Queen’s Speech
Lord Layard Excerpts(4 years, 6 months ago)
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Lord Layard (Lab)
My Lords, the first question one should ask about any Queen’s Speech is: what is the overall objective of government policy? Is it the nation’s wealth? Is it the well-being of the citizens? What is it? To have coherent government, you must have an overall objective against which to measure policy. More and more people worldwide are demanding that the objective should be human experience—the well-being of the people—and I agree with that.
How does the Queen’s Speech stack up against the objective of well-being? Not well, I fear. To see this, let me compare the Speech with a recent report from the All-Party Parliamentary Group on Wellbeing Economics. The report addressed the key issue of what priorities for public spending would be if it were targeted at the well-being of the people—at the things that people really worry about. It concluded that the top four priorities were: better mental health services, which many noble Lords have said; secondly, child well-being and schools; thirdly, further education and apprenticeships—the transition to work; and, fourthly, social care. Of those four objectives, none of the first three appears in the Queen’s Speech, although they are things that parents—and all adults—are crying out for positive action on. Instead, the Speech is full of punishments of all kinds and the new strategy for the nation’s physical infrastructure. Those are the main priorities in the domestic part of the Speech.
What about the social infrastructure of our country? Over the past 10 years, we have closed hundreds of children’s centres, youth clubs and community centres. We have produced a crisis in child mental health. What is the sense of spending what new money we have on, for example, building high-speed rail, before we have rectified the desperate shortcomings of our social infrastructure? Many argue that the top priority must be physical infrastructure because that is what the market is willing to fund, because it gives a financial return, but so does social infrastructure. I shall give some examples from the field of mental health.
The NHS programme for improving access to psychological therapies has been found, within two years, to save more in reduced welfare benefits and reduced physical healthcare expenditure than the total amount spent on the programme. The net cost of the programme is zero. Similarly, if you are worried about adolescent knife crime, a proven method is to train the parents of badly behaved youngsters when the youngsters are aged five to seven. This training has been shown to reduce anti-social behaviour 10 years later by well over half, and it costs very little. Remarkably, we used to have such training. We had 4,000 people trained as parent trainers but, under the coalition Government, those services were cut as part of the general cut to social infrastructure. Those people are still there and are ready for re-employment—if only we put our next available money into that kind of provision.
As has been said, we have to upgrade and accelerate the general rollout of mental health services in schools, and the teaching of life skills in the school curriculum. These are key to producing a happier generation of children, and a generation that causes less trouble to adults. What is so depressing about the Speech is its almost totally punitive approach to any kind of behavioural problem. The word “rehabilitation” appears once and “prevention” never appears, yet there are good psychological treatments and preventive programmes for all kinds of behavioural problems, such as domestic violence, which is rising in priority, and family conflict. Only small sums of money are needed to make major inroads into these problems. How much more important to do this than to build yet another bit of high-cost physical infrastructure.
On further education, I had high hopes of the Government because they said it would be a priority. Very little money has been provided so far—only one year of it—and no programme has been announced for how to deliver the universal rights to level 3, which the Augar report recommends, which in turn requires that we remove the cap on further education, just as we have removed the cap on university and higher education. All these deficiencies come from there being no clear overall objective of government policy to influence priorities. The time has come for every political party to commit to the objective of well-being and to support that with a social infrastructure strategy. I very much hope that the next Queen’s Speech will do just that.
Mental Health of Children and Young Adults
Lord Layard Excerpts(4 years, 11 months ago)
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Lord Layard (Lab)
My Lords, in her excellent speech my noble friend Lady Royall described the dismal state of access to treatment for young people with mental health problems—a point repeated by almost every speaker. The question is how to deal with it. I think that the way forward is quite clear, because the situation for children now is almost exactly the same as it was for adults in 2008. However, since then, the situation for adults has been improved radically through the programme for improving access to psychological therapy, otherwise known as IAPT. This includes a large programme for training therapists, plus new services rolled out across the country to deal with all but the most serious cases, who continue to use regular mental health services.
What we need to do for children now is exactly what has already been done for adults, and that is the approach that the Government agreed to in the Green Paper. That was an excellent document. It proposed creating a nationwide system of mental health support teams to do for children what IAPT has been doing for adults. The teams will take all those cases that fall below the very high CAMHS threshold, and typically they will do that in the friendly setting of a school. Therefore, this is a moment of great hope and I congratulate all those in the Department of Health and Social Care and in NHS England who have brought us to this point. However, I also want to raise three key issues in respect of which I think the programme could be significantly strengthened.
The first is training. At present, the training is mainly for handling only mild to moderate problems. However, unless the service can also handle moderate to severe cases, it will end up passing many children who start off in it upwards to CAMHS and the blockage in CAMHS will continue, just as happens now. Therefore, in these new support services we need a stream of “high-intensity” therapists, as they are known, working with young people in the same way as they work with adults in IAPT.
The other issue is conduct disorder, which is not adequately covered in the training of the support teams. It is as serious a problem as anxiety and depression. We have already trained 4,000 practitioners to deliver the group training of parents of children with conduct disorder but very few of them are being used. We should be using them.
The second issue that I want to raise is the management of the service. When adult IAPT started, it was helped enormously by an expert reference group, which included leading psychological therapists, who brought their experience to bear on the design of the service and, conversely, carried back to the profession their own excitement about what was happening. However, we do not have any such group for children, and many leading figures in the profession feel excluded from the process. That is a real pity, and I hope that the Minister can assure us that such a group will be created. I hope that she can also assure us that the more ambitious training scheme that I have mentioned can be put in motion.
The third issue is scale. The Government have allocated only £250 million to the support teams over the first three years. In current money, that is half the figure that was spent on adult IAPT in its first five years. This timorous approach means that, as has been mentioned, under a third of the country will be touched by the new children’s service in the first three years. Surely we should be more ambitious than that. In fact, I would like to suggest that we should be more ambitious about mental health overall. Since 2000, mental health has been the top priority of the NHS—that is what has always been said—but the share of NHS expenditure has remained exactly the same. That will change only if the NHS has a specific, separate, ring-fenced budget for mental health. This is an issue that we should all think about. I suggest that we need a budget for mental health growing at 6% a year in real terms compared with 3% for physical health.
Finally, I would like to ask two questions about schools. First, the Prime Minister has promised to enable schools to measure the well-being of their children. That is an excellent idea that will affect schools’ ability to help children and incentivise them to take well-being much more seriously as a goal alongside academic achievement. However, we have not heard what is going to happen as a result, and what I have heard has been worrying. Can the Minister tell us what, concretely, is going to happen with the Prime Minister’s promise?
My second question concerns life skills. This Government have been the first to make life skills compulsory. That is a huge and excellent step forward, but they have not said how much time as a minimum should be devoted to life skills. In some schools, it will be rather a small amount. Can the Minister assure us that some guidance will be given on the minimum amount of time to be spent on this? I suggest that it should be at least one lesson a week.
Therefore, things are moving forward, as many speakers have said. That is wonderful, but surely they need to move a lot faster.
The Long-term Sustainability of the NHS and Adult Social Care
Lord Layard Excerpts(6 years ago)
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Lord Layard (Lab)
My Lords, I, too, congratulate the committee and, like many earlier speakers, think that something more radical is needed on funding. The fundamental problem with the present system is the complete disconnect between the Government’s funding decisions and, on the other hand, what the public want and are willing to pay for. For example, in a recent MORI poll, people were asked to pick out their preferred option for the NHS, and no less than 66% of the public picked out the following option:
“I would be willing to pay more taxes in order to maintain the … spending needed”,
in the NHS. However, the problem is that under the present system there is no mechanism by which they could implement their wish. Taxation and spending are totally separate issues in the way the system operates, and the public will get what they want only if we can find a way to bring the two together—and that is of course a hypothecated tax.
If you have a hypothecated tax and the public vote for a manifesto, they are voting simultaneously for the end and for the means. You have to bring the end and the means together into a single decision. So I am happy that our colleague, the noble Lord, Lord Macpherson, formerly of the Treasury, has asked me to say that he now favours hypothecation. The Treasury is the main obstacle to this proposal; it wants to make the spending decisions and thinks that it is best placed to do the trade-offs. But it is the Treasury that got us into the mess we are in now.
One obvious objection to hypothecation is that the health service needs certainty about its funding, while taxes are uncertain and depend on the business cycle. I discussed this issue in my evidence to the committee, and the following arrangement would work well. At the beginning of each Parliament, the Government would present a 10-year plan for the NHS, including services, workforce and expenditure. The second five years would be indicative, but the first five years would be a commitment. Associated with that commitment would be a preannounced rate for the health tax such that the forecast proceeds would equal the committed expenditure over the Parliament. If in the upshot because of the cycle there was some difference, year by year or even overall, between the proceeds of the tax and the committed expenditure, the Treasury would make up the deficit or collect the surplus.
As many people have said, we want a funding system that simultaneously covers health and the part of social care that is paid for by public funds. As some other noble Lords suggested, we would have to extend the insurance tax base to include all income at all ages. However, once this was put in place and we had converted the national insurance system into national health insurance and raised enough extra money for the health and social care system, which would be needed, to some extent we could cut other taxes which currently finance health and social care.
I will end on the issue of what scale of expenditure would be likely to emerge if we had such a system. First, over the last 40 years health expenditure has steadily risen as a share of the national income, except in the last decade, and that has been so in every advanced country, including in our own. We ought to expect that pattern to be ongoing, because it reflects people’s preferences on how they want to spend their additional income. But in addition to that we need a rapid one-off upward adjustment to get us back on track, because we are off track. That is what people say they want, as I quoted, and I will also give your Lordships another research-based reason for a one-off adjustment.
This comes from happiness research—something I practise—which shows that physical health and, even more, mental health, have very large impacts on human happiness. These impacts are also very large when compared with the effect of variations in household disposable income after tax. In spite of the huge importance of health, health spending is now rationed by the NICE regulations, which require that you have to have at least one extra—this is jargon—quality-adjusted year of life for every £30,000 spent. It will not allow you to spend the £30,000 unless you have one extra quality-adjusted year of life as a result. But from happiness research we know that, when households collectively give up £30,000 in taxes, they lose only one-thirtieth of a quality-adjusted year of life. So spending more on health gives you a benefit-cost ratio of 30, which is a pretty good argument for spending more money.
So we need a hypothecated tax, and I see no reason why the British public would want to spend less than the average percentage of GDP that is spent on health in northern Europe. That would require an extra £40 billion a year as of now. That is the direction in which we should move, and we should move as fast as possible.