learned phrases than me.
My contribution to a debate of this kind necessarily has to be broad-brush. Can we sense an urgency in how we address the questions that flow from the very successes of the internet, which carry with them baggage of an altogether more threatening kind? It is quite incumbent upon us to show an ability to do precisely that.
My Lords, before I make my remarks it would be appropriate—given what they will be—to remind the House of my declared interests and the fact that I am dyslexic.
I wish to address the subject of how people from neurodiverse groups and those with other disabilities get through exams, given that, in the new culture, they must have good spelling, punctuation and grammar. We have got to the nub of it quickly. This new culture is here: people must all have these largely technical skills, even if they have a brain like mine. I have a bad short-term memory and bad language-processing ability, which means that I acquire these skills slowly.
This is most manifest in the apprenticeship system, or the new T-level system that it is threatened will follow it. I thank the noble Baroness, Lady Berridge, who has said that she will write to me to confirm this. This puts pressure on the people I have mentioned. From the information I have picked up, at the entrance-level requirement—which you must pass to get the qualification—between 30% and 40% of the marks will be removed if you use assistive technology that allows you to take the rest of the exam.
Once you have a job and the qualification, assistive technology will be provided through Access to Work. You will be provided with it if you are going to university with a disabled students’ allowance, but you will not get any marks for it if you happen to be doing an apprenticeship.
Many noble Lords will be thinking, “Why is he going on about this again? Didn’t we deal with it all those years ago in Children and Families Act?” The noble Baroness laughs, which is probably appropriate. We went through it all once because of the idea that you had to pass English to get through exams to become a carpenter or a hairdresser. Hairdressing was the first occupation that drew me to this issue because someone who had won a national prize was failing their apprenticeship because they could not pass the English test.
“we will include new text in the skills funding statement to remind education and training providers of their duty to support young people with learning difficulties or disabilities and of their responsibility for providing reasonable adjustments, including the use of assistive technology where appropriate”.—[Official Report, 7/1/14; col. 1474.]
Which is true? Is it this new obsession with making sure that you can spell properly, even though you have a disability that says you cannot?
Let us go a little wider. If you have a visual impairment and depend on similar types of technology, differently formatted, or if you are dyspraxic—another big group; between the two, that covers 15% to 20% of the population —which of those commitments is dominant?
All those in this House involved in education are on the Front Bench at the moment. The noble Baroness, Lady Blackwood, will be justified in asking for support from them—I appreciate that that is the situation—but how are we are going to deal with this issue? I do not want to spend another three years boring this House senseless trying to get another solution to this problem. Something has gone wrong. Can the Government give us an assurance that they will put it right—and as soon as possible?
My Lords, I shall speak on health issues in the Queen’s Speech and in principle on a pressing problem that needs government action but does not appear in the Government’s agenda.
I welcome the Health Service Safety Investigations Bill, with its focus on learning and not attributing blame or finding fault. This could transform morale in the NHS, which is fundamental to staff retention and high-quality care. However, it will achieve these benefits only if the blame culture of the many other NHS monitoring bodies is adjusted accordingly. I applaud the Government for that initiative.
The social care proposals, unfortunately, do not reflect the urgency of the situation for older people, those with mental health problems in particular, others and the NHS itself. Several other noble Lords have referred to this problem, in particular that there is no timeframe for the substantive proposals and legislative plans in this area to respond to this problem. Can the Minister give the House some assurance on that issue if at all possible?
I welcome the commitment to issue a mental health reform White Paper by the end of the year, which will pave the way for reform of the Mental Health Act. Can the Minister assure the House that legislation in that field will come forward in this Session?
I hope to contribute to work in these areas, but today I will focus on a health issue that could save the NHS billions of pounds and precious consultant time and which, in my view, should have been included in the Queen’s Speech. On
In the UK, the average cost of medical cannabis for a child with epilepsy is about £2,000 per month for the family, despite medical leaders in the field, such as Dr Mike Barnes, taking no fee for their work. Dr Barnes has spent hundreds of hours hacking through bureaucratic red tape and inertia for no fee. The high cost is due to the crazy rules which require medical cannabis to be imported on a named-patient basis for just one month at a time. The Government need to address this urgently. Bulk importation would slash costs. Cultivation licences are urgently required so that the medicine could be supplied locally and, again, more cheaply.
The Government need to remove cannabis medicines from the “specials” category and enable GPs to prescribe. Only then will the UK begin to come into line with the 50 other countries where medical cannabis has been legalised and patients are rapidly gaining access to the medicine they want and need. In all 50 countries, epilepsy sufferers are prescribed medical cannabis and in 49 countries pain sufferers benefit.
Another major problem in the UK has been the incredibly restrictive NICE guidelines. In its review of medical cannabis, NICE considered 19,491 research studies but dismissed all but four of them because they were not double-blind placebo-controlled trials. However, these trials are not appropriate to assessment of these plant products. I appeal to the Government to raise this issue with NICE so that the hundreds of thousands —probably close to 1 million—patients who suffer the unpleasant side-effects of approved drugs, or risk arrest by buying cannabis in the illegal market, can go to their doctor, get and prescription and improve their health.
In the meantime, drug science is doing its bit to tackle the problem. Professor David Nutt, notoriously sacked as chair of ACMD for telling the truth about the UK’s destructive drug laws, is one of the great experts on medicines and, in particular, medical cannabis. Drug science is doing some important work which will be launched in a couple of weeks’ time.
The NHS could save billions of pounds if medical cannabis was available at realistic prices at GP level. Hospital bed days, consultant appointments and costly medications could be saved. I hope the Minister can give some assurance about the Government’s determination to bring the UK into line with our leading European neighbours, Canada and others.
My Lords, it is a great pleasure to follow the noble Baroness, Lady Meacher, and I applaud her campaign. Recent years have seen a number of key changes to the UK pensions landscape, some concerning accumulation, such as auto-enrolment and master trusts, and some decumulation, notably pension freedoms. Some concern compliance and regulation, such as the charge cap, but, as the Pension Schemes Bill demonstrates, there is still much to do. On much, but not all, of it there is an underlying political consensus.
Auto-enrolment has rightly been acknowledged as a huge success, but data from the Pensions Regulator has shown that more than 9 million workers are not enrolled in a workplace pension scheme and, as usual, it is the low paid and those with several jobs, mostly women, who are missing out. What needs to be done to expand the scope of AE is well known and, although it is right to assess the impact of the 8% contribution level on opting out, we should make faster progress if we are to address the national challenge of undersaving. Expanding the scope to include the self-employed and others with non-standard forms of employment, lowering the age criteria and calculating earnings from the first pound earned will make a difference.
There is a long-standing issue concerning workers earning below the tax personal allowance whose employer enrols them into a net pay arrangement. Opportunities to address the inequity of tax relief for the low paid in these circumstances are not unfamiliar to HMRC. They exist and should be addressed.
As for pension freedoms, a policy introduced under the coalition Government without proper thought and analysis has proved to hold significant risks for savers and has left the FCA and TPA having to play catch up. Recent FCA data identifies that some 646,000 pension pots were accessed in the year to March 2019, with more than half withdrawn in full and almost half accessed without advice or guidance. This raises the prospect of avoidable financial harm, particularly from pension scams and unsustainable withdrawal rates. TPR and FCA research points to the increasing threat posed by pension scams.
We agree with the Government that it is high time to strengthen the oversight of pension saving, including powers to tackle irresponsible management of private sector schemes, and to have enhanced powers for the regulator. The “clearer, quicker, tougher” approach included in the Bill for TPR looks to be headed in the right direction, but it will have to be tested in Committee.
Nearly two-thirds of UK adults have multiple pension pots, which is not surprising given that the average person will have around 11 jobs over their lifetime. The PPI’s last pension survey revealed that 6% of unregulated pots are considered to have gone missing by providers, amounting to a staggering £10 billion. This is why we support a pensions dashboard that will compel providers to make consumer data available. It will increase individual awareness and understanding of their pension information, but we are mindful of concerns expressed about the absence of representation from the auto-enrolment sector on the steering group. How such arrangements are to be structured and operated will be important. The quality of scheme data will be fundamental to its success. Recent research has found that to be trusted, the dashboard should be government-funded. How do the Government respond to this?
Our consideration of pensions policy has hitherto been typically a binary matter characterised by DB or DC schemes. There is another way; the noble Lord, Lord Willetts, mentioned it. In 2017, following on from but not implementing the provisions of the Pension Schemes Act 2015, Royal Mail and the CWU agreed a new pensions arrangement: a collective defined contribution arrangement, as used in the Dutch and Danish systems. Multiple studies show that in the right circumstances a CDC can give a better outcome than others available, but it needs to be understood that that it is not guaranteed. It also needs to be understood that a CDC provides a target income, and work needs to be done to ensure that workers are aware of that and properly informed of its implications. We know that CDC schemes enjoy the support of the CBI, the TUC, the PLSA and the DWP Select Committee. Indeed, the RSA and the Pensions Policy Institute have been promoting a regulated form of CDC for a number of years. The Bill contains much that we have to examine, notwithstanding that we inherently support the CDC approach.
My Lords, I shall speak on education, although this is stretching the Queen’s Speech way beyond its content. As my noble friend Lord Storey and others have said, the only mention of it is:
“My Ministers will ensure that all young people have access to an excellent education, unlocking their full potential and preparing them for the world of work”.
That is hardly controversial, but it would be good to know just how the Government think they are preparing young people for the world of work with their constant focus on academic GCSE and A-level results at the expense of vocationally talented and motivated learners. Do the Government never make the connection between the growth in gangs and violent crime among young people and the fact that their compulsory education has left them alienated from learning, with a lack of self-confidence and self-respect because Shakespeare and algebra were not their skill set? Had there been encouragement and opportunity to work on cars, plumbing, construction, catering, hairdressing, caring or the arts, how different their lives after school might have been, but schools are not measured on practical achievements.
I declare interests as a fellow of Birkbeck, which has adult and lifelong learning at its heart, and as a vice-president of City & Guilds, which for more than 140 years has provided highly respected and well-understood employer-led vocational qualifications.
Preparation for the world of work depends on careers information and guidance at the earliest stage—certainly at primary school. The country faces a critical skills shortage and all the encouragement we can muster should be going to those young people whose motivation and talents lie in areas where GCSEs will be, to a great extent, irrelevant. What are the Government doing to motivate those young people? They may gain no credits for their schools in the narrow definition of education against which schools are judged. They may wish to embark on apprenticeships, often in the teeth of the opposition of schools and parents who fail to understand just how important a skilled workforce may be, even if they cannot pass GCSE English and maths in the approved fashion.
Where is the Government’s encouragement for lifelong learning? We certainly need the skills of adults to make up for the shortfall in younger skilled people. The Augar report, which seems to have been conveniently parked, recommended much better funding and support for further education for adults and work-based education. I endorse all that the noble Lord, Lord Lingfield, said on this subject. Love Our Colleges has been an active campaign, because for too long colleges have been the Cinderella service of our education system, with lower funding and lower pay for staff than for school teachers, but with huge responsibilities put on their shoulders. This has to be wrong.
As Liberal Democrats, we would aim to rectify this and to extend the pupil premium to the age of 19, because deprivation does not stop at 16. The £400 million that the Government have announced marks the first meaningful investment in further education for 16 to 19 year-olds for more than 10 years. It is not enough to reverse the decade of cuts, nor to properly stabilise the sector for the future, but it is a good start. We would introduce a personal education skills allowance to give motivation and funding to adults to retrain and reskill at key points in their working life. We would encourage support for those who take Open University degrees, who are motivated by learning but deterred by funding.
Given my portfolio, I must address the dreaded T-levels. I echo all that the noble Lord, Lord Willetts, said. This innovation is mistimed, mistaken and flawed. Instead of building on BTEC and City & Guilds qualifications, which have long been the benchmarks for industry, the Government threaten to undermine such tried and tested qualifications in favour of untried, untested T-levels. The noble Baroness, Lady Barran, repeated the mantra that by renaming vocational qualifications as technical qualifications we would, at a stroke, solve the academic and vocational divide. If only life were that simple.
This Government will not be forgiven if, in pursuit of this latest initiative—which might well be one of many that founders in the course of time—they withdraw funding and support from technical, craft and vocational qualifications that have long served employers so well. I therefore appeal to the Government to think again on T-levels, to give more time to pilots and, meanwhile, to ensure that existing qualifications remain available and supported to work-based learners. I will not hold my breath for a response today as we do not have an education Minister here to reply, but the education team on these Benches will keep pressing the Government for action on further education and lifelong learning and for recognition of the very real value of practical work-based achievement.
We face huge skills shortages in this country: in construction, engineering, hospitality and the creative industries. We deserve an education system that meets the needs of learners and of the economy. Yes, of course we need to support our brilliant universities, but for the 50% or more who do not go to universities, let us celebrate their talents and the skills that they acquire that meet the needs of employers.
My Lords, the guiding principles of our health service are compassion, healing, prevention and equality. Every patient has their own concerns; all are to be treated as valuable individuals and not as units of whom we disapprove or with whom we have no empathy. Therefore, I again urge the Minister to find a way to show compassion and equality to a small but growing group of women who have frozen their eggs—a lifeline for women whose natural fertility is beginning to fade but who have failed to find a partner.
Typically, such women freeze their eggs in their early 30s, and the law is that they can be kept for only 10 years. Therefore, in their early 40s, when they might well think that the last possible chances of natural conception are ending, they will have to destroy those perfectly viable eggs. There was no logical reason for setting the 10-year limit. More than 1,000 women do this every year now, and the freezing technique has improved. The cost of egg removal starts at about £4,000, and then the woman has to pay whatever the clinic asks annually for storage—and of course she cannot refuse. At the end of this expensive journey, costing £7,000 to £8,000, there may be nothing except, to her, a mini death.
We should not condemn women who freeze their eggs because they cannot find a father for their longed-for baby. We should be sympathetic. The pressures on women when the biological clock is ticking are such that their psychological health is affected, and that is likely to make the forming of a permanent relationship even more difficult. No woman should be forced into the mindset of putting instant pressure on a new manfriend to procreate; or to settle for Mr Average or Mr He-Will-Do, rather than Mr Right, not least because such a man might not be the one to stick around and be a good father. Extending the time limit would actually lead to healthier practices, for a woman might then freeze her eggs in her 20s, when they are even more viable, rather than waiting until her 30s. Moreover, if her eggs have to be destroyed after 10 years, she may well resort to a donated egg, with the extra complications in that.
It has been argued that older motherhood is not a good idea and that a short storage period forces women to make up their minds. The law, however, lays down no upper age limit for the treatment of women. The law says that the clinician considering treating her should take into account the welfare of the potential baby and whether it will receive supportive parenting, thus each patient would be considered on the basis of her age, and there are plenty of births to over-40s these days. That is not to mention the lack of public disapproval of old men, such as the wrinkly old popstars on their fifth wife, whose new fatherhood is regularly celebrated in the media. It is not, therefore, for us or anyone involved to try to impose an artificial upper age limit on female procreation.
Another argument is that storage of eggs will increase to unmanageable proportions, but in the 40 years since IVF started, the number of embryos stored has increased by a huge amount without any trouble. Rules for storage for people who are, or are likely to become, prematurely infertile should be amended very slightly in order to accommodate the needs of women who have frozen their eggs. My Private Member’s Bill, about to be introduced, asks simply for consultation and suggests that where a woman has not yet completed her family—in her view, confirmed by a medical practitioner—the eggs should be stored for longer; that period could be confirmed by consultation, or could be 20 years, which really would be reasonable.
Women need the same ability as men to balance career aspirations and family- building. Extended storage gives them just this. They need a law that respects their human rights to a private life and to found a family. They need to be free of discrimination, for men can usually store their sperm for 55 years. Litigation about the human rights elements may take place, but how much more generous it would be for the department to consult and be kind.
A change would mean a great deal to many women and would have a profound and beneficial psychological effect on the way they lead their lives. Surely the Minister cannot deny the strength of this appeal to her better nature and that of her department. The Royal College of Obstetricians and Gynaecologists, the Progress Educational Trust and the British Fertility Society—in fact, the entire profession—have all written to her to urge consultation. The profession and the patients are united in calling for this. In these troubled times, a gesture of kindness would be profoundly welcome.
My Lords, I want to touch on the health service staff and on universal credit. I am very grateful to the noble Baroness, Lady Finlay of Llandaff, for raising the issue of hospital doctors on the third day of debate on the gracious Speech. She warned that more legislation would not lead to better care. There might well be some improvements for the health service in the long-term plan, but it does not take away the responsibility of the Government for their top-down reorganisation, their failure to fund the service adequately and their past treatment of staff.
In 2016 there was another important event—the referendum was not the only one. It was the hospital doctors’ dispute. The Government’s treatment of the hospital doctors was shameful. They were called greedy, while what they wanted was to be able to get home occasionally and spend more time with their families. Family breakdown and suicide rates are shockingly high among doctors, and professional support is patchy at best. Staff shortages through illness and failure to recruit put extra strain on all involved. Should we really be treated by doctors who are beyond exhaustion? The failure by the Government to deal with these issues will affect our health and that of the vulnerable in the future.
Let us not forget that the shortage of GPs was exacerbated by the Government’s action on their pensions. It became fashionable to attack public service pensions, and the outcome was that GPs decided to go in their thousands. Professor Ted Baker, the CQC’s Chief Inspector of Hospitals, has linked the issue of poor community care with the 50% of A&E departments that are failing. Patients are increasingly frustrated at not being able to have an appointment, and this will eventually be reflected in people’s attitudes to GPs and the health service. The Government use the right words, but their actions need to speak louder.
I turn now to universal credit. The Prime Minister has indicated his support for the continued rollout of universal credit. This is worrying in the light of so many structural problems. The DWP has hired 1,000 extra staff to develop a specialist intelligent automation garage. A unit based in Newcastle and Manchester is developing machine learning to check claims for fraud through 100 welfare robots. The details are secret, as the DWP has refused freedom of information requests to explain how it gathers data on citizens.
There are clearly huge benefits to be claimed from automated intelligence-gathering, but if the human element of the welfare state is being diluted, and the vulnerable end up in what has been described as a “digital poorhouse”, what are the human rights implications? As Ed Pilkington said in his excellent article:
“What happens if you are one of the five million adults in the UK without regular access to the internet and with little or no computer literacy? What if the algorithm merely bakes in existing distortions of race and class?”
There is evidence of a rising error rate. Some 5,700 people a month are affected by claims of incorrect data sharing between HMRC and the DWP. I ask the noble Baroness for assurances—if not tonight then after the debate—on human rights, transparency, the objectivity of algorithms being used and on how vulnerable claimants will get to speak to a human being.
Turning to the “controversial Managed Migration pilot”—not my words but those of the Secondary Legislation Scrutiny Committee in its seven-page commentary on
“on the cusp of the summer recess”, and three months after the High Court judgment, using the negative procedure when it was clearly a matter for the affirmative procedure. Members of the House described it as “disrespectful to Parliament”. The Secondary Legislation Scrutiny Committee described it as a “tactical ploy”. I describe it as sharp practice. It has been stated that the DWP will publish an “evaluation strategy” by the end of 2019 and publish the evaluation of the pilot before returning to Parliament with further legislation to continue migration activity. Can the Minister say when the evaluation will be available to Parliament and when there will be a debate in this House on the managed migration pilot?
Finally, I will say a brief work on universal credit and the self-employed. I have said many times that UC is not fit for purpose for the self-employed because of its clunky methodology known as the “minimum income threshold”. It is estimated that about 700,000 families with at least one self-employed earner will claim support from universal credit. A study by Policy in Practice has revealed that this figure is likely to be a significant underestimate, which makes it all the more important for the Government to look at it again, and in particular at the vulnerable self-employed. If nothing is done, they too will end up in the digital poorhouse.
My Lords, I refer to my interests, as listed in the register.
It is welcome that the Government have referred to social care in the gracious Speech. However, adult social care is in crisis and has been for a number of years. The issues of cost and funding will only get more difficult if Governments are not willing to see the social care sector through the same lens as they see the NHS. As a provider of homecare over the last 20 years, I am aware that, with a reduction in funding and in the time available for care workers to deliver care calls, the increasing requirements imposed on providers by local authorities cannot be met.
We all recognise that we have a growing ageing population. Living longer should be not a burden but a celebration. It should be recognised as a sign of improved living standards. However, it appears that, although politicians are willing to go out and actively and publicly claim their admiration and affection for the NHS—they are absolutely right to do so—it is not about loving the NHS so much as loving the people who work in it and the people who are looked after by it. Why cannot politicians do the same in relation to the incredible and challenging work carried out by those delivering adult social care within our communities? Millions of people depend on the services of trained, poorly paid care staff, who provide a lifeline to families struggling to care for their loved ones.
I will focus on adult social care, predominantly around the older age group. Care staff deliver care across all age groups and to people with varying degrees of disabilities, whether they are physical or unseen disabilities. For far too long, the social care sector has required a fundamental shift in how that care is delivered. Instead of tinkering around the edges with intermittent small injections of funding to fend off crisis after crisis, a total rethink is needed of how care within the community setting is delivered. There is already a challenge in making the care sector an attractive place to work. Pay is low and the working conditions are deeply challenging, and an expectation of increasing responsibilities is making care work an ever-demanding job that offers few benefits but increases stress for both care workers and families.
Recruitment in the care sector has hit an all-time low. Providers are worried about the tone that has been taken in the Brexit debate on immigrants and immigration, and they fear that care provision will face serious employment problems. Filling vacancies is already extremely difficult. It is unrealistic to assume that the gap will be filled by local people because, as is evident in the NHS, those posts have always required immigrants to come in to support our critical infrastructures. The Government are talking about a points-based system and skilled workers being welcome in the UK. However, unless we are able to provide home-grown workforces to deliver for an increasingly ageing population, our hospitals will have further expensive challenges thrust upon them.
A realistic and pragmatic approach has to be taken to respond to the challenges that we face. Unless there is a fundamental shift in how care provision is viewed in this country, people who have worked throughout their lives and contributed to the growth of this great nation will increasingly be airbrushed out of society and out of government commitments. They are not seen as vote-winners or contributors. Although we have a housing crisis, it should not be acceptable for people wishing to downsize to smaller properties as they get older to have no available provision, or choice about where they spend their later years. Going into a residential home or a nursing home should not be among the few options available. It seems that, once you have less to offer, you are redundant and surplus to requirements, and can be put out of sight and out of mind. What a reflection of the country we are becoming.
The one inevitability in our lives is that we will grow old. Surely, it is not beyond our wit to develop a care system that provides care, dignity and independence. The feedback that we continually receive from our clients and their families is that care must be about more than just addressing physical needs such as washing, showering and toileting. It is about mental well-being and continuing to engage with the community at large. It is about being socially active and feeling valued. Offering a more holistic approach to care in a community setting would fundamentally reduce the pressures associated with people having to visit the NHS.
Although we talk about NHS staff with affection, care staff in the community are viewed in a completely negative way. Both systems support people in our communities, yet the care sector, which acts as a complete support system for millions of families, is, unfortunately, disregarded. I urge the Government to rethink how care provision is delivered and funded, and not to make it the Cinderella arm of looking after people. The demands associated with health and well-being will not reduce; instead, as we grow in number, they will increase. Unless we see a fundamental shift in how care provision is funded and care staff are rewarded in their pay packets, this crisis will most definitely grow and create unsustainable pressure on the NHS.
My Lords, I am delighted to make the first contribution to this debate since the defeat of the Government’s programme Motion in the other place.
It is a long time since the last Queen’s Speech in June 2017, but now we have this one and another is due shortly. It is like waiting a long time for a bus and then seeing two of them come almost at once. However, this Speech is more manifesto than legislative programme. It promises that,
“Measures will be brought forward to support and strengthen the National Health Service”.
But those words may be just an election slogan, because the NHS long-term plan is under threat in several ways, and I will outline just three of them.
The first is the obvious lack of a specific funding plan to tackle the social care crisis. We were told in the gracious Speech that proposals will be brought forward to,
“reform adult social care in England”.
However, we were told in the 2017 Speech that:
“My ministers will work to improve social care and will bring forward proposals for consultation”.
Almost two and half years later, we are still waiting. Unless any new proposals are bold, and recognise what we need to pay for, then most, if not all, of the promised extra resources for the NHS will be taken up by looking after people in hospital who really should not be there. These people should be looked after in ways that they prefer, with greater independence and cost-effectiveness, at home or somewhere else outside hospital.
A second threat to the NHS plan is the Government’s lack of commitment to funding public health initiatives to address issues such as obesity, overconsumption of alcohol and tobacco smoking. The OECD estimates that obesity shortens lives by an average of 2.7 years and cuts GDP by 3.3%. It cites specifically the effectiveness of tackling the problem of obesity with measures such as the sugar tax, but this has been branded a “sin tax” by our Prime Minister.
So far, the Government are also failing to follow the successful lead of Scotland by introducing minimum unit pricing for alcohol. In fact, we are going in the opposite direction. Studies conducted using the University of Sheffield’s alcohol policy model suggest that cuts in alcohol duty over the last six years have resulted in not just the loss of £1.2 billion per year in revenue but over 60,000 additional hospital admissions. The additional costs to the NHS are estimated to be around £341 million.
Government funding is also being denied for cost-effective advertising campaigns which promote ways in which people are helped to quit tobacco. The amount spent on these campaigns in 2018-19 is less than half of that spent in 2015-16 and just 10% of the amount spent 10 years ago. Smoking remains the leading cause of preventable, premature death in the UK, killing around 100,000 people every year, which is around 300 people per day. The Government have committed to considering a “polluter pays” approach for the tobacco companies. Although there is no reference to this in the gracious Speech, I hope that they will now act on this principle to help deliver the additional national and local tobacco control activity needed to achieve their own target of a smoke-free England by 2030.
Thirdly, the greatest threat to the long-term sustainability of the NHS may be Brexit itself. The Government are clearly running away from producing an impact assessment of their Brexit deal. They know that our economy will be significantly smaller outside the EU than if we remained within it. Goldman Sachs estimates that the damage already done to the economy by Brexit over the last three years has been around £600 million per year. Brexit means less funding for the NHS and certainly not the additional £350 million per week that was promised. The economic facts contradict the claim painted on the side of that infamous red bus, which was probably the greatest lie of the decade. The NHS has serious staff shortages and Brexit is already causing some of the people we need to leave it.
It is astonishing that all this can be considered a price worth paying for changing our relationship with the EU from one in which we have a voice, a vote and a veto into one that means we will, like other neighbours of the EU, have to spend the rest of our lives negotiating with a much weaker hand than we have at present, accepting much of what we do not like in order to do business.
One reason for supporting Brexit is given by the tobacco lobbyists. They do not like the EU regulations to which we have agreed, which have successfully helped reduce tobacco consumption. Will the Minister confirm that, even if we are outside the EU, the Government will remain committed to maintaining exactly this kind of regulation and achieving the goals set out in their tobacco control policy?
My Lords, I am delighted to follow the noble Lord, Lord Rennard. I will concentrate largely but not exclusively on two subjects in the gracious Speech: education and culture. In many ways, these are intertwined, synonymous and mutually dependent on each other. Well, that at least should be the case. However, despite the huge success of the creative industries in this country and their significant economic contribution to the Treasury, I fear that there is real slippage in terms of investing in the next generation of creative artists.
During a recent Oral Question about government preparation for the future of subsequent generations, asked by my noble friend Lord Bird, I asked the Minister about reported financial threats to music hubs. These hubs have been deservedly lauded by the Government but have also been used as their “get out of jail” card when they have been tackled on the very real lack of music in schools and its disappearance from syllabuses such as the Ebacc. Concern over the funding of music hubs has been highlighted by widely reported comments from, for example, Sir Simon Rattle and the mother of the brilliant young cellist Sheku Kanneh-Mason. She said that his success would never have happened in today’s schools—a pretty sobering thought—and that the lack of state-school funding for the creative arts is creating a “two-tier culture”. Sheku, the winner of BBC “Young Musician of the Year”, was educated at a state school in Nottingham and his mother has expressed deep concern for the future of succeeding generations of children. The noble Baroness, Lady Stedman-Scott, graciously promised me a response on the financial security of music hubs from the Department for Education and I would be most grateful if the Minister could chase up this much-needed reassurance.
Exposure to the creative arts is not only a good financial investment. It also has a profound social dividend and should be the right of every child, not just the privileged. Being given the means to express joy, anger or frustration through the arts is cathartic. It helps to reduce friction and, potentially, violence. Playing in an orchestra or singing in a choir teaches children how to listen to each other and work as a team.
I move on to another concern widely held in the musical and arts world, which has already been voiced in this Chamber: that of the difficulty of travel post Brexit—especially when accompanied by a cello. Artists visiting this country already accept much lower fees than those offered on the continent. Promoters and orchestral managers really worry that, if increasingly stressful visa and travel arrangements are added to that, these artists, who contribute to the vibrant exchange of ideas, simply will not bother coming. For much the same reason, foreign students, who bring in cross-cultural ideas as well as vital funds, will no longer come to our colleges and academies. I know that the Government are looking at this and I would be grateful for any update on progress.
Finally, I move on to health—a drum I have frequently beaten. I think the only Private Member’s Bill to start in the Lords and make its way onto the statute book in the last Session was an amendment to the Children Act 1989. It related to FGM and strengthened the protection for young girls at risk from this barbaric practice, which has absolutely no foundation in either religion or medicine. I do not suppose that there is a single noble Lord in this Chamber who is not appalled by this and who does not think that mutilating a young girl’s genitals is an utterly abhorrent, and of course criminal, act. But the most recent figures from NHS Digital, where FGM must be reported if it is seen, show that, every quarter, between 1,000 and 2,000 cases are seen by health workers. So, despite enormous efforts by the Ministry of Justice and the Department of Health—I know how seriously they take this—we cannot and must not be complacent. We must continue to educate. I, for one, will continue to agitate until this loathsome practice is entirely eradicated from what we surely all like to think of as our civilised society.
My Lords, I too pay tribute to the gracious Speech. I declare an interest: I have family members who have worked in the NHS for many years.
In the gracious Speech we were told:
“Measures will be brought forward to support and strengthen the National Health Service, its workforce and resources”— so, a promise of new hospitals to replace leaking, creaking, not fit for purpose buildings. But why were they allowed to get into that state in the first place? While some 34 hospitals will receive £100 million in initial funding for development projects, the money will not be available for some years.
Over recent weeks, my attention has been caught by a number of reports on the NHS. Rachel Clarke, a palliative care doctor working in the NHS, wrote in the Guardian about staff trying to care for their patients amid collapsing ceilings, broken boilers and unsafe fire cladding. But she says that it is people, not bricks and mortar, that the NHS is really crying out for. The Care Quality Commission reported that more than half of the A&E units in England are providing sub-standard care because they are understaffed and cannot cope with the continuing surge in patient numbers. Sally Warren of the King’s Fund reports:
“Staff are working under enormous strain as services struggle to recruit, train and retain enough staff with the necessary skills”.
Nick Scriven from the Society for Acute Medicine told of an inadequate workforce that is haemorrhaging senior staff. He warns that the NHS is reaching a vital tipping point where care will be compromised. But as well as an urgent need for more trained staff, the Government need to act on ways to reduce waiting lists and bed-blocking.
Dame Sally Davies, the retiring Chief Medical Officer, recently called on politicians to put children’s health before company profits. She demanded tough action against the tide of junk food, which is causing obesity and shortening lives. Ten primary school children in every 30 are overweight, which in later life will lead to heart disease, cancer and type 2 diabetes.
In April 2018, the Government put a tax on sugary drinks, which has resulted in manufacturers cutting sugar content by nearly 29%. It is reckoned to have taken 90 million kilos of sugar out of the nation’s diet. But, during the Tory leadership campaign, Boris Johnson, not yet Prime Minister, pledged to halt any new “sin tax”—his words—on sugary drinks. That same day, obesity was named by Cancer Research UK as causing more cases of four common cancers than smoking.
The Government was urged to put a tax on sugar and calories in everyday foods consumed by children. Instead, in March 2017, they challenged companies to reduce sugar and calories in those foods by 20% by 2020. So far, companies have managed a less than 5% reduction. How much healthier might the nation be if it had been a tax rather than a challenge? The Prime Minister apparently prefers to listen to the manufacturers and sellers of junk food in dealing with a health crisis—one assumes for company profits rather than the health of the nation.
My Lords, I start by remarking on what very strange times we live in and the frankly rather surreal context to the debate. I was particularly struck yesterday by the remark of my noble friend Lord Beith, who I am delighted is in his place next to me, who called this the “fantasy gracious Speech”—and that was before the vote to reject the timetable for the withdrawal agreement Bill and the Prime Minister’s recent announcement that it will now be “paused”.
With that preamble aside, I will start with one aspect of the gracious Speech that I welcome: the commitment to reform the Mental Health Act to,
“improve respect for, and care of, those receiving treatment”.
That is based on the independent review of the Mental Health Act, chaired by Sir Simon Wessely, which reported in December 2018 with 154 recommendations aimed at improving and updating the Mental Health Act 1983. That is critical, given the growing number of detentions, of which we know that there was a 40% increase over a 10-year period, and grave concerns about the disproportionate numbers of people from black and minority ethnic communities being detained.
Unless my hearing failed me, at the start of the debate I was pleased to hear the Minister confirm that it is the Government’s intention to publish the White Paper outlining their response to the independent review by the end of the year. I welcome that, but is the Minister able to say anything more about the timetable for bringing forward a new mental health Bill and whether the Government will be able to accept the Wessely review’s recommendations in their entirety? We should not lose sight of the fact that the best way to reduce the need to detain patients under the Act is to prevent their health deteriorating and reaching a mental health crisis in the first place. That is best done through expanding and improving mental health services.
So it is to be hoped that delivering the improvements contained in the NHS long-term plan will bring real benefits to people with mental illness. However, as we have heard before this afternoon, these all rest on having enough staff with the right skills to deliver care to patients—so could the Minister also say when the Government will publish their legislative proposals to implement the long-term plan? While I welcome plans for a new piece of mental health legislation, as I have said, it is also important that the forthcoming White Paper considers the non-legislative steps needed to improve patient care.
The noble Lord, Lord Ribeiro, made the really important point that the review of the Mental Health Act found that mental health facilities where patients are admitted are often some of the most out of date. Indeed, they were described as the “worst estate” in the NHS, at times with more in common with prisons than hospitals. Badly designed, dilapidated buildings and poor facilities contribute to a sense of containment and make it difficult for patients to effectively engage in therapeutic activities. This capital investment to improve the in-patient physical environment, which was recommended by the review and supported by the long-term plan, is critical, so could the Minister set out what action is being taken to fund these infrastructure improvements?
Ensuring that patients are not detained any more than is absolutely necessary—something I am sure we would all agree with—requires expanding mental health services and having the medical workforce to deliver and sustain the commitments in the long-term plan. That will require the Government both to sort out the short-term recruitment and retention crisis in the mental health workforce and to prepare for the longer term by doubling the number of medical school places by 2029, as was discussed in Questions yesterday.
One group who would benefit from proposals for greater integration of mental and physical healthcare are those who have mental illness and alcohol and substance abuse issues. They are often seen by various services but do not get the holistic care that they need. I think that we all know that patients being seen for mental health conditions often do not get the physical healthcare they need and vice versa, with those with physical health conditions often having their mental health needs ignored. I was therefore interested in the proposals put forward by NHS England and NHS Improvement for an NHS integrated care Bill to assist the delivery of the NHS long-term plan and allow services to work together more easily. Can the Minister say what is happening in this area?
A common misunderstanding is that the Mental Health Act applies only to adults rather than to young people, but we should note that, in total, almost 3,500 children and young people were admitted to inpatient mental health hospitals in 2017-18, with more than 1,000 formally detained under the Mental Health Act and more than two-thirds of those children aged 16 and 17. Therefore, as the review makes clear, detention should only ever be a last resort. Consequently, it is vital that reforms to the Mental Health Act are accompanied by greater investment in early intervention for children and young people, so that more young people receive support in their communities before they reach crisis point. Again, I would be grateful for anything that the Minister might be able to say, either now or later, about the specific steps being taken by the Government to make early support a real priority.
My Lords, I declare my interests as outlined in the register. It is a pleasure to follow the speech of the noble Baroness, Lady Tyler, because I have had to cut my own considerably so that I might contribute to this debate on the gracious Speech not only on my own account but to some extent on behalf of my noble friend Lady Emerton, of Tunbridge Wells, who has given notice of her retirement from
On a more personal note, her encouragement, mentorship and support to me as a “fellow nurse” has been exemplary since my appointment to this House four years ago. I wish my noble friend a happy retirement and I am fully aware, having spoken to her on the phone this afternoon, that she is following my contributions in the House now and will do so in future. I can only hope that, with further experience, I will live up to at least some of her high expectations.
I welcome the new laws that the Government intend to bring forward to assist in the implementation of the NHS plan in England, in particular the £33.9 million per annum increase in the budget by 2023-24. However, how do they intend to ensure that the appropriate workforce will be available to deliver the plan? The recent NHS people strategy outlines the challenges that we face in this domain. Is it not time for the Government seriously to consider writing off student debt for healthcare professionals who work in the NHS and state-funded social care roles for three to five years after graduating from university? Providing “golden hellos” to recruit to hard-to-fill roles, including learning disability and mental health nursing, podiatry and some areas of medicine, should be seriously considered. Having investigated the Army support structure for attracting nurses, it is clear to me that there are established successful schemes of this kind in the UK public sector. Why cannot this approach be adopted more widely? We will not be able to provide safe staffing in the NHS unless we recruit and retain excellent healthcare professionals.
I was a member of the pre-legislation scrutiny committee for the Health Service Safety Investigations Bill, ably chaired by Sir Bernard Jenkin MP, a strong advocate for the Bill. As others have outlined, the Bill will transform the way in which patient safety incidents in the NHS are investigated. Investigations would be for the purpose of learning and not to attribute blame or fault, thus improving patient safety by encouraging staff to identify areas of concern and to be candid in the information they provide to the investigatory body. I fully support this approach, while recognising that the Bill requires proper debate and amendment, as other noble Lords have outlined. I hope that we might be able to do this in what might be a very short term after what has happened today.
My noble friend Lady Emerton has been a champion in promoting high standards of community-based, individualised care for people with a learning disability. On behalf of us both, I ask what the Government’s plans are for finally replacing inappropriate, institutionally-based services with more suitable provision. This issue appears notably absent from the gracious Speech.
It is essential that the proposed Mental Health Act reforms are initiated. This will require additional investment in mental health services, as others have outlined, yet the NHS long-term plan, with investments relating to 40 new hospitals, makes no mention of new community mental health facilities. The Royal Colleges of Nursing and Psychiatrists call for an end to dormitory provision in mental health wards; a fleet of vehicles to transport people having a mental health crisis to a care facility, rather than using police vehicles; and the provision of more appropriate assessment space in emergency departments, in particular therapeutic calming spaces. Can the Minister outline whether any such investment is planned?
It is acknowledged by the King’s Fund that the NHS plan will not be achieved without further investment in social care, as was far more ably outlined by the right reverend Prelate the Bishop of London. The Government intend to bring forward the Green Paper proposals to reform adult social care to ensure dignity in old age. This is urgent. What is the planned timetable for this legislation? It is unacceptable in 2019 that dignity in old age should be a vision for the future rather than a right today.
Health is adversely affected by poverty. Barnardo’s, the Trussell Trust and many other bodies estimate that Brexit will create inflationary pressures that will hit the poorest in our society the hardest. Will the Government commit to providing a hardship fund for those on universal credit if there are sudden increases in food prices? If so, can they guarantee that such a fund would provide grants and not loans? Reducing food poverty and investing in public health measures, including health visiting services, particularly for children, may do more to improve the nation’s health than the proposed hospital building programme. We need a rounded approach.
It has been a pleasure to contribute to this debate. I look forward to the Minster’s responses to the issues that I have raised. Finally, I wish on behalf of the nursing profession to thank other noble Lords for their appreciation of my noble friend Lady Audrey Emerton’s public service contributions and her long and distinguished service in nursing, the NHS and this House.
I was not going to talk about local government finance today; I have bored this House often enough on that subject. However, I must respond to the reference in the Minister’s introduction to yet another social care precept and emphasise how unfair such a system is. If you put 1% or 2% on council tax it sounds even across the country, but the amount of revenue raised by it depends on the value of properties, the banding and so on. Quite frankly, there are more £1 million houses in Richmond than there are in Wigan. A 1% increase in Wigan raises about £1 million; in Richmond it is about £2 million, and our population is bigger. This is a discriminatory move, and I hope that the Government have learned from previous problems.
Sustainable health is an important area which has been mentioned by a number of noble Lords. Just before the Conservative Party conference, the Prime Minister visited north Manchester and announced that a new hospital was going to be built as part of the capital programme. That was welcome in the city, because the old one is a disgrace and ought to have been replaced many years ago. The health outcomes in that part of the city are among the very worst in the country. Manchester has some of the worst anyway, and north Manchester is one of the most deprived parts of the city, with life expectancy between four and five years below average. Even greater is the gap in healthy life expectancy. In north Manchester, people become ill in their mid to late 50s with a series of long-term conditions and become dependent on drugs and so on. In Oxford, people are probably in their 70s before that happens, so they can have a number of years of healthier life.
Welcome as the new hospital is, it is only going to have a marginal impact on those health statistics because we know that the determinants of health are not simply medical facilities but lifestyles and economic and social factors. In that area, 21.7% of people smoke, whereas the national average is 15.5%, which is considerably different; one in four is economically inactive, which we know makes a difference to health; and one in three older people is said to be destitute. As the right reverend Prelate the Bishop of London said, Sir Michael Marmot’s report in 2010 identified all these wider links to health outcomes which we need to think about. We need to rethink how we are going to change health. The long-term plan was a welcome move in the right direction, but it is not far enough. We need to go further.
It was recently said that life expectancy in the UK has risen for about 47 years, but it has now begun to tail off. There are international comparisons, but it is probably worse in the UK than anywhere else. We need to understand this. The gap in healthy lifestyle between the top fifth of the population and the bottom fifth is growing. People have said that this is down to austerity; I do not want to get into that argument. We need to acknowledge that this is happening and try to find ways of dealing with it. The CQC report, which a number of noble Lords have mentioned, highlighted the inexorable rise in demand for the NHS. July levels in A&E were the highest for a number of years. On Friday, we had a conference in Manchester about winter pressures. We need to recognise that, for the NHS, winter now lasts about 10 months of the year.
As your Lordships may know, there was some devolution of health powers to Greater Manchester in 2016. We have a partnership made up of health authorities, local authorities, voluntary and community groups and so on. We want to recognise that our challenge is not simply to deliver a good and effective health service. It is not enough to make sure that there is better integration between different parts of the system. We must address the fundamental issues of health and well-being outcomes. We are not going to do that simply by concentrating on health matters; we want to concentrate on wider social issues. We surprised some people with our early strategy which included school readiness and economic activity. We have achieved some things, but I do not have enough time to go through them.
I want to look to some solutions. Health cannot do this on its own; it has to work in partnership with other people. It is part of public service reform: reshaping services to meet people’s needs; thinking about population health with prevention and early intervention. Above all, it is about keeping it local: identifying local needs and encouraging collaboration and innovation. There are things we can do together to improve and make the health service more than just an ill-health service.
My Lords, I will touch on three issues, all to do with higher education, and I declare an interest as a member of council at UCL. The first is the decline in part-time and adult students. There really is a crisis here. Between 2010 and 2016, there was a 60% fall in part-time students. The decline was especially heavy in sub-degree courses which we rely on to train the next generation. Because of this enormously steep decline, and the failure of the Government to intervene, since 2010 we have lost about one-third of part-time education providers. All those who gave evidence to the recent Economic Affairs Committee inquiry stressed the huge importance of life-long learning, of part-time study, of upskilling and reskilling, but none had a plan for actually doing any of that at scale. How do the Government intend to address this enormously important issue, and what is their plan for delivering lifelong learning?
The next issue is the very high interest rates charged on student loans, currently standing at RPI plus 3%. Students have been paying, and are continuing to pay, around 6% interest. This is a very high rate and very much greater than the Government’s cost of borrowing. The Government and some commentators have defended this very high interest rate on the grounds that it is progressive. Many disagree, including the Economic Affairs Committee. We concluded that,
“graduates who only just pay off the loan within the 30 years will pay far more in real terms than higher-earning graduates who pay the loan off sooner”.
We called for the interest rate to be reduced to the level of the 10-year gilt rate, currently around 1.5%. Do the Government still believe that the 6% interest rate is progressive? Will they consider adopting the committee’s proposal to reduce it?
The third issue is that of a sharia-compliant student funding system. I first raised this issue with Ministers in January 2016 and have raised it frequently since. Sharia law forbids interest-bearing loans. That prohibition is a barrier to Muslim students attending our universities and has been a problem since 2012. Successive Governments have known about this problem and have recognised that the current system effectively discriminates against devout Muslims. In April 2014, a BIS consultation on the issue generated an astonishing 20,000 responses. The consultation report noted:
“It is clear from the large number of responses ... that the lack of an Alternative Finance product as an alternative to conventional student loans is a matter of major concern to many Muslims”.
But the report also identified the solution. The solution is a takaful, a well-known and frequently used non-interest bearing Muslim financial product. The Government explicitly supported,
“the introduction of a Sharia-compliant Takaful Alternative Finance product available to everyone”.
That was five and a half years ago. Two years ago, we passed the enabling legislation, but nothing else has happened. Why this extraordinary delay? The Government blame complexity, completely overlooking the fact that the sharia-compliant version of Help to Buy took only five or six months from the beginning to develop and launch. I am told that the reason really lies in a lack of political will and in the inability of the Student Loans Company and HMRC to organise themselves to deliver the product.
I last asked the Government about this in an Oral Question on
“set out plans for implementation as we conclude the post-18 review at the spending review”.—[
The spending review took place seven weeks ago, and still we hear nothing. I remind the Minister that in 2013 David Cameron promised, at the World Islamic Economic Forum, to introduce a sharia-compliant student finance scheme, saying:
“Never again should a Muslim in Britain feel unable to go to university because they cannot get a student loan – simply because of their religion”.
That was six years ago. It is shameful that we have allowed so much time to elapse; it is shameful that we have known the solution for more than five years; and it is shameful that the Government display such an apparently casual contempt and disregard for our Muslim community. Can the Minister say when David Cameron’s promise will be fulfilled?
My Lords, it is an honour to follow the noble Lord, Lord Sharkey, and so many others more qualified than I. This was my first Queen’s Speech and it was a surreal experience indeed—and not just because I sat between the noble Lord, Lord Pannick, and the erudite noble Viscount, Lord Ridley. Given the messy political reality of a legislative programme that will never see the light of day, this was, effectively, a party-political broadcast, and I question whether that is an appropriate use of Her Majesty’s ancient and regal authority.
As for the topics of today’s debate, I refer to the register. I am proprietor of a heritage-based social enterprise active in health and well-being, social care, and education. I am also a technology litigator with clients in the digital space, and I am a father of school-age children.
I am encouraged by support for integrated healthcare and the opportunity for the NHS to work more freely with partners. In Devon, I see how much volunteers, charities and private enterprise do to support public health and well-being: the more the Government can support local delivery of health and social care within communities, the better. I applaud the renewed focus upon mental health and highlight the need to ensure that everyone in society has ready access to a mental health professional—not because of mental illness but to support our mental wellness. I also strongly support the development of social prescribing. This will strengthen communities, improve health and decrease reliance on primary healthcare.
I note the commendable position that the NHS is not for sale in any future trade deal, but this must not preclude reasonable commercialisation. There are major benefits to be obtained by the secure use of anonymised health data at a national level. Given our single health system and our strength in data science, the UK must lead the world in the use of AI in healthcare, yet we lag behind in basic digitisation of medical records. What are the Government doing to address this?
In the digital space, the Government are focused upon online harms and a desire to make the UK “the safest place in the world to be online”. Though I support age verification, I sound a note of caution: in the brave new post-Brexit world, undue restrictions on internet platforms in the UK may well limit our access to cutting-edge ideas and technology. Rather than restrictive censorship, is it not better to encourage education in safe and appropriate internet usage? Rather than child-proofing the internet, it is more empowering to internet-proof our children and ensure that it is treated as a public space with enforceable public standards of behaviour.
Turning to culture and tourism, on which the noble Baronesses, Lady Doocey and Lady Bull, spoke so well, I applaud the work of the APPG on Arts, Health and Wellbeing, particularly its work on heritage and its contribution to healthy and sustainable communities.
While welcoming the recent announcement of funding to support public museums, I ask that the Minister acknowledge the huge contribution of private heritage to this sector. Historic Houses, of which Powderham is a member, preserves thousands of heritage landscapes, collections and buildings in their natural state, generating over 26 million visits each year—more than the National Trust—without any recourse to the public purse. Historic Houses is to our heritage what national parks are to our nature: thriving cultural centres alive within their natural environment. In comparison, galleries and museums are often lifeless efforts to preserve heritage outside its meaningful context—a form of zoo. Will the Government acknowledge that it is a national shame that these buildings are carrying over £1.3 billion in repair backlogs, with insurance and compliance costs now skyrocketing?
Finally, multiple heritage bodies have major concerns that the draft Environment Bill introduced today in the other place excludes heritage from its definition of the natural environment. It is dishonest to decouple our natural and man-made environments. We occupy the most man-made landscape in the world, and we need to be responsible for it.
Take the River Exe estuary as a simple example. The five miles of boggy marsh between my home and Exeter tell of over 3,000 years of human interaction with nature, from Bronze Age trading ingots through a major Roman city, to the medieval Countess Wear, creating England’s second biggest wool port. Thereafter we see England’s earliest canal, alongside acres of Dutch-drained early modern pasture, rearing England’s finest spring lamb. Then, we see Brunel’s remarkable atmospheric railway embankments, which stoically hold back the ever-rising sea levels to protect Exeter’s “green lung”—and Europe’s largest selection of car showrooms at Marsh Barton. The area is also, uniquely, an SSSI, a Ramsar site and a major RSPB reserve, not to mention the shellfish, cycle trails, foreshore and pubs, and England’s oldest sailing club. Nature and culture are indivisible in this landscape. As recognised by UNESCO’s Convention Concerning the Protection of World Cultural and Natural Heritage, the integration of culture and nature is essential to the sustainable development of both. We cannot and must not separate the two.
My Lords, I join my noble friend Lord McKenzie of Luton in welcoming some aspects of the Pension Schemes Bill, particularly easier access to information through the pensions dashboard and greater protection from misleading information.
Unfortunately, the Government’s understanding of their legal and moral responsibilities relating to misleading information was exposed recently when their QC in the “Back to 60” court case stated:
“It’s clear from case law that the enactment of primary legislation carries with it no duty of fairness to the public”.
Rather than acknowledge that a lack of fairness from government was unacceptable, as it would be from a private pension company, it was used to justify leaving many thousands of older women in poverty. Even the judges in the case said they were saddened by the women’s situation.
This proposed Bill on pensions again fails to take account of the differences in working lives of men and women and, as a result, will continue to treat women unfairly. The gender pay gap remains significant, even when comparing women and men in full-time employment. Women earn considerably less than men through their working lives, and the gap is at its widest for women over the age of 60. It is estimated that women starting work today can expect to receive £225,000 less over their working lives than men.
The pay gap is a disadvantage to women throughout their working years and goes on to make a substantial difference to their pension entitlement should they enrol and stay in an occupational pension scheme, but, not surprisingly, women of all ages are less likely to join workplace pension schemes than men. Nearly 10% of women opt out of auto-enrolment compared with 7% of men. For older women, this increases to 33% opting out.
The reasons are clear. Women are more likely to be in part-time, temporary or unskilled jobs. They are also more likely to be single parents and carry the responsibility of caring for elderly or disabled family members. It is often their money that is vital for immediate household needs such as food and clothes, and they often meet childcare costs from their salary. When every penny is needed for the here and now, it is hard to balance that against a distant future, particularly when that future seems further away than ever.
The treatment of the WASPI women is likely to make all women sceptical about pensions. Rules change and goalposts shift, but never to the benefit of women paying in. Is there any possibility that the Government will make an act of good faith to the women who were misled over their pension entitlement? After all, the Prime Minister agreed that he felt that the answer he got back from the Treasury on behalf of his own constituents was “not yet satisfactory”, and said that, if he was lucky enough to become Prime Minister, he would undertake to return to this issue with fresh vigour and new eyes to see what he could do to sort it out. That being the case, can we expect to see fresh action on this issue soon?
Finally, can the Minister comment on how workers who invest their future in pension schemes can be represented in decisions about how those funds are invested? The money is, after all, their deferred wages.
My Lords, listening to the Queen’s Speech, what drew my attention was the reform of the immigration regulations and that these would include restriction of freedom of movement. I agree that we need reform of the Home Office Immigration Rules, because they are totally unfit for purpose. For instance, this year we saw Windrush remembered, and only last week heard that a lass born in Glasgow 30 years ago now faces deportation. The whole thing is agony for so many people. They are here and yet the Home Office seems to treat them very unjustly. I therefore suggest that we make a fair adjustment of the regulations so that nobody will feel that they are being used in an unfair way.
We face immigration problems that will increase as the years progress. We see that climate change in Africa could well turn many people from their homeland to look for somewhere else to survive. Warfare in places such as Syria and Afghanistan will also lead many people to leave their homeland to look for somewhere they can have a fair and peaceful existence. We, as the United Kingdom, could be the leaders in this reform of immigration thinking. So often we are the people who react, not the people who lead. We could be the people who lead on these immigration transformations. That means we would need to take the initiative; we would have to forget building walls and start building bridges. That is the only way we can become a whole human family.
I sometimes wonder how we disregard all the benefits of freedom of movement. People came here from other parts of the world, bringing new medication, new engineering and new academia. So many new things came from places other than the United Kingdom. Now we are thinking of restricting that. It will make us a country that does not meet its obligations, denies people their rights and denies itself the benefits of immigration—the benefits of new people coming here.
Last Sunday morning, I was in London—we had a special sitting on Saturday that had kept a Welshman here. On the Sunday morning, I went to the Castle Street Welsh Baptist Chapel. It was one of many Welsh churches built here over the past century as people came from Wales and worked in the shops, as schoolteachers and as dairy people.
I am told that there were 3,000 Welsh dairies in London in the 1920s and 1930s. What would have happened if the farmers and milkmen of Carmarthenshire, Cardiganshire and the Conwy Valley had decided to stay at home? I hate to think what people in London would have done for their cup of tea. We came: we brought ourselves and our abilities here to London. Imagine if the vineyard owners of France had been denied the right to come to the UK. I am a teetotaller, but I am sure others would have felt the strain of that situation.
We can lead, but we must do that in a fair way. Schoolteachers who came to London—Miss Jones, Miss Roberts, Miss Edwards and Miss Hughes—were great teachers, but if they had stayed in Wales, what would have happened to education in England? I am told that in some places, half the teachers came from Wales. We were glad you had us, but we must keep encouraging freedom of movement, not denying the future or what we have inherited from the past.
We can do it. Where there is no vision, the people perish. We must have the vision to keep freedom of movement so that the benefits of other places can be ours and our contribution, such as the parliamentary system, can be theirs. Canada had a general election yesterday. I like the result—not everybody will, but I do. It is the same format as ours. One thing they beat us on is that they have desks to bang in the chamber of their Parliament. We exported that, we exchange ideas, we are people who are free to move—and that is a benefit to us all.
My Lord, it is a great pleasure to follow the noble Lord, Lord Roberts, and I was very pleased to hear about the Welsh dairy farmers. As far as I know, Stoke Newington was an area where the milk for London used to be produced and where the cows lived.
Although it is a pleasure to follow the noble Lord, the Queen’s Speech was certainly not a pleasure to hear on my area of passion, which is our food system. As ever with the Government, there was little to do with food policy and our need to change. Every day, we hear stories about how our food system does not work. Take the first thing of the day—breakfast. Every day, 1.8 million children are at risk of starting the day hungry. Hungry children cannot concentrate. They miss out on hours of valuable learning. By the time they leave school, children eligible for free school meals are, on average, 19.3 months behind their wealthier peers. This is data recently collected from Magic Breakfast. This is not just gross inequality; it is also economic madness. It is certainly not unlocking our children’s full potential.
Children from the poorest households also struggle to eat healthily, which in part explains why children with severe obesity are four times more likely to live in deprived areas than in less deprived areas. The Chief Medical Officer’s report two weeks ago told us about the devastating consequences of childhood obesity, to which other noble Lords have referred. There are 100 new cases of childhood type 2 diabetes every year. There are 650,000 children with fatty liver disease and 90,000 children eligible for bariatric surgery, of whom less than 10 get the operations every year. Sally Davies was right to say this is a blatant contravention of children’s right to health.
Food is not only fundamental to health; it is also fundamental to the climate emergency. Currently, a third of greenhouse gas emissions derive from deforestation, as we grow palm oil for processed food and cut down rainforests to grow soy to feed livestock—possibly the most inefficient way of obtaining proteins that we could manage. It drives species extinction, as well as ill health.
Yet, in the gracious Speech, there was silence on all of this. The Agriculture Bill, which is making its way through Parliament very slowly—after the news tonight, I have no idea when it might arrive here, so I would be grateful if any noble Lord has a clue—concentrates a lot on the environmental goods that farmers need to provide. It promises public funds for public goods and nobody wants to disagree with that, but we need this Bill to help support farmers to deliver health goods as well.
Support for the horticulture sector is a case in point. Much neglected by the common agricultural policy, we could grow a great deal more of our fruit and veg in the UK. With the right mix of marketing and demand-side incentives, including public procurement, we could help our farmers improve our diets. It is a staggering fact that, for every one of your five a day you eat, your risk of early mortality decreases by 5%. Yet, according to the Food Foundation, of which I am a trustee, 30% of our children eat no vegetables at all, unless you count chips from McDonald’s.
Food is an incredibly complicated area. We need much more than the right support for farmers. Food is in almost every ministry; it touches health, trade and the environment—right across the board—and we have not, since the war, had a national food strategy. But one is being worked on right now, and I am very proud to say that I am an adviser on it. Over in Defra, Henry Dimbleby and a fantastic team are pulling together a strategy that will bring all these different elements together to try to give us a food system that really is fit for purpose and works for the future. It is so important that every noble Lord in this place supports it. We must not let this golden opportunity pass; we need to start debating all these key issues.
“Business as usual” is no longer good enough. Our food system runs, basically, for profit, like our agriculture system. It does not run to protect our health or the environment. In my years running the London Food Board—eight of them for our current Prime Minister and two of them for Mayor Sadiq Khan—I used to say, “Every day in London, we dish up 30 million meals”. As anyone who knows it can be quite difficult dishing up dinner for two, 30 million is mind-boggling. I understand why it is very hard for politicians to get their heads around this. It truly is awesome. But if we carry on with our small piecemeal policies and relying on the wonders of companies such as Magic Breakfast, which feeds 48,000 children every day through charity and raising money, then we really only have ourselves to blame for an environmental crisis and a health crisis, both of which could be prevented.
I would like the Minister to assure me that, whatever happens—I understand that she or anyone else is probably not in the position to give a definite answer to this—that her Government will continue to support the work of the food strategy and, hopefully, usher it into life, regardless of who sits in No. 10.
My Lords, unlike most of my colleagues here, I want to address the question of culture, which forms part of the debate. I want to ask very briefly how our public culture has been profoundly distorted by the controversy surrounding Brexit and the way in which it has been formulated and pursued.
Historically, we have been a liberal democracy in the sense that liberalism had the upper hand and set the framework within which democracy was articulated. Over the years, we have moved in the opposite direction where democracy has the upper hand and lays down the framework within which liberalism should be pursued. When democracy has been detached from liberalism in this way, it comes to be equated with crude majority rule. So democracy stands for majority rule, and we are told that in a democracy majority opinion—the will of the majority—must be respected and not to do so is to be a traitor to democracy. That kind of thing can work at the level of elections, where people vote on a wide range of issues and it is difficult to pinpoint people’s opinion on this or that matter. However, when we conduct a referendum, the situation becomes very difficult because people vote on a specific issue and their differences are expressed publicly.
That is what happened in 2016. Brexiters had a majority, remainers were in the minority and the argument was that the voice of the majority must be respected. The difficulty there was that remainers felt that they were politically disfranchised and that their vote counted for nothing, because even though they secured 48% of the vote, it amounted to nothing because Brexiters had the full gain to themselves. So what resulted was triumphant Brexiters and rather subdued remainers, who felt slighted and diminished.
The other problem associated with this issue is that the two sides have little respect for each other. For remainers, Brexiters are a bunch of fools; they are rather backward, not terribly bright and could be seduced by any kind of information provided by the peddlers of the Brexit model. If only they had been provided with better information, they could easily have been won over to the other side. For Brexiters, by contrast, remainers are ruthless, cosmopolitan liberals with no love for the country in which they live—they have no sense of patriotism. So the result is that we have two sharply defined groups with precisely articulated differences along these lines.
This polarisation between the two groups is particularly acute because of the issues involved, including British identity and British independence or sovereignty. What is Britain, really? Is it or is it not European? Since the question goes right to the heart of what Britain is, therein lie very powerful emotions, with the result that the Brexit controversy has virtually monopolised the entire public debate. There is hardly an area of life where the Brexit/remain division does not infiltrate.
The result of this kind of polarisation, with two groups facing each other, has been the following. First, the two groups have very little in common and cannot even talk to each other. Secondly, each group is self-righteous and, as a result, contemptuous of the other. Thirdly, each group thinks that the other is deeply misguided and is misleading the country and so, in that sense, is a traitor. Fourthly, it has created new identities. I am not only an Indian or an academic; I am also a Brexiter or a remainer. In other words, it has created a new generalised identity under which people can be subsumed. The media have also been highly polarised, and no space has been left for impartial assessment.
More importantly, the polarisation has extended to the very structure of our democratic way of life. What is democracy? Is it all about majority? What is the relationship between the people—the electorate—and their representatives? Should the representatives simply reproduce what the electorate want? Therefore, the crisis of culture I am talking about extends not only to specific issues but to the very fundamentals of our political system.
It is no less important to note that this kind of polarisation has, sadly, distorted our political discourse. It is suffused with the language of “traitors”, “betrayal” and being “ashamed to be British”. Not surprisingly, it has led to physical threats. So questions of civility and scepticism, which have traditionally been characteristic of our political culture, seem to have been thrown out the window. This is the crisis of our culture. As a crisis of culture, it also affects the very bonds that bind people together, it undermines the public realm where impartial discussion can take place and it eats up almost everything that comes in its way.
We must ask: how do we reduce the crisis and resolve it? Equally important is that, even when it has been resolved, it is not going to disappear and the consequences will continue to haunt us. Like so many others, I suggest that, like a tsunami, Brexit has flooded all of our major institutions and forms of language, so it is important to take this question very seriously and give it the importance it deserves.
My Lords, when thinking about what to say today about last week’s gracious manifesto, I found myself facing two challenges. The first was how to address commitments that seem unlikely to be implemented before another Queen’s Speech following a general election. The second was that the Speech itself had little to say about two of the three issues I wish to cover. A third challenge is that most of what I want to say has already been said, more eloquently and better, by other noble Lords.
The first issue is education and skills. The Speech states that:
“Ministers will ensure that all young people have access to an excellent education, unlocking their full potential and preparing them for the world of work”.
It is hard to argue with that. The extra £400 million promised to further education is welcome, but it will hardly make up for years of underfunding. FE funding has declined by 30% over the past 10 years, at a time when colleges’ role in skills training is more important than ever, with the additional challenge of delivering T-levels.
“to give my all to make technical and vocational education the first choice for anybody with the aptitude, desire and interest to pursue it”.
T-levels should be central to that laudable aim, as should apprenticeships, which were not mentioned in the Speech. I hope that the Minister will be able to say rather more about exactly how the Government’s strategy will achieve this aim beyond providing extra funds and stating ambitious goals that no one could disagree with. For example, will they continue to support and extend the careers strategy led by the Careers & Enterprise Company and already showing encouraging results since its launch in 2017? What action will they take on the FE and technical education recommendations of the Augar review? How will they engage employers, including SMEs, both in expanding and improving apprenticeships and in meeting a greatly increased need for work experience?
My second topic concerns the creative sector. Your Lordships may be tired of being reminded that the creative industries make up one of the largest sectors in the UK economy, although perhaps not quite as large as tourism, as well as being the fastest growing, but the conditions that have made this success possible need to be safeguarded, including in relation to music, freedom of movement and a strong music education system, as powerfully argued by my noble friends Lady Bull and Lord Berkeley of Knighton. How will the Government ensure that UK musicians will still be able to travel, tour and perform abroad after Brexit without prohibitive costs and bureaucracy, while at the same time we can continue to attract top musical talent into the UK?
What are the Government’s plans for the future of the national plan for music education, launched in 2012 with the aims of giving all schoolchildren opportunities to experience and take part in music and singing? This was a notable achievement, but it needs to be refreshed. The current funding for music education hubs runs out next March. It should be renewed and increased to a more realistic level, and the effectiveness of the plan’s delivery should be reviewed to ensure that all children benefit, so that the risk of a two-tier music education culture, described by my noble friend Lord Berkeley, is avoided.
Last week, the Durham Commission on Creativity in Education published its report emphasising the urgent need for the teaching of creativity in schools to be prioritised, not just for the benefit of the arts but for all disciplines. I hope that the Minister and her colleagues will look closely at its recommendations, including for the establishment of a funded national plan for cultural education.
I will comment finally on broadband access. The Government promise to:
“Roll out gigabit capable broadband across the UK”, and have pledged £5 billion to support this goal in the hardest to reach 20% of the country. But with a home on a hillside in rural Carmarthenshire, I count myself lucky to get broadband speeds of 10 megabits per second, if conditions are favourable and the oak trees across the valley are in the right alignment. I take the promise of 1,000 megabits with a pinch of salt and ask some questions. How much of the £5 billion will be used for developing new technologies to serve locations where a physical connection—for example, via fibre—is just not feasible? How will this UK-wide commitment apply to the devolved nations, including Wales, and how much of the funding will be allocated to them?
Thirdly, I am slightly puzzled by the lack of mention of mobile phone coverage. Will the Government look at enabling roaming in areas such as my own, where the number of providers with coverage is very limited? If you are not on the right network, you do not get any mobile phone coverage.
These issues may not have as much popular appeal as the NHS, crime and policing, social care, the environment and others addressed in the gracious Speech, but tackling all those requires resources. Skills, creativity and digital access are essential to generating those resources, so I hope they will be given due prominence in a Queen’s Speech from a Government able to implement their proposals.
My Lords, I am pleased to be able to make a short contribution to this last day of the Queen’s Speech debate. I refer to my declarations in the register of interests. I also commend my noble friend Lady Sherlock on her excellent opening speech, which clearly laid out the context for this debate on behalf of these Benches.
The first issue I raise is education, and specifically the crucial policy area for the future well-being of our economy: apprenticeships. On this, as the noble Lord, Lord Aberdare, rightly said, the Queen’s Speech is silent. The University of Salford, where I am chair of the board of governors, is rapidly growing its degree apprenticeship provision. Combining degree-level study with on-the-job training, degree apprenticeships are a shining example of the high-quality technical and vocational education that the Secretary of State quite rightly champions as vital to the future economic well-being of the country, but we are not making the most of them. A recent report by Universities UK showed that four in five year 10 to 12 school pupils know “little or nothing” about degree apprenticeships. If young people are not made aware of the different educational opportunities, particularly vocational and technical, they are unable to make informed choices as the Secretary of State so wishes. I therefore encourage the Government to do more to raise the profile of degree apprenticeships among school leavers and their parents.
I cannot speak about apprenticeships without mentioning the apprenticeship levy. Now more than two years old, the objectives of the levy were sound, but the outcomes it has produced are not. The overall number of apprenticeship starts has fallen since the introduction of the levy, and there is a shocking lack of transparency around how firms’ levy contributions are spent. While many big employers report a significant underspend, there is an overspend on the overall apprenticeship budget, meaning limits on the funding made available for non-levy payers, which are predominantly SMEs.
At the University of Salford, we have around 50 SMEs that want to take on apprentices with us, but we have to turn them away because we do not have sufficient funding. This has to change. SMEs cannot be left out in the cold from the degree apprenticeship revolution, and I hope the Government will look at this to enable apprenticeships, at all levels, to be a viable and valued education and training route for businesses and careers.
The second issue I raise is mental health and the reform of the Mental Health Act. I was pleased to be able to contribute to the review of the current Act by Sir Simon Wessely, and I welcome his report. I hope the Government’s response with a White Paper will be published before Christmas, that we will move more quickly to legislation, and that tonight the Minister will allay the fears that we may have to wait at least two years before legislation is introduced into Parliament.
I will highlight just two of Sir Simon’s recommendations as they relate to the criminal justice system. First, recommendation 130 states that,
“Prison should never be used as a ‘place of safety’ for individuals who meet the criteria for detention under the Mental Health Act”.
I agree. This prohibition, like the use of police cells as a place of safety for children—which should of course be extended to adults—must be enacted as a matter of urgency. Secondly, recommendation 132 concerns the transfer of prisoners sectioned under the Mental Health Act from prison to healthcare. It specifically sets a statutory time limit of 28 days broken down into two 14-day periods, the first for assessment and the second for transfer. This is a more realistic and practical proposal than the similar one I made in my report some years ago, but, again, it must be enacted as a matter of urgency. However, both these recommendations rely on urgent investment in appropriate high-quality alternative facilities as places of safety across the country, and investment in NHS secure beds to ensure that the transfer target can be met.
My third point relates to investment in mental health services for children and young people, and particularly for those with special complex needs. The Association of Child Psychotherapists, among many organisations, has suggested that as many as 40% of children with mental health problems have complex conditions—often arising from early trauma or adverse childhood experiences—which are likely to require specialist input. We urgently need a national multidisciplinary commissioning proposal to address the situation as part of the planned investment in mental health services in the NHS long-term plan.
I hope the Minister will be able to respond to each of these points when she concludes this debate.
I draw the attention of the House to my interests, particularly that of being chair of the 5Rights Foundation.
We know that a person’s trajectory is largely defined by the circumstances of their birth and that prevention and early intervention are more effective than policies driven by headlines and voter frustrations. This should put children at the top of the policy agenda but, while jiggling a baby for the camera is a well-worn meme of the campaigning politician, the fact remains that children have no electoral capital, and this gracious Speech, like those preceding it, reflects their lack of political power.
Nowhere is that truer than in the digital world. Like others, I welcome the online harms Bill but I am concerned by the shifting language that prioritises the burden on business rather than the welfare of children. Almost every aspect of a young person’s life is mediated by devices and services that impact, both beneficially and problematically, on their life chances. Children are more vulnerable to the risks associated with profiling: behavioural advertising, abuses of health and education data, gaming, gambling, bullying, self-harm, anxiety, identity fraud, unwanted contact and unwanted content. We are in the grip of an anti-vax movement that results in children having measles. Children are vulnerable to a system that fails to separate fact from fiction. Even this morning we saw reports that one-third of all searches on Google to buy a teething toy featured potentially dangerous products. As Professor Sonia Livingstone says,
“children are the canaries in the coal mine for threats to all”.
Other noble Lords have asked when we might see a Bill, but I ask the Minister when, in her estimation, parents, teachers and children—to whom successive Secretaries of State have made repeated promises—can reasonably expect the online harms Bill to be law? I also ask whether the teams in DCMS and the Home Office will remain at current strength or be reduced or in any way downgraded until that time? While I very much welcome the commitment to high-speed broadband, can the Minister confirm whether we are to get an online harms Bill before broadband rollout? If we do not, we will exacerbate the problems rather than deliver the desired benefits for children.
I shall briefly address three urgent matters that cannot wait for an online harms Bill. First, the Federal Trade Commission is undertaking a review of the Children’s Online Privacy Protection Act, known as COPPA. For those who do not know, COPPA is responsible for 13 being the de facto age of adulthood online. COPPA leaves children aged 13 to 17 with no specific protections and is so poorly upheld that the sector routinely engages with tens of millions of children aged under 13 on services designed for adults. The review could and should put in place protections for all children aged under 18 wherever they are online, but instead a powerful tech lobby proposes to weaken it further. I would be grateful to know what steps the UK Government are taking to ensure that children in the United Kingdom do not inherit a US law that may undermine the considerable efforts we are making here to improve our own laws.
Secondly, there is the plan of Facebook and others to implement end-to-end encryption, which has been widely condemned as a disaster for the global effort to prevent the spread of child sexual abuse material. Mark Zuckerberg dismissed the problem by characterising privacy as a social good at any cost, while simultaneously highlighting that that cost included “bad people” doing “bad things”, including the global dissemination of child sexual abuse material. Meanwhile, the Home Secretary, alongside her Australian and American counterparts, responded by calling on Facebook to allow lawful access to encrypted services, which resulted in a ferocious backlash about government access to personal data. In reality, existing detection services, such as PhotoDNA, do not challenge user privacy since they identify only known images and do not require a back door. Conflating issues of privacy or security with the protection of child sexual abuse victims makes vulnerable children collateral damage in an information war between commercial entities and Governments. Are the Government willing to mandate that end-to-end encryption be deployed in a manner that allows detection of CSAM, independently and transparently assessed, with no accompanying requirement for a back door to encrypted services?
Finally, last week the Government reaffirmed that they will shortly lay the age-appropriate design code before Parliament. I look forward to that, but ask that we swiftly adopt Article 80(2) of the GDPR, so that civil society can act on behalf of vulnerable groups. We asked for this during the passage of the Data Protection Act and were told it would be reviewed. Perhaps the Minister can provide an update on its status.
My Lords, I declare an interest as an apprenticeship ambassador and an ex-apprentice. Noble Lords can guess from that introduction that I shall focus on apprenticeships in my contribution.
I start from the premise that I want the apprenticeship levy to succeed. I was a bit puzzled about the Government’s commitment to it when I looked through the list of Ministers, only to find that we no longer have a Minister for Apprenticeships. I do not know whether that is intended to signal a lack of interest or is just the accidental result of a reshuffle, but if we look at the list of government Ministers—I can see a puzzled response—we will not find a designated Minister with that responsibility. Of course, the Secretary of State has the ultimate responsibility, but that is not quite the same as when we had a Minister for Apprenticeships.
The Government had a target of 3 million apprentices during the life of this Parliament. I remember many of us saying that they should forget the target and focus not on the quantity but on the quality of apprenticeships. You need to convince people—potential apprentices, their parents and their teachers—that this is a worthwhile career path. It seems that the Government are beginning to realise, first, that they will not reach that target, and, secondly, that we were right when we said that they should focus on quality.
I started to look at some of the statistics, and the most worrying was for the starts at level 2. Why does that matter? Level 2 apprentices are often the young people who will not go on to an academic education. They are the young people who, perhaps, have a more practical bent at this point in their lives and who—I hope—we want to prevent becoming NEETs: not in employment, education or training. They really are an important group. I listened carefully to what the noble Baroness, Lady Garden, said, and I agree with many of her points. If you look at those statistics, it really is quite worrying. We started in 2016, before the levy, with 260,000 and we are now down to 142,000. That is a worrying loss.
I discussed the next area of statistics that I am concerned about with the Government. I told them that if they wanted the apprenticeship levy to succeed, they had to ensure that they moved the needle on the dial on the number of small and medium-sized enterprises involved. Again, I failed significantly. It is really hard to get statistics, but the House of Lords Library gave me this one: we started, again in 2016, with 473,761, and by the time we reached 2019, we were down to 170,325. That is a really worrying drop in the number of apprentices employed by SMEs.
I acknowledge that the Government have listened to large employers who said, “We’re not managing to spend our levy money; we would like to send more of it to our supply-chain SMEs”. The Government increased the amount to 25%. Did that solve the problem? No, because, as companies tell me, you cannot just throw money at these SMEs in their supply chains; they have to be managed. One thing I want to say to the Minister—I do not expect a reply today—is that some of that levy money ought to be used in the management of these supply chain SMEs, in admin costs, for example. If the Government really want to increase the number of SMEs employing apprentices, I recommend that they look at what are known as group training associations, which deal with things such as admin and basic skills.
I was really interested in the comments of the noble Baroness, Lady Featherstone, who is in her place, about the 2012 Olympics. A major theme in that unforgettable opening ceremony was the NHS. I could not help thinking that we have 40,000 nurse vacancies at the moment. It was a really smart decision by the Government to charge potential nurses for their degree programmes. Why would we do that when we are desperate to fill those skilled vacancies? That has had an unfortunate impact on morale in the National Health Service. The Government ought to scrap the charges for nursing degrees. We surely want to encourage a vocational route and encourage healthcare assistants who have the potential to become nurses, which many have.
I am coming to the end of my allotted time, so I will be brief. On average, employers claim only 50% of their levy money. They say to me, “What will happen to the unclaimed levy?” Sending it back to the Treasury does not seem a very smart solution to me.
My Lords, I refer to my interests as listed in the register.
In reflecting on the Queen’s Speech and its relevance for the nation’s mental health, I wondered how, in 2019, we would now understand Nye Bevan’s assertion that no society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means. Over the past 71 years we have deepened our understanding of what it means to be sick and what it means to be healthy. We have seen the futility of separating health from social care, and learned that a person’s capabilities are as essential a resource as their finances.
One of the earliest debates that I was involved with in this House related to the Health and Social Care Act 2012 and the issue of parity of esteem for mental health. Informally, in preparing for that debate, I asked Members of your Lordships’ House what they understood by “health” and “illness”. Your Lordships spoke about strokes, heart attacks, diabetes and so on, but at that time there was little mention of mental illness or mental health.
The conversation has changed since 2012. There is more and better-informed talk about mental health. However, despite the commitment to parity, only 40% of people with mental illness receive treatment, and only £1 in £10 of NHS spending goes on mental health. There has been a 14% fall in the number of mental health beds since 2014 and community services have not been equipped to compensate for this change. For example, at least seven people are known to have died between June 2018 and March 2019—people who had been assessed as requiring admission but for whom no mental health bed was available.
When people are admitted to hospital, as we have already heard from many noble Lords, they are likely to experience some of the worst estate within the health service. The Government’s recent announcement of,
“the biggest, boldest hospital building programme in a generation”, contained no new funding for psychiatric hospitals.
We are now more cognisant of the social determinants of health. Theresa May noted in her first address as Prime Minister that people born into poverty will live nine years less on average, and we have heard again today about the reduction in life expectancy for black and minority-ethnic users of mental health and learning disability services.
We also better understand the detrimental effects on adult mental health of adverse childhood experiences, including abuse, neglect and parental death or separation. I hope that the Government will seriously consider the effects of proposed longer criminal sentences and the consequent further break-up of families on intergenerational cycles of mental ill-health.
It is difficult to recover from severe mental illness if you do not have shelter, yet half of delayed discharges from mental health beds are due to difficulties in securing appropriate housing and care packages, with some patients choosing to discharge themselves and be homeless rather than remain on understaffed mental health wards, while others remain detained under the Mental Health Act for prolonged periods because of their vulnerability should they be discharged to inadequate provision. This is clearly an inappropriate use of the Mental Health Act and of hospital beds, and it is a problem based on a deficit of adequate housing and social care.
Offering psychotherapy to someone who cannot be sure that tomorrow they will have a roof over their head is like providing medication to a patient in hospital but not feeding them. For people with serious mental illnesses, learning disability and autism, the division between health and social care is not just artificial but harmful.
It is time to extend the parity principle to social care as well as healthcare and ensure that both are adequately funded. Can the Government commit to employing the principle of parity of esteem in their response to the social care crisis by placing the social care needs of people with long-term mental disability on an equal footing with the social care of people with physical illness and frailty in later years?
Just because the health service does not cost money to use does not mean that everyone has the means to use it. Many people are unable to navigate an increasingly complicated healthcare system by themselves. Fragmented and ever-changing services are difficult enough for the professionals working in them to fathom, and it takes effort and luck for any patient to get the best out of the NHS.
With the failure of the Transforming Care programme and the abuse reported at Whorlton Hall eight years on from Winterbourne View, fears that a hospital admission could lead to abuse or even death are understandable. Ongoing review by the CQC into the use of segregation for young people with learning disabilities and autism is essential. These are some of society’s most vulnerable and overlooked people and we need to understand what has gone wrong, without apportioning blame. For this, the newly announced health service safety investigations Bill is welcome.
I hope that some of the difficulties I have highlighted will be addressed through increased integration of services in line with the Government’s commitment to the NHS long-term plan. I want to end by applauding my noble friend Lady Audrey Emerton’s extraordinary contribution both in this House and as a leader in nursing in enabling better life chances for people with learning disabilities. I personally will miss her wisdom and good humour and I wish her a contented retirement.
My Lords, it really is a pleasure to contribute to this debate. While I cannot claim to have listened to every single speech, it has been a great pleasure to listen to the many that I have heard, which have been notably well informed. I know that the Minister will have a very difficult task in winding; I can see from her face that she has worked that out already. I also know that she has been listening very carefully and I very much hope that she is not alone.
We have been told several times already what the gracious Speech says about education—which is frankly not very much and certainly nothing that it would be possible greatly to disagree with. In fact, no Government in modern times would really have said anything different, which suggests that this is a largely policy-free area. The real question is not what you say about aspiration but what you do to make sure that that aspiration is achieved. In opening, the noble Baroness, Lady Barran, who is in her place, talked about additional money. That is of course very welcome, but it is not the whole story if there is nothing to say about content.
I will ask the Minister to pick up two recent reference points. One of them, the Durham commission report which was published last week, has already been mentioned several times. The commission was of course graced by the noble Baroness, Lady Kidron, among others and was chaired by Sir Nicholas Serota. Last Saturday, the Guardian summarised the report’s significance rather well. It said:
“The report, put together in collaboration with academics from Durham University, concludes that creativity is not something that should inhabit the school curriculum only as it relates to drama, music, art and other obviously creative subjects, but that creative thinking ought to run through all of school life, infusing the way human and natural sciences are learned”.
The second reference point is a current Science Museum and Radio 4 collaboration which I have been very much intrigued by. It is called “The Art of Innovation” and is co-presented by the director of the Science Museum, Sir Ian Blatchford, and his colleague, the head of collections, Dr Tilly Blyth. It is a whole range of perfect little programmes about how art and science have inspired each other. I highly recommend them to anybody who has not already heard them. Both of these things point in the same direction, as did Sir Ken Robinson’s report, All Our Futures, 20 years ago. Like the Durham commission, he emphasised that creativity can be taught.
Art, science and mathematics all rely on creative thinking, curiosity and imagination—as the noble Baroness, Lady Bull, for example, said earlier. In my view, all start with the same question, which is, “What if?” Asking this question requires the confidence and courage in both students and teachers to challenge, doubt, question and get things wrong. Nothing in current education policy supports this approach, even though many fine teachers try every day to encourage it. The emphasis on testing knowledge has been shown to narrow focus, and to breed caution and anxiety. At this point, I refer to the many contributions that have touched on mental health. Mental ill-health in young people is a serious matter and something that we are not currently dealing with very well in either the NHS or the education system. We could do better quite easily.
The day I hear a government Minister say from the Dispatch Box that he or she understands that education is far more than the acquisition of knowledge; that young people need imaginative reach in all areas of learning; that simply getting more students to take exams in drama, art or music, while very important, is by no means enough; that passing exams is only one measure of educational success, not the be all and end all; and that these things will be reflected in future policy will be a good day for me. I hope that when the noble Baroness comes to wind up she can make my day.
My Lords, it is a pleasure to follow the noble Baroness, Lady McIntosh, following her dash from the Woolsack, and to join your Lordships in discussing two issues dear to my heart: education and health—or, as Tony Blair used to say, “schools ’n’ hospitals”. These are the everyday issues that our fellow citizens are concerned about: their health and that of their parents, their loved ones, partners and children, and, of course, where those children will go to school, college and university. What a joy it is and has been—a throwback, perhaps, to a gentler time—to take part in a debate in which there has been so little mention of the “B” word. Perhaps this is what political normality looks like. Do any of us remember?
I join other noble Lords in paying tribute to the noble Baroness, Lady Emerton. She has been a fine servant of this House and a source of wise advice on health issues. She will be sorely missed. It has been commented many times, in this debate and elsewhere, that there are perhaps too few nurses in the NHS. I am afraid that there are now too few in this House as well. We wish her well. Before I go any further, I refer noble Lords to my interests as set out in the register.
On education, contrary to some of the views expressed this evening, I believe that the Government have a track record to be proud of: hundreds of thousands more children educated in outstanding schools, hundreds of new schools and academies created, and the introduction of a wide set of reforms to standards on phonics, maths, the curriculum and qualifications that will help young people reclaim their right to be among the best educated in the world. I could not help but note that the noble Lord, Lord Storey, was not so impressed by these reforms, pointing to the results of the international PISA survey. In the interim, between his speech and mine—I hope he will not mind—I checked online. I noticed that the most recent published data was for tests sat in 2015. The 15 and 16 year-olds taking part had spent most of their life being educated under a Labour Government. Nevertheless, I share his urgency on improving school standards, but it is only fair, since the national curriculum was introduced in September 2014, to wait for future evaluations before we come to any final judgments.
In the last few years, school funding has been a growing pressure. The promised increase in the school budget to level up spending for the worst-funded schools is welcome, but it is further education that most needs our attention. FE has always been the Cinderella service among policymakers, usually because people in positions of power have little experience of it. The extra £300 million set aside for this sector in the recent spending round was good news, but it is only a one-year settlement. I hope that my noble friend the Minister can provide some comfort to your Lordships that it is only the first step of many towards a properly funded lifelong learning and further education system.
On health issues, I congratulate my noble friend and her department on a full slate of major reforms in the most gracious Speech. We are looking forward to the Health Service Safety Investigations Bill, which receives its Second Reading next week. I will reserve my comments on it until then. Perhaps in the interim, however, my noble friend could reassure the House that the Government are not putting all their eggs in this basket and that other separate but equally important patient safety initiatives, such as my noble friend Lady Cumberlege’s review of the safety of medicines and medical devices, will be acted on with the same energy.
The most gracious Speech also contains details of an important Bill that will determine the future regulatory system for the medicines and medical devices we rely on in the NHS. Does my noble friend agree that, on regulation, our aim for the future relationship with the European Medicines Agency should be to become an active and participating full associate member, but, if that is not possible, that we should use the opportunity to create the fastest, most sophisticated and joined-up system for bringing advanced therapies to patients anywhere in the world?
One way of achieving this goal is to ensure that the NHS has world-leading digital infrastructure. I know that my noble friend cares deeply about this topic, so can she tell the House how she will maximise the benefits of the UK’s health data assets for NHS patients? A significant investment by the Treasury in this project at the upcoming Budget would be a welcome sign of progress.
Finally, the Queen’s Speech was strong on promoting science and R&D. Nowhere does this matter more than in the life sciences and in health. Does my noble friend agree that a major focus for increased spending should be the National Institute for Health Research, one of our most effective research organisations, which has had only a flat cash settlement for the past 10 years? Funding this institution should be part of a collective strategy to reimagine the NHS as the world’s biggest and best R&D organisation. It will be patients who benefit the most from such an ambition. In these divided times, surely that is something we can all agree on.
My Lords, the Government may aspire to the uplands of the “greatest place on earth”, but social and economic headwinds may undermine that persuasive rhetoric. The growth in employment has been positive for households, but the labour market is softening and there is a growing body of evidence that household financial resilience is weakening. Many households are living on the edge. They are getting by, some comfortably so, but a single adverse event can push them over that edge. Low financial resilience is not reserved to those on low incomes; it has travelled up the income scale. Some are well placed to weather the storm of a sudden fall in income or unavoidable rise in expenditure, but others are not.
Each year, some 6 million working-age people face a life event likely to cause a substantial fall in income; a further 6 million face a sudden, unplanned expenditure need. These shocks arise for reasons such as illness, job loss, reduced hours, relationship breakdown, bereavement and new caring responsibilities. Low resilience has consequences for people, for welfare and health costs, for employers, and elsewhere in the economy. A range of factors increases resilience: access to employment benefits, state benefits, private insurance, savings, affordable credit, help from family and fewer pre-existing debts, but those factors are weakening, shifting more responsibility for financial resilience on to the individual, which many are ill prepared to take on.
Support from employer occupational benefits such as sick pay, redundancy pay and death-in-service payments is declining in coverage and value: only 28% of employers provide more than the basic statutory sick pay of £94.25 a week. State benefit rates have fallen in real terms; help with housing and mortgage costs has reduced. While it is true that more people are in work, one in six is self-employed, one in 12 has contracts with reduced employment protections and some 73% of people in regular jobs face significant fluctuations in monthly earnings. Fewer people work for large businesses, which traditionally offered benefits that mitigated income shocks. Now, 60% of private sector employees, more than 16 million people, work for small and medium-size enterprises and more than half, 8.8 million people, work for micro businesses.
On savings and insurance, the FCA found that 13% of adults have no cash savings whatever and that a further one in three has savings of only between £1 and £2,000, while 65% have no form of life or protection insurance.
Secure, regular work, with good employment benefits, is an important defence against low household financial resilience. Given the weight of the current evidence, moving away from a level playing field on employment standards, which the new Brexit allows, will not build the greatest place on earth but will push more families over the edge. Employment growth has been positive but as David Ramsden, a Deputy Governor of the Bank of England, observed, that businesses are increasing employment at the same time as they are reducing investment raises concerns over that resilience in the labour market. One explanation could be that businesses are substituting labour for capital, as hiring is easier to reverse than capital expenditure. A further explanation could be a shift away from capital-intensive, export-oriented businesses and into labour-intensive, domestically focused ones. Either way, neither is beneficial for financial resilience in households.
I welcome the pensions Bill. There is about £7.6 trillion of state, public and private pension entitlements in the UK pension system. The market and public policy supporting that system demand scrutiny and the Bill provides a further opportunity to do that. However, I am concerned it does not lock in that a pensions dashboard is for the public good, and that the best interests of pension savers are not to be traded off against the interests of financial providers. I am sure that this House will want to debate that issue with the Government at some length.
The Government could do much more to address the persisting gender pensions gap. Only about 36% of those eligible for auto-enrolment are women. Women’s ability to save is also constrained by income inequality throughout their lives. The highly regarded Fawcett Society has outlined the case for the introduction of a carers’ credit towards occupational pension saving, to ensure that those who take time out of paid work to care for children or adults would see their caring contribution recognised not only in the state pension system, where this is already the case, but also under the auto-enrolment system. Prior to the introduction of the flat-rate state pension in 2016, the principle of crediting carers applied to the state second-tier pension, S2P. That principle should not be lost but should continue to apply now that the second tier has transferred to private provision through auto-enrolment. I hope that the Bill will be the opportunity to push the Government on what progress they can offer to address this persistent gender pensions gap.
My Lords, I refer to my interests in the register. I am going to be talking about Bills and what I call missing measures—or perhaps that is my wish list. We welcome the healthcare Bills in the Queen’s Speech. The Health Service Safety Investigations Bill seems sensible, and I look forward to a departmental briefing before Second Reading. The Mental Health Act was passed in 1983 and updated in 2007. Sir Simon Wessely has carried out his consultation on the Act, which should finish by the end of this year, and we look forward to the White Paper and subsequent Bill. The Medicines and Medical Devices Bill may well be critical in the event that we leave the EU. There will be a Bill to deliver the long-term plan, which will be interesting because it will have to enact some kind of reverse surgery on the Health and Social Care Act 2012, undoing some of the stuff that was done and putting other bits together. With apologies to St Matthew, what has been joined together may be very difficult to rend asunder; we shall see. With all these Bills the devil will be in the detail, and I am sure the Minister will understand that we will not hesitate to hold the Government’s feet to the fire where we think it necessary.
Everyone in the UK is thankful for the NHS, values it and understands how important its success is, but it is struggling, as we see in the parlous state of our cancer survival rates and one of the worst rates of depression in the EU. Some 1.4 million people this year did not receive any social care support, meaning that they went without a bath, help getting dressed in the morning or help with food, which puts a huge strain on family carers. The noble Baroness, Lady Bakewell, spoke about the need of elderly people for personal contact and how good it is for their well-being and mental health. Our workforce is in crisis as never before, with shortages of nurses, care workers and doctors, GPs and consultants across most specialities. The latter are particularly affected by the pension issue mentioned by the noble Baroness, Lady Donaghy. Can the Minister tell us whether the Treasury is close to resolving this issue?
For the past few years, we have watched as the Government have repeatedly cut public health funding. In the UK, a wealthy first-world country, life expectancy is decreasing for the first time ever. That statement should shame us all. It is not something that we should ignore, and the Government should not be surprised if there is a campaign to increase or at least sustain funding for health and social care.
Several areas vital to the future of health in this country are being sidelined at the moment. First, the state of mental health services is a scandal. We welcome the commitment to a new mental health Act, but it will not be worth the paper it is written on unless we can do something urgently about the workforce and local access to services for both adults and children. It is a sign of the times that a wonderful new residential facility for 12 children in Cornwall had to be funded by a local charity. The NHS did not have the funding locally to do it, but it is a brilliant facility.
For most of us, our first point of contact with the NHS is the local GP, but many feel unable to diagnose mental health conditions, so we need to improve mental health training for all GPs and health staff. Many long-term physical conditions have free prescriptions: I hold my hand up as being in receipt of that. Have the Government looked at replicating this for the most mentally unwell, where the condition is enduring? I know that for many there is a worry every month about which medications they feel they must have and which they feel they can do without. That is a scandal, too. While she was Prime Minister, Mrs May promised a Green Paper on social care. Many noble Lords referred to this and it was referred to in the Queen’s Speech. We all know that the only way to secure the future of social care is through a cross-party commission on social care funding. All parties have agreed to sit around a table, yet the promised Green Paper is hidden in the long grass. Two Prime Ministers have promised to sort this out, but we are still waiting.
We need to ensure that the quality of social care, both for our elderly and for those with disabilities, is excellent. The people who care for them, whether a family carer or a professional, need recognition and support. I gently remind the House that adult social care concerns vulnerable older people and disabled people of working age—that is often forgotten. I would welcome more ambitious targets on reducing life expectancy inequality for people with learning disabilities. Can the Minister confirm whether work to achieve this is in hand? On public health, we need to keep working with manufacturers to reduce sugar and to ensure that there is minimum unit pricing for alcohol. This is not the nanny state; it is, as the noble Lord, Lord Young of Cookham, put it, “benign paternalism”. I think that is far nicer. Over the past 20 years or so, the public have continued to eat too much of what is not good for them, and the taxpayer picks up the bill for NHS care for their type 2 diabetes, stroke, heart disease and cancer.
Our dedicated workforce determines everything within the health and social care system; nothing will succeed if there are not trained staff right across the system.
The NHS is not universally a good employer, with flexible working and mental health support. Many junior doctors do not even qualify for shared parental leave. The unresolved contract issues need to be sorted. Pharmacists are key to improving community healthcare right across the country, but services are not being commissioned from them. Many of us have friends or family who have been looked after by care workers on the minimum wage. I would like to see in the next Queen’s Speech some legislation to require care work to be a profession and care workers to be registered.
This debate should be in praise of the NHS and social care. Most noble Lords present will have a reason to be grateful to NHS or care workers who have gone the extra mile, whether in A&E, specialist services or a late night attendance at home. I would like to express all our thanks for the hundreds and thousands of friends and family carers who have gone unnoticed in the Queen’s Speech, who give up their jobs and lives to care for someone who can no longer care for themselves. Although she is not in her seat, I am sure that the noble Baroness, Lady Pitkeathley, would remind us that they save the state the equivalent of the whole annual NHS budget. I also applaud the carer’s credit of the noble Baroness, Lady Drake.
Like others, I am sorry that the noble Baroness, Lady Emerton, is not in her place. When I was new here, she was hugely helpful and gave me much advice about dealing with both health policy and noble Lords. She was a formidable nursing leader, made a DBE when I was in my 30s—which seems a really long time ago now—and will probably remain the only nurse to have a building named after her. I hope she is better soon.
I must praise the voluntary sector in both health and social care, the professional bodies and our world-leading think tanks. They carry out research and act as beacons for good treatment and health and social care policy, and thus improve care of patients and the professionalism of health and care workers. I also echo the words of the right reverend Prelate the Bishop of London in applauding the work of faith groups and local charities in health and social care delivery. This has been a wide-ranging debate, and we have learned much about the challenges of other disciplines. I eagerly await the Minister’s response.
My Lords, a field of 60 speakers covering four government departments has produced wide-ranging and in many cases thought-provoking contributions. I have time to refer to just a few of them.
The noble Earl, Lord Devon, said he felt that simply being part of this debate was a surreal experience. Well, today is the sixth and final day of what is a rather surreal Queen’s Speech debate, as all noble Lords are only too aware that it is not a serious plan for government. But that is not its intention. It is merely a draft of the next Conservative Party manifesto, as noted by so many noble Lords. We shall be here again quite soon—although not necessarily on the same sides of the Chamber.
We cannot be oblivious to events taking place simultaneously in another place. Boris Johnson assumed the premiership with a promise to return to Brussels and open discussions on the withdrawal agreement. It took some degree of skill to negotiate an even worse deal than that concluded by Theresa May, but he has done precisely that. The Minister said in her opening remarks that the Queen’s Speech would deliver EU exit. Well, we shall see.
This phantom Queen’s Speech had nothing to offer on education, as many noble Lords have noted, with no commitments for new legislation or policy to improve our education system. It is now three years since we had an education Bill—although I suppose I should be careful what I wish for, because education legislation since 2010 has not been at all welcome or beneficial to the life chances of our young people, as the noble Lord, Lord Storey, said. Despite making a number of commitments that would require legislation, it seems the Government have now abandoned their own policies.
The Minister in her reply will no doubt claim that the Government outlined additional investment for schools in the recent spending review. Quite so, but that funding announcement has been massaged to make it sound much more impressive than it is. It talks of a £14 billion increase, but that represents the extra spending aggregated over the entire period from 2020 to 2023. It is not a measure of how much higher spending will be at the end of the three-year period than at the beginning—and it emphatically will not reverse the cuts of the past nine years.
Then there is the issue of the politicisation of the distribution of that funding, which will clearly favour the schools with the least disadvantaged pupils. Data analysis by BBC’s “Newsnight” last month found that overwhelmingly Conservative-held constituencies would be the beneficiaries of the proposed increase in schools funding. This reveals a clear targeting strategy by the Government with, one suspects, an eye on the general election.
The recent spending review committed the Government to “level up” funding for schools by 2021-22. But analysis shows that nine of the top 10 beneficiaries, in terms of an increase per pupil, are in Conservative-held constituencies. All but four of the 36 seats which get no uplift at all from this additional spending are Labour-held. As the Education Policy Institute commented:
“Levelling up doesn’t mean addressing social inequality. In this context, it means bringing generally more affluent schools up to the same level of funding as more disadvantaged schools”.
I think that most people understand that funding needs to be higher in disadvantaged than advantaged schools, and they understand why. Most people—but not, it appears, those in this Government.
Detailed analysis by the teaching unions has further demonstrated the strong link between deprivation and the scale of government cuts to school funding. Cuts to schools serving the poorest pupils are more than three times as deep as those to schools teaching the wealthiest. Of the 10 poorest local authorities in England, the cuts are above average in seven of them. Of the 10 most prosperous local authorities in England, the cuts are below average in eight of them. I do not expect the Minister to justify these shocking figures, because education is not her responsibility. But she should not worry, because even her DfE counterparts could not do other than concede that it was done for political advantage. Playing politics with the life chances of young people says all that needs to be said about the Government’s lack of fitness to govern.
Beyond schools, my noble friends Lord Bradley and Lord Young, and the noble Lord, Lord Aberdare, rightly spoke of their concerns about apprenticeship numbers. The Open University recently published its Access to Apprenticeships report, which clearly demonstrated a strong desire on behalf of employers to recruit more people with disabilities into apprenticeships and to close the gap in employment between those with and without a disability. Yet the Queen’s Speech had nothing to say on that subject or on the wider skills agenda. As my noble friend Lady Blackstone said, our FE colleges play a vital role in preparing young people for careers, but they could do much more if they were properly funded. I echo her call for funding to be raised to £5,000 per FE student, to match the figure in secondary schools.
My noble friend Lord Bassam, the noble Lord, Lord Lingfield, and the noble Baroness, Lady Garden, all highlighted the need to follow up on the Augar report. I fear that that will never see the light of day.
A strong case needs to be made also for maintained nurseries, which are once again facing the possibility of transitional funding running out due to a lack of long-term investment from the Government. The noble Baroness, Lady Boycott, highlighted the gap in children’s development when they first arrive at school. It is now widely accepted that the greatest contribution to social mobility is made in early-years settings, and that should be reflected in the way they are resourced to do their job. Labour will give each level of education the investment it needs as part of the development of a national education service, to transform educational opportunities for the next generation.
As my noble friend Lady Sherlock said, the welfare state embodies a vision of a country where we take care of each other. It is based—or ought to be—on a concept and an understanding of social solidarity. But that is a concept and an understanding that, it seems, are alien to many in the Conservative Party, particularly those who have now shouted and elbowed their way to dominant positions in the party and the Government. No wonder the noble Lord, Lord Young of Cookham, in his contribution bemoaned the decline of one-nation Conservatism.
Deep cuts to benefits over the past nine years have served to drive people into poverty. The noble Lord, Lord Willetts, rightly highlighted in-work poverty. However, the system of working tax credits introduced by a Labour Government to make work pay has been swept away—a process which, I have to say, was begun by a Government of which the noble Lord, Lord Willetts, was a member. How can it be right—how can it be regarded as civilised—to have a society in which even families where both parents are in work have to rely on food banks? Yet there was no social security Bill in the humble Address, and not even a mention of poverty.
Perhaps that should have come as no surprise, as the Government have banished the word “poverty”. They abolished the Child Poverty Act in 2016 and got rid of the target to end child poverty. That same year, the Social Mobility and Child Poverty Commission was renamed the Social Mobility Commission, but the Government have certainly not banished poverty, as several noble Lords highlighted in this debate.
The only DWP Bill in the Queen’s Speech was the Pension Schemes Bill, on which my noble friends Lady Drake and Lord McKenzie spoke forcefully. I think my noble friend Lady Bryan merits a response from the Minister on the wrongs suffered by WASPI women that she so effectively outlined.
On health, all we heard was repeats of previously announced spending plans, together with ill-defined proposals to reform the Mental Health Act and address social care. Many noble Lords, most forcefully my noble friends Lady Bakewell and Lady Wheeler, spoke of the urgent need for action on social care—which was, let us not forget, first promised by the Government in the March 2017 Budget, then in the 2017 election manifesto and again on the steps of Downing Street in July that year. The Government have consistently failed to deliver. This July, the Financial Times reported that the Green Paper had been ditched and that instead a White Paper would be published in the autumn of 2019. Here we are in the autumn, and still nothing has appeared. Perhaps the noble Baroness can explain that lack of action in an area where legislation is desperately needed.
In contrast, Labour has set out our vision for a national care service that includes free personal care for older people, a lifetime cap on care costs and immediate funding up front to deal with the crisis of nine years of cuts to council budgets.
Will the Minister explain why the mental health Bill announced by the Government 10 months ago did not make it into the Queen’s Speech? Will the Government now implement the recommendations of the independent review of the Mental Health Act asked for by so many noble Lords?
In conclusion, I hear some noises from the Government Front Bench in response to some of my comments. If I appear to be more political than some people might have expected, let me say that it is in response to a Queen’s Speech that is more political than people had a right to expect. I think it is appropriate, as this is a low point of the political and economic standing of this country. As noble Lords who have travelled abroad recently will know—I was in France at the weekend—you meet people who are incredulous about what is happening in this country, particularly within Parliament. When I speak to people of other nationalities, they laugh rather nervously when I say that I, too, am incredulous at some of the developments. I believe that I am not alone in that.
Today, the Prime Minister has failed once again to impose his will on Parliament. He is a discredited figure here, as well as abroad. The noble Baroness, Lady Barran, was apparently serious when she said in her opening remarks that this is a country “happy and confident” about its future. With the greatest respect, she needs to get out more, because that is very far from reality. I fear that the scars caused by the past four years will not heal quickly.
In a few weeks, no one will recall this Queen’s Speech, and nor should they. The next one will map out the future direction of this country, and we can only hope that the Administration who are dragging us down in the eyes of the world will not be its authors.
My Lords, I am honoured to close this final day of debate in support of the gracious Speech. As ever, debate has been robust, largely courteous, but underpinned by the extensive expertise of this House. In this age of partisan rancour, our debate has been informed by a deeply held belief that in this place, regardless of political persuasion, we are bound together by a collective responsibility to use our roles here to improve the lives of our fellow citizens. That is something to be proud of.
The topics we have debated today—education, work and pensions, culture and health—make more difference than any others to the lived experience of people across this country. That is why the past seven hours have flown by for me as I have listened with pleasure to the important contributions of 61 noble Lords. It is because of the importance of these issues and the consensus on the need for action that the Prime Minister and his Government have prioritised them over recent months and, of course, in the gracious Speech, investing £14 billion in schools over the next three years, supporting the modernisation of pensions, accelerating access to broadband—perhaps even to the home of the noble Lord, Lord Aberdare—and three new health Bills, with a commitment to work towards a further two. It is an ambitious agenda and has been fully reflected in today’s wide-ranging debate.
I will now do my best to respond to the many important points raised today, but it will be necessary, I am afraid, that the relevant Minister might have to write on a few issues that I am not able to cover in the time that is available. I begin by focusing on education. I know that the whole House is passionate about supporting investment in education and the importance of ensuring, as the noble Baroness, Lady Massey, so clearly put forward, that all children, no matter their background, can benefit from an outstanding education. As the noble Lords, Lord Storey and Lord Berkeley, and the noble Baronesses, Lady Bull and Lady McIntosh, noted, there should be a broad and varied education. As a former musician myself, noble Lords are preaching to the choir when they emphasise the value of creativity to society and its role in preparing children for the future—even its role in preparing a recalcitrant Health Minister.
As has been mentioned, the Government have announced welcomed investment in schools. I can confirm to the noble Lord, Lord Watson, that, following the funding allocation statements issued by DfE last week, all schools will be better off in three years’ time.
The noble Lord, Lord Addington, raised very important issues around special educational needs, and the Government have announced an additional £770 million of investment in 2021 for SEND education. But the whole House will appreciate that providing the best possible education is not just about money. That is why the DfE has commissioned a review of SEND education to assess what further we need to do in order to support pupils with special educational needs, so I will put forward the specific points that he raised in order to ensure they are properly considered.
The Government have also set up a cross-government hub for all disability issues in the Cabinet Office to draw together a catalysed, more effective cross-government action on these points. The DWP has increased the size of Access to Work grants by £15,000 in the last year, driving forward a 7% increase in the volume of grants made in recognition of their importance. This will support those with disabilities and special educational needs in the workplace.
A wide range of noble Lords noted the critical role of further education, with my noble friends Lord Lingfield and Lord O’Shaughnessy, and the noble Lord, Lord Aberdare, and the noble Baronesses, Lady Blackstone and Lady Garden, all drawing attention to it. Further education is at the heart of the Government’s plans for an education system that works for everyone. That is why we have announced—as has been noted—an additional £400 million of funding and a focus on improving not only the quality of teaching and learning but also its status.
Many noble Lords have welcomed an investment as well of £290 million in 20 institutes of technology to deliver higher technical education as a clear route to high-skilled, high-wage employment, but they also sought more clarity on how this will work in practice. I shall ask for those points to receive an individual response as I cannot get through all of those right now.
The noble Lord, Lord Storey, and others also raised the response to the Augar review, which is awaited. I confirm that Ministers are considering this very carefully and will respond shortly. This is a policy area that would clearly benefit from close attention in the spending review that is coming up next year.
On essay mills, I can confirm that, in the first instance, the Office for Students will engage the sector in order to eliminate the use of such organisations, but the Government do not rule out further action.
Clearly, more progress needs to be made on apprenticeships, but much progress has been made: over 1.8 million apprenticeships have started since 2015, investment annually is over £2.5 billion and over 60% of apprenticeships are of the highest industry-desired standards. I recognise the need for progress, and we are working hard on it. That is why the Secretary of State has taken the portfolio of apprenticeships as his personal responsibility, in response to the point made earlier.
I turn to work and pensions. The noble Baronesses, Lady Donaghy, Lady Watkins and Lady Sherlock, and the noble Lord, Lord Willetts, all raised universal credit and concerns about in-work poverty. I think there is a consensus that work should always pay. Universal credit is a welfare system designed to help people into work, to support those who need help and to be fair to everyone who pays for it. The DWP recognises, however, the need to continually review and improve universal credit. This year alone, the DWP has committed to running a pilot on moving to universal credit to ensure the further and safe rollout of the advantages of universal credit. I noted the question about an update on that progress and I will ensure that a note comes to the noble Baroness about that. The department has announced that it will reduce the maximum single sanction that a claimant can face from three years to six months, and the number of those sanctions has also fallen. The department has instructed work coaches to use the flexible support fund to support parents with childcare costs. It is also providing £3 billion to support transitional arrangements for claimants moving over from other benefits. Noble Lords also raised concerns about the benefits freeze being extended. I can confirm now that it will come to an end by 2020.
The noble Baroness, Lady Bryan, and a number of noble Lords mentioned the pensions Bill. I genuinely feel that pensions is an area where there has been positive progress over the past decade. The Bill now goes a step further to improve both the options available to employers and accessibility for employees, so that they can track their pension as they would their bank account.
Our debate on DCMS was particularly robust, it is fair to say. I begin with broadband rollout, which was mentioned by the noble Lords, Lord Clement-Jones and Lord Aberdare. The Government have been clear in their commitment to delivering nationwide, gigabit-capable, reliable and resilient broadband—that is not easy to say at the end of a long debate—as soon as possible. That is why the gracious Speech included the telecommunications Bill, to ensure that millions of leaseholders are not left behind as we upgrade our communications network. I am conscious of the time but I am also aware that the Second Reading is imminent, so I am sure that many of the points made by your Lordships will be answered in letter form and that there will be ample time for detailed debate and robust scrutiny, which I am sure this House will provide.
The noble Lords, Lord Clement-Jones and Lord Griffiths, and a range of Peers noted the challenge of online harms and how to regulate and respond to digital technologies that can change and evolve rapidly. The online harms White Paper was published in April. It set out the Government’s plan for world-leading legislation to make the UK the safest place in the world to be online. The public consultation has closed and the Government’s response will be published in the coming months. We will then publish a draft Bill for pre-legislative scrutiny. Let me be clear: the Government recognise that this is one of the fundamental challenges facing our society in the coming years and they are determined to address it.
I want explicitly to recognise the strength of feeling expressed by the noble Baronesses, Lady Benjamin and Lady Howe, the noble Lords, Lord Clement-Jones and Lord McNally, and other noble Lords on the issue of age verification and the pace of reform. I will confer that back to the department. The Government are clear that protecting children is at the heart of our online reform agenda and is key to wider government priorities. The issue here is making sure that those reforms are as effective as possible and do the job that they are intended to do.
Moving on to health and social care, my department was delighted to begin the year by publishing the clinically led NHS long-term plan and by securing £33.9 billion to support its implementation. On the point made by the noble Lord, Lord Smith, the plan focuses not on funnelling ever-greater funding into the health service but on ensuring sustainable and substantive reform that can support what we all want to see in the health service. As my noble friend Lord O’Shaughnessy noted, there are delicate balances to be struck on integration versus accountability, which the upcoming NHS long-term plan Bill is intended to address. That has also been clinically and NHS-led.
I follow the noble Lord, Lord Hunt, who is not in his place—
Sorry, he is in a different place. I follow the noble Lord in paying tribute to the noble Lord, Lord Patel, and his colleagues on the Long-Term Sustainability of the NHS Committee, which he chaired, because many of its proposals were replicated in the long-term plan.
The noble Baronesses, Lady Greengross, Lady Walmsley and Lady Massey, and my noble friend Lord Young raised the importance of prevention, primary care and tackling inequalities. These are all important agendas for the Government and for my department, which is why the Government have committed more than £4.5 billion of additional funding to support GP services and will recruit an additional 20,000 staff to work in practices.
It is also why the Government have published their prevention vision, which sets out an ambitious agenda in order to put public health at the heart of everything the department and the NHS do, including aggressive action to tackle obesity such as the sugar tax, which has proved to be a great success. I am happy to reassure my noble friend Lord Young of Cookham that this will continue to be right at the heart of our agenda. Moreover, the department is addressing the real and valid concerns about health inequalities. We have just recently finished consulting on how to improve the health of people living in the poorest communities. Reducing inequalities is a key part of the long-term plan and will be a requirement as part of our PCMs.
We have also worked closely with Defra on the introduction of the clean air strategy, which was noted by the noble Baroness, Lady Walmsley, and on antimicrobial resistance, which no one noted but I do so now, and with Henry Dimbleby on his food strategy. On this last point, while I cannot commit the Leader of the Opposition to continuing commitment on this agenda, I can certainly reassure the noble Baroness, Lady Boycott, of the Government’s ongoing commitment and I thank her for both her expertise and her work on this agenda because it is essential.
The noble Baronesses, Lady Greengross, Lady Meacher, Lady Hollins, Lady Watkins, Lady Sherlock, Lady Campbell, Lady Wheeler and Lady Bakewell, along with my noble friend Lord Young, the noble Lord, Lord Hunt, and the right reverend Prelate the Bishop of London also raised the critical issue of social care. As my noble friend Lord Willetts said, we must just get on with it, and I do not think that I can improve on what the noble Baroness, Lady Bakewell, said: “Ageing is not an option”, and nor is substantial reform in this area.
The Prime Minister was clear on the steps of Downing Street about this Government’s determination to fix the crisis in social care to ensure that every older person has dignity and security and that no one needs to sell their home to fund their care. He wants this to be a bold, once-in-a-generation reform and I can reassure the House that officials across government are working, probably at this moment, on developing ambitious proposals on top of the £17.1 billion invested in the past financial year. However, I will strongly reiterate to the Secretary of State and to the Prime Minister, as I often do, the very strong mood in this House that the time for action is now. I will also confirm that the department will consider carefully the recommendations set out by the Independent Living Strategy Group, led by the noble Baroness, Lady Campbell, and those of the Intergenerational Fairness Committee, of which the noble Baroness, Lady Greengross, is a member, as part of those considerations.
The noble Baronesses, Lady Jolly, Lady Donaghy, Lady Janke and Lady Watkins, along with the noble Lord, Lord Patel, raised the issue of NHS staffing. Having the right staff is crucial to delivering the aims and objectives of the long-term plan. To address this, we are recruiting more staff than ever before with, for example, a 25% increase in training places for medical students. We have also given a significant pay rise to more than 1 million staff and my noble friend Lady Harding is currently preparing for publication the people plan, which will set out a range of ambitious options for what more we can do to improve the situation. In answer to the noble Baroness, Lady Watkins, this will specifically consider the whole range of potential financial incentives which could support recruitment and retention. At this point I will follow other noble Lords in putting on the record my department’s deep appreciation of the noble Baroness, Lady Emerton, for her wonderful work as a champion of the nursing profession.
The noble Baronesses, Lady Jolly, Lady Hollins, Lady Sherlock, Lady Featherstone, and Lady Tyler, and my noble friends Lady Verma and Lord Kirkhope, along with the noble Lord, Lord Watson, noted the importance of getting mental health right, the reform of the Mental Health Act and the care of those with disabilities. This is not only a crucial issue but a complex area, so it is important that we get the reform right. I recognise the impatience of noble Lords to go further faster, but there is real progress to report. The Government have already accepted a number of the recommendations made in the independent review. We will publish a White Paper by the end of the year and we will set out in detail our legislative and non-legislative response. To address the immediate service challenges, the Government are also investing record amounts in NHS mental health care as well as in care for those with learning disabilities and autism. I can also report that capital will not be overlooked. Since 2017, we have recruited more than 3,000 additional staff to put in place a wide range of measures to ensure that care is provided closer to home.
The noble Lord, Lord Rennard, and my noble friend Lord O’Shaughnessy raised Brexit and the health service. In any Brexit scenario my department is committed to maintaining the very highest standards of regulation and I can assure the noble Lord, Lord Rennard, and my noble friend Lord Young of Cookham that we will remain a world leader in the regulation of tobacco and of prevention, as we have laid out in our prevention vision. Our preference remains close co-operation with the EMA as well as with our other long-term friends and partners such as the Commonwealth, as my noble friend Lord Howell mentioned.
The importance of patient safety was also raised by a number of Peers in relation to the upcoming Health Service Safety Investigations Bill. I am very much looking forward to its Second Reading next week, when I am sure we will have plenty of time to debate it and I will be held to account in every possible way—so I shall not go into detail on that now.
I will say just a word about innovation, raised by the noble Lords, Lord Patel, Lord Kakkar and Lord Bassam, who raised the importance of life sciences and innovation. We have a very strong record in this area. I am afraid I do not recognise the picture presented in the IPPR’s recent report. Turnover and employment in UK life sciences have grown notably over the last decade, and the life sciences strategy sets out a powerful vision for action, which we are delivering against assiduously. This has included £1 billion of government investment and £3 billion of leveraged industry investment. We now have substantially better partnership between the NHS, academia, government and industry, but I agree with the noble Lord, Lord Kakkar, that we have to improve on our rate of progress between ideation and adoption. Part of that is better working between all those agencies engaged in trying to deliver against that objective.
I also noted strong support from the noble Lord, Lord Patel, and others on the fast-track visa for top scientists. I will take away the sensible suggestion from the noble Baroness, Lady Bull, that this be expanded to include the cultural and creative sectors.
Finally, the noble Baroness, Lady Deech, raised the storage of gametes. I agree on the importance of this, as I think she knows, and have continued to push this matter within my department. To that end, I hope to have a positive update in the coming weeks.
I am mindful that I have only a short amount of time and the clock is counting down. In closing, I reiterate my thanks to noble Lords for their many and varied insightful contributions. Responding to a debate such as this is a challenge, given the breadth of issues we have covered, but it is also a pleasure, giving me the opportunity to engage on many issues that I do not regularly come across in my brief. As has been pointed out, we debate the gracious Speech in unprecedented political times, but my commitment to this place on behalf of the Government and the departments for whom I speak today is that we will continue to strive day in, day out to improve the lives of and the services available to people right across the United Kingdom. I know that is an ambition to which all your Lordships here today will join me in being committed.
Motion agreed nemine dissentiente, and the Lord Chamberlain was ordered to present the Address to Her Majesty.
House adjourned at 10.17 pm.