(7 years, 8 months ago)
Lords ChamberMy Lords, it is clear that there is a huge mutuality of interest in negotiating a free, frictionless trade agreement between the EU and the UK. In the car industry and industries where, as the noble Baroness indicated in her question, there are integrated supply chains, it is doubly in the interests of both parties to negotiate such an agreement.
Why is it that the Foreign Secretary says one thing and the Prime Minister says another? Surely, the industry knows what is good for itself. The industry is quite clear that we need a deal, but the Foreign Secretary says that it is unimportant and we can walk away.
My Lords, I think it is clear, as the Prime Minister has said—and the Government subscribe to the views of the Prime Minister—that we would like to negotiate a free trade agreement with the European Union with as few non-tariff barriers as possible. If we are not able to negotiate such an agreement, we will fall back on the WTO rules.
(7 years, 11 months ago)
Lords ChamberI think the right reverend Prelate has raised an incredibly important issue. Around 300,000 young people go to A&E every year through self-harm, after cutting or burning themselves very badly. The right reverend Prelate asked about advice and guidance. In 2004, NICE put out explicit guidance that all those people should receive, at the very least, a psychosocial assessment; today, only 53% of those people—young people in the main—receive such an assessment. That means that 100,000-plus people are going to A&E with this very nasty self-harm and are really being sent home with very little. That is quite an indictment of our system and the words that we have about parity of esteem. I entirely take on board exactly what the right reverend Prelate said. There is a lot more we can do, and perhaps in response to subsequent questions I shall try to say what we are doing.
The Minister will know that the mental health service is in crisis. He says on a regular basis that the Government are putting more resources into the area of mental health for young people. He also knows that that money is not getting spent by the trusts. When is he going to sack the trusts, or sack the chief executives of the trusts, for failing to spend that money on vital services for young people?
Last year, the rate of spend by CCGs on mental health went up by 8.6%, compared to 3.7% across the board, so the money is starting to get through. The fact is, though, that there are nooks and crannies in our NHS—which we all love—where we have fundamentally let people down for many years. The issue of self-harm and the suicide risk that derives from self-harm is a very black hole at the heart of the NHS.
(8 years ago)
Lords ChamberThe noble Baroness is right to say that childhood oral health is very poor, but it is getting better. Some 75% of children no longer have tooth decay compared with 69% in only 2008, but it is still not good enough. The Government’s policy is very much around prevention rather than treatment. The new contract being discussed with dentists will put this work on to more of a capitated basis rather than an activity basis. NHS England has identified 10 areas of deprivation for special treatment and we are looking at a new programme with Public Health England to improve education in this area. Quite a lot is happening.
My Lords, surely the way to prevent this is by introducing fluoride into the water supply and to ignore those people who think it is a bad thing. Does not all the evidence seem to suggest that it would be very good, especially for deprived communities?
My Lords, the evidence for fluoride is incontrovertible: it is good for teeth. There may be other issues attached to fluoride, but in terms of dental health it is unquestionably a good thing. It is interesting to note that in Birmingham, which has been adding fluoride to its water for many years, the incidence of child tooth decay is 29% whereas in Blackburn it is 57% and in Hull, which is considering fluoridation, it is 37.8%. The evidence is very strong, but it is up to local authorities to decide.
(8 years, 1 month ago)
Lords ChamberMy Lords, I do not think I can answer the question about who will fund the training; I will write to the noble Baroness to answer it. She is absolutely right that a huge proportion of people who are in the criminal justice system, in prison, also suffer from mental health problems. Tackling the mental health problems of people in prison is just as important as tackling them outside. If I may, I shall write to the noble Baroness on this matter.
I must tell the Minister that there is very little sign of any investment in mental health services taking place in Merseyside. Will he investigate what is happening to that investment strategy and why Merseyside is failing our children and failing to invest in this vital service?
My Lords, I am obviously disappointed to hear what the noble Lord says about Merseyside; I cannot answer specifically on Merseyside today. We have the Future in Mind strategy, which pledged £1.4 billion of extra spending over the lifetime of this Parliament for children and young people. If it is not reaching the front line in Merseyside, we should look at that.
(8 years, 4 months ago)
Lords ChamberNo, I do not agree with that. Where I do agree with the noble Baroness is that this has gone on for far too long. We have been in discussion on this issue for nearly four years. It has got to come to a resolution, so the Secretary of State is absolutely right to introduce this new contract.
My Lords, what would the Government do if large numbers of junior doctors decided to resign rather than accept the new contract?
There is no indication that large numbers of junior doctors are resigning because of the introduction of this new contract. If it does happen, we will have to address that issue when it occurs.
(8 years, 4 months ago)
Lords ChamberI entirely endorse the words of the noble Baroness, which I am sure will be reiterated in the obesity strategy when it is announced later in the summer.
My Lords, does the Minister agree with me that far too much attention has been given to sugary drinks, the consumption of which has been in decline for the past 10 years, and not enough attention given to other unhealthy foods that are causing the problems?
I think that the levy on sugary drinks has been universally welcomed as a start. That the proceeds of the levy will be put into the sport premium in primary schools and lengthening the school day in secondary schools is all for the good. If we are to address obesity, it has be across a very wide front.
(8 years, 5 months ago)
Lords ChamberMy Lords, under the Care Act there is an assessment, eligibility criteria and a support plan. Clearly there is no point having a plan without the support.
My Lords, will the Government consider setting up an independent review to look at the sorts of budgets that local authorities will require to provide a decent service?
As part of the consultation that is being conducted in preparation for the publication of the strategy at the end of the year, the Government have called for evidence, looking at international comparisons as well as an economic review, which I am sure will take into account the issues the noble Lord raises.
(8 years, 6 months ago)
Lords ChamberMy Lords, traffic accidents caused by alcohol have been costed. I cannot give the noble Baroness that figure today but I will write to her with it. I do not believe that we are currently reviewing the alcohol limit for driving, although I know that in Scotland it has recently been reduced.
My Lords, have the Government considered using the tax system to encourage people to drink lower-alcohol drinks?
That is a very good question. I do not have the answer to hand but I would like to think about that and write to the noble Lord. As part of the responsibility deal that was done with the industry in 2010, there has been a significant increase in lower-alcohol drinks, but I will have to come back to the noble Lord on that issue.
(8 years, 6 months ago)
Lords ChamberNo; the noble Lord has misunderstood the contract. The number of hours are coming down, not going up.
My Lords, the Government are pursuing a policy which is not evidence-based and is driven by dogma. Would it not be better to seek arbitration to get us out of the mess they have got us into?
My Lords, we now have a pause for five days. This is not dogma; we have two parties who have different views about a small part—about 10%—of the existing contract. Over the next five days we have a chance to resolve that.
(8 years, 7 months ago)
Lords ChamberMy Lords, I find it hard to believe that anyone can think that mental health is not a key priority for this Government, given that we have promised to spend another £1.4 billion on children and young people’s mental health and a further £1 billion a year on adult mental health, along with accepting the findings of the Farmer report in full. I assure the House that mental health remains an absolute priority for the Government.
My Lords, quite frankly, our experience is that a crisis is taking place, especially in children’s mental health services. Has the Minister visited these centres to see whether that money is being delivered? Our experience is that it is not.
I think there is a general recognition that mental health has been the Cinderella service of the NHS for generations and that, within that, mental health provision for children and young people has been a Cinderella service within the Cinderella service. We are putting a great deal of resource into it. Yes, I have visited a number of mental health care trusts. We all know at first hand that the service is highly underfunded, which is why we have committed to spend this extra money on it over the next five years.
(8 years, 8 months ago)
Lords ChamberMy Lords, clearly it must make more sense to provide better treatment for elderly people in their homes, away from hospitals, particularly for those with often multiple long-term conditions. One of the tragedies of government policy since 2000—this goes across both parties—is that, although the rhetoric has been about moving care out of hospitals into the community, it has been extremely difficult to do it.
My Lords, does the Minister accept that, although they may not be the only cause, the cuts in social care have had a profound effect on overcrowding in our hospitals? Would it not be a good idea to reverse those cuts and take some of the pressures away from our hospitals?
My Lords, I think it is well understood that the integration of healthcare and social care is hugely important and that the two cannot be seen in isolation. It will be very interesting to see how things develop in Manchester, where we are going to see an experiment in the integration of health and social care on a very large scale.
(8 years, 8 months ago)
Lords ChamberThe noble Lord raises an interesting point. I do not have an answer to his question except the straightforward, “I do not know”. I hope that when the WRES data on staff come through, they can be extended to patients and carers as well—as suggested in the recent report by the noble Lord, Lord Crisp. That information and evidence should then be made available.
My Lords, the Government seem to be setting great store by the fact that they are waiting for a review. It is well known that mental health services are massively under-resourced. Would it not be a good start to put some resources into those services?
My Lords, the Government are committed to putting more resources into mental health. There is a recognition, across all parties in this House, that mental health has been a Cinderella service for ever. We are all committed to parity of esteem between mental and physical health and more resources are now going into mental health.
(8 years, 9 months ago)
Lords ChamberMy Lords, the noble Baroness raises an important point, but it is not new: 24% of all doctors who work in the NHS have been trained overseas. This problem goes back over 20 to 30 years. We must train more of our own doctors. On the specific point on emergency medicine, I was surprised that, over the last 10 years, there has been an increase in emergency doctors—A&E doctors in the main—of 9% per annum, against growth in demand of between 2% and 3%. That does not fully answer the noble Baroness’s point, but, compared with other parts of the NHS, there has been greater investment in doctors and other staff in emergency medicine.
My Lords, will the Minister give us more detail on the action he has taken on the scandalous use of agency staff in the NHS? Will he tell us how long it will take to deal with this problem?
My Lords, this is a big problem, and to fully address it will take up to two years. We are addressing it in two respects: first, the number of people coming in through agencies; and, secondly, the mark-up that agencies charge, which is sometimes more than the cost of the person being supplied.
(8 years, 9 months ago)
Lords ChamberMy Lords, that is clearly a very good question. At our level, we will monitor this through the mandate given to NHS England. Within that mandate, it has told all CCGs that they must increase their spending on mental health services by, I think, at least 3.7%. The noble Baroness will be interested to know that in the first six months of this year the increase in spending on mental health has been 5.4%, so it is higher than the stipulated 3.7%. Over the next five years I think we will see a trend towards more money going into mental health and primary care and away from acute care. We should not underestimate the very difficult impact that will have on many of our acute hospital services. The transformation will be very difficult. We may not agree on how much money it will take but I think we all agree in this House on the direction of travel—that it must be right for money to be spent in those areas. I hope that answers the noble Baroness’s question.
My Lords, the Minister will be aware of the acute shortage of mental health beds for children. How many new beds will be provided by the Statement?
My Lords, this Statement does not deal with children. The Government have promised to spend an extra £1.4 billion on children and young people over the next five years. I cannot recall the impact that it will have on the number of beds but there will certainly be more beds for children experiencing severe eating disorders. I will have to write to the noble Lord with that information if that is all right.