NHS: Long-term Sustainability

Lord Evans of Rainow Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, it is a pleasure to follow the noble Lord, Lord Crisp, and I thank the noble Lord, Lord Patel, for providing the opportunity to consider this challenging but vital issue. I look forward to the maiden speech of my colleague, my noble friend Lady Ramsey of Wall Heath.

I shall focus my remarks on care needs, highlighting the crucial interdependence of care and the NHS. I will draw on my experience as a member of this House’s Select Committee on Adult Social Care, so ably and empathetically chaired by my noble friend Lady Andrews, whose report, A “Gloriously Ordinary Life”, was published at the end of 2022.

It is clear to me that, if we are to ensure the long-term ability of the NHS to deliver comprehensive healthcare for all, adult social care is crucial. Fundamental changes to social care funding and provision, in the form of a national long-term plan for adult social care, are a national imperative. We engage with the NHS at all points in our lives, but adult social care is often invisible and off the public agenda until we have a sudden need for it. Yet as our report noted, 10 million of us are affected by it at any one time, either because we receive care and support or because we provide paid or unpaid care. Because we are living longer and with more complex conditions, we are all increasingly likely to be one day included in that number.

Noble Lords will be aware that there is no national government budget for adult social care in England. Services are financed primarily through local authorities, bolstered by large numbers of people who fully or partly fund their own care. As the APPG on Adult Social Care highlights in its recent report Future of Care 5, this piecemeal approach means that social care is particularly vulnerable and will often be the first to lose out when—I say that advisedly—the NHS or local authorities have their budgets cut. The 29% cut in local government funding since 2010 has led to an estimated 12% drop in spending per person on adult social care services.

If we are looking at new models and systems of care and funding within the NHS, we have to change short-term emergency funding. Social care needs a long-term funding plan. As our Select Committee highlighted, improving adult social care should be seen not only as an investment in the NHS but in ourselves, as a resilient and caring society. As the quality and consistency of services has suffered, so has the pressure and demand on unpaid carers risen. Estimates suggest that there are more than 6 million unpaid carers in the UK, and the actual figure is likely to be much higher. Estimates of the value of unpaid care provided by family and friends vary between £100 billion and £132 billion a year. That is an extraordinary contribution to the health of this country and it really needs to be seen to be valued. However, as one carer who gave evidence to our report told us:

“Unpaid carers are often not even considered to be a part of the health sector and yet without them the sector would collapse”.


Despite their numbers, carers feel invisible and many are at financial, emotional and physical breaking point. Hearing the lived experiences of those who gave evidence to the Select Committee was sobering, at times even harrowing. Time and again, they told us of being unaware of what help was available, not knowing who to ask or how to access help, or of not being listened to and being put through tick-box exercises that bore no relation to their actual circumstances or needs. Time and again, these carers were falling between the gaps of a broken system, often over many years.

One parent carer told us that, while her daughter was under the age of 18, she had a central point of contact within the NHS, a paediatrician, who could project manage the different strands of specialism her daughter needed. Once she turned 18, all this fell off a cliff. The distinction made between a health need and a social care need means that unpaid carers, often family members, are on their own, battling to get information and help.

In the Select Committee report, we urged the Government to establish a commissioner for care and support who would be able to raise the profile of social care, act as a champion for older adults, disabled people and unpaid carers and accelerate a more accessible adult social care system. Sadly, this recommendation gained no traction with the Government, but, in light of the overwhelming body of evidence on the need to improve adult social care and advocate for those at the heart of adult social care of all ages, can the Minister give us any assurance that this will be revisited?

[Lord Evans of Rainow (Con)]

My Lords, I am most grateful to the noble Baroness for finishing just before five minutes were up, but she has been the only one. The excellent speech of the noble Lord, Lord Patel, finished two minutes before his allotted time. I gently remind all noble Lords to keep to their allotted time of five minutes. I know that the next speaker will keep to it because he is a perfect timekeeper.