National Health Service: Pensions Tax

Lord Forsyth of Drumlean Excerpts

Wednesday 30th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

As I said in an earlier answer, we are expecting the consultation proposals to be implemented in April. However, I reassure the noble Baroness that these proposals would also apply to clinicians working in the Armed Forces and in medical schools, provided they are in the NHS pension scheme. I hope she find that encouraging.

[Lord Forsyth of Drumlean (Con)]

My Lords, this is not just a problem for the NHS; it applies across the public sector—to senior people in the police, the fire service, the Army and elsewhere. It is a problem of the Government’s making. It was the Government who put a limit on the size of people’s pension pots and this is the unintended consequence. We are losing the most experienced, dedicated people. It is a false economy. My noble friend answers for the Government as a whole, not just on the health service, and it is not good enough to say that the Treasury is considering this matter. It has been brought up time and again, and it is time for the Treasury to admit that it made a mistake that is costing the public service dear.

[Baroness Blackwood of North Oxford]

As usual, my noble friend speaks with alacrity and force. It has been made quite clear by the Treasury that it will look at the impact on front-line services across the system and not just in the NHS. I am of course speaking for the Department of Health and Social Care, but where sensible evidence is brought forward by other services, it will be looked at by the Treasury in its review.

Drugs: Methadone

Lord Forsyth of Drumlean Excerpts

Monday 28th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness in her question has outlined her expertise in this. She is quite right that the evidence base for the effectiveness of methadone is robust. It is provided for by NICE guidance and UK drug misuse and dependence treatment guidelines. Those have recently been updated in the Orange Book, which provides clinical guidance to clinicians and was published in 2017. There is also an update coming to NICE guidelines on how to manage drug dependency, which will be published in 2021. Therefore, up-to-date guidance is available for clinicians which ensures that they are able to provide both therapeutic and dependency management to those on prescription but also on withdrawal treatment. I therefore reassure the House that this is being taken extremely seriously by the Department of Health and Social Care, and by all related departments.

[Lord Forsyth of Drumlean (Con)]

My Lords, how can my noble friend say that it represents value for money if she does not know the cost? To go back to the question of the noble Lord, Lord Brooke, surely that cost has to be taken as an opportunity cost compared to other forms of treatment that do not continue with people being dependent on drugs.

[Baroness Blackwood of North Oxford]

My noble friend is quite right that we have to ensure that we prevent individuals getting addicted to drugs in the first place. That is why there is a wider drugs strategy, which ensures that we take action to reduce the number of people who become addicted in the first place, why the Home Office is holding a summit in Glasgow focused on tackling the problem of drug use, and why Dame Carol Black is working on the association between drug use and violence. However, we recognise that the use of methadone is an evidence-based and effective way to reduce the harm as cost-effectively as possible, which has been proven through extensive clinical and evidence-based trials.

Healthcare: Brain Tumours

Lord Forsyth of Drumlean Excerpts

Thursday 24th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness will know that this has been identified as a priority, not only from the call to action from carers themselves that services and systems that work for them should be improved, but also because it is one of the 64 actions in the carers action plan. It is something the Government are determined to take action on. We are concerned by the reports and taking action to improve it.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend noticed that at its conference the Labour Party adopted as its policy on social care pretty well the recommendations of the all-party Economic Affairs Committee of this House? Is there now a unique opportunity for us to get a political consensus on the need to provide free personal care? The root of this problem is that access to free personal care depends on diagnosis, not need. Is it not now time for the Government to produce a White Paper and work with the Opposition to produce the consensus that everyone concerned with this matter realises needs to be achieved?

[Baroness Blackwood of North Oxford]

I first congratulate my noble friend on his leadership on this issue; it has been noted by the House and very much welcomed. He is absolutely right that leadership on social care is essential and that it is time for action on this. The Prime Minister has been clear that he wants to end the suffering in social care once and for all, and will bring forward announcements on his immediate plans for that very soon.

Adult Social Care

Lord Forsyth of Drumlean Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,

“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.

He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.

[Lord Forsyth of Drumlean (Con)]

My Lords, I welcome the statement by the incoming Prime Minister. However, does my noble friend share the concern about the unfairness of the current system? People suffering from dementia or motor neurone disease are not given access to free care, whereas people suffering from cancer are. People who choose to be looked after at home do not get free care until their assets have been run down to £23,500, but their home is not taken into account. However, if they go into residential care, their home is taken into account. As my noble friend indicated, what we need now is not another White Paper; we need the Government to write a cheque. We need to move away from a system where local authorities are asked to fund this out of business rates, which results in a postcode lottery and differences in care throughout the United Kingdom.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for the work he has done on this issue. It is very much welcomed. He will know that, as one of his first statements, the Prime Minister said that his job was to,

“protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care”.

This was one of the first points he made. The noble Lord will also know that one of the Government’s long-term principles is that there must be a level of personal responsibility for social care in England, as well as the safety net that supports significant numbers of people today. However, we accept that there will need to be a significant amount of funding as part of the spending review commitment. That is being considered at the moment and will be coming forward imminently.

Social Care: Green Paper

Lord Forsyth of Drumlean Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an extremely important question. I know that she will agree that decisions on future reforms must be aligned. That is precisely why the long-term plan and the upcoming social care Green Paper have been considered alongside each other. Some important measures within the long-term plan are already beginning to improve social care; for example, the enhanced health in care homes model, which will ensure stronger links between primary care networks and local care homes; the comprehensive model for personalised care, which will put the individual at the centre of services; and personal health budgets. However, the noble Baroness is also right that we have to make sure that we get funding reform right—that is why we have increased funding from £3.6 billion in 2018-19 to £3.9 billion in 2019-20. She is also right that we must ensure that we build on the carers action plan and put carers at the heart of social care. Finally, we must ensure that we recruit, retain and build on workforce development at the heart of the social care Green Paper. That is what we will do, and I look forward to the debates in this House when we bring it forward.

[Lord Forsyth of Drumlean (Con)]

My Lords, is my noble friend aware that the Economic Affairs Committee is conducting an inquiry at the moment into social care? One of the manifestly obvious conclusions is that we will not be able to address this important issue unless we are able to get a degree of consensus between the Opposition and the Government? Would it not be a good idea for the Opposition to take a constructive approach when the Green Paper is published?

[Baroness Blackwood of North Oxford]

I think that the noble Lord speaks for the whole House when he calls for consensus on social care. One reason why it is taking slightly longer to bring forward the plan is that we are doing a lot of work on consultation and collaboration to ensure that we produce a robust proposal which can command the support of the House and be delivered effectively and implemented well. The Government are committed to ensuring that everyone has access to the care and support they need, but we need to be clear that there should continue to be a principle of shared responsibility and that people should expect to contribute to their care as part of preparing for later life. The Green Paper will bring forward ideas for including an element of risk pooling in the system to help protect people from the highest costs. We look forward to support from the Opposition on those proposals.

GP Partnership Review

Lord Forsyth of Drumlean Excerpts

Thursday 21st February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her Question. She is absolutely right that recruitment and retention of GPs is a core priority for the Government. That is exactly why funding for GPs in the long-term plan was increasing at a rate higher than in the rest of the NHS, at £4.5 billion. That is also why we have a target to recruit 5,000 more GPs. I am pleased to report that HEE has reported that we recruited a higher number of GPs last year than ever before. We also have some core recruitment schemes to increase GP retention: the GP Retention Scheme, the Local GP Retention Fund, the GP retention service and the Releasing Time to Care programme, with £30 million in funding. However, we accept that this is a challenging thing to achieve, and we are working hard to improve our performance.

[Lord Forsyth of Drumlean (Con)]

My Lords, on the subject of GPs retiring, what are the Government going to do about the fact that many GPs are retiring once they reach the age of 55 because their final salary pension scheme exceeds the £1 million limit, which the Government successfully reduced from £1.8 million, and then come back as locums, costing the health service even more? That affects not only GPs but a number of people elsewhere in the public sector, who are behaving completely rationally because they suddenly find themselves being taxed at 55%.

[Baroness Blackwood of North Oxford]

I am not able to talk about other parts of the public sector, but we recognise that there are legitimate concerns here, and we are working with the BMA and NHSE as part of our work on the recruitment and retention of GPs and consultants, and considering what mitigations, if any, would be appropriate.

NHS: Staff

Lord Forsyth of Drumlean Excerpts

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

We agree that there is a need for more staff, and indeed there are more NHS staff than ever. I can tell the noble Lord that we are increasing doctor, nurse and midwife training places, and more GPs than ever started training in the NHS this year. With an ageing and growing population, we absolutely recognise the need for more doctors, nurses, midwives and many other professions. The Budget made no changes to health spending.

[Lord Forsyth of Drumlean (Con)]

My Lords, will my noble friend acknowledge that, as nurses are not paid highly, they will not repay the loan for their maintenance grant or tuition fees? Therefore, would it not make sense to allow them to go back to bursaries? In the long run, this would save the taxpayer money and mean that 30 years from now we would not have to write off a substantial loan—or, rather, the nurses who have not benefited from that support would not have to pay to write off that loan. Is it not time that the Government looked at the fiscal illusion that has led to this state of affairs and moved instead to a system that would help in the recruitment of more nurses?

[Lord O'Shaughnessy]

I greatly respect my noble friend on this topic, which we have gone around several times. As he knows, I defend the current system as being the most progressive. Nevertheless, I am grateful for his report, which he sent me and which I am reading with interest. However, at this point, we are confident that we have the right policy.

General Practitioners

Lord Forsyth of Drumlean Excerpts

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is correct, unfortunately: she is using accurate figures. We have not achieved the GPs numbers that we wanted but we still intend and need to recruit those other 5,000 GPs. It is worth pointing out that the funding for general practice will have increased by around £2.5 billion over the five years between 2015 and 2020, so I do not accept her point about funding shortfalls. The money is there, but we need to recruit more GPs and keep them in the service.

[Lord Forsyth of Drumlean (Con)]

Is my noble friend aware that one of the reasons that the numbers of GPs are falling is because, when they get to age 55, they find that their pension contributions are taxed at 55% due to the Government’s decision to lower the threshold for their pension funds? They then rejoin the health service as locum doctors, thus costing it more. Is it not time that the Treasury learned the unintended consequences of interfering with pension rules?

Personal Social Care: Funding

Lord Forsyth of Drumlean Excerpts

Tuesday 16th October 2018 Lords Chamber

[Lord O'Shaughnessy]

It is the Scottish Government’s decision to do that. Of course, they receive higher public funding per citizen than we do in England, and we make different decisions, just as we have on higher education funding and so on. As I said to the noble Baroness, the details of the proposal will be set out in the Green Paper during the year, and I am afraid that the noble Lord will have to wait.

[Lord Forsyth of Drumlean (Con)]

Will my noble friend resist the temptation to do what has been done in Scotland, which is to announce free personal care, only for people to find that the resources are not there and the care is not available to them because of rationing? We need a properly funded system which will give everyone the quality of care that they need.

NHS: Staffing

Lord Forsyth of Drumlean Excerpts

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

It is absolutely not the case that they are not valued as much as in Scotland. This country has completely different higher education funding arrangements from those in Scotland. We are taking multiple routes to increase the number of nursing staff in the NHS, including increased funding for clinical places, the nursing apprenticeship route, more retention and bringing nurses back into the profession. We are determined to increase nursing numbers.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend had the opportunity to read the Economic Affairs Committee report, Treating Students Fairly, which shows that by 2050 the write-off on student loans will be £1.2 trillion? Given that most student nurses are not paid sufficiently to be able to repay most of that money, why not write off the loans for graduate nurses at an early stage in their careers and show a commitment to the health service—and actually save the taxpayer a lot of money 30 years from now?

[Lord O'Shaughnessy]

I am aware of my noble friend’s long-standing interest in this area. It is an issue on which we disagree. I happen to think that the changes to the funding of higher education introduced by a Labour Government and continued by the coalition Government provide a fair distribution of benefit and cost to both the taxpayer and those who benefit from higher education.