King’s Speech

Baroness Tyler of Enfield Excerpts

Friday 19th July 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, as this debate draws to an end, I warmly welcome the newly appointed Ministers to their important new roles. I thank the outgoing Ministers, and commend the two excellent maiden speeches that we have heard today. I particularly commend my noble friend Lady Jolly for her excellent valedictory speech and pay tribute to her outstanding contribution as a Government Whip during the coalition and as a party spokesperson, and in particular the work she does for people with learning disabilities. She will be sorely missed on these Benches and beyond.

Like so many others today, I welcome many of the measures in the gracious Speech and look forward to scrutinising legislation when it comes to this House. There are areas where the measures do not go far or fast enough, and there are some key omissions that I will highlight. My noble friends Lord Storey, Lord Sharkey, Lord Addington and Lady Garden have all talked about education with great expertise. I will focus on health.

I welcome the commitment in the gracious Speech to improve the NHS, specifically the urgent need to reduce waiting times, focus on prevention and improve mental health provision. I wholeheartedly agree that there is an urgent need for a more preventive model of care, with investment moved upstream; it is crucial if we are to lower waiting times, improve access and reduce health inequalities.

The answer to overcrowded hospitals is not simply more hospitals: the health and care system must be radically refocused to put primary and community care at its core if it is to be effective and sustainable. In my view, this should include new patient-centric integrated services, such as walk-in clinics, diagnostic centres and polyclinics, to improve speedy access, give patients more control, and take the weight off overburdened GPs and hospitals. We also need to use existing hospitals more efficiently. We know that valuable NHS equipment and operating theatres too often stand idle in the evenings and at weekends. Will the Minister say what plans the Government have to address this and whether they include bringing in independent clinical teams from outside the NHS?

A more radical shift to a preventive model of care was one of the key findings of the integrated care Select Committee, so expertly chaired by the noble Baroness, Lady Pitkeathley, on which I had the privilege to sit. I hope Ministers will take heed of that excellent report and what it recommended. We really do not want to end up reinventing the wheel.

Like my noble friend Lady Walmsley, perhaps my biggest disappointment is the silence on social care. We all know that the current problems in accessing healthcare will never be resolved until social care is fundamentally reformed. There has been talk recently of a royal commission, but no mention of it in the gracious Speech. I wonder whether a royal commission, however well-intentioned, is what we need; I worry that it will simply kick the issue into the long grass. In the last decade, we have seen countless reports, reviews and commissions into social care, but, to the huge frustration of those in the sector and beyond, nothing ever happens. In short, the political will simply evaporates. We know what the problems are and, broadly, we know what needs to happen; we just need to start moving on what will inevitably be a gradual path.

The Government have pledged to establish a fair pay agreement in the adult social care sector and improve working conditions. I welcome that, given that there are over 130,000 vacancies in adult social care. It is certainly to be hoped that measures in the planned employment rights Bill to increase pay and scrap exploitative zero-hours contracts will help to attract and retain more staff, but that will happen only if they are accompanied by commensurate local government funding increases. Will the Government commit to a social care workforce plan to complement the NHS workforce plan?

I turn now to the critical issue of unpaid carers, echoing the words of the noble Baroness, Lady Pitkeathley. Labour’s Plan to Make Work Pay, published in May, included a commitment to review the implementation of the Carer’s Leave Act 2023 and examine all the benefits of introducing paid carer’s leave. However, the background briefing to the employment rights Bill, published on Wednesday, contained no mention of this. There is a real opportunity here for the Government to move quickly to deliver this review and introduce enabling provisions to ensure that a new right to paid carer’s leave is introduced as part of the Bill. What specific plans are in place to deliver that review and to introduce these enabling provisions?

I greatly welcome the commitment to ensure that mental health is given the same attention and focus as physical health and to modernise the Mental Health Act. To say it is grossly overdue is an understatement, and I understand the scepticism of some in the sector who have heard all these promises many times before, only for nothing to happen. For too long the Mental Health Act has failed people who require mental health care. Racial inequalities in the use of detention, high levels of restraint and the removal of patient autonomy are just some of the problems of the current Act. Introducing a new mental health Bill to reform that Act provides a crucial opportunity to enhance patients’ rights, to strengthen safeguards for those admitted to mental health hospitals, particularly for children placed in inappropriate settings and on adult wards, and to rebalance the system to one that prioritises and promotes the patient’s voice and choice in their treatment.

It is welcome to see the tobacco and vapes Bill reintroduced. We should not forget that, of those people suffering from mental health conditions, more than 40% smoke, compared to just over 12% of the general population.

I declare an interest here as a member of the Financial Inclusion Commission, which has not had a mention yet today. Too many people experiencing mental health problems also suffer from financial and digital exclusion. That is why I was so delighted that the Liberal Democrat manifesto included a commitment to introduce a national financial inclusion strategy, including measures such as promoting access to cash, particularly in remote areas, and supporting banking hubs and vulnerable consumers. Could the Minister say what plans the Government have to introduce a comprehensive financial inclusion strategy?

I turn now to children’s mental health. As we have debated so often before, those accepted into child and adolescent mental health services—CAMHS, as we know it—are often left waiting for many months, if not years, for treatment, during which time their mental health often deteriorates. It is estimated that only around a third of children with a probable mental health problem are able to access treatment, showing how far away from the parity of esteem with physical health we really are. I look forward to hearing the Government’s plans in this area.

I welcome the children’s well-being Bill, particularly the pledge to introduce free breakfast clubs in all primary schools, but I would also like to see an equal focus on promoting children’s mental health at primary school age. The gracious Speech contained a pledge to improve mental health provision for young people, which I very much support, and the Labour Party manifesto committed to providing specialist mental health support for every school, mirroring my recent Private Member’s Bill. Could the Minister confirm whether this will include primary schools, as my recent Private Member’s Bill did? Sadly, it narrowly missed its Third Reading, because the election was called. Leaving it until secondary school is simply too late. Could the Minister say when we can expect to see action on introducing open-access mental health hubs for children and young people in every community?

Finally, I turn to child poverty. We have had some powerful interventions here. I was proud that the Liberal Democrat manifesto contained a pledge to abolish the iniquitous two-child benefit cap. I wish there had been more focus on this and on other elements of our ambitious anti-poverty strategy during the campaign. We have heard the figures today of those in child poverty and the fact that it is going up and that many of those families suffering have had at least one parent in work. We welcome the Prime Minister’s very recent announcement of a child poverty task force, but it is quite clear that the two-child benefit cap is the principal policy contributing to this alarming rise. Could the Minister set out the timetable for the task force reporting and say how quickly we can expect to see action taken on the two-child limit?