The Long-term Sustainability of the NHS and Adult Social Care

Lord Bishop of Carlisle Excerpts

Thursday 26th April 2018 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, like other noble Lords who have already spoken and who will speak in this debate, I had the great privilege of serving on the Select Committee that produced the report of which we are, I hope, taking note today. Like them, I pay tribute to my colleagues, from whom I learned a great deal, and to our excellent chairman, the noble Lord, Lord Patel.

Since the report was published, more than a year ago, I found myself presenting its findings in various venues in Cumbria, where I live and work. On some occasions, local Members of Parliament and senior NHS staff have also been involved, but on every occasion the interest generated has been huge, which is a reminder, should we need it, of the importance of this topic to every citizen in every part of this country. At the same time, I have tried to emphasise again and again the underlying theme, the recurring refrain of the whole report—the serious lack of long-term vision and planning for the NHS, especially with regard to issues such as funding and workforce transformation, both of which have already been mentioned. Simon Stevens’s five-year forward view is extremely encouraging and greatly to be welcomed, and I echo the positive comments made about it by the noble Lord, Lord Patel, in his introduction to this debate. But we need to look 15 or even 20 years ahead and, at present, that is simply not happening.

In attempting to summarise our 34 recommendations, the one that has consistently for me come out on top is number 33, which calls for the establishing of an office for health and care sustainability, rather like the Office for Budget Responsibility or the National Infrastructure Commission. The need for such a body was highlighted for us by the president of the Royal College of Physicians, Dr Jane Dacre, in her evidence to the committee. She said:

“We are blighted by short-term planning that goes along with the electoral cycle. The health service is a very big and very expensive organisation that does fantastically well. But it is frequently the victim of short-term political decisions that make it less efficient”.


We clearly need a co-ordinated, cross-governmental approach that requires an independent mechanism to scrutinise longer-term issues.

What would this look like? The audit of independent and semi-independent public bodies, in appendix 5 of our report, provides a basis for determining the remit for just such an office for health and care sustainability. We have suggested that it should focus on three key issues in particular: first, monitoring changing demographic trends, as mentioned by the noble Lord, Lord Kakkar, disease profiles and future service demand; secondly, thinking about the implications of future change for the NHS workforce and the skills mix; and, thirdly, looking at the stability and alignment of health and social care funding allocations relative to future demand, which, as we all know and as the noble Lords, Lord Patel and Lord Hunt of Kings Heath, have pointed out, is likely to grow hugely in the years to come. It should constantly look up to 20 years ahead and should play no part in the day-to-day operation of the NHS. It should report directly to Parliament, which I think addresses the cross-party hesitations expressed by the noble Lord, Lord Hunt. In fact, the value of such a body, which would not need to be very large, is blindingly obvious. That is why the Government’s response to this recommendation is so deeply disappointing. They say:

“We believe that the functions of the proposed body would replicate existing mechanisms”,


but existing mechanisms are not currently prompting or helping anyone to plan for the long-term sustainability of the NHS and adult social care. This dismissal of our fundamental recommendation is both perfunctory and inadequate.

As we have already been reminded, on 23 March this year the chair of the House of Commons Health and Social Care Committee, together with the chairs of several other parliamentary Select Committees, requested the Prime Minister to establish a parliamentary commission on health and social care across both Houses. I warmly support that request, I look forward to its approval and I hope very much that the commission’s proposals will firmly include establishing an office for health and care sustainability.