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Queen’s Speech - Debate (6th Day)

Part of the debate – in the House of Lords at 9:37 pm on 22nd October 2019.

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Photo of Baroness Jolly Baroness Jolly Liberal Democrat Lords Spokesperson (Health) 9:37 pm, 22nd October 2019

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.