Future of Health and Care — House of Lords, 2021-02-23
Topic: Health
Sarah Virginia Brinton (Liberal Democrats, Centre to centre-left): I am grateful to the Minister for the short-notice briefing just as we were rising for recess If you had said to most people in the health and social care sector three weeks ago that the Secretary of State for Health and Social Care was announcing a new White Paper, virtually everyone would have assumed that it was the extremely long overdue White Paper on social care, promised by the Prime Minister in his party’s manifesto in the 2019 general election and repeatedly further promised at the Dispatch Box over the last 14 months. This Statement refers to it appearing at some point later in the year Instead, we have a comprehensive White Paper that focuses, despite the references to care, on the NHS and health systems, undoing some but not all of the 2012 Lansley reforms. This White Paper talks grandly of integrated systems, but you cannot integrate systems if one of the key parties is on its knees as a result of appalling neglect for many years. We agree that our clinicians, managers and associated health and social care staff have great ambitions for moving our health and care structures into the 21st century, and we compliment them, and Ministers, on their ambition, but we have been here before. A decade ago, the Government announced and legislated for a Dilnot-style cost model for social care, which, unfortunately, was later scrapped. We went from a point where all three main political parties were in agreement, but, sadly, the Conservatives withdraw from that agreement. As with manifesto promises on the care sector over the last three general elections, when will the Government start the long-promised cross-party talks to find a solution for the care sector? We remain ready and waiting The Statement makes the point that the pandemic has brought the structural difficulties in the care sector into sharp relief. That much is true. With more than 25,000 care home deaths, 10,000 of which have occurred since the lockdown started in January, what will it take for the Prime Minister to make good on his promise to fix social care? Why did it take weeks longer to arrange for residents and staff in care homes to get testing, whereas the NHS had reliable access as soon as it was available? Worse, the care sector’s experience of the Department of Health and Social Care taking its orders of PPE out of lorries and diverting them to protect the NHS first—which happened—and the NHS discharging Covid patients into care homes, while reassuring care staff that it was not doing that, has undoubtedly damaged trust. I do not deny that there has been a really strong attempt to get people to work cross-department, but this sort of behaviour has really not helped The Statement talks about making Ministers accountable again. A good step would be for the Secretary of State to come to Parliament and explain why he did not publish PPE and other contracts within the appropriate timeframe. There are concerns, too, about cronyism and possibly even corruption. So I say to Ministers: beware of what you wish for A further problem of the White Paper in front of us is the need to undo some of the perverse bureaucracies and expenses created by the 2012 reforms. The "internal market" was one such. I cannot see the logic of having a CCG of GPs overriding NICE and a hospital team on a medication pathway because it wants to spend the money elsewhere. The Minister told me that there will be changes and that there will be some representation from trusts, but, from what I hear, it is not enough to leave the clinicians who are expert in charge able to follow the advice of NICE The Statement also talks about the portrait of Sir Henry Willink, who published the 1944 White Paper from the Dispatch Box. But Sir William Beveridge’s report that led to that White Paper, and then to the post-war Labour Government’s creation of the NHS, had a clear structure. The five great evils that Beveridge, as a Liberal, set out could be tackled only by a cross- departmental approach, of which health was a vital component but not the sole driver When my grandfather was dean of St Mary’s Hospital Medical School, he always used to say that it took only 20 years for the NHS to move to a "national illness service", as demand and costs in hospitals increased exponentially and any budget that was not for hospitals was squeezed. That is why, in the 2012 reforms, we in coalition wanted at least elements of public health moved to local government, where it could more effectively work with the other parts of the system fighting Beveridge’s five great evils and, through the health and well-being boards, be accountable at a local level. The examples of the excellent directors of public health during this pandemic have shown that it can and does work, despite the NHS finding it difficult to delegate to them. It is no surprise that inequality is one of the greatest predictors of serious Covid illness or death. Can the Minister reassure us that, whatever happens to public health, it will have its funding ring- fenced to tackle these inequalities Next week, we have the Budget, in which the Chancellor will have to face the highest levels of national debt since the Second World War. After the publication of his report, Beveridge expressed concern, saying that the Government should be bold: "Now, when the war is abolishing landmarks of every kind, is the opportunity for using experience in a clear field. A revolutionary moment in the world’s history is a time for revolutions, not for patching." Now, too, is the time for such revolutions. This pandemic has left us with a health and social care system that needs not just reform but proper funding. Without it, integration and effective joint working will fail. Can the Minister assure us that there will be bold actions to ensure that any changes are fully funded? Without it, Atlee, Beveridge and Willink will be turning in their graves. Worse, these proposed reforms will fail the UK people, whether patients or just those living in their communities—the very people who need it most.