Health Bill

Lord Singh of Solihull Excerpts

Wednesday 11th November 2026 Lords Chamber

[Lord Singh of Solihull (Con)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Coffey, and I thank her for Amendment 48. Small employers rarely have access to occupational health and the NHS, our largest employer, loses far too many working days to sickness. Her amendment is about helping people stay in work; mine is about helping young people to get there, often for the first time. I am glad that our amendments are grouped together, because they rest on the same principle. Health and work are not competing concerns but integral parts in a single life.

I speak to Amendment 279QF in my name and refer the Committee to my interests on the register. I am an NHS consultant psychiatrist, and for the last 25 years I have devoted my life to delivering early intervention in psychosis, nationally and internationally. My amendment asks the Government to commission an independent review of the therapeutic role of work in recovery from mental illness for young people. For far too long, we have treated work as an economic question, and almost never as a clinical one.

Let me begin with a paradox. When in life we are at our most physically robust, during late adolescence and early adulthood, we are at our most vulnerable psychologically. Half of all adult mental disorders begin around the age of 14 or earlier; 75% begin before the age of 25. Therefore, mental illnesses arrive just when a life is being built: exams are being sat, jobs found, relations formed and independence discovered.

Among the many serious illnesses, the most serious are psychotic disorders such as schizophrenia. They fracture your thinking, break your networks, scatter friendships and delay your education. When I began training, our approach to psychosis was gentle management of inevitable decline. However, I vividly remember a young man I met on a psychiatric round, very early in my training. We fell into a conversation. Rather randomly, he asked me whether life was worth living, almost as if it was a joke. I said, “Life is what we make of it. We can think of each day as a blank page in a diary and, within reason, we can choose what we write on it”. We parted company and I forgot all about him. Three years later, I received a letter from him. It said that he had been diagnosed with schizophrenia while a patient in that hospital. He had been told by a doctor that he would never recover. He was considering suicide. That accidental encounter with me changed his mind. He was now at university, fully well and looking forward to a future. If a few words from a stranger can provide such comfort to someone in such deep anguish, imagine what hope engendered by trained clinicians can do for those who suffer.

Early intervention in psychosis has completely changed our view of it, from pessimism about inevitable decline to optimism about intervening early. We now know that early intervention works. The earlier we intervene, the better the outcomes. England now has the best early intervention services in the world. Most young people with early psychosis now reach remission from their symptoms, but recovery is more than absence of symptoms. Your voices may have gone but you still do not have a job. You are staying in your bedroom. You have no friends and are socially isolated. You have nothing to look forward to. The young man who is no longer hearing voices has not recovered; he is simply not acutely ill any more.

This is where IPS—individual placement and support—comes in. This is an approach to vocational rehabilitation. Traditional approaches were “train, then place”. IPS says, “Place and then train”. It helps a young person quickly to find a job that is of interest and to their preference, and then supports them, along with their employer, to stay in employment. As my noble friend Lady Coffey said, employers need support for that as well. IPS does not wait for full recovery. Nobody is turned away because they still have symptoms. You may still be hearing voices or be slightly low or anxious. Added to early intervention, IPS increases employment rates from around three in 10 to around six in 10. In a randomised trial with colleagues, we went one step further; it was published in the British Journal of Psychiatry. We randomised teams into those where clinicians were given some training, along with IPS in both teams. Among the clinicians, we tackled their ambivalence about young people returning to work. Employment rates in those teams more than doubled, from 18% to 43%.

We found that the obstacle was not the illness as much as people’s ambivalence about young people with mental illness returning to work. Clinicians had told us, “Work would be stressful and would trigger a relapse” or “This young person does not have the confidence to go to work”. These fears were well intentioned but completely wrong. As I said in my maiden speech, diagnosis should never be a prophecy.

Work is not incompatible with recovery; it is an essential part of it. There is robust evidence of the benefits of work. Those who work less have poor mental health, and those who return to work see their mental health improving. Work gives a day shape, and it gives an individual an identity and a role in society. It also builds self-esteem. We assume that confidence must come before achievement, but it is the other way around. Self-esteem is not a precondition for achievement; it comes from achieving and from facing adversity—getting back to work despite having to struggle. If young people with psychosis can return to work, and work is healing, then we should be offering similar opportunities to a much larger group of young people who are suffering from depression, anxiety or neurodevelopmental conditions such as autism and ADHD. Trials of IPS in young adults with a range of mental illnesses show that it can be effective.

Let me be clear: this is not an argument about cutting benefits or using work as a stick. A young person pushed into work that they cannot yet manage may fail, and that failure will only confirm the prophecy we are trying to break. But offered with skill and at the right time, work is therapeutic. The economic case is compelling, but the case I make for this review is also clinical, moral and humane. I hope the Minister can tell the Committee whether the Government will commission such a review within 12 months, and whether she will meet the noble Baroness and me to discuss how both our amendments can find their place in the Bill. Thanks to early intervention, we no longer think of a 16 year-old with emerging psychosis as facing inevitable decline. For young people recovering from psychosis, a job is not a reward for getting well. Very often, it is part of how they get well.

[Baroness Hollins (CB)]

My Lords, I support both amendments in this group. The amendment tabled by the noble Baroness, Lady Coffey, draws attention to the responsibility of the NHS not only to treat illness but to help people remain healthy enough to work, and to return to work.

As a psychiatrist, I am especially concerned about the growing impact of work-related stress, anxiety and depression, and the figures are deeply troubling. A recent Policy Exchange report estimated that sickness absence in the NHS represents the equivalent of more than 80,000 employees being absent throughout the year—enough to staff 80 hospitals—at an annual cost of some £4.6 billion. In June 2025, anxiety, stress, depression and other psychiatric illnesses accounted for almost 30% of NHS sickness absences. Behind these statistics are people whose health and confidence have been damaged, colleagues struggling to cover their work and patients waiting longer for treatment. When one clinician goes off sick with burnout, colleagues must take on additional clinics. Their workloads increase, their own well-being suffers and the risk of further sickness absence grows. This is a vicious cycle. It cannot be resolved simply by encouraging people to return to work more quickly. We must ask what made them ill in the first place.

There is also a more disturbing dimension. Suicide among healthcare professionals is a serious concern, particularly in some clinical occupations. Data from the Office for National Statistics in the 10 years up to 2020 showed that there were an average of four deaths of healthcare workers by suicide every week. While we need to be cautious about interpreting occupational suicide statistics, we cannot ignore the distress experienced by staff working under sustained pressure. The NHS has a duty of care to its workforce, just as it has to its patients. Occupational health needs to be about much more than assessing fitness to work; it needs to include early psychological support, effective supervision, manageable workloads and so on. Small employers need access to similar expertise, which many cannot afford to provide independently. I hope the Government will consider how NHS occupational health services, working with other providers, might help develop accessible support for smaller businesses without diverting resources from patient care.

The therapeutic value of good work depends on the work itself being healthy. If we want the NHS to help people remain in employment, it must demonstrate what it means to be a good employer. I added my name to the amendment by the noble Lord, Lord Singh, calling for a review of

“the therapeutic role of work in health and recovery”.

Good work can give us a reason to get up in the morning. It can provide structure, purpose, friendship and the satisfaction of knowing that our contribution matters and that we have something worthwhile to give. As a psychiatrist, psychotherapist and family carer, I believe that these ordinary human experiences deserve much more attention in our discussions about mental ill-health prevention and recovery.