NHS: Debt

Lord Maude of Horsham Excerpts

Monday 23rd January 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness’s Question is about debt in NHS trusts. I think that referred to deficits, and the facts I have given her are absolutely right. It did increase, not least because of important increases in staffing in response to the Francis inquiry, following events at Mid Staffordshire. Regarding the social care budget, there are a million more over-65 year-olds than there were in 2010 and social care is of course under a lot of pressure. That is why the Autumn Statement outlined additional money for social care. There is £900 million extra over the next couple of years, the precept is rising faster than previously and we have the Better Care Fund, so money is going in, but I accept that there is pressure on the system. That is something we are all working to address.

[Lord Maude of Horsham (Con)]

My Lords, will my noble friend reflect on the contribution that could be made to addressing the problem of overspending by NHS trusts, which has contributed to the growing deficit to which the Question refers, by reviving the programme of health service mutuals? Under the coalition Government, some tens of thousands of health service workers put themselves into not-for-profit social enterprises—staff-led and staff-owned—which showed a dramatic improvement in productivity and quality, and cut costs. A revival of this process, which has been slightly stifled, I suspect, by the attitude of the NHS establishment, could make a major contribution to improving productivity in the health service.

[Lord O'Shaughnessy]

I thank my noble friend for that point. I know he was a passionate advocate of mutuals when he was in government, not just in the health service but elsewhere. They can make a huge difference to productivity. Improving productivity in the health service is obviously one way in which we will meet our ambitious targets, as well as reducing demand on the most expensive bits of the system. I shall certainly look at the ideas he has suggested. Through the sustainability and transformation plans, the NHS has a number of routes to drive extra efficiency in the system, and I am sure that mutuals can play a part. I would be delighted to meet him to discuss that.

Health: HIV

Lord Maude of Horsham Excerpts

Monday 5th September 2016 Lords Chamber

[Lord Maude of Horsham (Con)]

My Lords, I join other noble Lords in congratulating my noble friend on securing this debate on an incredibly important subject. It is particularly important for me, personally, because just over 23 years ago my parents, my two sisters and I lost my older brother to AIDS. He had contracted HIV some seven years previously, at a time when the whole treatment of HIV and AIDS was at an early stage. I often reflect, as I think of him, that had he contracted HIV even five years later he might very well still be with us today. One thing to celebrate in this otherwise quite gloomy story is that medical advances have meant that HIV is not today the death sentence that it was for my brother Charles but a chronic condition that can be managed successfully.

It is a pleasure to see a new Lord Speaker on the Woolsack and to recall and celebrate what he did at that time in the mid-1980s, in leading that brave campaign of public information on the transmission of HIV. I had a very minor walk-on part as the very young Whip attached to the DHSS, and was in a number of those meetings, although I was not privy to any meetings that the Lord Speaker would have had with the Prime Minister at the time. However, given that the then Prime Minister was a scientist, I like to think that she would have been readily persuaded of the need for urgent action on this issue. At that stage a huge stigma was attached to this condition which undoubtedly deterred many from going through a test. My noble friend Lady Bottomley talked about the action of the ABI and insurance companies, which certainly deterred people from having tests which they would otherwise have done. The role that the current Lord Speaker played at that time is of historic importance and one of which he should be enormously proud.

I wish to make one or two reflections on the points made by other speakers in this important debate. My noble friend Lord Black is completely right: you cannot separate treatment and prevention. In the case of HIV they are very closely linked. We know that the more effective the treatment given to HIV-positive people, the less the condition will spread. There is a huge premium on people with HIV being given effective treatments that are easier for them to take and keep on taking, resulting in the viral load being lowered and therefore lessening transmission. Obviously, the more effective the prevention, the less the need for treatment. We have to think of prevention and treatment not as separate things but the same.

I also have one or two reflections on the vexed issue of PrEP, about which other noble Lords have spoken. I urge my noble friend the Minister to take back to the department the concern of many in this House that this is not a good way for the Government to proceed. We are told that the cost of making PrEP available is some £20 million a year. After the lawyers have had their cut from protracted legal action and several appeals, I doubt whether there would be much change from £20 million. We know for sure that the cost of people becoming infected with HIV is huge, protracted and continuing. Given the way in which our Government operate, we have very much a silo approach to government. This is not a feature of the current Government but goes back to the middle of the 19th century. As the noble Lord, Lord Scriven, said, there is an argument between two different bits of government in this regard but in this case local government is the agent of central government. This is not even a case of different pockets within the taxpayers’ disbursement. The reality is that we are talking about taxpayers’ pounds and they need to be used in the best way possible.

As people live longer, a key factor in the success of our society will be how good we are at keeping people well and living independently at home. As we live longer, more people will live with chronic illnesses. The cost of people being sick and needing active treatment, particularly hospital treatment, is borne not just by the health service as social care costs are involved. As people’s working lives are extended—as they certainly will be—costs will arise from the loss of tax revenues when they are sick. There are additional costs arising from welfare support for carers. These costs are disbursed in different pockets of taxpayers’ funds but also over time. Government is not well equipped to understand or harvest the benefits of savings that will accrue later if we spend modest amounts of money now.

We still suffer from the use of analogue structures. I noticed that Nick Clegg, the former Deputy Prime Minister, was quoted in a newspaper this morning as saying how frustrated he was when he was Deputy Prime Minister to discover that we used analogue structures in the processes of decision-taking that were ill equipped to deal with the pressures and tempo of the digital age. I completely understand and sympathise with that frustration. However, more important in this context is the analogue structure, the model deriving from the mid-19th century, as I say, with a theology of departmental sovereignty that is intolerant of central decision-taking and which makes it unbelievably hard to justify relatively modest expenditure in one part of the state apparatus because the consequential savings are disbursed over many different budgets—in this case both the costs and revenue losses of central government, the cost to the NHS and the cost to local government. We need to find better ways of doing this. I hope that in some way the debate my noble friend has initiated on this subject will help us to make progress towards that.