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The Government’s reform programme has been focused on centralised targets set for short-term expediency at the expense of longer-term health improvement. The concern is that Sir Derek’s own estimates for NHS demand were based on a scenario in which the population of this country would be fully engaged in its healthcare, fully informed and fully supported. He anticipated that if that were the case, the NHS would still require a 4.4 per cent growth funding in 2008, but we understand that the Treasury plans to provide only 1.5 per cent growth funding at that point. Therefore the NHS is not only experiencing cuts today but also storing up problems for the longer term. Over this period of investment the Government have constantly invested in short-term reforms and repeated reorganisations; as a result, there is not much to show for it.
Measures are set out in the gracious Speech, but there is also a huge gap. Nothing covers the implementation of the White Paper, Our Health, Our Care, Our Say; that is, there is nothing about social care. We know already that social care is severely underfunded. If it continues to be underfunded over the long term, that in turn will generate long-term demands on the NHS. The number of people set to live longer with high dependency needs continues to grow, but nowhere does the Queen’s Speech address these matters.
We also have a draft health Bill in the gracious Speech. It focuses to some extent on restructuring the regulation of human tissue and embryology; a Home Office Bill can be found masquerading as a health Bill—the Mental Health Bill—and reference is made to the possibility of legislation to replace patient forums with local authority-led local involvement networks. It pleases me to see that the noble Lord, Lord Hunt of Kings Heath, is to reply to the debate because he and I spent many happy hours discussing the formation of patient forums. I should like to ask him whether such a Bill will be forthcoming. If it is, I hope that those who are preparing it will look at a discussion paper produced by the Department of Management Studies at the University of York, entitled The Rise and Fall of the Patient Forum. It sets out succinctly what the demise of the CHCs and their replacement by patient forums at £10 million more per annum will mean and suggests why the current top-down performance management approach to running the NHS means that true patient involvement is highly unlikely ever to happen.
I should like to take this opportunity to agree with Mr. Andrew Lansley, who said in another place a few days ago that the Bill on human tissue and embryology should not be hijacked as a means to have a debate on abortion. The issues covered in the draft Bill are serious and need distinct and detailed consideration of the type best done in this House. I further agree with the health commentators who have said that we should have a debate about why different regulatory bodies should be merged before discussing how such a process will happen.
I turn briefly to mental health issues. After more than 20 years in which to evaluate the workings of the 1983 Act, two draft Bills, a Joint Scrutiny Committee
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The Minister thanked profusely the many people and organisations involved in considering the legislation up to this point. He did not say that the Government took any notice whatever of what most of those organisations and people said. Perhaps if they had, we would have had a Bill about mental health and not the punitive Bill before us.
If there had been that listening process, the Government might have understood that, of the 2.6 million people in this country on incapacity benefit, 40 per cent have mental health problems. That means that £5.2 billion per annum is spent on incapacity benefit for people with mental health problems. There are more people with mental health problems claiming IB than the total number on jobseeker’s allowance. Not only does unemployment adversely affect a person’s mental health but, as the CBI indicated in the report produced by the noble Lord, Lord Layard, on 6 December 2004, Mental Health: Britain’s Biggest Social Problem, the estimated output loss of time from work due to stress, anxiety and depression is about £4 billion per annum. Those two figures together exceed the £8 billion currently spent on mental health services.
It would have been good to have before us a Mental Health Bill which really sought to address the causes, incidence and prevalence of mental illness and to introduce the new means at our disposal to manage and assist those who have mental health problems, the vast majority of whom, as the Minister said, pose no danger to themselves or anyone else; they simply need assistance to live their daily lives.
We could have talked about ways in which healthcare workers could play a part in multi-agency arrangements to enable people to get back to work. We could have discussed how supportive employers can play a role in ensuring that people get a job and regain their self-esteem, which could so change their lives that they no longer need medication. Most of all, we could have talked about the chronic lack of access to community-based services such as talking therapies—those early interventions which, we know, enable people to avoid acute, serious episodes of illness. It would have been good to have a mental health Bill.
The Queen’s Speech has been delivered by a Government who seem to have focused on the short term and run out of strategic vision in their powers to tackle the underlying causes of ill health in this country. We will do our best to see that that is redressed and that the National Health Service is run with a strategic vision nationally and accountability locally.
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3.48 pm
The Lord Bishop of Southwark: My Lords, we shall shortly hear the first of the maiden speeches, which we eagerly anticipate. In order not to delay the House for too long, I shall focus most of my remarks on the proposed Further Education and Training Bill.
The Church of England has a long history of engagement with skills education, dating back to the early days of apprentice education in the medieval period, when the chaplain was responsible for the teaching of literacy and numeracy skills to young people in the guilds, trades and chapels, as they are still called in the print trade in London. The first FE college was in London—the Working Men’s College in Camden—which still dispenses an excellent range of skills courses to mainly adult students. It was founded in 1854 by Christian socialists F. D. Maurice and Charles Kingsley, and throughout the 19th century other educational initiatives for young people and adults were developed, usually with secular partners.
Last July, the General Synod debated further education and produced its own report, Pushing Further. The opening sentence of that report states: “FE changes lives”. Many will bear witness to the effect that FE can have in rescuing a young life going off the rails, encouraging young adults to develop the specialised skills to reach their full potential or enabling a single mother or a refugee to start on the road to fulfilment and employment.
FE is important but it is often undervalued, which is why we especially welcome the Bill and the Government’s commitment to raising the profile of FE. We also salute the national skills strategy, so vital for the future of this country’s economic interests but also for the benefit of each young person. We wholeheartedly support the Bill’s main purpose, which we understand is to enable the provision of the full range of 14 to 19 education for young people—vocational and skills options as well as academic opportunities—through partnerships in every area between healthy, thriving FE colleges, excellent sixth forms and sixth-form colleges, and employers.
However, we have one or two other comments and one major concern. Our comments refer first to the consultation mechanisms. The Learning and Skills Council’s strategy, Framework for Excellence, identifies three constituencies where consultation is vital—employers, learners and communities—but proposes consultation mechanisms for only two: employers and learners. The Bill repeats this limitation. Why cannot a mechanism be devised for consulting community interests, where the church and faith communities would be happy to play their part and would have much to contribute?
Secondly, we are disturbed by proposals announced earlier this month by the Learning and Skills Council that free further education and English language courses are to end for asylum seekers over the age of 18. These measures will also impact on those under 18 in asylum-seeking families. If parents are not entitled to language provision but their children are, the burden of translation and interpretation will fall more heavily on the children. Because of the disruption in their early education,
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Our major concern is that we had hoped that the opportunity would be taken in the Bill to correct a historical anomaly. In schools, 16 to 19 year-olds have an entitlement to provision for their spiritual, moral, social and cultural development, while those in FE colleges do not. In its draft form, the Bill makes no reference to extending this entitlement to FE students. The implication, which is that the Government do not consider that young people in FE colleges have spiritual and moral needs and that colleges have no duty to meet those needs, does not bear thinking about.
We are sure that this anomaly is a historical accident, in that the Education Act 1944 and the Education Reform Act 1988 which underpin this entitlement did not cover FE colleges, and FE students were, in the past, mainly on a part-time or day-release course. This argument is not about chaplaincy. We welcomed the endorsement of multi-faith chaplaincy arrangements in the White Paper earlier this year, and we are working with many of the 50 per cent of colleges that have not had chaplaincies to bring this about.
This entitlement is about equality of esteem for vocational and academic students, something that the Bill is designed to achieve. Even more importantly, it is about supporting colleges in ensuring that students of all faith backgrounds and those of no religious faith are enabled to explore—and challenge where appropriate—their faith background. The exclusion of faith from college campuses makes students more vulnerable to outside influences, which can sometimes be extremist, with all the potential dangers that that has for social cohesion and even security. It is when educational institutions celebrate and validate faith—in festivals and chaplaincies, certainly, but also in their overall provision—that students are encouraged to reject extremism and develop a sense of real meaning and purpose in their lives, with values appropriate to our multi-faith society.
I turn briefly to the Mental Health Bill. There is undoubtedly a difficult balance to be struck between the rights and liberties of mentally ill people and the protection of the public. But the potential dangerousness of a relatively small number should not skew the conditions for the application of compulsory powers to a much larger group. To detain mentally ill people to impose treatment that does not have a therapeutic benefit in arresting or improving their condition risks turning psychiatrists into guardians of public safety, which is not their proper function. We should beware of using mental health legislation as a pretext for preventive detention.
Of course, we fully acknowledge that there is a strong case for some form of supervised treatment to deal with patients who relapse in the community, but the proposals in the Bill are too widely drawn. They need to be targeted on a smaller number of vulnerable and in some cases dangerous patients or they will be counterproductive in making it more difficult for community mental health services to engage with people who need care and treatment.
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Finally, we regret that the Bill, in its predominant emphasis on public protection, fails to include earlier proposals for patients who are detained to have access to independent advocacy and that it fails to guarantee a right to assessment of mental health needs before a crisis is reached. Such provisions might have helped to avert some of the tragedies that have resulted from failure to heed the desperate warnings of patients and carers. In the end, we believe that public safety will be better served by effective and properly co-ordinated care than by unnecessary and damaging restrictions on liberty.
3.57 pm
Lord Bradley: My Lords, it gives me great pleasure to rise to speak for the first time in this House. I immediately thank noble Lords and those who serve your Lordships' House for their courtesy and warm welcome and the help and assistance that they have offered me and my family since I was introduced. I thank in particular my sponsors—the noble Lord, Lord Sheldon, of Ashton-under-Lyne, who I am pleased is in the Chamber, whose unstinting support for me as a resident in my former constituency will always be appreciated; and my noble friend Lady Taylor of Bolton, with whom I worked closely in the Government Whips’ Office in the other place, where we had extremely happy times in spite of the idiosyncratic behaviour of some of our former colleagues. Her kindness to me during that period and since will always be hugely appreciated.
It is 19 years since I made my maiden speech in the other House as the first ever Labour Member of Parliament for the Manchester Withington constituency. I was proud of that achievement and now I am proud that Withington forms part of my title. This area of south Manchester has generally thrived over the past 10 years because of the stable economy, low interest rates and low mortgage rates, and because of the investment in public services—especially in new schools and new childcare facilities, in the educational field, and in many new health facilities, in particular the new Withington Community Hospital. Clearly there is much more to be done, with far too many parts of Manchester and other great cities like Manchester suffering from areas of poverty. I believe that this gracious Speech will build on the progress that has already been made in this respect as a result of excellent regeneration projects within the city, employment programmes and world-class events such as the Commonwealth Games, which are a tribute to Manchester City Council and the partners who have worked so hard to address those issues.
I wish to highlight a number of policy areas from the gracious Speech. But first I must point out that since the good people of Manchester Withington decided that I needed a long rest, I have been employed as a special adviser in government and public relations in the University of Manchester. It is a privilege to work directly for the president and vice-chancellor of the university, Professor Alan Gilbert, whose inspirational leadership has already made the new combined university a powerhouse within the city, within the region, nationally and, I
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The first commitment in the gracious Speech that I welcome is the aim to reduce poverty even further, both here and abroad. Significant progress has been made to reduce family and child poverty in this country, but, as I have mentioned, this work must go deeper and wider in our urban centres, such as the city of Manchester, if all sections of society are to benefit from relative economic prosperity. That prosperity must also extend abroad to places such as Africa, where abject poverty is an indictment on us all. I know that the recently established Brooks World Poverty Institute at the university, with the Nobel laureate Professor Joseph Stiglitz as its chair, will play a significant role in helping to shape this very important agenda.
Secondly, the continuing programme of educational reform is essential if the aspirations of our young people in Manchester are to be significantly raised. The continued rollout of the Building Schools for the Future programme, the proposals for academies, the 14-to-19 agenda and now, with the Bill already published, the reform of further education, crucially underpinned by high-quality pre-school and primary education, must be coherently organised and clearly accountable to parents with the needs of children at the forefront, if these aspirations are to be achieved.
I have some concerns in this respect, however, regarding the reorganisation of the Learning and Skills Councils at the regional level. In Manchester, in my view, there has been a failure: until recently the Learning and Skills Council has not properly been part of the planning process and the strategic direction of education within the city. I will look carefully at the Bill to ensure that the changes proposed do not undermine the council’s renewed efforts to engage with the city and the other partners to bring about better educational standards there. Barely 15 per cent of 18 year-olds resident in Manchester achieve a place in higher education at any institution in this country. That is totally unacceptable. Again, the university will continue to play a key role in supporting all schools in the city by extending its excellent widening participation and leadership programmes.
Thirdly, as already mentioned, the emphasis in the gracious Speech on health is welcome. It was with great pleasure that I was recently appointed a non-executive director of the world-famous Christie Hospital, a specialist cancer hospital in Manchester. It has been, and will continue to be, at the forefront of delivering the Government’s commitments on cancer services. We must ensure, however, that the 62-day target for treatment is met throughout the country. The Christie Hospital is at the hub of cancer care, particularly for Greater Manchester and the north-west. It is the centre of the cancer network for radiotherapy and chemotherapy. The latest plans for the Manchester Cancer Research Centre, a partnership between the hospital, the university and Cancer Research UK, will provide a world-class
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Finally, perhaps I may stray for a moment into the area of transport. The gracious Speech announced a draft Bill to improve public transport. Nothing would be more welcome in the city of Manchester than measures to stop the chaos and havoc that bus deregulation has brought and has inflicted on our roads in the city. The farcical situation we recently had where the logjam of buses almost led to each of them receiving a parking ticket in the city centre must stop. Further investment in our Metrolink system to provide high-quality public transport would also be exceedingly welcome.
In closing this maiden speech, I reiterate the honour and pride that I have in entering this noble place. As I have clearly shown, I will use this as a platform to champion and promote the city of Manchester and the north-west region. I believe that the people of Manchester deserve nothing less.
4.06 pm
Lord Fowler: My Lords, the whole House would like to congratulate the noble Lord on his maiden speech and the manner in which he delivered it, and on the obvious love for Manchester that came through almost everything that he said. As well as education, he has a great knowledge of the health service—rather too much in my view. I see to my alarm that he was secretary of the Stockport Community Health Council between 1981 and 1987, which exactly coincides with the period when I was Secretary of State for Health. Although he did not quite say so, I know he feels how much better things were then than they are now. At least we had community health councils in those days.
The noble Lord had a very distinguished career in the other place from 1987, in which time he had a range of opposition and government jobs, all of which he did excellently. But I leave to last his greatest achievement. He was educated at Bishop Vesey’s Grammar School in Sutton Coldfield. As Sutton Coldfield is a constituency that I represented for 27 years, I congratulate him on that. It is a fine school and it self-evidently has fine old boys. We very much look forward to hearing him again very soon.
It is always difficult with these broad debates to decide what subject to choose. I should dearly like to speak about pensions policy. I hear what the noble Lord, Lord Warner, said about the success of government policy. I would have preferred to talk about the destruction of occupational pensions, the ludicrous rule of compulsory annuities at 75 and the parliamentary commissioner’s report which the Government have ignored. I would dearly like to have returned to the notorious 3 July meeting between Health Ministers and Labour Party representatives on the future of community hospitals. When I last raised that subject the noble Lord, Lord Warner, said
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Instead, I should like to concentrate on an area where there are very few opportunities for debate and where all too often the whole subject is simply swept under the carpet. I refer to HIV/AIDS and sexually transmitted infection generally. I must say that I was confirmed in my decision to concentrate on that by listening to the replies by the noble Lord, Lord Warner, to questions this afternoon—rose-tinted replies which I fear would not be shared by very many people on the ground.
Perhaps I may summarise the position we face in this country. Currently, more than 70,000 people are living with HIV in the United Kingdom. On present trends, that number will go over the 100,000 mark in the next two or three years. Those who told me in 1986 that I was exaggerating the threat and over-reacting to it might like to reflect on those figures and on their breakdown, which show that there were almost 8,000 new HIV diagnoses in 2005. About a third of people with HIV do not realise that they have it. Gay men are at particular risk, quite apart from the heterosexually acquired HIV that is mostly acquired in Africa. There is now undoubted evidence that the safe-sex messages of the 1980s are being widely ignored.
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