My Lords, I thank the noble Lord, Lord Darzi, for introducing this important debate. It is a privilege to follow him, as a fellow surgeon. The debate marks the 70th birthday of the NHS and the social care system, and the role that Aneurin Bevan played in it. Making our health service free at the point of need and use while social care remains means-tested has created an unfair system. Equal opportunities and the emancipation of the workforce has meant that an army of carers which used to exist to look after one’s own is no longer there, and increasingly we turn to care homes for our elderly.
The noble Lords, Lord Darzi and Lord Prior, in their excellent report Better Health and Care for All, published in June, focused on social care, public health and life sciences. This debate makes the case for integrated health, mental health, social care and community care. The creation of a Department of Health and Social Care this year is a welcome first step in recognising the importance of integration. This report makes the case for releasing time for health professionals to care and makes a plea to trust the judgment of professionals. These words are welcome in a health service where professionals feel that top-down management calls the shots, rather than those at the coalface—that is not meant to be a reference to Tredegar.
The challenge for government is to extend the principle of need and not the ability to pay to social care and to fully fund the service as part of a new social contract between citizen and state. We await the Government’s Green Paper on social care, alongside the NHS plan, in the autumn with keen interest, mindful that in the past 20 years, with 12 Green Papers and White Papers and five independent commissions, successive Governments have kicked the can down the road when social care reform is considered. The Government accepted the proposals in the Dilnot report of 2011, albeit with a different cap, yet in 2018 we do not have any action on them. I am sure that my friend, the noble Lord, Lord Warner, will say something about that in his speech. Can we expect a definitive statement on this, along with the Green Paper, in the autumn?
There also needs to be a paradigm shift in the model of urgent and emergency care, the workforce to deliver it and the contribution of patients to manage their own health. The days of “doctor knows best”—let alone politicians or managers—are over. As chairman of the Independent Reconfiguration Panel, which advises the Secretary of State for Health on contested service change, I know that a sound clinical case for change is necessary but not sufficient to achieve change. For that to happen in the future, the views of patients and the public must lead the decisions about their health and healthcare. The challenge, as always, is how to achieve that in a meaningful and effective way.