NHS: Targets

Baroness Thornton Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, first, I draw the House’s attention to my interests in the register. I thank my noble friend Lord Hunt for initiating this debate and all noble Lords who have participated. I particularly want to welcome and congratulate my noble friend Lady Wilcox on her maiden speech, which was a model of its kind. I was delighted when she joined us and I am very much looking forward to working with her in the future. I would also like to add my thanks to the Library, the Royal College of Surgeons, the Alzheimer’s Society, Independent Age, Age UK, the NHS Confederation, the Independent Healthcare Providers Network and many others that sent us briefings. I agree with the noble Baroness, Lady Brinton, that their analyses of the scale of the challenge and the solutions were remarkably similar.

My noble friend Lord Hunt and other speakers have set the Minister a challenging task in answering this wide-ranging debate, linking as it does priority targets, the impact of failing to deal with adult social care and the implications of that for patients in the context of what happens to primary healthcare, social care, mental health, public health and capital expenditure, which are all linked and interdependent. I agree with my noble friend Lady Crawley about how debates on the health service in the House of Lords are a love letter and a post-it note. My contribution is probably the latter.

The Government must own the effects of 10 years of austerity. They are not a brand new Government, as the Prime Minister would have us believe, but a continuation Conservative Government, and they cannot pretend that that the fact that our social care system is completely failing millions of people is a newly acquired responsibility. It is as a result of a deliberate action to starve this sector that we face NHS buildings and infra- structure which are crumbling and a danger to patient safety, that we are nowhere near parity of esteem in mental health in terms of spend or access, that public health is unable to deliver true prevention because of the cuts to local government spending, that parts of the NHS are, as the NAO reported, “seriously financially unstable” and that trusts and CCGs are building up debt.

Thus it is not surprising that, as my noble friend Lord Hunt tells us, the NHS is simply not able to meet the targets which are enshrined in the NHS constitution. While it is welcome that the long-term plan recognises that health and social care go hand in hand, we have yet to see the action and funding which will address the social care challenge. We will soon be discussing the NHS Funding Bill, which some might call window dressing. It is a testimony to a Government who must put into legislation a promise they have made to ensure that they keep it. That is a matter we will be discussing in a few weeks’ time, when there will be another opportunity for the Minister to address some of these issues.

I shall not repeat the statistics that noble Lords have adequately outlined, but at present it feels as if we are at a tipping point and the NHS is slipping back to the years before the last Labour Government, who of course made the historic investment and basically turned around the NHS to leave it in pretty good shape in 2010. However, I agree that we need to look forward, and the Government must make very good use of the resources they are already committing. Any news from the Minister about the likely outcome of the Budget and the spending review would be welcome, and some expansion on the Prime Minister’s declared intention to sort out social care would also be welcome. What exactly is his plan?

Given that I have served on a CCG for the past three years, noble Lords will not be surprised to hear that I intend to start by focusing on primary health care and its importance in future plans. I can bear witness to the tireless work of GPs and their commitment, and their staff’s commitment, to ensure that all patients receive high-quality care when they need it. I also witness the fact that front-line local healthcare is often under threat from funding being sucked out of the system by huge trusts with the push-me-pull-you funding formula that is still apparent in the system. I am pleased that there is some recognition of that in the long-term plan and that that will be reflected in the next round of NHS England’s planning process.

I echo my noble friend Lord Young’s story about his GP’s surgery. I think the Minister will recognise that, if the workforce and the funding for primary care are not sufficient and stable, the knock-on effect for acute services will be deleterious and significant. Along with the general NHS staffing crisis, there is a GP work- force crisis, and I wonder whether the Minister can update the House on how the delivery of 5,000 additional GPs and 5,000 additional staff in England is going. I am very proud of the work of the past three years in primary care delivery in Camden, with our innovative patient care-led commissioning, and I am very keen for that not to be lost in the latest reorganisation that is now under way. Clinical and lay members on CCGs all over the country are anxious that local primary care should not be lost in the creation of ICSs.

The social care system is broken, as many noble Lords, including my noble friend Lady Pitkeathley, and the noble Lord, Lord Turnberg, said. It is ignoring 1.5 million people with unmet needs, leaving carers to feel alone and unsupported in caring for their loved ones, and it is costing people their life savings. Age UK says that the social care crisis, with delayed discharges from hospital due to a lack of social care, is costing our NHS an eye-watering £500 every minute.

As a Labour and Co-operative Member of your Lordships’ House, I will take this opportunity to urge the Minister to look at a new model of social care that uses the principles of co-operation to build on the first-hand knowledge of those who rely on, receive and provide care. I urge her to read the report of yesterday’s debate in Westminster Hall, which explored this very positive proposition. It requires commissioning authorities and central government to recognise that co-operation and mutuality could provide some answers in this sector.

Thousands of people’s lives have been on pause as a result of underfunded mental health services over the last decade. My noble friend Lady Gale outlined the issues around Parkinson’s. There is a desperate need for the 19,000 new mental health workers promised in the next year. That is important not only because hundreds of thousands of people need care but because continuing not to resolve this problem has a knock-on effect on primary and secondary healthcare and social care. All these issues are interlinked.

On public health, I will say only that it really is time that there was real recognition that investment in prevention saves billions further down the line, so let us see that that actually happens. Let us not leave public health at the whim of the spending regime in local authorities whose funding has already been cut, because that is completely counterproductive.

On targets, I am concerned that the Government’s review of NHS clinical standards, including piloting the introduction of new average waiting times for elective care, is a problem. Does the Minister agree that the introduction of the 18-week target is a worthy achievement that should not be jeopardised by this review? The noble Baroness, Lady Watkins, made some very interesting points about how to reduce the pressures on, and redirect people from, accident and emergency departments through investment in GPs, primary care and minor care. She is absolutely right. However, there also needs to be an incentive to keep accident and emergency departments on their toes. We do not want to slip back to people waiting on trolleys in accident and emergency for 12 hours.

In conclusion, it is completely clear from this debate and from the briefings that we have all received that these wide-ranging issues are interlinked and inter- dependent. You cannot divorce primary care, mental health, the capital investment required, public health and secondary care from one another. That is why the long-term plan needs to be a longer-term plan and why it needs to take all these issues into account. The spending needs to be integrated so that we do not feed one side of the National Health Service while the other side—social care—puts such pressure on the system that it cannot possibly succeed. I look forward to the Minister’s response.