NHS: Targets

Lord Suri Excerpts

Thursday 6th February 2020 Lords Chamber

[Lord Suri (Con)]

My Lords, I am grateful for this opportunity to consider opportunities to improve the NHS and get waiting times down. I thank the noble Lord, Lord Hunt, for securing the time for us to discuss these issues.

There is little doubt that outcomes in the NHS have been slipping. In particular, NHS England has under- performed on the four-hour accident and emergency waiting time target for some time and November saw the worst performance since records began. Some of the issues driving this are essentially secular and will not simply dissipate. This is in no way due to the NHS staff, who always impress me with their attention and care.

There is a general understanding that the greatest pressure on the NHS is the increased care burden of an ageing society. This comes across in higher numbers of operations, but nowhere more so than in adult social care. Without better social care provision, the elderly will continue to recover in hospital rather than in the community and waiting lists will increase. Adult social care has become a lingering issue that previous Governments have been unwilling or unable to address. When a new funding system was proposed in 2017, the policy had to be walked back within a few days. This underlines the weakness of creating a lasting settlement without some sense of cross-party approach. Indeed, to create institutions that last there needs to be an understanding by all parties that the need must be met, as occurred at the founding of the NHS itself.

It is for this reason that I welcome the second of the Government’s points for the forthcoming social care proposals, to

“urgently seek a cross-party consensus in order to bring forward the necessary proposals and legislation”.

I hope that all English opposition parties will recognise that this is an existential issue and play a constructive role in shaping a lasting consensus. For many in opposition, this is a real chance to leave a legacy not normally achievable for parties out of power.

The real issue to resolve will be funding a more extensive care system. The sums involved are substantial but the gains must be remembered. Shorter waiting lists, more available beds and fewer unpaid carers will make a large combined contribution and free up some capacity in the public and private sectors. The Government have committed to making sure that nobody will have to sell their home to afford care. This is a sensible first step, but there must be an equitable element to the system.

The Barker commission gave serious thought to making those above pension age pay national insurance contributions and Sir Andrew Dilnot suggested to the Economic Affairs Committee of this House that the current exemption was a “major distortion” in the tax system. The exemption should be reviewed, alongside the current range of pension benefits, which may need to be means tested to deliver additional savings, including the winter fuel allowance.

Ultimately, without increased contributions from the elderly, any new system will be doomed to unsustainability as the proportion of working-age citizens to retirees increases. Other forms of wealth taxation will also need to be explored, including higher capital gains taxes on transfers of wealth. It will not be easy, but I am convinced that with a collegiate attitude and a real effort, a path forward is possible.