My Lords, I thank the noble Baroness, Lady Armstrong of Hill Top, for this debate and the Public Services Committee for its immensely insightful report. Future generations will wonder how their Government permitted nearly twice the number of their citizens to die during the Covid pandemic than all the civilians who died during the Second World War. Yes, we need to transform public services, but that cannot be done without transforming politics, and economic and social policies. We need a visible politics of care and compassion. The fact that the Prime Minister was comfortable with 83,000 Covid fatalities in the age group 18 or over is really a sad low point in British values. Front-line workers, including hospital staff, care home workers, transport staff and retirees feature disproportionately on the Covid death list.
As Sir Michael Marmot’s recent report demonstrates, the main reason is that, due to low incomes, people have poor access to good food, housing, healthcare and personal space. The pandemic has shown us that poverty and inequalities cause death, but the Government have done little to check that; indeed, they continue with their wage freezes, without any impact assessment on the lives of people or the capacity of the country to manage pandemics. In 1976, the workers’ share of the gross domestic product was 65.1%, and just before the pandemic it dropped to 49.4%—a decline unmatched in any other industrialised country. The average wage was stagnant in the decade preceding the pandemic. This economic legacy has weakened the people’s resilience to pandemics. Many people tested positive for Covid but could not find a safe place to isolate, as they lived in cramped accommodation, all because they are poor.
To manage pandemics, countries need institutional memories and capacities; we lack both. The NHS lacked investment before the pandemic. To manage the crisis, the Government hired expensive and often ineffective private sector consultants for their test and trace programme, which has not augmented the long-term capacity of the NHS. Consultants quickly enter and exit an organisation and leave little trace of their activities. This makes it harder to build a pool of experience and draw lessons.
The Government need to look at their own obsession with privatisation, a key factor in the deaths in care homes. Since 2010, central government grants to local authorities have been cut by 38% in real terms; this accelerated the privatisation of social care. In care homes owned by private equity, nearly 11% of revenues vanish in servicing contrived debt. Private equity also expects a return of 12% to 14% on its investment, which meant that 20% to 25% of the revenues of private equity disappeared in returns, leaving very little for care home residents. Care home workers and residents suffered. Of the 1.49 million workers in care homes, only 50% are full time—nearly 24% are on zero-hour contracts. Almost 42% of the domiciliary care workforce is on zero-hour contracts, and staff turnover is nearly 30%.
In March 2020, the real-term median hourly pay of staff was just £8.50 an hour. In these circumstances, it is difficult, if not impossible, for carers to get to know patients and provide personalised care. Low-paid staff cannot afford to isolate or take time off to recover. It is hard to recall any government concerns about the negative outcomes from privatisation of social care. We cannot build capacity to tackle future pandemics by just creating poverty.
The Government’s economic policies are also creating new dangers and diseases—just look at the water industry, where almost every water company has been fined for anti-social practices. Southern Water is the latest example. The company illegally dumped tonnes of raw sewage into rivers and seas, increasing the likelihood of diseases. Its directors calculated that it was better to pay fines than to treat the sewage, so they dumped it. The puny £90 million fine is no deterrent: Southern’s chief executive has just received a bonus of £551,000 for boosting profits. I cannot recall seeing any health impact that accompanied the Government’s two-thirds cut in the Environment Agency’s budget or deregulation, which expects water companies to self-report their illegal practices.
I hope the Government will reflect on how their political, economic and social policies have inflicted death on thousands and sadness upon millions of innocent people, but I am not too optimistic.