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My Lords, in my brief speaking time, I will focus on three important issues: first, the Government’s proposals to reform adult social care; secondly, the NHS long-term plan, prioritising prevention in an ageing world; and, thirdly, the Domestic Abuse Bill.
While I welcome the additional funding that the Government have announced for social care, what legislation can this House expect to scrutinise in this Session—or, perhaps I should say, the next Session of Parliament? Over the past 25 years, we have seen a lot of policy reports on how to reform adult social care but little substantive action. The problem has not gone away and will not do so until it is solved, which is why I hesitate to recommend another report to the Minister. She will no doubt be aware that, in July this year, the Intergenerational Fairness Forum, which I chair, published a cross-party report, Sustainable Funding for Social Care & Intergenerational Fairness. It put forward a range of recommendations seeking to build consensus through the prism of intergenerational fairness. In brief, the report recommended a Dilnot-style funding system built on a national pooling of risk, with a means-tested threshold for personal contributions and a cap on overall care costs. This would be partly paid for by a 1% social care insurance contribution for those aged over 40 until they retire and the replacement of higher-rate pension tax relief with a new, flat-rate relief below 40%, along with other tax and benefit changes to meet the existing, unmet demands for care. I hope that the Minister will consider these suggestions.
On the NHS long-term plan and prevention, I welcome the commitment to strengthen our NHS by addressing workforce shortages and improving service delivery, building on the set of recommendations published by the NHS last month. According to projections by the Nuffield Trust released this year, there is a current shortage of one in 12 NHS staff. Strengthening the NHS is especially important in the context of an ageing society, as recognised by the Government’s healthy ageing challenge. We know that there are currently 10 million people aged 65 and above living in the UK; that number is expected almost to double, to 19 million, by 2050. This means that we will see greater strain on health services still, and a growing number of limiting co-morbidities that require more costly and complicated secondary and tertiary care services. To ensure the future sustainability of our NHS, and to support people to lead longer, healthier and more productive lives, the prevention of ill health is crucial.
Therefore, I welcome the fact that,
“The Long Term Plan sets out how Government will improve the prevention, detection, treatment and recovery from major diseases, including cancer, heart attacks and strokes”.
However, the ambition should go further and be global, which is why the International Longevity Centre UK has launched an international programme of work, entitled “Prevention in an ageing world”. It is estimated that, in 2017 alone, 27.1 million years were lived with disability due to largely preventable diseases; that number is projected to increase by 17% in the next 25 years if we do not prioritise the prevention of ill health right across the life course. It was therefore welcome that the G20 leaders’ summit in Osaka this summer—and the G20 Health Ministers only last week—pledged to promote prevention across the life course. I hope that the Minister can help ensure that the UK positions itself as a world leader in the prevention of disease.
On the Domestic Abuse Bill, I am largely pleased that the legislation has now been carried over from the last Session, and I look forward to this House’s scrutiny of the Bill when it reaches us. However, I am concerned that the Government did not accept the recommendations of the Joint Committee, which considered the draft Bill, regarding the definitions of the “same household” criterion and “personally connected”. We may also wish to clarify further how abuse by carers is covered by the Bill, because domestic abuse is more than just abuse by a spouse. Depending on what amendments the other place makes to the Bill, I suggest to the Minister that we may wish to amend the Bill particularly in this respect.