Budget Statement

Baroness McIntosh of Pickering Excerpts

Wednesday 3rd November 2021 Grand Committee

[Baroness McIntosh of Pickering (Con)]

My Lords, I follow my noble friend in adding my congratulations to the right reverend Prelate the Bishop of Newcastle on not just her speech but, as others have commented, her years of service to the Church and her public service generally. I wish her every success. As a money spider has just walked over our papers, I strongly recommend that she buys a lottery ticket before the end of the week.

I will focus on two aspects. I note the right reverend Prelate’s remarks on Temple and add my request for everyone to have the right to a warm home. I am the honorary president of National Energy Action, which is based in Newcastle, in the north-east. I am also the daughter and sister of dispensing doctors and I advise the board of the Dispensing Doctors’ Association. Many of my remarks will focus on rural areas.

I will talk, in particular, about not so much what is in the Budget but what has been left out. I regard it is a missed opportunity for the fuel poor. There are currently 1.5 million fuel-poor households and I regret to say that 25% of all electricity bills are raising and paying for the green levy. It is undoubtedly true that those on the lowest incomes have the least efficient homes and spend a higher proportion of their income on energy. It is feared that, when the price cap is removed in April 2022, a further 1.5 million households may tip into fuel poverty. The rise in energy costs before then will impact on other households, often in rural areas, which are not covered by the price cap, such as those that are dependent on coal, LPG and heating oil. One in four of Britain’s lowest-income households say that they cannot afford even a £5 increase to their monthly energy costs, so I regret that many of the fair recommendations for the Budget from National Energy Action were overlooked. In both the Budget and spending review, no measures were taken to alleviate the plight of the 4 million in fuel poverty.

I turn briefly to health and social care. The Government announced an increase in national insurance contributions in the form of the social care levy, to which my noble friend referred. This not just breaks a manifesto commitment but hits the two sectors that are trying to help the NHS and social care, as they are the two largest employers in the land. I press my noble friend on what is happening about the pledge that was made for 6,000 new GPs by 2024-25. On page 49 of the Red Book, reference is made to the increased number of nurses and appointments in primary care, but none is made to GPs. I understand that it was announced in the other place that this commitment would no longer be met by that time. It would be helpful to know, before the end of the debate, if that is the case.

I pay tribute to my right honourable friend Jeremy Hunt, who, earlier today in the other place, raised the severe labour shortages that there are in nearly every specialty in the NHS. While the Government and my noble friend said today that the proceeds of the levy will go to the NHS and social care, the Library, in preparation for today’s proceedings, highlighted that there are eight bodies that, presumably, will employ large numbers of these staff. That is not counting the ICS and clinical commissioning groups. In fact, the Red Book gives no detail on how the additional money will be spent. I press my noble friend with a direct question today: how will the money be allocated between primary and secondary care?

I have to say with regret that morale as I see it among doctors, particularly GPs, is at rock bottom. Patients have been told that they are unable to wait in waiting rooms for GP and dental appointments, and they are voting with their feet and going to accident and emergency departments. The Red Book tells us that there has been a 20% increase in the number of NHS staff in hospital and community health services since June 2011. How many of those increases have been in patient-facing positions, because that is extremely important?

There is real concern as to how the increased money announced by my noble friend today is to be allocated. It is usually allocated through the integrated care systems. What is the make-up of those? Does my noble friend agree that they are made up predominantly of secondary care rather than primary care representatives? Who monitors how this spending is allocated between primary and secondary care, and how will the budget be spread between rural and urban areas? In previous times, specific regard had to be had to rurality and sparsity of population. I understand that those conditions have now been dropped.

I end with a simple plea to my noble friend: that the Government act now to address the balance—or imbalance—between spending on GP surgeries in rural and urban areas, and hospitals, to ensure that the NHS can manage the stresses facing us this winter, not least in rural areas.