NHS: Long-term Sustainability

Baroness Pitkeathley Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, it is an honour and pleasure to follow my noble friend Lady Ramsey, and to be the first to congratulate her on her truly memorable maiden speech. I should not be surprised that she has made a remarkable speech, because she is a remarkable person who brings a wealth of experience and achievement in public service to your Lordships’ House. As a barrister working in local authorities, as chair and non-exec on many health agencies and as an upholder of standards in public life, she has already achieved a great deal. Indeed, the range and breadth of her experience is so great that she could have made her first contribution in a variety of debates. I am sure your Lordships will be glad that she chose this one. As we have heard, she brings willingness, commitment and enthusiasm to continuing her work in this latest phase of her public service. Her colleagues on these Benches, and throughout your Lordships’ House, will be grateful for her presence, and look forward to many more memorable contributions.

I thank the noble Lord, Lord Patel, for this debate and for his indefatigable pursuit of improvements in health and social care. Like many noble colleagues, I could give examples of where great care is happening, and my own recent experience could not be improved. The use of technology to make appointments and to deliver care was fantastic, as was the skill and understanding of all the professionals with whom I came into contact. However, too often patients report very differently. As we know, 24% satisfaction with the NHS is nothing to be proud of.

I have lost count of the number of health debates in which I have taken part in my 27 years in your Lordships’ House, and in every one there has been agreement about what is needed to provide the comprehensive and timely care that we seek. We always agree on two things—first, that we need more preventive services, as the noble Lord, Lord Patel, and others have reminded us. We treat people too late and allow their conditions to become chronic, so that major interventions are needed when small ones would have sufficed. We do not treat the broader picture: we do not look at the lifestyle issues and diets that cause the conditions or the poverty that is the reason why people eat the wrong food, which in turn causes diabetes, the need for new joints and the disabilities that mean people cannot work or have a tolerable, pain-free life. Still less do we think of surveying living conditions, such as putting in a handrail and getting rid of the rugs that cause falls, which in turn create huge amounts of work for the NHS and distress for an older individual.

The second area on which we have always agreed is that we need more integration. I shall have more to say to your Lordships’ House next month, when the report of my Integration of Primary and Community Care Committee is debated, but, for now, I agree with other noble Lords that the NHS allocates an excessive amount of funding to reactive hospital care at the expense of preventive primary and community care. This was not just the conclusion of my committee but the strong opinion expressed by all former Health Ministers and Secretaries of State who gave evidence to it. They were from different parties and Ministers in different circumstances, but they were all adamant on this point, as many noble Lords will be in today’s debate.

The mismatch in the levels of funding and importance that is so clear in the NHS is even more significant when it comes to social care. We are all victims of the historical accident that means that local authorities fund social care. Nobody knew that we would live so long and have so much need for support in 1948, but we have made only pathetic or failed attempts to rectify that situation. I know that the Minister would not call the better care fund either “pathetic” or “failed”, but it is, at best, a sticking plaster to cover the basic flaw in our funding system.

Unless we get better integration between health and social care, we will never deliver comprehensive care, and the divide will continue. To overcome that divide, we have to address the join between the NHS and local authorities and areas where professional silos and the arrogance that goes with such divides have not been eradicated. We never seem to have found the ability to translate local success into national guidelines. The “not invented here” syndrome stymies all attempts at change.

Do not get me started on the main providers of both health and social care. I am grateful to the noble Baroness, Lady Warwick, for mentioning unpaid carers. It is not the NHS or local authorities but family carers who provide, willingly and with love, billions of pounds of care—estimates vary, but it is well over £150 billion, or the cost of a second NHS. Does it not make sound economics, as well as moral good sense, to support them better than we have ever succeeded in doing? They are the best-value service any nation could want. Yet what do we hear? We hear of carers being persecuted, even prosecuted, for invertedly going £1 over the earnings limit on the derisory amount of the carer’s allowance. We hear of carers being forced to abandon paid employment, building up future poverty for themselves and future liabilities for the state. We hear of carers being ignored, having their skills knowledge and experience dismissed and not being consulted, with their own health needs going unrecognised. Carers are, and will continue to be, the bedrock of health and care services, and I hope that the Minister will confirm the importance of recognising that.