Queen’s Speech

Baroness Tyler of Enfield Excerpts

Tuesday 15th May 2012 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, the gracious Speech contained a welcome commitment to improve the lives of children and families, and who could disagree with that? There is much that I would like to say about adoption, and indeed other forms of permanency, including life chances for children in care, speeding up processes in the family courts and improving the assessment and support available for disabled children and those with special educational needs. However, I shall save those comments for another day because today I want to highlight the complexity of families by talking about a group who are all too often put in too difficult and unglamorous a box: older people who are unable to look after themselves any longer.

In my experience, family policy often overlooks older people, both as regards the invaluable contribution that they can make to their own families and the wider community and as regards their own care needs if they are to lead a dignified life in old age with the quality of life that we would all wish for ourselves. It is a stark fact that over the next two decades, the number of people aged over 80 is set to double in Britain. That presents major challenges for the way in which public services are delivered, the way our houses, towns and cities are designed and the way in which families organise their lives.

The major shortcomings with the adult social care system are well documented and cause people to be fearful. In brief, the current system is fragmented: there is a postcode lottery; it is extremely variable in quality, confusing and hard to understand; it focuses on crisis cases and high-end needs rather than on preventive action; and, of course, as we have already heard, the funding is unsustainable. Many carers and those needing care find themselves let down by a faltering service and others find themselves having to sell their homes in order to pay for the care that they need. Of the 2 million older people in England with care-related needs, nearly 800,000 receive no support of any kind from public or private sector agencies. As the Health Select Committee stated in its recent report on social care, it comes as a great shock to many people to find that while the care provided by the NHS is free, care services such as help with washing and preparing food at home are means tested, and many will have to pay for them.

Every family in the land is affected by the issue. It is no respecter of class, income, geography or ethnic group. That is why I consider it to be the biggest social policy challenge facing the country. Caring for older people affects everyone in the family—particularly women. Increasingly, families find themselves caring for the needs of three, four and even five generations. This can place a huge strain on those caught in the middle. They may find themselves simultaneously supporting teenage children, looking after young grandchildren and caring for elderly and frail parents or even grandparents—all of this at the same time as being at their most stretched in their working lives. No wonder they are increasingly called the squeezed or sandwiched generation. Of course, it makes the new legislative measures proposed on flexible parental leave and flexible working particularly important.

I welcome the draft Bill announced in the gracious Speech that is intended to modernise the legal framework for social care; it is much needed. I also welcome the commitment to pre-legislative scrutiny. There is huge expertise and passion in your Lordships’ House on the subject and I very much hope that both Houses will be involved in the process. However, the Bill is only one element of the radical overhaul that is needed for the system as a whole. Our goal should be to create a coherent, consistent and comprehensive system of care, with effective strategic planning and commissioning, improved quality of care, substantial workforce development, more choice and personalisation of care, proper information advice—and above all, fair and transparent funding as well as a greater focus on early preventive services.

The forthcoming White Paper, the funding progress report and the draft Bill should be seen and judged as an overall package that needs to add up to considerably more than the sum of its parts. We heard a lot today about the Dilnot report. It is well known to many in this House and widely regarded as an excellent report. It is not the whole answer to the problems I described because its remit was to recommend a new funding system. However, the potential funding framework that it offers is by far the best yet produced. In short, Dilnot provides a framework for a long-term settlement for funding social care—a partnership between the individual and the state. The funding model aims to eliminate the catastrophic care costs faced by some people by capping the maximum amount that individuals contribute over their lifetime, beyond which the state will meet all future costs. By limiting people’s liability in this way it is expected that a market will develop with new financial products so that people can insure themselves against the costs of their contributions.

There are many other very good recommendations in the report, such as national eligibility criteria for services and portable assessments between local authorities. However, I will focus on why it is so difficult to make progress. Some have argued that the Dilnot proposals are too much about protecting the wealth and property of the majority and not enough about targeting help on the most needy. I do not see it that way. I see the Dilnot proposals as being about sharing costs and risks rather than about protecting the wealthy. At the moment, individuals assume all the risks of becoming unwell or disabled or having care needs, especially in old age. People who work hard all their lives to provide for themselves and their families risk losing everything and being reduced to a threadbare existence through simple misfortune.

Of course there is a key concern about affordability. In the current economic climate that is understandable, but it does not preclude the Government committing to key principles governing the future funding framework, including a cost cap, and considering the phased introduction of the cap with its level perhaps recalibrated as economic conditions improve. While those details are being sorted, immediate steps could be taken at modest cost to help people start planning for the future. These include creating a deferred payment scheme and developing comprehensive information and advice services.

In conclusion, I agree with Andrew Dilnot that this is primarily a moral crusade. Future generations will not forgive us if we duck the issue simply because it is difficult—as indeed it is, particularly with the economic climate being so tough. I urge the Government to be courageous and to start embarking on the path now, particularly if a cross-party consensus can be found, and to start a national conversation about the political priority that should be given to this area, and the trade-offs that may be needed in other areas. We owe it to future generations and we must not let them down.

National Well-being

Baroness Tyler of Enfield Excerpts

Wednesday 14th December 2011 Lords Chamber

Asked By

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what steps they are taking to promote and measure well-being and what role public policy should play in shaping national well-being.

[Baroness Tyler of Enfield]

My Lords, I would like to thank noble Lords who have found time in this very busy period to speak in this debate and I hope that it has not been too much to the detriment of their own well-being.

Why would I want to talk about well-being today and why do I think that it is important? We all know intuitively what well-being is but there is as yet no standard definition. There is general agreement from the growing body of social science research that a combination of physical, social, environmental and psychological factors influence well-being. Good mental and emotional health is a crucial element of well-being, but by no means the whole story. A good deal of work has already been undertaken to measure well-being and happiness at community and individual levels. This has demonstrated positive factors, such as good relationships, being employed and being financially secure, along with negative factors such as poor relationships, family bereavement, poor health and unemployment.

Back in 2008 the Government Office for Science’s Foresight report on mental capital and well-being referred to mental well-being as,

“a dynamic state, in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society”.

I think that sums it up very nicely.

Many thinkers, commentators and social scientists are giving the issue of well-being an increasing amount of attention and the idea has started to creep into the mainstream of public policy and political thinking. All three parties are starting to talk about well-being and quality of life, albeit in their own ways and using their own language. I would go so far as to say that it has prompted quite a deep philosophical debate about the central purpose of public policy and indeed government itself. I sense a greater recognition that economic growth is a means to an end rather than an end in itself and that good government is ultimately about improving the lives and well-being of our fellow citizens. But it is undoubtedly a very tough time to be having these sorts of ideas and of course sceptics are bound to view it as a distraction from our very pressing economic concerns.

In November 2010 the Prime Minister announced:

“From April next year we will start measuring our progress as a country not just by how our economy is growing, but by how our lives are improving, not just by our standard of living, but by our quality of life. We’ll continue to measure GDP as we’ve always done, but it is high time we admitted that, taken on its own, GDP is an incomplete way of measuring a country’s progress”.

He added—and I give him all due credit for doing this:

“To those who say that all this sounds like a distraction from the serious business of government, I would say that finding out what will really improve lives end acting on it is actually the serious business of government”.

The practical outcome is that the Office for National Statistics has been tasked with consulting on the development of new well-being measures that cover the quality of life of people in the UK, environmental and sustainability issues, as well the economic performance of the country.

Well-being clearly depends not just on the circumstances of people’s lives but on how they interpret and respond to those circumstances. Recent welcome policy initiatives, such as the promotion of emotional resilience among children in schools and the expansion of psychological therapies focus, on which I am sure we will hear more from the noble Lord, Lord Layard, all rightly recognise this. On the bright side, the very recent ONS statistics, which came out in December, found that around three-quarters of adults in the UK rated their own life satisfaction as seven or more out of 10. These findings also found that having a partner and being in good health were positively associated with life satisfaction. Some people considered these results surprisingly positive, given all the doom and gloom around, and it sparked the inevitable quips about the usefulness of what has been dubbed the “happiness index” from various quarters. Next year we will have much richer data when the ONS has the results from the full 200,000 households that are currently being surveyed.

I believe that a single national measure of well-being should help generate a national debate about what really matters to people. “If you treasure it, measure it” is a good adage. It will be relevant to government, of course, but also to employers, the media, the producers of consumer goods and many others involved in our national life. Others are calling for a wider set of indicators that local communities can use to measure their population’s well-being against other communities. Given the general thrust towards localism, this has much to commend it, and I would be very interested to hear from the Minister what he thinks on this.

There is much evidence, to which I have alluded, about what is important to well-being. It includes income, loss of income, unemployment, being able to do interesting and stretching work, the number of hours worked, commuting, consumption decisions, debt, being able to walk around the local neighbourhood, being able to participate in community activities, volunteering and trust in local institutions. It is a very long list. I do not have time to go through it in any detail here. Evidence shows a clear relationship between levels of well-being and inequality when different countries are compared. Well-being tends to be lower in countries with higher inequality of income and wealth. It is important to understand that. Equally, in terms of what drives well-being, evidence from surveys and research is quite consistent about what matters most in people’s lives. Individuals across nations and social classes put more value on non-monetary assets than on their financial situation. Indeed, quite often in surveys the biggest factors by far that influence people’s happiness are their family relationships and their relationship with their partner.

Turning to the workplace, Dame Carol Black’s review of the health of the working-age population in 2008 identified business as a key partner in promoting or otherwise adult health and well-being across Britain. According to that review, the annual economic costs of sickness absence and worklessness associated with ill health and well-being were over a staggering £100 billion, which is greater than the annual budget of the NHS.

Where does all this lead me? I would like to draw three conclusions. First, well-being should be a key political priority, as it encompasses the things that are most important for our society as a whole and to us as individuals. While prioritising well-being includes ensuring that we have a stable and thriving economy, it crucially also takes a much broader view of success than can be measured in just economic terms.

Secondly, we should warmly welcome the fact that the UK Government are now measuring people's subjective well-being in a substantial and meaningful way. I think it is important that we keep a cross-party consensus going on the importance of this. Thirdly, we need to move rapidly from measurement to action. Measurement on its own achieves very little, so it is essential that we reshape the processes of policy development, implementation and evaluation to take well-being into account as soon as we can. There are some encouraging signs here, with the Cabinet Secretary, Sir Gus O'Donnell, already ensuring that guidance for policy-makers is being updated so that well-being is taken into account. That includes the Treasury Green Book, which will be well known to some, and the setting up of the Social Impacts Task Force within government. Taken together, I very much hope that these measures will finally lead to that holy grail of truly joined-up policy-making in Whitehall. I know from many years’ experience in Whitehall how very difficult that is.

I welcome this focus on practical action. Nowhere is this more important than in family policy and the services available to support families and children, including help with parenting. We heard recently from the 2011 UNICEF child well-being report that British parents often feel stressed and lack the time or, indeed, the confidence to build a strong nurturing relationship with their children and family. Sometimes that gap is filled by a focus on material things and consumer goods. The message from children themselves was clear. Their well-being centred firmly on being able to spend time with a happy family whose interactions with them were consistent and secure, having good friends and having plenty of things to do outside the home.

That is why I think that personal, social and health education, focusing on the importance of relationships, is so critical and should form part of the core national curriculum and include a strong focus on emotional well-being. It is no co-incidence that schools that have pioneered this sort of approach, where well-being and building positive relationships run through the whole school ethos and curriculum and where counselling is available for those who need it, say that there is a clear link to improved academic performance. It is also why I would like to see counselling and other types of emotional support available in all schools in England, as it is currently in Wales and Northern Ireland.

I can think of no better way of concluding my opening remarks than to quote the oft-quoted words of Bobby Kennedy in a speech more than 40 years ago. I know noble Lords will have heard them before, but I will say them again. He said that GDP,

“does not allow for the health of our children, the quality of their education or the joy of their play ... It measures … neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile”.