Grand Committee
Arrangement of Business
The Deputy Chairman of Committees (Lord Haskel) (Lab)
My Lords, if there is a Division in the Chamber while we are sitting, this Committee will adjourn as soon as the Division Bells are rung and resume after 10 minutes. Does the noble Lord, Lord Evans of Rainow, wish to make a statement?
Lord Evans of Rainow (Con)
My Lords, for those noble Lords who were not at Question Time, I should say that the noble Lords, Lord Kennedy and Lord True, reminded the House of the time limits in speeches, so I also respectfully remind those participating here today of that. In this debate, the noble Lord, Lord German, has 10 minutes, the Minister has 12 minutes, and I am afraid the rest of you have four minutes, so please try to keep to the time.
Refugee Integration
Lord German
To ask His Majesty’s Government what assessment they have made of the current pathways for newly recognised refugees to integrate and establish themselves in the United Kingdom.
Lord German (LD)
First, I thank all those who have put their names down to speak in this short debate and cover an area that is somewhat neglected but of great importance to all of us. This debate is about people who have the legal right to be in the United Kingdom: people whom our Government have decided require our protection. No matter how they arrived or which country they are from, they should all receive the support they require to establish themselves in the United Kingdom. It is in the interests of the United Kingdom as a whole that we harness the skills and talents of our new residents; it is also our duty as serious members of the international community to give refugees every chance to flourish, as they have suffered persecution and fled their homelands.
Refugees are a wide-ranging cohort: professionals; academic; medics; engineers; university students; men; women; children and young people. There will be those without schooling in their home country, those suffering physical and mental ill-health from the impact of trauma they have experienced, those with years of work experience, those starting out in the world of work, those with digital skills and those without, and adults caring for family members. Support therefore needs to reflect this range of needs.
The ability for refugees to establish themselves and flourish in the United Kingdom is crucial to their well-being and future prospects and those of their families, and to the strength of our communities. It is also crucial that they can begin swiftly to contribute to the economy of our country. This is in their interest but, crucially, it is also in our interest. As recent arrivals to the United Kingdom, they require support to thrive as we all would if we were attempting to navigate life in a new country. The support they require reflects the huge range of refugee profiles. Refugees are often resourceful, entrepreneurial, skilled and resilient. They want to be self-sufficient and to make a good life for themselves in the safety that the United Kingdom offers. I was pleased that, at the Global Refugee Forum in Geneva last month, Foreign Office Minister Andrew Mitchell committed to:
“Continued support around the integration of refugees in the United Kingdom".
What is the reality of the current situation? In 2019, an Oxford University study found that 84% of refugees reported that they did not have sufficient English language ability to get a job. The study found that refugees in the United Kingdom are four times more likely to be unemployed than people born here and earn about half the amount per week that UK nationals do on average. This is despite high levels of qualifications and skills: about half of all refugees have a qualification equivalent to a UK A-level and above. For example, 38% of refugees from Syria living in the United Kingdom have a university degree.
Non-EU migrants moving to the UK seeking asylum have a higher unemployment rate and a lower employment rate than other migrants. Differences in health status, especially mental ill-health brought on by trauma, are probably one of the dominant factors that explain these differences. Asylum seekers and migrants who are employees earn less and work fewer hours than UK-born workers and other migrants. Among those who are in employment, refugee migrants are more likely to be in self-employment than UK-born people and other migrants.
Last week I visited ACH in Bristol, a refugee-led support body. I discovered that, on average, it takes nine months for a refugee to obtain employment after they receive their refugee status. Clearly, that time gap needs to be shortened as best we can. We need to address the underemployment of refugees and the fact that they find it very difficult to access work that matches their skills, qualifications and work experience. Refugee talent is being wasted and, as a result, the UK is losing out. Refugee employment support needs an element of long-term progression, not ceasing at the first job that these people get in the United Kingdom. This must be reflected in language and training support that can fit around work hours.
The current provision that we have in this country falls into three broad areas. First, there is signposting from migrant support and help from third-sector organisations such as the Refugee Employment Network, and small loans are made available for short-term needs. Secondly, we have the Refugee Employability Programme, which started in September 2023 and lasts two years so it is difficult to know what its outcome will be. However, it does not include housing support, and only one of the contractors is in the third sector. I hope that the Government have learned the lesson from the now scrapped rehabilitation of offenders scheme, where they put large private sector companies in place and then had to remove them and scrap the whole system because it could not deliver locally through local partners. What efforts is the Refugee Employability Programme making to match business needs and the skills deficit in the workforce with refugee skills? Why does the programme not include a housing element, as was the case with the refugee transition outcomes fund? What lessons are being learned from Operation Warm Welcome’s attempt to connect employers with refugees?
The third area is the refugee transition outcomes fund that I just mentioned, a pilot fund which finishes in March 2024, having started in 2022. It was focused on jobs and training but also included housing and integration support. In replying, will the Minister provide us with more information on the lessons learned from this programme? Will it now be rolled out across the country? Will it be seen as an addition to or expansion of the Refugee Employability Programme?
Accessible English language training is key to refugee integration. What plans do the Government have to increase availability of English language classes to ensure that they are accessible around work and caring responsibilities? The STEP Ukraine programme provided a strong model for making that happen.
In the Chamber on 18 December, a Home Office Minister—the noble Lord, Lord Sharpe—was asked about the current challenges for refugees in moving from asylum support to mainstream support once they get their legal status. He said that
“most of the people we are talking about have been in this country for a very long time, and one would hope that they at least had some English”.—[Official Report, 18/12/23; col. 2039.]
We cannot live on hope; we need intent to solve this issue. At the very least, we must not produce policy which effectively makes it harder for refugees to progress in the United Kingdom once they get legal status.
My visit to Bristol last week demonstrated how difficult it is to manage these top issues of finding a home, language training and a pathway to work. The competition for rented accommodation is huge, and landlords will often take the easier route of agreeing a tenant who does not have the need for background checks on status. Language training was available from local colleges, but the waiting lists to get on them are very long indeed. Consequently, the jobs that people found provided no progression route to match their skills and qualifications.
Thankfully, there is a wealth of good practice to build on. I was pleased to hear of ACH’s new programme, working with the regional hospitality sector to provide jobs with progression opportunities. I must tell noble Lords that I was even more pleased to meet Nesrin, a former refugee who now has a successful catering business, Nessi Cuisine—I recommend it. We need a national refugee integration policy framework to help to integrate refugees and reap the benefit of their contribution to our society and our economy, a framework with a focus on the needs of this cohort. Such a policy must be delivered locally, bringing together the full range of providers—business owners, language training providers, local jobcentres, community developers, landlords, local authorities—as well as the refugees themselves. No one size will fit all, but a non-silo policy solution with funding streams attached would meet the diverse needs of tailor-made provision.
My major ask of the Government today is whether they accept the need for a policy framework, negotiated with Wales and Scotland—they also have major powers in this space—and that will stand the test of time. If so, what would that look like? It is in all our interests that we improve the journey to integration and that we celebrate the contribution that refugees can and do make to our communities and to our economy. It would be foolish not to do so.
Lord Jackson of Peterborough (Con)
My Lords, I welcome this debate. There is a temptation, when focusing on specific granular issues such as housing and benefits, to ignore the wider context, which is whether we, as legislators, are discharging our obligations and duties to all British citizens to protect our borders and safeguard our people.
No one voted for record levels of unassimilated, irregular immigration or mass controlled immigration, and no one voted for this House to seek to frustrate the Government’s mandate to properly limit and control immigration. No one voted for a foreign legal entity to undermine our sovereign Parliament in so doing. Our asylum and immigration system is a shambolic mess and an embarrassment—and a costly one, at that. I urge noble Lords to look at Iain Martin’s column in the Times this morning about the human consequences of the mistakes that are being made. The international legal regime is outdated and in need of urgent review, as the Foreign Secretary stated in the House on Tuesday, when he said that it was a law “written for another age”, in specific reference to the 1951 refugee convention.
We as a country—the British people—are decent, warm, tolerant and generous. You need only look at the various schemes over the last number of years: we have welcomed 20,000 people under the two Afghanistan schemes, 185,000 under the Hong Kong partnership, 270,000 under the Ukrainian families schemes and 22,000 Syrians between 2014 and 2021, and that is not to mention 22,000 Vietnamese and Ugandan Asians between 1972 and 1974. There is an argument, however, that integration has failed. Diversity is a shibboleth, a cult that means that a shared sense of community cohesion, values, principles, beliefs, social tenets and a unity in belief in our country are often dismissed and ignored.
In the wider context, I have some specific questions for the Minister. Why has the refusal rate for asylum seekers decreased precipitously since 2010, from, for instance, 88% in 2004 to 24% now? Why are we granting asylum to many more people who passed through safe countries which have much higher refusal rates, such as France and Belgium? How many cases are currently in the asylum seeker caseload? What is our strategy for the 41,000 who are subject to removal and have not been removed?
For all that, I have a positive spin on where we are at the moment. I welcome the Integrated Communities Action Plan, the New Plan for Immigration: Policy Statement and the Refugee Employability Programme because it is our duty to support law-abiding, decent asylum seekers to become good British citizens. We need to bring back integration from the devolved Administrations. We need a robust template for citizenship ceremonies focusing on British history, culture, values and beliefs. We need to put more money into removals and to speed up the process, particularly the appeals process. I agree with the noble Lord, Lord German, that we need to look at more work with civil society to give asylum seekers skills, work preparation and language skills not to work before their application is determined but to volunteer and receive support as putative British citizens. We certainly need to expand the social impact bond models beyond the four pilot schemes that we have now, with clear targets and demonstrable objectives.
Millions of people want to come to Britain for a better life, and that is laudable. We have a right to choose which ones we accept, but we also have an obligation to help them to be good, honest, patriotic British citizens.
Lord Green of Deddington (CB)
My Lords, I agree broadly with much of what the noble Lord, Lord German, said, but it is no surprise that I will take a slightly different approach because I also agree with quite a lot of what the noble Lord, Lord Jackson, said.
There is a prior phase before we get into how we handle refugees, and that is the main point of this debate. We need much more confidence among the public that applicants for refugee status are genuine and, if they are not, that they will be refused and removed. The second part of that is, frankly, very weak at the moment. We have to convince the public that the number is satisfactorily under control. I suspect that there is growing public concern on both counts. The public are aware that roughly 75% of applicants are relatively young men who have nearly all destroyed their documents and who have nearly all—certainly those who cross the channel—come from a safe country. We cannot focus on the treatment of genuine asylum seekers unless we take account of this public feeling, which is strong and well based.
By way of illustration, I shall address one group of applicants on which the Government seem to be making a serious mistake. I refer to the so-called streamlining of applications from six Middle East countries announced on 23 February 2023, namely Afghanistan, Eritrea, Libya, Sudan, Syria and Yemen. I know most of those countries and have served in three of them. In the past five years, about 23,500 applicants and dependants from these countries have been granted asylum, but thousands of these applicants are now having their applications processed on paper and the “vast majority” are given the green light to stay in the UK without an interview. It is extraordinary. What is the reason? It is that their grant rate in recent years was 95% or higher. The system cannot be working effectively if it gives 95% approval to any group of people. What message does that send to their compatriots at home and how much does this matter?
A glance at the United Nations population statistics will show that the number of males aged between 20 and 39—the likely age group—from these six countries comes to a total of 23 million. Obviously, they are not all coming, but the word will spread rapidly, especially as all these countries are in chaos and many people in them live in poverty. It is surely only a matter of time before the numbers start to rise sharply.
This is just one example of the Government’s frankly limp and short-sighted policies in this field. The costs are enormous. Robert Jenrick, until recently Minister responsible for all this, has just said that it costs £500,000 to integrate and support one migrant. I put to the Minister that, if the Government are serious about pathways to integration—I hope that they are and I suspect that everyone here is—they will first need to get a grip of the process and to constrain the numbers.
Baroness Fox of Buckley (Non-Afl)
My Lords, it is absolutely right that we have the aspiration of fully integrating all those granted refugee status into UK life. I appreciate the application of thinking of the noble Lord, Lord German, about how we can do that, how they can provide for themselves and settle in, and so on. But, however short this debate is, we cannot ignore a broader political context and the contemporary problem of cultural integration.
Whether we like it or not, the status of refugees has become tarnished in the eyes of the public, discredited by the loss of faith in the process of determining who is legitimately here and the loss of control of our borders. The catastrophic backlog in assessing asylum claims means that there are worries that some are arriving in small boats, being waved through and so on. That causes resentments, which is not a good plan for integrating people. We have to be honest: integrating new refugees when the public are sympathetic to them escaping horrendous wars and brutal regimes is one thing, but it is different if they have a suspicion of status. There is a difference between integrating new refugees into a dynamic and self-confident country with a generous invitation to become part of British society and today’s reality, which is a combination of a polarised society, economic stagnation and all sorts of toxic things going on. We have failing public services, councils on the brink of bankruptcy and a housing crisis affecting all British citizens, so we cannot expect this to be all smooth sailing.
We need to take a step back. I refer noble Lords to recent events in Ireland over the last week or so. On Tuesday, Mayo County Council unanimously, in a cross-party resolution, passed a motion calling on all council staff to cease co-operation with the department of integration—aptly named for this debate. The issue is about housing asylum seekers and agreed refugees in the county. Both Fine Gael and Fianna Fáil councillors declared that non-co-operation would continue until
“an agreed strategy is put in place to properly co-ordinate the provision of additional services for the communities hosting refugees”.
This comes after violent clashes between the gardaí—the Irish police—and protesters outside a hotel in Roscrea in County Tipperary on Monday night, again in relation to housing asylum seekers and refugees.
It was interesting that Mayo councillors emphasised that, as much as anything else, they were acting to ensure that refugees would not be blamed for the scramble for scarce jobs, services and housing. They do not want scapegoating. As one councillor noted, the Irish state could be seen as discriminating against those already living in County Mayo, including migrants and earlier refugees who have been based there for years, sometimes decades. Such sentiments are reflected here in the UK.
Many people from a wide range of ethnic and social backgrounds feel uneasy about how best to integrate refugees here and about whether there is enough to go around. Perhaps even more challenging is the issue of cultural integration. Historically, refugees from all sorts of ethnic and religious backgrounds interacted and forged common bonds in British society. However, we have a problem with what the newly ennobled noble Lord, Lord Cameron, when Prime Minister, once called the doctrine of “state multiculturalism”, which splinters society into different cultural blocks, often competing identity groups, living parallel lives. This official policy has undermined national identity and fuelled disunity, all in the name of diversity. I fear that it will be the greatest threat that we have to properly integrating any new refugees.
Baroness Neuberger (CB)
My Lords, I declare an interest as chair of the Schwab & Westheimer Trust helping young asylum seekers and refugees access higher education and as a member of the Woolf Institute’s Commission on the Integration of Refugees—directly relevant. I also declare an interest as chair of University College London Hospitals NHS Foundation Trust. This is particularly relevant with UCLH, because it hosts the RESPOND team, an integrated asylum seeker and refugee service, which has been so successful in treating asylum seekers and refugees, under the leadership of the amazing Dr Sarah Eisen, that it was highly commended for a Health Service Journal award last year.
Asylum seekers and refugees face multiple barriers in accessing health services, and a direct outreach service can work wonders. Sadly, the main outreach service is closed at present, due to funding and commissioning issues, but this work is directly relevant. The Woolf commission’s report will be launched in March and is likely to recommend that the NHS collaborate with the third sector to carry out joint strategic needs assessments to understand the composition and needs of local asylum seeker and refugee populations. Those needs assessments should then be used to plan, develop and provide integrated care systems that are relevant, inclusive and responsive to any issues relating to community cohesion, as the noble Baroness, Lady Fox, just talked about, or to address health inequalities—exactly what RESPOND was set up for.
A further recommendation from the Woolf report is likely to be around the employment of refugees and indeed of asylum seekers while awaiting decisions. Once again, University College Hospital has tried to help, and not purely for moral reasons. Staff shortages are such that it makes no sense to have qualified health workers in our asylum system or newly accepted as refugees who cannot work with us. We started back in March 2022 in partnership with Liverpool John Moores University and recruited a mere four refugees. Two have since passed their OSCE, a test of professional competence required of anyone trained in another country who wishes to work as a registered nurse in the UK, and are now working with us, while two are finalising their training. It takes ages, as the noble Lord, Lord German, said, and it is expensive. However, this is exactly what we should be doing nationally on a far greater scale. It may be expensive to have such a system, but it is much more expensive if we cannot recruit at all. We have skills shortages while there are refugees who could fill the gaps and want to do so, but at present it is unbelievably hard to get into the NHS system, either as staff or as a patient, if you are an asylum seeker or even a refugee with status.
Can the Minister give us comfort that the Government are looking at this? Will they make it easier to work in the NHS as an asylum seeker or a refugee? Will they now fund outreach to asylum seekers and refugees from within the NHS to help deal with appalling illnesses and address shocking health inequalities? It is quite clear what should be done; the question is whether the Government will make it easier to do so.
The Lord Bishop of Durham
My Lords, I declare my interests as laid out in the register.
Successful integration into life in the UK is critical for refugees to rebuild their lives, enabling society to benefit from the valuable skills that they bring as a gift to this country. However, current policy makes integration difficult, leaving them with very little support, particularly in the early period.
My friend the right reverend Prelate the Bishop of London raised the 28-day move-on period in this House last month and in a letter to the Home Office with other faith leaders. I echo her concerns. Current policy gives refugees 28 days from the issuing of a biometric residence permit until they can no longer access asylum support and accommodation. In practice, refugees are often given much shorter notice to find accommodation and means to support themselves.
Last week, I witnessed this in the north-east, when a refugee, whom I have known for some years, was given a matter of hours by the Home Office to find new accommodation—he has just recently been given his status. As a male whose family has not yet joined him in the UK, he was not considered a priority for housing, so private rental was his only option. He is in full-time paid work as a social carer. Fortunately, the local authority agreed to provide a week in a guest house as he found a more permanent solution, but he was left in need of a guarantor, a deposit and a first month of rent. Had it not been for the generosity of local connections that he had made, plus the willingness of the local authority and charity sector to provide support and guidance, it would have been a very different story.
The 57% of refugees who end up sleeping rough, or in a hostel or night shelter, when they leave asylum accommodation are not as fortunate. Those who need to access universal credit when granted refugee status must endure the five-week wait for their first payment. Considering that the move-on period is 28 days yet the wait for a first universal credit payment is five weeks, how will the Government prevent those who have recently been granted refugee status but not yet found employment experiencing homelessness and destitution? Will they extend the move-on period to 56 days, so that it is compatible with the universal credit processing time or, as a minimum, correctly and clearly implement the current policy to ensure that all refugees truly have 28 days from receiving their BRP to leave their asylum accommodation?
I commend the Government for adopting community sponsorship as a safe and legal route to the UK. Community sponsorship has proven to help refugees to successfully integrate much more quickly, with the sponsoring communities providing wraparound support. I ask the Government what plans they have to upscale and promote this scheme, so that more refugees can integrate into life in the UK.
Refugees, when seen as a gift not a problem, have so much potential to contribute to our communities and economy. It is vital that newly recognised refugees receive the support they require with housing, employment, language skills and building social networks. Only then can they successfully integrate, rebuild their lives and fully contribute to life in the UK, which is exactly what they want to do.
Lord Carlile of Berriew (CB)
My Lords, I thank the noble Lord, Lord German, for raising this very important question before your Lordships. I support what he said in his excellent opening speech. I am glad that we are able to concentrate on a question that does not deal with the chaos of how refugee applicants arrive in this country. It is about what happens to people whose status as refugees is recognised; therefore, they are to be integrated.
Like my noble friend Lady Neuberger, I declare an interest as a member of the Woolf Institute’s Commission on the Integration of Refugees. It is a large commission, which has taken a vast amount of evidence. Its members are politically diverse and apolitical too. Some have lived experience. When it reports in March, I hope that the Government pay close attention to its recommendations. Given that we are in 2024, I hope that all political parties look closely at its provisions.
The Woolf Institute’s commission has taken a vast amount of evidence and it is becoming clear that your Lordships’ House and the other place do not have real visibility of what is happening with the integration of refugees. We need to introduce a new and much stronger governance process and a better and more clearly devolved structure for how refugees are dealt with, in the attempt to integrate and establish themselves in the United Kingdom.
My fervent belief—as a child of refugees—is that there is no real hostility to refugees in this country. Refugees who come here, work and participate in their communities are welcome. It is often the fault of us in this place that hostility arises. We need to move away from that situation by improving the governance of the refugee system.
How do we do that? I will give a couple of examples. First, we need a clearer statement of the strategy and goals for national refugee integration. Producing such a document is not rocket science. Secondly, we should ensure that we use those who are best at it already and give them the opportunity to improve what they do. Revising and upgrading the roles of strategic migration partnerships, as the key vehicles to implement the integration strategy, is absolutely essential. I used the word “devolved”; we should take into account the extremely important roles to be played by the devolved Governments, local authorities, the private sector and third-sector organisations, such as the many charities involved in this work.
To ensure that the work is done properly, in the coming years we should not face the sort of debates that we have had in the past couple of years about refugees and how they are integrated. To avoid that, we need a much stronger demonstration to Parliament of how these policies have been administered. I have a feeling that the Woolf Institute’s commission will suggest the implementation of a recommendation for an independent reviewer of how the refugee system works, so that there is a living instrument that deals with issues as they arise and reports independently to Parliament on the integration of refugees. Genuine refugees should—like my own parents, who were very successful refugees—have the opportunity to become full British people without losing their original national identities and ideas.
Baroness Hamwee (LD)
My Lords, I thank the organisations that sent us briefings; the material gets read even if one cannot refer to it in detail. I declare an interest as a trustee of the trust mentioned by the noble Baroness, Lady Neuberger, which supports young people in higher education. The students I have met show an impressive intention to progress to worthwhile careers. They are the catalysts for renewal and innovation in our nation.
I do not like the word “integrate”. It suggests a one-way activity when it should be reciprocal because integration is valuable and enriching to the host nation. A charity in south-west London, Community Action for Refugees and Asylum Seekers, uses the strap-line “Supporting diversity, challenging adversity”. Differences are valuable—societies are not static. As the noble Lord, Lord Carlile, said, several of today’s speakers—three of us sitting in a row—need look back only one or two generations of our own families. The noble Lord, Lord Jackson, used the description
“decent, warm, tolerant and generous”
of the British people. I agree, but will some of those who have benefited who are or have been in senior positions apply that? Would that the Government themselves showed leadership in acknowledging the benefits rather than scapegoating immigrants and, particularly, asylum seekers. All that does is stoke fear and hostility. I am sure we will hear from the noble Lord, Lord Gascoigne, about the positives, but I suspect not where there are shortfalls, nor where there is a lack of a holistic approach, which means that refugees are perceived as a burden.
My noble friend focused on the failure to align immigration policies with the UK’s economic needs, and other points that I now might be able to go through rather quickly—I did not expect him to be able to do so. The first is employment. Restrictions on asylum seekers undertaking volunteering, never mind working, deprive them of social connections, which are part of integration, as well as experience and dignity. I will canter through some other issues. Language is essential for a rounded life, and essential for a refugee to practise his or her profession and use his or her skills. Some of the language tuition needs to be work-related.
The right reverend Prelate referred in some detail to the issues around accommodation, which is an essential foundation for so much else. Like him, I ask the Government to think again about the move-on period—both the formal period and the procedures that apply so that 28 days is now largely a fiction. What is needed is 56 days, to align with applications for universal credit and with the Homelessness Reduction Act. It is said that if nothing else changes, universal credit advance payments will have to become the norm. The right reverend Prelate referred to problems with private rented accommodation.
More safe and legal routes would put the UK in a better position to welcome refugees. They would also put refugees in a better position not to be driven underground but to contribute to and become part of our society and communities—to everyone’s benefit.
Baroness Taylor of Stevenage (Lab)
My Lords, I thank the noble Lord, Lord German, for bringing this important debate forward today. I also thank my colleagues in local authorities across the country, faith leaders and their communities, and the voluntary and community sector for their exceptional efforts in this regard. In all the light and heat of the Government’s current chaotic and crisis-ridden approach to asylum seekers and refugees, it is too easy to overlook the fact that at the heart of this issue are people and communities here in the UK, and people who arrive in our country, often traumatised and persecuted, seeking refuge and the security that we take for granted.
Local authorities and the voluntary sector have done an outstanding job in attempting to support refugees into accommodation, supporting their mental health and welfare needs, providing access to English classes, and giving employment support and assistance with registering for benefits as well as cultural awareness support to enable people to build new lives in the UK. However, both our own excellent briefing from the House of Lords Library and the outstanding briefing from London Councils set out that there are still significant issues. The current lack of co-ordination, the failure to ensure that adequate time periods are in place for refugees to access employment, accommodation and benefits, and the constant changes of system and inconsistent time periods between refugee support and housing law are causing considerable distress. There are increases in rough sleeping and exceptional pressures on housing departments, which were already buckling under the demands for emergency and temporary accommodation due to the failures in the housing market.
The Government’s climbdown on asylum accommodation cut-off dates was followed by a huge increase in homelessness rates among new refugees. Are the Government considering how they may help by boosting homelessness prevention funding and/or discretionary housing payments? The chaos engulfing our asylum system, which has kept people in Home Office limbo for longer and longer, will not be solved by forcing refugees out of accommodation and on to our streets. What is being done to ensure that move-on periods from asylum-seeker status to refugee status align with homelessness legislation, universal credit application periods and access to essential health support, including for mental health? All those issues were mentioned by previous speakers in this debate.
Can the Minister outline how the Home Office and DLUHC will work together and with other departments to introduce the cross-departmental strategy, referred to as a national refugee integration framework by the noble Lords, Lord German and Lord Carlile, to ensure that newly confirmed refugees are able to secure housing, employment and support with health issues, including mental health, so that they can go on to build an independent life in this country? Can the Minister tell us how many refugees have been able to access the Refugee Employability Programme, and how its success is being monitored and assessed? What work is being undertaken to understand what works best in terms of outcomes for refugee integration?
It is in the interests of the settled people and communities across the UK, the very vulnerable refugees at the heart of this issue and the hard-working councils and agencies working in the front line to get this resolved, so can we please have closer co-ordination between and within departments and with those on the ground, without any further delay?
Lord Gascoigne (Con)
My Lords, like others, I thank the noble Lord, Lord German, and all who have contributed today. As he said, the debate has been well attended, which is a credit not just to him for securing the debate but to all noble Lords who are concerned about this issue and how we work together to integrate refugees further.
As has been clear, the debate is important, and I assure noble Lords that the Government approach this task with the seriousness and care that they would expect. We seek to support and help refugees as they begin their lives in the UK in a number of ways, and I will set those out before I respond to some of the other specific points that have been raised.
First, all those who have been granted refugee status or humanitarian protection in the UK are granted immediate access to public services—as we have discussed, this includes education, healthcare and the benefits system—as well as to the labour market. As has been said, these provisions are there to help foster integration and self-sufficiency, so that refugees can provide for themselves and their families, as well as make a positive contribution to the economy and society.
As has been noted by your Lordships, and as I think we all agree, employment can be and is an important step on the path to integration. There is the obvious financial benefit from earning an income and becoming self-sufficient in the longer term, but there are also opportunities to engage with others, expand social networks and learn and practise speaking English. That is why those granted refugee status have immediate and unrestricted access to the labour market.
Points have been well made about how refugees can sometimes face additional barriers to labour market participation, which is why the Government are funding the delivery of a bespoke support package to help refugees to overcome these barriers and move into work. The Home Office recently launched the Refugee Employability Programme in England, which is focused on increasing employability prospects for refugees through the provision of tailored employment support, integration support and English language training. The noble Baroness, Lady Taylor, asked a number of questions about departments working together. I hope she sees where they do so; this is one area. Officials also work closely with the Department for Work and Pensions to ensure that all those whom we resettle or whose refugee status is recognised are aware of and receive the support to which they are entitled.
As your Lordships raised, the ability to speak English is key to helping refugees integrate, as well as to breaking down barriers to work and career progression. That is why English language training is a fundamental element of the support available under the new Refugee Employability Programme. The Department for Education in England funds English for speakers of other languages through the adult education budget. All refugees and those granted humanitarian protection are eligible for full funding for ESOL if they are unemployed and looking for work. I will come back later to some of the other specific points on education.
Once granted asylum, individuals must transition to mainstream services from the support and accommodation provided while their asylum applications are processed. The Government currently have in place measures that ensure that an individual granted asylum remains on asylum support and in asylum accommodation for 28 days from the point of the biometric residence permit being issued. We recognise the importance of a biometric residence permit to obtain onward support; it allows newly recognised refugees to integrate and establish themselves. We are working to ensure that BRPs are issued within five to seven days of the initial decision. However, individuals should make plans to move on from asylum support as soon as they are served their asylum decision, regardless of when their BRP is issued. In most cases, this is in advance.
Early in this period, Migrant Help, which is contracted by the Home Office to support newly recognised refugees, will also provide support and advice on how to access services and where to get assistance with housing.
We recognise that the number of individuals moving on from the asylum support system is adding pressure on local authorities and their housing allocation capacity. The Home Office and the Department for Levelling Up, Housing and Communities are working closely on this and have been regularly engaging with local authorities to ensure that they are supported as well. There are a number of improvements in train to ensure that local authorities receive early notification of those being granted asylum and leaving Home Office asylum accommodation. Following notification of an asylum decision being made, accommodation providers will notify local authorities within two working days. We are working with providers to ensure that this is applied consistently and in a timely manner across all areas. We are also working to ensure that individuals are offered support from Migrant Help or other partner organisations when they receive a decision on their asylum claim.
I will try to address the very good points that have been made. Forgive me; there are some that I may have missed. I will do as much as I can and, if I am unable to answer them, I will write.
The noble Baroness, Lady Neuberger, spoke about asylum seekers not being able to work while they await the decision. I completely understand the point, which has been well made by many others not just in this debate but in previous debates, especially in the Chamber. We do not want to be in a position where we create pull factors. It would be an incentive for asylum seekers to enter our system if we were to go down that route.
Your Lordships made a number of points about grant rates, specifically on what the Government are doing to clear the backlog and on the checks. I assure your Lordships that rigorous checks are made on claims before and when decisions are made. My noble friend Lord Jackson asked about the grant rate compared to the European Union. Obviously it is not always possible to give a direct comparison. For example, there is a mix of nationalities, protection needs, operational resources and policy decisions. Currently there are a large number of applications with ongoing conflict. The department is prioritising older claims, children, those in support and those with extreme vulnerability.
The noble Lord, Lord German, asked about the RTOF and the pilot. The evaluation is ongoing, I am afraid. Once it has come to its conclusion we will write to him with further details once we have learned those lessons.
The noble Lord, Lord Green, asked about tracking the 90% who pass through safe countries. I assure him that our system is robust and that rigorous checks are made on that.
The noble Lord, Lord Carlile, asked whether the Government will take heed of the recommendations of the Commission on the Integration of Refugees. We look forward to seeing its report in due course, and I assure him that we will consider it carefully. I am sure it will be discussed in detail in the Chamber at some stage.
The noble Baroness, Lady Taylor, and others asked about the support and close working with other departments. As I said, there are a number of occasions where departments work together, which we will obviously continue to do. To be clear, it is not just the Department for Levelling Up, Housing and Communities but the DWP and the DfE.
The right reverend Prelate mentioned his right reverend friend the Bishop of London, and my understanding is that there is some outstanding correspondence and that one of the Home Office Ministers has since written. I spoke to the Minister this morning, and he wanted me to pass on that he is aware that there needs to be a response to that. He is happy to have the conversation once he is in a position to do so. I assure noble Lords that the department is on it and they will meet.
There were a number of other issues—I have written them down—but, in the interest of time, I will just thank the noble Lord, Lord German, again for raising this debate, and all those who participated in the debate. I hope one of the things we can take away is that the Government recognise the importance of supporting refugees towards integration. It is certainly not the case that we see them as a burden, as was said; we do not. We continue to explore how refugees can be supported towards integration more effectively and how to improve their outcomes. That is why we have been testing a different model of support through our recent refugee transition outcomes fund pilot, as mentioned, and it is why this programme and the new Refugee Employability Programme are being evaluated. This is so that learning can be captured and can inform policy developments in this space.
Lord Jackson of Peterborough (Con)
Will the Minister address, possibly in writing, extending the social impact bond projects and the learning from those? On a comment from the noble Baroness, Lady Hamwee, will he look again at the government policy on volunteering to enable better integration of asylum seekers through not work but volunteering?
Lord Gascoigne (Con)
I apologise—the noble Baroness, Lady Fox, and others also made that point about integration. I assure my noble friend that I will write on that.
The Lord Bishop of Durham
Will the Minister write to me about community sponsorship? He was meant to hit that out of the park for six as a positive, and he did not.
Lord Gascoigne (Con)
I thank the right reverend Prelate. I will write, and I apologise profusely—there are a number of other issues that I have not had a chance to address.
In conclusion—I say to the Whip that I am conscious of time—it is in refugees’ interest and that of the country as a whole that they are able to adapt to life in the United Kingdom, build rewarding and happy lives here, and contribute to society.
Religious Education in Schools
(11 months ago)
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Lord Harries of Pentregarth
To ask His Majesty’s Government what steps they are taking to improve the quality of religious education in schools.
Lord Harries of Pentregarth (CB)
My Lords, the 2023 report by Ofsted on religious education could hardly be more damning. It said that, in too many schools, RE was of “poor quality” and “not fit for purpose”. Ofsted suggested that, as a subject, RE was “undervalued” and often considered as an “afterthought” by schools. It argued that the
“lack of clarity and support”
from the Government made the schools’ job “harder”. This is not a new situation but one that has been known for many years and, despite some input by government, the situation has continued to deteriorate.
Religious education is education. It is not propaganda. It is simply basic to any understanding of what it is to be a citizen of our society in the world today. First, it is impossible to understand the literature, art, music, history or political values of this country and Europe without some basic knowledge of the Christian faith and the Hebrew scriptures on which it was built. It should be general knowledge in our culture as to why we have Christmas and Easter, for example, but polls indicate a widespread ignorance. Teachers of literature in universities are appalled at the lack of any kind of knowledge of the Christian faith that permeates so much of what students will study. Then, in our plural society in which Islam, Hinduism and Sikhism, for example, are so widely present, religious education should give people the mindset to begin to enter into the narrative of other worldviews. It goes without saying that, in a world of conflict such as ours, where religion is so often a factor, this is more important than ever.
I am delighted that a number of my humanist friends will be speaking in this debate, but I stress to them that what we are talking about is education, not propaganda. Most young people today say, apparently, that they have no religion. This makes it all the more important for them actually to know something about what it is that they say they do not believe. Religious education is therefore essential for understanding both our own society and the world in which we live. Why have successive Governments allowed it to be so marginalised for so long?
At the moment, the major responsibility for RE lies with local authorities and SACREs. Some of them take this responsibility seriously but, in others, very little has been done. In August last year, a survey of LA funding to SACREs found that five authorities declared no spending on RE at all, and a further 34—39 in all, or 31%—stated they do not spend any money supporting RE in schools. Some authorities allocated sufficient funding for a proper review of the agreed syllabus in a timely fashion, but 21 authorities had a syllabus from before 2017—over five years old.
SACREs have, on the whole, worked well as enablers of co-operation and community between the different faith communities, but they have not been able to bring about the radical improvement in RE that has been shown to be needed for many years now. The time has come for much more direction at a national level. I agree with the Religious Education Policy Unit that there should be a properly funded national plan for RE, which should include a national curriculum. A national curriculum is used as a benchmark for standards in other subjects and, if academies do not choose to follow it, they must provide a curriculum that is similarly broad and ambitious. The present situation, where responsibility lies at a local level, means that there is no standard available to the Government to challenge weak or invisible RE provision.
The present situation is lamentable. In England, schools have a statutory obligation to provide RE to their students. However, according to the school workforce data, one in five schools offers zero hours of RE in year 11; this equates to around 500 secondary schools. In the absence of a national standard, the current Government have no mechanism to challenge this.
It should also be noted that no government money has been spent on RE projects in schools over the last five years—that is, 2016 to 2021. During this time, English has received £28.5 million, music has received £387 million, maths has received £154 million and science £56 million. With the Government’s stated “firm belief” in the importance of RE in mind, there should be a national plan for RE on a par, at least, with the national plan for music. There should also be, as part of this national plan, the provision of teachers who are properly qualified to teach the subject and able to take part in continuing professional development; this is not the case at the moment. The Department for Education has missed its recruitment target for secondary RE teachers in nine out of the last 10 years. While the total number of secondary teachers in history and geography has risen by 6% and 11% respectively during that period, the number of teachers of RE has declined by almost 6% in the same time. The result is that pupils are now three times as likely to be taught RE by someone with no qualification in the subject than, for example, in history. Some 51% of RE lessons are taught by people whose qualification is in a subject other than RE, and RE often becomes the lesson that is filled by a teacher with a few spare lessons on their timetable.
One way in which this situation can be addressed is through the provision of more bursaries for those training to teach RE in a way that is comparable to those training to teach other subjects where there is a shortage of teachers. I welcome the Government’s commitment to fund bursaries of £10,000 for trainee teachers in RE and the provision of eight-week subject enhancement courses. However, even with these measures, recruitment for this year was predicted to be 60% short of the target, and this has the further effect of putting university courses where people learn the subject under strain and creating a vicious circle of decline. Despite the sterling efforts of some schools and some SACREs, it is widely recognised that the present situation is lamentable, and it is failing to prepare pupils for understanding the key role of religion in our culture and history and its importance for good community relations in the modern world. What is happening now in RE is professionally unacceptable.
I am grateful to the Library for its briefing and to the Religious Education Policy Unit for its recommendations, which I follow, on the whole. Finally, I will press the Minister on whether she agrees that: first, we need a properly funded, clear national plan for RE and that it can no longer simply be left to SACREs, and this plan should include a budgetary provision at least comparable to other subjects that need a boost, such as music; secondly, this plan should include what is expected from the syllabus and that what happens locally should be judged by this benchmark; and thirdly, that RE should be taught by people who have qualifications in the subject and who are given regular opportunities to enhance their professional skills, and that more bursaries and more money for enhanced professional training should be made available to this end. I beg to move.
Lord Griffiths of Burry Port (Lab)
My Lords, I am delighted to be part of this debate. The noble and right reverend Lord, Lord Harries, is to be thanked for yet again bringing it to our attention; it is as lamentable as he has said. The two of us have contributed to “Thought for the Day” for many years, and we both know how to tailor our remarks to two and three-quarter minutes. I feel quite at odds with him in this debate where he has 10 minutes and I have three.
I have counted, throughout my time as a Methodist minister, the number of years I have spent in the governance of schools: it amounts to well over 40. These have included every kind of secondary school that you can imagine—voluntary aided, academies, state sector, comprehensives, private schools too—and the shaping of a university at Roehampton where our denominational input was of some use. Over this time where I have been involved practically in this way, the situation has become ever more dire.
Since it is required of the education that we offer to our young people that the spiritual and religious be part of what a good education is considered to be, that raises all kinds of questions. I wonder, for example, why between 2016 and 2021 no government money was spent on RE projects in schools. I hope the Minister knows why or where it has been hidden for future use. When in September 2023 a joint letter was sent by the Religious Education Council to the Secretary of State, Gillian Keegan, pointing out a shortfall in this area, within a month it was discovered that the initial teacher training bursary was to be reintroduced for September 2024 entrants. Why did it have to be reintroduced? Why was it not there in the first place?
I know that the way that we look at and feel about religion varies from person to person and that it can produce great difficulties, because people feel that those with religion want to have an angle on the educational curriculum of a school to introduce and emphasise the things that are important to them. I do not think that is the case. I am a member of the British humanist society and its APPG here for the simple reason that I, like they and all religious people, believe in the humanum and that it is our duty, wherever our values are to be found, to seek the well-being of humanity at large. I certainly do not want religion to be categorised as simply reneging on its promises or undermining its commitments.
With those brief words—my one “Thought for the Day”—I can now leave the field open for others.
Lord Storey (LD)
My Lords, I have an interest in this issue as a former head of a Church of England school. Before the introduction of the national curriculum, RE was the only subject that schools had to teach by law; the rest of the curriculum was left to schools—heady days, one might think. Since then, much has changed; indeed, our society has changed too and become a very different place. We are a very successful multicultural and multifaith society, and two-thirds of young people and more than 50% of people as a whole are non-religious, and an increasing number have humanist values and beliefs.
It is important that children and young people understand different faiths and those of no faith. That has to be taught and available through our school system, with teaching of the highest quality—not the prevalent “pass the parcel” to see who will do it.
The figures, as we have heard, speak for themselves. Of our schools in England and Wales, 25% use teaching assistants to deliver the subject, while 20% of RE teachers have received no training and only 63% of teachers feel confident in teaching the subject—a worse situation than three years ago. In 30% of schools, RE is funded less than any other subject taught, and in 28% of schools no funding at all is provided towards the teaching of RE. One in five schools does not offer RE in the curriculum in year 7—they are breaking their statutory responsibilities, by the way—while 27.4% of academies which are not faith-based schools do not even teach RE. Is that part of academies’ right to choose their own curriculum? Perhaps the Minister could explain. Some 31% of schools spend less than the designated time teaching RE—again, a worse situation than three years ago.
Increasingly, therefore, fewer qualified teachers are teaching the subject; less money is spent on resources; less time is used to teach it; and, in many academies, it is not taught at all. Perhaps the Minister could tell us what the Government are planning to do and whether the time has come to take an honest and open-minded look at faith and non-faith education in our schools.
Let me end on a positive note. The Open University, in collaboration with a range of UK and international partners, has developed an exciting initiative in religious, civic and historical education for young people aged 13 to 18. They are encouraged to think outside the box about their own experiences of religious diversity, tolerance and intolerance. The creative process means working together and developing skills such as teamwork, empathy, curiosity and imagination, critical thinking and making “docutubes”, which are short films. Perhaps the Minister would look at this exciting project and its possible use in schools.
The Lord Bishop of Durham
My Lords, I declare my interests as in the register. Our modern society today is rich in diversity with varying cultures, religions and beliefs. Religious education gives young people an understanding of different world religions and beliefs, in a world where 70% of people affiliate themselves to a religion. It gives pupils an opportunity to explore their beliefs, enabling them to think critically and discuss belief systems in a non-offensive and non-discriminatory manner. However, RE is too often seen as inessential, with Ofsted stating, as was said earlier, that
“schools often consider RE as an afterthought”.
When current global conflicts have roots in religious histories, and with increases in faith hate crime in Britain, the provision of high-quality RE is crucial to creating a more respectful and tolerant society. Faith hate crime often comes from a lack of understanding, and it will not be eradicated when citizens lack knowledge of the beliefs of those alongside whom they live and work. I note the Government’s decision to omit RE from the English baccalaureate; will they reconsider this—it was disastrous—and include RE?
Despite the statutory requirement to teach RE at all stages, there are no clear expectations around RE provision regarding the breadth and depth of the syllabus. This results in the teaching of RE in many schools simply being inadequate. The National Content Standard for Religious Education in England, produced by the Religious Education Council of England and Wales, gives syllabus providers clarification and a benchmark for excellence in RE. Will the Government endorse the document and use it to raise the standard of RE provision across the country?
RE provision is further declining due to the lack of teachers qualified to teach the subject at a high standard. I appreciate the plans for bursaries for those training in the 2024-25 academic year, but I am concerned that these measures do not go far enough with—as already stated—51% of RE lessons in secondary schools taught by teachers who predominantly teach another subject and one in five schools reported to offer zero hours of RE teaching in year 11. How will the Government further ensure that an adequate number of teachers are qualified to teach RE well?
Religious education has the potential to be a vital component in addressing discrimination in the UK and creating a more understanding society. I urge the Government to ensure that RE is considered not as an afterthought, but as an essential part of education, equipping young people to live and engage in society today. The vision for education is to produce the best human beings possible. Surely RE has a vital part to play in that process.
Lord Hastings of Scarisbrick (CB)
I am grateful to the noble and right reverend Lord, Lord Harries, for making us have this debate and for the context he set out. I declare up front that I was an RE teacher between 1980 and 1986. Those were what the noble Lord, Lord Storey, called the “heady days” when we could decide exactly what we taught, and it was straightforward Christianity in my day—but in my latter years, a bit of something else was added for context.
I thoroughly enjoyed my six years of being a religious education teacher. I loved that I was able to inspire a transformation of attitudes and mindsets in a school in west London that, if Ofsted had existed, would have been closed down as a failing school; I do not mind admitting that. It was a school that did what we used to call CSEs, because the brightness level was somewhat dim there.
I remember a phrase that went round at that time, the 1980s: “Those who can’t, teach. Those who can’t teach, teach RE”. As an RE teacher, that made me feel that I was at the back end of the bottom of the bucket, but I loved those six years. I loved them, to be candid, because I was able to transform the energy and engagement of less academic students, so that RE became—to be honest about it—the single most pursued and sought-after subject at CSE, which was the GCSE equivalent, for 13 to 16 year-olds. The school in which I was teaching even introduced an A-level in the subject.
How was that possible? There is a distinguishing characteristic to RE that has been substantially and consistently ignored: it has to come from a living and vibrant commitment to faith. Whatever the faith, it had better be dynamic, realistic, passionate, personal and meaningful. We all know well from our school experience—we have all had it—that it is not so much the subject but the teacher that turns us on. If we could invest in bringing forward people of calibre and character, energy and enthusiasm, faith and distinction, RE would be changed.
It is not so much about pushing teachers on but about letting hearts and souls come out. When I went to that school, I was offered £400 to support 900 children in my first year. I raised £2,600 from a network of friends to support the curriculum of the whole school, because I really believed I had an important opportunity that we should pursue.
I ask the Minister, when she responds to all the fine points that have been raised in this debate so far, to tell us the extent to which the Government agree that vibrant commitment and understanding of the role of faith in today’s society—let alone understanding of the context of our troubled world, particularly areas of the Middle East—is so essential for our children that we had better get enthusiastic people in to the job.
Lord Parekh (Lab)
My Lords, I thank my good friend the noble and right reverend Lord, Lord Harries of Pentregarth, for securing this debate and introducing it with characteristic eloquence. The three minutes I have do not really allow me to say anything significant so I will make three quick points of criticism of religious education as it is practised in our schools.
First, it is not properly thought through or carefully organised; it is taught by teachers who are not properly trained and who do not have sufficient time; and there is no careful planning or organic build-up from one year to the next. That is one simple criticism that I wanted to start with.
The two other criticisms are far more significant. It is not clear why we want to teach religious education. Is it to fill time? Is it to deal with undisciplined children? Is it to placate religious people? Why is religious education part of our curriculum? I do not think that many people who insisted on this have really given it thought.
We have not realised that it is not concerned with being a good citizen. A citizen has no religion; only human beings have. It is concerned with how to make somebody a decent human being so that his humanity inspires citizenship in all that he does and is. We want to teach religious education to give him a better grasp of civilisation, in the composition of which religion has played an important part; to make him a better human being and to get him to appreciate the countless advantages and disadvantages in being religious. Religion has been a force for evil as well as good. We have seen both. When it has been a force for good, it has been concerned with ecological issues, human brotherhood and emphasising human finitude—that human beings cannot be the lords of the universe. They are the sorts of things that religion should be teaching.
The third question is: what is taught? When you say we teach religious education, what is that? Is it teaching religions? What does that mean? Does it mean teaching the history, or the moral values? No, that is morality. What is distinctively religious about religious education? Here, many of us tend to lose sight of the fact that religion is ultimately concerned with spirituality, which is neither moral nor religious. I can be spiritual without having to believe in God—lots of people are. I can be deeply moral without being religious. In other words, spirituality has a distinct space in human life, and religious education should cultivate this and the ability to sensitively appreciate the spiritual aspect of life. Religious education, as we teach it, does not seem to do so.
Lord Warner (CB)
My Lords, I declare my interest as a member of Humanists UK and a former chairman of the all-party parliamentary group on humanism.
I agree with much of what the noble and right reverend Lord, Lord Harries, said, but I believe the problems on this issue are more fundamental. The UK population’s commitment to religion has seriously changed since my teenage refusal to chant the Lord’s Prayer in school assembly. In 2021, the British Social Attitudes survey revealed that 53% of the population had no religion. Only 12% said they were Anglicans, with young people making the biggest shift to secularism: 68% of 18 to 24 year-olds belonged in no religion, with just 18% saying they were Christians. Only 0.7% were Anglicans. Church of England support among young people is in free fall, with no evidence that this shift will be reversed. The 2021 census points in the same secular direction.
Yet the Church hierarchy, Parliament and educational policy-makers seem unwilling to recognise this new reality. This House still insists on starting proceedings with Anglican prayers, and we still have 26 Anglican Bishops here by right. As a House, we badly need to face up to the implications of this fundamental population shift to secularism. It calls into question both the state’s funding of religious schools and the curriculum and practices of non-religious state-funded schools. There is now no justification, in my view, for compulsory daily acts of Christian worship in the two-thirds of state schools in England and Wales that are not Church schools. There are big question marks over the way in which religious belief is taught in these schools, and curriculum change is inevitable.
I appreciate that tackling the issue of Church of England schools is difficult but, even without tackling this contentious issue, other—quite major—reforms are possible. We could and should abolish compulsory acts of Christian worship in schools, and we should move to teach an independently devised and more broadly based national education curriculum, as others have suggested, on faith and non-faith beliefs. This House might like to set an example by changing some of its own religious practices.
Baroness Fox of Buckley (Non-Afl)
My Lords, we live in a period in which Jewish schools have had to ramp up security to protect their pupils, and religious symbols of Judaism are being hidden by students in fear in non-Jewish schools. My question is: given that religion and politics have got very messy, who would be an RE teacher dealing with such fraught difficulties? Over the last few days, the front pages had the story of Michaela Community School, led by Katharine Birbalsingh, whom I admire but others do not—she is certainly controversial. Of all things, the school has been taken to court by a pupil for banning Muslim prayers. The head teacher had basically said, “We shouldn’t be divided by religion. We should have no prayers”. I was fascinated that one of the things the teacher said was that some pupils were being intimidated by their peers for not being religiously pious enough, and it was a kind of bullying.
There is a poisonous atmosphere out there. Even the question of whether we live in a Christian country is rather more awkward than one would think. I loved the explanation given by the noble and right reverend Lord, Lord Harries, of religion as education and knowledge, and I totally agree with him on that, but many British institutions seem embarrassed by the western Judeo-Christian tradition. Its accomplishments are more likely to be labelled as white privilege than as the repository of positive values and virtues.
Instead, in recent years the new religion is diversity and inclusion, which has incentivised faith groups to adopt politicised cultural religious identities and has proved a recipe for stirring up divisive tensions and encouraging group grievance-mongering and offence-taking. We should not forget that a schoolteacher from Batley Grammar School is still in hiding, in fear for his life, for the blasphemy of showing pupils an image of Muhammad in a religious studies class. He had no support from politicians or trade unions, was labelled Islamophobic and was told he was making a fuss about nothing, although the Parisian teacher Samuel Paty was decapitated for a similar offence of showing cartoons of Muhammad. We have to admit that this is difficult.
I shall finish with the Reverend Bernard Randall, who lost his job at a Christian school—Trent College in Derbyshire—because he delivered a sermon expressing approval of mainstream Christian teaching on marriage, biological sex and gender, and the head teacher reported him to Prevent. That bodes badly for RE teachers. I would avoid it like the plague. We have to be honest that it is more difficult than it sounds by just paying bursaries.
Baroness Meacher (CB)
My Lords, I thank the noble and right reverend Lord, Lord Harries, for tabling this Question for Short Debate. This is an incredibly important issue affecting all children, and currently it is failing. He will not be surprised that I approach this subject from the perspective of non-religious children, whose beliefs are not recognised at present in RE. When the UK was overwhelmingly religious and Christian, the treatment of RE with that focus was completely understandable. The noble Lord, Lord Warner, has described the incredible decline in faith among young people. More than two-thirds describe themselves as non-religious. If RE is to be relevant to all children—and I want spiritual teaching as well as non-spiritual teaching to be relevant to all children—the Government’s first step should be to issue guidance making it clear that RE needs to be fully inclusive of non-religious worldviews. Indeed, the subject needs to be renamed “religion and worldviews”.
Last year’s Bowen judgment in the High Court provided legal clarity about the need for the subject to be objective and pluralistic and to include humanism within it. Indeed, since the Fox judgment of 2015, the subject has been required to be fully inclusive of humanism. In May 2023 a High Court ruling found that it was unlawful for Kent County Council to refuse to accept a humanist pupil as a member of an RE group. The Bowen judgment makes it clear not only that syllabuses must include humanism but that humanists must be included within RE. This is necessary in order for the UK to comply with the European Convention on Human Rights. That convention provides for non-religious worldviews to be read into most instances where religion is used in current law. As important as the legal requirement is the impact on children of an inclusive approach to RE. This enables children with belief to understand those who do not have a belief, and vice versa. Surely that is important for community cohesion.
I applaud the 2018 Commission on Religious Education chaired by the Very Reverend Dr John Hall, the Dean of Westminster. A core recommendation of that commission was the reform of RE to make it more inclusive. This reform is also the policy of the National Association of Teachers of Religious Education. This is the reform that the RE profession wants.
In conclusion, all faith schools should provide inclusive RE as an option on request but, most importantly, the Government need to legislate to reform the subject entirely, change its name to religion and worldviews, bring it within the national curriculum and ensure adequate funding for the subject. I support RE but want it to be broader.
Baroness Garden of Frognal (LD)
My Lords, it is a great pleasure to speak in this debate secured by the noble and right reverend Lord, Lord Harries. His contributions to “Thought for the Day” are always enlightening—as are those of the noble Lord, Lord Griffiths—and start the day in a really good way. I hold him in great admiration and affection, particularly so after he gave a moving tribute to my husband at his funeral 16 years ago. He has written any number of books on religion and ethics but also on defence, literature and the arts—a veritable polymath, but also a very senior member of the Church of England. He was a founder member of the Oxford Abrahamic Group, bringing together Christian, Muslim and Jewish scholars, so his wish to improve religious education in schools is not confined to Christianity.
As we have heard, RE is a compulsory subject in schools, but you would not always know that. It can be taught by teachers who have no religious education themselves. It can be passed from pillar to post, with no one teacher taking responsibility. This is not exactly a new issue. Many years ago, I taught French A-level at a convent where one of the set texts was Flaubert’s story of Salome and the beheading of John the Baptist. My convent-educated and bright sixth-formers had never heard of John the Baptist. When I asked what they studied in their RE lessons, they said social issues, such as drug-taking, poverty and war, but not, it appeared, the Bible. My class therefore ended up doing more RE in French A-level than they did in RE. Luckily, they had heard about Jesus and knew about Christmas and Easter and that Catholics went regularly to Mass but, even in a convent, the Bible was a mystery.
As the noble and right reverend Lord, Lord Harries, has mentioned, when Damian Hinds was heading the DfE—how transitory Education Ministers have been—he initiated the £10,000 tax-free bursaries to attract teachers into RE, but the standing committee on RE reports that little progress has been made. If there are so few specialist teachers, it is scarcely surprising that the subject is woefully taught.
RE lessons should be a place for exploring the great world faiths, ensuring that students have a moral compass. I agree with the comments that they should also encompass the other aspects of humanism. Bible stories should be part of general knowledge, quite apart from the value of learning about goodness and sacrifice and understanding religious diversity, toleration and peace. There should be open, in-depth discussions of faith, so that all students, whether from faith families or not, can learn what religion means to practitioners and how important it is to be tolerant of those whose beliefs are different from one’s own.
In our own communities, we see great division through religion, so it has to be good when Christian, Jewish and Muslim places of worship open their doors and welcome all to experience their forms of worship. To know is to understand and not to fear. But this will not be helped if children start life with no knowledge of religion. Can the Minister therefore say what consideration has been given to encouraging schools to work with local churches and faith groups to find people of religion for these lessons, and what plans do the Government have to ensure—as we are all calling for—that we have qualified teachers for this compulsory subject?
Baroness Twycross (Lab)
My Lords, this has been a most interesting and varied debate, and I join others in commending the noble and right reverend Lord, Lord Harries, for securing it. I cannot claim to have his knowledge, or the knowledge displayed by many speakers, including my noble friend Lord Griffiths, the right reverend Prelate the Bishop of Durham and the noble Lord, Lord Storey, or indeed the teaching experience of the noble Lord, Lord Hastings, and the noble Baroness, Lady Garden. However, we can all agree, whatever our level of expertise, on creating an education system that delivers for all children. We can get the core subjects such as maths, English and the sciences right, with expert teachers in the classroom, but our education also needs to be broad enough to ensure that children develop the knowledge and skills that they need to succeed at school and into employment and adult life—and that includes religious education. As the noble Baroness, Lady Garden, put very succinctly, we clearly need this for an understanding of literature, and I say that as somebody who studied literature at university.
Our communities in the UK reflect the rich religious diversity of our population, but also include people without faith, such as humanists, as referenced by my noble friend Lord Griffiths, who also choose to have a value-led approach to how they live their lives. My understanding was that humanism should be included in RE in schools, and I would be grateful for clarification on that from the Minister when she sums up.
Children today are growing up in a far more diverse and increasingly secular society than the generations before them. As the noble and right reverend Lord, Lord Harries, said, RE is fundamental to both a knowledge of our country’s Christian heritage and values and an understanding of other worldviews. It is hugely important that those of different faiths or no faith understand and respect each other. As many noble Lords, including the noble Baroness, Lady Fox, said, we have an increasingly polarised society. This debate is set against the context of conflict in the Middle East and the backdrop of a rise in hate crimes targeting people of particular faiths. We must work to counter hatred, intolerance and bigotry. Good RE teaching can and does contribute to this, and I want to make sure that we do not lose sight of the excellent work done by many RE teachers.
Given that RE is compulsory to offer in schools but is not part of the national curriculum and that parents can withdraw their children from classes, having high-quality and diverse teaching is clearly key to encouraging them not to do so. It should also not be the afterthought, as mentioned by a number of noble Lords, that Ofsted has found it to be in the school timetable. Does the Minister have specific numbers relating to how many children do not take part in RE where it is offered?
What is being done to end the postcode lottery when it comes to religious education in schools? As noted by many noble Lords, some students receive far more comprehensive and specialist teacher-led religious education than others. I would welcome the Minister’s views on what more the Government can do to reverse the apparent decline in the number of specialist RE teachers and in RE teaching and on the many other questions raised in this debate.
The Parliamentary Under-Secretary of State, Department for Education (Baroness Barran) (Con)
My Lords, I congratulate the noble and right reverend Lord, Lord Harries of Pentregarth, on securing this important debate on religious education and in true “Thought for the Day” style on expressing his thoughts so eloquently. I also thank noble Lords around the Room for their insightful contributions throughout the debate.
As many of your Lordships have mentioned, it is vital that our children receive high-quality religious education. In a society where, according to the 2021 census—as was noted by the noble Lord, Lord Warner, and the noble Baroness, Lady Meacher—there has been a significant shift in the religious demographic in recent years, it is as important as ever for our children to gain knowledge, understanding and tolerance of a wide range of religious and non-religious beliefs.
As the noble and right reverend Lord set out, religious education is a truly unique subject which has personal, social and academic benefits. The noble Lord, Lord Parekh, asked why we teach religious education and what the point of it was. Other speakers have perhaps answered some of that already but, certainly from the Government’s perspective, when done well, religious education can develop children’s knowledge of British values and traditions, help them better understand those of other countries, and refine their ability to construct well-informed, balanced and structured arguments. It provides opportunities for pupils to engage with questions of belief, values, the meaning and purpose of life, and issues of right and wrong, and to do so—picking up on the spirit of what the noble Baroness, Lady Fox, said—in a respectful and safe environment.
Knowledge of world religions is also valuable in supporting our children to thrive in our own multicultural society as well as in terms of Britain’s relationships with other countries. It is important that we all understand the values and perspectives of those who live around us as well as of those with whom we wish to conduct business or build diplomatic relationships overseas. The Government are committed to ensuring that RE delivers on all this, which is why it remains a compulsory subject in all state-funded schools in England for each pupil up to the age of 18. As we heard powerfully from the noble Lord, Lord Hastings, we also need teachers who bring great passion to the subject. In addition to the noble Lord, I want to thank a teacher from the West Country who sent me his thoughts ahead of this debate having seen an RE teacher. I am very grateful for his views.
Teacher recruitment and retention are crucial to every curriculum subject. As we have heard, teachers who are specialists in their subject are key to maintaining standards. The department is driving an ambitious programme to transform the teacher training process. Specifically in relation to recruitment, we are focusing on how we do our marketing, support prospective trainees and use more real-time data and insight from our new application process to boost recruitment where it is needed most.
A number of noble Lords, including the right reverend Prelate the Bishop of Durham, questioned the level of recruitment to RE teaching posts. As your Lordships set out, in the academic year 2023-24, 44% of the recruitment target for RE was reached. This is lower when compared with recent years, although it should be noted that the target increased by more than 45% to 655. There is work to be done here and the Government recognise that initial teacher training recruitment remains challenging due to the competitive graduate labour market. Therefore, we were pleased to announce that the department will again be offering a £10,000 bursary for RE trainee teachers starting initial teacher training in 2024-25, which we hope will incentivise greater numbers to apply.
We also continue to offer eight-week subject knowledge enhancement courses, or SKEs. Currently, in the 2023-24 academic year, a subject knowledge enhancement course is available for candidates who have the potential to become an outstanding teacher but need to increase their subject knowledge. Those courses are available in nine secondary subjects and primary maths. They include an eight-week course in religious education. All these courses can be undertaken on a full-time or part-time basis but they must be completed before qualified teacher status can be recommended and awarded. Eligible candidates may be entitled to a bursary of £175 per week to support them financially while completing their course.
The noble Baroness, Lady Fox, highlighted some of the pressures that RE teachers in particular face. Of course, once recruited, teachers should feel supported in their role. By its very nature, religious education can contain contentious and sensitive content, not least in the context of current world events, and pupils’ curiosity can rightly lead to challenging questions and comments. That links back to the fact that teachers who are teaching RE need to feel confident in their knowledge and their ability to deal with these challenges and that they are supported by a great curriculum and appropriate and accurate materials.
The noble Baroness, Lady Meacher, asked whether non-religious world views are being included in the RE curriculum. She referred to the recent court rulings which have made it clear that religious education should include the teaching of non-religious world views. Non-religious world views are already an integral part of the department’s religious studies GCSE and A-level subject content specification.
The noble and right reverend Lord, Lord Harries, and other noble Lords stressed the importance of having a strong curriculum. To assist in this, Oak National Academy is in the process of procuring curriculum resources for religious education which will mean that high-quality lessons are available nationwide, benefitting teachers and pupils where schools opt to use them. They will begin to be available from autumn this year and will be fully available by September 2025.
The noble and right reverend Lord also asked whether the Government intended to introduce a particular national plan for religious education. We currently have no plans to do this nor to revisit the recommendations made by the Commission on Religious Education. Our policy remains that curricula should be determined locally, whether through locally agreed syllabuses or by individual schools. Obviously the Oak resources I referred to will be available to all.
Having said that, the Government also welcome the work that the Religious Education Council has done to assist curriculum developers by publishing its National Content Standard for Religious Education in England. This is not a curriculum in itself but, without specifying precisely the content that schools should teach, it provides a non-statutory benchmark against which syllabus providers and others can choose to inform or evaluate their work.
That links to the question from the noble Lord, Lord Griffiths of Burry Port, about dedicated expenditure on religious education in schools. The Government’s stance remains that we trust schools to judge how to use the funding that we give them. We trust their judgment and we give them autonomy to decide how to use that funding. On the question from the right reverend Prelate the Bishop of Durham about whether we are planning to include religious education in the EBacc, I think he knows the answer: there are no current plans to do so.
The noble Lord, Lord Storey, and the noble Baroness, Lady Garden, both talked about the number of schools failing to comply with their duty to teach religious education. As your Lordships pointed out, schools that are not teaching RE are acting unlawfully or are in breach of their academy funding agreements. In answer to the noble Baroness, Lady Twycross, we do not monitor each school’s compliance with the duty to teach RE any more than we do for English, maths or any other subject. If there are concerns that a school is not teaching RE, they can be raised via the school’s complaints procedure. If they are not resolved, they can be escalated to the department.
In concluding, I restate the Government’s commitment to ensure that every school is fulfilling its statutory duty to deliver RE. It is mandatory now and there are no plans to change this. It is the right of every child to receive a well-rounded, comprehensive and high-quality religious education. We recognise some of the challenges that your Lordships have pointed out, but I agree with the noble Lord, Lord Griffiths, about the importance of “humanum”, of developing the human, which all our schools strive to do, every day.
National Immunisation Programme
(11 months ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what plans they have to accelerate the adoption of new innovative vaccines by the National Immunisation Programme.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I was delighted to secure this debate as it is a subject of significant importance and one in which I have a close interest. Noble Lords will be aware of my particular interest in RSV, on which I had a Question only yesterday. But this is more about the global issue of which vaccines can get accelerated on to the national immunisation programme.
Undoubtedly, vaccines have contributed significantly to health and prosperity around the world ever since the pioneering work of Edward Jenner, who developed the world’s first vaccines for smallpox. The World Health Organization has said that vaccinations are
“one of the best health investments money can buy”.
Vaccines are critical to the prevention and control of infectious disease outbreaks, and they underpin global health security.
The Covid-19 pandemic imposed enormous pressure in 2020 and 2021, and it showed the importance of having robust plans and systems in place to address emergencies. Despite some setbacks, what both the UK and other countries achieved was remarkable. The pace at which vaccines were developed, manufactured and rolled out to patients was excellent. It was good that government, industry and the NHS came together to collaborate in order to accelerate existing timetables, taking months rather than years to get the job done.
I welcome the recently published NHS Vaccination Strategy and its emphasis on improving uptake rates and optimising the quality of the delivery of clinical trials. However, the strategy focuses on the better rollout of existing vaccines but does not include what more can be done to ensure that the UK has in place the right infrastructure for approvals and delivery, in order to enable new vaccines to reach patients as quickly as possible. I believe this is a mistake: we should focus on both. Put simply, we must improve the delivery of existing vaccines and spend existing money more effectively and efficiently in order to get new vaccines to patients more quickly and effectively. In fact, I received briefings this week from the Royal Pharmaceutical Society about the value of community pharmacies—their work had already been seen in the rollout during Covid-19—and how they can be used in this new deployment.
I was delighted recently to chair a round-table discussion with key stakeholders, hosted by GSK in your Lordships’ House on 19 October. It looked at this issue, lessons learned from Covid and how they could be applied to the national immunisation programme as we move forward. That discussion was very timely, following the Health and Social Care Committee’s report on vaccination, in which it said:
“It would be incredibly disappointing to reach a point where the vaccines themselves were ready but the infrastructure to approve and deliver them was still some time away”.
Our round table concluded many things, such as that quicker availability and increased uptake of vaccines would lead to a healthier nation, which in turn would have direct and immediate benefits for our economy.
Rather than looking at vaccines as a cost, we should see them as an investment. Recent studies have shown that the return on investment for vaccines can be as high as 14:1. Slow and low uptake of vaccines can cost the NHS money and soak up valuable resource. Each month that vaccine rollout is delayed means more patients attending general practice and A&E, and being there for hours on end, as well as more patients being admitted to hospital.
Working together, the Government, the NHS and industry can deliver a first-class national immunisation programme that gets new vaccines to patients as quickly as possible and delivers significant financial, operational and economic benefits. At a time when the Prime Minister has said that reducing waiting lists is a key priority for his Government, we must not forget the role that vaccines can play in helping to deliver this. I hope the Government are listening and will act. I am happy to share the round table’s report and its key recommendations with Members of your Lordships’ House, but we must turn words into action. We should be ambitious for patients, because we want to deal with all the health implications. We also want to address the new diseases that have not been subject to vaccines and could be readily dealt with.
We need a clear commitment from the Government to accelerate the NIP, and a clear and timetabled plan to achieve that. We need a commitment to work with industry and other stakeholders to deliver that plan. We must not let capacity or capability determine the speed at which vaccines enter the programme. That will mean a commitment to resourcing the JCVI adequately, and we need to improve JCVI horizon scanning and the liaison with industry. As we did during Covid-19, we should also establish a single front door to help industry navigate across government on routine vaccines.
I have some questions for the Minister. Will he give concrete commitments today to ensure the acceleration of the NIP, with a clear and timetabled plan to achieve it, and to work with industry and other stakeholders to develop that plan? If such commitments are given, can the Minister provide us with the timetabled plan, including an indication of the resources—staff and money—to deliver it? I know that there are many competing priorities for the Government, but there are also many for the National Health Service, not least the need to keep people well. However, these recommendations are all based on valuable lessons learned during Covid. I therefore seek your Lordships’ support for delivering them, as they will benefit patients, the NHS and the economy.
The UK built a world-leading vaccine development and deployment system during Covid-19 that enabled it to be at the forefront of global pandemic efforts. It is vital that the lessons learned during the pandemic are built on, to ensure that the UK has the right infrastructure in place for the approval and delivery of new vaccines on to the NIP, reaching patients as quickly as possible. We have the proven wherewithal to do it through the NHS and all the associated bodies.
Finally, when will the acceleration and accompanying works for NIP take place, and when will the funding be in place? I look forward to the Minister’s response and the contributions of other noble Lords on this very important issue, which impacts right across the UK. It relates specifically to NHS England, but I come from Northern Ireland, where this is a devolved matter. I am sure Scotland, Wales and Northern Ireland would like to do the same and see these approvals on to the national immunisation programme. It is vital for our health, our economy and our society.
Baroness Twycross (Lab)
My Lords, I thank my noble friend Lady Ritchie for securing this debate. I declare an interest as the chair of the London Resilience Forum and vice-president of the Encephalitis Society, a charity that advocates the use of vaccines for prevention of encephalitis.
Like my noble friend, I feel very strongly about vaccination and access to it. I would not normally use my own life story to back up a point in a debate but it feels appropriate to do so on today’s subject. As a teenager, I got mumps. It was very mild and nobody was particularly concerned. In those days it was treated as another childhood sickness that it was helpful for children to pick up at some point. The routine vaccine was introduced just a few years later as part of the MMR suite of vaccines, but it was not available at that time. Over the course of the few weeks after my mild dose of mumps, I became increasingly ill, and after several weeks of acute illness I was diagnosed with viral encephalitis, an inflammation of the brain. I am one of the lucky people who has contracted encephalitis but had a good recovery, with very few lasting effects. In the worst-case scenario, encephalitis can kill or cause brain damage or severe long-term disabilities.
Had MMR been available to me as a child, I would not have had this serious illness, which severely impacted my health throughout my teenage years and into my early 20s. Childhood vaccines save lives, limit disabling side-effects and prevent serious illness, but we do not yet have all the vaccines available that could do this.
We know that chickenpox can also lead to viral encephalitis or other complications, including death. I am delighted that the JCVI now recognises the life-saving potential of the varicella vaccine. I pay tribute to all those who have been campaigning on this issue over many years, including Professor Benedict Michael from Liverpool University, to whom I had the pleasure of speaking about this issue earlier this week. As noble Lords are probably aware, the varicella vaccine is routinely used in other countries, such as the USA, where it has been part of a suite of childhood vaccines since the 1990s. Other developed countries use it, including Italy and Israel. As the chair of the JCVI, Professor Sir Andrew Pollard, has said:
“Adding the varicella vaccine to the childhood immunisation programme will dramatically reduce the number of chickenpox cases in the community, leading to far fewer of those tragic, more serious cases”.
I understand that one of the arguments used previously against the introduction of the varicella vaccine has been a general belief in the UK that having some chickenpox circulating in the population provides greater immunity to older people at risk of shingles or shingles encephalitis from the virus. We should have evidence-based medical interventions. There is no evidence of higher rates of shingles or shingles encephalitis in older people as a result of childhood vaccination against varicella over the past 30-plus years in the States. Now that older and more vulnerable people are routinely offered a vaccine against shingles, which I welcome, this herd immunity argument should be discarded as the outdated argument that it is and confined to the past. Does the Minister agree with this position, and that chickenpox parties, which, shockingly, still take place, belong to the Victorian era and should also be confined to the past?
Can the Minister tell us whether and when the Government are planning to introduce the varicella vaccine? If he cannot, can he say when the Government are likely to take a decision on this issue? If the vaccine is added to the suite of childhood diseases that parents and guardians are encouraged to take up on behalf of children, how will the Government increase public health messaging to ensure that they understand exactly why this is needed?
Tragically, it is not just new vaccines that require public health messaging. In recent days we have heard of measles outbreaks in the West Midlands. We know that vaccine take-up is not uniform across social demographic groups. Can the Minister say how the department is addressing this and making sure that the current outbreak does not disproportionately impact specific groups?
Regrettably, the false claims about MMR are still causing vaccine hesitancy among some parents, and a whole generation of children, who are now young people, are undervaccinated. I raised the low take-up of MMR in London with the Minister last year and am grateful for his response at the time. I was pleased to hear from the UKHSA in London about work that is being done to ensure that MMR vaccines are available to students.
I appreciate that the Minister may not have this information to hand, but will he commit to looking into this work to ensure that this type of initiative is taking place across the country? Are there similar initiatives for other groups of adults who may have missed out? Will he commit to making sure that every effort is made to push back on the continued false claims or rumours about the MMR vaccine?
My noble friend mentioned the RSV vaccine. As noble Lords will be aware, this virus is the major cause of babies and young children having to be admitted to hospital, with more than 33,000 admissions every year, including 20 to 30 avoidable and tragic deaths of otherwise healthy children. Can the Minister commit to a timeline for introducing the vaccine for this age group? We know that RSV affects older people too and leads to an estimated 175,000 GP visits, 14,000 hospital admissions and 8,000 deaths among people aged over 60 in the UK every year. These are not insignificant numbers.
The House of Lords Library Note helpfully outlines the range of vaccines currently available. Missing from this list is the Covid vaccine, which over the past few years has saved innumerable lives and reduced the already frightening number of people suffering from long Covid. We know from recent reports that by June 2022 only 44% of the population had taken up their recommended number of jabs and boosters. In the early stages of the vaccine programme, a huge amount of cross-sectoral effort went into tackling disproportionate uptake in the face of considerable organised disinformation about the vaccine. What learning have the department and the NHS taken from that effort during the pandemic? How can and will that be applied to ensure that take-up improves to prevent future serious impacts of Covid, where possible, including preventing avoidable deaths? Will the Minister tell us when we will know what the long-term plans are for continuing to offer Covid vaccinations as part of a suite of vaccines offered to older and vulnerable people? Are the Government planning to include vaccines against RSV for these groups? Returning to the Covid vaccine, I ask: will the Government allow and perhaps encourage the commercial provision of Covid vaccines in future, as is the case with the flu vaccine, which is readily available in pharmacies?
My final point is on investment in science and technology. I think we are all proud of the ground-breaking work of British scientists in the fight against Covid. It was an unprecedented achievement in terms of the speed of the development and delivery of a new vaccine, as my noble friend Lady Ritchie stated. Can the Minister say what planning the department is undertaking to ensure that we use this generation’s success to inspire the next generation of epidemiologists and what investment it is planning to do this? How is he working with colleagues in other relevant departments to ensure this is possible? As I am sure noble Lords have gathered, this is an issue I feel very passionately about. I look forward to hearing the Minister’s response to this debate.
Lord Allan of Hallam (LD)
My Lords, I am extremely grateful to the noble Baroness, Lady Ritchie, for both the opportunities she has provided us with to debate vaccination this week. The bulk of my remarks will follow closely the comments made by the noble Baroness, Lady Twycross, but first I want to follow up on the RSV Question yesterday. The Minister’s Answer made me rather more nervous than reassured. I asked who was going to be responsible for the RSV vaccination programme and he described a landscape in which there are different teams dealing with infants, children, old people and so on. I do not want to be mean to the Minister because I know he is struggling through a cold while turning up to debate these issues and I am hesitant to correct him, but I wonder whether the correct answer actually is that Steve Russell, the chief delivery officer of NHS England and the person responsible for vaccination screening, is the person whom we should praise if the RSV programme is rolled out well or hold accountable if it is not. It seemed to me as I looked at it that Steve Russell may be the name I was looking for as the single responsible owner for that programme.
In terms of my broader comments, there are three areas that I want to touch on. The first is access to vaccination and immunisation records where any individual wants to understand what they or their children have had and where the gaps are. This still leaves a huge amount to be desired. Again, we saw an example during Covid of how this can work well. Everybody had an immediate interest, not least related to travel and access to facilities, in getting hold of those records; we produced them in double-quick time, and they are still there today. However, if you go beyond that and try to find your broader vaccination and immunisation records, it is a mess. I went online to look for it and found Connected Nottinghamshire, which helpfully offered some advice. That advice is multiple screenshots saying go into the NHS app and click on “consultations and events” or “medicines” and various other routes through, and they all basically end up telling you to go back and ask your GP. That is a super inefficient use of a GP’s time.
We have done all this work with the NHS app—take-up was boosted dramatically though the Covid vaccination certificate programme, we have invested a huge amount in it, and we now have medical records accessible through it—but, unless the Minister can correct me, it seems that, in most of the country, if an individual says, “I want to see what vaccinations I have had and what is missing”, they will not be able to do that. There is no simple, straightforward way to do it. I hope that the Minister can talk about whether the Government have a programme to enable that to happen, as it seems a very basic and fundamental thing. Knowing that information can help to boost take-up rates, which is what we are looking for. If people can see the gaps, they are much more likely to try to fill them.
The other part of that is integration with other sources of vaccination and immunisation. Obviously, there are travel vaccines, most of which are, correctly, not offered by the NHS; they are seen as a voluntary thing that individuals should pay for. However, if they have paid for a travel vaccine, there is an interest for the individual and a broader public health interest to make sure that that is integrated into their medical records. That is not the case today. There may also be workplace vaccinations. A lot of workplaces offer flu programmes. Other noble Lords may have had this experience: I took up the flu vaccine here, at our workplace, and was then pinged every few weeks by a reminder from my GP practice to come in for a flu vaccine, and I would go back to it saying, “I’ve had it”, and it would say “We don’t know that you’ve had it”. There is clearly a lack of joined-up connection there. This year, I went to have it done by the GP just to make sure I did not get those reminders every week. If workplaces have gone to the trouble of putting in place vaccination programmes, the least that we could do is to integrate those into NHS records. There are models, such as Patients Know Best, that allow you to integrate your own personal health data, and I hope that the Minister can indicate that there is some work going on in government to make sure that we follow that kind of model and bring this all together.
The second area that I am interested in is around invitations to participate in programmes and how those information flows work. Again, Covid was a model of clarity: you knew what you were getting and why you were getting it. The invitations went out to people using lots of modern channels, which made it very easy. People learned the language of Covid vaccination—“Are you getting a Spikevax or a Pfizer?”—but it was a very rare and exceptional situation. If you look back at the norm, the norm is that it is very confusing. The NHS produces a nice chart of all the vaccinations that you will get, but it uses jargon and abbreviations. I understand why—those are the accurate terms—but, for an ordinary person coming across this, they really are not very clear about what they are getting, why they are getting it and why it is important for them.
Again, I do not think that this is just in the area of vaccinations. I cite my personal experience: I got a text message from my practice asking if I wanted to come in for AF screening. As I am a health spokesperson in this place, I thought “I should know what AF is”. I looked it up and it stands for atrial fibrillation. If it had sent me a message that said, “We want to check that your heart is ticking over as it should; please pop in”, it would have been a lot more attractive than one asking if I wanted to come in for AF screening. I think most people will not have bothered to look it up and decide whether they should have it. I hope that the Minister can say who is looking at both the language of and the distribution channels for all these invitations for vaccinations and immunisations to make sure that they are optimised. To people working in the tech sector, this is known as UX—user experience—and they understand that changing the language on something changes the click-through rate dramatically. Similar discipline is needed here to make sure that all the invitations to vaccinations and immunisations are optimised for the target audiences and make them as likely as possible to click and to go and get that vaccination.
There is a generalised problem with distribution channels in the NHS that each screening programme has its own systems for call and recall, and they are not co-ordinated or joined up. If we want take-up of screening, vaccination and immunisation, the least we can do is to join up those programmes, have consistency around language and channels and some kind of pattern and schedule so that people understand what they are being invited for and when. I hope the Minister comments on consistency and co-ordination.
The final area on which I will touch is that of risk. This again follows the comments of the noble Baroness, Lady Twycross, and this is critical to take-up. MMR showed us how this can go off course. People weighed a risk that turned out to be false against a genuine and much more significant risk of suffering from a real disease. The noble Baroness’s personal comments showed us just how important it is that people take up these kinds of vaccinations. The result was a situation in which children have been harmed and not benefitted, which is still ongoing today. There will be children catching measles now, some of whom will, sadly, have very serious complications, essentially because of a false assessment of risk: the risk of MMR against the so-called, supposed risk that people presented on the other side. In some ways, this is comparable to people switching to driving every time there is a train crash. The data is clear: the train is safer than the car at all times. People often react to a single incidence of a problem. With a vaccine, as we saw with Covid, there will be somebody who has a heart attack following a vaccination, but that does not mean that the risk of not having the vaccination is better than the risk of having it. It just means that one person, sadly, had a heart attack.
There is a lot to be done on communicating risk. We need continually to help people to understand the rationale for each vaccination programme, not just the new ones but existing ones, as MMR has shown. I would be interested in understanding what the Government are doing to address this challenge, particularly considering the different levels of trust that different messengers have. We all understand that doctors, for example, are far more trusted than politicians like us. Pharmacists have a very trusted role within the community. We need to think carefully about how we communicate risk and use the most trusted sources.
I again thank the noble Baroness, Lady Ritchie, for this opportunity, and I hope that the Minister will refer to the points I have raised, perhaps in writing, to spare his voice, if he cannot respond to everything verbally today.
Baroness Merron (Lab)
My Lords, I add my congratulations to my noble friend Lady Ritchie, who is as we all agree a great champion for better health through greater take-up and availability of vaccines and immunisation programmes. She rightly described them as a sound investment by the NHS, and I certainly agree.
There are two main issues at play: first, the failure of already approved and recommended drugs to be included in the national immunisation programme and, secondly, the number of factors that have slowed down how long the whole process takes. It potentially takes around a decade to pass through every stage of trial and approval and two years or more for a new vaccine to reach patients post regulatory authorisation.
I am sure that we all want vaccines to be available to patients quicker and to see full account taken of patient safety and cost effectiveness. It seems to me that the way forward is to emphasise systemic options to improve availability without sacrificing the necessary safeguards.
Like other noble Lords, I am grateful to the many stakeholders who have conveyed their views to me on how to accelerate the adoption of new innovative vaccines by the national immunisation programme. Their main suggestions for tackling these damaging delays focus on ensuring that the overall system works better while adapting to additional risk, perhaps in extraordinary circumstances, such as those we saw in the Covid pandemic.
But it bears pointing out that this is against the backdrop of a step in the wrong direction, which we have heard about, such that, due to a decade of declining rates of uptake of the MMR vaccination among preschool children, for example, the UK no longer has the status of having eradicated measles, according to the World Health Organization. This is borne out by Steve Russell, whom the noble Lord, Lord Allan, referred to; he is the chief delivery officer and national director for vaccinations and screening at NHS England. He highlights a decline in vaccination-programme uptake, particularly for childhood vaccinations, in the foreword to the NHS England strategy.
I thank my noble friend Lady Twycross for bringing before us the importance of childhood vaccination. She brought it into focus by sharing her own story, for which I am sure we all thank her, but her call for evidence-based intervention and for ensuring coverage by immunisation programmes surely must be heeded. It would be helpful to hear what discussions continue to take place across government about tackling misinformation and disinformation about MMR and other vaccines, which we obviously still see proliferating on social media.
I will put a few points to the Minister about the much-needed improvement of the UK’s performance in immunisation development and delivery. We heard from my noble friend Lady Ritchie about the GSK-hosted round table, which she kindly chaired. I noticed that she described the response during the Covid-19 pandemic as “remarkable” and I endorse her comments. That response magnified the value of vaccines to individuals, health systems, society and the economy, and it is absolutely vital to embed the lessons that were learned before they are lost, as she said. So I amplify the points made by my noble friend, because it would help to hear from the Minister about what lessons the Government have learned from the pandemic, what assessment they have made of the potential value of each of those lessons and what steps are being taken, at the very least, to assess the potential benefits from continuing in that manner, but ideally to take action to embed in the system all the good practice from which we have learned.
Within this, I echo the call for pharmacies to be complimented for rising to the challenge during the pandemic. They continue to play an increasingly key role in providing advice and healthcare, including convenient and accessible vaccination services. Does the Minister consider that community pharmacies can play an even larger role in immunisation programmes by expanding the range of vaccines that they can offer, including those for shingles, RSV and pneumonia? What steps are being taken to marshal the forces of community pharmacies and expand their potential as community well-being hubs?
The second point is a predictable issue with a bearing not on safety but on bureaucracy. I am aware of the potential complexities, but what steps are the Government taking to explore the adaptation of funding mechanisms to expected new programmes in order to avoid delays and issues because of the constraints of rigid envelopes and complex approval processes? What are the general steps in the areas of improving resourcing, co-ordination and process across regulators and health-technology assessment bodies?
There is an increasing focus on the role of vaccination in fighting AMR. The JCVI has shown some willingness to consider its impact in its value-assessment criteria. I suggest to the Minister that this could be an interesting development. Given that it is newer science, it would be interesting to hear from the Government what assessment they have made of the AMR-reduction benefit from vaccines and whether they are taking any steps to explore how it can be harnessed further.
With further reference to the JCVI, I want to raise the suggestion of evolving its work to better enable the adoption of innovative vaccines. Broadly, it is important that the JCVI is continuously looking ahead. Can the Minister indicate how the Government are working with JCVI to ensure this mode of travel?
I was very interested in the argument put forward by Policy Exchange that a busy pipeline of new vaccine technologies in the coming years, including a growing number of therapeutic as well as preventative candidates, coupled with a concerning decline—as we have discussed —in the uptake of key programmes such as MMR, necessitates a fresh look at the architecture and delivery model for vaccine development and deployment. Policy Exchange’s key recommendations on delivery include boosting ministerial oversight—I am sure the Minister will have a view on that; expanding the role for community pharmacy, which we have talked about many times in our Chamber; creating a new workforce model; and piloting a local delivery model called a “vaccine collaborative”. The positive and overarching principle behind those suggestions is that of extending care further into the community. It would be helpful to get a sense of the Government’s ambition in this area and the steps they are taking to move beyond traditional delivery mechanisms to make this improvement.
As I said at the beginning, we all want an improvement in the UK’s performance in immunisation development and delivery. I look forward to hearing the Minister’s response.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I too thank the noble Baroness, Lady Ritchie, for allowing us to have this debate today. To my mind, this is the right way to do business—for want of a better word. We have smart people who know about the subjects as well as people who have personal experience, and we are having a good conversation about how we can learn the lessons from the situation, make improvements and make sure that we are up to speed with the latest that is going on. Again, I thank the noble Baroness and all the contributors to this debate. I hope that I respond in the right vein.
As many have mentioned, we have a good track record in terms of the standing of the immunisation programme. NIHR is a fundamental piece of that. As mentioned on a few occasions, the horizon scanning by the JCVI is obviously a key part as well. I want to talk later about some of the Covid dividends that I am starting to see in terms of point-of-care medicines, with Moderna and BioNTech using messenger RNA. That goes right to what the noble Baroness, Lady Merron, said about the need to look at the new delivery mechanisms.
The JCVI is key to it all. This debate gave me the opportunity to understand more about the process that it goes through in trying to do that horizon scanning and make sure that we understand what is coming through in the pipeline, what differences it will make and how we evaluate that quickly. We have also commissioned the National Immunisation Schedule Evaluation Consortium to undertake policy research, going upstream even further, looking at the use of different vaccines and schedules.
As I mentioned before, probably the best thing we are doing in terms of the heritage is putting in place the new agreements, which I very much call a Covid dividend, knowing that we will be spending hundreds of millions a year on Covid vaccines for the foreseeable future. Let us make a benefit out of that necessity and get both BioNTech and Moderna to invest in the infrastructure in the UK so that we can do more of this research going forward. That is what I mean by the Covid dividend, as the noble Baroness, Lady Twycross, mentioned. It means looking at the point of care for some cancers, which is particularly exciting. It looks at a person’s particular cancer and cells and then alters and gives personalised treatment. I am sure we are all familiar with some of this. The beauty is that a person’s own body attacks the affected cells, without the blunt instrument of chemo, which kills lots of cells around the cancer as well.
The challenge—this goes right to the point made by the noble Baronesses, Lady Ritchie and Lady Merron, who asked how we deliver and whether the infrastructure is right for doing these sorts of things—is that all of our sudden you are moving from a model of mass production of vaccines in a big factory to individual, tailored creation of vaccines, and often some of the substances are very unstable. In one example I was given, you have only 20 minutes to use it. In that environment, you need to look much more at the real point of care and have a point-of-presence delivery that is not a big factory but where the capability is very close to the patient, whether in a GP or hospital environment, to produce and then deliver those sorts of drugs. In terms of our main learnings, that will be a major dividend from Covid and will transform the whole way in which we deliver our medicines. I hope that, in time, we will see the replacement of chemo in a lot of places with much more specific, delivered medicines.
As I said, I will write about anything I may have missed—as noble Lords will be able to hear, I am very croaky, and I have another debate after this one. In reply to the noble Baroness, Lady Ritchie, I would indeed be interested in hearing the GSK results from the round table. I hope that I have given some reassurance on the infrastructure, but I will give more detail on that as well.
The key point is that, while we can talk about all the sexy stuff in terms of the innovation and treatments, the point made by the noble Baroness, Lady Twycross, from her own experience of issues around MMR, really shows the importance of this. As I mentioned in the debate the other day, I spoke to Chris Whitty specifically about this. It is the most infectious disease out there. We all got used to R rates of 1.1 and 1.2 during Covid. That is a really big R rate, where you know it will be exponential. Noble Lords heard me mention that the R rate on measles is 13, which is massive. One in 1,000 people suffer from brain damage from it, so I completely agree with the noble Baroness that the idea of chickenpox parties is very outdated. I remember them from my childhood. I know that they are reviewing the chickenpox vaccine as we speak.
As I said, we are gearing up on the RSV process. The tender is going out as we speak, and we are looking at delivery this autumn. As I mentioned the other day, it is a different process depending on whether it is for maternal or baby use, or for the over-75s, but we are going through that process.
I will come on to some of the other questions. Thank you for the research; I agree on Steve Russell. The main point made by the noble Lord, Lord Allan, was about user-friendliness. I had my own experience of this when, knowing that I had these debates coming up, I asked the team to get me a schedule of everything that the JCVI has approved. They gave me a list of all these vaccinations, and I had to go back with my tail between my legs and ask, “Can you tell me what all these things are for?”. The noble Lord mentioned AF—I like to think that, similarly, I know quite a few of the abbreviations these days, but I needed them to give me the Noddy guide. The language for those using the app is vital. It is a critical piece to help inform people, especially when they are looking at their records. As the noble Lord is probably aware, the records are currently forward-looking: we need to start getting them to go back historically, and that is something I see a real utility in; it is not there today but it needs to be. The beauty of that is it can be optimised for the target audience. On the question of how we increase uptake in those hard-to-reach areas—as the noble Baroness, Lady Merron, mentioned—the most effective way of doing that to date has been ringing up the parents of under-5s, and then moving on to under-11s and under-25s. Doing that through the app will clearly be more effective in terms of time and money, so that must be the way forward.
The role of community pharmacies is a vital part of delivering point-of-care medicines. I was really interested to hear on one of my trips that GPs in America are really struggling as a profession these days. They cannot recruit them; I asked why not, and they said the problem was that many of the routine things that GPs were making money from had been mass-industrialised by the likes of CVS and Walgreens. This really resonated when the noble Baroness mentioned the app; we need to make sure these vital medicinal and well-being hubs are thriving, and that we do not repeat the American experience. That is why Pharmacy First is a very positive thing for promoting community pharmacies as a place for patients to get care and as a way of improving the finances and commercial viability of these places that I see as key assets.
The question about the AMR benefits of these vaccines was interesting; I do not know the answer off the top of my head, but I will take it away and try to come back with a detailed answer. To conclude—
Baroness Ritchie of Downpatrick (Lab)
I thank the noble Lord for giving way. In the fullness of time—I know time is short today—could he give some thought, along with his ministerial colleagues, to the acceleration of the NIP programme so that it is possible to get other vaccines on to it, because of the infrastructure, the funding, the investment and the staff in it, so that we can use the good practice we have to benefit our economy, health and patients generally?
Lord Markham (Con)
Yes, I must admit that I need to write to the noble Baroness on the NIP programme because I do not have the detail, but I undertake to do that.
In conclusion, I thank noble Lords; these informed debates have real value. I will take up those points about the use of clear language and acronyms, and make sure that we are accelerating those basic vaccines, which is a vital part of this.
Dementia
(11 months ago)
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Baroness Browning
To ask His Majesty’s Government how they plan to create a parity of esteem between health and social care to address dementia.
Baroness Browning (Con)
My Lords, I declare my interests as co-chair of the All-Party Parliamentary Group on Dementia and as an ambassador of the Alzheimer’s Society. I bring this debate to the House today because dementia affects 944,000 people in the UK, or one in 11 of those over the age 65, and the number is predicted to reach 1.6 million people by 2040. It is the leading cause of death in this country.
Dementia is an umbrella term for a number of conditions, the most prevalent of which is Alzheimer’s. Symptoms include memory loss, behavioural change, motor function loss and visual processing issues, among many others. It is degenerative and terminal and, as of now, there is no cure. All stages of the disease have a need for both social care and healthcare, from diagnosis to death. Ironically, diagnosis is still a long wait in many parts of the country. Unfortunately, we do not know how long people are waiting because the data is not collected. I will say more later about end-of-life care.
It is essential that these two services—health and social care—work in tandem and are resourced to enable them to do so. This will avoid the historic tension of buck-passing of responsibility, excessive delays in support and letting down both the patient and their carers. I know that many Members of this House have first-hand experience of caring for people with dementia—I do myself. To give a real feel for what this is like, I commend the current ad on our screens from the Alzheimer’s Society called “The Ultimate Vow”—noble Lords may have seen it—which portrays Laura and Adam, a married couple on their dementia journey. It is very moving and also very accurate.
Today, I would like the Minister to address healthcare and social support as of equal value and inseparable. That requires not just parity of esteem between them but a reorientation of systems away from siloed professions and a focus on care in hospital. Shockingly, NICE reports that one-quarter of hospital beds are occupied by people with dementia, often due to emergency admissions for avoidable reasons such as falls and urinary tract infections. I therefore say to the Minister that there is no more compelling reason for hospital at home, including residential care homes, than this group of people, and I add that that should also apply to hospice at home. Decades of failure to plan and resource services adequately to enable personalised care for a condition as complex and as common as dementia is long overdue. Starting from diagnosis, all patients should have a care plan, which clearly will need reviewing as things change, for change they will, becoming more challenging over time. In six years of caring for my husband with Alzheimer’s, nobody ever suggested a care plan. The one that I had was one that I devised in my brain. Care plans should apply to everyone, including those who are self-funding.
Less than 65% of people with dementia have a formal diagnosis—a figure we simply would not tolerate for other conditions. We are not talking just about people with memory lapses; at all stages of the pathway trained staff are essential. I welcome the Government’s recent announcements of funding for social care training. Only 45% of the social care workforce have a record of dementia training, but please do not forget healthcare: district nurses receive good training, but training for hospital ward staff, even those on some geriatric wards, requires improvement, particularly on caring for people at the end of life. Some 30% of people with dementia do not die in their normal place of residence. Aside from the disorientating activity of an open ward or an A&E department, we should think twice about admitting anyone with advanced dementia into hospital unless there is a real medical imperative. Neither nurses nor healthcare workers are properly trained to provide palliative care for dementia patients. They certainly cannot provide the one-to-one care necessary. I know that my noble friend will have noted my earlier request for hospice at home for dementia patients.
There are more ways that we need parity and integration, and the establishment of integrated care systems in England provides some hope of a mechanism through which they might be achieved. There is no specific mandate for them to focus on dementia, but they are required to commission on local need.
The APPG on Dementia published a report last month entitled Raising the Barriers, which proposed local dementia strategies for each area, a named dementia lead in each integrated care system and a dementia steering group. Is this special pleading? Yes, it is and I make no apologies for it. The scale of dementia nationally is going to increase and, while we all hope that medical science will one day alleviate this challenge, this is today’s challenge and tomorrow’s and the day after’s. This would be a huge move forward, combining health, social services and the voluntary sector.
Can the Minister say what the rules are for the decision-making of integrated care systems being made publicly available? Recently, owners of care home providing for people with dementia expressed concern to me about the transparency of decision-making, particularly on the transfer from hospital to residential care for the first time.
So far, I have not mentioned the cost to the patient or their carer. We have had many debates in the House about personal expense to the individual. The Alzheimer’s Society estimates that two-thirds of the annual cost of dementia, reckoned at £34.7 billion, is paid for by people with dementia and their families, either in unpaid care or in paying for private social care. In addition, care providers often charge an extra premium because of the complexity of dementia, adding 15% to costs. Additionally, support such as NHS continuing healthcare, including for complex health needs, is not easily obtained for dementia.
I realise that the much-promised reform of social care will be the catalyst that makes the financial cost to the individual more bearable, but that is now deferred until 2025. In the meantime, there is much that can be done to bring parity and fairness to the lives of dementia sufferers and their carers. I hope that the Minister finds constructive suggestions in our contributions to this debate that he can take forward. I am grateful to all Members here and to the Alzheimer’s Society and the House of Lords Library, which provided briefings in preparation for this debate.
Baroness Pitkeathley (Lab)
My Lords, I give my thanks to the noble Baroness, Lady Browning, who, against convention, I should call my noble friend, because we have worked together on these issues for many years. I thank her not only for securing this debate but for hitting the nail on the head when it comes to the situation between health and social care. That lack of parity of esteem is at the root of all the problems she outlined.
Although a health condition and the biggest cause of death in the UK, dementia receives most attention through not the NHS but social care, which has always been the poor relation—the tail-end Charlie—vis-à-vis the NHS. That did not matter in 1948 when it was set up, because we all died much earlier, but as we grow older, with greater incidence of dementia and other comorbidities, it matters hugely. It matters for diagnosis—the noble Baroness mentioned the long waits—or the absence of any diagnosis at all. It matters for services, both the access to services suitable for dementia patients and their carers, and the quality of the services. We heard from the noble Baroness, Lady Browning, about the lack of training of many people who provide those services. It also matters for access to medication, because we hear about the postcode lottery of what dementia medication is available.
Of course, its effect is nowhere more significant than it is on the biggest providers of care for those with dementia: not the NHS or social care but their own families—the spouses, sons, daughters and friends—who are often locked into an intolerable situation by the care they provide, however willing they are to undertake it. They suffer financially—we heard about the enormous costs of care—and they suffer physically, as their physical and mental health is at risk. Three-quarters of all carers report damage to their health as a direct result of their caring. They lose financial security and end up in poor health and often isolated, since their social circle shrinks dramatically. If there were more parity, we might be able to focus more on preventive services for dementia sufferers and their carers. There is no cure, but the progress of the disease can be slowed, or its onset delayed, by such things as exercise, group activities and interest groups—just the sort of things that are cut in times of austerity.
I hope the Minister will assure the Committee that the Government are committed to providing diagnosis and support at the earliest possible stage, and that they will shortly publish a long-term workforce strategy, such as the NHS one, for the social care workforce. I remind your Lordships that one in three of us will get dementia—that is seven people in this Room. We owe it to ourselves as well as future society to make it a priority.
Baroness Greenfield (CB)
I thank the noble Baroness, Lady Browning, for drawing attention to this timely and important issue. I am a neuroscientist working on brain mechanisms that underlie dementia and, accordingly, I declare an interest as the founder and CEO of a biotech company, Neuro-Bio Ltd, which is developing a novel approach to the diagnosis and treatment of Alzheimer’s disease. From first-hand experience, I can speak to the importance of strengthening the dementia research landscape. It is only by increasing resources for research that we will ever be able to realise if not a cure then, very plausibly and at last, a truly effective treatment. I thank the Alzheimer’s Society for its assistance in preparing these remarks on the situation in the UK, where, as we heard from the noble Baroness, Lady Browning, some 900,000 people are already living with dementia, a figure expected to rise to 1.6 million by 2040. As we also heard, one in three of those born today will develop the condition in their lifetime.
Yet combating this devastating disease is still not seen as the political priority it needs to be, and it has been historically underfunded. For example, just 31p is spent on dementia research for every pound invested in cancer research. That said, we should welcome the launch last year of the Government’s £95 million commitment to the Dame Barbara Windsor dementia mission, but we now need to see a delivery timeline for this funding, and we urgently request further detail about how the Government plan to invest the money.
But it is not just about the money. The APPG on Dementia, of which I am a proud member, released in 2021 a report entitled Fuelling the Moonshot, which found that people affected by dementia feel a sense of empowerment from being involved in research, but also that patients are often unaware of the opportunities to take part. This has to change—action must be taken to improve participation in, and access to, clinical trials. Recent investment in research is welcome, but it will be wasted without increased participation in these studies.
Moreover, any consideration of those living with dementia also needs to include the carers. This is where social issues should be given equal attention. In 2011, I gave a lecture tour on behalf of Alzheimer’s Australia, and I still vividly recall a conversation with a husband who had been caring for his wife, to whom he had been married for many decades. In the early hours of one morning, when he was changing her incontinence pads during a bout of diarrhoea, she, the love of his life, just stared at him, questioning who he was. It was then, he said, that he snapped. This gentleman described his situation as a “living death”, which is a phrase that I have heard repeated by other carers of those with dementia. Often, those closest undergo all the experiences of bereavement, no longer able to share memories with a very special individual who none the less is still breathing. The big difference is that society does not accord them the time and support it would to those grieving an actual death.
We need more resources for research, action on optimising clinical trials and wraparound support for the carers. Indeed, as highlighted in this debate, we need parity in health and social care. Dementia presents the biggest unmet clinical need of our time. Let us work towards a future where we are no longer haunted by the spectre that perhaps, one day, we will ask our spouse who they are, or that they in turn will describe their life with us as a living death.
Baroness Berridge (Con)
My Lords, I am grateful to my noble friend for tabling this debate. As well as having family experience, I also served on the Joint Committee on the Draft Mental Health Bill.
Lack of parity has created complex administrative processes for practitioners, patients and families. It is clear to me, from having two elderly relatives needing support, that you risk not getting the best outcome if you do not understand the system and are not able to advocate for them. With the first relative, we had the baptism of fire of continuing healthcare assessments. Putting aside the obvious distress to the patient and relatives caused by these meetings, there is also the time off work and lost income. The typical cast at these meetings would be the nurse, manager and staff of the nursing home, the discharge team from the hospital, social workers, patient and relatives. Meetings last one to two hours, plus travel time for the professionals, of course, as they have to take place in the nursing home. They may also need to be repeated or paused as the patient may be in and out of lucidity or competence.
The amount of resource gobbled up by these meetings was remarkable, and we had three attempts at it. Often the agenda seemed not to be about nursing care requirements, just whose pot of money it would be coming from—it is all taxpayers’ money, of course. Can my noble friend the Minister outline what assessment has been made by the Government of how much the process of continuing healthcare assessments is costing the NHS? If there was the parity outlined by my noble friend Lady Browning, this resource could of course be saved.
By the second relative, we were no longer newbies but, in that case, we bumped into the Mental Health Act. Some forms of dementia include mental health symptoms, such as delusions or hallucinations. My relative, who had such symptoms but had not yet been diagnosed with dementia, consented to going into a secure mental health hospital. I was quite affronted when a friend who commissions local authority services said to me, “Shame they consented and weren’t detained under the Mental Health Act”. Later, when I was on the draft Bill committee, I knew what he meant: Section 117, on aftercare. Although not automatic, it includes accommodation and can include all your care, hence the Times newspaper headline back in 2014: “The ‘secret’ law that means dementia care can be free”. It is not means-tested and you do not have any more continuing healthcare assessment meetings.
Can my noble friend the Minister outline whether there is data on how many people with dementia are detained under the Mental Health Act without any pre-existing history of disease? Also, is he aware of the anecdotal reports of clinicians now feeling under pressure to detain people when relatives know that it will not alter the care but could save them tens or hundreds of thousands of pounds? Are we at risk of this coming to be seen like the EHCP situation, where relatives know that the Mental Health Act will lead not only to the best care but to the taxpayer funding it? More importantly, is this adding to the pressure on NHS mental health beds?
Nothing that I have said detracts from the amazing care staff, who were often as bemused as we were by this not so wonderful world of administration and bureaucracy. Surely there must be a better, kinder and more efficient system.
Baroness Donaghy (Lab)
My Lords, I thank the noble Baroness, Lady Browning, for initiating this debate. I look forward to the day when this debate is held in the main Chamber.
Losing a loved one while they are still alive is a particularly gruelling experience and any assumptions that one makes about diagnosis and care turn out to be wrong. For example, I had assumed that hospice care took place in hospices. I am not criticising the hospice movement, far from it; its development of care at home, particularly in London, is quite remarkable, and I pay tribute to St Christopher’s Hospice for its invaluable support to me. I had also assumed that there was a system; I was wrong again.
In the short time available, I will concentrate on diagnosis and a social care workforce strategy. As has been said, more than 250,000 people live with undiagnosed dementia in England alone. We have one of the lowest per capita ratios of MRI, CT and PET scanners in the OECD, behind Russia, Slovakia and Chile. Recent effective disease-modifying treatments are not yet approved or commissioned in our country, but, even if they are approved, they require early diagnosis of Alzheimer’s disease and, at present, only 2.2% of people receive the tests in the diagnosis process. Will the Minister tell us what steps the Government are taking to invest in diagnostic infrastructure for dementia? The Alzheimer’s Society has said that improvements in diagnosis should be part of a major condition strategy between the NHS and the Government to put in place a funded plan to improve rates beyond the national ambition of 66.7%, if possible. What plans do the Government have for a major conditions strategy?
My second point is about a social care workforce strategy. The care workforce pathway is a welcome step to improve career development and increase access to training, but it falls far short of a comprehensive long-term social care workforce strategy providing a trained workforce. There are 152,000 vacancies in the adult social care workforce, with 390,000 leaving their care jobs annually. Only 45% of care staff are recorded as having any level of training in dementia, and training is not mandatory. The Alzheimer’s Society has called for a minimum mandatory level of training in dementia for all care staff to tier 2 of the dementia training standards. Can the Minister say when a long-term social care workforce strategy might be available?
The Office for National Statistics identifies dementia as the UK’s biggest killer, with one in three people due to develop it. Why is it not on the front pages of newspapers? Why is it not a political priority? Why does it have the same level of obscurity that cancer had 50 years ago? Perhaps it is reduced to individual human misery and dread for the future, and those affected do not have the resilience to force the pace. Does the Minister think that the Government have any responsibility for this?
Lord Warner (CB)
My Lords, I share the views of the noble Baroness, Lady Browning, on parity of esteem, but my contribution will concentrate on the problems caused by a failing NHS and a failing adult social care system. It is very difficult to achieve parity of esteem between the two services if both are failing and both are trying to shift costs to someone else.
I declare my interest as a member of the three-person Dilnot commission on social care funding. Our 2011 report had cross-party support and was accepted in principle by the coalition Government. For less than £2 billion, we demonstrated that it would be possible to cap at £50,000 individuals’ lifetime liability to pay for adult social care. This would have made a real difference to people with dementia. Despite legislation to implement our proposals, successive Chancellors from George Osborne onwards have deferred implementation. Jeremy Hunt has now achieved what his predecessors achieved by deferring the introduction of any form of cap until at least October 2025.
This is only part of a very sorry social care saga. Successive Governments since 2010 have allowed the funding of adult social care to decline relative to the funding of the NHS, increased service demands and the true cost of care for our ageing population. This approach has reduced NHS capacity, with more elderly patients admitted to, and staying in, hospital for longer because of the absence of social care. Governments have relied on council tax increases and occasional government handouts, rather than thinking through the funding of the social care system—even though one Prime Minister said that he would fix social care within a year; guess who. Whatever glowing account the Minister may give of the Government’s track record on social care funding, the really accurate assessment of that funding is set out in the King’s Fund contribution to the Library evidence for this debate.
Asking the NHS to do more for dementia patients in its current state is totally unrealistic. I am afraid that it is a failing institution in many parts of the country: it has not met its main access targets since before Covid, it has a backlog of about 7 million patients awaiting treatment and it is as short of staff as the adult social care system. It is totally impossible to think about making huge changes to improve services for dementia if we cannot repair the basic structures of the NHS and the adult social care system.
Lord Weir of Ballyholme (DUP)
My Lords, as both a member of the APPG and formerly a carer for my late mother, who suffered from vascular dementia, I welcome this debate and thank the noble Baroness, Lady Browning, for bringing it forward.
We are facing a tsunami of additional care needs in this country as a result of dementia, and it will require a step change from government, of what whatever political complexion. A myriad of solutions is required—some of them have been outlined today—but the noble Baroness, Lady Browning, was right to highlight a key component: parity of esteem between healthcare and social care.
Some of the implications of that lack of parity at present can be seen. It has been mentioned already that 45% of the social care workforce does not have direct training in dementia. The number of vacancies within social care is estimated to be 192,000, because there is a difficulty with both recruitment and retention of staff. The implication for individual dementia patients and their families across the country is a postcode lottery where both the quantity and the quality of care are deeply variable. For many of those families, the gap in what can be provided to them means that what they get simply does not cover the needs of the individual patient, and, somehow, they have to cope both financially and from a caring point of view to fill that gap.
If we can meet this issue of parity, there are a number of benefits. First, in many ways, we are facing an even greater difficulty than the official estimates of numbers show. Fortunately, we are beginning to see some solutions. New drugs are likely to appear in the near future, and they will at the very least slow the progress of dementia. That is a very good thing—it will mean that people live longer—but the implication of it is that, ultimately, we will probably have a lot more people with dementia. It will also shift the pressures from healthcare directly and to a much greater extent on to social care.
Secondly, parity will act as a driver for a much more joined-up approach to tackling dementia. In Northern Ireland, healthcare and social care have always been under one department and one system. That is not necessarily a panacea, but no one in Northern Ireland would try to disaggregate those two elements—it is perhaps one of the rare occasions when the rest of the country could learn something from Northern Ireland.
Thirdly, as indicated, parity would have major financial implications for the country’s healthcare. Too many people are unnecessarily in hospital and too many are not only admitted to hospital when they do not need to be but bed-blocking because there is nowhere to place them. Most of all, it will increase choice for families. For many who have dementia, being in hospital or in a residential home is either a choice they make or, from a practical point of view, there is not really an alternative. However, on many occasions, it has been forced on people because they do not have the choice.
Dealing with the issue of parity between healthcare and social care will be a key driver in ensuring that we can look after those with dementia and their families to meet the needs not just of now but of the future.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I welcome the ability to participate in this debate and I congratulate the noble Baroness, Lady Browning, on securing it. I wanted to participate in it as I have family members and political colleagues who, sadly, have either died as a result of dementia or are currently living with it. For me, one of the keys is diagnosis and the need for greater levels of investment in diagnostic tools and then medicine to slow down the progression of the illness.
More than a quarter of a million people are living with undiagnosed dementia in England. More than one-third of people with dementia in England and Northern Ireland do not have access to a diagnosis and, therefore, to the vital care and support it unlocks. Like the noble Lord, Lord Weir, I am a member of the APPG. We readily know the problem in Northern Ireland, and I agree with him that there is definitely a measure of equality in the integration of health and social care.
Part of the problem to do with diagnostic tools is the lack of magnetic resonance imaging and computed tomography scanning capacity in the memory assessment pathway, and lack of positron emission tomography scanners for accurate diagnosis of dementia subtypes. We have one of the lowest per capita ratios of these scanners in the OECD; we are behind Russia, Slovakia and Chile. Can the Minister advise on what steps the Government are taking to further invest in diagnostic infrastructure for dementia?
Furthermore, with the Government’s proposed reforms to the MHRA, cutting-edge medicines could be made available in the UK much more quickly than previously. This includes drugs such as lecanemab and donanemab—the first drugs proven to slow down the progression of Alzheimer’s disease. This means that the NHS must also be supported to prepare for this prospect. I therefore ask the Minister to provide details on what steps the Government are taking to prepare the NHS to deliver ground-breaking treatments such as those already mentioned. There is also a need for an adequate long-term social care workforce strategy, which has already been referred to by the noble Baroness, Lady Browning.
I look forward to the Minister’s answers. I hope that he will be able to provide a pathway to better investment in diagnostic tools and the provision of medicine to slow down the progression of dementia.
Baroness Murphy (CB)
My Lords, like the noble Baroness, Lady Browning, I am proud to be an ambassador for the Alzheimer’s Society. I spent my entire working life as a psychiatrist, working with older people who mostly had dementia and depression.
The situation has got a lot worse in both health and social care since I started working in it. The situation in the health service is appalling, in that they have no training with dementia, and that has not improved. In fact, most people in the health service have no idea what social care is. Indeed, if you asked most of the ladies and gentlemen in our main House, they would not have a very good grasp of what social care is either.
First, we need a total rethink around how we educate the general public about what this disease is about and how it imposes costs on society. The phrase “parity of esteem” is all very well and I like it—it started as a funding phrase in the United States—but almost all the real costs of dementia in this country fall on social care services and on families. At the moment, the estimated cost is £27 billion. Of that, a good 80% is spent by families and social care.
It is not the severity of dementia that demands care; it is the activities of daily life. There was a lovely, elegant piece of research in Denmark looking at what factors of dementia require care from others, and they are always the activities of daily life. That is what social care is and where we should put most of our money.
I do not agree that more MRI and PET scanners would make a jot of difference to diagnoses because a diagnosis is usually made by the family or home carers before they get anywhere near. I know it is nice that we can now diagnose; I had a lecture called “150 Types of Dementia”, which went down a bundle at Queen Square I can tell you. The reality is that half a dozen are interesting, and there are some more that we are starting to understand better, but that is not the issue. It is about very basic care. The drugs will not be around for a long time yet. The ones we have now are nowhere near fruition in terms of clinical service to all the patients who need them.
I back up what my noble friend Lord Warner said about the need to fund both organisations—health and social care need to be integrated to deliver this service—but we are a hell of a long way off.
Lord Allan of Hallam (LD)
My Lords, I am grateful to the noble Baroness, Lady Browning, for this debate. There are some repeated themes to our questions and debates that we need because these are complex challenges affecting millions of people that require a hard slog and real attention to detail. I have learned a lot about the specific challenges and solutions from all the speakers in the debate.
I will first return to some of the issues raised in the Oral Question on social care today. The noble Baroness, Lady Donaghy, rightly flagged it is not just the number of care workers, but their skills, which are quite different for carers who have to deal with people with dementia. I hope the Minister will talk, as he did earlier, about the Government’s intention to upskill care workers.
On the numbers, it is important that much of this care will be delivered in the home, over the long term, yet the skills care data shows that vacancy rates are higher in the domiciliary sector than in care homes. They are still running at over 10% and are barely improving. Does the Minister agree that we need to make social care roles more attractive, which must involve decent salaries that increase as skill levels increase? Is he concerned about the acute problems in the domiciliary sector? The numbers suggest that the Government’s actions to date have not had the same effect there that they may have had in care homes.
Another key issue that I want to raise is around long-term conditions generally and specifically dementia. There is a lot of discussion about who pays for these services and which budget they come from. The noble Baroness, Lady Berridge, highlighted this with a very graphic example. The questions are about who pays, where the budgets sit and, critically in this area, self-pay, which was referred to by the noble Lord, Lord Warner. These questions are still wide open; they have not been resolved. No one can say, hand on heart, that they understand what the long-term path is when someone has a diagnosis, who is going to pay for their care and how that will be resolved over the long term.
The split between the NHS and local authorities has long been recognised as an issue. Integrated care boards have been highlighted as the solution that bridges that divide. Can the Minister say how this is going for dementia services? Are there now examples of real pooling of resources for patient-focused services, which is the promise of the integrated care board? The noble Lord, Lord Weir, talked about the example of Northern Ireland, and my fear is that people are already queuing up to see the integrated care boards fail and that they will be booking another reorganisation of the NHS in England.
The example of Northern Ireland given by the noble Lord, Lord Weir, was very telling: he said that no one would go back. I hope that we do not go back; I am not wishing for that outcome. However, unless we see real pooling of resources, real patient focus and a genuine overcoming of this crazy divide where some public money is in Pot A and some in Pot B, we will not have made the progress that we needed. I hope the Minister agrees that dementia services in particular are a prime example of a test case on whether ICBs can deliver the promise that was in the legislation.
Baroness Wheeler (Lab)
My Lords, I thank the noble Baroness, Lady Browning, for this debate and for giving us the valuable—if nowhere near long enough —opportunity to shine a spotlight on many key issues that were at the heart of the scrutiny of the social care cap provisions of the Health and Care Act. In particular, I note its impact on people with dementia and our concerns about how NHS continuing healthcare operates arbitrarily with regard to people receiving free care or having to pay for it themselves, as well as how we move towards genuine parity between the NHS and social care and how good social care is vital for people with dementia and their carers. The current social care system is just not set up to meet these needs.
I have three points. First, on carers, the 60% of people with dementia drawing on care at home are being cared for by their spouses and relatives—mostly unpaid carers, as my noble friend Lady Pitkeathley again reminded us. As a carer myself, I meet many unpaid carers locally who are daily, for 24 hours, looking after loved ones at various stages of dementia, most of them with breaks of only a few hours a day or a week. The carer role is often rewarding, but it is also relentless for many. We urgently need a comprehensive national carers strategy, and I look forward to the Minister’s explanation of why we do not have one.
I turn, secondly, to care costs and the devastating impact of the financial costs for those living with dementia and their families—an average of £100,000 is spent by individuals over their lifetimes. Despite extensive modelling at the time of the 2022 Act showing that just 19% of people with dementia would reach the care cap, and despite the disproportionately detrimental impact on dementia sufferers in some of the poorest parts of the country, it would have made a start as part of a wider package of reforms that Labour argued for. Instead, the new reform money has been allocated largely to propping up the existing social care system. What action are the Government taking to tackle the staggering care costs faced by individuals with dementia in the absence of the care cap implementation? Can we please be updated on the Government’s plans for social care charging reform?
Thirdly, on NHS continuing care, the excellent Lords Library briefing reminds us of the CHC’s ill-defined primary health need assessment criteria and the huge inequities in the current system, particularly relating to the funding—or lack of funding—for care costs for dementia, either in the home or in care homes. The Alzheimer’s Society has pointed out that NHS England’s stats do not record diagnostic details, so there is no way of knowing how many people with dementia receive CHC or have been turned down. There is also no way of making assessments or comparisons from which transparent criteria could be developed. There are also huge geographical variations in the length of time taken to assess claims and handle appeals. Can the Minister update the House on what work is being undertaken to improve the transparency of CHC processes, procedures and decision-making, and also to address the urgent problem with assessing the eligibility for CHC of people with dementia?
Noble Lords’ priorities for dementia today have focused on urgent improvements to diagnostic rates, speeding up the introduction of vital modifying drugs to help slow down disease progression, investment in the dementia diagnostic infrastructure, and rebuilding the workforce and addressing the 152,000 vacancies in the adult social care workforce. This needs to be a fully comprehensive plan that is fully integrated with the NHS workforce plan if we are to avoid exacerbating the already chronic social care workforce crisis that we have.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I add my thanks to my noble friend Lady Browning not only for bringing this debate but for her commitment generally in this area. I also thank all noble Lords for their contributions. These sorts of debates are always a pleasure, and one thing I have learned in the almost 18 months that I have been involved in the Lords is that it does not matter what the subject is; you always find expertise and learn about colleagues’ experience, such as that of the noble Baronesses, Lady Greenfield and Lady Murphy. I always find having the power of that knowledge around the table a real asset for the Lords and a real contribution to these types of debates.
My noble friend Lady Browning quite rightly said in her introduction that the statistics are gobsmacking, if I can use that word. I note the fact about one in 11 of those over 65. The one that really resonated with me—noble Lords have heard me mention it many times—is the fact that 25% of our beds are occupied by people with dementia. There is a real feeling that not only is that not the right place for them but it is not a good use of money. I therefore totally agree with that sentiment.
We see virtual wards and hospices at home as part of the answer to this. I have seen some good technological advances: at the light end of the scale, for want of a better word, we could look at people’s electricity usage, for example, and start to learn their patterns. For a lot of people, there is a surge at 8 am when they put on the kettle, so if that surge suddenly is not there, that is an early warning that perhaps there should be a call because something is wrong. There are also motion detectors around the house to start to understand their patterns. To my mind there is a spectrum of those sorts of virtual wards from the very heavy intervention ones to just trying to make sure that people are generally fine and going about in their normal way or, if they are not, it can be an early warning.
I will come on to staffing, but a key part of that in the home is dom carers. It is a point that the noble Lord, Lord Allan, made well. We have made a lot of progress in what we are trying to do with career progression, but I want to be assured that we have really got this area right.
My noble friend Lady Browning mentioned the fundamental need for a care plan in all that. In preparing for this, my noble friend Lord Evans said that that was what he needed in his recent situation with his mother. That is what ICSs should be starting to do now. I take the point made by the noble Lord, Lord Allan, that there is probably no better example of trying to learn how they are working than using this as a case study. My general experience of ICSs—of course it is early days, even now I think we are only 18 months or so in—is that, as ever with these things, there are some very good examples and probably some which need to do a bit more work. I am quite happy to take that away to try to find some test cases that we can try to learn from. The NHS has set out best practice guidance that it expects all ICSs to follow. My understanding, which I will check on, is that part of that is having a dementia lead, which my noble friend Lady Browning mentioned.
As the noble Baronesses, Lady Ritchie and Lady Donaghy, and other noble Lords mentioned, diagnosis is key. The target is two-thirds. We are getting quite close to that, but we have been behind, so there has been an investment of £17 million to catch up. I accept the point about whether two-thirds is enough and whether we would accept that in other areas and let one-third go undiagnosed, but step one is making sure that we hit that two-thirds.
The noble Baroness, Lady Ritchie, asked what sort of resource we are putting behind this. CDCs already have the equipment, in terms of scanners, and the ability to do that, but I accept the point made by the noble Baroness, Lady Murphy, that it is probably more about the people. It is less the equipment than making sure that people are trained to do that. I will come on to staffing later, but I take that basic point.
What is the point of diagnosis? First, it is to make sure that people get the right care. Secondly, it is so that we can start to deploy some of these new treatments. Again, it is great to have the expertise of the noble Baroness, Lady Greenfield. In answer to the question from the noble Baroness, Lady Ritchie, we are expecting NICE approval of the drugs to slow dementia down in early summer, and we expect to then roll that out during the summer period. However, we all know that they are only on the nursery slopes, and that is why there is a commitment to research of £160 million per year.
To fuel the moon shot, I am really excited about the power of the data that we own. I was recently on a fact-finding mission to Boston and they were talking about a major $250 million investment that a private venture group had made into the 9 million hospital records in Mayo Clinic. They were saying, “You don’t realise what you have in the UK. You have 50 million records in England, and you have primary care as well”. The whole problem around dementia is that we do not know what we are trying to tackle, in terms of the early causes. The reason we were so good at tackling Covid was that we knew exactly what we were going after. Right now, in things such as dementia and Alzheimer’s disease, it is still a case of shots in the dark.
However, regarding the 50 million records we have, if we look at people who have dementia today, wind back 15 years and ask what they were visiting their GP about then, and throw that all at AI, we can get some of those early-warning indicators. I know some of the anecdotal ones. For instance, as mentioned, urinary tract infections are often an early indicator of dementia because people do not understand that they are there. Throwing all that at AI and making sure that that data exists is a real way to fuel the moon shot so that we know where we should be putting our research efforts to try to find treatments.
On the funding of social care, as I said, the £8.1 billion investment over two years is a major investment. I learned a lot from my noble friend Lady Berridge. I did not realise that being committed under the Mental Health Act is a main way to get there. On the question from the noble Baroness, Lady Wheeler, about CHC transparency, I do not know the answer off the top of my head, but I will come back on that because it is a good point. As ever, I will try to come back and cover it more fully in writing.
The reform plans that we have announced are about making sure that we have the proper staffing to do this. As I mentioned in answer to the earlier Question today, we are starting to turn a corner, although it is early days. On career progression and training, I believe that what we announced last week is a key part of making this a real profession that people will want to stay and progress in. I agree with the point made by the noble Lord, Lord Allan, that paid progression has to come along with those qualifications; otherwise, you will not get people wanting to enter it.
I understand, as a few noble Lords have mentioned, including the noble Baronesses, Lady Wheeler and Lady Pitkeathley, that the role of the carer is vital and often overlooked. As noble Lords know, I have had personal experience of that as a carer. Quite honestly, all I can say is that we are making some early steps in trying to get some of the funding, but I freely accept, from personal experience, that there is a lot more that could be done in that space.
I have tried to give a flavour—before my throat totally gives way—of what we are trying to do in this area. As ever, I will respond fully in writing, but I hope there is an understanding from the Government’s side, as echoed by all noble Lords, that this is something we do take seriously.
Lord Warner (CB)
I am sorry to test the Minister’s vocal cords, but he mentioned that there was good practice guidance issued to ICSs. My experience as a Minister is that the department is extremely good at sending out guidance but extremely bad at checking whether anyone ever follows it. What arrangements has the department got to see if that good practice guidance is put into operation?
Lord Markham (Con)
The noble Lord makes a very good point, and it is one I have some personal experience of as well. The hope, when setting up 42 ICSs, was that this would be the right size for them to pool resources and take a holistic view, and that 42—while still a lot— would be a manageable number. As Ministers, we have divided those up into seven each that we can get to know, and live and breathe and understand; we also have dashboards that we can use to monitor progress in these areas. That is the way we plan to do that. I freely admit, again, that it is early days; I accept the noble Lord’s point that you can give out guidance until you are blue in the face—and they will receive a lot—but it is the follow-up that really matters.
I thank the noble Baroness again for the debate. I hope there is a feeling that we understand and that we are trying to give the parity of esteem that this deserves, and I look forward to following up more thoroughly in writing.