Economy: The Growth Plan 2022

Baroness Tyler of Enfield Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, the last couple of weeks have left me bewildered but also angry. Frankly, the Chancellor’s “fiscal event”—the most significant Budget, in terms of size of new commitments, in 50 years—demonstrated a staggering lack of understanding of how markets work. By contrast, the energy crisis relief package had been trailed and, rightly, broadly welcomed, but—and it is a big but—failing to get the energy companies to carry a fair share of this through a windfall tax contribution was a major missed opportunity.

As we have heard today, the totally untrailed and completely unfunded £45 billion package of tax cuts—including for the highest earners, the banks and large corporations—spooked the markets and angered voters across the country. It also created the clear impression that the Government were not interested in wealth and income inequalities and that tax cuts for the well off were being privileged over support for those on low and modest incomes. I also find it odd that there has been very little focus so far today on how the freeze on income tax thresholds means that many households will not see any savings from the 1p cut to income tax. None of this remotely passes the “Does it feel fair?” test that I think is so important to the British people.

In short, as we have heard, this extraordinary package caused sterling to plunge to an all-time low, caused gilt yields to rocket and caused mortgage rates to rise by more than two percentage points. The Bank of England had to make a £65 billion emergency intervention to prevent major pension providers becoming insolvent. To calm markets further, the Bank of England was also forced to indicate that it would be making a major rise in interest rates in the short term. The housing market was badly hit. The severity of the markets’ reaction demonstrated also that they were, to say the least, unimpressed with the Chancellor sacking his Permanent Secretary and sidelining the OBR, thereby evading appropriate challenge, transparency and accountability.

In the middle of a devastating cost of living crisis, voters were left with severely increased levels of anxiety and uncertainty. Would they be able to make their new mortgage payments? Would they be able to buy the new house they had been dreaming of? The IMF issued a rare and brutal criticism of the Chancellor’s measures. The world’s Governments and media speculated that the UK was fast becoming a failing economy.

The Government’s response was, again, extraordinary. It sought to lay the blame for the entire meltdown on Putin. It claimed there was no meltdown. The PM finally admitted “communications issues”. This was not a case of communications weaknesses; this was a case of the Prime Minister and the Chancellor demonstrating their complete lack of understanding of how markets work and their total lack of empathy with the major concerns and anxieties of voters.

Following the welcome but humiliating U-turn on the scrapping of the top rate of income tax, the Government now have to decide whether working-age benefits stay in line with inflation. This will be another major test of their sense of fairness and what sort of society we are. Anything less than uprating these benefits in line with inflation will lead to untold anxiety and suffering among the most vulnerable, particularly those caught by the poverty premium, whereby those on low incomes pay more for essential products and services, such as energy. At the same time as the Prime Minister seeks to blame all her problems on her newly invented anti-growth coalition, NHS nurses are skipping meals in order to feed and clothe their children, with many hospital trusts now having to offer food banks to their staff.

I am pro growth and in favour of improving productivity—frankly, most people are, whether or not they live in north London—but it does depend on how the fruits of growth are used, who benefits, and how sustainable that growth is. I believe that the ultimate goal of public policy should be how GDP contributes to individual and societal well-being and becoming a better, greener and fairer society. Sadly, I hear precious little talk of such things coming from the Government.

Independent Adviser on Ministers’ Interests

Baroness Tyler of Enfield Excerpts

Thursday 16th June 2022 Lords Chamber

[Lord True (Con)]

My Lords, first, the Prime Minister has set out the reasons in the specific case to which the noble and learned Lord may be alluding: the fixed-term penalty notice and why he did not think that was a breach of the Ministerial Code. That has perhaps been the focus of most of the criticism. The fundamental position is that the constitutional position in this country is that the Prime Minister is responsible for the appointment of Ministers and the holding of office, and that is where accountability of the Prime Minister lies: first, to Parliament and secondly to the people. There is accountability, my Lords.

[Baroness Tyler of Enfield (LD)]

We read in the press today that it was indeed a trade issue that finally pushed the noble Lord, Lord Geidt, over the edge rather than partygate. Indeed, it was said at one point this morning that it was to do with commercially sensitive measures that would lead to a

“purposeful breach of the Ministerial Code”.

Is the Minister able to cast any light on this?

[Lord True (Con)]

The letter from the Prime Minister alluded to this. Noble Lords will see from the details in the letters themselves that they allude to commercially sensitive matters, so, clearly, I cannot get into further detail beyond what is set out in the letters: you have the Prime Minister’s words. But I draw your Lordships’ attention to the fact that the Prime Minister was seeking guidance on the Ministerial Code in this particular instance.

UK Cash Network

Baroness Tyler of Enfield Excerpts

Monday 8th November 2021 Lords Chamber

[Lord Agnew of Oulton (Con)]

My Lords, the Government’s consultation set out proposals for the Financial Conduct Authority to become the lead regulator for oversight of the retail cash system, including having responsibility for monitoring and enforcing new legislation and cash access requirements. In adopting this approach, the Government intend that the Payment Systems Regulator and the Bank of England continue with their existing functions with regards to cash. Co-ordinated actions by the FCA and PSR on cash as part of the Covid response have shown that joint working between the regulators at both strategic and operational levels is working.

[Baroness Tyler of Enfield (LD)]

My Lords, following on from the questions from the noble Lords, Lord Hunt and Lord Tunnicliffe, will the Government commit to giving the Financial Conduct Authority responsibility to start tracking trends in cash acceptance levels among UK businesses to help understand what action might be required to prevent that problem worsening? Separate from the legislation—it will be great to get a timetable for when it will be introduced—what specific measures will the Government take to ensure that people, particularly those who rely on cash, can continue to use cash to pay for goods and services?

[Lord Agnew of Oulton (Con)]

My Lords, as part of the FCA’s role in monitoring and enforcing cash access, the Government consider that it should be given responsibility for ensuring that access points provide reasonable access. In terms of recent activity, since the passing of the Financial Services Act, retailers now have the ability to offer cashback without purchase—I think it was from 29 June—and we are already seeing some take-up of that. Indeed, PayPoint, which operates terminals in several thousand outlets across the country, has committed to provide that extension to its service.

Health and Social Care Levy Bill

Baroness Tyler of Enfield Excerpts

2nd reading & Order of Commitment discharged & 3rd reading
Monday 11th October 2021 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I declare an interest as a close family member is a long-term care home resident. Before turning to the specifics of the Bill, I will make a few general points about reform of social care, as others have done.

First, as well as looking at how the money is raised to provide a cap on social care costs and a more generous means test—as we are today—we must consider how we can best shore up a fragile and highly fragmented sector reeling from the impact of the pandemic, increased costs and low occupancy rates, with some care homes becoming increasingly financially unviable. Immediate funding is needed to improve the quality of care and introduce minimum standards for care homes.

Secondly, we urgently need a new deal for the care workforce, with action on pay, training development, career progression, professionalisation and recognition. In my view, care staff, who have given so much during the pandemic, deserve to be paid well above the minimum wage. Thirdly, and as the noble Lord, Lord Forsyth, pointed out, half the adult social care budget is spent on working-age adults—often people with learning disabilities—many of whom do not own their own home. So framing this whole social care debate in terms of trying to prevent older people having to sell their homes is only one part of a much bigger picture. Finally, the social care sector is complex and little understood, with both large and small providers providing both domiciliary care and care in care homes—something I hope I can expand on when we have our debate on Thursday.

The Bill takes forward the Government’s decision to introduce a new tax to pay for social care, beginning as a 1.25% rise in national insurance from next year and then becoming a separate tax on earned income from 2023—the levy. It is estimated to raise £12 billion per year.

As others have already said, raising this money primarily from national insurance is regressive, falling disproportionately on the young and low-paid. While I welcome the fact that the levy will be payable on dividends and pension earnings, which is a step forward, there is no getting away from the fact that this tax will impact hardest the lowest earners and youngest, as the noble Lord, Lord Hunt, said, as well as hammering small businesses. The threshold for paying national insurance contributions is lower than the income allowance threshold, so a worker has to earn only £9,560 to start paying NI contributions, as opposed to £12,570 for income tax. The rate paid on national insurance falls as earnings increase, in contrast to the more progressive structure of income tax.

As well as its regressive nature, national insurance is levied only on earnings and not on unearned income, so those in work contribute more. In addition, increasing national insurance increases the tax gap between employees and the self-employed, and the gap between the tax that people pay on their employment income and the tax that they pay on income from renting out property. Those last two points were compellingly covered by the noble Lord, Lord Macpherson.

None of this feels fair to me. As Paul Johnson, director of the Institute for Fiscal Studies—much quoted already in this debate; I hope he is listening—has said previously:

“Funding social care just from national insurance would be very inequitable.”


He pointed out that the levy on employee earnings and employer wage costs, despite applying to working pensioners and running alongside an increase in tax rate dividend—we do not know what that will be yet—remains

“a tax which will be overwhelmingly borne by workers with very little coming from pensioners.”

That is a serious concern.

We already know that the vast majority of the money raised will go to the NHS, including £5 billion for healthcare in the devolved nations, to increase capacity and help with the backlog of treatments built up over the pandemic. Of course that is much needed, but it leaves only £5.3 billion to be allocated to social care, and the bulk of that—£2.5 billion—will fund the cap on lifetime care costs. Ultimately that leaves, by my calculation, some £2.8 billion over three years for social care reform, which is so much lower than many respected commentators, such as the Health Foundation, have said is needed. Indeed, a total reform package which included investment to improve access to social care, paid workers decent wages and enabled providers to deliver higher-quality care is estimated by the Health Foundation to cost about £12 billion, as the noble Lord, Lord Hunt, said. That sounds a lot but, to put it in perspective, it represents about a month’s NHS funding or 0.6% of GDP.

Now that the Government have finally published their proposals for social care, it is time to start the long-overdue cross-party talks that have been promised for years to bring on a proper, long-term, sustainable solution that ensures that everyone gets the quality care they need, which this short-term fix clearly does not. For me, nothing should be off the table in those long-term cross-party talks; they should certainly include looking at other sources of income and wealth. It seems illogical that income from property rental is excluded, so we end up with a situation whereby a relatively low-paid pensioner earning a little extra to help make ends meet will end up paying national insurance, whereas a property owner receiving a good income from rent will pay nothing, a point made by the noble Lord, Lord Eatwell. To throw in another idea, how about taxing the IT giants in the digital economy—the Facebooks and Googles of this world—so that they can start making a proper contribution to health and social care?

I have long believed that we should look for a long-term solution through the prism of intergenerational fairness, in which all generations contribute but no one generation is impacted unfairly. That will be vital to ensure greater buy-in across the generations. Although it may be a bit out of fashion, I have always sympathised with the recommendation of the Barker commission back in 2014 that the over-40s pay an additional national insurance contribution earmarked for adult social care. However, proper cross-party talks involving a wide range of stakeholders are far more likely to come up with a long-term funding solution that sticks, rather than being a political minefield in every general election.

This is a deeply flawed Bill which fails to set out a plan to fix the crisis in social care or improve pay and conditions for social care workers. Only a small proportion of the money raised will go to social care over the next three years, and even that is not guaranteed. It is deeply concerning that there is no commitment that Parliament will get a vote on the social care plan when it is finally published before spending the money it raises.

I end by asking the Minister to explain more convincingly than I have heard so far why the Bill was brought forward before details of the Government’s social care reform plans for England have been published—which is very much the wrong way round, as many other noble Lords have said. Can he also clarify whether the cap on lifetime costs will be available only for those starting care from 2023—that is, it will not apply to those already in the system? If that is the case, it strikes me as very unfair.

Covid-19 (Public Services Committee Report)

Baroness Tyler of Enfield Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, it has been a pleasure and a privilege to serve on the Public Services Committee under the exemplary leadership of the noble Baroness, Lady Armstrong. I too thank our excellent committee staff.

Our first inquiry offered a unique opportunity to examine the state of public services in response to the pandemic, to acknowledge the positives, the amazing innovations to meet the Covid challenges and the incredible dedication of front-line workers, and to identify what needs to change as part of a major programme of public service transformation.

As we have already heard, the committee identified a number of fundamental weaknesses which must be addressed to make services resilient enough to withstand future crises. These included insufficient support for prevention and early intervention, overcentralised delivery of public services, poor communication from the centre, a tendency for service providers to work in silos and a lack of integration, especially in services working with vulnerable children and between health and social care. None of this is new—indeed, it will be depressingly familiar to many in your Lordships’ House—so why has it proved so difficult to move the dial: inertia, lack of political will or not?

As we have heard, the committee identified a number of key principles for public service reform which will require a fundamentally different mindset. I highlight just three: first, the vital role of preventive services in reducing the deep inequalities that have been exacerbated by Covid; secondly, central government and national service providers radically improving how they communicate and co-operate with local-level service providers; and, thirdly, the much-needed integration of services—the joining up of the silos—which is best achieved by public service providers working together, certainly at the local level but, critically, supported by joined-up working across government departments at the national level.

Other noble Lords have already highlighted the importance of preventive action. One of the report’s key recommendations was that an approach to public health that focused on preventing health inequalities would pay real dividends by increasing the resilience of communities and reducing the pressure on the NHS when a crisis occurred. The committee heard that many deaths from Covid could have been avoided if preventive public health services had been better funded. Therefore, I am disappointed that the Government have not committed to publishing a public health strategy to reduce health inequalities to fulfil their 2019 general election manifesto commitment to

“extend healthy life expectancy by five years by 2035”.

I join other noble Lords in asking the Minister when the Government intend to set out their plans for doing this. What assurances can he give that the Health and Care Bill will place clear duties on integrated care boards to reduce health inequalities, with sharp lines of accountability?

On the lack of integration between health and social care, our conclusions were stark. They were that

“the Government’s own pandemic planning … identified that social care would need significant support during the outbreak of a disease like COVID-19, yet social care was the poor relation to the NHS when it came to funding”

and allocation of PPE during the first lockdown. Discharging people from hospitals into care settings without testing and with inadequate PPE led to the tragic loss of the lives of thousands of older and disabled people. Our evidence suggested that the failures in adult care resulted from insufficient planning coupled with years of underfunding. The Nuffield Trust told us that although the Government’s 2016 pandemic planning exercise, Exercise Cygnus, had shown that care homes and domiciliary care

“would be in need of significant support in a pandemic”,

no advance arrangements were put in place to meet those needs. It concluded that integration between health and social care hinged on reform in three key areas: first, parity of resources; secondly, equal visibility and priority in policy-making, and, thirdly, commitment to better data collection and sharing. These things lie at the very heart of the report’s findings.

A further key issue revealed in our excellent international evidence, already referred to by the noble Lord, Lord Young, was on health system resilience—specifically, the need to build in spare capacity rather than have the NHS run continually at red-hot levels of bed occupancy. It was salutary to learn that the UK has 2.7 hospital beds per 1,000 of the population, compared to an EU average of 5.2—far lower than Germany with 8.2 and France with 6.2.

The committee produced 41 recommendations for government, including recognising the vital role of preventative services and early intervention and committing to interim funding to ensure that adult social care gets sufficient support to protect older and disabled people in any further waves of coronavirus and future pandemics. In short, it came up with a comprehensive agenda for change to address the systematic weaknesses revealed by the pandemic to deliver lasting and transformative reform.

Being charitable, as I like to be, I can only describe the Government’s response as lacklustre. While they largely agree with the committee’s main conclusions—it would be hard not to—their response contains very little detail on how or whether they plan to address its recommendations. It is, to say the least, disappointing that after tantalising rumours in the press that the PM is finally going to bring forward his proposals to reform adult social care before the Summer Recess, they appear to have been relegated to the long grass again.

Covid has been a serious wake-up call for this country and particularly for the way we plan and fund our public services. There really is a chance to build back better if the Government are prepared to do things differently and invest in the areas highlighted in this report.

Government Departments: Non-Executive Directors

Baroness Tyler of Enfield Excerpts

Thursday 1st July 2021 Lords Chamber

[Lord True (Con)]

I certainly agree with the noble Baroness that conflicts of interest should be clear and prevented. At the time of the appointment of the person to whom she referred, there was no evidence of any conflict of interest. The former Secretary of State, who strived hard to serve the country, recognised that he did wrong and he has left the Government, as has Ms Coladangelo her appointment.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, there is a large variance in the number of non-execs sitting on departmental boards. While some difference is to be expected between smaller and larger departments, the fact that BEIS, which has a policy lead for corporate governance and so should know something about well-functioning boards, has only two while the Home Office has a staggering eight seems extraordinary. Can the Minister explain the rationale for this difference and why the Home Secretary needs so many NEDs, paid for by the public purse? Can he also explain what central guidance exists on this point and who oversees numbers at the centre of government?

[Lord True (Con)]

My Lords, I notice that there is a difference in numbers, but I could not comment on the specific motivations in appointments by Secretaries of State. There is corporate governance and a code of conduct for board members of public bodies in relation to their behaviour and their political role or otherwise. I can only repeat that the appointment of non-executive board members, who I think play an important role inside government—I pay tribute to the very large number who contribute every day to the betterment of government—is a matter which is subject to ongoing review.

EU-UK Trade and Cooperation Agreement

Baroness Tyler of Enfield Excerpts

Friday 8th January 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, last January the Prime Minister told MPs that there was

“no threat to the Erasmus scheme.”—[Official Report, Commons, 15/1/20; col. 1021.]

What a difference a year makes. In our debate last week, many noble Lords voiced concerns about the absence of a two-way exchange scheme, its funding base and the loss of opportunities to young people, particularly those from low-income backgrounds; and about the effect on our international reputation for keeping to our word. I share those concerns and wish to ask the Minister some further questions.

First, what practical steps have the Government taken to ensure that UK universities can continue to receive incoming Erasmus students from the EU as they export UK Turing students? Have they agreed this with the EU? Secondly, what assessment have the Government made of the impact of withdrawing from Erasmus in terms of the numbers of EU students studying in UK universities and on the local economies of university towns and cities? Thirdly, could the Government confirm that the £100 million promised for the Turing programme is an annual commitment? How many years do the Government commit to this level of funding? Is the £100 million a budget increase or decrease on a like-for-like basis? Finally, what negotiations have the Government had with the Turing Trust and the Turing family about the use of the name, and what was their reaction?

Brexit has happened, something I profoundly regret. Those of us who believe in the European vision have to accept that and work within the new framework in which our nation finds itself. The idea that we should simply move on is deeply flawed. We must maintain the closest possible relationship with our former European partners to help put right some of the self-imposed errors, such as the withdrawal from the Erasmus scheme.

The noble Lord, Lord Heseltine, wrote in the Times earlier this week that

“Brexit is not done: it is a process of change.”


We should not and we must not just move on, as some people would have us do. Like him, I am proud to be a voice for a new, positive and close relationship with Europe as we seek to re-establish our reputation on the world stage.

Income Equality and Sustainability

Baroness Tyler of Enfield Excerpts

Wednesday 6th May 2020 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, in the short time available, it is simply not possible to go into any detail about the measurement of income inequality, which is a complex and contested area. Suffice it to say that, according to the OECD, the UK has one of the highest levels of income inequality in Europe, albeit lower than in the USA.

Of particular relevance to today’s debate, the Resolution Foundation has pointed out that while everyone is feeling the effects of Covid-19, the impact is not equally distributed. Indeed, workers in shut-down sectors such as hospitality and non-food retail are among the lowest paid in the workforce, earning less than half than those able to work from home. There are strong links too with wider social inequalities. Private renters, who already face a great deal of insecurity, are also 40% more likely to work in shut-down sectors than their homeowning counterparts. Key workers, particularly those in health and social care, are more likely to be parents. Indeed, almost 40% of working mothers were key workers before Covid-19 and are much more exposed to health risks. Most starkly, earners in the bottom half of the earnings distribution are twice as likely to be key workers and 2.4 times as likely to work in those shut-down sectors. These are our fellow citizens, who are bearing the economic brunt of the crisis.

From a well-being perspective, those who are most likely to be back at work in a reopened economy—those who may not have the option to work from home—are also those more likely to be on a lower income, at risk and in need of assistance; for example, with childcare. I join others in calling on the Government to start framing policy responses to Covid-19 through the lens of well-being, which can help expose the complex multifaceted problems that it presents and the policy trade-offs that will be needed. Inequalities, be they in income distribution, health or well-being more broadly, are erosive of trust and social cohesion—things that we need now more than ever. Policies such as improving job security as well as proposals for a universal basic income must surely come to the fore.

Spending Review: Intergenerational Fairness and Well-being

Baroness Tyler of Enfield Excerpts

Monday 20th May 2019 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what steps they are taking to ensure that issues of (1) inter- generational fairness, and (2) well-being, are properly considered as part of the forthcoming spending review.

[Lord Young of Cookham (Con)]

My Lords, inter- generational fairness and improving living standards are core considerations for the Government’s tax and spending policy. The Government routinely assess the impact of all their policies, in line with the obligations of the Equality Act and their strong commitment to promoting fairness. To fulfil these commitments, the Government will consider carefully the distributional impact of spending decisions made in the forthcoming spending review.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his Answer. Given that the idea of intergenerational fairness is coming ever more under the spotlight, with real concerns that our current younger generation will be the first to experience worse pay, job security and housing prospects than their parents, what specific steps are the Government taking to collect regular data on the intergenerational impact of tax and benefit policies and spending decisions, and to publish a distributional breakdown of the effects of government budgets and spending reviews by age group to allow for independent scrutiny of their long-term sustainability?

[Lord Young of Cookham]

I commend the noble Baroness and her colleagues on the Select Committee on Intergenerational Fairness and Provision for its report. It has just come out and I read it over the weekend. I like the sentence in paragraph 3:

“Policy based on the expectation that future generations will disproportionately pay for present or past consumption cannot be considered just or sustainable”.


I agree with that. One of the ways of reducing intergenerational unfairness is to take further steps to reduce the deficit, and the report explains exactly why it is unfair for any Government to go on borrowing and borrowing and load on to subsequent generations ever higher debt. I hope that that part of the report will encourage support for the difficult decisions that the Government may have to take on public spending.

On the specific question about publishing a distributional analysis of the impact, I understand that that is quite difficult to do. If, for example, the Government decide to spend more money on high-quality childcare, would that score as an advantage for the child, who is getting the benefit of the childcare, or as a benefit for the parent, who would then be able to go out to work or who would not have to pay for that childcare? There are some real issues about definition before we can go too far down the road of identifying a solution along the lines suggested by the noble Baroness.

Health: Parity of Esteem

Baroness Tyler of Enfield Excerpts

Monday 28th November 2016 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I congratulate my noble friend Lord Alderdice on securing tonight’s debate, which provides a timely opportunity to consider one of the most fundamental issues in healthcare today. Efforts to achieve equal value of physical and mental health span many decades. The Royal Commission of 1957, the year of my birth, noted, not quite in today’s language, that:

“Most people are coming to regard mental illness and disability in much the same way as physical illness and disability”.

That was almost 60 years ago.

In recent times there has been a welcome shift in public attitudes towards mental health and a growing commitment among communities, workplaces and schools, and within government, to change the way we think about this issue. As we know, there have been a raft of commissions and taskforces as well as Future in Mind, looking at young people’s mental health, and of course the recent Five-Year Forward View for Mental Health. They have provided many important recommendations on how we can achieve genuine parity of esteem. They have all stressed, as has been stressed tonight, the inextricable link between mental and physical health. What does that actually mean? To help define this, I looked back at the All-Party Parliamentary Group’s very good report last year on parity of esteem. It said:

“What this would mean in practice is that taking a holistic view of an individual’s health (seeing the interdependencies between both their physical and mental health needs) would be the norm”.

Having listened carefully to my noble friend Lord Alderdice, I would add “health and well-being”.

The fundamental question for us is why it has been so difficult to achieve real and sustained progress. I did a quick survey of the scene, and many aspects I did not find very reassuring. As Michael Marmot so powerfully reminded us in his recent book The Health Gap: The Challenge of an Unequal World, people with mental ill health have a life expectancy between 10 and 20 years shorter than people with no mental illness. I am sure we all find that shocking.

Only a quarter of those with mental illness such as depression are receiving treatment, a figure that contrasts with 78% of those with heart disease and 91% of those with high blood pressure. A recent CQC report noted that, when facing a crisis, a shocking 32% of people do not know who to contact out of hours. Indeed, 24% of those who did know said they did not receive the care they needed.

It is not all doom and gloom—there has been some progress. Thanks to the persistence particularly of Liberal Democrats in the coalition Government, the first ever mental health waiting time standards were introduced. This was a real achievement and helped to bring mental health services into line with other NHS services, such as cancer and A&E waiting times. It was a tangible step on the journey towards parity of esteem. However, as the Mental Health Taskforce report earlier this year noted, for first appointments and for the right follow-on support, waiting times are still “unacceptably long”. Only a couple weeks ago, the Education Policy Institute’s report Time to Deliver found that only 18% of areas were meeting the four-week waiting times for routine cases and only 14% were meeting one-week waiting times for urgent cases. The noble Lord, Lord Lansley, drew attention to this lack of progress, and I very much look forward to hearing what the Minister has to say.

A number of factors underpin that lack of progress, and I want to focus first on the problems of funding, both disparity and historical underfunding. To their credit, the Government committed £1.25 billion to children and young people’s mental health over the next five years, which is £250 million a year. Despite that commendable promise, only £143 million was released in the first year and of that, only £75 million was actually distributed to clinical commissioning groups. Even less got to the front line.

As we have already heard, last year, across the board, 40% of NHS mental health providers had their funding reduced, despite NHS England instructing commissioners to increase it. This raises serious questions as to whether funding is reaching the areas where it is most needed, and it highlights the damaging impact of the Government’s refusal to ring-fence mental health funding. I know Jeremy Hunt said that he does not have the power to do that, but frankly, Governments, if they are so minded, can do something about it if they do not have the powers.

It is the same story with the £1 billion announced last year for mental health, much of which does not come on stream until the end of this Parliament. One could be forgiven for assuming that in last week’s Autumn Statement, the Chancellor would have offered a lifeline to mental health services, as well as other areas of health and social care. Instead, the Government found £240 million for the expansion of grammar schools, but not a penny for the NHS.

On a more positive note, the introduction of the five-year forward view included dashboards, an initiative welcomed by the Royal College of Psychiatrists. I, too, welcome them as representing a viable solution to ensuring better accountability and transparency from clinical commissioning groups. Obliging CCGs to publish facts and figures on their spend on mental health and the services they deliver will go some way to addressing the funding disparity, and stop money intended for mental health being siphoned off elsewhere. What is being done to publicise and promote the CCG dashboards, and how will people be able to compare the performance of their local CCG with others in other parts of the country?

Funding impacts on other factors which are also preventing parity of esteem. The mental health sector, in particular, is suffering from recruitment and staff morale problems. As noted in the report of the noble Lord, Lord Crisp, on acute adult psychiatric care, Old Problems, New Solutions, these problems are in part due to disproportionate financial cuts. The same report found an 8% decrease in the number of mental health nurses between 2010 and 2014, while there was a 1% increase in physical healthcare nurses over that period. Given that NHS England estimates that implementing access and waiting time standards will require a 7% increase in the number of mental health nurses by 2020, how do the Government expect to achieve that standard without staffing levels rising?

It is not for lack of ideas, recommendations or reports that progress on parity has been unsatisfactory—nor is it, as many other noble Lords have said, solely about money. There are other, non-financial issues, including cultural issues, and that provides the starting point for the Values-Based Child and Adolescent Mental Health System Commission, which I had the privilege of chairing. Its report, published on 7 November, explores how different values drive deep-seated culture, attitudes, decision-making, practice and behaviour—the invisible drivers, if you like—which can either inhibit or promote a truly system-wide approach to redesigning and transforming services. The report’s 10 recommendations were all about how a more explicitly values-based approach with a shared language could really improve the mental health and well-being of children by focusing single-mindedly on what really matters to them. That report, and the recent report Time to Deliver, by the Education Policy Institute, chaired by my right honourable friend Norman Lamb, had a number of important recommendations. In particular, it proposed that the Prime Minister should announce a national challenge on children’s mental health. Can the Minister indicate how the Prime Minister intends to respond to that recommendation?

In conclusion, we should aim to achieve a healthcare system in which parity of esteem means that mental healthcare is not only as good as physical healthcare but is delivered, as the recent King’s Fund report recommends, as part of an integrated approach to health and well-being, as my noble friend Lord Alderdice so powerfully reminded us this evening.