My Lords, on behalf of all noble Lords, I thank His Majesty for his gracious Speech. I am truly honoured to be a Minister in his Government and to open this debate.
I always said that I wanted to be a different kind of Minister, and today is no different. Over the past few days, I have thought a lot about the sort of speech that I wanted to give. I could not quite make up my mind, but it finally clicked late last night, as I leaned over my five year-old son, Xavi, as he slept in his bed. I thought that, if I am making a speech about the long-term changes that this Government want to make in health, education, housing and welfare, I need to explain what kind of country we want to build for Xavi and his generation—so forgive me if this is a bit unconventional.
As I have told Xavi when he asks me about work, the National Health Service is probably our country’s most beloved institution. It represents how we think of ourselves as a nation: caring, compassionate, and a place where everyone will have their needs cared for at no cost, according only to need. It touches so many lives every day. It saved Xavi’s brother, Sam, when he was born more than 20 years ago and, more recently, it saved Xavi’s grandfather with an emergency operation.
However, it is a health service that faces huge challenges. It is a health service that must care for an ageing population that is growing rapidly and has rapidly growing needs, where it costs five times more to care for 70 year-olds than for 20 year-olds. It is a health service that is still recovering from a once-in-a-generation pandemic, which stretched it more than ever before and created health needs both physical and mental, which even now we are only just beginning to understand. So it is a health service where we need to make decisions for the long-term, to change how it operates and how we approach it, so that it is there for Xavi’s generation and the one after, just as it has been for ours.
That means we will all have to have to take more responsibility over our health, and that government must empower us all to make long-term decisions that benefit our health. That means diagnosing and treating conditions faster, but it must start with prevention. The single biggest thing that Xavi and his generation can do to protect their health is to never start smoking, and this Government are going to help them do that. We are making it illegal for Xavi and his friends, and anyone who is 14 or younger, to ever be sold tobacco. This will save thousands of lives and prevent thousands more people suffering from cancer. Vaping is, of course, much safer than smoking, and it helps many smokers to quit for good, but that does not mean that Xavi and his friends should ever take up vaping. That is why, following a consultation, we will bring forward measures to restrict the availability of vapes to our children, targeting sweet flavours, colourful packaging, eye-catching displays and disposable vapes, making sure that we do not replace a generation of nicotine addicts who smoke with another who vape.
We are not only taking steps to prevent Xavi’s generation suffering major illnesses but steps that will allow them to take more responsibility for their health. Just as we use apps and technology to manage our finances, retail preferences and social lives, they will be able to manage their health using technology, through the NHS app. As we speak, we are loading more features which will allow patients to understand their health needs through accessing their health records, and to navigate and decide whether they are best served by seeing a pharmacist through our Pharmacy First programme, seeing a nurse or a doctor, or referring themselves straight to a specialist at one of our 160 new community diagnostics centres. Patients will be able to make appointments from the app and then get their results directly to their phones. If they need follow-up treatment with a specialist, at a hospital or at a CDC, they will be able to exercise choice to find an appointment that suits them, whether that is seeing a particular doctor, getting care closer to home, or getting a shorter waiting time.
Artificial intelligence and technology are already allowing us to do great things. AI is allowing us to halve the time that it takes to treat people with strokes, making it more likely to recover completely. It is allowing radiologists to read lung and breast scans to detect cancers more quickly and more accurately than ever before. For Xavi’s generation, AI can do so much more. It could help us to discover medicines and cures that have defeated us so far, and it could analyse health records, helping us to join the dots between what links different generations and different conditions, to allow scientists to develop medicines and treatments to target the causes of major diseases.
All the work that we are doing to improve the nation’s health is underpinned by our long-term workforce plan—ground-breaking in its purpose—ensuring that we have the right numbers of nurses, doctors and specialists, and the right training and pathways into the profession, whether that is by expanding degrees, apprenticeships, or more on-the-job development. Underlying all our work is the need to focus our most precious resource, our people, on getting upstream of the problem. Rather than just focusing on hospital treatment centres and primary care, we are focusing resources on prevention and increasing the use of technology.
At this stage, I want to emphasise the Government’s commitment to creating parity between mental and physical heath and to introducing the mental health Bill in the future, when parliamentary time allows. In the meantime, we are taking decisive action. We are eliminating dormitory accommodation, so that people with mental health conditions are treated where they can be best cared for—in the community. We are making sure we have mental health ambulances available to answer 999 calls where we need a mental health response. We are also investing an additional £2.3 billion to support 2 million more people to receive mental health treatment.
As well as building a sustainable future for the NHS for our children, we are making sure it is ready for winter. Average category 2 ambulance response times were over 10 minutes faster in September than in the same month last year—and we are going further. This year, we are investing an additional £600 million into our discharge fund, supporting hospitals to discharge patients when they are ready, with the right support, and stopping patients who do not medically need to be in hospital from taking up important beds and delaying ambulance handovers. We are also providing 5,000 additional permanent staffed beds, introducing 800 new ambulances and using our 10,000 hospital-at-home beds to keep thousands of patients out of hospital.
As well as protecting the health of Xavi and the next generation, we are getting them ready for their futures. We are proud of our education record to date. Xavi and his friends are far more likely to go to a school rated good or outstanding. When we took office, just 70% of schools met this standard; today, that figure is 90%. Our nine and 10 year-olds lead the western world in reading, and our 15 year-olds perform significantly above the OECD average for reading, maths and sciences. However, the parallel nature of A-levels and technical qualifications limits the breadth of young people’s education, stops progression in maths and English far too early and prevents parity of esteem between academic and technical qualifications. Furthermore, we are an international outlier from 16 to 19 in terms of subjects taken and the number of hours taught. The advanced British standard will ensure that, when Xavi and his friends turn 16, they will face a world-class system, placing equal value on technical and academic knowledge, giving them depth and breadth of knowledge to succeed in further study and the world of work.
I now turn to housing and the world that we want to create for Xavi’s generation and those that follow. First, we understand the vital role of housing supply. Since 2010, we have delivered nearly 2.3 million homes, realising dreams of home ownership and delivering decent rented accommodation. We are on track to deliver our manifesto commitment of building 1 million more homes over this Parliament. At some point, all of us, including Xavi, are likely to rent their home, maybe as a stepping stone to home ownership, or maybe for the long term. Whatever the circumstance, we have acted to make renting better and fairer by cracking down on those 400,000 non-decent homes and banning tenant fees. With the Renters (Reform) Bill, we are going further. We will ban no-fault evictions that carry just two months’ notice, empower tenants to raise concerns about the quality of their property and give them greater security. At the same time, we want to be fair to landlords, making it easier for them to evict tenants who display anti-social behaviour or wilfully do not pay their rent.
We also want to help people like Xavi and young people today into home ownership. For some of us, that will mean buying a leasehold property. This Government are committed to improving the experience of the owners of the 5 million leasehold dwellings in England and Wales. We have already capped ground rents in most new leases at very low rates and we will deliver further leasehold reform with the leasehold and freehold reform Bill, which will ban the sale of new leasehold houses. Where leaseholds are required for practical purposes, such as in flats and apartments, we will extend their lease to 990 years and cap new ground rents, with the intention of giving future leaseholders the equivalent experience as if they owned the freehold on their home. We will also launch a consultation to see how we can further improve leaseholder rights. This legislation will fundamentally reform the leaseholder system, ensuring that families have the right fully to enjoy their homes and giving them increased opportunities to pass them on to their children.
While this Government are committed to supporting our society in health, education, housing and living and working independently, I want Xavi to know that we take care of those who need our support—now more than ever with the heightened cost of living. We spend £31 billion on supporting renters with housing costs and £276 billion in total through the welfare system in 2023-24, including providing more than 8 million low-income households with cost of living payments totalling up to £900. For those who need it most, we have increased benefits and the state pension by 10%, in line with inflation. We have made strong progress towards halving inflation by the end of the year, thereby reducing cost of living pressures. I am proud to say there are 1.7 million fewer people in absolute poverty than in 2010, including 200,000 fewer pensioners and 400,000 fewer children.
While we must support people who cannot work, it is vital that we give a leg up to those who can. As well as bringing economic benefits to a person, work boosts their confidence and well-being. The Government have made work pay with the introduction of a national living wage and by ensuring that those earning £12,570 or less pay no income tax or national insurance. These steps led to record employment rates before the pandemic and, last year, the lowest level of unemployment for 50 years. At the same time, there are 2.6 million people who are economically inactive due to disability or long-term sickness. Over a quarter of those who are long-term sick want to work, to the benefit of themselves and the economy. With flexible working and the ability to work from home, we want to help these people into the types of work that they can do, while understanding their conditions. That is why we have launched a consultation to change the work capacity assessment to come into force by 2025 and to provide tailored support for people to safely move into employment, to benefit them, their health, well-being and confidence and, of course, our economy.
I finish by addressing an issue of utmost importance, given the ongoing events in the Middle East. The aftermath of Hamas’s attack on Israel on
Taxpayer-funded public bodies should never interfere in foreign policy. That is why this Government have carried over the Economic Activity of Public Bodies (Overseas Matters) Bill into this parliamentary Session. It will deliver on our 2019 manifesto commitment to ban public bodies from imposing boycotts, divestments or sanction campaigns against foreign countries. It will prevent them pursuing divisive policies that undermine community cohesion and stoke anti-Semitism, ensure that the UK speaks with one voice internationally and guarantee that taxpayers only pay for foreign policy once.
Across housing, welfare, health and employment, this Government are taking the long-term decisions to help give Xavi and young people across the country a brighter future. We will create a health system that puts patients first, give more families a quality home, get more people into work and grow our economy. My noble friend Lord Younger and I look forward to hearing noble Lords’ valuable reflections on the measures that I have outlined today on how we can all take the long-term decisions needed to create brighter future for Xavi and all our young people.
My Lords, I thank the Minister for introducing today’s debate on the humble Address with such a personal and heartfelt speech. It was a privilege to be present to hear the King’s first Speech of his reign to this House earlier this week, and it is a privilege to open this debate for His Majesty’s Opposition. I declare an interest as one of London’s deputy mayors as I will refer to London in relation to housing.
The gracious Speech unfortunately demonstrated that this Government have run out of steam, have few new ideas and are rehashing old ones in the hope that nobody will notice. The Prime Minister started his introduction to the background notes to the King’s Speech by stating that he has delivered on his promise a year ago to deliver “Integrity, professionalism, accountability” in government, ignoring the fact that his party has been in power since 2010 and that his road to being Prime Minister led him from No. 11 to No. 10, and ignoring the fact that the King’s Speech was held against a backdrop of the Covid-19 public inquiry in which the Government in whom he served appear to have lacked any integrity or professionalism and felt themselves to be above accountability.
This King’s Speech regrettably lacks substance. With only 20 Bills announced, it is also seriously lacking in ambition. I will leave my noble friend Lady Merron to speak on health and social care in her closing remarks. However, I would like to highlight the lack of reform of the Mental Health Act 1983, which is outdated and discriminatory. People do not have trust in it and reform is long overdue. The Government first announced a review in 2017 and published its findings in 2018. Can the Minister explain why, given the Conservative manifesto pledge to reform the Mental Health Act, this was not included in the King’s Speech? We have a mental health crisis and the Government know this.
In the background notes to the Speech, the Prime Minister states that the Government are
“continuing to roll out our mental health support teams in schools and colleges across the country so that 50 per cent of pupils are covered by 2025”.
Place2Be, a leading children’s mental health charity in schools, is clear that by intervening early we can help prevent problems becoming more serious. How, then, is 50% cover by 2025 acceptable? Pupil absences are on the rise, not least due to stress and anxiety. Can the Minister tell us why this Government are failing to do more to tackle mental health issues among children and young people?
It also seems staggering that, with schools literally crumbling and teacher recruitment and retention falling, the only announcements on education were rehashing previous ones. There is no sign of further legislation on schools and no sign of ambition for our children. Instead, we got a repeat announcement of the advanced British standard. Planned for 10 years in the future, this proposed reform of exams is at least two general elections away. Plans for a DfE workforce plan have apparently been delayed because of work on the advanced British standard, but the Government need to address teacher shortages now. It is simply not good enough.
The King’s Speech also referred to proposals to
“reduce the number of young people studying poor quality university degrees and increase the number undertaking high quality apprenticeships”.
“On an occasion when the UK pulls out all the stops to impress the world with tradition and pageantry, it is beyond belief that the UK government would even contemplate asking His Majesty the King to speak negatively of the national asset that is our world-leading higher education and research sector”.
Labour believes that people should have the opportunity to get well-paid jobs, whatever their background and whatever part of the country they come from. For the Conservatives, it seems, limited opportunity to get well-paid jobs and a cap on aspiration are things that happens to other people’s children. There are already mechanisms to assess the quality of courses and limit recruitment for low-progression courses through the Office for Students.
Labour would be delighted if the Government, having run out of their own ideas on education to put in the King’s Speech, wanted to borrow some from these Benches. We have plans to reform childcare and early years support and plans for breakfast clubs in every primary school. With 1.9 million children in the UK facing challenges in talking and understanding words, Labour will ensure that every child develops a strong foundation in speech and language. Labour will boost maths teaching in primary schools; we will have a curriculum and assessment review; we will establish regional improvement teams and implement a body to ensure that schools can recruit and retain the staff they need now. We will transform existing FE colleges into technical excellence colleges. Labour plans to break down barriers to opportunity in every part of our system, in every year of a child’s life and in every corner of our country. Aspiration and ambition should be for everyone, and so should excellence and opportunity.
On housing, Labour is clear that the Government should support the aspiration of home ownership and be more ambitious on what they aim to do. However, this Government promise a lot and are delivering little on housing for local communities. They are failing to give councils the tools and resources to deliver housing. It is hugely disappointing that, despite all the promises, the Government have dropped major housing pledges and failed to support housebuilding.
It is also of deep concern that homelessness apparently does not come into this debate: it was covered yesterday by the noble and learned Lord, Lord Bellamy, in the context of a debate largely focused on crime. Homelessness is not a crime and being destitute should not be criminalised. Can the Minister explain why this Government apparently believe that tackling homelessness should come under the Home Office and not under the relevant department covering housing?
Despite promises to radically overhaul the housing system, the Government have watered down leasehold pledges first made six years ago, and U-turned on promises made to private renters four years ago. The leasehold and freehold Bill comes after six years and 115 further press releases or announcements on leasehold reform. It has been watered down to not even include those living in flats. If you want people to feel that they effectively have freehold, you could give them freehold. This Bill will not deliver on the Government’s commitments. It will benefit developers, not leaseholders.
The Renters (Reform) Bill claims to deliver on a four-year promise to abolish Section 21 no-fault evictions, but the Government’s own briefing reveals that they will not commence these parts
“until stronger possession grounds and a new court process is in place”,
and renters are facing problems now. In London, City Hall analysis reveals that an average of 290 London renters a week have faced a no-fault eviction since the Government promised an end to them in 2019. Based on the figures from 2023 so far, every further six-month delay could mean almost 15,000 more Londoners facing no-fault evictions. This picture is repeated across the country.
A Labour Government will get Britain building and boost home ownership through a housing recovery plan. This will combine policy and regulation, including reversing changes to the National Planning Policy Framework announced in December 2022; reinstating compulsory local targets; strengthening requirements to maintain a deliverable supply of housing land; and a presumption in favour of sustainable development. Labour in government will build and is committed to more action on housing in the first six months of office than the Conservatives have delivered in the past six years.
We can already see how Labour in power is delivering, with a new golden era of council house building in London, where more council homes are being built than at any time since the 1970s, through partnership between the Mayor of London and local councils including Southwark, Newham, Ealing and Brent. As we have seen in the past nationally—for example, under Harold Wilson in the 1960s—high levels of private housebuilding and high levels of social housebuilding can and should go hand in hand. Labour’s policy on housing will enable this, and we on these Benches are now, once more, the party representing the aspiration of the British people.
Finally, I turn to the subject of communities. With denial and distortion of the Holocaust rising and anti-Semitism increasing over the past few weeks, we all have a responsibility to tackle misinformation and hate. Discussion of communities in this debate comes at a time when we see parents anxious about their children even wearing their Jewish school uniform, and British families have missing or dead family members in Israel and Gaza. From these Benches, Labour looks forward to supporting the Holocaust Memorial Bill through the parliamentary process, having supported the memorial from the outset, as I know Members across this House do. The memorial and learning centre will be a truly fitting tribute to the 6 million Jewish men, women and children who were murdered during the Holocaust, and will also offer a place to learn about more recent genocides. It is indeed right that such a memorial will sit at the heart of our democracy, next to Parliament.
I look forward to an interesting day’s debate.
My Lords, I will largely speak to the health and care aspects of the gracious Speech, while colleagues who are more expert will cover some of the other areas.
I have been very struck that, when talking about the gracious Speech, whatever question the Health Secretary is asked, his answer is the new measures on tobacco control. This was echoed to a certain extent by the Minister today, although he does it far more graciously than his colleague down the way. We have all done media training and know the tactic whereby whatever you are asked you try to talk about the thing you want to talk about. However, in this case it feels entirely inappropriate. It feels as though the Health Secretary is using the fig leaf of the new tobacco control measures to cover up his naked embarrassment at the paucity of serious health and care measures in the gracious Speech.
I am inclined to support the new measures, but they are not a cover for inaction elsewhere and should not be used as such. It does not help the families of people being held in inappropriate mental health facilities, who have been waiting for the legislative reform that they need, to be told that children will no longer be able to buy cigarettes. For someone who cannot get a rapid scan of a potentially cancerous lump because there is a lack of scanners and trained staff to operate them, there may be some comfort in knowing that we will reduce the number of people suffering cancer in future but it does not get them the help they need today, and the longer they wait, the higher the risk is to them and the less likelihood that they will survive. There is small comfort for an older person struggling to find the social care they need, who believed the former Prime Minister when he said that he would fix social care, to know that although their grandchildren may be protected from the temptation of vaping—that is a good thing—it does not get them the social care they need today. These measures all could and should have been in the gracious Speech.
The other focus in the gracious Speech is long-term planning, particularly long-term staffing planning, as the Minister touched on. These Benches called for that long-term plan and have welcomed it, but we must recognise that a long-term plan is necessary but not sufficient. The journey towards a better health and social care system requires three things: a road map to the destination, but also a vehicle fit for the rigours of the journey and a driver with the skills and energies to get us there. The recent performance of this Government hardly inspires confidence.
I recognise that the Covid inquiry still has a long way to go, but the picture so far has us alternating between horror and shame at the way in which our health system has been managed. The image it paints is of a car veering from side to side, with the former Prime Minister behind the wheel while his passengers—Messrs Hancock, Sunak and Cummings, the latter using choice expletives as though he were an extra from “The Thick of It”—shout conflicting directions at him and so he jerks the wheel from one way to another. The car occasionally veers off into the VIP lane when it gets flagged down by its mates, but it can hardly be described as a picture of good management. We should give some leeway to the Government, because there was no road map for the specifics of the Covid pandemic we suffered. However, we must also ask what all that civil contingencies legislation and planning was for, given that it appears to have given us very little benefit when we hit the crisis. The driving of that vehicle seems to have been appalling and that is all on the Government, past and present—the same people are in government today, with a few notable exceptions, as those who were driving at that point.
The bright spot is that the vehicle held up remarkably well. That is all to the credit of the staff of our health and social care systems, who went above and beyond. We gave them credit and thanks for it then and should continue to reiterate that today. We have moved on from that episode but it now feels as though the Government are parked up in a lay-by doing route planning but very little else.
Their record on vehicle maintenance is also not looking good. We have record waiting lists that are still growing in many areas. Access to GPs and dentists—the fundamental building blocks of our system—is a daily source of complaint and frustration for millions of people up and down the country, as recognised by the Government when they issue papers describing NHS dental deserts, which are a real thing in many parts of the country today. We have a hospital building programme that will not meet the promises made at election time and staff who are demoralised by a Government who seem to prefer confrontation to conciliation and threats to settlements—settlements which Governments in the devolved parts of the United Kingdom have been able to reach because they approached them with a very different attitude.
This gracious Speech shows us that this Government have lost interest in making real improvements to health and care. If these were a priority, there would be a mental health Bill and long-term reforms to the provision of social care. The Minister said there will be a mental health Bill when parliamentary time allows. Forgive me, but the time of the gracious Speech is precisely when the parliamentary calendar is empty. If this were a higher priority than pedicabs and self-driving vehicles, there would be parliamentary time. It is a choice that the Government have made. We would also be seeing serious efforts to address and update the primary care contracts so that people can get easier access to GPs and NHS dentists. I hope the Minister in summing up may indicate that there is some action in that area. It is clear that this Government prefer to deal with other legislation, which I presume they think is sexier to the electorate, than with the stuff we need to get our health and social care right.
While the Minister may not want my sympathy, I praise him for his ability to defend this very thin gruel with quite a helpful speech. I believe that he personally is sincere in his interest in improving health and care and that he is making valuable contributions to those road maps, particularly on staffing and the new hospital programme. However, his, our and the country’s problem is with the drivers at the other end of the building. They are not a new Government—however hard they try to push the message otherwise—but a Government who have been in power as a single party for the last eight years. The people in charge now—the drivers at the other end—have been at the heart of that poor Administration and they are now too tired and unfocused to give us the solutions we need.
I hope that, over the coming year, the Government will keep working on these long-term road maps for where health and social care need to go, as these are valuable. Can the Minister in responding say whether that includes looking at GP and dental contracts, which are a priority? I hope they will face up to the maintenance challenge, so that this incredible vehicle that is our NHS is not allowed to deteriorate beyond repair. Will he say how they will deal with the deficits that are publicly building up in NHS trusts across the country? That needs to be dealt with this year—it is not a long-term issue—as they are facing real deficits and cash crises.
I will happily travel down the tobacco control lane with the Government to explore the effectiveness of the measures, but I can close only with a statement with which I know the Minister will have to disagree: the best way now to improve health and care in the United Kingdom is for this Government to hand the keys over to somebody else so that they can drive, as soon as possible.
My Lords, it is a pleasure to contribute to this debate on the King’s gracious Speech, and to acknowledge His Majesty’s Government’s commitments for this Session. I declare my interests as chair of Look Ahead, a housing association that supports homeless people, and as a non-executive director at NHS England.
First, I turn to education. The Children’s Commissioner emphasises that school attendance is an absolute priority if children are to be offered the best start to further their ambitions, relationships and learning when in school. However, current data demonstrates that, since schools have reopened after the pandemic, one in five children remains persistently absent, on average missing at least one day in school a fortnight or 1/10th of the academic year. This means that 1.8 million children are regularly missing education.
It is suggested that the social contract between schools and parents had been broken following the lengthy period of school closure and that many children are waiting for mental health support and education, health and care plans. The wait is reportedly two years in some situations. So, while I support the Government’s intention to introduce a register of children not in school, can the Minister explain how this information will be used to support those children and their families to increase school attendance? Will there be a national or local authority register of waiting times for assessment for education, health and care plans, with clear targets for achievement in the way that there is, for example, for NHS cancer targets? We know that the future health and happiness of those children regularly missing school are severely impacted if mental health intervention and tailored educational support are not available within—shall we say, conservatively—six months of regular absence.
Secondly, what early years entitlement will be made available for younger children? The Early Education and Childcare Coalition reports that only 17% of nursery managers say that they are likely to increase the number of places they provide due to the difficulty in recruiting staff. Can the Minister say whether it is the Government’s intention to re-establish a career development hub at the Department for Education for a national apprenticeship scheme in early years education that will encourage not only women but men into this important area of work? There is probably a need to restart the graduate-led grant scheme.
The King’s Speech was deeply disappointing in having no reference to reforming the Mental Health Act 1983. Others have spoken about this, but in 1983 I was a junior lecturer introducing the changes to staff in the Lambeth health authority. I distinctly remember a slide that said, “This is a really interesting review, but remember that it is only a review of the 1959 Act, and we will have a proper, new Mental Health Act soon”. That was 40 years ago. There was a manifesto commitment in both 2017 and 2019 to reform this. It seems to me that this particular revision has been on a waiting list for a minimum of 40 years. Yet over 53,000 people were detained under the Mental Health Act in 2021-22, many, of course, for appropriate assessment, support and treatment.
However, significant disparity between ethnic diversity and detention under the Act continues, with white people five times less likely to be detained than those from different racial communities. Does the Minister agree that, while reforming the Act is long overdue, that should not stop us enhancing patients’ rights and strengthening safeguards for those admitted to hospital much sooner than an Act might come? I believe it is essential that we find sufficient resources to ensure that we can deliver high-quality, compassionate care—which is often in the community—before we review the Mental Health Act, if we are not to get it in this Session.
We know that many people with significant mental health needs are in prison, when many would be far better served by proper community support and treatment in safe, secure housing—particularly before they offend. Sometimes, individuals who have significant mental health challenges offend because they are homeless and have difficulty in claiming benefits and accessing the healthcare system.
I acknowledge other noble Lords’ contributions to this debate on the proposed reforms associated with housing, leasehold and renters; I will leave it to others to speak on that. I hope that this will result in fairer systems, but it will not result in a significant increase in social housing, which is completely vital to improve healthcare in this country.
Finally, I welcome the Government’s commitment to supporting the NHS workforce plan and hope that, in the longer term, this will have a positive effect on current waiting lists, which are in part due to a shortage of qualified staff as well as the Covid pandemic. However, I was concerned to hear the Minister say that he believes that the pandemic was a once-in-a-generation situation; I only hope that he is right, because we need to be ready in case we get a second wave. Do not let us be complacent; we need the right social care to support people if that happens.
I commend the proposals relating to tobacco and vapes. As many noble Lords know, my concern about the use of alcohol by young people remains, and I wish that there had been something about that too in the Speech.
My Lords, it is a pleasure to participate in this debate on the gracious Speech. I declare my interests as recorded in the register.
I begin by joining noble Lords across the House in welcoming the indication in the Speech that the Government will legislate for a ban on smoking. As we have heard, smoking is the single biggest preventable killer in the UK, but it is also an example of pronounced health inequality. The Chief Medical Officer gave this evidence to the Commons Health and Social Care Select Committee:
“Smoking is usually twice as high in people with lower incomes and more than twice as high in people living with mental health issues”.
He went on to say:
“The cigarette industry goes absolutely unerringly for the most vulnerable in society”.
So I welcome the decision by the Government, which will undoubtedly account for significant reductions in preventable cancers. However, there are many things that determine our health, and we have been discussing the social determinants of health for years. They were highlighted as early as 1980 in the Black report, yet we seem to be having the same conversations about the same statistics, with the same consensus again and again. The differences in life expectancy and healthy life expectancy remain truly shocking.
The failure to publish the health inequalities White Paper in the previous Session is lamentable, and I seek assurances from the Minister that health inequalities will be a key focus of the major conditions strategy. For the NHS to have the future that the Minister speaks about, we are dependent on reducing inequalities in health. Inequalities in health outcomes between racial and ethnic groups also persist. The most recent CQC State of Care report highlights these, especially in maternal and neonatal care and in mental health care. The report lists instances in which patients are not listened to and how their symptoms are not recognised due to the poor teaching of certain conditions that present in ethnic minority patients. The CQC report also highlights, as did the noble Baroness, Lady Watkins, that there are ethnic differences in the detention of mental health patients.
I add my voice to the disappointment that a mental health Bill has not been brought forward as part of the gracious Speech. As we have heard, reform of the Mental Health Act is long overdue, and the inequalities that people face under it need serious attention. There is much work to be done here, including in resourcing community care and increasing patients’ ability to make choices about their care. The Joint Committee on the draft Bill found that this would be a significant factor in the reduction of detention and inequalities. It is a great shame that the work already undertaken is not being taken forward.
We are all aware that the health service is straining. I too welcome the long-term workforce plan, but there are questions that remain unanswered, and I expect that its implementation will be challenging. The NHS staff experience remains one of exhaustion, overwork and understaffing, and I continue to remain concerned about the state of industrial relations following the Strikes (Minimum Service Levels) Act. If we are to exercise choice in our future, as the Minister rightly said, we need a workforce that is not tired, is appropriately trained and is valued.
Some 22 years ago, I commissioned the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group, which has carried out truly inspiring work. However, the work is not done. The CQC report highlights the experience of not just ethnic-minority patients but staff. Midwives from ethnic-minority groups described a culture of tolerated discrimination and unchallenged stereotyping. This is something that we all need to work to reduce.
It is disappointing to see no mention of social care in the gracious Speech. Skills for Care’s latest report estimated a 28.3% staff turnover rate in 2022-23. With 400,000 people working in social care over the age of 55 and likely to retire within the next 10 years, we are desperate for a workforce strategy. Carers are finding it difficult to get by in the cost of living crisis, and the sector represents 5% of the entire economy.
The Archbishops’ Commission on Reimagining Care sets out the type of ambitious vision that I had hoped to see in the gracious Speech. The commission identified the need for a fundamental change in the way in which care is thought about, organised and delivered, with a national care covenant at the heart of a new approach that truly incorporates the views, voices and experiences of the people most affected. Social care should enable everyone, regardless of age or ability, to lead a life of purpose and fulfilment.
I also note the disappointment of many that the gracious Speech did not contain news of a ban on conversion therapy. The General Synod of the Church of England voted to call on the Government to ban conversion therapies in 2017; it remains firm that abuse of power in this way must be prevented.
What underpins everything I say today and will say in the coming Session is that people are made in the image of God and are immeasurably valued. Recognising that value, we must do more to pursue health equality and provide adequate resources. As Nye Bevan famously said in 1948:
“Illness is neither an indulgence for which people have to pay nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community”.
My Lords, it is a great pleasure for me to follow Sarah Mullally, the right reverend Prelate the Bishop of London. She has a very interesting—I was going to say “past” but I think they call it a “back story” today. She has done a huge amount in the National Health Service. We know that she was the Chief Nursing Officer; she did so much for all of us who work in the service and especially for the patients who use it.
I want to say something about Sarah because we so often dismiss people; we just think that they are in a certain position, and that that is their life and how they run it. However, Sarah has three distinguished university doctorates and was made a Dame Commander of the Order of the British Empire for her contribution to nursing and midwifery. She was of course much admired when she was the Chief Nursing Officer in the Department of Health, where she made a great contribution to the NHS. I must say that it is a great pleasure to have you, Sarah, in this House and on these Benches, making the sort of contribution that you have made this afternoon.
I want to put forward to noble Lords an idea to correct a terrible shame and injustice. When medicines and devices do harm, redress or compensation is too often withheld. Sadly, many victims are dead before they could receive any contribution. The Government have urged people to settle their claims—they mention pharmaceutical companies in particular—in court. That is quite a cruel, unjust proposition because redress and compensation are often withheld until many of the victims are no longer alive; we have seen exactly what can happen all too clearly with the infected blood tragedy. Pharma companies have huge powers and resources to delay proceedings, which can bankrupt a charity or group, pending the settlement of ginormous legal costs. The United Kingdom is not the only country to experience harm caused by sodium valproate, vaginal mesh and Primodos—the subjects that I studied for my report, First Do No Harm. We must find a solution for people in need of redress that is delivered speedily when it is needed. Unreasonable and unnecessary delays inflict more agony for individuals, their families and their friends.
When considering the then Medicines and Medical Devices Bill, I and my team concluded, after very careful consideration, that there should be a new post in the management of the NHS: a person whom we named the Patient Safety Commissioner, because we were back thinking about the patients all the time, we wanted to ensure their safety and we thought a commissioner would have a standing that would actually make a difference. The Bill was enacted in February 2021. Dr Henrietta Hughes was appointed in June 2022, and she took up her post last September. She is a force for good, and she has already embarked on—embraced, indeed—her new role and made a difference to professionals and to patients; and after all, it is the patients we must all think about.
I and my colleagues suggested that the Patient Safety Commissioner should explore the redress options for those who have already been harmed by pelvic mesh and sodium valproate. Those were the areas I studied with my team. I understand her report is due to be launched in the new year, and I urge the Government to respond with speed, as there are still too many women who have been waiting and suffering for too long. Our report, which we entitled First Do No Harm, discovered scandals that had already happened, but a number of our recommendations were not looking at the past but looking forward. We recommended a redress agency to administer funds provided to cover future harms. This was not acceptable to the Department of Health, and I felt it was really an opportunity lost. Even the best pharmaceutical producers may, despite their clinical trials, fail to realise that a product may, especially after time, prove to be harmful. The funds I am suggesting will provide a safety net when this happens. We also suggested that no medical product should be approved for sale without a levy paid into a fund wholly independent of the Government. At the very least, it should be a condition of sale in the UK. Where Governments bear some responsibility for approving harmful products, they should contribute to the fund.
Also, there should be an expert team to assess the claims of harm that have been clearly recognised by producers and make them clear to people, especially the users. They need to know what is going on with the products they are taking, and to understand the huge impact of marketing, which is on a global basis. Is not it time to work with our neighbours in Europe and possibly worldwide to seek specialist input and views on the harms caused by these products? The fund I am suggesting would provide redress to those who are harmed by medicines and devices, without them having to go through long, drawn-out adversarial lawsuits. We saw, first-hand how litigation had failed women who had already been failed by the healthcare system. We must provide a better way for the future, particularly regarding the blood issues.
I suggest that the fund be administered independently of both government and industry to ensure that it can command the confidence of injured patients. I urge the Minister to consider this and to act with speed on the points I have made.
My Lords, I follow other noble Lords, in welcoming and supporting the measures to reduce smoking, but like the right reverend Prelate, I am most concerned this afternoon about the lack of any broad-based public health programmes in the gracious Speech. Public health, after all, is central to successful healthcare in this country and, indeed, to the overall health of the nation, yet it has been neglected for many years and is neglected again. I repeat my welcome for the tobacco products Bill, but one Bill does not create a strategy. In every area we look at, the need for a broad-based programme to meet the public health crisis we are facing is urgent. In every problem you look at—from obesity to sexual health, from children’s dentistry to disease caused by damp housing—the situation is getting worse and worse. At the same time, we have seen the capacity of the NHS fall. Sadly, it has become a struggling health sickness service, rather than a positive health service. If we want the NHS to be renewed and restored to its proper role, we must primarily focus on avoiding preventable disease and promoting healthy living through cross-government programmes.
At the Labour conference last month, the shadow Health Secretary, Wes Streeting, promised that a Labour Government would deliver a prevention-led revolution. He insisted that a broad revolution, putting prevention first, could be delivered through social, economic and environmental change. This, he said, must lead to less illness and therefore less pressure on the NHS. Now there is no doubt that achieving this type of change is complex, difficult, expensive and long term. But under the Conservative Government, many prevention initiatives have been greeted with the cliched expression, “a nanny state” calling for intervention in our private lives. I understand that even the new anti-smoking Bill, which has the Prime Minister's personal endorsement, has already been criticised by his own MPs on this basis.
In the last 13 years, many of the specialised institutions that focused on promoting good health have disappeared or been marginalised. The Government abolished Public Health England, which had a global reputation for its expertise and research. The grandly titled Office for Health Improvement and Disparities has been recently set up, but so far no grand practical statement of environmental activity has been announced. Today, many of the responsibilities for public health have been devolved to local authorities; at first sight that seems a good idea as so many services that can affect people’s general health are provided at a local level. However, the Treasury’s public health grant to local authorities has been reduced by a staggering 26% in the last years; not surprisingly, basic services have suffered badly or completely collapsed. Apart from the financial cutbacks, the connections between organisations commissioned by individual councils and the health service can be weak and can reduce vital capacity. Services have sometimes been outsourced to independent bodies, which do not have the necessary expertise to deliver them. This has been recently drawn to my attention in relation to HIV and other sexually transmitted infections. There has recently been an alarming increase in many of these infections, some of which are growing by as much as 50%. These must require medical care, which is often lacking in an outsourced clinic. For example, only half the clinics can now offer face-to-face appointments for individual advice and treatment—they simply cannot deliver good practice.
However, even if the Government have somewhat neglected the needs of good public health, it is encouraging to see the current level of parliamentary interest and engagement with these issues. The well-established All-Party Group on Health in all Policies has been able to broaden the discussion about reducing health inequalities and promoting healthy lives in ways that go way beyond traditional concerns about, for example, working conditions and safety. The Levelling-up and Regeneration Act 2023 could have been an opportunity to put some of these policies into legislation, specifically in the area of poor housing. There were several attempts to amend the Act in this way but all failed, although it must be remembered that the health effects of inadequate housing already cost the NHS about £1.4 billion a year. In this House, the noble Lord, Lord Crisp, with his vast experience in public health, pursued his amendment on healthy new homes to the point of ping-pong proceedings and still he did not succeed. In final exasperation he said:
“I have taken the key message that the Government do not want to … ensure that new homes and neighbourhoods promote health, safety and well-being. I think this is extraordinary.”—[Official Report, 23/10/23; col. 437.]
I must say that I agree with him.
Meanwhile, our very active Peers for the Planet organisation is urging an even broader approach to public health, which I support. It argues that the crises of climate change and threats to nature have a profound impact, and there are calls for the WHO to declare this a global health emergency. As far as the UK is concerned, the effects of higher temperatures have already been observed. In 2022, heat-related mortality in this country was up by as much as 42%, which is well over the five-year average. The very respected journal the Lancet has suggested that we should act immediately in this country on cleaner energy, improved air quality and access to green space. It is a vast agenda, but it should not be overwhelming. It needs a new clear strategic approach by the Government and resources to match. Given their record, I do not expect the present Government to give priority to this in the last months before a general election. On the other hand, the Labour Party has already published ambitious plans for its prevention and revolution in health. I am confident that there will be manifesto commitments on public health in all social policy. We can then have a programme that both improves health and renews the NHS. I look forward to discussing a new approach in the debate on the next gracious Speech.
My Lords, a gracious Speech is a helpful indicator of a Government’s position and their intended programme for the coming years. This speech is quite clear: it is a series of individual bits and pieces with not a strategy in sight. That is something we should pay a great deal of attention to when we think about the run-up to the next election because we are desperate for a Government who will take seriously the issues facing all our public services, addressing the growing demands on them and the likelihood that there will be fewer resources in real terms to provide them.
I spent the last two years in various Select Committees of your Lordships’ House—one on social care, one on scrutinising the mental health Bill and one, which is about to conclude, on the integration of community and primary care. Across those three pieces of work, there have been a number of recurrent themes.
The most fundamental to this is the need for an informed public debate about sharing personal data. Our personal data will be the basis on which the future of health and public services is built. At the moment, we have a great deal of confusion, not least on the part of practitioners, about the status of data protection laws and the importance of public health. Time and again in those different committees, we heard frustration on the part of practitioners, service planners and patients at the utter impossibility of getting data on individuals, or even at a community level, in a manner that is timely and makes for the effective and efficient provision of services.
I wonder whether the Minister will take from this the urgent need to revisit the Caldicott principles and update them in the light of technological information advances, and to begin the process of having a public debate about the ethics and principles of sharing data. In that way, we might move quickly towards an improved performance of public services, particularly health and social care, based on the resources that we have at the moment.
It is regrettable and a great shame that the Government have turned their back on the widespread consensus on how mental health law should be reformed that has developed since Sir Simon Wessely produced his report. Nevertheless, a great deal of work has been done, which will be there waiting for an incoming Government to do it.
There are three things that the current Government should do now, which do not require legislative change. First, there should be mandatory training for all mental health professionals in the recognition and diagnosis of autism and learning disabilities. That would stop the inappropriate treatment of people with learning disabilities and autism, which sometimes not only leads to them being inappropriately detained at length under mental health legislation but results in them going into the criminal justice system when they should not.
Secondly, with a number of long-term conditions such as Parkinson’s disease, there is a great incidence of mental illness. I wonder whether the Minister will look at the major conditions strategy and the need to make sure that practitioners, in certain physical conditions, understand the mental health aspects of those conditions.
Finally, when we worked on the mental health Bill, we looked time and again at the disproportionate effect of mental health legislation on people from black and brown communities. They are far more likely to be detained inappropriately than other groups. We were told by all the people to whom we spoke that one thing that would have a direct impact on that is the introduction of an electronic system of advance choice documents. Advanced work is being done on that, based on work done in the field of palliative care by people at South London and Maudsley, the psychiatrists at Guy’s and so on. It needs only the Minister’s department to swing in behind the work already being done for pilots to be rolled out, ready for an incoming change in the legislation.
Let us be honest: none of us can see a time when local authorities will suddenly have new, massive amounts of money to put into social care. It is already underfunded and is subsidised by individuals. The one key thing that the Government could do is make sure that local government retains the requirement to give people assessments of their needs and to tell them what is available to them, wherever they choose to get their help from. Funding those independent assessments, and not leaving it to providers of services, is the one critical thing that might make a difference to the increasing number of people who will be living in the community with long-term conditions and really need help to stay in their homes—which I hope will be built to a lifetime standard in the future, so that people can stay in their home whatever the tenure of the home in which they live, whether rented or private.
I take the opportunity to say one final thing: King’s Speeches are about Governments’ priorities and choices. When the Government can find the time to license pedicabs but cannot be bothered to bring in a ban on conversion therapy, the lesbian and gay community understands the message. We get it: we are not safe while this Government continue to be in office. It is absolutely time that they went.
My Lords, I declare my various housing interests on the register, including as chair of the Devon Housing Commission, whose work informs my comments today. I welcome the Government’s proposals in the Renters (Reform) Bill and the announcement of important legislation on leasehold reform. I am sure that there will be significant work for your Lordships when these legislative measures reach us in the months ahead. But today I will concentrate on the bigger picture and the need for a longer-term national housing strategy to address a housing situation that, I believe, has taken a serious turn for the worse, even in the last few months.
I suggest that there are three areas crying out for long-term forward planning. First, we must dramatically increase the amount of new accommodation created each year; the 300,000 homes per annum target is a start. Secondly, we must have a plan for upgrading the standards and energy efficiency of outdated existing properties to address health inequalities, fuel poverty and climate change imperatives. Thirdly, in respect of building new homes and upgrading existing homes, we must target that half of the population where incomes are below the median.
My starting point for believing that the situation has become more urgent over recent months is the evidence from the temporary accommodation statistics. The numbers in this predicament have seen an alarming increase. We have the extraordinary statistic that one in 50 Londoners, and one in 23 children, are classified as homeless. But this phenomenon has spread nationwide. For example, the position in the unitary council covering Cornwall demonstrates the crisis: from having to house 200 households in temporary accommodation before Covid, the figure today is around 800. This has a drastic impact on local authority finances at a time when, as we all know, these are badly stretched. The national bill for temporary accommodation—which is often entirely unsuitable and far from friends and family—is now approaching £2 billion per annum across the country.
Of course, housing shortages, while most painful for those on the lowest incomes, also affect many people who have expected to become home owners. The number of first-time buyers has fallen by 22% this year. The cost of becoming a home buyer has doubled as a percentage of earnings, now compounded by higher interest rates. But, because of supply shortages, prices have not fallen. Overall, home ownership has declined to around 64%, from its peak of over 71%. Some 4.9 million people in the 25 to 34 age group are now living with their parents. Even where a couple have been able to purchase on their combined income, the price has often been paid in being unable to start a family.
Private renting will be the only option, but there is recent evidence that even the private rented sector is proving unable to help the next generation. Although rents are up 27% since the pandemic, the industry reports an average of 24 would-be tenants for every vacancy. For 23 of the applicants, there is nothing but disappointment if not the horrors of homelessness. The reason is that demand has risen but landlords are exiting the market. This is because of taxation arrangements rightly intended to deter speculative investors, necessary requirements for higher standards, the higher interest rates that affect the two-thirds of PRS properties that have mortgages, and much-reduced prospects of making capital gains.
I should add, drawing on the work of the Devon Housing Commission, that the decline of private renting has been exacerbated by the advantages of switching to short-term lettings of the Airbnb kind. This is hastening the loss of homes for locals to rent in almost all rural and seaside locations. Although remedies are in the pipeline, they will close the stable door only after this horse has, I fear, bolted.
This is the background to my contention that we need a long-term plan to massively increase production of new homes, while embarking on a programme of modernisation of poor-quality existing accommodation. Although these are necessary measures, they are not sufficient to ensure that the benefits reach those in the lower half of earnings. It is the not-for-profit sector—the housing associations, councils and community-led housing providers—that has the potential to step up new production and, indeed, to acquire and modernise existing substandard properties, but even this sector faces new challenges. It must invest heavily in its own existing housing stock to rectify building safety problems, to upgrade outdated council housing of yesteryear and to decarbonise homes. It is hit by both inflation, with building costs rising by more than rents, and escalating interest rates, so, regrettably, boosting this sector will not come cheap.
In conclusion, there will be valuable changes for this House to make to improve forthcoming housing legislation, but a much more ambitious, longer-term national housing strategy is required to address the underlying issues of land acquisition, planning, construction skills and so on—a road map with a timeline to chart progress over the next 25 or 30 years. Action to bring this together desperately needs to start now.
My Lords, it is a pleasure to follow the noble Lord, Lord Best. A wise political party would cut and paste his speech and put it in its next election manifesto under housing.
I warmly welcome three of the Bills relevant to today: the leasehold and freehold Bill, the Renters (Reform) Bill, and the tobacco and vapes Bill. The leasehold Bill will make progress towards phasing out a feudal system of tenure that exists nowhere else in the world and crystallises the tension between freeholder and leaseholder. But the Bill bans new leasehold only for houses, of which hardly any are built. Most of the new leaseholds are in blocks of flats. If we are to achieve the Secretary of State’s ambition of abolishing leasehold, we need to make commonhold the default tenure for all new developments of flats. I hope the Government will consider an amendment to that effect, which I might conceivably table.
There is also unfinished business on the Building Safety Act, which protects leaseholders against remediation costs for which they are wholly innocent. As the noble Earl, Lord Lytton, and I have consistently pointed out, that Act has crucial omissions. The leasehold Bill offers an opportunity to provide the protection that Ministers originally promised, but never delivered, to groups of people such as those living in buildings under 11 metres, those who have enfranchised and those who have invested in buy to let. All those—thousands of them—live in buildings that they cannot mortgage or sell, and they are exposed to high service charges. There is an opportunity to build on the BSA and make it a more comprehensive piece of legislation.
On housing, I welcome the Renters (Reform) Bill, but we need clarity on the timetable for implementation. I read the Secretary of State’s speech on Second Reading and he was pressed on this. This is what he said:
“The sooner the Bill is on the statute book, the sooner we can proceed. Alongside that, we of course need to ensure that the justice system … is in a position to implement it effectively”.—[Official Report, Commons, 23/10/23; col. 638.]
Does this mean Section 21 will not be abolished until the court backlog has been cleared? In June, the mean time from claim to repossession in London was 40 weeks, and the backlog also disadvantages tenants who want to take action against their landlord. Can my noble friend put some timeframe on Section 21 abolition and also give an assurance that the MoJ has the necessary resources to tackle the backlog?
On the rental market, which the noble Lord, Lord Best, referred to, we need to reduce our overreliance on the small private landlord and replace it with what happens nearly everywhere else, where rented accommodation is funded by long-term institutional finance with professional management, and where tenancies are not terminated simply because the owner wants to sell.
Finally on housing, we need to increase the local housing allowances, which have been frozen in cash terms since 2020, while rents have risen by up to a fifth. Low-income households are being forced to find, on average, £1,900 for a two-bedroom flat, out of the resources not covered by the LHA. These shortfalls are nearly double what they were a year ago. Many tenants cannot pay, leading to evictions for non-payment. Data published in July shows that more than 104,000 households were in temporary accommodation at the end of March 2023—the highest figures since records began in 1998. The Autumn Statement should increase the local housing allowances, along with the discretionary housing payments, as more and more local authorities have exhausted their budgets.
Along with others, I regret the Home Secretary’s remarks about rough sleepers. I launched the original rough sleepers initiative in 1990 as Housing Minister, and met many rough sleepers, along with the noble Baroness, Lady Casey, whose work in this area I applaud. I never met anyone who was sleeping rough as a lifestyle choice, and I commend the letter which the noble Lord, Lord Bird, wrote in Tuesday’s Times.
If I may say a quick word on education, I welcome the commitment in the Speech to
“strengthen education for the long term”,
with steps to be taken to ensure young people have the necessary knowledge. But young people will only get this if they actually go to school—a point made by the noble Baroness, Lady Watkins. One of the adverse consequences of the pandemic was to weaken that contract between children and parents, on the one hand, and schools, on the other, with a quantum leap in non-attendance. Persistent absenteeism has more than doubled in the last four years to 22.5%. A recent report by the Children’s Commissioner found that just over a third of all pupils were either persistently or severely absent in either Year 10 or 11, with correspondingly poor GCSE results. So we do need to reset that relationship between families and schools, and build on the extension of attendance hubs, with perhaps more national training for national attendance officers.
I commend the commitment to introduce the tobacco and vapes Bill, as would the noble Baroness, Lady Finlay, had she been able to be here. I hope that this short measure might be introduced very early in the Session. Its key recommendation of progressively raising the age at which it is legal to sell cigarettes was a recommendation in last year’s Khan report. It puts England, along with New Zealand, ahead of the pack in the campaign to phase out smoking over time and re-establishes our reputation as a pioneer in this particular field of public health. But its impact is essentially long-term. In the short term, if we are to hit the Government’s target of a smoke-free England by 2030, we need additional measures. As the noble Baroness, Lady Jay, has just said, the public health budget has been hit hard. Khan proposed a levy on tobacco company profits, ring-fenced for public health to give it the boost it needs. I hope the Treasury will reflect on that for the Autumn Statement.
Finally, I turn to social care. The gracious Speech said the
“priority is to make the difficult but necessary long-term decisions to change this country for the better”,
but there was no mention of social care. We need reform of how social care is funded and a workforce plan for social care to complement that for the NHS workforce. If this is now not going to happen in this Parliament, then the Autumn Statement should ensure that local authorities have the necessary resources to fund the current system adequately, while work goes on for fundamental reform in the next Parliament, ideally on an all-party basis.
To conclude, I welcome the measures I have spoken about, but I will seek to make them even better by tabling some amendments.
My Lords, there is no vision in the gracious Speech to remedy the poverty and injustice that blight our nation. The Minister spoke of the miscellaneous measures the Government intend to take, but they fall far short of what is needed in relation to the challenge. The plans to reform leasehold and rents will doubtlessly be beneficial as far as they go—they will not actually abolish leasehold—but they will do nothing to address the fundamental problem of supply. There are severe shortages of housing, whether to rent or to buy. The dream of the property-owning democracy has turned sour. The Government have again funked serious reform of the planning system. They have no strategy to ensure over time that everyone will be able to live securely in a healthy, safe, environmentally suitable home that meets their needs. The noble Lords, Lord Best and Lord Young of Cookham, spoke about this, and it is a pleasure to follow them with their deep knowledge of housing issues.
The promise of a ban on no-fault evictions has been made before but broken. As the Government have said that it will not go ahead until significant progress has been made to improve the courts, nothing will happen soon. Ill-judged reform of the tax regime for private landlords and rising mortgage costs have reduced supply at a time when demand has been strongly increased. Local housing allowance has been frozen since 2020, while rents have soared. The provision of new social housing has been minimal. Young people seeking a roof over their head at a price they can afford, particularly in London and the south-east, are in a desperate plight.
A study for the National Housing Federation has found that 800,000 people are spending more than one-third of their net income on mortgages, 600,000 are spending an equally unaffordable proportion of their income on rent, all too often for accommodation that is in an unhealthy and even dangerous condition, 2 million people are living in homes that are not adapted or accessible for their needs, 131,000 children are living in emergency accommodation—bed and breakfast and hostels—and 270,000 people are homeless. The Home Secretary, horribly, has inveighed against rough sleeping as a lifestyle choice and has proposed to ban homeless people putting up tents and to fine charities for providing tents.
A housing crisis deepens inequality, destroys communities and undermines the economy. The physical and mental effects of homelessness or unaffordable accommodation have an impact on health. A devastating combination of economic mismanagement, hostility to local government and an ideological commitment to a small state and minimal public expenditure means that the Government have no strategy to reduce health inequality by improving the conditions in which people live. They have cut funding for public health, as the right reverend Prelate and my noble friend Lady Jay mentioned. The upshot has been that the healthy life expectancy gap between people in the poorest and the richest areas is now 18 years for men and 20 years for women. People in the most deprived areas of England are more than four times as likely to die from a health condition that could have been prevented or treated.
The regions of England and local communities within them have been denied opportunity to thrive by central government’s hoarding of power. Power has been released only, grudgingly and inconsistently, to combined authorities. In an act which exemplifies the controlling, insulting attitude of central government, the Local Government Minister the other day actually threatened local authorities with penalties if they choose to move their staff on to four-day working. Mayoralties and local authorities have been denied the powers they need to raise taxes in their areas if they are to exercise responsibility meaningfully and accountably and improve public services, and they have been impoverished by central austerity. Expensively and humiliatingly, they have been made to beg for pots of funding, some distributed according to political bias rather than objective need. Dilatory decision-making and central bureaucracy have made it impractical for local authorities to spend some of the money handed down to replace EU funding.
Well-managed authorities are now financially precarious. County councils are buckling under the rising cost of children’s services, while private providers are making fat profits. Inspectorates and charities report poor conditions in privately run children’s homes and a shortage of places. District councils are buckling under the costs of provision for the increasing numbers of homeless.
The Speech says nothing about reform of the social care system. Some 400,000 people left social care jobs in the last year, with a third of them leaving the sector altogether. Achieving a sustainable financial basis for social care, including adequate pay and career progression for care staff, as well as reforming the fragmentation and complexity of the system, are essential not only for the well-being and safety of those in need of care but to take unnecessary pressure off the NHS.
The litany of failure continues when we consider transport. We have seen the fiasco of the mismanaged HS2 project, while motorists and rail travellers have their lives blighted by gridlock and erratic services. This has been an aspect of the Government’s failure to develop a coherent strategy to address the poor economic productivity, which militates against improving our national competitiveness, incomes and public services.
Education is crucial to productivity, as well as to personal fulfilment and social flourishing, yet the Government have reduced spending per pupil in schools. School attendance has fallen worryingly. Only 21% of children from the poorest fifth of households get five good GCSE passes. The Government have also induced a crisis in our universities by freezing fees for a decade, which are now down 30% in real terms. Despite constant chopping and changing of policy, successive Education Secretaries have failed to design a satisfactory system of further, adult and vocational education, and the Treasury has starved the chaotic system we have.
As a result of the Government’s ministrations, the number of people who are destitute—unable to meet the basic needs to stay warm, dry, clean and fed—has increased to 3.8 million, including 1 million children. Inequalities of incomes and wealth, and regional, ethnic and generational, have greatly increased. The state to which the Government have reduced our country is truly shocking.
My Lords, the central theme of the gracious Speech was long-term decisions to change this country for the better, but so very much was missing. I particularly liked the description we heard of it as thin gruel.
As other noble Lords have said, in appropriately trenchant terms, and my key point today, where was the long-awaited mental health Bill? It is beyond disappointing that a new mental health Bill to reform the 1983 Act was not part of the King’s Speech. Coupled with the abandonment of the 10-year mental health plan earlier this year, many in the sector and beyond are now understandably concerned that mental health is no longer a political priority.
I will just give a quick reminder of the facts. A new mental health Bill was a manifesto commitment from this Government in both 2017 and 2019. As we have already heard from the noble Baroness, Lady Watkins, and my noble friend Lady Barker, there is a totally unacceptable disparity between the white population and black and other racial groups when it comes to detention under the Act. This cannot go on. The 2018 independent review of the Mental Health Act, chaired by Sir Simon Wessely, set out very clear recommendations for modernisation, including greater legal recognition of detained people’s treatment choices. The Act simply does not work for children and young people, with many having bad experiences when detained in hospitals. Much time and effort has already taken place to reform the Act, including a White Paper, and a draft mental health Bill introduced last year, which underwent pre-legislative scrutiny, as we have heard, in a Joint Committee chaired by the noble Baroness, Lady Buscombe, earlier this year.
Given all of this, is it any wonder that Sir Simon Wessely expressed his deep disappointment in the summer at the prospect of the Bill being delayed yet again, when, to use his own words,
“we’re so close to the finishing line”?
“Lots of people have put a lot of work into this. It’s not controversial. Nobody seems to disagree with what we’re trying to do”.
I cannot help wondering whether that is at the heart of its non-appearance.
Can the Minister say when the Government will issue their response to the Joint Committee report and explain what they intend to do in the absence of this much-needed reform? Will the Minister explain precisely why the Government have reneged on their commitment?
The gracious Speech mentions that “record levels of investment” are expanding mental health services. This is of course to be welcomed, but that is only part of the picture. Simply put, the current levels of investment do not in any way match the level of increasing need. Mental health has not received any of the additional funding committed to bring down elective waiting lists. As a result, over 1.2 million are stuck waiting for mental health support and targets contained in the NHS Long Term Plan are slipping backwards on perinatal mental health, children and young people’s services, NHS talking therapies and mental health crisis care. On top of this, there are chronic shortages in the mental health workforce, with 20% of mental health nursing posts currently vacant.
It is welcome that the Government are restating their commitment to deliver on the NHS Long Term Workforce Plan. However, the plan is much weaker on retention measures and fails to address many issues that contribute to high attrition rates across the whole NHS workforce. As others have said, implementation of the long-term workforce plan simply will not work without an accompanying social care workforce strategy. We urgently need a national workforce strategy that raises the status of the social care workforce and ensures that career progression, pay and rewards attract and retain the right people in the right numbers. Can the Minister say if and when the Government will commit to such a plan?
The CQC State of Care annual report, published only last month, received surprisingly scant attention in this Chamber, despite drawing attention to how the combination of the cost of living crisis and workforce pressures has led to what it termed “unfair care”, with longer waits, reduced access and poorer outcomes for some people in accessing health and care services. Most worryingly, it reported that “unfair care” really means that those who can afford to pay for treatment do so and those who cannot face longer waits and reduced access. Research by YouGov shows that eight in 10 of those who used private healthcare last year would previously have used the NHS, with separate research showing that 56% of people had tried to use the NHS before using private healthcare.
As we have heard, smoking is a big contributory factor in health inequalities, particularly for people with mental illnesses. That is why I welcome legislation to create a smoke-free generation by restricting the sale of tobacco and e-cigarettes to children. But other than that, sadly, there was little of real substance to address the difficult and persistent issues facing many babies, children and young people. Although the Speech contained a pledge to
“ease the cost of living for families”,
there was no specific commitment to support the 4.2 million children living below the poverty line. According to ONS polls, the cost of living remains the most pressing issue facing the country, with 89% of respondents reporting it as an important issue. What plans do the Government have to tackle child poverty?
On financial inclusion, we have heard so much about people’s problems and concerns about the cost of living and about their lack of financial resilience. We urgently need clear leadership from the Government, with a national financial inclusion strategy joining up the work of government and industry, and building the long-term financial resilience of the country.
In conclusion, there is simply so much more to do to change this country for the better for all our fellow citizens. This requires a radically new approach.
My Lords, health and social care did not feature prominently in the gracious Speech. The mental health Bill, about which we have heard, was a much-needed reform, as was social care reform. I welcome the measures to reduce smoking, both for individuals and for the cost benefit this would bring to the NHS.
Here lies my concern. I worked in the National Health Service in the 1970s, and my family have been regular users of the NHS. Like many, we have much to be grateful for. However, we should not allow that to cloud our judgment: the NHS is not what it was; reform is needed. There are too many critical incidents across the country and in different disciplines. Only today, we heard the BMA state that NHS Wales is not fit for purpose.
It is not just health and social care that need to be integrated; within the health service itself, people work in silos. Bureaucracy rules. It saps time and resources; it affects the delivery of the all-important health service free at the point of use. I fully agree with the noble Baroness, Lady Barker, about the need to sort out the data problems. Until that is done, we will not have a fully integrated computer system within the NHS, which would almost certainly be of great benefit not just to patients but to those who work in the NHS.
Across too many disciplines, the standard of service fails. I want to emphasise just one of those services: that for the elderly at the end of life. Our generation, if I may call it that, has seen the rapid development of technology, genetics, pharmacology and, now, AI, but little is said about how we as a nation will manage the results of those advances. People will continue to live longer and the age of the retired population will be even higher than it is now. But how and where will people die? Marie Curie states today that one in four people does not receive the care they need at the end of life. With old age comes frailty, disease and loneliness. At primary care level, the lack of continuity fails older people. The “family doctor” is now just a euphemism. In hospitals, people in the final year of life have endless waits in A&E, overlong stays in noisy wards and delayed discharges.
I looked up the NICE guidance on this. NG142, on the last year of life, states:
“There are wide ranging benefits to be gained from identifying people who may be nearing the end of life … Reducing the burden of treatments that may be unnecessary and minimising the risk of inappropriate hospital admission are potential benefits to be gained from effective identification of this cohort”.
I quite agree with that, but, in practice, where do the eyes on the patient come from to identify what is a very complex and sensitive area?
On care homes, I am particularly concerned that people funded by local authorities cannot be guaranteed that they will stay in the care home to which they were originally admitted, not because there has been a significant change in their circumstances but purely because the funding does not follow the patient. Frankly, when there is just a reassessment for the purpose of moving somebody somewhere else when they are in their 80s or 90s, that is an act as predictable as smoking to kill you.
An NHS free at the point of use needs major reform. It may be the last year of this Parliament, but I really regret that the Government did not grasp this nettle. I say to my noble friend that there are solutions, particularly for people at the end of life, which will not necessarily be the most expensive things that the Treasury has ever had to contemplate. For example, a coalition of health and social care organisations is calling on the Government to tackle failings in the way that older people are cared for in their final years of life. The new Coalition of Frontline Care for People Nearing the End of Life, which includes Care England, the British Geriatrics Society and the Gold Standards Framework Centre, is calling for enhanced core training in end-of-life care for the UK’s 3 million front-line health and social care workers. It also wants a step change in health and care integration from the new integrated care boards and heightened recognition of end-of-life care by the regulator, the CQC.
While people are dying in conditions and circumstances that are very often a great burden to carers trying to do their best for them, at home particularly, we cannot honestly say that in serving this group of people the NHS that we see today is the gold standard or a national treasure. I hope that my noble friend, whether this is the final year of this Parliament or not, will take that on board and try to move things along for this group of people.
My Lords, it is always a pleasure to follow the noble Baroness, Lady Browning. I found myself in the position that she has just described only last year.
I appreciated the tone of the Minister’s introduction to the debate. The gracious Speech referred to delivering on the NHS workforce plan, the first long-term plan to train the doctors and nurses that the country needs. If I had taken 13 years to produce a workforce plan, I would not want to crow about it—and if I had possibly fewer than 12 months in which to deliver it, I would expect a sceptical response.
To give equal weight to minimum service levels to prevent strikes undermining patient safety is a useful electioneering point, but it neglects the fact that most people do not blame the NHS staff for fighting their corner but they do blame this Government for bringing the health service to its knees.
I want to concentrate on two omissions in the gracious Speech relating to the health service. One omission, for which I am profoundly grateful, is that there is no major reorganisation of the health service planned. How much time, money and effort have been put into reorganisations by this Government in the last 13 years, which could have been spent on positive progress?
The second omission is any reference to osteoporosis care. If mental health is the Cinderella service, treatment for the prevention and care of osteoporosis is even further behind. I want to press the Minister on what steps the Government intend to take to end the postcode lottery, whereby some people access a world standard of care while others are fixed up and forgotten in A&E fracture clinics, leaving them at high risk of further injury.
“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their … quality”.—[Official Report, 14/9/2023; col. GC 241.]
Some of us were pleased and, frankly, quite surprised by the positive response from the Minister to the debate. However, the following day we sank back down into the slime of low expectation and inaction when we received a “what I should have said” letter from the Minister. I should emphasise that this is not a personal attack on the noble Lord, Lord Evans of Rainow, who sent a detailed response to all those who took part in the debate and who was positive and constructive throughout—perhaps too positive for HM Treasury, which does not like what it regards as premature announcements. The letter from the noble Lord to participants said:
“I should have said ‘the Government will continue to consider options for further work to support those with osteoporosis and at risk of fractures’”.
He concluded by saying:
“I hope this clarification is of use”.
I am prepared to swallow my disappointment at the retraction and even accept that there may have been a breach of Treasury etiquette, but the real issue is whether the Treasury will fund a proposal for a package of funding to support fracture liaison services. This is currently offered to only 51% of NHS trusts in England.
If funding for the package is included in the Autumn Statement, it will be possible to free up 750,000 hospital bed days by 2028, including prevention of 31,000 life-threatening hip fractures. This is an invest-to-save measure that would free up hospital beds—1 million acute hospital bed days are taken up by hip fracture patients—and would prevent disability, or further disability. A universal fracture liaison service would reduce re-fracture levels by up to 40% and improve the chances of providing anti-osteoporosis medications. The stark and horrific fact is that two-thirds of people at risk are missing out on anti-osteoporosis medication—that is 90,000 people.
Fractures caused by osteoporosis affect half of women over 50 and one-fifth of men. They are the fourth most consequential health condition measured in disability and premature death. Hip fracture care costs £2 billion per year, and family carers give 227 hours per year to sufferers. Preventing fractures can help the economy, because 2.62 million sick days a year are caused by osteoporosis fractures, and can help levelling up, because people from lower-income households have a 25% higher risk of fractures and a higher mortality rate following hip fractures.
The Sunday Express has been running a Better Bones campaign, which has attracted widespread support. This needs some strong, visible leadership from the Government and NHS, so that everyone over 50 should have access to quality-assured services. There is already a ministerial model available, adopted in Wales from February 2023. Osteoporosis sufferers have missed out because of the short-term planning forced on the NHS. With focused funding and determined leadership, we might just catch up with the best providers.
My Lords, I too thank the Minister for the tone of his introduction to this debate, but a King’s Speech is an opportunity for a Government to take stock of progress towards their objectives. One might therefore have expected that this Government would have looked at their earlier manifesto promises when drafting the gracious Speech and considering whether their 13-year tenure had in fact improved the health of the nation. Covid, of course, was an unexpected roadblock, but the very fact that it was unexpected is an issue in itself. One hopes that lessons are being learned from the Covid inquiry.
There are pluses and minuses in the Government’s thin programme for their last year in office. Like many other Lords, I regret that, despite all the work done on proposals for revising the Mental Health Act, including a White Paper, the Government have still not fulfilled the revision promised in successive manifestos, nor their promise to implement the recommendations of the Infected Blood Inquiry. Instead, despite that inquiry’s strong interim recommendations that compensation be paid now, the Government still insist on waiting until the final report.
There is, however, one measure in the gracious Speech of which I approve: the proposal to raise every year the age at which retailers can legally sell tobacco products to young people by one year. This does not ban smoking as such, but it should deter more people from starting. We know that most smokers start young and that tobacco is unique in that it either kills or shortens the lives of two-thirds of those who use it for any length of time. I have always supported measures to reduce smoking because it is different from all other ways in which people freely choose to damage their own health. It is addictive, harmful when used as recommended, can harm other people and costs us and the NHS millions every year. That is why there is overwhelming public support for, for example, the ban on smoking in enclosed public spaces.
There will also be consultation on measures to tackle the widespread illegal sale of disposable vapes to children. Vapes have their place. They are of value to adult smokers who wish to quit, and are rightly sometimes provided free on prescription, but I believe that the vaping industry has cooked its own goose by the reckless and widespread promotion—and sometimes the free supply—of single-use vapes to children. That undoubtedly has to stop, because these things are addictive and not without danger. The massive environmental damage done by these brightly coloured gadgets, with their sickly-sweet flavours and colours obviously aimed at children, has been well-rehearsed elsewhere, so I do not need to elaborate. I hope that, after the consultation, the Government will clamp down firmly on this already illegal practice. Of course, public health budgets have also been cut and this has resulted in fewer smoking cessation services, which must also be addressed.
The Government have announced an NHS workforce plan. This is a step in the right direction, but many of us would have preferred the proposal of the noble Baroness, Lady Cumberlege, during the Health and Care Act 2022, supported by us. This provided for an independent review of current supply, an assessment of need of the right staff in the right places in the future, and a plan for how to fulfil that need over five and 10 years. The Prime Minister mentioned doctors, nurses and dentists, and of course we need more of those, especially in disadvantaged areas. However, current resources could be used better. Many of the care problems that patients experience are about systems, processes and communication. There is much efficient good practice, and I agree with the noble Baroness, Lady Donaghy, about the very cost-effective fracture liaison clinics, which save a lot of time and NHS bed days but are available in only half of trusts—that is the problem. Will the Minister ensure that the workforce plan includes staff skilled in designing and implementing efficient systems and processes which make the most of the resources we have?
Taking stock means looking to the future and focusing on the major challenges to the NHS. Three things are needed. The first, as has been said, is sorting out social care and integrating it with health services. Despite Boris Johnson’s promise of an oven-ready plan, which never materialised, social care is still suffering from lack of funding and enough properly paid staff with opportunities to develop their skills. If there ever was an oven-ready plan, it is well past its sell-by date and should be thrown in the bin. The recent Covid inquiry has exposed how very important this is, especially at times of extra stress on the system, but it did not feature in the gracious Speech.
The second is the need for more prevention of ill health. Preventable diseases, as has been said, are now the major causes of death, since modern sanitation and vaccination have conquered many of the communicable diseases. If Wes Streeting focuses on this, he will get my support. The three main factors needed here are action on healthy diets, clean air and healthy homes. The Government are failing on healthy diets despite having legislated for, but not implemented, several important measures that would have helped people make good food choices. Everyone, especially children, should have access to good, affordable food, and the Government should be doing a lot more to ensure that.
We have had many debates on clean air, but the legal limit for particulates in our air in the UK is still much higher than in other developed countries. Dirty air kills people through respiratory and cardiac diseases and interferes with the development of children’s brains. More action is needed on this now, rather than using it as a wedge issue at by-elections. Unhealthy, damp, cold homes also lead to respiratory diseases. It is a national disgrace that too many lower-income families are living in homes with mould growing on the walls and cannot pay their heating bills, and I did not hear anything positive in the gracious Speech about this.
The last factor is earlier diagnosis and treatment, and here there has been some progress. I welcome the units going around the country to check for early liver cancer, heart valve disease, lung cancer, et cetera, but what is needed is widespread access to treatment. I want to mention minimally invasive cancer therapies. These were invented here and are highly cost-effective. Can the Minister let us know what progress there is in extending these right across the country, instead of in only about half of it?
My Lords, the Holocaust Memorial Bill has been carried over from the previous Session. I speak with a heavy heart. Since the brutal mass slaughter undertaken by Hamas against innocent communities in Israel, there has been a worldwide outbreak of anti-Semitism, not least in this country. On our streets, people fear for their safety as bloodcurdling mobs call for jihad and the elimination of 7 million Jews in Israel and others around the world. We know that “from the river to the sea” means the complete elimination of Israel, because the presence of Jews in the Middle East has never been accepted by their neighbours, who killed, dispossessed and expelled Jews from nearly all Middle Eastern countries in the 1940s.
Among the worst offenders have been in our universities. At Nottingham Trent, Jewish freshers were attacked; at Bristol, the slogan is “Death to Zionists”; at Edinburgh people say “Heil Hitler” and at UCL “Intifada until victory”. I remind the House that last year the president of the National Union of Students was sacked for anti-Semitism. The same is true of some of our schools. These young people have had compulsory Holocaust education, but the only result seems to be that if they want to upset Jews then they resort to swastikas and references to gas and crematoria. They know nothing of modern Jews or Israel because they have been taught only that Jews are victims and that it was all the fault of the Nazis.
The late and much missed Lord Jonathan Sacks said of anti-Semitism: “In the past they hated us for our religion; then they hated us for our race; and now they hate our one and only state, our safe haven, Israel”. The old anti-Semitic slurs of the past have transferred themselves seamlessly to attacks on Israel, anti-Semitism dressed up as anti-Zionism.
In this country we have the National Holocaust Centre in Newark, the Holocaust Centre North in Huddersfield, the Holocaust Galleries at the Imperial War Museum, the Kindertransport Memorial at Liverpool Street and others in Hyde Park, Harwich and Swanage. We have Holocaust Memorial Day, Kristallnacht commemoration and outstanding Holocaust education centres at the Wiener Holocaust Library, the Sir Martin Gilbert Learning Centre, the British Library’s “Voices of the Holocaust”, the Holocaust Educational Trust and the Hull History Centre. Depending on how you count, there could be as many as 80 museums and collections.
What have they achieved? The history of the Holocaust is well documented and ongoing, for example in the Channel Islands, and the memories of the survivors are recorded. What is missing is the link to Jews today and their homeland and safe haven of Israel. Holocaust memorialisation tends to package up that genocide and consign Jew hatred to the past—nothing to do with us today and no mention of how the survivors went on to establish the state of Israel. In Britain, those memorials are designed to project Britain as a liberal democracy where nothing like that can happen and where all genocides are equally awful and in the past—Kosovo, Darfur, Rwanda and so on.
The proposed memorial in Victoria Tower Gardens will continue this, despite what we see in the streets right now. Its location is built on a false premise. It will fail to educate people about Israel and anti-Semitism today. I have watched politicians who are arch-enemies of Israel’s existence queuing up to sign the remembrance day book here in Parliament. Hypocrisy is too mild a word. As the American Dara Horn said, everyone loves dead Jews—the living, not so much.
Not only that, but to spend £138 million on a memorial to the dead of various genocides when the one and only Jewish museum in London has closed for lack of funds is a disgrace. We could and should have a splendid Jewish museum in central London dealing with the entire history of Jews in this country over a thousand years, triumph and tragedy, and with the Holocaust in context, as Lord Sacks wanted. The learning centre planned for here is a shallow specimen, ironically to be created by digging down two storeys at huge cost in funds and to the environment.
Given the protests in London recently, it will be a focus for graffiti and worse in no time. That is not a reason not to build it, but, if it is built, parliamentarians must prepare themselves for barriers and armed guards there, as well as disturbances and defacement. The children in the playground there will bear the brunt of it. How tin-eared is it to place a playground and café on top of a memorial to children who had no childhood and who starved to death? Would it be appropriate to have a café and playground right by the Cenotaph?
It is well meaning, but naive and misguided to go ahead with this. It will not improve the situation for the persecuted Jews of today. It will enable the sponsors to say, “Look what we have done for you. No more complaints please; it is all sorted”. It will provide a photo backdrop for politicians who like to say that they do not have a racist bone in their bodies—and give them carte blanche to join the Israel-haters.
I plead with those behind the Bill to educate themselves before pretending to educate others. Abandon the design for the current memorial, which is meaningless; it has been called a giant toast rack. It was designed by an architect who is now in disgrace for his sexual assaults and has been dropped by his clients. How could one stand in reverence before such a monument? Instead, we could have a figurative memorial that means something, like the one at Liverpool Station, or the Warsaw ghetto. We could have a new Jewish museum that includes the Holocaust and its impact on Britain. We could have all that without the expense and legislation before us, which will result in the spoiling of the only decent green space near us without any compensating features. I urge noble Lords as strongly as I can to change course on this.
My Lords, I join others in saying that I appreciate greatly the tone in which the Minister introduced the debate. I very much regret that I cannot say the same thing about the grief he was required to articulate.
When thinking about what I should say today, I came across the following: “We make a living by what we get. We make a life by what we give”. Those words were spoken by Winston Churchill, and they are at the heart of what I want to say. The voluntary and charitable sector has been part of the British way of life for as long as I can remember. Giving makes us all feel good and contributes to building and strengthening our communities, but the future is looking bleak for many charitable organisations. A recent survey carried out by the National Council for Voluntary Organisations showed that some 85% of charities believe that the coming winter will be tougher than last year. Without more help, one in five charities could disappear, leaving people and communities at risk.
The NCVO statement revealed that over £16.8 billion of income for the charitable and voluntary sector comes from the Government and local government. However, these contracts are not uplifted each year to reflect the rising costs of delivering these vital services. Ahead of the Autumn Statement, the NCVO is asking the Government to ensure that contracts for services it provides, and direct grants to charities, are uplifted. Like the NCVO—and, I am sure, like many in this House—I endorse that.
Why is that so important? If nothing is done, people will not be able to access the vital services they need. I spent 20 years as a member of Gwent County Council before entering the House of Commons, where I served as chair of the Finance Committee. I saw first-hand how important public funding support was for local charitable initiatives. Unfortunately, all too often local council grant support was very short-term, covering one, two or a maximum of three years. I soon discovered that many local charities, having secured funding and employed staff, had, within a year, to use the staff as fundraisers in order to continue the service they were trying to provide. Public funding for charities is still too short-term; I strongly believe that five years is the minimum that will be required.
The contribution each of us makes as an individual is vital in building and strengthening communities, but, as the NCVO report has shown, the bedrock of income for many voluntary and charitable groups comes from local councils and government. More than that, the NCVO said that costs are increasing, income is falling and demand is increasing. In addition to the cost of living crisis, it now finds that there is a cost of giving crisis. For many, despite their resilience and ingenuity, the cost of giving crisis has created a melting pot of pressures as they continue to support their communities.
There is no doubt that the Covid pandemic left many voluntary and charitable organisations in a far worse position than we first thought. Now they are struggling while faced with falling income, increased costs and a growing demand for services. This cost of living crisis has hit very hard. Evidence of that can be seen in every supermarket. I am sure that I am not alone in this but, in recent months, when shopping I have noticed that the large crates at every exit, put there so that we can donate to local food banks, are now more often empty than full. In fact, there is hardly anything in there at all because people are feeling the pinch and cannot give as they did before.
This brings me back to a point I made earlier. In these circumstances, more government and local government financial support is necessary. I accept that many will say that public funding is already overstretched and is not a bottomless pit. I know that—we all know that—but, in these circumstances, the Government and local government will have to decide priorities. I passionately believe that increased financial support for contracts for and work done by the charitable sector should be a top priority for both the Government and local government.
Why do I feel this? As I said, I spent 20 years as a county councillor. I was a Member and Minister in the other place for nearly 16 years and I have been in this House for about 13 years. In that time, I have learned one important thing: no matter how good the Government and local government are at providing services, without the services provided by the voluntary sector, the quality of life of many people in our country would not be what it is today. Looking around the Chamber now, I suspect that many of us have at one time or another turned to the voluntary and charitable sectors for help or advice. We know how important their work is. Many of us are demonstrating it right now. Most of us in the Chamber are wearing poppies; each one bought provides help and financial support for one of the greatest charities in our country, the Royal British Legion.
The Government must ensure that contracts and grants for charities delivering services are uplifted to meet the costs of delivery. If this does not happen, people will not be able to access the vital services that they need. I sincerely hope that the Minister and the Government will be prepared to listen.
My Lords, in the time available to me, I would have liked to address my remarks to the effect that the new legislation will have on two of my main areas of interest: equalities and prisoner welfare. However, that would have made a very short speech indeed. The word “equality” does not feature once in the gracious Speech and one government equalities pledge, made more than five years ago, has still not found its way into proposed legislation. I refer, of course, to a conversion therapy banning Bill.
I should not have been surprised. After coming first as the most LGBTI-friendly country in the Rainbow Europe rankings between 2011 and 2015—this coincides with the time when the Liberal Democrats were in the coalition Government—we have since slumped to 17th place today. But do not worry: I have a cunning plan to help the Government out. Reading the runes, I feared that this Bill might drop off the parliamentary agenda, so I entered the ballot for Private Members’ Bills to bring in my own Bill—and guess what? My conversion therapy prohibition Bill came first in the ballot. This is definitely meant to be; we will be able to debate this issue in Parliament, as we should.
It is a shame that a mental health Bill has also been omitted from the Government’s agenda. I do not need to take up the House’s time to spell out how much of an effect poor provision and lack of resources are having on those suffering from mental illness as my noble friend Lord Allan has already more than done that issue justice today. Compared with crowd-pleasers such as pedicab regulations and a football regulator, which I am sure are important to many—well, football is at least—the Government have chosen to put mental health in the “too difficult to tackle” box before they lose the next general election.
However, we have the criminal justice Bill, some aspects of which are very welcome, such as taking steps to equip our police and criminal justice systems to better tackle violence against women and girls, criminalising the sharing of intimate images and introducing a statutory aggravating factor at sentencing for offenders who murder partners at the end of a relationship. However, long sentences and mandatory terms of imprisonment may well be contrary to some of the Government’s other worthy aspirations for prisons. You cannot grow your way out of an increasingly overcrowded penal system by locking up more and more people for longer and longer periods. In this country we lock up more people per head of population than many other countries, even those more right wing than this one. In fact, we lock up 50% more per head of population than the EU average. While mandatory sentencing and increased length of sentences might look good to right-wing voters on an election leaflet, they will be counterproductive in the longer run—not that this Government need necessarily worry about the longer run.
Every pound we spend housing prisoners is a pound less to spend on rehabilitation and support to help ensure that, on release, prisoners can take their place in society as citizens and do not end up back in prison, costing the taxpayer even more money and causing victims of crime even more suffering in future.
Finally, I want to tackle race hate, which is of course an equality issue. This feels particularly timely given the impact the horrific Israel-Gaza conflict has had in the UK. The Home Secretary has only added fuel to the fire with her divisive rhetoric and declarations of “hate marches”, which have incensed our Muslim communities and many others, while British Jews continue to feel unsafe, as well they might. Since
My Lords, it is a great privilege to take part in this debate on the first King’s Speech in more than 70 years from a gracious sovereign who as Prince of Wales did so much to bring people together in purposeful collaboration; that will be much of my theme.
Noble Lords will know that I am a chartered surveyor and a member of other property-related bodies. I have three principal points to raise in the debate. Two are related in one sense or another to housing and the third to community. The first is general. I am not normally prone to quoting the Leader of the Opposition, but I did take to a point she made on Tuesday in her opening remarks in this debate, when she said she was an optimist
“and government does not have to be about just managing or looking to see where an issue can be exploited to maximise votes. Government can and should be a force for good: an innovator, an enabler and an investor”.—[
That really caught my attention. Going from that was the sense of needing to seize the moment. We have a new monarch, and in 12 months we will possibly have a new Government. I do not suggest of which persuasion they may be; other noble Lords with more partisan views can work that out for themselves.
I too am an optimist. A welcome reference was made in the gracious Speech to long-leasehold matters, but there is a need to go well beyond make good and mend and the constant patching which has been going on for decades. The whole panoply of self-interest from central government downwards needs to change to something that I might describe as a more settled climate of contentment, with less adversarial conduct and fewer polarised positions—because none of those do any good.
I may be old-fashioned, but I believe in ethics. I am sorry to be mentioning this just before the right reverend Prelate gets up and makes her contribution, but I do not do so in any religious sense; I do so because I believe in the decent treatment and respect of fellow human beings. Residential accommodation should be delivered as a service built on trust and transparency, without avarice or creating trauma, without generating fear or other adverse consequences, and looking towards those desirable commonalities of gains in health and productivity on all sides. This may sound altruistic but I believe it also adds value and security in property terms; it is of benefit all round. I agree with so much of what the Government propose and more, but some of those purposes and rationales are quite unclear to me and risk making matters difficult in new areas.
Any analysis starts with good data, but I am unclear on the sufficiency of what has been undertaken. To give one example, take the long-term effects of a 999-year lease extension in a building that may be obsolete in less than 150 years and what that means further down the road, and whether the transfer of asset by eliminating marriage value for the enfranchisement costs of a block benefits householders or, as I am told, a significant proportion of those who are in fact investors with renters in occupation. Is that what was intended? I simply ask the question; I do not make a value judgment on it. I turn to the proposed future threshold for block enfranchisement of 50%. What are the consequences for investment in mixed-use development, for post-development investment in the block, for block management and for the business tenant element of confidence in somebody who understands their particular aspect? I am not sure the question is one that the Government have asked.
The private rented sector is one in which I am, in a small way, a player. I lament the reputational damage done by those who abuse tenants financially and emotionally and who are careless of the basic fitness of their properties. But where is the support and nurturing of the gold standard of service delivery, in which renters have confidence and are met with openness, collaboration and respect? I beg to differ with the noble Lord, Lord Young of Cookham, when he suggested that perhaps private landlords should be phased out and it should become some sort of institutional thing. I do not agree with him on that; I think a lot of individual private landlords, of which a large percentage own perhaps one or two properties, have valuable and good relationships with their tenant and a personal interest in what goes on. I believe that the renters are my eyes and ears. They are not only people who pay rent but personal friends. I try to do things for them and they try to do things for me, and we are not worried about asking each other for a favour ever now and then. This is absolutely critical. The ethics are personal, corporate, municipal, professional and political, and we must bear that in mind.
If that all sounds odd coming from a professional, I underline for noble Lords that this underpins transactional analysis at all levels, fosters confidence in the marketplace and is a benefit to investors and all those who participate. I believe that a reset and a new vision are needed, and that opportunity now exists.
My second theme refers to building new housing and I will make only one comment here. Before noble Lords proceed down the road of land value capture, which is so often put forward as necessary, I ask them to be aware of just how much is paid to the original landowner as a proportion of gross development value. It is much less than one might think, and before we rush to policy we should make that explicit by doing some research.
My final quick point comes out of my vice-presidency of the National Association of Local Councils and relates to the proposals following the Manchester Arena attack. Parish and town councils welcome these but, as providers of venues, they urgently need an impact assessment of how this will work for them, guidance, financial assistance and other resources, and a better communications campaign. I hope the Government are listening to all those requests.
My Lords, it is a privilege to speak in this debate and I thank the Minister for his thorough introduction.
In the Old Testament there is a beautiful vison of the prophet Isaiah of the perfect future with God:
“Never again will there be an infant who lives but a few days … No longer will people build houses for others and not live in them … People will not labour in vain, nor will they bear children doomed to misfortune”.
Whether or not you are a person of faith, I believe most of us would say yes to those words in the gracious Speech about the Government seeking, in all respects, to make long-term decisions in the interests of future generations. But how will that be realised? We need interconnectedness across disparate Bills and government departments, and a commitment to the well-being of individuals, always set within the big picture of people belonging together as interdependent human beings—hence that word “community” and its importance in the gracious Speech being picked up in the themes of today’s debate.
The gracious Speech spoke not only of delivering a plan to regenerate towns and to put local people in control of their future but of the Government’s commitment to keep communities safe. All of this is possible only if there is joined-up, holistic and long-term thinking. Discussions around local communities, housing, health and public services cannot be boxed separately from that stated commitment to keep communities safe.
I will unashamedly mention prisons again today, and declare my interest as Anglican Bishop for His Majesty’s Prisons. I was delighted to hear the speech of the noble Baroness, Lady Burt. Prisons hold up a mirror to so much that is needed regarding housing, education and training, health and public services. On my most recent prison visit, a couple of weeks ago, the group of men I met shared their stories, mainly owned their failings, and named things that had contributed to their offending—mental health problems, broken relationships, constant movement through the care system, a lack of housing which could be called “home”, addiction to numb the pain of poverty, lack of education and training, learning about crime in prison, and the consequences of a criminal record when even attempting to turn their lives around on accessing work and housing on release. A focus on rehabilitation in prisons and beyond the gate is broadly lacking. Given that two-thirds of people in prison are there for non-violent offences and that over half go on to reoffend within a year of leaving custody—rising to almost two-thirds among those sentenced to less than 12 months—prison is failing everyone, not least victims, families and whole local communities, and it is not addressing serious contributory factors.
For example, we know that the instability created by lack of, or inadequate, housing puts strain on families and communities and can create a domino effect, impacting health, education, and many of those underlying causes of criminal behaviour. We also know that a high percentage of people who leave prison do so with no home to go to and, unsurprisingly, soon return through the revolving door of prisons. It is an expensive way to house people.
In Gloucester, there is a business creating modular, eco-friendly homes which, incidentally, employs prisoners. These homes could be the answer to so much homelessness but, despite the enthusiasm of police and crime commissioners and councillors, bureaucratic processes and funding stymie the possibilities. Combine lack of appropriate housing with poor education and training and a lack of adequately resourced addiction and mental health services, and the risk of offending is increased.
This is about asking not for more money but for redistribution of finance. On top of the annual cost of prison at over £50,000 per person, the social and economic cost of reoffending has been estimated at £18 billion per annum, while the cost to victims, families and communities is impossible to estimate and undoubtedly impacts on the pressure on health and public services, not least regarding the health and mental health needs of prison staff and their families. It is vital to see the big picture and refocus the finance.
The very welcome government commitment to sensible presumption against short sentences will require redirecting funding to substantially supporting probation and community alternatives, which again link with the themes of today’s debate: for example, community sentence treatment requirements aiming to reduce reoffending by improving access to mental health and substance misuse treatment in the community. There is some good early data from pilot areas.
Incidentally, as other noble Lords have said, it is disappointing that the gracious Speech did not include plans to take forward reforms to the Mental Health Act. Many women in particular are still sent to prison as a place of safety or for their own protection. This is inappropriate, expensive and does not lead to change, and prison staff are not equipped to deal with the levels of self-harm and disturbing behaviour.
In my recent engagement with the justice system in the Netherlands, I have been struck by the focus on integration and reintegration, which is so different from the vocabulary of being tough and more punitive. There, people in prison work on their reintegration from day one. This includes plans for housing, purposeful work, health and care plans, plus a focus on a prisoner’s social networks and family ties. The rate of crime continues to decline in the Netherlands.
That wording of “long term”, which was used in relation to regenerating towns in the gracious Speech, needs to be writ large across all policy and decision-making in the themes of today’s debate. There are no short-term, quick solutions here. We need courageous, data-driven and joined-up decision-making if we are to truly change this country for the better. It does not begin with tough, law-and-order rhetoric.
My Lords, I will speak about education and skills. Although the King’s Speech included an encouraging paragraph on this topic, there was rather a dearth of specific action, legislative or otherwise. It is good to hear that:
“My Ministers will strengthen education for the long term”.
But we need to know more about how this goal will be pursued in the shorter term, beyond a consultation and White Paper, which could presumably take us close to the end of the current Session, if not of the Parliament.
The principle of introducing an advanced British standard, bringing technical and academic routes into a single qualification, sounds like a promising move towards a baccalaureate-style system. But how will it be brought about, and in the time available?
Seeking an answer, I consulted the public policy paper on the advanced British standard published last month, and I was delighted to read that:
“Education is the closest thing we have to a silver bullet. It is the best economic policy, the best social policy and the best moral policy”.
I strongly agree—so how is the silver bullet going to be forged?
The paper sets out some excellent aspirations. Greater parity of esteem between academic and technical routes has long been a sort of holy grail, and the Government are right to pursue it, even if defunding well-regarded existing qualifications such as BTECs in favour of T-levels may not be the right answer, at least in the short term. More teaching hours for pupils, as in other countries, must be good, especially if that enables them to study a broader range of subjects than at present—but how will teachers to deliver those extra hours be recruited, motivated and retained? The paper also sensibly envisages alternative qualifications for the so-called forgotten third of pupils who find it hard to pass GCSE exams in English and maths at 16, and as a result are condemned to an often prolonged cycle of morale-sapping resits before they can make further progress.
The gracious Speech spoke of increasing the number of young people undertaking high-quality apprenticeships. I say amen to that, but what are the Government’s plans to make it happen, given the poor take-up of apprenticeships to date, particularly among 16 to 19 year-olds, and widespread employer concerns that the apprenticeship levy is not flexible enough, and that few small businesses find the support available to them adequate to persuade them to offer apprenticeships? I hope the Minister can tell us.
I will also say something about education for 11 to 16 year-olds, as a member of the House’s committee on this subject. We have heard from many witnesses about issues that badly need to be addressed. These include the baleful impact of the English baccalaureate measure in crowding out subjects not included in the five EBacc pillars, notably arts and creative subjects such as music. Another concern is the unreasonable pressures imposed by GCSEs, resulting from their excessive content, their rigorous assessment and the resulting high level of stress that they impose on pupils and their mental health. GCSEs are also far from ideal for many less academic subjects—the more practical subjects.
A further concern is the current imbalance between knowledge and skills, with insufficient focus on key technical subjects such as digital and green skills. I am confident that the committee will come up with excellent ideas for tackling such issues when it publishes its report shortly, but I am less confident of the Government’s likely commitment to implementing them beyond “looking at further improvements to GCSEs”. Perhaps the Minister can reassure me.
There is only a passing mention in the ABS paper of the importance of careers advice and guidance. Much progress has been made in this area over recent years, thanks to the efforts of the Careers & Enterprise Company, the National Careers Service, local careers hubs, and careers leaders in individual schools and colleges. But there is still some way to go to ensure that all students are made aware of the range of career pathways available to them, including through employer encounters and work placements. What plans do the Government have to produce an updated careers strategy, building on the success of the previous one in 2017, and to ensure that schools deliver the minimum number of employer encounters required by the Skills and Post-16 Education Act?
I accept that forging a silver bullet to deliver a world-class education system is a long-term project which could indeed take up to 10 years. That underscores the need to seek a strong consensus on the approach to be taken, across government departments, across the devolved nations and regions—some of which, including Wales, Scotland and Manchester, are pursuing ambitious education ideas—across education institutions, teachers, parents and pupils, and, of course, across political parties. This should not be a party-political issue. I hope that the Minister will be able to tell us how the Government’s laudable commitment to a world-class education and skills system will aim to set a clear and widely agreed long-term direction, rather than one open to abandonment or redesign with each change of Administration, as has happened too often in the past.
The theme of the debate today, given that so much of the King’s Speech was about long-term laudable aims, is: what can actually be achieved in the current Session that does not then find itself becoming a dead end?
My Lords, it is a great pleasure to follow the noble Lord, Lord Aberdare, particularly because he has covered much of what I might have said, had I had 14 minutes rather than only seven.
Responding to the King’s Speech, the Association of Directors of Children’s Services was mainly concerned by what was not in the Speech. Its president said:
“Unfortunately the speech missed an opportunity to focus on a significant long term challenge affecting children, their health, wellbeing and their ability to learn in school”.
That is, of course, poverty. In saying this, he echoed points made by the National Education Union about the need for a plan to tackle, among other things, the root causes of persistent post-Covid absence, a plan that should focus on the impact of poverty, insecure housing and mental health—all absent from the Speech.
After years of austerity and cuts to school funding, there needs to be a concerted effort to rebuild local authority services, including SEND support and mental health services, to be available to children and families in a truly timely fashion, as well as rebuilding pastoral support in schools. This question of poverty is set against the background of the Joseph Rowntree Foundation reporting that 1 million children are living in destitution in our country, as we were reminded yesterday by the most reverend Primate the Archbishop of York.
The lack of government funding continues to have a major impact on schools and children’s learning. Ministers claim that they have restored per-pupil funding to 2010 levels in real terms. That is not good enough. No net growth in over 13 years represents a considerable squeeze on school resources in all respects. I remind your Lordships that last month, the Government admitted to a £370 million error in their school funding. This will cause further cuts at school level. Perhaps the Autumn Statement will be the moment to reinstate that £370 million.
What might be welcome, as has been referenced by the noble Lord, Lord Aberdare, is the signalled intention to create parity of esteem between academic and vocational education, especially as the OECD continues to report that there is much to do on skills in this country. However, it is not at all clear that the so-called advanced British standard is the answer, not least because it is unlikely to be taken up in Scotland or Wales, and possibly not in Northern Ireland, so is not really British. A better way to encourage more students to achieve would be for the Government—the noble Lord, Lord Aberdare, has already mentioned this—to reverse the decision on applied general qualifications and to continue to fund them. They are a tried and tested qualification which provides a pathway for disadvantaged students into employment or higher education.
The advanced British standard would also face a challenge, in that there are currently insufficient teachers in our schools, with future prospects not looking good. While the Schools Minister Nick Gibb talks about this being the best time to be a teacher, recruitment figures to the profession seem to give the lie to that. The Government recruited only 59% of their target for trainee secondary teachers this year, with a projection of only 50% for next year. Retention continues to be a big problem. Some 25% of teachers leave within three years and about a third within five years, and only 60% remain after nine years. That is not good enough. The Government will say that the number of teachers has increased by 27,000 since 2010, but the number of pupils has increased by close to 995,000. The NEU calculates that that equates to 37 extra pupils for every extra teacher. Clearly, more teachers are needed.
I could give chapter and verse on the number of teachers who are not properly qualified to teach the subjects on their timetable, but I will just say this about English and maths: one in six English teachers and one in five maths teachers has no post A-level qualification in the subject—yet another indication that the advanced British standard may well have problems.
Turning to the state of our school buildings, reinforced autoclaved aerated concrete—RAAC—is, as the NEU says, just the tip of the iceberg of the acute problems caused by the real-terms decline in capital spending of 44% between 2009-10 and 2019-20. The Office of Government Property has calculated that to maintain the school estate in line with best practice—and surely our children deserve conditions in which to learn that represent best practice—the Government should be spending £7 billion a year. The current figure is £2.6 billion, so perhaps that is another idea for the Autumn Statement.
Finally, I return to poverty. A key way to improve children’s capacity to learn would be to legislate for universal free school meals. Hungry children cannot learn. If work and potentially the dignity of work is beyond the reach of many, particularly single parents, because of childcare costs, the Government need to address the fact that what is currently on offer to so many is simply not adequate. What proposals might they have in this direction?
Just before I sit down, where is the long-promised employment Bill?
My Lords, there was nothing in the gracious Speech about the most debilitating and underreported health problem which has arisen as a result of the pandemic, known as long Covid. It has become a serious health matter, especially since the Office for National Statistics stopped reporting on long Covid in March this year. Following the outbreak of Covid-19, the NHS committed to providing centralised funding specifically allocated to fund specialised long Covid services across the country. This funding has now been removed, meaning that the services are being absorbed back into local integrated care boards, which are now deciding service by service whether they will continue to fund and run a specialised long Covid service.
Yet it is now that we need to know the extent of the problem, as we know it affects 1.9 million people in the UK, which is 2.9% of the population. This figure comes from research done by the all-party parliamentary group on long Covid. People have been unable to get back to work because of the devastating side-effects they have experienced following a bout of the Covid virus. More will follow, as the latest information on the government website tells us that 6,832 people tested positive for the virus in the week to
Many people have suffered after contracting the virus and their symptoms are so varied that I wonder what research is being done to support them. Some 1.82 million days were lost by healthcare workers alone suffering from long Covid, from March 2020 to September 2021, across 219 NHS trusts. A survey carried out by the Chartered Institute of Personnel and Development found that one-quarter of UK employers cited long Covid as one of the main causes of long-term sickness absence among staff. Clearly, this is an alarming figure.
I wonder if the Minister can tell me what research is going on in this country to try to mitigate the effects of long Covid on our own population? In Canada, for instance, research by the Ontario Covid-19 rapid research fund found that an MRI technique developed by Western University was able to see how tiny branches of air tubes in the lungs were moving oxygen into the red blood cells. They know that this happens in long Covid patients and are now researching to find out why this occurs, as they believe it has an important bearing on why long Covid happens in some people and not in others.
I have been introduced to an interesting programme by the English National Opera called ENO Breathe. It is a breathing and well-being programme developed specifically for people recovering from Covid-19 who are still suffering from breathlessness and associated anxiety. It is delivered in collaboration with Imperial College healthcare teams and is entirely online. It focuses on breathing retraining through singing. Would the Minister undertake to look at this programme and see how this sort of approach could be used more widely in the national health system?
I have a very personal interest in this subject, as one of my grandsons is a sufferer, having been unable to attend school since November 2020, having caught Covid-19 earlier. It is only because of the amazing help and support he had from his school, the Royal Grammar School in High Wycombe, his headmaster Mr Philip Wayne and some members of his staff, that he has been able to pass his GCSEs and enter the sixth form. Although still capable of doing only a fraction of what he had been able to do pre-Covid, Tate has been very lucky. Not every child will have had the parental and school support he has.
We know that school attendance has been plummeting; we have already heard that. The Children’s Commissioner, Dame Rachel de Souza, has stated that one in five children were persistently absent from school, which is equivalent to 1.8 million children regularly missing. Has any research been done to see if long Covid has a part to play in these absences?
Recommendations on long Covid from the APPG include: launching specialised care pathways for children living with the illness; that guidance is issued to schools and educational settings on the management of and support for pupils living with long Covid; and that the UK Government issue urgent guidance to medical practitioners on long Covid in children. May I ask that the Government look urgently and favourably on these recommendations so that our young people, having endured two years of disruption to their studies already, should not have to worry further if they contract this awful virus?
My Lords, I draw attention to my interests in the register. It is a great privilege to be able to partake in this debate. I was pleased that my noble friend the Minister opened with his own personal remarks because I want to shape what I am going to say around my personal experiences.
I want to talk about hate in schools. When I was growing up in the 1960s and 1970s, it was hate because of the colour of your skin; today, sadly, most of the hate is because of the faith you belong to. It is so important to raise this because schools should be a place where children go to learn, to be happy, to have well-being and not—like as I experienced when I was a child—a place of dread. Every single day going to school was: were they going to be nice to me? Were they going to call me names? Were they going to beat me up or try to beat me up?
Sadly, earlier this year I saw a report on anti-Hindu hate in schools. Hate of any kind, for any faith, is unacceptable, but 1.6% of the population of this country is British Hindu. It is a community that does not make a noise or raise its voice against things because, by and large, it just gets on. But it was so sad when I came across parents who had moved their children several times because they had been called names, identified as non-believers, told they would burn in hell and had different types of meat chucked at them. I say this because we all have a duty of care, but local authorities were put in charge of reporting bullying or hate incidents. I worry because, when you give a local authority that authority, I do not know how much it can fairly find time to investigate. It is critical that every single child going to school feels that everyone is on their side.
After I read the report, I went out to speak to parents, and I found that this was not a small but a large problem. I have stood up and fought against discrimination all of my life, and I will fight for every faith and for every child to be able to go to school and have a safe haven, where the teachers will not stand by and allow this practice to carry on. But when I found that some parents had reported their children telling them that the teachers had not intervened to stop it, that raised some red flags. I hope that my noble friend the Minister will take this back to the Department for Education because it is critical that, in this day and age, we should respect each other’s faith and have tolerance—I do not like that word—or respect for each other’s identities, which is so important.
I know how difficult it was to go to school and the knotted feeling I had in my stomach, thinking, “Will they be my friend today or not? Will the teacher be nice to me or not?” It is not acceptable that that is still happening all of these years later. So, in his response, can my noble friend the Minister assure me that the concerns I raise will be taken to the Department for Education and the Secretary of State?
I have raised many times in this Chamber my concerns about the disadvantage that children from low-income families face, particularly those from minority communities and those, like those in my city of Leicester, where there are incredibly disadvantaged people from the white, Asian and black communities. When we talk about the digital age and all of these things being part of our lives, I do not want those children to miss out. So I would appreciate an assurance about how we work to ensure that they are part and parcel of our discussions, so that no child is at a disadvantage in being able to aspire to their full potential.
The important thing for me, like the Prime Minister, Rishi Sunak, and many people who have come from the Indian subcontinent, is that this country has given us an opportunity because of education and how social mobility enables us to enjoy this country’s wealth and growth. I do not want children growing up today to miss out on those opportunities. So it is critical—I repeat this—that the parents are part of the solution. Mothers and fathers from minority communities need to be able to speak English and understand the services available to them. They cannot integrate if they cannot communicate.
I therefore urge my noble friend the Minister to make sure that my concerns are heard. Too many communities are still left behind because of inability in language skills, which then reduces all the other possibilities that those young people could have.
I am glad that there were not lots of Bills in the King’s Speech, because I want quality, not quantity; I want it to be based on delivery and not because we want to tag everything on to a Bill. However, I would like all religious places and all places with charitable status, if they are teaching children, to have Ofsted inspections, because it is critical that we know that children are not being taught in an environment that encourages hate.
My Lords, in the seven minutes in which we are asked to speak today, seven people will have hospital appointments because of their smoking habit. The Department of Health and Social Care estimates that this amounts to around 450,000 hospital appointments in England every year. In the seven hours we expect to debate today, around 700 GP appointments will be made because of smoking. Cancer Research UK estimates that around 900,000 GP appointments are made every year because of smoking. In England alone, nearly 200 people will die every day because of smoking.
The tobacco manufacturers try to suggest that the frequent ill health and the 50% death rate of those who smoke are a simply a matter of their personal choice, but smoking tobacco has consequences for many other people beyond those trapped by nicotine addiction.
Aged 16, I was woken by my younger brother, as our mum had overslept and we were late for school. I got up, but I could not wake her. She was just 53, and she never woke up. She was a heavy smoker and severely disabled. She died of hypertensive heart disease, and smoking was a significant contributory factor in her death. She did not choose to die that way; she was addicted. She did not choose for her children to become orphans and for us to lose our home—and becoming homeless at that time was not a “lifestyle choice”. So, yes, the issue is a personal one about the consequences of smoking: it is not a choice but an addiction, and one which the vast majority of smokers, having started in their youth, come to regret.
There was little in the gracious Speech to inspire anyone, including those on the Government Benches. Change is not change when little more is promised than bland slogans about a brighter future but with the same people and the same policies. But praise must be given where praise is due; and the latest in a lengthy line of successful measures to help reduce the prevalence of tobacco smoking is to be heartily welcomed. Lives will be saved; people will be healthier and wealthier, and the whole country will benefit.
This year, the cost to the public purse of early deaths due to smoking will be £31 billion. This year, the cost of lost productivity due to smoking will be £38 billion. This year, the cost due to smoking in terms of lost tax receipts, increased social security spending and extra costs to public services such as the NHS will be more than £9 billion, and that is after the tax receipts from tobacco are taken into account.
Meanwhile, the tobacco companies continue to make enormous profits. This year, the four biggest tobacco companies in the UK will make around £900 million in profits. It is no wonder that they spend so much money on desperate tactics to deceive people about every single measure that we have ever introduced to reduce the prevalence of tobacco smoking. We should listen instead to medical advice. Sir Chris Whitty, the Chief Medical Officer for England, spoke recently about the plan to gradually raise the age at which you can be legally sold tobacco. He said:
“The overwhelming majority of the medical profession, the nursing profession and all the health charities support this”.
He described claims from the tobacco industry that the policy would not work as “bogus”. He told the BBC:
“As a doctor I’ve seen many people in hospital desperate to stop smoking because it’s killing them and yet they cannot—their choice has been removed”.
The Bill has support from the British Heart Foundation, Cancer Research UK, the Royal Society of Public Health, the UK Faculty of Public Health, Asthma + Lung UK, and Alzheimer’s Research UK, among all the many organisations putting public health above the vast private profits of the tobacco companies. However, using their well-funded front organisations, the tobacco companies are orchestrating their usual deceptive and devious techniques to try to protect those profits. They have a few champions, such as Liz Truss and the Institute of Economic Affairs, which helped her to crash our economy—and Boris Johnson, whose judgment and integrity are well known, who says that the plan is a ban.
The plan is not a ban on smoking, because no smoker will be banned from their habit. What will be made illegal is underage sale, in the same way that a few years ago we extended the minimum age for someone who can be sold cigarettes from 16 to 18. The plan will extend this further year by year. The measure offers great hope to everyone below the age of 14, for whom it will never be legal to be sold cigarettes. The evidence is that such measures will not increase the illicit market. When the age of sale increased from 16 to 18 in 2007, it had no negative impact on this market, which continues to fall.
The issue of moving to a more smoke-free Britain, and seeking to be smoke-free by 2030, does not involve a choice between restricting sales of tobacco and more public health activity to help smokers quit. We need both. Two-thirds of those people trying just one cigarette, usually as children, go on to become daily smokers, and daily smokers are addicted smokers. The plan to limit cigarette sales further has strong public support; it does not divide the Government and the Opposition Front Benches—and I hope that pressure from the tobacco lobbyists will be firmly resisted across both Houses, as it clearly has been in this House today.
That was a very interesting speech about cigarettes—good. It is interesting, because what you are going to try to do is stop people smoking. What I know about smoking is that most of the people who smoke—and I work with homeless people—are great smokers. Most of the other people I know who live in poverty are great smokers. I am interested in looking at it another way: what about getting rid of poverty? If we get rid of poverty, we can get rid of the driving force that turns people into addictive persons.
I am addicted to red wine. I gave up the addiction to cigarettes 30 years ago, but I still find I need to have a few drinks every now and then, and I do not always stick to two glasses. That is largely because I come from poverty. I know those addictive powers. I know the way that you almost feel that you need to hide somewhere, and the palliatives provide one of the best ways. Virtually all the homeless people I have worked with have been smokers and users of drugs and all sorts of things. I always tell people that one reason I came into the House of Lords was to get rid of poverty.
When I look at the King’s Speech, I feel sorry for the guy. He had to say that he wants to do things such as hand out licences to extend the amount of oil that we are getting, and so on. There was not an awful lot to encourage us that, in this year before the election, the Government would say, “Okay, let’s do something original and new; let’s inspire the electorate”, thinking that they might be voted in for another four or five years.
This week, I had a run-in with Suella Braverman after she came up with the incredibly mad idea—I do not think anyone in the Government would agree with her—that people who are homeless and sleeping in tents, the street homeless, have made a lifestyle decision to become a part of the homeless fraternity because they want to give up on paying taxes and live off begging and so on. I find this really difficult and I have written about this; I do not know of any piece of research that I or any other people have been involved in over the past 30 years—or 32 years since the Big Issue started—that shows the kind of data that the Home Office must have turned up to find this out. Why would you talk like that without the data? But the data is not there. If you talk to most people who are caught in the trap—the bastille—of homelessness, they will talk to you about all the reasons why they ended up homeless. They will not say that they simply decided it at some stage.
What Suella may have done wrong is to have got a number of people around her who said, “Yes, we talked to a homeless person the other day; they said they like to be on the streets”. I know those people. I have met a few of them. Some of them are ex-members of the Armed Forces who have been caught in bivouacking and all those things—I knew three or four of them who used to live on Wimbledon Common, up there with the Wombles, for years, even decades. Most of the people who say “I want to be on the streets” do not want to be in the hostels; they do not want to be controlled. Unfortunately, hostels—even those run by the best charities—are very hostile places to be. They are not places of safety. Quite a number of people who move away from them end up on the streets, because it is the less bad choice.
What I am worried about when I see the Queen’s Speech—I mean the King’s Speech, the gracious, what do you call it?
Forgive me; I will get it right by next year, I promise. One thing that worries me is the talk of giving tenants a better ride. The Government say they are going to protect tenants. Earlier this year, they said that they were not going ahead with the banning of Section 21, but I hear from the noble Lord, Lord Markham, that they will in fact do something about it. What does that mean though? This has been in the manifesto since 2019 and there has been no movement in the last four years.
Yet if we look at the reasons people end up on the streets, Suella is right about one thing. I checked with a friend of mine who runs a church in Hounslow only the other day and said, “Who is coming to you who is most desperate?” I will tell you who it is: a new cohort of homeless people who have been given asylum and then told to leave their hostels or their hotels within a matter of a week or two. Actually, Suella is right: there is a new group of people coming on the streets, but driven there by the Home Office. At the same time, there are people on the streets who are there because they are not getting the correct social help that would address their mental health and all the other problems.
I wanted to talk about other things but I just say, lastly, that I came into this world to do something about homelessness; I came into this House to do something about homelessness. What is happening in Gaza really frightens me. Everywhere I go and whoever I talk to—and I speak at many places—I do not meet people who are siding with His Majesty’s Government and siding with Israel. Most of them are saying, “A ceasefire, please”. If I am walking around and I go to a meeting in Norwich and there are 100 people, most of them say to me, “John, we’ve got to stop the bombing”. It may not make military sense to stop the bombing, but what worries me is the possible outburst of anti-Semitism—the most evil thing, that I as a child was taught to embrace, because I came from an anti-Semitic Catholic family. I am seeing it. I want to head off that anti-Semitism and I think we may be walking into a trap. I am sorry; I might be the only person in the House who believes this, but I worry about the homelessness that is being created and I worry about the long-term effect on Jewish people in this country, because people are turning away, and that really worries me.
My Lords, I shall address two matters today. Each concerns education, on which this Government have rightly placed a premium, but there remain significant areas which the proposed legislative programme does not address. Indeed, we do not have an education Bill. I hope that time may yet be found to address them none the less.
The first point I make concerns the right of parents and prospective parents to know what their children are being taught in schools. In RSE, too many schools still have contracts with outside providers of teaching materials whose terms purport to forbid teachers from showing copies to parents or others who want to know what is being taught. That is often because the provider is really a lobby group promoting unorthodox ideas in sex education or race theory. They do not want the public to see what is being taught. I do not need to cite examples; the press in recent months has been full of this.
When the now defunct Schools Bill came before the House last year, I, with other noble Lords from across the House, from all four Benches—three anyway—tabled an amendment in Committee which would have given parents the statutory right to see such materials. That came to nothing when the Bill died but, on
“The Department is clear that parents should be able to view all curriculum materials. This includes cases where an external agency advises schools that their materials cannot be shared due to restrictions in commercial law, or a school’s contract with the provider prohibits sharing materials beyond the classroom”.
I welcome that, but it is not a substitute for legislation. First, legislation has a permanence which cannot be provided by departmental guidance. Secondly, a letter from a Minister does not bind the courts; it is possible that the propositions of law set out in a circular will fail to stand up in some future litigation. Thirdly, the experience to date has been that circulars and guidance from the department have not been enough to secure compliance with the policy of transparency. Fourthly, it does not address the position of prospective parents—those who have yet to send their children to a school—only the rights of parents of current pupils. Finally, the propositions in the circular themselves are subject to some limitations and qualifications.
The right way to provide for the rights of parents and prospective parents hoping to make an informed choice of school is a parental rights Bill. This will properly protect their rights under Article 2 of Protocol 1 of the European Convention on Human Rights, as reinforced by the court in Strasbourg. Such a Bill is to be found on the website of the Society of Conservative Lawyers, whose chair of research I am. I commend it to the House. Failing that, there is the Bill recently presented in the other place by Miriam Cates MP, which I believe deserves support. A critical point in its favour compared to the circular is that it would require all RSE teaching materials from external providers to be either published in the public domain or obtainable on payment of a modest fee.
I move briefly to my second topic, the vital life skill of financial awareness. I have addressed the House on this before but I want to urge the Government forward. There is a clear and pressing need to include financial education in primary schools, not just secondary schools. As the Centre for Social Justice has explained, money habits and behaviours that will stick for life are formed by the age of seven. However, two-thirds of primary school children receive no financial education. The Centre for Financial Capability has made the same points in its report this month on financial literacy in the community. We know as adults that we have to manage rent, mortgages and a range of household bills. Children must be equipped for this and it must start young. Too many school leavers still leave ill equipped because the grounding has not been laid at the outset. These skills must be embedded young. While financial education is now taught in secondary schools, many teachers say that too many leave school with an inadequate grasp of it. We must do something about it. It must start in primary schools and I urge this Government to do something now.
My Lords, today’s debate covers some of the important areas so vital to a well-functioning society, but it is regrettable that the measures announced in the gracious Speech do precious little to make a real difference to the ambitions and opportunities available to our country’s most precious resource—our children and young people. I have worked in education for much of my career, and I hope that experience will bring a helpful contribution.
Schools and further and higher education institutions continue to be impacted by the after-effects of the pandemic. It is well documented that there is a disparity in this impact between schools in deprived areas and those in the most affluent areas of our nations and regions. The biggest disparity is the epidemic of low attendance.
We face a lost generation of children. More than 1.5 million children were persistently absent across both the autumn and spring terms, which is almost double the number for the same period five years ago. Every day of education matters, so tackling persistent absence would be at the heart of Labour’s mission for education, as there appears to be no plans from this Government to get to grips with this epidemic.
A main education focus in the forthcoming legislation, if you look hard enough for it, is the proposition to replace A-levels and T-levels with the advanced British standard—although I would argue that it is an advanced English standard. During my teaching and examining career, I was fortunate to be part of the development of Curriculum 2000, which extensively rewrote A-level specifications and introduced the AS-level. I understand significant change and how carefully it needs to be implemented, and I believe that this is the wrong policy at the wrong time.
Admittedly, the post-16 curriculum in England is narrow by international standards, but that partly reflects the chronic underinvestment in sixth-form education, which is 15% lower in real terms than in 2010. Furthermore, under Conservative Governments, young people have experienced a narrowing of the curriculum far earlier than 16; it therefore makes little sense to broaden it from 16 onwards without doing more for earlier age groups. Ofsted has repeatedly warned against teaching to the test, but this is exactly what this Government have prioritised. These reforms do nothing to take on the attainment gaps that are established in the early part of the education system and only widen as young people progress through school.
The other area that was given scant attention in the Speech was the idea of low-value degrees. It is important for the Government to remember that we already have controls, so the regulator can impose sanctions for courses which breach certain minimum thresholds for continuation, progression and completion. If the Government really feel that those controls are not enough, they have had over 13 years to deal with this. Let us treat universities as a public good, not a political battlefield.
Persistent absence, crumbling schools, a recruitment and retention crisis and a postcode lottery of standards are some of the immediate issues that need to be dealt with. An extensive reconfiguration of the post-16 landscape and an attack on our universities is another unnecessary distraction. Fix the roof first, stop the rain pouring in and replace the crumbling concrete. Let us stop teachers leaving the profession in droves and ensure a proper teacher recruitment drive, so that we can fully staff our education establishments and give them the decent pay and conditions deserving of a professional workforce.
I was glad to see that Labour has commissioned the respected former chief inspector of Ofsted, Sir David Bell, to deliver an early years review to consider how to deliver new places, a motivated, well-trained workforce for high standards, and more accessible childcare; that will happen under Labour’s plans. In Breaking Down the Barriers to Opportunity, Keir Starmer set out clearly our fifth mission in government: breaking down the barriers to opportunity for every child, at every stage, and shattering the class ceiling. We will track this progress through three stages of education—boosting child development, with half a million more children hitting the early learning goals; achieving a sustained rise in young people’s school outcomes; and building young people’s life skills with an expansion of high-quality education, employment and training routes—so that more people than ever are on pathways with good prospects.
Nevertheless, I agree that it is a positive step that the Government will continue to act on concerns about the increasing number of children receiving an education outside the classroom. If we have the proposed register for all home educators, it will ensure that children are receiving a suitable education in a safe environment, with the tools and flexibilities for local authorities to check that.
In conclusion, I have spent my life as a public servant and I genuinely despair at the Government’s legislative plans for health and social care, education, welfare and public services; they are lacking in ambition and vision. I would have hoped that in at least one of these Bills, we might have seen something of true substance in one of the areas that are so crucial to a well-functioning society. As it is, it will fall to us parliamentarians to probe, push and negotiate our way to legislation that delivers real outcomes and some hope for the public. If that means sitting here until the early hours of the morning to defend the indefensible, so be it. After too many years of Conservative Governments, that is our democratic duty, and we will willingly contest for what is right and proper for the people of Britain.
My Lords, I will focus on three areas in relation to the gracious Speech: children who are not in school; the quality of courses in higher education; and mental health inequalities.
I support having a register for children who are not in school. As the recent case of Sara Sharif highlighted, children being home-schooled drop off local authorities’ radar and become invisible. However, a register alone will not solve the problem of safeguarding the well-being and healthy development of children. Although many parents provide a stimulating and safe learning environment at home, not all do. For example, children with special educational needs may not receive the educational support that they require. Furthermore, the surge in online schooling that accelerated during the Covid pandemic poses additional risks to children. Who is monitoring the quality and content of these online courses?
Legislation should be strengthened to include: the establishment of a regularly updated register; the authority routinely to monitor children’s educational progress and well-being; and the power to scrutinise reasons for home-schooling and even relocating to a different jurisdiction, including overseas. For example, some girls from ethnic-minority communities could be at increased risk of female genital mutilation and forced marriage.
It is really important to understand the current situation and fully establish the facts. The Government should therefore publish the rates of home-schooled children over the past several years, the demographics, the hotspots and the reasons for home-schooling. No doubt some of the reasons may include bullying, mental health, subpar education or curriculum-related apprehensions. How do the Government propose to address these concerns? If they are not addressed, we will see a further rise in home-schooling.
Next, I want to address the quality of university courses. The Government want to tackle the growth of low-quality courses, apparently, but I am concerned about the criteria used to determine what these are; they might even take away opportunities from minority-ethnic students who are already disadvantaged in higher education. For example, the criteria might be the ability to be employed. Some students may live in areas where there is a lack of jobs or wages are low and may not have the means or the freedom to move away to a different locality. In some communities the burden of caring is much higher, which may hinder a student’s ability to move away or go into full-time employment. Some people study courses because they enjoy the subject and it may be a way for them to stay local, have some freedom from home life and socialise.
Finally, I want to talk about mental health. I too am disappointed that a mental health Bill was excluded from the King’s Speech. As has been mentioned several times already, a higher proportion of black and Asian people have poor mental health outcomes and they are more likely to be detained under the Mental Health Act. Under the Equality Act, health and social care providers have a legal duty to reduce inequalities between patients in terms of access to health services and the outcomes achieved. There is enough existing data and information telling us that minority-ethnic people are overrepresented in secondary care and underrepresented in primary care. If they get the care they need at an earlier stage, they are less likely to be detained.
We do not need to wait for a new Bill. The Government can act now, implement policies and put greater effort into the following: improving access to primary healthcare; increasing trust and confidence in mental health services; improving educational awareness in minority communities to recognise poor mental health symptoms and know how to get help; tackling the stigma associated with mental health, which may be greater in some communities; improving training and capacity so that mental health is not dismissed due to stereotypes; and improving the availability of culturally sensitive counselling rather than limiting treatment to medication only, the rate of which seems to be higher in ethnic-minority communities.
The final point I want to make is about people with autism, and I declare an interest here: I have a teenage son who has autism. He developed severe anxiety over the summer and also self-harmed. I had to take him to mental health professionals, and I was really appalled by the way he was treated. He was routinely dismissed, and more than once I was told, “Take him to an autism charity”. I then asked whether the health professionals had autism training; most had not. It makes a difference, because when I finally came across a doctor who understood autism, she understood that you can have autism and anxiety, which a lot of the other health professionals did not understand. I want to mention her by name: I thank Dr Lily Abedipour. Because of her, my son received the right treatment and is doing better than he was in the summer. So autism training matters; it makes a difference. I finish my contribution with a question to the Minister: when will all health professionals receive autism training according and appropriate to the needs of their roles?
My Lords, I follow a most moving speech. Despite being the son of a superb medical practitioner and the grandson of another, I rarely speak at any length about health issues. I think this restraint owes something to my failure to master the subjects that would have enabled me to follow the family tradition and serve the community in my turn as a doctor. However, as a close observer of the many grave issues confronting our health service today, I have recently been impressed by the determined efforts of the Royal Osteoporosis Society to direct public attention to the very patchy provision of fracture liaison services in our country. It is an urgent and pressing matter that calls for action by the Government in this new Session, as the noble Baroness, Lady Donaghy, made clear in her important speech. I agree with all that she said and I support from these Benches the case that she made.
The Royal Osteoporosis Society deserves much credit for the way it has heightened awareness of the situation through its Better Bones campaign, conducted over many weeks in partnership with the Sunday Express. Thanks to this campaign, we know that fracture liaison services, the world standard for diagnosing osteoporosis at an early stage, are not provided by more than half of NHS trusts. In areas where they are not available, those with fractures generally receive treatment in A&E departments, but they are often not told that osteoporosis was the cause. That means that they do not receive the treatment they need and disappear from the system, inevitably to suffer another fracture in due course.
The royal society’s estimate of the cost of filling the gaps where fracture liaison services are not currently provided would be a not-unthinkable £27 million a year. The potential savings are large, not just in reduced healthcare costs but in ensuring that people can continue to work until later in their lives. It is a common misconception that action to tackle osteoporosis mainly involves preventing hip fractures in people over the age of 70, like me. Osteoporosis and fractures can have a huge effect on younger people’s professional lives. One in every 12 women over 55 experiences a spinal fracture, rising to one in 10 for those over 60.
We should be deeply troubled by the extent to which osteoporosis goes undiagnosed. It is estimated that some 2.6 million women and men endure the effects of undiagnosed spinal fractures. They inevitably find themselves reducing their hours of work or being pushed into early retirement due to vague back pain that is often the result of undetected fractures. This is borne out in the statistics. Every year in England, there are around 67,000 fractures in the working-age population. As a result, some 2.6 million working days are lost every year, according to the International Osteoporosis Foundation. Drug therapies can reduce the rates of refracture by up to 90% for the most common fractures.
Both business leaders and trade unions are firmly behind this year’s hugely informative Better Bones campaign in its call for universal fracture liaison services. How can that be achieved? The Government are being urged by the experts in this field to establish a transformation fund to fill the stubborn gaps in existing provision. Such a fund would enable us to keep up with the rest of the world in diagnosing osteoporosis early, before the disease has the chance to inflict grave damage on individuals and society. This is a proposal to which the Government should give the most serious consideration in this new Session, as the noble Baroness, Lady Donaghy, and I, and no doubt other noble Lords across the House, will agree.
As other noble Lords have noted, there is a most welcome reference in the gracious Speech to the need to
“strengthen education for the long term”.
Those words will attract wide cross-party support in both Houses, along with a strong desire to know more about the Government’s thinking and intentions. A succession of authoritative reports from highly respected bodies have in the last few years made major proposals for the reform of the existing education system, and a large degree of consensus has emerged about what should be done. It will be reinforced shortly by a report from a Select Committee of your Lordships’ House on Education for 11-16 Year Olds. I am a member of this committee but an infinitely less distinguished one than the noble Lord, Lord Aberdare, and indeed the noble Baroness, Lady Blower. Reform should proceed, as far as possible, on a cross-party basis to ensure that it provides the stability and confidence that schools, teachers and families need for the long term.
There is, sadly, one highly contentious matter on the education agenda: the Labour Party’s proposal to slap VAT on independent school fees. In the 1990s, the party buried this idea, which it had kept putting in its election manifestos; now it has dug it up again. It is a total myth that the independent sector of education is stacked with wealthy, well-endowed schools, educating the children of wealthy parents who can easily afford a sudden 20% fee increase. I declare my interest as president of the Independent Schools Association. Its 650 member schools are virtually unknown outside their own local communities, which they serve faithfully alongside colleagues in the state sector. The hard-working families without financial reserves who send children to these mainly small, unpretentious, but highly successful schools do not deserve to be hit by a brutal tax increase. Some will be forced to move their children to schools in the state sector. Why should they be uprooted in this way?
My Lords, the 2019 Conservative manifesto, on which this Government’s programme was based, devoted well over a page to constitutional reform, democratic accountability and the rule of law. This King’s Speech is entirely silent on the subject, except for the promise to focus on long-term decisions instead of the repeated short-term changes in policies and Ministers from which the UK has suffered in the past four years.
The Prime Minister’s introduction to the briefing on forthcoming Bills gives the game away. His reiteration that “integrity, professionalism and accountability” will mark his Government’s approach underlines the absence of these qualities under his immediate predecessors. Since 2017, the constitutional conventions that structure the way Britain is governed have been seriously damaged by competing factions and populist politicians within the Conservative Party. Boris Johnson claimed to govern by “the will of the people”, that dangerous phrase, rather than by parliamentary consent. Ministers challenged the rule of law. The Commons has been sidelined to a point where, in the last Session, it sat for fewer hours per week than the officially part-time House, this Chamber. Constitutional guardians established by former Conservative and Labour Governments have been ignored or overruled, or their independence threatened. These include the Committee on Standards in Public Life, the Independent Adviser on Ministers’ Interests, the Advisory Committee on Business Appointments, the House of Lords Appointments Commission and the Electoral Commission. The Covid inquiry is now informing the public of the chaos that has characterised this Government, the disregard for rules and due process, and the errors and corruption to which all this has led.
Decent Conservatives must be as worried about this move away from constitutional democracy as the rest of us, and I hope they share our concern around the decline of public trust in Westminster politics to which it has led. Multiple studies of public attitudes indicate that trust in national politics and politicians in Britain is now lower than any comparable advanced democracy except the United States, and that it has sunk further since the Covid lockdown and the Johnson premiership and now hovers between 5% and 10% in an otherwise disillusioned and disengaged public. The comment of the noble Lord, Lord Hayward, on the two most recent by-elections—that the winners on a low turnout were disengaged non-voters rather than the Labour Party—ought to concern and worry all of us.
It ought also to concern partisans of the current Government that, in answer to public opinion pollsters, voters say that they trust local government significantly more than Downing Street and Westminster, trust judges and courts far more than politicians and Ministers, and trust the Civil Service more than the Ministers who so often rubbish it. Oh, and a majority trust the BBC as a source of unbiased news a great deal better than they trust the Government’s information services.
The only Bill in the agenda set out for this Session that touches on our structures of democratic government is the Economic Activity of Public Bodies (Overseas Matters) Bill. That seeks to tighten even further detailed ministerial direction of what directly elected local councils may do. I suggest that this is totally unacceptable to democratic accountability.
Local government has been the nearest governing body to which most of our citizens relate, dealing with issues that affect their communities and daily life. Local government has been undermined, reorganised and starved of financial resources for many years. The Covid inquiry has heard that Ministers bypassed the network of public health officers across England’s cities and towns, who could have managed the response to the epidemic, in order to outsource Covid testing to multinational companies—with disastrous results. Any incoming Government should make the revival of local democracy an urgent priority to rebuild public trust and effective local administration.
This exhausted Government have abandoned their promise to strengthen our constitution, so it will be up to whichever Government emerge after the election to take up the task of rebuilding our constitutional safeguards and attempting to rebuild public trust. They should do their best to build cross-party consensus—I note that the noble Lord, Lord Lexden, talked about the desirability for good policy—on the changes that are needed, rather than impose the partisan perspectives that right-wing think tanks such as Policy Exchange have urged on this Government. In opposition, after all, Conservatives will discover again that electoral dictatorship is hateful when imposed against them, and may then support reform.
The Constitution Unit has provided a list of rapid changes that any new Government could introduce; for example, a cross-party business committee for the Commons to loosen the Government’s control of the timetable, statutory status for constitutional guardians, cuts in the size of the Government’s bulging parliamentary payroll, and tighter rules on political finance. The Institute for Government has also proposed a Joint Committee on the constitution to oversee executive adherence to constitutional rules. I am very glad to hear that our Constitution Committee will examine that proposal further.
If all the next election leads to is a change of government, without significant changes in how we are governed and our democracy works, public distrust of Westminster will fester. Where this King’s Speech is silent, the next Government must commit to a broad reform programme of our overcentralised and Executive-dominated structures, to rebuild competence and trust in constitutional democracy.
My Lords, it is a privilege to have been present at the first King’s Speech in over seven decades and to take part in this debate. I declare my interests as set out in the register.
With the spotlight currently on the Covid inquiry and the mistakes made, damage done and lessons to be learned, it was heartening to see the opening of the Speech set government plans in the context of the long-term challenges that Covid has created for the UK. Unfortunately, optimism that it might include necessary measures to address the pandemic’s wickedly long tail faded as the pages turned.
To understand the real damage wrought by the pandemic, we need not to look back but to the future: to the challenges of long Covid for individuals and the NHS, to the impact of isolation and loss on mental health, and to the future success of a generation of children whose education was so severely disrupted by lockdowns.
Most children lost half a year of schooling through Covid. That is about 5% of their overall learning. The effect of this will echo through their lives, on career options, earning potential and, by extension, tax revenues available for public services. As ever, children from disadvantaged backgrounds suffered the most.
The full-blown pandemic may be behind us, but its impact on young people’s education goes on. Many have simply not returned to the classroom, which is a scenario described by the Children’s Commissioner as
“the issue of our time”.
In the last autumn term before the pandemic, 4.7% of all children were absent from school. In 2023, the figure was 7.5%. Persistent absence, which is when a child misses at least 10% of possible sessions, has also risen sharply, from 13.1% to 24.2% over the same period.
There is nothing in the gracious Speech to tackle this, despite strong evidence linking school absenteeism with various life-course problems, including risky behaviours, teenage pregnancy, psychiatric disorders, delinquency and substance abuse. The commissioner’s latest report highlights the link between absence and attainment; the likelihood that persistently absent children will end up not in education, employment or training; and the fact that 81% of children entering the criminal justice system have a history of persistent absenteeism.
The causes of absenteeism are complex and diverse, but it does seem to be a particular issue where additional vulnerabilities are present, particularly in children with special educational needs, physical disabilities and behavioural, emotional and social difficulties. This means that the failure to deal with absenteeism is another route by which the already disadvantaged are disproportionately affected, and that the gap between the more and less fortunate in our society grows ever wider. As the gracious Speech was silent on this issue, can the Minister perhaps tell the House how the Government plan to tackle this epidemic of absenteeism and the causes that lie behind it?
The introduction of the advanced British standard makes it into the gracious Speech, with a promise that increasing the number of subjects at key stage 5 to a minimum of five, expanding overall taught hours and introducing maths and English as mandatory until 18 will
“ensure young people have the knowledge and skills to succeed”.
It is unclear whether the evidence supports those assertions. Studies from Switzerland and Germany suggest that increasing instruction time has, yet again, the effect of widening the gap between high- and low-performing students and benefits only the students who already do better at school. It also flies in the face of OECD principles for curriculum redesign, one of which is to allow for flexibility and choice for teachers and students.
Of course, numeracy—and, indeed, financial literacy and budgeting—are important skills for employment and for life. But improvements need to be targeted across all stages of education. The key question is what kind of maths is to be included post-16, given that so many students achieve excellent results in GCSE maths but go on to struggle with A-level. It is vital, too, that reforms carefully consider the impact on the 6% of UK children who suffer from dyscalculia, a specific learning disability that impacts the ability to understand, learn and perform maths and number-based operations.
Children are already concerned about what this means for them. I have been lobbied by a 10 year-old relative who argued cogently and passionately that her educational experience and outcomes would be impacted by these reforms, given her learning style and needs. Significant improvements have been made in the teaching of children with dyslexia and other reading disabilities, but despite the Department for Education’s assertion:
“All teachers are teachers of special educational needs and disabilities”,
there is currently no formal requirement for maths teachers to learn about dyscalculia as part of their training. Regardless of whether the advanced British standard is progressed, does the Minister agree that training needs to be updated so that maths teachers can recognise dyscalculia and better support students affected by this condition?
I shall finish by echoing concerns already expressed around the House about the absence from the gracious Speech of a mental health Bill. This is a bitter blow for the 2,000 people with a learning disability and/or autism currently locked away in mental health in-patient units, who often receive poor-quality, and sometimes horrific, treatment, as has been revealed in numerous undercover investigations and Select Committee reports.
Our understanding of mental health has changed a great deal since the Mental Health Act received Royal Assent in 1983. There has been some updating, but legislation still lags behind ambition, and the fact that laws currently allow people to be detained for no other reason than that they have a learning disability or autism is, in itself, evidence of the need for change. So I hope the Minister will be able to tell the House why the Government chose to omit this Bill from the gracious Speech. There is widespread agreement, and cross-party consensus on the need for reform. Surely the Government should be using the last Session of this Parliament to deliver a manifesto commitment on which they were elected—not once, but twice—to bring this Bill before the House?
My Lords, it is a pleasure to follow the noble Baroness, Lady Bull, and her thoughtful and thought-provoking speech. I also agreed with the noble Baroness, Lady Deech, on her powerful speech about the Holocaust Bill. I support a Holocaust memorial and learning centre, but the current proposals reflect the fact that it is the wrong location and the wrong design, at an exorbitant cost of £139 million.
I am here in your Lordships’ House today to speak about housing. In that case, I need to declare an interest in that I have been a landlord in the private rented sector since the 1990s and before that I was a renter in the private rented sector up until my mid-30s. I have seen renting from both sides of the fence.
I welcome His Majesty’s Government’s determination in the gracious Speech to proceed with both the Renters (Reform) Bill and the leasehold and freehold Bill. Both are long overdue, in my view. However, in almost 30 years of being a private landlord, I have never known the situation facing both landlords and private renters to be so bad. We are moving towards an inheritocracy, where only those who inherit will own property and wealth. Social inequality will increase as a result. Better to tax unearned inherited wealth, rather than everyone else, to provide the housing that is so badly needed.
One of the fundamental problems we have heard today in your Lordships’ House is the shortage of property to rent. The Government thus urgently need to increase the supply of socially rented housing to make it affordable for people, as the noble Lord, Lord Howarth of Newport, said earlier today. It is a simple question of demand and supply. When demand outstrips supply, prices, or in this case rents, go up. There are of course other contributing factors; recent rises in mortgage rates mean landlords with buy-to-let mortgages—and there are 1.7 million of them—have seen their mortgages triple or even quadruple. In that event, it is not surprising to see rents in some cases go up by 30% to 40%. There are other factors; tax changes have meant that buy-to-let landlords are the only business owners I know to be taxed on their turnover, rather than profits. Increasing regulation, often necessary, has nevertheless meant costs have been piled on landlords, which they pass on to their tenants.
Let us look at these private landlords. Profits are at their lowest for 14 years. Over the last year, the level of landlords defaulting on their mortgages has doubled, so arrears have been building up. Most landlords just have one or two properties, which they have worked hard to buy, to provide for them in their old age. In the past, property capital growth has enabled landlords to cross-subsidise tenants in lean times, but this is no longer the case.
On the specifics of the Bills, I welcome the abolition of Section 21, so giving security to tenants. But His Majesty’s Government should be careful of the unintended consequences of introducing periodic tenancies to replace assured shorthold tenancies. In city centres and resort areas, short-term tenancies and increased use of Airbnb-type ultra-short tenancies will mean less property is available to local residents and students, not more, as the noble Lord, Lord Best, already mentioned. It does seem bizarre to me that His Majesty’s Government will outlaw longer tenancies, so guaranteeing more security of tenure when both parties want it.
I am glad that pets, particularly dogs, will be banned when the lease forbids them. That should remain at the discretion of the landlord. Dogs may be appropriate in houses, but in flats they can cause nuisance and even be dangerous. We have seen a massive increase in dangerous dog attacks and fatalities in recent years; my wife and I were on the receiving end of one in our own garden from tenants who had a dog in breach of the lease. I would not recommend the experience.
In terms of the leasehold Bill, I welcome His Majesty’s Government’s intention to abolish the feudal and archaic leasehold system, as the noble Lord, Lord Young of Cookham, referred to previously. For centuries, freeholders and their agents have had a licence to fleece leaseholders, with little or no chance of redress. In particular, I agree leaseholders should be given greater rights to self-manage, ending the opportunity for freeholders and their agents to exploit vulnerable leaseholders with excessive service and other charges.
It is time that lease extensions and valuations were made more transparent, quicker, cheaper and easier, rather than the theatrical system we have today, which is designed to benefit everyone except the leaseholder. The opaque lease extension system in place, its absurd marriage value and other calculations mean leaseholders have little or no control over the process or the cost.
It is regrettable, as the noble Lord, Lord Best, has mentioned on numerous occasions in the past, that property management agents remain wholly unregulated. What other body sometimes dealing with millions of pounds is totally unregulated and requires no professional qualifications and standards whatsoever? On balance, His Majesty’s Government should be supported in reforming the private rented sector and leasehold. They should be awarded six out of 10, but need to do better still.
My Lords, I welcome much that is in the gracious Speech but would like to concentrate on the housing measures, both new and carried forward from the previous Session. In this respect, I thank the noble Lord, Lord Truscott, for his remarks and would like to build on some of them. I therefore declare my own interests in the private rented sector, as set out in the register.
As the Secretary of State Michael Gove has said in the other place, the best solution to our housing problem in this country would be a greater supply of housing, which I hope this Government and future Governments will address. However, in the meantime there are challenges in the housing market that need to be addressed urgently. In this respect, one of the biggest problems is the private rented sector. I am greatly looking forward to the swift arrival of this Bill in this House, as it will belatedly address some very real issues that are causing significant pain to those who rent and unnecessary uncertainty among those who provide rental properties to the degree that some are exiting this important market which serves many important roles in the economy. Indeed, the rental sector is approximately 20% of the housing market. Our debates at Second Reading and in Committee will look into these issues in depth and from the side of both the renters and the owners of rental property and, hopefully, we will be able to improve the Bill.
In the meantime, I want to highlight the cross-departmental aspects of this legislation that are already causing concern—certainly that concern is not unique to this legislation but affects other Bills across the spectrum. In respect of housing, it is correct that the lead should be the Department for Levelling Up, Housing and Communities, but in the instance of the Renters (Reform) Bill there is the necessity of huge input from the Ministry of Justice and the Department of Energy and Climate Change. I will be grateful if the Minister will explain how exactly this interministerial involvement works, how commitments made in the Bill are actually delivered and in what timescale. It is clearly unacceptable that a housing Bill is conditional on the involvement of another ministry that perhaps does not see its work on a housing Bill as a priority focus.
The principal issues before the Ministry of Justice are Section 21, which allows no-fault evictions and Section 8 which is the alternative legal route for evictions and repossessions. The noble Lord, Lord Markham, outlined what needs to happen, and the noble Lord, Lord Young, and others highlighted some problems of the Government’s approach. With the Renters (Reform) Bill, the Minister of State has made it clear that unless landlords have confidence in systems that underpin the justice system, we will not have good landlords to provide properties available to rent throughout the country. She emphasised that work to provide that confidence remains a priority for the department and for the Ministry of Justice, but absolutely no timeframe is given. It all sounds like, in the words of Lewis Carroll,
“jam to-morrow and jam yesterday—but never jam today”.
Meanwhile, until improvements are agreed and Section 8 is fit for purpose, no-fault evictions under Section 21 will continue with all the associated misery caused by unscrupulous landlords. At the same time, good landlords may take the opportunity provided by the delay and the uncertainty about the outcome of legal reforms to exit the sector. The CLA has already suggested that this is happening with the direct consequence of there being fewer houses available to rent and continued pressure on rental levels.
A similar issue is the involvement of the Department of Energy which has withdrawn the current minimum energy efficiency standards, which were certainly not fit for purpose in a large proportion of our older homes, but no new standards have been proposed nor any timetable given. Surely this, together with other proposals related to the promised decent homes standards, should have been part of this or another Bill and been included in the gracious Speech.
The issue of interdepartmental co-operation, or lack thereof, is certainly not unique to housing. As a cautionary tale, we passed the Agriculture Act in 2020 and the Environment Act in 2021, but we still await clarification from the Treasury on the tax treatment of farmers and landowners for environmental schemes developed and encouraged by those Acts. Tax issues relating to VAT, income tax, capital gains tax and inheritance tax are involved. Treasury consultation has taken place and closed back in June, but we still have no decisions. Inevitably, lack of information on tax has caused farmers and landowners to sit on their hands, thereby delaying measures designed to address carbon emissions.
The interrelationship of housebuilding, environment and tax will all come to a head very soon when the Government’s policy on biodiversity net gain is finally introduced. Failure by the Treasury to resolve tax issues will severely limit the incentive for farmers and landowners to offer land for biodiversity net gain and consequently affect housebuilding numbers, leaving aside lost biodiversity opportunities in the process.
I have tried to highlight the importance of interdepartmental co-operation, which has the power to make or break good legislation unless it operates in a strict timeframe, and warn of the consequences of not co-operating. I look forward to the Minister’s response on this issue.
My Lords, I apologise to the noble Lord, Lord Carrington, for jumping the gun. I had looked around for my noble friend Lord Carrington of Fulham, so it was entirely my mistake.
As someone who went through the torturous process of extending the lease on a property I used to own, I too welcome the Bill to reform the housing market by making it cheaper and easier for leaseholders to purchase their freehold. However, I hope the House will indulge me if I confine my remarks to a housing-related issue that compromises my ability as a severely disabled parliamentarian to keep my promise made in this Chamber to speak truth to power without fear or favour.
When I joined your Lordships’ House almost eight years ago, I could never have imagined that I would encounter a double whammy of discrimination not only on account of my disability but as a severely disabled parliamentarian. Yet that is the sad and bizarre situation in which I now find myself and which I am taking this opportunity to bring to the attention of noble Lords.
It was my severe disability that informed my recent decision to move to a housing development where accessibility is an integral part of the design. Credit for that must go, ultimately, to the Earl of Moray, the landowner who conceived the exciting vision that is Tornagrain. My acute vulnerability as a severely disabled parliamentarian also informed my need for privacy, which email exchanges show I communicated to the developers almost two years before I reserved my house. Emails show not only that that need was expressly acknowledged in writing but that I was advised as to the possible suitability of various plots on that basis. Noble Lords might therefore imagine my surprise when I discovered on moving in that my house lacked any privacy and created genuine security concerns. As a result, I do not feel safe in my own home.
I was grateful to Police Scotland for issuing a crime prevention assessment survey report that made recommendations as to how the situation should be remedied. In doing so, it made specific reference both to my additional vulnerability as a severely disabled parliamentarian and to the Equality Act 2010, particularly with regards to the duty to make reasonable adjustments.
Unfortunately, Moray Estates, acting on behalf of the landowner—and, specifically, the Tornagrain Conservation Trust, whose managing director sits on the trust board—have seen fit to reject the most important recommendations made in Police Scotland’s report, despite my having made clear in writing that this would void my privacy and security. My neighbours, with whom I am keen to enjoy good relations—and who, it was confirmed in writing, had previously approved a compromise proposal by the developer—suddenly changed their minds, following an approach by the Tornagrain Conservation Trust. I can assume only that this was done on the premise that, if I do not feel safe, as a severely disabled parliamentarian, in my own home, I will have to sell up and leave. In other words, sit tight, do nothing and the problem will disappear because I will have been forced out. The point here is that if I, as a disabled Member of the House of Lords, am having such a challenging experience securing the accessible housing in which I can feel safe, what does that say for a disabled person who does not have a voice, particularly given the evidence of the challenges that people who have disabilities find in accessing accessible accommodation?
For the avoidance of doubt, my experience is not a planning dispute. It is actually far more serious because it is impacting directly on my ability to carry out my parliamentary duties. I am encountering two organisations, the Tornagrain Conservation Trust and Moray Estates, that give every impression of ignoring their legal duty to make reasonable adjustments to policies, procedures and practices on account of disability—and of acting in a manner that I think most people would say belonged to feudal times. To be clear, the trust exercises what would generally be recognised as, effectively, planning authority powers, without either transparency or accountability. No minutes of meetings are published, requests for the trust board to visit sites of residents applying for permissions go unheeded and residents are discouraged from attending the AGM.
Housing is a devolved matter, so I conclude by respectfully suggesting that the Scottish Parliament might want to look again at the Title Conditions (Scotland) Act 2003 and consider specifically whether the spirit of the legislation, particularly as it pertains to the 2016 amendment order, which added the Tornagrain Conservation Trust to the list of prescribed conservation bodies, is being honoured in practice. In light of my experience, I respectfully suggest that it ensures that an equality impact assessment, which was not undertaken at the time on the basis that the policy does not have any impact on equality issues, is now undertaken.
I close with this point. It is surely wrong that in 2023 a severely disabled parliamentarian should be placed in the utterly invidious position of having to bring such an issue to the attention of your Lordships’ House and our fellow parliamentarians in Scotland. I hope this will be resolved quickly so that I may keep my promise to speak truth to power, on whatever issue, without fear or favour.
My Lords, it is a pleasure to follow the noble Lord, Lord Shinkwin, who talked twice of his obligation to speak truth to power. Perhaps I may say to the House and to him that I think he did that rather well.
This has been a wide-ranging and very interesting debate. I hope that the noble Lord, Lord Markham, will forgive me if I say that I thought his introduction, which was also wide-ranging, put a rosy gloss on the Government’s performance in the fields of health, education and housing in particular. The debate has rather demonstrated that the evidence for that is lacking and that in all those areas and others that we have heard about there are some serious structural and resourcing problems.
The gracious Speech proposed a number of Bills. I missed a proposal for audit reform and hope that it will appear in the not-too-distant future. I thought that we might get something on adult social care and children’s social care, and we did not, but it is possible that something is proposed for the Autumn Statement.
I had hoped for something to promote dentistry and healthy teeth, particularly in children. As my noble friend Lord Allan pointed out, NHS dentistry services are in serious trouble. Perhaps something will be said in the Autumn Statement because the Minister talked about the importance of prevention of illness. It is not happening in terms of the state of the nation’s teeth.
I had also hoped for something to promote real devolution in England. England is too centralised, but while all control of resources and tax raising lies with the Treasury, devolution to combined authorities will prove problematic, because they will end up competing with one another for the favours of the Treasury. What happened, I wonder, to the blueprint produced by the Northern Powerhouse Partnership in March this year on how to devolve tax to the regions of England, which was launched by the noble Lord, Lord O’Neill, a few months ago? It seems to be commanding support from members of all parties, but it may require a new Government to get implemented.
The Prime Minister said that the King’s Speech would not contain gimmicks, so I am pleased that it contained no proposals to ban tents occupied by homeless people. As we have heard from a number of speakers, homelessness is not a lifestyle choice; tents are given to homeless people for good reason. It can make them feel safer, and keeping people safe is a stated objective in the gracious Speech.
The noble Lord, Lord Howarth of Newport, reminded us that 130,000 children live in temporary accommodation; it is the highest figure ever. The cost of temporary homes, including bed and breakfast costs, has risen to £1.7 billion a year—which could, of course, be used to promote social housing. Demand from young people aged 16 to 24 for advice on homelessness has increased by 5% in the past year, with 135,000 young people a year accessing homelessness services. Homelessness among all ages rose by 50% between May 2022 and May 2023. We know that the affordable homes programme is not delivering the volume of homes needed. We know that we need more housing that is truly affordable, with rents tied to local income. That means that we need more homes for social rent.
Only the state can provide protection to citizens. A public housing crisis needs public, and not private, solutions. There are some appalling conditions in the private rented sector, which is not properly regulated. There have been record rises in rents—the fastest annual rate now since records started seven years ago. Private rents are up by 5.6%.
I welcome the Renters (Reform) Bill. Section 21 has increased the number of evictions without a reason, and the proposals in the Bill will certainly help. But I am very concerned, as was the noble Lord, Lord Young of Cookham, about the delay in implementation of the ban on Section 21 evictions. How long is that likely to take? I hope that selective licensing schemes will continue to allow local authorities to improve private rented sector properties. I hope that a future Government will amend the Housing Act 2004 to remove the requirement for councils to seek approval for larger selective licensing schemes. I should declare my vice-presidency of the Local Government Association. The problem is that England is too centralised for everything to come to Whitehall for decision.
Finally, I am very pleased by the leasehold and freehold Bill. I think that is generally the view in your Lordships’ House, because it represents a huge step forward. It will make it easier for existing leaseholders to extend their lease or buy their freehold. As the Secretary of State said, the current system is reminiscent of a feudal system, which is against the interests of consumers. There will be many issues to test when the Bill comes before the House; it needs to be part of a major reform of property law. As we have heard from the noble Lord, Lord Truscott, we need better regulation of managing agents, and we must address the need for commonhold in flats.
I look forward in the months ahead to taking on many of these issues to improve the Bills we have, as the noble Lord, Lord Young of Cookham, said.
My Lords, it is a pleasure to follow the noble Lord, Lord Shipley, and I applaud his comments on homelessness and the desperate need for social housing. I thank the Minister for his particularly interesting introduction to today’s debate, with his apparent investment in the themes of today’s subjects. That approach will be very helpful as the Bills come through, and we will achieve a finer, more fruitful result.
In response to the gracious Speech, I want briefly to address the leasehold and freehold Bill and the Renters (Reform) Bill. I shall try to do so without repetition; then, I shall follow with comments on health. I declare my interests as a former chartered surveyor and as the owner of a buy-to-let property, as detailed in the register.
The principal problem for the freehold, leasehold and renters Bills is the inefficiencies and bad practices of landlords and agents, some aspects of which have been cleaned up through Bills that have been through this House, but it is a sector that desperately needs reform. However, interfering with the status quo after generations of evolution is not without difficulties, and those challenges will be met in our forthcoming debate. As the noble Lords, Lord Shipley and Lord Young, have reminded us, commonhold is a very important option, and it should be trumpeted as an objective by the Government. It provides an alternative to the traditional tenure patterns, and we need to focus more carefully on that when the time comes.
Both Bills aim to simplify and introduce fairness into the residential property market, but these Bills alone, as we have heard from so many speakers this afternoon, will not provide more homes. My disappointment with the declared legislative programme is the lack of reference to the promised planning Bill, also referred to today. Current arrangements are not working and are an impediment to housebuilding. The huge Levelling-up and Regeneration Bill that occupied so much of the last Session included planning matters, but no attempt to speed up the process at service delivery level. Planning departments are frequently understaffed and underfunded and experience a high turnover of case officers. Those case officers may change during the progress of a single application, making life extremely difficult for an applicant. The background, detail and relationships that are important to efficient service delivery and outcomes are at stake—and that itself is a brake on new housing numbers.
Housing provision is a crisis that the Government repeatedly promise to resolve, but I see no reference to one of the really very straightforward solutions, in my opinion, which is to develop on brownfield land. This resource of hundreds, perhaps thousands, of acres of sterile land needs money invested in it to bring it forward. However, it is ignored, as the Government appear to continue to favour the quick-fix, green-belt or agricultural land solution for more housing. Why? What a missed opportunity. Brownfield land is substantial in towns and cities throughout the UK. There is infrastructure—public transport, schools, hospitals, roads, everything—already in place; unlike agricultural land, it does not need the extra billions of investment to develop on a wholesale scale.
I turn to health. Like several others, I am disappointed that there was no reference to a mental health Bill. Forty years is a very long time since the last substantial Act and, during that time, understanding, general knowledge and care in the mental health arena has grown hugely, to such an extent that the Mental Health Act is now terribly out of date. We need to improve services in this area, as the numbers suffering are also growing very rapidly, particularly since Covid.
I particularly want to raise the difficulties of care and treatment for those suffering from or living with Huntington’s disease and chorea. The difficulty is within the NHS. This is a neurological condition and often falls between mental health and organic brain disorder. Too often, these labels appear to be mutually exclusive in the context of services provided by the NHS, denying Huntington’s sufferers access to mental health support, when it is desperately needed by those with this condition. The condition has physical, cognitive and psychiatric symptoms, and, without support, mental health issues spiral. In turn, there is a ripple effect on family and carers—frequently, of course, the families are the carers.
Mental health services are supposed to be accessible to all, no matter the root cause of the mental health issue. I hope that the Government will resolve the NHS exclusion for those struggling with this and other neurological conditions—we know of motor neurone disease, Parkinson’s and MS, and there are many others—and thus end the dilemma facing those who suffer, and their families, from exclusion from NHS mental health services. We should be ashamed that the problem of definitions is allowed to become a barrier to treatment and care. The most likely psychiatric disorders that Huntington’s sufferers experience are depression, anxiety, changes in personality and mood, irritability, apathy or disinhibition. How can those within the NHS who analyse medical conditions possibly deny these as mental health criteria?
I thank the Huntington’s Disease Association for its help in preparing my comments. I ask the Minister to ensure that all mental health support services are available, UK wide, to those living with this condition. Through definitions, and perhaps misunderstandings within the NHS, these people are often excluded. That is unforgivable.
The gracious Speech, in my judgment, reflects that at least now we have a Prime Minister who understands economics, who is determined to listen to what the general public, and indeed obviously our own party, wants to happen, and to give leadership. There is no better demonstration—and I admit to being one of those who campaigned hard to keep the ticket offices open, alongside the best part of a million others—than him being brave enough to say, and thank goodness, “Right, they are staying open”. For me, that is the sort of action I expect to see from a Prime Minister. I have had the privilege of serving in the other House for 23 years and in your Lordships’ House for a good few years since, and quite frankly this is the first time, since that fateful date of
I shall speak mainly on housing, but there are three issues on energy that I would like to raise. First, I welcome the fact that we are going to drill in the North Sea, for the future. It is a crucial decision to safeguard our supplies. Secondly, I am following Rolls-Royce’s efforts on mini nuclear reactors. We could have signed a document and had those mini reactors being built now—nobody suggested that it should have an exclusive right to the mini reactor market, but at least we could have got going. But we have not. Will my noble friend on the Front Bench at least try to move this forward, so that we get some decision on mini reactors? They are important. Thirdly, on hydrogen, we all know that Infrastructure UK appeared to be totally anti-hydrogen. We have only to look at our German colleagues. Germany has now got to a state where it believes it can do tests, and that there is a market for a combination of gas and hydrogen for domestic premises. If we think back to the period when we went from coal to LPG for our heating, we see that no wonder it is a big project—it affects the vast majority of homes in the United Kingdom. We know that Germany is doing the work. Imperial College has come out with a report saying that it is going to move things forward, and there are a host of others doing work in that area. I would like to see some support from His Majesty’s Government in that area.
That brings me to housing. It is my privilege to have been in public service for 50 years. I was the first leader of the London Borough of Islington and chairman of its housing committee. I have saved squares in Islington, along with my colleagues. We got rid of the Crumbles, which was a terrible old Victorian tenement block, with not even bathrooms or toilets on the floors—people had to go down to the ground floor. Thanks to the architect in Islington, we built low-level, high-density council housing and encouraged young people to get grants to renovate the infrastructure that they bought. In 1974, I was elected in Northampton, a new town, which I support totally, and I once wrote a pamphlet called The Disaster of Direct Labour. The challenge that every family faces is housing. So many of my colleagues here today have raised the issue, and I certainly believe that it is key to the future.
The Secretary of State produced his vision in his speech of
“The regeneration and renaissance of the hearts of 20 of our most important towns and cities … Building beautiful … Greener homes … A new deal for tenants”— he has this Bill coming forward—
“And extending ownership to a new generation”.
Unfortunately, we have lost the right to buy, so I am not quite sure how we will encourage new generations. It sounds wonderful, but in reality we find the Grenfell problem. Only 9% of those affected have been restored. That is not good progress. It is not helping tenants. Many must be in dire worry about where they are living.
What about tenanted properties? In Bedford and half a dozen other places, there are empty properties all the way down the high street, yet we charge 20% VAT on anybody who wants to renovate them. If we want to renovate those properties, for heaven’s sake let us offer local authorities the option not to have to pay that 20%. I notice that the Secretary of State does not think that Marks & Spencer, as a key retailer in Oxford Street, should be allowed to alter its building, although everybody else accepts that it is a good idea.
The time taken on planning has trebled since 1990, which is not that long ago. No wonder it is taking time to get moving on anything. The Home Builders Federation points out that some of the hardest hit are our smaller builders, who have to grapple with this time dimension. The number of new homes forecast for 2024 is just 120,000—a record low—compared with 204,530 in 2022. With a demand of 340,000—not 300,000—and people wanting their own home, lifetime ISAs needing modifying because they are out of date and the whole population having gone up by 600,000, we now have a real need for 380,000. We have to take action. I hope my noble friends on the Front Bench and those who can make a difference will do so. Two of us in this room know about new towns in particular. Why not have perhaps 50 new garden towns around the United Kingdom, with the benefit of single-family homes at low density, alongside a successful town? That would produce really good homes for the future.
My Lords, I will focus my response to the gracious Speech on mental health, learning disability and autism. I remind the House that I have autistic family members and have had a long career as a psychiatrist.
The recent Royal College of Psychiatrists report Infant and Early Childhood Mental Health: The Case for Action urgently draws to our attention that children under five in the United Kingdom are at risk of suffering from lifelong mental health conditions that could be prevented with the right support and that 50% of mental health conditions arise before the age of 14. Prevention and early intervention are essential, and the truth is that every family in the land is affected in one way or another.
For people of all ages who develop mental illness, the right health and social care must be provided within the right legislative framework. I was a member of the Joint Committee that reported on the urgently needed Draft Mental Health Bill in January. A government response is still awaited. The absence of a mental health Bill will affect so many families.
Last year, 50,000 people—I do not apologise for repeating that: 50,000 people—were detained in hospital under mental health legislation, including more than 2,000 people with a learning disability and autistic people, who were often detained without any therapeutic benefit. Years have been spent working on legislative reform, beginning with the 2018 independent review chaired by Professor Sir Simon Wessely, which was commissioned in part because of rising rates of detention under the Act. New legislation is needed to promote the least restrictive practices and to prioritise good mental health care at home. A key element of the draft Bill was to remove learning disability and autism as reason enough to be detained under Section 3. We are no longer a society that sees a learning disability and/or autism as a problem to be treated or fixed, and our legislation must reflect this change.
We need to see more effective progress against the target in the NHS long-term plan to close half of in-patient beds by March next year for people with learning disabilities and autism. Mencap’s analysis suggests that, at the current rate, this target would not be hit until 2028. Although learning disability admissions and discharges are reducing, the detention of people with autism is going up, which may be due to better awareness and recognition of autism.
We must not lose momentum; it is urgent to reform adult social care and the Mental Health Act. The Government’s building the right support action plan made it abundantly clear that reforming the Mental Health Act was key to reducing the number of autistic people and people with learning disabilities being inappropriately detained in psychiatric hospitals. How do the Government now expect to meet the objectives of the action plan, if the mental health Bill has been shelved?
At the request of the Secretary of State, in 2019 I agreed to chair an oversight panel on long-term segregation for people with a learning disability and autistic people. We finished our work in March this year—I say “finished”, but the work is not finished. There are still about 115 people detained in long-term segregation in in-patient mental health care. Yesterday, a Written Ministerial Statement was published about my report, and I am grateful to the Minister for tabling it. My report is entitled My Heart Breaks—Solitary Confinement in Hospital Has No Therapeutic Benefit for People With a Learning Disability and Autistic People. My letter to the Secretary of State for Health and Social Care and Minister Caulfield’s response were published alongside my report.
Our task was to oversee and report on the effectiveness of a Department of Health programme of independently chaired care, education and treatment reviews. The reviews were for people with learning disabilities and/or autistic people who have been detained in long-term segregation under mental health legislation. We found that it was often social care failings and inadequacies in community mental health that led to admissions. Our recommendations are wide ranging. We suggested that long-term segregation should be named “solitary confinement”, hence the use of that term in the title of my report; that it should be notifiable, which requires changes to CQC regulations; that it should become a never event for children and young people; and that it should be severely curtailed for adults, with stringent standards for accommodation and care. This would require changes to the code of practice to the Mental Health Act, but the urgent changes needed are unlikely to be considered until His Majesty’s Government bring forward a new mental health Bill or at least agree to review the code of practice.
Where is this Government’s commitment to improving the nation’s mental health? The omission of a new mental health Bill is particularly poignant in circumstances where legislation is needed to protect some of the people in the most vulnerable circumstances and where it is being repeatedly sidelined. The strapline of the Royal College of Psychiatrists is:
“No health without public mental health”.
I have tabled a Private Member’s Bill—although I have not seen the result of the ballot—to address some of the recommendations in the oversight panel report, in lieu of a mental health Bill in the Government’s programme of work. If I am unsuccessful, I hope that a Member in the other place will be willing to pick it up. We need urgent clarity on the future of social care reform and a commitment to a funded national workforce plan. Workforce pressures, a cost of living crisis, the Covid-19 pandemic and escalating waiting times are increasing the demand for mental health support. There has never been a more urgent time to reform mental health care.
The Minister began his speech today by saying that mental health and parity of esteem with physical health are priorities. This needs to include public mental health as well. I see no sign of that commitment. I hope that the Minister will at least commit to looking at the code of practice for the Mental Health Act so that some urgent changes can be implemented, including some of the recommendations from my report.
My Lords, it has been a pleasure to listen to so many eloquent, insightful and passionate contributions in this debate on the gracious Speech. I rise to speak in favour of the Government’s leasehold and freehold reform Bill, which represents a crucial step in eliminating the opaque management fees, exploitative ground rents and short leases associated with leasehold tenure. Many noble Lords and Members in the other place have campaigned on this for many years. I pay particular tribute to my noble friend Lord Young, the noble Earl, Lord Lytton, and the noble Lord, Lord Kennedy, for their tireless advocacy.
In moving the Motion for an humble Address, my noble friend Lord McInnes pointed out that leasehold reform was first announced in 1952 and that too little has happened in the intervening years. My daughter, who is pretty apolitical, announced that she would vote for any party that finally ended the unfairness of leaseholds; I am pleased that we are possibly giving her a reason to vote Conservative.
We say that an Englishman’s home is his castle, but that is sadly not the case for the owners of more than 5 million homes across England and Wales that languish under leasehold covenants. Some examples of exorbitant charges include: a £60 consent fee for replacing a doorbell; a £360 charge for a new doormat; and, unforgivably, a £250 consent fee to have a pet dog. The leasehold system has been described as feudal, but such mercenary practices would give even the Sheriff of Nottingham a run for his money.
This has been a long debate and several noble Lords have already spoken on these points, so I will restrict my comments to three important reforms in this Bill. The first concerns service charges and management fees. The Bill will bring such opaque fees into the light by requiring transparent, standardised service charges. This will end exploitative practices, such as charging a 50% commission on buildings insurance, and will prevent management companies treating service charges as profit-making schemes.
Secondly, I turn to ground rents. In the past decade, developers of new-build homes have sold leaseholds to unsuspecting customers, promising low ground rents while auctioning the freehold to investors. These investors can then exploit the new home owners with unfair and opaque service charges, as well as charging them a fortune to rectify the situation. This Government have already legislated to cap all new ground rents at a peppercorn rent; this Bill takes the next step. In England and Wales, all new houses will be freehold. This will ultimately sound the death knell for leasehold houses and put an end to sharp practices by predatory developers and investors.
Thirdly, on short leases, ending the creation of leasehold houses is welcome but will do nothing for existing leaseholders. Currently, leaseholders have a right to extend their tenure by 90 years, but that is perilously close to the 80-year cut-off where people face exorbitant marriage value costs to secure their home. This has been tolerated by the housing system for too long, so I welcome confirmation that the Bill will abolish marriage value. This Bill will increase the standard lease extension tenfold, from 90 to 990 years, and will remove the requirement for two years’ ownership from eligibility for lease extensions. These are all welcome changes, but they beg the question as to why the Government do not simply finish the business and abolish the leasehold system entirely.
On that note, I turn to the main area of weakness in the Bill. Of the 5 million leasehold properties in the UK, 70% are flats. I am disappointed that this Bill neither stops the creation of new leasehold flats nor sets out a path out of leaseholding for existing flats. There is an alternative system, as many noble Lords have pointed out, which is commonhold. Unlike leasehold, with commonhold there is no limited tenure and no requirement for a third-party overseer, while the home owners have total control over the management and administration costs. In 2021, the then Secretary of State committed that the legislation was the beginning of even more fundamental change to English property law through the widespread introduction of the commonhold tenure.
Despite the commonhold model being widespread in Scotland—they abolished their feudal rent and feu duties in 2004—we have only 20 commonhold developments. The Law Commission’s 2020 report into commonhold states that it is the preferred alternative to leasehold. I would therefore have welcomed a commitment by the Government, by the Minister, to restate that we are moving towards the commonhold tenure system and to implement the Law Commission’s recommendations in full. Is that indeed the Government’s final intention?
The debate today also encompasses public services. Like many people, I have been dismayed by the accounts of the growing debacle of HS2. It is a sorry story of poor planning, mismanagement and overspending. I read that the Cabinet Secretary had received a request from a senior government adviser for an investigation into the Permanent Secretary at the Department for Transport over the mismanagement of this project. Astonishingly, it is alleged that he forwarded the request directly to the Permanent Secretary for a response. I cannot verify whether such an account is correct, but the root cause of this debacle is a lack of accountability, which is felt through our increasing inability to get the basics of public services right or to build large infrastructure products on time or on budget. My noble friend Lord Maude recently—well, actually, a while ago—completed his review into the governance and accountability of the Civil Service. We look forward to the recommendations with keen anticipation, and I hope that the Government will not delay its publication any longer.
My Lords, it has been a really interesting, wide-ranging and well-informed debate. I hope Ministers have been listening carefully, because they have been given plenty of ideas, freely given, for them to take up and introduce as part of their bid to create a better Britain—or whatever the phrase is. What has become crystal clear during this debate is the disappointment expressed by many at the paucity of the Government’s ambition. The Government have run out of energy and ideas, but what has not diminished is the scale of the challenges facing people who are delivering vital public services. For people who are waiting for an operation, waiting for years on the housing list or waiting for a GP appointment, these challenges have direct and personal consequences. The failure of the Government to show some understanding of the situation many people face by addressing the immediate issues they are facing in the gracious Speech is leading so many to complete despair.
As my noble friend Lady Barker said, there is not a strategy in sight in this gracious Speech. As the right reverend Prelate the Bishop of Gloucester said, where is the long-term vision that is promised? That leads me to the NHS. We are all now going to remember the wonderful image provided by my noble friend Lord Allan of the Government in the driving seat of the NHS car. It is veering across all the lanes, doing many U-turns, running out of fuel and failing to reach its destination. It is memorable, but what is sad is that it resonates so much to so many: that that is where we are with our National Health Service.
On the long-promised reform to the Mental Health Act, I had not realised it was 40 years since the previous Mental Health Act was passed. That has raised concerns across the House, including by my noble friends Lady Tyler, Lady Walmsley and Lady Burt—all my noble friends and many others as well. There does not seem to have been any justification for not introducing that in the gracious Speech. There is cross-party support and consensus has been arrived at, so where is the Bill? It will be genuinely important for us all to hear why the Government have chosen not to include it in their programme for government.
My noble friend Lady Barker made the very important point about data sharing across the health service, local government, social care and children’s social services; I hope the Minister will respond to that query.
There is growing pressure on primary care, which some Members have raised. We know that there is a grave recruitment struggle for general practitioners, which obviously has a consequential impact on hospital care. We have the long-term workforce plan for the NHS, but we also need some short-term change to fill the gap until we reap the benefits of it. Meanwhile, people across the country are not able to get a GP appointment when they need one. My noble friend Lady Harris spoke eloquently—as did the noble Baroness, Lady Bull—about long Covid and the impact it is having on many people across the country. The Government perhaps need to give more attention to dealing with that.
I was pleased that my noble friend Lord Shipley raised dentistry and the failure of many families to find NHS dental care. It is shameful that some communities where I live rely on a third-world charity called Dentaid to access free dental care. Perhaps we all ought to be ashamed that this is the case in the seventh richest country in the world, so I am really pleased that my noble friend drew attention to that.
My noble friends Lady Burt and Lady Barker and the right reverend Prelate the Bishop of London all raised the issue of the Bill to ban conversion therapy: where is it? I will leave it at that because it is very important for a section of our society, and for some of us who have a commitment to equality across all our communities. I repeat, where is it?
One area that received good support across the House was the plan to reduce the availability of tobacco and to ban vapes for children. My noble friends Lord Rennard and Lady Walmsley, who have been constant campaigners on this issue, have spoken for us all. We are going to welcome it because we believe in cutting disease and early death. There is a green light for it. I will reflect what the noble Baroness, Lady Jay, said about the 26% cut to the public health grant. Without public health you cannot reduce health inequalities, which was raised by the right reverend Prelate the Bishop of London.
This brings me to adult social care. Reform has been promised and promised, but where is it? Too many families tell me that they are struggling to find appropriate home or residential care, particularly for those suffering from dementia. Somebody has to grasp this issue. There is not enough funding going into it and it is causing councils to teeter on the brink of bankruptcy. We are asking council tax payers to pay into this social care premium. In my council area, people are paying an average £200 a year extra on their council tax for adult social care that is not being reformed. That is disgraceful and needs to change.
I will say a word on local government finance, which is important and I hope will be addressed in the Autumn Statement. Today, another major council is on the brink of issuing a Section 114 notice of impending bankruptcy. Without local government to deliver public services locally, we are all bereft. My noble friends Lord Wallace of Saltaire and Lord Shipley both pointed to the importance of local democracy and the need to shake off the shackles of central control to allow it to flourish and do what it does best.
That brings me to housing. We are all glad that tents have not been banned, but we are not happy about everything in the Renters (Reform) Bill. Although the Bill is good, it is not good that Section 21 evictions are not being ended and banned straight away and will still be hanging over private sector tenancies.
The noble Lord, Lord Best, was right to talk about the housing crisis, as we did all through the debates on the levelling-up Bill and we are still having to deal with it. I agree with the noble Lord, Lord Young of Cookham, that it is about time the local housing allowance is thawed and raised, so that people do not have to sub the cost of their rent from meagre benefits.
The leasehold reform Bill gets a muted welcome from me, because it does not deal with the abolition of leasehold for flats. Without that, we cannot deal with the other big issues that are raised in that potential Bill about the Building Safety Act, which is unfinished business.
It has been a really good debate. It is a pity that the Government’s programme is not as good as the debate we have heard.
My Lords, it is a great honour to be closing this important debate on behalf of His Majesty’s Opposition. This is a new chapter for our sovereign and our country and, with it, His Majesty brings the optimism and sureness that we need in these times of division and instability—both in people’s lives and across the world.
The Coronation was a visible illustration of the King’s determination to mark his reign as one celebrating the strength of our multifaith nation. For me, it was the greatest honour to make history by being a part of the ceremony, representing the Jewish community, alongside the noble Lords, Lord Patel, Lord Kamall and Lord Singh, who represented other faiths.
In declaring my interests in the register that relate to the Jewish community and in turning to the gracious Speech, I say how warmly I appreciated the acknowledgement of anti-Semitism and the need to remember the horrors of the Holocaust. Recognition of the barbaric acts of terrorism against the people of Israel exactly one month before the gracious Speech, the facilitation of humanitarian support into Gaza and support for the cause of peace and stability in the Middle East all sent a clear and welcome message.
The areas for debate across the days are crying out for the
“competence, optimism, confidence and vision,”—[
I would like to focus on the health and social care aspects of the gracious Speech. Let me start with something we can receive well. From these Benches, we look forward to the passage of the tobacco and vapes Bill, although at present it seems that the Government still do not know how to tackle vaping. We are sleepwalking into a new generation of young people being hooked on nicotine through vaping, when the Government should have been coming down hard on the industry, starting with banning the branding, advertising and marketing of vapes to children, actions to which Labour has committed. It is worth reminding ourselves that an amendment to the Health and Care Bill in 2021 that proposed getting the ball rolling in this way was voted down.
Professor Sir Chris Whitty has put it very well:
“The key points about vaping … can be easily summarised. If you smoke, vaping is much safer; if you don’t smoke, don’t vape; marketing vapes to children is utterly unacceptable.”
Reports not so long ago suggested that the Government were considering an outright ban, but now they are exploring and consulting on options. I look forward to hearing from the Minister about when we can expect a clear plan from the Government.
I turn to just some of the glaring omissions from the gracious Speech. The NHS workforce plan, on which the gracious Speech leant heavily, has failed to consider social care, even though the two services are inextricably linked. Social care reform needs to be system-wide, long term and joined up around the needs of those being cared for, so that comprehensive and integrated care at home and in the community can be properly provided. But when will we receive a plan to do this? After all, as the noble Lord, Lord Young, remarked, does social care not come into the Government’s category of necessary long-term decisions?
In all this, the role of paid and unpaid carers is crucial, as is that of charities, as highlighted by my noble friend Lord Touhig. So where was the long-term social care workforce plan to overcome the severe staff shortages in the care sector? I venture to suggest that Labour’s new deal for care workers could be an essential first step in tackling the staffing crisis. It will be the first ever fair pay agreement collectively negotiated across the sector.
The gracious Speech could have addressed retention and the issues that contribute to high attrition rates across the NHS workforce, but it did not. I am concerned that this is at a time when a recent NHS survey reports that nearly one-third of staff often think about leaving their job, while the workforce plan also fails to address the maintenance and building backlogs that bedevil the ability to have enough physical capacity with which to deliver services. I note that my noble friends Lady Blower and Lady Wilcox made similar comments about inadequate retention and recruitment plans for teachers, another significant staffing group who are crucial to success.
The Government have promised to deliver their plan to cut waiting lists. But where is the actual plan? We on these Benches stand ready with a commitment to provide 2 million more appointments by paying staff extra to work evenings and weekends, which will be paid for by abolishing the non-dom tax status. Is that something the Government would consider doing? If so, we would be pleased to have provided the inspiration.
Instead, what we have is regressive legislation in the form of the Strikes (Minimum Services Levels) Act. It seems that the Government’s answer to the shortage of doctors and nurses is to sack NHS staff. They say they want minimum service levels on strike days, but what is their plan to provide minimum service levels on non-strike days? Had Ministers not spent months refusing to negotiate with NHS staff, there might not have been more than 1 million operations and appointments cancelled due to strike action this year, and NHS England would not be asking for £1 billion extra from the Treasury. We all want minimum standards of service and staffing, but it is this Government who consistently fail to provide them.
It is significant that so many noble Lords, including the noble Baroness, Lady Hollins, have criticised the absence of a Bill to provide the desperately needed reform of the outdated, untrusted and discriminatory 1983 Mental Health Act. As the noble Baroness, Lady Watkins, so aptly observed, this Bill has been on a wating list for 40 years. Since the Government published, in 2018, the findings of their own commissioned review, more than 200,000 people have been detained under the Act—many inappropriately, including those with autism and learning difficulties—and more than 20,000 people have been subjected to a community treatment order.
A White Paper responding to the review was published in 2021. Last year a draft Bill was published, and pre-legislative scrutiny got under way. A huge amount of valuable and informed cross-party work has been undertaken, with wide consultation among stakeholders. The failure to bring forward those long overdue reforms, including changes to the criteria for detaining patients, is letting down our most vulnerable. This cannot continue.
Health and social care is not the only area of omission. In the gracious Speech there is no legislation to build the homes we need or the education system that people of all ages need, or to tackle the increasing level of persistent absenteeism in schools—which was noted by the noble Baronesses, Lady Gohir and Lady Bull, and many other noble Lords.
There were two general themes underlying the debate today, about which many noble Lords have spoken, and on which I shall conclude my remarks. First, inequalities run ever deeper across our society, whether we look at maternity care, life expectancy, the quality of health throughout life, or detention on mental health grounds. As the noble Lord, Lord Best, said, there are also inequalities in housing availability, affordability and quality. We are seeing an increasing divide on the basis of social determinants, of which the right reverend Prelate the Bishop of London spoke, whether they be because of race or colour, or where people live, their income, their education and/or their start in life.
Secondly, as my noble friend Lady Jay said, one Bill a strategy does not make. The gracious Speech provides a disconnected programme, with no strategy to address the deep-rooted fractures in people’s lives to which my noble friend Lord Howarth referred.
I listened closely to the right reverend Prelate the Bishop of Gloucester, who spoke of the very real impact of disjointed government on victims, families and communities. What a missed opportunity this gracious Speech has been. I can only hope that the next gracious Speech will be different and will grasp every opportunity for change.
My Lords, I start by echoing the opening comments made by the noble Baroness, Lady Merron. It is a great honour for me as well to close this debate on His Majesty’s gracious Speech. I also take this opportunity to echo her points, and the points made by other Peers, on anti-Semitism. It was an important point that she made, and we are all very aware of what is going on in that particular area. I also thank noble Lords for their very valuable contributions and thank my noble friend Lord Markham for opening this important debate with, if I may say so, his very personal approach. As the noble Baroness, Lady Donaghy, pointed out, he did indeed hit the right note.
I am very aware that I am speaking at the end of an extraordinary day—an extraordinarily sad, sombre and emotional day, as we continue to remember the late noble and learned Lord, Lord Judge. Despite his huge loss, as we have seen this afternoon, this House sails on, and there have been a great number of varied and eloquent remarks made, covering at least four departments—so I have a lot of work to do. As noble Lords might expect, there will be a long letter coming, because I suspect I will not be able to cover everything.
My noble friend Lord Markham and I are aware of the plethora of health-related questions that have been raised this afternoon, all thoroughly relevant and important, ranging from end-of-life care, osteoporosis, long Covid, autism, dentistry, smoking—which I will touch on later—and conversion therapy. I will take this opportunity to congratulate the noble Baroness, Lady Burt, on securing her Private Member’s Bill. That is hot off the press for me, so I am sure we will be happy to engage with her on that particular Bill.
On rather a different note, I want to pick up on what my noble friend Lady Verma said. She devoted her speech to a most important subject: hate in schools. She is absolutely right that every child must be able to go to a school where there is always 100% respect for every individual in the school, but also within that community. That includes pupils and teachers. I will indeed pass her points on to the Department for Education, with my own endorsement and, I am sure, the endorsement of the rest of the House. This chimes with the comments made by the right reverend Prelate the Bishop of Gloucester. I listened carefully to her points, which admittedly were linked to prisons but did focus on the very important subject of communities.
At the heart of the gracious Speech—here I might have been lucky, but was not in the end, to have some words from the noble Baroness, Lady Pinnock, but here goes—are long-term decisions that will deliver a brighter future for millions of people around the country, whether by providing greater security for home owners and tenants, getting people the care they need more quickly, protecting the health of future generations and ensuring that every young person has the education they need to succeed, or strengthening society by ensuring that public bodies are focused on delivering for the communities they serve.
I will just go straight in and talk about housing, which was one of the key themes this afternoon. Whether you are a home owner, private renter or social tenant, as a result of actions already taken, more people are benefiting from a secure and decent home. But, as has been pointed out this afternoon, there is more to do. I am acutely aware of comments made by Peers such as the noble Lords, Lord Howarth and Lord Best. The gracious Speech builds on our progress to make the leasehold system fairer and ensure that home ownership is a more affordable reality, while also delivering a new deal for the private rented sector. Banning the sale of new leasehold houses, for example, will help to restore true home ownership, meaning that, other than in exceptional circumstances, every new house in England and Wales will be freehold from the outset.
That brings me to questions that were raised by my noble friend Lord Young of Cookham and a question raised by my noble friend Lady Finn who asked about leasehold reforms and noted that commonhold should be the default for new build. We think the best way forward is to help leaseholders by making existing leases fairer and more affordable. A rapid transition from leasehold to commonhold will not work for everyone, and we are not going to force uncertainty on to people. The Bill delivers what leaseholders need, which is true home ownership experience. We are making it cheaper and easier for leaseholders to purchase the freehold of their building or a long 990-year lease on their property. We are also empowering leaseholders who will be able to buy out their ground rents and take control of their building’s management from the freeholder so that they have greater control of their property, including management fees, as raised by my noble friend Lady Finn.
Through our Renters (Reform) Bill, abolishing no-fault evictions will also give tenants much more security while delivering a fairer deal for responsible landlords, who deserve to know that their rights are protected and their investments are safe. Questions were raised by the noble Lords, Lord Best and Lord Thurlow, and were touched on by my noble friend Lord Naseby. They were concerned that there was no long-term planning for housing. I hope I can reassure the House that we do indeed have a long-term plan for housing because the Government have committed to a new era of regeneration and housing delivery across England with transformational plans to supply safe and decent homes in partnership with local communities. Some £800 million will be allocated from the brownfield, infrastructure and land fund to unlock new homes on brownfield sites. We are also funding Homes England with £550 million and providing investment of £150 million to Greater Manchester and the same to the West Midlands. Additional reforms to the planning system will speed up new developments, put power in the hands of local communities and unlock planning decisions.
I want to pick up on some comments made about homelessness, which I know is a subject close to the heart of the noble Lord, Lord Bird, and which was also raised by the noble Baroness, Lady Twycross, earlier in the debate. We are determined to end rough sleeping and prevent people ending up on the streets in the first place. That is why last year we published our strategy to end rough sleeping for good and have already made an unprecedented £2 billion-worth commitment over three years to accelerate these efforts. This includes more specialist accommodation to make sure people have a route off the streets, including 6,000 move-on homes, through the rough sleeping accommodation programme, which is the biggest-ever investment in housing for people sleeping rough. I am sure the noble Lord, Lord Bird, knows about those statistics.
A point was made by my noble friend Lord Young of Cookham and the noble Lord, Lord Carrington, about cross-departmental work in the area of renters reform. I will just give a very short answer to that. We are very clear we need to proceed at pace with our court improvements, so we are working very closely with the MoJ to make sure that both landlords and tenants can benefit as quickly as possible. However, we are ensuring that an improved court system meets the needs of users and has been thoroughly tested prior to launch. We are also very aware of the overloading of the justice system, and that is something we are certainly working through. If it is any consolation, landlords will need to go through the courts in only a small minority of cases where a tenant does not leave at the end of the notice period.
Moving on now to health and social care services, which is another major theme for this afternoon, the gracious Speech underlines the Government’s commitment to ensuring that people can access the care that they need as well as taking the long-term decisions that will support and protect the NHS for the future. In meeting immediate challenges, we are providing record levels of funding to help the NHS continue to recover from the pressures caused by the pandemic, also a subject raised this afternoon, and to support the NHS through this winter. Last year, we virtually eliminated long waits of two years or more for elective procedures and by June this year waits of more than 78 weeks.
The right reverend Prelate the Bishop of London, who is not in her place, raised the subject of minimum service levels, and I think it was touched upon by other Peers. Our top priority is to protect the life and health of patients and the public. The aim is to keep patients safe, give the public much-needed assurance that vital health services can continue through strike action and ensure that emergency, urgent and essential care are there when patients need them most.
It is for employers to decide what, if any, disciplinary action is taken if workers choose to strike when they are expected to work in order to provide a minimum service level. We hope that employers will be fair and reasonable and take this sort of action only where it is really necessary.
To further reduce pressures, through our primary care recovery plan we are making it easier to see a GP. We are investing an additional £600 million this year and £1 billion next year to reduce delays in discharging patients who would receive better health outcomes outside hospital. Through the first ever comprehensive NHS long-term workforce plan, we are putting staffing on a sustainable footing, ramping up the number of training places for doctors, GPs, nurses and dentists.
I will pick up on a number of perhaps rather negative comments that the noble Lord, Lord Allan, made, supported by the noble Baroness, Lady Pinnock. I think the noble Lord used a number of driving analogies—basically saying that he was concerned about the long-term workforce plan and that it did not nearly go far enough. Perhaps I can give some sort of reassurance to him. The long-term plan for the NHS workforce is the first of its kind in the history of the NHS—so I would argue that it is a brand new, quality car.
The 15-year plan developed by the NHS will put the NHS workforce on a sustainable footing for the long term. The Government are backing the plan with over £2.4 billion over the next five years to fund additional education and training places. Taken with retention measures, the NHS plan could mean that the health service has 60,000 extra doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036-37—which I admit seems rather a long way off.
Through the tobacco and vapes Bill, by effectively ensuring that anyone turning 14 or younger this year will never legally be sold tobacco, we will protect future generations from the harms of smoking and reduce future demand on the NHS. There has been—I think it is fair to say I am on safer ground with this—a general welcome for this. I appreciate the comments from the House, with a very personal speech from the noble Lord, Lord Rennard. This was also spoken to by the noble Baroness, Lady Walmsley, and the right reverend Prelate the Bishop of Gloucester. This Bill will also tackle vaping among young people by taking measures currently under consultation, which was mentioned, to reduce the appeal and availability of vapes.
I move on to tackle some points raised by a number of Peers—I am going on a different track here—on the mental health Bill. This was raised by the noble Baronesses, Lady Twycross, Lady Watkins and Lady Bull, the noble Lord, Lord Thurlow, and others. I am aware of the strength of feeling on this. I recognise the disappointment that the mental health Bill was not included in the King’s Speech. I reassure noble Lords that the Government are committed to seeing that mental health is treated on par with physical health. I recognise the time and effort dedicated by the Joint Committee on the draft Bill. We are reviewing its pre-legislative scrutiny report and we will respond to it in due course.
In the meantime, the Government will continue to take forward non-legislative commitments to improve the care and treatment of people detained under the Act. This includes continuing to pilot models of culturally appropriate advocacy, providing tailored support to hundreds of people from ethnic minorities to better understand their rights when they are detained under the MHA. We also show our commitment through the historic levels of investment in NHS mental health services and will invest at least £2.3 billion more funding by March 2024, allowing an extra 2 million people to benefit.
The sharing of data was raised by the noble Baroness, Lady Barker, and my noble friend Lady Browning. Again, to give some reassurance, in June 2022 we published Data Saves Lives, our data strategy for health and social care. We are committed to demonstrating that the health and social care system is a trustworthy data custodian. One of the ways we will do this is by increasing levels of transparency about how data is used, both for individual care and for improving population health, planning, innovation and research. Our strategy set out plans for a transparency hub, the beginnings of which are now live on NHS.UK. We are currently developing phase 1 of a transparency statement for publication in the autumn and winter. This will be followed by a series of large-scale engagement events from 2024 with members of the public.
A number of Peers raised points to do with funding for social care, not least the noble Lords, Lord Allan and Lord Howarth, and my noble friend Lord Young. The Government are delivering a significant reform programme to make progress towards our 10-year vision for adult social care, backed by up to £700 million of investment. We are supporting workforce development, sector digitisation and innovation, and helping people to remain independent at home. The Autumn Statement includes £1 billion of new grant funding in 2023-24 and £1.7 billion in 2024-25, as well as £1.3 billion leading on into the next three years, made available through the social care grant and further flexibility for local authorities on council tax.
Sustained government investment has helped local authorities steadily increase their spending on adult social care, which reached £21.4 billion in 2021-22. This is an average increase of 2.5% per year in real terms between 2014-15 and 2021-22. We are also improving care workers’ skills and supporting career progression, investing in technology and digitisation and adapting people’s homes to allow them to live independently. We have always acknowledged that our reforms will not solve all problems in social care, but they are a significant step in moving us towards a new vision that the whole of government is committed to.
I will touch briefly on osteoporosis, which was raised by my noble friend Lord Lexden, the noble Baroness, Lady Donaghy, and others. Services for those with musculoskeletal conditions, including osteoporosis, are commissioned locally by ICBs, which are best placed to plan and provide services in line with local priorities and funding. NHS England’s Getting It Right First Time programme has a workstream on MSK help, and there are ongoing assessments of the accessibility of fracture liaison services, using data captured in the national falls and fragility fracture audit programme. These will help to reduce inequities in provision. I hope that gives a short answer to that.
My noble friend Lady Cumberlege and the noble Baroness, Lady Walmsley, raised infected blood, on which I will write to the House. Briefly, we will act swiftly in response to the final report of the infected blood inquiry, following the interim payments we have already made. The use of infected blood and blood products was an appalling tragedy and a dreadful failure.
Just as we are protecting the next generation’s health, so too are we ensuring that today’s young people gain the knowledge and skills required to succeed in tomorrow’s world of work and beyond—so I now turn to the education measures in the gracious Speech. Over the past decade, this Government have made significant improvements. Our nine and 10 year-olds are the best in the western world at reading, and the performance of 15 year-olds in England in reading, maths and science is significantly higher than the OECD average.
However, we must do more to ensure that our post-16 approach is more ambitious and internationally competitive in its breadth and depth. By introducing a new advanced British standard—ABS—for 16 to 19 year-olds, we will establish a world-class system that places equal value on technical and academic knowledge and skills by combining the best of A-levels and T-levels into a single qualification.
The noble Lord, Lord Aberdare, the noble Baroness, Lady Wilcox, and my noble friend Lord Lexden asked how we would deliver the scale of reform. Perhaps I can reassure the House that this is a long-term reform, and A-levels and T-levels will remain until it is fully rolled out. We are retaining apprenticeships as the gold standard for young people who want to move straight into on-the-job training. It will need careful development in partnership with students, teachers, leaders, schools, colleges, universities and employers, as well as the public. As mentioned by my noble friend Lord Markham, we will consult extensively and in detail over the coming months on the design of the new qualification, informing a White Paper next year setting out our plan for delivery, accompanied by a programme of stakeholder engagement.
The noble Lord, Lord Aberdare, touched on careers and made important points; I know that he speaks frequently on this subject. We will publish a strategic action plan for careers in 2024. It will be based around the three priorities of a single, unified careers system; skills, training and work experience; and social justice.
School attendance was another theme raised, not least by the noble Baronesses, Lady Watkins and Lady Wilcox. The Government are rightly focused on helping pupils attend school. We have expanded attendance hubs across 800 schools, benefiting over 400,000 pupils. A wealth of wider activity also supports attendance, including £5 billion of investment in education recovery.
I can see that time is marching on quickly. I wanted to focus on my own department, the DWP, which was not raised too much today. If I may, I shall include that in a letter, in which I shall be very pleased to cover many of the points raised in respect of other departments.
Before closing, I remind noble Lords that I will write a letter, which will be quite a long one, on all the points that were not answered by me today; conversion therapy springs to mind.
As His Majesty’s gracious Speech demonstrates, this Government are committed to delivering on the issues that really matter to the people of the United Kingdom, improving lives, prospects and opportunities, and strengthening society in every part of the country now and in the future.
Debate adjourned until Monday 13 November.
House adjourned at 6.36 pm.