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

Lord Suri Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Suri (Con)]

My Lords, this is a valuable and important report, which gets to the issues that we must start to grapple with if we want a decent National Health Service to hand over to future generations. The noble Lord, Lord Patel, and the committee he leads have done an excellent job and his vast experience in the NHS has clearly shaped the recommendations that it makes.

I have often been a critic of the way some departments are structured and how spending is delivered to priority areas. It often seems to me that government struggles with long-term funding for areas that are not specific projects with their own funding framework. This report picks up on an endemic culture of short-termism in the NHS. From adult social care to the public health budget, those responsible are sometimes more concerned about next year’s figures than the overall picture over the medium term. This is not to disparage the excellent and valuable work of all our NHS staff, but is rather a reflection on the current NHS structure. I am therefore heartened to read about the five-year plan proposed for NHS funding.

In any business or service, planning year-by-year would be seen as inefficient practice, especially so when the recipient is being treated over a far longer period. In my view, the greatest current failing of the entire system is in adult social care. The fact that adult social care falls to local councils is a consequence of the Poor Laws and the end of workhouses, and seems outdated in the current context. Delayed discharges are one of the most significant factors that put pressure on the health service, but a lack of joined-up thinking and planning makes it harder for an effective policy solution to be found, although I welcome the additional £2 billion earmarked in the Spring Statement. Councils are not naturally suited to managing complex residential needs, and the obvious overlap between recipients of adult social care and NHS services suggests wide scope for efficiencies to be found. If not a full merge, some sort of shared responsibility must be a top priority, and I am glad the Minister has committed to such a policy.

One area that concerns me is the lack of engagement with the public for some of the new sustainability and transformation plans. Local communities deserve and ought to receive proper consultation on transformations to services in their areas. Failing to engage meaningfully is an own goal when communities are willing to help and can provide valued input or insight. STPs have no statutory footing, which is part of the problem. A statutory duty to engage local authorities at all stages of the planning process seems a sensible update to the existing framework. Do the Government have any plans to place the STPs on a statutory footing, and if so, will there be a duty to seek engagement from local stakeholders?

Finally, I am glad that the Greater Manchester agreement will allow for some experimentation in what works in social care. Devolution allows greater flexibility and allows us to see what works best. I hope that this new partnership finds some ways to make social care more efficient, and that any lessons learned are recognised at the national level.