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.

Older Persons: Human Rights and Care

Lord Rea Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord Rea (Lab)]

My Lords, my noble friend Lord Foulkes has done an excellent job as rapporteur for the Council of Europe’s Parliamentary Assembly, and we should thank him for presenting this report so well. It is an important contribution to the increased international concern for the human rights of older people. Your Lordships’ House is uniquely qualified to debate this issue, since exactly half of our membership is aged 70 or over. In fact, the psychogeriatrician Professor Tom Arie once described the House of Lords as an excellent model for a psychogeriatric day centre.

The report to the Council of Europe is thorough and cogent. It lists 14 measures that states should take towards,

“combating ageism, improving care for older persons and preventing their social exclusion”.

It says member states should,

“adopt a charter of rights for older persons in care settings to be used, inter alia, to empower older persons, as well as in the monitoring of long-term care institutions by an independent body”.

This has been touched on by several noble Lords already. The CQC is definitely a step in the right direction, but it needs better funding and more qualified staff. Here, I echo several other noble Lords who have spoken.

The purpose of the report is to stimulate Governments to take action to enact its recommendations, but it is not mandatory. If it were to be made part of an international convention, to be ratified by each of the states party to it, action would be more likely to follow. As the noble Lord knows, and as my noble friend Lord Foulkes mentioned, the UN has, since 2010, been hosting annual meetings of a working group on ageing. This is open ended, as my noble friend says, and is working towards the creation of a suitable UN convention on the needs of older people, to be ratified by member states.

However, a declaration such as the one we are discussing can still be influential in steering UN and national policy. I hope that it will influence the UN working group as it draws up a document to serve as a basis for an international treaty or convention. Perhaps the Minister can tell us about the progress being made by this group, and particularly the contribution of the UK representatives.

Life expectancy is increasing, but healthy, disability-free life lags behind by five to 10 years, strongly related to the level of social deprivation. Not only do those of lower socioeconomic status live shorter lives, but for more of that shorter life they live with disability, as has already been alluded to by several noble Lords. Many of the health problems of the old have their origins earlier in life. Most of their disease burden is due to chronic non-communicable disease—obesity, diabetes, cardiovascular disease, stroke, dementia and cancer—which is to a greater or lesser extent preventable, or at least whose onset can be postponed. A person with less disability in old age has usually had a lower burden of disease throughout life. Improving the health and lives of older people cannot be separated from measures needed to improve the health of the whole population. This is strongly influenced by the social determinants of health and disease, a topic which we have debated in the past in your Lordships’ House and which we will certainly debate again in the future.