The National Health Service

Norman Lamb Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), whose personal leadership on tackling modern slavery is something we very much appreciate in this place. We may well have seen a reminder today of why that is more necessary than ever.

I made my maiden speech in a Queen’s Speech debate. Google tells me it was 848 days ago, which feels very strange. It feels simultaneously like a lifetime ago and yesterday. These have been very strange and tumultuous times. If I had been told then about things that have happened subsequently, I would have been sceptical, but no more sceptical than at the idea that we would still not have a social care Green Paper. We have had five delays and, despite it not being a laughing matter at all, it has become a long-running joke and a focus of derision.

The ever-delayed social care Green Paper is absolutely critical, because we know that up and down the country millions of people, paid and unpaid carers, are getting up in the dark, coming home from work in the dark, working split shifts and double shifts, and working for poor pay on insecure contracts. They are the backbone of not only the social care system, but the NHS and all public services. If only 10% of our social carers, whether paid or unpaid, walked away tomorrow, all our public services would come to a grinding halt. We need to do much, much better by them. I hope the Government, in showing movement on this issue, intend to bring forward their plans quickly.

In its latest annual assessment, the CQC highlighted concerns about cultural and geographic barriers to access to care, deficient regional staffing, a lack of stability in the adult social care market, and the Government’s failure to implement a sustainable long-term plan to fund social care. It said that that directly impacts nearly 1.4 million older people and millions of people with disabilities or illness who do not have access to the care and support they need. It is time for us to act.

The Government need to be brave and honest. If they are worried about the reaction of current service users to their proposals, I would remind them that the current service users have lived experience of the fact that the current system does not work, so they have no need to be afraid of them when it comes to change. When it comes to millennials like me, we are realistic. We know that the system that cares for our grandparents and our parents will not be the same for us. Let us be honest about that. There are profound and difficult decisions that have to be taken—let us get to that point. We do not need to be afraid.

I know that the Minister for Health, the hon. Member for Charnwood (Edward Argar) is a good and honest man, but when it comes to funding for social care—this is a really important point—we always see the Secretary of State or the Prime Minister use phrases such as, “We have given access to an extra £11 billion”. The Government should be honest about where that money comes from, because the bulk of it is from a social care precept on the local ratepayer. There is a political argument—I disagree with it fundamentally—that says, “Well, the Government believe that there should be a transition of the burden for social care from the national taxpayer to the local taxpayer”. I disagree, but if that is the belief on funding the social care system, the Government ought to say so, because that is very important.

Similarly, I know that this is a health debate, but I will not miss the opportunity to say that we must all reflect for a moment on the BBC and the removal of the free TV licence. As part of someone’s care, and as part of someone’s life in their 70s and beyond, we know that television plays an important part. We should be honest about why this has happened because that cut lands at the door of the Government, despite what they might say.

We know that failures in social care have a profound impact not only on the individual, but on the national health service. I have a real passion for integrated care—I cannot quite see the shadow Secretary of State from where I am standing, but when I was his Parliamentary Private Secretary, I used to bore him at great length about the virtues of integrated social care. When I was health and social care lead in Nottingham for three years, it was by far the least popular thing I did and I had campaign groups at my door weekly talking about my enthusiasm for certain models. There were flaws in the models for sustainability and transformation plans, accountable care organisations and accountable care systems—whatever re-branding we are on at that moment —but, fundamentally, integrating the national health service with our local authority social care is a very good thing and, if we did it properly, it would lead to people not having to ring up multiple agencies to sort out their loved one’s care. It would lead to proper, seamless care that, rather than being based around organisations, would be based around individuals. Again, I say to the Minister: Ed, let’s be bold on integrated care. Let’s be brave —[Interruption.] Madam Deputy Speaker wasn’t concentrating, I got away with it. Let’s be bold about this. If you are, you will see the best of politics working and a lot of consensus building.

I want to use the limited time available to me to refer to public health. I am proud of what I said on integrated health and what we did in Nottingham—we did good things. One area from my time in local government that I reflect on without pride is public health. We did good things on trying to be more innovative with the public health grant, but fundamentally, because of the nature of the cuts that have come down the line over the last nine years, we made cuts to public health services. I made cuts to smoking cessation services—a terrible public policy decision—because there simply was not enough money.

[Norman Lamb (North Norfolk) (LD)]

Is the hon. Gentleman aware of the Health and Social Care Committee report today that highlights the fact that there has been a 30% cut in funding for drug treatment services over just the last three years, which is catastrophic for the people involved?

[Alex Norris]

Having had a long four-and-a-bit hour vigil in the Chamber, I have not had chance to see that, but I certainly will. That is the picture up and down the country, including in Nottingham. The key thing is that as well as being absolutely dreadful for the individuals affected, it is terrible for the system not to have those good, often early, interventions on drugs and alcohol. If we let those things spiral, the impact on the individual and the costs related to the system grow exponentially. These are really bad value choices and we could do much better on public health.

I will finish with a point about cannabis on prescription. We have had important conversations on this today, and it is good that both the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Gower (Tonia Antoniazzi) are here. Their leadership on this has been absolutely crucial. I heeded what the right hon. Gentleman said about how to describe it, and I changed my speech from saying “medicinal cannabis” to “cannabis on prescription” as a result. I have had a case in my constituency, as many have, with a very, very frustrated parent who could not understand why their child did not fit the criteria.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (LD)]

It is a pleasure to follow the hon. Member for Hartlepool (Mike Hill) and I share a number of the assessments that he made in his contribution, because as the House pursues our debate on the Queen’s Speech, it is becoming ever more apparent that the casualty of a Tory Brexit will be Britain’s national health service.

The NHS is our greatest national asset; it is the product of the fusion of radical and enlightened minds in the last century that gave us healthcare for all based on need, not means. But now, in this century, the NHS is in great peril from a toxic combination of chronic underfunding and withdrawal from the EU, and responding to very different challenges from those when it was first created so long ago.

Notwithstanding the announcements in the Queen’s Speech, let us be very clear that the NHS is not in receipt of the resources that it needs to be effective. That was discussed only yesterday at the Health and Social Care Committee, when we had with us the Secretary of State and we talked about the backlog of £6 billion in NHS repairs alone, so an announcement of half that really is no cause for celebration. We heard from the Health Foundation, and its assessment of the Queen’s Speech funding announcement says that

“it falls well short of the scale of the challenge.”

We have a Prime Minister who announced 40 new hospitals, which then was downgraded to six within days, and we see demand for healthcare from our growing and ageing population outstripping the availability and quality of services, which means rationing and a diminution of quality of care; many right hon. and hon. Members from both sides of the House have referred to that in the debate this afternoon.

[Norman Lamb]

Does my hon. Friend agree that another sign of a system under unacceptable strain is the fact that teenagers around the country are often waiting a year or more for access to mental health treatment? I know of two teenagers who have recently had their first appointment after a year of waiting, which seems to me to be utterly intolerable.

[Luciana Berger]

I thank my right hon. Friend for making that really important contribution, and waiting times are a particular issue in our NHS, especially in the Cinderella of all Cinderella services, our CAMHS. Too many young people right across our country are struggling to get a referral and then, if they do get that referral, having to wait months on end. Frankly, it is unacceptable.