My Lords, this has been an excellent debate with some fascinating speeches. I shall certainly go on the website. There were three interesting maiden speeches. I was fascinated by my noble friend Lord Foster of Bath’s examples of how business and the arts can contribute to our health. Of course, I would say that as a founder member of the Parliament choir—although I am not sure that last night’s excellent concert has particularly enhanced my health.
Last September at the Liberal Democrat party conference, I made a speech about the future of health provision in the UK. I did not spend all my time talking about the NHS because, like the noble Lord, Lord Crisp, I believe that the crisis in the health service cannot be resolved by the NHS alone. The noble Lord and I are clearly on the same wavelength, so I very much welcome this debate.
As many have said, health affects everything: how long we live and our well-being, achievements, family life, contribution to society and, of course, happiness. Yet the NHS is struggling. Some say it has become a sickness service rather than a health service, spending a huge amount of resource fire-fighting preventable diseases, dealing with the complex needs of an ageing population and providing ever more wonderful, but expensive, treatments.
The pressures on NHS staff are enormous, and it seems that no matter how hard they work, how much they care, and how much the Government spend, it is never enough. However, it is incredibly cost effective. Despite spending less per capita on health than most developed nations, the NHS is top in most rankings but next to bottom on living “healthy lives”. So unless we can turn around our public health problems, the pressures on the NHS will continue.
So I agree with the noble Lord, Lord Crisp, that we must stop dealing with health policy in isolation when its implications are so broad. Health should be a “whole government” responsibility, not just the job of the Department of Health. As I said to my party conference, suggesting that health is just the responsibility of the NHS is like expecting the goalkeeper to win the match on his own without the help of the other players. It should be very obvious that the rest of the team have to play their part, too.
The keys to the sustainable future of the health and social care systems are prevention, integration, innovation and “getting it right first time”. If 40% of ill health is due to diet and lifestyle, it is therefore preventable. New ways of working are also vital, and the vanguard sites, set up in response to the NHS Five Year Forward View, demonstrate that better care can be delivered for less if people will only work together. However, we need to ensure that competition legislation does not get in the way of providers working together. They also need the £3.8 billion announced this week to achieve that transformation, yet the Treasury says that the money will be spent on more treatments. Either the money is there to cover part of the shortfall in NHS budgets or it can be used to initiate new ways of working which will bring cost benefits in the future. It cannot do both—you cannot spend money twice.
“Getting it right first time” is the mantra of a number of ground-breaking hospitals that have shown that it is cheaper in the long run to provide excellent services first time round rather than have a lot of readmissions. We also need a complete overhaul of patient discharge and transfer arrangements, which cause bottlenecks and waste money. I am delighted that former Health Minister Paul Burstow is leading a commission on behalf of NHS providers to identify and disseminate best practice on transfers of care. More efficient working will enable the NHS to fulfil its important ambition in the wider picture of sickness prevention, and it should start at the very beginning.
A good start for a baby depends on the health and well-being of its mother and her ability to bond with her child, but perinatal mental health services are patchy—yet this is health creation at its most basic. We need a new standard, delivered everywhere, to promote the future health of the baby and the well-being of the mother. Academics believe that UK children are at a higher risk of premature death than their western European counterparts because of the growing gap between rich and poor and a lack of targeted public health policies. But if a child is born into a low-income family, he is not automatically on a pathway to ill health, as several imaginative interventions have already shown. A new, holistic approach to child health would tackle health inequalities at source.
Moving beyond the NHS’s own role in the health-creating society, it is clear that poverty is a major cause of poor health. According to Sir Michael Marmot’s recent book, 200,000 people die prematurely every year in the UK simply because they are poor. Dealing with the economic divide would go a long way to improving the health of the country and address health inequalities.
Since the foundations of a healthy life are laid in childhood, the Department for Education has a role to play. Liberal Democrats support mandatory personal, social, health and economic education in all state-funded schools, but we still fall far short of that. Children need to know about a healthy diet, the importance of physical activity, how to recognise a respectful relationship as opposed to an abusive one, about the dangers of tobacco, drugs and alcohol, and so on. Therefore they need good-quality PSHE.
A love of sport is often developed at school, and this can stand a child’s health in good stead in the future. I really commend the daily mile, run or walked by every child in St Ninians primary school in Stirling every morning. But many children drop sport as soon as they leave school. This is where the Department for Culture, Media and Sport, local sports clubs and local government come in. But the cuts of the last five years have made it very difficult for them to provide the facilities needed—we just need to look at the number of swimming pools that have closed.
Local authorities are ideally placed to deliver public health interventions that will improve community health outcomes. Yet within a month of being in power on their own, the Conservative Government announced an immediate £200 million cut in public health funding, putting further at risk the health service’s ability to make ends meet. This and yesterday’s further cuts to local authorities are appallingly short-sighted. How can the Government justify it?
Then there is housing. Cold, damp homes foster colds, bronchitis and many other problems. We need more decent affordable homes for families to rent as well as buy, and smaller, well-insulated homes for older people. I am one of those who is currently about to downsize to a highly insulated passive house—a home for life, I hope. Successive Governments have failed on this for decades and, as the cost of energy has risen, even people who have decent homes are finding it hard to heat them. We know that the most cost-effective way to reduce energy bills is good insulation, but much of our old housing stock is poorly insulated. The Green Deal home improvement fund provided funding for energy efficiency improvements to homes, making them greener, cheaper, warmer and of course healthier. But the Conservative Government decided to cut it. Where now will people get help to make their homes warmer and healthier?
The Department for Transport does not escape responsibility. Air pollution causes major problems for asthmatics such as myself and others. Transport policies therefore play a part. I have heard it rumoured that, alongside cutting the subsidy for solar and wind power, the Government are now planning to cut the £5,000 subsidy for electric cars. Can the Minister confirm or deny this?
If health is a whole-government issue, which I believe it is, it requires proper oversight. My answer is very slightly different from that of the noble Baroness, Lady Jay. I would like to see the Government beef up the Cabinet Committee on Health, headed by a senior Minister and involving all relevant departments at a senior level to ensure that all government policies can be scrutinised as to whether they contribute to the better health of the nation. There can be no better focus for a Government if they are truly concerned about the well-being of their people. I also believe that the Chancellor of the Exchequer should be answerable to Parliament for the health consequences of his policies.
The NHS is supported by the whole nation. It must be supported by all of government, national and local. Let us not leave it to the goalkeeper. Let us ensure that the whole team contributes to winning the cup.