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My Lords, I am delighted to make the first contribution to this debate since the defeat of the Government’s programme Motion in the other place.
It is a long time since the last Queen’s Speech in June 2017, but now we have this one and another is due shortly. It is like waiting a long time for a bus and then seeing two of them come almost at once. However, this Speech is more manifesto than legislative programme. It promises that,
“Measures will be brought forward to support and strengthen the National Health Service”.
But those words may be just an election slogan, because the NHS long-term plan is under threat in several ways, and I will outline just three of them.
The first is the obvious lack of a specific funding plan to tackle the social care crisis. We were told in the gracious Speech that proposals will be brought forward to,
“reform adult social care in England”.
However, we were told in the 2017 Speech that:
“My ministers will work to improve social care and will bring forward proposals for consultation”.
Almost two and half years later, we are still waiting. Unless any new proposals are bold, and recognise what we need to pay for, then most, if not all, of the promised extra resources for the NHS will be taken up by looking after people in hospital who really should not be there. These people should be looked after in ways that they prefer, with greater independence and cost-effectiveness, at home or somewhere else outside hospital.
A second threat to the NHS plan is the Government’s lack of commitment to funding public health initiatives to address issues such as obesity, overconsumption of alcohol and tobacco smoking. The OECD estimates that obesity shortens lives by an average of 2.7 years and cuts GDP by 3.3%. It cites specifically the effectiveness of tackling the problem of obesity with measures such as the sugar tax, but this has been branded a “sin tax” by our Prime Minister.
So far, the Government are also failing to follow the successful lead of Scotland by introducing minimum unit pricing for alcohol. In fact, we are going in the opposite direction. Studies conducted using the University of Sheffield’s alcohol policy model suggest that cuts in alcohol duty over the last six years have resulted in not just the loss of £1.2 billion per year in revenue but over 60,000 additional hospital admissions. The additional costs to the NHS are estimated to be around £341 million.
Government funding is also being denied for cost-effective advertising campaigns which promote ways in which people are helped to quit tobacco. The amount spent on these campaigns in 2018-19 is less than half of that spent in 2015-16 and just 10% of the amount spent 10 years ago. Smoking remains the leading cause of preventable, premature death in the UK, killing around 100,000 people every year, which is around 300 people per day. The Government have committed to considering a “polluter pays” approach for the tobacco companies. Although there is no reference to this in the gracious Speech, I hope that they will now act on this principle to help deliver the additional national and local tobacco control activity needed to achieve their own target of a smoke-free England by 2030.
Thirdly, the greatest threat to the long-term sustainability of the NHS may be Brexit itself. The Government are clearly running away from producing an impact assessment of their Brexit deal. They know that our economy will be significantly smaller outside the EU than if we remained within it. Goldman Sachs estimates that the damage already done to the economy by Brexit over the last three years has been around £600 million per year. Brexit means less funding for the NHS and certainly not the additional £350 million per week that was promised. The economic facts contradict the claim painted on the side of that infamous red bus, which was probably the greatest lie of the decade. The NHS has serious staff shortages and Brexit is already causing some of the people we need to leave it.
It is astonishing that all this can be considered a price worth paying for changing our relationship with the EU from one in which we have a voice, a vote and a veto into one that means we will, like other neighbours of the EU, have to spend the rest of our lives negotiating with a much weaker hand than we have at present, accepting much of what we do not like in order to do business.
One reason for supporting Brexit is given by the tobacco lobbyists. They do not like the EU regulations to which we have agreed, which have successfully helped reduce tobacco consumption. Will the Minister confirm that, even if we are outside the EU, the Government will remain committed to maintaining exactly this kind of regulation and achieving the goals set out in their tobacco control policy?