Queen’s Speech

Lord Warner Excerpts

Thursday 29th June 2017 Lords Chamber

[Lord Warner (CB)]

My Lords, the gracious Speech raises more questions than it answers as far as the NHS and social care are concerned. These questions relate to funding and workforce issues but also to the modernisation of professional regulation and mental health services. I will focus on these issues.

First, on funding, £124 billion a year is spent on health services in England. By the end of this Parliament, the Government have promised to spend another £8 billion. On the Minister’s own figures, this is a real-terms increase of less than 1% per year for five years. This proposed increase makes it impossible to lift the 1% pay cap, given that two-thirds of the NHS budget goes on pay. The Labour Party did rather better: it promised another £11 billion. On present forecasts, it would cost another £13 billion for the NHS to keep up with GDP growth. This was the recommendation of the House of Lords Select Committee’s April report on NHS sustainability, to which the Government have yet to respond. None of these figures, however, matches the OBR forecasts or realistic estimates of the increases in NHS costs and demand. Can the Minister tell us whether the Government will reconsider their position on the £8 billion, in the light of the evidence of its inadequacy from your Lordships’ Select Committee and elsewhere?

Secondly, there is the crucial area of social care, which a number of people have mentioned and which was handled with such crassness by No. 10 during the election. Even after the council tax precept increases and the extra £2 billion for social care over the next three years that the Government have already announced, there will still be a shortfall of at least £2 billion by the end of 2019-20. Publicly funded care providers—residential and domiciliary—are now leaving at scale, as the recent ADASS survey shows.

More than a million older people now have unmet social care needs, which means that the hard-pressed NHS will find its acute hospitals even more full of older patients who should not be there and do not want to be there. We will all be interested to see the Government’s promised consultation paper on the future funding of social care—let us hope it is a bit more convincing than their manifesto. But social care needs more money now—this financial year in fact—to halt the attrition of publicly funded social care providers.

If the Government can produce in a fortnight or so an extra £1 billion for Northern Ireland, which has less than half the population of Greater Manchester, they should be able to do no less for the elderly and disabled people across England. Can the Minister say whether the Government will try to find for the next three years, starting now, at least £2 billion for English adult social care over and above the money already promised? Will they keep on increasing the adult social care budget at least in line with the growth of the NHS, which is another recommendation from this House’s Select Committee?

Thirdly, there are the serious workforce issues caused by Brexit mishandling. There are some 60,000 EU nationals working in the NHS, many of them doctors and nurses, as well as 90,000 working in social care, a high proportion of them in the London area. Registrations of nurses from the EU are falling significantly, and many doctors qualified in EEA countries—who amount to about 7% of the NHS’s medical workforce—are seriously considering leaving the UK. This flight of valued professionals is entirely of the Government’s own making, through their failure to produce any credible reassurances to EU citizens living and working here. The new White Paper looks unlikely to do that, and when the proposed immigration Bill comes to this House, we may have to help the Government do a proper job in this area. In the meantime, can the Minister tell us what bespoke measures the Government will take to give greater reassurance to staff from the EU currently working in the health and care sectors?

Fourthly, there is considerable need for clarification on the gaps between the Government’s manifesto and the gracious Speech on regulatory matters. Legislation to reform outdated laws on mental health, now 34 years old, was promised in the manifesto, but is not in the Queen’s Speech. When are we going to see that legislation, at the very least in draft form? Again, the manifesto promised to,

“reform and rationalise the current outdated system of professional regulation of healthcare professions, based on the advice of professional regulators”.

Legislation is badly needed, by both the GMC and many other regulators. Can the Minister say when we will see the legislation to reform this antiquated system— which is, again, 34 years old, and again as recommended by this House’s Select Committee?

Finally, I draw the attention of the Minister and his senior colleagues to the latest British Social Attitudes survey, published yesterday. This shows that an increasing majority of people in this country support higher taxes for better public services, especially education and health. I remind the Minister that it was penny-pinching on the NHS in the 1990s that contributed to the Conservatives’ landslide loss in 1997, helped of course by a Labour leader who knew how to actually win elections—three on the trot, as I recall.