(4 years ago)
Lords ChamberMy Lords, once again we are debating a measure long after the horse has bolted. We need a radical change in our procedures so that we do not face this situation of Executive diktat in the future.
I want to ask the Minister if we can have a mature reflection on the lessons learned in the Leicester lockdown. It is clear that we are making progress in terms of better information sharing between the national and local systems. This is very much to be welcomed. But there is still a fundamental confusion of responsibility. Who is taking the decisions? Is it the responsible local people or is it Ministers? The regulations divide responsibility between the two. Can we not get to a situation where Ministers trust local decision-makers and give them the power and resources to organise effective local action?
Finally, the noble Lord, Lord Robathan, made an excellent point about what is happening to tackle the problems of sweatshops and the social circumstances which propagate the disease. Is stronger action being taken by the inspectorates, and will the Minister let us know what that is?
(4 years, 1 month ago)
Lords ChamberMy Lords, here we go again: statutory instruments being debated after they have come into effect. This is not parliamentary scrutiny; it is government diktat. The Minister will argue that this is necessary in an emergency, and of course I accept an element of that, but it is part of a more general trend. The legislation going through the House on agriculture and immigration gives Ministers wide powers to set policy in the future by statutory instrument. I know that this is common practice in some southern European democracies but I thought that the whole point of Brexit was supposed to be to reassert parliamentary sovereignty, not to concentrate executive power in the hands of civil servants and hard-pressed Ministers. The British Parliament is becoming a helpless adult in old age by comparison with the growing authority of the European Parliament. We can force change. If we refuse consent to these SIs, the Government will have to agree to a more effective system of pre-implementation scrutiny with the power of amendment.
(4 years, 2 months ago)
Lords ChamberMy Lords, I join this debate as a relatively novice member of the House’s Secondary Legislation Scrutiny Committee, and it has not been a very satisfactory experience, in terms of the accountability of the Executive to the legislature. Of the regulations before us today, the (No. 3) regulation came into force on 1 June, was not considered by our committee until 9 June and is being debated today, on 25 June. Similarly, the (No. 4) regulation was laid on 12 June and not considered by our committee until it came into force. This is not satisfactory. We need a better process and I hope that the inquiry or review that will inevitably be set up at the end of the crisis will look at better methods of parliamentary accountability in national emergencies.
My other point is on policy. Regulations are not ready at the point when Ministers make announcements about the policy in them. That is bad practice, because it means that Ministers are making policy announcements without having a grip on the detail of what they will imply. That has to change, and change now, if we are to have effective management of what we can already see will be a very difficult period.
(4 years, 2 months ago)
Lords ChamberMy noble friend makes an incredibly perceptive point on the BAME research. He is entirely right that this important aspect of our understanding in relating the ethnic, social and behavioural elements of the response to the disease is essential. The report has not covered all the ground yet: that work is being done at the moment, as I mentioned earlier. Frankly, only when all those elements are linked together will we get a full picture.
Regarding the “little boats”, we absolutely celebrate them. In order to get the industrial-level testing numbers up, it was correct to back big laboratories that could do the automation necessary to achieve that. I am a huge admirer of Sir Paul Nurse and have spoken to him often. The role of laboratories such as his is in connection with their local NHS trusts. Many local laboratories are doing extremely good work with local NHS trusts and we are putting measures in place to facilitate and encourage such connections.
My question concerns the “track and trace” system. I declare an interest as a county councillor in Cumbria, where we have had severe outbreaks of the virus. A world-beating system was supposed to be in place on 1 June and we were given, as I understand it, less than two weeks’ notice of what the local government involvement in this “track and trace” arrangement would be. Does the Minister think that this has been handled adequately? How does he see the relationship between what is done by local authorities and what is done nationally by the Serco system that is being recruited?
(4 years, 3 months ago)
Lords ChamberI am very sorry that the noble Lord had coronavirus, and it is good to see him on such fine form and in characteristically enthusiastic shape. The bottom line is that lots of people do not lose their sense of smell or taste, and the addition of this symptom was delayed because we did not want to put off those who had not lost their sense of smell and taste from declaring their symptoms. The WHO is right about many things but not about everything.
I thank the noble Lord, Lord Bethell, for the directness and frankness of his answers tonight, and I agree with his praise for the NHS workers and many others who have played such a valiant role in fighting this virus. However, does he not agree that, as time goes on, it is becoming clear that we have the highest number of deaths in Europe and that this gives a new and very tragic meaning to the concept of British exceptionalism? Does he not agree that there will have to be some kind of independent inquiry into where this all went wrong?
My Lords, the noble Lord is right. As a nation, we have been hit really hard by this disease and it is heart-breaking. I would have loved this country to have somehow dodged the bullet and not been the one that was hit so hard. We all feel it: we feel a great sense of responsibility and a great sense of sadness that so many lives have been lost, and that there are so many for whom the result of having had the disease and survived will be life changing. One thing that we have learned is that this disease hits you really hard and some people will never fully recover from it. However, I cannot help but pay tribute to those involved.
I do not know why we have been hit so hard. I do not know whether it is due to British behaviours and the fact that we have obesity in this country. I do not know whether it is because we are such an international country with such a large number of people coming to and fro, particularly from China. I do not know whether the Government made massive and colossal mistakes, as their critics suggest, and whether we got it all completely wrong. All I know is that the response to this disease by the British public, the NHS and the Government has not lacked energy, innovation and enthusiasm, and I stand here at this virtual Dispatch Box extremely proud of our country and of the people who have played a role in the response to this disease.
(4 years, 3 months ago)
Lords ChamberLord Dobbs. As Lord Dobbs is not responding, we will go to Lord Liddle.
Following up on the question from my noble friend Lady Thornton, when the number of deaths in Britain is now the highest in Europe and the second highest in the world, do the Government really believe that their level of accountability to Parliament matches the scale of the crisis? If they can manage a press conference every day, can they not manage a regular parliamentary session which allows for proper questioning of what is going on?
(4 years, 4 months ago)
Lords ChamberI note my noble friend Lady Buscombe’s question, but I reject the sentiments behind it. I do not regard a second wave as inevitable; I do not share her fatalism. The priorities of the Government are to save life and to protect the NHS and our care system. That requires us to lower the prevalence level, reduce infection and put in place systems such as track and trace to keep a lid on the disease so that we can protect life and our systems.
My Lords, I thank the Minister for his frankness on this occasion. On European co-operation, how have we got ourselves into a situation where for PPE we are so dependent on supplies from China, Turkey and other faraway countries, and allowed ourselves to get into a position where we do not have much domestic manufacture? Similarly, on vaccines, I read a report in the Financial Times that we have no vaccination manufacturing capacity at scale in Britain. If that is the case, should we not look at whether European co-operation can help us there?
I welcome what the Minister said about testing. I had a report locally of care workers in Silloth, in the west of Cumbria on the coast of the Irish Sea, being told that if they wanted to be tested, they had to go to Gateshead, some 80 miles away, with no means of transport to do so. Will there be no repetition of that problem?
The noble Lord, Lord Liddle, is not entirely right. We have fantastic manufacturing in the UK—I reinforce the view of my noble friend Lady Buscombe that the sector provides jobs for the economy—but we do not have low-margin, high-volume manufacturing. The image of a Burberry gown always sticks in my mind on this point. Burberry makes £500 shooting jackets, but it does not make £5 surgical gowns. That is something that we need to address, and it will be the priority of my noble friend Lord Deighton.
(4 years, 4 months ago)
Lords ChamberMy Lords, I declare an interest as a member of Cumbria County Council. I take as my text my noble friend Lady Wheeler’s excellent opening speech, where she emphasised that the Covid crisis has brought the social care crisis to the fore. To use a phrase that we are unfortunately hearing too much at the moment, the social care sector has suffered from a lot of pre-existing conditions that have sadly weakened it. It was not ring-fenced from austerity to the extent that the National Health Service was in the last decade. Recently, we have had the sticking plaster of the social care precept on council tax, but that is very inadequate. We face a rapidly ageing demographic.
I will focus on the sector’s structural problems—the fact that many of the providers of social care are on the edge of bankruptcy and that the sector has seen widespread financialisation as big companies and private equity groups have moved in. Providers have been loaded up with debt and the margin of profitability is very low. Property has been sold off at high prices because of promises of high rentals that are probably now unsustainable. It is a sector in deep crisis, particularly where there is private ownership. We have to tackle this problem.
Part of the problem is the lack of long-term stable funding for social care. It was a mistake not to go ahead with the Dilnot recommendations. In the general election, Boris Johnson promised us action in months on stable funding for social care. This crisis should be a reason to bring that forward, not postpone it. If we get more stable funding, we have to ensure that it does not just go into rescuing bankrupt companies to make them viable for their shareholders. We want to see a new deal for people working in social care. Statutory arrangements have to be made in the sector to improve pay and conditions.
My experience as a county councillor has honestly changed my mind about this: we need an expansion of local authority care. In my own county council division in Wigton, we have an excellent local authority care home. Unlike most authorities, Cumbria did not privatise all its care homes; indeed, we are building new ones. The care home in Wigton has been rated excellent two years running by the Care Quality Commission. We need a bigger role for the public sector in the provision of care. That would enable decency for workers who are doing such a valiant job in the present circumstances. It has to be backed up by action now on a long-term funding solution for the sector.
(9 years, 7 months ago)
Lords ChamberMy Lords, I, too, congratulate the noble Lord, Lord Turnberg, on the way in which he introduced this debate. It has been a civilised and, in many respects, expert debate. I am worried that I may lower the tone because I want to make a couple of more political comments. However, I shall try to do so in a civilised way.
The basic reason I wanted to speak in this debate is that I fear for the future of the National Health Service given the implications of the emerging Conservative approach to public finance in the next Parliament. I do not in any way doubt the sincerity of Members opposite—my friend the noble Lord, Lord Horam, the noble Baroness, Lady Cumberlege, who has just spoken, and the Minister—the Secretary of State for Health or the Prime Minister, or their commitment to the principle of the National Health Service. However, I doubt the sustainability of that commitment given the approach to public finance set out in the pre-Budget report at the beginning of December, particularly the prioritisation of tax cuts when resources become available and the intention to reduce by the end of the next Parliament the share of public expenditure in GDP to 35%.
The Government have done their best in this Parliament, in their way—I congratulate them on that—to maintain NHS spending in real terms, which, given the financial pressures on the country, was a good thing to do. That has worked for a while. The previous Government increased spending on the NHS a great deal. There were productivity gains to be made from that increase in spending and we have continued to see outcomes improving in the present Parliament.
However, the strains are now beginning to show. We know that, because of the increase in population, NHS spending per head is falling. Simon Stevens’s five-year analysis—I confess to being an admirer and friend, having worked with him—is brilliant. It demonstrates that there is a large potential funding gap unless, as the noble Lord, Lord Horam, pointed out, it can be closed by a more rapid rate of efficiency gain. With respect to the noble Lord, that will be difficult to achieve in a highly labour-intensive service. It is not like private sector manufacturing. This is a highly labour-intensive activity and 3% efficiency gains will be very difficult to achieve. So we will need additional investment.
As to what will happen to the rest of the public sector under this public spending outlook in the next few years, we will see severe austerity in welfare and public services, as set out in the pre-Budget report; more strain on poor families; a continuation of inadequate supply of social housing; weaker children’s services unable to protect children at risk; a narrower school curriculum because schools cannot afford to teach more broadly; and local authorities unable to meet the needs of all but very needy people in adult social care.
What will be the consequence of all this? Every academic and expert in public health tells us that if there is an increase in poverty, ignorance, bad housing and social neglect, what we will get is more pressure and problems for the National Health Service. On a holistic view of public spending, the Government’s plans are flawed and we need a more sustainable position. So I congratulate my party on at least indicating what it will do in the first year of the next Parliament in terms of extra spending and how it will be paid for.
Finally, we need cross-party debate and consensus on a long-term funding model for the NHS. I firmly support Frank Field’s ideas for a broadly based hypothecated tax that would take the funding issue out of politics and enable managers in the NHS to plan ahead for a more efficient service.
(9 years, 8 months ago)
Lords ChamberMy noble friend is absolutely right. One of the critical elements of the Five Year Forward View is to ensure that we have the right number of staff with the right qualifications in the right places. While Health Education England is the body charged with ensuring that that happens, it is up to us in government to ensure that there is adequate funding to enable it to do that. I can assure my noble friend that Ministers are very clear that Health Education England should be fully supported to deliver the programme that it has mapped out for itself. That programme is an exciting one. It involves more doctors and nurses in training over the next few years. Our ambition is to see by 2020 an extra 10,000 people working in primary care, for example—and that is only one detail.
As a result of the Government’s reforms to the health service, we have been able to afford a large number of extra posts in front-line care, including doctors and nurses in both primary and secondary care. We have done that by reducing the number of administrators in the system—20,000 fewer than there were in 2010. My noble friend is right to draw attention to this issue; it is one that is very much in our focus.
My Lords, pursuing the point about the integration of health and social care—I declare an interest as a member of Cumbria County Council—we in Cumbria face a situation where already our budget has gone down by over £100 million, we face another £80-odd million of cuts in the next four years, and this does not take account of the cost of the tax reductions that the Conservative Party is promising. The numbers of staff will have declined by 2,500 from 2010 to 2017, out of a staff of about 8,000. In this situation, it is impossible to protect social care. It is interesting that the Government are promising a longer-term perspective on health funding. Does this perspective apply to social care funding as well? What guarantees are the Government able to give that they will continue to fund local councils adequately in order to meet the rapidly growing demands of social care?
My Lords, the noble Lord makes a very good point. It is for precisely that reason that we have looked at the mechanism that we have called the Better Care Fund to bring together budgets for health and social care. It will amount in practice to a transfer of funding into social care from the NHS. We are clear that that is the best way in which we can realise the vision that we have set, which is a preventive one for people—in other words, to forestall admissions to hospital.
Local government is feeling the strain—I do not seek to deny that—but so are many other areas of our national life. Up to now, the Better Care Fund aside, we have found an extra £1.1 billion from the NHS budget to bolster local authority budgets, and we are maintaining public health allocations at the same figure as before, so no cuts there. I realise that the strains are considerable and that local authorities are having to find ingenious ways of moving forward, but I am encouraged by the Better Care Fund plans that are coming forward; they look credible and exciting in terms of the quality of care that local authorities are now looking at.