NHS: Long-term Sustainability

Lord Bishop of Newcastle Excerpts

Thursday 18th April 2024 Lords Chamber

[The Lord Bishop of Newcastle]

My Lords, I thank the noble Lord, Lord Patel, for securing this debate. It is a pleasure to follow my friend, the noble Baroness, Lady Tyler, and I commend the noble Baroness, Lady Ramsey, on her excellent maiden speech. I welcome this debate’s focus on health and social care and in this regard I pay tribute to the noble Baroness, Lady Warwick, for her speech. Too often, social care is considered in public debates primarily in the context of ensuring that the NHS is not overwhelmed.

This debate’s title is rightly ambitious about social care reform. But given the current state, social care simply needs to be there when people need it, in a comprehensive, timely and affordable way. This was highlighted by the case in Newcastle of Dr Jo Wilson, who had been diagnosed with dementia in 2020. Following her death in January 2023, her husband Bill, who had provided round-the-clock care as a result of inadequate and inconsistent care support, described the care system as “broken”. Many cases, such as those raised by campaigns such as John’s Campaign, founded 10 years ago, are also linked to poor dementia care, particularly access for loved ones to those under care.

The Archbishops’ Commission on Reimagining Care developed a vision for social care, drawing on Christian theology and values. The commission heard the need for a fundamental shift in how social care is thought about, organised and delivered. It proposed a national care covenant, a process initiated by government in dialogue with stakeholders to clarify the responsibilities of everyone: individuals, families and communities, alongside local and national government. What assessment does the Minister make of a covenant as a means of rebalancing social care roles and responsibilities?

Areas prioritised by the Government in recent years are worthy of attention. We need more digitisation of systems and databases. We certainly need more care workers, and an attitude shift around that work’s importance, reflected in pay and conditions, as other noble Lords have mentioned. Indeed, the greatest challenge the sector faces in delivering high-quality care and support nationally is workforce recruitment and retention. The north-east is no exception: in 2022-23, the vacancy rate was 8.7%, with 6,400 vacant posts.

I commend the newly published report by the think-tank Theos, which considers the intersection between love, work and care and offers a different and profoundly helpful lens for valuing care more highly. It says:

“Love is a skill, and … is what makes care possible”.


The lack of a shared sense of why social care matters may contribute to attempts at reform being abandoned. With the health and social care levy scrapped and the cap on costs delayed, there lacks a long-term strategy around funding social care. I worry that neither this debate nor the fundamental debate about the value and purpose of social care are taking place. It can feel as though there is a collective burying of heads and a desire to avoid the next NHS crisis rather than recognising that the success of our health and care systems are fundamentally bound up with one another. Where is the vision? Social care demands our focus, not as an end in itself but as the very means by which we begin to experience life in all its fullness.