Health — House of Lords, 2015-11-26
Topic: Health
Philip Alexander Hunt (Labour, Centre-left): My Lords, as we have debated public health so much, I must remind the House of my presidency of the Royal Society for Public Health I pay tribute to the noble Lord, Lord Crisp. He was a very distinguished chief executive in the NHS and Permanent Secretary, and more recently he has led some incredibly important work on global health issues. I thought he made a very profound speech this afternoon I, too, congratulate our maiden speakers, the noble Baroness, Lady Redfern, and the noble Lords, Lord Foster and Lord Smith. They were excellent maiden speeches and we very much look forward to hearing them, I hope, in the not too distant future We have had some amazing contributions from speakers: my noble friend Lady Jay on cross-government working; the noble Baroness, Lady Campbell, on independent living; the noble Lord, Lord Best, on housing. I find it quite remarkable that so many health and well-being boards do not have the housing sector represented, given that they are meant to be driving forward public health in their locality. We heard from the noble Baroness, Lady Masham, on the really worrying issue of sexual health programmes and policies, which risk being decimated because of the transfer of responsibility to local government The noble Lord, Lord Alton, spoke about the very different health and social care scene that we face now compared with 1948, yet we are still trying to work with a 1948 model. In fact, a lot of the barriers to the integration that noble Lords want to see are built into the very architecture—the targets that separate government departments set. I take the point made by the noble Baroness, Lady Walmsley, about vanguards, but until we get Whitehall to change its own architecture, it will always be driving forward the type of change that she identified with a hand behind its back The noble Lord, Lord Foster, talked about personal responsibilities, and the right reverend Prelate the Bishop of Bristol talked about isolation, which a number of noble Lords referred to. The noble Baroness, Lady Lane-Fox, talked about the NHS and technology. I agree with her—finally, having dabbled in this and spent a few billion pounds on the issue as well, we are on the edge of a major change in healthcare, and there are positive signs now coming through The noble Lord, Lord Smith, talked about human contact and the role of clubs, which I fully accept. The noble Baroness, Lady Neuberger, spoke about children and isolation, and the noble Lord, Lord Rea, spoke about the role of government in regulation and taxation, dealing with poverty in particular. The noble Earl, Lord Listowel, talked about loneliness and mentioned housing security in particular I thought that the noble Lord, Lord Mawson, was very interesting. He described health as an outdated silo and wondered how you translate excellence using the example of Bromley-by-Bow. I take his point. You cannot just ordain this: you have to grow it locally Clearly, in essence all speakers support the general point made by the noble Lord, Lord Crisp, which is that we need a paradigm shift in the way that we think about health and the role of the National Health Service. However, I am very wary of the five-year forward plan on the basis that suddenly, if we build these new models, we can actually expect to see a shift of resources from the NHS in order to fund them. I do not believe that If we look at the international comparisons, we spend so little on health and social care in this country. The recent OECD report showed that, of the OECD countries, we are 19th in terms of health expenditure per capita. In terms of doctors, we are 24th, nurses 19th, and hospital beds 26th, yet we know that the population will rise hugely. It has risen by 10 million in the past 10 years and it will rise hugely in the next 10 years. We have to be very careful not to think that suddenly we can turn off the tap of NHS provision by adopting this approach. All we can do is to slow down the growth I am very wary of people who think that the NHS can lose acute capacity. The idea that we could actually reduce the number of beds in the health service is ill-thought-out and ill-considered. It just does not accord with the reality of the pressure on the system. When I look at the five-year forward plan and the models, I can see that they are very good models, but the reason why no one believes we can reach the efficiency savings of £22 billion is that it is built on the fantasy of being able to transfer money from NHS acute care The other point made by the noble Lord, Lord Crisp, was about the huge range of inequalities in this country. The noble Baroness, Lady Walmsley, referred to the Commonwealth Fund, which gave us a great rating except in health outcomes. The OECD report does not give us such a good rating. Where it agrees with the Commonwealth Fund is about our appalling health status. Again, if we look at the OECD statistics for life expectancy at birth for men, we are 14th and for women we are 24th. It is the same when you look at life expectancy at 65. In terms of smoking among adults, we are 20th; we are 19th on alcohol consumption; and on obesity, where levels are appalling, we are 27th..There are 26 countries with a better record on obesity that this country We could also have mentioned mental health—again there is a huge worry about the scale of mental health issues. I have seen recent research suggesting that common mental disorders are twice as frequent in carers who care for more than 20 hours a week than in the general population. We know, simply from looking at population statistics, that the number of carers will have to grow hugely in the next few years The challenge is immense. I have to say to the noble Lord, Lord Prior, that the great thing in the five-year forward plan was the reference in a managerial document to the importance of health. That is the first time I have seen it so explicitly expressed. Yet, we see the public health budget being cut. It is so hard to fathom how a Government could do that. I hope that the noble Lord, Lord Prior, will address that in his response On the issue of Whitehall working, I agree with my noble friend Lady Jay. We used to have public service agreement targets which tied in different government departments into a common goal. I know that we can overdo targets, and I suspect we did, but there is no doubt that if different departments can be tied into a target that is enforced either by the Treasury, the Cabinet Office, or often by Downing Street, something does get done. This Government do not really do that We can see that in relation to the Department for Education. The Department for Education seems to be totally isolated from anything else in public policy in Whitehall. We debated a Bill on education recently. It is bizarre that, in respect of the Cities and Local Government Devolution Bill, which is all about the devolution of powers from Whitehall to the combined authorities, the Department for Education seems to know nothing about it and wants to have nothing to do with it. If we take the issue of obesity and the points raised by noble Lords on the lack of activity in PE, again the Department for Education is oblivious to this and its outcomes The DCMS is another example of a government department that does not understand Whitehall working at all. I have read its recent sports strategy. It is true that the Department of Health has a half-page in it, but why on earth is DCMS not doing, along with the Department of Health, a sports and health strategy In conclusion, this has been a great debate, but I would say to the noble Lord, Lord Prior, that the Government can do much; they cannot do everything. They can give leadership, and in this regard that is what this debate is asking for.