NHS: Targets

Baroness Pinnock Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, I draw the House’s attention to my registered interests as a councillor and a vice-president of the Local Government Association. I thank the noble Lord, Lord Hunt, for instigating this important debate. As this is such a wide-ranging issue, I want to concentrate my contribution on adult social care. As the wording of the debate indicates, a significant part of the increasing pressure on the NHS is a direct consequence of the Government’s failure to find a solution to the social care funding crisis.

Two years ago, the House of Commons Library produced an excellent briefing paper on adult social care funding in England. The report stated:

“A lack of suitable care services can delay hospital discharge, putting pressure on acute NHS services. Between 2014 and 2016, delays in discharging patients from hospital increased by 37%.”


The two main reasons given for this increase—not a surprise to any of us here—were patients waiting for care packages at home or in residential care. The report went on to say that

“the National Audit Office estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million.”

I have no doubt that both of those figures have risen substantially, as so little has been done to alleviate the pressures.

In December last year, Age UK updated its Care in Crisis figures for older people and reported that, in the last five years, there has been a £160 million cut in total public spending on older people’s social care, despite rapidly increasing demand; 1.5 million people aged 65 and over do not receive the care and support that they need; and cuts in local authority care services have placed increasing pressure on unpaid carers. Of course, there is also a growing number of young adults with severe disabilities for whom long-term care is provided by local authorities, hence the estimate from the Local Government Association that there will be a £3.6 billion funding gap in four years’ time unless there is an immediate and substantial increase in funding.

In summary, we therefore have what is currently described as a perfect storm, although I see nothing at all perfect in this crisis. People are becoming less independent and not receiving the support that they need to retain their independence. When they reach a crisis point—for example, following a preventable fall—and are admitted to hospital, where their care needs are assessed after treatment, there is often no residential care package or home care team to meet their new need. This is a situation where nobody wins: not the elderly person, who has unnecessarily lost a degree of independence; not the NHS, which is unable to transfer such patients to home or community settings; and not public services, whose funding is not being used efficiently and effectively.

What then are the potential changes that could help resolve this? There have been numerous reports and commissions to seek answers to the funding of adult social care. The Prime Minister declared himself committed to solving the problem, yet there were no proposals for reform in the latest Queen’s Speech. All we have is a relatively small amount of additional funding and a requirement for council tax payers to find an extra 8% on top of the capped limit over the last four years. This is no more than chicken feed in the face of the challenge.

The human cost is unacceptable; the additional, preventable pressures that are piled onto the NHS are unacceptable; the inability of the Government to propose a solution is unacceptable. The options for the future are clear. The Government have a duty and an electoral mandate to act—and act they must.