My Lords, since coming here 10 months ago, I have read a lot of legislation and reports and to be honest, it has all been a bit of a chore. However, this report sparkled. I know it has had lots of plaudits, but I commend the noble Baroness, Lady Armstrong of Hill Top, and all the members of the Public Services Committee for an accessible, informative and thought-provoking document. There is lots in it I disagree with, but it was just so useful—and unusual for these toxic times, in that it was free from rancour and “gotchas”. As it says itself, it is not about apportioning blame for past failures, but making constructive suggestions for future reforms—a great relief.
One caveat: in general, I am wary of any sphere allowing the normal of the pandemic to automatically become a new normal by default. The call in the report is to lock in innovations, but that makes me nervous. Yes, it is very useful to kickstart debate, but not to institutionalise as a rigid fait accompli. For example, we all know that digital technology may have facilitated everything from working from home to digital health consultations. But as the report itself points out, Zoom teams and the like could never, and should never, replace face-to-face services. I note with concern that too many GPs and, for example, university lecturers and senior managers, seem reluctant to resume real-life interaction, at the expense of service users.
One striking feature of the report that I would like to make explicit is the cost of treating the NHS as almost a sacred cow public service. It is understandable to celebrate and almost sacralise the health service in a health pandemic, but this can be at the expense of other services. Testimony in the report noted that support for the NHS, especially during the initial part of the pandemic, might have been necessary but should not have come at the expense of preventive and public health services. I agree.
The Nuffield Trust is quoted as noting how the Covid crisis highlights the startling inequality between health and social care services. Many of us felt uncomfortable that that initial “clap for the NHS” neglected care workers. Even today, all the focus is on the pay rise for the heroic NHS staff, whereas social care is plagued with poor wages and awful employment conditions; and now we have even singled out social care workers as the only workforce facing mandated vaccines or the sack.
So, it is important that the report highlights that, long before Covid, successive Governments prioritised funding the NHS—especially acute services—and neglected funding social care. The Nuffield Trust notes that the NHS received generous emergency funding from the Treasury in the early stages of the pandemic, which then enabled a dramatic expansion of capacity. Care providers, in contrast, said that extra funding did not reach them. Also, and related, the deputy director of the New Local Government Network contrasted the experience of local government with the NHS. The NHS had its costs met in full and deficits written off unquestioningly, but that was a privilege not afforded to councils or other public services. I do wonder about this hierarchy of priorities.
The consequences go beyond material funding. As ADASS points out, the historical tendency to prioritise the NHS has influenced policy decisions, sometimes with tragic consequences. In the name of saving the NHS, rather than the NHS saving lives or the public, we now face the collateral damage of non-Covid deaths from cancer and heart disease and huge waiting lists for many in dire need of medical interventions, with the terrible news of an increase of 50% of under-20s hospitalised with eating disorders. In a different debate earlier today, we also heard about the use of “do not resuscitate” in hospitals. We cannot ignore these things.
But perhaps the greatest horror associated with the focus on the mantra of protecting the NHS was the scandal of patients being discharged from hospital into care homes without testing—what the Nuffield Trust called, as quoted in the report, a
“rapid clearing of hospital beds in the early stages”,
regardless of the
“lack of preparedness of the care settings”.
The most vulnerable died as a consequence and, at the very least, it is important that we be able to query NHS policies without being shut down as somehow disloyal to NHS staff who, I agree, have been and are heroic and hard workers—but so are other workers. I do not think that you should be called a traitor to the institution if you query it.
Another striking aspect I read from the report is the wasted potential of civil society in helping deal with the pandemic. On a positive note, of course, the report gives lots of examples of innovation happening because bureaucracy was swept away. In fact, sometimes to tear up the red tape is caricatured as a laissez-faire, careless approach, but the removal of overly bureaucratic hurdles allowed public services to work alongside charities and community groups and volunteers, and the private sector stepped up. Altogether, this played a huge role in delivering services.
The surge of civic action, such as the 4,000 Covid-19 mutual aid groups and the local WhatsApp and Facebook groups I am sure we were all in as volunteers, showed a real appetite for providing practical solidarity in the emergency from so many people. We saw the generosity of 750,000 people signing up in four days when NHS England’s Royal Voluntary Service was launched in April 2020, but sadly that was wasted. The Institute for Volunteering’s research rightly notes in the report that overcentralised co-ordination was not aligned to locally organised activities, significant time was taken to respond, enthusiasm dwindled and people became demoralised. I think it was just so sad when volunteers could have helped, for example, relieve the pressure on social care workers, or indeed NHS workers.
In general, the official approach to Covid was to demobilise the public—to squash initiative and volunteerism. The report notes how the German public health service, in contrast, mobilised and seconded public servants from across departments: forestry, museums—