NHS Long Term Plan

Baroness Tyler of Enfield Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I too congratulate the noble Lord, Lord Hunt, on securing this debate. Like him, I think that there is a lot to welcome in the long-term plan, particularly the commitments to increased investments in mental health, primary care and community care, as well as the emphasis on prevention and health inequalities.

However, there is also much to worry about—mainly things about which the plan is silent. The NHS does not operate in isolation, and I am concerned—like many other noble Lords—that many of the laudable aims of the plan are being directly undermined by cuts elsewhere to public health and social care budgets. For example, the plan’s commitment to a more concerted and systematic approach to reducing health inequalities is welcome, but it comes at a time when public health funding has been reduced in real terms by some £700 million in five years, according to the LGA. So my first question to the Minister is simple: do the Government plan to reverse these cuts to public health?

Adult social care is facing a £3.6 billion funding gap by 2025. With such a focus on prevention in the plan, it simply does not make sense to underfund social care. In fact, according to the National Audit Office, one-fifth of emergency admissions to hospitals are for existing conditions that community or good social care could manage. Unless we invest sustainably in social care and public health, the funding in the plan will not be well used. Given the vital role social care will play in the success or failure of the plan, it is a great shame that the Green Paper was not published alongside it. Could the Minister give a firm commitment on when the social care Green Paper will be published?

While proper funding is vital, services cannot operate if we do not have the workforce to run them—a point that has already been clearly made this afternoon. The National Audit Office has warned that the NHS will not be able to use its new funding optimally, precisely because of staff shortages. This is a particularly pressing issue for adult mental health services, where more than 20,000 mental health positions in England are currently vacant. These positions are simply not being filled fast enough. According to the charity Mind, mental health trusts employed more than 179,000 staff in August 2017. A year on, this figure had risen by only 1,500—nothing like the additional 21,000 mental health practitioners the Government themselves said were needed to treat the additional 1 million people by 2021. Could the Minister give a date for when the NHS workforce plan will be published?

Finally, I will draw attention to the continuing issue of out-of-area placements for mental health in-patients, about which the plan says little. At the end of June 2018, NHS Digital reported some 680 active out-of-area placements, of which 95% were deemed “inappropriate”. Could the Minister say what precise plans the Government have to tackle the use of out-of-area placements in mental health services?