Queen’s Speech

Lord Smith of Leigh Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Smith of Leigh (Lab)]

My Lords, I declare my interests as a vice-president of the LGA and chair of the Greater Manchester Health and Social Care Partnership; and I am still an elected councillor for Wigan.

I was not going to talk about local government finance today; I have bored this House often enough on that subject. However, I must respond to the reference in the Minister’s introduction to yet another social care precept and emphasise how unfair such a system is. If you put 1% or 2% on council tax it sounds even across the country, but the amount of revenue raised by it depends on the value of properties, the banding and so on. Quite frankly, there are more £1 million houses in Richmond than there are in Wigan. A 1% increase in Wigan raises about £1 million; in Richmond it is about £2 million, and our population is bigger. This is a discriminatory move, and I hope that the Government have learned from previous problems.

Sustainable health is an important area which has been mentioned by a number of noble Lords. Just before the Conservative Party conference, the Prime Minister visited north Manchester and announced that a new hospital was going to be built as part of the capital programme. That was welcome in the city, because the old one is a disgrace and ought to have been replaced many years ago. The health outcomes in that part of the city are among the very worst in the country. Manchester has some of the worst anyway, and north Manchester is one of the most deprived parts of the city, with life expectancy between four and five years below average. Even greater is the gap in healthy life expectancy. In north Manchester, people become ill in their mid to late 50s with a series of long-term conditions and become dependent on drugs and so on. In Oxford, people are probably in their 70s before that happens, so they can have a number of years of healthier life.

Welcome as the new hospital is, it is only going to have a marginal impact on those health statistics because we know that the determinants of health are not simply medical facilities but lifestyles and economic and social factors. In that area, 21.7% of people smoke, whereas the national average is 15.5%, which is considerably different; one in four is economically inactive, which we know makes a difference to health; and one in three older people is said to be destitute. As the right reverend Prelate the Bishop of London said, Sir Michael Marmot’s report in 2010 identified all these wider links to health outcomes which we need to think about. We need to rethink how we are going to change health. The long-term plan was a welcome move in the right direction, but it is not far enough. We need to go further.

It was recently said that life expectancy in the UK has risen for about 47 years, but it has now begun to tail off. There are international comparisons, but it is probably worse in the UK than anywhere else. We need to understand this. The gap in healthy lifestyle between the top fifth of the population and the bottom fifth is growing. People have said that this is down to austerity; I do not want to get into that argument. We need to acknowledge that this is happening and try to find ways of dealing with it. The CQC report, which a number of noble Lords have mentioned, highlighted the inexorable rise in demand for the NHS. July levels in A&E were the highest for a number of years. On Friday, we had a conference in Manchester about winter pressures. We need to recognise that, for the NHS, winter now lasts about 10 months of the year.

As your Lordships may know, there was some devolution of health powers to Greater Manchester in 2016. We have a partnership made up of health authorities, local authorities, voluntary and community groups and so on. We want to recognise that our challenge is not simply to deliver a good and effective health service. It is not enough to make sure that there is better integration between different parts of the system. We must address the fundamental issues of health and well-being outcomes. We are not going to do that simply by concentrating on health matters; we want to concentrate on wider social issues. We surprised some people with our early strategy which included school readiness and economic activity. We have achieved some things, but I do not have enough time to go through them.

I want to look to some solutions. Health cannot do this on its own; it has to work in partnership with other people. It is part of public service reform: reshaping services to meet people’s needs; thinking about population health with prevention and early intervention. Above all, it is about keeping it local: identifying local needs and encouraging collaboration and innovation. There are things we can do together to improve and make the health service more than just an ill-health service.

NHS Long-term Plan

Lord Smith of Leigh Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend raises a hugely important issue. We are seeing an improvement in the quality of training for GPs; the RCGP has been playing an important role in this, especially in raising specialist areas such as perinatal mental healthcare through the champions that it spreads through its system. We are seeing the impact on the ground, with CCGs meeting the mental health investment standard and rolling out specific access waiting times, so it is having an impact. But there is always more to do and the royal colleges have a specific role to play in raising awareness and the quality of training.

[Lord Smith of Leigh (Lab)]

My Lords, I declare an interest as chairman of the Greater Manchester Health and Social Care Partnership. There is much to welcome in this White Paper’s implementation—after all, a lot of the ideas were taken from Greater Manchester in the first place so we are pleased about that. We are particularly pleased about population health being a major factor now within government. I want to raise again two of the main issues that noble Lords have already raised. First, in deciding on local needs, if we think about only health we are missing a lot. Many times when people present with health symptoms, other social and economic issues are causing them to present. It could be loneliness or unemployment, but all these things create ill health in people and we need to think of things in the round rather than just about health. Secondly, I have a local government background, as Members know, but I must emphasise that unless we get social care right the NHS will grind to a halt. There is a real crisis in social care at the moment; it needs more money and there is no flexibility. We cannot solve the issues in the NHS unless we resolve care as well.

[Baroness Blackwood of North Oxford]

I thank the noble Lord and he is absolutely right, which is exactly why one of the core priorities in the long-term plan is the creation of integrated care systems, so that there can be a holistic approach to health while recognising that a lot of ill health is driven by social determinants. If we do not address what are often perverse incentives within healthcare systems, we will not be able to address the problems that we all know have been experienced through multiple Governments and generations. In addition, in the prevention Green Paper we have already announced a desire to bring in much more social prescribing, making it much easier for general practitioners and others within the system to address some of those wider challenges that lead to ill health and transform the system. We have already seen some fantastic pioneers of social prescribing transform the healthcare in their area, such as those in Tower Hamlets, and we want to see that thriving across the country.

NHS and Social Care: Winter Service Delivery

Lord Smith of Leigh Excerpts

Thursday 25th January 2018 Lords Chamber

[Lord Smith of Leigh (Lab)]

My Lords, I too welcome this timely debate, which has been initiated by my noble friend. I declare an interest as yet another vice-president of the LGA—that makes three of us so far, and our president has spoken. I am also leader of Wigan Council and chairman of the Greater Manchester Health and Social Care Partnership, so I can see these issues from both sides—although whichever way you look at them, it is not a pretty sight.

Reading in the press about the daily problems in A&E, it is tempting to talk about a winter crisis, as many noble Lords have done, but like the noble Lord, Lord Kerslake, I think that this is not a winter crisis but symptomatic of the general crisis in health and social care. Fundamentally, it is caused by the ageing population—which should come as good news in your Lordships’ House: we can live longer—but obviously that puts pressure on both the health and social care sectors. We have not commensurately increased money for the health service to reflect the increased pressure that comes with an ageing population, and in social care, as we have heard, there has also been a reduction. Although noble Lords have concentrated on the revenue side, it is also true of the capital side. To refer to one example, Watford General Hospital was built and designed to take 45,000 to 50,000 admissions per year. It currently deals with 90,000. Is it remarkable, then, that it has had to use corridors and other places to deal with admissions?

Workforce issues are key in the NHS. Although we know that the NHS suffers shortages generally, it is particularly true in A&E, which is not the most popular area for people to go into. It has been said that we are 2,000 consultants short in A&E, and of course the numbers in nursing are going down too. As we saw in the report last week, the numbers leaving the nursing profession outweigh the numbers going in. Although that is caused by a great number of factors which I will not go into, it puts severe pressure on those who remain. Finally, there is a lack of integration between health and social care.

Now that the Secretary of State has acquired an additional title he will discover that funding is the most fundamental issue he faces in social care. Colleagues have talked about the quantum of money. That is important but we should also remember to ask who will pay for social care. The Tory party made a bit of a mess of it in the last general election when it tried to talk about how much individuals should contribute to social care. The Tory party is very unclear on that point. In the short term, the Government have tried to put more of the burden of paying for social care on to local taxpayers: instead of putting up general taxation, they have put up local taxation. The noble Baroness, Lady Pinnock, mentioned one aspect of the regressive nature of council tax. I could spend all of my allotted time here or longer talking about reforming council tax—a subject referred to by my noble friend Lord Desai. It is something that I have long advocated.

The other issue is that the council tax situation between local authorities is unfair. For example, many northern authorities like mine have more properties in the lower tax bands than do other places. Therefore, a 1% increase in council tax gains six times as much in Richmond and five times as much in Windsor and Maidenhead as it does in my authority. We might say, “Well, we’re all giving 1%”, but that 1% raises very different amounts of money, and that cannot be justified.

Although health and social care needs more money, the fundamental problems are such that we cannot just put more money in. We need to change the NHS from being an ill-health service, which, on the whole, it does pretty well, to a proper health service. I wonder whether anyone has read the recent report on children’s dental health. We are spending money on repairing and replacing children’s teeth instead of simply getting them to clean their teeth. Yesterday’s Times reported on lifestyles which are likely to cause long-term problems. People will be four or more times likely to develop chronic conditions by the time they get to 65, and that will mean more pressure on the NHS. Unless we put more effort and energy into prevention and early intervention, the extra demand will eventually overwhelm not just the NHS but government overall.

I do not want to end on too desperate a note—there are reasons to be cheerful. In my authority, the use of transformation funds from Greater Manchester will make a difference. We are working to keep lots of vulnerable people in care homes. We have a 180-bed care home which we think has saved 36 people from going to A&E. We are also working with GPs, many of whom have to deal with what are really non-medical issues, such as housing problems, fuel poverty and loneliness. Those are issues where GPs try to provide medicines but those are not the answer. We need to turn the system around. That is a real challenge and we need real leadership to do it. I hope that the Secretary of State is up for it.