Queen’s Speech

Baroness Donaghy Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I want to touch on the health service staff and on universal credit. I am very grateful to the noble Baroness, Lady Finlay of Llandaff, for raising the issue of hospital doctors on the third day of debate on the gracious Speech. She warned that more legislation would not lead to better care. There might well be some improvements for the health service in the long-term plan, but it does not take away the responsibility of the Government for their top-down reorganisation, their failure to fund the service adequately and their past treatment of staff.

In 2016 there was another important event—the referendum was not the only one. It was the hospital doctors’ dispute. The Government’s treatment of the hospital doctors was shameful. They were called greedy, while what they wanted was to be able to get home occasionally and spend more time with their families. Family breakdown and suicide rates are shockingly high among doctors, and professional support is patchy at best. Staff shortages through illness and failure to recruit put extra strain on all involved. Should we really be treated by doctors who are beyond exhaustion? The failure by the Government to deal with these issues will affect our health and that of the vulnerable in the future.

Let us not forget that the shortage of GPs was exacerbated by the Government’s action on their pensions. It became fashionable to attack public service pensions, and the outcome was that GPs decided to go in their thousands. Professor Ted Baker, the CQC’s Chief Inspector of Hospitals, has linked the issue of poor community care with the 50% of A&E departments that are failing. Patients are increasingly frustrated at not being able to have an appointment, and this will eventually be reflected in people’s attitudes to GPs and the health service. The Government use the right words, but their actions need to speak louder.

I turn now to universal credit. The Prime Minister has indicated his support for the continued rollout of universal credit. This is worrying in the light of so many structural problems. The DWP has hired 1,000 extra staff to develop a specialist intelligent automation garage. A unit based in Newcastle and Manchester is developing machine learning to check claims for fraud through 100 welfare robots. The details are secret, as the DWP has refused freedom of information requests to explain how it gathers data on citizens.

There are clearly huge benefits to be claimed from automated intelligence-gathering, but if the human element of the welfare state is being diluted, and the vulnerable end up in what has been described as a “digital poorhouse”, what are the human rights implications? As Ed Pilkington said in his excellent article:

“What happens if you are one of the five million adults in the UK without regular access to the internet and with little or no computer literacy? What if the algorithm merely bakes in existing distortions of race and class?”


There is evidence of a rising error rate. Some 5,700 people a month are affected by claims of incorrect data sharing between HMRC and the DWP. I ask the noble Baroness for assurances—if not tonight then after the debate—on human rights, transparency, the objectivity of algorithms being used and on how vulnerable claimants will get to speak to a human being.

Turning to the “controversial Managed Migration pilot”—not my words but those of the Secondary Legislation Scrutiny Committee in its seven-page commentary on 5 September—there has been strong criticism of laying the replacement regulations,

“on the cusp of the summer recess”,

and three months after the High Court judgment, using the negative procedure when it was clearly a matter for the affirmative procedure. Members of the House described it as “disrespectful to Parliament”. The Secondary Legislation Scrutiny Committee described it as a “tactical ploy”. I describe it as sharp practice. It has been stated that the DWP will publish an “evaluation strategy” by the end of 2019 and publish the evaluation of the pilot before returning to Parliament with further legislation to continue migration activity. Can the Minister say when the evaluation will be available to Parliament and when there will be a debate in this House on the managed migration pilot?

Finally, I will say a brief work on universal credit and the self-employed. I have said many times that UC is not fit for purpose for the self-employed because of its clunky methodology known as the “minimum income threshold”. It is estimated that about 700,000 families with at least one self-employed earner will claim support from universal credit. A study by Policy in Practice has revealed that this figure is likely to be a significant underestimate, which makes it all the more important for the Government to look at it again, and in particular at the vulnerable self-employed. If nothing is done, they too will end up in the digital poorhouse.

Academic Health Science Centres

Baroness Donaghy Excerpts

Tuesday 2nd July 2019 Grand Committee

[Baroness Donaghy (Lab)]

My Lords, I am grateful to the noble Lord, Lord Butler of Brockwell, for initiating this important debate. As he did, I took part in the debate nearly nine years ago introduced by the noble Baroness, Lady Finlay of Llandaff. I was a non-executive director at King’s at that time and an independent panel member of the National Institute for Health Research. I was going to say a bit about King’s but I think the noble Lord has covered that, and I will spare the rest of the company. However, I chaired consultant appointment panels for a number of years, and it was clear from the calibre of applicants, all with research and international experience, that the AHSCs were expected to provide an atmosphere in which they could work and flourish.

My first question to the Minister is: given the internationalism of the best clinicians, how will the Government ensure the flow of talent needed and maintain that standard? In her speech to the Association of British HealthTech Industries last month, she said that,

“we must be relentless in our drive to ensure that the UK maintains its place at the cutting edge of health innovation”.

Only yesterday, in repeating the Statement on the NHS long-term plan, the Minister referred to,

“more investment in research and innovation”.—[Official Report, 1/7/19; col. 1270.]

Does she consider £39 million sufficient to maintain AHSCs as centres of excellence? The Government have enjoyed a lot of good will from these institutions and structures. I wonder whether it has now worn a little thin.

The noble Baroness, Lady Finlay of Llandaff, is sorry not to have been able to take part in this debate; she is on her way to Bangor—I am sure that there is a song about that somewhere. She indicated that what she regards as the jewel in the crown could be in jeopardy. Grants are so hard to come by that we are not growing our next generation of researchers. What action is being taken?

I want us to be able to compete on the world stage to attract the best consultants, researchers and innovators and, of course, to keep pharmaceutical companies here in the UK, but this is ultimately all about people. Perhaps I may give two examples from King’s. The CAR-T, or chimeric antigen receptor T-cell, to which the noble Lord, Lord Butler, has referred, is treating adult patients with lymphoma. Mike Simpson, a 62 year- old solicitor from Durham, was one of the first to receive the treatment. He said:

“I’m incredibly grateful for being given the opportunity to have this therapy … I describe it as my L’Oréal treatment… because I’m worth it”.


King’s College researchers, along with Cambridge University, have identified why arteries harden and how a medication used to treat acne could be an effective treatment for the condition. Trials are due to start shortly. I am sure that such exciting and positive developments sometimes help us forget the shortage of, and growing need for, skills in the health service, but we should feel proud of them and ensure that they continue. I hope that the Minister can answer my questions.

Social Workers: Recruitment and Retention

Baroness Donaghy Excerpts

Thursday 16th May 2019 Lords Chamber

Asked by

[Baroness Donaghy]

To ask Her Majesty’s Government what is their strategy for increasing the number of social workers and improving their retention rate.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government remain committed to supporting local authorities and other social work employers to meet their duties regarding social work workforce planning and helping them to understand best practice in recruiting, retaining and developing staff. We have invested over £1.2 billion since 2010 in supporting both mainstream and fast-track qualifying routes into the profession, and our improvements to the supervision and leadership that social workers receive support people to remain and progress in social work.

[Baroness Donaghy (Lab)]

I thank the Minister for that Answer but I do not think that they can fulfil their requirements or their responsibilities. Particularly for directly employed local authority social workers, workloads must be at red on the risk register and must have been like that for some years. Stress levels, staff shortages and the inability of some areas to recruit—there is a 26% vacancy rate in London—indicate that this must have a much higher priority than this Government are prepared to give. Will she give some more practical answers on how to stop the increasing numbers of social workers leaving the profession, how to recruit more—there has been a 6% drop—and how to get some support for a very pressed service?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for what is a very important Question. She is absolutely right that we have to ensure that we recruit and retain the social work workforce: it is vital and, like any employers, local authorities are responsible for ensuring that they have the right staff with the right skills. The Government also recognise that we have a role in supporting them. That is why we provide financial support to students who qualify as social workers. We make sure that those entering social work receive the best training possible, with some new programmes to support those who are newly qualified, such as the assessed supported year in employment, so that those who come in with quite a significant workload can be supported in their first year. We understand that high caseloads can be a challenge. Local authorities are responsible for the recruitment and deployment of social workers, but we work with them to think about how they can best manage the delivery of services and make caseloads manageable so that we retain those social workers who are vital to delivering care and support for some of the most vulnerable in our society.

The NHS

Baroness Donaghy Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Donaghy (Lab)]

I thank my noble friend Lord Darzi for initiating this debate and I thank Nye Bevan for his towering achievement in setting up the NHS against concerted opposition—a miracle for those who had no money.

We still expect the NHS to cure all our social ills while tackling permanent supply and demand challenges. Government-imposed changes in legislation, reorganisation and financial stop/start policies make it difficult to plan for the long term and apply consistent recruitment and training policies.

If there is a chronic shortage of doctors, we import them. The Royal College of Physicians says that we are currently training only half the number of doctors required by 2030 and the cap on medical school places means that we reject half of all eligible applicants— 770 of them with at least three straight grade A’s at A-level. While I am not trying to correlate the possession of three A-levels with suitability, we should be training more in the UK. Instead, 700 rejected medical student applicants a year are studying to be doctors in the eight English-language medical institutions set up in former eastern bloc countries. This is crazy, and it is the responsibility of the Government. The recent announcement of more places is too little, too late.

The NHS cannot solve all our social ills. We do not have a proper social care system, and that has an immediate impact on hospital beds. Our GP system has been weakened to the extent that many patients do not have a hope of seeing their local doctor when they need to. There were 1 million hospital visits last year because of drug or alcohol usage. The human cost of obesity is appalling, but so is the cost to the health service, which has to pay for larger stretchers, beds and mortuary places.

It is vital that we improve transparency and accountability in our NHS. The Government abolished the independent review panels in 2004 and the recently established Healthcare Safety Investigation Branch plans to cover only 30 cases a year. Will the Minister say how the Government intend to invest in independent reviews, deal with complaints and protect whistleblowers?

The advances in medicine in the past 70 years are almost beyond belief. Some of the potential breakthroughs are exciting. One drug is being made from the strain of cannabis grown legally under Home Office licence. It has a high concentration of anti-convulsant and very low content of THC, the psychoactive compound. If approved, it could help up to 5,000 people with epilepsy. Research has shown that metformin, an anti-diabetes pill, also cuts the number of heart attacks, strokes and heart failures. Researchers call that repurposing.

Finally, I thank the BBC and ITV for their coverage of the 70th birthday of the NHS and for all the programmes that have been enjoyable, historical and absorbing. They have been inspiring and have made me realise that any future attacks on the health service will be met by an army of fierce defenders, all of whom have a story to tell.

National Health Service: Assaults on Staff

Baroness Donaghy Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Baroness that it is scandalous and that we therefore want to support the Bill. I believe that it will have its Second Reading here on 29 June. I can confirm that the Government will be supporting the Bill.

[Baroness Donaghy (Lab)]

I am grateful for that reply from the Minister. I have the privilege of taking the Bill through its Second Reading next week. It will create, for the first time, an aggravated offence for those who attack all emergency workers, including paramedics, nurses, doctors and all those associated with helping NHS staff in emergency work, such as St John Ambulance and other volunteers, if they are doing emergency work. So I am thankful that the Government have provided time, and I hope that we will be able to get the Bill through quickly by the summer.

[Lord O'Shaughnessy]

I salute the noble Baroness for taking it through its stages in the House of Lords. I reiterate our support for it—not just the principles behind it but the specific measures in it. Clearly it is unacceptable to assault the very people who devote their lives to serving.

Breast Cancer Screening

Baroness Donaghy Excerpts

Thursday 3rd May 2018 Lords Chamber

[Lord O’Shaughnessy]

As always, the noble Baroness makes a very incisive point. The inquiry must look at whether there were signals and whether they were missed. That may be at the macro level or the micro level, with individual women saying to their GP, “Hang on, this is odd, I haven’t got this”. The problem has arisen because of the interaction between the screening process, which is due to run until a woman’s 71st birthday, and the extension, which was meant to run from a woman’s 71st birthday to the end of her 73rd year but was taking women into this clinical trial prematurely and randomising them. Hence, women in their 70th year did not get anything. It was the interaction of the two. It is technically quite devilish. A 70 year-old woman might or might not have known that she was due to have another one. This is one of things we have to get to the bottom of because, as the noble Baroness said, although this is about technology and computers, ultimately humans are at the centre of this problem.

The inquiry is primarily focused on the incident itself, but I imagine that if, during the course of its work, it finds out or establishes that other issues need to be pursued, such as increasing screening rates variation and so on, it will have the freedom to make those recommendations.

[Baroness Donaghy (Lab)]

My Lords, this is very close to home for me—I am probably not the only one in the Chamber. It was probably the breast screening programme that saved my life. I had no symptoms and if it had not been for regular mammograms, I would not have known. I am grateful to the health service, just as the noble Baroness, Lady Maddock, is.

The worry I have is that although I had a regular mammogram directly resulting from treatment every year for eight years, I was then told last summer at the age of 73 that the following year I would not be able to have a mammogram unless I went private. This seems to rely too much on people taking individual responsibility for their own health, which I support, but does not provide sufficient back-up for those who are perhaps fearful of having a mammogram. It is extremely painful for some women. The fear of it is still there. That explains why some of the take-up is quite poor. We have a duty of care for those in that position. Those of us who are vocal will do our best to look after ourselves.

My final point is that the cut-off is arbitrary and has a sniff of age discrimination about it. I agree with the noble Baroness, Lady Masham: there is sometimes an element in hospitals whereby perhaps you are not worth it any more. I feel obliged to say that I am still very active and working, just to make sure people think I am worth saving. That should not be the case and it ought to be reviewed. There is age discrimination. It might be just a clinical thing, but I cannot help thinking that there is some self-limitation when some of these clinical groups get together and decide what is appropriate for a woman, without consulting them as individuals.

[Lord O'Shaughnessy]

I know that the whole House will join me in saying that the noble Baroness is definitely worth it. Indeed, I am pleased to hear that her care was successful and that she is with us today. It is a very interesting question about age discrimination. We have again to separate it from the clinical advice, which I am reassured, having spent time with those involved in putting it together, is based on a proper weighing of costs and benefits—of course, that is inevitably in aggregate because we are talking about whole populations. Clinicians have autonomy to do things differently. Indeed, the offer we have given to women aged over 72 is that they can refer themselves and they will have an appointment if they want one. I can provide that reassurance to the noble Baroness.

There is perhaps a separate issue. There are sometimes problems of age discrimination in society and in the national health system itself. Could that be an issue regarding why signs were missed? We know that in some instances, the National Health Service has not been very good at listening to women on some of the issues we have debated in this House and that my noble friend Baroness Cumberlege is looking at in her review. This is a very good point that needs to be investigated properly: are there cultural reasons why signs that might otherwise have been picked up during these nine years were not? I can reassure her that the inquiry will look at this.

Social Care

Baroness Donaghy Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Yes, I will certainly do so.

[Baroness Donaghy (Lab)]

My Lords, in the absence of my noble friend Lady Pitkeathley and the noble Lord, Lord Warner, I feel a sense of responsibility for seeking an assurance that all the evidence and issues that have been submitted to the various reports, not least Dilnot and the carers reports, will be put together as part of the consideration and that we will not reinvent the wheel. This is a well-trodden path; some of us are quite disappointed that we have got only to Green Paper stage. As my noble friend Lady Pitkeathley said only on Monday, we know what the problem is and what the answers are, so why cannot we just get on with it? Can we have an assurance that all that work will not be wasted?

NHS: Staff

Baroness Donaghy Excerpts

Thursday 30th November 2017 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, what a great privilege it is to follow the noble Baroness, Lady Emerton, and what a champion she has been for nurses, midwives and the health service. I think that the House will have another opportunity to pay tribute to her work but I am so pleased that she was able to participate in this debate.

I also thank my noble friend Lord Clark of Windermere for initiating this important debate. It is important because it is about the future welfare of about 1.3 million people in the NHS—let alone the people in their care—and they are all on the Agenda for Change pay system. But this is part of a wider context, which is important to remind ourselves of. The health service needs a higher ratio of spending as a percentage of GDP if we are to match the standards of other advanced nations, notwithstanding the extra resources required to care for our ageing population. The total UK health spending—including public and private expenditure—was 9.8% of national income in 2015 according to the Institute for Fiscal Studies. Although that was in line with the EU-15 average, it was below the levels of the United States at 16.9%, Japan at 11.2%, Germany at 11.1%, and France at 11%. Health spending has increased since 2009-10 but at an historically slow rate—1.4% a year. Also, it should be remembered that cuts in other departments, particularly local government, were disproportionately severe and have acted as a major obstacle to progress on social care. We must bear in mind that the average increase over the previous 60 years was 4.1% per year.

The second, larger bit of the context is that all the government reassurances about supporting the values of the NHS should be taken together with the appalling Health and Social Care Act. This was a top-down piece of legislation which created even more bureaucracy in the health service. It has not dealt with social care at all and many of today’s problems can be laid at its door.

In the 1960s I spent a couple of summers working as a ward orderly at Warwick Hospital, so I have been a health service worker—admittedly in a very different era and on a pretty low wage. I would march up and down the ward in a full-length cow gown—I am sure the noble Baroness, Lady Emerton, will remember the cow gowns—pulling a trolley full of urine bottles. I thought I was the bee’s knees.

For many years I was also a non-executive director at King’s College Hospital foundation trust. I chaired a considerable number of consultant appointment panels and was impressed by the calibre of the applicants, and the amount of training, study and moving around the country at frequent intervals that our system seems to require. I was also impressed by their internationalism. From whatever country they came, they had worked and conducted research in a different country from their birthplace. We are extremely fortunate to have people who are pathfinding in different forms of medicine and different methods of healthcare. The shortages in emergency medicine, psychiatry and general practice are extremely worrying and mean that some of our population may receive suboptimal care. What practical steps are the Government taking to address these shortages and maintain the internationalism of our consultants?

I will mention nursing briefly, not because nurses are not vital and recruitment and retention are not reaching crisis point, but because many other speakers, not least the noble Baroness, Lady Emerton, have far more expertise than I do. My former union, UNISON, is asking the Government to legislate for safe staffing levels so that acceptable nurse-to-patient ratios improve recruitment and encourage nurses to stay in the profession. UNISON’s annual survey in April this year showed that wards are now so understaffed that nurses cannot ensure safe, dignified and compassionate care. Half of respondents had to work through their breaks to make up for the lack of colleagues and 41% worked more than their contracted hours. This is leading to exhaustion and burnout.

UNISON has no confidence that the Government can deliver on their commitment to triple the number of nursing associates and increase the number of training places for student nurses. The demise of the bursary means the Government no longer commission training places directly, depending instead on universities creating extra places and recruiting students. One pro-vice-chancellor I spoke to two days ago said that his university was negotiating to establish a course of nurse training. It was so complex and demanding that the university doubted it would be financially viable or that it would actually run. Abolishing the nursing bursaries is in the same category as charging for employment tribunals and the notorious employee share ownership scheme—they should be put in the “daft” box.

I turn to the majority of health service staff—the unsung heroes and heroines, many in comparatively low-paid jobs who the pay cap has been particularly tough on: cleaners, porters, catering staff, admin staff, medical secretaries and primary care staff. This also includes professions allied to medicine: midwives, health visitors, healthcare assistants, paramedics, ambulance staff, occupational therapists, speech therapists and operating department practitioners. I make no apology for repeating my noble friend Lord Clark’s list of important staff. Since I mention speech therapists, I recall a debate many years ago initiated by my noble friend Lady Turner of Camden, who has a long-term illness. She was a champion of speech therapists. It was a very moving debate. The supporting speech by the noble Earl, Lord Attlee, was particularly powerful. We need more champions of health service staff, even with half the dedication of my noble friend Lady Turner and the noble Baroness, Lady Emerton. Such champions could make a difference.

I am sure that I have left some categories out and I apologise if I have. They have all paid the price of the Government’s austerity measures, in terms of living standards for their families and coping with increasing pressures in their workplace. While on the face of it the Chancellor’s announcement that the Government will give conditional support to pay review bodies this year is welcome, we do not know how many pay review bodies he is referring to. Can the Minister enlighten us as to who will be covered? Can he explain what the Chancellor meant when he spoke about,

“pay structure modernisation for ‘Agenda for Change’ staff, to improve recruitment and retention”?—[Official Report, Commons, 22/11/17; col. 1054.]

I have a lot of experience of pay structure modernisation. It usually means leaving people stuck on their grade ceiling, plussages which are divisive and discriminatory, and moving on to new pay structures on condition that staff accept unwelcome changes to their terms and conditions.

The Chancellor has said that any deal will be linked to improved productivity. Can the Minister explain what is meant by “improved productivity” in the health service? Would it involve a porter pushing two patients along in wheelchairs, catering staff serving half a dinner, or nurses scooting up and down wards? It would conjure an image of “Carry on Nurse” if it were not so serious. How on earth can people be expected to work any harder?

One of the complaints of staff, particularly nursing staff, is that there is insufficient flexibility in working patterns. I am not surprised that the bill for agency staff has nearly doubled between 2011 and 2016, reaching £3.6 billion in England and £250 million in the other nations. If I were a trained nurse with young children, I would probably opt for the flexibility of agency working, rather than the increasingly heavy burdens of full-time staff responsibilities. The House of Lords Long-term Sustainability of the NHS Committee looked at the link between pay and morale. Those at the lower end of the pay scale were particularly badly affected. The committee made this recommendation about pay policy:

“We recommend that the Government commissions a formal independent review … with a particular regard to its impact on the morale and retention of health and care staff”.


The Government have not yet responded to this recommendation. Will the Minister say what the Government’s response is to the committee’s recommendation?

Finally, paying lip service to the NHS and issuing overblown statements about how the Government support it, while at the same time squeezing it by the neck, is unacceptable. Actions speak louder than honeyed words.

Queen’s Speech

Baroness Donaghy Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I want to speak up for public servants. I question whether we have the capacity in public services to sustain the enormous workload that is ahead of them and to carry out the heavy responsibility that is expected of them. The gracious Speech makes it clear that public servants are also-rans in the battle to balance the books. They have already had seven years of job cuts and pay cuts and it is clear that it will be more of the same in the next five years unless the Government change course. We need a sustained programme of public infrastructure investment and essential capacity-building for public servants and not just to throw money at emergencies.

It is interesting that a key point in our general election match, which resulted in a painful no-score draw, was the adverse publicity faced by the throwaway Prime Minister over the 20,000 police cuts and 5,000 armed police cuts at a time when the public wanted reassurance. It is interesting because, when Theresa May was Home Secretary, she took pride in taking on the Police Federation and cutting it down to size. These actions have consequences. If I were in the police force right now, I would be less concerned with being called a hero and more concerned that there would be someone to replace me at the end of my shift, that I could stick to the family leave I had planned, with no worry that it would be cancelled, and that I would be properly equipped in uniform and career development.

The background briefing to the gracious Speech states that the Government,

“values the important work that public sector workers do in delivering essential public services”.

However, there is not a single policy proposal as to how the Government intend to support that important work.

One of my areas of interest is health and safety. I worked closely with the Health and Safety Executive when I produced my report on construction fatalities. I have watched with astonishment as the HSE budget has been cut and cut again, with a 25% reduction in the number of HSE inspectors. By the end of this Parliament, the total HSE budget will have been halved. The cuts are still coming. At the same time, the Conservative Government have attacked health and safety legislation, nibbling away at the edges in a series of Bills. It is shameful.

I turn to the Civil Service. Although numbers have increased since December 2016, mainly as a result of leaving the EU, there has been an overall reduction of 20% since 2009. The Department of Health has lost 49% of its workforce since 2010 and the DCLG has lost 42%. Another five departments have lost over a quarter of their staff. Of course, the Cabinet Office, which supports the Executive rather than the country, has increased by 23%.

The workload around leaving the EU and making a minority Government work cries out for increased resources. The brightest and best will be seconded to the exit department, even if some remain within their departments. The numbers are woefully thin. Perhaps the Minister can tell us what will happen to the day-to-day work of government. The DWP has to run universal credit, which requires a heavy and ongoing administrative burden and has not yet been completely rolled out because of its complexities.

Most worrying to me is the capacity of HMRC. The Public Accounts Committee talks of a “catastrophic collapse” in customer service if more operations move online. The PAC was not convinced that HMRC had a credible plan to prevent a “disastrous decline” in service. It also questioned whether HMRC might be,

“painting too rosy a picture”,

of its success in reducing the gap between the amount of tax due and the total collected.

Time does not allow me to mention other services. I am grateful to my noble friend Lord Kennedy, the right reverend Prelate the Bishop of Southwark and the noble Baroness, Lady Pinnock, for their comments in Tuesday’s debate, and my noble friends Lady Sherlock and Lord Whitty for their comments in today’s debate. They encapsulated what I would have liked to say about those services.

In the past seven years, the Government have attacked the jobs, pay and pensions of public servants and have tried to separate them from their trade unions. The country will not run itself. I do not believe that this Government are capable of delivering strong public services. I am concerned about the inevitable collapse in some of our services that will happen in the next five years, and about the cost to the country of such neglect.