King’s Speech

Baroness Tyler of Enfield Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, the central theme of the gracious Speech was long-term decisions to change this country for the better, but so very much was missing. I particularly liked the description we heard of it as thin gruel.

As other noble Lords have said, in appropriately trenchant terms, and my key point today, where was the long-awaited mental health Bill? It is beyond disappointing that a new mental health Bill to reform the 1983 Act was not part of the King’s Speech. Coupled with the abandonment of the 10-year mental health plan earlier this year, many in the sector and beyond are now understandably concerned that mental health is no longer a political priority.

I will just give a quick reminder of the facts. A new mental health Bill was a manifesto commitment from this Government in both 2017 and 2019. As we have already heard from the noble Baroness, Lady Watkins, and my noble friend Lady Barker, there is a totally unacceptable disparity between the white population and black and other racial groups when it comes to detention under the Act. This cannot go on. The 2018 independent review of the Mental Health Act, chaired by Sir Simon Wessely, set out very clear recommendations for modernisation, including greater legal recognition of detained people’s treatment choices. The Act simply does not work for children and young people, with many having bad experiences when detained in hospitals. Much time and effort has already taken place to reform the Act, including a White Paper, and a draft mental health Bill introduced last year, which underwent pre-legislative scrutiny, as we have heard, in a Joint Committee chaired by the noble Baroness, Lady Buscombe, earlier this year.

Given all of this, is it any wonder that Sir Simon Wessely expressed his deep disappointment in the summer at the prospect of the Bill being delayed yet again, when, to use his own words,

“we’re so close to the finishing line”?

He added:

“Lots of people have put a lot of work into this. It’s not controversial. Nobody seems to disagree with what we’re trying to do”.


I cannot help wondering whether that is at the heart of its non-appearance.

Can the Minister say when the Government will issue their response to the Joint Committee report and explain what they intend to do in the absence of this much-needed reform? Will the Minister explain precisely why the Government have reneged on their commitment?

The gracious Speech mentions that “record levels of investment” are expanding mental health services. This is of course to be welcomed, but that is only part of the picture. Simply put, the current levels of investment do not in any way match the level of increasing need. Mental health has not received any of the additional funding committed to bring down elective waiting lists. As a result, over 1.2 million are stuck waiting for mental health support and targets contained in the NHS Long Term Plan are slipping backwards on perinatal mental health, children and young people’s services, NHS talking therapies and mental health crisis care. On top of this, there are chronic shortages in the mental health workforce, with 20% of mental health nursing posts currently vacant.

It is welcome that the Government are restating their commitment to deliver on the NHS Long Term Workforce Plan. However, the plan is much weaker on retention measures and fails to address many issues that contribute to high attrition rates across the whole NHS workforce. As others have said, implementation of the long-term workforce plan simply will not work without an accompanying social care workforce strategy. We urgently need a national workforce strategy that raises the status of the social care workforce and ensures that career progression, pay and rewards attract and retain the right people in the right numbers. Can the Minister say if and when the Government will commit to such a plan?

The CQC State of Care annual report, published only last month, received surprisingly scant attention in this Chamber, despite drawing attention to how the combination of the cost of living crisis and workforce pressures has led to what it termed “unfair care”, with longer waits, reduced access and poorer outcomes for some people in accessing health and care services. Most worryingly, it reported that “unfair care” really means that those who can afford to pay for treatment do so and those who cannot face longer waits and reduced access. Research by YouGov shows that eight in 10 of those who used private healthcare last year would previously have used the NHS, with separate research showing that 56% of people had tried to use the NHS before using private healthcare.

As we have heard, smoking is a big contributory factor in health inequalities, particularly for people with mental illnesses. That is why I welcome legislation to create a smoke-free generation by restricting the sale of tobacco and e-cigarettes to children. But other than that, sadly, there was little of real substance to address the difficult and persistent issues facing many babies, children and young people. Although the Speech contained a pledge to

“ease the cost of living for families”,

there was no specific commitment to support the 4.2 million children living below the poverty line. According to ONS polls, the cost of living remains the most pressing issue facing the country, with 89% of respondents reporting it as an important issue. What plans do the Government have to tackle child poverty?

On financial inclusion, we have heard so much about people’s problems and concerns about the cost of living and about their lack of financial resilience. We urgently need clear leadership from the Government, with a national financial inclusion strategy joining up the work of government and industry, and building the long-term financial resilience of the country.

In conclusion, there is simply so much more to do to change this country for the better for all our fellow citizens. This requires a radically new approach.