Debate on the Address

My Lords, I very much look forward to the six maiden speeches which we will hear during this debate. Whatever the fate of this House, when people at both ends of the long corridor come to an eventual decision about reform it will be difficult to remove the expertise and range of experience which noble Lords bring to bear in debates on very complex matters. I am sure that the six noble Lords whom we will hear today will be part of that long, rich tradition. I welcome them very much. It has been a year of huge change in the NHS. From these Benches, we pay tribute to NHS staffwho have faced a year of great uncertainty, but who have nevertheless continued to display remarkable dedication to public service, which is the lifeblood of the NHS. On 21 April 2006, Patricia Hewitt told NHS staff that the NHS was enjoying its ““best year ever””. She got as big a laugh as the Queen did with her line about government statistics. On 21 November, a bit more soberly, Tony Blair said that the NHS is experiencing ““real difficulties””. I shall look at how those real difficulties are reflected in the Speech, whose theme was security. When Ministers talk about Department of Health plans, they are quick to cite examples of local successes that would lead one to think that the populace of this country should believe that there is greater security in healthcare. They should, as the NHS has had an unprecedented increase in funding—a 51 per cent increase since 1999. People should feel more secure about the health service than they did at the end of the Conservatives’ term but evidently they do not. Despite all that spending—in 2005-06 it was £80 billion—in the past few weeks we have seen unprecedented demonstrations on the withdrawal of maternity services, the threatened closures of A&E departments and the unavailability of drug treatments. I imagine that that included people who have never before taken to the streets. Those are hardly signs of a sense of security. At around this time of year, it is traditional in the NHS that hard-faced trusts try to achieve a balance by reducing their variable costs, and some elective procedures are always delayed, with a disproportionate effect on patients. Behind the headlines, one sees that this year something deeper, and perhaps more worrying, is going on. Up and down the country, preventive and community-based services are being cut drastically. For example, in the London Borough of Hillingdon, the PCT has announced cuts of £500,000 to the voluntary sector, which includes the cutting of core funding for Crossroads, the carers’ organisation, and the mental health advocacy services of Rethink, which supports people with severe mental illness. A further £0.3 million worth of cuts will be made unless the local authority can come up with funding. If it does not, services such as the Child Accident Prevention Trust programme will go. More than that, the organisations themselves will disappear. In practice, without the presence and services of those organisations, many more people will present with acute demands for healthcare, and the NHS will face an ever-increasing demand. We know that because in 2004 Sir Derek Wanless told us so in his report, Securing Good Health for the Whole Population. The Government’s reform programme has been focused on centralised targets set for short-term expediency at the expense of longer-term health improvement. The concern is that Sir Derek’s own estimates for NHS demand were based on a scenario in which the population of this country would be fully engaged in its healthcare, fully informed and fully supported. He anticipated that if that were the case, the NHS would still require a 4.4 per cent growth funding in 2008, but we understand that the Treasury plans to provide only 1.5 per cent growth fundingat that point. Therefore the NHS is not only experiencing cuts today but also storing up problems for the longer term. Over this period of investment the Government have constantly invested in short-term reforms and repeated reorganisations; as a result, there is not much to show for it. Measures are set out in the gracious Speech, but there is also a huge gap. Nothing covers the implementation of the White Paper, Our Health, Our Care, Our Say; that is, there is nothing about social care. We know already that social care is severely underfunded. If it continues to be underfunded over the long term, that in turn will generate long-term demands on the NHS. The number of people set to live longer with high dependency needs continues to grow, but nowhere does the Queen’s Speech address these matters. We also have a draft health Bill in the gracious Speech. It focuses to some extent on restructuring the regulation of human tissue and embryology; a Home Office Bill can be found masquerading as a health Bill—the mental health Bill—and reference is made to the possibility of legislation to replace patient forums with local authority-led local involvement networks. It pleases me to see that the noble Lord, Lord Hunt of Kings Heath, is to reply to the debate because he and I spent many happy hours discussing the formation of patient forums. I should like to ask him whether such a Bill will be forthcoming. If it is, I hope that those who are preparing it will look at a discussion paper produced by the Department of Management Studies at the University of York, entitled The Rise and Fall of the Patient Forum. It sets out succinctly what the demise of the CHCs and their replacement by patient forums at £10 million more per annum will mean and suggests why the current top-down performance management approach to running the NHS means that true patient involvement is highly unlikely ever to happen. I should like to take this opportunity to agree with Mr. Andrew Lansley, who said in another place afew days ago that the Bill on human tissue and embryology should not be hijacked as a means to have a debate on abortion. The issues covered in the draft Bill are serious and need distinct and detailed consideration of the type best done in this House. I further agree with the health commentators who have said that we should have a debate about why different regulatory bodies should be merged before discussing how such a process will happen. I turn briefly to mental health issues. After more than 20 years in which to evaluate the workings of the 1983 Act, two draft Bills, a Joint Scrutiny Committee report and other expert reviews such as that led by Genevra Richardson, this Government must find the time and the means to come up with considered legislation which will set the framework for the improvement of mental healthcare for a generation. Instead, we have this clunking fist of a Bill which, for the most part, was not wanted and which few believe will work in practice. The Minister thanked profusely thanks the many people and organisations involved in considering the legislation up to this point. He did not say that the Government took any notice whatever of what most of those organisations and people said. Perhaps if they had, we would have had a Bill about mental health and not the punitive Bill before us. If there had been that listening process, the Government might have understood that, of the2.6 million people in this country on incapacity benefit, 40 per cent have mental health problems. That means that £5.2 billion per annum is spent on incapacity benefit for people with mental health problems. There are more people with mental health problems claiming IB than the total number on jobseeker’s allowance. Not only does unemployment adversely affect a person’s mental health but, as the CBI indicated in the report produced by the noble Lord, Lord Layard, on 6 December 2004, Mental Health: Britain’s Biggest Social Problem, the estimated output loss of time from work due to stress, anxiety and depression is about £4 billion per annum. Those two figures together exceed the £8 billion currently spent on mental health services. It would have been good to have before us a Mental Health Bill which really sought to address the causes, incidence and prevalence of mental illness and to introduce the new means at our disposal to manage and assist those who have mental health problems, the vast majority of whom, as the Minister said, pose no danger to themselves or anyone else; they simply need assistance to live their daily lives. We could have talked about ways in which healthcare workers could play a part in multi-agency arrangements to enable people to get back to work. We could have discussed how supportive employers can play a role in ensuring that people get a job and regain their self-esteem, which could so change their lives that they no longer need medication. Most ofall, we could have talked about the chronic lack of access to community-based services such as talking therapies—those early interventions which, we know, enable people to avoid acute, serious episodes of illness. It would have been good to have a mental health Bill. The Queen’s Speech has been delivered by a Government who seem to have focused on the short term and run out of strategic vision in their powers to tackle the underlying causes of ill health in this country. We will do our best to see that that is redressed and that the National Health Service is run with a strategic vision nationally and accountability locally.