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

Lord Rennard Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the attention of the House to my entry in the Register of Lords’ Interests.

Some years ago, when I was advising my noble friend Lord Ashdown on what to say during elections, I asked him to avoid using the phrase “rationing” when it came to talking about the NHS because the phrase is perceived very negatively. But in reality, trying to meet ever-growing demands with resources that are not growing proportionately will always mean having to ration those resources in some way.

The noble Lord, Lord Patel, and his committee are to be congratulated on their report. It does much to address the issue of NHS sustainability—much more than the Government seem willing to admit is necessary, at least publicly. The problem results from both significant demographic changes and a reluctance in the past to ask people to pay higher levels of taxation to fund the consequences of people living far longer, needing pensions for far longer, and needing much more healthcare intervention, particularly to deal with long-term conditions.

Forty years ago, a man who had worked and paid taxes for 50 years retired at 65 and lived, on average, for just two years in retirement. The cost of his pension and his healthcare was therefore not very great. Today, a man is expected to live for 20 years in retirement. His state pension, therefore, has to be paid for 10 times as long as was the case 40 years ago. Women may live for longer, but both women and men on average will now expect to have 12 years of good health in retirement but eight years when more active health and care intervention will be required, some of it very expensive.

We have had great economic growth over the last 40 years, and this has financed far greater levels of taxpayer support for the NHS than might ever have been expected during most of the last 70 years. Even so, the increasing level of taxpayer funding for the NHS is not keeping pace with the growing demands on it, or with the demands for social care. So we need people to pay more for their health and social care, and to recognise that the most efficient way of doing so is via general taxation to pay for a national health service and to integrate this properly with social care.

The noble Lord, Lord Layard, referred a few moments ago to a MORI opinion poll. I draw the House’s attention to the recent British Social Attitudes survey, which showed that most voters now back tax rises to fund the NHS if it needs more money—and, as the noble Lord, Lord Prior, indicated, it most certainly does. Options for paying more taxes found support in that survey from 61% of people. It showed that the alternatives—for example, charging for non-medical costs such as hospital food, or paying £10 to visit a GP—received just 21% support. The latter approaches are, I think, quite unacceptable.

The highest level of support in the survey was for people to pay more through a separate tax that would go directly to the NHS. A 1p increase in the basic rate of income tax, for example, would produce an additional £6 billion per year. However, it seems to me that a much more radical restructuring of the income tax and national insurance system is required to fund what is needed. I wish the Select Committee report had been less equivocal about hypothecating taxes for the NHS, because I believe that that is the only way forward by which people will agree to pay more taxation.

However, in my view the report was right to say that the long-term sustainability of the NHS requires more than an increase in taxpayer funding. For example, we need to do much more to reduce the demands on the NHS caused by factors such as the escalating rates of obesity and diabetes, and problems with alcohol misuse, and we still need to reduce further the prevalence of smoking tobacco.

In trying to tackle all these issues, we have to overcome the powerful lobbying interests of the food and drinks industry, as we have largely done with the tobacco industry’s activities in this country. We need also to promote healthier lifestyles. At this point, I should declare my interest in having benefited from a GP referral programme that successfully encouraged me to take more physical exercise. The result of that may not be immediately self-evident—but your Lordships should have seen me 10 or 20 years ago.

We also need to make much more effective use of technology to improve the functioning of the NHS, which has been far too slow in replacing paper and fax-based correspondence with electronic communication. Much greater use must also be made of assistive technology, whether funded publicly or privately or through the increased use of personal health budgets. Providing specialist equipment to children that reduces the likelihood of surgery in later life, adapting people’s homes, whether with grab rails, stairlifts or specially adapted kitchens, and ensuring that people have the most appropriate assistive technology to enable them to live their life to the fullest and most independent degree possible should become a much greater priority in the decades ahead.

That is all absolutely essential if we are to curb successfully the escalating demands on the NHS and, at the same time, enable more people with disabilities or long-term conditions to enjoy more gainful employment and contribute positively to society and to the economy.