Health Workers: Training
Lord Turnberg Excerpts(8 years ago)
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Lord O'Shaughnessy
The Prime Minister has been incredibly clear on this point—and was again yesterday. It is our intention to do so, and to agree that early with our EU partners. But that is something that needs to be reciprocated.
Lord Turnberg
My Lords, we certainly need more doctors and nurses. The problem is that we are not retaining as many as we should, and there is no doubt that they feel denigrated and devalued. They really need to feel appreciated rather than kicked around all the time. Are the Government going to help them in any way whatever, or are they going to be constantly criticised?
Lord O'Shaughnessy
I do not believe that we are criticising. To take the noble Lord’s point, he is right that there is often negativity in the media about the performance of health professionals. But it is worth pointing out that in a recent poll earlier this week, those who believe that the NHS provides a high standard of care is now at 71%, up 13% since 2013. That is a huge testament to the amazing work that our NHS does.
Health and Social Care
Lord Turnberg Excerpts(8 years, 2 months ago)
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Lord Turnberg (Lab)
My Lords, I also congratulate the noble Baroness, Lady Finlay, on securing the debate and giving us this opportunity in her usual clear and erudite manner. I refer noble Lords to my interests in the register.
It is pretty obvious that the noble Lord, Lord Hunt, could not be here today. I am sure he is almost as unhappy as I am that he is not here, but this has been rather a depressing debate. Of course, this is not the first time we have had a debate on this topic. When we had our earlier debate in July, the noble Lord, Lord Prior, suggested that we should have another debate in three or four months’ time, when he must have presumed that we would have more clarity on the Government’s thinking. I therefore very much look forward to hearing what he has to say today.
Two messages are clear from virtually every noble Lord who has spoken. First, the NHS and social care are in dire straits. Every report we see and everything we hear from people working in these services say the same thing. Even the National Audit Office and the Public Accounts Committee say that we cannot go on as we are. The Chancellor did nothing yesterday to offer any relief.
On top of that, we are threatened by the possibility of losing the support of our EU immigrant staff on whom we rely so heavily—a double whammy. Everyone who has spoken today, and everyone both inside government and outside it, say the same thing: that these staff represent an invaluable asset and provide vital support for the NHS and social care.
I sit on the Select Committee on the Long-Term Sustainability of the NHS. While the ostensible purpose of that committee is to gain an idea of what the future will bring for the NHS in 20 or 30 years, we have been unable to get any of the innumerable witnesses who have come before us to engage in anything but the immediate problems they face today. They are entirely taken up with how they are going to survive this next year and cannot lift their heads up from firefighting today.
I shall not reiterate the catalogue of uncomfortable data that we have heard today which emphasise the size of the problems we face, save to mention just a couple of the most glaring facts. My noble friend Lord Lipsey spoke so clearly about social care, where the 25% cuts that we have seen over the past few years are causing the most acute problems. According to Age UK, 1.8 million elderly people are not receiving the care they need—the noble Baroness, Lady Brinton, spoke of 1.2 million; I do not know which figure is right, but both are awfully large numbers.
Last week’s debate in the other place spelt out in unhappy detail the dire problems due to the cuts in local authority funding. Now the CQC and the Local Government Association talk of social care services being at “tipping point”. In the NHS, eight out of 10 hospitals say that they cannot ensure a safe rota of nurse care throughout the day and night. The Royal College of Paediatrics and Child Health tells us that it cannot fulfil its rota arrangements as its paediatric vacancy rates rise. Everyone, from the royal colleges, the King’s Fund, the Nuffield Trust and now even the GMC, is warning of the impact of the cumulative shortfall on standards of care—the noble Lord, Lord Warner, laid it all out in depressing detail.
This week, I met a young doctor working in a large London teaching hospital who told me that he had just spent a 10-hour stretch without a break in the A&E department. When I asked him how many of the patients whom he saw did not need to come to that department, he said that the great majority should have been dealt with by their GPs if only they did not have to wait a couple of weeks for an appointment. What a sad state of affairs. Now the public are waking up to the problems, as newspapers begin to show pictures of queues of patients lying waiting for hours on trolleys in A&E departments.
It is against that background that we have to face the possibility that 5% or 10% of the workforce might be lost if we do not take action to prevent the potential damage of Brexit. We have heard the figures: a vulnerable 5% overall and a particularly severe impact in London and the south-east, where 10% of the workforce are EU immigrants. The figures are frightening. In London, more than 40% of social care workers are immigrants. In nursing, already with 23,000 vacant posts, they are desperate to reassure and retain the 33,000 nurses trained outside the UK who now feel rather insecure. Midwifery is no better off. A striking example of its vulnerability is UCH, 32% of whose midwives are qualified in the EU outside the UK.
Among the 30,000 doctors on the UK medical register and who qualified in other EU countries there are many vulnerable specialties such as surgery, psychiatry and so on. There is a particular case in the large teaching hospitals that are so attractive to academic clinicians from abroad. Overall, 15% of academic clinicians in our hospitals qualified in the EU. They can go almost anywhere in the world to work. Will we be able to keep them here and will we continue to attract a continuing stream of them? We will certainly be at a disadvantage if we lose our capacity to attract them. The noble Lord, Lord Bilimoria, spelled out the need for scientific collaboration.
We have heard all sorts of encouraging words from the Secretary of State, the Prime Minister and the noble Lord the Minister about how much they value the contribution of our immigrant staff and how important it is to reassure them that their future is safe. However, there remains considerable uncertainty in the minds of many and this perception is not helped by the way that the Government keep their negotiating cards so close to their chest. There is a feeling among our own EU staff that they are being used as bargaining chips in the negotiation to strengthen the position of UK expats living in other EU countries—that if they can stay there then we can allow EU healthcare workers to stay in the UK. That may be a cynical view and it will probably be denied, but that is certainly one perception that is difficult to dispel.
Let me briefly outline a couple of other areas of concern. First, in public health, we rely on the European Centre for Disease Prevention and Control to work closely with our own Public Health England laboratories for the rapid detection of outbreaks of infectious diseases and the sharing of information about them. As the noble Baroness, Lady Finlay, said so powerfully, infections, unlike immigrants, know no borders, and we can ill afford a barrier to the flow of information. What discussions are being held to ensure that we can maintain this vitally important link?
I mentioned the need to attract academic clinicians, but what is the Government’s plan to deal with the fall-out when the European Medicines Agency moves out of the UK, as is now inevitable? We will certainly lose jobs, but currently we have very close and invaluable access to the EMA by industry and researchers engaged in clinical trials. This will be lost unless we can make special arrangements. What thoughts have the Government given to dealing with this problem?
The European working time directive has had its critics, but its aim to improve the health and safety of our staff should not be readily jettisoned. Will we be able to retain it or something similar?
Several other actions the Government could take might offer some mitigation. For a start, they could certainly be more open about their intentions for this particular group of workers. The suggestion that they do not want to reveal their negotiating hand too early really does not wash. Surely starting with a strongly stated and clear position on what we require can only strengthen our position.
What about the status of the Migration Advisory Committee? I understand that it maintains a shortage occupation list that provides for certain groups of staff to come to work in the UK from abroad, and that this includes nurses. Will the noble Lord consider the prospect of expanding that committee’s list of permitted staff to include a range of threatened and vitally important NHS staff?
To reiterate the plea from the noble Baroness, Lady Finlay, about the Medical Training Initiative that we currently operate for non-EU specialists to come to the UK for two years’ training before they return home, is there a prospect for that scheme to be expanded to incorporate EU doctors across all specialties?
As far as doctors and nurses already here are concerned, can the Minister confirm that if they are now on the register they will continue to be recognised and as a result will be able to continue to work here? That would go an enormous way to reassure them. There are many steps the Government might take to reassure both our services and our immigrant staff. I hope that the noble Lord, Lord Prior, will be able to offer some comfort.
Bread and Flour Regulations (Folic Acid) Bill [HL]
Lord Turnberg Excerpts(8 years, 6 months ago)
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Lord Turnberg (Lab)
My Lords, the usual folate aficionados speaking in this debate do not need me to talk about all the nasty effects of neural tube defects, spina bifida and the impact on children’s lives and that of their parents, or repeat that folic acid given early in pregnancy is an extraordinarily effective preventive measure akin to vaccination and immunisation. There is no argument anywhere against that. We also know that if it is to work, folic acid must be taken before a woman knows she is pregnant because the neural tube forms in the first 28 days. Taking it when she confirms that she is pregnant is just too late. All that is accepted.
The argument for fortification has been made many times and, indeed, as we have heard, has been accepted in very many countries. Now many millions of people across the world have been eating bread made with fortified flour for very many years, and it seems that Scotland is about to follow. So what are the arguments against fortification in the UK? These rely on two major premises. First, this would be a case of mass medication and we should avoid that whenever possible. That is not unreasonable. It is a type of philosophical argument about free will and freedom of choice, and I understand that. However, I cannot accept it in this case. We already fortify our flour with iron, calcium and Vitamin B1—thiamine—without a peep from anyone.
I hope that I do not offend noble Lords if I say that I have just had a sandwich in the Bishops’ Bar, and that I do not scare them when I tell them what was in the sandwich. In the white bread there was some wheat flour—that was useful—with added calcium, iron, niacin and thiamine. There was water, yeast, salt—that is reasonable—emulsifier, E472e, soya flour, preservative, E282, rapeseed oil, flour treatment agent—whatever that is—and a smidgen of E300. We add these things, and many others, despite the fact that the case for these sorts of fortification, especially of vitamin B1, are not nearly so compelling as that for folic acid. Vitamin B1 deficiency was something we saw in concentration camp victims. In normal life and normal diets, it is as rare as hen’s teeth. Folate deficiency, on the other hand, is common, and its potential to cause devastating disease is there for everyone to see and accept.
The second argument against fortification is that folic acid, when taken in excess, can cause unpleasant side effects. That, too, is a rather specious argument. The amounts we are talking about, and the form in which it is added to flour, have been shown to be perfectly safe. Just look at the control trial in which the whole population of North America—many millions of people—took fortified flour for 10 or more years. You might have expected some of the threatened changes and dangers to have emerged, but there has been none. Large doses of folic acid may possibly be problematic, but then large doses of iron are also dangerous, yet we have carried on with iron fortification. Large doses of almost anything are dangerous. However, what we are talking about here is a small dose—a minute dose—that would pose no conceivable danger to anyone else and would prevent a very nasty disease.
I strongly support this Bill and am grateful to the noble Lord, Lord Rooker, for his persistence and tenacity. I hope that the Minister will think again about this whole thing.
NHS: Junior Doctors’ Contract
Lord Turnberg Excerpts(8 years, 6 months ago)
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Lord Prior of Brampton
Safety was clearly a major consideration in the minds of junior doctors when the original contract was negotiated, but the leadership of the BMA agreed with us that their safety concerns had been fully taken into account in the new contract. As far as numbers of doctors are concerned, we have plans to train a further 5,000 GPs over the next four years, but unquestionably there are gaps in many rotas around the country, and we do rely heavily on doctors from overseas to fill those gaps.
Lord Turnberg (Lab)
There has been much made of the fact that the junior doctors are extremely disillusioned. I think that is undeniable. It is perhaps not so well recognised that “junior doctors” includes a large number who are well into their 30s, who are very well trained and on whom the NHS relies entirely.
Lord Prior of Brampton
One fact that has come over very loudly to me during the past year is that the whole definition of “junior doctors” is an absurd one. Many junior doctors have been in training for many years and we rely on them to deliver much of our front-line care. It is just another reason why it is so important, as other noble Lords have mentioned, that we rebuild the trust of junior doctors.
NHS: Bursaries
Lord Turnberg Excerpts(8 years, 8 months ago)
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Lord Prior of Brampton
My Lords, the reason for the discrepancy is that at the moment the bursary system effectively caps the number of student places for nursing. One of the purposes of moving to the loan system is to remove that cap and our estimate is that by so doing an additional 10,000 places will be created between 2017 and 2020.
Lord Turnberg (Lab)
My Lords, if you go to any nursing graduation ceremony you will see lots of 30 and 40 year-old women who have been carers and who now wish to retrain as nurses. This is a very valuable asset for the health service, and yet they are just the people who may be disenfranchised by this policy. Is it not crazy to do this?
Lord Prior of Brampton
My Lords, the loan will be available to mature students as well as to students taking their first degree. The loan structure is such that if someone will not be working for as long as a younger nurse they will not in all likelihood repay the whole of the loan, which will be written off at the end of the period. I agree entirely with what the noble Lord says; we depend heavily on mature students coming into nursing. Our view is that this will not put off those people.
Health: Neural Tube Defects
Lord Turnberg Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
My Lords, I cannot answer the latter question, but I will try to find out and write to the noble Baroness. She is right that Scotland is considering this and looking at the practical issues around implementation. She is right that other countries in the world—I think 50—have done this, but many others have not, including all European Union countries.
Lord Turnberg (Lab)
My Lords, I realise that the noble Lord is in the hands of his scientific advisory committee and cannot say anything without it, but I ask him to draw to its attention the fact that it may be using outdated research evidence if it believes that adding the small amounts of folic acid to bread has the same metabolic effect as taking 1 milligram of tablet a day. It does not. The very remote possibility that there is danger in taking 1 milligram of tablet a day is eliminated completely if you add it to food and take it during the day. Will he draw that to the committee’s attention and ask it to think again?
Lord Prior of Brampton
I will certainly draw that point to the attention of the SACN. It would be surprising if it was not already aware of that fact, but as I said I am addressing not really the science but whether it is right or proportionate to fortify bread for everybody to reach such a small number of people.
General Practitioners: Appointments
Lord Turnberg Excerpts(8 years, 10 months ago)
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Lord Turnberg (Lab)
My Lords, I am extremely grateful to the noble Earl, Lord Attlee, for bringing this important subject to debate. I fear that it is now widely acknowledged that the situation in primary care is dire. However, I have to say that my own general practice seems to be an exception; perhaps because it is in leafy Hampstead, perhaps because it has enough partners and staff to withstand the buffeting of the rest of the NHS, and perhaps because it has such excellent leadership. Or, most likely, because it has all three. Elsewhere, in much of the country, general practice lacks all three and the picture is less than rosy. Many practices are small, with two or three partners, and if one goes off sick, retires early or goes abroad, the remaining one or two are stuck in an almost unsustainable situation.
One young GP I know is struggling with just such a burden. She is about to lose her partner, who is retiring early, and she is now running her practice with little or no support. She is finding it impossible to attract any staff to join her and cannot find another GP to come into her practice. There are just too few around who want to work in a less than affluent part of London, despite the Government’s blandishments. It is very hard for her to find other staff too. Meanwhile, she is running around, sitting on committees and the local CCG, as well as dealing with the mound of NHS-inspired paperwork and trying to look after her young family at the same time. Working from eight in the morning until eight at night is an impossible burden to place on anyone. I fear that that is the experience of far too many GPs and it is not much wonder that too many are leaving early and too few are willing to join.
It is absolutely vital that the Government rethink their efforts to encourage and support GPs. Whatever they are doing now is clearly not working properly. Of course, every area of the NHS is suffering from underfunding but primary care, once the beacon of the service, is now merely a flickering candle. If there is anywhere that the NHS needs to see reignited, it is primary care. Of course, a move to larger group practices, with added support, where that can be achieved, would help. But too many practices are too small at the moment. Some GPs gain comfort from being salaried rather than self-employed. That at least cuts down their administrative burden. If it can be made a more attractive option—something the Government might pursue—it offers advantages to some.
Finally, I will say just a few words about research in primary care. I express my interest as scientific adviser to the Association of Medical Research Charities, an organisation whose member charities well understand the valuable role that GPs can play in research. But at the moment too many GPs are so stretched and overworked that there is no way that they can even think about research in the face of everything else they are asked to do. If we are to achieve what Ministers, the Chancellor and even the Prime Minister have spoken about, which is to embed research in the NHS as a major function, and if we are to see what is mandated in the Health and Social Care Act 2012 on making research an inextricable part of the NHS, we are going to have to give GPs all the support necessary for them to be able to fulfil their part. We are still way off that and if, as I understand it, NHS England has not even signed off its research strategy for last year, never mind this year, what hope do we have that we will see any change here? Is there anything the Minister can do to persuade NHS England to do more to support research in primary care and, incidentally, stimulate it into publishing its long-awaited research strategy?
To return to the main thrust of my remarks, is there anything the Minister can do to persuade the Government to look at how we can get general practice out of the black hole it is heading for before it is too late?
E-cigarettes: Regulation
Lord Turnberg Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
My Lords, as I said, these new products are not perfect but are substantially better than smoking cigarettes. One of the purposes of the new directive is that there should be proper labelling on the products.
Lord Turnberg (Lab)
My Lords, the noble Lord dismissed the idea of an excise tax, but there is a strong rumour that the EU intends to impose a tax on these products. Will the Government do everything they can to counteract this counterproductive suggestion?
Lord Prior of Brampton
My Lords, as I said, there is no proposal for an excise duty as part of the tobacco directive, as I understand it. I would agree entirely with the intent behind the question, which is that we should be promoting this product not discouraging it.
NHS: Junior Doctors’ Pay
Lord Turnberg Excerpts(9 years ago)
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Lord Turnberg (Lab)
Is not the reason why young doctors and not-so-young doctors are threatening to go on strike not so much the pay but because this is the last straw in a continuing series of alienation, and of feeling undervalued and underappreciated by the management from the Secretary of State down?
Lord Prior of Brampton
I agree. I do not think that this dispute is fundamentally about pay; it is much more profound than that. It is about a feeling among many junior doctors, which is shared by many senior doctors as well, that they are not properly valued and fully appreciated. That is the underlying cause of the problems we are facing.
National Health Service
Lord Turnberg Excerpts(9 years ago)
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Lord Turnberg
That this House takes note of the ability of the National Health Service to meet present and future demands.
Lord Turnberg (Lab)
My Lords, I am extremely grateful for the opportunity to open this debate and delighted that so many noble Lords have agreed to speak. I very much look forward to the maiden speech of the noble Baroness, Lady Watkins of Tavistock. I am only sorry that speakers have only three minutes to express their views.
It seems entirely possible that one or two noble Lords might draw attention to the parlous state of funding of the NHS. They may even echo Matthew Parris when he wrote:
“Our health service is heading, if not for the rocks, then for the sandbank of chronically sub-optimal performance and monthly threats of insolvency”.
It is tempting to say that this cannot go on. But of course it always does, because of the people in it—the nurses, the doctors, the physios, the porters and so on—who work their socks off to do their very best, despite the lack of resources. They regard it as a privilege to work in a service that aims to care for people and their ills, as indeed did I during most of my working life. When the NHS works well, there is nothing quite like it and the public know that. But when staff morale is at a low ebb, as it certainly now is, and when we have a Secretary of State who seems quick to lay blame but is quite incapable of showing the least sign of appreciation of the staff, then that impacts directly on patient care.
I would not want to be ungrateful for the bit of light relief provided by the Chancellor in the recent spending review, even though that was partly achieved by robbing the budgets for public health, education and NICE. It is hard not to feel, as do the Health Foundation and the Nuffield Council, that this is just another emergency bailout—a temporary fix—when the basic underfunding continues apace as the NHS tries to cope with an ever increasing demand. Having said all that, I hope that I do not disappoint the Minister if I say that I will not be taking that line, at least not yet. What I want to do is to lay out what would be an ideal system for providing total care for the population in the community and in hospital. None of what I say will be entirely foreign or original. Perhaps you know what they say about originality: it is the art of concealing your sources. My sources will be obvious.
The ideal service would have to be completely joined up, with social services, general practice and hospital care integrated. That is so often talked about but rarely achieved because it requires the integration of management and, often, the budget. The silos of primary and secondary care would disappear as GPs were able to work as a team across the divide, in and out of hospital, perhaps even under the same management. This may be a pipe dream, and many—perhaps most—GPs would object, but enough may see the advantages, especially now when they are under such unsustainable pressure that so many are thinking of giving up. Health visitors and district nurses, as well as social workers, could be employed by the hospital so that they could be completely integrated. They would be able to see their patients in hospital as easily as in general practice and the community, without this delaying referral system we have set up.
We had a debate before Christmas about the problems of the care home sector. A number of significant private providers are threatening to go out of business with the potential loss of a large number of care home beds. Currently, about one-third of acute hospital beds are already occupied by patients who would be better cared for in the community. Even more pressure may be put on those beds as care homes are lost.
Would it not be much better if hospital trusts opened their own care homes? A bed in their care homes would cost them about half what a hospital bed costs them, and the trusts would save money and beds—a no-brainer, you might think. Your Lordships may ask where these care homes might come from, but most trusts have obsolete stock that could be rescued, and what about the homes that private providers may vacate? It would need a little capital, but the potential rewards are enormous.
What about those isolated mental health services? At the moment they are far from providing the equity of esteem with physical illness services that everyone talks about. Would they not stand a better chance if they were more joined up with other health services?
There are two other elements in this brave new world that I should touch on briefly. First, why do patients who need to be checked up from time to time by their consultant always have to spend hours travelling to and from the hospital and waiting to be seen? Consultants and patients have telephones, for heaven’s sake. We could do much more if we could get round the tariff system that rewards hospital trusts for out-patient visits but not for telephone calls. The noble Lord, Lord Prior, and I have discussed this before. We are making nowhere near enough use of IT, the internet, remote monitoring devices built into vests and so on. Patients deserve much better.
The other area I should briefly mention is medical research. I should express my interest here as scientific adviser to the Association of Medical Research Charities, which puts around £1.3 billion a year into research. Research should underpin our integrated NHS, and we must take advantage of our excellent basic research capacity and link it with our unrivalled access to the whole NHS population. It is worth remembering that about 50% of our increasing lifespan is the result of advances gained from research.
I suspect that noble Lords will have noticed that much of the full integration I have described requires local authorities and hospital trusts to agree to a single management system and, where possible, a merged budget. That is something that has eluded successive Governments for ever, it seems. What about the idea of patients being given their own personal budgets, which could ease the transition? Perhaps the Minister could say where we have got to with that.
It is not difficult to see why there is resistance. Social services and GPs are reluctant because they see their precious limited resources being used to prop up the hospitals, while the hospitals have historically seen themselves as providers of acute care and only reluctantly as having a responsibility to the community. It does not help when both are financially squeezed. So is it an impossible dream? It seems to me that we do now have an opportunity to go some way along that route, with increasing recognition by all parties that they cannot go on as they are. It will be difficult, but I did not just dream up these ideas.
We have had excellent example of good practice around the country in Torbay and a number of other places for ever, it seems. But most of my ideas have emanated from Salford Royal Hospital, where David Dalton, its chief executive, has already set up much of this integration and has agreement for more. Here I must admit to some pride in speaking about that hospital, because it is where I spent most of my working life as a professor and consultant. It used to be called Hope Hospital, and has obviously taken advantage of my leaving to do great things.
The hospital trust has been employing its own health visitors for some time. It even has two general practices in its employ, one providing out-of-hours services and the other with responsibility for looking after all the residents of care homes in Salford—both in addition to their normal practice.
Incidentally, all 49 of the other general practices in Salford are linked into the hospital’s electronic case records system. The hospital is now virtually paperless, and GPs and hospital staff have access to all the clinical information about their patients wherever they are. From April this year, agreement has been reached between the trust and the local authority that adult social care, including domiciliary and residential care, will come under the trust’s management with a merged budget—remarkable. Perhaps equally exciting is the fact that the mental health trust will in April be contracted through the new single integrated care organisation, a chance to see much better cohesion between mental and other services.
Salford Royal no longer sees itself as simply a hospital but as part of the community for which it provides for the health and care of all of Salford’s 250,000 residents. All those remarkable developments have been possible only because of inspired leadership in both the trust and the local authority, and it has taken many years of patient negotiation between them, and much legwork with the GPs. Salford is of course a nice, circumscribed, if deprived city which sees itself as progressive, and it has the big advantage of having just one CCG.
None of that has required another health Bill to reorganise or, as Ray Tallis has put it, to redisorganise the service. I have lived through no fewer than eight NHS Bills during my 16 years in this House; that is one every two years, and we certainly do not need any more. I have spoken about the Salford experience because that is what I know best, and it may well not be replicable everywhere else, but Sir David Dalton’s report for the Government of a year ago presented a series of different ways in which closer integration has been able to occur. It does not have to be the hospital trust that manages the budget. It could, for example, be some form of unified joint management system. Much more important is inspired and inspiring leadership—not available everywhere, I fear. It has been that leadership that has produced the essential elements of team-working together, with all members feeling appreciated for doing a good job. That is something that the Government could take to heart.
We have heard about the 25 so-called integration pioneers that NHS England talked about last year. Can the Minister update us on them, and on the pilot schemes in east London announced recently? Then there is the much heralded devolution of budget to Greater Manchester, of which Salford is of course an important part. That is clearly the route that the Government want to take, but therein lies the rub. First, in devolving responsibility, the Government get themselves off the hook if things go wrong. That is what devolution means.
Secondly, merging two inadequate budgets by itself may improve efficiency but is unlikely to be sufficient. It would be a huge blow to the Government’s devolution agenda if Greater Manchester failed for lack of funds. It would mean a big step back for the integration that we desperately need and would put off anyone else thinking of taking the same route. It is inevitable that money must come into it, and, to their credit, the Government have recognised that and have now agreed to provide transitional funding for Greater Manchester of £450 million over four years—just over £100 million a year. Whether that will be sufficient remains to be seen, but it is undoubtedly helpful and should be welcomed.
Although it is good to know that the Government are aware of the need for some temporary funding, there remains the more serious, longer term sustainability of the NHS and, in particular, social care. Almost everyone recognises that the UK spends one of the smallest proportions of GDP on health of almost all European countries: about 6.5% of GDP, compared to an average within the EU of about 9% or 10%. Social service funding is even worse off. All of that is in the face of increasing demand from an ageing population and a frightening increase in the number of patients with dementia. Almost every day we read in the papers of yet another failure or crisis.
We can become more efficient, and I have tried to indicate one way that we might be able to do just that, but short-term injections will not be the solution. We must find a way to provide a more sustainable level of funding to bring our services up to the standards of our neighbours in Europe. It is true, as Mark Britnell describes in his book, In Search of the Perfect Health System, that nowhere in the world has a perfect system, and many Governments struggle. But that is no excuse for starving our own service and having to accept an increasingly inadequate level of health and social care. If we are to gain the advantages of integration that we can clearly see in a few places, we must have the sustainable resources to do it. Of course, there is a separate debate to be had about how we fund our health services, which is something for cross-party discussions, royal commissions and so on, and I do not want to get into it today, although I suspect that other noble Lords may do so.
Meanwhile, the Government must get into the habit of valuing their staff and not blaming them; they must try to show that they are supporting and not confronting nurses and doctors all the time. I am sorry to end, as I started, by decrying the low level of government funding and criticising their attitude to NHS staff, but I do so only against the background I described of what it is possible to achieve by an efficient system of integration. Mark Britnell in his book finds that the most important reason why people are proud to be British is the NHS. Its fairness and accessibility to everyone, regardless of ability to pay is a precious resource, and we must not let it fail.
Lord Turnberg
My Lords, it has been a fascinating debate and I am grateful to all speakers who have participated in it. It is amazing how much information people can pack into three minutes. It has been very helpful. I was bowled over by the maiden speech of the noble Baroness, Lady Watkins.
There is no way in which I can summarise the debate in no time at all but one or two themes have emerged. Everyone agrees that we should focus to a greater extent on prevention. That makes it seem even more ridiculous that we are cutting funding for public health at this time. Most people agree that there is a need to integrate services across the social care/hospital divide, and most people feel that we should begin to appreciate our staff to a much greater extent than we do. To alienate them at a time when we need them so desperately is counterproductive.
On the point that we are seeing a rise in demand and the costs of healthcare, I detected more than a hint from the noble Lord, Lord Prior, that he might believe that the spreading of good practice—there is all sorts of good practice around—and increasing efficiency will solve the funding crisis. I suspect he is the only speaker in the debate, on either side of the House, who believes that. It focused the minds of most people on how we fund the gap.
If one thing has come out of this debate it is that we have begun to think about how—
The Deputy Speaker (Baroness Stedman-Scott) (Con)
My Lords, the time allotted for this debate has now elapsed. I must now put the question that this Motion be agreed to.