NHS: Targets

Lord Turnberg Excerpts

Thursday 6th February 2020 Lords Chamber

[Lord Turnberg (Non-Afl)]

My Lords, I am grateful to my noble friend Lord Hunt for getting this debate and setting out the facts in such a devastating way. I heartily endorse his words. May I also say how much I appreciated the maiden speech of my noble friend Lady Wilcox? It was a breath of fresh air.

When I saw the announcement about this debate, I thought: “Here we go again. We will go around the well-worn track of rising demands from an increasingly ageing population needing more and more expensive treatments, while at the same time we suffer from inadequate staffing levels, poor buildings falling to pieces, lower morale and barely enough money to keep our heads above water.” While many patients seem satisfied, and indeed many—as we have heard—praise the services for acute, one-off care, the long-term sick and disabled are poorly cared for, especially by community services.

Of course, both the NHS and social services need more money. We are still way behind the level of 10 years ago and have some way to go to catch up, but we have to face the fact that if we are to match demand to resources, we will have to be much cleverer and more efficient in how we provide care.

I will talk about just two things that we must do, with or without the additional funding that we desperately need. First, we must find a way of bridging the gap between the way we fund the NHS and the way we fund social care. The current divide is a nightmare of inefficiency.

I will give noble Lords an example. Imagine an elderly gentleman sitting in a bed in a crowded NHS hospital, having been brought in following a fall in which he injured himself. He has been repaired and is ready for home, but he lives alone. There is no one there to look after him as he recovers and no obvious places available in the local care home. It is a weekend, and no one is available in the social care department until Monday. Meanwhile, patients are piling up in the A&E department, waiting for the bed that the current occupant is keen to leave. That is the normal Catch-22 situation in far too many places.

Now imagine another situation in which the hospital trust itself has the budget for social care, employs its own social care staff in the community and funds its own care homes. It does not have to negotiate with any other organisation when it wants to bring in or discharge any of the patients in its community. It simply uses its own resources. It is the integrated, undivided care system that we have long been talking about. I fear it is the one I have been banging on about for ever.

That system has been in operation for some years now in Salford, in the hospital where I happily spent most of my working life, Salford Royal. David Dalton, the then chief executive, gained the confidence of the local authority so that it was happy to hand over the social care budget for the common good of the whole population of Salford—250,000 people. He used it very well. Indeed, the hospital trust now runs Salford’s mental health services and employs a number of GP practices, so that the whole care system works as one. Staff morale is high, as they recognise that they are all involved in providing high-quality, efficient care. I should say that David Dalton took advantage of my having left Salford to undertake all these changes.

So it is possible to run an effective and efficient combined NHS and social care service that works and saves money, but why have we not been able to spread that system more widely? Of course, much depends on the personalities locally and the confidence they can gain to trust each other, but should the Government not be providing the push and stimulus to combine these services, inadequately funded though they both are? There are likely to be many variations on the theme of integrated services. For really radical change, the Treasury should be changing its funding model and merging these two streams. Meanwhile, will the Minister spend a little time examining what can be done short of that, perhaps even by visiting Salford, where a number of previous Health Secretaries have already been, to see how it can be done and then persuade her colleagues in the department to bestir themselves?

Briefly, my second concern is the care and support of our staff in the community and in care homes. It is no secret that these workers are the lifeblood of care in the community and we rely on them absolutely to look after the huge number of people that I fear society has tended to ignore. Yet these critically important staff are vastly underrated, underappreciated and underpaid. It is a scandal. Of course we should pay them more—at the moment, they would not even reach the lower cap that would allow them entry from the EU—but equally importantly we should provide them with not a voluntary but an obligatory training programme, give them a qualification and offer the possibility of career progression. We certainly need to do more to give them the respect and recognition that they rightly deserve.