Queen's Speech

Lord Warner Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Warner]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Murphy, with whose speech I largely agree. The Government would do well to take heed of many of the remarks that she and the noble Lord, Lord Patel, have made.

I shall speak today on adult social care and the NHS but, first, I congratulate the two Ministers on their new appointments. As one of the Ministers that the noble Earl, Lord Howe, has seen off, I congratulate him on his strong grasp of health and social care. Even when he was skewering me as a Minister, it was always done with elegance and with a sense of doing so in the best interests of the NHS.

I greatly enjoyed the maiden speech of the noble Lord, Lord Hill. It reminded me that it was one of his former boss’s ideas on GP fund holding that I pinched and turned into practised-based commissioning. I have never owned up to that publicly but this seems an appropriate occasion to do so.

I begin by congratulating the Government on administering a speedy coup de grâce to the ill-conceived Personal Care at Home Act. This has removed an important roadblock to achieving sustainable long-term reform in this area. Unlike the noble Lord, Lord Sutherland of Houndwood, I welcome the idea of an independent commission to look into this. I think that we need to dig quite a few people out of rather entrenched positions on some of these issues, and a commission of independent mind might help us to do that. However, it is important that it focuses quickly on the considerable amount of common ground that exists among different shades of opinion in this area. A few of us identified this common ground in March in a pamphlet produced on a cross-party basis with Sir Derek Wanless. I know that Ministers have seen that pamphlet but when we were writing it, it was very clear that there was a large measure of agreement on many issues in this area, and that is something on which the commission needs to build.

It is clear from the public debate so far that total funding for adult social care has to be increased significantly to cope with demography. It is also clear that there has to be a larger contribution from individuals and families who can afford it, rather than from the taxpayer. It is equally clear that risk-pooling through some form of insurance has a key role to play. These points are all well documented and well settled, and we need to build on them. We need to do more—and I hope that the commission will do this—to engage the insurance industry in ways forward in this area.

Before leaving the subject of social care, perhaps I may say a few words about the idea of a national care service. Like all parties, the Government rightly want to achieve more integration of health and social care for the benefit of service users. No one could disagree with that. However, I suggest that a better starting point for improved integration is the local commissioning role, rather than just concentrating on the provider side. This will particularly be the case if GPs are to be more powerful service commissioners in the future. We now need joint commissioning which supports more personal budgets and user choice and which creates greater diversity of service providers. It seems to me that the rather statist-sounding national care service is not self-evidently the best way to achieve this, and we need to look at that idea very carefully before we take it too much further forward.

I turn briefly to the subject of dementia, which has been raised a number of times today. I support and welcome the Government’s decision to prioritise dementia research but I would encourage them to think more widely about whether the current allocation of service and financial responsibilities for dementia between the NHS and social care is right. After all, dementia is very much an illness; it is a disease, and I wonder whether the NHS is bearing its full proportion of the burden in this area. Another look at that might change some of the calculations that the independent commission might have to make in adult social care. I do not have a strong view on that, but it is an area that we should look at again.

Turning to the NHS, the Labour Government’s record on investment in the NHS was outstanding. We recognised that that needed to be done after almost two decades of parsimony in the 1980s and 1990s. I shall not recite all the figures; many in this House have heard me recite them from the Front Bench many times. However, I emphasise one point: the independent evidence from the Nuffield Trust shows that the much maligned targets did a lot to improve services, however much NHS staff disliked them. Before we ditch targets we should consider whether, in a democratically parliamentary accountable system like the NHS, we have a few levers in Richmond House that enable us to satisfy the public that taxpayers’ money has been spent reasonably well.

Latterly—the noble Baroness, Lady Murphy, put it very well—my party lost its appetite for NHS reform and certainly lost its appetite for some of the agenda that was promised in the 2005 Labour election manifesto, particularly those parts about more competition and greater diversity of providers to give patients more choice. I am a little hesitant about asking the coalition Government to help to implement that Labour Party manifesto. I notice in the new health Bill that this Government are to make Monitor into a proper economic regulator, a move which I have long supported. This is a good opportunity to ditch, once and for all, the rather misguided idea of the NHS as a preferred provider. A good start could be made by starting with market-testing PCT provider services, which the Department of Health has already said are inefficient and lacking in good productivity. I wonder whether the noble Earl can say whether there will be a review of some of the mergers that have quietly taken place or are in prospect of some of these less than efficient PCT provider services.

There is not time for me to go into any other areas of the NHS. As the new Government tackle the very difficult financial challenges ahead, which the NHS has never faced in its history on this kind of scale, I hope we in this House can settle down and discuss all these changes, which would have been inevitable whoever had won the election, and start doing so in a constructive and non-partisan way.