Artificial Intelligence: Safeguarding

Baroness Berger Excerpts

Tuesday 4th November 2025 Lords Chamber

Asked by

[Baroness Berger]

To ask His Majesty’s Government, following recent reports by Open AI that many people have exhibited signs of suicidal ideation or other mental health emergencies while messaging a generative artificial intelligence chatbot, whether they have plans to safeguard such individuals.

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

My Lords, safeguarding people experiencing suicidal ideation or a mental health crisis is a priority. We recognise the growing use of generative AI chatbots and the potential risks that they can pose, particularly when people seek support during moments of acute distress. Whether content is created by AI or humans, the Online Safety Act places robust duties on all in-scope services, including those deploying chatbots, to prevent users encountering illegal suicide and self-harm content.

[Baroness Berger (Lab)]

My Lords, ChatGPT is giving British teens dangerous advice on suicide, eating disorders and substance abuse. A report from the Center for Countering Digital Hate found that, within two minutes, the AI platform would advise a 13 year-old how to safely cut themselves; within 40 minutes, it would list the required pills for an overdose; and, after 72 minutes, it would generate suicide notes. Can my noble friend confirm that Ofcom will treat ChatGPT and other chatbots as search engines under the Online Safety Act, and assure the House that the regulator has both the powers and the will to enforce the protection of children code when it comes to generative AI platforms such as ChatGPT?

MBRRACE-UK Report 2025

Baroness Berger Excerpts

Thursday 23rd October 2025 Lords Chamber

Asked by

[Baroness Berger]

To ask His Majesty’s Government what assessment they have made of the MBRRACE-UK 2025 report Saving Lives, Improving Mothers’ Care 2025: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2021–23.

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

My Lords, although the maternal mortality rate has slightly decreased recently, this report makes it quite clear that further urgent action is needed. That is why this Government have launched an independent investigation into NHS maternity and neonatal services, with interim findings expected in December. Moving from care to prevention, the publication of a new maternal mortality care bundle planned for next month targets the five key areas that disproportionately contribute to maternal mortality.

[Baroness Berger (Lab)]

I thank my noble friend the Minister for her reply. I want to ask specifically about the issue of late maternal deaths, which were significantly higher in this reporting period. Deaths linked to mental health issues, including suicide and substance use, were the leading cause of late maternal deaths. Almost half of women who died by suicide were from the most deprived areas. What can we do to stop it being the case that if you are from a poorer background, you are most likely to take your life during this period? Would the Minister consider introducing an urgent referral pathway for women with complex social needs?

[Baroness Merron (Lab)]

My noble friend is quite right in her observation. The maternal care bundle will be a real focus for change and tackling inequalities. Maternal mental health is one of the areas that has been identified for urgent action, because of the ability to improve outcomes and reduce inequalities. Identified pathways, as she describes, are part of the solution that we have under way.

Terminally Ill Adults (End of Life) Bill

Baroness Berger Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Berger (Lab)]

My Lords, there are passionately held views on the subject before us, and the informed and respectful deliberation so far shows your Lordships’ House at its best. We are being asked to legislate for autonomy, but we also have a duty to set out that principle within the reality of our unequal society. I am deeply concerned that the Bill as it stands would not only ignore but deepen those inequalities.

My views are shaped in part from learning about my mother’s work as a counsellor in a palliative care unit and the hours I spent at the bedside of three of my grandparents as they neared the end, including as they took their last breaths. While I am one of the younger Members of this place, and I hope I have at least another 50 years ahead of me, I have thought about the end of my life. Ideally, I would like to die naturally at home, with, if needed, access to the high-quality palliative care that everyone deserves.

While I would not want an assisted death, I recognise that some noble Lords do, as expressed during this debate. We are fortunate: as noble Lords, we have a voice, above-average resources, and agency—the ability to make our own choices, free from interference, prejudice, coercion or undue influence. But assisted dying, if introduced, would exist as a choice not only for us and other comparatively fortunate people; it would enter the lives of those most at risk—people already overlooked, unprotected and vulnerable at the end of life.

It was a privilege to be a Member of Parliament for almost a decade, and I have so many fond memories of my former constituents. But some of the most searing moments I experienced as a Member of the other place came at my weekly surgeries. The first time I heard someone speak openly, in the most unsavoury terms, about wanting a family member dead, I shook. I was appalled, and I could not believe what I was hearing. I was naive to think that this would be an isolated case. I have also not forgotten the words and realities of too many former constituents: people isolated and abused in their own homes, sometimes for decades, in fear for their own lives; people who felt like a burden because of long-term illness or serious mental health conditions, especially the elderly; and people treated as though their lives were worth less because they had a disability. Many were from low-income backgrounds, facing not only poor health but the crushing stress of unaffordable care costs.

These voices still ring in my ears and motivate me profoundly as I consider this Bill, alongside the many powerful representations we have heard in recent weeks, including, as we have heard from other Members, that there is no organisation of or for disabled people in this country that supports the Bill. In considering who the Bill might benefit by giving them more autonomy, we must equally consider who it may harm by taking their autonomy away.

We have a duty in this House to test the Bill’s safeguards when they meet reality, and I think we must also consider the role of family members and carers. The Bill does not require their involvement. It does not even guarantee they will be informed. Yet these are exactly the people who know a patient best, and who may spot signs of coercion, confusion or fear that professionals might miss. Their exclusion is not just a procedural oversight; it is a moral failing.

In conclusion, if the Bill passes, the relationship between vulnerable people and their doctors and the state would change for ever. There would be no going back. This Bill touches the deepest and most exposed moments of human life. It demands our utmost scrutiny, not just in principle but in practice—and, in practice, it currently falls short. We cannot legislate for irreversible decisions on the basis of incomplete protections. We have important work to do.

--- Later in debate ---

Moved by

[Baroness Berger]

At end insert “but that the Committee of the Whole House shall not commence before a report has been received from a select committee appointed by the House to consider certain aspects of the bill.”

[Baroness Berger (Lab)]

My Lords, I have spoken already about how my experience as a Member in the other place has made me very concerned about this Bill, and more determined that it must not be a cause of further harm to vulnerable people. Many unanswered questions about the Bill before us have been raised during the course of this important debate. This is why I have tabled the amendment and the following Motion to hold a Select Committee before Committee of the whole House begins.

This is a significant and complex piece of legislation by any definition. It demands a process that can withstand the weight, but it is clear that there are serious shortcomings, as both the Constitution Committee and the Delegated Powers and Regulatory Reform Committee noted in their reports last week. Indeed, I am concerned that the legislative process is being asked to compensate for the absence of robust policy-making before the Bill was published: no comprehensive review; no public consultation or prior engagement with professionals and other stakeholders; no Green Paper or White Paper, which we would have seen had it been a government Bill—I understand the case made for why it is not a government Bill, but that has diminished what is before us today; and no published analysis of international experiences. Instead, Parliament has been asked to grapple with questions about implementation, safeguards and NHS implications without this groundwork, which we would usually turn to for a law change of this magnitude.

Back in March, Jill Rutter of the Institute for Government—which is neutral on the principle of assisted dying—said:

“We’re expecting Commons scrutiny to do far too much—things it simply can’t do … Commons scrutiny is being left to solve a whole range of problems it isn’t equipped to deal with”.


We have seen the dropping of key but expensive safeguards, such as the review by a High Court judge, and whole new clauses and schedules introduced to replace them with very little opportunity for thorough scrutiny.

It was a clear pattern in the other place that when significant concerns were raised that had not been anticipated, the response was often to add another delegated power. There are now, as we know, 42 delegated powers contained within the Bill: 42 areas where government will work out the detail later, with Parliament largely excluded from the conversation. The result is a Bill that is today substantially different from when the Bill Committee in the other place took evidence in January this year, but now with less clarity.

I do not wish to detain the House any longer than is necessary, but I have been asked many questions on the process about what is before us, which I will seek to address. My amendment ensures that we can have some evidence, expertise and insight on the Bill before us today. We need this information before we commence line-by-line scrutiny.

Noble Lords will have received a letter setting out a condensed list of witnesses that I and other supporters believe this House must hear from, including my noble and learned friend Lord Falconer of Thoroton and those who will bear the responsibility for delivering the Bill, should it pass, and setting out how they would use their delegated powers. These witnesses are to include the Secretary of State for Health and Social Care, the chief executive of NHS England, the Secretary of State for Justice and the Chief Secretary to the Treasury.

We must also take evidence from the professional bodies whose members will be asked to carry out the functions that the Bill sets out: the Royal College of Psychiatrists, the Royal College of Physicians, the Royal College of General Practitioners, the British Association of Social Workers and the Law Society.

We are, of course, not able to hear from serving members of the judiciary, but may hear from the former Chief Coroner of England, Thomas Teague KC, and Sir James Munby, President of the Family Division of the High Court. We must also ensure that we understand the impact of the Bill on our hospices and care homes, through Hospice UK, the Association for Palliative Medicine and Care England.

A previous suggestion of a Select Committee in parallel, alongside a Committee of the whole House, would not achieve—

[Lord Kamall (Con)]

I apologise, I do not want to detain the House any longer than is necessary. Just to clarify, will all the evidence before the Select Committee be published?

[Baroness Berger (Lab)]

I am very grateful for the intervention, and I was just about to come on to that, but I will answer that now. The answer is yes, absolutely. The intention is that all the evidence accumulated and amassed during that time will be published for everyone in the House to interrogate and consider in advance of us going into Committee of the whole House. To confirm, this Select Committee cannot take place in parallel in order that we can receive evidence on vital parts of the Bill before we go into debate, so that we are not in the unenviable position of knowing what is wrong with the Bill but being unable to amend it.

My Motion provides that a Select Committee would be intended as a focused piece of work, hearing vital expert oral evidence, as I have just set out, rather than it being a more time-intensive open exercise. It may report by simply publishing that evidence before we go into Committee of the whole House, in order to inform our detailed consideration of the Bill. As I understand it from the clerks, the revised timetable allows the committee to hold six meetings over three weeks, with two panels of witnesses on each of the days, to begin the week commencing 20 October and allowing it to conclude by 7 November. The revised timetable ensures that the Bill can progress to its next stage and maintain the opportunity for four sitting Fridays before Christmas.

We have, over the past two Fridays, shown the determination of your Lordships’ House to discuss the Bill in a considered and constructive way, and it is my strongest hope that we can continue to do that. If my amendment is accepted, I do not intend to speak on the Motion that will follow, which contains the detail that I have just set out. I am grateful to my noble and learned friend Lord Falconer of Thoroton—

[Baroness Watkins of Tavistock (CB)]

Is the list to give evidence that the noble Baroness has detailed finally determined or would it be possible for us to add the Royal College of Nursing with its 500,000 nurses?

[Baroness Berger (Lab)]

I thank the noble Baroness for her intervention. As I understand it, it is within the gift of the Select Committee to determine who will be called for evidence. I have sought to set out the key people, but of course there will be many other suggestions. Obviously, conscious of the tight timetable, we will not be able to have an extensive list, but I am sure that the chair, when appointed, will consider the suggestion that has been made.

I return to expressing my gratitude to my noble and learned friend Lord Falconer of Thoroton for being prepared to work with me to reach an agreement that would allow the House to engage carefully with the substance of what is being proposed and the powers we are being asked to bestow on Ministers. I am grateful to the many noble Lords who have already indicated in their speeches their support for my amendment and my Motion. I beg to move.

Amendment to the Motion agreed.

--- Later in debate ---

Moved by

[Baroness Berger]

That it is desirable that a select committee be appointed to consider the safeguards and procedures contained in the Terminally Ill Adults (End of Life) Bill; that the Committee shall hear evidence from professional bodies, those with professional experience of coronial services, and Ministers; that the Committee, notwithstanding the usual practice of the House, may report by drawing the attention of the House to the evidence received without making recommendations; and that the Committee do report by Friday 7 November.

[Baroness Berger (Lab)]

I beg to move.

Motion agreed.

Suicide Reduction

Baroness Berger Excerpts

Monday 8th September 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right that there is disparity, which is often linked to priority risk factors, including, for example, financial difficulty, physical health, alcohol and drug abuse, harmful gambling, domestic abuse, social isolation and loneliness. Those priority risk factors are, sadly, more at play in the more disadvantaged areas to which the noble Lord referred. As we seek to develop further the effectiveness of the strategy—we have made great progress so far, but it is not enough—we need to ensure that the whole country is attended to and that we address the risk factors for suicide for everybody.

[Baroness Berger (Lab)]

My Lords, I too extend my warm welcome to my colleague; it is fantastic to see my noble friend back on the Front Bench. In our country, the greatest killer of women in the year after birth is suicide. What are my noble friend and her department specifically doing, within the suicide prevention strategy, to look at this very serious issue? What can we do to stop these tragedies, which affect not only the mothers but their children?

[Baroness Merron (Lab)]

I thank my noble friend for her comments and kindness. She is quite right that maternal health is absolutely key and to speak about the impact not only on mothers but on their children. We have developed a considerable programme for mental health well-being. We are also recruiting 8,500 mental health workers to reduce delays and provide fast treatment, because we need to ease pressure on what are incredibly busy mental health services. The area to which my noble friend referred is key and will be part of our development on maternity provision.

Perinatal Mental Health

Baroness Berger Excerpts

Wednesday 25th June 2025 Lords Chamber

Asked by

[Baroness Berger]

To ask His Majesty’s Government what assessment they have made of the spending on perinatal mental health services in England in the financial year 2024-25.

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

My Lords, this Government recognise the importance of perinatal mental health services. Spending on specialist community perinatal mental health services continued to increase in 2024-25. The latest NHS figures show that integrated care boards spent £212 million that year, which is an increase of £18 million from 2023 to 2024. This does not include spending on mother and baby units. The final spend for those in 2024-25 is not yet available, but £58 million was spent in 2023-24.

[Baroness Berger (Lab)]

I thank my noble friend the Minister for her reply and declare my interest as chair of the Maternal Mental Health Alliance. It is heartening to hear the Government’s assessment that there have not been any real terms cuts to perinatal mental health services this year. That is in spite of evidence from the Royal College of Psychiatrists. I listened very closely to what my noble friend said. She will know that maternal suicide remains the leading cause of maternal death in this country six weeks to a year after birth. Will the Government look to reintroduce the target to increase access to perinatal mental health care, which was dropped from the 2025-26 NHS planning guidance, to ensure that commissioners do not divert funds elsewhere?

[Baroness Merron (Lab)]

I pay tribute to my noble friend for her work as the chair of the Maternal Mental Health Alliance. I share her great concerns about the rate of suicide among new mothers in particular. The NHS planning guidance is not an exhaustive list of everything the NHS does. I am sure my noble friend will remember that the Darzi review highlighted that one of the problems in the NHS was too many targets. We have reduced the number of national priorities by focusing on what matters most to patients but, as my noble friend acknowledged, maternity funding has not been cut. Indeed, healthcare systems leaders now have more autonomy to meet the demands of their local populations.

Care Quality Commission: Mental Health Care Waiting Times

Baroness Berger Excerpts

Thursday 8th May 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for raising her experience with her family. It is clear that patients are individual people and they need to be cared for and communicated with in the way that is appropriate to them. So I am sorry to hear what she reports; that is not what we expect. If she has not already provided the details, I will be pleased to look into the matter she raises, because it has repercussions across the whole system, as she rightly says.

[Baroness Berger (Lab)]

My Lords, the overwhelming majority of mental health conditions start in childhood and adolescence, and we need to do everything to give those children and young people the very best start in life. Yet, regrettably, we know that there are 35,000 children in this country who have been on a waiting list for two years or more. I listened closely to my noble friend on the excellent work that this Government are doing with the support teams in schools, but for those children and young people who have met the threshold for services, what more can be done to alleviate these unacceptable waits?

[Baroness Merron (Lab)]

I pay tribute to my noble friend for her contribution in supporting awareness and improved mental health, not just for young people but in maternity settings and across all mental health services. This morning I was at Alexandra Park School, where I saw what I regard as the exemplar for what my noble friend is talking about, because we need to prevent mental ill-health in young people. That is why we are extending the mental health support teams to ensure that every school has that available. While that is being developed, funding is available for mental health leads in schools. We are also working with local areas to ensure that they meet their obligations to the local community, which of course includes young people. I also feel that our Young Futures hubs will make a big difference. I agree with her: we have inherited a difficult position, but I assure your Lordships’ House that we are working to make progress, particularly for young people.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 29th October 2019 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (LD)]

People outside the House will have listened to the Minister’s warm words, yet we know that still far too many people right across our country are having to travel hundreds of miles to access services. Young people having to travel 300 miles to get a bed is unacceptable. Will the Minister tell us whether the investment she outlined will be ring fenced, because it has not been thus far? Will she also be investing specifically in young people’s mental health services?

[Ms Dorries]

That is a big question because it covers two areas. This Government have invested £2.3 billion in mental health services, a huge amount of which is to go into salaries, to deliver community health services where they are needed: close to patients and to their relatives and families. It is also to provide community health teams and support teams in schools for young people. Clinical commissioning groups are under an obligation to provide those mental health services with the set funding. If the hon. Lady would like to meet to hear more about that, I will be happy to discuss it with her.

The National Health Service

Baroness Berger Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

We are absolutely acting on the area that the hon. Lady quite rightly raises. The number of patients who are in in-patient facilities who have learning disabilities and/or autism has been falling—the number has fallen from 2,700 a couple of years ago to 2,250 on the latest figures. We have a plan to reduce that number further. We must ensure that everybody who comes out of in-patient facilities has the proper care plan and the community support to ensure that that is a sustained change in circumstance. It is something on which we are working incredibly hard. In fact, I was having a meeting with the Minister for Care only yesterday on precisely this issue, and I am very happy to ensure that the hon. Lady gets a full briefing on what we are doing.

[Luciana Berger (Liverpool, Wavertree) (LD)]

rose—

[Mr Speaker]

Order. Before the Secretary of State takes the intervention from the hon. Member for Liverpool, Wavertree (Luciana Berger), I simply make the point that 35 hon. Members wish to speak, and therefore I think I can say with great confidence that he is approaching his peroration.

[Luciana Berger]

I thank the Secretary of State for very kindly giving way, and I welcome the fact that he will be taking forward into legislation the recommendations of the independent review into the Mental Health Act. Will that be accompanied by Sir Simon Wessely’s recommendation that the sector needs £800 million of capital infrastructure to bring mental health settings up to the same standards as those of physical healthcare?

[Matt Hancock]

I want to pay tribute to the work that Sir Simon has done in bringing this matter forward. We are absolutely looking at the capital requirements, as well as the requirements for revenue funding, which have gone up in this area. We will be publishing a White Paper by the end of the year, and then we will bring forward the new mental health Bill as a draft Bill. Mental health is a priority for the Government. These reforms need to be done with care, and I hope again with consensus. The timetable for reform is that requested by the mental health community, but Members should make no mistake, we will act. I am very happy to talk to the hon. Lady with more details.

I do not think that I have ever taken more interventions in a speech, Mr Speaker, and I am now happily coming to my conclusion. This Queen’s Speech has health and social care at its heart. The reforms will help to improve the delivery of the NHS and to bring new cutting-edge treatments to work. They will make sure that our world-beating life sciences are supported; that we have a safer NHS, where we always seek to learn and to improve; that we have a permanent solution for social care, not just a short-term fix and dignity; and that we have dignity and support for everyone receiving mental health care as we put record funding into mental health services. All that will be properly funded, because we have turned the economy round—without a strong economy, we just cannot properly fund the NHS. Today’s debate has shown why we Conservatives are now regarded as the true party of the NHS and we will make sure that it is always there for generations to come up.

Debate interrupted.

Health Visitors (England)

Baroness Berger Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Tim Loughton (East Worthing and Shoreham) (Con)]

I beg to move,

That this House has considered the reduction in the number of health visitors in England.

I am grateful to the hon. Members who have come to speak on this important subject. I declare an interest as the chair of the all-party parliamentary group for conception to age two—the first 1,001 days. I also chair the board of trustees of the Parent-Infant Foundation, which runs attachment facilities and lobbies for better early intervention around the country.

I will start with some slightly alarming statistics. The cost of perinatal mental ill health in this country has been worked out at £8.1 billion per annum, according to the Maternal Mental Health Alliance, with up to 20% of women experiencing some form of mental health problem during pregnancy or the first 12 months after birth. The cost of child neglect in this country has been estimated at some £15 billion, with 50% of all maltreatment-related deaths and serious injuries occurring to infants and babies under the age of one. We currently spend in excess of £23 billion getting it wrong in those early years, particularly for mums and new babies. That is equivalent to something like half the defence budget.

There are 122,000 babies under the age of one living with a parent who has some form of mental health problem. Amazingly—this statistic came out time and again during conversations on the Domestic Abuse Bill—a third of domestic violence begins during pregnancy, and suicide is one of the leading causes of death for women during pregnancy or in the year after giving birth. About 40% of children in the United Kingdom have an insecure attachment to a parent or carer at the age of 12 months, according to Professor Peter Fonagy and others. Alarmingly, there is a 99% correlation between a teenager experiencing some form of mental illness or depression at the age of 15 or 16 and his or her mother having had some form of perinatal mental ill health during pregnancy. It is that close a correlation, making it that much more important that we make sure that the mums bearing those children, and also fathers, are as happy, settled and healthy as possible in those early stages, from conception to age two.

[Luciana Berger (Liverpool, Wavertree) (LD)]

The hon. Gentleman set out the costs incurred in trying to prevent such travesties. Does he agree that the figures he refers to are actually conservative estimates? I believe that he was at the launch, quite a number of years ago, of the Maternal Mental Health Alliance, which arrived at the figure of more than £8 billion. Is it not the case that, although the economic costs are significant, it is the social and moral reasons that have brought Members from both sides of the House here for this important debate?

[Tim Loughton]

If the hon. Lady is patient, I will come on to the social impacts. I think the MMHA report came out in 2014 or 2015, so obviously things will have moved on, although the birth rate has slightly fallen in that time as well. These are substantial financial figures, but as she says, most important are the social impacts and the impact on the child.

On the physical impacts, our childhood obesity rates are among the worst in Europe, while breastfeeding rates in the United Kingdom are among the lowest in the world. We have rising emergency department attendances by children under the age of five, and infant mortality reductions have recently stalled. Just last week, we had the worrying figures about the dwindling vaccination rates in England in particular, with only 86.4% of children having received a full dose of the MMR vaccine. We have effectively lost our immune status, because the World Health Organisation vaccination target to protect a population from a disease is 95%.

The Children’s Commissioner estimates that, in total, 2.3 million children live with risk because of a vulnerable family background, but that, within that group, more than a third are effectively invisible and not known to services and therefore do not get any support. We are talking about an expensive and widespread problem.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (LD)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Bone. I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this important debate and on his work with the all-party parliamentary group for conception to age two—the first 1,001 days.

I will start by paying tribute to the Institute of Health Visiting and, most importantly, to the army of health visitors themselves. I know what an important job they do from my own experience as a mum to a two-and-a-half-year-old and a seven-month-old. In particular, I put on record my thanks to Gill and Katie, who have helped me and my family. Health visitors do a brilliant job against a backdrop of falling numbers, growing caseloads and, in some cases, unconscionable pressures. In the wake of the cuts to public health, it is now clear that we have seen a steady diminution in health visitors across England.

As we have heard, since October 2015, the number of health visitors in England has reduced by a quarter from just over 10,000 to just under 8,000, which piles extra pressure on existing health visitors. Nearly a third of health visitors have case loads of more than 500, which is twice the safe level set by the Institute of Health Visiting. Unfortunately, that can only have a detrimental impact on the quality of care. At best, it risks health visitors being less helpful. At worst, it is counterproductive to their aims and goals.

Looking at a number of indicators, we see that there is mounting evidence that things are getting more challenging. The reductions in infant mortality have stalled. We have already heard about issues around breastfeeding, which is a subject that is particularly close to my heart. We now have some of the worst breastfeeding levels in Europe, and I say that as an MP in Liverpool, where so much work has gone on via our Babies and Mums Breastfeeding Information and Support—or BAMBIS—service to support and assist mums in their own homes. We have seen a great increase in the proportion of women breastfeeding in Liverpool, but levels countrywide are still far lower than they should be. We are facing an obesity crisis. Immunisation rates are falling. We have missed the target for measles and the UK has lost its measles-free status. We are living through a mental health crisis, and I reflect on the fact that the period of a woman’s life where she is 30 to 40 times more likely to experience a period of psychosis is the year after birth. That is the moment in her life where extra additional support is needed.

We see a particular challenge with adverse outcomes not being distributed evenly, which speaks to health inequalities. That issue falls far down the agenda and gets much less attention than it deserves, but we are seeing a widening of inequalities across the country. Poor health goes hand in hand with someone’s postcode, income, social status and what their parent or parents do for a living. The impact of inequality is keenly felt in too many areas, including in Liverpool and other disadvantaged neighbourhoods. Nearly 70% of health visitors have reported having to access emergency food aid and go to food banks on behalf of the families they are supporting. The Institute of Health Visiting stated in its report that those inequalities resulted in poorer physical and mental development, poorer academic achievement and poorer employment prospects at every stage of a child’s life.

We are talking about the most fundamental of issues: how can we ensure that every child born in this country has the best life outcomes and best life chances? Health visitors play such an important part in those outcomes and provide such a vital intervention in supporting new parents. The list of what they do goes on and on, and we have heard much about that already. They also play an important part in preventing ill health, rather than trying to cure it later. Health visitors play a critical role beyond health, whether that is supporting troubled families, improving early language development and learning at home, particularly where a child might have special educational needs, or improving parental confidence and knowledge to avoid unnecessary trips to our health service.

Health visitors should form part of a truly integrated system of health, care and wellbeing that is tailored to the parent and child, with the right interventions, advice and support at the right time. I reflect on that as a member of the Health and Social Care Select Committee on. We did a report called “First 1000 days of life”, in which the first priority was for every child to receive the five mandatory visits. In fact, we said that that number should be increased to six, with a visit at three or three and a half years old to ensure that every child is ready for school. We perhaps do not like to talk about that issue, but we are seeing increasing concern about it from teachers across the country.

I am conscious that my time is coming to an end, so I want to reflect on that recommendation from the Health and Social Care Committee. Health visitors play such an important role. They support families where others do not have the opportunity to do so. They enter people’s homes and they are trusted. When I think about all the health professionals I connected with as a new parent, it was my health visitor whom I relied on. We need to ensure that we are not creating the conditions for a public health crisis for future generations, and I hope that in the Minister’s response we will get some glimmers of hope that we will see an increase in the number of health visitors, not a further decrease.

The National Health Service

Baroness Berger Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (LD)]

It is a pleasure to follow the hon. Member for Hartlepool (Mike Hill) and I share a number of the assessments that he made in his contribution, because as the House pursues our debate on the Queen’s Speech, it is becoming ever more apparent that the casualty of a Tory Brexit will be Britain’s national health service.

The NHS is our greatest national asset; it is the product of the fusion of radical and enlightened minds in the last century that gave us healthcare for all based on need, not means. But now, in this century, the NHS is in great peril from a toxic combination of chronic underfunding and withdrawal from the EU, and responding to very different challenges from those when it was first created so long ago.

Notwithstanding the announcements in the Queen’s Speech, let us be very clear that the NHS is not in receipt of the resources that it needs to be effective. That was discussed only yesterday at the Health and Social Care Committee, when we had with us the Secretary of State and we talked about the backlog of £6 billion in NHS repairs alone, so an announcement of half that really is no cause for celebration. We heard from the Health Foundation, and its assessment of the Queen’s Speech funding announcement says that

“it falls well short of the scale of the challenge.”

We have a Prime Minister who announced 40 new hospitals, which then was downgraded to six within days, and we see demand for healthcare from our growing and ageing population outstripping the availability and quality of services, which means rationing and a diminution of quality of care; many right hon. and hon. Members from both sides of the House have referred to that in the debate this afternoon.

[Norman Lamb]

Does my hon. Friend agree that another sign of a system under unacceptable strain is the fact that teenagers around the country are often waiting a year or more for access to mental health treatment? I know of two teenagers who have recently had their first appointment after a year of waiting, which seems to me to be utterly intolerable.

[Luciana Berger]

I thank my right hon. Friend for making that really important contribution, and waiting times are a particular issue in our NHS, especially in the Cinderella of all Cinderella services, our CAMHS. Too many young people right across our country are struggling to get a referral and then, if they do get that referral, having to wait months on end. Frankly, it is unacceptable.

[Mike Gapes]

There is a further problem with teenagers when they reach the age of 18, because there is a gap between the CAMHS and adult services. Far too often, young people who have been given help when they are 16, 17 and 18 suddenly fall off the cliff and there is no support for them.

[Luciana Berger]

I thank my hon. Friend for making that important contribution. There is a cliff edge in our young people’s mental health services when they transition into adult mental health services. They have to start all over again and repeat themselves. There are a few places across the country that are creating mental health services for young people up to the age of 25, and that is welcome, but it is the exception rather than the rule. We need to do everything possible to ensure that young people have continuity of support in their mental health services at that fragile moment in their life, because not receiving that critical support can have a detrimental impact on their ability to access education, to maintain relationships with family and friends and to get into employment.

I am particularly concerned that we have seen a serious reduction in the state of our services in the past year. I refer to the Care Quality Commission’s “State of Care” report, which came out this month. It looked at acute wards for adults of working age, psychiatric intensive care units, child and adolescent mental health in-patient services and in-patient services for people with learning disabilities or autism, and it found a significant increase in the number of those services that are now rated inadequate. Those are services for some of the most vulnerable people in our country, and we should be improving them rather than seeing an increase in inadequate ratings from 2% to 8%, 9% or 10%. That is unacceptable, and I hope the Minister will address that serious point in his response. In particular, we know that this is as a result of too many of the people using mental health and learning disability services being looked after by staff who, according to the CQC,

“lack the skills, training, experience or support from clinical staff to care for people with complex needs.”

Again, I hope the Minister will respond to this important point.

This is not just about care for people with mental illness or disability. We are seeing that same story right across our NHS, with patients waiting far too long. We have heard significant figures, with millions of people across the country struggling to access services. They are also having to travel too far for the treatment they need, and too many areas still have too few staff and not enough resources. That is reflected in the 2019 British social attitudes survey, which shows overall satisfaction in our NHS falling by 3% in the last year to 53%. The main reasons given for that include long waiting times, staff shortages and a lack of funding.

Notwithstanding the announcements in the Queen’s Speech on patient safety and changes to mental health legislation, which I welcome, I want to reinforce the point I made to the Secretary of State that this is not just about changing the Mental Health Act and that we need to have the resources for the capital infrastructure to ensure that we raise the standard of mental health in-patient settings to the same standard as physical health in-patient settings, along the lines of the recommendations given by Sir Simon Wessely, who conducted that important review for the Government.

Let us be clear that the pressures on our NHS are urgent and that they demand action, before we even contemplate the existential threat to our NHS because of Brexit. I want to talk about Brexit, because we did not hear about it today from the Front Benches. We had a reference to it from the Secretary of State, but not an actual analysis of how Brexit will impact on the provision of our national health service. We know that the impact on our economy so far from Brexit has been between 1.5% and 2.5% of GDP since 2016, and by the Government’s own assessment, Brexit will impact on our GDP by up to 9.3% over the next 15 years. We are still waiting for those further economic impact assessments on the withdrawal Bill that we have seen in the past week.

We have already discussed the impact of Brexit on our NHS workforce. We know that 63,000 EU nationals work in our NHS and that 104,000 work in adult social care. We should be lining up to thank each and every one of them for the role they play and the contribution they make to our national health service, instead of making them feel like unwanted strangers. I am surely not the only MP who has received representations from people who are serving our NHS and social care service, who go above and beyond under incredible pressure to provide the best possible levels of care and who are feeling worried about what the future holds. They are particularly concerned about the Home Secretary’s proposed immigration rules and the damage that they will inflict on our ability to recruit doctors, nurses and social care workers from the EU and the rest of the world.

I could talk about the threat of access to medicines, the creation of a new medicines approval regime, which will lead to further delays, and the impact on medical research.

[Chris Ruane (Vale of Clwyd) (Lab)]

Will the hon. Lady give way?

[Luciana Berger]

Forgive me, but I only have 18 seconds, so I will not give way.

We should be addressing all that as a nation, and how we keep people well was missing from the Queen’s Speech. Other people have talked about prevention, and the lack of focus on public health in the Queen’s Speech is pitiful. We could be doing so much more, and I urge the Minister to refer to that in his response.