NHS and Social Care: Winter Service Delivery

Lord Bishop of Carlisle Excerpts

Thursday 25th January 2018 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, as ever, much of what I might have wished to say has already been said so I will not repeat it. I will try to keep my contribution brief.

In one sense, the current situation in health and social care, which, as we have heard, has been widely reported and analysed by the media, is nothing new. Admittedly, the number of patients with flu this year, especially elderly ones, has not helped. Last year, though, in its document entitled Winter Warning, NHS Providers commented that, “NHS performance last winter”—that is, 2016-17—

“showed unacceptable levels of patient risk as growing demand outstripped NHS capacity”.

Every winter has brought its own challenges, and short-term problems and pressures are not necessarily indicators of long-term difficulties. At the same time, though, as we all know, and as was pointed out by the noble Lord, Lord Macpherson of Earl’s Court, an increasingly large and elderly population with multiple morbidities has been steadily putting a huge strain on both the NHS and social care in this country.

The delivery of services is not an issue only over the winter period: it is a constant headache, not least in accident and emergency departments across the country, but also in care homes and private homes that are struggling to cope. As the noble Baroness, Lady Wheeler, pointed out, in a recent survey, no less than 91% of trusts reported a lack of social care capacity as winter approached, despite the promise made in the March 2017 Budget of an extra £1 billion for social care in 2017-18.

This emphasises the need for two things to happen, one of them short term, the other long term. The short-term need should be relatively straightforward to meet. It involves not only planning for next winter now but making sure that the necessary funding is released well before the winter actually arrives. As the noble Baroness, Lady Wheeler, reminded us, in the Budget on 22 November 2017 the Chancellor of the Exchequer committed £337 million to address winter pressures. That was very welcome but it came about four months too late. Health and social care providers are clear that any extra funding to help with the demands of the winter period needs to be committed by the end of July at the latest to enable effective planning.

The longer-term need is rather less simple but even more important. This is the need to tackle the thorny issue, alluded to several times, of the long-term sustainability of both the NHS and social care. I had the privilege of sitting on the ad hoc Select Committee of your Lordships’ House chaired by the noble Lord, Lord Patel, which produced a report on this exact topic last year. Unfortunately, the report came out just before the general election, which means that we are still awaiting a response from the Government and proper debate on its many recommendations.

Those recommendations relate directly to the subject under discussion this afternoon. Recurring winter pressures cannot be separated from the pressing need to address the ongoing issues around sustainability, including personal responsibility, increasing integration—we welcome the new Department of Health and Social Care—workforce planning, a model for funding and, above all, a non-party-political group, rather like the OBR, to advise the Government of the day about long-term requirements.

I greatly look forward to that debate in the hope that it may help to mitigate the need for ongoing debates such as this.