My Lords, the report is the Public Services Committee’s first. The committee was established in February 2020 and is the first in this House to hold the Government to account on a range of issues that cut across public services and on policy areas that are the responsibility of multiple departments and so, too often, are the priority of none. It is a Standing Committee, so will continue to work for many years, I hope. I have the enormous privilege of being the first chair and am working with an outstanding group of Members from across the House, who have all worked with energy,
commitment and challenge throughout. We have also been served by similarly outstanding officials, and I want to say thank you to all involved.
The establishment of the committee coincided with Covid-19 and it soon became clear that the pandemic was the most testing experience that our public service model had faced for several generations. It would reveal its strengths and weaknesses, and would be an opportunity, some might say a critical juncture, for reform. This became the focus of our first report.
We heard from 165 organisations and individuals, and I am enormously grateful to them. Unfortunately, no government Minister found it appropriate to come and talk to the committee. However, much of what we heard has informed our follow-up work on commissioning and data sharing, as well as our current inquiry on child vulnerability. How public services are organised, how they are funded and how effectively that funding is spent, how different services work together and, most importantly, how services are experienced by the people and communities that use and need them are the priorities for the committee.
Covid-19 has been a national tragedy for the United Kingdom. We have lost more than 130,000 people to the virus and Covid-related pressures have pushed many families to crisis point. After 18 months of tireless service, our front-line workers are exhausted and their well-being is at an all-time low.
However, the inquiry also gave us cause for hope. Amid all this despair were incredible innovation and civic action, often at local level, to support communities to stay resilient under unprecedented pressure. Decisions that before the pandemic took months or even years were made in minutes. National government worked with councils to accommodate 15,000 rough sleepers. Many of those had access to addiction and mental health services for the first time.
We were inspired by the surge in voluntary action: there are now more than 4,000 mutual aid groups across the UK. Innovative local authorities played a key role in co-ordinating volunteers to support hard-to-reach groups. For example, Agatha Anywio, 76 years old from London, relied on her local Age UK group to support her during the first lockdown. A few weeks ago the committee heard from her again. She told us that she was still getting support from the local voluntary sector to connect her to her local community. Age UK even organises two virtual exercise classes a week, which she participates in and loves.
We also saw how digital technology was used more widely and more successfully than ever before. Changing Lives, a charity working with vulnerable adults, moved many of its addiction recovery services online during the pandemic. This gave service users greater flexibility and responsibility. They were not given daily scripts by the NHS, but weekly ones instead. This meant that they were more empowered. It was risky, but, actually, it resulted in increased engagement with services, a reduction in the relapse rate and, ultimately, fewer drug- related deaths.
However, while these innovations are impressive, unless government acts urgently to lock in such changes, this good work will be lost, and we heard evidence that
this is already happening. Shay Flaherty is recovering from addiction and now volunteers in Birmingham with the charity Revolving Doors. At a follow-up evidence session last month, he warned us that much of the good work with rough sleepers during the early stages of the pandemic had already been undermined. He said that, once people had been moved out of temporary accommodation, their point of contact with mental health and addiction workers was often lost. Many have relapsed and returned to the streets.
Moreover, Covid-19 revealed how innovation and community resilience are too often undermined by fundamental weaknesses in the way we deliver public services in this country. Going into the crisis, the national Government too often did not take local expertise seriously. This played out with disastrous consequences. Jessica Studdert, who is the deputy chief executive of the New Local Government Network, told us that, during Covid’s early stages, too many local authorities did not get the information that they needed from the NHS about shielded groups, even though it was the local authorities’ responsibility to deliver food and essential supplies.
We found that our poorest communities went into the pandemic with incredibly low levels of resilience. Witnesses told us that the funding of preventive and early intervention services had not been a priority in the years preceding Covid-19. This had placed greater pressures on the NHS and increased costs to the state through poorer education, employment and justice outcomes for the most vulnerable.
Sir Michael Marmot reported to the committee that cuts to local authorities’ public health grants had fallen disproportionately on the most deprived areas. Since 2014, England as a whole has seen a cut in public health budgets of £13.20 per person: in the Midlands, it was £16.70 per person; in the north, it was £15.20; and the north-east has been worst affected, with cuts of £23.24 per person in the public health budget. Witnesses told us that the upshot of those cuts was that obesity and associated diseases such as diabetes were concentrated in our very poorest communities and among our most marginalised groups. That made them extra vulnerable.
Covid-19 mortality rates in the most deprived areas were almost twice as high as those in the least deprived. Diabetes was mentioned on 21% of death certificates where Covid was also mentioned. The proportion was 43% among Asian people and 45% among black people. It was higher in all BAME groups than in the white British population.
Pre-existing inequalities have only deepened during the last 18 months. Sir Kevan Collins, who resigned as a government adviser over school catch-up funding, recently told the committee that disadvantaged children had fallen even further behind their better-off peers as a result of lost school time. His resignation should be a wake-up call to the Government that such disparities cannot be left unaddressed.
The pandemic influenced innovative local areas to break down long-standing barriers between the NHS, local authorities and other services, but in much of the country we found that collaboration between agencies was wanting. Many did not share crucial data on people’s needs. During the crisis, the lack of integration
and parity of esteem between health and care saw patients discharged from hospitals into care settings without testing, resulting—we believe—in thousands of unnecessary deaths. The proposals in the Future of Health and Care White Paper and the subsequent legislation to strengthen co-ordination between the two services are welcome and necessary. True integration will depend on delivering real parity of esteem between the NHS and social care. It is deeply disappointing that the legislation to put adult social care on a secure financial footing has been delayed yet again—until, we are now told, later this year. Can the Government confirm whether the forthcoming legislation will include proposals for the reform and integration of social care, alongside any new funding settlement, to increase the resilience of the sector?
To address fundamental weaknesses in public services, strengthen the resilience of our communities to future crises and ensure that the innovations from the pandemic are not lost, the committee called for a national programme of reform. In carrying out this essential task, we asked that the Government should be guided by eight key principles. These included the Government and public service providers recognising the vital role of preventive services and early intervention.
In its response to the report, the Government said that they were committed to levelling up life expectancy. They have not yet set out how they will invest in preventive services in order to meet their 2019 general election manifesto commitment to extend healthy life expectancy by 2035, and to narrow the gap between the richest and the poorest. Health prevention and early intervention in education were not a focus of the March 2021 Budget. To date, levelling-up announcements have largely focused on physical infrastructure and skills. How will the Government address this in the forthcoming spending review? The role of charities, community groups, volunteers and the private sector as key public service providers must also be recognised. They must be given appropriate support and encouragement.
Witnesses told us that the procurement guidance, introduced by the Cabinet Office in response to the pandemic, granted local public service commissioners greater flexibility to award long-term funding and contracts based on social value, rather than just the lowest cost. We were disappointed that the Transforming Public Procurement Green Paper failed to embed those flexibilities. It did not differentiate between the commercial purchasing of goods from the private sector and the commissioning of services for people, whether delivered by the voluntary sector or by other organisations to meet the needs of the local community. In recent letters to the Government, we have urged them to work with the voluntary sector and with commissioning experts to ensure that the procurement Bill promotes social value and delivers long-term funding agreements for charities delivering services. Can the Minister update us on progress in engaging the voluntary sector on this issue?
Another principle is that public services require a fundamentally different, vastly more flexible approach to data sharing. The Information Commissioner wrote to us as part of our current inquiry on children’s vulnerability. In her letter, she acknowledged that the current threshold for sharing data on children was too
high and that her office would be working with the Department for Education to update its data-sharing guidance. Can the Minister tell us how this important work is progressing?
We argue that integrating services to meet the diverse needs of individuals and communities is best achieved by public service providers working together at local level. This should be supported by joined-up working across government departments at national level. I welcome the establishment of a Cabinet committee. Will the Minister set out how this committee will co-ordinate government activity to improve data sharing and integration? Local services and front-line workers must be given the resources and autonomy to improve, and innovate in, the delivery of services. How will the Government use the forthcoming levelling-up and devolution White Papers to achieve this?
People themselves are best placed to understand how services should meet their needs, strengthen their resilience and support them to thrive. I am running out of time, so I cannot go into this in detail. It is critical that the government strategy for public service reform takes this as its core in the months and years ahead. If people and places are to be resilient in the face of future crises, services must have political and financial support, as well as autonomy, to be truly preventive and integrated around the needs of their local area and people. They must have the places and the people they serve at their heart. I beg to move.
2.08 pm