NHS and Social Care Commission

Liz Kendall Excerpts

Thursday 28th January 2016 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to follow the hon. Member for Totnes (Dr Wollaston), who is always open to discussion and debate, and who speaks with great experience. I am sure I speak for many hon. Members in saying that we are all the better for it.

I support today’s motion not because I think we can somehow take the politics out of the NHS and social care. Services that are used by millions of people, employ more than 3 million staff and cost more than £130 billion of taxpayers’ money every single year will always be the subject of political debate and, in my view, rightly so. I support the motion because the NHS and social care face huge challenges—they are bigger now than they were at any point in our history. We must no longer ignore or downplay those challenges and expect services, staff and the families who need care to try to struggle through.

I agree with the right hon. Member for North Norfolk (Norman Lamb) that we need a new settlement for health and social care in England, and an independent commission involving the public, staff and experts could play an important role in helping us to achieve that goal. Cross-party support for such a commission is vital. As the former shadow Minister for care and older people, I know that it is extremely difficult for Front-Bench politicians, whether in opposition or in government, to be open about what it will take to ensure that our care services are fit for the future, how much that will cost, where the money will come from and, as importantly, what changes are needed to ensure that our care services are truly fit for the future. Front Benchers’ comments are likely to be leapt upon, twisted and exaggerated and end up as screaming headlines, but in the end it is not the politicians who suffer, but the patients, users, families and staff.

Many important reviews and commissions, and Green and White Papers, from both the Opposition and the Government, have addressed the issue in recent years. In particular, I give credit to the commission on the future of health and social care in England, set up by the King’s Fund and chaired by Dame Kate Barker, from which many of my comments today are drawn. However, all those initiatives have failed to achieve genuine cross-party involvement and agreement. The commission proposed in today’s motion could help to create the political space and buy-in that we desperately need to agree a long-term settlement for the NHS and social care, whichever party or parties are in power.

The need for such a commission is urgent. As the Barker commission said, given the budget settlement that the NHS has had since 2010, staff have performed remarkably, but the NHS is now struggling to meet many of its waiting time targets: the target for diagnostic services has not been met for 18 months; the 62-day cancer waiting time target has not been met for more than a year; and A&E waits are back to the levels of the early 2000s. NHS finances are also under acute pressure, with a projected year-end deficit already of more than £2 billion.

The situation in social care is even worse. Some 400,000 fewer people are receiving publicly funded social care than received it in 2010, even though our population is ageing. Many of those who still get care are getting less support than they were. More than 1 million people who have difficulties in the very basics of daily living, such as getting up, washed and dressed and going to the toilet, now receive no formal or informal help at all. Last year, the Care Quality Commission found that one in five nursing homes do not have enough staff on duty to ensure good-quality care. The latest survey from LaingBuisson shows that, for the first time since it started collecting figures, more older people’s care beds closed than opened. Five of the largest care home providers predict significant provider failure within the next 12 to 24 months. Three of the larger home care providers have already withdrawn, or signalled their intention to withdraw, from providing publicly funded care.

Those problems are not going away. The NHS “Five Year Forward View” sets out how the NHS hopes to close a gap in health spending that is estimated to reach £30 billion a year by 2020. That will require efficiency savings of £22 billion, and at least an additional £8 billion a year of real additional funding, which the Government have committed to provide, but no health service in the world has achieved efficiency savings of 5% in one year, let alone for five years in a row. As Simon Stevens, the chief executive of the NHS, has repeatedly stressed, the very broad calculations in the forward view depend on social care receiving a decent level of funding, given that cuts to social care inevitably increase pressure on the NHS.

I do not believe that there is a decent funding settlement for social care. The Dilnot reforms, which have been postponed to the end of the Parliament, were not intended to address current underfunding, but to cap the costs of care to individuals. The better care fund, which is welcome, and the new 2% precept on council tax for social care, will not fill the gap either. Indeed, even with the precept, it will be harder for areas with the greatest need for publicly funded social care to cover their costs, because they raise the lowest amount from council tax.

Our population is ageing and demand for care will increase, so the question we face is not whether the money will be spent, but where the costs will fall. Will they fall on collective provision through public expenditure, or on those individuals and families who are unlucky enough to need care and support?

There is no shortage of proposed solutions to that problem. The Barker commission has called for changes to the national insurance system to help increase funding, including removing the complete exemption from employee national insurance contributions for those past state pension age, and raising to 3% the additional rate for those above the upper earnings limit. The commission also proposes restricting winter fuel payments to the least affluent pensioners, so that at least some of the extra costs of care are met by those above state pension age who have the means to contribute. In his recent interview in The Guardian, Simon Stevens called on the Government to consider the housing assets, benefits and other support received by older people to achieve

“more flexibility between current disconnected funding streams for older people, so that at times of need everyone is guaranteed high quality social care”.

I believe we must face up to the vital question of intergenerational fairness. The vast majority of older people have worked hard all their lives in paid employment and bringing up their families. They need and deserve support, and they do not want to end up having to sell the family home to pay for care if they need it, but I know from my own family as well as from my constituency that older people also worry about their children and grandchildren, and how on earth they will be able to afford to pay the bills or go to college or university, let alone have the chance to own their own homes. In my view, we simply cannot ask the working age population to shoulder all the extra costs required to properly fund the NHS and social care in future. I believe many older people would agree.

An independent commission with proper cross-party support that genuinely involves and engages with the public—after all, they are the ones who ultimately fund the NHS and social care—could finally help us to make progress on finding lasting solutions to these inevitably difficult and controversial questions. As the Barker commission says, the challenges we face are clear: more people in need are receiving no support at all; fewer people are receiving publicly funded social care; care home providers are closing in the face of rising demand; companies that provide care in people’s own homes are leaving the publicly funded market; individuals and families who are unlucky enough to need high levels of care continue to face enormous bills; and staff shortages are leading to a rise in neglect as good people are unable to deliver good care, piling further pressure on the NHS, which in turn is likely to lead to declining standards of patient care. That is not a future that anyone would wish for their parents, themselves or their children, but it is the future that is upon us. It is time for politicians on both sides of the House to act.

--- Later in debate ---

[Alistair Burt]

If I may say so, Simon Stevens said, “Look, it needs £8 billion.” It also needs £22 billion in efficiencies. We have met the challenge and put in even more than £8 billion—by 2020 it will be £10 billion. I understand the pressures in the system and fully appreciate the right hon. Gentleman’s remarks. The King’s Fund stated in its 2015 report:

“‘Business as usual’ is not sustainable. But that does not mean the NHS is fundamentally unsustainable.”

Simon Stevens recently said:

“The NHS has a huge job of work to do ensuring an already lean health service is as efficient as it can be—which, in my assessment, people are entirely up for.”

He recently told the Health Committee, “In headline terms, £22 billion is a big number, but when you think about the practical examples and do the economic analysis, we have some pretty big opportunities in front of us.” We know that the challenge is there; nobody denies that. However, NHS England put its assessment of what it needs to the political parties at the last election. We met that challenge and were elected.

We have spoken about a process, and I will return to that in a moment. What NHS England produced was developed by it, along with Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. The Government back the plan, but we need a strong economy to be able to do that, as a number of colleagues have said. Without trespassing too much into other areas, that is the meat of political debate in this country. The public are not just asked to make a judgment on the delivery of one particular service, however precious it is. It is about whether they think that those who are promoting their view of a particular service have the economic background to deliver it. That question was also comprehensively answered at the general election. We now have responsibility for carrying that forward. People believed that we could put the money into it, and we have done so.

[Liz Kendall]

The Minister says that he believes that the Government have met the challenge, so does he think, with regard to funding the NHS and social care, that it is job done?

[Alistair Burt]

I said that we have met the challenge that was put before us, which was to support what NHS England said it needed. We have done that through the financial commitment we have made. We looked very hard in the spending review to see what social care would need, and the Chancellor came up with the £2 billion social care precept, plus the £1.5 billion from other resources, so that is £3.5 billion extra by the end of 2020. We have put in place the financing that we believe will allow the delivery of health and social care over the next few years. But—and it is a big but, which I will refer to later—it is not just about the resources; it is also about how they are spent. Most colleagues have spoken about variability and how best practice is not always available elsewhere. We have to ensure that best practice comes in, and that is not just about resources; it is also about how things are done.