NHS Funding Bill (Money Bill)

Baroness Penn Excerpts

3rd reading & 2nd reading & Committee negatived & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords & Committee negatived (Hansard) & Committee negatived (Hansard): House of Lords
Wednesday 26th February 2020 Lords Chamber

[Baroness Penn (Con)]

My Lords, I declare an interest as vice-chair of the Specialised Healthcare Alliance, and shall endeavour to keep my remarks—like the Bill—brief. Having been part of the process that negotiated the funding that we are legislating for today, I felt compelled to speak. It took many months to reach agreement on what was to become the longest and largest funding increase in the NHS’s history, so I wholeheartedly welcome the contents of the Bill.

I would, however, like to make two points. First, as has been said in the Chamber today and as was acknowledged at the time, the job was not finished. Understandably, perhaps, the Treasury felt considerable consternation at announcing such a large fiscal commitment outside of a formal fiscal event. Therefore, a number of items were left on the to-do list for a later date: capital; education and training budgets; public health delivery; and social care funding and reform.

The Minister said that it might be premature to include those in this Bill, but I say to him gently that we have had several formal fiscal events since this spending was announced over 18 months ago. There have been welcome steps in these areas, but ultimately they remain unresolved. I will not ask the Minister to preview what is in next month’s Budget or the spending review later this year but I hope that the Government will use them as an opportunity to provide for long-term, multiyear commitments in these outstanding areas. If they do not, we will continue to face situations such as with the public health grant allocation, where providers do not know their financial position, with just over a month to go before the start of the financial year. Can the Minister tell the House when the allocations for that grant will be confirmed? Only if we invest in prevention, capital and workforce on a long-term basis will we create the capacity in the system for the extra money in this Bill to actually improve services and outcomes for patients.

The second area I wanted to touch on is mental health. During the discussions about the funding settlement provided for in the Bill, I had a specific aim: to ensure that the money and the long-term plan that accompanied it reflected in a meaningful way the priority the Government gave to improving mental health services. Too often the refrain on mental health was that, while all the work across different government departments and across society, from tackling stigma to improving workplaces and schools, was welcome, it would not shift the dial while mental health services were underfunded and overpressured.

I do not pretend that the funding we are voting on today solves that problem, but there were two important steps in the right direction, as has already been noted: first, that mental health funding would increase as a proportion of overall health funding in each and every year, and secondly, and importantly, that this commitment would be traceable and auditable. Alongside that funding, though, the Government committed to reform and in particular to updating the Mental Health Act, which dates back to 1983. Although I support the Bill, it is also, as the House of Lords Library politely puts it,

“an example of the Government committing in primary legislation to an action which is already within its power.”

In contrast, there are few areas of legislation that so directly impact the lives of individuals as the Mental Health Act, and it is overdue for reform. I therefore hope the Minister is able to reassure me that the time spent on this Bill has not been at the expense of producing the White Paper and drafting the legislation needed to implement the recommendations in Sir Simon Wessely’s excellent review of the Mental Health Act.

I was pleased to receive a Written Answer from the former Minister. I took heart that the White Paper would be published not merely “in due course” but in the next few months, although I am not sure where that sits in the hierarchy of government timings compared with “shortly”. If I am able to tempt the Minister to go even further today and specify a month by which we can expect that White Paper to appear, my support for the Bill will be even more fulsome than it already is.

--- Later in debate ---

[Lord Bethell]

The noble Baroness makes an important point and her work in this area is well known. It would be, however, slightly outside the remit of the Bill to go into that in great detail. I do not have the answer she is looking for but should be glad to meet her to discuss this important matter. I share her concerns and my interests in the area are entirely aligned with hers.

My noble friend Lady Penn put us all on the rack regarding the mental health White Paper. I would very much like to give her the absolute date and concrete publication arrangements for it but that is slightly beyond me. However, I reassure her that it will be within the next few months; spring is the hoped-for arrival time.

[Baroness Penn]

Can the Minister define when spring ends and summer begins?

[Lord Bethell]

My noble friend asks a question of such philosophical Whitehall subtlety that it is way beyond my pay grade to provide a clear, etymological answer to that. However, I reassure her that the matter is an enormous priority, and when I go back to the department I will lean on it hard to deliver this important publication.

The commentaries of my noble friend Lady Penn and the noble Baroness, Lady Tyler, on the visibility of spending on children’s mental health was important. The Government are 100% aligned on this. I noted the Minister of State from another place standing at the Bar, nodding with agreement while those words were being said. I know that a meeting has been agreed on this matter and a date is in the diary, I believe for next week, and I very much look forward to the outcome. I reassure the House that this question of visibility and publication is taken ex3tremely seriously.

The noble Baroness, Lady Tyler, asked about the mental health investment standard. CCGs are required to increase investment in mental health, as discussed earlier. All CCGs are on track to meet that standard, as the noble Baroness, Lady Hollins, rightly pointed out in 2019-20. I suggested in my previous speech that it would be premature to legislate for specific aspects in the Bill and capital will be considered in other fiscal events.

The noble Lord, Lord Bradley, spoke movingly about children’s mental health. I reassure the House that, in addition to increased mental health funding, we are implementing a progressive programme of transformational change for children and young people’s mental health services. This will include incentivising every school or college to identify and train a senior lead for mental health, creating new school and college-based mental health support teams, and piloting a four-week waiting time for children and young people’s specialised services.

The noble Lord, Lord Hunt, the noble Baroness, Lady Finlay, and others brought up the sensitive subject of adult social care. Fixing that long-term issue is one of the great challenges that this Government have taken to their shoulders. The reassurance I can give noble Lords is a political one. There are many complex questions to address, but our pledge as a Government has been clear: everybody will have safety and security, and nobody will be forced to sell their home to pay for care. Delivering on this promise will require an enormous amount of stakeholder engagement and political bridge-building, and we are embarking on that important process.

The noble Baroness, Lady Finlay, was quite right to say that social care workers are wrongly described as low skilled. I entirely agree with her sentiments; they are low paid but highly valued.

I am running out of time and have a few more points to make. I will jump to the conclusion and say that the Government take this Bill very seriously. The execution of the money involved in the Bill is also taken very seriously. There have been a number of exciting, important ideas about how that money should be spent from the noble Lords, Lord Willis and Lord Kakkar, among others.

We made our commitment in the manifesto and the Queen’s Speech to enshrine record NHS funding in law. We are delivering on that commitment and putting the NHS on a secure and stable footing for the future. The NHS belongs to us all, and this Government are backing that idea. I commend this Bill to the House.