Childhood Obesity Strategy

Baroness Thornton Excerpts

Monday 25th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. The last time we discussed childhood obesity in your Lordships’ House it centred on chapter 1 of the Government’s policy, which scored a C-minus at best among noble Lords. Today we have chapter 2, which we can probably score as a C. It offers 13 consultations, a review and a great deal of promotion.

My questions are as follows. First, does the Minister believe it is possible for voluntarism to deliver even in the generous time the Government have given themselves to reduce childhood obesity? For example, Alpro soya growing-up milk contains unnecessary fructose and sugar, but the packaging will tell you it is good for your child, particularly if your child is lactose intolerant, where there are fewer choices. Will that be on the noble Lord’s agenda for legislation or persuasion, and what would be the timeline? Secondly, given that the evidence is clear, why does the Statement not include a proposal and a timetable for legislation and regulation to ban the advertising of high fat and sugar content products on TV and social media? When will we see a draft Bill?

Long-term Plan for the NHS

Baroness Thornton Excerpts

Tuesday 19th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating this Statement. I also declare an interest as a member of a local clinical commissioning group.

It would indeed be churlish to say that an injection of funding into our NHS is not welcome right now. However, the 70th birthday present is an uplift in funding of below the 60-year average—from 1948, the birth of the NHS, to 2010, it is just on 4%. Of course, we would all, not least the patients and staff, welcome not having to face another winter crisis like the one we have just had. After what, I suspect, were some serious tussles within the Government about quantum, timing and explanation of where the funding will come from, the Minister and his colleagues must be a little disappointed in the headlines that have been generated so far. The IFS said, with respect to the Brexit dividend that,

“over the period, there is literally zero available”.

Sky News has done a data poll which suggests a majority of people do not believe there will be a Brexit dividend to help to boost NHS funding, a reaction made more unpalatable to the Government because the same polls show that a majority of people, 54% to 38%, say that they would be happy to pay more tax to fund the NHS, which we in the Labour Party have known for quite some time. In 2002, when the then Prime Minister Tony Blair made a commitment to massively increased funding to the NHS, he also announced an increase in national insurance to pay for it. He and then Chancellor Gordon Brown had spent two years preparing for that announcement and preparing the plans for the investment in the NHS that was necessary to turn it round from the previous 18 years of Conservative neglect and underfunding and to deliver the waiting list targets, cancer treatment targets and A&E targets which then followed. So when Theresa May says, as she did over the weekend, that Labour spent only half of the increased expenditure on patient care, that is completely misleading and plain wrong. If she means that replacing falling-down buildings and worn-out equipment, paying staff decent wages, and investing in massively increasing the number of doctors and nurses available is in some way not spending money on patient care, one has to question the right honourable lady’s understanding of what the NHS is and what it does.

Leaving aside the issue of how the £20 billion will be raised, we do indeed need to address how it can best be spent. We recognise that it will take time and planning to work out how to make the best use of this funding over 10 years. The challenge is huge because the prevailing state created by a combination of cuts for both health and social care, and the overcomplex bureaucracy of the NHS as a result of the Health and Social Care Act, make this a serious challenge. Waiting lists of 4 million last winter in the NHS were so severe it was branded a humanitarian crisis. Some 26,000 cancer patients are waiting more than 60 days for treatment. There have been billions in cuts to local government and social care.

My questions to the Minister start with three basic ones about the legal obligations of the NHS. These were also asked by my honourable friend Jonathan Ashworth. Will the waiting list for NHS treatment be higher or lower this time next year than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer—a target not met since 2015?

If the Secretary of State wants, as he says he does, to transform the health and social care system, how will he do this when every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population—which the Minister mentioned—increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still? As my honourable friend Liz Kendall put it yesterday:

“We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together”.—[Official Report, Commons, 18/6/18; col. 63]


Why are the Government still ducking that vital integration issue?

Why is the social care Green Paper delayed yet again, and how can this funding be used to mitigate the £7 billion in cuts and 400,000 people losing care support? How will the Government bring together health, social care, parity in mental health and the essential preventive work of public health, when they are scattered across different delivery bodies, often with differing commissioning regimes and accountable sometimes to different regulatory regimes? How will that be done under the proposals for the 10-year plan? Will this injection of funding ensure that we have a service with new models of care fit for the 21st century? Finally, we have a £5 billion repair bill facing our NHS right now, and outdated equipment. When will the Government start investing in the fabric and equipment of the NHS?

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for his Statement. I welcome any increase in funding. Should the Chancellor be wondering how to pay for it, we on these Benches would be quite happy to see a 1% increase on income tax, for starters. The IFS has said that increases of close to 4% are needed for social care, as well as a funding boost for the NHS. Yet the Statement had nothing to say on this vital issue. We all know that the NHS cannot function efficiently unless social care is working well too. Many local authority leaders are indignant that the Green Paper has been moved further down the track, so when the new funding does arrive there is already a sizeable deficit to claw back. They are extremely anxious about the situation with adult social care funding being insufficient for this financial year.

What conversations have been held with the LGA, local council leaders and the Ministry of Housing, Communities and Local Government in advance of these statements? We are also dismayed about the silence on mental health, public health and community health funding. One in four of us will be affected by mental illness, there is an obesity epidemic among our children, too few health visitors, and we are critically short of psychiatric social workers. Is the Minister confident that these issues can wait until the autumn NHS plan and the Budget?

Hospices: Impact of NHS Pay Increases

Baroness Thornton Excerpts

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I will certainly do everything that I can. I agree that hospices are a fantastic example of the kind of mixed economy that this country does so well, with philanthropic and public contributions, and we must make sure that both those continue.

[Baroness Thornton (Lab)]

My Lords, I am sure that the Minister will be aware that this affects not just hospices, which of course are an integral and very important part of the health service, but the pay of those who work in all the charities and social enterprises which contract with the NHS. I would like to broaden the Question slightly from hospices and ask what the Minister’s reaction is to the Royal College of Nursing, which has called on the Secretary of State to establish a non-NHS national staff council to facilitate a more integrated way of looking at the pay of all nurses and healthcare staff in health and social care settings across the piece.

[Lord O'Shaughnessy]

I was not aware of that proposal but I will certainly look at it and write to the noble Baroness with our response.

Psychiatrists: Referral Fees

Baroness Thornton Excerpts

Thursday 7th June 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty's Government what steps they will take to address concerns that psychiatrists treating patients suffering from addiction have been receiving referral fees from private clinics.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the General Medical Council is the independent regulator of doctors in the United Kingdom. Its guidance is clear that doctors must not allow any financial interest to affect the way that they treat patients. The GMC is aware of the allegations in the media, will consider the evidence and, if it finds that doctors have breached its guidance, will take action. Serious or persistent failure to follow the GMC’s guidance may put a doctor’s registration at risk.

--- Later in debate ---

[Baroness Thornton (Lab)]

I thank the noble Lord for that Answer. Like many noble Lords, I am sure, I was alarmed to read allegations that people suffering from addiction were being used for what sounded like profiteering, which is absolutely against the rules. However, the wider issue seems to be that there is a shortage of mental health experts in the system at all levels and cuts in budgets, so there is vulnerability in the system that is being exploited. What are the Government doing to increase the number of psychiatrists and other physicians in mental health, and to increase funding given the amount lost in the mental health system?

[Lord O'Shaughnessy]

If these allegations are substantiated, there must obviously be serious consequences for the doctors concerned and clearly it is right that the GMC investigates that. In terms of the noble Baroness’s overall question, there is of course local authority-commissioned alcohol and drug treatment available; it does not need to be purchased privately. More generally, in terms of mental health support, she will know that there is a commitment to recruit 21,000 more mental health staff and that, through the new mental health investment standard, CCGs have to continue increasing their mental health spending year on year.

Abortion

Baroness Thornton Excerpts

Wednesday 6th June 2018 Lords Chamber

[Lord O'Shaughnessy]

Our intention—that of the Government and the Northern Ireland Office—is to restore a power-sharing agreement and arrangement in Northern Ireland so that it will be up to the people of Northern Ireland and their elected officials to decide on abortion policy.

[Baroness Thornton (Lab)]

My Lords, the Northern Ireland Assembly is not meeting at the moment. This matter, which is the issue of the Question put by the noble Baroness, is not a devolved matter. Could the Minister give the House an indication of the Government’s response to the debate led by my honourable friend Stella Creasy in the Commons yesterday? A cross-party amendment will be tabled to the upcoming Domestic Violence Bill that will seek to decriminalise abortion across England, Wales and Northern Ireland through the repeal of Sections 58 and 59 of the Offences against the Person Act 1861. That is not a devolved matter.

[Lord O'Shaughnessy]

I merely reiterate the point that abortion policy is a devolved matter. Indeed, that has been the policy of successive Governments of all hues. Of course, it is ultimately up to Parliament to make a decision, and any move that came from Parliament would emanate from within Parliament, from the Back Benches, on the basis of a free vote, as I set out in my first Answer.

Health Inequality: Autism and Learning Disabilities

Baroness Thornton Excerpts

Thursday 10th May 2018 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend on introducing this important debate, made particularly poignant by the learning disabilities mortality review, which we discussed yesterday. I also congratulate all noble Lords on sticking to the time limit, on being succinct and on being informative and moving in their remarks. I also thank the National Autistic Society, Mencap and SeeAbility for their briefings.

I was going to talk about eye care because I was so taken by the brief that we got on that. SeeAbility points to a gap and I hope that the Minister will be able to assist with that. The National Autistic Society quite rightly wanted to know when the autism pathway will be progressed. That has been mentioned by many noble Lords and I echo that. It is important also that the department looks at whether the Transforming Care programme meets the needs of autistic people and takes action to ensure that it does. Given that the Government are reviewing the Mental Health Act, will the Minister commit to look explicitly at how the Act works for autistic people?

I shall finish with something also to do with eyes. Desmond’s story, which came from the National Autistic Society or Mencap, is worth reading into the record:

“My learning disability means I grasp things more slowly and I need people to communicate clearly. Normally I go to my local hospital for my eye care—they are good with me. But in 20113 they referred me to another hospital to get an operation. That is where the problems began. I had a new doctor looking at my eye before the operation and he didn’t explain anything to me about what would happen. In the past, the hospital staff sedated me for operations on my eyes. I thought this would happen again. But instead, the doctor immediately started operating on me, while I was still awake. I was scared, and they were telling me not to close my eyes. It was a horrible feeling. I didn’t have a chance to explain what would make me feel more comfortable. There was no-one to talk it through and no time for the doctors to get to know me. I wish the doctors could have told me what was happening and why—it’s what anyone should expect. I hope staff get better training in the future to make sure they communicate better with people with a learning disability”.

Learning Disabilities Mortality Review

Baroness Thornton Excerpts

Wednesday 9th May 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating that briefing. He may find that the decision about the date of the publication was actually that of NHS England and, frankly, publishing it on the Friday before a bank holiday is either incompetent or shameful. However, seven years after the Winterbourne View scandal and five years since the avoidable death of Connor Sparrowhawk, the findings of this review show a much worse picture than previous reports about the early deaths of people with learning difficulties. One in eight of the deaths reviewed so far show there to have been abuse, neglect and delay in treatment and gaps in care. Women with a learning disability are dying 29 years younger, and men 23 years younger, than the general population; 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% in the general population. This is a terrible situation.

I would like to ask the Minister two questions. First, almost one in 10 of the people who have died have been in out-of-area placements, without the support of family, friends, or any local, familiar community support. The Government have repeatedly said that such placements must be avoided, so will the Minister tell the House what action is being taken to ensure that government statements and guidance on this matter are being followed? Secondly, will the Minister expand on the last part of the Statement, and tell us what action the Government are taking to address the alarming gap in life expectancy of people with learning difficulties?

[Lord O'Shaughnessy]

I thank the noble Baroness for her questions and agree with her that it is a troubling report; it paints a troubling picture of the shockingly poor outcomes that people with learning disabilities have in terms of their mortality and morbidity. I would not disagree with her about that picture and I will come to the actions we are taking to try and address it.

On the publication, I agree with her that the timing was less than ideal. The department did not have sight of it; it was an independent report commissioned by NHS England. We are investigating that, but I agree it was not done as it should have been and we will endeavour to ensure that this does not happen again. On the areas of policy that she referred to, on out-of-area placements there is a programme called Building the Right Support, which is trying to increase the amount of care delivered in community settings, bringing people with learning difficulties, disabilities and autism out of in-patient care to more suitable care in the community. The intention is to reduce the use of in-patient beds for people in mental health hospitals by 35% to 50% between March 2015 and March 2019. It is an attempt to locate much more of that care in the community.

The noble Baroness also asked about other actions we are taking to improve outcomes. I want to focus on the annual health checks that are now available for adults and young people from 14-plus years. That is happening every year. We know the use of these checks is increasing; it has increased by 17% year on year up to 2017-18. There is a real ambition to raise that further by 64% in 2018-19 compared to 2016-17. We know this group does not always feel equipped to come forward and bring health issues to the notice of the health system. It needs extra support; it needs people to be on their side, checking in with them to make sure their issues are addressed. I think this is one way in which we will make some difference.

Breast Cancer Screening

Baroness Thornton Excerpts

Thursday 3rd May 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for repeating that Statement and say to him that, along with millions of other people in this country, I am looking at my older relatives and wondering if any of them were caught by this. I do not think I am alone in that. As a woman of my age, it is important to say that we absolutely depend on the screening process to take care of us, to be invited for the smears and breast cancer screening and to be warned and told. So this is a massive public health failure—I think that we would all agree about that.

The noble Lord is quite right: there are a great many questions that he has mentioned that need to be answered. I appreciate his candour in questioning why this problem was not picked up, because eight years is a long time for an error of this magnitude to go undetected. Did the department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any opportunities to change this mistake that were missed? We on these Benches indeed welcome the establishment of a national inquiry. Will the inquiry be hosted and staffed by the Department of Health or by another department? In the interests of transparency, I hope that Public Health England’s analysis from this year will be put in the Library, so that we can see what was identified as the problem with the algorithm. The noble Lord says that NHS England will take steps to expand capacity of screening services. Can he say a little more about that? Where are those extra resources going to be found and how will they provide extra screening?

The reason that this is so terrible in many ways is that we all know that the screening rates were falling; we have known that for years. The proportion of women aged between 50 and 70 taking up routine breast screening invitations fell to 71% in 2016-17; in London, I understand it is about 64%, so this is very serious indeed. In a way, I hope that the inquiry will address how we can make sure that those warnings are heeded and will allow questioning to take place of the whole process, which should be escalated to the right level in the Department of Health. There is an enormously wide range of variation in screening rates, which I hope the inquiry will also address. It seems that the fact that there is such a wide variation is also connected with things such as kit and staff—yesterday we were discussing the understaffing at various levels in the National Health Service. So beyond the problems identified by the Minister today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can possibly be?

We are all concerned—this has cast a shadow that will bring fear and anxiety to millions of people. I know that all Members on all sides of the House who want to see cancer prevented will see this as an issue which we will all join in helping to resolve.

[Baroness Maddock (LD)]

My Lords, I am sure that all of us in this House are considerably concerned about those older women who at the moment are suffering acute anxiety because of what happened, and not only them but their families. It would appear that this was a software error. As I understand it, the same situation has not occurred in Wales, although the health service there appears to be on the same system. Can the Minister tell us a little more about that?

The Minister said that past notes will be looked at. How long does it take to get notes from the archive? Not all notes are held with GPs, and hospitals sometimes archive historic records. Are there enough current NHS staff to look at this, or will we need to take on new staff? That leads me on to another point about speed being of the essence. Depending on the uptake, as has already been alluded to, there may be a need to get women in this cohort X-rayed quickly and at scale. I know that we have had a shortage of radiologists; do we have enough to meet this need?

There is a wider issue, already referred to by the noble Baroness, Lady Thornton, of the lowering of the take-up rate. One thing that has come to my notice because of where I live and from talking to other people, is that if you happen to be unable to take up the appointment in the travelling van that comes round, you are often referred to a hospital. Sometimes that works and sometimes it does not—it can be a long way to go. However, when one of my colleagues asked whether she could have it done when she was here in London and have the X-ray emailed to her, she was told that that was not possible. Can the Minister look at that? While on technology, perhaps the problem of not detecting this is connected with the fact that we have become so reliant on technology that we think it is looking after things and so people do not personally ask the questions they need to.

I hope that the Minister will give us a bit more information about other steps that the Government are taking to try to help improve the take-up rate of screening. Unfortunately, this episode will cause some people to lose faith in the system, and we need to do something about that. Can he also say what his department will do to raise awareness, particularly among women over 70, so that they can continue to be checked?

I hope that the House will indulge me if I take this opportunity to thank those in the health service who have served me with my breast cancer. I may or may not have been one of these people; I self-referred when I was 70 because I had been through the screening process and had been looking out for signs that I had been warned of, so that is one very good thing. I had excellent service at the Royal Victoria Infirmary in Newcastle, which has been rated as outstanding after an inspection, and I was fortunate enough to be able to have chemotherapy down the road in my local hospital in Berwick. The two nurses who run that are absolutely fantastic. So I am very fortunate, and I know that that is what happens in my part of the country. I therefore thank the National Health Service for helping me, and I look forward to hearing from the Minister.

Health: Cancer Nurses

Baroness Thornton Excerpts

Wednesday 2nd May 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the impact of the shortage of more than 400 specialist cancer nurses reported by Macmillan Cancer Support.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, we welcome Macmillan Cancer Support’s report, which acknowledges the fact that the number of specialist cancer nurses has increased by nearly 1,000 full-time equivalent posts, or by 30%, since 2014. There is more to do, however, and Health Education England is working closely with Macmillan and the cancer alliances, so that we can achieve our aim that every cancer patient has access to a specialist cancer nurse by 2021.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. The census also pointed to the facts that there are vacancy rates as high as 15% for chemotherapy nurses in some areas, that the proportion of specialist cancer nurses who are over 50 years old continues to climb, and that almost one in 10 specialist cancer nurses comes from the European Union. We know that there has been a cliff edge for recruitment from the European Union. I want to ask two questions. First, will the Minister assure the House that this census will be used by the Department of Health and Social Care, Health Education England and the cancer alliances to inform their strategic workforce planning? Secondly, will he explain what steps the department has taken to assess the level of funding required to deliver the recommendations contained in the Cancer Workforce Plan, including the long-term strategy?

[Lord O'Shaughnessy]

The noble Baroness is quite right that the Macmillan report highlights some challenges around vacancy rates and the age profile of cancer nurse specialists. It was explicitly set out in the cancer workforce strategy that it would have a phase 2 of planning once the census had been published. This census has been published, so there is an absolute commitment by Health Education England to work with Macmillan and the cancer alliances to bottom out how many more staff are required to meet the standard that we have set out—for every patient to see a cancer nurse specialist by 2021—and how many extra people we would need to recruit for that, and therefore to deliver the funding that would enable that to happen.

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

Baroness Thornton Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first congratulate the noble Lord, Lord Patel, and his committee both for the excellent report we have been discussing and for persisting in pushing the Government to respond—a response, I think, which merits a C-plus perhaps, although my noble friend Lord Hunt thinks that is generous, and was late and could do better.

I declare an interest as a member of a CCG. In that part of my life, I am what noble Lords might call “up close and personal” with the results of the reforms of the noble Lord, Lord Lansley. I witness a great deal of great work, often in spite of the heavy hand of NHS England and our swingeing QIPP. In many ways, the report gladdens my heart.

I thank all noble Lords for their contributions, particularly my noble friends Lord Hunt and Lady Wheeler. As I said, the report is excellent and there is much that we can agree about in it. As the noble Baroness, Lady Finlay, said, it is a birthday present to the NHS from the noble Lord, Lord Patel, and the House of Lords—or perhaps it brings a new dawn to the NHS, as my noble friend Lady Pitkeathley put it.

I was struck by many excellent contributions today, such as that of the right reverend Prelate and his comments about an office for health and care sustainability. That idea is definitely worthy of consideration, and the recommendation did not deserve the dismissive response it received. I think that I would support it, but only if we can get rid of some of the other bodies that this report suggests are not necessary. My noble friend Lord Turnberg and other noble Lords have urged the Minister to be bold and think the unthinkable. I definitely look forward to him doing so.

In his plea to integrate academic medicine into our hospitals, my noble friend Lord Winston told me something that I did not know, as he always does. It often shocks me when I realise that what he is saying is true. I look forward to the Minister’s response to what he had to say.

The noble Baroness, Lady Finlay, and my noble friend Lord Carter made powerful contributions about the workforce in their different ways.

The noble Lords, Lord Kakkar, Lord Willis and Lord Saatchi, and the noble Baroness, Lady Tyler, talked about cross-party consensus. I need to respond to them. If I might put it like this—certainly to the noble Lord, Lord Kakkar—we could look at this in a different way. There is a great deal of agreement on many matters that we discuss. We all agree about the need for a preventative, not an illness-based, NHS. We all agree about patient safety, primary care and many other matters. Indeed, we in this House spend our lives finding agreement on how to proceed and what we might do.

The best way I can put it is that this problem is about trust. It is not only we on these Benches who struggle with trusting this Government. That lack of trust is based on solid experience of things such as the Dilnot report, but the state of the NHS is also the single biggest issue vexing Conservative voters, with more than seven out of 10 of them citing their concern in January this year. Notwithstanding my noble friend Lord Turnberg’s support for the Secretary of State, fewer than four out of 10 Conservative voters thought that the Secretary of State should keep his job. The polling shows, as did the last election, that there is a problem with trusting this Government on the NHS.

The noble Lord, Lord Willis, should remember that his party was decimated in 2015, partly because of that trust. It is a problem that all political parties face in this country. It is to do with not just this issue, but the way we run our country. We need to contemplate and think about that issue, because it is obviously a very important one regarding how we proceed and build consensus about our National Health Service.

My intention is to speak about social care and the crucial issue of integration, which is so central to this report. As the report indicates, all the investment we might want to put into the health service will not work if we do not also deal with social care. I know from personal experience, both as a carer for my mother and as a CCG member, how complex it is to achieve integration, but there are, as many noble Lords said, examples of really great integration programmes going on at local level, with local leadership and innovation. My question to the Minister is: how can the system learn from that? Many of us have posed that question over many years. How can we replicate the systems that work?

Today, we see the announcement from the think tank the IPPR, which now seeks also to address the issues of the long-term future of our health and social care system, led by my former boss and noble friend Lord Darzi and the noble Lord, Lord Prior, also a former Minister, whose contribution about the fragmentation of the NHS I completely agree with. We should welcome this report and the consideration because it is being led by two very experienced former Ministers. I am sure it will look at the huge challenges that the health and social care system faces: the re-emergence of rationing and waiting times on the rise; deteriorating finances, with the zigzag that the noble Lord, Lord Warner, talked about on funding; demoralised staff, referred to by my noble friend Lord Carter; and all the issues that come with Brexit.

As many noble Lords have said, the future of the NHS and of social care are inextricably linked. A sustainable NHS is predicated on a sustainable social care system. My noble friend Lord Rea said that even better than I could. These are enormous questions about how the health and social care system can succeed in an age of rising demand and take advantage of new technology, and how to truly integrate health and social care systems.

How can we deliver parity of esteem for patients receiving support for mental health problems and join up health and care around those patients, as my noble friend Lord Bradley explained with great eloquence? If I have a particular criticism of the Government’s response, it is that it was not robust enough at all on mental health.

Next year we will celebrate the 70th anniversary of the founding of the NHS. The health and social care system deserves a secure future that gives us confidence that it will celebrate its centenary in a little more than 30 years from now. The noble Baroness, Lady Watkins, is right: we need to take a 30-year perspective on this.

I need to comment on the idea of a royal commission. The Government have promised us a Green Paper. Since the royal commission on social care and long-term funding for older people first reported in 1999, we have seen 12 consultations and four independent reviews. With the Government undertaking yet another consultation and producing yet another Green Paper, the question is whether it will lead to action. Some £1 million was spent on the Dilnot review, only for the Government to delay the introduction of its recommended care cap before shelving it indefinitely. The Government are wasting time and public money on consultations. How can we have confidence that a royal commission will be any different? I do not think we can, or that we can wait for a royal commission to be established. I say to the noble Lord, Lord Saatchi, that we on these Benches would take some convincing that this is a sensible way forward.

We should be calling for social care to be placed on an equal footing with the NHS, rather than being an adjunct. We need care and health operating as one—locally led, focused on prevention and person-centred. It is social care that keeps people out of hospital in the first place and takes the pressure off the NHS. Delayed discharges are a good example of this, as was explained by the noble Baroness, Lady Greengross.

Are the Government going to give equal priority to social care and mental health? Will the Minister answer the questions, posed by many noble Lords, from the excellent Age UK briefing? It asks when the social care Green Paper will be published; how the Government will ensure that older people in care are consulted properly; and whether the Government will undertake—as my noble friend Lady Pitkeathley and other noble Lords outlined—to make sure that people understand what the cost of social care will be to their families.

In conclusion, the Government should return to this report and take a better look at it. This is one of those occasions where we should give them back their homework and say, “Have another go at this”, because the report is full of great suggestions and recommendations and the response is not great. The long-term sustainability of the NHS and adult social care deserves a great response.