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My Lords, I have recently had cause to be very grateful to the NHS and its dedicated staff. However, a service that leaves a vulnerable elderly patient in A&E waiting seven hours to see a doctor and, on two other occasions, waiting in A&E for a bed in a ward for 12 hours and overnight is a service that is either inadequately resourced or inadequately staffed, and probably both. Patients are well named in the health service of today.
The health service relies on a thriving economy to provide its funding. This Government have played fast and loose with the prospects for our health service by their relentless pursuit of the hardest of hard exits from the European Union, within which our economy has thrived for more than 40 years. Brexit has already cost our economy £70 billion. It has also hit NHS staffing hard, with many well-trained and well-motivated staff either going home or not coming here at all.
Why are so many A&E departments not reaching the target of seeing 95% of patients within four hours? It is not because the staff are not working hard. Clearly the reasons are complex, and demographics play a part. There are people who go to A&E who could have used other services. Here, I stress that all three visits I mentioned earlier were made after all other sources of help had been tried.
However, two elements of the problem are outside A&E. One is delayed transfers of care, meaning that beds are occupied by patients who would be much better off at home with support or in social care. The second lies in primary care. Therefore, when I heard the Prime Minister’s headline-grabbing claim that his Government will build 40 new hospitals, I looked at it very closely and found that it is really only six new hospitals and a bit of seed corn money for the rest. More importantly, I realise that this unelected Prime Minister has no idea what the problem really is if he thinks that the solution is six new hospitals.
Patients who cannot get to see their GP will go where the lights are on, and that is A&E. It is very common for patients to have to wait three weeks to see their GP, and that is unacceptable. In many parts of the country, there are not enough GPs. In some places, this problem has been tackled by GP practices taking on other professionals to lighten the load on the doctor. This is an enlightened approach but it requires forward planning, funding and suitable premises. In the case of my local primary care services, that is not happening. There are no suitable premises for a modern all-service primary care facility, and that can make it hard to attract GPs. Therefore, to move to an efficient primary care service and reduce the pressure on A&E, we need funding and planning, but we are unlikely to get that from a Government intent on damaging our economy and promising not to increase taxes. Of course, the best course is to avoid damaging our economy and our health service by remaining in the EU.
The other way to reduce pressure on our health services is to prevent ill health, and I absolutely agree with the gist of the speech of the noble Lord, Lord Young of Cookham. I welcome the focus on prevention in the NHS Five Year Forward View. However, I would like to mention a preventable cause of illness which the noble Lord, Lord Young, did not mention and which is linked to another of the Government’s stated objectives—that is, action on climate change.
Outside this building for the past two weeks, thousands of citizens have demanded urgent action on the climate change crisis. They did so while breathing air that has 50% more of the most dangerous small particulates than the WHO recommended maximum. In London, the average level of PM2.5 is 15 micrograms per cubic metre, while the WHO recommended limit is 10. Polluted air kills about 40,000 people a year. It causes respiratory and cardiovascular illness and affects the brain development of babies and young children. There is evidence that older people who breathe polluted air have a steeper reduction in cognition with advancing age compared with clean air breathers. Research from the University of Warwick shows a significant reduction in memory, equivalent to ageing 10 years, in those who breathe polluted air. Polluted air therefore attacks our thinking power as well as our health.
Tackling climate change from the health perspective is also the right thing to do for the planet. It is bad for your health and tackling it is the healthy option, but the forthcoming Environment Bill needs to go further. It promises legally binding limits on air pollution but we have not been told what those will be. Actually, we already have them within the EU but have continually failed to reach them. What is required, as called for by the All-Party Parliamentary Group on Air Pollution, is much more than painting the number plates of electric cars green; it is a phased reduction in the legal limit for PM2.5 to 15 by 2020, 12 by 2025 and 10 by 2030. This would provide the incentive to government and local councils to reduce car use and speed up the introduction of non-polluting electric and hydrogen-powered vehicles, while bringing forward the phasing out of those powered by fossil fuels to 2030. We need radical action on charging and refill infrastructure. This would help the UK meet its climate change commitments, which it is otherwise unlikely to do.
The proposed office of environmental protection also falls short. We need an independent body capable of rigorous scrutiny, with powers to investigate and gain access to data and the ability to monitor and force compliance and take Ministers to court if they fail to address these issues. We need these things for our health’s sake and our planet’s sake. So will the Government support the Private Members’ Bills introduced today by my noble friend Lord Tope and the noble Baroness, Lady Jones of Moulsecoomb? That would be a step in the right direction.