(3 years, 2 months ago)
Lords ChamberI congratulate my noble friend Lady Morris on her wonderful introduction to this important and pertinent debate. Of course, I also send birthday greetings to both her and Vernon, my noble friend Lord Coaker.
On the first day of our being able to go out, 9 April, I took my seven year-old granddaughter to the Hampton Court Palace Magic Garden—I can heartily recommend it as a wonderful day out to all parents, grandparents, would-be parents and would-be grandparents—to meet her cousins, whom she had not seen for a year. I was captivated by a two year-old. I watched her staring in wonder and joy at other children, and occasionally reaching out to prod one who came close by her. Her parents explained that this was the first time she had been in the company of other children for a year and she was too young to remember the last time.
Echoing the remarks of my noble friend Lady Andrews, I thought of all the babies, children and young people who might have forgotten how to play or socialise and have not had the chance to learn over this pandemic. I also thought of all the children and young people who have not been at school with their mates, and of the damage to their mental health, well-being and learning. The mental health of our children and young people will be the subject of my brief remarks today.
I thank YoungMinds and other organisations for their excellent briefings, not only for today but over many years and certainly over the past year. It is important to state from the outset that the crisis in young people’s mental health predates the pandemic. I have a feeling that the Government are attempting to disguise the fact that many of our health and public services were starved and on their knees before we went into the pandemic, and will blame the pandemic, which undoubtedly made things worse, for the short- comings and shortfalls facing us today. The reality is that child and adolescent mental health services were not expanding fast enough to reach pre-pandemic levels of need, let alone current levels.
The former Children’s Commissioner said in her 2021 annual report that, of the over half a million children and young people referred to CAMHS in 2019-20, 350,000 had their referral closed or were still on a waiting list by the end of the reporting period. Waiting months to help a child is just cruel. NHS Providers found that two-thirds of trust leaders said they are “unable to meet demand” for CAMHS, and every leader surveyed stated that demand for children and young people services is much higher now compared to last year.
All the research shows that things are getting worse for our children and young people. For example, in 2017, suicide was the most common cause of death among boys and girls aged between five and 19, at 16% and 13.3% respectively. We do not know the figures for the past year, but I suspect they will show that those rates have not improved.
NHS Digital research reports that, during lockdown, children and young people may be experiencing anxiety, behavioural problems or increased conflict at home. New research has found that 54% of children and young people with a mental disorder said that lockdown has made their life worse. Parents of children with a mental disorder also reported that their child was more likely to be worried about catching Covid-19, or their family and friends catching it. Some young people have been adversely affected by traumatic experiences, including bereavement, social isolation, a loss of routine, uncertainty about their futures and a breakdown in formal and informal support structures. There has also been an increase in domestic violence. So, we have another pandemic before us: that affecting children’s mental health. There is an urgent need for investment. How much will the Government invest in children and young people’s mental health?
I ask the Minister: will the Government support the creation of early hubs, as suggested by YoungMinds in partnership with a range of children’s mental health organisations? They are calling for a national rollout of early support hub models which would ensure that young people in every area across England could access early support for their mental health. We need to train the workforce. We need to invest in the delivery of early support. That is why the Labour Party announced a children’s recovery plan.
In conclusion, we all accepted the parity of esteem for mental health many years ago. We are a long way from realising it. Surely we need to ensure that the well-being and mental health of our children and young people has to be even more of a priority today than it was two or three years ago. Are this Government prepared to deliver the investment and policy to make that happen?
(3 years, 3 months ago)
Lords ChamberIt is our first day discussing the gracious Speech and we have had almost 90 speakers, so the first thing I need to say is “good luck” to the Minister responding to the outstanding contributions and pertinent questions that have been put to him.
I welcome the two maiden speakers. As I expected, my noble friend Lady Blake drew on her huge experience. We are confident that my noble friend will be a huge asset to our Benches and to the House. I am sure that the noble Lord, Lord Lebedev, speaking from the Cross Benches, will gain much from joining the distinguished ranks of outstanding expertise and independence of party alignment that he will find there. I am sure that we will also miss the right reverend Prelate the Bishop of Portsmouth, whose forthright and—if I might say—sometimes progressive views have been greatly appreciated in your Lordships’ House. I wish him all the very best in his retirement.
I am grateful to my noble friend Lord Watson and other noble Lords—my noble friends Lord Winston, Lord Bassam, Lord Monks, Lady Morris, Lady Blower and Lady Massey—for their high-quality and comprehensive questioning of the Government’s education and training proposals, apprenticeship schemes and the lack of an employment Bill in the Queen’s Speech.
I realise that lumping together the economy, business, health and education in this debate is the Government’s idea of playing to their theme of levelling up, mentioned by many noble Lords. The problem is that the levelling-up agenda seems to be faltering and to be inconsistent; it is jargon without substance. Will it really tackle the inequalities of our country—the inequalities of race, poverty, distribution of wealth, and gender—and the sorts of problems that my noble friend Lady Lawrence outlined? Is it the case that Downing Street briefings suggest that financial constraints mean that it will be impossible to deliver?
Indeed, there is no doubt that this crisis has pulled back the curtain on the Conservatives’ insecure economy. It did not create opportunities for people across the country and left us badly exposed to the virus. We have had one of the worst death tolls in Europe and, while Covid has closed much of our economy, as my noble friend said, the Conservative Government have crashed it. This has been recognised by the OBR, which believes that a short-term initial recovery will quickly revert to the sluggish GDP growth of recent years, with an unemployment level that might reach 6.5%.
I was confident when I saw that my noble friends Lord Davies, Lord Eatwell, Lord Haskel, Lord Triesman and Lord Hain were all speaking today that they would be putting the important questions to the Minister. They certainly have, by saying that the only way to get the public finances back on to a firm footing is to secure the economy and get Britain on the road to recovery. I think my noble friend Lord Eatwell summarised in five minutes what the Government need to do.
Does the Minister agree that transforming social care must be treated as an economic priority, because the sector is as much a part of the economic infrastructure as roads and railways? The Labour Party recognises this, as does the US President, Joe Biden, who has included an investment in home care as part of his post-pandemic infrastructure plan. Will the Government do the same?
The Government’s sticking-plaster approach to supporting businesses has left firms hanging by a thread. Will the Government stand by their commitment to do “whatever it takes” to help businesses and workers through this next phase and recovery? Part of doing so involves the contents of the public procurement reform Bill: reforms to public procurement to help SMEs get better access to government procurement, which is absolutely right. Can the Minister guarantee that social enterprises, mutuals and co-operatives will not be excluded from this legislation and that due regard to social value regimes will be there?
I will pick up on a point made by my noble friend Lord Haskel about free ports. It appears that the Government have made a catastrophic blunder by signing trade agreements with 23 countries which include clauses that prohibit manufacturers in free-port zones from securing these perceived benefits. Is this indeed the case? What are the Government going to do about it?
I turn to health and social care—on International Nurses Day. I have, at least once a week while your Lordships’ House has been sitting in the last year, praised and thanked our NHS for getting us through the last 14 to 16 months of the pandemic. To our scientists, the volunteers, the auxiliary staff, the porters and those who have delivered the vaccine, we have all registered our thanks. This has been the public sector delivering what we needed it to deliver, in sharp contrast to the appalling waste of public money in the early days of track and trace. I welcome the Prime Minister’s commitment to a public inquiry into Covid.
The test of whether this Queen’s Speech genuinely delivers for the people of Britain is whether it brings forward a proper rescue plan for the NHS and delivers a social care solution, as the Prime Minister promised on the steps of 10 Downing Street almost two years ago. What is the timetable?
I was very dispirited reading the blurb the Government published alongside the gracious Speech, which says:
“The Bill will include provisions to allow us to get much better data and evidence about the care that is delivered locally.”
What nonsense! What evidence? What more evidence do we need that social care needs to be reformed? It sounds like kicking it into the long grass again.
Can the Minister confirm that we will see a draft mental health Bill very soon and it will go into pre-legislative scrutiny? Perhaps he could tell us what the timetable for that will be.
There are so many neglected areas in our health system—for example, dentistry. Millions of people have struggled to access NHS dentistry as the pandemic hit. Will the proposed reforms ensure that both primary and secondary care dentistry will be protected?
Public health, where we need a focus on tackling health inequalities, has been alluded to, but, with the creation of a new body in the middle of the pandemic and the previous 10 years of funding starvation and neglect of what were very effective public health services, can the Minister confirm how much the Government intend to invest to support public health services in the UK? How will they be integrated into the new proposals for health and social care?
Ten years ago, many of us attempted to persuade the Government that the then Health and Social Care Bill—the Lansley Bill—was a bad idea. I was very pleased to see that the noble Lord, Lord Owen, was in his place today, because he joined us in trying to persuade the Government to change their mind on that Bill. Well, we told you so. The promised NHS Bill has at its core the reversal of key aspects of the Lansley Act. The cost, both monetary and in terms of wasted opportunity, runs to many billions. The NHS must not repeat this waste—so why a Bill now? The noble and gallant Lord, Lord Stirrup, and my noble friend Lady Donaghy said it. Why is the NHS Bill being presented when recovery from the pandemic must have priority? It is far more important that the NHS recovers from Covid, that there is a solution to social care, that we invest in mental health, that we repair the destructive break-up of public health and that we have a sensible long-term workforce plan—to name just five priorities that must be ahead of reorganising the NHS. However, we can agree that competition for care services does not work and has not worked in the interests of patients, staff and often even the providers of care—so good riddance to that.
As my noble friend Lord Hunt said, there are some serious challenges in the White Paper proposals, with a complexity and multiplicity of bodies involved in planning and commissioning. Almost nothing is said about the vital role of patients, carers, families, voluntary organisations and communities in shaping how services are provided. This is a major weakness.
We can all agree that integrated care is better than disintegrated care, but structures alone do not produce integrated care. A culture change, robust accountability and strong governance—these will be what we examine when the Bill reaches your Lordships’ House. We will be strong in our scrutiny of how the new provider selection regime is set out in statute and guidance. It must eliminate pointless competition while not making crony contracts and outsourcing easier.
The new regime must bring total transparency, with no commercial confidentiality nonsense. The cost of doing business with the NHS should be to be a decent employer and a taxpaying and honest organisation. My noble friend Lady Bakewell flagged up in her speech the dangers we face here.
I look forward to the Minister’s response, but I ask that his noble friend the noble Lord, Lord Bethell, might address some of the questions he might not be able to.
(4 years, 5 months ago)
Lords ChamberMy Lords, I thank the Minister, the noble Baroness, Lady Berridge, for opening this debate and I welcome her to her new role. As ever on International Women’s Day we have had a treasure trove of a debate, with the diamond in the middle of the maiden speech of the noble Lord, Lord Ranger. You know what they say about diamonds. The noble Lord brings to the House a wonderful, interesting and unique experience, which I think we will all find most valuable as time passes.
I realise that the Minister will tell us when she sums up this debate—I wish her good luck in doing that—about the great record of this Government in their support for women in many different ways, because that is her job. Indeed, she can be proud of their record compared with that of previous Conservative Governments over many years who voted against any equality legislation. I hope that she will also reflect on the many accounts we have heard today of the challenges that women in the UK face. This is a rich, civilised country with mostly enlightened views on equality and discrimination, but there is still some way to go.
I start by thanking my noble friends Lady Gale, Lady Bryan, Lady Donaghy, Lady Prosser, Lady Wilcox, Lady Nye, Lady Healy, Lady Osamor, Lady Crawley, Lady Goudie and our honorary sister, my noble friend Lord Young, for great contributions and for showing the deep, broad and very practical equality traditions of the Labour movement, going back to the match girls, the Durham women, the Grunwick women, the Ford women and the parliamentary pioneers such as Harriet Harman and Barbara Castle, of whom we are very proud indeed.
My contribution will reflect on “invisible women”, using the title that Caroline Criado Perez used for her ground-breaking research and publication of that name, which I am sure many Members of the House will have read, or certainly read about. It describes and illustrates the gender data gap and data bias in a world designed for men and allows us to say with some accuracy that we live in a male-dominated world in almost every aspect we care to examine—culture, art, music, science and government.
As we all know, enlightenment and knowledge are the first step along the road to change, so this is not a counsel of despair but a plea to understand and change. I recommend reading this book to those who have not done so; I particularly recommend it to those who make decisions about how to spend money and make senior appointments. As Simone de Beauvoir said:
“Representation of the world, like the world itself, is the work of men; they describe it from their point of view, which they confuse with absolute truth.”
It is important to say from the outset that the gender data gap is not deliberate or malicious; it is the product of a way of thinking that has been around for millennia. Sometimes it is not thinking; it is a gap, an absence, a non-collection of data. I shall relate two examples to illustrate this.
The first one, which we know and are very familiar with, is the issue of who should feature on the new bank note, replacing the only female figure with another man. As we know, Caroline Criado Perez led a successful campaign for that not to happen. In the process, some men got so angry that they threatened her with rape, mutilation and death. Even those men who were more measured in their displeasure showed that they were experiencing anger because even minor female representation was an iniquity. The interesting question is how the Bank of England came to this conclusion. It set up a series of objectives which it said would reflect merit. It set up objective selection criteria—we all read that it said this at the beginning—and said that the person it would choose had to be a key figure from the past, had to have name recognition, had to have good artwork, to be uncontroversial, had to have made a lasting contribution and to be universally recognised and enduring. So it was not surprising that it ended up with five white men on the shortlist. It is a good illustration of the historical gender data gap which means that women are far less likely to fulfil those criteria. It is not that the Bank of England deliberately set out to exclude women—indeed, I hope that it will have looked at its objective criteria and taken a different view.
Another example in the book concerns snowploughs in Sweden. In 2011, a town called Karlskoga in Sweden decided to re-evaluate its policies and practices though a gender-equality lens. One presumably slightly jaundiced official said that at least snow clearing would be “something that the gender people would keep their noses out of.” Of course, that guaranteed that the gender lens would be focused on this essential service. Every year, snow clearing started with the main arterial roads and ended with the clearance of pedestrian walkways, cycle paths and so on. Noble Lords can see this coming: women walk more than men do, we take more diverse routes to work, to schools and shops, while the men were largely driving their cars to work and back again. The outcome was that more women fell over on the snow and ice, broke their arms and legs and hurt themselves. It was shown that snow clearing was in fact not gender neutral at all. It did not cost much to reverse those things, and it is clear that it is much easier to drive through three inches of snow than push a buggy through it. It saved a lot of money, because women were not going to accident and emergency, were not having to be mended and did not have to take time off work. I do not need to go into the detail because noble Lords can read about it.
The most telling matter—it was referred to by the noble Baroness, Lady Rock—is how the missing gender data impacts on a world increasingly dependent on big data: big truths dependent on big algorithms using big computers. If half the data that should be there is simply absent, it will have big consequences. As noble Lords know, I deal with health issues in this House. Gender bias can affect women in countless ways, but the gender health gap is putting women’s lives at risk. Seat belts, head rests and airbags in cars have been designed mainly based on data collected from car crash dummies using the physique and seating positions of men. Women’s breasts and pregnant bodies do not feed into the standard measurements, with the result that women are 47% more likely to be seriously insured and 17% more likely to die than a man in a similar accident.
Medical trials have been found to exclude representative samples of women—including pregnant women, women in menopause and women using birth control pills—which may result in medical advice that is not necessarily suitable for females. Women who suffer heart attacks are dying needlessly because they fail to recognise their symptoms and they receive poorer care. The British Heart Foundation found that, over 10 years, more than 8,000 women in England and Wales died unnecessarily after a heart attack because of inequalities in diagnosis, treatment and aftercare.
Online apps based on data collected mainly from men have also been found to suggest that a woman’s symptoms of pain in the left arm and back might be due to depression, and that she should see a doctor in a couple of days. In contrast, a male user of the app is more likely to be asked to immediately contact his doctor based on a diagnosis of a possible heart attack.
A 2018 study by the University of Pennsylvania showed that women are less likely to receive cardio- pulmonary resuscitation from bystanders during a cardiac arrest. This has been attributed to the fact that CPR training uses only male dummies. Training with female dummies would eliminate fears of causing injury, and the misconception that breasts make CPR more challenging. Verbal memory tests used to detect Alzheimer’s disease disadvantage women. Research in the United States shows that women in the early stages of Alzheimer’s perform better than men in these tests. However, as this difference is not taken into account, the disease is detected later in women, preventing earlier treatment.
As these examples show, when products, medication, training and advice cater predominantly for men or are based on male profiles, terrible things can happen. Tackling the entrenched gender divide in health is key to saving lives, by ensuring that essential products and services meet the needs of both women and men. This is about women stepping out of the shadows and claiming their data and presence, and increasingly I think we will see that this will make more progress.
I would like to end by thanking everyone who has spoken in this debate. I note that we had nine blokes taking part, which is more than usual and might be a record; I welcome that and thank every one of them. As my noble friend Lady Gale said at the outset, the Government need to take further action to move towards equality. My noble friend asked many questions; many noble Lords have asked questions. What they have showed is that we have come a long way, but we still have some way to go.
(5 years, 6 months ago)
Lords ChamberMy Lords, I have great sympathy with Amendment 81 in the noble Lord’s name. It struck me, as a former Member of the Scottish Parliament, that one result of our leaving the European Union will be that we have, in effect, a single market within the United Kingdom, while, for the implementation of trade agreements, some elements of those agreements will be under the auspices of the devolved Administrations. Therefore, if it comes to compliance, the body that has entered into the agreement with the third country will be the United Kingdom if the United Kingdom Government are also a regulatory body to the devolved Administrations for areas for which they have executive and legislative competence. That is potentially an uncomfortable situation. There is merit, therefore, in considering how the United Kingdom might have, in effect, the equivalent of the European Commission. What will be the bodies that operate across the United Kingdom that will consider compliance with trade agreements? It sits uncomfortably if the UK Government are that body when it comes to the component parts of the UK that have both ministerial and legislative competence for those.
Turning to my Amendments 52 and 60, one of the issues concerning what the Government call continuity agreements, which they are seeking, is that they might not just be temporary rollover agreements: they might last a long time. They will be treaties in their own right which, by definition, will be permanent, but the regulations that come with them to translate them for ratification could well be permanent or, at the very least, operate for three-year terms, which could be indefinite if they are renewed. On the point that the noble Baroness, Lady Neville-Rolfe, made about a five-year period, the option I have put forward is that, in advance of Parliament being asked at the end of the initial three years about the impact on the United Kingdom, before decisions have been taken on whether they should be renewed or whether the Government might seek to go back and consider the contents of those agreements, that is the appropriate time for reporting to be carried out. Therefore, it is important at that stage, in advance of the end of the initial three-year period, that a review is carried out of the impact on the UK and specifically on the nations and regions. We know from both Governments’ data, information from the devolved Administrations and academic research that trade deals with countries that have a particular bias in certain sectors affect some parts of the United Kingdom more than others, whether car manufacturing in the north-east of England or food and drink in Scotland. Therefore it is very important to specifically mention the nations and regions.
It is also important, as suggested in subsection (2) of my proposed new clause in Amendment 52, that we have a means by which we can test what has been said repeatedly—that we could trade with those countries better if we were not part of the single market than if we had continued to be part of it.
Amendment 60 looks forward to any proposed future trading relationship between the UK and the EU and its impact on the British economy. I hope that the Government will be sympathetic to this amendment because it has already been agreed in principle to publish modelling of what the impacts on the British economy would be for some of these areas, even if—and this is the most charitable way of describing it—the Government had to be persuaded to publish this information rather than allowing MPs to enter a darkened room to study it in private. Now that this information is out in the public domain and the principle is there, economic modelling of the impact of our relationship with the EU, depending on the way forward and the options taken on that trading relationship that are to be negotiated, is very important. After last night’s vote in the House of Commons, it is even more important, given that whatever alternative arrangements are considered which have an impact on our future trading relationship, we will need to know what kind of impact they will have on the British economy and its different parts.
Regardless of that, it is necessary now for us to consider what architecture we put in place to consider the impact of our trading relationships with countries around the world on the different parts of the United Kingdom and then on the United Kingdom as a whole. It will be even more important given that the European Union has been and will continue to be our biggest trading partner, so that we do not repeat the process we have had over the last two years and try to reverse engineer what the likely impact will be. We are starting to establish some of that framework now, which is why Amendment 60 has been tabled. I hope that the Government will be sympathetic to it. If it is not accepted in this precise language, I hope that the Minister may be able to present in some form of language that there will be consideration of the architecture of how we look at the economic impact across the UK of the future relationship with our biggest trading partner.
My Lords, I will intervene on the Bill, which is not my normal territory, although I have 20 years’ experience of working on equalities issues in your Lordships’ House. I will speak in support of Amendment 32, in the name of my noble friend Lord Stevenson, which requires the Government to lay before Parliament a qualitative and quantitative assessment, after five years, of the impact of new international trade agreements on human rights standards and people with protected characteristics under domestic equality law, among other things. It also provides transparency on the impact of such agreements on fundamental rights. As far as I can tell, the UK Government are a party to all the bodies mentioned in this amendment, so this should not be an issue and there should be no question about it. I should like some assurance from the Minister that, over the next five years, we will comply with all these international treaties on human rights and equalities.
I agree with noble Lords who said that compliance with equalities has to be judged by an independent body—I certainly know that. It should not be judged by the Government themselves. I thank the Equality and Human Rights Commission for its briefing on this subject. Its concern is that we,
“retain the UK’s equality and human rights legal framework as we leave the EU”,
and we ensure that,
“the UK remains a global leader on equality and human rights”,
after we leave the European Union. That is consistent with the UK being an open and fair place to live and do business. Certainly, if the Government do not accept the length of this amendment, I hope that they will accept the spirit of it, and that that will be expressed at the next stage of the Bill.
My Lords, I also have sympathy with the concept of impact assessments. After all, they will apply equally to rollover agreements and future trade agreements, so it is perfectly appropriate to raise this issue and discuss it at this stage of the Bill. I also agree that it is important to have an independent body and not the Government themselves as a monitoring body, and that there should be arrangements to cover all parts of the United Kingdom equally and fairly. I am persuaded by the argument for simplicity in all this; therefore, I support my noble friend Lady Neville-Rolfe’s amendment in particular. There is a danger in making lists, because they can become out of date.