NHS and Social Care: Winter Service Delivery

Lord Warner Excerpts

Thursday 25th January 2018 Lords Chamber

[Lord Warner (CB)]

My Lords, I too congratulate the noble Baroness, Lady Wheeler, on securing this debate and on her elegant demolition of the Government’s winter planning. I also welcome the conversion of the noble Lord, Lord Macpherson, to hypothecated tax—having left the Treasury—as well as his rather telling analysis.

Each night the BBC brings us the latest bulletin on what is happening in our hospital, GP and ambulance services up and down the land. Sick patients wait on trolleys and in cubby-holes for a doctor to see them; ambulances queue to discharge their patients and then cannot leave because they cannot get their trolley back; cancer patients wait longer and some probably die sooner; and surgery waits lengthen as more operations are cancelled. Welcome to Britain’s 21st century NHS, often said by Ministers to be the best in the world. What the Government have achieved, I suggest, is to make Hugh Pym a household name.

This winter’s crisis has highlighted how dysfunctional our health and care system has become and how difficult it is for staff to work in it. Committed doctors, nurses and a multitude of other staff are being driven to exhaustion and burn-out. Their good will and professional commitment are being taken for granted and will not last—they are rapidly evaporating. We are now well past the point where the promise of a Boris £5 billion bung in a glorious post-Brexit future will encourage the staff to stay. What people working in the NHS and social care want to see is a credible and funded plan for fixing a broken NHS business model, and rebuilding and aligning the social care system effectively with the NHS.

The Government remind me a bit of Blackadder waiting for Baldrick to come up with a cunning plan. Even when they were given a respectable route map by your Lordships’ Select Committee last April, they did not seem to know what do with it. Ten months later we still await a response. The 2011 Dilnot proposals for capping individual liability for care costs was legislated for and then abandoned. Social care reform has been kicked into the long grass following the election campaign fiasco. We now have yet another review, which almost certainly will delay any substantial reform until the early 2020s. Sadly, I think that this Government are so preoccupied with Brexit that they lack the bandwidth to get to grips with the complex and difficult problem of making our NHS and social care system fit for purpose for 21st century needs.

Yet the narrative on social care is appalling. There has been a 25% to 30% real-terms funding cut since 2010, and that is only starting to be reversed this year. The shortfall from these cumulative cuts will never be made up. The absence of further funding in the Autumn Budget and the local government finance settlement means that a further funding gap of £2.3 billion is now emerging. Those are not my calculations; that is according to the Conservative-led LGA.

Hundreds of thousands fewer people now get publicly funded social care than in 2010, and the numbers are continuing to rise. Furthermore, thousands of care beds have simply disappeared from view. In this situation, why should we be surprised that so many older people now turn up in A&E and hospital beds? The Government were warned repeatedly that this would happen, and now it has. It is inevitable that many local authorities simply will not be able to reach the Government’s totally unrealistic and “undeliverable”—not mine but the Conservative LGA’s word—expectations on delayed transfers of care from hospital. The Government seem reluctant to face up to what we have all known for some time—that a sustainable NHS requires a sustainable social care system.

If the Government want to avoid continuing NHS crises, they must start spending more money now on social care than they are currently planning to do. They must do this for the next three years or so while they work out a longer-term funding plan. That means probably allocating a further £5 billion to £6 billion over the next three financial years. In order to be a bit constructive, as a short-term expedient I suggest that the Minister and his colleagues start quickly to think about reducing hospital bed-blocking by funding more transfers of NHS patients to step-down care in nursing and residential care homes as part of NHS continuing care, instead of waiting for the unavailable care packages.

Finally, I want to say a few words about NHS sustainability, and this is where I share the views of the noble Lord, Lord Macpherson. No Government can have a sustainable NHS that meets the population’s needs without a plan for handling the unrelenting rising demand that has an unaffordable funding tab of a 4% increase a year. This Government have no such plan and, as far as I can see, nor do the Opposition. This Government have demonstrated that you cannot achieve NHS sustainability with funding increases of a little over l% in real terms a year for the best part of a decade and with no investment strategy for changing the wrong business model to meet demand. Unless we change faster the way that we deliver health and social care, we will be setting up the NHS and its staff to fail. We also have to ensure that when we give the NHS more money, sufficient of it is ring-fenced for investment and that it does not go towards propping up the present system.