Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020
Lord Desai Excerpts(3 years, 7 months ago)
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Lord Desai (Lab) [V]
My Lords, there are various things to say here. First, whenever we make regulations, I guess that we have to assume that people are the same, depending on their age, gender or profession—but they are different. Even among the elderly, there is a great difference among BAME people, some of whom live in crowded surroundings and are not easily reachable by modern technology. It is assumed that everybody has a smartphone or is accessible via wi-fi or some other device. We have to look after people in a way that recognises that different circumstances require separate agencies to reach them.
We also have to be clear about whether we are taking these measures to slow down the spread of infection or to try to reduce mortality. As I said the other day, we have to be clear about whether our objective is to reduce mortality or to reduce infection. If it is to reduce mortality, we need only to reach the affected person quickly and give them notice that, having tested positive, they are in danger and ought to do something about it.
We have to be quite sure that local community agencies, mosques, temples and corner shops are used to reach people who might be in danger. Lastly, there ought to be a single source that people can reach to give them clarity about the rules, because right now there is no single source that people can go to.
Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020
Lord Desai Excerpts(3 years, 7 months ago)
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Lord Desai (Lab) [V]
My Lords, I welcome the noble Baroness, Lady Fox, to your Lordships’ House. She will remember that we have known each other since before either of us got into the public eye—I will keep all her secrets if she keeps all mine.
The noble Lord, Lord Moylan, said many important things in this debate. What are we trying to minimise? Are we trying to minimise infections or deaths? Again and again, the infection numbers are published. The Prime Minister long ago said he wanted to flatten the sombrero, which is all about the rate of infections, whereas the real number that we are, I hope, trying to minimise is the mortality rate. Because a lot of our strategy has been based on the rate of infection, there has been neglect of other morbidities. As many people have pointed out, hospitals cannot cope with the non-Covid morbidities and we are losing people on that score.
So it would be very good if the Government specified whether the objective is to reduce infections or reduce mortality. If it is to reduce infections, of course the whole thing about 10 pm is very important—but the 10 pm measure actually increases crowding at closing time, which is a very bad thing. Since the elderly are more subject to mortality than younger people, let us see that older people do not get infected in any of the activities that they undertake, indoors or outdoors.
Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020
Lord Desai Excerpts(3 years, 7 months ago)
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Lord Desai (Lab) [V]
My Lords, the Government have alternately claimed to follow science and to want to save the economy. They have managed to do neither efficiently, because they have not followed science faithfully ever since this crisis started. They delayed the first lockdown and then did not implement it properly. They want to release the economy but they know that, in some cases such as the hospitality sector, relaxing rules is harmful. When they try to implement a lockdown, they do not do it efficiently; they have failed to do the testing and tracing properly. The IT performance has been abysmal, almost shameful. I have seen nothing as badly incompetent since the Heath Government of 1970 to 1974.
As the amendment in the name of the noble Lord, Lord Robathan, says, what is the magic about 10 pm that makes it so sacrosanct? Indeed, if you say 10 pm you increase the chance of overcrowding and of too much contact between too many people. You need to find way to manage these closures in a staggered way. That would be a more sensible way of controlling Covid and encouraging the economy than what has been done.
I strongly support the amendment in the name of my noble friend. The country deserves better than the performance of this Government, who are probably the worst in all developed countries.
Covid-19: NHS Long-term Plan
Lord Desai Excerpts(3 years, 8 months ago)
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Lord Bethell (Con)
I completely agree. It is a grave shame that too many diagnoses happen late. We are proud of our acute care, but it is this Government’s mission to move to a priority around early intervention which will have a huge impact on the quality and length of people’s lives and make modern healthcare more affordable. The noble Baroness is entirely right that respiratory interventions are an important priority.
Lord Desai (Lab) [V]
My Lords, it is not good enough just to praise NHS staff. Will the Government commit to spending a certain percentage of GDP on health as soon as possible? I suggest that 12% of GDP should be spent on health; then we would not have a repetition of this disaster.
Lord Bethell (Con)
We do not just stand and praise. We are recruiting a huge number of new staff—50,000 more nurses and more GPs—and we invest in them through our people plan.
Independent Residential Care
Lord Desai Excerpts(3 years, 10 months ago)
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Lord Bethell [V]
The noble Baroness makes her case well. There are a large number of considerations in this matter—my noble friend Lord Forsyth has already made a strong case for the recommendations of the Economic Affairs Committee—and we need to look at all of them. It is an extremely complicated area. We need to get buy-in from cross-party support and from a wide number of stakeholders and the businesses involved. Once we are in that position, we will be able to make a plan that delivers a long-term solution to this knotty problem.
Lord Desai (Lab) [V]
My Lords, we must welcome Sir Simon Stevens’ promise to help independent care providers, but will we make sure that when the money goes to those providers they pay their staff properly, give them protective equipment and do not let them go on working in an unsafe and underpaid profession?
Lord Bethell [V]
My Lords, the role of the staff is essential. We have put in place an infection fund of £500 million to help to provide a safe working environment for staff, and we are looking at mobilising a huge PPE effort, led by my noble friend Lord Deighton. The protection and payment of staff are essential. However, a long-term solution for staff will depend on a long-term deal. We are working on that but I cannot give any assurances until the important work of building cross-party support has been fulfilled.
The Long-term Sustainability of the NHS and Adult Social Care
Lord Desai Excerpts(6 years ago)
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Lord Desai (Lab)
My Lords, it is a privilege to follow the noble Baroness, who has done so much on the health front. I join everyone else in congratulating the noble Lord, Lord Patel, on an excellent report. We have had a very good debate. I think it is right to say that the NHS is a sort of religion in this country—the only religion that everybody has—but, for the same reason, we are always extremely dissatisfied with the state of the NHS. I have lived here for 52 years and not a day has gone by without the NHS being in crisis. We actually love it only if we can see it in crisis; if it ever became satisfactory, we would lose all faith.
I am going to concentrate on an issue that many others have talked about: the funding of the NHS. I have said before that our problem is that as longevity increases, it gives us a longer-living population with more medical needs. But we have also discovered that there are many more dimensions of health than we used to think there were, such as mental health. We are now discovering dementia not only in the elderly but in children. As we discover these problems, the demand for healthcare increases continuously and because we price it at zero, there will always be excess demand anyway. So how are we to fund it?
There has been a back-and-forth argument about national insurance contributions being hypothecated, or not. I asked the Library to do some research for me and it turns out that if we look at the total collection of NICs and the total budget for the National Health Service, for a long time we used to be able to collect more money in NICs than we spent on the National Health Service. Going back over the last 20 years, it found that during the first 10 years, from 1999 until about 2007, the difference between those two budgets was either a small amount of plus—that is, more revenue in NICs than NHS expenditure—or a small amount of minus. The difference was always under £10 billion, so it was possible once upon a time to think of NIC revenue as sufficient to finance the National Health Service. Whether that is done through a hypothecated rise is a separate problem.
What disrupted this happy relationship was of course the crisis of 2008. Once that happened, our NIC revenue stopped growing by as much as our NHS expenditure. We should remember that NHS expenditure had been increased from a slightly lower level to the European level of 8% by Tony Blair in 2003, so our expenditure went up sharply but our revenue from NICs were not adequate to service that. Now, the gap between what we collect in taxes and what we spend on the NHS has gone up to £20 billion. It is quite clear that whether we hypothecate or not, it would be good to keep track of that number. We have to see how we can get more money under NICs, because that happens to be the most convenient tax to play with.
I quite agree with people that there should be no exemption from NICs for people beyond a certain age, if they are earning money. Because we are already going beyond the standard retirement age of 65, anyone earning money in any capacity should pay NICs. I do not see why we should exempt anybody. I have also complained before in your Lordships’ House that the category of self-employment is becoming more and more a category of tax avoidance from NICs. We all noticed how the BBC was advising its highly paid personnel to become companies, because then they would pay much less tax than the ordinary punter was paying. That is outrageous. We really ought to put a stop to this boondoggle and say that self-employment will get no concession. It is no good pretending that those people are really self-employed. Those two things may increase our collection under NICs.
It is not so much about whether we hypothecate, but when budgeting we ought to keep an eye on how those two numbers track each other and at what stage we may need supplementary revenue from other sources, or perhaps even some kind of borrowing programme so that over five or 10 years, the budgets would balance out. It is worth doing it from that longer perspective. We ought to think about funding the NHS in a five to 10-year cycle. That is one suggestion.
My other suggestion is that we have to do something about social care. On taxation, some people have asked why the people who are working and not using the health service very much should pay, while the people who go to the health service and are retired or elderly do not pay very much. The logic of this system is that while you are working, you pay. It is as if you are saving because you will use it when you are elderly—and when you are elderly, the corresponding younger generation will be working and saving. They will be financing your retirement expenses. In economics, that is called an overlapping generations model: in the first part of your life, you work, and in the second part of your life, you consume, but your savings in the first part finance your spending in the second. It is quite fair for working people to pay the tax that finances the medical needs of the elderly. In some sense, they are paying for their own retirement expenditure, as in a social insurance fund. We should be more positive about relying on national insurance contributions than we have been so far.
By the same logic, on social care costs, we ought to say that to the extent that people who have assets, mainly houses, are reluctant to sell them to finance care costs, we ought to rely on inheritance tax, increase it and hypothecate it to social care. I shall not go further because I do not have time.
NHS and Social Care: Winter Service Delivery
Lord Desai Excerpts(6 years, 3 months ago)
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Lord Desai (Lab)
My Lords, I welcome this debate. Thankfully, much of what I wanted to say has been said by the noble Lord, Lord Macpherson of Earl’s Court. I wish that more Treasury mandarins like him retired, came here and became progressive. We would welcome that.
However, at the bottom of this crisis, which is not new but occurs perennially, is the fact that we have undertaxed ourselves and refused to raise the resources necessary to enable a civilised society to look after itself. We have not taken on board the seriously high cost of living longer. Our pension systems have been wrecked by that because, when we started them, we thought that people generally lived about 10 years beyond retirement. However, if people live 30 years beyond retirement, the pension system is wrecked. I agree with the noble Lord, Lord Macpherson—indeed, I do so because I proposed this measure—that there should be a hypothecated tax system and national insurance contribution, as he said, with much stiffer taxation for self-employment, which I think is a species of fraud practised upon the tax system. Indeed, in the Budget before last, the Chancellor tried to tackle that problem but he was shot down in no uncertain terms. We have to stop believing that tax cuts are great, borrowing is bad and that somehow in between we can finance a welfare state. Therefore, we should definitely have a hypothecated tax.
We should also tackle the financing of local councils. We have a tax, the council tax, which is, of course, regressive. But worse than that, it is frozen at old levels of house prices. We proudly proclaim how much house prices have gone up but for many years we have not taxed the capital gains that home owners have made. It is time that we tackled that question. Some noble Lords will remember that it was when we had to revalue properties in the light of the rise in prices way back in the Thatcher Administration that the entire fiasco of poll tax happened because of the timidity of that Government in revaluing property. Again and again, Governments have not revalued property and therefore council finances have suffered. It makes no sense whatever. We need a serious revaluation of private properties. You may keep the council tax rate the same, just move the bands up. A lot of people would move up the bands: that is the reality. If people pay the appropriate tax, they will receive good social care in return, so they would not lose anything. As I say, we need a hypothecated tax and we need a revaluation of council tax.
Something was revealed to me last week in a report of the National Audit Office on the PFI and all those things. The Carillion disaster has coincided with some early nights so I read that. When PFIs were proposed, it was quite clear that it was a piece of imaginative accounting and the Government could borrow off the balance sheets and pretend that they were being fiscally responsible but at the same time hiving off a huge debt. The important point is that that borrowing was very fruitful for the NHS. We need that kind of borrowing to expand hospital capacity and the health and social care infrastructure. Whether you do that kind of borrowing under a PFI or openly is a question we can go into. But given that currently the rates of borrowing are very low, now would be a chance—perhaps the last chance very soon—to borrow a lot of money dedicated to improving the health and social care sector. We cannot go on complaining about winter deaths and not pretend that it is the lack of resources which is causing this problem. So we need more taxation. I was sacked twice from the shadow Front Bench for proposing more taxation, and that was in the Labour Party before new Labour. I do not want to get anyone sacked but I think it is still worth saying that we are an undertaxed nation and we are paying the price for that.
National Health Service
Lord Desai Excerpts(8 years, 4 months ago)
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Lord Desai (Lab)
My Lords, as a professional economist—the only one speaking in this debate—I should say that any service that is free at the point of use will perpetually suffer from excess demand. The NHS is no different; more or less since its founding, it has faced a continuous demand for more money and the public fisc has been unable to quite meet it, so we have had a history in which it is perpetually in a funding crisis. At the same time, though, there is a great deal of satisfaction with the service, so we need to understand how it works.
We have to be careful about the fact that the percentage of GDP spent on health is not a good measure of outcomes; it is a measure of inputs. As someone has said, we have one of the best-ranked health services, despite not being the highest-spending nation. The highest-spending nation is probably the United States, which has a lousy health service.
Having said that, we need to make the user more aware of the costs of the service, as my noble friend Lord Brooke said. In many previous debates, I have suggested that every user of the NHS be given an annual return showing what they have used it for and how much that has notionally cost the NHS. They should be made aware that even if they miss an appointment it costs money. Whatever they have had, somewhere it has been paid for. They do not have to pay for it themselves, but they ought to be made aware that there is a cost to each thing that they do or indeed do not do. At the same time, we ought to provide people with another sheet of paper showing how the total NHS money is spent, just for information. People ought to understand what their money goes on. Right now they do not understand, and they take it for granted.
I shall say just one more thing because my time will be up very soon. We have made all sorts of predictions about what proportion of GDP should go on health. I can more or less tell the House, with all the certainty that I can command, that the era of high growth is over and that for the next 10 or 15 years the GDP growth rate will not be high, and nor is inflation. Whatever we do, we will have to find ingenious ways to achieve efficiency, perhaps by nudging users to be more economical with their use of the NHS, and somehow changing behaviour so that we do not always take for granted that there will be more money, and if there is not more money, it is someone’s fault. One of the last—no, I do not think I have any more time.
National Health Service: Sustainability
Lord Desai Excerpts(8 years, 10 months ago)
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Lord Desai (Lab)
My Lords, it is a pleasure and a privilege to follow the noble Lord, who has such vast experience in both Houses.
I thank my noble friend Lord Patel for introducing this debate. I think that I have spoken in every health debate that he has initiated. He is quite right to say that there ought to be a royal commission, but I expect that the Government will pour cold water on that. Any royal commission appointed any time soon would report around the time of the next election, and no Government want a royal commission report on their hands when they are trying to fight an election. Perhaps, as the noble Lord, Lord Cormack, said, we will continue this debate—and perhaps all the debates in your Lordships’ House on the National Health Service, collected together in one volume, might by themselves tell us a lot about how to cure the NHS.
As a lot of people have said, there is a consensus that we all love the National Health Service. A number of individual experiences, including those of the noble Lord, Lord Mawhinney, tell us that it is extremely helpful and valuable to our lives. At the same time, in all the years that I have been in this country—more than 50—there has never been a time when people have not said that the NHS is in crisis. We can sustain the National Health Service only by believing that it is perpetually in crisis and that something has to be done about it.
We tend to look at the NHS from the supply side, which involves asking how we can get more money and increase productivity, and how can we reorganise it. Every party reorganises the health service when in power and, when in opposition, criticises any reorganisation carried out by the Government. We have sustained a good National Health Service but, in my view—I have said this before in your Lordships’ House—so far we have not done anything on the demand side. Because we promise to deliver healthcare for free to whomever demands it, we have taken it for granted that all the adjustments have to be on the supply side, not the demand side.
I believe that there are a number of things that we ought to be able to do, as some noble Lords have mentioned, to, as it is called, “nudge” the behaviour of the public who demand healthcare. If there is ever a health commission, it ought to examine how to bring about behavioural change, perhaps by providing incentives to people to change their behaviour. Yesterday, the Chancellor revived the idea of using vehicle excise duty for road building. I had always thought that the Treasury did not like hypothecated taxes but here we have a hypothecated tax. There is no reason why the Chancellor should not tax sugar and salt and link the tax quite explicitly to the health service—even though it would finance only a very small proportion of the costs. We are worried about obesity and diabetes but we do nothing about salt and sugar in food. However, there is absolutely no reason why we cannot do this. We ought to urge the Government to explore things that will influence behaviour.
Another suggestion that I have made before in your Lordships’ House is that, although we do not want anyone to feel that they are being charged for using the health service, we ought to make clear to people the cost of providing it. People think that because it is free, it is costless—but it is not. We often worry about people missing GP appointments, so I propose a sort of health Oyster card for every citizen. Every time they used the National Health Service, they would have to swipe their Oyster card and a certain number of points would be deducted. The Oyster cards could be recharged. At the end of the year, people would get a bill showing how many points had been used and on which health service facilities. If people missed a GP appointment, 15 points would be deducted rather than two—things like that. Perhaps something like that could be done to make it clear to people that a free National Health Service is not a costless one. If we can somehow get people involved as patients and potential patients so that they modify their behaviour in demanding healthcare, it may solve some of the problems of the National Health Service.
NHS: Whistleblowing
Lord Desai Excerpts(8 years, 10 months ago)
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Lord Desai
To ask Her Majesty’s Government what is their policy on whistleblowing in the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, the Government are committed to improving openness in the NHS and ensuring that whistleblowers are considered an asset and receive proper support. The Freedom to Speak Up report sets out principles and actions to help create a culture change in the NHS. It calls for local accountability, with system regulators providing national oversight and guidance. We will publish our consultation response on a package of measures arising from the review and next steps shortly.
Lord Desai (Lab)
I thank the noble Lord for that Answer, but is he aware that there is considerable anxiety among junior doctors, especially among those from a black or ethnic-minority background, that their career prospects may be harmed or they may even find their contract terminated if they are whistleblowers? Will he promise to take a look into that problem?
Lord Prior of Brampton
The noble Lord makes a very important point. There are many junior doctors from BME backgrounds who do indeed feel that it is difficult to raise concerns. One recommendation in Sir Robert Francis’s report is that every NHS organisation should have a local freedom to speak up guardian, which I hope will help. But whatever we do to change the law or codes from the GMC and others, it will not replace the need to have an open, transparent and learning culture in all NHS organisations.