Queen’s Speech

Baroness Walmsley Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, this has been a fascinating debate with powerful contributions from many noble Lords. It was admirably kicked off by the passionate speech from the noble Baroness, Lady Sherlock, on poverty, public services and a fair welfare state.

Noble Lords have heard from 10 of my colleagues on these Benches whose speeches have ranged far and wide. My noble friend Lord Storey absolutely demolished the Government’s claims that they are protecting school budgets in real terms. My noble friend Lord Kirkwood talked about the importance of exploiting the talents of the whole of the UK. I hope he is right that we are becoming a kinder country. My noble friends Lady Bonham-Carter and Lord Clement-Jones talked about the creative industries and the importance of starting in schools. I often think of your Lordships’ House as being a bit like a school. However, it is clear to me that we in this place understand the importance of arts and culture because we have created so many APPGs on those subjects to enrich our own lives, not least of which, of course, is the famous parliament choir, which reaches its 17th birthday this year. So why should we deprive children of that enrichment?

My noble friend Lord Lee talked about tourism and the important contribution that it can make in helping young offenders. My noble friend Lady Benjamin talked about school gardening. As a keen gardener and somebody who established a school garden herself 40 years ago, I could not agree with her more.

My noble friend Lady Jolly talked about the effect of recent judgments on charities and about defence. My noble friend Lord Rennard asked for a new smoking strategy. My noble friend Lady Brinton talked about social care, and my noble friend Lord Addington spoke about disabilities. I was very interested in all those valuable contributions.

I shall focus my remarks today on an issue that is usually top of the list with voters in a general election. In the last election, health and social care started off as second in line to Brexit, but concerns about Tory social care policy quickly became the turning point. As it happens, I had managed to talk my way in among the Tory faithful when Theresa May did her notorious U-turn in our village hall about 100 yards from my house, so I heard first hand the announcement of the U-turn on a cap on social care payments and the vigorous denial that it was anything of the sort. As it happens, I heard Jeremy Hunt, only four days earlier at the Alzheimer’s Society conference, firmly denying the need for a cap. It was indeed a U-turn and a wobbly Monday for Mrs May.

Other measures, such as including the value of the patient’s home when they apply for help with domiciliary care costs, would put the incentive in exactly the wrong place and discriminate against dementia patients, who often need long-term care. Dementia is a disease. So is heart disease, but you do not have to sell your home for that. I call on the Minister to ensure that the Green Paper announced in the gracious Speech addresses the incentives as well as the funding and quality of the provision of social care.

It amazes me that a Government can publish a gracious Speech with so little about a public service that is in multiple crises. There is a crisis of public confidence, illustrated by a recent BMA survey that showed that for the first time more people were dissatisfied with the NHS than were satisfied with it. There is also a staffing crisis, with vacancies reaching record numbers, despite the Government’s recruitment of more doctors and nurses. A recent BMA survey found that around two-thirds of hospital doctors have experienced rota gaps in the past 12 months and that 48% of GPs reported vacancies in their practices. Clearly, with rising demand, what the Government are doing is not enough.

Your Lordships’ Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care, mentioned by the noble Lords, Lord Ribeiro and Lord Warner, among others, was very critical of the limited powers of Health Education England and the lack of leadership in the Department of Health, resulting in poor planning to provide the workforce needed to keep patients safe in the long term. The committee referred to,

“the absence of any comprehensive national long-term strategy”.

It recommended that Health Education England’s powers be substantially strengthened and criticised cuts to its funding. This is not just a matter of clinical staff. Denmark has three times as many trained radiologists per head as the UK. Such technicians are needed for cancer diagnosis and treatment and are just one example of where we fall behind other developed countries.

The NHS has always relied on international doctors to fill gaps in the medical workforce. Over the next five years, the general population is expected to rise by 3%, while the number of patients aged over 65 is expected to rise by 12% and those aged over 85 by 18%. Given that the medical needs of these patients will grow ever more complex, the demand for doctors and nurses from overseas will continue. Following our withdrawal from the EU, any future immigration system must be flexible enough to allow EU staff to fill the gaps in the health and care services, as well as in university and research sectors and in public health. So will the Government make special arrangements for the health and care workers whom we so badly need?

The Government have announced legislation for an independent health service safety investigation board, but will the Minister accept that the greatest danger to patients is a shortage of properly trained staff with high morale? Until the pay cap of 1% per year for public sector workers is removed and the service is properly funded, the results of investigations by the new body will be a foregone conclusion.

There is also a financial crisis in health and social care. The Public Accounts Committee report on financial sustainability showed that the financial performance of NHS bodies had “worsened considerably”. NHS trusts’ deficits reached £2.5 billion in 2015-16. Two-thirds of trusts were in deficit that year, up from 44% the previous year. Some 40% of mental health trusts saw their budgets actually cut. No wonder the Select Committee concluded that health and social care are underfunded and require a stable and predictable fix, not the short-term sticking plaster referred to by the noble Baroness, Lady Pitkeathley.

I see no attempt to address this in the gracious Speech. Instead, the Government’s response is the capped expenditure process, which is not transparent and in some places risks patients’ lives. I have read that cancer surgery has been cancelled in order for one trust to stay within its financial targets. In another place, £900,000 for mental health was diverted to other services in order to stay within financial targets. This makes a mockery of the commitment in the gracious Speech to ensure parity of esteem for mental health. While there is a need for the NHS to get a financial grip, there is a danger to patients if cuts are arbitrary.

There is also a mental health crisis, despite the marvellous work of my colleague in the other House, Norman Lamb. Last year it was revealed that there had been a 47% increase in detentions under the Mental Health Act compared with 10 years ago. In response, as the noble Baroness, Lady Sherlock, mentioned, the Prime Minister promised to rip up the 1983 Act and introduce new law. However, the gracious Speech instead committed to a review of existing legislation. Actually, I think that that is just as well, as many in the sector call for the Government to exercise caution. The noble Baroness, Lady Browning, was right to ask for pre-legislative scrutiny. The Royal College of Psychiatrists warns against the assumption that the rise in detentions is caused by flaws in the law. Instead, it blames lack of early intervention and of community services. I join the right reverend Prelate the Bishop of Peterborough in asking the Government to ensure that the funding for mental health services reaches them and is not diverted to other services. Timely access to preventive care, a whole-system approach and sufficient funding will do more than any legislative change ever could.

We also need more skilled staff. There has been a 10% drop in trainees for psychiatric specialisms since 2014. Some 41% of trainee psychiatrists come from abroad—the highest proportion of all the medical specialties—and that would be impacted by the £2,000 international skills charge which the Government intend to impose. If the Government are serious about mental health, they should scrap that tomorrow.

In some places, there is also a crisis of standards, according to the CQC, and there is certainly a crisis of health inequality between rich and poor. If you look at all these crises, you have to conclude that there has never been a better time for a cross-party health and care commission, as proposed by Norman Lamb MP, to engage with all interested parties to find sustainable solutions. He has already taken a cross-party initiative supported by nearly 20 MPs from other parties, and I understand that a further initiative is imminent. When opposing parties are able to agree on something like this, surely Governments should act.

Another important proposal from the Select Committee was about public health. It criticised the cuts as being short-sighted. I agreed with it when it said that prevention of preventable disease is the only hope for the NHS, but it accepted that with patient rights come patient responsibilities. But people need help and services in order to look after their own health. I did not expect legislation for this in the Speech but there is a role for health education; cultural, arts and sports facilities; food labelling; and drug, alcohol and smoking cessation services; and these need to be encouraged, not cut, during this two-year Parliament.

I was about to ask for the Secretary of State for Health to reverse the injustice of not providing abortions for women from Northern Ireland on the National Health Service. I was pleased to learn during the course of this debate in your Lordships’ House that the announcement has been made that this will be done. However, I regret that it took the threat of a defeat in another place for the Government to see that they need to do the right thing.

Finally, the Government’s hard Brexit approach cost them the big majority they were seeking. A Brexit that protects the economy is vital for funding the public services we have been debating today. However, the Government’s approach reminds me of “The Wizard of Oz”. Dorothy is happily skipping along the yellow brick road along with her three friends. I will leave your Lordships to decide which one has no heart, which has no brain, and which is the scarecrow. However, off they go, expecting to find a great wizard behind the curtain at the end of the road. But instead of a little man with a megaphone, as in the film, they will find 27 well-prepared EU officials, determined that the UK will not get as good a deal as we have now. How will the Government deal with this while protecting our public services?