Care Services: Elderly People

Lord Warner Excerpts

Wednesday 6th March 2013 Grand Committee

[Lord Warner]

My Lords we are all grateful to my noble friend for securing this debate and for his usual masterly introduction and analysis. Whatever our views on the right size for the total health and social care budget, it will always have a cash limit and, in the long period of fiscal austerity we face, that limit will be very constrained. That makes it imperative that we get our expenditure priorities right, especially in relation to the NHS. Our failure to do this is damaging care of the elderly at a time when we are all living longer and, on present demographic evidence, will continue to do so. The number of over 85s will double to 3 million by 2030, with increasing numbers suffering from dementia, as my noble friend has mentioned.

I will confine myself to three strategic points. First, we may be living longer but we are not living healthier lives when compared with many other affluent countries. We are 12th out of 19 such countries, according to a recent study by the Institute for Heath Metrics and Evaluation in Seattle. We can expect in this country 68.6 years of healthy life from birth before disease and disability take their toll. This compares with 70.9 years for Spain, which is top of the pops. Better healthcare is unlikely to change our position much, but a higher priority for expenditure on public health and prevention services is more likely to do so.

Secondly, the balance of what we spend on the NHS and social care is fundamentally wrong for our demographic and disease profile. Under successive Governments we have overfavoured the NHS and have neglected adult social care. There is, however, an opportunity to change this with the proposed Care and Support Bill, now undergoing pre-legislative scrutiny. Here I declare my interest as a member of the Joint Select Committee that will report shortly. That Bill has received a wide measure of support, publicly and politically, especially for its provision for an overarching principle of securing well-being for the recipients of care and support services.

We will no doubt debate the committee’s findings another day. All I want to do here is register the widespread concern that exists that the Bill’s reforms, including the Dilnot changes, will not be adequately funded because of the existing shortfall in funding that has developed over the years. I do not blame this Government particularly for that. In my view, that shortfall now stands at about 10% of the adult social care annual budget, or approaching £1.5 billion, and I suggest it is growing despite the Government’s partial efforts to close the gap. We must not pass a reforming Bill without appropriate funding to implement those much needed changes.

Thirdly, and finally, we need to re-engineer and rebalance our healthcare services and associated expenditure away from our preoccupation as a country with 24/7 services delivered through acute hospitals to more community-based services integrated with social care. Here I may diverge a little from the approach of my noble friend. The core business of the NHS is care with an acute treatment adjunct, not the other way round as it has been for 60 years. We cannot carry on with this pretence that it is in the best interests of patients to have so many clinically and financially unstable and unsustainable district general hospitals claiming to provide a wide range of 24/7 acute services. Do not believe me: listen to what specialist clinicians are saying, particularly the current president of the Academy of Medical Royal Colleges. Sir Terence Stephenson said last July:

“I don’t think it is possible in quite a small country ... to have 200 to 300 24/7 acute centres offering every single discipline … we need to move to a smaller number of bigger centres giving treatment that’s either hi-tech, risky and rare”.

I do not have time to develop this theme today but will return to it in one of our NHS debates next week. Suffice it to say that we need to start educating the public on the need, in their interests, to consolidate these acute services on fewer hospital sites and to create a 10-year development programme and funding for integrated 24/7 community-based services embracing primary community health services—including mental health services—and adult social care. I recognise that none of this will be easy for elected politicians but this direction of travel is inevitable if we are truly interested in preserving our NHS and meeting the needs of our growing elderly population in a sustainable way. I hope the Minister will feel able to reflect seriously on this kind of reorientation as the Department of Health prepares for the next public expenditure review.