My Lords, it is a great pleasure to follow my noble friend Lord Cashman and pay tribute on this special day to all the work he has done on AIDS awareness. I am grateful to my noble friend Lord Hunt for introducing such an important debate to the House today, with a tour de force of a speech on the opportunities for and challenges facing our NHS.
We recently held an event in Stevenage to celebrate the 75th anniversary of the NHS, and we were privileged to be joined by my honourable friend the shadow Secretary of State for Health and Social Care. During that occasion, we looked back to days before the NHS existed and the insecurity that working-class communities experienced when their health failed. Ill health could bring about disastrous consequences for families not able to afford treatment, and home treatments and remedies often made matters worse—a situation, I can tell the noble Lord, Lord Lexden, that existed hundreds of years before a Labour Government introduced the NHS. We reflected on the current situation the NHS faces: the marvellous and heroic dedication of the staff being tested daily by increasing demands; an epidemic of mental health issues; digital and pharmaceutical treatments that are incredibly effective but extraordinarily expensive; and an ageing population. Then we considered what the future of the NHS might be with the development of AI technology, robotic surgery, and the aspect I would like to concentrate on for the purpose of this debate—a much clearer focus on prevention. But that will require considerably more partnership working, especially, but not exclusively, with local government, which is what prompted me to take part in this debate.
Local government has always played its part. The first Public Health Act was passed as far back as 1848, and much of the drive to local governance in Victorian times was exactly to tackle the public health issues arising in the overcrowded and squalid living conditions of Britain’s working cities. As recently as 2013, those responsibilities came to the fore again when public health commissioning was transferred from the NHS to local authorities, which took on responsibility for improving health in their local populations, including services to reduce drug and alcohol misuse, social prescribing, promotion of health and well-being through their leisure facilities, and direct intervention to tackle prevention priorities such as smoking and obesity.
An excellent report co-produced by the District Councils’ Network and the University of East Anglia showed that the engagement of just over 1 million of the inactive population of England in prescribed leisure services could provide significant outcomes over a 10-year period, such as 45,000 diseases avoided, giving a direct saving to the NHS of £314 million; 70,000 additional years of life in good health, with an economic value of £4.2 billion; and a reduction of 3.7 years in the healthy life expectancy gap.
In my own area, we set up a healthy hub to deliver rehabilitation programmes following strokes, cardiac episodes and cancer treatment. More recently, we instigated a young persons’ healthy hub to support our young residents, especially with their mental health issues. These services now sit alongside the adult and social care services which we have heard so much about in this debate and which are so key to keeping our vulnerable residents healthy and our hospital beds available to the most acutely sick. I hope no one here would deny the enormous role played during the Covid pandemic, as local government developed our relationship with our health partners even further to support our communities through the worst healthcare crisis for generations.
All this work in partnership with health colleagues is very much part of the NHS aim to deliver healthy communities. The figures are clear: it is set out in a report from the Public Accounts Committee that community sport and physical activity, such as social prescribing, brought an estimated contribution of £85.5 billion in social and economic benefits, including £9.5 billion from improved physical and mental health. The part played by local councils in saving costs to the NHS can hardly be disputed, but we have had cuts to local government funding, which has seen a 27% real-terms cut in core spending power since 2010, and the LGA predicts that councils will face an eye-watering £3.5 billion funding shortfall over just the next two years to keep services standing still. Councils’ role in preventive healthcare, public health, and adult and children’s social care, both of which face extreme pressures, is in jeopardy.
Much of healthcare, such as social prescribing, rehabilitation and preventive programmes, is delivered through council leisure functions but—it is a big “but”—most are funded as discretionary spend. The Public Accounts Committee warns that 70% of councils are considering scaling back their leisure services, not least because their energy bills have seen an increase from £500 million in 2019 to £1.2 billion last year. This comes on top of over £71 million already cut from leisure budgets since 2010, a 14% cut. Most sporting facilities in our towns and cities have an average age of over 30 years, with no funding available to improve or replace them.
Councils and councillors want to go on playing their part in supporting our NHS to keep our communities healthy and to tackle health inequalities. Indeed, the King’s Fund recently said that councils have a fundamental role in determining the health of their communities. But while relationships with the NHS are strong and the political will is there, the funding model is incredibly fragile and, should it come tumbling down, the consequences in additional costs and demands, both short and long-term, to our NHS are extremely serious. I hope that the Minister will persuade the Chancellor to consider this as he finalises the local government funding settlement in the next couple of weeks, and to invest to save in local government, in prevention and in a healthy future. As Nye Bevan said:
“There is no test for progress other than its impact on the individual”.
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