NHS and Social Care: Winter Service Delivery

Lord Smith of Leigh Excerpts

Thursday 25th January 2018 Lords Chamber

[Lord Smith of Leigh (Lab)]

My Lords, I too welcome this timely debate, which has been initiated by my noble friend. I declare an interest as yet another vice-president of the LGA—that makes three of us so far, and our president has spoken. I am also leader of Wigan Council and chairman of the Greater Manchester Health and Social Care Partnership, so I can see these issues from both sides—although whichever way you look at them, it is not a pretty sight.

Reading in the press about the daily problems in A&E, it is tempting to talk about a winter crisis, as many noble Lords have done, but like the noble Lord, Lord Kerslake, I think that this is not a winter crisis but symptomatic of the general crisis in health and social care. Fundamentally, it is caused by the ageing population—which should come as good news in your Lordships’ House: we can live longer—but obviously that puts pressure on both the health and social care sectors. We have not commensurately increased money for the health service to reflect the increased pressure that comes with an ageing population, and in social care, as we have heard, there has also been a reduction. Although noble Lords have concentrated on the revenue side, it is also true of the capital side. To refer to one example, Watford General Hospital was built and designed to take 45,000 to 50,000 admissions per year. It currently deals with 90,000. Is it remarkable, then, that it has had to use corridors and other places to deal with admissions?

Workforce issues are key in the NHS. Although we know that the NHS suffers shortages generally, it is particularly true in A&E, which is not the most popular area for people to go into. It has been said that we are 2,000 consultants short in A&E, and of course the numbers in nursing are going down too. As we saw in the report last week, the numbers leaving the nursing profession outweigh the numbers going in. Although that is caused by a great number of factors which I will not go into, it puts severe pressure on those who remain. Finally, there is a lack of integration between health and social care.

Now that the Secretary of State has acquired an additional title he will discover that funding is the most fundamental issue he faces in social care. Colleagues have talked about the quantum of money. That is important but we should also remember to ask who will pay for social care. The Tory party made a bit of a mess of it in the last general election when it tried to talk about how much individuals should contribute to social care. The Tory party is very unclear on that point. In the short term, the Government have tried to put more of the burden of paying for social care on to local taxpayers: instead of putting up general taxation, they have put up local taxation. The noble Baroness, Lady Pinnock, mentioned one aspect of the regressive nature of council tax. I could spend all of my allotted time here or longer talking about reforming council tax—a subject referred to by my noble friend Lord Desai. It is something that I have long advocated.

The other issue is that the council tax situation between local authorities is unfair. For example, many northern authorities like mine have more properties in the lower tax bands than do other places. Therefore, a 1% increase in council tax gains six times as much in Richmond and five times as much in Windsor and Maidenhead as it does in my authority. We might say, “Well, we’re all giving 1%”, but that 1% raises very different amounts of money, and that cannot be justified.

Although health and social care needs more money, the fundamental problems are such that we cannot just put more money in. We need to change the NHS from being an ill-health service, which, on the whole, it does pretty well, to a proper health service. I wonder whether anyone has read the recent report on children’s dental health. We are spending money on repairing and replacing children’s teeth instead of simply getting them to clean their teeth. Yesterday’s Times reported on lifestyles which are likely to cause long-term problems. People will be four or more times likely to develop chronic conditions by the time they get to 65, and that will mean more pressure on the NHS. Unless we put more effort and energy into prevention and early intervention, the extra demand will eventually overwhelm not just the NHS but government overall.

I do not want to end on too desperate a note—there are reasons to be cheerful. In my authority, the use of transformation funds from Greater Manchester will make a difference. We are working to keep lots of vulnerable people in care homes. We have a 180-bed care home which we think has saved 36 people from going to A&E. We are also working with GPs, many of whom have to deal with what are really non-medical issues, such as housing problems, fuel poverty and loneliness. Those are issues where GPs try to provide medicines but those are not the answer. We need to turn the system around. That is a real challenge and we need real leadership to do it. I hope that the Secretary of State is up for it.