Social Care

Lord Sutherland of Houndwood Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, I too, thank the noble Baroness, Lady Pitkeathley, for organising what seems to be an annual reunion of those of us who are the usual suspects. I would like to think that after the Minister’s speech the noble Baroness will organise an annual celebration, but perhaps I will hold my breath on that.

My remarks are intended to help establish two main points. First, the lack of central policy in England on the relationship between social care and healthcare is creating huge uncertainties for both providers and clients. Secondly, much of the difficulty already recounted in the debate is to be found in the practicalities of providing unified care services for many of those who need them. These difficulties of both policy and implementation will not be resolved until there is clear leadership at both national and local levels. Alongside this, structures must be created to enable the positive implementation of new policies. I pay tribute to the analysis that the noble Lord, Lord Warner, just gave on this.

What of the uncertainties that I mentioned? The legacy of a decade and more of a failure of leadership to face demographic realities is that it has brought huge uncertainty and consequent misery. The realities have been known for a long time. The demographic changes in society are as plain as plain could be. Whether we think of the developed or the developing world, even China now has begun to take note of the fact that the one child per family policy is building future demographic nightmares. To compare that with something else, the facts of climate change are all too evident this week as much as any. Those facts now have a leadership response from the Government and things are beginning to happen. Perhaps some would like them to happen more quickly but they are beginning.

The realities of demographic change are equally plain if not less contestable. Why does no similar cold shower of reality bring minds and political will to the table of demographic change? I can think of many reasons for that. One is that we always have on our desks the “too hard” basket. It is easy—and has been too easy—to put this set of issues into that basket. I confess that my own “too hard” basket at home contains a series of domestic tasks that I think are too hard but my wife clearly does not. However, if I were a government Minister, I would have a rather different use for that basket. That is what tends to happen.

The second possible reason is that it will cost too much. The issue has been raised of how much is too much when the reality of demographic change, rather than evading it, calls for a change in leadership direction. Reality, not habit and precedent, should dictate priorities in spending. If reality means spending less on this or that to face demographic change, then so be it. That is not a request for an additional or new priority to be added, but rather to reassert and re-examine what our priorities are. Are they still top of the list in view of demographic change?

A third reason given for doing nothing is, “We shall deal with this after the next election”. We have heard that more than once. What we have after the next election is usually a request for a review, report or even a commission. God forbid that that is where we will be in 2015, but we begin to worry that that will be the reality. The burst of enthusiasm that leaders have before elections for this issue tails off into long discussion and prevarication. The Dilnot report is the latest example of this—and, some are beginning to fear, the latest victim.

What are the uncertainties of which I speak? There are uncertainties, for example, for those attempting to make provision for themselves and their family. There are questions that they all ask: “Where do I go?”, “Whom do I ask?”, “How much will it cost?”, “Can I afford it?” and, “Can I insure against future need?”. Those are real questions masking real uncertainties. There is uncertainty for those in the insurance industry, who could surely help us here. They ask: “Are the risks pooled in any way?”, “Is there a cap on liability?” and, “How much will the market bear as a charge for insurance products in this area?”. We tend not to pay too much attention to private providers and the banks which finance them, but they have uncertainty, too: “Should I invest in building new care homes?”, “Should I invest in extending, refurbishing and improving my current stock of care homes?”, “Will local authorities commission places from me?” and, “Will they be able to afford to do so?”. Bankers might reasonably ask: “Should my bank offer loans to any of the above?”. Unless there is investment, there will not be adequate provision for the future. The banks would reasonably ask what the rate of return will be.

Then, of course, there are the uncertainties for those already in the care system: “Will I have to sell my house?”, “What happens if the money runs out?”, “Is my care package portable if I move to be nearer relatives?” and, “Are benefits assessed and commissioned to common standards or is there still a postcode lottery?”. I acknowledge the points made by the right reverend Prelate the Bishop of Liverpool on that. There will be differences and those will become accentuated. Successive Governments have failed to deal with these core uncertainties over at least 15 years. Ironically, the only certainty is the remorseless march of demographic change and yet we do not recognise it for what it is. The system is burst and we must fix it, and fixing it means radical thought and change.

In conclusion, I refer the Government to some recent research sources which point to future action. The King’s Fund has already been mentioned more than once. It commissioned a series of studies recently, including an excellent and balanced study by Raphael Wittenberg and his colleagues from the LSE. These complement work in this area in pointing to the central pathway down which we must travel—a unified system of providing and funding care, initially and most importantly by removing disincentives to combining assessment, commissioning and the provision of care packages. As the noble Lord, Lord Warner, pointed out, the disincentives are there now and we have to get away from that. We all know something of the problem of delayed discharges and unplanned hospital admissions—indeed, of unplanned readmissions. The separation of the budgets for health and social care and restrictions within healthcare budgets between one area and another add to the difficulty rather than contract it.

Lastly, in the University of Edinburgh and the Royal Infirmary, Edinburgh, there is important new research about what happens to those discharged from intensive care units. The researchers reckon that approximately 60% will be readmitted. Many of those readmissions are unplanned. The reason for that—this is an area to which not enough attention has been given—is a lack of coherent and adequate community provision. A re-examination of priorities would show real leadership.

Social Care: Sustainable Funding

Lord Sutherland of Houndwood Excerpts

Tuesday 17th July 2012 Lords Chamber

[Earl Howe]

My Lords, we look forward to a continuation of the constructive cross-party talks that have taken place. We have been clear that we accept the principles of the Dilnot recommendations, including financial protection through capped costs and an extended means test. They are the right basis for any new funding model. That sets out, if you like, our high-level view on what a new funding system should look like, but there will be many questions to answer—such as on the level of the cap and whether the funding system should be voluntary, universal or opt-in—before we can make any firm decisions. It is right that we take time to work through this, including engaging with stakeholders to make sure that any reform is the right one. That means that the next spending review is the appropriate time to take those decisions.

[Lord Sutherland of Houndwood]

My Lords—

[Baroness Campbell of Surbiton]

My Lords—

Care and Support

Lord Sutherland of Houndwood Excerpts

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

I agree with my noble friend. Only last week, I talked to people at the Norwich and Norfolk University Hospital who emphasised that very point. Very often, the absence of packages of care that are tailored to the needs of the individual results in delayed discharge from hospital and often a deterioration in the condition of the patient. That helps no one. There is therefore a burning need for commissioners, providers and those providing care in the community to work together to define appropriate packages. I fully agree with my noble friend that those who have had strokes are particularly in need of the kind of packages that can best assist them when they move back into their own homes. This is an area that is crying out for further work. We hope that it will flow from the creation of clinical commissioning groups and health and well-being boards at a local level.

[Lord Sutherland of Houndwood]

My Lords, I am very happy to welcome the ministerial Statement as one of the first distant tweets of a swallow, perhaps announcing some hope of spring. However, as we all know this year, summer does not inevitably follow spring. I do not take the view that the glass is half-empty; I take the view that it is currently about 20% full. The real question is about how you put the other 80% in. That has to do with money—there are no two ways about it. Until that is confronted, I will not be convinced that the Government or—even more so—the Treasury understand the scale of the issues facing us. Demography has been announcing them for 15 or 20 years and they will get more and more urgent. There is a requirement not just for an incremental change but for a reassessment of priorities, as the Statement suggested.

One suggestion in the Statement is the importance of the integration of care. I thoroughly agree with that but have a question for the Minister. Can he reassure us that it will at least be considered that the integration of care be followed by the integration of budgets between health and social care? Many of us believe that that is one element that has to be put in place. I would not want it ruled out as an issue.

Health and Social Care Bill

Lord Sutherland of Houndwood Excerpts

Monday 27th February 2012 Lords Chamber

[Baroness Wall of New Barnet]

My Lords, I, too, support the amendment. I want to focus particularly on integration in terms of what is provided by an acute hospital, compared with what is provided in the community. The noble Earl will know how many times I have spoken about how important and welcome it is that—as my noble friend Lady Pitkeathley said—the Bill includes social care and the patient pathway. However, the patient pathway does not and will not happen for the very reasons that this amendment identifies. It does not happen because of the integration described in the patient pathway, all parts of which patients are attached to, and all parts of which the providers of care try to work to. It will not happen unless the commissioners ensure two things. First, the tariff must make it happen. A tariff must be developed which says that this should be done somewhere else and we must say what the tariff measurement will be. Secondly, they must account for it. We know that while very often commissioners—certainly in the clusters that I am involved with in north-central London—try hard to prevent patients from going to hospital and to prevent repeat visits to hospital, in reality it does not work.

I am very supportive of this part of this Bill, and very keen on the integrated elements, not just with the local authorities—as has been said—but also within the health provision itself, because it is not happening now. These amendments address just that. Can we please hear from the Minister that he understands that the only way for people to be treated nearer to home is by addressing what the tariff is and how we measure it, as well as through accountability of both of the Commissioning Board and Monitor to ensure that this happens? Even in well intentioned trusts, it does not happen because there is nothing in place to make it happen.

[Lord Sutherland of Houndwood]

My Lords, I support the amendment for three reasons. First, were it to be implemented, the effectiveness of the care provided would be magnified and significantly improved for every individual involved. Secondly, there would be better value for money. Whether we like it or not, the two professions fight with each other over budget: that is the reality. Unless they are pushed towards talking to each other seriously—which this amendment does—that will continue, and we will have the consequence of expensive hospital care militating against the provision of adequate home care. Thirdly, human beings are individuals. Over time especially, they have a number of ailments that need to be seen together, and they need to be treated as individuals. An individual does not break up into bits, going to one institution for part of his or her care and to a second institution for another part. There is a real difficulty here. Previous research shows very clearly that trying to put a dividing line between health and social care does not work.

We hear statements implying that it is going to be really quite difficult. This is not rocket science. It must be based on two professions coming together. This is being done in Scotland at the moment, and they have found ways to move ahead. I understand that there are pilots going on in England at the moment sponsored by the department, and I look forward with great interest to seeing what comes out of these. However, there is a lacuna in the Bill regarding how health and social care integrate. As long as this is so, the amendment would push things forward significantly.

[Lord Turnberg]

My Lords, we have heard that integrated care means different things to different people. As far these amendments are concerned—including the one to which my name is attached—the focus is on the integration of hospital care, NHS care and social care. Almost since its inception, the biggest problem for the NHS has been the division between health and social services; the division between funding—which of course drives everything—and management.

Acute services have always been the focus of most NHS funding. One might expect me to say, as a former acute care physician, that that is entirely appropriate. However, it has always been clear that this division, with different funding streams, has led to dreadful miscommunication between two sets of staff working under quite different systems, who fail to talk to each other in anything like a timely manner.

The end result is well rehearsed. Patients who would have been much better cared for at home—or in a nursing home if one were available and if someone could have made a proper assessment—finish up in an acute hospital which is poorly designed to provide the sort of care that they really need. On the other side, patients—usually elderly—are admitted to hospital for entirely appropriate reasons, but linger there well after their acute need has been sorted out. Clearly, if we had common funding of health and social services, we could see people employed across this divide. That is what we need: people with a foot in both camps. I take the point made by the noble Lord, Lord Mawhinney, that it takes two to tango—it takes both the heath service and local authorities, and they do not tango terribly well. While we do not have common funding, however, at least we can work towards it. Here we have an opportunity to emphasise the duty that should be placed on the NHS, for one, to ensure integration at this level. This is of such importance for patients that we should emphasise it at the least in this relatively minor way here.

Funding of Care and Support

Lord Sutherland of Houndwood Excerpts

Thursday 24th November 2011 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for introducing this debate in such a comprehensive, clear and incisive manner. I thank her, too, for the reference to the usual suspects. I am happy and proud to join her as one of them. Looking around the Chamber, most of us have form in this area. Remember “Butch Cassidy and the Sundance Kid”? In the film, as they are pursued by the Pinkerton men, Butch and Sundance look back and Butch, seeing the cloud on the horizon, says, “Who are these guys?”. We are these guys. We will not give up. We will continue the pursuit because this is such a critical matter. I thank Paul Newman and company for that. I shall group my remarks under a heading borrowed from Al Gore's influential book An Inconvenient Truth. I may use other catchphrases, some of which are stolen from MBA speak, such as “the elephant in the room”, but I want our minds to focus on “inconvenient truth”.

Today we address the Dilnot report, a good report, as one would expect from that stable. I have no hesitation in giving it my very warm support. Contrary to basic belief, we did not profligately recommend the free expenditure of money; we recommended a form of co-payment. I accept that the co-payment line has to be different today, and that is why I find it easy to support what Dilnot proposed. We address the report, but we do not address a government response. That is interesting and important. We have been here before—a situation where apparently the Government take longer to read the report than the excellent team took to write it. From past experience, this is not a good sign.

Occasional possible sightings of Dilnot have been reported, but they are usually accompanied by a pursing of Treasury lips and mutters about the state of the euro and that spendthrift bunch who were in government before. But of the report, there has not been a clear, authenticated sighting. Perhaps we should put David Attenborough on to it. It is perhaps in some frozen grotto in the north awaiting revival.

However, my simple thesis is this: the Dilnot report represents an inconvenient truth—none the less true for being inconvenient. The problems to which it points and the reasons for which it was commissioned—yes, it was commissioned, to the credit of the current coalition Government—have not gone away. It is not that the report has not gone away, but that the issues have not gone away, which is why some of us are here again. They will not go away. They will become more and more pressing the longer we ignore them.

What are the reasons for the delay in the Government’s response? They are the usual ones: “We need more time and information” or “We are consulting”. One thing successive Governments are not short of is advice. There is no need for further consultation. Think of the range of reports I could drop before the House today—I thought about bringing them in, but I would get back strain lifting them: the Joseph Rowntree Foundation report; the Wanless report from the King’s Fund; a report from the LSE by Raphael Wittenberg and colleagues; the 2006 report from the Audit Commission, the Healthcare Commission and CSCI; Her Majesty's Government’s 2006 report Opportunity Age; and their 2009 Green Paper Shaping the Future of Care Together. There was also an IPPR report; I could go on. The Law Commission has already been mentioned. There is plenty of advice. It is decisions that are needed. We need a policy.

All of those reports presented inconvenient truths to successive Governments. We have 13 years of history of this. For example, a government report in 2005 pointed out that by 2051 over 25 per cent of the population will be over 65. Wanless pointed out that the cost of care of older people will rise from £3.7 billion to £8 billion with the net cost to government rising to £1.7 billion. Wittenberg has equivalently devastating statistics. We all know them. I look around the House. Noble Lords know these statistics, and I do not need to repeat them. There is a constant litany on demographic change in this and in other countries. My favourite statistic is that in the course of this debate, if we all keep to time, noble Lords’ statistical life expectancy will rise by 30 minutes. That is not a cashable cheque, but statistically that is the rate of demographic change. These are facts. They are true, but they are inconvenient.

There is a litany of further inconvenient truths: our systems for coping with demographic change are getting worse rather than better. We should note the report that was published yesterday, of which mention has been made, about the failings of care at home; the continuing drip, drip of stories about the failings of residential care and care of the elderly in hospital; and the way in which money allocated to local authorities for these purposes, because it not being ring-fenced, is not visible at point of delivery.

I had a letter last week from someone who runs care homes, which, as far as I can see, are run very well. She reports that the price local authorities are willing to pay is £200 per week under the real price. The homes deal with it, not by cutting staff, which is the inevitable route taken by many, but by raising the money elsewhere. I say, good for them, but not everyone has that capacity. The drip, drip, drip, the points to note and the failures of the system are inevitably reported to us. They are the inconvenient truths.

A further inconvenient truth is an unplanned, unco-ordinated and inadequate system, which is approaching the point of breakdown. Ministers should beware because they will be to blame. MPs should beware because older people vote and will hit them in the ballot box, which is the only place that they have left. Governments may contrive to ignore this but they cannot. These inconvenient truths will not go away.

There are convenient ways in which the Government operate which set these aside. I shall list them. Do not upset the Treasury applecart—it has a system for limiting expenditure and no exceptions are allowed. Do not tamper with the historic power of departments—their budgets should be subject to only marginal change. Especially, do not tamper with the fortifications which separate the budgets for healthcare and social care. We do not recognise the elephant in the room. I put it to the Government that it is time now to recognise it and to deal with these inconvenient truths.

Southern Cross Care Homes

Lord Sutherland of Houndwood Excerpts

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

I think the noble Lord and I are at one in wanting to see diversity of provision. The restructuring that I suspect we are likely to see emerge from this will result in just that, as a matter of fact. It appears that Southern Cross is to be split into a number of smaller enterprises, and that in itself should, we hope, lead not only to a more diverse arrangement but a more secure one. However, I do not take issue with the thrust of the noble Lord’s remarks at all.

On the issue of the ownership of some of these care homes, our concern as Ministers is not so much where the shareholdings lie as on whether that in itself has implications for the quality of the care that residents receive. I am not aware that that has been a factor. As long as the ownership of these care homes is legal and we are not seeing tax evasion as opposed to tax avoidance, to an extent it is not an issue for the Government. But it is something that is likely to be examined quite closely as the restructuring takes place.

[Lord Sutherland of Houndwood]

My Lords, I welcome the way in which the Minister’s Statement has given reassurance to those in care homes and their families. It is immensely important that we continue to do that. There is, however, a further area of reassurance that I hope the Minister will be able to say something about. We have reassured staff through TUPE that perhaps there is some protection for their terms and conditions, but speculation in the press today suggests that the cost of care in these homes might rise significantly because of a period of underinvestment. I hope that we can at least monitor any such rises to ensure that they are gradual rather than sudden and therefore financially debilitating.

[Earl Howe]

My Lords, the noble Lord, Lord Sutherland, makes a very good point. The advice I have been given is that during the restructuring process, the cost of care should not be a factor. While local authorities may have to revise their budgets, that should not result in disruption for residents.

NHS: Reform

Lord Sutherland of Houndwood Excerpts

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My Lords, the criticisms that my noble friend has received have no doubt been considered under the umbrella of the NHS Future Forum. I can tell him only that I have personally received many expressions of support for the key principles that we have outlined.

[Lord Sutherland of Houndwood]

My Lords, the NHS makes a considerable contribution to the health of patients through its participation in major research projects, working with drugs companies and those concerned to improve the quality of care in hospitals and outside. What protection is there for this continuing?

[Earl Howe]

The Bill states that the prospective NHS commissioning board will have a duty to promote research and continuous improvement in the quality of care. As the noble Lord will know, that duty will be underpinned by the role of NICE, which will be tasked with producing quality standards that are informed by the latest innovations coming through from the research agenda.

Genomic Medicine: S&T Committee Report

Lord Sutherland of Houndwood Excerpts

Wednesday 9th June 2010 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, I, too, congratulate my noble friend Lord Patel and his colleagues on producing an excellent report. I also congratulate my noble friend on a judicious, clear and dazzling introduction, not least to those of us who are not specialists in the field. As chairman of the Science and Technology Select Committee I had the privilege of ex officio and visiting membership of the sub-committee. It gave me, along with the reports I received, ample evidence of a fine and important report in gestation, which has now come to birth and is before us.

I thank those who submitted evidence to the committee—those 140 individuals and 110 groups who took the time and effort. I simply ask your Lordships to look at all 640 pages of volume 2. It is a heavy and weighty tome in every sense. This is the distillation of scientific expertise, information and knowledge of which many a government around this world would be deeply envious. Please pay detailed attention to it. It tells a very important story. I wholly endorse the points made by my noble friend about the importance of bioinformatics and institutional development in this area. It is essential that we seize the opportunities which our scientists and technologists have given us.

This series of submissions leads me to be briefly political—with a small “p”. My first political point to the Government is that this is evidence of a strong, informed and powerful national interest in these topics. It will continue to subject government policy and practice to scrutiny, along, I hope, with the help of future emanations from the Science and Technology Select Committee. This issue will continue to be scrutinised in some detail.

The second political point—with a small “p”—is not quite as direct to the Minister, but a request to him to carry a message back. A measure of the impact of the report of the Science and Technology Select Committee is to be found, first, in this volume of evidence, and, secondly, in the subsequent reports from those who gave evidence in the first place in response to the Government’s reply. This is a measure of the impact of the importance of this committee. It is an impact which goes far beyond this Chamber. Will the Minister draw this to the attention of those who are charged with making proposals for the reform of the House of Lords? An elected House, which would have no room for the calibre of scientific expertise and wider scientific engagement which this committee attracts, would be a much impoverished House. That point needs to be before those who are to think about the future shape of this House.

However, perhaps I may slightly deviate from my noble friend Lord Patel, who expressed his disappointment eloquently on the government response. That was a relative disappointment: I simply have to add that if noble Lords had seen some of the government responses that I have seen over the years, this is pretty good. At least there are some proposals which suggest that the previous Government were interested in moving forward in this area, which are to be welcomed. The fact that there is a good, considered government response, although it does not agree on all points, is a civilised way of advancing debate on this important and complex topic. I shall come to this issue shortly.

As other speakers have indicated, I should like to say a word first on the broader context which we inhabit. In scientific terms, the context is one of significant scientific advance in this country and elsewhere. There are fruits to be cropped here of huge significance; namely, medically, the health of the nation, commercially for the economic health of the nation and so on. These advances give us the capacity over time to extend the range of medical treatments and the good health of the nation. It should be noted that most of the advances proposed in this report are potentially part of that holy grail of preventive medicine—that after which we all seek and strive, but to which we seldom pay sufficient attention. Preventive medicine is to be preferred to the rather more expensive remedial alternative. Again, this report gives a direction of travel if we are to make the most of that. That is the scientific context.

The economic context is well expressed in the perhaps ill judged joke—“Sorry there's no money left”. However, the truth of this is evident to all of us—we are in times of severe financial constraint. That constraint allows various responses. One response is special pleading on our part and I have no doubt that there will be a fair bit of that. There will be special pleading to say that this is important, and it is, but that is not the direction I wish to follow now. A second response is to cut and slash percentagewise across the board, which would be ill considered in this area. Let us be strategic in our thinking.

There are other responses, but the third, on which I want to focus, is that this constraint gives us an opportunity to consider future strategies in some detail. I hesitate to go so far as to say that this is the silver lining in the financial clouds, which would be rather overoptimistic, but there is the possibility of taking time for careful, calm and deliberative thought. We can be sure, for example, that no ambitious Minister will be ready to make his or her name with a promise of high-profile, short-term spending which has not been properly evidenced or evaluated, as we had before the election with suggestions around the House for spending on the long-term care of groups within the community—political stunts that did not bear discussion. We are absolved from the likelihood of that because of the financial picture within which we live. A time of financial retrenchment is a time when the backroom engine should be devoted to long-term planning and priority setting. It is not necessarily a time to say, “Let’s not discuss this, we can’t afford it”. It is a time to think through to the future when we hope we will be in better times.

In this spirit I warmly welcome the previous Government’s pre-election proposal to create a human genomics strategy group. I know that we wanted a White Paper—it would be good to have that too—but I see the potential value of such a group. Does this proposal have the support of the coalition Government? If not, why not? Perhaps I may be optimistic. If it does, might we first work on the remit and the membership of such a strategy group? There could be a very good starting point in asking the group chaired by my noble friend Lord Patel to give advice to the Government on what such a remit should be. It is not easy and completely obvious how best we should advance on this. My view is that the remit should not simply be confined to questions of a scientific, medical and technical nature—they should be central but not exclusive. I shall supplement my own suggestions on these issues by referring to the work of Generation Scotland, whose advisory board I have the privilege of chairing. Generation Scotland has a significant presence at my noble friend Lord Patel’s university, Dundee. It works in consort with the other Scottish universities with medical schools—Aberdeen, Edinburgh and Glasgow—and alongside the National Health Service for Scotland.

The intention is to build a database, which is complementary to the UK Biobank, but different in important respects. Largely through general practices in Dundee, Aberdeen and Glasgow, so far more than 15,000 families—I stress “families”—have been recruited to this study, which amounts to more than 70,000 individuals. Through genetic screening a picture is being built up of the correlation between family genetic inheritance and the medical histories of those families. It puts on to an evidential scientific basis the information that, informally and tentatively, a GP tries to piece together by asking when your parents died and, if you know, why they died. This is a scientific approach to providing data that will correlate genetic inheritance with perceived and actual illness patterns within families. The potential benefits are huge both for knowledge and for treatment.

So much for the example now happening in Scotland, and I draw on that, but what is its relevance to the proposed human genomic strategy group? One central conclusion I have drawn is that the oversight of such matters requires more than technical and scientific expertise. Certainly these are both central and essential, but a whole penumbra of related questions arise that may require much more than simply expertise in the scientific and technical context. They are issues of commercial exploitation—already referred to—of data sharing; of ethical principles and informed consent in relation to data sharing; and issues around the future shape of healthcare and the appropriate training and manpower needs that will arise as a result. There is a temptation to shunt all of these off to specialist committees, but it is too early to do that. A human genomic strategy group should be charged with recommendations not simply for the short term—tomorrow—but for the next decade and the decade after that. The issues of science, healthcare, commercial exploitation, ethics and regulation all bear on each other and would benefit, at least initially, from being considered in the round rather than by competing specialist committees that can easily become policy silos. In passing, I have to say that the sceptic in me does not think that there is such a thing as, for example, an ethical expert. There are experts who can aid ethical discussion, but ethics is a matter for the wider community and should not be shunted off to be considered by a separate body absent from those who know about the technology.

That is why I believe that the human genomic strategy board, if it is set up, would have important work to do and why its remit and membership should be a matter of careful discussion and decision-making. Since we cannot afford initially to commit hugely significant sums of money, we have the opportunity for thoughtfulness through this mechanism. I look forward to the Government’s response to this suggestion.

Queen's Speech

Lord Sutherland of Houndwood Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, I add my welcome and congratulations to the new members of the government Front Bench, and look forward to jousting with them both today and next Monday at Second Reading of the Academies Bill. I congratulate also those who have given excellent maiden speeches.

A new political dawn; a new style of government; a new shape to politics; youth at the helm; old ways banished to history; the legacy of previous Administrations overcome, set to rights and relegated to the past; radical solutions called for—I could go on. I am describing 1997, not 2010. Is it the case that things only got better? In one respect at least, clearly not: in one respect, the elections of 1997 and 2010 have a depressing similarity. They both observed a guilty and impotence silence on one of the major issues of the day: demographic change. If noble Lords do not know what that is, they should look around now. We on these Benches exemplify and embody demographic change.

In the campaign, despite the fact that this is a major issue, comparable to that of global warming, there was no significant word from any major party. Noble Lords may recall that, in the early months of this year, there was a flurry, if not of activity, then at least of words about this matter. New initiatives on care of the elderly—one aspect of the problem—burst like bubbles on the surface of a simmering volcano. Much hot air was expended in this House in March, debating a late but ill-conceived government Bill on the subject; but at least and at last, we thought, the matter was back on the agenda. So we turned eagerly to the public debate during the general election that was to follow—and there was nothing. Despite all the hot air and the promises of the importance attached to the topic, there was nothing. That is the first eerie similarity between 1997 and 2010: an issue of major significance kicked into the long grass during the election.

The second eerie similarity is that apparently this is not a matter for discussion in polite hustings society, and certainly not in front of the electorate; and so we had to live with it. However, optimistic as ever, some of us awaited the proposals for legislation in the Queen’s Speech: and our reward was a commission:

“A commission will be appointed to consider a sustainable long-term structure for the operation of social care”.

My first, irreverent thought was, “This is a joke”. My second irreverent thought was, “If this is a joke, I have heard it before, 13 years ago”. The same proposal was made on a major issue: let us have a commission. Perhaps this reminds noble Lords of something. I look at the promise in the coalition document, Our Programme for Government, that the commission will report within a year. The same promise was made—and fulfilled—in 1997; but here we are, 13 years on, back at the starting line. This is incredible. It is also unacceptable.

A group of well meaning and doubtless well minded individuals will consider and report, for that is their remit. What then? There is no promise that the Government will make some decisions, or that a Bill will be presented to this Parliament. We have had groups of well meaning people in significant number over the past 13 years considering and reporting. Even the royal commission and its appendix offered two, or two and a half, solutions. There followed an IPPR report, at least two reports from Rowntree, and two, including Wanless, from the King's Fund. We have had lots of consideration; of considering and reporting there has been no shortage. Of action there has been none—at least none in England.

Do we need a commission? Probably not. Most of the main options for funding are already in the public arena. A competent civil servant could summarise and present them to Ministers within a week. However, if we are to have a commission—which seems inevitable—I will offer two or three proposals for what it could helpfully contribute to the decisions that many of us hope will come out of it. The first—this is a major task to be done in due course—is an analysis of all the streams of funding that go unco-ordinated in to this black hole. This would include the enormous sums already spent by local authorities and the health service on the needs of older people. It would look at attendance allowances, housing benefit, disability benefit and contributions to the cost of care in both cash and kind from private sources and private individuals. These are unco-ordinated and I have no doubt that better co-ordination would produce better care and a more effective use of the resources that we already spend.

Secondly, we could do with an analysis of the policies and practices of the devolved Administrations, each of whom take a different position from that taken in England. If we looked at those, we might learn something both about mistakes and about what works. We also need a plan to integrate health and social care spending across the country. This is the question that we always duck—it is too hard and the civil servants will not like it—but it has to happen if we are to have competent and efficient care. Lastly, as was emphasised in the debates here in March, we need a scheme to enable the portability of benefits from one part of the country to another.

If all this were part of the work of the commission, it would help the Government to lay effective plans to deal with the implications of demographic change. These implications have not gone away in the past 13 years and they will not go away in the foreseeable future. They have to be faced. Despite what some say, I have no illusions about affordability here or, for that matter, in Scotland. I accept that we are in different financial times from those in 1997 and 1998.

In conclusion, I ask the Minister two questions. First, will he give Members of this House opportunities to comment on the remit to be given to the commission? We want to know what it will do. Secondly, can he assure us that the commission will face the big questions and that thereafter the Government will act, whether in agreement or disagreement? We need to move forward; 13 years is too long to wait.