My Lords, I thank the Minister for his introduction to our debate and, like him, I welcome our maiden speakers, who we all look forward to listening to later. I also refer noble Lords to my health interests as set out in the register.
With the country facing so many formidable challenges, last Wednesday’s Queen’s Speech was an opportunity for the Government to outline a positive agenda for jobs and growth, and to help hard-pressed families cope with the drastic fall in living standards, but positive change it was not. Instead, we were treated to a desperately disappointing and dispiriting programme from a Government who are out of touch, out of ideas, and out of support from a significant number of their own MPs. Nowhere is that more evident than in the subjects we are covering today: in welfare, where the welfare bill continues to rise, the universal benefits scheme is in trouble, and the Work Programme simply is not getting the long-term unemployed into work; in energy, where the dithering and discord between the Treasury and the Department for Energy and Climate Change is putting our energy supply at risk and investment in renewable and nuclear energy in jeopardy; in the environment, where the Prime Minister’s claim to lead the greenest Government ever lies in tatters; in agriculture, where the water Bill is effectively only half a Bill that fails to deal with public affordability; in culture, media and sport, where we have no communications Bill and our wonderful Olympic legacy has been squandered as schools sport provision has been woefully undermined by Mr Gove; and in education, with no plans for vocational education and the Government’s lamentable plan to weaken early years childcare ratios in total chaos.
However, nowhere is the Government’s stewardship so much in evidence in terms of failure than in the field of health and social care. The Government’s backtracking on public health is but one example. The noble Earl who is to wind up our debate later will know that the scale of health inequalities in the UK is formidable. He also knows that smoking is one of the most important contributors to ill health and early death. That is why there was such a warm welcome when reports emanated from Whitehall in the spring promising legislation to enforce plain packaging for cigarettes. Why was there no mention of the Bill in the Queen’s Speech, and why no Bill to set a minimum price for alcohol? Does the noble Earl agree with his colleague, Dr Sarah Wollaston MP, who has said that a U-turn on plain packaging would send a message that public health has been completely abandoned by the coalition?
I would also like to ask the noble Earl about the establishment of Health Education England, which is set out in the Care Bill. I note Schedule 5 to the Bill regarding the make-up of its board and would ask him whether he will ensure that there is a balance of non-executives in terms of gender and diversity. I ask him that because I was astounded to learn that all of the non-executives on the advisory board of Public Health England are men, including the chairman. I am equally astounded that my noble friend Lady Massey of Darwen, having gone through all due process, was vetoed by Ministers from joining the board. Why was that so?
We then come to the health implications of the Government’s immigration measures. They have made much of their proposals to ensure that only NHS patients who properly qualify for the NHS should get free treatment. No one would quarrel with that as a proposition, but it is clear that the Government do not have a clue how to implement their proposals, apart from forcing GPs into the role of immigration officers. The existing guidance produced by the Government on the charging of overseas patients is 90 pages long. It is one of the most incomprehensible pieces of draftsmanship that I have ever seen.
The highly respected Nuffield Trust showed in 2011 that immigrants are far less likely to use hospital services than the general population. On the Francis report and the legislation contained in the Care Bill, I certainly look forward to debating Ofsted-style ratings for NHS hospitals and I support the intention to make it a criminal offence for NHS and social care organisations to provide false or misleading information about their performance. But why is the duty of candour restricted to hospitals and other service providers? Why should commissioning bodies such as clinical commissioning groups and NHS England not have a similar duty apply to them? Mr Robert Francis called today for more honesty from the NHS. However, that means all of the NHS. I also echo some questions asked by Mr Francis. Why are the Government not providing for the ability to prosecute individual staff in the case of serious patient neglect? Why are the Government refusing to merge CQC and Monitor into a single organisation? What response does the noble Earl have to Mr Francis, who warns of the potential of a communications failure between the two organisations?
The Government claim that the Care Bill, which is probably one of the most important Bills that this House will debate in the next few weeks, will reform the way long-term care is paid for to ensure that the elderly do not have to sell their homes to meet their care bills. The Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation initiated by the previous Government and on the proposals in Labour’s White Paper before the last election. The Bill may well be a step towards a better system but the key question I put to the noble Earl is this: where is the funding to implement it? On its own, the Bill will not go anywhere near far enough in tackling the crisis that is now engulfing health and social care, openly acknowledged by the Secretary of State. We have hospitals full to bursting, discharge is becoming ever more difficult, and handovers to social services are slower and subject to more disputes. Social care and the voluntary sector are struggling to fulfil demands placed on them. On the front line, thousands of nursing posts have been lost and many services are under pressure. In social care, the recent report of the Association of Directors of Adult Social Services laid bare the scale and severity of the financial squeeze on councils: £2.7 billion stripped from adult social care services since 2010, equivalent to 20% of their care budgets, even as demand for those services continues to rise.
Ministers have today been forced to announce new measures to get the NHS and social care working together in integrated teams. However, the whole reform programme of enforced marketisation has actually encouraged the opposite—the fragmentation of services. At national level there is utter confusion as to who is in charge. We have even had NHS England arguing with the Secretary of State over the release of money to help hard-pressed accident and emergency services. The Secretary of State has finally grasped that the A&E crisis is a crisis of the whole system but NHS England persists in its foolish approach of blaming everyone but itself. How else to explain the bullying of clinical commissioning groups to fine those very same hard-pressed A&E and ambulance services? The Secretary of State itches to intervene, but his powers are limited because his predecessor and the noble Earl were adamant that they wanted to hand powers over to a quango, NHS England. No wonder Chris Hopson, chief executive of the Foundation Trust Network, described the Government’s response to the A&E problems as an “omnishambles”.
The Care Bill may well be a step towards a better system but new rights to services and support risk being meaningless as council budgets are cut to the bone and people are faced with spiralling charges. Many searching questions remain to be asked about the Government’s proposals. Can the noble Earl confirm that Andrew Dilnot warned that anything above a
£50,000 cap on care costs would not provide enough protection to people with low incomes and wealth? Can he explain the rationale of persisting with a £72,000 cap? Has the noble Earl seen a paper published today by the LSE and the University of East Anglia which points out that the government proposals will provide greater benefit to relatively better off older people? What will the Government do to provide help for those of relatively low to modest means?
Dilnot hoped that the capping of care costs would lead to appropriate private insurance packages coming on to the market. Can the noble Earl tell us what discussions he has had with the ABI to stimulate such a market? Will he confirm that the cap on care payments does not include the hotel costs that a care home will charge, and that people in residential care will still need to pay up to £12,000 a year to fund their accommodation and living expenses?
Does the noble Earl accept that the national eligibility scheme will not work if it acts to restrict services for many people? Can he respond to the comments made by Age UK, which said that in the majority of councils only those assessed as having “substantial” care needs are now able to access the current system? It says that unless the Government set the proposed national eligibility criteria at the equivalent of “moderate”, hundreds of thousands of people who cannot carry out tasks such as washing, getting dressed and preparing food and laundry will be left without any help.
The contribution of carers to our society can never be overestimated. Why are there no provisions in the Bill for adults caring for children, and young carers? As Barnardo’s says, young carers represent a uniquely valuable group of people whom the Government should be ensuring receive help to address the very serious effects that caring has on their lives.
I would also welcome the noble Earl’s response to the point made by the Joint Committee in its scrutiny of the draft Bill, when it said:
“The introduction of a capped cost scheme, which will result in many more people”— including self-funders—
“being assessed and entitled to a personal budget is likely to lead to an increase in disputes and legal challenges”.
The committee was,
“not confident that Ministers have yet fully thought through the implications for local authorities of these changes”.
Can the Minister comment?
Of course, we will explore these issues in greater detail in Committee, but however much we scrutinise the Bill it looks set to do little to help those who currently face a daily struggle to get the support they need. This is echoed by the Joint Committee, which said that,
“care and support have increasingly been rationed and restricted to those with the highest levels of need. This is ultimately self-defeating—shunting costs and reinforcing the dominance of crisis and acute care over approaches that prevent and postpone the need for formal care and support”.
The Government say they are acting to help people with care costs but the reality behind the spin is that under this Government people’s savings are being washed away. Ministers are promising to give a little in the future with one hand, while social care provision is collapsing in the other.
Above all, we need a genuinely integrated NHS and social care system, which helps older people stay healthy and live independently in their own homes for as long as possible. That is why Labour’s proposals for whole-person care are so important. This is surely one of society’s greatest challenges, which we need to tackle with urgency. In the absence of any such vision in the Queen’s Speech, it will be Labour’s mission to achieve this after the next election.