Health and Social Care Levy Bill

Lord Lansley Excerpts

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

[Lord Lansley (Con)]

My Lords, I am very pleased to follow the noble Baroness; I agree with her on one or two items I will come to in a minute. She had some ideas about how these revenues might be otherwise achieved. I will not offer my own ideas, but there is a question here; I wondered whether the noble Lord, Lord Macpherson of Earl’s Court, might have said this. It seems very misplaced to have a fiscal effect of this scale in September when the Chancellor should be on his feet in late October with what ought to be the fiscal event that gives us the OBR’s judgments, which enables us to see the whole panoply of revenue and expenditure, and I am surprised that it was done this way. It is obviously done for political reasons; it has enabled the Treasury to distance itself somewhat from the decision that led to this. I am grateful to my noble friend on the Front Bench for introducing the Bill in this way. He set out the Treasury’s arguments in favour of the Bill; it was therefore necessarily a short speech.

The noble Lord, Lord Eatwell, is not in his place at the moment but I was surprised that he did not refer to Gordon Brown’s hypothecation of a national insurance increase to the NHS. As a subsequent Secretary of State, I can say that this was important only in so far as it made the accounting for the NHS in the departmental accounts more complicated. It had no impact whatever on the decisions made about revenue and expenditure in the Department of Health, as it then was. This will not have an impact either. The NHS will continue to be funded out of general taxation, and the only impact of this increase is that it further reinforces the misplaced belief on the part of the general public that the NHS is funded out of national insurance contributions and it is therefore a contributory tax. It is not like that, has not been like that and will not be like that. The noble Lord, Lord Eatwell, made a point about whether people think that they have access to the NHS because they pay for it. They have free access to the NHS because they pay for it through general taxation, not because they pay for it through national insurance contributions, and the extent of their national insurance contributions has no impact, and should have no impact, on their access to the NHS.

I have two problems with using national insurance contributions in this way for the National Health Service. The first is that it is a tax on jobs. This is happening in the week after the Prime Minister has told the business community that it is going to have to pay higher wages, so it may well say, “If we have to pay higher wages, you might not impose on us additional costs of employing people”, which is exactly the point that the noble Lord, Lord Macpherson, made. There is a gap at the moment between the cost of employing people in this country and the cost of employing people in, for example, continental Europe. However, we cannot be complacent about that, because there is a different gap and a cheaper cost of employing people in many of our other competitor countries. We have to be very aware of the risks associated with continuously increasing the cost of employment.

All that said, increasing national insurance is an inappropriate way of funding social care. Like my noble friend Lord Forsyth of Drumlean, I welcome the fact that the Government are addressing the funding of social care. They have done so in the past, through one or two mechanisms, but at no stage have we seen the increases in resources for social care keep pace with the rising cost. That is where we need to be. The NHS, as I know perfectly well from past experience, needs, broadly speaking, a 4% per annum increase in real terms to keep pace with demand. Social care is getting nothing like that, but the increase in demand for social care is very like that for the NHS.

More of these resources should go to social care than the Government intend—not all of them, but perhaps one-third over the next three years—and that should start now. If you ask people in the NHS whether funding for social care and funding for the NHS are separate, they of course understand the essential link between them. Funding social care now, so that we can remedy some of the lack of access to local authority-funded social care and enable people who have substantial, not just critical, care needs to get access to social care, will do a great deal to reduce the crisis in demand for the NHS.

This is particularly true of accident and emergency units, which are often presented with older, frailer people with comorbidities—incredibly difficult patients with whom to work. The NHS does not want to discharge such patients to their homes with comorbidities and unresolved issues, so the cost to the NHS is very high. But such patients can be managed through the social care system and in primary care—we just need to make sure that they have fewer crises that have not been anticipated and dealt with.

Speaking as the Secretary of State who asked Andrew Dilnot to form his commission and prepare his report, I note that it is now over 10 years since it was presented. We legislated for it in 2014. It is available and it could be implemented now, but in my view it should not be paid for out of the national insurance increase. I proposed, more or less 10 years ago, that it should be paid for by removing the exemption for people’s principal private residence from the means test for domiciliary care. My noble friend Lord Forsyth of Drumlean asked this question. Now, it would, I think, raise something like £1.3 billion a year. If, in addition, higher-rate taxpayers who are pensioners were not to receive the winter fuel allowance, we would have about the amount of money necessary to pay for the cap on care costs and the changes to the means test.

That is how it should be paid for—within the system, essentially by those who will benefit from it, because they have the underlying resources to do so, not least in the properties that they own. So let us not go down the path of unfortunate intergenerational impacts, particularly for younger people, of putting this on to national insurance contributions.

My final point is that a White Paper on social care and healthcare is coming. We already have the Health and Care Bill. The integrated care in that Bill is not integrated care between health and social care. When we talk about integrating health and social care, what we need is not institutional integration but integration around the care user and patient themselves. That is the only integration that will really work: integration around the person themselves. Whether it is done by personalised care or self-directed care, it needs to be supported by pooled budgets and joint commissioning. Fundamentally, it is about giving patients and care users themselves, and their families, much greater control over the nature of the services provided to them by the NHS and social care. I hope that is what we shall see in the autumn.

Brexit Opportunities

Lord Lansley Excerpts

Thursday 16th September 2021 Lords Chamber

[Lord Frost (Con)]

My Lords, the purpose of these reforms is, in the long run, to improve the productivity of the UK by putting in place regulations that are tailored to our conditions, rather than the average. So the goal of this Government is to improve productivity, growth and prosperity for everybody after Brexit. That is obviously one of the metrics on which the British people will make their judgment when the time arises.

[Lord Lansley (Con)]

My Lords, I am sure that the business community, which faces considerable pressures on costs and competitiveness, will be pleased to hear about the standing commission and the opportunity to address regulatory issues. However, will my noble friend add something about the Government’s quantified objectives in this regard? Last year, not including the effects of Covid, Brexit or Grenfell, regulation on business increased by £5.7 billion while the Government’s target was a net-zero increase. So what kind of objectives are the Government looking for in this regard, and will he and the Government confirm the importance of independent verification of that by the Regulatory Policy Committee?

[Lord Frost (Con)]

My Lords, the matters that my noble friend raised in his question are germane to the consultation on the regulatory framework, which I touched on and which obviously is still open—so I do not want to get ahead of that. I certainly very much agree with his general proposition that there is a kind of dead weight that tends to move in one direction, and it takes a lot of effort to push back against it and improve regulatory conditions overall. As I said, the possibility of “one in, x out” is one way of doing that, but there are other ways, and we are looking into how Governments around the world, including national sub-states and so on, have achieved this—so we will have more to say on that question.

Public Procurement (International Trade Agreements) (Amendment) Regulations 2021

Lord Lansley Excerpts

Tuesday 15th June 2021 Grand Committee

[Lord Lansley (Con)]

My Lords, I am glad to follow the noble Lord, Lord Haskel, although, unlike his interesting and wide-ranging remarks, I am afraid that that I am going to be very specific and quite pedantic. This is not in any particular spirit of criticism of these regulations; in introducing them, my noble friend was clear about their purposes. They are indeed entirely noncontroversial and, to a large extent, much anticipated and much welcomed to implement the continuity agreement so far as government procurement and access to public procurement in the United Kingdom is concerned.

I want to make two points. The first is for those who are often prone to saying that it is our Government’s intention to expose the National Health Service to competition pressures. Whether or not they think that is detrimental, I will not argue; the point is that, here, as in other public procurement measures, the Government have taken the opportunity to make specific exemptions for clinical healthcare services, which indeed they did in the EU-UK Trade and Cooperation Agreement. So those who talk about the exposure of the NHS to competition should look at that and recognise that the Government have, if anything, moved in the opposite direction.

The pedantic point I want to make is that, in introducing the instrument, my noble friend reflected what is said at paragraph 7.2 of the Explanatory Memorandum, which may have been the intention when it was written:

“This instrument will only affect trade agreements that have already been scrutinised via the procedure set out in the Constitutional Reform and Governance Act”—


that is, CRaG. This is almost entirely true, but it is not true in relation to the agreement with Serbia. The Serbia agreement was signed on 16 April using powers under Section 2 of the Trade Act, which was given Royal Assent on 29 April. This statutory instrument was created and laid on 13 May. The Serbia agreement was laid under CRaG on 11 May and, I understand, was provisionally applied on 20 May; the Secondary Legislation Scrutiny Committee and the Joint Committee on Statutory Instruments looked at it on 25 and 26 May. It might have been anticipated that the CRaG scrutiny period would have ended by now but it has not because the Whit Recess intervened and the CRaG scrutiny period expires on 23 June. The International Agreements Committee, of which I am a member, will examine the UK agreement with Serbia tomorrow. So there is an exception to this point.

Does it matter? I think the short answer is that it does not. The provisional application is in place, as one would expect in order to minimise any discontinuity in our trading relationship with Serbia because we have been operating on quasi-WTO rules since the turn of the year and the provisional application was quite right. So it does not matter but there is a point here: if instruments are laid with Explanatory Notes, the timing and sequencing need to be very clear. In this case there is, I think, no controversy, but if there were controversy, and if we were in a position where the House was being asked to put in place implementing legislation in circumstances where the CRaG scrutiny had not concluded, that would be regrettable. I just want to note this because we are all finding our way with all these processes but I hope that care will be taken to understand the sequencing for future occasions.

Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Act 2014

Lord Lansley Excerpts

Thursday 22nd April 2021 Lords Chamber

[Lord True (Con)]

My Lords, we have long had a paid-advocacy rule in your Lordships’ House, and it is a good rule.

[Lord Lansley (Con)]

My Lords, my noble friend will recall that I took charge in the Commons of the passage of the transparency of lobbying et cetera Act. In my view it was wrong then and is wrong now to include in-house lobbyists, because many thousands of people working in companies will have to register simply to speak on behalf of their own company.

My noble friends Lord Grade and Lord Norton of Louth have it right. There has never been a sufficient level of openness about who Ministers receive lobbying from, or indeed receive any communication from. That should be published. It was not sufficient then and it is not sufficient now.

[Lord True (Con)]

My noble friend puts his finger on a key issue that I alluded to in my reply to the noble Baroness opposite, in terms of the scale of the undertaking that would be required. I agree—government publishes data on meetings between Ministers, Permanent Secretaries and external interests. Regulation must balance the need for transparency on third-party lobbyists while not preventing engagement by the voluntary and private sector. These issues require and will receive very careful consideration. I can assure all noble Lords that the matter of integrity in public life is something that this Government take profoundly seriously.

Budget Statement

Lord Lansley Excerpts

Friday 12th March 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, it is a great pleasure to welcome my noble friend to this House and to congratulate him on his excellent maiden speech. It was brief, but it had a moment of humour in it. I think many of us know that my noble friend comes from what we can call a parliamentary heritage. I do not mean the 32 years that he spent in the other place, distinguished as that was, but that over 200 years ago his ancestor was responsible for the only assassination of a Prime Minister, Spencer Perceval, just beyond the Bar of the House. Happily, my noble friend is now putting a positive parliamentary legacy in place to offset the Bellingham legacy from many years past. As it happens, it is clear that Prime Ministers did not hold that against my noble friend since he was advanced to ministerial office. Among the many subjects that he will bring to this House, on which we look forward to hearing from him, his ministerial experience will be very valuable, not least in relation to trade and Africa. We look forward to hearing from my noble friend and from all those who have made their maiden speeches in this debate.

I want to make just one point. My noble friend Lord Gadhia said that crises come in pairs. Looking at the Chancellor’s Budget, I think he has addressed with many well-judged measures the pandemic crisis that we face. But, actually, we face two crises because we are also facing a climate crisis. I do not think that this Budget addresses the climate crisis in the way that we need to. Every fiscal event must now be directed towards achieving our climate objectives. In that context, I want to focus on one thing. In two months, we will introduce the UK emissions trading scheme. One month ago to the day, the Government increased the auction reserve price from £15 to £22, but nothing else was done in the Budget. We need to know how we are going to use emissions trading—and, more importantly in my view, carbon pricing—to deliver on our decarbonisation objectives. Industry needs those strategies to be set out.

EU-UK Trade and Cooperation Agreement

Lord Lansley Excerpts

Friday 8th January 2021 Lords Chamber

[Lord Lansley (Con) [V]]

My Lords, it is a pleasure to follow the noble Lord, Lord Krebs, and his focus on science as vital to our future is commendable. I am also pleased to welcome my noble friend Lord Wharton of Yarm. We look forward to his contributions, not least in promoting the interests of the north of England. I draw attention to my interests as recorded in the register.

In opening, the Minister said that the European Union (Future Relationship) Act 2020 enabled the provisional application of the deal. The agreement was signed on 30 December, it is implemented in our domestic legislation, and has been provisionally applied by both parties. But it has not yet been ratified. The European Union has allowed two months for the European Parliament to debate the agreement prior to ratification. This Parliament could have completed CRaG scrutiny in that time as well. But Section 36 of the future relationship Act disapplied CRaG parliamentary scrutiny of these agreements. This was not necessary and is highly regrettable. Listening to this debate has shown that there are many issues relating to implementation and unfinished business arising from these agreements. It tells me that our European affairs committee should none the less proceed with detailed scrutiny of the TCA and I call on the Government to co-operate fully in that, and to facilitate debate on such a report in parallel with the European Parliament.

I add one question of my own. Talking about integrated supply chains, the food and drink sector says that where EU-finished goods are brought to GB hubs and then re-exported to the EU, the rules of origin mean they are subject to the EU’s common external tariff. This is potentially very destructive and damaging to integrated supply chains. The sector thinks it was not intended on either side. Can the Minister say that it can be resolved?

UK-EU Future Relationship Negotiations and Transition Period

Lord Lansley Excerpts

Tuesday 8th December 2020 Lords Chamber

[Lord True (Con)]

As the noble Lord says, our outstanding academic sector and the adequacy of data are of course extraordinarily important. As he knows, negotiations are continuing, and we must await the outcome.

[Lord Lansley (Con) [V]]

My Lords, does my noble friend agree that the majority of people have not entered into negotiations with the objective of reducing our standards—on the environment, on labour rights or in other areas? That should be of some assurance to our European colleagues. Will he also confirm that, as an independent country, we cannot agree to take rules from the EU in future? We should negotiate our standards and they should accept that.

[Lord True (Con)]

I agree with my noble friend’s final remarks. The UK’s reputation for quality, safety and performance is what drives the demand for UK goods. The Government have no intention of harming this reputation.

Civil Society and the Democratic Process

Lord Lansley Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord Young of Cookham]

I am grateful to the noble Lord. I know he has taken a particular interest in this and served on the Select Committee that produced the report Stronger Charities for a Stronger Society. One of its conclusions was that although charities are quite properly regulated in their campaigning activities, particularly at election times, any new regulation or guidance should clearly recognise that advocacy is an important and legitimate part of their role, to be set out in clear and unambiguous language. We need to strike a balance between, on the one hand, the rights of civil society to campaign in the way the noble Lord has just mentioned, and on the other, maintaining the integrity of the electoral process by having transparency on expenditure.

[Lord Lansley (Con)]

My Lords, does my noble friend agree that there is no legal bar to an organisation campaigning at a general or other election as long as, if it is a charity, it is consistent with its charitable objectives? However, it is right that it should be transparent about that by registering to do so with the Electoral Commission.

[Lord Young of Cookham]

I am grateful to my noble friend, who piloted the relevant legislation through the other place. During those debates he made the point that the boundary between what you could and could not do has not changed. What we did was insist on transparency and accountability. Therefore, if charities or civil society organisations want to engage in certain activities during a campaign, they have to register and declare their expenditure.

Health and Social Care

Lord Lansley Excerpts

Thursday 15th December 2016 Lords Chamber

[Lord Lansley (Con)]

My Lords, it is a privilege to follow the noble Lord, Lord Harris, and I pay tribute to him for his commitment over many years to patient and public involvement in health and care. The House is grateful to him for once more bringing these issues forward so that we can debate them, and I am glad to contribute. I join with him, as I know all noble Lords will, in sending our condolences to my noble friend Lord Prior of Brampton, whose father was a most-esteemed Member of both this House and another place and will be much missed.

The noble Lord is quite right about visiting hospitals. As it happens, I think that I visited the great majority of hospitals in this country in the course of being shadow Secretary of State and Secretary of State, but I was admitted to hospitals only when I was the shadow Secretary of State. If the noble Lord thinks that being the director of the Association of Community Health Councils sends a junior doctor into a flap, he should see what happens when the shadow Secretary of State arrives.

I am in completely the same place as the noble Lord on what is at the heart of patient involvement in healthcare. It is the principle of shared decision-making: “No decision about me without me”, as I enunciated it. That was not my original phrase but I adopted it. That should be a driving sentiment and form a cultural shift in how healthcare is delivered in this country. It is often still honoured in the breach rather than the reality but there are mechanisms to make it happen. They are not really structural; they are fundamentally clinical and cultural, and provide for shared decision-making not just in clinical guidance.

I remember, not so long ago, a very promising programme for preparing shared decision-making. The first that I saw was about prostate cancer; those who are familiar with what prostate cancer is, and what it means, will understand that the decisions made about treatment are very personal and important. They are not derived simply from what your clinician tells you should happen but are very much about one’s personal view. We have seen in quite recent scientific evidence that the clinical direction might often take people in a way which they would find less than immediately helpful, from a personal point of view.

Patients having the opportunity to exercise the choices that emerge from shared decision-making—clinical choices and choices on treatment and service provision—is at the heart of it. However, the debate about Healthwatch is not about shared decision-making for patients, and we should not confuse the two. There is nothing in the role of Healthwatch which should take away, or in any way substitute for, the central responsibility of any healthcare or care service provider to involve the public in scrutiny and engagement when designing their own activity. There is nothing which should stop them from ensuring that individual patients and care users are involved in their own care and the decisions relating to it.

In my view, Healthwatch is not about that. It may well look at whether people are doing that and comment upon it, but the responsibility lies with the providers of services, not with some external and independent regulatory function. The noble Lord said that it is a deliberately flawed system. I do not agree that it is flawed nor, certainly, that it is in any sense deliberate. The essence of the system is that there are providers of services, those who commission those services and those who regulate them. As we have seen in many other areas of public life, particularly where the Government are involved, it is in the regulatory function that we are looking for independence and scrutiny and, among the regulatory functions, one that is about being the champion for the consumer, the service user. That is what Healthwatch is about: providing within the independent process of regulation a voice that is dedicated to the consumer. It is not without precedent in other areas. For example, Postwatch, which I am sure many noble Lords will remember, was part of the Postcomm regulator but was also an independent consumer champion on behalf of users of postal services. In a sense, that was exactly the model that was to be used and that the Health and Social Care Act implemented for Healthwatch.

The noble Lord, Lord Harris, rather swiftly glossed over the fact that community health councils were abolished under the last Labour Government. He recited it as if one was followed by another which was followed by another, so there were patient and public involvement forums, then there were LINks and then there was Healthwatch. Let me make it to clear to him—I know he would, in truth, acknowledge this—that my experience of community health councils in my constituency was positive. Many of us were aghast in the early part of the Labour Government at their plan to abolish them. We knew perfectly well why they did it: it was because they said things that were inconvenient and unhelpful. Patient and public involvement forums then led to a significant deterioration in the voluntary effort. They virtually saw the paid staff giving executive support to community health councils abolished and the impact lessened. Under LINks, the impact lessened still more and even more of the immensely valuable volunteer effort that went into PPI was lost as a consequence.

Frankly, we did not create Healthwatch on the basis that we were simply rebadging something that had come before. We were setting out to recreate the independence and impact that we had seen in the best community health councils in the past, and I think that is the measure by which we should judge it. Last year’s King’s Fund report indicated that many in local Healthwatch think that they have made progress. I think Anna Bradley was an excellent chair and that she would probably say that within the structure she was working in, she made progress, but there is still a long way to go. With Imelda Redmond, the new chief executive and new chair in due course, we need Healthwatch England to assert itself much more. My view is very straightforward: it is independent. It is erroneous to suppose that Healthwatch England’s position as part of the Care Quality Commission is not independent. The Care Quality Commission is independent of the commissioners and providers of services, and it is the job of CQC and Healthwatch England to be external, independent, rigorous scrutineers of the performance, and sometimes the design, of the services that are provided to users. Within that, Healthwatch England should use its place within CQC to leverage the power of CQC, which is undeniably great inside the system, to be active on behalf of consumers—patients and care users—in giving them access to the services they want and, especially, to the kind of shared decision-making which is at the heart of this debate.

In my view, it is evident that at the moment the CQC does not see Healthwatch England as giving it that sense of what consumers want for priority-setting and helping to determine CQC’s activity and priorities. Equally, CQC should not be seen, to the extent perhaps that it sometimes is, as trying to put Healthwatch England into any kind of box and saying, “Your job is PPI, and you should not be impacting on what our priority decisions are in relation to scrutinising the service and reporting on it”. That is where it should be, as part of the CQC’s role is about bringing to bear the powers of the overall organisation. But remember that local Healthwatch organisations and Healthwatch England have their own powers, including powers of entry and scrutiny which were not available to their predecessor organisations and not there before. They should use them, although they are not a substitute for the overview and scrutiny of local authorities or for the democratic accountability of those authorities.

The solution reached in 2012 was won in a coalition Government, where the involvement of local government was very much at the heart of the Liberal Democrat participation in decision-making on that Bill. That is why local Healthwatch organisations are, in part, where they are in relation to local government. But we need now to recognise that as you progress inevitably sometimes people lose sight of the powers they have got, the potential they have and the structure that is available. It is not a flawed structure; it is viable structure, but it depends on those who participate in it using their powers to the full and, in particular and most significantly, on local authorities and the CQC recognising that they must use, amplify and assist the voice for the patient and the care user represented by Healthwatch nationally and locally, and not marginalise it.

Health: Parity of Esteem

Lord Lansley Excerpts

Monday 28th November 2016 Lords Chamber

[Lord Lansley (Con)]

My Lords, I congratulate the noble Lord, Lord Alderdice, on securing this short debate and on the way he introduced it. He set a very helpful frame for it. It is fundamentally not just about funding and structures, but about culture and attitudes. That is what we are aiming for, although I confess that, not for the first time, I will need to talk about funding and structures as well. Perhaps they are entirely complementary.

The noble Lord was kind enough to refer to back to 2011 and the inclusion in the Health and Social Care Act of language intended to demonstrate the commitment to providing health care services to tackle both physical and mental illness. Of course, it was not the first time that public policy had set that objective. It was simply intended to reinforce the February 2011 strategy document, No Health Without Mental Health, published by myself and Paul Burstow, who, as the noble Lord Alderdice, has just said, has been his colleague and was mine at the time. I pay tribute to his work on the document and indeed on the Care Act 2014 which was passed subsequently.

The point about No Health Without Mental Health is precisely the point made by the noble Lord in his introduction to this debate: we completely mislead ourselves if we see physical health and mental health as occupying in any sense different places for us as individuals and us as a society. We cannot have one without the other. In truth, I suspect that if we want to make the greatest possible progress in improving the health of the nation overall, it is in improving mental health that we can secure the best potential return. For young people suffering from serious mental health problems, the impact on their lifetime health and life chances is dramatic. The premature mortality of those with severe mental illnesses is clear, and this is probably the group in society on whom we could make the greatest impact if we could reach out and treat them successfully at an earlier stage. People are not dying because of their mental illnesses; they are dying because of the range of physical illnesses and lack of physical health which are the concomitants of their severe mental illness.

That is why No Health Without Mental Health was the title chosen for the document. Because of that thought, the strategy set itself the objective of trying, as we put it, to “mainstream” mental health into the NHS. It is a fact of NHS life since its establishment in the 1940s that mental health has always been regarded as something separate and different, but frankly it is not. It is a single part of the picture of how we deliver NHS services. Our objective, as part of the structural process, was to try to engineer mental health services into the mainstream provision of NHS services. However, we are still a long way from that. Mental health is not treated in the same way as other services. But we put that into public policy in February 2011, when we said:

“We are clear that we expect parity of esteem between mental and physical health services”.

It was a cross-cutting strategy that was intended to deliver that parity.

As the noble Lord pointed out, why do I and all other former Secretaries of State going back 20 years feel a sense of distress and sometimes despair about our ability to produce precisely that result? I think the answer is that the structures, funding and culture have not yet accepted that mental services should be brought into the mainstream, with all the benefits that that would bring. In my experience as a Secretary of State, mental health trusts were often extremely well run organisations, even by comparison with other community healthcare services. That is why I was so disappointed that the Uniting Care Partnership contract for Cambridgeshire and Peterborough, which faced severe problems from the outset and then collapsed, did not bring acute community and mental health services into one organisation, which would have been really useful.

We all support and want integration of services, but it is not happening in many places, and even where people put the services under a single umbrella, they often do not achieve integration of the professions. Least of all do they provide the integration that should be at the heart of the patient experience, so that people feel that health services are being provided by an organisation that works around them, not to its own structures and definitions. We have a long way to go to make that happen. Another real concern is that we have failed to achieve integration, notwithstanding successive requirements in recent years from government and NHS England for commissioners to increase funding for mental health services at least as fast as for the service overall.

I have to say that, although there were some announcements in September by NHS England and NHS Improvement, the structure of funding to the National Health Service from commissioners plays a part. Most of the time, most of the NHS is funded on the basis of tariff. To that extent, in so far as somebody receives a service from a provider, the provider has recourse—sometimes not enough, they think—to the commissioners to provide for that activity. Mental health trusts are pretty much still all under block contracts. As I said, an effort has been made since September to extend tariffs into mental health services. It should be done on the basis not of episodes of care, but of bundled care and care pathways. When that happens, it will enable mental health trusts to escape from this situation: because commissioners know they have to pay for the tariffs, such trusts are often provided with the residual sum, which means they do not get the funding they could for the activity they undertake.

My colleagues and I could see some of the problems: the number of suicides among young men aged under 45; people having to travel great distances to access care; and rising levels of mental health problems among young women. These and other issues are presenting us with problems. We know we can change the culture. Time to Change, for example, was a very successful programme that continues to be extremely useful, and we now have access standards for mental health services. However, I ask the Minister to take back these questions. How much progress has been made so far in 2016-17 in securing those access standards? How much further do we have to travel? When will we be told what the objectives will be in 2017-18 and 2018-19 for measuring progress towards the 2020 objectives in the mandate for securing access to mental health services?

There is more we can do. We can extend the access standards. We need more quality standards applicable to mental health—the forward programme has only one, although the number published by NICE is valuable. It feels to me and my colleagues that we have much further to go and we need to inject a sense of urgency. That is why I welcome the debate.