Ministerial and other Maternity Allowances Bill

Baroness Brinton Excerpts

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Thursday 25th February 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, this afternoon, we have heard once again from many noble Lords who are concerned about erasing women through the use of gender-neutral language. However, as liberals, we remain of the view that wording that excludes or removes the rights of any one group in favour of another is a problem.

The noble Lord, Lord Hunt, talked about the rights of one group conflicting with another, but the compromise that his Government and successive Governments have reached shows that gender-neutral language does not do this. That is why it was used: to avoid excluding certain groups. The noble Lord, Lord Triesman, made some important points about our own use of language in this House, and I am grateful for his final comments, in which he expressed concerns for trans people and the poor census officials.

I am deeply sorry for anyone receiving abuse on social media. We on this side of the argument, including myself, have been on the receiving end of some over the last few days, but nothing like as much or as horrible as that which I know that my noble friend Lady Barker and others receive on a regular basis. I agree with the noble Baroness, Lady Hayman; there is an important issue there about our society and its use of social media. The Prime Minister spoke about finding some protection for MPs, especially women and BAME MPs, from this hate-filled abuse. I hope that he will extend that more widely when the online harms Bill starts its legislative journey.

The reality of this change in language in this Bill is that some people, perhaps very few in number, will be affected. I was very moved by the speech of my noble friend Lady Barker; she is right that the law is there to protect all members of our society. Over the years, equal rights have been granted to the nine protected characteristics because they need protecting, not least against those parts of society that not only do not understand them but may even want to do them harm. I note that our trans community is at extremely high risk of being victims of domestic abuse and violence.

As a woman who campaigned for women’s rights over many years and joined the “Reclaim the Night” marches in my student days, I could certainly not support language that I felt totally excluded women, but I just do not believe this to be the case. For all the reasons that my noble friend Lady Barker has outlined, we now risk impacting the rights of trans men and non-binary and intersex people through the revised language.

I am, and will always be, happy—even proud—to be referred to as a mother. However, if I were Freddy McConnell’s mother, I would want to respect his wishes and refer to him as a father to my grandchild because, legally, he is recognised as a man. It is factually incorrect, as the noble Baroness, Lady Meyer, has asserted today, to suggest that only women can become pregnant. It has been legally recognised that men and non-binary and intersex people can also get pregnant, so it is vital that the Bill is fit for this purpose and can function in a real-world context. The only way to achieve this would have been for the Bill to retain its original drafting and to refer to “person”.

On Monday, the noble Lord, Lord Pannick, referred to Mr McConnell’s case, where a trans man who had gained legal recognition as a man became pregnant and then gave birth to a child. Mr McConnell specifically objected to being recorded as the mother on the child’s birth certificate. It is worth looking at this case to understand the potential consequences of changing the wording from gender-neutral language, given that many noble Lords have referred to the contribution of the noble Lord, Lord Pannick.

The case was heard first by the High Court, then the Court of Appeal. It is worthy of note that both courts found that the rights of the child are paramount—so they should be—and that Mr McConnell was legally male, and socially and psychologically the father of the child. The case revolved on how the parent who gives birth to the child should be registered. Society and science continue to develop, so terminology used when laws were drafted and enacted may be superseded by scientific or social progress.

Their court ruling applied to the case before them, but Parliament could legitimately take an informed view and change the policy on registering births. The language that the Government currently use for registering births requires Mr McConnell to be identified as the mother of the child for that purpose. The mechanism was for a legitimate aim and the process was a proportionate means of accomplishing it.

The Bill before this House relates to benefits accruing to those who give birth, not to registering births, and extending those benefits to government Ministers and some opposition spokespeople who currently do not have them. Let me say that again: it does not deal with the registration of births. The process for the registration of births is not proposed to change under the Bill; I am concerned that the noble Lord, Lord Pannick, drew the conclusion that an issue relating to the law on birth registration certificates can have a direct read-across beyond that narrow matter.

The judges in the original case and the appeal recognised that this was complex and, importantly for this House and another place, that Parliament had not dealt well with all the issues it should have done in the past. Us trying to do so in what amounts to two working days in your Lordships’ Chamber in one week—and at very short notice—means that there are risks and problems.

The law should deal practically with how our society currently works. We know that people who are legally male can give birth, due to advances in medical science as well as the law. While some may find this baffling or even immoral, the reality is that it is legal and it happens. The scope of the Bill does not extend to either legal gender recognition or restrictions on fertilisation and embryology.

Changing the language on birth certificates would resolve a number of these issues, which is where discussions were beginning to go when things were calm and the language warriors had not got started. That was actually prompted by the changes to marriage certificates during the enactment of the Marriage (Same Sex Couples) Act 2013, but this would require changes to statute law and is clearly not feasible now.

However, as the courts made clear in this case, this remains a political issue. If Parliament wants to persist in using gender-neutral language because trans men, non-binary and intersex people can give birth while living as men, there is absolutely no reason why Parliament should not ensure that the legislation does so. Doing so does not erase women giving birth and being called mothers.

I want to end by asking those who have proposed and succeeded with their amendments today whether, in their congratulations to one another on their success, they will undertake to help to protect the rights of our LGBT community, many of whom have felt a very chill wind in our United Kingdom today. As my noble friend Lord Wallace of Saltaire commented, given the threat that LGBT people face in Poland, Hungary and some of the Baltic states at the moment, we need to protect their human rights. I particularly thank the noble Baroness, Lady Goudie, for her comments in support of the trans community.

From these Benches, we are proud to stand up for the LGBT community, but we are also proud to support the Bill because it starts to give Ministers and opposition spokespeople some, though not all, of the maternity and parental rights that they deserve.

Ministerial and other Maternity Allowances Bill

Baroness Brinton Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Monday 22nd February 2021 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I too support this Bill, even though it does not go far enough in giving Ministers who are parents the same rights that other workers have now come to expect. As others have already said, these include adoption leave, sick leave and shared parental leave. The last is particularly important and affects any Minister who becomes a parent and who is still missing out on the rights to share in the care of their new baby with their partner. I hope the Minister will remedy this urgently.

There is one other parental benefit that has not yet been mentioned—statutory parental bereavement pay and leave. I worked with the noble Lord, Lord Knight of Weymouth, for a number of years to win this right for parents, but it is omitted from this legislation for Ministers. I urge the Minister to ensure that it is added to the other forms of parental allowance and leave for future discussion. One hopes that it is never needed but it is vital to have it in place to cover such awful circumstances.

My former colleagues, Jo Swinson and Jenny Willott, both had their first babies while they were Ministers. No arrangements were made for them. They had to cover for each other without maternity pay at exactly the time when they were working in government for better rights for women and parents in the workplace.

I agree with my noble friend Lady Hussein-Ece about the lack of equality impact assessments. We need to remedy this and to reflect on why, as a society, we have moved over the years to gender-neutral language. The gender-neutral language in this Bill is inclusive. Changing it, as many speakers have asked, would make it exclusive—perhaps not to many, but to some people for whom it matters a great deal. No one is trying to erase women but rather to accept that, over recent years, there have been advances in medicine. I am grateful to the noble Baroness, Lady Jones of Moulsecoomb, for referring to trans men in Brighton. We also have to remember that non-binary and intersex people who were born women would be excluded. Both equality law and clinical care have kept pace with them and their circumstances. Medical care, in particular, has adapted in order to provide the best possible care for them in rare and difficult circumstances. That is why I would gently correct the noble Baroness, Lady Noakes, in her reporting of the Brighton hospital trust introducing “chestfeeding” and “pregnant people” and removing “breastfeeding” and “women” from its documentation. It is not. Snopes, that excellent debunker of myths, explains this carefully:

“A maternity department at a U.K. hospital announced in February 2021 that it was expanding terms it used in maternity care to include, for example, ‘chestfeeding’ and ‘pregnant people’, in order to be more inclusive of trans and nonbinary patients … To be clear, the NHS said that such language—like referencing ‘pregnant women’ and ‘breastfeed’—will not change for those who identify as such … Adding terms like ‘chestfeeding’ and ‘birthing parent’ was not intended to take away from women-oriented language already in use. Rather, the move was meant to be additional support that offers more inclusion for trans and nonbinary individuals.”


I was also moved by the remarks of the noble Baroness, Lady Grey-Thompson. Like her, I am disabled and have been on the receiving end of some pretty despicable hate crimes and trolling. Just like her, I am concerned that the trolls will descend on me this evening, but they will be those from the other side of her argument. However, that is nothing as to the daily abuse that trans and non-binary people suffer.

Over the years, your Lordships’ House has learned how to disagree well. In this sensitive debate, I hope that people who are not here with us in the Chamber will choose to watch and listen to those on both sides of the argument. I have heard from trans men that, even though there are currently no trans Members in either the House of Lords or the House of Commons, they think it is important that language used in legislation remains inclusive. Using the word “woman” excludes trans men and therefore removes their rights.

Finally, we must focus on the specific nature and the urgency of this Bill. I hope that the Minister can reassure the House not only that the Bill will proceed but that all Ministers who are new parents will benefit from the same parental rights as workers across the country.

Covid-19: Scientific Advice

Baroness Brinton Excerpts

Wednesday 17th June 2020 Lords Chamber

[Lord True [V]]

I strongly agree with my noble friend, who has great experience as a Minister and a distinguished career. Of course, responsibility ultimately lies with Ministers for taking decisions. Ministers wrestle with those difficult decisions every day. On balance, I believe that Ministers have done their very best to serve the people of this country in this unprecedented crisis. The time for reviews is when the curtain comes down, not when we are still fighting the drama.

[Baroness Brinton (LD) [V]]

In the week after the SAGE meeting that my noble friend Lord Scriven and the noble Baroness, Lady Wheatcroft, referred to, SAGE met again, on 20 February. The SPI-M report on community transmission, dated 17 February, that was presented at that meeting states at paragraph 16:

“Some believe … that there may already be sustained transmission.”


However, government guidance on 25 February for care homes states:

“There is no need to do anything differently in any care setting at present.”


Why were care homes still being advised that there was little likelihood of infection?

Covid-19: Restrictions

Baroness Brinton Excerpts

Monday 18th May 2020 Lords Chamber

[Lord True]

My Lords, the Government are talking with people, scientists and organisations right along the front. The noble Baroness injected a political note into this question, which I thought unfortunate. All parties should share in the aspiration to protect those she rightly describes as the most precious in our community, who have served the country longest. That is why the advice is in place. As I have said, that advice will be reviewed and further announcements made before the end of June.

[Baroness Brinton (LD)]

My Lords, the Government’s guidance on social distancing for vulnerable people—the tier below those who have to shield—was published on 16 March and withdrawn on 1 May. Pregnant women and those over 70 without underlying conditions now have no guidance at all. Which group should they regard themselves as part of?

[Lord True]

My Lords, it would be best if I wrote to the noble Baroness on that matter, as I am not scientifically qualified to answer it. However, I note the very important point that she has raised.

Public Services: Update

Baroness Brinton Excerpts

Wednesday 29th April 2020 Lords Chamber

[Lord True]

My Lords, my noble friend raises a very important point. Prisoners are a vulnerable part of the community and mental health is important for everyone, not least prisoners. I assure him that although this is at an initial stage, action has already been taken to ensure that locked mobile telephones can be given to prisoners in settings where there is no access to call boxes. Provision is being made to bring in the kinds of virtual conferences and meetings that he describes. I cannot give him an exact figure on the number of settings, or the timing, but I assure him that the Government are aware of the issue and addressing it.

[Baroness Brinton (LD)]

My Lords, I thank the Government for agreeing the £60,000 award for health and social care workers who have died, but I ask them to extend this to other workers who have died on the coronavirus front line. Will the Government please ensure that bereaved families of those who have died on the front line but who are not in the NHS Pension Scheme get the same benefits, including a monthly allowance for dependants?

[Lord True]

My Lords, my honourable friend the Minister for Health has said that he will consider the details of the scheme further. I am glad that it was welcomed by the noble Baroness and I will ensure that he is aware of the important points she raised.

Housing: Permitted Development Rights

Baroness Brinton Excerpts

Tuesday 23rd July 2019 Lords Chamber

[Lord Young of Cookham]

At the moment, building regulations do not require that, and that is one of the issues the review will look at. At the moment, there are no requirements for a property to have windows, natural light or minimum space standards. That is why we are reviewing the position, and the noble Lord is quite right to make that point.

[Baroness Brinton (LD)]

My Lords, may I very gently correct the Minister? He said, “the London borough of Watford”, but the Borough of Watford is not in London; it proudly sits in Hertfordshire. The planning inspector says very clearly that he is constrained by the GPDO 2015 rules. He says he recognises that,

“living without a window would not be a positive living environment”.

When planning inspectors are so constrained, surely it is time urgently to review these planning regulations? They are clearly not fit for purpose. Can the Minister come back to the House as soon as possible with a revised review date?

[Lord Young of Cookham]

This Minister may not be in a place to come back to the House, but I take the noble Baroness’s point. There is clearly strong feeling in your Lordships’ House that the current position is wholly unsatisfactory. We are reviewing it and I take the point about urgency that all noble Lords have impressed on me; we will come back the moment we have some progress to report. I take on board what noble Lords have said: that people should not be required to live in properties of the kind described by the noble Lord, Lord Cunningham.

Railways: Disabled Passengers

Baroness Brinton Excerpts

Thursday 24th May 2018 Lords Chamber

Asked by

[Baroness Brinton]

To ask Her Majesty’s Government what steps they are taking to ensure that all train operating companies are complying with the Equality Act 2010 in providing assistance to disabled passengers.

[Lord Young of Cookham (Con)]

My Lords, we expect all train companies to do everything possible to make travel easy for all passengers, including those with disabilities. Train companies have a legal obligation to make reasonable adjustments and must comply with the Equality Act 2010. They must also publish a disabled people’s protection policy which sets out their plans for disabled access and which must be approved by the independent Rail Regulator. The Government will publish an inclusive transport strategy later this year.

[Baroness Brinton (LD)]

I thank the Minister for his reply. Last week, Govia Thameslink introduced new formal guidance for staff stating that if the train might be delayed or late the PRM—that is a passenger with reduced mobility to you and me—must not be put on the train, not even if they have pre-booked and arrived in time: the train is now more important. I believe this breaches the Equality Act, and the Office of Rail and Road has said so. What can the Government do to ensure that all train operating companies comply with the Equality Act, and what will they say to Govia Thameslink?

[Lord Young of Cookham]

I have seen the guidance issued by Govia. It is insensitive and unacceptable. The Government have made their views clear to GTR. It is withdrawing the guidance and replacing it with guidance that makes it clear that its policy is to assist all passengers safely who need help with their journey. We are keen to see the Office of Rail and Road use its enforcement powers to hold train operating companies to account where they let disabled passengers down. I understand the distress caused by the guidance to which the noble Baroness referred.

Building Regulations and Fire Safety: Government Response

Baroness Brinton Excerpts

Thursday 17th May 2018 Lords Chamber

[Lord Young of Cookham]

I am grateful to my noble friend, himself a former Secretary of State at the Department of the Environment with responsibility for building regulations. The Hackitt review has recommended what she calls “gateways”—steps that must be fulfilled before the next stage in the construction process can happen, from design, to planning, to completion. On inspection, there is an interesting section in the report about approved inspectors, where Dame Judith sees a perceived conflict of interest and recommends some changes. On regular inspection, there is a recommendation that high-rise buildings should be inspected rigorously at least every five years for safety. On resources for the planning regime, my noble friend will know that we have recently increased the fees that planning authorities may charge with the increase being ring-fenced for actions such as enforcement.

I should have said in response to the noble Lord, Lord Beecham, that I have the latest figures from the royal borough on the rehousing of the Grenfell survivors. As of 14 May, of the 210 households that needed to be rehoused, 201—95%—have accepted offers of temporary or permanent accommodation. Of those, 138 have moved into temporary or permanent accommodation of which 64 are currently living in temporary accommodation and 74 have moved into permanent accommodation. Kensington and Chelsea Council is spending £235 million on providing the homes needed and we know that the council plans to spend an additional £83 million on top of the £152 million it has already reported spending. It has reported that it has now made over 300 permanent homes available to survivors to give people as much choice as possible.

On the building regulations, Dame Judith’s point was that the problem was not so much the regulations but a failure of the system that supervises and enforces them.

[Baroness Brinton (LD)]

My Lords, I declare my interest as a member of the Fire Safety and Rescue APPG. I welcome the report from Dame Judith. It is time that the principle of a golden thread ran right through the entire planning, delivery and maintenance of buildings. I know that many others agree with that. I endorse the comments made by my noble friend Lord Stunell about the timing of legislation coming through, and I hope that those things that can be done swiftly will start to give confidence to the various parts of the industry that changes need to happen.

Wearing my fire safety hat, I am slightly concerned that in the Statement the Minister referred to working with industry to clarify the building regulations fire safety guidance. I hope that does not just mean with the private industry side but includes the public sector, whether fire services or local government—or indeed those people who act as approved inspectors going in to have a look.

Five years ago, the Secretary of State promised a full review of the approved document B regulations after the Lakanal House fire inquest. We need an urgent review of those. My concern is that Dame Judith Hackitt’s review is not explicit about what will happen to them. If they are to be made part and parcel of a general regulations review, please will the Government assure us that the reasons behind the review proposed five years ago remain and will be addressed as a matter of urgency? Everybody agreed five years ago that we should never let something like the Lakanal House tragedy happen again, yet here we are.

Finally, I also endorse the comments made by my noble friend Lord Stunell. Please can we not just have guarantees and hopes that private freeholders will not pass on the costs? I completely accept the Minister’s point that many leaseholders are also freeholders, but I am afraid there are too many examples already of leaseholders being faced with massive charges by freeholders who are taking none of the risk and none of the liability. That is unacceptable.

[Lord Young of Cookham]

I am grateful to the noble Baroness. On legislation, I can only repeat what I said: the Government place a high priority on public safety. I know that the Bill managers will take on board the points made by a number of noble Lords.

On consultation, it will not just be a review of the industry. The noble Baroness is quite right. It will involve the fire and rescue service, local authority building standards people, approved inspectors and others.

On the building regulations, we agree that the building regulations fire safety guidance needs clarification. Work actually began before the Grenfell fire last year. When the interim report was published, we promised to complete it. A clarified version of the guidance will be published for consultation in July. We want to ensure that there is no room for doubt about compliance of materials with the building regs. We will consult on Dame Judith’s recommendations, as I said, including the proposal that only non-combustible cladding can be used on high-rise buildings. Also in the report are proposals for much more stringent testing of materials, and other recommendations along those lines.

Child Sexual Abuse: Football Clubs

Baroness Brinton Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, for those of us who have for decades supported football at all levels, from being the mum on the touchline on the Sunday boy’s league through to being a season ticket holder at professional games at various levels, the recent revelations cast an ugly shadow on the beautiful game. That is why I start by paying tribute to all those who have had the courage to come forward and witness through their personal stories, saying what until now has been unsayable.

We know that child sexual abuse is a society-wide problem. The problem has been getting everyone in society to accept that. The one good that can come from these revelations is that it will, I hope, become easier for others who have been abused to come forward in future.

Anne Longfield, the Children’s Commissioner, in her 2015 report on protecting children from harm, cites the following in her assessment of the impact of child sexual abuse in the family environment, but it is just as pertinent outside the family environment:

“Many victims do not recognise that they have been sexually abused until much later in life … Victims and survivors face considerable barriers to telling anyone and accessing help … Child-sexual abuse … casts a long shadow over the life of victims and survivors”.

I particularly welcome the proposal this week that a trust should be established to assist former young footballers who have been abused. The scale of abuse is huge, and no doubt there is more to follow in football and other sports where coaches come into contact with young people.

However, it is of deep concern that victims’ charities and organisations are not currently regulated by any governing body, statutory or voluntary. In effect, that means that anybody could establish a charity without the necessary qualifications. This in itself raises safeguarding issues, especially due to the vulnerability of the victims. That is why I tabled amendments to the Policing and Crime Bill that would place statutory duties on elected policing bodies and the Commissioner for Victims and Witnesses to ensure that quality standards are developed, published and adhered to.

Your Lordships’ House debated the amendments and agreed to them on Monday night and, if implemented, they would ensure that a quality standard in relation to the provision of victims’ services was prepared and published. They would also ensure that the quality standard is reviewed at least every five years; and that, in preparing the quality standards, the commissioner and the policing bodies would have a duty to consult the public. These quality standards would cover appropriate qualifications: minimum standard of experience; correct indemnity insurance; compliance with data protection and safeguarding laws; complaints procedures; regulatory bodies to take complaints and ensure that the standards are adhered to; and a strict compliance with the victims’ code. Those quality standards would ensure much-needed services for abused boys and girls, men and women in sports and elsewhere, and that they are adhered to to protect everyone. Can the Minister help us to progress these when the amendments return to the Commons?

Finally, I mention the excellent work of Mandate Now, the campaigning group, which makes the important point that we need mandatory reporting of possible child sexual abuse, which we do not have. Here I pay tribute to my noble friend Lady Walmsley, who has long been advocating this in your Lordships’ House. Mandate Now makes it plain that the FA’s own safeguarding policy is confused and inconsistent. While it says that it is mandatory to report, when it is not, its procedures are only guidance, not a requirement on its bodies. Worse, it is not clear who should undergo a criminal records check. When will mandatory reporting be introduced, and when will those inconsistencies be clarified? The time for prevarication on this is now over.

Health and Social Care

Baroness Brinton Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I, too, thank the noble Lord, Lord Harris of Haringey, for instigating this important debate and add my condolences to Lord Prior’s family: his voice will be sadly missed, not just in this House but in the whole of the health and social care sector, to which he devoted much of his political life.

As a patient and service user with rheumatoid arthritis, a life-limiting condition, I have extensive experience of the NHS, but also of the charitable sector, which I suspect is not often mentioned in patient engagement. In particular, I put on record my thanks to the National Rheumatoid Arthritis Society for its advocacy and support, Arthritis Care, which, before I was in my wheelchair, kept me out of one with tai chi for people with disabilities, and Arthritis Research UK, for its medical and practical daily living research.

Over the years, the NHS has launched a number of initiatives to improve patient engagement, and the words are very fine. It is interesting to note from the 2015 report from the think tank Reform entitled Expert Patients that the NHS constitution was established to drive greater patient engagement yet, according to one survey, 76% of patients had not heard of the constitution before receiving any treatment and only just over half were aware of their right to choice of NHS services. According to a survey three years ago, nearly 100% of patients wanted to access their electronic records but 67% did not know where to start to get them.

The 2002 Wanless review of health spending projected that higher levels of public engagement could both improve health outcomes and reduce cost—very important in our society 15 years on, with a significantly ageing population and real pressures on our health and social care sector. Under Wanless’s fully engaged scenario—your Lordships will remember that he had three scenarios about how seriously the NHS could implement engagement—a key component of healthcare expenditure was public behaviour: not how the service responds over the next 20 years but how the public and patients respond. The problem is that public and patients need education on how to respond. It is absolutely clear that costs could be reduced if that were the case, but I think most patients with experience of the NHS would say that their experience was patchy—even expert patients such as myself, who probably have considerably more than the average interaction with the NHS.

Patient awareness is entirely reliant on information and attitude support from every quarter. It was interesting to hear noble Lords contribute their experience of A&E. On an unfortunate visit to A&E when people thought I was coming down with an infection, I was told by the A&E consultant that I knew too much about my disease; whereas my consultant is always keen to ensure that his patients know and understand exactly what is going on, so that they can recognise problems. Continuing my theme of using rheumatoid arthritis as my exemplar of where it can work extremely well, the British Society for Rheumatology service care pathway articulates very clearly how even non-health interactions are vital. Patients’ understanding of the need for an improved diet and making sure that they get out and meet new people, that a life-limiting disease will also affect their emotional life, that they will need to address that and get help when they need it, and that they need self-awareness of both their disease and self-worth, because people often end up having to give up work—all those things, and the informal education you get from that, will increase confidence. It will also improve health and decrease anxiety, provide better sleep, make patients want to try new things and increase their motivation. All those things then have a knock-on effect for every part of the society that they are in, whether it is with family, work, friends or, very importantly, in the healthcare sector.

Just to give noble Lords a picture of what was happening with rheumatoid arthritis 20 years ago, people with my level of disease would spend perhaps three spells in hospital a year—perhaps a week at a time when they had a flare-up—and they had very little access to physiotherapy. Five years ago, in-patient stays were virtually removed, but treatment was being given as with cancer treatment: you would go in for a half-day a month for an infusion. Now most patients with the sort of disease that I have are self-injecting at home and—whisper it carefully—have interaction with the private sector, which delivers my injections and provides support in the early days to make sure that all is going on well. So it is not just about acute hospital times and costs. With this one disease, through the attitude of the consultants working with patients, the entire patient pathway has been completely transformed within five years and is unrecognisable from that of 20 years ago.

NHS RightCare has articulated very well some of the issues about how we increase patient pathways at an earliest possible date. One or two very good examples are offered by Professor Matthew Cripps, of fictional pathways. The first is for someone with diabetes. In our current standard care system, at the age of 45, after two years of a bit of trouble, Paul—this fictitious patient—goes to the GP, who does tests. She is a good GP, but she does not understand about diabetes pathways, so she manages his condition with diet, exercise and pills, but it is not working. Five years on, he has given up smoking and is reducing his drink. He is certainly managing his exercise, but his condition has worsened and, within two years, he is facing amputation of a leg; his condition further deteriorates, with heart problems as well, and within a few years he dies. The alternative patient pathway would mean that from the moment he first went to his GP, the entire health system would have picked up his support. He would be referred to specialist clinics for advice and support, including on stopping smoking, changing his diet and making sure that he got the right exercise. That first journey costs £49,000 to the NHS; the second, where the condition is managed over the same period, costs £9,000. So not only do we have a happy patient with a significantly reduced exposure to his disease but we have a significant cost saving to the NHS.

The other example is of elder care, which is often not talked about with patient experience. Not many people are aware that the time that somebody aged 65-plus who goes in after a fall, say, spends in hospital can equate to a year per week in muscle deterioration, so that you could come out after five weeks in hospital five years older. Or, if you spend, as is currently common with delayed discharge, 10 weeks in hospital, you could have aged 10 years in your body, with all the concomitant problems that go with that.

It is extremely important that every single part of the health and social care system participates in patient involvement. Wanless predicted that we could save a significant amount of money, but the Reform think tank updated his figures and said that by 2021, with real engagement, the NHS could save £1.9 billion, rising to £3 billion by 2063.

Simon Stevens, in his first speech as chief executive of the NHS, said:

“At a time when resources are tight, we’re going to have to find new ways of tapping into … sources of ‘renewable energy’”—

by,

“boosting the critical role that patients play in their own health and care”.

The example that I just gave from RightCare shows that it is not consistent in the NHS, nor indeed is the balance that we have as a society between health and social care working for us. The public health and social care system—which is where, importantly, Healthwatch comes in; I will not repeat the issues about its funding—is absolutely vital.

I spent a day with Healthwatch Stockport just over a year ago. The groups do not perceive themselves as regulators. They understand that it is part of their role but they are absolutely clear that they represent the voice of the people who use services and carers, and that they have responsibility for overseeing those services and reporting concerns back. There is that regulatory role but it is about the community work that they are doing. I saw this with ordinary people, the patients who had developed their own interest, working as the voice back to the NHS to make sure that things were working in Stockport. It was an extremely impressive community operation.

I support Healthwatch and the health and well-being boards as absolutely vital in local development. The noble Lord, Lord Lansley, is right to say that this was a priority for the Lib Dems when they were in government. The problem we face these days is that the funding gap, both for local councils and for social care, is creating a real problem. The King’s Fund said that a £2.4 billion funding gap as a result of the refusal to fund social care in the Autumn Statement is very real. That is one reason why the Liberal Democrats made it absolutely plain that we must prioritise funding immediately—not wait until next year’s local government settlement can come in to start to deliver. We hope the announcement will follow later today; it has been widely leaked. Two per cent per annum over three years of increased council tax to 3% over two years in council tax is not new money. That will not solve the problem, nor will it resolve the issues about patient engagement.