My Lords, I am delighted to speak in this debate on the humble Address and draw attention to my interests in the register, particularly those in relation to nursing. I welcome Her Majesty’s Government’s commitments to publishing draft legislation to reform the Mental Health Act. The White Paper sets out proposals to amend criteria for detention under Section 3, excluding people with a learning disability and people with autism unless detention is for treatment of a co-existing mental disorder.
Efforts to reduce detention and so-called warehousing of people with a learning disability have received broad support—understandably so given that, in March 2022, 57% of in-patients with learning disabilities and/or autism had been in hospital for more than two years. However, we need assurance from Her Majesty’s Government that, when the Act is reformed, the rights and needs of patients detained under Section 3 without a diagnosed mental illness will be protected and that, in the absence of safe discharge, continued holding in hospital will not simply be transferred under the frame- work of the Mental Capacity Act.
The Queen’s Speech made fleeting reference to supporting the NHS, and none to supporting social care to manage already pressured services. However, greater investment is absolutely essential. The White Paper proposed a duty on commissioners that requires
“adequate supply of community services”.
Such a legal requirement must be accompanied with sufficient resource to support the mobilisation of service and development of workforce.
The need for improved community support spans different populations, including people living with dementia, which leads me, like others, to ask: when do the Government intend to publish the national dementia strategy? Briefings received from carers’ associations are questioning whether the Government intend to ensure carers’ rights to a minimum of one week’s unpaid care leave. Other noble Lords have spoken on this more eloquently than me. My important point is that supporting carers will reduce unnecessary admissions to hospital and be cost effective.
Leaders in the NHS have made it clear that investment in community services is vital, both to reduce the unsustainable pressures on in-patient services and to provide dignified care in people’s homes. I believe that a minimum wage for social care workers delivering personal care is essential. Do the Government intend to introduce a national minimum wage for personal social care workers and to fund time for travel between their clients’ homes?
Coming, as I do, from a rural village near Tavistock on Dartmoor, it is almost impossible to plan a care worker’s rota without at least 20 minutes of travel between their clients. Central government allocations to local authorities from the levy should have sufficient resources to let contracts that enable payment for travel time.
The new health and social care levy is widely supported by the population. This is in effect a hypothecated tax that the public expect to improve seamless health and social care. Recent reports about standards in some independent care providers where NHS contracts are delivered cause particular concern. Can the Minister advise the House what requirements there will be for ILACS to monitor contracts it lets—for example, in mental health—in addition to CQC monitoring and inspections? It is necessary to take a whole-systems approach that recognises the pressures all areas of care are suffering from and focuses on reducing inequality in delivery. How will the Government ensure a fully funded workforce plan so that we have sufficient competent staff to meet demand for care?
I will speak briefly on the issue that my noble friend Lord Laming wanted to raise. What are the Government’s intentions on tracing the estimated 135,000 “ghost children” who have not returned to school after lockdown? If every child matters equally, there is a child protection issue at stake here. How do the Government intend to ensure the regular attendance in school of all children to promote equitable opportunity for lifelong success?
It is vital that young people going to university who leave with significant debt feel valued in the workplace. We must stop hammering our young. I reiterate a previous request: will the Government consider writing off student fee debt for at least five years for graduates who work in a range of public services where face-to-face contact is essential? These graduates appear to be at significant disadvantage compared with those in the independent sector, where salaries have risen to reflect the cost of regular student loan repayments.