Autumn Budget 2024

Baroness Tyler of Enfield Excerpts

Monday 11th November 2024 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, my focus tonight is squarely on health and social care. As we have heard, the Chancellor announced £22.6 billion over two years in new day-to-day funding for the NHS, and £3.1 billion in capital funding. This funding boost is very welcome and long overdue. These are very large sums and must be spent both well and in the right places. She also announced an extra £600 million next year for social care, a very small amount given the acute challenges faced by the sector.

The recently published autumn survey of directors of adult social services shows that adult social care budgets are under acute strain, with many overspending their budgets. That £600 million, while welcome, is so very meagre, especially as it has to be shared between children’s and adult’s services; indeed, it has been described by some as a drop in the ocean. Yet again, social care is the Cinderella of the NHS. As my noble friend Lord Shipley explained, most of this funding is likely to be wiped out instantly by increases in the national minimum wage and employers’ national insurance contributions. This is simply giving with one hand and taking with the other. This tax rise could force care homes to close, and certainly will do very little for the stabilisation of the sector that is so badly needed. It is also inconsistent. The Chancellor is compensating the NHS and other public sector employers for the cost of the tax increases. However, given that GP surgeries and most care providers are private, they will not benefit from this help. This is simply counterproductive and—dare I say it—just has not been thought through. It has just been estimated that more than 2 million GP appointments per year could be at risk.

My central call today, along with other noble friends on these Benches, is that the Government exempt social care providers and GPs, along with NHS dentists, pharmacies and charitable providers of health and care, from the employers’ national insurance tax rise. In responding, can the Minister tell me what impact assessment the Government made when preparing the Budget of these additional costs to social care providers, and how they expect that money to be found? While all this is being picked over, the seemingly endless wait for the far-reaching fundamental reform of social care that is so badly needed goes on, which is heartbreaking for all the older and disabled people who need social care, and for their families.

As my noble friend Lord Fox said, unless the Government get a grip on social care, we will not be able to end the crisis in the NHS and patients will pay. I join the noble Lord, Lord Empey, in urging the Government to launch urgent cross-party talks so we can set social care on a sustainable footing. Frankly, the very last thing we need right now is a royal commission—we need a 10-year plan for social care sitting alongside the NHS 10-year plan, promised for the spring.

The decision to increase the earnings limit for carer’s allowance was very welcome and a good first step that Liberal Democrats have long campaigned on. The entire social care system depends on the good will and unpaid labour of millions of families and friends who are carers. Without them, the whole system would grind to a halt. However, on its own it will not end the repayments scandal or fix the system. The Government need to go further, get rid of the cliff edge altogether and launch a broader review to give carers the wider support they deserve, including increasing the rate of carer’s allowance. I am pleased that there will be further opportunities to look at this in forthcoming legislation.

Mental health has not really been covered so far. Along with many in the sector, I am waiting with bated breath to see what proportion of the £22.6 billion increase will be allocated to it. There must be a specific allocation. What assurances can the Minister give me on this point? At present, people with mental illness face some of the longest delays to care. The Chancellor has committed to providing specific funding for more hospital beds and to improving the health estate. This must be fairly distributed, so that mental health patients do not have to be seen in dilapidated buildings which predate the NHS or sent hundreds of miles away for care due to a lack of locally available beds. Good-quality mental health services in the right place will ultimately boost the nation’s productivity.

There is much more that I could say, but time is running out, so I will finish by reverting to my central theme and asking the Minister: what additional levels of service will be achieved by this extra NHS money in terms of timely GP appointments, cancer treatment targets and NHS dental services?