King’s Speech

Baroness Walmsley Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for the tone of his introduction to this debate, but a King’s Speech is an opportunity for a Government to take stock of progress towards their objectives. One might therefore have expected that this Government would have looked at their earlier manifesto promises when drafting the gracious Speech and considering whether their 13-year tenure had in fact improved the health of the nation. Covid, of course, was an unexpected roadblock, but the very fact that it was unexpected is an issue in itself. One hopes that lessons are being learned from the Covid inquiry.

There are pluses and minuses in the Government’s thin programme for their last year in office. Like many other Lords, I regret that, despite all the work done on proposals for revising the Mental Health Act, including a White Paper, the Government have still not fulfilled the revision promised in successive manifestos, nor their promise to implement the recommendations of the Infected Blood Inquiry. Instead, despite that inquiry’s strong interim recommendations that compensation be paid now, the Government still insist on waiting until the final report.

There is, however, one measure in the gracious Speech of which I approve: the proposal to raise every year the age at which retailers can legally sell tobacco products to young people by one year. This does not ban smoking as such, but it should deter more people from starting. We know that most smokers start young and that tobacco is unique in that it either kills or shortens the lives of two-thirds of those who use it for any length of time. I have always supported measures to reduce smoking because it is different from all other ways in which people freely choose to damage their own health. It is addictive, harmful when used as recommended, can harm other people and costs us and the NHS millions every year. That is why there is overwhelming public support for, for example, the ban on smoking in enclosed public spaces.

There will also be consultation on measures to tackle the widespread illegal sale of disposable vapes to children. Vapes have their place. They are of value to adult smokers who wish to quit, and are rightly sometimes provided free on prescription, but I believe that the vaping industry has cooked its own goose by the reckless and widespread promotion—and sometimes the free supply—of single-use vapes to children. That undoubtedly has to stop, because these things are addictive and not without danger. The massive environmental damage done by these brightly coloured gadgets, with their sickly-sweet flavours and colours obviously aimed at children, has been well-rehearsed elsewhere, so I do not need to elaborate. I hope that, after the consultation, the Government will clamp down firmly on this already illegal practice. Of course, public health budgets have also been cut and this has resulted in fewer smoking cessation services, which must also be addressed.

The Government have announced an NHS workforce plan. This is a step in the right direction, but many of us would have preferred the proposal of the noble Baroness, Lady Cumberlege, during the Health and Care Act 2022, supported by us. This provided for an independent review of current supply, an assessment of need of the right staff in the right places in the future, and a plan for how to fulfil that need over five and 10 years. The Prime Minister mentioned doctors, nurses and dentists, and of course we need more of those, especially in disadvantaged areas. However, current resources could be used better. Many of the care problems that patients experience are about systems, processes and communication. There is much efficient good practice, and I agree with the noble Baroness, Lady Donaghy, about the very cost-effective fracture liaison clinics, which save a lot of time and NHS bed days but are available in only half of trusts—that is the problem. Will the Minister ensure that the workforce plan includes staff skilled in designing and implementing efficient systems and processes which make the most of the resources we have?

Taking stock means looking to the future and focusing on the major challenges to the NHS. Three things are needed. The first, as has been said, is sorting out social care and integrating it with health services. Despite Boris Johnson’s promise of an oven-ready plan, which never materialised, social care is still suffering from lack of funding and enough properly paid staff with opportunities to develop their skills. If there ever was an oven-ready plan, it is well past its sell-by date and should be thrown in the bin. The recent Covid inquiry has exposed how very important this is, especially at times of extra stress on the system, but it did not feature in the gracious Speech.

The second is the need for more prevention of ill health. Preventable diseases, as has been said, are now the major causes of death, since modern sanitation and vaccination have conquered many of the communicable diseases. If Wes Streeting focuses on this, he will get my support. The three main factors needed here are action on healthy diets, clean air and healthy homes. The Government are failing on healthy diets despite having legislated for, but not implemented, several important measures that would have helped people make good food choices. Everyone, especially children, should have access to good, affordable food, and the Government should be doing a lot more to ensure that.

We have had many debates on clean air, but the legal limit for particulates in our air in the UK is still much higher than in other developed countries. Dirty air kills people through respiratory and cardiac diseases and interferes with the development of children’s brains. More action is needed on this now, rather than using it as a wedge issue at by-elections. Unhealthy, damp, cold homes also lead to respiratory diseases. It is a national disgrace that too many lower-income families are living in homes with mould growing on the walls and cannot pay their heating bills, and I did not hear anything positive in the gracious Speech about this.

The last factor is earlier diagnosis and treatment, and here there has been some progress. I welcome the units going around the country to check for early liver cancer, heart valve disease, lung cancer, et cetera, but what is needed is widespread access to treatment. I want to mention minimally invasive cancer therapies. These were invented here and are highly cost-effective. Can the Minister let us know what progress there is in extending these right across the country, instead of in only about half of it?