The Long-term Sustainability of the NHS and Adult Social Care

Baroness Thornton Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first congratulate the noble Lord, Lord Patel, and his committee both for the excellent report we have been discussing and for persisting in pushing the Government to respond—a response, I think, which merits a C-plus perhaps, although my noble friend Lord Hunt thinks that is generous, and was late and could do better.

I declare an interest as a member of a CCG. In that part of my life, I am what noble Lords might call “up close and personal” with the results of the reforms of the noble Lord, Lord Lansley. I witness a great deal of great work, often in spite of the heavy hand of NHS England and our swingeing QIPP. In many ways, the report gladdens my heart.

I thank all noble Lords for their contributions, particularly my noble friends Lord Hunt and Lady Wheeler. As I said, the report is excellent and there is much that we can agree about in it. As the noble Baroness, Lady Finlay, said, it is a birthday present to the NHS from the noble Lord, Lord Patel, and the House of Lords—or perhaps it brings a new dawn to the NHS, as my noble friend Lady Pitkeathley put it.

I was struck by many excellent contributions today, such as that of the right reverend Prelate and his comments about an office for health and care sustainability. That idea is definitely worthy of consideration, and the recommendation did not deserve the dismissive response it received. I think that I would support it, but only if we can get rid of some of the other bodies that this report suggests are not necessary. My noble friend Lord Turnberg and other noble Lords have urged the Minister to be bold and think the unthinkable. I definitely look forward to him doing so.

In his plea to integrate academic medicine into our hospitals, my noble friend Lord Winston told me something that I did not know, as he always does. It often shocks me when I realise that what he is saying is true. I look forward to the Minister’s response to what he had to say.

The noble Baroness, Lady Finlay, and my noble friend Lord Carter made powerful contributions about the workforce in their different ways.

The noble Lords, Lord Kakkar, Lord Willis and Lord Saatchi, and the noble Baroness, Lady Tyler, talked about cross-party consensus. I need to respond to them. If I might put it like this—certainly to the noble Lord, Lord Kakkar—we could look at this in a different way. There is a great deal of agreement on many matters that we discuss. We all agree about the need for a preventative, not an illness-based, NHS. We all agree about patient safety, primary care and many other matters. Indeed, we in this House spend our lives finding agreement on how to proceed and what we might do.

The best way I can put it is that this problem is about trust. It is not only we on these Benches who struggle with trusting this Government. That lack of trust is based on solid experience of things such as the Dilnot report, but the state of the NHS is also the single biggest issue vexing Conservative voters, with more than seven out of 10 of them citing their concern in January this year. Notwithstanding my noble friend Lord Turnberg’s support for the Secretary of State, fewer than four out of 10 Conservative voters thought that the Secretary of State should keep his job. The polling shows, as did the last election, that there is a problem with trusting this Government on the NHS.

The noble Lord, Lord Willis, should remember that his party was decimated in 2015, partly because of that trust. It is a problem that all political parties face in this country. It is to do with not just this issue, but the way we run our country. We need to contemplate and think about that issue, because it is obviously a very important one regarding how we proceed and build consensus about our National Health Service.

My intention is to speak about social care and the crucial issue of integration, which is so central to this report. As the report indicates, all the investment we might want to put into the health service will not work if we do not also deal with social care. I know from personal experience, both as a carer for my mother and as a CCG member, how complex it is to achieve integration, but there are, as many noble Lords said, examples of really great integration programmes going on at local level, with local leadership and innovation. My question to the Minister is: how can the system learn from that? Many of us have posed that question over many years. How can we replicate the systems that work?

Today, we see the announcement from the think tank the IPPR, which now seeks also to address the issues of the long-term future of our health and social care system, led by my former boss and noble friend Lord Darzi and the noble Lord, Lord Prior, also a former Minister, whose contribution about the fragmentation of the NHS I completely agree with. We should welcome this report and the consideration because it is being led by two very experienced former Ministers. I am sure it will look at the huge challenges that the health and social care system faces: the re-emergence of rationing and waiting times on the rise; deteriorating finances, with the zigzag that the noble Lord, Lord Warner, talked about on funding; demoralised staff, referred to by my noble friend Lord Carter; and all the issues that come with Brexit.

As many noble Lords have said, the future of the NHS and of social care are inextricably linked. A sustainable NHS is predicated on a sustainable social care system. My noble friend Lord Rea said that even better than I could. These are enormous questions about how the health and social care system can succeed in an age of rising demand and take advantage of new technology, and how to truly integrate health and social care systems.

How can we deliver parity of esteem for patients receiving support for mental health problems and join up health and care around those patients, as my noble friend Lord Bradley explained with great eloquence? If I have a particular criticism of the Government’s response, it is that it was not robust enough at all on mental health.

Next year we will celebrate the 70th anniversary of the founding of the NHS. The health and social care system deserves a secure future that gives us confidence that it will celebrate its centenary in a little more than 30 years from now. The noble Baroness, Lady Watkins, is right: we need to take a 30-year perspective on this.

I need to comment on the idea of a royal commission. The Government have promised us a Green Paper. Since the royal commission on social care and long-term funding for older people first reported in 1999, we have seen 12 consultations and four independent reviews. With the Government undertaking yet another consultation and producing yet another Green Paper, the question is whether it will lead to action. Some £1 million was spent on the Dilnot review, only for the Government to delay the introduction of its recommended care cap before shelving it indefinitely. The Government are wasting time and public money on consultations. How can we have confidence that a royal commission will be any different? I do not think we can, or that we can wait for a royal commission to be established. I say to the noble Lord, Lord Saatchi, that we on these Benches would take some convincing that this is a sensible way forward.

We should be calling for social care to be placed on an equal footing with the NHS, rather than being an adjunct. We need care and health operating as one—locally led, focused on prevention and person-centred. It is social care that keeps people out of hospital in the first place and takes the pressure off the NHS. Delayed discharges are a good example of this, as was explained by the noble Baroness, Lady Greengross.

Are the Government going to give equal priority to social care and mental health? Will the Minister answer the questions, posed by many noble Lords, from the excellent Age UK briefing? It asks when the social care Green Paper will be published; how the Government will ensure that older people in care are consulted properly; and whether the Government will undertake—as my noble friend Lady Pitkeathley and other noble Lords outlined—to make sure that people understand what the cost of social care will be to their families.

In conclusion, the Government should return to this report and take a better look at it. This is one of those occasions where we should give them back their homework and say, “Have another go at this”, because the report is full of great suggestions and recommendations and the response is not great. The long-term sustainability of the NHS and adult social care deserves a great response.