My Lords, I join other noble Lords in thanking the noble Lord, Lord Darzi, for tabling this timely debate and for his excellent speech in kicking it off. It is one of those speeches that we will want to reread, and we will need to pick up a copy of Hansard on Monday.
These Benches are proud that on this day 70 years ago the Leader in your Lordships’ House was Lord Beveridge, author of the report implemented by the Attlee Government, thus creating the NHS and social care entitlement. So perhaps this is true co-production.
I start by noting the contribution to today’s NHS of all the staff who over the last 70 years have worked tirelessly, whether as clinicians, carers, cleaners or managers, and I pay tribute to the current employees too. But what would somebody from 1948 make of the NHS now? My father-in-law graduated from Leeds medical school in that year and was one of the first cohort of NHS doctors—and very proud he was too. He recalled that there was a handful of drugs that they could prescribe, and after their six years’ training they knew pretty well all the medicines that there were to know. Later, he ran a GP practice from his home. One room became the waiting room and another the surgery. The family recall syringes being sterilised on the kitchen stove. He and a partner set up a practice which grew and grew, and it still exists. Today, I think he would be delighted to see his practice offer patients the ability to book appointments online and order repeat prescriptions, but he might be rather bemused by the need for a practice Facebook page.
Today, the life expectancy for men is 77 and for women 81. Then, it was 66 and 71. I think several of us have been looking at different briefings with different numbers, but the numbers are in the right sort of order. No one quite appreciated the impact of the impending baby boom rippling through the population. Most of the residents in today’s care homes were born before the NHS came into existence, and unless we mend our lifestyles a large proportion of us will not live as long as our parents.
In the new NHS, public health and prevention was important. I remember queuing in the village hall for cod liver oil, orange juice and polio jabs, and once at school we had nit inspections, eye and hearing tests, and TB jabs. Public health looks very different today—gone are the nit inspections—but local authorities have public health responsibility all over again. They look at health as a determinant in housing, social care and wider community services.
Prior to the NHS, the first port of call often was the high-street chemist for a chat with the pharmacist, who would be able to recommend the right remedy. This conversation was free, and a visit to the GP was out of reach for many. Now, too many of us visit our GPs expecting a prescription when we have a cough, cold or sore throat. We are unaware that we can get better with the help and advice of the pharmacist. If this was to be adopted as the first port of call by us all, our GPs would have time to deal with the people who are really poorly.
There cannot be a sustainable NHS without sustainable adult social care. Adequately funding social care would deliver benefits for local communities and savings for the public purse. For example, funding an expansion in social care capacity would alleviate NHS pressures and therefore enable more people to be discharged quickly and safely from hospital. We all have friends and relatives who, whether due to age, ill health or dementia, have found themselves in need of social care. The continued underfunding of social care affects us all. It is making it increasingly challenging for local authorities to fulfil their legal duties under the Care Act, leaving the ambitions of some aspects of the legislation at risk. Equally concerning is that, by 2025, another 350,000 people will need high levels of social care from councils. As the ADASS budget survey highlights, moving towards prevention and early intervention is one of the most important savings areas identified by councils. However, as budgets reduce, it becomes harder for councils to manage the tension between prioritising statutory duties towards those with the greatest needs and investing in services that will prevent and reduce future needs.
The current move towards integrated care organisations is welcome, but success will depend on strong leadership and a willingness of both health and care to co-operate, to share a budget and to involve patients, those in care and carers, and the voluntary sector in system design. As mentioned by the noble Baroness, Lady Morris of Bolton, the initiative currently under way in Greater Manchester, where 10 councils came together to deliver health and care services locally, has much potential. We await evidence of success and impact on the health community. In Cornwall, my part of the world, for the last year or so the local council has been working closely with the CCG to achieve the same end but on a much smaller scale and in a rural setting. However, where any services are devolved, we are also clear that national standards need to remain and that accountability will be key. As a quick note to the noble Baroness, Lady Gardner of Parkes, Cornwall still has all its community hospitals and they are used as step-up and step-down units. The challenge posed by the increased localisation of services is the risk of a postcode lottery in both availability and standards. Those local councils where there was the greatest need have low-rated housing, and any dividend from raising council tax is not enough to plug a gap.
Almost two years ago now, my right honourable friend Norman Lamb commissioned a group of experts from within the sector to look at the vexed issue of funding the NHS and social care. Among the recommendations were an annual rise in real-terms funding for the NHS in England in line with long-term growth. For the next five years, we believe that a 2% rise per year is a realistic figure. This should be matched by equivalent increases in funding for the devolved nations under the Barnett formula. A further recommendation was to set up an independent OBR for health to make recommendations to government about the funding required for a three-year cycle.
Recently, the noble Lord, Lord Patel, who sadly is not in his place, chaired a Select Committee of the House on the long-term sustainability of the NHS and adult social care. This was a look at the current system by a group of Peers with long experience of working in the NHS, government and social care. Their report was full of positive recommendations—it read like a critical friend’s review of an organisation in need of change. It took the Government some time to bring it to the House for debate; let us hope it takes less time to implement some of the recommendations.
Artificial intelligence, biosimilars, genomic medicine and robotic surgery would have been unimaginable to those doctors in 1948, but who knows what the next 70 years will bring. In many areas, we are on the cusp of system failure yet, in others, huge system innovation. Organisations needing support should be encouraged, not punished. The Government need to be bold in their decisions and announcements in November. The Green Paper on social Care and its funding should be person-centred, encourage creative solutions and provide the necessary funding to deliver appropriate support for the NHS and for its stable future.