My Lords, it has been a pleasure and a privilege to serve on the Public Services Committee under the exemplary leadership of the noble Baroness, Lady Armstrong. I too thank our excellent committee staff.
Our first inquiry offered a unique opportunity to examine the state of public services in response to the pandemic, to acknowledge the positives, the amazing innovations to meet the Covid challenges and the incredible dedication of front-line workers, and to identify what needs to change as part of a major programme of public service transformation.
As we have already heard, the committee identified a number of fundamental weaknesses which must be addressed to make services resilient enough to withstand future crises. These included insufficient support for prevention and early intervention, overcentralised delivery of public services, poor communication from the centre, a tendency for service providers to work in silos and a lack of integration, especially in services working with vulnerable children and between health and social care. None of this is new—indeed, it will be depressingly familiar to many in your Lordships’ House—so why has it proved so difficult to move the dial: inertia, lack of political will or not?
As we have heard, the committee identified a number of key principles for public service reform which will require a fundamentally different mindset. I highlight just three: first, the vital role of preventive services in reducing the deep inequalities that have been exacerbated by Covid; secondly, central government and national service providers radically improving how they communicate and co-operate with local-level service providers; and, thirdly, the much-needed integration of services—the joining up of the silos—which is best achieved by public service providers working together, certainly at the local level but, critically, supported by joined-up working across government departments at the national level.
Other noble Lords have already highlighted the importance of preventive action. One of the report’s key recommendations was that an approach to public health that focused on preventing health inequalities would pay real dividends by increasing the resilience of communities and reducing the pressure on the NHS when a crisis occurred. The committee heard that many deaths from Covid could have been avoided if preventive public health services had been better funded. Therefore, I am disappointed that the Government have not committed to publishing a public health strategy to reduce health inequalities to fulfil their 2019 general election manifesto commitment to
“extend healthy life expectancy by five years by 2035”.
I join other noble Lords in asking the Minister when the Government intend to set out their plans for doing this. What assurances can he give that the Health and Care Bill will place clear duties on integrated care boards to reduce health inequalities, with sharp lines of accountability?
On the lack of integration between health and social care, our conclusions were stark. They were that
“the Government’s own pandemic planning … identified that social care would need significant support during the outbreak of a disease like COVID-19, yet social care was the poor relation to the NHS when it came to funding” and allocation of PPE during the first lockdown. Discharging people from hospitals into care settings without testing and with inadequate PPE led to the tragic loss of the lives of thousands of older and disabled people. Our evidence suggested that the failures in adult care resulted from insufficient planning coupled with years of underfunding. The Nuffield Trust told us that although the Government’s 2016 pandemic planning exercise, Exercise Cygnus, had shown that care homes and domiciliary care
“would be in need of significant support in a pandemic”,
no advance arrangements were put in place to meet those needs. It concluded that integration between health and social care hinged on reform in three key areas: first, parity of resources; secondly, equal visibility and priority in policy-making, and, thirdly, commitment to better data collection and sharing. These things lie at the very heart of the report’s findings.
A further key issue revealed in our excellent international evidence, already referred to by the noble Lord, Lord Young, was on health system resilience—specifically, the need to build in spare capacity rather than have the NHS run continually at red-hot levels of bed occupancy. It was salutary to learn that the UK has 2.7 hospital beds per 1,000 of the population, compared to an EU average of 5.2—far lower than Germany with 8.2 and France with 6.2.
The committee produced 41 recommendations for government, including recognising the vital role of preventative services and early intervention and committing to interim funding to ensure that adult social care gets sufficient support to protect older and disabled people in any further waves of coronavirus and future pandemics. In short, it came up with a comprehensive agenda for change to address the systematic weaknesses revealed by the pandemic to deliver lasting and transformative reform.
Being charitable, as I like to be, I can only describe the Government’s response as lacklustre. While they largely agree with the committee’s main conclusions—it would be hard not to—their response contains very little detail on how or whether they plan to address its recommendations. It is, to say the least, disappointing that after tantalising rumours in the press that the PM is finally going to bring forward his proposals to reform adult social care before the Summer Recess, they appear to have been relegated to the long grass again.
Covid has been a serious wake-up call for this country and particularly for the way we plan and fund our public services. There really is a chance to build back better if the Government are prepared to do things differently and invest in the areas highlighted in this report.