Health and Social Care in England

Baroness Tyler of Enfield Excerpts

Thursday 11th July 2013 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, it is a privilege to follow such a powerful and moving personal testimony from the noble Lord, Lord Graham. I, too, add my congratulations to the noble Lord, Lord Patel, on securing this very timely debate. Why do I say timely? As so many other noble Lords have said today, it is an opportunity to look at some of the underlying causes of the escalating costs of healthcare and what can be done about it. The National Audit Office recently released figures showing that 30% of all non-emergency hospital admissions are avoidable. With resource inefficiency such as that alongside the pressures from our ageing population, technological advances in healthcare and increasing public expectations of the system—we have heard so much about these today—it is clear to me that standing still and having more of the same is not an option, particularly in a prolonged era of less public money.

I speak today particularly as a member of the Select Committee on Public Service and Demographic Change, so ably chaired by the noble Lord, Lord Filkin, who has already spoken very eloquently. The Committee’s report, Ready for Ageing?, put considerable emphasis on the need for major redesign of the way the health and social care system is funded and delivered. I say respectfully to the noble Lord, Lord Owen, that that committee made much of the very important contribution that older people make both to society and to the economy.

We have already heard some alarming figures in today’s debate. I will not repeat them but I refer to the Nuffield Trust’s prediction of the budget shortfall by 2021 if nothing happens, and the fact that 70% of current spending goes on people with long-term conditions. I want to focus my remarks on the ways in which the existing £120 billion budget could be better spent, fully recognising that this is only part of a much wider debate. The Select Committee received overwhelming evidence that a radically new system was needed with a funding model designed to ensure that health and social care funding is aligned so that it incentivises preventative care, early diagnosis and intervention, and active management of long-term conditions, thereby avoiding worsening health and the unnecessary use of acute hospital stays—with the home, in essence, becoming the hub of care.

The committee concluded that a remarkable shift in NHS services was needed, particularly to have older people with long-term conditions receiving good joined-up primary care, community care, social care and effective out-of-hours services; that is, a health and social care system that works well 24 hours a day and 7 days a week. I think we would all agree that we do not see that at the moment. This would be designed to shift funding from acute and emergency services, which currently consume more than half of the NHS’s budget, and allow for more investment in community and social care.

Welcome moves are already being made by the Government to ensure more integrated and co-ordinated care as part of the NHS mandate refresh. These are clearly steps in the right direction. Much more radical thinking, however, will be required. I urge the Government, and indeed politicians across all parties, to consider more fundamental changes in the run-up to the next election. One such change I would put forward—as the Select Committee did—was that there should be serious long-term strategic planning which can look 10 years ahead, with the Government introducing a 10-year spending envelope for NHS and publicly-funded social care.

I do not for one moment envisage that this will be an easy sell to the British people, who understandably fear changes to the local hospital arrangements on which they rely. However, it is a conversation in which we, as parliamentarians, need to engage with the public openly and honestly, as many noble Lords have said today. I, too, was very interested in the recent findings of the King’s Fund and Ipsos MORI deliberative event, which the noble Lord, Lord Patel, referred to at the beginning. It is very interesting to see how little appetite there was for the charging of clinically necessary care. When the former Health Minister, my honourable friend Paul Burstow, was looking at ways in which we could use more widely the resources that we and the wider community have, he put it very succinctly. He wrote that:

“Our current systems are predicated on perverse incentives: people have to prove dependence and refuse informal help to qualify for services. We need to work with the strengths of people and communities to foster resilience, reciprocity and support self-care”.

He also wrote that:

“The future of our care system lies in preventing or postponing people from needing care in the first place”.

Pooling health and social care budgets is one way to achieve this sort of prevention, along with person-centred commissioning and a single point of care for all commissioning.

There are other areas we could focus on—as the King’s Fund has recently indicated—where there is real potential to transform health and social care. I shall mention just one, as time is running out, but they include that of embracing more joined-up procurement so that the vast collective purchasing power of the NHS can be used far more effectively to keep costs down.