Social Care Reform

Lord Forsyth of Drumlean Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend makes very strong points, which I absolutely concur with. This is an issue that needs to be able to stand the test of time and changes, whether they be in leadership or of Government. That is why we are taking the approach that we are. My noble friend will have seen the terms of reference that have been published. They are deliberately broad because we are tasking the noble Baroness, Lady Casey, to lead the work fully independently, which is particularly important in seeking cross-party consensus. Indeed, the noble Baroness’s review is very much about having the conversations cross-party and seeking to bring people together across parties and across sectors and the many individuals who have an interest in this.

[Lord Forsyth of Drumlean (Con)]

My Lords, is not the truth of the matter that there is a consensus between the parties? The Economic Affairs Committee of this House published a report some five years ago. There was unanimity across the House. There has since been another report. This setting up of commissions and so on is just to appease the Treasury, which refuses to provide the money that is needed for social care and is the key to cutting waiting lists and moving forward in the health service. Should not the Government just have the courage to commit to the resource that is necessary instead of kicking this into the long grass for another three years while elderly people and young people suffer from inadequate services and clog up beds in the health service?

[Baroness Merron (Lab)]

I understand the noble Lord’s impatience—I am sure we share it—and I hear what he says, but I have to remind your Lordships’ House that the previous Government did not commit funding to their plans, and I am glad the noble Lord agreed with that. I do not accept the characterisation of this. As my noble friend Lady Pitkeathley said, it has to stand the test of time. We are not waiting to take action; we have already put a number of pieces of work in place to lay the groundwork, including additional funding for social care authorities, increasing the carer’s allowance weekly earnings limit and an extra £172 million for home adaptations. We are not just waiting for this report. By the way, I do not recognise the three-year characterisation because the first phase will report in 2026 and then there will be a further report back by 2028. I feel this is the right way forward.

[Lord Forsyth of Drumlean (Con)]

Eight minus five is three.

Hospice Funding

Lord Forsyth of Drumlean Excerpts

Monday 6th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making, because planning ahead and certainty are key. I can confirm that my ministerial colleague, Minister Kinnock, will soon meet all major stakeholders to discuss long-term sustainability of funding. We are very aware of the difficulties that have been caused thus far and seeking a way forward.

[Lord Forsyth of Drumlean (Con)]

My Lords, I commend to the Minister a scheme that I introduced when I was Secretary of State for Scotland, at the suggestion of the broadcaster Martyn Lewis, who wrote a book on the hospice movement in tribute to Dame Cicely Saunders. That scheme introduced pound-for-pound funding: every pound raised was matched by the Government, which had the effect of greatly increasing funding and the incentive for people to support the hospice movement. Will she consider introducing such a scheme, which, alas, did not survive the introduction of the Scottish Parliament?

[Baroness Merron (Lab)]

The noble Lord makes a very interesting point. Of course, the introduction of gift aid supported charitable funding, including to hospices, and I know was very warmly welcomed. These are all important ways of looking at funding and we will consider the best way forward, but I note from discussions with the hospice movement that hospices very much value their autonomy in terms of funding; the more linked it is to government funding, the less autonomy they have. We want dignified and appropriate care for patients and families, and to find the best way to deliver that.

Northern Ireland Dentists: Amalgam Fillings

Lord Forsyth of Drumlean Excerpts

Monday 22nd July 2024 Lords Chamber

[Baroness Merron (Lab)]

Yes, I can confirm that amalgam is safe. The reason for this phase-down of the use of mercury, which is in amalgam fillings, is related to the environment. When mercury is released into the environment—for example, through emissions from crematoria—it can get into the food chain, where it accumulates mainly in fish such as shark and tuna. That can affect those who have a fish-rich diet, in countries such as Greenland, Brazil, Japan and China. However, there is no evidence whatsoever that amalgam is unsafe, and it is with that in mind that we have sought this arrangement for Northern Ireland.

[Lord Forsyth of Drumlean (Con)]

Further to the noble Lord’s rather ungracious question, can the Minister confirm that if we had not left the EU, it would not have been possible to continue with the use of amalgam?

[Baroness Merron (Lab)]

I am sure that there are many opinions in your Lordships’ House about what would have happened if we had not left the EU, and I think it is probably appropriate that I leave it there.

Adult Social Care: Staffing

Lord Forsyth of Drumlean Excerpts

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

The shorthand for the German system is the “double doughnut”, which tries to give wraparound care. We can learn many things from that system, which is why a part 2 reform needs to happen here. I accept that we are clearly not there yet.

[Lord Forsyth of Drumlean (Con)]

My Lords, is not the truth of the matter that the Government have just shuffled off responsibility on to local authorities? Can the Minister tell the House what percentage of expenditure by local councils is now being spent on social care to fill the gap, at the expense of vital local services?

[Lord Markham (Con)]

My noble friend is correct: on average, it is about 74% or 75% of a local authority budget. I think we would all agree that that is not a good situation, because obviously a local authority has a number of matters it needs to deal with. This is one of the issues around long-term reform that we will need to consider.

Adult Social Care

Lord Forsyth of Drumlean Excerpts

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

I thank ADASS for its report. The outcomes we are seeing show a number of things: as well as the £8.1 billion investment we put in, we have brought down waiting lists for assessment by 13% since the peak level. We are seeing high levels of satisfaction with a lot of the work we are doing; 83% of people say that they are satisfied with the services they are receiving. Yes, there is a lot more to be done, but there is a lot of good progress as well.

[Lord Forsyth of Drumlean (Con)]

My Lords, in July 2019, the Government promised that they would fix the crisis in social care. When does my noble friend think that that will be redeemed?

[Lord Markham (Con)]

Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

Children’s Hospices: Funding

Lord Forsyth of Drumlean Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

As I said, it is a responsibility for all of them, but I will happily give the noble Baroness a detailed reply so that it is very clear exactly what they are doing to make sure that happens.

[Lord Forsyth of Drumlean (Con)]

My Lords, a bazillion years ago when I was the Scottish Health Minister pre-devolution, we introduced a pound-for-pound match-funding system for hospices. That worked brilliantly because it meant that hospices could raise more cash and the Government provided support for organisations that depend on being voluntary. Would my noble friend consider doing that, not just for children’s hospices but for the movement as a whole, which does such fantastic work?

[Lord Markham (Con)]

My noble friend makes an excellent point. My understanding is exactly in this vein: £7 million was paid in match funding to children’s hospices in exactly the way he mentioned. As to whether we should be doing that more widely, it is a good idea, and I am happy to take it away and come back on it.

NHS: Staff Numbers

Lord Forsyth of Drumlean Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

My first point on that is to ask what the real facts are. Five years on from qualification, around 95% of doctors are still registered with the General Medical Council and still practising in the UK. So the fact is that retention is very high. That notwithstanding, we want to do everything that we can to retain people, and professional development is what the long-term workforce plan is all about. Also, we all know that pensions were a big reason for a lot of the brain drain and doctors leaving the profession, and that was something we were quite radical in supporting and changing. We are going through this bit by bit, asking what key things we need to do to retain our staff and resolve this.

[Lord Forsyth of Drumlean (Con)]

My Lords, I have seen press reports that suggest, from future projections, that one in 11 people in the workforce will end up being employed by the NHS. Does the Minister really believe that this is sustainable? What plans does he have to avoid what would be a completely impossible situation for the economy?

[Lord Markham (Con)]

Yes, I am aware of this. Health spending equates to roughly 11% of the GDP of our country. Not surprisingly, the number of people in the workforce reflect that. It is absolutely mind-blowing; the amount of investment going into this space is bigger than the economy of Greece. Without a doubt, we have to make productivity improvements and look to technology, AI and all the things we can do to improve output and make sure that that total is not just ever-increasing.

Ultra-processed Food

Lord Forsyth of Drumlean Excerpts

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

My understanding is that those guidelines are there; it is absolutely the right question. The Department for Education, working with the Department of Health, makes sure that a nutritionally balanced diet is there. There is also a joint DfE/DHSE programme in respect of nursery milk and fresh fruit and vegetables for young children, to give them a good start in life.

[Lord Forsyth of Drumlean (Con)]

My Lords, is it not the solution to this problem not to ban things but to improve education so that people understand what they are eating and make rational and clear choices? Is it not the case that many of these processed foods are bought by people because they are cheaper? If we could encourage people in schools to learn what used to be called domestic science—cooking skills and so on—so they can use fresh ingredients, then we would advance this case far more effectively than by banning things.

NHS GP Surgeries: Purchase by US Companies

Lord Forsyth of Drumlean Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

My understanding is that it is a range of issues, clearly including workload, pay and conditions. We are trying to address those; I think the change in the pensions rule has been generally welcomed in terms of encouraging more doctors to stay on in place. But it is a range of those measures—again, all things we are hopefully addressing through the new training and skills programmes, and the long-term workforce plan.

[Lord Forsyth of Drumlean (Con)]

My Lords, could my noble friend take the Question from the noble Lord, Lord Warner, a little more seriously? If we look at what has happened to vets, for example, private equity has bought up veterinary practices and prices have gone through the roof in order to pay for the funding costs. If this were to happen with general practice, I think that would be a very retrograde step.

[Lord Markham (Con)]

My understanding on this is that actually it is not a massively profitable area at the moment. The biggest provider in this area, Babylon Health, as we all know, did not manage to make it work. So, while I think we all understand my noble friend’s concerns, I do not believe that this is the case with the GP funding model.

Life Expectancy: Pensions, Health and Insurance

Lord Forsyth of Drumlean Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

This goes very much to our strategy of improving healthy life expectancy by five years by 2035. “Healthy” is a key component of that, taking the major conditions strategy and looking at the six major causes of death—cancers, heart disease, respiratory issues, dementia, and mental health and musculoskeletal issues—and what we can do on each one to improve lifestyles.

[Lord Forsyth of Drumlean (Con)]

My Lords, considering inflationary pay demands in the health service, has my noble friend given enough emphasis to the benefits provided in the form of final salary index-linked pensions? Is there not a conflict between being concerned about inflation and knowing that you will be protected? How long is it possible to sustain such a system?

[Lord Markham (Con)]

I know that my health brief is broad but including pensions and insurance in it is quite a challenge. Like other noble Lords, I am very aware of the impact of inflation on the final salary scheme and on lifestyles, and of the fact that not many employers can afford the schemes any more—apart from, dare I say it, government. That has an impact. However, I am happy to meet my noble friend to go through this in further detail.