Queen’s Speech

Lord Scriven Excerpts

Wednesday 12th May 2021 Lords Chamber

[Lord Scriven (LD)]

My Lords, like other noble Lords, I welcome the two maiden speakers to your Lordships’ House and wish the right reverend Prelate the Bishop of Portsmouth an exciting new chapter in his work outside this House.

I live in a city where, if I get on a bus outside my house and go six stops, life expectancy decreases by 10 years. The people in those communities are not left behind; they have been neglected for generations. Trickle-down economics has not worked; allowing people to become filthy rich has not worked or met their needs. These issues are deep-seated and deep-rooted, so it is commendable that the Government want to improve health inequalities and concentrate on population health as outlined in the health and care Bill. But focusing on what is required to improve health and well-being would not lead people to conclude that another structural reform of the NHS is the solution in either the short or the long term. The most urgent need, if we are to save lives and improve health, would be to deal with the backlog of 4 million people waiting for care and treatment. Time spent trying to replumb a complex NHS bureaucracy is going to take effort and resources over the next two to five years. It is not only the wrong solution; it is the wrong solution at the wrong time.

For me, as a former NHS manager, this yet again raises the million-dollar question: how do you move resources out of acute and ambulatory care, which account for over 80% of NHS spending and are mostly a sunk cost, to a health service that is focused far more on poor health prevention and keeping people healthy? Will the Minister explain, in simple terms, how this structural reform of the NHS will move the whole system to a more preventive one and move resources to that end? If the Minister cannot answer that question and convince the House and the nation on this fundamental question, this is a reform of fantasy rather than one based on the reality of what is required to improve the nation’s health.

Of course, when we talk about healthcare, we are really talking about the staff, who provide outstanding care, who have gone above and beyond the call of duty over the last 14 months, sometimes at great personal sacrifice for them and their families. The Minister cannot stand at the Dispatch Box and say with sincerity that the Government value the NHS if they refuse to value the NHS staff’s contribution in getting the nation through one of its most difficult peacetime episodes. That is why a decent pay rise is required and not the odd token clap on the doorsteps of official residences.

The aim to deal with health inequalities is welcome, but the solution presented by government, of integrated care systems looking at population health, is totally impractical and will not deal with the real underlying causes that lead to the inequality. Some 80% of the root causes of poor health and lack of well-being have nothing to do with the healthcare system. They are based on cold, damp, inadequate housing; on generations of families not having the opportunities to meet their full potential; on the Government feeling that punishing people on benefits, and offering tax breaks to those on the highest incomes, is the way to balance the nation’s books; and on the only measure of success being growing GDP and not including measures of well-being and fairness as part of growth.

I see very little in the Queen’s Speech that will get under the skin of these issues and tackle them in the sustained way that is required. Slogans such as the vacuous “levelling up” are not going to solve the issues —the same as with the previous slogan of the “northern powerhouse”. Fundamental changes to government need to take place, including stopping ministries working in silos, believing they have the power, through structural change, to improve people’s health and well-being. This means a more federal way of governing the UK, including England, so innovation and creative local solutions are delivered to deal with long-standing local and regional issues, backed up with significant fiscal resources and flexibilities. It also includes how we measure the success of the nation. It cannot be all about GDP but needs to include measuring fairness and well-being for the areas and people of the UK.

The life chances and life expectancy at the end of that six-stop bus journey will be the real indication of success, not new slogans or reorganisations of the NHS.