Spending Round 2019 — House of Lords, 2019-09-25
Topic: Health
Timothy Kirkhope (Conservative, Centre-right): My Lords, this is a slightly anticlimactic situation after the business that has gone on in the middle of this debate. I want to concentrate on two areas, neither of which are given much space in the spending round, but which, to me, are of great importance. My arguments will be more to do with realignment of resources rather than suggesting any increase in public spending per se. I am not an economist and do not have my noble friend’s qualifications, although I note that he was at one stage an economic adviser to the Post Office Corporation—I think that was just before it started to increase the cost of stamps, but I will not hold that against him I want to talk first of all about mental health. I had the honour of being one of the founder members of the Mental Health Commission, which was set up in 1983 under the chairmanship of my noble friend Lord Glenarthur. We were formed primarily to improve standards in mental health care and in particular to protect the interests of mental patients, especially those who were detained within closed establishments. Even then, over 30 years ago, it became obvious that facilities were inadequate and improvements were needed, but our work highlighted the particular need for greater co-operation between the health authorities and the providers of social care in the community to manage those who were released or encouraged to rejoin the community, particularly those from special hospitals. There was a key move by that commission to try to make sure that facilities nevertheless continued to be provided for those who needed to be protected within a secure environment. Sadly, I am afraid that some of the policies of government were to move people out into the community even though they did not have adequate resources available in the community from other providers, particularly local authorities and those in social care, to look after them. That was 30-odd years ago The five-year plan produced in 2016 by the independent Mental Health Taskforce again recommended improvements, all those years later, in community resources, as currently 90% of adults with mental health problems are supported in primary care at one point or another in their needs. The so-called care programme still has many deficiencies, and I am therefore rather disappointed to see that within the spending round, although the health service resources are referred to, there is no understanding that one in four people in this country will in their lifetime suffer from some mental illness which needs to be dealt with. I believe we should therefore be looking specifically at mental health care, rather than simply allotting up to 10% of spending on it. That is one thing I wanted to press very hard on my noble friend the Minister For my second point, which follows almost on from that of the right reverend Prelate the Bishop of Durham, I want to talk about devolution for a second. We find the only direct reference to resources for devolved powers on page 16 of the spending round, under the Ministry of Housing, Communities and Local Government. It talks of, "continued funding for the Midlands Engine and Northern Powerhouse" I happen to be currently the co-chair of the All-Party Parliamentary Group for One Yorkshire, which is very strongly supporting devolution from the centre to our regions, particularly to Yorkshire. I am getting more and more concerned about the rather confusing number of organisations, and the financial support for them, which are supposedly looking at the issue of devolution In a recent Institute for Government paper on devolution, most of the discussion, needless to say, is on Scotland and Wales, but it also acknowledges the less cohesive and successful attempts in England to bring about devolution. I remind my noble friends that, in 2004, 80% of voters rejected in the north-east of England a proposed assembly, which virtually killed off proposals for assemblies across the whole of England, which were at that time at least in the Government’s mind. Eight metro mayors have been created since 2015, with very mixed outcomes and not always adequate resources to do the things they have been asked to do. The criterion has been that "functional economic areas" must be the basis on which devolution is allowed, leaving the door open for new ideas and new designs. There is little clarity on funding or responsibilities. We have the northern powerhouse covering the north-east, Yorkshire, the Humber and the north-west. Under that umbrella sits Transport for the North, advocating better infrastructure—which is needed in that part of the country—and a northern powerhouse investment fund. That fund is currently benefiting not only from the British Business Bank but from the EU, through European funds. I hope my noble friend will confirm that in this case, as the Government have attempted to do in other cases, the funds that will be lost to these organisations and to our local enterprise partnerships will actually be provided by central government in the event of our leaving the EU. There is considerable concern about that There is a lot of confusion about future devolution and the relationships between different organisations. The people of Britain outside London have shown interest in this but, even if there is a will by the Government to proceed, the funding is certainly unclear and should be better defined. I find it disappointing that it is not specifically located within the spending round, and I hope that to some extent my noble friend and his colleagues are going to rectify that situation soon.