Health and Adult Social Care Reform

Lord Kamall Excerpts

Tuesday 7th January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by echoing the comments made by my right honourable friend the shadow Secretary of State in the other place in support of all those who worked in the NHS and social care sectors over the Christmas period. They sacrificed their time, which could have been spent with their friends and families, to care for those most in need.

On the NHS app, we support the digitisation of health and care to modernise the NHS, and support digital patient records to allow joined-up health and social care to deliver better outcomes for patients and to inform patients. However, the NHS app already sends appointments and updates on treatment to some patients, while some GP surgeries prefer patients to use their own website, not the app. I would be grateful if the Minister could expand on how the updated app will differ and offer up further information to your Lordships’ House. Also, where your GP cannot see you, is the plan to allow all patients to book an appointment with another GP without having to deregister from their current practice and reregister with another practice? Will that be allowed with the updated app? One of the problems was always where there were GPs who could not see their patients but other GPs in the same area had spaces on their lists.

In the Statement, the Secretary of State said:

“We are rewarding trusts that cut waiting times fastest”,


and the carrot of “extra capital investment” is used as an incentive. This appears to make sense, but noble Lords will know that I have always been interested in potential unintended consequences. If the Government reward trusts with extra investment if they cut waiting times fastest, what will happen to those trusts that are not able to cut their lists as quickly? Will they see reduced investment, and will that simply lead to them continuing to perform poorly? What is the solution? Will hit squads—in the best possible terms—be sent in to turn them around? What other plans are there to tackle underperforming trusts which do not qualify for these extra incentives? How do the Government and NHS intend to avoid perverse incentives such as trusts prioritising certain patients over others—not necessarily based on medical needs—to cut waiting times to win this extra cash? How do we avoid that?

On social care, I appreciate the candour of the Statement in acknowledging that Governments of all colours, for decades, have not really dealt with this problem of long-term social care. As my right honourable friend the shadow Secretary of State said in the other place, we will work with the Government and the commission. However, I will put a few observations to the Minister. For decades, successive Governments have known about the ageing population, and Governments of all colours have commissioned report after report, which mostly gathered dust on the shelf. Although I have the greatest respect for the noble Baroness, Lady Casey, given that most commentators on social care agree that everything to be written about funding social care has already been written, I am curious to know what the Government expect to achieve by initiating yet another commission.

A solution was proposed in the Health and Care Act 2022. Noble Lords welcomed that we finally had a solution but disagreed on some of the details. But we had a solution to which the Treasury agreed. I remember the Opposition criticising the Government not for introducing the social care cap but for not doing it earlier, and they also suggested a number of tweaks. The incoming Government could have tweaked the numbers to address the concerns that they expressed at the time, and they could have grasped the nettle, but I am afraid that the announcement looks like yet another Government kicking the can down the road. So will the Minister write to noble Lords with the terms for the commission led by the noble Baroness, Lady Casey? This time, will the Department of Health and Social Care continue to work with the Treasury to ensure that whatever solution is finally proposed, even if it is likely not to be a new solution, has the agreement of the Department of Health and Social Care, other government departments and the Treasury? If not, it will simply find itself kicking the can down the road yet again when it comes to 2028.

My final point is on how to cut the backlog. These Benches welcome the Government continuing the policy of the last Government in opening new surgical hubs and community diagnostic centres at weekends and evenings. But, when we were in government, we found a potential workforce issue in opening community diagnostic centres at weekends and evenings. Of course, there are only so many staff who can be employed to keep these services open for longer, so have the Government made an assessment of how many staff they envisage will be available to keep these centres open for longer hours? What is the plan? Will it be a redeployment of existing staff, will existing staff be asked to work longer hours and overtime, or will they recruit new staff?

[Lord Scriven (LD)]

My Lords, we on these Benches welcome the Statement and can see some positives in the way forward, but we have some reservations about timescales and unintended consequences in the implementation that I would like to explore with the Minister.

On social care, we have already called for cross-party talks, as many noble Lords will know. Social care is in crisis and at a tipping point, and it is an unbearable pressure for many families. But we cannot understand why the review will take until 2028 and full implementation will probably not happen until 2029-30. It is a bit like calling the fire service when your house is on fire and asking it to attend once it is out. So what specific components of this review that are not already in the public domain have the Government already determined will take until 2028 to be dealt with? Will the review tackle all forms of social care, including continuing care and young people’s services?

The NHS elective reform plan marks a significant initiative for reducing waiting times and enhancing patient access to elective care. The plan introduces some welcome measures, but many are not new, such as the expansion of the diagnostic and surgical hubs, increased utilisation of digital platforms such as the NHS app and a commitment to meeting the 18-week referral to treatment standard by the end of this Parliament. Although these proposals are commendable, I have been of the view for many years that elective and emergency care need to be provided in different, and probably separate, ways. Several critical concerns warrant attention to ensure the plan’s success and sustainability.

A primary concern is that the plan focuses predominantly on elective care, potentially overlooking the broader health and social care ecosystem. The Nuffield Trust emphasises that, for the plan to be sustainable, there need to be concurrent reforms in social care, significant investment in community services and attention paid to the determinants of ill health, such as housing and education. The focus on throughput measures will mean that it will be focused purely on those. What outcome measures will be put in place, not just for the quantity and speed of care but for the clinical outcomes for patients?

The emphasis on meeting elective care targets should not overshadow other clinical priorities. It is critical to ensure that resources allocated to elective procedures do not detract from urgent and complex care needs. Indeed, the financial model set out in the plan on tariffs will create incentives to focus on elective cases when budgets are stretched. What measures will be put in place so that the expanded diagnostic and surgical hubs, along with the extra reported 3.5 million procedures in the independent sector, will avoid pulling staff away from urgent care and complicated patient needs? This must be based on a fully costed workforce plan, so when will that be presented?

The plan has been announced with little firm detail on funding, especially considering that the £3 billion ring-fenced for cutting waiting times this financial year will not be available from April. Will this ring-fenced scheme be reintroduced? While we welcome the thrust of this plan, there will be some unintended consequences, and we really need to see a detailed implementation plan to ensure that elective care does not overshadow emergency care and those seeking social care.