Lords Chamber
12:41
Baroness Anderson of Stoke-on-Trent (Labour)
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Baroness Anderson of Stoke-on-Trent (Labour)
Campbell, who I was delighted to see in your Lordships House last week and is definitely on the road to recovery. Lady Featherstone, who has ensured that we have a human voice always. And of course, lady, as their resolve in seeking justice for the victims of this scandal cannot be understated, and their generosity of time to make sure that I am fully abreast of such issues has been incredibly, personally beneficial. I'd also like to thank my opposite number, Lady Phin, for how constructive we have worked together on these issues to deliver for a community that needs to be that rightly has limited faith and trust in government after their experiences, and it is the onus on all of us in your Lordships' House to make sure that they know that we are listening to them.
My Lords, I'm going to look in detail at the comments of the noble Baroness Lloyd Brinton. Obviously, as she highlighted, they were very specific questions. I think it may be useful for us actually to have a meeting with officials, which I will invite all of those who have participated today to to attend. But I will also reflect on the points. I'm right in advance of the meeting. My Lords, we're here today first and foremost to debate the regulations, and I will prioritise the issues raised on the regulations in my response.
I'm aware of the other points that have been raised, and I'll do my best to address those too. But obviously I will reflect on Hansard if I've missed any of them. In terms of the specific points that have been raised, I'd like to start by the points raised by the noble Lady Baroness Finlay. These are incredibly important points, and she did worry me when she raised in advance. When she gave me the detail in advance. And I had worried that there was a gap that we had missed.
So to clarify for the record, I think it would be very useful. Someone infected as a child would receive injury, social impact, autonomy, care, and basic financial loss awards in the same way as an adult. They do not receive an additional financial loss award for the years where they were aged under 16. However, they will still receive an additional financial loss award for the years where they were or will be aged 16 or over, and I hope that gives a level of reassurance.
And with regards to the heartbreaking situation of when an infected child had passed away, a bereaved parent, a parent would receive injury, social impact and autonomy. Awards based on the infection and infection severity that that child had. This will not change based on how old their child was when they passed away. The awards to parents are higher where their child's infection has caused, or is expected to cause an early death in the future. This includes those infected with HIV or level three, four and five hepatitis infections.
They would also be the likely beneficiary of their child's estate under the under the law of intestacy. All such would likely be the recipient of whatever injury, social impact, autonomy, care and financial loss awards are due to the child's estate, so there is still a level of compensation, but I will make sure that I also write to the noble Lady so she has a copy in writing as well as from Hansard. I just want to touch on prioritisation because I think that is helpful in the context of what we're talking about it, our prioritising those nearing the end of their lives because community members and representatives have highlighted how important it is for these people to start their compensation claim.
Nearing the end of life means a person has been told by a doctor or medical professional that they might have less than 12 months to live. This could be due to any medical illness or condition. It does not need to be caused directly by an infection from contaminated blood. With regards to previous payments.
**** Possible New Speaker ****
Intervene. The noble Lady has said that this is the case for those who are infected victims. those who are infected victims. Will the same rules be applied to affected victims who are nearing the end of their life, because many the end of their life, because many of them are. Many are dying now.
**** Possible New Speaker ****
of them are. Many are dying now. As I believe that to be the case, I will confirm to the noble Lady in I will confirm to the noble Lady in writing, given the issues that we're talking about, and I would not want to mislead anybody, but I believe that is also because approach for affected estate as well. With regards to previous payments that have been made, they are all pre the 31st of March ex-gratia. Only payments from the 31st of March count towards compensation calculations.
No payments from an r r compensation. But I will again in our conversations and reflecting on Hansard, write to the noble Lady in terms of the special category mechanism. Now noble Lady asked very specific points about the system, but I want to confirm, while I recognise the level of community concern about how the scheme considers and recognises the impacts captured by the special category mechanism, the matter of how the scheme recognises and compensates people for the impacts that make someone eligible for SCM is part of the public consultation and further regulations.
The consultation proposes that anyone currently receiving special category, mechanism or equivalent payments through the Infected Blood Support Screen schemes would now be automatically eligible for a Severe Health Condition Award. Everyone who receives SCM payments should have been contacted by ICA already, as part of the cohort of infected people registered with a support scheme. I hope that gives a level of reassurance, but I'm aware the noble Lady asked for more specific questions about that and I will revert. Moving on to inheritance tax.
Well, the noble Lady will appreciate that. Such was the statement from the Chancellor that no such meeting was required because the Chancellor there were private conversations happened about this. Reflecting on both the conversation about the issues raised in your Lordships' House and in the other place about how important this was. Representations were made and the Chancellor reflected that in the budget. And I am very, very pleased that she did so. So there was no such meeting in terms of a meeting that I had offered, but proved to be unnecessary.
I hope nobody could appreciate that it now proved to be unnecessary. In terms of the inheritance tax. Though raised by the noble Lady Baroness Finn, I think it would be helpful if I can just outline what we've actually agreed to. I know that the issue of inheritance tax policy has been widely raised by noble, by many members of your Lordships' House and in the community, and was of huge concern. Compensation payments made under the scheme will be exempt from income, capital gains and inheritance tax.
This is in line with tax exemptions for the first and second interim payments. At the budget. The government announced that further updates to Inheritance Tax disregard will be made to ensure that infected blood compensation payments are relieved from inheritance tax in cases where the original infected or affected person eligible for compensation has sadly died before the compensation is paid. I know this was an important issue for many members of the community, and I'm pleased that the government has been able to listen and make this change.
The changes mean inheritance tax credit will be automatically applied to the estate of the first beneficiary of the infected or affected person's estate, for example, this would mean that the children of a bereaved partner who inherits their infected partner's estate and then dies would not face an inheritance tax charge on the compensation they inherit. This will apply to compensations made before or after the 26th of November, 2025. The government has also made changes to the rules on gifting compensation payments. The change means that the first living recipients of compensation payments will have two years in which to give some or all of their compensation payment, without an inheritance tax charge.
This applies to gifts of compensation made on or after the compensation made on or after the 4th of December, 2025. Noble Lady Baroness Finn also raised the fact that no one should fall through the cracks. Noble Lady is absolutely right. It is working with those affected and infected to build an evidence base where where people are struggling to. And I think noble Lords would appreciate that as we move from the infected who are claiming to the effective, who have claims that some of the evidence base is going to become more challenging, and it is right that the that the case handlers are working will work with people to help support their evidence efforts.
With regard to the Tyrone Urch review, we're still reflecting and I look forward to discussing on the recommendations and working and talking to colleagues to see what support, because many of the recommendations were for them. I will report back in due course and to confirm these are the changes to these regulations will not slow us down. Where there are enhancements that have been made, those will be retrospectively applied to those people who've already received compensation without them having to come forward again.
And we don't believe that anything we're proposing at this point will slow anything down. With regard to the clear plan, noble Lords are aware that over the earlier this year I went to visit it. I met with their comms team. I think we can all agree that there have been significant communication challenges from during this process. I personally think having seen some of their new materials that they're using and the fact that they are using the different level of basic English standard now, as opposed to a level of science that that has made this much more accessible.
My Lords, we are talking about a number of people who have different experiences and personal and different personal circumstances. Comms is always going to be a challenge, but I want to put on record my thanks for both the women who are and they are overwhelmingly women who are answering the calls at the first instance, who are providing huge support, and for the the handlers that are based at ICA who are doing a very, very good job, having built an organisation from scratch since May last year to deliver over £2 billion of compensation, there is a long way to go, but I believe that they are on track.
My Lords, these regulations will action several of the inquiry's recommendations and bring them into force as quickly as we have been able to. But I am very clear that this is not the end of the process. These regulations are only one part of the government's response to the inquiry's additional report. The consultation that is currently away does not close until the 22nd of January, and I encourage all of those impacted by the scandal to respond, to ensure that your voice is part of those helping to guide us forward, and if there are problems in people being able to access the consultation, then please let us know.
And we will. And we are. We
**** Possible New Speaker ****
are making other mitigations, but if there are specific challenges, I would want to hear them. Thank you.
**** Possible New Speaker ****
Thank you. Absolutely clear. The comment I was making was not about the consultation, which is a written one. It was about the fact that nobody with lived experience was invited to attend the round table
**** Possible New Speaker ****
meetings. Looking at the detail. But that has now been resolved.
**** Possible New Speaker ****
But that has now been resolved. Okay, I will explore. I will speak to officials and look to see what's actually happened. Many of the points raised today are subject to the consultation. I look forward to discussing these in more detail response. In the meantime, I hope the changes we are making today with these regulations demonstrate that we are fully committed to ensuring that justice is finally brought to a group of people who have waited far too long. My Lords, I beg to move here.
My Lords, I'm going to look in detail at the comments of the noble Baroness Lloyd Brinton. Obviously, as she highlighted, they were very specific questions. I think it may be useful for us actually to have a meeting with officials, which I will invite all of those who have participated today to to attend. But I will also reflect on the points. I'm right in advance of the meeting. My Lords, we're here today first and foremost to debate the regulations, and I will prioritise the issues raised on the regulations in my response.
I'm aware of the other points that have been raised, and I'll do my best to address those too. But obviously I will reflect on Hansard if I've missed any of them. In terms of the specific points that have been raised, I'd like to start by the points raised by the noble Lady Baroness Finlay. These are incredibly important points, and she did worry me when she raised in advance. When she gave me the detail in advance. And I had worried that there was a gap that we had missed.
So to clarify for the record, I think it would be very useful. Someone infected as a child would receive injury, social impact, autonomy, care, and basic financial loss awards in the same way as an adult. They do not receive an additional financial loss award for the years where they were aged under 16. However, they will still receive an additional financial loss award for the years where they were or will be aged 16 or over, and I hope that gives a level of reassurance.
And with regards to the heartbreaking situation of when an infected child had passed away, a bereaved parent, a parent would receive injury, social impact and autonomy. Awards based on the infection and infection severity that that child had. This will not change based on how old their child was when they passed away. The awards to parents are higher where their child's infection has caused, or is expected to cause an early death in the future. This includes those infected with HIV or level three, four and five hepatitis infections.
They would also be the likely beneficiary of their child's estate under the under the law of intestacy. All such would likely be the recipient of whatever injury, social impact, autonomy, care and financial loss awards are due to the child's estate, so there is still a level of compensation, but I will make sure that I also write to the noble Lady so she has a copy in writing as well as from Hansard. I just want to touch on prioritisation because I think that is helpful in the context of what we're talking about it, our prioritising those nearing the end of their lives because community members and representatives have highlighted how important it is for these people to start their compensation claim.
Nearing the end of life means a person has been told by a doctor or medical professional that they might have less than 12 months to live. This could be due to any medical illness or condition. It does not need to be caused directly by an infection from contaminated blood. With regards to previous payments.
**** Possible New Speaker ****
Intervene. The noble Lady has said that this is the case for those who are infected victims. those who are infected victims. Will the same rules be applied to affected victims who are nearing the end of their life, because many the end of their life, because many of them are. Many are dying now.
**** Possible New Speaker ****
of them are. Many are dying now. As I believe that to be the case, I will confirm to the noble Lady in I will confirm to the noble Lady in writing, given the issues that we're talking about, and I would not want to mislead anybody, but I believe that is also because approach for affected estate as well. With regards to previous payments that have been made, they are all pre the 31st of March ex-gratia. Only payments from the 31st of March count towards compensation calculations.
No payments from an r r compensation. But I will again in our conversations and reflecting on Hansard, write to the noble Lady in terms of the special category mechanism. Now noble Lady asked very specific points about the system, but I want to confirm, while I recognise the level of community concern about how the scheme considers and recognises the impacts captured by the special category mechanism, the matter of how the scheme recognises and compensates people for the impacts that make someone eligible for SCM is part of the public consultation and further regulations.
The consultation proposes that anyone currently receiving special category, mechanism or equivalent payments through the Infected Blood Support Screen schemes would now be automatically eligible for a Severe Health Condition Award. Everyone who receives SCM payments should have been contacted by ICA already, as part of the cohort of infected people registered with a support scheme. I hope that gives a level of reassurance, but I'm aware the noble Lady asked for more specific questions about that and I will revert. Moving on to inheritance tax.
Well, the noble Lady will appreciate that. Such was the statement from the Chancellor that no such meeting was required because the Chancellor there were private conversations happened about this. Reflecting on both the conversation about the issues raised in your Lordships' House and in the other place about how important this was. Representations were made and the Chancellor reflected that in the budget. And I am very, very pleased that she did so. So there was no such meeting in terms of a meeting that I had offered, but proved to be unnecessary.
I hope nobody could appreciate that it now proved to be unnecessary. In terms of the inheritance tax. Though raised by the noble Lady Baroness Finn, I think it would be helpful if I can just outline what we've actually agreed to. I know that the issue of inheritance tax policy has been widely raised by noble, by many members of your Lordships' House and in the community, and was of huge concern. Compensation payments made under the scheme will be exempt from income, capital gains and inheritance tax.
This is in line with tax exemptions for the first and second interim payments. At the budget. The government announced that further updates to Inheritance Tax disregard will be made to ensure that infected blood compensation payments are relieved from inheritance tax in cases where the original infected or affected person eligible for compensation has sadly died before the compensation is paid. I know this was an important issue for many members of the community, and I'm pleased that the government has been able to listen and make this change.
The changes mean inheritance tax credit will be automatically applied to the estate of the first beneficiary of the infected or affected person's estate, for example, this would mean that the children of a bereaved partner who inherits their infected partner's estate and then dies would not face an inheritance tax charge on the compensation they inherit. This will apply to compensations made before or after the 26th of November, 2025. The government has also made changes to the rules on gifting compensation payments. The change means that the first living recipients of compensation payments will have two years in which to give some or all of their compensation payment, without an inheritance tax charge.
This applies to gifts of compensation made on or after the compensation made on or after the 4th of December, 2025. Noble Lady Baroness Finn also raised the fact that no one should fall through the cracks. Noble Lady is absolutely right. It is working with those affected and infected to build an evidence base where where people are struggling to. And I think noble Lords would appreciate that as we move from the infected who are claiming to the effective, who have claims that some of the evidence base is going to become more challenging, and it is right that the that the case handlers are working will work with people to help support their evidence efforts.
With regard to the Tyrone Urch review, we're still reflecting and I look forward to discussing on the recommendations and working and talking to colleagues to see what support, because many of the recommendations were for them. I will report back in due course and to confirm these are the changes to these regulations will not slow us down. Where there are enhancements that have been made, those will be retrospectively applied to those people who've already received compensation without them having to come forward again.
And we don't believe that anything we're proposing at this point will slow anything down. With regard to the clear plan, noble Lords are aware that over the earlier this year I went to visit it. I met with their comms team. I think we can all agree that there have been significant communication challenges from during this process. I personally think having seen some of their new materials that they're using and the fact that they are using the different level of basic English standard now, as opposed to a level of science that that has made this much more accessible.
My Lords, we are talking about a number of people who have different experiences and personal and different personal circumstances. Comms is always going to be a challenge, but I want to put on record my thanks for both the women who are and they are overwhelmingly women who are answering the calls at the first instance, who are providing huge support, and for the the handlers that are based at ICA who are doing a very, very good job, having built an organisation from scratch since May last year to deliver over £2 billion of compensation, there is a long way to go, but I believe that they are on track.
My Lords, these regulations will action several of the inquiry's recommendations and bring them into force as quickly as we have been able to. But I am very clear that this is not the end of the process. These regulations are only one part of the government's response to the inquiry's additional report. The consultation that is currently away does not close until the 22nd of January, and I encourage all of those impacted by the scandal to respond, to ensure that your voice is part of those helping to guide us forward, and if there are problems in people being able to access the consultation, then please let us know.
And we will. And we are. We
**** Possible New Speaker ****
are making other mitigations, but if there are specific challenges, I would want to hear them. Thank you.
**** Possible New Speaker ****
Thank you. Absolutely clear. The comment I was making was not about the consultation, which is a written one. It was about the fact that nobody with lived experience was invited to attend the round table
**** Possible New Speaker ****
meetings. Looking at the detail. But that has now been resolved.
**** Possible New Speaker ****
But that has now been resolved. Okay, I will explore. I will speak to officials and look to see what's actually happened. Many of the points raised today are subject to the consultation. I look forward to discussing these in more detail response. In the meantime, I hope the changes we are making today with these regulations demonstrate that we are fully committed to ensuring that justice is finally brought to a group of people who have waited far too long. My Lords, I beg to move here.
12:53
Short debate: Plans to publish a strategy for a wheelchair provision by NHS and social care services
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Short debate: Plans to publish a strategy for a wheelchair provision by NHS and social care services
The question is that this motion be agreed to. As many as of that opinion will say content. Contrary, not content. The contents have it. not content. The contents have it. We move now to the next business question for short debate strategy for wheelchair and community for wheelchair and community equipment provision Lord Hunt of Kings Heath.
12:53
Lord Hunt of Kings Heath (Labour)
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Lord Hunt of Kings Heath (Labour)
My Lords, I'm very grateful to noble Lords who taking part in this debate, and I particularly want to welcome the noble Baroness Gerada who is making her maiden speech. She has, of course, been a She has, of course, been a absolutely brilliant president and chair of the Royal College of GPS. chair of the Royal College of GPS. But if I can say so, more than that, an excellent GP and brilliant champion of primary care and the NHS, and it's a pleasure to welcome her to this debate.
I shall also inform the House of my patronage of the Wheelchair Alliance and also the Healthcare Supply Association, and my daughter Philippa works for backup, which supports people with spinal injury. My Lords, the provision of wheelchair and community equipment in this country for disabled people is, to put it quite bluntly, a disgrace. The nub of the problem was described in The Guardian on the 2nd of December by the distinguished academic doctor, Paul Sager. He was paralysed in a climbing accident and described how inconsiderate, illogical and incompetent many of the current wheelchair providers are.
He talked about the bureaucratic barriers, organisational inflexibilities and patchiness of the services he encountered. I thought particularly telling for me were the words of a physiotherapist he quoted, who had been working with people with spinal cord injury for more than 20 years. Many of her clients are discharged from hospital, she said, in heavy manual wheelchairs that an able bodied person would struggle to push frequently. They're the wrong type or size and at the very least are uncomfortable often, she said, people who have impaired functions in their upper limbs cannot push these wheelchairs themselves and become effectively housebound, in some cases confined to their bed.
Sometimes they develop complications from poorly prescribed wheelchairs, and it lands them back in hospital on average, she added, people wait at least ten months after discharge before being assessed, let alone getting the wheelchair that is right for them. Unbelievably, some local wheelchair services apparently refused to assess a patient until they have left hospital. So much, my Lords, for integrated care, which I thought integrated care boards were established to actually achieve. Now, Doctor Sage's experience, of course, is not unusual.
The Wheelchair Alliance has produced convincing evidence to show how inconsistent and under-resourced wheelchair services are. Over 50% of providers come from the private sector, and there are real worries regarding the financial frailty of many of them. With a system that prioritises lowest initial cost over long term value and reliability, there are no consistent national standards, no independent regulation, few clear paths for users seeking repairs, reporting thoughts or making complaints. As a result, many disabled people experience long waiting times, delays in hospital discharge, loss of independence, social inclusion and tragically avoidable deterioration in health and well-being.
My Lord, it's the same dismal picture with community equipment embracing hoists, scrap rails, harnesses, medical beds and a wide range of essential medical products. The all party Group for Access to Disability Equipment has recently reported on the systematic crisis in the sector. 60% 63% of carers, 55% of equipment users feel that services are getting worse, not better, and the all party group concluded the system's inconsistent, underinvested, fragmented and lacking leadership. Now, government policy is that local authorities and integrated care boards are share responsibility for community equipment.
In practice, this means a fragmented, inconsistent delivery equipment providers describe a landscape in which every authority works differently without alignment or accountability, so the consequence is a postcode lottery, with 74% of equipment providers aware of patients experiencing delayed hospital discharge due to unavailability of community equipment. And I would argue, and I'm looking forward to Baroness Brinton speech later on this, I would argue that community equipment is almost the silent crisis at the root of the challenges we face in providing community and social care.
And the tragedy is it would be so easy to sort this out if there was a will to do it now, my Lords, in April, the government published the Wheelchair Quality Framework to assist integrated care boards and will share service providers deliver high quality provision. I have read it. It's welcome. But my Lords, the problem is, first of all, its guidance. It lacks binding universal standards, does not guarantee equitable provision across all of the country. It does not address systematic under-investment.
It does not mandate robust data reporting. It lacks external oversight or performance management. And so there is no statutory legally guaranteed entitlement, ensuring that every person in need receives the right wheelchair or community equipment in a timely fashion. My Lords, what is required? I am absolutely convinced that we need a national strategy, underpinned by the appointment of a national clinical director, accountable to Ministers and backed up by strong performance management and the remit of the director, should embrace community equipment as well as wheelchairs.
Miles what that needs to be underpinned by a vision, a national, comprehensive vision of what a high quality wheelchair and community equipment provision should look like, and the government should embrace the report of the all party group on access to Disability equipment by introducing a dedicated national strategy for community equipment and wheelchair provision. Users must be around the top table with a real input into policy, a nationally defined eligibility and quality standard for wheelchairs and community equipment uniform across all regions, and removing the current postcode lottery, a legally guaranteed entitlement to appropriate equipment for all those assessed as needing them.
A long term funding model that accounts for rising costs of equipment, manufacturing, maintenance, energy, staff and supply chain resilience, and a simple, user friendly service for wheelchair users and carers to report issues, requests, papers, make complaints or feedback and be heard on procurement. We need to shift from lowest cost procurement to value based procurement, which is happening, my Lords, in general procurement, it ought to be extended to wheelchairs and community equipment and my Lords for community equipment itself.
National training standards for clinicians, commissioners, OTS, other professionals and suppliers involved in equipment provision. I don't think anyone in this debate is going to argue that wheelchair and community equipment is absolutely woeful. The tragedy, as I've said before, is that it's so easily sorted. If the government were prepared to say we're going to sort it, we're going to have a national, we're going to do what I've suggested in relation to have national leadership. And I lost so many of the issues in community care, and the blockages would be dealt with if this were really taken seriously.
We all know what happens. It's not regarded as at all serious by either the NHS or local authorities and many, many people suffer as a result. My Lords, I beg to move.
I shall also inform the House of my patronage of the Wheelchair Alliance and also the Healthcare Supply Association, and my daughter Philippa works for backup, which supports people with spinal injury. My Lords, the provision of wheelchair and community equipment in this country for disabled people is, to put it quite bluntly, a disgrace. The nub of the problem was described in The Guardian on the 2nd of December by the distinguished academic doctor, Paul Sager. He was paralysed in a climbing accident and described how inconsiderate, illogical and incompetent many of the current wheelchair providers are.
He talked about the bureaucratic barriers, organisational inflexibilities and patchiness of the services he encountered. I thought particularly telling for me were the words of a physiotherapist he quoted, who had been working with people with spinal cord injury for more than 20 years. Many of her clients are discharged from hospital, she said, in heavy manual wheelchairs that an able bodied person would struggle to push frequently. They're the wrong type or size and at the very least are uncomfortable often, she said, people who have impaired functions in their upper limbs cannot push these wheelchairs themselves and become effectively housebound, in some cases confined to their bed.
Sometimes they develop complications from poorly prescribed wheelchairs, and it lands them back in hospital on average, she added, people wait at least ten months after discharge before being assessed, let alone getting the wheelchair that is right for them. Unbelievably, some local wheelchair services apparently refused to assess a patient until they have left hospital. So much, my Lords, for integrated care, which I thought integrated care boards were established to actually achieve. Now, Doctor Sage's experience, of course, is not unusual.
The Wheelchair Alliance has produced convincing evidence to show how inconsistent and under-resourced wheelchair services are. Over 50% of providers come from the private sector, and there are real worries regarding the financial frailty of many of them. With a system that prioritises lowest initial cost over long term value and reliability, there are no consistent national standards, no independent regulation, few clear paths for users seeking repairs, reporting thoughts or making complaints. As a result, many disabled people experience long waiting times, delays in hospital discharge, loss of independence, social inclusion and tragically avoidable deterioration in health and well-being.
My Lord, it's the same dismal picture with community equipment embracing hoists, scrap rails, harnesses, medical beds and a wide range of essential medical products. The all party Group for Access to Disability Equipment has recently reported on the systematic crisis in the sector. 60% 63% of carers, 55% of equipment users feel that services are getting worse, not better, and the all party group concluded the system's inconsistent, underinvested, fragmented and lacking leadership. Now, government policy is that local authorities and integrated care boards are share responsibility for community equipment.
In practice, this means a fragmented, inconsistent delivery equipment providers describe a landscape in which every authority works differently without alignment or accountability, so the consequence is a postcode lottery, with 74% of equipment providers aware of patients experiencing delayed hospital discharge due to unavailability of community equipment. And I would argue, and I'm looking forward to Baroness Brinton speech later on this, I would argue that community equipment is almost the silent crisis at the root of the challenges we face in providing community and social care.
And the tragedy is it would be so easy to sort this out if there was a will to do it now, my Lords, in April, the government published the Wheelchair Quality Framework to assist integrated care boards and will share service providers deliver high quality provision. I have read it. It's welcome. But my Lords, the problem is, first of all, its guidance. It lacks binding universal standards, does not guarantee equitable provision across all of the country. It does not address systematic under-investment.
It does not mandate robust data reporting. It lacks external oversight or performance management. And so there is no statutory legally guaranteed entitlement, ensuring that every person in need receives the right wheelchair or community equipment in a timely fashion. My Lords, what is required? I am absolutely convinced that we need a national strategy, underpinned by the appointment of a national clinical director, accountable to Ministers and backed up by strong performance management and the remit of the director, should embrace community equipment as well as wheelchairs.
Miles what that needs to be underpinned by a vision, a national, comprehensive vision of what a high quality wheelchair and community equipment provision should look like, and the government should embrace the report of the all party group on access to Disability equipment by introducing a dedicated national strategy for community equipment and wheelchair provision. Users must be around the top table with a real input into policy, a nationally defined eligibility and quality standard for wheelchairs and community equipment uniform across all regions, and removing the current postcode lottery, a legally guaranteed entitlement to appropriate equipment for all those assessed as needing them.
A long term funding model that accounts for rising costs of equipment, manufacturing, maintenance, energy, staff and supply chain resilience, and a simple, user friendly service for wheelchair users and carers to report issues, requests, papers, make complaints or feedback and be heard on procurement. We need to shift from lowest cost procurement to value based procurement, which is happening, my Lords, in general procurement, it ought to be extended to wheelchairs and community equipment and my Lords for community equipment itself.
National training standards for clinicians, commissioners, OTS, other professionals and suppliers involved in equipment provision. I don't think anyone in this debate is going to argue that wheelchair and community equipment is absolutely woeful. The tragedy, as I've said before, is that it's so easily sorted. If the government were prepared to say we're going to sort it, we're going to have a national, we're going to do what I've suggested in relation to have national leadership. And I lost so many of the issues in community care, and the blockages would be dealt with if this were really taken seriously.
We all know what happens. It's not regarded as at all serious by either the NHS or local authorities and many, many people suffer as a result. My Lords, I beg to move.
13:01
Lord Shinkwin (Conservative)
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Lord Shinkwin (Conservative)
My Lords. the noble Lord Hunt of Kings Heath, and I thank him firstly for securing this important debate. Secondly, for his work on improving health outcomes, which he has been involved with for probably far longer than he cares to remember. And thirdly, for choosing to champion wheelchair services in which I should declare an interest as a user. I trust his noble friend. The Minister will bear in mind the noble Lords tenacity in her response, which we look forward to hearing as we do the maiden speech of Baroness Baroness Gerada.
None of us will ever forget the trepidation with which we each faced the prospect of addressing the Lordships House for the first time. There may be issues which divide us, but the nerve wracking experience and making our own maiden speech say it into each member's memory surely unites us. I have no doubt that we will all be rooting for her. May Lords are referred to the Lord's tenacity. It's much needed, not least because, as he very helpfully outlined, the absence of a strategic approach on wheelchair services will be costing the NHS an awful lot of money, money it cannot afford to waste.
So in a little time I have now put three questions to the noble Baroness Minster. She'll no doubt be familiar with the finding of the Appg for Access to Disability Equipment Support that the Community and Medical Equipment system is, to quote in crisis with the Wheelchair Alliance's recent report, Wheelchair Provision How to Drive Effective Change, which details the costly consequences of inadequate and inconsistent provision which the Lord Lord Hanson mentioned, including delays in hospital discharge, loss of independence, social isolation was the inevitable impact on mental health and, of course, avoidable deterioration in health and wellbeing, a point the noble Lords made in his excellent speech.
So would she agree with me that that is the avoidable? And would she further agree that it is? If it is avoidable, then we are putting our nose to spite our face. If we allow ICBs to misrepresent as a saving what is actually in the strategic big picture, a completely false economy which is costing the NHS and indeed the taxpayer far too much money. And my third and last question is this Frontier Economics setting out a few reports, the value of the wheelchair estimated the potential value.
I would say saving that high quality wheelchair provision to provide wheelchair users and crucially, society. Will she undertake to put that thinking at the heart of any strategy? My Lords, the current situation is untenable because it does not make economic sense. That is why the noble Lords call for a strategy deserves to be heard and deserves to be acted upon urgently.
None of us will ever forget the trepidation with which we each faced the prospect of addressing the Lordships House for the first time. There may be issues which divide us, but the nerve wracking experience and making our own maiden speech say it into each member's memory surely unites us. I have no doubt that we will all be rooting for her. May Lords are referred to the Lord's tenacity. It's much needed, not least because, as he very helpfully outlined, the absence of a strategic approach on wheelchair services will be costing the NHS an awful lot of money, money it cannot afford to waste.
So in a little time I have now put three questions to the noble Baroness Minster. She'll no doubt be familiar with the finding of the Appg for Access to Disability Equipment Support that the Community and Medical Equipment system is, to quote in crisis with the Wheelchair Alliance's recent report, Wheelchair Provision How to Drive Effective Change, which details the costly consequences of inadequate and inconsistent provision which the Lord Lord Hanson mentioned, including delays in hospital discharge, loss of independence, social isolation was the inevitable impact on mental health and, of course, avoidable deterioration in health and wellbeing, a point the noble Lords made in his excellent speech.
So would she agree with me that that is the avoidable? And would she further agree that it is? If it is avoidable, then we are putting our nose to spite our face. If we allow ICBs to misrepresent as a saving what is actually in the strategic big picture, a completely false economy which is costing the NHS and indeed the taxpayer far too much money. And my third and last question is this Frontier Economics setting out a few reports, the value of the wheelchair estimated the potential value.
I would say saving that high quality wheelchair provision to provide wheelchair users and crucially, society. Will she undertake to put that thinking at the heart of any strategy? My Lords, the current situation is untenable because it does not make economic sense. That is why the noble Lords call for a strategy deserves to be heard and deserves to be acted upon urgently.
13:05
Lord Rennard (Liberal Democrat)
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Lord Rennard (Liberal Democrat)
Yeah. Well said, well said. >> My Lords. I declare my interest. >> As the conference. Chair of the National Association of Equipment Providers for the last five years. Providers for the last five years. Before that, for ten years I was director of communications for the British Healthcare Trades Association, representing manufacturers and suppliers of wheelchairs and assistive technology, upholding industry standards, promoting innovation, and supporting purchasers and users who are code of practice. My personal interest began as a teenager, pushing my mother in a second hand wheelchair bought through an advert in the Liverpool Echo.
There was no assessment, training or support in the 1970s. Much has improved in the 50 years since then. Yet the Wheelchair Alliance report in December 2023 showed that wheelchair provision was varying very widely. They said then that whilst wheelchair users in some areas receive an excellent service, users in other areas may experience significant delays. Inappropriately tailored equipment, a lack of training and or a slow response to breakdowns. The report also showed how high quality provision can improve lives and deliver financial benefits.
Wheelchairs are not just medical devices, they're gateways to independence, inclusion, work, education and activity. Poor provision restricts life chances, limits employment and can harm the health of carers. Pressures in wheelchair services are mirrored across community equipment, from hoists and specialist beds to bathing aids and home adaptations. The problems are systemic, not just localised. The Appg for Access to Disability Equipment found the delays are driven by staff shortages, particularly of occupational therapists, supply chain and recycling constraints, and wide inconsistencies between local authorities.
At the root of this crisis is weak oversight and blurred accountability between local authorities and integrated care boards, driving wide regional variation. The provision is fragmented and inconsistent, so I also hope that the government will now drive forward a national strategy with clear structures for provision. I agree with the Wheelchair Alliance that all integrated care boards must adopt the quality framework for wheelchair provision and the model service specification when commissioning services. I also support the call by the Appg for Access to Disability Equipment for a dedicated national strategy for Community equipment, alongside a dedicated DHSC Minister to oversee delivery.
This would ensure that needs are appropriately and fairly met everywhere. I welcome the government's wheelchair quality framework, but it doesn't go nearly far enough and I also welcome increased use of personalised budgets. But providers and users both really need to understand these budgets to ensure real choice and best provision, giving users more control over their daily lives. Fundamentally, what we need to address is balancing the costs of the provision of wheelchairs and community equipment with long term benefits, including preventing accidents, reducing the need for healthcare intervention, future enabling people with disabilities to work, pay taxes and reduce their dependency on benefits, whilst at the same time significantly increasing emotional well-being for many families.
There was no assessment, training or support in the 1970s. Much has improved in the 50 years since then. Yet the Wheelchair Alliance report in December 2023 showed that wheelchair provision was varying very widely. They said then that whilst wheelchair users in some areas receive an excellent service, users in other areas may experience significant delays. Inappropriately tailored equipment, a lack of training and or a slow response to breakdowns. The report also showed how high quality provision can improve lives and deliver financial benefits.
Wheelchairs are not just medical devices, they're gateways to independence, inclusion, work, education and activity. Poor provision restricts life chances, limits employment and can harm the health of carers. Pressures in wheelchair services are mirrored across community equipment, from hoists and specialist beds to bathing aids and home adaptations. The problems are systemic, not just localised. The Appg for Access to Disability Equipment found the delays are driven by staff shortages, particularly of occupational therapists, supply chain and recycling constraints, and wide inconsistencies between local authorities.
At the root of this crisis is weak oversight and blurred accountability between local authorities and integrated care boards, driving wide regional variation. The provision is fragmented and inconsistent, so I also hope that the government will now drive forward a national strategy with clear structures for provision. I agree with the Wheelchair Alliance that all integrated care boards must adopt the quality framework for wheelchair provision and the model service specification when commissioning services. I also support the call by the Appg for Access to Disability Equipment for a dedicated national strategy for Community equipment, alongside a dedicated DHSC Minister to oversee delivery.
This would ensure that needs are appropriately and fairly met everywhere. I welcome the government's wheelchair quality framework, but it doesn't go nearly far enough and I also welcome increased use of personalised budgets. But providers and users both really need to understand these budgets to ensure real choice and best provision, giving users more control over their daily lives. Fundamentally, what we need to address is balancing the costs of the provision of wheelchairs and community equipment with long term benefits, including preventing accidents, reducing the need for healthcare intervention, future enabling people with disabilities to work, pay taxes and reduce their dependency on benefits, whilst at the same time significantly increasing emotional well-being for many families.
13:09
Lord Harries of Pentregarth (Crossbench)
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Lord Harries of Pentregarth (Crossbench)
I'd like to thank the noble Lord, >> I'd like to thank the noble Lord, Lord hunt for introducing this debate, which I think is of very great importance indeed. I am the main carer for my wife, who is very severely disabled, and I've calculated that we probably need at least nine pieces of equipment in order to lead any kind of reasonable life. She has a hospital bed to stop her having sores, a hoist to get her out of bed, a commode wheelchair to wheel her to the stairlift, a turner to actually get her onto the chairlift, a chairlift to take her downstairs, another turner to get her onto the commode lift, and the commode lift to take her into the bathroom, in addition to a lifting wheel chair.
In addition, of course, special amputations in the in the bathroom with rails, and so on. A powered wheelchair and a wheelchair. Because we can only get into the GP with a small handrail, at least three ramps in order to get her out of the house. My Lords, we are very fortunate. This is a good story. We have what we want in order to rid a a decent life, partly provided and partly purchased ourselves. But it brings to my mind the nightmare, the total nightmare of people who do not have that equipment or equipment breaks down and they're not able to get emergency help in order to, to, to, to mend it.
And as we've already heard from the noble Lord Wharton and other people, there is very widespread dissatisfaction with people who need equipment because of frustrations and, and delays and, and bureaucracy. And I won't repeat those figures, but I was particularly moved and I think perhaps others have been moved also by the story of Reece Porter, who had cerebral palsy, and who was without essential equipment, including a hoist and home adaptations for two years, my Lord, for two years.
And during this time, apparently his parents had to help him use a commode seat in his bedroom and drag him into the family bathroom on a towel once a week, putting them all at risk of injury. And when he needed surgery, there was no immediate help to have a hoist in order to to get him out of bed. To do do that. This equipment for Reece and countless others is critical not only to support day to day activities, but also to ensure essential medical treatment can take place, avoiding further complications.
My Lords, such delays are not just occasional. The crisis impacting community equipment causing months, sometimes years of delay for assessment and medical kit is systematic rather than down to individual actors. And the main reason, as we've already heard, my Lord, but it is worth repeating, is that there is a lack of national oversight. Statutory responsibilities have left, or local authorities and ICBs, which is creating inconsistent and patchy provision. And moreover, confusion over who ultimately is responsible for this essential service.
Moreover, my Lords, the situation is likely to get worse with an ageing population and the rise of chronic health conditions, the demand for mobility aids of various kinds is going to increase, and it's vitally important for the government to act now before the situation deteriorates even further. So I'd like to ask the Minister, in the light of the APPG, for access to disability equipments, finding that there is no national strategy, no coherent commissioning framework and no single accountable Minister for Community equipment, will the government now commit to developing a national strategy for both community equipment and wheelchair services, overseen by a named Minister with clear responsibility for delivery?
In addition, of course, special amputations in the in the bathroom with rails, and so on. A powered wheelchair and a wheelchair. Because we can only get into the GP with a small handrail, at least three ramps in order to get her out of the house. My Lords, we are very fortunate. This is a good story. We have what we want in order to rid a a decent life, partly provided and partly purchased ourselves. But it brings to my mind the nightmare, the total nightmare of people who do not have that equipment or equipment breaks down and they're not able to get emergency help in order to, to, to, to mend it.
And as we've already heard from the noble Lord Wharton and other people, there is very widespread dissatisfaction with people who need equipment because of frustrations and, and delays and, and bureaucracy. And I won't repeat those figures, but I was particularly moved and I think perhaps others have been moved also by the story of Reece Porter, who had cerebral palsy, and who was without essential equipment, including a hoist and home adaptations for two years, my Lord, for two years.
And during this time, apparently his parents had to help him use a commode seat in his bedroom and drag him into the family bathroom on a towel once a week, putting them all at risk of injury. And when he needed surgery, there was no immediate help to have a hoist in order to to get him out of bed. To do do that. This equipment for Reece and countless others is critical not only to support day to day activities, but also to ensure essential medical treatment can take place, avoiding further complications.
My Lords, such delays are not just occasional. The crisis impacting community equipment causing months, sometimes years of delay for assessment and medical kit is systematic rather than down to individual actors. And the main reason, as we've already heard, my Lord, but it is worth repeating, is that there is a lack of national oversight. Statutory responsibilities have left, or local authorities and ICBs, which is creating inconsistent and patchy provision. And moreover, confusion over who ultimately is responsible for this essential service.
Moreover, my Lords, the situation is likely to get worse with an ageing population and the rise of chronic health conditions, the demand for mobility aids of various kinds is going to increase, and it's vitally important for the government to act now before the situation deteriorates even further. So I'd like to ask the Minister, in the light of the APPG, for access to disability equipments, finding that there is no national strategy, no coherent commissioning framework and no single accountable Minister for Community equipment, will the government now commit to developing a national strategy for both community equipment and wheelchair services, overseen by a named Minister with clear responsibility for delivery?
13:13
Baroness Gerada (Crossbench)
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Baroness Gerada (Crossbench)
Here are. >> Here are. >> My Lords. I rise for the first time with gratitude, humility and, if I'm honest, a certain amount of surprise until I remember how hard it is to see a GP these days and having me in the house at the solves that problem. It's though a great honour, of course, to stand here, particularly in such a significant debate that concerns dignity, fairness and independence. I thank the noble Baroness, Lady Kennedy of the Shaws and Lord Patel of Bradford, who so kindly introduced me.
I also thank the staff of this House for their warm welcome, for their patience with my many questions and for their kindness. So a little bit about me. I have Maltese heritage and I was born in Nigeria where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service.
My father became a general practitioner in the NHS. His surgery was the front room of our home. Patients have therefore been part of my life from a very early age. As a young girl, dad would take me to home visits to the community still bearing the scars of the Second World War. Through him, I learnt what general practice truly involves not merely medicine, but community, continuity and compassion, and that the measure of a doctor lies in not just what he knows, but in how he or she cares.
I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy in 1990. After completing my training in psychiatry, I became a GP in Kennington and I have lived and worked in a community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit the next day. It was returned to the surgery with a note reading sorry doc, it won't happen again.
Of course, it can never happen when I visit this house, as my little Brompton has two armed policemen guarding it every day. Thank you officers. My patients have included the great, the good and given that I work in the Division bell occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children. To that continuity seems lives unfold across time, gives general practice its unique moral and social power.
It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses of change. We observe how illness is linked with housing, with poverty, with work, and the myriad pressures of everyday life. This is not the soft end of medicine. It is its foundation, the undramatic, continuous care that underpins the entire National Health Service. GPS carry out more than 300 million patient consultations every year.
80% of all NHS contacts, for less than 10% of its budget. Most of our encounters end without referral or admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed, and saves money. And where the story of our NHS begins anew every day. My Lords, it is a privilege to be amongst the very few GPS admitted to this noble House. And now that I have completed my my maiden speech, my first surgery is tomorrow, ten minutes only.
And only one problem allowed. My Lords, thank you very much. It's a great honour to listen to Baroness Gerada, and to have enjoyed a small sample of the immense knowledge that she
I also thank the staff of this House for their warm welcome, for their patience with my many questions and for their kindness. So a little bit about me. I have Maltese heritage and I was born in Nigeria where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service.
My father became a general practitioner in the NHS. His surgery was the front room of our home. Patients have therefore been part of my life from a very early age. As a young girl, dad would take me to home visits to the community still bearing the scars of the Second World War. Through him, I learnt what general practice truly involves not merely medicine, but community, continuity and compassion, and that the measure of a doctor lies in not just what he knows, but in how he or she cares.
I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy in 1990. After completing my training in psychiatry, I became a GP in Kennington and I have lived and worked in a community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit the next day. It was returned to the surgery with a note reading sorry doc, it won't happen again.
Of course, it can never happen when I visit this house, as my little Brompton has two armed policemen guarding it every day. Thank you officers. My patients have included the great, the good and given that I work in the Division bell occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children. To that continuity seems lives unfold across time, gives general practice its unique moral and social power.
It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses of change. We observe how illness is linked with housing, with poverty, with work, and the myriad pressures of everyday life. This is not the soft end of medicine. It is its foundation, the undramatic, continuous care that underpins the entire National Health Service. GPS carry out more than 300 million patient consultations every year.
80% of all NHS contacts, for less than 10% of its budget. Most of our encounters end without referral or admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed, and saves money. And where the story of our NHS begins anew every day. My Lords, it is a privilege to be amongst the very few GPS admitted to this noble House. And now that I have completed my my maiden speech, my first surgery is tomorrow, ten minutes only.
And only one problem allowed. My Lords, thank you very much. It's a great honour to listen to Baroness Gerada, and to have enjoyed a small sample of the immense knowledge that she
13:18
Baroness Lane-Fox of Soho (Crossbench)
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Baroness Lane-Fox of Soho (Crossbench)
will bring to this house. It is, however, somewhat ironic that I am being asked to talk about her in a time limited debate, when it's time limited debate, when it's clear possible to fill a whole hour with her public achievements and contributions to public life. As we contributions to public life. As we heard, Baroness Gerada qualified as a doctor in 1983, trained in psychiatry in the Maudsley in psychiatry in the Maudsley in Bethlehem and then as a GP in South London, her career has consistently sat at the intersection of general practice and mental health, including addiction, gambling, harm and, critically, the well-being of the healthcare workforce itself.
From 2008 to 22, she founded and led the NHS Practitioner Health Service, now the largest confidential mental health and addiction service for health professionals in the world, supporting 50,000 clinicians across England and Scotland. From 2019 to 25, she co-chaired the NHS Assembly, helping to bridge policy, policy and patient experience at a national level. Ever the entrepreneur, it seems she also co-developed Econsult, now used by around a third of GP practices, and she continues to lead the primary care gambling service and serves as patron of Doctors in Distress.
And as if this was not all enough, she has been Chair and president of the Royal College of General Practitioners, only the second woman to hold both roles. But before I end, I must mention perhaps her most remarkable career high her stint as a stand up comedian. In the show, she co-wrote 50 Minutes to Save the NHS, which should perhaps have been a clue as to how effective she would be in a time limited debate on an important subject. Baroness Gerada brings not only expertise but wit to this House, and I have no doubt she'll make an important and exceptional contribution.
We often file wheelchair and community equipment services under health or social care. In reality, they are ought to be part of our national employment infrastructure. When services fail, people don't just lose mobility, they lose their ability to contribute. The numbers tell this story starkly. Only around 53% of working age disabled people are in employment, compared with 82% of non-disabled people. And it's even wider for young disabled people. As a recent House of Lords report on the transition to work made clear, 1.2 million of people rely on a wheelchair and many more on other pieces of equipment.
So when these systems fail, we're not just talking about inconvenience, we're talking about large parts of the labour market losing the tools that make work possible for many disabled people, daily life and work depend on reliable access to the right equipment, wheelchair seating, mobility aids, home adaptations, assistive tech when systems slip. When assessments take months, repairs take weeks. The consequences are immediate. Parliamentary inquiries have described these failures as systemic. As we've heard charities report people stuck at home with unsafe chairs or unable to start new jobs because their equipment simply hasn't arrived.
Services designed to enable independence become gatekeepers to your ability to work. This is an economic cost. We rarely acknowledge if someone is unable to work purely because essential equipment is delayed or incorrect, the ripple effect hits every public budget. They're less likely to earn, less likely to pay tax to progress in their career, more likely to draw on welfare, and likely to need avoidable support. Independent assessments show that timely wheelchair provision provides substantial net fiscal benefits over a lifetime. This is not charity.
It's investment in people, productivity and public finances. So what can we do? I would like to offer that the private sector has a bigger role than it realises. Many employers have disability inclusion strategies, but too often the effort stops at the workplace door. Rarely do companies engage with the upstream systems that determine whether someone can physically get to work. Access to equipment, responsiveness of service providers, or the basic accessibility of buildings and bathrooms. Employers can change that. They can partner with local social care services.
They can use procurement to demand guarantee, repair times, loan equipment, or minimum quality standards. They can appoint a senior sponsor for end to end online accessibility, responsible for everything from recruitment to evacuation plans. They can embed requirements for accessibility and rapid occupational therapy assessments in their HR processes. They can also use their data tracking how many dates slip because equipment isn't in place, how many job offers fall away, how many days of work are lost to broken or missing equipment? They can work with unions to help work into disabled staff networks and design no detriment policies.
When external equipment failures prevent people from working, government and commissioners must stop treating equipment services as a marginal welfare line, they are essential. Economic infrastructure outcomes should be judged not just clinically, but in terms of employment, education and participation. Services should publish transparent data on waiting times for the assessments, delivery and repair broken down by age, region and employment status. At a minimum, we must know how many working age disabled people are being delayed or denied work because of delays to equipment.
Access to work should be fully integrated with NHS wheelchair and community equipment pathways. Leaders such as Sara Weller, a non-exec at BT, have long been arguing that disability inclusion must mean more than good intentions. It means designing systems that work from end to end. This is the core point. Mobility, accessibility and equipment are not optional extras for many disabled people. They are the foundation that makes employment possible. I learned this the hard way when I was in a wheelchair for a year, but before my own experience, I learned from another lane-fox who terrorised the halls of this building in her electric wheelchair.
My great aunt Felicity Lane-fox. If we're serious about closing the disability employment gap, boosting productivity and unlocking talent, we must put disability equipment services in our growth strategy,
**** Possible New Speaker ****
not marooned on the edge of the health system. Thank you. My Lords. I'm delighted to be the first conservative to.
**** Possible New Speaker ****
the first conservative to. Congratulate the noble Baroness, Lady Garrard, on an excellent maiden speech. As one would expect from such a distinguished doctor, and how wise of her to speak today and how wise of her to speak today and not step into the maelstrom of assisted dying tomorrow. Although, of course, there will be plenty more days and plenty of opportunity more days and plenty of opportunity for her to give a view. As a former distinguished president of the Royal College of General Practitioners, of course, we shall also expect her to single handedly save the NHS and solve the serious
From 2008 to 22, she founded and led the NHS Practitioner Health Service, now the largest confidential mental health and addiction service for health professionals in the world, supporting 50,000 clinicians across England and Scotland. From 2019 to 25, she co-chaired the NHS Assembly, helping to bridge policy, policy and patient experience at a national level. Ever the entrepreneur, it seems she also co-developed Econsult, now used by around a third of GP practices, and she continues to lead the primary care gambling service and serves as patron of Doctors in Distress.
And as if this was not all enough, she has been Chair and president of the Royal College of General Practitioners, only the second woman to hold both roles. But before I end, I must mention perhaps her most remarkable career high her stint as a stand up comedian. In the show, she co-wrote 50 Minutes to Save the NHS, which should perhaps have been a clue as to how effective she would be in a time limited debate on an important subject. Baroness Gerada brings not only expertise but wit to this House, and I have no doubt she'll make an important and exceptional contribution.
We often file wheelchair and community equipment services under health or social care. In reality, they are ought to be part of our national employment infrastructure. When services fail, people don't just lose mobility, they lose their ability to contribute. The numbers tell this story starkly. Only around 53% of working age disabled people are in employment, compared with 82% of non-disabled people. And it's even wider for young disabled people. As a recent House of Lords report on the transition to work made clear, 1.2 million of people rely on a wheelchair and many more on other pieces of equipment.
So when these systems fail, we're not just talking about inconvenience, we're talking about large parts of the labour market losing the tools that make work possible for many disabled people, daily life and work depend on reliable access to the right equipment, wheelchair seating, mobility aids, home adaptations, assistive tech when systems slip. When assessments take months, repairs take weeks. The consequences are immediate. Parliamentary inquiries have described these failures as systemic. As we've heard charities report people stuck at home with unsafe chairs or unable to start new jobs because their equipment simply hasn't arrived.
Services designed to enable independence become gatekeepers to your ability to work. This is an economic cost. We rarely acknowledge if someone is unable to work purely because essential equipment is delayed or incorrect, the ripple effect hits every public budget. They're less likely to earn, less likely to pay tax to progress in their career, more likely to draw on welfare, and likely to need avoidable support. Independent assessments show that timely wheelchair provision provides substantial net fiscal benefits over a lifetime. This is not charity.
It's investment in people, productivity and public finances. So what can we do? I would like to offer that the private sector has a bigger role than it realises. Many employers have disability inclusion strategies, but too often the effort stops at the workplace door. Rarely do companies engage with the upstream systems that determine whether someone can physically get to work. Access to equipment, responsiveness of service providers, or the basic accessibility of buildings and bathrooms. Employers can change that. They can partner with local social care services.
They can use procurement to demand guarantee, repair times, loan equipment, or minimum quality standards. They can appoint a senior sponsor for end to end online accessibility, responsible for everything from recruitment to evacuation plans. They can embed requirements for accessibility and rapid occupational therapy assessments in their HR processes. They can also use their data tracking how many dates slip because equipment isn't in place, how many job offers fall away, how many days of work are lost to broken or missing equipment? They can work with unions to help work into disabled staff networks and design no detriment policies.
When external equipment failures prevent people from working, government and commissioners must stop treating equipment services as a marginal welfare line, they are essential. Economic infrastructure outcomes should be judged not just clinically, but in terms of employment, education and participation. Services should publish transparent data on waiting times for the assessments, delivery and repair broken down by age, region and employment status. At a minimum, we must know how many working age disabled people are being delayed or denied work because of delays to equipment.
Access to work should be fully integrated with NHS wheelchair and community equipment pathways. Leaders such as Sara Weller, a non-exec at BT, have long been arguing that disability inclusion must mean more than good intentions. It means designing systems that work from end to end. This is the core point. Mobility, accessibility and equipment are not optional extras for many disabled people. They are the foundation that makes employment possible. I learned this the hard way when I was in a wheelchair for a year, but before my own experience, I learned from another lane-fox who terrorised the halls of this building in her electric wheelchair.
My great aunt Felicity Lane-fox. If we're serious about closing the disability employment gap, boosting productivity and unlocking talent, we must put disability equipment services in our growth strategy,
**** Possible New Speaker ****
not marooned on the edge of the health system. Thank you. My Lords. I'm delighted to be the first conservative to.
**** Possible New Speaker ****
the first conservative to. Congratulate the noble Baroness, Lady Garrard, on an excellent maiden speech. As one would expect from such a distinguished doctor, and how wise of her to speak today and how wise of her to speak today and not step into the maelstrom of assisted dying tomorrow. Although, of course, there will be plenty more days and plenty of opportunity more days and plenty of opportunity for her to give a view. As a former distinguished president of the Royal College of General Practitioners, of course, we shall also expect her to single handedly save the NHS and solve the serious
13:25
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
problems of general practice moving patients into hospital care. And so we all look forward to hearing from her again. I also congratulate the noble Lord Lord Hunt of Kings Heath for securing this debate and his excellent contribution. NHS wheelchair provision has been widely criticised for inconsistency, widely criticised for inconsistency, long delays and poor suitability of equipment costs are driven up by inefficiencies and the false inefficiencies and the false economy of supplying inadequate wheelchairs. A cost effective strategy would focus on on standardising services, improving assessments and investing in fit for purpose equipment to reduce downstream health and social costs.
Now, one of the key criticisms of NHS wheelchair provision. First a postcode lottery. Services vary significantly across regions, leading to inequitable, inequitable access. Second, long waiting times, delays in assessment and delivery leave users without mobility support for months. Third, poor suitability of equipment. Many wheelchairs provide a heavy, cumbersome or not tailored to users daily lives, forcing some to buy their own. And fourth, limited user involvement assessments often fail to consider lifestyle needs, reducing independence and social participation, and fifth or sixth inconsistent standards.
NHS England acknowledges variation in service quality and outcomes. My Lords, putting it simply, NHS wheelchairs are dirt cheap and for that you get big, heavy, ugly things which appal young people who may need to use them. The wheels may not detach. Car transport may be difficult, if not impossible. Now noble Lords have seen my sophisticated wheelchair parked around the corner, similar to the one of the noble Baroness, Lady Brinton. And. But these wheelchairs are of a ten year old design, and their solid steel frame and very heavy design, no doubt for 40 to 50 stone Americans.
Now a replacement these days will be lightweight aluminium and lightweight aluminium wheelchairs have been taking over the scene for the last few years. That's what people want and need. But of course there is a higher cost now that cost, my Lords, I suggest, can be contained. If there was a national NHS strategy. First standardised provision nationally. Implement the NHS Wheelchair Quality Framework across all ICBs to reduce variation and appoint a senior NHS England lead to oversee wheelchair services. Second, improve assessments and user involvement.
Ensure assessments include. Consider lifestyle, employment and education needs, not just the medical factors and co-design services with wheelchair users to avoid unsuitable provision. Third, My Lords invest in fit for purpose equipment, provide wheelchairs that meet individual needs, reducing downstream costs from poor health outcomes as they get worse in the future with bad wheelchairs, and expand the personal health badges to allow choice and flexibility. Fourth, streamline procurement and maintenance. Centralised purchasing to leverage economies of scale. Introduce rapid response maintenance contracts to minimise downtime, and finally measure outcomes by Lloyd's.
Not just costs. Track independence, employment and health outcomes as key performance indicators. The value added and use data to demonstrate long term savings from better provision. My Lords, while upfront costs of better equipment and services may rise, the long term strategy in savings and health, social care and productivity make this a cost effective strategy. Standardisation, user centred assessments and investment in suitable wheelchairs are the most impactful reforms and
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I beg to support it. Yes. My Lords, I congratulate Lord Hunt of Kings Heath on securing Hunt of Kings Heath on securing this important debate. I also want to congratulate Lady Gerada on her excellent maiden speech. And from excellent maiden speech. And from these benches, we look forward to her many future contributions. The. her many future contributions. The. I'm also a member of the All Party Parliamentary Group for Access to Disability Equipment, and the Appg Disability Equipment, and the Appg published a forensically detailed report in October into the systematic barriers that prevent
Now, one of the key criticisms of NHS wheelchair provision. First a postcode lottery. Services vary significantly across regions, leading to inequitable, inequitable access. Second, long waiting times, delays in assessment and delivery leave users without mobility support for months. Third, poor suitability of equipment. Many wheelchairs provide a heavy, cumbersome or not tailored to users daily lives, forcing some to buy their own. And fourth, limited user involvement assessments often fail to consider lifestyle needs, reducing independence and social participation, and fifth or sixth inconsistent standards.
NHS England acknowledges variation in service quality and outcomes. My Lords, putting it simply, NHS wheelchairs are dirt cheap and for that you get big, heavy, ugly things which appal young people who may need to use them. The wheels may not detach. Car transport may be difficult, if not impossible. Now noble Lords have seen my sophisticated wheelchair parked around the corner, similar to the one of the noble Baroness, Lady Brinton. And. But these wheelchairs are of a ten year old design, and their solid steel frame and very heavy design, no doubt for 40 to 50 stone Americans.
Now a replacement these days will be lightweight aluminium and lightweight aluminium wheelchairs have been taking over the scene for the last few years. That's what people want and need. But of course there is a higher cost now that cost, my Lords, I suggest, can be contained. If there was a national NHS strategy. First standardised provision nationally. Implement the NHS Wheelchair Quality Framework across all ICBs to reduce variation and appoint a senior NHS England lead to oversee wheelchair services. Second, improve assessments and user involvement.
Ensure assessments include. Consider lifestyle, employment and education needs, not just the medical factors and co-design services with wheelchair users to avoid unsuitable provision. Third, My Lords invest in fit for purpose equipment, provide wheelchairs that meet individual needs, reducing downstream costs from poor health outcomes as they get worse in the future with bad wheelchairs, and expand the personal health badges to allow choice and flexibility. Fourth, streamline procurement and maintenance. Centralised purchasing to leverage economies of scale. Introduce rapid response maintenance contracts to minimise downtime, and finally measure outcomes by Lloyd's.
Not just costs. Track independence, employment and health outcomes as key performance indicators. The value added and use data to demonstrate long term savings from better provision. My Lords, while upfront costs of better equipment and services may rise, the long term strategy in savings and health, social care and productivity make this a cost effective strategy. Standardisation, user centred assessments and investment in suitable wheelchairs are the most impactful reforms and
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I beg to support it. Yes. My Lords, I congratulate Lord Hunt of Kings Heath on securing Hunt of Kings Heath on securing this important debate. I also want to congratulate Lady Gerada on her excellent maiden speech. And from excellent maiden speech. And from these benches, we look forward to her many future contributions. The. her many future contributions. The. I'm also a member of the All Party Parliamentary Group for Access to Disability Equipment, and the Appg Disability Equipment, and the Appg published a forensically detailed report in October into the systematic barriers that prevent
13:29
Baroness Brinton (Liberal Democrat)
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Baroness Brinton (Liberal Democrat)
millions of disabled children and adults from across the UK from accessing the medical and community equipment, including wheelchairs, that they need to live safely and that they need to live safely and independently, and that are holding back the sector from supplying the equipment that is needed. Lord equipment that is needed. Lord Shinkwin helpfully set out a wider social picture because community equipment is the backbone of social equipment is the backbone of social care and key to removing barriers for disabled people.
14 years ago, I was referred to my local wheelchair services. They told me that as I could walk slowly with a stick from my sitting room to my kitchen, I didn't qualify for an electric chair, but the very reason my physio had recommended me was that I was doing around 10 to 12,000 steps a day, travelling to, from and around your Lordships' House, and the damage that that was doing to my already damaged joints was significant. I had to buy my own chair.
Even this week I have heard people saying they're facing the same inconsistent decisions, not based on actual needs, but on rules to keep costs down because that is what it is all about. That's why the Wheelchair Alliance were right to say that services should be patient focussed first. The Appg report found that 63% of carers and 55% of users said services are getting worse. Over half of equipment users reported they don't have access to the medical equipment they need for their long term needs.
And as Lord Blencathra said, there is widespread reports of users being let down by the current system. So it was also good to hear from Lord Harris that the system has worked for him and his wife, and my own family's experience with requiring emergency equipment for end of life care was absolutely wonderful. But I note that the Kent end of life service bypassed the usual wheelchair and equipment service in order to get things done. There are lessons to be learned from that.
Lord Reynolds contribution was so important. We need to hear from the equipment sector and understand their problems too. One of the key issues in the medical equipment supply sector is that contracting by local authorities of services from the sector is not strategic. So as the Appg report shows, most local authorities became very dependent on one supplier who was cheaper than all the others when they went bust. Earlier this year, the sector and the commissioners in local authorities and above all, wheelchair and equipment users found that they were left high and dry.
I am pleased to report that the sector has come together with local authorities to try and remedy this, but this is a strategic fault. What's needed by the government is a national strategy that is different to a voluntary framework, as Lord hunt outlined, that serves the needs of disabled people and their families whilst offering value for money to commissioners and the public purse. What we have at the moment is the exact opposite. Sir, can I ask the Minister if she would agree to meet with the all party group for access and disability equipment and discuss
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these issues? My Lords, can I thank the noble Lord, Lord King Lord Hunt of Kings Lord, Lord King Lord Hunt of Kings Heath for securing this valuable debate today and thank all noble Lords who share their valuable experiences. But I also welcome experiences. But I also welcome Lady Gerard. I hope I pronounced that correctly who in her maiden speech shared her valuable speech shared her valuable background, which we know will contribute hugely to this House. At its heart, this is a discussion about people's freedom, about about people's freedom, about people's dignity and independence.
Wheelchairs are, for many, the difference between participating in daily life or being excluded. Enabling people to leave their homes, to see loved ones, and to access work and education. But the reason for today's debate is that the current system faces serious problems. Indeed, NHS England's 2025 Wheelchair Quality Framework recognises this, while the Appg for Access to Disability Equipment describes the system as being in
14 years ago, I was referred to my local wheelchair services. They told me that as I could walk slowly with a stick from my sitting room to my kitchen, I didn't qualify for an electric chair, but the very reason my physio had recommended me was that I was doing around 10 to 12,000 steps a day, travelling to, from and around your Lordships' House, and the damage that that was doing to my already damaged joints was significant. I had to buy my own chair.
Even this week I have heard people saying they're facing the same inconsistent decisions, not based on actual needs, but on rules to keep costs down because that is what it is all about. That's why the Wheelchair Alliance were right to say that services should be patient focussed first. The Appg report found that 63% of carers and 55% of users said services are getting worse. Over half of equipment users reported they don't have access to the medical equipment they need for their long term needs.
And as Lord Blencathra said, there is widespread reports of users being let down by the current system. So it was also good to hear from Lord Harris that the system has worked for him and his wife, and my own family's experience with requiring emergency equipment for end of life care was absolutely wonderful. But I note that the Kent end of life service bypassed the usual wheelchair and equipment service in order to get things done. There are lessons to be learned from that.
Lord Reynolds contribution was so important. We need to hear from the equipment sector and understand their problems too. One of the key issues in the medical equipment supply sector is that contracting by local authorities of services from the sector is not strategic. So as the Appg report shows, most local authorities became very dependent on one supplier who was cheaper than all the others when they went bust. Earlier this year, the sector and the commissioners in local authorities and above all, wheelchair and equipment users found that they were left high and dry.
I am pleased to report that the sector has come together with local authorities to try and remedy this, but this is a strategic fault. What's needed by the government is a national strategy that is different to a voluntary framework, as Lord hunt outlined, that serves the needs of disabled people and their families whilst offering value for money to commissioners and the public purse. What we have at the moment is the exact opposite. Sir, can I ask the Minister if she would agree to meet with the all party group for access and disability equipment and discuss
**** Possible New Speaker ****
these issues? My Lords, can I thank the noble Lord, Lord King Lord Hunt of Kings Lord, Lord King Lord Hunt of Kings Heath for securing this valuable debate today and thank all noble Lords who share their valuable experiences. But I also welcome experiences. But I also welcome Lady Gerard. I hope I pronounced that correctly who in her maiden speech shared her valuable speech shared her valuable background, which we know will contribute hugely to this House. At its heart, this is a discussion about people's freedom, about about people's freedom, about people's dignity and independence.
Wheelchairs are, for many, the difference between participating in daily life or being excluded. Enabling people to leave their homes, to see loved ones, and to access work and education. But the reason for today's debate is that the current system faces serious problems. Indeed, NHS England's 2025 Wheelchair Quality Framework recognises this, while the Appg for Access to Disability Equipment describes the system as being in
13:33
Lord Kamall (Conservative)
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Lord Kamall (Conservative)
crisis. So, my Lords, we welcome acknowledge NHS England's initial steps to improve wheelchair steps to improve wheelchair services, such as the National Wheelchair Data Set and personal wheelchair budgets. These are welcome and should be acknowledged. But data from the British Healthcare Trades Association shows that only around 80% of users receive a wheelchair or much needed modification within 18 weeks, below the 92% national target. And people with complex needs can wait significantly longer, and a delay in receiving a wheelchair is not simply an inconvenience or a statistic, it is a barrier to living a fuller life.
And also, we find that where a person lives determines how their wheelchair services are assessed, whether they qualify their level of support, how clearly the process is explained, what kind of equipment they ultimately receive, and the NHS. England's own national data set shows significant regional variation between integrated care boards in meeting the 18 week standard. There is also a wide variation in eligibility criteria. In North Bristol, the threshold for regular use is at least four times weekly on a regular basis.
In Oxford, regular use is defined as at least three days per week. In Wirral and west Cheshire, regular use is worded as more often than not for powered wheelchair assessments. We find in West Suffolk a person must demonstrate indoor need, appropriate home accessibility, get GP clearance and pass a driving assessment while in north west London that uses a tiered categorisation system of need, with detailed thresholds and criteria for the effects that denying access to certain items could foreseeably have. So when noble Lords discussed this topic last month, the noble Lady the Minister said, and I quote, integrated care boards are responsible for commissioning of local wheelchair services based on the needs of the local population.
My Lords, I appreciate the need for such flexibility and reflecting local populations. But could the Minister tell the House if the government believes that there should be more co-ordination or better coordination on eligibility, but also communicating the criteria and what plans it has for achieving this? My Lords, the noble Lord hunt shared an article from Paul Sagar about his own experience when he was on his hospital bed, distressed, worried about his future being phoned by the wheelchair service. Obviously being unable to speak right now and then assuming that he would be called back.
Instead, a letter was sent to his home address and upstairs flat, which he would never access again. And I thought that shows just valuable sort of situation some users find themselves in. So can I ask a noble Lady Minister, what is the recourse of patients where local ICPs offer such poor and unempathetic services? What's the accountability mechanism and what is the department's thinking on making them accountable to allow such poor services while respecting local differences? And does the government have any plans for regular reviews of wheelchair service providers to make sure that they all meet in standards? My Lords, I appreciate that noble Lords have asked a lot of questions, but I hope the noble Lady, the Minister who we know cares deeply about patients, will appreciate that we see this not as a party political issue, but one on which all benches can agree touches directly on people's independence, touches directly on people's dignity, and touches directly on
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people's everyday lives. My Lords, I'm most grateful to
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My Lords, I'm most grateful to my noble friend Lord hunt, not just for securing this important debate for securing this important debate on what is a vital issue. As the noble Lord Lord Kamall said, but noble Lord Lord Kamall said, but also for his campaigning, along with other noble Lords and groups and individuals outside of your and individuals outside of your Lordships House over many years. I'm also grateful to noble Lords, not just for their contributions, but also for sharing their experiences, some of which are painful to relate and painful to hear.
To the maiden speech of the noble Lady Baroness Gerada, let me welcome her experience and her approach, and let me welcome her to your Lordships House. The noble Lady spoke of choosing to speak in this debate because of its feature of, amongst other things, dignity and fairness, and I was very
And also, we find that where a person lives determines how their wheelchair services are assessed, whether they qualify their level of support, how clearly the process is explained, what kind of equipment they ultimately receive, and the NHS. England's own national data set shows significant regional variation between integrated care boards in meeting the 18 week standard. There is also a wide variation in eligibility criteria. In North Bristol, the threshold for regular use is at least four times weekly on a regular basis.
In Oxford, regular use is defined as at least three days per week. In Wirral and west Cheshire, regular use is worded as more often than not for powered wheelchair assessments. We find in West Suffolk a person must demonstrate indoor need, appropriate home accessibility, get GP clearance and pass a driving assessment while in north west London that uses a tiered categorisation system of need, with detailed thresholds and criteria for the effects that denying access to certain items could foreseeably have. So when noble Lords discussed this topic last month, the noble Lady the Minister said, and I quote, integrated care boards are responsible for commissioning of local wheelchair services based on the needs of the local population.
My Lords, I appreciate the need for such flexibility and reflecting local populations. But could the Minister tell the House if the government believes that there should be more co-ordination or better coordination on eligibility, but also communicating the criteria and what plans it has for achieving this? My Lords, the noble Lord hunt shared an article from Paul Sagar about his own experience when he was on his hospital bed, distressed, worried about his future being phoned by the wheelchair service. Obviously being unable to speak right now and then assuming that he would be called back.
Instead, a letter was sent to his home address and upstairs flat, which he would never access again. And I thought that shows just valuable sort of situation some users find themselves in. So can I ask a noble Lady Minister, what is the recourse of patients where local ICPs offer such poor and unempathetic services? What's the accountability mechanism and what is the department's thinking on making them accountable to allow such poor services while respecting local differences? And does the government have any plans for regular reviews of wheelchair service providers to make sure that they all meet in standards? My Lords, I appreciate that noble Lords have asked a lot of questions, but I hope the noble Lady, the Minister who we know cares deeply about patients, will appreciate that we see this not as a party political issue, but one on which all benches can agree touches directly on people's independence, touches directly on people's dignity, and touches directly on
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people's everyday lives. My Lords, I'm most grateful to
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My Lords, I'm most grateful to my noble friend Lord hunt, not just for securing this important debate for securing this important debate on what is a vital issue. As the noble Lord Lord Kamall said, but noble Lord Lord Kamall said, but also for his campaigning, along with other noble Lords and groups and individuals outside of your and individuals outside of your Lordships House over many years. I'm also grateful to noble Lords, not just for their contributions, but also for sharing their experiences, some of which are painful to relate and painful to hear.
To the maiden speech of the noble Lady Baroness Gerada, let me welcome her experience and her approach, and let me welcome her to your Lordships House. The noble Lady spoke of choosing to speak in this debate because of its feature of, amongst other things, dignity and fairness, and I was very
13:38
Baroness Merron (Labour)
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Baroness Merron (Labour)
touched by the noble Ladies description of what and who and GP really is within their community. And I know that we all look forward to hearing more from the noble Lady. to hearing more from the noble Lady. Could I just say the government has promised more GPS, and we're promised more GPS, and we're delighted to have more GPS sitting on our red benches. My Lords. This has been a affecting debate, not least as people describe the impact of services not being in the right place as they should be.
And I'm sure that we would all agree that there is more work to do. But I would like the opportunity to outline what the government has done and is doing, and we are focussed on ensuring that disabled people do have access to services and support that they need to lead a fulfilling life. And my ministerial colleague Zubeir Ahmed MP is the relevant Minister and I look forward to sharing the points and questions raised in this debate with him in respect of provision of wheelchair services.
Integrated care boards are responsible, as we have heard, and the noble Lord Lord commanders quoted are responsible for the provision and commissioning of local wheelchair services based on the needs of their local population. I'm glad that the noble Lord Lord Kamall did recognise the importance of flexibility. However, flexibility cannot be an excuse for not providing, which I believe is a point I've heard. I have heard rightly and repeatedly today. So, my Lords, I do have to say that there aren't no plans to publish a national strategy for wheelchair provision.
I know that will be disappointing to noble Lords, but I can say that NHS England has developed policy, guidance and legislation to support ICBs who are crucial in this, to ensure commissioning effective, efficient and personalised wheelchair services, including the Wheelchair Quality Framework, which was published just in April in collaboration with NHS England National Wheelchair Advisory Group and local authorities, do have a statutory duty to arrange for the provision of community disability equipment to meet the assessed care and support needs for people in their area.
And I would also want to add that our ten year plan for health gives that freedom and autonomy to serve local people to local commissioners. And I do think in this regard, it's important that we are giving systems control and flexibility to a greater degree about how funding is deployed to get this done. But I have heard about delays to wheelchair provision, and I say this not as any excuse at all, but the pandemic still continues to have an impact on wheelchair services, not least because, in fact, some providers have not only reduced their services with the inevitable outcome, but now face a backlog of referrals.
Also, I was interested to explore that some services have also experienced lower referral, lower referral rates during the pandemic. This, of course, has led to a surge in referrals later. It has meant waiting times for both adults and children to fluctuated as services have worked to recover. However, we do need action to address waiting times and I absolutely recognise the impact that delays have. And so to that point, in October, we published the NHS Medium Term Planning Framework, which requires all icbs and community health services to actively manage and reduce waits over 18 weeks and to develop a plan to eliminate all 52 week waits.
The noble Lord Lord Blencathra rightly referred to the need to focus on measuring outcomes, and the Community Health Services Situation Report will be used to monitor ICB performances against waiting time targets in 20 2627, and currently monitors waiting times for children and young people and adults under wheelchair orthotics, prosthetics and equipment, and these targets will guide systems to reduce the longest waits. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments take place have to take place in the most suitable environment, including hospitals.
But the key thing here is based on the need of the individual. My Lords, my noble friend Lord hunt and other noble Lords rightly spoke to delays in discharge being linked to temporary or short term lone well wheelchairs rather than long term provision. Let me say that access to temporary wheelchair provision to support hospital discharge is determined locally by ICBs. It doesn't fall within the remit of NHS Wheelchair Services, which does provide services to people of all ages with long term mobility needs.
I did hear the point made very clearly about the technology and quality of wheelchairs, and certainly that's one of the things I will be raising and discussing with Minister Ahmed in terms of improving the quality of wheelchair services. As I said, reducing waiting time is part of it. It's not the whole story. So the quality framework and the noble Lord Lord Shinkwin asked about this point, is very much designed to assist Icbs and NHS wheelchair service providers to get it right.
I have heard that the experience of noble Lords, both within this chamber and also in lives outside, this is not always the case and I do understand that. But the quality framework sets out quality standards relevant to all suppliers and does align with the CQC assessment framework and and to the point raised not just by the noble Lord, Lord Blencathra, but also the noble Lady, Baroness Brinton. This is about aiming to tackle the inequalities that we know do exist.
I want to acknowledge that in outcomes, in experience and access. My Lords NHS England statutory guidance sets out how Icbs should be working with people, communities, key partners and with local authorities. And that's why each ICB must have executive leads who work closely with local authorities, who promote integrated working for the benefit of those including those with learning disability and autism, down syndrome, and children and young people with special educational needs and disabilities. NHS England, also as was referred to in the debate, introduced a personal wheelchair budgets in 2019 and gave a clear framework for ICBs to commission personalised wheelchair services, focusing on outcomes and also in integrated care, giving people greater choice over the wheelchair provided.
And I have heard what noble Lords have said today, and also to the noble Lady Baroness Lane-Fox, who spoke quite correctly about the impact of the quality of services on the ability to be in the market for employment. That is about quality of life as well as the economy. And I share her views to the noble Lords, Lord Harris and Lord Rennard about dissatisfaction with services. And again, I heard that spoken of a number of times. NHS bodies and local authorities must arrange for dealing properly with complaints.
And let me say, overall, the approach of the ten year health plan identifies disabled people as a priority group and our Neighbourhood Health service will support disabled people. It's about choice and control over their care, and the ten year plan focuses on that. My Lords, I have heard what noble Lords have said and as I said, I will be taking that back. I hope the steps we have made will make a
**** Possible New Speaker ****
difference, but I do recognise Lords. I'm going.
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I'm going. To just pause for a short moment to allow any movement around the Motion Motion for. Motion for. Debate Motion for. Debate Common Good Foundation and Centre for Policy Studies report. Don't stop thinking about tomorrow. And with all best wishes for his valedictory speech. Lord Hodgson, of Astley Abbotts.
And I'm sure that we would all agree that there is more work to do. But I would like the opportunity to outline what the government has done and is doing, and we are focussed on ensuring that disabled people do have access to services and support that they need to lead a fulfilling life. And my ministerial colleague Zubeir Ahmed MP is the relevant Minister and I look forward to sharing the points and questions raised in this debate with him in respect of provision of wheelchair services.
Integrated care boards are responsible, as we have heard, and the noble Lord Lord commanders quoted are responsible for the provision and commissioning of local wheelchair services based on the needs of their local population. I'm glad that the noble Lord Lord Kamall did recognise the importance of flexibility. However, flexibility cannot be an excuse for not providing, which I believe is a point I've heard. I have heard rightly and repeatedly today. So, my Lords, I do have to say that there aren't no plans to publish a national strategy for wheelchair provision.
I know that will be disappointing to noble Lords, but I can say that NHS England has developed policy, guidance and legislation to support ICBs who are crucial in this, to ensure commissioning effective, efficient and personalised wheelchair services, including the Wheelchair Quality Framework, which was published just in April in collaboration with NHS England National Wheelchair Advisory Group and local authorities, do have a statutory duty to arrange for the provision of community disability equipment to meet the assessed care and support needs for people in their area.
And I would also want to add that our ten year plan for health gives that freedom and autonomy to serve local people to local commissioners. And I do think in this regard, it's important that we are giving systems control and flexibility to a greater degree about how funding is deployed to get this done. But I have heard about delays to wheelchair provision, and I say this not as any excuse at all, but the pandemic still continues to have an impact on wheelchair services, not least because, in fact, some providers have not only reduced their services with the inevitable outcome, but now face a backlog of referrals.
Also, I was interested to explore that some services have also experienced lower referral, lower referral rates during the pandemic. This, of course, has led to a surge in referrals later. It has meant waiting times for both adults and children to fluctuated as services have worked to recover. However, we do need action to address waiting times and I absolutely recognise the impact that delays have. And so to that point, in October, we published the NHS Medium Term Planning Framework, which requires all icbs and community health services to actively manage and reduce waits over 18 weeks and to develop a plan to eliminate all 52 week waits.
The noble Lord Lord Blencathra rightly referred to the need to focus on measuring outcomes, and the Community Health Services Situation Report will be used to monitor ICB performances against waiting time targets in 20 2627, and currently monitors waiting times for children and young people and adults under wheelchair orthotics, prosthetics and equipment, and these targets will guide systems to reduce the longest waits. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments take place have to take place in the most suitable environment, including hospitals.
But the key thing here is based on the need of the individual. My Lords, my noble friend Lord hunt and other noble Lords rightly spoke to delays in discharge being linked to temporary or short term lone well wheelchairs rather than long term provision. Let me say that access to temporary wheelchair provision to support hospital discharge is determined locally by ICBs. It doesn't fall within the remit of NHS Wheelchair Services, which does provide services to people of all ages with long term mobility needs.
I did hear the point made very clearly about the technology and quality of wheelchairs, and certainly that's one of the things I will be raising and discussing with Minister Ahmed in terms of improving the quality of wheelchair services. As I said, reducing waiting time is part of it. It's not the whole story. So the quality framework and the noble Lord Lord Shinkwin asked about this point, is very much designed to assist Icbs and NHS wheelchair service providers to get it right.
I have heard that the experience of noble Lords, both within this chamber and also in lives outside, this is not always the case and I do understand that. But the quality framework sets out quality standards relevant to all suppliers and does align with the CQC assessment framework and and to the point raised not just by the noble Lord, Lord Blencathra, but also the noble Lady, Baroness Brinton. This is about aiming to tackle the inequalities that we know do exist.
I want to acknowledge that in outcomes, in experience and access. My Lords NHS England statutory guidance sets out how Icbs should be working with people, communities, key partners and with local authorities. And that's why each ICB must have executive leads who work closely with local authorities, who promote integrated working for the benefit of those including those with learning disability and autism, down syndrome, and children and young people with special educational needs and disabilities. NHS England, also as was referred to in the debate, introduced a personal wheelchair budgets in 2019 and gave a clear framework for ICBs to commission personalised wheelchair services, focusing on outcomes and also in integrated care, giving people greater choice over the wheelchair provided.
And I have heard what noble Lords have said today, and also to the noble Lady Baroness Lane-Fox, who spoke quite correctly about the impact of the quality of services on the ability to be in the market for employment. That is about quality of life as well as the economy. And I share her views to the noble Lords, Lord Harris and Lord Rennard about dissatisfaction with services. And again, I heard that spoken of a number of times. NHS bodies and local authorities must arrange for dealing properly with complaints.
And let me say, overall, the approach of the ten year health plan identifies disabled people as a priority group and our Neighbourhood Health service will support disabled people. It's about choice and control over their care, and the ten year plan focuses on that. My Lords, I have heard what noble Lords have said and as I said, I will be taking that back. I hope the steps we have made will make a
**** Possible New Speaker ****
difference, but I do recognise Lords. I'm going.
**** Possible New Speaker ****
I'm going. To just pause for a short moment to allow any movement around the Motion Motion for. Motion for. Debate Motion for. Debate Common Good Foundation and Centre for Policy Studies report. Don't stop thinking about tomorrow. And with all best wishes for his valedictory speech. Lord Hodgson, of Astley Abbotts.
13:48
Debate: Common Good Foundation and Centre for Policy Studies report: "Don’t stop thinking about tomorrow" and of the implications of projected population growth for the UK’s demographic future
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Debate: Common Good Foundation and Centre for Policy Studies report: "Don’t stop thinking about tomorrow" and of the implications of projected population growth for the UK’s demographic future
Thank you for those good wishes. I hope you'll still feel the same I hope you'll still feel the same at the end of my speech. My Lords, the issue of population change and the issue of population change and its consequences has long been an interest of mine, because I believe that successive governments have failed to give the topic sufficient strategic analysis and attention in the country where we appear to want
13:48
Lord Hodgson of Astley Abbotts (Conservative)
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Lord Hodgson of Astley Abbotts (Conservative)
a plan for almost everything. Conspicuously, we fail to plan for one of the essential building one of the essential building blocks in our society the number of people living in this country. Over the past ten years, I've published three reports trying to analyse this issue in as transparent and evidence based way as I could evidence based way as I could manage, and this report before your Lordships' House today is the third of them and provides an appropriate of them and provides an appropriate bookend to my time in your Lordships' House.
So I want to put on record my sincere thanks to the captain Bodyguard, noble Lord Kennedy, my own Chief Whip Baroness Williams of Trafford for enabling the scheduling of this debate. I'm not so far had the pleasure of debating the noble Baroness Anderson. I hope she'll forgive me if I say that this is a valedictory debate, and when she comes to reply, I hope she will not confine herself to a speaking at which might, just might just say we inherited a broken system from the party opposite.
Give us three years and we will have fixed it. I hope instead that she will spend some time to give some genuine consideration to the issues and concerns that I and others will be raising, because, my Lords, we all know, we all know that this is an issue which is not susceptible to piecemeal, short term solutions often produced to meet a particular crisis. By contrast, it requires careful strategic analysis conducted and transparent evidence based way, which should lead to discussions in Parliament.
This, in turn, will reassure the many concerned members of our population. In short, my Lords, we need to create space. Space for what best can be described as the wisdom of the crowd to make itself felt, and so marginalise the unrealistic and often unpleasant views at either end of the spectrum. Now the impacts of demographic change are very long. In the words of demography, the world of demography. Yesterday is the year 2000, so we are today living with the consequences of the decisions made by the Blair government in the early 2000, and tomorrow will be 2045, when our successors will have to assess the results of the what was called the Boris Wave.
And they have then become fully apparent. And that's why my report is called Don't Stop Thinking About Tomorrow. But since this is a topic where every word counts. Let me define two of them. First, the subtle population means people who have a legal right to be in the UK and expect to spend all or substantially all of the rest of their of their lives here. It is not, as some will immediately another word for white. It is not another word for white.
But since close to 20% of the UK's population is now made up of minority communities, many of whom are not white, but whatever their colour, this group is. This is a group which polling shows has a high level of concern about their interests, and the interests of their children are being overlooked and too often being sacrificed to short term political expediency. And secondly, my Lords, the word immigrant. This has become a loaded term, as in, I'm an immigrant and I'm proud as opposed to those immigrants down the road not quite so proud.
So I prefer to use the phrase new arrivals. Now, of course, I understand, and I appreciate the moral imperative that drives those new arrivals, many of whom have been for a long time, and who have benefited from a life in the UK, to be concerned about not trying to close the door on those seeking to follow them. But while recognising that moral imperative, it is unarguable. My Lords, the numbers and scale do matter. So, however sensitive and however painful it is, the key point of numbers has to be recognised and taken into account in our discussions.
And that, my Lords, takes us to the heart of of the strategic of the demographic challenge we face as a result of a series of events which which none of the major political parties can escape responsibility, some being deliberate policy decisions and some being events forced upon us by outside events, such as the Russian invasion of Ukraine. Over the last 30 years, since 1995, the population of this country has risen from 58 million to 69.5 million, an increase of 20%, about 11.5 million people.
What do 11.5 million people look like? Well, the population of Greater Manchester. My Lords, is 2.8 million. So we've added rather over four for Manchester's in that time. And drilling into the issue of housing, since we live 2.4 people per dwelling, we have to have built 4.8 million homes to house these new arrivals. And we and we have to do that before we tackle any of the shortages of housing amongst our settled population. And if you want a snapshot, a snapshot of how the country is changing.
31% of all children born in this country last year were born to mothers who were not born here. 25 years ago, that figure was 10 or 11%. Now, my Lords, where do we go from here? And what does the future look like? Well, the ONS suggests that between now and 2025, we'll have another 10% increase in our population, or 6.6 million people, and the growth is expected to slow over the period of 2045. But by 2045, we'll have between in the middle 70s, 76, 77 million people, and we will have overtaken Germany as the most populous country in Europe.
Where will these people come from? Well, of course there is the natural increase the excess of births over deaths. But leaving that aside, because of the level of press publicity, the man in the street will likely point to refugees and asylum seekers. And in this, my Lords, he would be wrong, because historically the main components have come from two sources. We've always controlled. First, UK higher education. It has built a business model based on recruiting an increasing number of foreign students, of whom 30 to 40% have morphed into our workforce at the end of their studies.
And second, British industry, which uses overseas recruitment as the Migration Advisory Committee, describes it as the default option and has ruthlessly exploited the shortage occupation list, which enables you to recruit overseas at lower wages. As I speak, my Lords, there are 61 categories in the shortage occupation list. Many will be familiar, but not all. How many members of your Lordships' House would realise we have a shortage of dancers and choreographers? So, my Lords, it is worth noting also that our democratic challenge and challenge has made more acute by the fact of our being a relatively small island.
For example, France has 120 people per square kilometre, UK has 279 more than double and England 438, nearly four times as densely populated as France. So for my this my third report, I concluded that to increase credibility, I should not write alone. So I was lucky to get the Common Good Foundation and the Centre for Policy Studies to respectively centre left and centre right think tanks to support me. And I asked a number of experts in the world of demography to discuss the demographic challenge as seen through the eyes.
It is, of course, impossible to summarise nine detailed chapters in this debate, but the overall conclusion of them all was that the country we've not been taking a sufficiently coherent, strategic approach to this particular problem. Further, since this demographic challenges one faced by all countries I made made contact with three countries overseas the Netherlands, Japan which of course facing the opposite problem of a rapidly declining population, and Denmark, which has now become the poster boy for immigration policy. Many interesting ideas emerged, but Denmark, perhaps slightly sadly, enforces very strict conditions on new arrivals and moves them on if they're not complied with.
Rather depressingly, when I asked the Danish people how, how, where do they go to? Oh, they said they did it all go to the UK because, oh, the word on the street is, once you get to the UK, no one will check anything. You are free to do what you like. So, my Lords, I believed that there was an interest to for the in the public. So I asked YouGov to do some polling and the results were 70% of our population.
Of those polled thought the government has no plan to manage population growth and 56% support the idea of creating some official body. An important message for the three parties in your Lordships' House is that only 10% thought the Labour Party had the best answers, only 8% thought the Conservative Party had the best answers, and only and only 5% thought the Liberal Democrats. By contrast, 22% supported reform. So what could be done? We have to have the courage to recognise that the irrevocable nature of demographic change means that departmentally based solutions will never, never, never provide a coherent response.
We have to cut through what I call the firewalls, which suggest that the issues raised by demographic change are not appropriate subject for discussion, and we have to call out cases where any proper discussion is closed down as a result of what Dame Sara Khan called in her government Commission review on social cohesion freedom restricting harassment. Thus, as an example, while it is perfectly acceptable to discuss policies to help achieve net zero, it is not acceptable. Not acceptable to suggest that adding 6 million people to this country might impede that achieving that objective.
So I believe, my Lords, there is a strong argument for creating a new strategic body to be called the office for Demographic Change, or perhaps the office for Population Sustainability, which would subsume within it the existing Migration Advisory Committee. It will be tasked with learning from the past to collect evidence about and analyse consequences of past policies with looking to the future, impacts of likely population changes, economic, environmental, ecological, societal and finally to undertake research into demographic developments and to learn from best practice around the world.
It would, however, not be a policy making body. This new authority will be stand alone, but reporting to the Cabinet Office, Cabinet Office and of course it would also report at least annually to Parliament. It would help create conditions by Lords for a broader, better and more balanced discussion about democracy. For example, is there a maximum level annual population increase we can absorb without prejudicing the position of our population? What can be done to improve the data sources which are clearly inadequate? Is there an argument for seeking to increase the birth rate amongst existing population and so on? So let me conclude, my Lords, the governments may choose to continue to muddle along, but recent events have shown rising public temperature and these pressures seem set to increase.
It is not just individual events such as Crowborough or Epping, it is about public mood. And so the issue seems set to be become a major driver of political change. Writing in The Times on the 15th of September, Trevor Phillips article was headlined and I quote dismissed the United Kingdom March at your peril, unquote. And he went on to say, again, I quote, calling this movement the product of extremist rabble rousers will no longer do. Mainstream politicians must wake up, unquote.
Successive governments, my Lords, have tried ignoring the problem, insinuating that those who are concerned about it is racist, suggesting nothing can be done about it, and that if only everyone would stop talking about it, it would go away. Or finally making aspirational statements with no measurable follow through. The mainstream parties here in your Lordships' House now need to set up a comprehensive, measurable response to public concerns. My report suggests one such approach, but if we fail to respond, events will likely become increasingly ugly.
As wild as spirits make the running, I can think of no more pressing threat to expressing internal threat to the long term prosperity and harmony of our, of our society, of this country than our future population levels. So I'm proud and I'm pleased to be able to hold my valedictory debate on this topic. And I beg to move.
So I want to put on record my sincere thanks to the captain Bodyguard, noble Lord Kennedy, my own Chief Whip Baroness Williams of Trafford for enabling the scheduling of this debate. I'm not so far had the pleasure of debating the noble Baroness Anderson. I hope she'll forgive me if I say that this is a valedictory debate, and when she comes to reply, I hope she will not confine herself to a speaking at which might, just might just say we inherited a broken system from the party opposite.
Give us three years and we will have fixed it. I hope instead that she will spend some time to give some genuine consideration to the issues and concerns that I and others will be raising, because, my Lords, we all know, we all know that this is an issue which is not susceptible to piecemeal, short term solutions often produced to meet a particular crisis. By contrast, it requires careful strategic analysis conducted and transparent evidence based way, which should lead to discussions in Parliament.
This, in turn, will reassure the many concerned members of our population. In short, my Lords, we need to create space. Space for what best can be described as the wisdom of the crowd to make itself felt, and so marginalise the unrealistic and often unpleasant views at either end of the spectrum. Now the impacts of demographic change are very long. In the words of demography, the world of demography. Yesterday is the year 2000, so we are today living with the consequences of the decisions made by the Blair government in the early 2000, and tomorrow will be 2045, when our successors will have to assess the results of the what was called the Boris Wave.
And they have then become fully apparent. And that's why my report is called Don't Stop Thinking About Tomorrow. But since this is a topic where every word counts. Let me define two of them. First, the subtle population means people who have a legal right to be in the UK and expect to spend all or substantially all of the rest of their of their lives here. It is not, as some will immediately another word for white. It is not another word for white.
But since close to 20% of the UK's population is now made up of minority communities, many of whom are not white, but whatever their colour, this group is. This is a group which polling shows has a high level of concern about their interests, and the interests of their children are being overlooked and too often being sacrificed to short term political expediency. And secondly, my Lords, the word immigrant. This has become a loaded term, as in, I'm an immigrant and I'm proud as opposed to those immigrants down the road not quite so proud.
So I prefer to use the phrase new arrivals. Now, of course, I understand, and I appreciate the moral imperative that drives those new arrivals, many of whom have been for a long time, and who have benefited from a life in the UK, to be concerned about not trying to close the door on those seeking to follow them. But while recognising that moral imperative, it is unarguable. My Lords, the numbers and scale do matter. So, however sensitive and however painful it is, the key point of numbers has to be recognised and taken into account in our discussions.
And that, my Lords, takes us to the heart of of the strategic of the demographic challenge we face as a result of a series of events which which none of the major political parties can escape responsibility, some being deliberate policy decisions and some being events forced upon us by outside events, such as the Russian invasion of Ukraine. Over the last 30 years, since 1995, the population of this country has risen from 58 million to 69.5 million, an increase of 20%, about 11.5 million people.
What do 11.5 million people look like? Well, the population of Greater Manchester. My Lords, is 2.8 million. So we've added rather over four for Manchester's in that time. And drilling into the issue of housing, since we live 2.4 people per dwelling, we have to have built 4.8 million homes to house these new arrivals. And we and we have to do that before we tackle any of the shortages of housing amongst our settled population. And if you want a snapshot, a snapshot of how the country is changing.
31% of all children born in this country last year were born to mothers who were not born here. 25 years ago, that figure was 10 or 11%. Now, my Lords, where do we go from here? And what does the future look like? Well, the ONS suggests that between now and 2025, we'll have another 10% increase in our population, or 6.6 million people, and the growth is expected to slow over the period of 2045. But by 2045, we'll have between in the middle 70s, 76, 77 million people, and we will have overtaken Germany as the most populous country in Europe.
Where will these people come from? Well, of course there is the natural increase the excess of births over deaths. But leaving that aside, because of the level of press publicity, the man in the street will likely point to refugees and asylum seekers. And in this, my Lords, he would be wrong, because historically the main components have come from two sources. We've always controlled. First, UK higher education. It has built a business model based on recruiting an increasing number of foreign students, of whom 30 to 40% have morphed into our workforce at the end of their studies.
And second, British industry, which uses overseas recruitment as the Migration Advisory Committee, describes it as the default option and has ruthlessly exploited the shortage occupation list, which enables you to recruit overseas at lower wages. As I speak, my Lords, there are 61 categories in the shortage occupation list. Many will be familiar, but not all. How many members of your Lordships' House would realise we have a shortage of dancers and choreographers? So, my Lords, it is worth noting also that our democratic challenge and challenge has made more acute by the fact of our being a relatively small island.
For example, France has 120 people per square kilometre, UK has 279 more than double and England 438, nearly four times as densely populated as France. So for my this my third report, I concluded that to increase credibility, I should not write alone. So I was lucky to get the Common Good Foundation and the Centre for Policy Studies to respectively centre left and centre right think tanks to support me. And I asked a number of experts in the world of demography to discuss the demographic challenge as seen through the eyes.
It is, of course, impossible to summarise nine detailed chapters in this debate, but the overall conclusion of them all was that the country we've not been taking a sufficiently coherent, strategic approach to this particular problem. Further, since this demographic challenges one faced by all countries I made made contact with three countries overseas the Netherlands, Japan which of course facing the opposite problem of a rapidly declining population, and Denmark, which has now become the poster boy for immigration policy. Many interesting ideas emerged, but Denmark, perhaps slightly sadly, enforces very strict conditions on new arrivals and moves them on if they're not complied with.
Rather depressingly, when I asked the Danish people how, how, where do they go to? Oh, they said they did it all go to the UK because, oh, the word on the street is, once you get to the UK, no one will check anything. You are free to do what you like. So, my Lords, I believed that there was an interest to for the in the public. So I asked YouGov to do some polling and the results were 70% of our population.
Of those polled thought the government has no plan to manage population growth and 56% support the idea of creating some official body. An important message for the three parties in your Lordships' House is that only 10% thought the Labour Party had the best answers, only 8% thought the Conservative Party had the best answers, and only and only 5% thought the Liberal Democrats. By contrast, 22% supported reform. So what could be done? We have to have the courage to recognise that the irrevocable nature of demographic change means that departmentally based solutions will never, never, never provide a coherent response.
We have to cut through what I call the firewalls, which suggest that the issues raised by demographic change are not appropriate subject for discussion, and we have to call out cases where any proper discussion is closed down as a result of what Dame Sara Khan called in her government Commission review on social cohesion freedom restricting harassment. Thus, as an example, while it is perfectly acceptable to discuss policies to help achieve net zero, it is not acceptable. Not acceptable to suggest that adding 6 million people to this country might impede that achieving that objective.
So I believe, my Lords, there is a strong argument for creating a new strategic body to be called the office for Demographic Change, or perhaps the office for Population Sustainability, which would subsume within it the existing Migration Advisory Committee. It will be tasked with learning from the past to collect evidence about and analyse consequences of past policies with looking to the future, impacts of likely population changes, economic, environmental, ecological, societal and finally to undertake research into demographic developments and to learn from best practice around the world.
It would, however, not be a policy making body. This new authority will be stand alone, but reporting to the Cabinet Office, Cabinet Office and of course it would also report at least annually to Parliament. It would help create conditions by Lords for a broader, better and more balanced discussion about democracy. For example, is there a maximum level annual population increase we can absorb without prejudicing the position of our population? What can be done to improve the data sources which are clearly inadequate? Is there an argument for seeking to increase the birth rate amongst existing population and so on? So let me conclude, my Lords, the governments may choose to continue to muddle along, but recent events have shown rising public temperature and these pressures seem set to increase.
It is not just individual events such as Crowborough or Epping, it is about public mood. And so the issue seems set to be become a major driver of political change. Writing in The Times on the 15th of September, Trevor Phillips article was headlined and I quote dismissed the United Kingdom March at your peril, unquote. And he went on to say, again, I quote, calling this movement the product of extremist rabble rousers will no longer do. Mainstream politicians must wake up, unquote.
Successive governments, my Lords, have tried ignoring the problem, insinuating that those who are concerned about it is racist, suggesting nothing can be done about it, and that if only everyone would stop talking about it, it would go away. Or finally making aspirational statements with no measurable follow through. The mainstream parties here in your Lordships' House now need to set up a comprehensive, measurable response to public concerns. My report suggests one such approach, but if we fail to respond, events will likely become increasingly ugly.
As wild as spirits make the running, I can think of no more pressing threat to expressing internal threat to the long term prosperity and harmony of our, of our society, of this country than our future population levels. So I'm proud and I'm pleased to be able to hold my valedictory debate on this topic. And I beg to move.
14:01
Baroness Stuart of Edgbaston (Crossbench)
-
-
Baroness Stuart of Edgbaston (Crossbench)
The question is that this motion be agreed to. My Lords, it's.
**** Possible New Speaker ****
Honour and a pleasure to. Follow the noble Lord Hodgson of Astley Abbotts.
**** Possible New Speaker ****
Opening of this debate, and I want to add my admiration for his want to add my admiration for his work over the over the years. And in those years, when I was a party political politician, we were in on political politician, we were in on the other side. In many ways I was a West Midlands politician. So I would have come across a great many would have come across a great many of the people who have played a role in his political life.
And I'm particularly glad that we're having this debate because it's on a subject which is so important. But for reasons which I don't entirely understand, we are extremely reluctant to debate. And the noble Lords started by hinting at some of the problems we appear to be having, and I do sometimes wonder whether it literally goes back to the 1970s, when you had countries like China and India trying either with a one child policy or in India, in a particularly aggressive population control policy, that that that started us to shy away from this as a subject, which we shouldn't address.
But I think we'd be wrong to do so, and we'd be wrong to do so for a number of reasons. And the one aspect I want to focus on, which is in the report, is actually the one on national security. And in, in, in, in the report, don't stop thinking about tomorrow. Professor Michael Clarke, his chapter is headed ask not what your country can do for you and the implications for National security of demographic change. And I think he very accurately, and I think with an important focus is on what is national cohesion.
He takes us through the various arguments, but he essentially says the UK's demographic development and the way it interprets its own deep and erstwhile pluralism can be either strength or a weakness in these circumstances, on the one hand a source of deeper resilience and on the other, a series of fault lines capable of exploitation by the country's adversaries. And I think this danger that could be a strength. We must not allow it to become a weakness by not addressing some of the issues and having some open discussions, he essentially concludes that as long as we don't face these internal and external security challenges, our demographic evolution will be addressed largely through strategies merely of hope rather than anything more precise or new approaches based on better knowledge and understanding of the phenomenon.
So I think he identifies the things which we need to look at if resilience and national defence and national security play into the debate about demography, and in a sense, the government has acknowledged that that is an issue. If you go back to the Strategic Defence Review from 2025, it actually has home defence and resilience, and it very explicitly calls for a whole of society approach. And in that whole of society approach, it calls for building national resilience, increasing national warfighting readiness.
It makes it clear the government must promote unity of effort across society, leading a national conversation to raise public awareness of the threats to the UK, how defence deters and protects against them, and why defence requires support to strengthen the national resilience. And it states what ought to be obvious but is often forgotten. The connection between the UK armed forces and wider society is a long standing and necessary foundation for the defence of the country, and that all of that requires cohesion of society and for cohesion to happen, it requires certain other elements, and this may also be the moment to declare that I am an honorary captain in the Royal Navy's Reserve Force.
All right. Navy's Reserve Force. All right. Thank you. And it's it's it's it's. And on top of that, I am what you would have called an immigrant. I came in in the early 70s. And I do think that this report, when it says we don't have we mustn't stop thinking about tomorrow. I would challenge and say we probably haven't even properly started to think about tomorrow. And if I just were to open today's newspapers or listen to the news, it tells me it asks, Will residential doctors strike again or is offered to provide extra places for early career doctors? Sufficient now, as the the noble Lord reminded us that in demographic terms, the 2000 is yesterday.
I'm now talking about something called yesterday because it was 25 years ago that we published the Black Country Strategy, and it identified in terms of doctors, the needs of a region. It made connections between doctors and nurses propensity to remain in the region in which they had trained. It therefore, said the regions which require those extra doctors which require between three, seven and 15 years to be fully trained, Birmingham University requires 100 extra places. So there's a logic in that approach and you take a regional needs demography and what happens.
So it's not that we don't know how to do it, but somehow we seem to curiously keep forgetting how the decisions which we've made, which at one stage were long term, we kind of pull back from. So when the places the Birmingham University Medical School were cut, I couldn't I literally could not find out who had made that decision. In 2025. We're seeing those consequences. So we're talking about ageing population. We talk about pension contributions. We talk about inheritance tax. And as the noble Lord himself said about higher education and a system where we ended up creating an extraordinary dependency for the funding of higher education students on international students without having thought through the consequences.
So I won't go on with those examples, but I want to say that I always was taken back to 2008, when the the late Majesty the Queen Elizabeth went to the London Stock Exchange in the wake of the financial crisis. And she essentially said to them, why did nobody notice it? Why did nobody see this coming? And then the answer to this was, roughly speaking, at every stage someone was relying on somebody else, and everybody thought that there were individually were doing the right thing.
And what they did not do is either see how these individual decisions were hanging together, or what the consequences of a very complex system were. And I fear that with a lot of these debates as, as, as recently told by Minister, when I raised the problem and they looked at me rather surprised and said, the facts are known now. Yes, I know the facts are known, but what are we doing with them? And with a lot of what is in that report? The facts are known, but we do need to pull them together in a way that they become a meaningful basis for future decision making.
And as the noble Lord said, there's this office for demographic changes, and I can see the logic. I would just like to add one extra dimension, because this is a report by the Common Good Foundation, and therefore I think it would be it would be wrong of me not to mention that in all this there is a need for identity, community and belonging. And these are things which are too easily overlooked, whether it's cohesion or resilience, it is community. It is feeling of belonging to the community, and it is having a sense of identity.
And that's why the national debate should also have a very local dimension. And I hasten to ever try and go back to Victorian values. But there's one Victorian value which I would like recommend to the house, and that is the civic audacity of a Joe Chamberlain in Birmingham. It was a kind of confidence in place. It was where cities would compete with each other to be better than the other one. Their competition wasn't based on having to fight for a central pot of money, which was coming out of Whitehall, because that doesn't lead to good decision making.
And I think similarly on the debate on demography, I think we do need national figures, but I do think we need some very granular regional figures and regional data, and one which takes account of the needs of those communities. And I do think there will be best met by those local communities themselves. They have to take ownership of those. And therefore this whole society approach, together with a bit of civic audacity, will give us, allow us to have a national view, but have a regional implementation because we will not be able to face the problems which are coming our way, whether it's either in some pockets of highly ageing populations or in other areas that we don't have the facilities in terms of schools or medical facilities, we can see them coming, we can plan, but only if we're willing to face up to it, have the data, but implement it in a much more granular way than we do at the moment.
Because if we don't start to think about the future, it's going to happen whether we like it or not. And we can't go on just
**** Possible New Speaker ****
being surprised by things. I'm grateful to the noble Lords
**** Possible New Speaker ****
I'm grateful to the noble Lords Lord Hodgson for his work in bringing together this report, and for giving us the opportunity today to debate it. I want to add my to debate it. I want to add my thanks to him for his fascinating speech today, and indeed his wider contribution to this House, and to contribution to this House, and to wish him well for the future. The authors of this report raise authors of this report raise various thorny policy problems, each of which demands careful negotiations so as to manage conflicting trade offs.
It would be easy to brush them aside in favour of more electorally popular concerns, or to oversimplify them, to stoke division. But I want to
**** Possible New Speaker ****
Honour and a pleasure to. Follow the noble Lord Hodgson of Astley Abbotts.
**** Possible New Speaker ****
Opening of this debate, and I want to add my admiration for his want to add my admiration for his work over the over the years. And in those years, when I was a party political politician, we were in on political politician, we were in on the other side. In many ways I was a West Midlands politician. So I would have come across a great many would have come across a great many of the people who have played a role in his political life.
And I'm particularly glad that we're having this debate because it's on a subject which is so important. But for reasons which I don't entirely understand, we are extremely reluctant to debate. And the noble Lords started by hinting at some of the problems we appear to be having, and I do sometimes wonder whether it literally goes back to the 1970s, when you had countries like China and India trying either with a one child policy or in India, in a particularly aggressive population control policy, that that that started us to shy away from this as a subject, which we shouldn't address.
But I think we'd be wrong to do so, and we'd be wrong to do so for a number of reasons. And the one aspect I want to focus on, which is in the report, is actually the one on national security. And in, in, in, in the report, don't stop thinking about tomorrow. Professor Michael Clarke, his chapter is headed ask not what your country can do for you and the implications for National security of demographic change. And I think he very accurately, and I think with an important focus is on what is national cohesion.
He takes us through the various arguments, but he essentially says the UK's demographic development and the way it interprets its own deep and erstwhile pluralism can be either strength or a weakness in these circumstances, on the one hand a source of deeper resilience and on the other, a series of fault lines capable of exploitation by the country's adversaries. And I think this danger that could be a strength. We must not allow it to become a weakness by not addressing some of the issues and having some open discussions, he essentially concludes that as long as we don't face these internal and external security challenges, our demographic evolution will be addressed largely through strategies merely of hope rather than anything more precise or new approaches based on better knowledge and understanding of the phenomenon.
So I think he identifies the things which we need to look at if resilience and national defence and national security play into the debate about demography, and in a sense, the government has acknowledged that that is an issue. If you go back to the Strategic Defence Review from 2025, it actually has home defence and resilience, and it very explicitly calls for a whole of society approach. And in that whole of society approach, it calls for building national resilience, increasing national warfighting readiness.
It makes it clear the government must promote unity of effort across society, leading a national conversation to raise public awareness of the threats to the UK, how defence deters and protects against them, and why defence requires support to strengthen the national resilience. And it states what ought to be obvious but is often forgotten. The connection between the UK armed forces and wider society is a long standing and necessary foundation for the defence of the country, and that all of that requires cohesion of society and for cohesion to happen, it requires certain other elements, and this may also be the moment to declare that I am an honorary captain in the Royal Navy's Reserve Force.
All right. Navy's Reserve Force. All right. Thank you. And it's it's it's it's. And on top of that, I am what you would have called an immigrant. I came in in the early 70s. And I do think that this report, when it says we don't have we mustn't stop thinking about tomorrow. I would challenge and say we probably haven't even properly started to think about tomorrow. And if I just were to open today's newspapers or listen to the news, it tells me it asks, Will residential doctors strike again or is offered to provide extra places for early career doctors? Sufficient now, as the the noble Lord reminded us that in demographic terms, the 2000 is yesterday.
I'm now talking about something called yesterday because it was 25 years ago that we published the Black Country Strategy, and it identified in terms of doctors, the needs of a region. It made connections between doctors and nurses propensity to remain in the region in which they had trained. It therefore, said the regions which require those extra doctors which require between three, seven and 15 years to be fully trained, Birmingham University requires 100 extra places. So there's a logic in that approach and you take a regional needs demography and what happens.
So it's not that we don't know how to do it, but somehow we seem to curiously keep forgetting how the decisions which we've made, which at one stage were long term, we kind of pull back from. So when the places the Birmingham University Medical School were cut, I couldn't I literally could not find out who had made that decision. In 2025. We're seeing those consequences. So we're talking about ageing population. We talk about pension contributions. We talk about inheritance tax. And as the noble Lord himself said about higher education and a system where we ended up creating an extraordinary dependency for the funding of higher education students on international students without having thought through the consequences.
So I won't go on with those examples, but I want to say that I always was taken back to 2008, when the the late Majesty the Queen Elizabeth went to the London Stock Exchange in the wake of the financial crisis. And she essentially said to them, why did nobody notice it? Why did nobody see this coming? And then the answer to this was, roughly speaking, at every stage someone was relying on somebody else, and everybody thought that there were individually were doing the right thing.
And what they did not do is either see how these individual decisions were hanging together, or what the consequences of a very complex system were. And I fear that with a lot of these debates as, as, as recently told by Minister, when I raised the problem and they looked at me rather surprised and said, the facts are known now. Yes, I know the facts are known, but what are we doing with them? And with a lot of what is in that report? The facts are known, but we do need to pull them together in a way that they become a meaningful basis for future decision making.
And as the noble Lord said, there's this office for demographic changes, and I can see the logic. I would just like to add one extra dimension, because this is a report by the Common Good Foundation, and therefore I think it would be it would be wrong of me not to mention that in all this there is a need for identity, community and belonging. And these are things which are too easily overlooked, whether it's cohesion or resilience, it is community. It is feeling of belonging to the community, and it is having a sense of identity.
And that's why the national debate should also have a very local dimension. And I hasten to ever try and go back to Victorian values. But there's one Victorian value which I would like recommend to the house, and that is the civic audacity of a Joe Chamberlain in Birmingham. It was a kind of confidence in place. It was where cities would compete with each other to be better than the other one. Their competition wasn't based on having to fight for a central pot of money, which was coming out of Whitehall, because that doesn't lead to good decision making.
And I think similarly on the debate on demography, I think we do need national figures, but I do think we need some very granular regional figures and regional data, and one which takes account of the needs of those communities. And I do think there will be best met by those local communities themselves. They have to take ownership of those. And therefore this whole society approach, together with a bit of civic audacity, will give us, allow us to have a national view, but have a regional implementation because we will not be able to face the problems which are coming our way, whether it's either in some pockets of highly ageing populations or in other areas that we don't have the facilities in terms of schools or medical facilities, we can see them coming, we can plan, but only if we're willing to face up to it, have the data, but implement it in a much more granular way than we do at the moment.
Because if we don't start to think about the future, it's going to happen whether we like it or not. And we can't go on just
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being surprised by things. I'm grateful to the noble Lords
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I'm grateful to the noble Lords Lord Hodgson for his work in bringing together this report, and for giving us the opportunity today to debate it. I want to add my to debate it. I want to add my thanks to him for his fascinating speech today, and indeed his wider contribution to this House, and to contribution to this House, and to wish him well for the future. The authors of this report raise authors of this report raise various thorny policy problems, each of which demands careful negotiations so as to manage conflicting trade offs.
It would be easy to brush them aside in favour of more electorally popular concerns, or to oversimplify them, to stoke division. But I want to