That this House takes note of the National Health Service’s performance in relation to its priority area targets; and the impact of adult social care pressures on patients of the National Health Service, and their safety.
My Lords, I welcome this opportunity to debate the current performance of the National Health Service. I declare my membership of the GMC board, my trusteeship of the Royal College of Ophthalmologists and my presidency of GS1, the organisation responsible for the “scan for safety” programme. I am very pleased that my noble friend Lady Wilcox will be making her maiden speech in this debate.
I have instituted this debate because I am increasingly worried about the performance of our National Health Service. Despite the heroic efforts of many staff, every key indicator is being missed. Last November saw the worst four-hour wait performance in A&E since figures were first collected in 2010. Two-week waits for GP appointments rose by 13% last year. The target of a maximum wait of 18 weeks for hospital treatment has not been met since 2016. The cancer target of 62 days between urgent referral and first treatment was last met in 2013-14.
I fully accept that these targets are not the only way to judge the NHS, but they reflect overall performance. At the same time, we have seen an increase in the rationing of medicines, and failings in ambulance services and services for people with learning disabilities or mental health issues. The CQC’s review of the Mental Health Act today refers to a number of very worrying problems in that area.
Given this, it is a huge tribute to NHS staff that so much care remains of a very high quality. I absolutely acknowledge that. However, the calamitous drop in performance over the past decade is clearly having an impact on patient safety and leading to those longer waits.
I was very struck just before Christmas by the Norfolk and Norwich University Hospitals NHS Foundation Trust advising staff to make “the least unsafe decision” following a huge rise in admissions. Over the new year, the Royal Cornwall Hospitals NHS Trust told its staff to reduce severe overcrowding by discharging patients, despite the obvious risks involved. These are not isolated incidents. What has caused this? Many factors and pressures are at play. The alignment of austerity with workforce shortages, inadequacies of adult social care and a complete failure to factor in the growing older population mean it is little surprise that the NHS is reeling.
If we look at funding, the lowest five-year period of funding growth was between 2010 and 2014, and the past five years have seen little improvement. It is no wonder that the NHS is cash-strapped, in deficit and finding it very hard to invest the resources necessary to prevent hospital admissions. We can see similar trends in the workforce. In March, the Health Foundation highlighted a shortage of more than 100,000 full-time equivalent staff, including more than 40,000 nurses. The GP workforce has continued to stagnate, despite government promises to increase the numbers, and the GMC’s 2019 workforce survey showed that one-third of doctors have refused requests to take on additional workloads and one-fifth have reduced their hours. It is part of a vicious cycle in the workforce. Fewer doctors and more patients means that doctors are overworked. They get ill from stress and exhaustion. They decide to cut their hours or just leave the profession, and the remaining workforce feels under even greater pressure.
My Lords, I draw the House’s attention to my registered interests as a councillor and a vice-president of the Local Government Association. I thank the noble Lord, Lord Hunt, for instigating this important debate. As this is such a wide-ranging issue, I want to concentrate my contribution on adult social care. As the wording of the debate indicates, a significant part of the increasing pressure on the NHS is a direct consequence of the Government’s failure to find a solution to the social care funding crisis.
Two years ago, the House of Commons Library produced an excellent briefing paper on adult social care funding in England. The report stated:
“A lack of suitable care services can delay hospital discharge, putting pressure on acute NHS services. Between 2014 and 2016, delays in discharging patients from hospital increased by 37%.”
The two main reasons given for this increase—not a surprise to any of us here—were patients waiting for care packages at home or in residential care. The report went on to say that
“the National Audit Office estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million.”
I have no doubt that both of those figures have risen substantially, as so little has been done to alleviate the pressures.
In December last year, Age UK updated its Care in Crisis figures for older people and reported that, in the last five years, there has been a £160 million cut in total public spending on older people’s social care, despite rapidly increasing demand; 1.5 million people aged 65 and over do not receive the care and support that they need; and cuts in local authority care services have placed increasing pressure on unpaid carers. Of course, there is also a growing number of young adults with severe disabilities for whom long-term care is provided by local authorities, hence the estimate from the Local Government Association that there will be a £3.6 billion funding gap in four years’ time unless there is an immediate and substantial increase in funding.
My Lords, I thank the noble Lord, Lord Hunt, for securing this debate and look forward to hearing the maiden speech of the noble Baroness, Lady Wilcox.
My proposition is that, all things considered, the performance of the NHS in delivering free-at-the-point-of-need healthcare to the people of the United Kingdom is utterly outstanding, and that the credit for that should go to the 1.5 million people who give of their all every day to make it so. Each year in England, 300 million GP appointments, 23 million attendances at A&E and over 10 million operations take place. The NHS in England treats 1 million patients every 36 hours, yet, according to the 2018-19 NHS England annual report, of these hundreds of millions of engagements, just 6,395 complaints and 7,967 concerns were raised by the public through the Parliamentary and Health Service Ombudsman. Most find their treatment to be good or outstanding.
Opinion surveys agree. The NHS comes top of Mintel’s list of things about Britain that make us most proud. In 2018, a YouGov poll found that 87% of people were very or fairly proud of the NHS. And it is not just at home: the Commonwealth Fund’s latest survey ranked the UK as the best healthcare system in the world for the second successive time, with Sweden ranked sixth and France 10th.
The NHS has come a long way since its formation in 1948. At that time, total government spending on health was £11.4 billion in today’s prices; today the budget stands at £134 billion—12 times higher in real terms. Staffing in 1948 was 144,000; today it is over 1.5 million, a figure which does not include 369,00 GPs, dentists, opticians and temporary staff. The demands on NHS services have changed too, with breakthrough surgical procedures and new drugs. Life expectancy has risen from 68 in 1948 to 80 now. Age is a principal driver of demand for the NHS. Those over 65 require, on average, 2.5 times the NHS resource needed for the average 30 year-old, and those over 85 an average of five times more. The over-85 age group is the fastest-growing age group in the UK and is set to double in size over the next 25 years, hopefully with my help.
12:06 pm
The Lord Bishop of Carlisle
My Lords, this is a very timely debate. I am most grateful to the noble Lord, Lord Hunt of Kings Heath, for securing it. I also look forward very much to the maiden speech of the noble Baroness, Lady Wilcox. We have already heard many statistics with regard to NHS targets and shall no doubt hear many more. But there seems to be general agreement that one of the biggest problems facing the NHS is what many now call a crisis in social care, which has been highlighted by this debate and emphasised by the noble Baroness, Lady Pinnock, and to which I will address this contribution.
The crisis consists of several factors—most already mentioned, so I will not repeat them—that lead to delays in discharge, the cancellation of elective operations due to lack of beds and an increase in A&E admissions, including elderly people whose health has suffered as a result of a lack of adequate care. All this is of course immensely costly in time, money and misery, as well as immensely disruptive for an NHS desperately trying to meet its targets. Given that the laudable aims of the NHS long-term plan will never be realised unless we sort out social care, what needs to be done?
I suggest that in the first place we remind ourselves just why this is so important. It is not only because it is vital for an effective NHS but primarily because the hallmark of a civilised society is the way in which it treats its vulnerable members. Recognising the intrinsic value and dignity of every member of our society, we want to offer care and respect to all, and aspire to the best by enhancing rather than just maintaining people’s lives. That will involve three fundamental changes. First, and most important, is the proper integration of health and social care. This was one of the main recommendations of the ad hoc Select Committee on the Long-term Sustainability of the NHS, mentioned by the noble Lord, Lord Hunt, of which I had the privilege to be a member. Although we now have a Department of Health and Social Care, there is still a very long way to go. The root of today’s problem was the separation of health and social care and their means of funding, even though they are linked aspects of health and well-being. Secondly, we need proper training, care and status of care workers. We need a professional, motivated and committed workforce who enjoy high esteem, which is not always the case at present. We also need to acknowledge the immense and invaluable contribution of unpaid carers.
Thirdly, social care in this country needs adequate funding. Noble Lords will have seen the seven key principles for that offered by the Health for Care coalition in our briefing note from the NHS Confederation. The need is estimated at an extra £8 billion per annum, which obviously has to come from somewhere. That somewhere is presumably our pockets. Of course, that is one reason why this subject is so politically sensitive. It is also one of the many reasons why we so urgently need the sort of cross-party consensus to which this Government have declared their commitment.
My Lords, to begin at the beginning, I thank the doorkeepers who have guided me more than once along different corridors, parliamentary staff who supported my induction, my party colleagues and the Front-Bench team who patiently explained the rules and regulations of this House. I have been shown great kindness and I appreciate the privilege that it is to be here. My parents are no longer here to share this day, but I have a wonderful partner who has always made sure that our life together over 30 years has allowed me the freedom to pursue a political career, which is not always conducive to family life. I will always be grateful to her for her love and support.
A girl from the Rhondda, I attended the Central School of Speech and Drama and then had a teaching career in London and south Wales that lasted almost 35 years. I was an elected member of Newport City Council from 2004, the first woman to lead that council and subsequently the first woman to lead the Welsh Local Government Association. I am immensely proud of the work of local government, running public services day in and day out despite all the difficulties, and working in such ventures as city deals. I now look forward to the future of the ground-breaking collaboration across both countries and both Governments, with the innovative Western Gateway project that stretches from Swindon in the east to Swansea in the west, bringing breadth and depth to the model of economic growth.
I thank my noble friends Lord Hain and Lady Morgan of Ely for supporting me through my introduction on 4 November, the day that marked the 180th anniversary of the Newport Rising at the Westgate Hotel. We owe the Chartists an enormous group debt of gratitude for their immense bravery and sacrifice in fighting for the vote for ordinary people. I was keen to have my introduction on that day and to remember that Newport is indeed the UK’s city of democracy.
My Lords, it is a great pleasure and privilege to follow my noble friend’s maiden speech and I congratulate her on it. It will be the first of many such speeches in your Lordships’ House that we will all have the pleasure of hearing.
I have followed my noble friend’s career over many years and watched her progress both in the Labour Party and in local government. She is a formidable campaigner and a straight talker. She has a no-nonsense approach to whatever she undertakes, as I am sure noble Lords will have noticed in her maiden speech.
Like me, she was born and brought up in the Rhondda Valley, which no doubt gave her a good grounding in local politics. She has a keen interest in education and worked as a teacher in Brixton in south London, was head of drama and media studies at Hartridge High School in Newport, and head of the performing arts faculty at Hawthorn High School in Pontypridd, with over 35 years’ experience in front-line education. She was an external examiner for the WJEC and AQA examination boards for over 25 years and became principal examiner for A-level theatre studies.
She also has an interest in local government, as she mentioned. She has served as a Newport councillor since 2004 and by 2016 she was elected leader of Newport Council—the first woman to hold such a post. Those of us who are involved in Welsh politics will appreciate what an achievement that was: for a woman to be elected leader of a local council.
But it did not stop there. By 2017, my noble friend had been elected leader of the Welsh Local Government Association—again, the first woman to hold such a post. That was even more of an achievement, as the Welsh Local Government Association has been dominated by men for so long—I could say “centuries”, because it feels like that; we waited for so long to get a woman in post. In 2018, my noble friend was invited to become a Fellow of the Royal Society of Arts, an award granted to individuals whom the RSA judges to have made outstanding achievements in social progress and development.
12:26 pm
Baroness Masham of Ilton (CB)
My Lords, I thank the noble Lord, Lord Hunt, for this debate, which is of the utmost importance. There is nothing more important than the safety of patients. It is thanks to the press and relatives that some of the neglect and horrifying bullying of patients in some hospitals has been highlighted over the years. I hope that the Government agree with me that we need a transparent and open way of reporting concerns. Members of staff, friends and relatives should not be punished and penalised for doing this; perhaps we need another word to replace “whistleblowing”.
It is of great concern that some ambulances have not been able to meet their targets. It is not acceptable that patients have to wait for hours on trollies in corridors. This illustrates the pressure on beds and staff. Recently, a member of my household was admitted to Harrogate District Hospital. One night, a nurse came to him in tears, saying she had 12 patients to look after. She could not give them enough of the care they needed. Well-trained nurses should be a priority if patient safety is to be safeguarded. In Birmingham, some cancer patients having treatment, such as radiotherapy, for their conditions, and who have to travel many miles, can stay free and look after themselves in a hostel—part of the hospital—during the week while having treatment. This alleviates them of the stress and exhaustion of travelling. I hope that this excellent plan can be extended across the country.
I belong to several all-party parliamentary health groups. When taking evidence, there is one overriding similarity: late diagnosis. Many people are told to go home and take paracetamol. This can happen several times. In the end, it can turn out that they have a serious long-term condition. What can the Government do to improve this dangerous problem?
I am president of the Spinal Injuries Association. Many of our members who are patients of the spinal unit at Stoke Mandeville Hospital cannot get appointments or new patients cannot be admitted because non-spinal patients are being placed in the allocated spinal beds. This illustrates the pressure on beds in a busy hospital. It also means that patients with life-threatening injuries, resulting in paralysis, are treated in intensive care beds without specially trained spinal nurses in general hospitals—blocking these beds while waiting for a transfer to a spinal unit.
I end by paying tribute to Brian Gardner, who was a spinal injuries surgeon at Stoke Mandeville. He was an outstanding doctor and always had time for patients and advised GPs on their needs. He died of cancer a few weeks ago. We need more doctors like Brian. He was one of the SIA’s advisers and is missed by very many people. He was an excellent communicator. Better communication throughout the NHS is what is needed. If public health, NHS England, social services and voluntary bodies do not work in co-operation, patients will not be safe. I add my congratulations to the maiden speaker for her passionate speech.
My Lords, do not be confused, I am not my noble friend Lord Brooke; I am grateful to him for swapping places with me—noble Lords will be hearing from him later.
I am grateful to my noble friend Lord Hunt for securing this debate; nobody knows more about this than he does. I am particularly pleased with the wide range of his topic: we can focus on the performance of the NHS in relation to its targets but also recognise the impact of adult social care pressures on those targets and that performance—I am glad that so many noble Lords who have spoken realise this.
My noble friend draws attention to a whole-system failure, and we can see evidence of that in the shocking statistic that shows how life expectancy in the United Kingdom is falling, contrary to what the noble Lord, Lord Bates, said to us. Life expectancy had been rising for decades, but has now started to decline, with the elderly, poor and newborn worst affected. Life expectancy for those over 65 has dropped by more than six months. Why? Academics have said that it is a direct result of the austerity measures imposed by the coalition Government in 2010. These cuts, which removed more than £30 billion from welfare payments, housing subsidies and social services, were some of the severest made by any nation after the 2008 financial crisis. They triggered dramatic reductions in social care, meals on wheels, rural transport, health visitors and district nursing services.
Community and voluntary services, which have always been so important in the care of the elderly and isolated especially, suffered similar reductions. If no one visits an isolated older person, no one notices if they have stopped eating or are having trouble moving about. They fall over, are finally discovered, and are then admitted to hospital where they have to be given more serious interventions than would have been the case if services had been available earlier. Then there is difficulty in discharging them because social care services are not available or are inadequate, and so the whole sorry cycle starts again, inevitably leading to shorter lives.
20 of 45 shown
All of this is happening when social care is in meltdown. In 2018, the House of Lords Economic Affairs Select Committee reported that 1.4 million older people in England had an unmet care need. We know that the number of older people and working-age adults requiring such care is increasing rapidly, yet public funding declined in real terms by 13% between 2001 and 2015. We see a second vicious cycle. The level of unmet need in the system increases, the pressure on unpaid carers grows stronger, the supply of care providers diminishes, the strain on the care workforce continues and the stability of the adult social care market worsens.
What is the Government’s response? It seems to be twofold. The attitude of the Secretary of State appears to be to get rid of any target on which the NHS is not delivering, but I remind the Minister that the Royal College of Emergency Medicine has said of A&E that there is
“nothing to indicate that a viable replacement for the four-hour target exists”.
I strongly encourage the Government to think again before they agree to change that target.
The second line of the Government’s defence is essentially to argue that they are dealing with an unprecedented increase in demand. I am the first to acknowledge that the drivers of change are intensifying and that the NHS is clearly caring for a patient population with more long-term conditions, more comorbidities and increasingly complex needs, but this is not a new problem. The Labour Government of 1997 faced the same demographic challenge, but turned it around through investment in 300,000 more staff, 100 new hospitals and new services such as NHS Direct and walk-in centres. Waiting times came down as dramatically as public satisfaction went up. It can be done.
The Government have their own long-term plan with a new five-year settlement of around 3.4% per annum. However, as the right reverend Prelate the Bishop of London said in the debate on the Queen’s Speech, the additional funding is not a bonanza; it will serve only to stabilise NHS services, and the right reverend Prelate knows what she is talking about when it comes to the NHS. Yesterday, the NAO warned that NHS trusts reported a combined deficit of £827 million and clinical commissioning groups reported a £150 million deficit in the financial year ending 31 March 2019. The NAO said that short-term fixes have made some parts of the NHS seriously financially unstable, with trusts in financial difficulty increasingly relying on short-term loans from the Minister’s department.
As we look at the funding promised—we will have a Bill on it in your Lordships’ House soon—I refer noble Lords to a letter written by NHS leaders to the Times on Tuesday, which pointed out that this funding does not include areas crucial to the Government’s election promise to provide more hospitals, nurses and GP appointments. The additional funding does not cover investment in buildings and equipment, so there is very little relief for our crumbling infrastructure or money to fund new technology to improve care. We know that the NHS is facing a workforce crisis but the funding does not cover education and training budgets to help with recruitment and retention. Nor does it offer any relief for public health and social care services, which would, I hope, if properly invested in, keep more people healthy and independent.
Therefore, the question before us is how to turn this around. I am sure that noble Lords will come forward with many ideas in this debate but I would like to propose four key measures. First, we have to plan for the long term—not five but 20 or 30 years ahead. I want to come back to the House of Lords Select Committee report on the long-term sustainability of healthcare. It was published three years ago and chaired by the noble Lord, Lord Patel. The committee said that we have to get away from the short-term fixes that we currently see and have seen in the past. It suggested that we set up an office for health and care sustainability to look at the likely funding and workforce requirements for up to 20 years ahead. Like the Office for Budget Responsibility, which has now been well accepted as giving authoritative, independent advice to government, this body could give advice to government, Ministers and parliamentarians on the likely demands on health and social care over the next 20 years. I believe that would be the start of a much more fundamental way of ensuring that we have a high-quality healthcare service in the future.
Secondly, alongside those kinds of projections, of course we need the commensurate funding. The funding challenge is immense. No one in the health service believes, for instance, that the 3.4% being given will allow them to invest in services for the long-term five- year plan. The money is not there to invest in services to keep people out of hospital; we have a crumbling primary care service because of the pressure from patients coming through the door; and people who work in the health service regard the local plans—the STPs—as a flight of fancy. They have had to publish them and have had to agree the figures with the Government because, if they do not, they will get their heads chopped off. However, Ministers are living in a dream world if they think that these plans will be delivered. Therefore, we have to find a way of funding the health service seriously in the future, but at the moment I see no indication that the Government recognise the scale of the challenge they face.
Thirdly, on the workforce, we need better recruitment and retention, and we need to increase our training numbers, but much of the problem is due to what I am afraid I have come across many times—a bullying and blame culture. It is very off-putting for many staff in the health service. I know that Ministers are concerned about this but it starts with them, their attitude and the way they deal with the health service and the bodies responsible for it. They have to lead from the centre.
Fourthly, we have to find a solution to social care. The Government have promised to come forward with one but, as we know, the last 20 years have seen a failure of nerve and an absence of political consensus. Frankly, at the moment we seem no nearer to a solution. I must acknowledge that it is a wicked problem. However, can we really wash our hands of the pernicious situation in which many people receive no care at all and many face the loss of not just their homes but their savings as the price of their long-term care?
In this debate noble Lords will raise many other issues, including improving outcomes, developing a more robust approach to public health, targeting health inequalities, and prioritising mental health and learning disability services. However, at heart, I hope the debate will come back to the issue of performance. The targets were not plucked out of the air. They were chosen because they were a very good proxy for the overall quality and performance of the NHS as a whole. In 1997, we inherited something called the Patient’s Charter, which said that there should be a maximum waiting time of 18 months for hospital treatment. The Conservative Government at that point had come nowhere near meeting that target. We turned that around and delivered an 18-week maximum wait. We hit other targets as well. I fear that it will not be too long before we go back to those bad old days if we carry on as we are at the moment. I ask the Government to think seriously about the kind of health service that they want for the public in the future. Based on current trends, I am afraid the situation is deteriorating. I beg to move.
In summary, we therefore have what is currently described as a perfect storm, although I see nothing at all perfect in this crisis. People are becoming less independent and not receiving the support that they need to retain their independence. When they reach a crisis point—for example, following a preventable fall—and are admitted to hospital, where their care needs are assessed after treatment, there is often no residential care package or home care team to meet their new need. This is a situation where nobody wins: not the elderly person, who has unnecessarily lost a degree of independence; not the NHS, which is unable to transfer such patients to home or community settings; and not public services, whose funding is not being used efficiently and effectively.
What then are the potential changes that could help resolve this? There have been numerous reports and commissions to seek answers to the funding of adult social care. The Prime Minister declared himself committed to solving the problem, yet there were no proposals for reform in the latest Queen’s Speech. All we have is a relatively small amount of additional funding and a requirement for council tax payers to find an extra 8% on top of the capped limit over the last four years. This is no more than chicken feed in the face of the challenge.
The human cost is unacceptable; the additional, preventable pressures that are piled on to the NHS are unacceptable; the inability of the Government to propose a solution is unacceptable. The options for the future are clear. The Government have a duty and an electoral mandate to act—and act they must.
All things considered, the NHS is performing extraordinary well, with its productivity growth running at three times that of the rest of the economy, which means that staff are working harder and smarter. Cancer detection and survival rates are increasing while deaths from heart disease are falling, but we cannot expect them to take all the strain. This, after all, is our NHS and we need to work together to ensure that it can meet the challenges of the future. I will make three quick suggestions as to how it can.
First, the NHS should not be used as a political football. The NHS is currently under the stewardship of the Conservatives in England, Labour in Wales, the SNP in Scotland and the power-sharing Executive in Northern Ireland. It has prospered and struggled under Governments of all political parties. Every healthcare system in the world is struggling with advancing science and advancing ages. It would be true political leadership if we could work together to find solutions, rather than blaming each other for mistakes.
Secondly, we need to treat staff in the NHS much better. They are not a vending machine delivering care packages but human beings putting their heart and soul into it. That makes all the difference. Yet clinical negligence claims have increased by 200% over the past 10 years, reaching £2.4 billion of claims in 2018—enough to train 10,000 doctors. Most worryingly, the number of attacks on NHS staff is increasing at an alarming rate, as pointed out by Unison and the Nursing Times. They have estimated that the number of violent incidents could be as high as 75,000, or 200 per day.
Thirdly, we all need to take greater personal responsibility for our own health and our use of precious NHS services. Fifteen million GP appointments are missed each year, while hospital admissions for obesity have doubled in just five years. Our NHS is our shared responsibility. If politicians and the public can all play their part to the same standard as our NHS staff demonstrate every single day, our beloved NHS can not only survive but thrive in the future.
I support calls that have been made for a Select Committee or cross-party group of some kind to be established immediately to produce specific long-term proposals—that expression, “long-term”, has been used several times already in this debate—to break the current deadlock. There are plenty of previous reports on which to draw and although this might look like yet another delay to the long-awaited Green Paper, if it results in decisions and actions, that brief delay will be well worth it. Without it, the situation will only get worse to the detriment of all concerned. As we have already been eloquently reminded, a well-funded and good-quality social care sector is fundamental to a well-performing NHS.
I am pleased to make my first contribution to the House on the NHS. Wales is the inspirational source for this great institution and I feel entirely comfortable offering personal reflections. But I intend to do this through the prism of well-being and, in particular, as the former leader of Newport City Council, I will concentrate on the crucial impact of social care. Noble Lords will know that the additional NHS funding will be wasted if we do not deal with the continuing and growing problem of social care. I am from that tradition of socialism that seeks workable answers to people’s problems. Social care has been subject to a plethora of reports, commissions and solutions. The promised government Green Paper was postponed at least six times and Simon Bottery, a senior fellow at the King’s Fund, has described it as the
“zombie of modern policy debate, stumbling unsteadily around in circles.”
All Governments of various hues and all political parties have failed our communities on this issue. If we are to solve the problem of what amounts to the most pernicious means test in the welfare state, a new political consensus is required. Genuine attempts by recent political leaders of all hues to do something different blew up in the face of blunt political onslaughts.
The Prime Minister announced in his first speech last August that
“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve”.
A fully worked-up plan is desperately needed, not another rough draft. No one doubts the difficulty of delivering a solution. Contextually, those in local government have had to deal with a decade of austerity. I can testify to the day-to-day grind of trying to protect the public realm—which libraries and leisure centres do I cut to protect the looked-after children’s budgets? Can we afford to maintain those CCTV cameras and at the same time sustain direct payments for disabled adults and young people?
In Wales, our Welsh Government and Welsh councils resolved to protect social care. We put in place the Social Services and Well-being (Wales) Act 2014 with all attention aimed at supporting those who rightly desire independent living. Furthermore, in Wales, no one who is eligible for care at home is expected to pay more than £90 a week towards it. But I am not claiming that we have solved the problem. Huge efforts are under way to find new funding models, including a common social insurance scheme. A report by the economist Gerry Holtham is looking at an emerging preference from that work for a simpler social care tax in Wales to pay for social care. Indeed, the idea that there is a magic solution that does not involve paying more tax is disingenuous. In a statement to the Assembly just this week, the Health Minister told Assembly Members that the cost of care is expected to grow between £30 million and £300 million by 2023. If the Government seriously want to improve the quality and reach of care, it will require more funding. If Members say they do not want to raise more taxes, they have to identify where the money will come from. Raising money from elsewhere will target other areas for cuts. After a decade of austerity, there is little more that public services can absorb.
Our responsibility as politicians is to tell the truth on this. My plea is simple: let us work together to find a solution. It will not happen overnight and it will cost billions, but it is the greatest political imperative we face since the founding of the NHS over 70 years ago. More delay or failure is not an option for those who need that care.
My noble friend has certainly smashed her way through the glass ceiling of Welsh politics and has been an example and an encouragement to women in Wales. I know that she will continue to be so as she begins her life in your Lordships’ House.
I thank my noble friend Lord Hunt for bringing this important debate before us today. I intend to focus on two NHS priority areas that impact people with Parkinson’s: mental health and dementia. I declare an interest, as I co-chair the All-Party Parliamentary Group on Parkinson’s.
Up to 40% of people with Parkinson’s will have depression, and up to 31% of people with the condition will experience anxiety. In 2017, in response to reports from Parkinson’s UK information and support staff, the APPG on Parkinson’s held an inquiry into the experiences of people with the condition who have anxiety and depression. The inquiry and subsequent report, published in 2018, found that people with Parkinson’s wait months, and sometimes years, to see a mental health professional once a problem has been identified; that the difficulty of diagnosing a mental health problem in someone with Parkinson’s is compounded by a lack of guidance for health professionals; and that there are complexities in the referral process, as a Parkinson’s professional must send an individual back to their GP so that they can refer them on to a mental health professional, which creates further, unnecessary delays. Professionals who presented evidence to the inquiry described communication barriers between departments, difficulties accessing patient notes, and a shortage of mental health professionals with the knowledge and skills to meet the specific needs of people with Parkinson’s. The mental health support received through improving access to psychological therapies, or IAPT, is not tailored to the needs of people living with Parkinson’s, and specialists such as neuropsychologists and neuro- psychiatrists are in short supply, leaving many people with Parkinson’s accessing IAPT services that are not tailored to their needs.
It is almost two years since the release of our report, and we are yet to see progress on several of the recommendations, which included funding research on effective mental health interventions for people with Parkinson’s, training in Parkinson’s for talking therapists working in IAPT services, and the publication of data on how mental health services for people with Parkinson’s are performing.
Every two years, the UK Parkinson’s Excellence Network, started by Parkinson’s UK to link up professionals who treat people with the condition, conducts an audit on the quality of Parkinson’s services. While the audit is not mandatory, an increasing number of services are taking part to track how they are improving. The results of the 2019 audit were released last week. They showed that, from 2017 to 2019, there was a reduction in the number of people with Parkinson’s being reviewed each year by their neurologist or elderly-care consultant, and less than 20% of these services were offering multidisciplinary clinics.
The results around mental health show how improvements are needed in screening and access to referrals. Almost a fifth of Parkinson’s services across the UK could not refer psychiatric services. The Excellence Network will now support Parkinson’s professionals to deliver an action plan to improve their services ahead of the next audit cycle, which will happen next year. Parkinson’s UK is currently interviewing people with Parkinson’s-related dementia and their carers about their experience of the health and social care system. Initial findings show that carers are struggling with some of the more distressing symptoms of Parkinson’s-related dementia, such as challenging and aggressive behaviour. They also show that NHS support for people with Parkinson’s-related dementia drastically reduces after entering a care home, and that social care staff do not generally understand the condition, leaving families and carers to step in and explain how they should provide care.
Acknowledging the importance of social care to an effective NHS, can the Minister say what progress the Government have made towards a future funding solution for social care, so that people with Parkinson’s dementia are not continually let down?
The cancelled operations, the ambulances queueing outside A&E and the patients dying in corridors are in fact a crisis in social care. NHS budgets may have been ring-fenced, but social care has lost £6 billion from its total spend and the 50% rise in elderly people and others stuck in hospital is because there is nowhere for them to go in the community. Thousands of care homes have closed and more than 30,000 places have been lost because providers can no longer afford to operate on the money they receive from the state. Even those homes that keep going—and there are many of high quality—face a constant battle to keep staff, since the starting wage for a care assistant is about £2,000 a year less than you could earn if you went to work in Asda or Aldi.
I mentioned a whole-system failure, and part of that whole system is of course the huge contribution of unpaid carers to our health and social care system—many noble Lords have mentioned this. Noble Lords would expect me to remind them that this contribution is worth £132 billion a year, or the cost of another whole NHS. But let us not forget the cost to the carers themselves, in terms of their own physical and mental health and the financial strain on them, which is not just the extra costs associated with providing care but the loss of future income because of lost earnings and pension provisions. I acknowledge with pleasure the commitment to carers’ leave in the gracious Speech, but it is to be unpaid so, frankly, it will not help much.
Your Lordships will be familiar with all the arguments about social care that some of us have been making ad nauseam for many years. I will not call that group the “usual suspects”, but after her wonderful maiden speech today I am delighted to welcome my noble friend Lady Wilcox to that group. We are familiar with reports followed by endless delay and indecision about how to tackle the complete unpredictability of the cost of care so that we pray we will die of cancer quickly rather than dementia slowly.
The Minister will quote the £1.5 billion given to local authorities for adult social care. That is a sticking plaster on an open wound, as I have said before in this House. I urge political consensus, as others have done, but we cannot get away from the fact that a very large chunk of money is required immediately to prevent more deaths in a situation which is surely the most pressing problem facing our nation. I have urged the Government before to be honest and bold about tackling this problem. I do so again. I ask the Minister to confirm that we will have an honest and bold proposal before the end of this year.