Queen’s Speech

My Lords, I thank the noble Lord, Lord Darzi, for his customary eloquent introduction to today’s debate. Like him, I see wisdom and valour in leaving DWP and education matters to my very able colleagues, my noble friends Lord Kirkwood and Lady Walmsley. I, too, will confine myself largely to talking about health and social care. In his introduction, the Minister referred to the 60th anniversary of the NHS. We should remember that it was the work that went in beforehand on the creation of the NHS and the welfare state that was of importance. It was led in large part by William Beveridge, or as he is known on these Benches, ““that great Liberal, William Beveridge””. It is my hope that, just as John Maynard Keynes is going through something of a renaissance at the moment, the rest of the world will come to understand what we on these Benches know: that it may take a lifetime for a Liberal to be recognised as being right, but we Liberals are, and we keep going on. I am not being entirely facetious in those statements, because it is important to state that, although the measures in the gracious Speech are welcome, to discuss them in isolation from the current economic situation would be foolish. Therefore, we need to talk about the gracious Speech with reference to the economic climate, the Pre-Budget Report and the NHS operating framework for 2009-13. The NHS has been through a period of unprecedented funding, but it faces a period of unprecedented demand. The questions that politicians must focus on for the next two years are how in our public services, and health and social care in particular, we can achieve efficiency, we can avoid false economies, we can invest in preventive services that will increase well-being and how we can build a health service that has been designed to meet one set of challenges but which will operate over the next few years in a wholly different climate. I disagree with some statements made by Conservative MPs over the past couple of months that the recession must run its course and that a recession might be good for the nation’s health. One only has to look at the lessons of history to see what happens to health during a recession. There is a wealth of evidence from factory closures that people who lose their jobs suffer increased illness—both physical and mental—no matter how healthy they were to start with, and that there is an increase in mortality and morbidity. Although some studies from around the world say that some conditions associated with affluence decrease, health inequalities increase in a recession because poorer people are more directly and immediately affected by lack of money. They also have an increased susceptibility to harmful behaviours. It will be different in this recession; we will not have the regional impact of recession that we had in times past, when manufacturing areas suffered disproportionately. It is quite interesting to look back over history. In the 1970s, the recession gave rise to the Black report on health inequalities, and in the 1980s—to which I refer reluctantly, given how many Members of this House were busily engaged in Government then—a report produced for Mrs Thatcher’s Cabinet, which was leaked, proposed drastic increases in user charges in the NHS and a reversion to health insurance funding for healthcare. Mrs Thatcher rejected that publicly, and saw the value of making continued investment in the NHS. In a recent edition of the Health Service Journal, the noted economist Professor Alan Maynard gave cause for some hope when he said that in periods where more money is available the NHS has tended to be taken by surprise, causing inefficiency, while when there is less money around the NHS becomes more resourceful, not least because it has to work to clear priorities. Over the coming year, it will be the job of responsible politicians to work with the professions and say what those clear priorities are. Today, I want to set out the view from these Benches: that it should be the job of politicians to ensure that the NHS does not make the mistake of going for quick wins, but continues to invest in underfunded areas—public health and social care—in order that we can prevent some of the causes of ill-health, and tackle others. The Pre-Budget Report, which was in effect a Budget Statement, set out the Government’s case. They intend immediately to take £5 billion from public service provision, and to achieve greater savings from 2011—the point at which the NHS budget was already going to cease to grow. It is likely that there will be cuts to the NHS of between £1.35 billion and £2.5 billion, and there is already widespread comment that the Treasury has identified the NHS commissioning budget as a ripe candidate for those cuts. Could the Minister say whether the department and the Treasury intend that savings should be achieved in the commissioning process, rather as local authorities have done in social care, or intend to achieve those savings by cutting levels of service? I also think that the question of how tariffs work within the NHS, which we have discussed many times in this House, will come back with a vengeance. It cannot continue to be the case that some independent providers and trusts build up large surpluses on the basis of the existing tariff system, when there will have to be greater efficiencies elsewhere in the service. I, too, read the Healthcare Commission report with great interest and took two particular points from it, which lead us back to the decisions that need to be made about where NHS expenditure should not be cut. I refer to the continued lack of robust information on how well community services are performing, and on how acute and out-of-hours services integrate with other organisations to ensure that urgent care pathways work both for staff and patients. Connecting for Health is an obvious and easy target, because it is a massive budget which has overrun. I caution the Government not to make a knee-jerk response by cutting that budget, but rather to conduct an urgent review of the parts of the NHS IT system which have worked well and those which can be speeded up and worked on in the next two years. It is vital that the NHS has an IT system which enables staff to do their jobs and enables patients to have a better service, but generates the data necessary for everyone to make informed decisions about treatments and operating systems. I wish to make another suggestion. We have talked in this House a great deal about mental health since the passage of the legislation. The Healthcare Commission noted in its report that access to talking therapies is being increased, but still needs to be improved, and that there are still major gaps between the quality and safety of community mental health services in particular. One does not have to be particularly gifted with foresight to know that the mental health of a nation is likely to suffer in a recession. Therefore, I suggest to the Government that they continue to look at that. It is debateable as to whether the NHS Constitution is a constitution at all. I simply observe that all the pieces of landmark legislation, such as the National Assistance Act 1948, the Children Act 1989, the Mental Health Act 1983, and policy statements such as the Seebohm report in 1965 and the Griffiths report in 1983, were interventions that brought about tangible improvements for patients and social care users. I am not convinced that the NHS Constitution is a document of that magnitude or import, as it was aptly described by the noble Earl, Lord Howe. However, in so far as it clarifies and codifies the rights of patients, he is right, it will have our support. The other matter which is looming, but has not been the subject of discussion so far, is the adult social care Green Paper. The truth is that we have a social care system that has been chronically underfunded in comparison to need for some considerable time. Since this Government came to power, it has been well known that there needs to be a settlement between individuals and the state about how we will fund social care, particularly that of older people. I would simply say to the Government again that their own adviser, Sir Derek Wanless, in 2002 set out in detail that for every pound spent on social care, there is at least an equivalent saving to the NHS. It would be terribly tempting in times of economic hardship to make cost savings in social care. Were we to do that, the health impact would be immense. I wish to make three points about matters that we think should be the subject of continued investment to meet health needs. First, preventive health services such as sexual health clinics are important, as people in times of austerity have a tendency to behave in rather unsafe ways, and that increases the burden of disease. Secondly, I flag up to the Government the point made by Jamie Oliver in his recent presentation to the Health Select Committee in its inquiry on health inequalities that there is a need for co-investment in culinary skills, because a generation of people have lost the knowledge and the art of cooking, and of cooking well on a budget. Not only will that work to further the Government’s set goals for tackling obesity, but it will ensure that children do not suffer by eating bad food. Finally, although it is outwith the subjects of today’s debate, there is a significant health challenge as regards the crisis in social housing, and I hope that government departments will work together to address it. Boom and bust is not good for an economy and it is certainly not good for the National Health Service. There is much to do and a very short time in which to do it. I hope that by the end of today we will manage to achieve a consensus on where the funding priorities should be and that we will enable the Government to avoid some of the false economies that they might be tempted to make.