The Long-term Sustainability of the NHS and Adult Social Care

Baroness Pitkeathley Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, in my 20-odd years in your Lordships’ House I have lost count of the number of times I have spoken on health and social care issues and called attention to the challenges of maintaining and developing a system of health and care on which we all depend. Like many others in your Lordships’ House I owe my life to the NHS, and in my professional life I spent 40 years campaigning for the rights of carers, on whom so much of that system depends.

The last few times I have made speeches here, as well as mentioning the problems in the NHS and care system—which we all know are legion and have been expertly detailed here today—I have said that I ventured to see a little more hope than I had hitherto, a ray of light at the end of the tunnel. If there have been rays of light—little chinks, perhaps—the report of the noble Lord, Lord Patel, was more like a search-light, a shaft of sunshine, perhaps even a new dawn. I congratulate him and his colleagues on their excellent report dealing with the difficulties and, above all, suggesting practical solutions and emphasising that the time for action is now. The emphasis on integration of health and social care, on realistic and consistent funding, on public health and prevention are music to the ears of anyone who has ever worked in or with our systems.

The call towards a lasting political consensus is also to be welcomed. The official government response is, to say the least, pedestrian. However, the ideas and flexibility which I think we see coming from the Secretary of State now give us hope that this time we will see a long-term solution. This is the time for a new Beveridge, as some have termed it. Let us remember that our forebears managed to agree and implement those Beveridge reforms at a time of world war and when the country was bankrupt, so being preoccupied with Brexit and periods of austerity is really no excuse.

The report gives many details on how the much-needed reforms could be implemented. I support them all. I say to the Government three important things they should remember as they develop ideas for NHS reform and the Green Paper on social care. First, be bold. Adopt the bold and far-sighted recommendations this important committee has made. Try to put out of your minds the fact that bold proposals in the past have been labelled death tax or dementia tax, according to what various parties have said, and the resultant media furore. This has always resulted in those previous bold proposals being kicked into the longest possible grass. Have the courage to take a long view.

Secondly, be inclusive. You must take the views of those who know the areas of health and social care well and are familiar with trying to navigate around their problems to deliver services. Consult the directors of adult social services and the voluntary sector. Charities have the ear of consumers and are familiar with operating on tight budgets. Above all, take the views of the patients, users and carers. Do not let this be a top-down operation.

Thirdly, be honest. No Government of whatever colour or combination have ever made it crystal clear to the public that outside the NHS the responsibility for paying for care and arranging it rests with individuals and their families, with public funding available only to those with least money and the highest needs. As a consequence, no one ever prepares or plans for care. They scrabble around at the last minute when the crisis occurs and the truth dawns on them, so proposals in the report that new mechanisms should be introduced to make it easier for individuals to save for and plan for care are welcome.

In addition, the expectation has grown up that savings and property assets can be passed down to our children and grandchildren. We have to rethink this, which requires political honesty and courage. I endorse what the noble Lord, Lord Warner, said: we must tackle that other sacred cow, the protection of older people. Well-off older people should not be exempt from contributing. Why should they be exempt from national insurance? Why should they have all the freebies that we enjoy? How many noble Lords need the £200 the Government are generous enough to give them at Christmas?

The report of the noble Lord, Lord Patel, emphasises that patients too must take responsibility for their own health, a view which many of us will endorse. However, when we are thinking about responsibility, we cannot and must not ignore the role of the family and the informal carers. No proposals for reform or the future can ever ignore the contribution of those 6 million people, whom your Lordships have heard me mention on many occasions and whom any Government ignore at their peril. This contribution based on family obligation and duty is worth more than £132 billion and, however well we organise and fund health and care systems, it will remain the bedrock and must be supported to continue.

Two years ago we were promised a new carer’s strategy, and much work was done on it. Thousands of carers were consulted and had their hopes raised about the new strategy. Then we were told it was going to be rolled up in the social care consultation. When that was first announced, the contribution of carers went totally unacknowledged. Perhaps by way of apology for that we were then promised in December a carer’s action plan in the new year. I have asked the Minister before: where is the action plan? He told me he was writing to me. I have not yet received a letter and it is now almost May. Above all I want to ask him how the 9,000 responses that carers sent in in good faith about a new carer’s strategy will be used and how those problems will be addressed. Every one of us will either be a carer or be cared for at some point in our lives—probably both. It is short-sighted to ignore their needs.