King’s Speech

Lord Warner Excerpts

Monday 13th November 2023 Lords Chamber

[Lord Warner (CB)]

My Lords, as a number of people have said this afternoon, the UK has an economy that is flatlining, with high debt, high taxes and little fiscal headroom. I want to speak this evening about making better use of public expenditure, an issue totally ignored in the King’s Speech.

First, I will address an old favourite: adult social care, which Boris Johnson promised to fix within a year back in 2019. After a few financial handouts to local government, the Government have given up on fixing social care’s workforce, funding and organisational problems, so we continue to burden families unfairly, load unnecessary costs on to the NHS and leave patients marooned in expensive acute hospitals.

Secondly, our failing NHS is spending an ever-increasing proportion of GDP. The Prime Minister indulges in a fantasy that he can fix things by pledging again to cut the NHS waiting list backlog, transforming the NHS with a long-term workforce plan and passing new legislation to curb smoking. The new anti-smoking Bill is well intended but will take years to have much impact, and the backlog has increased to over 8 million people since Rishi Sunak first promised to cut it. The workforce plan arrived in June, a decade too late, NHS doctors have not stopped strikes and the King’s Fund has pointed out that the workforce plan has no measures for retaining disgruntled NHS doctors and nurses now being tempted by attractive offers from aggressive American and Australian recruiters.

The NHS now faces an existential crisis seemingly unrecognised by our Prime Minister. Thankfully, the Treasury has stepped in and refused to give NHS England all the extra funding it is seeking despite having been given £20 billion more than pre Covid. McKinsey has now been called in to find out why NHS productivity is so poor. The Prime Minister must wish that he had not ignored the advice of Sajid Javid, who, when he was Health Secretary, called for radical NHS reform because it was financially unsustainable.

The NHS remains an inefficient ill-health service, dominated by costly acute hospitals and neglectful of community services. Women are getting a particularly raw deal, with two-thirds of England’s maternity units rated as substandard by the Care Quality Commission. Obesity and other lifestyle diseases continue to kill people prematurely, with public health disgracefully underfunded. The public are voting with their feet and increasingly using the private sector for diagnosis and treatment.

Thirdly, there is the burgeoning problem of mental ill-health, which has been referred to, and its impact on families and the labour market. Over 12% of sickness days absence are attributed to mental health problems. The King’s Speech promises

“expanding and transforming mental health services”.

This is difficult to take seriously when there are over 1 million patients waiting for mental health services and 10% of consultant psychiatrist posts are unfilled. That is about 600 posts. As has again already been mentioned, the legislative programme contains no updated mental health Bill, despite promises in the 2017 and 2019 Conservative manifestos.

It is not just health and care that test the credibility of the King’s Speech. I do not have time to go into the housing market promises not being implemented, or the rather crazy idea that we need tougher sentences for serious offenders when we have a record high prison population and only 500 spare places. Where are the extra prisoners going to go? Perhaps we will have another prison ship.

Lastly, I turn to the Government’s problems with life sciences, which the Prime Minister has said are going to be world-beating. In fact, the UK currently has the highest tax in Europe for clawing back money from pharmaceuticals sold to the NHS: 27.5%, compared with 12% in Germany. This results in large companies like AstraZeneca making new investments in medicines research and manufacturing facilities outside the UK, with the consequent loss of research jobs here in the UK. A new claw-back scheme is being negotiated at present for 2024. If he wants to protect the UK economy, Rishi Sunak now needs to get his hands dirty and ensure that the new scheme secures some competitive advantage for UK plc.