Debate on the Address

My Lords, let me begin by restating the Government’s commitment through a strategy of investment and reform to improving and protecting the health of the whole population, with special attention to the needs of the poorest and those with long-term conditions. We have seen the health budget treble between 1996-97 and 2007-08, when it will reach £92 billion. This has enabled us to expand the workforce by more than 300,000, including over 85,000 more nurses and more than 32,000 doctors. We are treating more patients faster and better than ever before. Today, 95 per cent of people referred by their GP with suspected cancer are diagnosed and start their treatment within 62 days. Between 1996 and 2004, death from cancer in people under 75 fell by nearly 16 per cent, saving an estimated 50,000 lives. The total waiting list has fallen by a quarter in the past six years—a reduction of 260,000. From the end of 2008, patients will wait no longer than 18 weeks from GP referral to the start of treatment. A&E departments now consistently treat over 98 per cent of patients within a maximum wait of four hours. Ten years ago, half the NHS estate was built before the NHS itself. That is now down to a quarter. There are now 157 new hospitals open, under construction or in procurement—the largest sustained hospital-building programme since the NHS was founded. More than 2,800 GP premises have been improved or refurbished. More than 75 NHS walk-in centres are open, including four commuter walk-in centres. We have introduced treatment centres so that planned surgery can be just that. There are 44 NHS treatment centres, which have treated more than 300,000 people since 2003, and 21 independent sector schemes, which have delivered more than 300,000 treatments and diagnostic tests—all under the NHS, free at the point of need. No wonder 92 per cent of adult patients rated their care as good or better, as do 94 per cent of adult out-patients and 88 per cent of those who use accident and emergency departments. It is the same picture in primary care, where 97 per cent of patients say that their main reason for visiting their practice was dealt with to their satisfaction. We are giving more choice for people about the services that they use and more autonomy to local hospitals through foundation trust status. We have more diverse providers, with more freedom to innovate and improve in response to what patients and commissioners want. The White Paper that we published in January will bring more care closer to home, as people want, and give a stronger emphasis to health promotion and public health, along with greater integration of health and social care. The improvements across the NHS have encompassed mental health services, which remain a key priority for the Government. Since the publication of the national service framework in 1999, planned spending on mental health has gone up by more than 25 per cent in real terms—nearly £1 billion. There has been a huge shift in services from in-patient services to the community, with new roles for staff and new, more individual services for service users. In 2005-06, almost 84,000 home treatment episodes took place for people who would otherwise have required in-patient admission. At the end of June 2006, almost 19,000 people were receiving assertive outreach services. Mental health services have become increasingly responsive to the needs and wishes of the people who use them. The new Mental Health Bill, introduced on 16 November, is a key part of this plan to improve life for people with mental health problems and to make treatment more focused on their needs. The Bill amends the Mental Health Act 1983, which sets out the circumstances in which a person with a mental disorder can be detained in hospital and treated without their consent, to protect them, or others, from harm. On behalf of the Government, I thank all those who have helped in the development of the Government’s proposals for reforming this legislation, from Members of this House who contributed through the pre-legislative scrutiny committee, to the 1,000 or so organisations and individuals who commented on the earlier Green Paper, and the 2,000 or so organisations and individuals who commented on the 2002 draft Bill. We are very grateful for the enormous amount of time and effort that has gone into reshaping and improving this legislation. Although one in six of us may experience some sort of mental health problem in the course of a year, most people never need to be detained in hospital and treated under this legislation. Mental health legislation affects only a very small minority but, crucially, it helps to ensure that people with serious mental disorders can be required, where necessary, to receive the treatment that they need to protect them and the public from harm. The new Bill will modernise the legislation in line with developments in the NHS, and strengthen patient safeguards. In addition, it is being used as the vehicle for introducing the so-called Bournewood safeguards, through amending the Mental Capacity Act 2005. These safeguards are for people who lack capacity to decide about their care, are deprived of their liberty to protect them from harm, but are not covered by the Mental Health Act safeguards. Early in 2007, we will also publish a draft Bill, for pre-legislative scrutiny, to update the law on assisted reproduction and embryo research, following the department’s review of the law in this area. The United Kingdom is at the forefront of developments in human reproductive technologies. This country has pioneered new techniques for alleviating infertility and for conducting research into serious diseases.We also pioneered a system of effective regulatory oversight. We are committed to ensuring that the law is up to date and continues to promote public confidence in human reproductive technologies. The law and the regulator—the HFEA—have performed well to date, but it is time to update the legislation, given new technology and attitudes. We will shortly publish the policy proposals related to the Bill. The Bill also provides an opportunity to establish a single regulator responsible for the whole range of human tissue and cells: the Regulatory Authority for Tissue and Embryos or, in short, RATE. RATE will replace the Human Fertilisation and Embryology Authority and the Human Tissue Authority and will take on important regulatory functions in relation to blood. The intention to create RATE was announced in the department’s review of arm’s-length bodies in 2004. The Government will continue the programme of education reform to improve equality of opportunity and the skills base that our economy needs if it is to remain competitive. The Further Education and Training Bill is a key next step in the Government’s programme to reform further education. It implements key aspects of the Government’s White Paper published in March 2006. It will restructure and streamline the Learning and Skills Council. It will change the way the council is able to work with partners to make it more responsive to local needs and the needs of learners and employers. It will enable new forms of delivery and will encourage diversity and choice in further education provision. We announced in the White Paper our intention to introduce a more robust intervention strategy to address provision that is inadequate, barely satisfactory or coasting. The Further Education and Training Bill includes the legislative changes needed for that. It will also strengthen the leadership of further education by requiring principals to have relevant qualifications. The Bill also simplifies the operation of industrial training levies and includes relevant measure-making powers for the Welsh Assembly. The Government wish to extend opportunities for people to study for higher education qualifications. The Bill will enable that by allowing colleges to award foundation degrees. The key measures in the Bill will help to equip the further education sector so that it can respond effectively to the skills challenge articulated by the noble Lord, Lord Leitch, in his report to the Government on the UK’s future skills needs. It will support employers and individuals in developing the skills that Britain needs to ensure our future prosperity. The gracious Speech included three pieces of welfare reform legislation that reflect our vision of the state supporting people to achieve their aspirations and potential: a Bill on child maintenance to end the legacy of failure; a Welfare Reform Bill that will support those who face the most difficult journey back into work; and a Pensions Bill that will cement the broad consensus to support savings and pensions in an enduring pensions settlement for the long term. Since 1998, 700,000 children have been taken out of poverty, reversing a trend from the 1980s that condemned children by stalling opportunity and mobility. Last month, we had the highest rate of employment on record. More than 29 million people were in employment, and that figure had risen by 120,000 in the past three months. The UK continues to have the best-performing labour market among the major world economies. Since 1997, our measures have taken 2 million pensioners out of absolute poverty and 1 million pensioners out of relative poverty. When my right honourable friend the Prime Minister announced that this Labour Government would seek to end child poverty in a generation, he set an objective that reflected the scale of our ambition by seeking to eradicate child poverty by 2020 and so secure equal life chances for all. The system of child maintenance embraces the principle of caring for the welfare of children and requires parents to fulfil their financial responsibilities, particularly in the difficult transition of family break-up. However, the Government recognise that the current system is not working; it works against parents rather than working with them to deliver the best outcomes for their children. There is a backlog of 225,000 cases awaiting assessment or calculation and there is an accumulated debt of £3.5 billion. That is why we commissioned the comprehensive redesign from Sir David Henshaw and have accepted the vast majority of his recommendations. In broad terms, the new Bill will promote parental responsibility by encouraging and empowering parents. It will lift more children out of poverty by increasing the amount of maintenance that parents on benefit can keep; it will ensure that more parents take responsibility for paying for their children and that more, especially the poorest, benefit from this; and it will create a new organisation to replace the Child Support Agency and to deliver a more focused and cost-effective child support system. Importantly, the new system will crack down harder on the non-payers. We will create more enforcement powers to deal with parents who repeatedly fail to pay maintenance by suspending passports and imposing curfews. Our Welfare Reform Bill, introduced in another place in June, puts forward a comprehensive package of reform to support our aspiration of an 80 per cent employment rate for people of working age. With record rates of employment, we can focus even more of our efforts on those who need particular support back into work to raise people out of poverty. The Bill replaces incapacity benefits with a new employment and support allowance for those whose health affects their capacity for work. This focuses on capability and continuing support to manage a condition and return to work. Further support is extended to individuals through the national implementation of the successful Pathways to Work pilots, delivered through the private and voluntary sectors to secure maximum innovation and flexibility in addressing complex individual needs. Housing benefit reforms will make it easier for people to move into work by helping to speed up local authority administration, promoting greater choice and responsibility for tenants, promoting financial inclusion and helping the fight against benefit fraud. Powers to sanction housing benefit to people evicted for anti-social behaviour and refusing to engagewith rehabilitation provision strengthen the rightsand responsibilities contract that we expect between individuals and the state. The third of our welfare measures is the Pensions Bill, which will reform the UK pension system for generations to come. The work of the noble Lord, Lord Turner, and his commission has led a process that has brought broad consensus. The measure outlined in the gracious Speech provides a clear way forward to tackle demographic challenges and support savings and retirement in the future. We will link the uprating of pensions to earnings—restoring the link broken in 1980—to provide a solid foundation on which to save for retirement. We will make entitlement to basic state pension fairer for women and carers by reducing the number of qualifying years. The Bill will simplify the state pension and streamline the private pension regulatory environment, making it easier for people to plan and save. We will secure the long-term financial stability of the pension system by gradually raising the state pension age to 68 by 2046 to keep the proportion of life spent receiving the state pension stable for each generation. Finally, the Bill establishes a delivery authority to prepare for the infrastructure of personal accounts that will provide a low-cost savings vehicle. The measures on child support, on welfare reform and on pensions reform provide a step forward in our support for people throughout their lives. Together they seek to improve children’s start in life and support people of working age facing difficult circumstances to get back into employment, and they provide a lasting and comprehensive package of support for savings and pensions that help to give comfort and independence in old age when, as a society, we are living longer. Taken with our measures on further education, mental health and regulating human fertility assistance, and with our broader programme of NHS improvement, these welfare changes represent a vibrant programme for strengthening our social programmes that support people through their lives.