My Lords, it is a pleasure to follow the noble Lord, Lord Patel. We enjoyed his deferential tribute to the noble Baroness, Lady Emerton, and I shall pick up in a moment what he and other noble Lords have said about social care. My noble friend who is replying to this debate has a long frontier to patrol, so perhaps I can make her task easier by saying that I want no mention in her wind-up speech.
I want to make three brief points on health. First, the Department of Health has set a great example to every other government department in that, since 2010, it has had only three Secretaries of State. Contrast that with the eight Secretaries of State at DCMS, seven Secretaries of State at both DWP and Justice over the same period, or indeed the nine Housing Ministers over nine years.
Why is this important? It takes time for a Secretary of State to build an effective team of Ministers; to understand and, at times, change the culture of a department; to build relationships with the external stakeholders, often crucial to the success of the department; to build a relationship with the parliamentarians and Select Committees who are holding that department to account; and to build a political base for support for reform. You simply cannot do that if there is a constant churn at the top of a department. No other organisation— commercial or voluntary—would tolerate that instability, and nor should a government department which spends billions of pounds, employs thousands of people and provides key services to the country. So, if Ministers cannot match the excellent continuity of service of Her Majesty the Queen, perhaps Prime Ministers should strive for greater stability, such as we have seen in health.
My second point concerns the balance between curative medicine on the one hand and preventive medicine on the other. Like other noble Lords, I welcome the commitment to extra funding for the NHS. The CQC report last week, State of Care, underlines the pressure on A&E and the staff shortages—the justification for the extra resources—and I welcome the Bills in the Queen’s Speech.
However, we are now reaching the point of diminishing returns from investment in curative medicine. The major improvements that we all want to see in the nation’s health will come from lifestyle changes and public health measures. My noble friend the Minister, in the department in a previous capacity, was responsible for public health and took some commendable decisions, which I applaud. I hope that she escapes my fate when I was Public Health Minister in 1981 and Dennis Thatcher persuaded his wife to transfer me to another department because of my aggressive stance towards the tobacco companies.
Against that imperative of focusing on public health to achieve real improvements, noble Lords will understand my alarm at reading in the Telegraph on
It went on to say:
I assume that he has subsequently relented, as he now refers to himself as a one-nation Tory leading a one-nation Government. As a former chairman of One Nation in another place, I am delighted that he is now one of us. However, one-nation Conservatism embraces a benign paternalism that is prepared to take public health measures in the national interest. We are suspicious of neoliberalism, with its overreliance on the free market with minimum state intervention, as implied in the quotation to which I referred.
Noble Lords may recall the cries of “nanny state” whenever people make this speech. I remember hearing it when we debated the compulsory wearing of seat belts—which was introduced by a Conservative Government—with crash helmets for motorcyclists, with health warnings on cigarettes and with the banning of smoking in public places. No one would now go back on those reforms, which have saved countless lives and reduced demands on the NHS.
However, we need to build on them, giving adequate resources to Public Health England and to local authorities for their public health responsibilities. Making England smoke free by 2030, which is the objective of the prevention Green Paper, will require introducing measures so far turned down, some of them based on the polluter pays principle.
Tackling tooth decay will involve revisiting the regime for introducing fluoride. Tackling obesity, which was mentioned by the noble Baroness, Lady Massey, will involve more radical measures than those so far introduced, such as a sugar tax. We should look again at minimum prices for alcohol, where the initial response in Scotland has been positive. So, although it is controversial, I want to see more emphasis on preventive medicine and a willingness to take decisions that may initially be unpopular with the right-wing press but that are right for the nation.
My final point is about social care for the elderly, and this is not a happy story. The Queen’s Speech says:
“My Government will bring forward proposals to reform adult social care in England to ensure dignity in old age”.
Noble Lords may ask where they have heard those words before. In 1997, the then Health Secretary, Frank Dobson, said that the arrangements for long-term care of older people were so unsatisfactory that they,
“cannot be allowed to continue for much longer”.—[
The Queen’s Speech in December 2000 said:
“The legislation will also take forward my Government’s response to the Royal Commission on Long Term Care for the Elderly”.
That was the Sutherland commission. Nothing happened. At the end of their time in office, the Labour Government were back where they started with the July 2009 Green Paper Shaping the Future of Care Together. The coalition agreement echoed what Labour said in 1997:
“We will establish a commission on long-term care, to report within a year”.
The Dilnot commission, which was mentioned by the noble Baroness, Lady Bakewell, suffered the same fate as Sutherland. The Queen’s Speech in 2017 said:
“My Ministers will work to improve social care and will bring forward proposals for consultation”.
They are still awaited.
This makes the negotiations with the EU positively streamlined—and in this case we are negotiating with ourselves. I recognise that in the fag end of this Parliament we are unlikely to make progress, but at least let us have the promised Green Paper, narrowing the range of options and building a consensus, so that when we next debate the Queen’s Speech we can welcome measures, rather than proposals, to ensure dignity in old age.