King’s Speech

We are not only taking steps to prevent Xavi’s generation suffering major illnesses but steps that will allow them to take more responsibility for their health. Just as we use apps and technology to manage our finances, retail preferences and social lives, they will be able to manage their health using technology, through the NHS app. As we speak, we are loading more features which will allow patients to understand their health needs through accessing their health records, and to navigate and decide whether they are best served by seeing a pharmacist through our Pharmacy First programme, seeing a nurse or a doctor, or referring themselves straight to a specialist at one of our 160 new community diagnostics centres. Patients will be able to make appointments from the app and then get their results directly to their phones. If they need follow-up treatment with a specialist, at a hospital or at a CDC, they will be able to exercise choice to find an appointment that suits them, whether that is seeing a particular doctor, getting care closer to home, or getting a shorter waiting time.

Artificial intelligence and technology are already allowing us to do great things. AI is allowing us to halve the time that it takes to treat people with strokes, making it more likely to recover completely. It is allowing radiologists to read lung and breast scans to detect cancers more quickly and more accurately than ever before. For Xavi’s generation, AI can do so much more. It could help us to discover medicines and cures that have defeated us so far, and it could analyse health records, helping us to join the dots between what links different generations and different conditions, to allow scientists to develop medicines and treatments to target the causes of major diseases.

All the work that we are doing to improve the nation’s health is underpinned by our long-term workforce plan—ground-breaking in its purpose—ensuring that we have the right numbers of nurses, doctors and specialists, and the right training and pathways into the profession, whether that is by expanding degrees, apprenticeships, or more on-the-job development. Underlying all our work is the need to focus our most precious resource, our people, on getting upstream of the problem. Rather than just focusing on hospital treatment centres and primary care, we are focusing resources on prevention and increasing the use of technology.

At this stage, I want to emphasise the Government’s commitment to creating parity between mental and physical heath and to introducing the mental health Bill in the future, when parliamentary time allows. In the meantime, we are taking decisive action. We are eliminating dormitory accommodation, so that people with mental health conditions are treated where they can be best cared for—in the community. We are making sure we have mental health ambulances available to answer 999 calls where we need a mental health response. We are also investing an additional £2.3 billion to support 2 million more people to receive mental health treatment.

As well as building a sustainable future for the NHS for our children, we are making sure it is ready for winter. Average category 2 ambulance response times were over 10 minutes faster in September than in the same month last year—and we are going further. This year, we are investing an additional £600 million into our discharge fund, supporting hospitals to discharge patients when they are ready, with the right support, and stopping patients who do not medically need to be in hospital from taking up important beds and delaying ambulance handovers. We are also providing 5,000 additional permanent staffed beds, introducing 800 new ambulances and using our 10,000 hospital-at-home beds to keep thousands of patients out of hospital.

As well as protecting the health of Xavi and the next generation, we are getting them ready for their futures. We are proud of our education record to date. Xavi and his friends are far more likely to go to a school rated good or outstanding. When we took office, just 70% of schools met this standard; today, that figure is 90%. Our nine and 10 year-olds lead the western world in reading, and our 15 year-olds perform significantly above the OECD average for reading, maths and sciences. However, the parallel nature of A-levels and technical qualifications limits the breadth of young people’s education, stops progression in maths and English far too early and prevents parity of esteem between academic and technical qualifications. Furthermore, we are an international outlier from 16 to 19 in terms of subjects taken and the number of hours taught. The advanced British standard will ensure that, when Xavi and his friends turn 16, they will face a world-class system, placing equal value on technical and academic knowledge, giving them depth and breadth of knowledge to succeed in further study and the world of work.

I now turn to housing and the world that we want to create for Xavi’s generation and those that follow. First, we understand the vital role of housing supply. Since 2010, we have delivered nearly 2.3 million homes, realising dreams of home ownership and delivering decent rented accommodation. We are on track to deliver our manifesto commitment of building 1 million more homes over this Parliament. At some point, all of us, including Xavi, are likely to rent their home, maybe as a stepping stone to home ownership, or maybe for the long term. Whatever the circumstance, we have acted to make renting better and fairer by cracking down on those 400,000 non-decent homes and banning tenant fees. With the Renters (Reform) Bill, we are going further. We will ban no-fault evictions that carry just two months’ notice, empower tenants to raise concerns about the quality of their property and give them greater security. At the same time, we want to be fair to landlords, making it easier for them to evict tenants who display anti-social behaviour or wilfully do not pay their rent.

We also want to help people like Xavi and young people today into home ownership. For some of us, that will mean buying a leasehold property. This Government are committed to improving the experience of the owners of the 5 million leasehold dwellings in England and Wales. We have already capped ground rents in most new leases at very low rates and we will deliver further leasehold reform with the leasehold and freehold reform Bill, which will ban the sale of new leasehold houses. Where leaseholds are required for practical purposes, such as in flats and apartments, we will extend their lease to 990 years and cap new ground rents, with the intention of giving future leaseholders the equivalent experience as if they owned the freehold on their home. We will also launch a consultation to see how we can further improve leaseholder rights. This legislation will fundamentally reform the leaseholder system, ensuring that families have the right fully to enjoy their homes and giving them increased opportunities to pass them on to their children.

While this Government are committed to supporting our society in health, education, housing and living and working independently, I want Xavi to know that we take care of those who need our support—now more than ever with the heightened cost of living. We spend £31 billion on supporting renters with housing costs and £276 billion in total through the welfare system in 2023-24, including providing more than 8 million low-income households with cost of living payments totalling up to £900. For those who need it most, we have increased benefits and the state pension by 10%, in line with inflation. We have made strong progress towards halving inflation by the end of the year, thereby reducing cost of living pressures. I am proud to say there are 1.7 million fewer people in absolute poverty than in 2010, including 200,000 fewer pensioners and 400,000 fewer children.

While we must support people who cannot work, it is vital that we give a leg up to those who can. As well as bringing economic benefits to a person, work boosts their confidence and well-being. The Government have made work pay with the introduction of a national living wage and by ensuring that those earning £12,570 or less pay no income tax or national insurance. These steps led to record employment rates before the pandemic and, last year, the lowest level of unemployment for 50 years. At the same time, there are 2.6 million people who are economically inactive due to disability or long-term sickness. Over a quarter of those who are long-term sick want to work, to the benefit of themselves and the economy. With flexible working and the ability to work from home, we want to help these people into the types of work that they can do, while understanding their conditions. That is why we have launched a consultation to change the work capacity assessment to come into force by 2025 and to provide tailored support for people to safely move into employment, to benefit them, their health, well-being and confidence and, of course, our economy.

I finish by addressing an issue of utmost importance, given the ongoing events in the Middle East. The aftermath of Hamas’s attack on Israel on 7 October demonstrates a clear link between anti-Israel sentiment and anti-Semitism. In the 21 days following this attack, the Community Security Trust recorded more than 800 anti-Semitic incidents—the highest ever recorded in a 21-day period. We know that boycotts and sanctions are divisive and undermine community cohesion. Many target Israel, under the banner of the Boycott, Divestment and Sanctions—or BDS—movement. There is evidence that this movement has contributed to the horrific rise of anti-Semitism in the UK. Yet we have seen taxpayer-funded bodies attempt such boycotts. In 2014, Leicester City Council passed a BDS motion on boycotting goods from Israeli settlements; that same year, Gwynedd Council passed a BDS motion calling for a trade embargo with Israeli settlements; and, in 2021, Lancaster City Council passed a motion in support of the BDS movement.

Taxpayer-funded public bodies should never interfere in foreign policy. That is why this Government have carried over the Economic Activity of Public Bodies (Overseas Matters) Bill into this parliamentary Session. It will deliver on our 2019 manifesto commitment to ban public bodies from imposing boycotts, divestments or sanction campaigns against foreign countries. It will prevent them pursuing divisive policies that undermine community cohesion and stoke anti-Semitism, ensure that the UK speaks with one voice internationally and guarantee that taxpayers only pay for foreign policy once.

Across housing, welfare, health and employment, this Government are taking the long-term decisions to help give Xavi and young people across the country a brighter future. We will create a health system that puts patients first, give more families a quality home, get more people into work and grow our economy. My noble friend Lord Younger and I look forward to hearing noble Lords’ valuable reflections on the measures that I have outlined today on how we can all take the long-term decisions needed to create brighter future for Xavi and all our young people.

“continuing to roll out our mental health support teams in schools and colleges across the country so that 50 per cent of pupils are covered by 2025”.

Place2Be, a leading children’s mental health charity in schools, is clear that by intervening early we can help prevent problems becoming more serious. How, then, is 50% cover by 2025 acceptable? Pupil absences are on the rise, not least due to stress and anxiety. Can the Minister tell us why this Government are failing to do more to tackle mental health issues among children and young people?

It also seems staggering that, with schools literally crumbling and teacher recruitment and retention falling, the only announcements on education were rehashing previous ones. There is no sign of further legislation on schools and no sign of ambition for our children. Instead, we got a repeat announcement of the advanced British standard. Planned for 10 years in the future, this proposed reform of exams is at least two general elections away. Plans for a DfE workforce plan have apparently been delayed because of work on the advanced British standard, but the Government need to address teacher shortages now. It is simply not good enough.

The King’s Speech also referred to proposals to

“reduce the number of young people studying poor quality university degrees and increase the number undertaking high quality apprenticeships”.

A former adviser to Tory Ministers is quoted in the Times Higher Education as saying:

“On an occasion when the UK pulls out all the stops to impress the world with tradition and pageantry, it is beyond belief that the UK government would even contemplate asking His Majesty the King to speak negatively of the national asset that is our world-leading higher education and research sector”.

Labour believes that people should have the opportunity to get well-paid jobs, whatever their background and whatever part of the country they come from. For the Conservatives, it seems, limited opportunity to get well-paid jobs and a cap on aspiration are things that happens to other people’s children. There are already mechanisms to assess the quality of courses and limit recruitment for low-progression courses through the Office for Students.

Labour would be delighted if the Government, having run out of their own ideas on education to put in the King’s Speech, wanted to borrow some from these Benches. We have plans to reform childcare and early years support and plans for breakfast clubs in every primary school. With 1.9 million children in the UK facing challenges in talking and understanding words, Labour will ensure that every child develops a strong foundation in speech and language. Labour will boost maths teaching in primary schools; we will have a curriculum and assessment review; we will establish regional improvement teams and implement a body to ensure that schools can recruit and retain the staff they need now. We will transform existing FE colleges into technical excellence colleges. Labour plans to break down barriers to opportunity in every part of our system, in every year of a child’s life and in every corner of our country. Aspiration and ambition should be for everyone, and so should excellence and opportunity.

On housing, Labour is clear that the Government should support the aspiration of home ownership and be more ambitious on what they aim to do. However, this Government promise a lot and are delivering little on housing for local communities. They are failing to give councils the tools and resources to deliver housing. It is hugely disappointing that, despite all the promises, the Government have dropped major housing pledges and failed to support housebuilding.

It is also of deep concern that homelessness apparently does not come into this debate: it was covered yesterday by the noble and learned Lord, Lord Bellamy, in the context of a debate largely focused on crime. Homelessness is not a crime and being destitute should not be criminalised. Can the Minister explain why this Government apparently believe that tackling homelessness should come under the Home Office and not under the relevant department covering housing?

Despite promises to radically overhaul the housing system, the Government have watered down leasehold pledges first made six years ago, and U-turned on promises made to private renters four years ago. The leasehold and freehold Bill comes after six years and 115 further press releases or announcements on leasehold reform. It has been watered down to not even include those living in flats. If you want people to feel that they effectively have freehold, you could give them freehold. This Bill will not deliver on the Government’s commitments. It will benefit developers, not leaseholders.

The Renters (Reform) Bill claims to deliver on a four-year promise to abolish Section 21 no-fault evictions, but the Government’s own briefing reveals that they will not commence these parts

“until stronger possession grounds and a new court process is in place”,

and renters are facing problems now. In London, City Hall analysis reveals that an average of 290 London renters a week have faced a no-fault eviction since the Government promised an end to them in 2019. Based on the figures from 2023 so far, every further six-month delay could mean almost 15,000 more Londoners facing no-fault evictions. This picture is repeated across the country.

A Labour Government will get Britain building and boost home ownership through a housing recovery plan. This will combine policy and regulation, including reversing changes to the National Planning Policy Framework announced in December 2022; reinstating compulsory local targets; strengthening requirements to maintain a deliverable supply of housing land; and a presumption in favour of sustainable development. Labour in government will build and is committed to more action on housing in the first six months of office than the Conservatives have delivered in the past six years.

We can already see how Labour in power is delivering, with a new golden era of council house building in London, where more council homes are being built than at any time since the 1970s, through partnership between the Mayor of London and local councils including Southwark, Newham, Ealing and Brent. As we have seen in the past nationally—for example, under Harold Wilson in the 1960s—high levels of private housebuilding and high levels of social housebuilding can and should go hand in hand. Labour’s policy on housing will enable this, and we on these Benches are now, once more, the party representing the aspiration of the British people.

Finally, I turn to the subject of communities. With denial and distortion of the Holocaust rising and anti-Semitism increasing over the past few weeks, we all have a responsibility to tackle misinformation and hate. Discussion of communities in this debate comes at a time when we see parents anxious about their children even wearing their Jewish school uniform, and British families have missing or dead family members in Israel and Gaza. From these Benches, Labour looks forward to supporting the Holocaust Memorial Bill through the parliamentary process, having supported the memorial from the outset, as I know Members across this House do. The memorial and learning centre will be a truly fitting tribute to the 6 million Jewish men, women and children who were murdered during the Holocaust, and will also offer a place to learn about more recent genocides. It is indeed right that such a memorial will sit at the heart of our democracy, next to Parliament.

I look forward to an interesting day’s debate.

The other focus in the gracious Speech is long-term planning, particularly long-term staffing planning, as the Minister touched on. These Benches called for that long-term plan and have welcomed it, but we must recognise that a long-term plan is necessary but not sufficient. The journey towards a better health and social care system requires three things: a road map to the destination, but also a vehicle fit for the rigours of the journey and a driver with the skills and energies to get us there. The recent performance of this Government hardly inspires confidence.

I recognise that the Covid inquiry still has a long way to go, but the picture so far has us alternating between horror and shame at the way in which our health system has been managed. The image it paints is of a car veering from side to side, with the former Prime Minister behind the wheel while his passengers—Messrs Hancock, Sunak and Cummings, the latter using choice expletives as though he were an extra from “The Thick of It”—shout conflicting directions at him and so he jerks the wheel from one way to another. The car occasionally veers off into the VIP lane when it gets flagged down by its mates, but it can hardly be described as a picture of good management. We should give some leeway to the Government, because there was no road map for the specifics of the Covid pandemic we suffered. However, we must also ask what all that civil contingencies legislation and planning was for, given that it appears to have given us very little benefit when we hit the crisis. The driving of that vehicle seems to have been appalling and that is all on the Government, past and present—the same people are in government today, with a few notable exceptions, as those who were driving at that point.

The bright spot is that the vehicle held up remarkably well. That is all to the credit of the staff of our health and social care systems, who went above and beyond. We gave them credit and thanks for it then and should continue to reiterate that today. We have moved on from that episode but it now feels as though the Government are parked up in a lay-by doing route planning but very little else.

Their record on vehicle maintenance is also not looking good. We have record waiting lists that are still growing in many areas. Access to GPs and dentists—the fundamental building blocks of our system—is a daily source of complaint and frustration for millions of people up and down the country, as recognised by the Government when they issue papers describing NHS dental deserts, which are a real thing in many parts of the country today. We have a hospital building programme that will not meet the promises made at election time and staff who are demoralised by a Government who seem to prefer confrontation to conciliation and threats to settlements—settlements which Governments in the devolved parts of the United Kingdom have been able to reach because they approached them with a very different attitude.

This gracious Speech shows us that this Government have lost interest in making real improvements to health and care. If these were a priority, there would be a mental health Bill and long-term reforms to the provision of social care. The Minister said there will be a mental health Bill when parliamentary time allows. Forgive me, but the time of the gracious Speech is precisely when the parliamentary calendar is empty. If this were a higher priority than pedicabs and self-driving vehicles, there would be parliamentary time. It is a choice that the Government have made. We would also be seeing serious efforts to address and update the primary care contracts so that people can get easier access to GPs and NHS dentists. I hope the Minister in summing up may indicate that there is some action in that area. It is clear that this Government prefer to deal with other legislation, which I presume they think is sexier to the electorate, than with the stuff we need to get our health and social care right.

While the Minister may not want my sympathy, I praise him for his ability to defend this very thin gruel with quite a helpful speech. I believe that he personally is sincere in his interest in improving health and care and that he is making valuable contributions to those road maps, particularly on staffing and the new hospital programme. However, his, our and the country’s problem is with the drivers at the other end of the building. They are not a new Government—however hard they try to push the message otherwise—but a Government who have been in power as a single party for the last eight years. The people in charge now—the drivers at the other end—have been at the heart of that poor Administration and they are now too tired and unfocused to give us the solutions we need.

I hope that, over the coming year, the Government will keep working on these long-term road maps for where health and social care need to go, as these are valuable. Can the Minister in responding say whether that includes looking at GP and dental contracts, which are a priority? I hope they will face up to the maintenance challenge, so that this incredible vehicle that is our NHS is not allowed to deteriorate beyond repair. Will he say how they will deal with the deficits that are publicly building up in NHS trusts across the country? That needs to be dealt with this year—it is not a long-term issue—as they are facing real deficits and cash crises.

I will happily travel down the tobacco control lane with the Government to explore the effectiveness of the measures, but I can close only with a statement with which I know the Minister will have to disagree: the best way now to improve health and care in the United Kingdom is for this Government to hand the keys over to somebody else so that they can drive, as soon as possible.

The King’s Speech was deeply disappointing in having no reference to reforming the Mental Health Act 1983. Others have spoken about this, but in 1983 I was a junior lecturer introducing the changes to staff in the Lambeth health authority. I distinctly remember a slide that said, “This is a really interesting review, but remember that it is only a review of the 1959 Act, and we will have a proper, new Mental Health Act soon”. That was 40 years ago. There was a manifesto commitment in both 2017 and 2019 to reform this. It seems to me that this particular revision has been on a waiting list for a minimum of 40 years. Yet over 53,000 people were detained under the Mental Health Act in 2021-22, many, of course, for appropriate assessment, support and treatment.

However, significant disparity between ethnic diversity and detention under the Act continues, with white people five times less likely to be detained than those from different racial communities. Does the Minister agree that, while reforming the Act is long overdue, that should not stop us enhancing patients’ rights and strengthening safeguards for those admitted to hospital much sooner than an Act might come? I believe it is essential that we find sufficient resources to ensure that we can deliver high-quality, compassionate care—which is often in the community—before we review the Mental Health Act, if we are not to get it in this Session.

We know that many people with significant mental health needs are in prison, when many would be far better served by proper community support and treatment in safe, secure housing—particularly before they offend. Sometimes, individuals who have significant mental health challenges offend because they are homeless and have difficulty in claiming benefits and accessing the healthcare system.

I acknowledge other noble Lords’ contributions to this debate on the proposed reforms associated with housing, leasehold and renters; I will leave it to others to speak on that. I hope that this will result in fairer systems, but it will not result in a significant increase in social housing, which is completely vital to improve healthcare in this country.

Finally, I welcome the Government’s commitment to supporting the NHS workforce plan and hope that, in the longer term, this will have a positive effect on current waiting lists, which are in part due to a shortage of qualified staff as well as the Covid pandemic. However, I was concerned to hear the Minister say that he believes that the pandemic was a once-in-a-generation situation; I only hope that he is right, because we need to be ready in case we get a second wave. Do not let us be complacent; we need the right social care to support people if that happens.

I commend the proposals relating to tobacco and vapes. As many noble Lords know, my concern about the use of alcohol by young people remains, and I wish that there had been something about that too in the Speech.

I add my voice to the disappointment that a mental health Bill has not been brought forward as part of the gracious Speech. As we have heard, reform of the Mental Health Act is long overdue, and the inequalities that people face under it need serious attention. There is much work to be done here, including in resourcing community care and increasing patients’ ability to make choices about their care. The Joint Committee on the draft Bill found that this would be a significant factor in the reduction of detention and inequalities. It is a great shame that the work already undertaken is not being taken forward.

We are all aware that the health service is straining. I too welcome the long-term workforce plan, but there are questions that remain unanswered, and I expect that its implementation will be challenging. The NHS staff experience remains one of exhaustion, overwork and understaffing, and I continue to remain concerned about the state of industrial relations following the Strikes (Minimum Service Levels) Act. If we are to exercise choice in our future, as the Minister rightly said, we need a workforce that is not tired, is appropriately trained and is valued.

Some 22 years ago, I commissioned the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group, which has carried out truly inspiring work. However, the work is not done. The CQC report highlights the experience of not just ethnic-minority patients but staff. Midwives from ethnic-minority groups described a culture of tolerated discrimination and unchallenged stereotyping. This is something that we all need to work to reduce.

It is disappointing to see no mention of social care in the gracious Speech. Skills for Care’s latest report estimated a 28.3% staff turnover rate in 2022-23. With 400,000 people working in social care over the age of 55 and likely to retire within the next 10 years, we are desperate for a workforce strategy. Carers are finding it difficult to get by in the cost of living crisis, and the sector represents 5% of the entire economy.

The Archbishops’ Commission on Reimagining Care sets out the type of ambitious vision that I had hoped to see in the gracious Speech. The commission identified the need for a fundamental change in the way in which care is thought about, organised and delivered, with a national care covenant at the heart of a new approach that truly incorporates the views, voices and experiences of the people most affected. Social care should enable everyone, regardless of age or ability, to lead a life of purpose and fulfilment.

I also note the disappointment of many that the gracious Speech did not contain news of a ban on conversion therapy. The General Synod of the Church of England voted to call on the Government to ban conversion therapies in 2017; it remains firm that abuse of power in this way must be prevented.

What underpins everything I say today and will say in the coming Session is that people are made in the image of God and are immeasurably valued. Recognising that value, we must do more to pursue health equality and provide adequate resources. As Nye Bevan famously said in 1948:

“Illness is neither an indulgence for which people have to pay nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community”.

When considering the then Medicines and Medical Devices Bill, I and my team concluded, after very careful consideration, that there should be a new post in the management of the NHS: a person whom we named the Patient Safety Commissioner, because we were back thinking about the patients all the time, we wanted to ensure their safety and we thought a commissioner would have a standing that would actually make a difference. The Bill was enacted in February 2021. Dr Henrietta Hughes was appointed in June 2022, and she took up her post last September. She is a force for good, and she has already embarked on—embraced, indeed—her new role and made a difference to professionals and to patients; and after all, it is the patients we must all think about.

I and my colleagues suggested that the Patient Safety Commissioner should explore the redress options for those who have already been harmed by pelvic mesh and sodium valproate. Those were the areas I studied with my team. I understand her report is due to be launched in the new year, and I urge the Government to respond with speed, as there are still too many women who have been waiting and suffering for too long. Our report, which we entitled First Do No Harm, discovered scandals that had already happened, but a number of our recommendations were not looking at the past but looking forward. We recommended a redress agency to administer funds provided to cover future harms. This was not acceptable to the Department of Health, and I felt it was really an opportunity lost. Even the best pharmaceutical producers may, despite their clinical trials, fail to realise that a product may, especially after time, prove to be harmful. The funds I am suggesting will provide a safety net when this happens. We also suggested that no medical product should be approved for sale without a levy paid into a fund wholly independent of the Government. At the very least, it should be a condition of sale in the UK. Where Governments bear some responsibility for approving harmful products, they should contribute to the fund.

Also, there should be an expert team to assess the claims of harm that have been clearly recognised by producers and make them clear to people, especially the users. They need to know what is going on with the products they are taking, and to understand the huge impact of marketing, which is on a global basis. Is not it time to work with our neighbours in Europe and possibly worldwide to seek specialist input and views on the harms caused by these products? The fund I am suggesting would provide redress to those who are harmed by medicines and devices, without them having to go through long, drawn-out adversarial lawsuits. We saw, first-hand how litigation had failed women who had already been failed by the healthcare system. We must provide a better way for the future, particularly regarding the blood issues.

I suggest that the fund be administered independently of both government and industry to ensure that it can command the confidence of injured patients. I urge the Minister to consider this and to act with speed on the points I have made.

In the last 13 years, many of the specialised institutions that focused on promoting good health have disappeared or been marginalised. The Government abolished Public Health England, which had a global reputation for its expertise and research. The grandly titled Office for Health Improvement and Disparities has been recently set up, but so far no grand practical statement of environmental activity has been announced. Today, many of the responsibilities for public health have been devolved to local authorities; at first sight that seems a good idea as so many services that can affect people’s general health are provided at a local level. However, the Treasury’s public health grant to local authorities has been reduced by a staggering 26% in the last years; not surprisingly, basic services have suffered badly or completely collapsed. Apart from the financial cutbacks, the connections between organisations commissioned by individual councils and the health service can be weak and can reduce vital capacity. Services have sometimes been outsourced to independent bodies, which do not have the necessary expertise to deliver them. This has been recently drawn to my attention in relation to HIV and other sexually transmitted infections. There has recently been an alarming increase in many of these infections, some of which are growing by as much as 50%. These must require medical care, which is often lacking in an outsourced clinic. For example, only half the clinics can now offer face-to-face appointments for individual advice and treatment—they simply cannot deliver good practice.

However, even if the Government have somewhat neglected the needs of good public health, it is encouraging to see the current level of parliamentary interest and engagement with these issues. The well-established All-Party Group on Health in all Policies has been able to broaden the discussion about reducing health inequalities and promoting healthy lives in ways that go way beyond traditional concerns about, for example, working conditions and safety. The Levelling-up and Regeneration Act 2023 could have been an opportunity to put some of these policies into legislation, specifically in the area of poor housing. There were several attempts to amend the Act in this way but all failed, although it must be remembered that the health effects of inadequate housing already cost the NHS about £1.4 billion a year. In this House, the noble Lord, Lord Crisp, with his vast experience in public health, pursued his amendment on healthy new homes to the point of ping-pong proceedings and still he did not succeed. In final exasperation he said:

“I have taken the key message that the Government do not want to … ensure that new homes and neighbourhoods promote health, safety and well-being. I think this is extraordinary.”—[Official Report, 23/10/23; col. 437.]

I must say that I agree with him.

Meanwhile, our very active Peers for the Planet organisation is urging an even broader approach to public health, which I support. It argues that the crises of climate change and threats to nature have a profound impact, and there are calls for the WHO to declare this a global health emergency. As far as the UK is concerned, the effects of higher temperatures have already been observed. In 2022, heat-related mortality in this country was up by as much as 42%, which is well over the five-year average. The very respected journal the Lancet has suggested that we should act immediately in this country on cleaner energy, improved air quality and access to green space. It is a vast agenda, but it should not be overwhelming. It needs a new clear strategic approach by the Government and resources to match. Given their record, I do not expect the present Government to give priority to this in the last months before a general election. On the other hand, the Labour Party has already published ambitious plans for its prevention and revolution in health. I am confident that there will be manifesto commitments on public health in all social policy. We can then have a programme that both improves health and renews the NHS. I look forward to discussing a new approach in the debate on the next gracious Speech.

It is regrettable and a great shame that the Government have turned their back on the widespread consensus on how mental health law should be reformed that has developed since Sir Simon Wessely produced his report. Nevertheless, a great deal of work has been done, which will be there waiting for an incoming Government to do it.

There are three things that the current Government should do now, which do not require legislative change. First, there should be mandatory training for all mental health professionals in the recognition and diagnosis of autism and learning disabilities. That would stop the inappropriate treatment of people with learning disabilities and autism, which sometimes not only leads to them being inappropriately detained at length under mental health legislation but results in them going into the criminal justice system when they should not.

Secondly, with a number of long-term conditions such as Parkinson’s disease, there is a great incidence of mental illness. I wonder whether the Minister will look at the major conditions strategy and the need to make sure that practitioners, in certain physical conditions, understand the mental health aspects of those conditions.

Finally, when we worked on the mental health Bill, we looked time and again at the disproportionate effect of mental health legislation on people from black and brown communities. They are far more likely to be detained inappropriately than other groups. We were told by all the people to whom we spoke that one thing that would have a direct impact on that is the introduction of an electronic system of advance choice documents. Advanced work is being done on that, based on work done in the field of palliative care by people at South London and Maudsley, the psychiatrists at Guy’s and so on. It needs only the Minister’s department to swing in behind the work already being done for pilots to be rolled out, ready for an incoming change in the legislation.

Let us be honest: none of us can see a time when local authorities will suddenly have new, massive amounts of money to put into social care. It is already underfunded and is subsidised by individuals. The one key thing that the Government could do is make sure that local government retains the requirement to give people assessments of their needs and to tell them what is available to them, wherever they choose to get their help from. Funding those independent assessments, and not leaving it to providers of services, is the one critical thing that might make a difference to the increasing number of people who will be living in the community with long-term conditions and really need help to stay in their homes—which I hope will be built to a lifetime standard in the future, so that people can stay in their home whatever the tenure of the home in which they live, whether rented or private.

I take the opportunity to say one final thing: King’s Speeches are about Governments’ priorities and choices. When the Government can find the time to license pedicabs but cannot be bothered to bring in a ban on conversion therapy, the lesbian and gay community understands the message. We get it: we are not safe while this Government continue to be in office. It is absolutely time that they went.