My Lords, I thank my noble friend Lord Hunt of Kings Heath for initiating this debate. There are three factors which will ensure that the NHS survives, and the Minister has no control over any of them: finance, social care and decently funded local government. The NHS Confederation has said that that constitutes 80% of health needs, so we are really talking to the Minister only about the remaining 20%. The levels of funding are below those needed to serve an ageing society. It is as simple as that. The absence of long-term funding cycles prevents capital investment. The NHS Confederation states that nine out of 10 health leaders believes that underinvestment in capital is undermining their ability to tackle elective backlogs.
The Government’s complete failure to fix social care has led to acute problems around hospital discharge and an increase in human misery and fear. No sustainable system for care homes means unexpected closures for some and private equity landlords for others. Local government has more and more responsibility piled on it for less and less funding. Whatever happened to the civic pride in the Conservative Party? Without a sustainable local government service, the NHS will
continue to bear the brunt of social care failings, and the population will continue to experience inequalities in treatment.
I am sure that other speakers have received numerous briefings; my noble friend Lady Taylor referred to some of them. I appreciate the trouble they have taken and thank the House of Lords Library for its background document. Even allowing for their individual advocacy, they reveal the deeply worrying state of the NHS, whether in capital spending, mental health, skills training, cancer treatments, maternity care or the virtual collapse of GP and dental services in some areas.
I will speak about osteoporosis, to which the noble Lord, Lord Lexden, has already referred. We know that there were talks between the Department of Health, the Treasury and the Royal Osteoporosis Society about funding fracture liaison services in the Autumn Statement. The Minister, Maria Caulfield, made a commitment to action by the end of the year. As the noble Lord, Lord Lexden, said, the noble Lord, Lord Evans of Rainow—who I see in his place—announced in a debate initiated by the noble Lord, Lord Black of Brentwood, that osteoporosis care would be improved, saying that the Government were
“proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality”.—[Official Report, 14/9/23; col. GC 241.]
However, that statement was withdrawn 24 hours later.
Come the Autumn Statement, it became clear that Ministers had broken their promises to fund fracture liaison services as it contained no references to fracture liaison. NHS England has also confirmed that no expert steering group has been set up or is even in the planning stage. Osteoporosis has been excluded from the advisory groups and working groups of the Government’s major conditions strategy despite being the fourth-worst cause of disability and premature death. Failing to deliver on what was thought to be a commitment will waste £88 million on preventable fractures, including 150,000 hospital bed days. Every year, 81,000 working-age people suffer fractures due to osteoporosis, with a third quitting their job due to long-term pain and disability. If the Government honoured their promise, 74,000 fractures could be prevented in the next five years, including 31,000 life-threatening hip fractures. What plans does the Minister’s department have to honour the ministerial promises made on osteoporosis?
My direct experience in the health service is varied. I was a ward orderly in the 1960s in a Warwickshire hospital, traipsing up and down wards with a cow gown on and pulling a trolley of urine bottles—I must admit, I felt like the bee’s knees in those days. I went on to become a non-executive director at King’s College London and a champion of elder care. However, I still cannot quite get over being older than the National Health Service. I know that the Minister cannot do anything about that but, with the 20% of things he can do something about, can he improve osteoporosis care or is he effectively reduced to rifling in that trunk in the attic marked “reorganisation, reconfiguration, privatisation, efficiency gains and distance medicine”? He is a hard-working and sincere Minister who commands
the respect of the House—at least this side of the House. I hope that his expertise will continue to be used in whatever happens in future.
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