My Lords, declaring my interests in the register, I will briefly touch on three issues from the Queen’s Speech relating to healthcare. I also congratulate my noble friend Lady Blower on her excellent maiden speech.
First, I turn to the intention to enshrine in law the National Health Service’s multiyear funding settlement. This commitment and additional resources for the NHS are obviously always welcome, but in 2018-19 the outturn spend on mental health services was around only £12.2 billion, which is roughly £1 in every £10 of the overall NHS budget. If we are truly going to make the essential additional investment desperately needed in mental health services for both children and adults, would it not perhaps also be appropriate to enshrine in law the commitment to achieve parity of esteem and equality of access between mental health and physical health expenditure over the same funding period, rather than merely retain it as an aspiration in the NHS mandate?
Secondly, I turn to NHS investment. As pro-chancellor of the University of Salford, which has one the largest—and, dare I say, best—training departments for nurses in the country, I welcome the announcement to restore some level of bursaries for nurse training. However, I understand that there will be a delay in implementation until September this year. Universities recruit for such training at a number of points in the year, such as January and March, so it is likely that potential applicants will delay entry until September to understandably take advantage of the bursaries. However, this could further undermine the already fragile nurse workforce planning across the NHS. Will the Minister therefore consider the immediate restoration of the bursaries to ensure a more robust pipeline of nurses over the coming years and give more certainty to university recruitment?
Thirdly, I turn to the Mental Health Act and the commitment in the Queen’s Speech to continue work to reform it. Such reform is urgent following the excellent review of the current Act by Sir Simon Wessely. I strongly support two of his recommendations regarding the interface between mental health and the criminal justice system, which are similar to recommendations I made in my independent report to government some 10 years ago. First, he recommended that by 2023-24 investment in mental health services, health-based places of safety and ambulances should allow for the removal of police cells as a place of safety under the Act and ensure that the majority of people detained under police powers are conveyed to places of safety by ambulance. This is obviously subject to satisfactory and safe alternative health-based places of safety being established. I totally agree with this recommendation.
Good progress has been made in this area, with the banning of the use of police cells as places of safety for children. However, to ensure that the recommendation is implemented, we need significant further investment in, for example, crisis care assessment units away from A&E departments—they are totally the wrong environment for people in mental health crises—and liaison and diversion services. These services have now reached 100% coverage of the country but should be further enhanced by, among other things, connection to speech and language therapy services and appropriate adult support, and the rapid development of the excellent reconnect programme for rehabilitation.
His second recommendation—that NHS England should take over the commissioning of health services in police custody; again, similar to my recommendation
—would significantly improve the co-ordination between mental health, learning disabilities and physical health assessment in police custody, and would be a key component in improving the quality and timeliness of crucial information about a person’s complex needs as they pass, where appropriate, along the criminal justice pathway. Again, I hope that the Minister will support these recommendations and the early introduction of the Bill in order to reform the Mental Health Act at the earliest opportunity, following diligent consideration of the complex issues through the publication of the White Paper.
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