Health and Care Bill

Lord Bethell Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

It begs the question, therefore, why my noble friend Lord Forsyth would want to table such an amendment. Is it possible he believes that the drafting of a Bill by government would confer legitimacy on an otherwise non-government policy? If so, this amendment should be treated with great care. The value and worth of our terminally ill, mentally competent adults are too great to be dealt with in such a way. Are we really arguing that because end-of-life palliative care is so patchy, we need to introduce euthanasia? Surely we need a universal service of palliative care rather than this amendment.

[Lord Bethell (Con)]

My Lords, I would like to speak in support of Amendment 297 from my noble friend Lord Forsyth and specifically address the issue of timing that the amendment refers to:

“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill,”


and so on. I feel competent to address this point because I was asked myself, when I was Minister, whether the Government should support a debate with a Government-supported Bill on this issue. There were five conclusions that I reached during my thoughts on the matter.

The first was that a Private Member’s Bill, however worthy, was just not going to get across the Table. It was like a soggy piece of spaghetti—very difficult to push across. This issue is very complex, and a large amount of consultation is needed, quite rightly on such a delicate issue, that only a Government can engage in. PMBs may be all right for cosmetic fillers, but not for assisted dying.

Secondly, on soundings with the professions, there was clearly a massive change in the sentiments of the medical professions, and the appetite and desire for reform was profound, among both the membership and the leadership. That was something we had to take account of.

Thirdly, reform in like-minded countries such as Canada, New Zealand and even Ireland had changed the international context for this issue. We cannot duck the fact that Britain is actually behind the curve on this matter.

Fourthly, public opinion has moved a long way on this. The noble Baroness, Lady Wheatcroft, referred to this.

Lastly, there was a large amount of interest, privately, among parliamentary colleagues in engaging on this subject, particularly among those who were not necessarily highly focused on the issue.

My conclusion was that the time was right to have this debate. My message to the Minister is that it is right that the inconsistencies and delicacies of this issue are tackled by the Government and soon. In the phrase of TS Eliot in “The Waste Land”:

“HURRY UP PLEASE ITS TIME”.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I rise to make just a short contribution. I listened carefully to the words of the noble Lord, Lord Forsyth, for whom I have great personal respect. I watched him in another place and saw his great ability in debate, and I have no doubt whatever that he has much to contribute to the debates here in this House and will do so in the future. However, I have to say that I profoundly disagree with him in this case.

The noble Lord said that he had changed his mind on assisted suicide. He mentioned personal circumstances within the family and then he said that he thought about his own personal circumstances if he were in that position. I do not believe that that is the best way to bring legislation forward, based on your own personal circumstances; you are therefore bringing legislation in for the whole country to meet your own personal circumstances. I have empathy with him and understand the personal circumstances he has had to face.

I say to the noble Lord that I come from a different perspective. I have personal experience of the awful pain of the suicide of a loved one. I know what it is for a family member to come to their wits’ end because of their personal circumstances, where cancer had ravaged the whole family circle, even taking a little child of four, and they could not face life any more. Were they terminally ill? I tell your Lordships, they had died within because of their circumstances. Were they mentally competent to make a decision? They made a decision, and I am sad to say that the rest of the family circle has had to live with that awful pain within their hearts.

This is not an easy situation. I understand that we say that we are not talking about the particulars of a Bill, but this amendment says:

“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill to permit terminally ill, mentally competent adults legally to end their own lives with medical assistance.”


That is certainly assisted suicide. I heard other noble Lords saying that this was simply asking for parliamentary time to have a debate. We had a long debate in this House on the Bill in the name of the noble Baroness, Lady Meacher, which is in fact progressing.

I notice that the noble Lord is shaking his head. I have to ask this question. Numerous Private Members’ Bills are going through this House and are progressing, perhaps at a slow speed. Why is this one different from the others? Do we ask the Government simply to pick this one out and forget about all the rest, or are we saying that they should do it in a timely fashion? Let the Government give this special time to those that are already in that process, and when it comes to the Bill in the name of the noble Baroness, Lady Meacher, time can be given for that to progress and to provide a Bill.

Over these past two years this whole nation has been fighting to save life, not take it. We have spent billions of pounds in trying to do that and I pay tribute to the health service for all its efforts. An assisted suicide law, however well intended, would alter society’s attitude towards the elderly, the seriously ill and the disabled, sending a message that assisted suicide is an option that they ought to consider. Society should not allow a double standard in allowing some people an assisted suicide while we do all we can to prevent young people and other vulnerable groups committing suicide—

Health and Care Bill

Lord Bethell Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Lord Mawson (CB)]

My Lords, I did not want to speak in this part of the discussion but I will make a few comments. I absolutely support what the noble Baroness, Lady McIntosh, and the noble Lord, Lord Howarth, have been saying.

When I first arrived in Bromley-by-Bow 37 years ago this year, I found on my doorstep the largest artistic community outside New York and none of the systems had even noticed or understood its significance. Over the last 37 years, we have been exploring the whole arts and health agenda and the massive impact it can have on local people’s lives.

When we began to put the Olympic project together —as I said on Tuesday, I was involved in it from day one for 19 years—we took that really seriously and engaged with that large artistic and creative community in health, jobs and skills, education et cetera. That £1.2 billion development going on at the moment in the middle of the Olympic park, bringing together University College London, the London College of Fashion, Sadler’s Wells, the V&A, the BBC orchestra and others, is all about this innovation agenda. It is moving it to scale. If this is to happen, we need the systems of the state and the public sector to learn from this entrepreneurial behaviour, which is happening on the ground, in real places and now to scale, and to understand the detail of what it means for the macro systems of the NHS.

I will say more about place later today, but I thank the noble Baroness for making those points, and the noble Lord, Lord Howarth, because this is fundamental. It relates to the fundamental question: what is a human being? A human being is fundamentally a creative being. Health and creativity and, I suggest, entrepreneurship and doing things, are fundamentally connected.

[Lord Bethell (Con)]

My Lords, I came face to face with the nation’s health inequalities every morning in the departmental Covid response group, the COBRA meetings and the COBRA gold, when we went through the hospitalisation details and ICU data and heard stories from the front line of how people who had comorbidities particularly associated with obesity were filling up our hospitals as the virus spread through the country in wave after wave. That health inequality hit this country hard in very real terms. It cost a lot of lives, caused a lot of misery and cost our health system an enormous amount of money. It cost this country and its economy a huge amount of money and it is time that we came to terms with that challenge and solved the problem.

As a number of noble Lords have pointed out, the NHS must step up to its responsibilities in this area. There are complex reasons for these inequalities; some are environmental, some are behavioural and some are to do with access. But the NHS and whole healthcare system must realise that it needs to be involved in all aspects of those, and prioritise and be funded accordingly. The Bill already does an enormous amount to change the healthcare system’s priorities. Putting population at the heart of the ICSs is one really good example of that.

To anticipate some of his remarks, I know that the Minister will point to the Office for Health Improvement and Disparities. As the noble Lord pointed out, however, it has a tiny budget and cannot take responsibility for the nation’s health. Our councils are stony broke, as I found in my experience of dealing with them over the last two years. There is no one else to do this; this is not someone else’s problem. This is to do with the British healthcare system, and it needs to stand up to that responsibility. Zero progress has been made in the round over the last few years and we have gone backwards in the last two years in a big way. We need to make this a massive priority.

This is a fantastic Bill; I am really supportive of it. It came from the healthcare system originally. In this one area, however, there is a graphic lacuna that needs to be addressed. The noble Lord, Lord Kakkar, put it so well in his inimitable way. The prioritisation of inequality must be put in the Bill and it needs to be heard throughout the healthcare system that this is the new, central priority that needs to be added to everyone’s job description.

If, for some reason, we do not do that there will be huge consequences. The healthcare system is unsustainable in its current form. We cannot continue to have a large part of the population carrying grievous comorbidities or disease and afflictions which are undiagnosed or not properly mended turning up in our hospitals at a very late stage and costing a fortune to mend. These health inequalities, whether they relate to disease, injury or behavioural issues such as obesity, are costing us a fortune. Only by putting tackling inequality on the face of the Bill can we really give it the priority it deserves.

I also say to the Minister that there is a sense of political jeopardy about this as well. We went into the last election committed to levelling up on health. We have gone backwards in the last two years through no fault of the Government, but if the Government do not step up to their responsibilities in this area, and if the NHS and the healthcare system do not change their priorities, the voters will judge us extremely harshly. For that reason, I urge the Minister to listen to this debate and look very carefully at ways of amending the Bill.

[Baroness Neuberger (CB)]

My Lords, I want to pay tribute, as other noble Lords have, to the noble Baroness, Lady Thornton, for her very thoughtful introduction. It is remarkable and absolutely wonderful to see consensus breaking out across the Committee. I will speak specifically to Amendments 152, 156 and 157 in the name of the noble Lord, Lord Young of Cookham, whose words on the need to make this really serious by stating it on the face of the Bill I echo.

I am a former chief executive of the King’s Fund and am currently chair of University College London Hospitals and Whittington Health. These issues are very dear to my heart and the hearts of those institutions. I also want to say thank you to Crisis for its briefing and add to the words of the noble Lord, Lord Young of Cookham, in praise of Pathway, which has done the most extraordinary work in this area over very many years.

I want to talk particularly about the NHS-funded Find & Treat service, which was set up 13 years ago and is run by UCLH, which I chair. This service was set up in response to a TB outbreak in London and aimed to provide care for people experiencing homelessness and people facing other forms of social exclusion. The service did exactly what it says on the tin: it went out and found people—and still does—who were at risk of contracting TB, wherever they were sleeping, and offered them diagnosis and treatment. Back in 2011, a study concluded that this service had been not only effective in helping to treat people with TB who were experiencing homelessness but cost effective in doing so, both in terms of costs saved to the health service and improved quality and length of life for the people receiving care. Fast-forward a decade and the evolution of this service meant it could be similarly mobilised at the beginning of the Covid pandemic. It provided urgent and necessary care to people who continue to experience the poorest health outcomes.

The King’s Fund published a report in 2020 on delivering health and care for people sleeping rough. It supported the need for inclusion health services to be provided much more broadly than at present. Importantly, it also concluded that local leadership is absolutely vital in crafting that approach and said that local leaders should model effective partnership working across a range of different organisations.

Embedding inclusion health—I cannot say I really like the term, but everybody knows what it means—at the level of integrated care partnerships will help ensure that our healthcare system can no longer ignore, forget or overlook people who are all too often considered “hard to treat”, despite proven interventions showing the opposite. It will ensure that integrated care partnerships and systems take that vital first step towards closing the gap of the most significant health inequalities in our society by having to recognise and consider people facing extreme social exclusion and poor health outcomes in their local areas.

We all know that there will be considerable discussion during the course of this Bill on the need not to be overly prescriptive and burdensome to ICSs and ICPs by way of legal duties. But ICSs and ICPs know all too well the realities of failing to support people with complex and overlapping needs. I know that the chair of my own North Central London ICS, Mike Cooke, is sympathetic to the spirit of these amendments and believes it is important that extra steps are taken to meet the health needs of the most excluded, such as street homeless people. The chief executive of UCLH, David Probert, and the chief executive of Whittington Health, Siobhan Harrington, concur in thinking that if we extend the aspiration to reach out to excluded groups to something that all ICSs, ICPs and systems must focus on, it would be hugely beneficial for planning and joining up systems to avoid inappropriate or unnecessary admissions and poor care planning. Plenty of people want to do this within our health system.

I support Amendments 152, 156 and 157 and look forward to working with the Government and colleagues across the House and within the NHS to ensure their success in achieving a critical and long-needed systemic change to our health and care system. Addressing the needs of the most excluded has to be on the face of the Bill.

Health and Care Bill

Lord Bethell Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I thank the Minister for his extremely good introduction to the Bill, He has taken to the job incredibly quickly, taking on this massive Bill so enthusiastically; it is incredibly impressive. I also make a personal testimony to the noble Lord, Lord Stevens, who I knew from the battle against the pandemic over the last two years. His expertise and experience were brought to bear against that awful disease, and I am so pleased to see him now in the Chamber contributing to this important debate.

The Minister is right: this is a proportionate and welcome Bill that enables us to make important changes. The noble Lord, Lord Stevens, is right that it came originally from the health and care system. We should remember that when we comment on it, because it is an omnibus Bill that gives those at the front line the tools they need to improve the system. I completely endorse those who have spoken about the importance of collaboration. My noble friend Lady Harding spoke much more fluently than I possibly could. Medical clinical care very often involves complex issues that need a huge amount of collaboration and work to succeed. Therefore, this Bill should try to smooth out anything that creates inadvertent competition, barriers to discussion or hurdles to getting things done. I think that it gives the system the tools to be able to do that.

I also endorse those who have talked about the importance of prevention. The noble Baroness, Lady Cavendish, is absolutely right; the noble Lord, Lord Stevens, called it a challenge that many advanced economies are facing and he is entirely right. Prevention is key. The pandemic showed us that our current health system is living beyond its means, and we have nothing but challenges ahead of us. The population health measures enabled by the ICSs are potentially critically important. This Bill only enables that potential; I would endorse its power and encourage the Minister to run really hard at prevention.

That is why I support Clause 4 on cancer detection, which was introduced in the other place. It touches on the point referred to by the noble Baroness, Lady Cavendish; by putting an emphasis on outcomes rather than the operational details of cancer detection, it is trying to introduce an important inflection point that I think could be duplicated elsewhere. That is also why I support Schedule 17 on junk food advertising; we have to seize the nettle on that. There was so much sadness in the daily meetings that I used to attend in ICU units. When the numbers of people being intubated were ticking up, so often they were because of comorbidities created by overweight. We need to tackle our obesity epidemic; that is why Schedule 17 is so important. I would also endorse those who have supported the work on hymenoplasty; while I welcome the Government’s moves in this area so far, I think they can go further.

What I really want to endorse is innovation. Data has been mentioned by a large number of noble Lords. The noble Baroness, Lady Cavendish, talked a bit about productivity; the noble Baroness, Lady Barker, talked about patient care; one noble Lord talked about safety. They are all absolutely right. Clauses 81 to 87 in Part 2 are critical, and I would like to hear the Minister’s endorsement of those. I also support the commitment to research. The noble Lord, Lord Kakkar, spoke very well—much better than I could—about the case for strengthening ICSs’ commitment to research. If the NHS is to achieve what it needs to achieve, it needs to double down on its ability to deliver research; this is an area that the Minister should very firmly commit to looking at, as the Bill makes its progress.

NHS: Primary Care Surgeries

Lord Bethell Excerpts

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness will understand that it is not for the Government to intervene in the decisions of CCGs. All who believe in devolution and decisions being made as close to the people as possible believe that we should not be interfering. These decisions are made by CCGs and it is not for the Government to interfere.

[Lord Bethell (Con)]

My Lords, I entirely welcome the Minister’s assertion that much of what is great about the NHS is the collaboration with international partners and the private sector. During the pandemic, many things that went well, including the vaccine, relied on that. With a special session of the World Health Assembly next week to discuss new global agreements on pandemic preparedness, what steps will the department be taking to foster international and business collaboration?

[Lord Kamall (Con)]

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

Dementia: Art and Music-based Interventions

Lord Bethell Excerpts

Monday 22nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The NICE quality standard on dementia, published in June 2019, includes guidelines for offering activities and social prescribing. They are also included in the NHS long-term plan. Obviously, different components are modelled that are social prescribe-enabled—not only music but other art-based activities. The education question will be for my noble friend in the Department for Education, but if the noble Baroness can write to me, I am sure that we can get the answer.

[Lord Bethell (Con)]

My Lords, music therapy is also increasingly helping Covid patients hit by inflammation and fibrosis that causes shortness of breath—a horrible condition. The Breathe programme from the ENO and Imperial College has classical-singing coaches providing psychological and physiological therapy to great effect. Can the Minister endorse this kind of social prescribing, and can he commit to meeting Dr Harry Brünjes and the Breathe team, which is seeking to take this programme nationally?

[Lord Kamall (Con)]

I thank my noble friend for that question. As an amateur musician—I stress “amateur”—I know that there is no better feeling than when you connect with your audience as a live musician. Music tugs at your heartstrings. Music touches your soul. But it can also unlock the mind. This shows the importance of music in social prescribing.

New Hospitals

Lord Bethell Excerpts

Thursday 18th November 2021 Lords Chamber

[Lord Kamall (Con)]

I hope that the noble Lord will recognise that whenever a new project is started and there is a decision to build a new hospital in a community, it surely makes sense to look at whether there is space on existing sites. Otherwise, if we start criticising new hospitals on existing sites, there may be a perverse disincentive for a hospital to say, “Well, let’s build elsewhere”. when there is a perfectly good site. It is important, whatever you call it, whatever the semantics, to recognise that we are building modern, digital, sustainable hospitals for the future.

[Lord Bethell (Con)]

My Lords, we very much welcome the investment in physical buildings, but the modernisation of the NHS also depends on digital infrastructure and training. Will the Minister please tell us what steps he is taking towards a programme of technological improvements that are needed to modernise the NHS?

[Lord Kamall (Con)]

I thank my noble friend for the question—I have picked up many of the things that he started when he was in post. One of the great things about being the Minister for Technology, Innovation and Life Sciences is having a real ability to drive through digitisation of the health service, making sure that we have a modern health service that is fit for the future, so that if you are a patient in one part of the country and something happens to you, all your information is available elsewhere for the clinicians at the time and you get the best possible care. That is something that we should be celebrating.

Gametes and Embryos: Storage Limit

Lord Bethell Excerpts

Tuesday 9th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for raising this very important issue, because not everyone is aware of the biological facts around fertility, particularly the decline of fertility with age. If a woman freezes her eggs in her 20s, she has a higher chance of success than if she does it in her 30s. In fact, while IVF treatment has improved over the years, the success rates of IVF are still only around 30%, so it is important that as many women and couples know as much as possible. On the detailed questions that she asked, I will write to the noble Baroness.

[Lord Bethell (Con)]

My Lords, I am enormously encouraged by the Minister’s warm words and look forward to holding him to account for them. We know that women have a much better success rate when freezing their eggs at a younger age. However, the Minister knows that there are also proposals to introduce requirements to renew storage permissions every 10 years. What arrangements is the Minister considering to put in place to ensure that this does not become a bureaucratic nightmare and does not create disappointment for those who somehow do not keep up to date?

[Lord Kamall (Con)]

I thank my noble friend for his work on the subject when he was the responsible Minister to help change the policy so that all people, regardless of medical need, may benefit from greater choice about when to start their family. The 10-year renewal periods will be put in place to give people the opportunity to decide whether they wish to continue with their storage of gametes or embryos. The department is currently working with the Human Fertilisation and Embryology Authority to set out the plans for detailed implementation, including on how the renewal periods should be handled by fertility clinics to ensure that they work.

Fertility clinics will be expected to contact people storing their gametes or embryos a year before a renewal period has ended, so there would be 12 months’ notice. In addition, people will have a six-month grace period following the expiry of any renewal period, in which they can get in touch with clinics to re-engage storage if they wish. I am sorry that I am going on longer than usual, but this is an important issue. It is our view that we would provide an appropriate amount of time for clinics to contact their patients, and for patients to decide what they wish to do with their gametes or embryos in storage.

Health Care and Adult Social Care

Lord Bethell Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her reference to the £162.5 million of funding for social care through the workforce retention and recruitment fund to help boost staff numbers and support existing care workers through the winter. This is on top of the third infection control and testing fund, introduced in October 2021, which is providing a further £388.3 million of adult social care Covid-19 support until March 2022. This means that, during the pandemic, we have made available more than £2.5 billion in funding specifically for adult social care. We are also taking action to support adult social care providers through a national recruitment campaign.

[Lord Bethell (Con)]

My Lords, this important report is challenging reading for all those who worked on the front line of the pandemic. Its most challenging section is undoubtedly the part on the recovery of services; in particular, as the noble Baroness, Lady Wheeler, said, the importance of

“investment in workforce development and formal changes in service specifications.”

Can the Minister give us some more precise details on how that budget will be spent?

[Lord Kamall (Con)]

I thank my noble friend for his question and for the advice he has given me to date. Even though I have size 11 feet, I am finding it rather difficult to fill his large shoes. On the funding announced, local authorities have a key role in supporting recruitment and retention in their local areas. We are working with them to make sure that they support local providers by identifying workforce shortages, developing workforce plans and encouraging joined-up services. We also continue to work closely with providers, councils and our partners to assess the situation and consider what further action may be necessary.

Health: Chronic Fatigue Syndrome

Lord Bethell Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

First, I thank the noble Baroness for her warm welcome. I look forward to many exchanges with her and to learning from Ministers across the House and those who have been in the Department of Health and Social Care before. I know that the noble Baroness is recognised as a champion of the 250,000 people who are living with ME/CFS. As the noble Baroness knows, there are a number of complex symptoms, and experts disagree over the multifaceted way to address this.

As the noble Baroness knows, the NICE guidelines were delayed twice. They were first delayed because it wanted to make sure that it had taken on board all the various submissions that had been made; they were delayed a second time because, just as they were about to be announced, concerns were raised by clinicians and other stakeholders. If you are going to have guidelines, it is important that they are accepted and recognised by as wide a range of stakeholders as possible; otherwise, they might lose their authority.

We want to make sure that, whenever we have this situation and there are people with a range of views, we get them around a table and have a conversation, as common sense tells us, to see if we can agree on a way forward. I very much hope that, once we have had this round table, we will be able to agree a way forward.

[Lord Bethell (Con)]

My Lords, I welcome my noble friend to the Dispatch Box as a Minister for the Department of Health and Social Care and Minister for Life Sciences. It is, without doubt, the best job in government, and I know that he will acquit himself extremely well.

We are making huge progress on the syndrome called “long Covid”, and I note the encouraging progress that NICE is making on guidance for post-Covid syndrome. But does the Minister accept that this shines a clear spotlight on how far behind and wrongheaded we are with the diagnosis and management of ME and CFS? In particular, does he accept that, in the interests of health equality and national productivity, we need to rethink the way that people are got back on their feet after they have been hit by these horrible viruses?

Social Care Funding: Intergenerational Impact

Lord Bethell Excerpts

Thursday 16th September 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I say very sincerely that this was a powerful debate, very worthy of this Chamber. I congratulate the noble Baroness, Lady Greengross, for securing it and thank her for her thoughtful comments and the well-argued case she put before the House today. The noble Baroness brings an enormous wealth of experience on this subject. I pay tribute to her contribution to the House of Lords Intergenerational Fairness and Provision Committee, to which a number of noble Lords referred; to her role as a former commissioner of the Equality and Human Rights Commission; to her previous role as director-general for Age Concern England; and to her current role as chief executive of the International Longevity Centre.

I also thank the noble Baroness for the work she has done with the Intergenerational Fairness Forum, in publishing its report on sustainable funding for social care and intergenerational fairness. This report is informed, thought-provoking and extremely influential. There were a series of insightful points in that report with which I completely agree. First, funding social care is a problem not just for those who need it, but for all of us. Secondly, there should be greater integration between health and social care services, as I have said from this Dispatch Box many times over the last 18 months. Thirdly, catastrophic care costs should be capped, with increased risk pooling across society. Fourthly, those who are able to contribute towards their care costs should continue to, even in retirement. The steps that we have taken following the announcement last week, in the Health and Care Bill, show our commitment to exactly those principles. We are in complete agreement about the need for generational fairness. I will say a few words of context about that.

The future of adult social care is at the heart of this debate. Our country’s adult social care system has never been under the pressure it is today, as the noble Baroness rightly pointed out. The coronavirus pandemic posed unprecedented challenges to the sector and only strengthened the case for urgent reform. That is why, earlier this month, the Prime Minister took the bold step of publishing Build Back Better: Our Plan for Health and Social Care. The reforms presented will make a real difference to the front line of adult social care, and they include care users and—as many noble Lords, including the noble Baroness, Lady Tyler, rightly pointed out—the dedicated care workforce, who have been so brilliant during this pandemic.

Underpinning these reforms is a vital injection of funding over the next three years. This will end wholly unpredictable care costs and include at least £500 million to support the adult social care workforce. It also includes funding to enable all local authorities to move towards paying providers a fair rate for care, which should drive up the quality of adult social care services, improve workforce conditions and increase investment.

I remind the noble Baroness, Lady Bennett, who gave a powerful case for a completely alternative approach, that the current system, while not perfect, has a high level of satisfaction among those who use it. We do not think the moment is right to abandon the benefits of the market economy or that that would improve satisfaction rates. Let me set out how the reforms I have described will benefit future generations.

Of the two principal pillars of our reforms, the first is a cap on care costs, funded by the health and social care levy. This means that, for the first time, everyone will be protected from unlimited care costs. People who have done the right thing and saved for their old age have previously been hit hard by the roulette wheel of health and social care needs. That means that one in seven faces care costs of over £100,000. It is right that society provides a backstop against that. Introducing a cap means that they can keep more of their savings in assets, so people can leave some of their savings to their loved ones. I remind noble Lords, including the noble Baroness, Lady Brinton, who made a point on this, that this often includes many who provide unpaid care and fear for the loss of these assets.

Secondly, those who have limited or no savings will be protected by a much more generous means test. They and their loved ones will have the certainty of support when it is needed, and everyone will have more of their assets fully protected. I am very proud to be part of this, especially as the reforms this Government are bringing forward will increase the number of older adults receiving some state support by roughly two-thirds, up from about half at the moment.

The Intergenerational Fairness Forum report recommended a review of DPAs—deferred payment agreements—and the introduction of new equity release schemes. DPAs complement the reforms well, and I agree that equity release is a clear mechanism for protecting people from selling their homes within their lifetime. There are issues within the current system, including narrow eligibility criteria and low take-up, but I assure the noble Baroness, Lady Greengross, and the noble Lord, Lord Griffiths, that as part of the announcement last week we are committed to working with partners to review the existing scheme in order to provide more flexibility for people to defer their care payments. I would very much welcome and hugely appreciate the noble Baroness’s insights into this area to inform that review.

These measures, which are being fully funded by a new, UK-wide health and social care levy, mean that we are not passing on the costs to future generations or increasing the public debt. I remind the noble Lord, Lord Davies, that by using national insurance contributions we are also ensuring that business contributes; it is not left just to the individual. It is progressive, in that those earning more will pay more, and has a clear UK-wide approach, meaning that everybody pays the same, wherever they live in the UK. Crucially, I remind noble Lords that we are tackling intergenerational fairness by extending the levy to all those over state pension age from April 2023, ensuring that individuals of all ages play their part.

I remind the noble Lord, Lord Howarth, that the new levy is not just for social care. It will fund the full range of health priorities and support people of all ages. New spending on the NHS will not just benefit older individuals, with recent evidence suggesting that more than half of NHS spending goes to people in households below retirement age. In adult social care, currently more than half of all public spending goes towards under-65s. Working-age people will also benefit from limits on what they will have to pay if ever they need care later in life. It is entirely consistent with the contributory principle for national insurance, whereby working-age employees pay NICs, which gives them access to contributory benefits when out of work, including the state pension.

I say to the noble Baroness, Lady Watkins, that we know there is no one-size-fits-all approach to the social care system. I acknowledge that in 2019-20 we had more than 250,000 younger adults and more than 375,000 older adults receiving state support. These reforms will provide support to people of all ages. Younger and older adults will benefit from the same cap on care costs. Once they reach it, they will no longer pay for their personal care from their income or any assets. This will provide certainty and reassurance, help people plan for their future and ensure that more people are able to pass on more to their loved ones.

Finally, I assure noble Lords that this Government completely recognise the real need for intergenerational fairness, the subject at the heart of this debate. I will try to persuade the noble Lord, Lord Lipsey, who spoke with such characteristic learning on this subject, that we are making changes to that effect in many areas of policy. First, the Government’s new Environment Bill, which has taken up a lot of noble Lords’ time this week, looks to the future, focusing on creating a new governance framework for the environment, setting a new direction for resources and waste management, improving air quality, securing our water services, enhancing green spaces, updating laws on chemical use, and so on. Secondly, the Government are committed to strengthening their management of the public sector’s assets and liabilities to the benefit of future generations. Thirdly, our Kickstart scheme provides funding to employers to create jobs for 16 to 24 year-olds on universal credit.

I remind the noble Baroness, Lady Tyler, that we are working hard to drive up provision of affordable housing, and the new mortgage guarantee scheme launched in April will help increase the supply of 5% deposit mortgages for creditworthy households. We will support lenders to offer products through a government-backed guarantee on new 95% mortgages until 31 December 2022. These are some of the ways this Government are ensuring that we are building back better for future generations.

I reassure the noble Baronesses, Lady Wheeler and Lady Brinton, that we have made a bold step on the journey to reform, which will make a real difference to a great many people of all ages and backgrounds, including care users and the adult social care workforce, who have worked so brilliantly through the pandemic. I reassure the noble Baroness, Lady Greengross, and the noble Lord, Lord Griffiths, that we will work with partners in the development of these policies.

I thank the noble Baroness, Lady Greengross, who has been such an advocate for this important issue and secured such an interesting debate today. I thank all noble Lords who have taken part.