NHS Funding Bill (Money Bill) — House of Lords, 2020-02-26
Topic: Health
Dorothea Glenys Thornton (Labour, Centre-left): I would just note that the noble Earl, who is an expert in procedure, was not actually in the debate that we have just had. We all know how competent the noble Lord, Lord Bethell, is at the Dispatch Box, but the Government put health at the centre of their programme. I think that it is not respectful to this House not to have a Health Minister in their place, and I look forward to there being one. If that is the noble Lord, Lord Bethell, that would be brilliant for him—I just want to put that on the record We have had some excellent contributions today. We are quite correct to use this opportunity to hold the Government to account, even if we cannot amend the Bill. As the noble Baroness, Lady Brinton, said, we have had many briefings asking us to pose questions during this debate, many of which have been reflected in the contributions that we have heard This is a short Bill, but I have to say that, even by the standards of some of the very daft legislation that we have seen from the Conservatives over the past few years, the NHS Funding Bill, all stages of which will be debated on your Lordships’ House today, is rather strange. We know that Boris Johnson, the Prime Minister, struggles to trust himself to carry out the things that he promised before and during the general election. In this case, it is the promise to increase NHS funding by £33 billion before the end of 2023-24—a promise that of course, as the noble Baroness, Lady Penn, said, was made in 2018 by his predecessor. To ensure that the Prime Minister meets his commitment, we have what my honourable friend Jonathan Ashworth has already said in the other place is a political gimmick: he has decided to put it on the statute book. Frankly, given Mr Johnson’s ongoing proximity to obeying the law and to the truth, that is probably no guarantee of anything at all In addition, with the proposed legislation designated as a money Bill, Peers will be unable to send any amendments back to the House of Commons for consideration. That is frustrating as the Bill, originally announced by Theresa May back in June 2018, contains, as many noble Lords have said, many serious problems and flaws. We agree with the King’s Fund, the Nuffield Trust and the Health Foundation that an increase of at least 4% is required to modernise and improve standards in the NHS, and that the 3.4% that this funding proposal brings might just about keep the show on the road. Indeed, as many other noble Lords have said, given that inflation is set to be higher than initially anticipated, the increase will be of even less value The Government’s proposals, as noble Lords have said, omit some very important factors. The Bill does not apply to the whole of the healthcare budget, and the exceptions mean it will not deliver, I believe, the transformation that the Government—and, indeed, all of us—desire. If the new funding is not accompanied by equivalent and sustainable investment in public health—we have had a discussion this afternoon that they do not even know what their budget is for the coming year in public health, which really makes their life impossible—social care and capital investment, the strains on the NHS will increase, storing up further problems for the future. Indeed, as many other noble Lords have said, the Bill does not address workforce, education and training Several noble Lords outlined the challenges that the NHS faces right now, so I will not repeat the issues about waiting times and trolley waits increasing, the 4.42 million people waiting for elective treatment and the delays of hospitalisation, often due to the lack of social care provision. Indeed, after this debate we will be discussing how we can deal with what might become a pandemic. We hope that it will not, but it adds to the serious challenges facing the NHS The British Medical Association is calling for a comprehensive spending plan that increases total health spending by at least 4.1% per year in real terms to address the gap between the funding of current services and future demand, and to put the NHS on a sustainable long-term footing. This equates to an extra £9.5 billion a year by 2023-24. What is the Minister’s view on that? I think the noble Lord, Lord Low, and the noble Baroness, Lady Brinton, together hit the nail on the head about social care, so I do not think I can add to that, except to echo that it has to be properly funded, otherwise this funding will not work. The strain on the NHS from the inadequacies of our social care system will ensure that it will not work. That, to me, seems to be a matter of the greatest urgency I am looking at capital investment. The NAO has reported that £4.3 billion was transferred from the capital budget to the revenue budget in the NHS between 2014-15 and 2018-19. The impact of these transfers can now be seen in an estimated backlog of maintenance of £6.5 billion. This affects patient care and safety: it means that there is water running down walls, so the wards cannot be used; it is a disruption of clinical services; and it means that the kit that people are using is outdated and, therefore, they have to be referred on because the X-rays and the MRI scans are not adequate. The Government’s stated aim of delivering the long-term plan will not be achievable without urgent and sustained investment in these areas through another multiyear settlement The Bill does not address staffing, as many other noble Lords have said. There are now over 106,000 vacancies across the NHS in England and no allowance seems to have been made for the growing cost of recruitment and retention of staff at every level, so the NHS people plan needs to be published urgently so that we can see how the Government intend to deliver on their commitment to support with the additional resources. As other noble Lords have said, Macmillan Cancer Support and Cancer Research UK say that adding 50,000 general nurses will not solve the crisis in the cancer workforce. Cancer Research UK says that the increase completely fails to address the significant and growing problem there is in the diagnostic workforce I turn to mental health. My noble friend Lord Bradley explained the urgent priorities there, particularly in children’s mental health services. As other noble Lords have said, mental illness represents up to 23% of the total burden of ill health in the UK but only 11% of the NHS budgets. So the Government will ensure the delivery of effective spending on mental health only if, as the noble Baroness, Lady Brinton, said, we have detailed breakdowns for each CCG, including separate figures for mental health investment and assessment, spending on learning disability and spending on dementia services In conclusion, I agree with my noble friend Lord Hunt about short-termism. Would the Minister care to look at the report from the noble Lord, Lord Patel, and its recommendations and proposals about short-termism and take them into account when discussing how to proceed with the long-term plan This week, we saw the launch of the Marmot 10-year review of health inequalities. As the noble Baroness, Lady Finlay, said, it makes very dismal and serious reading. It also shows the context in which our NHS is struggling to meet the appalling health inequalities facing the UK. As noble Lords have said, for the first decade in 100 years, life expectancy has failed to increase. As Sir Michael Marmot says: "Put simply, if health has stopped improving it is a sign that society has stopped improving." The report points a finger at the all-too-familiar social and economic conditions that have increased health inequalities, which are now quite literally a matter of life and death. The NHS Funding Bill therefore should feed into a more general discussion about creating a fairer society and improving people’s well-being—and, by doing so, should help to improve the health of the whole population.