King’s Speech

Lord Bishop of London Excerpts

Thursday 9th November 2023 Lords Chamber

[The Lord Bishop of London]

My Lords, it is a pleasure to participate in this debate on the gracious Speech. I declare my interests as recorded in the register.

I begin by joining noble Lords across the House in welcoming the indication in the Speech that the Government will legislate for a ban on smoking. As we have heard, smoking is the single biggest preventable killer in the UK, but it is also an example of pronounced health inequality. The Chief Medical Officer gave this evidence to the Commons Health and Social Care Select Committee:

“Smoking is usually twice as high in people with lower incomes and more than twice as high in people living with mental health issues”.


He went on to say:

“The cigarette industry goes absolutely unerringly for the most vulnerable in society”.


So I welcome the decision by the Government, which will undoubtedly account for significant reductions in preventable cancers. However, there are many things that determine our health, and we have been discussing the social determinants of health for years. They were highlighted as early as 1980 in the Black report, yet we seem to be having the same conversations about the same statistics, with the same consensus again and again. The differences in life expectancy and healthy life expectancy remain truly shocking.

The failure to publish the health inequalities White Paper in the previous Session is lamentable, and I seek assurances from the Minister that health inequalities will be a key focus of the major conditions strategy. For the NHS to have the future that the Minister speaks about, we are dependent on reducing inequalities in health. Inequalities in health outcomes between racial and ethnic groups also persist. The most recent CQC State of Care report highlights these, especially in maternal and neonatal care and in mental health care. The report lists instances in which patients are not listened to and how their symptoms are not recognised due to the poor teaching of certain conditions that present in ethnic minority patients. The CQC report also highlights, as did the noble Baroness, Lady Watkins, that there are ethnic differences in the detention of mental health patients.

I add my voice to the disappointment that a mental health Bill has not been brought forward as part of the gracious Speech. As we have heard, reform of the Mental Health Act is long overdue, and the inequalities that people face under it need serious attention. There is much work to be done here, including in resourcing community care and increasing patients’ ability to make choices about their care. The Joint Committee on the draft Bill found that this would be a significant factor in the reduction of detention and inequalities. It is a great shame that the work already undertaken is not being taken forward.

We are all aware that the health service is straining. I too welcome the long-term workforce plan, but there are questions that remain unanswered, and I expect that its implementation will be challenging. The NHS staff experience remains one of exhaustion, overwork and understaffing, and I continue to remain concerned about the state of industrial relations following the Strikes (Minimum Service Levels) Act. If we are to exercise choice in our future, as the Minister rightly said, we need a workforce that is not tired, is appropriately trained and is valued.

Some 22 years ago, I commissioned the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group, which has carried out truly inspiring work. However, the work is not done. The CQC report highlights the experience of not just ethnic-minority patients but staff. Midwives from ethnic-minority groups described a culture of tolerated discrimination and unchallenged stereotyping. This is something that we all need to work to reduce.

It is disappointing to see no mention of social care in the gracious Speech. Skills for Care’s latest report estimated a 28.3% staff turnover rate in 2022-23. With 400,000 people working in social care over the age of 55 and likely to retire within the next 10 years, we are desperate for a workforce strategy. Carers are finding it difficult to get by in the cost of living crisis, and the sector represents 5% of the entire economy.

The Archbishops’ Commission on Reimagining Care sets out the type of ambitious vision that I had hoped to see in the gracious Speech. The commission identified the need for a fundamental change in the way in which care is thought about, organised and delivered, with a national care covenant at the heart of a new approach that truly incorporates the views, voices and experiences of the people most affected. Social care should enable everyone, regardless of age or ability, to lead a life of purpose and fulfilment.

I also note the disappointment of many that the gracious Speech did not contain news of a ban on conversion therapy. The General Synod of the Church of England voted to call on the Government to ban conversion therapies in 2017; it remains firm that abuse of power in this way must be prevented.

What underpins everything I say today and will say in the coming Session is that people are made in the image of God and are immeasurably valued. Recognising that value, we must do more to pursue health equality and provide adequate resources. As Nye Bevan famously said in 1948:

“Illness is neither an indulgence for which people have to pay nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community”.