My Lords, my little granddaughter is appearing today in her first school nativity play, rather wittily titled “A Midwife Crisis”. I am sure it was a midwife crisis, but a veil was drawn over the actual birth of the infant child—I think it was a do-it-yourself affair. Sadly, we too have a midwife crisis, along with a nurse crisis, a doctor crisis and indeed an across-the-NHS crisis.
If we take the pulse of the NHS, we find that it is in serious trouble. If we ask why, the quick answer is now always “Covid”—but of course that is not true, and the Benches facing us know that in their hearts. When the Conservative Party came into government in 2010, waiting lists were low. Today waiting lists are at 6 million, and they were already at 4 million before Covid struck. Why? The answer is that for a decade annual NHS funding increases had been at their lowest levels ever. That withdrawal of funding was described as efficiency cuts. How can it ever be efficient to cut 17,000 beds or to have over 100,000 vacancies for doctors and nurses? George Osborne, in his austerity policies, took a scythe to training places in his very first Budget. So let us not hear from the Conservative Benches that somehow this has all just come upon us by surprise; it was a deliberate set of policies.
Let us look at the whole business of the public health budget. Colleagues spoke about its importance in creating health and preventing illness. That budget has been cut by 24% since 2015-16. Do we think it is going to be restored in the Bill? Not one bit, yet that money would be well spent because it would reduce the number of people who got ill. As we know—all the statistics have shown it, along with the work of the Institute for Fiscal Studies—the Sure Start programme, which was cut, in itself reduced the hospitalisation of children by 18%, but that project has been thrown to the winds.
There is now an emergency in our hospitals and GP surgeries, and people are worn out. I recently completed a report for the Royal College of Surgeons on improving diversity and inclusion in the surgical profession. When you dug deeper and asked why women had left the profession in their thirties, the answer was that it was the whole business of their lives. Staying on was impossible because of the failure of any real consideration of the demands made on people’s lives and the ways in which women just found it too difficult to combine all those things, including childcare and having a home somewhere close to where they worked. If you are married to another doctor, they are often sent miles away and given a job nowhere connected to you. That whole lifestyle has not been considered in any of this. However, the Bill addresses none of that.
The original plan was worthy: it was to undo the vandalism done to the NHS by David Cameron and the noble Lord, Lord Lansley—I make no apologies about saying that, even if he is in this Chamber—which blew the NHS into marketised fragments that were forced by law to compete rather than co-operate. Now
the word is “collaboration”, but that was not the word being thrown around then. The whole point is that in 2012 that Act opened up all contracts to private tenders. Competition law should have no place in the running of our National Health Service because services need to work together. Yes, the word should be “collaboration”, and I have heard it from any number of persons in this House. Collaboration and integration should be the bywords of our National Health Service.
The original plan was to have integrated care systems across the country to rationalise and plan local services. The idea was to include local authorities and combine social care with health, but the Bill does not marry social care and health. The NHS and local authorities could be pooling their resources, but there is no machinery for doing so in the Bill. The Government have given themselves the absolute power to appoint all the directors of an integrated care service, and refuse to bar private providers from sitting on those boards. The Government have also resisted an amendment in the other place to make the NHS a preferred provider in any tendering process. This is all about privatisation, and it is always done by stealth. Look at all the disgraceful cronyism that was displayed in distributing contracts at the outset of Covid. Many in this Government have a distrust of public service. They refuse to accept all the evidence that a state-run NHS is a success story, yet we spend less money on it than our comparators, we run it with too few doctors, nurses and other healthcare professionals, and we pay them all badly.
This could have been a great opportunity to create an even better NHS but also to create a unified national system of health and social care that worked together in a seamless way. Unfortunately, it is in the hands of an ineffectual, incompetent and ill-led Government, so I do not have much confidence in what is being promised.
7.57 pm