Covid-19 (Public Services Committee Report) — House of Lords, 2021-07-22
Topic: Health
George Young (Conservative, Centre-right): My Lords, I begin with a tribute to the noble Baroness, Lady Armstrong, who chaired our committee with tact and skill. Her professional background in social work has been a real advantage, not just in putting witnesses at ease but in managing any neuroses from committee members. We were well-served by our clerk, Tristan Stubbs, our policy analyst, Mark Hudson, and our operations officer, Claire Coast-Smith, who navigated the virtual network between us and our witnesses We are a collegiate committee with a broad range of relevant expertise, and our discussions have been non-partisan and good humoured. Thanks to Zoom, I am now familiar with my colleagues’ tastes in literature, paintings, casual dress and light refreshment. In our report, we mentioned what went well during the pandemic—often overlooked by the commentariat: the success of DWP in coping with a huge number of claimants for universal credit, and introducing the £20 supplement; the Treasury’s furlough scheme and wider support for business; and, of course, the stunning success of vaccine procurement and distribution. But we also identified a number of structural problems, some touched on by the noble Lord, Lord Shipley: over-centralisation, departmental silos, underinvestment in preventive measures and ill-preparedness for emergencies, themes that are recurring in our current inquiries I want to focus on the lessons to be learned from the three countries from which we took evidence: New Zealand, Taiwan and Germany. They are all different, but they are grappling with identical viruses with the same range of policy options and the same information about the disease I have three points to make about New Zealand. First, like Great Britain, it is an island—or, rather, two islands—but unlike us it challenged the early WHO advice that border restrictions were unnecessary, and in retrospect it was absolutely right Secondly, to deal with departmental silos, it has just set up interdepartmental boards, which they call joint ventures. We were told that "all the interesting and difficult public policy issues are on the interface", by which was meant that they cross departmental boundaries. Here, NHS Health and local authority social care spring to mind. The joint ventures bid direct to the treasury for funds and a cabinet Minister is in charge, but instead of a permanent secretary, a board of the relevant permanent secretaries delivers the policy. My noble friend might like to ask the Cabinet Office to keep in touch with New Zealand on this, as it is often ahead of the game in the development of public policy Thirdly, public confidence in the Government rose as the pandemic progressed, whereas the opposite has happened here. We did not press too hard for the reasons—again, the Government might want to pursue that further—but it was ascribed to firm leadership, a strong culture of co-operation and robust dealing with fake news Taiwan’s approach avoided lockdown entirely and last year it recorded record GDP growth, but its experience may not be entirely representative as it had the background of coping with SARS and a tradition of wearing masks, which was described to us as the equivalent of a vaccine Its equivalent of Eat Out to Help Out was more broadly based, focused on retail spending rather than just spending in restaurants, and those on low incomes were included, receiving vouchers worth about £80, whereas our scheme was much narrower and arguably regressive. Ninety-eight per cent of the population in Taiwan participated, and you got a bonus if the money was spent out of doors I turn finally to Germany, with its federal structure, where health and education is devolved to the Länder, which managed most of the Covid response. Perhaps the most remarkable contrast was on health spending, where there are no government-imposed cash limits, as insurance picks up the tab. I quote verbatim what we were told: "There is no room for refusing somebody an operation that he needs or a pharmaceutical drug that she needs for financial reasons … There is no place in the German health system for refusing money because somebody is 90 years old and has a life expectancy of only seven more years. In that case … if it does not medically kill them and they can stand the operation—then go for it and the finance system has to follow that." That, of course, has wide ramifications for how we fund the NHS, but against the current background, I thought it worth mentioning I make one final point on Germany. The local authorities there all have equal powers. Our witness, John Kampfner, told us: "It is one thing to advocate the devolution of powers within England to local authorities; it is quite another to be able to deliver that within the patchwork quilt of local government that we have at the moment, which in my view is really not fit for purpose to deal with a crisis like this, as distinct from what exists in Germany." Clearly, it is easier to manage devolution if the bodies you are devolving to have equal powers. At the end of the session on Germany, we asked for a key message. "Plan for the future and build in some slack", was the reply I hope the Minister in response to our debate will recognise that the present system of running the country is capable of improvement—without wholly adopting the Cummings agenda of hard rain—and can tell us that the Government have an open mind on some of the radical implications of our report.