NHS Plan: Consultation

Lord Bishop of London Excerpts

Monday 2nd December 2024 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government what steps they are taking to ensure the consultation for the NHS 10 Year Plan reaches all communities, including those who have least interaction with the health service.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we want to ensure that the voices and experiences of patients are at the heart of our plans to make the NHS fit for the future, especially those voices that often go unheard. We are working with charities, faith groups, health and care providers, local government and others to ensure that we hear from those that national government often fails to reach. We will monitor this closely and target underrepresented groups before the engagement exercise concludes in spring 2025.

[The Lord Bishop of London]

I thank the Minister for her reply, and I am encouraged by the Government’s consultation on the NHS 10-year plan. However, does she agree with me that, if we are to move from sickness to prevention, any engagement ICBs have with their communities has to be long term and systematic? If so, what are the Government doing to resource ICBs to make sure that their engagement with communities is long term and systematic?

[Baroness Merron (Lab)]

I agree with the right reverend Prelate. Integrated care systems, which are responsible for reflecting the needs of the community and its spending, must follow guidance, and it is important that we identify the seldom-heard groups. We have built into the consultation plans a “workshop in a box”—a toolkit to support discussion in local communities, which ICBs are rolling out. It is a good way of encouraging ICBs to talk directly to local communities.

Mental Health Bill [HL]

Lord Bishop of London Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[The Lord Bishop of London]

My Lords, I am grateful to be able to participate in Second Reading of this important Bill. It is a privilege to follow the noble Baronesses, Lady Barker and Lady Watkins, who have a real breadth of experience in this field. I too welcome, along with many noble Lords, the reform of the Mental Health Act, which is long overdue.

The noble Earl, Lord Howe, highlighted the over-representation of minoritised communities detained under the Act but also placed on community treatment orders. Some groups are also more likely to be detained through contact with the criminal justice system or emergency departments. It is important to remember that we are speaking about these inequalities in the wider context of health inequalities; some groups present to health services far later, when their symptoms have worsened. The Royal College of Nursing notes in its briefing that mental health services are

“not seen as accessible to all communities”,

and that:

“Many black men have a first interaction with a service via the police during a crisis”.


Many of the organisations that have helpfully sent briefings ahead of the debate have acknowledged that the legislative actions available to address this issue are limited. The Minister highlighted the advanced choice directives, which are a welcome step towards this. As the Joint Committee on the Draft Mental Health Bill notes, this is important for those who have experienced trauma, disempowerment and discrimination.

Data collection has also been discussed during scrutiny of the Bill. Although data collection is improving, capturing more complex data on ethnicity is important when looking at health inequalities in this way. In much of the work I have done on health inequalities with the NHS and faith groups, ethno-religious identity is significant if communities are to be better understand at an ICB level or higher how to reduce inequalities.

It is also important that, in evaluating the changes to the Act, the Secretary of State has the appropriate data to do so. What steps are the Government are taking in the Bill or in other ways to mandate this kind of data collection, so that racial inequalities are monitored?

The Royal College of Speech and Language Therapists also emphasises that communication considerations are important to the Bill. In my experience, some faith communities find it very hard to discuss mental health, and that is made worse by the biases and discrimination they meet when they seek help. The patient and carer race equality framework is to be welcomed as the first ever anti-racism framework for mental health trusts and service providers. In order to assist in this, the Royal College of Nursing has recommended that mandatory training on equalities be given to all working under the Mental Health Act. As I often say in this place, faith literacy is an essential component of that.

Much of this is still about trust and culturally competent care. It is critical that services be accessible and effective for people with different traditions, cultures and faiths. Empowering patients to offer their data is as important as mandating that it be collected.

Many briefings note that the Bill will be effective in reducing racial discrimination and health inequalities only if there is investment in community services and other actions. Not everything we can and should do is medical; the involvement of the voluntary and community sector is also crucial.

I welcome the provisions in the Bill to restrict the long-term detention of autistic people and those with learning disabilities. I support the Joint Committee on the draft Bill’s recommendation of clearer duties for ICBs and local authorities to develop robust community services and social support.

I pay tribute to the work of the work of the noble Baroness, Lady Hollins, and the independent care and treatment review programme to expose the serious harm and trauma inflicted by the use of solitary confinement, detention and long-term segregation in mental health and specialist learning disability hospitals. I too support the comments made by the noble Earl, Lord Howe, with regard to young people.

The right reverent Prelate the Bishop of Gloucester is the lead Bishop on prisons for the Church of England, and she apologises for not being in her place. She and I commend the Government on bringing forward the long-overdue provisions to end the use of prisons and police cells as places of safety. The right reverend Prelate has told me that last year more than 300 people suffering mental health crises were taken not to a hospital but to a police station. According to the recent report from the Chief Inspector of Prisons, the average time to wait to transfer mentally ill patients from prisons to hospitals is 85 days—almost three months. We welcome the statutory time limit of 28 days, but I highlight, as other noble Lords have, that if this is actually to happen, it needs to be resourced. As the noble Baroness, Lady Watkins, highlighted, there is a question of resource not just on this point but for much of the Bill.

Shortages of mental health nurses and doctors impact on those detained under the Mental Health Act and in the community. The learning disability nursing workforce in the NHS has dropped by 44% since records began in 2009. Investment in the workforce will be key to the success of the Bill. Community services can be developed and resourced only as far as the NHS, local authorities and directors of adult social care are supported to do so. I welcome the Bill and look forward to following its passage and working on what is an extremely important reform.

Type 2 Diabetes: Continuous Glucose Monitors

Lord Bishop of London Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

It is probably important to say at the outset that type 1 diabetes, as the noble Lord knows, is not related to lifestyle issues, and at this point cannot be prevented, so it is a case of management. The technology that is available now is quite remarkable— not just the CGMs that the noble Lord, Lord Rennard, inquired about, but also hybrid closed loop systems, where the CGM is paired with an insulin pump, so it is administered automatically without the person having to calculate. I think that is incredibly helpful. It is only available to those eligible, with type 1 diabetes, but the rollout began in April 2024. The noble Lord makes a good point, as did the noble Lord, Lord Rennard, about access and inequality in access. That is something we continue to work on, ensuring that everybody can fairly access these wonderful technology advancements.

[The Lord Bishop of London]

My Lords, women with type 2 diabetes face a higher risk of miscarriage, stillbirth, neonatal deaths and birth defects. As we have heard, women who live in areas of high deprivation as well as women who come from black and minority ethnic groups are more likely to be impacted by type 2 diabetes. This compounds the existing inequalities in the maternal mortality rate. What steps are the Government taking to support integrated care boards to build relationships with these women who are most likely to experience these impacts, to ensure that they have the best maternity care and diabetic care, including ensuring they have access to continuous glucose monitoring where necessary?

[Baroness Merron (Lab)]

The right reverend Prelate is quite right in what she says, including that responsibility for CGM implementation rests with integrated care boards. It is their responsibility to ensure that the technologies we are talking about can be accessed by all eligible patients regardless of their ethnicity or their indices of multiple deprivation. I assure the right reverend Prelate that achieving that equality of access in all diabetes technology is an absolute priority. We will continue to monitor progress and encourage ICBs to do that by the NDA quarterly dashboard in 2025-26. In other words, we will give ICBs the tools to do the job they need to do.

Hospices: Funding

Lord Bishop of London Excerpts

Thursday 24th October 2024 Lords Chamber

[The Lord Bishop of London]

My Lords, I too thank the noble Lord, Lord Farmer, for introducing this debate. I declare my interests as outlined in register, particularly that I am patron of Hospiscare in Exeter.

I suspect there has never been a more important moment in time to discuss the funding of the hospice sector, which is facing extreme challenges. It is also important to remember that hospices deliver excellent care to a significant number of people who are dying well. However, according to Hospice UK, the sector is facing the worst financial crisis in more than 20 years.

The state provides on average only a third of hospice funding. A large proportion is found by fundraising. Those who live in affluent areas are more likely to financially support their hospices than those in deprived areas. That will have a direct impact on not only access but quality of care to those in the deprived areas.

It also entrenches the worsening inequalities in health, as highlighted by the noble Lord, Lord Farmer, not just between regions but also within them. In addition, the funding given to ICBs for palliative and end-of-life care is highly variable, and sometimes disproportionate for the demographics of their population. In the absence of any long-term plan, I echo the request of the noble Lord, Lord Farmer, and ask the Minister what support the Government are giving to ICBs as they make their commissioning decisions in this area.

As already indicated by the contributions made, noble Lords are aware of the introduction of the Private Member’s Bill in the other place which seeks to change the law for those who are terminally ill. How can we consider this if we do not give enough funding to hospices, palliative care and palliative care research, so that people dying receive the best care—the care that they need to make life worth living and, in the words of Dame Cicely Saunders, to live life until they die?

I hope that we are not prioritising the care of those who need it based on their contribution to our economy. This is contrary to how God values each one of us, contrary to the principles on which the NHS is founded, and contrary to human dignity. How the Government choose to prioritise palliative care matters very much. I look forward to hearing from the Minister about the Government’s plan to secure a sustainable future for hospices, palliative care and palliative care research.

Palliative and End-of-life Care: Funding

Lord Bishop of London Excerpts

Wednesday 4th September 2024 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the adequacy of funding arrangements for accessible and equitable palliative and end of life care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we want a society where every person receives high-quality, compassionate care, including at the end of their life. Integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. This is to promote a more consistent national approach and supports commissioners in prioritising palliative and end-of-life care. We will be considering the next steps, including funding, more widely in the coming months.

[The Lord Bishop of London]

I thank the Minister for her reply. We know that the hospice sector depends on charitable giving because of the low level of statutory funding at present. This means that the wealth and resilience of a community define the level of hospice services. This entrenches inequalities of place and means that access to hospice services is extremely unequal. Can the Minister outline what the Government are doing to look at the funding settlement, and particularly the wider hospice funding model, to ensure that this is not just another service that has poorer access for those in more deprived areas?

[Baroness Merron (Lab)]

I certainly take on board the point that the right reverend Prelate makes. It is the case that the amount of funding that charitable hospices receive varies by ICB area. That, in part, is dependent on the breadth of a range of palliative and end-of-life care provision within the ICB area. I can assure your Lordships’ House that my colleague, Minister Kinnock, the Minister of State for Care, has recently met with NHS England, and discussions have started on how to reduce inequalities and variation in access to services and their quality.

Covid-19 Inquiry

Lord Bishop of London Excerpts

Tuesday 3rd September 2024 Lords Chamber

[The Lord Bishop of London]

My Lords, I declare my interest as set out in the register. It is good to have this opportunity to speak in this debate and to acknowledge the important recommendations of this first report from the Covid inquiry. The pandemic was a seismic event for us all, and a great tragedy for many. My thoughts and prayers go to those who have lost individuals because of the pandemic. My thanks and gratitude go to those who stepped up and beyond to care for and protect us.

I want to highlight a couple of points from the report. The first is that the clearest flaw identified in the risk assessment was the underlying health of the UK population prior to 2020, as mentioned by the noble Baroness, Lady Tyler. We are all aware of the entrenching and exposing effect that the pandemic had on health inequalities. We are all aware of the impact that non-clinical factors such as housing have on our health. We are all aware of the vast difference in healthy life expectancy depending on where we live. We are all aware that those living in more deprived areas are more clinically vulnerable on average, but spend much more time in front-line jobs.

We are an interconnected people whose health and well-being are bound up in one another’s. It is the weighty responsibility of all of us, especially in this place, to take on such an injustice with priority and focus. In the section on data, the inquiry recommends that:

“The UK government should … commission a wider range of research projects ready to commence in the event of a future pandemic,”


including to

“identify which groups of vulnerable people are hardest hit by the pandemic and why”.

The Covid-19 Bereaved Families for Justice spokesman responded to the publication of this report by saying that we must

“challenge, address and improve inequalities”

and not just understand

“the effects of these failures”.

In fact, I wonder whether we have really and completely understood the impact. We were all affected, but we were not equally affected. At the height of the virus, the Bangladeshi population had a death rate around five times higher than the white British population. The rate in the Pakistani population was around three times higher and in the black African population it was twice as high. But even these statistics do not communicate the extent of the damage that the virus caused to specific communities. Between March 2020 and February 2021, the Church End area in Brent lost 48 people. The damage done to individual communities was, in some cases, very severe. What action are the Government taking to address the widening health inequalities in our communities, not just for future pandemics but for now?

There are questions I believe we need to ask about how these devastating events have impacted the trust that those communities have in the health service, local government services and the Government. In 2021, I did a piece of work examining the role that faith communities played during the pandemic and heard their stories and experiences. Many shared stories of loss and resourcefulness, but they also shared stories of culturally incompetent care. This included the story of a Sikh man in Southall, who had had a stroke and was unable to speak, who had his moustache and beard cut without obtaining the permission or seeking the consent of his family. This was deeply offensive and after investigation it was found there was no medical reason for it to have occurred. We heard stories of distrust of the health service and a lack of understanding from statutory bodies of the provision for their communities that faith groups had held for generations. They said:

“There was a lack of cultural knowledge about how a burial for the Muslim community happens so we did it ourselves. We raised money so people could die with dignity”.


During the pandemic, faith leaders were rightly identified as important partners, and there are fantastic accounts of successful vaccination rollouts and health campaigns supported by them. However, that engagement has not been sustained. Forming relationships in a moment of crisis is not the way that resilient and interconnected communities are built. I have said many times in this place that, if we are to make a serious and sustained effort to tackle health inequalities, faith groups must be involved. I was encouraged to hear the words of the noble Lord, Lord Evans, about including diverse views, which I would see as also including faith groups.

Areas of high deprivation often have a higher level of faith observance. A person’s faith is also significant to their healthcare needs. Because of these things, systematic engagement with faith communities at a local, regional and strategic level is vital. This both ensures that the PLUS target populations are prioritised and makes sure that appropriate healthcare is offered to those with faith-based requirements. In addition, the extraordinary effort that faith groups gave to supporting their communities during the pandemic and continue to give should be recognised for the benefit not just to their communities but to us all. What progress are the Government making to engage with faith groups not just in the moment of crisis but over the long term?

This report should inform not just the earmarked actions that we take to prepare for the next pandemic but our approach to other areas of life and health. Our collective health will be undermined if these entrenched inequalities persist and will make us all the more vulnerable to future health threats. I urge the Government to consider carefully how they respond to this report to improve the health of those communities which bore the brunt of the Covid-19 pandemic and to undertake a serious reform of social care. This has never been more urgent.

Adult Social Care: Staffing

Lord Bishop of London Excerpts

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct: on average, it is about 74% or 75% of a local authority budget. I think we would all agree that that is not a good situation, because obviously a local authority has a number of matters it needs to deal with. This is one of the issues around long-term reform that we will need to consider.

[The Lord Bishop of London]

My Lords, we are very familiar with the pressure on the social care workforce. As the Minister pointed out, we have seen vacancies fall within the social care sector, which is very welcome, but that is supported by the recruitment of 70,000 staff from overseas. I am glad that the health and care sector is exempt from the new visa charges, because we are clearly reliant on assistance from overseas. However, given that they are no longer able to bring dependents on their visa, have the Government considered the impact that this will have on recruiting workers from overseas into the social care sector?

[Lord Markham (Con)]

We have tried to adopt a balanced approach here. While we all understand the necessity in the healthcare sector, I think most of us would agree that 750,000 net migration is a very high number. The balance we have struck is to protect this sector. Our figures generally show that we will be able to keep the recruitment coming. We are now moving on to part 2 of the reform, through the other things we are doing, particularly around qualifications—we know that people who are qualified are far more likely to stay in a social care setting. That is what the whole investment is about. It will be rolled out next year and will fund hundreds of thousands of places. I think it will make a real difference to the motivation, recruitment and retention of staff.

National Health Service: 75th Anniversary

Lord Bishop of London Excerpts

Thursday 30th November 2023 Lords Chamber

[The Lord Bishop of London]

My Lords, I declare my interests in the register. It is a privilege to participate in this debate about one of our most valued institutions and to follow some excellent contributions. One of the focuses of my work in this House has been reducing health inequalities. The NHS was founded in the face of extreme inequality, in the hope that financial means would not be the sole determinant of health. The universal service that is free at the point of use is something we can be extremely proud of.

The 75th anniversary of the NHS is very close to the 75th anniversary of the Windrush generation, which I will celebrate today. As we know, many of the passengers on HMT “Empire Windrush” took up roles in the NHS, which launched just two weeks later. When experiencing workforce shortages from 1948 onwards, British politicians visited the Caribbean as part of a recruitment programme that had 16 agencies in the British colonies by 1955. By 1977, 66% of overseas student nurses and midwives originated from the Caribbean. In the face of overt racism and unequal opportunities for professional development, their contribution has been truly extraordinary. Without it, the health service would not be what it is today.

I am sure much of our nation would say that the true treasure of the NHS is its workforce, whose example should be a great encouragement to all of us. In this House, I have not held back from highlighting the challenges that the workforce currently face: significant vacancies, sometimes poor working conditions and enormous pressure. The industrial action we have seen is a product of the erosion of trust between the front line and this Government. Since the passing of the minimum service levels Act in the last Session, what ongoing work is being done to build relationships of trust with the unions and other bodies to ensure that the concerns and needs of the workforce are truly listened to?

As I have said before in your Lordships’ House, the global majority heritage staff continue to face troubling challenges. The Care Quality Commission’s State of Care report highlights instances of tolerated discrimination and a lower chance of being represented in leadership and managerial roles. There are over 256,000 black and minority-ethnic nurses and midwives, but they are overrepresented in bands 1 to 5. When I was the Government’s Chief Nursing Officer for England, I commissioned the government Chief Nursing Officer’s black and minority-ethnic advisory group, which it was a joy meet with on its 22nd anniversary. The most recent race equality standard report from the NHS shows that there is progress heading in the right direction; although it is slow, it should celebrated.

Amid the celebration of this great institution, many challenges remain. The strain placed on the service is clear in key areas, including the number of people waiting for care and the significant workforce challenges. But there are also challenges with our health, distinct from our healthcare. Some 50% of people in the most deprived areas report poor health by the ages of 55 to 59, which is over two decades earlier than in the least deprived areas. It remains an injustice that where exactly you live can change the length of your healthy life in such a serious way. In light of this, what consultation has taken place with other departments to seize the opportunity of the Major Conditions Strategy to give new focus on health inequalities?

It is good to see the new integrated care systems becoming more established. I hope that we will see real progress in place-based and community-focused preventive care. Research published recently by the NHS Confederation shows that every £1 invested in community and primary care brings back £14 to the economy, compared to £11 per £1 for acute services. It is through working for a healthier population that the pressure will be lifted off the NHS and the opportunity to address health inequalities will be realised. I commend the small-scale projects happening in London, where I am. The community health and well-being worker model, which is being rolled out in Westminster, is already encouraging the uptake of health screenings that would otherwise not happen, management of low-level health conditions and promoting well-being. There is much to celebrate about the NHS but, as we have heard, there remains work to be done if we are to press ahead in the same spirit as the architects of the NHS 75 years ago.

Adult Social Care

Lord Bishop of London Excerpts

Wednesday 22nd November 2023 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the financial situation facing adult social care leaders and providers, following information published by the Association of Directors of Adult Social Care Services that 83 per cent of councils expect to overspend by an average of 3.5 per cent on adult social care in 2023-24.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The department carries out regular assessments of the financial pressures facing adult social care. Since the spending review, the Government have made available up to £8.1 billion in additional funding over two years to support adult social care and discharge. This includes an additional £570 million announced in July. This will put the adult social care system on a stronger financial footing and improve the quality of and access to care.

[The Lord Bishop of London]

The autumn survey of the Association of Directors of Adult Social Services paints a worrying picture of the state of adult social care: a third of directors of adult social care services said that they have been asked to make additional savings to their budgets, on top of the £1 billion of savings that they are expected to make by 2024-25. The Homecare Association’s deficit report, published on the same day, states that providers are being paid less than the work costs and cannot pay their employees a competitive salary. In this context, can the Minister explain what outcomes social care users can expect to see as a result of the investments he spoke of?

[Lord Markham (Con)]

I thank ADASS for its report. The outcomes we are seeing show a number of things: as well as the £8.1 billion investment we put in, we have brought down waiting lists for assessment by 13% since the peak level. We are seeing high levels of satisfaction with a lot of the work we are doing; 83% of people say that they are satisfied with the services they are receiving. Yes, there is a lot more to be done, but there is a lot of good progress as well.

King’s Speech

Lord Bishop of London Excerpts

Thursday 9th November 2023 Lords Chamber

[The Lord Bishop of London]

My Lords, it is a pleasure to participate in this debate on the gracious Speech. I declare my interests as recorded in the register.

I begin by joining noble Lords across the House in welcoming the indication in the Speech that the Government will legislate for a ban on smoking. As we have heard, smoking is the single biggest preventable killer in the UK, but it is also an example of pronounced health inequality. The Chief Medical Officer gave this evidence to the Commons Health and Social Care Select Committee:

“Smoking is usually twice as high in people with lower incomes and more than twice as high in people living with mental health issues”.


He went on to say:

“The cigarette industry goes absolutely unerringly for the most vulnerable in society”.


So I welcome the decision by the Government, which will undoubtedly account for significant reductions in preventable cancers. However, there are many things that determine our health, and we have been discussing the social determinants of health for years. They were highlighted as early as 1980 in the Black report, yet we seem to be having the same conversations about the same statistics, with the same consensus again and again. The differences in life expectancy and healthy life expectancy remain truly shocking.

The failure to publish the health inequalities White Paper in the previous Session is lamentable, and I seek assurances from the Minister that health inequalities will be a key focus of the major conditions strategy. For the NHS to have the future that the Minister speaks about, we are dependent on reducing inequalities in health. Inequalities in health outcomes between racial and ethnic groups also persist. The most recent CQC State of Care report highlights these, especially in maternal and neonatal care and in mental health care. The report lists instances in which patients are not listened to and how their symptoms are not recognised due to the poor teaching of certain conditions that present in ethnic minority patients. The CQC report also highlights, as did the noble Baroness, Lady Watkins, that there are ethnic differences in the detention of mental health patients.

I add my voice to the disappointment that a mental health Bill has not been brought forward as part of the gracious Speech. As we have heard, reform of the Mental Health Act is long overdue, and the inequalities that people face under it need serious attention. There is much work to be done here, including in resourcing community care and increasing patients’ ability to make choices about their care. The Joint Committee on the draft Bill found that this would be a significant factor in the reduction of detention and inequalities. It is a great shame that the work already undertaken is not being taken forward.

We are all aware that the health service is straining. I too welcome the long-term workforce plan, but there are questions that remain unanswered, and I expect that its implementation will be challenging. The NHS staff experience remains one of exhaustion, overwork and understaffing, and I continue to remain concerned about the state of industrial relations following the Strikes (Minimum Service Levels) Act. If we are to exercise choice in our future, as the Minister rightly said, we need a workforce that is not tired, is appropriately trained and is valued.

Some 22 years ago, I commissioned the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group, which has carried out truly inspiring work. However, the work is not done. The CQC report highlights the experience of not just ethnic-minority patients but staff. Midwives from ethnic-minority groups described a culture of tolerated discrimination and unchallenged stereotyping. This is something that we all need to work to reduce.

It is disappointing to see no mention of social care in the gracious Speech. Skills for Care’s latest report estimated a 28.3% staff turnover rate in 2022-23. With 400,000 people working in social care over the age of 55 and likely to retire within the next 10 years, we are desperate for a workforce strategy. Carers are finding it difficult to get by in the cost of living crisis, and the sector represents 5% of the entire economy.

The Archbishops’ Commission on Reimagining Care sets out the type of ambitious vision that I had hoped to see in the gracious Speech. The commission identified the need for a fundamental change in the way in which care is thought about, organised and delivered, with a national care covenant at the heart of a new approach that truly incorporates the views, voices and experiences of the people most affected. Social care should enable everyone, regardless of age or ability, to lead a life of purpose and fulfilment.

I also note the disappointment of many that the gracious Speech did not contain news of a ban on conversion therapy. The General Synod of the Church of England voted to call on the Government to ban conversion therapies in 2017; it remains firm that abuse of power in this way must be prevented.

What underpins everything I say today and will say in the coming Session is that people are made in the image of God and are immeasurably valued. Recognising that value, we must do more to pursue health equality and provide adequate resources. As Nye Bevan famously said in 1948:

“Illness is neither an indulgence for which people have to pay nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community”.