Cost of Living: Public Well-being

Baroness Janke Excerpts

Thursday 20th October 2022 Lords Chamber

[Baroness Janke (LD)]

My Lords, I too add my thanks to the noble Baroness, Lady Drake, for initiating this debate and for comprehensively and analytically setting out the context. My comments concern the education of children, particularly those with special educational needs, as well as the impact of years of underfunding on the morale of teachers, parents and schools.

Having read an article in a local paper by a parent of a child with special educational needs, about the fear they feel at the prospect of more cuts, I made my own inquiries and found a situation that makes me also fear for the future of these children, particularly those from disadvantaged homes, and their education across the country. I found that schools in general feel very undervalued and the lowest priority of Governments. I was told:

“Every year we need to do more with less and it is simply unsustainable”.


I am including direct comments from schools and parents, so I apologise if they sound slightly out of context.

The first thing to say is that not having enough funding encompasses just about every problem in any school, and the effects are: not enough teachers or assistants in the classroom, so schools cannot deliver an individualised education for disabled pupils and those with special educational needs; provisions for personal growth and mental health cannot be met with not enough staff, and neither can early intervention; and alternative provisions for those most in need are not fit for purpose: students have been refused places in schools that are specialised and should be meeting their needs. But, if a specialised school, with all the equipment and funding, deems a child “too difficult”, how is a mainstream school supposed to deliver an effective education and a safe place for that child, with no specialised provisions or training?

There is very limited language provision. When 25% of a school does not speak English, even as a second language, there is no access to or funding for translators. One translator on one morning a week for six weeks does not cover the revolving door of refugees from places such as Afghanistan and Ukraine. Staff work very hard with these children to give them the best possible chance and to provide some stability, only for them to be moved on, with other schools refusing to take them. One refugee child could not get a school to take him because of disabilities, which is of course devastating for the child.

The increase in teaching assistants’ wages of around 10% is very much welcomed, but this now has to be funded by the school’s budget, so the choice is between having fewer teaching assistants or cutting the school’s budget in another way. Having fewer teaching assistants impacts on the quality of teaching and learning. Already, not all classes have a general teaching assistant to support those who need extra help.

Energy cost measures apparently apply only to residential premises, so schools will have to find the funds to meet the increases in energy, or not heat classrooms. One school has estimated increases of 230%.

As the right reverend Prelate the Bishop of Oxford said, feeding children is also extremely important. Free school meals are grossly underfunded, and they struggle to offer a good nutritious meal for the price, including vegetarian, halal and kosher alternatives. Children are not engaged and ready to learn if they are hungry, and this might be their only hot meal of the day. A large proportion of pupils in the school I mentioned—43%—receive free school meals.

Parents too feel that they have been left high and dry and fear that worse is to come. Many of them suffered indignity and encountered rudeness in fighting for their children’s rights. The education, health and care plans which have replaced statements are also a cause of great concern. They are supposed to take 20 weeks to achieve but in some cases it is 50 to 70 weeks, fraught with numerous assessments and shed loads of bureaucracy. Mainstream schools focused on performance are reluctant to make proper provision for children with special educational needs.

Council services are starved of cash, so parent support groups, play groups and social arrangements for children with special needs and learning difficulties are closed due to lack of funding. There is heavy reliance on private provision. This is very expensive and many councils now have enormous debts in their special educational needs departments, which are in crisis. All this is happening now, before anything in the future budgets. It is clear that the system cannot bear any more cuts without threats to the very existence of many schools and services.

The current system clearly needs reform. It already offers woefully inadequate services to the most disadvantaged children, particularly those with special educational needs and those with disabilities. I hope that the Minister might propose some form of in-depth review of what is clearly a failing service.

We have heard ample evidence throughout the debate that current services cannot sustain future cuts. Indeed, they are in danger of collapse already. The noble Baroness, Lady Sherlock, spoke about indexing and the link to reality, and proper systems to protect us all. The noble Baroness, Lady Tyler, mentioned the effect of poverty on anxiety and mental health, and fear and insecurity and the need for reassurance with health and advice. The noble Lord, Lord Layard, underlined the importance of services to all sectors of the population and providing for their enduring needs. The noble Lord, Lord Howarth, mentioned inequality and how that leads to poor physical and mental health as well as social problems. The noble Lord, Lord O’Donnell, talked about well-being and the importance of targeting, as well as energy efficiency and labour shortages. All these concern different departments of state. It seems to me that one of the most important messages from this debate is that poverty concerns all the services; it certainly should not be left as being led by the concerns of the Treasury. I hope that message will hit home.

I urge the Government to protect our children, particularly those who are already disadvantaged, from any further attempt to cut essential services. As the right reverend Prelate the Bishop of Oxford said, children’s futures are on the line. Our country will pay the price if we do not face up to our responsibilities and make sure that children are fully protected in these difficult times.

Eating Disorders

Baroness Janke Excerpts

Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

As a result of the work that has been undertaken in response to the report, and in conjunction with Beat and many other stakeholders, we are looking at the issues. First, we are making sure that people are trained to understand the issues as part of their education. Secondly, we are looking at what we can do retrospectively for those who have already qualified. We are working with various bodies—the royal colleges and others—to see how we can make sure there is more awareness and training available, including e-learning resources.

[Baroness Janke (LD)]

My Lords, there is a need for urgency on this issue. We do not get the impression that the Government are treating this very urgently, but anorexia has the highest mortality rate of any mental illness. If it is not treated early, it becomes worse, much harder to treat and puts lives at risk. In view of the unprecedented growth in sufferers, what will the Government do to accelerate access to treatment for those in urgent need and prevent more needless deaths?

[Lord Kamall (Con)]

I think the noble Baroness is being unfair in suggesting that the Government are not taking this issue seriously. In the conversations that I have had in the lead-up to this Question, it has been quite clear that they are taking it very seriously. They recognise its granularity and the differences in types of eating disorder. As the noble Baroness rightly said, people quite often associate eating disorders with adolescents or young females and young men, but binge eating disorders in particular can occur among adults who are 30 or 40 years old. The Government are looking, first, at education. Secondly, they have made a number of investments in adult and children’s services relating to mental health, including eating disorders.

Eating Disorders

Baroness Janke Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

As noble Lords can imagine, because of the pandemic, sadly, waiting times have gone up, but we are making sure that we are doing as much as we can to address that. Longer term, we are focusing on prevention, not only cure. We are also making sure that we are able to understand the various forms of eating disorder better. It is very simple to lump them all together, but there are different elements and you can distinguish between them. Then we will, I hope, be able to tackle that as much as possible.

[Baroness Janke (LD)]

My Lords, given that many young people with eating disorders find it very difficult to seek help and identify themselves, what specific additional resources have been provided for schools to help and support young people with this actually life- threatening illness?

[Lord Kamall (Con)]

The noble Baroness raises a very important point about how we identify children and young people who are suffering from these disorders or may be a few steps away from it. We know that there are programmes from the Department for Education and our department to tackle mental health issues in schools, identifying pupils and encouraging them to come forward, to talk to a counsellor in the school, and making sure that there is signposting in the right place to ensure that we can tackle their issues.

Eating Disorders: Provision of Care

Baroness Janke Excerpts

Tuesday 4th February 2020 Lords Chamber

[Baroness Janke (LD)]

My Lords, I too am grateful to my noble friend Lady Parminter for the debate today. I will speak particularly about anorexia, a killer disease that frequently affects young girls and women between 14 and 25. That is the area I have had most experience of, although, as other noble Lords have said, anorexia also affects adults.

As other noble Lords have said, anorexia has the highest mortality rate of any psychiatric disorder. The death rate associated with anorexia nervosa is 12 times higher than the rate for all other causes of death for females aged 15 to 24. Yet, as other noble Lords have said, there is much to be grateful for in that there can be a recovery, with enough support and treatment. Research suggests that 46% of anorexia patients fully recover, 33% improve and 20% suffer chronically. I am grateful that my daughter was one of the 46% who recovered.

According to Beat, the eating disorders charity, the average duration of the illness is eight years, but it can become severe and enduring, lasting for many years and having a hugely debilitating effect on the sufferer and their family. Thinking about people at the younger end of that age group, we know that the teenage period is a time of such emotional development as well as physical growth. It is a time of intellectual development and moving into the adult world. For sufferers of anorexia, isolated not only in their body but socially, the illness brings this growth and development to a halt. Cognitive development at this age is of huge importance, as it is often much more difficult to catch up afterwards, even if there is a full recovery. Eight years is the average time it takes to recover. Eight years in the life of a 14 year-old is a lifetime, and a huge loss of a key period in anyone's life.

The disease is sometimes considered not so much a disease as a life choice. There is perhaps a lack of awareness that the obsession with weight and body is so compulsive; that there is an overwhelming fear of gaining weight, and a distorted body image. Sufferers will do anything to get thinner, and the thinner they get, the more they think they need to become even thinner.

Sufferers also change personality. If somebody in your house is suffering from anorexia, you will find that your cheerful, open teenager can become aggressive, abusive, deceitful and manipulative, and an expert in inflicting pain on their loved ones. It is very hard for anyone who has not had first-hand experience of this debilitating and vicious disease to imagine what it is like to have to keep up surveillance and constant care just to keep your precious child alive. It is a deadly disease but, as the noble Lord, Lord Lexden, said, it is often seen as an extension of vanity—the obsession with image and appearance. It is far more complex than that, as other noble Lords have said in the debate.

It is alarming that the January NHS figures show that hospital admissions for eating disorders have risen by 37% across all age groups in the last two years. Hospital admissions are only for those who have to be prevented from starving themselves to death, so this is just the tip of the iceberg. It is a huge issue, and sufferers need intensive support and early intervention. As other noble Lords have said, the sooner they get the treatment they need, the more likely they are to make a full recovery. Prompt access to high-quality treatment and support can prevent people getting to the point where hospital admission is the only course of action that will keep them alive.

I agree with what has already been said: research has been starved of funding. My experience was quite some time ago, but there was very much a feeling that this was not really an illness but the teenage behaviour of adolescent girls, and a failure to recognise the results that could occur when people did not get the care that they needed.

I was interested to hear that research has proposed the idea that there may be a hereditary aspect, for example, and also that people are now looking into a metabolic dimension. As has been said, the relation to obesity is something that appears to be being looked into more. Certain individuals may be much more likely to suffer from anorexia when they experience stress, bullying or very severe pressure. I feel that we need to raise awareness of this as a disease that kills people, not a lifestyle choice, affectation or folly of teenage girls.

I hope that treatment and support will be made available consistently across the country. Whether you survive this disease should not be a matter for a postcode lottery. In my opinion, eating disorders have for many years been a Cinderella service within mental health, which is itself a Cinderella service. I hope, from the information we have had, that the Minister will reassure us that this will not continue to be the case. If not, there will be more and more tragic and unnecessary deaths, as sufferers’ lives continue to be at risk. Again, families and carers live with that risk of death every day. I hope that we are to get assurances from the Minister, as more and more families will be torn apart if there is not very prompt and urgent action to provide support and treatment for people suffering from all eating disorders. However, I make a special plea for anorexia.

Health: Vaping

Baroness Janke Excerpts

Tuesday 14th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend has asked a comprehensive and pointed question. It is notable that e-cigarette use among young people in the United States has increased dramatically— 78% in high-school students and 48% in middle-school students. We have not seen that in the UK because of the very effective and tightly regulated methods we have brought in around advertising and access for under-18s, which have borne fruit. I am proud of the way in which we have managed that in the United Kingdom.

[Baroness Janke (LD)]

My Lords, is the Minister aware that smoking has again become much more normal, and indeed quite fashionable—particularly in the form of e-cigarettes, among not just smokers but young people and people who have never smoked? Does she consider that this risks growing nicotine use and dependence? If so, what is being done to monitor and evaluate in health terms the increased use of e-cigarettes?

[Baroness Blackwood of North Oxford]

I am not quite sure I agree with the fundamental hypothesis of the noble Baroness’s question. If the normalisation hypothesis were true, we would not have expected to see smoking rates continue to decline as they have. Since 2013 smoking rates have fallen from 18.4% to 14.4%, and among young people regular use is very small. It is at 2% for those who have never smoked and is very rare or less, at 0.5%, for 11 to 15 year-olds.

Queen’s Speech

Baroness Janke Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Janke (LD)]

My Lords, when thinking about the debate today, I wondered what will change for the poorest and most vulnerable as a result of the new government agenda. For example, how will the 4.1 million children in poverty—referred to by the noble Baroness, Lady Blower, in her excellent maiden speech—benefit? Will food banks become redundant? Is the number of rough sleepers likely to go down? The answer seems rather depressing: that very little will change, particularly in the short term.

The hope is, however, that the rise in the minimum wage, which we welcome, will in time help some of those in most dire need. But we should not underestimate the scale and misery of poverty across the country. With low unemployment rates, 4 million workers live in poverty, an increase of 500,000 in the last five years. In-work poverty is rising faster than employment and is higher than at any time during the last 20 years. Some 60% of people in poverty live in a household where at least one person works, and 2.8 million people in poverty are in a household where both adults work. So the rise will be welcomed by many and seen as long overdue.

Policies such as the benefit cap and freeze, the two-child limit and the introduction of full job-seeking requirements for single parents of children as young as three have had a stark impact. In August 2018, two-thirds of those who had benefits capped were single parents. Single parents in the bottom 20% of income will have lost 25% of their 2010 income by 2021-22. As a result of tax and benefits changes, the poverty rate for children will jump to 62% by then if nothing changes.

Women earn, on average, 17.9% per hour less than men and make up 60% of workers receiving low pay. Reductions in social care services place a greater burden on primary care givers, who are also disproportionately women. Single-parent families, of whom 90% are women, are twice as likely to be in poverty as any other social group. Nearly half of those in poverty—6.9 million—are from families where someone has a disability. They have also been some of the hardest hit by austerity measures. Changes to taxes and benefits will mean that some families are projected to lose £11,000 by 2021-22—more than 30% of their income.

It is shocking to British people in the 21st century that we should have 14 million people in poverty. The UK has the fifth-largest economy in the world, a leading centre of global finance and record low levels of employment, yet one-fifth of the population is in poverty, with 4 million people more than 50% below the poverty line. Historically, the UK has had a proud record in terms of a strong social safety net, yet this has been systematically removed over recent years. People who, in former times, found a resource base to support them when they were afflicted by a major catastrophe now find that there are only volunteers and charities with limited resources providing for their most basic needs. How can a country such as ours not be shamed by such a state of affairs, with our benefit service likened to the 19th-century workhouse made infamous by Dickens?

Worse still, the support services that used to be a lifeline for those in poverty have been almost completely removed: youth and community services, social care, debt counselling and libraries have all been closed in record numbers. Surely the Prime Minister’s new golden age must see tackle the record levels of poverty. There must be not just a commitment but a plan to actually do this: to rebuild an effective social safety net national and locally, to address the issues that lead to low pay and insecure employment and to ensure that disadvantaged and vulnerable people are not driven into the deepening despair, humiliation and desperation that poverty brings, as victims of a system with a safety net full of holes.

Health and Social Care: Malnutrition

Baroness Janke Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right that it is critical that people have good and healthy food in hospitals. That is exactly why there are very strict food standards in hospitals and health and care settings which are already enforced by the CQC. It is also why we appointed the former head of the Hospital Caterers Association, Philip Shelley, to look at what more could be done to improve the situation with the hospital foods review, to look at the safety of food available to patients, visitors and staff, improve nutrition and make available healthier choices, and ensure that we can improve the expertise of caterers, suppliers, staff and those who work in hospitals, to ensure that we raise standards and reduce the incidence of malnutrition across the system.

[Baroness Janke (LD)]

My Lords, in the light of the very real pressures on care services in communities, could the Minister say what steps the Government are taking to ensure that the elderly and vulnerable living in their own homes are not suffering from malnutrition due to poverty and neglect?

[Baroness Blackwood of North Oxford]

The noble Baroness is right to raise the important issue of malnutrition in the community. We have put together a malnutrition task force, which has published a series of guides of expert advice on prevention and early identification of malnutrition in later life. These guides draw together principles of good practice and offer a framework for making sure that the situation which the noble Baroness has identified does not arise. We have also published a guide for care homes on integrating good nutrition into daily practice. This includes screening, initiating nutritional care plans and considering fortifying food and using oral nutritional supplements when appropriate.

Queen’s Speech

Baroness Janke Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Janke (LD)]

It is a great pleasure to follow the noble Baroness, Lady Bakewell. As a former council leader, I am very familiar with some of the issues she raised here today, but I shall confine my remarks to the worsening conditions of the least well off in our country. They deserve consideration, although sadly they are not a priority of the Government in the gracious Speech. There is ample evidence that conditions are getting worse for the poorest, whether in the form of research and reports, or in the daily experiences of children, families and individuals. Reports from the UN rapporteur, the Joseph Rowntree Trust, the Children’s Commissioner, the Child Poverty Action Group and a host of others provide shaming testimony in a country that once led the world in the social welfare of its citizens.

The gracious Speech makes reference to unlocking the full potential of children, yet we hear that teachers are buying food, clothing and equipment out of their own pockets for children who are too ashamed to come to school because their families cannot afford clothes and basic needs. The number of children attending food banks in the last year has doubled. Some 4.1 million children are in poverty, and 70% of them are from families where at least one parent works. Single parents, of whom 90% are women, are twice as likely to be in poverty as married couples. Half the children in one-parent families are in poverty. Furthermore, as far as housing is concerned, there has been a surge in homelessness, which was up by 320,000 in November 2017. Rough sleeping has shot up by 15% in a year; this is because of the paring back of housing benefit and the freezing of local housing allowance.

Nearly 50% of those in poverty—6.9 million—are from families where someone has a disability. On this I support the speech of the noble Baroness, Lady Campbell, and some of the examples she gave us. The crisis in PIP assessments whereby 75% of appeals are upheld requires attention. Even if the Government were concerned only with finance it would be sensible to look at a better way of doing this; in terms of the suffering it inflicts on people who already have to face financial penalties in various forms, it is just unforgivable. Families with disabilities are projected to lose £11,000 a year by 2021-22, more than a third of their income.

Indications also show that the worst off and most vulnerable will suffer more under Brexit. I understand from talking to those involved that very little assessment of this has been done, yet already the depreciation of the pound, rising prices and inflation are making things very difficult for those on fixed income. Unless the full uprating of benefits and low incomes takes place, there will be a crisis and the poorest and most vulnerable will not be protected. Indebtedness has already reached pre-2008 levels, yet little appears to have been done in terms of emergency support.

The gracious Speech states:

“My government will bring forward measures to protect individuals, families and their homes”.


The Government really need to look at the evidence of how they are protecting families and their homes. The two-child limit and the four-year benefits freeze both directly affect children. If what people are saying about the effect of Brexit is right, emergency payments would be indispensable, but they are going to be lost. In the past they have prevented families falling into destitution; they need to be reinstated. The sanctions imposed by the Government are a source of destitution and debt and are particularly damaging to people with disabilities or health conditions such as heart disease.

Payments to young people of £250 per month are not enough to live on for those who do not have supportive homes. Split payments need to be made so that abused women are not kept under the control of their abuser. As the noble Lord, Lord Willetts, has already mentioned, the disincentives to work, the effect of sanctions and flexible working need to be thoroughly investigated and action needs to be taken.

There is ample evidence of the worsening lives of the poor and vulnerable. Our priorities must be to build an effective social safety net nationally and locally, to address the issues that lead to low pay and insecure employment and to ensure that measures are in place for the least well-off, the least protected and the most vulnerable so that they do not slip through the holes of an insufficient safety net and drift into destitution and poverty.

Children: Oral Health

Baroness Janke Excerpts

Tuesday 12th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is exactly right, in that improving children’s oral health is a wider picture: it is about not just access to dentistry but a preventive approach, which is a core government priority. This is exactly why we introduced the children’s obesity plan, one aspect of which is a consultation on advertising. Proposals on that will be brought forward shortly.

[Baroness Janke (LD)]

My Lords, what is the Government’s assessment of the number of children receiving dental care from Dentaid, a peripatetic charity that provides emergency care in third-world countries? Does she consider this an acceptable way of safeguarding children’s oral health, and what will she do about children’s lack of access to NHS dentists in many parts of the country?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. I shall have to write to her about access via Dentaid, which I was not aware of; it is a very important point. We are committed to driving down inequality of access and are pleased that the number of young people accessing dentists has increased. One of the key measures in reducing inequality is the Starting Well Core programme, which has targeted areas of highest need, and its performance is encouraging. However, she is absolutely right: we must drive out inequality of access to children’s dentistry and the Government are committed to doing that.

Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Janke Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Janke (LD)]

My Lords, it is a privilege to speak to this report. I pay tribute to the noble Lord, Lord Jay, and to his diplomatic skills in putting such a positive face on yet another report on Brexit, which again faces us with very worrying findings. I also thank the committee members and staff for their contributions; the staff provided us with very high-quality support.

In the words of one of our witnesses, Raj Jethwa, director of policy at the BMA,

“the best situation is one in which you are able to replicate or mirror as closely as possible the current reciprocal arrangements”.

So for many people it is a something of a “mad riddle”—to quote another recent discussion of Brexit—to understand quite how so much time, money and effort are being devoted to achieving something as close as possible to what we have already. Worse still, having taken part in this inquiry, I realise that lots of people simply have no idea of the risks ahead in healthcare post Brexit.

I add my thanks to the Minister, who has clearly attempted to reassure us and has put quite a lot of time into doing so. As such, I do not doubt his motives in any way; I am sure he wants to achieve the best possible solution. The report, however, provides us with a clear picture of the enormous benefits that have accrued to us as members of the EU.

There are the four routes to healthcare in the EU. First, the European health insurance card allows freedom of movement and access to healthcare wherever we might be. For holidaymakers and workers alike, there is no problem in accessing care or medicine. Secondly, the S1 scheme for people who live in the EU provides a simple, easy, accessible system. I am old enough to have lived in Europe before the EU. The system that existed before was so complicated and difficult that many people came home to the UK to get treatment where they could, rather than try to access it in Europe. Thirdly, there is the S2 scheme, which entitles British people to be referred to a specialist provider for treatment. Fourthly, the parent’s right directive gives British people the right to access high-quality treatment in the EU, particularly that which is unavailable in their own country, and to have the cost reimbursed. We often find that cheaper treatment for UK residents can be found in the EU than in the NHS. The average cost per pensioner has recently been calculated at €4.173 in Spain, as against £4.396 under the NHS, so there is even a savings benefit.

The noble Lord, Lord Ribeiro, spoke about Northern Ireland. I, too, was particularly moved to hear of the improvements and not just the peace dividend but the health dividend that has resulted from cross-border working, close co-provision and co-planning and, on an island as sparsely populated as Ireland, the absolute need to access high-quality healthcare, which had not been available before. The noble Lord also talked about children waiting four years for ear, nose and throat treatment, with all the ensuing difficulties that that entailed for their development. So there are enormous benefits.

I welcome the joint report, which tells us that the Government want the common travel area to continue, and the assurances that there will be no hard border. However, this gives rise to quite a few questions. I am sure that many people I know are unaware that the EHIC system is even at risk, but if it does not exist after March, can the Minister tell us about some of the issues that people will face over insurance? In the report, the insurance industry tells us that it is not completely prepared for a major impact of this kind after Brexit. How can families deal with this? What will the cost be for pensioners and people with long-standing illnesses? How will they be able to afford insurance and how much more will their holiday cost?

If we are to keep the common travel area—I understand that, as people say, nothing is agreed until everything is agreed—how will it happen? How exactly will this work with the red line of no freedom of movement and with the Government saying, as the Minister said yesterday, that there will be no barrier between Ireland and the EU? People need confidence; they need to understand what is going to happen and they need to make their own plans.

We heard Simon Stevens on “The Andrew Marr Show” on Sunday saying that the NHS is now planning contingencies for a no-deal scenario. This was one of the things we were assured: that there will not be a no-deal scenario. However, when we hear that the NHS is planning for this, it must raise all sorts of worries. The Government need to come clean with people, let them know what the risks are and let them understand what we are facing. All these things take time to resolve. They cannot be changed overnight or a magic wand easily waved so that everything will be as it was before. People need to know this. There is a huge lack of trust as these effects seem to come out slowly and have to be dragged out, whereas if people were able to understand that there were these risks, they could make their own plans for them. As the clock ticks, we can see that there is an urgent need for the Government to lead and reveal their plans; to make clear the extent of the shortfall in healthcare; and to let members of the public know what they can expect in terms of healthcare after March and after Brexit.