5.54 pm

Lord Quirk (CB): My Lords, we all know that government faces massive tasks in education. Demographic changes demand a great deal of school building as well as a big expansion in the number of teachers trained to fill existing and projected shortages. In April this year, Tessa Jowell estimated a shortfall by 2020 of 40,000 secondary and primary places in London, with more than 3,500 of them in Lambeth alone.

Then there is the gross unevenness of provision across the country. In the north of England, only a quarter of pupils sit for high-value GCSEs as compared with the south-east. No wonder Sir Peter Lampl is so horrified. Nor must we forget our need for a dramatic expansion and improvement of vocational education, an area in which the noble Baroness, Lady Neville-Rolfe, noted:

“England has had a historic weakness and where we continue to lag behind the performance of other developed countries”.

She doubtless had in mind Germany and its famed Berufsschulen.

But there is more. In the New Statesman last month, the noble Lord, Lord Adonis, recalled that, in his first Administration, Mr Blair set up a “standards and effectiveness unit” whose,

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“main responsibility was the implementation of national literacy and numeracy strategies, intended to ensure that all 11-year-olds demonstrated the competence expected of their age in reading, writing and maths”.

It is deeply frustrating that today, nearly 20 years on, we still cannot achieve even these modest aims. The despairing complaints of employers are as loud as ever. International comparisons are as gloomy as ever as they chart this country’s humble progress. The latest example is the lengthy OECD report Universal Basic Skills, published last month. Our distance behind Hong Kong, Singapore, Korea and Taipei is, of course, familiar and not particularly dismaying. Education is deeply embedded in, and inseparable from, the whole social, familial, behavioural and political nexus. We could not, nor would we want to, buy into the co-occurring value systems of China or Korea. What is far more serious and relevant is that we also lag behind our European neighbours whose social and political liberalism we share, and whose education systems we could and should regard as models. The OECD report shows us behind no fewer than 11 countries of the European Union, including big ones such as Germany and Poland. The lag includes mother-tongue literacy, where we are no match for our neighbours in, for example, the field of lexicology, which plays a prominent role in schools from Calais to Moscow but which is largely ignored in this country, with dire consequences such as the communicational poverty with which we are all too familiar among British school-leavers.

During the recent consultation on the national curriculum, the Department for Education was sent copies of the mother-tongue curricula operating in the biggest of the German Länder. These insist on vocabulary study being at the heart of linguistic communication for the understanding of all school subjects. Lexical systems are taught in carefully planned stages, together with the essential understanding of semantic structures such as polarities and hierarchies. Yet when the new curriculum was published recently, almost nothing had happened, and it seems that at the highest level in the DfE it is believed that vocabulary is something that can be picked up randomly. This was of course precisely the case with spelling and grammar in the bad old days of “anything goes”. Welcome action was taken and the Government now issue pages and pages of detailed spelling rules and a modern exposition of grammar—but not so with vocabulary.

Earlier this year I put several Written Questions to the noble Lord, Lord Nash, asking him to explain why the extensive curriculum framework document had a lengthy section entitled—note the order—“Vocabulary, grammar and punctuation” but with literally nothing in it on vocabulary despite it being the first named. In response, the noble Lord, Lord Nash, confessed that there was no separate programme of study for vocabulary but that there was “a clear expectation” that teachers were required to develop students’ vocabulary “actively” and “systematically”. Despite further Questions during the last days of the coalition, I have still not been informed on what this “clear expectation” is based or where teachers can learn of the systems on which they are expected to be building. Will the new Government now address these issues seriously and urgently? After

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all, English and maths are rightly identified as the core subjects and we must have curricula in both that are fit for purpose.

Finally, I will say a brief word on higher education. Will Ministers address the steep decline in part-time student numbers? Are they fully alive to the vital needs of our foremost research universities, such as UCL and Imperial? Will the ring-fenced science and research budget continue to be protected? What is going to happen to the resource and capital budgets of the Department for Business, Innovation and Skills? Will the Government pay heed to the role of the EU research funding into which our universities have been tapping so successfully? Lastly, may I remind Ministers that every pound of public money spent on research attracts the generous support of foundations such as Wellcome and Wolfson?

6.03 pm

Lord Griffiths of Burry Port (Lab): My Lords, I wish to speak on education. I was heartened to hear the prominence the Minister gave to education in his opening remarks—within what must have been a ragbag of possible subjects—especially since it seemed to have been lost or marginalised in the recent general election campaign. I am really delighted to follow so closely on from my noble friend Lady Morris in front of me. If ever there were a subject that deserved the best and the most dispassionate energies of our Parliament as a whole, regardless of party, it surely has to be education.

How many years ago was it that the clarion call was, “Education, education, education”? Surely we must restore the subject to that level of importance. We heard in the Queen’s Speech that:

“Legislation will be brought forward to improve schools and give every child the best start in life”—

who could be against that? There will be “new powers”—when we have witnessed the flooding of powers to the Department for Education and the accumulation of executive authority with the department and with the Secretary of State for Education—

“to take over failing and coasting schools and create more academies”.

I need not repeat the points made by my noble friend Lady Morris about 17 different school structures and the lack of ability of any single one to deliver all the objectives we wish for them. Pragmatism, variety and approaching issues according to the needs of a particular locality have to be in our minds as well as a one-size-fits-all, monochrome approach, which I sometimes feel the ideologisation of the question of academies has done for the debate on education. Like my noble friend, I have no hesitation in recognising the real qualities of good academies but I hope we can all agree that time has not yet lapsed sufficiently for us to take an objective, proper and balanced view of their contribution to the total scene we are seeking to provide. We must recognise that.

I note that in his speech the Minister itemised and named a number of successful academies—good for them, but I could name a similar number of schools in local authorities that are as successful. Since the Minister was bold enough to cite particular examples, I am going to boast. I am the chair of trustees of the

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Central Foundation Schools of London. When I became a governor of the boys’ school some 12 or 15 years ago, both schools were in special measures but now 85% of our kids doing GCSEs get A* to C, including in English and maths. The Central Foundation Schools of London can match any academy, in the most putrid and awful buildings and premises that one could imagine. I am proud of our headmaster and proud of our staff, and I will not have it that it is only academies that can register this degree of success. It is not fair to the discussion that education deserves.

What is more, we must look a bit more critically at the question of academies. The lawyers we retain at the Central Foundation School have just held a very high-level forum. Out of it all they noticed the following. This is a trend, not yet a final position, but your Lordships should note it well. It is about multiple academy trusts. MATs are not simply partnerships of schools. There are economies of scale. We can take advantage of shared experience. We can teach subjects across our schools and have a fantastic ability to harmonise a good result out of our disparities. But the report says that there is,

“also a danger that, with the imposition of rules and regulations across the chain, MATs might increasingly reproduce the bureaucracy of local authorities. Such bureaucratization might endanger the innovative character within MATs; standardisation of practice might also hinder the ability to respond to community needs in different schools or localities”.

I do not offer that quotation as a judgment on the whole experiment but I urge this House to look seriously and in a balanced way at the pluses and the minuses—the good things and the bad things, the dangerous trends as well as the wonderful accomplishments—of academies. They do not of themselves spell a future that is success. They must be looked at with more dispassionate eyes than that.

Because I am going to observe the time limit, I just want to mention that we are operating on budgets in our schools which will see a reduction in real terms as we face extra costs. We are looking at a reduction of 7.6% because of extra insurance and pension contributions, and savings of a considerable nature have to be made. Ring-fencing does not make sense when we are looking at budgets that have to be reduced in this way. We will of course look for greater efficiency and productivity but let us be honest about the fact that our schools are under great pressure at the moment. Let us not limit our attention to the academies, all of whose successes we laud but which are not a panacea for the educational needs of our country at this time in our history.

6.10 pm

Lord Addington (LD): My Lords, when I put my name down to speak in this debate, I must admit that it was to make a general point about something that has been missed. However, it fits into the last few speeches because the noble Lord, Lord Griffiths, and the noble Baroness, Lady Morris, spoke about the confusing state of education and the organisation of schools. This has also led to a slightly confusing state when it comes to teacher training, with various levels of qualification going in and out, and leads directly to the point that I shall make. Here, I come to my more

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familiar ground and if the rest of the House wants to put itself into doze mode as I talk about dyslexia and other special educational needs, I would not hold it against any of your Lordships.

Teacher training has one great hole in it: the fact that it does not train people properly to deal with those with special educational needs through specialist training. Dyslexia is reckoned by everybody outside government to affect 10% of the population, while the Government reckon that it is 8%. Let us compromise on 9%, so that in a standard classroom you will normally get only two point something or three such people in there, although getting four or five will be as common as getting none. We have accepted that we need to do more work here. Indeed, from the previous Government I pay tribute to Sarah Teather, who set up the process of the special educational needs bit of the Children and Families Act, to David Laws, who saw it through, and indeed to the noble Lord, Lord Nash, who got that Bill through this House. I understand that it is a busy day but I hope that the Government Front Bench will convey the fact that I appreciate the work that the Minister did on the process of that Bill, because he listened.

If we are to go through a process where we extend the time over which people need to be trained, would it not be sensible to make sure that teachers—the initial people you are talking about—have the skills to identify those with different learning patterns from the rest of those in their classrooms? I was thinking of another way of describing this but I am afraid that I have come down to only one: it is the bleeding obvious. Three of your normal class do not have the same learning pattern because they are dyslexic. Their brains do not process information in the same way and they have bad short-term memories. When chalk and talk are used—that is, to convey information to them—they cannot absorb it in the same way. We then come to those with dyscalculia or dyspraxia, who will have other problems. Once again, they will not be able to process the information in the same way as the norm. Then we could put in people with things such as autism, most of whom are at the high-functioning end. They will have other social problems, which will mean that they will not relate to the classroom properly or absorb the information. If the teacher cannot spot this, he cannot make any adaptations to their learning style. You are effectively asking somebody to make bricks without straw.

Who has said that it would be a good idea to bring this in? I have a list of reports from the past few years and I have excluded from it all those with “dyslexia” in the title. We have had the Rose review, the SEND code of practice and the Driver Youth Trust with its lovely report, titled The Fish in the Tree. There was the Every Child a Chance Trust report and the Carter review. There was a report from the Communication Trust—the list goes on. Everybody has agreed that this is a huge hole because you are asking the professional to do something which they are not trained to do. The result is that we have people who cannot join in the process of education because they have problems processing.

The Government could turn around and say, “Let’s have a few more specialists”. That falls down quickly

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because if you do not identify the person to be put in front of the specialist, you cannot get the help—and the people who always end up getting the worst deal are those just on the edge, who are not very obvious. Dyslexia in particular is called the middle-class disease but that is wrong. It is the exam-passing classes’ disease because what happens now is that a parent says, “Why is my child not achieving?”. They take it to the teacher and then the teacher goes, “Oh, I’m not sure. Do you think that it could be dyslexia?”. There is then a legal struggle to get that person assessed. I want, in the course of this Government, to get a little closer to where the teacher turns round to the parent and says, “Your child is not achieving because I think they could have one of these hidden disabilities”. If we do that, we will address many of the problems and make the job of the teacher, and the whole process, much easier.

I come back to my point: it is the bleeding obvious. Unless we are prepared to take something along the lines that will improve the situation, we will be guaranteed a continued amount of failure—and the costs that go with it in those who cannot find employment or access the norms of procedure, as we have heard about before. Why should they, since it does not apply to them? Unless we start to do this, we will be storing up more trouble. I encourage all in this House to pay attention to this because one small change—an extra week of training, in a course of about a year—could have massive, positive results for the whole of society.

6.16 pm

Baroness Wheeler (Lab): My Lords, I shall speak about the NHS and fully endorse the deep concerns of a number of noble Lords at how promises in the gracious Speech such as closer working integration, seven-day working and better access to GP and mental health services can be met in the light of the scale of the huge financial and quality challenges facing the NHS, and while social care continues to take such a heavy burden in cuts.

Today, however, I shall speak about NHS specialised services and rare diseases, which present a major challenge to the NHS on no lesser a scale than some of those already referred to. In so doing, I declare an interest as chair of the Specialised Healthcare Alliance, a cross-party coalition of more than 100 patient-related organisations supported by 16 corporate members, which campaigns on behalf of people with rare and complex conditions. The alliance works closely with Members across parties. The noble Earl, Lord Howe, the former Lord Speaker, the noble Baroness, Lady Hayman, the noble Baroness, Lady Jolly, and my noble friend Lady Pitkeathley are all past chairs or vice-chairs of the alliance, so I am part of an illustrious bunch. They have all been strong advocates for quality and coherent specialised healthcare services. Of course, this House has a proud record of pioneering the development of national commissioning and standards for specialised services, under the Health and Social Care Act 2012.

Collectively, tens of thousands of people call on these services for conditions such as HIV, cystic fibrosis, multiple sclerosis, muscular dystrophy, epilepsy, haemophilia, leukaemia and other cancers and renal

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dialysis, among many others. Alliance membership thus ranges from the larger charities such as Macmillan and the Cystic Fibrosis Trust through to smaller charitable organisations, established by people with close personal experience of a condition and covering such diseases such as Niemann-Pick and Guillain-Barré syndrome. Medium-sized charities in the alliance’s membership support patients requiring complex but not uncommon care. The Terrence Higgins Trust, the National AIDS Trust, the Brittle Bones Society and Roald Dahl’s Marvellous Children’s Charity are just some of these.

Specialised services are a vital part of the NHS, affecting large numbers of patients and their families and often providing the last resort in the care pathway. The annual budget is £14.6 billion, accounting for more than 10% of the overall NHS budget. Services include some of the most advanced technologies and procedures, playing a crucial role in fostering innovation in clinical expertise and service provision. The challenges and opportunities facing specialised services reflect those facing the NHS as a whole. Commissioning and accountability for standards of care are the main two of these.

First, there have been considerable financial pressures on NHS England’s specialised commissioning budget in recent years, arising principally from inaccurate budget-setting based on flawed assumptions about historic spending prior to the last NHS reforms, alongside an overspend in the cancer drugs fund and some increase in specialised activity on the part of providers. Fortunately, the budget is now in balance, but deep concerns remain that new and not-so-new service developments have stayed in the long grass of NHS England’s decision-making structures for an unforgivably long time. In April 2013, NHS England promised a rapid review of the principles underlying its investment decisions in specialised care. Two years on, a not-so-rapid review is belatedly nearing completion, but it took a legal challenge to prompt NHS England into action. In the mean time, patients have been unable to access a whole range of treatments, causing huge concern and anxiety, and in some cases jeopardising their health. Moreover, in future, patients will still need to await the deliberations of NHS England on new services and treatments. I hope the Minister acknowledges that NHS England needs urgently to refine its policy-making processes and ensure that they become robust, timely and efficient, as per the wishes of the patient and the clinical community.

Secondly, and fundamentally, the Health and Social Care Act made NHS England accountable for prescribed specialised services following the confusion and inertia that previously surrounded local budget-holding and accountability, which was vested in primary care trusts. NHS England is now pursuing “collaborative commissioning” for specialised services with local CCGs. Its March guidance on this subject contained mutually contradictory statements, endorsing the role of mandatory national service specifications but also a direction of travel towards place-based—that is, local—commissioning. Although the need for collaboration between NHS England and CCGs to ensure integration between services is fully recognised, this must not be at the expense of NHS England’s clear accountability for the specialised commissioning budget and prescribed services.

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We know from NHS clinical commissioners that CCGs will not be bound by national specifications or commissioning policies where they hold the budget for specialised services. IVF, where less than 20% of CCGs commission in accordance with NICE guidelines and an increasing number do not commission at all, shows the potential vulnerability of specialised services in this region. No assurances have been given as to where the budget will lie in 2016-17. NHS England has confirmed that it will develop proposals for place-based budgeting for 2016 and onwards for consideration later this year. This stands in stark contrast to the endorsement of national standards in the earlier commissioning guidance. It is also fundamentally counter to the wishes of the patient community and cross-party consensus under the 2012 Act.

I hope the Minister can reassure the House that the provisions of the 2012 Act will be adhered to in the future provision of specialised healthcare. Pooled resources and expertise must be retained for specialised commissioning at national level. This is absolutely essential to the maintenance of national service standards and clinical access policies across the country, and to providing the services that patients need, depend on and deserve.

6.23 pm

Lord Bichard (CB): My Lords, a new Government and a first gracious Speech provide an opportunity for us to revisit some of the most intractable of our problems. My particular hope is that the Government think long and hard now about how better to reform our public services, especially those which we are debating today.

Few people do not believe that reform is still needed. Successive Governments have tried, but what really matters is that, from the citizen’s perspective, the user’s perspective and the patient’s perspective, the results have been disappointing. It is true that, recently, the lack of resources has made the task even more difficult, but the problem is not primarily one of resources. Too many of the services that we provide are unnecessarily complex and therefore very difficult to access—we have heard many examples of that already today. Too many make more sense to the providers than they do to the users, too many provide poor value for money and some just do not work very well. If that sounds too pessimistic, your Lordships should take an honest look at the availability and quality of much social care, take a look at the extent to which the NHS is truly patient centred, and ask themselves whether improvements in educational attainment have kept pace with our international competitors.

So why have we not been more successful, in spite of all the effort and good intentions? Perhaps we continue to place too much emphasis on changing the structures of our institutions. Few people now would deny that the Health and Social Care Act 2012 was a classic example of that. As the noble Baroness, Lady Morris, pointed out, quite rightly, all the evidence suggests that structural change does not make that much difference to quality; in fact, it often demotivates the staff who can make the difference. At the end of

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the day, it is the quality of teaching in the classroom and the quality of nurses and clinicians that make the difference.

Perhaps we have continued to place too much reliance on regulation and inspection, which can only ever describe services, never improve them. Perhaps, in spite of all the protestations, we are still too fond of centralisation, prescription and intervention when things just do not go according to plan. Perhaps the many targets we have set from the centre have served to confuse rather than to clarify priorities. It may be that creating ever more specialist agencies has made it more difficult for teams to work effectively together at a time when few, if any, of our social problems can be resolved by one department or agency working in isolation.

What I am sure of is that if all we do is to continue with these same approaches, then we will get the same disappointing results. Is there a better way, a way we could do things differently? I think that there is, and that some of the things that we can do are really quite simple. For example, instead of constantly beginning any process of reform by thinking about how departments, agencies and authorities should change, we might start by looking more closely at the experience of users and what they really need. Having spent more time understanding that better, we might try and design services and policies around users’ needs rather than around our bureaucratic boundaries. We might try and make those services more accessible, seamless and reliable.

We could certainly do much more to involve users in the design of services and the development of policy at an early stage, instead of leaving it to belated and sometimes meaningless consultations after decisions have already been taken. We could, in other words, seek to achieve a genuine process of co-production. In doing all that, as the noble Lord, Lord Giddens, suggested, we could do a lot more to integrate technology into the design of our public services, building on the excellent work of the Government Digital Service: using technology as a way of giving people more power but also as a way of giving them greater personal independence and improving the quality of our services. We could and should be much more imaginative in drawing on and supporting the potential which I believe exists in every place and community, so that people become less dependent on the state and more able to provide together for their own needs.

Am I optimistic? There is some hope. The Care Act, which came into force only on 1 April, does seek to build around the needs of clients, not the convenience of providers. It talks about building on users’ strengths, not just assessing their weaknesses, and points towards the need for co-production. It needs more resources, and I for one cannot understand why we always talk about protecting the health resource, but never the health and social care resource, which is what we actually need to do. This is a piece of legislation which I hope the new Minister will give real priority to, because it will not only bring benefit to the users of these services but could offer a new model for our public services.

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However, in ending, I contrast the ambitions of the Care Act with the way in which we provide financial support for those in need of care. They, or more usually their dependants, have to struggle still with a complex, confusing maze of bureaucracy, involving: the Department for Work and Pensions, which provides lower and higher-rate attendance allowance; local authorities, which provide or commission domiciliary or residential care; and the NHS, which provides continuing healthcare. This is a system full of perverse incentives and different assessment arrangements, some means-tested and some not. It is a system designed by bureaucrats for bureaucrats and makes no sense at all to users. If you look on the internet, you can see that the system has spawned an industry of companies that are offering paid-for advice to vulnerable people on how to obtain the best deal from those bureaucracies. On top of all that, it wastes taxpayers’ money. If we really did design services with users around the needs of users, we would never end up with such an unsatisfactory set of arrangements. Beacons of light are all very well, but we need user-led services to be the norm.

6.30 pm

Lord Lingfield (Con): My Lords, I am sure that the aspiration in the Queen’s Speech to improve schools is one which we all share. It is a sad fact, however, that our schools system has to rely too heavily on the further education sector to remediate poor literacy and numeracy skills in 16 to 18 year-olds. This type of FE work has to be done extensively at present, but we look forward to a time when it ceases to distort the central and foremost aim of FE institutions, which is to provide young people with high-quality technical skills, to give them lifelong chances of employment.

In 2012, I was privileged to chair a government review of professionalism in further education, which produced the so-called Lingfield report. During our work, we visited many providers of further education, in both the public and private sectors. I was struck by the huge variation among them in their provision, one of the sector’s strengths, and the huge variation among them in their quality, one of the sector’s weaknesses. I saw teaching and learning of the highest standards, but was aware of rather too much that was mediocre—and there are, of course, a few colleges that are simply not up to the task of providing what is required of them.

I started my investigation into further education by speaking to young people in schools, and to parents. It became obvious that, virtually all 16 to18 year-olds know that a university will, if they can pass the entry requirements, provide them with either a BA or a BSc degree course in a large choice of subjects. Employers know too what a graduate is and what a degree, for instance, from an institution in membership of the Russell group of universities is likely to be worth. On the other hand, confusion reigns about qualifications in vocational education, what their standards are and how much an employer can rely on each one. In 2014, there were an incredible 21,000 FE qualifications available from 161 awarding bodies, and thus bewilderment is caused to students, parents, lecturers and, especially, employers. The time has come for a simple set of

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pre-eminent benchmark qualifications, recognisable by all, and proof to employers of high-quality vocational skills.

It is an important part of the Government’s strategy that, as with schools, further education providers should become as autonomous as possible, with their priorities set by the professionals on the spot to suit local employment needs, and not by government. This is the only way that we shall drive up standards in the sector. To that end, I was requested last year to start the process of founding a new royal chartered body, the Institution for Further Education. I pay tribute to officials from the Department for Business, Innovation and Skills, who have been extraordinarily helpful to me in this quest. I am delighted to say that we now have a council drawn from among the best practitioners in the sector, an office in London and a chief executive appointed. This month, I am told, the Privy Council will consider our petition for a charter; it would be wrong for me to attempt to pre-empt its decision, but we are very hopeful that we shall be able to go ahead shortly.

The new body will admit new member institutions, using a series of criteria concerned with governance, financial probity, high quality of teaching and learning and success rates in current qualifications. Above all, those would-be members will have to submit the highest references from local and other companies on the employability of their students. FE providers will be judged for admission by a committee of their most distinguished peers and colleagues. There are various privileges of membership, which above all will confer a special new status and a high-quality assurance mark on those colleges and other institutions, public or private, which earn them. Membership will be a guarantee to students, parents and employers alike of the high standards of the courses on offer. It is our hope that, in time, all FE providers will aspire to qualify for membership. As with other chartered bodies, those who let standards slip will risk exclusion. One of its early aims will be to further the development, with the various awarding bodies, of the limited set of benchmark qualifications that I mentioned earlier and which will ameliorate the present confusion. We want these to be as well known and valued as if they were university qualifications.

In 2005, Sir Andrew Foster in his review of further education called it “the neglected middle child” of education. That is still, alas, the case, and the situation ought not to be allowed to continue any longer. It is our hope that this new sector-led chartered body, at arm’s length from government, will drive up standards throughout further education and, as an innovative and dynamic entity, assist it to provide for the nation the highly qualified, technically able workforce on which our country’s economy in future decades will depend, as the noble Lord, Lord Quirk, has just reminded us.

6.37 pm

Baroness McIntosh of Hudnall (Lab): My Lords, I was pleased to see that education had been grouped with culture in today’s debate on the gracious Speech, but I wish that I felt convinced that the Government accepted the need for them to keep equally close

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company in the development of education policy. That is what I want to talk about before touching briefly on two other matters. Last month, a letter from a head teacher appeared in the


newspaper, which I think would be of particular interest to the right reverend Prelate the Bishop of Norwich, who is sadly not in his place—and, indeed, to the noble Lord, Lord Kirkham. I understand that, at this hour in a long debate, the call of the dinner table becomes very insistent, but I am sad that neither of them is here to hear it because it very much goes to the points that they raised. It says:

“As the headteacher of a 1,000-pupil comprehensive school in the West Midlands I have mixed emotions as I look back over the school year.

At Christmas the school choir sang in a hauntingly beautiful carol service in the local church. Following a recent charity week, my pupils presented more than £4,000 to national and local charities. My Year 8 boys have just won the English Schools’ National Under-14 Football Cup. While walking in the Shropshire hills last weekend, I met 20 of my Year 10 pupils who were trekking as part of their Duke of Edinburgh Award.

The mixed emotions I feel are delight and despair: delight that all these activities are what a school is all about, helping pupils become well-balanced young adults able to take their place in society—and despair because nothing I have described to you counts a jot in the school league tables by which all schools are measured”.

That was from a head teacher in the West Midlands.

Those words precisely encapsulate what many of us find so troubling about government attitudes to education over the past five years and about the tone of the gracious Speech in promising further legislation, with its references to “failing and coasting”. The relentless focus on testing, the slow but unmistakable downgrading of arts subjects in the curriculum, the insidious undermining of teachers—my family is full of them, so I see the effects at first hand—all contribute to a good deal of anxiety and despondency in the classroom, in the playground and at the school gate. The determination of many schools to provide, in spite of everything, a creative environment for their students, which I see, for example, when I take part in the Peers in Schools programme, is almost a miracle in the face of a Government apparently bent on draining the joy that is so essential to effective learning out of education.

Polly Toynbee, writing recently in the Guardian—I know she is a leftie, so she will be ignored by a large number of people in this House, but none the less—said:

“Research shows how the arts improve attainment in all subjects: drama improves literacy, music improves maths and early language. The arts make most difference to children from low-income families—those who get arts teaching are three times more likely to get a degree and a job … but the English baccalaureate excludes the arts altogether, leading to a sharp fall in arts subjects, especially in deprived areas. I would bet both Gove and Morgan”—

her nomenclature, not mine—

“would reject any school for their own child that had abandoned arts teaching”.

I leave that one to stick to the wall, as they say.

I want to say a brief word on mental health care. Those of us who have had mental health problems know how frightening and lonely the experience can be. Appropriate and, above all, timely intervention is essential. Parity of esteem was the key mantra of the last Government. I noticed that it was absent from

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today’s speech from the Front Bench. It is a fine phrase, but the problem is that fine words, as we know, butter no parsnips. I do not know why parsnips, but proverbially they butter no parsnips.

Recruitment and retention of mental health professionals is still a huge challenge. Psychiatric beds, so vital for acute mental health crises, are being closed all over the country, and access to invaluable talking cures, such as cognitive behavioural therapy, is subject to long waits and significant rationing. Most disturbing of all, services for young people are under more pressure than ever, which is particularly worrying when we hear today, for example, that the incidence of anorexia nervosa is rising sharply. Given these realities, will the Minister explain exactly how the Government intend to deliver on the promise in the gracious Speech to improve access to mental health care?

Finally, I shall say a word on the BBC. I was amused to read, immediately after the appointment of the new Secretary of State for Culture, dark threats from some quarters about how he was plotting revenge on the BBC for its partisan coverage of the election. It amused me partly because the right honourable gentleman is an experienced politician and a cultured man and I have no doubt that he will plough his own furrow without assistance from headbangers in the press or elsewhere who see the BBC as an obstacle to their interests. I was also amused because I, too, spent quite a few hours during the election campaign with my pen hovering metaphorically over the green ink bottle ready to rail at the BBC for its partisan coverage of my party. It has often been said, and well said, that if we all feel ill-used it must be getting it pretty much right.

The BBC is not just another broadcaster in a competitive marketplace. It is one of this country’s most significant cultural achievements, and we have quite a few to our name. The original mission to inform, educate and entertain—the words carefully arranged in that order—has, of course, been tested by the passage of time, the evolution of technology and societal change, but it stands up pretty well. The funding model which supports it has been challenged many times but still bears scrutiny when compared with other possibilities.

Over its long history the BBC has, of course, made many mistakes and infuriated many people, but that should neither surprise nor dismay us. However grudgingly, most people acknowledge that, with all its faults, it is a unique feature of our heritage, our future and our currency in the world. The Secretary of State should act as a critical friend, not an asset stripper, as he goes into the charter negotiations. He will not be forgiven if he gets it wrong.

6.44 pm

Lord Kirkwood of Kirkhope (LD): My Lords, it is pleasure to follow the noble Baroness, Lady McIntosh of Hudnall, and I agree wholeheartedly with the majority of her speech, particularly her final point supporting the BBC. I am very pleased to take part in this debate. I am deeply relieved. The ministerial appointment that I was looking for most after the election was that of the noble Lord, Lord Freud, because without him

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universal credit would be in a much worse place than it is now. He still has a job on his hands, but I am really grateful for and encouraged by his return. I was even more encouraged—if I can put it that way—by the addition to the ministerial team of the noble Baroness, Lady Altmann. She must not give up her campaigning zeal in her Twitter feed. If any departmental official tries to turn the noble Baroness’s gas to a small peep—and knowing her as I do I know it would be a brave person who did that—they would doing the nation a great disservice. I hope she will continue to inform her followers as she has been doing over the past few years. She has an important role in pensions, and we look forward to working with her in future.

I want to lay down a couple of markers about things that I think are really important. The theme of the Queen’s Speech that came through to me was the desire of the new Government to develop a one-nation approach, and that is correct. It is certainly correct coming from a Scot who experienced the election. I have done 10 now, one way and another, and it was in many ways one of the hardest, and not for just the most obvious reason. I found the tenor of the background environment very difficult, and there are some problems there that the Government will need to deal with.

I want to spend my restricted time looking at how a one-nation approach can be applied to low-income families. It is true, and the noble Lord, Lord Freud, knows this, that active labour markets are the obvious first port of call for getting people off benefits and into work, but there are now many more working households in poverty. We must not forget that, and I fear that sometimes we do. I am looking the Minister straight in the eye when I say that the prospect of £12,000 million cuts annually over a two-year period when we still do not know the full cumulative effect of the cuts in the previous Parliament is deeply worrying.

In 2012, the Minister oversaw the Committee stage of the Welfare Reform Bill in a masterly way which improved the Bill, but it was not helped by financial privilege being thrown at us from the other place. I hope he will adopt that approach—as much as he can because I am not stupid and know that all this is Treasury-driven—in trying to explain in good time to Members from all sides of the House the options that are being canvassed and give us a chance to think about them, reflect and give him both publicly and privately our views about how they can be done. I think two years is impossible. Trying to do this by 2017 is just impossible. In a powerful speech, the noble Lord, Lord Fowler, referred to the fact that there is a smaller pool of benefit recipients from which we are deriving this saving. It just is not safe. I promise the Minister that my colleagues and I will work with him as energetically as we are allowed. The leader of our group, my noble and learned friend Lord Wallace of Tankerness, was right to say that of course the Government have a manifesto commitment to make the saving, but they do not have any Salisbury protection for individual benefit cuts. So I say to the Minister that I will be looking to him to return to his positive and consultative approach to try to make the best of what I think will be a very bad job.

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As I said earlier, I do not think that universal credit would have got past the first reset if the noble Lord had not been the Minister in charge, and I know that he is still engaged in it. People forget that the 2010 coalition settlement was based on the idea that universal credit would already be in place and helping low-income households at the margins of worklessness and benefit receipt. At the moment it is available to only 50,000 families; I know why that is, but too often we forget—certainly as far as I was concerned—that by 2015 the 2010 deal should have seen hundreds of thousands of families benefiting from universal credit, and they are not.

I urge the Minister to make as much progress as he can. People are losing confidence in this programme. The department has managed 30 significant policy changes over the past five years, with 18% less resource in the departmental expenditure limit. Most of that has worked, but universal credit is still at risk and, sadly, coming from Scotland, I know that people are beginning to lose confidence in it. We really need to concentrate on universal credit.

My final thought is that I look again to the noble Baroness, Lady Altmann, to work with the Treasury on this. I have just finished a fascinating session with Sir Sherard Cowper-Coles on the need for financial inclusion, and an element of that is necessary to deal with the digital divide in universal credit. Can the department please work with the Treasury in future to try to get financial inclusion more broadly based across the United Kingdom so we can ensure that people can get the full advantage of universal credit when it is rolled out across the country?

6.52 pm

The Earl of Listowel (CB): My Lords, I join the noble Lord, Lord Kirkwood, in welcoming the noble Lord, Lord Freud, back to the Front Bench. Perhaps there is no more important mission than getting as many of our people into work as possible. I remember that the primary mechanism for the success of Louise Casey, when she was the tsar for rough sleeping, was getting those people into purposeful activity. It is so important for all of us to feel that we are doing something purposeful and useful.

I declare my interest as a landowner. From the age of 15 I remember visiting my tenants. The property that I was to inherit was held in trust for me until the age of 21, but I had been visiting it since the age of 15.

I welcome much of the Queen’s Speech. I particularly welcome the legislation on psychoactive drugs. More and more of our children are growing up without fathers in the family; we will soon overtake the United States in the numbers of boys and girls who grow up without a father in the home. It really cannot be helpful to young people to have powerful drugs easily available to them and then to say, “Well, they’re legal”. It is hard for them to know what to do when perhaps they are not getting the guidance at home that they need.

I take this opportunity to thank the coalition for what they did for looked-after children and care leavers in the last Government. It was extraordinarily good

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work. We have heard today about the work around adoption. In particular I praise the encouragement of the voluntary adoption agencies, which have been so powerful. Edward Timpson MP, the Minister, introduced virtual school heads to promote the education of looked-after children and put it on a statutory basis. We had pupil premium plus. All these things are so important for these young people.

The Government introduced Staying Put, which enables young people in care to remain with their foster carers past the age of 18 to the age of 21, where they choose. Until recently, one-quarter of young people in care were leaving care at the age of 16. That went up to one-third fairly recently. The Government realised the importance of making a change to enable them to stay past the age of 18. In the first year of their attempts, only 5% were staying on and the figure was the same the next year, so clearly something had to be done and the coalition Government did it. I commend them, particularly Edward Timpson, the Minister for Children, the noble Lord, Lord Nash, who took the Bill through the Lords, and the Secretary of State at the time, Michael Gove.

I have some concerns. Last night I read with great interest the speech by the noble Lord, Lord Best. He called for the Government’s plans around housing to have a pause and for them to think deeply. I second his concern. Housing has been overlooked for so long in this country—I say this as a landlord—and the need for affordable and social housing means that the issue must be carefully thought through, so I support his call. I ask the Minister to take my request back, if he would, to the Minister responsible.

A recent case of a woman, which I have been following for the past year, brings this home to me. Her daughter was raped at the beginning of her adolescence, about a year ago. The man who raped her lives nearby in the local high street. The police have said that she and her daughter should be moved, as has their psychologist. The baby has been born and still they have not been moved. There is a severe shortage of social housing; in some boroughs it could take decades to get back to the supply that is needed. I welcome what the Government are proposing with regard to 275,000 units of new affordable housing but often, although the aspirations are large, we need to triple, quadruple or even quintuple the effort to get the affordable and social housing that we need.

In past visits with health visitors, I have been dismayed at seeing water running down the walls and mothers sharing a bed with maybe two young children in the most insanitary conditions. The landlords are clearly neglecting their care. There are no places for the children to play. They have to share facilities with several other families, sometimes arriving to find that the front door is open. There is isolation: a young mother with her first child, her husband or partner not in this country, can hardly speak the language, and the only people she knows are the local church people who visit her from time to time. The health visitor has to try to help her in the few minutes that she has while the mother is crying. I praise the Government for resurrecting and investing in health visiting—that was a triumph of the coalition Government.

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I ask the Health Minister, the noble Lord, Lord Prior, if he might be prepared to consider visiting with a health visitor and myself, and seeing these conditions. A recent report on perinatal mental health emphasised that it costs the nation £8.1 billion a year not fully to address the mental health needs around perinatal care—£10,000 per birth. There is clear evidence that poor housing and homelessness impact on the mental health of mothers. I would be very grateful if the noble Lord, Lord Freud, would take that invitation back to the noble Lord, Lord Prior, or indeed any Minister. These housing issues have a strategic impact on all departments, and I would very much welcome the opportunity to meet with any Ministers and take them along with a health visitor to speak to these mothers about their experiences.

If I saw the conditions that I have seen and I were the landlord, I would want to shoot myself. If my mother were in such a situation, I would be heartbroken. I urge your Lordships to listen to the request from the noble Lord, Lord Best, for deep thought before progressing.

6.59 pm

The Lord Bishop of Rochester: My Lords, I welcome the opportunity to speak in this debate on the gracious Speech. I am delighted to follow the noble Earl because he has paved the way for me in reminding us of some of the contributions which were made in yesterday’s debate on matters to do with housing and the proposed housing Bill. He has illustrated the points rather more graphically and personally than I might be able to do. I make that connection between yesterday and today because I think it is very clear that issues to do with housing have a real relevance to the matters which are our main focus in today’s debate in your Lordships’ House. For example, research over decades has underlined the point which has just been so graphically made—that there is a clear connection between the quality and conditions of housing on the one hand, and people’s mental and physical health and well-being on the other. There can be very little debate about that; I do not need to labour the point.

In relation to education, it is just common sense to note that housing stability and the stability of households have a marked impact on the educational achievement of children from those households, not least when we are thinking about the most vulnerable children in our communities and in our society. Put very simply, if a child moves home frequently because the family is in insecure housing, for example, that cannot but have an impact on the educational outcomes as far as that child is concerned, however great the efforts of those who are charged with the education of children in those circumstances. I will not labour the points, but in those and other respects, the provision of good, appropriate and affordable housing is clearly vital if we wish to achieve our best aspirations in the areas before us today of health, education and welfare.

Yesterday there was considerable attention given to the proposal in the Queen’s Speech and in the proposed housing Bill in relation to the extension of right to buy to housing association tenants. I will spare noble Lords my thoughts on that particular thing, because

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all the points were well and ably made by different noble Lords in yesterday’s debate. However, if time allows, I will comment on three related matters.

Housing associations—and I declare my past membership of various housing association boards—are much more than providers of housing. Reference has already been made in today’s debate to housing associations as providers of welfare and care services. Among other things, in different places they offer debt and welfare advice; many work with the most vulnerable in our society in offering different kinds of social and health care. Many housing associations have initiated schemes around employment, training and employability. They are very well placed to do this because of their integration into local communities in many cases, and they do it very well. They have a noble history of innovation and enterprise, and capacity to integrate housing with social and community well-being. It is therefore vital that we do not in any way undermine the capacity of housing associations to make their contribution in those ways.

When we come to look at the proposals in the proposed housing Bill I hope that we will look very carefully at those things, including right to buy, which could undermine the stability and sustainability of those organisations. I therefore support the call, which has just been echoed to the Government, to think carefully about the legislation to make sure that we do not have any unforeseen consequences for the capacity of those organisations to do the things that they do beyond the provision of housing plain and simple.

I turn to our rural communities. In many villages we have five or six affordable or social homes, and often the planning permission was granted for those on the assumption that they would remain available for social rent in perpetuity. The diversity of tenure which they represent is vital for the economic and social vitality of those places, including sometimes the sustainability of village schools. There is an exemption under the current legislation with regard to right to buy when it applies to smaller communities, and I urge the Government to consider the extension of that exemption when the new legislation comes forward in relation to right to buy for housing association properties. It is vital for the sustaining of these rural communities in our midst.

My third comment is on the private rented sector, which is becoming of increasing importance in our housing landscape. However, it is a sector which, at times at least, is marked by short and insecure tenancies—and insecurity, therefore, in family situations and household life. I have already made the point that stability of housing has potential good effects in terms of children’s education and in terms of health and well-being more generally. I hope, therefore, that at some point in the life of this Parliament it might be possible for legislation to be framed which will offer the possibility of longer-term secure tenancies in the private sector. It can be done—it has been done in other nations—and it would have profound good effects for our communities and for the well-being of families and individuals. It has benefits not only for tenants but also for landlords.

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Lastly, because the time is ticking away, I underline the willingness of churches and faith organisations to play our part, not least in places where considerable new housing development is being brought forward, not least in my own diocese of Ebbsfleet and other such places. We have the will to engage positively, not least so as to play our part in creating the kind of community infrastructure that is necessary for the delivery of good health, education and welfare in our communities. In Ebbsfleet we are already in conversation with developers and with the development corporation about possible schools, childcare initiatives, community provision of one kind or another, and the placing of workers on the ground early in the day to help build communities. We want to work with government and with all concerned to ensure that collections of houses become places where people wish to belong and where their true and full welfare may flourish.

7.06 pm

Lord Rooker (Lab): My Lords, I wish to raise the issue of pregnancies affected by neural tube defects. Neural tube defects are serious birth defects that include spina bifida, and are a consequence of a vitamin deficiency.

It is well known that taking folic acid—vitamin B9—before conception reduces the risk of an affected pregnancy by over 50%, the exact percentage depending on the level of folic acid intake. Research on the issue by the Medical Research Council-funded study in 1991 has not been in question, and the United States of America changed its policy on folic fortification of white bread flour to mandatory in 1998 as a result of that UK research. Today, over 70 countries have mandatory fortification of flour with folic acid. The principle of fortifying part of the diet of a nation based upon science is not an issue. The United Kingdom has for decades been fortifying wheat flour—except wholemeal flour—with calcium, iron, niacin and thiamine. The cost is borne by the milling industry.

For many years, the Department of Health’s advice to women “planning pregnancy” has been to take folic acid supplements. The snag here is that the UK, to its international discredit, has the second-highest rate of unplanned pregnancies. The neural tube closes at 27 days, hence the Department of Health advice for women “planning” a baby. Many women are not aware of a pregnancy until after 27 days, by which time it is too late.

In 1996, the number of women in England and Wales taking supplements was 40%. In 2012, it was 28%. The Department of Health “advice” policy is not working. Affected pregnancies can be discovered at the 20-week scan, and around 80% are terminated. The use of this large percentage of terminations is the Department of Health “policy instrument” for dealing with neural tube defects—there are around 15 to 18 per week.

I was present earlier this year at a meeting of the All-Party Parliamentary Food and Health Forum, when, as the minutes record, the chief executive of Shine, the spina bifida charity, said:

“It looks to Shine as if the Government is avoiding acting. A senior civil servant told me that the Government’s view is that the issue of folic acid deficiencies leading to spina bifida is ‘well managed through terminations’”.

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There are about three live neural tube defect births a week in England and Wales—that is 150 a year. In 2012 in England and Wales there were 908 affected pregnancies—only 28% of women were taking folic supplements.

Independent scientific committees such as the Scientific Advisory Committee on Nutrition and the Food Standards Agency have given advice to government to fortify white bread flour. Chief Medical Officers have come and gone, but they have never really collectively—there are four—taken the issue seriously to Ministers because they have always found something else to wait for by way of research; I will refer to two.

I arrived at the Food Standards Agency in 2009 after it had advised the Government that flour should be fortified, although I was aware of the issue from my days at Defra. I therefore knew of the claim that colon cancer would, or might, increase. Research was commissioned and in 23 March 2013 a paper by Vollset et al was published in the Lancet which found “no significant effects” of folic acid on the incidence of cancer on any specific site.

Folic acid in the form of supplements or fortification in flour is remarkably safe. More than 70 countries follow the fortification policy, and there have been some spectacular reductions in the number of babies born with disabilities, and of course reductions in terminations.

Earlier this year, the United States Centers for Disease Control and Prevention published an update on neural tube defects prevented by mandatory folic acid fortification between 1999 and 2011. Over the period, the number of births occurring annually without the defects that would otherwise have been affected is approximately 1,326. A long paper showed an overall reduction of 28% of affected births, and it estimated a net saving of more than $500 million in total direct costs for the affected births that were prevented. The United States still has a national birth defects prevention month and a folic acid awareness week. There have been substantial reductions in Chile, which has used a higher level of fortification than the US. Leading scientists say the Chile level should be used worldwide.

Turning to the second cause of delay, in response to a series of Oral Questions that I asked in 2014-15, the noble Earl, Lord Howe, indicated that the Government were awaiting the latest blood folate information from the national diet and nutrition survey. After a very long delay, the blood folate results became available at 9.30 am on Friday 20 March this year, showing that many women had low blood folate levels. The Government now have all the evidence they have been waiting for. Is the policy going to change? The UK has the highest level of neural tube defects in Europe, so neighbouring nations do not see a need for action. It is the UK population who are affected, so we need to act.

Taking the results of the US evidence I mentioned earlier and applying them to the statistics for England and Wales, scientists say that in the period 1998-2012 there would have been about 1,800 pregnancies without, instead of with, a neural tube defect. That is a very substantial potential reduction in distress all round.

Folic acid intake levels of 5 milligrams per day or more have no known adverse effects. While folic

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fortification is necessary to prevent neural tube defects, there is no need to set an upper intake level, and no need to limit voluntary folic acid fortification at the same time as instituting mandatory fortification.

During the recent parliamentary Dissolution period, I did not completely waste my time campaigning on electoral matters—I wasted a lot of it, but not all of it. I joined Sir Nicholas Wald and Sir Colin Blakemore on two visits, to the food supplement manufacturers trade body and to the Food and Drink Federation, to discuss the industry aspects of mandatory folic fortification. Sir Nicholas, of the Wolfson Institute of Preventive Medicine, led the Medical Research Council research in 1991, and more recently published, with colleagues, a study of more than half a million women who had been antenatally screened and had provided details on folic acid supplementation. It concluded that the current policy is failing and has led to health inequalities. Sir Colin, a former chief executive officer of the MRC, is professor of neuroscience at the University of London.

We genuinely believe that putting public health first and joining more than 70 other nations in fortification will take a major step towards ending the distress caused by the large number of avoidable terminations, stillbirths and cases of permanent serious disability in surviving children. A change will take time to implement, but Sir Nicholas, Sir Colin and I are ready to help Ministers in advocating and implementing such a policy.

On 19 May, I asked the reappointed Public Health Minister, Jane Ellison, whether she would meet me, Sir Nicholas and Sir Colin. If she does not want to listen to me, she should, I believe, meet the scientists. We are dealing with a vitamin deficiency-induced birth defect, and we are using abortions—more neutrally, terminations—of 80% of affected pregnancies as an instrument of policy. This cannot be right. It is not right and what is more, it need not happen.

7.15 pm

Baroness Hollins (CB): In Her Majesty’s gracious Speech, we heard that her Government intend to,

“secure the future of the National Health Service”.

There would be widespread dismay if this intention were not honoured. However, the NHS is limping. That is not helped by an overdose of bureaucracy, and is made worse by a grave shortage of general practitioners and nurses, continuing shortages of mental health professionals, and serious underfunding of mental health services.

However, Her Majesty’s Government have recognised some key areas for investment, notably the need to introduce measures,

“to improve access to … mental healthcare”.

This is a very welcome promise, because during the last Parliament, funding for mental health services was cut in real terms by 8.25%—almost £600 million. I join the noble Baroness, Lady Tyler, in asking the Minister how much of the additional £8 billion committed to the NHS by 2020 will go towards these measures to improve mental health care.

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For too many years, mental health has been considered the poor cousin of physical health—something I know all too well as a past president of the Royal College of Psychiatrists. A staggering 7 million people experience mental illness at any one time, touching an estimated one-third of all households. A further 2 million British people are expected to experience mental illness by 2030. We need public mental health prevention strategies, not just better access to treatment.

During the last Parliament, the burden of mental illness was at last recognised, in part because of the courage of Members in the other place in speaking about their own mental illness, and in part because of my own amendment to health and social care legislation, which defined health as mental and physical health, and illness as mental and physical illness. The principle of parity of esteem for physical and mental illness was adopted, with parity of outcomes becoming a policy objective. Effective legislative and funding decisions will be needed as levers to sustain a government focus on parity over the coming years, as well as investment in developing the evidence about what works best.

Only 5.5% of the UK health research budget is spent on mental health, despite mental illness accounting for 25% of all illness. I was pleased to hear that an overarching goal of the Government is to promote social cohesion through legislating in the interests of everyone in our country. There was no specific mention in Her Majesty’s Speech of how the needs of people with learning disabilities, a particularly vulnerable group, will be protected in the legislative programme. This is a significant group, numbering about 1.5 million people in the United Kingdom—people who live their whole lives with a learning disability.

I worked clinically as a psychiatrist for more than 30 years with people with learning disabilities, retiring from the NHS in 2008. People with learning disabilities have six times the risk of mental health problems and three to four times the risk of developing dementia, so when talking about mental health problems, we are also talking about issues that particularly affect people with learning disabilities. These issues are all the more pertinent to me, as the mother of an adult with a learning disability. I have lived experience, through my son, of the challenges arising from the lack of integration of health and social care, limited personalisation of commissioned care packages, the lack of nurses specifically qualified to care for people with a learning disability, and the lack of doctors and nurses who know how to use their skills for the benefit of this patient group.

The coalition Government’s Green Paper of March 2015, No Voice Unheard, No Right Ignored, proposed to strengthen the rights of disabled people and their families, and in particular to challenge hospital admissions and to support people with learning disabilities to live independently in their local communities. The consultation period has ended. Can the Minister confirm the timetable for reporting on this consultation?

Simon Stevens, the chief executive of NHS England, has placed,

“support and care for people with learning disabilities”,

as one of the four priorities in the NHS business plan for 2015-16, alongside mental health, cancer and diabetes. In February, he also committed at the Public Accounts

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Committee to begin a closure programme of assessment and treatment units for people with learning disabilities. This followed Sir Stephen Bubb’s report,

Winterbourne View—Time for Change

, which highlighted the outdated and inappropriate practice of keeping people in long-stay institutions a long distance from home.

Care and treatment reviews undertaken by NHS England in the last few months are beginning to bear fruit, with the number of discharges beginning to reduce the number of people inappropriately placed in in-patient hospitals. The Government’s intention to integrate health and social care is welcomed and is expected to improve the lifelong mental and physical health and well-being of people with learning disabilities—a seamless service, co-created with each service user, as envisaged by my noble friend Lord Bichard.

Mencap highlights the need for training on learning disabilities for all health professionals. In the last Parliament, I introduced two debates on inequalities in healthcare for people with learning disabilities. The confidential inquiry reporting two years ago found that 37% of deaths were considered avoidable had there been an adequate health response. This equates to more than 1,200 people across England dying every year because they do not get the right healthcare. Therefore, there is a huge training agenda if we are to address some of the gaps in service provision.

Slow progress was made by the coalition Government in both learning disability and mental health care. I intend to focus my efforts in this Session on scrutinising legislation and progress in these two areas.

7.21 pm

Lord Morris of Handsworth (Lab): My Lords, I, too, pay tribute to the gracious Speech, which provides an opportunity for the House to reflect on the Government’s performance in the field of welfare. I hope that the experience gained from legislation in the last Parliament will be used to inform the Government’s approach in this Parliament.

I take the view that the structure and values of welfare define a society. They define our common humanity, our collective compassion and our sense of social justice. I believe that they should also provide a moral compass for the Government and, indeed, for society as a whole.

We can all agree that the underpinning culture of our welfare system should be to enable those in need to attain personal independence. However, reform of our welfare system over recent years has been underpinned by a culture of fear and bureaucracy. There is now a popular belief, built on the experience of those claiming benefits and those who support them, that the culture of the DWP is not to enable but to punish. Of course there is a need to cut down on benefit cheats. Who could disagree? Certainly not this House. I believe in punishing any fraud, whether by benefit recipients or by those who run our financial system, yet there is a belief that we concentrate on the former and the latter go free.

Most people involved in the financial sector are honest, hard-working citizens, and so too are most benefit recipients. Some benefit recipients, due to ill

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health or caring responsibilities, are unable to work, and some cannot find work. Two-thirds of those who found work last year earned less than the living wage, leaving their families in poverty, according to a report from the Joseph Rowntree Foundation. Under the new universal credit system, benefit claimants are at risk of sanctions if they do not apply for or accept zero-hours contracts.

When the bedroom tax was introduced, the Government said that it would have no negative impact on health or well-being. However, a study published in the Journal of Public Health in March concluded that the bedroom tax has increased the level of poverty and is having an adverse effect on health, well-being and social relationships. Those deemed to have a spare room have a choice: pay extra for their housing and have less for food and heating or they have to move. The Tory flagship council of Wandsworth is reported to have moved families 120 miles to Birmingham. I had to ask myself: what on earth have these families done to be treated in this way? I concluded that this must represent the worst form of social cleansing.

Last year, these policies and others led to 1 million users of the food banks run by the Trussell Trust, which believes that this is just the tip of the iceberg in relation to food poverty. The Government told us that people use food banks only because they are there. That is arrogant complacency at its very worst.

A story from Cheshire links the effects of these policies and demonstrates the vindictiveness of our benefits system. It also shows us why food banks are a vital lifeline to more than 1 million of our fellow citizens—like Robert, whose only crime is poverty. Robert had been working full-time but was now receiving employment support allowance due to a leg injury which required his attendance at a DWP work-related activity group. He was on his way when he collapsed with a serious blood clot and was rushed to hospital. As a result, he missed the appointment and his benefits were stopped for five weeks. To manage, he naturally had to turn somewhere and he turned to the food bank.

That is not an isolated case; it is yet another example of a vindictiveness which creates fear. What has happened to our common humanity, our collective passion and our sense of social justice? We now have a new Government, a new Parliament and new policies. Among those, I hope we can find a new moral compass.

7.27 pm

Baroness Stedman-Scott (Con): My Lords, I was delighted that Her Majesty’s gracious Speech referred to our Government’s commitment to give new opportunities to the most disadvantaged through education and welfare reform. I want to use my time today to talk about our responsibility and commitment to help young people, particularly, but not exclusively, if they are leaving the care system: helping them make a good transition to adulthood by preventing them from becoming NEET—or, if they are already NEET, helping them to get and keep a job. This is essential if they are to lead a fulfilling life, fulfil their potential and achieve their aspirations. One thing that the election made clear was that, in order to achieve this, our

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country needs a thriving economy and a complete commitment to ensuring that everyone gets a fair crack of the whip.

Welfare reforms have been implemented and—yes—more needs to be done, but it has to be right that work must pay. None of us can be in a party, a Government or a society that appears soft on people who do not want to do anything, but we all want to be part of a party, a Government and a society that wants to be strong in its resolve to help those who need our help. Abraham Lincoln made many speeches, which are quoted often. He is credited with the following:

“You cannot strengthen the weak by weakening the strong … You cannot lift the wage earner by pulling down the wage payer … You cannot help the poor man by destroying the rich”.

After those points were made and the phrases coined, it turned out that they were said not by Abraham Lincoln but by an obscure German vicar 50 years after Lincoln died. However, whoever said them, they have complete resonance with us today.

Time is short, but, suffice to say, strengthening and stabilising communities and families has to be a major priority for this Conservative Government if we are to begin to make the much-needed progress in the battle to improve social mobility.

A child who grows up without the safe, stable and nurturing relationships that are usually provided in a loving family is at a significant disadvantage when they try to make their way in the world. When they have been removed from their parents and been in the care system, the state’s major responsibility as the corporate parent must be to ensure that they benefit from other close relationships that can help them forge a strong sense of identity and security.

I join the noble Earl, Lord Listowel, in congratulating the Government on the progress that they have made on adoption for young children. However, only this week we learned the extent to which teenagers in care are moved from placement to placement, undermining any chance that they have to settle and build secure relationships with those who care for them. One-quarter of teenagers in foster care are now on at least their fourth placement. I know that the Government will be as committed to this group of young people as they have been to others and I really look forward to progress being made for them.

Although the adoption reforms announced in the Queen’s Speech are welcome, we must not forget that this is largely a solution for younger children, as I have said. Last year, there were 40,000 children aged 10 to 18 years old in care. Of these, only 70 were adopted. We must take this opportunity to raise our game here.

Sadly, outcomes for those who have recently left care are often poor. As the former chief executive of Tomorrow’s People, I know just how important a job is to provide young people with a sense of purpose and self-worth, and with a structure of routine. Therefore, I remain deeply concerned that at least 38% of young care leavers are NEET.

Almost always, what is necessary for young people to reach their potential is someone who believes in them and will push them to achieve. I am a fellow at the Centre for Social Justice, which recently published

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heir Feet

report on improving outcomes for care leavers. This emphasised the central need for continuity of relationships. There is a clear, proven and effective way for disadvantaged children to get that one relationship with someone who believes in them and will push them to achieve in life: by introducing a highly trained coach to work with them. I have spoken about this many times and am so sorry to tell noble Lords that I have got no intention of letting this one go.

An initiative called ThinkForward, which is delivered through Tomorrow’s People in partnership with the Impetus Private Equity Foundation in Tower Hamlets, Islington and Hackney, is right now transforming the lives of young people. Young people can go there if they are at risk of becoming NEET, are in care or are vulnerable. They get a coach at the age of 14, and many young people have been the beneficiaries of this service. Some 96% of them have not gone on to become NEET. This is a grand way of proving our commitment to those on the margins, to love them and get them through so that they can indeed have a job. A coach for all who need it is a worthy aspiration and one that I will continue to pursue. I am absolutely convinced that we may not need to spend more money but instead spend what we have in a better way.

I am looking forward to my Government doing a number of things, and I completely support them. I am an optimist. With fervent intent, we can have a very strong economy. We are going to reform the welfare system with diligence and care and, with passion beyond anything, make sure that we nurture those on the margins of our society to give them opportunity and aspiration to make sure that they can succeed.

7.33 pm

Baroness Pitkeathley (Lab): My Lords, I want to concentrate on the care agenda and especially on the contribution of the 6.5 million people who are caring for older, sick or disabled loved ones. Your Lordships will be familiar with the figures that I never tire of quoting—that their unpaid care saves the state £119 billion a year and that, without their contribution, health and social care services would completely collapse.

Let me begin by being positive. The commitment in the gracious Speech to integrate health and social care, which many of us have been banging on about for many years, is very welcome, as is the proposal to increase the NHS budget by £8 billion a year. Looking back at the work of the previous Parliament, no one could have welcomed more than I did—and indeed the whole carers’ movement did—the introduction of the Care Act, enshrining as it does the rights for carers, for which many of us have been fighting for many years, and the very important changes made in the Children and Families Act, which also benefited parent carers. So far, so positive, but there is no explicit commitment to increase spending on social care and consequently much worry about how the positive changes introduced under the Care Act may be undermined.

Historic underfunding of social care has left thousands of older and disabled people without access to the care that they need and vastly increased pressure on family carers, who are stepping in to provide care—as families

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always do—at great personal, societal and economic cost. ADASS and the Local Government Association suggest that £3.53 billion has been taken from adult social care budgets over the past four years and that:

“Contrary to what the Government has said repeatedly since the 2010 Spending Review, its injection of an additional £7.2 billion for adult social care over the last four years has not solved the social care funding question”.

The number of carers’ assessments has been falling steadily since 2008, with a drop of 7% over the last seven years, despite the significant growth in the number of carers. Higher eligibility requirements mean that 500,000 older and disabled people who would have got care in 2009 are no longer entitled to it, placing extra pressure on carers. This is reflected in Carers UK’s most recent State of Caring survey, done this year, where almost one in three respondents said that they or the person they care for have experienced a change in the amount of care and support that they receive and, of those, 42% said that the amount of care and support arranged by social services has been reduced. Half of all carers responding to the State of Caring survey are worried about the impact of cuts to care and support services over the next year.

The Government need urgently to commit to a sustainable settlement for social care and the NHS that sets out the funding mechanisms that will deliver the money that is needed to implement the Care Act, tackle the existing gap between need and supply, and keep pace with the growing demand that we can never ignore.

Let me turn now to social security. It is deeply concerning that the cumulative impact of welfare reform measures will affect carers. The prospect of a further £12 billion in cuts to the social security budget, which we have heard about a lot today, is causing fear and anxiety among carers. We need urgent reassurances that carers’ benefits will be protected from further cuts.

Almost half of carers who responded to the State of Caring survey are struggling to make ends meet: 41% are cutting back on essentials such as food and heating, 26% are borrowing from family and friends, and 38% are using their life savings to get by. This squeeze on carers’ finances is not sustainable in the long term. Over half of carers responding to the State of Caring survey—it was completed, by the way, before the election—are worried about the impact of cuts to social security over the next year. As a result of the changes that the Government have already made, carers will see a cut of over £1 billion to their incomes between 2011 and 2018.

Let me turn specifically to carer’s allowance, which is the main benefit for carers. It is not means tested. The benefit is worth £62.10 per week or £3,229 if claimed for a year. It is the lowest benefit of its kind and provided to those providing at least 35 hours of care a week. Almost 700,000 people under the age of 65 receive the allowance and 72% of those recipients are women. Although it may be the lowest benefit of its kind, carer’s allowance means a great deal to carers and provides important recognition, as well as income. Any cut to carer’s allowance would be severely detrimental to carers and take policy back at least 30 years to when women were dependent on their partner’s or parents’

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income. Again, we need urgent reassurances from the Minister tonight that carer’s allowance will not be cut or restricted to those entitled to universal credit only. I conclude by reminding the Minister of what I am sure he knows: as well as it being morally unacceptable not to support those who provide so much care, it is also economically short-sighted.

7.40 pm

Lord Sharkey (LD): My Lords, I declare an interest as chair of the Association of Medical Research Charities and I will speak about medical research and the NHS.

The United Kingdom is a world leader in medical research. More than 75% of clinical research in the United Kingdom is rated as world-leading and internationally excellent. Every morning on my way here, I drive past the magnificent new Crick Institute, which is a tribute to our commitment to leading the field in biosciences, a tribute to the Government’s support and, of course, a tribute to the drive and vision of Sir Paul Nurse.

The Crick Institute is a reminder of what we have achieved in medical research and a token of what we hope and intend to achieve in the future. But all this requires funding and that raises some questions. The ring-fencing of the science budget by the previous Government certainly provided welcome stability and certainty for planning purposes, but it did not allow for inflation, resulting in an erosion in real terms of more than £1 billion during the past five years. Given the leveraged investment that the science budget brings, do the Government have plans to increase and to ring-fence the science budget for this Parliament?

As the Minister will know, a vital part of our spending on medical research comes from charitable donations. Last year, the members of the Association of Medical Research Charities invested £1.3 billion in research in the United Kingdom, which is more than was invested by either the Medical Research Council or the National Institute for Health Research. Ninety per cent of this £1.3 billion research funding is spent in our universities.

The Government help significantly with this via the Charity Research Support Fund. This fund was introduced in 2005 to cover the universities’ broader infrastructure and general operating costs associated with charity-funded research. That means that the Charity Research Support Fund ensures that the money so very generously donated for research is spent directly on research. Unfortunately, the fund has failed to keep pace with the very welcome increase in charity spend. The fund was frozen in 2010 at £198 million. Since then, eligible charity funding has grown by 17%. So my second question for the Minister is: are the Government planning to increase the Charity Research Support Fund so that it keeps pace with charity spend?

There is also a question about funding for the National Institute for Health Research. It is generally recognised that research in the NHS has undergone a renaissance since the establishment of the NIHR, but its budget is less than 1% of the overall NHS budget. Most knowledge-based organisations spend between 5% and 30% of turnover on R&D. There is also a clear business case for increasing research spending via the

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NIHR. Every £1 of government and charity investment in health research returns between 37p and 40p through health and economic benefits every year in perpetuity. The Government have committed an additional £8 billion of funding for the NHS. Will this result in an increase in the budget for the National Institute for Health Research?

I turn now, in a little more detail, to the NHS itself. The report entitled Every Patient a Research Patient?, commissioned by Cancer Research UK and published two weeks ago, paints rather a mixed picture of the research landscape within the NHS. Professor Dame Sally Davies said in response to the report that,

“there is considerably more to do to improve the commitment, culture, capacity and capability of the NHS to promote, support and conduct research”.

However, I regret to say that evidence seems to suggest that support for research from NHS England remains lukewarm at best. In fact, apart from reference to the 100,000 Genomes Project, research is barely mentioned in its business plan for 2015-16.

The Prime Minister’s own aspiration, espoused at the launch of the strategy for UK life sciences, was that every patient would be a research patient. Could the Minister say how the Government plan to achieve this? How will they deliver on the NHS constitution’s pledge that service users will be informed about research studies in which they may be eligible to participate? The door is open here, surely. We have clear evidence of wide public support.

Finally, there is the question of patient data. The UK has a proud and pioneering record of using epidemiological data to support public health. Successive Governments have outlined ambitious plans to realise the enormous potential in patients’ data. But the current situation is far from satisfactory. Failure to record, link and share data for care and for research has damaging consequences. This failure compromises the safety of patients, reduces opportunities for efficiency gains in the NHS and reduces opportunities for the research which could transform our ability to predict, diagnose and treat disease. Furthermore, the confusion and uncertainty following the care.data debacle have resulted in a significant deterioration of the environment for health records-based research. This is not a satisfactory situation, as I am sure the Government are only too well aware.

There are things that we need to do urgently. We obviously need a simple way to enable patients to opt out of sharing their personal records, if that is what they want, without impacting on their care. We need clarity on which organisations will have access to data and for what purposes. We need clarity on secure storage and on the handling and dissemination of patient data, and we need sanctions—real sanctions, with teeth—for those who mishandle or misuse patient data. And we need, most of all, to get on with all this. I very much hope that the Government feel the same way. I look forward to discussing all these issues in the near future with the noble Lord, Lord Prior, whom I am very glad to welcome to the Front Bench.

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7.46 pm

Baroness Finlay of Llandaff (CB): My Lords, in the gracious Speech it was welcome to see a commitment to seven-day working. Indeed, in my own Access to Palliative Care Bill, which has now been introduced, I have included a requirement for seven-day services. Like the noble Lord, Lord Sharkey, I welcome the noble Lord, Lord Prior of Brampton, to his position and look forward to working with him closely on this matter.

However, when we talk about seven-day services, we must not forget the nights, because disease does not respect the clock or the calendar. When patients are at home, it is the family who carry the full responsibility for whether to phone somebody and what to do, and that burden of responsibility on them can be huge, particularly if they do not have adequate social care support.

In its report, What’s Important to Me, the National Council for Palliative Care—I must declare an interest because I am taking over as its next chair—has shown just how many patients recognise that they need seven-day services. The appalling findings in the report, Dying Without Dignity, from the Parliamentary and Health Service Ombudsman demonstrate what happens when you do not have seven-day services.

In 2010, the Royal College of Physicians called for such services, with 68% of physicians supporting the move, but physicians are already working on average 50 hours a week. So there is a need for a remodelling of what they do, decreasing bureaucratic burdens on them and ensuring that there are proper roster reviews, otherwise they will not be able to cope and the system will collapse.

An analysis from the Manchester Centre for Health Economics, published last week, looked at the additional risk of death from weekend admissions—it is not just greater on a Saturday but it is even greater on a Sunday. It costs the move to seven-day services at between £1.07 billion and £1.43 billion. Why are those deaths happening? Fewer senior staff are on duty at weekends, with fewer support services, especially in pathology, radiology and pharmacy, and there are fewer allied health professionals, who are so important. There is a higher disease burden in those admitted at the weekends as an emergency, making them less likely to respond well to treatment. The NHS was founded on a principle of equitable care. Failure to provide equity across each day of the week must be considered a failure in one of its fundamental obligations.

For patients who are at home, the need for community support becomes the mainstay of their being able to stay at home. However, they need not only carers but physiotherapy and occupational therapy to maintain their independence. Fortunately, the number of physiotherapy training places has gone back up, having dipped previously, but is not keeping pace with the demand for physiotherapy.

Social care integration is to be welcomed if we are going to use our resources widely. The emergency services, of course, already provide 24/7 cover but the winter funding put in by the previous Government did not reach front-line emergency departments. Only just

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over 1% of the £700 million went into those departments. The remainder was meant to cut back the pressure on the departments but that seems to have failed. There was an increase in attendances by 500,000, an increase in admissions by 7% and a doubling of delayed discharges.

In its document prescribing the remedy, the Royal College of Emergency Medicine has solutions. Through its future hospital programme, the Royal College of Physicians wants to help the Government to achieve better equitable care, and the Royal College of Surgeons is supportive. However, we must take the administrative pressures off front-line staff to free them up to do the clinical work that we need them to do.

There is a commitment to increasing GP numbers and the Prime Minister, I believe, has said that he wants one in two medical graduates to go into general practice—but how? It will not happen quickly. The time from entry to medical school to being fully trained as a GP is, on average, nine years. However, the shortfall of GPs is already 3,300 and estimated to go up to 8,000 by 2020. Sixty per cent are already providing extended opening hours and 17% are open at weekends.

A Citizens Advice report, Registering Frustration—which was issued after the start of this debate—shows that GP registration is so complex that one in 10 patients finds that it takes them more than two weeks to register; when they cannot register they are directed to walk-in centres; and one in seven GPs has felt that their only option has been to redirect patients to A&E. We should look again at the skill set of those people noble Lords might feel are the least trained and the least qualified—the care assistants and social carers—because, with better training, we will be able to empower them to provide better care.

The UK has a low doctor-to-patient ratio. We are 24th out of the 27 European nations. The Government must re-engage with those who will bring about change— including re-engaging in negotiations with the BMA—to find solutions to work patterns and to the ways that people work.

The noble Lord, Lord Giddens, is right to say that IT must be used imaginatively. We cannot just transfer lengthy paper records on to IT systems and expect that that will do anything other than increase the bureaucratic burden.

As to the threat that comes from the Transatlantic Trade and Investment Partnership, on 28 May the European Parliament’s trade committee agreed a resolution backing the TTIP for the full Parliament to vote on this month. This controversial initiative reintroduced investor state dispute settlements. It would allow corporations to sue the UK for laws protecting public health and represent a destructive force to our NHS. Can the Minister clarify what the Government’s position was in the trade committee and what it will be in a future vote on TTIP? It would be tragic if we undermined our NHS by such a move.

7.53 pm

Lord Rea (Lab): I wish to talk about two aspects of health—the health of the NHS and the health of the population which the NHS serves. The health of the NHS was summarised recently in a letter to the press

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by David Nicholson, the former chief executive of the NHS, and nine distinguished clinicians, including my noble friend Lord Turnberg, as in early terminal decline and in dire financial straits.

Social care is at the heart of the problem due to savage cuts. This is leading to queues in A&E, delays in discharge, lack of community services and joined-up care, and increased difficulty in getting access to GPs. Overall the share of GDP spent on health has fallen from 8% to 7%, below that of many other developed countries. I remind the Minister and the noble Lord, Lord Prior of Brampton, that it was the decision of a Labour Government in the early years of this century to match the EU average of 8% of GDP spent on health. That allowed long waiting lists to fall and public satisfaction with the NHS to rise to its highest ever level. One per cent of GDP is in the same area as the £22 billion per annum extra calculated by Simon Stevens, in his five-year forward view, to be necessary to keep the NHS working. To raise this sum through savings is pie in the sky without decreasing effectiveness and patient safety.

There are ways of raising this sum which would be politically acceptable—for instance, an earmarked health tax. This was mentioned by the noble Lord, Lord Fowler, and should certainly be on the agenda even if the Treasury might not like it. It should be remembered that several international studies have pointed out that the NHS is very cost effective. It will become less effective if it is not adequately funded.

Central to the role of the NHS is the state of health of the nation. It is well known that chronic non-communicable diseases—obesity, diabetes, heart disease, stroke and cancer, to name the most common—cause the greatest burden on the health and social services of developed, and now less developed, countries: “Hunger persists but the world as a whole got fat”, to steal a quote from Margaret Chan, the director-general of the World Health Organization. These conditions are seldom curable because they are part of a degenerative process although their symptoms can be alleviated and life prolonged by a galaxy of medical and surgical treatments that are now available.

However, as we have discussed before in your Lordships’ House, this is expensive and is one of the main reasons for the relentless increase in the costs of the NHS. To prevent or delay the onset of these diseases must be the way forward. We now know many of the underlying causes or risk factors for non-communicable disease—physical inactivity, unsuitable diet leading to obesity, excessive alcohol consumption and, particularly, tobacco smoking. The list is familiar but repeated health education campaigns aimed at informing people and helping them to avoid these risk factors and live more healthy lives have so far been disappointing—apart from tobacco legislation, which has had beneficial results.

Campaigns to encourage people to alter their behaviour are, of course, counteracted by promotion of unhealthy products as well as other less easily assessed social factors. These are well described in the House of Lords Science and Technology Select Committee’s report of 2012, Behaviour Change. The food and tobacco industries fully understand the power of these subtle, sometimes subliminal, factors in shaping behaviour

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and huge resources are put in to promoting their often unhealthy products. Margaret Chan—as you can see, I am a fan of hers—has spoken of the influence of not only big tobacco but “big food, big soda and big alcohol” on behaviour and of the need for,

“all sectors of government to consider the health impact of their policies”,


“The determinants of health are exceptionally broad”.

It is a matter of regret, therefore, that the cross-departmental Cabinet Committee on the impact of policies on health has been allowed to wither on the vine. It was perverse of the Government to ask the food and alcohol industries to join a Responsibility Deal to advise on measures to make their products healthier when their least healthy products are often the most popular and profitable—for example, carbonated soft drinks. However, it is perfectly possible for the food industry to make healthy products while still making a profit. But without regulation it is very unlikely that they will at the same time stop marketing their profitable less healthy products.

A recent study has shown that so far, after four years, the Responsibility Deal has had no overall effect on improving the nutritional quality of the food that is marketed. I join many voices in calling for Her Majesty’s Government to seriously consider bringing in regulations to restrict the sale and promotion of these obesogenic food and drinks.

8 pm

Baroness Kidron (CB): The humble Address promised a data Bill and a British Bill of Rights but said nothing of the digital rights of children and young people. I declare my interest as the founder of iRights, a coalition of organisations and individuals which supports the introduction of digital rights for those under the age of 18. I congratulate the noble Baroness, Lady Shields, on her ministerial appointment. Her work in protecting children from sexual exploitation is exceptional and hugely admired, particularly by me.

However, the protection and safety of children must be balanced with rights and responsibilities, about which I shall make three points. The first I raised in a debate on 20 November last year, the substantive arguments of which can be found at col. 567 in Hansard, so I will be brief. The United Nations Convention on the Rights of the Child is the gold standard for children’s rights. It is designed to articulate their rights and our responsibilities in every possible context. In the 25 years since it was inaugurated, a technological revolution has impacted immeasurably on the lives of children, but with no corresponding change to the provisions of the convention. Young people spend an ever increasing proportion of their lives online and it is imperative that the UNCRC reflects that reality. Therefore, I ask Her Majesty’s Government to advocate for a new protocol that describes how the rights embodied in the UNCRC should be interpreted in digital environments. The idea of making the convention fit for the digital age is gathering steam among other nations and it would be fitting for the UK to be at the forefront of this thinking.

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Turning to my second point, we have existing legislation that could, if implemented, do much more to support children online. I acknowledge the privacy law firm, Schillings, for its excellent work in exploring this. I cannot do justice to the Schillings’ briefing as it interrogated vast swathes of consumer legislation, two decades of data and telecommunications regulations and a dozen or more Acts of Parliament, and we simply do not have the time tonight. But I shall give two glimpses of what it has been looking at.

Section 7 of the Data Protection Act 1998 provides the right to make a “subject access request”—that is, request the precise reasoning behind any decision made by “automated means”. Few subject access requests are made by or on behalf of our young people. The mechanism is relatively unknown and operates on an ad hoc basis, website by website. Each automated decision has to be challenged individually, which is a time-consuming business for something that seems, in most instances, relatively benign.

However, how about when an online search of a disease by one member of a household creates a mark on those with the same ISDN address? Might that mark impact on a young person’s future employment, or ability to get a mortgage, or in ways that have not yet been invented because they have wrongly been marked a health risk? How might they reasonably be expected to challenge something they do not yet know has happened?

In another example, Schillings points to Section 5 of the Defamation Act, which goes some way to providing a legal framework for identifying anonymous online posters. But unless the perpetrator, once contacted, voluntarily reveals their identity to the victim or expresses a desire to take the offending material offline, the only recourse available is the court. Which young person has the confidence or the cash to defend their reputation in a courtroom? The young suffer reputational damage disproportionately, often without support, in bedrooms and classrooms all over the United Kingdom. I ask Her Majesty’s Government to build on the work that has already been done and to seek ways in which existing legislation can be routinely implemented on behalf of children and young people, and in doing so support a more responsible and transparent online culture.

Finally, the ubiquitous sight of young people’s eyes on a screen is not simply modernity in action but the result of billions of dollars spent gathering their data, creating a picture of their behaviour and their psychological DNA, and re-engineering it to extend their use and to deliberately keep them online. Sites whose content may in itself be innocuous use the same sort of techniques that keep gambling addicts on slot machines, with small random rewards to keep them hooked. The debate around children and young people cannot be about content alone. Age rating has a valuable place, most particularly for the youngest users, but we must also start to determine what level of compulsive technology, data gathering and personal profiling is acceptable as a method of orchestrating the online behaviour of minors.

Digital technology brings with it such vast opportunity but it is not entirely neutral. It is imperative that where the Government are considering the safety and well-being

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of children online, these considerations are at the forefront of the debate. There are many actors in the digital world—tech companies, corporations, parents, teachers and young people themselves—but if we are to deliver in the digital dimension the rights young people enjoy offline, the Government too must play their part.

8.07 pm

Lord Winston (Lab): My Lords, it is very good to see the noble Lord, Lord Prior of Brampton, on the Front Bench. I am just sorry that he will not be crossing swords with me this evening, but no doubt there will be occasions in the future when we will have an opportunity to argue. I must say that he replaces a wonderful man, the noble Earl, Lord Howe.

I want to draw the House’s attention to a matter which most people regard as trivial, although it is not trivial to the people concerned. There are around 900,000 pregnancies a year in this country, and something like 20% to 25% of those end in miscarriage or pregnancy loss. One in eight couples in Britain has failure or problems in getting pregnant. What is happening at the moment is absolutely shocking and the National Health Service should be doing much more about it. I would like to describe a model that can be used on a wider basis in the NHS. In his introduction, my noble friend Lord Hunt pointed out that the NHS has, unhelpfully, been used as a political football. I ask noble Lords to forgive me for saying that but it is not directed at the Government as it has happened on all sides. We tend to make all sorts of financial claims which are very difficult to justify. I will say no more than that.

It is not understood how serious a matter it is for those who are trying to conceive. Initially there is a degree of anxiety and then there is a loss of self-esteem. People who are infertile, or having difficulty with miscarriage, start to have a great deal of pain. It is not a physical pain but a pain which erodes their relationships with their parents, with their partner and with other people—so much so that it is very common for people having difficulty getting pregnant to be unable to socialise with their peers. For example, they do not go to dinner parties or do the usual things because the discussion is about children and schools. They become increasingly isolated.

One aspect of that isolation is, of course, the effect on their sexual relationship. I must tell your Lordships that in my experience it is extremely common to see men become impotent and women suffer loss of orgasm as a result of this condition. What is worse, of course—it happens frequently to those who are having difficulty getting pregnant—is that they are likely to miscarry, and they are treated abominably when it happens. They go into hospital to have their uteruses scraped out. Normally they have to wait until the end of the list, sometimes overnight, because the staff are too busy to deal with them. Because it is so common, most people do not see what a tragedy it is for the individual. I should say that it is very common for a woman who has miscarried, and sometimes her husband as well, to remember the date of the miscarriage in the following years and, while not celebrating it, recognising it as a date when something significant happened. I have

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seen people with infertility problems who have miscarried 10 or 15 pregnancies, and that loss is massive. In a way, that is what happens during in vitro fertilisation as well, because once a woman has had an embryo transfer, she will fantasise that she is pregnant. When her period then comes, it is a shocking psychological injury.

At the moment, as your Lordships know, provision in the National Health Service is inadequate. I think that it is about time we were honest. We should decide which treatments are actually going to be provided and which are not. It is important to recognise that the way we account for so much in the health service, including in vitro fertilisation, does not seem to be justified. For example, in one area IVF treatment costs £1,000 to the health service while in another it costs £6,000. I would like confirmation that this really happens, but it is what I have been told. Several people in senior positions in the health service have said to me that IVF treatments and abortions pay for pregnancy care because the budget is not big enough. There is a curious irony in that.

The NHS website covering infertility is really quite shocking. In the first sentence, women are advised that they should not worry about getting pregnant until they have had unprotected sex for at least two years or 12 months of artificial insemination and have not yet got pregnant. There is no evidence that artificial insemination is any use at all in the treatment of infertility. In fact, the Dutch figures suggest that people who are having sex naturally are just as likely to get pregnant. Much mention is made of lifestyle, but generally it is not really important. Further, we screen people for conditions like chlamydia. I would like to know how much that screening is costing the National Health Service, because in my experience as someone who has worked with infertile people for 40 years, I have seen no serious evidence that chlamydia definitely causes infertility in its acute stages. It may occasionally be possible for it to leave scarring.

There is a conflict of interests. People go to an NHS clinic, and they fail. Overall, there is a 25% chance of getting pregnant, so most people will fail. The same practitioners will then be operating in a private clinic where the same patients will then go afterwards for continuity. It is therefore not in everyone’s interests to see success. It is a massive issue and we need to address it. Sadly, however, the regulatory authority—the Human Fertilisation and Embryology Authority—has been extremely bad at regulating the cost of IVF treatment in the private sector, where at the moment the prices are escalating. People are paying as much as £9,000 or £10,000 for a cycle of treatment, particularly if there are added diagnostic procedures, most of which are of unproven value. Examples are biopsy of the embryo and immunological procedures that are not justified, along with a whole range of other issues, which the NHS actually licenses, but in fact they are research procedures for which I do not believe people should be charged.

It is important for us to consider what the real costs of procedures are throughout the health service. I do not think that we know the figures, and what is happening in in vitro fertilisation is probably happening on a much bigger scale in a whole range of treatments.

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Because we now have a considerable private practice sector providing treatments within the National Health Service, it is extremely important that the service should understand precisely what the cost of an individual treatment should be. Unless we know that, we will continue to see spiralling costs, as well as the problems of all the people who are not getting treatment. Imagine having one cycle of IVF and finding out that you are no longer eligible for any more, which is the case in many health authorities. The chances of success are 25%. Would we give up a cancer therapy after administering 25% of the drugs, or perhaps 25% of the treatment required for arthritis? We continue with treatments until they are successful. That must be the standard that we need to consider.

8.14 pm

Lord Rana (CB): My Lords, I do appreciate the gracious Speech. The subject of education is a most important one that concerns us all. Education, which is the ability to read and write, was necessitated for the general masses by the Industrial Revolution almost three centuries ago. Since then, great strides have been made in bringing education at the higher levels in engineering, medicine and the humanities within the reach of many, especially with the introduction of the social welfare system and, in recent years, with the introduction of information technology and the great advancements made in the field of science.

Education has become even more important not only to get a decent job in order to earn a living, but also to cope with daily life and indeed with the machines which surround us in every sphere of living. For the economic development and economic progress of any community or country, education and the learning of skills are most important. In the UK, the old system of apprenticeships is nearly all gone, and there is not enough focus on skills to develop entrepreneurship. To grow more businesses, there has to be an emphasis on skills development. In other parts of the world, especially the poorer and developing countries, there are large populations which have little or no opportunity to access higher education and to learn skills. With modern information technology, it should be possible to reach young people growing up in the rural areas of developing countries by providing them with online learning and training opportunities.

In countries like Northern Ireland, where education in many cases is essentially segregated, young people while they are growing up do not have the opportunity to interact with those from the other part of the community until, for the more fortunate, they get a job or go to university. Segregation creates misconceptions and mistrust, and Northern Ireland has suffered from this divide. There has, however, been an effort to bring young people of school age together through the development of integrated schools, but a lot more needs to be done. The Government should focus their efforts on promoting integrated education in schools. That would be the best and most certain way of creating a trusting and harmonious society in a place such as Northern Ireland. The current proposals for shared facilities between schools is very much second best when compared with genuine integrated education.

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Whereas the emphasis is increasingly on teaching science and technical subjects, there is hardly any form of education for citizens on how to lead their lives, how to interact with each other, and how to cope in the multicultural, multireligious society we live in today. Both this year and last year we have been commemorating the centenary of the First World War when millions of people died in that horrible war. One hundred years on, we still live with the threat of war. There are wars going on, whether in Afghanistan or in various Middle East countries, with the great mistrust of those involved being so apparent. There is the grave global threat of terrorism and suicide bombers. A serious matter for all of us to consider is how young people growing up in an advanced and civilised part of the world such as the United Kingdom may somehow become involved in terrorism. One must question what we may be doing wrong or what is missing in the education and upbringing of young people in our society that makes them resort to such abhorrent activities.

Learning is a lifelong process. This is more important now than at any time in the past. There has to be greater emphasis on teaching young people about various religions, customs and rituals, and the means of achieving a better understanding and trust in each other. The world is suffering from acute poverty in many parts and sections of communities—indeed, even in some rich, developed nations, where there are people who are also unbelievably rich. In countries such as India, the caste system is nearly at an end, but in parts of the world there is some form of class system that is equally bad. To create a more harmonious, tolerant and caring society, you need to educate not only young people: even the grown-ups need to be re-educated to overcome their misconceptions and prejudices.

As I said earlier, education—the right education—is the ultimate key to peace, understanding and prosperity. We must all focus on this issue and provide appropriate facilities designed to educate people to meet the demands of living in the present-day world.

8.21 pm

Lord Colwyn (Con): My Lords, I must declare my interest as a now fully retired dental surgeon. Single-minded as my focus on dentistry has been, and may be, it is no mere quirk or niche focus, but rather a genuine concern for an area of health that deserves much more attention over the course of this Parliament.

The election campaign demonstrated the importance of all health issues. The parties tried to outbid each other on spending, but where does dentistry sit in that health debate? When it comes to issues the public care about, oral health is conspicuously absent. I was flattered to be included in meetings with my noble friend Lord Howe and with the Secretary of State to consider likely health issues for the manifesto, but it was telling that, of all the major parties, only the Greens and Plaid Cymru mentioned dentistry in their manifestos. It was conspicuously absent from the manifestos of my party and that of the Opposition Labour Party’s policy platform.

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This is in spite of some worrying figures. In the 2013 Childrens Dental Health Survey, nearly a third of five year-olds and nearly half of eight year-olds had obvious decay experience in their primary teeth. Under a Government led by a one-nation vision, we must feel deep concern about oral health inequality that sees a fifth of five year-olds eligible for school meals with severe or extensive tooth decay, compared with 11% of those from more privileged backgrounds.

Dentistry is too readily seen in aesthetic terms and so perhaps more easily dismissed, but at its core is a commitment to good health that has holistic benefits for individuals’ overall health, including mental health. More than a third of 12 year-olds and more than a quarter of 15 year-olds reported being embarrassed to smile or laugh due to the condition of their teeth.

The 2010 Conservative manifesto promised to,

“introduce a new dentistry contract that will focus on achieving good dental health, not simply the number of treatments achieved”.

Beyond a few pilot schemes, the dental profession is still waiting for any conclusions. A contract that ends perverse incentives to undergo more costly interventions and instead rewards improving oral health can only be to the benefit of patients and dentists. I sincerely hope that we can finally implement the promise from 2010.

Worldwide scientific evidence, including three systematic reviews of studies comparing children from fluoridated and non-fluoridated communities, indicates that water fluoridation reduces the amount of tooth decay experienced by children and increases the proportion of children who do not experience tooth decay at all. A fourth systematic review found that adults who have lived mainly in fluoridated areas have lower tooth decay rates than those who have lived mainly in non-fluoridated ones. Water fluoridation has made a significant contribution to oral health improvements in communities where it has been introduced. Fluoride has the greatest efficacy in preventing caries, so it was with disappointment that I noted Southampton’s recent rejection of water fluoridation. Hull is currently undergoing a consultation to fluoridate its water supply to deal with an epidemic of poor oral health. More than 43% of children aged five in Hull have fillings and tooth decay; fluoride would play a vital role in combating that. Last year, Birmingham celebrated 50 years of water fluoridation—a great success that saw the number of children with tooth decay halve in six years. Other cities could learn from that example.

Many dentists will also hope that this Parliament will have a rethink as to how the profession is regulated. The dental profession has expressed grave concerns with its regulator, but also a willingness to move to a better model for all. It is therefore disappointing that the gracious Speech made no reference to the Law Commission’s recommendations for health regulation—something health regulators and unions are all keen to scrutinise with a move to implementation.

The gracious Speech called for integration of health services, as well as devolution across the UK and within England. It is essential that dentistry is factored into integrated healthcare and “devo-Manc” style devolution of health budgets and priorities. More than 25,000 children were admitted to hospital in 2013-14 because of tooth decay—the single largest

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reason for admission across all the National Health Service, and up from 22,500 three years previously. This cost about £30 million. It is clear that dentistry cannot be considered in isolation: the interplay between oral health and general health, dentistry budgets and other NHS budgets, must feature in any discussion on healthcare provision over the next five years.

Dentists are not by nature the most militant of professionals, but there are worries among many that the trade union reforms set out in the gracious Speech will impact on them. Many have called for the introduction of electronic balloting, so that should unlikely industrial action ever take place it could be done with a legitimate turnout, meeting the threshold being suggested by the Government and proving that these reforms are about legitimacy, not diminishing the right to withdraw labour.

In conclusion, I thank my noble friend Lord Howe and his team for their long and important contribution to dental politics, and more recently my honourable friend Dr Daniel Poulter for his time at the Department of Health. I also welcome my right honourable friend Alistair Burt as the new Minister of State for Care and Support, with responsibility for dentistry. There are many challenges ahead and real opportunities for dentistry in the UK. With a Conservative majority Government, we should show what we can do to end inequalities and improve oral health for all.

8.28 pm

Lord Stone of Blackheath (Lab): My Lords, despite advancements in technology, with instant connectivity around the globe, referred to expertly by my noble friend Lord Giddens, there is a general feeling that communication is breaking down everywhere. Nationally and individually, people can hardly talk to each other without fighting or becoming offended. We do not really communicate at all, except in shallow, superficial ways. There is a deepening crisis and what is required in government now is a paradigm shift. People say that to change the system, each one of us, individually, needs to attempt to change ourselves for the better. I certainly know that I need to change: I have behaved in the past from ego, without intention, in a way that has hurt people.

So it surprises and delights people that here in Parliament we have an All-Party Group on Mindfulness. Most people know that mindfulness is a state of mind that helps us to be present in the moment, and aware that we are all connected. It enables us to experience something greater than our habitual selves and thereby live and work more compassionately. I will talk about individual change first and then mindfulness and the legislative programme.

First, on individuals, I spent a week last month with politicians from 10 different countries, including the UN, discussing wiser government. The Brahma Kumaris in its global retreat centre invited its spiritual leader, Dadi Janki, in her 100th year, to travel to be with us. Our main conclusion was that good governance would entail engendering individual self-sovereignty. I was proud to be able to report to them that here in the United Kingdom over the past two years 115 parliamentarians have all completed an eight-week course on mindfulness practice here on the estate.

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Fellow Peers and Members of the other place of all parties and their staff have accepted that changing oneself not to be in a state of constant anxiety, aggression and pressure is a first step to changing the system, with each of them now relating to colleagues on all sides of the House in a different way.

So how does this all relate to the gracious Speech? In addition to spreading these practices to millions of individuals, we must also change the way our society works in health, education, the criminal justice system, the workplace and international affairs. On health, the National Health Service is expanding the provision of mindfulness-based cognitive therapy as a treatment for many mental and physical conditions and has proven to NICE that it is more cost-effective and longer-lasting than other, more expensive interventions.

Furthermore, last month I was with the new chief executive of Great Ormond Street Hospital, Peter Steer, and his enlightened senior team. I then met Julia Samuel from St Mary’s Hospital with Dr Bob Klaber and Dr Hyde, who are paediatricians. They are all convinced that mindfulness, when used effectively among healthcare workers, is a way to reduce stress throughout their hospitals, improve care and attentiveness and engender compassion and kindness. This is a way for a Government who wish to integrate health and social care and improve our National Health Service to help patients, professionals and carers by engendering compassion.

On education, soon Professor Patrick Pietroni at the University of Chester is to set up an international institute for the study of compassion, which could help compassion across government and society. In the criminal justice system, His Royal Highness Prince Charles gave us a great example of compassion last month by agreeing to a very difficult face-to-face meeting. The Forgiveness Project, where I declare in interest as a patron, has for more than 10 years brought together criminals and perpetrators and victims and their families to face each other personally, often transforming the lives of both. This can reduce anger and release grief, stop the cycle of reoffending, allow victims to lead more active lives and thus save the Government money and resources spent on supporting broken lives.

In the workplace, mindfulness is a way to improve resilience, reduce stress and anxiety and develop creativity. Managing organisational learning and engendering insightful collaboration within organisations helps people to enjoy their work, and as a result the objectives of the organisation are better met. In this way a Government can raise productive potential and increase job creation.

Finally, in international relations, education and culture, the Abrahamic religions all began with contemplative practice, often in silence. From this emerged great compassion. We have seen what can happen in the Middle East when the essence of compassionate contemplation is replaced by religious fanaticism. Some 25% of the people in the MENA region live in Egypt. Now is a vital time for us to help them tackle their major economic, humanitarian and international security challenges. We admire the courage of the Egyptian people over recent years and their

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pragmatic determination to play a central role in Egypt’s political future, restoring its historic tolerant identity. Long-term stability and prosperity for all Egyptians can be achieved only in a climate of trust and inclusion. Flourishing opposition movements are integral. They provide accountability and offer a political voice for all. However, these movements must be untainted and peaceful and seek to influence not via acts of violence or terror but with the tools of democracy and free speech.

I suggest that our Prime Minister should invite President Abdel Fattah el-Sisi to the United Kingdom as soon as possible. Rather than wringing our hands from the sidelines, we must take the opportunity to serve and help shape Egypt’s democratic cause and history. The wise and noble Lord, Lord Howell of Guildford, spoke here in March about soft power and the UK’s potential to use it to influence the modern world. We could discuss with President el-Sisi, who commands significant support across society, how we might continue to assist the Egyptians. They want to develop a first-class secular democracy with improved civil liberties, education for all and human rights. They have now completed the first two stages of their four-stage road map: a new constitution; an elected President; and now, thirdly, later this year, a brand new Parliament with a judicial framework to monitor its elections. Finally, they plan to create better economic conditions for all their people.

France, Italy and Russia have all hosted President el-Sisi in the last year. Germany has done so this month. They have seen the value to the region, to the world’s safety and security and to themselves of engaging now with the new leadership in Egypt. Our industry should be encouraged and helped to engage there, too. Coming back to education, we are already linking our great universities with theirs. The 10 year-old British University of Egypt now has 6,000 students in Cairo learning and researching in collaboration with UK universities. Now a new Knowledge City in Cairo of more than 200 acres is to be developed with an ambition of having 30,000 students in 10 years. It is now forging links with some of our greatest centres of research and education.

In closing, I ask the Minister to ask Her Majesty’s Government to invite President el-Sisi here for talks soon. In general, how will Her Majesty’s Government apply the relevance, importance and urgency of mindfulness to all that they do? Are we using these proven methodologies to begin to make Britain a mindful nation, so that the United Kingdom can evolve as a centre from which we may spread this, our education and compassion to other countries?

8.35 pm

Lord Mawson (CB): My Lords, not for the first time, I find myself in full agreement with the good intentions in the gracious Speech and the sound purpose of a Government’s health policy. It seems to me that the desire to improve health outcomes for patients and to do that more efficiently and effectively are laudable twin goals and ones with which few could argue. However, I want to reflect on matters beyond these good intentions. In my case, it is not to question Her

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Majesty’s Government’s underlying purposes with their health policy but to challenge their narrow definitions of health and social care and, indeed, to suggest that they are simply not being radical enough.

Professor Sir Michael Marmot published his seminal report Fair Society, HealthyLives in 2010. It was a comprehensive review of the causes of health outcomes and contained a damning indictment of health inequalities prevalent in many of our most deprived communities in the UK. One of Sir Michael’s key contentions—one that has not been seriously challenged—is that positive health outcomes are significantly more influenced by social determinants than clinical determinants; indeed, that our health is 70% driven by social determinants and only 30% by clinical factors.

Over the past few years I have been astonished by how little mainstream health policy takes the findings of the Marmot review and seeks to turn them into a new and radical approach to how we define health and deliver better services. Indeed, it feels like our attention has been deliberately drawn into an important but none the less constrained conversation about the merging of health and social care. It seems to me that this narrowly defined health and social care debate has had two consequences.

First, it has enabled the principal focus to remain—not exclusively but largely—on how the public and statutory systems talk to each other. I am constantly hearing about earnest initiatives that will pool health and social care budgets and force a new way of working. To my mind, this focus keeps us away from a more radical debate. Secondly, the health and social care debate has kept us away from the conclusions of the Marmot review. It has kept us away from the fundamental questions that inextricably link health outcomes with their social determinants. It keeps us from asking the awkward questions about how we unshackle the central control of health and unleash it into communities.

I am frequently reminded that the vast majority of health interventions happen in communities, not hospitals. They happen in primary care. Some 20 years ago, a young East End mother died of cancer in tragic circumstances. Her name was Jean and her death has had profound consequences for both my life and my work. There were two sides to Jean’s story. The first was that she fell through all the nets of statutory provision that we reasonably expect to be there for us. The health system did not work for Jean. The social care system did not work for Jean or her family. In short, everything that could go wrong went wrong. Jean was badly let down by the state.

However, the other side of Jean’s story was more life-affirming. Just as the state was busy letting Jean down, something very interesting—and very normal and human—happened. Suddenly there was a rota for going down the launderette and doing her washing, and people were going off to Tesco to get her shopping. Jean was inundated with offers of help. Jean was being cared for, not by professionals but by young mums like herself. She was being cared for by the community in the community. She was having the social determinants of her health addressed.

Some months later, there was an inquiry at the Royal London Hospital into the circumstances of Jean’s death. That in turn led to the building of the first healthy

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living centre in Britain in Bromley-by-Bow—the first health centre in Britain to be owned by the patients and rented to the doctors. Something had shifted in who owned health in that community. Critically, the initiative was supported by the noble Lord, Lord Mawhinney, who helped to navigate the tricky waters of an NHS for which this approach was radical and difficult.

My belief is that we need a different approach to health, creating centres of heath in our communities that address the full range of health determinants. We need a big purpose in our pursuit of a healthy community. Today the Bromley by Bow Centre—I declare an interest as founder—offers a vast array of services to its local community. These stretch from conventional healthcare for local residents to opportunities to set up your own business; from support with tackling your credit card debts to becoming a stained glass artist; from learning to read and write to getting a job for the first time or a helping hand up the career ladder. The centre hosts visits from thousands of visitors and health leaders every year from across the world who come to learn from its experience and who want to see the model in action first-hand. One health leader recently asked, “What do you think we learn from the Bromley by Bow Centre’s experience about how we should build health centres in the future?”. Our CEO Rob Trimble’s answer was very simple: “Do not build health centres”.

This is not an argument that denigrates clinical health. On the contrary, it positions it within a broad range of services that drive well-being in communities by creating a locally blended offer, where doctors sit alongside others, including patients and local residents, in high-quality buildings to provide what people need. Creating buildings which act as centres of the community, not just health centres, makes sense for so many other reasons, not least financial ones. Our friends who run successful businesses such as John Lewis will tell you that the idea of a well-run department store where you can offer a whole range of products makes complete sense for the customer and complete financial sense for the business. You can capture the customer and have the opportunity, in the convenience of one place, to offer myriad products and services. This is the same principle in integrated holistic centres, where health is about life and living, not just disease and illness. It is about sweating our community assets and ensuring that one investment in a new set of buildings creates benefits and savings across a whole range of Whitehall departments, not just the Department of Health.

I am led to believe that there are few avowed disciples of the silo approach left, yet in many parts of Whitehall it seems to remain the prevailing culture. We need more of the department store approach and less of the citadels of health and social care approach. I urge Her Majesty’s Government to be brave and back dynamic and radical local solutions—more human solutions—and to move on from old-fashioned silo thinking in Whitehall.

8.42 pm

Lord Touhig (Lab): My Lords, I have to admit that this is not the Queen’s Speech I had hoped to be debating today but the electorate have made their decision and we are where we are.

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For me, raising academic standards is clearly of the utmost importance in any education policy. However, the Government should also recognise the essential role that schools play in children’s broader development. Schools must be given the freedom to prepare pupils for adulthood. This means teaching about the importance of strong and positive relationships, educating children about respect and tolerance, and safeguarding children through clear messages about online safety and bullying.

Church schools make up a third of the maintained sector in England. They are popular with parents and play an important role in educating children from deprived and minority backgrounds. In light of this, it is important that measures in the Education and Adoption Bill take account of the views of education leaders in the church sector. Their expertise is invaluable and I hope that the Minister can confirm that they will be consulted in advance of the Bill being brought before Parliament.

This would also be an appropriate point for the Government to remove the arbitrary restrictions on school admissions, which are currently preventing many new church schools being opened. The Minister will be aware that in areas of the country, there is a strong demand for new Catholic schools. However, the church is not able to meet this demand through building free schools because they are subject to a 50% cap on faith-based admissions, which means that some of the Catholic children needing places would be turned away. I am sure that noble Lords will agree that parents should have the option of sending their children to a church school, if they wish to do so. I hope that the Government will review this situation at the earliest opportunity.

Turning to health, the interaction with migration policy is likely to re-emerge as a prominent issue in the coming months. During the last Parliament, steps were taken to restrict the availability of free healthcare for people from overseas, particularly those with irregular immigration status. Striking a balance between protecting the finite resources of our National Health Service and protecting the most vulnerable migrants is a significant challenge to any Government but should legislation be introduced to implement new charges or strengthen eligibility checks, it must be handled with sensitivity. I am sure the House would agree that medical professionals should never be expected to act as immigration officers. It is also important that migrants receive clear information about exactly what they are entitled to.

Particular concerns have been expressed about migrants who experience trafficking, domestic abuse or female genital mutilation. No one wants to see the recent advances in tackling these horrendous crimes undermined by inadvertently restricting victims’ access to medical care, especially considering the crucial role that doctors and nurses play in identifying those affected. Above all, we should not allow the exaggerated perceptions of so-called health tourism to obscure reasonable discussion about eligibility for NHS services. It is of course essential to address the very small number of people who seek to exploit our system, but never at the expense of those genuinely in need. Will the Minister outline what

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changes the Government are considering to affect how migrants can access healthcare, and what safeguards will be included?

The Government have announced a full employment and welfare Bill. As a vice-president of the National Autistic Society, I welcome any proposal that addresses disability employment. Certainly, only 15% of people with autism are now in full-time employment. The Government have exempted benefits relating to the additional costs of disability from their freeze, but I am not sure as to the status of the employment and support allowance. The Bill will also freeze working-age benefits, tax credits and child benefit and reduce the level of the benefit cap. I know that the National Autistic Society hoped that the Government would use this opportunity to honour their manifesto pledge and halve the disability employment gap. Unfortunately, there is no mention of this in the Queen’s Speech. If the Government are to achieve their stated aim of full employment, reducing the disability employment gap will be crucial to doing this. According to the Office for National Statistics, the employment rate currently stands at 73% but for people with disability it falls to 48%. Can the Minister tell the House whether measures will be brought forward to address the disability employment gap?

The Bill will also contain changes to welfare, in particular a lowering of the welfare cap and a freeze on the majority of working-age benefits. The National Autistic Society tells me it understands that the personal independence payment will be protected, but what about employment and support allowance? As well as being given to those with a disability who cannot work, this allowance is a crucial benefit for those who are able to work but need additional support to stay in employment. Does this mean that the personal independence payment is exempt and can the Minister confirm whether the employment and support allowance is also exempt? More broadly, I hope that the Minister will be able to clarify what steps will be taken to prevent people being forced into poverty as a result of lowering the benefit cap. While no one denies that difficult spending decisions have to be made, the escalating levels of child poverty, food poverty and housing insecurity demonstrate that the impact is all too often falling on the most vulnerable. Ultimately, the savings achieved will be of marginal significance to overall deficit reduction. If the cap is to be lowered, would this not be the appropriate point to look at some flexibility to account for variations in family size or regional housing costs?

I have no doubt that the House will give the most careful and positive scrutiny to the Bills that the Government will bring forward from the Queen's Speech. We will support them where it is justified to do so but seek to amend and improve them if we think it necessary. If I may conclude by being presumptuous, I say to the Minister: do not reject a good idea which improves a Bill, simply because the Government did not think of it first.

8.49 pm

Baroness Benjamin (LD): My Lords, there is a fundamental belief that every child deserves the best chances in life. It is such an easy belief to hold, but it

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can be a very difficult one to convert into reality. However, difficult though it is, this is a task the Government must try to undertake. The Government must ensure that the most vulnerable children are not left behind. First, the Government need to address children’s academic success, which is determined before they even set foot in the classroom. I am proud to say that the Lib Dem policy of the pupil premium provides vital extra funding for schools so they can support these poorer children and help them catch up with their peers. The next step is to extend extra support for the poorest three and four year-olds, and not just those on free school meals.

The gracious Speech contained some welcome proposals for young people, with the promise of 3 million more apprenticeships. But employment provision also needs to offer realistic opportunities for young people who have been in care, those who have a disability and those who care for a family member at home. The full employment and welfare benefits Bill is an excellent opportunity to transform the road to employment. For the first time, we could have a system where the most vulnerable and the most in need of support are at its very heart.

One of the major challenges we face today in relation to children is child sexual exploitation and child abuse. These are horrific crimes, and the effect they have on children is unimaginable, on both girls and boys, from all areas of the UK and from all social, cultural, ethnic and religious backgrounds. Thankfully, we are finally beginning to wake up to the reality of this horror, but there is still a long way to go according to the charity Barnardo’s, because more and more children are seeking its help. Much more must be done to ensure that joined-up help and support reach those who need it.

Easy access to online pornography is causing children as young as 10 to inflict sexual abuse on each other. I have been told of victims as young as four. The Government must ensure that all schools provide age-appropriate sex and relationship education, and must keep their promise to provide better online protection, coupled with stringent penalties for those who flout laws designed to protect children and their innocence. We must encourage children to speak out, and tell them they are worthy and that the abuse is not their fault. I say this when I go into schools, and once an eight year-old boy put his hand up and said, “Floella, my dad comes into my room at night and pulls my pants down and does things to me I do not want him to do. Can you make him stop?”. Does that not bring a tear to your eye?

It is great to hear the Government’s decision to place children at the top of their priority list and to continue to make progress to give every single child the best start in life. The All-Party Group on a Fit and Healthy Childhood, which I am proud to chair, has promoted this vigorously. Our reports have been widely influential, and the group believes that prioritising the health and welfare of children makes social and economic common sense—both in the long term by protecting and safeguarding our future and in the short to medium term by tackling the problem of childhood obesity, which has become the plague of today’s society. Among its 100 recommendations, the group’s early years report

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argued that it is crucial to extend the excellent measure of universal free school meals to all children of school age, because food plays an essential part in their learning and concentration. However, most importantly, the report highlights the need to ensure that policies are co-ordinated at the very highest level by a Cabinet Minister with specific responsibilities for children and a remit to ensure that all departments form policies that are truly child centred.

I have spent my entire working life making this argument: making the case for all our children and campaigning to help families reach their full potential. What is so encouraging is that I am no longer a voice in the wilderness. More and more people are beginning to get it, so I am now asking the Government to help us make the group’s policies a reality. I would welcome a meeting with Ministers to begin the most important dialogue we can have, so that together, and from a genuinely cross-party basis, we can protect every child’s right to be fit and healthy, both physically and mentally.

Finally, I turn my attention to one of my favourite subjects, children's television—and of course I declare an interest. Much progress was made by the last Government around supporting and investing in children’s television. I worked with the Producers Alliance for Cinema and TV, the BBC and others to secure changes to child performance regulations through the Children and Families Act, which now ensures that equal opportunities as well as performance and development opportunities in a safe environment are available to all children across the UK. We also secured animation tax credit, as well as the introduction of a tax relief for children’s live action television productions. But despite these positive steps forward, there is a crisis looming—a crisis in investment in children’s public service content. Over the last 10 years, there has been a dramatic fall of 95% in spend on original content on all four main television channels. They now show less than two hours per week of first-run children’s programming, down from 12 hours in 2003. Is this what our children deserve, endless repeats of content that is years old and does not originate from the UK? Interestingly, only 1% of new UK productions are made here in this country.

The children’s television industry has become heavily reliant on the BBC for new productions, which reduces diversity of programmes and competitive stimulus and creates risk, given the threats to BBC budgets and the licence fee. We should be creating content that is rich in cultural terms for children. Childhood lasts a lifetime, and we all remember our children’s television programmes—so they, like us, deserve their own cherished content that is relevant to them. Therefore, we need more commercial PSB investment in children’s television. Will the Government encourage Ofcom to report on this issue in their next PSB review? Also, will they encourage broadcasters to take a voluntary approach to improving their investment in children’s content? If they fail to do this, will the Government consider applying some form of quotas for children’s content?

Children deserve the best we can provide for them, and the Government have a responsibility to do just that. We must not stand by and let down our children—we have a duty to protect, love and nurture all children. So let us get on with the job.

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8.57 pm

Lord Berkeley of Knighton (CB): My Lords, listening to the various topics debated this week, I could not help but think about how interrelated so many of them are. Indeed, these days of consideration of the gracious Speech provide a valuable opportunity to foster joined-up thinking where, in the coming months, we may sometimes suffer from tunnel vision. I am always exhorting students to look beyond their own sphere of interest and at other disciplines to help to clarify their own.

Why is this pertinent to today’s debate, particularly on culture? Let me give some examples. My greatest concern in this field is the provision of music in schools, which has suffered dreadfully over the past 15 years. Not only should music-making be the right of all and not just the privilege of the wealthy few, but research has shown that music and choral singing lead to a more cohesive society, one where the individual’s ability to express personal turbulence through an artistic outlet acts as a release of internal pressure. Improvements in behaviour and academic achievement follow, as the noble Lord, Lord Bragg, pointed out earlier. So culture, education and health are all stakeholders in this.

I accept that everyone has to take their share of the current cuts, and many small and large arts companies are really struggling. The noble Lord, Lord Hunt of Kings Heath, told us about the difficulties facing the City of Birmingham Symphony Orchestra, and if a world-renowned organisation such as the CBSO is struggling, just imagine what is happening to chamber groups, small theatre companies and the like. Yet it is precisely here that we find the seed bed that feeds talent into our international successes, which bring a fortune into the Treasury, as we have heard. So we must fight for the arts at grass-roots level, but the primacy of the need for children—our next generation of artists and audience, after all—to be versed in the arts seems to me of paramount importance.

There is, too, an aesthetic element involved in planning. In my area of mid-Wales, which, incidentally still does not have efficient digital coverage let alone high-speed broadband, there is considerable rejoicing that the Government are set to strengthen the representation of local communities in deciding about onshore wind farms, since one threatened Offa’s Dyke and a Repton grade 1 park. This issue is not confined just to energy, which we discussed yesterday; it also embraces agriculture, tourism, landscape and culture. I sincerely hope the Government will give this proposal real teeth.

We failed lamentably in the previous Parliament to curb, let alone stop, female genital mutilation. We simply must do better in this Parliament, even if that requires more draconian action by the state, as in France. It is a national disgrace that this appalling practice has been illegal since 1985 and, as the late and much-missed Baroness Rendell consistently pointed out, we have still to secure a single conviction. Part of the problem is cultural and part is educational, while the implications for health are truly shocking—I am sure the noble Lord, Lord Winston, would confirm this—including loss of sensation, sepsis, haemorrhage and complicated childbirth, to name but four.

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