NHS: Targets

Baroness Brinton Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I add my thanks and congratulations to the noble Lord, Lord Hunt, for instigating this important debate and, as ever, to noble Lords for their stimulating and informative contributions. I also thank the many organisations that have sent us briefings, starting with the Library. I found the NHS Providers briefings especially helpful. It is instructive how many of those briefings cover the same concerns about the NHS and social care in England that we have reflected upon in this debate.

I echo the comment made by the noble Lord, Lord Bates, about the brilliant staff in the NHS. I want to extend that to staff in the social care sector and its volunteers, carers and patients. In recent years we have asked patients to change how they receive their healthcare, and many have adapted and responded to that well.

When I was chair of education in Cambridgeshire, I was told very clearly by my director that free school meals were a proxy indicator for children in poverty, and this House has on many occasions debated whether it is appropriate to do that and whether it is an effective proxy. As the noble Lord, Lord Hunt, said, NHS targets are a proxy for the NHS and social care performance. Whether we call them targets, access standards or some new fancy name in any government review, the most important thing from the perspective of these Benches is that they should not be scrapped. They act to make our NHS and social care sector think about and change what it is doing to achieve a better outcome.

The 3.6% increase in the NHS is welcome from the Government, but as so many have said, it is not enough. I am pleased that the Secretary of State, in another place last week at the Second Reading of the healthcare funding Bill, kept saying that this is a floor, not a cap—we will hold the Government to that. It is only a sticking plaster to get us from total emergency to perhaps being able to manage services. It provides no scope for improvement or for the large changes in technology that I know the current Secretary of State is looking for. Unless the long-term underlying problems are addressed in our health system, we will remain in crisis.

I reflect on why the Conservatives introduced the Patient’s Charter in the 1990s. As other noble Lords have said, the NHS was, frankly, in total crisis, with a lack of funding, buildings completely unfit for purpose and a burgeoning crisis in social care, with too many delayed discharges. I remember a story in Cambridgeshire of a woman being taken to Addenbrooke’s Hospital in a horse-box after a three-hour wait for an ambulance. The Patient's Charter worked. The Labour Government adapted and developed it further. I echo the many points made from the Labour Benches about the strength of those targets. Although politicians and media hold every Government to account for those targets, I do not believe that anyone thinks that they are simplistic. We understand the complexity of performance that goes on behind that. The problem is that they are consistently being missed. It is not just about lack of performance; it is about lack of resource—not only money but resource.

I really liked the four key points made by the noble Lord, Lord Hunt. I am going to focus my remarks and try to bring in what other noble Lords have said under those. Long-term planning is right. Woe betide us if we think that five years is long-term planning. It needs to be at least 20 years, and probably a quarter of a century. There is so much changing in care. The way that consultants treat people with a long-term condition such as mine has completely changed in the last five years, let alone the last 10 years. Are the resources available, whether it is staff funding or technology, to match those changes as they come? We need to ensure that it is completely fit for purpose.

Many people outside politics say that we should take the NHS away from politicians. I say no. The NHS is such a key part of our public life that the public will always come back to politicians to say, “What are you doing about it?” Let us just say that we need to tackle the issues. The noble Lord, Lord Suri, rather plaintively said that he hoped the opposition parties would come together behind the Government. I gently remind him that, in the Dilnot review, all the parties came together but the Conservatives walked away the moment a decision needed to be made. All the opposition parties will support the Government in ensuring that we work together in the future. We look to them to ensure that we have a proposal that will work.

The noble and gallant Lord, Lord Stirrup, talked about having no proper strategy. That is also a problem, but we have covered the myriad areas in the debate this morning. I think that the will is there; I know it is there among the staff, but we need to ensure that this is moved with speed to ensure that everybody understands. When I talk to senior managers in hospitals, I hear about their local strategies. I do not always see the golden thread going back to NHS England.

The noble Baroness, Lady Wilcox, made a wonderful maiden speech. I loved her phrase “not another rough draft”. It is just so pertinent. As someone else who went to the Central School of Speech and Drama—I did stage management; she trained as a teacher— I know that, no matter what you did there, you were taught to speak. Other noble Lords commented on the noble Baroness’s content; I, as a fellow alumna, congratulate her on the style of her delivery.

The funding challenge has already been covered, but it remains a persistent issue. It is vital that the funding challenge in adult social care is also addressed. We have seen the knock-on effect on the NHS of not getting adult social care right for nearly three decades. I was pleased when it was decided to make the Secretary of State the Secretary of State for Health and Social Care, but a title on its own does not do enough. The better care fund started to make progress in these areas, but it was not rolled out and is certainly not consistent.

My noble friend Lady Pinnock, who has considerable expertise in local government, talked about that perfect storm, and she is absolutely right. I welcome the comments from the right reverend Prelate the Bishop of Carlisle, and the noble Baronesses, Lady Gale and Lady Pitkeathley.

Workforce development is vital. I echo the point made by the noble Baroness, Lady Watkins, about nurse practitioners. If I hear another Member of this House say that nurses do not need to be qualified but just need to know how to care, I will grind my teeth so hard I will not have any left. I rely on my advanced nurse practitioner for advice and support in my condition, and I see nods from other noble Lords around this House. We should be developing them further in primary care because we are not going to resolve the shortage of GPs. That brings me to my other workforce point: we are not training enough doctors and other healthcare professionals. Not just this Government but Government after Government have avoided the expense of developing our doctors, in particular. That is why we continue to need people to come in from elsewhere.

We need to change the culture. The noble Lords, Lord Hunt and Lord Young, spoke about that. It is important that we do not have just little pockets of good practice. I do not understand why there is not a culture of continuous improvement in the NHS. One can go into an organisation and tell it about something wonderful that is happening elsewhere, and it is completely missed. It is more than just talking about each other. It is more than workshops. I know that NHS Improvement and NHSX are beginning to change that, but the culture changes too slowly.

Can the Minister confirm that the Government will not impose 5% cuts anywhere in the Department of Health or in local government because, if other parts of those departments are asked to take further cuts, any increase in baseline budget will become meaningless. They are way beyond saving or cutting to the bone. We are in danger of beheading the very thing the Government say they want to protect. Do the Government have any plans for a long-term strategy of at least two decades? In the meantime, a commission on adult social care is essential, as is further integration.

Let us get together, all parties, all stakeholders, to make this a national priority over the next few months. It is time to make it happen.