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

Lord Rea Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Rea (Lab)]

My Lords, I add my congratulations to those that have already been given to my noble and professional friend Lord Patel and his Select Committee for a very complete and relevant analysis. I declare an interest as a retired NHS GP and a fellow of the Royal College of General Practitioners who has also worked in epidemiology. I am also honorary president of the UK Health Forum, a think tank linking some 60 organisations interested in primary prevention. I am pleased that evidence from both these bodies is cited in the Select Committee’s report.

I would like to say also that I have now joined the age group that gives the NHS the most trouble. I have had to use the NHS more in the past five years than I did in the whole of my life before that. Every time I have received care, I have been impressed by the courtesy, good humour and skill of the staff, even when they have been under very great pressure.

The report makes plain—as does most informed opinion—that greater resources are needed. I am repeating what nearly every other noble Lord has said. The Office for Budgetary Responsibility points out that the percentage of GDP spent on health in the UK, 7.4% in 2015-16, is low compared with other comparable countries, and projects that on present trends it will fall to 6.8% in 2020. As practically all other speakers have said, the NHS and social care have suffered for too long from short-termism and, recently, from serious underfunding, which makes intelligent planning difficult.

Our demographic problem of an ageing population with an increasing need for care is well documented but has not been acted upon adequately—if at all. Prevention in particular has been neglected. Despite the intention of the five-year forward view to step up preventive activities, progress has been slow and has not been made any easier by the Government’s recent cutbacks to local authority funding for public health.

The history of public health includes many examples of products that are harmful to health but whose manufacturers resist calls to reduce or change their composition or their promotion. The tobacco industry is of course the prime example of powerful and dishonest but extremely skilled resistance to all measures—and it is still doing so. The alcohol and food industries are now doing much the same. Simon Stevens says that,

“obesity is the new smoking”.

Voluntary agreements to make products less harmful have had only limited success. In the end, mandatory regulation will have to be brought in, as have most successful public health measures in the past, beginning with the water companies more than one and a half centuries ago when cholera was rife. Governments initially shy away from regulation, such is the lobbying pressure that industry can exert. Recently, proposed robust restrictions on food promotion to children were delayed and toned down. Why?

Health education messages will have less effect when the harmful habit concerned is ingrained and there are strong social and commercial pressures to continue it. Some noble Lords may have seen Hugh Fearnley-Whittingstall’s TV programme on fast food promotion last night—exactly this topic. Poor housing, depressing environments, unemployment and dead-end jobs make it more difficult to break habits that give temporary relief, such as smoking, alcohol, drugs or takeaway junk food, often sweet and containing too much sugar.

In such circumstances, to say that people need to change their lifestyle amounts to a form of victim blaming. More resources need to be directed to those living in deprived communities. To promote good housing and employment opportunities is part of the wider agenda of public health. The closer liaison of local authorities with public health, which was one of the better parts of the 2012 Act, has been frustrated by funding cuts.

Finally, I will say a word about the Select Committee’s recommendation to set up a new high-level independent standing body on the lines of the Office for Budget Responsibility, with the power to advise on all matters relating to the long-term sustainability of health and social care, and which will report directly to Parliament. It should continually look forward for 10 or even 20 years. I agree with the right reverend Prelate the Bishop of Carlisle that this is an excellent plan which should lead to continuity and diminish short-term political pressures on health policy.