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My Lords, I am focusing on health and social care. My noble friend Lady Sherlock’s excellent speech made clear the context in which the Government’s recent rush to show their concern and commitment to the NHS needs to be seen. There have been swingeing cuts since 2010—just to remind ourselves how long this Government have been in office—staff vacancies in key areas such as GPs, nursing, psychiatrists and vital specialities such as radiography are at a record high, and there is still no specific funding allocated to implement the NHS staffing plan, which was finally published earlier this year after a two-year wait. There are some 4.4 million people on NHS waiting lists, nearly 65,000 people have been left stranded on hospital trolleys for four hours or longer, and thousands are waiting in anguish and distress for cancer treatment. Five out of eight of the cancer waiting-time targets were missed in August, including the 62-day waiting-time target which has not been met since December 2015.
The CQC’s state of care report warns of a perfect storm across health and social care, where people cannot access the services they need or where care is provided too late, pushing the NHS and social care nearer and nearer to the tipping point it warned of last year.
We know that two definite health Bills are promised. One is on patient safety investigations and the other is on medicines and medical devices, to try to pick up the pieces after we fall out of EU regulation on clinical trials and access to medicines post Brexit, and to develop new ways of regulating personalised medicine and medical AI. We welcome both Bills and will work constructively with the Government and noble Lords across the House to ensure the vital improvements to patient safety and the access to innovative treatments that are so urgently needed.
“to free up different parts of the NHS to work together and with partners more easily”,
but in reality to dismantle the heavy, laden and bureaucratic structures set up under the Government’s flagship Health and Social Care Act 2012, which have proved such a huge and costly disaster for the NHS. We currently have the ludicrous situation of authorities across the country desperately working around the 2012 Act to try to build the integrated primary and acute care and multispeciality community systems across local authorities and NHS and community settings which implement the NHS long-term plan. Can the Minister tell the House what work has been done with NHS England to develop legislative proposals on a new statutory framework? What is the proposed timescale for the Bill? Is she confident that the work currently being undertaken through CCGs on integrated care system, PACs and MCPs will proceed effectively within the legal and statutory authority contained in the 2012 Act?
I remind the House, too, that it was this Act that abolished the National Patient Safety Agency, against strident opposition from noble Lords across the House. From an initial reading of the Bill, many of the functions of the proposed new Health Service Safety Investigations Body were undertaken successfully by the NPSA. Does the Minister accept that abolishing that body has proved to be yet another damaging retrograde step under the 2012 Act?
On social care, we have had shameful and inexcusable inaction and delay since the Government abandoned the Care Act and the Dilnot provisions for capping the costs of care in 2016, despite strong cross-party support. Successive Prime Ministers and Health Ministers have all given hollow pledges about “getting on with the job” and have told us that a Green Paper is “imminent”. Now Boris Johnson has promised to fix it all, “once and for all” with the “clear plan” that he has prepared. But we now see that there has been no preparation: he has nothing new to offer. Indeed, recent press reports have revealed that No. 10 is still mulling over all the familiar options, including going back to the care cap and free personal care to match Labour’s long-standing commitments on this.
Meanwhile, the social care crisis continues to get worse. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down; nearly 1.3 million have developed an unmet need for basic care support such as washing, dressing or going to the toilet. Macmillan research shows that 8% of people living with cancer who have a critical or substantial need and who should qualify for council support receive no practical help at all, with 60% of their carers experiencing stress, anxiety or depression.
The Alzheimer’s Society estimates that, over the past 26 months, there have been more than 500,000 delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Where is the PM’s “clear plan”? Does this mean the Green Paper has actually been drafted? What is holding it up? The recent IPPR report showed that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs.
Your Lordships’ economic committee produced an excellent report on what it recognised as the “national scandal” of social care, advocating free personal care for the over-65s. Surely this is one of the first steps to solving the care crisis. What plans are there in place to fulfil Mr Johnson’s pledge to provide older people with the dignity and security they deserve and prevent them from having to sell their homes to meet crippling care costs? In the Minister’s response, I hope she will not simply repeat the Government’s stock answer that we have heard today on so-called extra funding. The King’s Fund, Nuffield Trust and Health Foundation have independently identified both the huge scale of government and local authority social care cuts and the £2.5 billion investment needed just to keep the system afloat in the short term. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for their future care needs.
Finally, on a more positive note, we welcome the pledge to continue the work on the reform of the Mental Health Act following the excellent review last year. However, we are very disappointed not to see a detailed timetable for the actual Bill that has been promised. The CQC State of Care report is again a sharp reality check on the deteriorating state of mental health care. Can the Minister explain why the Government’s NHS capital announcements so far have failed to mention or include urgent funding for mental health hospitals and trusts, which the review has made clear are the worst estate in the NHS?