My Lords, I declare my interests as a vice-president of the Local Government Association and a vice-chair of the All-Party Group on Coronavirus and the All-Party Group on Adult Social Care. I start by thanking on behalf of these Benches the noble Baroness, Lady Armstrong, and her committee, as well as those who gave evidence, for their time and for this excellent report. I agree with the noble Baroness, Lady Jones of Moulsecoomb, that it is outstanding and should act as a blueprint for any future Government to use for public service reform—which, frankly, should happen straightaway, but, having read the Government’s response, I am not convinced it will happen soon.
Like many others, I find it quite extraordinary that no Minister found it appropriate to give evidence. Even today, in an earlier Statement, the Health Minister said that the best time for reflecting was after the pandemic. We have learned since the publication of this report last November that lessons could have been learned; mistakes were repeated because they were not.
My noble friend Lady Tyler talked of the dedication of all public sector workers. These Benches agree. There is often high performance and a strong sense of duty and they go beyond what is called for. Most of the problems outlined here are cultural and structural, and no reflection on the individuals who work in beleaguered public services, often trying to cope with cuts with no reduction in their responsibilities.
The noble Baroness, Lady Armstrong, rightly said that action is needed urgently and that the Government should not delay. The noble Lord, Lord Haskel, made the vital point that, since the report’s publication, lessons should have been learned and that the Government were therefore doomed to repeat mistakes.
The noble Lord, Lord Bichard, rightly focused on the need for substantial reform, setting out eight areas. His noted expertise in local government means that, along with other members of the committee, he understands the real practical stumbling blocks of public services in our society and the ways of managing them.
The noble Baroness, Lady Fox, is right that challenge is vital in every single way we do things. From my experience of local government over the years, giving professionals and the people they are working for the chance to find value-for-money solutions can frequently result in better public services in their area.
The noble Lord, Lord Young, helped us with lessons from other countries. I will briefly mention Taiwan, which, in addition to the points the noble Lord raised, from day one, early in January, closed its borders to make sure that the virus was not brought in. It was also completely frank with the public, explained why it was doing things and put in place strong support for those who had to self-isolate, bringing them food and helplines. That, plus daily television programmes on which scientists were quizzed about what was happening, remains one of the absolute strengths in its community.
The noble Lord, Lord Young, also made the point about local authorities in Germany having equal powers, which is very helpful. Our mixed democratic structures and different local authority economies are just not fit for purpose in the 21st century. However, the answer is not more metro mayors. Things need to be clear, simplified and accountable to the people in ways they can understand.
As the noble Lord, Lord Liddle, said, our public emphasis must move to prevention, but it must be funded. It has not been over the last few years. Levelling up was not evident in March’s Budget, but it is critical in dealing with early intervention and prevention, as other noble Lords have said. I echo the request of my noble friend Lady Tyler and others that Ministers say clearly when their public health strategy—and the funding for it—will be published. Public health cuts over the years are one of the reasons why levelling up will not happen any time soon under this Government.
The noble Lord, Lord Bourne, spoke of the importance of the need for positive action on food reform; the Dimbleby review, key parts of which were immediately dismissed by the Prime Minister on its publication, has many lessons for us. Yet the sugar tax on soft drinks, and other pressures, mean that our large supermarkets have started to move to reformulate. While the results are encouraging, the 2024 target must be met and pressure must be maintained. Educating children and their parents about good food choices is vital, too, but the cost of healthy food, especially fruit and vegetables, often means that the most nutritious foods are out of reach for the poorest families, thus building in poor health and other problems in yet another generation.
Sir Michael Marmot’s evidence, as well as an enormous amount of data, has shown that inequality and disadvantage put people not just at much higher risk but, in the pandemic, at risk of death. The noble Lord, Lord Bilimoria, reminded us of the high percentage of severe death and disease in our ethnic-minority communities. Frankly, as a country, we should hang our heads in shame. Where health inequalities are baked into our public services, it is too easy to turn a blind eye, but this appalling death rate is a wake-up call to us all. He is also right to say that poor health costs the economy. That is why we need the innovative thinking about how investment in public health and education will act as a driver for the economy and for productivity.
The noble Baroness, Lady Goudie, rightly reminded us that early years support, through schemes such as Sure Start, are vital in deprived communities. America learned this through the Tennessee STAR project over three decades ago. We have still not learned that lesson fully.
The example given by the noble Baroness, Lady Pitkeathley, of the user voice and coproduction in pandemic provision for the homeless was important, breaking down barriers with those people who are hardest to reach and getting to the root of the problem and solving it. We must not lose that experience.
One problem very evident in the pandemic was the way that officials—whether health, education or local authorities—failed to listen to parents of disabled children when they explained that they were struggling without their essential regular respite care. The result was that they were often criticised by social services; some were even threatened with having their children taken away from them. That must not happen again. Contrast that with my noble friend Lady Pinnock’s example of the Leicestershire cell for social care. It is vital that we mark and learn where things have worked and find mechanisms to make sure that this good practice is not just debated in your Lordships’ House but is in every community in our country.
The noble Lord, Lord Sikka, outlined one of the key crises in our adult social care sector over the last 30 years, which is increasingly moving from public sector provision to commercial companies. That is not bad in itself, but it now includes hedge funds and others who should not be in the business of care and certainly not using a business model that exploits the cheapest labour and expects low retention of staff when caring for other human beings. Now a combination of Brexit and the pandemic has shown that the social care workforce deserves to have a proper plan, to be paid in parity with their health opposite numbers and to have proper career pathways like those in the NHS. There are currently over 120,000 vacancies in social care. Government proposals must tackle the root and branch, not just the funding of beds, and ensure that we have a reliable and functioning social care sector as the baby boomers move into their old age.
The noble Baroness, Lady Armstrong, is right that the Government have focused in their procurement White Paper on commercial contracts, when this report demonstrates that, by empowering local services and communities and using the voluntary sector, many key services can be joined up.
My noble friend Lord Shipley’s point that you cannot run England from Westminster is vital, too. I hope that the Minister and the Government really understand that. The hub and spoke models of central bureaucracy never trust local areas. Often in the pandemic, that is where things went wrong. There were national attempts at recruiting volunteers when local councils had already done so; local councils got people to help people who had been asked to shield and then suddenly an NHS scheme was announced and nobody knew who was running the volunteer scheme. That is so easily avoidable, but the NHS, in its towers, just felt that it would start a new scheme at short notice without referring back to local government.
My noble friend Lady Pinnock commented that local staff, whether in local authorities or working in the community, wanted to rise to the challenging circumstances and to work differently, embracing innovation and feeling empowered. Again, we must capture that for the future. It is not just a pandemic issue but about our life in our communities. She also referred to codesign and coproduction as a powerful way of real innovation, value for money and value to individuals involved in receiving this public service.
The noble Lord, Lord Bichard, said that the committee found countless ways in which data sharing worsened the lives of people. Those points were extraordinarily well made and we must resolve that. However, this is not just about giving everyone the data. It must be safe and secure, and for public service.
Finally, it is vital that fundamental reform comes soon. It means, as with social care 10 years ago, cross-party working and the Government working with other parties to make it happen. I hope that the one message that the Minister will take away from this debate is that they need to be spurred into action now to deliver the recommendations in the report and take our communities and the agencies that work with them into a 21st century that will be safe and secure for them.