Queen’s Speech

My Lords, we are here to debate the health, welfare and children Bills announced in the gracious Speech. I hope to inform that discussion by outlining the key proposals in those Bills. I will begin with the subject that is the closest to my heart. This year we celebrate the 60th anniversary of the NHS. Just over 10 years ago the NHS was in disarray and chronically underfunded. In 1997, people questioned whether it could survive at all. Now, in 2008, the NHS has not only survived but also flourished. That is testimony to the hard work and dedication of many of my NHS colleagues. Their efforts have been supported by three phases of reform. The first began with the NHS plan in 2000. This marked the biggest investment in the history of the NHS, with more doctors, more nurses and better facilities for staff and patients. Such capacity building was a necessary means to an end, giving the NHS the resources it needed to provide better care. Alongside that great investment we set some tough targets for tackling immediate problems, such as unacceptably long waiting times. We also needed to set minimum standards for key services, such as cancer and coronary heart disease. National targets, such as that of a maximum 18-week wait from referral to treatment, were not popular but have done their job by providing clarity to the NHS on key priorities. The second phase was to reform the processes and systems, moving away from central direction by creating incentives to improve and introducing greater transparency and accountability. We needed to give patients real choices about their care through greater diversity of provision, strengthened healthcare commissioning and new incentives for better performance. So we introduced patient choice, payment by results and foundation trusts. Those reforms have coincided with the greatly improved management of NHS resources and further dramatic falls in waiting times. I had the privilege to lead the third phase of reform, a new and fundamental focus on quality. It is what motivates me and my clinical colleagues. Now that we in the NHS have the resources and processes in place, we can be free to focus on the quality of care we provide. In High Quality Care for All, the review that I published this summer, I explained that quality needed to become the organising principle of the NHS. If that happens, the NHS will have the necessary foundation for another 60 years. Quality cannot be centrally determined. It cannot be achieved by diktats from Whitehall. It can, and will, occur if front-line staff are instead freed to innovate and make changes that work for people locally. That is why High Quality Care for All is a national enabling document, supporting the local NHS to embed quality. For patients, the document means that they will be supported in taking responsibility for staying healthy, they will have fair access to the best treatments, they will be kept as safe as possible in clean environments and they will have the right information to exercise real and informed choice. Much of High Quality Care for All can be achieved without legislation, but some of its proposals must be enshrined in law through a health Bill. Previous Bills have marked the stages of reform. Just as the Bill in 2003 that introduced foundation trusts identified the second stage, so the forthcoming health Bill will enable the ““quality”” phase. It will do so by improving the availability of information about quality for patients, clinicians and managers with the new quality accounts. In keeping with the spirit of my review, the way these are constituted will not be imposed by the Department of Health but will be determined by jointly designing them with those who provide the services. The Bill will place a duty on all providers of NHS services to produce quality accounts, starting from April 2010. The accounts will contain new quality metrics, providing information on safety, patient experience and outcomes in relation to clinical services. Through the accounts, that information will be available to all, helping people decide where to be treated, giving clinicians feedback on the care they offer and supporting managers in identifying local priorities. This represents a new modus operandi for the NHS and the Government. Its aspirations far exceed what has gone before. We are saying to the NHS, ““You have discretion but you are also fully accountable””, with quality accounts a key measure of local responsibility. The Bill will also reinforce the core purpose and values of the NHS by placing a duty on NHS bodies to take account of the new NHS constitution. The constitution will be published alongside the Bill, and will secure the enduring principles of the NHS and set out the rights and responsibilities of staff and patients. The Bill will commit the Government to renewing the constitution every 10 years, in consultation with patients who use it, the public who fund it and the staff who work in it. The third commitment from High Quality Care for All, contained within the Bill, is the introduction of direct payments for health services in certain circumstances and with certain constraints. This is one of the ways in which we will explore the use of personal health budgets which have the potential to give people more control and influence over their healthcare. The experience of social care suggests that giving people greater scope to organise treatment and care around their own needs will increase both the quality of care people receive and their satisfaction with that care. The Bill will also contain proposals not included within my review, but certainly consistent with its principles. Most notably, it will introduce measures to control the selling of tobacco, tackling the biggest single preventable cause of ill health and one which disproportionately affects the most disadvantaged in our society. On 9 December, we announced in the other place the Government’s response to the consultation on the future of tobacco control. The vast majority of the 97,000 responses to that consultation were supportive. The Bill will therefore include provision to ban the display of tobacco by retailers and, via regulation, to prohibit the sale of tobacco from vending machines or to restrict access to those machines to people under 18. This will be a major step in preventing ill health, which, as your Lordships know, is always preferable to treating health problems that have developed. Finally, the Bill will, as noble Lords asked and we agreed during the passage of the Health and Social Care Act in the summer, extend the remit of the Local Government Ombudsman to deal with the complaints of people who fund their own social care services. I am grateful to the House for championing the voice of this important group of service users. As a humble surgeon, I am often enough told by other doctors, and to a lesser degree by nurses, that I cannot grasp the intricacy of their particular specialism. So I hesitate to risk the wrath of job centre employees and teachers by heading into their domains. However, as a non-expert, I ask your Lordships’ leave to outline our proposals on welfare reform and improving chances for children and young people. We announced our intention in the Queen’s Speech to introduce a welfare reform Bill, a Bill that will help hundreds of thousands of people to find and keep work. It will turn lives around. We are offering a fair deal: more support in return for higher expectations. Put simply, the proposals outlined in that Bill will help us to achieve our ambition of ensuring that almost everyone claiming benefits should have the support and expectation to look for work. These measures are more relevant today, in these difficult economic times, than they could have been in the past. Most of all, we cannot afford to waste a single person’s talent. The measures in the welfare reform Bill will bring about radical change. Our proposals are in stark contrast to the position, just over 10 years ago, when less than a third of claimants had to do anything substantial in return for their benefits. Even that third got only limited support to get back in to work. The rest got nothing. This Government set about putting that right. We created the New Deal. We merged the Benefits Agency and the Employment Service to create Jobcentre Plus. So everyone who signed on for jobless benefits was put on the path back to work. That was the first phase of reform, deepening the obligation to work so that there is not an option to stay on benefits. As we saw those obligations cause youth and long-term unemployment to tumble, we set about the second phase of reform by widening their scope. We piloted helping those on incapacity benefits with the New Deal for Disabled People and then with the groundbreaking Pathways to Work programme, which increases the chances of someone being in work by about 25 per cent. Since this April, we have required all new claimants to take part, except those with the most severe conditions. In October, we replaced the incapacity benefits with the employment and support allowance, which focuses on what people can do and not what they cannot. We improved help for lone parents. With the help of New Deal for Lone Parents, over 330,000 more of them are in sustained work. However, we wanted more people to benefit, so we are requiring lone parents of children between seven and 16 to look for work, which we expect to increase employment and lift 70,000 children out of poverty. The Bill, combined with the measures outlined in the White Paper, Raising Expectations and Increasing Support: Reforming Welfare for the Future, published on 10 December, starts the third phase of the Government’s welfare reforms. Our proposals are based on a simple idea: that no one should be left behind, that virtually everyone should be required to take up the support that we know works. The reforms will simplify the benefits system to ensure that it offers the right support; devolve power and responsibility to individuals, communities and suppliers to tailor services to local priorities and needs; increase the role of the private and voluntary sector, paying by results to help more people; develop a personalised programme of help for everyone on benefits who can work; increase targeted support and activity for groups most at risk from exclusion from the labour market; expect more of jobseekers and others in return for back-to-work support; enshrine in legislation our commitment to tackle child poverty, which is the biggest obstacle to individual achievement; ensure that housing benefit supports people moving off benefits; provide additional support for disadvantaged jobseekers; clarify rights and responsibilities; and facilitate choice and control. The themes of the health Bill can be seen in our approach to welfare reform. They extend also to the children, skills and learning Bill, which we will bring forward. Last year, the Secretary of State for Children, Schools and Families published the Children’s Plan, which set out the Government’s vision for making this country the best place in the world to grow up, and making sure that every child, whatever their background and wherever they live, can have a safe, happy, fulfilling and healthy childhood. Today, the Secretary of State has issued a report setting out the progress that has been made over the past year and the challenges that remain in achieving this long-term vision. There has been some significant progress. We are implementing Dr Tanya Byron’s recommendations on addressing the potential risks from harmful and inappropriate content on the internet; a root-and-branch review of the primary curriculum, led by Sir Jim Rose, is under way; and the Youth Crime Action Plan has been developed, setting out a cross-government approach to reducing youth crime. The Education and Skills Act, which received Royal Assent on 26 November, established an historic milestone by requiring that, from 2015, all young people stay in education until the age of 18. This has been welcomed by the education sector, business and trade unions alike. As David Frost, the Director General of the British Chambers of Commerce, put it, "““Raising the compulsory age of participation in the education system will help to ensure that Britain has a suitably well qualified workforce in the future””." The children, skills and learning Bill will build on these achievements and the wider themes set out in the Children’s Plan. It will enhance our efforts to ensure that services to children and their families are locally owned, locally integrated and locally accountable. Children’s trust boards will be placed on a statutory footing, with new responsibilities to drive more effective local co-ordination. Sure Start children’s centres will be given legal recognition that they are part of the local infrastructure of support available to all parents. Local authorities will become responsible for ensuring that 16 to 19 year-old learners are able to pursue the education, training and apprenticeships opportunities that best suit their needs and aspirations, and local authorities will also have new responsibilities for the education of young people in custody, to help ensure that our most vulnerable young people are given the best possible chance to get their lives back on track. In education, as in health, more autonomy is being given to local services. Where national bodies exist, they do so to support local service delivery. That will be the case with the Young People’s Learning Agency, there to support local authorities in delivering on their new responsibilities to 16 to 19 year-old learners, and the Skills Funding Agency, responsible for adult skills, which has been designed to be flexible and highly responsive to employer needs and the changing economic demands facing this country. Further support will be available through the national apprenticeships vacancy matching service which we hope will lead to an increase of more than a third more people starting apprenticeships in England by 2020. We are bringing in a new right for those in employment to request time to train. This right will encourage individuals to refresh their skills and businesses to invest in training to boost their productivity. Certain functions must be retained nationally to ensure consistency. To increase public confidence in the standards of qualifications and tests, the Bill will establish a new independent regulator for England—the Office of the Qualifications and Examinations Regulator, which will be accountable to Parliament rather than to Ministers. The Bill will continue the drive to ensure that every school is a good school. For the best schools, this will mean a more flexible Ofsted inspection cycle. For those that are causing concern, there will be new powers to require local authorities to take earlier action. Where parents have concerns that cannot be resolved with the school, there will be a new way of handling such complaints. School support staff, including teaching assistants, caretakers and bursars will be recognised for their vital contribution to school life through the establishment of a new Schools Support Staff Negotiating Body, and the Bill will give local authorities and Ministers new powers to ensure that all schools take seriously their responsibilities to provide teachers with time for marking and lesson planning. Finally, the Bill will support secondary schools in coming together to tackle poor behaviour and attendance more effectively by sharing expertise, resources and facilities. In response to Sir Alan Steer’s recommendations, schools and colleges will also be given extended powers to search pupils for alcohol, illegal drugs and stolen property. This wide-ranging bill will be supplemented by the final Bill I want to bring to noble Lords’ attention. This is a Bill aimed at tackling one specific problem—child poverty. In 1999, this Government pledged to eradicate child poverty by 2020. The child poverty Bill will enshrine that momentous commitment in legislation. I hope that noble Lords can see the common threads running through these Bills. Let me summarise the parallels. I see quality being fundamental, whether it is in a hospital or in a school. I see help for the most deprived, to raise children out of poverty and to make it easier to quit smoking. I see clear rights and responsibilities, whether it is for the NHS worker or for the benefit claimant, and I see more personalised services, whether it is a tailored package of training for a teenager or a personal health budget for a patient. The Bills contained in the gracious Speech are nothing less than a coherent vision for public services for the 21st century and I commend them to the House.