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  • Mar 14, 2018:
    • Universal Credit: Free School Meals - Question | Lords debates

      My Lords, on what basis was it decided that the earnings threshold for eligibility in Northern Ireland would be double what it is in England? Is this because poor children in Northern Ireland are twice as malnourished as they are in England, or could it be political expediency?

  • Mar 12, 2018:
    • Cannabis - Question | Lords debates

      My Lords, I welcome the Minister's acceptance that perhaps it should be a Health Minister standing at the Dispatch Box. Even so, is he aware that doctors in the UK are allowed to prescribe heroin to addicts in certain circumstances? How does he square that with the fact that they are not permitted to prescribe most effective cannabis medicines to patients in pain, even though these are available legally in many other countries? Is it not time that we stopped criminalising patients?

  • Mar 7, 2018:
    • Nurses: Training - Question | Lords debates

      My Lords, is the Minister aware that the vacancy rate for nurses in social care settings has doubled over the last four years? Given the other pressures on nursing homes, will the Government take specific action-perhaps grants for placements-to relieve this problem, which the NAO has described as dangerous?

  • Feb 21, 2018:
    • Cannabis-based Medication - Question | Lords debates

      I am grateful to the Minister for her commitment to explore every option. Is she aware of the legal opinion from Landmark Chambers making it clear that there is an exception under Section 30 of the Misuse of Drugs Act 1971, which allows that a licence for possession of a controlled drug can be permitted for medical purposes? Will she make use of that exception to save this little boy's life?

  • Feb 20, 2018:
    • Nuclear Weapons - Question for Short Debate | Lords debates

      My Lords, I congratulate my noble friend Lady Miller on asking this very important question.

      I speak in a personal capacity about the greatest threat to mankind and the planet: nuclear war. I believe that there are no safe hands for these weapons of mass destruction-not even ours. Global warming is a very major threat, but the threat of any detonation of nuclear weapons is even greater. Yet, despite the lead the UK has shown on the issue of global warming, we are not showing the same leadership on getting rid of nuclear weapons. Of all weapons of mass destruction, only nuclear weapons will kill not just one generation, but kill and maim future generations, resulting in the starvation of 2 billion people, even when used on a small, regional basis, as my noble friend said. It has also been made clear by the Red Cross and the Red Crescent that no medical response to a nuclear detonation would be anywhere near adequate.

      It should hardly be necessary to restate that it is illegal to possess such weapons, let alone use them, but that is what the new UN ban treaty seeks to do. In my contribution, therefore, I urge the UK Government to demonstrate by their actions their commitment to a world free of nuclear weapons, which they frequently express to Parliament and at the United Nations. Although the UK is a signatory to the 1968 nuclear non-proliferation treaty, very little progress has been made for five decades on the incremental reduction of nuclear weapons to which the treaty commits us. It is time we did something about that. Indeed, it seems that weapons are proliferating rather than reducing. It saddens me, therefore, that the UK Government refused to sign the new Treaty on the Prohibition of Nuclear Weapons-negotiated by the UN last July-and still seem not to have made up their mind as to whether they will attend the UN high-level conference on nuclear disarmament in May. If not this way, which way?

      The new ban treaty lays out a process leading to multilateral disarmament. The conference to discuss urgent next steps will be held in a climate of increasing possibility of a nuclear exchange between North Korea and the United States, or India and Pakistan, or Russia and NATO. There is no better time for world leaders to come together to take nuclear war off the table. The principal aim of the conference is to make progress on effective measures for nuclear risk reduction and disarmament. Membership of the NPT already commits us to that, so we really must take part. If we do not, we will increasingly be seen as out of step with the international community and rejecting the opportunity for global leadership that it presents.

      The UK should not wait for other states to take action: surely we should make our own decisions about something as important as this. The non-nuclear countries have shown the way by agreeing the resolution last summer, and many have now signed and ratified it. But without the participation of the nine nuclear countries, the threat-not just of intentional detonation, but of accidental detonation too-remains acute. The presence of nuclear convoys on our roads brings the latter very close to home.

      The treaty calls for progress to be made on a global agreement, which would include the nuclear-armed states and provide a phased and verified process for prohibiting and eliminating nuclear weapons. Verification is an area where the UK has considerable expertise to offer, so we should take part in discussions about how this can be done. Such processes have been very successful in reducing the use of chemical and biological weapons, and it is essential that the global community learns from that success in relation to nuclear weapons too. Chemical and biological weapons were banned first and then eliminated, so making them illegal was the essential first step.

      Parliamentarians and civil society organisations have called on world leaders to commit to attending the conference at the highest possible level. The Organization for Security and Co-operation in Europe Parliamentary Assembly, which includes the Parliaments of France, Russia, the UK, the USA and 52 other members, adopted declarations in 2016 and 2017 calling on member Governments to reduce nuclear threats, adopt no-first-use policies and support UN negotiations, including on the nuclear ban treaty and at the 2018 UN high-level conference. Even though we might be leaving the European Union, we are being told that we will still be in Europe, so there is no reason why we cannot continue to play an active role in this organisation and to support its demands.

      Jonathan Granoff, president of the Global Security Institute and UN representative for the World Summit of Nobel Peace Laureates, said recently:

      "Nine nations continue to hold the world at risk of nuclear annihilation. Although 120 non-nuclear weapons states have negotiated a treaty to ban the weapons, the states with the weapons remain deadlocked in inertia. It is time for leaders to come together … to discuss measures to reduce nuclear threats".

      So will our Prime Minister attend? Frankly, I would not trust the Foreign Secretary to make a positive contribution, but the Prime Minister might. If not now, when?

      While millions starve, over $100 billion per year is spent globally on nuclear weapons, including many millions of pounds by the UK. Personally, I believe that this is a terrible waste because I do not believe that the deterrence principle makes us any safer. On the contrary, possession of these weapons makes us a potential target, as it clearly does for the United States. Certainly the people of Scotland think so, which is why they are overwhelmingly against the location of these weapons on their soil. The money could be better spent to create jobs, support renewable energy, protect the climate and clean air, maintain our conventional defence forces and implement the sustainable development goals.

      The ban treaty also has something important to say about the ongoing humanitarian legacy of past nuclear weapons use and testing, and obliges states to provide medical rehabilitation and socioeconomic assistance to those affected by nuclear weapons and to make affected environments clean and safe again. The UK has nuclear test veterans, so I ask the Minister: what are the UK Government doing for them and what contribution are they making to assist victims in other parts of the world? Taking the first steps to engage with the ban treaty by attending the conference is not only compatible with our membership of NATO, the NPT and the Comprehensive Nuclear Test-Ban Treaty, it is a vital step towards fulfilling our legal obligations in relation to nuclear disarmament.

      Given the aggressive stance of the current holder of the office of US President, it is time for us, one of the United States's oldest friends, to show that jaw-jaw is better than war-war by participating in the high-level conference, even as an observer. Even if the other nuclear states refuse to take part, the presence of the UK would prove what the Government have recently been claiming-that even after Brexit, the UK will remain an outward-facing country, engaged with the rest of the world and taking a leading role in efforts for peace. I challenge the Government to prove their claim by attending the conference.

    • Charities, Social Enterprises and Voluntary Organisations - Question | Lords debates

      My Lords, charities are affected not just by regulation but by policy developments. Will the Minister say whether there is a protocol across government to investigate how new policy developments impact on charities and their ability to do their work?

  • Jan 30, 2018:
    • Women: Events Industry - Question | Lords debates

      My Lords, does the Minister agree that if you want to influence the behaviour of men you should start when they are boys? That is why it is very important that the curriculum for PSHE lessons includes elements that ensure that young people leaving school understand that both genders should be properly respected.

    • Brexit: Negotiations - Question | Lords debates

      My Lords, is it not common knowledge that the Prime Minister has shifted the focus of negotiations to a competent official in the Cabinet Office, because she has lost confidence in a Brexit Secretary who complacently thinks the whole the matter is simple? His incompetence was proved by the shambles in the first stage of negotiations, which was only ended by a fudge on the Irish border. Will the Minister clear the matter up once and for all today, by telling the House how the Government plan to avoid a hard border while also leaving the customs union?

    • Brexit: Negotiations - Question | Lords debates

      To ask Her Majesty's Government who is conducting the negotiations for the United Kingdom leaving the European Union; and to whom that person reports.

  • Jan 25, 2018:
    • NHS: Cancer Treatments - Question for Short Debate | Lords debates

      My Lords, this has been a unique, moving and effective debate. I am proud to be able to support the demands of the courageous noble Baroness, Lady Jowell.

      In my three minutes I want to focus on two of her demands: early diagnosis and patient rights. Public Health England says:

      "Diagnosing cancer earlier is one of the most important ways to improve cancer survival and we know that those patients who have their cancer diagnosed as an emergency have poorer outcomes".

      That is why new screening and diagnostic methods must be made available quickly.

      In fact, I am standing here because of screening. I say to the noble Lord, Lord Turnberg, that I have had two as well; perhaps we should start a club. That shows how far we have come, does it not? Screening does not merely diagnose disease but can sometimes predict the risk of it through identifying gene mutations, as we have heard. Genomic screening can also contribute to treatment decisions by predicting how the tumour will respond to chemotherapy. That can avoid chemotherapy for those patients who will not benefit from it.

      Diagnoses of colorectal cancer through the national bowel screening programme remain under 10%. This effective early diagnostic tool is not being used widely enough. Is that because CCGs are not offering the screening, or is it because people are not returning the samples? What are the Government doing to improve those figures?

      I agree with the noble Baroness, Lady Jowell, that patients should have a great deal more say in the risks that they are prepared to take, and that adaptive trials should be allowed where they could help. I will not repeat many of the cancer-related examples that we are today, but I shall give the House a non-cancer example of where the system is preventing a patient from receiving medicines that have already been shown to work, to illustrate that the problems that the noble Baroness has identified go wider than cancer.

      A small boy, whom I will call A, has rare and serious epilepsy. He was treated, at great expense to the NHS, with powerful pharmaceutical drugs to stop his fits, although some of them were not even licensed for use on children. His condition did not improve and the doctors admitted the drugs could damage his vital organs and shorten his life. His parents heard of a similar case in Holland where a child was being treated successfully with cannabis-based medicines, which were licensed there.

      Child A has now been receiving cannabis treatment in The Hague with enormous success. His doctor here is convinced of the safety and efficacy of these medicines, which are not licensed here, but is frightened to treat him with them because he is afraid that the GMC will strike him off. The family can no longer afford to remain in The Hague, yet the Home Office tells me that it will not grant a special licence for the treatment in the UK. This child could die of his fits. His parents would agree in a heartbeat for him to receive the medicines here, even though they are unlicensed. They know the risk is small and the benefits huge. They should have the right to make that decision for their child, just as the cancer patients mentioned by the noble Baroness should have the right to make decisions about risks and about their own treatment. What is the Minister going to do about that?

  • Jan 22, 2018:
    • Transfer of Responsibility for Relevant Children (Extension to Wales, Scotland and Northern Ireland) Regulations 2017 - Motion to Approve | Lords debates

      My Lords, we on these Benches support the national transfer scheme. We believe it is only fair that it should be extended, preferably on a voluntary basis, to the devolved Administrations, particularly since they have been widely consulted. We thank and congratulate those local authorities that have accepted children. Often it is a significant burden, particularly to certain local authorities because of their geographical location, so it is only right that the burden should be spread.

      However, I have some questions. How many unaccompanied asylum-seeking children have already been received by the devolved Administrations under the voluntary scheme? What representations have been received from the devolved Administrations about the adequacy of the financial support available to them? How well are families who look after asylum-seeking children supported? There are considerable language and cultural issues with which they need support.

      What about the social workers and, preferably, guardians who are needed to steer the children through the process of giving statements to solicitors and to the Home Office? They need advice on the meaning of, for example, "leave until 17 and a half", which actually means the refusal of an asylum application although it does not sound like it. They need proper professional advice. Lastly, under the present circumstances, what will be the effect on these regulations, if any, of the lack of a power-sharing Administration in Northern Ireland?

  • Dec 21, 2017:
    • Climate Change: Health - Motion to Take Note | Lords debates

      My Lords, I thank the Minister for her valiant defence of the Government's record. I will leave noble Lords to decide how many marks out of 10 it should get. I also thank all those who have spoken in this debate. It was a particular pleasure to hear the maiden speech of the noble and learned Lord, Lord Neuberger. Early in his speech, he mentioned that he had had to do a lot of risk assessments in his career. If I found that there was a 95% chance of something I was doing causing a negative effect, I would stop doing it. I am glad to see that the vast majority of the Members of your Lordships' House are on the side of the 95% rather than the 5%. I believe it is in fact 99% of scientists who believe that it is human activity that is causing climate change. Indeed, they also tell us that, even if we stopped this very day all the activities that cause climate change, global warming would continue. It is a bit like an ocean liner: you switch off the engine but it still carries on for several miles. So the sooner we stop doing those things the better.

      I was very struck by the comments of the right reverend Prelate the Bishop of Derby about how, as a community and a country, we need to take action, but also how we have individual responsibility. Some years ago, I made a new year's resolution that, the next year, I would live more lightly on the planet. My most recent effort in that respect has been to build a passive house-a highly insulated house-and it is very gratifying to see how many public housing projects are now being built to that gold standard; it is terrific. I recommend such a new year's resolution to all noble Lords. If we all take a step every year then we will be moving in the right direction.

      Finally, I wish all noble Lords a happy Christmas and a green and healthy new year. I beg to move.

      Motion agreed.

    • Climate Change: Health - Motion to Take Note | Lords debates

      My Lords,

      "Climate change isn't just hurting the planet-it's a public health emergency".

      That is the conclusion of Christiana Figueres, chair of the Lancet Countdown, a collaborative research project which published a report in October that has shone a light on the damaging impacts that climate change is having on our health.

      In 2009, the UCL-Lancet Commission published its first report on the relationship between climate change and health. It concluded, simply, that climate change represents the biggest threat to global health in the 21st century. Since that publication, the Lancet has continued to work on this topic, and instead of describing climate change as a threat, the most recent report concluded, optimistically, that climate change represents the biggest opportunity for global health in the 21st century. This change of tone reflects a growing recognition that action on climate change can bring about dividends for public health, a notion which empowers the health and climate community to capture these co-benefits. More recently, the Lancet has pioneered the concept of planetary health. The foundation of this concept is the growing body of evidence that the health of humanity is intrinsically linked to the health of the environment. But by its actions, humanity now threatens to destabilise the earth's key life-support systems, with significant implications for the political systems and economies that run the nations of the world.

      This year's Lancet Countdown is the latest report in this field from a cross-sectoral partnership of universities and organisations from across the world. It is an accountability mechanism, using 40 indicators to track progress annually on climate action and health, and to catalyse political and scientific discussion about its importance. Today's debate is proof that it has already succeeded in the second of those aims. The Lancet has committed to producing this annual state of the union report in order to try to sustain, in the interests of global health and stability, the momentum on climate change that was achieved with the negotiation of the Paris Agreement.

      The key conclusion from the report is that climate change is damaging health worldwide. The multiple threats to human health of climate change are unequivocal, interacting and potentially irreversible: from direct impacts such as heat waves and extreme weather events such as storms, forest fires, floods or drought, to indirect effects on ecosystems, such as agricultural losses and changing patterns of disease, and effects on economies and social structures, such as migration and conflict. These effects disproportionately impact the most vulnerable populations, but every community will be affected. The World Health Organization agrees that climate change negatively affects the basics of life: safe drinking water and access to food and shelter. Here in the UK, the latest climate change risk assessment under the Climate Change Act 2008 includes heat waves, flooding and drought as aspects that risk UK public health.

      According to Countdown, the critical issue at hand globally has been the delay in our response to climate change, which over the past two decades has jeopardised human life and livelihoods. However, the good news is that the past five years have seen an accelerated response, and in 2017, momentum is building across a number of sectors. The direction of travel is set, with clear and unprecedented opportunities for public health. That is why the tone of the latest report is more optimistic than before.

      I am glad to note that here in the UK the Climate Change Act 2008 is legally binding whether we are in or out of the EU, and we will also continue to be a signatory to the Paris Agreement although we will have to submit our own submission separately from the rest of the EU. But even if all the signatories to the Paris Agreement achieve their commitments, it is estimated that there will still be an increase in mean global surface temperature of 2.7 degrees by 2100, resulting in significant environmental change, so the Paris targets are not enough. However, if the targets are not achieved, and the attitude of the current US Administration makes it likely that they will not, over 4 degrees is possible, with profound damage to the planet and human health.

      So let us look in more detail at the impact of climate change on health. Annual weather-related disasters increased by 46% between 2000 and 2013, and scientists attribute this increase to climate change. These disasters have a monumental effect on the health of the affected communities. Droughts and flooding result in starvation and the mass movement of people, all of which are disastrous for health. Here in the UK, 1.8 million people are living in areas susceptible to flooding or coastal erosion. Although relatively few people die from drowning during UK floods, the psychological trauma and effects on mental health of having your home or business flooded are considerable. A UK study found that flood victims were more than six times more at risk of depression and anxiety and seven times more at risk of PTSD than the general population. So what are the Government doing to reduce the risk of flooding and protect vulnerable areas, and how are the planning regulations being used to discourage new building in areas susceptible to flooding?

      Massive storms destroy people's homes, and most of this damage worldwide is not insured. Again, these storms result in the displacement of people and major health issues, such as cholera, where populations are living close together in poor-quality temporary shelter. Accelerated efforts towards poverty reduction and sustainable development have helped to minimise harm to date. However, the Countdown report's authors believe that limits to adaptive capacity will soon be reached, so we must address the root cause of these disasters, which is climate change itself, and I shall come to that in a minute. In the meantime, what are the UK Government doing to help populations that are displaced by such disastrous weather events?

      Secondly, global warming has a direct effect on the livelihoods of vulnerable people exposed to heat-wave events. From 2000 to 2016, the global average temperature where people are actually living has risen by approximately 0.9 degrees Celsius, more than twice the global mean land temperature increase. Since 2000 the number of those vulnerable people exposed to heat-wave events has increased by around 125 million. This means more people dying from overheating and more people working on the land whose productivity is impacted. The report calculates that global physical labour capacity in populations exposed to severe temperature rises decreased by around 5.3% from 2000 to 2016. This reduces their income and has an effect on local and global food security. Of course, extreme cold weather also usually results in increased deaths, especially of older people through hypothermia, while the increase in the number of UK deaths due to overheating is projected to rise by a massive 250% by the 2050s, partly due to our ageing population, unless action is taken. Both these effects put major stress on the resources of our NHS.

      Then there is the effect of global warming on communicable diseases. The geographical scope of some of the vectors of communicable diseases has increased considerably, and this is very worrying for us in the UK. We are already seeing Culex modestus, a vector for the West Nile virus, being found in south-east England. Higher temperatures in future will also increase the suitability of the UK's climate for other invasive mosquito species. Plant diseases are already reaching us, with major effects on the countryside. For example, in the last few years many of our large and important trees have suffered from diseases that we did not see decades ago, and this has been linked to climate change as well as the increase in the cross-border sales of trees.

      So are we doing enough to adapt to the effects of climate change? The report concludes that we are not. However, there are great opportunities. Mitigating climate change benefits health in many ways, but there are some areas where the two are particularly closely linked-for example, air pollution, which is a global health crisis. Seventy-one per cent of the almost 3,000 cities in the World Health Organization's database do not satisfy WHO annual fine particulate matter exposure recommendations. That includes London and 43 other British cities. This poor air quality results in 40,000 premature deaths each year in the UK-and not just of those who suffer from lung problems.

      The UK Government have identified poor air quality as the largest environmental risk to public health, being linked to cancer, asthma, stroke and heart disease, diabetes, obesity and changes linked to dementia. In the case of fine particulates, we also know that they particularly affect young children, including the brain development of infants.

      It is the heating, transport, industry and energy sectors which are the source of man-made air pollution, producing most of the particulates, as well as carbon dioxide and other gases linked to global warming, so we need clean transport and clean energy production, but we have an economic system in which the full costs of climate change are not paid for by those responsible for the problem. Will the Government look at the real cost of the use of fossil fuels and consider carbon pricing as a means of getting the balance right? Will they take positive action to reduce the number of diesel vehicles on our roads? What action are they taking to encourage and enable people to insulate their homes properly?

      Progress on coal phase-out has tangible benefits for air quality globally, and it is good to see that in 2016-17, the amount of additional coal capacity planned for construction halved. In addition, traffic emissions make a major contribution to the quality of the air we breathe, especially in cities. Sustainable travel uptake, such as walking and cycling, can mitigate climate change while at the same time encouraging healthier lifestyles and improving air quality.

      In these ways, mitigation tackles climate change and reduces the harm to health from air pollution. When will the Government spend on sustainable travel reach £10 per head annually, as they have committed to do, and why are they planning to reduce the "active travel" investment from £287 million per year now to £147 million per year by 2020? As physical inactivity and obesity cost the NHS more than £1 billion a year, this seems a very unwise reduction.

      I also draw the Minister's attention to the need for a comprehensive carbon capture and storage strategy, as recommended in the report of the advisory group on CCS, ably led by the noble Lord, Lord Oxburgh. Clean energy production is essential, but as we grow our ability to produce electricity by sustainable means, we expect to have to depend on fossil fuels for many years. In the light of that, it was very disappointing that the Government cancelled the carbon capture and storage competition. The noble Lord's report is unequivocal that CCS is an essential component in delivering the lowest-cost decarbonisation across the whole economy, and there is no justification for delay in getting a national strategy up and running. His six recommendations provide a blueprint for how this needs to be done, yet the Government have not responded to the report. I hope that the noble Baroness can tell us why that is and when a government response will be provided.

      Food and agriculture is also a sizeable contributor to climate change. The average dietary CO2 emissions per person in the UK are 5.6 kilograms per day, but if we ate according to the WHO's nutritional guidelines, they would fall by 17%. The dietary changes would also save almost 7 million life years over a 30-year period, mainly due to a reduction in coronary heart disease equivalent to an average increase in life expectancy of just over six months. Here is another opportunity to improve health and address climate change by focusing on the links between the two.

      What are the Government doing to promote healthy eating in line with the WHO nutritional guidelines, so that the health of the population can benefit while also reducing greenhouse gases? Are they putting into practice lessons learned from the success of the campaigns to reduce smoking and drink-driving and applying them to healthy eating? There is some good news from right inside the NHS itself. The NHS Sustainable Development Unit has had considerable success in reducing the health sector's greenhouse gas emissions.

      If noble Lords agree that our environment has a major effect on public health, they have to be worried about the life sciences part of the industrial strategy. In his evidence to your Lordships' Science and Technology Committee, Sir Paul Nurse recently said that the strategy should really be called the health science strategy, because it completely leaves out the environmental and other life sciences, in which the UK has considerable strength. Do the Government plan to publish a separate strategy for life sciences that are not directly linked to health? The reason I ask is that environmental sciences are very much connected with health and there is a danger that they will be ignored. Unlike many other departments, however, the Department of Health has a very large research budget, which should be used in this area. Sir Paul also observed that a great deal of money is being spent on genome sequencing, but that there has been very little work on how the environment affects the expression of the genome on the health of our people.

      In conclusion, I very much welcome the noble and learned Lord, Lord Neuberger of Abbotsbury, to your Lordships' House and look forward to his maiden speech; I am very honoured that he has chosen to use this debate for it. I also pay tribute to all the scientists and publishers who worked on the Lancet Countdown report, which has inspired this debate. I beg to move.

  • Dec 13, 2017:
  • Dec 12, 2017:
    • NHS: EEA Doctors - Question | Lords debates

      My Lords, according to the BMA, almost half of EEA doctors are considering leaving the UK and one in five has already made plans to do so. Given that it takes 13 years to train a consultant, what is the Minister doing to fill these gaps in the short term? Is he aware that there are numerous doctors from around the world already resident in the UK but whose qualifications fall short of what is required by the NHS? They would dearly love to be able to upgrade their qualifications and help us to fill the gap that is going to be left by the Tory Brexit, but there is no organisation that will advise and support them to improve their qualifications. What will the Minister do about that?

    • NHS: EEA Doctors - Question | Lords debates

      To ask Her Majesty's Government what assessment they have made of the number of doctors from European Economic Area states working in the United Kingdom who may be planning to leave the NHS after the United Kingdom's withdrawal from the European Union.

  • Nov 30, 2017:
    • NHS: Staff - Motion to Take Note | Lords debates

      My Lords, I thank the noble Lord, Lord Clark of Windermere, for bringing forward the debate today. It is high time that we debated the fiscal issues in relation to health.

      Although it is always nice to see the noble Lord, Lord O'Shaughnessy, answering a debate, I fear he is the wrong Minister for this one. Indeed, I think there should be a whole row of Ministers sitting on the Government Front Bench today, led by a Minister from the Treasury. Here is the reason. Noble Lords who know me will recall that my favourite word in health debates is "prevention". Without prevention of a great deal of the country's ill health, of which we are perfectly capable, the cost burden of preventable diseases will bring the NHS to its knees. Our hard-pressed health and care workers will never be able to work hard enough. My party's policy, for the moment, is to add one penny in the pound on income tax for health and social care, while continuing to take lower-paid people out of tax altogether by raising the personal allowance. However, while this would provide the NHS and social care with what they need for the moment, in the long term, this will not be enough if we carry on the way we are going.

      I am a great believer in evidence-based policy and also a great admirer of Professor Sir Michael Marmot and his rigorous work on health inequalities and the social determinants of health. That is why I said what I did about the Minister being the wrong person to answer this debate. If you want to lead a healthy life, all the evidence shows that you need to be conceived and born to a family that is comfortably off. The Marmot indicators show very clearly that poverty and deprivation are the clearest indicators pointing to poor health. So what are the factors that contribute to this-those things known as the social determinants of health? Of course, they are low income; poor housing; low educational attainment, leading to lack of well-paid work; poor air quality; poor access to the cultural activities that contribute to our well-being and mental health; and poor access to the healthy food, help and advice that help us make the right choices for our own health.

      So until we get a truly progressive tax system that taxes poor people less than rich people, until we stop subsidising the fossil fuels that pollute our air and warm our planet, until we train a highly skilled workforce and until we start building affordable well-insulated homes for poor people, we will never iron out the major health problems that keep our doctors and nurses far too busy. That is why we should have a Treasury Minister leading a team of Ministers from transport, housing, education, DWP, DCMS, DCLG, BEIS, Defra and all the other acronyms. Until we get a whole-government approach to the health of the nation, we will never solve the problems of health and social care. So as the noble Lord, Lord Clark, has rightly identified, fiscal policy is a powerful tool in this battle. I would like to hear the Minister say that the Prime Minister will show a bit of leadership on this and set up a powerful Cabinet sub-committee with teeth, which will be able to hold all the other departments to account on their contribution to the health of the nation. Until I hear about some mechanism of that sort, I fear that the Marmot indicators will never shift.

      In addition to that, we politicians need to put our heads together. I fear that the Government's failure to heed the calls of my right honourable friend Norman Lamb MP and others to put together a cross-party commission on a sustainable health and care service is very wrongheaded. Good-quality health and social care are things that people care about and vote about, and they depend very much on the welfare of staff. So I would have thought that any sensible Government would prefer to bring in all points of view to find the answers to a problem that has been growing for years, as the noble Lord, Lord Clark, just said. And no, the Government do not have all the answers. This House's Select Committee, led by the noble Lord, Lord Patel, had many of the answers, but they nearly all involved money, yet what did we get in the recent Budget for an NHS that needed more than £4 billion extra and a care system that needed £2.6 billion? We got £1.6 billion for the NHS and nothing at all for social care. But of course, we got £3 billion put aside for Brexit. How many doctors and nurses could we get for that?

      It is clear that the overwork, stress and effective pay cuts suffered by our doctors, nurses and other health professionals will continue. These are contributing to their low morale and the fact that many of them want to leave, cut their hours or retire early. The public service pay cap imposed by the Chancellor for many years has not been lifted, despite a comment to the contrary by Jeremy Hunt. The small easing of the pay restraint announced by the Chancellor last week is conditional on the money being saved elsewhere by the removal of year-on-year increments of other health workers. It is all about saving money, not patient safety, yet patient safety is a big issue when you have demoralised staff working longer than they should in a team with vacancies. The Royal College of Physicians told us that 69% of doctors work on a rota with vacancies and that 74% of them are worried about the ability of their service to deliver safe care. Half of those polled by the RCP believe that patient safety has deteriorated over the past 12 months. What are the Government doing to ensure patient care?

      What about nurses? The Royal College of Nursing has reminded us that, since 2011, nurses' pay has dropped in real terms because their tiny pay awards have nowhere near kept up with inflation. No wonder trusts are having difficulty recruiting and retaining enough nurses and we now have 40,000 vacancies. So trusts are having to turn to expensive agency nurses-and things will get worse if Brexit ever happens. Indeed, it is happening already as some nurses from other EU countries go home and the number of applications to come here has fallen by 96% in the last year. UK applicants, too, are being deterred from training by the withdrawal of the student nurse bursaries.

      Another fiscal measure that is demoralising nurses is the serial cuts to the budget for continuing professional development. This has gone from £205 million to £104 million, and now £83.49 million, over two years, so the opportunities for nurses to increase their income by undertaking specialist training are diminishing. Will the Government restore that funding for CPD and also look again at the bursaries for student nurses?

      We are very dependent on doctors from abroad, including from the EU countries. We are not training enough of our own doctors. Despite the increase in medical training places by up to 1,500 per year by 2020, this simply will not do while we have rising demand and some doctors going back to their home country. It takes 13 years to train a consultant, so what are we to do in the meantime? Further funding for specialist training for home-grown doctors will be required, as well as an assurance to those who come to us from abroad that they are welcome here.

      I have a particular concern about the cancer workforce. I have been involved in an inquiry by the All-Party Group on Cancer about where we are at this point, half way through the timeframe of the cancer strategy in England. Are we on track to deliver all the objectives or not? Although the report will not be published until next week, I think I can whet your Lordships appetites by revealing that all the evidence points to the fact that we are not. In particular, my colleagues and I were very concerned about the evidence of workforce shortages. We are still expecting the strategic review of the cancer workforce from Health Education England, which was promised a year ago. We were told it would come in December 2017, which starts tomorrow. I look forward to it. However, its delay has meant that the shortages which are apparent all across the NHS workforce are even more severe in cancer services because of the specialist staff needed to achieve the strategy. We heard that the lack of the staffing review, delays in releasing funding from NHS England and the last-minute changes in the criteria for transformation funding have meant that cancer alliances have not been able to plan properly and have certainly not been able to commit to funding staff posts until they are sure that they have the money available.

      The cancer workforce is just one sector where, because of the clear objectives in the cancer strategy, it has been possible to measure progress against aspiration. However, we heard from several sources that workforce is the greatest challenge to delivering the strategy. I believe that fiscal measures could improve the situation here and right across the NHS, if only the Government were willing to put them into place.

  • Nov 16, 2017:
    • Young Women: Self-Harm - Question | Lords debates

      My Lords, I thank the Minister for acknowledging the shocking 68% increase in the number of young girls being admitted to hospital for self-harm over the last decade. Does he agree that school counsellors can be a very valuable resource in helping to tackle this terrible epidemic of emotional distress among young people, because they are non-stigmatising and easily accessible? However, I visited an area yesterday where I was told that all the school counsellors have had to be sacked because the schools cannot afford to pay them. Will the Minister work with the Department for Education to ensure that by the end of this Parliament every secondary state school in this country has a school counsellor, so that we can tackle the welfare requirements of young people as well as their academic requirements?

    • Young Women: Self-Harm - Question | Lords debates

      My Lords, on behalf of my noble friend Lord Storey, and at his request, I beg leave to ask the Question standing in his name on the Order Paper.

  • Nov 2, 2017:
    • A Manifesto to Strengthen Families - Motion to Take Note | Lords debates

      My Lords, I start by welcoming the Minister to the House of Lords and congratulate him on his meteoric rise to the Government Front Bench. I also thank the noble Lord, Lord Farmer, for a very interesting debate and extremely important manifesto. There are so many policy areas that could be improved in order to redress the magnitude of family breakdown in this country that it is hard to know where to start. However, I plan to mention adoptive families, the benefits of family hubs, what can be done to keep offenders in touch with their families to reduce reoffending and the importance of teaching children about relationships in school.

      I start with adoptive families-not mentioned by anybody except the right reverend Prelate the Bishop of Oxford-since I have a particular interest in them. I was recently contacted by a couple who are both psychologists and are adoptive parents. I took very seriously the points they were making, which were about burnout of adoptive parents and the lack of support for them. They reminded me that adoptive parents take on some of the most needy and challenging children in our society-traumatised children whose mental and physical health has been damaged by their life experiences. The people who take on these children are heroes and their attempts to give them a stable and loving family in which to recover from their previous trauma should be applauded and supported. However, these adoptive parents often have to deal with violence directed at them or other siblings, self-harm, incontinence, inappropriate or dangerous sexual behaviour, anger, school refusal and many sorts of mental health problems. Adoptive parents cannot take sick leave, resign or ask for a transfer to another department. Unlike foster parents, they do not get much help. Indeed, if they adopt after fostering, whatever help they had before often just stops.

      Adoption UK thinks that as many as a quarter of all adoptive parents are in crisis and in need of professional help to keep the family together. But local authority post-adoption services vary tremendously; despite the fact that adopters save local authorities a massive amount of money, some are less than helpful when asked for help. Can the Minister say what is being done to ensure that an appropriate level of support for adoptive families is offered everywhere? If we do not do this, the NHS will be saddled with the cost of the mental health issues of the parents as well as their children.

      Mental health has been mentioned by several noble Lords-the noble Lords, Lord Farmer, Lord Shinkwin and Lord Alton, among others. This brings me to the subject of teaching relationship and sex education in schools and the ability of schools to identify and signpost mental health problems. The best way to deal with mental health is of course to prevent the problems arising in the first place-the noble Lord, Lord Bird, mentioned prevention. Many of the issues that children face arise from family break-up or from violence or poor relationships in the family. Many children do not have a good model of healthy and respectful relationships at home. It is therefore often the job of the school to pick up the pieces and help build up children's resilience. There is a major role for relationship and sex education in this, so I welcomed the Children and Social Work Act earlier this year, which should ensure that all children get it in an age-appropriate manner as part of their PSHE curriculum.

      I have become aware, however, that the regulations to mandate schools to prepare and publish their RSE policy have not yet been made. Can the Minister say why this is and when it will be done? I welcomed the Prime Minister's initiative on mental health first aid training in schools and wonder if the Minister can update us on how that is progressing. Such work can help children to ride out the worst effects of family unhappiness or even breakdown.

      We live in a very unequal country, and an interesting statistic in the briefings we have received caught my eye. It showed that poor families break up more frequently than more affluent ones. As the noble Lord, Lord Parekh, said, almost half of five year-olds in poorer families are in broken families, compared with 16% in wealthier ones. This did not surprise me. It is widely known that a high percentage of parents are worried about money, and that money is frequently the cause of family arguments, so what is being done to improve the finances of families with children? I am afraid that the marriage tax allowance, which the noble Lord, Lord Morrow, mentioned, brings in less than £5 a week, even if the family applies for it, so that is not going to make much difference. By the way, I am not suggesting that it be improved, as I do not approve of it in the first place. I do not think it is the role of the state to support particular kinds of families.

      Benefit cuts and the six-week wait for universal credit have sent far too many families into debt, and to food banks. If the Government are really concerned to keep families together, which, of course, is a laudable aim, they need to do everything possible to ensure that parents can feed their children and pay the bills. We hear about the record number of people in work, but the fact is that many jobs are very low paid and a high percentage of poor people are in work and eligible for benefits, which makes a nonsense of the Government's constant claim that the best way out of poverty is through work. I would say it depends what sort of work, and how well it is paid. Can the Minister say what plans the Government have to make what they choose to call the living wage into something people can actually live on?

      Many families need a range of services to help them survive, stay together and bring up their children successfully, and it is desirable that these services be easily accessible and linked together. That is why I, like the noble Lord, Lord Farmer, and others, support the idea of family hubs, which can be based on children's centres or Sure Start centres. I hope they will not become what the noble Lord, Lord Mawson, called the shiny new thing that disappears before long, as they would offer a wide range of services for parents as well as children. This is not a new idea. Several years ago, I visited the Coram Centre, where all kinds of services such as debt advice, immigration advice, English lessons and help to find a job and a home were offered to the parents of children in the nursery. It was a great example of what can be done in response to the particular needs of the families in the locality. Therefore, can the Minister say whether the Government support family hubs and whether extra funding will be made available, given the savings to many other services that they could provide in the future?

      I will say a few words about prisoners and their families. There is an important role for families to keep in touch with offenders while they are in prison in the interests of their relationships with their spouses and children, and of reducing reoffending. However, in many cases, the prison system does not make it easy for families to visit. There is some very good practice, such as Skype conversations, but in some cases it is hard to see the logic of where offenders are placed. For example, there is a large, brand new prison in Wrexham, near where I live in north Wales. I recently learned that only 10% of the inmates come from Wales and that many come from a very long way away in England. In addition, the prison is located on an industrial estate miles from the nearest railway station. It cannot be easy for families without their own car to visit in those circumstances, so what is being done to ensure that families who want to keep up their relationship with the offender are helped to do so?

      Finally, from experience, I issue a warning about impact assessments. During the coalition Government, my then honourable friend Sarah Teather said that policies would have a child rights impact assessment. I am not aware that that is being done. Therefore, if we are to have a family impact assessment, I hope that it really happens.