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My Lords, I declare my membership of the GMC, trusteeship of the Royal College of Ophthalmologists and presidency of GS1, the barcoding association. I too pay tribute to the noble Baroness, Lady Emerton; she was an undoubted tour de force over decades of leading the nursing profession. I particular remember her kindness in attending the badge-giving honours at the Heart of England NHS Foundation Trust, which I chaired; she came and spent about three or four hours with the nurses before travelling on to a meeting in Leeds. She is an extraordinary woman who gave so much to our health service.
The Queen’s Speech promised a Bill on the long-term plan, which I suppose is really a cover for getting rid of the calamitous Health and Social Care Act 2012. Any of us should welcome that, but the problem is that it does not answer the much more substantive question of how we will fund and develop a sustainable health and social care system over the next three decades.
The NHS has done wonderfully well in meeting many of the challenges it has faced over the last nearly 70 years or so, but no one can be in any doubt that, with the growing number of older people with comorbidities and the kind of good pressure that new technology and invention bring, the health service is struggling hugely. The CQC’s annual State of Care report, published only last week, shows that there is huge pressure on all health and care services. Waiting times for treatments are going up, and I fear that we will return to the bad old pre-1997 days unless we take decisive action. We have the wholly unstable adult social care market, which noble Lords have already referred to, and there seems to be general agreement that about 1.4 million people who ought to be receiving care at the moment are not.
The question is how we will respond to this issue. The Government’s immediate response is their own long-term plan, a new five-year settlement of around 3.4% growth per annum. That is of course welcome, in contrast to the years of austerity; when the demand was going up, adult social care was being reduced in real terms and for five years the health service received its lowest ever funding level since its foundation. Obviously, 3.4% real-terms growth is a great improvement on that. The problem, as anyone reading the IFS report on public finance going ahead will know, is that this is a temporary blip—we will return to austerity.
The report of the Long-Term Sustainability of the NHS Committee, excellently chaired by the noble Lord, Lord Patel, was very clear that we cannot go on having this short-term upfunding followed by reductions without any serious attempt to solve the real problem of funding health and social care over the next 20 or 30 years. There are no easy answers: it is pretty clear that the public and the political class as a whole will not see any change in the basic premise of a publicly funded service free at the point of use as far the NHS is concerned; it is also clear that public opinion does not favour any increase in charges. One way or another we have to persuade the public to pay more money through taxes to get us back to a sustainable growth figure.
The only possible way that we can do this is through some kind of hypothecated health and social care tax. It is probably not popular with the Treasury, or with many noble Lords. National insurance is the obvious way to do it; the UK take for national insurance roughly equals the amount we spend on health and social care in England, so it is probably the easiest way to do it. There would have to be changes—as my noble friend reminded me just now, the fact that many of us do not pay national insurance any more while still earning is clearly unacceptable. However, we have to think radically about whether we seriously want to go on funding our health service and whether we want a sustainable, excellent health service.
The committee of the noble Lord, Lord Patel, did not quite recommend a hypothecated tax, although I think that perhaps it was trying to get there. However, it recommended that we set up an OBR for health and social care as well. That is an excellent idea: an independent body giving advice on the long-term funding needs of the health and social care system, alongside workforce projections and demographic challenges. If you put the two together, that would be about the only hope we have of maintaining an excellent health and social care system in the future. The alternative is a long period of austerity with a little bit of growth, no certainty and a continuation of some of the pressures we see at the moment.