Health and Care Bill

Lord Bradley Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Earl Howe (Con)]

My Lords, I begin by thanking my noble friend Lady Morgan for raising these important matters both via this Committee and by engaging—as I understand she has recently—with my honourable friend the Minister of State for Health. I am also grateful to all other noble Lords who have spoken so powerfully and knowledgably on these issues.

There is no escaping one overarching reality in this policy area, to which the noble Baroness, Lady Thornton, has just alluded. As a Government of the whole United Kingdom, Ministers are responsible for all people of the UK; that is a given. However, while the core principles of the NHS are shared across all parts of the United Kingdom, it is the devolved Governments in Scotland, Wales and Northern Ireland who are responsible for developing their own health policies. Health is largely a devolved matter in the UK, and the commissioning and provision of health services for people in Scotland, Wales or Northern Ireland will continue to be a matter for the devolved Governments.

It will not surprise my noble friend to know that the UK Government continue to respect existing devolution settlements, so our aim is close collaboration with the devolved Administrations to deliver the best outcomes for the people across the four nations. This means that, while we are sympathetic to the spirit of these amendments, I am afraid that we cannot accept them.

I shall address the detailed issues. On Amendment 17, I agree with my noble friend that there is more we can do to align our healthcare for the good of patients across the United Kingdom. We are already exploring several projects to support the NHS to work more closely across the UK, and this includes refreshing the current memoranda of understanding between all four Governments and working with the Office for National Statistics to establish a number of UK-wide datasets. Steps like that will improve transparency and collaboration for the good of all patients across the UK. We do not believe that these steps require primary legislation, but we will keep that question under review. We will also continue to work with NHS England to ensure that a number of groups that it currently hosts, such as the rare diseases advisory group, and their specialised commissioning processes, also meet the relevant needs of the devolved Administrations.

Turning to Amendment 205, we know that choice of healthcare is an important right for patients across the UK. The NHS Constitution for England, for example, enshrines the patient’s right to informed choice. We will be preserving the important right for patients in England to choose their first elective outpatient appointment, GP and GP practice through regulations made under powers provided by the Bill. NHS England works closely with the devolved Governments, including on commissioning and ensuring access to specialised services. Requests for patients to have treatment in other nations are generally to secure continuity of care, to provide care close to patients’ support mechanisms, or because of specialist expertise.

The health services in Scotland, Wales, and Northern Ireland already have the power to contract with any NHS provider in England. As my noble friend Lord Lansley rightly pointed out, they already have in place arrangements for commissioning specialised services from English providers, including cross-border agreements, referral schemes and service-level agreements. Taking further steps, as suggested in this amendment, would place a significant burden on a smaller number of providers, particularly those along borders, with consequences for the smooth running of those health systems. From a legal perspective, such a change would be a significant impingement on a devolved competence and would require the consent of the devolved legislatures. Of course, patients matter most, but such a change would also be unlikely to greatly benefit them, since they are already served by existing arrangements.

Amendment 301 deals with data interoperability. The UK Government are committed to working with officials across the devolved Administrations to explore the benefits that healthcare data can provide while working collaboratively to respect the devolved nature of this work. As in other areas, we are looking at ways to improve collaboration on data matters and address issues with data sharing. There are commitments within the data strategy for health and social care to work across central government and the devolved Administrations to improve appropriate data linkage, thus supporting people’s health care outcomes. This builds on the work of units such as the Joint Biosecurity Centre, and the newly established UK Health Security Agency.

That work will help us to collaborate to solve public health issues, improve disease surveillance and overcome any behavioural or structural obstacles to appropriate data sharing across our respective health and social care systems. In addition, we are speaking to the Office for National Statistics about collecting data on performance and outcomes across the UK. We are pursuing this with it, working in concert with the devolved Administrations. The ONS has assured us that it does not need additional powers to gather such data.

The problems encountered by the daughter of my noble friend Lady Fraser in proving her vaccination status are being actively addressed on both sides of the border. I must concede that the problems are not fully resolved yet, but understand that a Covid status pass from Wales, Scotland or Northern Ireland will be recognised in England and vice versa.

[Lord Bradley (Lab)]

My Lords, I am sorry to interrupt, but I have been meaning to ask this question for a while. Will that also apply to students who currently study abroad and had their first vaccinations abroad, and who then come back to work in their home country? Will that be connected to the NHS app as well?

--- Later in debate ---

[Baroness Masham of Ilton (CB) [V]]

My Lords, I want to support the proposed new paragraph (h) in Amendment 37, which says,

“at least one member appointed to represent the voice of patients and carers in the integrated care board’s area.”

The patient’s voice should be heard throughout the Bill. What is the National Health Service for if not patients? Patients should be involved in planning, ensuring that patients’ and carers’ views continue to be represented. Their experience should be collected. They, with their carers, are the people who know what good, safe care is and what poor results are. I hope the patient’s voice will be involved. I am pleased that many Members already stated this in amendments last Tuesday. I hope the Government agree, and I look forward to hearing from the Minister.

[Lord Bradley (Lab)]

My Lords, I speak to my Amendment 38 and declare my health interests in the register, particularly as a trustee of the Centre for Mental Health and an honorary fellow of the Royal College of Speech and Language Therapists.

This amendment is short and simple. As its explanatory statement makes clear, it merely adds to the list of requirements for membership of an integrated care board that must be included in the ICB constitution. I believe it is essential to have a representative of mental health trusts for each ICB area, and therefore on the ICB, as it is the key strategic body for, among other things, healthcare commissioning, planning priorities and resource allocation for a local area.

Health and Care Bill

Lord Bradley Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I declare my health interests in the register. I am pleased to speak in this debate and add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his excellent maiden speech.

The Government set out their laudable intentions to integrate health and social care some years ago. In 2018, they changed the name of the Department of Health to the Department of Health and Social Care. I believe that that was a step in the right direction but progress since then has been woefully slow. Recent initiatives have tended to reinforce the separation of the two services rather than their integration, and have not led to the development of seamless pathways of care centred on the needs of the individual. With this Bill strangely pre-empting a further integration White Paper, the Government seem more concerned with the architecture of the NHS, recentralising powers and decision-making to the Secretary of State than with having a genuine ambition to devolve powers to local communities to deliver efficient and effective integrated services.

Belatedly and controversially, a new clause was introduced in the Commons to set up a new funding stream for social care, but it was not clearly ring-fenced for the purpose, with most of the money initially going to support the NHS further. While that money is much needed by the NHS to tackle appalling backlogs of care, it ensures that the current crisis in social care is not addressed—particularly, as we have heard, the dire workforce situation and the failure to address funding for local authorities, where the demand on them for social care provision also remains critical.

Despite these reservations, I am sure we all want to see a system develop that genuinely addresses proper health and care integration. So much work will be done during Committee and beyond to try to improve and shape that ambition, including full scrutiny of the social care funding clauses. As a starting point today, I want briefly to raise two issues.

The first is clarity about service planning at local place level. Local services such as primary, community and many secondary care services require planning, oversight and management at local level. This Bill allows ICSs to delegate resources and responsibility to place-level entities, but there is no statutory framework for the form of local commissioning bodies or their governance and relative accountability relationships. With the abolition of clinical commissioning groups, it is unclear to me how this important function will be fulfilled in the future. I hope the Minister will be able to clarify that point later this evening.

The second issue is the structure and governance of ICSs. A dual structure is planned for ICSs, with the integrated care board and a partnership board. There is obviously a risk that ICBs will be dominated by acute trusts, with other services being relegated to the partnership board. In my view, it is essential that if, for example, parity of esteem between mental and physical health is to mean more than words, mental health trusts are recognised in statute to sit on the ICB. Similarly, it is essential that allied health professionals such as speech and language therapists and the voluntary sector are at the ICB table to ensure their voices are heard loudly and locally. Finally, how will the public voice be heard, to ensure that the best interests of the health of local populations are duly considered? I would welcome the Minister’s views on this when he winds up.

I hope the Government will listen carefully to the concerns and issues raised in our debates on the Bill in order to ensure that this is not another missed opportunity to make a proper step forward, not only in the integration of health and social care but towards early intervention and prevention programmes which tackle the root causes and determinants of ill health and health inequality, as was brilliantly articulated recently by Professor Sir Michael Marmot and his team in my home area of Greater Manchester. As Archbishop Desmond Tutu famously said:

“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”


That should be the guiding principle during our deliberations on this Bill.

Mental Health Act Reform

Lord Bradley Excerpts

Monday 18th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have met the Race Disparity Unit and can share my noble friend’s testimony to the critical work that it does. The statistical collections managed by NHS Digital have shone a light on the extent of the disparities illustrated by Sir Simon, most notably that black people are more than 10 times more likely to be made subject to a community treatment order after discharge from hospital. That is an astounding number. We are determined to take action; we will introduce a new patient and carer race equality framework which will support NHS mental health care providers to work with their local communities to improve the ways in which patients access and experience treatment. The Race Disparity Unit will continue to play a key role.

[Lord Bradley (Lab) [V]]

My Lords, while I welcome the White Paper, it is unlikely that the legislation will be enacted until 2023. Many reforms can be made before that date to implement some of Sir Simon’s recommendations, including the development of community facilities to support people with learning disabilities and autism so as to hugely reduce the use of in-patient beds and, crucially, alternative provision to finally stop the use of prison and police custody suites as places of safety. I therefore press the Minister again to assure the House that sufficient capital funds are available within the NHS long-term plan to implement such key recommendations.

[Lord Bethell (Con)]

The noble Lord is 100% right: we can definitely start work on the recommendations of the report. As I said earlier, we have already done so: committing £400 million to end dormitories in 40 trusts. That sort of parallel processing can be done for other elements of the report. The consultation began last week, which shows our determination to get moving. Some recommendations of the report are spellbindingly obvious; we will work on them immediately. The role of police suites in safe refuge, cited by the noble Lord and by the noble Lord, Lord Winston, is exactly such an example.

Medicines and Medical Devices Bill

Lord Bradley Excerpts

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[Lord Ramsbotham (CB) [V]]

My Lords, I must declare two interests in explaining why I have put my name to the amendment—first, as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties, and secondly, as an honorary fellow of the Royal College of Speech and Language Therapists. As always, it is a great pleasure to follow the noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, both of whom know a great deal more about this subject than I do.

As I reported on Second Reading, on 12 August the Minister in the other place wrote that the Bill would allow the Government to update those professional organisations that can prescribe medicines when it was safe and appropriate to do so. This is in line with what the Minister said on Second Reading, which was quoted by the noble Lord, Lord Hunt. If the experience of dieticians, orthoptists, diagnostic radiographers and speech and language therapists is anything to go by, the role of such people has expanded considerably during the pandemic, during which there has been ever-increasing pressure on health professionals.

Prescribing responsibilities would enable allied professions to share the burden with their NHS colleagues and avoid unnecessary delay and duplication for patients. Their call for increased prescribing responsibilities is backed up by hard-pressed NHS trusts, which have identified a means of increasing their capacity. Therefore I hope that, on the basis of experience during the pandemic, the Minister will be able to announce proposals and a timetable for extending prescribing rights for certain carefully chosen health professional organisations within three months of the Bill being passed, as part of the NHS long-term improvement plan.

[Lord Bradley (Lab) [V]]

My Lords, I am pleased to support this timely amendment, which, as we have heard, would introduce a new clause to the Bill to extend prescribing rights to additional healthcare professionals. It is a consequence of the debate on Second Reading, which clearly laid out the benefits of extending prescribing rights to such allied health professionals as dieticians, orthoptists, diagnostic radiographers and speech and language therapists. I will not repeat all the advantages this would bring, because that argument has already been well made, both on Second Reading and in the speeches we have already heard this afternoon. In summary, I believe that it would help to deliver better support and more timely care for patients, reduce pressure on other health professionals, increase system efficiency and maximise the ability to respond to the Covid-19 pandemic, both now and in the predicted post-pandemic surge in the pressure on services.

Medicines and Medical Devices Bill

Lord Bradley Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Lord Bradley (Lab) [V]]

My Lords, I shall raise just one issue—that of prescribing rights, already highlighted by the noble Lord, Lord Ramsbotham. Clause 2(1)(n) deals with amendments made to provisions that govern who can supply or prescribe human medicines. As the Minister, Jo Churchill, recognised in Committee in the other place on 8 June, the provisions referred to are set out in Clause 2(2). The power gives the Government the ability to amend the rules around who can supply, administer and prescribe medicine in line with healthcare needs when it is safe and appropriate to do so. The most recent changes to prescribing responsibilities were in 2018, when legislation was amended to allow trained paramedics to act as independent prescribers.

The Minister informed the Committee that the Government had published an illustrative SI, showing how the provision could be made to permit dental hygienists to supply and administer certain medical products in the course of their professional duties. That is important, because the Government could use the opportunity presented in this Bill to extend supplementary prescribing rights training for occupational therapists and extend independent prescribing rights training to other allied health professionals, including dieticians, orthoptists, diagnostic radiographers and speech and language therapists. As the noble Lord, Lord Ramsbotham, has made clear, this could help to deliver better support and more timely care for patients; reduce pressure on other health professionals; increase system efficiency; and maximise the ability to respond to the Covid-19 pandemic now and in the predicted post-pandemic surge on services. The extension would also build on the groundwork already undertaken by NHS England’s scoping exercise over the last few years on extending prescribing rights. However, having had full consultation with professional bodies, any SIs laid must be subject to affirmative resolution in this House—and, of course, such SIs must be underpinned by efficient, robust and coherent regulation.

I support the views of the allied health professionals that there could be considerable benefits to extending these prescribing rights, including better support and more timely care for the patients they work with, enabling them to have more equitable access to treatment and reduced pressure on other stretched professionals, especially GPs. As an example of those benefits, I highlight the work of speech and language therapists. Without independent prescribing rights, speech and language therapists have to hand over a prescription to a different prescriber, such as the GP. If the prescriber is on another site, that can sometimes result in considerable delays. In addition, for those patients with eating and drinking difficulties, the current situation could increase the risk to their safety, including adverse effects such as aspirational pneumonia or reflux, with the possible increased likelihood of hospital admissions.

As noble Lords will be aware, speech and language therapists provide life-changing treatment, supporting care for children and adults who may have difficulties with communication or with eating, drinking and swallowing. They are also involved in key clinical and health pathways, including cancer, particularly head and neck cancers, learning disabilities, brain injuries, stroke and progressive neurological conditions such as dementia. Expending prescribing rights to them and allied health professionals could enable safer and more efficient patient care, and I hope that the Minister will confirm that he will support this issue as this legislation progresses though this House.

Covid-19: Mental Health

Lord Bradley Excerpts

Wednesday 1st July 2020 Lords Chamber

Asked by

[Lord Bradley]

To ask Her Majesty’s Government what action they are taking to address the impact of the COVID-19 pandemic on mental health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, we have released tailored guidance to help people deal with their mental health on GOV.UK and the Every Mind Matters website. NHS mental health services have remained open for business, offering support using digital, telephone and face-to-face approaches as appropriate. We have provided £9.2 million of additional funding to charities to support adult and children’s mental health. We are working with the NHS, Public Health England and others to gather evidence and assess potential long-term impacts of Covid-19 as we plan for support for mental health through the recovery phase.

[Lord Bradley (Lab) [V]]

I refer to my interests in the register and thank the Minister for that reply. However, as he will be aware, research on the impact of the pandemic already shows that demand for mental health and well-being services is increasing substantially. Will he therefore ensure that specific funding across government is available to groups who are particularly at risk at this time, including: those who have had the virus and been treated in hospital, who suffer from high rates of PTSD; people who have been bereaved in distressing circumstances; those living and working in care homes and in our hospitals; and children, who require immediate psychological support as they return to school?

[Lord Bethell]

The noble Lord is entirely right to be focused on the potential increase in demand for mental health services, although it is an area where we have some reassurance that the explosion of mental health demand has not hit the heights that at one point we feared. None the less, we have ploughed money into mental health charities and have recruited 3,500 volunteers who are helping with the Check-in and Chat Plus process. We remain incredibly vigilant in this area, and I entirely support the focus on specific mental health issues which the noble Lord outlined.

Queen’s Speech

Lord Bradley Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Bradley (Lab)]

My Lords, declaring my interests in the register, I will briefly touch on three issues from the Queen’s Speech relating to healthcare. I also congratulate my noble friend Lady Blower on her excellent maiden speech.

First, I turn to the intention to enshrine in law the National Health Service’s multiyear funding settlement. This commitment and additional resources for the NHS are obviously always welcome, but in 2018-19 the outturn spend on mental health services was around only £12.2 billion, which is roughly £1 in every £10 of the overall NHS budget. If we are truly going to make the essential additional investment desperately needed in mental health services for both children and adults, would it not perhaps also be appropriate to enshrine in law the commitment to achieve parity of esteem and equality of access between mental health and physical health expenditure over the same funding period, rather than merely retain it as an aspiration in the NHS mandate?

Secondly, I turn to NHS investment. As pro-chancellor of the University of Salford, which has one the largest—and, dare I say, best—training departments for nurses in the country, I welcome the announcement to restore some level of bursaries for nurse training. However, I understand that there will be a delay in implementation until September this year. Universities recruit for such training at a number of points in the year, such as January and March, so it is likely that potential applicants will delay entry until September to understandably take advantage of the bursaries. However, this could further undermine the already fragile nurse workforce planning across the NHS. Will the Minister therefore consider the immediate restoration of the bursaries to ensure a more robust pipeline of nurses over the coming years and give more certainty to university recruitment?

Thirdly, I turn to the Mental Health Act and the commitment in the Queen’s Speech to continue work to reform it. Such reform is urgent following the excellent review of the current Act by Sir Simon Wessely. I strongly support two of his recommendations regarding the interface between mental health and the criminal justice system, which are similar to recommendations I made in my independent report to government some 10 years ago. First, he recommended that by 2023-24 investment in mental health services, health-based places of safety and ambulances should allow for the removal of police cells as a place of safety under the Act and ensure that the majority of people detained under police powers are conveyed to places of safety by ambulance. This is obviously subject to satisfactory and safe alternative health-based places of safety being established. I totally agree with this recommendation.

Good progress has been made in this area, with the banning of the use of police cells as places of safety for children. However, to ensure that the recommendation is implemented, we need significant further investment in, for example, crisis care assessment units away from A&E departments—they are totally the wrong environment for people in mental health crises—and liaison and diversion services. These services have now reached 100% coverage of the country but should be further enhanced by, among other things, connection to speech and language therapy services and appropriate adult support, and the rapid development of the excellent reconnect programme for rehabilitation.

His second recommendation—that NHS England should take over the commissioning of health services in police custody; again, similar to my recommendation —would significantly improve the co-ordination between mental health, learning disabilities and physical health assessment in police custody, and would be a key component in improving the quality and timeliness of crucial information about a person’s complex needs as they pass, where appropriate, along the criminal justice pathway. Again, I hope that the Minister will support these recommendations and the early introduction of the Bill in order to reform the Mental Health Act at the earliest opportunity, following diligent consideration of the complex issues through the publication of the White Paper.

Queen’s Speech

Lord Bradley Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I am pleased to be able to make a short contribution to this last day of the Queen’s Speech debate. I refer to my declarations in the register of interests. I also commend my noble friend Lady Sherlock on her excellent opening speech, which clearly laid out the context for this debate on behalf of these Benches.

The first issue I raise is education, and specifically the crucial policy area for the future well-being of our economy: apprenticeships. On this, as the noble Lord, Lord Aberdare, rightly said, the Queen’s Speech is silent. The University of Salford, where I am chair of the board of governors, is rapidly growing its degree apprenticeship provision. Combining degree-level study with on-the-job training, degree apprenticeships are a shining example of the high-quality technical and vocational education that the Secretary of State quite rightly champions as vital to the future economic well-being of the country, but we are not making the most of them. A recent report by Universities UK showed that four in five year 10 to 12 school pupils know “little or nothing” about degree apprenticeships. If young people are not made aware of the different educational opportunities, particularly vocational and technical, they are unable to make informed choices as the Secretary of State so wishes. I therefore encourage the Government to do more to raise the profile of degree apprenticeships among school leavers and their parents.

I cannot speak about apprenticeships without mentioning the apprenticeship levy. Now more than two years old, the objectives of the levy were sound, but the outcomes it has produced are not. The overall number of apprenticeship starts has fallen since the introduction of the levy, and there is a shocking lack of transparency around how firms’ levy contributions are spent. While many big employers report a significant underspend, there is an overspend on the overall apprenticeship budget, meaning limits on the funding made available for non-levy payers, which are predominantly SMEs.

At the University of Salford, we have around 50 SMEs that want to take on apprentices with us, but we have to turn them away because we do not have sufficient funding. This has to change. SMEs cannot be left out in the cold from the degree apprenticeship revolution, and I hope the Government will look at this to enable apprenticeships, at all levels, to be a viable and valued education and training route for businesses and careers.

The second issue I raise is mental health and the reform of the Mental Health Act. I was pleased to be able to contribute to the review of the current Act by Sir Simon Wessely, and I welcome his report. I hope the Government’s response with a White Paper will be published before Christmas, that we will move more quickly to legislation, and that tonight the Minister will allay the fears that we may have to wait at least two years before legislation is introduced into Parliament.

I will highlight just two of Sir Simon’s recommendations as they relate to the criminal justice system. First, recommendation 130 states that,

“Prison should never be used as a ‘place of safety’ for individuals who meet the criteria for detention under the Mental Health Act”.


I agree. This prohibition, like the use of police cells as a place of safety for children—which should of course be extended to adults—must be enacted as a matter of urgency. Secondly, recommendation 132 concerns the transfer of prisoners sectioned under the Mental Health Act from prison to healthcare. It specifically sets a statutory time limit of 28 days broken down into two 14-day periods, the first for assessment and the second for transfer. This is a more realistic and practical proposal than the similar one I made in my report some years ago, but, again, it must be enacted as a matter of urgency. However, both these recommendations rely on urgent investment in appropriate high-quality alternative facilities as places of safety across the country, and investment in NHS secure beds to ensure that the transfer target can be met.

My third point relates to investment in mental health services for children and young people, and particularly for those with special complex needs. The Association of Child Psychotherapists, among many organisations, has suggested that as many as 40% of children with mental health problems have complex conditions—often arising from early trauma or adverse childhood experiences—which are likely to require specialist input. We urgently need a national multidisciplinary commissioning proposal to address the situation as part of the planned investment in mental health services in the NHS long-term plan.

I hope the Minister will be able to respond to each of these points when she concludes this debate.

Mental Health of Children and Young Adults

Lord Bradley Excerpts

Thursday 16th May 2019 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I, too, congratulate my noble friend Lady Royall on her excellent opening speech to this very important debate. I also declare my interests in health and education as recorded in the register.

I will take a few moments of my time to sincerely thank both Houses of Parliament, including the Ministers—the noble Baroness, Lady Blackwood, and the noble Baroness, Lady Goldie, who has just left the Chamber—and my noble friend Lady Thornton, on behalf of my sister Janet, Gavin, Miles and both of our families for the very kind messages of sympathy following the deaths of my sister, Dr Sally Bradley, and her husband, Bill Harrop, in the Sri Lankan bombings. They were a great comfort to us all. Thank you.

Turning to the subject of the debate, I will first make a brief comment about the funding of mental health services. In a Written Answer, the Minister advised me that the cumulative increase in NHS England’s revenue funding would be £6.2 billion in 2019-20, rising to £25.4 billion in 2022-23. The NHS Long Term Plan indicates that at least £2.3 billion more will be spent on mental health care. Assuming we receive that £2.3 billion, it means that over the period, the percentage spend on mental health will actually reduce from 37% in 2019-20 to 9% in 2022-23. We also know that the proportion of that spend on children and adolescent mental health services is only about 15% of the total. If we are really to tackle the gaps in mental health services for children, a significant further shift in resource allocation from physical to mental health must be made to achieve the ambition of parity of esteem. I should be very grateful for the Minister’s views on that point.

Secondly, I will say a brief word on the workforce. The long-term plan states that,

“we will continue to increase the NHS workforce, training and recruiting more professionals—including thousands more clinical placements for undergraduate nurses”.

There is a real crisis in our current mental health workforce, given the age profile of those extremely dedicated staff and the number who will retire in the next few years. It was disappointing that the workforce plan was not published at the same time as the long-term plan. Obviously, we welcome the work that the noble Baroness, Lady Harding, is undertaking on behalf of the Government, but can the Minister confirm today when the final report will be published and what engagement the noble Baroness has had with universities undertaking high-quality nurse training, such as the University of Salford in Greater Manchester, where I am honoured to be the pro-chancellor? Without a clear, robust workforce plan, whatever the increase in funding, timely access to essential support for the spectrum of mental health needs—the key issue—will not be achieved.

Turning to mental health and well-being in the education system, I will raise two issues. First, many representations—including my own—have been made through YoungMinds and the Children and Young People’s Mental Health Coalition to Ofsted as it reviews its inspection framework to ensure that it assesses and recognises the effectiveness of schools and academies in supporting children and young people’s well-being. I hope the Minister will ensure that it becomes part of the Ofsted framework to ensure that early intervention in schools is comprehensive and consistent across the country.

Secondly, it is clear from the speeches we have already heard that mental health issues in higher education are a crucial challenge that universities need to address. Over the past five years, 94% of universities have experienced a sharp increase in the number of people trying to access support services. I therefore commend to the Minister an initiative in Greater Manchester that established a task force, following a workshop bringing together all the universities in Greater Manchester, the Greater Manchester Health and Social Care Partnership, the Mayor of Greater Manchester, mental health experts and clinicians. The task force designed an integrated single pathway and hub for all 100,000 students in Greater Manchester and included a central physical treatment hub in the area of greatest student density—on Oxford Road, near the centre of Manchester—and two further hubs in Salford and Bolton, as well as a clear pathway to enable students to be referred through existing support channels, digital consultation sessions, digital communication with students and many other initiatives. This is a two-year pilot going live at the start of the new academic year in September and co-funded by the universities and the NHS. I hope the Minister will visit Greater Manchester to review this project, with a view to it being rolled out as a model across the country.

Finally, I will make a brief comment on mental health, learning disabilities and the criminal justice system. Over the past few years, since my report was published in 2009, a core all-age liaison and diversion service has been rolled out across the country to support people who hit against or find themselves in the criminal justice system. It is anticipated that the scheme will reach 100% geographical coverage over the next year. The next stage, for the next 10 years, is to address particular health issues. I raise one today—autism—in recognition of how many people with that condition may find themselves a witness, victim or suspect in the criminal justice system. We must improve access to training for all staff working in the criminal justice system—whether in police stations, courts, probation services or prisons—on autism and other key vulnerabilities, and deliver on the commitment in the NHS Long Term Plan to,

“invest in additional support for the most vulnerable children and young people in, or at risk of being in, contact with the youth justice system”.

I hope the Minister will help drive this forward.

NHS Funding: Mental Health Services

Lord Bradley Excerpts

Wednesday 1st May 2019 Lords Chamber

Tabled by

[Lord Bradley]

To ask Her Majesty’s Government what proportion of the additional money allocated to the National Health Service budget over each of the next five years will be ring-fenced for the development of mental health services.

[Baroness Thornton (Lab)]

With his consent, I beg leave to ask the Question standing on the Order Paper in the name of my noble friend Lord Bradley. Noble Lords will know why he cannot be with us today, and the House will wish to know how much he and his family appreciate the sympathy that has been expressed.