Exercise Cygnus

Lord Hunt of Kings Heath Excerpts

Tuesday 9th June 2020 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what action they took following Exercise Cygnus to prepare the United Kingdom for responding to a major pandemic.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, Exercise Cygnus addressed the greatest risk in the National Risk Register of Civil Emergencies: a flu pandemic. All the recommendations from Exercise Cygnus were accepted and taken on board. Many of these proved invaluable for informing the response to Covid, including plans for legislation that would assist in response measures, for bringing back retired clinical staff, for flexing systems beyond normal capacity and for establishing a group of expert advisers on moral, ethical and spiritual issues.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, if the Minister is so confident that the lessons from Exercise Cygnus informed the UK’s preparedness, why was the care sector so neglected? To deal with the surge of NHS patients expected in the event of a pandemic, the exercise identified that extra capacity would be required in care homes. Why was that not heeded and why, as Martin Green, chief executive of Care England, put it, was PPE redirected away from care homes and the NHS given a clear instruction in March to send people to care homes despite no testing for infection being available?

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Lord Hunt of Kings Heath Excerpts

Monday 8th June 2020 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House regrets the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020 (SI 2020/469) and the lack of a long-term plan to ensure the financial sustainability of care homes.

Relevant document: 14th Report from the Secondary Legislation Scrutiny Committee

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the care sector has never been more in the eye of the storm than during the Covid-19 pandemic. I pay tribute to all in the sector for the care they have given to so many people, under huge pressure and at no little risk to the workforce. As my mother is in a care home, my tribute is personal and based on first-hand experience.

There is no denying that care homes have been dealt a poor hand during the crisis, which unfortunately is consistent with the long-standing neglect of the sector. We must do better and ensure that as we come out of the crisis, we bring long-term sustainability to care homes and peace of mind to those who live in them. This SI does not aim to do that. None the less, I welcome the proposed increase in the rate that the NHS pays to care homes to cover the cost of services carried out by a registered nurse.

The new rate follows a Supreme Court judgment in Wales, with implications for England. It has also been influenced by a challenge to the 2019-20 rate and the 3.1% efficiency gain assumed within that rate. The 2019-20 rate was subsequently revised and the rate for 2020-21 is built on that revision. Can the Minister explain what efficiency rate had been built into the new rate and whether it is realistic to expect care homes to meet those efficiency savings at this time, when their costs are going well above the inflation rate?

This is borne out by many in the sector. As Richard Adams, the chief executive officer of Sears Healthcare, a small group of care homes, reported to me:

“We are seeing people coming into our nursing homes much later in their life course. Their health care needs are multiple and complex and require very specialised nursing care in order for them to be able to continue to live and to die well.”


Unfortunately, there is very little recognition of this in the contract arrangements in place with clinical commissioning groups. Will the Minister review these contracts and ensure that care homes are adequately recompensed to provide this type of care?

Of course, care homes were already under significant pressure when the pandemic hit us. Covid-infected patients were moved from NHS beds with no consideration of whether the care homes they were sent to would be able to cope. The care sector was clearly a long way down the chain of command, as illustrated by the lack of priority given to it in relation to PPE, testing and the recording of deaths. The absence of reliable figures for deaths in care homes for many weeks was indeed telling.

At times the care sector felt deserted by the Government. The Association of Directors of Adult Social Services has said that the national handling of protective equipment for care workers was “shambolic”, with early drops of equipment “paltry” and more recent deliveries “haphazard”. Martin Green, the CEO of Care England, put it even more explicitly:

“From the start the NHS was prioritised … PPE was redirected away from care homes ... There was a clear instruction to empty hospitals in March to send people to care homes despite no testing for infection.”


When it comes to funding, £3.2 billion has been made available for local authorities to help respond to the Covid-19 pressures across all services, including adult social care, but a report from Care Providers suggests that funds are not making it to the front line in some areas, with learning disability services facing particular problems. As Care England has documented, overheads are rising as occupancy falls, with serious cash-flow implications. There is a risk that providers may become insolvent and collapse, or alternatively raise fees considerably. Over the weekend Age UK reported that some residents were paying a Covid-19 surcharge of up to £150 per week to cover extra costs. Does the Minister agree that this is a massive hike, and that it is unfair as self-funders are in effect subsidising council-funded places?

Richard Adams of Sears Healthcare has stated

“Future funding agreements for social and nursing care must include provision increased costs associated with … Purchasing additional PPE … health surveillance activities … Increased costs incurred by the need to flex staff in order meet the requirements of any self-isolation … Increased training costs in relation to infection prevention and control, correct use of PPE and outbreak management.”


Does the Minister accept this?

I am afraid that the experience of care homes in the last few months reflects the neglect that the sector has long experienced, and it is a damning indictment of this country’s failure to provide a solution to the funding of long-term care. We are in a vicious cycle: after decades of reviews and failed reforms, the level of unmet need in our care system increases, the pressures on unpaid carers grow stronger, the supply of care providers diminishes and the strain on the care workforce continues—and that is before the new immigration controls are imposed on so-called low-skilled workers at the end of the year. I want the Minister to say tonight whether the Government will soon publish their proposals to deal with the long-term challenge.

I thought Philip Collins put it very well in the Times on 14 May when he wrote:

“There are three ways to fund social care. We can wrap it into the NHS and fund it through general taxation, or perhaps a hypothecated levy. We can ask the individual to pay, drawing on savings which might be mandated through a social care auto-enrolment scheme or equity released from the family home. Or we could do some combination of those two options, which is what Dilnot suggested all the way back in 2011—the individual pays”


up to a certain level

“subject to means, and then the state steps in.”

Are the Government prepared to come forward with a concrete proposal? I certainly hope so. Fudge it, delay it, and we will continue to fail to deal with the fact of ageing and consign millions of people to a worrying and often miserable old age. We can and surely must do better than that. I beg to move.

--- Later in debate ---

[Lord Hunt of Kings Heath [V]]

My Lords, I thank all noble Lords, and the Minister for his considered response. The debate has shown the very serious situation facing many of our care homes. I heard what the Minister said about support for the social care system. However, far from experiencing a protective shield, many care homes felt abandoned by the Government and the NHS in March. They remain very vulnerable financially, and the workforce crisis in the offing because overseas recruitment will effectively come to an end at the end of this year cannot be wished away.

The Minister has reconfirmed the Government’s commitment on the long-term future. This is welcome. I also agree with the noble Baroness, Lady Wheatcroft, about the desirability of cross-party consensus. Looking back, it was a great pity when Andy Burnham’s plan was labelled a death tax by David Cameron in 2010. That has made cross-party consensus that much harder.

One thing is for sure: we owe a huge debt to care workers and carers for the fantastic work they have done over the last few months. They have responded magnificently to this huge and unprecedented challenge. We thank them all. I beg leave to withdraw my Motion.

Motion withdrawn.

Dental Care

Lord Hunt of Kings Heath Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

The noble Lord is entirely right that poor dental care is extremely damaging to individual health. The current situation is one that we massively regret, but the safety of patients and dental professionals is paramount. The aerosols generated by dental drilling and other dental practices leave the threat of germs in the air in a dental practice for hours to come, which could be caught by staff or future patients. It is for that reason that we have focused the infection protocols in 500 special units that have the right kit, the right training and the right arrangements.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare my interest as president of the British Fluoridation Society. I recognise the work done in setting up urgent treatment centres, but they are patchy in England and many provide only for pain relief and tooth extraction. Many high street dentists are in danger of bankruptcy, because the Chancellor’s schemes to help businesses have not been applied to them. Will the Minister consider setting up a programme of work with the BDA and the Chief Dental Officer to establish a national plan to get dentistry back on track and save the profession from ruin?

[Lord Bethell]

My Lords, I completely understand the points that the noble Lord has made. He refers to a situation that we are fully aware of, and I completely agree with his analysis. The truth is that tooth extraction avoids some of the risks that I described, but treatment in the centres is not limited to extraction and other protocols are arranged. The Chief Dental Officer is working on a dental plan, and we are liaising with colleagues in the Treasury to see what more can be done to help dental practices.

Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020

Lord Hunt of Kings Heath Excerpts

Monday 18th May 2020 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, along with Geoffrey Robinson, former MP for Coventry North West, and supported by Dan Jarvis MP, I was very proud to sponsor what became the Organ Donation (Deemed Consent) Act 2019 through your Lordships’ House, on which these orders are based. I hope that the Minister, when he comes to wind up, will join me in thanking Geoffrey Robinson and Dan Jarvis for the tremendous work that they did.

Our aim was to increase the number of organ donations while maintaining strong family involvement in the decision to donate, which remains a remarkable act of giving. The Bill was known as Max and Keira’s Bill—now Max and Keira’s law—in honour of the recipient, Max Johnson, for his immense bravery while waiting for a heart transplant, and the donor, Keira Ball, who tragically died in a road accident. I pay tribute to both of them. I also pay tribute to the Mirror newspaper and its readers for the tremendous support they gave to the campaign. Thanks, too, to Kidney Care UK and many other charities, who have been such a help.

Our aim is quite simply to inspire more people to have that incredibly important conversation with their loved ones, knowing that this could save the life of a person waiting for a transplant. It is estimated that 700 more transplants a year could take place. I fully support the regulations and the associated codes of practice, which have a greater focus on faiths and beliefs and should support better conversations and greater reassurance for many families.

I know that the NHS is working to continue organ donation where possible, but the impact of Covid-19 on transplants has been major, with many centres having to close or at least limit the scale of transplants. We know, for instance, that some people waiting for a kidney transplant have had to commence dialysis rather than have pre-emptive treatment. Although there is no known transmission of Covid-19 through organ donation, any risks need to be minimised as much as possible because patients who need a transplant must be immunosuppressed.

The Covid-19 outbreak has also brought the need to address health inequalities faced by people from BAME communities into sharp relief. There is too much inequality in transplant cases, too. As Kidney Care UK put it to me, people from BAME communities wait six months longer for an organ, despite being more at risk of kidney failure, because fewer organs are available from donors from this community.

I know that it is unlikely that transplants will proceed under the deemed consent provisions during the coronavirus pandemic. Perhaps the Minister could expand on that a little more. I hope that he will commit to a major public awareness campaign when we are out of the crisis; it is essential in maintaining public support and trust for organ donation. The campaign launched by NHS Blood and Transplant in April 2019 was successful in raising awareness and was an excellent start. However, it had to be significantly reduced during the epidemic to enable messaging to focus on keeping the public safe and well. That is quite understandable, but I ask the Government to ensure that, when we come out of this, they fund campaigns on a regular basis to encourage people to consent and understand the new issues that this legislation brings in.

I ask the Minister to ensure also that the NHS is fully prepared for the expected increase in donations. The specialist nurses for organ and tissue donation are essential to the successful implementation of the Act. These amazing people provide advice, support and information to the family. They determine the last known decision of the deceased and ensure that no organs or tissues are retrieved without consent being in place. It is essential that the number of nurses is increased so that families continue to receive the highest possible care and support.

During the passage of the then Bill, the Minister’s predecessor, Lord O’Shaughnessy, stated that the Government would

“make sure that there are enough highly trained staff to make the most of the changes resulting from this Bill”

and that we should

“make sure that they are fully trained and fully financed for the future.”—[Official Report, 23/11/18; col. 447.]

I seek a commitment from the Minister that that additional funding will be provided to ensure that the increase in nurses continues in future, so that the families of every donor can be approached with the necessary care, sensitivity and empathy.

It is also very important that we make the most of every single precious gift of donation. We know that transplant units are already under pressure. NHS Blood and Transplant recently established a new system for flagging instances where organs were declined for a named patient purely because of a lack of available resources to enable the team to undertake the transplant. We need to ensure that transplant units can keep pace with the anticipated increase in organ donation. They too need to be funded and resourced to make sure that every organ that could be transplanted is transplanted. No organ should be declined by a transplant team due to a lack of resources.

Finally, I refer to novel technologies. The UK is currently leading the world in novel technologies to support organ transplantation. We have developed new techniques and machines that enable us successfully to transplant organs that would not have been transplantable before. I ask the Government to confirm that they will support transplant units and fund them to ensure that they can use these novel technologies and save more lives through the gift of donation. And I hope, again, that the Minister will acknowledge the work of Geoffrey Robinson and Dan Jarvis MP in supporting the Bill through the other place.

Health Protection (Coronavirus, Restrictions) (England) Regulations 2020

Lord Hunt of Kings Heath Excerpts

Tuesday 12th May 2020 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for his introduction to these statutory instruments. The Prime Minister’s Statement will be debated later, so I will focus on these regulations. As the Minister said, they give considerable power to Ministers to make significant demands on us: to stay at home as far as possible, closing many businesses and stopping gatherings of more than two people in public. As Liberty points out, although the regulations expire in six months, Parliament has to approve them only once, yet Ministers are required to review them every three weeks. Ministers can change the guidance and, through a ministerial direction, can terminate a requirement or restriction contained in these instruments. The Minister said that the regulations get the balance right, but Ministers are given huge authority. Liberty suggests that, as a minimum, the regulations should be remade under the Civil Contingencies Act, as opposed to the Public Health Act. This would enable regular parliamentary scrutiny. Will the Minister look at this again?

The other point which I want to raise, which the Minister touched on, is the use of police powers. Overall, the police have responded magnificently to the incredible challenge they have been given. However, there has been confusion, not least over the extent to which people are permitted to exercise and gather outside. As Liberty says, the combination of sweeping powers, haste in drafting legislation and mixed communication strategies is in part to blame for some of the police confusion. This is likely to grow, given the Prime Minister’s Statement and fears among doctors and police chiefs that the new message to stay alert rather than to stay at home may confuse the public and make it harder to enforce the restrictions.

Liberty recommends that any guidance published to supplement the regulations should distinguish between what is law and what is best practice advice to the public. The Lords Scrutiny Committee made similar points and worried about the confusion between the law and the guidelines. It is keen to ensure that the police are aware of the scope of these regulations, as distinct from the guidance. Given the road map laid out by the Government for lifting the restrictions, we are likely to see changes to the guidelines on a regular basis. I hope that the Minister can assure me that all will be done to make clear to the police just what the law is in the regulations that we are asked to approve today.

Covid-19: Personal Protective Equipment

Lord Hunt of Kings Heath Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

I am not sure that I agree with the analysis of the noble Lord. No one could have anticipated the huge demand for PPE not just in the NHS and care homes but in other workplaces. This is a global phenomenon. The chase for PPE is difficult in all countries around the world. Britain is not alone in struggling with this. I do not think now is the time for apologies; now is the time for delivering PPE, and that is what this Government are focused on doing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as president of the Health Care Supply Association and thank the Minister for his tribute to procurement professionals in the NHS and the supply chain, SCCL. I return to the issue raised by the noble Baroness, Lady Smith, and the noble Lord, Lord Patel, about cross-government working. It is clear that this is a concern of not just the department of health. It certainly involves the Cabinet Office as well. Is there someone in the Government who has the authority to make the final decisions? It is not clear at the moment.

[Lord Bethell]

The noble Lord asked for clarity; let me be clear. The NHS is the client. The department of health pays the bills. Other departments are doing their bit to help. We are very grateful to the Cabinet Office in particular for providing contract and procurement staff, and we are thankful to all other departments that have lent us their staff or their logistical skills in delivering our PPE commitments.

Covid-19: Social Care Services

Lord Hunt of Kings Heath Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very glad to speak in this debate and to pay tribute to my noble friend Lady Wheeler for her excellent introductory speech. I very much agree with the noble Baroness, Lady Verma, in her praise of the amazing work being undertaken by care workers at the moment. They have been left almost defenceless by the lack of preparation and I am afraid that this is yet another indication of how far down the food chain the care sector is in the Government’s concerns.

I am particularly concerned about the financial vulnerability of so many care homes. The noble Lord, Lord Astor, asked the Minister to ensure that the money being routed through local government actually gets to those homes. However, as the noble Baroness, Lady Verma, said, even that is not enough to ensure their financial viability in the future. I hope that the Minister will reassure us on that point.

There is a great risk, with all the focus being put on the crisis today, that the fundamental reforms needed in the care sector will be put on the back burner. Yet we know from the House of Lords Economic Affairs Committee that we have a huge amount of unmet care need and that the demographics mean that that need will grow. We have a vicious cycle here. After decades of reviews and failed reforms, the level of unmet need is growing, the pressure on unpaid carers is getting stronger, the supply of care providers is diminishing because of their financial vulnerability and the strain on the care workforce just gets worse and worse. Moreover, that is before the new immigration cap comes in towards the end of the year. The Government have agreed to extend the visas of doctors and nurses due to expire on 1 October but, inexplicably, this does not apply to care workers.

We have long been promised a government response to the long-term care crisis. It was promised in 2017 and again in the 2019 general election. I urge the Minister to ensure that the Government do not backtrack on ensuring that we shall see very soon strong proposals for the kind of care system we need so that never again will we see a dreadful situation where people in the care sector are neglected and, frankly, treated very much as second-class citizens.

Covid-19

Lord Hunt of Kings Heath Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

I would like to recruit my noble friend to our testing organisation, because she has exactly the right ideas, and the programme she described is exactly what we are doing. The Army is putting together 50 transit vans with tents and cones to be able to travel to places such as care homes to conduct testing, particularly at times of epidemic. Amazon is putting together home testing kits, which means that no one need drive anywhere to have a test, and we are working with care homes so that care workers can take the swabs and then drop off bags of them at a reasonable place so that they can be processed by our laboratories. Drive-in testing was an early but limited programme, and we have a lot more going on than that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister; he has had a lot of work to do in the Lords today. He commented on ONS figures and the analysis it has done on the number of people who have so sadly died. The figure he gave in the Statement was, I think, around 18,000. I assume that these are deaths from the virus of people in hospital. I suspect he will have seen a piece in the Financial Times earlier this week which did some analysis of the ONS figures. It suggested that the figure of deaths caused by the pandemic was as much as 41,000. Have his officials looked into this and can he comment on its veracity?

[Lord Bethell]

I have not seen the piece in the FT, so cannot comment on the noble Lord’s remarks. All I would remind him, as I have said in previous answers to similar questions, is that false reporting of a death is an offence. Doctors are required to make a clear report of a death. If it is associated with Covid in any way, the word “Covid” will be in the death certificate. If it is in the death certificate, it will make its way through the CQC to the ONS figures. There should be no ambiguity about this at all.

Access to Palliative Care and Treatment of Children Bill [HL]

Lord Hunt of Kings Heath Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Ribeiro, and to lend my support to the Bill. I declare an interest as a supporter of St Mary’s Hospice in Birmingham. I will focus on palliative care, but I also support the second part of the Bill in response to the heartrending cases that the noble Baroness, Lady Finlay, mentioned, where disagreement arises between doctors and patients over the treatment of life-threatening illnesses suffered by children. She makes a powerful case for parents and doctors to have early access to mediation. Perhaps the Minister might agree to the possibility of funding a pilot programme to examine whether this might be a sensible way forward.

Like other noble Lords, I have received a briefing from the organisation, Together for Short Lives, which has some reservations about the wording of Clause 2(4). Its initial analysis is that this provision might qualify what we understand as the child’s best interests. I think that the organisation has been in subsequent discussions with the noble Baroness and that it now understands the motivation behind what she is offering, but it would be helpful if she could say that she will be in further discussions with it between now and when we reach Committee.

On palliative care funding, I support the main thrust of what the noble Baroness and the noble Lord, Lord Ribeiro, have said. We have a problem with palliative care in this country which is not confined to the funding of hospices; it is about the way the NHS organises palliative care and what happens in care homes. Overall, we do not have a comprehensive palliative care service, and the way I see it, the Bill aims to do just that.

The noble Baroness made some important points about access by palliative care providers to pharmaceutical services. Again, the BMA supports that, and I support its comment that clinicians providing general palliative care advice should have access to specialist care at all times. The other evidence I have looked at is from the Association for Palliative Medicine, which certainly knows what it is talking about. It has warned that access to palliative care services are poor for those of black, Asian and minority ethnic backgrounds and for older people. This is a well-remarked concern about palliative care which, again, argues for a much more consistent approach, and the noble Baroness’s Bill points us in the direction of how we might achieve that.

I will refer to St Mary’s Hospice in Birmingham because the challenges it is facing are very relevant to those being faced in all parts of the country. Over the past 12 months this extraordinary place has supported 1,756 individuals living with a terminal illness. That case load has risen by 30% over the past five years. The hospice has looked at future projections and it expects demand to rise again over the next decade or even longer. The problem is that NHS funding has not risen to the same extent. Birmingham has had to reduce its service and the number of in-patient beds from 20 to 15 as a result. It costs £8.5 million per year to run the hospice; NHS funding amounts to 36% of this. Rising costs, particularly of drugs and pharmacy services, are not fully covered by the grant that comes from the NHS.

I said that St Mary’s Hospice is a wonderful place. I should have said it is a wonderful concept, because most of the work it does is in the community. It has developed the concept of satellite sessions, particularly in the inner city of Birmingham. The noble Lord, Lord Howard, came and spoke about this exciting new development to a reception we held in your Lordships’ House a year or two ago. It has a case load of 500 patients living in the community at any one time. When you compare the wonderful service it gives with the fact that too many people—the estimate we have at the moment is 54% of people—are dying in hospital, when most people express a wish to die at home, we clearly have some major problems.

I pay tribute to the NHS, because there is a pan-Birmingham approach. St Mary’s Hospice has been given a leadership role across Birmingham and Solihull Clinical Commissioning Group to work with partners to plan and transform the delivery of palliative care and address some of the challenges I have talked about. They have a shared vision which aims to identify everybody who might benefit from palliative care, to enable more people to live independently and to reduce overreliance on specialist and acute resources. That is just in the right framework. I think the Minister will agree that it fits into the philosophy of the NHS long-term plan and is something to be supported. I hope that Birmingham and Solihull CCG and STP will be able to look at this carefully and provide the wherewithal to enable it to happen. Clearly, at the moment patients in acute hospitals or the care sector are really missing out on the kind of service we know could be delivered if we could only shift the resources around in a more effective way.

The Prime Minister’s announcement in August of an additional £25 million investment was, of course, very welcome indeed, but I echo the noble Lord, Lord Ribeiro: it would be very helpful if this could become an annual payment rather than a one-off. The Government are reluctant to intervene in the NHS but in this area they need to tell the NHS to get real about funding, to stop having annual contracts and to have long-term, running contracts so that hospices know three years ahead the amount of money they have. When we come to the Second Reading of the NHS Funding Bill, the Minister will talk about the certainty she has given the NHS over five years. I think the Government should give certainty to hospices as well. I very much support the Bill.

NHS: Targets

Lord Hunt of Kings Heath Excerpts

Thursday 6th February 2020 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House takes note of the National Health Service’s performance in relation to its priority area targets; and the impact of adult social care pressures on patients of the National Health Service, and their safety.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I welcome this opportunity to debate the current performance of the National Health Service. I declare my membership of the GMC board, my trusteeship of the Royal College of Ophthalmologists and my presidency of GS1, the organisation responsible for the “scan for safety” programme. I am very pleased that my noble friend Lady Wilcox will be making her maiden speech in this debate.

I have instituted this debate because I am increasingly worried about the performance of our National Health Service. Despite the heroic efforts of many staff, every key indicator is being missed. Last November saw the worst four-hour wait performance in A&E since figures were first collected in 2010. Two-week waits for GP appointments rose by 13% last year. The target of a maximum wait of 18 weeks for hospital treatment has not been met since 2016. The cancer target of 62 days between urgent referral and first treatment was last met in 2013-14.

I fully accept that these targets are not the only way to judge the NHS, but they reflect overall performance. At the same time, we have seen an increase in the rationing of medicines, and failings in ambulance services and services for people with learning disabilities or mental health issues. The CQC’s review of the Mental Health Act today refers to a number of very worrying problems in that area.

Given this, it is a huge tribute to NHS staff that so much care remains of a very high quality. I absolutely acknowledge that. However, the calamitous drop in performance over the past decade is clearly having an impact on patient safety and leading to those longer waits.

I was very struck just before Christmas by the Norfolk and Norwich University Hospitals NHS Foundation Trust advising staff to make “the least unsafe decision” following a huge rise in admissions. Over the new year, the Royal Cornwall Hospitals NHS Trust told its staff to reduce severe overcrowding by discharging patients, despite the obvious risks involved. These are not isolated incidents. What has caused this? Many factors and pressures are at play. The alignment of austerity with workforce shortages, inadequacies of adult social care and a complete failure to factor in the growing older population mean it is little surprise that the NHS is reeling.

If we look at funding, the lowest five-year period of funding growth was between 2010 and 2014, and the past five years have seen little improvement. It is no wonder that the NHS is cash-strapped, in deficit and finding it very hard to invest the resources necessary to prevent hospital admissions. We can see similar trends in the workforce. In March, the Health Foundation highlighted a shortage of more than 100,000 full-time equivalent staff, including more than 40,000 nurses. The GP workforce has continued to stagnate, despite government promises to increase the numbers, and the GMC’s 2019 workforce survey showed that one-third of doctors have refused requests to take on additional workloads and one-fifth have reduced their hours. It is part of a vicious cycle in the workforce. Fewer doctors and more patients means that doctors are overworked. They get ill from stress and exhaustion. They decide to cut their hours or just leave the profession, and the remaining workforce feels under even greater pressure.

All of this is happening when social care is in meltdown. In 2018, the House of Lords Economic Affairs Select Committee reported that 1.4 million older people in England had an unmet care need. We know that the number of older people and working-age adults requiring such care is increasing rapidly, yet public funding declined in real terms by 13% between 2001 and 2015. We see a second vicious cycle. The level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes, the strain on the care workforce continues and the stability of the adult social care market worsens.

What is the Government’s response? It seems to be twofold. The attitude of the Secretary of State appears to be to get rid of any target on which the NHS is not delivering, but I remind the Minister that the Royal College of Emergency Medicine has said of A&E that there is

“nothing to indicate that a viable replacement for the four-hour target exists”.

I strongly encourage the Government to think again before they agree to change that target.

The second line of the Government’s defence is essentially to argue that they are dealing with an unprecedented increase in demand. I am the first to acknowledge that the drivers of change are intensifying and that the NHS is clearly caring for a patient population with more long-term conditions, more comorbidities and increasingly complex needs, but this is not a new problem. The Labour Government of 1997 faced the same demographic challenge, but turned it around through investment in 300,000 more staff, 100 new hospitals and new services such as NHS Direct and walk-in centres. Waiting times came down as dramatically as public satisfaction went up. It can be done.

The Government have their own long-term plan with a new five-year settlement of around 3.4% per annum. However, as the right reverend Prelate the Bishop of London said in the debate on the Queen’s Speech, the additional funding is not a bonanza; it will serve only to stabilise NHS services, and the right reverend Prelate knows what she is talking about when it comes to the NHS. Yesterday, the NAO warned that NHS trusts reported a combined deficit of £827 million and clinical commissioning groups reported a £150 million deficit in the financial year ending 31 March 2019. The NAO said that short-term fixes have made some parts of the NHS seriously financially unstable, with trusts in financial difficulty increasingly relying on short-terms loans from the Minister’s department.

As we look at the funding promised—we will have a Bill on it in your Lordships’ House soon—I refer noble Lords to a letter written by NHS leaders to the Times on Tuesday, which pointed out that this funding does not include areas crucial to the Government’s election promise to provide more hospitals, nurses and GP appointments. The additional funding does not cover investment in buildings and equipment, so there is very little relief for our crumbling infrastructure or money to fund new technology to improve care. We know that the NHS is facing a workforce crisis but the funding does not cover education and training budgets to help with recruitment and retention. Nor does it offer any relief for public health and social care services, which would, I hope, if properly invested in, keep more people healthy and independent.

Therefore, the question before us is how to turn this around. I am sure that noble Lords will come forward with many ideas in this debate but I would like to propose four key measures. First, we have to plan for the long term—not five but 20 or 30 years ahead. I want to come back to the House of Lords Select Committee report on the long-term sustainability of healthcare. It was published three years ago and chaired by the noble Lord, Lord Patel. The committee said that we have to get away from the short-term fixes that we currently see and have seen in the past. It suggested that we set up an office for health and care sustainability to look at the likely funding and workforce requirements for up to 20 years ahead. Like the Office for Budget Responsibility, which has now been well accepted as giving authoritative, independent advice to government, this body could give advice to government, Ministers and parliamentarians on the likely demands on health and social care over the next 20 years. I believe that would be the start of a much more fundamental way of ensuring that we have a high-quality healthcare service in the future.

Secondly, alongside those kinds of projections, of course we need the commensurate funding. The funding challenge is immense. No one in the health service believes, for instance, that the 3.4% being given will allow them to invest in services for the long-term five- year plan. The money is not there to invest in services to keep people out of hospital; we have a crumbling primary care service because of the pressure from patients coming through the door; and people who work in the health service regard the local plans—the STPs—as a flight of fancy. They have had to publish them and have had to agree the figures with the Government because, if they do not, they will get their heads chopped off. However, Ministers are living in a dream world if they think that these plans will be delivered. Therefore, we have to find a way of funding the health service seriously in the future, but at the moment I see no indication that the Government recognise the scale of the challenge they face.

Thirdly, on the workforce, we need better recruitment and retention, and we need to increase our training numbers, but much of the problem is due to what I am afraid I have come across many times—a bullying and blame culture. It is very off-putting for many staff in the health service. I know that Ministers are concerned about this but it starts with them, their attitude and the way they deal with the health service and the bodies responsible for it. They have to lead from the centre.

Fourthly, we have to find a solution to social care. The Government have promised to come forward with one but, as we know, the last 20 years have seen a failure of nerve and an absence of political consensus. Frankly, at the moment we seem no nearer to a solution. I must acknowledge that it is a wicked problem. However, can we really wash our hands of the pernicious situation in which many people receive no care at all and many face the loss of not just their homes but their savings as the price of their long-term care?

In this debate noble Lords will raise many other issues, including improving outcomes, developing a more robust approach to public health, targeting health inequalities, and prioritising mental health and learning disability services. However, at heart, I hope the debate will come back to the issue of performance. The targets were not plucked out of the air. They were chosen because they were a very good proxy for the overall quality and performance of the NHS as a whole. In 1997, we inherited something called the Patient’s Charter, which said that there should be a maximum waiting time of 18 months for hospital treatment. The Conservative Government at that point had come nowhere near meeting that target. We turned that around and delivered an 18-week maximum wait. We hit other targets as well. I fear that it will not be too long before we go back to those bad old days if we carry on as we are at the moment. I ask the Government to think seriously about the kind of health service that they want for the public in the future. Based on current trends, I am afraid the situation is deteriorating. I beg to move.

--- Later in debate ---

[Lord Hunt of Kings Heath]

My Lords, I first thank the Minister for her comprehensive response, and I thank all noble Lords who have taken part in what has been a wide-ranging and excellent debate. I congratulate my noble friend Lady Wilcox on what was, on any count, a brilliant maiden speech. I hope that she will speak many times in your Lordships’ House over the coming months.

In such a wide-ranging debate, one cannot do justice to what has been said, but I would identify three core themes. First, on social care, we are united in wanting to see a solution. The Minister is reassuring about the proposals that will come from the Government at some point in the year. I say to her that it is very important that these proposals deal with the now as much as they do with the future; it is now that so much pressure is being felt. I say to the noble Baroness, Lady Brinton, that if she is really looking for a quick solution, she just has to go back: you legislated for Dilnot. Raise the means test cap; implement Dilnot; and put more money into adult social care—that at least would give you a fundamental way to go forward. Your Government legislated for it; this is the remarkable thing about capping the cost of social care for individuals. It is quite remarkable that we are here, still desperately hoping that we will get a solution for the future, when we had it.

Secondly, I echo all noble Lords who have spoken so highly about the work of staff and so many great things happening in the health service. There is no doubt about that. The noble Lord, Lord Bates, referred to the US Commonwealth Fund designation of the NHS as the number one healthcare service in the world. He was right to do so. As he will know, the reason for this is that we came out very highly on cost-effectiveness and access to services. He will also know that we came bottom, with the US, on health outcomes. My concern about the issue of targets is that our continuing failure to meet them will lead to worsening health outcomes in the future.

This brings me to my final point. The Minister referred to the pressures that we are under. These are not going to go away, whether demographic pressures, growing health inequality or the fantastic opportunities of new medicine and treatments, which cost additional money. This is the way that health will go over the next period; it is not until the 2060s that the population demographic will start to change again. At the moment, the health service is reeling under huge pressure. It is simply not sustainable to think that we can go on like this over the next 10, 20 or 30 years. We have to level with the public that, if they want the NHS—and I think they do—they will one way or another have to pay for it.

We cannot run away from the kind of debate that the noble and gallant Lord, Lord Stirrup, said that we ought to have. I go back to what the House of Lords Select Committee on Long-term Sustainability of the NHS said three years ago: that we must face up to the long term to have any hope at all of getting through this and landing the NHS in the excellent shape in which we want it to be. I thank noble Lords for the opportunity to debate this.

Motion agreed.