The Long-term Sustainability of the NHS and Adult Social Care

Lord Taverne Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Taverne (LD)]

My Lords, like everyone else who has spoken in the debate, I was most impressed by this very important report. I shall confine myself to funding. I believe we should scrap national insurance contributions in their present form. NICs no longer fulfil the purpose for which they were designed. First, the public do not understand them. They believe NICs pay for the NHS, but in fact only 5.3% of NIC receipts go directly to the National Health Service. The rest goes into the general pool of tax receipts for a variety of welfare benefits. The NHS is overwhelmingly paid for out of general taxation. Next, NICs are now the biggest source of taxation after direct taxes. That too is not generally known. They are a very regressive and inefficient tax on jobs.

Thirdly, everyone now agrees that health and social care are interdependent and should be amalgamated, but a new integrated service desperately needs a new source of funding. Under the present system, while demand, for well-known reasons, rises inexorably faster than GDP, the projections are that the amount of GDP spent on health and social care is set to diminish. I quote paragraph 186 from the report:

“The OBR projects, based on current spending plans, that UK spending on health and care as a percentage of GDP is due to drop from 7.4% in 2015-2016 to 6.8% in 2020-21”.


That is unsustainable and intolerable. We already have the lowest spending of any country by GDP. We spend less than anybody else.

That is why I could not agree more strongly with the report’s conclusion that we should have an independent body, such as an office for health and care sustainability. I, perhaps naively, contemplated such a body as having a rather more ambitious role: that it should have civic as well as professional representatives, and should produce a comprehensive budget, funded by the new system of health and social care contributions—a fair system based on ability to pay.

I discussed with the IFS the reasons for the Treasury’s objections to hypothecation and to such an independent body. First, it limits the flexibility of the Government to allocate public spending most efficiently. This is not an objection to be lightly discarded or ignored because we have more and more hypothecation—for defence spending, overseas aid and many others. Flexibility in the Treasury’s control of public spending is important. Next—this point has not yet been made—at times of recession demand will increase. The last thing needed is a decision by a commission or anyone else to raise contributions to meet rising demand. My answer was that the same problems face Governments. “Yes”, I was told, “but Governments can borrow”. My answer was, “Why not give the independent commission the power to borrow?” “Yes”, was the answer again, “but this can lead to reckless borrowing by an unaccountable body”. That is a function that perhaps only Governments should exercise. As a former Financial Secretary, I see the force of those objections.

There are two answers to this. The first was very strongly argued by a noble Lord. The overriding force is the fact that the public are prepared to pay if they believe proceeds go to a good cause. That is not a reason why they should be bamboozled, because Brown’s extra penny on NICs was popular, but the public did not realise that four-fifths of it did not go to the NHS but to the general pool of tax receipts. However, there is no doubt that a good cause will be strongly supported, if necessary by more taxation.

We also have something to learn from the Dutch experience. The Dutch, of course, have a very different system. They administer social and health care through private insurance companies, which provide a strictly regulated service. I would of course keep our National Health Service. What is relevant is that the Dutch insurance service is paid for by a compulsory national insurance premium based on ability to pay, which is in essence no different from the new hypothecated health and social care contributions I mentioned. As I understand the system, the premium is fixed by an independent body with wide representation, which is responsible for deciding an integrated total health and social care budget. I will have to look at the Dutch body again to see exactly what its powers are, but it seems to have successfully navigated the problems raised in my discussions with the IFS.

The Dutch system of health and social care is possibly the best in Europe. It is the most expensive, but it is popular because it is fair and money is seen to be spent on a good cause. In fact, the high taxation is a very good example of the dictum of the famous American judge, Oliver Wendell Holmes, who said that taxes are the price we pay for a civilised society.

Health: Zika Virus

Lord Taverne Excerpts

Thursday 4th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think we are the second biggest contributor of funds to WHO and have just contributed £6.2 million to its emergency contingency relief fund. I think that the work that we have done in the UK on developing genetically modified mosquitoes to combat this disease and other diseases spread by mosquitoes will almost certainly play a very major part as we go forward.

[Lord Taverne (LD)]

My Lords, since there is no prospect of an early vaccine to deal with Zika, is not the only show in town which could deliver an early answer to Zika the genetically modified mosquitoes to which the noble Earl, Lord Selborne, referred? This is a mosquito that has been modified so that its offspring die off before they can develop, and it is a mosquito that transmits both the dengue and the Zika virus. Since there has been astonishing success in the Oxitec company’s trials in parts of Brazil which, after the release of hundreds of millions of the modified mosquitoes, has virtually extinguished dengue, should the Government not support and fund extended trials by this company in Brazil? That would be extremely good not only for the reputation of British science but for the economy, since this is a field in which Britain leads the world.

[Lord Prior of Brampton]

There is no doubt that the work that we have done in this country on developing genetically modified mosquitoes will play a very large part in tackling Zika and other infectious diseases of this type. Sally Davies, the Chief Medical Officer, has convened a science committee which is meeting either today or tomorrow to assess the issues raised by the current outbreak. I am absolutely sure that she will be considering what the noble Lord has said as part of our response.

National Health Service

Lord Taverne Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Taverne (LD)]

My Lords, the National Health Service is facing its most serious financial crisis since its birth. The Health Foundation estimates that there will be a £6 billion funding gap by 2020, which I suspect is likely to be an underestimate, given the growing number of hospitals unable to stay within their budget.

I very much support the proposal of the noble Lord, Lord Fowler, supported by others, too, for a royal commission, but if there is no royal commission there should be strong support for Norman Lamb’s proposal, supported by two former Secretaries of State for Health, Conservative and Labour, for a powerful independent commission. One of its recommendations should be to fund health and social care through a specially earmarked, hypothecated tax. The Treasury hates hypothecated taxes. I believe that I am the only former Treasury Minister speaking in this debate, although that was a long time ago, when Roy Jenkins was Chancellor. But the health service is a very special case; its need for funds is greater and grows faster than almost any other public service, and much faster than GDP. At the same time, it is Britain’s most cherished institution. People would be prepared much more readily to pay for its needs than through general taxation if there were a special tax for the health service. The obvious special tax would be a reformed, progressive system of national insurance contributions, which in their present form have neither rhyme nor reason and should either become part of income tax or, much better, finance a special NHS fund.

I have one final, more general point. The needs of the National Health Service are, perhaps, one of the clearest illustrations of why we should reject the Government’s strategy on making us a low-tax, low-spending country, with public spending reduced to 36% of GDP, the lowest in the major countries of the European Union. Health and social spending are already the lowest. Low tax and low public spending societies are the most unequal and dysfunctional; they lower the quality of life of their citizens in numerous ways, as convincingly argued in that seminal book, The Spirit Level, and in Joseph Stiglitz’s splendid volume, The Price of Inequality. One of the main tasks of opposition parties in this Parliament should be to expose the dire consequences for our society of the Government’s declared central aim to shrink the state. One of its most notable casualties would be the National Health Service.

Alcohol: Calorie Labelling

Lord Taverne Excerpts

Thursday 13th March 2014 Lords Chamber

[Earl Howe]

My Lords, in fact, sales of alcopops are in marked decline, to such an extent that the market for these products looks like disappearing in the next few years. Nevertheless, I take the noble Lord’s point. It is always a concern if people are putting their health at risk by drinking too much alcohol or consuming too much sugar. At the same time, one should not always assume that an alcopop is a high-calorie drink. For example, ready-mixed gin and tonic is technically an alcopop, but very often low-calorie tonic goes into it.

[Lord Taverne (LD)]

My Lords, there is an unfavourable contrast in the behaviour of the UK alcohol industry as compared with the French when it comes to social responsibility. The UK alcohol industry strongly markets super-strong beers and lagers as the cheapest way of getting alcohol, whereas the French industry has suppressed access to low-quality wines and other cheap drinks through pricing. Would my noble friend urge the industry in the UK, as part of the social responsibility deal, to follow the French example?

[Earl Howe]

My noble friend may like to know that, in fact, 125 companies have pledged, under the responsibility deal, to help people drink within the guidelines. Perhaps the most significant pledge that has been made is the one by more than 30 alcohol retailers and producers to remove 1 billion units of alcohol from the market—around 2%—by the end of 2015. Companies, pub chains and retailers have also made a whole range of other pledges. We are making significant progress in this area.

Professional Standards Authority

Lord Taverne Excerpts

Thursday 7th November 2013 Lords Chamber

Asked by

[Lord Taverne]

To ask Her Majesty’s Government whether they intend to appoint a scientist to the Professional Standards Authority.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Government have no plans to change the membership of the council of the Professional Standards Authority. The authority is required under the Health and Social Care Act 2012 to set standards for organisations holding voluntary registers for health and social care occupations, and accredits those which meet these standards. It is not required to make a judgment on the beliefs and practices of individuals registered with the organisations that it accredits.

[Lord Taverne (LD)]

My Lords, the Professional Standards Authority has recently approved the registration of the Complementary and Natural Healthcare Council—which is known in scientific circles, quite justifiably, as Ofquack. It means, in effect, that craniosacral therapists, reflexologists and homeopaths can now claim to be covered by the same professional standards as doctors and nurses. In the past, the Department of Health has sometimes suggested that it will not take sides between evidence-based medicine, which is based on science, and complementary medicine, which is based on pseudo-science. Does the Minister not agree that the Department of Health should not be neutral between sense and nonsense?

[Earl Howe]

My Lords, it is important to understand that the accreditation scheme that we are talking about does not endorse any particular therapy as effective, and that it makes clear that accreditation does not imply that it has. The principle remains that it is for individuals, in consultation with health practitioners, to decide which therapy is right for them. The scheme is not a form of regulation, nor is the PSA a regulator. It sets standards for organisations holding voluntary registers for health and social care occupations, and accredits those that meet the standards.

Smoking: Cigarette Packaging

Lord Taverne Excerpts

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, I have never adopted a personal position on plain packaging; the noble Lord is wrong about that. As an opposition spokesman, yes, I did make it my business to talk to all sectors—to the tobacco companies, to ASH and to other lobby groups—to make sure that the picture I presented from the Benches on which he now sits was a balanced one. I took no personal position, nor, indeed, a position on behalf of the Conservative Party; I need to make that very clear. The decision that the Government have taken has been in no way influenced by Mr Crosby.

[Lord Taverne]

My Lords, will the Government take into account the effect of postponing a decision, in the light of the very strong evidence cited by the Public Health Research Consortium in coming to the conclusion that such a measure would help to deter smoking? That seemed to be confirmed by the statement by the brand director of Imperial Tobacco that now that advertising was banned, the company should look at the design of packaging. Is it not unwise for the Prime Minister, after the Coulson disaster, the decision on alcohol pricing and the postponement of a register of lobbyists, to have appointed as special adviser to the Government someone who has turned out to be a lobbyist for the alcohol and tobacco industries?

[Earl Howe]

I emphasise that the Government have by no means a closed mind on the issue of plain packaging of tobacco—quite the reverse. We want to take the time needed to consider fully the many relevant issues around standardised packaging, before making any decision. My noble friend’s last comment might have had greater force if I had been announcing that we would not be proceeding with plain packaging, but that is not the case.

Medicine: Experimental Drugs

Lord Taverne Excerpts

Monday 10th June 2013 Lords Chamber

[Earl Howe]

My Lords, the Medicine and Healthcare Products Regulatory Agency is at the forefront of the negotiations at European level to ensure that the new clinical trials regulation, which will replace the current directive, is much more conducive to companies directing their clinical trials towards Europe, in particular, we hope, the United Kingdom. This needs to happen. The trend over the past 10 years has been in the wrong direction and we want our own market share to increase; there are already signs that it is doing so.

[Lord Taverne]

The Minister’s Answer is encouraging. Does he agree that if one looks at the possible benefits to patients and the public from avoiding delays and extra costs, to press on with it is a no-brainer?

Homeopathy

Lord Taverne Excerpts

Tuesday 19th March 2013 Lords Chamber

Asked By

[Lord Taverne]

To ask Her Majesty’s Government why the Department of Health removed from the NHS Choices website the advice that there was no good quality evidence to show that homeopathy was more successful than placebo.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, NHS Choices consults the Department of Health as necessary to ensure the consistency of its information with government policy. A recent review of the homeopathy web pages led to a change in the way the evidence was presented. Following concerns that the changes were unclear, NHS Choices has further clarified this information.

[Lord Taverne]

My Lords, I am delighted to hear that the passage has been restored. However, it is disturbing that inquiries made under the Freedom of Information Act revealed that officials deleted the passage as it stood in response to lobbying by a charity founded by the Prince of Wales. They seemed to be more concerned not to offend that formidable lobbyist than to listen to the advice of their Chief Medical Officer, who declared in a recent statement to a House of Commons Select Committee:

“I am perpetually surprised that homeopathy is available on the NHS”.

I have only recently learnt that a BBC South West programme found that Prince Charles’s favourite pharmacy has been selling sugar pills as vaccines against some serious diseases. I am sure that my noble friend, to whom I could not give notice of this point, will look into the matter. Will he assure the House that the policy of the Department of Health is to promote evidence-based medicine and not treatment based on nothing but water?

[Earl Howe]

My Lords, I shall certainly look into the particular matter raised by my noble friend. The change in the way the information was presented on NHS Choices was as a result of a formal review, which happens automatically to all NHS Choices pages every 24 months. The page on homeopathy reached the formal 24-month review point in January 2011. The policy of NHS Choices is to provide objective and trustworthy information and guidance on all aspects of health and healthcare, and the page on homeopathy does exactly that.

NHS: Evidence-based Medicine

Lord Taverne Excerpts

Wednesday 10th October 2012 Lords Chamber

Asked By

[Lord Taverne]

To ask Her Majesty’s Government whether they will ensure that treatment provided by the National Health Service is founded on evidence-based medicine.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, evidence should be at the heart of modern medicine. The National Institute for Health and Clinical Excellence develops authoritative, evidence-based guidance that we expect the National Health Service to take fully into account in its decision-making. However, it is ultimately the responsibility of clinicians to determine the most appropriate treatments to prescribe, in discussion with their patients and taking account of individual clinical circumstances.

[Lord Taverne]

My Lords, the Secretary of State has announced his support for homeopathy and his opposition to research into hybrid stem cells. He has also stirred up the abortion debate. Would the Minister perhaps persuade the Secretary of State to make a public reassuring statement that he will not use his position as head of the health service to promote the kind of anti-science views and primitive social attitudes which are normally associated with the American Tea Party?

[Earl Howe]

My Lords, I would expect that my right honourable friend the Secretary of State is well aware of the public comment on his recent statements, but he is entitled to his personal views. The Government’s position remains that it is the responsibility of local NHS organisations to make decisions on the commissioning and funding of healthcare treatments, such as homeopathy, for NHS patients.

Drugs: Prescribed Drug Addiction

Lord Taverne Excerpts

Thursday 12th July 2012 Lords Chamber

[Earl Howe]

Most certainly yes, and that conforms to all the expert advice that we in the department and local commissioners have received.

[Lord Taverne]

Will the Minister ensure that whatever else is done, nothing shall prejudice the treatment of illegal drugs and of alcoholism, which is the greatest problem? Will he also take note that in the distant past, when I was a Home Office Minister and Roy Jenkins was Secretary of State for the first time, the use and possession of drugs such as heroin was not a crime and that this greatly facilitated the possibility of access to treatment?

[Earl Howe]

There are no plans to revert to the former situation as regards heroin, but my noble friend makes the point that alcohol addiction is an extremely important issue. The commissioning of services to treat addiction will in the future architecture of the system be devolved to local areas. The all-party group on benzodiazepines on which the noble Earl sits has done some important work in exposing those areas where services are not as good as they should be.