Health and Care Bill

Lord Stevens of Birmingham Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

Moved by

[Lord Stevens of Birmingham]

5: Clause 3, page 2, line 8, at end insert—
“(ba) in subsection (2) insert— “(c) whether for the period covered by the mandate NHS England must ensure that revenue expenditure on mental health services increases as a proportion of total NHS revenue expenditure.””Member’s explanatory statement
This amendment would require the Secretary of State to be explicit and transparent about whether NHS England is required to ensure funding for mental health services grows as a share of total NHS revenue expenditure during the period covered by its mandate from the Government.

[Lord Stevens of Birmingham (CB)]

My Lords, these amendments all relate to mental health, and I should perhaps start by following in the wake of my former colleague, the right reverend Prelate the Bishop of London, and declaring my former interest as an NHS chief executive.

I doubt whether anyone here needs persuading of the importance of mental health. Over the past decade, there has been a sea change in public awareness and attitudes and, at the same time, the NHS has begun to expand services to make good historic deficits, but it is not mission accomplished—far from it. The mission has just got a lot tougher. The pandemic has exacerbated and intensified mental health needs not just in this country but across the industrialised world. To take just one data point, we have seen a 69% increase in the number of young people being referred to specialist children and adolescent mental health services, including for eating disorders. At a time when, entirely appropriately, the focus is on cutting waits for surgical operations, we must make sure that mental health continues to get the focus, priority and constancy of commitment that it requires.

The purpose of this group of amendments is to ensure that that occurs. Having moved Amendment 5, I shall speak to related Amendments 12 and 136 in my name and those of the noble Baronesses, Lady Hollins, Lady Merron and Lady Tyler.

In a nutshell, our Amendment 5 would ensure that Government mandates to NHS England always contain explicit and transparent marching orders on mental health funding. I think it was a fellow called James Frick who said:

“Don’t tell me where your priorities are. Show me where you spend your money and I'll tell you what they are.”


That is why, in England, each year since 2015, mental health investment has been required to grow as a share of the NHS funding pie, and I am pleased to tell your Lordships that it has done so. The Minister should not take this amendment as a criticism; it is an encouragement to stay the course of putting our money where our mouth is, towards parity of esteem—or, if he prefers, levelling up between physical and mental health.

Of course, the mathematically minded among your Lordships might argue that if the share of NHS spending going on mental health keeps increasing, eventually we will have overshot what is needed. My response is twofold. First, in the real world, we are many years away from that happy state of affairs, and, in any event, the amendment does not require Governments to increase the relative share of resourcing for mental health; it simply requires them to be intentional and public about their mental health funding choices. It does not tie Ministers’ hands; it just requires them to reveal their hand. It means that the Government have to be clear about their asks of the NHS, and Amendments 12 and 136 mean that the NHS in turn has to be transparent in reporting on its delivery of them.

That is why these amendments command strong support outside this House from leading mental health charities, patients’ groups, and professions. Taken together, in practice the amendments represent spine stiffeners for the Government and accountability boosters for the NHS. I beg to move.

[Lord Howarth of Newport (Lab) [V]]

My Lords, I welcome the amendments in the names of the noble Lord, Lord Stevens, and the noble Baroness, Lady Hollins. The emphasis on prevention in her Amendment 13 is particularly important.

I will make two points. There is abundant evidence that the engagement of the creative imagination can benefit mental health through improving well-being, confidence and self-esteem. The Creative Health report of the All-Party Parliamentary Group on Arts, Health and Wellbeing discusses, for example, the work of Artlift, a charity founded by a GP, Dr Simon Opher, which delivers arts on prescription in Gloucestershire and Wiltshire. One participant said:

“I had split up from my partner, found myself without anywhere to live and couldn’t see my children. I couldn’t work as I wasn’t physically able to do the job and wasn’t in a position mentally or financially to start a building business again after going bankrupt. Since going to Artlift I have had several exhibitions of my work around Gloucester. I find that painting in the style that I do, in a very expressionistic way, seems to help me emotionally. I no longer take any medication and, although I am not without problems, I find that as long as I can paint I can cope. It doesn’t mean that depression has gone but I no longer have to keep going back to my GP for more anti-depressants, I just lock myself away and paint until I feel slightly better. I now mentor some people who have been through Artlift themselves and they come and use my studio a couple of times a week to get together, paint, draw and chat and I can see the benefit to them”.


The World Health Organization scoping review of 2019 synthesises evidence of the efficacy of the arts in preventing stress and anxiety and building self-esteem and self-confidence. A report to DCMS in April 2020 entitled Evidence Summary for Policy: The Role of Arts in Improving Health & Wellbeing, by Dr Daisy Fancourt of UCL et al, draws attention to

“a large literature of RCTs”—

randomised controlled trials—

“on the treatment or management of mental illness through arts involvement”.

Creatively Minded, a Baring Foundation report of 2020, maps 170 examples of organisations running arts and mental health projects in the UK.

--- Later in debate ---

Having said all that, I have heard the passion and strength of feeling from noble Lords across the House. I want to reassure all noble Lords that I will continue to reflect carefully on the specific points raised in the amendments and in the debate today. I would be happy to meet noble Lords to discuss their ideas and proposals further. I hope that we can find some agreement. I thank your Lordships for the thoughtful debate on this important subject. I hope I have reassured noble Lords that this Government are committed to delivering parity of esteem between physical and mental health. In our conversations between this stage and Report, I hope that we can seek to reduce that gap in understanding. For these reasons, I ask noble Lords to consider withdrawing or not pressing their amendments.

[Lord Stevens of Birmingham (CB)]

I thank the Minister for that careful response. Across the Committee, we have all obviously heard the breadth and depth of concern for the issues surfaced through these amendments. It is obviously for other noble Lords to infer this for themselves, but my sense is that these were not simply explanatory or probing amendments but, significantly, amendments with a view towards testing the view of the House on whether we can change the wording in the Bill itself. That is obviously not a matter for tonight, but I anticipate that we will return to some of these issues, perhaps on Report. In the meantime, I beg leave to withdraw Amendment 5.

Amendment 5 withdrawn.