King’s Speech

Baroness Finlay of Llandaff Excerpts

Friday 19th July 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I warmly congratulate the Ministers, the noble Baronesses, Lady Smith of Malvern and Lady Merron, on their appointments. We will all miss the wisdom, experience and kindness of the noble Baroness, Lady Jolly. I declare that I chair the Bevan Commission in Wales, was a governor of Howell’s School, Llandaff, and president of the Chartered Society of Physiotherapy, and my palliative care roles.

I welcome the focus in the gracious Speech on prevention in healthcare, its crossover to the well-being of children, and how rehabilitation can prevent further problems when disease or injury strikes. Our previous tobacco control legislation did not go far enough; we never anticipated the advent of addictive vapes. Last year, one in five children used a vape. More than 7.5% of children are current users, mostly of disposable vapes from shops, so new controls are welcome and long overdue.

Some 2.5 million children in England are overweight or obese, setting a lifetime of problems. Good nutrition starts with breastfeeding and support to new mothers in the early years, but despite tackling junk food the gracious Speech failed to mention the addictive calorie-laden product, alcohol, which is closely linked to violence and anti-social behaviours. Will the Government support my Private Member’s Bill on alcoholic beverage labelling?

Yes, the NHS needs transformation. Only yesterday, I encountered an ICB whose risk-averse policies are inhibiting community hospice carers from meeting patients’ analgesic needs. We must shed silly rules and wasted duplication of effort, free staff to care with initiative, and support innovation. A funding formula for palliative care is long overdue.

Rehabilitation is critical to prevention. It reduces pressure on acute and emergency services, reduces social care need, and supports those who want to and can go back into work. Today, one in three people’s health conditions would benefit from rehabilitation, and more than a million emergency department attendances a year could be avoided. Improving cardiac rehabilitation from its current 50% level to 85% could prevent 50,000 admissions in England alone. Each year, 120,000 patients survive critical illness, but 98% of those develop post-intensive care syndrome, with impaired physical, cognitive and psychological functioning and loss of independence, and a third remain care-dependent with major impacts on their families, especially their children.

Specialist rehabilitation programmes starting in ICU are cost effective. There is, for example, a lifetime saving of about £700,000 per patient with traumatic brain injury. Patients can even get back to work, but sadly few such programmes exist. For those who do not survive and who are dying, integrated palliative care can be transformative. Reliance on charity donations is invidious.

For children with serious conditions, rapid early diagnosis and intervention can move them from a life of dependency to a life of independence, yet more than a quarter of a million children are waiting for community health services, with 22% of them waiting over a year. Some 21% of A&E attendances overall are in children from nought to 14 years, and for 40% of those continuity would be better had they been seen in the community.

Finally, I turn to schooling for children with difficulties. Overall, there are 90,000 children with special educational needs in private schools, as well as children who have been seriously bullied, are refusing school, and whose parents or grandparents do without for the child’s supported education. Independent schools estimate that they save £4.4 billion from the education budget. I wonder what will happen to service families whose children have to board. Will we risk the income to the country, already experienced by universities, if we lose many of our 63,000 international schoolchildren? In Wales, if 19 of the 69 independent schools have to close, the Welsh Government will face an £80 million funding gap. Can the Minister reassure us that Wales will receive its proportion of the estimated increased revenue from VAT, in line with Barnett differentials? I hope so.