NHS Long Term Plan

Baroness Watkins of Tavistock Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate, and draw attention to my interests as set out in the register. Like other noble Lords, I welcome the plan and the certainty it brings to health service funding, and in particular the aim to achieve parity of esteem between mental health and physical health through investing in the causes and consequences of poor mental health.

However, it is vital to provide truly integrated social and healthcare services in our population to promote healthier lives and provide support and treatment to those with a range of disabilities, including both physical and mental health conditions. Yet we still await the Government’s Green Paper on social care, which is another essential part of the jigsaw. Without clear indications of the funding source available for social care, the implementation of the NHS plan will flounder, with many people remaining in hospital when they are ready for discharge—not only older people with comorbidities but younger people with learning disabilities and autism, a proportion of whom are still in institutional care despite all political parties’ commitment to eradicating this approach.

Public health budgets have been cut since 2015, yet we know, for example, that for every publicly funded pound spent on contraception there is a saving of £9 over 10 years—before considering the wider societal costs and impacts of unplanned pregnancies. The number of health visitors is being reduced in many local authorities—not necessarily because decision-makers want to do so, but because they must make provision for minimal statutory services, so they are faced with selecting the least-worst options to balance budgets. How swiftly will PHE budgets be restored and increased so that both contraception and health visiting services can be adequately provided?

The noble Lord, Lord Turnberg, and the noble Baroness, Lady Tyler, spoke eloquently on workforce issues, but I want to draw attention to the fact that, while we talk about the NHS having a shortage in the region of 40,000 nurses, there are a number of vacancies in the voluntary and independent sectors—particularly in nursing and care homes. At a conservative estimate, there is a shortage of at least 60,000 nurses in England. Yet the NHS plan says that by 2028 it will improve the vacancy rate by 5%. A simple arithmetic equation tells us that this means only 2,000 more nurses. What impact will this really have in assisting the delivery of the new plan?

Finally, there is a section in the plan relating to limiting A&E admissions for alcohol-related problems. This is an excellent aim, but surely the swiftest effective approach would be to introduce a minimum unit price for alcohol, as adopted in Scotland and recommended by medical experts in public health, not only in England but internationally. Could the Minister tell us how the review on minimum unit pricing in England is developing?