King’s Speech

Lord Warner Excerpts

Monday 13th November 2023 Lords Chamber

[Lord Warner (CB)]

My Lords, as a number of people have said this afternoon, the UK has an economy that is flatlining, with high debt, high taxes and little fiscal headroom. I want to speak this evening about making better use of public expenditure, an issue totally ignored in the King’s Speech.

First, I will address an old favourite: adult social care, which Boris Johnson promised to fix within a year back in 2019. After a few financial handouts to local government, the Government have given up on fixing social care’s workforce, funding and organisational problems, so we continue to burden families unfairly, load unnecessary costs on to the NHS and leave patients marooned in expensive acute hospitals.

Secondly, our failing NHS is spending an ever-increasing proportion of GDP. The Prime Minister indulges in a fantasy that he can fix things by pledging again to cut the NHS waiting list backlog, transforming the NHS with a long-term workforce plan and passing new legislation to curb smoking. The new anti-smoking Bill is well intended but will take years to have much impact, and the backlog has increased to over 8 million people since Rishi Sunak first promised to cut it. The workforce plan arrived in June, a decade too late, NHS doctors have not stopped strikes and the King’s Fund has pointed out that the workforce plan has no measures for retaining disgruntled NHS doctors and nurses now being tempted by attractive offers from aggressive American and Australian recruiters.

The NHS now faces an existential crisis seemingly unrecognised by our Prime Minister. Thankfully, the Treasury has stepped in and refused to give NHS England all the extra funding it is seeking despite having been given £20 billion more than pre Covid. McKinsey has now been called in to find out why NHS productivity is so poor. The Prime Minister must wish that he had not ignored the advice of Sajid Javid, who, when he was Health Secretary, called for radical NHS reform because it was financially unsustainable.

The NHS remains an inefficient ill-health service, dominated by costly acute hospitals and neglectful of community services. Women are getting a particularly raw deal, with two-thirds of England’s maternity units rated as substandard by the Care Quality Commission. Obesity and other lifestyle diseases continue to kill people prematurely, with public health disgracefully underfunded. The public are voting with their feet and increasingly using the private sector for diagnosis and treatment.

Thirdly, there is the burgeoning problem of mental ill-health, which has been referred to, and its impact on families and the labour market. Over 12% of sickness days absence are attributed to mental health problems. The King’s Speech promises

“expanding and transforming mental health services”.

This is difficult to take seriously when there are over 1 million patients waiting for mental health services and 10% of consultant psychiatrist posts are unfilled. That is about 600 posts. As has again already been mentioned, the legislative programme contains no updated mental health Bill, despite promises in the 2017 and 2019 Conservative manifestos.

It is not just health and care that test the credibility of the King’s Speech. I do not have time to go into the housing market promises not being implemented, or the rather crazy idea that we need tougher sentences for serious offenders when we have a record high prison population and only 500 spare places. Where are the extra prisoners going to go? Perhaps we will have another prison ship.

Lastly, I turn to the Government’s problems with life sciences, which the Prime Minister has said are going to be world-beating. In fact, the UK currently has the highest tax in Europe for clawing back money from pharmaceuticals sold to the NHS: 27.5%, compared with 12% in Germany. This results in large companies like AstraZeneca making new investments in medicines research and manufacturing facilities outside the UK, with the consequent loss of research jobs here in the UK. A new claw-back scheme is being negotiated at present for 2024. If he wants to protect the UK economy, Rishi Sunak now needs to get his hands dirty and ensure that the new scheme secures some competitive advantage for UK plc.

Assisted Dying Bill [HL]

Lord Warner Excerpts

Friday 7th November 2014 Lords Chamber

[Lord Carlile of Berriew]

I am grateful to my noble friend. I believe that legal aid would be available if necessary under the exceptionality provisions. When I was asked this question yesterday, I reflected on the cost of the recent funeral of my own mother. I anticipate that these costs would potentially be about the same as for a funeral. We are talking about life and death here. My noble friend is a distinguished member of the medical profession. We are talking about taking a huge constitutional step which would allow a medical practitioner to participate in the killing of another human being, deliberately bringing about their death. This is very different from the doctrine of double effect, about which the noble Baroness, Lady Finlay, and other noble Lords have spoken on numerous occasions in your Lordships’ House. I do not regard the cost issue of life and death as being very significant in this context.

In conclusion, I hope that I have made the basic—

[Lord Warner (Lab)]

My Lords—

[Lord Carlile of Berriew]

When I have finished my sentence, I will give way. I hope that I have made the basic reasons clear. Now that I have finished my sentence, I will delay sitting down in order to respond to the noble Lord opposite.

--- Later in debate ---

[Lord Warner]

I am extremely grateful to the noble Lord. Does he accept that, under the amendment in the name of the noble Lord, Lord Pannick, the family court would have to have regard to the Human Rights Act in forming its judgment?

[Lord Carlile of Berriew]

I accept that the family court would have to have regard to the considerations which are set out in the amendment of the noble Lord, Lord Pannick. The difference between that amendment and ours is that ours sets out a very clear way in which the convention issues would have to be considered by the court rather than what amounts to verifying that a process has been followed. On the one hand, we have a process-driven amendment; on the other, we have a legal framework. I will happily give way to the noble Baroness.

Queen’s Speech

Lord Warner Excerpts

Monday 13th May 2013 Lords Chamber

[Lord Warner]

My Lords, nearly six hours into this debate I thought I would give us a change of subject. I was reliably informed by the Chief Whip’s Office that if I wanted to talk about the Care Bill and its implications for local government, I should speak today. In doing so, I declare my interests both as a member of the Commission on Funding of Care and Support, whose recommendations the Bill largely implements, and as a member of the Joint Select Committee that considered the draft Bill. However, before turning to that Bill I want to make a few observations on youth unemployment.

It is rare for me to quote approvingly remarks made by the late Lady Thatcher. However, nearly 30 years ago she said something that was true then and remains true today. She said:

“Young people ought not to be idle. It is very bad for them”.

She might have added that it is also bad for society, but that was not a word that easily passed her lips.

As the founding chair of the Youth Justice Board, set up after the 1997 election, I dealt with some of the consequences of unemployed, untrained and uneducated young men ending up in the criminal justice system. I am not going to lay all the blame on the current Government, because youth unemployment is a global problem. OECD figures suggest that 26 million 15 to 24 year-olds in developed countries are not in employment, education or training. Our performance in the UK is better than some but it is certainly not as good as it ought to be, with 1 million young people unemployed. Unless we improve the way that we tackle this problem, we will be storing up trouble not just for those young people but for ourselves.

Much current social policy is preoccupied with the demography of an ageing society. This is understandable and my noble friend Lord Filkin chaired a committee of your Lordships’ House which produced an excellent report on our lack of preparedness for the service demands of an ageing society. However, one of the social requirements of that ageing society is a well trained and educated workforce that is generating wealth—not a growing number of sullen, unemployed malcontents.

As we grapple with the needs of an ageing society through worthwhile measures such as the Care Bill, we also must ensure that we set aside sufficient resources to educate, train and employ our young people, and not waste their talents. That means striking a better balance than we have now in our priorities for public expenditure between the young and the elderly. That may be an unfashionable thing to say but, as one of the elderly, I think I am entitled to say it.

All the parties need to stop oversubsidising the well-off elderly with winter fuel allowances, free travel passes and free TV licences. I am sorry but on this I disagree with the noble Lord, Lord Shipley, who is not in his place. If tough decision-making is the political mantra of today, why not start by at least taxing those entitlements or partially withdrawing them, and removing exemption from national insurance contributions for those who work after retirement age? Will the Minister comment on those issues in her response, even if it gets her into a bit of trouble with No. 10?

Let me turn now to the Care Bill. The coalition Government are to be congratulated on grasping the nettle of both reforming social care law, as recommended by the Law Commission, and on accepting the thrust of the proposals in the Dilnot commission’s report. Here, I pay tribute to Paul Burstow and Norman Lamb for tenaciously pursuing reform despite Treasury obstacles. I do not intend today to comment on the detail of the Bill and will save those comments for the Bill’s Second Reading next week.

However, I want to comment on social care funding and the problems that it presents in implementing the Bill’s good intentions, particularly on some of the implications of that parlous state of funding for the NHS. Adult social care is now consuming more and more of local government’s budgets and is set on a course to consume virtually all of it in a couple of decades. Yet, strangely, the latest survey from the Association of Directors of Adult Social Services shows that by next April local councils will have stripped out £2.7 billion—I repeat, billion, not million—from adult social care services since 2010. That is equivalent to 20% of their budget for care at a time when demand for their services is rising considerably. Domiciliary care is being paid for at below the minimum wage by some councils and some care homes are relying on subsidies from self-funders because councils simply are not paying the true cost of providing decent care.

The transfer of £850 million to councils from the NHS this year does no more than cover the budget reductions that councils are making. One-third of the directors of ADASS consider that many people who in the past would have qualified for help will no longer get it as a result of the existing tightening of eligibility criteria. On present plans, that rises to half of directors in two years’ time when the Care Bill will be implemented. The idea that this Care Bill can be implemented without a significant increase in the service and administrative budgets for adult social care is pure fantasy. However, let me emphasise that I am not suggesting an increase in public expenditure, as I shall explain.

The Dilnot commission made clear that its proposals would do nothing to bring up to speed the existing shortfall in funding of adult social care. On the most conservative estimate I suggest that the shortfall is somewhere in excess of £1.2 billion a year. Demography is worsening these matters by about 3% a year—another half a billion pounds a year. The consequences of this social care funding crisis for the NHS are already clear to see in the overcrowded medical wards of acute hospitals. Experts acknowledge that those wards have around a quarter to a third of patients who simply should not be there. The great majority of those people are aged 80 and older. This is both bad for the patients and extremely costly for the taxpayer. The present way in which we are caring for elderly patients in some of our hospitals and care homes is simply another Mid Staffordshire waiting to happen.

What we need now is a much clearer policy across the political parties of resource transfer from the £110 billion a year NHS budget to fund adult social care properly, where the taxpayers’ money would be better spent. Can the Minister tell the House what further plans the Government have to transfer resources from the NHS to social care this year and next to make good the budget shortfall before implementation of the Care Bill starts?

We have heard a lot today about Europe. Whether we leave or stay in Europe, we will still have to tackle these and the many other domestic problems that have been identified today. Endless banging on about EU membership seems to many of us a self-indulgent political diversion from resolving some of the difficult problems in our own back yard.