Hospital Beds: Availability

Lord Crisp Excerpts

Thursday 9th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is of course quite right about the need for more money. I re-emphasise that an additional £7 billion or more for social care is going to councils during this Parliament. Councils have the ability to raise council tax, although the leverage obviously varies from place to place. This is why the Better Care Fund was created—to provide extra help to areas that do not get the same income from council tax increases as the better-off places.

[Lord Crisp (CB)]

My Lords, a year ago, the Royal College of Psychiatrists published a report which showed that about one-fifth of adult mental health beds were occupied by people who were ready for discharge or who should not have been admitted in the first place. They were only admitted because there were no adequate facilities in the community. Could the Minister tell us what the figure is today and what is being done about mental health specifically?

[Lord O'Shaughnessy]

The noble Lord is quite right to raise the issue of mental health. I do not have the specific figure with me but I will write to him with it. We know that there has been a historic disparity between the two services. This was recognised by the Prime Minister in a very important speech she gave a few weeks ago, setting out some of the ways in which the Government are doing more on this. However, there is clearly a lot more to do.

Health Workers: Training

Lord Crisp Excerpts

Wednesday 18th January 2017 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to increase the number of training places for doctors, nurses and other health workers.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, on 4 October the Health Secretary announced that from September 2018, the Government will fund up to 1,500 additional undergraduate medical places each year. Reforms to the funding of nursing, midwifery and allied health preregistration training will come into effect on 1 August 2017. The reforms will enable universities to offer up to 10,000 additional training places by the end of this Parliament.

[Lord Crisp (CB)]

I thank the Minister for his Answer and welcome him to what I think is his first parliamentary Question. I am sure that the Government recognise that there is a growing shortage of health workers globally that comes about as countries, particularly in Asia, expand their workforce enormously. There is a global market and global competition for health professionals. The UK was going to be affected by it regardless of Brexit, but the uncertainties of Brexit make it worse. First, what assessment have the Government made of the scale of the risks from those two factors? Secondly, what assessment have they made of the opportunities? The UK is a world leader in the education of health professionals. What are the Government doing to help universities and others take the opportunity to train more health workers both here and abroad to meet both the UK’s and the world’s demand for increased numbers?

[Lord O'Shaughnessy]

I thank the noble Lord for his welcome. The WHO has identified a global shortage of medical staff of more than 2 million, so clearly there is a big need and, as he says, it is being driven by the development of countries, particularly those with large populations, and the need to grow their own staff. At the moment, about 25% of NHS staff in the UK come from abroad and, like all NHS staff, they do a fantastic job for us. Clearly, given the problem that the noble Lord identified, we will need to become less reliant on overseas staff, which is one reason driving our desire to increase the number of training places for doctors, nurses, midwives and others.

In answer to the second part of his question, I think something like 10 of the world’s top universities are based in the UK. We are a world leader in education; that is a great strength of ours and something that we want to continue. Healthcare UK is the government body responsible for working with universities to unlock partnerships with other countries, and there have been a number of successful examples of where that has happened.

Smoking-Related Diseases

Lord Crisp Excerpts

Wednesday 14th September 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I, too, congratulate the noble Lord, Lord Faulkner, on his comprehensive and clear introduction to this important debate. I also acknowledge and congratulate everyone, including the Government, on the progress that has been made over recent years. But we must keep the pressure on. It is easy to think that smoking is beaten as it is relatively rare in public, but it is still very common in some parts of the country.

Most key points have been made. I will bring in only one additional point, but I will first reiterate three fundamental aspects that have already been mentioned. The first is the importance of having a tobacco control plan. The evidence is there that those countries that have one, such as Australia and Canada, do much better in controlling smoking than those such as France and Germany that do not have a strategy. Of course, a strategy is only as good as its contents, and a good strategy and a good plan are needed. The important point here is that there is evidence: local smoking cessation works, properly constructed mass media campaigns work, and the use of vaping or e-cigarettes is also important. So when will we see this strategy and plan, and will it be built properly on the evidence?

The second point, simply put, is that smoking hits poorest people hardest. As the Prime Minister said, if you are born poor you are likely to die earlier. There is evidence that 50% of that impact is due to smoking-related diseases.

The third point I will reiterate is that this is of course not an isolated subject and that stopping smoking has an impact on other diseases and on the health of people in so many different ways, including reducing stillbirths, as has already been said. The key point here is that smoking should not be treated in isolation—although smoking cessation clinics are important—but should be part of a properly integrated health promotion policy.

My single additional point is on overseas development. I was interested to see that the Public Health Minister said in December 2015 that the Department of Health had received a grant to help other countries with their tobacco control strategies and was setting up a dedicated team. This is a global problem that is still growing in many low and middle-income countries. I would be interested if the Minister were able to give us an update on this work by the Department of Health and perhaps by other parts of the UK Government.

NHS and Social Care: Impact of Brexit

Lord Crisp Excerpts

Thursday 21st July 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I too congratulate my noble friend on securing this debate, on her excellent overview and on the detailed illustration of nursing that she gave us. As she said, there is trouble ahead. The NHS is very vulnerable, but so too is social care. It is too early to be clear about exactly what will happen, but it is evident that there will be both short-term impacts and some very much longer-term implications. It is about future recruitment, as well as about maintaining the current workforce. As many other noble Lords have said, there need to be strong and constant reassurances for health workers from the EU, and from other countries, from Ministers, chief executives, professional bodies and colleagues.

It is particularly sad that, as others have said, the referendum result has released suppressed racism and other anti-social attitudes among some parts of the population, and that it seems to have given permission for them to be expressed. These need to be put very firmly back into the box, but the underlying causes also need to be addressed. The Government have particular responsibility to provide clarity in this respect and not to destabilise the situation by questioning the status of immigrants now coming in from the EU. We need careful and considered public statements and policies.

I am one of the later speakers in this debate, so I shall start from a slightly unusual place by emphasising what is, I think, a potentially positive aspect of the Brexit vote. The UK currently has the most extraordinary strength in health, biomedical sciences and life sciences. Some noble Lords may know that last year the All-Party Parliamentary Group on Global Health, of which I am a co-chair, put together a very large report on this issue, looking at our strengths in four sectors that are all linked: academia, government—by which we mean the work of DfID as well as the NHS—commerce and NGOs. In all those sectors the UK is a real world leader, coming first, second or perhaps third, generally with the US beating us. We argued in that report that we should build the UK as a great health hub or centre for health—rather as we have a great financial centre—for the benefit of the world and the UK.

We have a great tradition. Over the years we have produced many great global public goods in health. I think of the work on malaria, on the genome, on neglected tropical diseases and on a whole range of areas, some of which have no immediate or direct relevance to us in this country. As a result of all that work, we have the most astonishing range of global partnerships. One sees that particularly in our academic work but also in these other areas. All that is good for UK influence and UK commerce—for the UK’s status and economy.

Most obviously, Brexit provides an opportunity as the UK seeks to find a new role in the world. It gives extra emphasis and importance to this vision of an outward-focused country and of a world leader in health and related sciences—influential and respected. It is good for our security and prosperity, for trading, influencing and leading, and for spreading a clear set of values. It seems to me that this is a vision that needs to be given greater energy as a result of the vote. That is very positive but there are also enormous risks, of which I shall draw attention to just four.

First, as has been said by many noble Lords, the NHS is in trouble. The Prime Minister’s vision of working for those struggling and just managing applies very much here. We need to expect the NHS to be there for everyone in the country. The NHS as it stands needs to be given a much higher priority than has been the case. I too applaud the piece by Simon Stevens in the Telegraph and his call for some special treatment for, and indeed infrastructure investment in, the NHS in the future. The NHS needs to be part of the future of our country in the way that it has been in the past.

The second risk is to staffing, which we have talked about very largely in terms of the NHS and social care. However, it applies also to staff in our research teams—our biomedical lifeblood, if you like. Where is the immigration policy that will allow us to sustain those fantastic research and scientific partnerships around the world?

Thirdly, there is a risk that has not yet been mentioned: that we must maintain the UK commitment to the World Health Organization’s code of practice for international recruitment. Many noble Lords will recall that we signed up in 2010 to this global code, following on from earlier UK and Commonwealth codes, which essentially said that we should be recruiting people only from countries where there was not a shortage of health workers and, indeed, in some cases, where the Government were keen for us to recruit people. While we have done reasonably well, others around the world have not. However, one can well imagine the pressures coming from this debate leading to us seeking to recruit in ways that are not consistent with that code of practice and perhaps taking us back to where we were before.

The fourth big risk is to research. We already know anecdotally—I suspect that many noble Lords are aware of the fact—that university researchers applying for EU grants now are being told by their EU collaborators, “Please don’t bother; we don’t actually need you and we certainly don’t need you as the lead partner in this application”. The impact is already being felt in that very important area.

Although I might want to try to paint a vision of us as a great health leader in the world, we are vulnerable, for all the reasons that we have talked about. Not only is the NHS vulnerable, as my noble friend’s debate is leading us into discussing, but so is our place in the world in this developing field. Health is the biggest industry in the world now and one of the fastest growing, at 5.2% annually.

The last comments that I made are all very negative and make it difficult to see how we can alleviate these problems. But let me finish with two points. First, what are we doing to become more self-sufficient in health staffing? What are we doing to boost training? We have been, over many years, on a rollercoaster of increasing and reducing training—for example, of nurses, although I do not just mean of nurses. It seems to me that this needs to be given much more priority so that we can approach being self-sufficient. Secondly, the effect of Brexit and the staffing shortages we can already see starting to happen add extra impetus to the need to be innovative, in both service and staffing models.

I will deal briefly with the latter point, which is about how we deploy and use staff within the NHS and within health and social care more generally. We have heard already about nursing associates—bearing in mind my noble friend Lady Emerton’s strictures, I hope I have got it right when I say nursing associates rather than associate nurses. Another example is one that my noble friend Lady Watkins and I have been working on together in the all-party parliamentary group, looking at the role of nurses. By and large, and not just in the UK but globally, nurses are undervalued and not enabled to operate to their full extent. The extraordinary fact is that we train people up to a certain level and then do not let them operate at that level. There is enormous waste in training people and not using them fully. We will be publishing some proposals about that and hope that the Government will not just listen to those proposals but think even more about how the impact of Brexit is forcing people, or can be used as an impetus, towards greater innovation.

Although I and others have many questions for the Minister, let me finish with the four that I have highlighted already, if I may—as opposed to the 10 that I had written down. First, will the Government maintain their commitment to the WHO code of practice on international recruitment and report on their performance against it? Secondly, what are they doing to develop the UK’s role as a global hub and centre for health, biomedical sciences and life sciences? Thirdly, what are they doing to increase training and move towards self-sufficiency? Fourthly, what are they doing to develop the role of different groups of health workers, and particularly to enable nurses to fulfil their potential?

Mental Health: Ensuring Equal Access to Mental and Physical Healthcare

Lord Crisp Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I congratulate the noble Baroness, Lady Brinton, on her very impressive speech in which she laid out the issues extremely well. I also congratulate the noble Lord, Lord Oates, on his personal and moving speech which reminded us of what this is all about and that this affects individuals. We sometimes talk quite blandly about policies and forget that this is all about individuals.

I will start with a third congratulation, to the Government and all the political parties on having pushed this agenda so hard that we are moving towards parity of esteem between mental and physical health. I do not know whether this is the first country in the world to do that, but this is an enormous commitment with enormous implications; it is not just about access to healthcare, which the Motion in front of us is about, but about access to outcomes and a whole range of other aspects of the health system, including access to research funding and so on.

I will take a moment just to comment on the global implications. The UK has a leadership role here. Some 25% of disability globally is connected with mental illness, yet globally only 1% of health funding is spent on it. That is completely disproportionate, even more so than the figures for the UK mentioned earlier by the noble Baroness, Lady Brinton. Some changes are happening globally: there is a new World Health Organization action plan, and the sustainable development goals recognise that health needs to be thought of as a bio-psycho-social concept and not just thought of in terms of the biological health aspects. However, DfID does no better than other donors in promoting mental health, and its spend on mental health is very low. I have a question, not for the Minister but for the Government: will DfID adopt the same policy of parity of esteem between mental and physical health in its work locally?

On the UK and the five-year plan, as the noble Baroness, Lady Brinton, has already said, there is still uncertainty about what is meant in practice. I know that it is early days but there are all sorts of questions about implementation. One gets the impression from talking to people involved in mental health in England that people take very different views about what this means. As has already been said, only just over 50% of providers this year reported a real-terms increase in funding, and there is low confidence among providers that the £1 billion will find its way to mental health. I would like to hear the Minister’s comments on these points in his response to the noble Baroness, Lady Brinton.

As the Minister knows, I chaired a commission on acute care that coincided pretty much with this five-year working party and which was referred to in the five-year plan. Three issues arise from that, which I will ask about specifically. The first is that out-of-area treatments—the practice of sending people long distances across the country for admission, not for specialist care but for general acute emergencies—is a significant problem for patients, carers and the system. The latest figures suggest that this may be getting worse. In our commission we believed that this could be dealt with quite quickly, and we suggested that it could be eliminated by September 2017. We also said that in many cases it would save money to do so, because people are kept at very significant expense, often a long way away, where they get stuck because it is difficult for social workers or health workers to visit them. We therefore believed—and we saw evidence from a number of trusts around the country—that it was possible to do this quite quickly and that in many cases it was a cost-neutral option. I understand that the Government propose to set a target for achieving this by 2020, not by October 2017, as we suggested. I suspect that putting it off will mean that people will not start even thinking about this until 2018 or 2019, and it is a great pity that this is a missed opportunity to do something that is probably very symbolic as well as important as regards showing that we are serious about improving mental health.

I also predict that, in the meantime, complaints about this will grow. This will become a bigger issue and will happen more and more, and I suspect that we will have this sort of debate in your Lordships’ House more often. My first question to the Minister is: will he and the Government reconsider that timetable and move the timetable for eliminating out-of-area treatments forward? We suggested September 2017, but certainly 2020 is far too far away.

Turning from a four-year wait to a four-hour wait, our commission suggested that written into the NHS constitution—not purely as a target—should be the constitutional right for people with mental health problems to be admitted to hospital or be received by a crisis resolution and home treatment team within four hours of being assessed. At the moment that happens in some cases, but in very many cases people are kept hanging around, often in police stations and all kinds of other locations, waiting to be admitted. We believe that this is very important. We do not yet have a baseline figure for the average time that people wait for admission once it has been decided that they should be admitted. We think that work needs to be done to measure this and that there should be a commitment to deal with this waiting time. Will the Minister let us know what progress is being made on that recommendation?

My third and final question concerns a matter to which I know the Minister is very committed—ethnicity and race. For a long time there has been a problem with both real and perceived racism within mental health services. We certainly came across a large number of people from black and minority-ethnic communities who felt that they were disadvantaged or discriminated against in some way within the services. We found it very difficult to decide how to deal with this, because mental health services by themselves cannot deal with what are often societal problems. Incidentally, we also found that there was a large amount of discrimination against gay people in a number of institutions around the country.

We concluded that the way to deal with this was to introduce a race equality standard for patients and carers—such a standard is applied for staff across the whole of the NHS—as a means of measuring the differences between the treatments that people from different communities receive. We believe that that could be done relatively quickly. There are only 50 or so trusts in the country, and it would be very easy to pilot it with five or 10 of them over the next few years. I know that this is something that the department is considering and I would be very interested to hear from the Minister what is happening in this regard. We believe that showing that this issue is taken very seriously within mental health will not only be a very significant gesture but provide the sort of information that trusts need to identify the problems and plan how to deal with them.

Finally, I turn to something that was not directly mentioned in the five-year review, although there was reference to people not being given a full understanding of the side-effects of medicine. I refer to dependence on prescribed drugs. My noble friend Lord Sandwich has been a pioneer in raising the profile of this hidden and often invisible problem affecting many thousands of people, causing pain and grief, and wasting millions of pounds within the health system.

I draw particular attention to the rising levels of pharmaceutical treatments for mental health conditions. Data published in April show that anti-depressant prescription numbers rose by 7% last year to 61 million prescriptions—enough for more than one for each of us in the country, and five times the number that there were 25 years ago. There has also been a significant increase in the number of prescriptions for drugs used for psychosis, as well as for ADHD, which are usually given to children. While of course these drugs can be helpful in the short term—and that is why they are given—there is worrying evidence of an increase in long-term use of anti-depressants, as well as reports of many individuals suffering from disabling withdrawal symptoms, which can last for several years. There are also concerns that long-term use can be harmful and lead to disability.

I should therefore like to draw the attention of the House to the work of the All-Party Parliamentary Group for Prescribed Drug Dependence. Among other things, it is campaigning for a national helpline to help patients who are having problems with these drugs to come off their medication. Currently they are unable to access appropriate support. I therefore ask the Minister for his comments on the request for support for a national helpline.

Mental Health Services

Lord Crisp Excerpts

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

It is partly a question of resource, although I point out to the noble Lord that the country that spends the most money on healthcare and has the worst results is America. It is not just a question of resource. It is how we spend it as well as the amount of money.

[Lord Crisp (CB)]

I am sure that the Minister well understands that people working in mental health see this as a very negative signal, given all that has been said before. Will he answer two questions, please? First, what would he say to people working in mental health to reassure them that the Government are still giving this level of priority to mental health? Secondly, as he has already said, these quality premiums are intended to incentivise quality. What impact does he think removing mental health from the national priorities —the national quality premium—will have on quality in mental health?

[Lord Prior of Brampton]

What I would say to people in the NHS is that the Government are committed to spending a lot more money—more money than has ever been spent before on mental health—so we are putting our money where our mouth is. We are the Government who signed up, with the Liberal Democrats, to putting parity of esteem in law in the 2012 Act, and we are absolutely committed to doing that. There is no ground for thinking that we are deprioritising mental health. The quality premium that NHS England uses to focus the attention of CCGs will change every year. It had mental health in it last year; it had other issues in it this year; and I hope that it will have mental health in it next year.

NHS (Charitable Trusts Etc) Bill

Lord Crisp Excerpts

Friday 26th February 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I have very little to add to that extremely eloquent and clear speech, which sets out precisely what the Bill is about and why it is so important. Indeed, the Bill is sensible, practical, simplifying, and in essence we should just get on with it in your Lordships’ House. However, I will say a little about NHS charities and their importance, although I will not detain your Lordships’ House for too long.

All of us in this House will be familiar with the work of some of these charities and the way in which they provide facilities; however, they are also able to do things which the NHS cannot do as regards making improvement and change. I will pick out three particular areas. Charities can very often fund innovation in ways which the public sector cannot always do. Secondly, they can support staff, which is incredibly important, particularly at times like now, when the NHS is under such pressure; and they can also do what the great charity across the water from us here, Guy’s and St Thomas’ Charity, does, which is not just to look at the hospital but at the community itself as well, to develop and support innovation and community service. Those are all ways in which charities have modernised and innovated in recent years, and this Bill is very important in bringing about less bureaucracy and more scope for them to do those things.

There is one other way in which charities are moving in this direction globally, nationally and, I hope, within the NHS. When I am not in your Lordships’ House, I am quite often engaged in development activities in Africa. We are very well aware that charities are extremely important in Africa, but alongside those charities it is equally important to enable people, giving them the tools to look after themselves and develop their own solutions to their problems. I hope that in future NHS charities will go even further by developing the way in which they help the NHS to adjust during this current massive period of change.

I am delighted that my noble friend Lord Bird is to speak in this debate. I wonder whether he will have something to say about the very important question of how people can do things for themselves rather than just rely on charity. I think that the two things go together. This Bill will be a great help in ensuring that NHS charities have the freedom to use their imagination and creativity to support the development of health and social care in this country.

Health: Adult Psychiatric Care

Lord Crisp Excerpts

Monday 22nd February 2016 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what is their response to the report Old Problems, New Solutions: Improving acute psychiatric care for adults in England.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government very much welcome this report and are considering its recommendations. We have asked NHS England to reduce out-of-area treatments and eliminate their inappropriate use. NHS England published its independent Mental Health Taskforce report last week, backed by a £1 billion investment announced in January. NHS England will develop standards on access to mental health treatment.

[Lord Crisp (CB)]

My Lords, I thank the Minister for that reply, and I am delighted to see the commitment to parity of esteem between mental and physical health and to the funding allocated last week. Parity of esteem means equal standards for people with mental and physical conditions. The report recommends that requiring people to travel long distances to be treated should be phased out within 18 months, and there is evidence as to why that is a good target; and yet the Government have indicated in their response to the task force that it would take four years to phase it out. Will the Minister explain why that is and say whether there is scope for the Government to reconsider the timing?

[Lord Prior of Brampton]

My Lords, I reiterate my thanks to the noble Lord for his excellent report: it is 134 pages and reads very well and very quickly. It is obviously highly unsatisfactory that so many people have to travel long distances to get in-patient care. The noble Lord’s report shows that, in one month—in September, I think—500 people had to travel more than 50 kilometres to get to in-patient care. It is a priority for the Government and we are considering the noble Lord’s recommendations. I cannot give a commitment that we can reduce the four years to 18 months now. I can only repeat that we fully understand the importance of addressing this issue.

National Health Service: In-Patients with Learning Disabilities

Lord Crisp Excerpts

Monday 18th January 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, the new learning disability strategy, Building the Right Support, proposes that people with learning disabilities should get their mental health treatment from mainstream mental health services—which as noble Lords will know are already under considerable strain. Can the Minister let us know what assessment the Government have made of the likely impact that this will have on mental health services and how they envisage that the financial and other implications will be managed?

[Lord Prior of Brampton]

The noble Lord refers to the paper Building the Right Support, which I think he will be very supportive of. It is designed to treat and look after many more people with learning difficulties outside institutional settings—in their own homes or in special purpose, much smaller homes. Where necessary, they will of course need to receive mental health services. I am not aware that we have done a particular impact study on that, but I will investigate it and write to the noble Lord.

Health

Lord Crisp Excerpts

Thursday 26th November 2015 Lords Chamber

Moved by

[Lord Crisp]

To move that this House takes note of the case for building a health-creating society in the United Kingdom where all sectors contribute to creating a healthy and resilient population.

[Lord Crisp (CB)]

My Lords, first, I thank my noble friends on the Cross Benches for choosing this debate today, but I also thank all noble Lords who are taking part in it. I am very much looking forward to hearing everybody’s contributions. I recognise that this is last business on a Thursday, so I am particularly grateful to noble Lords taking part. I also welcome the three noble Lords making their maiden speeches. I know that we are very much looking forward to what they have to say now and in many future contributions in your Lordships House.

The health and care system is under great strain as needs grow, particularly from older people with long-term conditions, and as costs rise. This mirrors the position elsewhere, not only in Europe and America but in many fast-developing countries. Not surprisingly, and not just in the UK, there is widespread concern and considerable confusion about the future for health. This uncertainty and insecurity means that it is more important than ever to understand the complex nature of health problems and what can be done about them, and to set out a long-term vision and strategy for the future.

Health and well-being are affected by three big things: the availability and quality of health and care services; individual lifestyles and behaviours—individual responsibility for our own health is absolutely vital; and all the physical, economic and social factors such as education, employment, wealth, social structures and the physical environment. Those are the many determinants of health, and co-ordinated action is need across all three areas. However, my focus today is on the third of these—the wider determinants of health, which go way beyond the reach of the NHS and individuals.

There is a great World Health Organization quotation:

“Modern societies actively market unhealthy life styles”.

I want to talk about how we can set that on its head. What would it be like, instead, to build a health-creating society where everyone—citizens, families, communities and businesses alike—had a role to play? None of what I have said, however, should detract from the importance of the first two—the health and care system, and the choices and actions of individuals—and I am sure other noble Lords will address those.

Let me just give a few examples of what I am talking about. Barely half of our children achieve a good level of development by the time they start school, which affects their future physical and mental health and, of course, their ability to learn. Going to the other end of the age range, social isolation and loneliness in old age have the equivalent health impact of smoking 15 cigarettes a day and a slow recovery from illness. There is recent evidence that they also lead to earlier death. Having a social network and some meaning in life is hugely beneficial. Some groups in the population are affected more than others, including people with mental health problems. Men with severe mental health problems die up to 20 years earlier, and women 15 years earlier, than people without such problems. Importantly, there are also lower levels of subjective well-being and a higher burden of ill health in people from black and minority ethnic communities. Moreover, as Sir Michael Marmot has demonstrated, inequality damages health, with the most disadvantaged being most prone to ill health and living shorter lives.

Perhaps the most alarming statistic of all is that, on average, UK citizens have about seven years of ill health before we die; at the top of the scale, the Norwegians have only two years. What if we could reduce the UK figure by even one year? What a difference that would make for individuals and, at the same time, for the health and care system and therefore the economy. What is so different about Norway? This surely gives us a target to aim at.

These are complex problems, and they illustrate clearly that health cannot simply be left to individuals, the NHS, professionals or government. Everyone in every sector has a role to play. Moreover, improvements in health go hand in hand with improvements elsewhere. Education, the environment and the economy: all will benefit from a health-creating society. Better health and greater prosperity go together.

This is also very relevant to the future sustainability of the NHS, which is often discussed, like so much in health, in largely economic terms, as if it were really an economic problem and there could be purely economic solutions concerned with financing and/or restricting services and treatments. However, experience from the Netherlands to the USA shows that those solutions produce at best limited gains and may increase the economic cost to society as well as individuals. The long-term sustainability of the health and care system will come from changes in practice, finding health solutions to health problems and moving upstream into prevention, health promotion and, as I suggest here, building a health-creating society. Arguably, the NHS will not be sustainable without this.

Those are the problems, but an enormous amount is already being done. We can look at what is going on in the community and voluntary sector, and I am sure we will hear a great deal about that from other noble Lords. We know, for example, that informal carers contribute services worth an estimated £119 billion a year at least. If the informal care sector fails, the burden falls on the formal sector. People do not want to be dependent and are keen to live independent lives.

Connecting Communities brings together many of the organisations that work on small, local health projects. There is a wonderful African saying: health is made at home, hospitals are for repairs. It matches the scientific evidence about creating the right environment in every sense. It is also for us a reminder of the work in the UK of the Early Intervention Foundation.

Let me turn to other sectors: to designers, architects and planners, who can design buildings which encourage walking and the use of stairs, communities where people meet each other and public buildings which bring together different services. I declare an interest as a member of the council of Reading University, and note as an example the work going on there on the built environment. Researchers are looking at topics as diverse as indoor air quality in schools and workplaces and its effect on health and the well-being and educational performance of children and workers, and the relationship between the design of homes and health and well-being.

Moving on to businesses, as well as developing healthy products, they can create healthy environments for their workforce, recognising how much time and productivity is lost every year through ill health. They can both promote health and tackle specific problems, as the firms working together in the City Mental Health Alliance are doing. It is good to see the work of Dame Carol Black as a government adviser raising standards in this area. Schools, colleges and universities can promote health literacy and competencies, integrate healthy activities into daily life and share facilities with health and other services.

I very much hope that my noble friend Lord Mawson will talk about the St Paul’s Way Transformation Project in the East End of London. It is perhaps the most complete example of all these things that I have ever come across. It is about the community coming together with the private sector, education, health and care services: joining up the dots, as I suspect he may say, and informed by an entrepreneurial spirit. It is very much a model for the future.

Of course, government has many roles here. I recognise the importance of the economy and that the aspiration for a higher skilled and higher paid workforce is fundamental to health and well-being. Government is also able to address regulation and legislation, be it on salt, sugar, alcohol or elsewhere. Government can run great public education campaigns, but it also needs to do more to support civil society. I question whether it is doing enough now to build the sort of enabling environment we want, with all the social and community activities I mentioned earlier. It can also support disabled people to live independent lives. I am sure that my noble friend Lady Campbell will have something to say on this, both in this debate and elsewhere.

So there is already an enormous amount going on. Let me note the work of NHS England, Public Health England and other such bodies, local government—I welcome the devolution of responsibilities in Manchester and elsewhere—voluntary bodies, professional associations, researchers and many more than I have listed here. My purpose in this debate is to point to all this and ask how much more we could achieve if we did it in an even more co-ordinated way. I am sure the Minister has a briefing folder bulging with excellent examples of policies, initiatives and activities, and I look forward to hearing about them. There are many out there. However, the Government could do much more in a joined-up way across government, bringing in all those bodies and sectors of society that shape the health of the population. In truth, only Government can really mobilise everyone who needs to be involved.

As the Minister knows, I wrote to the Prime Minister immediately after the election to propose that he and the Government take a big, bold initiative to mobilise all sectors around building a health-creating society. I received a broadly warm reply and understand that the time needs to be right for such an initiative. Now, with winter coming and industrial action planned, is certainly not it, but the time will come for a bold and imaginative commitment to engage all sectors in building a health-creating society. Does the Minister accept this analysis? Will the Government, at the right time, reach out and mobilise all those other sectors to help build a health-creating society—and not, as it so often appears in the newspapers, leave it all to the NHS, government and individuals?

There is also a challenge here for all political parties. I meet a lot of people working in the health and care system and I observe two things. One is frustration, depression and sometimes even despair about the future. However, when I listen to them I also hear a common vision of what that future might be like. In summary, and in very simplified form, this vision is of a transition from the current hospital-led, professional-dominated and fragmented system where things are done to and for patients, to a much more seamless people and community-based one where patients and communities play their roles alongside professionals. This is a vision of high-quality services, delivered in homes as well as local facilities, with a different infrastructure and far greater use of technology. My noble friend Lady Lane-Fox has talked about that, and I suspect she will do so again. With these changes comes the potential for both higher quality and lower costs.

This vision will require major change. I have no doubt that it will require the closure of some hospitals and changing roles for staff. This will be difficult, both practically and politically, and will need political support. The challenge to the political parties seems to be that we need a shared vision for the future and some cross-party political will to make this happen. There will be plenty of political differences about the means of getting there but it seems that this end, this sort of vision, is common ground.

We already have some elements of such a vision in current policy: the Five Year Forward View is very good and has a lot of support, but is ultimately a technocratic and managerial document—I know because I have written such documents in the past. There is a need for a broad-based, cross-party coalition of agreement about what the future looks like. I do not know how that should be achieved, whether through some appointed commission or otherwise. What I do know is that people in the NHS and the country more widely would benefit from clarity of vision and strategy.

Your Lordships’ House also has a role here. It has very often led the way in discussing new and coming ideas and influencing the future. I think of debates I have heard here, for example, on genetics and, most recently, on securing parity between mental and physical health. Noble Lords from all sides of this House argued that case cogently and ultimately very successfully. I hope we might be able to do the same sort of thing here. I note that we are presently asked if we want to put forward proposals for ad hoc committees. I wonder if we should put forward one on building a health-creating society, so that these important ideas can be deliberated on in much more detail than the five minutes noble Lords have today allows. I would be interested to know if noble Lords thought that a good idea and would like to join me in making such a proposal.

Let me finish in optimistic and mildly jingoistic style. The UK is a great world leader in health. We have astonishing strengths in academia, the NHS, the role of DfID globally, the voluntary sector and our commercial organisations. The UK was a pioneer in providing a National Health Service that covered everyone in the population. It would be wonderful if we could lead the way again in moving beyond the professionally dominated and rather industrialised system of service to build a health-creating society served by a modern, fit for purpose health and care system. That would benefit us all as individuals, and bring with it wide-ranging benefits to the country in both prosperity and health. I beg to move.

--- Later in debate ---

[Lord Crisp]

My Lords, as I said at the beginning of the debate, I am very conscious that this is the last business of the day, so I will not detain the House for any length of time. I just want to thank noble Lords for the outstanding contributions from all parts of the House and for the wisdom, experience, imagination, practicality and practical experience that they have brought to bear to the debate. I have learnt a lot, not least about the Isle of Axholme and Bath, and indeed I intend to visit the Hindhead Tunnel—when I say it like that, I make it sound a bit like a pub, which is perhaps appropriate.

We have heard three impressive maiden speeches covering the health and well-being hubs in north Lincolnshire, personal responsibility and the role that government should play, and the importance—this was also drawn out by other noble Lords—of sociability and social networks.

There are four big themes, which I shall set out briefly. The first is the role of the Government. At the beginning of the debate, the noble Baroness, Lady Jay, spoke about needing a Cabinet-level Minister to provide some real drive and traction. The second theme, which I was slightly surprised to hear so much about, concerns relationships, sociability and loneliness. Many noble Lords raised that issue, which is of fundamental importance. The third theme is concern about vulnerable people and inequality, with the recognition that we understand that social structures affect health. The final theme is innovation and imagination, and the fact that there are new things which we can do and which we need to deploy.

Noble Lords will not be surprised to hear that I do not want to leave this subject here. A lot is happening but, as I said at the beginning, it is not being done with enough scale and co-ordination—or perhaps “oomph”, to use a technical expression. Therefore, I will be pressing for an ad hoc committee to dive deeper into these issues and to find practical ways of moving this issue forward.

Motion agreed.