NHS: Targets

Baroness Pitkeathley Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, do not be confused, I am not my noble friend Lord Brooke; I am grateful to him for swapping places with me—noble Lords will be hearing from him later.

I am grateful to my noble friend Lord Hunt for securing this debate; nobody knows more about this than he does. I am particularly pleased with the wide range of his topic: we can focus on the performance of the NHS in relation to its targets but also recognise the impact of adult social care pressures on those targets and that performance—I am glad that so many noble Lords who have spoken realise this.

My noble friend draws attention to a whole-system failure, and we can see evidence of that in the shocking statistic that shows how life expectancy in the United Kingdom is falling, contrary to what the noble Lord, Lord Bates, said to us. Life expectancy had been rising for decades, but has now started to decline, with the elderly, poor and newborn worst affected. Life expectancy for those over 65 has dropped by more than six months. Why? Academics have said that it is a direct result of the austerity measures imposed by the coalition Government in 2010. These cuts, which removed more than £30 billion from welfare payments, housing subsidies and social services, were some of the severest made by any nation after the 2008 financial crisis. They triggered dramatic reductions in social care, meals on wheels, rural transport, health visitors and district nursing services.

Community and voluntary services, which have always been so important in the care of the elderly and isolated especially, suffered similar reductions. If no one visits an isolated older person, no one notices if they have stopped eating or are having trouble moving about. They fall over, are finally discovered, and are then admitted to hospital where they have to be given more serious interventions than would have been the case if services had been available earlier. Then there is difficulty in discharging them because social care services are not available or are inadequate, and so the whole sorry cycle starts again, inevitably leading to shorter lives.

The cancelled operations, the ambulances queueing outside A&E and the patients dying in corridors are in fact a crisis in social care. NHS budgets may have been ring-fenced, but social care has lost £6 billion from its total spend and the 50% rise in elderly people and others stuck in hospital is because there is nowhere for them to go in the community. Thousands of care homes have closed and more than 30,000 places have been lost because providers can no longer afford to operate on the money they receive from the state. Even those homes that keep going—and there are many of high quality—face a constant battle to keep staff, since the starting wage for a care assistant is about £2,000 a year less than you could earn if you went to work in Asda or Aldi.

I mentioned a whole-system failure, and part of that whole system is of course the huge contribution of unpaid carers to our health and social care system—many noble Lords have mentioned this. Noble Lords would expect me to remind them that this contribution is worth £132 billion a year, or the cost of another whole NHS. But let us not forget the cost to the carers themselves, in terms of their own physical and mental health and the financial strain on them, which is not just the extra costs associated with providing care but the loss of future income because of lost earnings and pension provisions. I acknowledge with pleasure the commitment to carers’ leave in the gracious Speech, but it is to be unpaid so, frankly, it will not help much.

Your Lordships will be familiar with all the arguments about social care that some of us have been making ad nauseam for many years. I will not call that group the “usual suspects”, but after her wonderful maiden speech today I am delighted to welcome my noble friend Lady Wilcox to that group. We are familiar with reports followed by endless delay and indecision about how to tackle the complete unpredictability of the cost of care so that we pray we will die of cancer quickly rather than dementia slowly.

The Minister will quote the £1.5 billion given to local authorities for adult social care. That is a sticking plaster on an open wound, as I have said before in this House. I urge political consensus, as others have done, but we cannot get away from the fact that a very large chunk of money is required immediately to prevent more deaths in a situation which is surely the most pressing problem facing our nation. I have urged the Government before to be honest and bold about tackling this problem. I do so again. I ask the Minister to confirm that we will have an honest and bold proposal before the end of this year.