Tobacco and Vapes Bill

Lord Bichard Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

[Lord Bichard (CB)]

My Lords, I declare an interest as chair of the National Trading Standards Board. In that capacity, I make one or two points that I made in the Bill Committee and at Second Reading, as they may be helpful in the context of this debate on these early amendments and because trading standards professionals will of course be on the front line in enforcing this legislation. It is therefore important to know whether they are confident about it. By the way, I regret suggestions that trading standards is in some way being ineffective at the moment. It has certainly been starved of resources, but I cannot think of a profession that has found new ways of using its resources more effectively better than trading standards. I once again pay tribute to the work that it does—in no way is it ineffective.

What it currently feels about this Bill is quite interesting. In saying these few words, let me say that I have spoken to the Chartered Trading Standards Institute and it is content with what I am about to say. The first point is that, in a recent survey of all trading standards staff, 80% of professionals supported this Bill and felt that it provides a good balance between the strategy that people have to get off smoking and protecting, in particular, younger people. They believe quite strongly that the provisions in this Bill can be enforced. They feel very positive about what I would call the “one date policy” because it will avoid retailers having to check several dates on ID every year; there will be just one date for them to focus on. It will also avoid—this has not been mentioned yet—people who are currently able to buy cigarettes having that right taken away from them. That is a flashpoint for retailers; I take very seriously the point that has been made about the threat that retailers are working under.

Trading standards also points to the fact that people often say that increased regulation and increased costs cause the illicit market to boom. There is no real evidence for that—certainly not in this country. I am not a smoker, but the cost of cigarettes has increased from £1 for 20 in 1987 to £16 or £17 for 20 in 2025; that has already been mentioned. Yet the market for illegal cigarettes reduced from 15 billion sticks sold to 2 billion sticks sold in the same period; actually, that was from 2000 to 2025. So the impact of regulation and price increases has not, at least in this country, been to increase the illicit market; that market is under control.

The other two points that the professionals make are, first, that they believe that the retail licensing in the Bill will actually improve standards in the retail landscape and, therefore, they support that as well. Where do they have doubts? They want resources, of course; everyone always does. Is the fixed penalty notice a sufficient sanction? Perhaps, but perhaps not; it depends on the circumstances, I think, and it will need to be kept under review.

I am trying to paint a picture here of a group of professionals who are under huge pressure, who have great commitment to their work and who actually support most of the provisions in this Bill.

[Baroness Northover (LD)]

My Lords, most of the amendments here may seem limited in scope but, as we have heard, they have in fact been set down to seek both to delay and to water down this Bill.

This weekend, my daughter and I visited my 24 year-old nephew where he is currently studying. As we walked along, he rolled cigarettes. I mentioned to him that I would be involved in the Tobacco and Vapes Bill today and that the aim was to create a smoke-free generation. He stopped in his tracks, turned to me and said, “Just get this passed now”. He then said, “I never want my son, if I ever have one, ever to take up smoking”. He told me that, several weeks earlier, he had given up vaping. He told me how difficult he found it. He hopes he can keep to it, despite repeatedly seeking to give up both vaping and smoking. He started among his peers in his teens, at the age of 14. He has not managed to kick the habit thus far. No one else in his family smokes. He fully knows the risks. No amount of warning on packets can deter the urge that he has. Try as he might, he just cannot kick the habit.

We know how addictive this is, which is why it is vital to stop the habit starting among the young. My nephew’s desire in his teens to do what all his friends were doing led him to smoking via highly attractive vapes, which is precisely what the industry knows. It is also precisely why this legislation, brought forward after the Khan review and then by former Prime Minister Rishi Sunak, is so visionary. We must deliver this, yet many of these amendments seek to undermine it. The industry is very adept at working on opposition, as has been the case over so many years.

Tobacco and Vapes Bill

Lord Bichard Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Bichard (CB)]

My Lords, I declare an interest as chair of the National Trading Standards Board, which is responsible for the most complex trading standards prosecutions and which works with government on a number of key priorities, including preventing the sale of illicit tobacco and vapes. Since trading standards receives so little parliamentary attention, I hope the House will excuse me if I pay tribute tonight to the officers across the country who do an outstanding job in protecting consumers and legitimate businesses. Thank you for allowing me that.

The trading standards community, it must be said, strongly supports this Bill, for four main reasons. First, we believe that, overall, it strikes the right balance between the need to protect consumers, especially young people, and the need to achieve the public health benefit of vaping as an alternative for those who already smoke. The noble Earl, Lord Howe, made one or two points which need to be given attention, but we think that, overall, the balance is about right. Secondly, we welcome that the Secretary of State will be able to regulate vape advertising, packaging, flavour descriptors and retail displays so that products can no longer be deliberately—some might even say cynically—designed to attract children. We hope that those relevant regulations can be introduced swiftly.

Thirdly, we believe that the introduction of a licensing scheme for businesses selling tobacco, vapes and nicotine products is long overdue. It will clarify and strengthen enforcement, support legitimate business and deter rogue retailers. Finally—a point that has not been mentioned yet today—we support the introduction of fixed penalty notices to enable action to be taken more swiftly, and to take some of the pressure off our court system.

So there is a great deal of support for this legislation in the trading standards community, but we are also confident that we can enforce it. We are already used to policing regulations which cover advertising products, product content and age of sale, although clearly, there is more work and thinking to be done on that issue. We are also increasingly effective at dealing with illicit tobacco and vapes. Last year alone, 1 million vapes, 19 million cigarettes and 5,000 kilograms of illicit tobacco were seized. The important point is that the Chartered Trading Standards Institute feels quite strongly, and has evidence, that better regulation, better enforcement and tax disincentives do not lead to a thriving black market. In the last 20 years in the UK there has been a reduction in the sale of illicit cigarettes—down from 17 billion to 2.5 billion.

The trading standards community supports the Bill and thinks it can enforce it, but with four caveats. Of course, there are always “buts”. First, successful enforcement depends on resources. Over the last decade, spending on trading standards has been cut by 50%, staffing numbers have reduced by between 30% and 50%, and last year one London borough did not even employ a trading standards officer. The promised additional £10 million is welcome, but it should be seen as a downpayment. If the Government cannot support more funding, they should seriously look at the idea of a “polluter pays” levy, as the Khan review and the APPG have suggested, and as the noble Lords, Lord Young, Lord Crisp and Lord Bethell, have suggested this evening.

The second caveat is that when introduced, regulations need to be clear and simple to make enforcement straightforward. That means that enforcement agencies should be involved in drafting the regulations to avoid loopholes. Policy experts in Whitehall are not the best people to draft such regulations. Thirdly, the Government need swiftly to regulate nicotine pouches because of their rapid growth and great danger. Finally, we need to take more seriously the illegal importation of tobacco and nicotine products at our ports. I recently visited Southampton and Dover. The trading standards and Border Force officials there were committed and working hard to avoid illegal products being imported, but frankly, I left feeling that they did not have the resources to do the job well. We need to stem the flow of illegal products into our ports. Legislation without resources achieves very little.

Health and Social Care: Winter Update

Lord Bichard Excerpts

Tuesday 21st January 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend about the need to plan sooner. It gives the opportunity to assess what is, is not, and can be made available. I also very much share my noble friend’s comments about involvement—involvement of the patient themselves but also of their loved ones. I know from the reports that my noble friend has done over the years how she has shone a spotlight on the exclusion of the very people who could assist in the discharge procedure and make it go smoothly. I welcome her comments that the discharge is as important as the admission and the care people get while they are in hospital.

[Lord Bichard (CB)]

I too acknowledge the commitment and effort being made, and also, of course, the commitment on the front line. I am not a health professional—and I feel particularly conscious of that, given some of the people in the Chamber this afternoon—but I have spent too much time in the last 12 months as a client and had much time to reflect upon the fact that the problems with the health service are much the same as the problems in most other public services. First of all, we do not design the service around the client and the patient, and, whatever I am told, that still seems to me to be so obvious. We do not join up the various services: pharmacies, GPs and district nurses, who I have got to know quite well. We do not make effective use of digital or AI, and we do not make good use of the community and voluntary sector and charities. Sometimes, we resent them, or they are resented. Of course, there is the issue of social care.

I think we all know this, and I am hearing the right things coming out of government at the moment, but, actually, these things have been there for 20 years. They have been said about and talked about for 20 years, yet things have not really changed. I really want to be convinced that they are going to change, but I want to be convinced that we are learning from the lessons of past failures and that we are focusing on owning up to those failures, because that is the only way in which we will move on. Can the Minister reassure me that we are looking at why it has taken so long and that we are really determined to take on the barriers?

[Baroness Merron (Lab)]

I am grateful to the noble Lord. These things do not just happen; we are here because of a failure to reform, a failure to invest and a failure to get the right productivity and results that we need. Indeed, there has been a failure over a number of years to do exactly what the noble Lord spoke about. I could not have put it better myself. The noble Lord came up with the most marvellous advert in his comments for the central pillars, to which I referred, of the 10-year plan, which will soon be available, following the biggest ever consultation in the history of the NHS.

The noble Lord talked about community. One of the things that we will be ensuring will happen in the NHS is a movement of focus from hospital into community. The noble Lord talked about digital. We will move from analogue to digital. He also talked about services being around the patient. I have frequently said that we need to get the services around the patient, not the patient around the services. There is also the move from sickness to prevention. All these three pillars will completely transform the National Health Service.

The noble Lord also referred to the third sector, including charities. We could not deliver much of what we deliver without them, and charities often are extremely well-placed to do things that statutory services cannot, so they are part of the equation and I offer all respect to them.

Health and Care Bill

Lord Bichard Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Bichard (CB)]

My Lords, I begin by welcoming, with others, the noble Lord, Lord Stevens, and congratulate him on his maiden speech. To use an analogy that I think he will understand, in my experience maiden speeches are like kidney stones: they are much better when you pass by them.

I too welcome the emphasis that the Bill belatedly places on collaboration, integration and partnerships, which is something that many of us have been seeking for a very long time and that I was personally associated with when leading the Total Place initiative more than a decade ago. We have been seeking this because none of the major issues that afflicts us can be resolved by a single public service—even one as large as the NHS. As your Lordships’ own Public Services Committee has stressed in its recent reports, better collaboration is critical to successfully addressing challenges such as obesity, diabetes and child safety. It is not just collaboration within the health service and between health and social care; it goes beyond that.

Let us be clear: we cannot legislate for collaboration, we cannot structure it into an organisation, we cannot impose it from the top down—as we have so often tried to do—and it does not happen with the flick of a switch. Ultimately, it depends upon the culture of the organisation. I have to say that, while so much about the NHS is positive, it has never in my experience been an exemplar of collaborative working, so turning the collaborative thrust of the Bill into reality will take a real effort. I hope that, as it progresses through the House, noble Lords will be able to make some amendments that make that more likely.

In other respects, I am afraid that I am less positive about the Bill as it stands simply because, as others have said, it seems to me to ignore so many of the health-related problems that we need to address urgently —whatever “urgently” now means. It does not, for example, tackle health inequalities, which have almost certainly worsened during the pandemic. The extent of these inequalities is a stain on our society—I am not exaggerating for effect—and others have mentioned Professor Michael Marmot, who has long sought to evidence this. Could we not at least incorporate this into the new triple aim, as the King’s Fund and others here today have suggested? We have heard a lot about levelling up, but, to be honest, it means nothing to me unless the health inequalities that we are experiencing are addressed.

While the Bill was described as a health and social care Bill, there is little of real substance about social care, and the proposed changes to the social care cap are regressive, as I think most people now accept. I shudder to think how my parents would have responded to these proposals. One of their proudest achievements was to own their own home, and they would have been devastated by the threat of losing that as a result of provisions like this. I agree with the noble Lord, Lord Lansley, that this should be taken out of the Bill.

There is also nothing in the Bill to suggest that the importance of prevention and early intervention has been recognised—the noble Lord, Lord Bradley, touched upon this. The truth is that we are spending ever greater public resources on crises and ever less on prevention, not least in the way that we seek to improve the life chances of vulnerable children, for which the NHS has a major responsibility.

The extensive new powers given to the Secretary of State to intervene in local service reconfigurations, as drafted at the moment, fly in the face of the stated intent to give local places and communities greater power over local priorities. Surely there needs to be at least some stronger requirement in the Bill for local communities to be involved before such interventions are made.

There is nothing in the Bill to suggest, to me at least, that there is a real strategy for tackling current chronic staff shortages—or, indeed, for ensuring that users have a real say in the way that services are designed. We hear a lot about patient-centred care—the only way that you can achieve it is if patients and users are involved in the design of the services in the first place.

Finally, could we not resolve one of the greatest practical barriers to collaboration: the failure to share data effectively? Whenever you mention data, people switch off. It is really important. Part 2 of the Bill begins to address data sharing between adult social care and health, but, for reasons that I simply do not understand, it does not address the same issue where children are concerned.

As your Lordships’ Public Services Committee identified in its recent report on vulnerable children, this is a serious practical problem. I know that it has been at the heart of many of the most tragic child abuse cases over the last 50 years. Perhaps the Minister can say in replying why we have not taken this opportunity to address that practical barrier and whether he would be sympathetic to amendments which did. It is something which the DHSC and the DfE need to do together, and I hope they will.

Social Care in England

Lord Bichard Excerpts

Thursday 14th October 2021 Lords Chamber

[Lord Bichard (CB)]

My Lords, I am proud to count myself as one of the usual suspects that the noble Baroness, Lady Pitkeathley, referred to earlier. In that capacity, I congratulate her on winning this debate and on a quite brilliant opening speech.

As we all know, social care has been in need of urgent reform for a decade or more. When history is written, I think it will be one of the greatest failings of Parliament that so little has been done. Resources have been inadequate. Too many providers are struggling to survive, too many users are dissatisfied with the service they receive, too many unpaid carers are, quite simply, exhausted, and too few people see social care as an attractive career option. For people suffering the consequences of these failings, arguments about who is to blame and promises of future improvements feel a world away from their lived reality. Their lives cannot be put on hold; they have to be lived now. They should be, and they deserve to be lived well.

Sadly, the long-awaited White Paper has still not materialised. There was yet another promise that it will be with us in three months; I have lost count of how many of those I have seen. The recently published Build Back Better fails to address the real problems, focusing almost entirely on how to fund the cap on costs. Any future plan and the White Paper itself need to deal with the really big issues comprehensively.

First, we still need to deal with resources, because, as others have said, the Health and Social Care Levy Bill does nothing to increase the capacity of the sector. It is regressive, and somehow even finds a way to increase the financial burden placed on providers and on care staff themselves. The Economic Affairs Committee of this House judged that £8 billion was needed to bring the sector back to where it was a decade ago, and many have suggested ways in which this could be found by reallocating public expenditure if there was no new money available. It needs to be done.

Any future plan needs to ensure, as others have said, that care services are better integrated, but as the noble Lord, Lord Lansley, said in Monday’s debate, that will not be done by great promises about further major institutional changes—reorganisations that often mean nothing in terms of improved services on the ground. A national care service and integrated care services will not provide immediate succour for people suffering as they are. They need us to address the real barriers to collaboration on the ground. People in residential homes do not want promises about new structures; they want free, convenient access to GP services, 24/7.

Again as others have said, we have to confront the crisis of the workforce far more convincingly than Build Back Better does. Social care should be seen as the noblest of professions, not as a last resort for a career. Could we encourage former clients—care leavers, for example—to use their lived experience and join the profession? Could we extend initiatives such as Teach First and Frontline? Do we know enough about why and when people leave so that we can target our workforce planning? How can we improve and make training and development more attractive to the workforce? Nothing will change or improve without a committed, skilled and valued workforce.

Something that has not been mentioned today is that we need to sort out the benefits system. At the moment, you can apply for attendance allowance, higher-level attendance allowance, domiciliary care, residential care or continuing healthcare. Some of these are administered by the DWP, some by local authorities and some by the NHS. Some are means tested and some are not. Continuing healthcare seems to vary widely in the way it is administered across the country. This is a confusing mess. It costs money, but it brings huge stress to people when they are at their most vulnerable.

We could support providers better. Education leaders have been able to access information and support online for a decade or more, but social care providers are left to their own devices, struggling to balance the books, cope with increased regulation and cater for clients with increasingly complex conditions. Why do we not establish an innovation and improvement fund to give them some support in the immediate future? Are we using digital technology as well as we could, not just to help providers but to help more people to stay independent? I do not think we are.

What is the strategy for unpaid carers, so often and rightly mentioned today—13 million of them, saving the Exchequer nearly £200 billion a year? The Secretary of State highlighted the importance of these at conference, but they cannot be taken for granted, so where is the strategy to support them?

Finally, how can we give users and their families a greater say in the way that services are provided? The time should have gone when well-intentioned central bureaucrats decide how services should be shaped and delivered. We need more influence from lived experience.

Fixing social care is about fixing all those issues, not just putting a cap on care costs. I hope the Minister can reassure us on two things today: first, that we will finally see the White Paper by Christmas, and, secondly, that it will cover this comprehensive range of issues.

Queen’s Speech

Lord Bichard Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Bichard (CB)]

My Lords, it is a new year with a new Government and there is new energy with new ideas and new policies, and even, we are told, some money. There is a sense of anticipation and, in the words of the Prime Minister, the dawning of a new golden age. What could possibly go wrong? Quite a lot could go wrong because, on past evidence, Governments in this country have found it very difficult to deliver projects, improved services, policies, targets or promises. We have become a nation that is good on ideas, ambitions and aspirations, but rather weak on achievement. As chair of the National Audit Office, I see countless examples of that week by week.

Take a look at some of our recent reports. Take a look at Crossrail, which is over budget and still not there. Take a look at HS2. Take a look at the starter home target of 200,000 houses, which delivered, well, none at all, actually. If you have time, take a look at the Great Western Railway modernisation or perhaps the decommissioning of our nuclear submarines. That has been a policy commitment since 1990, which so far has led to no vessels at all being decommissioned and untold riches being spent on stockpiling disused submarines. We now have more submarines in storage than in operation.

You can add to those recent failures universal credit, countless failed IT projects and, as many noble Lords have said in the debate, social care—or the lack of it. We are wasting billions of pounds when resources are tight and at the same time failing to deliver policies, many of which would help some of the most disadvantaged people in our society. So I often ask myself: why does this happen and what could we do to improve the current situation?

We at the National Audit Office are not actually interested in being mortuary attendants; we would actually quite like to improve public services. So I make a few suggestions to a new Government who may be in listening mode. For a start, we could make clear, from the very top of government, that delivering outcomes successfully matters just as much as endless policy commitments. We could be careful to ensure that policies and targets are stretching but achievable rather than designed primarily to grab the headlines and capture short-term political advantage. We could limit legislation so that the programme for any Session of Parliament is realistic and manageable. We could do more to ensure that civil servants are equipped with the skills to deliver services and projects effectively. We could, for example, insist on officials being required to spend a reasonable amount of time in operational or project management posts before entering the Civil Service, because it was clear to me all those years ago when I was a civil servant that policy development mattered and was recognised much more than delivery, and I fear that that is still the case.

We could hold people, civil servants as well as Ministers, more accountable for failures and stop the recycling of incompetence. We could ensure that competent Ministers stay in post for longer than the current average of around 15 months and that civil servants are not constantly churned to benefit their careers at the expense of results. We could devolve more power closer to communities, because large centralised bureaucracies rarely deliver successfully, and, frankly, in recent times local government and the voluntary sector have shown themselves to be more competent, agile and trustworthy than large central government departments and agencies. We could do a lot more to learn the lessons of failure and from our mistakes rather than seek to explain away the inexplicable or defend the indefensible. Finally, we could better understand and exploit the potential of digital technology to transform health, social care and many other essential services.

There are many reasons why the reputations of both Westminster and Whitehall are at such a low ebb, but in part it is because people have lost trust in their ability to deliver improvements, not least in public services. Addressing that has to be a priority for this new Government, and success will not be achieved by yet more promises to do better or to try harder, or indeed by just throwing money at the problem. That is why I for one have welcomed the signals from No. 10 that the Prime Minister is supporting radical changes in the way we govern, even if I may not have used exactly the same words, but that support and interest needs to be sustained in the face of many other pressures. However, all revolutions have to start somewhere and maybe this one should start with the Government saying very clearly, “We will promise only what we can deliver, but we will deliver what we promise.” Or to put it another way, “Let us promise a little less and deliver a lot more.”

Adult Social Care in England

Lord Bichard Excerpts

Tuesday 10th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I am sorry to disappoint the noble Baroness but I am not able to give her any more details on the timing of the consultation.

[Lord Bichard (CB)]

Will the Minister reassure the House that the long-delayed Green Paper will address not just resources but some of the other points that have already been raised, and maybe one or two others? For example, how do we recruit, retain and motivate a high-quality workforce? How do we provide urgent support for many small providers, which are struggling to survive, let alone improve the quality of the service? How do we make use of the digital potential that exists, which is currently not being realised? How do we get a real integration of health and social care services around the client? Will he reassure the House that these issues will be addressed explicitly?

[Lord O'Shaughnessy]

The consultation is looking primarily at the funding situation but in doing so it will have to consider the shape of the market and making sure that the whole system is put on a sustainable basis for the future, which obviously will involve looking at some of the issues the noble Lord has highlighted.

Social Care

Lord Bichard Excerpts

Thursday 1st December 2016 Lords Chamber

[Lord Bichard (CB)]

My Lords, I draw attention to my interests as set out in the register. I thank the noble Baroness, Lady Pitkeathley, for giving us this opportunity to discuss a desperately important issue and I congratulate the noble Baroness, Lady Cavendish, on a maiden speech that was well-informed, challenging and constructive. I would have expected nothing else; I know that she will be a real asset to the House. She is a very welcome new member of the usual suspects club.

There is no one who can deny that social care is in crisis: significant increases in those needing support, both young and old; too many providers failing; too many commissioners feeling disempowered by a lack of resource; too few people seeing social care as an attractive career option; and clients who are not “just about managing” but struggling to survive. We cannot leave it like this; we need to change. I want to throw a few ideas into this debate about how we might change.

I am not someone who believes that resources are ever the complete answer, but I could not start without saying that the social care sector has suffered disproportionately from recent cuts. Some urgent investment is needed now, as well as a long-term resource plan. That is what we argued in the Barker commission report a year or so ago and the situation has deteriorated further since then. It is possible to do it and, as we said in that report, to look again at the priorities for investment and to change them. That is what we need to do.

But, as I say, this is not just about money. I have been struck increasingly by the number of users who tell me that they do not get what they need in the form that they want and can access, because they were never involved in how the services were designed, shaped and prioritised. That needs to change. Frankly, to provide services in a time of austerity which people do not feel are a priority is an affront to our society. We could perhaps start by involving them in the way that we deliver care support. The current arrangements involving attendance allowance—lower and higher levels—domiciliary and residential care and continuing healthcare are confused, wasteful and distressing for many clients. We have reorganised much else in the benefits system but not this confused and stress-laden mess. We could, and we should, if we wanted to.

People will only receive whole-person care if we, the bureaucrats—in my case, a former bureaucrat—and politicians learn to work better across organisational boundaries. The rhetoric of integration has taken root. Yes, we do need one budget and integration, but the user’s experience is often that nothing much has changed as a result of these words. That is because we have not started looking from the point of view of the client. We have convinced ourselves that bringing two large bureaucracies together will inevitably lead to better services and less waste, but it will not. Two large bureaucracies brought together can be even more inaccessible and wasteful.

No one has mentioned today the possibility of the digital dividend. There are some fantastic examples already out there. They are not rocket science, but the problem is that although there are great examples, they are not uniform—they could be, and should be by now.

Do we not need to do something more to help providers, many of whom have either failed or are on the brink of failure? The CQC has shown that providers who need to improve find it extremely difficult to do so. They do not know where to go or where to get the money. Is this not one of those occasions where the Government could just offer some assistance? We used to have something called Business Link, which helped small and medium-sized enterprises. Are we not now in a crisis where we should have something similar for providers in this sector?

We have a crisis in the workforce. This should be the noblest of professions and yet most people would rather stack shelves in the supermarket than work in this profession. It is possible to change this. I chair the Social Care Institute for Excellence and we are doing some really interesting work with JP Morgan in east London, trying to involve people who have been in the system to come and work in the system. We need government to be giving more support to those sorts of schemes.

As someone said a moment ago, we need to look at how we can better involve the community. We have got into a state of mind of thinking that we have to live in a centralised, state-based, dependent culture. That is not the case; social care requires communities to be involved, but somehow we have lost the knack of realising that potential and helping some of the charitable groups in our communities to be involved.

I do not see at the moment that there is a strategy for social care. There needs to be one—the sustainability and transformation plans are not providing it. I ask the Minister: why can we not have a five-year plan for social care to sit alongside the five-year NHS review?

Residential Care: Cost Cap

Lord Bichard Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Bichard (CB)]

My Lords, I declare an interest as chair of the Social Care Institute for Excellence and as a vice-president of the Local Government Association. I want to begin, as others did, by thanking the noble Baroness, Lady Wheeler, for giving us the opportunity to have this debate. It is not only timely; many of us probably feel that it is long overdue.

I hope my new-found friend on these Benches, the noble Lord, Lord Filkin, will not be upset if I say I shall try to avoid using words such as “crises”, “disasters” and “catastrophes”, though it will not be easy on this occasion. For many of us, the condition of the care sector in this country is one of the most pressing and serious issues facing us at the moment. It has increasingly serious consequences, especially for older people with limited means. As other noble Lords have said, this is a people issue. My worry, quite simply, is that the Government appear not yet to have a convincing strategy for resolving the issue.

Others, not least the noble Baroness, Lady Brinton, have referred to the perfect storm facing the sector. The living wage—necessary though it is to raise the status of care workers—will impact on the economics of care provision. Those now in residential care tend to have multiple, complex conditions which require intensive support. The huge reductions in local authority budgets cut the number of those in receipt of adult social care by 28% between 2008-09 and 2013-14 and forced local authorities to drive down the price they were able to pay providers. What is not yet fully grasped by the great British public is that those who can afford to pay are now subsidising those who cannot. Self-funders are now paying an average premium of 40% for their care.

For all the rhetoric, the vanguards, the pioneers and the ring-fenced budgets, there is still insufficient integration of health and social care around the client. The noble Baroness, Lady Brinton, gave the example of legs. I think she will also remember the example of an assisted bath; is it a social care assisted bath, or is it a health assisted bath? How did we get into this situation?

The CQC has warned that a third of care providers require improvement, while the five largest providers have warned of significant failure in the next two years. These are the facts that have shaped the current reality. It is a reality highlighted recently by the latest survey carried out by LaingBuisson which shows that, for the first time since 1990, in the six months to March, more older people’s care beds have closed than have opened, with a net loss of 3,000 places. Every loss—every one of those 3,000 places—increased pressure on a beleaguered NHS. As the noble Lord, Lord Filkin, pointed out, those are the same facts that, this week, led the chief executive of Care England, Martin Green—a man who I know does not overstate his case—to advise care providers to start thinking clearly about how they manage their exit from publicly funded services. Already, three of the largest providers have signalled their intention to exit publicly funded home care. Meanwhile, in the last week, I have met local authority chief executives who are looking seriously at whether they need to re-enter the provider market to protect places.

This is, by any means, a serious situation, but is there a way out of it? Last year, I sat on the King’s Fund commission—which has been referred to by several other noble Lords—looking at the future of health and social care. We concluded that the current arrangements were no longer fit for purpose and that there needed to be a single budget for health and social care, with a single commissioner. After all, as the Chancellor said in his Statement in the last couple of weeks, the NHS cannot function effectively without good social care. They are interdependent. We also recommended a commitment to spend 11% to 12% of GDP on health and social care by 2025 and suggested what we felt were very practical ways for how this could be resourced, not least by rebalancing resources between the poorer and better-off pensioners. Again, others have referred to this but we felt clearly that there needed to be further investment in the social care sector. I, too, might ask: what has happened to the Dilnot money?

Last month, we revisited our recommendations a year later and reluctantly concluded that things had got worse, not better, and that there was still no coherent strategy to address the problem—not least, the need to stabilise the care support sector. Since we published that follow-up, it is true that the Government have responded by allowing local authorities to levy a precept of 2% to fund social care but, as many others have said, that is nothing like the sum needed to make good recent losses. The poorer authorities with the greatest need will of course not benefit most from that proposal. Again, the need for a convincing, comprehensive strategy is even more urgent.

I said that I would not overstate the case, and I will not. I will merely read the concluding paragraph of the King’s Fund commission’s most recent report. If we take no action, the future looks like this:

“More people in need receiving no support at all. Fewer people receiving publicly funded social care. Care home providers closing in the face of rising demand … companies that provide care in people’s own homes leaving the publicly funded market. Individuals and families who are unlucky enough to need high levels of care continuing to face enormous, and uncapped, bills. Staff shortages leading to a rise in abuse and neglect as good people”—

and they are good people, who are no longer able—

“to deliver good care. And further pressure applied to the NHS that in turn is likely to lead to declining standards of patient care”.

That, surely, is a future that none of us would wish for, but it is a future that is upon us.

Ageing: Public Services and Demographic Change Committee Report

Lord Bichard Excerpts

Thursday 17th October 2013 Lords Chamber

[Lord Bichard (CB)]

My Lords, I congratulate the noble Lord, Lord Filkin, on the way in which he has led the work of this committee, which has been quite exceptional. I also want to congratulate the noble Lord, Lord Livingston, on a quite outstanding maiden speech. I cannot share the noble Lord’s passion for Glasgow Celtic but I agreed with every other word. The greatest compliment that I can pay is that the noble Lord would have made a quite exceptional member of this Select Committee. I look forward to hearing more from him in the future.

The Select Committee inquiry was not just about ageing but about our public services and how well equipped they are to cope with the major social challenges that we face. I am afraid that I came to the conclusion that they are not well equipped: not because they do not have the resources—although clearly there are problems at the moment—but because somehow we have still not been able to design, build and shape our public services around citizens and clients. Whatever the rhetoric and whatever the good intentions, our focus has continued to be on the providers and their convenience rather than on the needs of clients and citizens.

The evidence for that is very clear. For many years, we have encouraged different agencies to develop plans and objectives in isolation. We have set separate targets for each of them, which have sometimes been in conflict. We have developed different and sometimes contradictory regimes. We have failed to provide support for users seeking to find a way through this increasingly complex system. We have failed to encourage and incentivise collaboration between different agencies.

That has been the case especially in Whitehall, where departments have fought, mostly successfully, to maintain their independence, sometimes reinforcing their empires by building their own inspection and regulation regimes which have made it very difficult, sometimes impossible, for local agencies to work together for the benefit of clients. In addition, we have designed measures of success which have had more to do with bureaucracy and budgets than the needs of clients. We have responded to problems by reorganising structures, not redesigning services. Perhaps most of all, we have consistently failed to involve clients in the design of our public services.

The work of the Select Committee exposed four consequences of these fault lines. First, the failure of departments to work together means that there is still no coherent strategy for ageing in this country, because to have one would need housing through the DCLG and finance through the Treasury, and for health, social care, planning, education and DWP to get together meaningfully to produce a coherent strategy. They have not done it.

Secondly, the fragmentation of the system means that it copes particularly badly with people who have complex problems. Most older people now have what is known as comorbidity—they have complex problems. I am afraid to say that they often find themselves having to go to different providers or agencies to deal with each of their conditions.

The third consequence is that when those on the front line trying to provide joined-up care have succeeded it has been in spite of the system that we have designed and not because of it—they told us that very clearly. Fourthly and worst of all, vulnerable old people, often with long-standing and debilitating conditions, find their final days consumed with stress and bureaucracy. I was hearing yesterday of an old lady—let us call her Mrs Jones—who was in hospital when she was given the news that she was reaching the end of her life. Mrs Jones wanted to end her life, like most people do, at home. The hospital staff, to their credit, wanted to support her in that ambition. In order to realise that single, simple wish required the involvement of 23 different teams, the completion of 25 assessment forms and the convening of two separate funding panels. It took three agonising months and she finally got home two weeks before she died.

I have been speaking about the need for designing around clients and collaboration in our public services for many years. Many people think that you are talking about something dry: the reorganisation of Whitehall or whatever. But you are not. You are talking about the implications for Mrs Jones and the countless people like her for whom this system does not work.

The Minister, who I know shares many of these thoughts, will point to many very good initiatives which are under way. The integration pioneer programme is fantastic and, similarly, much in the care plan. I applaud that; I wish him well with it. But we need even more. We need a crusade to ensure that in future we never design public services for the benefit of providers; we design them for the benefit of clients.