Cost of Living: Public Well-being
Baroness Sherlock Excerpts(1 year, 6 months ago)
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Baroness Sherlock (Lab)
My Lords, my noble friend Lady Drake has done a characteristically brilliant job of describing the impact of the rising cost of living across the whole landscape. I will focus specifically on the impact of inflation on low-income households, especially those who depend on benefits for their survival. I warn noble Lords up front that this will get techy and dull in parts but, frankly, given what is happening down the other end, a bit of dullness would not do us any harm.
I get really cross when I hear jibes, to this day, about the idle poor and Benefits Street. If we are to be a country where your well-being is not determined solely by having chosen your parents with care, we need a thriving welfare state. We have the basics of it there but we do not need one that is simply a safety net. We also want something that can fulfil its original ambition to be a companion service to the NHS—something that pools risk across the population and across lifetimes, so that we pay in, work and contribute when we can and we take out when we cannot or when our needs are greater. We need a system that helps us: when we cannot work or can work only part-time; when we retire; if we get sick or injured; or if we are caring or bereaved.
We have a system but for it to work, benefits need to keep their value. Prior to 2011, rates were linked to the retail prices index—RPI—or a variation called Rossi. From 2011, they were linked to the consumer prices index—CPI. Incidentally, that RPI to CPI shift saved the Government a lot of money at the expense of the poor. The current measure used for uprating is the CPI 12-month rate for the September before the April when the increases take effect. That gap between September and April is allegedly there to allow the computers to be updated but, at a time of rising, high or unstable inflation, it can cause problems.
For example, the CPI rate in September 2021 was 3.1%, so benefits rose in April by that much; unfortunately, in April inflation was 9%. The CPI rate in the month just gone was 10.1%. Logically, that suggests benefits would rise by 10.1% in April—but if they do, the IFS says that would leave their real value around 6% below pre-pandemic levels, equivalent to about £500 per year for the average out-of-work claimant. That is because the rise last April was so much lower than inflation.
As noble Lords will have heard, many Ministers are now suggesting that CPI inflation uprating is too generous, and that perhaps some lower figure should be chosen. Does this mean that indexing is becoming a one-way bet, so that if inflation is low in September it must be stuck to, but if it is high in September it has to be rethought? What is the argument? Maybe it is that inflation is different for those on lower incomes. In fact, it is different. The ONS figures on inflation show that rising food prices were the biggest driver of rising inflation, at around 14%, but of course the poor spend far more of their income on essentials such as food. The IFS estimated that even with the energy price guarantee, from this month the poorest 1/10th will face an average inflation rate of 14%, compared with 10% for the richest. So maybe Ministers are arguing that these are very special circumstances, and that for one time only we have to move away from uprating by inflation, but let us look at what has happened since 2010.
The coalition Government limited most working-age benefits to a 1% annual increase for three years from 2013-14. The Conservative Government then froze those benefits in cash terms at their 2015-16 levels for another four years, so for seven years the value of benefits was slashed year on year, saving around £4.7 billion. Those cuts are baked in because every year future increases are a percentage of that lower value. That is before I even mention all the other cuts in benefit support—the two-child limit, the benefit cap, the bedroom tax, cuts in housing and council tax benefits, Sure Start and so much more.
Why would they do it? Ministers may say that they had no choice given the financial circumstances but let us look at a detailed study by Ruth Lupton et al, The Coalition’s Social Policy Record 2010-2015, which found that
“the poor bore the brunt of its changes to direct taxes, tax credits and benefits”.
Meanwhile, with the exception of the richest 5%, those in the top half of the distribution were net gainers. The report concluded:
“Perhaps surprisingly, overall the ‘welfare’ cuts and more generous tax allowances balanced each other out, contributing nothing to deficit reduction.”
Those austerity cuts were not needed to cut the deficit but to pay for tax cuts. Recently, when Ministers announced that they were going to cut taxes and might need benefit cuts to pay for them, this was a shift in scale rather than principle—albeit, I grant, a pretty dramatic shift in scale. I still cannot quite believe that we have seen a Government who have imperilled the stability of our entire economy, driven up inflation, interest and mortgage rates, and put pension funds at risk, then have the nerve to suggest that low-income families should pick up the bill for it.
Instability really matters on a macro scale because it shakes markets and makes us all poorer. It also matters on a micro scale because, when you can only just make ends meet, above all you need certainty. I am sure other noble Lords have had similar experiences, but I have never met so many people so scared about how they are going to manage in the weeks and months ahead. They are terrified that they cannot pay their bills, feed their kids or keep a roof over their head. Not only do we now have some 2,500 food banks, but already roughly 1,000 churches and 200 libraries have registered to become warm, welcome spaces because people cannot afford even to sit in their houses and heat them.
The problem with the rollercoaster politics we have been having is that no one trusts anything. Last night BBC News interviewed a pensioner, Betty from Sunderland, about the cost of living. She said:
“It fills you with dread. Are we going to have to start living on what little bit we’ve got saved? When that’s gone, where do we go from there?”
Faisal Islam told her the Government had decided they would after all uprate the state pension. She replied:
“That’s today. What happens tomorrow? They could change their minds by tomorrow because every day they change their minds.”
Quite so. This is not a game It is a life-or-death matter for millions of our citizens and they deserve better. I urge the Government to get a grip or get out.
Covid-19: Self-isolation Payment Scheme
Baroness Sherlock Excerpts(3 years, 8 months ago)
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Baroness Sherlock
To ask Her Majesty’s Government what are the eligibility criteria for the new payment scheme for people self-isolating and unable to work from home in areas with a high incidence of COVID-19.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, to be eligible for this payment, individuals must live in Blackburn with Darwen, Oldham or Pendle and have been asked to self-isolate by Test and Trace, be employed or self-employed, stand to lose income because they are unable to work from home while self-isolating, and receive at least one of the following benefits: universal credit, working tax credit, income-related employment and support allowance, income-based jobseeker’s allowance, income support or pension credit or housing benefit.
Baroness Sherlock (Lab) [V]
My Lords, I am grateful. People are told to quarantine as soon as they have symptoms and wherever they live. Can I ask the Minister two questions? First, why is the payment only for those who have had a positive test or been told to isolate by NHS test and trace? Secondly, the Government’s description of the scheme says that it is intended only for those in high-infection areas, but if there is an outbreak elsewhere, in a care home or a factory, do those workers not need support? If they cannot afford to stay at home, does that not risk creating a new high-infection area?
Lord Bethell (Con)
My Lords, the reality of the epidemic is that it targets some communities in specific areas with laser-like focus. The feedback from some of those communities, local authorities and community leaders is that support is needed in some areas where there has been a local lockdown. We have responded to those suggestions and put this financial support in place for specific communities in specific areas. In that, we are responding to local suggestions.
Covid-19: Social Care Services
Baroness Sherlock Excerpts(4 years ago)
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Baroness Sherlock (Lab)
My Lords, I am grateful to my noble friend Lady Wheeler for securing this debate and for her excellent introduction. I want to talk about the financial circumstances of care workers, especially when they get sick. Care workers are on the front line doing important work in highly risky conditions, usually for the minimum wage, but what happens if they get sick?
Let us look at two circumstances. The first is a carer working in a care home for 35 hours a week on the minimum wage taking home about £277 a week. If she develops symptoms and has to self-isolate, the good news is that she qualifies for statutory sick pay. The bad news is that SSP is just £95 per week, so overnight her net income falls by two-thirds. Can the Minister tell the House how she is meant to manage? Can she apply for universal credit to top up her SSP? That is not made clear in any of the Government’s web pages.
The second example is someone caring for a number of people in their own homes and travelling between them. She works for two different employers but does not earn enough in either job to qualify for SSP. If she needs to self-isolate, she would have to claim universal credit, but how long would that take? The last figures published for universal credit showed on average 40,000 people a week claiming the benefit, but in the past month 1.4 million people have applied, so can the Minister tell the House what the average wait is for someone who has applied for universal credit in the past month? Secondly, even if our care worker’s claim is processed quickly, there is a built-in wait of five weeks to get money on universal credit. She can ask for an advance, but it is a loan deducted from future universal credit payments. She is only just managing as it is and is scared of getting into debt.
Ministers have made some welcome changes to universal credit, but these case studies show that carers need more. We need action on the two-child limit, the savings threshold and the failure to uplift legacy benefits. Most urgently I want to plead again with Minsters to abolish the five-week wait in universal credit. If they cannot or will not do that, will they give everyone an advance automatically when they apply, but as a grant, not a loan?
These may not sound like health issues, but their effects really are, because if carers cannot pay their rent and feed their families they may feel that they have no choice but to carry on working when they should be self-isolating. That is bad for carers, but also, since their work takes them from one person to another, they must be at serious risk of spreading the virus to some of the most vulnerable people in our country. I urge Ministers to act now.
Queen’s Speech
Baroness Sherlock Excerpts(4 years, 6 months ago)
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Baroness Sherlock (Lab)
My Lords, I thank the Minister for that introduction. She need not worry about repeating herself; I do that all too often—and I write my own speeches, so she has my sympathy. I am really looking forward to hearing speeches from around the House, but it is a disappointment that we will not get to hear the valedictory by the noble Baroness, Lady Emerton. I simply want to say for the record how much we on this side, especially my colleagues in the health team, have valued her contribution to the House, nursing education and the NHS more broadly. She will be greatly missed.
It feels slightly strange and unreal to be here discussing the details of Bills when out there, the Government only have eyes for Brexit. Indeed, the Prime Minister is champing at the bit to dissolve the Parliament which Her Majesty opened only last week with this gracious Speech. However, here we are, so we must do our job. The Minister has ably set out the Government’s vision for the future of Britain. As she said, the Prime Minister claims it is an ambitious programme which has at its heart a new vision for Britain and that the Government want to make the UK the greatest place to live, work and do business. This cannot be the greatest country to live in unless it is a great place for all our people to live in. We are interdependent, and the true flourishing of any of us depends on the flourishing of all of us, so my test of this speech and this programme is whether it can deliver on that vision.
The welfare state embodies a vision of Britain as a country where we take care of each other. We all pay into it and for it, because we all need it at some point. Some will need it more, but we do not know who that is going to be or whether it might be us. It supports those raising the next generation. It helps all of us at key life stages or in times of need—in pregnancy, sickness, unemployment or bereavement. It gives extra help to those who need it most: those with long-term illnesses or disabilities, or who care for others. It helps make work pay, and it supports us all in retirement. However, our system is increasingly losing its way. The past decade has seen massive cuts to benefits, damaging reforms, especially of disability benefits, and the awfulness that is universal credit. It has seen the demonisation of claimants and an explosion in benefit sanctions, often for the most minor infractions, which have combined to drive people into poverty and to take away their dignity. More and more people are struggling to make ends meet, dependent on food banks or even sending their kids to school hungry.
What, then, does the Queen’s Speech have to say about that situation? As we heard, there is one DWP Bill, the Pension Schemes Bill. We are in broad agreement with the stated aims of the Bill and we will crawl over the detail. My noble friends Lord McKenzie of Luton and Lady Drake will speak more about pensions later, but that is it: there is nothing on social security and the word “poverty” is mentioned nowhere, even though 14 million of our citizens—4 million of them children—are living in poverty. In-work poverty is on the rise and most poor children now live in working households.
What did Ministers think was going to happen when they set out to cut £37 billion from our social security system? The benefit freeze alone will have taken £4.4 billion from our poorest families by the time it ends next year. I was horrified recently to hear the Secretary of State for Work and Pensions refuse to rule out extending the freeze still further. To do that would be to deliberately and knowingly drive more people into poverty and deeper poverty, so I hope the Minister can reassure us that that will not happen. I trust that she will not say that that is a matter for the Budget, because while Ministers have been quite happy to trail tax cuts—there is always money for tax cuts—it is strange that there is never as much money when it comes to benefits for the poorest.
Labour has committed to a £3 billion programme to reverse the worst of the cuts, including the disgraceful two-child limit, and to begin to unpick the disasters of universal credit. A Labour Government would seek to change the culture and create a system dedicated to dignity, universalism and ending poverty. That is our vision of a country where everyone can flourish. Will the Minister tell us what the Government’s vision is?
Our welfare state pools risk across our population and across lifetimes. It is the companion service to the NHS, which also works on the basis that we pool our risk because any of us can get sick. It is because of that underlying vision that the NHS is more than just a public service: it embodies how we as a nation see ourselves as an interdependent community. I am sorry to say, however, that our NHS is struggling and there was not much comfort in the Queen’s Speech. Most of the funding announcements had previously been announced and most of the proposals—for example, for a long-term plan, reforming the Mental Health Act and addressing social care—are very much in the future. Right now, across the NHS, services are missing financial and performance targets. People are waiting ever longer for treatment and a shortage of staff threatens the quality of patient care. Where is the urgent concrete action to deal with these problems?
Meanwhile, social care is in crisis: adult social care is badly failing those who rely on it, with high levels of unmet need and providers struggling to deliver the quality of care that vulnerable people need and have a right to expect. However, the funding announcement on social care had previously been announced and £500 million has to be raised by councils themselves, even though those in the industry had made it clear that that was, in their words, a “short-term sticking plaster”. Without more funding or a detailed plan as to how we get there, older and disabled people will continue to be left without the care they need, and carers will increasingly buckle under the strain.
Labour has set out its vision for a national care service, but we do not know what the Government’s vision is. The Prime Minister promised us that he had a plan to fix the crisis once and for all, but I see no plan, just endless consultation. One has to assume that the ever-delayed Green Paper has perhaps finally bitten the dust. If so, we are left with no proposals and no legislative timetable for a social care Bill in this Parliament. I hope the Minister can contradict me because, if not, that simply is not good enough.
Mental Health was too often addressed in similarly broad terms. It is now almost a year since the independent review of the Mental Health Act was published, but we still do not have a White Paper. Ministers announced a mental health Bill in December 2018 but we still do not have one. There are urgent problems: mental health beds are closing; the mental health estate is crumbling; the CQC has recently reported chronic staff shortages and deteriorating services; children and young people are waiting more than a year for mental health services and many have been turned away because they were not yet bad enough. Can the Minister tell us when will we see some action? My noble friend Lady Wheeler will say more about social care in her contribution.
I am afraid that that pattern of revisiting old promises with slightly vague offers of new ones permeates the Queen’s Speech. In education, again, we are short on commitments to new legislation or policy. Even previous ministerial commitments that need legislation have not made their way into the Queen’s Speech. For example, Ministers said they would introduce a schools’ level-funding formula “as soon as possible” but where is it?
Only a few weeks ago the Secretary of State said that he would,
“put the school uniform guidance on a statutory footing”,
and will do so when a suitable opportunity arises. School uniform costs are rocketing and something is needed, but where is the legislation? Where is the guidance? Furthermore, despite specifically consulting on primary legislation to regulate home education, there is no sign of it in the Queen’s Speech. Can the Minister tell us why and when it will be brought forward? My noble friend Lord Watson of Invergowrie will talk more about education across the spread in his contribution.
The DCMS is the final area covered today but the key announcements on broadband rollout and online harms were covered in part by my noble friend Lord Stevenson of Balmacara on Thursday and my colleagues will pick that up later, so I will not dwell further on it here. However, I want to note the widespread disappointment that Ministers did not use the Queen’s Speech to commit to reverse the cuts to BBC funding for the over-75s licence fee. That should never have been dumped on the BBC in the first place and I urge the Government to review it. Labour will; will the Minister please do likewise?
We have looked at this programme through the lens of some of our most important public services and the welfare state as a safety net for all of us. Does that vision stand up to scrutiny? I do not think that it does. It is not enough just to declare that you want to make Britain great again. If we want a country where all our people can flourish and where they can fulfil their potential and contribute to the flourishing of the nation, government must will the means as well as the end.
We do not need another decade of cutting taxes for the better-off while slashing benefits for the poorest, of letting our most important public services lurch from crisis to crisis and of abandoning vulnerable people to the care of friends and family. We need a new era characterised by mutual care and by a determination to tackle inequality, protect the vulnerable and give every child the best possible start in life, wherever they live and however unwisely they chose their parents. That is the vision that I want to see and I urge the Government to follow that instead.
Queen’s Speech
Baroness Sherlock Excerpts(6 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)
My Lords, in the spirit in which the noble Lord, Lord Hunt, started his speech, I, too, make declarations, not only of my position as a trustee of academy trust Floreat Education, which I set up, but, given that he has brought his family into it, that my wife is also a journalist. I think it is probably worth saying that.
I sincerely thank all noble Lords for this thought-provoking and wide-ranging debate. When I got my marching orders from the Leader’s Office, I thought that, compared with my noble friend Lord Ashton, who opened so expertly, I had perhaps pulled the short straw. But the opportunity to reflect on the wise and incisive comments made by noble Lords has been a privilege, and I am grateful for it.
I am particularly grateful for the speeches from the Front Bench from the noble Baronesses, Lady Sherlock and Lady Walmsley, and the noble Lords, Lord Hunt and Lord Storey, for their as ever searching questions. I also wanted to highlight what I felt were some of the more uplifting speeches. The right reverend Prelate the Bishop of Ely talked about how we could live well with difference and create a society that supports common flourishing. My noble friend Lady Stowell talked about the importance of behaving with dignity and respect for one another. I join the noble Baroness, Lady Masham, in paying tribute to the emergency services. My noble friend Lady Cumberlege mentioned a phrase that stuck with me: “treat me kindly”. The right reverend Prelate the Bishop of Gloucester talked about providing hope for the most vulnerable, and the noble Earl, Lord Listowel, about encouraging exchanges between young people. The noble Baroness, Lady Benjamin, in her fantastic way, gave a wonderful and optimistic exposition of the preciousness of childhood. My noble friend Lord Grade talked about bipartisanship —there is a thing—in praise of Gordon Brown. I may move off that slightly.
Before turning to noble Lords’ specific comments and questions, I would like to reflect on some of the measures in this Queen’s Speech. Some noble Lords have criticised the legislative agenda set before Parliament last week. I believe that that criticism is misguided. This Government are delivering on the British people’s desire to leave the European Union—a desire echoed in the recent general election when more than 80% of votes cast were for parties that supported leaving the European Union—and we wish to do so on good terms. The only magic trick at work here, the only illusion, is the attempt by the Liberal Democrats to pretend otherwise. This has rightly been described as the greatest peacetime challenge ever faced by any Government. Unambitious it ain’t.
Yet beyond that, the Queen’s Speech demonstrates the Government's commitment to broader social reform, and the business of government very much goes on. In the areas that we are discussing today, it includes enhancing our efforts to make the NHS the safest health system in the world, helping people to make more informed financial decisions, correcting 70 years of policy failure to deliver a high-quality system of technical education, improving the quality and safety of our digital economy, and challenging the culture of indifference that ranks mental health below physical health. This is an agenda that will deliver a strong and safe society in which everyone should have the chance to thrive. It is one of which any Government can be proud, and this Front Bench is delighted to be playing its part in delivering it.
The actions outlined in Her Majesty’s most gracious Speech build on a record of success, despite the gloomy prospectuses of so many noble Lords in this debate. I mention in passing that the ONS started collecting self-reported happiness measures in 2012 and, despite the tone of the debate, believe it or not they have never been higher. The ONS only started collecting them in 2012, so in the halcyon days of Tony Blair no doubt they were much higher. However, I believe that the word “crisis” has been used far too liberally. I gently chastise the noble Lord, Lord Pendry, for politicising the NHS in the way he did. The BMA was against the founding of the NHS some time ago, but things change, and the Conservative Party is deeply supportive, as supportive as any political party in this country, of what my noble friend Lord Lawson once described as the closest thing we have to a religion.
We recognise the pressures that our public servants are under, and I would not want to be involved in running down their achievements over the past seven years. We have 1.8 million more children in good and outstanding schools, the best ever health outcomes, low crime rates, record employment, the closing of the gender pay gap, and reductions in income inequality so that they are the lowest since 1984. These have been possible because of the sound economic management of this Government and their willingness to take decisions to restore public finances to order. These decisions have enabled record investment in schools and hospitals despite the need to reduce borrowing.
The Government recognise absolutely the impact these actions have had on public servants’ pay, and I agree with the noble Lord, Lord Storey, that they are our greatest asset. I also know that this period has been difficult for people in both the public and private sectors. That is all the more reason to finish the job so that we can deliver the pay increases that staff want. The alternative, set out in the Labour manifesto is, if I may say so, to promise free things for everyone. But nothing is free. It all has to be paid for by someone, so the question is: by whom? Either, as the Institute for Fiscal Studies has pointed out, by ordinary taxpayers, not just the rich because there is not enough there to soak, or through more borrowing and more debt, loading yet more costs on to future generations.
I do not believe that it is fair to ask the young to continue to support older generations, which is what is happening now. The noble Lord, Lord Whitty, laments the end of the benefits that his generation enjoyed, such as pensions, secure jobs and so on, but I wonder whether he has reflected on the fact that the reason young people do not have access to these things may be at least in part because of the choices made by his generation. Perhaps, as my noble friend Lady Browning hinted, the baby boomers might consider footing the bill to improve conditions for the young. We had some ideas for that in our manifesto. That might satisfy the desire for more taxes, which appears to have been picked up in the British Social Attitudes survey, as the noble Lords, Lord Kirkwood and Lord Warner, pointed out.
I shall move on to education and start where the noble Lord, Lord Hunt, finished: on the purpose of education, if you like—the philosophical element. I agree with him that the purpose of education is to provide a broad, rich and rounded education. At Floreat Education, we use a quote from Martin Luther King, who said:
“Intelligence plus character—that is the goal of true education”.
It is the development of that wider human flourishing that I think we are all seeking. That absolutely includes gardening, as the noble Baroness, Lady Benjamin, pointed out. Indeed, I do not know whether she noticed, but one of her colleagues, the noble Lord, Lord Wallace of Saltaire, is a chief grandparent at Floreat Wandsworth school and has been deeply involved in planting the new garden that has opened there in the past year, so I am a deep believer in it. Indeed, the Government’s purpose is to provide more good school places that are open to any pupil.
I turn now to school funding. We know that the current funding arrangements in England are unfair. That is why we have recently consulted on the national funding formula for schools and we will work with Parliament to bring forward proposals. The core schools budget, which the noble Baroness, Lady Sherlock, and the noble Lord, Lord Storey, referred to, has been protected in real terms since 2010 and is set to rise to £42 billion by 2019-20, albeit with increasing pupil numbers. Teacher numbers have also increased in recent years. There are more than 450,000 teachers in state-funded schools, which is up by 15,000 since 2010.
A great deal of concern has been voiced in the debate about the EBacc and arts education. I agree that every child should experience a high-quality arts and cultural education. Since the EBacc was announced, and bearing in mind that the point of the EBacc is to provide the foundation of a rich and robust academic education for every child, the proportion of state-funded pupils taking at least one arts subject increased from 45.8% in 2011 to 48% in 2016. Noble Lords may be wondering how that squares with some of the facts, but it is quite possible that each pupil is taking fewer subjects but more are taking subjects, meaning that more students are actually getting the balanced education that we want to see.
The right reverend Prelate the Bishop of Ely talked about the importance of character education. I am delighted to say that he has visited one of my schools, and that we continue to invest in that element. I can also reassure him that religious education is compulsory at all key stages and that entries into the RE GCSE full course have been rising each year since 2009.
On apprenticeships, raised by the noble Lord, Lord Aberdare, and the noble Baroness, Lady Bonham-Carter, we believe in the importance of apprenticeships in delivering skills. That is why the £2 billion raised by the apprenticeship levy is being invested. That is being designed by business; it is about having something that fits the needs of businesses.
As we set out in the manifesto, we want to look at the funding of further, technical and higher education to ensure that there is parity of esteem and the right approach so that we have the skills we need. As my noble friends Lady Stowell and Lady Stedman-Scott pointed out, it is vital that we value not just people who have been through the university route. That lies at the heart of our proposals to provide an extra £0.5 billion a year for technical education.
I should take this opportunity to respond to points made by the noble Baronesses, Lady Lawrence and Lady Cohen, about international students. We absolutely value the significant contribution that they make to our universities and our society. The UK remains the second most popular destination globally for international HE students. Our purpose as we leave the European Union is to gain control of, not to end, immigration. It becomes much easier to defend immigration to those concerned about it if there is a sense that the Government are in control.
Several noble Lords, including my noble friends Lady Stowell and Lady Stedman-Scott and the noble Lord, Lord Aberdare, talked about careers advice. The Careers & Enterprise Company is promoting careers education. As the noble Earl, Lord Kinnoull, pointed out, that is a vital part of social mobility. I welcome his committee’s report, which is influencing the way government thinks. However, as my noble friend Lady Stowell pointed out, we need to tread slightly carefully with social mobility. There is a version of social mobility that says simply that the most important thing is to get out of your community, but, as she said, we should provide the ability to succeed in your community; you should not need to leave where you come from to be considered a success.
The right reverend Prelate the Bishop of Gloucester, the noble Earl, Lord Listowel, and the noble Lord, Lord Addington, talked about vulnerable young people with learning difficulties. I can reassure them all that this is still very much a priority for the Government. I share their sadness that Edward Timpson lost his seat. We all acknowledge that he was an excellent Minister who was a truly passionate proponent of the issues relating to such children. I deeply hope he will be back; I am sure that he will be working hard on those issues in some other guise in the meantime.
The noble Lord, Lord Clement-Jones, asked about the data protection Bill and the digital charter, and about responding to and being guided by the reports from the Royal Society and the British Academy. We welcome those reports, which will be a useful contribution to the Government’s work across this agenda. We are looking at measures to share data in a way that is safe but brings benefits to citizens. HMRC holds a lot of data which are highly sensitive. The Digital Economy Act, taken through this House by my noble friend Lord Ashton, allows those data to be used subject to rigorous safeguards. We will bring those powers into force shortly.
The noble Baroness, Lady Sherlock, asked about protection for people using social media. As I have said before, as a parent of young children who are on the brink of getting into that world, what is possible frankly terrifies me. However, I think the manifesto— which, as we know, had some strengths and weaknesses—was commendably robust on those issues. We will bring forward an internet safety strategy to try to make the UK the safest place in the world to be online.
As for Channel 4 moving out of London, I can see that this could become a bun fight between different corners of the country. I do not want to weigh into that and suggest any kind of preference—I was born in Maidenhead, the Prime Minister’s constituency, so there might be a chance.
Lord O’Shaughnessy
It is our intention that Channel 4 should move out of London to provide that stimulation to regional creative industries.
The noble Baroness, Lady Bonham-Carter, asked whether we would set up a licence fee committee. I shall have to disappoint her on that front.
There were a number of questions about the impact of Brexit on the creative and digital industries. This is an area where we can talk ourselves into a very negative position. As I stated at the beginning, the Government’s desire is to have a close and deep partnership with the European Union. The mood music we are picking up in Europe from industries—I know it is true in my own area of pharmaceuticals—is that there is that strong desire from the other side as well. It is about reaching for a strong and integrated partnership and not being tempted down a different route. The creative industries are clearly an absolute mainstay of the UK economy and a flagship pillar of the industrial strategy—I can reassure noble Lords that they are very much in our thoughts as the negotiations to leave the European Union go forward.
I have touched on immigration. The noble Lord, Lord Young, asked about cybersecurity. We are obviously under attack all the time in terms of cybersecurity. The Government have done a great deal in this area. There was a particular effect in the health service, as we know, back in May. There are new standards coming, through the Caldicott review for healthcare, which we will publish our response to in due course. The Government take this very seriously and have invested heavily in it.
The noble Lord, Lord Lee of Trafford, asked about tourism, another vital part of our economy which will remain vital.
Moving on to work and pensions, first, I thank the noble Lords, Lord Kirkwood and Lord McKenzie of Luton, for their support for the Financial Guidance and Claims Bill. It will make a big difference to people’s ability to make more effective financial decisions and to deal more competently with financial services.
The noble Baroness, Lady Sherlock, asked about this Government’s commitment to the welfare state. I can tell her that our commitment is as deep and as strong as ever. We believe that there should be a strong welfare state, consisting not only of the social security system but of pensions, care, health and education, committed to helping everyone, with extra help for those who need it. Part of the reforms to the welfare state, to make it fit for purpose, involves universal credit. I believe it is a simplifying rather than a complicating of the system. It has clearly been introduced carefully to make sure that it works, as is right. The current system does not make sure that work pays in every instance, but that is something that universal credit does.
The noble Lord, Lord McKenzie, asked specifically about Grenfell Tower and the passage in the speech of my noble friend Lord Ashton of Hyde. I can confirm that no one will be worse off as a result of rehousing because of the fire at Grenfell Tower if they move into larger accommodation. I think that that provides the reassurance that the noble Lord was after.
Disability issues were raised by a number of noble Lords, including my noble friend Lord Shinkwin. I think we were all very moved and rather shocked to hear of the treatment he had received. I know I was when I read about it and then spoke to him about it. The Minister for Disabled People is taking an active interest in this and I know that my noble friend is talking to her. Improving the lives of disabled people is a core part of this Government’s approach. We had a Green Paper in October last year and a consultation was launched in February. Responses are being considered before we move ahead. The noble Lord, Lord Addington, talked about disability employment advisers and disability recruitment. There is not yet perhaps the coverage he would like, but there are nearly 500 employment advisers across the country and those numbers have been increasing. We will aim to get a million more people with disabilities into employment over the next 10 years. I think the Government have a very good record on that.
Finally, on health, the fundamental question that has been raised by the noble Baroness, Lady Masham, the noble Lords, Lord Warner and Lord Pendry, and others is the sustainability of the NHS. It has been working hard to manage its finances in a challenging period and yet, of course, it has been experiencing real-terms increases as well. Although I do not for a minute underestimate the challenges that it faces, with a growing and ageing population, we are planning to spend £8 billion more in real terms over the next few years to improve it. As a result, there are more people going through treatments, more people being seen in A&E and the targets that the noble Lord, Lord Hunt, referred to are still very much part, as he knows, of the NHS five-year forward view. Clearly, one of the ways we can improve health outcomes is to prevent accidents in the first place, as the noble Lord, Lord Jordan, my noble friend Lord Ribeiro and the noble Baroness, Lady Donaghy, said. I utterly agree with them about the importance of good health and safety. Public Health England works with the Child Accident Prevention Trust on these issues and preventing accidental injuries is part of the public health outcomes framework.
The noble Lord, Lord Pendry, and my noble friend Lady Browning talked about dementia. Dementia Friends has been a core part of the Government’s strategy and we understand just how deeply loneliness can harm health outcomes and cause misery and pain in people’s lives. Addressing that is an important part of this approach.
That brings me on to social care. The noble Baroness, Lady Pitkeathley, encouraged us to be bold and honest. I think if you could say anything about the manifesto promise, it is that it was bold and honest. Nevertheless, the ageing population presents one of our most difficult and profound challenges. As noble Lords know, more money is going into social care to put it on a stable footing in the short term. The proposals on which we will consult will include a floor and a limit on the amount that people can be asked to pay. I hope that provides reassurance to those who asked whether there will be proposals or yet more open-ended questions.
As part of our strategy, we need to think about carers. They do an amazing job in often extremely difficult circumstances—particularly older people looking after a spouse or children caring for their parents. We are considering carefully how to help those people.
My noble friend Lady Cumberlege, the noble Baroness, Lady Masham, and the noble Lord, Lord Freyberg, asked about maternity care. I feel very deeply about this issue. My eldest daughter was born in quite difficult circumstances and had to be delivered by emergency c-section. It was, frankly, a terrifying time. I want to ensure that there is good maternal safety, so that we do not risk what in her case was a strep B infection that had almost got up the umbilical cord—she had a raging temperature within the womb and a heart rate of 150 beats per minute. Your Lordships can imagine what that was like for us all, and for my wife in particular. So I feel that point very deeply and we have a real commitment from the Secretary of State on this issue.
I congratulate my noble friend Lady Cumberlege on her national maternity review. We are taking forward many of the ideas that she is interested in promoting, such as the rapid resolution and redress scheme, backed with more funding so that we can have a safer, more personalised and kinder approach to maternity, and prevent some of the awful injuries and deaths that sadly happen in that environment.
One issue that affects maternity and other areas is when there are staff shortages. The number of midwives has increased over the past few years. We know that there is growing demand from a growing population and we want a workforce that is capable of dealing with the challenges ahead—even more so given the impact of not only Brexit but, as we were discussing the other day, the language tests. That is why we are increasing the number of staff in training and offering new routes into the profession, such as the nursing associate and nursing apprenticeship.
I will touch briefly on the payment of the national minimum wage for sleep-in shifts, which was raised by the noble Baronesses, Lady Jolly and Lady Brinton. Through the living wage we want to make sure that pay is fair in all sectors of social care—but I understand the problem with this issue. We are looking at it and I will come back to update both noble Baronesses on the particular concerns they raised in the debate today.
Regarding mental health, the Government have a better story to tell than perhaps we have been given credit for. There is much more money going in—and, yes, it is getting to the front line, as well as other commitments, including waiting time commitments on treatment. There is an issue to be discussed, at another time, about the extent to which we have ring-fencing and direction, because the whole way the NHS works is predicated on clinical autonomy. Just as with the operational autonomy of the police force, that autonomy is rather important. Of course there should be targets—or goals, if you like—and sometimes they will be in conflict with one another. Nevertheless, it needs to be for professionals to make that decision. We will bring forward the Green Paper on children’s and young people’s mental health that the noble Earl, Lord Listowel, hoped for. I can reassure him on that front.
My noble friend Lady Browning asked about people in prison. They should absolutely be getting the same level of care as those who are out of prison. Patient safety has been talked about, and is at the core of this Queen’s Speech. We have the draft patient safety Bill, and it is our intention, as the noble Lord, Lord Freyberg, and my noble friend Lord Ribeiro, said, to learn the lessons from other sectors such as aviation, to make sure that we have one of the safest healthcare systems in the word. We intend to publish the Bill in draft later this year, ahead of pre-legislative scrutiny within this two-year Parliament.
The noble Lord, Lord Rennard, asked about tobacco control. I am afraid I cannot give him a precise date for the plan, although I know he is itching for one. He will understand that there has been a reorganisation of Ministers in our department since the election, but our commitment to it remains.
My noble friend Lord Astor asked about Lyme disease. There is a public health pathway on this issue, but I realise the seriousness—the growing seriousness—of it, and will write to him on the further work that we are doing.
My noble friend Lord Bridgeman raised the issue of GP surgeries. General practice is changing: partnerships are merging into federations, and there are other things going on, but improving primary care is at the heart of the five-year forward view. The nature of practices will change over time, but I totally understand what he says about making sure we do not punish those who are most entrepreneurial.
I am sure that your Lordships will be delighted that I am about to bring my speech to a close. I have tried to be comprehensive, but we have also agreed on the importance of arts and culture for children, and I am due to take my children to see “The Wind in the Willows” tonight, so I will bring my comments to a close.
Discussions in this Chamber are not always conducted without rancour, and I am as guilty of that as others, but on reflection it is noticeable that the speeches I highlighted to begin with for their uplifting qualities came largely from either Baronesses or Bishops, despite their being in a minority in this House—that is probably a lesson for us male, temporal Lords.
In an attempt to reach the bar that they have set, I would like to close the debates on the humble Address by turning to an idea that has motivated me through my life, and which I know motivates every Member of this House, those in another place and millions of citizens throughout this country. We are here and we serve our country because we believe in Britain. We believe that it has a great past but an even better future, and that our country is at its best when it pulls together in pursuit of an ambitious and admirable goal.
We have seen that attitude at work in response to the tragic incidents of which we have suffered too many recently. These tragedies all hit home in various ways, whether because our Parliament was attacked or because we live with, know or work with people affected. I can see the burned-out remains of Grenfell Tower from a window at home. It is right next to the leisure centre where I take my children swimming—no doubt some of the children who swam in that pool have died. It is a black scar on London's landscape and a dreadful reminder of the importance of looking after one another more carefully than we sometimes do.
However, it should not need tragedy to pull us together. As Brendan Cox, the courageous husband of murdered MP Jo Cox reminds us with great dignity, we have more in common than that which separates us. The task for this Government, and indeed this House and Parliament, is to bring people together. We need to create more and new opportunities for common enterprise—joint endeavours that allow our people to achieve happiness for themselves, their families and their communities. If this is what motivates us all in the years ahead, then, despite the challenges, I believe that we can face the future with confidence.
Health: Mental Health
Baroness Sherlock Excerpts(11 years, 5 months ago)
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Baroness Sherlock
To ask Her Majesty’s Government, further to the remarks by Earl Howe on 8 February (HL Deb, col. 273), what action they have taken to ensure mental health is treated on a par with other National Health Service services.
Baroness Sherlock
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a director and former chair of Chapel Street community health.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Health and Social Care Act 2012 creates equal status for mental and physical health; the new mandate to the NHS Commissioning Board tasks it with delivering this goal. One of the eight objectives of the mandate is,
“putting mental health on an equal footing with physical health–this means everyone who needs mental health services having timely access to the best available treatment”.
The NHS will be expected to demonstrate progress by March 2015.
Baroness Sherlock
I thank the Minister for that Answer. The NHS constitution gives a patient the right to drugs and treatment recommended by NICE for use in the NHS where clinically appropriate. “Recommended” means that they have passed NICE’s technological appraisal. For mental health, the problem with talking therapies is that they are not appraised because they are not technological. Will the Minister reassure the House that “parity of esteem” will mean that the NHS constitution will give someone the right to any therapy or treatment recommended by NICE for use in the NHS, even if it has not passed the technology appraisal, provided that there is good evidence for its efficacy—for example, CBT for schizophrenia?
Earl Howe
My Lords, as the noble Baroness made clear, the NHS constitution sets out that patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS if their doctor says that they are clinically appropriate for them; that includes talking therapies for certain problems. The mandate to the NHS Commissioning Board is clear about everyone who needs mental health services having timely access to the best available treatment. The NHS will be expected to demonstrate progress in achieving that by 2015, as I mentioned. For many patients, there are few better therapies than talking therapies. Given that the board must deliver those outcomes, the rest follows.
NHS: Standards of Care and Commissioning
Baroness Sherlock Excerpts(13 years, 1 month ago)
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Baroness Sherlock
My Lords, I thank my noble friend Lord Turnberg for securing this debate and I declare a non-pecuniary interest as the next chair of Chapel St, a charitable enterprise which delivers services in partnership with primary healthcare.
I should like to wave another report at the House. This one came out last week. It is from the King’s Fund and is called Improving the Quality of Care in General Practice. In fact, it begins where the noble Viscount, Lord Bridgeman, left off, looking at variations in care. The report was the result of a major inquiry conducted over two years by an independent panel. The panel looked at general practice and found that most care is good, which is a relief, but it also found that there is a widespread variation in performance, as well as gaps in the quality of care delivered by general practice. The report is full of examples, which I commend to the House. It showed variations in the quality of prescribing, in the quality of diagnosis—for example, one-third of patients with stomach or oesophageal cancer who required urgent referral to hospital were given non-urgent referrals—and in the rate of referrals. The report also highlighted variations in the continuity and co-ordination of care. It showed some significant differences.
Almost as telling was the fact that it found a significant problem in accessing public information, particularly comparative data, on performance in general practice. When we consider the avalanche of data available for almost every other part of the health service, that is quite striking, and I should be interested in hearing the Government’s reaction.
I see that the noble Earl, Lord Howe, told the Health Service Journal last week that, in response to the report, the Government’s plans to move 80 per cent of the NHS commissioning budget to GP-led consortia will improve this situation. I am very keen to learn how, and perhaps the Minister will take the opportunity to explain it to the House. He may not want to go into detail today but I wonder whether I can encourage him to assure the House that he will engage with the King’s Fund, as well as with the Royal College of General Practitioners and the BMA. I was delighted to hear that they both welcome the report, so there is a fair wind behind it, but perhaps the Minister will engage with them in looking at how these problems can be tackled. Perhaps, in particular, I could encourage him to do so before this House starts to look in detail at the Health and Social Care Bill that will be coming before us.
For me, this report could be a metaphor for the state of the health service: most general practice is good; the NHS is good; popular satisfaction has never been higher; its efficiency is admired; but there are pockets of significant problems, as described by my noble friend Lord Turnberg. It is clear that performance and outcomes vary too much. We all want to see continuous improvement and we all are open to the idea of changing how healthcare is delivered. However, it is not at all obvious to me how the revolution in the health service, on which the Government are embarking, will necessarily solve these problems. Risks will inevitably be taken by such large-scale reform, so not just this House but the country needs to be persuaded that the changes will produce results that will solve the kind of problems that have been identified. I strongly encourage the Minister to look not just at the specific problems raised but to say why the Government think that their prescription will cure the ills. That is the challenge for all of us.
When I thought about what I would talk about today in my four marvellous minutes, I went back to a list of notes that I had made at the wonderful all-party seminars that many of us have attended with experts in the field, and I found a list of 20 questions to which I did not know the answer. It is not simply a list of questions that I cannot answer, as that would be a rather greater list, but a list of questions to which the experts at these seminars had been unable to find the answers after carefully reading the Bill and all the associated documentation. If that is the case, we have to question the wisdom of proceeding at the current pace. This House has enormous respect for the integrity and experience of the Minister. I wonder whether he could speak to his colleague the Secretary of State and encourage him to reflect on the fact that a wise man does not demolish his house while the architects are still sketching the new one.
NHS: Reorganisation
Baroness Sherlock Excerpts(13 years, 4 months ago)
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Baroness Sherlock
I add my thanks to my noble friend Lord Touhig for securing this debate. Before I start, I declare an interest in that I did some work recently for the Social Care Institute for Excellence on the establishment of a college of social work. The SCIE is interested in the social care elements of this debate.
I spent some time as an adviser in the Treasury, and whenever a new idea came up the kiss of death from Treasury officials was to bill it as “a solution looking for a problem”. When I came up with a pet idea, it was incredibly annoying—I would be pretty clear that it was a great idea—and I would not for a moment suggest to the noble Earl that this was a solution looking for a problem. However, that experience taught me that even when reform is desirable and well implemented, the costs of transition in so many different ways are so huge in terms of a reduction in productivity and all the disruption that it causes that the test has to be set very high to decide that the game is worth the candle. That is something that concerns me now. We have heard a very good defence today from my noble friend Lord Hunt of Kings Heath and the noble Baroness, Lady Williams of Crosby, who remind us that the NHS, with which we are perhaps over-familiar, is a real and rare jewel and something that we should celebrate and defend. It is something that we should take very careful steps to amend only very slowly, if at all, unless the case for change was overwhelming.
Secondly, if there is a case for change, surely if it is on this scale it should happen only when the weather is fair and the wind is at our back. I am afraid that at the moment it does not feel so. We are aware of the constant pressures on the NHS finances of demographics, complex health needs, and the price of drugs and technology. That is why there has been so much investment in the health service in the past decade, which the noble Lord, Lord Alderdice, was kind enough to acknowledge. Now the NHS will face an enormous squeeze; it has to find £20 billion of efficiencies a year, which is a huge challenge. Who will have to find those efficiencies? It will be the PCTs, which will close and their staff face losing their jobs. The PCTs will have to address themselves to the management of change and prepare for the brave new world.
In that circumstance, the only argument for introducing this level of structural change will be if it can be shown that it was necessary in order to achieve those economies. The King’s Fund, for which I have a great deal of respect, as do other Members of this House, has this week disagreed with the idea that structural changes will help to meet the productivity challenge. Indeed, it said that it shared,
“the concerns set out by the Health Select Committee yesterday, that they will still act as a distraction from delivering the enormous productivity improvements required across the system”.
We should take that warning very seriously.
Thirdly, I shall comment on the new governance arrangements. Like many observers, I have been concerned from the first time I heard of these proposals about what would happen to the community aspects of health. We do not live as individuals and we do not experience our health or welfare as individuals; we live in communities. If we move to commissioning by GP practices gathered together in commissioning groups, who will be responsible, and how, for the health of a whole community? I understand from the Government’s response that the local health and well-being boards will be the vehicle for securing collaboration between the NHS, public health, adult social care and other services. Of course, there is also the local government scrutiny, but will not some health and well-being boards have GP consortia that straddle their boundaries, making co-ordination more difficult? How will that be addressed?
There is also the specific role of local authority scrutiny, but this adds up to quite a complex piece of governance machinery. Accountability will run downwards to service users and communities, and sideways through the health and well-being board, the local authority scrutiny group, and perhaps Local Health Watch. It will run upwards to the national commissioning board and perhaps to the CQC, the national health watch Monitor, and the national public health service. That is quite a complex form of governance. What will happen when those different parts of the system pull in different directions? How should a judgment be made by a consortium if one set of pressures comes down from the national commissioning board and another comes locally or sideways for the local variations? How will that work in practice?
I have two specific questions for the noble Earl. Because they are so specific, I would quite understand if he would prefer to write to me. First, much is said about the need for the integration of health and social care. I am very much behind that principle and wish the Government every success in pursuing it, but could the Minister explain how, in practice, social care will be represented on the commissioning boards? How will it have a place in the commissioning structure to ensure that it is delivered in practice as well as thought about in theory?
My second set of concerns relates to the safeguarding of children. I am sure that the Minister is aware of the comments reported in the Telegraph last week by Tim Loughton, the Minister in another place who is responsible for children, who said that it would be more difficult for doctors to spot child abuse as groups of GPs already adopt widely different standards in relation to that. I am sure that the Minister is aware that a number of children’s charities are concerned that aspects of the health service have long been the weak link. That can be a significant concern when one reads serious case reviews. What will happen in this new system? Will the Minister explain how, if the system is to be changed in the way that is described, the Government will ensure consistently high standards of policy, training and practice in safeguarding under the new commissioning arrangements?
Finally, will the Government think of another way of doing this? I was struck by the comments by the noble Baroness, Lady Williams of Crosby, about the expertise in this House. Given that pathfinders will try this in practice—even allowing for the idea of the noble Lord, Lord Rea, that they might do this under canvas—will the Minister consider, when the pathfinders have run their course, pressing the pause button, evaluating carefully what the results tell us and bringing something back for the scrutiny of this House and another place so that we can work out whether people such as me who are worried are wrong? It is very hard for me to admit that I might be wrong, but I concede that on rare occasions this happens—a little less laughter, please. It may even be true of other noble Lords in this House. That would give us an opportunity to take a step back and consider whether our worries have turned out to be right. If they have not, we can carry on with less concern. However, if we are right, we could protect the NHS from damage. The NHS is a jewel in our crown, and we risk public wrath if we do anything that could damage it.
Health: NICE
Baroness Sherlock Excerpts(13 years, 5 months ago)
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Baroness Sherlock
To ask Her Majesty’s Government which groups were consulted prior to the announcement that the National Institute for Health and Clinical Excellence was to lose the power to decide that some drugs may not be supplied by the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, it is important to make clear that the National Institute for Health and Clinical Excellence does not have any powers to ban the use of drugs in the NHS, so suggestions that this is a role that will be removed from it are based on a misunderstanding of the position. Our NHS White Paper makes it clear that the role of NICE will continue and, indeed, that it will be extended.
Baroness Sherlock
My Lords, I thank the Minister for that Answer. I am a little confused, but perhaps he can help me to understand the change. In the world that he envisages, is it intended that every single GP consortium will take its own decision about which drugs it is willing to fund? If that is the case, will it be about every single individual drug or treatment? And, if that is the case, can the Minister explain how he will protect patients from the uncertainty and confusion that must arise from a return to a postcode lottery of that magnificence?
Earl Howe
My Lords, currently the NHS is faced with the decision of whether to say in effect yes or no to a new drug at the price that is proposed by a pharmaceutical company. We want to change that so that the price of a drug to the NHS is based on an assessment of its value, rather than pharmaceutical companies being free to set whatever price they choose and expecting the NHS to pay. So value-based pricing, which is the term we have used, will ensure that licensed and effective drugs are available to NHS clinicians and patients at a price to the NHS that reflects the value that they bring. That should get rid of the postcode lottery.